Faculty Bibliography

We report a case of hairy polyp of the pharynx diagnosed on brain MRI in order to stress the need to examine carefully all tissues included on an imaging study, even those outside the clinically stated region of interest, and to remind practitioners to consider unusual as well as common etiologies for neonatal respiratory distress. Our case is unique in that thorough examination of a brain MRI, ordered in the evaluation of presumed central apnea, led to the correct diagnosis

Although abnormalities of vascular anatomy in the forearm are common, variations of the radial and ulnar arteries are rare. Nevertheless, arterial variants in the forearm may present clinically with neurovascular signs or symptoms. Even when anomalous arteries are not apparent, they may complicate surgery of the forearm and hand, as well as reconstructive surgery that involves the harvest of radial or ulnar artery-based forearm free flaps. For example, the superficial ulnar artery has an incidence of 2.7% and has been well described as a 'hidden trap' in the harvest of radial forearm flaps. We present a case report of a variant of the radial artery-the superficial dorsal artery of the forearm. This artery has an estimated incidence of 0.75% and is associated with either an absent or small-caliber radial artery. We believe this is the first report of such an artery presenting to clinical attention, as well as the first imaging of this structure with magnetic resonance angiography. The embryology of this structure and its clinical implications to the hand surgeon, peripheral vascular surgeon, and reconstructive microsurgeon, are also discussed

AIMS: To provide a large database of pre-operative CA 125 levels which may predict inappropriate cytoreductive surgery in patients with advanced epithelial ovarian cancer. METHODS: A multicenter review of the records of 424 patients with FIGO stage III and IV epithelial ovarian cancer of patients who underwent primary cytoreductive surgery was performed. The validity of pre-operative CA 125 level measurement as a single predictor of the possibility to achieve only suboptimal cytoreduction was evaluated by calculating the sensitivity and the specificity of various cut-off values. The relative importance of different cut-off values in achieving the best predictive validity was assessed by a receiver operating characteristics (ROC) curve. RESULTS: Optimal cytoreduction (largest diameter of residual tumour < or =1 cm) was achieved in 242 patients. The median CA 125 level in optimally cytoreduced patients was lower than in those patients suboptimally debulked (304 vs 863 U/mL; p<0.001). The area under the ROC curve was 0.65 (95% confidence interval, 0.60-0.71) and the CA 125 threshold derived from the ROC was 400 U/mL. The accuracy of the test at this level was 62%. CONCLUSIONS: The clinical applicability of the ROC derived CA 125 threshold is limited. The data accrued in the study provides a basis for decision-making regarding the place of primary surgery various CA 125 levels.

OBJECTIVE:To determine the feasibility of achieving births using sperm retrieved from a solitary testis with cancer. DESIGN/METHODS:Prospective clinical study of azoospermic men with testis cancer in a solitary testis. SETTING/METHODS:Infertility patients in an academic environment. PATIENT(S)/METHODS:Azoospermic men with previous history of orchiectomy and testis cancer in a remaining solitary testis. INTERVENTION(S)/METHODS:Viable sperm were retrieved by immediate microdissection of paratumor testicular tissue from orchiectomy specimen. MAIN OUTCOME MEASURE(S)/METHODS:Live births were achieved using sperm from immediate microdissection of orchiectomy specimen with testis cancer. CONCLUSION(S)/CONCLUSIONS:Azoospermic men with cancer in a solitary testis have potential for fertility.

Spectrally encoded confocal microscopy (SECM) is a technique that allows confocal microscopy to be performed through the confines of a narrow diameter optical fiber probe. We present a novel scheme for performing SECM in which a rapid wavelength swept source is used. The system allows large field of view images to be acquired at rates up to 30 frames/second. Images of resolution targets and tissue specimens acquired ex vivo demonstrate high lateral (1.4 mum) and axial (6 mum) resolution. Imaging of human skin was performed in vivo at depths of up to 350 mum, allowing cellular and sub-cellular details to be visualized in real time

OBJECTIVES: As a result of universal newborn hearing screening and improved evaluation tools, many children with severe to profound hearing loss are being diagnosed as infants. This affords the opportunity to provide these children access to cochlear implantation, although medical and audiologic challenges must be addressed. The purpose of this study was to investigate the safety and efficacy of cochlear implantation in children who are younger than 1 year. METHODS: A prospective study was conducted of 18 children who had confirmed severe to profound sensorineural hearing loss and received cochlear implants at our medical center before 12 months of age. The length of device usage ranged from 6 months to 4 years, 5 months. The main outcomes measured were perioperative and postoperative surgical/medical aspects, the Infant-Toddler Meaningful Auditory Integration Scale and age-appropriate phoneme, and word and sentence recognition tests, when appropriate. RESULTS: All children had full insertions of the electrode array without surgical complications and are developing age-appropriate auditory perception and oral language skills. CONCLUSIONS: Early implantation is feasible and beneficial in some children who are younger than 12 months and should be considered with attention to variables involved in the decision-making process, including possible increased surgical risk, skull size and scalp thickness, and mastoid development

OBJECTIVES/HYPOTHESIS: Preliminary results of the endoscopic two-surgeon technique for the management of benign infratemporal fossa tumors are presented. METHODS: Four patients with juvenile nasopharyngeal angiofibroma, a patient with an inverting papilloma, and a patient with a maxillary nerve schwannoma were reviewed. The average age was 22.7 years; the male-to-female ratio was 5:1. The endoscopic anatomy and surgical technique are presented. RESULTS: The two-surgeon technique allowed complete resection of all six tumors extending into the infratemporal fossa. There has been no recurrence of tumor within the infratemporal fossa, after a mean follow-up of 31.3 months (SD = 11.2 mo). CONCLUSION: The two-surgeon transnasal technique allows benign infratemporal fossa tumors to be resected endoscopically