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At least 235 records · Page 13Linked to original sources
PubMed2003

The role of midfacial degloving approach for maxillary cysts and tumors.

PURPOSE: The midfacial degloving approach has been used as a surgical approach to gain access to regions of the midface that would otherwise require external incisions. This article describes the role of this technique for various maxillary lesions. PATIENTS AND METHODS: Thirteen patients underwent the midfacial degloving technique for 8 maxillary benign lesions and 5 malignant lesions. This procedure uses 4 basic incisions: 1) sublabial incision, 2) bilateral intercartilaginous incisions, 3) septocolumellar-complete transfixion incisions, and 4) bilateral piriform aperture incisions extending to the vestibule. RESULTS: All patients successfully underwent the planned procedures after the midfacial degloving technique for the treatment of benign or malignant lesions without significant complications. Postoperative sequelae were nasal crusting and infraorbital hypesthesia, both of which resolved. CONCLUSIONS: The midfacial degloving approach offers good exposure of the mid third of the face with excellent cosmetic results. This approach may be combined with downfracture of the maxilla for access to expose and resect sinonasal malignancies. The midfacial degloving technique is a viable procedure with low morbidity and excellent cosmetic outcomes.

Adolescent↗
PubMed2005

Thalamic thermo-algesic transmission: ventral posterior (VP) complex versus VMpo in the light of a thalamic infarct with central pain.

The respective roles of the ventral posterior complex (VP) and of the more recently described VMpo (posterior part of the ventral medial nucleus) as thalamic relays for pain and temperature pathways have recently been the subject of controversy. Data we obtained in one patient after a limited left thalamic infarct bring some new insights into this debate. This patient presented sudden right-sided hypesthesia for both lemniscal (touch, vibration, joint position) and spinothalamic (pain and temperature) modalities. He subsequently developed right-sided central pain with allodynia. Projection of 3D magnetic resonance images onto a human thalamic atlas revealed a lesion involving the anterior two thirds of the ventral posterior lateral nucleus (VPL) and, to a lesser extent, the ventral posterior medial (VPM) and inferior (VPI) nuclei. Conversely, the lesion did not extend posterior and ventral enough to concern the putative location of the spinothalamic-afferented nucleus VMpo. Neurophysiological studies showed a marked reduction (67%) of cortical responses depending on dorsal column-lemniscal transmission, while spinothalamic-specific, CO2-laser induced cortical responses were only moderately attenuated (33%). Our results show that the VP is definitely involved in thermo-algesic transmission in man, and that its selective lesion can lead to central pain. However, results also suggest that much of the spino-thalamo-cortical volley elicited by painful heat stimuli does not transit through VP, supporting the hypothesis that a non-VP locus lying more posteriorly in the human thalamus is important for thermo-algesic transmission.

Brain Infarction↗
PubMed2004

Spontaneous cervical epidural hematoma: case report and literature review.

BACKGROUND: Spontaneously occurring epidural hematomas for which no etiology is identified are rare phenomenon. These are often neurosurgical emergencies; therefore, prompt diagnosis and treatment are paramount. Because of the rarity of this condition, we have illustrated in this recent case its presentation, evaluation and management. METHODS: A 63-year-old male presented to our emergency room with right-sided hemiparesis and contralateral hypesthesia, consistent with a C5 Brown-Séquard syndrome. An initial evaluation for cerebral infarction was unremarkable, including a negative brain magnetic resonance image. Further imaging revealed a cervical epidural hematoma of unknown etiology. RESULTS: The patient underwent emergent laminectomy for decompression and evacuation of the hematoma within 24 hours of his presentation to the emergency room. The patient's symptoms improved remarkably after surgery and a 4-month follow-up imaging evaluation revealed no recurrence of his hematoma. CONCLUSION: This report highlights the various presentations, evaluation, and management options for this rare diagnosis. It emphasizes the necessity of prompt diagnosis for possible emergent intervention.

Aged↗
PubMed1987

Specular microscopy of corneal epithelium after epikeratophakia.

We studied the characteristics of the corneal epithelium by specular microscopy in 12 eyes of 11 patients, at three, six, and 16 months after epikeratophakia surgery. We found attenuation of cells; irregular shape; decreased density; loss of differentiation into dark and light cells and into small, medium, and large cells; and poor interdigitation between adjacent cells. Corneal hypesthesia noted in these grafts may contribute to the aberrant epithelial characteristics.

