Multidisciplinary treatment of superior sulcus (Pancoast) tumors

Ten patients with a Pancoast tumour, seven with pulmonary carcinoma, three with a soft tissue tumour, were treated surgically with or without preoperative chemotherapy or external radiotherapy, and with postoperative external radiotherapy mostly in combination with brachytherapy using a flexible intraoperative template. The results were highly variable, e.g. one patient died after three months, another was still alive without tumour after 36 months. Optimal treatment requires cooperation of experienced surgeons, radiotherapists and medical oncologists.     

Femoral sulcus angle measurements

Six bovine cosmid-derived microsatellites (IDVGA53, BTA3/U6; IDVGA61, U13; IDVGA41, BTA12/U27; IDVGA32, BTA15/U19; IDVGA59, BTA26/U26 and IDVGA71, U8), previously assigned to cattle chromosomes, were FISH-mapped to river buffalo chromosomes (BBU) 6q15, 8q34, 13q15, 16q25, 23q22 and 24q13 respectively. Sequential FISH/RBA-banding allowed the precise identification of chromosomes and localization of probe-signals on chromosome bands. These localizations allowed us to assign indirectly, for the first time, six bovine syntenic groups to river buffalo chromosomes, thereby extending its physical map. The localization of IDV-GA71 (bovine U8) to the marker BBU24 adds further information to resolve definitively cattle chromosome ambiguities involving cattle chromosomes 25, 27 and 29.     

Nasal polyps of olfactory sulcus

To explore the origin of olfactory sulcus polyp (OSP) and observe the recovery of olfaction after functional endoscopic sinus surgery, fifty-nine olfactory sulcus polyps in 31 patients were reviewed. The origin of OSP was carefully observed. In these patients 69.5% (41 sides) originated from the mucosa of posterior ethmoid sinus, including the superior meatus (23 sides) and ethmoid cells near the ostia (18 sides). OSP originated from middle turbinate (8 sides) and superior turbinate (4 sides). Six OSP originated from the mucosa of both ethmoid and sphenoid sinus. Olfactory changes were dynamically observed after endoscopic sinus surgery in 26 patients. The smell improved significantly in 26 sides (52.0%) within three months. The olfaction improved slowly in those patients with recurrent polyps and polysinusitis associated with polyps. We suggest that minimal endoscopic sinus surgery is the treatment of choice for OSP.     

The full coverage restoration in relation to the gingival sulcus

The full coverage restoration (FCR) and its effect on the periodontium have been the subject of much controversy over the last half century. The conflict relates to whether the margin of the FCR should be placed at or above the gingival crest, or into the gingival crevice. Clinicians and researchers alike have focused their attention primarily on the mechanistic aspects of fixed prosthetic design (i.e., marginal configuration and fit). Although marginal quality and form are factors in the fabrication of the FCR, they alone will not determine periodontal health and restorative success. What determines the success of the FCR is its ability to restore form and function to the masticatory system without adversely affecting its biology. Each technical phase of treatment (i.e., tooth preparation, impression-taking, the provisional restoration, and the final restoration) must be performed within the limits of biologic adaptation. This literature review discusses the scientific evidence regarding FCR margin placement and periodontal health.     

Critical review of phonosurgical methods in the treatment of sulcus vocalis

INTRODUCTION: Sulcus vocalis is an epithelial invagination along the free edge of the membranous vocal fold. It interferes with the glottic closure and vibration pattern. Sulcus vocalis provokes voice fatigue, hoarseness and breathiness, and it usually appears in association with hyperkinetic phonatory pattern. Hyperkinesis develops secondarily, due to the compensatory effort to overcome the deficiency in glottic closure. The treatment of sulcus vocalis is very difficult. Phonosurgery is used, and is followed by postoperative voice therapy. PHONOSURGICAL OPERATIONS: Various surgical techniques are used in the therapy of sulcus vocalis. Over a 10-year period we have operated on 1550 patients with benign lesion of the vocal folds, of whom only 11 had sulcus vocalis (0.7%). We carried out various surgical techniques. a) Excision of sulcus A longitudinal incision of mucosa is performed along the upper surface of the vocal fold, distant of the free edge. Mucosa is undermined caudally, and sulcus is detached from its base. Sulcus is then removed by surgical scissors. With this technique we could not provide physiological phonation and vibration pattern, in spite of an apparent improvement in the voice. b) "Slicing mucosa" technique This procedure was suggested by Pontes, and it also begins with a longitudinal incision followed by creation of inferiorly based slices of mucosa. c) Excision plus rhyroplasty Excision of sulcus is combined with thyroplasty type I in order to achieve medialization of the vocal fold. It can be used in cases with severe glottal gap in order to improve the results of excision. d) Implants Various materials were used in order to enlarge the mass of the vocal fold. In our patients, the results of this procedure were inferior as related to excision surgery. DISCUSSION: The surgical procedure which is safe and accepted by the majority of surgeons has not yet been at our disposal. The treatment of sulcus vocalis should start with voice therapy, which lasts as long as the patient shows a progress. Only then the surgical procedure can be discussed. We obtained the best results with the combination of excision and voice therapy. However, the surgeon and the patient must be aware that the treatment is demanding and long-lasting.     

