bluuebunny/crossref_metadata_2025 huggingface dataset:
Epiglottic reconstruction of laryngeal stenosis secondary to cricothyroidostomy
Authors: Kennedy Thomas L.
Published: October 2006

Two cases of laryngeal stenosis secondary to cricothyroidostomy are presented with their management. Both laryngeal injuries involved the glottis and subglottis regions with the second case sustaining total closure of the larynx by scar tissue. Although different surgical procedures were employed, management was successful in each case with one surgical attempt. Total glottic and subglottic reconstruction was necessary in the second case and was successfully handled with a modification of the epiglottic laryngoplasty. The surgical technique is described in detail. Caution is raised concerning the routine use of cricothyroidostomy. Epiglottic laryngoplasty is presented as a simple and encouraging procedure for laryngeal reconstruction of laryngeal stenosis.
Acute epiglottitis in adults: Experience with fifteen cases
Authors: Ossoff Robert H. , Wolff Allan P. , Ballenger John J.
Published: October 2006

Fifteen adults with acute epiglottitis are discussed. Three required tracheostomy because of delayed diagnosis. There were no deaths.

Epiglottitis occurs more often in adults than is generally recognized. The early symptoms of epiglottitis in adults are sore throat and dysphagia. Any patient with acute, painful dysphagia should have indirect laryngoscopy to rule out epiglottitis.

Throat and blood cultures were obtained from 14 of our cases. Cultures from only two patients were positive for Hemophilus influenzae, type B; cultures from the other 12 patients did not grow any bacterial pathogens.

The primary treatment of adult epiglottitis is intravenous steroids, antibiotics, and humidified oxygen. Observation by the managing physician is mandatory during the first four hours of treatment. Tracheostomy is indicated in progressive disease.
Jet insufflation anesthesia for endolaryngeal surgery
Authors: Rontal Michael , Rontal Eugene , Wenokur Milford
Published: October 2006

The ideal anesthetic in endolaryngeal surgery provides a quiet completely unobstructed larynx in a patient who is comfortable and has respiratory functions maintained. Dissatisfaction with the intubation and venturi techniques has led to the use of a high pressure jet insufflation method. The results of this study have shown that anesthetically this technique is safe for a wide range of patients and endoscopic procedures. Laryngologically, the absence of glottic obstruction has broadened the scope of endoscopic procedures performed under general anesthesia.
Energy dispersive X‐ray analysis of intråcochlear ion shifts produced by anoxia
Authors: Bone Robert C. , Ryan Allen F.
Published: October 2006

Contemporary understanding of cochlear physiology has changed significantly in the last twenty years, due in large measure to experimental advances based on technological innovations. Since the early 1950's, it has been known that the cochlea is the site of several unique electrical events, among them the endocochlear potential. This potential is known to be biphasic, consisting of both positive and negative components. That the positive component of this potential is oxygen dependent, employs as part of its mechanism an ATP‐driven potassium pump, and is sensitive to several metabolic poisons is well established. It is the second or negative portion of the endocochlear potential about which significant controversy still exists.

The importance of the endocochlear potential in contemporary theories of auditory function requires that more be known about its subcomponents in order that deafness be better understood. Measurements of the unique cationic concentrations within the endolymph have been made in the past in order to correlate concentration changes that may occur over time with already known changes in the negative endocochlear potential per se. Practical as well as theoretical shortcomings of studies employing micropipette, resistance measurement and ion‐specific electrode techniques have led to this investigation in which ion concentration changes during prolonged anoxia were investigated by first freeze‐drying the cochleas to be studied to prevent contamination. Second, material recovered and isolated after freeze drying was examined by energy dispersive X‐ray analysis, a highly sensitive and precise method of determining elemental concentration within biological fluids.

Relative concentrations of Na+, K+ and Cl− were recorded within the first hour and at subsequent hourly intervals after decapitation of chinchillas. During the time of emergence and subsequent decay of the negative endocochlear potential, no significant change in the relative concentration of K+ or Na+ occurred. At much longer intervals (6 to 8 hours) large changes were measurable by the methods employed.

K+ flux or diffusion has, in the past, been thought by many to be the likely source of the negative endocochlear potential. However, observed measurements of the relative concentration of K+ do not correlate with the magnitude of change in the negative endocochlear potential, rendering endolymphatic K+ concentration or flux an unlikely source of the negative endolymphatic potential. Other experimental data suggesting alternate regions within the cochlea such as Reissner's membrane or the organ of Corti, specifically the hair cells or supporting cells as more likely sources of the negative endocochlear potential, are reviewed.
Cryosurgery for the treatment of cancer
Authors: Neel H. Bryan
Published: October 2006

Cryosurgery is that branch of cryobiology and surgery which deals with the therapeutic application of cold at profoundly low temperatures (those below 0°C) for the purpose of destroying tissues in selected target sites. The freezing process induces coagulation necrosis and is confined to the tissues within the region of the probe application and the ice ball. The degree and extent of tissue destruction depend largely on the size of the ice ball and the temperatures within it.

Various types of equipment and probes are commercially available for cryosurgery, but it was only after the development of reliable, versatile cryosurgical systems cooled by liquid nitrogen that numerous applications for cryosurgery were proposed, including therapy for cancer.

