Stapedectomy Training With the Carbon Dioxide Laser

All primary carbon dioxide (CO₂) laser stapedectomies supervised by the senior author since 1986 were retrospectively reviewed and reported according to 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing guidelines. Sixty-three cases had more than 6 weeks of follow-up with an average residual gap of 6.49 dB (SD = 5.55 dB) and an 89% success rate. Thirty cases had more than 1 year of follow-up with the average hearing result of 6.58 dB (SD = 5.93 dB) and an 87% success rate. In 11 cases, 14 operative problems or complications occurred. Suctioning the vestibule occurred in five cases. Because suction is required to evacuate laser smoke, these cases are attributed to the laser. One of these patients had delayed sensorineural hearing loss. One patient had profound delayed sensorineural hearing loss as a result of granuloma formation. These were the only major complications. The laser is a tool that gives reproducible technique and good success rates.     

Involvement of deprivation and environmental lead in neural tube defects: a matched case-control study

OBJECTIVE: To analyse the prevalence of neural tube defects in small geographical areas and seek to explain any spatial variations with reference to environmental lead and deprivation. SETTING: The Fylde of Lancashire in the north west of England. DESIGN: Cases were ascertained as part of a prospective survey of major congenital malformations in babies born in the Fylde to residents there between 1957 and 1981. A matched case-control analysis used infants with cardiovascular system, alimentary tract, and urinary system malformations as controls. Conditional logistic regression was used to assess the effects of more than 10 micrograms/l lead in drinking water and the Townsend deprivation score. RESULTS: The prevalence of neural tube defects in 1957-73 was higher in Blackpool, Fleetwood, and North Fylde, whereas the three control groups showed no significant spatial variation. In 1957-81 mothers living in electoral wards with either a higher proportion of houses with more than 10 micrograms/l lead in the water or a higher deprivation score had a greater risk of having a baby with a neural tube defect. For spina bifida and cranium bifidum alone, this was also true. For anencephaly, deprivation was less important although the effect of lead was still seen. In some neural tube defects, lead may act independently of other possible factors associated with deprivation. It seemed unlikely that lead levels changed significantly during the survey. The percentage of houses with 10 micrograms/l or more of lead in the water in 1984-5 was similar to that found in Great Britain 10 years previously. CONCLUSION: There is evidence to suggest that lead is one cause of neural tube defects, especially anencephaly. This could link the known preventive actions of hard water and folic acid. Calcium is a toxicological antagonist of lead. One cause of a deficiency of folic acid is impaired absorption secondary to zinc deficiency, which may be produced or exacerbated by lead.     

p16INK4A immunoexpression and HPV in situ hybridization signal patterns: potential markers of high-grade cervical intraepithelial neoplasia

Integration of human papillomavirus (HPV) into the cell genome is considered to be an important event in the progression of cervical neoplasia. p16, also a useful biomarker of cervical intraepithelial neoplasia (CIN), shows increased immunoexpression with worsening grades of CIN. This study examines the correlation between p16 immunoexpression, grade of CIN, HPV type, and HPV in situ hybridization diffuse and punctate signal patterns (linked to episomal and integrated viral particles, respectively) in 44 cervical biopsies/LEEP excisions classified as CIN 1 and CIN 2/3. In 22 of 25 (88%) CIN 1 lesions, p16 immunoexpression was confined to the lower half of the epithelium, with sporadic to focal staining in 11 of 25 cases (44%). In CIN 2/3 lesions, 15 of 17 (88.2%) showed diffuse, two-thirds to full-thickness staining of the epithelium. High-risk HPV types were found in 20 (80%) CIN 1 lesions and 17 (100%) CIN 2/3 lesions. Punctate signals were detected in only 3 (13.6%) of high-risk HPV-positive CIN 1 lesions and in 17 of 17 (100%) CIN 2/3 lesions (P<0.001). p16 immunoexpression and the presence of punctate signal on HPV in situ hybridization correlated with the degree of cervical neoplasia (P<0.001). However, 3 cases of CIN 1 demonstrating punctate signals did not demonstrate a comparable CIN 2/3 p16 staining pattern. Similarly, two CIN 1 lesions with comparable CIN 2/3 p16 staining showed no evidence of viral integration. Both increased p16 immunoexpression and punctate signal correlate with CIN 2/3 grade, supporting the use of either, or both, tests to confirm CIN 2/3. Strong p16 immunostaining in CIN 1 appears independent of HPV punctate signal type.     

