bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of bottled waters in Turkey
Authors: Pehlivan Rustem
Published: April 2019

In Turkey, 103 bottled waters (from natural springs and mineral waters) were sampled for testing their quality. The test revealed that in them some ions exceed the limits permitted by the World Health Organisation, European Community, and Turkish Standards. The appearance of Fe, Zn, As, and Al in the natural spring and mineral waters indicates their inorganic contamination. Such bottled waters can cause adverse effects on human health. If the information reported on the bottled water consumed in Turkey and other countries of the world is updated with current results of water chemistry analysis, consumer’s confidence in companies that produce them will increase.
Status of water pollution in the coalmine of Basundhara block, Ib valley, Orissa, India
Authors: Singh K. N. , Singh R. K.
Published: April 2019

Water pollution in coalmines has become a serious concern of everyone and with the growing demand of energy, the quest for more coal exploitation has increased. The Basundhara block of Ib valley, Orissa, India, is an opencast mine at its developing stage. Looking into the state of its progress, the coalmine water quality and its impact on organisms are discussed in this study. To reduce the health hazard from coalmine waters, necessary plant species as accumulators or absorbents are suggested in this paper.
“ON THE VERGE OF CONTENDING CENTURIES”: THE HISTORICAL ANTHROPIC DIMENSION IN V.BRUSOV’S POETRY
Authors: ANTONOVA LUDMILA
Published: April 2019

The author views V.Brusov’s poetry from the “historical antropic dimension” perspective as a valuable unity of verity, boon, and beauty. The semantic focus of the approach is the value “measure” of the human kind in cultural evolution. The author concludes that historical eras vary in the value composition of human kind’s “measure”.
VALERY BRUSOV: FROM VITAL AND CREATIVE IDEAS TO RECREATING REALITY AND THE CREATIVE PERSONALITY IN THE SPIRIT OF BOLSHEVISM
Authors: KLING OLEG
Published: April 2019

We don’t need to blame Brusov and other symbolists for all the deadly sins almost including the October revolution. In fact, the Bolsheviks first destroyed symbolism as an old school, and their attempts in selecting figures of the new culture went far beyond Symbolistic ideas on the creation of life. After all, it is not the fault of the Russian Symbolists that their idea to reshape a new creative personality resulted in the destruction of this very personality in the U.S.S.R.
ABOUT BRUSOV’S WAY TO DAMASCUS: ONTOLOGY OF PASSION
Authors: KOSHEMCHUK TATIANA
Published: April 2019

One of the main Brusovs’ themes, passion, is dealt with in this article, the originality of which in the poetry of Brusov is described in its ontological aspects as opposed to the divine and demonic. Passion in Brusovs’ poetry appears in the imagery of the biblical context as “the way to Damascus” and as the gift of Lucifer, as a result of overcoming the secular and entering the spiritual domain without reaching a stable religious position.
"FREE VERSE IN BRUSOV’S THEORY AND PRACTICE"
Authors: ORLITSKIY YURY
Published: April 2019

"In the article the Brusov`s theory on free verse in its development (1900 – 1923) as well as the verses written by the author in those years which refer to the main thesis statements of this theory are examined."
"ALEXANDER THE GREAT AS CHARISMATIC LEADER IN THE V.BRUSOV’S CREATIVE PERCEPTION"
Authors: POKACHALOV MAXIM
Published: April 2019

"The article views the peculiarities of the Valery Brusov’s creative perception of the personality of Alexander the Great. The main components of the charismatic leadership of the ancient commander are analyzed on the material of Brusov’s two poems. The article substantiates the interest of the Russian poet-symbolist to the personality of Alexander the Great and his doings"
"SEVEN COLORS OF THE RAINBOW” AS A REFLECTION OF THE POET’S PERSONAL DRAMA (THE SECTION “IN THE COUNTRY OF SILENCE”)
Authors: PROTASOVA NATALIA
Published: April 2019

The article analyses the section “In the country of silence”, which opens the literary cycle “The Green” of Brusov’s book “Seven Colors of the Rainbow”. The conducted analysis allowed to reveal a thematic commonality among the verses of the section that reflect one of the most tragic episodes of the poet’s life.
"I.S.TOURGENEV'S CREATIVE WORKS UNDER HISTORICAL AND LITERARY INTERPRETATION OF VALERY BRUSOV (THE METHODOLOGICAL ASPECT)"
Authors: GOLOVKO VYACHESLAV
Published: April 2019

"Methodological principles and approaches to the analysis of I.S.Tourgenev's creative works that are realized within historical and literary attempts of Brusov are reviewed through the context of literature development in the late 19th and early 20th centuries. The researcher poet’s reflexion on scientific interpretations of various phenomena of Russian classical literature allows to ascertain his attitude towards realism and symbolism, clarifies the idea of crucial problems of his aesthetics."
"“IN ANY CASE, THE WAR IS A MAN’S BUSINESS”. BRUSOV’S CORRESPONDENCE WITH JOANNA BRUSOV (1914 – 1915) AS A BIOGRAPHIC SOURCE"
Authors: ORLOVA MONIKA
Published: April 2019

"The article concerns the unpublished biographic facts taken from the correspondence of V.Y.Brusov and I.M.Brusova from August 15th 1914 till May 21th 1915, when the poet worked in Warsaw as a reporter of the Moscow newspaper “Russkie Vedomosti” and his wife while living in Moscow helped him in his work."
"THE PERCEPTION OF WORLD LITERATURE IN “DREAMS OF HUMANITY” BY V.BRUSOV AND “CANTOS” BY E.POUND"
Authors: GULANYAN KARINA
Published: April 2019

