Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

The search for a convenient, rapid manual dexterity examination, which could be used at the time of the otolaryngology resident applicant's interview, led us to assess the following areas: purposeful hand direction, depth perception, tactile discrimination, finger pressure coordination, finger visual tracking of moving objects, spatial visualization, finger strength, speed of movements, fine control precision, finger dexterity, steadiness during movement, steadiness without movement, and neatness. With the astronomical increase in applicants to a limited number of positions in the field of otolaryngology-head and neck surgery, the application of an accurate, efficient manual dexterity assessment at the time of applicant interview is desirable. Presently, dental school applicants are screened by a series of manual dexterity tests. To develop our screening test, we integrated manual performance tests currently in use by private industry, occupational therapists, and dental school admission committees. Thus, applicants who are able to master fine microsurgical and macrosurgical techniques common in our specialty will be preferentially selected.

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Some chronic renal failure patients maintained on dialysis have uncontrollable hypertension. Those with elevated renin levels require bilateral nephrectomies prior to kidney transplant to avoid nephrosclerosis. The morbidity and mortality from surgical nephrectomies are high. In 2 such patients we embolized the renal arteries with gelfoam and successfully occluded all the major vessels. One patient became normotensive. The second remained hypertensive and had increased renin levels, probably on the basis of ischemia. Subsequent surgical nephrectomies demonstrated completely occluded segmental branches but only focal areas of infarction. Collateral blood supply determines the success of the procedure.

The clinical and radiographic manifestations of intramural gastrointestinal hemorrhage are presented together with a review of the literature. The observations described are based on the analysis of 20 cases affecting different segments of the gastrointestinal tract. The pathologic process is induced principally by anticoagulant therapy, bleeding diathesis, or abdominal trauma and occurs as a localized, well-defined, intramural mass or as a more diffuse segmental involvement. The clinical features are nonspecific and can vary from mild crampy abdominal pain to severe shock. Other manifestations include rebound tenderness, muscle guarding, and small bowel obstruction. The duodenum and small bowel are the most frequent sites of involvement. The intestinal mucosal folds may be prominent, stretched, and sharply defined or completely affaced, accompanied by a smooth narrowing. There is rapid clinical and radiographic remission with conservative therapy. Intestinal perforations and fibrotic strictures resulting in small bowel obstruction are a rarity, observed only in the posttraumatic variety.