bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcriptome profiling of human hepatocytes treated with Aroclor 1254 reveals transcription factor regulatory networks and clusters of regulated genes
Authors: Reymann Susanne , Borlak Jürgen
Published: October 2006

Background

Aroclor 1254 is a well-known hepatotoxin and consists of a complex mixture of polychlorinated biphenyls (PCBs), some of which have the ability to activate the aryl hydrocarbon receptor (AhR) and other transcription factors (TFs). Altered transcription factor expression enables activation of promoters of many genes, thereby inducing a regulatory gene network. In the past, computational approaches were not applied to understand the combinatorial interplay of TFs acting in concert after treatment of human hepatocyte cultures with Aroclor 1254. We were particularly interested in interrogating promoters for transcription factor binding sites of regulated genes.

Results

Here, we present a framework for studying a gene regulatory network and the large-scale regulation of transcription on the level of chromatin structure. For that purpose, we employed cDNA and oligomicroarrays to investigate transcript signatures in human hepatocyte cultures treated with Aroclor 1254 and found 910 genes to be regulated, 52 of which code for TFs and 47 of which are involved in cell cycle and apoptosis. We identified regulatory elements proximal to AhR binding sites, and this included recognition sites for the transcription factors ETS, SP1, CREB, EGR, NF-kB, NKXH, and ZBP. Notably, ECAT and TBP binding sites were identified for Aroclor 1254-induced and E2F, MAZ, HOX, and WHZ for Aroclor 1254-repressed genes. We further examined the chromosomal distribution of regulated genes and observed a statistically significant high number of gene pairs within a distance of 200 kb. Genes regulated by Aroclor 1254, are much closer located to each other than genes distributed randomly all over the genome. 37 regulated gene pairs are even found to be directly neighbored. Within these directly neighbored gene pairs, not all genes were bona fide targets for AhR (primary effect). Upon further analyses many were targets for other transcription factors whose expression was regulated by Aroclor 1254 (secondary effect).

Conclusion

We observed coordinate events in transcript regulation upon treatment of human hepatocytes with Aroclor 1254 and identified a regulatory gene network of different TFs acting in concert. We determined molecular rules for transcriptional regulation to explain, in part, the pleiotropic effect seen in animals and humans upon exposure to Aroclor 1254.
A novel mutation in STK11gene is associated with Peutz-Jeghers Syndrome in Indian patients
Authors: Thakur Nikita , Reddy D Nageshwar , Rao G Venkat , Mohankrishna P , Singh Lalji , Chandak Giriraj R
Published: September 2006

Background

Peutz-Jeghers syndrome (PJS) is a rare multi-organ cancer syndrome and understanding its genetic basis may help comprehend the molecular mechanism of familial cancer. A number of germ line mutations in the STK11 gene, encoding a serine threonine kinase have been reported in these patients. However, STK11 mutations do not explain all PJS cases. An earlier study reported absence of STK11 mutations in two Indian families and suggested another potential locus on 19q13.4 in one of them.

Methods

We sequenced the promoter and the coding region including the splice-site junctions of the STK11 gene in 16 affected members from ten well-characterized Indian PJS families with a positive family history.

Results

We did not observe any of the reported mutations in the STK11 gene in the index patients from these families. We identified a novel pathogenic mutation (c.790_793 delTTTG) in the STK11 gene in one index patient (10%) and three members of his family. The mutation resulted in a frame-shift leading to premature termination of the STK11 protein at 286th codon, disruption of kinase domain and complete loss of C-terminal regulatory domain. Based on these results, we could offer predictive genetic testing, prenatal diagnosis and genetic counselling to other members of the family.

Conclusion

Ours is the first study reporting the presence of STK11 mutation in Indian PJS patients. It also suggests that reported mutations in the STK11 gene are not responsible for the disease and novel mutations also do not account for many Indian PJS patients. Large-scale genomic deletions in the STK11 gene or another locus may be associated with the PJS phenotype in India and are worth future investigation.
Aqueous extract of Terminalia arjuna prevents carbon tetrachloride induced hepatic and renal disorders
Authors: Manna Prasenjit , Sinha Mahua , Sil Parames C
Published: September 2006

Background

Carbon tetrachloride (CCl4) is a well-known hepatotoxin and exposure to this chemical is known to induce oxidative stress and causes liver injury by the formation of free radicals. Acute and chronic renal damage are also very common pathophysiologic disturbances caused by CCl4. The present study has been conducted to evaluate the protective role of the aqueous extract of the bark of Termnalia arjuna (TA), an important Indian medicinal plant widely used in the preparation of ayurvedic formulations, on CCl4 induced oxidative stress and resultant dysfunction in the livers and kidneys of mice.

