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Biomedical subjects

M May

Publications and source records attributed to M May.

At least 145 records · Page 8Linked to original sources
PubMed1990

Selective termination: clinical experience and residual risks.

Assisted reproductive technologies have aided thousands of couples, but complications have resulted in multifetal pregnancies creating a bitter irony for infertility patients. In an effort to increase the rate of intact survival, we have successfully performed transabdominal first-trimester selective termination procedures on 22 pregnancies including one octuplet, five quintuplet, twelve quadruplet, and four triplet gestations. There have been eight sets of twins, and two singletons delivered, seven twin pregnancies are ongoing, and one early and four late losses of pregnancies. With experience we now counsel as to a high likelihood of a technically successful procedure, but we still have concerns for late losses. We have tried to balance the arguments about the direct harms of performing selective termination and the obstetric risks of not performing selective termination. We believe that selective termination should not be considered a "social" procedure. Our data do not yet make clear whether one, two, or three is the optimal number of embryos to leave. Therefore, on the basis of both current obstetric risk factors and ethical reasoning we will continue to support our protocol of optimally leaving twins.

Abortion, Induced↗
PubMed1990

Protection from glucocorticoid induced thymic involution by dehydroepiandrosterone.

Dehydroepiandrosterone (DHEA), the most abundantly secreted human adrenal steroid, has no known specific function. In spite of this fact there is an abundance of data associating DHEA with "health" in both man and experimental animals. Research in our laboratory has demonstrated evidence for an antagonistic interaction between DHEA and glucocorticoids (GC) in liver and brown adipose tissue. We hypothesized that DHEA also antagonized effects of GC on the immune system and that this "immune protective effect" might explain the diffuse positive effects of DHEA reported in the literature. Effects of GC on the immune system include involution of the thymus when given in animals in vivo and death of thymic lymphocytes in vivo with exposure to these steroids. We hypothesized that DHEA would block this GC mediated thymocyte destruction in vivo and in vitro. Pretreatment with DHEA for three days blocked approximately 50% of the thymic involution seen with dexamethasone. Results of in vitro experiments confirmed protective effects of DHEA in pretreated animals. (less than 50% of cell death in lymphocytes from pretreated mice compared with lymphocytes from control mice.) We conclude from these studies that DHEA protects against at least one GC anti-immune effect, thymic lymphocyte lysis.

Animals↗
PubMed1990

Early facial reanimation following radical parotid and temporal bone tumor resections.

A retrospective study of 35 patients who underwent early facial reanimation following extirpative parotid and temporal bone surgery requiring facial nerve sacrifice was performed. Regional facial reanimation performed immediately or within several days included 16 patients who underwent temporalis muscle transposition and 27 who underwent gold weight or eyespring lid reanimation with lower lid tightening. Simultaneous nerve grafts or nerve crossover procedures were performed in 22 patients. The authors' favored approaches to facial reanimation are discussed, with an emphasis on the value of early reanimation using properly selected techniques.

Adult↗
PubMed1990

Lumbo-sacral chordoma with high-grade malignant cartilaginous and spindle cell components.

A recurrent lumbo-sacral chordoma with high-grade cartilaginous and spindle cell components is described. The tumor was excised from a 71-year-old man who previously had a conventional chordoma resected from his sacrum 26 years earlier. The original conventional chordoma was treated postoperatively with external beam radiation therapy, and the patient was free of disease until he presented at the age of 71 with leg weakness. Computerized tomography revealed a lumbo-sacral soft tissue mass. This was excised and found to have three distinct histologic aspects. The largest component was that of a conventional chordoma. The second component consisted of islands of malignant cartilage intimately admixed with the cells of the conventional chordoma. The third component consisted of high-grade malignant, poorly differentiated spindle cells. This case suggests that chondroid chordomas do exist and that they may also occur outside of the spheno-occipital region.

Aged↗
PubMed1990

Anomaly of the hypoglossal nerve: embryologic, anatomic, and surgical considerations.

An anomaly of the hypoglossal nerve was discovered during a procedure to anastomose the 12th and 7th cranial nerves. This anomaly is described, and an embryologic mechanism is proposed to explain the occurrence of this particular anomaly. The surgical anatomy of the hypoglossal nerve is reviewed, and reasonable approaches to the surgical identification of the hypoglossal nerve are discussed.

Anastomosis, Surgical↗
PubMed1990

The location of the maxillary os and its importance to the endoscopic sinus surgeon.

