We describe a unique case of an intracranial extension of acquired cholesteatoma. Previous reports have described cholesteatoma extension through the middle fossa plate and into the middle cranial fossa, but to our knowledge ours is the first report of a case in which the sac herniated into the temporal lobe and overlying dura from a site far lateral to the otic capsule. The findings on magnetic resonance imaging were most unusual, and we call the radiologic characteristics of the mass in this case the “billiard pocket sign.” We also discuss the possible mechanisms that produced such an image.
The Money Point Sustainable Revitalization Plan—Chesapeake, VA Crisman+Petrus; UVA School of Architecture Money Point is a 330-acre peninsula on the Elizabeth River in Virginia that acquired its name as a result of jobs and wealth created during its heyday as a site of shipping termi- nals, factories, and wood-treatment plants. In 1963, however, a catastrophic fire released a vast quantity of creosote into the river, and industrial runoff over subsequent decades has added to the toxins in the soil, groundwater, and river sedi- ment. For years, the quality of the local environment was essentially written off, despite the continued presence of a small, largely African-American residential community and the industrial workers whose jobs still brought them to the area’s remaining scrap, cement, and petroleum businesses. After years of neglect by local, state and federal agen- cies, a nonprofit environmental group, the Elizabeth River Project, undertook the revitalization of Money Point in 2005. The group convened a task force that joined with the award-winning consultant team to engage in a two-year public process to envision an environmentally, socially and economically sustainable future for Money Point. The result is a ten-year action plan, unveiled in October 2006. As its descriptive subtitle (“Intertwined Human + Environmental Ecologies”) suggests, this job will require attention to both human and natural needs. It identifies five goals and corresponding implementation strategies: clean up the river at Money Point, prevent new releases of pollution there, enhance the quality of life for its remaining residents, establish an ethic of environmental stewardship among remaining industries, and restore and conserve the area’s natural resources. Most impressive about this planning effort, the jury agreed, was its linking of environmental restoration to renewed concern for Money Point’s remaining residents. They also praised its ability to engage government and industry in the process. Individuals have been designated “keepers of the vision,” and the plan identifies milestones and the agencies responsible for reaching them. The jury also praised the design of a “learning barge” by architecture students at the University of Virginia under the direction of architecture professor Phoebe Crisman. The barge will allow schoolchildren to experience the river ecosystem up close and at small scale, and it will also raise pubic awareness of the Elizabeth River Project’s restora- tion efforts at Money Point and elsewhere. A Grassroots Campaign Home to 1.6 million people, the Norfolk-Chesapeake- Portsmouth area grew up largely around the navigable, three-forked estuary of the Elizabeth River. Native Ameri- cans had long occupied its fertile wetlands before English colonists arrived, in 1607, at nearby Jamestown. Its strate- gic location, at the mouth of Chesapeake Bay, eventually led to its becoming the site of a major Navy base and one of the oldest and largest shipyards in the U.S. During the twentieth century, towns in the area grew together, and many of the wetlands were filled in for mili- tary facilities, shipping terminals, and industrial plants. As a result, the Elizabeth River is now one of the most pol- luted waterways on the Eastern Seaboard, earning it a place in the Environmental Protection Agency’s Urban Rivers Program. And along the river’s southern branch, Money Point is one of the most contaminated stretches of river anywhere in the U.S. In 1992, the Elizabeth River Project set out to change this legacy of industrialization and restore the biological health of the Elizabeth River watershed. 1 The organization’s goal was to work “one creek at a time” to build a constituency for change. It mobilized local communities through such activities as planting new oyster beds, cleaning up trash, and restoring growths of Spartan alterniflora, a native marsh grass. In a politically conservative region, the strategy also entailed working with industry and seeking voluntary com- pliance with environmental regulations. The group’s board includes leaders of industry, scientists, government offi- cials, and military officers as well as engaged citizens and environmental activists. According to Crisman, such a “willingness to sit down with the enemy” has led to criticism from other environ- mental groups that the Elizabeth River Project has not taken a hard enough line against polluters. But raising awareness and instilling a sense of stewardship may be the best long-term tactic for the region. “The whole economy is based on the Navy and shipping. I don’t know if you can achieve anything if you don’t work with them,” she says. The executive director of the Elizabeth River Project, Marjorie Jackson, a former journalist, has a reputation for being “a dynamo” when it comes to bringing people together, Crisman says. The task force behind the plan includes politicians, residents, business owners, design pro- fessionals, members of nonprofit and academic organiza- tions, and federal, state, and local government officials. Opposite top: Panorama of Money Point. Photo courtesy of Crisman+Petrus Architects and the Elizabeth River Project. Opposite bottom: Virginia Pilot newspaper photo of the 1963 fire at Eppinger and Russel. Maps of the lower Chesapeake Bay and the Elizabeth River estuary showing the location of Money Point. Images courtesy of Crisman+Petrus Architects and the Elizabeth River Project. Crisman+Petrus & UVA / Money Point
