Second osteocutaneous fibular free flaps for head and neck defects.

Objective: To analyze the morbidity of a second fibular free tissue transfer when necessary in rare instances when the initial fibular flap fails. CASE DESIGN: Retrospective analysis of a case series.

Methods: A database of patients who underwent resection of head and neck malignancies with resultant free flap reconstruction was analyzed retrospectively.

Radial forearm free tissue transfer in the management of persistent cerebrospinal fluid leaks.

Objective: Cerebrospinal fluid (CSF) leaks can occur after head trauma or skull base surgery. Persistent or spontaneous leaks should be repaired, since they put patients at risk for serious intracranial complications. Although numerous repair methods have been successful, the occasional patient develops a persistent leak.

Gold standard medical therapy for glaucoma: defining the criteria identifying measures for an evidence-based analysis.

Background: Over the past decade, several new medical therapies have become available for the treatment of primary open-angle glaucoma (POAG). A systematic evidence-based approach for identifying an optimal therapeutic agent is lacking.

Objectives: The aims of this review were to critically evaluate published treatment recommendations for POAG and, based on a systematic review of the literature, to develop criteria that would define a "gold standard" medical therapy that reflects new treatment advances and established therapeutic goals.

Detection of the free acid of bimatoprost in aqueous humor samples from human eyes treated with bimatoprost before cataract surgery.

Purpose: To determine whether bimatoprost is hydrolyzed to its free acid after topical application in humans in vivo.

Design: Prospective, masked, and vehicle controlled.

Participants: Thirty-one eyes of 31 patients with cataracts.

Cervical sympathetic chain schwannoma.

Objectives: Schwannomas are benign, slow-growing tumors that arise from nerves. Those originating from the sympathetic cervical chain are rare. We describe our experience with the clinical presentation, surgical management, and outcomes of patients with this pathology.

Simplifying head and neck microvascular reconstruction.

Background: Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources.

Methods: This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital.

Results: Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%).

Hypoxia-inducible factor 1alpha in the glaucomatous retina and optic nerve head.

Objective: To examine tissue hypoxia in the retina and optic nerve head of glaucomatous eyes by the assessment of a transcription factor, hypoxia-inducible factor 1alpha (HIF-1alpha), which is tightly regulated by the cellular oxygen concentration.

Methods: Using immunohistochemical analysis, the cellular localization of HIF-1alpha was studied in the retina and optic nerve head of 28 human donor eyes with glaucoma compared with 20 control eyes from healthy donors matched for several characteristics. The relationship between the retinal regions that exhibited immunostaining for HIF-1alpha and functional damage was examined using visual field data.

Unilateral and bilateral surgery for parathyroid disease.

The principles of successful parathyroid surgery, regardless of the approach, demand a clear understanding of the philosophy behind the surgical exploration. A systematic approach, founded in science and refined by experience, is necessary to achieve long-term, reproducible surgical success. This article discusses the underlying logic and the advantages and disadvantages of the two basic approaches to parathyroid pathology: unilateral and bilateral cervical exploration.

Quantitative ex vivo detection of rodent retinal ganglion cells by immunolabeling Brn-3b.

To evaluate the neuroprotective potential of drug candidates to treat human glaucoma, a short-term rodent model of retinal ganglion cell death was employed. Transient ischemia applied to the rodent retina, with subsequent reperfusion for 1-4 weeks, produces an experimental retinal ganglion cell death that is quantifiable. A widely used method to detect viable retinal ganglion cells involves surgical injection of labeling compounds into the superior colliculus of the rodent brain, the retrograde transport of the compounds along the axons to the retina, and subsequent microscopic evaluation of the retina.

Perioperative parathyroid hormone levels in thyroid surgery: preliminary report.

Objectives/hypothesis: An immediate method of accurately predicting postoperative hypocalcemia after total thyroidectomy would allow for selective early discharge of patients at low risk. The objective of the study was to determine the utility of perioperative parathyroid hormone measurement in predicting postoperative hypocalcemia after a thyroid surgery that places total parathyroid function at risk.

Study Design: Prospective case series.

Heat shock proteins, immunity and glaucoma.

Glaucoma is no longer viewed simply as elevated intraocular pressure (IOP) that damages the optic nerve. In addition to high IOP, evidence is rapidly accumulating that suggests damage to the optic nerve may be initiated or sustained by any number of factors including ischemia, excitotoxicity, neurotrophin insufficiency, peroxynitrite damage or others not yet defined. These different harmful influences then likely act through common final pathways that eventually activate the cellular proteases that accompany neuronal programmed cell death.

The immune system and glaucoma.

Purpose Of Review: Compelling evidence obtained from studies over the last decade strongly suggests the involvement of immune system regulation in cell fate decisions in glia and retinal ganglion cells that lead to glaucomatous optic nerve degeneration.

Recent Findings: Recent studies reveal seemingly conflicting roles of the immune system in glaucomatous optic nerve degeneration. T cells directed against specific antigens may have a beneficial effect to protect neurons from the consequences of axonal injury.

Impact of retropharyngeal lymph node metastasis in head and neck squamous cell carcinoma.

