Citations

The authors report on 2 patients with bilateral vestibular schwannomas (VSs) who underwent unilateral surgical tumor removal. One patient was followed up for 4 years, the other for 9; in both cases, the contralateral VS regressed markedly without any additional treatment during the follow-up period. Serial MR imaging was performed to monitor the untreated tumor, which in both cases involved the only hearing ear. The tumors were assessed volumetrically. The contralateral tumors appeared to enlarge mildly at initial follow-up and then, with no treatment, regressed (to 23% of the original maximum volume in Case 1 and to 15% of the original maximum in Case 2). The largest posterior fossa diameter decreased from 30.1 mm to 18.6 mm in Case 1 over 4 years and from 27 mm to 16 mm over 8 years in Case 2. Hearing declined only mildly during follow-up in both patients. These cases demonstrate the first well-documented, long-term, spontaneous VS regressions in patients with neurofibromatosis Type 2. They underline the importance of careful observation of VS involving the only hearing ear in the management of bilateral VS to determine the natural growth pattern of the tumors. The mechanism of the dramatic spontaneous tumor regression is uncertain.

AbstractAlthough silicone radial head arthroplasty has been successful in many patients, it has been associated with complications such as fractures of the prosthesis and silicone synovitis. Synovectomy and removal of the failed silicone radial head, with or without reimplantation of a metallic radial head, is indicated in such complications. In an effort to perform minimally invasive surgery, we performed arthroscopic removal of the silicone head combined with synovectomy in a series of such patients. The silicone prostheses were cut into two or three pieces and then removed. After a median follow up of 26 months, all patients reported excellent pain relief and there were no residual loose bodies. Removal of a failed silicone radial head can be successfully performed arthroscopically. This arthroscopic technique has the advantage of being minimally invasive and can be combined with other procedures including capsulectomy, if necessary.

A custom computer-controlled rapid prototyping system was designed and developed in this research. This system for bio-manufacturing of polymer scaffolds included 3D motion control components, a nozzle, a pressure controller, and a temperature-controlled reservoir containing a biomaterial. Heating elements built into the reservoir melted the biomaterial. The pressure line attached to the reservoir provided a controllable force that extruded the polymer biomaterial through the nozzle and deposited the polymer biomaterial onto a platform to fabricate scaffolds. A low pressure (830 KPa) system was designed and fabricated to accommodate different temperatures, motion speeds, and viscosities of polymer biomaterials. The reservoir with the nozzle was mounted to servo motor-controlled linear x-y motion devices along with a third servo motor-controlled device that controlled the z-position of the platform. Poly(ε-caprolactone) [PCL] was used to fabricate scaffolds with designed structure that were used in cell and tissue regeneration studies. 3D computer-aided design (CAD) with Pro-Engineer and computational finite element analysis (FEA) programs with MSC_Patran and MSC_Marc were used to model scaffold designs with appropriate architecture and material selection. The CAD models were used in FEA to develop new methods for determining mechanical properties of tissue scaffolds of desired structure and geometry. FEA models were validated by mechanical testing and other published results. Technology developed in this research has potential for the advancement of bio-manufacturing, and design optimization of scaffolds for tissue engineering.

The objective of this study was to assess growth patterns of hyperlipidemic children enrolled in a preventive cardiovascular health clinic. A retrospective chart review of hyperlipidemic children enrolled in the Mayo Clinic Cardiovascular Health Clinic for the Young was performed. All participants were counseled to eat an American Heart Association Step-One Diet and exercise regularly. Weight and height were measured every 3 months. Growth was assessed using attained heights and weights and body-mass index Z scores compared to standard distributions for North American children. Sixty-three patients (33 males and 30 females) were enrolled in the study. Mean age at clinic entrance was 7.8 ± 3.5 years (range: 2 to 16 years). We conclude that participation in a preventive health clinic is generally safe for hyperlipidemic children. However, medical management of hyperlipidemic children must include meticulous surveillance to detect the infrequent occurrence of excessive weight loss or weight stabilization resulting from inappropriate response to dietary counseling.

