Combined Microsurgical, Endoscopic and Neuronavigation Assisted Transseptal- Transsphenoidal Resection of Pituitary Tumors.

OBJECTIVE: To describe the technical nuances of multimodal transseptal-transsphenoid surgery for pituitary tumors using a combination of microneurosurgery, neuroendoscopy, and electromagnetic neuronavigation. MATERIALS AND METHODS: A transnasal approach to the sella is performed endoscopically and widely exposed by an otolaryngologic surgeon. Surgery is next performed by the neurosurgeon with microscope and neuronavigation for microsurgical resection of pituitary tumors. Neuroendoscope is also used at the end of surgery to confirm tumor resection and inspect operative site. During surgery, the patient's head, angle and height of the microscope, and position of the table are repositionable to allow for multiple angle views. Abdominal fat harvested prior to the procedure is used to ensure cerebrospinal fluid seal. RESULTS: The senior author (KIA) has used the combined approach with 84 consecutive patients. Radical resection was achieved in 66 patients, subtotal in 11, and partial in 7. There were no perioperative complications. Six patients experienced postoperative transient diabetes insipidus. The pituitary gland and stalk were preserved in all cases. Visual symptoms were improved in 78% and endocrinological symptoms in 56% of cases. CONCLUSION: This combined approach is safe and effective. It increases the efficacy and radicality of surgical resection, helps to preserve the pituitary gland, and improves and resolves preoperatively altered patient hormonal function and impaired vision. It also reduces complications, provides less postoperative pain and discomfort, reduces the surgery time, and enables a shorter hospital-stay.

Advanced Preparation Makes Research in Emergencies and Isolation Care Possible: The Case of Novel Coronavirus Disease (COVID-19).

The optimal time to initiate research on emergencies is before they occur. However, timely initiation of high-quality research may launch during an emergency under the right conditions. These include an appropriate context, clarity in scientific aims, preexisting resources, strong operational and research structures that are facile, and good governance. Here, Nebraskan rapid research efforts early during the 2020 coronavirus disease pandemic, while participating in the first use of U.S. federal quarantine in 50 years, are described from these aspects, as the global experience with this severe emerging infection grew apace. The experience has lessons in purpose, structure, function, and performance of research in any emergency, when facing any threat.

Orbital hyperostosis following exenteration.

PURPOSE: To report the development of unilateral, diffuse hyperostosis of orbital bones in 3 postexenteration patients. METHODS: Three advanced cases of periorbital and orbital malignancies are presented, and their clinical, radiologic, and histopathologic features are reviewed. RESULTS: Postexenteration CT showed thickened orbital walls in all 3 cases. The histopathology revealed necrotic destruction of the trabeculae mixed with randomly distributed chronic inflammatory cells and fibrosis and inflamed overlying granulation tissue. CONCLUSION: The delayed healing of the granulation tissue during secondary intention in these cases is quite likely the cause of chronic osteitis of the underlying orbital bone that, in turn, led to postoperative diffuse hyperostosis.

The promise and perils of CNS drug delivery: a video debate.

Neurodegenerative and infectious disorders related to host genetics, aging, and environment are rapidly increasing. Drugs, vaccines, or regenerative proteins offer "real" possibilities for positively affecting disease outcomes but are limited by access across the blood-brain barrier. New developments in nanomedicine and cell based drug delivery are becoming available. These discoveries can lead to improved neurological disease outcomes. Such obstacles include the toxicities inherent in the delivery systems de novo such as immuno- and neurological dysfunctions and perturbations of blood-brain barrier function. This debate by leading experts in the field highlights the promise and perils of CNS drug delivery. Click on Supplemental HTML to watch the streaming video.

Proteomic analysis of high-grade dysplastic cervical cells obtained from ThinPrep slides using laser capture microdissection and mass spectrometry.

