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Biomedical subjects

H Ramsay

Publications and source records attributed to H Ramsay.

At least 37 records · Page 2Linked to original sources
PubMed1998

Epitympanic diaphragm in the new-born.

A series of 80 temporal bones included four specimens from infection-free new-born children. The microdissections showed that the epitympanic diaphragm in the new-born consists, in addition to the position fixed ligamental folds and ossicles, of only two position changing duplicate folds. These were the lateral incudomalleal fold, separating the upper and lower lateral attics, and the tensor fold, separating the anterior epitympanum from the supratubal recess. All other duplicate folds present during the fetal development had disappeared, a finding in accordance with the study on fetuses by Hammar in 1902 and with our own microdissection findings in normal adult temporal bones. Folds in other locations, even if until lately considered as participants of a normal epitympanic diaphragm, are of inflammatory origin.

Ear Ossicles↗
PubMed1998

Lateral and anterior view to tensor fold and supratubal recess.

HYPOTHESIS: The aim of this study was to find suitable methods for basic anatomic evaluation of the supratubal recess and the anterior surface of the tensor fold. BACKGROUND: The current method of superior microdissection via the middle fossa floor provides a good picture of the anatomy and pathology of the epitympanum, but the supratubal recess can be evaluated only after excision of the tensor fold. Postinflammation changes cannot be examined accurately because destruction of the tensor fold necessarily alters the anatomic details. METHODS: Eight temporal bones were studied via a lateral and 14 via an anterior approach, both complemented by the superior microdissection. Data on 51 earlier superior dissections were reevaluated as to the state of the supratubal recess. Histology was documented from eight biopsy specimens and of four serially sectioned temporal bones, two normal and two infected. RESULTS: The lateral route offered a good view to the tensor tendon and lower portion of the tensor fold, but the anterior malleal ligament obstructed the view to the fold's upper portion. The anterior route offered excellent visibility to the anterior pouch, mesotympanum, tensor fold, and the whole supratubal recess. The tensor fold was mostly fixed superiorly to the bony roof with a narrow or broad soft band of composite tissue, infrequently to the transverse crest directly. Inflammatory changes spread from the tympanic isthmus region to the supratubal space over the fold and, if extensive, formed broad inflammatory and scar tissue bands between the fold and the anterior bony wall. CONCLUSIONS: The supratubal recess and the mesotympanum can best be evaluated via the anterior approach, which should be added to the temporal bone microdissection program. It serves well as the starting route, followed by the conventional superior dissection of the epitympanum. The knowledge gained is indispensable in surgery for chronic otitis media for creation of a large common middle ear air space and functioning aeration pathways.

Culture Techniques↗
PubMed1997

Tensor fold and anterior epitympanum.

HYPOTHESIS: The aim of this study was to investigate the anatomy and pathology of the anterior epitympanum and of the tensor fold. BACKGROUND: Early studies reported data that are primarily still relevant, but contemporary reports present conflicting data, including several erroneous concepts. METHODS: Fifty-one temporal bones were dissected, and the anatomic details were photographed in 42 normal and nine infected bones. Histology was documented from seven serially sectioned bones, five normal and two infected. RESULTS: The tensor fold formed the frontal wall of the anterior epitympanum between tensor tendon and attic bony wall, the anterior insertion consisting of composite connective and fatty tissue with some bone trabeculae. The transverse crest was posterior to it and extended from the anterior tympanic spine to the facial canal. The tensor fold angle in 78% of the specimens was between 45 degrees and 80 degrees, seldom horizontal, and the size of the supratubal recess (or space) increased as the fold angle increased. In 14 ears (27%) the fold had a membrane defect connecting the two spaces. Blockade of the tympanic isthmus caused inflammatory obliteration of the anterior epitympanum when the tensor fold was intact. CONCLUSIONS: The anterior epitympanum, a closed space around the anterior half of the head of the malleus, is normally closed by an intact tensor fold, but about one fourth of ears may show membrane defects. Aeration occurs via the tympanic isthmus through a constriction formed by the head of the malleus with the medial attic wall. In surgery for ears with epitympanal pathology, incus transposition should be combined with resection of the thin portion of the tensor fold for safeguarding permanent attic aeration.

Humans↗
PubMed1996

A simple technique for introducing anterograde and retrograde tracers into the vestibular and cochlear sensory organs.

