bluuebunny/crossref_metadata_2025 huggingface dataset:
CONSTRAINTS ON A PARITY-CONSERVING/TIME-REVERSAL-NON-CONSERVING INTERACTION
Authors: VAN OERS WILLEM T. H.
Published: October 2002

Time-reversal-invariance non-conservation has for the first time been unequivocally demonstrated in a direct measurement at CPLEAR. One then can ask the question: What about tests of time-reversal-invariance in systems other than the kaon system? Tests of time-reversal-invariance can be distinguished as belonging to two classes: the first one deals with parity violating (P-odd)/time-reversal-invariance-odd (T-odd) interactions, while the second one deals with P-even/T-odd interactions (assuming CPT conservation this implies C-conjugation non-conservation). Limits on a P-odd/T-odd interaction follow from measurements of the electric dipole moment of the neutron (with a present upper limit of 6 × 10-26 e.cm [95% C.L.]). It provides a limit on a P-odd/T-odd pion-nucleon coupling constant which is less than 10-4 times the weak interaction strength. Experimental limits on a P-even/T-odd interaction are much less stringent. Following the standard approach of describing the nucleon-nucleon interaction in terms of meson exchanges it can be shown that only charged rho-meson exchange and A 1-meson exchange can lead to a P-even/T-odd interaction. The better constraints stem from measurements of the electric dipole moment of the neutron and from measurements of charge-symmetry breaking in neutron-proton elastic scattering. The latter experiments were executed at TRIUMF (497 and 347 MeV) and at IUCF (183 MeV). Weak decay experiments may provide limits which will possibly be comparable. All other experiments, like gamma decay experiments, detailed balance experiments, polarization–analyzing power difference determinations, and five-fold correlation experiments with polarized incident nucleons and aligned nuclear targets, have been shown to be at least an order of magnitude less sensitive. The question then emerges: is there room for further experimentation?
Sézary syndrome patients demonstrate a defect in dendritic cell populations: effects of CD40 ligand and treatment with GM-CSF on dendritic cell numbers and the production of cytokines
Authors: Wysocka Maria , Zaki Mohamed H. , French Lars E. , Chehimi Jihed , Shapiro Michael , Everetts Suzanne E. , McGinnis Karen S. , Montaner Luis , Rook Alain H.
Published: October 2002

Sézary syndrome (SzS) is an advanced form of cutaneous T-cell lymphoma associated with involvement of the peripheral blood by malignant T cells. The disease is defined by impaired cell-mediated immunity and the production of interferon-γ (IFN-γ) and interleukin-2 (IL-2), possibly as a result of deficient IL-12 production. To understand the mechanism of this impairment, we examined the composition and function of dendritic cells and monocytes in the blood of SzS patients with different levels of peripheral blood tumor burden. Consistent with our previous observations, numbers of monocytes in SzS patients were comparable to numbers observed in healthy donors. In contrast, decreased IL-12 production correlated with a decrease in the numbers of CD11c+ dendritic cells, which was particularly profound among patients with medium (20%-50% circulating malignant T cells) and high (more than 50% circulating malignant T cells) tumor burden. Furthermore, CD123+ dendritic cells, major producers of IFN-α, were significantly diminished in SzS patients, regardless of the level of tumor burden. Granulocyte macrophage–colony-stimulating factor–treated patients experienced an increase in the number of dendritic cells but not in IFN-α or IL-12 production. However, in vitro stimulation of peripheral blood mononuclear cells from SzS patients with rCD40L and IFN-γ significantly increased the production of IL-12. Thus, our results demonstrate a profound defect in circulating dendritic cells in SzS patients that may contribute to the pathogenesis of the cytokine disorders and to the depressed cellular immunity. Importantly, the ability of rCD40L to potently induce IL-12 production from monocytes and residual dendritic cells of SzS patients could potentially serve as an immune-restorative therapeutic agent.
Mouse T cells receive costimulatory signals from LIGHT, a TNF family member
Authors: Shi Guixiu , Luo Hongyu , Wan Xiaochun , Salcedo Theodora W. , Zhang Jun , Wu Jiangping
Published: October 2002

LIGHT is a tumor necrosis factor (TNF) family member and is expressed on activated T cells. Its known receptors are TR2 and LTβR on the cell surface, and TR6/DcR3 in solution. TR6/DcR3 is a secreted protein belonging to the TNF receptor family. It binds to Fas ligand (FasL), LIGHT, and TL1A, all of which are TNF family members. In the present study, we report that solid-phase TR6-Fc costimulated proliferation, lymphokine production, and cytotoxicity of mouse T cells upon T-cell receptor (TCR) ligation. A monoclonal antibody against LIGHT similarly costimulated mouse T cells in their proliferation response to TCR ligation. These data suggest LIGHT, although a ligand, can receive costimulation when expressed on the T-cell surface. Mechanistically, when T cells were activated by TCR and CD28 co–cross-linking, TCR and rafts rapidly formed caps where they colocalized. LIGHT rapidly congregated and colocalized with the aggregated rafts. This provided a molecular base for the signaling machinery of LIGHT to interact with that of TCR. Indeed, LIGHT cross-linking enhanced p44/42 mitogen-activated protein kinase activation after TCR ligation. This study reveals a new function and signaling event of LIGHT.
Platelet factor 4 inhibits FGF2-induced endothelial cell proliferation via the extracellular signal–regulated kinase pathway but not by the phosphatidylinositol 3–kinase pathway
Authors: Sulpice Eric , Bryckaert Marijke , Lacour Julie , Contreres Jean-Olivier , Tobelem Gerard
Published: October 2002