In the treatment of cancer, clinical success with cryosurgery has led to the more widespread application of this modality in selected patients. Cryosurgery has been used for readily accessible lesions in specific anatomic areas, most frequently the skin and oral cavity. It is an attractive alternative to extirpative surgery, particularly in the head and neck, where removal of large portions of the mandible or maxilla are often required to control cancer. Therefore, it is not surprising that many of the pioneering efforts in the treatment of cancer have been conducted by otorhinolaryngologists.

The full theoretic potential of cryotherapy was somewhat slow to be realized because many early endeavors were directed toward palliation, especially of accessible tumors of the skin and oral cavity, after failure of tumor control by radiation or surgery or both. This limited application during the early period of evaluation reflected a naturally timorous course that was taken by those who introduced the new modality into clinical practice. This period paralleled the development of new apparatus, early clinical trials, and the assessment of the clinical potential of cryosurgery in patients with incurable cancer — those whose conditions were deemed hopeless. Today, cryosurgery is selectively applied for the treatment of patients with tumors involving structures such as bone, oropharyngeal mucosa, temporal bone, skin, brain, retina, prostate, uterine cervix, and tracheobronchial tree.

Although general guidelines for the application of cryosurgery to cancer can be gleaned from various clinical reports, the optimal conditions of freezing have not been specifically defined. Animal experiments are necessary to study the variables methodically and in detail. The temporal and physical conditions for cryogenic necrosis of cancer require delineation so that cell death can be predictably and consistently reproduced. This is the thrust of this paper.
The contralateral effects of large tumors on brain stem auditory evoked potentials
Authors: Nodar Richard H. , Kinney Sam E.
Published: October 2006

Brain stem auditory evoked potential (BAEP) testing has been demonstrated to be a useful diagnostic tool in the presence of severe or complete sensorineural hearing loss. From a series of 38 patients with tumors in the vicinity of the VIIIth nerve, 13 patients with tumors larger than 2 cm had abnormal BAEP results contralateral to the involved side. The abnormalities observed on the noninvolved side included prolonged peak latencies, reduced amplitudes, poor wave shape and poor response stability. The significance of these findings is twofold: 1. Large tumors may disrupt BAEP test results on the side contralateral to the lesions, 2. Important information may be obtained on patients having complete sensorineural hearing loss on the involved side.
The argon laser in otology
Authors: Dibartolomeo Joseph R. , Ellis Maxine
Published: October 2006

The use of lasers in microsurgery is now an accepted procedure. As we learn more about the absorption properties of biologic tissue, we can use different electromagnetic wave lengths to accomplish surgical alteration of these tissues. The electromagnetic wave length of the Argon laser is compatible for surgical alteration of the soft tissue and bone of the middle and inner ear. Thirty patients requiring external ear canal or middle ear surgery were treated using the Argon laser during the course of the surgical procedure. The treatment of soft tissue pathology included tympanoplasty with fascia graft, control of bleeding, lysis of adhesions, and myringotomies performed using the Argon laser. Osseous disease of the external canal was removed and stapedectomy was performed, using the Argon laser on 15 patients.

A review of the physics of laser energy and its application in otology is presented. The results of this investigative study demonstrate the advantages of the Argon laser in otologic microsurgery.
Primary chordoma of the maxillary sinus
Authors: Shugar J. M. A. , Som P. M. , Krespi Y. P. , Arnold L. M. , Som M. L.
Published: October 2006

A case of primary chordoma of the maxillary sinus is presented. The embryology of the notochord is reviewed and it is suggested that the frequently used adjective “ectopic” is a misnomer. The literature of primary paranasal sinus chordomas is reviewed and the clinicopathological features described. It is emphasized that these lesions can mimic other benign and malignant processes both clinically, radiographically and histologically. The treatment and prognosis is more favorable than the more common craniocervical chordoma.
Malignant fibrous histiocytoma of the frontal sinus
Authors: Schaefer Steven D. , Denton Richard A. , Blend Benjamin L. , Carder Henry M.
Published: October 2006

The first case of malignant fibrous histiocytoma of the frontal sinus is reported. The aggressive nature of the tumor despite its relatively benign histologic pattern and value of electron microscopy are emphasized. Ultrastructural examination reveals a progression of several principal cell types, lending support to the multi‐potent mesenchymal cell origin of these malignancies. These cells may have arisen from the supporting stroma of the ectodermally derived respiratory epithelium of the paranasal sinuses. Wide local excision is currently the primary mode of therapy. The value of radiation therapy or chemotherapy in this tumor is unproven.
The overall management of salivary gland disorders
Authors: Eichel Berkley S. , Bray David A. , Kaplan Harold J.
Published: October 2006

Two studies are reported in an attempt to give a broader interpretation of the management of salivary gland disorders. One study analyzes 232 patients seen over a six year period and divides the grouping into parotid, submaxillary, and accessory salivary gland disorders. The numbers and percentages of patients who underwent surgery are reported along with a pathological break‐down of the various lesions encountered. Eighty‐five (36%) of the 232 patients had a documented surgical procedure. Thirty‐eight of the entire 232 patients had tumor involvement, for a 16% incidence of neoplasia.

