Biomedical subjects
Publications and source records attributed to C D Hall.
The authors discuss the choice of the transoral-transclival approach for the repair of a lower basilar artery aneurysm in a 32-year-old sickle-cell patient. Efficiency of approach and minimization of damage to vital structures support the use of this technique. The risks of cerebrospinal fluid fistula and meningitis are considered. One year after operation, the patient is neurologically intact.
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We have operated on 20 patients with various forms of complex skull defects due either to trauma, tumor, or craniofacial problems. These cases have required complex reconstruction of defects involving the calvarium and anterior skull base. We review here our techniques of using locally harvested split-thickness calvarium bone grafts in the reconstruction of complex face and anterior fossa defects, secondary to tumor, trauma and craniofacial problems. With these harvesting techniques sufficient bone becomes available for large reconstructions, with minimum morbidity to the patient. The aesthetic results are excellent allowing for good facial and forehead contouring with minimal risk to the patient. In the case of traumatic injuries the surgery can also be performed early with the risk of infection being markedly reduced. Long-term results with split-thickness calvarial grafts have shown less bone resorption when compared with rib grafts.
Neurobehavioral functioning was tested in 34 asymptomatic HIV-seropositive and 43 HIV-seronegative male homosexual subjects without substance abuse and CNS disorders. The HIV-positive subjects exhibited mild motor slowing compared to the seronegative subjects. These differences remained after controlling for potential cofactors. Early neurobehavioral impairment in HIV infection seems limited to subclinical motor deficits and attributable to HIV rather than possible confounding factors.
A reversed-phase high-performance liquid chromatographic (HPLC) method has been developed for the determination of trace concentrations of benomyl, carbendazim, aldicarb, aldicarb sulphoxide and aldicarb sulphone in drinking water. A 10-ml sample of water is passed through a 3-cm precolumn, packed with 5-microns C8 sorbent, at a flow-rate of 5 ml/min. The HPLC system is then switched to an acetonitrile-water gradient elution program. The preconcentrated analytes are eluted from, and separated by, the 3-cm C8 precolumn and determined by UV absorption. The total analytical time is 25 min. The lowest detectable concentrations are in the range of 2.5 x 10(-9)-11.0 x 10(-9) g/ml for the five analytes investigated with 10 ml of sample.
We describe a patient with congenital monomelic hypertrophy who later developed progressive footdrop due to a degenerative myopathy. The clinical, electrophysiologic, and pathologic features of the case are described and compared with those of a previously reported case.
A cohort of 94 patients infected with human immunodeficiency virus was evaluated clinically and electrophysiologically for the presence of peripheral neuropathy, and the results were compared with evaluations of central nervous system function. Thirty-two (34%) had some degree of peripheral neuropathy; 18 (19%) (six [12%] of the 49 asymptomatic patients, five [45%] of the 11 patients with acquired immunodeficiency syndrome [AIDS], and seven [21%] of the 34 patients with AIDS-related complex) had neuropathy on clinical examination; and 21 (23%) (eight [16%] asymptomatic, four [36%] AIDS, and nine [26%] AIDS-related complex) had neuropathy on electrophysiologic evaluation. There was a significant correlation between the presence of neuropathy and evidence of central nervous system dysfunction.
OBJECTIVE: The authors examined HIV-positive subjects to determine the relationship of patient complaints of cognitive and motor dysfunction to psychiatric status and performance on established cognitive and motor function tests. METHOD: HIV-positive volunteers (N = 77) were evaluated at entry into a longitudinal neurological study. Forty were asymptomatic, 29 had AIDS-related complex, and eight had AIDS. The subjects were not selected for the presence or absence of cognitive or motor complaints. Complaints of cognitive and motor dysfunction were assessed with items from the AIDS Clinical Trials Group Macro Neurologic Exam. Current depression and anxiety were assessed with the Profile of Mood States. Psychiatric status was assessed with the NIMH Diagnostic Interview Schedule, a structured interview that provides DSM-III psychiatric diagnoses. Actual cognitive and motor performance was measured with standard neuropsychological tests known to be sensitive to the effects of HIV. RESULTS: Cognitive complaints were found in 38 (49%) of the subjects. These complaints were associated with psychiatric symptoms but not with cognitive performance. Motor complaints, found in 12 (16%) of the subjects, were associated with poorer motor performance but not with psychiatric symptoms. The overall frequency of psychiatric diagnosis was high. CONCLUSIONS: Self-reports of cognitive and motor dysfunction were common in this unselected group and are of concern to health care providers. Potentially treatable psychiatric conditions were also common, particularly in subjects with cognitive complaints, and appropriate treatment referrals are indicated. Patients who report motor dysfunction should be neurologically evaluated for treatable causes.