As functional endoscopic sinus surgery continues to gain popularity and support, the necessity for a clear and accurate understanding of the anatomy of the ostiomeatal complex becomes essential. To clarify this anatomy, serial cadaver dissections were performed and the anatomy of the ostiomeatal complex was detailed in three dimensions, with an emphasis on precise localization of the internal os of the maxillary sinus as it relates to the orbit, natural antronasal canal, and ethmoid infundibulum. Measurements of the position of the internal os relative to the position of the anterior and posterior walls of the maxillary sinus and the position of the orbit were taken. The dimensions and configuration of the antronasal canal and its relationship to the infundibulum were also detailed. These measurements and relationships must be understood for an endoscopic sinus surgeon to locate the natural ostia without injuring the orbit.

Cadaver↗
PubMed1990

Managing segmental facial nerve injuries by surgical repair.

This report describes our experiences and evolving philosophy with regard to managing segmental facial nerve injuries. We present the results of 13 facial nerve repairs of traumatic injury to a segment of the facial nerve. All peripheral facial nerve branches contribute essential elements to normal mimetic facial movement; therefore, we recommend early, appropriate repair of the nerve segment. This recommendation is based on principles established for managing disruptions of the main trunk of the facial nerve. It offers the patient the chance for complete recovery of facial function.

Adult↗
PubMed1990

Video telescopic sinus surgery technique for teaching.

Video-endoscopic sinus surgery is a team approach which has evolved from classic, endoscopic sinus surgery in treating over 500 patients. Unlike classic endoscopic sinus surgery which has the surgeon viewing and operating through the endoscope, this technique permits the surgeon to operate while viewing the T.V. monitor using two hands for instrumentation. This technique greatly facilitates hands-on teaching and learning, while simultaneously providing a reproducible method of documentation.

Computer Terminals↗
PubMed1990

Slowly progressive facial paralysis due to vascular malformation of the brain stem.

Slowly progressive facial paralysis is suggestive of a diagnosis other than Bell's palsy. A case of slowly progressive facial paralysis caused by a cavernous angioma of the brain stem is presented. The classification of vascular malformations of the central nervous system is described with emphasis on the MRI appearance of these lesions.

Brain Neoplasms↗
PubMed1990

Disseminated Pneumocystis carinii infection causing extrapulmonary organ failure: clinical, pathologic, and immunohistochemical analysis.

Pneumocystis carinii pneumonia is an important infection in the immunocompromised host, and the rate of symptomatic infections has risen dramatically with the advent of immunosuppressive therapies and infections with the human immunodeficiency virus (HIV). However, dissemination of P. carinii is thought to be an unusual event, and it is rarely suspected of causing extrapulmonary symptomatology. We have recently examined the cases of patients with acquired immunodeficiency syndrome (AIDS) who demonstrated at autopsy extrapulmonary infection with P. carinii. Three of these patients had widespread pneumocystosis, and in one patient dysfunction in several organs could be directly attributed to effects of P. carinii, which contributed to his death. The possible factors leading to dissemination of P. carinii are discussed. We also describe the use of a newly developed monoclonal antibody to P. carinii in detecting extrapulmonary infections.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Grading facial nerve function: House-Brackmann versus Burres-Fisch methods.

Many systems for reporting results of facial function tests have been proposed, but after five International Facial Nerve Symposia, a perfect system for reporting has yet to be developed. In 1985 the American Academy of Otolaryngology-Head and Neck Surgery adopted the House-Brackmann (H-B) six-point subjective grading scale as a universal standard. This decision was based on the recommendation of the Facial Nerve Disorders Committee. The next year, 1986, Burres and Fisch proposed the Linear Measurement Index (B-F LMI) as an alternative, objective grading system. To determine the ability of each system to grade the facial function of patients with facial palsy, and the relative merits of each system, 41 patients with facial weakness and one normal patient were studied. The H-B grading system is easy to use and provides simple, concise criteria for each separate grade of facial function. The B-F LMI grading system is time-consuming and labor-intensive, and requires a complex calculation to derive a percentage value that represents facial function. The most important finding of this study was the high degree of correlation between the two systems, in spite of the fact that the H-B system is subjective and qualitative while the B-F LMI system is objective and quantitative. Until the perfect grading system is developed, the authors favor combining the H-B and B-F LMI systems as the best method available at the moment to evaluate facial function.

Facial Injuries↗
PubMed1989

Tumoral calcium pyrophosphate deposition disease.

A report of two patients in which a soft tissue mass, initially regarded as a malignant tumor, was shown to be the result of calcium pyrophosphate deposition disease. The first case, a woman aged 71 years, presented with a mass involving the right fifth finger. In the second case, also a woman aged 71 years, the lesion involved the tissues adjacent to the right hip. Each lesion consisted of a mass of highly cellular tissue containing deposits of calcium pyrophosphate dihydrate crystals. The clinical, radiological, and pathological features of the two cases are compared with those of seven similar cases reported in the literature.

Aged↗