Background Complete biceps tendon avulsions are frequently missed on clinical examination, suggesting the need for a reliable diagnostic test. Hypothesis Complete distal biceps avulsions can be reliably detected with the Hook test. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The hook test was performed by a single surgeon in a cohort of 45 patients undergoing surgical exploration of the distal biceps tendon. While the patient actively supinates with the elbow flexed 90°, an intact hook test permits the examiner to hook his or her index finger under the intact biceps tendon from the lateral side. With an abnormal hook test, indicating distal avulsion, there is no cord-like structure under which the examiner may hook a finger. Results Thirty-three patients had an avulsion and 12 had a partial tear. The hook test was abnormal in 33 of 33 (100%) patients with complete biceps avulsions, and intact in 12 of 12 with partial detachments. However, it was painful in 9 of those 12. In the noninjured contralateral arms, which served as the normal control group, 45 of 45 (100%) had a normal hook test. Magnetic resonance imaging (MRI) diagnosed a complete tear in 11 of 12 patients with partial tears and in 11 of 13 with complete lesions. The sensitivity and specificity were both higher with the hook test (both 100%) than with MRI (92% and 85%, respectively). Conclusions The hook test is a highly sensitive and specific test for assessment of distal biceps tendon avulsions.

Patients who experience chronic recurring head and face pain present a diagnostic and therapeutic challenge. Treatment options for Sluder's neuralgia, an uncommon cause for recurring head and face pain, are controversial. We reviewed the outcomes of patients who underwent intranasal phenolization of the sphenopalatine ganglion for the treatment of Sluder's neuralgia. Eight patients were treated with intranasal cauterization of the sphenopalatine ganglion between 1990 and 1995. Patients were treated an average of 13 times. Overall, patients experienced a 90% decrease in head and face pain for an average of 9.5 months duration. Interestingly, the patients described recurrent pain as less severe, less frequent, and of shorter duration. Intranasal phenolization of the sphenopalatine ganglion appears to be a safe and effective, although temporary, treatment for patients with Sluder's neuralgia. This article will review the symptomatology, differential diagnosis, and phenolization technique for treatment of Sluder's neuralgia.

OBJECTIVETo review hearing results after implantation of a self‐crimping stapes prosthesis.STUDY DESIGN AND SETTINGAnalysis of hearing results in patients implanted with a self‐crimping stapes prosthesis at two academic hospitals from 2000 to 2004.RESULTSSeventy‐nine ears were divided into short‐term and intermediate follow‐up groups. The mean postoperative air‐bone gap (ABG), preoperative minus postoperative ABG, and preoperative minus postoperative bone conduction values were 5.7, 21.4, and 4.1 dB, respectively, for the short‐term group, and 6.3, 22.3, and 4.7dB, respectively, for the intermediate group. The ABG was <10 dB in 88 percent of the short‐term group and in 79 percent of the intermediate group.CONCLUSIONSThe self‐crimping Nitinol stapes prosthesis provides excellent short‐term and intermediate postoperative hearing results, and may overcome the limitations of stapes prostheses requiring manual crimping.SIGNIFICANCEThis paper provides evidence for the use of a self‐crimping Nitinol stapes prosthesis, which may simplify hearing restoration surgery for stapes fixation.

The purpose of this study was to compare 2 radio graphic methods for measuring anteversion and to de termine whether glenoid anteversion is a significant fac tor in recurrence of instability after anterior repair. West Point axillary roentgenograms were obtained in 128 pa tients (138 shoulders) at a mean of 9 years after sur gery. Two methods to measure glenoid anteversion were compared: The angle between the glenoid and the body of the scapula, and the angle between the glenoid and the posterior margin of the acromion. There was less variation in the measurements using the glenoid margin-posterior acromion angle. By this method, an teversion was 11 ° ± 4° for the 15 patients with multiple (2 or more) recurrences, 8° ± 3° for the 15 patients with 1 recurrence, and 6° ± 5° for the 109 patients with no recurrences. Although these differences are statistically significant (P = 0.003), they probably are not clinically important because they are small (mean of only 5°). The differences obtained by measuring the angle between the glenoid and the body of the scapula were not sta tistically significant.

OBJECTIVETo evaluate hearing outcomes and effects of stimulation rate on performance with the Nucleus Freedom cochlear implant (Cochlear Americas, Denver, CO).STUDY DESIGN AND SETTINGRandomized, controlled, prospective, single‐blind clinical study using single‐subject repeated measures (A‐B‐A‐B) design at 14 academic centers in the United States and Canada and comparison with outcomes of a prior device by the same manufacturer.PATIENTSSeventy‐one severely/profoundly hearing impaired adults.RESULTSSeventy‐one adult recipients were randomly programmed in two different sets of rate: ACE or higher rate ACE RE. Mean scores for Consonant Nucleus Consonant words is 57%, Hearing in Noise Test (HINT) sentences in quiet 78%, and HINT sentences in noise 64%. Sixty‐seven percent of subjects preferred slower rates of stimulation, and performance did not improve with higher rates of stimulation using this device.CONCLUSIONSSubjects performed well, and there was no advantage to higher stimulation rates with this device.SIGNIFICANCEHigher stimulation rates do not necessarily result in improved performance.