At the same time 244 patients had various sorts of salivary gland surgery in the four local hospitals. Of these, 210 had either a parotidectomy or submaxillary gland excision. A surgical and pathological breakdown of the 117 neoplastic lesions fairly well corresponds to most of the published series, but fails to relay the overall picture that the head and neck surgeon encounters in dealing with salivary glands.
The incidence of neoplastic versus inflammatory disease in major salivary gland masses diagnosed by surgery
Authors: Gallia Louis J. , Johnson Jonas T.
Published: October 2006

What is the incidence of non‐neoplastic disease when dealing with masses of the major salivary glands? A knowledge of this information would aid the physician in making decisions relative to the management of the masses. Furthermore, the expected malignancy rate may need to be adjusted according to the findings of this study.

Many reported series of salivary gland neoplasms show the relative incidence of benign vs. malignant neoplasms; however, not every patient with a mass of the salivary gland who comes to surgery is finally diagnosed as having had a neoplasm. Knowing the relative incidence of neoplastic vs. non‐neoplastic salivary gland diseases has important diagnostic, therapeutic, and prognostic implications.

Records of all patients who underwent either a parotidectomy or submandibular gland excision from 1975 to the present at the Eye and Ear Hospital of Pittsburgh were reviewed; 73% of the parotidectomies performed were done for neoplastic disease. A patient with a parotid mass has a likelihood of 1:10 of having a malignancy. Similarly, on a population basis, 1 submandibular mass in 12 will be malignant.
Assessment of cobalt 57 tagged bleomycin as a clinical aid in staging of head and neck carcinoma
Authors: Cummings Charles W. , Larson Steven M. , Dobie Robert A. , Weymuller Ernest A. , Rudd Thomas G. , Merello Augusto
Published: October 2006

Critical assessment of head and neck cancer with respect to staging has, on occasion, been disappointingly ineffective. We have attempted to correlate the incidence of measureable uptake of cobalt 57 tagged bleomycin by primary squamous cell carcinoma and metastatic cervical lymph nodes. Forty‐six cases have been evaluated with respect to histopathological confirmation of the suspected metastatic disease. We have found that this diagnostic measure increases our acumen in staging of head and neck cancer.

The relevance of the Co‐Bleo scans as a diagnostic aid is reported in 46 cases. Malignant tumors greater than 2 cm in size appear to demonstrate active uptake of the imaging agent. Small tumor size and excess background radioactivity contribute to the false‐negatives (17%). Inflammatory conditions or benign tumors of the salivary apparatus may result in minimal uptake, thus, a false‐positive result (10%). An increase in the radioactivity of the Co‐Bleo may enhance the benefits of this procedure in the search for an undiagnosed primary, as well as undiagnosed local or distant metastases.
A multiple‐channel cochlear implant: An evaluation using open‐set cid sentences
Authors: Clark Graeme M. , Tong Yit Chow , Martin Lois F. A.
Published: October 2006

A multiple‐channel cochlear implant and speech processor have been used in two postlingually deaf adult patients with a total hearing loss, to enable them to perceive varying degrees of running speech. The results have been confirmed with open‐set CID everyday sentence tests. Using the implant alone, the patients obtained 8% and 14% scores with prerecorded material, and 34% and 36% scores for “live” presentations. This was equivalent to the perception of 35% of connected discourse. When the implant was used in conjunction with lipreading, improvements of 188% and 386% were obtained over lipreading alone, and the scores were 68% and 98% which were equivalent to the perception of 60% and 95% of connected discourse.
Ear disease in patients with wegener's granulomatosis
Authors: Kornblut Alan D. , Wolff Sheldon M. , Fauci Anthony S.
Published: October 2006

From a group of 60 patients with histologically‐proven Wegener's granulomatosis managed at the National Institute of Allergy and Infectious Disease, approximately 45% were found to have disease that involved the ears. The majority of these patients had either recurrent or persistent serous otitis, resulting from eustachian tube dysfunction as a consequence of nasopharyngeal inflammations. Other pathologies included suppurative otitis, cholesteatoma, facial nerve paralyses, temporal bone grnnulomata, and sensory hearing losses. The presentation and management of these changes and their relationships to underlying disease are described in selected case reports, and a general philosophy of patient management is presented.
Postauricular undersurface tympanic membrane grafting: A follow‐up report
Authors: Glasscock Michael E. , Jackson C. Gary , Nissen Alan J. , Schwaber Mitchell K.
Published: October 2006

The authors review 1,939 chronic ear surgeries in which 1,556 underwent some form of tympanic membrane grafting. The overall take rate was 93%. There was no selection of cases with regard to presence of infection, cholesteatoma, polyps, or granulation tissue at the time of surgery. There appeared to be no difference in the take rate based upon age of the patient, presence of infection, or cholesteatoma. Autogenous and homograft fascia performed well and there was no significant difference in take rate. Complications were minimal and were related more to the disease process than the grafting technique per se.

In addition to reviewing the long‐term follow‐up of the original technique the authors present a method of dealing with tympanic membrane retraction pockets. Called a cartilage tympanoplasty this procedure incorporates a large piece of full thickness tragal cartilage with attached perichondrium into the substance of the tympanic membrane.

