University of Iowa Hospitals and Clinics

About: University of Iowa Hospitals and Clinics is a healthcare organization based out in Iowa City, Iowa, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 7201 authors who have published 9476 publications receiving 276995 citations. The organization is also known as: University of Iowa Hospitals & Clinics.

Craniocervical developmental anatomy and its implications

Abstract: Introduction Congenital and developmental osseous abnormalities and anomalies that affect the craniocervical junction complex can result in neural compression and vascular compromise and can manifest itself with abnormal cerebrospinal fluid dynamics. An understanding of the development of the craniocervical junction is essential to recognize the pathological abnormalities.

Arthrodesis of the cervical spine in rheumatoid arthritis.

Abstract: Forty-one patients who had rheumatoid arthritis were treated with a cervical arthrodesis and were followed for a minimum of twenty-three months. Twenty patients had had an isolated atlanto-axial subluxation; five, isolated cranial settling; and four, subaxial subluxation alone. Twenty patients had an atlanto-axial arthrodesis; sixteen, an occipitocervical arthrodesis; and five, a posterior arthrodesis of the subaxial spine. In addition, two patients had a transoral odontoidectomy and one, an anterior cervical vertebrectomy. At the latest follow-up, thirty-six (88 per cent) of the patients had osseous union, two had fibrous union but were stable, and three had a non-union. All of the problems with union occurred in the patients who had had an isolated atlanto-axial arthrodesis. Clinically, twenty-seven (66 per cent) of the patients had improved, fourteen were unchanged, and none were worse. The preoperative neurological status remained the same postoperatively in thirty patients (73 per cent) and it improved in eleven (27 per cent). Twenty-one of the twenty-three patients who had had marked pain preoperatively had little or no pain at the latest follow-up. Complications included a transient hemiparesis in one patient, a superficial wound infection in two, displacement of an anterior graft in one, a broken wire in three, and erosion of methylmethacrylate into the outer part of the occipital cortex in one. Four patients died, but not as a result of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections.

Abstract: FULLY implantable devices or drug–device combinations, such as intrathecal drug delivery (DD) systems and spinal cord stimulation (SCS) systems, increasingly are used for the treatment of chronic intractable pain. Another approved indication for intrathecal DD systems is the administration of intrathecal baclofen (ITB) to treat medically intractable spasticity of spinal or cerebral origin. Although patients with cancer, spinal cord injuries, or cerebral palsy have a reduced life expectancy, the majority of intrathecal drug administration devices— and nearly all SCS devices—are implanted in patients with painful non–cancer-related disorders that are associated with a normal life span. Therefore, long-term implantable devices used for the treatment of pain and spasticity should have a relatively benign safety record. Device-related infection is the most common, potentially reducible, serious adverse event associated with intrathecal DD or SCS devices. Reducing the number of implantable DD and SCS device infections is important for various reasons. One is that treatment of an established infection often involves temporary or permanent removal of the device, which causes cessation of drug or stimulation therapy. Therapy cessation (with or without eventual device replacement) increases the risks, discomfort, inconvenience, and expenses of patients who experience infectious complications. Abrupt cessation of intrathecal drug therapy may precipitate drug withdrawal symptoms and, in the case of ITB, can have fatal consequences. In rare cases, device-associated infections can progress to fatal sepsis, meningitis, or both. Available data indicate that implantable DD and SCS device infections share important features with other surgical site infections (SSIs), including those that affect cerebrospinal fluid (CSF) shunts and electrophysiologic cardiac devices such as implantable pacemakers and cardioverter–defibrillators (ICDs). Management of infections associated with DD and SCS systems typically involves administration of antibiotics and explantation of the devices. Measures that reduce the incidence of other SSIs also should reduce the infection rate associated with the implantation of SCS and intrathecal DD devices.

National cancer database report on chondrosarcoma of the head and neck.

Abstract: Background Management of chondrosarcoma of the head and neck is largely based on single-institution reports with small numbers accrued over several decades. Methods The American College of Surgeons' National Cancer Data Base included 400 cases of chondrosarcoma of the head and neck diagnosed between 1985 and 1995. Chi square analyses of selected contingency tables and Wilcoxon regression analyses of selected survival stratifications were performed. Results Histologic types included conventional (80.8%), myxoid (10.5%), and mesenchymal (8.8%). The mesenchymal and myxoid subtypes were rare among white patients (17.1%) and more common among African-American (31.8%) and Hispanic patients (44.9%). Treatment was most commonly surgery alone (59.5%) and surgery with irradiation (21.0%). Disease-specific survival was 87.2% at 5 years and 70.6% at 10 years. Worse 5-year survival was associated with higher grade (67.3%), regional or distant spread (71.0%), and the myxoid (45.0%) or mesenchymal (53.2%) subtypes. Conclusions Chondrosarcoma of the head and neck encompasses a variety of lesions that differ substantially by demographic and tumor characteristics. Individual tumors can be classified further according to site of origin, histologic subtype, and tumor grade, which can be used to predict biologic behavior and prognosis. © 2000 John Wiley & Sons, Inc. Head Neck 22: 408–425, 2000.