Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevent... more Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to (1) perform and assess cadaveric facial transplantation for each sex-mismatched scenario using virtual planning with cutting guide fabrication and (2) review the advantages/disadvantages of cross-gender facial transplantation. Cross-gender facial transplantation feasibility was evaluated through 2 mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient and male donor-to-female recipient. Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point and sellion-nasion-B point angles, and lower-anterior-facial-height to total-anterior-facial-height ratio. Donor and recipient cutting guides were designed with virtual planning based on our team's experience in swine dissections and used to optimize the results. Skeletal proportions and facial-aesthetic harmony of the transplants (n = 2) were found to be equivalent to all reported experimental/clinical sex-matched cases by using custom guides and Mimics technology. Cephalometric measurements relative to Eastman Normal Values are shown. On the basis of our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of sex-matched pairs using preoperative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over sex-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.
Generation of patient-derived, autologous dendritic cells (DCs) is a critical component of cancer... more Generation of patient-derived, autologous dendritic cells (DCs) is a critical component of cancer immunotherapy with ex vivo-generated, tumor antigen-loaded DCs. An important factor in the ability to generate DCs is the potential impact of prior therapies on DC phenotype and function. We investigated the ability to generate DCs using cells harvested from pediatric patients with medulloblastoma for potential evaluation of DC-RNA based vaccination approach in this patient population. Cells harvested from medulloblastoma patient leukapheresis following induction chemotherapy and granulocyte colony stimulating factor mobilization were cryopreserved prior to use in DC generation. DCs were generated from the adherent CD14+ monocytes using standard procedures and analyzed for cell recovery, phenotype and function. To summarize, 4 out of 5 patients (80 %) had sufficient monocyte recovery to permit DC generation, and we were able to generate DCs from 3 out of these 4 patient samples (75 %). ...
In this study, we investigated the feasibility of an intracranial catheter transducer capable of ... more In this study, we investigated the feasibility of an intracranial catheter transducer capable of real-time 3D (RT3D) imaging and ultrasound hyperthermia, for application in the visualization and treatment of tumors in the brain. We designed and constructed a 12 Fr, integrated matrix and linear array catheter transducer prototype for combined RT3D imaging and heating capability. This dual-mode catheter incorporated 153
We present three cases of genetically confirmed Gorlin syndrome with desmoplastic medulloblastoma... more We present three cases of genetically confirmed Gorlin syndrome with desmoplastic medulloblastoma (DMB) in whom tumor recurred despite standard therapy. One patient was found to have a novel germline missense PTCH1 mutation. Molecular analysis of recurrent tumor using fluorescent in situ hybridization (FISH) revealed PTEN and/ or PTCH1 loss in 2 patients. Whole exome sequencing (WES) of tumor in one patient revealed loss of heterozygosity of PTCH1 and a mutation of GNAS gene in its non-coding 3' -untranslated region (UTR) with corresponding decreased protein expression. While one patient died despite high-dose chemotherapy (HDC) plus stem cell rescue (ASCR) and palliative radiotherapy, two patients are currently alive for 18+ and 120+ months respectively following retrieval therapy that did not include irradiation. Infants with DMB and GS should be treated aggressively with chemotherapy at diagnosis to prevent relapse but radiotherapy should be avoided. The use of molecular prog...
Cerebrospinal fluid overproduction resulting in communicating hydrocephalus is observed in patien... more Cerebrospinal fluid overproduction resulting in communicating hydrocephalus is observed in patients who have choroid plexus papilloma or choroid plexus carcinoma. Less often, patients with these conditions have diffuse villous hyperplasia. Prior studies report CSF production greater than 3 L per day in these patients. These patients are treated with CSF shunting or by either unilateral choroid plexectomy or staged bilateral choroid plexectomy. The authors present a patient who had a number of congenital anomalies and a karyotype that revealed balanced translocations, 5 to 7 and 9 to 11. She presented with hydrocephalus and had CSF production of 5 L per day, greater output than ever previously reported. She was treated with a single-stage bilateral choroid plexectomy. Histopathological analysis revealed a bilateral choroid plexus papilloma. Postoperatively, the patient responded well clinically and showed radiographic improvement of her hydrocephalus. Bilateral choroid plexus papillo...