The standard method for labeling the afferent and efferent innervation of the cochlear and vestibular sensory organs is by microinjection of tracer substances into the labyrinth. Injection of small amounts of tracer often result in incomplete and inconsistent labeling, but large injections can cause spurious labeling of brainstem structures due to diffusion from perilymph to cerebrospinal fluid. Effective labeling with minimal artifact can, however, be achieved by a relatively simple method involving placement of a tracer-saturated pledglet of gelatin sponge in the round window after rupture of its membrane. The gelatin sponge simultaneously acts as a continuous-release vehicle for the tracer and prevents reflux of perilymph and tracer into the middle ear cavity. Use of this technique produces labeling with a degree of intensity and anatomic detail that rivals that seen with more complicated methods of tracer placement.

Animals↗
PubMed1996

Prussak's space revisited.

Thirty temporal bones were dissected under the operating microscope, and four whole temporal bone specimens were studied by light microscopy for evaluation of the lateral malleal space and Prussak's space. In all specimens Prussak's space showed a blind end toward the anterior pouch and communicated with the posterior pouch. Its roof consisted of the lateral malleal ligamental fold, which was always strongest in its anterior half and as a rule had a thin area in its posterior portion. In four ears there was a membrane defect connecting Prussak's space to the lateral malleal space. The latter did not contain additional folds and communicated freely with the upper attic. The pathways for spread of an acquired primary cholesteatoma from Prussak's space are outlined.

Culture Techniques↗
PubMed1996

Incudal folds and epitympanic aeration.

Thirty-seven temporal bones were dissected, and the posterior tympanic and epitympanic folds recorded and photographed. Histologic details were documented from four serially sectioned temporal bones, two normal and two inflamed. Of these 41 specimens, 31 were normal, and 10 showed signs of inflammation. The type for the lateral fold was incudomalleal in 16 and incudal in 25 ears. Incus intercrural and incudostapedial folds appeared only exceptionally. Medial and superior incudal folds were not present in normal ears. The anterior tympanic isthmus was a constant, large aeration pathway. In chronically inflamed ears, its partial or total block was caused by polypoid or large sheet-like folds. Inactive sequelae appeared as mature, simple, one-layer or extensive multilayer networks of webs, connected with a deeply indrawn incudomalleal fold. The small posterior isthmus was open to the incudal fossa in 13 ears, and in 28, it was sealed off by a posterior incudal fold. The mastoid air cell tracks were (in ten of 37 dissected ears) open to the incudal fossa, or directly, to the posterior tympanum. Auxiliary pathways due to membrane defects were found in both the horizontal and descending portions of the incudomalleal fold. Excepting the chordal, incudomalleal, and posterior incudal folds, fold-like webs in the posterior tympanum and epitympanum are of inflammatory origin.

Cholesteatoma↗
PubMed1995

Myringoplasty and tympanoplasty--results related to training and experience.

The results of surgery in a series of 452 ears having either myringoplasty (281 ears) or tympanoplasty (171 ears) were studied in relation to the experience of the surgeons. The trainees received an annual course in temporal bone dissection and were given daily surgical instruction in the operating theatre. The 142 ears operated by them showed less disease than those operated upon by the programme chairman (114 ears) and by the faculty (196 ears). The performance of the trainees was safe, and as to healed tympanic membrane and hearing results all studied parameters were statistically equal to those of the faculty. Repair of anterior perforations proved to be the most difficult and the overall results of both the faculty and trainees left place for improvement. On-line recording of surgical data and annual evaluation of an individual surgeon's results is suggested as a necessary means for continuous post-graduate training.

Education↗
PubMed1995

Middle ear imaging in neurotological work-up.

Middle ear imaging constitutes a homogeneous test battery for evaluation of neurotological disease. The imaging comprises infra-sound fistula test, ABR, tympanoscopy, ECoG, and trans-promontiorial cochlear blood flow measurement. We used a fistula test with infra-sound loading on posturography. In tympanoscopy we used 5 degrees and 25 degrees endoscopes with a diameter of 1.9 mm and length of 125 mm. In blood flow measurement we used laser-Doppler system with a stainless steel tip placed on the basal turn against stira vascularis. The flux was analyzed with a computer with custom-made software. In ECoG, a silver ball electrode was placed on the round window. In 64 cases evaluated we were not able to verify a spontaneous PLF by tympanoscopy. Symptoms typical for spontaneous PLF with positive fistula test turned out to be caused by endolymphatic hydrops. Sudden deafness usually did not show reduced cochlear blood flow, but often an endolymphatic hydrops. Fistula test was positive in about 25% of cases with endolymphatic hydrops. Tympanoscopy caused very few complication. The procedure takes about one hour and is done ambulatorily.

Adolescent↗
PubMed1994

A low pH 111In-bleomycin complex: a tracer for radiochemotherapy of head and neck cancer.