Methods

Animals were pretreated with the aqueous extract of TA (50 mg/kg body weight) for one week and then challenged with CCl4 (1 ml/kg body weight) in liquid paraffin (1:1, v/v) for 2 days. Serum marker enzymes, namely, glutamate pyruvate transaminase (GPT) and alkaline phosphatase (ALP) were estimated in the sera of all study groups. Antioxidant status in both the liver and kidney tissues were estimated by determining the activities of the antioxidative enzymes, superoxide dismutase (SOD), catalase (CAT) and glutathione-S-transferase (GST); as well as by determining the levels of thiobarbutaric acid reactive substances (TBARS) and reduced glutathione (GSH). In addition, free radical scavenging activity of the extract was determined from its DPPH radical quenching ability.

Results

Results showed that CCl4 caused a marked rise in serum levels of GPT and ALP. TBARS level was also increased significantly whereas GSH, SOD, CAT and GST levels were decreased in the liver and kidney tissue homogenates of CCl4 treated mice. Aqueous extract of TA successfully prevented the alterations of these effects in the experimental animals. Data also showed that the extract possessed strong free radical scavenging activity comparable to that of vitamin C.

Conclusion

Our study demonstrated that the aqueous extract of the bark of TA could protect the liver and kidney tissues against CCl4-induced oxidative stress probably by increasing antioxidative defense activities.
Identification of estrogen-regulated genes by microarray analysis of the uterus of immature rats exposed to endocrine disrupting chemicals
Authors: Hong Eui-Ju , Park Se-Hyung , Choi Kyung-Chul , Leung Peter CK , Jeung Eui-Bae
Published: September 2006

Environmental estrogenic compounds which bind to the estrogen receptor (ER) can block or alter endogenous functions of estrogen in reproductive and developmental stages. A microarray technology is a very valuable method for the prediction of hormone-responsive activities in various gene expressions. Thus, we investigated the altered gene expression by estrogen and endocrine disruptors (EDs) using microarray technology in the uterus of immature rats. In this study, the expression levels of only 555 genes (7.42%) among the 7636 genes spotted on microarray chips were enhanced by more than two-fold following treatment with estradiol (E2), suggesting that direct or rapid response to E2 is widespread at the mRNA levels in these genes. In addition, elevated expression levels of the genes (over 2-fold) were observed by diethylstilbestrol (DES; 9.01%), octyl-phenol (OP; 8.81%), nonyl-phenol (NP; 9.51%), bisphenol-A (BPA; 8.26%) or genistein (9.97%) in the uterus of immature rats. The expression levels of representative genes, i.e., calbindin-D9k (CaBP-9k; vitamin D-dependent calcium-binding protein), oxytocin, adipocyte complement related protein (MW 30 kDa), lactate dehydrogenase A and calcium binding protein A6 (S100a6; calcyclin), were confirmed in these tissues by real-time PCR. In addition, the mRNA levels of these genes by real-time PCR were increased at follicular phase when E2 level was elevated during estrous cycle of adult female rats. In conclusion, these results indicate distinct altered expression of responsive genes following exposure to E2 and estrogenic compounds, and implicate distinct effects of endogenous E2 and environmental endocrine disrupting chemicals in the uterus of immature rats.
Ethical issues in epidemiologic research and public health practice
Authors: Coughlin Steven S
Published: October 2006

A rich and growing body of literature has emerged on ethics in epidemiologic research and public health practice. Recent articles have included conceptual frameworks of public health ethics and overviews of historical developments in the field. Several important topics in public health ethics have also been highlighted. Attention to ethical issues can facilitate the effective planning, implementation, and growth of a variety of public health programs and research activities. Public health ethics is consistent with the prevention orientation of public health. Ethical concerns can be anticipated or identified early and effectively addressed through careful analysis and consultation.
Jury service: a personal view
Authors: Black Andrew K.
Published: September 2006

Traditionally doctors have been excused from jury service, as I was on a couple of previous occasions when I received a jury summons. However, changes to the Criminal Justice Act 2003 came into force in April 2004, with the effect that doctors would normally not be excused from jury service.
Treatments recommended by health shops for symptoms of depression
Authors: Reed Joyce E. , Trigwell Peter
Published: September 2006

Aims and Method

We assessed the appropriateness of treatments recommended by health shop staff for symptoms of mild-to-moderate depression using participant observation with ten members of staff from ten different health shops selling herbal medicinal preparations.

Results

A wide range of treatment options were suggested by health shop staff when presented with common symptoms of depression. The majority have no firm evidence base, with the exception of St John's wort (Hypericum perforatum).

Clinical Implications

Most alternative treatments recommended by health shops for the treatment of depression have a poor evidence base. Implications for training and communication between agencies are discussed.
A forgotten tribe: a survey of the experience of working as a non-consultant career grade psychiatrist
Authors: Claxton Nicola , Griffin Lucy
Published: September 2006

Aims and Method

We surveyed the experience of working as a non-consultant career grade psychiatrist (NCCG). A postal questionnaire was sent to 140 NCCG psychiatrists in the south-west region.

Results

A total of 90 doctors responded (65% response rate); 30 (33%) had never had supervision and 45 (50%) were not eligible to sit the MRCPsych examination. Only 41 respondents (46%) had administrative support for non-clinical work.