The authors present the case of a child with an untreated lipomyelomeningocele who developed an a... more The authors present the case of a child with an untreated lipomyelomeningocele who developed an acquired Chiari malformation Type I (CM-I) with a large syrinx over the course of 3 years. To the best of the authors' knowledge, this is the first report to document a case in which an acquired CM-I evolved in a patient with an untreated tethered cord.
2009 IEEE International Ultrasonics Symposium, 2009
In this study, we investigated the feasibility of dual-mode intracranial catheter transducers for... more In this study, we investigated the feasibility of dual-mode intracranial catheter transducers for visualization and treatment of tumors in the brain. Feasibility is demonstrated in two ways: 1) by developing a 12 Fr, integrated matrix and linear array catheter transducer prototype for combined real-time D imaging and heating, and 2) by testing 3.5 Fr IVUS-catheter-packageable transducers for therapeutic potential. The 3.6 MHz, 12 Fr catheter acquired real-time 3D images of canine brain structures in vivo while placed in the superior sagittal sinus via a burr hole in the skull, and achieved a 3.5°C temperature rise in tissue-mimicking material at a 2 cm focus in vitro. The IVUS-sized prototype transducers were tested for maximum intensity and mechanical index, and a thermal model was used to extrapolate and estimate each transducer's maximum potential temperature rise in brain tissue.
2010 IEEE International Ultrasonics Symposium, 2010
In this study, we investigated the feasibility of using 3.5-Fr IVUS catheters for minimally-invas... more In this study, we investigated the feasibility of using 3.5-Fr IVUS catheters for minimally-invasive, image-guided hyperthermia treatment of tumors in the brain. Feasibility is demonstrated in two ways: 1) by fitting a 3.5-Fr IVUS catheter with a 5 × 0.5 × 0.22 mm PZT-4 transducer for 9-MHz imaging, and 2) by testing an identical transducer for therapy potential with 3.3-MHz
The case of a 3-year-old patient with tuberous sclerosis and a 13-mm Chiari malformation Type I t... more The case of a 3-year-old patient with tuberous sclerosis and a 13-mm Chiari malformation Type I that spontaneously disappeared over the course of 4 years is presented. Using morphometric measurements of the posterior fossa and cerebellum in this patient, the authors show that the volume of the posterior fossa at the time of initial evaluation was consistent with that reported as normal in the literature (180.24 cm3; normal volume 132-198 cm3). Moreover, the patient showed a normal rate of growth of his posterior fossa over the period of observation (201.05 cm3; normal range 153-230 cm3). Cerebellar volumes were found to increase only minimally during this time period, which is compatible with observations in healthy controls. The posterior fossa volume, on the other hand, was shown to increase significantly more than that of the cerebellum (p=0.0185). This differential growth may permit the tonsils to ascend back up into the posterior fossa. Therefore, pediatric patients with normal posterior fossa volumes and normal development may have a spontaneous resolution of their asymptomatic Chiari malformation Type I.
In this study, we investigated the feasibility of using 3.5-Fr intravascular ultrasound (IVUS) ca... more In this study, we investigated the feasibility of using 3.5-Fr intravascular ultrasound (IVUS) catheters for minimally-invasive, image-guided hyperthermia treatment of tumors in the brain. Feasibility was demonstrated by: (1) retro-fitting a commercial 3.5-Fr IVUS catheter with a 5 × 0.5 × 0.22 mm PZT-4 transducer for 9-MHz imaging and (2) testing an identical transducer for therapy potential with 3.3-MHz continuous-wave excitation. The imaging transducer was compared with a 9-Fr, 9-MHz ICE catheter when visualizing the post-mortem ovine brain and was also used to attempt vascular access to an in vivo porcine brain. A net average electrical power input of 700 mW was applied to the therapy transducer, producing a temperature rise of +13.5°C at a depth of 1.5 mm in live brain tumor tissue in the mouse model. These results suggest that it may be feasible to combine the imaging and therapeutic capabilities into a single device as a clinically-viable instrument.