Intraoperative evaluation of sentinel lymph nodes in invasive lobular carcinoma of the breast

Background

In breast cancer treatment, sentinel lymph node (SLN) evaluation is used to identify patients who may benefit from axillary lymph node dissection (ALND). Intraoperative evaluation (IE) of SLNs facilitates immediate ALND. Controversy exists regarding the accuracy of intraoperative SLN evaluation for patients with invasive lobular carcinoma (ILC) compared to invasive ductal carcinoma (IDC).

Methods

Using breast cancer registry data from January 2003 to March 2008, the intraoperative SLN evaluation of 66 ILC and 810 IDC patients was compared to the final SLN pathology result and to the performance of ALND.

Results

In ILC, the sensitivities of IE for isolated tumor cells (≤.2 mm, N0[i+], n = 9), micrometastases (>.2 mm and ≤ 2.0 mm, N1mi, n = 6), and macrometastases (>2.0 mm, N1a-3a, n = 21) were 0%, 17%, and 71%, respectively. The specificity was 100%. IE identified 16/27 (59%) of SLN-positive (N1mi, N1a-3a) axillae, resulting in synchronous ALND. Delayed ALND for false negative IEs (11/27, 41%) occurred in 7/11 patients (64%). In IDC, the sensitivities of IE for N0(i+) (n = 60), N1mi (n = 75), and N1a-3a (n = 129) metastases were 0%, 7%, and 71%, respectively. The specificity was 99.6%. IE identified 97/204 (48%) of SLN-positive (N1mi, N1a-3a) axillae, resulting in synchronous ALND. Delayed ALND for false negative IEs (107/204, 52%) occurred in 38/107 patients (36%).

Conclusions

Sensitivity and specificity of intraoperative SLN evaluation is very similar in ILC and IDC patients. Intraoperative SLN evaluation facilitated synchronous ALND in concordance with recommended practice guidelines.     

Comparison of reconstruction accuracy and efficiency among autocalibrating data‐driven parallel imaging methods

The class of autocalibrating “data‐driven” parallel imaging (PI) methods has gained attention in recent years due to its ability to achieve high quality reconstructions even under challenging imaging conditions. The aim of this work was to perform a formal comparative study of various data‐driven reconstruction techniques to evaluate their relative merits for certain imaging applications. A total of five different reconstruction methods are presented within a consistent theoretical framework and experimentally compared in terms of the specific measures of reconstruction accuracy and efficiency using one‐dimensional (1D)‐accelerated Cartesian datasets. It is shown that by treating the reconstruction process as two discrete phases, a calibration phase and a synthesis phase, the reconstruction pathway can be tailored to exploit the computational advantages available in certain data domains. A new “split‐domain” reconstruction method is presented that performs the calibration phase in k‐space (k_x, k_y) and the synthesis phase in a hybrid (x, k_y) space, enabling highly accurate 2D neighborhood reconstructions to be performed more efficiently than previously possible with conventional techniques. This analysis may help guide the selection of PI methods for a given imaging task to achieve high reconstruction accuracy at minimal computational expense. Magn Reson Med 59:382–395, 2008. © 2008 Wiley‐Liss, Inc.     

The Utility of Intraoperative Evaluation of Sentinel Lymph Nodes in Breast Cancer