Yuhu Elementary School and Community Center — Lijiang, China Li Xiaodong For centuries the ancient city of Lijiang in China’s south- western Yunnan province has served as the cultural center for the Naxi minority group, and today it is a UNESCO World Heritage Site. Architect Li Xiaodong remembers when he first developed a fascination for the Naxi and their mountainous homeland. In 1988 a school classmate gave a slideshow on the Naxi and their distinct cultural blend of local, Chinese and Tibetan influences. However, it wasn’t until 1997, as leader of a research trip from the National University of Singapore, that he was able to visit the area himself. What struck him then was how perfectly the area’s fusion of local materials and technology, landscape pat- terns, and cultural values defined the idea of a vernacular tradition developed in harmony with place. After that first visit, Li, a Beijing-born designer and educator, returned to his overseas teaching job in Singa- pore. As an advocate of the theories of critical regionalism promoted by Kenneth Frampton and Alexander Tzonis, however, he remained haunted by the idea of engaging Naxi building traditions through a project of his own. As this project took shape in his mind, he envisioned it both as research into local building practices and a means to help sustain such cultural inheritance in the face of China’s rapid modernization. Over the next several years Li promoted these ideas in correspondence with local officials, and eventually, he arranged a second trip to Lijiang in 2002. During this visit Li and a Ph.D. student conducted more focused research and began searching for a building site. Ultimately, that search led to the village of Yuhu, 15 kilometers outside Lijiang itself. Here, Li was shown an elementary school in need of repair and expansion. His subsequent project for the school was completed in Febru- ary 2004 at a cost of $29,000 — an amount he personally raised from foundations in Singapore, friends, and local government agencies. Echoes of “Shangri-La” At an elevation of some 2,760 meters, Yuhu sits at the foot of the dramatic Jade Dragon Snow Mountain. In the 1920s its cool, dry climate and dramatic scenery attracted the National Geographic writer/photographer Joseph Rock to build a house there. Rock was known as an expert on the cultures and geography of far-southwestern China, an area of towering mountains and deep river valleys that gave rise to the myth of Shangri-La. Yuhu’s great claim to outside fame was that Rock built a house there and lived in it off and on during the 1920s and 30s. Otherwise, Yuhu was, and still is, home to some 1,300 villagers, mostly farmers. Li believes that in such places vernacular building prac- tices often develop in a way that gives enduring form and texture to the world. Thus in Yuhu he found “an almost perfect balance between landscape and human settlement.” In fact, “one feels strongly that the culture is actually part of nature,” he explains. But Li is also well aware of just how fragile such a balance may be. And this is nowhere more evident than in other parts of rural China, where the country’s opening to the outside has caused many similarly ancient dwelling patterns to be scrapped for the convenience and supposed prestige of more standardized, “modern” practices. Clearly, the vernacular cannot solve all problems, and Li describes this problem in a statement about his Yuhu project: “Vernacular design basically repeats tradition; changes in lifestyle and production method are usually not [accounted for].” By contrast, he wanted his project to serve as a tool to “derive continuity, beyond mere repeti- tion, by reinterpreting tradition for its sustainability within a modern context.” For the layman, Li says, this means that as an out- sider concerned with vernacular sustainability, “you have to bring something new. You have to preserve the best of the old while adding a beneficial increment of modern knowledge.” Three Areas of Innovation The project itself consists of an 830-sq.m. village cul- tural center and school expansion — encompassing eight rooms in two buildings, a semi-enclosed exhibition space, and two courtyards. Li explains there were three areas in particular where he hoped to extend local practices in pro- ductive new directions. The first was structural performance. Lijiang sits in a region of known earthquake hazard (the existing govern- ment-built school in Yuhu was damaged by quakes of magnitude 7.0 and 5.6 in 1996 and 1998). Village buildings have traditionally been constructed of local stone, timber and earth. But in his design for the school, Li attempted to marry local stone construction to a new method of internal steel reinforcement and a continuous concrete foundation. In addition, the stone walls in the Yuhu school are not load bearing; the roof and floors are supported on a heavy- timber frame, designed at each gable end to resemble local grain-drying racks. A second area of innovation was spatial structure. Li Right: View across existing basketball court to new school and community center. The former residence of the writer Joseph Rock is just out of sight to the right. Yuhu Elementary School and Community Center
