bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of Orbital Preservation for Advanced Malignant Maxillary Sinus Tumors
Authors: Nishino Hiroshi , Ichimura Keiichi , Tanaka Hidetaka , Ishikawa Kazuhiro , Abe Kouichi , Fujisawa Yoshiro , Shinozaki Takeshi
Published: November 2003

Objective The purpose of the study was to examine the oncological and functional outcomes of multimodality therapy for patients with advanced malignant maxillary sinus tumors that invaded the orbit.

Study Design Retrospective study.

Methods The medical records of 26 patients with orbital invasion were retrospectively analyzed. The patient group consisted of 16 men and 10 women, with a median age of 58 years. The mean follow‐up period was 73 months. The most common disease was squamous cell carcinoma. Seven patients had nodal disease. All patients underwent simultaneous combined therapy consisting of conservative surgery through a sublabial incision, radiotherapy, and regional chemotherapy. Patients with nodal disease were treated with either irradiation or selective neck dissection.

Results The 5‐ and 10‐year overall survival rates were 68% and 51%, respectively. The 5‐ and 10‐year local control rates were 66% and 51%, respectively. Overall survival rates and local control rates were significantly worse in patients with disease other than squamous cell carcinoma. Local control rates were significantly worse in patients with orbital apex disease than in patients without orbital apex disease. All 26 patients, despite orbital involvement, retained their orbital contents. Nineteen of these patients demonstrated adequate ocular function.

Conclusions Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy is an effective method for local control and preservation of ocular function. However, performing orbital conservation procedure in patients with disease other than squamous cell carcinoma and with orbital apex disease must be considered carefully.
Myospherulosis Following Sinus Surgery: Pathological Curiosity or Important Clinical Entity?
Authors: Sindwani Raj , Cohen Jacob T. , Pilch Ben Z. , Metson Ralph B.
Published: November 2003

Objectives/Hypothesis Myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of sinus surgery. This reaction has been associated with postoperative adhesion formation. The purpose of the study was to determine whether the occurrence of myospherulosis has an adverse effect on clinical outcome following sinus surgery.

Study Design Case‐control study at an academic medical center.

Methods Thirty‐two cases of myospherulosis were identified in 28 patients (4 with bilateral disease) who underwent sinus surgery between 1989 and 1999. Cases were staged according to histological and radiological grading systems. Clinical outcome was compared with a control group of 28 patients who had similar surgery during the same time period.

Results Patients with myospherulosis were found to have a significantly higher likelihood of developing postoperative adhesions compared with control subjects (50% vs. 18%, respectively [P = .023]). Histological stage, based on the extent of lipid vacuoles and spherules (erythrocyte remnants) present in the surgical specimen, was found to correlate with disease severity based on preoperative sinus computed tomography staging (P = .009). Patients with myospherulosis tended to have a shorter interval between their last two surgeries than did control subjects (2.2 ± 2.1 vs. 4.5 ± 7.1 y, respectively [P = .086]). Patient age, sex, comorbid conditions, CT stage, and number of previous operations were not predictive for the occurrence of myospherulosis.

Conclusions Patients who develop myospherulosis from lipid‐based packing material used during sinus surgery are more likely to form postoperative adhesions. These adhesions appear to be clinically relevant and may hasten the need for revision surgery.
Serum Antidiuretic Hormone Levels in Patients With Unilateral Meniere's Disease
Authors: Lim Jin S. , Lange Mary E. , Megerian Cliff A.
Published: November 2003

Objectives/Hypothesis Prior studies have indicated a possible role of antidiuretic hormone (ADH) in the pathogenesis of Meniere's disease. Animal studies have shown presence of ADH receptors in the inner ear, and chronic vasopressin administration has been shown to induce endolymphatic hydrops. Furthermore, elevation of serum ADH levels in human has been noted in patients with Meniere's disease. The goal of the study report was to analyze ADH levels in a series of patients with definite unilateral Meniere's disease to further investigate this relationship.

Study Design Retrospective analysis

Methods Antidiuretic hormone levels were obtained from 26 consecutive patients with a diagnosis of definite Meniere's disease as defined by the 1995 guidelines from the Committee of Hearing and Equilibrium (American Academy of Otolaryngology—Head and Neck Surgery). The ADH levels were drawn for each patient within one week of an acute episode of vertigo. These values were compared to ADH levels from 31 healthy volunteers. Statistical analysis was performed using a two‐tailed t test.

Results Mean ADH level for patients with Meniere's disease was 4.07 pg/mL (SD = 2.82 pg/mL) and for the control group, 3.37 pg/mL (SD = 1.48 pg/mL). The difference in ADH levels was not statistically significant (P >.05).

Conclusions Although previous reports have demonstrated a possible role of ADH in the pathogenesis of Meniere's disease, the study did not show a statistically significant elevation of ADH levels in patients with unilateral Meniere's disease. Before excluding an ADH‐inner ear pathogenic relationship, ADH levels in patients with bilateral Meniere's disease should be investigated.
Surgical Excision of Acoustic Neuroma: Patient Outcome and Provider Caseload
Authors: Barker Fred G. , Carter Bob S. , Ojemann Robert G. , Jyung Robert W. , Poe Dennis S. , McKenna Michael J.
Published: November 2003

Objectives/HypothesisFor many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume–outcome relationship for surgical excision of acoustic neuromas.

