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Objective: To document differences in the microbiota of healthy cats versus cats with urethral obstruction (UO); compare the urinary microbiota with the oral, preputial, and rectal microbiota; and demonstrate that 16S rRNA gene sequencing will reveal rich and diverse urinary microbiota., Methods: 15 client-owned cats with UO and 15 age-matched healthy cats were included from July 2020 through April 2021. Exclusion criteria were evidence of urinary tract infection, urolithiasis, antimicrobial administration, urinary catheterization in the past 30 days, or a comorbidity. This study was a prospective, observational study. Both groups had a baseline CBC, chemistry panel, urinalysis, urine culture, and focal bladder ultrasound. Swabs of the cystocentesis site, buccal mucosa, rectum, prepuce, and urinary samples were collected, and 16S rRNA gene sequencing was used to compare the groups and sites., Results: Differences in the microbiota richness and diversity were found in the urine of cats with UO (n = 15) compared to healthy cats (15), along with differences in the preputial and oral samples, supporting the presence of a urinary dysbiosis in cats with UO., Conclusions: Our preliminary data demonstrates a dramatic change in the urinary microbiota of cats with UO along with changes in microbiota in other sites compared to healthy cats., Clinical Relevance: A urinary dysbiosis in cats with UO has been minimally supported in prior studies using 16S rRNA gene sequencing. Although these are preliminary results, documenting this dysbiosis in cats with UO provides a potential avenue for novel therapeutics.

Drops are retained or held on surfaces due to a retention force exerted on the drop by the surface. This retention force is a function of the surface tension of the liquid, drop geometry, and the contact angle between the drop and the surface. When external or body forces exceed the retention force, the drop begins to move. This work explores the conditions for which drop departure occurs on structured superhydrophobic surfaces in the presence of an applied shear flow. Drop departure is explored for five microstructured superhydrophobic surfaces, one nanostructured carbon nanotube surface and one smooth hydrophobic surface. Surface solid fractions range from 0.05 to 1.00, and measured static contact angles range from 121° to 161°. Droplet volumes of 5, 10, 20, 30, 40, and 50 μL are tested on each surface. For each experiment, increasing air velocity is applied to a droplet placed on a surface until the droplet departs. High-speed imaging is used to track droplet base length, height, cross-section area (as viewed from the side) and advancing/receding contact angles. Measurements of drop advancing and receding contact angles are reported at the point of departure, with increasing contact angle hysteresis observed prior to departure. Contact angle hysteresis is observed to be a good indicator of droplet mobility. Measurements of the average air velocity over the height of the droplet are determined at the point of departure for all conditions. The measured air velocity shows strong dependence on the surface solid fraction, and the required shear flow velocity decreases as the surface solid fraction decreases. This is most pronounced at very low solid fractions. A coefficient of drag for the departing drops in shear flow is calculated and is shown to decrease with increasing Reynolds number.

Objective: To compare the accuracy of a point-of-care coagulation analyzer (POCCA) with a reference laboratory coagulation analyzer (LabCA) and to evaluate for confounding factors that could alter the performance of the POCCA., Design: Prospective, observational study., Setting: Two university veterinary teaching hospitals., Animals: Forty-three client-owned dogs undergoing coagulation testing between April 2020 and June 2021., Methods: Samples were obtained from dogs undergoing coagulation testing as part of a diagnostic workup. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were measured on the POCCA and on the LabCA. PCV, platelet count, total plasma protein, hyperbilirubinemia, hemolysis, lipemia, and autoagglutination were recorded., Results: Moderate correlation was seen for PT and strong correlation was seen for aPTT between the POCCA and the LabCA (PT: 0.59, P < 0.0001; aPTT: 0.71, P < 0.0001). The POCCA results were consistent with normal or hypocoagulable samples for 30 of 38 PT and 33 of 37 aPTT results, as identified by the LabCA. Samples with PCV of 30%-55% were moderately correlated (PT: 0.63, P = 0.0004; aPTT: 0.63, P = 0.0003), but those outside that range were more likely to register an error message on the POCCA or provide disparate results. When hemolysis was present, there was a weak correlation between the POCCA and the LabCA for PT (rho: 0.38 [95% confidence interval: 0.19-0.76], P = 0.18) and a strong correlation for aPTT (rho: 0.86 [95% confidence interval: 0.62-0.95], P < 0.0001). Samples with hyperbilirubinemia were strongly correlated for PT (0.97, P = 0.002) but not for aPTT. Lipemia and autoagglutination were not observed., Conclusion: There was an acceptable correlation in patients with PCV within the manufacturer's recommended reference range; however, measurements on samples with PCV outside the reference range were inconsistent with the LabCA. Caution should be used when using the POCCA in patients with coagulopathy and anemia or other potential confounders., (© Veterinary Emergency and Critical Care Society 2024.)

