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Sample records for acoustic neuroma excision

  1. Acoustic Neuroma

    MedlinePlus

    ... search IRSA's site Unique Hits since January 2003 Acoustic Neuroma Click Here for Acoustic Neuroma Practice Guideline ... to microsurgery. One doctor's story of having an acoustic neuroma In August 1991, Dr. Thomas F. Morgan ...

  2. Acoustic neuroma

    MedlinePlus

    Vestibular schwannoma; Tumor - acoustic; Cerebellopontine angle tumor; Angle tumor; Hearing loss - acoustic; Tinnitus - acoustic ... Acoustic neuromas have been linked with the genetic disorder neurofibromatosis type 2 (NF2). Acoustic neuromas are uncommon.

  3. Acoustic Neuroma

    MedlinePlus

    An acoustic neuroma is a benign tumor that develops on the nerve that connects the ear to the brain. ... can press against the brain, becoming life-threatening. Acoustic neuroma can be difficult to diagnose, because the ...

  4. Functional outcome in patients after excision of extracanalicular acoustic neuromas using the suboccipital approach.

    PubMed Central

    Kane, N. M.; Kazanas, S.; Maw, A. R.; Coakham, H. B.; Torrens, M. J.; Morgan, M. H.; Stranjalis, G.; Butler, S. R.

    1995-01-01

    An audit of surgery for acoustic neuroma was carried out to determine the frequency and nature of postoperative symptoms and their impact upon the patient's quality of life and vocation. Fifty-six patients were interviewed between 6 months and 5 years (mean 26 months) after surgical excision of an acoustic neuroma. The objective surgical results in these patients are good, with normal or near normal functional preservation rates of 80% for the facial nerve (House-Brackmann grade I/II), and 27.3% for a previously functioning acoustic nerve. Despite this there was no significant overall reduction in the reported occurrence of balance problems, tinnitus, headache and other neurological sequelae of the tumour after surgical excision. In 20% of the patients persistent symptoms, including deafness and facial weakness, had prevented the resumption of former social activities. As a result of these symptoms 8.6% of the patients were certified medically unfit for work, but of those employed preoperatively over 70% had returned to their jobs. The success of neuro-otological surgical management of acoustic neuroma is offset by some degree of chronic morbidity. Our patients expressed the need to know whether their symptoms would resolve, but were often too afraid to ask. Patients can be reassured that the majority resume their former social and vocational activities, but should be advised that some symptoms can persist or occur de novo after surgery. Our data suggest that early intervention would reduce the incidence of these troublesome sequelae. PMID:7598420

  5. Symptoms of Acoustic Neuroma

    MedlinePlus

    ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ...

  6. Identifying the Acoustic Neuroma

    MedlinePlus

    ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ...

  7. Acoustic Neuroma Educational Video

    MedlinePlus

    ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ...

  8. Acoustic Neuroma Association

    MedlinePlus

    ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ...

  9. Treatment of Acoustic Neuroma

    MedlinePlus

    ... acoustic neuroma. There are several different commercially-available machines that are used to treat acoustic neuromas with ... how the radiation is precisely delivered. Gamma Knife® machines derive their radiation from a fixed-array of ...

  10. Acoustic Neuroma Educational Video

    MedlinePlus

    ... provider Request a patient kit Treatment Options Overview Observation Radiation Surgery What is acoustic neuroma Diagnosing Symptoms ... effects Question To Ask Treatment Options Back Overview Observation Radiation Surgery Choosing a healthcare provider Request a ...

  11. Symptoms of Acoustic Neuroma

    MedlinePlus

    ... provider Request a patient kit Treatment Options Overview Observation Radiation Surgery What is acoustic neuroma Diagnosing Symptoms ... effects Question To Ask Treatment Options Back Overview Observation Radiation Surgery Choosing a healthcare provider Request a ...

  12. Diagnosing Acoustic Neuroma

    MedlinePlus

    ... provider Request a patient kit Treatment Options Overview Observation Radiation Surgery What is acoustic neuroma Diagnosing Symptoms ... effects Question To Ask Treatment Options Back Overview Observation Radiation Surgery Choosing a healthcare provider Request a ...

  13. Post Treatment of Acoustic Neuroma

    MedlinePlus

    Home What is an AN What is an Acoustic Neuroma? Identifying an AN Symptoms Acoustic Neuroma Keywords Educational Video Pre-Treatment Treatment Options Summary Treatment Options Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions ...

  14. Subarachnoid fat embolism complicating autologous fat grafting following translabyrinthine excision of acoustic neuroma.

    PubMed

    Reece, A T; O'Reilly, B; Teasdale, E; Todd, N V

    1989-09-01

    A 64-year-old man had complete excision of an acoustic schwannoma via the translabyrinthine route and the mastoid cavity was packed with fat. Post-operatively there were two episodes of aseptic meningitis and CT scanning demonstrated migration of fat into the basal subarachnoid CSF spaces. This unusual complication should be recognized and differentiated from both true infective meningitis and aseptic meningitis from other causes.

  15. What Is an Acoustic Neuroma

    MedlinePlus

    ... provider Request a patient kit Treatment Options Overview Observation Radiation Surgery What is acoustic neuroma Diagnosing Symptoms ... effects Question To Ask Treatment Options Back Overview Observation Radiation Surgery Choosing a healthcare provider Request a ...

  16. [Treatment of giant acoustic neuromas].

    PubMed

    Samprón, Nicolás; Altuna, Xabier; Armendáriz, Mikel; Urculo, Enrique

    2014-01-01

    To analyze the treatment modality and outcome of a series of patients with giant acoustic neuromas, a particular type of tumour characterised by their size (extracanalicular diameter of 4cm or more) and high morbidity and mortality. This was a retrospective unicentre study of patients with acoustic neuromas treated in a period of 12 years. In our institutional series of 108 acoustic neuromas operated on during that period, we found 13 (12%) cases of giant acoustic neuromas. We reviewed the available data of these cases, including presentation and several clinical, anatomical, and microsurgical aspects. All patients were operated on by the same neurosurgeon and senior author (EU) using the suboccipital retrosigmoid approach and complete microsurgical removal was achieved in 10 cases. In one case, near total removal was deliberately performed, in another case a CSF shunt was placed as the sole treatment measure, and in the remaining case no direct treatment was given. One patient died in the immediate postoperative period. One year after surgery, 4 patients showed facial nerve function of iii or more in the House-Brackman scale. The 4 most important prognostic characteristics of giant acoustic neuromas are size, adhesion to surrounding structures, consistency and vascularity. Only the first of these is evident in neuroimaging. Giant acoustic neuromas are characterised by high morbidity at presentation as well as after treatment. Nevertheless, the objective of complete microsurgical removal with preservation of cranial nerve function is attainable in some cases through the suboccipital retrosigmoid approach. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  17. Decision Making in Acoustic Neuroma Management

    PubMed Central

    Naguib, Maged B.; Saleh, Essam; Aristegui, Miguel; Mazzoni, Antonio; Sanna, Mario

    1994-01-01

    Patients with acoustic neuroma in their only hearing ear are not frequently seen in clinical practice. Managing this group of patients is a challenge to both patient and surgeon. In this study we report on five cases of acoustic neuroma in an only hearing ear. Our decision for nonsurgical management of those patients with regular follow-up using auditory brainstem responses and magnetic resonance imaging is discussed. Other management options currently available are considered as well. PMID:17170923

  18. Clinical and diagnostic evaluation of acoustic neuromas.

    PubMed

    Stucken, Emily Z; Brown, Kevin; Selesnick, Samuel H

    2012-04-01

    In the past century, significant advances have been made in understanding the clinical features of acoustic neuromas. Furthermore, rapid technological advances have led to the development of sensitive, rapid, and relatively noninvasive diagnostic modalities, which has allowed for earlier discovery of acoustic neuromas and has reduced the average tumor size at time of diagnosis. The ultimate result has been improved clinical outcomes after surgery and radiotherapy.

  19. Incidental discovery of acoustic neuromas.

    PubMed

    Selesnick, S H; Deora, M; Drotman, M B; Heier, L A

    1999-06-01

    Our objective is to report 4 cases of incidentally discovered acoustic neuromas (ANs) and to determine the incidence of asymptomatic ANs. A prospective study of 161 consecutive patients undergoing gadolinium-enhanced MRI (Gd-MRI) at a tertiary-care university-affiliated medical center was carried out from September 1994 to April 1995. The Gd-MRI scans were performed for tentative diagnoses other than AN or sensorineural hearing loss. In 161 consecutive patients examined, no ANs were found incidentally on Gd-MRI scans. Previous studies have suggested that the incidence of occult ANs is as high as 1%. On the basis of our results, we suggest that the actual incidence may be lower. However, our study is limited by its small size and the low incidence of ANs in the general population. Also reported are the clinical and MRI characteristics of 4 patients with incidentally diagnosed ANs.

  20. Loud noise exposure and acoustic neuroma.

    PubMed

    Fisher, James L; Pettersson, David; Palmisano, Sadie; Schwartzbaum, Judith A; Edwards, Colin G; Mathiesen, Tiit; Prochazka, Michaela; Bergenheim, Tommy; Florentzson, Rut; Harder, Henrik; Nyberg, Gunnar; Siesjö, Peter; Feychting, Maria

    2014-07-01

    The results from studies of loud noise exposure and acoustic neuroma are conflicting. A population-based case-control study of 451 acoustic neuroma patients and 710 age-, sex-, and region-matched controls was conducted in Sweden between 2002 and 2007. Occupational exposure was based on historical measurements of occupational noise (321 job titles summarized by a job exposure matrix) and compared with self-reported occupational noise exposure. We also evaluated self-reported noise exposure during leisure activity. Conditional logistic regression was used to estimate odds ratios. There was no statistically significant association between acoustic neuroma and persistent occupational noise exposure, either with or without hearing protection. Exposure to loud noise from leisure activity without hearing protection was more common among acoustic neuroma cases (odds ratio = 1.47, 95% confidence interval: 1.06, 2.03). Statistically significant odds ratios were found for specific leisure activities including attending concerts/clubs/sporting events (odds ratio = 1.82, 95% confidence interval: 1.09, 3.04) and participating in workouts accompanied by loud music (odds ratio = 2.84, 95% confidence interval: 1.37, 5.89). Our findings do not support an association between occupational exposure to loud noise and acoustic neuroma. Although we report statistically significant associations between leisure-time exposures to loud noise without hearing protection and acoustic neuroma, especially among women, we cannot rule out recall bias as an alternative explanation. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Occupational exposures and risk of acoustic neuroma.

    PubMed

    Prochazka, Michaela; Feychting, Maria; Ahlbom, Anders; Edwards, Colin G; Nise, Gun; Plato, Nils; Schwartzbaum, Judith A; Forssén, Ulla M

    2010-11-01

    Acoustic neuroma is a benign tumour accounting for approximately 6-10% of all intracranial tumours and occurs mainly in patients aged ≥50 years. Our aim was to investigate a wide range of occupational exposures, individual occupational titles and socioeconomic status (SES) as potential risk factors for acoustic neuroma. We conducted a population-based case-control study of 793 acoustic neuroma cases identified through the Swedish Cancer Registry and 101,762 randomly selected controls. Information on SES and occupation was obtained from censuses and linked to job-exposure matrices. Logistic regression was used to estimate ORs and calculate 95% CIs. An increased OR was seen for mercury exposure <10 years before the reference year (OR 2.9; 95% CI 1.2 to 6.8), and a more modest association for benzene exposure (OR 1.8; 95% CI: 1.0 to 3.2) ≥10 years before the reference year. We observed a threefold increased risk for females working as tailors and dressmakers ≥10 years before the reference year, and a more than threefold significantly elevated OR for those working as truck and conveyor operators <10 years before the reference year. We found no convincing evidence that SES is related to disease development. We observed an increased risk of acoustic neuroma associated with occupational exposure to mercury, benzene and textile dust. Men working as truck and conveyor operators <10 years before the reference year had the highest increased risk of acoustic neuroma, but it is unclear what in those occupations might contribute to disease development. Our study also suggested an association between acoustic neuroma and being a class teacher or policeman. However, these findings should be further investigated to exclude the possibility of detection bias.

  2. Resection planning for robotic acoustic neuroma surgery

    NASA Astrophysics Data System (ADS)

    McBrayer, Kepra L.; Wanna, George B.; Dawant, Benoit M.; Balachandran, Ramya; Labadie, Robert F.; Noble, Jack H.

    2016-03-01

    Acoustic neuroma surgery is a procedure in which a benign mass is removed from the Internal Auditory Canal (IAC). Currently this surgical procedure requires manual drilling of the temporal bone followed by exposure and removal of the acoustic neuroma. This procedure is physically and mentally taxing to the surgeon. Our group is working to develop an Acoustic Neuroma Surgery Robot (ANSR) to perform the initial drilling procedure. Planning the ANSR's drilling region using pre-operative CT requires expertise and around 35 minutes' time. We propose an approach for automatically producing a resection plan for the ANSR that would avoid damage to sensitive ear structures and require minimal editing by the surgeon. We first compute an atlas-based segmentation of the mastoid section of the temporal bone, refine it based on the position of anatomical landmarks, and apply a safety margin to the result to produce the automatic resection plan. In experiments with CTs from 9 subjects, our automated process resulted in a resection plan that was verified to be safe in every case. Approximately 2 minutes were required in each case for the surgeon to verify and edit the plan to permit functional access to the IAC. We measured a mean Dice coefficient of 0.99 and surface error of 0.08 mm between the final and automatically proposed plans. These preliminary results indicate that our approach is a viable method for resection planning for the ANSR and drastically reduces the surgeon's planning effort.

  3. Repeat Stereotactic Radiosurgery for Acoustic Neuromas

    SciTech Connect

    Kano, Hideyuki; Kondziolka, Douglas; Niranjan, Ajay M.Ch.; Flannery, Thomas J.; Flickinger, John C.; Lunsford, L. Dade

    2010-02-01

    Purpose: To evaluate the outcome of repeat stereotactic radiosurgery (SRS) for acoustic neuromas, we assessed tumor control, clinical outcomes, and the risk of adverse radiation effects in patients whose tumors progressed after initial management. Methods and Materials: During a 21-year experience at our center, 1,352 patients underwent SRS as management for their acoustic neuromas. We retrospectively identified 6 patients who underwent SRS twice for the same tumor. The median patient age was 47 years (range, 35-71 years). All patients had imaging evidence of tumor progression despite initial SRS. One patient also had incomplete surgical resection after initial SRS. All patients were deaf at the time of the second SRS. The median radiosurgery target volume at the time of the initial SRS was 0.5 cc and was 2.1 cc at the time of the second SRS. The median margin dose at the time of the initial SRS was 13 Gy and was 11 Gy at the time of the second SRS. The median interval between initial SRS and repeat SRS was 63 months (range, 25-169 months). Results: At a median follow-up of 29 months after the second SRS (range, 13-71 months), tumor control or regression was achieved in all 6 patients. No patient developed symptomatic adverse radiation effects or new neurological symptoms after the second SRS. Conclusions: With this limited experience, we found that repeat SRS for a persistently enlarging acoustic neuroma can be performed safely and effectively.

  4. Management of hydrocephalus resulting from acoustic neuromas.

    PubMed

    Briggs, R J; Shelton, C; Kwartler, J A; Hitselberger, W

    1993-12-01

    Patients with large acoustic neuromas may have secondary obstructive hydrocephalus and occasionally significant neurologic deficit develops. At the House Ear Clinic, we have managed patients with hydrocephalus by translabyrinthine tumor removal without preoperative ventriculoperitoneal shunting. Forty-three patients with documented hydrocephalus who underwent acoustic neuroma removal have been reviewed. Six patients had neurologic deficit resulting from raised intracranial pressure before surgery. In each of these six cases, the deficit resolved after tumor removed without requiring shunting. Two patients had had ventriculoperitoneal shunts inserted because of neurologic deficit before referral for tumor removal. Two other patients underwent postoperative shunting for neurologic deficit --one at 2 weeks and one at 2 years. Cerebral or cerebellar herniation was not noted in any case. Cerebrospinal fluid leak occurred in five patients (11.6%) and culture-positive meningitis in two patients (4.6%). We conclude that decompression by translabyrinthine tumor removal is a safe method of management for patients with hydrocephalus resulting from large acoustic tumors.

  5. LINAC radiosurgery and radiotherapy treatment of acoustic neuromas. 2007.

    PubMed

    Likhterov, Ilya; Allbright, Robert M; Selesnick, Samuel H

    2008-04-01

    This article provides an introduction to radiation therapy as it applies to intracranial tumors. It also provides a review of the natural growth progression of acoustic neuromas and accuracy of tumor size determination. Literature on the use of linear accelerator stereotactic radiosurgery and fractionated radiotherapy in acoustic neuroma management is reviewed and summarized. Specifically, the rates of reported tumor control, hearing preservation, facial and trigeminal nerve complications, and hydrocephalus are analyzed. Although the complication rates associated with linear accelerator therapy are relatively low, hearing preservation is poor and acoustic neuroma control is variable.

  6. LINAC radiosurgery and radiotherapy treatment of acoustic neuromas.

    PubMed

    Likhterov, Ilya; Allbright, Robert M; Selesnick, Samuel H

    2007-06-01

    This article provides an introduction to radiation therapy as it applies to intracranial tumors. It also provides a review of the natural growth progression of acoustic neuromas and accuracy of tumor size determination. Literature on the use of linear accelerator stereotactic radiosurgery and fractionated radiotherapy in acoustic neuroma management is reviewed and summarized. Specifically, the rates of reported tumor control, hearing preservation, facial and trigeminal nerve complications, and hydrocephalus are analyzed. Although the complication rates associated with linear accelerator therapy are relatively low, hearing preservation is poor and acoustic neuroma control is variable.

  7. Painful neuroma requiring surgical excision after lower limb amputation caused by landmine explosions

    PubMed Central

    Sehirlioglu, Ali; Yazicioglu, Kamil; Tugcu, Ilknur; Yilmaz, Bilge; Goktepe, Ahmet Salim

    2007-01-01

    This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time period from start of pain symptoms to neuroma surgery was 7.8 months. All clinically proven neuromas were surgically resected. In the mean follow-up of 2.8 years, all patients were satisfied with the end results and all were free of any pain symptoms. Painful stump with clinical diagnostic findings of neuroma described above may be regarded as neuroma without requiring any further imaging modalities and is an indication for surgery if conservative measures fail. PMID:17940765

  8. Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia.

    PubMed

    Ducic, Ivica; Felder, John M; Endara, Matthew

    2012-01-01

    To demonstrate that occipital nerve injury is associated with chronic postoperative headache in patients who have undergone acoustic neuroma excision and to determine whether occipital nerve excision is an effective treatment for these headaches. Few previous reports have discussed the role of occipital nerve injury in the pathogenesis of the postoperative headache noted to commonly occur following the retrosigmoid approach to acoustic neuroma resection. No studies have supported a direct etiologic link between the two. The authors report on a series of acoustic neuroma patients with postoperative headache presenting as occipital neuralgia who were found to have occipital nerve injuries and were treated for chronic headache by excision of the injured nerves. Records were reviewed to identify patients who had undergone surgical excision of the greater and lesser occipital nerves for refractory chronic postoperative headache following acoustic neuroma resection. Primary outcomes examined were change in migraine headache index, change in number of pain medications used, continued use of narcotics, patient satisfaction, and change in quality of life. Follow-up was in clinic and via telephone interview. Seven patients underwent excision of the greater and lesser occipital nerves. All met diagnostic criteria for occipital neuralgia and failed conservative management. Six of 7 patients experienced pain reduction of greater than 80% on the migraine index. Average pain medication use decreased from 6 to 2 per patient; 3 of 5 patients achieved independence from narcotics. Six patients experienced 80% or greater improvement in quality of life at an average follow-up of 32 months. There was one treatment failure. Occipital nerve neuroma or nerve entrapment was identified during surgery in all cases where treatment was successful but not in the treatment failure. In contradistinction to previous reports, we have identified a subset of patients in whom the syndrome of

  9. Acoustic Neuroma Mimicking Orofacial Pain: A Unique Case Report

    PubMed Central

    Srinivas, Naveen; Mendigeri, Vijaylaxmi; Puranik, Surekha R.

    2016-01-01

    Acoustic neuroma (AN), also called vestibular schwannoma, is a tumor composed of Schwann cells that most frequently involve the vestibular division of the VII cranial nerve. The most common symptoms include orofacial pain, facial paralysis, trigeminal neuralgia, tinnitus, hearing loss, and imbalance that result from compression of cranial nerves V–IX. Symptoms of acoustic neuromas can mimic and present as temporomandibular disorder. Therefore, a thorough medical and dental history, radiographic evaluation, and properly conducted diagnostic testing are essential in differentiating odontogenic pain from pain that is nonodontogenic in nature. This article reports a rare case of a young pregnant female patient diagnosed with an acoustic neuroma located in the cerebellopontine angle that was originally treated for musculoskeletal temporomandibular joint disorder. PMID:28053796

  10. Co-existing post-stapedectomy fistula and acoustic neuroma.

    PubMed

    1977-02-01

    A 66 year old woman had light-headedness and ataxia which increased slowly despite tissue seal of a post-stapedectomy oval window fistula. The cause was shown to be a large acoustic neuroma, ipsilateral to the side of the fistula. The history, physical, and laboratory findings are presented.

  11. MRI in acoustic neuroma: a review of 35 patients.

    PubMed

    Curati, W L; Graif, M; Kingsley, D P; King, T; Scholtz, C L; Steiner, R E

    1986-01-01

    This retrospective study is aimed to assess the diagnostic efficacy of MRI in relation to contrast enhanced CT and air-CT-cisternography. MRI examinations were performed in 35 patients with suspected neurosensorial damage and suggestive of acoustic neuroma: 27 presented on MRI with unilateral tumors, 3 patients had a bilateral tumor and 5 patients were negative on all imaging modalities. The total number of acoustic neuromas detected was therefore 33. To date microscopic analysis has been performed on 12 tumors and histological data based on type Antoni A and Antoni B classification is available. Contrast enhanced CT detected 19 tumors, yielding an overall sensitivity rate of 58%. Air-CT cisternography identified an additional 5 tumors with a sensitivity rate of 100%. MRI identified 33 acoustic neuromas in 30 patients and was negative in 5 patients (sensitivity and accuracy 100%). Considering sensitivity in relation to location, MRI was much better than contrast enhanced CT for internal auditory canal (IAC) tumors (100% versus 36%) and better for cerebello-pontine angle tumors (CPA) tumors (100% versus 68%). The evolution of MRI technique, the various pulse sequences used and their actual selection is discussed. Seven patients received a paramagnetic contrast agent (Gadolinium-DTPA) with the additional benefit of a better demonstration of the tumor. The results suggest that MRI is the best non invasive technique for demonstrating acoustic neuromas.

  12. Gait instability in patients with small acoustic neuroma.

    PubMed

    Wang, Yan; Jiang, Hai-Yang; Guan, Chao; Jiang, Xue-Jun; Kazuo, Ishikawa; Zhou, Hong-Wu

    2011-06-01

    Small acoustic neuromas seldom result in typical vestibular symptoms, despite the tumor arising from the vestibular nerve. In this study, we have shown that abnormal gait in eleven patients with small acoustic neuroma could be detected in gait analysis by the use of tactile sensor. Patients displayed no oculomotor abnormality and had tumors less than 10 mm from the porus acoustics. Gait related parameters including the coefficients of variations (CV) of stance, swing, double support, area ratio of trajectories of center of force (TCOF), in addition to the foot pressure difference between both feet, were used for assessment of gait. The CV of swing and the area ratio of TCOF were greater in patients than those in the control group (P < 0.05). The values of these two parameters became greater under an eyes closed condition compared to eyes open (P < 0.05) in the patient group. These results indicate that gait analysis may be helpful to assess vestibulospinal function of patients with small acoustic neuroma, the slight vestibular deficits of which can not be detected by visual observation.

  13. [Sudden deafness as a presentation of acoustic neuroma].

    PubMed

    Bartoszewicz, Robert; Niemczyk, Kazimierz; Marchel, Andrzej; Kowalska, Małgorzata

    2005-09-01

    Sudden deafness (SD) is thought to be a heterogenic group of disorders as to etiopathogenesis. Acoustic neuroma should always be considered in the differential diagnosis. The authors analysed symptoms occurring in the group of 89 patients, diagnosed with acoustic neuroma. A special attention was paid to the role of sudden deafness as a clinical manifestation of the VIIIth nerve pathology. Progressive hearing loss, tinnitus, headache and sudden deafness were the most common complaints. Sudden deafness was developed by approximately 1 of the investigated patients (24.7%). Progressive hearing loss, tinnitus and sudden deafness were also dominating initial signs. The sudden deafness onset was preceded by the period of progressive hearing loss in 3 patients. In one case episode of SD occurred twice.

  14. Safety and efficacy of fractionated stereotactic radiotherapy for acoustic neuromas.

    PubMed

    McClelland, Shearwood; Gerbi, Bruce J; Higgins, Patrick D; Orner, James B; Hall, Walter A

    2008-01-01

    The treatment of acoustic neuromas (AN) has historically involved surgical excision or stereotactic radiosurgery, with a relatively limited number of reports available describing the use of fractionated stereotactic radiotherapy (FSRT). To enhance the existing knowledge regarding the safety and efficacy of this treatment modality, we describe our initial experience with FSRT for AN. From 1999-2005, 20 patients (12F, 8M) with AN underwent FSRT. All patients were treated using the Radionics X-Knife 4.0 3D planning system, receiving 54 Gy in 1.8 Gy daily fractions with a prescription isodose line of 90%. Treatments were delivered stereotactically using a dedicated Varian 6/100 linear accelerator, with immobilization achieved via the Gill-Thomas-Cosman relocatable frame. Median tumor size (maximum diameter) was 2.1 cm (range, 1.1-3.4 cm). Median patient age was 49.5 years, with median follow-up of 22 months (range, 1-66 months). All patients were evaluated with pre- and post-gadolinium-enhanced magnetic resonance imaging. Following FSRT, local tumor control was achieved in every patient, with the treatment well-tolerated by all patients. No patient experienced acute complications or facial nerve weakness. Two patients experienced permanent trigeminal nerve morbidity manifesting as facial numbness. All nine patients with preserved hearing before treatment had hearing preservation at last follow-up, although four of these patients experienced hearing decline following FSRT. In our series of 20 patients with AN, all had local tumor control following FSRT, with minimal morbidity. These results support the growing body of literature demonstrating the safety and efficacy of FSRT in achieving local control for AN, further validating the viability of FSRT as a treatment modality for this patient population.

  15. Long-term mobile phone use and acoustic neuroma risk.

    PubMed

    Pettersson, David; Mathiesen, Tiit; Prochazka, Michaela; Bergenheim, Tommy; Florentzson, Rut; Harder, Henrik; Nyberg, Gunnar; Siesjö, Peter; Feychting, Maria

    2014-03-01

    There is concern about potential effects of radiofrequency fields generated by mobile phones on cancer risk. Most previous studies have found no association between mobile phone use and acoustic neuroma, although information about long-term use is limited. We conducted a population-based, nation-wide, case-control study of acoustic neuroma in Sweden. Eligible cases were persons aged 20 to 69 years, who were diagnosed between 2002 and 2007. Controls were randomly selected from the population registry, matched on age, sex, and residential area. Postal questionnaires were completed by 451 cases (83%) and 710 controls (65%). Ever having used mobile phones regularly (defined as weekly use for at least 6 months) was associated with an odds ratio (OR) of 1.18 (95% confidence interval = 0.88 to 1.59). The association was weaker for the longest induction time (≥10 years) (1.11 [0.76 to 1.61]) and for regular use on the tumor side (0.98 [0.68 to 1.43]). The OR for the highest quartile of cumulative calling time (≥680 hours) was 1.46 (0.98 to 2.17). Restricting analyses to histologically confirmed cases reduced all ORs; the OR for ≥680 hours was 1.14 (0.63 to 2.07). A similar pattern was seen for cordless land-line phones, although with slightly higher ORs. Analyses of the complete history of laterality of mobile phone revealed considerable bias in laterality analyses. The findings do not support the hypothesis that long-term mobile phone use increases the risk of acoustic neuroma. The study suggests that phone use might increase the likelihood that an acoustic neuroma case is detected and that there could be bias in the laterality analyses performed in previous studies.

  16. Radiosurgery as treatment for acoustic neuroma. Ten years' experience.

    PubMed

    Llópez Carratalá, Ignacio; Escorihuela García, Vicente; Orts Alborch, Miguel; de Paula Vernetta, Carlos; Marco Algarra, Jaime

    2014-01-01

    The acoustic neuroma is a benign tumour that usually affects the vestibular portion of the vestibulocochlear nerve. It represents 8% of all intracranial tumours and 80% of those arising at the cerebellopontine angle. There are 3 treatment options: microsurgery (the technique of choice), radiosurgery and observation. The objective of the study was to evaluate the results and side effects obtained using radiosurgery as treatment for acoustic neuroma. We performed a review of all patients treated with radiosurgery (Gamma Knife and linear accelerator) at doses of 1200-1300 cGy for unilateral acoustic neuroma in our hospital from January 1999 until January 2010. In all patients we evaluated the overall state, tumour growth control rate (tumour smaller or remaining the same size), the involvement of v and vii cranial nerves and central nervous system disorders. We also assessed follow-up time and changes in hearing thresholds after radiosurgery. From a total of 35 patients studied, with a mean age of 58.29 years and lacking statistically significant differences in gender, the tumour growth control rate was over 90%. The main reason for visit (65.71%) was unilateral and progressive hearing loss. After treatment, 34.28% of patients had hearing loss. The involvement of the cranial nerves (v-vii) was transitory in 100% of cases. Gamma Knife radiosurgery was administered in 82.85% of patients. Although microsurgery is the treatment of choice for acoustic neuroma, we consider radiosurgery as a valid alternative in selected patients (elderly, comorbidity, small tumour size and sensorineural hearing loss, among others). Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  17. [Diagnostic strategy of acoustic neuroma. Evaluation of efficacy of auditory evoked potentials. Apropos of a series of 50 neuroma cases].

    PubMed

    Gilain, L; Bouccara, D; Jacquier, I; Achouche, J; Casteran, J M; Freyss, G; Tran Ba Huy, P

    1991-01-01

    The authors carry out a retrospective study of the diagnostic procedures used in a series of 50 acoustic neuromas. AEP were performed for thirty-four neuromas at some stage of their history. The findings were perfectly normal for eight of them, which represents a sensitivity level of 76%. Various elements likely to account for this are put forward, then the role of AEP and MRI in the diagnostic strategy for neuroma is discussed in the light of this study. Finally, the authors emphasize the necessity to regularly evaluate the diagnostic methods in order to guarantee their quality and reliability.

  18. Stereotactic Radiosurgery for Acoustic Neuromas: What Happens Long Term?

    SciTech Connect

    Roos, Daniel E.; Potter, Andrew E.; Brophy, Brian P.

    2012-03-15

    Purpose: To determine the clinical outcomes for acoustic neuroma treated with low-dose linear accelerator stereotactic radiosurgery (SRS) >10 years earlier at the Royal Adelaide Hospital using data collected prospectively at a dedicated SRS clinic. Methods and Materials: Between November 1993 and December 2000, 51 patients underwent SRS for acoustic neuroma. For the 44 patients with primary SRS for sporadic (unilateral) lesions, the median age was 63 years, the median of the maximal tumor diameter was 21 mm (range, 11-34), and the marginal dose was 14 Gy for the first 4 patients and 12 Gy for the other 40. Results: The crude tumor control rate was 97.7% (1 patient required salvage surgery for progression at 9.75 years). Only 8 (29%) of 28 patients ultimately retained useful hearing (interaural pure tone average {<=}50 dB). Also, although the Kaplan-Meier estimated rate of hearing preservation at 5 years was 57% (95% confidence interval, 38-74%), this decreased to 24% (95% confidence interval, 11-44%) at 10 years. New or worsened V and VII cranial neuropathy occurred in 11% and 2% of patients, respectively; all cases were transient. No case of radiation oncogenesis developed. Conclusions: The long-term follow-up data of low-dose (12-14 Gy) linear accelerator SRS for acoustic neuroma have confirmed excellent tumor control and acceptable cranial neuropathy rates but a continual decrease in hearing preservation out to {>=}10 years.

  19. Protection of Facial Nerves During Acoustic Neuroma Surgery.

    PubMed

    Xing, Hong-Shun; Wang, Shou-Xian; Wang, Zhe; Cao, Pei-Cheng; Ma, Yong-Qian; Wang, Zeng-Wu

    2015-05-01

    The objective of this study was to summarize the experience about the protection of the facial nerve in surgery for acoustic neuroma surgery with the aim to improve the retention of facial nerve function and the quality of life. Forty-two patients with acoustic neuroma were recruited from the year 2010 to 2013. Using microsurgical techniques, the tumors were resected through the suboccipital approach over the posterior edge of the sigmoid sinus, and intraoperative electrophysiological monitoring of the facial nerve function was performed. The House-Brackmann (H-B) grading was used to evaluate the facial nerve function evaluation postoperatively. Total tumor resection was achieved in 32 cases, and partial resection in 10 cases, without any intraoperative deaths. Also facial nerves were retained in 35 of 42 cases (83.33 %). One week after surgery, the facial nerve H-B grading was grade I in 8 cases, grade II in 15 cases, grade III in 12 cases, grade IV in 6 cases, and grade V in 1 case. The key to improved protection of the facial nerve during acoustic neuroma surgery includes a complete understanding of the anatomy of the cerebellopontine angle, proper use of microsurgical techniques, and intraoperative electrophysiological monitoring of the status of facial nerve functions to avoid damage to the nerves.

  20. Acoustic neuroma as first sign of inner ear functional disorders.

    PubMed

    Bielińska, Marzena; Owczarek, Kalina; Nowosielska-Grygiel, Joanna; Olszewski, Jurek; Pietkiewicz, Piotr

    2016-10-31

    The aim of this work was to describe acoustic neuromas as the first signs of inner ear functional disorders. The study covered 3,456 audiological and otoneurological patients, who were treated in the Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics Military Medical Academy University Teaching Hospital in Lodz within the period of 2011-2016. Among the studied subjects, an acoustic neuroma on the vestibulocochlear nerve was diagnosed in 13 cases (5,16%), including 9 women and 4 men. Each patient underwent a medical interview and an objective examination with static and dynamic tests, pure tone audiometry and speech audiometry tests, impedance audiometry tests, characteristics of tinnitus, videonystagmography and auditory brainstem evoked potentials (ABR) in crack. In each case of an incorrect ABR recording, contrast-enhanced MRI was performed. The conducted tests showed an incorrect ABR recording in 252 patients (7,29%, including 54,37% women and 45,63% men). In the performed contrast-enhanced MRI, 13 patients (5,16%), including 3,57% women and 1,59% men, had an image typical to neuroma of the vestibulocochlear nerve. Each one of the studied patients showed signs and symptoms typical to an acoustic neuroma such as hypoacusia and balance disorders, tinnitus in 12 subjects, headaches in the temporal and occipital area in 4 subjects, trigeminal neuralgia symptoms in 2 subjects and vision problems like scotoma and blurred vision reported by 1 patient. Each case of sensorineural hearing loss, particularly unilateral sensorineural hearing loss, requires expanded hearing tests and auditory brainstem evoked potentials tests. An incorrect brainstem evoked potentials recording such as: an elongated latency of the 5th wave, an elongated interlatency of 1-2-3 and 1-2-3-4 waves, requires a contract-enhanced magnetic resonance imaging to diagnose cerebellopontine angle tumours.

  1. Intraoperative monitoring during surgery for acoustic neuroma: benefits of an extratympanic intrameatal electrode

    PubMed Central

    Mullatti, N; Coakham, H; Maw, A; Butler, S; Morgan, M

    1999-01-01

    OBJECTIVES—To assess the utility of an extratympanic intrameatal electrode for intraoperative monitoring during acoustic neuroma and other cerebellopontine angle tumour surgery and to define the neurophysiological and surgical factors which influence hearing preservation.
METHODS—Twenty two patients, 18 with acoustic neuromas and four with other cerebellopontine angle tumours, underwent intraoperative monitoring during tumour excision. The extratympanic intrameatal electrode (IME) was used to record the electrocochleogram (ECoG) and surface electrodes to record the brainstem auditory evoked response (ABR).
RESULTS—The compound action potential (CAP) of the ECoG was two and a half times greater in amplitude than wave I of the ABR and was easily monitored. Virtually instant information was available as minimal averaging was required. Continuous monitoring was possible from the commencement of anaesthesia to skin closure. The IME was easy to place, non-invasive, and did not interfere with the operative field. Operative procedures which affected CAP or wave V latency or amplitude were drilling around the internal auditory meatus, tumour dissection, nerve section, and brainstem and cerebellar retraction. Hearing was achieved in 59% of patients.
CONCLUSIONS—The IME had significant benefits in comparison with other methods of monitoring. The technique provided information beneficial to preservation of hearing.

 PMID:10209169

  2. Dural Defect Repair in Translabyrinthine Acoustic Neuroma Surgery and Its Implications in Cerebrospinal Fluid Leak Occurrence

    PubMed Central

    Netto, Aloysio Augusto Tahan de Campos; Colafêmina, José Fernando; Centeno, Ricardo Silva

    2012-01-01

    Cerebrospinal fluid (CSF) leak is a complication that may occur after translabyrinthine (translab) acoustic neuroma (AN) removal. The aim of this study is to verify the incidence of CSF leak using two techniques for dural defect closure in translab AN surgery and present a new technique for dural repair. A retrospective study was held, reviewing charts of 34 patients in a tertiary neurotologic referral center. Out of these 34 patients that underwent translab AN excision in a 1-year period, 18 had their dural defect repaired using only abdominal fat graft and 16 using synthetic dura substitute (SDS) plus abdominal fat tissue. One patient (5.5%) in the first group had CSF leak and 1 (6.2%) in the second group had CSF leak postoperatively. Our data suggest that there are no significant differences in CSF leak rates using both techniques, although studies in a larger series must be undertaken to conclude it. We believe that the development of some points in the new technique for dural repair can achieve better results and reduce the CSF leak incidence in the translabyrinthine acoustic neuroma surgery in the near future. PMID:24083124

  3. Ocular vestibular evoked myogenic potentials in patients with acoustic neuroma.

    PubMed

    Piras, Gianluca; Brandolini, Cristina; Castellucci, Andrea; Modugno, Giovanni Carlo

    2013-02-01

    To assess the usefulness of vestibular testing in patients with acoustic neuroma, considering two main aspects: to compare diagnostic sensitivity of the current vestibular tests, especially considering ocular vestibular evoked myogenic potentials (OVEMPs) and to identify pre-operative localization of the tumor (inferior vestibular nerve vs. superior vestibular nerve) only with the help of vestibular electrophysiological data. Twenty-six patients with unilateral acoustic neuroma (mainly intracanalicular type) were studied with a full audio-vestibular test battery (pure tone and speech audiometry, caloric bithermal test, vibration-induced nystagmus test (VIN), cervical and OVEMPs). 18 patients (69 %) showed abnormal caloric responses. 12 patients (46.2 %) showed a pattern of VIN test suggestive of vestibular asymmetry. 16 patients (61.5 %) showed abnormal OVEMPs (12 only to AC, 4 both to AC and BC). 10 patients (38.5 %) showed abnormal cervical vestibular evoked myogenic potentials (5 both to AC and BC, 5 only to AC). In one case, results of vestibular evoked potentials and caloric test were confirmed by intra-operative and post-operative findings. Results of electrophysiological tests in AN patients could be helpful for planning the proper surgical approach, considering that sensitivity of every exam is quite low in intracanalicular lesion; clinical data allow a better interpretation of vestibular evoked myogenic potentials.

  4. Preoperative computerized dynamic posturography as a prognostic indicator of balance function in patients with acoustic neuroma.

    PubMed

    Bergson, Eric; Sataloff, Robert T

    2005-03-01

    We conducted a study to determine the prognostic reliability of preoperative computerized dynamic posturography (CDP) in patients undergoing surgical excision of an acoustic neuroma. Our goal was to determine the correlation between objective preoperative assessments of balance function and subjective postoperative patient self-assessments. To that end, we retrospectively reviewed the records of 21 adults who had undergone preoperative CDP, and we subsequently obtained their subjective assessments of balance function by follow-up telephone surveys at least 1 year postoperatively. We conclude that although CDP has proven to be useful in many aspects of balance evaluation, it did not appear to be a valuable predictor of subjective postoperative balance function in these patients.

  5. Stereotactic radiosurgery using the gamma knife for acoustic neuromas

    SciTech Connect

    Foote, R.L.; Coffey, R.J.; Swanson, J.W.

    1995-07-15

    The purpose of this investigation was to assess the efficacy and toxicity of stereotactic radiosurgery using the gamma knife for acoustic neuromas. Between January 1990 and January 1993, 36 patients with acoustic neuromas were treated with stereotactic radiosurgery using the gamma knife. The median maximum tumor diameter was 21 mm (range: 6-32 mm). Tumor volumes encompasses within the prescribed isodose line varied from 266 to 8,667 mm{sup 3} (median: 3,135 mm{sup 3}). Tumors {<=} 20 mm in maximum diameter received a dose of 20 Gy to the margin, tumors between 21 and 30 mm received 18 Gy, and tumors > 30 mm received 16 Gy. The dose was prescribed to the 50% isodose line in 31 patients and to the 45%, 55%, 60%, 70%, and 80% isodose line in one patient each. Nine tumors (26%) were smaller, and 26 tumors (74%) were unchanged. No tumor had progressed. The 1- and 2-year actuarial incidences of facial neuropathy were 52.2% and 66.5%, respectively. The 1- and 2-year actuarial incidences of trigeminal neuropathy were 33.7% and 58.9%, respectively. The 1- and 2-year actuarial incidence of facial or trigeminal neuropathy (or both) was 60.8% and 81.7%, respectively. Multivariate analysis revealed that the following were associated with the time of onset or worsening of facial weakness or trigeminal neuropathy: (a) patients < age 65 years, (b) dose to the tumor margin, (c) maximum tumor diameter {>=} 21 mm, (d) use of the 18 mm collimator, and (e) use of > five isocenters. The 1- and 2-year actuarial rates of preservation of useful hearing (Gardner-Robertson class I or II) were 100% and 41.7% {plus_minus} 17.3, respectively. Stereotactic radiosurgery using the gamma knife provides short-term control of acoustic neuromas when a dose of 16 to 20 Gy to the tumor margin is used. Preservation of useful hearing can be accomplished in a significant proportion of patients. 30 refs., 5 tabs.

  6. VESTIBULAR SCHWANNOMA (ACOUSTIC NEUROMA) MIMICKING TEMPOROMANDIBULAR DISORDERS: A CASE REPORT

    PubMed Central

    Bisi, Maurício A.; Selaimen, Caio M. P.; Chaves, Karen D.; Bisi, Melissa C.; Grossi, Márcio L.

    2006-01-01

    Approximately 6 to 16% of patients with trigeminal neuralgia symptoms present intracranial tumors, the most common being the vestibular schwannoma (acoustic neuroma). Some symptoms reported by patients include hearing loss, tinnitus, headaches, vertigo and trigeminal disturbances. An increased muscle response in the surrounding head and neck musculature may also be observed, which mimics signs and symptoms of temporomandibular disorders. In these cases, magnetic resonance imaging (MRI) has proved to be a useful tool in tumor diagnosis. The differential diagnosis between myofascial and neuralgic pain is important, as both may present similar characteristics, while being of different origin, and demanding special treatment approaches. The purpose of this paper is to demonstrate the relationship among trigeminal neuralgia symptoms, intracranial tumors and temporomandibular dysfunction by presenting a clinical case. PMID:19089251

  7. Acoustic (loudspeaker) facial EMG monitoring: II. Use of evoked EMG activity during acoustic neuroma resection.

    PubMed

    Prass, R L; Kinney, S E; Hardy, R W; Hahn, J F; Lüders, H

    1987-12-01

    Facial electromyographic (EMG) activity was continuously monitored via loudspeaker during eleven translabyrinthine and nine suboccipital consecutive unselected acoustic neuroma resections. Ipsilateral facial EMG activity was synchronously recorded on the audio channels of operative videotapes, which were retrospectively reviewed in order to allow detailed evaluation of the potential benefit of various acoustic EMG patterns in the performance of specific aspects of acoustic neuroma resection. The use of evoked facial EMG activity was classified and described. Direct local mechanical (surgical) stimulation and direct electrical stimulation were of benefit in the localization and/or delineation of the facial nerve contour. Burst and train acoustic patterns of EMG activity appeared to indicate surgical trauma to the facial nerve that would not have been appreciated otherwise. Early results of postoperative facial function of monitored patients are presented, and the possible value of burst and train acoustic EMG activity patterns in the intraoperative assessment of facial nerve function is discussed. Acoustic facial EMG monitoring appears to provide a potentially powerful surgical tool for delineation of the facial nerve contour, the ongoing use of which may lead to continued improvement in facial nerve function preservation through modification of dissection strategy.

  8. [Strategy of the diagnosis and treatment for hydrocephalus associated with acoustic neuroma].

    PubMed

    Zhang, M S; Zhang, H W; Gu, C Y; Wang, H R; Ren, M; Qu, Y M; Yu, C J; Zhu, M S

    2016-06-07

    To describe and analyze the strategy of the diagnosis and treatment for acoustic neuroma associated with hydrocephalus. A retrospective review was performed in 29 patients with hydrocephalus associated with acoustic neuroma form Apr. 2004 to Apr. 2015. The patients' clinical information, the types of the hydrocephalus, the treatment and the prognosis of the hydrocephalus were recorded. There were 20 patients with obstructive hydrocephalus and 9 patients with communicating hydrocephalus preoperatively. Among the 29 cases, 3 patients had ventriculoperitoneal shunts, 5 patients had external ventricular drains, the remaining 21 patients had no further managements for hydrocephalus; after removing the acoustic neuroma, the hydrocephalus improved in 10 cases, the ventricle unchanged in 10 cases among the obstructive hydrocephalus group, the ventricle unchanged in all 9 cases among the communicating hydrocephalus group. Nineteen cases were diagnosed with communicating hydrocephalus and 10 cases with obstructive hydrocephalus postoperatively. Among the patients of acoustic neuroma associated with hydrocephalus, communicating hydrocephalus is more common than obstructive hydrocephalus. The optimal management of acoustic neuroma associated with hydrocephalus is complete removal of the tumor, with treatment only for patients with persistent hydrocephalus.

  9. Intermedius nerve involvement and testing in acoustic neuromas.

    PubMed

    Thomsen, J; Zilstorff, K

    1975-01-01

    The clinical findings in 125 patients with surgically confirmed acoustic neuromas are presented, with special regard to the involvement of the intermedius nerve in the diagnosis. In assessing the function of the intermedius nerve the examination of the nasolacrimal reflex and the sensation of taste on the anterior two-thirds of the tongue are used. The methods of investigation are described in detail. The material consisted of 20 medium-sized and 105 large tumours; no intracanalicular tumor was found. Hearing loss was the initial symptom in 85% of the patients, 10% had tinitus and 4% vertigo as the first symptom. Apart from the VIII cranial nerve symptoms, a defective nasolacrimal reflex was the most significant evidence of cerebellopontine angle pathology. The test was positive in 65% of the medium-sized tumours, in the entire material, 85%. The figures are higher than the incidence of trigeminal nerve symptoms. This in contrast to the reports of most authors. The tests described are simple and quick to perform, and it is emphasized that they should be applied to all patients with unilateral hearing loss of unknown origin.

  10. Modified dynamic visual acuity tests after acoustic neuroma resection.

    PubMed

    Cohen, Helen S; Bloomberg, Jacob J

    2007-08-01

    These data suggest that visual acuity during quiet sitting is dynamic, requiring full body interaction of vestibulo-ocular and postural responses. These findings may have practical implications for seating design and design of tasks requiring good visual acuity while seated. Looking at something during quiet sitting is usually assumed to be a static activity. We tested the idea that visual acuity during quiet sitting is dynamic, requiring integration of whole body responses as well as intact vestibulo-ocular reflexes. Normal subjects and patients scheduled for acoustic neuroma resection were tested preoperatively. Patients were then tested during the four in-patient postoperative days. Testing was done while seated, with or without head and back support, while reading numbers from slides on a laptop computer at eye level, in font sizes from 20 pt to 12 pt. The dependent measure was percent correct per font size. In both groups scores while sitting unsupported were significantly higher than with full support or only back support. In patients, scores were significantly decreased on postoperative day 1 and gradually increased toward normal but maintained the pattern of better scores when sitting unsupported than with head or back support.

  11. Intraoperative monitoring of facial nerve antidromic potentials during acoustic neuroma surgery.

    PubMed

    Colletti, V; Fiorino, F; Policante, Z; Bruni, L

    1997-09-01

    The present paper presents monopolar recording of facial nerve antidromic potentials as an alternative technique to facial electromyography for the continuous monitoring of the facial nerve during acoustic neuroma surgery. The investigation involved 22 patients undergoing acoustic neuroma surgery via a retrosigmoid approach (tumour sizes ranging from 5 to 28 mm). Bipolar electrical stimulation of the marginalis mandibulae was performed to elicit facial nerve antidromic potentials. Stimulus intensity ranged from 2 to 6 mA with a delivery rate of 7/sec. A silver wire monopolar electrode positioned intracranially on the proximal portion of the acoustic facial bundle was used to record antidromic potentials. To define the specific origin of the action potentials and acquire normative data, monopolar and bipolar recordings of facial nerve antidromic potentials were performed in 15 subjects undergoing retrosigmoid vestibular neurectomy for Meniere's disease. The average facial nerve antidromic potential latency was 4.2 (+/- 0.6) msec in subjects with acoustic neuroma and 3.3 (+/- 0.2) msec in subjects with Meniere's disease. Facial nerve antidromic potentials furnished near real-time information about intraoperative facial nerve damage and postoperative facial nerve function during acoustic neuroma surgery. Facial nerve antidromic potentials may provide additional information to conventional EMG. They allow the use of endplate blockers, yield quantitative estimation of facial nerve conduction properties in terms of amplitude and latency, and allow actual continuous monitoring of the facial nerve.

  12. [Coexistence of acoustic neuroma and pineal region tumor in patient with sudden deafness].

    PubMed

    Durko, Marcin; Jankowski, Andrzej; Durko, Tomasz; Gajewicz, Witold; Pajor, Anna

    2008-01-01

    Acoustic neuroma usually presents as an unilateral tumor, seldom - bilateral and rarely in coexistence with other central nervous system neoplasms. The following paper reports such a case of a 21-year-old male patient presented with sudden deafness in left ear accompanied with tinnitus and vertigo. Symptoms started 4 weeks prior hospitalization. Their aggravation has been observed 7 days before admission to the hospital. Audiometry revealed moderate sensorineural hearing loss in left ear (for low and middle frequencies), brainstem auditory evoked potentials were absent on the left side and ENG examination showed left peripheral vestibular impairment. Initially patient received i.v. vasodilatators showing 20-25 dB improvement in low frequencies after 3 days of treatment. MRI study revealed in the left internal acoustic meatus mass (7 x 7 x 14 mm) suggesting acoustic neuroma and an oval mass (7 x 9 x 14 mm) in the pineal gland presenting radiological features of pinealoma. Patient has been qualified for neurosurgical treatment. Acoustic neuroma has been removed by suboccipital approach and pinealoma has been left for further observation as it was found incidentally. Histopathological examination confirmed diagnosis of left VIII nerve schwannoma. The left facial palsy (House-Brackmann III/IV grade) and profound hearing loss appeared after surgery. The postoperative course shows no evidence of acoustic neuroma recurrence.

  13. False diagnosis of acoustic neuroma due to subdural injection during gas CT cisternogram.

    PubMed

    Larsson, E M; Holtås, S

    1986-01-01

    Gas CT cisternography is a reliable examination for the detection of small acoustic neuromas. False-positive or equivocal findings do result, however, from a small number of these examinations. In this case report inadvertent subdural injection of gas caused diagnostic difficulties.

  14. Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

    PubMed Central

    Chen, Mantao; Fan, Zuoxu; Cao, Fei; Wang, Liang

    2016-01-01

    Purpose Many epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma. Materials and Methods We searched PubMed to identify relevant articles. Two researchers evaluated the eligibility and extracted the data independently. Results Eleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05–1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84–1.72 and OR=1.15, 95% CI: 0.80–1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30–0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81–1.10) and 0.49 (95% CI: 0.41–0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80–1.18), 0.91 (95% CI: 0.76–1.09), and 1.52 (95% CI: 0.90–2.54), respectively. Conclusion Our meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis. PMID:26996581

  15. [Analysis of the clinical salience for sudden hearing loss in acoustic neuroma].

    PubMed

    Lü, M; Liu, H; Wang, J

    2001-02-01

    To avoid misdiagnosis and misapplied therapy of acoustic neuroma. 92 cases of acoustic neuroma treated between 1983 and 1997 were retrospectively reviewed. Among them, 20 patients (21 ears, 21.7%) presented with sudden hearing loss as the starting symptoms. The diagnosis was based on audiological and radiologic examinations. The clinical and audiological analysis demonstrated that 57.1% of the ears showed hearing loss over 71 dBHL, and all ears had deteriorated ABRs. Acoustic reflex was nonreactive in all 10 ears tested. Positive findings in CT scan were 88.89%. CT pneumoencephalography or MRI provided useful information of diagnosis in those with negative findings of place CT scan. ABR should be used as a routine test for patients with sudden deafness. When ABR was abnormal, CT scan around the internal auditory meatus was needed.

  16. [Clinical and radiological evolution of a group of untreated acoustic neuromas].

    PubMed

    Escorihuela-García, Vicente; Llópez-Carratalá, Ignacio; Orts-Alborch, Miguel; Marco-Algarra, Jaime

    2014-01-01

    The acoustic neuroma is a benign tumour that originates in the vestibular branch of the eighth cranial nerve. The main treatment is surgery, but many authors suggest that with elderly patients or in small neuromas we can opt for watchful waiting. This was a retrospective study from 2007 to 2013 that included 27 patients diagnosed of acoustic neuroma that had not been treated due to the size of the tumour, age and comorbidities, or by patient choice. We evaluated overall condition, hearing thresholds, degree of canal paresis and central disorders. After 6 years of follow up, clinical manifestations of 18 patients remained unchanged, 5 patients underwent hearing loss and developed tinnitus, 2 cases had more intense tinnitus and 2 cases had dizziness. The radiological controls by magnetic resonance imaging showed that the initial maximum diameters (5-16mm) increased by 1.7mm on average, with annual growth rates below 0.5mm. In selected cases, such as for small neuromas and in elderly patients, the conservative option of close monitoring with magnetic resonance imaging is an important alternative given that, in our cases, clinical features and radiological image did not suffer major changes. If there were any such changes, therapeutic options could be proposed. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  17. Improved facial nerve outcomes using an evolving treatment method for large acoustic neuromas.

    PubMed

    Porter, Ryan G; LaRouere, Michael J; Kartush, Jack M; Bojrab, Dennis I; Pieper, Daniel R

    2013-02-01

    To describe a successful paradigm for the treatment of large acoustic neuromas (vestibular schwannomas). Retrospective case review. Tertiary referral center. The charts of 2,875 acoustic neuroma patients at Michigan Ear Institute were reviewed to identify 153 patients who underwent surgical resection for large acoustic neuromas (>=3 cm) between 2000 and 2009. Staged surgical resection or single stage surgery with or without adjuvant stereotactic radiosurgery. Postoperative facial nerve outcomes are reported using the House-Brackmann (HB) facial nerve grading scale and compared with historical controls from a literature review. Rates of adverse outcomes are also reported. Seventy-five patients underwent staged surgical resection of their tumors, whereas 78 patients underwent either single stage surgery or surgery with subsequent stereotactic radiosurgery. Eighty-one percent of patients in the staged surgical resection group had a postoperative HB Grade I or II facial nerve function compared with 75% in the single stage surgical group. Overall, 78% of patients in the current study had HB Grade I or II after treatment compared with a mean of 53% in the literature for similar sized tumors. Our methods including the decision to use staged surgery when necessary, dissection of tumor with stimulating dissector-directed intraoperative monitoring, and use of adjuvant stereotactic radiosurgery are described. Using the described paradigm, large acoustic neuromas can be successfully treated with either staged or single-stage surgical resection with or without adjuvant radiosurgery to obtain more favorable facial nerve outcomes than historically reported controls while minimizing morbidity for the patient. (C) 2013 Otology & Neurotology, Inc.

  18. Acoustic neuroma surgery as an interdisciplinary approach: a neurosurgical series of 508 patients

    PubMed Central

    Tonn, J.; Schlake, H.; Goldbrunner, R.; Milewski, C.; Helms, J.; Roosen, K.

    2000-01-01

    OBJECTIVES—To evaluate an interdisciplinary concept (neurosurgery/ear, nose, and throat (ENT)) of treating acoustic neuromas with extrameatal extension via the retromastoidal approach. To analyse whether monitoring both facial nerve EMG and BAEP improved the functional outcome in acoustic neuroma surgery.
METHODS—In a series of 508 patients consecutively operated on over a period of 7 years, functional outcome of the facial nerve was evaluated according to the House/Brackmann scale and hearing preservation was classified using the Gardner/Robertson system.
RESULTS—Facial monitoring (396 of 508 operations) and continuous BAEP recording (229 of 399 cases with preserved hearing preoperatively) were performed routinely. With intraoperative monitoring, the rate of excellent/good facial nerve function (House/Brackmann I-II) was 88.7%. Good functional hearing (Gardner/Robertson 1-3) was preserved in 39.8%.
CONCLUSION—Acoustic neuroma surgery via a retrosigmoidal approach is a safe and effective treatment for tumours with extrameatal extension. Functional results can be substantially improved by intraoperative monitoring. The interdisciplinary concept of surgery performed by ENT and neurosurgeons was particularly convincing as each pathoanatomical phase of the operation is performed by a surgeon best acquainted with the regional specialties.

 PMID:10896686

  19. Calculating the tumor volume of acoustic neuromas: comparison of ABC/2 formula with planimetry method.

    PubMed

    Yu, Yi-Lin; Lee, Meei-Shyuan; Juan, Chun-Jung; Hueng, Dueng-Yuan

    2013-08-01

    The ABC/2 equation is commonly applied to measure the volume of intracranial hematoma. However, the precision of ABC/2 equation in estimating the tumor volume of acoustic neuromas is less addressed. The study is to evaluate the accuracy of the ABC/2 formula by comparing with planimetry method for estimating the tumor volumes. Thirty-two patients diagnosed with acoustic neuroma received contrast-enhanced magnetic resonance imaging of brain were recruited. The volume was calculated by the ABC/2 equation and planimetry method (defined as exact volume) at the same time. The 32 patients were divided into three groups by tumor volume to avoid volume-dependent overestimation (<3 ml, 3-6 ml and >6 ml). The tumor volume by ABC/2 method was highly correlated to that calculated by planimetry method using linear regression analysis (R2=0.985). Pearson correlation coefficient (r=0.993, p<0.001) demonstrates nearly perfect association between two methods. The ABC/2 formula is an easy method in estimating the tumor volume of acoustic neuromas that is not inferior to planimetry method. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment.