Adult↗
PubMed1999

Indications for and results of surgical therapy for male gynecomastia.

BACKGROUND: The objective of our study was to analyze factors determining diagnostic versus cosmetic indication and postoperative results in the treatment of gynecomastia. PATIENTS AND METHODS: Data from 100 patients and 141 breasts were analyzed retrospectively, and reevaluated by questionnaire (n = 81) and clinical examination (n = 33). Except for 2 patients, all underwent subcutaneous mastectomy through various incisions. RESULTS: Diagnostic surgery was exclusively performed in unilateral, nodular gynecomastia being preferentially of grade I. Higher grade, bilateral gynecomastia led mainly to cosmetic surgery. Minor complications (skin retraction, hypertrophic scars, hypesthesia, skin redundancy) occurred in 53% of patients and significantly more often in grade III or II gynecomastia. Each incision was preferentially associated with specific sequelae. However, 86% of patients were satisfied with surgical results. CONCLUSIONS: Laterality, consistency, grade, and age at onset of symptoms determine surgical indication. Despite the high number of sequelae due to preoperative grade and selected incision, most patients are satisfied with postoperative results.

Adult↗
PubMed1999

Positive symptoms in multiple sclerosis: their treatment with sodium channel blockers, lidocaine and mexiletine.

Patients with multiple sclerosis (MS) often show positive symptoms of painful tonic seizure and dysesthesia as well as negative symptoms of paralysis and hypesthesia. Positive manifestation is paroxysmal and/or persistent. These are considered to be mediated by ectopic impulses generated at the site of demyelination, whereas negative symptoms are caused by conduction block. Conduction block at a demyelinated segment should reduce positive symptoms, but worsen negative ones. As reported previously, lidocaine, an Na channel blocker unmasks silent negative symptoms presumably by further reducing the action current in demyelinated portions and blocking conduction. Furthermore, because it blocks Na channels in a voltage- and frequency dependent manner, fibers that mediate positive symptoms are preferentially blocked. We administered lidocaine to 30 MS patients with positive symptoms. Lidocaine (mean plasma level, 2.4 pg/ml) almost completely abolished the paroxysmal manifestation of painful tonic seizures, neuralgic attacks, paroxysmal itching, and Lhermitte's sign. It also markedly alleviated persistent symptoms, but less so than paroxysmal symptoms. Similar effects were obtained with orally-administered mexiletine (300-400 mg/day), a derivative of lidocaine, but to a lesser extent. Na channel blockers have a dual effect on symptoms in MS, depending on whether symptoms are positive or negative. The mechanism that produces positive symptoms and the effects of the drugs on these symptoms are discussed.

Adult↗
PubMed2000

Surgical treatment of a massive chondrosarcoma in the skull base associated with Maffucci's syndrome: a case report.

BACKGROUND: A successfully treated massive chondrosarcoma in the skull base associated with Maffucci's syndrome is presented. The purpose of this report is to discuss the surgical approach to the tumor and reconstruction of the skull base. CASE DESCRIPTION: A 36-year-old woman who had a history of multiple enchondromas and subcutaneous hemangiomas presented with decreased right visual acuity and left papilledema. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a mass in the skull base. The tumor occupied the nasal and paranasal cavities, and extended to the anterior, middle, and posterior intracranial spaces. The midline skull base structures and the left middle cranial base were destroyed. Using a combined anterior craniofacial and left orbitozygomatic approach, the tumor was totally resected. The large skull base defect was reconstructed with a vascularized outer table parietal bone graft attached to a bipedicled temporoparietal galeal flap. The postoperative course was uneventful except for decreased left visual acuity, and temporary diplopia and facial hypesthesia. In 40 months of follow-up there was no recurrence. CONCLUSIONSA skull base approach should be selected to perform total resection of an extensive skull base tumor. The bipedicled temporoparietal galeal flap and vascularized calvarial bone was useful for simultaneous reconstruction.

Adult↗
PubMed2002

A case of ruptured aneurysm associated with spinal arteriovenous malformation presenting with hematomyelia: case report.

