Stapes footplate fistula and recurrent meningitis.
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Child↗
Biomedical subjects
R O Jones
Publications and source records attributed to R O Jones.
An ultrastructural comparison of mechanical dermabrasion and carbon dioxide laser resurfacing in the minipig model.
OBJECTIVE: To compare the histological and ultrastructural changes in skin collagen with mechanical dermabrasion and pulsed carbon dioxide laser resurfacing in the minipig model. SETTING: Academic medical center. SUBJECTS: Yucatan minipig animal skin model. MAIN OUTCOME MEASURES: Comparison of light microscopic and ultrastructural (electron microscopic) changes in the skin following the 2 resurfacing modalities. RESULTS: No significant difference in collagen histological characteristics or ultrastructure was detected between the 2 comparison groups. CONCLUSIONS: When mechanical dermabrasion or pulsed carbon dioxide laser resurfacing is used with similar-depth injury to the dermis in this model, the histological changes seen via light microscopy and ultrastructural changes seen via electron microscopy are similar between the 2 treatment modalities.
Animals↗
Protection against aminoglycoside otic drop-induced ototoxicity by a spin trap: I. Acute effects.
Topical administration of aminoglycoside antibiotic drops containing neomycin and polymyxin B disrupts cochlear structure and function in rodents, possibly as a result of reactive oxygen species generation. This study investigated the ability of a spin trap, alpha-phenyl-tert-butyl-nitrone (PBN), to prevent acute aminoglycoside antibiotic drop-induced cochlear dysfunction. Guinea pigs were monitored for compound action potential thresholds and 1.0 microV root-mean-square cochlear microphonic isopotential curve values, then injected intraperitoneally with PBN (60 mg/kg) or saline solution. After 10 minutes, 50 microl of PBN (100 mmol/L) or artificial perilymph was applied to the round window membrane, followed after 10 minutes with artificial perilymph or aminoglycoside antibiotic drops (50 microl). From 10 to 60 minutes after exposure, mean compound action potential thresholds progressively increased in the artificial perilymph-aminoglycoside antibiotic drop group, beginning with high frequencies and later including ever-lower frequencies. These threshold shifts in compound action potentials were significantly greater (p<0.05) than those seen in the artificial perilymph-artificial perilymph or PBN-aminoglycoside antibiotic drop groups. This finding indicates that PBN provided protection against acute aminoglycoside antibiotic drop-induced compound action potential threshold sensitivity loss. Mean cochlear microphonic shift values at 60 minutes in the artificial perilymph-aminoglycoside antibiotic drop group significantly exceeded those of the other groups only at the highest frequencies. These data suggest that acute aminoglycoside antibiotic drop-induced cochlear disruption primarily affects high frequency compound action potential function and may be partially reactive oxygen species-mediated and preventable.
Action Potentials↗
Cyclandelate in the management of tinnitus: a randomized, placebo-controlled study.
Cyclandelate is a vasodilating agent that, like papaverine, acts directly on the smooth muscles of blood vessels. The drug has been used primarily as an adjunctive treatment for various peripheral vascular diseases; some studies advocate its use for treating ischemic cerebrovascular disease. Early nonrandomized and uncontrolled studies suggest that cyclandelate is efficacious in treating tinnitus. Recent personal communications regarding cyclandelate's effectiveness in treating tinnitus prompted this study. Fifty-nine adult patients with constant tinnitus for more than 1 year were randomly selected for this prospective, placebo-controlled, double-blind study with a treatment period of 3 months. Audiometric testing with tinnitus pitch and loudness matching was performed before initiation of treatment and at the end of treatment, and frequent questionnaire evaluations were performed during the treatment period. Four patients in the cyclandelate group and three in the placebo group reported a subjective reduction in the loudness of their tinnitus. Audiologic testing before and after treatment showed no significant changes in tinnitus pitch or loudness. Although cyclandelate treatment was beneficial for some patients and the decrease in subjective loudness scoring was significant for the cyclandelate group, the impact of its effect did not appear to warrant its continued use by those patients. A significant percentage of patients could not tolerate the drug because of side effects.
Acoustic Impedance Tests↗
Expected neurologic outcomes for surgical treatment of cervical neurilemomas.
OBJECTIVE: Neurilemomas are classically described as fusiform tumors that eccentrically displace the undisturbed neural fascicles. The authors seek to clarify the relationship of cervical neurilemomas to their nerve of origin and assess the functional outcome of surgical extirpation. STUDY DESIGN: A retrospective review of clinical, intraoperative, and histopathologic data of six patients with cervical extracranial neurilemomas. METHODS: Additional histochemical staining of the pathologic specimens was performed to evaluate the tumor for neurites. A comprehensive literature review of cervical neurilemoma cases and meta-analysis of clinical outcomes in these cases were performed. RESULTS: In the series of five consecutive cervical neurilemomas, only one was an eccentric mass pushing the undisturbed nerve aside. In the five other cases, excision of the neurilemoma required complete nerve excision. Neural elements traveling through the central portions of the tumor were clearly demonstrated histologically. Collective analysis of the literature on cervical neurilemomas revealed that although some cases allow nerve preservation, preservation of function is frequently poor. CONCLUSIONS: This experience and that reported in the literature suggest that it is frequently impossible to preserve the function of the nerve of origin with surgical treatment of cervical neurilemomas.