"The article presents a comparative analysis of the world literature perception by Brusov and Pound in the literary cycle of poems “Dreams of humanity” and the poem “Cantos”. The author comes to a conclusion that the book by Brusov reflects the diversity of forms of lyrics, and “Cantos” by Pound appeals to a variety of plots in the world literature."
"BRUSOV’S POETIC WORD CREATION"
Authors: NIKULTSEVA VIKTORIA
Published: April 2019

"The article is about Valery Brusov's poetic word creation. Also an issue of the poet’s neologisms-originality in comparison with poetic neolexicon of the Silver Age are considered."
CONCEPTUALITY OF V. BRUSOV’S «DEATH ENLIGHTENMENT» IN «ABODE» – A NOVEL BY ZAKHAR PRILEPIN
Authors: POPOVA IRINA , GLAZKOVA MARINA
Published: April 2019

The issue of the Russian culture literature centricity in terms of the Silver Age poetry influence on the logosphere of the Russian society in 1920s as set in a novel «Abode» by Zakhar Prilepin is analyzed in the article. The author of the article shows that due to the dynamics ofBrusov ideas’ perception Zakhar Prilepin identifies the protagonistspecific features, unveiling the society total spiritual state.
BRUSOV-FUTURIST (A DRAMA «PIROENT» («PYROESIS»)
Authors: CHULYAN ANNA
Published: April 2019

The article is devoted to the issue of the future as set in Brusov’s dramas, the drama «Piroent» in particular. The author of the article comes to the conclusion that in his drama Brusov puts emphasis on the crucial issue of the epoch – the struggle between the spiritual and the technical
THE FIERY ANGEL BY BRUSOV AND FAUST BY GOETHE
Authors: DANUŠE KŠICOVÁ
Published: April 2019

The author of the article compares «The Fiery Angel» – Brusov’s first novel – with the tragedy «Faust». The comparison revealed deliberate antipodal binding to Goethe. The traditional wandering through the world (Faust) is replaced with the path to inner soul. The greed for everything is replaced with the desire for love. According to the author the adept´s initiation leads just to wisdom and not to love.
V. BRUSOV ON THE PAGES OF «REBUS» MAGAZINE
Authors: GEVORGYAN ARMEN
Published: April 2019

The author of the article studies the historical and literary facts of Brusov’s creative biography referring to his cooperation with «Rebus» magazine. The poet’s views and approaches to the analysis of paranormal phenomena presented in the article entitled «The Methods of Mediumism», in the letters and diaries and the debate about the publication have also been covered.
NONFATAL TRIANGLE
Authors: MIKHAILOVA MARIA , LE GOUIS CATHERINE
Published: April 2019

The article is aimed at revealing the drama of the personal life of Nina Petrovskaya, focusing on the period when her longtime relationship with Valery Brusov was coming to an end. The comparison of the facts presented in her letters to the poet with her biography demonstrates not only the particularities of the Symbolist concept of the creation of life, but also Brusov’s and Petrovskaya’s principles of modeling the identities of themselves and others
BRUSOV’S «SELECTED VERSES»: INTENTION, COMPOSITION, READERS
Authors: MOLODIAKOV VASSILI
Published: April 2019

This article deals with Brusov verse books selected by the author himself: “Izbrannye stikhi” (1915) and “Krugozor” (1922). The both were never analyzed as separate poetic books in the context of Brusov’s literary evolution. This study is focused on the composition of “selected verses” and their estimated readers.
FROM CORRESPONDENCE BETWEEN V. BRUSOV AND M. GERSHENZON
Authors: LITVIN ELENA
Published: April 2019

Unpublished Heritage
CHAPTERS FROM AN UNFINISHED FANTASTIC ESSAY «MYSTERIOUS WORLDS» BY V. BRUSOV (6TH DRAFT, 7TH DRAFT (CORRECTED). 1886-1889)
Authors: AVANESOVA AREVIK
Published: April 2019

Unpublished Heritage
ON V. BRUSOV’S FUTURISM
Authors: AKHSAKHALYAN ALEXANDRE
Published: April 2019

V. Brusov gave close scrutiny to the Futurists from the very moment they had begun publishing. From 1911 on, he wrote a series of articles, which reveal the evolution of his perception: from negating Futurism he passed on to establishing links between Futurism and Symbolism. The issue of influence of Futurism on V. Brusov brings out the complexity of correlation between the two movements.
FROM THE NOTES CONCERNING VERSES BY V. BRUSOV
Authors: BOGOMOLOV NIKOLAY
Published: April 2019

The author of the paper analyzes a number of poems by V. Brusov, published antemortem and postmortem, and shares his reflection and conclusions. The matter concerns, in particular, «a reply to acmeists», «a mystery of “A Fatal Row ”», and «Verea».
THE CHRONOTOPE PECULIARITIES IN V. BRUSOV’S NOVEL «JUPITER FALLEN»
Authors: GULANYAN KARINE
Published: April 2019

V. Brusov shows the theme of pagan Rome decline in the novel «Jupiter Fallen» with the help of the chronotope. Time and space, which are important for paganism, are presented as decayed, but Christian churches are capable of being restored after a short disgrace.
OPHELIA AND LAERTES AS V. BRUSOV’S LYRICAL HEROES
Authors: FEDOTOV OLEG
Published: April 2019

The paper deals with V. Brusov’s poems inspired by «Hamlet», a tragedy by W. Shakespeare. V. Brusov’s lyrical heroes impersonate Shakespearean characters. V. Brusov and A. Bely controversy over literature issues is also considered, since it can clear up V. Brusov’s perception of the great tragedy, in particular, the reasons why he chose not worthy characters of the tragedy as his lyrical alter ego.
STYLISTIC AND LINGUISTIC PECULIARITIES OF MIKHAIL KUZMIN’SWORKS ABOUT VALERY BRUSOV
Authors: GIK ANNA
Published: April 2019

