Peripheral facial paralysis: diagnosis.
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Biomedical subjects
Publications and source records attributed to M May.
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The benzyl (2), allyl (4), propyl (10), 3-hydroxypropyl (12), 2,3-dihydroxypropyl (11), 4 pentenyl (7), and pentyl (8) ethers of testosterone were synthesized. Compounds 2, 4, 7, 8, 10, and 12 were found to be almost devoid of anabolic or androgenic activity in a modified Hershberger Assay, but 2,4,10, and 12 were found to be effective inhibitors of testosterone 5alpha-reductase from human skin. These findings suggest that esters of testosterone and of 19-nortestosterone must hydrolyze before interacting with the hormonal receptors, but that the esters may competitively compete with the parent alchohols for interaction with enzymes. The latter effect may shift the distribution of metabolites of the esters relative to the alchohols and thus influence the pharmacological effect of these compounds.
Application of 50 para-aminobenzoic acid (PABA) to hairless mice one hour prior to ultraviolet light (UVL) irradiation will almost totally protect these animals from developing tumors induced by chronic exposure to UVL in the 290 to 320 nm range in conjunction with a chemical carcinogen. Mice exposed to UVL and not protected by PABA developed primarily squamous cell carcinomas. Two months after cessation of chronic UVL exposure, the non-PABA-treated irradiated mouse skin appeared thickened, yellow, and wrinkled while showing elevated DNA synthesis, hyperplasia, hypergranulosis, and increased amounts of elastotic material. The PABA-treated skin was grossly normal.
This study of 223 patients with penetrating neck wounds justifies individualizing surgical treatment. Twenty-four percent was selected for neck surgery. In spite of selective rather than mandatory neck exploration, the mortality rate related to the neck wound in this series was three percent. This compared favorably with the experience of others employing mandatory exploration. There were no deaths in our series attributable to selective observation.
Vestibular involvement in the acute phase of idiopathic facial paralysis (Bell's palsy) was observed in 22 percent and 14 patients. These patients were evaluated by history, physical examination and caloric tests with electronystagmography (ENG) employing the Cawthorne-Hallpike technique. Bell's palsy has been considered a mononeuropathy limited to the facial nerve. Evidence of occasional involvement of other cranial nerves (Vth and/or VIIIth) suggests a polyneuropathy. Several theories have been advanced to explain the involvement of the vestibular nerve.
The chorda tympani nerve plays an important role in the pathogenesis of Bell's palsy. The chorda tympani nerve is altered early in the course of the disease, perhaps before involvement of the facial nerve occurs. This was demonstrated by studying the pathophysiologic alterations of the chorda tympani nerves of 15 patients with Bell's palsy. Fifty-seven percent of the patients noted taste aberrations two days before the onset of the facial paralysis. In addition, chorda tympani nerve function, tested by electrogustometry and by determining submandibular salivary flow, was altered before the response to nerve excitability became reduced; further, the electron micrographic findings in two patients indicated that the involvement of the chorda tympani nerve preceded the time of onset of the facial paralysis. The study established a relationship between the pathologic involvement of the chorda tympani nerve and the facial nerve. There was a direct relationship between the severity of changes noted microscopically in the chorda tympani nerve specimens and the ultimate recovery of facial motor function. Examination of the chorda tympani nerve specimens was used to correlate the effectiveness of treatment. The results of steroid therapy and surgical decompression were compared. Steroids had no beneficial effect. Complete return of facial function was associated with surgical management when surgery was performed based on reduced salivary flow to 25 percent of normal and while the response to maximal stimulation was still normal.
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