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Biomedical subjects

D A Leopold

Publications and source records attributed to D A Leopold.

At least 37 records · Page 2Linked to original sources
PubMed1997

Current concepts in the surgical management of chronic frontal sinusitis.

The surgical management of chronic frontal sinusitis has lagged behind that of other sinuses because of a relative infrequency of the disease, the difficulty in diagnosing it, the anatomical complexity of the area involved, an inadequate understanding of the airflow and mucus drainage pathways, the complexity and lack of success of surgical procedures, and the need for advanced equipment. A review of the anatomy, embryology, and physiology of the nasofrontal region is given followed by a summary of the signs, symptoms, and radiologic findings of chronic frontal disease because often the most difficult decision is knowing when to intervene surgically. Finally, there is a discussion of current techniques and recent advances using powered instrumentation in the nasofrontal area.

Chronic Disease↗
PubMed1996

What is rivalling during binocular rivalry?

When different images are presented to the two eyes, they compete for perceptual dominance, such that one image is visible while the other is suppressed. This binocular rivalry is thought to reflect competition between monocular neurons within the primary visual cortex. However, neurons whose activity correlates with perception during rivalry are found mainly in higher cortical areas, and respond to input from both eyes. Thus rivalry may involve competition between alternative perceptual interpretations at a higher level of analysis. To investigate this, we tested the effect of rapidly alternating the rival stimuli between the two eyes. Under these conditions, the perceptual alternations exhibit the same temporal dynamics as with static patterns, and a single phase of perceptual dominance can span multiple alternations of the stimuli. Thus neural representations of the two stimuli compete for visual awareness independently of the eye through which they reach the higher visual areas. This finding places binocular rivalry in the general category of multistable phenomena, such as ambiguous figures, and provides a new way to study the neural cause and resolution of perceptual ambiguities.

Humans↗
PubMed1996

Activity changes in early visual cortex reflect monkeys' percepts during binocular rivalry.

When the two eyes view dissimilar images, we experience binocular rivalry, in which one eye's view dominates for several seconds and is then replaced by that of the other eye. What causes these perceptual changes in the absence of any change in the stimulus? We showed previously that some neurons in monkey cortical area MT show changes in activity during motion rivalry that reflect the perceived direction of motion. To determine whether perception-related modulation of activity occurs in other visual cortical areas, we recorded from individual neurons in V1, V2 and V4 while monkeys reported the perceived orientation of rival gratings of two orthogonal orientations. Many cells, particularly in V4, showed patterns of activity that correlated with the perceptual dominance and suppression of one stimulus. The majority were orientation-selective and could be driven equally well from either eye. It has been previously suggested that binocular rivalry involves reciprocal inhibition between monocular neurons within V1 (for example, see ref. 4), but our results do not support this view; rather, we propose that binocular rivalry arises through interactions between binocular neurons at several levels in the visual pathways, and that similar mechanisms may underlie other multistable perceptual states that occur when viewing ambiguous images.

Animals↗
PubMed1996

Optimal CT evaluation for functional endoscopic sinus surgery.

PURPOSE: To evaluate the optimal parameters for the CT examination of patients who are having functional endoscopic sinus surgery. METHODS: CT scanning was performed on two fresh cadaveric heads in the direct coronal plane, varying the section thickness, intersection gap, scanner gantry angle, and amperage. The nasal cavity and paranasal sinuses were examined independently in a blinded fashion by four staff neuroradiologists and a staff otolaryngologist with special attention to 10 anatomic landmarks within the ostiomeatal unit that are considered important for preoperative planning. A score of 0 (nonvisualization/incomplete visualization) or 1 (clear/complete visualization) was assigned to each of these 10 landmarks. Analysis of variance was used in which reader, subject, and side were simultaneously controlled by "blocking." Multiple comparison methods (ie, Bonferroni) were used to compare the different protocols. RESULTS: We found a significant reduction in the delineation, and therefore the perception, of the ostiomeatal unit structures when the section thickness was greater than 5mm, any intersection gap was used, and the gantry angle was greater than 10 degrees from the plane perpendicular to the hard palate. However, a reduction in the radiation exposure from 200 mA to 80 mA did not affect the display of the anatomic landmarks. CONCLUSION: We found the optimal screening CT protocol for the paranasal sinuses to be a section thickness of 3 mm, no intersection gap, and a section angle within 10 degrees from the plane perpendicular to the palate. Also, owing to inherent contrast between air, soft tissue, and bone in the paranasal sinuses, a reduction in the radiation exposure parameter to 80 mA did not affect image quality.

Endoscopes↗
PubMed1993

Histopathology of olfactory mucosa in Kallmann's syndrome.

