bluuebunny/crossref_metadata_2025 huggingface dataset:
Lectin Histochemistry of Laryngeal Squamous cell Carcinomas
Authors: TSAMBAOS DIONYSIOS , PASMATZI EFI , MANOLOPOULOS LEONIDAS , KAPRANOS NIKIFOROS , GOUMAS PANOS , ADAMOPOULOS GEORGE
Published: November 2005

A panel of five biotinylated lectins was applied to study the presence and distribution of membrane carbohydrate residues in the normal laryngeal epithelium and in laryngeal squamous cell carcinomas (SCCs) of 86 patients with the avidin‐biotin peroxidase complex technique. The lectin‐binding pattern of well‐differentiated SCCs was comparable to that of the spinous cells of the normal laryngeal epithelium. In the less differentiated SCCs, staining of the keratinocyte plasma membrane with lectins was either reduced or absent, indicating a decline in the glycosylation of cell surface glycoconjugates. The lectins applied here could be used in the rapid assessment of less‐differentiated areas within a laryngeal SCC, but they cannot be regarded as reliable markers of laryngeal keratinocytes undergoing malignant transformation. (Otolaryngol Head Neck Surg 1998;118:886‐91.)
Approach to the vestibular patient and driving: A patient perspective
Authors: Sindwani Raj , Parnes Lorne S. , Goebel Joel A. , Cass Stephen P.
Published: November 2005

OBJECTIVES

To learn about the impact of dizziness on driving from a patient perspective and to present an approach to the vestibular patient and driving.

DESIGN

An anonymous questionnaire completed by 265 dizzy patients at 3 different centers.

RESULTS

The participants were experienced drivers who needed to drive to function normally (83%). Those with constant or severe dizziness comprised a higher risk group of drivers. Although few had ever been warned not to drive, 52% said that if they were warned to stop driving, they would not. Most thought that it was the doctor's role to report unsafe drivers to the authorities (P < 0.001, χ2 = 87.2670).

CONCLUSIONS

The diagnosis of a vestibular disorder should not alone be grounds to suspend a patient's driver's license. Legislation should be amended to better reflect the views of doctors and patients alike.
Permeability of tympanotomy tubes to ototopical preparations
Authors: Arnold David J. , Bressler Kyle L.
Published: November 2005

Myringotomy with tube placement is the most frequently performed otolaryngologic procedure in the United States, and purulent otorrhea after this procedure is not uncommon. Believing that ototopical preparations have proved useful in treating this malady, our group was compelled to examine whether and in what quantities these preparations are able to penetrate tympanotomy tubes. To this end, models were constructed and in vitro testing carried out with several popular formulations.
Efficacy of a eutectic mixture of local anesthetics as a topical anesthetic in minor otologic procedures
Authors: Koutnouyan Hrair A. , Rasgon Barry M. , Cruz Raul M.
Published: November 2005

A eutectic mixture of local anesthetics (EMLA), prepared as a cream, is an oil‐in‐water emulsion of 2 anesthetic agents—lidocaine and prilocaine. Several clinical applications of EMLA cream, its effectiveness as a topical anesthetic, and its safety profile have been previously reported. We report our experience with EMLA cream in 17 adult and 24 pediatric patients. We find EMLA to be the preferred anesthetic for performing minor outpatient otologic procedures in adults. We also find EMLA to be a safe, well‐tolerated alternative to general anesthesia in some pediatric patients. Potential cost savings of EMLA cream during pediatric myringotomies in the clinic are also discussed.
Comparison of optokinetic nystagmus elicited by full versus partial visual field stimulation: Diagnostic implications
Authors: Kveton John F. , Limb Charles J. , Bell Moira D.
Published: November 2005

Optokinetic nystagmus (OKN) testing is one method to determine central vestibular dysfunction. OKN may be elicited by partial visual field stimulation with a light bar (OKN‐ENG) or by full visual field stimulation with rotating stripes in a rotational chair test booth (OKN‐RVT). OKN‐ENG and OKN‐RVT were elicited in 36 healthy subjects and 48 patients with known peripheral or central vestibular disorders. Abnormal test results suggested central pathology in 29 of 36 healthy subjects with OKN‐ENG versus 1 of 36 with OKN‐RVT. Twenty‐eight of 33 patients with peripheral pathology demonstrated abnormal OKN‐ENG findings, whereas 4 of 33 had abnormal OKN‐RVT results. Thirteen of 15 patients with central vestibular disorders had abnormal OKN‐ENG, whereas 7 of 15 had abnormal OKN‐RVT. Sensitivity and specificity of OKN‐ENG were 86.7% and 17.4% versus 46.7% and 92.7%, respectively, for OKN‐RVT. These findings were statistically significant (P < 0.00001). OKN elicited by full visual field stimulation (OKN‐RVT) is a more accurate indicator of central disease than OKN elicited by partial visual field stimulation (OKN‐ENG). The use of OKN‐ENG to identify central vestibular dysfunction is questionable.
Patterns of nodal metastasis and surgical management of the neck in supraglottic laryngeal carcinoma
Authors: Hicks Wesley L. , Kollmorgen Daniel R. , Kuriakose M. Abraham , Orner James , Bakamjian Vahram Y. , Winston Janet , Loree Thom R.
Published: November 2005

BACKGROUND

Appropriate management of the clinically negative (N0) neck in supraglottic laryngeal cancer continues to be an area of controversy in head and neck surgery. Our treatment policy has been aggressive surgical management even in the clinically N0 neck.