Background In breast cancer treatment, intraoperative sentinel lymph node (SLN) evaluation is used to identify patients who may potentially benefit from immediate completion of axillary lymph node dissection. Methods Prospectively collected breast cancer registry data identified 516 SLN biopsies between January 2003 and December 2005. Intraoperative evaluation (IE) of the SLNs was performed in 479 axillae. Final pathology by hematoxylin and eosin and, for negative nodes, by immunohistochemical stains was compared with the IE result. The effect of IE and final pathology on surgical treatment was examined. Results The sensitivities for IE of N0(i+) (n = 39), N1mi (n = 41), and N1a–3a (n = 89) metastases were 0%, 5%, and 63%, respectively. The specificity was 99.7%. IE identified 57 (44%) of SLN-positive (N1mi and N1a–3a) axillae, thus resulting in synchronous axillary lymph node dissection for those patients. Reoperation for false-negative IEs (N1mi or N1a–3a with negative IE) occurred in only 27 axillae (39%). Conclusions IE of SLNs has adequate sensitivity and excellent specificity. In addition to allowing patients to benefit from synchronous surgery, IE helped patients to receive care in concordance with recommended practice guidelines. The false-negative IE of SLNs highlights uncertainty with the clinical significance of axillary nodal staging when only small amounts of metastatic disease are identified in the axilla.     

The prognostic influence of chronicity of rhegmatogenous retinal detachment on anatomic success after reattachment surgery

PURPOSE: To investigate anatomic success after surgery for chronic retinal detachment. DESIGN: Retrospective, case series review. METHODS: The surgical outcomes of reattachment surgery for 36 eyes of 35 patients with chronic retinal detachments are reported and are compared with the outcomes for 129 fresh retinal detachments. RESULTS: After exclusion of retinal detachments secondary to retinal dialysis and of cases with proliferative vitreoretinopathy (PVR), success after a single procedure was seen in eight of 14 (57.1%) chronic retinal detachments, and this compares with 92 of 107 (86.0%) fresh retinal detachments (P = .0161). CONCLUSIONS: Chronicity of retinal detachment at presentation is an important and poor prognostic indicator for reattachment surgery.     

Acute myocardial ischemia: MR imaging with Mn-TP

Cardiac-gated magnetic resonance (MR) imaging was performed in rats to determine the effects of manganese ethylenediaminetetraphosphonate (TP). Ten normal rats received Mn-TP in a dose of 50 mumol/kg through a tail-vein injection. Spin-echo MR images were obtained before and every 10 minutes after Mn-TP injection for 1 hour. Cardiac signal intensity (SI) increased more than 70% after Mn-TP injection and remained nearly unchanged 1 hour after injection. Myocardial T1 was 517 +/- 49 msec in eight control rats and 282 +/- 61 msec (P less than .001) in six rats 81 +/- 0 minutes after injection. Nine rats underwent occlusion of the left anterior descending coronary artery prior to MR imaging. Images were obtained before and 15, 30, and 60 minutes after Mn-TP injection. In normal myocardium, SI increased up to 82% and remained elevated for 1 hour. In ischemic myocardium, SI rose 11%, leading to a marked contrast between the two tissue zones. T1 was also different in the two regions: In normal tissue, it was 206 msec +/- 54; in ischemic tissue, 338 +/- 82 (P less than .001). With T1-weighted MR imaging, Mn-TP showed a potential for delineating the jeopardized area after acute myocardial ischemia.     

Allogeneic marrow transplantation in patients with chronic myeloid leukemia in the chronic phase: a randomized trial of two irradiation regimens

A randomized trial was performed to compare two regimens of total body irradiation in patients with chronic myeloid leukemia treated by allogeneic marrow transplantation while in the chronic phase. All patients received cyclophosphamide 120 mg/kg followed by total body irradiation and marrow from HLA-identical siblings. Cyclosporine and methotrexate were used for prophylaxis against acute graft-versus-host disease. Fifty-seven patients were randomized to receive 2.0 Gy fractions of irradiation daily for 6 days and 59 were randomized to receive 2.25 Gy fractions daily for 7 days. The probabilities of relapse at 4 years were 0.25 for the 12.0 Gy group and 0.00 for the 15.75 Gy group (P = .008). The actuarial probabilities of survival and relapse-free survival at 4 years were 0.60 and 0.58 among the patients who received 12.0 Gy compared with 0.66 and 0.66 for those who received 15.75 Gy. The 4-year probabilities of transplant-related mortality were 0.24 and 0.34 respectively (P = .13) while the probability of moderate to severe acute graft-versus-host disease was 0.33 for the 12.0 Gy group and 0.44 for the 15.75 Gy group (P = .15). The lower relapse probability in the patients receiving the higher dose of total body irradiation did not result in improved survival because mortality from causes other than relapse was increased.