The management of midline transcranial nasal dermoid sinus cysts

The most common congenital midline nasal masses are nasal dermoid sinus cysts (NDSC) [Hughes GB, Sharpino G, Hunt W, Tucker HM. Management of the congenital midline nasal mass—a review. Head Neck Surg 1980;2:222–33.¹]. Their clinical importance hinges on their potential to communicate with the central nervous system. Preoperative diagnosis of an intracranial extension allows for referral to a craniofacial team with the appropriate skills and experience for a transcranial approach. All patients with a NDSC require imaging with high resolution multiplanar MRI scans and complimentary fine cut CT scan to reveal the anatomical extent of the tract and its relationship to the anterior cranial fossa.A single-stage craniofacial approach to resection of midline NDSC extending to the anterior cranial base is effective with minimal morbidity [Yavuzer R, Bier U, Jackson IT. Be careful: it might be a nasal dermoid cyst. Plast Reconstr Surg 1999;103:2082–3; Denoyelle F, Ducroz V, Roger G, Garabedian EN. Nasal dermoid sinus cysts in children. Laryngoscope 1997;107:795–800; Rohrich RJ, Lowe JB, Schwartz MR. The role of open rhinoplasty in the management of nasal dermoid cysts. Plast Reconstr Surg 1999;104:2163–70; Rahbar R, Shah P, Mulliken JB, et al. The presentation and management of nasal dermoid—a 30-year experience. Arch Otolaryngol Head Neck Surg 2003;129:464–71; Posnick JC, Bortoluzzi P, Armstrong DC, Drake JM. Intracranial nasal dermoid sinus cysts: computed tomographic scan findings and surgical results. Plast Reconstr Surg 1994;93:745–54 [discussion 755–56]; Bartlett SP, Lin KY, Grossman R, Kratowitz J. The surgical management of orbitofacial dermoids in the pediatric patient. Plast Reconstr Surg 1993;91:1208–15. ^{[2] , [3] , [7] , [9] , [11] and [18]} ]. The cyst and tract are accessed through a combination of a nasal and transcranial approach. This allows visualisation and dissection of the tract with only a small incision on the nasal dorsum to include the cutaneous punctum when present. Transnasal endoscopic techniques have been advocated where the dermoid is located within the nasal cavity and there is little or no cutaneous involvement [Weiss DD, Robson CD, Mulliken JB. Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 1998;101:2119–23.²⁶].We present a review of five cases referred to our unit between 1999 and 2004 with a diagnosis of a midline nasal dermoid sinus cyst and radiological evidence of intracranial communication. All cases had a communication with the anterior cranial fossa diagnosed preoperatively and were treated surgically with a craniofacial approach. An intracranial extension was identified at operation in each case and this was confirmed on histopathology. The only significant complication resulted from an early postoperative infection, requiring re-operation. There were no recurrences and acceptable aesthetic outcomes have been observed in all cases.     

The Leeuwenhoek Lecture, 1997. Marek's disease herpesvirus: oncogenesis and prevention

There are a number of neoplasias for which a herpesvirus is an essential part of the aetiology. Of these, Marek's disease is the most common and provides excellent opportunities for the study of a herpesvirus-induced tumour both experimentally and under natural conditions in the field. Marek's disease is caused by an alpha herpesvirus; it differs from the other oncogenic herpesviruses which are gamma herpesviruses. It is a ubiquitous virus in poultry populations of the world and is highly cell-associated and contagious, yet only a proportion of infected fowl develop tumours. Evidence is presented to suggest that at least one of the reasons for a wide variation in the incidence of the disease is a temporal interplay between virulent viruses and viruses of low or no virulence. The viral genes associated with the oncogenicity of Marek's disease virus (MDV) are discussed and it is concluded that it is likely that several genes are involved. Finally, a brief history of vaccination to control Marek's disease is given and mode of action discussed. It is concluded that the mechanism of protection is mainly through an antiviral cell mediated immune response, resulting in a lowered challenge virus burden. Marek's disease viruses over the past 40 years have been evolving greater oncogenicity, some of which are not adequately controlled by the vaccines that are currently available. It is suggested that for MDV to produce tumours, there is a need for the cytolytic infection phase and that infection must be with an MDV which possesses a functional gC, ICP4 for maintaining latency which allows the expression of at least the 1.8 kb family, pp38, meq, and possibly pp14 genes, for maintaining the tumour state and possibly initiating this state. Intervention in this process reduces the chance of tumour formation and incidence in a population which can occur through natural or man-mediated infection with non-pathogenic MDVs.     

