Intravascular papillary endothelial hyperplasia (Masson's tumor) manifesting as a lateral neck mass

Intravascular papillary endothelial hyperplasia is a benign lesion of vascular origin that is caused by an excessive proliferation of endothelial cells in normal blood vessels or vascular malformations. We report the case of a 26-year-old man who had such a lesion deep within the soft tissues of his neck. Imaging studies revealed a 6-cm-diameter mass, with its epicenter in the right retromandibular space. The mass extended into the right parapharyngeal space and compressed the pharynx. The mass was excised, and the patient recovered uneventfully. We discuss the management of this lesion, with emphasis on radiologic and histologic assessment and the differential diagnosis.

The symbolization of eggs in American culture: a sociologic analysis

OBJECTIVE

To demonstrate that the recent decline in egg consumption in the United States was, in part, the result of a food scare that began in the 1960's.

METHODS

Using the Reader's Guide to Periodical Literature, the frequency of articles about eggs, dietary cholesterol and heart disease in popular magazines was obtained. A content analysis was performed on a random sample of these articles.

RESULTS

The increased trend in magazine articles and public statements by groups such as the American Heart Association linking eggs, blood cholesterol and heart disease is associated with the downward trend in egg consumption.

CONCLUSIONS

Public exposure to negative messages about particular foods can contribute to a decline in their consumption. Exposure to more consistently positive messages about foods can bring about an increase in the consumption of those foods.

Telemedicine, hospital viability, and community embeddedness: a case study

Many hospitals today struggle to remain competitive through the adoption of medical technology or expansion of hospital services. This article presents a case study of one hospital's attempt to remain viable through the adoption of telemedicine. Through a 17-year analysis of local hospital-related news reports, it is argued that a hospital's relationship to the local community can affect the success and potential of such innovations. Establishing a pattern of trust and support between the local community and hospital should therefore be an important step in increasing hospital viability.

Blood lipids, cardiovascular fitness, obesity, and blood pressure: the presence of potential coronary heart disease risk factors in adolescents

OBJECTIVE

To identify and compare the presence of coronary heart disease (CHD) risk factors among 14- and 15-year-old boys and girls.

DESIGN

For this cross-sectional study of 54 subjects, a blood sample taken after subjects fasted was used to determine total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride concentrations. Dietary intake was estimated using a 24-hour recall and a 2-day food record. Height, weight, and skinfold thicknesses were measured to identify obese and severely obese subjects. Cardiovascular fitness, blood pressure, and cigarette use also were measured. TC, HDL-C, LDL-C, fitness, blood pressure, and smoking are modifiable risk factors, for CHD.

SUBJECTS

Adolescents were selected by random sampling from lists of students attending public schools in two central Texas cities. Adolescents who were 14 or 15 years old; were not pregnant; and had no history of high blood pressure, diabetes, or heart disease were eligible to participate.

STATISTICAL METHODS

Data were analyzed using Student's t and chi square tests.

RESULTS

Of the subjects, 25% demonstrated two or more risk factors for CHD. A significantly higher percentage of girls than boys had a TC concentration greater than 5.2 mmol/L. Boys (n=29) had a mean fitness score that indicated a higher level of cardiovascular fitness than girls (n=25); however, the mean score for both groups was below average.

CONCLUSION

Data provide support for increased interventions targeted toward lowering the risk factors for CHD and other chronic diseases in adolescents.

Factors associated with sources of influence/information in reducing red meat by elderly subjects

A number of studies have found that health beliefs and social influences predict changes in dietary intake, including red meat. These studies have not determined what kinds of individuals are more likely to change their diets due to the advice of physicians, the advice of significant others, or because of mass-media exposure. We obtained data from 424 elderly Houstonians regarding whether they had attempted to reduce red meat consumption and if so, why. Social network, health status, food attitude and demographic variables are used to differentiate those who have made physician-induced changes from other sources of influence/information for change. Elderly subjects with smaller abdominal girth measurements are more likely to make red meat reductions regardless of the source of influence/information; those who believe in the efficacy of health foods are more likely to give physicians and mass media as sources of influence/information for red meat reductions. Men are more likely than women to report red meat reductions because of mass media and physician influences. Women who receive a greater amount of companionship from their social networks are more likely to change because of friends/relatives influences.

Perceptions of risks of eating undercooked meat and willingness to change cooking practices

Knowledge and awareness of food safety issues relating to improperly cooked hamburger and willingness to change hamburger cooking practices were examined from a representative sample of 1004 adult Texans. Awareness of the danger of improperly cooked hamburger, knowledge of specific foodborne pathogens and knowledge of food safety practices had no effect on willingness to change behavior, but respondents who were better-educated, female and Hispanic and respondents who used newspapers/magazines or televisions were all more likely to report willingness to change their cooking practices.