Clinical Implications

Good supervision, comprehensive job plans and opportunities for further professional development are essential requirements for this group of doctors.
Personal injury compensation: no claim without pain?
Authors: Alexander David A. , Badial Raj , Klein Susan
Published: September 2006

Aims and Method

To identify the experiences of patients pursuing a personal injury claim, we carried out a retrospective questionnaire survey.

Results

Sixty-one patients from a regional traumatic stress clinic took part. Most were satisfied with the conduct of legal, medical and psychiatric personnel. Thirty-two (53%) reported that the legal proceedings had had an adverse effect on their health/well-being, and about a third reported an adverse effect on domestic relationships. Twenty-four patients (40%) were dissatisfied with the provision of information. More information about the whole legal process would have been welcomed by means of an information leaflet (n=57, 93%), a helpline (n=48, 79%), or a videotape (n=42, 68%).

Clinical Implications

Although seeking redress may contribute to the patient's adjustment, this survey demonstrates that it is not a step to be taken without consideration. As part of their therapeutic management, mental health professionals should consider the implications of such a step with their patients.
‘Do not resuscitate’ decisions in continuing care psychiatric patients: what influences decisions?
Authors: Chakraborty Nandini , Creaney William J.
Published: September 2006

Aims and Method

We evaluated the various aspects of ‘do not resuscitate’ (DNR) decisions taken for psychiatric continuing care patients within NHS Ayrshire and Arran. Records were reviewed and nursing staff were asked their opinions about DNR orders in general and the way these were implemented on their wards.

Results

There were 35 DNR orders among 88 continuing care patients in mental health wards for older adults. There were no DNR orders for the 25 continuing care patients in general adult psychiatry wards. Quality of life was the main issue when taking a DNR decision. Medical and nursing staff were involved in all decisions and the family in most. Patients were involved in only two cases. The documentation of the DNR order itself was satisfactory but documentation of the reasons behind the decision was inadequate. Patients with DNR status were perceived by ward staff to have more physical debilitation and more dependence on others. Local guidelines were being followed in most aspects, but these needed to be reviewed, as suggested within the resuscitation policy itself.

Clinical Implications

Decisions not to resuscitate may often be difficult to reach in psychiatric patients. Wards follow heterogeneous policies despite a resuscitation policy existing within the trust. Documentation needs to be improved and medical and nursing staff must reach a consensus regarding what constitutes quality of life and the appropriate time for a DNR decision.
Abuse in the workplace: experience of specialist registrars
Authors: Reddy Shalini , Kaplan Carole
Published: September 2006

Aims and Method

A survey was conducted to determine the experience of verbal and physical abuse among specialist registrars and the availability of training on managing abusive patients. A self-report questionnaire was sent to all specialist registrars working in the Northern Deanery.

Results

Completed surveys were received from 30 out of the 49 trainees (61% response rate). Twenty-three respondents (77%) reported being abused; all reported verbal abuse and 2 (9%) reported physical abuse. The experience of trainees of abuse differed between White doctors and those from other ethnic groups. The majority of trainees had received no training to deal with abuse.

Clinical Implications

In view of the high prevalence of abuse experienced by trainees, interventions to prevent both verbal and physical abuse should be identified. There should also be formal support for managing abuse and improved recording of abusive incidents.
Barriers to mental healthcare for psychiatrists
Authors: White Alfred , Shiralkar Purushottam , Hassan Tariq , Galbraith Niall , Callaghan Rhiannon
Published: September 2006

Aims and Method

To determine the opinions of psychiatrists on mental illness among themselves and their colleagues a postal survey was conducted across the West Midlands.

Results

Most psychiatrists (319/370, 86.2%) would be reluctant to disclose mental illness to colleagues or professional organisations (323/370, 87.3%). Their choices regarding disclosure and treatment would be influenced by issues of confidentiality (n=245, 66%), stigma (n=83, 22%) and career implications (n=128, 35%) rather than quality of care (n=60, 16%).

Clinical Implications

The stigma associated with mental illness remains prevalent among the psychiatric profession and may prevent those affected from seeking adequate treatment and support. Appropriate, confidential specialist psychiatric services should be provided for this vulnerable group, and for doctors as a whole, to ensure that their needs, and by extension those of their patients, are met.
Work-related stress and the psychiatrist: a case study
Authors: Harrison Tom , Cook Chris , Robertson Morag , Willey Jane
Published: September 2006

This case study aims to draw attention to the impact of work-related stress on psychiatrists. The first author's account of his own experience is supplemented by accounts from his secretary and wife. The aims of this report are to assist others to recognise the effects of work-related stress in themselves, to point out the impact on others, and to propose that doctors in training should be made aware of the issues.
Diary from Sri Lanka's east coast: departure
Authors: Rose Nick
Published: September 2006

