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Biomedical subjects

C M Barone

Publications and source records attributed to C M Barone.

At least 19 recordsLinked to original sources
PubMed2001

Venous air embolism during endoscopic strip craniectomy for repair of craniosynostosis in infants.

BACKGROUND: Various studies have reported an incidence of venous air embolism (VAE) as high as 82.6% during surgical procedures for craniosynostosis. There has been an increase in the use of minimally invasive, endoseopie surgical procedures, including applications for endoscopic strip craniectomy. The current study prospectively evaluated the incidence of VAF during endoscopic strip craniectomy. METHODS: Continuous, intraoperative monitoring for VAE was performed using precordial Doppler monitoring. A recording was made of the Doppler tones and later reviewed to verify its accuracy. RESULTS: The cohort for the study included 50 consecutive neonates and infants ranging in age from 3.5 to 36 weeks and ranging in weight from 3 to 9 kg. Surgical time varied from 31 to 95 min for a total of 2,701 mm of operating time, during which precordial Doppler tones were auscultated. In 46 patients, there was no evidence of VAE. In four patients, there was a single episode of VAE. Two of the episodes of VAE were grade I (change in Doppler tones), and two were grade H (change in Doppler tones and decrease in end-tidal carbon dioxide). No grade III (decrease in systolic blood pressure by 20% from baseline) VAF was noted. CONCLUSION: In addition to previously reported benefits of decreased blood loss, decreased surgical time, and improved postoperative recovery time, the authors noted a low incidence of VAF during endoscopic strip craniectomy in neonates and infants.

Craniosynostoses↗
PubMed2001

Effects of synthetic craniofacial materials on cerebral microcirculation.

Four groups were studied to look at effects of synthetic materials on the pial vasculature. Using Sprague-Dawley rats, an open pial window approach was used in which there was a control group, a hydroxyapatite cement group mixed with sodium phosphate, a methylmethacrylate slow-set, and a methylmethacrylate fast-set group. There were 10 animals with 20 vessels studied within each group. The permeability leakage outside the vessel was evaluated to determine the vascular albumin leakage, and the number of rolling and adherent leukocytes was studied within each group. It was seen that the control group was significantly different compared with the fast-set methylmethacrylate group during a 2-hour period in regard to the percentage leakage, as well as a number of rolling and adherent leukocytes. This is one of the first studies to demonstrate the effects of synthetic craniofacial materials on the underlying pial vasculature.

Animals↗
PubMed2001

Temporalis muscle resuspension using titanium miniplates and screws: technical note.

OBJECTIVE: To describe the technique for and results of using titanium miniplates and screws for resuspension of the temporalis muscle after osseous detachment during cranial procedures requiring exposure of and access to the frontotemporoparietal region. METHODS: Thirty-four patients, who were being treated with various cranial procedures, underwent resuspension of the dissected temporalis muscle, using 1.5-mm or 1.3-mm titanium plates and screws, after bone flap replacement. RESULTS: The temporalis muscle was successfully and securely resuspended in all cases, using the plates and screws. There were no infections, muscle tears, dislodgement, fractures, or temporal hollowing in any of the cases. In four cases that required re-exploration, the muscle was observed to be rigidly fixated and scarred to the bone. CONCLUSION: The use of titanium plates and screws is a safe, simple, successful alternative for reattachment of temporalis muscles for patients undergoing cranial procedures.

Adolescent↗
PubMed2000

Endoscopy-assisted wide-vertex craniectomy, "barrel-stave" osteotomies, and postoperative helmet molding therapy in the early management of sagittal suture craniosynostosis.

OBJECT: The purpose of this study was to assess the efficacy, safety, associated complications, and outcome in patients with sagittal suture craniosynostosis in whom endoscopy-assisted wide-vertex craniotomy and "barrel-stave" osteotomy were performed. METHODS: During a 4-year period, 59 patients with sagittal suture synostosis underwent endoscopy-assisted wide-vertex craniectomies, barrel stave-like osteotomies, and postoperatively were fitted with custom-made molding helmets. Data on operative time, blood loss, transfusion rates, hospital length of stay, complications, and hospital charges were collected prospectively. The mean patient age at the time of surgery was 3.7 months. The average blood loss was 31.8 ml; and only one patient required an intraoperative blood transfusion. Nine patients received transfusions of donor blood postoperatively. The mean operative time was 50 minutes, and all but three patients were discharged from the hospital the morning following surgery. There were no intraoperative complications. Normocephaly as well as normal cephalic indices were observed at latest follow up. CONCLUSIONS: The authors conclude that early treatment of infants with sagittal suture craniosynostosis by using minimally invasive, endoscopy-assisted wide-vertex craniectomies provides excellent results and a significantly lower morbidity rate than traditional calvarial vault reconstructive procedures.

Blood Transfusion↗
PubMed2000

BoneSource solidification: a comparison between water and sodium phosphate as the solvent.