Study DesignRetrospective cohort study.

MethodsThe Nationwide Inpatient Sample (1996 to 2000) was used. Multivariate regression analyses were adjusted for age, sex, race, payer, geographic region, procedure timing, admission type and source, medical comorbidities, and neurofibromatosis status.

ResultsAt 265 hospitals, 2643 operations were performed by 352 identified primary surgeons. Outcome was measured on a four‐level scale at hospital discharge: death (0.5%) and discharge to long‐term care (1.2%), to short‐term rehabilitation (4.4%), and directly to home (94%). Outcomes were significantly better after surgery at higher‐volume hospitals (OR 0.47 for fivefold‐larger caseload,P<.001) or by higher‐volume surgeons (OR 0.46,P<.001). Of patients who had surgery at lowest‐volume‐quartile hospitals, 12.3% were not discharged directly home, compared with 4.1% at highest‐volume‐quartile hospitals. There was a trend toward lower mortality for higher‐volume hospitals (P= .1) and surgeons (P= .06). Of patients who had surgery at lowest‐caseload‐quartile hospitals, 1.1% died, compared with 0.6% at highest‐volume‐quartile hospitals. Postoperative complications (including neurological complications, mechanical ventilation, facial palsy, and transfusion) were less likely with high‐volume hospitals and surgeons. Length of stay was significantly shorter with high‐volume hospitals (P= .01) and surgeons (P= .009). Hospital charges were lower for high‐volume hospitals (by 6% [P= .006]) and surgeons (by 6% [P= .09]).

ConclusionFor acoustic neuroma excision, higher‐volume hospitals and surgeons provided superior short‐term outcomes with shorter lengths of stay and lower charges.
Fiberoptic Endoscopic Evaluation of Swallowing
Authors: Hiss Susan G. , Postma Gregory N.
Published: November 2003

Objectives/Hypothesis Approximately 8 million people in the United States report some degree of dysphagia annually; as the population continues to age, this will become a greater problem. A comprehensibly performed and interpreted fiberoptic endoscopic evaluation of swallowing provides invaluable information for the evaluation and management of individuals with dysphagia or aspiration, or both.

Study Design Review.

Methods The state‐of‐the‐art technique, interpretation, predictive value, and safety of fiberoptic endoscopic evaluation of swallowing was reviewed.
Bacteria and Granulation Tissue Associated With Montgomery T‐Tubes
Authors: Schmäl Frank , Fegeler Wolfgang , Terpe Hans Joachim , Hermann Wolfgang , Stoll Wolfgang , Becker Karsten
Published: November 2003

Objectives Although complications (infection, development of granulation tissue) of silicone Montgomery T‐tubes have been reported, the microbiological consequences and the origin of granulation tissue have not yet been evaluated.

Study Design A prospective trial.

Methods Twenty‐three Montgomery T‐tubes from 10 patients were analyzed with regard to the development of granulation tissue, bacterial growth (including genotyping with polymerase chain reaction), and results of sensitivity testing. Furthermore, stent sterilization (n = 6) was investigated.

Results Granulation tissue occurred with 74% of the stents, and all specimens showed signs of infection but no foreign body reaction. The predominant organisms were Staphylococcus aureus (35%) and Pseudomonas aeruginosa (17%). The differences between groups with and without granulation tissue were significant for P aeruginosa. Polymerase chain reaction fingerprinting of the S aureus obtained from 15 stents (n = 3 patients) revealed a total of seven different genotypes. Whereas two of these patients harbored six different genotypes of S aureus, the third patient was persistently colonized by S aureus over a 15‐month period with the identical genotype. Susceptibility testing showed most commonly (65%) sensitivity to a combination of amoxicillin‐clavulanate and ofloxacin. After sterilization, 92% of analyzed stent segments showed no bacterial growth.

Conclusions Granulation tissue commonly occurred next to the silicone (subglottic area, stoma) where S aureus and P aeruginosa were commonly isolated. A combination of mechanical irritation and bacterial infection seems to account for the development of granulation tissue. Polymerase chain reaction fingerprinting showed both prolonged persistence and a change of colonizing strains after multiple stent replacements. A combination of amoxicillin‐clavulanate and ofloxacin is the most effective antibiotic therapy. Sterilization of the cost‐intensive silicone stents is feasible, and reuse in the same patient is justifiable from economic aspects.
Spatial Distribution of Tumor Vaccine Improves Efficacy
Authors: Couch Marion , Saunders John K. , O'Malley Bert W. , Pardoll Drew , Jaffee Elizabeth
Published: November 2003

Objectives Genetically engineered tumor cells were used as a vaccine in a murine model to compare tumor formation after inoculating multiple sites versus a single site. The effect of vaccinating draining lymph node basins was evaluated.

Study Design Mice were vaccinated in either the floor of the mouth, the draining nodes of the front legs, the hind leg, or a combination of sites. Seven days later, the mice were challenged with parental tumor cells in the floor of the mouth and followed for tumor growth.