The day I leave Ampara on Sri Lanka's east coast, a wild elephant kills a woman and severely injures two others on the road near my house. This is the second fatal attack in town this year and, as before, the animal is rounded up and bundled back to the jungle in a truck. The incident seems to encapsulate something important about the nature of Sri Lanka: dark forces coiled beneath an appearance of calm. In the past month, for example, three security guards have been gunned down at hospitals in Ampara, Batticaloa and Sammanthurai. Yet the world of crisp nursing bonnets and clinical order remains intact throughout. No one knows who the killers were or how they chose their victims, but in this smoke and mirror conflict, rumours are fuelled of a final push by one side or the other. Then nothing happens, just more of the same, daily isolated encounters, as if it were in no one's interest to go for all-out war. Meanwhile the world's attention moves on to Lebanon.
Partners in Care: diary of a carer
Authors: Hammond Terry
Published: September 2006

The old lady in black was bent over the body of her son. She rocked backwards and forwards, wailing. Do I really need to watch this I thought? I switched over and was subjected to the woeful groans of East Enders. That's enough, I thought. As I was about to take my cup of tea into the conservatory, my son Steve, who had been quietly studying the floor, suddenly raised his head and demanded to know why I had rung the BBC. ‘BBC! What are you talking about?’ ‘You know,’ he retorted. ‘You rang the BBC to tell them what a lazy sod I am; they've been broadcasting it all day.’ My heart missed a beat. I went cold, my stomach turned – I had become a carer.
Psychotherapy training experience in the Northern Region Senior Unified SHO Scheme: present and future
Authors: Carley Nicola , Mitchison Sally
Published: September 2006

Aims and Method

We conducted this survey to assess the current experience of psychotherapy training in the Northern Deanery and discuss possible effects changes might have on the future of this training. A postal questionnaire assessed the training experienced by the 41 trainees on the Northern Region Senior Unified Senior House Officer (SHO) Psychiatry Training Scheme in 2004. The results were compared with the guidelines from the Royal College of Psychiatrists.

Results

The response rate was 61%. Particular areas of strength included conducting a long case (64%) and obtaining sufficient teaching in psychodynamic and cognitive–behavioural therapy theory (88%); 92% rated their experience of the training as satisfactory or better, and 68% intended pursuing further training in psychotherapy.

Clinical Implications

Trainees ought to be familiar with the psychotherapy guidelines from an early point in their training. Specific areas of difficulty within the scheme need to be addressed. Proposed changes to specialist training are likely to have an impact on the psychotherapy training experience.
Improving Surge Capacity for Biothreats: Experience from Taiwan
Authors: Shih Fuh‐Yuan , Koenig Kristi L.
Published: October 2006

This article discusses Taiwan's experience in managing surge needs based on recent events, including the 1999 earthquake, severe acute respiratory syndrome in 2003, airliner crashes in 1998 and 2001, and yearly typhoons and floods. Management techniques are compared and contrasted with U.S. approaches. The authors discuss Taiwan's practices of sending doctors to the scene of an event and immediately recalling off‐duty hospital personnel, managing volunteers, designating specialty hospitals, and use of incident management systems. The key differences in bioevents, including the mathematical myths regarding individual versus population care, division of stockpiles, the Maginot line, and multi‐jurisdictional responses, are highlighted. Several recent initiatives aimed at mitigating biothreats have begun in Taiwan, but their efficacy has not yet been tested. These include the integration of the emergency medical services and health‐facility medical systems with other response systems; the use of the hospital emergency incident command system; crisis risk‐communications approaches; and the use of practical, hands‐on training programs. Other countries may gain valuable insights for mitigating and managing biothreats by studying Taiwan's experiences in augmenting surge capacity.
Maxillary giant cell reparative granuloma
Authors: Schlorf Richard A. , Koop Severin H.
Published: October 2006

“Giant cell reparative granuloma” was introduced into medical literature by Jaffe in 1953. Prior to that time most authors considered this lesion to be a variant of the benign giant cell tumor of the long bones, or a giant cell variant of osteitis fibrosa. Bernier and Cahn established the subdivision between the rare central giant cell reparative granuloma and the common peripheral epulis.

In the past, considerable emphasis has been placed on the importance of differentiating the true giant cell tumor from the giant cell reparative granuloma of the jaw bones. Most authors now believe the true giant cell tumor does not appear in the jaw bones except in rare cases associated with Paget's disease of the skull. Developing from membranous, rather than cartilaginous, ossification might account for this.

Both peripheral and central intraosseous lesions, parathyroid osteopathy and the pathologic tissue of cherubism show no appreciable histologic difference. These tumefactions are histologically a proliferative fibroblastic lesion with multinucleated giant cells. The histopathology of the giant cell tumor of the long bones is probably identical to the histopathology of the giant cell reparative granuloma of the jaw bones. The diagnosis of giant cell reparative granuloma must be made by physical examination, history, laboratory, X‐ray parameters and clinical follow‐up.

Localized maxillary swelling is the most important clinical feature. The swelling is smooth and palaption can reveal a rubbery, elastic sensation where bone has been thinned. There are no specific radiographic signs.

