Biomedical subjects
Publications and source records attributed to M L Pensak.
The last 20 years have brought many advances in surgical approaches to the posterior cranial fossa as well as improved surgical technique. The purpose in this article has been to describe the commonly used approaches and to discuss the major advantages and disadvantages.
Meniere's disease has been the focus of much controversy concerning its etiology and pathophysiology, not to mention treatment. A brief review is presented of the major proposed causative factors and therapy, both medical and surgical, founded upon these theories. We also present the diagnostic evaluation and therapeutic modalities employed by The Otology Group, P.C., as well as long-term, follow-up data on our patients.
BACKGROUND: The satisfactory management of facial paralysis after extirpative skull base surgery has been notoriously difficult. To optimize physical and psychological recovery, early perioperative use of polytef (polytetrafluoroethylene [PTFE]) facial suspension has been used in patients with either profound electrophysiological or anatomical disruption of the facial nerve. OBJECTIVE: To review the efficacy of this clinical algorithm. STUDY DESIGN: Retrospective medical record review. SETTING: Tertiary care University Hospital Inc, University of Cincinnati College of Medicine, Cincinnati, Ohio. PATIENTS AND METHODS: Medical records review of 32 patients who underwent lateral skull base surgery with resultant facial paralysis who had facial rehabilitation using polytef suspension. RESULTS: All patients who underwent polytef facial suspension reported improvement in both facial function as well as aesthetics. One patient had a late extrusion of the polytef implant. CONCLUSION: The early peri-extirpative application of this technique provides psychological and physical support to patients with facial paralysis who are recovering from lateral skull base surgery. Arch Facial Plast Surg. 2000;2:243-248
Hypercalcemia associated with head and neck malignancy is not an uncommon occurrence; its causes are multiple. Eight hypercalcemic patients with head and neck malignancy were studied. Serum calcium, serum phosphorus, tubular phosphorus threshold, fasting calcium excretion, plasma 1,25-dihydroxyvitamin D, nephrogenous cyclic adenosine monophosphate (AMP), and immunoreactive parathyroid hormone were measured. Excessive dietary calcium administration in the form of an oral hyperalimentation preparation appeared to be the cause of hypercalcemia in 2 patients. Six patients demonstrated humorally mediated hypercalcemia. These patients resembled patients with primary hyperparathyroidism in having elevated nephrogenous cyclic AMP excretion and reduced proximal tubular phosphorus reabsorption, but they differed from patients with primary hyperparathyroidism by having normal levels of immunoreactive parathyroid hormone, markedly increased fasting calcium excretion, and strikingly reduced mean plasma levels of 1,25-dihydroxyvitamin D. These data strongly suggest that the humoral factor responsible for hypercalcemia in patients with head and neck cancer is not parathyroid hormone, and that patients with hyperparathyroidism can now be distinguished with confidence from those with malignancy-associated hypercalcemia.
Acute upper airway obstruction from laryngeal polyps is uncommon. However, a large pedunculated laryngeal polyp, when unrecognized, may produce sudden airway obstruction. The importance of an early diagnosis and treatment is stressed. Primary care physicians, endoscopists, anesthesiologists, and otolaryngologists should be aware of this condition and add it to their differential diagnosis of sudden respiratory obstruction.
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