Combined retrolabyrinthine-retrosigmoid approach for improved exposure of the posterior fossa without cerebellar retraction

The combined retrolabyrinthine-retrosigmoid (CRR) approach utilizes anterior retraction of the sigmoid sinus to improve exposure of the posterior fossa without cerebellar retraction. The CRR was initially used for vestibular neurectomy but is now utilized for acoustic neuroma excision with hearing preservation and exposure for clipping of basilar and vertebrobasilar aneurysms. This excellent exposure of the cerebellopontine angle without cerebellar retraction can be used for all posterior fossa exposures.

Tinnitus in an active duty navy diver: A review of inner ear barotrauma, tinnitus, and its treatment

This case elucidates subtle cues that must be appreciated by the examiner in diving related injuries, who may not have experience with barotrauma-mediated pathology. Inner-ear barotrauma (IEBT) does not mandate ostensible hearing loss or vertigo; tinnitus may be the sole manifestation. Symptoms may present hours or even days post-dive. A common misconception exists that there are no efficacious treatment options for IEBT short of surgery for an overt perilymphatic fistula. Treatment options are available including acute high dose steroid administration, as prescribed for acute noise-induced or idiopathic hearing loss, optimally administered within three weeks of the acute insult. Tinnitus does not necessarily constitute a chronic untreatable symptom, which the patient must learn "to live with".

Reversal of diminished inhibitory sensory gating in cocaine addicts by a nicotinic cholinergic mechanism

Cocaine addiction, as with other stimulant abuse, produces psychotic symptoms. Although often moderate to mild in severity, these symptoms are, nevertheless, associated with poorer over-all outcome. Recent studies suggest diminished nicotinic cholinergic neurotransmission as a mechanism of a physiological deficit found in schizophrenia, failure of auditory sensory inhibition. Diminished inhibitory sensory gating also occurs in cocaine addicts, probably because of their increased catecholaminergic neurotransmission, which blocks the inhibition. In the present study, 11 cocaine addicts in the first week of detoxification were recorded electrophysiologically, after which the effects of 6 mg of nicotine gum, were assessed in a double-blind placebo-controlled crossover design. The test was repeated 10 days later. Treatment with nicotine, but not placebo, briefly reversed the inhibitory abnormality on both test days. Although nicotine itself may not be a desirable therapeutic agent, because desensitization of nicotinic receptors limits the time course of its effect, the study identifies a previously unexploited therapeutic target for new drug development for the neuropsychiatric sequelae of cocaine addiction.

A radical demise. Toxins and trauma share common pathways in hair cell death

The pathologic similarities noted after ototoxic and/or traumatic injury to the cochlea as well as the key features of the cochlea that make it susceptible to reactive oxygen species (ROS) damage are reviewed. Recent evidence linking ROS to cochlear damage associated with both ototoxins and/or trauma are presented. Mechanisms of generation of ROS in the cochlea and how these metabolites damage the cochlea and impair function are also reviewed. Finally, examples of novel therapeutic strategies to prevent and reverse hearing loss due to noise and/or ototoxins are presented to illustrate the clinical relevance of these new findings.

Percutaneous in situ fixation of slipped capital femoral epiphysis using two threaded Steinmann pins

Twenty-six patients with 34 slipped capital femoral epiphyses were treated by percutaneous in situ pinning with two 5/32-inch threaded Steinmann pins. Twenty-three patients with 31 hips were followed-up until the time of epiphyseal closure and pin removal. The average time to closure was 8.5 months (range, 3-25). The average operative time for pinning was 53 min (range, 18-115). The average operative time for pin removal was 42 min (range, 12-132). Complications included two progressive slips, two poorly placed pins, one pin breakage during removal, and one case of capital necrosis. This technique is a quick, efficient means of stabilizing the slipped capital femoral epiphysis, with case of hardware removal.

Use of endoscopes for chronic ear surgery in children

OBJECTIVE

To determine whether an endoscopic second-look examination of the mastoid and middle ear could replace an open second-look mastoidectomy.

DESIGN

Patients were examined endoscopically. The findings were compared with a standard open mastoidectomy procedure during the same operation. The mastoid can be inspected through a small postauricular incision and the middle ear can be inspected through a myringotomy incision or tympanomeatal flap.

PATIENTS

Ten patients aged 6 to 16 years.

RESULTS

Endoscopic findings correlated exactly with open mastoidectomy findings in all cases.

CONCLUSION

In light of this study an open second-look mastoidectomy may be avoided if minimal or no recurrent cholesteatoma is found during the endoscopic exploration. The use of the ridged endoscope has added another dimension to the standard microsurgical techniques used in pediatric otology. The indications, techniques, and findings of otoendoscopy in the management of chronic otitis media in children will be presented.

The implant supported mandibular bar overdenture: diagnosis and treatment planning

In selecting the treatment most appropriate to the patient, the practitioner should consider all of the factors mentioned in this paper, as well as the patient's economic status. A written treatment plan should be provided to the patient, and a signed authorization for treatment should be obtained before treatment begins.