Conservative surgical management is indicated and adequate for giant cell reparative granulomas. Radiation is not indicated because of long term risks. Steroids have not been proven useful.
The lateral conchal resection otoplasty
Authors: Stucker Fred J. , Christiansen Thomas A.
Published: October 2006

A procedure for surgical correction of protruding ears has been utilized in 118 cases. The technique incorporates steps to correct the most common deformities found on preoperative evaluation. The lateral conchal resection combined with mattress sutures is not complex and thus readily learned by residents. It has yielded consistently excellent cosmetic results combined with an exceedingly low complication rate. The procedure is adaptable to well over 90 percent of patients seeking an otoplasty procedure.
Necrotizing sialometaplasia involving the nasal cavity
Authors: Maisel R. H. , Johnston W. H. , Anderson H. A. , Cantrell R. W.
Published: October 2006

Nectrotizing sialometaplasia is a disease process which affects minor salivary glands. It may clinically and microscopically resemble squamons cell or mucoepidermoid carcinoma but is histologically benign. Thirteen patients with this process occurring on the hard palate have been reported in the past two years. We describe two cases in the nasal cavity and propose that compromise of the blood supply contributed to the occurrence of these lesions. This apparently benign lesion may represent nonspecific reaction of salivary and mucous glands to ischemic injury and must be distinguished from carcinoma.
Carcinoma in thyroglossal duct remnants
Authors: Trail Mervin L. , Zeringue Guy P. , Chicola Jeffrey P.
Published: October 2006

Two cases of carcinoma arising in thyroglossal duct remnants are reported to add to the previously documented 78 cases in the literature. This rare lesion, which occurs is less than 1% of thyroglossal duct abnormalities, pathologically and clinically is similar to primary tumors arising in the thyroid gland. Papillary adenocarcinomas constitute 75‐85% of all cases reported and most are confined to the duct remnant itself with metastasis being infrequently recorded.

Therapy consists of wide excision of the tumor‐bearing tissue (Sistrunk procedure) in those cases localized to the duct remnant itself. In instances where metastasis or additional lesions are detected in the thyroid gland, thyroid ablation and neck dissections are indicated. Additional modalities such as suppressive thyroid therapy, radioactive iodine, and external radiation have been employed. Distant metastasis is rare and the long‐term prognosis is very favorable.
Luetic hearing loss
Authors: Wong Raymond T. , Lepore Michael L. , Burch Gary R. , Henderson Robert L.
Published: October 2006

Luetic hearing loss has been noted with increasing frequency in recent years. Four cases of luetic hearing loss seen at Walter Reed General Hospital from 1974 to 1975 are presented and discussed. Symptoms and pathology of luetic involvement of the inner ear are also presented. Serum FTA‐ABS and TPI, in addition to VDRL, must be routinely obtained during the workup of hearing loss. CSF FTA‐ABS should be obtained if serum FTA‐ABS and TPI are positive. Reversibility may be dependent on early detection of luetic hearing loss and treatment with high doses of antibiotics and steroids.
Supernumerary nasal tooth
Authors: Thawley Stanley E. , Laferriere Keith A.
Published: October 2006

A tooth presenting in the nasal cavity is an unusual phenomenon. Supernumerary teeth usually occur in the upper incisor area. Other locations may be the maxillary third molar and the mandibular bicuspid areas. Nasal teeth are a rare form of supernumerary teeth. They may be asymptomatic or may present with nasal obstruction and infection. They may be removed through a nasal approach.
Nasopharyngeal angiofibroma: A twenty year study.
Authors: Briant T. D. R. , Fitzpatrick P. J. , Berman Joel
Published: October 2006

A control rate of approximately 80% has been obtained in 45 cases of juvenile nasopharyngeal angiofibroma treated by a single moderate dose of radiotherapy at the Princess Margaret Hospital, Toronto. The remaining patients ultimately achieved control, generally after further irradiation. Immediate side‐effects of the treatment have been minimal, and no late complications have been observed. In 2–20 years' follow‐up, no irradiation‐induced tumors have been found.

Superiority of irradiation in these cases over surgery is emphasized, as well as the importance of using sophisticated techniques to limit the volume of tissues irradiated and protect vulnerable radiosensitive structures. Because tumor regression can be expected to continue for many months after treatment has been completed, a policy of observation following radiotherapy is recommended.
Immediate local tissue reactions to teflon vocal cord implants.
Authors: Lewy Robert B. , Millet Dan
Published: October 2006

From the beginning of the teflon injection technique for paralyzed vocal cords there has been an obvious interest in its role as a foreign body. There are a number of previous reports after varying periods of time of residence. This case report describes the tissue response of the foreign body reaction very early, 48 hours after the injection of teflon. It is consistent with early inflammatory foreign body reaction.
Civilian air travel and the otolaryngologist
Authors: Love J. Thom , Caruso Vincent G.
Published: October 2006

Thousands of individuals fly commercial airlines and private aircraft daily. One airline boasts of serving more than 100,000 passengers each day. Of these individuals exposed to barometric alterations, an undocumented number will develop significant barotrauma and may seek help from an otolaryngologist. Although many otolaryngologists learn the mechanics and management of barotrauma as military flight surgeons, residents in otolaryngology usually receive no specific training in this area. Because private and commercial aviation are so common today, we believe that a basic knowledge of barometric changes experienced while flying is essential for the practicing otolaryngologist.

