Facial artery musculomucosal flap for reconstruction of skull base defects

Facial Artery Musculomucosal Flap in Skull Base Reconstruction Xie L. MD, Lavigne F. MD, Rahal A. MD, Moubayed SP MD, Ayad T. MD Introduction: Failure in skull base defects reconstruction can have serious consequences such as meningitis and pneumocephalus. The nasoseptal flap is usually the first choice but alternatives are necessary when this flap is not available. The facial artery musculomucosal (FAMM) flap has proven to be successful in head and neck reconstruction but it has never been reported in skull base reconstruction. Objective: To show that the FAMM flap can reach some key areas of the skull base and be considered as a new alternative in skull base defects reconstruction. Methods: We conducted a cadaveric study with harvest of modified FAMM flaps, endoscopic skull base dissection and maxillectomies in 13 specimens. Measures were taken for each harvested FAMM flap. Results: The approximate mean area for reconstruction from the combination of the distal FAMM and the extension flaps is 15.90 cm2. The flaps successfully covered the simulated defects of the frontal sinus, the ethmoid areas, the planum sphenoidale, and the sella turcica. Conclusion: The FAMM flap can be considered as a new alternative in the reconstruction of skull base defects. Modifications add extra length to the traditional FAMM flap and can contribute to a tighter seal of the defect as opposed to the FAMM flap alone.

Reconstruction of Skull Base and Fronto-orbital Defects following Tumor Resection

Reconstruction of the anterior skull base and fronto-orbital framework following extensive tumor resection is both challenging and controversial. Dural defects are covered with multiple sheets of fascia lata that provide sufficient support and avoid herniation. Plating along the skull base is contraindicated. After resection of orbital walls, grafting is necessary if the periosteum or parts of the periorbital tissue had to be removed, to avoid enophthalmus or strabism. Free bone grafts exposed to the sinonasal or pharyngeal cavity are vulnerable to infection or necrosis: therefore, covering the grafts with vascularized tissue, such as the Bichat fat-pad or pedicled temporalis flaps, should reduce these complications. Alloplastic materials are indispensable in cranial defects, whereas microsurgical free tissue transfer is indicated in cases of orbital exenteration and skin defects. The authors review their experience and follow-up of 122 skull base reconstructions following extensive subcranial tumor resection. Most significant complications were pneumocranium in 4.9%, CSF leaks in 3.2%, and partial bone resorption in 8.1%.

Long-term outcomes and prognostic factors of skull-base chondrosarcoma patients treated with pencil-beam scanning proton therapy at the Paul Scherrer Institute

BACKGROUND Skull-base chondrosarcoma (ChSa) is a rare disease, and the prognostication of this disease entity is ill defined. METHODS We assessed the long-term local control (LC) results, overall survival (OS), and prognostic factors of skull-base ChSa patients treated with pencil beam scanning proton therapy (PBS PT). Seventy-seven (male, 35; 46%) patients with histologically confirmed ChSa were treated at the Paul Scherrer Institute. Median age was 38.9 years (range, 10.2-70.0y). Median delivered dose was 70.0 GyRBE (range, 64.0-76.0 GyRBE). LC, OS, and toxicity-free survival (TFS) rates were calculated using the Kaplan Meier method. RESULTS After a mean follow-up of 69.2 months (range, 4.6-190.8 mo), 6 local (7.8%) failures were observed, 2 of which were late failures. Five (6.5%) patients died. The actuarial 8-year LC and OS were 89.7% and 93.5%, respectively. Tumor volume > 25 cm(3) (P = .02), brainstem/optic apparatus compression at the time of PT (P = .04) and age >30 years (P = .08) were associated with lower rates of LC. High-grade (≥3) radiation-induced toxicity was observed in 6 (7.8%) patients. The 8-year high-grade TFS was 90.8%. A higher rate of high-grade toxicity was observed for older patients (P = .073), those with larger tumor volume (P = .069), and those treated with 5 weekly fractions (P = .069). CONCLUSIONS This is the largest PT series reporting the outcome of patients with low-grade ChSa of the skull base treated with PBS only. Our data indicate that protons are both safe and effective. Tumor volume, brainstem/optic apparatus compression, and age were prognosticators of local failures.

Angiogenesis and skin carcinomas with skull base invasion: A case-control study

Background. Some skin carcinomas may be very aggressive. Intensity of angiogenesis, measured by intratumoral vessel density using expression of CD34, has been associated with tumor aggressiveness. In this study, the expression of CD34 in basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) with skull base invasion was compared with that in tumors with good outcome.Methods. Expression of CD34 was graded as mild, moderate, and intense, in 24 BCCs and 11 SCCs with skull base invasion. The control group included 23 BCCs and 10 SCCs.Results. Intense expression of CD34 was noted in 25.00% of BCCs with skull base invasion, compared with 4.35% in the control group (p =.058). Regarding SCCs, intense expression of CD34 was found in 54.55% of aggressive tumors, compared with 10.00% in the control group (p = 133).Conclusions. A trend toward denser microvascular angiogenesis was observed in both BCCs and SCCs with skull base invasion compared with less aggressive controls. (C) 2004 Wiley Periodicals, Inc.