BACKGROUND: Spinal cord arteriovenous malformation (AVM) associated with spinal aneurysm is not particularly rare, but cases presenting with hematomyelia are relatively rare compared to those with subarachnoid hemorrhage (SAH). We report a rare case of successfully treated spinal AVM associated with ruptured aneurysm presenting with hematomyelia. CASE DESCRIPTION: A 52-year-old male was admitted to our hospital with sudden onset of tetraplegia, respiratory disturbance, and superficial sensory disturbance. Computed tomography revealed hematomyelia at the level of C3-4. Gadolinium-enhanced magnetic resonance imaging showed small, enhanced lesions. Angiography revealed an intradural perimedullary arteriovenous malformation associated with two aneurysms on the feeding arteries. Administration of high-dose methylprednisolone gradually ameliorated his symptoms. Direct surgical obliteration was performed on the 30th day after the onset. The bilateral C3 cervical radicular arteries and the nidus were coagulated. Angiography performed after surgery showed neither the aneurysms nor the nidus. He was discharged with only mild weakness in the left upper extremity and mild left hypesthesia 3 months after surgery, and was fully independent. CONCLUSION: We report a case of hematomyelia caused by ruptured aneurysm associated with spinal arteriovenous malformation that was successfully treated with surgical obliteration.

Aneurysm, Ruptured↗
PubMed1999

Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease.

BACKGROUND: In Taiwan, from April to July, 1998, an epidemic of hand, foot, and mouth disease associated with enterovirus 71 (EV71) occurred with fatal complications. We did a clinical study of EV71-related diseases in Taiwan. METHODS: We studied 154 children with virus-culture confirmed EV71 infection. Children were divided into three groups: 11 patients with pulmonary oedema; 38 patients with central nervous system (CNS) involvement and no pulmonary oedema; and 105 children without complications. We compared the clinical features, laboratory findings, risk factors, and outcome among these three groups. FINDINGS: Nine children with pulmonary oedema had hand, foot, and mouth disease, one had herpangina, and one had febrile illness with eight children with limb weakness and one with limb hypesthesia. All children had had sudden onset of tachycardia, tachypnoea, and cyanosis 1-3 days after onset of the disease. Nine of 11 children died within 12 h of intubation; one child was braindead within 15 h and died 17 days after intubation; one child was in deep coma and died 3 months later. In children with CNS complication and no pulmonary oedema, one child died of pneumonia after 4 months of ventilator support and four children had sequelae. All 105 children without complications recovered. There was a significant association between CNS involvement and pulmonary oedema (odds ratio 12.4 [95% CI 2.6-60.1], p=0.001). Risk factors for pulmonary oedema after CNS involvement were hyperglycaemia, leucocytosis, and limb weakness. Hyperglycaemia was the most significant prognostic factor for pulmonary oedema (odds ratio 21.5 [3-159], p=0.003). INTERPRETATION: EV71 can cause hand, foot, and mouth disease, CNS involvement with severe sequelae, and fatal pulmonary oedema. Hyperglycaemia is the most important prognostic factor.

Adolescent↗
PubMed1999

Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation.

OBJECTIVE: To describe the nonsurgical treatment of acute S1 radiculopathy from a large (12 x 12 x 13 mm) L5-S1 disk herniation. CLINICAL FEATURES: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. His symptoms began 5 days before the initial visit and progressed despite nonsteroidal anti-inflammatory drugs and analgesic medication. An absent left Achilles reflex, left S1 dermatome hypesthesia, and left gastrocnemius/soleus weakness was noted. Magnetic resonance imaging demonstrated a large L5-S1 disk herniation. INTERVENTION AND OUTCOME: Initial treatment of this patient included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy. Counseling was provided to reduce abnormal illness behavior risk. Later, flexion distraction and side-posture manipulation were provided to improve joint function. Sensory motor training, trunk stabilization exercises, and trigger point therapy were also used. He returned to modified work 27 days after symptom onset. A follow-up, comparative magnetic resonance imaging (MRI) study was unchanged. He was discharged as symptomatic (zero rating on both the Oswestry and numerical pain scales) after 50 days and 20 visits, although the left S1 reflex remained absent. Reassessment 169 days later revealed neither significant symptoms nor lifestyle restrictions. CONCLUSION: This case demonstrates the potential benefit of a chiropractic rehabilitation strategy by use of multimodal therapy for lumbar radiculopathy associated with disk herniation.

Adult↗
PubMed2002

Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis.

