Biomedical subjects

R L Goode

Publications and source records attributed to R L Goode.

At least 19 recordsLinked to original sources

PubMed1999

Evaluation of a cement incus replacement prosthesis in a temporal bone model.

In reconstruction of the ossicular chain for a damaged incus, it is important that the incus replacement prosthesis (IRP) length is ideal in order to provide optimal tension between the tympanic membrane or malleus and stapes head to achieve the best post-operative hearing result. Even though the length of commercially available IRPs can be adjusted, it still may be difficult to achieve clinically. We describe experiments in a human temporal bone model using dental cement as an IRP after removal of the incus. This cement IRP (CIRP) hardens in situ and becomes the length of the gap to be spanned so that tension should be ideal. Two different CIRPs were studied; one was a conventional rod-type CIRP connecting either the umbo or mid-malleus handle to the stapes head. The second was a Y-shaped CIRP (Y-CIRP), connecting two sites on the malleus to the stapes head. The wide Y-CIRP connected the malleus head and umbo to the stapes head, while the narrow Y-CIRP connected the malleus neck and mid-handle to the stapes head. The acoustic performance of these experimental CIRPs was studied using a laser Doppler vibrometer system in 12 fresh human temporal bones. The CIRP demonstrated better acoustic performance than conventional IRPs studied previously in the same model. While all the CIRPs showed similar function below 2.0 kHz, the narrow Y-CIRP appeared best above 3.0 kHz. A prosthesis of this type may have an acoustic advantage over conventional IRPs.

Acoustic Stimulation↗

PubMed1999

Analysis of the best site on the stapes footplate for ossicular chain reconstruction.

Experiments were performed in 22 fresh human temporal bones to compare the relative acoustic function of three stapes footplate sites for an incus stapes superstructure replacement prosthesis (I-SRP). The three sites evaluated were the anterior, centre and posterior footplates. A new round window (RW) measurement method was used to make the comparisons. A small glass microsphere was placed in the centre of the RW as a target. A Polytec laser Doppler vibrometer was used to measure round window displacement in response to 50 pure tones between 200 and 10,000 Hz presented at 80 dB SPL at the tympanic membrane (TM). After a baseline measurement of RW displacement in the intact temporal bone, the incus was removed and a cement I-SRP (CIRP) formed between the mid-malleus handle and each of the three test footplate sites, in random order. RW displacement was again measured after placement of the CIRP at each of three sites. We found the centre site to be 3.0-7.0 dB better than the anterior site above 2,000 Hz. There were no differences between the anterior and centre sites below 2,000 Hz. The posterior site was the worst at all frequencies.

Aged↗

PubMed1999

Radiofrequency energy tissue ablation for the treatment of nasal obstruction secondary to turbinate hypertrophy.

OBJECTIVE/HYPOTHESIS: We hypothesized that the success rate of radiofrequency energy (RFe) tissue ablation of the inferior turbinate for nasal obstruction achieved by previous investigators would be improved by using a longer needle electrode and creating two lesions per turbinate. METHODS: Ten patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. A 40-mm needle delivered RFe to two sites in each inferior turbinate. Patients used a visual analog scale (VAS) to grade nasal obstruction preoperatively and at 1 week and 8 weeks after surgery. Preoperative and postoperative digital images of the nasal cavity were graded for obstruction (0% to 100%) in a blinded manner. RESULTS: All patients (100%) were subjectively improved at 8 weeks. Mean obstruction (VAS) improved from 50%+/-21% to 16%+/-15% (right side) and from 53%+/-29% to 13%+/-13% (left side). Mean improvements were 68% (right side) (P = .004) and 75% (left side) (P = .001). Mean obstruction graded during blinded review of nasal cavity images improved from 73.5%+/-8% to 51%+/-8% (right side) and from 76%+/-6% to 64%+/-7% (left side). Of nine patients using medications for nasal obstruction before treatment, eight (89%) noted no further need for medications at 8 weeks. CONCLUSION: The use of RFe for submucosal tissue ablation in the hypertrophied inferior turbinate is an effective modality for reducing symptoms of nasal obstruction. Improved results may occur by using a longer needle and creating two lesions per turbinate. Of patients in this study, 100% reported improvement of nasal obstruction.

Aged↗

PubMed1999

Who needs a sleep test? The value of the history in the diagnosis of obstructive sleep apnea.

