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Biomedical subjects

R R Gacek

Publications and source records attributed to R R Gacek.

At least 19 recordsLinked to original sources

Fiber grouping in the feline vestibular nerve before and after labyrinthectomy.

The vestibular nerve is composed of fibers with a wide spectrum of diameters. The fibers of largest diameter are known to innervate the type I hair cells of the cristae, while the small-diameter fibers innervate the type II hair cells. Midsized fibers (dimorphic fibers) represent neurons that innervate both type I and type II hair cells. Reports by others have commented on the tendency for clustering of fibers with like diameters. Rigorous statistical proof for or against clustering has not yet been presented. The explanation for this is, in part, the mathematic complexity of analyzing clustering in a system composed of three elements. We report a new method for analysis of fiber clustering and apply this method to large-, medium-, and small-diameter fibers in the feline vestibular nerve. The fiber grouping in the caudal and rostral ends of the vestibular nerves of six normal animals is compared to that in similar areas of the nerves of five animals 12 to 17 months after unilateral labyrinthectomy. No statistically significant clustering of fiber types was found in the rostral portion of either the control or the labyrinthectomized animals. In the caudal portion of the control nerves, clustering of the large fibers was demonstrated (p < .005, chi2 test). This clustering was not demonstrated after labyrinthectomy. An explanation of these findings is discussed. The method used in this study to analyze fiber clustering may be applicable to other nerve systems of greater complexity.

Animals

Transneuronal down regulation of vestibulo-ocular neurons following vestibular ablation.

Unilateral ablation of vestibular input causes lasting morphological changes bilaterally in superior vestibulo-ocular neurons (SVON). The present study was performed to see if these changes in SVON are more pronounced after bilateral vestibular neurectomy. Twenty-three SVON from both vestibular nuclei of 2 cats sacrificed 8 weeks after bilateral ablation were examined utilizing morphometric ultrastructural techniques. There was a significantly greater somal atrophy, loss of synaptic profiles, rough endoplasmic reticulum and polyribosomes compared to unilateral neurectomy. These changes indicate a down regulation that is proportional to the level of deafferentation and may account for functional deficits seen in the vestibulo-ocular reflex after peripheral ablation.

Animals

Morphologic changes in the vestibular nerves and nuclei after labyrinthectomy in the cat: a case for the neurotrophin hypothesis in vestibular compensation.

Morphological changes in the vestibular nerves and superior vestibulocular neurons (SVON) after unilateral labyrinthectomy in cats revealed a progressive loss of axons in the ipsilateral vestibular nerve (35%) and synaptic profiles (SP) on ipsilateral SVON (60%) up to a 1-year survival period. Although the ipsilateral vestibular nerve showed further degeneration (45%) at 2 years post ablation, the number of SP on ipsilateral SVON increased to 60% of normal (40% loss). These SP likely represent sprouting from crossing commissural or cerebellar pathways. Contralateral vestibular nerves at 1 and 2 years post ablation revealed normal numbers and size spectrum, but the number of SP contacting the contralateral SVON at 8 weeks, 1 and 2 years paralleled the levels of SP found on ipsilateral SVON. The symmetry in adjustment of SP on the SVON of both sides of the brainstem after ablation may be explained by the neurotrophin hypothesis.

Adaptation, Physiological

Comparison of labyrinthectomy and vestibular neurectomy in the control of vertigo.

One hundred twenty-six patients who were treated with labyrinthectomy (81 patients) or vestibular neurectomy (45) between the years 1979 and 1994 were reviewed. The cause for vertigo in 124 of the 126 patients was Meniere's disease (89 patients), labyrinthitis (15), delayed endolymphatic hydrops (8), vestibular neuritis (7), and failed labyrinthectomy (5). In the remaining 2 patients, a normal labyrinth was sacrificed to fistulize a petrous apex cyst. Both procedures were equally effective in relieving vertigo (labyrinthectomy 98.8%; neurectomy 97.8%), but the length of hospitalization, length of disability before return to work, and cost were twice as great with vestibular neurectomy than with labyrinthectomy. More patients exhibited prolonged ataxia following neurectomy (5 patients) than after labyrinthectomy (2). Vestibular neurectomy was associated with several complications: reversible facial paresis (15 patients), meningitis (1), cerebrospinal fluid leak (1), and epidural hematoma (1). Labyrinthectomy was complicated by postoperative hyponatremia in 1 patient. Selective vestibular neurectomy preserved hearing in 32 (82%) of 39 patients. Criteria for recommending either ablation procedure are discussed. The incidence of sequential involvement of the contralateral ear was 1.5%.

Aged

Cricoarytenoid joint mobility after chronic vocal cord paralysis.