The research tasks: the comparison of language structures for texts describing the stages of Silver Age poets interactions; specifics of narration modes in diary, epistolary and critical discourses. The research material are Mikhail Kuzmin’s diary records; correspondence between Valery Brusov and Mikhail Kuzmin; poetic messages in the form of acrostics; Valery Brusov obituary..
LEONID ANDREYEV’S OEUVRE THROUGH BRUSOVIAN LENS
Authors: PROTASOVA NATALIA
Published: April 2019

The paper deals with V. Brusov’s reviews of the works by Leonid Andreyev in the magazine «Vesy» (The Balance). The author mentions some peculiarities of L. Andreev’s stories positively reviewed by V. Brusov, as well as his remarks concerning the writer’s experiences in drama.
A VERSE «БЕЗГЛАГОЛЬНОСТЬ» BY KONSTANTIN BALMONT TRANSLATED INTO ARMENIAN BY VAHRAM MARTIROSYAN
Authors: POGHOSYAN IRINA
Published: April 2019

The paper deals with translations of verses by K. Balmont into Armenian. In particular, the matter concerns a verse entitled «Безглагольность», translated into Armenian by Vahram Martirosyan. The author concludes that the translator managed to remain close to the original source, however, in the two final lines he distorted the system of poetic images a bit, thus, consequently, distorting the thrust.
ARMENIAN WRITERS, POETS AND PUBLIC FIGURES IN V. BRUSOV’S SOCIAL CIRCLE
Authors: BAGHDASARYAN ROBERT
Published: April 2019

The Armenian intellectual community of Russia realized the positive aspects of Russian and Armenian peoples’ mutual influence, united by common social and political destiny. V. Teryan, K. Mikaelyan, P. Makintsyan and their colleagues – prominent writers and strong advocates of Armenia’s pro-Russian orientation and productive development of Russian-Armenian cultural links, actively participated in the creation and publication of a unique anthology «The Poetry of Armenia», edited by V. Brusov, in Moscow in 1916.
Research on multi-scale simulation model for single-phase water pipe networks
Authors: Sun J.-L. , Xue R.-J. , Peng M.-J.
Published: April 2019

Fluid transients occur mainly during fluid transfer in the networked pipe systems in nuclear power plants. Research on pipe network simulation is presented in literature. However, there are still some open technical gaps. In this paper, to satisfy the different time step requirements in different stages of nuclear power plant operation, and to improve the accuracy of simulation results, a multi-scale simulation model of single-phase water pipe networks is proposed. Therefore, the pipe networks are divided into control nodes and flow lines in a complete simulation map. The multi-scale simulation is obtained through the combination of simplified equations, time step selection and refined nodes. The accuracy and stability of the simulator are verified by modeling the feed water system of the Chinese experimental fast reactor. In addition, the output is compared with output of the commercial software, Jtopmeret. As a conclusion, the new model calculates results for this feed water system with a higher accuracy under dynamic operations which consistent with theoretical analysis.
The Development of Ilocano Word Lists for Speech Audiometry
Authors: Sagon Reynita R. , Uchanski Rosalie M.
Published: April 2019

Objective: The goal of this work is the creation of word lists, in Ilocano, suitable for use in speech audiometry.

 

Methods: First, estimates of the distribution of speech sounds and of the most common syllable structures in Ilocano were found from a phonetic transcription analysis of nearly 3000 words obtained from three magazine articles. Second, 372 two-syllable words were rated, for commonness, by fifteen native speakers of Ilocano who currently reside in Hawai’i. Finally, various combinations of two-syllable words were made to produce 50-item lists.

 

Results: First, an estimate of the distribution of speech sounds in Ilocano was found, with frequencies of occurrence ranging from 22.4%, for the speech sound /a/, to 0.007%, for the speech sound /v/. The syllable-structure analyses revealed that a very small number of distinct monosyllabic words were used very frequently. Two-syllable words were also used frequently, but were attributed to many distinct words. Second, from the rating results, approximately 70% of the two-syllable words in the rating survey were judged as common by 12 or more of the raters.

Finally, four lists of 50 words each were constructed using only common two-syllable words with the most frequent two-syllable structures found in Ilocano. Each word list has a distribution of speech sounds that approximates that found from the phonetic analysis, and hence each list is roughly phonetically-balanced.

 

Conclusions: These word lists may be of value to otolaryngologists and audiologists who work with native speakers of Ilocano.

 

Keywords: Ilocano, Ilokano, phonetically-balanced, speech audiometry, word lists
Small - Incision Technique for Med-El Combi 40+™ Implantation
Authors: Chiong Charlotte M. , Mueller Maribel B. , Ungui Erwin Voltaire M.
Published: April 2019

Objectives: 1) To present a technique for implanting the Med-El Combi 40+™ using a small incision with minimal access. 2) To describe the short term postsurgical outcomes in these patients.

 

Methods: Two patients (1 child and 1 adult) underwent a novel small incision technique for implantation of the Med-El Combi 40+™ cochlear implant device. The short term outcomes in these two patients were described and compared with previous experience using the standard implantation technique citing advantages and possible limitations. As these two patients had bilateral implantation utilizing different techniques on the two sides interesting comparisons could be made on the same individuals.

 

Results: The preliminary experience with a novel small incision technique for the Med-El Combi 40+™ implantation shows encouraging results in terms of healing and initial performance of these patients.

 

Conclusion: This small incision technique may be offered to patients especially to those who wish to have bilateral implantations as this allows a less invasive approach, good cosmesis without sacrificing the safety and performance outcomes at least in the short term.

