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Biomedical subjects

C Sen

Publications and source records attributed to C Sen.

At least 55 records · Page 3Linked to original sources
PubMed1995

Management of anterior ethmoid and frontal sinus tumors.

This article has focused on the management of anterior ethmoid and frontal sinus tumors by the otolaryngologist-head and neck surgeon. It emphasizes surgical treatment and describes clinical "pearls and pitfalls" for both the resident and senior clinician. The opinions that we have formulated and that we present herein are based on experience with over 100 cases of tumors of the paranasal sinuses. During this experience, we have utilized and initiated a variety of surgical and reconstructive techniques. Only those that have consistently afforded the best anatomic exposure, surgical flexibility, and reconstructive reliability have been high-lighted and confidently recommended.

Chemotherapy, Adjuvant↗
PubMed1994

Craniofacial resection. An analysis of 73 cases.

OBJECTIVE: To determine the morbidity and mortality associated with a large series of patients undergoing craniofacial resection at one institution. The series is also analyzed with respect to pathology, disease recurrence, and role of adjuvant therapy. DESIGN: Retrospective review with a mean follow-up of 3 years (range, 6 months to 8 years). SETTING: Tertiary care, urban referral center. PATIENTS: The study included 73 consecutive patients (39 male and 34 female). Ages ranged from 13 to 78 years with a mean of 53.1 years. All patients had benign or malignant tumors of the paranasal sinuses. MAIN OUTCOME MEASURES: Morbidity associated with craniofacial resection was categorized as follows: early (within 30 days of surgery) or late (> 30 days); neurologic, ocular, or infectious. RESULTS: Overall morbidity rate was 63%, and the mortality rate was 2.7%. Of the patients who had complications develop, 26 had development of major morbidities and there were two mortalities. The most common complications were transient alteration in mental status (15 patients), diplopia (11 patients), cerebrospinal fluid leak (10 patients), and osteomyelitis of the frontal bone flap (eight patients). CONCLUSIONS: Craniofacial resection is an effective surgical treatment for paranasal sinus tumors. The mortality rate is acceptable and morbidity appears directly related to experience with the procedure. Infectious complications were the most devastating.

Adolescent↗
PubMed1994

Treatment of paranasal sinus cancer with cranial base surgery: results.

Paranasal sinus cancer has been difficult to treat with surgery. A significant negative factor has been the high frequency of tumor-positive surgical margins. The goal of this study was to evaluate the effectiveness of cranial base surgery in achieving higher tumor-free resective margins and its impact on the disease control. Fifty patients with paranasal sinus cancer were treated with cranial base surgery and retrospectively evaluated. Surgery was performed for both primary and recurrent disease ("salvage"), with more than half of the surgeries being salvage procedures. The survival at 40 months of mean follow-up is 74%, and 64% of the patients either have no evidence of disease (NED) or have died of other causes (DOC). Cranial base surgery is an effective treatment of paranasal sinus cancer. The ability to achieve tumor-free surgical margins (77% in squamous cell carcinoma [SCC]) is directly related to NED status (75% of NED patients had free margins).

Adenocarcinoma↗
PubMed1994

Cranial base surgery: results in 183 patients.

OBJECTIVE: To learn about the effects of cranial base surgery. DESIGN: Cohort study with a mean follow-up of 30 months. SETTING: Population-based. PATIENTS: A consecutive sample of 183 patients who underwent cranial base surgery; 118 patients had malignant skull base tumors, the majority of which were previously treated; 50 had benign tumors; 9 had congenital malformations of the skull base; 3 had inflammatory lesions, and 3 had traumatic defects of the skull base. MAIN OUTCOME MEASURES: Disease-free interval, overall survival, and rate of complications and functional status. INTERVENTION: Cranial base surgery was followed by radiotherapy (in previously untreated patients). RESULTS: After completion of follow-up (mean, 30 months), 30 (25.4%) patients had died of their malignant tumors and 8 (6.8%) had died of other causes. One patient (0.84%) was lost to follow-up. The overall cancer survival rate without regard to histologic type was 67% (63% with no evidence of disease). Among the patients who were treated for benign neoplasm, 72% had no evidence of disease at a mean follow-up of 39 months. The group of patients with congenital malformations and inflammatory and traumatic lesions demonstrated successful correction of their presurgical problem with skull base surgery. One patient (who had invasive aspergillosis) died of disease. The overall surgical-medical mortality rate was 2%; the complication rate was 33%, and the Karnofsky performance score was improved or unchanged after surgery in 83% of patients. The average duration of surgery, number of blood transfusions used, and length of the hospital stay were 10 hours, 3 units, and 15 days, respectively. CONCLUSIONS: Cranial base surgery is a valid surgical technique for treatment of cranial base afflictions. In this study it was found to be beneficial in controlling benign and malignant disease and to be the treatment of choice for selected congenital malformations, trauma, and inflammatory lesions.

