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ABSTRACT: The supraclavicular artery island (SAI) flap is a viable fasciocutaneous option for the reconstruction of head and neck defects. Although authors have reported success using SAI flaps for various reconstructive indications, concerns of a tenuous blood supply and distal ischemia have previously limited its use in the posterolateral skull base. This case series reports the outcomes of 5 consecutive patients receiving SAI flaps for posterolateral skull base reconstruction. All flaps were harvested in less than 1 hour with primary closure of all donor sites. A single patient developed superficial necrosis of the distal flap, which was repaired with a full-thickness skin graft. There were no other complications, and no donor site morbidity was observed. The SAI flap is an excellent option for the reconstruction of posterolateral skull base defects. The close color match, easy harvest within 1 hour, lack of microsurgical anastomosis, and absence of donor site morbidity support its continued utilization.
The Journal of craniofacial surgery 09/2011; 22(5):1751-4. · 0.81 Impact Factor
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Ear, nose, & throat journal 03/2011; 90(3):98-100. · 0.66 Impact Factor
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ABSTRACT: Sestamibi scintigraphy and neck ultrasonography have both been proposed as screening modalities for the detection of abnormal parathyroid glands in patients with primary hyperparathyroidism. As a result, many surgeons use both techniques prior to surgery. The goal of this study was to independently evaluate both ultrasound and sestamibi as single-modality preoperative screening tools for primary hyperparathyroidism.
A retrospective review of consecutive patients who underwent surgery for primary hyperparathyroidism from January 1999 to December 2009. Imaging results were compared to surgical findings.
440 patients were found to meet inclusion criteria. Sensitivities for correct localization of a single parathyroid adenoma for sestamibi versus ultrasound were: 83% (95% CI 78-86) versus 72% (95% CI 67-76). Ultrasound operator had no influence on sensitivity, and ultrasound identified nodular thyroid disease in 31% of patients.
Ultrasonography alone can be used as the primary screening modality in patients with primary hyperparathyroidism. Ultrasound sensitivity is conserved despite operator variability, and identifies concomitant thyroid pathology.
ORL 03/2011; 73(2):116-20. · 0.91 Impact Factor
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The Laryngoscope 10/2010; 120(S3):S119. · 1.75 Impact Factor
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The Laryngoscope 09/2010; 120(11):2347. · 1.75 Impact Factor
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ABSTRACT: Mycophenolate mofetil is a recently identified therapy for disorders associated with systemic fibrosis, but has never been reported in the treatment of Reidel's thyroiditis. We report the first case of Reidel's thyroiditis that became resectable after treatment with mycophenolate and prednisone.
A 27-year-old woman presented to an outside hospital with thyromegaly associated with compressive symptoms. The patient underwent a neck exploration with thyroid biopsy that revealed evidence of fibrosing variant Hashimoto's thyroiditis. The patient was then treated with tamoxifen and prednisone at an outside hospital without resolution. After initial evaluation she underwent an open thyroid wedge biopsy that revealed Reidel's thyroiditis. She was subsequently treated with both 1 g mycophenolate twice daily and 100 mg prednisone daily. The patient experienced immediate subjective improvement of compressive symptoms and objective decrease in mass size at 30 days, as seen by serial computed tomography examination. By 90 days of therapy the mass had decreased to a size small enough to allow subtotal thyroidectomy, which was completed over two staged procedures.
Reidel's thyroiditis remains a primarily surgical disease. Patients who are not surgical candidates have been treated with tamoxifen and prednisone with equivocal results. Our report is the first to suggest the combination of mycophenolate and prednisone as a viable treatment option for patients with Reidel's thyroiditis.
Thyroid: official journal of the American Thyroid Association 01/2010; 20(1):105-7. · 2.60 Impact Factor
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ABSTRACT: Gastrointestinal dysmotility has recently been recognized as a sequela of cerebrovascular accident.
This paper reports the case of a 58-year-old man who presented to an emergency department with severe abdominal pain and distention. He had no prior history of constipation or other symptom of gastrointestinal dysmotility, but did suffer a cerebrovascular accident ten years previously. A diagnosis of colonic volvulus was made. Following partial mechanical decompression, sigmoid colectomy was performed, revealing a severely distended colon with marked wall thickening. Pathology revealed hypogangliosis and disrupted crypt architecture, establishing the diagnosis of idiopathic megacolon with hypogangliosis.
Chronic gastrointestinal dysmotility has recently been recognized as a sequela of cerebrovascular accident, but is also commonly found following other forms of central nervous system injury. This association likely follows disrupted communication between central autonomic regulatory pathways and intestinal enteric pacemakers.
Gastrointestinal dysmotility is a consequence of neurologic injury, and must be addressed in recommendations for long-term care following a cerebrovascular accident. Current recommendations focus on acute treatment, but do not recommend measures to promote colonic health and gastrointestinal motility.
The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society 162(2):92-5.