Platelet factor 4 (PF-4) is a member of the chemokine family with powerful antiangiogenic properties. The mechanism by which PF-4 inhibits endothelial cell proliferation is unclear. We investigated the effects of PF-4 on the intracellular signal transduction induced by basic fibroblast growth factor (FGF2). We found that PF-4 (10 μg/mL) inhibited the FGF2-induced proliferation of adrenal cortex capillary endothelial (ACE) cells. The inhibition of MEK1/2 (mitogen-activated protein kinase kinase) by PD98059 or of PI3K (phosphatidylinositol 3-kinase) by Ly294002 abolished the proliferation induced by FGF2, suggesting that ACE cell proliferation required dual signaling through both the extracellular signal–regulated kinase (ERK) and PI3K pathways. Ly294002 had no significant effect on ERK phosphorylation, whereas PD98059 had a weak effect on the phosphorylation of Akt, suggesting that 2 separate cascades are required for ACE cell proliferation. The addition of PF-4 (10 μg/mL) significantly inhibited ERK phosphorylation (95%), showing that PF-4 acted directly on or upstream from this kinase. Surprisingly, PF-4 did not affect FGF2-induced Akt phosphorylation. This suggests that PF-4 disrupts FGF2 signaling via an intracellular mechanism of inhibition. To exclude the possibility that PF-4 inhibited the binding of FGF2 to only one FGF receptor, preferentially activating the ERK pathway, we investigated the effect of PF-4 on FGF2-induced ERK and Akt phosphorylation, using mutant heparan sulfate–deficient Chinese hamster ovary cells transfected with the FGF-R1 cDNA. The addition of PF-4 (1 μg/mL) significantly inhibited ERK phosphorylation (90%), with no effect on Akt phosphorylation, suggesting that PF-4 acts downstream from the FGF-R1 receptor. In conclusion, this is the first report showing that PF-4 inhibits FGF2 activity downstream from its receptor.
Selective peroxynitrite scavenging activity of 3-methyl-1,2-cyclopentanedione from coffee extract
Authors: Kim Ae Ra , Zou Yani , Kim Hyung Suk , Choi Jae Sue , Chang Gregory Youngnam , Kim You Jung , Chung Hae Young
Published: October 2002

It has been known that reactive oxygen and nitrogen species such as nitric oxide (NO), superoxide radical (.O−2) and their byproduct peroxynitrite (ONOO−) induce cellular and tissue injury, ultimately resulting in several human diseases. In this study, we examined scavenging effects of 3-methyl-1,2-cyclopentanedione (MCP) from coffee extract on the reactivity of those toxic molecules. MCP significantly inhibited both the oxidation of 2,7-dichlorodihydrofluorescein diacetate (H2DCFDA) by reactive oxygen species (ROS) (mainly .O−2) from kidney homogenate (41% at 100 μM) and the generation of fluorescent 4,5-diaminofluorescein (DAF-2) by NO from sodium nitroprusside (IC50 (concn producing 50% inhibition), 63.8 μM). More potently, however, MCP suppressed the oxidation of dihydrorhodamine 123 (DHR 123) to fluorescent rhodamine 123 mediated by authentic ONOO− with an IC50 value of 3.3 μM. The neutralizing effect of the reactivity of ONOO− by MCP was due to electron donation, not nitration of the compound. Additionally, MCP also decreased ONOO− formation of nitrotyrosine adducts of glutathione (GSH) reductase, and consequently protected the enzyme activity of GSH reductase against decreasing by ONOO−, indicating that MCP may prevent ONOO−-induced damage of GSH reductase. Furthermore, MCP only weakly suppressed NO production, which is one of the upstream sources of ONOO− in-vivo, suggesting that NO production may be not a pharmacological target for MCP. Taken together, our results suggest that MCP may be regarded as a selective regulator of ONOO−-mediated diseases via direct scavenging activity of ONOO−.
Emission Spectra and Relaxation Mechanism of b State O2 in Low Temperature Ar Solids
Authors: Takizawa Kenji , Koda Seiichiro
Published: October 2002

The b → X emission of electronically excited O2 isolated in Ar solids was observed under the pulsed KrF excimer laser irradiation at 248 nm. The relaxation proceeds along the b → a → b interstate transition. The time evolution of each b → X (v′, v′′) band was fitted by multi-exponential curves. The nonradiative rate is limited at the b → a transition due to the energy gap, which is larger than that of the a → b transition. The relaxation rate constants of individual vibrational levels (v ≤ 8) of the b state were determined. The vibrational quantum number and temperature dependence of the nonradiative rate constants could be explained based on a multiphonon relaxation theory.
Ion Pairs between Maleonitriledithiolato Complex Dianions of Cobalt and Nickel and Macrocyclic Ligand Complex Dications of Nickel(II) — Control of Intrapair Interaction through Ligand Modification
Authors: Nowicka Beata , Schmauch Georg , Chihara Teiji , Heinemann Frank W , Hagiwara Masayuki , Wakatsuki Yasuo , Kisch Horst
Published: October 2002