The elimination of hypernasal speech in patients with cleft palate following pharyngeal flap surgery in childhood is well established. However, pharyngeal flaps in adults have been considered to yield more modest results. This study reports on 20 adult patients with cleft palate-related hypernasality who underwent pharyngeal flap surgery. Normal nasal resonance was achieved in 15 cases, hyponasality occurred in 3 cases, and hypernasality persisted in 2 cases. However, speech intelligibility was not always dramatically improved. Indications and outcome were found to be highly dependent on preoperative articulation.
An automated reversed-phase high-performance liquid chromatographic (HPLC) method has been developed for the determination of trace concentrations of propoxur, carbofuran, carbaryl, propham, captan, chloropropham, barban and butylate in drinking water. A 100-ml of sample water is passed through a 3-cm precolumn, packed with 5-microns ODS sorbent, at a flow-rate of 5 ml/min. The HPLC system is then switched to an acetonitrile-water gradient elution program. The analytes, which are concentrated on the precolumn, are eluted and separated on a 25-cm C8 analytical column and determined by measuring the UV absorption at 220 nm. The resolution of analytes is excellent regardless of whether the elution from the precolumn is done unidirectionally or with backflushing. The precolumn can be used repeatedly for at least 30 samples without a significant decrease in efficiency. The total analytical time is 60 min. Tap, distilled, deionized, commercial spring and HPLC-grade waters were analyzed. The lowest detectable concentrations are in the range of 10.10(-12)-460.10(-12) g/ml for the eight pesticides with 100 ml of sample.
Craniofacial osteotomies have by convention been bilamellar translocations of the entire substance of the dysmorphic bone. This approach limits the surgeon by reducing the stable bone mass available for fixation, creating dependence on concave surfaces. Most important, it changes the bony topography that determines the preoperative plan. This paper presents a new craniofacial concept and technique used in 26 patients with various dysmorphic syndromes who were reconstructed by performing a lamellar split osteotomy. This technique maintains the internal lamella in its native position, thereby allowing it to act as a reference for the bony topography and providing a stable facial framework for rigid fixation. This interlamellar osteotomy has led to improved aesthetic results in the orthomorphic reconstructions of congenital and other deformities. It can be used in any aesthetic patient in whom contour changes or augmentation of form is desired. It is recommended as a preferred method for achieving quantitative contour improvement in patients over 3 years of age.
There are conflicting reports on the early effects of human immunodeficiency virus (HIV) infection on the nervous system. Some studies have suggested that there may be early cognitive impairment, while others have refuted this. We describe the results of extensive neuropsychological testing in a group of 40 infected subjects. These indicate that the degree of impairment is closely related to confounding factors other than the infection itself. Our conclusion is that the early stages of HIV disease are not associated with a high frequency of cognitive impairment if these confounding variables are taken into consideration.
This paper chronicles 3 years of a continuing study comparing porous hydroxyapatite to autogenous bone grafts as onlays in maxillofacial surgery. Twenty-five patients, seen from June of 1984 to May of 1985, underwent onlay augmentation on various maxillary and mandibular locations. A total of 68 onlay augmentation sites comparing Interpore porous hydroxyapatite and autogenous bone were followed for 2 years or more. This long-term study compares these substances in radiologic longevity, histologic incorporation, clinical function, and aesthetic appearance.
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We have described a patient with muscle weakness caused by ingestion of quinidine sulfate. Intrafascicular perivasculitis and rare muscle fiber regeneration were present in the muscle at biopsy. A similar clinical picture has previously been reported in patients taking other medications, but not quinidine.
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School problems are common in children with neuromuscular disease irrespective of their degree of handicap. They are related to difficulties in transportation and access, difficulties with adaptation of school tasks to the motorically handicapped, and difficulties that arise because of misunderstanding of the disease processes by teachers and parents. Most of these can be easily rectified by efforts by the clinic staff to educate school personnel and to enlist them as members of the treatment team. In view of the importance of the school experience to this group of patients, it is urged that these problems be identified and aggressively managed by those involved in the care of neuromuscularly handicapped children.