Proximal interphalangeal joint autofusions after extensive burns

Seven patients with third-degree burns of > 70% of their body had autofusions of 19 proximal interphalangeal joints. In 13 of the joints there was fixed deformity of > 60 degrees. In addition to these deformities, each of the patients had deformities due to burns in the axilla and elbows bilaterally. There was only one independently functional hand and in that hand no proximal interphalangeal joint deformity was > 40 degrees. Two patients were totally dependent because of either bilateral involvement or infectious complications of the burn itself. In four patients the hand was used as a helping hand to some extent. In each of these four the patient had a less involved other hand and had satisfactory activity of daily living skills as a consequence. Early splinting or skeletal fixation of burned joints developing flexion positions might have avoided autofusions in poor position.

Histochemical identification of guinea-pig macrophages by monoclonal antibody MR-1

A monoclonal antibody is described which reacts with monocytes and macrophages of the guinea-pig. The antibody recognizes a cytoplasmic component in the majority of tissue macrophages, as detected by histochemical analysis. It reacts positively with all macrophages in lymphoid organs, including Tingible body macrophages. In addition it recognizes the cells of Von Kupffer in the liver, and macrophages in bone marrow and peritoneal cavity. In comparison to other monoclonal antibodies that have been described in the guinea-pig, MR-1 shows a unique tissue distribution. The antibody is a useful tool to discriminate macrophages by immunohistochemical methods.

The Thompson-Patterson Scale of Psychosocial Development: II. Investigation of its use in the assessment of preschool children

The Thompson-Patterson Scale of Psychosocial Development (TP) is a parent interview questionnaire, each item scored on a 3 point scale and computer analyzed to yield a histogram profile consisting of 11 scale scores. Eight of these scales measure coping styles characteristic of sequential stages of psychosocial development and the remaining 3 are symptom scales. A pilot study was conducted to assess the usefulness of the TP as a diagnostic and therapeutic assessment instrument for preschoolers. The results indicated the following: i) a "healthy" profile emerged in the control group ii) a significant difference existed in the initial assessment profiles of the clinic and control groups; iii) the control group profiles were stable over the period of study; and iv) the profiles of the clinic group showed a movement towards health with treatment that reflected changes in the clinical status of the children. The promising results of this preliminary study suggest there is value in further investigation of the TP scale as an instrument for the dynamic developmental assessment of preschool children.

Triple arthrodesis for children with spastic cerebral palsy

A retrospective review was done of 20 children with spastic cerebral palsy who had had a total of 25 triple arthrodeses at Rancho Los Amigos Hospital. The average age at the time of surgery was 15.5 years and average follow-up was 4.5 years. Indications for surgery were progressive deformity (15) and relief of pain (five). The deformities was planovalgus (12), equinovalgus (six), equinovarus (six) and calcaneovalgus (one). All 13 patients with braces had problems in wearing them. Two patients were non-ambulatory preoperatively and remained so after fusion. Of the 18 who were ambulatory preoperatively, 15 remained so and there was no change in the type of ambulation: the other three stopped ambulating. Three children were made independent of braces. It is concluded that triple arthrodesis is an excellent procedure for children with spastic cerebral palsy, to correct deformity and relieve pain, but it should be done while the children are still walking for the best chances of continued ambulation.

Jaw muscle silent periods by tooth tap and chin tap

Electromyographic silent periods from jaw closing muscles were elicited during a clench by tapping on the chin and on selected teeth both in asymptomatic subjects and in subjects reporting symptoms of temporomandibular joint dysfunction. The mean duration in response to a chin tap was significantly shorter in the asymptomatic group than in the dysfunction group. No significant differences in mean duration elicited by tooth taps were found between groups. Other comparisons of mean durations such as among muscles, among teeth, or between chin taps and tooth taps failed to achieve statistical significance.

Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital

Between 1954 and 1970, 351 patients with severe paralytic scoliosis were treated at Rancho Los Amigos Hospital. During this time the treatment evolved through five stages: body cast alone, halo cast, halo cast with buttons and traction wires, Harrington instrumentation, and finally preoperative halo-femoral traction and Harrington instrumentation. Coincident with this evolution, correction improved from 20 to 57 per cent, the incidence of curve progression dropped from 38 to 0 per cent, and curve extension decreased from 25 to 0 per cent, while postoperative recumbency was reduced from one year to about three weeks. In addition, complications changed, in general decreasing except for the rate of pseudarthrosis, which remained essentially the same. Clinically significant hyperlordosis involving the thoracic and lumbar spine was seen in sixteen patients who had long fusions from the fourth cervical vertebra and above to the fourth lumbar vertebra or the sacrum.

EXCEPTIONS TO HUDSON'S RULES OF ISOROTATION: THE NUCLEAR MAGNETIC RESONANCE SPECTRA OF ANOMERIC PYRIMIDINE 2-DEOXY-D-RIBONUCLEOSIDES

Nuclear magnetic resonance spectroscopy and optical rotatory dispersion measurements were used to correlate the configurations of anomeric pairs for the 1-(2-deoxy-D-ribofuranosyl) derivatives of 5-methyl- and 5-fluoro-uracil. The optical rotations of the anomers were found opposite to those expected on the basis of Hudson's rules of isorotation.