Olfactory mucosa was harvested by intranasal biopsy from a man with Kallmann's syndrome in whom the absence of the olfactory bulbs was documented by magnetic resonance imaging. On electron microscopic examination, several pathologic changes were evident in the olfactory mucosa. First, most olfactory neurons lacked cilia (ie, were morphologically immature). Second, the fila olfactoria had fewer than the normal number of axons, and a large proportion of them were apparently undergoing electron lucent degeneration. Finally, neuromatous collections of axons were seen superficial to the basement membrane in the epithelium. Similar changes have been observed in the mucosa of experimentally bulbectomized rodents. Accordingly, a constellation of pathologic changes--axonal degeneration, neuronal immaturity, and the formation of intraepithelial neuromas--seems to be characteristic of olfactory mucosa that cannot innervate the olfactory bulb in both humans and animals. On the basis of our observations, it is worth investigating the status of the olfactory bulb in other forms of human anosmia in which similar morphological changes are observed in the mucosa, such as persistent posttraumatic anosmia and isolated congenital anosmia.

Adult↗
PubMed1992

Evaluation of poly(L-lactic acid) as a material for intravascular polymeric stents.

Poly(L-lactic acid) (PLLA) monofilaments were evaluated for use as intravascular polymeric stents. The PLLA monofilaments were extruded and drawn to different draw ratios. They were then subjected to different thermal treatments and their mechanical properties characterized. Stents constructed with similar monofilaments were tested under hydrostatic pressure, and the results correlated with the properties of the monofilaments. Stent collapse pressure was a decreasing function of stent diameter and filament draw ratio.

Biocompatible Materials↗
PubMed1992

Congenital lack of olfactory ability.

Twenty-two patients, all of whom reported never having been able to smell anything, were studied to determine the particular features that distinguish individuals with congenital anosmia. The clinical evaluation on these patients included a thorough medical and chemosensory history, physical examination, nasal endoscopy, chemosensory testing, olfactory biopsies, and imaging studies. There was no evidence to indicate that these patients ever had a sense of smell. The results of olfactory testing suggested that these patients had an inability to detect both olfactory and trigeminal odorants; however, many of the patients in the group seemed to have a slight ability to perceive at least some component of trigeminal odorants. The olfactory epithelium, if it was present at all on biopsy, was abnormal in appearance.

Adolescent↗
PubMed1992

Pollution: the nose and sinuses.

The nose and sinuses are constantly exposed to the huge quantities of gases needed to maintain life. Not only is the human nose well-equipped to warm and humidify this inhaled air, but it is also uniquely able to clean much of it. Any material other than physiologic amounts of oxygen, nitrogen, carbon dioxide, and water that accompanies the airstream can be considered a pollutant, and this pollutant could potentially injure the individual. The following discussion will review the defense mechanisms that allow the nose and sinuses to protect the lower airways. The effects of pollutants on the respiratory mucosa will then be described, including some recent trends in those effects. These trends include specific population consequences of indoor and outdoor air pollution, and changes in risk for individuals in several occupations. Throughout these discussions, specific areas that would benefit from further research will be mentioned.

Airway Resistance↗
PubMed1991

Successful treatment of phantosmia with preservation of olfaction.

A 26-year-old woman had an 8-year history of phantosmia in her left nostril. The phantosmia could be eliminated by nostril occlusion or cocainization of the olfactory epithelium on the involved side. Because her symptoms and testing suggested a peripheral problem, a full-thickness "plug" of olfactory epithelium from under the cribriform plate (including all the fila olfactoria) was excised. At 5 weeks postoperatively, the phantosmia was completely gone, and her olfactory ability had returned to preoperative levels. Either the removal of abnormal peripheral olfactory neurons from the nose or the interruption of incoming signals to the olfactory bulb eliminated the phantosmia. This form of therapy for phantosmia offers an alternative to more radical procedures such as olfactory bulbectomy and may offer a significant sparing of olfactory ability.

Adult↗
PubMed1991

Disorders in taste and smell.

Although many conditions and medications have been associated with chemosensory disturbances, data from major chemosensory clinical research centers support three major disorders as being causative: nasal and paranasal sinus disease (21%), post-upper respiratory tract viral infection (19%), and head trauma (14%). Despite extensive evaluation, 22% of patients do not demonstrate identifiable causation.

Craniocerebral Trauma↗
PubMed1990

Fish-odor syndrome presenting as dysosmia.