Intracranial epidermoid and dermoid cysts. Results of microneurosurgery

A number of radon-related properties have been surveyed in underground shopping centers in Hong Kong. These parameters include the radon concentration, the total potential alpha energy concentration of radon progeny, the equilibrium factor and the unattached fraction of radon progeny. The mean values recorded for these were 29.2 +/- 7.8 Bq/m3, 3.60 +/- 1.53 mWL, 0.46 +/- 0.16 and 0.05 +/- 0.03, respectively. Based on these figures, we have calculated the average radon dose received by employees in an underground shopping center in Hong Kong to be 0.22 mSv/yr, which represents an approximate increase of 8% over the total dose of about 2.7 mSv/yr received by the average person in Hong Kong.     

The 1997 Schering Lecture. Quality of life in oncology: nurses' perceptions, values and behaviours

Quality of life is an important dimension of cancer care. Yet, within our current environment of fiscal restraint, restructuring and cancer care system reform, pressures exist which may make it difficult to provide care which attends to issues of quality of life. Oncology nurses are key providers of cancer care and their perspectives on quality of life for cancer patients are very important. In addition, much of the satisfaction oncology nurses experience in their practice emerges from matters related to attending to quality of life issues. Are oncology nurses currently able to incorporate quality of life issues into their daily care of patients? How are they doing so? The purpose of this qualitative study is to identify major themes and dimensions of nurses' perceptions and values related to quality of life and create a profile of the oncology nurse's role in integrating quality of life in nursing practice. A total of 25 oncology nurses in regional cancer centres across Ontario were interviewed. Each semistructured interview was taperecorded and transcribed. Analysis was completed to identify the major themes and dimensions. This presentation will report the findings from the study and will focus on understanding the existing values oncology nurses hold surrounding quality of life, how quality of life is conceptualized, and the patterns of practice and decision-making regarding quality of life.     

Pathology of MEN-1: morphology, clinicopathologic correlations and tumour development

Augmentation therapy is used for those situations where a patient's depression is either treatment-resistant, or partially and/or insufficiently responsive to treatment. It also may be used to attempt to induce a more rapid treatment response. Using drugs together may increase the risk of adverse effects, through potentiation of existing adverse effects or alterations in plasma concentrations of the drug. It is important that clinicians are aware of potential risks of augmentation therapy. Lithium augmentation of a tricyclic antidepressant is relatively well tolerated and the dangers are no greater than using these medications on their own. There are also no reports of serious adverse events when lithium is added to a monoamine oxidase inhibitor. With lithium augmentation of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) therapy there have been case reports of the development of a central serotonin syndrome, and thus caution must exercised. A serious concern when using a tricyclic antidepressant to augment an SSRI is the effect of the SSRI on the cytochrome P450 system and the resulting significant increase in tricyclic antidepressant blood concentrations. Augmentation with thyroid hormones appears to be well tolerated and effective. Case reports and open studies indicate that augmentation with buspirone and the psychostimulants, carbamazepine and valproic acid (valproate sodium) is effective and results in minimal adverse effects. However, there is no empirical evidence supporting these results. Recent work supports the tolerability and efficacy of pindolol augmentation. Considerable caution should be exercised when combining psychotropic drugs. The practitioner should only do so with a full knowledge of the compounds involved and their pharmacological properties.     