PURPOSE: To assess the quality of information in the literature and suggest guidelines for repair of isolated orbital floor fractures. CLINICAL RELEVANCE: Orbital floor fractures are a common result of orbital injury. Enophthalmos, diplopia resulting from extraocular muscle dysfunction, and infraorbital nerve hypesthesia may occur. The indications and timing for fracture repair are still controversial. LITERATURE REVIEWED: A MEDLINE literature review was performed using PubMed. Articles published from 1983 to the present were retrieved using the key words, "orbital floor fracture, orbital trap-door fracture, and orbital blow-out fracture." Suggested indications and timing for repair of isolated orbital floor fractures were extracted from selected articles. Each recommendation was rated according to its importance in the care process and strength of evidence supporting the given recommendation. RESULTS: No prospective randomized clinical trials on the treatment of orbital floor fractures have been performed. Despite this, most recommendations were rated as most important to patient care (A) and had strong support for treatment (level I). CONCLUSIONS: The timing and treatment indications for orbital floor fractures are evolving. Nonresolving oculocardiac reflex, the "white-eyed" blowout fracture, and early enophthalmos or hypoglobus are indications for immediate surgical repair. Surgery within 2 weeks is recommended in cases of symptomatic diplopia with positive forced ductions and evidence of orbital soft tissue entrapment on computed tomography examination or large orbital floor fractures that may cause latent enophthalmos or hypo-ophthalmos.

Diplopia↗
PubMed1983

Corneal sensitivity after epikeratophakia.

Corneal sensitivity was tested in 60 eyes of 30 patients who underwent unilateral epikeratophakia for the correction of aphakia (20 patients) or keratoconus (10 patients). Postoperative recovery time ranged from 2 months to 21 months (mean: 10 months). Our results indicate a relative hypesthesia of the epikeratophakia lenticule when compared with the peripheral host cornea and contralateral control cornea. However, corneal sensitivity tested in 11 patients with more than 1 year follow-up was increased compared with the sensitivity of 19 patients whose postoperative recovery was less than 1 year. Histopathologic findings in two lenticules from a nonhuman primate demonstrated sparse epithelial axon terminals. Host corneal nerves appear to innervate the lenticules by intraepithelial extension and by penetration of the superficial keratectomy scar.

Animals↗
PubMed1988

Late bacterial and fungal keratitis after corneal transplantation. Spectrum of pathogens, graft survival, and visual prognosis.

The authors reviewed 108 bacterial and fungal corneal ulcers that developed 1 to 72 months after penetrating keratoplasty in 79 eyes of 78 patients. Graft hypesthesia, topical corticosteroid and antibiotic treatment, exposed sutures, epithelial defects, and poor visual acuity commonly predated infectious keratitis. There were 69 bacterial, 34 fungal, and 5 combined infections. Candida albicans and Staphylococcus epidermidis were the most common pathogens. Follow-up after infection averaged 23 months (range, 1-80 months). Despite hospitalization and fortified topical antibiotic treatment, complications such as wound dehiscence and corneal perforation necessitated emergency regraft in 38 (35%) cases. Of 73 previously clear grafts, only 29 (40%) retained clarity. Median visual acuity, 20/200 before infection, fell to counting fingers at last follow-up; 12 eyes lost light perception.

Adolescent↗
PubMed1997

Ocular and orbital trauma from water balloon slingshots. A clinical, epidemiologic, and experimental study.

PURPOSE: The authors report the findings of 17 patients with ophthalmic injuries produced by launched water balloons; they determine water balloon kinetic energies in experimental and theoretical studies. METHODS: Six case summaries are presented; one case report was retrieved from the literature; ten injuries were reported to the Consumer Product Safety Commission. Energies were determined by field trials and calculations. RESULTS: Injuries included periorbital edema and ecchymoses, orbital contusions and hematomas, maxillary sinus hematomas, facial hypesthesia, eyelid lacerations, subconjunctival hemorrhages, corneal edema and abrasions, hyphemas, traumatic iritis, iris sphincter ruptures, iris atrophy, angle recession, iridodialysis, traumatic cataract, vitreous hemorrhages, retinal hemorrhages, macular hole formation, optic atrophy, and bony orbital wall fractures. Epidemiologic analysis revealed that children and young adults, more often males, were injured, most commonly in the warm weather months. In field trials, maximum water balloon velocities ranged from 38 to 41 m/sec (85-92 mph) with kinetic energies from 176 to 245 joules; by calculation, maximum velocities ranged from 42 to 54 m/sec (95-121 mph) with kinetic energies from 141 to 232 joules. In a field demonstration, a slingshot-launched water balloon exploded a watermelon. CONCLUSION: Energies are comparable to or greater than those experienced with a variety of common objects, including some rifle bullets that are known to cause serious ophthalmic injuries. These energies are far in excess of those required to perforate a cornea, rupture a globe, or fracture the bony orbit. This study demonstrates the serious and potentially vision- and life-threatening injuries inflicted by these "toys."

