Hearing results with clothespin ossiculoplasty: preliminary report on the Kraus Modified Schuring Ossicle-Cup Prosthesis (Clothespin Prosthesis).

The clothespin partial ossicular replacement prosthesis (PORP) is designed to increase joint stability during incus replacement ossiculoplasty. Fundamental modifications have been made in the Schuring ossicle-cup, which include a forked well, increased well wall thickness and length, and a flexible tip disk added to the shaft. The forked well functions like a straight clothespin rather than an inverted cup. The forked well enables the clothespin prothesis to slide down over the stapes superstructure, between the facial nerve canal and the promontory, to form a stable, mortise-and-tenon prosthesis-stapedial joint. Joint stability is enhanced because the inferior tine of the forked well is able to lever against the inferior surface of the stapes superstructure, creating a counterforce to gravity. This is in contrast to the more unstable ball-and-socket joint created by most partial ossicular replacement prostheses when they articulate with the stapes capitulum. The addition of a flexible disk to the shaft tip produces a tight, stable union between the prosthesis and the ossicular cap by increasing resistance at the shaft-ossicle interface. Fluoroplastic composition maximizes intraoperative versatility and reliability while the ossicle cap minimizes extrusions. One-year hearing results for twelve chronic ear patients with mobile stapes undergoing clothespin ossiculoplasty during intact canal wall tympanomastoidectomy revealed postoperative air-bone gaps within 20 dB in 92% of cases. The mean postoperative air-bone gap was 8.9 dB, and the mean improvement in air-bone gap was 14.4 dB.(ABSTRACT TRUNCATED AT 250 WORDS)

Haemophilia: strategies for carrier detection and prenatal diagnosis.

In 1977 WHO published in the Bulletin a Memorandum on Methods for the Detection of Haemophilia Carriers. This was produced following a WHO/WFH (World Federation of Haemophilia) Meeting of Investigators in Geneva in November 1976, and has served as a valuable reference article on the genetics of haemophilia. The analyses discussed were based on phenotypic assessment, which, at that time, was the only procedure available. The molecular biology revolution in genetics during the 1980s made enormous contributions to our understanding of the molecular basis of the haemophilias and now permits precise carrier detection and prenatal diagnosis. WHO and WFH held a joint meeting on this subject in February 1992 in Geneva. This article is the result of these discussions.

Pregnancy in a cohort of long-term partners of human immunodeficiency virus-seropositive hemophiliacs.

Since 1981, there have been 17 pregnancies in 12 long-term female sexual partners of human immunodeficiency virus (HIV-1)-seropositive hemophilic men at the New England Hemophilia Center. Eleven of 12 women were seronegative for HIV antibody and one was seropositive. Six of the women followed a specific antibody testing schedule for nine pregnancies. This involved antibody testing at specific points before, during, and after pregnancy. All of the seronegative women had at least one negative antibody test at the conclusion of each pregnancy. Fourteen of 16 pregnancies in the seronegative women resulted in live-born infants. The children now range in age from 7 months to 7 years and 8 months, and have no significant medical problems. The woman found to be seropositive at 8 weeks' gestation of her first pregnancy subsequently delivered an infected infant. In this small group, 11 of 12 women at risk for HIV transmission were able to become pregnant and remain seronegative for HIV antibody. Antibody testing during pregnancy gave the women information on which to base reproductive choices.

Assessment of reproductive risks and intentions by mothers of children with hemophilia.

Thirty-five mothers of children with hemophilia were studied in order to ascertain the impact of hemophilia on family planning. Attitudes about reproductive risks and prenatal diagnosis were also examined. The most important factors influencing family planning in this group were parental fulfillment and availability of medical care and education for their affected child. Although 79% of mothers viewed their reproductive risk as moderate to very high, 57% indicated that their reproductive plans had not changed even with this knowledge. While 43% of the group would consider prenatal diagnosis, only 17% would terminate a pregnancy if the fetus was found to have hemophilia. Of those interested in prenatal diagnosis, the majority were interested in knowing if the fetus was affected but would not consider termination of the pregnancy. The majority of mothers in the group did not view having a child with hemophilia as an insurmountable burden on their lives. Therefore, the disease appeared to have little impact on family planning.

Evaluation of ultrasonography for monitoring follicular growth in rhesus monkeys.

The purpose of this study was to determine if the ovaries and uterus of rhesus monkeys could be visualized by ultrasonography and to detect changes associated with follicular growth and ovulation. Animals were examined during 15 menstrual cycles, for an average of nine consecutive days. Ultrasonic recordings were correlated with hormonal parameters (estradiol 17beta, E(2); luteinizing hormone, LH; and progesterone, P) and laparoscopic findings. The uterus and both ovaries were observed in more than 90% of the examinations. A dominant follicle (DF) was identified during all ovulatory cycles, on average 1 d preceding the E(2) peak. The maximal diameter of the DF ranged from 3 to 7 mm. Laparoscopic examinations to determine the site of the DF confirmed ultrasonic findings in 10 of 14 cycles (P < 0.1). There was no significant difference in the size of the dominant and contralateral ovaries; however, more follicles with a diameter of 2 to 7 mm were found on the dominant ovary (P < 0.05). Two animals stimulated with exogenous gonadotropins showed a linear increase in ovarian size for 6 d prior to oocyte recovery (P < 0.05), reflecting an increase in the number of developing follicles. Ultrasonography can be used to identify the DF during spontaneous cycles in rhesus monkeys and to monitor the response of monkeys to exogenous gonadotropins.