The Heidelberg Project — Detroit, Michigan Tyree Guyton First, let’s talk about shoes. As a kid in a broken family, Detroit artist Tyree Guyton wore old shoes. When the soles wore out, he had to mend them with cardboard. However, this was not the only asso- ciation that opened his eyes to the iconic power of shoes. His grandfather, Sam Mackey, was also an artist, and gave Guyton his first paintbrush. He also told Guyton stories of his ancestors who had been sold into slavery and never seen again. And he told him about lynchings from the trees. “You couldn’t see the people,” Guyton remembers his grandfather saying. “But you could see the soles of their shoes.” Today such troubled meaning pervades “Soles of the Most High,” one of the most powerful elements of the Heidelberg Project, Guyton’s evolving environment of art installations on the street where he grew up and still lives. To make it, the artist threw hundreds of pairs of shoes into the branches, where they hang, symbols of the lynchings. Once again, you can only see the soles. New Life Amid Devastation When Guyton was a child, Detroit burned; he still remembers the city on fire. Now, as the camera pans along streets of abandoned buildings and overgrown lots in Come Unto Me, an award-winning film by Nicole Cattell about the Heidelberg Project, he narrates: “It looks like a bomb was dropped . . . a reflection of the people. That’s crazy, this is madness.” It was his grandfather, a commercial painter, who also encouraged Guyton to study art at the College for Creative Studies in Detroit. But afterwards, instead of moving to New York or Los Angeles, Guyton returned to Heidelberg Street. Over the next five years, as neighbors watched in amaze- ment, the street became a showplace for installations such as “Soles of the Most High.” His artistic method was based on weird juxtapositions and transformations of found objects. Along with paint and imagination, he used dis- carded car hoods, barrels, chairs, sinks, clothing and dolls to decorate the houses, vacant lots, trees and street. He explained it as his way, as an artist, of reclaiming a neigh- borhood forgotten by civil society. Guyton’s work made powerful use of myth and symbol, building on traditions of African American art. But it did so in a way that often looked harsh and uncompromising. In particular, it targeted the many serviceable wood-frame houses that had been abandoned since Guyton’s youth. Not only were these sites of drug dealing and prostitution, but they spoke of the forces of racism, neglect, and social pathology that had overrun inner-city Detroit and many other once-viable urban neighborhoods. Such confrontational work did not make him popular with certain community groups and local political leaders. In particular, in the early 1990s it pointed out the ineffectiveness of then-Mayor Coleman Young in stem- ming the tide of urban decay. One day in 1991, Young sent in the bulldozers. By the end of the week the houses and the installations they supported had been carted off to the dump. Above: The impact of art on the lives of children has long been a concern of Guyton’s Heidelberg Project. Photo by Larry Peplin. Right: The Project makes use of all manner of discarded items to call attention to place. The tree at left is part of the work Guyton has called “Soles of the Most High.” Photo by James R. Cliff. The Heidelberg Project
The objective of this study is to determine whether magnetic resonance imaging (MRI) at 2 years following complete vestibular schwannoma (VS) excision using a translabyrinthine approach is sufficient to detect recurrent tumor. The study is set in a tertiary referral skull base unit. A service evaluation of a prospective database identified patients who underwent complete translabyrinthine VS excision with prospectively recorded MRI results at 2 and 5 years following surgery. The main outcome measures were evidence of tumor recurrence on MRI at 2 and 5 years after surgery. Of 314 patients in the study, all patients where MRI was reported to show no recurrence at 2 years (97%) also had no signs of recurrence on MRI at 5 years. All eight patients with MRI suspicious of recurrence (linear enhancement of internal auditory canal [IAC]) at 2 years had no progression on MRI at 5 to 15 years. One patient had evidence of definite recurrence (nodular enhancement of IAC) at 2 years, who went on to have radiosurgery at 8 years. Where patients have MRI with no linear enhancement of the IAC at 2 years, no further imaging is required. Where linear enhancement is seen, no change in enhancement at 5 years is reassuring and no further imaging is required.
Abstract Objective: To report a rare condition affecting the temporal bone. Immunoglobulin G4 related systemic sclerosing disease is a recently described autoimmune condition with manifestations typically involving the pancreas, biliary system, salivary glands, lungs, kidneys and prostate. Histologically, it is characterised by T-cell infiltration, fibrosis and numerous immunoglobulin G4-positive plasma cells. This condition previously fell under the umbrella diagnosis of inflammatory pseudotumour and inflammatory myofibroblastic tumour. Case report: We present the case of a 58-year-old woman with multiple inflammatory masses involving the pharynx, gall bladder, lungs, pelvis, omentum, eyes and left temporal bone, over a seven-year period. We describe this patient's unusual clinical course and pathological features, which resulted in a change of diagnosis from metastatic inflammatory myofibroblastic tumour to immunoglobulin G4 related systemic sclerosing disease. We also review the literature regarding the management of inflammatory pseudotumours of the temporal bone, and how this differs from the management of immunoglobulin G4 related systemic sclerosing disease. Conclusion: We would recommend a full review of all histological specimens in patients with a diagnosis of temporal bone inflammatory pseudotumour or inflammatory myofibroblastic tumour. Consideration should be given to immunohistochemical analysis for anaplastic lymphoma kinase and immunoglobulin G4, with measurement of serum levels of the latter. Management of the condition is medical, with corticosteroids and immunosuppression, rather than surgical excision.
Microsurgery of the Skull Base. Fisch Ugo and Joseph Santos Douglas. (with contributions by U. Aeppli and A. Valavanis) Georg Thieme Verlag, Stuttgart, New York1988 ISBN 3 13 717101 6 Price: DM 440. pp. 704. 1310 Illustrations. - Volume 103 Issue 7
Intelligent Mixing Systems (IMS) are being integrated into mixing workflows, however, there is little discussion around how these technologies are impacting mixing practices. This study explores th ...
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