 

Keywords: cochlear implantation, minimally invasive surgery
Temporalis Muscle-Coronoid Swing and Forehead Skin Island Flap Reconstruction of the Orbit after Maxillectomy
Authors: Carrillo Ryner Jose C. , Caparas Mariano B.
Published: April 2019

The use of local regional flaps is often the most practical and easy means of reconstruction in the management of head and neck tumors. The temporalis muscle coronoid swing has been used to reconstruct the orbital floor and is described in literature as early as 1983. Difficulty is encountered when the medial wall and orbital floor are completely removed and a temporalis muscle-coronoid swing is rendered insufficient for orbital reconstruction.

 

Objective: To describe a combination of forehead island flap and temporalis muscle-coronoid swing in orbital reconstruction.

 

Design: Surgical Innovation/ Case Report.

 

Subject: 12-year-old female with recurrent maxillary chondroblastic osteosarcoma one year after chemotherapy.

 

Methods: The course of tumor excision and defect reconstruction is described.

 

Results: There was no diplopia or other morbidity. There was minimal added operative time for reconstruction with acceptable results.

 

Conclusion: Local flaps can be combined in order to repair the orbital floor. Acceptable function with minimal cosmetic deformity can be achieved with less extensive surgery.

 

Keywords: Forehead flap, temporalis muscle, coronoid, orbit, reconstructive surgical procedures, maxillectomy
Langerhans Cell Histiocytosis: An Unusual Presentation
Authors: Fellizar Kathleen R. , Chiong Charlotte M.
Published: April 2019

Objective:  To describe an unusual presentation of Langerhans cell histiocytosis in the craniofacial skeleton in a patient previously diagnosed with Pott’s disease.

Methods:

Design: Case report.

Setting:  Tertiary care center. 

Patient: One (1) 

Result:  A 30-year old male who previously underwent cervical spine surgery for Pott’s disease, presenting with watery ear discharge and mandibular resorption was initially diagnosed with tuberculosis.  On MRI, a mildly contrast-enhancing soft tissue mass involving the left infratemporal and middle cranial fossae consistent with residual or recurrent tumor as well as an inflammatory process was seen.  He underwent transtemporal excision of the mass with external auditory canal blind sac closure and obliteration.  Final histopathology revealed Langerhans cell histiocytosis.  A review of slides of the specimen from the previous spine surgery was done and signed out as Langerhans cell histiocytosis.

Conclusion:  Langerhans cell histiocytosis occurs rarely, but has frequent head and neck manifestations.  It may also be confused with other diseases in the head and neck, such as tuberculosis, in this case.  Otorhinolaryngologists and head and neck surgeons should be well aware that isolated lesions in the bony framework of the head and neck should include Langerhans cell histiocytosis in the differential diagnosis.  Early detection is the key to preventing disease progression and instituting timely definitive management. 

 

Key words:  Langerhans cell histiocytosis, watery ear discharge, mandibular resorption
Anterolateral Thigh Flap Reconstruction of Full Thickness Buccal Defect
Authors: Castañeda Samantha S. , Alonzo Daniel M. , Ramos Rodney Marc H.
Published: April 2019

Objective: To present our experience with the anterolateral thigh flap in reconstructing a full thickness defect of the buccal mucosa and cheek.

Methods:

Design: Case Report

Setting: Tertiary Private Hospital

Patient: One

Results: A 36 year old male with a T4aN0M0 Stage IVa buccal carcinoma on the left underwent wide excision, marginal mandibulectomy and modified radical neck dissection with preservation of the spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle. The resultant through-and-through defect of the cheek skin measuring 8 x 6cm and buccal mucosa measuring 6 x 10 cm with a concomitant ¼ upper lip and 1/3 lower lip defect was reconstructed with an anterolateral thigh free flap. The patient recovered uneventfully and underwent adjuvant concurrent chemoradiotherapy 1 month post-operation. At 2 ½ months post-operation, he had no oral incontinence and could resume a normal diet with good speech.

Conclusion: The anterolateral thigh free flap is an excellent soft-tissue flap for reconstruction of a full thickness defect of the buccal area.

Key words: Surgical flap, Carcinoma, squamous cell, Oral cancer
A Ten-Year Review of Brainstem Auditory Evoked Response Testing at the Philippine Children’s Medical Center: Patient Demographics and Outcomes
Authors: Tipayno Mary Jane C.
Published: April 2019

Objective: The study aims to present the clinical and demographic profile of subjects who have undergone Auditory Brainstem Response (ABR) test at the Philippine Children’s Medical Center over a 10-year period.

Methods:

Design: Retrospective chart review

            Setting: Tertiary children’s hospital

Population: All patients referred for ABR testing from January 1996 to December 2005.

Results: A total of 2783 cases were included in the study with 1.63:1 male-to-female ratio. Almost 50% belonged to the 2-to 5-year old age group. There were 111 different indications for referral, with speech and language disorders ranking first at 38%. Patients with Congenital Rubella had the highest incidence of pathologic ABR results with 90.62%. There was no significant difference in the degree of hearing loss between the pre-school (2-5 years old) and school age (>5 to 10 years old) group. Our patients who presented with speech delay had a much older average age of hearing loss detection by ABR compared to foreign studies.

Conclusion: Speech and developmental delays were the leading causes for ABR referral across age groups with most belonging to the 2-to-5-year old age group.  There was no statistically significant difference in the degree of hearing loss between the preschool and school-age groups with speech delay. ABR in hearing screening of neonates and children constitutes only a small fraction of the total indications for ABR Testing at the Philippine Children’s Medical Center. Detection of hearing loss at an earlier age may reveal the true burden of illness and facilitate earlier intervention. Universal hearing screening should be performed for all newborns and not just for high risk infants.  