Objectives: To develop a novel illness severity scoring system to identify canine patients with infection that are at higher risk of mortality., Key Findings: Mentation (Modified Glasgow Coma Scale and the Acute Patient Physiologic and Laboratory Evaluation mentation score), heart rate, pH, P v co 2 , potassium, and total plasma protein were found to be associated with mortality on univariate analysis. Logistic regression found that mentation, heart rate, and P v co 2 combined to form the following score: [(100 × mentation score) + (3 × heart rate) + (10 × P v co 2 ], which was predictive of mortality (area under the receiver operating characteristic curve: 0.88). A cutoff of 900 provided a sensitivity of 80% and a specificity of 80%. If the cutoff was changed to 800, the sensitivity was 100% and the specificity was 50%., Significance: A novel scoring system was developed to predict mortality in hospitalized dogs with confirmed or suspected infection. Further prospective evaluation in a larger patient cohort is necessary to validate this score., (© Veterinary Emergency and Critical Care Society 2024.)

A 4-year-old male neutered Boston Terrier was presented with status epilepticus. He was diagnosed with idiopathic epilepsy and hospitalized with supportive care. During hospitalization, the patient developed both supraventricular and ventricular arrhythmias as well as focal left ventricular dyskinesis. Cardiac troponin I was significantly increased, which was supportive of myocardial damage. Neurogenic stunned myocardium was suspected, and the patient was treated and responded to esmolol. Follow-up echocardiography demonstrated the resolution of the ventricular dyskinesia. This report describes the clinical presentation, diagnostic findings, treatment, management, and outcome of the first reported case of naturally occurring neurogenic stunned myocardium in a dog. Electrocardiogram monitoring, cardiac troponin I, and echocardiography should be considered in patients presenting with seizure activity, especially when exhibiting cluster seizures or in status epilepticus., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Dunham, Horridge, Lim, Lyons and Wiggen.)

Objective: To evaluate the effect of abdominal thrusts as a synergistic procedure to IV apomorphine administration on the occurrence and rate of onset of successful induction of emesis in dogs., Animals: 31 client-owned dogs., Methods: Dogs in which induction of emesis via IV apomorphine was prescribed by the attending clinician were prospectively randomized to either receive abdominal thrusts performed by a nurse or clinician or to have no physical interventions performed following IV apomorphine administration. Data collected included signalment, weight, reason for emesis, time from suspected ingestion to presentation, time from the dog's last meal to presentation, dose of apomorphine administered in milligrams, and time from apomorphine administration to emesis., Results: Emesis induction was successful in 14 of 14 (100%) of the dogs in the abdominal thrust group and 13 of 17 (76.5%) in the control group (P = .02). In dogs with successful emesis, median time to emesis was 90.5 seconds (range, 36 to 348 seconds) in the abdominal thrust group and 106 seconds (range, 37 to 360 seconds) in the control group (P = .29)., Clinical Relevance: Abdominal thrusts were associated with an increased frequency of successful emesis in dogs following IV apomorphine, but did not shorten the rate of onset of emesis in dogs that vomited. Application of abdominal thrusts may be beneficial in dogs in which emesis is indicated and that do not have a clear contraindication.