Anterior cranial base meningiomas are rare tumors in children. Due to the extensive involvement o... more Anterior cranial base meningiomas are rare tumors in children. Due to the extensive involvement of orbit, paranasal sinuses, midface, and anterior skull base, a multidisciplinary approach is warranted. We present a case of a child with a large planum sphenoidale meningioma extending into subfrontal region, ethmoid and maxillary sinuses inferiorly, and orbits laterally. The patient, a 4-year-old girl, presented with long-standing nasal stuffiness and swelling of the midface. An extended frontobasal approach through a bifrontal craniotomy was used to resect the intracranial portion of this mass. The tumor had eroded through nasal septum, medial orbital walls, and left maxilla, structures which were not readily accessible from a cranial approach alone. A modified Weber-Ferguson incision was used for a transfacial approach to resect the residual mass below the skull base. The advantages of combining the bifrontal craniotomy with a transfacial split provided the added exposure to maximize the extent of resection.
Hypothalamic hamartomas (HHs) are congenital, benign masses in the hypothalamus and tuber cinereu... more Hypothalamic hamartomas (HHs) are congenital, benign masses in the hypothalamus and tuber cinereum that may cause central precocious puberty and gelastic seizures. Nodules of small neurons are thought to be a universal feature of the microarchitecture of HH lesions associated with epilepsy. Here we describe the case of a 5-year-old boy with gelastic seizures who underwent resection of a HH that contained nodules of glial cells, but only few, randomly distributed neurons. HHs that contain few or no neurons have only been reported thus far in cases associated with precocious puberty. This case demonstrates that few solitary neurons in HHs can drive the development of gelastic seizures, and nodules of small neurons may not be a universal feature of HHs associated with epilepsy. This finding is clinically important since hypothalamic hamartomas with rare neurons can easily be misdiagnosed as pilocytic astrocytomas or subependymomas if their presence is overlooked. A neuronal stain is helpful in making the correct diagnosis in these cases.
1. N Engl J Med. 2007 Aug 23;357(8):830-1. Tympanic-membrane perforation as a marker of concussiv... more 1. N Engl J Med. 2007 Aug 23;357(8):830-1. Tympanic-membrane perforation as a marker of concussive brain injury in Iraq. Xydakis MS, Bebarta VS, Harrison CD, Conner JC, Grant GA,Robbins AS. PMID: 17715421 [PubMed - indexed for MEDLINE]. Publication Types: Letter. ...
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
The US military has reported over 10,000 improvised explosive device attacks attributing to over ... more The US military has reported over 10,000 improvised explosive device attacks attributing to over 400 deaths in Iraq in 2005. Otologic blast injury and tympanic membrane (TM) perforation have traditionally been used as a predictor, or biomarker, of serious or occult primary blast injury (PBI). Although combat injuries from the US-Iraq conflict have been described, the utility of TM perforation as a marker of PBI has not. The objective of this study is to determine the incidence of tympanic perforation in patients subject to blast exposures and describe its utility as a biomarker of more serious primary barotrauma, as observed at a US military hospital in Iraq. In our institutional review board-approved study, all patients during a 30-day period who arrived at a tertiary US military hospital in Iraq were evaluated. All patients with blast injures were identified on arrival to the hospital emergency department and were followed up through their hospital course and evacuation to the United States to assure they received proper otolaryngology evaluation and follow-up. Demographic data and manifestations of PBI (TM perforation, pneumothorax, pulmonary contusion, nonpenetrating facial sinus injury, and bowel perforation) and other combat injuries were recorded. The diagnostic tests and clinical examination findings used to identify these complications were also recorded. One hundred sixty-seven patients were enrolled over 30 days. All blast exposures resulted from primary or secondary explosions from munitions used in combat. This included both combatants and civilians. All patients were men. The mean patient age was 28 years (range, 12-55 years). Sixteen percent (27 of 167) of blast-exposed patients had TM perforation. Thirteen of 27 patients with perforations had bilateral perforations. Twelve of 167 patients (7%) had PBI. Six of 12 patients (50%) with PBI had TM perforation. The use of TM perforation as a biomarker for PBI resulted in a sensitivity of 50% (95% CI, 22-78%) and specificity of 87% (95% CI, 81-92%). Both TM perforation and PBI are rare with improvised explosive devices and other explosive devices in the current Iraqi-US conflict. Contrary to previous belief and management guidelines, TM perforation had low sensitivity for serious or occult PBI and was not a good biomarker. On the basis of the findings of this study, the absence of TM perforation does not appear to exclude other serious PBI.
