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Biomedical subjects

J A Persing

Publications and source records attributed to J A Persing.

At least 91 records · Page 5Linked to original sources
PubMed1985

Modified prone position for cranial remodeling procedures in children with craniofacial dysmorphism: a technical note.

A new head position for use during operation on young children with cranial deformities is described. The position allows exposure of the entire calvarium from the supraorbital ridges to the posterior rim of the foramen magnum. It is a modification of the conventional prone position involving hyperextension of the neck. The authors have safely used this position to perform one-stage radical cranial remodeling procedures that previously required two stages. The advantages of this position and the methods for achieving it are discussed.

Acrocephalosyndactylia↗
PubMed1985

Bifrontal osteoplastic craniotomy utilizing the anterior wall of the frontal sinus: technical note.

There are various flaps for bifrontal exposure of the anterior fossa classically described in the neurosurgical literature. This article describes a bifrontal split osteoplastic flap that is characterized by removal of the anterior wall of the frontal sinus without the placement of burr holes on the external surface of the frontal bone. The procedure is safe and rapid, gives the same exposure as other techniques, and allows a superior cosmetic result.

Craniotomy↗
PubMed1985

Lightning injuries.

Lightning causes more deaths than any other weather phenomenon. It is an electrical current that will choose the shortest paths between the contact points of the human body and may involve vital structures in its pathway. Almost every organ system can be injured by the electrical current of lightning. A broad spectrum of complications resulting from damage to the various organ systems has been reported. The sequelae peculiar to this specific type injury will dictate the choice of therapy.

Bone and Bones↗
PubMed1984

Galeal-pericranial flaps in head and neck reconstruction. Anatomy and application.

Head and neck deformities of congenital, traumatic, or neoplastic cause often require reconstruction. At the University of Virginia over the past 14 years, we have used galeal, temporalis fascial, and pericranial flaps to correct these defects in more than 150 patients. Dissection of these flaps on both cadavers and reconstructive patients had demonstrated new anatomic findings different from those reported in standard textbooks. The galea is the most superficial layer of fascia. The pericranium is the next tissue layer. It is continuous above and separate from the temporalis muscle fascia. We may, therefore, consider three separate fascial layers for reconstruction. A rich vascular plexus arises from branches of the external and internal carotid arteries. Blood flow is axial to the galea and temporalis fascia. Pericranium has a dual supply from peripheral axial vessels and from perforating vessels from the overlying galea. Galeal, temporalis fascial, and pericranial flaps are reliable, thin, and supple and have a good arc of rotation and minimal donor site morbidity. They may be used to cover bone, cartilage, or implants, may be folded for bulk, may be used to carry blood to poorly vascularized recipient sites, or may be used to nourish bone, cartilage, skin, and mucosal grafts. Their versatility permits a wide variety of potential applications in head and neck surgery.

Adult↗
PubMed1984

The late treatment of vertical orbital dystopia resulting from an orbital roof fracture.

Traumatic fracture of the orbital roof is uncommon and it may be unrecognized at the time of injury. In this article we describe a patient with progressive vertical orbital dystopia four years after he sustained a fracture of his "frontal" bone. Surgical exploration revealed an orbital roof fracture complicated by a chronic dural leak. An intracranial-extracranial approach through a modified frontal craniotomy provided excellent visualization to elevate the bony orbit and globe safely and repair the dural tear. Our study illustrates the need to correct residual soft tissue deformity at a second operation. Orbital roof fracture is a complex injury and is best treated by a multispecialty team using the methods learned from the treatment of patients with congenital orbital dystopia.

Child↗
PubMed1984

Alternative techniques in the treatment of unilateral coronal synostosis.

Premature closure of one coronal suture results in bilateral abnormalities. There is always ipsilateral flatness of the orbital rim, and contralateral frontal bossing is often found. The authors have employed three operative techniques for correction of unilateral coronal synostosis: frontal bone overlay, lateral canthal advancement, and the tongue-in-groove procedure. The choice of operative technique depends upon the exact deformity to be corrected. The authors believe that altering the relations between the bone and dura by techniques such as radical remodeling and dural plication may improve the results of surgical correction of craniosynostosis.

Craniosynostoses↗
PubMed1984

Variants of sagittal synostosis: strategies for surgical correction.

Sagittal synostosis is discussed with respect to the variations seen with the deformity. The morphological spectrum ranging from marked frontal bossing to prominent occipital bulging is described. Surgical techniques have been specifically designed for these variants. These techniques provide an immediate correction of scaphocephaly, and achieve a reduction of the specific deformity with morbidity comparable to that associated with conventional operations. The lack of large areas of craniectomy and the avoidance of synthetic materials are cited as additional advantages of these techniques. The importance of altering the surgical approach to the specific clinical problem is underscored. Two illustrative cases of sagittal synostosis variants are described, and recent experience with the modified operative techniques in treating these and similar cases is discussed.

Child, Preschool↗
PubMed1982

Skull growth after coronal suturectomy, periostectomy, and dural transection.