Keywords: Hearing loss, Speech delay, Auditory Brainstem Response, ABR
Comparative Study of the Auditory Steady-State Response (ASSR) and Click Auditory Brainstem Evoked Response (ABR) Thresholds among Filipino Infants and Young Children
Authors: Tan Laurence Ian C. , Reyes-Quintos Maria Rina T. , Tantoco Maria Leah C. , Chiong Charlotte M.
Published: April 2019

Objective: To compare the results of auditory steady-state response (ASSR) and click auditory brainstem response (click ABR) among infants and young children tested at the Ear Unit of a Tertiary General Hospital.

 

Methods:

Design: Cross-sectional Study

Setting: Tertiary General Hospital

Population: Within-subject comparisons of click auditory brainstem response (click ABR) thresholds and auditory steady-state response (ASSR) thresholds among 55 infants and young children, 2 months to 35 months of age referred to the Ear Unit for electrophysiologic hearing assessment.

Results: Click ABR showed strong positive correlation to all frequencies and averages of ASSR. Highest correlation was noted with the average of 1-4 kHz ASSR results with Pearson r = 0.89 (Spearman r=0.80), the average of 2-4 kHz had strong positive correlation r = 0.88 (0.79). Correlation was consistently strong through all ASSR frequencies (0.5 kHz at r=0.86 (0.74), 1 kHz at r=0.88 (0.78), 2 kHz at r=0. 87 (0.79), 4 kHz at r=0.85 (0.76)). Average differences of click ABR and ASSR thresholds were 8.2±12.9dB at 0.5 kHz, 8.6±12.6dB at 1 kHz, 5.3±11.8dB at 2 kHz and 7.8±13.4dB at 4 kHz. Among patients with no demonstrable waveforms by click ABR with maximal click stimulus, a large percentage presented with ASSR thresholds. Of these, 80.5% (33 of 41) had measurable results at 0.5 kHz with an average of 107.3±11.1dB, 85.4% (35 of 41) at 1 kHz with an average of 110.5±11.8dB, 73.2% (30 of 41) at 2 kHz with an average of 111.2±11.1dB and 63.4% (26 of 41) at 4 kHz with and average of 112.2±8.21dB. Auditory steady-state response results were comparable to auditory brainstem response results in normal to severe hearing loss, and provided additional information necessary for complete audiologic assessment especially among patients with severe to profound hearing loss wherein click ABR showed no responses. Up to 85.4% of patients that would have been noted to have no waveforms by click ABR still demonstrated measurable thresholds by ASSR

 

Conclusion: Our study suggests that ASSR may be the best available tool for assessing children with severe to profound hearing loss, and is a comparably effective tool in overall hearing assessment for patients requiring electrophysiological testing. The advantages of ASSR over click ABR include: 1) detection of frequency-specific thresholds and; 2) the detection of hearing loss thresholds beyond the limits of click ABR.

 

 

Key words: Auditory Steady-State Response, ASSR, Auditory Brainstem-Evoked Response, ABR, Hearing Thresholds, Electrophysiologic Testing
An Improvised Tracheostoma Button Fabricated from Disposable Plastic Syringe
Authors: Vencio Reynerio M. , Cruz Emmanuel Tadeus S.
Published: April 2019

Objective: To design inexpensive, easily fabricated stoma buttons for post-laryngectomy patients with stomal stenosis and patients who require prolonged tracheotomy.

 

Methods:       

Design: Surgical Instrumentation

Setting: Tertiary Government Hospital

Participants: Tracheostoma buttons fabricated from 3 or 5 cc disposable plastic syringes were tested on two post-laryngectomy patients with stomal stenosis and a tracheotomized patient with bilateral vocal cord paralysis.

 

Results: The tracheostoma buttons were inexpensive and relatively easy to fabricate. They were easily inserted and well tolerated by all three patients, compared to previously-used commercially-available tracheotomy tubes.

 

Conclusion: In a developing country setting, improvised tracheostoma buttons made from disposable plastic syringes may be viable alternatives to commercially-available stoma buttons or tracheotomy tubes. Clinical trials on more subjects should be conducted to assess parameters for use and long-term efficacy and safety issues.

 

Keywords: stomal stenosis, tracheostoma/stoma button
An Anatomical Study of the Cochlea among Filipinos using High-Resolution Computed Tomography Scans
Authors: Fernando Adrian F. , De Jesus Brian Joseph dG. , Opulencia Alejandro P. , Maglalang Gil M. , Chua Antoio H.
Published: April 2019

Objective: To describe the cochlear anatomy among Filipinos through high resolution computed

tomography (HRCT) imaging.

 

Methods:

Design: Retrospective Study

Setting: Tertiary Private University Hospital

Patients: Cochlear images retrospectively obtained from computed tomography (CT) scans of subjects who underwent cranial, facial, paranasal sinus and temporal bone computed tomography from October 2009 to July 2010 were reconstructed and analyzed.

 

Results: 388 cochlear images were obtained from the scans of 194 subjects (101 males and 93 females, aged 1 to 90 years old, mean = 52 years) and reconstructed for analysis. The mean coiled cochlear height measured 4.36 mm on the right (A.D.) and 4.34 mm on the left (A.S.). Measurement from the oval window to the distal end of the basal turn (equivalent to the horizontal dimension of the cochlea or the mean length of the basal turn) was 7.55 mm A.D. and 7.60 mm A.S. The vertical and horizontal dimensions of right and left cochleas were identical in all subjects (S.D. = 0.35). The right and left cochlear turns were identical in each subject, exhibiting 2 ½ turns in 92.3% of subjects and 2 ¾ turns in 7.7% of subjects.The cochlear dimensions were similar in all subjects, regardless of age. No cochlear ossification or malformation was noted on any CT image.