    PubMed

    Nellis, Jason C; Sharon, Jeff D; Pross, Seth E; Ishii, Lisa E; Ishii, Masaru; Dey, Jacob K; Francis, Howard W

    2017-03-01

    To identify factors associated with treatment modality selection in acoustic neuromas. Prospective observational study. Tertiary care neurotology clinic. Data were prospectively collected from patients initially presenting to a tertiary care neurotology clinic between 2013 and 2016. Patients who did not have magnetic resonance imaging (MRI), demographic, psychometric, or audiometric data were excluded from analysis. Demographic information, clinical symptoms, tumor characteristics, and psychometric data were collected to determine factors associated with undergoing acoustic neuroma surgical resection using univariate and multiple logistic regression analysis. The decision to pursue acoustic neuroma surgical resection versus active surveillance. A total of 216 patients with acoustic neuroma (mean age 55 years, 58% women) were included. Ninety eight patients (45.4%) pursued surgical resection, 118 patients (54.6%) pursued active surveillance. Surgical treatment was significantly associated with patient age less than 65, higher grade tumors, growing tumors, larger volume tumors, lower word discrimination scores, Class D hearing, headache, and vertigo as presenting symptoms, higher number of total symptoms, and higher headache severity scores (p < 0.05). There was no significant association between surgical intervention and preoperative quality of life, depression, and self-esteem scores. On multiple logistic regression analysis, the likelihood of undergoing surgical resection significantly decreased for patients older than age 65 (odds ratio [OR] 0.19; 0.05-0.69) and increased in patients with medium (OR 4.34; 1.36-13.81), moderately large (OR 33.47; 5.72-195.83), large grade tumors (OR 56.63; 4.02-518.93), tumor growth present (OR 4.51; 1.66-12.28), Class D hearing (OR 3.96; 1.29-12.16), and higher headache severity scores (OR 1.03; 95% confidence interval [CI] 1.01-1.05). The likelihood of undergoing surgical resection was completely predictive for giant grade

  1. Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

    PubMed Central

    Hong, WenMing; Cheng, HongWei; Wang, XiaoJie; Feng, ChunGuo

    2017-01-01

    Objective To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma. Methods Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function. Results Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I–II level) cases accounted for 75.2% (79/105), facial nerve function III–IV level cases accounted for 22.9% (24/105), and V–VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I–II level) was 74.4% (58/78). Conclusion Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient’s age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms. PMID:28264236

  2. Trigeminal nerve deficit in large and compressive acoustic neuromas and its correlation with MRI findings.

    PubMed

    Karkas, Alexandre; Lamblin, Eléa; Meyer, Mikael; Gay, Emmanuel; Ternier, Jessica; Schmerber, Sébastien

    2014-10-01

    Evaluate the prevalence of preoperative trigeminal nerve deficit in large/compressive acoustic neuromas and try to find a correlation between pre/postoperative magnetic resonance imaging (MRI) findings and pre/postoperative trigeminal nerve deficit. Case series with chart review. University medical center. Retrospective study (1994-2009) including patients with stage 4 or 5 acoustic neuromas (Zini-Magnan classification). All patients underwent surgical resection. Pre- and postoperative trigeminal symptoms were sought. Imaging criteria were sought on pre- and 3-month postoperative MRI scans. Pearson χ(2) statistical test was used. Fifty-three patients (27 females, mean 51 years) were operated on. Preoperatively, 3 patients (5.7%) had trigeminal neuralgia, 1 (1.9%) trigeminal anesthesia, and 28 (52.8%) trigeminal hypoesthesia. Sixteen patients (30.2%) had no corneal reflex (ophthalmic branch); keratitis occurred in 1 patient (1.9%). Postoperatively, 2 patients (3.8%) had trigeminal neuralgia, 1 (1.9%) trigeminal anesthesia, and 24 (45.3%) trigeminal hypoesthesia. Twenty-six patients (49%) had no corneal reflex; keratitis occurred in 11 patients (20.7%). Preoperative trigeminal hypoesthesia was statistically correlated with impaction of the tumor on cerebellar peduncles on preoperative MRI. Postoperative trigeminal hypoesthesia was statistically correlated with nonvisibility of the trigeminal nerve on postoperative MRI. In large/compressive acoustic neuromas, trigeminal nerve deficit has to be sought to avoid corneal complications in particular. Trigeminal hypoesthesia occurs preoperatively in about half of the cases. It remains relatively stable after tumor removal, but there appears to be an increased rate of absent corneal reflex and keratitis postoperatively. We were able to correlate pre/postoperative trigeminal hypoesthesia with pre/postoperative MRI findings. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  3. Trends in acoustic neuroma management: a 20-year review of the oxford skull base clinic.

    PubMed

    Mackeith, Samuel A C; Kerr, Richard S; Milford, Chris A

    2013-08-01

    Objective To describe the change in the management of acoustic neuromas at one United Kingdom center over a 20-year period and to compare this with what is known regarding trends in practice on a national and international scale. Design, Setting, and Participants Data was collected prospectively on all patients attending the Oxford Skull Base Clinic between 1990 and 2009. Main Outcome Measures The proportion of patients managed initially by observation versus radiotherapy versus surgery was recorded for each year. Results Significantly more patients received radiation treatment (instead of surgery) between 2000 and 2009 when compared with 1990 to 1999. Compared with national audit data, the Oxford Skull Base Clinic treats a higher proportion of patients with radiotherapy and significantly lower proportion with surgery, though the trend nationally is toward more observation and radiotherapy and less surgery. Conclusion Surgery will remain crucial in the management of some patients with acoustic neuromas (usually those with the larger tumors where radiosurgery is recognized to be less appropriate), but using current trends to predict future practice would suggest that alternative nonmicrosurgical treatment may play an increasingly important role in the future.

  4. Facial reanimation after acoustic neuroma resection: options and timing of intervention.

    PubMed

    Boahene, Kofi

    2015-04-01

    Facial paralysis following acoustic neuroma (AN) resection can be devastating, but timely and strategic intervention can minimize the resulting facial morbidity. A central strategy in reanimating the paralyzed face after AN resection is to restore function of the native facial muscles using available facial nerves or repurposed cranial nerves, mainly the hypoglossal or masseter nerves. The timing of reinnervation is the single most influential factor that determines outcomes in facial reanimation surgery. The rate of recovery of facial function in the first 6 months following AN resection may be used to predict ultimate facial function. Patients who show no signs of recovery in the first 6 months, even when their facial nerves are intact, recover poorly and are candidates for early facial reinnervation. With delay, facial muscles become irreversibly paralyzed. Reanimation in irreversible paralysis requires the transfer of functional muscle units such as the gracilis or the temporalis muscle tendon unit.

  5. Hearing preservation in acoustic neuroma resection: Analysis of petrous bone measurement and intraoperative application

    PubMed Central

    Tanrikulu, Levent; Lohse, Peer; Fahlbusch, Rudolf; Naraghi, Ramin

    2016-01-01

    Background: There is an increased risk for labyrinthine injury for the resection of acoustic neuromas (AN) on the suboccipital, retrosigmoid approach. Prognostic factors should be analyzed for the postoperative hearing function. Methods: We examined 51 patients with ANs using preoperative intact hearing function. Audiological data were obtained by pure tone audiogram (PTA) and speech audiogram. The preoperative and postoperative anatomical localization of the labyrinth was measured with specific distances regarding the tumor and corresponding anatomy of the posterior fossa by high-resolution magnetic resonance imaging (MRI). Results: Postoperative MRI controls confirmed no injuries to the labyrinth (0%). The postoperative hearing results showed 100% hearing preservation for T1-tumors (<1 ml/<1.1 cm), 50% for T2-tumors (1–4 ml/1.1–1.8 cm), 40% for T3-tumors (4–8 ml/1.8–2.3 cm) and 18% for T4-tumors (>8 ml/>2.3 cm). Postoperative deafness was seen in all cases with ventral tumor extension higher than 5.5 mm. Postoperative loss of hearing was seen in all cases with hearing preservation with 6–8% of speech discrimination and an increase in the hearing threshold of 12 dB in the PTA compared to the preoperative hearing status. Conclusion: Petrous bone measurement by high-resolution MRI data enables safe surgical exposure of the internal acoustic canal with avoidance of injury to the labyrinth and a better postoperative prognosis, especially for intrameatal ANs and for the resection of intrameatal portions of larger neuromas. The prognostic factors enable the patients and the surgeon a better estimation of postoperative results regarding deafness and postoperative hypacusis and support a consolidated treatment planning. PMID:28144470

  6. Risk of a second cancer from scattered radiation in acoustic neuroma treatment

    NASA Astrophysics Data System (ADS)

    Yoon, Myonggeun; Lee, Hyunho; Sung, Jiwon; Shin, Dongoh; Park, Sungho; Chung, Weon Kuu; Jahng, Geon-Ho; Kim, Dong Wook

    2014-06-01

    The present study aimed to compare the risk of a secondary cancer from scattered and leakage doses in patients receiving intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic radiosurgery (SRS). Four acoustic neuroma patients were treated with IMRT, VMAT, or SRS. Their excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) of a secondary cancer were estimated using the corresponding secondary doses measured at various organs by using radio-photoluminescence glass dosimeters (RPLGD) placed inside a humanoid phantom. When a prescription dose was delivered in the planning target volume of the 4 patients, the average organ equivalent doses (OED) at the thyroid, lung, liver, bowel, bladder, prostate (or ovary), and rectum were 14.6, 1.7, 0.9, 0.8, 0.6, 0.6, and 0.6 cGy, respectively, for IMRT whereas they were 19.1, 1.8, 2.0, 0.6, 0.4, 0.4, and 0.4 cGy, respectively, for VMAT, and 22.8, 4.6, 1.4, 0.7, 0.5, 0.5, and 0.5 cGy, respectively, for SRS. The OED decreased as the distance from the primary beam increased. The thyroid received the highest OED compared to other organs. A lifetime attributable risk evaluation estimated that more than 0.03% of acoustic neuroma (AN) patients would get radiation-induced cancer within 20 years of receiving radiation therapy. The organ with the highest radiation-induced cancer risk after radiation treatment for AN was the thyroid. We found that the LAR could be increased by the transmitted dose from the primary beam. No modality-specific difference in radiation-induced cancer risk was observed in our study.

  7. Acoustic Neuroma

    MedlinePlus

    ... from your inner ear to your brain (eighth cranial nerve) — appears to be a malfunctioning gene on chromosome ... create complications, including worsening of symptoms, if certain nerve or cranial structures are affected during the operation. These risks ...

  8. Acoustic tumors: operation versus radiation--making sense of opposing viewpoints. Part II. Acoustic neuromas: sorting out management options.

    PubMed

    Kondziolka, Douglas; Lunsford, L Dade; Flickinger, John C

    2003-01-01

    Patients with acoustic neuromas have several options available to them. Large tumors with significant brain stem compression usually require surgical resection. For patients with small or medium-sized tumors, radiosurgery has become a common treatment, with excellent long-term results being reported. Patients must be comfortable with the concept of tumor control rather than tumor removal. Most seem to be satisfied with this concept if it allows them to avoid brain surgery. Surgeons should strive to educate their patients with information from the peer-reviewed literature. Confusion exists among patients, because the information from Internet sources, newsletters, support groups, and physicians has not always been validated and supported by outcomes data. Although we are asked to provide our opinions, our comments should not be based on myth, conjecture, training bias, or socioeconomic concerns.

  9. In vivo visualization of the facial nerve in patients with acoustic neuroma using diffusion tensor imaging-based fiber tracking.

    PubMed

    Song, Fei; Hou, Yuanzheng; Sun, Guochen; Chen, Xiaolei; Xu, Bainan; Huang, Jason H; Zhang, Jun

    2016-10-01

    OBJECTIVE Preoperative determination of the facial nerve (FN) course is essential to preserving its function. Neither regular preoperative imaging examination nor intraoperative electrophysiological monitoring is able to determine the exact position of the FN. The diffusion tensor imaging-based fiber tracking (DTI-FT) technique has been widely used for the preoperative noninvasive visualization of the neural fasciculus in the white matter of brain. However, further studies are required to establish its role in the preoperative visualization of the FN in acoustic neuroma surgery. The object of this study is to evaluate the feasibility of using DTI-FT to visualize the FN. METHODS Data from 15 patients with acoustic neuromas were collected using 3-T MRI. The visualized FN course and its position relative to the tumors were determined using DTI-FT with 3D Slicer software. The preoperative visualization results of FN tracking were verified using microscopic observation and electrophysiological monitoring during microsurgery. RESULTS Preoperative visualization of the FN using DTI-FT was observed in 93.3% of the patients. However, in 92.9% of the patients, the FN visualization results were consistent with the actual surgery. CONCLUSIONS DTI-FT, in combination with intraoperative FN electrophysiological monitoring, demonstrated improved FN preservation in patients with acoustic neuroma. FN visualization mainly included the facial-vestibular nerve complex of the FN and vestibular nerve.

  10. Retrosigmoid versus translabyrinthine approach to acoustic neuroma resection: A comparative cost-effectiveness analysis.

    PubMed

    Semaan, Maroun T; Wick, Cameron C; Kinder, Kimberly J; Stuyt, John G; Chota, Rebecca L; Megerian, Cliff A

    2016-02-01

    Approach-specific economic data of acoustic neuroma (AN) resection is lacking. The purpose of this study was to analyze and compare adjusted total hospital costs, hospital and intensive care unit (ICU) length of stay (LOS), and associated factors in AN patients undergoing resection by translabyrinthine (TL) approach versus retrosigmoid (RS) approach. Retrospective chart review. A total of 113 patients with AN undergoing TL (N = 43) or RS (N = 70) surgical resection between 1999 and 2012 were analyzed. Data including age, health status, preoperative hearing, tumor size, postoperative complications, hospital, ICU LOS, and disposition after discharge were collected from medical records and compared between both groups. Cost data was obtained from the hospital finance department and adjusted based on the Consumer Price Index for 2013. There were no significant differences in demographic data, preoperative hearing, preoperative health status, or postoperative complication rate. Total hospital LOS and ICU LOS were significantly longer in the RS compared to the TL group (4.3 ± 3.6 vs. 2.6 ± 1.1 days; P < 0.001, and 1.5 ± 1.1 vs. 1.0 ± 0.5 days; P = 0.015, respectively). Tumors were larger in RS compared to the TL group (2.1 ± 1.0 cm vs. 1.5 ± 0.7 cm, respectively; P = 0.002). When patients were stratified by tumor size < or ≥ 2 cm, the total hospital LOS remained greater in the RS group in both subgroups (< and ≥ 2 cm, P < 0.001, and P = 0.031, respectively). However, there was no difference in the total ICU LOS between both subgroups. The adjusted mean total hospital cost was higher in the RS compared to the TL group ($25,069 ± 14,968 vs. $16,799 ± 5,724; P < 0.001). The adjusted mean total hospital cost was greater in the RS group with tumor < 2 cm (P < 0.001) but not significantly different in patients with tumors ≥ 2 cm. Univariate analysis showed that greater tumor size, poorer preoperative health status, the presence of major postoperative

  11. Mobile phone use and risk of acoustic neuroma: results of the Interphone case–control study in five North European countries

    PubMed Central

    Schoemaker, M J; Swerdlow, A J; Ahlbom, A; Auvinen, A; Blaasaas, K G; Cardis, E; Christensen, H Collatz; Feychting, M; Hepworth, S J; Johansen, C; Klæboe, L; Lönn, S; McKinney, P A; Muir, K; Raitanen, J; Salminen, T; Thomsen, J; Tynes, T

    2005-01-01

    There is public concern that use of mobile phones could increase the risk of brain tumours. If such an effect exists, acoustic neuroma would be of particular concern because of the proximity of the acoustic nerve to the handset. We conducted, to a shared protocol, six population-based case–control studies in four Nordic countries and the UK to assess the risk of acoustic neuroma in relation to mobile phone use. Data were collected by personal interview from 678 cases of acoustic neuroma and 3553 controls. The risk of acoustic neuroma in relation to regular mobile phone use in the pooled data set was not raised (odds ratio (OR)=0.9, 95% confidence interval (CI): 0.7–1.1). There was no association of risk with duration of use, lifetime cumulative hours of use or number of calls, for phone use overall or for analogue or digital phones separately. Risk of a tumour on the same side of the head as reported phone use was raised for use for 10 years or longer (OR=1.8, 95% CI: 1.1–3.1). The study suggests that there is no substantial risk of acoustic neuroma in the first decade after starting mobile phone use. However, an increase in risk after longer term use or after a longer lag period could not be ruled out. PMID:16136046

  12. Results of linear accelerator-based stereotactic radiosurgery for recurrent and newly diagnosed acoustic neuromas.

    PubMed

    Suh, J H; Barnett, G H; Sohn, J W; Kupelian, P A; Cohen, B H

    2000-06-20

    Stereotactic radiosurgery (SRS) is used to treat acoustic neuromas, but additional information is needed to firmly establish its safety and efficacy. We review our experience over 7 years treating 29 consecutive patients with a modified linear accelerator (linac) SRS system. Between August 1989 and October 1995, 29 patients with a median age of 67 years (range 26 to 83) underwent linac SRS treatment. Twenty-five patients had unilateral acoustic neuromas, and four patients with neurofibromatosis type II had bilateral vestibular schwannoma. Eligibility criteria for SRS were recurrent tumors (n = 9), age >65 (n = 16), or patient preference (n = 6). Follow-up magnetic resonance imaging scans were performed on all patients. The most common presenting symptoms were hearing impairment (18 patients) and gait difficulties (17 patients). Ten patients were deaf in the affected ear prior to treatment. Doses to the periphery of the tumor ranged from 800 to 2,400 cGy (median 1, 600 cGy) prescribed to the 50% to 80% isodose line (median 80%). After a median radiographic follow-up of 49 months (range 4 to 110 months), 11 tumors were smaller, 17 were stable, and one had evidence of progression (at 41 months). The 5-year local disease control rate (Kaplan-Meier estimate) was 94%. Acute complications were minimal, with only two patients experiencing nausea and vomiting after the procedure. Long-term complications included new or progressive trigeminal and facial nerve deficits with estimated 5-year incidences of 15% and 32%, respectively. Subjective hearing reduction or loss occurred in 14 (74%) of the 19 patients who had useful hearing prior to treatment. Five patients died from unrelated causes. These results suggest that linac SRS provides excellent short-term tumor control rates. Since there was a high risk of cranial nerve neuropathy, we do not recommend using only computed tomography-based planning and high prescription doses. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 145

  13. Auditory Pathway Features Determined by DTI in Subjects with Unilateral Acoustic Neuroma.

    PubMed

    Kurtcan, S; Alkan, A; Kilicarslan, R; Bakan, A A; Toprak, H; Aralasmak, A; Aksoy, F; Kocer, A

    2016-12-01

    In the studies concerning the pathology of the auditory pathway in the vestibulocochlear system, few use advanced neuroimaging applications of magnetic resonance imaging (MRI) such as diffusion tensor imaging (DTI). Those who did use reported DTI changes only at the lateral lemniscus and inferior colliculus level. The aim of our study was to determine diffusion changes in the bilateral auditory pathways of subjects with unilateral acoustic neuroma (AN) and compare them with healthy controls. A total of 15 subjects with unilateral AN along with 11 controls underwent routine MRI and DTI. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values obtained from the lateral lemniscus, inferior colliculus, corpus geniculatum mediale, and Heschl's gyrus of the auditory pathway were then compared. The subjects' ADC values measured from the contralateral side were significantly higher at the lateral lemniscus, inferior colliculus, and corpus geniculatum mediale compared with those of the controls. Also, decreased FA values were noted at the inferior colliculus for both the contralateral and ipsilateral sides. The highest ADC values were detected in the inferior colliculus of the auditory pathway. In the auditory pathway of subjects with AN, the contralateral side is more affected than the ipsilateral side, the most affected region being the inferior colliculus. DTI is an advanced neuroimaging technique that can be used to determine the presence of microstructural damage to the auditory pathway in subjects with AN, whereas conventional MRI is not sensitive enough to detect damage.

  14. Use of piezosurgery for internal auditory canal drilling in acoustic neuroma surgery.

    PubMed

    Grauvogel, Juergen; Scheiwe, Christian; Kaminsky, Jan

    2011-10-01

    Piezosurgery is based on microvibrations generated by the piezoelectrical effect and has a selective bone-cutting ability with preservation of soft tissue. This study examined the applicability of Piezosurgery compared to rotating drills (RD) for internal auditory canal (IAC) opening in acoustic neuroma (AN) surgery. Piezosurgery was used in eight patients for IAC drilling in AN surgery. After exposition of the IAC and tumor, the posterior wall of the IAC was drilled using Piezosurgery instead of RD. Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, preservation of cranial nerves, influences on neurophysiological monitoring, and facial nerve and hearing outcome. Piezosurgery was successfully used for selective bone cutting, while cranial nerves were structurally and functionally preserved, which could be measured by means of neuromonitoring. Piezosurgery guaranteed a safe and precise cut by removing bone layer by layer in a shaping way. Compared to RD, limited influence on neurophysiological monitoring attributable to Piezosurgery was noted, allowing for continuous neuromonitoring. No disadvantage due to microvibrations was noticed concerning hearing function. The angled tip showed better handling in right-sided than in left-sided tumors in the hands of a right-handed surgeon. The short, thick handpiece may be improved for more convenient handling. Piezosurgery is a safe tool for selective bone cutting for opening of the IAC with preservation of facial nerve and hearing function in AN surgery. Piezosurgery has the potential to replace RD for this indication because of its safe and precise bone-cutting properties.

  15. Long-term outcome of stereotactic radiosurgery (Srs) in patients with acoustic neuromas

    SciTech Connect

    Combs, Stephanie E. . E-mail: Stephanie.Combs@med.uni-heidelberg.de; Thilmann, Christoph; Debus, Juergen; Schulz-Ertner, Daniela

    2006-04-01

    Purpose: To evaluate the effectiveness and long-term outcome of stereotactic radiosurgery (SRS) for acoustic neuromas (AN). Patients and Methods: Between 1990 and 2001, we treated 26 patients with 27 AN with SRS. Two patients suffered from neurofibromatosis type 2. Before SRS, a subtotal or total resection had been performed in 3 and in 5 patients, respectively. For SRS, a median single dose of 13 Gy/80% isodose was applied. Results: The overall actuarial 5-year and 10-year tumor control probability in all patients was 91%. Two patients developed tumor progression after SRS at 36 and 48 months. Nineteen patients (73%) were at risk of treatment-related facial nerve toxicity; of these, 1 patient developed a complete facial nerve palsy after SRS (5%). A total of 93% of the lesions treated were at risk of radiation-induced trigeminal neuralgia. Two patients (8%) developed mild dysesthesia of the trigeminal nerve after SRS. The hearing preservation rate in patients with useful hearing before SRS was 55% at 9 years. Conclusion:: Stereotactic radiosurgery results in good local control rates of AN and the risk of cranial nerve toxicities is acceptable. As toxicity is lower with fractionated stereotactic radiotherapy, SRS should be reserved for smaller lesions.

  16. SU-E-T-208: Incidence Cancer Risk From the Radiation Treatment for Acoustic Neuroma Patient

    SciTech Connect

    Kim, D; Chung, W; Shin, D; Yoon, M

    2014-06-01

    Purpose: The present study aimed to compare the incidence risk of a secondary cancer from therapeutic doses in patients receiving intensitymodulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic radiosurgery (SRS). Methods: Four acoustic neuroma patients were treated with IMRT, VMAT, or SRS. Their incidnece excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) were estimated using the corresponding therapeutic doses measured at various organs by radio-photoluminescence glass dosimeters (RPLGD) placed inside a humanoid phantom. Results: When a prescription dose was delivered in the planning target volume of the 4 patients, the average organ equivalent doses (OED) at the thyroid, lung, normal liver, colon, bladder, prostate (or ovary), and rectum were measured. The OED decreased as the distance from the primary beam increased. The thyroid received the highest OED compared to other organs. A LAR were estimated that more than 0.03% of AN patients would get radiation-induced cancer. Conclusion: The tyroid was highest radiation-induced cancer risk after radiation treatment for AN. We found that LAR can be increased by the transmitted dose from the primary beam. No modality-specific difference in radiation-induced cancer risk was observed in our study.

  17. Immunohistochemical localization and mRNA expression of aquaporins in the macula utriculi of patients with Meniere's disease and acoustic neuroma.

    PubMed

    Ishiyama, Gail; Lopez, Ivan A; Beltran-Parrazal, Luis; Ishiyama, Akira

    2010-06-01

    Meniere's disease is nearly invariably associated with endolymphatic hydrops (the net accumulation of water in the inner ear endolymphatic space). Vestibular maculae utriculi were acquired from patients undergoing surgery for Meniere's disease and acoustic neuroma and from autopsy (subjects with normal hearing and balance). Quantitative immunostaining was conducted with antibodies against aquaporins (AQPs) 1, 4, and 6, Na(+)K(+)ATPase, Na(+)K(+)2Cl co-transporter (NKCC1), and alpha-syntrophin. mRNA was extracted from the surgically acquired utricles from subjects with Meniere's disease and acoustic neuroma to conduct quantitative real-time reverse transcription with polymerase chain reaction for AQP1, AQP4, and AQP6. AQP1 immunoreactivity (-IR) was located in blood vessels and fibrocytes in the underlying stroma, without any apparent alteration in Meniere's specimens when compared with acoustic neuroma and autopsy specimens. AQP4-IR localized to the epithelial basolateral supporting cells in Meniere's disease, acoustic neuroma, and autopsy. In specimens from subjects with Meniere's disease, AQP4-IR was significantly decreased compared with autopsy and acoustic neuroma specimens. AQP6-IR occurred in the sub-apical vestibular supporting cells in acoustic neuroma and autopsy samples. However, in Meniere's disease specimens, AQP6-IR was significantly increased and diffusely redistributed throughout the supporting cell cytoplasm. Na(+)K(+)ATPase, NKCC1, and alpha-syntrophin were expressed within sensory epithelia and were unaltered in Meniere's disease specimens. Expression of AQP1, AQP4, or AQP6 mRNA did not differ in vestibular endorgans from patients with Meniere's disease. Changes in AQP4 (decreased) and AQP6 (increased) expression in Meniere's disease specimens suggest that the supporting cell might be a cellular target.

  18. Immunohistochemical localization and mRNA expression of aquaporins in the macula utriculi of patients with Meniere’s disease and acoustic neuroma

    PubMed Central

    Ishiyama, Gail; Lopez, Ivan A.; Beltran-Parrazal, Luis

    2010-01-01

    Meniere’s disease is nearly invariably associated with endolymphatic hydrops (the net accumulation of water in the inner ear endolymphatic space). Vestibular maculae utriculi were acquired from patients undergoing surgery for Meniere’s disease and acoustic neuroma and from autopsy (subjects with normal hearing and balance). Quantitative immunostaining was conducted with antibodies against aquaporins (AQPs) 1, 4, and 6, Na+K+ATPase, Na+K+2Cl co-transporter (NKCC1), and α-syntrophin. mRNA was extracted from the surgically acquired utricles from subjects with Meniere’s disease and acoustic neuroma to conduct quantitative real-time reverse transcription with polymerase chain reaction for AQP1, AQP4, and AQP6. AQP1 immunoreactivity (−IR) was located in blood vessels and fibrocytes in the underlying stroma, without any apparent alteration in Meniere’s specimens when compared with acoustic neuroma and autopsy specimens. AQP4-IR localized to the epithelial basolateral supporting cells in Meniere’s disease, acoustic neuroma, and autopsy. In specimens from subjects with Meniere’s disease, AQP4-IR was significantly decreased compared with autopsy and acoustic neuroma specimens. AQP6-IR occurred in the sub-apical vestibular supporting cells in acoustic neuroma and autopsy samples. However, in Meniere’s disease specimens, AQP6-IR was significantly increased and diffusely redistributed throughout the supporting cell cytoplasm. Na+K+ATPase, NKCC1, and α-syntrophin were expressed within sensory epithelia and were unaltered in Meniere’s disease specimens. Expression of AQP1, AQP4, or AQP6 mRNA did not differ in vestibular endorgans from patients with Meniere’s disease. Changes in AQP4 (decreased) and AQP6 (increased) expression in Meniere’s disease specimens suggest that the supporting cell might be a cellular target. PMID:20461409

  19. Acoustic neuroma: potential risk factors and audiometric surveillance in the aluminium industry.

    PubMed

    Taiwo, Oyebode; Galusha, Deron; Tessier-Sherman, Baylah; Kirsche, Sharon; Cantley, Linda; Slade, Martin D; Cullen, Mark R; Donoghue, A Michael

    2014-09-01

    To look for an association between acoustic neuroma (AN) and participation in a hearing conservation programme (HCP) and also for an association between AN and possible occupational risk factors in the aluminium industry. We conducted a case-control analysis of a population of US aluminium production workers in 8 smelters and 43 other plants. Using insurance claims data, 97 cases of AN were identified between 1996 and 2009. Each was matched with four controls. Covariates included participation in a HCP, working in an aluminium smelter, working in an electrical job and hearing loss. In the bivariate analyses, covariates associated with AN were participation in the HCP (OR=1.72; 95% CI 1.09 to 2.69) and smelter work (OR=1.88; 95% CI 1.06 to 3.36). Electrical work was not significant (OR=1.60; 95% CI 0.65 to 3.94). Owing to high participation in the HCP in smelters, multivariate subanalyses were required. In the multivariate analyses, participation in the HCP was the only statistically significant risk factor for AN. In the multivariate analysis restricted to employees not working in a smelter, the OR was 1.81 (95% CI 1.04 to 3.17). Hearing loss, an indirect measure of in-ear noise dose, was not predictive of AN. Our results suggest the incidental detection of previously undiagnosed tumours in workers who participated in the company-sponsored HCP. The increased medical surveillance among this population of workers most likely introduced detection bias, leading to the identification of AN cases that would have otherwise remained undetected. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Validation of the facial dysfunction domain of the Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale.

    PubMed

    Lodder, Wouter L; Adan, Guleed H; Chean, Chung S; Lesser, Tristram H; Leong, Samuel C

    2017-04-08

    The objective of this study is to evaluate the strength of content validity within the facial dysfunction domain of the Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale and to compare how it correlates with a facial dysfunction-specific QOL instrument (Facial Clinimetric Evaluation, FaCE). The study design is online questionnaire survey. Members of the British Acoustic Neuroma Association received both PANQOL questionnaires and the FaCE scale. 158 respondents with self-identified facial paralysis or dysfunction had completed PANQOL and FaCE data sets for analysis. The mean composite PANQOL score was 53.5 (range 19.2-93.5), whilst the mean total FaCE score was 50.9 (range 10-95). The total scores of the PANQOL and FaCE correlated moderate (r = 0.48). Strong correlation (r = 0.63) was observed between the PANQOL's facial dysfunction domain and the FaCE total score. Of all the FaCE domains, social function was strongly correlated with the PANQOL facial dysfunction domain (r = 0.66), whilst there was very weak-to-moderate correlation (range 0.01-0.43) to the other FaCE domains. The current study has demonstrated a strong correlation between the facial dysfunction domains of PANQOL with a facial paralysis-specific QOL instrument.

  1. Outcomes of 75 patients over 12 years treated for acoustic neuromas with linear accelerator-based radiosurgery.

    PubMed

    Hsu, Peng-Wei; Chang, Cheng-Nen; Lee, Shih-Tseng; Huang, Yin-Cheng; Chen, Hsien-Chih; Wang, Chun-Chieh; Hsu, Yung-Hsin; Tseng, Chen-Kan; Chen, Yao-Liang; Wei, Kuo-Cheng

    2010-05-01

    The aim of this study was to investigate the efficacy of linear accelerator (LINAC)-based radiosurgery in the treatment of acoustic neuromas. In this retrospective study, we enrolled 75 patients with non-neurofibromatosis type 2 acoustic neuromas who were followed-up for more than 5years. The 75 patients were divided into 3 groups: patients with a newly diagnosed tumor; those with a residual tumor; and those with a recurrent tumor. The average follow-up period was 97.8months. The overall tumor progression-free rate was 92%, and corresponding rates among those with newly diagnosed tumors was 100%, residual tumors was 84.4%, and recurrent tumors was 92.8% (p=0.028). Lesion localization using CT scans correlated with a higher tendency for tumor progression than lesion localization using CT-MRI fusion images (15.6% versus 2.4%, respectively). Residual tumors treated with radiosurgery have a higher progression rate, and careful lesion localization using CT-MRI image fusion is required.

  2. Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches.

    PubMed

    Becker, Samuel S; Jackler, Robert K; Pitts, Lawrence H

    2003-01-01

    To determine whether the choice of surgical approach affects the rate of postoperative cerebrospinal fluid leakage in patients who have undergone surgical resection of acoustic neuroma. Retrospective chart review. Tertiary referral center. Three hundred patients who underwent surgery for acoustic neuromas were selected by consecutive medical record number until 100 resections via each surgical approach (translabyrinthine, middle fossa, and retrosigmoid) had been gathered. Surgical approach used, cerebrospinal fluid leak incidence, tumor size, patient age. Postoperative cerebrospinal fluid leak of any severity was observed in 13% of translabyrinthine, 10% of middle fossa, and 10% of retrosigmoid patients. These difference in the rate of cerebrospinal fluid leakage were not statistically significant (p = 0.82). The majority of leaks were managed conservatively with fluid and activity restriction, often accompanied by a period of lumbar subarachnoid drainage. There was a need to return to the operating room for a definitive procedure in 4% of translabyrinthine, 2% of middle fossa, and 3% retrosigmoid patients; again not statistically different among the approaches (p = 0.43). Tumor size was not correlated with cerebrospinal fluid leak rate (p = 0.13). Patient age, for patients older than 50 years, was suggestive of increased odds of cerebrospinal fluid leak (p = 0.06). Neither surgical approach nor tumor size affects the rate of postoperative cerebrospinal fluid leakage or the necessity of managing a leak with a return to the operating room. Cerebrospinal fluid leakage rates have remained stable in recent decades despite numerous innovative attempts to improve dural closure, seal transected air cell tracts, and occlude anatomic pathways. The finding that leak rates were similar among three dissimilar surgical techniques suggests that factors other than techniques of wound closure, such as transient postoperative rises in cerebrospinal fluid pressure, may be

  3. Outcome of hearing preservation related to tumor morphologic analysis in acoustic neuromas treated by gamma knife radiosurgery.

    PubMed

    Pan, Szu-Yen; Liu, Shih-An; Sun, Ming-Hsi; Tsou, Hsi-Kai; Lee, Shinh-Dung; Chen, Yen-Ju; Sheehan, Jason; Sheu, Meei-Ling; Pan, Hung-Chuan

    2017-08-15

    Gamma Knife radiosurgery (GKRS) is an important part of the neurosurgical armamentarium in the treatment of acoustic neuromas. However, the treatment outcome related to the morphology of the tumor has not been rigorously studied. In this cohort, we evaluated the morphological features of the tumor in the tumor response and neurological outcomes after GKRS. From July 2003 to December 2008, there were 93 cases of acoustic neuromas treated upfront with GKRS with 64 cases with serviceable hearing and 29 cases without serviceable hearing to fulfill the margin dose of 12Gy with at least follow up 5 years. The duration of symptom before GKRS in serviceable /no serviceable hearing was 7.9 ± 1.2 and 15.3 ± 3.1 months (p < 0.001) and associated no-hearing symptom was 70% and 35%, respectively (p < 0.001). There was 81.2% of hearing preservation after GKRS in serviceable hearing group including 27 cases of pear type (84%), 14 of linear type (70%), and 9 cases of sphere type (90%) (p < 0.01); however, there was no case of hearing improvement in the no-serviceable hearing group (0 of 29). There were 85% of patients with decreased tinnitus in serviceable hearing groups as compared to 61.5% of patients in no serviceable hearing group (p < 0.05). In multivariate analysis, the tumor morphology was highly correlated to hearing preservation rate (p < 0.01). In the limited case of this cohort, we found that the tumor morphology and timing of treatment was highly correlated to the rate of hearing preservation. The sphere type of tumor morphology was associated with the best chance of hearing preservation.

  4. Fat graft-assisted internal auditory canal closure after retrosigmoid transmeatal resection of acoustic neuroma: Technique for prevention of cerebrospinal fluid leakage.

    PubMed

    Azad, Tareq; Mendelson, Zachary S; Wong, Anni; Jyung, Robert W; Liu, James K

    2016-02-01

    The retrosigmoid transmeatal approach remains an important strategy in the surgical management of acoustic neuromas. Gross total resection of acoustic neuromas requires removal of tumor within the cerebellopontine angle as well as tumor involving the internal auditory canal (IAC). Drilling into the petrous bone of the IAC can expose petrous air cells, which can potentially result in a fistulous tract to the nasopharynx manifesting as cerebrospinal fluid (CSF) rhinorrhea. We describe our method of IAC closure using autologous fat graft and assessed the rates of postoperative CSF leakage. We performed a retrospective study of 24 consecutive patients who underwent retrosigmoid transmeatal resection of acoustic neuroma who underwent our method of fat graft-assisted IAC closure. We assessed rates of postoperative CSF leak (incisional leak, rhinorrhea, or otorrhea), pseudomeningocele formation, and occurrence of meningitis. Twenty-four patients (10 males, 14 females) with a mean age of 47 years (range 18-84) underwent fat graft-assisted IAC closure. No lumbar drains were used postoperatively. There were no instances of postoperative CSF leak (incisional leak, rhinorrhea, or otorrhea), pseudomeningocele formation, or occurrence of meningitis. There were no graft site complications. Our results demonstrate that autologous fat grafts provide a safe and effective method of IAC defect closure to prevent postoperative CSF leakage after acoustic tumor removal via a retrosigmoid transmeatal approach. The surgical technique and operative nuances are described.

  5. Twenty years' experience in the treatment of acoustic neuromas with fractionated radiotherapy: A review of 45 cases

    SciTech Connect

    Maire, Jean-Philippe . E-mail: jean-philippe.maire@chu-bordeaux.fr; Huchet, Aymeri; Milbeo, Yann; Darrouzet, Vincent; Causse, Nicole; Celerier, Denis; Liguoro, Dominique; Bebear, Jean-Pierre

    2006-09-01

    Purpose: To evaluate very long-term results of fractionated radiotherapy (FRT) of acoustic neuromas (AN). Methods and Materials: From January 1986 to January 2004, FRT was performed in 45 consecutive patients (46 AN). Indications were as follows: poor general condition contraindicating surgery, hearing preservation in bilateral neuromas, partial resection, nonsurgical recurrence. A 3-field to 5-field technique with static beams was used. A mean total dose of 51 Gy was given (1.80 Gy/fraction). The median tumor diameter was 31 mm (range, 11-55 mm). The median follow-up from FRT was 80 months (range, 4-227 months). Results: The particularity of our series consists of a very long-term follow-up of FRT given to selected patients. Nineteen patients died, two with progressive disease, and 17 from non-AN causes. A serviceable level of hearing was preserved in 7/9 hearing patients. No patient had facial or trigeminal neuropathy. Tumor shrinkage was observed in 27 (59%) and stable disease in 16 (35%). Tumor progression occurred in three patients, 12 to 15 months after FRT. Two additional tumors recurred after shrinkage 20 and 216 months after treatment and were operated on. Actuarial local tumor control rates at 5 and 15 years were 86%. For the patient who had a tumor recurrence at 216 months, histologic examination documented transformation to a low-grade malignant peripheral nerve sheath tumor. Conclusion: Very long-term efficacy of FRT is well documented in this series. However, our results suggest that malignant transformation can occur many years after FRT so we advocate caution when using this treatment for young patients.

  6. SU-E-T-14: A Comparative Study Between Forward and Inverse Planning in Gamma Knife Radiosurgery for Acoustic Neuroma Tumours

    SciTech Connect

    Gopishankar, N; Agarwal, Priyanka; Bisht, Raj Kishor; Kale, S S; Rath, G K; Chander, S; Sharma, B S

    2015-06-15

    Purpose: To evaluate forward and inverse planning methods for acoustic neuroma cases treated in Gamma Knife Perfexion. Methods: Five patients with acoustic neuroma tumour abutting brainstem were planned twice in LGP TPS (Version 10.1) using TMR10 algorithm. First plan was entirely based on forward planning (FP) in which each shot was chosen manually. Second plan was generated using inverse planning (IP) for which planning parameters like coverage, selectivity, gradient index (GI) and beam-on time threshold were set. Number of shots in IP was automatically selected by objective function using iterative process. In both planning methods MRI MPRAGE sequence images were used for tumour localization and planning. A planning dose of 12Gy at 50% isodose level was chosen. Results and Discussion: Number of shots used in FP was greater than IP and beam-on time in FP was in average 1.4 times more than IP. One advantage of FP was that the brainstem volume subjected to 6Gy dose (25% isodose) was less in FP than IP. Our results showed use of more number of shots as in FP results in GI less than or equal to 2.55 which is close to its lower limit. Dose homogeneity index (DHI) analysis of FP and IP showed average values of 0.59 and 0.67 respectively. General trend in GK for planning in acoustic neuroma cases is to use small collimator shots to avoid dose to adjacent critical structures. More number of shots and prolonged treatment time causes inconvenience to the patients. Similarly overuse of automatic shot shaping as in IP results in increased scatter dose. A compromise is required in shot selection for these cases. Conclusion: IP method could be used in acoustic neuroma cases to decrease treatment time provided the source sector openings near brainstem are shielded or adjusted appropriately to reduce brainstem dose.

  7. Use of mobile phones and cordless phones is associated with increased risk for glioma and acoustic neuroma.

    PubMed

    Hardell, Lennart; Carlberg, Michael; Hansson Mild, Kjell

    2013-04-01

    The International Agency for Research on Cancer (IARC) at WHO evaluation of the carcinogenic effect of RF-EMF on humans took place during a 24-31 May 2011 meeting at Lyon in France. The Working Group consisted of 30 scientists and categorised the radiofrequency electromagnetic fields from mobile phones, and from other devices that emit similar non-ionising electromagnetic fields (RF-EMF), as Group 2B, i.e., a 'possible', human carcinogen. The decision on mobile phones was based mainly on the Hardell group of studies from Sweden and the IARC Interphone study. We give an overview of current epidemiological evidence for an increased risk for brain tumours including a meta-analysis of the Hardell group and Interphone results for mobile phone use. Results for cordless phones are lacking in Interphone. The meta-analysis gave for glioma in the most exposed part of the brain, the temporal lobe, odds ratio (OR)=1.71, 95% confidence interval (CI)=1.04-2.81 in the ≥10 years (>10 years in the Hardell group) latency group. Ipsilateral mobile phone use ≥1640h in total gave OR=2.29, 95% CI=1.56-3.37. The results for meningioma were OR=1.25, 95% CI=0.31-4.98 and OR=1.35, 95% CI=0.81-2.23, respectively. Regarding acoustic neuroma ipsilateral mobile phone use in the latency group ≥10 years gave OR=1.81, 95% CI=0.73-4.45. For ipsilateral cumulative use ≥1640h OR=2.55, 95% CI=1.50-4.40 was obtained. Also use of cordless phones increased the risk for glioma and acoustic neuroma in the Hardell group studies. Survival of patients with glioma was analysed in the Hardell group studies yielding in the >10 years latency period hazard ratio (HR)=1.2, 95% CI=1.002-1.5 for use of wireless phones. This increased HR was based on results for astrocytoma WHO grade IV (glioblastoma multiforme). Decreased HR was found for low-grade astrocytoma, WHO grades I-II, which might be caused by RF-EMF exposure leading to tumour-associated symptoms and earlier detection and surgery with better

  8. Obstetrical brachial plexus palsy: Can excision of upper trunk neuroma and nerve grafting improve function in babies with adequate elbow flexion at nine months of age?

    PubMed

    Argenta, Anne E; Brooker, Jack; MacIssac, Zoe; Natali, Megan; Greene, Stephanie; Stanger, Meg; Grunwaldt, Lorelei

    2016-05-01

    Accepted indications for exploration in obstetrical brachial plexus palsy (OBPP) vary by center. Most agree that full elbow flexion against gravity at nine months of age implies high chance of spontaneous recovery and thus excludes a baby from surgical intervention. However, there are certain movements of the shoulder and forearm that may not be used frequently by the infant, but are extremely important functionally as they grow. These movements are difficult to assess in a baby and may lead to some clinicians to recommend conservative treatment, when this cohort of infants may in fact benefit substantially from surgery. A retrospective review was conducted on all infants managed surgically at the Brachial Plexus Center of a major children's hospital from 2009 to 2014. Further analysis identified five patients who had near-normal AMS scores for elbow flexion but who had weakness of shoulder abduction, flexion, external rotation, and/or forearm supination. In contrast to standard conservative management, this cohort underwent exploration, C5-6 neuroma excision, and sural nerve grafting. Data analysis was performed on this group to look for overall improvement in function. During an average follow-up period of 29 months, all patients made substantial gains in motor function of the shoulder and forearm, without loss of elbow flexion or extension, or worsening of overall outcome. In select infants with brachial plexus injuries but near-normal AMS scores for elbow flexion, surgical intervention may be indicated to achieve the best functional outcome. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Validation of the Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL) for Spanish-Speaking Patients.

    PubMed

    Medina, Maria Del Mar; Carrillo, Alvaro; Polo, Ruben; Fernandez, Borja; Alonso, Daniel; Vaca, Miguel; Cordero, Adela; Perez, Cecilia; Muriel, Alfonso; Cobeta, Ignacio

    2017-04-01

    Objective To perform translation, cross-cultural adaptation, and validation of the Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL) to the Spanish language. Study Design Prospective study. Setting Tertiary neurotologic referral center. Subjects and Methods PANQOL was translated and translated back, and a pretest trial was performed. The study included 27 individuals diagnosed with vestibular schwannoma. Inclusion criteria were adults with untreated vestibular schwannoma, diagnosed in the past 12 months. Feasibility, internal consistency, test-retest reliability, construct validity, and ceiling and floor effects were assessed for the present study. Results The mean overall score of the PANQOL was 69.21 (0-100 scale, lowest to highest quality of life). Cronbach's α was 0.87. Intraclass correlation coefficient was performed for each item, with an overall score of 0.92. The κ coefficient scores were between moderate and almost perfect in more than 92% of patients. Anxiety and energy domains of the PANQOL were correlated with both physical and mental components of the SF-12. Hearing, balance, and pain domains were correlated with the SF-12 physical component. Facial and general domains were not significantly correlated with any component of the SF-12. Furthermore, the overall score of the PANQOL was correlated with the physical component of the SF-12. Conclusion Feasibility, internal consistency, reliability, and construct validity outcomes in the current study support the validity of the Spanish version of the PANQOL.

  10. Multistep translation and cultural adaptation of the Penn acoustic neuroma quality-of-life scale for German-speaking patients.

    PubMed

    Kristin, Julia; Glaas, Marcel Fabian; Stenin, Igor; Albrecht, Angelika; Klenzner, Thomas; Schipper, Jörg; Eysel-Gosepath, Katrin

    2017-08-31

    Monitoring the health-related quality of life (HRQOL) for patients with vestibular schwannoma (VS) has garnered increasing interest. In German-speaking countries, there is no disease-specific questionnaire available similar to the "Penn Acoustic Neuroma Quality-of-life Scale" (PANQOL). We translated the PANQOL for German-speaking patients based on a multistep protocol that included not only a forward-backward translation but also linguistic and sociocultural adaptations. The process consists of translation, synthesis, back translation, review by an expert committee, administration of the prefinal version to our patients, submission and appraisal of all written documents by our research team. The required multidisciplinary team for translation comprised head and neck surgeons, language professionals (German and English), a professional translator, and bilingual participants. A total of 123 patients with VS underwent microsurgical procedures via different approaches at our clinic between January 2007 and January 2017. Among these, 72 patients who underwent the translabyrinthine approach participated in the testing of the German-translated PANQOL. The first German version of the PANQOL questionnaire was created by a multistep translation process. The responses indicate that the questionnaire is simple to administer and applicable to our patients. The use of a multistep process to translate quality-of-life questionnaires is complex and time-consuming. However, this process was performed properly and resulted in a version of the PANQOL for assessing the quality of life of German-speaking patients with VS.

  11. Pooled analysis of case-control studies on acoustic neuroma diagnosed 1997-2003 and 2007-2009 and use of mobile and cordless phones.

    PubMed

    Hardell, Lennart; Carlberg, Michael; Söderqvist, Fredrik; Mild, Kjell Hansson

    2013-10-01

    We previously conducted a case-control study of acoustic neuroma. Subjects of both genders aged 20-80 years, diagnosed during 1997-2003 in parts of Sweden, were included, and the results were published. We have since made a further study for the time period 2007-2009 including both men and women aged 18-75 years selected from throughout the country. These new results for acoustic neuroma have not been published to date. Similar methods were used for both study periods. In each, one population-based control, matched on gender and age (within five years), was identified from the Swedish Population Registry. Exposures were assessed by a self-administered questionnaire supplemented by a phone interview. Since the number of acoustic neuroma cases in the new study was low we now present pooled results from both study periods based on 316 participating cases and 3,530 controls. Unconditional logistic regression analysis was performed, adjusting for age, gender, year of diagnosis and socio-economic index (SEI). Use of mobile phones of the analogue type gave odds ratio (OR) = 2.9, 95% confidence interval (CI) = 2.0-4.3, increasing with >20 years latency (time since first exposure) to OR = 7.7, 95% CI = 2.8-21. Digital 2G mobile phone use gave OR = 1.5, 95% CI = 1.1-2.1, increasing with latency >15 years to an OR = 1.8, 95% CI = 0.8-4.2. The results for cordless phone use were OR = 1.5, 95% CI = 1.1-2.1, and, for latency of >20 years, OR = 6.5, 95% CI = 1.7-26. Digital type wireless phones (2G and 3G mobile phones and cordless phones) gave OR = 1.5, 95% CI = 1.1-2.0 increasing to OR = 8.1, 95% CI = 2.0-32 with latency >20 years. For total wireless phone use, the highest risk was calculated for the longest latency time >20 years: OR = 4.4, 95% CI = 2.2-9.0. Several of the calculations in the long latency category were based on low numbers of exposed cases. Ipsilateral use resulted in a higher risk than contralateral for both mobile and cordless phones. OR increased per 100 h

  12. Sudden deafness as a presenting symptom of acoustic neuroma: case report.

    PubMed

    Nascentes, Sérgio Marquez; Paulo, Eduardo Augusto de Oliveira Henrique; de Andrade, Eduardo Carvalho; da Silva, Ana Lúcia; Vassoler, Trissia Maria Farah; Scanavini, Adriana Bernardini Antunes

    2007-01-01

    Vestibular schwannoma, also known as acoustic neurinoma, is the most frequent tumor of the cerebellopontine angle, and represents 9% of all intracranial tumors. The authors report a case of sudden deafness with unilateral tinnitus. The patients responded to therapy with Prednisone and Pentoxifylline after the diagnosis of acoustic neurinoma by imaging exams. Sudden deafness can be described as an intense and abrupt sensorineural loss. Usually it is higher than 30 dB at three or more frequencies and develops in less than three days. Investigation of the etiology of sudden deafness is extremely important to establish the adequate strategy for the case.

  13. A rare case of Pacinian corpuscle neuroma.

    PubMed

    Narayanamurthy, Vb; Winston, A Thomas; Gupta, Amit

    2005-01-01

    The authors discuss an interesting case of a Pacinian corpuscle neuroma in the thumb of an elderly woman who presented with severe digital pain. The pain was initially attributed to osteoarthritis of the interphalangeal joint of the thumb. The clinical signs were very subtle. The patient had complete pain relief following excision of the tumour. Pacinian corpuscle neuromas are rare, with only about 70 cases reported in the literature. The histology, presenting features and associated conditions are discussed in detail. In addition to a neuroma or glomus tumour, Pacinian corpuscle hyperplasia should be considered in the differential diagnosis of digital or palmar pain of unknown etiology.

  14. [The role of brain stem evoked potentials in acoustic neuroma screening and diagnosis].

    PubMed

    Maurer, J

    2008-08-01

    For acoustic tumours > 2 cm the sensitivity of brainstem evoked auditory potentials (BAEP) to detect the retrocochlear lesions is 100 % as for magnetic resonance imaging (MRI). According to the literature the sensitivity for detection of retrocochlear pathology in tumours < 1 cm is estimated to be between 75 % and 95 %. In the MRI the sensitivity and specificity in such smaller tumours is reported to be 100 %. A normal result of the BAEP examination and for additional neurootologic tests helps to increase the rate of safe exclusion of retrocochlear pathology. By at this time not yet routinely available modifications of the BAEP examination and by additional neurootologic tests the sensitivity of the electrophysiological screening procedure can be brought up to nearly 100 %. Thereby their important role as the primary screening procedure can be re-established. Besides a possible detection of a retrocochlear lesion the BAEP together with the additional neurootologic test provide important information on the functional status of the hearing and equilibrium system. Possible safe indications for inclusion and for exclusion criteria of an MRI screening for individual patients will be provided and discussed.

  15. Pooled analysis of case-control studies on acoustic neuroma diagnosed 1997–2003 and 2007–2009 and use of mobile and cordless phones

    PubMed Central

    HARDELL, LENNART; CARLBERG, MICHAEL; SÖDERQVIST, FREDRIK; MILD, KJELL HANSSON

    We previously conducted a case-control study of acoustic neuroma. Subjects of both genders aged 20–80 years, diagnosed during 1997–2003 in parts of Sweden, were included, and the results were published. We have since made a further study for the time period 2007–2009 including both men and women aged 18–75 years selected from throughout the country. These new results for acoustic neuroma have not been published to date. Similar methods were used for both study periods. In each, one population-based control, matched on gender and age (within five years), was identified from the Swedish Population Registry. Exposures were assessed by a self-administered questionnaire supplemented by a phone interview. Since the number of acoustic neuroma cases in the new study was low we now present pooled results from both study periods based on 316 participating cases and 3,530 controls. Unconditional logistic regression analysis was performed, adjusting for age, gender, year of diagnosis and socio-economic index (SEI). Use of mobile phones of the analogue type gave odds ratio (OR) = 2.9, 95% confidence interval (CI) = 2.0–4.3, increasing with >20 years latency (time since first exposure) to OR = 7.7, 95% CI = 2.8–21. Digital 2G mobile phone use gave OR = 1.5, 95% CI = 1.1–2.1, increasing with latency >15 years to an OR = 1.8, 95% CI = 0.8–4.2. The results for cordless phone use were OR = 1.5, 95% CI = 1.1–2.1, and, for latency of >20 years, OR = 6.5, 95% CI = 1.7–26. Digital type wireless phones (2G and 3G mobile phones and cordless phones) gave OR = 1.5, 95% CI = 1.1–2.0 increasing to OR = 8.1, 95% CI = 2.0–32 with latency >20 years. For total wireless phone use, the highest risk was calculated for the longest latency time >20 years: OR = 4.4, 95% CI = 2.2–9.0. Several of the calculations in the long latency category were based on low numbers of exposed cases. Ipsilateral use resulted in a higher risk than contralateral for both mobile and cordless

  16. Impact of insurance status and race on receipt of treatment for acoustic neuroma: A national cancer database analysis.

    PubMed

    McClelland, Shearwood; Kim, Ellen; Murphy, James D; Jaboin, Jerry J

    2017-03-23

    Acoustic neuroma (AN) management involves surgery, radiation, or observation. Previous studies have demonstrated that patient race and insurance status impact in-hospital morbidity/mortality following surgery; however the nationwide impact of these demographics on the receipt of each treatment modality has not been examined. The National Cancer Data Base (NCDB) from 2004 to 2013 identified AN patients. Multivariate analysis adjusted for several variables within each treatment modality, including patient age, race, sex, income, primary payer for care, tumor size, and medical comorbidities. Patients who were African-American (OR=0.7; 95%CI=0.5-0.9; p=0.01), elderly (minimum age 65) (OR=0.4; 95%CI=0.4-0.6; p<0.0001), on Medicare (OR=0.6; 95% CI=0.4-0.7; p=0.0005), or treated at a community hospital (OR=0.4; 95%CI=0.2-0.7; p=0.007) were less likely to receive surgery. Patients on Medicaid (OR=1.2; 95%CI=0.8-1.8; p=0.04) or treated at an integrated network (OR=1.2; 95%CI=0.9-1.6; p=0.0004) were more likely to receive surgery. Patients who were elderly (OR=2.2; 95%CI=1.7-2.9; p<0.0001) or treated in a comprehensive cancer center (OR=1.5; 95%CI=1.3-1.9; p=0.02) were more likely and Medicaid patients (OR=0.8; 95%CI=0.5-1.2; p=0.04) were less likely to receive radiation. Patients who were elderly (OR=2.2; 95%CI=1.7-2.7; p<0.0001), African-American (OR=1.5; 95%CI=1.1-2.0; p=0.01), on Medicare (OR=1.8; 95%CI=1.4-2.3; p=0.0003), or treated in a community hospital (OR=3.0; 95%CI=1.6-5.6; p=0.0007) were more likely to receive observation. Patients on Medicaid (OR=0.8; 95%CI=0.5-1.2; p=0.04) or treated in an integrated network (OR=0.8; 95%CI=0.6-1.0; p=0.0001) were less likely to receive observation. African-American race, elderly age, and community hospital treatment triaged towards observation/away from surgery; age also triaged towards radiation. Conversely, integrated networks triaged towards surgery/away from observation; comprehensive cancer centers triaged towards

  17. Aerodynamic and acoustic effects of false vocal folds and epiglottis in excised larynx models.

    PubMed

    Alipour, Fariborz; Jaiswal, Sanyukta; Finnegan, Eileen

    2007-02-01

    The purpose of this study was to examine the aerodynamic and acoustic effects of the false vocal folds and the epiglottis on excised larynx phonation. Several canine larynges were prepared and mounted over a tapered tube that supplied pressurized, heated, and humidified air. Glottal adduction was accomplished either by using two-pronged probes to press the arytenoids together or by passing a suture to simulate lateral cricoarytenoid muscle activation. First, the excised larynx with false vocal folds and epiglottis intact was subjected to a series of pressure-flow experiments with longitudinal tension and adduction as major control parameters. Then, the epiglottis and finally the false vocal folds were removed and the experiment was repeated. The subglottal pressure and the electroglottographic, flow rate, audio, and sound pressure signals were recorded during each experiment. Glottal flow resistance was calculated from the pressure and flow signals. The electroglottographic signal was used to extract the fundamental frequency. It was found that the false vocal folds and the epiglottis offer a positive contribution to the glottal resistance and sound intensity of the larynx. Also, vocal fold elongation and glottal medial compression caused an increase in glottal resistance. The pressure-flow relationships were approximately linear regardless of the structure. The addition of the supraglottic laryngeal structures has a significant impact on both aerodynamic and acoustic characteristics of excised larynges.

  18. On the acoustic effects of the supraglottic structures in excised larynges

    PubMed Central

    Alipour, Fariborz; Finnegan, Eileen

    2013-01-01

    The acoustic effects of the supraglottic laryngeal structures (SGSs), including the false vocal folds (FVFs) laryngeal ventricle, and the epiglottis were investigated in an excised canine larynx model with and without these anatomical structures. The purpose of this study was to better understand the acoustic contributions of these structures to phonation. Canine larynges were prepared and mounted over a 3/4 in. tube, which supplied pressurized, heated, and humidified air. Glottal adduction was accomplished by rotating the arytenoids with a suture passed behind the vocal folds to simulate the lateral cricoarytenoid muscle action. The SGSs were kept intact in the first part of the experiment and were removed in the second part. Results indicated that when the FVFs vibrated, a low frequency component was observed in the spectral data. The excised larynx with a SGS had a limited range of frequency with subglottal pressure, while the larynx without a SGS had a larger frequency range. The excised canine larynx with a SGS oscillated with a higher phonation threshold pressure and significantly louder. PMID:23654402

  19. Validation of self-reported start year of mobile phone use in a Swedish case-control study on radiofrequency fields and acoustic neuroma risk.

    PubMed

    Pettersson, David; Bottai, Matteo; Mathiesen, Tiit; Prochazka, Michaela; Feychting, Maria

    2015-01-01

    The possible effect of radiofrequency exposure from mobile phones on tumor risk has been studied since the late 1990s. Yet, empirical information about recall of the start of mobile phone use among adult cases and controls has never been reported. Limited knowledge about recall errors hampers interpretations of the epidemiological evidence. We used network operator data to validate the self-reported start year of mobile phone use in a case-control study of mobile phone use and acoustic neuroma risk. The answers of 96 (29%) cases and 111 (22%) controls could be included in the validation. The larger proportion of cases reflects a more complete and detailed reporting of subscription history. Misclassification was substantial, with large random errors, small systematic errors, and no significant differences between cases and controls. The average difference between self-reported and operator start year was -0.62 (95% confidence interval: -1.42, 0.17) years for cases and -0.71 (-1.50, 0.07) years for controls, standard deviations were 3.92 and 4.17 years, respectively. Agreement between self-reported and operator-recorded data categorized into short, intermediate and long-term use was moderate (kappa statistic: 0.42). Should an association exist, dilution of risk estimates and distortion of exposure-response patterns for time since first mobile phone use could result from the large random errors in self-reported start year. Retrospective collection of operator data likely leads to a selection of "good reporters", with a higher proportion of cases. Thus, differential recall cannot be entirely excluded.

  20. Fractionated Stereotactic Radiotherapy in the Treatment of Vestibular Schwannoma (Acoustic Neuroma): Predicting the Risk of Hydrocephalus;Vestibular schwannoma; Hydrocephalus; Fractionated; Stereotactic radiotherapy

    SciTech Connect

    Powell, Ceri; Micallef, Caroline; Gonsalves, Adam; Wharram, Bev; Ashley, Sue; Brada, Michael

    2011-07-15

    Purpose: To determine the incidence and predictive factors for the development of hydrocephalus in patients with acoustic neuromas (AN) treated with fractionated stereotactic radiotherapy. Patients and Methods: Seventy-two patients with AN were treated with fractionated stereotactic radiotherapy between 1998 and 2007 (45-50 Gy in 25-30 fractions over 5 to 6 weeks). The pretreatment MRI scan was assessed for tumor characteristics and anatomic distortion independently of subsequent outcome and correlated with the risk of hydrocephalus. Results: At a median follow-up of 49 months (range, 1-120 months), 5-year event-free survival was 95%. Eight patients (11%) developed hydrocephalus within 19 months of radiotherapy, which was successfully treated. On univariate analysis, pretreatment factors predictive of hydrocephalus were maximum diameter (p = 0.005), proximity to midline (p = 0.009), displacement of the fourth ventricle (p = 0.02), partial effacement of the fourth ventricle (p < 0.001), contact with the medulla (p = 0.005), and more brainstem structures (p = 0.004). On multivariate analysis, after adjusting for fourth ventricular effacement, no other variables remained independently associated with hydrocephalus formation. Conclusions: Fractionated stereotactic radiotherapy results in excellent tumor control of AN, albeit with a risk of developing hydrocephalus. Patients at high risk, identified as those with larger tumors with partial effacement of the fourth ventricle before treatment, should be monitored more closely during follow-up. It would also be preferable to offer treatment to patients with progressive AN while the risk of hydrocephalus is low, before the development of marked distortion of fourth ventricle before tumor diameter significantly exceeds 2 cm.