Using radiocephalometric procedures, the authors examined the separate effects of suturectomy, periostectomy, and dural transection on the growing skull in young rabbits. When the coronal suture was surgically removed during normal growth, The freed frontal and parietal bones separated at a significantly accelerated rate. No accelerated separation was found when only the overlying periosteum and aponeurosis were transected. Furthermore, no additional separation was observed when the dura mater and falx cerebri were transected following suturectomy. Analysis of growth at the adjacent frontonasal and anterior lambdoid sutures suggested that the accelerated separation of bones after suturectomy was compensated for by reduced growth at these adjacent sutures. The result of these compensatory actions was that the total length of the skull remained unchanged. This study not only supports earlier observations that sutures grow in response to extrinsic separative forces but, significantly, that the suture tissue itself, rather than the dura or pericranium, acts as a restraint during normal translatory growth.

Animals↗
PubMed1982

Compensatory growth following premature closure of the coronal suture in rabbits.

Premature closure of a cranial suture results in skull deformation characterized by inhibited skull growth in a direction perpendicular to the course of the affected suture. Early surgical release of the closed suture results in a "normal" skull morphology. The present experimental study measured alterations in growth at the transverse cranial sutures that occurred following induced premature closure of the coronal suture and its subsequent release in New Zealand White rabbits. Using roentgenocephalometric methods, growth and morphometric changes were monitored at the frontonasal, coronal, and anterior lambdoid sutures following premature closure of the coronal suture at 9 days of age. The results indicated that premature closure of the coronal suture did not result in compensatory (increased) growth at the other transverse sutures of the vault. In fact, growth at these sutures was significantly reduced. This reduced growth at adjacent transverse sutures was not ameliorated by early surgical release of the fused suture.

Animals↗
PubMed1980

Language-induced seizure. A case of cortical origin.

After anastomosis of the superficial temporal to the middle cerebral artery, partial motor seizures referable to the left inferior motor strip and Broca's area developed in a 48-year-old man. These seizures were readily induced by attempts to speak, to read silently or aloud, and to write. The seizures were not induced by simple movements of the ocular, facial, jaw, throat, and extremity muscles, primary sensory stimuli, or higher intellectual function such as calculation. The patient had nonfluent dysphasia, but he had no comprehension disorder. A clear focal onset of electrographic seizures was recorded maximally at the left temporal region on reading aloud and at the left central area on writing. The cerebral evoked potentials were mildly abnormal on the affected hemisphere. This case shows cortical onset of language-induced seizure.

Action Potentials↗
PubMed1980

Lidocaine or thiopental for rapid control of intracranial hypertension?

The effectiveness of intravenously administered lidocaine for rapid control of acute intracranial hypertension was compared to the effectiveness of thiopental in 20 patients with brain tumors undergoing craniotomy. Despite normal radial arterial and intracranial pressures (ICP) after induction of N2O-O2-morphine anesthesia, mean ICP increased from 13.8 torr +/- 1.5 SE to 31 torr +/- 2.3 SE (p less than 0.001) in response to application of a pin-holder or scalp incision. To treat the elevated ICP a bolus injection of lidocaine, 1.5 mg/kg IV, was given to 10 patients, whereas the other 10 received thiopental, 3 mg/kg IV. Lidocaine reduced ICP 15.7 torr +/- 5.6 SE (p less than 0.025) did not significantly affect mean arterial pressure. In contrast, thiopental lowered ICP 18.4 torr +/- 9.6 SE (p less than 0.02) and also lowered mean arterial pressure by 26.1 torr +/- 9.6 SE (p less than 0.025). Mean time for injection of medication to ICP nadir was 66 seconds +/- 10 SE after lidocaine versus 48 seconds +/- 9 SE after thiopental (p greater than 0.20). It is concluded that lidocaine is as effective as thiopental for rapid reduction of intraoperative intracranial hypertension but that it causes less cardiovascular depression. Lidocaine may be of particular benefit to patients with both intracranial hypertension and marginal circulatory function.

Brain Neoplasms↗
PubMed1979

Craniofacial growth following experimental craniosynostosis and craniectomy in rabbits.

Premature fusion of the coronal suture was produced in 9-day-old rabbits by immobilization of the suture area bilaterally with methyl-cyanoacrylate adhesive. The effects of suture fusion and its surgical release on suture growth and on skull morphology were evaluated by radiographic cephalometry. Immobilization resulted in significant changes in the angular dimensions in the vault toward an anteroposterior shortening. No permanent deformity was observed in the angular relationship between the cranial base and the facial skeleton. Craniectomy at 30 days, when a skull deformity had been established, resulted in rapid separation of the bones at the suture site which returned the deformed skull to a normal configuration by 90 days of age. Surgical removal of a normal suture in a control group also resulted in accelerated separation of the bones at the excised suture site, but it was less than after removal of an immobilized suture. The experimental data indicate that premature fusion of rapidly growing sutures results in consistent skull deformity. Early release of the fusion, when this is the primary abnormality, will result in spontaneous correction of the deformity.

Age Factors↗
PubMedDate not supplied

Multiple sclerosis and brain tumor: a diagnostic challenge.

Multiple sclerosis may present as a lesion indistinguishable clinically and radiologically from brain tumor. A case of multiple sclerosis is reported with clinical and radiologic features of a brain tumor. A brain biopsy was later undertaken that provided pathological confirmation of the diagnosis of this demyelinating disease. This case report in conjunction with those in the literature indicate that conservative treatment with steroid therapy and serial computed tomography should establish the diagnosis of multiple sclerosis without the need for surgical intervention.

Adrenocorticotropic Hormone↗