The ion pairs {[Ni(cyclam)]2+[M(mnt)2]2−} (M = Co, Ni: 1a,b), {[Ni(tmc)]2+[M(mnt)2]2−} (M = Co, Ni: 2a,b) and the solvent complexes {[Ni(cyclam)(dmso)2]2+[M(mnt)2]2−} (M = Co, Ni, mnt2− = maleonitriledithiolato = (Z)1,2-dicyano-1,2-ethylenedithiolato, cyclam = 1,4,8,11-tetraazacyclotetradecane, tmc = 1,4,8,11-tetramethyl-1,4,8,11-tetraazacyclotetradecane) were isolated and structurally characterised. The nature of the macrocyclic ligand and the presence of coordinating solvents determine whether the dication is present as a tetra-, penta- or hexacoordinated complex. In 1a the tetracoordinated dications and dianions are arranged in a mixed stack structure; the absences of any short contacts and of a mutual ion pair charge transfer band indicate the absence of charge transfer interaction. The highly puckered cyclam ligand will prevent a close approach of the planar bis(maleonitriledithiolato)cobaltate(II). When cyclam is replaced by its tetramethyl derivative tmc, a strong coordinative interaction is introduced as indicated by the structure of 2a. One dianion coordinates to two dications through two trans-cyano groups. The resulting trinuclear dications {[Ni(tmc)][Co(mnt)2][Ni(tmc)]}2+ form segregated columns separated by the non-interacting, remaining dianion. Crystallisation in the presence of a coordinating solvent like dimethyl sulfoxide (dmso) leads to the ion pairs {[Ni(cyclam)(dmso)2]2+[M(mnt)2]2−}containing hexacoordinated dications. Magnetic susceptibility measurements at room temperature are in accord with the observed structures. While 1b is diamagnetic, 1a, 2a, 2b, and the two solvent complexes exhibit values characteristic of the isolated ions, in agreement with the absence of any electronic interaction between dication and dianion within the ion pair. Temperature- dependent measurements down to 1.7 K indicate that a weak antiferromagnetic interaction is present in 2a.
Dielectric Constant of Sintered Compact of Oriented Barium Titanate Short Fibers Doped with Mica
Authors: Park Young-Jin , Igarashi Kaoru , Shimizu Tadao
Published: October 2002

A compact consisting of BaTiO4 fibers oriented mostly in one direction was fabricated via piling sheets made by the doctor blade method. After calcination, in the obtained sintered-compact, the shape of individual fibers was 1ost and spherical ceramic grains appeared. Nevertheless the c-axis of micro-crystals of the ceramic was oriented mainly in the direction of the press that had been applied to the green compact in the fabrication process. Although the compacts were calcined at 1250 °C, which is 1ower than the calcination temperature of typical BaTiO3, the densities of the obtained sintered compacts were high because of the addition of mica. The relative dielectric constant of the 2% doped sample was higher by 1000 than that of the undoped matelia1. BaTiO3 doped with mica by 5% had a dielectric constant independent of frequency in the range of 100 Hz to l MHz.
Nickel Oxide Particles Coated with Silica
Authors: Sato Satoshi , Takahashi Ryoji , Sodesawa Toshiaki , Ichikuni Nobuyuki , Amano Hidefumi
Published: October 2002

Fine particles of SiO2-coated Ni metal were prepared by depositing silica on a Ni(OH)2 precipitate in a dissolution–deposition process of silica glass under hydrothermal conditions, followed by calcination and reduction. A fresh precipitate of Ni(OH)2 was heated with a NaOH solution containing several pieces of silica glass chips in a pressure vessel at 100 °C. Silica components dissolved from the glass chips were deposited on the Ni(OH)2 precipitate, and the silica loading increased with increasing the hydrothermal period. Even after calcination at 500 °C, a specific surface area of the resulting SiO2–NiO increased with silica loading, and exceeded 200 m2 g−1. SiO2–NiO, reduced at 500 °C, had a metal surface area as high as 22 m2 g−1. In contrast to the fact that pure Ni(OH)2 readily aggregates during heating, the SiO2-coated Ni(OH)2 particles are protected from agglomerating during the hydrothermal process, calcination, and reduction.
Glomus jugulare tumour with metastases to cervical lymph nodes
Authors: Brewis C. , Bottrill I. D. , Wharton S. B. , Moffat D. A.
Published: October 2002

Glomus jugulare tumours are classically described as benign tumours with a long time course often measured in decades. Although these tumours may be locally invasive, most cases are histologically benign and metastases are rare. The case of a malignant glomus jugulare tumour with a particularly aggressive pattern of spread is presented. At the time of surgery, which was within 12 months of the development of symptoms, intracranial spread and metastasis to cervical lymph nodes had already occurred, demonstrating that glomus jugulare tumours are not always benign.
Meningitis following stapedotomy: a rare and early complication
Authors: Nielsen Torfinnur Rubek , Thomsen Jens
Published: October 2002

Controversy exists concerning stapedotomy for patients with small unilateral air-bone gaps. Surgical treatment of otosclerosis involves an opening to the labyrinth and accordingly, a risk of complications, usually vertigo and sensorineural hearing loss and infrequently anacusis. In this paper we present a 33-year-old woman with a small unilateral air-bone gap, who developed bacterial labyrinthitis with meningitis and anacusis three days after stapes surgery. The patient had a stapedotomy with the small fenestra piston prosthesis technique. Due to the potential for serious complications, patients with unilateral otosclerosis and mild hearing loss should be given the possibility to choose between a hearing aid and surgery. Although stapedotomy in the vast majority of interventions is a highly successful procedure and the best method of treatment for otosclerosis if successful, there is a high price to pay in the event of failure.
Aberrant internal carotid artery in the middle-ear space
Authors: Botma Marissa , Kell Robin A. , Bhattacharya Jo , Crowther John A.
Published: October 2002