ABSTRACT The spruce seed moth, Cydia strobilella (L.), is a serious and widely distributed pest... more ABSTRACT The spruce seed moth, Cydia strobilella (L.), is a serious and widely distributed pest of spruce seed orchards in North America and Europe. Current pest management activities in seed orchards rely mainly on chemical pesticides for insect control. Mating disruption with sex pheromone is a potential alternative pest management tool for C. strobilella. In 2002, field tests confirmed that sticky traps baited with 3 μg of (E)-8-dodencenyl acetate (E8-12:Ac), the sex pheromone of C. strobilella, could capture males in Quebec, a region of Canada not previously monitored for this insect. In the following years (2003–2005), grey rubber septa loaded with 0.75, 1.5, or 2.0 mg of E8-12:Ac were deployed separately in two white spruce seed orchards at a density of 40 and 60 dispensers/ha to test the potential for mating disruption. The results showed that the captures of male C. strobilella in the pheromone-treated plots were reduced by up to 98%. Furthermore, at the end of the experiment in 2005, 17.3% of cones were damaged by C. strobilella in the treated plot, compared with a significantly (P < 0.0001) higher 56.4% in the control plot. The results suggest that mating disruption has potential for controlling C. strobilella to protect seed cones in white spruce seed orchards.
The United States military reported more than 10,000 improvised explosive device (IED) attacks in... more The United States military reported more than 10,000 improvised explosive device (IED) attacks in Iraq in 2005. Otological blast injury and tympanic membrane (TM) perforation are traditionally considered less concerning and are frequently unrecognized. However, this type of injury ...
Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevent... more Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to (1) perform and assess cadaveric facial transplantation for each sex-mismatched scenario using virtual planning with cutting guide fabrication and (2) review the advantages/disadvantages of cross-gender facial transplantation. Cross-gender facial transplantation feasibility was evaluated through 2 mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient and male donor-to-female recipient. Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point and sellion-nasion-B point angles, and lower-anterior-facial-height to total-anterior-facial-height ratio. Donor and recipient cutting guides were designed with virtual planning based on our team's experience in swine dissections and used to optimize the results. Skeletal proportions and facial-aesthetic harmony of the transplants (n = 2) were found to be equivalent to all reported experimental/clinical sex-matched cases by using custom guides and Mimics technology. Cephalometric measurements relative to Eastman Normal Values are shown. On the basis of our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of sex-matched pairs using preoperative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over sex-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.
Generation of patient-derived, autologous dendritic cells (DCs) is a critical component of cancer... more Generation of patient-derived, autologous dendritic cells (DCs) is a critical component of cancer immunotherapy with ex vivo-generated, tumor antigen-loaded DCs. An important factor in the ability to generate DCs is the potential impact of prior therapies on DC phenotype and function. We investigated the ability to generate DCs using cells harvested from pediatric patients with medulloblastoma for potential evaluation of DC-RNA based vaccination approach in this patient population. Cells harvested from medulloblastoma patient leukapheresis following induction chemotherapy and granulocyte colony stimulating factor mobilization were cryopreserved prior to use in DC generation. DCs were generated from the adherent CD14+ monocytes using standard procedures and analyzed for cell recovery, phenotype and function. To summarize, 4 out of 5 patients (80 %) had sufficient monocyte recovery to permit DC generation, and we were able to generate DCs from 3 out of these 4 patient samples (75 %). ...