  1. Excised acoustic black holes: The scattering problem in the time domain

    SciTech Connect

    Cherubini, C.; Federici, F.; Tosi, M.P.; Succi, S.

    2005-10-15

    The scattering process of a dynamic perturbation impinging on a draining-tub model of an acoustic black hole is numerically solved in the time domain. Analogies with real black holes of general relativity are explored by using recently developed mathematical tools involving finite elements methods, excision techniques, and constrained evolution schemes for strongly hyperbolic systems. In particular it is shown that superradiant scattering of a quasimonochromatic wave packet can produce strong amplification of the signal, offering the possibility of a significant extraction of rotational energy at suitable values of the angular frequency of the vortex and of the central frequency of the wave packet. The results show that theoretical tools recently developed for gravitational waves can be brought to fruition in the study of other problems in which strong anisotropies are present.

  2. Aerodynamic and nonlinear dynamic acoustic analysis of tension asymmetry in excised canine larynges.

    PubMed

    Devine, Erin E; Bulleit, Erin E; Hoffman, Matthew R; McCulloch, Timothy M; Jiang, Jack J

    2012-12-01

    To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension asymmetry, mimicking unilateral SLNP. Two sets of weights were used, 1 light and 1 heavy. Five conditions were evaluated: (a) no tension, (b) symmetrical light tension, (c) asymmetrical light tension, (d) symmetrical heavy tension, and (e) asymmetrical heavy tension. Perturbation parameters were not significantly different across conditions: percent jitter, χ(2)(4) = 3.70, p = .451; percent shimmer, F(4) = 0.95, p = .321. In addition, many measurements were invalid (error values >10). Second-order entropy was significantly different across conditions, F(4) = 5.432, p = .002, whereas correlation dimension was not, F(4) = 0.99, p = .428. Validity of these nonlinear dynamic parameters was demonstrated by low standard deviations. Phonation threshold pressure, χ (2)(4) = 22.50, p < .001, and power, χ (2)(4) = 9.50, p = .05, differed significantly across conditions, whereas phonation threshold flow did not, χ (2)(4) = 4.08, p = .396. Nonlinear dynamic analysis differentiated between symmetrical and asymmetrical tension conditions, whereas traditional perturbation analysis was less useful in characterizing type 2 or 3 vocal signals. Supplementing acoustic with aerodynamic parameters may help distinguish among laryngeal disorders of neuromuscular origin.

  3. Aerodynamic and nonlinear dynamic acoustic analysis of tension asymmetry in excised canine larynges

    PubMed Central

    Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

    2013-01-01

    Objective/hypothesis To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Methods SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension asymmetry, mimicking unilateral SLNP. Two sets of weights were used, one light and one heavy. Experimental measurements were made for five conditions: no tension; symmetrical light tension; asymmetrical light tension; symmetrical heavy tension; and asymmetrical heavy tension. Results Perturbation parameters were not significantly different across conditions (percent jitter: p=0.451; percent shimmer: p=0.321). Additionally, many measurements were invalid (error values > 10). Second order entropy (K2) was significantly different across conditions (p=0.002), while correlation dimension (D2) was not (p=0.428). Validity of these nonlinear dynamic parameters was demonstrated by low standard deviations. Phonation threshold pressure (p<0.001) and power (p=0.05) differed significantly across conditions, while phonation threshold flow did not (p=0.396). Conclusions Nonlinear dynamic analysis differentiated between symmetrical and asymmetrical tension conditions while traditional perturbation analysis was less useful characterizing type 2 or 3 vocal signals. Supplementing acoustic with aerodynamic parameters may help distinguish among laryngeal disorders of neuromuscular origin. PMID:22562826

  4. Probabilistic Multiple-Bias Modeling Applied to the Canadian Data From the Interphone Study of Mobile Phone Use and Risk of Glioma, Meningioma, Acoustic Neuroma, and Parotid Gland Tumors.

    PubMed

    Momoli, F; Siemiatycki, J; McBride, M L; Parent, M-É; Richardson, L; Bedard, D; Platt, R; Vrijheid, M; Cardis, E; Krewski, D

    2017-10-01

    We undertook a re-analysis of the Canadian data from the 13-country case-control Interphone Study (2001-2004), in which researchers evaluated the associations of mobile phone use with the risks of brain, acoustic neuroma, and parotid gland tumors. In the main publication of the multinational Interphone Study, investigators concluded that biases and errors prevented a causal interpretation. We applied a probabilistic multiple-bias model to address possible biases simultaneously, using validation data from billing records and nonparticipant questionnaires as information on recall error and selective participation. In our modeling, we sought to adjust for these sources of uncertainty and to facilitate interpretation. For glioma, when comparing those in the highest quartile of use (>558 lifetime hours) to those who were not regular users, the odds ratio was 2.0 (95% confidence interval: 1.2, 3.4). After adjustment for selection and recall biases, the odds ratio was 2.2 (95% limits: 1.3, 4.1). There was little evidence of an increase in the risk of meningioma, acoustic neuroma, or parotid gland tumors in relation to mobile phone use. Adjustments for selection and recall biases did not materially affect interpretation in our results from Canadian data. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Management of painful clitoral neuroma after female genital mutilation/cutting.

    PubMed

    Abdulcadir, Jasmine; Tille, Jean-Christophe; Petignat, Patrick

    2017-02-08

    Traumatic neuromas are the result of regenerative disorganized proliferation of the proximal portion of lesioned nerves. They can exist in any anatomical site and are responsible for neuropathic pain. Post-traumatic neuromas of the clitoris have been described as an uncommon consequence of female genital mutilation/cutting (FGM/C). FGM/C involves partial or total removal of the female genital organs for non-therapeutic reasons. It can involve cutting of the clitoris and can cause psychological, sexual, and physical complications. We aimed to evaluate the symptoms and management of women presenting with a clitoral neuroma after female genital mutilation/cutting (FGM/C). We identified women who attended our specialized clinic for women with FGM/C who were diagnosed with a traumatic neuroma of the clitoris between April 1, 2010 and June 30, 2016. We reviewed their medical files and collected socio-demographic, clinical, surgical, and histopathological information. Seven women were diagnosed with clitoral neuroma. Six attended our clinic to undergo clitoral reconstruction, and three of these suffered from clitoral pain. The peri-clitoral fibrosis was removed during clitoral reconstruction, which revealed neuroma of the clitoris in all six subjects. Pain was ameliorated after surgery. The seventh woman presented with a visible and palpable painful clitoral mass diagnosed as a neuroma. Excision of the mass ameliorated the pain. Sexual function improved in five women. One was not sexually active, and one had not yet resumed sex. Post-traumatic clitoral neuroma can be a consequence of FGM/C. It can cause clitoral pain or be asymptomatic. In the case of pain symptoms, effective treatment is neuroma surgical excision, which can be performed during clitoral reconstruction. Surgery should be considered as part of multidisciplinary care. The efficacy of neuroma excision alone or during clitoral reconstruction to treat clitoral pain should be further assessed among symptomatic

  6. What Is an Acoustic Neuroma

    MedlinePlus

    ... non-cancerous) growth that arises on the eighth cranial nerve leading from the brain to the inner ear. ... eighth nerve, along with the facial or seventh cranial nerve, lie adjacent to each other as they pass ...

  7. Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges

    ERIC Educational Resources Information Center

    Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

    2012-01-01

    Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension…

  8. Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges

    ERIC Educational Resources Information Center

    Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

    2012-01-01

    Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension…

  9. [Computed tomography in the diagnosis of intracranial trigeminal neuroma].

    PubMed

    Xiao, J; Wang, D; Deng, K

    1993-12-01

    CT scans of 12 cases of intracranial trigeminal neuroma were presented. Three of the neuromas were located in petrous apex-middle cranial fossa, two in posterior cranial fossa, and 7 in both the middle and posterior cranial fossae. The tumors appeared hypo- and isodense on the plain CT scan. After contrast infusion, all tumors were well circumscribed with marked enhancement, which was homogeneous, inhomogeneous or circular. None of the trigeminal neuroma had surrounding brain edema. Of 12 cases, 10 showed change of cranial bones, which included dilatation of Meckle's cave and destructions of petrous apex, clivus and the bottom of middle cranial fossa. The tumor in one case extended to paranasopharyngeal space from the bottom of middle cranial fossa, Various features of trigeminal neuroma on CT were reviewed. Also presented were the author's experiences in differentiating intracranial trigeminal neuroma from meningiom, from pituitary adenoma spreading to parasella and glioma adjacent to cranial bottom in middle cranial fossa, and from acoustic neuroma, meningioma, cholesteatoma in cerebellopontine angle.

  10. Penile Traumatic Neuroma: A Late Complication of Penile Dorsal Neurotomy to Treat Premature Ejaculation.

    PubMed

    Park, Hyun Jun; Kim, Tae Nam; Baek, Seung Ryong; Lee, Kyung Min; Choi, Kyung-Un; Park, Nam Cheol

    2016-09-01

    Traumatic neuroma is a reactive process caused by the regeneration of an injured nerve that usually forms a nodular proliferation of small nerve bundles. Penile traumatic neuroma is rare; only a few cases related to circumcision have been reported. To report on a case of traumatic neuroma in the penis after selective dorsal neurotomy (SDN) to treat premature ejaculation. The penile traumatic neuroma was successfully removed by excision and confirmed by histopathology. A 55-year-old man who had had several painless, slow-growing nodules on his penis for 2 years presented to our hospital. He had no history of genital trauma, urinary tract infection, or penile surgery, except SDN to treat premature ejaculation. The nodules were excised and the final diagnosis was traumatic neuroma. No recurrence has been detected during 1 year of follow-up. The main complications of SDN are recurrence of premature ejaculation, pain or paresthesia on the glans penis, and erectile dysfunction. However, no traumatic neuroma has been reported as a complication. We report that a traumatic neuroma can occur after SDN. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  11. [MRI and leg stump neuroma].

    PubMed

    Martinet, N; Foisneau-Lottin, A; Henrot, P; Paysant, J; Blum, A; André, J M

    2001-12-01

    To describe RMI aspects of leg stump neuroma and to evaluate RMI scan interest for neuroma diagnosis and management. During a 2 years period, 224 amputated patients consulting for pain or prostetics problems were studied. In 10 cases, a characteristic pain leads to neurona diagnosis. This is described as a sensation of ascending or descending electric shock induced by the stimulation of an identified point with a reproducible topography. In all these cases, RMI scans were performed. In thirty two other cases, a RMI scan was performed to confirm a pathology (bursitis, bone abnormality) or in order to establish an etiologic diagnosis. Twelve neuromas were diagnosed. RMI scan showed a neuroma in the ten cases with a clinical suspicion and two asymptomatic neuromas were diagnosed out of the 32 patients without clinical suspicion. Medium delay between amputation and neuroma diagnosis is 11,6 year. In six cases, staking was modified and in six other cases, surgery was necessary. In aIl cases, clinical manifestations disappeared. Vanous RMI aspects ofneuromas are described and illustrated. Neuroma is observed on the extremity of a nerve that have a wavy aspect on its top. The neuroma is an oblong structure, with clear limits. There is an hyposignal with Ti sequence and variable signal with T2 and after gadolinium injection. RMI scan is a good way to diagnose amputee neuroma. It makes it possible to demonstrate the pathological character of the neuroma. It has to be performed when a neuroma is suspected. It enables to confirm the diagnosis and establish the exact topography and anatomic connection. Mechanical strains role as a factor of discovering the neuroma is discussed because of the concomitant evolution of associated lesions (bursitis, bone edema). Surgical repair takes place after correcting abnormal mechanical strains.

  12. Morton's interdigital neuroma: a comprehensive treatment protocol.

    PubMed

    Bennett, G L; Graham, C E; Mauldin, D M

    1995-12-01

    One hundred fifteen patients with signs and symptoms of Mortons' interdigital neuroma were studied in an attempt to evaluate the efficacy of a staged treatment program. The first stage consisted of patient education, footwear modifications, and metatarsal head relief. The second stage consisted of a steroid/local anesthetic injection into the affected interspace. The third stage was surgical excision of the inflamed interdigital nerve. Overall, 97 of 115 patients (85%) believed that they had improved with the treatment program. Twenty-four patients (21%) eventually required surgical excision of the nerve and 23 of 24 patients (96%) had satisfactory results. The results of the staged treatment protocol were very satisfactory and patient satisfaction was high.

  13. Traumatic neuroma of the anus after Milligan-Morgan hemorrhoidectomy.

    PubMed

    Takawira, Catherine; Shenouda, Suzan; Mikuz, Gregor; Sergi, Consolato

    2014-01-01

    There are several clinical settings of traumatic neuroma and a few may occur following surgical procedures. A 42-year-old man presented with anal pain five years after a Milligan Morgan hemorrhoidectomy for prolapsing hemorrhoids. A 4×4×3 mm sized anal polyp was seen during a rectal examination at a follow-up five years after surgery. The patient complained of point tenderness, pruritus, and anal discomfort as well as fecal retention. An endoscopy revealed a rectal polyp. Remarkably, histopathological examination and immunohistochemistry of the excised polyp showed a polypoid traumatic neuroma of the rectal plexus. After the excision of the polyp, the patient's complaint resolved completely. Traumatic neuromas may be a cause of significant pain and tenderness in patients with anal surgery or repair of anal lacerations. Interestingly, this is the second case of anal traumatic neuroma since Dr. Marks' first case in 1956 and is a possible complication of Milligan Morgan hemorrhoidectomy for prolapsing hemorrhoids. Similar complications of rectal surgery are reviewed. © 2014 by the Association of Clinical Scientists, Inc.

  14. Neurofibromatosis and the Painful Neuroma

    DTIC Science & Technology

    2010-01-01

    clinical treatment of neuropathic pain and pain from neuroma formation. Systemic administration of lidocaine has also been used to treat neuropathic... pain . We performed an experiment to compare the effect of pregabalin(PGB), morphine, and lidocaine (LDC) on the TNT model. Method: TNT model...of mechanical hyperalgesia (partially dennervated skin). Further, systemic lidocaine can be expected to impact neuroma sensitivity related pain

  15. Aerodynamic and Acoustic Effects of Abrupt Frequency Changes in Excised Larynges

    ERIC Educational Resources Information Center

    Alipour, Fariborz; Finnegan, Eileen M.; Scherer, Ronald C.

    2009-01-01

    Purpose: To determine the aerodynamic and acoustic effects due to a sudden change from chest to falsetto register or vice versa. It was hypothesized that the continuous change in subglottal pressure and flow rate alone (pressure-flow sweep [PFS]) can trigger a mode change in the canine larynx. Method: Ten canine larynges were each mounted over a…

  16. Aerodynamic and Acoustic Effects of Abrupt Frequency Changes in Excised Larynges

    ERIC Educational Resources Information Center

    Alipour, Fariborz; Finnegan, Eileen M.; Scherer, Ronald C.

    2009-01-01

    Purpose: To determine the aerodynamic and acoustic effects due to a sudden change from chest to falsetto register or vice versa. It was hypothesized that the continuous change in subglottal pressure and flow rate alone (pressure-flow sweep [PFS]) can trigger a mode change in the canine larynx. Method: Ten canine larynges were each mounted over a…

  17. Neurofibromatosis and the Painful Neuroma

    DTIC Science & Technology

    2007-01-01

    tibial nerve exposure group on all postoperative test days except day 33. Thus, proximal tibial nerve transection led to a reversal of the neuroma pain ...AD_________________ Award Number: W81XWH-06-1-0176 TITLE: Neurofibromatosis and the Painful ...TYPE Annual 3. DATES COVERED (From - To) 01 Jan 06 – 31 Dec 06 4. TITLE AND SUBTITLE Neurofibromatosis and the Painful Neuroma 5a. CONTRACT

  18. Neurofibromatosis and the Painful Neuroma

    DTIC Science & Technology

    2008-01-01

    Wheat Germ Agglutinin (WGA) coupled to Saporin as an interesting neuronal toxin. This toxin will bind 5 preferentially to small neuronal fibers...from a neuroma and lead to a significant reduction of neuroma tenderness. Wheat Germ Agglutinin - SAP In our open labeled studies we used doses...application of Wheat Germ Agglutinin – SAP to a nerve will result in retrograde transport of the neural toxin and loss of small fiber axons. In

  19. An Excised Canine Model of Anterior Glottic Web and Its Acoustic, Aerodynamic, and High-speed Measurements.

    PubMed

    Xue, Chao; Pulvermacher, Allyson; Calawerts, William; Devine, Erin; Jiang, Jack

    2017-03-01

    This study aims to build an excised anterior glottic web (AGW) model and study the basic voice-related mechanisms of the AGW through investigating the acoustic, aerodynamic, and vibratory properties. Overall, four conditions were tested for each of the eight canine larynges used. At baseline, 10%, 20%, and 33% occlusion (as determined by the placement of the suture), acoustic, aerodynamic, and high-speed video data were collected while each larynx was phonated in a soundproof booth. The phonation threshold pressure (PTP) and the phonation threshold flow significantly increased as percent occlusion increased (P < 0.001). There were significant increases in jitter % and shimmer % from baseline group to AGW model groups at PTP, 1.25 PTP, and 1.5 PTP (P = 0.039, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.001, respectively). The fundamental frequency significantly increased as percent occlusion increased at all given pressures (P < 0.001). Correlation dimension (D2) was significantly higher in the AGW model groups than in the baseline group at PTP, 1.25 PTP, and 1.5 PTP (P = 0.002, P < 0.001, P = 0.01, respectively). High-speed videos revealed that, the left phase shift in the AGW model groups compared with the baseline at 1.25 PTP was significant (P = 0.027) and right phase shift at 1.5 PTP (P < 0.001). We presented an anatomically similar model of a type 1 AGW and confirmed its validity through aerodynamic, acoustic, and high-speed video analysis in our study. We observed and investigated the glottic web movement, which may be a new explanation for the pathologic voice-related mechanism of AGW. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  20. Three Cycles of Radiofrequency Ablation Are More Efficacious Than Two in the Management of Morton's Neuroma.

    PubMed

    Brooks, David; Parr, Adam; Bryceson, William

    2017-05-01

    Morton's neuroma is a common cause of forefoot pain. Outcomes of conservative therapy are mixed and many patients undergo operative intervention. Radiofrequency ablation has recently gained favor as a treatment option, although the optimal regime is unknown. This study investigates the effectiveness of 2 versus 3 cycles of radiofrequency ablation for the treatment of Morton's neuroma. We surveyed a cohort of patients with Morton's neuroma who had progressed to radiofrequency ablation after failed conservative treatment. Patients received either 2 or 3 cycles of radiofrequency ablation by a single surgeon. We assessed patients based on their change in numerical pain rating scale, symptom improvement, complications, and progression to surgical excision through a series of telephone interviews. Outcomes between the 2 treatment arms were compared by parametric tests. Twenty-eight patients were included in the study. Eighteen patients with 21 neuromas received 2 cycles and 10 patients with 11 neuromas received 3 cycles. Mean time of follow-up was 12.9 months. Overall, 88% of patients were either very or moderately satisfied with their outcome. In patients who received 2 cycles mean numerical pain scores decreased from 7.9 ± 1.1 to 3.4 ± 2.4 postprocedure. Three patients progressed to operative excision. In patients who received 3 cycles, numerical pain scores decreased from 8.0 ± 1.0 to 1.5 ± 2.0 postprocedure. One patient progressed to operative excision. Patients who received 3 cycles had reduced medium-term pain postoperatively compared with 2 cycles (3.4 ± 2.4 vs 1.5 ± 2.0, P = .011). Radiofrequency ablation provides a high rate of patient satisfaction in the treatment of Morton's neuroma with few side effects. It appears that 3 cycles may be superior to 2 cycles but a randomized controlled trial will be required to confirm these results. Intervention, Level III: Comparative study without concurrent controls.

  1. Unusual case of traumatic neuroma of the orbit.

    PubMed

    Ulivieri, Simone; Muscas, Giovanni; Miracco, Clelia; Oliveri, Giuseppe; Galluzzi, Paolo; Giorgio, Antonio

    2016-01-01

    Traumatic or amputation neuromas are neoformations developing after damage to a peripheral nerve. They are not proper tumors but rather a reactive process or a frustrated attempt of nerve regeneration. Traumatic neuromas are potentially found in every sensory peripheral nerve and often at the site of past surgical intervention, including orbital surgery. A 29-year-old Northern African migrant presented progressive exophthalmos and progressive loss of acuity in left eye, which had started about 6 months before after a cranio-facial trauma caused by a violent assault. MRI of the orbits showed a massive intra-orbital, intra-conical lesion, clearly compressing and dislocating the optic nerve and extending posteriorly to the orbital apex. Surgery was performed through lateral approach of Kroenlein and led to complete excision of the lesion. Histology revealed fibrotic, adipose and striated muscle tissues, a disordered, non-neoplastic overgrowth of small and large fascicles of nerves, inflammatory infiltrates, and fibrosis with sparse calcifications were diffusely observed in a background of fat, scar and striated muscle tissued. Patient was discharged on the fifth day in good health condition, without deficit of eye motion but without recovery of visual acuity. In conclusion, this case demonstrates that traumatic neuromas may arise in the orbit in patients with minor direct trauma to nerves and without previous surgical treatment.

  2. Neurofibromatosis and the Painful Neuroma

    DTIC Science & Technology

    2009-01-01

    identified two other neural toxins that may be effective: Wheat Germ Agglutinin (WGA) coupled to saporin and cholera toxin B (CTB) coupled to saporin...degeneration. There is a dose dependent loss of axons and prevention of neuroma formation. The application of Wheat Germ Agglutinin – SAP to a nerve will

  3. Neuromas of the calcaneal nerves.

    PubMed

    Kim, J; Dellon, A L

    2001-11-01

    A neuroma of a calcaneal nerve has never been reported. A series of 15 patients with heel pain due to a neuroma of a calcaneal nerve are reviewed. These patients previously had either a plantar fasciotomy (n = 4), calcaneal spur removal (n = 2), ankle fusion (n = 2), or tarsal tunnel decompression (n = 7). Neuromas occurred on calcaneal branches that arose from either the posterior tibial nerve (n = 1), lateral plantar nerve (n = 1), the medial plantar nerve (n = 9), or more than one of these nerves (n = 4). Operative approach was through an extended tarsal tunnel incision to permit identification of all calcaneal nerves. The neuroma was resected and implanted into the flexor hallucis longus muscle. Excellent relief of pain occurred in 60%, and good relief in 33%. One patient (17%) had no improvement and required resection of the lateral plantar nerve. Awareness that the heel may be innervated by multiple calcaneal branches suggests that surgery for heel pain of neural origin employ a surgical approach that permits identification of all possible calcaneal branches.

  4. Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts

    PubMed Central

    Souza, Jason M.; Purnell, Chad A.; Cheesborough, Jennifer E.; Kelikian, Armen S.; Dumanian, Gregory A.

    2016-01-01

    Background: Localized nerve pain in the foot and ankle can be a chronic source of disability after trauma and has been identified as the most common complication following operative interventions in the foot and ankle. The superficial location of the injured nerves and lack of suitable tissue for nerve implantation make this pain refractory to conventional methods of neuroma management. We describe a novel strategy for management using processed nerve allografts to bridge nerve gaps created by resection of both end neuromas and neuromas-in-continuity. Methods: A retrospective review of a prospectively maintained database was performed of all patients who received a processed nerve allograft for treatment of painful neuromas in the foot and ankle between May 2010 and June 2015. Patient demographic and operative information was obtained, as well as preoperative and postoperative pain assessments using a conventional ordinal scale and PROMIS (Patient Reported Outcomes Measurement Information System) Pain Behavior and Pain Interference assessments. Twenty-two patients were identified, with postoperative pain assessments occurring at a mean of 15.5 months after surgery. Results: Neuromas of the sural and superficial peroneal nerves were the most common diagnoses, with 3-cm nerve allografts being used as the interposition graft in the majority of cases. Eight patients had end neuromas and 18 patients had neuromas in continuity. Analysis of paired data demonstrated a mean ordinal pain score decrease of 2.6, with 24 and 31 percentage-point decreases in PROMIS Pain Behavior and Pain Interference measures, respectively. All changes were significant (P < .002). Conclusion: The painful sequelae of superficial nerve injuries in the foot and ankle was significantly improved with complete excision of the involved nerve segment followed by bridging of the resulting nerve gap with a processed nerve allograft. This approach limits surgery to the site of injury and reconstitutes the

  5. Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts.

    PubMed

    Souza, Jason M; Purnell, Chad A; Cheesborough, Jennifer E; Kelikian, Armen S; Dumanian, Gregory A

    2016-10-01

    Localized nerve pain in the foot and ankle can be a chronic source of disability after trauma and has been identified as the most common complication following operative interventions in the foot and ankle. The superficial location of the injured nerves and lack of suitable tissue for nerve implantation make this pain refractory to conventional methods of neuroma management. We describe a novel strategy for management using processed nerve allografts to bridge nerve gaps created by resection of both end neuromas and neuromas-in-continuity. A retrospective review of a prospectively maintained database was performed of all patients who received a processed nerve allograft for treatment of painful neuromas in the foot and ankle between May 2010 and June 2015. Patient demographic and operative information was obtained, as well as preoperative and postoperative pain assessments using a conventional ordinal scale and PROMIS (Patient Reported Outcomes Measurement Information System) Pain Behavior and Pain Interference assessments. Twenty-two patients were identified, with postoperative pain assessments occurring at a mean of 15.5 months after surgery. Neuromas of the sural and superficial peroneal nerves were the most common diagnoses, with 3-cm nerve allografts being used as the interposition graft in the majority of cases. Eight patients had end neuromas and 18 patients had neuromas in continuity. Analysis of paired data demonstrated a mean ordinal pain score decrease of 2.6, with 24 and 31 percentage-point decreases in PROMIS Pain Behavior and Pain Interference measures, respectively. All changes were significant (P < .002). The painful sequelae of superficial nerve injuries in the foot and ankle was significantly improved with complete excision of the involved nerve segment followed by bridging of the resulting nerve gap with a processed nerve allograft. This approach limits surgery to the site of injury and reconstitutes the peripheral nerve anatomy. Level IV

  6. Implantation of Nerve Stump Inside a Vein and a Muscle: Comparing Neuroma Formation in Rat

    PubMed Central

    Prasetyono, Theddeus O. H.; Permatasari, Erythrina; Soetrisno, Esti

    2014-01-01

    Among many techniques independently reported to manage neuroma formation, manipulation of the nerve stump inside muscle and vein is the most advantageous technique. This study aimed to enrich the basic data of macroscopic appearance and histo-pathology regarding which technique generates less neuroma: nerve stump implantation inside vein or inside muscle. An experimental study with posttest-only control-group design was conducted in 24 rats that were randomly arranged into 3 groups. One centimeter of the lateral branch of the right ischiadic nerve was cut. Group A served as the control group, where the proximal nerve stumps were left as they were after the excision; whereas the stumps of groups B and C were implanted inside muscles and veins, respectively. The samples were assessed with histologic examination after 4 weeks to measure the morphometric changes in the nerve endings. The data were statistically analyzed with t test. All rats healed uneventfully. No thrombosis was found within group C, and the stumps were free of neuroma formation. The muscle group formed smaller neuroma than the control group. Statistical analysis showed significant differences between the groups (P < 0.05). The outcome of nerve stump implantation inside the lumen of a vein is superior to the implantation inside a muscle in preventing neuroma formation. PMID:25437591

  7. Reexcision Perineural Invasion and Epithelial Sheath Neuroma Possibly on a Spectrum of Postinjury Reactive Hyperplasia Mediated by IL-6.

    PubMed

    Wang, James Y; Nuovo, Gerard; Kline, Mitchell; Magro, Cynthia M

    2017-01-01

    Epithelial sheath neuroma is a rarely recognized but established entity in the medical literature. First described in 2000 by Requena et al, there have only been 7 published cases to date, mostly in female patients and presenting as symptomatic solitary lesions on the back without a known history of trauma. In 2006, Beer et al described and reviewed a dozen cases in which epithelial sheath neuroma-like features were seen in the advent of a surgical procedure, which was termed "re-excision perineural invasion" and attributed to possible eccrine duct implantation during surgery. Our case is a 66-year-old male patient who underwent an excision of a melanocytic neoplasm in which a reactive epithelial sheath neuroma was incidentally discovered in the excision specimen, adjacent to the biopsy site cicatrix. Histologically, there was benign cutaneous nerve hyperplasia with a proliferation of squamous epithelium in intimate apposition to the nerve bundles in the superficial dermis. We postulate that the process active in the formation of re-excision perineural invasion is the same as in epithelial sheath neuroma and that minor trauma not appreciable on histologic examination is responsible in the latter entity. We performed IL-6 staining and documented that IL-6 was upregulated at the interface of the nerve and reactive epithelium, but was absent in nerves distant from the site of surgery, suggesting that IL-6 may be essential to the lesion's development. The recognition of reactive epithelial sheath neuroma including the subcategory of re-excision perineural invasion is crucial for the dermatopathologist to prevent mislabeling this reactive entity as a perineural squamous cell carcinoma, which has clinical consequences for the patient such as wider re-excision and radiation treatment. Additionally, we have identified a potential pathophysiologic basis for this lesion.

  8. Vestibular Schwannoma (Acoustic Neuroma) and Neurofibromatosis

    MedlinePlus

    ... MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: nidcdinfo@ ... questions in English or Spanish. Voice: (800) 241-1044 TTY: (800) 241-1055 nidcdinfo@nidcd.nih.gov ...

  9. Palisaded Encapsulated Neuroma of the Trunk: A Case Report and Review of Palisaded Encapsulated Neuroma

    PubMed Central

    Cohen, Philip R

    2016-01-01

    Palisaded encapsulated neuroma is a rare, benign cutaneous tumor. It most commonly presents as a solitary, flesh-colored, dome-shaped nodule affecting the face. However, albeit rarely, palisaded encapsulated neuroma may also appear on the trunk, genitals, or extremities. We describe the clinical and pathologic findings of a male patient who presented with a palisaded encapsulated neuroma on his left flank. In addition, we review the characteristics of patients with truncal palisaded encapsulated neuromas and summarize the clinical and histologic differential diagnosis of this tumor. PMID:27630799

  10. Treatment of painful neuroma by resection and nerve stump transplantation into a vein.

    PubMed

    Koch, Horst; Haas, Franz; Hubmer, Martin; Rappl, Thomas; Scharnagl, Erwin

    2003-07-01

    Twenty-three patients (14 men, 9 women) with 24 painful neuromas underwent resection of neuroma and transposition of the nerve stump into an adjacent vein. The neuromas resulted from amputations (N = 7), tumor excision (N = 5), laceration injuries (N = 4), different types of wrist surgery (N = 3), vein-stripping procedures (N = 2), open fracture of the radius (N = 1), and toe harvest for thumb reconstruction (N = 1). The duration of painful symptoms averaged 66.7 weeks at the time of operation. Average follow-up was 26.5 months. In 22 patients the symptoms improved permanently. Twelve patients experienced complete and permanent relief of pain; some mild degree of pain returned in 8 patients. Two patients experienced moderate pain, and pain recurred unchanged 2 months postoperatively in 1 patient. The results presented are consistent with results of animal experiments demonstrating that typical neuroma does not develop in nerve stumps transposed into veins. Further clinical use of this approach is encouraged.

  11. Postoperative radicular neuroma. Case report.

    PubMed

    Erman, T; Tuna, M; Göçer, A I; Idan, F; Akgül, E; Zorludemir, S

    2001-11-15

    Lumbar discectomy is the most common surgical procedure performed in neurosurgery clinics. Such a large number of procedures underscore not only the prevalence of conditions such as intervertebral disc herniation, but also the strong belief of surgeons that the operation does provide benefits to patients suffering from sciatica. In spite of this belief, sciatic pain may continue after the surgery. The recurrence of sciatic and/or back pain after primary discectomy is called the "failed back surgery syndrome." The rate of the complications involved in standard lumbar discectomy ranges from 5.4 to 14%. One of the complications of the lumbar disc surgery is nerve root injury. The complication rate of this injury ranges from 0.7 to 2.2%. Postoperative radicular neuroma must be considered in differential diagnosis for the patient who has failed back surgery syndrome. In this study the authors evaluate a patient who had undergone surgery for lumbar disc herniation and suffered intractable pain. A traumatic radicular neuroma is demonstrated and the pertinent literature is presented.

  12. Excision without excision

    SciTech Connect

    Brown, David; Sarbach, Olivier; Schnetter, Erik; Diener, Peter; Tiglio, Manuel; Hawke, Ian; Pollney, Denis

    2007-10-15

    to turducken (turduckens, turduckening, turduckened, turduckened) [math.]: To stuff a black hole. We analyze and apply an alternative to black hole excision based on smoothing the interior of black holes with arbitrary initial data, and solving the vacuum Einstein evolution equations everywhere. By deriving the constraint propagation system for our hyperbolic formulation of the BSSN evolution system we rigorously prove that the constraints propagate causally and so any constraint violations introduced inside the black holes cannot affect the exterior spacetime. We present evolutions of Cook-Pfeiffer binary black hole initial configurations showing that these techniques appear to work robustly for generic data. We also present evidence from spherically symmetric evolutions that for the gauge conditions used the same stationary end-state is approached irrespective of the choice of initial data and smoothing procedure.

  13. Corticosteroid Injection for the Treatment of Morton's Neuroma: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Trial.

    PubMed

    Lizano-Díez, Xavier; Ginés-Cespedosa, Alberto; Alentorn-Geli, Eduard; Pérez-Prieto, Daniel; González-Lucena, Gemma; Gamba, Carlo; de Zabala, Santiago; Solano-López, Alberto; Rigol-Ramón, Pau

    2017-09-01

    The effectiveness of corticosteroid injection for the treatment of Morton's neuroma is unclear. In addition, most of the studies related to it are case-control or retrospective case series. The purpose of this study was to compare the effectiveness between corticosteroid injection associated with local anesthetic and local anesthetic alone (placebo control group) for the treatment of Morton's neuroma. Forty-one patients with a diagnosis of Morton's neuroma were randomized to receive 3 injections of either a corticosteroid plus a local anesthetic or a local anesthetic alone. The patients and the researcher who collected data were blinded to the treatment groups. The visual analog scale for pain and the American Orthopaedic Foot & Ankle Score (metatarsophalangeal/interphalangeal score) were obtained at baseline, after each injection, and at 3 and 6 months after the last injection. There were no significant between-group differences in terms of pain and function improvement at 3 and 6 months after treatment completion in comparison with baseline values. At the end of the study, 17 (48.5%) patients requested surgical excision of the neuroma: 7 (44%) in the experimental group and 10 (53%) in the control group ( P = 1.0). The injection of a corticosteroid plus a local anesthetic was not superior to a local anesthetic alone in terms of pain and function improvement in patients with Morton's neuroma. Level I, randomized controlled trial.

  14. Neuromas

    MedlinePlus

    ... Profiles CPME REdRC Manage Your Practice Reimbursement Issues Compliance Materials Hospital Privileging and Credentialing Health Information Technology State Laws & Regulations Coding Resource Center APMA Buyers' Guide Promote ...

  15. Epineural Sheath Jacket as a New Surgical Technique for Neuroma Prevention in the Rat Sciatic Nerve Model.

    PubMed

    Siemionow, Maria; Bobkiewicz, Adam; Cwykiel, Joanna; Uygur, Safak; Francuzik, Wojciech

    2017-10-01

    Terminal neuromas resulting from severe nerve injuries and traumatic or surgical limb amputations can become a source of pain, and significantly impair patients' quality of life. Recently, the number of patients with peripheral nerve injuries increased due to modern war conflicts, natural disasters, and traffic accidents. This study investigated the efficacy of the epineural sheath jacket (ESJ) as a novel technique for neuroma prevention in the rat sciatic nerve model. A 20-mm segment of the right sciatic nerve was excised in 18 Lewis rats, and the animals were divided into 3 experimental groups (n = 6/group): group I-control, nerve stump without protection; group II-muscle burying group, nerve stump buried in the muscle; group III-ESJ group, nerve stump protected by ESJ. The ESJ was created from the excised sciatic nerve and applied as a "cap" over the proximal nerve stump. The presence of neuropathic pain was assessed weekly by pinprick test and Tinel sign, up to 24 weeks postsurgery. At 24 weeks, assessments, such as macroscopic evaluation, retrograde neuronal labeling analysis, histomorphometry, and neural/connective tissue ratio were performed. Epineural sheath jacket significantly reduced neuroma formation, which was associated with decreased Tinel sign (16.7%, P < 0.05) response compared with the nerve stump control. Moreover, ESJ reduced axonal sprouting, bulb-shaped nerve ending formation and perineural adhesions, as confirmed by macroscopic evaluation. Histological evaluation confirmed that nerve stumps protected with the ESJ showed less fibrosis and presented well-organized axonal structure. Neural/connective tissue ratio and retrograde neuronal labeling analysis revealed significantly improved results in the ESJ group compared to the control nerve stump group (P = 0.032 and P = 0.042, respectively). The protective effect of the ESJ against neuroma formation was confirmed by behavioral and histological analyses, showing outcomes comparable to the muscle

  16. [Amputation neuroma mimicking common bile duct cancer: a case report].

    PubMed

    Koh, Dong Wook; Lee, Woo Jin; Kim, Ji Hoon; Choi, Jun-Il; Kim, Seong Hoon; Hong, Eun Kyung; Park, Joong-Won; Kim, Chang-Min

    2008-07-01

    Amputation neuroma or traumatic neuroma is a tumor-like secondary hyperplasia that may develop after an accidental or surgical trauma. Amputation neuroma of the bile duct has occasionally been reported which occurred in the cystic duct stump late after the cholecystectomy. However, even if the amputation neuroma is suspected in a patient with late-onset jaundice after cholecystectomy, the differential diagnosis from a malignancy is difficult preoperatively. We experienced a case of the amputation neuroma of common bile duct (CBD) developed in a 70-year-old man who presented with a polypoid mass in CBD. He had undergone cholecystectomy 25 years ago and choledochojejunostomy 12 years ago, respectively. We have performed pylorus-preserving pancreatico-duodenectomy (PPPD) under the impression of CBD cancer. He had not been diagnosed of amputation neuroma until having undergone PPPD. We report a case of CBD neuroma mimicking CBD cancer, which was confirmed after PPPD.

  17. Swimming Training Reduces Neuroma Pain by Regulating Neurotrophins.

    PubMed

    Jinge, Tian; Xin, Zhang; Tingting, Yu; Yongming, Xu; Shaofeng, Pu; Yingying, Lv; Dongping, Du

    2017-08-25

    Neuroma formation after peripheral nerve transection leads to severe neuropathic pain in amputees. Previous studies suggested physical exercise could bring beneficial effect on alleviating neuropathic pain. Yet the effect of exercise on neuroma pain still remained unclear. In addition, long-term exercise can affect the expression of neurotrophins (NTs), such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), which play key roles in nociceptor sensitization and nerve sprouting following nerve injury. Here, we investigated whether long-term swimming exercise could relieve neuroma pain by modulating NTs expression. We used a tibial neuroma transposition (TNT) rat model to mimic neuroma pain. Following TNT surgery, rats were performed swimming exercise for 5 weeks. Neuroma pain and tactile sensitivities were detected using von Frey filaments. Immunofluorescence was applied to analyze neuroma formation. NGF and BDNF expression in peripheral neuroma, dorsal root ganglion (DRG) and spinal cord were measured using ELISA and western blotting. TNT led to neuroma formation, induced neuroma pain and mechanical allodynia in hind paw. 5-week swimming exercise inhibited neuroma formation, relieved mechanical allodynia in the hind paw and neuroma pain in the lateral ankle. The analgesic effect lasted for at least one week, even the exercise ceased. TNT elevated the expressions of BDNF and NGF in peripheral neuroma, DRG and spinal cord to different extents. Swimming also decreased the elevation of NTs expression. Swimming exercise not only inhibits neuroma formation induced by nerve transection, but also relieves pain behavior. These effects might be associated with the modulation of NTs.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way

  18. Diagnosis and treatment of Morton's neuroma.

    PubMed

    Summers, Anthony

    2010-09-01

    Morton's neuroma is a benign foot condition that occurs more often in women than men, and particularly in those who wear narrow, high-heeled shoes. This article presents a case study of the condition, discusses its symptoms and diagnosis, and provides information about the range of treatments on offer.

  19. Neuroma under the fifth metatarsal head. A retrospective study.

    PubMed

    Valero, J; Gallart, J; González, D; Agustín, L; Marquina, R; Deus, J; Lahoz, M

    2012-08-01

    This retrospective study was carried out over 83 surgical cases at the distal portion of the fifth metatarsal, compromising the treatment of tailor's bunion, fifth metatarsal overload and the concomitant presence of both pathologies in some cases. Neuromas were founded under the fifth metatarsal head in 18 of the cases studied (21.7%). The results look at whether if there is an association between different fifth metatarsal pathologies and the presence of neuromas and found a significant association between the appearance of neuromas in patients with the same metatarsal overload, especially if it is accompanied by a tailor's bunion pathology.

  20. Amputation neuroma mimics common hepatic duct carcinoma.

    PubMed

    Koike, N; Todoroki, T; Kawamoto, T; Inagawa, S; Yoshida, S; Fukao, K

    2000-01-01

    Most amputation neuromas of the biliary tract occur in the cystic duct stump after cholecystectomy and are asymptomatic. However, when they arise in the main hepatic duct and are associated with obstructive jaundice, it is difficult to distinguish them from carcinoma. We describe a case in which preoperative differential diagnosis was difficult. A 60-year-old man was admitted to the Institute of Clinical Medicine, University of Tsukuba, with a chief complaint of jaundice. Cholangiography showed an irregularly elevated nodular lesion on the lateral wall of the common hepatic duct and multiple floating stones in the choledochus. Ultrasonography and computed tomography revealed one-sided regional thickening of the common hepatic duct associated with dilatation of the intrahepatic and extrahepatic bile ducts. Carbohydrate antigen 19-9 level was markedly elevated to 11,200 IU/mL in the bile juice, but was only 38 IU/mL in the serum, below the limit of abnormality. Cholangioscopy showed papillary tumor with coarse granular surface mimicking papillary carcinoma, but biopsy revealed no malignancy. The patient underwent hepaticocholedochus resection. Although the macroscopic finding from the surgical specimens was papillary carcinoma of the common hepatic duct penetrating to the hepatoduodenal ligament, histopathological examination revealed an amputation neuroma consisting of hypertrophic nerve tissues and giant cells containing foreign bodies, probably as a consequence of a previous cholecystectomy. The postoperative course was uneventful and the patient has been living well for the 5 years since the resection.

  1. Acoustics

    NASA Technical Reports Server (NTRS)

    Goodman, Jerry R.; Grosveld, Ferdinand

    2007-01-01

    The acoustics environment in space operations is important to maintain at manageable levels so that the crewperson can remain safe, functional, effective, and reasonably comfortable. High acoustic levels can produce temporary or permanent hearing loss, or cause other physiological symptoms such as auditory pain, headaches, discomfort, strain in the vocal cords, or fatigue. Noise is defined as undesirable sound. Excessive noise may result in psychological effects such as irritability, inability to concentrate, decrease in productivity, annoyance, errors in judgment, and distraction. A noisy environment can also result in the inability to sleep, or sleep well. Elevated noise levels can affect the ability to communicate, understand what is being said, hear what is going on in the environment, degrade crew performance and operations, and create habitability concerns. Superfluous noise emissions can also create the inability to hear alarms or other important auditory cues such as an equipment malfunctioning. Recent space flight experience, evaluations of the requirements in crew habitable areas, and lessons learned (Goodman 2003; Allen and Goodman 2003; Pilkinton 2003; Grosveld et al. 2003) show the importance of maintaining an acceptable acoustics environment. This is best accomplished by having a high-quality set of limits/requirements early in the program, the "designing in" of acoustics in the development of hardware and systems, and by monitoring, testing and verifying the levels to ensure that they are acceptable.

  2. Posttraumatic neuroma of the radial nerve treated with an autogenous epineural conduit technique. A case report.

    PubMed

    Ignatiadis, I A; Yiannakopoulos, C K; Avram, A M; Gerostathopoulos, N E

    2009-01-01

    We present the outcome of the first clinical application of a new technique using an epineural flap to bridge a short nerve defect. A 28-year-old male had suffered a radial nerve laceration at the lower third of the arm, proximal to the brachioradialis branch, 3 weeks before surgery. During surgery, a neuroma-in-continuity was excised preserving the epineural sleeve. Two longitudinal epineural flaps were created, one from the proximal and one from the distal nerve stump and used to bridge a 1-cm-long nerve defect. Each epineurium flap was sutured to the intact epineurium of the other side and additionally to each other. An electromagnetic nerve stimulator was used to enhance the nerve regeneration process. Nerve regeneration was followed up for 17 months with excellent functional results.

  3. Acoustic Neuroma: Questions to Discuss with Your Doctor

    MedlinePlus

    ... products will be searched. Shopping Cart Description Qty Price The Harvard Medical School 6-Week Plan for ... Memory: Understanding Age-Related Memory Loss (PDF - Lowest Price!) $18.00 Harvard Health Letter (Print & Online Access ( ...

  4. Acoustic Neuroma: Questions to Discuss with Your Doctor

    MedlinePlus

    ... Conditions Osteoporosis Stroke Thyroid Diseases Men's Health « Back Erectile Dysfunction Exercise & Fitness Healthy Eating Men's Sexual Health Prostate ... to your inbox ! Men's Health Inside Men's Health: Erectile Dysfunction Exercise & Fitness Healthy Eating Men's Sexual Health Prostate ...

  5. Carcinoma Metastatic to Both Cerebellopontine Angles Masquerading as Acoustic Neuromas

    PubMed Central

    Sargent, Eric Winslow; Herschman, Barry Ronald; LaRouere, Michael Joseph

    1995-01-01

    Metastases to the cerebellopontine angles (CPAs) are rare. Typically, the clinical course is one of rapid onset and progression of crarial nerve deficits. The clinical presentation and course of carcinoma metastatic to the CPAs are reviewed. We report a case of bilateral CPA metastases with a radiographic appearance similar to neurofibromatosis type 2 presenting with rapidly progressive bilateral hearing loss followed by unilateral facial nerve palsy. ImagesFigure 1Figure 2Figure 2Figure 3 PMID:17171154

  6. Transection of the deep metatarsal transverse ligament in Morton's neuroma surgery does not increase risk of splayfoot development.

    PubMed

    Kasparek, Maximilian; Schneider, Wolfgang

    2016-05-01

    Although operative excision is regarded as the treatment of choice in Morton's neuroma, it remains unclear whether transection of deep transverse metatarsal ligament (DTML) is a risk for metatarsal splaying and whether simultaneous surgery in adjacent intermetatarsal spaces is a risk for osteonecrosis of the adjacent metatarsals. Fifty-seven feet in 47 patients had excision of a Morton's neuroma, with a mean follow-up of 15.3 years. Feet were categorised depending upon whether the DTML was or was not divided. Pre-operative and post-operative intermetatarsal angles were measured on standardised weightbearing radiographs and inspected for evidence of osteonecrosis. Comparison of pre- and post-operative intermetatarsal angles in patients with surgery in the second web space showed no significant increase (transected p = 0.659, preserved p = 0.142). In regards to comparison of pre- and post-operative radiographic intermetatarsal angles in patients with surgery in the third web space, statistical analysis also did not show a significance increase (transected p = 0.240, preserved p = 0.078). Radiological assessment showed no signs of osteonecrosis of metatarsal heads, not even in cases of double-space surgery. In conclusion, DTML transection does not increase the intermetatarsal angle or the risk of splayfoot development. Moreover, transection is recommended due to an enhanced overview during surgery and better clinical outcome. Our data could also prove that double-space surgery is not a risk for avascular osteonecrosis.

  7. Ultrasound Evaluation of Morton Neuroma Before and After Laser Therapy.

    PubMed

    Gimber, Lana H; Melville, David M; Bocian, Darin A; Krupinski, Elizabeth A; Guidice, Matthew P Del; Taljanovic, Mihra S

    2017-02-01

    The objective of our study was to retrospectively assess for differences in imaging appearances of Morton neuromas before and after laser therapy using diagnostic ultrasound (US). A retrospective review was performed to identify patients who underwent US imaging to evaluate for Morton neuroma during the study period (June 1, 2013-July 1, 2014); of the 42 patients identified, 21 underwent US evaluations before and after laser therapy. US reports and images were reviewed and correlated with clinical history. The final study group consisted of 21 patients who had a total of 31 Morton neuromas evaluated using US after treatment. A retrospective review was then performed to characterize the appearances of these lesions before and after therapy followed by an analysis of variables. Retrospective US review of 31 pretreatment Morton neuromas showed fusiform, heterogeneously hypoechoic masses with well-defined borders in most cases and that pain was reported when transducer pressure was applied in 97% (30/31) of cases. After treatment, lesions showed ill-defined borders (23/31), and pain with application of transducer pressure was either significantly decreased or absent (29/31); these findings were concordant with the clinical findings. Both of these characteristics were statistically significant (p < 0.0001). In addition, more Morton neuromas occurred in the second intermetatarsal space than in the third intermetatarsal space (p < 0.0001). US may be used to identify posttreatment changes after laser therapy of Morton neuromas. Posttreatment changes include ill-defined borders and less pain or the absence of pain with the application of transducer pressure. These criteria may be applied in future clinical studies evaluating the efficacy of laser therapy for Morton neuroma.

  8. A systematic review of animal models for experimental neuroma.

    PubMed

    Toia, Francesca; Giesen, Thomas; Giovanoli, Pietro; Calcagni, Maurizio

    2015-10-01

    Peripheral neuromas can result in an unbearable neuropathic pain and functional impairment. Their treatment is still challenging, and their optimal management is to be defined. Experimental research still plays a major role, but - although numerous neuroma models have been proposed on different animals - there is still no single model recognised as being the reference. Several models show advantages over the others in specific aspects of neuroma physiopathology, prevention or treatment, making it unlikely that a single model could be of reference. A reproducible and standardised model of peripheral neuroma would allow better comparison of results from different studies. We present a systematic review of the literature on experimental in vivo models, analysing advantages and disadvantages, specific features and indications, with the goal of providing suggestions to help their standardisation. Published models greatly differ in the animal and the nerve employed, the mechanisms of nerve injury and the evaluation methods. Specific experimental models exist for terminal neuromas and neuromas in continuity (NIC). The rat is the most widely employed animal, the rabbit being the second most popular model. NIC models are more actively researched, but it is more difficult to generate such studies in a reproducible manner. Nerve transection is considered the best method to cause terminal neuromas, whereas partial transection is the best method to cause NIC. Traditional histomorphology is the historical gold-standard evaluation method, but immunolabelling, reverse transcriptase-polymerase chain reaction (RT-PCR) and proteomics are gaining increasing popularity. Computerised gait analysis is the gold standard for motor-recovery evaluation, whereas mechanical testing of allodynia and hyperalgesia reproducibly assesses sensory recovery. This review summarises current knowledge on experimental neuroma models, and it provides a useful tool for defining experimental protocols

  9. Is the difference in the volume of the pharyngeal space, as measured by acoustic pharyngometry, before and after tonsillectomy proportional to the volume of the excised tonsils?

    PubMed

    Di Francesco, Renata C; Kreibich, Mariana Schmidt

    2016-05-01

    Adenotonsillectomy is recognized as an effective therapy for snoring and sleep disorders in children. It is important to understand whether adenotonsillectomy significantly increases the volume of the pharyngeal space. The goal of this study was to evaluate the change in oropharyngeal volume after adenotonsillectomy and the correlation of this change with the objective volume of the tonsils and body mass index. We included 27 subjects (14 males) with snoring caused by tonsil and adenoid hypertrophy. The mean age of the subjects was 7.92 (±2.52) years. Children with craniofacial malformations or neuromuscular diseases or syndromes were excluded. The parents/caregivers answered an adapted questionnaire regarding sleep-disordered breathing. All patients were subjected to weight and height measurements and body mass index was calculated. The subjects underwent pharyngometry before and after adenotonsillectomy and the volume of both excised tonsils together was measured in cm3 in the operating room. Pharyngometric analysis showed that the mean pharyngeal volume was 28.63 (±5.57) cm3 before surgery and 31.23 (±6.76) cm3 after surgery; the volume of the oropharynx was significantly increased post-surgery (p=0.015, Wilcoxon test). No correlation was found between the objective tonsil volume and the post-surgical volume increase (p=0.6885). There was a fair correlation between the oropharyngeal volume and body mass index (p=0.0224). Adenotonsillectomy increases the volume of the pharyngeal space, but this increase does not correlate with the objective tonsil size. Furthermore, greater BMI was associated with a smaller increase in the pharyngeal volume. Oropharyngeal structures and craniofacial morphology may also play a role in the increase in oropharyngeal volume.

  10. Traumatic neuroma of the inferior alveolar nerve: a case report.

    PubMed

    Arribas-García, Ignacio; Alcalá-Galiano, Andrea; Gutiérrez, Ramón; Montalvo-Moreno, Juan José

    2008-03-01

    Traumatic neuromas are rare entities which characteristically arise subsequently to surgery and are usually accompanied by pain, typically neuralgic. We present an unusual case of an intraosseous traumatic neuroma of the inferior alveolar nerve following tooth extraction. A 56-year-old man consulted for paresthesias and hyperesthesia in the left mandibular region following extraction of the left mandibular third molar (#38). The panoramic radiograph revealed a radiolucent lesion in the inferior alveolar nerve canal, and CT demonstrated the existence of a mass within the canal, producing widening of the same. Nerve-sparing excisional biopsy was performed. Histopathology and immunohistochemistry were consistent with traumatic neuroma of the left inferior alveolar nerve. After 3 years of follow-up, the patient is asymptomatic and there are no signs of recurrence.

  11. [A clinical analysis for sudden sensorineural hearing loss with acoustic neurinoma].

    PubMed

    Gong, Qi-lin; Zhou, Ai-dong; Lin, Chang

    2013-04-01

    Retrospectively analyzed the clinical data of sudden sensorineural hearing loss with acoustic neuroma. The clinical data of 467 cases with sudden sensorineural hearing loss were collected between Jan, 2008 and Aug, 2012. Discussed the clinical data which were diagnosed as acoustic neuroma. In 467 cases of sudden sensorineural hearing loss, nine cases were diagnosed as acoustic neuromas (9 ears, 1.93%), two males and seven females, with a age range of 28 to 57 years. Among them, seven cases accompanied with tinnitus, seven cases with vertigo. The hearing results in nine cases, two cases were found to be mild, two were moderate, four were severe, and one was profound hearling loss respectively. Hearing was classified into five types according to audiogram shape (1 of up-sloping, 1 of down-sloping, 2 of mid-frequency, 1 of profound loss, 4 of flat audiogram). Eight cases had abnormal ABR, nine cases with ear ipsilateral stapedius reflex were completely not elicited, seven cases with health ear contralateral stapedius reflex were completely not elicited. Tumors were graded by Koos Grades according to size (7 of grade I, 1 of grade II, 1 of grade IV). Seven small acoustic neuroma was taken waiting strategies. Meanwhile, we use glucocorticoid and improve the microcirculation of the inner ear medication short-termly for these patients. Four patients' hearing were improved. The initial symptoms of some acoustic neuroma are sudden hearing loss, especially the small tumors in internal auditory canal. In order to prevent misdiagnosis, MRI and ABR should be performed as a routine test for sudden sensorineural hearing loss. It is necessary to give appropriate treatment to protecting hearing for the small acoustic neuroma patients whose first symptoms are diagnosed as sudden sensorineural hearing loss.

  12. Intravenous Glomus Tumor Masquerading as Lateral Antebrachial Cutaneous Neuroma.

    PubMed

    Chim, Harvey; Al-Qattan, Husain; Valencia, Herbert; Brathwaite, Carole; Price, Andrew; Grossman, John A I

    2017-03-01

    Background: Intravenous glomus tumors are extremely rare. Methods: We report a patient with an intravenous glomus tumor within a venous aneurysm misdiagnosed as a neuroma of the lateral antebrachial cutaneous nerve, based on clinical exam, electrodiagnostic studies, and findings on a magnetic resonance imaging neurogram. Results: After surgical resection, the patient's symptoms, including pain and localized hypersensitivity, totally resolved. Conclusions: This case illustrates 2 important points. First, unlike extradigital glomus tumors, magnetic resonance imaging is not reliable in diagnosing intravenous glomus tumors. Second, in the presence of chronic localized neuroma type pain and sensitivity in the upper limb without a clear cause, an extradigital cutaneous or intravenous glomus tumor must be considered in the differential diagnosis.

  13. Spontaneous radial nerve palsy subsequent to non-traumatic neuroma.

    PubMed

    Ebrahimpour, Adel; Nazerani, Shahram; Tavakoli Darestani, Reza; Khani, Salim

    2013-09-01

    Spontaneous radial palsy is a not rare finding in hand clinics. The anatomy of the radial nerve renders it prone to pressure paralysis as often called "Saturday night palsy". This problem is a transient nerve lesion and an acute one but the case presented here is very unusual in that it seems this entity can also occur as an acute on chronic situation with neuroma formation. A 61 year-old man presented with the chief complaint of inability to extend the wrist and the fingers of the left hand which began suddenly the night before admission, following a three-week history of pain, numbness and tingling sensation of the affected extremity. He had no history of trauma to the extremity. Electromyography revealed a severe conductive defect of the left radial nerve with significant axonal loss at the upper arm. Surgical exploration identified a neuroma of the radial nerve measuring 1.5 cm in length as the cause of the paralysis. The neuroma was removed and an end-to-end nerve coaption was performed. Complete recovery of the hand and finger extension was achieved in nine months.

  14. Histopathologic study of the neuroma-in-continuity in obstetric brachial plexus palsy.

    PubMed

    Chen, Liang; Gao, Shi-chang; Gu, Yu-dong; Hu, Shao-nan; Xu, Lei; Huang, Yi-gang

    2008-06-01

    Operative treatment of traction lesions in obstetric brachial plexus palsy is still controversial. The authors analyzed the histopathology of neuroma-in-continuity of the upper trunk by study of the resected neuroma. The neuroma-in-continuity of the upper trunk was studied histopathologically in 28 children with Erb palsy who had undergone resection of the neuroma and nerve reconstruction of the plexus at the age of 3 to 11 months. The authors recorded the distribution of myelinated motor nerve fibers and the proportions of collagen and regenerating nerve fibers traveling the neuroma, analyzed the relationship between the percentage of nerve fibers across the neuroma and findings of intraoperative neurophysiologic investigations and the patient's age at surgery, and compared the number of nerve fibers in C5 and C6 proximal to the neuroma with that in their normal counterparts. In the central segment of the neuroma, the structure of the upper trunk was replaced by copious collagen and sporadic nerve fibers wrapped by an undeveloped myelin sheath, and the percentage of collagen was statistically greater than that of the normal upper trunk. The mean percentage of regenerating nerve fibers across the neuroma was 41.83 percent (95 percent confidence interval, 38.69 to 44.69 percent) and this was not statistically correlated with the outcome of intraoperative neurophysiologic investigations or the patient's age at surgery. The number of nerve fibers was statistically less in C5 and C6 proximal to the neuroma than in their normal counterparts. The nerve structure of the neuroma-in-continuity is substantially damaged in obstetric brachial plexus palsy. Its resection followed by nerve reconstruction of the plexus is favored.

  15. Hemangioma excision - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100114.htm Hemangioma excision - series—Indications To use the sharing features ... Go to slide 3 out of 3 Overview Hemangiomas are the most common type of benign blood- ...

  16. Hemangioma excision (image)

    MedlinePlus

    A hemangioma is a non-cancerous (benign) growth of blood vessels. They are the most common benign blood vessel ( ... time and occasionally with medication. Large or disfiguring hemangiomas may require surgical excision.

  17. [Neurofibromatosis 2 (bilateral acoustic neurofibromatosis)].

    PubMed

    Yalcinkaya, C; Sarioglu, A; Boltshauser, E

    1989-10-14

    We report a personal series of 28 patients with neurofibromatosis 2 (NF-2), emphasizing the differences from classical NF-1. The hallmark of NF-2 is bilateral acoustic neuromas with initial symptoms usually occurring in the second or third decade. The natural history may lead to bilateral deafness, but hearing loss may also be a complication of surgery. NF-2 is frequently accompanied by additional intracranial tumors (particularly multiple meningiomas). Half of our patients had a spinal space-occupying lesion. NF-2 is inherited as an autosomal dominant trait, and many patients appear to represent new mutations.