The incidence of an aberrant internal carotid artery in the middle ear is approximately one per cent and most patients are asymptomatic. We present two patients with an aberrant internal carotid artery who presented with pulsatile tinnitus and an intra-tympanic mass. Here we discuss the clinical presentation, relevant radiographic investigations and further management of these patients.
Insular carcinoma of thyroid presenting as cervical cord compression
Authors: Ganly I. , Crowther J.
Published: October 2002

Insular carcinoma of thyroid is a very rare subtype of thyroid carcinoma which is characterized by its advanced stage at presentation and aggressive clinical course. We describe a case of insular carcinoma of the thyroid presenting in an unusual fashion with cervical cord compression at initial presentation. Cord compression is shown to be due to spinal metastases from vascular spread of the tumour and this typifies the high metastatic potential of this tumour subtype.
Oculostapedial synkinesis following Bell’s palsy
Authors: Donne A. J. , Homer J. J. , Woodhead C. J.
Published: October 2002

A case of oculostapedial synkinesis occurring after Bell’s palsy is described. This rare phenomenon has not previously been reported following Bell’s palsy. The authors discuss the method of objectively proving the diagnosis, which can be difficult. The patient was successfully treated by stapedius tendon section under local anaesthesia.
Uvulopalatopharyngoplasty changes fundamental frequency of the voice - a prospective study
Authors: Brosch Sibylle , Matthes Christiane , Pirsig Wolfgang , Verse Thomas
Published: October 2002

The aim of the study was to find whether a muscle-sparing uvulopalatopharyngoplasty (UPPP) and tonsillectomy cause a measurable change in the voice. The fundamental frequency and the first two formants of five sustained vowels were measured before and nine (six to 15) months following operation. The operation consisted of tonsillectomy and UPPP with preservation of the musculature of the soft palate. All patients received a pre- and post-operative 12-canal polysomnography (level-I sleep study). No patient showed signs of any post-operative velopharyngeal insufficiency. Acoustic analysis showed a significant raising of the fundamental frequency of up to 10 Hz. There was also a lowering of the second formant in two of the five vowels. This was correlated with the volume of the excised tissue. The minimal changes will probably have no significance for those who place no special reliance on their voice, but the possible post-operative changes should be made clear to singers and those relying on their voice for professional reasons.
The Future of ORL-HNS and Associated Specialties Series: The future of audiological rehabilitation
Authors: Baguley David , Luxon Linda
Published: October 2002

The field of audiological rehabilitation in adults faces an array of opportunities. Some of these are technological, as with the advent of fully digital hearing-aids, and some involve clinical practice, such as opportunities for true multidisciplinary working, and for changes in hearing-aid prescription and provision. The development of well-validated questionnaire instruments should facilitate robust research into the effectiveness of clinical interventions in adult audiological rehabilitation, for such evidence is urgently needed if the field is to thrive.
First branchial cleft sinus presenting with cholesteatoma
Authors: Lee Stewart , Saleh Hesham A. , Abramovich Solomon
Published: October 2002

Disorders of the first branchial cleft are rare and often present difficulties in diagnosis. A case is reported that presented with the clinical and histological features of cholesteatoma. The embryology, diagnosis and treatment of branchial arch defects are also reviewed. The case highlights the fact that a high index of suspicion should be aroused for patients with a discharging ear in the presence of an intact tympanic membrane.
Retropharyngeal abscess as a complication of oropharyngeal trauma in an 18-month-old child
Authors: Siou  , Yates
Published: October 2002

An 18-month-old boy presented to the accident and emergency department following trauma to the oropharynx by a doll’s umbrella. Although no significant injury could be identified at first, it later transpired that he had developed retropharyngeal surgical emphysema with abscess. This case report aims to review the nature of retropharyngeal abscesses and to highlight and re-emphasize the fact that apparently non-serious pharyngeal injuries in children should be treated with suspicion.
Paraganglioma of the external auditory canal: an unusual case
Authors: Skinner Liam J. , Curran Aongus J. , Barnes Colma , Timon Conrad I
Published: October 2002

Primary paraganglioma of the external auditory canal is a rare otological finding. To date, only three cases have been reported in the world-wide literature. Such a tumour is now described in a 42-year-old female. The clinical and histopathological features of the case are discussed. The role of immunocytochemistry in defining diagnosis, from a large list of differentials, is illustrated. We present the first magnetic resonance images of this rare tumour and highlight the benefit of intra-operative frozen section in limiting surgery to canal excision.
Neck mass caused by an intraluminal jugular paraganglioma
Authors: Husband A. D. , Spedding A. , Davis A. E.
Published: October 2002

Paragangliomas can develop in a number of head and neck sites, the most common being the carotid body paragangliomas and glomus jugulare tumours. This is a case of a paraganglioma confined entirely within
the lumen of the jugular vein.
Laryngeal leiomyosarcoma
Authors: Marioni Gino , Bertino Giulia , Mariuzzi Laura , Bergamin-Bracale Anna Maria , Lombardo Mattia , Beltrami Carlo Alberto
Published: October 2002

Abstract We report one case of leiomyosarcoma (LMS) of the larynx occurring in a patient with a history of immunosuppressive therapy, and offer a critical review of the literature. Epstein-Barr virus (EBV) genome was not identified in the neoplastic cells. The patient was treated with endoscopic resection and post-operative radiotherapy. Lung metastasis and thyroid infiltration became evident 14 months following treatment despite the absence of laryngeal recurrence. Progressive decline occurred and the patient died 15 months after diagnosis.
New method for the effective instillation of nasal drops
Authors: Raghavan U. , Logan B. M.
Published: October 2002

The main cause of sinus pathology is disease in the middle meatus, therefore, unless nasal drops are deposited in this site they will not be effective. Currently, one of three standard head positions are used by patients for the instillation of nasal drops, ‘head back’, ‘praying to Mecca’, and ‘Mygind’s’, all are uncomfortable and only one, Mygind’s position, effectively deposits the drops in the middle meatus.

