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Biomedical subjects

H R Konrad

Publications and source records attributed to H R Konrad.

At least 19 recordsLinked to original sources
PubMed1992

Rehabilitation therapy for patients with disequilibrium and balance disorders.

Vestibular rehabilitation is based on the use of adaptive and compensatory mechanisms already existing in the human brain. Research using animals provides a great deal of information on the neural mechanisms responsible for these functions and suggests strategies that should be helpful in rehabilitation of patients with disequilibrium and balance disorders. Research in animals and human beings suggests that rehabilitation should be specifically designed, depending on the patients' deficits. It also suggests that to be effective it needs to be started soon after impairment and that vestibulosuppressive medication may reduce recovery. Studies are now underway to evaluate the effectiveness of vestibular rehabilitation on several groups of patients and to answer some fundamental questions about the mechanisms and the effectiveness of these treatment methods. Current information suggests that vestibular rehabilitation is an effective method of therapy for many patients with disequilibrium and balance disorders and that for some patients it is the best therapy available.

Animals↗
PubMed1979

Tracheal carcinoma after tracheostomy.

The trachea is rarely the site of origin of a primary malignant tumor. Causal factors have not been determined, but cigarette smoking is one suspected cause. We report an unusual case of tracheal carcinoma that occurred many years after permanent tracheostomy for benign disease, and we review other cases of posttraumatic tracheal cancer. This study suggests that trauma can be a factor in the development of certain malignant tumors of the trachea.

Carcinoma, Squamous Cell↗
PubMed1979

Pediatric otoscopy and photography of the tympanic membrane.

A further miniaturization of the lens telescopes (Hopkins Rod) has resulted in a telescope (length, 6 cm; diameter, 2.7 mm) that is suitable for pediatric otoscopy. The adaptation of otoscopic specula, a lightweight motor-driven remote flash camera, and movie and video photography to this telescope has resulted in a system that represents a significant advance in the examination of the ear. In this study, we document ear diseases in children with the use of color photographs.

Child↗
PubMed1979

Immediate postembolization excision of glomus jugulare tumors: advantages of new combined techniques.

Preoperative percutaneous transfemoral catheter embolization of feeding vessels in glomus jugulare tumors, followed by immediate application of standard surgical techniques, presents the treatment of choice, allowing meticulous microsurgery with virtually complete hemostasis. Therefore, the surgeon can operate in a bloodless environment throughout the compressed and intricate anatomic field, amidst such important yet vulnerable structures as cranial nerves, inner ear, carotid artery, jugular bulb, venous sinuses, and dura, while reducing surgical error and functional deficit for the patient. Review of the last 11 cases of glomus jugulare tumors at UCLA shows that even extensive Alford grade 2 tumors of the middle ear, jugular bulb, and mastoid had only minor blood losses with this combined technique of embolization-immediate surgery, as compared with earlier surgical methods. Pertinent literature on glomus jugulare and its treatment is reviewed. Combined embolization and immediate surgery offer the best approach for treatment of resectable glomus jugulare tumors.

Adult↗
PubMed1978

Epidermoid carcinoma of the palate.

A retrospective study was made of 80 cases of epidermoid carcinoma of the palate that were treated at the UCLA Center for the Health Sciences between 1955 and 1977. Tumor size larger than 3 cm, extension to neighboring structures, and contralateral, bilateral, and "fixed" lymph node metastases substantially decreased survival. The presence of ipsilateral nodes and the modality of treatment used (surgery or irradiation) did not appear to affect the outcome. Three-year cure rates for all cases was 40%. Ninety percent of recurrences took place during the first two years after treatment, and additional cancers developed in the upper aerodigestive tract of 20% of the patients.

Adult↗
PubMed1978

Lethal thyroid carcinoma.

Forty-three patients who died of thyroid carcinoma (29 well-differentiated and 14 poorly differentiated tumors) were evaluated to define the parameters that affect the lethal nature of this tumor. Differentiated, limited extent of tumor and a young age at diagnosis correlated favorably with length of survival. Sex showed a trend in favor of female patients, while specific histologic characteristics and extent of resection showed no positive correlation. Based on these findings and a review of the literature, we recommend a radical approach in the management of localized, poorly differentiated tumors. For well-differentiated cancer, resection of the thyroid gland and the paratracheal, jugular, and upper mediastinal lymph nodes is advised.

Adenocarcinoma↗
PubMed1977

Transpalatal approach to deeper cranial structures.

The approach to deep midline cranial structures is technically difficult. The transpalatal approach has a relatively wide exposure as compared to the transnasal, transantral and transethmoidal approches. The added advantage of a medial approach which follows medial landmarks and the flexibility of being able to extend exposure to the maxillary sinuses and pterygomaxillary space makes this an attractive approach for large lesions in the nasal passages, nasopharynx and sphenoid sinuses. Large mucoperiosteal flaps, care to avoid the palatine vessels, and application of palatal splint postoperatively, minimize complications and patient discomfort. The authors have used this approach to repair nasopharyngeal atresia, remove nasopharyngeal angiofibromas, approach the pituitary, craniopharyngioma and isolated sphenoid sinus opacification as well as sphenoid sinusitis with cavernous sinus thrombosis.

Biopsy↗
PubMed1977

Childhood myxomas of the head and neck.

Childhood myxomas of the head and neck are rare, benign, locally invasive tumors. They present great difficulties in histological diagnosis and because of their tendency to recur, present great difficulties in treatment. The combination of vital structures in the head and neck and longevity in children places the head and neck surgeon in a difficult position when determining how radical treatment should be. From a review of the literature and our own experience with four cases, the treatment of choice was found to be surgical resection with tissue margins checked by frozen section and modified by consideration of function and cosmetic appearance. Recurrence occurs in approximately one-third of these patients, but careful longterm follow-up will aid in early detection and local re-excision.