METHODS

Between 1971 and 1991, 104 patients had the primary diagnosis of supraglottic laryngeal cancer. Ninety of these patients received their treatment at Roswell Park Cancer Institute and are the subject of this retrospective review.

RESULTS

All neoplasms included in this study were squamous cell cancers. The most common subsite involved with tumor in our series was the epiglottis, followed by the aryepiglottic folds and false cords. Supraglottic laryngectomy was performed of 29% of the cases; the remainder received total laryngectomy. Thirty‐six percent of the patients had pathologic stage I/II disease, and 64% had stage III/IV. The 5‐year survival rates were 100%, 81%, 73%, and 63% for stages I through IV, respectively. Fifty‐seven patients had clinically N0 disease at presentation; of these 34 underwent elective neck dissection, and the remaining 23 patients were observed. Of those patients receiving neck dissection, 30% (n = 10) were found to have histologically positive disease, and of the 23 patients observed, 30% (n = 7) had histologically positive regional (neck) disease. Of the 17 clinically N0 and pathologically N+ patients, 82% (14 of 17) had involvement of level I (submandibular triangle), and 100% had involvement of level II. The incidence of bilateral disease in the clinically N0 patient was 44%. There were no local failures.

CONCLUSIONS

There is a high incidence of occult regional disease even in early‐stage supraglottic squamous cell carcinoma of the larynx. In the surgical management the clinically N0 neck, we presently recommend bilateral neck dissection of levels I through IV to adequately address those regions at highest risk for occult disease.
Calvarial bone graft harvest in children
Authors: Frodel John L.
Published: November 2005

Bone grafts are occasionally required in the reconstruction of bony defects in the pediatric population. Strong recommendations have existed in the past toward the use of principally inner table bone grafts in children. In this retrospective series with an upper age limit of 14 years, outer table calvarial bone grafts were used as the material of choice for bony reconstructions. There were no complications relative to the outer table graft harvest in any of these 12 patients. Discussion of harvest techniques in different pediatric age groups will be reviewed.
Management paradigms for posterior epistaxis: A comparison of costs and complications
Authors: Monte Eric D. , Belmont Michael J. , Wax Mark K.
Published: November 2005

OBJECTIVES

Posterior epistaxis is a common otolaryngologic emergency. Management is controversial because of the many treatment options available. These options vary in efficacy, rates of complications, and cost. Posterior nasal packing is the medical management most frequently used to control posterior epistaxis. It is associated with major complications, including stroke, myocardial infarction, arrhythmias, and death. Because of these potential complications, many otolaryngologists monitor patients with posterior nasal packing in the intensive care unit (ICU). However, the level of care used to monitor these patients is variable, and standards have not been established.

METHODS

From 1991 to 1997, 46 patients had posterior nasal packing placed to control epistaxis. Management, complications, and hospital charges were analyzed.

RESULTS

Six patients (13%) were admitted to the ICU, 2 (4%) were admitted for telemetry monitoring, and 38 (83%) were sent to the ENT ward for continuous pulse oximetry. Four major complications occurred (1 episode of syncope [emergency department], 2 arrhythmias [ICU], and 1 death [hospice]). Twenty‐six patients were treated with posterior packing in the ENT ward, at a mean cost of $2988. Fourteen patients underwent intervention (5 ligations, 6 endoscopic cauterizations, and 3 angiograms), with a mean cost of $5482. Six patients spent time in the ICU, with a mean cost of $8242. Patients treated in the ENT ward had significantly lower costs than those undergoing intervention (P = 0.017) or those admitted to the ICU (P = 0.020).

CONCLUSION

We propose that most patients with posterior epistaxis can be treated in specialized ENT wards. This can be done without increasing complications and with significantly decreased costs.
Critical pathways in anterior cranial base surgery
Authors: Moore Charles E. , Ross Donald A. , Marentette Lawrence J.
Published: November 2005

New advances in anterior cranial base surgery have dictated the need for a comprehensive, multidisciplinary approach in the treatment of lesions of this area, necessitating multiple modes of diagnostic and surgical techniques. Traditional consideration of the complex problems presented by neoplastic involvement of the anterior cranial base predicated on isolated syndrome analysis is no longer sufficient to adequately assess tumor pathology. To address these complex problems, we discuss a method of localization of pathology based on anatomic structure and function as well as the corresponding surgical approach to the anterior cranial base.
Long‐term study of quality and safety of osseointegration for the retention of auricular prostheses
Authors: Westin Thomas , TjellstrÖm Anders , Hammerlid Eva , BergstrÖm Kerstin , Rangert Bo , Myers Eugene N.
Published: November 2005