In this paper, we review these three positions by utilizing a preserved cadaver head and conducting a simple gravitational flow study using white liquid latex as a nasal drop substitute. We also describe a new fourth ‘Ragan’ position, on the side, head down, that is effective in consistently delivering nasal drops into the middle meatus and should prove a most comfortable position for patients to adopt.
Oropharyngeal foreign body
Authors: Mishra Anupam , Shukla G. K. , Naresh Bhatia
Published: October 2002

An unusual extremely benign course of an 8 cm long, rusting, metallic oropharyngeal foreign body that had entered post-aurally (penetration injury) four years previously to lie completely within the pharyngeal lumen has not yet been reported in the world literature. The need for additional investigations and special precautions to be taken during surgical extraction are highlighted.
Intraductal papilloma of the submandibular gland
Authors: Mirza Showkat , Dutt Sunil N. , Irving Richard M. , Jones E. L.
Published: October 2002

Salivary tissue intraductal papillomas are rare, benign tumours that predominantly affect minor salivary glands. We report a case of an intraductal papilloma arising in the unusual site of the submandibular gland. The tumour was completely excised and recurrence is not expected. A brief review of this histologically distinct lesion is presented.
Surgical voice restoration following ablative surgery for laryngeal and hypopharyngeal carcinoma
Authors: Ahmad I. , Kumar B. N. , Radford K. , O’Connell J. , Batch A. J. G.
Published: October 2002

Surgical voice restoration is an important part of functional rehabilitation of patients following ablative surgery for laryngeal and hypopharyngeal carcinoma. The aim of this retrospective study was to assess the functional status with regard to speech of a cohort of 100 patients (age ranged 34-84 years), who underwent laryngectomy and laryngopharyngectomy over a 10-year period (1989-1999).

Ninety-two patients consented to surgical voice restoration. Primary tracheoesophageal punctures were performed in 70 and secondary punctures in 22 (mainly after jejunal flap reconstruction). Nine patients were excluded from this analysis (seven patients died prior to assessment, one had the prosthesis removed at her request and one patient had insufficient follow-up). Tracheoesophageal speech was assessed in the remaining 83 patients using a rating scale measuring the number of syllables per breath, use of voice and intelligibility by non-professional listeners. Currently, Provox 2 valves are being used in the majority of patients. Overall tracheoesophageal speech results were good in 45/83 (54.2 per cent), average in 22/83 (26.5 per cent) and poor in 15/83 (18 per cent). One patient could not develop tracheoesophageal speech. The majority of laryngectomy patients had good speech but in patients who had complex reconstructions tracheoesophageal speech was mostly rated as average.

Average to good speech in more than two-thirds of the cohort of patients show that surgical voice restoration is a highly successful and valuable technique to restore speech functions after ablative surgery for laryngeal and hypopharyngeal carcinoma.
Sudden bilateral hearing loss and sporadic mitochondrial DNA deletion
Authors: Berrettini Stefano , Forli Francesca , Siciliano Gabriele , Mancuso Michelangelo
Published: October 2002

Abstract Several studies have indicated that a number of different mitochondrial DNA (mtDNA) mutations may be responsible for human pathologies. Sensorineural Hearing Loss (SNHL) may be associated with known syndromes (syndromal SNHL) or represent the only manifestation of mitochondrial damage (non-syndromal hearing loss). Moreover, mtDNA alterations may be responsible for aminoglycoside-induced deafness.

We describe a patient harbouring a single sporadic mtDNA deletion, who presented with sudden adult-onset bilateral, although non-simultaneous SNHL, that was partially responsive to corticosteroids. Increased values of rest, and exercise, blood lactic acid were decisive for diagnosis, prompting muscle biopsy that revealed the mtDNA deletion. The case underscores the importance of investigating a mitochondrial disease in cases of SNHL of unknown origin and points out the importance of an increased blood level of lactic acid as a screening test.
Post-tonsillectomy bleed: a delayed diagnosis of duodenal ulceration
Authors: Mahendran Suresh , Kumar Manoj , Preece Mark
Published: October 2002

Post-operative haemorrhage is one of the commonest complications of tonsillectomy. We report a case of a 36-year-old lady who presented with three haemorrhagic episodes following tonsillectomy. Although initially treated as secondary tonsillar haemorrhage, the actual cause of the bleeding was later identified to be a duodenal ulcer. The case is presented with a review of the literature.
Alveolar rhabdomyosarcoma of the parotid gland
Authors: De M. , Banerjee A. , Graham I. , Dempster J.
Published: October 2002