Many experts believe that a polysomnogram to screen for obstructive sleep apnea should be performed on every patient who has a history of loud snoring and sleepiness. In contrast, the author believes that with a careful history and physical examination, there is no need to study all such patients, at least not until home polysomnography units become as convenient and economical as pulse oximetry.

Diagnosis, Differential↗

PubMed1999

A human temporal bone study of stapes footplate movement.

OBJECTIVE: This study was designed to determine whether stapes movement is pistonlike or complex. BACKGROUND: The literature provides conflicting information on whether stapes footplate motion is only pistonlike or has other types of movement, such as hingelike or rocking. METHODS: Using 10 freshly harvested human cadaver temporal bones, 3 targets were placed on the stapes footplate through an extended facial recess approach. The targets were 0.5-mm pieces of reflective adhesive material positioned on the long axis of the footplate at the anterior crus, central footplate, and posterior crus. Displacement and phase of the three targets were measured from 0.2 to 10 kHz at a 90dB sound pressure level input at the tympanic membrane. The measuring system was a sophisticated laser Doppler vibrometer (LDV). A computer program (Tymptest) calculated footplate displacement and relative phase at the three sites and the ratio of anterior-posterior rocking movement of the footplate long axis to displacement at the center. RESULTS: Below 2.0 kHz, stapes vibration is predominately pistonlike. Above 2.0 kHz, anterior-posterior rocking motion increases logarithmically with frequency, and, near 4.0 kHz, rocking and pistonlike motion are approximately equal. CONCLUSIONS: Stapes footplate vibration is primarily pistonlike up to 2.0 kHz but becomes more complex at higher frequencies because of an increase in anterior-posterior rocking motion. Hingelike movements were not observed. This information may be helpful in the design of ossicular replacement prostheses that mimic or improve upon normal stapes vibration.

Adult↗

PubMed1998

Sniffing and smelling: separate subsystems in the human olfactory cortex.

The sensation and perception of smell (olfaction) are largely dependent on sniffing, which is an active stage of stimulus transport and therefore an integral component of mammalian olfaction. Electrophysiological data obtained from study of the hedgehog, rat, rabbit, dog and monkey indicate that sniffing (whether or not an odorant is present) induces an oscillation of activity in the olfactory bulb, driving the piriform cortex in the temporal lobe, in other words, the piriform is driven by the olfactory bulb at the frequency of sniffing. Here we use functional magnetic resonance imaging (fMRI) that is dependent on the level of oxygen in the blood to determine whether sniffing can induce activation in the piriform of humans, and whether this activation can be differentiated from activation induced by an odorant. We find that sniffing, whether odorant is present or absent, induces activation primarily in the piriform cortex of the temporal lobe and in the medial and posterior orbito-frontal gyri of the frontal lobe. The source of the sniff-induced activation is the somatosensory stimulation that is induced by air flow through the nostrils. In contrast, a smell, regardless of sniffing, induces activation mainly in the lateral and anterior orbito-frontal gyri of the frontal lobe. The dissociation between regions activated by olfactory exploration (sniffing) and regions activated by olfactory content (smell) shows a distinction in brain organization in terms of human olfaction.

Adult↗

PubMed1998

Synthesis and 5 alpha-reductase inhibitory activity of 8-substituted benzo[f]quinolinones derived from palladium mediated coupling reactions.

Benzoquinolinones have been shown to be potent, selective inhibitors of the Type I 5 alpha-reductase enzyme, which is responsible for the production of dihydrotestosterone from testosterone localized in the scalp. In an effort to identify compounds that demonstrate inhibition of both 5 alpha-reductase isozymes, we have employed 8-bromobenzoquinolinone as an advanced intermediate for participation in a variety of palladium mediated carbon-carbon bond forming reactions. By varying the 8-substituent it is possible to alter the selectivity profile of the series.

Cholestenone 5 alpha-Reductase↗

PubMed1998

Closed dressings after laser skin resurfacing.