Adolescent↗
Prophylactic antibiotics in surgery for chronic ear disease.
OBJECTIVES/HYPOTHESIS: The role of prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused. Prior studies have provided conflicting evidence with regard to the benefit obtained from the use of prophylactic antibiotics in surgery for chronic otitis media. The current study was designed to evaluate the role of prophylactic antibiotics in the outcomes of surgery for chronic ear disease. It was the authors' impression that there was no indication for prophylactic antibiotics in such surgery. STUDY DESIGN: Randomized prospective study performed in a tertiary care facility. METHODS: Patients who met inclusion criteria (n = 146) were randomly assigned to an antibiotic treatment group or a control group receiving no prophylactic antibiotics. Patients in the antibiotic treatment group were given preoperative intravenous antibiotics followed by oral antibiotics for 5 days after surgery. Patients were followed postoperatively and observed for clinical evidence of infection and graft failure. RESULTS: There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival. CONCLUSIONS: The use of prophylactic antibiotics in surgery for chronic ear disease cannot be recommended based on the findings of this study.
Adolescent↗
Rheumatoid nodules affecting both heels with surgical debulking: a case report*.
The presence of subcutaneous nodules in association with rheumatoid arthritis is well documented. In most cases, these nodules occur in association with severe rheumatoid disease. Treatment should be initiated with conservative measures such as custom-molded shoes, nonweightbearing, and oral antibiotic therapy to control infection. The goals of surgery were to alleviate pain, improve function and cosmesis, remove infected bone, and prevent further infection. The surgical sites are completely healed without complications 2 years postoperatively.
Arthritis, Rheumatoid↗
Lichen simplex chronicus.
A review of the literature for the last 20 years shows no monumental advances in the diagnosis or treatment of the disease; however, there have been some very intriguing insights into the causes. The physical and emotional aspect of the skin condition is well known but the genetic, vascular, and neurogenic implications are of interest.
Diagnosis, Differential↗
Prophylactic antibiotic drops after tympanostomy tube placement.
OBJECTIVE: To evaluate the effectiveness of prophylactic polymyxin B sulfate-neomycin sulfate-hydrocortisone drops in decreasing the incidence of posttympanostomy otorrhea. DESIGN: Prospective randomized controlled study. SETTING: University referral center. PATIENTS: Three hundred patients undergoing tympanostomy tube placement (including those undergoing tonsillectomy, adenoidectomy, or both) were randomized into three groups. INTERVENTION: The use of polymyxin B-neomycin-hydrocortisone drops. Patients in group 1 received no antibiotic drops; group 2, a single dose intraoperatively, and group 3, an intraoperative dose followed by a 5-day course. MAIN OUTCOME MEASURE: Posttympanostomy otorrhea. RESULTS: A statistically significant decrease was observed in the incidence of posttympanostomy otorrhea between the control (16.4%) and treatment groups (group 2, 8.3%; group 3, 8.1%) (P = .011). A single dose of antibiotics was effective when patients' middle ears were dry or had serous effusions. A 5-day course was indicated for those whose ears had mucoid or purulent contents. CONCLUSIONS: Antibiotic ear drops are indicated in all patients. A single dose is as effective as a 5-day course, but our data support a longer course in certain subgroups.
Child↗
Plasminogen activator inhibitor-1 rises after hemorrhage in rats.
Large hemorrhage leads to hypercoagulability, a phenomenon that has never been well explained. Because an elevation of plasminogen activator inhibitor (PAI)-1 increases procoagulant activity, we have determined whether plasma PAI activity and tissue PAI-1 mRNA are elevated after hemorrhage. Sprague-Dawley rats were bled (20 or 15 ml/kg) 4 days after cannulation. Plasma PAI activity was determined by the capacity of plasma to inhibit tissue-type plasminogen activator activity. Changes of PAI-1 mRNA in various tissues were detected by high-performance liquid chromatography after reverse transcription and polymerase chain reaction. Hemorrhage (20 ml/kg) significantly elevated plasma PAI activity at 0.5, 1, 2, 4, 6, and 8 h after hemorrhage and PAI-1 mRNA in liver at 1, 2, 4, and 6 h after hemorrhage. The PAI-1 message was also significantly elevated in lung, heart, and kidney at 4 h after hemorrhage. The increases of PAI-1 mRNA after 20 ml/kg hemorrhage were significantly greater than those after 15 ml/kg hemorrhage. These findings indicate that large hemorrhage can induce the increases in PAI activity and PAI-1 message and suggest that induction of PAI-1 may be involved in the thrombogenic responses observed after large hemorrhage.
Animals↗
Role of intestinal fluid in restitution of blood volume and plasma protein after hemorrhage in awake rats.