Adolescent↗
PubMed1994

Management of the eye after iatrogenic facial paralysis.

The aesthetic and functional morbidity associated with facial palsy is significant. Fortunately, corneal exposure and ulceration with the potential for the loss of visual acuity can be minimized by eyelid procedures such as gold weight implantation and horizontal eyelid shortening. Although primarily designed for restoration of eyelid function, these procedures also improve ocular cosmesis. However, uncertainty remains regarding the indications for eyelid surgery: When should surgery be performed, in whom, and which procedure(s)? On the basis of our series of 60 patients evaluated for facial paralysis, guidelines for the management of the paralyzed eyelids after iatrogenic injury to the facial nerve are proposed.

Corneal Ulcer↗
PubMed1994

The value of antithrombin-III and fibronectin in hypertensive disorders of pregnancy.

In this study we evaluated fibronectin as a marker of endothelial cell injury and antithrombin III as a marker of chronic activation of intravascular coagulation. The aim of the study was to establish to normal trends of plasma antithrombin III and fibronectin in general obstetric population and to determine the value of both in predicting, distinguishing and understanding the pathophysiology of pregnancy induced hypertension. The all cases consisted of 173 pregnant, 19 of them were chronic hypertensive, 45 were pregnancy induced hypertensive and 119 were normotensive at blood sampling. Out of 119 normotensive cases, 109 cases had no adverse outcome during their pregnancy. These cases were used as a control group and for the normal trends of antithrombin III and fibronectin in general obstetric population. Ten out of 119 cases who developed preeclampsia during follow up, 19 cases with chronic hypertension and 45 cases with pregnancy induced hypertension consisted of the study group. In the cases who developed preeclampsia during follow up, the value of plasma fibronectin level (above 95% confidence limit for that gestational week) to predict preeclampsia had 90% sensitivity and 94.4% specificity. In distinguishing hypertensive disorders of pregnancy (chronic hypertension or pregnancy induced hypertension) fibronectin had 71.1% sensitivity and 100% specificity. Plasma antithrombin III level (of antigenicity) measured by immunodiffusion method had no value in predicting and distinguishing pregnancy induced hypertension.

Antithrombin III↗
PubMed1994

Neurosurgical management of the rheumatoid cervical spine.

Rheumatoid arthritis affects the cervical spine in up to 88% of patients with seropositive disease. Neurologic sequelae result either from direct compression by a rheumatoid pannus or from spinal subluxations. Indications for and techniques of neurosurgical intervention are discussed.

Arthritis, Rheumatoid↗
PubMed1994

New approach for operative management of vascular lesions of the infratemporal internal carotid artery.

Direct operative management of aneurysms of the internal carotid artery is associated with significant morbidity. Preauricular surgical approaches to this area can result in violation of the inner ear, temporomandibular joint, or mandibular ramus, and cranial nerves V, VII, IX, X, XI, and XII. A new technique for saphenous vein bypass of the infratemporal and petrous internal carotid artery, using a postauricular curvelinear groove drilled in the mastoid cortex, is described. Proximally, the reverse vein graft is anastomosed to either the internal or external carotid artery, whereas the distal anastomosis is to the horizontal petrous internal carotid artery. The latter is accessed through a small pterional craniotomy. The internal carotid artery is then ligated between points of anastomosis, thus isolating the lesion and eliminating dissection in the infratemporal fossa. The posterior location of the vein graft also avoids potentially infected areas adjacent to the oropharynx, nasopharynx, and soft tissues of the face. Use of the external carotid artery decreases carotid cross-clamp time and minimizes graft length, and creation of a bony canal protects the graft from subsequent compression and kinking.

Adult↗
PubMed1993

Assessing collateral cerebral perfusion with technetium-99m-HMPAO SPECT during temporary internal carotid artery occlusion.