 

Conclusion: The 7.55 mm mean length of the cochlear basal turn among Filipinos in this study was 1.24 mm shorter than the average length of the basal turn of 8.81 mm reported elsewhere. Further studies of the cochlear dimensions in specific age groups and its correlation to audiometric status are recommended to determine other significant physiologic correlations.

 

Keywords: cochlea, cochlear turn, high-resolution computed tomography (HRCT), magnetic resonance imaging (MRI)
Intraparotid Facial Nerve Schwannoma with Temporal Bone Extension
Authors: Laoag Alexander T. , Chua Antonio H. , De Guzman Thanh Vu T. , Castañeda Samantha S. , Malanyaon Jose A.
Published: April 2019

Objective: To present a rare case of facial schwannoma manifesting as a parotid mass and discuss its diagnosis and treatment.Methods:     Design: Case Report     Setting: Tertiary Government Hospital     Patient: OneResults: A 48-year-old female was seen for a 2-year progressive left hemifacial paralysis and a 5-month gradually enlarging left infraauricular mass with episodes of tinnitus but intact hearing and balance. Physical examination showed a left-sided House Brackmann grade VI facial paralysis and a 5 x 4 x 3 cm soft, ill-defined, slightly movable, nontender, left infraauricular mass. Gadolinium-enhanced magnetic resonance imaging revealed a 5 cm heterogeneouslyenhancing lobulated mass centered within the deep lobe of the left parotid gland extending to the left mastoid, with facial nerve involvement. A diagnosis of a facial nerve tumor, probably a schwannoma, was entertained. Pure tone audiometry revealed normal hearing thresholds for both ears with dips at 6-8 KHz on the left. The patient underwent total parotidectomy withfacial nerve tumor resection via transmastoid approach, with simultaneous facial – hypoglossal nerve anastomosis reconstruction. Histopathologic findings confirmed the diagnosis of a schwannoma. Postoperative facial function was Grade VI. Hearing and hypoglossal nerve function were preserved.Conclusion: A progressive hemifacial paralysis of chronic duration with or without the presence of an infra-auricular mass should raise the suspicion of a facial nerve tumor. Gadolinium-enhanced magnetic resonance imaging is valuable since intraparotid facial nerve schwannomas are mostly diagnosed intraoperatively when the neoplasm and the nerve are exposed and determined to be contiguous. The clinician should be aware that not all parotid masses are salivary gland in origin.Keywords: intraparotid facial nerve schwannoma, facial nerve paralysis, parotid mass
Auricular Perichondritis in a Tertiary Rural Hospital
Authors: Dhar Gautam , Basak Bijan , Gayen Ganesh Chandra , Ray Ritam
Published: April 2019

Objective:  Auricular perichondritis refers to inflammation involving the perichondrium of the external ear. It is a very serious disease which may lead to permanent deformity of the pinna. We describe the predisposing factors, pathogenic organisms, interventions and residual deformities in a prospective consecutive sample of patients.

Methods:

Design:           Prospective Cohort Study

Setting:           Tertiary Rural Government Teaching Hospital

Participants: All patients presenting with auricular perichondritis for a period of one year, between March 2011 and February 2012 were consecutively enrolled, and a clinical history and demographic details were obtained. Routine hematologic, blood biochemical examinations and culture / sensitivity of discharge from the pinna were conducted, and empiric intravenous ciprofloxacin was administered and continued if confirmed by culture and sensitivity. Those sensitive to co-amoxiclav, ceftazidime or amikacin were shifted to those medications. Medications were shifted to oral forms when available and indicated by resolution of acute inflammation, wound healing and no growth on cultures. Parenteral medications were maintained until the same parameters were achieved. Surgical incision and drainage was also performed when indicated, followed by a standardized wound care regimen. Follow up was for six months ending with assessment of pinna deformity.

Results: Of the total study population of 50, 76% were male and 24% were female; 15-75 years of age (range 60 years) displaying male predominance and clustering in the fourth decade of life. The most common predisposing factors were trauma from motor vehicle accidents (30%) followed by high ear piercing (22%). Pseudomonas aeruginosa (48%) followed by Staphylococcus aureus (20%) were the most common organisms isolated. All were managed with intravenous antibiotics, but 76% also required surgical intervention.  Sixty-eight percent developed residual deformities of the pinna, with 50% being total and 18% being partial.

 

Conclusion: Auricular perichondritis is a frightening disease which requires early management.  As  Pseudomonas aeruginosa  is  the  commonest  organism,  antipseudomonal  antibiotics  should  be started  as  early  as  possible. Despite medical and surgical intervention, residual deformities may ensue.

 

Keywords:  auricular perichondritis, pinna, trauma, Pseudomonas aeruginosa
Gastrointestinal Stromal Tumor of the Tongue
Authors: Formanez Andrie Jeremy , Galvan-Bravo Grace Naomi B.
Published: April 2019

Objective: To report a case of a gastrointestinal stromal tumor presenting as a recurrent tongue mass

Methods:

Study Design: Case Report

Setting: Tertiary Public Hospital

Participant: One patient

Results: A 40-year-old Filipino soldier from Camarines Sur presented with a recurrent tongue mass two years after excision of a progressively-enlarging, firm, fixed, non-tender mass at the left posterior third of the tongue diagnosed as a Schwannoma. Repeat surgery involved partial glossectomy via midline mandibular swing. Final histopathologic report after immunohistochemical studies for CD117, SMA, and S100 was extraintestinal gastrointestinal stromal tumor of the tongue. The patient was started on the c-kit tyrosine kinase inhibitor Imatinib with no recurrence 10 months post treatment.

