Biomedical subjects
Publications and source records attributed to K H Calhoun.
We report a metallic foreign body that entered through the anterior table of the frontal sinus, and rolled down to lodge in the nasofrontal duct. An electromagnet was used to remove the foreign body through a trephination.
All admissions to the Shriner's Burn Institute in Galveston over a 5-year period were reviewed. One hundred of 1,092 patients admitted (9.2%) required airway support (endotracheal intubation or tracheostomy) for more than 24 hours. All clinical variables relating to general presentation and airway care were tabulated. Children who required open airway operations for resolution of acquired airway defects were analyzed separately. No predictive factors could be identified. Guidelines for optimal airway management in the burned child are reviewed.
Reconstruction of the anterior skull base (ASB) following craniofacial resection must seal off the cranial cavity from the upper respiratory tract and provide structural support for the brain. The inferiorly based pericranial flap is strong, pliable, and well vascularized and is especially suited for reconstruction of small-to moderate-sized midline defects of the ASB. Surgical technique of pericranial flap reconstruction used in three cases is described. Indications for this flap and other types of reconstruction are discussed and compared. We believe pericranial flap reconstruction of the ASB is technically easy, cosmetically acceptable, and safe.
We report a case of 'matured' lipoblastoma occurring within the parotid gland of a 7-month-old male. This benign fatty tumor is considered to represent localized continuation of fetal fat development into the post-birth period. At least 7 cases have been reported in the head and neck region, but this is the first known occurrence within a salivary gland.
Tumoral calcinosis manifests soft-tissue calcification, usually near major joints. It variably includes hyperphosphatemia, elevated 1,25-dihydroxycalciferol, and an affected sibling. Serum calcium, alkaline phosphatase, and parathyroid hormone are normal. Tumoral calcinosis of the head and neck is very rare, but this diagnosis should be considered when x-ray film of a poorly defined mass shows irregular soft-tissue calcification.
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Voice restoration for laryngectomees is challenging, but in recent years the tracheosophageal (TE) fistula procedure using a one-way valved prosthesis has had relatively good success. The purposes of this study were to determine the success rate for the primary TE fistula procedure, analyze failures, and study methods for selection and training of these patients. In a prospective study, 21 consecutive patients had primary TE fistula procedures performed over an 18-month period. Thirteen of 20 who had adequate follow-up developed fluent, intelligible speech using either duckbill or low-pressure one-way valves. Complications included one stomal infection and one paratracheal fistula. This experience has led to development of a protocol for selection and training of patients for this procedure and to the conclusion that the procedure can improve voice restoration success without an increase in morbidity.
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Invasive frontoethmoidal sinus mucoceles extending into the anterior cranial fossa or orbits are difficult to manage and can lead to lethal complications. In the past four years, nine cases of frontoethmoidal mucoceles were treated at the University of Texas Medical Branch, Galveston. Five cases were complicated by anterior cranial fossa invasion, orbital invasion, or both. The choice of surgical procedures used to manage these cases depended on mucocele extent and location, which were best determined by computed tomography. Two cases required craniotomy, one of which required an inferior-based pericranial flap for reconstruction of the floor of the anterior cranial fossa. Two cases were managed by osteoplastic flap and fat obliteration procedures. Intranasal drainage was the procedure used in one case that had extensive orbital involvement. Surgical complications included an intracranial abscess in one patient and a cerebrospinal fluid leak in a second patient.
Interpretation of vestibular test results derived from rotational and other electronystagmography studies often give confusing diagnostic and prognostic information. We have reviewed 90 consecutive patients seen in the Vestibular Clinic at the University of Texas Medical Branch comparing the accuracy of the damped torsion swing test (DTS) with a conventional vestibular test battery (VTB) to predict vestibular function abnormality (peripheral or central). These predictions were compared with vestibular diagnoses obtained by long-term follow-up (24-36 months). VTB and DTS results were evaluated in a double-blind study by two of the authors (W.C.L. and M.J.C.). Agreement of both VTB and DTS interpretation was uncommon (23/77) (30%); however, when present, it resulted in a 91% accuracy in predicting correct final diagnosis. Where VTB and DTS diagnoses differed, the DTS was more accurate in determining final vestibular system abnormality. In fact, while DTS testing correctly detected abnormality in 17 patients, the VTB was normal in 11. Rotation testing alone may provide a useful and accurate screening test prior to initiating further vestibular testing, particularly when central pathology is suspected.
