Role of middle turbinate biopsy in the diagnosis of fulminant invasive fungal rhinosinusitis.

OBJECTIVE: To determine the efficacy of middle turbinate biopsy in the diagnosis of fulminant invasive fungal rhinosinusitis. STUDY DESIGN: Nonrandomized prospective study. METHODS: Directed middle turbinate biopsy was performed in 25 patients suspected of having fulminant invasive fungal rhinosinusitis. All patients were immunocompromised and had fever of unknown origin, symptoms of rhinosinusitis, or both. RESULTS: Six patients were found to have fungal invasion on histopathological review (6 true-positive findings), disease developed in 2 patients with negative results on biopsy (2 false-negative findings), and disease never developed in 17 patients with negative results on biopsy (17 true-negative findings), resulting in an overall sensitivity of 75% and a specificity of 100%. CONCLUSIONS: Middle turbinate biopsy is a safe and effective method of making a timely diagnosis of fulminant invasive fungal rhinosinusitis. The added morbidity and cost of surgery can be avoided in the patient with a negative finding on biopsy. However, the effect of earlier diagnosis on overall patient survival is unclear at present.

Assessment of donor-site functional morbidity from radial forearm fasciocutaneous free flap harvest.

OBJECTIVE: To quantitate the functional morbidity to the hand and wrist following harvest of a radial forearm fasciocutaneous free flap. DESIGN: Prospective case-control study, with each patient providing his or her internal control, comparing preoperative and postoperative operated to nonoperated forearms. SETTING: Tertiary care hospital in large metropolitan area. PATIENTS: A consecutive sample of 11 patients who underwent a radial forearm free flap reconstruction of the head and neck from April 1997 to May 1998. MAIN OUTCOME MEASURES: Range of motion of the wrist (flexion and extension, ulnar and radial deviation), grip and pinch strength, and sharp and dull sensation in the distribution of the radial, ulnar, and median nerves. RESULTS: Statistically significant differences (P<.05) were measured in wrist flexion, pinch strength, and sharp sensation in the anatomical snuffbox of the operated forearm. No subjective complaints of loss of function were reported by any patient. CONCLUSIONS: Donor-site functional morbidity associated with harvest of the radial forearm fasciocutaneous free flap is measurable. The statistical differences found do not translate into subjective patient complaints of everyday functional morbidity.

Ultrastructural analysis of primary endings in deaf white cats: morphologic alterations in endbulbs of Held.

Changes in structure and function of the auditory system can be produced by experimentally manipulating the sensory environment, and especially dramatic effects result from deprivation procedures. An alternative deprivation strategy utilizes naturally occurring lesions. The congenitally deaf white cat represents an animal model of sensory deprivation because it mimics a form of human deafness called the Scheibe deformity and permits studies of how central neurons react to early-onset cochlear degeneration. We studied the synaptic characteristics of the endbulb of Held, a prominent auditory nerve terminal in the cochlear nucleus. Endbulbs arise from the ascending branch of the auditory nerve fiber and contact the cell body of spherical bushy cells. After 6 months, endbulbs of deaf white cats exhibit alterations in structure that are clearly distinguishable from those of normal hearing cats, including a diminution in terminal branching, a reduction in synaptic vesicle density, structural abnormalities in mitochondria, thickening of the pre- and postsynaptic densities, and enlargement of synapse size. The hypertrophied membrane densities are suggestive of a compensatory response to diminished transmitter release. These data reveal that early-onset, long-term deafness produces unambiguous alterations in synaptic structure and may be relevant to rehabilitation strategies that promote aural/oral communication.

Ultrastructural changes in primary endings of deaf white cats.

Changes in brain structure occur as a consequence of altered experience. During maturation of the auditory nervous system, sensory deprivation is known to cause cell loss, abnormal axonal projections, and synaptic alterations. These animal data may be relevant to clinical observations that cochlear implants provide superior benefit for individuals who become deaf postlingually compared with those who become deaf prelingually. That is, implantation appears most efficacious if it occurs after functional connections are established but before deprivation-induced changes in the central auditory system. After this period, synaptic reorganization may underlie the diminished effectiveness of cochlear implants.

Time course of the effect of maternal deprivation on the hypothalamic-pituitary-adrenal axis in the infant rat.

Prolonged (i.e., 24-hr) maternal deprivation leads to a marked disinhibition of the infant rat's adrenocortical response to stress and/or ACTH. In the following study we examined the time course over which these effects develop. Pups were maternally deprived for varying lengths of time (i.e., 0, 2, 4, 8, & 24 hr); at the end of this period, corticosterone (CORT) secretion in response to stress (novelty or novelty plus saline injection) and ACTH injection was measured. Basal levels of CORT increased progressively over time in 7- and 11- (but not 3-) day-old pups. CORT release in response to stress followed a similar pattern. In contrast, ACTH injection resulted in marked increases in CORT levels regardless of the length of maternal deprivation in 3-day-old animals; at older ages, however, 24 hr of deprivation led to a much larger increase. These findings support the hypothesis that the hypothalamic-pituitary-adrenal axis of the neonatal rat is subject to maternal regulation.