Clinical signs of orbital ischemia in rhino-orbitocerebral mucormycosis

Mucormycosis is the most acutely fatal fungus infection of man (Ferry and Abedi). The most common clinical type of infection is rhino-orbitocerebral mucormycosis. Prompt recognition of the clinical picture is essential if the appropriate urgent management is to be instituted without delay. The presence of black eschar in the region of the nasal passages, palate, midface, and orbit is the best-recognized clinical sign alerting the clinician to the diagnosis. Black eschar is, however, a feature in only a minority of these patients at the time of presentation. This paper discusses other clinical signs, particularly orbital ischemia, which should suggest the diagnosis. The clinical presentation of orbital ischemia in mucormycosis includes proptosis, total external and internal ophthalmoplegia, and early blindness. A lax, nontender periorbital puffiness, which does not feel warm to the examiner's touch, is typical. Proptosis and chemosis, if present, are mild. These signs are compared with those of pyogenic orbital cellulitis, with which the condition might most easily be confused.

Life events, social support, and immune response in elderly individuals

One hundred ninety-two elderly men and women were investigated to determine the effects of recent life events, psychological adjustment, and social support on lymphocyte count, controlling for nutritional status, age, education, income, and the presence of lymphocyte-altering drugs. Effects of specific recent life events were found. For elderly males, recent sexual dysfunction lowers lymphocyte count, while psychological adjustment and percentage kin in the intimate network elevates it. For elderly females, the experience of either family or legal problems elevates lymphocyte count as does frequent interaction with members of the intimate network. These results suggest that life events have very different effects on elderly men and women's immune systems. Social support has direct but mediating effects on lymphocyte count for both genders.

Drill-generated sensorineural hearing loss following mastoid surgery

Drilling during mastoid surgery may result in temporary noise-induced hearing loss. This has practical implications for both the patient and surgeon. In a prospective study of 40 patients, audiometric testing was done both preoperatively and postoperatively to try to detect any significant hearing loss in the immediate postoperative period. The data were analyzed using the Student's paired t test. No statistically significant difference was found. A sensorineural hearing loss soon after mastoid surgery is not due to the noise generated by the drill. In the event of any hearing loss during this period, other causes should be sought.

Cystic parotomegaly in an HIV-seropositive patient. A case report

The case of a middle-aged woman with a 1-year history of painless, bilateral parotid gland enlargement is reported. The clinical signs and immunological markers of Sjögren's syndrome were absent. Serology for human immunodeficiency virus (HIV) was positive and radiological findings were characteristic of a well-described, HIV-associated cystic parotomegaly. Attention of clinicians is drawn to this clinical presentation, which may precede classic AIDS stigmata by several years.

Anthropometry and health in the elderly

Measurements of height, weight, skinfold thicknesses, and circumferences were obtained along with data on health practices and disease from 424 independent-living elderly in the Houston area. The objectives of the study were to examine anthropometric measurements of younger (58 through 74 years) and older (75 through 100 years) elderly individuals and to assess relationships between these measurements and health behaviors and disorders. Results demonstrated differences in anthropometric indexes due to aging and sex. Individuals who considered themselves to be more active than peers or who smoked had lower values for some anthropometric variables such as body mass index and waist circumference. Those who drank alcoholic beverages had lower values for some variables than those who stated that they did not drink alcohol. Diabetes and hypertension in the younger elderly were associated with higher values of some measurements, including waist circumference and body mass index. Anthropometric measurements in the elderly varied with sex, age, health practices, and the presence of certain disorders.

Progress in the development of a nutritional risk index

The development of a 16-item nutritional risk index (NRI) is chronicled from its inception through its application in three studies designed to assess its reliability and validity. Study I involved a survey of 401 community-dwelling elderly in St. Louis, Missouri who were interviewed at baseline, 4-5 mo later, and 1 yr later. Study II involved a cross-sectional survey of 377 male outpatients attending two clinics at the St. Louis Veterans Administration Medical Center. Study III involved a cross-sectional survey of 424 community-dwelling elderly in Houston, Texas. Internal consistency reliability coefficients ranged between 0.47 and 0.60, and test-retest reliability coefficients ranged between 0.65 and 0.71. Validity was established by using the NRI to predict the use of health services, as well as by correlating it with a variety of anthropometric, laboratory, and clinical markers of nutritional status. The utility of the NRI for future applications is discussed.