Background: Nonhemorrhagic ascites (NHA) can be caused by cardiac diseases (cNHA) and noncardiac diseases (ncNHA). N-terminal brain natriuretic peptide (NT-proBNP), cardiac troponin-I (cTnI), and point-of-care ultrasound (POCUS) may differentiate between cNHA and ncNHA., Hypothesis/objectives: We compared NT-proBNP and cTnI concentrations as well as POCUS findings in dogs presented with cNHA and ncNHA., Animals: Dogs (n = 60) were enrolled based on identification of NHA with an effusion packed cell volume < 10%., Methods: Blood samples were collected and POCUS was performed on all dogs. Dogs were diagnosed with cNHA (n = 28) or ncNHA (n = 32) based on echocardiography. The cNHA group was subdivided into cardiac non-pericardial disease (n = 17) and pericardial disease (n = 11)., Results: The NT-proBNP concentration (median; range pmol/L) was significantly higher in the cNHA group (4510; 250-10 000) compared to the ncNHA group (739.5; 250-10 000; P = .01), with a sensitivity of 53.8% and specificity of 85.7% using a cut-off of 4092 pmol/L. The NT-proBNP concentrations were significantly higher in the cardiac non-pericardial disease group (8339; 282-10 000) compared with the pericardial disease group (692.5; 250-4928; P = .002). A significant difference in cTnI concentration (median; range ng/L) between the cNHA group (300; 23-112 612) and ncNHA group (181; 17-37 549) was not detected (P = .41). A significantly higher number of dogs had hepatic venous and caudal vena cava distension in the cNHA group compared to the ncNHA group, respectively (18/28 vs 3/29, P < .0001 and 13/27 vs 2/29, P < .001). Gall bladder wall edema was not significantly different between groups (4/28 vs 3/29, P = .74)., Conclusions and Clinical Importance: NT-proBNP concentration and POCUS help distinguish between cNHA and ncNHA., (© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Understanding how a subset of expressed genes dictates cellular phenotype is a considerable challenge owing to the large numbers of molecules involved, their combinatorics and the plethora of cellular behaviours that they determine 1,2 . Here we reduced this complexity by focusing on cellular organization-a key readout and driver of cell behaviour 3,4 -at the level of major cellular structures that represent distinct organelles and functional machines, and generated the WTC-11 hiPSC Single-Cell Image Dataset v1, which contains more than 200,000 live cells in 3D, spanning 25 key cellular structures. The scale and quality of this dataset permitted the creation of a generalizable analysis framework to convert raw image data of cells and their structures into dimensionally reduced, quantitative measurements that can be interpreted by humans, and to facilitate data exploration. This framework embraces the vast cell-to-cell variability that is observed within a normal population, facilitates the integration of cell-by-cell structural data and allows quantitative analyses of distinct, separable aspects of organization within and across different cell populations. We found that the integrated intracellular organization of interphase cells was robust to the wide range of variation in cell shape in the population; that the average locations of some structures became polarized in cells at the edges of colonies while maintaining the 'wiring' of their interactions with other structures; and that, by contrast, changes in the location of structures during early mitotic reorganization were accompanied by changes in their wiring., (© 2023. The Author(s).)

Sepsis is currently defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis may occur secondary to infection anywhere in the body, and its pathogenesis is complex and not yet fully understood. Variations in the host immune response result in diverse clinical manifestations, which complicates clinical recognition and fluid therapy both in humans and veterinary species. Septic shock is a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Although septic shock is a form of distributive shock, septic patients frequently present with hypovolemic and cardiogenic shock as well, further complicating fluid therapy decisions. The goals of this review are to discuss the clinical recognition of sepsis in dogs and cats, the basic mechanisms of its pathogenesis as it affects hemodynamic function, and considerations for fluid therapy. Important pathophysiologic changes, such as cellular interaction, microvascular alterations, damage to the endothelial glycocalyx, hypoalbuminemia, and immune paralysis will be also reviewed. The advantages and disadvantages of treatment with crystalloids, natural and synthetic colloids, and blood products will be discussed. Current recommendations for evaluating fluid responsiveness and the timing of vasopressor therapy will also be considered. Where available, the veterinary literature will be used to guide recommendations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Montealegre and Lyons.)