  18. Role of Nd:YAG laser for prevention of neuroma formation: an in vivo experimental study.

    PubMed

    Elwakil, Tarek F; Elkharbotly, Ahmad

    2008-04-01

    Nerve transection is commonly followed by the development of neuroma at the proximal stump. It can be very painful especially at exposed sites. It may arise spontaneously or after mechanical irritation. Neuroma and its high recurrence rate might be resisting problems to treat. Various treatment modalities for neuroma and its recurrence have been proposed, but none has provided satisfactory results. The present study was conducted to evaluate the neodymium:yttrium aluminum garnet (Nd:YAG) laser (1,064 nm) nerve transection technique for prevention of neuroma formation. There were 48 facial nerves out of 24 Rex rabbits divided into two equal groups. The 24 left-sided facial nerves at group A were subjected to Nd:YAG laser for nerve transection, while the 24 right-sided facial nerves at group B were subjected to scalpel nerve transection. The results were grossly and histopathologically evaluated. Grossly, laser-transected nerves showed an infrequent incidence of neuroma formation. Histopathologically, laser-transected nerves showed photothermal degenerative changes of the axons and myelin sheaths with intact perineurium and endoneurium. No Schwann cell hyperactivity could also be elicited among laser-transected nerves. Nd:YAG laser was found to be an effective tool that could be applied, whenever it is possible, for division of major nerves to prevent the formation of the subsequent stump neuroma. Moreover, this technique should be considered during treatment of well-established neuroma to prevent the challenging reported high incidence of recurrence.

  19. Treatment of posttraumatic painful neuromas at the digit tip using neurovascular island flaps.

    PubMed

    Kakinoki, Ryosuke; Ikeguchi, Ryosuke; Atiyya, Ahamed N; Nakamura, Takashi

    2008-03-01

    We report the treatment of 9 patients with 9 painful neuromas at the tips of the digits using reverse pedicled island flaps containing subcutaneous nerves that were connected to the digital nerve stumps after removal of the neuromas. There were 9 patients (7 men and 2 women) with painful cutaneous neuromas at the tips of the digits. The ages of the patients at time of surgery were 21 to 66 years (mean, 46 y). All neuromas were formed in the palmar digital nerves in the hand. Preoperative and postoperative status of the patients with neuromas were assessed and graded using a system modified from previously described grading systems for patients with neuromas. Recovery of sensation in the transplanted skin islands was assessed using the Semmes-Weinstein monofilament test. In the preoperative assessment of patients using the grading system for neuromas, 3 patients were assessed as grade 4 (severe), 5 patients as grade 3 (moderate), and the remaining patient as grade 2 (mild). After surgery, Tinel sign disappeared completely in 6 of 9 patients. According to the grading system for neuromas, 6 patients were assessed as grade 1 (normal), and the other 3 patients were assessed as grade 2 (mild) postoperatively. Using the Semmes-Weinstein monofilament test for assessing recovery of sensation of the skin islands, 3 patients recognized the 2.83 monofilament (normal), 2 patients recognized the 3.22 monofilament (loss of tactile sense), and the remaining 4 patients recognized the 3.66 monofilament applied (loss of tactile sense). This skin island approach provided us with good pain control and recovery of hand function after painful neuromas. Therapeutic IV.

  20. Regenerative Peripheral Nerve Interfaces for the Treatment of Postamputation Neuroma Pain: A Pilot Study

    PubMed Central

    Woo, Shoshana L.; Kung, Theodore A.; Brown, David L.; Leonard, James A.; Kelly, Brian M.

    2016-01-01

    Background: Originally designed for prosthetic control, regenerative peripheral nerve interfaces (RPNIs) prevent neuroma formation by providing free muscle grafts as physiological targets for peripheral nerve ingrowth. We report the first series of patients undergoing RPNI implantation for treatment of symptomatic postamputation neuromas. Methods: A retrospective case series of all amputees undergoing RPNI implantation for treatment of symptomatic neuromas between November 2013 and June 2015 is presented. Data were obtained via chart review and phone interviews using questions derived from the Patient Reported Outcomes Measurement Information System instruments. Statistical analyses were performed using dependent sample t tests with a significance threshold of P < 0.01. Results: Forty-six RPNIs were implanted into 16 amputees for neuroma relief (3 upper extremities and 14 lower extremities). Mean age was 53.5 years (6 females and 10 males). All patients participated in postoperative phone interviews at 7.5 ± 3.4 (range: 3–15) months. Patients reported a 71% reduction in neuroma pain and a 53% reduction in phantom pain. Most patients felt satisfied or highly satisfied with RPNI surgery (75%), reporting decreased (56%) or stable (44%) levels of analgesic use. Most patients would strongly recommend RPNI surgery to a friend (88%) and would do it again if given the option (94%). Complications included delayed wound healing (n = 4) and neuroma pain at a different site (n = 2). Conclusions: RPNI implantation carries a reasonable complication profile while offering a simple, effective treatment for symptomatic neuromas. Most patients report a significant reduction in neuroma and phantom pain with a high level of satisfaction. The physiological basis for preventing neuroma recurrence is an intriguing benefit to this approach. PMID:28293490

  1. Interdigital Neuroma in the Second Intermetatarsal Space Associated with Metatarsophalangeal Joint Instability

    PubMed Central

    Chang, Song Ho; Izawa, Naohiro; Ohshiro, Yohei

    2016-01-01

    The entrapment theory is the most commonly accepted theory concerning the development of interdigital neuroma; it incriminates the deep transverse metatarsal ligament as the major causative factor of the condition. This report presents a patient with interdigital neuroma in the second intermetatarsal space, which was strongly suspected to be caused by the metatarsophalangeal joint instability due to plantar plate injury. Surgical intervention revealed that the neuroma was located more distally and dorsally than the deep transverse metatarsal ligament and was pinched between the adjacent metatarsal heads, suggesting the involvement of the metatarsophalangeal joint instability and chronic trauma as etiologies in this case. PMID:28003923

  2. Computed tomography analysis of third webspace injections for interdigital neuroma.

    PubMed

    Hembree, W Chad; Groth, Adam T; Schon, Lew C; Guyton, Gregory P

    2013-04-01

    Injection for interdigital neuroma (IDN) may not selectively target the common digital nerve. We investigated the anatomical localization and extent of extravasation with injection for IDN. Two fellowship-trained foot and ankle surgeons injected radiopaque contrast into the third webspace of 49 cadaveric specimens (29 with 2 mL and 20 with 1 mL). Computed tomography scan of each specimen was obtained. An independent blinded foot and ankle surgeon analyzed the scans. All injections were accurate. Contrast was found in the second (greater than 70%) and fourth (greater than 30%) webspaces in both injection volume groups. No contrast was found within the third metatarsophalangeal joint. Extravasation extent was significantly greater with 2 mL versus 1 mL of solution in the medial to lateral (27.9 [7.8] mm vs 23.7 [6.0] mm; P = .05) and distal to proximal (52.1 [13.7] mm vs 40.4 [16.1] mm; P = .01) planes. No differences were observed in extravasation extent between surgeons. Injection for IDN was accurate, and extravasation extended into adjacent webspaces in a large percentage of specimens with both solution volumes. Lower extent of extravasation with 1 mL of solution did not indicate better selectivity of injection. Steroid injections for interdigital neuroma were accurate for therapeutic purposes but not diagnostic, except potentially for distinguishing webspace pain from joint pain.

  3. Human Neuroma-in-Continuity Contains Focal Deficits in Myelination.

    PubMed

    van Vliet, Arie C; Tannemaat, Martijn R; van Duinen, Sjoerd G; Verhaagen, Joost; Malessy, Martijn J A; De Winter, Fred

    2015-09-01

    Functional recovery does not occur in 10% of patients with neonatal brachial plexus palsy. In these patients, resection of a neuroma-in-continuity (NIC) and surgical nerve reconstruction are required. The formation of a NIC seems to prohibit functional recovery, but the underlying biologic mechanisms for this failure are poorly understood. We systematically analyzed a large series of NIC tissue samples from 17 neonatal and 3 adult patients using an array of immunohistochemical techniques. In a large proportion of patients (74%), the NIC contained multiple focal globular areas with markedly diminished myelination. These focal myelin deficits (FMDs) contain Schwann cells that enwrap axons in an apparently normal configuration but do not form myelin. Biomathematical analysis of a 2-cm neuroma predicted a higher-than-95% probability that an axon would encounter 10 FMDs. Axon segments in FMDs also had disturbed nodes of Ranvier (i.e., FMDs contained significantly fewer clustered Na(v)1.6 channels and decreased Caspr and ankyrin G). These observations indicate that axons in NIC course through multiple FMDs and that this may be the pathobiologic basis for conduction blocks in patients with neonatal brachial plexus palsy. These observations indicate the need for novel strategies to promote functional recovery after neonatal brachial plexus palsy by improving myelination in the NIC.

  4. A Rat Excised Larynx Model of Vocal Fold Scar

    ERIC Educational Resources Information Center

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.

    2009-01-01

    Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…

  5. A Rat Excised Larynx Model of Vocal Fold Scar

    ERIC Educational Resources Information Center

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.

    2009-01-01

    Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…

  6. Ultrasonic output from the excised rat larynx

    PubMed Central

    Johnson, Aaron M.; Ciucci, Michelle R.; Russell, John A.; Hammer, Michael J.; Connor, Nadine P.

    2010-01-01

    The source of ultrasonic vocalizations (USVs) produced by rats is thought to be within the larynx. The purpose of this investigation was to determine if the rat larynx is capable of producing ultrasounds with the full range of frequencies reported in vivo. Acoustic output of excised rat larynges with and without vocal fold constriction was measured. At biologically-reasonable airflow rates and pressures, only larynges with a constriction produced the full range of ultrasounds reported in vivo, providing support for the hypothesis that a constriction within the larynx is likely the source of rat USVs. PMID:20707418

  7. Multiple Neuromas Cause Painful "Jumping Stump" in a Transfemoral Amputee: A Case Report.

    PubMed

    Buntragulpoontawee, Montana; Pattamapaspong, Nuttaya; Tongprasert, Siam

    2016-09-01

    Painful "jumping stump" is an uncommon but very disturbing complication postamputation. This condition is one of the movement disorder entities resulting from peripheral nerve pathology, often known as "peripherally induced movement disorders." Previously case reports have been written about painful and nonpainful incidence of "jumping stump"; however, only the earliest "jumping stump" article in 1852 suspected that neuromas might influence the involuntary movement. In this study, we describe a 38-year-old man with bilateral transfemoral amputee who suffered from painful "jumping stump" with multiple neuromas confirmed by imaging. He was treated successfully by ultrasound-guided phenol injection into the sciatic neuroma stalks. The pathophysiology of jumping stump and its possible association with neuroma are briefly discussed.

  8. Prokaryotic Nucleotide Excision Repair

    PubMed Central

    Kisker, Caroline; Kuper, Jochen; Van Houten, Bennett

    2013-01-01

    Nucleotide excision repair (NER) has allowed bacteria to flourish in many different niches around the globe that inflict harsh environmental damage to their genetic material. NER is remarkable because of its diverse substrate repertoire, which differs greatly in chemical composition and structure. Recent advances in structural biology and single-molecule studies have given great insight into the structure and function of NER components. This ensemble of proteins orchestrates faithful removal of toxic DNA lesions through a multistep process. The damaged nucleotide is recognized by dynamic probing of the DNA structure that is then verified and marked for dual incisions followed by excision of the damage and surrounding nucleotides. The opposite DNA strand serves as a template for repair, which is completed after resynthesis and ligation. PMID:23457260

  9. Prokaryotic nucleotide excision repair.

    PubMed

    Kisker, Caroline; Kuper, Jochen; Van Houten, Bennett

    2013-03-01

    Nucleotide excision repair (NER) has allowed bacteria to flourish in many different niches around the globe that inflict harsh environmental damage to their genetic material. NER is remarkable because of its diverse substrate repertoire, which differs greatly in chemical composition and structure. Recent advances in structural biology and single-molecule studies have given great insight into the structure and function of NER components. This ensemble of proteins orchestrates faithful removal of toxic DNA lesions through a multistep process. The damaged nucleotide is recognized by dynamic probing of the DNA structure that is then verified and marked for dual incisions followed by excision of the damage and surrounding nucleotides. The opposite DNA strand serves as a template for repair, which is completed after resynthesis and ligation.

  10. Laparoscopic Total Mesorectum Excision

    PubMed Central

    Quilici, F.A.; Cordeiro, F.; Reis, J.A.; Kagohara, O.; Simões Neto, J.

    2002-01-01

    The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of portsite tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons – 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum. PMID:12113422

  11. Prevention and treatment of amputation neuroma by an atelocollagen tube in rat sciatic nerves.

    PubMed

    Sakai, Yasuo; Ochi, Mitsuo; Uchio, Yuji; Ryoke, Koji; Yamamoto, Soichiro

    2005-05-01

    To evaluate the potential of the atelocollagen tube as a cap for amputation neuromas, the histological and histochemical characteristics of the neuroma and spinal cord were compared with those following silicone capping. Four weeks after the transection of 18 rat sciatic nerves, the amputated neuroma was resected, and the nerve stump inserted into an atelocollagen or silicone tube. The histological changes in the nerve ends and c-fos expression in the dorsal horn of the fourth lumbar spinal cord were evaluated at 4 weeks postoperatively. The regenerated nerve structure in the atelocollagen or silicone tube was very thin. In contrast, a typical bulbous neuroma was observed in the control group (the nerve stump was left in place). The atelocollagen and silicone tube groups demonstrated fewer c-fos-expressed cells in the spinal cord than the controls. These results suggest that capping by an atelocollagen tube, like that by a silicone tube, might successfully prevent an amputated neuroma from forming, and suppress induced pain. The atelocollagen tube may be a promising biomaterial for the prevention or treatment of a painful amputation neuroma.

  12. Arthroscopic excision of ganglion cysts.

    PubMed

    Bontempo, Nicholas A; Weiss, Arnold-Peter C

    2014-02-01

    Arthroscopy is an advancing field in orthopedics, the applications of which have been expanding over time. Traditionally, excision of ganglion cysts has been done in an open fashion. However, more recently, studies show outcomes following arthroscopic excision to be as good as open excision. Cosmetically, the incisions are smaller and heal faster following arthroscopy. In addition, there is the suggested benefit that patients will regain function and return to work faster following arthroscopic excision. More prospective studies comparing open and arthroscopic excision of ganglion cysts need to be done in order to delineate if there is a true functional benefit.

  13. Pain and neuroma formation in Wallenberg's lateral medullary syndrome.

    PubMed

    Moffie, D; Hamburger, H L

    1986-01-01

    We report a patient with a Wallenberg's lateral medullary syndrome in which pain was a prominent feature. This led to substitution of the original and correct diagnosis by that of a thalamic syndrome for which a prefrontal leucotomy was performed. The patient died some years later from a myocardial infarction and autopsy was performed. In the dorsolateral part of the medulla oblongata a cavity was found in which aberrant nerve fibres with neuroma-like formations could be seen. These fibres coursed along blood vessels, and penetrated from the surface of the medulla oblongata. On the base of the clinico-pathological correlations, it is conjectured that destruction of the lateral reticular formation cannot be the sole cause of the severe pain.

  14. The diagnosis and management of Morton's neuroma: a literature review.

    PubMed

    Jain, Sameer; Mannan, Ken

    2013-08-01

    Morton's neuroma is a common condition mainly affecting middle aged women, and there are many proposed etiological theories involving chronic repetitive trauma, ischemia, entrapment, and intermetatarsal bursitis. Incorrect terminology suggests that the underlying pathological process is a nerve tumor, although histological examination reveals the presence of inflammatory tissue-that is, perineural fibrosis. The common digital nerve and its branches in the third planter webspace are most commonly affected. Diagnosis is usually made through history taking and clinical examination but may be aided by ultrasonography and magnetic resonance imaging. Current nonoperative treatment strategies include shoe-wear modifications, custom made orthoses, and injections of local anesthetic agents, sclerosing agents, and steroids. Operative management options primarily involve either nerve decompression or neurectomy. We have reviewed the published literature to evaluate the outcomes of the available diagnostic modalities and treatment options and present an algorithm for clinical practice.

  15. In-continuity neuroma of the median nerve after surgical release for carpal tunnel syndrome: case report.

    PubMed

    Depaoli, R; Coscia, D R; Alessandrino, F

    2015-03-01

    Iatrogenic injuries of the median nerve after surgical release for carpal tunnel syndrome resulting in the formation of a neuroma are rare. We present here the case of two patients, one with a bifid median nerve, showing in-continuity neuroma after surgical release for carpal tunnel syndrome. The patients reported persistent post-operative pain and showing symptoms. In both cases, ultrasound showed an in-continuity neuroma with a hypoechoic and enlarged median nerve at the carpal tunnel. The case report shows that ultrasound may be helpful in confirming the clinical diagnosis of neuroma and it is useful for evaluation of the percentage of the area affected by the tear.

  16. Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma.

    PubMed

    Fader, Ryan R; Mitchell, Justin J; Chadayammuri, Vivek P; Hill, John; Wolcott, Michelle L

    2015-11-01

    Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms. Copyright 2015, SLACK Incorporated.

  17. RFI Mitigation / Excision techniques

    NASA Astrophysics Data System (ADS)

    Roshi, D. A.

    2004-06-01

    Radio frequency interference (RFI) is increasingly affecting radio astronomy research. A few years ago, active research to investigate the possibility of observing in the presence of interference using RFI mitigation techniques was initiated. In this paper, I briefly discuss four RFI mitigation/excision projects. These projects are:- (1) A technique to suppress double sideband amplitude modulated interference in which I show that an astronomical signal in the presence of a DSB interference can be observed with a signal-to-noise ratio factor of 2 less compared to observations if the RFI were not present. (2) Techniques to suppress interference due to synchronization signals in composite video signals are presented. A combination of noise-free modelling of the synchronization signals and adaptive filtering is used for suppressing the interference. (3) Design techniques to minimize spurious pick-up at the analog input of an analog-to-digital converter are discussed. (4) Spectral RFI excision using a spectral channel weighted scheme and its application to Green Bank telescope observations are also presented.

  18. Base Excision Repair

    PubMed Central

    Krokan, Hans E.; Bjørås, Magnar

    2013-01-01

    Base excision repair (BER) corrects DNA damage from oxidation, deamination and alkylation. Such base lesions cause little distortion to the DNA helix structure. BER is initiated by a DNA glycosylase that recognizes and removes the damaged base, leaving an abasic site that is further processed by short-patch repair or long-patch repair that largely uses different proteins to complete BER. At least 11 distinct mammalian DNA glycosylases are known, each recognizing a few related lesions, frequently with some overlap in specificities. Impressively, the damaged bases are rapidly identified in a vast excess of normal bases, without a supply of energy. BER protects against cancer, aging, and neurodegeneration and takes place both in nuclei and mitochondria. More recently, an important role of uracil-DNA glycosylase UNG2 in adaptive immunity was revealed. Furthermore, other DNA glycosylases may have important roles in epigenetics, thus expanding the repertoire of BER proteins. PMID:23545420

  19. GALFACTS RFI Excision Methods

    NASA Astrophysics Data System (ADS)

    Andrecut, M.; Guram, S. S.; George, S. J.; Taylor, A. R.

    2011-07-01

    Radio astronomical observations are susceptible to Radio Frequency Interference (RFI) contamination. In this case, the signal from astrophysical sources is distorted due to close, and relatively strong, radio emissions from other sources operating on the same frequency spectrum (communication services, for example). As a consequence, the observed data needs to be cleaned, by removing the undesired RFI components, while preserving as much of the underlying useful information as possible. As the data acquisition rates of radio telescopes increases and observations bandwidth extend beyond protected spectral allocations, software systems to mitigate RFI signals are becoming critical. Here, we discuss some of the RFI excision methods implemented in the data processing pipeline of the Galactic ALFA Continuum Survey (GALFACTS), which is a large-area spectro-polarimetric survey being carried out with the Arecibo Radio telescope in Puerto Rico.

  20. A late unusual complication after an open cholecystectomy: Amputation neuroma of the CBD causing obstructive jaundice.

    PubMed

    Sleiman, Youssef A; Hassoun, Ziad A; Nasser, Haydar A; Abs, Leila; Allouch, Mustafa

    2017-07-25

    Cholecystectomy is one of the most frequently done procedures in general surgery. There are few reports of amputation neuromas following this procedure. This presentation describes a case of obstructive jaundice due to amputation neuroma in a patient with a history of cholecystectomy. We report about a 53 y o lady who presented with obstructive jaundice, 8 years following open cholecystectomy. Paraclinical investigations were in favor of cholangicarcinoma, however the final pathology revealed an amputation neuroma of the CBD. Amputation neuromas are rarely seen in the era of laparoscopic cholecystectomy. They are benign reparative lesions of the CBD following surgery or manipulation of the extra hepatic biliary tree. It is very difficult to diagnose them pre-operatively. Surgical resection is the first choice of treatment. Traumatic neuromas should always be among the differential diagnosis, when assessing a CBD mass in patients with a previous history of open cholecystectomy or surgery to the gastrointestinal tract. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  1. Intraoperative and pathological findings of intramedullary amputation neuroma associated with spinal ependymoma.

    PubMed

    Arishima, Hidetaka; Takeuchi, Hiroaki; Tsunetoshi, Kenzo; Kodera, Toshiaki; Kitai, Ryuhei; Kikuta, Ken-ichiro

    2013-07-01

    Amputation neuromas typically arise in injured peripheral nerves; rarely, however, they arise in the spinal cord. We report a rare case of intramedullary amputation neuroma associated with ependymoma in the cervical spinal cord. A 73-year-old woman presented with a 5-year history of progressive gait disturbance. Neurological examination revealed complete motor deficit of her hands and legs. Magnetic resonance imaging of the cervical spine revealed an enhancing mass within the spinal cord at the C6/7 level. The patient underwent C5-C7 laminectomy surgery. During resection of the spinal tumor, we found a whitish string resembling an aberrant nerve root or schwannoma with adhesion to the tumor on the ventral side of the spinal cord. After resecting the tumor, the surgical specimen was cut and separated into a soft greyish tumor (spinal tumor) and the tough whitish string. Histopathological and immunohistochemical examination revealed the former was a spinal ependymoma and the latter was a neuroma. An intramedullary amputation neuroma associated with a spinal ependymoma is rare, and this is the first known case in which intraoprerative findings were clearly shown. Neurosurgeons should be aware that spinal ependymomas might coexist with neuromas.

  2. Traumatic neuroma in a patient with breast cancer after mastectomy: a case report and review of the literature.

    PubMed

    Li, Quan; Gao, Er-Li; Yang, Yin-Long; Hu, Hong-Ye; Hu, Xiao-Qu

    2012-02-13

    The incidence of traumatic neuroma is extremely low, especially in those patients with breast cancer after mastectomy. There are only 10 cases reported in the literature. We report a patient who developed a palpable nodular mass near the mastectomy scar. The result of excisional biopsy was traumatic neuroma. Review of the literature reveal 10 cases with breast cancer of traumatic neuromas after mastectomy. Traumatic neuroma is a benign lesion and a reparative response of the nerve to injury, either direct/indirect trauma or chronic inflammation. Benign lesions as traumatic neuromas are more rarely seen after mastectomy. However, in order to manage patients' treatment, the most critical problem is to distinguish it from recurrent breast carcinoma. Although assistant examination methods such as ultrasound and computed tomography are valuable to a certain extent, the final diagnosis can only be confirmed on pathologic examination.

  3. [Mesocolic excision for colonic adenocarcinoma].

    PubMed

    Debove, Clotilde; Lefèvre, Jérémie H; Parc, Yann

    2017-02-01

    On the same principle than total mesorectal excision in rectal cancer, the effect of complete mesocolic excision on short and long-term outcomes is actually evaluated for colonic adenocarcinoma. This method, usually performed for left colectomy, offers a surgical specimen of higher quality, with a larger number of lymph nodes harvested. For right colectomy, surgical specifications make it less common complete mesocolic excision and conventional surgery offer comparable outcomes, as regards to postoperative morbidity and mortality rates. No differences are identified between laparoscopic and open surgery. On oncologic outcomes, only two studies report a higher free-disease survival after complete mesocolic excision. Then, there is evidence that complete mesocolic excision offers a higher rate of specimen with extensive lymph node resection, without increased morbidity rate. However, there is limited evidence that it leads to improve long-term oncological outcomes.

  4. Myelinated sensory and alpha motor axon regeneration in peripheral nerve neuromas

    NASA Technical Reports Server (NTRS)

    Macias, M. Y.; Lehman, C. T.; Sanger, J. R.; Riley, D. A.

    1998-01-01

    Histochemical staining for carbonic anhydrase and cholinesterase (CE) activities was used to analyze sensory and motor axon regeneration, respectively, during neuroma formation in transected and tube-encapsulated peripheral nerves. Median-ulnar and sciatic nerves in the rodent model permitted testing whether a 4 cm greater distance of the motor neuron soma from axotomy site or intrinsic differences between motor and sensory neurons influenced regeneration and neuroma formation 10, 30, and 90 days later. Ventral root radiculotomy confirmed that CE-stained axons were 97% alpha motor axons. Distance significantly delayed axon regeneration. When distance was negligible, sensory axons grew out sooner than motor axons, but motor axons regenerated to a greater quantity. These results indicate regeneration differences between axon subtypes and suggest more extensive branching of motor axons within the neuroma. Thus, both distance from injury site to soma and inherent motor and sensory differences should be considered in peripheral nerve repair strategies.

  5. Tender papule rising on the digit: Pacinian neuroma should be considered in differential diagnosis.

    PubMed

    Cho, Hyun Hee; Hong, Jong Soo; Park, Se Young; Park, Hyun Sun; Cho, Soyun; Lee, Jong Hee

    2012-01-01

    Pacinian corpuscles are sensory nerve-end organs located in the deep dermis and subcutaneous tissue of the palms or soles. Pacinian neuroma is an extremely rare feature, defined as hyperplasia or hypertrophy of Pacinian corpuscles. About half of Pacinian neuromas present with point tenderness. There have been a limited number of cases reported around the world. We observed a 45-year-old woman with an 8-month history of a tender whitish papule on her left thumb tip. Histopathologically, an enlarged hypertrophic Pacinian corpuscle in subcutaneous tissue, surrounded by numerous nerve fibers, was found. Herein, we report a case of Pacinian neuroma presenting as a tender papule on a fingertip that was clearly related to repetitive trauma at that site. This case shows that a meticulous history and histological examination can lead to an exact diagnosis and proper treatment.

  6. Myelinated sensory and alpha motor axon regeneration in peripheral nerve neuromas

    NASA Technical Reports Server (NTRS)

    Macias, M. Y.; Lehman, C. T.; Sanger, J. R.; Riley, D. A.

    1998-01-01

    Histochemical staining for carbonic anhydrase and cholinesterase (CE) activities was used to analyze sensory and motor axon regeneration, respectively, during neuroma formation in transected and tube-encapsulated peripheral nerves. Median-ulnar and sciatic nerves in the rodent model permitted testing whether a 4 cm greater distance of the motor neuron soma from axotomy site or intrinsic differences between motor and sensory neurons influenced regeneration and neuroma formation 10, 30, and 90 days later. Ventral root radiculotomy confirmed that CE-stained axons were 97% alpha motor axons. Distance significantly delayed axon regeneration. When distance was negligible, sensory axons grew out sooner than motor axons, but motor axons regenerated to a greater quantity. These results indicate regeneration differences between axon subtypes and suggest more extensive branching of motor axons within the neuroma. Thus, both distance from injury site to soma and inherent motor and sensory differences should be considered in peripheral nerve repair strategies.

  7. The relationship between foot posture index, ankle equinus, body mass index and intermetatarsal neuroma.

    PubMed

    Naraghi, Reza; Bremner, Alexandra; Slack-Smith, Linda; Bryant, Alan

    2016-01-01

    The main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index. The study also examined whether there was a relationship between foot type and the interspace affected with intermetatarsal neuroma, and whether ankle equinus or body mass index had an effect. In total, 100 participants were recruited from The University of Western Australia's Podiatry Clinic, 68 of whom were diagnosed with inter-metatarsal neuroma from 2009 to 2015. There were 32 control participants recruited from 2014 to 2015. The age of subjects was recorded, as were weight and height, which were used to calculate body mass index. The foot posture index and ankle dorsiflexion were measured using standard technique. Independent t-tests and Kruskal-Wallis tests were used to compare differences in foot posture index, body mass index and ankle dorsiflexion between the inter-metatarsal neuroma and control groups. Multivariable logistic regression was also used to model relationships for outcome. The 68 intermetatarsal neuroma subjects had a mean age of 52 years (range 20 to 74 years) and comprised of 56 females and 12 males. The 32 control subjects had a mean age of 49 years (range 24 to 67 years) with 26 females and six males. There were no significant differences between the control and the intermetatarsal neuroma groups with respect to the mean foot posture index scores of the left and right foot (p = 0.21 and 0.87, respectively). Additionally no significant differences were detected between the affected intermetatarsal neuroma interspace and foot posture index (p = 0.27 and 0.47, respectively). There was no significant difference in mean body mass index between the intermetatarsal neuroma (26.9 ± 5.7) and control groups (26.5 ± 4.1) (p = 0.72). There was, however, a significant difference in mean ankle dorsiflexion between the intermetatarsal neuroma and control groups (p

  8. Supraorbital nerve neuroma caused by blind curettage of an infected epidermal cyst.

    PubMed

    Lim, Hyoseob; Lee, Il Jae; Pae, Nam Suk; Park, Myong Chul

    2009-11-01

    A 38-year-old woman presented with a tender mass with mild erythematous change above the left eyebrow area. She had received curettage in another clinic after a diagnosis of infected epidermal cyst 5 years previously. On examination, a round, irregular scar and a mass of 1-cm diameter associated with mild erythematous region were observed above the right eyebrow.Exploration disclosed a 1-cm neuroma with mild adhesion to a branch of the supraorbital nerve. The neuroma was completely removed. However, although partial transection of the supraorbital nerve was performed during surgery, the nerve was not repaired. The open wound was repaired securely. A histopathologic examination of the resected specimen resulted in a diagnosis of traumatic neuroma. The patient had no forehead numbness before or after surgery.

  9. Influence of nerve stump transplantation into a vein on neuroma formation.

    PubMed

    Koch, Horst; Herbert, Timothy J; Kleinert, Reinhold; Hubmer, Martin; Scharnagl, Erwin; Pierer, Gerhard

    2003-04-01

    The objective of this animal study was to investigate the influence of nerve stump transposition into a vein on neuroma formation. In 24 rats the femoral nerve was severed and the proximal nerve stump was transposed into the lumen of the femoral vein on one side. On the other side, the nerve was severed and left in place. The distal nerve stump was shortened to knee level on both sides. In group 1, the bloodstream was released; in group 2, the segment of the femoral vein containing the nerve stump was excluded from circulation. Histological assessment was performed 8 months later. There were significant differences between the treatment and control sides with respect to neuroma size, endoneural architecture, neural-tissue-to-connective-tissue ratio, and myelination of axons. These data suggest that nerve transposition into a vein could inhibit the formation of classic neuroma.

  10. Iterative marker excision system.

    PubMed

    Myronovskyi, Maksym; Rosenkränzer, Birgit; Luzhetskyy, Andriy

    2014-05-01

    The deletions of large genomic DNA fragments and consecutive gene knockouts are prerequisites for the generation of organisms with improved properties. One of the key issues in this context is the removal of antibiotic resistance markers from engineered organisms without leaving an active recombinase recognition site. Here, we report the establishment of an iterative marker excision system (IMES) that solves this problem. Based on the phiC31 integrase and its mutant att sites, IMES can be used for highly effective deletion of DNA fragments between inversely oriented B-CC and P-GG sites. The B-CC and P-GG sites are derived from attB and attP by substitution of the central core TT dinucleotide with CC and GG, respectively. An unnatural RR site that resides in the chromosome following deletion is the joining product of the right shoulders of B-CC and P-GG. We show that the RR sites do not recombine with each other as well as the RR site recombines with B-CC. The recombination efficiencies between RR and P-GG or RR and LL are only 0.1 % and 1 %, respectively. Thus, IMES can be used for multistep genomic engineering without risking unwanted DNA recombination. The fabrication of multi-purpose antibiotic cassettes and examples of the utilisation of IMES are described.

  11. Traumatic Neuroma in Continuity Injury Model in Rodents

    PubMed Central

    Kemp, Stephen William Peter; Khu, Kathleen Joy Ong Lopez; Kumar, Ranjan; Webb, Aubrey A.; Midha, Rajiv

    2012-01-01

    Abstract Traumatic neuroma in continuity (NIC) results in profound neurological deficits, and its management poses the most challenging problem to peripheral nerve surgeons today. The absence of a clinically relevant experimental model continues to handicap our ability to investigate ways of better diagnosis and treatment for these disabling injuries. Various injury techniques were tested on Lewis rat sciatic nerves. Optimal experimental injuries that consistently resulted in NIC combined both intense focal compression and traction forces. Nerves were harvested at 0, 5, 13, 21, and 65 days for histological examination. Skilled locomotion and ground reaction force (GRF) analysis were performed up to 9 weeks on the experimental (n=6) and crush-control injuries (n=5). Focal widening, disruption of endoneurium and perineurium with aberrant intra- and extrafascicular axonal regeneration and progressive fibrosis was consistently demonstrated in 14 of 14 nerves with refined experimental injuries. At 8 weeks, experimental animals displayed a significantly greater slip ratio in both skilled locomotor assessments, compared to nerve crush animals (p<0.01). GRFs of the crush- injured animals showed earlier improvement compared to the experimental animals, whose overall GRF patterns failed to recover as well as the crush group. We have demonstrated histological features and poor functional recovery consistent with NIC formation in a rat model. The injury mechanism employed combines traction and compression forces akin to the physical forces at play in clinical nerve injuries. This model may serve as a tool to help diagnose this injury earlier and to develop intervention strategies to improve patient outcomes. PMID:22011082

  12. The treatment of a large acoustic tumor with fractionated stereotactic radiotherapy.

    PubMed

    McClelland, Shearwood; Gerbi, Bruce J; Cho, Kwan H; Hall, Walter A

    2007-01-01

    The treatment of acoustic neuromas (AN) usually involves surgical excision or stereotactic radiosurgery. However, for large AN (mean diameter > 3 cm), stereotactic radiosurgery is rarely used, leaving patients with limited noninvasive treatment options. Recently, the use of fractionated stereotactic radiotherapy (FSRT) has been effective in treating small to medium-sized AN. We present a patient with a large AN treated with FSRT. The patient was a 43-year-old man presenting with imbalance, tinnitus, vertigo, and right-sided hearing decline associated with vomiting and hydrocephalus. Magnetic resonance (MR) imaging revealed a large, 3.8-cm, right cerebellopontine-angle tumor compressing the fourth ventricle. Following right frontal ventriculoperitoneal shunt placement, the patient underwent FSRT for treatment of the tumor. Using the Radionics X-Knife 4.0 3D treatment planning system, a total of 54 Gy was delivered in 1.8-Gy daily fractions with the prescription isodose line of 90%. Treatments were delivered using a dedicated Varian 6/100 linear accelerator, and head immobilization was achieved with the Gill-Thomas-Cosman relocatable stereotactic frame. The patient was subsequently evaluated with serial contrast-enhanced MR imaging. Following FSRT, local control (defined as the absence of tumor progression) was achieved, and treatment was well tolerated. There was no hearing-related, trigeminal, or facial-nerve morbidity following FSRT at 63-month follow-up. Treating a patient with a large AN with FSRT resulted in local tumor control, with no trigeminal nerve, facial nerve, or hearing-related morbidity. These results support FSRT as a potential noninvasive treatment modality for AN some would consider too large for single-fraction stereotactic radiosurgery (SRS).

  13. Treatment of painful median nerve neuromas with radial and ulnar artery perforator adipofascial flaps.

    PubMed

    Adani, Roberto; Tos, Pierluigi; Tarallo, Luigi; Corain, Massimo

    2014-04-01

    To review the outcomes of 8 patients with painful median nerve neuromas at the wrist treated with external neurolysis and covered with pedicled perforator adipofascial flaps. Between 2004 and 2010, we treated 8 patients, who had a mean age of 37 years, and who had posttraumatic painful median nerve neuromas at the level of the wrist but with retained median nerve function . All of them reported neuropathic pain and had a positive Tinel's sign over the site of the presumed neuroma. The surgical procedure included external neurolysis and coverage with an ulnar artery perforator adipofascial flap (4 patients) or with a radial artery perforator adipofascial flap (4 patients). Patients were reviewed after a mean follow-up of 41 months (range, 18-84 mo). Preoperative and postoperative pain was measured with a visual analog scale. Pain improved from a preoperative mean value of 7.8 to a postoperative mean value of 3.6. There was complete resolution of pain in 5 patients, mild pain persisted in 2 patients, and 1 patient reported no improvement. No complications occurred at the donor site. Vascularized soft tissue coverage of painful median nerve neuromas is an effective treatment. We do not believe that a free flap is of any particular advantage over a local pedicle flap which we suggest using to protect the median nerve. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Manual therapy in the management of a patient with a symptomatic Morton's Neuroma: A case report.

    PubMed

    Sault, Josiah D; Morris, Matthew V; Jayaseelan, Dhinu J; Emerson-Kavchak, Alicia J

    2016-02-01

    Patients with Morton's neuroma are rarely referred to physical therapy. This case reports the resolution of pain, increase in local pressure pain thresholds, and improvement of scores on the Lower Extremity Functional Scale and Foot and Ankle Ability Measure following a course of joint based manual therapy for a patient who had failed standard conservative medical treatment.

  15. Surgical management of neuroma pain: a prospective follow-up study.

    PubMed

    Stokvis, Annemieke; van der Avoort, Dirk-Jan J C; van Neck, Johan W; Hovius, Steven E R; Coert, J Henk

    2010-12-01

    Painful neuromas can cause severe loss of function and have great impact on the daily life of patients. Surgical management remains challenging; despite improving techniques, success rates are low. To accurately study the success of surgical neuroma treatment and factors predictive of outcome, a prospective follow-up study was performed. Between 2006 and 2009, pre- and post-operative questionnaires regarding pain (VAS, McGill), function (DASH), quality of life (SF-36), symptoms of psychopathology (SCL-90), epidemiologic determinants and other outcome factors were sent to patients surgically treated for upper extremity neuroma pain. Pain scores after diagnostic nerve blocks were documented at the outpatient clinic before surgery. Thirty-four patients were included, with an average follow up time of 22 months. The mean VAS score decreased from 6.8 to 4.9 after surgery (p<0.01), 19 (56%) of patients were satisfied with surgical results. Upper extremity function improved significantly (p=0.001). Neuroma patients had significantly lower quality of life compared to a normal population. Employment status, duration of pain and CRPS symptoms were found to be prognostic factors. VAS scores after diagnostic nerve block were predictive of post-operative VAS scores (p=0.001). Furthermore, smoking was significantly related to worse outcome (relative risk: 2.10). The results could lead to improved patient selection and treatment strategies. If a diagnostic nerve block is ineffective in relieving pain, patients will most likely not benefit from surgical treatment. Patients should be encouraged to focus on activity and employment instead of their symptoms. Smoking should be discouraged in patients who will undergo surgical neuroma treatment.

  16. Change in tinnitus after acoustic neuroma removal using a translabyrinthine approach. A Prospective study.

    PubMed

    Alvarez, Leire; Ugarte, Ane; Goiburu, Miren; Urreta Barallobre, Iratxe; Altuna, Xabier

    Tinnitus is one of the primary symptoms of vestibular schwannoma (VS) and the effect of surgery is unpredictable. We conducted a prospective study of the patients who underwent a translabyrinthine approach for the treatment of their VS (2009-2013) at our Hospital. Patients answered the Tinnitus Handicap Inventory (THI) questionnaire pre- and postoperatively. The clinical charts provided data such as age, gender, tumour size, preoperative audiometry and postoperative facial function. The study included 39 patients. Of these, 71.8% suffered from tinnitus: 50% grade I, 17.9% grade II, 10.7% grade III, 21.4% grade IV and 0% grade V. We found no statistical association between tinnitus and the different variables measured preoperatively. Postoperatively, 48.7% of the patients suffered from tinnitus: 31.6% grade I, 36.8% grade II, 10.5% grade III, 15.8% grade IV and 5.3% grade V. The difference between mean pre- and postoperative THI was statistically significant (P=.011); this difference was greater in younger patients. We have found a significant negative correlation (r=-0.335; P=.037) between preoperative audiometry and postoperative THI. We did not find any significant association between tinnitus and age, gender, tumour size and postoperative facial function. Translabyrinthine surgical removal of VS in these patients led to better THI results, with the younger patients having better outcomes. The patients with poorest preoperative audition were the ones that had the best results in the postoperative THI questionnaire. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  17. Toward Dose Optimization for Fractionated Stereotactic Radiotherapy for Acoustic Neuromas: Comparison of Two Dose Cohorts

    SciTech Connect

    Andrews, David W. Werner-Wasik, Maria; Den, Robert B.; Paek, Sun Ha; Downes-Phillips, Beverly; Willcox, Thomas O.; Bednarz, Greg; Maltenfort, Mitchel; Evans, James J.; Curran, Walter J.

    2009-06-01

    Purpose: To describe our initial experience of fractionated stereotactic radiotherapy dose reduction comparing two dose cohorts with examination of tumor control rates and serviceable hearing preservation rates. Methods and Materials: After institutional review board approval, we initiated a retrospective chart review to study the hearing outcomes and tumor control rates. All data were entered into a JMP, version 7.01, statistical spreadsheet for analysis. Results: A total of 89 patients with serviceable hearing had complete serial audiometric data available for analysis. The higher dose cohort included 43 patients treated to 50.4 Gy with a median follow-up (latest audiogram) of 53 weeks and the lower dose cohort included 46 patients treated to 46.8 Gy with a median follow-up of 65 weeks. The tumor control rate was 100% in both cohorts, and the pure tone average was significantly improved in the low-dose cohort (33 dB vs. 40 dB, p = 0.023, chi-square). When the patient data were analyzed at comparable follow-up points, the actuarial hearing preservation rate was significantly longer for the low-dose cohort than for the high-dose cohort (165 weeks vs. 79 weeks, p = .0318, log-rank). Multivariate analysis revealed the dose cohort (p = 0.0282) and pretreatment Gardner-Robertson class (p = 0.0215) to be highly significant variables affecting the hearing outcome. Conclusion: A lower total dose at 46.8 Gy was associated with a 100% local control tumor rate and a greater hearing preservation rate. An additional dose reduction is justified to achieve the optimal dose that will yield the greatest hearing preservation rate without compromising tumor control for these patients.

  18. DNA excision repair at telomeres.

    PubMed

    Jia, Pingping; Her, Chengtao; Chai, Weihang

    2015-12-01

    DNA damage is caused by either endogenous cellular metabolic processes such as hydrolysis, oxidation, alkylation, and DNA base mismatches, or exogenous sources including ultraviolet (UV) light, ionizing radiation, and chemical agents. Damaged DNA that is not properly repaired can lead to genomic instability, driving tumorigenesis. To protect genomic stability, mammalian cells have evolved highly conserved DNA repair mechanisms to remove and repair DNA lesions. Telomeres are composed of long tandem TTAGGG repeats located at the ends of chromosomes. Maintenance of functional telomeres is critical for preventing genome instability. The telomeric sequence possesses unique features that predispose telomeres to a variety of DNA damage induced by environmental genotoxins. This review briefly describes the relevance of excision repair pathways in telomere maintenance, with the focus on base excision repair (BER), nucleotide excision repair (NER), and mismatch repair (MMR). By summarizing current knowledge on excision repair of telomere damage and outlining many unanswered questions, it is our hope to stimulate further interest in a better understanding of excision repair processes at telomeres and in how these processes contribute to telomere maintenance. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Excised larynx evaluation of subthyroid cartilage approach to medialization thyroplasty.

    PubMed

    Thompson, James D; Hoffman, Matthew R; Scholp, Austin; Devine, Erin E; Jiang, Jack J; McCulloch, Timothy M

    2017-09-11

    To describe an alternative approach to medialization thyroplasty involving dissection underneath the thyroid cartilage with placement of a Gore-Tex implant, and to evaluate its effect on a range of phonatory measures using an excised canine larynx model. Animal model. On each of eight excised canine larynges, the conditions of normal, paralysis, medialization thyroplasty by standard transthyroid cartilage approach, and medialization thyroplasty by experimental subthyroid cartilage approach were performed. Aerodynamic, acoustic, and mucosal wave parameters were measured for each condition. Compared to the vocal fold paralysis state, both the transthyroid and subthyroid approaches for Gore-Tex insertion resulted in significant decreases in phonation threshold pressure and phonation threshold flow. Both approaches also significantly decreased percent jitter, decreased percent shimmer, and improved signal-to-noise ratio. The mucosal wave was preserved after insertion of the Gore-Tex implant for both approaches. For all the phonatory measures except phonation threshold flow, there were no significant differences between the transthyroid and subthyroid approaches. Gore-Tex implantation via a subthyroid approach in an excised canine larynx model can produce effective medialization, preserve the mucosal wave, and significantly improve aerodynamic and acoustic parameters without meaningful difference compared to a traditional transthyroid approach. The subthyroid approach does not require creation of a thyroid cartilage window and could be a potentially valuable alternative method of performing medialization thyroplasty. NA Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  20. The expression of α-SMA in the painful traumatic neuroma: potential role in the pathobiology of neuropathic pain.

    PubMed

    Yan, Hede; Gao, Weiyang; Pan, Zhijun; Zhang, Feng; Fan, Cunyi

    2012-12-10

    The exact mechanism of neuroma-associated pain is not yet fully understood, thus contributing to the substantial challenge faced in managing patients with painful neuromas. We aimed to observe the expression of alpha smooth muscle actin (α-SMA) in the painful traumatic neuroma and to investigate its possible roles in the cause of neuroma-associated pain. Its expression is considered to be a useful phenotypic marker for myofibroblast, and may contribute to its increased contractile activity. We collected peripheral neuroma specimens prospectively and subsequently divided them into two groups: painful (n=21) and non-painful (n=27) based on blinded preoperative visual analogue scale (VAS) pain scores. We also harvested normal nerve specimens from the discarded limbs as a control group (n=8). We performed immunohistological studies to observe the expression of α-SMA in each group, and calculated the expression level by a high-resolution pathological image analysis system. There was no positive staining of α-SMA observed in the control group, slight positive staining in the non-painful group, and obviously positive staining in the painful group. Pearson correlation analysis demonstrated that VAS scores were significantly associated with the expression intensity of α-SMA (R=0.831; p<0.001). Linear regression analysis indicated that the expression intensity of α-SMA was positively related to the scale of VAS (R(2)=0.691, p<0.001). These findings suggest that: 1) expression of α-SMA may play certain roles in painful traumatic neuroma, either as a direct cause of neuroma-associated pain or as an indirect marker of local mechanical stimuli, and 2) the presence of α-SMA in the painful group may provide rationale for transpositional procedures in the management of traumatic neuroma. The persistent existence of α-SMA in the painful group and the correlation with VAS scores may provide insight into the development of new therapeutic strategies.

  1. Traumatic Neuroma at the Inferior Mesenteric Artery Stump after Rectal Cancer Surgery: A Case Report and Literature Review.

    PubMed

    Jeon, Sung Mi; Lee, Jae Young; Byeon, Sun Ju

    2016-11-25

    Traumatic neuroma results from regeneration attempts of the proximal end of an injured or severed nerve, resulting in a non-neoplastic nodular lesion. The lower extremity after amputation is the most common site, followed by the head and neck. Traumatic neuromas occurring in the abdomen, however, are rare. In the abdominal region, traumatic neuromas occur in the cystic duct stump and the common bile ducts as well as around the celiac trunk. This study reports a case of a 59-year-old man who presented with a traumatic neuroma arising at the stump of the inferior mesenteric artery after rectal cancer surgery. Traumatic neuromas at the stump of the inferior mesenteric artery have not been previously reported. The lesion exhibited atypical imaging features, including a well-enhanced nodule, a significant interval growth in size and a mild increase in 18F-fluo-rodeoxyglucose uptake, resembling lymph node metastasis. This case report will help physicians understand the sites of occurrence and imaging features of traumatic neuromas in the abdomen.

  2. Femoral Head and Neck Excision.

    PubMed

    Harper, Tisha A M

    2017-07-01

    Femoral head and neck excision is a surgical procedure that is commonly performed in small animal patients. It is a salvage procedure that is done to relieve pain in the coxofemoral joint and restore acceptable function of the limb. Femoral head and neck excision is most commonly used to treat severe osteoarthritis in the coxofemoral joint and can be done in dogs and cats of any size or age. The procedure should not be overused and ideally should not be done when the integrity of the coxofemoral joint can be restored. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Therapeutic Massage Provides Pain Relief to a Client with Morton's Neuroma: A Case Report.

    PubMed

    Davis, Faith

    2012-01-01

    Morton's neuroma is a common cause of pain that radiates from between the third and fourth metatarsals and which, when symptomatic, creates sensations of burning or sharp pain and numbness on the forefoot. Many conservative and surgical interventions are employed to reduce associated pain, but not enough research has been conducted to recommend patients to any one approach as the most reliable source of pain management. The objective of this case report is to describe the effect of massage therapy on one woman with symptomatic Morton's neuroma. A physically active 25-year-old female with diagnosed symptomatic Morton's neuroma who has not found relief with previous conservative intervention. Six session of massage therapy once weekly for 60-75 minutes focused on postural alignment and localized foot and leg treatment. The client also completed an at-home exercise each day. Change was monitored each week by the massage therapist reassessing posture and by the client filling out a pain survey based on a Visual Analog Scale. The client reported progressive change in the character of the pain from burning and stabbing before the first session to a dull, pulsing sensation after the third session. She also recorded a reduction in pain during exercise from a 5/10 to 0/10 (on a scale where 10 is extreme pain). This study describes how massage therapy reduced pain from Morton's neuroma for one client; however, larger randomized control studies need to be done in order to determine the short- and long-term effects of massage therapy on this painful condition.

  4. Nucleotide excision repair in humans

    PubMed Central

    Spivak, Graciela

    2015-01-01

    The demonstration of DNA damage excision and repair replication by Setlow, Howard-Flanders, Hanawalt and their colleagues in the early 1960s, constituted the discovery of the ubiquitous pathway of nucleotide excision repair (NER). The serial steps in NER are similar in organisms from unicellular bacteria to complex mammals and plants, and involve recognition of lesions, adducts or structures that disrupt the DNA double helix, removal of a short oligonucleotide containing the offending lesion, synthesis of a repair patch copying the opposite undamaged strand, and ligation, to restore the DNA to its original form. The transcription-coupled repair (TCR) subpathway of NER, discovered nearly two decades later, is dedicated to the removal of lesions from the template DNA strands of actively transcribed genes. In this review I will outline the essential factors and complexes involved in NER in humans, and will comment on additional factors and metabolic processes that affect the efficiency of this important process. PMID:26388429

  5. T1-nerve root neuroma presenting with apical mass and Horner's syndrome

    PubMed Central

    2007-01-01

    Background The appearance of dumbbell neuroma of the first thoracic root is extremely rare. The extradural component of a T1-dumbbell neuroma may present as an apical mass. The diagnosis of hand weakness is complex and may be delayed in T1-neuroma because of absence of the palpable cervical mass. One-stage removal of a T1-root neuroma and its intrathoracic extension demanded an extended posterior midline approach in the sitting position. Case presentation A 51-year old man had suffered a traumatic partial tendon rupture of his wrist flexor muscles 6 years ago. Since the incident he occasionally felt fullness and tenderness in the affected forearm with some tingling in his fingers bilaterally. During the last two years the hand weakness was continuous and hypotrophy of the medial flexor and intrinsic hand muscles had become apparent. Electrophysiological studies revealed an ulnar neuropathy in addition to mild median and radial nerve dysfunction, including a mild contralateral carpal tunnel syndrome. The diagnostic work-up for multiple mononeuropathy in the upper extremity was negative. Repeated electrophysiological studies revealed fibrillations in the C7 paravertebral muscles on the affected side. Chest x-ray revealed a large round apical mass on the affected side. A Horner's syndrome was noted at this point of diagnostic work-up. MRI of the cervical and thoracic spine revealed a dumbbell T1 neuroma enlarging the intervertebral foramen at T1-2 and a 5 cm large extradural tumor with extension into the apex of the ipsilateral lung. The patient underwent surgery in sitting position using a left dorsal midline approach. Although the T1 root could not be preserved, the patient's neurological condition was unchanged after the surgery. Conclusion Extended posterior midline exposure described here using hemilaminectomy, unilateral facetectomy and costo-transversectomy is efficient and safe for one-stage removal of dumbbell tumors at the T1 level with a predominantly

  6. Retrosigmoid approach for acoustic tumor removal. 1992.

    PubMed

    Cohen, Noel L

    2008-04-01

    The retrosigmoid technique has evolved from the traditional suboccipital operation and, when combined with removal of the posterior wall of the internal auditory canal (IAC), affords a wide exposure of the cerebellopontine angle. This approach may be used for acoustic neuromas of all sizes, from intracanalicular, to more than 4 cm from the porus acusticus. Hearing preservation may be attempted and is generally successful in a substantial minority of cases. The facial nerve is readily visualized at the lateral end of the IAC and is at no greater risk than in the translabyrinthine operation. The authors use this approach for all hearing preservation surgery as well as for tumors of more than 3 cm, regardless of hearing.

  7. Proteomic profiling of neuromas reveals alterations in protein composition and local protein synthesis in hyper-excitable nerves

    PubMed Central

    Huang, Hong-Lei; Cendan, Cruz-Miguel; Roza, Carolina; Okuse, Kenji; Cramer, Rainer; Timms, John F; Wood, John N

    2008-01-01

    Neuropathic pain may arise following peripheral nerve injury though the molecular mechanisms associated with this are unclear. We used proteomic profiling to examine changes in protein expression associated with the formation of hyper-excitable neuromas derived from rodent saphenous nerves. A two-dimensional difference gel electrophoresis (2D-DIGE) profiling strategy was employed to examine protein expression changes between developing neuromas and normal nerves in whole tissue lysates. We found around 200 proteins which displayed a >1.75-fold change in expression between neuroma and normal nerve and identified 55 of these proteins using mass spectrometry. We also used immunoblotting to examine the expression of low-abundance ion channels Nav1.3, Nav1.8 and calcium channel α2δ-1 subunit in this model, since they have previously been implicated in neuronal hyperexcitability associated with neuropathic pain. Finally, S35methionine in vitro labelling of neuroma and control samples was used to demonstrate local protein synthesis of neuron-specific genes. A number of cytoskeletal proteins, enzymes and proteins associated with oxidative stress were up-regulated in neuromas, whilst overall levels of voltage-gated ion channel proteins were unaffected. We conclude that altered mRNA levels reported in the somata of damaged DRG neurons do not necessarily reflect levels of altered proteins in hyper-excitable damaged nerve endings. An altered repertoire of protein expression, local protein synthesis and topological re-arrangements of ion channels may all play important roles in neuroma hyper-excitability. PMID:18700027

  8. Virtual Acoustics

    NASA Astrophysics Data System (ADS)

    Lokki, Tapio; Savioja, Lauri

    The term virtual acoustics is often applied when sound signal is processed to contain features of a simulated acoustical space and sound is spatially reproduced either with binaural or with multichannel techniques. Therefore, virtual acoustics consists of spatial sound reproduction and room acoustics modeling.

  9. Endoscopic excision of cheek lipomas.

    PubMed

    Pyon, Jai-Kyong; Park, Bum-Jin; Mun, Goo-Hyun; Cha, Myung-Kyu; Lim, So-Young; Bang, Sa-Ik; Oh, Kap-Sung

    2008-10-01

    Although the removal of forehead and brow benign tumors using an endoscopic technique has proven to be valuable, the efficacy of an endoscopic excision for cheek masses is unclear. A retrospective review was performed on 8 patients with a lipoma (7) and a foreign body granuloma (1) located at the cheek region. There were 7 men and 1 woman with a mean age of 34.8 years (range, 22-54 years). All the excisional procedures were performed with an endoscope through 2 small incisions, one on the hair-bearing sideburns and the other behind the earlobe. The masses varied from 0.7 x 0.7 cm to 4.0 x 3.0 cm in size. There were no intraoperative or postoperative complications, and no recurrence was detected after a 5- to 61-month follow-up. An endoscopically assisted excision of cheek lipomas is an effective procedure and might be a good alternative to the more conventional procedures.

  10. Nucleotide excision repair in humans.

    PubMed

    Spivak, Graciela

    2015-12-01

    The demonstration of DNA damage excision and repair replication by Setlow, Howard-Flanders, Hanawalt and their colleagues in the early 1960s, constituted the discovery of the ubiquitous pathway of nucleotide excision repair (NER). The serial steps in NER are similar in organisms from unicellular bacteria to complex mammals and plants, and involve recognition of lesions, adducts or structures that disrupt the DNA double helix, removal of a short oligonucleotide containing the offending lesion, synthesis of a repair patch copying the opposite undamaged strand, and ligation, to restore the DNA to its original form. The transcription-coupled repair (TCR) subpathway of NER, discovered nearly two decades later, is dedicated to the removal of lesions from the template DNA strands of actively transcribed genes. In this review I will outline the essential factors and complexes involved in NER in humans, and will comment on additional factors and metabolic processes that affect the efficiency of this important process. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Osteophyte excision without cyst excision for a mucous cyst of the finger.

    PubMed

    Lee, H-J; Kim, P-T; Jeon, I-H; Kyung, H-S; Ra, I-H; Kim, T-K

    2014-03-01

    Osteophyte excision is a mainstay of treatment for mucous cyst combined with Heberden's node in a distal interphalangeal joint or in an interphalangeal joint of the thumb. The aim of this study was to evaluate the results of osteophyte excision without cyst excision for the treatment of a mucous cyst combined with Heberden's node. The medical records of 37 patients (42 cases) with a mucous cyst with Heberden's node were retrospectively reviewed. Thirty-eight of 40 cases with available pre-operative simple radiographs showed evidence of joint arthrosis. A T-shaped skin incision of the joint capsule between the extensor tendon and lateral collateral ligament was used. Osteophyte excision without cyst excision was performed. All cysts, except one, regressed without recurrence or a skin complication after osteophyte excision, but eight cases showed post-operative pain and loss of range of motion. Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger.

  12. Nucleotide Excision Repair in Eukaryotes

    PubMed Central

    Schärer, Orlando D.

    2013-01-01

    Nucleotide excision repair (NER) is the main pathway used by mammals to remove bulky DNA lesions such as those formed by UV light, environmental mutagens, and some cancer chemotherapeutic adducts from DNA. Deficiencies in NER are associated with the extremely skin cancer-prone inherited disorder xeroderma pigmentosum. Although the core NER reaction and the factors that execute it have been known for some years, recent studies have led to a much more detailed understanding of the NER mechanism, how NER operates in the context of chromatin, and how it is connected to other cellular processes such as DNA damage signaling and transcription. This review emphasizes biochemical, structural, cell biological, and genetic studies since 2005 that have shed light on many aspects of the NER pathway. PMID:24086042

  13. Use of the rabbit larynx in an excised larynx setup

    PubMed Central

    Maytag, Allison L.; Robitaille, Mark J.; Rieves, Adam L.; Madsen, James; Smith, Benjamin L.; Jiang, Jack J.

    2012-01-01

    Objective To modify the excised larynx bench apparatus to accommodate experiments with rabbit larynges. Study design Methodological study using ex vivo rabbit larynges Methods Rabbit larynges (n=5) were dissected and mounted on a custom-made phonatory apparatus. The arytenoids were adducted by rods and humidified air was passed through the larynx to elicit vocal fold vibration. Acoustic, aerodynamic, electroglottographic, and videokymographic data were collected for each larynx. The same data were collected for 5 canine larynges for the purpose of comparison, and coefficients of variation were calculated for each parameter in both models. Results Reliable phonation was achieved in each larynx. Acoustic fundamental frequency, % jitter, % shimmer, signal-to-noise ratio, pressure and flow at phonation onset and offset, and fundamental frequency, closed quotient, speed quotient, jitter, shimmer, and contact quotient, as recorded by electroglottography, and mucosal wave amplitude and phase difference are reported for rabbit larynges. Coefficients of variation for each parameter are similar in magnitude between the two models. Conclusion We developed a method for recording reliable acoustic, aerodynamic, videokymographic, and electroglottographic data from rabbit larynges. When data obtained from leporine larynges were compared with data from canine larynges, the intra-larynx variability of rabbit larynges was found to be similar to that of canine larynges. PMID:23159025

  14. Use of the rabbit larynx in an excised larynx setup.

    PubMed

    Maytag, Allison L; Robitaille, Mark J; Rieves, Adam L; Madsen, James; Smith, Benjamin L; Jiang, Jack J

    2013-01-01

    To modify the excised larynx bench apparatus to accommodate experiments with rabbit larynges. Methodological study using ex vivo rabbit larynges. Rabbit larynges (n=5) were dissected and mounted on a custom-made phonatory apparatus. The arytenoids were adducted by rods, and humidified air was passed through the larynx to elicit vocal fold vibration. Acoustic, aerodynamic, electroglottographic (EGG), and videokymographic data were collected for each larynx. The same data were collected for five canine larynges for the purpose of comparison, and coefficients of variation were calculated for each parameter in both models. Reliable phonation was achieved in each larynx. Acoustic fundamental frequency (F(0)), percent jitter, percent shimmer, signal-to-noise ratio, pressure and flow at phonation onset and offset; and F(0), closed quotient, speed quotient, jitter, shimmer, and contact quotient, as recorded by EGG; and mucosal wave amplitude and phase difference are reported for rabbit larynges. Coefficients of variation for each parameter are similar in magnitude between the two models. We developed a method for recording reliable acoustic, aerodynamic, videokymographic, and EGG data from rabbit larynges. When data obtained from leporine larynges were compared with data from canine larynges, the intralarynx variability of rabbit larynges was found to be similar to that of canine larynges. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  15. Nonneoplastic Neuroma After Radical Prostatectomy Is Not a Mimicker of Lymph Node Metastases on 68Ga-PSMA Ligand PET/CT.