Methods A retroviral vector was used to transduce the granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) gene into SCCFVII/SF tumor cells, which were then irradiated to prevent replication in vivo. Syngeneic C3H/HeJ mice were vaccinated with 1 × 106 cells in various sites, then challenged with 1 × 105 parental cells after 7 days.

Results Animals vaccinated in multiple sites had better protection from later tumor challenge than those receiving single vaccinations. Of the animals receiving vaccination at multiple sites, those vaccinated in the site of tumor challenge (floor of the mouth) had more protection than those not vaccinated at the site.

Conclusions Mice vaccinated at multiple draining lymph node sites were better primed against tumor challenge than mice receiving single inoculations. Vaccination strategies that included the challenge site (floor of the mouth) and the nodes near this site were optimal.
Herpes Simplex Virus and Meniere's Disease
Authors: Vrabec Jeffrey T.
Published: November 2003

Objective/Hypothesis This study was designed to investigate the hypothesis that Meniere's disease is associated with herpes simplex virus (HSV) reactivation in the vestibular ganglion.

Study Design Case control study.

Methods Vestibular ganglia were obtained from archival surgical pathology specimens from patients undergoing vestibular neurectomy for vertigo caused by Meniere's disease. All patients met criteria for classification as definite Meniere's disease according to American Academy of Otolaryngology/Head and Neck Surgery (AAO‐HNS) criteria. Control specimens were obtained from willed body donors. Sections from each ganglion were studied for prevalence of viral DNA using a nested polymerase chain reaction designed to amplify the HSV DNA polymerase gene. Quantitative analysis determined the number of viral copies per standard unit of ganglionic DNA.

Results HSV DNA was more prevalent in paraffin embedded ganglia from patients with Meniere's disease (100%) than in fresh‐frozen control ganglia (81%) (P = .02). Fixation and paraffin embedding substantially reduced recovery of HSV virus in selected control specimens. Quantitative analysis found no correlation between viral copy number in control ganglia processed frozen versus formalin fixed and paraffin embedded.

Conclusions HSV is more commonly isolated from vestibular ganglia of patients with Meniere's disease than the general population. The routine histologic preparation of formalin fixation and paraffin embedding significantly altered the quantity of virus detected though not in a predictable manner. The study provides supportive evidence for a viral etiology in Meniere's disease.
Therapeutic Selective Neck Dissection: A 25‐Year Review
Authors: Muzaffar Kamil
Published: November 2003

Objectives/Hypothesis The aim of the study was to show the efficacy of selective neck dissection in combination with postoperative radiation therapy in controlling squamous cell carcinoma metastatic to the cervical lymph nodes. The study compared the incidence of recurrences and overall disease‐free survival between comparable cohorts undergoing a selective neck dissection and classic radical or modified neck dissection.

Study Design Retrospective, 25‐year review was made of data from a tertiary care academic facility comprising both private patients and veterans.

Methods Inclusion criteria studied patients with untreated head and neck cancer who had squamous carcinoma metastatic to cervical lymph nodes on histological examination and were treated with a selective (n = 61), modified (n = 54), or radical neck dissection (n = 61). The three groups were compared with respect to regional control and overall cancer‐free survival. All patients remained cancer free at the primary site, received postoperative radiation therapy, and had a minimum follow‐up of 2 years. The median follow‐up was 4.3 years.

Results Control of recurrent carcinoma in the neck, as well as the incidence of overall cancer‐free survival, was comparable in the three cohorts with no significant statistical difference. Eight of 176 sides of the necks (4.5%) showed evidence of recurrence (2 of 61 [3.3%] in the selective neck dissection group and 6 of 115 [5.2%] in the radical and modified neck dissection group. Disease‐free 2‐year survival was 80% in the selective neck dissection group and 64% in the radical and modified neck dissection group.

Conclusion Selective neck dissection, when used in combination with postoperative radiation therapy, is an efficacious way to manage metastatic squamous cell carcinoma to the neck.
Evaluation of Parathyroid Hormone as a Functional Biological Marker of Rat Laryngeal Transplant Rejection
Authors: Nelson Marc , Dan Olivia , Strome Marshall
Published: November 2003

Objectives/Hypothesis Short‐term immunosuppressive protocols in a preclinical rat model that have led to prolonged survival of the graft in preliminary trials were investigated. Rat allografts, by their heterotopic nature, do not allow direct examination or functional interpretation. The primary objective of the study was to identify a reliable functional biological marker allowing monitoring of graft status. A secondary goal was to use this marker to indicate onset of rejection.

Study Design The authors elected to study rat parathyroid hormone as a functional marker of laryngotracheal complex rejection. Theoretically, a pulsed immunosuppressive regimen that is administered when parathyroid hormone levels begin to fall could prevent rejection.

Methods Eleven Lewis recipient rats underwent parathyroidectomy one week before laryngeal transplantation. Parathyroid hormone levels were obtained on various days following transplantation, then analyzed with an intact rat parathyroid hormone assay. Animals were killed on different days to allow for comparison of parathyroid hormone levels with histopathological signs of rejection.

Results All animals had undetectable levels of parathyroid hormone before transplantation. By 24 hours after transplantation, parathyroid hormone levels were within normal range. At 72 hours, the parathyroid hormone levels dropped precipitously. Rejection of parathyroid glands paralleled the early histological changes of rejection seen in the other anatomical areas of interest in the laryngotracheal graft.