To determine whether food and/or water in the gastrointestinal tract affects restitution of blood volume and plasma protein after hemorrhage, fed and 24-h-fasted awake rats received a 20 ml.kg-1 x 3 min-1 hemorrhage, and restitution of blood volume was measured by Evans blue dye and dilution of hematocrit. Restitution of blood volume and plasma protein in fed rats was complete by 2-4 h. In contrast, restitution was severely attenuated in fasted rats and was not complete by 24 h. Because initial blood volume was significantly lower in the fasted rats (55.4 +/- 1.7 vs. 64.9 +/- 2.5 ml/kg in fed), the percent blood lost during hemorrhage was significantly greater (36 vs. 31%). However, the attenuated restitution was not the result of the larger hemorrhage, as fed rats receiving a 36% hemorrhage also restored blood volume completely by 4 h. In fasted rats, complete restitution of blood volume did occur when either water or food and water were given 4 h after hemorrhage. Gastrointestinal water content fell (from 65.5 +/- 4.8 to 47.9 +/- 1.6 ml/kg) 2h after hemorrhage in fed but not in fasted rats (33.5 +/- 2.4 to 30.6 +/- 2.5 ml/kg). These data suggest that gastrointestinal fluid is essential for complete restoration of blood volume in the awake rat.
Animals↗
Changes in regional vascular resistance and blood volume after hemorrhage in fed and fasted awake rats.
To determine whether fasting alters the response of blood flow to hemorrhage, blood flow was measured by radiolabeled microspheres before and after a 20 ml.kg-1.3 min-1 hemorrhage in fed and fasted chronically cannulated male Sprague-Dawley rats. Restitution of blood volume, as determined by dilution of hematocrit, was attenuated in fasted rats, although the responses of arterial blood pressure, heart rate, cardiac output, and total peripheral resistance were not significantly different. Fasting only affected resting blood flow in the bronchial artery and fat and had no effect on resting vascular resistance in any organ studied. In both fed and fasted rats, hemorrhage led to a significant fall in blood flow to the stomach, small intestine, cecum, colon, spleen, pancreas, kidney, bronchial artery, thymus, and muscle and a rise in blood flow to the adrenals. However, fasting did not significantly alter the response of flow or vascular resistance to these organs. Fasting did alter the blood flow response to hemorrhage in bone, fat, and the hepatic artery. These results demonstrate that 24 h of fasting does not affect the responses of blood flow and vascular resistance to hemorrhage in most organs, even though restitution of blood volume is attenuated.
Animals↗
Direct extension osteomyelitis secondary to chronic onychocryptosis. Three case reports.
The podiatric physician should be alert to the possibility of underlying bony infections in cases of chronic or neglected nail infections. X-rays should be taken when drainage has been present for 4 weeks. This will rule out bony changes as well as provide assistance in following the progression, if no improvement is seen, despite treatment.
Adolescent↗
Duration of buffered lidocaine versus unbuffered lidocaine: a double-blind, randomized prospective study.
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Analysis of Variance↗
A circulating shock protein that depolarizes cells in vitro depresses myocardial contractility and rate in isolated rat hearts.
Previously, we identified the presence of a circulating shock protein (CSP) in the plasma of hemorrhaged rats that depolarizes a variety of cells in vitro. In isolated perfused rat hearts, partially purified CSP produced dose-dependent decreases in contractility and heart rate associated with an increase in coronary perfusion pressure (CPP). Electrical pacing failed to prevent the negative inotropic effects. Preventing the coronary vasoconstriction with nitroglycerin or attenuating it with a cyclooxygenase inhibitor also failed to prevent the inotropic or chronotropic effects of CSP. Carbocyclic thromboxane A2 (50ng/min) caused a similar increase in CPP to CSP but had no effect on contractility or rate during the first minute of infusion. These data indicate that the protein that appears in rat plasma after hemorrhage produces negative inotropic and chronotropic effects on the isolated heart that are independent of changes in CPP. Vasoactive arachidonic acid metabolites elicited by CSP are partially responsible for the increase in coronary vascular resistance.
Animals↗
Enhanced magnetic resonance imaging of the first metatarsal after a bunionectomy.
Unenhanced magnetic resonance imaging diagnoses osteonecrosis on the basis of loss of fatty marrow and the presence of edema. Enhanced magnetic resonance imaging, however, directly assesses marrow perfusion and allows earlier prediction of osteonecrosis after a bunionectomy.
Hallux Valgus↗
Anomalies of the branchial apparatus: a case report and review of embryology, anatomy and development.
The majority of congenital anomalies occurring in the neck are related to the development of the branchial apparatus. This area is responsible for the development of multiple structures in the head and neck and thus its anatomy and embryology are complex. Although cysts, sinuses, and fistulas of the branchial region are not common occurrences, they do present in a variety of settings and are generally easily managed if diagnosed early. A fundamental understanding of their anatomy, embryology, and presentation is needed to appropriately diagnose and manage them. These fundamentals are reviewed and a case report is used to illustrate one of the more common presentations.
Branchial Region↗
The neuroanatomy of pain.
Pain is the most frequent complaint of patients visiting all types of physicians. With pain perception, sensation is described and perceived as causing actual tissue damage. In contrast, nocioception is defined as a response specific to a potentially tissue-damaging stimuli. This articles defines the various nocioceptive pathways and connections.
Axons↗