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Biomedical subjects

S Manolidis

Publications and source records attributed to S Manolidis.

28 records · Page 2Linked to original sources
PubMed1997

Lateral skull base surgery: the otology group experience.

Lateral skull base surgery has remained the surgical frontier of new developments in the treatment of lesions heretofore difficult to access. Examination of surgical results stimulates technical innovation and provides an intervention risk-benefit ratio assessment for particular lesions useful in management planning. With this in mind, we report the updated collective experience with lateral skull base surgery at the Otology Group over the past 20 years. Two hundred ninety-eight patients underwent surgical intervention for lateral skull base lesions. In 81 patients these lesions were malignant; in 217, benign. Of the benign lesions, 165 were glomus tumors: 139 glomus jugulare, 19 glomus vagale, and 7 glomus tympanicum. The remainder comprised 21 menigniomas, 14 neuromas, two neurofibromas, and a small group of much rarer entities. The philosophy of surgical approach, results, and follow-up are discussed.

Journal Article↗
PubMed1997

Brain herniation into the middle ear and mastoid: concepts in diagnosis and surgical management.

OBJECTIVE: To review the occurrence characteristics of and clinical repair experience with brain herniation in to the middle ear and mastoid from 1970-1995. STUDY DESIGN: Retrospective chart/case review. SETTING: Private Otology/Neurotology referral practice. PATIENTS: Thirty-five patients with temporal bone brain herniation diagnosed and treated from 1970-1995. INTERVENTION: Diagnosis confirmed by CT and/or MRI. Treatment was surgical. MAIN OUTCOME MEASURES: Success of surgical repair of the problem in a large experience with follow-up of up to 180 months (mean, 48.7 months). RESULTS: Diagnosis is most effectively made by both (computed tomography (CT) and magnetic resonance imaging (MRI). In this series diagnosis was accurate in 89% with MRI. Primary repair was successful in all but three patients, two of whom required a second repair. One was unreconstructable. CONCLUSIONS: Temporal bone encephaloceles occur after ear surgery and in chronic otitis media. Prompt and effective surgical repair is successful and integral to complication avoidance.

Adult↗
PubMed1997

Management of acoustic neuroma in the elderly population.

OBJECTIVE: Ongoing controversy regarding the optimal treatment of acoustic neuromas in the elderly population has prompted us to examine the our experience in order to arrive at a treatment algorithm. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: The records of 48 elderly patients ranging from age 70 to 90 years with acoustic tumors were reviewed. INTERVENTIONS: In 34 cases, tumor size was followed through serial imaging for a mean 28.5 months (range 5-108 months). Eight of these patients subsequently required surgery for significant tumor growth. An additional 12 patients were managed surgically from the time of diagnosis. MAIN OUTCOME MEASURE: The natural history of acoustic neuromas in the elderly population. RESULTS: The mean tumor growth rate for the watched group was 0.29 cm/y. Fifteen patients demonstrated no growth whereas accelerated growth was noted in eight cases. Ten patients with tumors confined to the internal auditory canal demonstrated an average growth rate of only 0.06 cm/y over a mean interval of 38 months. For the surgically treated group, the mean tumor size at the time of resection was 2.8 cm. Resection was described as complete in 17 cases and near-total in three cases. Perioperative complication rates and facial nerve results were comparable to our figures for all age groups. There was one perioperative death. CONCLUSIONS: Elderly patients with small acoustic neuromas should be offered a trial of observation. When significant tumor growth, size, or neurologic deterioration are demonstrated, early surgical intervention is required to avoid complications associated with the removal of larger tumors.

Abdomen↗
PubMed1996

Pediatric neurotologic skull base surgery.

The objectives of neurotologic skull base surgery are complete resection of the lesion and high-grade function following surgery. There is a perception that these goals are more difficult to achieve in children than in adults. Skull base disease in children and adolescents is rare. Of the 292 skull base tumors treated from 1970 to 1995 by The Otology Group in Nashville, 15 were in patients 21 years of age or younger, with only 5 patients under 10 years old. In this retrospective study, the authors review these 15 cases and compare them to their adult series. The pathology encountered in the 15 young patients with skull base tumors included 8 glomus lesions and 4 schwannomas. In these patients, 13 tumors occurred sporadically, and 2 tumors were related to neurofibromatosis type 2. Advanced-stage disease and malignancy were prevalent in this younger patient group. All patients underwent excision of their skull base tumor, with one procedure considered a subtotal resection. As compared with an adult glomus tumor series, postoperative cranial nerve function and complication rates were generally worse in the young glomus patients. However, postoperative function and complications were consistent with the extensive procedures required for the treatment of advanced disease. Despite the advances that have been made in imaging and treatment modalities, this study illustrates the need for more timely diagnosis in younger patients with skull base tumors.

Adolescent↗
PubMed1995

Adenoid cystic carcinoma of the head and neck: a clinicopathologic study of 37 cases.