These basic principles are covered in this presentation. Case histories will also be discussed. One patient, who presented with signs of perilymph fistula, including sensorineural deafness and abnormal ENG, recovered spontaneously.
Respiratory rate and atp content of stria vascularis of guinea pig in vitro
Authors: Marcus Daniel C. , Thalmann Ruediger , Marcus Nancy Y.
Published: October 2006

Stria vascularis from guinea pig cochleae was incubated in vitro to determine its metabolic response to variations in substrate and ion composition of the incubation medium. The respiratory rate at 37° in a medium containing glucose and pyruvate as substrate was 17.3 ± 1.33 (SEM, n = 51) μI O2/mg dry weight‐hour. The stria could not maintain constant respiration by relying solely upon endogenous fuel stores. With substrate supplied, the ATP level could be maintained at about 73% of that existing in vivo. Glucose appears to be an adequate substrate for stria in vitro since glutamate, pyruvate, and fumarate did not increase the respiratory rate. Succinate increased respiration markedly but did not increase the ATP level. Ouabain (10−4 M) caused a 48% decrease in the respiratory rate. Incubation in Na+‐free and K+‐free medium, each resulted in irreversible decrease of respiratory rate comparable to (or greater than) that caused by ouabain. These data are in accord with the high activity of Na+‐K+‐ATPase in the stria and the pronounced sensitivity of the endolymphatic potential to ouabain.
Improved case finding for pediatric hearing loss: Cost analysis of school screening programs
Authors: Jacobs Edward E. , Lavelle William G.
Published: October 2006

The majority of school hearing conservation programs employ pure tone identification audiometry as a basis of referral for further evaluation. An analysis of the cost impact of school screening programs is presented and a method of relating costs to screening program accuracy is described. This type of analysis may be used as a model for estimating cost impact and cost‐benefit for pure tone audiometry and other techniques of screening for hearing loss.
Symposium: Otologic surgery reassessment after 25 years. The current status of tympanoplasty
Authors: Glasscock Michael E. , Jackson C. Gary , Steenerson Ronald L.
Published: October 2006

Approximately 25 years ago, Wullstein and Zollner introduced the concept of tympano‐plasty to the field of chronic ear disease. Prior to this time, the main objective of surgery was to eliminate otorrhea and very little thought was given to the functional restoration of hearing. To convert a draining ear to a dry, functioning one has been the goal of tympanoplasty for this ensuing quarter of a century. The state of the art has developed to where currently the majority of surgeons obtain graft takes in the vicinity of 90‐97%. Return or preservation of hearing is anywhere from 60‐85%, depending upon the type of ossicular defect. This, of course, has economic overtones both from the cost of medical care and from restoration of function to the patient. There is certainly something to be said for control of the disease process so the patient does not periodically lose time from work and does not have to buy drugs. With restoration of function the patient many times can obtain a better job and increase his standard of living. Many patients are happy to have their ears repaired so they no longer have to see a doctor five or six times a year for consultation and prescriptions. Some of these individuals have been having difficulty for 15 to 20 years and they are most appreciative when they no longer require outpatient care. While there are still problems to overcome, it is the authors' opinion, based on the current state of the art, that tympanoplasty has progressed a great deal since the early 1950's and at this time is a successful method of dealing with chronic ear disease.
Symposium: Cochlear implant, 1978—fact or supposition. Bilateral cochlear implants: Histological findings in a pair of temporal bones
Authors: Johnsson Lars‐Göuran , House William F. , Linthicum Fred H.
Published: October 2006

The specimens were obtained from a 63‐year‐old white male with acquired lues. The patient experienced sudden profound deafness on the left side 15 years prior to death, and a similar loss on the right side 3 years later. By the time of death he had carried a single induction coil in the right ear for 3 years and multiple (5) hardwire electrodes in the left ear for 8 years.

A complete micro‐dissection or “mini‐autopsy” of the specimens was performed, and the modiolus was sectioned. Photomicrographs of the dissections will be shown.

In the right ear supporting elements and numerous nerve fibers were present in the apical turn. The electrode on this side was apparently tolerated well; scala tympani was normal in shape and appearance.

On the left side no nerve fibers were found in the osseous spiral lamina and there was extensive new bone formation in scala tympani. It is difficult to determine if or to what extent the implants were responsible for the severe sensorineural degeneration observed in both specimens.

There was severe scarring and ossification of the posterior ampulla in both ears, in all likelihood resulting from the surgery.