With 2 years follow‐up at this writing, this procedure has markedly reduced postoperative retraction pockets and recurrent cholesteatoma.
Evaluation of orbital cellulitis and results of treatment
Authors: Schramm Victor L. , Curtin Hugh D. , Kennerdell John S.
Published: October 2006

Optimal management of patients with orbital cellulitis depends on how accurately the disease is classified and on the appropriateness with which antibiotics and surgery are used to treat the disease. Therapy must be adjusted on the basis of the extent of the disease. In order to determine the balance of treatment modalities which is most beneficial for certain disease presentations, we reviewed a series of 303 patients with orbital cellulitis. The anatomical and bacteriological etiology of the disease was determined in each case on the basis of the examination, visual acuity, results of sinus radiography, results of culture, ultrasonography, and computerized tomography. To avoid the 5% complication rate that occurred in this series, an evaluation and treatment protocol is recommended.
Lateral sinus thrombosis: A modern perspective
Authors: Teichgraeber John F. , Per‐Lee John H. , Turner John S.
Published: October 2006

At Emory, six cases of lateral sinus thrombosis (LST) were seen over the last ten years — two children and four adults.

The picture and bacteriology of LST have changed with the advent of antibiotics as has the usefulness of various diagnostic tests. Less is it a disease of children in association with acute otitis media. More often it is seen in the adult patient after a long history of chronic ear disease. Fever and mastoid and neck tenderness are still universal signs of the affliction. However, rarely patients do present with progressive anemia, emaciation and evidence of septic emboli. Since antibiotics are commonly used during the prodromal ear infection, cultures are often negative. If they do identify an organism, it is usually a mixed flora rather than beta hemolytic streptococcus. Spinal fluid results are variable and seldom is there evidence of increased spinal fluid pressure. Arteriography, venography, and digital subtraction venography are the most reliable tests to prove and delimit the thrombus.

Early management involves high dose broad spectrum, intravenous antibiotics including chloramphenicol. Surgical intervention involves a mastoidectomy, exposure of the sinus, incision and drainage, but not necessarily removal of the thrombus. Internal jugular vein ligation should be reserved for those cases in which septicemia and embolization do not respond to initial surgery and intravenous antibiotics.
Acute klebsiella epiglottitis: Considerations for initial antibiotic coverage
Authors: Berthiaume John T. , Pien Francis D.
Published: October 2006

Acute epiglottitis due to Klebsiella pneumoniae in an adult patient is described. The patient failed to respond to ampicillin and required cephalosporin therapy as well as surgical drainage. In view of increased resistance of Hemophilus influenzae to ampicillin and because of other possible etiologic agents such as Staphylococcus aureus and non‐Hemophilus gram‐negative rods, consideration should be given for the initial use of one of the recently introduced cephalosporins such as moxalactam or cefamandole in the treatment of adult epiglottitis.
Viral labyrinthitis: Early pathology in the human
Authors: Karmody Collin S.
Published: October 2006

The histologic findings in the temporal bones of three patients who died from viral encephalopathy are presented. Pathology was restricted to the scala media, vestibular labyrinth, and internal auditory canal and was considered to be expressions of viral labyrinthitis. The changes were different degrees of degeneration of the organ of Corti, early encapsulation of the tectorial membrane, degeneration of the stria vascularis, and round cell infiltration of the modiolus and contents of the internal auditory canal. A new finding in the organ of Corti and early stages of cystic degeneration of the stria vascularis are documented. In all cases, the saccule was degenerated with sloughing of the otolithic membrane and vestibular labyrinth was involved in varying degrees.
Significance of tomography in meniere's disease: Visualization and morphology of the vestibular aqueduct
Authors: Hall Stephen F. , O'Connor A. Fitzgerald , Thakkar C. H. , Wylie I. G. , Morrison A. W.
Published: October 2006

The revival of endolymphatic sac surgery has led to many investigations in Meniere's disease, including lateral tomography of the vestibular aqueduct. Contrary to recent literature, we found no difference in the presence and morphology of the vestibular aqueduct when assessed radiologically in a group of Meniere's patients and a control group. Our assessment of this information in regard to etiology and treatment of Meniere's disease is presented.
Autoradiographic evidence of sex steroid receptors in laryngeal tissues of the baboon (papio cynocephalus)
Authors: Aufdemorte Thomas B. , Sheridan Peter J. , Holt G. Richard
Published: October 2006

A number of studies have implicated the gonadal steroids as significant factors in laryngeal development and disease. In addition, antiandrogens are receiving limited trials in the treatment of laryngeal carcinoma. However, there is little experimental data to document the presence, and more specifically the location of receptors for the sex steroid hormones in the larynx. The purpose of this study is to provide such data. Utilizing an autoradiographic technique, tissues from baboons injected with tritiated estradiol (3H‐E2) or dihydrotestosterone testosterone (3H‐DHT) were examined and analyzed. The data gathered confirmed that the larynx is rich in receptors for these steroids and that there are specific patterns of distribution of receptor positive cells. The vocalis muscle and other mesenchymal tissues contained the largest number of receptors, while ciliated columnar and stratified squamous epithelium were negative. The significance of these findings is discussed.
Pediatric temporal bone fractures
Authors: Williams William T. , Ghorayeb Bechara Y. , Yeakley Joel W.
Published: October 2006