Alveolar rhabdomyosarcoma of the parotid gland is a rare condition. The treatment should involve an aggressive multi-modality approach incorporating surgical removal of the tumour, radiotherapy, and multi-agent chemotherapy. The presentation of this condition along with the most appropriate line of treatment is discussed.
Improving standards in the treatment of acute otitis externa by the use of a treatment protocol and open access to aural toilet
Authors: Tierney P. A. , Price T. , Gillet D. , Oyarzabal M. O. , Salama N.
Published: October 2002

A prospective audit of the procedure and outcome in the management of acute otitis externa was undertaken in our unit. The first cycle demonstrated a heterogeneous approach and clinical isolation of junior staff. A questionnaire survey of local general practitioners highlighted clinical confusion over the use of topical medication and a need for improved access to facilities for aural toilet. General practitioner liaison and education was an essential component in formulating a change in practice. In particular, open access for aural toilet was introduced and utilization encouraged. Following changes in practice, the second cycle of the audit showed that treatment protocols were effective and adhered to by junior staff.
Tympanometric findings in cleft palate patients: influence of age and cleft type
Authors: Handžić-Ćuk Jadranka , Ćuk Višeslav , Gluhinić Miroslav , Rišavi Ranko , štajner-Katušić Smiljana
Published: October 2002

Tympanometry was analysed according to cleft type with respect to age in 239 cleft palate patients (57 with bilateral cleft lip and palate (BCLP)), 122 with unilateral cleft lip and palate (UCLP) and 60 with isolated cleft palate (ICP)). The frequency of type B tympanograms was 46.5 per cent in the BCLP group, 50.6 per cent in the UCLP group and 58.3 per cent in the ICP group. Type A tympanograms were more frequently observed in older patients (median age 11 years) in comparison to type B (median age five years; p<0.001) and type C (median age six years; p<0.001). The total sample showed an age-related decrease in the frequency of type B tympanograms (rs = −0.3942; p<0.001). The frequency of type A tympanograms increased significantly with age (rs = 0.4263; p<0.001), whereas type C was not correlated with age. In the UCLP group, the frequency of type B tympanograms decreased with age (rs = −0.4430; p<0.001), the decrease being faster than in the BCLP group (rs = −0.3186; p = 0.001) and the ICP group (rs = −0.3378; p<0.0001)). Type B tympanograms had the highest correlation with a hearing loss of 21–40 dB at mean hearing level at speech frequencies (MHLSF) (rs = 0.4574; p<0.001), a lower correlation with a hearing loss of 11–20 dB (rs = 0.2184; p = 0.02) and the lowest correlation with hearing loss above 40 dB. At the ages of one to three, the frequency of type B is higher in UCLP patients than in the BCLP and ICP groups, decreasing at seven to 12, increasing again at 13 to 15, and thereafter showing a continuous decrease. In the BCLP group, the frequency of type B increased significantly at the ages of four to six and then decreased continuously from seven to 18. In ICP patients, the changes in the frequency of type B with age are not significant until the age of 15; at the age of seven, it is higher than in the BCLP and ICP groups. The type C tympanogram is not typically found in cleft palate patients and its frequency is not correlated with age.

It can be presumed that each type of cleft lip and palate, due to its characteristic conditions in the epipharynx, will favour a different mode of pathophysiological development of middle-ear disease.
Solitary infantile myofibromatosis in the lateral orbit floor showing spontaneous regression
Authors: Tokano Hisashi , Ishikawa Norihiko , Kitamura Ken , Noguchi Yoshihiro
Published: October 2002

Infantile myofibromatosis is a rare benign tumour usually occurring early in infancy. We describe the case of a 10-year-old boy with solitary infantile myofibromatosis in the left lateral orbit floor which regressed spontaneously. Although our patient was older than previously reported cases and showed bony destruction confirmed by computed tomography (CT), this tumour was diagnosed as infantile myofibromatosis based on immunohistochemical findings. The tumour disappeared spontaneously six months after incisional biopsy, that also indicated this tumour was an infantile myofibromatosis.
Endoscopic transnasal neurolytic sphenopalatine ganglion block for head and neck cancer pain
Authors: Varghese Bipin T. , Koshy Rachel C.
Published: October 2002

Nasal endoscopy is a valuable adjunct to the localization of the sphenopalatine ganglion. Twenty-two patients with advanced malignancies of the head and neck region whose pain was not adequately controlled with conventional medications, including oral morphine, were given nasal endoscopically guided neurolytic sphenopalatine ganglion block with six per cent phenol after a prognostic block with local anaesthetic solution. Seventeen patients had good immediate relief. One had partial relief and four had inadequate relief. On follow-up for one month, the patients had significantly lower pain intensity and the pain was more manageable with oral medication. The vicious cycle of pain was broken. This block is relatively safe and can be usefully performed as an out-patient procedure.
A very rare benign tumour in the parotid region: calcium pyrophosphate dihydrate crystal deposition disease
Authors: Olin Helle Birgitte Dahl , Pedersen Kaj , Francis Dorthe , Hansen Hanne , Poulsen Finn Willy
Published: October 2002