In this study, we investigated the feasibility of an intracranial catheter transducer capable of ... more In this study, we investigated the feasibility of an intracranial catheter transducer capable of real-time 3D (RT3D) imaging and ultrasound hyperthermia, for application in the visualization and treatment of tumors in the brain. We designed and constructed a 12 Fr, integrated matrix and linear array catheter transducer prototype for combined RT3D imaging and heating capability. This dual-mode catheter incorporated 153
We present three cases of genetically confirmed Gorlin syndrome with desmoplastic medulloblastoma... more We present three cases of genetically confirmed Gorlin syndrome with desmoplastic medulloblastoma (DMB) in whom tumor recurred despite standard therapy. One patient was found to have a novel germline missense PTCH1 mutation. Molecular analysis of recurrent tumor using fluorescent in situ hybridization (FISH) revealed PTEN and/ or PTCH1 loss in 2 patients. Whole exome sequencing (WES) of tumor in one patient revealed loss of heterozygosity of PTCH1 and a mutation of GNAS gene in its non-coding 3' -untranslated region (UTR) with corresponding decreased protein expression. While one patient died despite high-dose chemotherapy (HDC) plus stem cell rescue (ASCR) and palliative radiotherapy, two patients are currently alive for 18+ and 120+ months respectively following retrieval therapy that did not include irradiation. Infants with DMB and GS should be treated aggressively with chemotherapy at diagnosis to prevent relapse but radiotherapy should be avoided. The use of molecular prog...
Cerebrospinal fluid overproduction resulting in communicating hydrocephalus is observed in patien... more Cerebrospinal fluid overproduction resulting in communicating hydrocephalus is observed in patients who have choroid plexus papilloma or choroid plexus carcinoma. Less often, patients with these conditions have diffuse villous hyperplasia. Prior studies report CSF production greater than 3 L per day in these patients. These patients are treated with CSF shunting or by either unilateral choroid plexectomy or staged bilateral choroid plexectomy. The authors present a patient who had a number of congenital anomalies and a karyotype that revealed balanced translocations, 5 to 7 and 9 to 11. She presented with hydrocephalus and had CSF production of 5 L per day, greater output than ever previously reported. She was treated with a single-stage bilateral choroid plexectomy. Histopathological analysis revealed a bilateral choroid plexus papilloma. Postoperatively, the patient responded well clinically and showed radiographic improvement of her hydrocephalus. Bilateral choroid plexus papillo...
The authors present the case of a child with an untreated lipomyelomeningocele who developed an a... more The authors present the case of a child with an untreated lipomyelomeningocele who developed an acquired Chiari malformation Type I (CM-I) with a large syrinx over the course of 3 years. To the best of the authors' knowledge, this is the first report to document a case in which an acquired CM-I evolved in a patient with an untreated tethered cord.
2009 IEEE International Ultrasonics Symposium, 2009
In this study, we investigated the feasibility of dual-mode intracranial catheter transducers for... more In this study, we investigated the feasibility of dual-mode intracranial catheter transducers for visualization and treatment of tumors in the brain. Feasibility is demonstrated in two ways: 1) by developing a 12 Fr, integrated matrix and linear array catheter transducer prototype for combined real-time D imaging and heating, and 2) by testing 3.5 Fr IVUS-catheter-packageable transducers for therapeutic potential. The 3.6 MHz, 12 Fr catheter acquired real-time 3D images of canine brain structures in vivo while placed in the superior sagittal sinus via a burr hole in the skull, and achieved a 3.5°C temperature rise in tissue-mimicking material at a 2 cm focus in vitro. The IVUS-sized prototype transducers were tested for maximum intensity and mechanical index, and a thermal model was used to extrapolate and estimate each transducer's maximum potential temperature rise in brain tissue.
