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Biomedical subjects

R R Gacek

Publications and source records attributed to R R Gacek.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Pathophysiology and management of cupulolithiasis.

Substantial support for the concept that the posterior semicircular canal is responsible for benign paroxysmal positional vertigo comes from four sources: clinical observations, temporal bone histopathology, experimental observations, and results of selective denervation of the posterior canal crista (singular neurectomy). The complete immediate relief of the positional vertigo and nystagmus that resulted from 39 of 40 singular neurectomies establishes this procedure as an effective management for patients with the chronic disabling form of cupulolithiasis. The ocular response in cupulolithiasis and the release nystagmus that follows singular neurectomy are explained by neural pathways that have been previously elucidated by anatomic and physiologic techniques. Although sensorineural hearing loss followed surgery three times among the first 15 patients, hearing loss has not occurred in the last 25 operations for cupulolithiasis.

Adult↗
PubMedDate not supplied

The pathology of facial and vestibular neuronitis.

OBJECTIVE: To measure disease of idiopathic nature in the ganglia of the human facial (FN) and vestibular nerves (VN). METHOD: One hundred horizontally sectioned human temporal bones (TB) were examined under light microscopy. The TB were sectioned at 20 microm, and every 10th section was stained with hematoxylin and eosin and mounted. The volume fractions (VF) of degenerated cells in the FN ganglion and focal axonal degeneration in the VN were measured with stereologic techniques. RESULTS: Twenty-five TB were excluded because of artifact or poor staining of the FN and VN. Fifty-one TB contained degenerated cells in the FN meatal ganglion (MG) and/or focal axonal degeneration in the VN. Thirty-one FN had degenerated cells in the MG (VF = 1% to 55%) and none in the geniculate ganglion. In 45 TB, focal axonal degeneration was found in the VN (VF = 1% to 50%; the VF was less than 15% in all but one TB). MG and VN degeneration occurred together in 25 TB. None of the cases had a history of FN paralysis, but 20 had a history of vertigo. Twenty-four TB from patients of similar ages with similar otopathologies did not reveal degeneration in the FN or VN. CONCLUSION: The FN and VN lesions in these 51 TB may be virus-induced and reflect a higher incidence of idiopathic FN and VN neuronitis than previously thought.

Adolescent↗
PubMedDate not supplied

Menière's disease as a manifestation of vestibular ganglionitis.

OBJECTIVE: To present morphologic evidence of viral-induced vestibular nerve pathology in Menière's Disease (MD). MATERIAL STUDIED: Twelve temporal bones (TB) from 8 patients with the clinical symptoms of MD. RESULTS: There was endolymphatic hydrops (EH) and perilymphatic fibrosis in 10 of the 12 TB from MD patients. Of the 10 TB with EH of the pars inferior, 3 also contained outpouchings in the pars superior (utricle and canals), and 3 showed apical spiral ganglion cell loss. Focal vestibular nerve axonal degeneration was observed in all but one TB. CONCLUSION: Morphologic changes in TB of patients with MD, and clinical observations in patients with recurrent vestibulopathy, support the concept that the pathologic mechanism responsible for auditory and vestibular symptoms in MD may be reactivation of a latent viral vestibular ganglionitis.

Aged↗
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Diagnosis and management of primary tumors of the petrous apex.

Five patients with primary tumors of the petrous apex were diagnosed and treated between the years 1968 to 1974; two had congenital epidermoids, two had chondromyxosarcomas and one had neurofibroma. The embryological development of the foramen lacerum and the pattern of expansion of these primary tumors support the contention that these three categories of tumors arise in the foramen lacerum. Knowledge of the structures surrounding the foramen lacerum can provide a guide to early diagnosis of petrous apex tumors. Since these tumors cannot be completely removed, the goal of surgery is to obtain histological diagnosis and to produce permanent fistulization of the petrous apex. Although there are several recommended surgical approaches to the petrous apex, the transmastoid-translabyrinthine procedure was used in this series.

Adult↗
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Hereditary abductor vocal cord paralysis.

Familial bilateral abductor cord paralysis was described in the father and two sons of a family in which the ramaining siblings (obe boy and three girls) were normal. The onset of stridor ranged from six months to nine years after birth in these patients who were all treated with a tracheostomy. Normal development and intelligence was experienced by all three patients. Since previous reports of hereditary abductor cord paralysis described mental retardation in all patients who were maintained without tracheostomy, anoxia from unrelieved laryngeal obstruction may be a significant complication following nonsurgical management of patients who appear to tolerate bilateral abductor vocal cord paralysis.

Child↗
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Schwannoma of the jugular foramen.

Two cases of schwannoma limited to the jugular foramen are described. This entity may clinically and radiologically resemble glomus jugulare tumors so closely, that only careful histological examination of an adequate surgical tumor specimen can provide a definitive diagnosis. Since documentation of this form of neurogenic tumor is lacking in the literature, it suggests that the entity is very rare or that such tumors may be erroneously classified as glomus jugulare tumors. The two cases in this study were managed surgically by subtotal removal via a wide transmastoid approach.