Some aspects of surgical techniques will be discussed in view of the histopathological findings.
Cerebrospinal fluid rhinorrhea
Authors: Charles David A. , Snell D.
Published: October 2006

One hundred and nine cases of cerebrospinal fluid rhinorrhea occurring over a ten‐year period are reviewed. Experience with the use of fluorescein localization techniques in 45 cases is detailed. The simplicity, easy availability and safety of fluorescein techniques are stressed. Primary rhinologic repair is advocated.
Hemophilus influenzae type b soft tissue infections of the head and neck
Authors: Simpson George T. , McGill Trevor I. J. , Healy Gerald B.
Published: October 2006

Hemophilus influenzae soft tissue infections produce a variety of specific and dangerous pathologic manifestations in the head and neck. Problems include periorbital cellulitis and abscess, sinusitis, supraglottitis and otitis media. Complications include meningitis, airway obstruction and death. Pediatric patients are especially susceptible to these infections and complications. Effective management includes correct diagnosis, prevention of complications, and high doses of appropriate antibiotics. Increasing ampicillin resistance necessitates alternative antibiotic regimens. Specific physical findings, diagnostic studies and appropriate current treatments are discussed with illustrative cases from Children's Hospital Medical Center, Boston, and reference to pertinent recent litrature.
Heterotopic salivary tissue and branchial cleft sinus
Authors: Goodman Roy S. , Daly John F. , Valensi Quentin
Published: October 2006

Bilateral lesions which appeared clinically to be branchial cleft sinuses were removed from a patient's neck. One was indeed a branchial cleft sinus, with elements of salivary tissue, but the other proved to be pure salivary tissue with a duct characteristic of a salivary gland. The embryology and clinical characteristics of heterotopic salivary glands are discussed. The occurrence of a heterotopic gland together with a branchial cleft sinus supports the contention that the heterotopic glands arise through errors of development in the branchial apparatus.
High resolution computed tomography in the staging of carcinoma of the larynx
Authors: Sagel Stuart S. , Aufderheide John F. , Aronberg Dixie J. , Stanley Robert J. , Archer Carol R.
Published: October 2006

The normal anatomy of the larynx as displayed on computed tomography is illustrated. Pathological alterations in patients with carcinoma of the larynx are depicted and discussed.

Computed tomography (CT) is recommended as the initial radiological procedure when additional diagnostic information is required to supplement the findings of laryngoscopy. CT provides information regarding deep penetration of tumor, including cartilaginous invasion, and about the inferior extension of neoplasm, including the subglottic area. This knowledge helps to determine whether conservation surgery as opposed to total laryn‐gectomy is possible.
Aerobic and anaerobic bacteriology of adenoids in children: A comparison between patients with chronic adenotonsillitis and adenoid hypertrophy
Authors: Brook Itzhak
Published: October 2006

Adenoids were obtained from 18 children with chronic adenotonsillitis (Group A) and from 12 others with adenoid hypertrohy (Group B). Patients' ages ranged from 20 months to 15 years (means 6 years) 18 were males and 12 females. The adenoids were sectioned in half after heat searing of the surface, and the core material was cultured for aerobic and anaerobic microorganisms.

Mixed aerobic and anaerobic flora were obtained from all patients, yielding an average of 7.8 isolates (4.6 anaerobes and 3.2 aerobes) per speciman. There were 97 anaerobes isolated. The predominant isolates in both groups were: Bacteroides sp. (including B. melaninogenicus and B. oralis), Fusobacterium sp., gram‐positive anaerobic cocci, and Veillonella sp. There were 138 aerobic isolates. The predominant isolates in both groups were: alha and gamma hemolytic streptococci, beta hemolytic streptococci (Group A, B, C, and F), S. aureus, S. pneumoniae, and Hemophilus sp. Hemophilus infulenzae type B, and S. aureus were more frequently isolated in Group A. B. fragilis was only recovered in Group A. Beta lactamase production was noted in 27 isolates obtained from 18 patients. Fifteen of these patients belonged to Group A (83% of Group A), while 3 were members of Group B (25% of Group B). These bacteria were all isolates of S. aureus (11) and B. fragilis (2), 8 of 22 B, melaninogenicus group, 4 of 11 B. oralis, and two of 8 H. infulenzae type B.

Our findings indicate the polymicrobial nature of deep adenoid flora and demonstrate the presence of many beta lactamase‐producing organisms in children with recurrent adenotonsillitis.
Laryngoscopy in neonates and infants: Experience with the flexible fiberoptic bronchoscope
Authors: Fan Lbland L. , Flynn Joseph W.
Published: October 2006

A small flexible fiberoptic bronchoscope was used for laryngeal examination in a series of neonates and infants; 104 laryngoscopies were performed in 59 patients. A high yield of diagnostic information was obtained in both postextubation patients and patients presenting with upper airway obstruction. No major complications were observed. This technique is useful in the evaluation of neonates and infants with potential upper airway problems.
The singer‐blom speech rehabilitation procedure.
Authors: Wetmore Stephen J. , Krueger Kathleen , Wesson Kathleen
Published: October 2006

Singer and Blom have recently reported a new surgical method for speech rehabilitation of the alaryngeal patient. The method consists of a tracheoesophageal puncture (TEP) followed 2 to 3 days later by insertion of a silicone “duckbill” prosthesis which acts as a one‐way valve allowing pulmonary air to enter and vibrate the esophagus but preventing aspiration.