Twenty‐seven temporal bone fractures in 25 pediatric patients were evaluated over a 6‐year period. The diagnosis was confirmed with otoscopy and high‐resolution computed tomography scans (HRCT). Three‐dimensional reconstruction of high‐resolution computed tomography scans were used to aid in the diagnosis. The most common fracture was an oblique fracture which is oriented in an axial or horizontal plane with the temporal bone. Facial nerve paralysis was found in 6 of our patients, which is less than the expected incidence when compared to adults. Hearing loss was found in 24 patients, the most common of which was conductive hearing loss, which had a higher incidence than expected when compared with adults.
Noise‐induced hearing loss in children
Authors: Brookhouser Patrick E. , Worthington Don W. , Kelly William J.
Published: October 2006

Occupational noise exposure remains the most commonly identified cause of noise‐induced hearing loss (NIHL), but potentially hazardous noise can be encountered during leisure‐time activities. NIHL in the pediatric population has received scant attention. This study focuses on 114 children and adolescents (ages 19 and under: 90.3% males) who were diagnosed as having probable NIHL on the basis of history and audiometric configuration. In 42 children the loss was unilateral, while the remaining 72 had sensorineural losses of varying configurations in the contralateral ear. The mean age of referral for evaluation was 12.7 years (range 1.2 to 19.8, SD 4.21), although 26% of these losses were diagnosed in children aged 10 years and younger. Such irreversible, but potentially preventable losses, should be given high priority on the public health agenda. Comprehensive, age‐appropriate educational programs must be developed for elementary and secondary students and their parents to acquaint them with potentially hazardous noise sources in their environment.
Effects of denervation on laryngeal muscles: A canine model
Authors: Shindo Maisie L. , Herzon Garrett D. , Hanson David G. , Cain Donald J. , Sahgal Vinod
Published: October 2006

The purpose of this study was to chronologically evaluate the changes in function and histomorphometry of denervated laryngeal muscles. In 14 adult mongrel dogs, a 2.5‐cm segment of the right recurrent laryngeal nerve was excised. Videolaryngoscopy and electromyography were performed at 1, 2, 3, 4, 5, 6, and 9 months under intravenous sedation. The animals were then killed, and the laryngeal muscles were processed for histochemical reactions. The mean muscle fiber diameter, standard deviation, and muscle fiber type composition were determined. The findings indicate that, following recurrent laryngeal nerve sectioning, the canine intrinsic laryngeal muscles undergo denervation atrophy for approximately 3 months, after which reinnervation occurs. The source of reinnervation appears to be from regenerated nerve fibers of the sectioned recurrent laryngeal nerve. The nerve fibers nonselectively reinnervated the abductor and adductor muscles of the larynx.
Effects of bacterial endotoxin applied to the guinea pig cochlea
Authors: Darrow David H. , Keithley Elizabeth M. , Harris Jeffrey P.
Published: October 2006

The ototoxic potential of bacterial endotoxin present in middle ear effusions was evaluated by inoculating endotoxin solutions of 10 μg/mL or 1000 μg/mL directly into the scala tympani of the guinea pig cochlea. Median auditory brainstem response threshold shifts of 12.5 and 20 dB were observed in the experimental ears exposed to the higher dose at days 2 and 4, respectively, with gradual improvement to near baseline by day 28. Histologic examination revealed inflammatory infiltrates in the scala tympani and scala vestibuli of several of these cochleas. The lower concentration, closer to that found in human effusions, elicited no significant loss of hearing and a milder inflammatory response. It is concluded that brief exposure of the cochlea to endotoxin from middle ear effusions is insufficient to cause hearing loss. Under chronic conditions, however, persistent inflammation within the cochlea may result in a sensorineural deficit.
S‐100 protein in human inner ear: Use of a novel immunohistochemical technique on routinely processed, celloidin‐embedded human temporal bone sections
Authors: Shi Shan‐Rong , Tandon Atul K. , Coté Catherine , Kalra Krishan L.
Published: October 2006

The authors recently developed a new antigen retrieval technique which allows immunohistochemical detection of proteins in routinely processed, celloidin‐embedded human temporal bone sections. This technique was used in the present study, which reports the occurrence of S‐100 protein in the human inner ear. Fifteen celloidin‐embedded human temporal bone sections, obtained from the Eastern Temporal Bone Bank at the Massachusetts Eye and Ear Infirmary, were tested with the monoclonal antibody to S‐100. This protein was found in the spiral ligament, in Reissner's membrane, in the spiral limbus, and in the basement membrane of the cochlea. S‐100‐positive, thin fibers could be seen as supporting elements in the acoustic nerve and the facial nerve. This protein was localized along the surface of vestibular wall. The new technique provides an immunohistochemical approach to studying routinely processed human temporal bone sections and may prove useful in the field of immuno‐otopathology.
Laryngeal chondrosarcomas: A clinicopathologic study of 11 cases, including two “dedifferentiated” chondrosarcomas
Authors: Brandwein Margaret , Moore Sandra , Som Peter , Biller Hugh
Published: October 2006

Laryngeal chondrosarcomas are uncommon, and those that contain a distinct, nonchondroid, high'grade spindle cell sarcoma (the so'called “dedifferentiated” chondrosarcoma or chondrosarcoma with additional malignant mesenchymal component [CAMMC]) are extremely rare. Laryngeal CAMMC merit special attention, as CAMMC in other sites portends a poor prognosis. Eleven patients with laryngeal chondrosarcomas are reported on; 2 of these patients had CAMMC.