Conclusion: Gastrointestinal stromal tumor may be considered when presented with a recurrent tongue mass despite complete surgical resection. Surgical removal is curative for most lesions. Post-operative chemotherapy with the use of Imatinib is valuable.

Keywords: recurrent tongue mass, gastrointestinal stromal tumor, immunohistochemistry, c-kit tyrosine kinase inhibitor
CT 3D Reformatting Technique to Aid Microtia Reconstruction Procedure Planning
Authors: Bickle Ian C.
Published: April 2019

This 8 year-old girl presented to a tertiary surgical centre with a history from birth of an absent left and a malformed right pinna, and associated bilateral hearing impairment.

On clinical examination, the left pinna was absent and the right dysplastic.  No penetrable external auditory meati were evident.  Bilateral hearing impairment, more pronounced on the left, was confirmed with auditory testing.

Prior to surgery high resolution CT imaging of the temporal bones was performed.  In addition a CT of the lower thoracic cavity was undertaken to assess the costal cartilage for surgical planning.

 

Discussion

Microtia is a congenital deformity of the pinna, with a wide spectrum of abnormalities ranging from complete absence (anotia) to a relatively, well formed, but dysplastic pinna (Figure 2). It occurs in 1 in every 6,000 births, with a higher preponderance in select racial groups, such as the Japanese.1   

For decades surgical procedures have been performed and evolved for the treatment of microtia.  In contemporary practice theses may either be autogenous, using costal cartilage or  alloplastic, using the likes of porous high density polyethylene (Medpor).2 The key autogenous surgical techniques in common practice are those described by the Brent and Nagata.3,4

Autogenous costal cartilage is utilised in one of the key stages in reconstructing the pinna to fabricate the auricular framework.  The age at which the procedure is performed is typically in childhood (8 – 10 years of age), when costal cartilage is believed to be well formed and fusion may have occurred at the mid-lower ribs levels (7th – 9th).  Traditionally no pre-operative imaging has been undertaken given the difficulties with visualising cartilage at this age. On standard CT chest with traditional viewing methods the costal cartilage is poorly if at all seen in children.  However, utilising some of the more advanced 3D software algorithms on contemporary CT scanners, accurate assessment to aid the surgeon prior to scheduling a procedure can be performed (Figure 1).  The configuration of costal cartilage may be reviewed and if adequate fusion has occurred. A potential framework can then be outlined (Figure3a).  In addition selective dimensions can be recorded to the nearest millimeter (Figure 3b). This post-processing work is undertaken with the reporting radiologist and surgical lead for the procedures.

*Images in our institutions were acquired on Siemens Somatom 64 slice scanner with radiographic parameters of kV 120, Mas 46, slice thickness 0.6mm and DLP of 68 without the use of intravenous contrast.  Coronal 3D reconstructions were performed using the InSpace software, using an arterial algorithm (Figures 1 and 3a). Alternatives employed include the use of soft tissue algorithm (Figure 3b).
Epithelial-Myoepithelial Carcinoma of the Salivary Gland
Authors: Carnate Jose M. , Lapeña José Florencio F.
Published: April 2019

The World Health Organization  (2005) defines an epithelial-myoepithelial carcinoma (EMC) as a malignancy composed of two cell types that typically form duct-like structures.1 We present herein an archival case from the parotid gland.

 

EMC occurs primarily in the major salivary glands particularly in the parotid where it presents as a painless, slow-growing mass.1  Microscopic examination shows bi-layered tubular duct-like structures with pale to clear areas (Figure 1). The inner luminal layer is composed of cuboidal cells that are of epithelial derivation while the outer layer is composed  of polygonal cells that are of myoepithelial derivation (Figures 2 and 3). The latter typically have abundant clear cytoplasm.1,2

The  epithelial-myoepithelial  dualism is confirmed using immunohistochemical  stains; the epithelial cells being immunoreactive  for low molecular weight keratin and the myoepithelial cells for S-100 protein, muscle specific actin, vimentin and p63.1, 3

 

EMC is primarily a tumor of adulthood with peak incidence in the sixth and seventh decades. First described by Donath et al. in 1972,3   they are rare salivary gland neoplasms with an incidence of less than 1% arising mainly in the parotid gland4   although they have been documented in the lungs.5  Perineural and vascular invasion are frequent and recurrence occurs in around 40% of cases and metastasis in 14%.1 Although thought to be of low-grade malignancy, fatal courses have been described4  and “analysis of the various series have demonstrated that tumors with a solid growing pattern, nuclear atypia, DNA aneuploidy and high proliferative activity, generally have a more aggressive behavior and a higher frequency of local recurrences and metastases.”3
Intraoperative Distance Between the Main Trunk of the Facial Nerve and Surgical Landmarks Used in Parotidectomy: A Prospective Study
Authors: Mendoza Daniel Jose C. , Castañeda Samantha S. , Chua Antonio H.
Published: April 2019

Objective: to determine the mean distance of the main trunk of the facial nerve from two commonly employed surgical landmarks (tragal pointer and tympanomastoid suture line) among a sample of Filipino adults undergoing parotidectomy.

 

Methods

Study Design:            Prospective Descriptive Study

Setting:                       Tertiary Government Training Hospital

Subjects:                    22 patients without facial paralysis undergoing surgery for parotid neoplasms were evaluated intraoperatively.

 

Results: The main trunk of the facial nerve was found to be 9.0mm (standard deviation of 2.8mm) from the tragal pointer and 6.1mm (standard deviation of 2.0mm) from the tympanomastoid suture line.