We describe a patient who had perceived an unpleasant odor or taste for at least 20 years. Several other physicians had unsuccessfully treated her for infections, mucus membrane dryness and inflammation, chronic tonsillitis, and psychiatric disorders. Her workup at the State University of New York Health Science Center at Syracuse Olfactory Referral Center included a thorough history, examinations (including endoscopic studies of her nose, pharynx, and lungs), roentgenograms, taste testing, olfactory testing, and selective anesthesia of her chemosensory areas. The perception occurred only during exhalation, and appeared to be binasal. These findings, together with her morning mucus sample having a strong fishlike odor, prompted us to suspect a metabolic problem. Further testing at the Monell-Jefferson Chemosensory Clinical Research Center, Philadelphia, Pa, confirmed that she had trimethylaminuria. It is important to consider this and other treatable conditions when evaluating individuals with olfactory complaints.

Adult↗
PubMed1988

Hospital mortality for otolaryngologic disorders in New York State.

Hospital mortality in New York State during 1983, 1984, and 1985 for diagnosis related groups (DRGs) that addressed principal diagnoses of otolaryngologic disorders was evaluated. Inpatient data from 291 acute care hospitals in the state indicated that 66.6% of hospital mortality for these conditions was produced in a single category, DRG 64--Ear, Nose, and Throat Malignancy (treated medically). Other otolaryngologic DRGs that were sources of hospital mortality in New York State addressed otitis media and upper respiratory tract infections for elderly persons and patients with complications who were treated medically, a wide range of ear, nose, and throat diagnoses that were treated medically, major head and neck surgical procedures, and a wide range of other surgical procedures for malignant neoplasms. This information should contribute to the evaluation of disease trends that cause mortality in individual hospitals, statewide and nationwide, as well as to efforts at evaluation of quality of care in otolaryngology.

Adolescent↗
PubMed1988

The relationship between nasal anatomy and human olfaction.

The relationship between nasal anatomy and olfactory ability was evaluated by correlating measurements from nasal cavity CT scans with the results of an established clinical measure of olfactory function (Odorant Confusion Matrix, or OCM). The most appropriate mathematical model of this relationship was developed by analyzing the logarithms of 30 anatomical measures and a logistic transform of the OCM percent correct score. Two nasal cavity regions were found to be the most important factors in accounting for the olfactory test results, with a third region modifying the effects of the first two. The results of this study suggest that nasal anatomy may play a role in controlling the access of an odorant to the olfactory receptor area. The conclusions of this study have implications for nasal surgeons who, when possible, should make attempts to repair or preserve these nasal regions which seem to be so important to olfactory function.

Humans↗
PubMed1987

Airflow patterns in a human nasal model.

Nasal airflow patterns were studied by using xenon 133 gas to image the course taken by air as it flowed through a plastic model of the human nasal cavity. The model was produced from the head of a human cadaver, and was anatomically correct. A needle catheter was used to infuse the radioactive xenon into a continuous flow of room air maintained through the model by a variable vacuum source connected to the nasopharynx. The radioactive gas was infused at one of five release sites in the nostril, and the distribution of the radioactivity was imaged in the sagittal plane with a scintillation camera. The data were organized to show the activity in six contiguous regions of the midnose. For each catheter, release site activity patterns were determined for three flow rates. The results of this experiment showed that both catheter position and flow rate had significant and reproducible effects on the distribution of radioactivity within the model.

Catheterization↗
PubMed1986

Patterns of otolaryngologic surgery utilization in Syracuse, NY.

Utilization of otolaryngologic surgical procedures performed in Syracuse, NY, during 1983 and 1984 was evaluated. Both inpatient and outpatient procedures were included; classification was according to diagnosis related groups. The system-wide portion of the analysis demonstrated that 62.5% of otolaryngologic operations carried out during the study were performed in outpatient settings. Total utilization was highest for myringotomies, tonsillectomies, and adenoidectomies, over 80% of which were performed on an outpatient basis. The program-specific portion of the analysis indicated that the highest volumes for these procedures were produced by a free-standing ambulatory surgery program with dedicated facilities and staff. However, a hospital-integrated program, which made use of inpatient resources, also served a majority of total hospital cases for several types of procedures.

Adenoidectomy↗
PubMed1985

Components of the alternative pathway of complement in otitis media with effusion.

An evaluation of the alternative pathway of complement was undertaken in patients with otitis media with effusion (OME). Middle ear fluid (MEF) and serum specimens were obtained from 34 patients at the time of elective myringotomy for OME. Bacterial, viral, and mycoplasma cultures were made for all specimens of the fluids. Immunochemical determinations by radial immunodiffusion were performed for C3, C5, factor B, properdin, factor H, factor I, and albumin. Each patient's recent clinical course and past history were reviewed. The results of all viral and mycoplasma cultures were negative. Three of 55 bacterial cultures were positive for type B Haemophilus influenzae. All components of the alternative pathway measured were found to be present in varying amounts in MEF. When the levels of the complement components were compared to the clinical factors studied, there were no observable differences. These data suggest that components of the alternative pathway of complement are present in OME and are not useful in predicting the clinical course or outcome of this disorder.

Adolescent↗