Conclusion The study represents the first time a hematological marker has been identified that has predictive value for rejection of transplanted rat larynges. As such, it not only enables a 3‐month experimental window with reasonable numbers of animals, but also opens the door for novel sequencing of immunosuppressive modalities.
Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma
Authors: Batra Pete S. , Kern Robert C. , Tripathi Anju , Conley David B. , Ditto A. M. , Haines G. K. , Yarnold Paul R. , Grammar Leslie
Published: November 2003

Objective: To investigate the efficacy of endoscopic sinus surgery (ESS) in the management of chronic sinusitis and asthma in patients with nasal polyps and steroid‐dependent asthma. Study Design: Retrospective chart review. Methods: The study included 17 patients who underwent ESS with nasal polyps, steroid‐dependent asthma with or without aspirin sensitivity and a minimum of 1 year postoperative follow‐up. Nine patients were ASA sensitive, and eight patients were ASA tolerant. Chronic sinusitis and asthma were evaluated using subjective (patient complaints) and objective (computed tomography scans, pulmonary function tests, steroid doses) criteria. Preoperative data were compared with data obtained 12 to 18 months postESS. Tissue samples were graded for degree of inflammation and edema. Results: Thirteen of the 17 (76.5%) patients reported improved clinical symptoms postESS. The postoperative Lund‐Mackay scores were statistically lower for the 17 patients (P < .0001). The group experienced improvement in postoperative forced expiratory volume at 1 second (FEV1) (P < .014). Twelve of 17 (70.6%) experienced reduction in systemic steroid usage (P < .048). The ASA sensitive patients did not have a statistical improvement in postoperative FEV1 (P > .08) and sinonasal symptoms (P > .16) compared with the ASA tolerant group. Polyp tissue from the ASA sensitive patients demonstrated more edema and more inflammation on average than ASA tolerant polyps, but the results were not statistically significant. Conclusion: ESS demonstrates a beneficial effect on the sinonasal and asthma symptomatology in patients with nasal polyps and asthma using objective measures. Subset of aspirin‐tolerant patients have statistically better outcome for sinonasal symptoms and pulmonary function testing than aspirin‐sensitive patients.
Tutorials in clinical research: VII. Understanding comparative statistics (contrast)—part B: Application of T‐test, Mann‐Whitney U, and Chi‐Square
Authors: Neely J. Gail , Hartman James M. , Forsen James W. , Wallace Mark S.
Published: November 2003

Objective: This tutorial on comparative statistics has been written in two complementary segments. The first paper (part A) focused on explaining the general concepts of the null hypothesis and statistical significance. This second article (part B) addresses the application of three specific statistical tests. These two articles should be read sequentially and the first article should be available for reference while one reads the second. Study Design: Tutorial. Methods: The authors met weekly for 10 months to discuss clinical research articles and the applied statistics. The difficulty was not the material but the effort to make it easy to read and as short as possible. Results: The article discusses the application of three common statistical indexes of contrast, χ2, Mann‐Whitney U, and Student t‐test and other concepts, such as sample size, degrees of freedom, errors, power, and confidence intervals. Conclusions: Statistical tests generate a number known as a statistic (χ2, U, t), which is sometimes called a “critical ratio” because it helps us to make a decision. This number is then associated with a probability, or P value. Sample size is a crucial element in the initial design of a research project and in the subsequent ability of the results to show statistical significance if the difference is clinically important. The example data used in this paper demonstrate the application of the three specific tests and illustrate the effect of sample size on the results.
Tissue engineered muscle implantation for tongue reconstruction: A preliminary report
Authors: Bunaprasert Tanom , Hadlock Tessa , Marler Jennifer , Kobler James , Cowan Douglas , Faquin William , Varvares Mark
Published: November 2003

Objectives/Hypothesis: Because current tongue reconstructive methods introduce adynamic, variably sensate tissue into the mouth, the critical functions of the tongue in articulation and deglutition may be compromised. The objective of this work was to introduce a combination of myoblasts and scaffolding material into rat hemiglossectomy defects and to examine the extent of neomuscle formation in the reconstructed area, under the hypothesis that the presence of myoblasts leads to formation of new muscle. Study Design: Randomized, prospective animal study. Methods: Myoblasts were harvested from neonatal Lewis rats, and a growth factor enriched collagen gel was prepared. Syngeneic adult animals received either hemiglossectomy alone or reconstruction with one of four experimental reconstructive preparations: collagen gel alone, collagen gel with suspended myoblasts, the gel‐cell combination in undifferentiated muscle construct form by way of tissue culture for 7 days in a preformed mold, or differentiated constructs, cultured in myoblast fusion medium. After 6 or 16 weeks, animal weight gain was recorded, animals were killed, and the tongues harvested. The tissue was examined histologically, and quality of the muscular regenerate was rated on a scale according to predefined criteria. Results: Animals in all groups gained weight appropriately. In groups receiving hemiglossectomy alone or acellular (gel only) reconstruction, there was significant scarring and lack of neomuscle formation. In groups receiving myoblast transplantation, either by way of gel suspension or in the form of undifferentiated or differentiated constructs, muscle quality was superior to controls. Conclusions: Myoblast transplantation into hemiglossectomy defects appears to lead to new muscle formation and does not inhibit normal weight gain in animals after tongue implantation.
Management of vascular malformations of the mandible and maxilla
Authors: Persky Mark S. , Yoo Helen J. , Berenstein Alejandro
Published: November 2003

