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Biomedical subjects

L A Mankarious

Publications and source records attributed to L A Mankarious.

6 recordsLinked to original sources

Methicillin-resistant Staphylococcus aureus: pediatric otitis.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a potentially lethal organism in pediatric patients. MRSA is an uncommon otologic pathogen that requires special diagnostic and therapeutic intervention. METHODS: Three pediatric patients with community-acquired MRSA otologic infections were identified during 1999. SETTING: Tertiary care ear institution. RESULTS: All patients required intravenous antibiotic therapy to achieve resolution of the infections. CONCLUSIONS: MRSA in children can be community acquired and can cause otitis externa, otitis media with otorrhea, or acute mastoiditis; intravenous therapy that includes vancomycin is necessary for resolution.

Anti-Bacterial Agents↗

Novel cell proliferation marker for identification of a growth center in the developing human cricoid.

BACKGROUND: Developmental histomorphology of the human cricoid cartilage has never been well described. Regional growth centers in the cricoid have been hypothesized, but have never been demonstrated in histological sections. OBJECTIVES: To apply Mib-1 immunostaining, a monoclonal antibody directed at a nuclear proliferation marker, in human cricoids to identify a growth center and to study the changing histomorphology of the developing cricoid. DESIGN: Immunohistochemical Mib-1 studies were performed on postmortem cricoid sections of 2 fetuses (gestational age, 18.5 and 33 weeks), 1 newborn (full term, 41 weeks), and 3 children (aged 1, 4, and 13 years, respectively). Cell counts, surface areas, and organizational patterns of the chondrocytes were studied and described in hemotoxylin-eosin-stained sections. RESULTS: Differential Mib-1 staining was found. The 18.5-week fetus showed diffuse cell proliferation throughout the cricoid. The cricoid sections of the 33-week fetus and 1-year-old child revealed a distinct ring of proliferation in the outer third of the cricoid ring. The 4- and 13-year-old exhibited no cell proliferation. Histomorphologically, with increasing age came chondrocyte hypertrophy, decreasing cell count per standard square, and increasing organization from a scattered to radial columnar pattern. CONCLUSIONS: Growth of the cricoid involves a diffuse pattern of cell proliferation throughout the cricoid in fetal tissue. At term and until age 1 year, the region of proliferation is more restricted to the outer subperichondrial surface. By age 4 years, cell proliferation has stopped. Histomorphologic changes in the developing cricoid include decreasing cell counts per standard unit area, but increasing surface area with age. The aging chondrocytes develop an increasingly organized layout to form a radially arranged columnar pattern similar to that in the growth plate of the developing limb bud.

Adolescent↗

Growth and development of the human cricoid cartilage: an immunohistochemical analysis of the maturation sequence of the chondrocytes and surrounding cartilage matrix.

OBJECTIVES: The goal was to determine maturational changes in the human cricoid cartilage. STUDY DESIGN: The study involved immunohistochemical staining of collagen II (a marker of proliferating chondrocytes), matrilin-1 (a marker of post-proliferative chondrocytes), and collagen X (a marker of hypertrophic chondrocytes). Specimens included uninjured human cricoid cartilages at 18 and 41 weeks' gestation and 1, 4, and 13 years postpartum. RESULTS: This study demonstrated that type II collagen peaks in concentration at approximately 41 weeks' gestation. Matrilin-1 is present in progressively lower concentration in the central core of the cricoid ring, but the peripheries of the ring contain the protein in relatively high concentration. Type X collagen is not expressed in the age groups tested. CONCLUSIONS: These biochemical markers lend further support to a chondrocyte proliferative phase that slows between 1 and 4 years of age. Chondrocytes then enter a phase histologically similar to the hypertrophic phase but are biochemically different than hypertrophic chondrocytes destined for endochondral ossification.

Adolescent↗

Long-term follow-up of submandibular duct rerouting for the treatment of sialorrhea in the pediatric population.

OBJECTIVE: To determine the long-term control of sialorrhea in children who underwent submandibular duct rerouting (SMDR) and to identify potential preoperative predictors of outcome. DESIGN: Retrospective chart review of children who underwent SMDR; information updated by discussion with the permanent caregiver. SETTING: Tertiary care center. PATIENTS: Children who had significant sialorrhea resulting from a variety of neuromuscular disabilities between January 1980 and December 1995. OUTCOME: We report the outcome on 59 patients who underwent SMDR for the treatment of sialorrhea. Patients were ascribed a preoperative sialorrhea and global neurologic deficit score. Postoperative outcome was scored as marked, moderate, no improvement, or worse. Twenty-eight of 59 (47.4%), 28 of 59 (47.4%), and 3 of 59 (5.1%) of the patients had preoperative sialorrhea scores of 3 (profuse), 2 (moderate), and 1 (mild), respectively. Twenty of 59 (33.9%), 29 of 59 (49.2%), and 10 of 59 (16.9%) had preoperative scores of 3 (severe), 2 (moderate), and 1 (mild) neurologic impairment, respectively. Mean time to follow-up of the 59 patients was 5.46 years. Postoperative improvement scores were as follows: 50.8% had marked, 28.8% had moderate, and 20% had no to minimal improvement in their sialorrhea. Two patients were transiently worse. A complication rate of 11.3% (9 of 79) was demonstrated: 7 ranulae, 1 transient swelling of the floor of the mouth, and 1 submandibular gland infection. The preoperative global neurologic deficit score was found to be more predictive of surgical outcome than sialorrhea score.

Adolescent↗

External rhinoplasty approach for extirpation and immediate reconstruction of congenital midline nasal dermoids.

Surgical extirpation is the treatment of choice for nasal dermoids in the pediatric population. Approaches include vertical-dorsal rhinotomy, lateral rhinotomy, transverse rhinotomy, and external rhinoplasty. While short-term results suggest that the last approach is cosmetically most acceptable, the required wide undermining of the nasal tip and dorsum may affect subsequent nasal growth. To assess long-term results, we reviewed our experience with 8 cases encountered over the past 10 years. Modifications of the technique to minimize midline dorsal depression are described.

Adolescent↗

Microvascular replantation of a traumatically amputated ear.

We describe the replantation of a traumatically severed auricle using microvascular anastomosis to reestablish blood flow to the ear. Microvascular reattachment of the severed auricle occurred 10 hours after the trauma. Postoperatively, adjunctive measures, including anticoagulation and the use of medicinal leeches, were used to relieve venous congestion of the replanted auricle. The replanted auricle healed completely with 100% survival, resulting in an essentially normal-appearing external ear. In the management of a traumatically severed auricle, microvascular replantation should be considered as the intervention of first choice in selected cases. If the procedure is successful, the cosmetic results are excellent; if it is not successful, a number of other reconstructive techniques remain as options.

Adult↗