Comparison of ciliary sulcus fixation techniques for posterior chamber intraocular lenses

OBJECTIVE: To anatomically and histologically evaluate suturing techniques for sulcus fixation of posterior chamber intraocular lenses. SETTING: Kitano Hospital, Osaka, Japan. METHODS: The reproducibility of three suturing techniques (perpendicular to the eye wall; parallel to the iris; midway between perpendicular to the eye wall and parallel to the iris) were evaluated in a postmortem eye. Histologic sections of another eye and ultrasound biomicroscopy (UBM) images of 21 normal eyes were evaluated to determine the safety zone for the needle to avoid damaging adjacent structures. RESULTS: The ciliary sulcus was completely penetrated in the three techniques in 100, 40, and 70% of cases, respectively. The histologic sections and the UBM images showed that when sutures were placed perpendicular to the eye wall, there was the possibility of postoperative angle closure and suturing parallel to the iris might damage adjacent structures because of a narrow safety zone. CONCLUSIONS: The needle should penetrate obliquely, as in the technique in which the suturing is midway between perpendicular to the eye wall and parallel to the iris. This technique provides better reproducibility and causes less damage to adjacent tissue.     

Superior visual search in autism.

Children with a diagnosis of autism and normally developing children, matched for age and general ability, were tested on a series of visual search tasks in 2 separate experiments. The children with autism performed better than the normally developing children on difficult visual search tasks,. This result occurred regardless of whether the target was uniquely defined by a single feature or a conjunction of features, as long as ceiling effects did not mask the difference. Superior visual search performance in autism can be seen as analogous to other reports of enhanced unique item detection in autism. Unique item detection in autism is discussed in the light of mechanisms proposed to be involved in normal visual search performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visual motion processing in the anterior ectosylvian sulcus of the cat

1. Neurons that are selectively sensitive to the direction of motion of elongated contours have been found in several cortical areas in many species. However, in the striate cortex of the cat and monkey, and the extrastriate posteromedial lateral suprasylvian visual area of the cat, such cells are generally component motion selective, signaling only the direction of movement orthogonal to the preferred orientation; a direction that is not necessarily the same as the motion of the entire pattern or texture of which the cell's preferred contour is part. The primate extrastriate middle temporal area is the only cortical region currently known to contain a substantial population of pattern-motion-selective cells that respond to the shared vector of motion of mixtures of contours. 2. From analyzing published data on the connectivity of the cat's cortex, we predicted that the anterior ectosylvian visual area (AEV), situated within the anterior ectosylvian sulcus, might be a higher-order motion processing area and thus likely to contain pattern-motion-selective neurons. This paper presents the results of a study on neuronal responses in AEV. 3. Ninety percent of AEV cells that responded strongly to drifting grating and/or plaid stimuli were directionally selective (directionality index > 0.5). For this group, the mean directionality index was 0.75. Moreover, 55% of these cells were unequivocally classified as pattern motion selective and only one neuron was classified as definitely component motion selective. Thus high-level pattern motion coding occurs in the cat extrastriate cortex and is not limited to the primate middle temporal area. 4. AEV contains a heterogeneous population of directionally selective cells. There was no clear relation between the degree of directional selectivity for plaids or gratings and the degree of selectivity for pattern motion or component motion. Nevertheless, 28% of the highly responsive cells were both more strongly modulated by plaids than gratings and more pattern motion selective than component motion selective. Such cells could correspond to a population of "selection units" signaling the salience of local motion information. 5. AEV lacks global retinotopic order but the preferred direction of motion of neurons (rather than axis of motion, as in the middle temporal area and the posteromedial lateral suprasylvian visual area) is mapped systematically across the cortex. Our data are compatible with AEV being a nonretinotopic, feature-mapped area in which cells representing similar parts of "motion space" are brought together on the cortical sheet.     