Adolescent↗
PubMed1976

Cerebellar-pontine angle tumors. Results of quantitative vestibulo-ocular testing.

A new quantitative vestibulo-ocular test battery was evaluated in 12 patients with surgically confirmed cerebellar-pontine angle tumors. The battery consisted of precise vestibular and visual stimuli and digital computer analyses of responses. Eleven of 12 patients, including all patients with acoustic neurolemmomas, had significant vestibular deficits on the tumor side (P less than .01). Contrary to previous reports, rotatory tests (impulse and sinusoidal acceleration) reliably identified the side and magnitude of vestibular deficit. Eight of nine patients with surgically confirmed brain stem compression had significantly impaired smooth pursuit (P less than .05). Optokinetic nystagmus was impaired in five of nine patients with brain stem compression (P less than .05). By combining the results of the entire test battery with standard clinical evaluation, a good prediction of tumor size, location, and type was possible.

Adolescent↗
PubMed1976

Myxomas of the head and neck.

Myxomas are benign mesenchymal tumors that occur rarely in the head and neck. When they do occur, they are prevalent in the jaws and occur less frequently in the subcutaneous tissues. We report ten new cases and review the clinical, structural, and behavioral characteristics of myxomas arising in various head and neck locations. All ages are affected. The most common initial complaint is the presence of a slow-growing mass. The sarcomas, especially liposarcomas and fibrosarcomas, rank high in the differential diagnosis of myxomas. These tumors are stubborn infiltrators. When a capsule is present, it is usually incomplete and insufficient to contain the tumor. Treatment is by wide surgical excision. The high recurrence rate previously reported is probably due to incomplete excision and is higher when enucleation or curettage are used. Long-term follow-up is mandatory since recurrences may develop several years after treatment.

Adolescent↗
PubMed1976

Porencephalic cyst of the mastoid.

A 10-year-old boy developed a porencephalic cyst of the mastoid in conjunction with otitic meningitis and cerebrospinal otorrhea. A defect of the tegmen tympani allowed extrusion of the cyst into the antrum and the mesotympanum. The otorrhea was controlled by closure of the defect. Our review of 251 cases in the literature showed no prior incidence of mastoid involvement by a porencephalic cyst.

Brain Diseases↗
PubMed1976

Periodic alternating nystagmus.

Three patients with periodic alternating nystagmus (PAN) are described in detail. Digital computer methods were used to quantify their disordered eye movement in an attempt to understand the pathophysiology. One of the patients was unusual in showing rebound nystagmus with fixation and PAN without fixation. Each patient had hyperactive vestibular responses and the phase and gain of the PAN cycles were altered in a predictable fashion by vestibular stimuli. It is postulated that PAN represents cyclical firing between reciprocally connected groups of inhibitory neurons within the vestibular and oculomotor nuclei. The cyclical firing is initiated by a critical imbalance of tonic input to either group of normally functioning neurons.

Adult↗
PubMed1976

The sternomastoid "tumor" of infancy.

The sternomastoid "tumor" of infancy is a firm, fibrous mass, appearing at two to three weeks of age. It may or may not be associated with torticollis. Generally, the "tumor" initially grows, then stabilizes, and in about half the cases recedes spontaneously after a few months. It may leave a residual torticollis or may be associated with a facial or cranial asymmetry of a delayed torticollis. The etiology is unknown, a direct cause and effect relationship to birth trauma has been largely disproved although approximately half these children are products of breech deliveries. The treatment is controversial. Approximately half of these "tumors" will resolve spontaneously without sequelae. Progressive torticollis or development of facial asymmetry are considered indications for surgery. The purpose of this report is to acquaint the head and neck surgeon with this entity which may confront him for diagnosis and treatment.

Head and Neck Neoplasms↗
PubMed1975

The saccade velocity test.

Scatter plots showing the amplitude versus velocity (maximum and average) relationship of horizontal saccades in 25 normal subjects and four groups of patients were statistically compared. Three patients with "subclinical" medial longitudinal fasciculus syndromes had significant slowing of adducting saccades, and two of these patients had unsuspected slowing of abducting saccades (although to a lesser degree). Five patients with olivopontocerebellar degeneration and three patients with myotonic dystrophy had significant slowing of saccades in both directions. Five patients with surgically documented acoustic neuromas did not have significant slowing despite brain-stem compression in three. It is concluded that the saccade velocity test can be a useful clinical tool in addition to its potential in clinical research.

Adult↗
PubMed1975

Vestibulo-ocular function in patients with cerebellar atrophy.

Eye movement abnormalities were quantiatively assessed in four patients with clinically pure cerebellar atrophy (group A), six patients with brainstem plus cerebellar atrophy (group B), and five patients with Friedreich's ataxia (group C). Twelve patients had one or more types of spontaneous nystagmus; eight gaze nystagmus, three rebound nystagmus, wo positional nystagmus, and one vestibular nystagmus. Catoric-induced and rotatory-induced nystagmus was hyperactive in group A and diminished in group C. Group B had mixed responses. All patients demonstrated significant fixation instability and impaired smooth pursuit. There was dysmetria of voluntary saccades, with flutter and "rebound" saccades. Nine of 15 patients had significant slowing of induced saccades, including two patients in group A. It is concluded that quantitative vestibulocular tests can be useful in classifying the cerebellar atrophy syndromes.

Cerebellar Ataxia↗