OBJECTIVE: To evaluate the safety, efficacy, and patient acceptance of closed dressings after full facial resurfacing with the carbon dioxide laser. DESIGN: Prospective cohort of men and women undergoing full facial carbon dioxide laser resurfacing. SETTING: Ambulatory surgical center at a university hospital. PATIENTS: Forty consecutive patients randomized to 1 of 4 dressing groups. INTERVENTIONS: All patients underwent full facial resurfacing with a carbon dioxide laser system. One of 5 closed dressings (single- or 3-layer composite foam, plastic mesh, hydrogel, or polymer film) was placed immediately after the procedure. Closed dressings were changed on postoperative day 2 and removed on postoperative day 4. OUTCOME MEASURES: Objective postoperative criteria of erythema, scarring, reepithelialization, and surface irregularities were recorded and photodocumented. Comparisons were made among the closed dressing groups as well as with a group of historical control subjects treated with open dressings. The ease of application, office time for preparation and application, and cost of the individual dressings were collected. Patient characteristics of overall acceptance, comfort, and ease of maintenance were recorded with a visual analog scale. RESULTS: There were no complications of scarring, surface irregularities, or contact dermatitis from the application or maintenance of the closed dressings. There were no significant differences in the number of days of postoperative erythema or in the rate of facial reepithelialization among the groups. Most patients preferred not to continue with the closed dressings past 2 days. Positive features from the use of closed dressings included reduction in crust formation, decreased pruritus, decreased erythema, and decreased postoperative pain, compared with historical controls. Negative features included time in preparation and application of the dressings. Costs ranged from $9.79 to $50 per dressing change. CONCLUSIONS: Closed dressings are safe and offer benefits noted during the first 4 postoperative days. Patients can be expected to maintain a closed dressing for at least 24 hours but no longer than 4 days. The positive features of closed dressings and patient acceptance outweigh the cost and office time involved with their application and maintenance.

Adult↗

PubMed1998

Cavernous sinus syndrome caused by a primary paranasal sinus non-Hodgkin's lymphoma.

Although uncommon, non-Hodgkin's lymphomas occasionally arise from the nose and paranasal sinuses. Rarely, they may invade into the cavernous sinus and produce signs and symptoms that characteristically include unilateral ophthalmoplegia, sensation loss in the distribution of the ophthalmic and other divisions of the trigeminal nerve, sympathetic nerve paralysis and proptosis. In this report, we present a case of cavernous sinus syndrome (CSS) caused by infiltration of non-Hodgkin's lymphoma from the adjacent paranasal sinuses and address issues regarding its diagnosis and treatment.

Aged↗

PubMed1998

The failing flap in facial plastic and reconstructive surgery: role of the medicinal leech.

OBJECTIVE: To review the use of the medicinal leech, Hirudo medicinalis, in salvaging the failing, venous-congested flap. A protocol for the use of leeches is presented. Four illustrative cases of failing flaps (pectoralis major, midline forehead, and temporalis) are presented. STUDY DESIGN: Literature review comprised of MEDLINE search 1965 to present. Retrospective review of four cases involving the management of the failing, venous-congested flap. METHODS: A retrospective review of four cases of failing, venous-congested flaps was performed. RESULTS: The authors' experience, as well as the data from the reviewed medical literature, demonstrates the importance of early intervention in order to salvage the failing, venous-congested flap. Leeches are an immediate and efficacious treatment option. CONCLUSIONS: 1. Review of the literature indicates that the survival of the compromised, venous-congested flap is improved by early intervention with the medicinal leech. H medicinalis injects salivary components that inhibit both platelet aggregation and the coagulation cascade. The flap is decongested initially as the leech extracts blood and is further decongested as the bite wound oozes after the leech detaches. 2. When a flap begins to fail, salvage of that flap demands early recognition of reversible processes, such as venous congestion. The surgeon must be familiar with the use of leeches and should consider their use early, since flaps demonstrate significantly decreased survival after 3 hours if venous congestion is not relieved. In the four cases presented, a standardized protocol facilitated early leech use and provided for the psychological preparation of the patient, availability of leeches, and an antibiotic prophylaxis regimen. 3. The complications associated with leech use can be minimized with antibiotic therapy, wound care, and hematocrit monitoring. 4. The use of the medicinal leech for salvage of the venous-congested flap is a safe, efficacious, economical, and well-tolerated intervention.

Aged↗

PubMed1998

Direct bonded orthodontic brackets for maxillomandibular fixation.