Eleven whole organ laryngeal specimens (10 human and 1 dog) with a history of long-standing (6 months to 17 years) paralysis were studied histopathologically for changes in the cricoarytenoid (CA) joints and the intrinsic laryngeal musculature. In 9 cases the paralysis was unilateral and in 2 bilateral. No evidence of CA joint ankylosis (fibrous/osseous obliteration of joint space or degeneration of articular surfaces) was seen in the specimens. The absence of CA joint ankylosis permits the efficacy of thyroplasty medialization procedures.

Aged

Morphologic changes in contralateral superior vestibulo-ocular neurons following labyrinthectomy in the cat.

Ultrastructural changes were measured in 22 contralateral superior vestibulo-ocular neurons (SVONs) from four cats painlessly sacrificed at 8 weeks and 25 contralateral SVONs from four cats sacrificed at 1 year following unilateral labyrinthectomy. The SVONs at 8 weeks showed a 43% decrease in somal size, a 34% loss in rough endoplasmic reticulum (RER), a 48% loss of ribosomes, and a 47% decrease in the number of synaptic profiles (SPs) contacting the soma. At 1 year the SVONs had a 31% decrease in size, a 43% decrease in RER, a 50% loss of ribosomes, and a 71% decrease in SPs. Synaptic vesicles (SVs) in both groups of SVONs showed no change in size or shape compared to control SVs. These findings resemble the contralateral SVON changes that occur following excision of the vestibular ganglion.

Animals

Ultrastructural changes in superior vestibular commissural neurons following vestibular neurectomy in the cat.

The ultrastructural changes of the feline superior vestibular commissural neurons (CNs) were quantitatively assessed 8 weeks following ipsilateral vestibular neurectomy. Results indicated a slight degeneration of synaptic profiles (SPs; 25%) representing the primary vestibular afferent input onto CN soma. The synaptic vesicles of the remaining SPs, which likely originate from the cerebellum and the contralateral CNs, were smaller and rounder, suggesting a transition from an inhibitory to an excitatory mode of response. The SP loss had little impact on the CNs' capacity for protein synthesis and structural maintenance, since there was no change in the volume fraction of intracellular organelles. These data suggest that CNs do not degenerate and are likely functional after vestibular compensation. These findings support the role of the commissural pathway in vestibular compensation as proposed by Galiana et al, which is based on the assumption that the intervestibular commissural connections remain intact following vestibular neurectomy.

Animals

Morphologic changes in superior vestibulo-ocular neurons and vestibular nerve following labyrinthectomy in the cat.

Morphologic changes in ipsilateral superior vestibulo-ocular neurons (SVON) and the vestibular nerve were measured in 4 cats 8 weeks after labyrinthectomy and 4 cats 1 year after labyrinthectomy. There is a 20% decrease in SVON size and 30% decrease in rough endoplasmic reticulum and ribosomes with no change in the volume fractions of Golgi apparatus or mitochondria. In the central nervous system degeneration of the vestibular nerve terminals ipsilateral to the labyrinthectomy was represented by a 25% loss of synaptic profiles (SP) on SVON at 8 weeks and 57% loss of SP at 1 year after labyrinthectomy. There was no significant loss of fiber number in the vestibular nerve at 8 weeks post lesion but a 35% loss of fibers primarily of the large size at 1 year post lesion.

Animals

Technique and results of singular neurectomy for the management of benign paroxysmal positional vertigo.

One hundred thirty-seven patients with chronic disabling paroxysmal positional vertigo were treated surgically with singular neurectomy (SN) during the years 1972-1994. One hundred forty-six SN were performed on these patients. One hundred twenty-eight patients underwent unilateral SN while 9 patients underwent bilateral sequential SN. The patients ranged in age from 25 to 86 years with a mean of 57 years and a female to male ratio of 92: 45. One hundred thirty-eight patients (94%) experienced complete relief of vertigo following SN. Three patients (2%) experienced partial relief of positional vertigo following SN and 5 patients failed to have any improvement of symptoms following SN (4%). A partial sensorineural occurred following SN in 4 patients (3%) in this series. The results indicate that SN is a safe and effective surgical treatment for chronic disabling BPV caused by the posterior semicircular canal.

Adult

Singular neurectomy in the management of paroxysmal positional vertigo.

Paroxysmal positional vertigo is one of the common causes of episodic vertigo seen in neurotologic practice. It is thought to be caused by high specific gravity deposits in the cupula (cupulolithiasis) or membranous posterior semicircular canal (canalithesis) as a result of trauma, aging, viral insult, or surgical insult to the inner ear. The vast majority (90%) of patients undergo spontaneous resolution or cure by positioning maneuvers designed to dislodge the otoconial debris. The very small number of patients with disabling chronic paroxysmal positional vertigo (more than 1 year duration) can be effectively relieved of the positional vertigo (95%) by selective transection of the nerve supply to the posterior canal sense organ (singular neurectomy) through a tympanotomy approach using local anesthesia. The risk of sensorineural hearing loss is 3%.