Cerebral infarction following internal carotid artery occlusion results from either embolism or inadequate collateral blood flow. Although risk of embolism can be minimized, detecting compromised collateral circulation is more difficult. Cerebral angiography, carotid stump pressures and clinical evaluation during internal carotid artery occlusion are of limited utility. Xenon-133 radionuclide studies and stable xenon computed tomography are not readily available. We evaluated 99mTc-HMPAO SPECT, during temporary carotid artery occlusion, in 20 patients considered for internal carotid artery occlusion. Fourteen demonstrated symmetric cerebral perfusion during occlusion; eleven underwent transient and three had permanent carotid artery occlusion without complications. Five patients had ipsilateral globally decreased perfusion during temporary occlusion. One patient underwent transient occlusion of this vessel and one underwent carotid sacrifice without bypass grafting; both recovered without sequelae. The three remaining patients underwent carotid artery bypass grafting prior to sacrifice of this vessel. One patient with a small focal perfusion defect underwent carotid artery sacrifice without bypass grafting and developed acute neurologic deficits postoperatively. These initial results suggest that symmetric cerebral perfusion during temporary occlusion indicates that internal carotid artery occlusion will be tolerated. Although its implications are not yet well defined, the abnormal study identifies patients potentially at risk for postocclusion complications, thus providing a basis for neurosurgical management.

Adolescent↗
PubMed1992

The predictive value of fetal heart rate monitoring: a retrospective analysis of 2165 high-risk pregnancies.

The predictive value of fetal heart-rate monitoring on fetal well-being was studied in 2165 high-risk pregnancies. 1883 reactive nonstress test (NST) patterns and 278 nonreactive NST patterns and 4 cases of sinusoidal pattern were obtained. Oxytocin challenge test (OCT) was applied to 263 nonreactive cases. OCT was not applied to 15 cases out of 278 nonreactive NST cases, because of placenta previa, abruptio placenta and previous cesarean section. There were 155 cases with negative OCT, 84 cases with positive OCT and 24 cases with equivocal, prolonged or severe variable decelerations. Sensitivity and specificity were for NST 50 and 88% and for OCT 60 and 67%. The positive and negative predictive values were 11 and 98% for NST and 18 and 93% for OCT. It is concluded that the reactive nonstress test is a reliable test for good outcome but a positive oxytocin challenge test is not a reliable test for poor outcome. Additional procedures are necessary such as assessment of fetal growth, doppler velocity waveforms and fetal biophysical profile to avoid unnecessary obstetric interventions and to reach good fetal outcome.

Adolescent↗
PubMed1992

FHR monitoring and perinatal mortality in high-risk pregnancies.

The aim of the study was to evaluate the effect of the introduction of fetal heart rate monitoring on perinatal mortality rates in high-risk pregnancies. Results were compared with the perinatal mortality rates published previously from our clinics. The study group consisted of 2165 high-risk pregnant patients. The perinatal mortality rate in the study group was 28.6%, and the corrected rate 15.9%. The rates were significantly lower in comparison with the total perinatal mortality rates in former years. We are convinced that fetal heart-rate monitoring resulted in a significant decrease in the perinatal mortality rate. Although the increased use of fetal monitoring cannot reduce perinatal mortality resulting from problems such as genetic disorders, this study shows improved outcomes for many high-risk conditions, in particular postmature pregnancies.

Adolescent↗
PubMed1992

Chondrosarcomas of the skull base: MR imaging features.

The magnetic resonance (MR) images from 17 patients with chondrosarcomas of the skull base were retrospectively reviewed to characterize the size, location, signal intensity, and extension of these tumors. Eleven patients with chondrosarcomas received intravenously administered gadopentetate dimeglumine. In 16 patients, computed tomographic (CT) scans were obtained to evaluate intratumorous mineralization and bone erosion. On short repetition time (TR)/echo time (TE) MR images, chondrosarcomas generally had low to intermediate signal intensity; on long TR/TE MR images, they generally had very high signal intensity. Signal heterogeneity on long TR/TE MR images was seen in 10 of 17 tumors (59%) and was caused by matrix mineralization, fibrocartilaginous elements, or both. Matrix mineralization was demonstrated with CT in seven of the 16 chondrosarcomas. Chondrosarcomas showed marked enhancement after administration of gadopentetate dimeglumine in either a heterogeneous (n = 8) or homogeneous (n = 3) pattern. The information about the size and extent of these neoplasms was important in the choice of surgical approaches for gross total resection of tumor.

Adult↗
PubMed1992

Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases.