Adolescent↗
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Mastoid and middle ear cavity obliteration for control of otitis media.

Total soft tissue obliteration of the mastoid-middle ear cavity and primary closure of the external auditory meatus were employed in six patients to control chronic suppurative otitis media. Previously, all these patients had unsuccessful surgery and all but one had profound loss of cochlear function. Thorough removal of cholesteatoma, granulation tissue, and ear canal skin is necessary before total obliteration can be performed safely. Wound healing was complete by one to two weeks postoperatively and all patients have been asymptomatic for two to seven years.

Adult↗
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Fiber components of the recurrent laryngeal nerve in the cat.

Experimental neuroanatomical methods were employed in 21 adult cats to determine 1) the number and size of myelinated motor and sensory fibers in the recurrent laryngeal nerve (RLN), and 2) the fiber components originating in the nucleus ambiguus (NA) and retrofacial nucleus (RFN) of the brain stem. Intracranial transection of the X and XI cranial nerves and selective destruction of the NA or RFN were the experimental lesions inflicted in order to obtain the following results. About 55% (312) of the right RLN (565 fibers) is composed of myelinated motor nerve fibers which measure 4 mu - 9 mu in diameter. Nine percent come from the RFN and are smaller (4-6 mu) than the 46% which emanate from the NA and measure 6-9 mu in diameter. The remaining 45% of the RLN is made up of sensory neurons which can be divided into three groups. 1) The largest numerical group (32%) is very small in caliber (1-3 mu) and supplies extralaryngeal regions (trachea, esophagus). 2) The intermediate size fiber group (4-9 mu) comprises 11% of the RLN and probably supplies the subglottic mucosa. 3) The smallest group (2%) of sensory fibers is the largest in diameter (10-15 mu) and may represent either the innervation of muscle spindles or afferents from the superior laryngeal nerve coursing down into the chest.

Accessory Nerve↗
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Further observations on posterior ampullary nerve transection for positional vertigo.

An evaluation was made on ten patients with benign paroxysmal positional vertigo (BPPV) in whom transection of the posterior ampullary nerve was performed by the middle ear approach under local anesthesia. The undermost ear in the provocative test position was selected for surgery. All ten patients were relieved of positional vertigo by the procedure. Of the five patients who were relieved of BPPV by posterior ampullary nerve transection prior to 1974, the long-term follow-up on four revealed continued relief of vertigo. Five additional patients treated by this surgical procedure since 1975 have also experienced relief from BPPV, but a moderate sensorineural hearing loss occurred in one patient. Two additional patients with BPPV were explored surgically but the singular canal could not be located. Persistence of the vertigo in these two patients strengthens the conclusion that the posterior semicircular canal sense organ is largely responsible for BPPV.

Adult↗
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Intralabyrinthine schwannoma.

Two cases of unsuspected intralabyrinthine schwannoma are reported and the literature is reviewed. The mean age of the patients was 56 years, with the most common symptoms being hearing loss, dizziness, and tinnitus. All patients demonstrated a profound sensorineural hearing loss with low discrimination scores, and recruitment was elicited in two patients. A radiographic evaluation was negative in all but one case. Five of the six patients had a preoperative diagnosis of Ménière's disease. Transcanal labyrinthectomy was employed to remove tumor in all patients. This review suggests that a patient, presenting with symptoms of atypical Ménière's disease and negative radiographic evaluation, should alert the surgeon to the possibility of an intralabyrinthine schwannoma.

Adult↗
PubMedDate not supplied

Congenital cerebrospinal otorrhea.

Four locations for congenital cerebrospinal fluid fistula in the region of a normal labyrinth are reviewed. A congenital leak may occur through the petromastoid canal, a wide cochlear aqueduct, Hyrtl's fissure, or the facial canal. A fistula through the initial segment of the fallopian canal was successfully repaired in a two-year-old boy who had three episodes of meningitis following otitis media. Knowledge of these four sites of congenital defects provides a guideline for the surgeon in the identification and repair of cerebrospinal fluid leaks in the region of the labyrinth.

Cerebrospinal Fluid Otorrhea↗
PubMedDate not supplied

Vestibular neuroanatomy: recent observations.

The modern neuroanatomical technique of using a retrograde axoplasmic tracer (horseradish peroxidase) to label neurons has aided the revelation of several important connections in the vestibular system. The organization of the oculomotor nucleus and the existence of an interneuron in the abducens nucleus have importance in understanding some ocular disorders. A detailed description of the location of vestibulo-ocular neurons to individual extraocular muscles is now available which may provide a basis for understanding how these reflexes function normally and abnormally. Interconnections between the vestibular nuclei are provided by commissural neurons located in the superior, medial and group Y nuclei. These projections are probably of importance in vestibular compensation. A possible hypothesis of vestibular hair cell projection suggests that type I cells project over vestibulo-ocular neurons while type II cells project over commissural pathways.

Hair Cells, Auditory↗