The records of 37 patients with histopathologically confirmed adenoid cystic carcinoma, who presented to McGill University's Department of Otolaryngology between 1956 and 1990, were reviewed to determine factors influencing local failure, distant metastases, and survival. Of the 37 cases, 12 developed local recurrences. Local failure was seen an average of 3.5 years following initial treatment, 62% of which were seen prior to 2 years. No statistically significant advantage was found for the use of postoperative radiotherapy in the prevention of local recurrences. Thirteen cases presented with or subsequently developed distant metastases. The mean interval between initial treatment and the appearance of distant disease was 8.1 years. A comparison of survival in patients with negative versus positive surgical margins was carried out. Survival at 15 years with negative margins remained 100%, while with positive margins, only 35% survived. Disease-free survival with negative and positive margins at 10 years was 80% and 31.1%, respectively. The effect of positive margins on survival was statistically significant with a p values between .01 and .001. The aim of this study was to demonstrate the importance of negative surgical margins with regard to survival. The results suggest that negative margins at initial resection significantly improve long-term disease-free survival.

Actuarial Analysis↗
PubMed1993

Mycobacterial infections of the head and neck.

Despite the decline of pulmonary tuberculosis in the Western world, the incidence of cervical mycobacterial infections has remained relatively unaffected. A retrospective review was conducted of 20 patients treated for head and neck tuberculosis from 1984 to 1991. They were mostly an immigrant group coming from underdeveloped countries close to the equator. All cases were treated with antituberculous chemotherapy; 18 patients also underwent surgical excision of their lymphadenopathy. Sixteen patients showed complete response to combined treatment and one relapse was successfully retreated with antituberculous medication. Three patients died from unrelated causes--two from human immunodeficiency virus infection and one from nasopharyngeal carcinoma. The most reliable indicator of mycobacterial infection was the pathologic specimen, making the need for surgical intervention an important diagnostic consideration. As with other reports, most patients in our series had negative chest x-ray films, variable responses to skin testing, and negative cultures. The epidemiology, pathogenesis, and management of this disease are discussed.

Adult↗
PubMed1991

Ultrastructural changes of stapedius muscle and stapedius branch nerve endings in otosclerotic patients.

We studied in the electron microscope 12 stapedius muscles and stapedius branches of the facial nerve excised from otosclerotic patients who underwent stapedectomy for hearing restoration. Almost all of the stapedius, muscles demonstrated morphological alterations, such as accumulation of lipids and osmiophilic material, dilatation of the sarcoplasmic reticulum, sarcoplasmic invaginations of the nuclei and accumulation of fibroblasts and satellite cells on the surface of the muscle fibers. The stapedius branch of the facial nerve demonstrated a marked loss of myelinated fibers. Most of the unmyelinated or demyelinated fibers were surrounded by thick processes of the Schwann cell. The axons showed a paucity of neurofilaments and the nerve endings showed a rough dilatation of the cisternae of the smooth endoplasmic reticulum as well as accumulation of osmiophilic material. The morphological alterations of the stapedius muscle and the stapedius branch of the facial nerve in otosclerosis suggest that in addition to the lesions of the bone at various areas of predilaction, a substantial pathological alteration of the muscle and nerve fibers also occurs in the middle ear adjacent or distal to otosclerotic foci, a fact that enlarges the concept of the pathological spectrum of the disease.

Facial Nerve↗
PubMed1990

Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial.

Percutaneous tracheostomy is increasingly being used for patients needing prolonged ventilatory support. The purpose of this study was to assess the feasibility of widespread application of endoscopic guided percutaneous tracheostomy. Sixty-one consecutive ICU patients requiring prolonged mechanical ventilation underwent bedside endoscopic guided percutaneous tracheostomy. Using a modified Ciaglia technique, a #6-10 tracheostomy tube was introduced between the second and third tracheal rings. Bronchoscopic transillumination facilitated identification of the appropriate tracheostomy site, and verified satisfactory placement of dilators and tracheostomy tube. There was one procedure-related death due to arrhythmia. Procedure-related complications included (n = 7): bleeding (controlled with local pressure), two infections, two cuff tears, and two obstructions of the tracheal tube. The tracheostomy was eventually removed in 13 patients. Bronchoscopic evaluation of three patients at 4 months post-tracheostomy removal was normal and there has been no clinical evidence suggestive of tracheal stenosis in the remaining ten extubated patients. There was a 50% reduction in cost when compared to operative tracheostomy. Percutaneous tracheostomy is a simple, safe, cost-effective bedside procedure for critically ill ventilator-dependent patients. Endoscopic guidance appears to increase the safety of this procedure and may prevent complications of pneumothorax, subcutaneous emphysema, and paratracheal false passage previously reported with blinded percutaneous methods.

Adult↗
PubMedDate not supplied

Substance P in the acoustic area of the cortex during neuronal development and maturation.

Substance P has been proved an important neurotransmitter and neuromodulator, serving not only as an excitatory transmitter of the first afferent synapse of pain pathways but as a valuable neuromodulator in the primary cortical areas of sensosensorial integration. In the human acoustic cortex, substance P has been found in the presynaptic terminals as well as in the cell bodies of numerous polyhedral, triangular and bipolar neurons. Using histochemical techniques, we found recently that substance P is first accumulated in the neuronal elements of the human acoustic cortex in 18-gestational-week (GW) fetuses. Most of substance P is distributed in the neurons of the 3rd and 4th cortical layers, mainly in the cell bodies, the initial part of the axons and the axonic terminals. In 24-GW fetuses, substance P is found in the 2nd cortical area inside the cell body of the granular and bipolar neurons. In 28-GW fetuses, substance P is found in the pre- and postsynaptic terminals. We would suggest that substance P is accumulated increasingly as a function of the neuronal maturity of the primary acoustic cortical area, serving mainly as a neuromodulator.

Auditory Cortex↗