Objectives/Hypothesis: Vascular malformations involving the mandible and maxilla are uncommon, and no uniform treatment of these lesions has been defined. The purpose of the study was to evaluate the effectiveness of treating vascular malformations with a multidisciplinary approach and emphasis on endo‐vascular therapy. Study Design: Retrospective chart review of patients. Methods: The treatment of 31 patients (13 male and 18 female patients) with mandibular and/or maxillary vascular malformations presenting between 1979 to 2001 was reviewed. Results: Thirteen patients (42%) presented with mandibular vascular malformations, and an equal number of patients had maxillary vascular malformations. Five patients had involvement of both the mandible and maxilla. Twenty‐six patients (84%) had adjacent soft tissue extension, whereas five patients had a vascular malformation isolated either to the mandible (four cases) or maxilla (one case). Twenty‐six cases consisted of arterial vascular malformations, and five patients had venous and capillary types. Twenty‐five patients (81%) were treated with embolization only, whereas six patients (19%) underwent combined embolization and surgical resection. “Cure” was defined as the complete eradication of disease or permanent resolution of symptoms with complete devascularization by embolization. The cure rates were 70% for mandibular malformations and 46% for maxillary lesions. None of the combined maxillary/mandibular lesions were cured, but all achieved improvement or stabilization of symptoms. The follow‐up range was 1 to 22 years with an average follow‐up of 6.7 years. Conclusion: The location and extent of vascular malformations dictate the treatment and resulting success. Endovascular therapy alone can effectively “cure” most mandibular and maxillary vascular malformations with limited soft tissue involvement. Extensive vascular malformations can be stabilized with control of symptoms, but eradication of the vascular malformation is unlikely even with combined surgery and embolization.
Identification of previously “undetectable” abnormalities of the bony labyrinth with computed tomography measurement
Authors: Purcell Derk D. , Fischbein Nancy , Lalwani Anil K.
Published: November 2003

Background: In patients with congenital sensorineural hearing loss (SNHL), a computed tomography (CT) scan of the temporal bone identifies inner ear malformations in approximately 25%, whereas the inner ear is grossly normal to visual inspection in the remaining 75% of the patients. In the latter group, the hearing loss is often attributed to radiologically undetectable abnormalities of the membranous labyrinth. However, subtle bony malformations may be missed because visual inspection alone is insensitive for detection. Objective: To test the hypothesis that there are subtle bony abnormalities of the inner ear in patients with SNHL who are radiologically deemed to have normal otic bone, using standardized measurements of the inner ear. Study Design: Retrospective review. Methods: Measurements of the cochlea, vestibule, and semicircular canals (SCCs) were made on axial and coronal temporal bone CT scans on 15 patients with normal hearing and 15 patients with congenital SNHL and grossly normal temporal bone CT scans. Student's t‐test was performed to compare the measurements of the two groups. Results: All studies from the SNHL group were deemed normal by visual inspection and standardized measurements (±2 SD from normal). Surprisingly, there were significant differences in the measurements of the cochlea and of the SCCs between patients with and without SHNL (P < .05). Conclusions: As a group, patients with SNHL and a “normal CT scan” have significant differences in the dimensions of the inner ear. This suggests that these patients have disturbed morphogenesis of both membranous and bony labyrinth. This novel observation has important implications for understanding the etiology of SNHL.
Quality of life after different treatment modalities for carcinoma of the oropharynx
Authors: Tschudi Dominique , Stoeckli Sandro , Schmid Stephan
Published: November 2003

Objectives: To assess the long‐term posttreatment quality of life of patients with carcinoma of the oropharynx treated with different treatment modalities. Study Design: Retrospective chart review and patient response to EORTC quality of life core questionnaire QLQ‐C30 and EORTC quality of life core head and neck cancer module QLQ‐H&N35 questionnaires. Methods: Two hundred and seventeen patients with carcinoma of the oropharynx were treated with curative intent between 1990 and 1998. In January 2001, a total of 111 disease‐free survivors were identified and included in this study. The questionnaires were completed by 99 patients (89% completion rate). Results: Of 99 patients, 31 patients were treated with surgery alone, 19 with radiation therapy alone and 49 with surgery followed by postoperative irradiation. Median follow‐up for the entire study group was 71 months. Physical, role, emotional, cognitive and social functioning reflected in the functional scale scores of the global EORTC QLQ‐C30 were generally good and showed no significant differences for the different treatment modalities. Comparison of the head and neck specific EORTC QLQ‐H&N35 scores revealed significantly less troubles with swallowing (P = 0.006), social eating (P = 0.007) and social contact (P = 0.008), dry mouth (P <0.0001), sticky saliva (P = 0.0001) and mouth opening (P = 0.001) in non‐irradiated patients versus those treated with any either primary or postoperative radiation therapy. Patients undergoing surgery (with and without postoperative irradiation) had less pain (P = 0.04), less problems with social eating (P = 0.009) and less restricted mouth opening (P = 0.03) than the nonsurgically treated patients. Conclusions: Quality of life after curative treatment of oropharyngeal carcinoma is generally good. Differences regarding quality of life between the different treatment modalities manifest themselves in the head and neck specific EORTC QLQ‐H&N35 module, not in the global core questionnaire EORTC QLQ‐C30.
Endoscopie posterior cricoid split and rib grafting in 10 children
Authors: Inglis Andrew F. , Perkins Jonathan A. , Manning Scott C. , Mouzakes Jason
Published: November 2003