    PubMed

    Derlin, Thorsten; Schumacher, Udo; Bengel, Frank M

    2016-10-01

    Traumatic neuroma is frequently observed after surgery. PSMA expression has been demonstrated in neoplastic nerve sheath tumors, which may mimic metastases on PSMA imaging. In this case, histopathologic evaluation of a pelvic lesion with assumed intense tracer uptake on Ga-PSMA ligand PET/CT in a patient with biochemical recurrence of prostate cancer revealed an amputation neuroma. However, immunohistochemical evaluation showed absent PSMA expression, and follow-up PET confirmed persistence of the metastasis. Unlike neoplastic nerve sheath tumors, traumatic neuroma does not show PSMA expression and is not a mimicker of metastases on Ga-PSMA PET/CT.

  16. Types of Vestibular Disorders

    MedlinePlus

    ... include complications from aging, autoimmune disorders, and allergies. Acoustic Neuroma Acoustic neuroma (also called a vestibular schwannoma) is a ... This nerve is also referred to as the acoustic nerve, hence the name.) As an acoustic neuroma ...

  17. Comparative light-microscopic and immunohistochemical study of traumatic and palisaded encapsulated neuromas of the skin.

    PubMed

    Argenyi, Z B; Santa Cruz, D; Bromley, C

    1992-12-01

    The primary hyperplastic nature of palisaded encapsulated neuromas (PENs) has been recently challenged by suggesting a traumatic origin. We studied eight cases of traumatic neuroma (TN) and 12 cases of PEN by routine light-microscopic, histochemical, and immunohistochemical methods to assess evidence of previous tissue injury. Sections from the formalin-fixed, paraffin-embedded tissue were stained with hematoxylin-eosin, trichrome, elastic, reticulin, Giemsa, colloidal iron (with and without hyaluronidase), and Bielschowsky silver stains. Antibodies were applied to collagen types I, III, and IV, MAC 387, factor XIIIa, alpha 1-antitrypsin (A1AT), epithelial membrane antigen (EMA), Leu-7, and myelin basic protein using ABC techniques. We found that (a) in TN the individual fascicles were usually surrounded by perineurial cells, whereas in PEN the perineurial cells were observed mainly in the capsular areas and only rarely within the fascicles as evidenced by EMA antibodies; (b) histochemically TN contained considerably larger amounts of collagen (types I and III), acidic mucin, and myelin products than did PEN; and (c) neither PEN nor TN contained increased inflammatory cells or cells positive for factor XIIIa, MAC 387, or A1AT. We conclude that (a) there are substantial structural and histochemical differences between TN and PEN, (b) the changes suggest that the classic form of PEN has a different histogenesis than TN, and (c) on histologic grounds, chronic minor trauma could not be excluded as an etiologic factor for PEN.

  18. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...

  19. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...

  20. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...

  1. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid by...

  2. Laparoscopic complete mesocolic excision: West meets East.

    PubMed

    Chow, Carina F K; Kim, Seon Hahn

    2014-10-21

    Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units' routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.

  3. Experiments on Analysing Voice Production: Excised (Human, Animal) and In Vivo (Animal) Approaches.

    PubMed

    Döllinger, Michael; Kobler, James; Berry, David A; Mehta, Daryush D; Luegmair, Georg; Bohr, Christopher

    Experiments on human and on animal excised specimens as well as in vivo animal preparations are so far the most realistic approaches to simulate the in vivo process of human phonation. These experiments do not have the disadvantage of limited space within the neck and enable studies of the actual organ necessary for phonation, i.e., the larynx. The studies additionally allow the analysis of flow, vocal fold dynamics, and resulting acoustics in relation to well-defined laryngeal alterations.

  4. Acoustic Seaglider

    DTIC Science & Technology

    2008-03-07

    a national naval responsibility. Acoustic sensors on mobile, autonomous platforms will enable basic research topics on temporal and spatial...problem and acoustic navigation and communications within the context of distributed autonomous persistent undersea surveillance sensor networks...Acoustic sensors on mobile, autonomous platforms will enable basic research topics on temporal and spatial coherence and the description of ambient

  5. Acoustic seal

    NASA Technical Reports Server (NTRS)

    Steinetz, Bruce M. (Inventor)

    2006-01-01

    The invention relates to a sealing device having an acoustic resonator. The acoustic resonator is adapted to create acoustic waveforms to generate a sealing pressure barrier blocking fluid flow from a high pressure area to a lower pressure area. The sealing device permits noncontacting sealing operation. The sealing device may include a resonant-macrosonic-synthesis (RMS) resonator.

  6. Acoustic Seal

    NASA Technical Reports Server (NTRS)

    Steinetz, Bruce M. (Inventor)

    2006-01-01

    The invention relates to a sealing device having an acoustic resonator. The acoustic resonator is adapted to create acoustic waveforms to generate a sealing pressure barrier blocking fluid flow from a high pressure area to a lower pressure area. The sealing device permits noncontacting sealing operation. The sealing device may include a resonant-macrosonic-synthesis (RMS) resonator.

  7. Clinical behavior of acoustic tumors. A flow cytometric analysis.

    PubMed

    Kesterson, L; Shelton, C; Dressler, L; Berliner, K I

    1993-03-01

    Recently, nonsurgical treatment of acoustic tumors has been advocated as an alternative to surgical resection. Because of the relatively short follow-up in reported series of radiation-treated acoustic tumors, the lack of growth of some tumors may merely reflect the variable biologic growth potential of these tumors and not the result of treatment. DNA flow cytometry has been used to predict biologic activity in other solid tumors. It is applied in this study to assess the variability of growth potential in a typical acoustic tumor population and to determine whether relationships exist between flow cytometric data and clinical characteristics of acoustic tumors. DNA flow cytometry techniques were used to evaluate formalin-fixed, paraffin-embedded tissue previously obtained from patients who were surgically treated for acoustic neuromas. Relationships between flow cytometry data and historical data were also statistically evaluated. Tissue samples were from patients of a large private otologic practice. Subjects were a convenience sample of 49 patients (26 female and 23 male) with a mean age of 59 years who had undergone surgical removal of an acoustic neuroma. None of the patients had other stigmata of neurofibromatosis or tumor recurrence. All tissue specimens were pathologically confirmed acoustic neurons, with a range in tumor size from 1 to 6 cm. The measures included DNA ploidy and S-phase fraction. Historical data included age, sex, size of tumor, presenting symptom, and symptom duration. All 49 tumors showed a diploid distribution, with S-phase values ranging from 1.07% to 20.74% (mean +/- SD, 6.30 +/- 4.24). The ploidy and S-phase data compare favorably with previously published data in which fresh tissue was used. There were no statistically significant relationships between S-phase value and historical data. The wide range of S-phase values is consistent with a large variation in tumor growth potential and suggests caution in interpreting the results of

  8. Mitochondrial base excision repair assays

    PubMed Central

    Maynard, Scott; de Souza-Pinto, Nadja C.; Scheibye-Knudsen, Morten

    2010-01-01

    The main source of mitochondrial DNA (mtDNA) damage is reactive oxygen species (ROS) generated during normal cellular metabolism. The main mtDNA lesions generated by ROS are base modifications, such as the ubiquitous 8-oxoguanine (8-oxoG) lesion; however, base loss and strand breaks may also occur. Many human diseases are associated with mtDNA mutations and thus maintaining mtDNA integrity is critical. All of these lesions are repaired primarily by the base excision repair (BER) pathway. It is now known that mammalian mitochondria have BER, which, similarly to nuclear BER, is catalyzed by DNA glycosylases, AP endonuclease, DNA polymerase (POLγ in mitochondria), and DNA ligase. This article outlines procedures for measuring oxidative damage formation and BER in mitochondria, including isolation of mitochondria from tissues and cells, protocols for measuring BER enzyme activities, gene-specific repair assays, chromatographic techniques, as well as current optimizations for detecting 8-oxoG lesions in cells by immunofluorescence. Throughout the assay descriptions we will include methodological considerations that may help optimize the assays in terms of resolution and repeatability. PMID:20188838

  9. Measures of Spectral Slope Using an Excised Larynx Model

    PubMed Central

    Alipour, Fariborz; Scherer, Ronald C.; Finnegan, Eileen

    2011-01-01

    Spectral measures of the glottal source were investigated using an excised canine larynx model for various aerodynamic and phonatory conditions. These measures included spectral harmonic difference H1-H2 and spectral slope that are highly correlated with voice quality but not reported in a systematic manner using an excised larynx model. It was hypothesized that the acoustic spectra of the glottal source were significantly influenced by the subglottal pressure, glottal adduction, and vocal fold elongation, and the resulting vibration pattern. Canine larynges were prepared, mounted on the bench with and without false vocal folds, and made to oscillate with flow of heated and humidified air. Major control parameters were subglottal pressure, adduction, and elongation. Electroglottograph (EGG), subglottal pressure, flowrate, and audio signals were analyzed using custom software. Results suggest that an increase in subglottal pressure and glottal adduction may change the energy balance between harmonics by increasing the spectral energy of the first few harmonics in an unpredictable manner. It is suggested that changes in the dynamics of vocal fold motion may be responsible for different spectral patterns. The finding that the spectral harmonics do not conform to previous findings was demonstrated through various cases. Results of this study may shed light on phonatory spectral control when the larynx is part of a complete vocal tract system. PMID:22056893

  10. Promotion of peripheral nerve regeneration and prevention of neuroma formation by PRGD/PDLLA/β-TCP conduit: report of two cases.

    PubMed

    Yin, Yixia; Li, Binbin; Yan, Qiongjiao; Dai, Honglian; Wang, Xinyu; Huang, Jifeng; Li, Shipu

    2015-06-01

    In the field of nerve repair, one major challenge is the formation of neuroma. However, reports on both the promotion of nerve regeneration and prevention of traumatic neuroma in the clinical settings are rare in the field of nerve repair. One of the reasons could be the insufficiency in the follow-up system. We have conducted 33 cases of nerve repair using PRGD/PDLLA/β-TCP conduit without any sign of adverse reaction, especially no neuroma formation. Among them, we have selected two cases as representatives to report in this article. The first case was a patient with an upper limb nerve wound was bridged by PRGD/PDLLA/β-TCP conduit and a plate fixation was given. After nearly 3-years' follow-up, the examination results demonstrated that nerve regeneration effect was very good. When the reoperation was performed to remove the steel plate we observed a uniform structure of the regenerated nerve without the formation of neuroma, and to our delight, the implanted conduit was completely degraded 23 months after the implantation. The second case had an obsolete nerve injury with neuroma formation. After removal of the neuroma, the nerve was bridged by PRGD/PDLLA/β-TCP conduit. Follow-up examinations showed that the structure and functional recovery were improved gradually in the 10-month follow-up; no end-enlargement and any other abnormal reaction associated with the characteristic of neuroma were found. Based on our 33-case studies, we have concluded that PRGD/PDLLA/β-TCP nerve conduit could both promote nerve regeneration and prevent neuroma formation; therefore, it is a good alternative for peripheral nerve repair.

  11. Electrosurgical excision of full-thickness burns.

    PubMed

    Lewis, R J; Quniby, W C

    1975-02-01

    Massive intraoperative blood loss and poor graft take have been the major problems associated with early excision and immediate grafting of full-thickness burns. By employing electrosurgery, excessive blood loss was virtually eliminated in a series of major burn excisions. Immediate graft take was excellent on electrosurgical wounds after primary burn excisions and in late reconstructive procedures. Simplicity, improved hemostasia, good graft take, and the absence of special anesthetic requirements make this method particularly applicable to the management of patients with burn injury.

  12. An alternative eukaryotic DNA excision repair pathway.

    PubMed Central

    Freyer, G A; Davey, S; Ferrer, J V; Martin, A M; Beach, D; Doetsch, P W

    1995-01-01

    DNA lesions induced by UV light, cyclobutane pyrimidine dimers, and (6-4)pyrimidine pyrimidones are known to be repaired by the process of nucleotide excision repair (NER). However, in the fission yeast Schizosaccharomyces pombe, studies have demonstrated that at least two mechanisms for excising UV photo-products exist; NER and a second, previously unidentified process. Recently we reported that S. pombe contains a DNA endonuclease, SPDE, which recognizes and cleaves at a position immediately adjacent to cyclobutane pyrimidine dimers and (6-4)pyrimidine pyrimidones. Here we report that the UV-sensitive S. pombe rad12-502 mutant lacks SPDE activity. In addition, extracts prepared from the rad12-502 mutant are deficient in DNA excision repair, as demonstrated in an in vitro excision repair assay. DNA repair activity was restored to wild-type levels in extracts prepared from rad12-502 cells by the addition of partially purified SPDE to in vitro repair reaction mixtures. When the rad12-502 mutant was crossed with the NER rad13-A mutant, the resulting double mutant was much more sensitive to UV radiation than either single mutant, demonstrating that the rad12 gene product functions in a DNA repair pathway distinct from NER. These data directly link SPDE to this alternative excision repair process. We propose that the SPDE-dependent DNA repair pathway is the second DNA excision repair process present in S. pombe. PMID:7623848

  13. Morton's Neuroma

    MedlinePlus

    ... to control foot problems common in runners, according... Softball Injuries to the Foot and Ankle Your feet ... ankles take a beating when you are playing softball. Softball players should be aware of the following ...

  14. Morton neuroma

    MedlinePlus

    ... in the development of this condition: Wearing tight shoes and high heels Abnormal positioning of toes Flat ... and sometimes toes Pain that increases when wearing shoes or pressing on the area Pain that gets ...

  15. Musical Acoustics

    NASA Astrophysics Data System (ADS)

    Gough, Colin

    This chapter provides an introduction to the physical and psycho-acoustic principles underlying the production and perception of the sounds of musical instruments. The first section introduces generic aspects of musical acoustics and the perception of musical sounds, followed by separate sections on string, wind and percussion instruments.

  16. Surgical complications of submandibular gland excision.

    PubMed

    Hernando, Monica; Echarri, Rosa Maria; Taha, Muhammad; Martin-Fragueiro, Luz; Hernando, Ana; Mayor, Guillermo Plaza

    2012-01-01

    Submandibular gland excision is the treatment of choice in chronic pathology resistant to medical treatments or in oncological cases. The aim of this study was to analyse its current postoperative complications. Retrospective study on submandibular gland excisions performed at our University Hospital between 2004 and 2010. A total of 29 submandibular gland excisions were performed: 44.8% (13) for chronic sialadenitis, 37.9% (11) for salivary gland neoplasm and 17.2% (5) for adjacent tumours. Median length of hospital stay was 2 days. Complications were more common after gland excision due to inflammatory causes. There were only 2 cases of paralysis of the marginal facial nerve branch (6.8%); 1 was due to neoplastic pathology and 1, from inflammatory pathology. Despite marginal facial nerve paresis being one of the most relevant issues after submandibular gland excision, this type of surgery is a safe technique in our experience. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  17. Partial excision of residual burn lesions.

    PubMed

    Engrav, L H; Gottlieb, J R; Millard, S P; Walkinshaw, M D; Heimbach, D M; Marvin, J A

    1987-01-01

    Most burn victims have unattractive residual lesions, which may include hypertrophic donor sites, unsightly skin grafts, hypertrophic scars, and mature scars with altered pigmentation or texture. Some of these lesions can be treated by total excision in one or more stages or they can be reconstructed utilizing grafts, flaps, Z-plasties, or tissue expansion. But frequently these procedures are either not indicated or not elected by the patient. In such a situation, the only surgical option is partial excision, with the goal of making the lesion less conspicuous and more easily concealed by clothing. Whether or not such partial excisions are worthwhile is the obvious question. We could not find an answer in the literature and therefore decided to review our own experience. Between 6/30/81 and 3/12/86, 92 such procedures were performed and followed in 25 patients. Partial excision of hypertrophic donor sites, unsightly skin grafts, and hypertrophic scars did yield improved appearance in most patients. However, partial excision of mature scars, ie, areas of altered pigmentation or texture, did not have the same success. We continue to treat the first three types of lesions in this fashion but no longer include the latter.

  18. Control of Staphylococcus aureus pathogenicity island excision.

    PubMed

    Mir-Sanchis, Ignacio; Martínez-Rubio, Roser; Martí, Miguel; Chen, John; Lasa, Íñigo; Novick, Richard P; Tormo-Más, María Ángeles; Penadés, José R

    2012-09-01

    Staphylococcus aureus pathogenicity islands (SaPIs) are a group of related 15-17 kb mobile genetic elements that commonly carry genes for superantigen toxins and other virulence factors. The key feature of their mobility is the induction of SaPI excision and replication by certain phages and their efficient encapsidation into specific small-headed phage-like infectious particles. Previous work demonstrated that chromosomal integration depends on the SaPI-encoded recombinase, Int. However, although involved in the process, Int alone was not sufficient to mediate efficient SaPI excision from chromosomal sites, and we expected that SaPI excision would involve an Xis function, which could be encoded by a helper phage or by the SaPI, itself. Here we report that the latter is the case. In vivo recombination assays with plasmids in Escherichia coli demonstrate that SaPI-coded Xis is absolutely required for recombination between the SaPI att(L) and att(R) sites, and that both sites, as well as their flanking SaPI sequences, are required for SaPI excision. Mutational analysis reveals that Xis is essential for efficient horizontal SaPI transfer to a recipient strain. Finally, we show that the master regulator of the SaPI life cycle, Stl, blocks expression of int and xis by binding to inverted repeats present in the promoter region, thus controlling SaPI excision.

  19. Acoustical oceanography

    NASA Astrophysics Data System (ADS)

    The Acoustical Society of America has formed a Technical Specialty Group on Acoustical Oceanography. At ASA meetings the new group will have special sessions where they will give invited and contributed papers and have panel discussions about ocean parameters that are measured effectively by acoustical techniques.The first special sessions will be May 22-23, 1990, at the ASA meeting at Pennsylvania State University, University Park. The focus on May 22 will be acoustical techniques for detection and measurement of internal waves and turbulence; conveners are Robert Pinkel of Scripps Institution of Oceanography, La Jolla, Calif., and Herman Medwin of the Naval Postgraduate School, Monterey, Calif. Acoustical studies of the physical and biological characteristics of ocean mass boundaries are the discussion topic on May 23. The convener is C. S. Clay, University of Wisconsin, Madison.

  20. Masseter-to-facial nerve transfer: a highly effective technique for facial reanimation after acoustic neuroma resection.

    PubMed

    Wang, Wei; Yang, Chuan; Li, Qingfeng; Li, Wei; Yang, Xianxian; Zhang, Yi Xin

    2014-09-01

    Masseter-to-facial nerve transfer is a new procedure for patients who acquire a proximal injury to the facial nerve. This article reports that this procedure is effective and associated with minimal morbidities. From November 2010 to February 2013, 16 patients underwent a masseter-to-facial nerve transfer. Their denervation periods varied from 2 to 18 months, with an average of 10.1±4.1 months. Their ages varied from 22 to 70 years, with an average of 34.7±15.4 years. The etiology of denervation was tumor resection in the cerebellopontine angle in all cases. All of the patients were followed up several times. The outcomes of the first follow-up at 3 months postoperatively and the last follow-up at a minimum 12 months postoperatively were documented. Using Terzis' and Metha's scales, the smile outcomes and synkinetic movements as visualized using standardized videos were graded preoperatively and postoperatively. The periods between the operation and the onset of mimetic muscle contraction were documented. A questionnaire was administered to evaluate the donor-site morbidity and the ability to smile without biting. The final outcomes for smile function were as follows: 9 patients (56.3%) had excellent or good function, 5 patients (31.3%) had moderate function, and 2 patients (12.5%) had poor function. There was significant improvement between the preoperative and postoperative time points and between the outcomes at the first and last follow-ups (P<0.05). Additionally, 13 (81.3%) patients had the ability to smile without biting 12 months postoperatively. The onset of muscle motion varied from 56 to 365 days and was positively correlated with age in the group of patients older than 40 years and negatively correlated with the outcome of the first follow-up. Four (25%) patients complained of concavity at the parotideomasseteric region, but none complained of disturbance in food intake. Synkinetic movements were observed in all patients and were rated as mild. The masseter-facial nerve transfer effectively reanimated the paralytic muscle in patients who acquired an intracranial facial nerve injury with minimal deficits at the donor site. After continued physical therapy, some patients were able to regain a symmetrical and effortless smile with mild synkinetic movements.

  1. [Neuro-otologic criteria in the diagnosis of tumor-induced hearing disorders. Studies of 300 patients with acoustic neuroma].

    PubMed

    Mausolf, A; Laubert, A

    1990-02-01

    Recently, costly technical procedures have been used for the diagnosis of a retrocochlear hearing loss. Electrophysiological methods such as ERA, electrocochleography and promontory tests, and imaging procedures such as CT and MRI have been widely used. Here we demonstrate the diagnostic value of conventional audiometry in retrocochlear lesions. As the clinical audiometric picture shows, a retrocochlear lesion is based on electrophysiological conduction phenomena. The threshold tone decay, absence of stapedius reflex, reduced speech discrimination and ERA findings with electric response decay and synchronization disorders within the brain stem are particularly significant.

  2. Tattoo Removal by Split Thickness Tangential Excision

    PubMed Central

    Wheeler, Ervin S.; Miller, Timothy A.

    1976-01-01

    Split thickness tangential excision is a simple means of tattoo removal with very acceptable cosmetic results. The technique has several advantages. (1) The depth of skin removal may accurately be controlled as the tattoo pigment is excised with a dermatome. The major portion, if not all of the remaining pigment, is extruded and sloughs with the crust. (2) Scar formation, if it occurs at all, is negligible. (3) No donor site is created. (4) The procedure may be carried out rapidly without admitting patients to hospital, is inexpensive for patients and conserves time for physicians. ImagesFigure 1. PMID:1266213

  3. Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma-in-continuity and recurrent carpal tunnel syndrome after carpal tunnel release.

    PubMed

    Yamamoto, Takumi; Narushima, Mitsunaga; Yoshimatsu, Hidehiko; Yamamoto, Nana; Mihara, Makoto; Koshima, Isao

    2014-02-01

    Treatment of recurrent carpal tunnel syndrome (CTS) is challenging, especially in a case with recurrent CTS and a neuroma formation. Resection of the neuroma causing the syndrome, reconstruction of the nerve gap of the median nerve, and covering up the reconstructed median nerve with well-vascularized soft tissue for prevention of CTS re-recurrence are the essential procedures. We report a case of recurrent CTS with severe pain due to a neuroma-in-continuity successfully treated using a free anterolateral thigh (ALT) flap with a vascularized lateral femoral cutaneous nerve (LFCN). A 2 cm neuroma existed in the median nerve and was resected. The nerve gap was repaired using a vascularized LFCN included in the ALT flap. The ALT flap was transferred to the wrist to cover the median nerve. The severe pain disappeared completely and the sensory and motor impairment of the median nerve improved 5 months after the free flap surgery, as the Tinel's sign moved distally away from the wrist and disappeared. The result of the Semmes-Weinstein test improved from 5.08 to 4.31 and she was able to flex and extend the right wrist and fingers without pain. CTS did not recur 15 months after the surgery. A free ALT flap with vascularized LFCN allows nerve reconstruction for the median nerve gap created after neuroma resection and coverage of the median nerve with well-vascularized soft tissue to prevent adhesion and CTS recurrence. Copyright © 2013 Wiley Periodicals, Inc.

  4. [Tumor-induced function disorders of the acoustic nerve and the lower portions of the auditory pathway].

    PubMed

    Lehnhardt, E

    1983-03-01

    The manyfold features of acoustic neuromas, respectively tumors of the cerebello pontine angle, are tried to explain by pathophysiologic phenomena of the neural conduction. They are the pathologic fatigue of hearing, the disturbed excitability of the acustico facial stapedial reflex, the impaired velocity of nerve conduction, a poor synchronization of conduction as well as the excessively reduced monosyllabic and dichotic discrimination. With respect to the original tissue, localization, size as well as regional spread and growth pressure there result different constellations of symptoms, eventually only marked discretely. However, all 35 tumors of a defined observation period as well could be diagnosed solely by functional hearing tests.

  5. Nonlinear dynamic analysis of voices before and after surgical excision of vocal polyps

    NASA Astrophysics Data System (ADS)

    Zhang, Yu; McGilligan, Clancy; Zhou, Liang; Vig, Mark; Jiang, Jack J.

    2004-05-01

    Phase space reconstruction, correlation dimension, and second-order entropy, methods from nonlinear dynamics, are used to analyze sustained vowels generated by patients before and after surgical excision of vocal polyps. Two conventional acoustic perturbation parameters, jitter and shimmer, are also employed to analyze voices before and after surgery. Presurgical and postsurgical analyses of jitter, shimmer, correlation dimension, and second-order entropy are statistically compared. Correlation dimension and second-order entropy show a statistically significant decrease after surgery, indicating reduced complexity and higher predictability of postsurgical voice dynamics. There is not a significant postsurgical difference in shimmer, although jitter shows a significant postsurgical decrease. The results suggest that jitter and shimmer should be applied to analyze disordered voices with caution; however, nonlinear dynamic methods may be useful for analyzing abnormal vocal function and quantitatively evaluating the effects of surgical excision of vocal polyps.

  6. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... OF THE TREASURY LIQUORS LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Rum Imported Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise taxes... and the Virgin Islands), will be deposited into the Treasuries of Puerto Rico and the Virgin Islands...

  7. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... OF THE TREASURY ALCOHOL LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Rum Imported Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise taxes... and the Virgin Islands), will be deposited into the Treasuries of Puerto Rico and the Virgin Islands...

  8. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... OF THE TREASURY LIQUORS LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Rum Imported Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise taxes... and the Virgin Islands), will be deposited into the Treasuries of Puerto Rico and the Virgin Islands...

  9. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Relating to Alcohol, Tobacco, Firearms, and Explosives Provisions Relating to Distilled Spirits, Wines, and Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid by... taxes incurred on distilled spirits, wines, and beer during the semimonthly or quarterly period. Payment...

  10. Minimally invasive excision of thoracic arachnoid web.

    PubMed

    Vergara, Pierluigi; Barone, Damiano Giuseppe

    2017-09-23

    Arachnoid webs are rare intradural lesions which can cause direct spinal cord compression and/or alteration of the CSF flow with syringomielia. Surgery has been historically performed via wide open laminectomies. The aim of this study is to prove the feasibility of minimally invasive techniques for the excision of arachnoid webs. A retrospective review of two cases of minimally invasive excision of thoracic arachnoid webs was performed. Surgery was carried out through expandable tubular retractors. Complete excision was achieved through the described approach, with minimal bony removal and soft tissue disruption. There were no intra- or peri- operative complications. Both patients were mobilised early and discharged home within 24hrs post-surgery. Postoperative imaging showed good re-expansion of the spinal cord, with no evidence of residual compression or tethering. For symptomatic arachnoid webs, surgery remains the only definitive treatment. In expert hands, the excision of arachnoid webs can be successfully achieved with tubular retractors and minimally invasive techniques. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... of paragraph (a), effective Feb. 22, 2011 through Feb. 24, 2014. ...

  12. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... OF THE TREASURY LIQUORS LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Rum Imported Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise taxes..., collected on all rum imported into the United States (including rum from possessions other than Puerto Rico...

  13. Room Acoustics

    NASA Astrophysics Data System (ADS)

    Kuttruff, Heinrich; Mommertz, Eckard

    The traditional task of room acoustics is to create or formulate conditions which ensure the best possible propagation of sound in a room from a sound source to a listener. Thus, objects of room acoustics are in particular assembly halls of all kinds, such as auditoria and lecture halls, conference rooms, theaters, concert halls or churches. Already at this point, it has to be pointed out that these conditions essentially depend on the question if speech or music should be transmitted; in the first case, the criterion for transmission quality is good speech intelligibility, in the other case, however, the success of room-acoustical efforts depends on other factors that cannot be quantified that easily, not least it also depends on the hearing habits of the listeners. In any case, absolutely "good acoustics" of a room do not exist.

  14. Microsurgical Anatomy of the Internal Acoustic Meatus as Seen Using the Retrosigmoid Approach.

    PubMed

    Scerrati, Alba; Lee, Jung-Shun; Zhang, Jun; Ammirati, Mario

    2016-06-01

    To show via a retrosigmoid approach the bony labyrinth anatomy and its relationship with the internal acoustic meatus so as to provide guidelines for a safer drilling to the fundus using this approach. Few studies deal with the complex anatomy of petrous bone structures as observed by a retrosigmoid approach. Ten retrosigmoid approaches were performed bilaterally on five fresh cadaveric heads. Afterward high-resolution computed tomographic scans were obtained. Measurements of landmarks and distances between important topographic structures of the pyramid were obtained on its surface using a navigation system. Semicircular canals, vestibular aqueduct, and internal acoustic meatus were dissected to show their anatomy and relationships. The anatomy of the inner ear structures was shown. Opening of the internal acoustic meatus was accomplished without injury to the labyrinth in 9 out of 10 sides. The distance between the drilled bone of the internal acoustic meatus and the vestibule was calculated on the postoperative computed tomographic scan. The mean value was 1.43 mm (SD, 0.30 mm; range, 1.0-1.8 mm). A better knowledge of the anatomy of the semicircular canals and of the vestibular aqueduct as observed by a retrosigmoid approach, together with their relationships to the fundus and other petrous bone landmarks, can be useful to get a general orientation in acoustic neuroma surgery. Using this information together with the neuronavigation, we were able to successfully open the internal acoustic meatus without entering labyrinthine structures in 90% of the study dissections.

  15. Brown recluse spider bites. A comparison of early surgical excision versus dapsone and delayed surgical excision.

    PubMed Central

    Rees, R S; Altenbern, D P; Lynch, J B; King, L E

    1985-01-01

    In a prospective study, 31 patients with brown recluse spider bites were treated by either immediate surgical excision or with the leukocyte inhibitor, dapsone, followed by delayed surgical excision. Patients were matched for age, gender, and lesion size and were excluded if the typical history and physical findings were not present. In patients treated with immediate surgical excision (N = 14), delayed wound healing (N = 5) and objectional scarring (N = 7) were common complications. However, pretreatment treatment with dapsone reduced the incidence of wound complications (N = 1) and objectional scarring (N = 1) (p less than 0.05), while reducing the need for surgical excision (N = 1). There were no severe drug reactions due to dapsone, although one patient had persistent G.I. upset. Pretreatment with dapsone not only reduced surgical complications but also improved the outcome of patients bitten by the brown recluse spider. PMID:4051613

  16. Nonlinear source-filter coupling due to the addition of a simplified vocal tract model for excised larynx experiments

    PubMed Central

    Smith, Benjamin L.; Nemcek, Steven P.; Swinarski, Krzysztof A.; Jiang, Jack J.

    2013-01-01

    Objectives Traditional excised larynx dissection and setup calls for the removal of all supraglottal structures, eliminating any source-filter interactions that measurably affect the acoustic properties of phonation. We introduce a simplified vocal tract model that can be used in excised larynx experiments and tested the nonlinear source-filter interactions that are present with the addition of highly-coupled, supraglottal structures. Methods Aerodynamic and acoustic data were measured at phonation threshold pressure (PTP) and +25% PTP in ten excised canine larynges using a modified dissection technique. PTP and phonation threshold flow (PTF) were defined as the pressure and flow at the phonation onset; phonation threshold power (PTW) is the product of these values. Data were recorded for four experimental conditions: PTP without vocal tract; +25% PTP without vocal tract; PTP with vocal tract; +25% PTP with vocal tract. Differences in PTP, PTF, and PTW were evaluated. For trials conducted at +25%PTP, differences in airflow were evaluated. Results PTP (p = 0.009) and PTW (p = 0.002) were significantly reduced with the addition of the novel vocal tract. A reduction in PTF was also present with the vocal tract (p = 0.021) but airflow was not significantly reduced in +25% PTP trials (p = 0.196). Conclusion The proposed vocal tract can be used with complete larynges when conducting excised larynx experiments. The effects of nonlinear source-filter interaction were observed during trials with the vocal tract, as evidenced by changes in threshold aerodynamic parameters. PMID:23490131

  17. 29 CFR 794.121 - Exclusion of excise taxes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Exclusion of excise taxes. 794.121 Section 794.121 Labor... Exclusion of excise taxes. The computation of the annual gross volume of sales of the enterprise for purposes of section 7(b)(3) is made “exclusive of excise taxes.” It will be noted that the excise taxes...

  18. Acoustic biosensors

    PubMed Central

    Fogel, Ronen; Seshia, Ashwin A.

    2016-01-01

    Resonant and acoustic wave devices have been researched for several decades for application in the gravimetric sensing of a variety of biological and chemical analytes. These devices operate by coupling the measurand (e.g. analyte adsorption) as a modulation in the physical properties of the acoustic wave (e.g. resonant frequency, acoustic velocity, dissipation) that can then be correlated with the amount of adsorbed analyte. These devices can also be miniaturized with advantages in terms of cost, size and scalability, as well as potential additional features including integration with microfluidics and electronics, scaled sensitivities associated with smaller dimensions and higher operational frequencies, the ability to multiplex detection across arrays of hundreds of devices embedded in a single chip, increased throughput and the ability to interrogate a wider range of modes including within the same device. Additionally, device fabrication is often compatible with semiconductor volume batch manufacturing techniques enabling cost scalability and a high degree of precision and reproducibility in the manufacturing process. Integration with microfluidics handling also enables suitable sample pre-processing/separation/purification/amplification steps that could improve selectivity and the overall signal-to-noise ratio. Three device types are reviewed here: (i) bulk acoustic wave sensors, (ii) surface acoustic wave sensors, and (iii) micro/nano-electromechanical system (MEMS/NEMS) sensors. PMID:27365040

  19. Acoustic biosensors.

    PubMed

    Fogel, Ronen; Limson, Janice; Seshia, Ashwin A

    2016-06-30

    Resonant and acoustic wave devices have been researched for several decades for application in the gravimetric sensing of a variety of biological and chemical analytes. These devices operate by coupling the measurand (e.g. analyte adsorption) as a modulation in the physical properties of the acoustic wave (e.g. resonant frequency, acoustic velocity, dissipation) that can then be correlated with the amount of adsorbed analyte. These devices can also be miniaturized with advantages in terms of cost, size and scalability, as well as potential additional features including integration with microfluidics and electronics, scaled sensitivities associated with smaller dimensions and higher operational frequencies, the ability to multiplex detection across arrays of hundreds of devices embedded in a single chip, increased throughput and the ability to interrogate a wider range of modes including within the same device. Additionally, device fabrication is often compatible with semiconductor volume batch manufacturing techniques enabling cost scalability and a high degree of precision and reproducibility in the manufacturing process. Integration with microfluidics handling also enables suitable sample pre-processing/separation/purification/amplification steps that could improve selectivity and the overall signal-to-noise ratio. Three device types are reviewed here: (i) bulk acoustic wave sensors, (ii) surface acoustic wave sensors, and (iii) micro/nano-electromechanical system (MEMS/NEMS) sensors.

  20. Intraoral Excision of a Huge Cheek Lipoma.

    PubMed

    Coelho, Rodrigo Carvalho Pinto; Oliveira, Eduardo Morato; Silva, Guilherme Costa Carvalho; Aguiar, Evandro Guimarães; Moreira, Allyson Nogueira; Souza, Leandro Napier

    2017-09-29

    Lipomas are benign tumors of mature adipocytes unusual in the oral and maxillofacial region. The average size of cheek lipomas in the literature ranges from 1.5 to 2.5 cm, with the maximum size of 5 cm. Their etiology remains unclear. Lipomas present, clinically, as well circumscribed, slow growing, painless masses, usually treated by complete excision. The aim of this paper is to present a 78-year-old Caucasian male patient with a huge cheek lipoma compromising facial esthetics and treated through an intraoral excision. Postoperative period was uneventful with no signs of recurrence. Concluding, the intraoral approach is a relatively simple technique that should be taken into account when considering the surgical removal of cheek lipomas.

  1. Transanal local excision of rectal cancer.

    PubMed

    Read, D R; Sokil, S; Ruiz-Salas, G

    1995-01-01

    Twenty-five patients with invasive rectal cancer treated by transanal excision between 1978-1989 are presented. Two patients had poorly differentiated tumours and were converted to abdominoperineal resection and one patient had extensive liver metastases documented preoperatively. The remaining twenty-two, mean age 64 years, fulfilled the criteria for local treatment. Eighty-two percent of tumours were T1 or T2 stage. There was no operative mortality. Six complications in five patients occurred, none requiring surgical intervention. Five patients died of unrelated causes without evidence of recurrence at 4, 4, 14, 26 and 58 months. The length of follow-up for the surviving group (17 patients) was 16 to 115 months (mean 63 months). Two patients developed local recurrence at 32 and 60 months. Transanal excision can be curative for selected rectal cancers.

  2. Robot-Assisted Laparoscopic Renal Schwannoma Excision.

    PubMed

    Kelley, Jeremy; Collins, Ryan; Allam, Christopher

    2016-01-01

    Background: To report the first case of a renal schwannoma excised with robot-assisted laparoscopy. Case Presentation: A 43-year-old Caucasian female patient with vague abdominal symptoms was noted to have incidental right renal mass. Physical examination and laboratory tests were within normal limits. CT revealed a 4.6 cm heterogeneous enhancing right renal mass arising near the hilum. RENAL nephrometry score was 11a. She was treated by right robot-assisted laparoscopic nephrectomy. She recovered well without complications. Pathology analysis revealed a benign renal schwannoma. Conclusion: Renal schwannoma is a rare kidney tumor. We report the first known case of this tumor excised by robot-assisted laparoscopic nephrectomy.

  3. Robot-Assisted Laparoscopic Renal Schwannoma Excision

    PubMed Central

    Kelley, Jeremy; Collins, Ryan

    2016-01-01

    Abstract Background: To report the first case of a renal schwannoma excised with robot-assisted laparoscopy. Case Presentation: A 43-year-old Caucasian female patient with vague abdominal symptoms was noted to have incidental right renal mass. Physical examination and laboratory tests were within normal limits. CT revealed a 4.6 cm heterogeneous enhancing right renal mass arising near the hilum. RENAL nephrometry score was 11a. She was treated by right robot-assisted laparoscopic nephrectomy. She recovered well without complications. Pathology analysis revealed a benign renal schwannoma. Conclusion: Renal schwannoma is a rare kidney tumor. We report the first known case of this tumor excised by robot-assisted laparoscopic nephrectomy. PMID:27872900

  4. 26 CFR 25.2512-7 - Effect of excise tax.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Effect of excise tax. 25.2512-7 Section 25.2512... TAXES GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 Transfers § 25.2512-7 Effect of excise tax. If jewelry, furs or other property, the purchase of which is subject to an excise tax, is purchased at...

  5. 29 CFR 779.264 - Excise taxes separately stated.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes separately stated. 779.264 Section 779.264... Coverage Excise Taxes § 779.264 Excise taxes separately stated. A tax is separately stated where it clearly... was no invoice or sales slip. In the absence of a sales slip or invoice, the amount of the tax may...

  6. Osteoid osteoma: excision with scintimetric guidance

    SciTech Connect

    O'Brien, T.M.; Murray, T.E.; Malone, L.A.; Dervan, P.; Walsh, M.; McManus, R.; Ennis, J.T.

    1984-11-01

    The definite diagnosis of osteoid osteoma relies on the demonstration of the nidus, best shown by CT, which also provides precise preoperative localization of the nidus. While bone-block excision to remove the nidus is feasible in the long bones, there may be unacceptable sequelae in the vertebral column and small bones of the hands. By precisely localizing the nidus, radionuclide scintimetry permits excellent therapeutic results, with minimal morbidity.

  7. Transvaginal sling excision: tips and tricks.

    PubMed

    Clifton, Marisa M; Goldman, Howard B

    2017-01-01

    Complications of synthetic midurethral sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is transvaginal mesh removal. The objectives of this video are to present cases of complications after sling placement and describe techniques to help with successful sling removal. Three patients are presented in this video. One experienced urinary hesitancy and was found to have bladder outlet obstruction on urodynamic study. The second patient presented to the clinic with diminished force of stream and significant dyspareunia. The last patient presented with mesh extrusion. After discussion of management options, all three patients wished to pursue transvaginal sling excision. All patients had successful removal of a portion of their synthetic midurethral sling. This video presents techniques to aide with dissection, mesh excision and prevention of further mesh complications. These include using an individualized surgical technique based on patient presentation and surgeon expertise, planning surgical incisions based on where mesh can be identified or palpated, using a cystoscope sheath or urethral dilator to identify any bladder outlet obstruction, and using a knife blade to identify mesh from surrounding tissue. Sling excision can be successfully performed with careful surgical technique and dissection.

  8. Nucleotide excision repair in Escherichia coli.

    PubMed Central

    Van Houten, B

    1990-01-01

    One of the best-studied DNA repair pathways is nucleotide excision repair, a process consisting of DNA damage recognition, incision, excision, repair resynthesis, and DNA ligation. Escherichia coli has served as a model organism for the study of this process. Recently, many of the proteins that mediate E. coli nucleotide excision have been purified to homogeneity; this had led to a molecular description of this repair pathway. One of the key repair enzymes of this pathway is the UvrABC nuclease complex. The individual subunits of this enzyme cooperate in a complex series of partial reactions to bind to and incise the DNA near a damaged nucleotide. The UvrABC complex displays a remarkable substrate diversity. Defining the structural features of DNA lesions that provide the specificity for damage recognition by the UvrABC complex is of great importance, since it represents a unique form of protein-DNA interaction. Using a number of in vitro assays, researchers have been able to elucidate the action mechanism of the UvrABC nuclease complex. Current research is devoted to understanding how these complex events are mediated within the living cell. PMID:2181258

  9. Acoustic Pump

    NASA Technical Reports Server (NTRS)

    Heyman, Joseph S.

    1993-01-01

    Pump uses acoustic-radiation forces. Momentum transferred from sound waves to sound-propagating material in way resulting in net pumping action on material. Acoustic pump is solid-state pump. Requires no moving parts, entirely miniaturized, and does not invade pumped environment. Silent, with no conventional vibration. Used as pump for liquid, suspension, gas, or any other medium interacting with radiation pressure. Also used where solid-state pump needed for reliability and controllability. In microgravity environment, device offers unusual control for low flow rates. For medical or other applications in which contamination cannot be allowed, offers noninvasive pumping force.

  10. Ultrasound-guided alcohol neurolysis and radiofrequency ablation of painful stump neuroma: effective treatments for post-amputation pain

    PubMed Central

    Zhang, Xin; Xu, Yongming; Zhou, Jin; Pu, Shaofeng; Lv, Yingying; Chen, Yueping; Du, Dongping

    2017-01-01

    Background Post-amputation pain (PAP) is highly prevalent after limb amputation, and stump neuromas play a key role in the generation of the pain. Presently, PAP refractory to medical management is frequently treated with minimally invasive procedures guided by ultrasound, such as alcohol neurolysis and radiofrequency ablation (RFA). Objective To record the immediate and long-term efficacy of alcohol neurolysis and RFA. We first used alcohol neurolysis and then, when necessary, we performed RFA on PAP patients. Study design Prospective case series. Setting Pain management center. Methods Thirteen subjects were treated with ultrasound-guided procedures. Results All patients were treated with neurolysis using alcohol solutions guided by ultrasound. Seven (54%) of 13 subjects achieved pain relief after 1–3 alcohol injection treatments. The remaining 6 subjects obtained pain relief after receiving 2 administrations of ultrasound-guided RFA. After a 6-month follow-up evaluation period, pain quantities were also assessed. Both stump pain (including intermittent sharp pain and continuous burning pain) and phantom pain were relieved. The frequency of intermittent sharp pain was decreased, and no complications were noted during the observation. Conclusion The use of ultrasound guidance for alcohol injection and RFA of painful stump neuromas is a simple, radiation-free, safe, and effective procedure that provides sustained pain relief in PAP patients. In this case series, RFA was found to be an effective alternative to alcohol injection. PMID:28223839

  11. Tautomerization-dependent recognition and excision of oxidation damage in base-excision DNA repair

    PubMed Central

    Zhu, Chenxu; Lu, Lining; Zhang, Jun; Yue, Zongwei; Song, Jinghui; Zong, Shuai; Liu, Menghao; Stovicek, Olivia; Gao, Yi Qin; Yi, Chengqi

    2016-01-01

    NEIL1 (Nei-like 1) is a DNA repair glycosylase guarding the mammalian genome against oxidized DNA bases. As the first enzymes in the base-excision repair pathway, glycosylases must recognize the cognate substrates and catalyze their excision. Here we present crystal structures of human NEIL1 bound to a range of duplex DNA. Together with computational and biochemical analyses, our results suggest that NEIL1 promotes tautomerization of thymine glycol (Tg)—a preferred substrate—for optimal binding in its active site. Moreover, this tautomerization event also facilitates NEIL1-catalyzed Tg excision. To our knowledge, the present example represents the first documented case of enzyme-promoted tautomerization for efficient substrate recognition and catalysis in an enzyme-catalyzed reaction. PMID:27354518

  12. Excised larynx evaluation of wedge-shaped adjustable balloon implant for minimally invasive type I thyroplasty.

    PubMed

    Hoffman, Matthew R; Devine, Erin E; McCulloch, Timothy M; Jiang, Jack J

    2014-04-01

    To describe the method of inserting a wedge-shaped adjustable balloon implant (wABI) via a minithyrotomy for medialization thyroplasty and evaluate its effect on a range of phonatory parameters using the excised larynx bench apparatus. Repeated measures with each larynx serving as its own control. A prototype wABI was deployed in six excised canine larynges of various sizes through a minithyrotomy and then filled with saline. Mucosal wave, aerodynamic, and acoustic parameters were measured for three conditions: normal, vocal fold paralysis, and paralysis with the wABI. Phonation threshold pressure (P < .001), flow (P < .001), and power (P = .002) were significantly lower for wABI compared to paralysis trials; values did not differ significantly from normal trials. Percent jitter (P = .002) and percent shimmer (P = .007) were also significantly decreased compared to the paralysis condition, and values were not significantly different compared to normal. The mucosal wave was preserved after insertion of the wABI. Effective vocal fold medialization with preservation of the mucosal wave was observed with the wABI in this preliminary excised larynx experiment. The wABI offers the potential for a minimally invasive insertion in addition to postoperative adjustability. Further studies in living animals and humans are warranted to evaluate clinical utility. NA. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Excised Larynx Evaluation of Wedge-Shaped Adjustable Balloon Implant for Minimally Invasive Type I Thyroplasty

    PubMed Central

    Hoffman, Matthew R.; Devine, Erin E.; McCulloch, Timothy M.; Jiang, Jack J.

    2014-01-01

    Objectives/Hypothesis To describe the method of inserting a wedge-shaped adjustable balloon implant (wABI) via a minithyrotomy for medialization thyroplasty and evaluate its effect on a range of phonatory parameters using the excised larynx bench apparatus. Study Design Repeated measures with each larynx serving as its own control. Methods A prototype wABI was deployed in six excised canine larynges of various sizes through a minithyrotomy and then filled with saline. Mucosal wave, aerodynamic, and acoustic parameters were measured for three conditions: normal, vocal fold paralysis, and paralysis with the wABI. Results Phonation threshold pressure (P <.001), flow (P <.001), and power (P =.002) were significantly lower for wABI compared to paralysis trials; values did not differ significantly from normal trials. Percent jitter (P =.002) and percent shimmer (P =.007) were also significantly decreased compared to the paralysis condition, and values were not significantly different compared to normal. The mucosal wave was preserved after insertion of the wABI. Conclusions Effective vocal fold medialization with preservation of the mucosal wave was observed with the wABI in this preliminary excised larynx experiment. The wABI offers the potential for a minimally invasive insertion in addition to postoperative adjustability. Further studies in living animals and humans are warranted to evaluate clinical utility. PMID:24115091

  14. Acoustic transducer for acoustic microscopy

    DOEpatents

    Khuri-Yakub, B.T.; Chou, C.H.

    1990-03-20

    A shear acoustic transducer-lens system is described in which a shear polarized piezoelectric material excites shear polarized waves at one end of a buffer rod having a lens at the other end which excites longitudinal waves in a coupling medium by mode conversion at selected locations on the lens. 9 figs.

  15. Acoustic transducer for acoustic microscopy

    DOEpatents

    Khuri-Yakub, Butrus T.; Chou, Ching H.

    1990-01-01

    A shear acoustic transducer-lens system in which a shear polarized piezoelectric material excites shear polarized waves at one end of a buffer rod having a lens at the other end which excites longitudinal waves in a coupling medium by mode conversion at selected locations on the lens.

  16. Pathologic Processing of the Total Mesorectal Excision

    PubMed Central

    Campa-Thompson, Molly; Weir, Robert; Calcetera, Natalie; Quirke, Philip; Carmack, Susanne

    2015-01-01

    Total mesorectal excision (TME) is the current optimal surgical treatment for patients with rectal carcinoma. A complete TME is related to lower local recurrence rates and increased patient survival. Many confounding factors in the patient's anatomy and prior therapy can make it difficult to obtain a perfect plane, and thus a complete TME. The resection specimen can be thoroughly evaluated, grossly and microscopically, to identify substandard surgical outcomes and increased risk of local recurrence. Complete and accurate data reporting is critical for patient care and helps surgeons improve their technique. PMID:25733973

  17. The Effect of Vocal Fold Inferior Surface Hypertrophy on Voice Function in Excised Canine Larynges.

    PubMed

    Wang, Ruiqing; Bao, Huijing; Xu, Xinlin; Piotrowski, David; Zhang, Yu; Zhuang, Peiyun

    2017-08-18

    This study aimed to explore the changes in vocal fold inferior surface hypertrophy (VFISH) on vocal fold vibration by aerodynamic and acoustic analysis. The present study allows us to gain new insights into the subglottal convergence angle (SCA), which will change with VFISH. The study is prospective, and designed for repeated measures with each excised canine larynx serving as own control. Three degrees of VFISH, initial, mild, and severe, were simulated by injecting different doses of fructose injections into the inferior surface of the vocal folds of 10 excised canine larynges. Computed tomographic images of the larynx were gathered, and three-dimensional models of the airway and vocal folds were reconstructed using the Mimics software. The SCA was measured from the reconstructed models. Phonation threshold flow (PTF), phonation threshold pressure (PTP), and mean flow rate (MFR) were recorded directly in the excised canine larynx phonation setup. Glottal resistance (GR), sound pressure level (SPL), fundamental frequency (F0), and formants 1-4 (F1-4) were measured when subglottal pressure (Psub) was at 1.5 kPa or 2.5 kPa, separately. Using ordinary one-way analysis of variance, we compared the aerodynamic outcomes and voice quality among the three groups of hypertrophy. The SCA, PTP, and PTF increased with the degree of VFISH. When the Psub was controlled at 1.5 kPa or 2.5 kPa, F0 also increased significantly with the degree of VFISH of the excised canine larynges. The MFR, GR, SPL, and F1-4 had little change between the three groups and were not significantly different. The VFISH makes onset phonation more difficult, increases the SCA, and increases the F0 in sustained phonation. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  18. Acoustic chaos

    SciTech Connect

    Lauterborn, W.; Parlitz, U.; Holzfuss, J.; Billo, A.; Akhatov, I.

    1996-06-01

    Acoustic cavitation, a complex, spatio-temporal dynamical system, is investigated with respect to its chaotic properties. The sound output, the {open_quote}{open_quote}noise{close_quote}{close_quote}, is subjected to time series analysis. The spatial dynamics of the bubble filaments is captured by high speed holographic cinematography and subsequent digital picture processing from the holograms. Theoretical models are put forward for describing the pattern formation. {copyright} {ital 1996 American Institute of Physics.}

  19. Medical Acoustics

    NASA Astrophysics Data System (ADS)

    Beach, Kirk W.; Dunmire, Barbrina

    Medical acoustics can be subdivided into diagnostics and therapy. Diagnostics are further separated into auditory and ultrasonic methods, and both employ low amplitudes. Therapy (excluding medical advice) uses ultrasound for heating, cooking, permeablizing, activating and fracturing tissues and structures within the body, usually at much higher amplitudes than in diagnostics. Because ultrasound is a wave, linear wave physics are generally applicable, but recently nonlinear effects have become more important, even in low-intensity diagnostic applications.

  20. Endoscopic-assisted excision of esthesioneuroblastoma.

    PubMed

    Prasad, Kishore Chandra; Kumar, Ashwini; Prasad, Sampath Chandra; Jain, Disha

    2007-09-01

    The purpose of this article is to report a case of esthesioneuroblastoma involving the bilateral paranasal sinuses, which was excised using an endoscopic-assisted transfacial approach. A patient presented with nasal swelling and left-sided nasal obstruction, epistaxis, and diplopia. Examination revealed broadening of the nasal dorsum with a fleshy pink mass in both nasal cavities. Computed tomographic scan showed a mass involving the nasal cavity and paranasal sinuses on both sides. The tumor was diagnosed as group C esthesioneuroblastoma. The mass was excised by bilateral medial maxillectomy and bilateral frontoethmoidectomy. Using a 0 degrees endoscope, the attachment of the tumor to the cribriform plate was identified and resected using a motordrill. On Waroff staining, Hispathology slides suggested esthesioneuroblastoma. The patient was asymptomatic for 1 year, following which he developed infection of the nasal cavity for which he had no form of treatment. He subsequently developed maggots in the nasal cavity after which he died. An endoscopic resection of the cribriform plate from the nasal cavity without a formal craniofacial resection can be safely performed with oncologic safety.

  1. Base Excision Repair in the Mitochondria

    PubMed Central

    Prakash, Aishwarya; Doublié, Sylvie

    2015-01-01

    The 16.5 kb human mitochondrial genome encodes for 13 polypeptides, 22 tRNAs and 2 rRNAs involved in oxidative phosphorylation. Mitochondrial DNA (mtDNA), unlike its nuclear counterpart, is not packaged into nucleosomes and is more prone to the adverse effects of reactive oxygen species (ROS) generated during oxidative phosphorylation. The past few decades have witnessed an increase in the number of proteins observed to translocate to the mitochondria for the purposes of mitochondrial genome maintenance. The mtDNA damage produced by ROS, if not properly repaired, leads to instability and can ultimately manifest in mitochondrial dysfunction and disease. The base excision repair (BER) pathway is employed for the removal and consequently the repair of deaminated, oxidized, and alkylated DNA bases. Specialized enzymes called DNA glycosylases, which locate and cleave the damaged base, catalyze the first step of this highly coordinated repair pathway. This review focuses on members of the four human BER DNA glycosylase superfamilies and their subcellular localization in the mitochondria and/or the nucleus, as well as summarizes their structural features, biochemical properties, and functional role in the excision of damaged bases. PMID:25754732

  2. Boron Uptake by Excised Barley Roots

    PubMed Central

    Bowen, John E.; Nissen, Per

    1976-01-01

    At 2 C, all boron accumulated by excised barley roots (Hordeum vulgare L. cv. Herta) remains in the free space; i.e. active uptake is nil at this temperature. Three component fractions of free space B were apparent: (a) a surface contaminant film of B on blotted roots, (b) water free space B, and (c) B reversibly bound in the cell walls. A stoichiometric release of H+ from the roots in the presence of B indicated that B was bound by borate complexes with polysaccharides in the cell walls. Polysaccharide-borate complexes are much less stable than those of monosaccharides, and the bound B fraction could be readily removed by rinsing the roots in the presence of a monomeric polyol possessing the necessary cis-diol configuration. Cell wall material separated from excised barley roots had a B binding capacity 66% greater than that of intact roots. A 30-minute rinse in distilled H2O or 0.5 mm CaSO4 was required to remove all cell wall-bound B from the roots after a 30-minute uptake period. Thus, although B in the contaminant surface film and the water free space is rinsed from the roots within 10 minutes, a 30-minute rinse is essential if all reversibly accumulated B is to be removed from the free space. PMID:16659482

  3. Acoustic dose and acoustic dose-rate.

    PubMed

    Duck, Francis

    2009-10-01

    Acoustic dose is defined as the energy deposited by absorption of an acoustic wave per unit mass of the medium supporting the wave. Expressions for acoustic dose and acoustic dose-rate are given for plane-wave conditions, including temporal and frequency dependencies of energy deposition. The relationship between the acoustic dose-rate and the resulting temperature increase is explored, as is the relationship between acoustic dose-rate and radiation force. Energy transfer from the wave to the medium by means of acoustic cavitation is considered, and an approach is proposed in principle that could allow cavitation to be included within the proposed definitions of acoustic dose and acoustic dose-rate.

  4. Evaluation of type II thyroplasty on phonatory physiology in an excised canine larynx model.

    PubMed

    Devine, Erin E; Hoffman, Matthew R; McCulloch, Timothy M; Jiang, Jack J

    2017-02-01

    Type II thyroplasty is an alternative treatment for spasmodic dysphonia, addressing hyperadduction by incising and lateralizing the thyroid cartilage. We quantified the effect of lateralization width on phonatory physiology using excised canine larynges. Normal closure, hyperadduction, and type II thyroplasty (lateralized up to 5 mm at 1-mm increments with hyperadducted arytenoids) were simulated in excised larynges (N = 7). Aerodynamic, acoustic, and videokymographic data were recorded at three subglottal pressures relative to phonation threshold pressure (PTP). One-way repeated measures analysis of variance assessed effect of condition on aerodynamic parameters. Random intercepts linear mixed effects models assessed effects of condition and subglottal pressure on acoustic and videokymographic parameters. PTP differed across conditions (P < .001). Condition affected percent shimmer (P < .005) but not percent jitter. Both pressure (P < .03) and condition (P < .001) affected fundamental frequency. Pressure affected vibratory amplitude (P < .05) and intrafold phase difference (P < .05). Condition affected phase difference between the vocal folds (P < .001). Hyperadduction increased PTP and worsened perturbation compared to normal, with near normal physiology restored with 1-mm lateralization. Further lateralization deteriorated voice quality and increased PTP. Acoustic and videokymographic results indicate that normal physiologic relationships between subglottal pressure and vibration are preserved at optimal lateralization width, but then degrade with further lateralization. The 1-mm optimal width observed here is due to the small canine larynx size. Future human trials would likely demonstrate a greater optimal width, with patient-specific value potentially determined based on larynx size and symptom severity. NA Laryngoscope, 2016 127:396-404, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies

    PubMed Central

    Elmasry, Moustafa; Steinvall, Ingrid; Thorfinn, Johan; Abdelrahman, Islam; Olofsson, Pia; Sjoberg, Folke

    2017-01-01

    Background: Different surgical techniques have evolved since excision and autografting became the treatment of choice for deep burns in the 1970s. The treatment plan at the Burn Center, Linköping University Hospital, Sweden, has shifted from single-stage excision and immediate autografting to staged excisions and temporary cover with xenografts before autografting. The aim of this study was to find out if the change in policy resulted in extended duration of hospital stay/total body surface area burned (LOS/TBSA%). Methods: Retrospective clinical cohort including surgically-managed patients with burns of 15%-60% TBSA% within each treatment group. The first had early full excisions of deep dermal and full thickness burns and immediate autografts (1997-98), excision and immediate autograft group) and the second had staged excisions before final autografts using xenografts for temporary cover (2010-11, staged excision group). Results: The study included 57 patients with deep dermal and full-thickness burns, 28 of whom had excision and immediate autografting, and 29 of whom had staged excisions with xenografting before final autografting. Adjusted (LOS/TBSA%) was close to 1, and did not differ between groups. Mean operating time for the staged excision group was shorter and the excised area/operation was smaller. The total operating time/TBSA% did not differ between groups. Conclusion: Staged excisions with temporary cover did not affect adjusted LOS/TBSA% or total operating time. Staged excisions may be thought to be more expensive because of the cost of covering the wound between stages, but this needs to be further investigated as do the factors that predict long term outcome. PMID:28123862

  6. Precise excision of transposons and point mutations induced by chemicals.

    PubMed

    Rusina OYu; Mirskaya, E E; Andreeva, I V; Skavronskaya, A G

    1992-11-01

    The ability of 23 chemicals (carcinogens and non-carcinogens) to induce precise excision of Tn10 and point mutations was studied in experiments with a single strain. The mutation assay was shown to detect a wider spectrum of genotoxic agents than the assay of Tn10 precise excision. The latter was induced only by potent SOS mutagens, which is in accordance with data on the SOS dependence of the induction of precise excision of Tn10. The precise excision assay as an additional test contributing to the knowledge of particular features of the action of a tested mutagen is discussed. The induction of precise excision of Tn10 by pyrene (and its failure to induce point mutations in this strain) demonstrates the value of using the transposon excision assay in cases of 'problem' mutagens.