Toynbee Memorial Lecture 1997. Middle ear mechanics in normal, diseased and reconstructed ears

A review of the structure-function relationships in normal, diseased and reconstructed middle ears is presented. Variables used to describe the system are sound pressure, volume velocity and acoustic impedance. We discuss the following: (1) Sound can be transmitted from the ear canal to the cochlea via two mechanisms: the tympanoossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). In the normal ear, middle-ear pressure gain, which is the result of ossicular coupling, is frequency-dependent and smaller than generally believed. Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears. (2) The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapes-cochlear input impedance are compromised. Such analyses are used to explain the air-bone gaps associated with lesions such as ossicular interruption, ossicular fixation and tympanic membrane perforation. (3) With type IV and V tympanoplasty, hearing is determined solely by acoustic coupling. A quantitative analysis of structure-function relationships can both explain the wide range of observed post-operative hearing results and suggest surgical guidelines in order to optimize the post-operative results. (4) In tympanoplasty types I, II and III, the hearing result depends on the efficacy of the reconstructed tympanic membrane, the efficacy of the reconstructed ossicular chain and adequacy of middle-ear aeration. Currently, our knowledge of the mechanics of these three factors is incomplete. The mechanics of mastoidectomy and stapedectomy are also discussed.     

Mail consultations in ophthalmology. The Tenth Richard E. Hoover Lecture

BACKGROUND: Although a number of diagnostic and therapeutic methods are available to assist the ophthalmologist, relatively little attention has been given to mail consultations. By this method, a clinical summary and photographs, fluorescein angiograms, ultrasonograms, and/or other relevant materials are mailed to a consultant who then renders an opinion by telephone and/or return mail. MATERIALS AND METHODS: The records of all mail consultations that were sent to the senior author and his colleagues during a 20 year period were reviewed to determine the total number of mail consultations, the reasons for the consultations, and the diagnoses and therapeutic recommendations that were made by the consultant. RESULTS: A total of 1357 mail consultations were received during the 20 year period, with a progressively increasing number of consultations each year. Consultations were received from 757 physicians representing all 50 states in the United States and 32 other countries. Because of the authors' subspecialty in ocular oncology and medical retinal diseases, the majority of the consultations received were related to those topics. In many cases, the initial diagnosis and treatment plan were altered based on our opinion through mail consultation. Based on the material received, the recommendations that we made included observation in 635 cases, enucleation in 152, surgical excision of a lesion in 120, plaque radiotherapy in 102, laser photocoagulation in 81, systemic evaluation in 40, external beam irradiation in 36, fine needle aspiration biopsy in 33, orbital exenteration in 25, chemotherapy in 21, and cryotherapy in 14. CONCLUSION: Although not as ideal as direct patient examination, mail consultation can be an effective method of making or confirming a diagnosis and obtaining a therapeutic opinion. Although the authors have received mail consultations related to ocular oncology, this method may be applicable to other subspecialties in ophthalmology and to general medicine.     

The 1998 Donald E. Cummings Memorial Award Lecture. The industrial hygiene paradox, dilemmas, and a vision for the future

How do we move from diatribe to dialogue? Since the Donald E. Cummings Award was first established in 1943, the profession of industrial hygiene has seen many changes. The traditional hazards Alice Hamilton addressed in her 1948 Cummings lecture have been controlled. However, the advent of the Occupational Safety and Health Administration (OSHA) has changed the approach of many of today's industrial hygienists from "best professional practices" to regulatory compliance or OSHA industrial hygiene. Further, the dialogue that has existed between academia, business, government, and labor that allows industrial hygienists to identify and resolve health hazards is now threatened by lawsuits and lobbyists. Industrial hygienists have a professional responsibility to workers, employers, clients, and the public. Our vision for the future must refocus on this responsibility as we once again embrace dialogue instead of diatribe. This lecture was presented at the American Industrial Hygiene Conference and Exposition in Atlanta, Ga., on May 13, 1998.     