Ultrasonographic assessment of the endometrium in rhesus monkeys during the normal menstrual cycle.

This study was undertaken to determine whether cyclical changes in the endometrium of the rhesus monkey could be observed by using ultrasound. Three indices of endometrial size were examined: the antero-posterior (or ventro-dorsal), longitudinal, and transverse diameters. Changes in the ultrasonic reflectivity of the endometrium were also assessed. We have attempted to correlate these endometrial parameters with the hormonal status of the animal. Ultrasonography was performed for an average of 12 consecutive days during 19 menstrual cycles. All ultrasonic recordings were normalized to the day of the estradiol (E2) peak (Day 0). We found that the reflectivity of the endometrium was dependent on the stage of the cycle: during the follicular phase, the endometrium appeared less echogenic (darker) compared to the myometrium; in the luteal phase, the endometrium was more echogenic (lighter). During the follicular phase (Days -9 to 0), there was a linear increase in the antero-posterior (p less than 0.001), longitudinal (p less than 0.05), and transverse (p less than 0.001) diameters. In the luteal phase (Days 1-15), no significant changes were observed in these diameters. An estimated endometrial volume (EEV) was obtained by the product of the antero-posterior, longitudinal, and transverse diameters. Each animal observed during the follicular phase (n = 14) exhibited a peak in the EEV, which correlated with the day of the E2 peak (p less than 0.01). From this study, we conclude that the sonographic appearance of the endometrium of the rhesus monkey reflects the cyclical changes that occur during the menstrual cycle.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors influencing survival in head and neck patients with giant cervical lymph node metastasis.

Giant cervical lymph node metastasis originating from head and neck epidermoid carcinoma has traditionally indicated a poor prognosis. However, some patients with stage IV disease may live many years. In order to identify factors which might contribute to long-term survival, a retrospective analysis of 94 patients with head and neck squamous cell carcinoma and metastatic cervical lymph nodes greater than 4 cm was performed. At the time of study, 15 patients were alive; 62 of the remaining 79 patients had died due to related causes. Of the 15 survivors, mean survival time was 10.3 years, and the determinate five-year or greater survival rate was 20%. In contrast, mean survival of the 62 determinate nonsurvivors was 1.4 years. Recommended treatment for stage IV head and neck cancer patients with giant cervical lymph nodes consists of preoperative radiation therapy followed by wide-field en bloc resection.

The giant apical air cell syndrome. A new entity.

A new entity, the giant apical air cell syndrome, is presented and its surgical management is described. The syndrome triad consists of a giant apical air cell, spontaneous CSF rhinorrhea, and recurrent meningitis. Constant pounding of the brain against the dura overlying the giant air cell eventually, cause dural rupture and CSF leak. The giant apical air cell communicates with the eustachian tube creating a direct route for CSF to leak from the subarachnoid space into the nasopharynx. The syndrome is best diagnosed by polytomography of the petrous apex, surgical exploration, and careful dissection using the operating microscope. Dye or contrast studies are no longer necessary. Extracranial surgical management is preferable to the intracranial approach. Tympanomastoidectomy is performed with obliteration of the eustachian tube, middle ear, and mastoid. In this manner, the subarachnoid space is separated from the nasopharynx, preventing further episodes of meningitis. A detailed knowledge of the regional anatomy and the application of basic surgical principles should enable the temporal bone surgeon to accurately diagnose and manage most CSF fistulae.

Skull preparation using the exzyme-active detergent technique.

With the increasing use and need for macerated skulls and bony structures in medical research and resident and medical student studies, an economical, easy, and efficient method of obtaining cleaned and bleached specimens has been developed. The process requires short-term skeletal simmering in a 10% solution of commercially available enzymatic detergent and water. Over 50 skulls have been macerated in our laboratory resulting in substantial saving in research money, time, and effort.

Tomography of the vestibular aqueduct in ear disease.

A controversy exists concerning whether or not roentgenographic narrowing or nonvisualization of the vestibular aqueduct is a specific sign for Meniere's disease. Of 190 ears that were evaluated, abnormal aqueducts were seen in 42.9% of ears with Meniere's disease, 45.4% of contralateral, noninvolved ears from patients with Meniere's disease, 41.3% of ears with diseases other than Meniere's disease, 30.4% of ears with no disease, and 51.6% of normal ears. Narrowing or nonvisualization of the vestibular aqueduct is a nonspecific roentgenographic sign that is seen in diseased, as well as in normal ears, and should not be used to make a diagnosis of Meniere's disease. Indications for polytomography in Meniere's disease include (1) preoperative evaluation of the aqueduct prior to endolymphatic shunt procedures and (2) exclusion of acoustic neurinomas or other organic causes of vertigo.