Objective: To document the clinical and clinicopathological changes in cats presenting with vehicular trauma (VT) and to determine whether the calculated animal trauma triage (ATT) score was associated with any clinicopathological abnormalities., Design: Retrospective descriptive study conducted between 1998 and 2009., Setting: University veterinary teaching hospital., Animals: Seventy-five client-owned cats that presented for VT to an urban veterinary hospital., Interventions: None., Measurements and Main Results: Pertinent history, physical examination findings, results of biochemical testing, and outcome were extracted from medical records. ATT score was calculated based on physical examination. Patients were classified as having either a low (<5) ATT (n = 30) or a high (≥5) ATT (n = 45) score. Male cats were overrepresented (60.0%), and a majority of cats had outdoor access (65.3%). Low PCV (P = 0.024), low total plasma protein concentration (P = 0.032), low venous blood pH (P = 0.047), high plasma lactate concentration (P = 0.047), low plasma bicarbonate concentration (P = 0.047), low base excess (P = 0.047), and high plasma glucose concentration (P = 0.047) were associated with higher ATT scores. In addition, low noninvasive blood pressure measurements (P = 0.008) were associated with higher ATT scores., Conclusions: There was a significant association between lower PCV, lower total plasma protein concentration, lower venous blood pH, higher plasma lactate concentration, lower plasma bicarbonate concentration, lower base excess, higher whole blood glucose concentration, and lower noninvasive blood pressure and higher ATT scores at presentation in feline patients suffering from VT. Prospective evaluation of these values may prove useful in furthering understanding of the pathophysiology of trauma in cats., (© Veterinary Emergency and Critical Care Society 2020.)

ABSTRACT The use of bromethalin rodenticides has risen since 2011, and in some states, it is the most common rodenticide ingestion reported to poison control. Although intravenous lipid emulsion (ILE) has been previously reported to lower serum desmethylbromethalin levels in an asymptomatic dog, and repeated mannitol has been investigated in a laboratory setting, there are no published reports of successful treatment of symptomatic bromethalin toxicosis in dogs. A 9 yr old castrated male Norwich terrier was evaluated for obtunded mentation, seizures, cranial nerve deficits, and tetraparesis secondary to bromethalin toxicosis. The patient was treated with ILE, mannitol, and ginkgo biloba and returned to normal neurological function. Bromethalin exposure was confirmed by serum desmethylbromethalin levels. Previous literature indicates that the prognosis for patients who suffer from symptomatic bromethalin toxicosis is poor to grave, and the return to normal neurological function after severe toxicosis has not been reported. ILE, mannitol, and ginkgo biloba are readily available and relatively inexpensive, and in combination may be of benefit in symptomatic bromethalin intoxication.

Objective: To document the clinical and clinicopathologic changes in cats presenting with trauma from bite wounds, identify common abnormalities associated with bite wounds, and to determine whether the calculated animal trauma triage (ATT) score is related to any clinicopathologic abnormalities., Design: Retrospective descriptive study., Setting: University veterinary teaching hospital., Animals: Forty-three client-owned cats that presented for bite wounds to a large, urban, veterinary hospital between 1998 and 2009., Interventions: None., Measurements and Main Results: Pertinent history, physical examination findings, results of biochemical testing, and outcome were extracted from medical records. Animal triage trauma score was calculated based on the physical examination at presentation in cats with adequate available information. Patients were classified as having either a low (<5) ATT (n = 20) or a high (≥5) ATT (n = 23) score. Male cats were overrepresented (65.1%), and a majority of cats had outdoor access (53.4%). Low venous blood pH (P = 0.047), high plasma lactate concentration (P = 0.018), and low ionized calcium concentration (P = 0.004) were associated with higher ATT scores., Conclusions: There is a significant association between low venous blood pH, high plasma lactate concentration, and low ionized calcium concentration and higher ATT scores at presentation in cats suffering from bite wounds. Early recognition of these abnormalities may help to identify more severely injured patients., (© Veterinary Emergency and Critical Care Society 2019.)