On follow'up, 3 of the 11 patients had recurrences. The first had recurrence 4 and 11 years after tumor enucleation; that patient died disease free 2 years after salvage total laryngectomy. The second had recurrence 2 years after partial laryngectomy and was lost to follow'up after salvage total laryngectomy. The last patient recurred 13 years after partial laryngectomy and underwent salvage total laryngectomy; that patient was one of the two who developed CAMMC, and he also developed stomal recurrence of the “dedifferentiated” component 3 years after total laryngectomy. The other 8 patients are disease free after partial laryngectomy (6) or total laryngectomy (2) 10 months to 12 years later (mean: 51 months). This includes the 1 other patient with CAMMC, who is disease free 60 months after total laryngectomy.

Laryngeal CAMMC has been shown, in at least one of the two patients, to be associated with a poor outcome. Patients with recurrent laryngeal chondrosarcomas do not have a poorer outcome after salvage total laryngectomy. The authors advocate partial laryngectomy if technically feasible.
Effectiveness of salvage neck dissection for advanced regional metastases when induction chemotherapy and radiation are used for organ preservation
Authors: Wolf Gregory T. , Fisher Susan G.
Published: October 2006

The recently completed VA Cooperative Study (CSP #268) of induction chemotherapy (cisplatin/5‐FU) and definitive radiation (6600 to 7600 cGy) for organ preservation in advanced (stage III or IV) laryngeal cancer demonstrated that, although larynx preservation could be achieved in 64% of randomized patients, overall survival rates were not improved over conventional treatment (surgery/postoperative radiation). Of 166 patients randomized to induction chemotherapy, 46 had N2 or N3 disease and were analyzed to determine the effectiveness of the organ preservation treatment strategy on control of neck disease and survival. The clinical response of neck metastases to induction chemotherapy was significantly associated with subsequent salvage neck dissection (P = .008). The overall death rate was increased (P = .014) and survival time decreased in patients with less than a complete response in the neck after chemotherapy (P = .15). This was related primarily to failure to control the disease in the neck. The overall survival of patients achieving a complete response in the neck was improved over the randomized group of N2 or N3 patients treated with primary surgery. The findings suggest that response of neck nodes should be assessed independently of primary tumor response in trials of organ preservation strategies using induction chemotherapy, and that failure to achieve a clinical complete response in the neck warrants planned early salvage neck dissection in order to achieve improved overall survival.
Nasopharyngeal carcinoma: Treatment results with primary radiation therapy
Authors: Bailet Jeffrey W. , Mark Rufus J. , Abemayor Elliot , Lee Steve P. , Tran Liu M. , Juillard Guy , Ward Paul H.
Published: October 2006

One hundred three patients with nasopharyngeal carcinoma were treated with radiotherapy at UCLA Medical Center from January 1955 to December 1990. Overall survival, disease‐free survival, and local control rates were analyzed. In addition, survival from 1955 to 1978 and from 1979 to 1990 were evaluated. Overall 5‐ and 10‐year actuarial survival rates for all patients were 58% and 47%, respectively. Disease‐free survival rates at 3 and 5 years were 45% and 30%, respectively. Local, persistent, or recurrent disease in the nasopharynx was the primary cause of failure, occurring in 32% of patients and correlating with the initial tumor size (T stage). Twenty‐four percent of patients developed distant metastases, which correlated with nodal status but not with T stage. Seventy‐nine percent of patients failed either locally or distally by 4 years. Sex, race, age, and T and N stage categories were evaluated as prognostic variables in terms of survival. Control of primary disease is important in determining long‐term outcome. Modern imaging techniques have greatly assisted in the evaluation of disease extent and treatment options.
Cochleovestibular nerve compression syndrome. II. Vestibular nerve histopathology and theory of pathophysiology
Authors: Schwaber Mitchell K. , Whetsell William O.
Published: October 2006

The present study was undertaken to systematically examine and characterize pathological changes in vestibular nerve specimens obtained at surgery in patients with symptomatic cochleovestibular nerve compression syndrome (CNCS). Vestibular nerves were obtained in six cases of CNCS and were intermingled with vestibular nerves obtained in cases of Meniere's disease. All of the nerve specimens were coded and reviewed microscopically in a blind‐study fashion by the neuropathologist. The vestibular nerves obtained from CNCS cases showed significant endoneurial fibrosis, compared to controls (specimens from patients with Meniere's disease). Based on observations in this study, as well as the clinical symptoms and audiovestibular test findings in these patients, a theory of pathophysiology in CNCS of the cochleovestibular nerve is proposed. The implications of this theory are discussed with respect to the diagnosis of CNCS.
Presence of urokinase‐type plasminogen activator (u‐PA) in tissue extracts of antrochoanal polyp
Authors: Yamashiro Yutaka , Nakamura Mariko , Huang Guang‐Wu , Kosugi Tadayoshi
Published: October 2006