2010 IEEE International Ultrasonics Symposium, 2010
In this study, we investigated the feasibility of using 3.5-Fr IVUS catheters for minimally-invas... more In this study, we investigated the feasibility of using 3.5-Fr IVUS catheters for minimally-invasive, image-guided hyperthermia treatment of tumors in the brain. Feasibility is demonstrated in two ways: 1) by fitting a 3.5-Fr IVUS catheter with a 5 × 0.5 × 0.22 mm PZT-4 transducer for 9-MHz imaging, and 2) by testing an identical transducer for therapy potential with 3.3-MHz
The case of a 3-year-old patient with tuberous sclerosis and a 13-mm Chiari malformation Type I t... more The case of a 3-year-old patient with tuberous sclerosis and a 13-mm Chiari malformation Type I that spontaneously disappeared over the course of 4 years is presented. Using morphometric measurements of the posterior fossa and cerebellum in this patient, the authors show that the volume of the posterior fossa at the time of initial evaluation was consistent with that reported as normal in the literature (180.24 cm3; normal volume 132-198 cm3). Moreover, the patient showed a normal rate of growth of his posterior fossa over the period of observation (201.05 cm3; normal range 153-230 cm3). Cerebellar volumes were found to increase only minimally during this time period, which is compatible with observations in healthy controls. The posterior fossa volume, on the other hand, was shown to increase significantly more than that of the cerebellum (p=0.0185). This differential growth may permit the tonsils to ascend back up into the posterior fossa. Therefore, pediatric patients with normal posterior fossa volumes and normal development may have a spontaneous resolution of their asymptomatic Chiari malformation Type I.
In this study, we investigated the feasibility of using 3.5-Fr intravascular ultrasound (IVUS) ca... more In this study, we investigated the feasibility of using 3.5-Fr intravascular ultrasound (IVUS) catheters for minimally-invasive, image-guided hyperthermia treatment of tumors in the brain. Feasibility was demonstrated by: (1) retro-fitting a commercial 3.5-Fr IVUS catheter with a 5 × 0.5 × 0.22 mm PZT-4 transducer for 9-MHz imaging and (2) testing an identical transducer for therapy potential with 3.3-MHz continuous-wave excitation. The imaging transducer was compared with a 9-Fr, 9-MHz ICE catheter when visualizing the post-mortem ovine brain and was also used to attempt vascular access to an in vivo porcine brain. A net average electrical power input of 700 mW was applied to the therapy transducer, producing a temperature rise of +13.5°C at a depth of 1.5 mm in live brain tumor tissue in the mouse model. These results suggest that it may be feasible to combine the imaging and therapeutic capabilities into a single device as a clinically-viable instrument.
Anterior cranial base meningiomas are rare tumors in children. Due to the extensive involvement o... more Anterior cranial base meningiomas are rare tumors in children. Due to the extensive involvement of orbit, paranasal sinuses, midface, and anterior skull base, a multidisciplinary approach is warranted. We present a case of a child with a large planum sphenoidale meningioma extending into subfrontal region, ethmoid and maxillary sinuses inferiorly, and orbits laterally. The patient, a 4-year-old girl, presented with long-standing nasal stuffiness and swelling of the midface. An extended frontobasal approach through a bifrontal craniotomy was used to resect the intracranial portion of this mass. The tumor had eroded through nasal septum, medial orbital walls, and left maxilla, structures which were not readily accessible from a cranial approach alone. A modified Weber-Ferguson incision was used for a transfacial approach to resect the residual mass below the skull base. The advantages of combining the bifrontal craniotomy with a transfacial split provided the added exposure to maximize the extent of resection.
Hypothalamic hamartomas (HHs) are congenital, benign masses in the hypothalamus and tuber cinereu... more Hypothalamic hamartomas (HHs) are congenital, benign masses in the hypothalamus and tuber cinereum that may cause central precocious puberty and gelastic seizures. Nodules of small neurons are thought to be a universal feature of the microarchitecture of HH lesions associated with epilepsy. Here we describe the case of a 5-year-old boy with gelastic seizures who underwent resection of a HH that contained nodules of glial cells, but only few, randomly distributed neurons. HHs that contain few or no neurons have only been reported thus far in cases associated with precocious puberty. This case demonstrates that few solitary neurons in HHs can drive the development of gelastic seizures, and nodules of small neurons may not be a universal feature of HHs associated with epilepsy. This finding is clinically important since hypothalamic hamartomas with rare neurons can easily be misdiagnosed as pilocytic astrocytomas or subependymomas if their presence is overlooked. A neuronal stain is helpful in making the correct diagnosis in these cases.