Adult

Evaluation and management of temporal bone arachnoid granulations.

The diagnosis and evaluation of temporal bone arachnoid granulations (AGs) is based on characteristic bone defects in the posterior or middle fossa surfaces of the temporal bone in adult patients with persistent serous otitis media or septic meningitis following acute otitis media. The cerebrospinal communication caused by AGs should be repaired by a middle fossa craniotomy (middle fossa AGs) or an intact canal wall mastoidectomy (posterior fossa AGs) to preserve normal sound transmission. In adult patients with chronic mastoiditis, the dural defect of an AG may permit intracranial extension of the chronic inflammatory process. This rare extension of disease should be considered in patients who have chronic ear inflammation and severe pain or signs of intracranial disease.

Adolescent

Quantitative ultrastructural study of cat abducens interneurons.

Abducens interneurons project to the medial rectus subdivision of the contralateral oculomotor nucleus and have a role in the mediation of horizontal conjugate gaze. Two types of interneurons have been reported based on shape (fusiform and circular) and differences in organelles. In this study, 41 abducens interneurons from three young adult cats were examined in the transmission electron microscope and were classified, on the basis of eccentricity (e), as circular (e less than 0.82; N = 18) or fusiform (e greater than or equal to 0.82; N = 23). The volume fraction of nucleus, nucleolus, mitochondria, rough endoplasmic reticulum, polyribosomes, and Golgi complex and the number of synaptic profiles per 100 microns of membrane were determined. Although there is a qualitative difference in these cell types, statistical analyses indicate no significant differences in organelle content, mean area, number of synaptic profiles per 100 microns of membrane, or diameter. While the differences in shape may possibly indicate different functional groups, this notion is not supported by the variables examined or by physiological studies.

Abducens Nerve

Ultrastructural changes in contralateral superior vestibulo-ocular neurons one year after vestibular neurectomy in the cat.

Twenty contralateral superior vestibulo-ocular neurons (SVON) from 3 cats were studied morphologically one year after a right vestibular neurectomy. Eighteen SVON contained a smooth or slightly crenated nuclear membrane, a 63% loss of synaptic profiles (SP) and a 22% decrease in size compared to control SVON. Two cells contained nuclear membrane invaginations, a 40% loss of SP and a 31% size decrease compared to control SVON. The volume fractions of rough endoplasmic reticulum and ribosomes were decreased in these two cell groups but no change was noted in Golgi apparatus and mitochondria. These contralateral SVON reached a size, innervation density and content of organelles similar to ipsilateral SVON at one year following vestibular neurectomy.

Animals

Otogenic brain abscess: the Syracuse experience.

A review is presented of five cases of otogenic brain abscesses (from among 34 cases of brain abscesses of all causes) treated during a 16-year period at a major university hospital in upstate New York. Although the morbidity and mortality rates are high for patients with brain abscess, advances in the microbial isolation methods, specificity of antimicrobial agents, and earlier diagnosis by CT scans have all contributed to an improved outcome for this dreaded disease.

Adult

Autosomal dominant sensorineural hearing loss. Pedigrees, audiologic findings, and temporal bone findings in two kindreds.

We report the clinical and otopathologic findings in three persons from two kindreds affected with adult-onset autosomal dominant progressive sensorineural hearing loss. The primary pathologic change is a deposit of acid polymucosaccharide ground substance in the cribrose areas; in the spiral ligament, limbus, and spinal lamina of the cochlea; and in the stroma of the maculae and cristae. These deposits obstruct the channels that accommodate the dendritic nerve fibers to the auditory and vestibular sense organs. The end result is strangulation and degeneration of dendrites followed by retrograde neuronal degeneration in association with varying degrees of atrophic change in the sense organs.

Adult

Ultrastructure of cat superior vestibular commissural neurons.

The ultrastructure of the feline superior vestibular commissural neurons (CNs) was studied after labeling by contralateral injection of horseradish peroxidase. These small spindle-shaped cells are found in clusters oriented in a rostrocaudal, dorsoventral or lateromedial direction. The CNs have a cleft nucleus, with the majority of nerve terminals contacting the CN near the emergence of polar dendrites. Polarization of the afferent synaptic profiles suggests a bidirectional nature of inputs to CNs by the vestibular nerve, contralateral CNs, and/or cerebellar systems. One type of labeled cell does not conform to this pattern, instead resembling a vestibulo-ocular neuron. Hence, it may function as a commissural and a vestibulo-ocular neuron. Characterization of different types of synapses, based on the size and eccentricity of their synaptic vesicles, indicates a continuum rather than separate populations. Volume fraction of intracellular organelles showed a larger volume fraction percent of polyribosomes in larger cells. Since this organelle is involved with protein synthesis, this finding may indicate that larger CNs have a more extensive dendritic tree.

Adaptation, Physiological