Objective: To report our experience with endoscopic posterior cricoid split and rib graft insertion (EPCS/RG) in children with posterior glottic (PGS) and subglottic stenosis (SGS). Design: Retrospective analysis of case series, with 1 to 2 year follow‐up. Setting: Tertiary‐care pediatric referral center. Patients: Ten consecutive patients undergoing EPCS/RG. Intervention: EPCS/RG is a new procedure that expands the posterior glottic opening by dividing the posterior cricoid lamina endoscopically with a laser and inserting a rib cartilage graft through the laryngoscope. Main Outcome Measures: Laryngeal function and hospital stay. Results: Successful decannulation in two of two patients with PGS and one of five patients with PGS and SGS without further surgery. Of the four not initially decannulated, two were decannulated with adjunctive procedures, and the other two can now tolerate tracheostomy capping for extended periods of time. We achieved improvement in exercise tolerance in three nontracheotomy‐dependent patients. For those with established tracheotomies, median hospital stay was 3 days and intensive care unit care was unnecessary. There were no major complications or deterioration of voice or feeding. Conclusions: EPCS/RG appears to be safe and effective in the management of PGS in selected pediatric patients. This minimally invasive procedure has advantages over traditional open approaches and destructive endoscopic techniques (cordotomy and arytenoidectomy). The role of EPCS/RG alone in the face of severe grades of SGS appears to be limited.
Coblation tonsillectomy versus dissection tonsillectomy: Postoperative hemorrhage
Authors: Belloso Antonio , Chidambaram A. , Morar P. , Timms M. S.
Published: November 2003

Objectives/Hypothesis: Coblation tonsillectomy is a recently introduced surgical technique. To measure its benefits against traditional tonsillectomy techniques, it is necessary to compare their complication rates. The study aims to identify differences in reactionary and secondary hemorrhage proportions, comparing coblation with dissection tonsillectomy. Study Design: Prospective observational cohort study. Methods: Hates of reactionary and delayed postoperative hemorrhage were measured, comparing 844 coblation tonsillectomies with a control group of 743 tonsillectomies performed by blunt dissection with bipolar diathermy hemostasis. Results: The secondary hemorrhage rate with coblation‐assisted tonsillectomy was 2.25% compared with 6.19% in the control group (P < .05). The rate of secondary hemorrhage in children following coblation tonsillectomy was 0.95% compared with 4.77% in the control group (P < .05). The difference was also significant (P < .05) in the adult population (4.40% vs. 8.81%, respectively). No difference was found in the reactionary hemorrhage proportions. Conclusion: In the study, coblation tonsillectomy was associated with a lesser incidence of delayed hemorrhage, more significantly in the pediatric population. The new technique using tissue coblation for tonsil dissection offers significant advantages in the postoperative period compared with dissection tonsillectomy with bipolar diathermy hemostasis. Coblation is associated with less postoperative pain and early return to daily activities. Also, there are fewer secondary infections of the tonsil bed and significantly lower rates of secondary hemorrhage with coblation. These results and the disposable nature of the coblation equipment promote coblation tonsillectomy as the authors' preferred dissection method.
Comparison of postoperative facial nerve outcomes between translabyrinthine and retrosigmoid approaches in matched‐pair patients
Authors: Ho Steven Y. , Hudgens Stacie , Wiet Richard J.
Published: November 2003

Objectives/Hypothesis: The objective was to assess whether the translabyrinthine approach for acoustic tumor removal offers better postoperative facial nerve function compared with the retrosigmoid approach. Study Design: Retrospective case review from a tertiary otology referral center. Methods: Patients who had undergone either retrosigmoid or translabyrinthine approach for removal of acoustic neuroma from January 1, 1980, to December 31, 1999, were included in the study. Two groups of patients were created, one containing retrosigmoid cases and the other, translabyrinthine. Attempts were made to match each retrosigmoid case to a translabyrinthine case with regard to tumor size, patient age, and date of operation. This matching served to eliminate these variables from influencing postoperative facial nerve outcomes. From an initial pool of 450 patients, 35 pairs of patients were matched for the study. Facial nerve functions were reported at immediate, 3‐month, and 1‐year postoperative periods. Results: Patient demographics demonstrated that matched patients had almost identical tumor size, patient age, and date of operation. Comparisons of postoperative facial nerve functions between the matched groups revealed that retrosigmoid approach carried 2.86 times higher risk of facial nerve dysfunction during the immediate postoperative period. However, by 1 year, the facial nerve outcomes were similar between the two groups. Conclusion: Compared with the translabyrinthine approach, retrosigmoid approach carries a higher risk of postoperative facial nerve dysfunction during the immediate postoperative period. However, long‐term facial nerve outcomes are identical between the two approaches.
Evidence for surviving outer hair cell function in congenitally deaf ears
Authors: Rea Peter A. , Gibson William P. R.
Published: November 2003

