Deep brain stimulation for advanced Parkinson's disease.

Deep brain stimulation (DBS) is a new and promising technique for the treatment of movement disorders. Medically intractable Parkinson's disease (PD) is one of the most common indications for DBS. There are three possible subcortical targets for PD, depending on the symptomatology (i.e., the motor subdivision of the thalamus, the globus pallidus internus, the subthalamic nucleus [STN]). Thalamic stimulation has been well established as a safe and effective treatment for essential tremor and the tremor associated with PD. Globus pallidus internus and STN DBS are being investigated for the treatment of all the cardinal signs of PD. This article describes the pathophysiology of PD, the surgical treatment history of PD, surgical techniques used for DBS implants, and the role the perioperative nurse has in the care of the patients undergoing these procedures.

Osteogenesis imperfecta with unusual skeletal lesions: report of three families.

Thirteen individuals with osteogenesis imperfecta (OI) from three families were evaluated. All examined persons with OI had multilocular radiolucent, radiopaque, or radiolucent-radiopaque lesions of the maxilla and mandible. In most patients, the lesions involved the tooth bearing areas, but in two, the rami also were involved. Teeth were normal. Radiologic findings in the extragnathic skeleton included marked coarseness of trabeculae and diffuse osteopenia. It is proposed that these patients represent yet another dominantly inherited OI syndrome.

Tomographic assessment of nasal septal changes following surgical-orthodontic rapid maxillary expansion.

Nine adult patients with transverse maxillary deficiency were examined for incidence of nasal septal deviation following surgical-orthodontic rapid maxillary expansion. The osteotomies for facilitation of maxillary expansion did not include sectioning of the nasal septum. The procedure did include sectioning of the lateral maxillary walls, the pterygomaxillary suture, and the midpalatal sutures. For each patient, four graduated coronal tomograms through the incisal, molar, tuberosity, and pterygoid areas were taken prior to and not less than 4 months after surgical intervention. Results showed no significant change in the nasal septal position from before to after surgery. Analysis of the nature of maxillary movement in the coronal plane revealed rotational as opposed to bodily expansion, with inferior rotation of the palatal vault. Significant increases in the available nasal airway space were recorded. These increases were attributed primarily to shrinkage of inflamed nasal mucosa. In view of the recorded data, surgical sectioning of the nasal septum to prevent septal deviation by surgical-orthodontic rapid maxillary expansion is not warranted.

Intraoral melanoacanthoma.

Two cases of melanoacanthoma occurring on oral mucous membranes are presented. Melanoacanthoma is considered to be a benign mixed tumor of keratinoacytes admixed with pigment-laden dendritic melanocytes. All intraoral melanoacanthomas reported thus far have been pigmented lesions of the buccal mucosa and have occurred in young to middle-aged black females. These tumors may grow rapidly and therefore they often mimic the radial growth phase of an intraoral melanoma. Because melanocanthomas have no distinguishing clinical features, biopsy is mandatory.

Clinicopathological conference. Case 29, part 2. Follicular thyroid carcinoma metastatic to the mandible.

A case of follicular carcinoma of the thyroid metastatic to the mandible is reported and the literature is reviewed. Present conventional methods for determining the presence of secondary deposits, both in living patients and in cadavers, may account, in part, for the small number of cases reported in the literature involving metastases to the jaws. Careful attention to the medical history, clinical examination, scintigraphy, and results of the biopsy will help to establish early diagnosis of which definitive treatment can be based.

Murine tumor induction by cytomegalovirus.

Cytomegalic inclusion disease can be induced in mice with relative ease. In the study reported here, grandular neoplasms were produced in four mice by means of immunosupression together with large doses of cytomegalovirus. The results of this study suggest that cytomegalovirus may well be an etiologic agent in the formation of salivary gland tumors.

Evaluation of cardiovascular and pulmonary changes during meperidine-diazepam anesthesia.

Studies were conducted in 189 oral surgery out-patients to evaluate the combination of meperidine hydrochloride and diazepam for anesthesia and to determine its effect on the cardiovascular and pulmonary systems. Results showed that neither ventricular cardiac arrhythmias nor clinically significant respiratory depression occurred in the sedated patients; meperidine-diazepam proved to be satisfactory for oral surgical procedures.