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BackgroundA variety of benign tumors present in the nasal and paranasal sinuses.MethodsWe review our experience over the last 10 years with endoscopic management of these tumors and discuss presentation, diagnostic considerations, and therapeutic options.ResultsEighteen patients with benign sinonasal tumors were managed with endoscopic techniques. Representative cases are presented, including pleomorphic adenoma, ameloblastoma, meningioma, cholersterol granuloma, ossifying fibroma, fibrous dysplasia, and osteomas. Three patients (16.7%) required one revision endoscopic sinus procedure. Average follow-up was 4 years.ConclusionsWith the treatment of more complex cases being undertaken endoscopically, the need for individual therapeutic consideration and close follow-up is stressed. The combination of removal of benign tumors endoscopically and endoscopic surveillance in the outpatient setting has allowed a less radical surgical approach while resulting in decreased morbidity and better tumor control.

Holes in surgical gloves are considered to be an important source of transmission of pathogens between patient and surgeon. The purpose of this study was to determine if electrosurgery could alter the integrity of latex surgical gloves. The effects of electrosurgery on 11 brands of commercially available latex surgical gloves were tested through an in vitro study that simulated the conditions in the operating room. Glove hole puncture was encountered only with coagulation current operating at the highest setting. In addition, maximal surface area contact with the hemostat to the glove surface was required to produce glove puncture. The presence of powder and glove hydration were not significant determinants of glove hole puncture. On the basis of our study, we believe that all surgical gloves tested offered the surgeon adequate protection at commonly used levels of cutting and coagulation current, as long as no breach existed prior to the donning of gloves.

Smart-looking clothes have been designed for wheelchair users. These clothes make dressing faster and easier, and the clothes fit better than the standard garments. The special features for new adaptive clothing for wheelchair users include easy handling fastenings, quick-access garment openings, conveniently placed pockets, custom-curved trousers, slacks, and jackets, custom-shaped dresses and skirts, ponchos or custom-made coats, easy-fit undergarments, and durable styled fabrics. These clothing adaptations are attractive and give the wearer and the observer the feeling that the person with the disability is not set apart by the clothing he or she wears.

A variety of benign tumors present in the nasal and paranasal sinuses.We review our experience over the last 10 years with endoscopic management of these tumors and discuss (presentation, diagnostic considerations, and therapeutic options.Eighteen patients with benign sinonasal tumors were managed with endoscopic techniques. Representative cases are presented, including pleomorphic adenoma, ameloblastoma, meningioma, cholersterol granuloma, ossifying fibroma, fibrous dysplasia, and osteomas. Three patients (16.7%) required one revision endoscopic sinus procedure. Average follow-up was 4 years.With the treatment of more complex cases being undertaken endoscopically, the need for individual therapeutic consideration and close follow-up is stressed. The combination of removal of benign tumors endoscopically and endoscopic surveillance in the outpatient setting has allowed a less radical surgical approach while resulting in decreased morbidity and better tumor control.

Objectives: To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis. Study Design: Retrospective, nonrandomized study. Methods: Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by frontal sinus trephination performed on 30 consecutive patients with chronic frontal sinusitis. Results: Six patients were having sinus surgery for the first time, 19 patients had undergone prior functional endoscopic sinus surgery without instrumentation of the frontal sinus/recess, and the third group included 5 patients who had undergone prior frontal sinus/ recess surgery. Preoperative computed tomography scan of the frontal sinuses revealed complete opacification in 63% (29/46 frontal sinuses) and partial opacification in 22% (10/46), and no data were available for 15% (7/46). Aerobic cultures revealed that 38% (13/35 cultures) had no growth, 21% (7/35) grew Staphylococcus aureus, 21% (7/35) grew coagulase-negative Staphylococcus, 9% (3/35) grew Haemophilus influenzae, and 26% (9/35) grew a variety of other organisms. Anaerobic cultures were positive in 3% (1/32) of sinuses, and fungal cultures were positive in 4% (1/24). Haemophilus influenzae was most common in primary cases, whereas coagulase-negative Staphylococcus was most common in patients undergoing revision frontal sinus surgery. There were no other significant differences between cultures from patients undergoing revision frontal sinus surgery, revision functional endoscopic sinus surgery without prior frontal surgery, and primary surgery. Conclusions: This study suggests that organisms involved in chronic inflammatory disease of the frontal sinus may change after previous sinus surgery. The study failed to support a significant role for anaerobes. The role for coagulase-negative Staphylococcus as a potential pathogen or a contaminating agent remains unclear.

