Biomedical subjects
B Black
Publications and source records attributed to B Black.
Elective mutism as a variant of social phobia.
To examine the relationship between the syndromes of elective mutism and social phobia, a case of elective mutism associated with social phobia in a 12-year-old girl is presented, and the clinical literature regarding the syndrome of elective mutism is reviewed. Elective mutism or reluctance to speak in unfamiliar social situations may be a symptom of social phobia. Social anxiety is a nearly universal characteristic of children manifesting the syndrome of elective mutism. Elective mutism may respond to treatment with medications that also are effective in the treatment of social phobia. Elective mutism may be a manifestation of social phobia rather than a separate diagnostic syndrome. Pharmacologic treatment may be effective.
Ossiculoplasty prognosis: the spite method of assessment.
A series of 535 ossiculoplasties were studied to determine statistically significant links between the presence of presenting preoperative clinical features and adverse audiologic results, in order to identify those aspects of case presentation that indicate a good or poor prognosis. Analysis by chi-square testing has identified twelve features classified as surgical, prosthetic, infection, tissue, and eustachian (SPITE) factors. Regrouping the significant features has demonstrated their value in predicting accurately an ossiculoplasty prognosis. The data were used to compare accurately the results of 247 Plastipore procedures and 265 procedures using the Richards Oval-Top hydroxylapatite implant. There was no statistical difference between the series. The use of these factors will permit precise matching of future series to allow accurate comparisons of prostheses, techniques, individual skills, and also surgical philosophies such as the open and closed cholesteatoma management. Most importantly, the SPITE factors permit an accurate preoperative individual assessment when counseling the patient as to the likelihood of success or failure of a proposed ossiculoplasty.
Acute dystonia and fluoxetine.
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Fluoxetine for the treatment of social phobia.
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Posterior geniculate artery: a surgeon's guide to the facial nerve.
Locating the facial nerve is an essential step in most mastoid procedures. A constantly occurring, easily identifiable, arterial bleeding point has been identified arising on the posterosuperior-lateral eminence of the posterior genu of the nerve, passing posterosuperiorly. The vessel permits exact sitting of the genu before the nerve is seen, and provides a timely warning of the nerve's presence.
Prevention of recurrent cholesteatoma: use of hydroxyapatite plates and composite grafts.
Recurrent cholesteatoma after closed techniques occurs in four patterns: (1) through an attic defect, (2) via erosions in the canal wall, (3) as a pars tensa invagination, and (4) as a borderline invagination between an attic defect repair and a normal pars tensa. Semicircular porous hydroxyapatite ceramic plates 7, 10, and 14 mm in diameter, and 1 mm thick are used as underlays to repair attic defects, supplemented by bone dust pate and fine tragal cartilage-perichondrium composite grafts. Pate and either the tragal composites or fine tragal cartilage shavings are used to minimize the risk of wall erosion pockets. Borderline invaginations and pars tensa recollapse are prevented with the fine tragal composites. The extent of pars tensa reinforcement is determined by the extent of disease. Care to anticipate and prevent each of the four patterns has produced a comprehensive reduction of recurrent cholesteatoma to acceptable levels (under 10%). Residual disease, found in 19 percent of second stage cases, has required open conversion in only 3 percent of cases. The above techniques therefore provide optimal results and are recommended as routine closed cavity techniques.
Evidence for hypothalamo-growth hormone dysfunction in panic disorder: profile of growth hormone (GH) responses to clonidine, yohimbine, caffeine, glucose, GRF and TRH in panic disorder patients versus healthy volunteers.
Given the abrupt and time-limited nature of daytime-awake and nocturnal-sleep panic attacks, several chemical and neuroendocrine challenge tests have been employed to investigate the neurobiology of "spontaneous" panic attacks. Previously we demonstrated that panic disorder patients have blunted growth hormone (GH) responses to clonidine, an alpha 2-adrenergic agonist. However, the mechanism of this blunted response and the role of hypothalamic-GH dysfunction, if any, remains unclear. To further delineate the status of hypothalamic-GH function in panic disorder, we review the literature and present original data on the GH responses to a number of different chemical and neuroendocrine challenge paradigms. Although stress-mediated increases in GH are thought to be a common correlate of stress in humans, our findings indicate that panic disorder patients have significantly blunted GH responses to clonidine, yohimbine, growth-hormone releasing factor, and caffeine compared to normal control subjects. A similar trend was noted in the delayed rise in GH after glucose challenge. There was no difference in the rate of abnormal GH responses to thyrotropin-releasing hormone in panic disorder compared to normal control subjects. No drug or neuroendocrine challenge, even if associated with marked increases in anxiety, produced a significantly enhanced GH response compared to normal control subjects. These findings provide support for a hyporesponsive hypothalamic-GH system in panic disorder. These observations, combined with preliminary observations from our clinic of short stature in several cases of prepubescent children with anxiety disorders, also underscore the need for assessing early growth patterns in individuals with panic disorder. Strategies for investigating the site(s) of possible neurotransmitter or hypothalamic-GH-somatomedin dysfunction are discussed.