The purpose of this discovery phase study was to identify candidate protein biomarkers for high-grade dysplastic cervical cells using mass spectrometry. Laser Capture Microdissection (LCM) was utilized to isolate high-grade dysplastic and normal cells from ThinPrep slides prepared from cervical cytological specimens. Following cell capture, samples were solubilized and proteins separated by gel electrophoresis in preparation for enzymatic digestion and liquid chromatography mass spectrometry analysis (LC-MS). Processed samples were subsequently analyzed using a linear ion trap coupled with a Fourier transform mass spectrometer (LTQ-FT MS). It was determined that both PreservCyt Solution and ThinPrep Pap Stain (Cytyc Corporation) were compatible with the sample processing and LC-MS analysis. In total, from 9 normal and 9 abnormal cervical cytological specimens, more than 1000 unique proteins were identified with high confidence, based on approximately 12,000 captured cells per specimen. Quantitative protein differences between HSIL (High-Grade Squamous Intraepithelial Lesion) and NILM (Negative for Intraepithelial Lesions or Malignancy) samples were determined by comparing the intensities of the representative (label-free) peptide ions. More than 200 proteins were found to exhibit a 3-fold difference in protein level. Interestingly, significant up-regulation of nuclear and mitochondrial proteins in HSIL specimens was noted. In several cases, the increased protein abundance observed in high-grade cells, as determined by quantitative LC-MS, was validated by immunocytochemical methods using ThinPrep cervical specimens. With the study of additional clinical specimens, the differential abundance of proteins in high-grade dysplastic cells versus morphologically normal cervical cells may lead to validated novel biomarkers for cervical disease.

Sutureless transconjunctival repair of orbital blowout fractures.

PURPOSE: To evaluate early postoperative results and complications in patients who underwent repair of isolated orbital floor blowout fractures with placement of nonfixed implants through a transconjunctival and sutureless incision. METHODS: We retrospectively reviewed 26 cases of isolated floor fractures repaired by this technique. Criteria for inclusion in this study were transconjunctival approach, nonfixed orbital implants, and sutureless closure. Early postoperative complications were evaluated. RESULTS: Twenty-six patients (16 male, 10 female) underwent repair of an isolated floor fracture and were followed after surgery for 1 to 26 months. No eyelid malposition, infection, or implant extrusion occurred. However, 1 patient (3.8%) had early migration of the orbital implant that did not require further intervention. CONCLUSIONS: Repair of orbital floor blowout fractures with a nonfixed implant through the transconjunctival approach and sutureless closure provides an excellent functional and cosmetic result.

Skin cooling before periocular botulinum toxin A injection.

PURPOSE: To determine if skin cooling decreases the pain associated with periocular botulinum toxin A injections. METHODS: In this prospective study, 14 patients given bilateral periocular injections for blepharospasm or wrinkle reduction were included. Prior to the injections, one side received a skin cooling agent and the other side served as the control. Relative pain scores were recorded to assess the effects of treatment. RESULTS: The range of pain scores on the noncooled side was 3 to 10 (average, 6.5); scores for the cooled side ranged from 0.5 to 7 (average, 3.6), which represents a 45% reduction in pain score. CONCLUSIONS: In most patients, skin cooling decreases the pain associated with periocular botulinum toxin A injection.

Bloody tears of unknown cause: case series and review of the literature.

PURPOSE: To report 4 cases of recurrent unilateral bloody tears. METHODS: Retrospective case series. RESULTS: One boy and 3 girls, ranging in age from 6 to 14 years, reported spontaneous bloody tearing. Workup included probing and irrigation of the nasolacrimal system, blood and coagulation profiles, blood typing, serum hormone levels, conjunctival biopsy, and imaging. All findings were normal and failed to suggest a cause in any of the cases. In all patients, bloody tearing eventually resolved without further sequela. No recurrence has been reported over a follow-up period of 9 months to 11 years. CONCLUSIONS: Bloody tearing is an unusual clinical entity that concerns patients and can perplex physicians. A thorough examination and proper workup are necessary to rule out serious conditions but may fail to determine a cause. These idiopathic cases typically resolve without treatment.

Cervical cancer control, priorities and new directions.

Cervical cancer is caused by infection with a range of high risk "oncogenic" human papillomavirus (HPV) types, and it is now accepted that >99% of cervical cancer is initiated by HPV infection. The estimated lifetime risk of cervical cancer is nevertheless relatively low (less than 1 in 20 for most community based studies). Although sensitivity and specificity of the available diagnostic techniques are suboptimal, screening for persistent HPV infection is effective in reducing the incidence of cervical cancer. Infection can be detected by molecular techniques or by cytological examination of exfoliated cervical cells. Persistent infection is the single best predictor of risk of cervical cancer. The latest findings of HPV and cervical cancer research need to be widely disseminated to the scientific and medical societies that are updating screening and management protocols, public health professionals, and to women and clinicians. This report reviews current evidence, clinical implications and directions for further research in the prevention, control and management of cervical cancer. We report the conclusions of the Experts' Meeting at the EUROGIN 2003 conference.