Bleomycin (BLM) is a well known natural antibiotic. It is toxic to dividing cells and has been used for the treatment of several forms of cancer. BLM has been labeled with various cations, but most of them have turned out be unstable in in-vivo experiments. In-BLM demonstrated high bone marrow uptake, but using 111In-bleomycin complex (BLMC) formed at low pH, the low in vivo stability and high bone marrow seeking behavior of the molecule could be avoided. The idea of using BLMC in combined radiotherapy and chemotherapy is intriguing. In this study we examined the effects of 111In-A'2a-c-BLMC in the treatment of 31 head and neck cancer patients. Findings were compared with those of surgery, and pre-operative radiology. The injected activity was 85-110 MBq, and the specific activity was approximately 100 MBq/mg. The half-life of 111In activity in serum varied from 1.5 to 3.1 hours. Maximum activity in the urine was achieved in all patients within 3 hours, and the average half-life in urine was 2 hours. In most patients 50% was excreted within 3 hours, in some 70%; in all patients > 95% of the activity was excreted within 22 hours. In surgical samples from 24 patients the best tumor-to-tissue ratios were: fat 60:1, bone 17:1, muscle 12:1, blood 3.6:1. All patients were examined on the injection day with ultrasonography of the neck. Using 111In-BLMC we missed a few small lymph nodes in 2 patients, but there were no false positive findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Bleomycin↗
PubMed1991

Myxoma of the external auditory meatus.

A case of myxoma of the external auditory meatus is described. The patient presented with a recurring tumour which had not been correctly diagnosed although the growth had been removed ten times over a period of two years. The tumour was skin covered, contained gelatinous material and was attached to the tympanic membrane and anterior canal wall. Following recognition of the tumour as myxoma, removal was performed with sufficiently wide margins and there has been no recurrence during follow-up for one year.

Adult↗
PubMed1991

Mast cells and histamine in adenoid tissue and middle ear.

Biopsy specimens from middle ear mucosa of patients with secretory (SOM) and chronic (COM) otitis media as well as specimens of adenoid and tonsil tissue were studied for mast cells. Effusion fluid, nasopharyngeal secretion and supernatant of crushed adenoid tissue were analyzed for histamine with a radioenzymatic method. Astra blue (AB) safranine stained highly significantly more mast cells than did toluidine blue. Mast cell counts in SOM and COM were similar. There were significantly more mast cells in adenoid subepithelial tissue than in middle ear mucosal subepithelial layer. For epithelium the counts were within the same range in adenoids and middle ear mucosa. Histamine concentrations were significantly higher than plasma levels for SOM fluid and nasopharyngeal secretion. Crushed adenoid tissue showed values over 100 times higher than the histamine level in the secretion.

Adenoids↗
PubMed1989

Treatment of labyrinthine fistula.

This cholesteatoma series comprises 84 ears, 81 of which had a labyrinthine fistula and 3 a horizontal semicircular canal opening that arose as a surgical complication. In 49 ears (58.3%), the operation was a primary one; in 35 ears (41.7%), it was a revision. Of all ears, 21 (25%) were deaf preoperatively. The fistula was located in the horizontal canal in 76 ears (90.4%). The matrix was removed in all these ears, and the fistula was covered with fibrin glue and fascia or periosteum. Hearing was preserved in all 57 ears in which matrix removal was carried out as the planned last stage. These included three ears in which the membranous canal was cut deliberately. Surgery that was performed against established rules caused deafness in three ears. Accidental opening of the horizontal canal caused no sensorineural loss in two ears as the fistulas were sealed immediately, while one ear in which the opening was not immediately recognized became deaf.

Cholesteatoma↗
PubMed1989

Vestibulo-ocular and vestibulo-spinal reflexes in evaluation of vestibular lesions.

In order to evaluate to what extent different diseases causing vertigo can be detected by studying vestibulo-spinal and vestibulo-ocular reflexes, 146 patients were examined. The diagnosis classes were: periodical attacks, position induced attacks, vestibular neuronitis, brain concussion, cerebrovascular disorders and acoustic neurinoma. Dynamic posturography was performed on all the patients, standard bithermal caloric test on 129 and voluntary saccades on 127 patients. The proportion of pathological test results in posturography exceeded that in the caloric test in all but one diagnosis class. In vestibular neuronitis the amount of abnormal test results was low in posturography, probably due to vestibular compensation. Posturography tested with eyes open and with 80 Hz vibration revealed disturbances in equilibrium the most sensitively.

Caloric Tests↗