Bone morphogenetic proteins (BMPs) are capable of inducing endochondral bone formation when applied on biologic carriers in numerous mammalian in vivo assay systems. Bone morphogenetic protein gene therapy is also currently being developed to promote osteogenesis for clinical indications such as spinal fusions, craniofacial bone loss, and osteoporosis. In this study, critical-sized mandibular defects were treated with a control adenoviral vector (Ad-beta-gal), a BMP-2 adenoviral vector (Ad-BMP-2), or a BMP-9 adenoviral vector (Ad-BMP-9). Gross tissue examination, radiographic analysis, and histologic analysis demonstrated significant bony healing in the BMP treated groups compared to controls. Osteogenesis was limited to the bony defect, without extension into the surrounding soft tissues. The study suggests that with further development, BMP gene therapy may be potentially useful for repair of bony defects in the craniofacial region.

Objectives: To review the use of hyperbaric oxygen in the management of radionecrosis of the head and neck. Study Design: A retrospective analysis of patients utilizing chart review and telephone interviews. All patients diagnosed with osteoradionecrosis and chondroradionecrosis of the head and neck and treated with hyperbaric oxygen at the University of Virginia are included. Methods: Demographics, pretreatment data, and precipitating events were recorded. Outcomes were evaluated using a grading scale of symptomatology and physical examination as determined by the patient and physician. Results: Sixteen patients with osteoradionecrosis and five with chondroradionecrosis were reviewed. All patients showed clinical improvement with decreased pain following HBO therapy. None of the patients with chondroradionecrosis required laryngectomies, and two of the four who were tracheotomy dependent were successfully decannulated. The patient and physician grading scores demonstrated moderate to significant improvement in both groups following therapy. Conclusion : The successful use of hyperbaric oxygen for the management of radionecrosis of the head and neck is supported. The unusual prevalence of chondroradionecrosis may be an early reflection of changes in treatment protocols for patients with head and neck cancer.

The purpose of this study was to compare the biomechanical performance of cutting edge needles made of S45500 stainless steel alloy to Surgalloy stainless steel. The new high-nickel stainless steel alloy, Surgalloy, has superior performance characteristics over that of the other high-nickel stainless steel alloy, S45500. The Surgalloy needle is produced from a stronger stainless steel alloy than the S45500 needle. The Surgalloy needle has considerably greater resistance to bending than the needle produced from S45500 alloy. In addition, Surgalloy stainless steel has almost a twofold greater resistance to fracture than the S45500 stainless steel alloy.

Objective To create a standardized nonhealing defect of craniofacial, minimal load–bearing, endochondral type bone with geometric properties that are amenable to quantitative and biomechanical testing that can be used to develop new osteoconductive and osteoinductive engineering repair techniques. Design Before-and-after randomized trial of an anatomical description. Subjects Twenty-four retired male breeder Sprague-Dawley rats. Methods A standardized osseous defect was created by removing the nasal bones with a cutting burr to the level of the nasal mucosal membranes. The defects were not repaired, and groups of 8 animals were examined using planimetry, computed tomographic scanning, and histological analysis at 1, 3, and 6 months following surgery to quantify defect repair. Results Mean repair rate by surface area measurements at 1, 3, and 6 months was 5.75%, 4.89%, and 7.09%, respectively. Results from histological analysis revealed that the defects were filled with fibrous tissue. Computed tomographic scans showed the bone defect without repair. Conclusion This nasal osseous defect fulfills criteria to be considered as a critical-size defect that can be used to investigate new techniques for bone reconstruction.