Faculty Bibliography

BACKGROUND AND OBJECTIVES: It is difficult to deliver light uniformly and efficiently over the complex shapes presented by various organs for photodynamic therapy (PDT). A balloon delivery device for photodynamic therapy was designed and tested for treatment of various anatomic tissues. The device uses the principle of optical integration by multiple internal diffuse reflections to achieve uniform output illumination. STUDY DESIGN/MATERIALS AND METHODS: Soft, white, medical-grade silicone balloons were made in various shapes and tested for optical output, uniformity, efficiency, and power capabilities. Balloons were cast to be approximately the shape of the target tissue surface, organ, or cavity. Laser power was introduced into the saline-filled balloon by one or more fiber optics. Devices were constructed and used to illuminate oral mucosa and uterine endometrium for PDT. RESULTS: The balloon walls had low optical absorption, high diffuse reflectivity (80-95%), and low diffuse transmittance (5-20%) in the 500- to 900-nm wavelength region. Optical efficiencies of 65% were typical with emitted light over complex, nonspherical surfaces. Efficiency increased with inflation of the device, such that irradiance (power/area) at the balloon surface was nearly constant with inflation. CONCLUSION: Optically integrating balloons can provide highly uniform, efficient light exposure over complex tissue surfaces. Uniformity and irradiance were not strongly affected by balloon inflation, and these robust devices are easy to produce in essentially any shape

BACKGROUND: Successful surgical management of primary hyperparathyroidism requires the ability to identify and distinguish normal from abnormal parathyroid tissue. Microscopic pathologic confirmation often helps with the diagnoses and decisions regarding the extent of parathyroid resection. Confocal reflectance microscopy (CRM) is an optical method of noninvasively imaging tissue without fixation, sectioning, and staining as in standard histopathology. The goal of this study was to determine if CRM imaging could be used to distinguish normal from diseased parathyroid tissue intraoperatively. METHODS: In this study, 44 parathyroid glands from 21 patients undergoing operations for primary hyperparathyroidism were imaged immediately after excision. CRM images were compared with conventional hematoxylin-and-eosin stained sections obtained from the same gland. The percentage area occupied by fat cells was calculated in images of both normal and diseased glands. RESULTS: Characteristic microscopic features of parathyroid glands were distinguishable by CRM and correlated well with histopathology. The stromal fat content of normal and diseased glands could easily be determined. The percentage area occupied by fat cells differed significantly (P <.00001) in normal glands (average, 23.0% +/- 10.9%) and adenomatous glands (average, 0.4% +/- 0.7%). CONCLUSIONS: CRM imaging rapidly revealed microscopic features that reliably differentiated normal and diseased parathyroid glands. The success of this preliminary ex vivo study promotes interest in further development of an in situ probe for in vivo clinical diagnostic use

Social Identity Theory (Tajfel, 1981) posits that members of minority groups achieve positive social identity by (a) attempting to gain access to the mainstream through individual mobility or (b) working with other group members to bring about social change. Some people may use a combination of both strategies. Through the use of cluster analysis, the existence of three identities associated with these strategies was discerned in a sample of 267 deaf adults: culturally hearing identity, culturally deaf identity, and bicultural identity, each comprising about a third of the sample. A subset of 56 people were interviewed in depth; excerpts are presented to illustrate the identity types. Qualified support was found for the prediction that people with culturally deaf and bicultural identities would have higher self-esteem

OBJECTIVE: To measure the impact of tonsillectomy and adenoidectomy (T&A) on children's behavioral and emotional problems using a standardized assessment. DESIGN: Prospective study. SETTING: Tertiary care children's hospital. PATIENTS: Thirty-six children, aged 2 through 18 years, with symptoms of nighttime snoring, observed apneas, and daytime mouth breathing and physical examination results demonstrating 3+ or 4+ tonsils scheduled for T&A. INTERVENTION: Parents completed a standard survey of their children's symptoms of sleep apnea and a standardized measure of children's competencies and problems, the Child Behavior Checklist for ages 2 through 3 years or 4 through 18 years, before T&A and 3 months postoperatively. MAIN OUTCOME MEASURE: The Child Behavior Checklist total problem score. RESULTS: The preoperative Child Behavior Checklist total problem score was consistent with abnormal behavior for 10 children (28%). After T&A (n = 15), only 2 scores were abnormal, but the change was not statistically significant. In contrast, the mean total problem score was 7.5 points lower after surgery (95% confidence interval, 5.1-9.7), indicating a significant decrease (P<.001, matched t test). CONCLUSIONS: This pilot study demonstrates a high prevalence (28%) of abnormal behavior in children undergoing T&A for chronic upper airway obstruction. Scores on a standardized measure of behavior improve following T&A, but larger studies with increased statistical power are needed to clarify the degree of improvement and its clinical importance

Although laryngotracheoesophageal clefts are often found in association with other well-described anomalies, we know of no previous reported association with eosinophilic gastroenteritis, a disorder of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal tract. We treated 2 children who had laryngeal clefts and eosinophilic gastroenteritis. Since the esophageal inflammatory changes found in eosinophilic gastroenteritis may persist despite aggressive therapy, management of the laryngotracheoesophageal clefts is more complicated. The diagnosis of eosinophilic gastroenteritis should not be overlooked in patients with laryngotracheoesophageal clefts and warrants prompt referral to a pediatric gastroenterologist

While studies of neuronal development and plasticity have focused on excitatory pathways, the inhibitory projection from the MNTB to the LSO provides a favorable model for studies of synaptic inhibition. This review covers recent studies from our laboratories indicating that inhibitory connections are quite dynamic during development. These findings suggest that there are two phases inhibitory transmission. During an initial depolarizing phase is growth and branching of pre- and postsynaptic elements in the LSO. During a second hyperpolarizing phase there is refinement of inhibitory afferent arborizations and the LSO dendrites that they innervate

The developmental refinement of excitatory synapses is often influenced by neuronal activity, and underlying synaptic mechanisms have been suggested. In contrast, few studies have asked whether inhibitory synapses are reorganized during development and whether this is accompanied by use-dependent changes of inhibitory synaptic strength. The topographic inhibitory projection from the medial nucleus of the trapezoid body (MNTB) to the lateral superior olive (LSO) undergoes synapse elimination during development (Sanes and Takacs, 1993). To determine whether there is an associated period of synaptic plasticity, whole-cell recordings were obtained from developing LSO neurons of gerbils in a brain slice preparation. In current-clamp recordings, low-frequency stimulation of the MNTB led to a decline in IPSP amplitude by 43%. In voltage-clamp recordings, hyperpolarized LSO neurons also exhibited a long-lasting depression of MNTB-evoked inhibitory synaptic currents (34%) after low-frequency stimulation. When LSO neurons were depolarized, low-frequency stimulation of the MNTB produced a significantly larger inhibitory synaptic depression (59%). This synaptic plasticity declined dramatically by postnatal days 17-19. Similar to well studied forms of excitatory synaptic plasticity, inhibitory depression depended on postsynaptic calcium. We propose that such activity-dependent synaptic depression may support the developmental rearrangement of inhibitory terminals as they compete with neighboring excitatory and/or inhibitory inputs