Along with more rapid acquisition of speech, the advantage of tracheoesophageal speech over esophageal speech is the greater volume of air flow through the vibrating segment of the esophagus, which allows smoother and more prolonged speech.

Thirteen of our 18 patients (72%) who have undergone TEP are currently using tracheoesophageal speech. The complications associated with this procedure include the TEP tract closing, tracheal mucositis, stenosis of the tracheostoma, aspiration of the prosthesis, esophageal tear, and aspiration from the esophagus.

Although we have encountered several problems, we enthusiastically endorse this procedure since it provides oral communication which is comparable to, and in many cases better than, that of the majority of esophageal speakers.
The Effect of nasal packing on sleep‐disordered breathing and nocturnal oxygen desaturation.
Authors: Taasan Vicente , Wynne James W. , Cassisi Nicholas , Block A. Jay
Published: October 2006

Nasal obstruction is known to cause abnormal ventilation during sleep in infants, but its effects on breathing and oxygenation during sleep in adults are unknown. However, in adults, obstruction of the nose by nasal packing has been shown to cause hypoxia, and on occasion, hypercarbia and sudden death. We have investigated the pattern of ventilation and the level of oxygenation during sleep in seven patients who had nasal packs after nasal polypectomy or septoplasty. Using standard polysomnographic techniques, we monitored chest wall motion, nasal and oral airflow, and arterial oxygen saturation and sleep stages. Nasal packing either caused or worsened sleep‐disordered breathing in all patients and significantly increased the number, duration, and frequency of episodes for the group as a whole. Several patients also had a greatly increased number and severity of episodes of nocturnal oxygen desaturation. This study shows that obstruction of the nose by packing causes marked alterations in breathing during sleep in adults.
Symposium on low frequency harmonic acceleration, the rotary chair.: Rotary chair results in comparison to eng findings
Authors: Pappas Dennis G.
Published: October 2006

A study was done to compare the effectiveness of electronystagmography (ENG), harmonic acceleration (Rotary Chair testing), and computerized tracking in diagnosing the vertiginous patient. The data from 109 patients with clearly defined symptoms has been carefully analyzed to determine the reliability of each diagnostic procedure. Numerically, a combination of harmonic acceleration testing and computerized tracking (72%) showed more abnormals than ENG (61%).
Symposium on low frequency harmonic acceleration, the rotary chair.: SHA as a modality for monitoring patient progress
Authors: Rubin Wallace
Published: October 2006

ENG organized and simplified the disorganized conventional vestibular evaluation. The addition of SHA to the vestibular evaluation has improved our capability for identifying subtle abnormalities and even more important its use has enabled us to effectively monitor habituation and compensation (patient progress). This then allows us to monitor patient progress, confirm the patient's history and in some cases even to predict the course of the disease or injury.
Primary malleus fixation: Diagnosis and treatment
Authors: Moon Cary N. , Hahn Milege J.
Published: October 2006

Primary malleus fixation occurs in an otherwise normal middle ear without evidence of congenital deformity and without chronic inflammatory changes. It occurs in the latter decades of life and is frequently associated with sensorineural presbycusis. We believe it is a ligament ankylosis with osteoarthritis related to the aging process.

The diagnosis of malleus fixation is facilitated through the use of a modified Siegle pneumatic otoscope in conjunction with the Zeiss binocular microscope. The literature pertaining to this subject as well as the more historical reports are reviewed. Goodhill has written extensively on malleus fixation.

The audiologic test results in the fixed malleus cases reviewed for this study often presented a misleading picture, sometimes mimicking stapedial otosclerosis with a characteristic Carhart's notch and sometimes indistinguishable from sensorineural presbycusis. Usually speech discrimination scores fell in the very good to excellent range. Weber tests, whether performed by tuning forks or audiometrically, almost always lateralized to the suspect ear. Impedance frequently failed to conform to the expected fixed malleus pattern of low static compliance and absent acoustic reflexes; there was an equal number of low compliance and normal range compliance tympanograms and 15% of the total number of our cases had abnormally high compliance tympanograms. Stapedial reflexes are normally expected to be absent with lateral ossicular fixation, but this was not a consistent finding with contralateral test stimulation.

The decision for surgical treatment is dependent on the audiological findings and the potential hearing gain. The technique described consists of the removal of the incus and the head of the malleus and the reconstruction of a sound conducting pathway from the handle of the malleus to the mobile stapes or from the mobile stapes to the under surface of the tympanic membrane using a prosthesis‐ossicle arrangement.

Malleus fixation occurs far more often than it is diagnosed. Surgical correction can result in a worthwhile hearing gain even when the air‐bone gap is narrow or nonexistent. The technique of ossicular reconstruction is dictated by the anatomical findings. Some form of autograft ossicular reconstruction from the malleus handle to the stapes is most frequently utilized.

Otosclerosis with stapes fixation sometimes causes a lateral ossicular fixation due to degenerative disease and fibrosis. In this instance a stapedectomy is performed as the primary procedure with subsequent revision as necessary to eliminate the lateral obstruction.