  7. Acoustic Tooth Cleaner

    NASA Technical Reports Server (NTRS)

    Heyman, J. S.

    1984-01-01

    Acoustically-energized water jet aids in plaque breakdown. Acoustic Wand includes acoustic transducer 1/4 wave plate, and tapered cone. Together elements energize solution of water containing mild abrasive injected into mouth to help prevent calculous buildup.

  8. Neuroma-in-continuity of the median nerve managed by nerve expansion and direct suture with vein conduit.

    PubMed

    Jeudy, J; Raimbeau, G; Rabarin, F; Fouque, P A; Saint-Cast, Y; Césari, B; Bigorre, N

    2014-06-01

    Autologous nerve grafting is the current standard for bridging large gaps in major sensory and motor nerves. It allows both function and pain improvement with predictable results. Clinical observations of nerve elongation caused by tumours have prompted experimental animal studies of induced gradual elongation of the nerve stump proximal to the gap. This technique allows direct suturing of the two nerve ends to bridge the gap. Here, we describe a case of neuroma-in-continuity of the median nerve managed by resection and direct suture after nerve elongation with a tissue expander. We are not aware of similar reported cases. Secondary repair 3 years after the initial injury improved the pain and hypersensitivity and restored a modest degree of protective sensory function (grade S1). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Variation in Base Excision Repair Capacity

    PubMed Central

    Wilson, David M.; Kim, Daemyung; Berquist, Brian R.; Sigurdson, Alice J.

    2010-01-01

    The major DNA repair pathway for coping with spontaneous forms of DNA damage, such as natural hydrolytic products or oxidative lesions, is base excision repair (BER). In particular, BER processes mutagenic and cytotoxic DNA lesions such as non-bulky base modifications, abasic sites, and a range of chemically distinct single-strand breaks. Defects in BER have been linked to cancer predisposition, neurodegenerative disorders, and immunodeficiency. Recent data indicate a large degree of sequence variability in DNA repair genes and several studies have associated BER gene polymorphisms with disease risk, including cancer of several sites. The intent of this review is to describe the range of BER capacity among individuals and the functional consequences of BER genetic variants. We also discuss studies that associate BER deficiency with disease risk and the current state of BER capacity measurement assays. PMID:21167187

  10. Local excision by transanal endoscopic surgery

    PubMed Central

    García-Flórez, Luis J; Otero-Díez, Jorge L

    2015-01-01

    Transanal endoscopic surgery (TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years, these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or, in some controlled trials, experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology, like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision. PMID:26309355

  11. Elasticity of excised dog lung parenchyma

    NASA Technical Reports Server (NTRS)

    Vawter, D. L.; Fung, Y. C.; West, J. B.

    1978-01-01

    An optical-electromechanical system is used to measure the force-deformation behavior of biaxially loaded rectangular slabs of excised dog lung parenchyma. In the course of the study, the effects of time, the consistency of reference lengths and areas, the presence of hysteresis, the necessity of preconditioning, the repeatability of results, the effects of lateral load, the effect of strain rate, the effect of pH, the influence of temperature, and the variations among specimens are considered. A new finding is that there is a change in elastic behavior when the tissue undergoes a compressive strain. When the tissue is in tension, increasing the lateral load decreases the compliance, whereas the opposite is true when compressive strain is present.

  12. Piezosurgery for Excision of Large Osteoid Osteoma.

    PubMed

    Gadre, Pushkar; Singh, Divya; Gadre, Kiran; Khan, Imran

    2016-10-01

    Osteoid osteoma, a rare benign osteoblastic tumor first described by Jaffe in 1935, is characterized as a small but painful lesion that mostly affects younger people. Usually benign and harmless, osteomas are removed for pain or esthetic reasons.Piezoelectric surgery is also increasingly being used effectively in major and minor osseous oral and maxillofacial surgeries, in delicate areas. It is used regularly for various procedures, including sinus lift procedures, bone graft harvesting, osteogenic distraction, ridge expansion, inferior alveolar nerve decompression and lateralization, cyst removal, dental extraction, and impacted tooth removal.The following report presents a patient of intraoral excision of a large osteoid osteoma from lingual aspect of mandibular lower border in the body region using piezoelectric surgery.

  13. Elasticity of excised dog lung parenchyma

    NASA Technical Reports Server (NTRS)

    Vawter, D. L.; Fung, Y. C.; West, J. B.

    1978-01-01

    An optical-electromechanical system is used to measure the force-deformation behavior of biaxially loaded rectangular slabs of excised dog lung parenchyma. In the course of the study, the effects of time, the consistency of reference lengths and areas, the presence of hysteresis, the necessity of preconditioning, the repeatability of results, the effects of lateral load, the effect of strain rate, the effect of pH, the influence of temperature, and the variations among specimens are considered. A new finding is that there is a change in elastic behavior when the tissue undergoes a compressive strain. When the tissue is in tension, increasing the lateral load decreases the compliance, whereas the opposite is true when compressive strain is present.

  14. Mammalian transcription-coupled excision repair.

    PubMed

    Vermeulen, Wim; Fousteri, Maria

    2013-08-01

    Transcriptional arrest caused by DNA damage is detrimental for cells and organisms as it impinges on gene expression and thereby on cell growth and survival. To alleviate transcriptional arrest, cells trigger a transcription-dependent genome surveillance pathway, termed transcription-coupled nucleotide excision repair (TC-NER) that ensures rapid removal of such transcription-impeding DNA lesions and prevents persistent stalling of transcription. Defective TC-NER is causatively linked to Cockayne syndrome, a rare severe genetic disorder with multisystem abnormalities that results in patients' death in early adulthood. Here we review recent data on how damage-arrested transcription is actively coupled to TC-NER in mammals and discuss new emerging models concerning the role of TC-NER-specific factors in this process.

  15. Base excision repair capacity in informing healthspan

    PubMed Central

    Brenerman, Boris M.; Illuzzi, Jennifer L.; Wilson, David M.

    2014-01-01

    Base excision repair (BER) is a frontline defense mechanism for dealing with many common forms of endogenous DNA damage, several of which can drive mutagenic or cell death outcomes. The pathway engages proteins such as glycosylases, abasic endonucleases, polymerases and ligases to remove substrate modifications from DNA and restore the genome back to its original state. Inherited mutations in genes related to BER can give rise to disorders involving cancer, immunodeficiency and neurodegeneration. Studies employing genetically defined heterozygous (haploinsufficient) mouse models indicate that partial reduction in BER capacity can increase vulnerability to both spontaneous and exposure-dependent pathologies. In humans, measurement of BER variation has been imperfect to this point, yet tools to assess BER in epidemiological surveys are steadily evolving. We provide herein an overview of the BER pathway and discuss the current efforts toward defining the relationship of BER defects with disease susceptibility. PMID:25355293

  16. Molecular mechanisms of pyrimidine dimer excision in Saccharomyces cerevisiae: excision of dimers in cell extracts

    SciTech Connect

    Reynolds, R.J.; Love, J.D.; Friedberg, E.C.

    1981-08-01

    Cell-free extracts prepared from rad1-19, rad2-2, rad3-1, rad4-3, rad7-1, rad10-1, rad14-1, rad16-1, and cycl-1 (rad7) mutants of Saccharomyces cerevisiae all catalyze the preferential excision of thymine-containing pyrimidine dimers from ultraviolet-irradiated DNA specifically incised with M. luteus ultraviolet deoxyribonucleic acid incising activity.

  17. Acoustic transducer

    DOEpatents

    Drumheller, Douglas S.

    1997-01-01

    An acoustic transducer comprising a one-piece hollow mandrel into the outer surface of which is formed a recess with sides perpendicular to the central axis of the mandrel and separated by a first distance and with a bottom parallel to the central axis and within which recess are a plurality of washer-shaped discs of a piezoelectric material and at least one disc of a temperature-compensating material with the discs being captured between the sides of the recess in a pre-stressed interference fit, typically at 2000 psi of compressive stress. The transducer also includes a power supply and means to connect to a measurement device. The transducer is intended to be used for telemetry between a measurement device located downhole in an oil or gas well and the surface. The transducer is of an construction that is stronger with fewer joints that could leak fluids into the recess holding the piezoelectric elements than is found in previous acoustic transducers.

  18. Acoustic transducer

    DOEpatents

    Drumheller, D.S.

    1997-12-30

    An acoustic transducer is described comprising a one-piece hollow mandrel into the outer surface of which is formed a recess with sides perpendicular to the central axis of the mandrel and separated by a first distance and with a bottom parallel to the central axis and within which recess are a plurality of washer-shaped discs of a piezoelectric material and at least one disc of a temperature-compensating material with the discs being captured between the sides of the recess in a pre-stressed interference fit, typically at 2,000 psi of compressive stress. The transducer also includes a power supply and means to connect to a measurement device. The transducer is intended to be used for telemetry between a measurement device located downhole in an oil or gas well and the surface. The transducer is of an construction that is stronger with fewer joints that could leak fluids into the recess holding the piezoelectric elements than is found in previous acoustic transducers. 4 figs.

  19. Acoustic iridescence.

    PubMed

    Cox, Trevor J

    2011-03-01

    An investigation has been undertaken into acoustic iridescence, exploring how a device can be constructed which alter sound waves, in a similar way to structures in nature that act on light to produce optical iridescence. The main construction had many thin perforated sheets spaced half a wavelength apart for a specified design frequency. The sheets create the necessary impedance discontinuities to create backscattered waves, which then interfere to create strongly reflected sound at certain frequencies. Predictions and measurements show a set of harmonics, evenly spaced in frequency, for which sound is reflected strongly. And the frequency of these harmonics increases as the angle of observation gets larger, mimicking the iridescence seen in natural optical systems. Similar to optical systems, the reflections become weaker for oblique angles of reflection. A second construction was briefly examined which exploited a metamaterial made from elements and inclusions which were much smaller than the wavelength. Boundary element method predictions confirmed the potential for creating acoustic iridescence from layers of such a material.

  20. 48 CFR 970.2902 - Federal excise taxes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Federal excise taxes. 970.2902 Section 970.2902 Federal Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Taxes 970.2902 Federal excise taxes....

  1. 27 CFR 24.323 - Excise Tax Return form.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Excise Tax Return form. 24.323 Section 24.323 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Records and Reports § 24.323 Excise Tax Return form. A proprietor who...

  2. Excision technique in constrained formulations of Einstein equations: collapse scenario

    NASA Astrophysics Data System (ADS)

    Cordero-Carrión, I.; Vasset, N.; Novak, J.; Jaramillo, J. L.

    2015-04-01

    We present a new excision technique used in constrained formulations of Einstein equations to deal with black hole in numerical simulations. We show the applicability of this scheme in several scenarios. In particular, we present the dynamical evolution of the collapse of a neutron star to a black hole, using the CoCoNuT code and this excision technique.

  3. Mechanism of integration and excision in conjugative transposons.

    PubMed

    Mullany, P; Roberts, A P; Wang, H

    2002-12-01

    Translocation of conjugative transposons proceeds via excision of the element to generate a circular molecule that can then integrate into a new site, which can be in the same or a different cell. This review summarises some of the different mechanisms used for excision and integration of conjugative transposons.

  4. 76 FR 66181 - Disregarded Entities; Excise Taxes and Employment Taxes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-26

    ... Internal Revenue Service 26 CFR Part 301 RIN 1545-BH90 Disregarded Entities; Excise Taxes and Employment Taxes AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final regulations and removal of... and excise taxes. These regulations also make conforming changes to the tax liability rule...

  5. 26 CFR 25.2512-7 - Effect of excise tax.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Effect of excise tax. 25.2512-7 Section 25.2512-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 Transfers § 25.2512-7 Effect of excise tax....

  6. P element excision in drosophila melanogaster and related drosophilids

    USDA-ARS?s Scientific Manuscript database

    The frequency of P element excision and the structure of the resulting excision products were determined in three drosophilid species, Drosophila melanogaster, D. virilis, and Chymomyza procnemis. A transient P element mobility assay was conducted in the cells of developing insect embryos, but unlik...

  7. Adaptive Signal Processing Testbed signal excision software: User's manual

    NASA Astrophysics Data System (ADS)

    Parliament, Hugh A.

    1992-05-01

    The Adaptive Signal Processing Testbed (ASPT) signal excision software is a set of programs that provide real-time processing functions for the excision of interfering tones from a live spread-spectrum signal as well as off-line functions for the analysis of the effectiveness of the excision technique. The processing functions provided by the ASPT signal excision software are real-time adaptive filtering of live data, storage to disk, and file sorting and conversion. The main off-line analysis function is bit error determination. The purpose of the software is to measure the effectiveness of an adaptive filtering algorithm to suppress interfering or jamming signals in a spread spectrum signal environment. A user manual for the software is provided, containing information on the different software components available to perform signal excision experiments: the real-time excision software, excision host program, file processing utilities, and despreading and bit error rate determination software. In addition, information is presented describing the excision algorithm implemented, the real-time processing framework, the steps required to add algorithms to the system, the processing functions used in despreading, and description of command sequences for post-run analysis of the data.

  8. Nonlinear source-filter coupling due to the addition of a simplified vocal tract model for excised larynx experiments.

    PubMed

    Smith, Benjamin L; Nemcek, Steven P; Swinarski, Krzysztof A; Jiang, Jack J

    2013-05-01

    Traditional excised larynx dissection and setup calls for the removal of all supraglottal structures, eliminating any source-filter interactions that measurably affect the acoustic properties of phonation. We introduce a simplified vocal tract model that can be used in the excised larynx experiments and tested the nonlinear source-filter interactions that are present with the addition of highly coupled, supraglottal structures. Aerodynamic and acoustic data were measured at phonation threshold pressure (PTP) and +25% PTP in 10 excised canine larynges using a modified dissection technique. PTP and phonation threshold flow (PTF) were defined as the pressure and flow at the phonation onset; phonation threshold power (PTW) is the product of these values. Data were recorded for four experimental conditions: PTP without vocal tract; +25% PTP without vocal tract; PTP with vocal tract; and +25% PTP with vocal tract. Differences in PTP, PTF, and PTW were evaluated. For trials conducted at +25% PTP, differences in airflow were evaluated. PTP (P = 0.009) and PTW (P = 0.002) were significantly reduced with the addition of the novel vocal tract. A reduction in PTF was also present with the vocal tract (P = 0.021), but airflow was not significantly reduced in +25% PTP trials (P = 0.196). The proposed vocal tract can be used with complete larynges when conducting excised larynx experiments. The effects of nonlinear source-filter interaction were observed during trials with the vocal tract, as evidenced by changes in threshold aerodynamic parameters. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  9. The Versajet water dissector: a new tool for tangential excision.

    PubMed

    Klein, Matthew B; Hunter, Sue; Heimbach, David M; Engrav, Loren H; Honari, Shari; Gallery, Ellen; Kiriluk, Diane-Marie; Gibran, Nicole S

    2005-01-01

    Goulian and Watson knives work well for tangential burn excision on large flat areas. They do not work well in small areas and in areas with a three-dimensional structure. The Versajet Hydrosurgery System (Smith and Nephew, Key Largo, FL) is a new waterjet-powered surgical tool designed for wound excision. The small size of the cutting nozzle and the ability to easily maneuver the water dissector into small spaces makes it a potentially useful tool for excision of burns of the eyelids, digits and web spaces. The Versajet Hydrosurgery System contains a power console that propels saline through a handheld cutting device. This stream of pressurized saline functions as a knife. We have used the Versajet for burn excision in 44 patients. Although there is a learning curve for both surgeons using and operating room staff setting up the device, the Versajet provides a relatively facile method for excision of challenging aesthetic and functional areas.

  10. Dimer excision in Escherichia coli in the presence of caffeine

    SciTech Connect

    Rothman, R.H.

    1980-07-01

    The observation that polA1 and recL152 mutations result in both slow pyrimidine dimer excision and large repair patch size leads to the hypothesis that patch size is directly related to the rate of excision. In this study caffeine, a known inhibitor of excision repair, was used to examine the extent of correlation between excision rate and patch size by measuring patch size in the presence of several concentrations of caffeine. Both the rate of excision and the resistance to ultraviolet radiation were reduced with increasing concentrations of caffeine after irradiation. Caffeine also inhibited the rate at which incisions were made and prolonged the time required to rejoin the discontinuities. Patch size, however, was unaffected by caffeine treatment.

  11. Alar base reduction: the boomerang-shaped excision.

    PubMed

    Foda, Hossam M T

    2011-04-01

    A boomerang-shaped alar base excision is described to narrow the nasal base and correct the excessive alar flare. The boomerang excision combined the external alar wedge resection with an internal vestibular floor excision. The internal excision was inclined 30 to 45 degrees laterally to form the inner limb of the boomerang. The study included 46 patients presenting with wide nasal base and excessive alar flaring. All cases were followed for a mean period of 18 months (range, 8 to 36 months). The laterally oriented vestibular floor excision allowed for maximum preservation of the natural curvature of the alar rim where it meets the nostril floor and upon its closure resulted in a considerable medialization of alar lobule, which significantly reduced the amount of alar flare and the amount of external alar excision needed. This external alar excision measured, on average, 3.8 mm (range, 2 to 8 mm), which is significantly less than that needed when a standard vertical internal excision was used ( P < 0.0001). Such conservative external excisions eliminated the risk of obliterating the natural alar-facial crease, which did not occur in any of our cases. No cases of postoperative bleeding, infection, or vestibular stenosis were encountered. Keloid or hypertrophic scar formation was not encountered; however, dermabrasion of the scars was needed in three (6.5%) cases to eliminate apparent suture track marks. The boomerang alar base excision proved to be a safe and effective technique for narrowing the nasal base and elimination of the excessive flaring and resulted in a natural, well-proportioned nasal base with no obvious scarring.

  12. Acoustic cryocooler

    SciTech Connect

    Swift, G.W.; Martin, R.A.; Radebaugh, R.

    1989-09-26

    An acoustic cryocooler with no moving parts is formed from a thermoacoustic driver (TAD) driving a pulse tube refrigerator (PTR) through a standing wave tube. Thermoacoustic elements in the TAD are spaced apart a distance effective to accommodate the increased thermal penetration length arising from the relatively low TAD operating frequency in the range of 15-60 Hz. At these low operating frequencies, a long tube is required to support the standing wave. The tube may be coiled to reduce the overall length of the cryocooler. One or two PTR's are located on the standing wave tube adjacent antinodes in the standing wave to be driven by the standing wave pressure oscillations. It is predicted that a heat input of 1000 W at 1000 K will maintain a cooling load of 5 W at 80 K. 3 figs.

  13. Acoustic cryocooler

    SciTech Connect

    Swift, G.W.; Martin, R.A.; Radebaugh, R.

    1990-09-04

    This patent describes an acoustic cryocooler with no moving parts is formed from a thermoacoustic driver (TAD) driving a pulse tube refrigerator (PTR) through a standing wave tube. Thermoacoustic elements in the TAD are spaced apart a distance effect to accommodate the increased thermal penetration length arising from the relatively low TAD operating frequency in the range of 15--60 Hz. At these low operating frequencies, a long tube is required to support the standing wave. The tube may be coiled to reduce the overall length of the cryocooler. One or two PTR's are located on the standing wave tube adjacent antinodes in the standing wave to be driven by the standing wave pressure oscillations. It is predicted that a heat input of 1000 W at 1000 K will maintain a cooling load of 5 W at 80 K.

  14. Acoustic cryocooler

    DOEpatents

    Swift, Gregory W.; Martin, Richard A.; Radenbaugh, Ray

    1990-01-01

    An acoustic cryocooler with no moving parts is formed from a thermoacoustic driver (TAD) driving a pulse tube refrigerator (PTR) through a standing wave tube. Thermoacoustic elements in the TAD are spaced apart a distance effective to accommodate the increased thermal penetration length arising from the relatively low TAD operating frequency in the range of 15-60 Hz. At these low operating frequencies, a long tube is required to support the standing wave. The tube may be coiled to reduce the overall length of the cryocooler. One or two PTR's are located on the standing wave tube adjacent antinodes in the standing wave to be driven by the standing wave pressure oscillations. It is predicted that a heat input of 1000 W at 1000 K will maintian a cooling load of 5 W at 80 K.

  15. Acoustic transducer

    DOEpatents

    Drumheller, Douglas S.

    2000-01-01

    An active acoustic transducer tool for use down-hole applications. The tool includes a single cylindrical mandrel including a shoulder defining the boundary of a narrowed portion over which is placed a sandwich-style piezoelectric tranducer assembly. The piezoelectric transducer assembly is prestressed by being placed in a thermal interference fit between the shoulder of the mandrel and the base of an anvil which is likewise positioned over the narrower portion of the mandrel. In the preferred embodiment, assembly of the tool is accomplished using a hydraulic jack to stretch the mandrel prior to emplacement of the cylindrical sandwich-style piezoelectric transducer assembly and anvil. After those elements are positioned and secured, the stretched mandrel is allowed to return substantially to its original (pre-stretch) dimensions with the result that the piezoelectric transducer elements are compressed between the anvil and the shoulder of the mandrel.

  16. Acoustic hemostasis

    NASA Astrophysics Data System (ADS)

    Crum, L.; Andrew, M.; Bailey, M.; Beach, K.; Brayman, A.; Curra, F.; Kaczkowski, P.; Kargl, S.; Martin, R.; Vaezy, S.

    2003-04-01

    Over the past several years, the Center for Industrial and Medical Ultrasound (CIMU) at the Applied Physics Laboratory in the University of Washington has undertaken a broad research program in the general area of High Intensity Focused Ultrasound (HIFU). Our principal emphasis has been on the use of HIFU to induce hemostasis; in particular, CIMU has sought to develop a small, lightweight, portable device that would use ultrasound for both imaging and therapy. Such a technology is needed because nearly 50% of combat casualty mortality results from exsanguinations, or uncontrolled bleeding. A similar percentage occurs for civilian death due to trauma. In this general review, a presentation of the general problem will be given, as well as our recent approaches to the development of an image-guided, transcutaneous, acoustic hemostasis device. [Work supported in part by the USAMRMC, ONR and the NIH.

  17. Acoustic telemetry.

    SciTech Connect

    Drumheller, Douglas Schaeffer; Kuszmaul, Scott S.

    2003-08-01

    Broadcasting messages through the earth is a daunting task. Indeed, broadcasting a normal telephone conversion through the earth by wireless means is impossible with todays technology. Most of us don't care, but some do. Industries that drill into the earth need wireless communication to broadcast navigation parameters. This allows them to steer their drill bits. They also need information about the natural formation that they are drilling. Measurements of parameters such as pressure, temperature, and gamma radiation levels can tell them if they have found a valuable resource such as a geothermal reservoir or a stratum bearing natural gas. Wireless communication methods are available to the drilling industry. Information is broadcast via either pressure waves in the drilling fluid or electromagnetic waves in the earth and well tubing. Data transmission can only travel one way at rates around a few baud. Given that normal Internet telephone modems operate near 20,000 baud, these data rates are truly very slow. Moreover, communication is often interrupted or permanently blocked by drilling conditions or natural formation properties. Here we describe a tool that communicates with stress waves traveling through the steel drill pipe and production tubing in the well. It's based on an old idea called Acoustic Telemetry. But what we present here is more than an idea. This tool exists, it's drilled several wells, and it works. Currently, it's the first and only acoustic telemetry tool that can withstand the drilling environment. It broadcasts one way over a limited range at much faster rates than existing methods, but we also know how build a system that can communicate both up and down wells of indefinite length.

  18. Diode Laser Excision of Oral Benign Lesions

    PubMed Central

    Mathur, Ena; Sareen, Mohit; Dhaka, Payal; Baghla, Pallavi

    2015-01-01

    Introduction: Lasers have made tremendous progress in the field of dentistry and have turned out to be crucial in oral surgery as collateral approach for soft tissue surgery. This rapid progress can be attributed to the fact that lasers allow efficient execution of soft tissue procedures with excellent hemostasis and field visibility. When matched to scalpel, electrocautery or high frequency devices, lasers offer maximum postoperative patient comfort. Methods: Four patients agreed to undergo surgical removal of benign lesions of the oral cavity. 810 nm diode lasers were used in continuous wave mode for excisional biopsy. The specimens were sent for histopathological examination and patients were assessed on intraoperative and postoperative complications. Results: Diode laser surgery was rapid, bloodless and well accepted by patients and led to complete resolution of the lesions. The excised specimen proved adequate for histopathological examination. Hemostasis was achieved immediately after the procedure with minimal postoperative problems, discomfort and scarring. Conclusion: We conclude that diode lasers are rapidly becoming the standard of care in contemporary dental practice and can be employed in procedures requiring excisional biopsy of oral soft tissue lesions with minimal problems in histopathological diagnosis. PMID:26464781

  19. Lingual Thyroid Excision with Transoral Robotic Surgery

    PubMed Central

    Ersoy Callıoglu, Elif; Bozdemir, Kazım; Ulusoy, Bulent; Oguzhan, Tolga; Korkmaz, M. Hakan

    2015-01-01

    Ectopic thyroid gland may be detected at any place between foramen caecaum and normal thyroid localization due to inadequacy of the embryological migration of the thyroid gland. It has a prevalence varying between 1/10.000 and 1/100000 in the community. Usually follow-up without treatment is preferred except for obstructive symptoms, bleeding, and suspicion of malignity. Main symptoms are dysphagia, dysphonia, bleeding, dyspnea, and obstructive sleep apnea. In symptomatic cases, the first described method in surgical treatment is open approach since it is a region difficult to have access to. However, this approach has an increased risk of morbidity and postoperative complications. Transoral robotic surgery, which is a minimally invasive surgical procedure, has advantages such as larger three-dimensional point of view and ease of manipulation due to robotic instruments. In this report, a case at the age of 49 who presented to our clinic with obstructive symptoms increasing within the last year and was found to have lingual thyroid and underwent excision of ectopic thyroid tissue by da Vinci surgical system is presented. PMID:26064746

  20. Phonation instability flow in excised canine larynges

    PubMed Central

    Hoffman, Matthew R.; Rieves, Adam L.; Budde, Adam J.; Surender, Ketan; Zhang, Yu; Jiang, Jack J.

    2011-01-01

    Objective Disordered voices are often associated with abnormal changes in aerodynamic parameters of subglottal pressure and airflow. Phonation instability pressure (PIP) has been previously proposed to evaluate subglottal pressure at the onset of chaotic phonation. We propose the concept of and measure phonation instability flow (PIF), the airflow at which phonation becomes chaotic. Phonation flow range (PFR), PIF minus phonation threshold flow (PTF), is proposed to assess the range over which normal vocal fold vibration occurs. Study Design Repeated measures with each ex vivo larynx serving as its own control. Methods Pressure and airflow were measured at phonation onset and chaos onset in seven excised canine larynges under three experimental conditions: 0% elongation with no glottal gap; 20% elongation with no glottal gap; 20% elongation with a 3 mm posterior glottal gap. Paired t-tests were performed to determine if experimental measurements differed between elongations (0% and 20%) or degrees of abduction (20% elongation with and without a 3 mm glottal gap). Results Both PIF and PFR were dependent on abduction but not elongation. PIP was not significantly dependent on either condition. PIF and PFR showed greater differences for abduction than either phonation threshold pressure (PTP) or PTF. Conclusions PIF and PFR may be useful parameters in the experimental or clinical settings, particularly when evaluating disorders characterized by a glottal gap such as vocal fold paralysis and presbylaryngis. PMID:21555205

  1. Experiments on Analysing Voice Production: Excised (Human, Animal) and In Vivo (Animal) Approaches

    PubMed Central

    Döllinger, Michael; Kobler, James; Berry, David A.; Mehta, Daryush D.; Luegmair, Georg; Bohr, Christopher

    2015-01-01

    Experiments on human and on animal excised specimens as well as in vivo animal preparations are so far the most realistic approaches to simulate the in vivo process of human phonation. These experiments do not have the disadvantage of limited space within the neck and enable studies of the actual organ necessary for phonation, i.e., the larynx. The studies additionally allow the analysis of flow, vocal fold dynamics, and resulting acoustics in relation to well-defined laryngeal alterations. Purpose of Review This paper provides an overview of the applications and usefulness of excised (human/animal) specimen and in vivo animal experiments in voice research. These experiments have enabled visualization and analysis of dehydration effects, vocal fold scarring, bifurcation and chaotic vibrations, three-dimensional vibrations, aerodynamic effects, and mucosal wave propagation along the medial surface. Quantitative data will be shown to give an overview of measured laryngeal parameter values. As yet, a full understanding of all existing interactions in voice production has not been achieved, and thus, where possible, we try to indicate areas needing further study. Recent Findings A further motivation behind this review is to highlight recent findings and technologies related to the study of vocal fold dynamics and its applications. For example, studies of interactions between vocal tract airflow and generation of acoustics have recently shown that airflow superior to the glottis is governed by not only vocal fold dynamics but also by subglottal and supraglottal structures. In addition, promising new methods to investigate kinematics and dynamics have been reported recently, including dynamic optical coherence tomography, X-ray stroboscopy and three-dimensional reconstruction with laser projection systems. Finally, we touch on the relevance of vocal fold dynamics to clinical laryngology and to clinically-oriented research. PMID:26581597

  2. Exploration of Acoustic Features for Automatic Vowel Discrimination in Spontaneous Speech

    ERIC Educational Resources Information Center

    Tyson, Na'im R.

    2012-01-01

    In an attempt to understand what acoustic/auditory feature sets motivated transcribers towards certain labeling decisions, I built machine learning models that were capable of discriminating between canonical and non-canonical vowels excised from the Buckeye Corpus. Specifically, I wanted to model when the dictionary form and the transcribed-form…

  3. Exploration of Acoustic Features for Automatic Vowel Discrimination in Spontaneous Speech

    ERIC Educational Resources Information Center

    Tyson, Na'im R.

    2012-01-01

    In an attempt to understand what acoustic/auditory feature sets motivated transcribers towards certain labeling decisions, I built machine learning models that were capable of discriminating between canonical and non-canonical vowels excised from the Buckeye Corpus. Specifically, I wanted to model when the dictionary form and the transcribed-form…

  4. Establishment and Analysis of False Vocal Folds Hypertrophy Model in Excised Canine Larynges.

    PubMed

    Jiao, Yanchao; Wang, Ruiqing; Zeng, Qingkai; Xu, Xinlin; Zhang, Yu; Leggon, Bobby; Jiang, Jack; Zhuang, Peiyun

    2017-09-18

    This study aimed to investigate the role of false vocal folds (FVFs) medialization in phonation and the acoustic impact of ventricular hypertrophy by establishing an FVF hypertrophy model. A prospective in vitro experiment was carried out. The study was carried out using a pseudolung platform with high-speed camera in a soundproof room. Control, degree I, and degree II FVFs hypertrophy were simulated in 10 excised larynges via fructose injection of 0.1 mL for degree I and 0.25 mL for degree II. Mean flow rate (MFR), fundamental frequencies (F0), formants, and sound pressure level were measured with a subglottal pressure of 1.5 kPa and 2.5 kPa, respectively. When the subglottal pressure was controlled at both at 1.5 kPa and at 2.5 kPa, the degree of FVF hypertrophy significantly influenced the distribution of the formants, F0, and MFR in excised canine larynges. Increasing the degree of hypertrophy was associated with a decrease in F0 and an increase in MFR. In degree II FVF hypertrophy models, the sound pressure level and the first formant were significantly higher (P < 0.05) than in normal models. Hypertrophy of the FVFs has a significant influence on the distribution of sound energy and is associated with changes in sound quality. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  5. 77 FR 43157 - Disregarded Entities and the Indoor Tanning Services Excise Tax; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-24

    ... Excise Tax; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correcting amendment... qualified subchapter S subsidiaries) and the indoor tanning services excise tax. DATES: This correction is... Employment taxes, Estate taxes, Excise taxes, Gift taxes, Income taxes, Penalties, Reporting...

  6. 77 FR 37806 - Disregarded Entities and the Indoor Tanning Services Excise Tax

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-25

    ... Services Excise Tax AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final and temporary... (including qualified subchapter S subsidiaries) and the indoor tanning services excise tax. These regulations affect disregarded entities responsible for collecting the indoor tanning services excise tax and...

  7. Nasal base narrowing: the combined alar base excision technique.

    PubMed

    Foda, Hossam M T

    2007-01-01

    To evaluate the role of the combined alar base excision technique in narrowing the nasal base and correcting excessive alar flare. The study included 60 cases presenting with a wide nasal base and excessive alar flaring. The surgical procedure combined an external alar wedge resection with an internal vestibular floor excision. All cases were followed up for a mean of 32 (range, 12-144) months. Nasal tip modification and correction of any preexisting caudal septal deformities were always completed before the nasal base narrowing. The mean width of the external alar wedge excised was 7.2 (range, 4-11) mm, whereas the mean width of the sill excision was 3.1 (range, 2-7) mm. Completing the internal excision first resulted in a more conservative external resection, thus avoiding any blunting of the alar-facial crease. No cases of postoperative bleeding, infection, or keloid formation were encountered, and the external alar wedge excision healed with an inconspicuous scar that was well hidden in the depth of the alar-facial crease. Finally, the risk of notching of the alar rim, which can occur at the junction of the external and internal excisions, was significantly reduced by adopting a 2-layered closure of the vestibular floor (P = .01). The combined alar base excision resulted in effective narrowing of the nasal base with elimination of excessive alar flare. Commonly feared complications, such as blunting of the alar-facial crease or notching of the alar rim, were avoided by using simple modifications in the technique of excision and closure.

  8. Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy

    PubMed Central

    Kayaalp, Cüneyt; Soyer, Vural; Ersan, Veysel; Aydın, Cemalettin; Karagül, Servet

    2016-01-01

    Congenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation. PMID:27436941

  9. Surgical Excision of Multiple Penile Syringomas With Scrotal Flap Reconstruction

    PubMed Central

    Vaca, Elbert E.; Mundinger, Gerhard S.; Zelken, Jonathan A.; Erdag, Gulsun

    2014-01-01

    Objective: Penile syringomas are rare lesions usually occurring in isolation. We report the excision and reconstruction of multiple synchronous penile shaft syringomas with local scrotal flaps. Methods: We report a rare case of excision of multiple penile syringomas and reconstruction with scrotal flaps in a 29-year-old man. Results: Penile syringomas were excised and reconstructed with scrotal flaps in a single-stage procedure. Conclusions: In addition to providing wound coverage, this reconstructive option allowed for excellent functional results with regard to shaft alignment and erectile function, and it should be considered in the reconstructive armamentarium for penile shaft lesions. PMID:24966995

  10. Robotic assisted excision of retrovesical angiomyxoma in a male patient

    PubMed Central

    Tyagi, Vipin; Dar, Tanveer Iqbal; Durani, Abdul Munan; Chada, Sudhir

    2014-01-01

    Angiomyxoma is a rare tumour found predominantly in pelvis of young females. Less than 150 cases have been reported, more than 90% in females and only few cases in males. Its surgical excision is a big challenge and usually leads to recurrence due to incomplete excision. We report a case of retrovesical Angiomyxoma in an elderly male. The aim of this report is to highlight the rarity of this disease, especially in males, and robotic assisted excision as an evolving option of treatment. PMID:24761083

  11. Schwannoma of the ciliary body treated by block excision.

    PubMed Central

    Küchle, M; Holbach, L; Schlötzer-Schrehardt, U; Naumann, G O

    1994-01-01

    A 26-year-old man developed a non-pigmented ciliary body tumour of his right eye. A 7 mm block excision and tectonic corneoscleral graft were performed. The excised tissue was studied using histopathological, immunohistochemical, and electron microscopic techniques. The tumour revealed characteristic features of a Schwann cell neoplasm including Antoni A and B patterns, acid mucopolysaccharides, S-100, and vimentin positivity, and--by electron microscopy--Luse bodies. It was classified as a schwannoma. Although rare, schwannoma should be included in the clinical differential diagnosis of non-pigmented ciliary body tumours. Local excision should be considered to avoid over-treatment by enucleation. Images PMID:8025076

  12. Surgical excision of acne keloidalis nuchae with secondary intention healing.

    PubMed

    Bajaj, V; Langtry, J A A

    2008-01-01

    Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that presents clinically as follicular papules and pustules. These can coalesce into firm hypertrophic plaques and nodules on the nape of the neck, most commonly affecting young adult men. Treatment includes topical steroids/antibiotics and oral antibiotics, but often has disappointing results. Surgical approaches include excision with primary closure or skin grafting, and hair-removal lasers. Another surgical approach is excision with secondary intention healing. This can result in good cosmesis with little or no recurrence. We report two men with AKN where treatment by excision with secondary intention was successful.

  13. DNA excision repair in permeable human fibroblasts

    SciTech Connect

    Kaufmann, W.K.; Bodell, W.J.; Cleaver, J.E.

    1983-01-01

    U.v. irradiation of confluent human fibroblasts activated DNA repair, aspects of which were characterized in the cells after they were permeabilized. Incubation of intact cells for 20 min between irradiation and harvesting was necessary to obtain a maximum rate of reparative DNA synthesis. Cells harvested immediately after irradiation before repair was initiated displayed only a small stimulation of DNA synthesis, indicating that permeable cells have a reduced capacity to recognize pyrimidine dimers and activate repair. The distribution of sizes of DNA strands labeled during 10 min of reparative DNA synthesis resembled that of parental DNA. However, during a 60-min incubation of permeable cells at 37 degrees C, parental DNA and DNA labeled by reparative DNA synthesis were both cleaved to smaller sizes. Cleavage also occurred in unirradiated cells, indicating that endogenous nuclease was active during incubation. Repair patches synthesized in permeable cells displayed increased sensitivity to digestion by micrococcal nuclease. However, the change in sensitivity during a chase with unlabeled DNA precursors was small, suggesting that reassembly of nucleosome structure at sites of repair was impaired. To examine whether this deficiency was due to a preponderance of incomplete or unligated repair patches, 3H-labeled (repaired) DNA was purified, then digested with exonuclease III and nuclease S1 to probe for free 3' ends and single-stranded regions. About 85% of the (3H)DNA synthesized during a 10-min pulse resisted digestion, suggesting that a major fraction of the repair patches that were filled were also ligated. U.v. light-activated DNA synthesis in permeable cells, therefore, appears to represent the continuation of reparative gap-filling at sites of excision repair activated within intact cells. Gap-filling and ligation were comparatively efficient processes in permeable cells.

  14. [Robotic total mesorectal excision for rectal cancer].

    PubMed

    Rossi, Gustavo; Alvarez, Fernando A; Mentz, Ricardo; Vaccaro, Carlos A; Im, Víctor; Quintana, Guillermo Ojea

    2013-06-01

    Laparoscopic total mesorectal excision (TME) has proven to be feasible and safe. However, it represents a major technical challenge, since it involves the dissection of the rectum in a confined space such as the bony pelvis using un-ergonomic surgical devices. This difficulty is accentuated in patients with distal tumors and high body mass index (BMI), in which the surgical margins and the hypogastric nerves may be affected. Therefore, robotic surgery aims to overcome these limitations that conspire against the mininvasive surgical approach of rectal cancer. We present an obese (BMI = 32 kg/m2) 82-year-old man with a history of smoking and prostate cancer that was recently diagnosed with a middle rectal adenocarcinoma at 9 cm from the anal verge. Rectal examination evidenced a mobile lesion. Computed tomography scan ruled out metastases and at the local staging by MRI, the tumor was considered as T3-N0 with free circumferential margins. Surgical treatment was decided and a hybrid technique was used combining an initial laparoscopic approach followed by the robotic TME. The patient had a full recovery and was discharged three days after surgery without complications. Pathological examination revealed a low-grade adenocarcinoma with mesorectal invasion, free circumferential and distal margins, and 24 negative lymph nodes (pT3-pN0-pM0/Stage II). Robotic TME was performed safely in an obese patient. It facilitated dissection maneuvers in a confined space with proper identification and preservation of the hypogastric nerves, allowing retrieving an intact mesorectum. Prospective randomized trials will define the role of this new technology.

  15. Acoustic hemostasis

    NASA Astrophysics Data System (ADS)

    Crum, Lawrence; Beach, Kirk; Carter, Stephen; Chandler, Wayne; Curra, Francesco; Kaczkowski, Peter; Keilman, George; Khokhlova, Vera; Martin, Roy; Mourad, Pierre; Vaezy, Shahram

    2000-07-01

    In cases of severe injury, physicians speak of a "golden hour"—a brief grace period in which quickly applied, proper therapy can save the life of the patient. Much of this mortality results from exsanguination, i.e., bleeding to death—often from internal hemorrhage. The inability of a paramedic to treat breaches in the vascular system deep within the body or to stem the loss of blood from internal organs is a major reason for the high level of mortality associated with blunt trauma. We have undertaken an extensive research program to treat the problem of internal bleeding. Our approach is as follows: (a) We use scanning ultrasound to identify internal bleeding and hemorrhage, (b) we use ultrasound imaging to locate specific breaches in the vascular system, both from damaged vessels and gross damage to the capillary bed, and (c) we use High Intensity Focused Ultrasound (HIFU) to treat the damaged region and to induce hemostasis. We present a general review of this research with some emphasis on the role of nonlinear acoustics.

  16. Sensory and sympathetic nerve fibers undergo sprouting and neuroma formation in the painful arthritic joint of geriatric mice

    PubMed Central

    2012-01-01

    Introduction Although the prevalence of arthritis dramatically increases with age, the great majority of preclinical studies concerning the mechanisms that drive arthritic joint pain have been performed in young animals. One mechanism hypothesized to contribute to arthritic pain is ectopic nerve sprouting; however, neuroplasticity is generally thought to be greater in young versus old nerves. Here we explore whether sensory and sympathetic nerve fibers can undergo a significant ectopic nerve remodeling in the painful arthritic knee joint of geriatric mice. Methods Vehicle (saline) or complete Freund's adjuvant (CFA) was injected into the knee joint of 27- to 29-month-old female mice. Pain behaviors, macrophage infiltration, neovascularization, and the sprouting of sensory and sympathetic nerve fibers were then assessed 28 days later, when significant knee-joint pain was present. Knee joints were processed for immunohistochemistry by using antibodies raised against CD68 (monocytes/macrophages), PECAM (endothelial cells), calcitonin gene-related peptide (CGRP; sensory nerve fibers), neurofilament 200 kDa (NF200; sensory nerve fibers), tyrosine hydroxylase (TH; sympathetic nerve fibers), and growth-associated protein 43 (GAP43; nerve fibers undergoing sprouting). Results At 4 weeks after initial injection, CFA-injected mice displayed robust pain-related behaviors (which included flinching, guarding, impaired limb use, and reduced weight bearing), whereas animals injected with vehicle alone displayed no significant pain-related behaviors. Similarly, in the CFA-injected knee joint, but not in the vehicle-injected knee joint, a remarkable increase was noted in the number of CD68+ macrophages, density of PECAM+ blood vessels, and density and formation of neuroma-like structures by CGRP+, NF200+, and TH+ nerve fibers in the synovium and periosteum. Conclusions Sensory and sympathetic nerve fibers that innervate the aged knee joint clearly maintain the capacity for robust

  17. Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft.

    PubMed

    Elmasry, M; Steinvall, I; Thorfinn, J; Olofsson, P; Abbas, A H; Abdelrahman, I; Adly, O A; Sjoberg, F

    2016-09-30

    During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA.

  18. Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft

    PubMed Central

    Elmasry, M.; Steinvall, I.; Thorfinn, J.; Olofsson, P.; Abbas, A.H.; Abdelrahman, I.; Adly, O.A.; Sjoberg, F.

    2016-01-01

    Summary During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA. PMID:28149249

  19. Acoustic source for generating an acoustic beam

    DOEpatents

    Vu, Cung Khac; Sinha, Dipen N.; Pantea, Cristian

    2016-05-31

    An acoustic source for generating an acoustic beam includes a housing; a plurality of spaced apart piezo-electric layers disposed within the housing; and a non-linear medium filling between the plurality of layers. Each of the plurality of piezoelectric layers is configured to generate an acoustic wave. The non-linear medium and the plurality of piezo-electric material layers have a matching impedance so as to enhance a transmission of the acoustic wave generated by each of plurality of layers through the remaining plurality of layers.

  20. Canonical Acoustics and Its Application to Surface Acoustic Wave on Acoustic Metamaterials

    NASA Astrophysics Data System (ADS)

    Shen, Jian Qi

    2016-08-01

    In a conventional formalism of acoustics, acoustic pressure p and velocity field u are used for characterizing acoustic waves propagating inside elastic/acoustic materials. We shall treat some fundamental problems relevant to acoustic wave propagation alternatively by using canonical acoustics (a more concise and compact formalism of acoustic dynamics), in which an acoustic scalar potential and an acoustic vector potential (Φ ,V), instead of the conventional acoustic field quantities such as acoustic pressure and velocity field (p,u) for characterizing acoustic waves, have been defined as the fundamental variables. The canonical formalism of the acoustic energy-momentum tensor is derived in terms of the acoustic potentials. Both the acoustic Hamiltonian density and the acoustic Lagrangian density have been defined, and based on this formulation, the acoustic wave quantization in a fluid is also developed. Such a formalism of acoustic potentials is employed to the problem of negative-mass-density assisted surface acoustic wave that is a highly localized surface bound state (an eigenstate of the acoustic wave equations). Since such a surface acoustic wave can be strongly confined to an interface between an acoustic metamaterial (e.g., fluid-solid composite structures with a negative dynamical mass density) and an ordinary material (with a positive mass density), it will give rise to an effect of acoustic field enhancement on the acoustic interface, and would have potential applications in acoustic device design for acoustic wave control.

  1. Excision of Mucocele Using Diode Laser in Lower Lip

    PubMed Central

    Ramkumar, Subramaniam; Ramkumar, Lakshmi; Malathi, Narasimhan

    2016-01-01

    Mucoceles are nonneoplastic cystic lesions of major and minor salivary glands which result from the accumulation of mucus. These lesions are most commonly seen in children. Though usually these lesions can be treated by local surgical excision, in our case, to avoid intraoperative surgical complications like bleeding and edema and to enable better healing, excision was done using a diode laser in the wavelength of 940 nm. PMID:28097026

  2. ASPT software source code: ASPT signal excision software package

    NASA Astrophysics Data System (ADS)

    Parliament, Hugh

    1992-08-01

    The source code for the ASPT Signal Excision Software Package which is part of the Adaptive Signal Processing Testbed (ASPT) is presented. The source code covers the programs 'excision', 'ab.out', 'd0.out', 'bd1.out', 'develop', 'despread', 'sorting', and 'convert'. These programs are concerned with collecting data, filtering out interference from a spread spectrum signal, analyzing the results, and developing and testing new filtering algorithms.

  3. Acoustic Holography

    NASA Astrophysics Data System (ADS)

    Kim, Yang-Hann

    One of the subtle problems that make noise control difficult for engineers is the invisibility of noise or sound. A visual image of noise often helps to determine an appropriate means for noise control. There have been many attempts to fulfill this rather challenging objective. Theoretical (or numerical) means for visualizing the sound field have been attempted, and as a result, a great deal of progress has been made. However, most of these numerical methods are not quite ready for practical applications to noise control problems. In the meantime, rapid progress with instrumentation has made it possible to use multiple microphones and fast signal-processing systems. Although these systems are not perfect, they are useful. A state-of-the-art system has recently become available, but it still has many problematic issues; for example, how can one implement the visualized noise field. The constructed noise or sound picture always consists of bias and random errors, and consequently, it is often difficult to determine the origin of the noise and the spatial distribution of the noise field. Section 26.2 of this chapter introduces a brief history, which is associated with "sound visualization," acoustic source identification methods and what has been accomplished with a line or surface array. Section 26.2.3 introduces difficulties and recent studies, including de-Dopplerization and de-reverberation methods, both essentialfor visualizing a moving noise source, such as occurs for cars or trains. This section also addresses what produces ambiguity in realizing real sound sources in a room or closed space. Another major issue associated with sound/noise visualization is whether or not we can distinguish between mutual dependencies of noise in space (Sect. 26.2.4); for example, we are asked to answer the question, "Can we see two birds singing or one bird with two beaks?"

  4. Acoustic Holography

    NASA Astrophysics Data System (ADS)

    Kim, Yang-Hann

    One of the subtle problems that make noise control difficult for engineers is the invisibility of noise or sound. A visual image of noise often helps to determine an appropriate means for noise control. There have been many attempts to fulfill this rather challenging objective. Theoretical (or numerical) means for visualizing the sound field have been attempted, and as a result, a great deal of progress has been made. However, most of these numerical methods are not quite ready for practical applications to noise control problems. In the meantime, rapid progress with instrumentation has made it possible to use multiple microphones and fast signal-processing systems. Although these systems are not perfect, they are useful. A state-of-the-art system has recently become available, but it still has many problematic issues; for example, how can one implement the visualized noise field. The constructed noise or sound picture always consists of bias and random errors, and consequently, it is often difficult to determine the origin of the noise and the spatial distribution of the noise field. Section 26.2 of this chapter introduces a brief history, which is associated with sound visualization, acoustic source identification methods and what has been accomplished with a line or surface array. Section 26.2.3 introduces difficulties and recent studies, including de-Dopplerization and de-re verberation methods, both essential for visualizing a moving noise source, such as occurs for cars or trains. This section also addresses what produces ambiguity in realizing real sound sources in a room or closed space. Another major issue associated with sound/noise visualization is whether or not we can distinguish between mutual dependencies of noise in space (Sect. 26.2.4); for example, we are asked to answer the question, Can we see two birds singing or one bird with two beaks?

  5. Base excision repair: A critical player in many games

    PubMed Central

    Wallace, Susan S.

    2014-01-01

    This perspective reviews the many dimensions of base excision repair from a 10,000 foot vantage point and provides one person’s view on where the field is headed. Enzyme function is considered under the lens of X-ray diffraction and single molecule studies. Base excision repair in chromatin and telomeres, regulation of expression and the role of posttranslational modifications are also discussed in the context of enzyme activities, cellular localization and interacting partners. The specialized roles that base excision repair play in transcriptional activation by active demethylation and targeted oxidation as well as how base excision repair functions in the immune processes of somatic hypermutation and class switch recombination and its possible involvement in retroviral infection are also discussed. Finally the complexities of oxidative damage and its repair and its link to neurodegenerative disorders, as well as the role of base excision repair as a tumor suppressor are examined in the context of damage, repair and aging. By outlining the many base excision repair-related mysteries that have yet to be unraveled, hopefully this perspective will stimulate further interest in the field. PMID:24780558

  6. Two-dimensional measurement of the nonlinearity parameter B/A in excised biological samples.

    PubMed

    Saito, Shigemi; Kim, Jung-Ho

    2011-06-01

    The method previously developed for measuring the acoustic nonlinearity parameter B/A in a liquid sample with a volume as small as 0.1 ml [S. Saito, J. Acoust. Soc. Am. 127, 51(2010)] has been automated and applied to two-dimensional measurements of excised biological samples using a LabVIEW program. The focus of the sound beam is laterally shifted on the 3 × 3 mm(2) area of the sample while measuring the B/A successively. By displaying the result of 256 time repeated measurements with an interval of 0.2 mm in two dimensions, a C-mode image was generated for B/A. The images of linear properties such as density, sound speed, and attenuation coefficient are also obtained. The image, whose pattern can be different from those of the density and sound speed, has the capability to reveal the detailed structure of the B/A, which varies from region to region in a single biological sample. The application of the method to small samples is also demonstrated by measuring a thermally coagulated biological sample.

  7. Two-dimensional measurement of the nonlinearity parameter B/A in excised biological samples

    NASA Astrophysics Data System (ADS)

    Saito, Shigemi; Kim, Jung-Ho

    2011-06-01

    The method previously developed for measuring the acoustic nonlinearity parameter B/A in a liquid sample with a volume as small as 0.1 ml [S. Saito, J. Acoust. Soc. Am. 127, 51(2010)] has been automated and applied to two-dimensional measurements of excised biological samples using a LabVIEW program. The focus of the sound beam is laterally shifted on the 3 × 3 mm2 area of the sample while measuring the B/A successively. By displaying the result of 256 time repeated measurements with an interval of 0.2 mm in two dimensions, a C-mode image was generated for B/A. The images of linear properties such as density, sound speed, and attenuation coefficient are also obtained. The image, whose pattern can be different from those of the density and sound speed, has the capability to reveal the detailed structure of the B/A, which varies from region to region in a single biological sample. The application of the method to small samples is also demonstrated by measuring a thermally coagulated biological sample.

  8. Characterizing Tissue with Acoustic Parameters Derived from Ultrasound Data

    SciTech Connect

    Littrup, P; Duric, N; Leach, R R; Azevedo, S G; Candy, J V; Moore, T; Chambers, D H; Mast, J E; Johnson, S A; Holsapple, E

    2002-01-23

    In contrast to standard reflection ultrasound (US), transmission US holds the promise of more thorough tissue characterization by generating quantitative acoustic parameters. We compare results from a conventional US scanner with data acquired using an experimental circular scanner operating at frequencies of 0.3 - 1.5 MHz. Data were obtained on phantoms and a normal, formalin-fixed, excised breast. Both reflection and transmission-based algorithms were used to generate images of reflectivity, sound speed and attenuation.. Images of the phantoms demonstrate the ability to detect sub-mm features and quantify acoustic properties such as sound speed and attenuation. The human breast specimen showed full field evaluation, improved penetration and tissue definition. Comparison with conventional US indicates the potential for better margin definition and acoustic characterization of masses, particularly in the complex scattering environments of human breast tissue. The use of morphology, in the context of reflectivity, sound speed and attenuation, for characterizing tissue, is discussed.

  9. Acoustic evidence of airway opening during recruitment in excised dog lungs.

    PubMed

    Hantos, Z; Tolnai, J; Asztalos, T; Peták, F; Adamicza, A; Alencar, A M; Majumdar, A; Suki, B

    2004-08-01

    The aim of this study was to test the hypothesis that the mechanism of recruitment and the lower knee of the pressure-volume curve in the normal lung are primarily determined by airway reopenings via avalanches rather than simple alveolar recruitments. In isolated dog lung lobes, the pressure-volume loops were measured, and crackle sounds were recorded intrabronchially during both the first inflation from the collapsed state to total lobe capacity and a second inflation without prior degassing. The inflation flow contained transients that were accompanied by a series of crackles. Discrete volume increments were estimated from the flow transients, and the energy levels of the corresponding crackles were calculated from the sound recordings. Crackles were concentrated in the early phase of inflation, with the cumulative energy exceeding 90% of its final value by the lower knee of the pressure-volume curve. The values of volume increments were correlated with crackle energy during the flow transient for both the first and the second inflations (r(2) = 0.29-0.73 and 0.68-0.82, respectively). Because the distribution of volume increments followed a power law, the correlation between crackle energy and discrete volume increments suggests that an avalanche-like airway opening process governs the recruitment of collapsed normal lungs.

  10. NPL closes acoustics department

    NASA Astrophysics Data System (ADS)

    Extance, Andy

    2016-11-01

    The UK's National Physical Laboratory (NPL) has withdrawn funding for its acoustics, polymer and thermoelectrics groups, triggering concern among airborne acoustics specialists that the move could undermine the country's noise-management policies.

  11. Deep Water Ocean Acoustics

    DTIC Science & Technology

    2016-10-07

    OASIS, INC. 1 Report No. QSR-14C0172- Ocean Acoustics-093016 Quarterly Progress Report Technical and Financial Deep Water Ocean Acoustics...Award No.: N00014-14-C-0172 Report No. QSR-14C0172- Ocean Acoustics-093016 Prepared for: Office of Naval Research For the period: July 1, 2016...to September 30, 2016 Submitted by: Principal Investigator/Author: Kevin Heaney Ocean Acoustical Services and Instrumentation Systems, Inc. 5

  12. Deep Water Ocean Acoustics

    DTIC Science & Technology

    2016-08-03

    OASIS, INC. 1 Report No. QSR-14C0172- Ocean Acoustics-063016 Quarterly Progress Report Technical and Financial Deep Water Ocean Acoustics...Award No.: N00014-14-C-0172 Report No. QSR-14C0172- Ocean Acoustics-063016 Prepared for: Office of Naval Research For the period: April 1...2016 to June 30, 2016 Submitted by: Principal Investigator/Author: Kevin Heaney Ocean Acoustical Services and Instrumentation Systems, Inc. 5

  13. Deep Water Ocean Acoustics

    DTIC Science & Technology

    2016-04-30

    OASIS, INC. 1 Report No. QSR-14C0172- Ocean Acoustics-043016 Quarterly Progress Report Technical and Financial Deep Water Ocean Acoustics...Award No.: N00014-14-C-0172 Report No. QSR-14C0172- Ocean Acoustics-093015 Prepared for: Office of Naval Research For the period: January 1...2016 to March 31, 2015 Submitted by: Principal Investigator/Author: Kevin Heaney Ocean Acoustical Services and Instrumentation Systems, Inc. 5

  14. Shallow Water Acoustics Studies

    DTIC Science & Technology

    2015-09-30

    this year towards publishing one of the last SW06 papers, on acoustic scattering from crossing nonlinear internal wave trains. This is submitted for...1 DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. Shallow Water Acoustics Studies James F. Lynch MS #12...N00014-14-1-0040 http://acoustics.whoi.edu/sw06/ LONG TERM GOALS The long term goals of our shallow water acoustics work are to: 1) understand the

  15. Acoustic emission frequency discrimination

    NASA Technical Reports Server (NTRS)

    Sugg, Frank E. (Inventor); Graham, Lloyd J. (Inventor)

    1988-01-01

    In acoustic emission nondestructive testing, broadband frequency noise is distinguished from narrow banded acoustic emission signals, since the latter are valid events indicative of structural flaws in the material being examined. This is accomplished by separating out those signals which contain frequency components both within and beyond (either above or below) the range of valid acoustic emission events. Application to acoustic emission monitoring during nondestructive bond verification and proof loading of undensified tiles on the Space Shuttle Orbiter is considered.

  16. Deep Water Ocean Acoustics

    DTIC Science & Technology

    2015-07-17

    under-ice scattering , bathymetric diffraction and the application of the ocean acoustic Parabolic Equation to infrasound. 2. Tasks a. Task 1...QSR-14C0172-Ocean Acoustics -063015 Figure 10. Estimated reflection coefficient as a function of frequency by taking the difference of downgoing and...OASIS, INC. 1 Report No. QSR-14C0172-Ocean Acoustics -063015 Quarterly Progress Report Technical and Financial Deep Water Ocean Acoustics

  17. Differential diagnosis and management of giant fibroadenoma: comparing excision with reduction mammoplasty incision and excision with inframammary incision.

    PubMed

    Ugburo, Andrew O; Olajide, Thomas O; Fadeyibi, Idowu O; Mofikoya, Bolaji O; Lawal, Abdulrazzaq O; Osinowo, Adedapo O

    2012-10-01

    Giant fibroadenoma (GFA) may present with breast asymmetry and can be excised with an inframammary incision (IFI) or reduction mammoplasty incision (RMI). This study investigated the clinical presentation and compared excision with the IFI and RMI. All patients with benign breast tumours greater than 5 cm underwent core needle biopsy and a histopathological diagnosis. All confirmed GFA had their clinical details documented and randomised into two groups for excision with an IFI or RMI. Twenty-two patients were studied. The age range was 12-46 years, mean 21.18 ± 2.22 years. The patients were divided into two groups: a juvenile group (n = 16) (73%) aged 12-18 years, mean age 14.06 ± 0.42 years, and a perimenopausal group (n = 5) aged 28-46 years. The juvenile group showed cyclic increases in breast size monthly with menstruation while the perimenopausal showed an initial slow growth of 6-24 months followed by a rapid growth. Fifteen patients (68%) had excision biopsy with IMI and seven patients with RMI. Seven of the patients treated with IFI had minimal preoperative asymmetry and satisfactory aesthetic outcome. Among the patients with severe preoperative asymmetry treated with IFI (n = 8) and RMI (n = 7), those treated with IFI had persistent postoperative skin redundancy and asymmetry, which was not found in those treated with RMI. In conclusion, for patients with significant asymmetry, excision with the IFI was associated with persistent asymmetry while excision with RMI was associated with restoration of symmetry.