Sarcoidosis with nasal obstruction and deformity. A case report

Sarcoidosis is a relatively uncommon disease, seldom seen by ear, nose and throat departments. There are interesting head and neck and, more specifically, nasal manifestations. A patient with sarcoidosis presented at our department with nasal obstruction and deformity. Although these were the predominant features of the disease, the diagnosis was made together with other systemic signs. A case of sarcoidosis involving the nose is presented, with discussion emphasising the features more commonly seen by the ear, nose and throat surgeon.

Cricotracheal separation in blunt neck injury--the sign of hyoid bone elevation. A case report

A case of a 23-year-old man who sustained a traumatic cricotracheal separation after a closed neck injury is reported. Hyoid bone elevation above the level of the superior surface of the body of the third cervical vertebra was present on lateral cervical radiography. The importance of the recognition of this sign is discussed.

Isolated sphenoiditis: a diagnostic problem

A case of primary isolated sphenoiditis that developed cavernous sinus thrombosis is presented. It is difficult to diagnose and patients are often not seen initially by an ENT surgeon, making it more important for other branches of medicine to be aware of this condition. We discuss isolated sphenoiditis with particular reference to the diagnosis, management and complications of this condition.

Social support, stressful events, strain, dietary intake, and the elderly

Little research exists linking social support, stressors, and related nutritional strain (loss of appetite) with the risk of poor nutritional health. Relationships among these concepts were investigated using a sample of elderly Virginians. It was hypothesized that the risk of poor nutritional health (dietary inadequacy) is reduced among elderly with high levels of social support and exacerbated among those experiencing stressful events and strain. Moreover, it was hypothesized that the negative effects of stressful events and strain on the diet are mitigated by high levels of social support. Using multiple regression models, these hypotheses were tested, controlling for age, sex, race, and socioeconomic status. The results indicated that elderly with 1) an extensive friendship network have more adequate diets; 2) greater financial stress experience greater nutritional stress (poorer appetite); and 3) greater nutritional stress have less adequate diets. Moreover, companionship serves as a buffer against the negative effects of poor appetite on dietary intake.

Food habits and future time: an exploratory study of age-appropriate food habits among the elderly

This exploratory research effort examines future time perspective and its association with a behavioral change, i.e., food habits, among a sample of elderly persons. Demographic and social conditions under which a positive or negative future time may be associated with changes in food habits are explored. The findings suggest that the elderly do make changes in their food habits, and there is an association of positive or negative food habit changes with a positive or negative future time perspective. The future time perspective and the food habit changes are couched in certain types of demographic and social conditions such as with whom one lives, recent widowhood, health status, and sex.

Trans-septal approach to unilateral posterior choanal atresia

A technique of trans-septal approach to unilateral bony choanal atresia in the older child or adult is described with the advantages of better exposure, less bleeding and better mucosal cover of raw bone than traditional methods. This seems to reduce post-operative re-stenosis at the site of the atresia.

Management of a glomus jugulare tumour with internal carotid artery involvement

A previously healthy 40-year-old female presented for surgical resection of a large glomus jugulare tumour with extensive involvement of the carotid siphon and intracranial extension. Conduct of anaesthesia with specific reference to cerebral protection is discussed. A combination of induced hypothermia, barbiturate therapy, normotension, normocarbia and prior clamping of the distal internal carotid artery was chosen. The role of barbiturates as a therapeutic intervention is debated.

Haemangioma of the mandible. Diagnosis and management

A case of haemangioma of the mandible is presented. The clinical and radiological features, including the use of angiography, are discussed. An approach to the surgical management of haemangioma of the mandible is given.

Fibromatosis and fibrosarcoma of the larynx and pharynx in an infant

A 14-month-old infant had congenital solitary fibromatosis of the larynx that showed fibrosarcomatous change and that spread to the pharynx and the anterior part of the neck. The histologic condition is discussed, as is the surgical treatment with total laryngopharyngectomy. A five-year postoperative follow-up is included.

Acceptance of conditional suicide and euthanasia among adult Americans

Analysis of the attitudes of a 1977 cross-sectional sample of 1,530 American adults concerning euthanasia and suicide indicates that sex, age, and education are significant variables. Males, those who are younger and those who are better educated, are more likely to approve of euthanasia and suicide when a person has an incurable disease. Religious affiliation was not an important variable, although those who were frequent church-service attenders or who were high on religiosity were highly likely to reject euthanasia and suicide.

Cheselden, Anatomist and Surgeon

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