Superior outcomes in pediatric renal transplantation

BACKGROUND: Nationally, results of renal transplantation in children, particularly in small children, are inferior to those obtained in adults. OBJECTIVE: To determine factors important for success in renal transplantation in children. DESIGN: Results of 108 consecutive renal transplantations performed in patients aged 7 months to 18 years were reviewed and compared with those reported by the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), the national registry. RESULTS: One-, 2-, and 3-year graft survival rates (+/-SE) were 99% +/- 1%, 95% +/- 3%, and 93% +/- 4%, respectively, for living donor grafts and 97% +/- 3%, 92% +/- 6%, and 92% +/- 6%, respectively, for cadaver grafts. Incidence of acute rejection was half that reported by NAPRTCS. There were no graft losses for technical reasons (19% in NAPRTCS). Twelve percent of patients were younger than 2 years (6% in NAPRTCS); 17% were 2 to 5 years old (16% in NAPRTCS). Most small children received an adult-sized kidney. Ninety-three percent of recipients weighing 15 kg or less received postoperative mechanical ventilation assistance to optimize fluid resuscitation and perfusion of adult-sized kidneys. Structural abnormalities of the urinary tract were present in 53.7% of the patients (48.5% in NAPRTCS; adults, 5.3%). Nephroureterectomy was required in 38 children; in 27 (71%) of them, it was performed at the time of transplant surgery. CONCLUSIONS: Excellent results can be obtained in pediatric renal transplantation by strict adherence to surgical detail, tight immunosuppressive management, aggressive fluid management in the small child, and careful integration of urologic and transplant surgery.     

Superior glenoid impingement. Current concepts

In the current decade impingement syndrome is becoming a less precise diagnostic entity. It is splitting into several categories of more exact diagnoses. The concept development, clinical picture, and currently recommended treatment of 1 of these entities, the superior glenoid impingement is reviewed. The complaint may be acute or chronic and may involve 1 or more of 5 structures: (1) superior labrum, (2) rotator cuff tendon, (3) inferior glenohumeral ligament, (4) greater tuberosity, and (5) the bony glenoid. The most commonly seen clinical entity is chronic dorsal shoulder pain in an athlete who throws with a positive relocation test. Treatment consists of strengthening of the cuff and scapular rotators. When there has been excessive inferior ligament stretch this must be augmented by anterior reconstruction.     

Superior ophthalmic vein at computed tomography

Simultaneous hemodynamic, ventilatory, and blood gas studies were performed in 16 men with congestive heart failure before and during infusion of sodium nitroferricyanide (nitroprusside). The cardiac index increased from 2.00+/-0.16 L/min/sq m (SE) to 2.38+/-0.14 L/min/sq m, and the total pulmonary and systemic peripheral resistances fell from 928+/-123 to 494+/-57 dynes sec cm-5 and from 2,208+/-210 to 1,558+/-121 dynes sec cm-5, respectively. Both systemic and pulmonary arterial decreased during infusion of sodium nitroferricyanide, and the mixed venous oxygen pressure increased. There was no change in total or alveolar ventilation, arterial carbon dioxide tension, pH, or base excess; however, the mean arterial oxygen pressure (PaO2) decreased from 74+/-3 mm Hg to 68+/-3 mm Hg and the venous admixture effect increased from 8+/-1% to 13+/-2%. We conclude that the decrease in PaO2 during infusion of sodium nitroferricyanide resulted from a worsening of the ventilation-perfusion relationships due to increased perfusion of underventilated pulmonary units.     