Thoracic radiographs are used as a screening tool for dogs and cats with a variety of disorders that have no clinical signs associated with thoracic structures. However, this practice has never been supported by an evidence-based study. The objective of this retrospective observational study was to determine if certain canine and feline populations have a higher proportion of radiographic abnormalities, and whether any of these abnormalities are associated with patient hospitalization and outcome. Patients were excluded if current or previous examinations revealed evidence of primary respiratory or cardiac disease, malignant neoplasia, or an abnormal breathing pattern consistent with pulmonary pathology. Any notable thoracic change in the radiology report was considered important and evaluated in this study. One hundred and sixty-six of these included patients were dogs and 65 were cats. Of the 166 dog radiographs evaluated, 120 (72.3%) had normal thoracic radiographs, while 46 (27.7%) had radiographic abnormalities. Of the sixty-five cats included, 36 (55.4%) had normal radiographs, while 29 (44.6%) had abnormal radiographs. Canine patients with abnormal radiographs had a significantly higher lactate level (P-value 0.0348) and feline patients with abnormal radiographs had a significantly lower packed cell volume (P-value 0.012). A large proportion of patients that had screening thoracic radiographs (32.5%) had documented abnormalities, but a relatively low percentage (6.5%) of our total population had their clinical plan changed as a consequence of detection of these abnormalities. Findings indicated that abnormal screening thoracic radiographs are more likely in dogs with an elevated lactate and cats with anemia, or a low normal hematocrit., (© 2017 American College of Veterinary Radiology.)

Cytosolic phosphoglucose isomerase (pgiC) is an enzyme essential to glycolysis found universally in eukaryotes, but broad understanding of variation in the gene coding for pgiC is lacking for ferns. We used a substantially expanded representation of the gene for Andean species of the fern genus Polystichum to characterize pgiC in ferns relative to angiosperms, insects, and an amoebozoan; assess the impact of selection versus neutral evolutionary processes on pgiC; and explore evolutionary relationships of selected Andean species. The dataset of complete sequences comprised nine accessions representing seven species and one hybrid from the Andes and Serra do Mar. The aligned sequences of the full data set comprised 3376 base pairs (70% of the entire gene) including 17 exons and 15 introns from two central areas of the gene. The exons are highly conserved relative to angiosperms and retain substantial homology to insect pgiC, but intron length and structure are unique to the ferns. Average intron size is similar to angiosperms; intron number and location in insects are unlike those of the plants we considered. The introns included an array of indels and, in intron 7, an extensive microsatellite array with potential utility in analyzing population-level histories. Bayesian and maximum-parsimony analysis of 129 variable nucleotides in the Andean polystichums revealed that 59 (1.7% of the 3376 total) were phylogenetically informative; most of these united sister accessions. The phylogenetic trees for the Andean polystichums were incongruent with previously published cpDNA trees for the same taxa, likely the result of rapid evolutionary change in the introns and contrasting stability in the exons. The exons code a total of seven amino-acid substitutions. Comparison of non-synonymous to synonymous substitutions did not suggest that the pgiC gene is under selection in the Andes. Variation in pgiC including two additional accessions represented by incomplete sequences provided new insights into reticulate relationships among Andean taxa., (Copyright © 2017 Elsevier Inc. All rights reserved.)