OBJECTIVES/HYPOTHESIS: Mandibular fracture treatment often includes arch bar maxillomandibular fixation (MMF), either alone or in combination with open reduction/internal fixation (ORIF) techniques. The glove perforation rate associated with arch bar placement, the incidence of blood-borne pathogen positivity in facial fracture patients, and the injurious effects of arch bars on dental enamel and gingiva have prompted the development of safer alternatives to arch bar MMF. This study evaluates the efficacy, ease of use, and safety profile of one such alternative: orthodontic direct bonded bracket fixation (MMF/DBB). STUDY DESIGN: Prospective study of consecutive mandible fracture patients treated with MMF/DBB. METHODS: Thirty-two patients with mandibular fractures were evaluated from January 1994 to July 1997. Fourteen were appropriate for treatment with MMF/DBB (12 men and two woman; mean age, 24.6+/-7.2 y; range, 16-42 y). Fracture sites included symphysis, angle, condylar neck, coronoid, and body. Nine patients underwent MMF/DBB alone; five underwent MMF/DBB with subsequent ORIF. RESULTS: No infection, malocclusion, malunion/nonunion, or enamel/ gingiva injury occurred. Mean follow-up was 6 months (range, 1-12 mo). Oral hygiene with MMF/DBB was superior to historical controls using arch bars. CONCLUSIONS: MMF/DBB can serve as the single treatment method with satisfactory results in patients with favorable, less complicated mandible fractures, although with increased experience, we have treated several more complex cases with MMF/DBB alone. In cases necessitating ORIF, MMF/DBB can be performed preoperatively to align fracture segments and reestablish occlusion. This facilitates placement of osteosynthesis plates and reduces ORIF operative time. MMF/DBB is an economical, safe technique that minimizes blood-borne-pathogen risk to the operative team, eliminates periodontal injury, facilitates postoperative dental hygiene, and is painless to apply and remove.

Adolescent↗

PubMed1998

Effect of increased inner ear pressure on middle ear mechanics.

Velocity of malleus, umbo, and stapes footplate in response to stepwise increases up to +400 mm H2O in hydrostatic pressure of the inner ear was investigated in 10 fresh human temporal bones by using a laser Doppler interferometer. The sound-pressure input was 114 dB SPL, and the frequency range was 0.4 to 5.0 kHz. Static displacement of these sites was also measured by a video measuring system. When the inner ear pressure was increased, the malleus and stapes moved outward. Amplitude of umbo velocity decreased below 1.0 kHz with a slight increase around 2.0 kHz, whereas stapes velocity decreased at all frequencies with the major effect below 1.0 kHz. The phase angle of malleus umbo velocity advanced markedly in response to the increased inner ear pressure between 1.0 and 1.4 kHz. Change in the vibration of the umbo was thought to be primarily caused by an increased stiffness of the middle ear conduction system, and that of the stapes was caused by distention of the annular ligament and increased cochlear impedance produced by the increased inner ear pressure. These changes in TM vibration and its phase angle may help detect indirectly an elevation of inner ear pressure.

Aged↗

PubMed1997

Transcalvarial suture fixation for endoscopic brow and forehead lifts.

OBJECTIVE: To evaluate the safety and effectiveness of transcalvarial suture fixation during endoscopic repair of brow ptosis. DESIGN: Case series. SETTINGS: A private ambulatory surgicenter and a Veterans Affairs Hospital. PARTICIPANTS: Fifty patients with brow ptosis with minimum follow-up of 12 months. RESULTS: Patients had improvement in brow position in all cases. There were no adverse effects of performing cortical tunnels and suture fixation. CONCLUSION: Transcalvarial suture fixation can be performed safely with good to excellent results and avoids the need for screw or plate fixation.

Endoscopy↗

PubMed1997

Patient selection in the treatment of glabellar wrinkles with botulinum toxin type A injection.

OBJECTIVES: To determine the dose-response characteristics and side-effects profile of Clostridium botulinum type A exotoxin (Botox) used to treat glabellar wrinkles and develop guidelines for patient selection based on the nature and severity of the treated wrinkles. DESIGN: Prospective, nonrandomized pilot and electromyogram (EMG)-guided studies. SETTING: Two ambulatory care clinics at university hospitals. PARTICIPANTS: For the pilot study, volunteer samples of 23 patients with glabellar wrinkles; for the EMG-guided study, volunteer samples of 57 patients with glabellar wrinkles. INTERVENTIONS: For the pilot study, 23 patients were serially injected with up to 10.0 mouse units (MU) of Botox into each corrugator muscle; for the EMG-guided study, 57 patients were injected under EMG guidance with an initial dose of 10.0 MU of Botox into each corrugator muscle. Eleven patients with persistent corrugator activity were reinjected with 10.0 MU of Botox. MAIN OUTCOME MEASURES: For the pilot study, slide photographs were obtained before and 2 weeks after injection; for the EMG-guided study, slide photographs were obtained before and at 2 weeks and at 2 months after injection. Patients were asked to evaluate results numerically. RESULTS: For the pilot study, injection of up to 10.0 MU of Botox into each corrugator muscle produced a satisfactory improvement in 12 patients; for the EMG-guided study, 43 patients were satisfied with improvement after full abolition of corrugator or accessory lateral brow muscle activity. Women were more likely to achieve satisfactory results than were men (80% [40/50] vs 43% [3/7]; P < or = .03). Improvement was not age related. No significant side effects or complications were observed. CONCLUSIONS: Glabellar wrinkles may be satisfactorily treated with Botox injection into the corrugator supercilii muscles. Improvement is temporary, dose dependent, and may not be seen in some patients even with successful denervation of the treated muscles. Clinicians may begin treatment with a dose of 10.0 MU of Botox into each corrugator muscle, and may select candidates for injection by determining the type of wrinkle to be treated and its spreadability (glabellar spread test).