The authors report a series of 30 patients who underwent reconstruction of the internal carotid artery (ICA) at the skull base with the saphenous vein during the surgical management of lesions at the cranial base. This group represents about 9% of the total patients in whom the ICA in the cavernous or petrous segment was manipulated either during the surgical approach or dissection from the tumor. Two of these patients failed a clinical balloon test occlusion of the ICA, and, in 9 patients, cerebral blood flow during balloon test occlusion dropped to between 15 to 30 ml/100g/min. The patency rate is 86% over a mean follow-up time of 18 months. Of the 4 patients with graft occlusion, 3 were asymptomatic. The fourth patient who suffered ICA dissection with graft occlusion subsequently died from a massive cerebral infarction. Three patients with inadequate collateral circulation sustained minor strokes as the result of the temporary ICA occlusion during the grafting, but all are capable of leading independent lives. Two patients suffered acute graft occlusion within 12 hours of the surgery and underwent successful revision of the graft. None of the grafted patients suffered delayed occlusion or ischemic or embolic problems. The patients with malignant tumors died within 2 years of the operation from the original disease; total tumor removal was accomplished in 14 of the 19 patients with benign tumors. The aneurysms were successfully eliminated in all 5 patients. The lessons learned from this experience are discussed.

Adolescent↗
PubMed1991

Complications of preoperative balloon test occlusion of the internal carotid arteries: experience in 300 cases.

Treatment of some tumors and aneurysms of the skull base may require internal carotid artery (ICA) sacrifice. Preoperatively to determine the dependence of the cerebral blood flow on a particular vessel, we perform a balloon test occlusion (BTO) by temporarily occluding the vessel in an awake patient. During occlusion, clinical evaluations and cerebral blood flow measurements are assessed. We have performed 300 BTOs. Eleven patients (3.7%) have had complications. Six (2%) were asymptomatic dissections. Five (1.7%) had neurologic deficits that persisted beyond the test period. Of these five, one was back to baseline in less than 24 hours, one recovered completely in a week, and one (0.33%) had a minimal but persistent dysphasia. These latter three cases are unexplained but might have resulted from unrecognized dissections or embolic events. Finally, one patient with a persistent deficit required energency surgery for reasons unrelated to the BTO and was therefore difficult to assess, and one required emergency middle cerebral artery embolectomy and repair of the dissection. The preoperative knowledge of carotid dependence in cases in which the ICA is at risk is essential, since vascular grafts or alternative surgical approaches are necessary in patients unable to tolerate carotid sacrifice. Since approximately 15 to 20% of the population falls into this category, a preoperative BTO appears justified.

Journal Article↗
PubMed1990

Modern strategies for treatment of acute myocardial infarction: significance of haemostaseological and rheological findings.

In spite of equivalent clinical efficacy of various thrombolytic agents for the treatment of acute myocardial infarction there is evidence of different drug-depending influences on the haemostatic and fibrinolytic system. In the present study 40 patients with acute myocardial infarction have been investigated. 20 patients received 750,000 and 1.5 mio U streptokinase (SK), respectively, 10 patients 30 mg anisoylated plasminogen streptokinase activator complex (BRL 26921) and 10 patients a combination of 200,000 U urokinase (UK) and 4.5 mio U pro-urokinase (PUK) as a short-term intravenous treatment. Reperfusion of coronary arteries has been achieved in 70 to 100 percent. Major not fatal bleedings occurred in 2 patients. One patient died within 72 hours after beginning of the myocardial infarction. The longest duration of fibrinolytic activity was observed in the BRL 26921 group (half-disappearance time close to 2 h). It was significantly shorter in the SK groups showing a dose-dependency. Plasma concentration of fibrinogen dropped beyond normal levels following SK and BRL 26921, but not under UK/PUK. Plasma viscosity correlated with fibrinogen decrease and displayed a dose-depending relationship with the presence of SK. Haemorheological effects are suggested to be important for the clinical efficacy of thrombolytic therapy in myocardial infarction.

Anistreplase↗
PubMed1988

Ulnar neuropathy caused by fat necrosis with cystic myxoid degeneration at the upper forearm: case report.

The case described is thought to be the first report of ulnar neuropathy caused by a cystic myxomatous degeneration of fat necrosis. The 12-day preoperative duration of symptoms is also the shortest reported for nontraumatic ulnar neuropathy; the average period between onset of symptoms and operation is 10 months. At operation, the patient's nerve was found to be stretched severely over the tumor, which was excised, thus decompressing the ulnar nerve. The procedure relieved the patient's symptoms of tingling and numbness, and he remained asymptomatic at the 12-month follow-up examination.

Aged↗