l-myo-inositol 1-phosphate synthase (MIPS; EC 5.5.1.4) catalyzes the rate-limiting step in the synthesis of myo-inositol, a critical compound in the cell. Plants contain multiple MIPS genes, which encode highly similar enzymes. We characterized the expression patterns of the three MIPS genes in Arabidopsis thaliana and found that MIPS1 is expressed in most cell types and developmental stages, while MIPS2 and MIPS3 are mainly restricted to vascular or related tissues. MIPS1, but not MIPS2 or MIPS3, is required for seed development, for physiological responses to salt and abscisic acid, and to suppress cell death. Specifically, a loss in MIPS1 resulted in smaller plants with curly leaves and spontaneous production of lesions. The mips1 mutants have lower myo-inositol, ascorbic acid, and phosphatidylinositol levels, while basal levels of inositol (1,4,5)P(3) are not altered in mips1 mutants. Furthermore, mips1 mutants exhibited elevated levels of ceramides, sphingolipid precursors associated with cell death, and were complemented by a MIPS1-green fluorescent protein (GFP) fusion construct. MIPS1-, MIPS2-, and MIPS3-GFP each localized to the cytoplasm. Thus, MIPS1 has a significant impact on myo-inositol levels that is critical for maintaining levels of ascorbic acid, phosphatidylinositol, and ceramides that regulate growth, development, and cell death.

Background: The design and construction of novel biological systems by combining basic building blocks represents a dominant paradigm in synthetic biology. Creating and maintaining a database of these building blocks is a way to streamline the fabrication of complex constructs. The Registry of Standard Biological Parts (Registry) is the most advanced implementation of this idea., Methods/principal Findings: By analyzing inclusion relationships between the sequences of the Registry entries, we build a network that can be related to the Registry abstraction hierarchy. The distribution of entry reuse and complexity was extracted from this network. The collection of clones associated with the database entries was also analyzed. The plasmid inserts were amplified and sequenced. The sequences of 162 inserts could be confirmed experimentally but unexpected discrepancies have also been identified., Conclusions/significance: Organizational guidelines are proposed to help design and manage this new type of scientific resources. In particular, it appears necessary to compare the cost of ensuring the integrity of database entries and associated biological samples with their value to the users. The initial strategy that permits including any combination of parts irrespective of its potential value leads to an exponential and economically unsustainable growth that may be detrimental to the quality and long-term value of the resource to its users.

Background: Despite increasing use of laryngeal preserving protocols, laryngopharyngectomy remains the gold standard treatment for locally advanced hypopharyngeal and upper oesophageal tumours and for salvage following failed chemoradiotherapy. Nevertheless, improved perioperative medical care and experience in reconstruction have reduced mortality and improved functional outcomes., Methods: All patients undergoing total laryngopharyngectomy between July 2001 and July 2006 were prospectively recorded in a head and neck database. Demographics and functional outcomes were recorded., Results: Eighteen patients underwent laryngopharyngectomies with 5 having failed chemoradiotherapy and 13 presented with locally advanced tumours. Patients were reconstructed using free jejunal interposition if the lower anastomosis was in the neck (50%). They developed early fistulas (33%), late strictures (33%) and 44% spoke with a tracheo-oesophageal puncture, the rest with an electrolarynx. If the lower anastomosis was below the manubrium, patients required a gastric pull-up (38.9%). Gastric pull-up patients had fewer fistulas but more number of chest complications. More gastric pull-up patients tolerated solid diet and 43% managed oesophageal speech, the remainder using an electrolarynx. Overall, 88.9% of jejunums and 100% of gastric pull-ups tolerated oral alimentation and 100% used verbal communication. During a mean follow up of 34 months, 7 patients (38.9%) died; four patients died of local recurrence, two of distant metastases and one of unrelated causes., Conclusion: Surgical treatment of neoplasms of the hypopharynx and cervical oesophagus is technically demanding and involves careful postoperative care to manage complications. Despite having a poor tumour-related prognosis, laryngopharyngectomy may be carried out in selected patients with low mortality and acceptable functional and survival results.