Using a biochemical technique, the authors characterized and identified a plasminogen activator (PA) derived from tissue extracts of antrochoanal polyp (AP) and paranasal mucous membrane (PMM) with chronic sinusitis. The results of fibrin zymography indicated that the tissue extracts of AP revealed two lytic zones and that those of PMM revealed a single lytic zone on fibrin‐agarose plates. One of the AP zones exhibited the same relative mobility as the PMM zone (molecular weight: 65 kd), while the other AP zone had a smaller molecular weight (about 54 kd). Goat immunoglobulin G (IgG) fraction of antihuman uterine tissue‐type plasminogen activator (t‐PA) inhibited the 65‐kd lytic zones of AP and PMM. Anti‐human low‐molecular‐weight urokinase inhibited only the 54‐kd lytic zone of AP, and nonspecific goat IgG failed to inhibit any of the lytic zones. On the other hand, 10−2 mol trans 4‐(aminomethyl)cyclohexane‐carboxylic acid (t‐AMCHA) inhibited all of the lytic zones. No lytic zones could be observed on plasminogen‐free fibrin‐agarose plates. These findings confirmed that the tissue extracts of PMM contained t‐PA, and that those of AP contained both t‐PA and urokinase‐type plasminogen activator (u‐PA). In addition, it appeared that u‐PA in inflammatory tissue was related to proliferative changes of the mucous membrane.
The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea
Authors: Miljeteig Harald , Hoffstein Victor , Cole Philip
Published: October 2006

The purpose of this study was to compare apnea and snoring in patients with different patterns of nasal resistance: normal, high unilateral, and high bilateral. The authors examined 683 unselected patients referred for evaluation of snoring and possible sleep apnea. All patients had determination of nasal resistance (performed during wakefulness in the seated posture) and nocturnal polysomnography including quantitative measurement of snoring. Analysis of variance showed no significant difference in apnea and snoring indices among the three nasal resistance groups (normal, high unilateral, and high bilateral). Furthermore, there was no significant difference in the frequency of patients with different severity of apnea and snoring among the three groups. It is concluded that 1. unilateral and bilateral elevation of nasal resistance may lead to equally severe snoring or apnea; 2. there is no direct relationship between awake seated nasal resistance measurement and sleep disordered breathing; and 3. measurements of supine nasal resistance during sleep may be required to elucidate the relationship between sleep‐disordered breathing and nasal obstruction.
Cholesteatoma in the pediatric population: Prognostic indicators for surgical decision making
Authors: Stern Scott J. , Fazekas‐May Mary
Published: October 2006

A review of surgical therapy for pediatric cholesteatoma at the Arkansas Children's Hospital was performed. Fifty‐three children treated surgically for cholesteatoma were studied over a 10‐year period. Primary acquired, or attic retraction cholesteatomas, were generally treated with a canal up tympanomastoidectomy; there were very few complications or secondary procedures in this group. Middle ear or secondary acquired cholesteatomas were initially treated by both canal up and canal down procedures; however, a large percentage of these patients eventually required an open cavity procedure. The presence of cholesteatoma in the sinus tympani strongly predicted failure to control disease with a canal up procedure (P < .05); conversely, the absence of matrix in the sinus tympani was predictive for success when a canal up procedure was used for attic cholesteatoma (P < .05). Finally, it was determined that follow‐up was not adequate in our patient population. With this in mind, guidelines for the management of pediatric cholesteatoma will be presented.
Shult sets and translation ovoids of the Hermitian surface
Authors: Cossidente A , Ebert G. L , Marino G , Siciliano A
Published: October 2006

Starting with carefully chosen sets of points in the Desarguesian affine plane AG(2; q
2) and using an idea first formulated by E. Shult, several infinite families of translation ovoids of the Hermitian surface are constructed. Various connections with locally Hermitian 1-spreads of 𝒬−(5, q) and semifield spreads of PG(3, q) are also discussed. Finally, geometric characterization results are developed for the translation ovoids arising in the so-called classical and semiclassical settings.
Hertzian Fracture, Kinetic Friction and the Mechanical Impact LOX Compatibility Testing of Polymers and Polymer Matrix Composites
Authors: Gerzeski R
Published: October 2006

A cascade of probabilistic mechanisms is proposed to better understand the 72 ft-lbs mechanical impact in liquid oxygen ignition threshold sensitivity testing of polymeric and polymer matrix composite materials. This model teams the well established and understood mechanisms of Hertzian fracture and kinetic friction. In conjunction they explain the mechanical fracturing of the specimen and the very rapid transformation of the test's mechanical energy into temperature rising heat energy. The model also provides the first explanation for the random probabilistic occurrence or nonoccurrence of ignitions in tested materials.
A New Concept for Leak Testing Environmental Enclosure Filtration Systems
Authors: Organiscak JA , Schmitz M
Published: October 2006