Primitive neuroectodermal tumors of bone and soft tissue: histological subclassification and clinicopathologic correlations

Recent reports of Ewing's sarcoma (EW) and extraskeletal Ewing's sarcoma (EEW) support the hypothesis that these tumors are neuroectodermal in origin. Primitive neuroectodermal tumors (PNET) of bone (32 cases) and soft tissue (25 cases) including those previously categorized as EW in 27 cases and EEW in 15 cases were carefully studied histologically, immunocytochemically and morphometrically, focusing on tumor cell differentiation. This study attempts to subclassify these tumors on the basis of the size of tumor cells and nuclei, their variations (uniformity or diversity), arrangement of tumor cells (rosette or non-rosette), focal differentiation to larger ganglion-like cells, and staining intensity for neural markers. All tumors were histologically subclassified as small, medium or large cell types, three basic subtypes (rosette type, abortive rosette type, non-rosette type) and four complementary subtypes (fibrillary type, non-fibrillary type, angiomatoid type, ganglion cell type). Classic EW or EEW is consistent with small or medium, non-rosette, non-fibrillary type tumors, previously described large cell EW with large, non-rosette, fibrillary or non-fibrillary type tumors, and classic neuroectodermal tumor with small or medium, rosette, fibrillary type tumors, according to the present subclassification. Clinicopathologic correlations with the different subtypes are discussed. Long-term survival, more than 5 years, was seen in patients with small cell type, and those younger than 14 years of age.     

1997 Sir William Refshauge Lecture. Skeletal muscle glucose metabolism during exercise: implications for health and performance

The shear bond strengths of an amalgam (Permite C) and a gallium alloy (Galloy) to dentin, mediated by four dentin adhesives (Super-Bond D-Liner, Super-Bond D-Liner II, Paama 2, and Panavia 21), were investigated. Flat labial dentin surfaces were prepared from bovine lower incisor teeth. A 3 mm-in-diameter area of dentin was bonded according to each manufacturer's directions before placement of Permite C or Galloy. The bonds were stressed in shear at a crosshead speed of 1 mm/min. The mean shear bond strengths were analyzed using one-way ANOVA and Student's t-test, and fracture modes were assessed under X20 magnification and analyzed using Kruskal-Wallis and Mann-Whitney U tests. Scanning electron micrographs were taken of the bond interface of separate samples. The results showed no significant difference among the bond strengths of Super-Bond D-Liner (2.79 MPa, 2.69 MPa), Super-Bond D-Liner II (3.41 MPa, 2.65 MPa), and Paama 2 (0.70 MPa, 0.50 MPa) bonded to Permite C and Galloy (respective values in parentheses); however, Panavia gave a significantly better bond with Permite C (0.42 MPa) than with Galloy (0 MPa). Super-Bond D-Liner and Super-Bond D-Liner II gave stronger bonds than Paama 2 and Panavia with both Permite C and Galloy. For each dentin adhesive, there was no difference in fracture mode between Permite C and Galloy. It was concluded that, since all bond strengths were very low, none of the dentin adhesives tested would enhance the clinical retention of Permite C or Galloy. However, although the use of Paama 2 with Galloy was originally recommended by the manufacturer for dentin sealing purposes, no adhesion was claimed.     

Ovarian cysts in children and adolescents: their occurrence, behavior, and management