Adult↗

PubMed1997

Distortion of the auriculocephalic angle following rhytidectomy. Recognition and prevention.

Distortion of ear protrusion after rhytidectomy results in an aesthetically unfavorable appearance. We have seen cases in which the auriculocephalic angle has widened postoperatively, producing a noticeable deformity. Herein, we report 3 cases that resulted in abnormal postsurgical ear protrusion. We also discuss prevention through the use of conchal setback sutures.

Adult↗

PubMed1997

Contemporary management of the aging brow and forehead.

Management of the aging brow and forehead has recently evolved based on available innovative technologies. Likewise, procedure-specific indications have changed based on collective surgical experiences. No longer is the approach based solely on hair pattern or degree of brow ptosis. Patients require varying combinations of brow elevation (prior to blepharoplasty), correction of brow asymmetries, and hairline-preserving forehead elevation. Some may only require excisional or paralytic procedures of the frontalis muscle (horizontal forehead creases), corrugator supercilii muscles (vertical glabellar furrows), and procerus muscle (horizontal glabellar furrows). We present a 3-year experience using a problem-specific approach. This incorporates endoscopic technology, botulinum toxin type A purified neurotoxin complex (Botox, Allergan, Irvine, CA) intramuscular injection, and traditional procedures such as the coronal, pretrichial, midforehead, and direct browlift. Current indications, patient selection, and results are also discussed.

Aging↗

PubMed1997

Acoustic effect of malleus head removal and tensor tympani muscle section on middle ear reconstruction.

In the reconstruction of ears with a missing incus, an incus replacement prosthesis (IRP) is commonly used to connect malleus and stapes. In some cases, it is necessary to resect the malleus head and/or section the tensor tympani muscle (TTM) tendon. The acoustic effects of these maneuvers have not been well studied. We performed experiments in a temporal bone model to measure the effect of these maneuvers on middle ear sound transmission. Measurements of umbo and stapes displacement were made before and after malleus head removal and TTM section plus incus replacement with an IRP. After malleus head removal, there was a peak gain in stapes displacement of 6 dB below 0.5 kHz and 8 dB above 2.5 kHz. TTM section had a similar but lesser effect. A clinical example is described.

Acoustic Stimulation↗

PubMed1997

Serum-free keloid fibroblast cell culture: an in vitro model for the study of aberrant wound healing.

The purpose of this study was to develop an in vitro serum-free keloid fibroblast model. Keloid formation remains a problem for every surgeon. Prior evaluations of fibroblast characteristics in vitro, especially those of growth factor measurement, have been confounded by the presence of serum-containing tissue culture media. The serum itself contains growth factors, yet has been a "necessary evil" to sustain cell growth. The design of this study is laboratory-based and uses keloid fibroblasts obtained from five patients undergoing facial (ear lobule) keloid removal in a university-affiliated clinic. Keloid fibroblasts were established in primary cell culture and then propagated in a serum-free environment. The main outcome measures included sustained keloid fibroblast growth and viability, which was comparable to serum-based models. The keloid fibroblast cell cultures exhibited logarithmic growth, sustained a high cellular viability, maintained a monolayer, and displayed contact inhibition. Demonstrating model consistency, there was no statistically significant difference between the mean cell counts of the five keloid fibroblast cell lines at each experimental time point. The in vitro growth of keloid fibroblasts in a serum-free model has not been done previous to this study. The results of this study indicate that the proliferative characteristics described are comparable to those of serum-based models. The described model will facilitate the evaluation of potential wound healing modulators, and cellular effects and collagen modifications of laser resurfacing techniques, and may serve as a harvest source for contaminant-free fibroblast autoimplants. Perhaps its greatest utility will be in the evaluation of endogenous and exogenous growth factors.

Cell Division↗