The purpose of this study was to determine the solidification rates for BoneSource (hydroxyapatite cement) mixed with sterile water versus BoneSource mixed with 0.25 ml of sodium phosphate. The average time for cure for BoneSource mixed with sterile water was 99 minutes, with a SD of 5.3 minutes. The average time for cure for BoneSource and sodium phosphate was 43 minutes, with a SD of 3.6 minutes (P < 0.0003). The average temperature for BoneSource in sterile water was 19.1 degrees C with a SD of 0.082, and the average temperature of BoneSource in sodium phosphate was 20.1 degrees C, with a SD of 0.1. Therefore, sodium phosphate shows that there is a significantly decreased amount of time required to solidify BoneSource and it remains isothermic throughout this reaction.

Bone Cements↗
PubMed1999

Endoscopic craniectomy for early correction of craniosynostosis.

Twelve patients between 0.4 and 7.8 months of age were treated by an endoscopic approach to strip craniectomy. Nine patients had sagittal suture involvement. Two patients had a single unilateral lambdoid suture synostosis, and one patient had a combination of a right coronal synostosis and a metopic synostosis. Postoperatively, all patients were placed in cranial remodeling helmets and the results showed that the estimated blood loss ranged from 5 cc to 150 cc, with blood transfusion required in only one patient. All patients were discharged from the hospital by day 2, and all patients had an improvement in their cranial head shape. The specific technique of using the endoscope to aid in performing a strip craniectomy will be discussed. Nine endoscopically treated patients with the diagnosis of sagittal suture synostosis were compared with nine patients treated by using the Marchac remodeling techniques. The mean operative time (1.6 hours versus 3.5 hours), estimated blood loss (43 cc versus 168 cc), hospital costs ($11,671 versus $36,685), and length of stay (1.16 days versus 5.1 days) were less by using the endoscopic technique. All nine patients treated by using the Marchac technique required a blood transfusion, whereas only one patient was transfused in the endoscopically treated group.

Brain↗
PubMed1998

Modification of Playtex nurser for cleft palate patients.

To facilitate the passive feeding requirements of children with cleft lip and palate deformities, as well as children with neurological deformities, a modification has been adapted to the Playtex nurser (Playtex, Dover, DE). It consists of removing the lower plastic portion of the bottle to allow passive delivery via a squeeze bag technique. This modification has been quite successful with these patients. We have found this bottle to be less expensive as well as easy to purchase compared with other available bottles. This bottle also has the capability of having multiple nipple variety types that can be adapted to it

Bottle Feeding↗
PubMed1998

Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis.

OBJECT: The authors sought to minimize scalp incisions, blood loss, and operative time by using endoscopically assisted strip craniectomies and barrel-stave osteotomies to treat infants with sagittal suture synostosis. METHODS: Four patients, aged 2, 4, 9, and 12 weeks, who presented with scaphocephaly underwent endoscopic midline craniectomies through small midline scalp incisions. The mean operative time for the procedure was 1.68 hours (range 1.15-2.8 hours); the mean blood loss was 54.2 ml (range 12-150 ml). Three patients did not require blood transfusions and were discharged within 24 hours. Postoperatively, all patients were fitted with custom cranial molding helmets. Follow-up evaluation ranged between 8 and 15 months. All patients had successful correction of their scaphocephaly with no mortalities, morbidities, or complications. CONCLUSIONS: The use of endoscopic techniques for early correction of sagittal synostosis is safe; decreases blood loss, operative time, and hospitalization costs; and provides excellent early surgical results.

Cranial Sutures↗
PubMed1998

Usefulness of endoscopy in craniofacial trauma.

To determine the extent of endoscopy utilized in craniofacial trauma, a questionnaire was mailed to 400 surgeons in the United States. A 40% response was obtained; 21.3% of the surgeons stated that they had used endoscopy to treat facial fractures; 33% of them had been in practice for 6 to 10 years, and 47% of those who had used endoscopy in craniofacial trauma were in full-time private practice. In facial fractures, endoscopes were used primarily to treat Le Fort fractures (55.9%), followed by zygomatic arch fractures (52.9%). Lack of accompanying instrumentation, such as appropriate drills, to use with the endoscope via small openings was cited as a significant problem; 46% of the respondents were unable to resolve it. Most respondents (55.6%) felt that if proper accompanying instrumentation were to be developed, endoscopes would become an integral component in the management of craniofacial trauma.

Attitude of Health Personnel↗
PubMed1998

Endoscopic repair of posttraumatic enophthalmos using medial transconjunctival approach: a case report.

A blowout fracture of the medial orbital wall should be suspected when periorbital trauma results in epistaxis, orbital hemorrhage, horizontal dysmotility or dystopia of the globe, and/or orbital emphysema. Large medial orbital wall blowout fractures are frequently complicated by posttraumatic enophthalmos. Clinicians should consider a medial transconjunctival approach for repair of these fractures when surgical repair is indicated by a comprehensive clinical and radiologic orbital evaluation. Excellent cosmetic and functional results can be achieved through the use of an extended transcaruncular incision, rigid endoscope, and high-density porous polyethylene implant placement. The technique can be used in the early, delayed, and late stages of medial orbital wall blowout fracture repair. The technique can be used alone in isolated medial orbital wall fractures or combined with other craniofacial approaches.