OBJECTIVE: This was a retrospective analysis of cytogenetic data from 600 cases with chronic myelogenous leukemia (CML) to investigate the features of Ph chromosome and its significance. METHODS: Bone marrow direct method and/or short-term culture were used to prepare the chromosomes and karyotype analysis was performed with R-banding technique. RESULTS: 30 cases (5%) were Ph negative; 570 cases (95%) were Ph positive. 535 cases (93.8%) had standard Ph translocation;34 cases(5.9%) had variant translocation, including 13 cases (2.2%) with simple variant translocation, 13 cases (2.2%) with complex variant translocation and 8 cases (1.4%) with masked Ph chromosome. 526 cases (92.2%) had 100% of Ph positive cells; 44 cases (7.7%) had normal karyotype in partial or all metaphases after treatment such as allogeneic bone marrow transplantation, interferon and pulse hydroxyurea therapy, but conventional chemotherapy had no effect on the percentage of Ph positive cells. 50.6% of Ph positive CML with blast crisis had extra chromosomal abnormalities, of which, the most common ones were +8(46.1%),2 Ph(33.9%) and i(17q) (23%) in descending order. CONCLUSION: These facts indicate that chromosome examinations not only help diagnose and differentiate CML,but also help predict the blast crisis, evaluate the therapeutic effect, and make a cytogenetic classification for CML.     

Obesity: Psychological causes, correlations, and speculations.

Reviews the literature for consistencies and disagreements about psychological factors associated with obesity, particularly the issue of external cue sensitivity. Methodological problems associated with these studies are discussed, as well as alternative explanations for the findings. Research on the association between other personality variables and obesity is also presented. The problems inherent in defining and measuring the obese state and in viewing obesity as if it were a unitary syndrome are considered. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The arterioportal fistula syndrome: clinicopathologic features, diagnosis, and therapy

BACKGROUND & AIMS: Arterioportal fistulas (APFs) are rare vascular disorders of the mesenteric circulation. The aim of this study was to determine the etiology, anatomical location, and main symptom at presentation of APFs, and analyze the various modes of treatment. METHODS: The etiology, clinical presentation, radiographs, and treatment of 12 patients with APFs are reported in detail, and another 76 cases published since 1980 are reviewed. RESULTS: APFs result from trauma (n = 25, 28%), iatrogenic procedures (n = 14, 16%), congenital vascular malformations (n = 13, 15%), tumor (n = 13, 15%), aneurysm (n = 12, 14%), and other causes (n = 11, 12%). The origin of APFs is the hepatic artery in the majority of patients (n = 56, 65%). The main symptoms at presentation are lower or upper gastrointestinal bleeding (n = 29, 33%), ascites (n = 23, 26%), heart failure (n = 4.5%), or diarrhea (n = 4.5%). Radiological intervention provides definitive treatment in 42% (n = 33) of patients, whereas the remainder are treated by surgery alone (n = 27, 31%) or a combination of radiological intervention and surgery (n = 8, 9%). CONCLUSIONS: APFs result in a protean syndrome variously combining portal hypertension and other hemodynamic imbalances (heart failure, intestinal ischemia). Single or multiple interventional radiological procedures using arterial and/or venous approaches allow definitive treatment of most APFs. With increasing technological advances, it is anticipated that surgery will only be indicated in rare instances after failure of radiological intervention(s).     

The Wilhelmine E. Key 1991 Invitational Lecture. The evolutionary history of the P family of transposable elements

Similar to other transposable genetic elements, P elements occasionally exhibit non-Mendelian inheritance because of their ability to move, from one genomic site in their host species to another, during certain phases of their life cycle. The biological range of this capacity for transposition is almost always restricted to new sites within the same nuclear genome, but exceptionally it appears that interspecific horizontal transfer of P elements can occur. Although the P family appears to have had an ancient origin, its present natural distribution appears to be patchy and phylogenetically restricted to a limited number of Dipteran species. The most likely explanation of the observed restriction is the requirement of transposition for a host-encoded factor whose range is itself similarly restricted. Occasional horizontal transfer of P elements into a new host species, together with the normal mode of vertical transfer, may be the mechanism that ensures the survival of this, and other transposable element families, over long periods of evolutionary time.     

Solitary non-parasitic cysts of the liver: presentation and management

Four cases (one asymptomatic and three symptomatic) of solitary non-parasitic cysts of the liver are presented. The asymptomatic cysts was an incidental finding at laparotomy. The other three patients presented with abdominal distension, jaundice and malignant transformation respectively. Management of these patients has been discussed and the literature reviewed.