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Biomedical subjects

J Boggan

Publications and source records attributed to J Boggan.

5 recordsLinked to original sources

Extra-abdominal fibromatosis (desmoid tumor) arising in the infratemporal fossa: a case report.

Aggressive fibromatosis (or desmoid tumor) refers to a histologically benign but locally aggressive lesion arising from musculoaponeurotic structures in various anatomic sites. Extra-abdominal desmoids represent about one third of all desmoid tumors; of these only about 11 to 15% arise in the head and neck. Desmoid tumors arising in the infratemporal fossa are exceedingly rare; to our knowledge only one such tumor has been reported in the literature. We present a desmoid tumor arising in the infratemporal fossa with intracranial extension in a twenty-seven year old male and review the literature on this rare condition.

Case Reports↗

Surgical correction of unilateral lambdoid synostosis: occipital rotation flap.

Virchow (1851) is credited with initially describing calvarial development following premature closure of individual sutures. He noted that resultant compensatory growth occurred perpendicular to the fused suture, resulting in asymmetrical calvarial development. Lambdoid synostosis, whether unilateral, bilateral, or associated with other cranial fusions, is reasonably uncommon. Previous authors report an incidence of less than 10% of all reported cases of premature fusion of the calvarial or skull base sutures. We report 27 patients (20 boys, 7 girls) ranging in age from 3 months to 8 years with unilateral lambdoid craniosynostosis followed over a three-year period. In 19 patients, calvarial reshaping was performed by repositioning a parietooccipital bone flap stabilized with lag-screw fixation to provide an increased radius of curvature to the affected area and to reestablish the resultant craniectomy between the parietooccipital junction and into the posterior fossa retromastoid occipital bone as an appropriate site for growth. Indications for one-stage calvarial reshaping included untreated lambdoid stenosis in older children or a failed simple lambdoid synostectomy after approximately 18 months. Each child experienced significant improvement in calvarial shape and ipsilateral ear position. Although we had no operative complications, two children underwent a second outpatient procedure for removal of hardware palpated by their parents.

Bone Screws↗

Sphenoidal and cavernous sinus resection for tumor.

Malignant neoplasms as well as those with an aggressive locally invasive character involving the sphenoid sinus have been considered heretofore to be inoperable and incurable. Because of fear of entering the cavernous sinus, the proximity of the internal carotid artery laterally and the optic chiasm superiorly as well as the middle fossa contents, these patients were relegated to palliative regimens of irradiation and chemotherapy. As methods have been developed of managing hemorrhage from the cavernous sinus, exposure and control or bypass of the internal carotid artery and combined subcranial and intracranial resection, the frontiers of surgery in the sphenoid sinus have been advanced. We have resected eight patients with tumors involving the sphenoid sinus in whom the walls of the sinus were exenterated, portions of the cavernous sinus removed, the internal carotid artery skeletonized, anterior and middle fossa dura resected, and in a few the temporal lobe was excised. Follow-up ranges from six years to 10 months. There have been no perioperative deaths; one patient succumbed to general inanition with locally recurrent tumor at four months; the rest are all alive and well without evidence of tumor, with the exception of one patient. This patient has a local recurrence anteriorly from an inadequate margin due to a technical error, but there is no recurrence in the sphenoid sinus, the cavernous sinus or the middle cranial fossa.

Cavernous Sinus↗

Brain gliomas: sonographic characterization.

To determine the ability of ultrasound (US) to help characterize brain lesions and determine the best site for biopsy, intraoperative sonographic examination of nine intracerebral gliomas was performed and correlated with the preoperative computed tomographic (CT), gross intraoperative, and histopathologic findings. Real-time US provided a precise and rapid method for intraoperative localization of intracerebral neoplasms in all cases. While the sonographic appearance of gliomas is nonspecific, US added information on tumor characterization to that provided by CT. All gliomas were sonographically echogenic compared with surrounding brain. US permitted good characterization of the cystic components of tumors; portions of the operation therefore involved surgical drainage rather than resection. Autopsy specimens from five anaplastic cerebral gliomas were examined with US and found to be echogenic. The central portions of all five tumors were echogenic and corresponded to areas of tumor necrosis; thus they were poor sites for biopsy. Alternatively, the best site for biopsy was the inner portion of the echogenic margin of the mass, which usually represented areas of active tumor growth. The information obtained from both preoperative CT and intraoperative US is beneficial in characterizing lesions and predicting the best site for biopsy.

Astrocytoma↗

Visual discrimination learning in mentally handicapped adults: comparative effects of two-choice and multiple-choice training methods on stimulus generalization performance.

The hypothesis that in mentally handicapped subjects a multi-choice discrimination learning method would result in superior generalization performance to the traditional two-choice method was investigated experimentally. Twenty-four mentally handicapped adults matched for age, intelligence and duration of institutionalization were divided into two equal groups and given visual discrimination training using a differential reinforcement, prompt-fading procedure. The groups were allocated separately to a two-choice and four-choice training condition in which the discriminative stimulus was associated with one and three non-discriminative stimuli respectively. Following training, stimulus discrimination performance was compared on a generalization test comprising increasing levels of distraction. The results showed a clear advantage for multi-choice training over two-choice. However, it was found that during generalization testing discriminative performance deteriorated as a function of increasing distraction in both groups, suggesting an underlying selective attention defect. Such a defect may be characteristic of stimulus generalization performance in the mentally retarded. Multi-choice discrimination learning appeared partly to counteract major generalization failure when the ratio of non-discriminative to discriminative stimuli was high.

Adult↗