  18. Tutorial on architectural acoustics

    NASA Astrophysics Data System (ADS)

    Shaw, Neil; Talaske, Rick; Bistafa, Sylvio

    2002-11-01

    This tutorial is intended to provide an overview of current knowledge and practice in architectural acoustics. Topics covered will include basic concepts and history, acoustics of small rooms (small rooms for speech such as classrooms and meeting rooms, music studios, small critical listening spaces such as home theatres) and the acoustics of large rooms (larger assembly halls, auditoria, and performance halls).

  19. Coding Acoustic Metasurfaces.

    PubMed

    Xie, Boyang; Tang, Kun; Cheng, Hua; Liu, Zhengyou; Chen, Shuqi; Tian, Jianguo

    2017-02-01

    Coding acoustic metasurfaces can combine simple logical bits to acquire sophisticated functions in wave control. The acoustic logical bits can achieve a phase difference of exactly π and a perfect match of the amplitudes for the transmitted waves. By programming the coding sequences, acoustic metasurfaces with various functions, including creating peculiar antenna patterns and waves focusing, have been demonstrated.

  20. Acoustic Casing Treatment Test

    NASA Image and Video Library

    2017-02-14

    Acoustic Casing Treatment Testing Completed in the W-8 Single Stage Axial Compressor Facility at NASA Glenn. Four different over-the-rotor acoustic casing treatment concepts were tested along with two baseline configurations. Testing included steady-aerodynamic measurements of fan performance, hotfilm turbulence measurements, and inlet acoustic measurements with an in-duct array.

  1. The Integration and Excision of CTnDOT

    PubMed Central

    Wood, Margaret M.; Gardner, Jeffrey F.

    2015-01-01

    Bacteroides species are one of the most prevalent groups of bacteria present in the human colon. Many strains carry large, integrated elements including integrative and conjugative elements (ICEs). One such ICE is CTnDOT, which is 65 kb in size and encodes resistances to tetracycline and erythromycin. CTnDOT has been increasing in prevalence in Bacteroides spp., and is now found in greater than 80% of natural isolates. In recent years, CTnDOT has been implicated in the spread of antibiotic resistance among gut microbiota. Interestingly, the excision and transfer of CTnDOT is stimulated in the presence of tetracycline. The tyrosine recombinase IntDOT catalyzes the integration and excision reactions of CTnDOT. Unlike the well-characterized lambda Int, IntDOT tolerates heterology in the overlap region between the sites of cleavage and strand exchange. IntDOT also appears to have a different arrangement of active site catalytic residues. It is missing one of the arginine residues that is conserved in other tyrosine recombinases. The excision reaction of CTnDOT is complex, involving excision proteins Xis2c, Xis2d, and Exc, as well as IntDOT and a Bacteroides host factor. Xis2c and Xis2d are small, basic proteins like other recombination directionality factors (RDFs). Exc is a topoisomerase; however, the topoisomerase function is not required for the excision reaction. Exc has been shown to stimulate excision frequencies when there are mismatches in the overlap regions, suggesting that it may play a role in resolving Holliday junctions containing heterology. Work is currently under way to elucidate the complex interactions involved with the formation of the CTnDOT excisive intasomes. PMID:26104696

  2. Hypofibrinogenemia Caused by Hemocoagulase After Colon Polyps Excision

    PubMed Central

    Zhou, Hai-Bo

    2017-01-01

    Case series Patient: — Final Diagnosis: Routine use of hemocoagulase for injection for the prevention of late-onset bleeding is not recommended for patients who have undergone excision of colon polyps. Hemocoagulase following excision of colon polyps can cause hypofibrinogenemia and even l Symptoms: Hematochezia Medication: — Clinical Procedure: Three patients also had lower gastrointestinal bleeding Specialty: Gastroenterology and Hepatology Objective: Unusual or unexpected effect of treatment Background: In patients with large colon polyps, late-onset bleeding may be more likely to occur because of the larger cutting surface. In these patients, hemostatic agents may be applied to prevent the late-onset bleeding. A total of 7 patients developed hypofibrinogenemia caused by hemocoagulase following excision of colon polyps in our center from November to December 2015. Case Report: Seven patients underwent excision of colon polyps in our center from November to December 2015. The cutting face was large in these patients after surgery; therefore, hemocoagulase was used to prevent potential late-onset bleeding. Evaluation of clotting function showed that the fibrinogen level was normal before surgery in all 7 patients. Hemocoagulase was intravenously administered twice daily beginning from postoperative day 1. Hypofibrinogenemia of varying severity occurred 2–4 d later. Three patients also had lower-gastrointestinal bleeding. After drug withdrawal and infusion of fibrinogen, blood fibrinogen level gradually returned to normal. In contrast, among 13 patients who had not received hemocoagulase treatment for preventing hemorrhage following excision of colon polyps, detection of blood fibrinogen before surgery and 2–4 d after showed normal results. Conclusions: Routine use of Hemocoagulase For Injection for the prevention of late-onset bleeding is not recommended for patients who have undergone excision of colon polyps. Hemocoagulase following excision of colon

  3. Cold adaptation regulated by cryptic prophage excision in Shewanella oneidensis

    PubMed Central

    Zeng, Zhenshun; Liu, Xiaoxiao; Yao, Jianyun; Guo, Yunxue; Li, Baiyuan; Li, Yangmei; Jiao, Nianzhi; Wang, Xiaoxue

    2016-01-01

    Among the environmental stresses experienced by bacteria, temperature shifts are one of the most important. In this study, we discovered a novel cold adaptation mechanism in Shewanella oneidensis that occurs at the DNA level and is regulated by cryptic prophage excision. Previous studies on bacterial cold tolerance mainly focus on the structural change of cell membrane and changes at the RNA and protein levels. Whether or not genomic change can also contribute to this process has not been explored. Here we employed a whole-genome deep-sequencing method to probe the changes at DNA level in a model psychrotrophic bacteria strain. We found that temperature downshift induced a 10 000-fold increase of the excision of a novel P4-like cryptic prophage. Importantly, although prophage excision only occurred in a relatively small population of bacteria, it was able to facilitate biofilm formation and promote the survival of the entire population. This prophage excision affected cell physiology by disrupting a critical gene encoding transfer-messenger RNA (tmRNA). In addition, we found that the histone-like nucleoid-structuring protein (H-NS) could silence prophage excision via binding to the promoter of the putative excisionase gene at warm temperatures. H-NS level was reduced at cold temperatures, leading to de-repression of prophage excision. Collectively, our results reveal that cryptic prophage excision acts as a regulatory switch to enable the survival of the host at low temperature by controlling the activity of tmRNA and biofilm formation. PMID:27482926

  4. Cold adaptation regulated by cryptic prophage excision in Shewanella oneidensis.

    PubMed

    Zeng, Zhenshun; Liu, Xiaoxiao; Yao, Jianyun; Guo, Yunxue; Li, Baiyuan; Li, Yangmei; Jiao, Nianzhi; Wang, Xiaoxue

    2016-12-01

    Among the environmental stresses experienced by bacteria, temperature shifts are one of the most important. In this study, we discovered a novel cold adaptation mechanism in Shewanella oneidensis that occurs at the DNA level and is regulated by cryptic prophage excision. Previous studies on bacterial cold tolerance mainly focus on the structural change of cell membrane and changes at the RNA and protein levels. Whether or not genomic change can also contribute to this process has not been explored. Here we employed a whole-genome deep-sequencing method to probe the changes at DNA level in a model psychrotrophic bacteria strain. We found that temperature downshift induced a 10 000-fold increase of the excision of a novel P4-like cryptic prophage. Importantly, although prophage excision only occurred in a relatively small population of bacteria, it was able to facilitate biofilm formation and promote the survival of the entire population. This prophage excision affected cell physiology by disrupting a critical gene encoding transfer-messenger RNA (tmRNA). In addition, we found that the histone-like nucleoid-structuring protein (H-NS) could silence prophage excision via binding to the promoter of the putative excisionase gene at warm temperatures. H-NS level was reduced at cold temperatures, leading to de-repression of prophage excision. Collectively, our results reveal that cryptic prophage excision acts as a regulatory switch to enable the survival of the host at low temperature by controlling the activity of tmRNA and biofilm formation.

  5. The Integration and Excision of CTnDOT.

    PubMed

    Wood, Margaret M; Gardner, Jeffrey F

    2015-04-01

    Bacteroides species are one of the most prevalent groups of bacteria present in the human colon. Many strains carry large, integrated elements including integrative and conjugative elements (ICEs). One such ICE is CTnDOT, which is 65 kb in size and encodes resistances to tetracycline and erythromycin. CTnDOT has been increasing in prevalence in Bacteroides spp., and is now found in greater than 80% of natural isolates. In recent years, CTnDOT has been implicated in the spread of antibiotic resistance among gut microbiota. Interestingly, the excision and transfer of CTnDOT is stimulated in the presence of tetracycline. The tyrosine recombinase IntDOT catalyzes the integration and excision reactions of CTnDOT. Unlike the well-characterized lambda Int, IntDOT tolerates heterology in the overlap region between the sites of cleavage and strand exchange. IntDOT also appears to have a different arrangement of active site catalytic residues. It is missing one of the arginine residues that is conserved in other tyrosine recombinases. The excision reaction of CTnDOT is complex, involving excision proteins Xis2c, Xis2d, and Exc, as well as IntDOT and a Bacteroides host factor. Xis2c and Xis2d are small, basic proteins like other recombination directionality factors (RDFs). Exc is a topoisomerase; however, the topoisomerase function is not required for the excision reaction. Exc has been shown to stimulate excision frequencies when there are mismatches in the overlap regions, suggesting that it may play a role in resolving Holliday junctions (HJs) containing heterology. Work is currently under way to elucidate the complex interactions involved with the formation of the CTnDOT excisive intasomes.

  6. Aerodynamic and Acoustic Effects of Ventricular Gap

    PubMed Central

    Alipour, Fariborz; Karnell, Michael

    2013-01-01

    Purpose Supraglottic compression is frequently observed in individuals with dysphonia. It is commonly interpreted as an indication of excessive circumlaryngeal muscular tension and ventricular medialization. The purpose of this study was to describe the aerodynamic and acoustic impact of varying ventricular medialization in a canine model. Methods Subglottal air pressure, glottal airflow, electroglottograph, acoustic signals and high-speed video images were recorded in seven excised canine larynges mounted in vitro for laryngeal vibratory experimentation. The degree of gap between the ventricular folds was adjusted and measured using sutures and weights. Data was recorded during phonation when the ventricular gap was narrow, neutral, and large. Glottal resistance was estimated by measures of subglottal pressure and glottal flow. Results Glottal resistance increased systematically as ventricular gap became smaller. Wide ventricular gaps were associated with increases in fundamental frequency and decreases in glottal resistance. Sound pressure level did not appear to be impacted by the adjustments in ventricular gap used in this research. Conclusions Increases in supraglottic compression and associated reduced ventricular width may be observed in a variety of disorders that affect voice quality. Ventricular compression may interact with true vocal fold posture and vibration resulting in predictable changes in aerodynamic, physiologic, acoustic, and perceptual measures of phonation. The data from this report supports the theory that narrow ventricular gaps may be associated with disordered phonation. In vitro and in vivo human data are needed to further test this association. PMID:24321590

  7. Indoor acoustic gain design

    NASA Astrophysics Data System (ADS)

    Concha-Abarca, Justo Andres

    2002-11-01

    The design of sound reinforcement systems includes many variables and usually some of these variables are discussed. There are criteria to optimize the performance of the sound reinforcement systems under indoor conditions. The equivalent acoustic distance, the necessary acoustic gain, and the potential acoustic gain are parameters which must be adjusted with respect to the loudspeaker array, electric power and directionality of loudspeakers, the room acoustics conditions, the distance and distribution of the audience, and the type of the original sources. The design and installation of front of the house and monitoring systems have individual criteria. This article is about this criteria and it proposes general considerations for the indoor acoustic gain design.

  8. ACOUSTICAL STANDARDS NEWS

    PubMed Central

    Stremmel, Neil B.; Struck, Christopher J.

    2017-01-01

    American National Standards (ANSI Standards) developed by Accredited Standards Committees S1, S2, S3, S3/SC 1, and S12 in the areas of acoustics, mechanical vibration and shock, bioacoustics, animal bioacoustics, and noise, respectively, are published by the Acoustical Society of America (ASA). In addition to these standards, ASA publishes a catalog of Acoustical American National Standards. To receive a copy of the latest Standards catalog, please contact Neil Stremmel. Comments are welcomed on all material in Acoustical Standards News. This Acoustical Standards News section in JASA, as well as the national catalog of Acoustical Standards and other information on the Standards Program of the Acoustical Society of America, are available via the ASA home page: http://acousticalsociety.org. PMID:28599517

  9. Developmentally programmed excision of internal DNA sequences in Paramecium aurelia.

    PubMed

    Gratias, A; Bétermier, M

    2001-01-01

    The development of a new somatic nucleus (macronucleus) during sexual reproduction of the ciliate Paramecium aurelia involves reproducible chromosomal rearrangements that affect the entire germline genome. Macronuclear development can be induced experimentally, which makes P. aurelia an attractive model for the study of the mechanism and the regulation of DNA rearrangements. Two major types of rearrangements have been identified: the fragmentation of the germline chromosomes, followed by the formation of the new macronuclear chromosome ends in association with imprecise DNA elimination, and the precise excision of internal eliminated sequences (IESs). All IESs identified so far are short, A/T rich and non-coding elements. They are flanked by a direct repeat of a 5'-TA-3' dinucleotide, a single copy of which remains at the macronuclear junction after excision. The number of these single-copy sequences has been estimated to be around 60,000 per haploid genome. This review focuses on the current knowledge about the genetic and epigenetic determinants of IES elimination in P. aurelia, the analysis of excision products, and the tightly regulated timing of excision throughout macronuclear development. Several models for the molecular mechanism of IES excision will be discussed in relation to those proposed for DNA elimination in other ciliates.

  10. Emerging roles for histone modifications in DNA excision repair.

    PubMed

    Mao, Peng; Wyrick, John J

    2016-11-01

    DNA repair is critical to maintain genome stability. In eukaryotic cells, DNA repair is complicated by the packaging of the DNA 'substrate' into chromatin. DNA repair pathways utilize different mechanisms to overcome the barrier presented by chromatin to efficiently locate and remove DNA lesions in the genome. DNA excision repair pathways are responsible for repairing a majority of DNA lesions arising in the genome. Excision repair pathways include nucleotide excision repair (NER) and base excision repair (BER), which repair bulky and non-bulky DNA lesions, respectively. Numerous studies have suggested that chromatin inhibits both NER and BER in vitro and in vivo Growing evidence demonstrates that histone modifications have important roles in regulating the activity of NER and BER enzymes in chromatin. Here, we will discuss the roles of different histone modifications and the corresponding modifying enzymes in DNA excision repair, highlighting the role of yeast as a model organism for many of these studies. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Pure cutting current for loop excision of squamous intraepithelial lesions.

    PubMed

    McLucas, B; McGill, J

    1994-05-01

    Clear margins are critical to the identification of complete excision of premalignant lesions on the cervix. Large loop excision of the transformation zone aids the pathologic evaluation of the excised specimen while it causes minimal thermal damage. Prior studies of loop excision were performed with a cutting current blended with a coagulating waveform to aid hemostasis. Blended current has higher voltage, which may cause tissue to stick to the electrode and produce thermal damage to the cervix. In this series, pure cutting current was used to excise the cervical transformation zone in 20 patients. The depth of thermal damage was studied in 6 patients; the average endocervical zone of damage was 0.47 mm and that of the exocervical zone, 0.43 mm. The base of the cervix could be examined with the colposcope for the presence of glands. None of our procedures was complicated by intraoperative or delayed bleeding. The preoperative injection of a vasoconstrictor into the cervical stroma is thought to aid the surgery by its hemostatic properties.

  12. Technical note on complete excision of choledochal cysts.

    PubMed

    Cheung, Tan To; Fan, Sheung Tat

    2013-04-01

    Choledochal cysts are congenital cystic dilatations of the extrahepatic or intrahepatic portion of the biliary tree. Complete excision of choledochal cysts is currently regarded as the gold standard treatment, while less extensive procedures including cystoduodenostomy have become obsolete due to the potential for malignant change in the remnant cyst. For type-1 choledochal cysts, which sometimes extend to the main pancreatic duct closely, some surgeons may adopt a less aggressive approach in order to avoid damage to the main pancreatic duct as such damage can lead to serious consequences. However, incomplete excision of choledochal cysts may also cause problems. Here we report on a reoperation treating incomplete excision of a choledochal cyst with focus on the technical aspect. In the reoperation, meticulous dissection of the liver hilum which had been previously operated on was performed. The hepaticojejunostomy was left intact. With the assistance of intraoperative cholangiography, the residual pancreatic portion of the choledochal cyst was completely excised. The pancreatic opening and the lower end of the common bile duct were reconstructed. Whipple operation was avoided. Careful planning with the aid of precise imaging before and during the operation largely enhanced the accuracy of the excision of the choledochal cyst.

  13. Dynamic control of strand excision during human DNA mismatch repair.

    PubMed

    Jeon, Yongmoon; Kim, Daehyung; Martín-López, Juana V; Lee, Ryanggeun; Oh, Jungsic; Hanne, Jeungphill; Fishel, Richard; Lee, Jong-Bong

    2016-03-22

    Mismatch repair (MMR) is activated by evolutionarily conserved MutS homologs (MSH) and MutL homologs (MLH/PMS). MSH recognizes mismatched nucleotides and form extremely stable sliding clamps that may be bound by MLH/PMS to ultimately authorize strand-specific excision starting at a distant 3'- or 5'-DNA scission. The mechanical processes associated with a complete MMR reaction remain enigmatic. The purified human (Homo sapien or Hs) 5'-MMR excision reaction requires the HsMSH2-HsMSH6 heterodimer, the 5' → 3' exonuclease HsEXOI, and the single-stranded binding heterotrimer HsRPA. The HsMLH1-HsPMS2 heterodimer substantially influences 5'-MMR excision in cell extracts but is not required in the purified system. Using real-time single-molecule imaging, we show that HsRPA or Escherichia coli EcSSB restricts HsEXOI excision activity on nicked or gapped DNA. HsMSH2-HsMSH6 activates HsEXOI by overcoming HsRPA/EcSSB inhibition and exploits multiple dynamic sliding clamps to increase tract length. Conversely, HsMLH1-HsPMS2 regulates tract length by controlling the number of excision complexes, providing a link to 5' MMR.

  14. Purification of PCNA as a nucleotide excision repair protein

    PubMed Central

    Nichols, Anne F.; Sancar, Aziz

    1992-01-01

    Human cell free extracts carry out nucleotide excision repair in vitro. The extract is readily separated into two fractions by chromatography on a DEAE column. Neither the low salt (0.1 M KCl) nor the high salt (0.8 M KCl) fractions are capable of repair synthesis but the combination of the two restore the repair synthesis activity. Using the repair synthesis assay we purified a protein of 37 kDa from the high salt fraction which upon addition to the low salt fraction restores repair synthesis activity. Amino acid sequence analysis, amino acid composition and immunobloting with PCNA antibodies revealed that the 37 kDa protein is the proliferating cell nuclear antigen (PCNA) known to stimulate DNA Polymerases δ and ε. By using an assay which specifically measures the excision of thymine dimers we found that PCNA is not required for the actual excision reaction per se but increases the extent of excision by enabling the excision repair enzyme to turn over catalytically. Images PMID:1352873

  15. Multi-parameter comparison of injection laryngoplasty, medialization laryngoplasty, and arytenoid adduction in an excised larynx model

    PubMed Central

    Hoffman, Matthew R.; Witt, Rachel E.; Chapin, William J.; McCulloch, Timothy M.; Jiang, Jack J.

    2010-01-01

    Objective Evaluate the effect of injection laryngoplasty (IL), medialization laryngoplasty (ML), and ML combined with arytenoid adduction (ML-AA) on acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup. Methods Measurements were recorded for eight excised canine larynges with simulated unilateral vocal fold paralysis (UVFP) before and after vocal fold injection with Cymetra. A second set of eight larynges was used to evaluate medialization laryngoplasty using a Silastic implant without and with arytenoid adduction. Results IL and ML led to comparable decreases in phonation threshold flow (PTF), phonation threshold pressure (PTP), and phonation threshold power (PTW). ML-AA led to significant decreases in PTF (p=0.008), PTP (p=0.008), and PTW (p=0.008). IL and ML led to approximately equal decreases in percent jitter and percent shimmer. ML-AA caused the greatest increase in signal to noise ratio (SNR). ML-AA discernibly decreased frequency (p=0.059); a clear trend was not observed for IL or ML. IL significantly reduced mucosal wave amplitude (p=0.002), while both ML and ML-AA increased it. All procedures significantly decreased glottal gap, with the most dramatic effects observed after ML-AA (p=0.004). Conclusions ML-AA led to the greatest improvements in phonatory parameters. IL was comparable to ML aerodynamically and acoustically, but caused detrimental changes to the mucosal wave. Incremental improvements in parameters recorded from the same larynx were observed after ML and ML-AA. To ensure optimal acoustic outcome, the arytenoid must be correctly rotated. This study provides objective support for the combined ML-AA procedure in tolerant patients. Evidence based medicine level Not applicable – animal study. PMID:20213797

  16. Extended infrabrow excision blepharoplasty for dermatochalasis in asians.

    PubMed

    Ichinose, Akihiro; Sugimoto, Takao; Sugimoto, Isao; Ishinagi, Hiroyoshi; Kuwazuru, Kenji; Nagai, Koji; Tahara, Shinya

    2011-01-01

    To describe extended infrabrow excision blepharoplasty (IBEB), whereby skin excision is extended to a substantial part of intrabrow skin and the intrabrow incision is made perpendicular to the hair shaft. A total of 194 Asian patients with moderate to severe dermatochalasis underwent extended IBEB. The mean width of excised skin at its widest was 12.8 mm (range, 6-22 mm). Extended IBEB significantly reduced eyelid laxity but produced a natural-looking eyelid because it did not damage the eyelid framework. With application of eyebrow makeup by women, routine social activity was resumed soon after surgery. Infrabrow scarring became inconspicuous in patients with thick eyebrows after regrowth. Extended IBEB is recommended for middle-aged and older Asian women with moderate to severe dermatochalasis. With precise incision and fine suturing, regrowth alleviates eyebrow reduction and scarring among Asians who do not use makeup (male patients and young female patients).

  17. Flexor Tendon Ruptures After Distal Scaphoid Excision for Scaphotrapeziotrapezoid Osteoarthritis.

    PubMed

    Deren, Matthew E; Mitchell, Charles H; Weiss, Arnold-Peter C

    2017-09-01

    Distal scaphoid excision is one treatment option for osteoarthritis of the scaphotrapeziotrapezoid (STT) joint following failure of conservative measures. Potential complications of this procedure include injury to the carpal ligaments, cartilage, and radial artery. A single case was identified by the senior author, and the medical record was reviewed for surgical notes, progress notes, and radiographs. A 68-year-old male sustained ruptures of the flexor digitorum superficialis (FDS) and flexor digitorum profundus to the index finger 3 years following a distal scaphoid excision for symptomatic STT osteoarthritis. He required a flexor tendon reconstruction using the remaining FDS tendon for graft incorporated with a Pulvertaft weave. His midcarpal pain continued after recovery of his index finger function, eventually requiring a 4-corner fusion of the wrist. Flexor tendon rupture is a previously unreported complication of distal scaphoid excision for STT arthritis.

  18. Management of Recurrent Stricture Formation after Transverse Vaginal Septum Excision

    PubMed Central

    Gupta, Ridhima; Bozzay, Joseph D.; Williams, David L.; DePond, Robert T.; Gantt, Pickens A.

    2015-01-01

    Background. A transverse vaginal septum (TVS) is a rare obstructing anomaly, caused due to improper fusion of Müllerian ducts and urogenital sinus during embryogenesis. Case. A 15-year-old girl presented with primary amenorrhea. She had multiple congenital anomalies. Initial examination and imaging investigation revealed the presence of a unicornuate uterus and a TVS. The TVS was excised; however the patient was unable to perform vaginal dilation postoperatively leading to recurrent stricture formation. She underwent multiple surgeries for excision of the stricture. The patient was eventually evaluated every day in the clinic until she was able to demonstrate successful vaginal dilatation in the presence of a clinician. Summary and Conclusion. Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation. PMID:26078895

  19. Management of Recurrent Stricture Formation after Transverse Vaginal Septum Excision.

    PubMed

    Gupta, Ridhima; Bozzay, Joseph D; Williams, David L; DePond, Robert T; Gantt, Pickens A

    2015-01-01

    Background. A transverse vaginal septum (TVS) is a rare obstructing anomaly, caused due to improper fusion of Müllerian ducts and urogenital sinus during embryogenesis. Case. A 15-year-old girl presented with primary amenorrhea. She had multiple congenital anomalies. Initial examination and imaging investigation revealed the presence of a unicornuate uterus and a TVS. The TVS was excised; however the patient was unable to perform vaginal dilation postoperatively leading to recurrent stricture formation. She underwent multiple surgeries for excision of the stricture. The patient was eventually evaluated every day in the clinic until she was able to demonstrate successful vaginal dilatation in the presence of a clinician. Summary and Conclusion. Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation.

  20. Outcome of extralevator abdominoperineal excision over conventional abdominoperineal excision for low rectal tumor: a meta-analysis

    PubMed Central

    Yang, Yue; Xu, Huirong; Shang, Zhenhua; Chen, Shouzhen; Chen, Fan; Deng, Qiming; Luo, Li; Zhu, Liang; Shi, Benkang

    2015-01-01

    Objective: A meta-analysis was undertaken to provide an evidence-based basis of clinical trials comparing extralevator abdominoperineal excision with conventional abdominoperineal excision for low rectal tumor. Methods: We searched through the major medical databases such as PubMed, EMBASE, Medline, Science Citation Index, Web of Science for all published studies without any limit on language from January 2009 until January 2015. The following search terms were used: extralevator abdominoperineal excision or cylindrical abdominoperineal resection or conventional abdominoperineal excision or abdominoperineal excision or rectal cancer. Furthermore, Additional related studies were manually searched in the reference lists of all published reviews and retrieved articles. Results: In this meta-analysis, there are a total number of 1797 patients included: 1099 patients in the ELAPE group and 698 in the APE group, and there are not statistically differences between groups in CRM [RR=0.65, 95% CI (0.41, 1.04), P=0.07] and wound complications [RR=1.14, 95% CI (1.09, 1.66), P=0.45] between ELAPE and APE. However, ELAPE has a lower rate of intraoperation perforation [RR=0.44; 95% CI (0.33, 0.60); P<0.00001] and local recurrence [RR=0.45, 95% CI (0.27, 0.77), P=0.003] than APE in terms of short follow-up time. PMID:26628967

  1. AST Launch Vehicle Acoustics

    NASA Technical Reports Server (NTRS)

    Houston, Janice; Counter, D.; Giacomoni, D.

    2015-01-01

    The liftoff phase induces acoustic loading over a broad frequency range for a launch vehicle. These external acoustic environments are then used in the prediction of internal vibration responses of the vehicle and components which result in the qualification levels. Thus, predicting these liftoff acoustic (LOA) environments is critical to the design requirements of any launch vehicle. If there is a significant amount of uncertainty in the predictions or if acoustic mitigation options must be implemented, a subscale acoustic test is a feasible pre-launch test option to verify the LOA environments. The NASA Space Launch System (SLS) program initiated the Scale Model Acoustic Test (SMAT) to verify the predicted SLS LOA environments and to determine the acoustic reduction with an above deck water sound suppression system. The SMAT was conducted at Marshall Space Flight Center and the test article included a 5% scale SLS vehicle model, tower and Mobile Launcher. Acoustic and pressure data were measured by approximately 250 instruments. The SMAT liftoff acoustic results are presented, findings are discussed and a comparison is shown to the Ares I Scale Model Acoustic Test (ASMAT) results.

  2. Teflon strip pneumostasis for excision of giant emphysematous bullae.

    PubMed Central

    Parmar, J M; Hubbard, W G; Matthews, H R

    1987-01-01

    Excision of giant emphysematous bullae commonly results in a persistent air leak that requires prolonged intercostal drainage and delays recovery. To minimise this we have used Teflon (polytetrafluoroethylene) strips to buttress the suture line and secure pneumostasis. During 1976-84 eight bullae were excised in seven patients. One patient had bilateral staged thoracotomies. All chest drains were removed within eight days (mean 4.5 days) and no patient developed pulmonary complications. At long term follow up (1-9 years, mean 5.5 years) no complications attributable to the Teflon felt have been identified. Images PMID:3324378

  3. Local Excision for the Treatment of Penile Verrucous Carcinoma.

    PubMed

    Jo, Dong In; Choi, Sang Kyu; Kim, Soon Heum; Kim, Cheol Keun; Chung, Hong; Kim, Hong Sup

    2017-07-01

    Penile verrucous carcinoma is known for its favorable biologic behavior and lack of metastatic potential. For preservation of function, treatment has been focused on partial penectomy. Despite partial penectomy for preservation of minimal functional and aesthetic aspects, patients have experienced psychosexual problems. A 73-year-old man had a cauliflower-like verrucous carcinoma on the penile glans and coronary sulcus diagnosed by using excisional biopsy. He underwent degloving excision to save the penile shaft and glans penis. Surgical margin was 3 mm. He had been tumor-free at the 2-year follow-up. For maximum preservation of the functional and aesthetic aspects, we recommend degloving excision.

  4. A complex twintron is excised as four individual introns.

    PubMed Central

    Drager, R G; Hallick, R B

    1993-01-01

    Twintrons are introns-within-introns excised by sequential splicing reactions. A new type of complex twintron comprised of four individual group III introns has been characterized. The external intron is interrupted by an internal intron containing two additional introns. This 434 nt complex twintron within a Euglena gracilis chloroplast ribosomal protein gene is excised by four sequential splicing reactions. Two of the splicing reactions utilize multiple 5'- and/or 3'-splice sites. These findings are evidence that introns with multiple active splice sites can be formed by the repeated insertion of introns into existing introns. Images PMID:7685079

  5. CCD filter and transform techniques for interference excision

    NASA Technical Reports Server (NTRS)

    Borsuk, G. M.; Dewitt, R. N.

    1976-01-01

    The theoretical and some experimental results of a study aimed at applying CCD filter and transform techniques to the problem of interference excision within communications channels were presented. Adaptive noise (interference) suppression was achieved by the modification of received signals such that they were orthogonal to the recently measured noise field. CCD techniques were examined to develop real-time noise excision processing. They were recursive filters, circulating filter banks, transversal filter banks, an optical implementation of the chirp Z transform, and a CCD analog FFT.

  6. Retroperitoneal anatomy during excision of pelvic side wall endometriosis

    PubMed Central

    Gingold, Julian A.; Falcone, Tommaso

    2016-01-01

    Surgical management of endometriosis has been shown to improve dysmenorrhea at all disease stages and is recommended in severe disease for treatment of infertility. Deeply infiltrating endometriosis (DIE) produces thick inflammatory tissue that precludes visualization of anatomical landmarks and distorts normal anatomy. Excision of DIE poses several technical and surgical challenges that mandate a clear understanding of the anatomy of the pelvic sidewall. This review details relevant surgical anatomy and addresses the principles of safe retroperitoneal entry, ureterolysis and excision of endometriotic lesions. Proper use of these techniques should facilitate safe and successful surgery for management of DIE. PMID:27642583

  7. AUXIN AND GROWTH OF EXCISED ROOTS OF Bryophyllum calycinum

    PubMed Central

    Robbins, William J.; Hervey, Annette

    1969-01-01

    Exogenous auxin (α-naphthalene acetic acid, indole acetic acid, or 2,4-dichlorophenoxyacetic acid) was essential for the growth of single excised root tips of Bryophyllum calycinum in 50 ml of a mineral salt-sucrose medium supplemented with vitamins. Large inocula with a dry weight of 2.0 mg or more grew with no auxin added to the medium. Evidence for the synthesis of auxin by the excised roots grown from the larger inocula is presented. Leaching of auxin from single root tips cultivated in 15 or 50 ml of basal medium is considered to account for their failure to grow. Images PMID:16591793

  8. AUXIN AND GROWTH OF EXCISED ROOTS OF Bryophyllum calycinum.

    PubMed

    Robbins, W J; Hervey, A

    1969-10-01

    Exogenous auxin (alpha-naphthalene acetic acid, indole acetic acid, or 2,4-dichlorophenoxyacetic acid) was essential for the growth of single excised root tips of Bryophyllum calycinum in 50 ml of a mineral salt-sucrose medium supplemented with vitamins. Large inocula with a dry weight of 2.0 mg or more grew with no auxin added to the medium. Evidence for the synthesis of auxin by the excised roots grown from the larger inocula is presented. Leaching of auxin from single root tips cultivated in 15 or 50 ml of basal medium is considered to account for their failure to grow.

  9. Nodular Fasciitis Complicating a Staged Surgical Excision of Dermatofibrosarcoma Protuberans

    PubMed Central

    Goodwin, Brandon; Wagner, Richard F.; Resto, Vicente; Kelly, Brent

    2016-01-01

    Dermatofibrosarcoma protuberans (DFSP) is an unusual spindle cell tumor with a high rate of local recurrence with traditional excision. Fortunately, Mohs micrographic surgery yields excellent cure rates for this neoplasm due to contiguous tumor spread and meticulous tumor mapping and margin analysis. We present the unique case of a patient treated with a modified Mohs technique with an analysis of the final margin with permanent sections, who developed a spindle cell neoplasm in the margins of her second stage excision consistent with nodular fasciitis. Distinguishing residual DFSP from a benign reactive process was an essential and challenging component of this patient's management. PMID:28018683

  10. Appropriate interval for repeat excision in women undergoing prior loop electrosurgical excision procedure for cervical neoplasia.

    PubMed

    Kietpeerakool, Chumnan; Srisomboon, Jatupol; Tiyayon, Jitima; Ruengkhachorn, Irene; Cheewakriangkrai, Chalong; Suprasert, Prapaporn; Pantusart, Aree

    2007-01-01

    The objective of the present study was to evaluate the impact of intervals on complications and pathological examination in women undergoing a repeat loop electrosurgical excision procedure (LEEP) for cervical neoplasia. During October 2004 and January 2007, 78 women who had undergone repeat LEEP at Chiang Mai University Hospital, were prospectively evaluated. The mean age was 47.5 years (range; 27-69 years). The mean duration of uncomplicated vaginal bleeding was 4.4 days (range; 1-20 days). The occurrence of persistent vaginal bleeding was noted in 9 women. Among 78 women, 2 (2.56%) and 7 (8.97%) experienced intraoperative and postoperative hemorrhage, respectively. Six (7.69%) had postoperative infection. These complications were not significantly different from those observed in women undergoing first LEEP in the same period (P=0.56). There was no significant difference in the incidence of perioperative complications and the incidence of non-evaluable cone margins among women who undergoing repeat LEEP within 4-6 weeks, between 6-8 weeks, and more than 8 weeks after first LEEP. In conclusion, repeat LEEP could be safely performed 4-12 weeks after the first procedure without any impact on pathological specimen examination.

  11. Acoustic Translation of an Acoustically Levitated Sample

    NASA Technical Reports Server (NTRS)

    Barmatz, M. B.; Allen, J. L.

    1986-01-01

    Acoustic-levitation apparatus uses only one acoustic mode to move sample from one region of chamber to another. Sample heated and cooled quickly by translation between hot and cold regions of levitation chamber. Levitated sample is raised into furnace region by raising plunger. Frequency of sound produced by transducers adjusted by feedback system to maintain (102) resonant mode, which levitates sample midway between transducers and plunger regardless of plunger position.

  12. Evaluation of an asymmetric anterior glottic web in an excised canine larynx model.

    PubMed

    Pulvermacher, Allyson C; Xue, Chao; Leggon, Robert; Mills, Randal; Jiang, Jack J

    2017-03-01

    The main objective of the study is to model asymmetry within anterior glottic webs in excised larynges using sutures and apply aerodynamic and acoustic analyses. Anterior glottic webs (AGW) were modeled in eight excised larynges using sutures secured at the level of the glottis to mimic the scar tissue of the web. Each of the eight larynges were tested under three different pressure increments for each of the three models of AGW: symmetric, vertically asymmetric, and laterally asymmetric. Phonation threshold pressure (PTP) and flow (PTF) differed significantly across AGW conditions (p = 0.006 and p = 0.005, respectively). Additionally, vocal efficiency was significantly different among conditions (p = 0.005) as well as significantly lower in the asymmetric groups (p = 0.015 and p = 0.007). Perturbation measures were not significantly different across conditions. Correlation dimension (D2) was significantly different at PTP, 1.25 × PTP, and 1.5 × PTP (p = 0.003, p = 0.010, and p < 0.001, respectively) as well as significantly higher in the asymmetric groups at each pressure increment. The increased PTP, PTF, and D2 values as well as decreased vocal efficiency among the asymmetric conditions indicates a significant decrease in vocal function, and thus represents that asymmetries could be a contributing factor to the pathological symptoms associated with glottic webs.

  13. Underwater Acoustic Carbon Nanotube Thermophone

    DTIC Science & Technology

    2016-09-23

    Attorney Docket No. 300042 1 of 10 UNDERWATER ACOUSTIC CARBON NANOTUBE THERMOPHONE STATEMENT OF GOVERNMENT INTEREST [0001] The invention...the Invention [0003] The present invention is an acoustically transparent carbon nanotube underwater acoustic source which acts as a thermophone...development of underwater acoustic carbon nanotube (CNT) yarn sheets capable of producing high acoustic output at low frequencies with broad bandwidth. An

  14. Radiosurgery for acoustic neurinomas: Early experience

    SciTech Connect

    Linskey, M.E.; Lunsford, L.D.; Flickinger, J.C. )

    1990-05-01

    We reviewed our early experience with the first 26 patients with acoustic neurinomas (21 unilateral, 5 bilateral) treated by stereotactic radiosurgery using the first North American 201-source cobalt-60 gamma knife. Follow-up ranged from 6 to 19 months (median, 13 months). Serial postoperative imaging showed either a decrease in tumor size (11 patients) or growth arrest (15 patients). Loss of central contrast enhancement was a characteristic change (18 patients). Seven patients had good or serviceable hearing preoperatively. In all 7 the preoperative hearing status was retained immediately after radiosurgery. At follow-up, 3 had preserved hearing, 1 had reduced hearing, and 3 had lost all hearing in the treated ear. Hearing in 1 patient that was nonserviceable preoperatively later improved to a serviceable hearing level. Delayed facial paresis developed in 6 patients, and delayed trigeminal sensory loss developed in 7 patients, none of whom had significant deficits before radiosurgery. Both facial and trigeminal deficits tended to improve within 3 to 6 months of onset with excellent recovery anticipated. Lower cranial nerve dysfunction was not observed. All 26 patients remain at their preoperative employment or functional status. At present, stereotactic radiosurgery is an alternative treatment for acoustic neurinomas in patients who are elderly, have significant concomitant medical problems, have a tumor in their only hearing ear, have bilateral acoustic neurinomas, refuse microsurgical excision, or have recurrent tumor despite surgical resection. Although longer and more extensive follow-up is required, the control of tumor growth and the acceptable rate of complications in this early experience testifies to the future expanding role of this technique in the management of selected acoustic neurinomas.

  15. "The lobbying strategy is to keep excise as low as possible" - tobacco industry excise taxation policy in Ukraine.

    PubMed

    Krasovsky, Konstantin S

    2010-08-31

    Tobacco taxes are one of the most effective ways to reduce tobacco use. Transnational tobacco companies (TTCs) claim they wish to develop and secure excise systems that benefit both governments and the profitability of the companies themselves. The objective of the paper is to use the case of Ukraine, with its inconsistent history of excise tax changes in 1992-2008, to explore tobacco industry taxation strategies and tactics, and their implications for governmental revenues. Details of tobacco industry policy on tobacco taxation in Ukraine were obtained by searching tobacco industry internal documents and various published reports. Even before entering the market in Ukraine, TTCs had made efforts to change the excise system in the country. In 1993-1994, TTCs lobbied the Ukrainian Government, and succeeded in achieving a lowering in tobacco tax. This, however, did not produce revenue increase they promised the Government. In 1996-1998, Ukrainian authorities increased excise several times, ignoring the wishes of TTCs, caused significant growth in revenue. Due to TTCs lobbying activities in 1999-2007 the tax increases were very moderate and it resulted in increased tobacco consumption in Ukraine. In 2008, despite the TTCs position, excise rates were increased twice and it was very beneficial for revenues. The Framework Convention on Tobacco Control includes provisions both on tobacco taxation policy and on protection of public health policy from vested interests of tobacco industry. This paper provides arguments why tobacco taxation policy should also be protected from vested interests of tobacco industry. TTCs taxation strategy appears to be consistent: keep excise as low as possible. Apparent conflicts between TTCs concerning tax structures often hide their real aim to change tax structures for competing interests without increasing total tax incidence. Governments, that aim to reduce levels of tobacco use, should not allow tobacco companies to influence the

  16. "The lobbying strategy is to keep excise as low as possible" - tobacco industry excise taxation policy in Ukraine

    PubMed Central

    2010-01-01

    Background Tobacco taxes are one of the most effective ways to reduce tobacco use. Transnational tobacco companies (TTCs) claim they wish to develop and secure excise systems that benefit both governments and the profitability of the companies themselves. The objective of the paper is to use the case of Ukraine, with its inconsistent history of excise tax changes in 1992-2008, to explore tobacco industry taxation strategies and tactics, and their implications for governmental revenues. Methods Details of tobacco industry policy on tobacco taxation in Ukraine were obtained by searching tobacco industry internal documents and various published reports. Results Even before entering the market in Ukraine, TTCs had made efforts to change the excise system in the country. In 1993-1994, TTCs lobbied the Ukrainian Government, and succeeded in achieving a lowering in tobacco tax. This, however, did not produce revenue increase they promised the Government. In 1996-1998, Ukrainian authorities increased excise several times, ignoring the wishes of TTCs, caused significant growth in revenue. Due to TTCs lobbying activities in 1999-2007 the tax increases were very moderate and it resulted in increased tobacco consumption in Ukraine. In 2008, despite the TTCs position, excise rates were increased twice and it was very beneficial for revenues. Conclusions The Framework Convention on Tobacco Control includes provisions both on tobacco taxation policy and on protection of public health policy from vested interests of tobacco industry. This paper provides arguments why tobacco taxation policy should also be protected from vested interests of tobacco industry. TTCs taxation strategy appears to be consistent: keep excise as low as possible. Apparent conflicts between TTCs concerning tax structures often hide their real aim to change tax structures for competing interests without increasing total tax incidence. Governments, that aim to reduce levels of tobacco use, should not allow

  17. Generalized acoustic energy density.

    PubMed

    Xu, Buye; Sommerfeldt, Scott D; Leishman, Timothy W

    2011-09-01

    The properties of acoustic kinetic energy density and total energy density of sound fields in lightly damped enclosures have been explored thoroughly in the literature. Their increased spatial uniformity makes them more favorable measurement quantities for various applications than acoustic potential energy density (or squared pressure), which is most often used. In this paper, a generalized acoustic energy density (GED), will be introduced. It is defined by introducing weighting factors into the formulation of total acoustic energy density. With an additional degree of freedom, the GED can conform to the traditional acoustic energy density quantities, or it can be optimized for different applications. The properties of the GED will be explored in this paper for individual room modes, a diffuse sound field, and a sound field below the Schroeder frequency. © 2011 Acoustical Society of America

  18. Deep Water Ocean Acoustics

    DTIC Science & Technology

    2016-12-22

    Final Report 3. DATES COVERED (From - To) 7/1/15 to 12/22/16 4. TITLE AND SUBTITLE Deep Water Ocean Acoustics 5a. CONTRACT NUMBER...NUMBER Ocean Acoustical Services and Instrumentation Systems, Inc. 5 Militia Drive, Ste. 104 Lexington, MA 02421-4706...FR-14C0172- Ocean Acoustics- 123116 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) Office of Naval

  19. Asymmetric acoustic gratings

    NASA Astrophysics Data System (ADS)

    He, Zhaojian; Peng, Shasha; Ye, Yangtao; Dai, Zhongwei; Qiu, Chunyin; Ke, Manzhu; Liu, Zhengyou

    2011-02-01

    The unidirectional transmission of acoustic waves is realized by a simple geometrically asymmetric steel grating structure. This exotic phenomenon stems from the one-way diffraction effect induced by the different periods of the slits on the both surfaces of the sample. And the frequency range of unidirectional transmission is simply determined by the structure periods. The experimental results agree well with the theoretical simulation. This remarkable effect is expected potential applications in ultrasonic devices, such as acoustic rectifiers and acoustic diodes.

  20. Nearfield Acoustical Holography

    NASA Astrophysics Data System (ADS)

    Hayek, Sabih I.

    Nearfield acoustical holography (NAH) is a method by which a set of acoustic pressure measurements at points located on a specific surface (called a hologram) can be used to image sources on vibrating surfaces on the acoustic field in three-dimensional space. NAH data are processed to take advantage of the evanescent wavefield to image sources that are separated less that one-eighth of a wavelength.

  1. Low Frequency Acoustics

    DTIC Science & Technology

    2016-06-13

    understanding of very low frequency (VLF) acoustics in the deep ocean as applicable to naval warfare and coexistence with marine mammals. OBJECTIVES The...characteristics in the deep ocean; (3) encourage a cooperative interagency working relationship to investigate acoustic impact on marine mammals; and...with NOAA(NMFS) and other parties has dealt with ocean acoustics related to issues stimulated by the Marine Mammal Protection Act. A focal point has

  2. Low frequency acoustic microscope

    DOEpatents

    Khuri-Yakub, Butrus T.

    1986-11-04

    A scanning acoustic microscope is disclosed for the detection and location of near surface flaws, inclusions or voids in a solid sample material. A focused beam of acoustic energy is directed at the sample with its focal plane at the subsurface flaw, inclusion or void location. The sample is scanned with the beam. Detected acoustic energy specularly reflected and mode converted at the surface of the sample and acoustic energy reflected by subsurface flaws, inclusions or voids at the focal plane are used for generating an interference signal which is processed and forms a signal indicative of the subsurface flaws, inclusions or voids.

  3. Acoustic dispersive prism

    NASA Astrophysics Data System (ADS)

    Esfahlani, Hussein; Karkar, Sami; Lissek, Herve; Mosig, Juan R.

    2016-01-01

    The optical dispersive prism is a well-studied element, which allows separating white light into its constituent spectral colors, and stands in nature as water droplets. In analogy to this definition, the acoustic dispersive prism should be an acoustic device with capability of splitting a broadband acoustic wave into its constituent Fourier components. However, due to the acoustical nature of materials as well as the design and fabrication difficulties, there is neither any natural acoustic counterpart of the optical prism, nor any artificial design reported so far exhibiting an equivalent acoustic behaviour. Here, based on exotic properties of the acoustic transmission-line metamaterials and exploiting unique physical behaviour of acoustic leaky-wave radiation, we report the first acoustic dispersive prism, effective within the audible frequency range 800 Hz–1300 Hz. The dispersive nature, and consequently the frequency-dependent refractive index of the metamaterial are exploited to split the sound waves towards different and frequency-dependent directions. Meanwhile, the leaky-wave nature of the structure facilitates the sound wave radiation into the ambient medium.

  4. Acoustic dispersive prism.

    PubMed

    Esfahlani, Hussein; Karkar, Sami; Lissek, Herve; Mosig, Juan R

    2016-01-07

    The optical dispersive prism is a well-studied element, which allows separating white light into its constituent spectral colors, and stands in nature as water droplets. In analogy to this definition, the acoustic dispersive prism should be an acoustic device with capability of splitting a broadband acoustic wave into its constituent Fourier components. However, due to the acoustical nature of materials as well as the design and fabrication difficulties, there is neither any natural acoustic counterpart of the optical prism, nor any artificial design reported so far exhibiting an equivalent acoustic behaviour. Here, based on exotic properties of the acoustic transmission-line metamaterials and exploiting unique physical behaviour of acoustic leaky-wave radiation, we report the first acoustic dispersive prism, effective within the audible frequency range 800 Hz-1300 Hz. The dispersive nature, and consequently the frequency-dependent refractive index of the metamaterial are exploited to split the sound waves towards different and frequency-dependent directions. Meanwhile, the leaky-wave nature of the structure facilitates the sound wave radiation into the ambient medium.

  5. Acoustic dispersive prism

    PubMed Central

    Esfahlani, Hussein; Karkar, Sami; Lissek, Herve; Mosig, Juan R.

    2016-01-01

    The optical dispersive prism is a well-studied element, which allows separating white light into its constituent spectral colors, and stands in nature as water droplets. In analogy to this definition, the acoustic dispersive prism should be an acoustic device with capability of splitting a broadband acoustic wave into its constituent Fourier components. However, due to the acoustical nature of materials as well as the design and fabrication difficulties, there is neither any natural acoustic counterpart of the optical prism, nor any artificial design reported so far exhibiting an equivalent acoustic behaviour. Here, based on exotic properties of the acoustic transmission-line metamaterials and exploiting unique physical behaviour of acoustic leaky-wave radiation, we report the first acoustic dispersive prism, effective within the audible frequency range 800 Hz–1300 Hz. The dispersive nature, and consequently the frequency-dependent refractive index of the metamaterial are exploited to split the sound waves towards different and frequency-dependent directions. Meanwhile, the leaky-wave nature of the structure facilitates the sound wave radiation into the ambient medium. PMID:26739504

  6. Do alcohol excise taxes affect traffic accidents? Evidence from Estonia.

    PubMed

    Saar, Indrek

    2015-01-01

    This article examines the association between alcohol excise tax rates and alcohol-related traffic accidents in Estonia. Monthly time series of traffic accidents involving drunken motor vehicle drivers from 1998 through 2013 were regressed on real average alcohol excise tax rates while controlling for changes in economic conditions and the traffic environment. Specifically, regression models with autoregressive integrated moving average (ARIMA) errors were estimated in order to deal with serial correlation in residuals. Counterfactual models were also estimated in order to check the robustness of the results, using the level of non-alcohol-related traffic accidents as a dependent variable. A statistically significant (P <.01) strong negative relationship between the real average alcohol excise tax rate and alcohol-related traffic accidents was disclosed under alternative model specifications. For instance, the regression model with ARIMA (0, 1, 1)(0, 1, 1) errors revealed that a 1-unit increase in the tax rate is associated with a 1.6% decrease in the level of accidents per 100,000 population involving drunk motor vehicle drivers. No similar association was found in the cases of counterfactual models for non-alcohol-related traffic accidents. This article indicates that the level of alcohol-related traffic accidents in Estonia has been affected by changes in real average alcohol excise taxes during the period 1998-2013. Therefore, in addition to other measures, the use of alcohol taxation is warranted as a policy instrument in tackling alcohol-related traffic accidents.

  7. An Economic Analysis of a Change in an Excise Tax

    ERIC Educational Resources Information Center

    Barron, John M.; Blanchard, Kelly Hunt; Umbeck, John R.

    2004-01-01

    The authors present an example of the effect a change in the excise tax can have on retail gasoline prices. The findings provide support for standard economic theory, as well as provide a vehicle for illustrating some of the subtleties of the analysis, including the implicit assumptions regarding the implications for the buying and selling prices…

  8. Nucleotide excision repair of DNA: The very early history.

    PubMed

    Friedberg, Errol C

    2011-07-15

    This article, taken largely from the book Correcting the Blueprint of Life: An Historical Account of the Discovery of DNA Repair Mechanisms, summarizes the very early history of the discovery of nucleotide excision repair. Copyright © 2011 Elsevier B.V. All rights reserved.

  9. Structural basis of HIV-1 resistance to AZT by excision

    SciTech Connect

    Tu, Xiongying; Das, Kalyan; Han, Qianwei; Bauman, Joseph D.; Clark, Jr., Arthur D.; Hou, Xiaorong; Frenkel, Yulia V.; Gaffney, Barbara L.; Jones, Roger A.; Boyer, Paul L.; Hughes, Stephen H.; Sarafianos, Stefan G.; Arnold, Eddy

    2011-11-23

    Human immunodeficiency virus (HIV-1) develops resistance to 3'-azido-2',3'-deoxythymidine (AZT, zidovudine) by acquiring mutations in reverse transcriptase that enhance the ATP-mediated excision of AZT monophosphate from the 3' end of the primer. The excision reaction occurs at the dNTP-binding site, uses ATP as a pyrophosphate donor, unblocks the primer terminus and allows reverse transcriptase to continue viral DNA synthesis. The excision product is AZT adenosine dinucleoside tetraphosphate (AZTppppA). We determined five crystal structures: wild-type reverse transcriptase-double-stranded DNA (RT-dsDNA)-AZTppppA; AZT-resistant (AZTr; M41L D67N K70R T215Y K219Q) RT-dsDNA-AZTppppA; AZTr RT-dsDNA terminated with AZT at dNTP- and primer-binding sites; and AZTr apo reverse transcriptase. The AMP part of AZTppppA bound differently to wild-type and AZTr reverse transcriptases, whereas the AZT triphosphate part bound the two enzymes similarly. Thus, the resistance mutations create a high-affinity ATP-binding site. The structure of the site provides an opportunity to design inhibitors of AZT-monophosphate excision.

  10. An Economic Analysis of a Change in an Excise Tax

    ERIC Educational Resources Information Center

    Barron, John M.; Blanchard, Kelly Hunt; Umbeck, John R.

    2004-01-01

    The authors present an example of the effect a change in the excise tax can have on retail gasoline prices. The findings provide support for standard economic theory, as well as provide a vehicle for illustrating some of the subtleties of the analysis, including the implicit assumptions regarding the implications for the buying and selling prices…

  11. [Treatment of Buruli ulcer desease by excision and skin graft].

    PubMed

    Ouattara, D; Meningaud, J P; Kaba, L; Sica, A; Asse, H

    2004-02-01

    Buruli ulcer is the most common mycobacteria disease after leprosy and tuberculosis. The purpose of our study is to make our contribution to the surgical treatment of Buruli ulcer and to asses our results. One hundred eighteen patients presenting progressive Buruli ulcers were operated on. The surgical procedure included excisions for necrotic lesions and grafts for clean wounds. The results were estimated on the time of hospitalization and appearance of complications. Seventy-three patients (62%) were subjected to excision followed by thin skin grafts and 35 patients (30%) were subjected to grafts only. The number of excision times varies from 1 to 7 per patient and from 1 to 4 for the skin grafts. All our patients heal within a period of 120 days with extremes going from 14 to 265 days. We deplored 26 complications (22%): eight new focus, seven infectious complications, six recurrences, five stiffnesses and ankyloses. The treatment of Buruli ulcer by excision and grafts is efficient but does not prevent recurrences and new focus from happening and for their prevention, it is necessary to discover pharmaceutical molecules that are efficient on Mycobacterium ulcerans.

  12. Laparoscopic stapled excision of non-parasitic splenic cysts.

    PubMed

    Kalogeropoulos, Gregory; Gundara, Justin S; Samra, Jaswinder S; Hugh, Thomas J

    2015-01-01

    A laparoscopic spleen preserving surgical approach is preferred for the management of symptomatic non-parasitic splenic cysts. The aim of this study was to review our experience with managing this rare presentation. A retrospective review of all cases of splenic cysts was performed over a 10-year period (2001-2011). Demographic data, clinical history, investigations, operative details and the outcome of each case were reviewed with an emphasis on patients who underwent laparoscopic stapled cyst excision. Eleven cases were identified. Seven patients were managed surgically; six by laparoscopic stapled cyst excision and one by open excision of remnant splenic tissue. Laparoscopic management was successful in all six cases and radiological and clinical follow-up (median: 28 months) revealed no evidence of cyst recurrence in five of six cases. One patient developed an asymptomatic, non-progressing and small recurrent anterior cyst and she continues to be observed. Laparoscopic stapled splenic cyst excision can be performed safely and is particularly effective for large superficial non-parasitic cysts. This technique allows spleen preservation with a low cyst recurrence rate. However, it may not be suitable for deeper intraparenchymal splenic cysts. Further studies are required to refine the management of specific subtypes of non-parasitic splenic cysts. © 2013 Royal Australasian College of Surgeons.

  13. Excise Taxes and the Price Elasticity of Demand.

    ERIC Educational Resources Information Center

    Gamble, Ralph C., Jr.

    1989-01-01

    Points out that, although the analysis of the imposition of an excise tax is widely used in economics courses, the consequences of a change in the tax rate are different and ignored. This article presents an effective way to teach about such a change. (GG)

  14. Finger assisted laparoscopic renal cyst excision: a simple technique.

    PubMed

    Kilciler, Mete; Istanbulluoğlu, Mustafa Okan; Basal, Seref; Bedir, Selahattin; Avci, Ali; Ozgök, Yaşar

    2010-06-10

    Simple renal cysts are asymptomatic incidental findings; however, for a small subset of benign renal cysts, patients may present with pain, hematuria, recurrent infection, pyelocaliceal obstruction, or hypertension. Laparoscopic cyst ablation is an effective minimally invasive modality for the treatment of symptomatic benign renal cysts. We describe a simple laparoscopic cyst excision technique. Between June 2003 and May 2008, 28 patients underwent laparoscopic renal cyst excision via retroperitoneal approach. In our technique, retroperitoneum and Gerota's fascia were dissected with finger blindly before insertion of the trocars to the retroperitoneal space. Following finger dissection, 3 trocars were placed and the cyst walls were excised at the level of renal cyst and base of the cysts were cauterized with electrocautery scissors. Mean patients' age was 59.3 years (range, 31 to 72 years). Mean operation duration time was 46 minutes (range, 27 to 102 minutes). Symptomatic and radiological success were achieved in 26 (92.8%) and 27 (96.4%) patients, respectively, with a median follow-up of 28 months (range, 6 to 56 months). No serious complications were encountered. Laparoscopy is a versatile minimally invasive modality ideal for treating benign symptomatic renal cysts. According to our experience, we think that the finger assisted laparoscopic cyst excision is an easy and noninvasive procedure.

  15. 76 FR 46677 - Indoor Tanning Services; Cosmetic Services Excise Taxes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-03

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 40 and 49 RIN 1545-BJ40 Indoor Tanning Services; Cosmetic Services Excise Taxes AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of public hearing on...

  16. Results of lumbar hemivertebral excision for congenital scoliosis.

    PubMed

    King, J D; Lowery, G L

    1991-07-01

    The purposes of this study were to determine the long-term correction achieved by excision of lumbar hemivertebrae and the risk attendant. Seven patients had a follow-up of 41.14 months for lumbar hemivertebral excisions. Six had two-stage anterior vertebral body excision and, 7-8 days later, posterior lamina and pedicle excision with fusion. One patient had a single-stage correction. After surgery, the patients were in pantaloon casts or braces for a minimum of 6 months (supine, first 6-12 weeks). Hemivertebrae were at L2 (N = 1), L3 (N = 1), L4-L5 (N = 1), and L5-S1 (N = 4). Preoperative curves or hemivertebral angles averaged 36.6 degrees (range, 30-52 degrees). Average age was 7.5 years (range, 22 months to 12.5 years). Mean follow-up was 41.14 months. Surgical correction of the seven cases averaged 28.0 degrees. Two-stage procedures yielded 29.7 degrees correction with no complications; single-stage yielded 18 degrees correction, and the only complication was an L5 nerve root paresis.

  17. Excise Taxes and the Price Elasticity of Demand.

    ERIC Educational Resources Information Center

    Gamble, Ralph C., Jr.

    1989-01-01

    Points out that, although the analysis of the imposition of an excise tax is widely used in economics courses, the consequences of a change in the tax rate are different and ignored. This article presents an effective way to teach about such a change. (GG)

  18. 29 CFR 779.264 - Excise taxes separately stated.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Excise taxes separately stated. 779.264 Section 779.264 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS THE FAIR LABOR STANDARDS...

  19. 29 CFR 779.264 - Excise taxes separately stated.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Excise taxes separately stated. 779.264 Section 779.264 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS THE FAIR LABOR STANDARDS...

  20. Acoustic Levitation With Less Equipment

    NASA Technical Reports Server (NTRS)

    Barmatz, M. B.; Jacobi, N.

    1983-01-01

    Certain chamber shapes require fewer than three acoustic drivers. Levitation at center of spherical chamber attained using only one acoustic driver. Exitation of lowest spherical mode produces asymmetric acoustic potential well.