A universal ossicular replacement prosthesis: clinical trials of 152 cases.
An ossicular replacement prosthesis is described that advances implant design in several respects. The head is a flattened egg shape, which eliminates pressure points against the pars tensa and provided balance on the stapes. Dense hydroxylapatite ceramic provides maximal biocompatibility. The shaft, of either Teflon or Plastipore, is easily cut to size and is replaceable to minimize wastage. Interchangeable partial or total shaft variants are provided. Trials in more than 200 patients have produced optimal results. Among 152 mature patients in 85% of the good-risk cases, the air-bone gap closed to within 20 dB and in 65% to within 10 dB; in 69% of all cases the gap closed to within 20 dB. Extrusion rates were 5% in good-risk cases and 7% overall. Long-term extrusions have not occurred. Inasmuch as cartilage interpositioning is unnecessary, the prosthesis is rapidly prepared and implanted by an easily mastered technique.
Mastoidectomy reconstruction: use of aluminum templates to shape hydroxylapatite canal wall implants.
Mastoidectomy reconstruction is a complex procedure in which the use of porous hydroxylapatite ceramic wall implant is optimal. Fitting the implant to the operation site requires considerable reshaping of the prosthesis with resultant delays and occasional breakages. The reshaping can be expedited considerably if a metal template is used to obtain the pattern required for the implantation site. A technique using aluminum foil templates to obtain a precise fit is outlined and discussed. The method has been utilized successfully in a series of 42 cases and is recommended to improve the speed and precision of the reconstruction considerably.
Phenomenology and neurobiology of social phobia: comparison with panic disorder.
Like panic disorder, social phobia is a common, frequently severe, anxiety disorder that can cause significant work and social impairment. Unlike panic disorder, social phobia has only recently begun to undergo neurobiologic study and to receive pharmacotherapeutic attention. There is a high comorbidity between social phobia and panic disorder; however, many differences exist--including age at onset, gender distribution, contextual framework of anxiety, help-seeking and help-avoidance behavior, quality of sleep and sleep patterns, caffeine and lactate sensitivity, and, most probably, pharmacologic responses. Social phobia can now be included among the growing number of anxiety disorders that respond to pharmacotherapy.
Chronic suppurative otitis media.
Chronic suppurative otitis media refers to those ears in which the ear drum has a chronic non healing perforation. The perforation may or may not be associated with ossicular fixation or necrosis, middle ear infections, tympanosclerosis or mastoiditis. It is a disease commonly found in lower socio-economic areas and is particularly prevalent worldwide in groups with low living standards.
Cholesteatomatous otitis media.
Cholesteatomas are cysts or sacs of keratinising squamous epithelium found in the middle ear cleft. The presentation of these lesions may be similar to that of chronic otitis media, but because of their predisposition towards major complications, surgery is the treatment of choice.
Concurrent chemoradiation in advanced cervical cancer.