Objective/Hypothesis: The hypotheses of the study were that congenital hearing impairment in infants can result from the isolated loss of inner hair cells of the cochlea and that this is shown by the presence of abnormal positive summating potentials on round window electrocochleography. The objectives were to establish the proportion of infants with hearing loss affected, the nature of the cochlear lesion, and its etiology. And to highlight the important implications for otoacoustic emissions testing and universal neonatal screening. Study Design: A prospectively conducted consecutive cohort study with supplemental review of notes was performed. Methods: Four hundred sixty‐four children underwent round window electrocochleography and auditory brainstem response testing under general anesthesia to assess suspected hearing loss. The presence of abnormal positive potentials was recorded. Otoacoustic emissions data were collected separately and retrospectively. Results: Three hundred forty‐two children had significant bilateral congenital hearing loss. All results were from hearing‐impaired children. Abnormal positive potentials were recorded in 73 of 342 children (21%). Eighty‐three percent of children with otoacoustic emissions also had abnormal positive potentials, but only 14% of children without otoacoustic emissions had abnormal positive potentials (P < .001). In the neonatal intensive care unit setting, 43% of infants were found to have abnormal positive potentials, whereas only 10% had abnormal positive potentials if not in the neonatal intensive care unit setting (P < .001). Abnormal positive potentials were present in 63% of infants born before 30 weeks gestation and in 14% of infants born at term (P < .001). Abnormal positive potentials were identified in 57% of infants with documented hypoxia and 11% of children with no episodes (P < .001). Otoacoustic emissions were present in 48% of infants from the neonatal intensive care unit, despite their hearing loss. Conclusion: Both otoacoustic emissions and abnormal positive potentials may originate from outer hair cell activity following inner hair cell loss. This may occur in more than 40% of hearing‐impaired children in the neonatal intensive care unit setting. Chronic hypoxia is the most likely cause. Otoacoustic emissions testing may not be a suitable screening tool for such infants.
Sequence dependence of β‐hairpin structure: Comparison of a salt bridge and an aromatic interaction
Authors: Kiehna Sarah E. , Waters Marcey L.
Published: November 2003

A comparison of the contributions and position dependence of cross‐strand electrostatic and aromatic side‐chain interactions to β‐sheet stability has been performed by using nuclear magnetic resonance in a well‐folded β‐hairpin peptide of the general sequence XRTVXVdPGOXITQX. Phe–Phe and Glu–Lys pairs were varied at the internal and terminal non–hydrogen‐bonded position, and the resulting stability was measured by the effects on α‐hydrogen and aromatic hydrogen chemical shifts. It was determined that the introduction of a Phe–Phe pair resulted in a more folded peptide, regardless of position, and a more tightly folded core. Substitution of the Glu–Lys pair at the internal position results in a less folded peptide and increased fraying at the terminal residues. Upfield shifting of the aromatic hydrogens provided evidence for an edge‐face aromatic interaction, regardless of position of the Phe–Phe pair. In peptides with two Phe–Phe pairs, substitution with Glu–Lys at either position resulted in a weakening of the aromatic interaction and a subsequent decrease in peptide stability. Thermal denaturation of the peptides containing Phe–Phe indicates that the aromatic interaction is enthalpically favored, whereas the folding of hairpins with cross‐strand Glu–Lys pairs was less enthalpically favorable but entropically more favorable.
Ingham Tauberian theorem with an estimate for the error term
Authors: Balanzario E. P. , Marmolejo-Olea E.
Published: November 2003

We estimate the error term in the Ingham Tauberian
theorem. This estimation of the error term is accomplished by
considering an elementary proof of a weak form of Wiener′s general
Tauberian theorem and by using a zero‐free region for the Riemann
zeta function.
City of Brass: The Art of Masking Reality in Digital Film
Authors: Bizri Hisham M.
Published: November 2003

The author's interest in film lies in its ability to expand consciousness and perception in ways unique to the medium. His films challenge the language of filmmaking, be it montage, color, sound, lighting, mise-enscène or acting. The author employs a wide palette of film vocabulary to mask reality and filter it through a personal vision. With the introduction of computers, new ways of seeing the world through film, and thus of acting in the world, may be accomplished.
Existential Technology: Wearable Computing Is Not the Real Issue!
Authors: Mann Steve
Published: November 2003

The author presents “Existential Technology” as a new category of in(ter)ventions and as a new theoretical framework for understanding privacy and identity. His thesis is twofold: (1) The unprotected individual has lost ground to invasive surveillance technologies and complex global organizations that undermine the humanistic property of the individual; (2) A way for the individual to be free and collegially assertive in such a world is to be “bound to freedom” by an articulably external force. To that end, the author explores empowerment via self-demotion. He has founded a federally incorporated company and appointed himself to a low enough position to be bound to freedom within that company. His performances and in(ter)ventions over the last 30 years have led him to an understanding of such concepts as individual self-corporatization and submissivity reciprocity for the creation of a balance of bureaucracy.
The NEXTPITCH Learning Classifier System: Representation, Information Theory and Performance
Authors: Federman Francine
Published: November 2003