Intracellular trafficking of the DeltaF508 cystic fibrosis transmembrane conductance regulator (CFTR) is repaired by sodium 4-phenylbutyrate (4PBA) by an undetermined mechanism. 4PBA downregulates protein and mRNA expression of the heat shock cognate protein HSC70 (the constitutively expressed member of the 70-kDa heat shock protein family) by approximately 40-50% and decreases formation of a HSC70-DeltaF508 CFTR complex that may be important in the intracellular degradation of DeltaF508 CFTR. We examined the potential mechanisms by which 4PBA decreases HSC70 mRNA and protein expression. In IB3-1 cells, 1 mM 4PBA did not alter the activity of the Chinese hamster ovary HSC70 promoter or of a human HSC70 promoter fragment in luciferase reporter assays nor did it alter HSC70 mRNA synthesis in nuclear runoff assays. In contrast, preincubation with 4PBA increased the rate of HSC70 mRNA degradation by approximately 40%. The initial rate of 35S-HSC70 protein synthesis in 4PBA-treated IB3-1 cells was reduced by approximately 40%, consistent with the steady-state mRNA level, whereas its rate of degradation was unaltered by 4PBA. 4PBA also reduced the steady-state accumulation of (35)S-HSC70 by approximately 40%. These data suggest that 4PBA decreases the expression of HSC70 mRNA and protein by inducing cellular adaptations that result in the decreased stability of HSC70 mRNA.

Oncocytomas are rare tumours that occur predominantly in the major salivary glands, particularly the parotid of older individuals. We present the exceptionally rare occurrence of an oncocytoma in the post-nasal space and its treatment for the first time via a Le Fort I osteotomy. The potential for local spread to the surrounding skull base makes it vital to achieve good oncological clearance. We found that this was possible using the Le Fort I technique and would recommend that this approach should be considered in future, when approaching such lesions.

Disorders of voice are a common problem in general practice. An understanding of the complex mechanism of voice production enables us to appreciate how many systemic disorders can affect voice. This article details the pathophysiology of voice production and how to assess the patient with hoarseness. Contemporary management of vocal disorders is described with reference to some newer surgical and investigative techniques.

Juvenile angiofibroma is a benign tumor, well known for aggressive extracranial growth, that frequently spreads to involve the skull base and intracranial compartment as well. The meninges, however, provide a strong barrier against intracerebral spread. This article reports an unusual case of angiofibroma with dural penetration, cavernous sinus involvement, and adherence to the temporal lobe of the brain. Controversy exists as to how the intracranial extensions are best managed. Our experience with this case, combined with review of the literature, suggests that these lesions can be removed surgically, eliminating in most cases the need for radiation therapy.

Inverting papilloma is a locally aggressive neoplasm; however, intracranial extension is very rare. The authors herein report a case of massive inverting papilloma with intracranial extension and an associated frontal sinus mucocele, causing marked frontal lobe compression. Treatment consisted of combined anterior craniofacial resection. Magnetic resonance imaging provided accurate preoperative differentiation between neoplasm and inflammation. Skull base reconstruction may prove more difficult when there is significant frontal dead space resulting from chronic brain displacement by an associated mucocele. The management of this unusual neoplasm and a review of the literature is presented.

Radical surgery for sinonasal neoplasms in combination with radiation therapy has vastly improved the outlook for these tumors. Magnetic resonance imaging (MRI) combined with high resolution computerized tomography (CT) scanning and recognition of symptoms suggestive of extensive disease has allowed more accurate determination of surgical margins. Long-term follow-up is still needed to define the limits of radical surgery necessary to treat very extensive tumors.

We have reviewed 21 cases with the clinical diagnosis of Post Traumatic Syringomyelia (P.T.S.). Fifteen of these cases had proven syrinx formation on Contrast Computed Tomography (C.C.T.) and the other 6 had obviously abnormal cords. A much earlier onset of P.T.C.M. was found in complete spinal injuries than in incomplete ones. We have discussed the technique of contrast computed tomography used at this hospital, its value in the diagnosis of this condition and its ability to define actual spinal cord structure. Most cases (91%) benefitted from surgery and several had marked sensory improvement, which previously has been described as unusual. Syringo-cisternal shunting, a new technique for the drainage of cervical and upper thoracic syrinxes is described. A theory is proposed to explain why, in some patients with classical presentations of P.T.S., no syrinx was found on C.C.T., although abnormal cords were found in all cases. It is felt that these abnormal areas of spinal cord are responsible for the presenting symptomatology and may be precursors of syrinxes.