三维模型分析法评价不同排龈时间下的龈沟宽度

目的:利用三维数字化模型分析法,研究排龈时间对牙龈不同部位龈沟宽度的影响.方法:选取10名志愿者的46颗前磨牙,对其颊侧龈沟共进行3次排龈,时间分别为5、10、15 min,两次排龈至少间隔2周,制取排龈前、后的印模并灌制石膏模型.用三维线激光扫描仪获取模型三维数据,通过专业软件进行模型重叠及坐标系的建立,测量并比较不同排龈时间及牙龈不同部位的龈沟宽度.结果:颊侧牙龈中部及轴角部位,龈沟宽度在排龈5、10 min组间均存在统计学差异;轴角部位龈沟宽度在排龈10、15 min组间也存在统计学差异,但差异绝对值明显小于5、10 min组间的差异;3种排龈时间下,龈沟宽度在颊侧中部均显著大于轴角部位.结论:印模制取前使用单线机械法排龈至少需10 min;排龈对牙龈不同部位的龈沟扩大程度不同,所需排龈时间也略有差别;三维数字化模型分析法可作为一种新的客观方法来评价不同排龈时间的排龈效果.     

Superior oblique tenotomy: indications and complications

Crude extracts of hydra contain a substance or substances which specifically inhibit foot formation in regenerating hydra. This foot inhibitor(s) is probably of low molecular weight, and it is present in the animal in an inactive, structure-bound form as a gradient from foot to head. The foot region contains 60% of this inhibitor in a 7-8 fold higher concentration than the other regions. The foot inhibitor was purified chemically from the head activator (Schaller, 1973) and the 'head' inhibitor (Berking, 1974). It is suggested that the substance under investigation is a new morphogen, responsible for foot inhibition in hydra.     

Superior mesenteric arterial occlusion from a leiomyoma

We report a solitary leiomyoma of the superior mesenteric artery resulting in arterial occlusion and gangrenous bowel. On histologic evaluation the lesion extended into the vessel lumen off its stalk and showed immunostaining for smooth muscle antigen and desmin. Leiomyomas can arise anywhere there is smooth muscle and occur most commonly in the uterus followed by the skin and gastrointestinal tract. We could not identify any previous case in the literature of a leiomyoma arising from within the wall of a mesenteric vessel.     

The femoral sulcus angle in neonatal cadavers: a macroscopical and ultrasonographical study

A modification in the design of the pedicled latissimus dorsi musculocutaneous flap is described that aims to minimize the cosmetic morbidity of its donor site. The implications of this variation are discussed with particular reference to use of the flap in postmastectomy reconstruction.     

Superior survival of young women with malignant melanoma

BACKGROUND: The Commission on Cancer data from the National Cancer Data Base (NCDB) relating to patients with malignant melanoma are used to examine patterns of long-term survival by patient gender and age, stage of disease, disease morphology, and anatomic subsite. METHODS: Five calls for data have yielded more than 3,700,000 cases of cancer for the years 1985 through 1993, including 23,341 cases of malignant melanoma between 1985 and 1989, from hospital cancer registries across the US, representing slightly less than a quarter of all melanoma cases diagnosed in the US between 1985 and 1989. RESULTS: Three statements can be made from this data: (1) There is little difference in the frequency of malignant melanoma between men and women with respect to stage of disease or morphology. However, differences between the genders do appear with respect to the anatomic subsite of melanotic tumors. (2) Overall, young women (45 years of age and under) enjoy superior survival rates when compared with older women (55 years of age and older) and men of any age. (3) The survival advantage held by young women is particularly pronounced among patients diagnosed with advanced stage disease. CONCLUSIONS: These data suggest that factors present in younger women may be critical in the superior survival rates seen among premenopausal women and might be hormonal in nature.     

Superior mesenteric artery blood flow in celiac disease

Measurements of the hemodynamic parameters of the superior mesenteric artery were performed in 18 patients with celiac disease. Ten were studied at the time of diagnosis, when a small bowel biopsy showed a flat mucosa. The remaining eight patients were studied after complete clinical and histological recovery induced by a gluten-free diet. Doppler ultrasound flowmetry was used to measure blood flow in physiological and fasting conditions and after a mixed liquid test meal (Ensure-Plus). The results were compared with those of healthy subjects (N = 7). Mean basal flow was 50% higher in untreated celiac disease patients than in healthy controls and patients with chronic pancreatitis (P = NS). Postprandial mesenteric blood flow was significantly increased (P < 0.002) and delayed in time (P < 0.005) in celiac disease as compared to controls. Successful treatment reduced the mesenteric blood flow in celiac disease to normal values. Our study demonstrates that pathophysiological changes in the small bowel mucosa during the active clinical phase of celiac disease induce an abnormal splanchnic circulation.