The knowledge base of subject-matter experts in teaching : A case study of a professional scientist as a beginning teacher

One method of addressing the shortage of science and mathematics teachers is to train scientists and other science-related professionals to become teachers. Advocates argue that as discipline experts these career changers can relate the subject matter knowledge to various contexts and applications in teaching. In this paper, through interviews and classroom observations with a former scientist and her students, we examine how one career changer used her expertise in microbiology to teach microscopy. These data provided the basis for a description of the teacher’s instruction which was then analysed for components of domain knowledge for teaching. Consistent with the literature, the findings revealed that this career changer needed to develop her pedagogical knowledge. However, an interesting finding was that the teacher’s subject matter as a science teacher differed substantively from her knowledge as a scientist. This finding challenges the assumption that subject matter is readily transferable across professions and provides insight into how to better prepare and support career changers to transition from scientist to science teacher.

Misleading conduct arising from public statements : establishing the knowledge base of the target audience

Despite the very substantial body of primary sources and secondary literature on Australia’s much-litigated statutory provisions proscribing misleading or deceptive conduct, the courts have provided little in the way of assistance about how to establish the knowledge base of the target audience at whom the public statement was directed. The purpose of this case note is to compare and contrast two recent decisions of the High Court of Australia that highlight the difficulties faced by applicants in attempting to establish a contravention of the relevant legislation where conduct is directed at a segment of the public or the public as a whole.

How design process for the Base of the Pyramid differs from that for the Top of the Pyramid

The base (BOP) and the top (TOP) of the world income pyramid represent the poor people and the people from developed countries, respectively. The design of products for the BOP is an important ingredient of the poverty reduction approach that combines business development with poverty alleviation. However, the current understanding of the design for the BOP is limited. This study, using a protocol analysis, compared design processes for the BOP and TOP markets. The results indicate the difference between the design processes for these markets in terms of the design strategy employed by the designers (i.e. problem driven, solution driven strategy), their requirements handling behaviour, and their information behaviour. (C) 2014 Elsevier Ltd. All rights reserved.

A CAPABILITY APPROACH BASED STAKEHOLDER ANALYSIS FOR THE BASE OF THE PYRAMID: A CASE STUDY OF THE FIREWOOD BASED COOK-STOVES

People living under $2 income per day, referred as Base of the Pyramid (BoP), face undesired situations like lack of nutrition, health, education etc. Design as a process of changing current undesired situation to a desired situation has failed. A crucial reason behind these failures is lack of normative basis to identify and understand the absent or unsatisfied stakeholder. Currently stakeholder analysis in the design is heuristic. This paper uses a normative framework of Capability Approach (CA) for the stakeholder analysis. A brief discussion on stakeholder theory and analysis is used to identify gaps in the literature. The constructs of the CA are discussed for its suitability to the purpose. Along with methodological details, data generated from the stakeholder interviews, focus groups in a case study of dissemination of improved cook-stoves is used to interlink the theory with the practice. The scope of this work is in identifying and investigating the motives of the stakeholders in the involvement in the product. Though a lot of insights to discern and manage crucial stakeholders is inbuilt in the methodology, this work does not claim explicit coverage of these aspects.

Hybrid metal-base transistor with base of sulfonated polyaniline and fullerene emitter

We demonstrate hybrid vertical architecture transistors that operate like metal-base transistors, using n-type silicon as the collector, sulfonated polyaniline as the base, and C-60 fullerene as the emitter. Electrical measurements suggest that the sulfonated polyaniline base effectively screens the emitter from electric field variations occurring in the collector leading to the metal-base transistor behavior.

The Home base of missions : with supplement, presentation and discussion of the report in the conference on 23rd June 1910.

http://www.archive.org/details/homebaseofmissio003154mbp

An integrated study (geochemistry, stable oxygen and carbon isotopes, nannofossils, planktonic foraminifera, inoceramid bivalves, ammonites and crinoids) of the Waxahachie Dam Spillway section, north Texas: a possible boundary stratotype for the base of the Campanian Stage

The spillway of Lake Waxahachie, Ellis County (Texas), exposes a > 17 m section of the Hutchins Member of the Austin Chalk Group, un-conformably overlain by Taylor Clay. The Austin sequence was regarded as a potential Global Stratotype Section for the base of the Campanian Stage at the 1995 Brussels meeting on Cretaceous Stage boundaries, with the last occurrence of the crinoid Marsupites testudinarius (von Schlotheim, 1820) as the potential boundary marker. An integrated study of the geochemistry, stable carbon and oxgen isotopes, nannofossils, planktonic foraminifera, inoceramid bivalves, ammonites and crinoids of this section place the last occurrence of M. testudinarius in a matrix of eighteen ancillary biostratigraphic markers, while the boundary can also be recognised on the basis of a delta C-13 excursion that can, in principle, be detected globally in marine sediments. A new forma of the crinoid Marsupites testudinarius is introduced. The Waxahachie section fulfils sufficient geological criteria as to be an excellent candidate GSSP for the base of the Campanian Stage, if problems of ownership and access to the section can be resolved.