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BACKGROUND: Allergic fungal sinusitis (AFS) usually follows a slow, nonaggressive course. However, massive bone destruction can occur, with extension of the disease process outside of the confines of the sinuses. METHODS: Our series of 28 cases of AFS was reviewed. We identified 6 cases of AFS with definite radiographic evidence of skull base erosion. RESULTS: Histologic diagnostic criteria for AFS were present in all 6 cases. All patients were managed with surgery, most recently conservative endoscopic surgery. An earlier patient underwent dural resection. Antibiotics were used in all patients, but no antifungal agents were administered. No patient has had a permanent neurologic complication, although one was seen with abducens palsy. There have been no cerebrospinal fluid (CSF) leaks. All 6 cases also had orbital bone erosion, but none has had permanent ophthalmologic sequelae. All patients were initially suspected to have a neoplastic disease. CONCLUSIONS: We propose a new diagnostic entity, "skull base allergic fungal sinusitis" (SBAFS), which incorporates the histologic diagnostic criteria of AFS with the computed tomographic (CT) criteria of bone erosion. Biopsy is necessary to rule out invasive fungus or tumor. Otolaryngologists, ophthalmologists, and neurosurgeons should be familiar with SBAFS so that systemic antifungal agents, craniotomy, and dural resection-which might initially appear necessary-can be avoided. Endoscopic surgical debridement and drainage combined with topical steroids can lead to resolution of disease, even in the presence of marked bone erosion and cranial neuropathy.
Defects of up to one third of the lower lip can usually be closed primarily, using one of the excision shapes described above. Defects of 30% to 50% of the lower lip can be closed with a stair-step or lip-switch flap. In most circumstances, stair-step reconstruction attains good function more quickly than the lip switch flap and has a better aesthetic result. Defects of 50% to 75% of the lower lip can be closed with a fan flap or a Karapandzic flap; the Karapandzic flap generally provides a better functional result. Both of these flaps cause rounding of the corner of the mouth that compromise the aesthetic result.
Stenosis of the larynx and trachea is an unfortunate sequel to many thermal injuries. Numerous surgical techniques have been developed for correction of such problems, many involving use of a tracheal T-tube. We report a serious complication attributed to the use of such a tube. Factors contributing to this complication are analyzed and methods for avoiding similar near-catastrophes discussed.
In normal epithelia differentiation and proliferation are regulated by factors involving p53 and related pathways. WAF1/CIP1 protein is believed to inhibit cell growth as a downstream mediator of p53 function. Also, WAF1/CIP1 is identified as a candidate gene linking differentiation signals to G1 arrest. Different epithelia with different keratinizing profiles respond differently to differentiation/proliferation signals, such as calcium or interferon gamma (IFNgamma). Other factors, such as p53 mutation or presence of human papillomaviruses (HPVs) also affect responses to those signals. Since WAF1/CIP1 can be regulated via a p53-dependent or an independent manner, our study aimed to determine: a.) differentiation-related expression of WAF1/CIP1 in keratinocytes, b.) involvement of WAF1/CIP1 in IFNgamma action, and c.) p53-dependence of WAF1/CIP1 transcription under these conditions. The results demonstrated that differentiation increases WAF1/CIP1 transcription in keratinizing but not in nonkeratinizing keratinocytes in a p53-independent manner. IFNgamma upregulated WAF1/CIP1 in keratinizing keratinocytes in a differentiation and p53 dependent manner. Inactivation of wild type p53 by mutation or by presence of HPVs uncouples IFNgamma-mediated WAF1/CIP1 transcription from p53 and from differentiation. Our data suggest a mechanism which operates via WAF1/CIP1 in keratinocytes and regulates epithelial differentiation/proliferation under different physiological conditions.