The pelvis is the predominant site of failure following radical radiotherapy (RT) for locally advanced cervical cancer. We report the results of phase I-II studies on 200 patients with bulky (greater than or equal to 5 cm) carcinoma of the cervix. Patients were treated between 1981 and 1988 on sequential protocols of concurrent chemoradiation to establish an acceptable treatment regimen. RT with daily or partially hyperfractionated pelvic (n = 154) or pelvic plus paraaortic (n = 46) fields was given by continuous (n = 154) or split course (n = 46) regimens. Infusional fluorouracil (5-FU) in a dose of 1 g/m2/day was given on the first and last 4 days of a 5-week course of continuous RT, or with both halves of split course RT. Seventy-eight patients received bolus mitomycin C (Mit-C), 6 mg/m2, once or twice with the start of the 5-FU infusion. The median external RT dose was 46 Gy (range 40 to 65 Gy) followed in 90% (n = 181) by a single intracavitary application of 40 Gy using a linear source of cesium-137. Median follow up is 2.5 years (range 0.6 to 6.9 years) and is sufficient to reliably estimate late toxicities. Acute toxicities were transient oral mucositis (13), RT interruption for enteritis (7), febrile neutropenia (3), and thrombocytopenic tumor bleed (1). Serious late toxicities resulted in death in 3 patients and occurred in bladder in 6 and in bowel in 25, including 8 patients with tumor recurrence. The incidence of late bowel toxicity correlated with the specific therapy given and decreased with each successive protocol. On logistic regression the only treatment variable showing a statistically significant effect on complications was the use of Mit-C (P = 0.0053). Pelvic RT and 5-FU alone produced fewer complications, only 4/105, than historically seen with standard pelvic RT alone. Three-year pelvic control and survival rates were 85 and 71% respectively in stage Ib/II (n = 100) and 50 and 42% in stage III/IV (n = 100). Encouraged by these results and decreased toxicity, we have begun a phase III study to determine whether the addition of concurrent 5-FU to continuous partially hyperfractionated pelvic RT improves local control and survival.
Microstaging of squamous cell carcinomas.
The clinical classification of squamous cell carcinoma, which was established primarily by the International Union Against Cancer (UICC), does not permit optimal estimation of expected metastasis. The authors' results indicate that metastasis can be more accurately estimated on the basis of invasion depth, histopathologic grading, and especially tumor thickness. One essential advantage of these criteria is that they can be established by a histopathologist. It is interesting to note that in the authors' collective no carcinoma less than 2 mm thick metastasized, that is, a relatively high percentage of carcinomas (48%) can be graded as no-risk carcinomas. The risk of metastasis for undifferentiated carcinomas greater than 6 mm thick that have infiltrated the musculature, the perichondrium, or the periosteum, however, is quite high. Tumors between 2 and 6 mm thick with moderate differentiation and a depth of invasion that does not extend beyond the subcutis can be classified as low-risk carcinomas.
Panic disorder in children and adolescents.
Panic disorder is a common and well-known psychiatric disorder which commonly has its onset during adolescence. However, the disorder has only recently been described in children and adolescents. The clinical literature describing panic disorder in children and adolescents is reviewed, and six cases are presented. Future directions for research are suggested.
Design and development of a contoured ossicular replacement prosthesis: clinical trials of 125 cases.
A columellar ossicular replacement prosthesis has been developed to simplify ossiculoplasties. The hydroxylapatite head has flattened egg-shaped contours set on a teflon shaft. One hundred and twenty-five prostheses have been implanted and the results of eighty-two cases between five and eighteen months' maturity are presented. Sixty-six percent of good risk partial ossicular replacement prosthesis (PORP) cases achieved air-bone closure within ten decibels and eighty-five percent within twenty decibels. Of all total ossicular replacement prosthesis (TORP) and PORP cases, 51.5 percent closed to within ten decibels and 69.5 percent to within twenty decibels. The design has simplified the preparation and implantation techniques and the prosthesis can be used in most ossiculoplasty situations. A malleus handle is not required and interposition of cartilage is unnecessary. The simplicity of the prosthesis should provide particular benefits for the occasional or trainee otologist.
Myeloma proteins from NZB and BALB/c mice: structural and functional differences.
Structural and functional analyses of myeloma immunoglobulins from inbred BALB/c mice and humans have provided important insights into the structure of the antibody molecule and the expression and evolution of antibody genes. One important question concerning these analyses is whether the myeloma process selects, in a nonrandom manner, the lymphocytes to be transformed. The availability of myeloma tumors in a second inbred strain of mouse, NZB, permits us to approach this question. In this respect. the NH2-terminal amino acid sequences of 27 kappa light chains as well as data relating to the antigen-binding properties and immunoglobulin class distribution of NZB myeloma proteins are presented and compared with similar data from the BALB/c mouse. These studies suggest that the myeloma proteins from the BALB/c and NZB mice constitute two populations of immunoglobulins with distinct functional and structural properties. The implication of this observation are discussed.