Scott D. London

The use of bone morphogenetic protein gene therapy in craniofacial bone repair.

&NA; Bone morphogenetic proteins (BMPs) are capable of inducing endochondral bone formation when applied on biologic carriers in numerous mammalian in vivo assay systems. Bone morphogenetic protein gene therapy is also currently being developed to promote osteogenesis for clinical indications such as spinal fusions, craniofacial bone loss, and osteoporosis. In this study, critical‐sized mandibular defects were treated with a control adenoviral vector (Ad‐&bgr;‐gal), a BMP‐2 adenoviral vector (Ad‐BMP‐2), or a BMP‐9 adenoviral vector (Ad‐BMP‐9). Gross tissue examination, radiographic analysis, and histologic analysis demonstrated significant bony healing in the BMP treated groups compared to controls. Osteogenesis was limited to the bony defect, without extension into the surrounding soft tissues. The study suggests that with further development, BMP gene therapy may be potentially useful for repair of bony defects in the craniofacial region.

Endoscopic management of benign sinonasal tumors: a decade of experience.

Background A variety of benign tumors present in the nasal and paranasal sinuses. Methods We review our experience over the last 10 years with endoscopic management of these tumors and discuss presentation, diagnostic considerations, and therapeutic options. Results Eighteen patients with benign sinonasal tumors were managed with endoscopic techniques. Representative cases are presented, including pleomorphic adenoma, ameloblastoma, meningioma, cholersterol granuloma, ossifying fibroma, fibrous dysplasia, and osteomas. Three patients (16.7%) required one revision endoscopic sinus procedure. Average follow-up was 4 years. Conclusions With the treatment of more complex cases being undertaken endoscopically, the need for individual therapeutic consideration and close follow-up is stressed. The combination of removal of benign tumors endoscopically and endoscopic surveillance in the outpatient setting has allowed a less radical surgical approach while resulting in decreased morbidity and better tumor control.

Hyperbaric oxygen for the management of radionecrosis of bone and cartilage

Objectives: To review the use of hyperbaric oxygen in the management of radionecrosis of the head and neck. Study Design: A retrospective analysis of patients utilizing chart review and telephone interviews. All patients diagnosed with osteoradionecrosis and chondroradionecrosis of the head and neck and treated with hyperbaric oxygen at the University of Virginia are included. Methods: Demographics, pretreatment data, and precipitating events were recorded. Outcomes were evaluated using a grading scale of symptomatology and physical examination as determined by the patient and physician. Results: Sixteen patients with osteoradionecrosis and five with chondroradionecrosis were reviewed. All patients showed clinical improvement with decreased pain following HBO therapy. None of the patients with chondroradionecrosis required laryngectomies, and two of the four who were tracheotomy dependent were successfully decannulated. The patient and physician grading scores demonstrated moderate to significant improvement in both groups following therapy. Conclusion: The successful use of hyperbaric oxygen for the management of radionecrosis of the head and neck is supported. The unusual prevalence of chondroradionecrosis may be an early reflection of changes in treatment protocols for patients with head and neck cancer. Key Words: Hyperbaric oxygen, osteoradionecrosis, chondroradionecrosis.

Microbiology of Chronic Frontal Sinusitis

Objectives To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis.

Adaptive clothing for persons with mobility disorders after burn injury

Smart-looking clothes have been designed for wheelchair users. These clothes make dressing faster and easier, and the clothes fit better than the standard garments. The special features for new adaptive clothing for wheelchair users include easy handling fastenings, quick-access garment openings, conveniently placed pockets, custom-curved trousers, slacks, and jackets, custom-shaped dresses and skirts, ponchos or custom-made coats, easy-fit undergarments, and durable styled fabrics. These clothing adaptations are attractive and give the wearer and the observer the feeling that the person with the disability is not set apart by the clothing he or she wears.

Studies of determinants of glove hole puncture during electrosurgery

Holes in surgical gloves are considered to be an important source of transmission of pathogens between patient and surgeon. The purpose of this study was to determine if electrosurgery could alter the integrity of latex surgical gloves. The effects of electrosurgery on 11 brands of commercially available latex surgical gloves were tested through an in vitro study that simulated the conditions in the operating room. Glove hole puncture was encountered only with coagulation current operating at the highest setting. In addition, maximal surface area contact with the hemostat to the glove surface was required to produce glove puncture. The presence of powder and glove hydration were not significant determinants of glove hole puncture. On the basis of our study, we believe that all surgical gloves tested offered the surgeon adequate protection at commonly used levels of cutting and coagulation current, as long as no breach existed prior to the donning of gloves.