Background: The impact of metastasis to the retropharyngeal lymph node (RPLN) group is poorly understood because of the difficult access of the retropharyngeal space. Previous studies concluding to the negative impact of RPLN metastasis rely heavily on radiographic assessment, which introduces the possibility of diagnostic error.

Objective: To better define the prognostic significance of metastatic retropharyngeal adenopathy in patients with non-nasopharyngeal squamous cell carcinoma of the head and neck.

Effects of Tisseel and FloSeal on primary ischemic time in a rat fasciocutaneous free flap model.

Objectives: Free flaps are the technique of choice for reconstruction of defects resulting from extirpation of tumors of the head and neck. Advances in microsurgical technique have resulted in success rates of greater than 95%. Numerous intraoperative factors, ranging from technical issues to topically applied agents, can complicate the outcome of microsurgical free tissue transfer.

Alterations in the morphology of lamina cribrosa pores in glaucomatous eyes.

Aims: To determine alterations which occur in the size and shape of lamina cribrosa (LC) pores in glaucomatous eyes over a period of time.

Methods: Baseline and follow up optic disc photographs were retrospectively studied in 39 eyes of 39 patients with glaucoma. Only eyes with a vertical cup to disc ratio equal to or greater than 0.

Role of tumor necrosis factor receptor-1 in the death of retinal ganglion cells following optic nerve crush injury in mice.

To assess the specific role of tumor necrosis factor (TNF) death receptor signaling in the induction of retinal ganglion cell (RGC) death, optic nerves of mice deficient for TNF receptor-1 (TNF-R1-/-) and control mice (C57BL/6J) were unilaterally subjected to crush injury. Counts of RGCs and their axons 6 weeks after the injury demonstrated that their loss was significantly less in TNF-R1-/- mice compared to controls. The most prominent decrease in neuronal loss detected in TNF-R1-/- mice was beyond the initial 2-week period after the injury.

Short-term functional donor site morbidity after radial forearm fasciocutaneous free flap harvest.

Objectives/hypothesis: The existing literature on postoperative donor extremity function describes a spectrum of morbidity in the long term (>3 mo after surgery). However, the consensus is that there is minimal to no impact of flap harvest on patients' activities of daily living. No previous reports have examined functional donor site morbidity in the early postoperative period; such may affect patients' overall perioperative progress, especially with respect to donor extremity dominance.

Interleukin-10 receptor signaling through STAT-3 regulates the apoptosis of retinal ganglion cells in response to stress.

Purpose: Interleukin (IL)-10 has recently been shown to promote survival of neurons and glia. The purpose of this report is to investigate whether IL-10 has any role in protecting retinal ganglion cells (RGCs) from death under conditions in which growth factors are removed, or in which oxidative stress is present. Signal transduction pathways that activate IL-10 signaling in RGCs were studied in both stress conditions.

The role of free tissue transfer in the reconstruction of massive neglected skin cancers of the head and neck.

Background: Most skin cancers involving the head and neck region are easily managed with surgical resection and local flap rotation. Occasional patients present with massive neglected skin cancers or skin cancers that have recurred after multiple treatments. Management of these massive tumors may involve craniofacial resection, maxillectomy, or mandibulectomy to obtain clear margins.

The effect of 2 sealants (FloSeal and Tisseel) on fasciocutaneous flap revascularization.

Background: Fasciocutaneous tissue transfer is one of the most common procedures performed in head and neck reconstructive surgery. These composite tissues can be transferred as either a free flap or a pedicled flap. Free tissue transfer has become the reconstructive modality of choice following head and neck oncologic ablation.

The role of positron emission tomography in the evaluation of the N-positive neck.

Background: A major prognostic indicator in patients with squamous cell carcinoma of the upper aerodigestive tract is the presence or absence of cervical metastasis. Nodal involvement at different levels affects treatment. Thus identification of the degree of nodal involvement is important.

Swallowing function and tracheotomy dependence after combined-modality treatment including free tissue transfer for advanced-stage oropharyngeal cancer.

Objectives/hypothesis: There are many treatments available for advanced oropharyngeal cancer. Organ-sparing protocols reserve surgery for salvage and are thought to provide adequate rehabilitation. Surgical resection with free tissue transfer may also provide adequate functional rehabilitation.

Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery.

Objectives/hypothesis: The incidence of cerebrospinal fluid (CSF) leak following trans-sphenoidal surgery ranges from 0.5% to 15.0%.

Immunohistochemical assessment of the glial mitogen-activated protein kinase activation in glaucoma.

Purpose: To determine whether retinal glial cells exhibit an activated phenotype in glaucomatous human eyes and whether the mitogen-activated protein kinases (MAPKs) are associated with glial activation in glaucoma.

Methods: Activated phenotypes of retinal macroglia (astrocytes and Müller cells) and microglia were identified by morphologic assessment and immunostaining for the cell markers glial fibrillary acidic protein (GFAP) and HLA-DR, respectively, in 30 eyes obtained from glaucomatous donor eyes in comparison with normal control eyes from 20 age-matched donors. Cellular localization of the activated forms of MAPKs, including extracellular signal-regulated kinases (ERK), c-Jun amino(N)-terminal kinase (JNK), and p38, were studied in the retina of these eyes by immunoperoxidase staining and double immunofluorescence labeling with phosphorylation site-specific antibodies.