1. N Engl J Med. 2007 Aug 23;357(8):830-1. Tympanic-membrane perforation as a marker of concussiv... more 1. N Engl J Med. 2007 Aug 23;357(8):830-1. Tympanic-membrane perforation as a marker of concussive brain injury in Iraq. Xydakis MS, Bebarta VS, Harrison CD, Conner JC, Grant GA,Robbins AS. PMID: 17715421 [PubMed - indexed for MEDLINE]. Publication Types: Letter. ...
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
The US military has reported over 10,000 improvised explosive device attacks attributing to over ... more The US military has reported over 10,000 improvised explosive device attacks attributing to over 400 deaths in Iraq in 2005. Otologic blast injury and tympanic membrane (TM) perforation have traditionally been used as a predictor, or biomarker, of serious or occult primary blast injury (PBI). Although combat injuries from the US-Iraq conflict have been described, the utility of TM perforation as a marker of PBI has not. The objective of this study is to determine the incidence of tympanic perforation in patients subject to blast exposures and describe its utility as a biomarker of more serious primary barotrauma, as observed at a US military hospital in Iraq. In our institutional review board-approved study, all patients during a 30-day period who arrived at a tertiary US military hospital in Iraq were evaluated. All patients with blast injures were identified on arrival to the hospital emergency department and were followed up through their hospital course and evacuation to the United States to assure they received proper otolaryngology evaluation and follow-up. Demographic data and manifestations of PBI (TM perforation, pneumothorax, pulmonary contusion, nonpenetrating facial sinus injury, and bowel perforation) and other combat injuries were recorded. The diagnostic tests and clinical examination findings used to identify these complications were also recorded. One hundred sixty-seven patients were enrolled over 30 days. All blast exposures resulted from primary or secondary explosions from munitions used in combat. This included both combatants and civilians. All patients were men. The mean patient age was 28 years (range, 12-55 years). Sixteen percent (27 of 167) of blast-exposed patients had TM perforation. Thirteen of 27 patients with perforations had bilateral perforations. Twelve of 167 patients (7%) had PBI. Six of 12 patients (50%) with PBI had TM perforation. The use of TM perforation as a biomarker for PBI resulted in a sensitivity of 50% (95% CI, 22-78%) and specificity of 87% (95% CI, 81-92%). Both TM perforation and PBI are rare with improvised explosive devices and other explosive devices in the current Iraqi-US conflict. Contrary to previous belief and management guidelines, TM perforation had low sensitivity for serious or occult PBI and was not a good biomarker. On the basis of the findings of this study, the absence of TM perforation does not appear to exclude other serious PBI.
ABSTRACT The spruce seed moth, Cydia strobilella (L.), is a serious and widely distributed pest... more ABSTRACT The spruce seed moth, Cydia strobilella (L.), is a serious and widely distributed pest of spruce seed orchards in North America and Europe. Current pest management activities in seed orchards rely mainly on chemical pesticides for insect control. Mating disruption with sex pheromone is a potential alternative pest management tool for C. strobilella. In 2002, field tests confirmed that sticky traps baited with 3 μg of (E)-8-dodencenyl acetate (E8-12:Ac), the sex pheromone of C. strobilella, could capture males in Quebec, a region of Canada not previously monitored for this insect. In the following years (2003–2005), grey rubber septa loaded with 0.75, 1.5, or 2.0 mg of E8-12:Ac were deployed separately in two white spruce seed orchards at a density of 40 and 60 dispensers/ha to test the potential for mating disruption. The results showed that the captures of male C. strobilella in the pheromone-treated plots were reduced by up to 98%. Furthermore, at the end of the experiment in 2005, 17.3% of cones were damaged by C. strobilella in the treated plot, compared with a significantly (P < 0.0001) higher 56.4% in the control plot. The results suggest that mating disruption has potential for controlling C. strobilella to protect seed cones in white spruce seed orchards.
The United States military reported more than 10,000 improvised explosive device (IED) attacks in... more The United States military reported more than 10,000 improvised explosive device (IED) attacks in Iraq in 2005. Otological blast injury and tympanic membrane (TM) perforation are traditionally considered less concerning and are frequently unrecognized. However, this type of injury ...
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Papers by Gerald Grant