Calcium pyrophosphate dihydrate crystal deposition disease, exhibits several clinical manifestations, from absence of symptoms to severely destructive arthropathy or conditions simulating neoplasm, which is frequently related to the temporomandibular joint. Fifteen of the 31 reported cases of tophaceous pseudogout were found in the head and neck region. A patient presented with a parotid swelling, which initially was suspected to be malignant because of the following findings: radiodensity, progression into the joint, osseous destruction of the major ala of the sphenoid and a fine needle aspirate with crystals, osteoblasts, megakaryocytes and irregular cells of varying size. At surgery there was found a tumour consisting of a white, firm gritty material. It progressed to the skull base where material had to be left, because of the presence of the nerves and vessels. A frozen specimen was reported to be benign. Histological examination showed inflammatory cells, macrophages, a chondroid material with embedded metaplastic chondroid cells and giant cells of foreign body type. Crystal examination of X-ray diffraction revealed calcium pyrophosphate dihydrate.
Solitary fibrous tumour of the thyroid gland
Authors: Deshmukh N. S. , Mangham D. C. , Warfield A. T. , Watkinson J. C.
Published: October 2002

Solitary fibrous tumours of the thyroid gland are rare; only five cases have been reported in the literature. Clinically, they present as a long-standing firm mass in the thyroid. Histologically, they show a range of appearances including so-called ‘patternless growth pattern’, spindle-cell morphology, alternating hypo- and hyper-cellular areas, keloid-like hyalinization and a prominent haemangiopericytoma – like architecture. The behaviour of extrathoracic solitary fibrous tumours is unpredictable and requires careful, long-term follow-up.
Auto-immune thyroiditis presenting as a thyroglossal tract swelling
Authors: McEwan John , Panarese Alessandro , Lee John A.
Published: October 2002

Both thyroglossal cysts and aberrant thyroid tissue may present as a mid-line neck swelling. We report a case of autoimmune thyroiditis presenting as a thyroglossal swelling in a middle-aged woman. This very rare finding is discussed with reference to the optimal management of thyroglossal tract swellings.
An observational study of the management of traumatic tympanic membrane perforations
Authors: Amadasun J. E. O.
Published: October 2002

Controversies of how best to treat fresh tympanic membrane perforations have always existed. While some otolaryngologists prefer the paper patch method, others prefer modified myringoplasty. A prospective study is needed to investigate the most effective and least expensive management of this common ear trauma.

This study examined prospectively, in three sections, a group of patients with a cellophane patch (n = 6), another group with a gentamicin ointment seal (n = 15) and a control group (n = 9) with a gentamicin plug placed at the distal end of the external auditory cavity. Successful healing of the traumatic tympanic membrane perforations was achieved in 50 per cent of the cellophane seal group, 86.7 per cent of the gentamicin ointment seal group and 77.8 per cent of the control group. This study shows that the management of a fresh tympanic membrane perforation should be limited to cleaning the traumatized ear and preventing infection.
Comparison of duration of deafness and tumour invasion to the inner ear from metastatic tumours of the internal auditory canal: human temporal bone pathology
Authors: Nishimura Shinichi , Kaga Kimitaka , Tsuzuku Toshihiro , Iino Yukiko
Published: October 2002

Four cases (seven ears) of metastatic tumour of the internal auditory canal were studied. The histopathological findings confirmed that the inner ear invasion of the tumour follows a unique course, as reported in the literature. Relationship between duration of deafness and extent of tumour invasion in the inner ear is discussed. It is suggested that the deafness could occur via neural invasion or compression near the ductus spiralis foraminosus.
Subclavian vein compression in anaplastic carcinoma of the thyroid
Authors: Ibrahim S. I. , England R. J. A. , Ettles D. F.
Published: October 2002

Anaplastic thyroid cancer is a condition with a dismal prognosis in most cases. We present a case of subclavian vein compression in a case of anaplastic thyroid carcinoma treated with subclavian venous stenting. Subclavian vein compression is a recognized complication in disseminated carcinomatosis particularly in carcinoma of the breast and bronchus. It has never been described in anaplastic thyroid carcinoma.
Ear involvement in ligneous conjunctivitis: a rarity or an under-diagnosed condition?
Authors: Hydén Dag , Latkovic Stefan , Brunk Ulf , Laurent Claude
Published: October 2002

Conjunctivitis lignosa, a rare affliction of the conjunctiva, is sometimes associated with other disturbances. We present two children with concurrent conjunctivitis lignosa and ear involvement. In these two cases, there were histopathologically verified ligneous changes of the middle ears.

Routine haematoxylin and eosin, van Gieson, periodic acid-Schiff (PAS) and alcian blue staining of specimens from the eyes and middle ears revealed findings typical for ligneous conjunctivitis. In addition, new histochemical and immunohistochemical studies for glycosaminoglycans on specimens from the eyes and middle ears showed that the accumulations of the amorphous, cell-deficient material stained strongly but heterogeneously for hyaluronic acid and weakly but uniformly for keratin sulphate. The staining for other glycosaminoglycans, e.g. chondroitin-4-sulphate and dermatan sulphate was confined to vessels and areas rich in collagen fibres and fibroblasts.