Adult↗
PubMed1997

The effects of methylmethacrylate's hyperthermic polymerization on cerebral vascular permeability.

This study was undertaken to analyze the effects of significant hyperthermia (> 100 degrees C) associated with the polymerization of polymethlymethacrylate (PMM) on the permeability of the cerebral vasculature in rats. The method used to visualize the pial vasculature included the open pial window technique and epifluorescence microscopy. Results indicated that there is a significant increase in cerebral vascular permeability following in situ polymerization of PMM over the craniectomy site.

Animals↗
PubMed1997

Intrathecal morphine for postoperative analgesia following repair of frontal encephaloceles in children: comparison with intermittent, on-demand dosing of nalbuphine.

STUDY OBJECTIVE: To determine the efficacy of lumbar intrathecal (i.t.) morphine in a dose of 0.02 mg/kg in providing analgesia following repair of frontal encephaloceles. DESIGN: Prospective, open-label investigation of i.t. morphine with secondary comparison to a retrospective cohort. SETTING: Metropolitan hospital in the Philippines. PATIENTS: 24 ASA physical status I and II children undergoing frontal encephalocele repair. INTERVENTIONS: Following induction of general anesthesia. I.t. morphine (Group 1) was administered via single-shot technique or through a lumbar i.t. drain placed for cerebrospinal fluid drainage during the surgical procedure. Postoperative analgesia was assessed by visual analog score in patients greater than 5 years of age or a behavioral score in patients less than 5 years of age. The retrospective cohort received postoperative analgesia with intermittent doses of intravenous nalbuphine (Group 2). MEASUREMENTS AND MAIN RESULTS: Group 1 had decreased postoperative analgesic requirements, decreased intraoperative inhalational anesthetic requirements, and a longer time to the first request for postoperative analgesia than Group 2. The time to the first request for postoperative analgesia was 16.0 +/- 9.1 hours in Group 1 and 1.6 +/- 1.2 hours in Group 2 (p < 0.0001). Six of 12 patients in Group 1 required no analgesic drugs during the first 24 postoperative hours while all 12 patients in Group 2 (p = 0.02) did require analgesic drugs during this period. The patients in Group 1 who did not require supplemental analgesic drugs maintained pain scores of 2 or less throughout the first 24 postoperative hours. CONCLUSION: Lumbar IT morphine provides effective analgesia following repair of frontal encephaloceles in children and adolescents.

Analgesics, Opioid↗
PubMed1997

Split-thickness calvarial grafts in young children.

Sixteen patients (mean age, 1.9 years) underwent split-thickness calvarial bone grafting using a full-thickness craniotomy, high-speed drill, and osteotomes for bone harvesting. The minimal calvarial bone thickness for a successful graft was found to be 7 mm. All patients were diagnostically studied preoperatively with computed tomographic scans and skull films. The mean follow-up was 2.9 years (range, 0.75-7.9 years). All patients had successful graft take. There were no infections or mortalities. Continued graft growth was seen in all patients. There was one dural tear during harvesting with no cerebrospinal fluid leak or postoperative sequelae. This analysis indicates that split-thickness calvarial grafts can be safely and adequately performed in children as young as 13 months of age.

Bone Transplantation↗
PubMed1997

Analysis of bone formation after cranial osteotomies with a high-speed drill.

Ten New Zealand white 22-week-old rabbits were divided into two groups of five each. The Midas Rex drill with a C-1 drill bit was used to make a full-thickness sagittal osteotomy 2 cm in length. A B-5 bit and footplate attachment were used to make a 2-cm linear osteotomy parallel to the first. Four drill holes 1 mm in diameter were made over the nasal bones on the ipsilateral side. In Group A animals, half of the skull had no irrigation; the other half of the skull was irrigated with room temperature saline. In Group B animals half of the skull was irrigated with iced saline irrigation; the other half of the skull was irrigated with room temperature irrigation fluid, and the osteotomy sites were filled with bone wax. Specimens were harvested at 8 weeks and evaluated grossly and histologically. The results showed that all the drill holes closed in the nasal bones regardless of the type of irrigation used or whether bone wax was used. Iced saline irrigation and room temperature irrigation had similar positive effects on bone formation in contrast to the no-irrigation group, which had inferior bone formation. Bone wax appeared also to have a detrimental effect on bone formation.

Animals↗
PubMed1997

Posttraumatic anosmia in craniofacial trauma.

Although the clinical implications of anosmia can be significant, posttraumatic anosmia is generally given relatively little attention in the clinical setting. Patients who sustain craniofacial trauma are most at risk. The incidence of posttraumatic anosmia varies according to the severity of injury and has an overall estimated incidence of 7%. Factors that increase the risk of developing anosmia include anterior skull base fractures, bilateral subfrontal lobe injury, dural lacerations, and cerebrospinal fluid leakage. Recovery of function has been estimated to be approximately 10%. Time of recovery, if it occurs, varies between 8 weeks and 2 years. Presented herein are the clinical, radiographic, pathophysiologic, and anatomic substrata of posttraumatic anosmia.

Adolescent↗