 

Conclusion:  The mean distance from the main trunk of the facial nerve to two of the most commonly utilized landmarks in identification of the nerve during parotidectomy was 9.0mm (standard deviation of 2.8mm) from the tragal pointer and 6.1mm (standard deviation of 2.0mm) from the tympanomastoid suture line. These may serve as reference values for surgeons in safer identification and preservation of the facial nerve during parotidectomy.

 

Keywords: facial nerve, parotidectomy, tragal pointer, tympanomastoid suture line, anatomic landmarks
An Incidental Nasopharyngeal Carcinoma Coexistent with Primary Nasopharyngeal Tuberculosis
Authors: Chong Hon Syn , Mohammed Yunus Mohd Razif , Ali Norafidaah
Published: April 2019

Objective:       To describe a case of nasopharyngeal carcinoma coexistent with primary nasopharyngeal tuberculosis and review the literature.

Methods:

            Design:  Case Report

            Setting: Tertiary Public University Hospital

            Patient: One

Results:  A 28-year-old man presented with recurrent sore throat and neck pain with clinically enlarged tonsils. He underwent a routine adenotonsilectomy. Histopathologic examination revealed non-keratinizing squamous cell carcinoma with caseating granulomatous inflammation typical for tuberculosis in the same adenoid specimen. Nasopharyngeal carcinoma was staged T2bN2M0. He was treated with concurrent chemoradiotherapy and a 9-month course of anti tuberculosis treatment. He recovered and remained symptom free 1 year after treatment.

Conclusion:    Nasopharyngeal carcinoma (NPC) and tuberculosis (TB) are both very common diseases in Sabah, East Malaysia. However, it is very rare that both diseases present at the same time and same anatomical area in a patient. Diagnosis can be very challenging and confusing. Multidisciplinary consultations are warranted for appropriate treatment. Combined anti-tuberculosis treatment and concurrent chemoradiotherapy may be appropriate and effective.

 

Keywords:  Nasopharyngeal carcinoma, Primary Nasopharyngeal Tuberculosis, adenotonsillectomy
Reconstruction of a Large Through and Through Defect of the Oral Cavity Using Double Anterolateral Thigh Free Flap
Authors: Alamani Jefferson A. , Castañeda Samantha S. , Fernando Adrian F.
Published: April 2019

Objective: To present our application of a double anterolateral thigh (ALT) free flap in reconstruction of a large full thickness defect of the oral cavity, cheek and cervical area.

Methods:

Design: Case Report

Setting: Tertiary Government Hospital

Patient: One

Results: A 77-year-old male with a 20 x 25 cm full thickness soft tissue defect on the facial and cervical area contiguous with a 6 x 6 cm buccal defect resulting from wide tumor ablation of a Stage IVA (T4aN2bM0) squamous cell carcinoma of the buccal mucosa underwent reconstruction using two ALT free flaps. An ALT flap was designed to cover the intraoral and cheek defect, while another ALT flap was used for external coverage of the cervical defect. The first ALT flap measured approximately 8 x 22 cm while the second ALT flap measured 6 x 22 cm harvested from the left and right thigh respectively. Temporary venous congestion was observed on the inferiorly placed ALT flap due to neck edema that spontaneously resolved on the 2nd post-operative day. Minimal donor site complications observed were linear scars, and a 1 x 4 cm dehiscence on the right thigh that healed spontaneously by secondary intention.

 

Conclusion: The utilization of a double anterolateral thigh free flap allowed single-stage reconstruction of the large soft tissue head and neck defect with little donor site morbidity, shorter operating time and shorter hospital stay.

 

Keywords: anterolateral thigh free flap (ALT flap), double ALT flap, full-thickness buccal defect
Assessment of the Ototoxic Effects of Amikacin and Meropenem among Neonates in a Tertiary Government Hospital
Authors: Agullo Edgar Jake A. , Victoria Francisco A.
Published: April 2019

Objective: Using pre and post-treatment otoacoustic emission (OAE) tests, this study aimed to assess the ototoxic effect of meropenem, amikacin and meropenem plus amikacin among neonates treated for sepsis neonatorum in a neonatal intensive care unit versus untreated outpatient controls.

Methods:

Study design:             Prospective Quasi-Experimental Controlled Clinical Trial

Setting:                       Tertiary Government Hospital

Subjects:                     Neonates treated for sepsis neonatorum in the Neonatal Intensive Care Unit between August to October 2012 who met inclusion criteria were included in this study. Controls were neonates born in the same institution who were not admitted and did not receive any antibiotic treatment. Excluded were those with APGAR < 5 at first minute, birth weight < 1000 grams, clinically evident congenital anomalies, and initial “refer” results on OAE.

            Neonates were subjected to OAE testing before and after 7 days treatment with amikacin, meropenem, or a combination of both drugs. Results were analysed using chi-square test. Maternal drug intake, family history of hearing impairment and clinical outcomes (whether expired or discharged improved) were not included in this study. Assessment of ototoxic effects were limited to OAE alone and not confirmed by ABR.

 

Results:  OAE “refer” rates were as follows: no amikacin and no meropenem, 0% (0/42); amikacin only, 33.3% (3/9); meropenem only, 25% (2/8) and amikacin and meropenem, 50% (10/20). Statistical analysis showed that hearing loss was dependent on treatment (c2 =23.741, p = < 0.001). Overall, statistical analysis showed that there is an increased risk of hearing loss when treated with amikacin and/or meropenem as compared to no treatment.

 

Conclusion: There is an increased risk of ototoxicity when amikacin, meropenem, or a combination of both drugs is administered to neonates. While the ototoxic effects of amikacin have been elucidated, further studies involving meropenem and its potential ototoxic effect are recommended.

 

Keywords: ototoxicity, amikacin, meropenem, otoacoustic emission testing, neonatal hearing loss