In patients with conjunctivitis lignosa, the ear involvement may remain undiagnosed due to its resemblance to secretory otitis media with effusion. Since isolated ear involvement may occur, we advocate biopsies for routine haematoxylin and eosin, and specific staining for hyaluronic acid and keratin sulphate, also in children with protracted, refractory otitis media with atypical effusion.
Occupational rhinitis: a poorly diagnosed condition
Authors: Drake-Lee A. , Ruckley R. , Parker A.
Published: October 2002

The civil claim of occupational rhinitis may be difficult to prove on the balance of probabilities and is the responsibility of the claimant. There are two types of occupational rhinitis, an allergic rhinitis or a rhinitis due to irritation. Occupational rhinitis can be likened to occupational asthma. Particular attention must be paid to the relationship to alleged exposure and symptoms. Irritation causes symptoms during exposure that cease afterwards unless clinically obvious damage has occurred. Tobacco smoke and nicotine may also cause symptoms. A full examination, both externally and internally of the nose, mouth and eyes should be undertaken. The presence of squamous metaplasia is important. The validity of a claimant’s symptoms must be checked against the medical records. Details of all occupations, compounds and protection should be noted. Manufacturing data on the compounds should also be obtained. The Health and Safety Executive publish occupational exposure limits for many industrial chemicals. Allergen-specific IgE may be raised when an allergy is considered to cause the occupational rhinitis. Nasal challenge tests have been used in Scandinavia to diagnose allergic occupational rhinitis. The sense of smell should be tested. There are two approaches, detecting threshold or recognition, which is suprathreshold. When present, three degrees of social effect occur: impairment, disability and handicap. The degree depends on the occupation of the individual.
Unilateral choanal atresia: surgical technique and long-term results
Authors: Holzmann David , Ruckstuhl Meike
Published: October 2002

Although transnasal techniques to treat choanal atresia have become the standard, risks remain of restenosis of the opened choana requiring dilatations. In addition, a new technique without stenting and requiring less invasive post-operative care would be an improvement. With this in mind, in a non-randomized trial, a modification of the transnasal surgical repair was used in eight patients with unilateral choanal atresia by which no stents were used. While the standard procedure consists of partial resection of the bony septum and the atretic plate, we additionally removed lower parts of the anterior wall and the floor of the sphenoid sinus, creating a new airway canal from the nasal cavity to the sphenoid into the epipharynx. Post-operative care by the patient and the surgeon was noted. The success of choanal patency was followed by nasal endoscopy and rhinomanometry with a mean post-operative follow-up time of 1.9 years. In all patients, both choanae remained patent confirmed by nasal endoscopy and rhinomanometry showing almost symmetric resistance. Post-operative care comprised antibiotic prophylaxis and nasal douching with saline solution by the patient; no further treatment by the surgeon was necessary. According to these long-term results we would recommend this type of surgery for two reasons: the use of stents no longer necessary and post-operative care by the surgeon can be minimized.
Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy
Authors: Jain Anubhav , Sahni J. K.
Published: October 2002

Forty children (age group four to 12 years) undergoing adenoidectomy and/or tonsillectomy were subjected to pre- and post-operative polysomnography. Thorough clinical evaluation and X-ray soft tissue nasopharynx lateral view was carried out for all the patients. The tonsils were clinically graded from grade I to IV, whereas the adenoids were measured radiographically (using three different measurements) in all children. Thirty out of 40 (75 per cent) children presented with predominant obstructive symptoms, out of whom 22 (73.3 per cent) were found to have obstructive sleep apnoea (OSA), i.e. apnoea index > five per hour. The remaining 10 (25 per cent) had predominantly inflammatory symptoms on presentation and out of these two (20 per cent) were found to have OSA. Relative adenoid size expressed as a ratio between the distance from the point of maximum thickness of adenoids along a line drawn along a straight part of the basiocciput and distance from the posterior nasal spine to the antero-inferior edge of the spheno-basioccipital synchondrosis, was found to have a highly significant correlation with the grade of OSA. In our study, all patients with this ratio greater than 0.64 were found to have OSA. No correlation between tonsil size and grade of OSA was found. There was a highly significant improvement in polysomnographic scores following surgery in all patients.
Gonorrhoea in Coventry 1991-1994: epidemiology, coinfection and evaluation of partner notification in the STD clinic
Authors: David L M , Wade A A H , Natin D , Radcliffe K W
Published: October 2002

The aim of this study is to analyse the epidemiology of gonorrhoea in the Coventry area between 1991-1994 and the implementation and outcome of partner notification. A total of 404 episodes in 382 patients comprised the study group. In Coventry, 97% of episodes were managed in the STD clinic. There was a decrease in female and heterosexual male cases from 172 cases in 1991 to 37 cases in 1994 and increase in homosexual male cases from 8 in 1991 to 13 in 1994 ( P 0.0001). Chlamydial coinfection was found in 38%. Among patients with gonorrhoea, 33% were asymptomatic and 40% with gonorrhoea and chlamydia were asymptomatic. Ten per cent of index cases were asymptomatic as were 83% of contact cases < ( P 0.0001). The health advisers (HAs) interviewed 82% immediately and 94% at some time after diagnosis. Of the average 1.5 partners per patient identified, 0.31 partners per patient were already screened, another 0.4 partners per patient were traced, 0.37 partners per patient were not traced, and for 0.41 partners per patient notification outcome was unknown or unconfirmed. Partner notification of 278 index cases traced 163 primary or tertiary contacts, 115 were new cases of gonorrhoea. <
National Trends in Billing Secure Messages as E-Visits
Authors: Holmgren A Jay , Oakes Allison H. , Miller Austin , Adler-Milstein Julia , Mehrotra Ateev
Published: January 2024

This study assesses US trends in e-visit billing using national all-payer claims.
Private Equity and Cardiovascular Health Care
Authors: Sardar Partha , Chatterjee Saurav , Song Zirui
Published: January 2024

This Viewpoint discusses involvement of private equity firms in health care.
Segmental Skin Induration in a Boy
Authors: Yang Yang , Zhang Lan , Li Jiu-Hong
Published: January 2024

An 11-year-old boy presented with progressive unilateral skin hardening on his right thigh and buttock for 7 years. What is your diagnosis?