A method (patent pending) has been developed to determine the quality of environmental cab filtration systems. This method utilizes specially configured filter cartridges to remove carbon dioxide from the ambient air with the environmental cab's air filtration system. A real-time gas monitor is placed inside an unoccupied cab with the filtration system running to time decay the carbon dioxide to its lowest concentration or equilibrium level. The outside carbon dioxide concentration level can be measured concurrently with another gas monitor or with the same inside cab gas monitor during a representative period before and after the inside sampling is conducted. Cab filtration system leakage is comparatively deduced from the difference between the special cartridge filter efficiency and overall cab efficiency. Laboratory trials have illustrated that desirable high efficiency test filter configurations (greater than 99 % efficiency) can be devised, but have air quantity and test time limitations. These trials also demonstrated that CO2 penetration was reflective of controlled air leaks around a high efficiency filter under equilibrium conditions. This report examines the elements of this patent pending method.
Chondroitinase ABC Promotes Sprouting of Intact and Injured Spinal Systems after Spinal Cord Injury
Authors: Barritt A. W. , Davies M. , Marchand F. , Hartley R. , Grist J. , Yip P. , McMahon S. B. , Bradbury E. J.
Published: October 2006

Chondroitin sulfate proteoglycans (CSPGs) are inhibitory extracellular matrix molecules that are upregulated after CNS injury. Degradation of CSPGs using the enzyme chondroitinase ABC (ChABC) can promote functional recovery after spinal cord injury. However, the mechanisms underlying this recovery are not clear. Here we investigated the effects of ChABC treatment on promoting plasticity within the spinal cord. We found robust sprouting of both injured (corticospinal) and intact (serotonergic) descending projections as well as uninjured primary afferents after a cervical dorsal column injury and ChABC treatment. Sprouting fibers were observed in aberrant locations in degenerating white matter proximal to the injury in regions where CSPGs had been degraded. Corticospinal and serotonergic sprouting fibers were also observed in spinal gray matter at and below the level of the lesion, indicating increased innervation in the terminal regions of descending projections important for locomotion. Spinal-injured animals treated with a vehicle solution showed no significant sprouting. Interestingly, ChABC treatment in uninjured animals did not induce sprouting in any system. Thus, both denervation and CSPG degradation were required to promote sprouting within the spinal cord. We also examined potential detrimental effects of ChABC-induced plasticity. However, although primary afferent sprouting was observed after lumbar dorsal column lesions and ChABC treatment, there was no increased connectivity of nociceptive neurons or development of mechanical allodynia or thermal hyperalgesia. Thus, CSPG digestion promotes robust sprouting of spinal projections in degenerating and denervated areas of the spinal cord; compensatory sprouting of descending systems could be a key mechanism underlying functional recovery.
Bladder Overactivity and Hyperexcitability of Bladder Afferent Neurons after Intrathecal Delivery of Nerve Growth Factor in Rats
Authors: Yoshimura Naoki , Bennett Nelson E. , Hayashi Yukio , Ogawa Teruyuki , Nishizawa Osamu , Chancellor Michael B. , de Groat William C. , Seki Satoshi
Published: October 2006

Nerve growth factor (NGF) has been proposed as an important mediator inducing bladder overactivity under pathological conditions such as spinal cord injury, bladder outlet obstruction, or cystitis. We therefore examined the effects of chronic NGF treatment on bladder activity and the properties of bladder afferent neurons. In adult female rats, NGF (2.5 μg/μl) was infused continuously into the intrathecal space at the L6–S1 level of spinal cord for 1 or 2 weeks using osmotic pumps (0.5 μl/h). Bladder afferent neurons were labeled with axonal transport of Fast Blue injected into the bladder wall. After intrathecal injection of NGF, cystometrograms under an awake condition showed bladder overactivity revealed by time-dependent reductions in intercontraction intervals and voided volume. ELISA analyses showed significant increases in NGF levels in L6–S1 dorsal root ganglia of NGF-treated rats. In patch-clamp recordings, dissociated bladder afferent neurons exhibiting tetrodotoxin (TTX)-resistant action potentials from NGF-treated animals were larger in diameter and had significantly lower thresholds for spike activation compared with sham rats. In addition, the number of TTX-resistant action potentials during 600 ms depolarizing pulses was significantly increased time dependently after 1 or 2 weeks of NGF application. The density of slowly inactivating A-type K+currents was decreased by 52% in bladder afferent neurons with TTX-resistant spikes after 2 week NGF treatment. These results indicate that increased NGF levels in bladder afferent pathways and NGF-induced reduction in A-type K+current density could contribute to the emergence of bladder overactivity as well as somal hypertrophy and hyperexcitability of bladder afferent neurons.
Imaging Dedicated and Multifunctional Neural Circuits Generating Distinct Behaviors
Authors: Briggman Kevin L. , Kristan William B.
Published: October 2006

Central pattern generators (CPGs) control both swimming and crawling in the medicinal leech. To investigate whether the neurons comprising these two CPGs are dedicated or multifunctional, we used voltage-sensitive dye imaging to record from ∼80% of the ∼400 neurons in a segmental ganglion. By eliciting swimming and crawling in the same preparation, we were able to identify neurons that participated in either of the two rhythms, or both. More than twice as many cells oscillated in-phase with crawling (188) compared with swimming (90). Surprisingly, 84 of the cells (93%) that oscillated with swimming also oscillated with crawling. We then characterized two previously unidentified interneurons, cells 255 and 257, that had interesting activity patterns based on the imaging results. Cell 255 proved to be a multifunctional interneuron that oscillates with and can perturb both rhythms, whereas cell 257 is an interneuron dedicated to crawling. These results show that the swimming and crawling networks are driven by both multifunctional and dedicated circuitry.