  1. The optimal time for early excision in major burn injury.

    PubMed

    Muangman, Pornprom; Sullivan, Stephen R; Honari, Shari; Engrav, Lorenz H; Heimbach, David M; Gibran, Nicole S

    2006-01-01

    Early excision and grafting (E&G) drastically changed burn care in America by reducing morbidity, mortality and hospital length of stay (LOS). The present study was intended to determine whether an optimal time window exists between resuscitation and wound sepsis for the first E&G in a patient with a large burn. The authors conducted a retrospective study of patients admitted between January 1994 and December 2000 with > or = 40% TBSA burns and at least 1 E&G procedure. Patients were grouped according to the day of their first operation. Patients allowed to heal indeterminate burns prior to excision and grafting of deep partial or full thickness burns were grouped as > or = d7 and were excluded from the present study. The authors correlated the time of first excision with infection, mortality and LOS. Seventy-five patients were identified and 12 patients allowed to heal indeterminate burn prior to excision and grafting of deep partial or full thickness burns were excluded. Sixty-three remaining patients included 51 males and 12 females. Mean burn size was 49% of total body surface area (TBSA) (44% deep partial or full thickness) and the mean age was 36 years. There were 61 flame (2 combined with electrical injuries), 1 scald and 1 chemical burn. Twelve died (19%) and 52 patients developed 121 infections. Whereas there was no statistical difference in mortality for patients operated on different days (p > 0.2), 60% of patients operated within the first 48 hours after injury died; this was not significant due to a small patient number The present data suggest that patients who undergo early excision and grafting within seven days following a major burn > or = 40% TBSA have equivalent infection or mortality rates regardless of when the first operation occurs between post burn day(PBD) 2 and PBD 7 (p > 0.2).

  2. Structure of fructans from excised leaves of New Zealand flax.

    PubMed

    Sims, I M; Cairns, A J; Furneaux, R H

    2001-07-01

    The accumulation of total water-soluble carbohydrate, and specifically sucrose and fructan, by excised leaves of Phormium tenax and P. cookianum (family Phormiaceae J. G. Agardh, order Asparagales) was investigated. Total water-soluble carbohydrate content of excised leaves of P. tenax and P. cookianum increased during 48 h of continuous illumination at an average rate of 1.3 and 0.9 mg g(-1) fresh weight leaf per hour, respectively. The sucrose content of excised leaves increased throughout the experimental period. The fructan content of excised leaves of P. tenax increased slightly throughout the experimental period, whilst that of P. cookianum was variable and showed no overall change. Chemical and spectroscopic analysis of the fructans obtained from the two Phormium species showed that they were similar to each other and contained mostly 1-linked and terminal fructofuranosyl (Fruf) residues, together with smaller amounts of 6-linked Fruf, 1,6-branched Fruf, terminal and 6-linked glucopyranosyl residues. Separation of the fructans by thin-layer and high-performance anion-exchange chromatography revealed the presence of a complex mixture of fructo-oligosaccharides and higher molecular weight fructan. The branched structure of the fructans isolated from excised leaves of Phormium resembles that of fructans and fructo-oligosaccharides isolated from some related species within the order Asparagales (Agave vera cruz, Cordyline australis and Urginea maritima), but is distinct from the linear structure of fructans from others (Allium cepa and Asparagus officinalis). The structural heterogeniety of fructans within both the order Asparagales and superorder Liliiflorae may be a useful chemotaxonomic aid.

  3. Os Trigonum Excision in Dancers via an Open Posteromedial Approach.

    PubMed

    Heyer, Jessica H; Rose, Donald J

    2017-01-01

    An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Options for operative excision include open excision, subtalar arthroscopy, and posterior endoscopy. The purpose of this paper was to present a series of dancers who underwent excision of a symptomatic os trigonum via an open posteromedial approach. This study is a retrospective case series of 40 ankles in 38 dancers who underwent os trigonum excision via an open posteromedial approach with FHL tenolysis between 2000 and 2013. All patients were interviewed and charts retrospectively analyzed. Collected variables included pre- and postoperative pain level, time to return to dance, and subjective satisfaction. The average age was 19.2 years; ballet was the primary dance form in 36 (95%) of patient-cases. Eight (20%) of the patient-cases were professional dancers, and 30 (75%) were students or preprofessional dancers. Average preoperative pain level was 7.7/10, which decreased to 0.6/10 postoperatively. Seventeen (42.5%) experienced concurrent preoperation-associated FHL symptomatology, all of whom experienced relief postoperatively. The average time to return to dance was 7.9 weeks, and time to pain-free dance was 17.7 weeks. Of the 37 patient-cases desiring to return to dance, 35 (94.6%) returned to their preoperative level of dance. There were no neurovascular or other major complications. Four (10%) had minor wound complications that resolved, and 38 cases (95%) considered the procedure a success. Open posteromedial excision of an os trigonum in dancers provided satisfactory pain relief, return to dance, and complication rates compared to other approaches, and allowed for identifying and treating any associated FHL pathology. Level IV, retrospective case series.

  4. CO2 laser excision of pediatric airway lesions.

    PubMed

    Bagwell, C E

    1990-11-01

    Treatment of life-threatening pediatric airway lesions has been greatly enhanced by development of the CO2 laser. Using this modality, endoscopic access and precise tissue destruction are possible with minimal local inflammation and subsequent edema of the narrow airway. From October 1986 through October 1988, 26 patients underwent 96 laser procedures for excision of airway lesions, in 23 patients via bronchoscopy and in three patients via microlaryngoscopy. Ages ranged from 1 day to 20 years, with most patients under 2 years of age. Diagnoses included: laryngeal cysts (1); cystic hygroma (3); tumor (neurofibroma, 1) subglottic hemangioma (1); excision of airway granulation tissue (8); and tracheal stenosis (13, including subglottic stenosis in 9). Therapy of the offending lesion required from one to eight laser procedures (mean, 2.8), excluding one patient with congenital long-segment tracheal stenosis who required 24 laser treatments for repeated excision of tracheal granulation tissue. Most lesions responded to only one or two laser treatments. No bleeding or perforation occurred secondary to laser use. Use of the laser was responsible for salvaging the airway or simplifying management of the airway in 21 of the 26 patients. In three patients with cystic hygroma affecting the laryngeal structures as well as soft tissues of the neck, laser excision was performed to maintain upper airway patency with a tracheostomy for airway control. Two patients with critical subglottic stenosis initially responded to laser excision, but moved away from the area and developed recurrence of their subglottic stenosis requiring tracheostomy, because further laser treatment was either unavailable or was deferred in their new locale.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. 76 FR 52862 - Time for Payment of Certain Excise Taxes, and Quarterly Excise Tax Payments for Small Alcohol...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-24

    ... excise tax on distilled spirits, wine, beer, tobacco products, and cigarette papers and tubes, and... (IRC). These provisions of the IRC concern the taxation of distilled spirits, wine, beer, tobacco... taxes. See 26 U.S.C. 5061 pertaining to distilled spirits, wine, and beer and 26 U.S.C. 5703 pertaining...

  6. 76 FR 3584 - Time for Payment of Certain Excise Taxes, and Quarterly Excise Tax Payments for Small Alcohol...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-20

    ... regulations pertaining to the semimonthly payments of excise tax on distilled spirits, wine, beer, tobacco... spirits, wine, beer, tobacco products, and cigarette papers and tubes. The temporary rule also reissues..., Research, Scientific equipment, Spices and flavorings, Surety bonds, Vinegar, Warehouses, Wine. 27 CFR Part...

  7. Preliminary results of comparative study for subsequent photodynamic therapy versus secondary excision after primary excision for treating basal cell carcinoma.

    PubMed

    Bu, Wenbo; Zhang, Mengli; Zhang, Qian; Yuan, Chunyu; Chen, Xu; Fang, Fang

    2016-11-22

    Some basal cell carcinomas (BCCs) are indistinguishable from nevi based on clinical manifestations. Therefore, it is often difficult for the excision margins of the initial surgical treatment to achieve radical removal of the malignancy. This study was a comparative analysis of the clinical results of aminolevulinic acid (ALA)-photodynamic therapy (PDT) or secondary surgery after the primary excision. In total, 20 patients with preoperative clinical diagnoses of nevi underwent in situ resection. The postoperative pathological diagnoses confirmed all cases were BCC. Ten patients received PDT twice after the primary excision, and 10 cases received extended resection after the primary excision. Patients were followed up for 8 months at least, and the 2 groups did not show statistically significant differences in the recurrence rate, while the PDT group had better results in terms of economic burden, healing period, and cosmetic satisfaction than the group with secondary surgery. Our study demonstrates that ALA-PDT can sever as a considerable remedial treatment for the BCC patients who have not accepted radical resection due to primary clinical misdiagnosis.

  8. "Flag Excision and Flap" Procedure: a Novel Modification for Off-Midline Closure After Pilonidal Sinus Excision.

    PubMed

    Yucel, Ergun; Tezcan, Levent; Yilmaz, O Cem; Akin, Mehmet Levhi

    2015-12-01

    Pilonidal sinus surgery has evolved with the novel flap techniques, and off-midline closure became a preferred surgical procedure due to shorter recovery time and low recurrence rates. To obtain a better off-midline closure without maceration and a possible wound problem, we modified a novel excision technique. We aimed to present this novel flag modification of rhomboid excision and flap reconstruction experience. From December 2007 to June 2009, 100 patients were treated with flag excision and flap reconstruction under regional anesthesia and followed with a mean of 42 (range 35-55) months. Competent closure results were obtained successfully in all patients without an overlap between incision line and midline. None of the patients had seroma. Two patients (2 %) had partial wound detachment superiorly. None of the patients had recurrence during follow-up. The flag excision and flap reconstruction procedure is an effective and comfortable technique both for the surgeon and the patient with a quick healing period and low complication rates without maceration.

  9. Acoustic diffusers III

    NASA Astrophysics Data System (ADS)

    Bidondo, Alejandro

    2002-11-01

    This acoustic diffusion research presents a pragmatic view, based more on effects than causes and 15 very useful in the project advance control process, where the sound field's diffusion coefficient, sound field diffusivity (SFD), for its evaluation. Further research suggestions are presented to obtain an octave frequency resolution of the SFD for precise design or acoustical corrections.

  10. The Acoustical Environment.

    ERIC Educational Resources Information Center

    Smith, Melissa

    Asserting that without an adequate acoustical environment, learning activities can be hindered, this paper reviews the literature on classroom acoustics, particularly noise, reverberation, signal-to-noise ratio, task performance, and recommendations for improvement. Through this review, the paper seeks to determine whether portable classrooms…

  11. Acoustics Critical Readiness Review

    NASA Technical Reports Server (NTRS)

    Ballard, Kenny

    2010-01-01

    This presentation reviews the status of the acoustic equipment from the medical operations perspective. Included is information about the acoustic dosimeters, sound level meter, and headphones that are planned for use while on orbit. Finally there is information about on-orbit hearing assessments.

  12. Cystic acoustic schwannomas.

    PubMed

    Lunardi, P; Missori, P; Mastronardi, L; Fortuna, A

    1991-01-01

    Three cases with large space-occupying cysts in the cerebellopontine angle are reported. CT and MRI findings were not typical for acoustic schwannomas but at operation, besides the large cysts, small acoustic schwannomas could be detected and removed. The clinical and neuroradiological features of this unusual variety and the CT and MRI differential diagnosis of cerebellopontine angle lesions are discussed.

  13. Comparison of Three Surgical Methods in Treatment of Patients with Pilonidal Sinus: Modified Excision and Repair/Wide Excision/Wide Excision and Flap in RASOUL, OMID and SADR Hospitals( 2004-2007).

    PubMed

    Hosseini, Mostafa; Heidari, Afshin; Jafarnejad, Babak

    2013-10-01

    This study is a comparison between three methods that are frequently used for the surgical treatment of pilonidal disease all over the world: modified excision and repair, wide excision and secondary repair, and wide excision and flap. The first technique is done by our group for the first time, and has not been described previously in the literature. This is an interventional study performed at Omid, Sadr, and Rasoul Akram hospitals on patients who had undergone operation because of pilonidal sinus disease and met the inclusion criteria between 2004 and 2007. Exclusion criteria were (1) acute pilonidal sinus diseases, (2) history of pilonidal sinus surgery, (3) history of systemic diseases (DM, malignancy, etc.), and (4) pilonidal abscess. Essential information was extracted from complete medical archives. Any data not available in files or during follow-up visits (all patients supposed to be followed at least for 1 year) were gathered by a telephone interview. A total of 194 patients met the criteria and had complete archived files. Longer duration of hospital stay was found in the "wide excision and closing with flap" method comparing with two other methods (P < 0.05). Length of incapacity for work was not different between the "wide excision and modified repair" and "wide excision" (P > 0.5) methods, but longer for "wide excision and flap" in comparison with two others (P < 0.05). Healing time was significantly longer in the "wide excision" method in comparison with two other methods (P < 0.05). However, "wide excision and modified repair" method had the least healing time between all above techniques, except for length of leaving the office. All the three recurrences (1.5 %) occurred in the wide excision and flap method (P < 0.05). The frequency of postoperative complications was 2 (3.3 %) in wide excision and modified repair, 15 (18.5 %) in wide excision, and 17 (32.7 %) in wide excision and flap closure; these differences in

  14. Acoustic integrated extinction

    PubMed Central

    Norris, Andrew N.

    2015-01-01

    The integrated extinction (IE) is defined as the integral of the scattering cross section as a function of wavelength. Sohl et al. (2007 J. Acoust. Soc. Am. 122, 3206–3210. (doi:10.1121/1.2801546)) derived an IE expression for acoustic scattering that is causal, i.e. the scattered wavefront in the forward direction arrives later than the incident plane wave in the background medium. The IE formula was based on electromagnetic results, for which scattering is causal by default. Here, we derive a formula for the acoustic IE that is valid for causal and non-causal scattering. The general result is expressed as an integral of the time-dependent forward scattering function. The IE reduces to a finite integral for scatterers with zero long-wavelength monopole and dipole amplitudes. Implications for acoustic cloaking are discussed and a new metric is proposed for broadband acoustic transparency. PMID:27547100

  15. Highly directional acoustic receivers

    NASA Astrophysics Data System (ADS)

    Cray, Benjamin A.; Evora, Victor M.; Nuttall, Albert H.

    2003-03-01

    The theoretical directivity of a single combined acoustic receiver, a device that can measure many quantities of an acoustic field at a collocated point, is presented here. The formulation is developed using a Taylor series expansion of acoustic pressure about the origin of a Cartesian coordinate system. For example, the quantities measured by a second-order combined receiver, denoted a dyadic sensor, are acoustic pressure, the three orthogonal components of acoustic particle velocity, and the nine spatial gradients of the velocity vector. The power series expansion, which can be of any order, is cast into an expression that defines the directivity of a single receiving element. It is shown that a single highly directional dyadic sensor can have a directivity index of up to 9.5 dB. However, there is a price to pay with highly directive sensors; these sensors can be significantly more sensitive to nonacoustic noise sources.

  16. Cochlear bionic acoustic metamaterials

    NASA Astrophysics Data System (ADS)

    Ma, Fuyin; Wu, Jiu Hui; Huang, Meng; Fu, Gang; Bai, Changan

    2014-11-01

    A design of bionic acoustic metamaterial and acoustic functional devices was proposed by employing the mammalian cochlear as a prototype. First, combined with the experimental data in previous literatures, it is pointed out that the cochlear hair cells and stereocilia cluster are a kind of natural biological acoustic metamaterials with the negative stiffness characteristics. Then, to design the acoustic functional devices conveniently in engineering application, a simplified parametric helical structure was proposed to replace actual irregular cochlea for bionic design, and based on the computational results of such a bionic parametric helical structure, it is suggested that the overall cochlear is a local resonant system with the negative dynamic effective mass characteristics. There are many potential applications in the bandboard energy recovery device, cochlear implant, and acoustic black hole.

  17. Direct Field Acoustic Testing

    NASA Technical Reports Server (NTRS)

    Larkin, Paul; Goldstein, Bob

    2008-01-01

    This paper presents an update to the methods and procedures used in Direct Field Acoustic Testing (DFAT). The paper will discuss some of the recent techniques and developments that are currently being used and the future publication of a reference standard. Acoustic testing using commercial sound system components is becoming a popular and cost effective way of generating a required acoustic test environment both in and out of a reverberant chamber. This paper will present the DFAT test method, the usual setup and procedure and the development and use of a closed-loop, narrow-band control system. Narrow-band control of the acoustic PSD allows all standard techniques and procedures currently used in random control to be applied to acoustics and some examples are given. The paper will conclude with a summary of the development of a standard practice guideline that is hoped to be available in the first quarter of next year.

  18. Acoustic suspension system

    NASA Technical Reports Server (NTRS)

    Lee, M. C.; Wang, T. G. (Inventor)

    1983-01-01

    An acoustic levitation system is described, with single acoustic source and a small reflector to stably levitate a small object while the object is processed as by coating or heating it. The system includes a concave acoustic source which has locations on opposite sides of its axis that vibrate towards and away from a focal point to generate a converging acoustic field. A small reflector is located near the focal point, and preferably slightly beyond it, to create an intense acoustic field that stably supports a small object near the reflector. The reflector is located about one-half wavelength from the focal point and is concavely curved to a radius of curvature (L) of about one-half the wavelength, to stably support an object one-quarter wavelength (N) from the reflector.

  19. Direct Field Acoustic Testing

    NASA Technical Reports Server (NTRS)

    Larkin, Paul; Goldstein, Bob

    2008-01-01

    This paper presents an update to the methods and procedures used in Direct Field Acoustic Testing (DFAT). The paper will discuss some of the recent techniques and developments that are currently being used and the future publication of a reference standard. Acoustic testing using commercial sound system components is becoming a popular and cost effective way of generating a required acoustic test environment both in and out of a reverberant chamber. This paper will present the DFAT test method, the usual setup and procedure and the development and use of a closed-loop, narrow-band control system. Narrow-band control of the acoustic PSD allows all standard techniques and procedures currently used in random control to be applied to acoustics and some examples are given. The paper will conclude with a summary of the development of a standard practice guideline that is hoped to be available in the first quarter of next year.

  20. Virtual acoustics displays

    NASA Astrophysics Data System (ADS)

    Wenzel, Elizabeth M.; Fisher, Scott S.; Stone, Philip K.; Foster, Scott H.

    1991-03-01

    The real time acoustic display capabilities are described which were developed for the Virtual Environment Workstation (VIEW) Project at NASA-Ames. The acoustic display is capable of generating localized acoustic cues in real time over headphones. An auditory symbology, a related collection of representational auditory 'objects' or 'icons', can be designed using ACE (Auditory Cue Editor), which links both discrete and continuously varying acoustic parameters with information or events in the display. During a given display scenario, the symbology can be dynamically coordinated in real time with 3-D visual objects, speech, and gestural displays. The types of displays feasible with the system range from simple warnings and alarms to the acoustic representation of multidimensional data or events.

  1. Virtual acoustics displays

    NASA Technical Reports Server (NTRS)

    Wenzel, Elizabeth M.; Fisher, Scott S.; Stone, Philip K.; Foster, Scott H.

    1991-01-01

    The real time acoustic display capabilities are described which were developed for the Virtual Environment Workstation (VIEW) Project at NASA-Ames. The acoustic display is capable of generating localized acoustic cues in real time over headphones. An auditory symbology, a related collection of representational auditory 'objects' or 'icons', can be designed using ACE (Auditory Cue Editor), which links both discrete and continuously varying acoustic parameters with information or events in the display. During a given display scenario, the symbology can be dynamically coordinated in real time with 3-D visual objects, speech, and gestural displays. The types of displays feasible with the system range from simple warnings and alarms to the acoustic representation of multidimensional data or events.

  2. Acoustic Remote Sensing

    NASA Astrophysics Data System (ADS)

    Dowling, David R.; Sabra, Karim G.

    2015-01-01

    Acoustic waves carry information about their source and collect information about their environment as they propagate. This article reviews how these information-carrying and -collecting features of acoustic waves that travel through fluids can be exploited for remote sensing. In nearly all cases, modern acoustic remote sensing involves array-recorded sounds and array signal processing to recover multidimensional results. The application realm for acoustic remote sensing spans an impressive range of signal frequencies (10-2 to 107 Hz) and distances (10-2 to 107 m) and involves biomedical ultrasound imaging, nondestructive evaluation, oil and gas exploration, military systems, and Nuclear Test Ban Treaty monitoring. In the past two decades, approaches have been developed to robustly localize remote sources; remove noise and multipath distortion from recorded signals; and determine the acoustic characteristics of the environment through which the sound waves have traveled, even when the recorded sounds originate from uncooperative sources or are merely ambient noise.

  3. Percutaneous excision: a viable alternative to manage benign breast lesions.

    PubMed

    Slanetz, Priscilla J; Wu, Shieh-Pei; Mendel, Jeffrey B

    2011-11-01

    Benign breast masses, such as fibroadenomas, are common, and their management is variable, depending on symptoms and patient concerns. We undertook this study to determine the safety, efficacy, and patient acceptance of percutaneous excision of benign breast masses by using a hand-held vacuum-assisted device. By using sonographic guidance, percutaneous removal was performed in 40 patients with 42 lesions by using a 9-gauge (n = 13) or 12-gauge (n = 29) probe (ATEC; Suros Surgical). Technical success, procedural complications, and patient experience were recorded at the time of excision and at 48 hours. Clinical, imaging, and/or surgical follow-up was obtained for 39 of 42 lesions (93%). Three of 42 lesions (7%) were lost to follow-up. Of 42 lesions, maximal diameters ranged from 0.6-4.0 cm (mean 1.6 cm), with lesion volumes between 0.05 and 11.2 mL (mean [SD] 1.4 ± 2.1 mL, median 7 mL). The procedure was well tolerated by all patients, and no residual mass was visible in any case at the conclusion of the procedure. All the patients preferred this approach to open surgical biopsy. After percutaneous excision, surgery was performed on 3 of 42 lesions (7%) for atypia (n = 2) or malignancy (n = 1), with a residual mass found only for the malignant case. Of the 26 of 42 lesions (62%) with imaging follow-up, 24 (92%) had no lesion recurrence. Overall, the procedure either completely removed the mass and/or relieved the patient's symptoms of a mass in 36 of 39 lesions (92%) for which clinical, imaging, and/or surgical follow-up was available. Three lesions were lost to follow-up. Ultrasound-guided percutaneous excision of benign breast masses is a safe, effective, and well-tolerated minimally invasive procedure for the diagnosis and removal of benign breast masses. It may serve as an alternative to surgical excision for women with a known benign or probably benign breast mass who desire excision but prefer to avoid surgery or who are poor surgical candidates. Copyright

  4. Long-term results of local excision for rectal cancer.

    PubMed

    Paty, Philip B; Nash, Garrett M; Baron, Paul; Zakowski, Maureen; Minsky, Bruce D; Blumberg, David; Nathanson, Daniel R; Guillem, Jose G; Enker, Warren E; Cohen, Alfred M; Wong, W Douglas

    2002-10-01

    To review the authors' experience with local excision of early rectal cancers to assess the effectiveness of initial treatment and of salvage surgery. Local excision for rectal cancer is appealing for its low morbidity and excellent functional results. However, its use is limited by inability to assess regional lymph nodes and uncertainty of oncologic outcome. Patients with T1 and T2 adenocarcinomas of the rectum treated by local excision as definitive surgery between 1969 to 1996 at the authors' institution were reviewed. Pathology slides were reviewed. Among 125 assessable patients, 74 were T1 and 51 were T2. Thirty-one patients (25%) were selected to receive adjuvant radiation therapy. Fifteen of these 31 patients received adjuvant radiation in combination with 5-fluorouracil chemotherapy. Median follow-up was 6.7 years. One hundred fifteen patients (92%) were followed until death or for greater than 5 years, and 69 patients (55%) were followed until death or for greater than 10 years. Recurrence was recorded as local, distant, and overall. Survival was disease-specific. Ten-year local recurrence and survival rates were 17% and 74% for T1 rectal cancers and 26% and 72% for T2 cancers. Median time to relapse was 1.4 years (range 0.4-7.0) for local recurrence and 2.5 years (0.8-7.5) for distant recurrence. In patients receiving radiotherapy, local recurrence was delayed (median 2.1 years vs. 1.1 years), but overall rates of local and overall recurrence and survival rates were similar to patients not receiving radiotherapy. Among 26 cancer deaths, 8 (28%) occurred more than 5 years after local excision. On multivariate analysis, no clinical or pathologic features were predictive of local recurrence. Intratumoral vascular invasion was the only significant predictor of survival. Among 34 patients who developed tumor recurrence, the pattern of first clinical recurrence was predominantly local: 50% local only, 18% local and distant, and 32% distant only. Among the 17

  5. 29 CFR 779.262 - Excise taxes at the retail level.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes at the retail level. 779.262 Section 779.262... Coverage Excise Taxes § 779.262 Excise taxes at the retail level. (a) Federal excise taxes are imposed at the retail level on highway vehicle fuels other than gasoline under the provisions of 26 U.S.C. 4041...

  6. 29 CFR 779.262 - Excise taxes at the retail level.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Excise taxes at the retail level. 779.262 Section 779.262... Coverage Excise Taxes § 779.262 Excise taxes at the retail level. (a) Federal excise taxes are imposed at the retail level on highway vehicle fuels other than gasoline under the provisions of 26 U.S.C. 4041...

  7. 29 CFR 779.262 - Excise taxes at the retail level.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 3 2013-07-01 2013-07-01 false Excise taxes at the retail level. 779.262 Section 779.262... Coverage Excise Taxes § 779.262 Excise taxes at the retail level. (a) Federal excise taxes are imposed at the retail level on highway vehicle fuels other than gasoline under the provisions of 26 U.S.C. 4041...

  8. 29 CFR 779.262 - Excise taxes at the retail level.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Excise taxes at the retail level. 779.262 Section 779.262... Coverage Excise Taxes § 779.262 Excise taxes at the retail level. (a) Federal excise taxes are imposed at the retail level on highway vehicle fuels other than gasoline under the provisions of 26 U.S.C. 4041...

  9. 29 CFR 779.262 - Excise taxes at the retail level.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Excise taxes at the retail level. 779.262 Section 779.262... Coverage Excise Taxes § 779.262 Excise taxes at the retail level. (a) Federal excise taxes are imposed at the retail level on highway vehicle fuels other than gasoline under the provisions of 26 U.S.C. 4041...

  10. Resolution of vitiligo following excision of halo congenital melanocytic nevus: a rare case report.

    PubMed

    Wang, Kai; Wang, Zhi; Huang, Weiqing

    2016-05-01

    Halo congenital melanocytic nevus (CMN) associated with vitiligo is rare, especially with regard to CMN excision. Only two reports of excision of halo CMN following repigmentation of vitiligo are found in the literature. We present a case of a girl with halo CMN and periorbital vitiligo. The halo CMN was excised and followed by spontaneous improvement of vitiligo. The result suggests excision of the inciting lesion may be a promising way to control vitiligo. © 2015 Wiley Periodicals, Inc.

  11. Biomolecular Simulation of Base Excision Repair and Protein Signaling

    SciTech Connect

    Straatsma, TP; McCammon, J A; Miller, John H; Smith, Paul E; Vorpagel, Erich R; Wong, Chung F; Zacharias, Martin W

    2006-03-03

    The goal of the Biomolecular Simulation of Base Excision Repair and Protein Signaling project is to enhance our understanding of the mechanism of human polymerase-β, one of the key enzymes in base excision repair (BER) and the cell-signaling enzymes cyclic-AMP-dependent protein kinase. This work used molecular modeling and simulation studies to specifically focus on the • dynamics of DNA and damaged DNA • dynamics and energetics of base flipping in DNA • mechanism and fidelity of nucleotide insertion by BER enzyme human polymerase-β • mechanism and inhibitor design for cyclic-AMP-dependent protein kinase. Molecular dynamics simulations and electronic structure calculations have been performed using the computer resources at the Molecular Science Computing Facility at the Environmental Molecular Sciences Laboratory.

  12. Nodular fasciitis of the hand: excision preserving 'vital' structures.

    PubMed

    Al-Qattan, M M; Arafah, M M

    2014-10-01

    Nodular fasciitis is an extremely rare benign fibrous tumour of the hand. Although benign, the tumour is frequently adherent to tendons/nerves and joints of the hand. However, the tumour may spontaneously regress and does not tend to recur following excision with histologically positive margins. For the last 20 years, the author has adopted a specific management approach for these and other benign fibrous tumours of the hand. Following the clinical/radiological diagnosis, tumour excision is done preserving 'vital' structures within the hand. The diagnosis is confirmed histologically and by immune stains, and the patient is then followed up for local recurrence. Over a 20-year period, the author has treated four cases of nodular fasciitis of the hand using this management approach. Despite the positive margins in all cases, there were no recurrences at a minimum follow-up interval of 3 years.

  13. Confocal reflectance imaging of excised malignant human bladder biopsies

    NASA Astrophysics Data System (ADS)

    Daniltchenko, Dmitri I.; Kastein, Albrecht; Koenig, Frank; Sachs, Markus; Schnorr, Dietmar; Al-Shukri, Salman; Loening, Stefan A.

    2004-08-01

    To evaluate the potential of reflectance confocal scanning laser microscopy (CM) for rapid imaging of non-processed freshly excised human bladder biopsies and cystectomy specimens. Freshly excised bladder tumors from three cystectomy specimens and random biopsies from twenty patients with a history of superficial bladder tumors were imaged with CM. Additional acetic acid washing prior to CM imaging was performed in some of the samples. Confocal images were compared to corresponding routine histologic sections. CM allows imaging of unprocessed bladder tissue at a subcellular resolution. Urothelial cell layers, collagen, vessels and muscle fibers can be rapidly visualized, in native state. In this regard, umbrella cells, basement membrane elucidated. Besides obvious limitations partly due to non-use of exogenous dyes, CM imaging offers several advantages: rapid imaging of the tissue in its native state like the basement membrane, normally seen only by using immunohistopathology. Reflectance CM opens a new avenue for imaging bladder cancer.

  14. Excision of Thoracic Chondrosarcoma: Case Report and Review of Literature

    PubMed Central

    Wadhwa, Rishi; Theodore, Pierre; Mummaneni, Praveen

    2016-01-01

    Chondrosarcomas are cartilage-matrix-forming tumors that make up 20-27% of primary malignant bone tumors and are the third most common primary bone malignancy after multiple myelomas and osteosarcomas. Radiographic assessment of this condition includes plain radiography, computed tomography, and magnetic resonance imaging for tumor characterization and delineation of intraosseous and extraosseous involvement. Most chondrosarcomas are refractory to chemotherapy and radiation therapy; therefore, wide en bloc surgical excision offers the best chance for cure. Chondrosarcomas frequently affect the pelvis and upper and lower extremities. In rare instances, the chest wall can be involved, with chondrosarcomas occurring in the ribs, sternum, anterior costosternal junction, and posterior costotransverse junction. In this article, we present a patient with thoracic chondrosarcoma centered at the left T7 costotransverse joint with effacement of the left T7-T8 neuroforamen. We also detail our operative technique of wide en bloc chondrosarcoma excision and review current literature on this topic. PMID:27588229

  15. Excise Tax Avoidance: The Case of State Cigarette Taxes

    PubMed Central

    DeCicca, Philip; Kenkel, Donald; Liu, Feng

    2013-01-01

    We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower-tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20 percent smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes. PMID:24140760

  16. Regulation of endonuclease activity in human nucleotide excision repair

    PubMed Central

    Fagbemi, Adebanke F.; Orelli, Barbara; Schärer, Orlando D.

    2011-01-01

    Nucleotide excision repair (NER) is a DNA repair pathway that is responsible for removing a variety of lesions caused by harmful UV light, chemical carcinogens, and environmental mutagens from DNA. NER involves the concerted action of over 30 proteins that sequentially recognize a lesion, excise it in the form of an oligonucleotide, and fill in the resulting gap by repair synthesis. ERCC1-XPF and XPG are structure-specific endonucleases responsible for carrying out the incisions 5′ and 3′ to the damage respectively, culminating in the release of the damaged oligonucleotide. This review focuses on the recent work that led to a greater understanding of how the activities of ERCC1-XPF and XPG are regulated in NER to prevent unwanted cuts in DNA or the persistence of gaps after incision that could result in harmful, cytotoxic DNA structures. PMID:21592868

  17. Nonlinear dynamics of phonations in excised larynx experiments.

    PubMed

    Jiang, Jack J; Zhang, Yu; Ford, Charles N

    2003-10-01

    Nonlinear dynamic methods including correlation dimension and Lyapunov exponents are applied to quantitatively analyze phonations in excised larynx experiments. Irregular phonations are typically characterized by aperiodic waveforms and broadband spectra. Finite correlation dimensions and positive Lyapunov exponents of irregular phonations demonstrate the existence of chaos in excised larynx phonations. Furthermore, the correlation dimension, maximal Lyapunov exponent, jitter, shimmer, and peak prominence ratio are used to statistically distinguish irregular phonations from normal phonations. The correlation dimension and maximal Lyapunov exponent indicate a significant difference between irregular and normal phonations; however, jitter, shimmer, and peak prominence ratio do not reveal such a significant difference and thus are unsuitable to differentiate between irregular phonations and normal phonations. These findings might potentially assist investigators in understanding rough phonations and developing clinically valuable methodologies for the diagnosis of voice disorders.

  18. Excise tax avoidance: the case of state cigarette taxes.

    PubMed

    DeCicca, Philip; Kenkel, Donald; Liu, Feng

    2013-12-01

    We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20% smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. 48 CFR 552.229-71 - Federal Excise Tax-DC Government.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...

  20. 48 CFR 552.229-71 - Federal Excise Tax-DC Government.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...

  1. 48 CFR 552.229-71 - Federal Excise Tax-DC Government.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...

  2. 48 CFR 552.229-71 - Federal Excise Tax-DC Government.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...

  3. 48 CFR 552.229-71 - Federal Excise Tax-DC Government.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue Tax...

  4. 77 FR 37838 - Disregarded Entities and the Indoor Tanning Services Excise Tax

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-25

    ... Services Excise Tax AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed rulemaking... (including qualified subchapter S subsidiaries) and the indoor tanning services excise tax. These regulations affect disregarded entities responsible for collecting the indoor tanning services excise tax and...

  5. 29 CFR 779.263 - Excise taxes not at the retail level.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Excise taxes not at the retail level. 779.263 Section 779... Coverage Excise Taxes § 779.263 Excise taxes not at the retail level. There are also a wide variety of taxes levied at the manufacturer's or distributor's level and not at the retail level. It should be...

  6. 29 CFR 779.263 - Excise taxes not at the retail level.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Excise taxes not at the retail level. 779.263 Section 779... Coverage Excise Taxes § 779.263 Excise taxes not at the retail level. There are also a wide variety of taxes levied at the manufacturer's or distributor's level and not at the retail level. It should be...

  7. 29 CFR 779.263 - Excise taxes not at the retail level.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes not at the retail level. 779.263 Section 779... Coverage Excise Taxes § 779.263 Excise taxes not at the retail level. There are also a wide variety of taxes levied at the manufacturer's or distributor's level and not at the retail level. It should be...

  8. 29 CFR 779.263 - Excise taxes not at the retail level.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 3 2013-07-01 2013-07-01 false Excise taxes not at the retail level. 779.263 Section 779... Coverage Excise Taxes § 779.263 Excise taxes not at the retail level. There are also a wide variety of taxes levied at the manufacturer's or distributor's level and not at the retail level. It should be...

  9. 29 CFR 779.263 - Excise taxes not at the retail level.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Excise taxes not at the retail level. 779.263 Section 779... Coverage Excise Taxes § 779.263 Excise taxes not at the retail level. There are also a wide variety of taxes levied at the manufacturer's or distributor's level and not at the retail level. It should be...

  10. 26 CFR 53.4940-1 - Excise tax on net investment income.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 17 2011-04-01 2011-04-01 false Excise tax on net investment income. 53.4940-1...-1 Excise tax on net investment income. (a) In general. For taxable years beginning after September 30, 1977, section 4940 imposes an excise tax of 2 percent of the net investment income (as defined in...

  11. BAER - brainstem auditory evoked response

    MedlinePlus

    ... be a sign of hearing loss , multiple sclerosis , acoustic neuroma , or stroke. Abnormal results may also be ... PA: Elsevier Saunders; 2016:chap 34. Read More Acoustic neuroma Central pontine myelinolysis Hearing loss Multiple sclerosis ...

  12. Treatment Options Summary

    MedlinePlus

    ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ...

  13. Neurofibromatosis

    MedlinePlus

    ... cranial nerves, which are called vestibular schwannomas or acoustic neuromas.. The tumors press on and damage neighboring ... cranial nerves, which are called vestibular schwannomas or acoustic neuromas.. The tumors press on and damage neighboring ...

  14. Stereotactic Radiosurgery - Gamma Knife

    MedlinePlus

    ... nerve that connects the ear to the brain ( acoustic neuroma ) Pituitary tumors Tumors that are not cancer ( ... and the A.D.A.M. Editorial team. Acoustic Neuroma Read more Brain Tumors Read more Radiation ...

  15. Vestibular Neuronitis

    MedlinePlus

    ... Inner Ear Disorders Overview of the Inner Ear Acoustic Neuroma Benign Paroxysmal Positional Vertigo Ear Disorders Caused ... Inner Ear Disorders Overview of the Inner Ear Acoustic Neuroma Benign Paroxysmal Positional Vertigo Ear Disorders Caused ...

  16. Stereotactic radiosurgery - discharge

    MedlinePlus

    ... pg=stereotactic . Accessed July 22, 2016. Read More Acoustic neuroma Brain tumor - primary - adults Cerebral arteriovenous malformation ... A.M. Editorial team. Related MedlinePlus Health Topics Acoustic Neuroma Arteriovenous Malformations Brain Tumors Childhood Brain Tumors ...

  17. Laparoscopic excision versus open excision for the treatment of choledochal cysts: a systematic review and meta-analysis.

    PubMed

    Zhen, Chen; Xia, Zhang; Long, Li; Lishuang, Ma; Pu, Yu; Wenjuan, Zheng; Xiaofan, Li

    2015-01-01

    In 1723, Vater first described choledochal cyst and in 1977, Todani et al classified this disease. For many years, open excision (OP) as the standard procedure made a great impact in the treatment of choledochal cyst. Since 1995, when Farello et al first reported laparoscopic choledochal cyst excision, laparoscopic excision (LA) has been used worldwide. However, its safety remains a major concern. The aim of this meta-analysis was to compare OP with LA in treating choledochal cyst and then to determine whether LA is safe and valid. The design of this study involved systematic review and meta-analysis. Data sources were Medline, Ovid, Elsevier, Google Scholar, Embase, and Cochrane library. The study selection entailed comparative cohort studies. For data extraction, 2 investigators independently assessed selected studies and extracted the following information: study characteristics, quality, outcomes data, etc. For the results, 7 comparative cohort studies about the effectiveness of LA compared with OP were performed meta-analysis. The results showed that although the LA group had a longer operative time (MD = 56.57; 95% CI = 32.20-80.93; P < 0.00001), LA had a shorter duration of hospital stay (MD = -1.93; 95% CI = -2.51 to -1.36; P < 0.00001), and recovery of bowel function (MD = -0.94; 95% CI = -1.33 to -0.55; P < 0.00001). Meta-analysis found no significant difference between most of the 2 groups: bile leak (RR = 0.60; 95% CI = 0.29-1.24; P = 0.17), abdominal bleeding (RR = 0.33; 95% CI = 0.01-8.98; P = 0.51), pancreatitis (RR = 0.26, 95% CI = 0.06-1.03; P = 0.06), total postoperative complications (RR = 1.04; 95% CI = 0.66-1.62; P = 0.88). The LA group had significant lower rates in intraoperative blood transfusion (RR = 0.20; 95% CI = 0.11-0.38; P < 0.00001), and adhesive intestinal obstruction (RR = 0.17, 95% CI = 0.04-0.77; P = 0.02). In conclusion, compared with open excision, laparoscopic excision is a safe, valid, and feasible alternative to open

  18. Excising das All: Evolving Maxwell waves beyond Scri

    NASA Technical Reports Server (NTRS)

    vanMeter, James R.; Fiske, David R.; Misner, Charles W.

    2006-01-01

    We study the numerical propagation of waves through future null infinity in a conformally compactified spacetime. We introduce an artificial cosmological constant, which allows us some control over the causal structure near null infinity. We exploit this freedom to ensure that all light cones are tilted outward in a region near null infinity, which allows us to impose excision-style boundary conditions in our finite difference code. In this preliminary study we consider electromagnetic waves propagating in a static, conformally compactified spacetime.

  19. Modulation of human nucleotide excision repair by 5-methylcytosines.

    PubMed

    Muheim, Regula; Buterin, Tonko; Colgate, Katharine C; Kolbanovsij, Alexander; Geacintov, Nicholas E; Naegeli, Hanspeter

    2003-03-25

    Previous reports showed that methylated CpG sites are primary targets of bulky lesions induced by UV radiation, benzo[a]pyrene (B[a]P), or other environmental genotoxic agents. This study was performed to determine whether the repair of DNA damage formed preferentially at CpG dinucleotides is sensitive to 5-methylcytosine substitutions. Reactivation assays using UV- or B[a]P diol epoxide-damaged shuttle vectors established that human nucleotide excision repair enzymes are able to process fully methylated target DNA molecules. Repair reactions in human cell extracts suggested that 5-methylcytosines modulate local repair efficiency in a seemingly unpredictable manner. In fact, excision of the predominant (+)-trans-anti-B[a]P-dG adduct situated in a mutational hot spot sequence (codon 273 of the p53 gene) was stimulated by CpG methylation. Interestingly, excision activity was increased by a single 5-methylcytosine residue flanking the adduct in the damaged strand, but the same stimulatory effect was also induced by a single 5-methylcytosine residue located opposite the adduct in the undamaged strand. No such stimulation was observed when the (+)-trans-anti-B[a]P-dG lesion was placed in a different site containing a sequence of contiguous guanines, and strong inhibition was detected when a representative of the rare (+)-cis-anti-B[a]P-dG isomer was tested in the same assay. These results raise the possibility that 5-methylcytosines in CpG dinucleotides modulate not only the distribution of bulky DNA lesions but, at least in some cases, also the kinetics of subsequent excision repair reactions. This study confirms that the efficiency of bulky lesion repair is determined by the configuration of base pairs at damaged sites.

  20. [Laryngeal interarytenoid neurilemmoma excised via microlaryngeal endoscopy: two case reports].

    PubMed

    Shen, Yi; Cheng, Lixin; Tang, Ming

    2015-12-01

    Laryngeal interarytenoid neurilemmomas (LIN) is a benign encapsulated tumor originating from the schwann cells lining nerve fibers. Even though LINs are extremely rare in incidence, they could present with potential threat to the airway and thus requiring prompt diagnosis and treatment. Here, we report two cases of LINs. Both patients underwent excision of the tumor via microlaryngeal endoscopic procedures and recovered well postoperatively without complications. No recurrence was observed postoperatively on routine follow-up after 14 months.

  1. Phaeochromocytoma and Paraganglioma Excision Involving the Great Vessels.

    PubMed

    Srirangalingam, U; Gunganah, K; Carpenter, R; Bhattacharya, S; Edmondson, S J; Drake, W M

    2017-01-01

    Phaeochromocytomas and paragangliomas are vascular neuroendocrine tumours distributed between the neck and the pelvis and may be associated with catecholamine secretion. The aim of the study was to describe the complex surgical management required to excise these tumours when in close proximity to the great vessels (aorta and vena cava). This was a retrospective case series. Patients included those undergoing surgical excision of a phaeochromocytoma or paraganglioma involving the great vessels. Data on clinical presentation; genetic mutations; tumour location; catecholamine/metanephrine secretion; surgical strategy; pre-, intra-, and post-operative course were collated. Five patients (age range 16-60 years) were identified; three had thoracic paragangliomas located under the arch of the aorta, one had an abdominal paraganglioma invading the aorta, and one had a massive phaeochromocytoma invading the inferior vena cava via the adrenal vein. Three patients had predisposing germline mutations. All patients had adrenergic blockade prior to surgery. A diverse range of complex surgical techniques were employed to excise tumours, including cardiopulmonary bypass, aortic resection, grafting and venotomy of the vena cava. Early post-operative complications were limited. Excision of phaeochromocytomas and paragangliomas involving the great vessels is high risk surgery optimally undertaken within a multidisciplinary setting in a tertiary referral centre. Comprehensive radiological and biochemical assessment, meticulous pre-operative preparation and close intra- and post-operative monitoring are essential. Radiological imaging may be unable to resolve the tumour extent and anatomy pre-operatively and direct visualisation of the tumour may be the only way to clarify the surgical strategy. Pre-operative knowledge of the genetic predisposition may influence surgical management.

  2. Open Wound Drainage Versus Wound Excision on the Modern Battlefield

    DTIC Science & Technology

    1988-02-01

    D7J FILE COPk " ’I Institute Report No. 256 •! • N ,Lt) Open Wound Drainage Versus Wound Excision N -" Oa on the Modern Battlefield 0) M. L. Facklsr...provided with adequate open drainage and systemic penicillin, heals as rapidly when the body defense mechanisms handle the disrupted tissue as when...modern generation assault rifle, provided with adequate open drainage and systemic penicillin, heals as rapidly when the body defense mechanisms

  3. Wide excision of accessory parotid gland with anterior approach.

    PubMed

    Choi, Hwan Jun; Lee, Young Man; Kim, Jun Hyuk; Tark, Min Seong; Lee, Jang Hyun

    2012-01-01

    Accessory parotid gland tissue has been described as salivary tissue adjacent to the Stensen duct that is distinctly separate from the main body of the parotid gland. Of all parotid gland tumors, 1% to 8% arise from the accessory parotid gland. Little is known about the accessory parotid gland, and it is seldom mentioned in the literature. Between 1999 and 2010, we have treated and followed 8 patients with tumors of the accessory parotid gland. There were 5 males and 3 females with a mean age of 35 years. They all presented with an asymptomatic cheek mass, and 4 of them underwent fine-needle aspiration. Ultrasound or computed tomographic scan was used in all patients. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. The mean follow-up time was 44 months (range, 6-120 months). Seven patients had benign disease. Four cases were pleomorphic adenoma, and the remaining 3 benign cases were parotid cyst, basal cell adenoma, and hemangioma. Only 1 patient had a malignant tumor that was a lymphoepithelioma-like carcinoma. In 7 cases, wide excision (excision of mass and accessory lobe of the parotid gland) was done because of the intra-accessory parotid gland lesion. One patient had concomitant superficial parotidectomy because the tumor was located very close to and has involved the parotid gland proper. There was no serious postoperative complication and recurrence. Prudent preoperative diagnostic evaluation and meticulous surgical approach are the keys to successful management of midcheek lesions. A wide excision of the accessory lobe of the parotid gland can be a definitive surgery in case of solitary tumor with an intact parotid fascia, and wide excision with anterior approach through a standard parotidectomy incision is preferred to a direct incision over the mass.

  4. Envisioning the molecular choreography of DNA base excision repair.

    PubMed

    Parikh, S S; Mol, C D; Hosfield, D J; Tainer, J A

    1999-02-01

    Recent breakthroughs integrate individual DNA repair enzyme structures, biochemistry and biology to outline the structural cell biology of the DNA base excision repair pathways that are essential to genome integrity. Thus, we are starting to envision how the actions, movements, steps, partners and timing of DNA repair enzymes, which together define their molecular choreography, are elegantly controlled by both the nature of the DNA damage and the structural chemistry of the participating enzymes and the DNA double helix.

  5. How are base excision DNA repair pathways deployed in vivo?

    PubMed

    Thapar, Upasna; Demple, Bruce

    2017-01-01

    Since the discovery of the base excision repair (BER) system for DNA more than 40 years ago, new branches of the pathway have been revealed at the biochemical level by in vitro studies. Largely for technical reasons, however, the confirmation of these subpathways in vivo has been elusive. We review methods that have been used to explore BER in mammalian cells, indicate where there are important knowledge gaps to fill, and suggest a way to address them.

  6. How are base excision DNA repair pathways deployed in vivo?

    PubMed Central

    Thapar, Upasna; Demple, Bruce

    2017-01-01

    Since the discovery of the base excision repair (BER) system for DNA more than 40 years ago, new branches of the pathway have been revealed at the biochemical level by in vitro studies. Largely for technical reasons, however, the confirmation of these subpathways in vivo has been elusive. We review methods that have been used to explore BER in mammalian cells, indicate where there are important knowledge gaps to fill, and suggest a way to address them. PMID:28357058

  7. Translational illusion of acoustic sources by transformation acoustics.

    PubMed

    Sun, Fei; Li, Shichao; He, Sailing

    2017-09-01

    An acoustic illusion of creating a translated acoustic source is designed by utilizing transformation acoustics. An acoustic source shifter (ASS) composed of layered acoustic metamaterials is designed to achieve such an illusion. A practical example where the ASS is made with naturally available materials is also given. Numerical simulations verify the performance of the proposed device. The designed ASS may have some applications in, e.g., anti-sonar detection.

  8. Acoustic sniper localization system

    NASA Astrophysics Data System (ADS)

    Prado, Gervasio; Dhaliwal, Hardave; Martel, Philip O.

    1997-02-01

    Technologies for sniper localization have received increased attention in recent months as American forces have been deployed to various trouble spots around the world. Among the technologies considered for this task acoustics is a natural choice for various reasons. The acoustic signatures of gunshots are loud and distinctive, making them easy to detect even in high noise background environments. Acoustics provides a passive sensing technology with excellent range and non line of sight capabilities. Last but not least, an acoustic sniper location system can be built at a low cost with off the shelf components. Despite its many advantages, the performance of acoustic sensors can degrade under adverse propagation conditions. Localization accuracy, although good, is usually not accurate enough to pinpoint a sniper's location in some scenarios (for example which widow in a building or behind which tree in a grove). For these more demanding missions, the acoustic sensor can be used in conjunction with an infra red imaging system that detects the muzzle blast of the gun. The acoustic system can be used to cue the pointing system of the IR camera in the direction of the shot's source.

  9. Acoustic cooling engine

    DOEpatents

    Hofler, Thomas J.; Wheatley, John C.; Swift, Gregory W.; Migliori, Albert

    1988-01-01

    An acoustic cooling engine with improved thermal performance and reduced internal losses comprises a compressible fluid contained in a resonant pressure vessel. The fluid has a substantial thermal expansion coefficient and is capable of supporting an acoustic standing wave. A thermodynamic element has first and second ends and is located in the resonant pressure vessel in thermal communication with the fluid. The thermal response of the thermodynamic element to the acoustic standing wave pumps heat from the second end to the first end. The thermodynamic element permits substantial flow of the fluid through the thermodynamic element. An acoustic driver cyclically drives the fluid with an acoustic standing wave. The driver is at a location of maximum acoustic impedance in the resonant pressure vessel and proximate the first end of the thermodynamic element. A hot heat exchanger is adjacent to and in thermal communication with the first end of the thermodynamic element. The hot heat exchanger conducts heat from the first end to portions of the resonant pressure vessel proximate the hot heat exchanger. The hot heat exchanger permits substantial flow of the fluid through the hot heat exchanger. The resonant pressure vessel can include a housing less than one quarter wavelength in length coupled to a reservoir. The housing can include a reduced diameter portion communicating with the reservoir. The frequency of the acoustic driver can be continuously controlled so as to maintain resonance.

  10. Acoustic mapping velocimetry

    NASA Astrophysics Data System (ADS)

    Muste, M.; Baranya, S.; Tsubaki, R.; Kim, D.; Ho, H.; Tsai, H.; Law, D.

    2016-05-01

    Knowledge of sediment dynamics in rivers is of great importance for various practical purposes. Despite its high relevance in riverine environment processes, the monitoring of sediment rates remains a major and challenging task for both suspended and bed load estimation. While the measurement of suspended load is currently an active area of testing with nonintrusive technologies (optical and acoustic), bed load measurement does not mark a similar progress. This paper describes an innovative combination of measurement techniques and analysis protocols that establishes the proof-of-concept for a promising technique, labeled herein Acoustic Mapping Velocimetry (AMV). The technique estimates bed load rates in rivers developing bed forms using a nonintrusive measurements approach. The raw information for AMV is collected with acoustic multibeam technology that in turn provides maps of the bathymetry over longitudinal swaths. As long as the acoustic maps can be acquired relatively quickly and the repetition rate for the mapping is commensurate with the movement of the bed forms, successive acoustic maps capture the progression of the bed form movement. Two-dimensional velocity maps associated with the bed form migration are obtained by implementing algorithms typically used in particle image velocimetry to acoustic maps converted in gray-level images. Furthermore, use of the obtained acoustic and velocity maps in conjunction with analytical formulations (e.g., Exner equation) enables estimation of multidirectional bed load rates over the whole imaged area. This paper presents a validation study of the AMV technique using a set of laboratory experiments.

  11. Some Problems of modern acoustics

    NASA Technical Reports Server (NTRS)

    Stan, A.

    1974-01-01

    The multidisciplinary and interdisciplinary character of acoustics is considered and its scientific, technological, economical and social implications, as well as the role of acoustics in creating new machines and equipment and improving the quality of products are outlined. Research beyond audible frequencies, as well as to extremely high acoustic intensities, which requires the development of a nonlinear acoustics is elaborated.

  12. Fluorescence and reflectance spectra of freshly excised cervical tissue

    NASA Astrophysics Data System (ADS)

    Zelenchuk, Alex R.; Oliva, Esther; Kaufman, Howard; Schomacker, Kevin T.; Bandarchi-Chamkhaleh, Bizhan; Pitts, Jonathan D.

    2002-05-01

    Fluorescence emission and diffuse reflectance spectra of freshly excised cervical tissue were studied with two specially designed contact probes. The objective of the study was to reach a better understanding of the relationship between spectroscopic measurements and cervical tissue morphology. Tissue samples from loop electro-surgical excision and hysterectomy specimens were measured within 20 to 90 minutes of excision. Emission spectra with 337 nm excitation, and reflectance spectra were collected at wavelengths between 370 and 720 nm from different tissue sites. Hematoxylin-eosin stained slides of the measured zones were obtained and compared to the spectra. In one experiment, a contact probe with a central illumination fiber and two concentric rings of detection fibers (radii 0.1 and 1 mm), was placed in contact with the epithelium and used to measure spectra from ectocervix and endocervix. The influence of 5% acetic acid on fluorescence and reflectance spectra was also investigated. In another experiment, a single 100-micron fiber probe was placed perpendicular to a cut edge of tissue and scanned to measure spectra in depth. Depth scans were made over various areas of the cervix

  13. Recombinant methods for screening human DNA excision repair proficiency

    SciTech Connect

    Athas, W.F.

    1988-01-01

    A method for measuring DNA excision repair in response to ultraviolet radiation (UV)-induced DNA damage has been developed, validated, and field-tested in cultured human lymphocytes. The methodology is amenable to population-based screening and should facilitate future epidemiologic studies seeking to investigate associations between excision repair proficiency and cancer susceptibility. The impetus for such endeavors derives from the belief that the high incidence of skin cancer in the genetic disorder xeroderma pigmentosum (XP) primarily is a result of the reduced capacity of patients cells to repair UV-induced DNA damage. For assay, UV-irradiated non-replicating recombinant plasmid DNA harboring a chloramphenicol acetyltransferase (CAT) indicator gene is introduced into lymphocytes using DEAE-dextran short-term transfection conditions. Exposure to UV induces transcriptionally-inactivating DNA photoproducts in the plasmid DNA which inactivate CAT gene expression. Excision repair of the damaged CAT gene is monitored indirectly as a function of reactivated CAT enzyme activity following a 40 hour repair/expression incubation period.

  14. New synthetic substrates of mammalian nucleotide excision repair system

    PubMed Central

    Evdokimov, Alexey; Petruseva, Irina; Tsidulko, Aleksandra; Koroleva, Ludmila; Serpokrylova, Inna; Silnikov, Vladimir; Lavrik, Olga

    2013-01-01

    DNA probes for the studies of damaged strand excision during the nucleotide excision repair (NER) have been designed using the novel non-nucleosidic phosphoramidite reagents that contain N-[6-(9-antracenylcarbamoyl)hexanoyl]-3-amino-1,2-propandiol (nAnt) and N-[6-(5(6)-fluoresceinylcarbamoyl)hexanoyl]-3-amino-1,2-propandiol (nFlu) moieties. New lesion-imitating adducts being inserted into DNA show good substrate properties in NER process. Modified extended linear nFlu– and nAntr–DNA are suitable for estimation of specific excision activity catalysed with mammalian whole-cell extracts. The following substrate activity range was revealed for the model 137-bp linear double-stranded DNA: nAnt–DNA ≈ nFlu–DNA > Chol–DNA (Chol–DNA—legitimate NER substrate that contains non-nucleoside fragment bearing cholesterol residue). In vitro assay shows that modified DNA can be a useful tool to study NER activity in whole-cell extracts. The developed approach should be of general use for the incorporation of NER-sensitive distortions into model DNAs. The new synthetic extended linear DNA containing bulky non-nucleoside modifications will be useful for NER mechanism study and for applications. PMID:23609543

  15. Acoustic well cleaner

    DOEpatents

    Maki, Jr., Voldi E.; Sharma, Mukul M.

    1997-01-21

    A method and apparatus are disclosed for cleaning the wellbore and the near wellbore region. A sonde is provided which is adapted to be lowered into a borehole and which includes a plurality of acoustic transducers arranged around the sonde. Electrical power provided by a cable is converted to acoustic energy. The high intensity acoustic energy directed to the borehole wall and into the near wellbore region, redissolves or resuspends the material which is reducing the permeability of the formation and/or restricting flow in the wellbore.

  16. Acoustic broadband metacouplers

    NASA Astrophysics Data System (ADS)

    Li, Kun; Liang, Bin; Yang, Jing; Yang, Jun; Cheng, Jian-chun

    2017-05-01

    We present the concept of acoustic metacoupler for broadband impedance match between two media with different impedances and cross sections. An implementation is demonstrated that produces spatial gradient of effective acoustic impedance by utilizing helical-like structure with continuously varying pitch instead of changing the cross-section or employing multiple layers. Numerical results verify the effectiveness of our design in achieving near-unity coupling efficiency in a broad band. We anticipate the proposed metacoupler with capability and flexibility to open route to broadband impedance matching and to have a wide realm of potential applications such as transducer design, acoustic imaging and energy harvesting.

  17. Acoustical heat pumping engine

    DOEpatents

    Wheatley, J.C.; Swift, G.W.; Migliori, A.

    1983-08-16

    The disclosure is directed to an acoustical heat pumping engine without moving seals. A tubular housing holds a compressible fluid capable of supporting an acoustical standing wave. An acoustical driver is disposed at one end of the housing and the other end is capped. A second thermodynamic medium is disposed in the housing near to but spaced from the capped end. Heat is pumped along the second thermodynamic medium toward the capped end as a consequence both of the pressure oscillation due to the driver and imperfect thermal contact between the fluid and the second thermodynamic medium. 2 figs.

  18. PRSEUS Acoustic Panel Fabrication

    NASA Technical Reports Server (NTRS)

    Nicolette, Velicki; Yovanof, Nicolette P.; Baraja, Jaime; Mathur, Gopal; Thrash, Patrick; Pickell, Robert

    2011-01-01

    This report describes the development of a novel structural concept, Pultruded Rod Stitched Efficient Unitized Structure (PRSEUS), that addresses the demanding fuselage loading requirements for the Hybrid Wing or Blended Wing Body (BWB) airplane configuration with regards to acoustic response. A PRSEUS panel was designed and fabricated and provided to NASA-LaRC for acoustic response testing in the Structural Acoustics Loads and Transmission (SALT) facility). Preliminary assessments of the sound transmission characteristics of a PRSEUS panel subjected to a representative Hybrid Wing Body (HWB) operating environment were completed for the NASA Environmentally Responsible Aviation (ERA) Program.

  19. Acoustical heat pumping engine

    DOEpatents

    Wheatley, John C.; Swift, Gregory W.; Migliori, Albert

    1983-08-16

    The disclosure is directed to an acoustical heat pumping engine without moving seals. A tubular housing holds a compressible fluid capable of supporting an acoustical standing wave. An acoustical driver is disposed at one end of the housing and the other end is capped. A second thermodynamic medium is disposed in the housing near to but spaced from the capped end. Heat is pumped along the second thermodynamic medium toward the capped end as a consequence both of the pressure oscillation due to the driver and imperfect thermal contact between the fluid and the second thermodynamic medium.

  20. The room acoustic rendering equation.

    PubMed

    Siltanen, Samuel; Lokki, Tapio; Kiminki, Sami; Savioja, Lauri

    2007-09-01

    An integral equation generalizing a variety of known geometrical room acoustics modeling algorithms is presented. The formulation of the room acoustic rendering equation is adopted from computer graphics. Based on the room acoustic rendering equation, an acoustic radiance transfer method, which can handle both diffuse and nondiffuse reflections, is derived. In a case study, the method is used to predict several acoustic parameters of a room model. The results are compared to measured data of the actual room and to the results given by other acoustics prediction software. It is concluded that the method can predict most acoustic parameters reliably and provides results as accurate as current commercial room acoustic prediction software. Although the presented acoustic radiance transfer method relies on geometrical acoustics, it can be extended to model diffraction and transmission through materials in future.