Adolescent↗
PubMed1999

The long lasting effects of peripheral nerve blocks for trigeminal neuralgia using high concentration of tetracaine dissolved in bupivacaine.

The management of trigeminal neuralgia in older patients who do not want neurolytic block and/or surgical treatment may be problematic. This paper describes three patients who had first and/or second division trigeminal neuralgia. The analgesic effects of infraorbital nerve block using 0.5% bupivacaine or 1% mepivacaine dissipated within a few days, however, the effects of nerve blocks using 4% tetracaine dissolved in 0.5% bupivacaine continued for more than 3 months. Hypesthesia was observed in two patients within a week following the block, but sensory level returned to normal within 2 weeks and there were no further complications in any patient.

Aged↗
PubMed2002

Proton beam stereotactic radiosurgery of vestibular schwannomas.

PURPOSE: The proton beam's Bragg peak permits highly conformal radiation of skull base tumors. This study, prompted by reports of transient (30% each) and permanent (10% each) facial and trigeminal neuropathy after stereotactic radiosurgery of vestibular schwannomas with marginal doses of 16-20 Gy, assessed whether proton beam radiosurgery using a marginal dose of only 12 Gy could control vestibular schwannomas while causing less neuropathy. METHODS AND MATERIALS: Sixty-eight patients (mean age 67 years) were treated between 1992 and 1998. The mean tumor volume was 2.49 cm(3). The dose to the tumor margin (70% isodose line) was 12 Gy. The prospectively specified follow-up consisted of neurologic evaluation and MRI at 6, 12, 24, and 36 months. RESULTS: After a mean clinical follow-up of 44 months and imaging follow-up of 34 months in 64 patients, 35 tumors (54.7%) were smaller and 25 (39.1%) were unchanged (tumor control rate 94%; actuarial control rate 94% at 2 years and 84% at 5 years). Three tumors enlarged: one shrank after repeated radiosurgery, one remained enlarged at the time of unrelated death, and one had not been imaged for 4 years in a patient who remained asymptomatic at last follow-up. Intratumoral hemorrhage into one stable tumor required craniotomy that proved successful. Thus, 97% of tumors required no additional treatment. Three patients (4.7%) underwent shunting for hydrocephalus evident as increased ataxia. Of 6 patients with functional hearing ipsilaterally, 1 improved, 1 was unchanged, and 4 progressively lost hearing. Cranial neuropathies were infrequent: persistent facial hypesthesia (2 new, 1 exacerbated; 4.7%); intermittent facial paresthesias (5 new, 1 exacerbated; 9.4%); persistent facial weakness (2 new, 1 exacerbated; 4.7%) requiring oculoplasty; transient partial facial weakness (5 new, 1 exacerbated; 9.4%), and synkinesis (5 new, 1 exacerbated; 9.4%). CONCLUSION: Proton beam stereotactic radiosurgery of vestibular schwannomas at the doses used in this study controls tumor growth with relatively few complications.

Adult↗
PubMed2002

Direct mini-incision thyroidectomy.

We recently developed a new surgical technique for carrying out thyroidectomy, to minimize surgical invasiveness and improve the cosmetic result. Our procedure differs from conventional thyroidectomy in requiring a 3-cm skin incision and no raising of the skin flap. Since this technique decreased tissue trauma by obviating unnecessary neck exploration, hypesthesia or paresthesia in the neck and discomfort while swallowing, related to a large skin incision and raising of the skin flap, are minimized. Since thyroidectomy is performed after delivering the thyroid gland through the small skin incision, sufficient exposure for dissection of the pretracheal and paratracheal space can be obtained. Therefore, injuring the recurrent laryngeal nerve and the parathyroid gland can be avoided. Although the number of patients that we have treated in this manner is still small, we believe that our new procedure constitutes a useful surgical treatment for patients with thyroid disease.

Adult↗