NEXTPITCH, a learning classifier system (LCS) using genetic algorithms, inductively learns to predict the next note in a musical melody. NEXTPITCH models human music learning by developing the rules that represent actual pitch transitions in the melody. In this article, the author addresses the issues of (1) the impact of the representation of a domain (the encoding of the characteristics of the field of study) on the performance of an LCS and (2) the classification of the input (the melodies to be learned) to an LCS in order to determine the highest percentage of correct next-note predictions.
THE EFFECT OF HANDLING TIME ON INTERFERENCE AMONG HOUSE SPARROWS FORAGING AT DIFFERENT SEED DENSITIES
Authors: Johnson Cheryl , Giraldeau Luc-Alain , Grant James W.A.
Published: November 2003

Interference models of the ideal free distribution (IFD) assume competition among foraging animals causes intake rates to decline with increasing competitor density and that the strength of the decline influences forager distributions among food patches. However, the resulting distributions of animals may depend on which components of foraging success contribute to interference. We examined the effect of group size (1-13 birds) on the prey encounter rates, handling times, and foraging rates of house sparrows, Passer domesticus, feeding at three seed densities in a suburban backyard. House sparrows did not experience interference during search. Interference arose primarily from foraging time lost handling seeds. Foraging rates decreased with increasing seed density as a consequence of increased handling times. Also, birds experiencing significant increases in handling time with group size suffered most from interference. Our results suggest that animals adjust handling time to avoid costly aggressive interactions, indicating that handling time may be an important component of interference in some foraging systems. Future studies estimating interference should try to identify which components of foraging contribute to interference, paying particular attention to handling times for species that monitor and avoid competitors.
Book review: I.C. Jackson, The Refugee Concept in Group Situations
Authors:   Zieck
Published: November 2003

No Abstract
Wilhelm G Grewe. The Epochs of International Law
Authors:   Neff
Published: November 2003

No Abstract
Professor Wang Tieya and the Law of the Sea
Authors:   Haiwen
Published: November 2003

No Abstract
Judge Wang: Citizen of the World
Authors:   de Sampayo Garrido-Nijgh
Published: November 2003

No Abstract
Le Viol et le Droit de la Guerre dans la Doctrine
Authors:   Antonioni
Published: November 2003

No Abstract
Wang Tieya and International Law in Asia
Authors:   Swan Sik
Published: November 2003

No Abstract
Mary Ann Glendon. A World Made New- Eleanor Roosevelt and the Universal Declaration of Human Rights
Authors:   Hobbins
Published: November 2003

No Abstract
The Intertwining of Law and Theology in the Writings of Grotius
Authors: Thomas
Published: November 2003

No Abstract
On the integration of renewable energy systems within the built environment
Authors: Born F J , Clark J A , Johnstone C M , Kelly N J , Burt G , Dysko A , McDonald J , Hunter I BB
Published: November 2003

Future cities are likely to be characterized by a greater level of renewable energy systems deployment. Maximum impact will be achieved when such systems are used to offset local energy demands in contrast to the grid connection of large schemes. This paper elaborates a method whereby passive renewable technologies are deployed locally to reduce energy requirements while active renewable technologies are deployed to meet a significant portion of the residual demand. A modelling system for the identification of suitable schemes is then described and its application to a real case reported.
Artificial neural networks for predicting air flow in a naturally ventilated test room
Authors: Kalogirou S A , Eftekhari M M , Pinnock D J
Published: November 2003

The objective of this research is to investigate air flow distribution inside a light weight test room which is naturally ventilated using artificial neural networks. The test room is situated in a relatively sheltered location and is ventilated through adjustable louvres. Indoor air temperature and velocity are measured at four locations and six different levels. The outside local temperature, relative humidity, wind velocity and direction are also monitored. The collected data are used to predict the air flow across the test room. A multi-layer feedforward neural network was employed with three hidden slabs. Satisfactory results with correlation coefficients equal to 0.985 and 0.897, for the indoor temperature and combined velocity, respectively have been obtained when unknown input data, not used for network training, were used as input. Both values are satisfactory especially if the fact that combined velocity readings were very unstable is considered. The work presented in this paper primarily aims to show the suitability of neural networks to perform such predictions. In order to make the method more usable the training database needs to be enriched with readings from actual measurements from a number of applications.
A new method of measuring the thermal conductivity of moist masonry units
Authors: Levitt M
Published: November 2003

A laboratory method for measuring the thermal conductivity of moist masonry units allowing free evaporation at the cold face has been developed. The data was found to be similar to that obtained by others in Standard mini-wall hot-box tests. Tests were also carried out on nominally dry and moist masonry units using the Standard guarded hot-plate method. The method was also modified in order to vary moisture contents without dismantling the apparatus. Results from units having up to about 3% v/v moisture content were found to relate to the oven-dry and not to the moist state. This was observed to have been due to a concentration of moisture at the cold plates leaving most of the material dry. Significant increases in conductivity were only observed at higher moisture contents.