Biomedical subjects
T J Garfinkle
Publications and source records attributed to T J Garfinkle.
Morphology of inner hair cell stereocilia in C57BL/6J mice as studied by scanning electron microscopy.
The observation that hair cell tuning curves exhibit frequency selectivity as sharply tuned as that seen in auditory nerve fibers has prompted closer examination of the sensory hairs or stereocilia. The present study was designed to examine the morphologic organization of inner hair cell stereocilia in a mammalian species, the neonatal C57BL/6J mouse. The cochleae of mice were fixed in OSO4, dehydrated, dissected, and prepared for scanning electron microscopy. An examination of the number of stereocilia per inner hair cell revealed an orderly decrease from base to apex. Conversely, there was a 300% increase in the height of the tallest stereocilia, a 100% increase in the height of the middle row stereocilia, and a 30% increase in shortest stereocilia from base to apex. The total surface area of the stereocilia, per hair cell, was shown to increase by approximately 250% from the base to the apex of the cochlea.
Hemangiomas of the head and neck in children - a guide to management.
Hemangiomas are the most common benign tumor of childhood occurring in the head and neck. The vast majority of these lesions are noted in the neonatal period and are a frequent cause for parental concern. Appropriate management requires familiarity with the varied types of lesions and syndromes, their natural histories, and their proven treatments. In general, treatment should remain conservative except when there is mechanical obstruction of the airway, hemorrhage, infection, tissue loss, or threatened cardiovascular decompensation. A review of the literature is presented with anatomic descriptions, classification, and discussion of treatment modalities. Special emphasis is placed on the diagnosis and treatment of the often life-threatening subglottic hemangioma.
Neurologic disorders: amyotrophic lateral sclerosis, myasthenia gravis, multiple sclerosis, and poliomyelitis.
The patient who has multiple cranial neuropathies may pose a diagnostic dilemma. The neurologic disorders of amyotrophic lateral sclerosis, multiple sclerosis, myasthenia gravis, and poliomyelitis often cause bulbar dysfunctions such as diplopia, facial weakness, slurred or hypernasal speech, dysphagia, and hoarseness. In general, treatment is supportive and is directed toward restoring or aiding lost function (i.e., tracheostomy, esophagostomy, and cricopharyngeal myotomy). The relative infrequency of these disorders can lead to delays in diagnosis and rehabilitative therapy.
Flexible fiberoptic bronchoscopy and pulmonary cytology in the evaluation of patients with head and neck malignancies.
In a study involving 107 patients with new primary tumors of the head and normal chest roentgenograms, the information gained from flexible fiberoptic bronchoscopy and pulmonary cytology was analyzed. A small but significant proportion of the patients (14%) had positive cytologies. Contrary to previous reports, contamination of bronchial washings with tumor cells from head and neck neoplasms did take place. In most patients, the source of contamination appeared to be the passage of the bronchoscope adjacent to the endotracheal tube. Two patients with normal chest radiographs and positive cytologic studies were discovered to have pulmonary metastases within one year of bronchoscopy. It is concluded that malignant involvement of the lungs is unlikely in patients with a normal chest radiograph, normal bronchoscopy, and negative bronchial washings. This information appears to be of value in staging patients with head and neck cancer. Positive bronchial washings are always associated with malignancy, either in the head and neck or the lungs, and should be considered an indication for further evaluation. Recommendations are made regarding the technique of bronchoscopy as part of panendoscopy in head and neck cancer patients, and diagnostic strategies are proposed for patients with positive bronchial washings and negative chest radiographs.
Experimental evaluation and clinical application of intraoperative counterpulsation without balloon pumping.
Cardiac assistance in the form of counterpulsation (CP), created by intraaortic balloon pumping (IABP), has recently been utilized to wean patients from cardiopulmonary bypass (CPB) after conventional modalities have failed. The use of IABP, however, is often delayed because it is not part of the standard CPB setup and requires an additional cutdown, an arterial graft, and the retrograde insertion of a foreign body into the arterial tree. To eliminate the disadvantages of IABP, an alternate technique for CP has been developed. A pneumatially actuated external blood reservoir connected via a "Y" connector to the standard arterial line of the CPB circuit can provide pulsatile flow, and when synchronized with the EKG, CP with or without CPB. Experimental evaluation with dogs comparing this technique with IABP has shown that the former can create comparable CP pressure curves to the latter. The technique was applied to 11 patients undergoing either aorto-coronary bypass surgery and/or valvular surgery. Two of the 11 patients could come off CPB only with the assistance of CP. Coronary bypass graft flow, when measured, increased by 25% due to CP in two out of seven patients. The arterial CP technique has proven to be easily adapted to clinical settings and provides immediate and effective CP when required.