The aim of this article is to describe the safety and quality of the osseointegrated implant technique for the retention of craniofacial prostheses, to present a protocol for collection of clinical data, and to discuss the impact of the procedure on the patient quality of life. A protocol was designed and used to study patients who had received auricular prostheses consecutively since 1979 at our department. The patients were asked to answer a questionnaire designed to describe symptoms and problems specific for someone wearing an auricular prosthesis. In total, 99 patients received 107 prosthetic ears (8 patients had bilateral defects) retained on 309 implants (2 to 4 implants/ear). Patients of all ages were represented, and only 9 discontinuities were reported. Most patients (95%) wear their prosthesis every day, in most cases more than 10 hours/day. The follow‐up period ranged from 1 to 12 years, giving a total of 2624 postoperative observations of implants, with a 3% incidence of significant skin reaction. We conclude that the surgical technique for auricular prostheses retained on osseointegrated implants is simple and associated with a low rate of peroperative and long‐term complications. It offers a high degree of stability and aesthetic satisfaction.
Central Nervous System Metabolic Activity after Cochlear Implantation in the Feline Neonatal Model
Authors: Baylor Jeffrey E. , McFeely William J. , Antonelli Patrick J.
Published: November 2005

OBJECTIVE

To determine the effects of deafening and cochlear implant stimulation on central nervous system (CNS) metabolic activity in the feline neonate model.

BACKGROUND

Deafening of fetal animals has been shown to result in acute, profound depression of CNS glucose metabolism, in both auditory structures and the cerebral hemispheres. Preliminary studies have suggested that electrical stimulation of the auditory system may increase central nervous metabolic activity after deafening. The purpose of this study was to investigate this possibility.

METHODS

This was a prospective, randomized, blinded, and controlled animal study of 13 random‐source newborn kittens. It was set in an animal research facility for otologic disorders.

OUTCOME

Deoxyglucose metabolism (assessed with autoradiograph densitometry) of brain cross‐sections of normal, deafened, and deafened and cochlear‐implanted animals after 6 weeks of auditory stimulation or deprivation.

RESULTS

Chronic deafening did not result in a profound reduction in CNS metabolic activity. Cochlear implantation and electrical stimulation did not significantly raise the level of CNS metabolic activity within either auditory pathways or the cerebral hemispheres.

CONCLUSIONS

Deafening is not associated with significant chronic reduction in CNS metabolic activity. Other parameters of CNS activity and maturation may be necessary to assess the effects of cochlear implantation and stimulation in animal models.
Early Detection and Treatment of Postoperative Pharyngocutaneous Fistula
Authors: Friedman Michael , Venkatesan T. K. , Yakovlev Alexander , Lim Jessica W. , Tanyeri Hasan M. , Caldarelli David D.
Published: November 2005

Fever during the early postoperative period traditionally has not been considered an indication of a postoperative wound infection or breakdown. Atelectasis is considered the most likely source for these early fevers. We studied 200 consecutive patients who underwent major head and neck surgery that involved reconstruction with a pharyngeal suture line. Patients were divided into 2 groups: those who had preoperative irradiation and those who did not. All patients had prophylactic antibiotic coverage, and all patients had identical suture material for closure. We showed a high correlation between fever (>101.5°F) that developed in the first 48 hours and eventual fistula formation and wound infection. We also studied length of hospitalization and number of days until decannulation and resumption of oral feedings. Our data indicate that in those patients in whom fistulas developed, early detection led to earlier healing and rehabilitation.
Dysphonia and Delayed Food Allergy: A Provocation/ Neutralization Study with Strobovideolaryngoscopy
Authors: Dixon Hamilton S.
Published: November 2005

In most cases the cause of intermittent dysphonia remains undiagnosed. This descriptive study explores the relationship between this problem and delayed food allergy. Double‐blind intradermal provocation/neutralization skin tests to food antigens were used to do 12 tests in 10 subjects with food allergies. Strobovideolaryngoscopy was used to document changes in the vocal folds and in the quality of the voice. Double‐blind measurements of signs and symptoms, digital audio recordings of the voice for perceptual and acoustic analysis, and aerodynamic laryngeal airflow and resistance measurements were done. The cause of dysphonia appeared to be associated with an increase in thick mucus production and irregular and asymmetric glottic edge edema of the vocal folds. Elimination of the positive specific foods resulted in cessation of dysphonia in all the test subjects. Statistical analysis was not done because of the lack of parametric data for paired analysis, lack of sufficient data points for resampling statistics, and the small sample size.
Quality‐of‐Life Outcomes after Osteoplastic Frontal Sinus Obliteration
Authors: Alsarraf Ramsey , Kriet J. David , Weymuller Ernest A.
Published: November 2005

Frontal sinusitis and its treatment remain controversial. Although several authors have evaluated the results of traditional endoscopic sinus surgery, few have assessed patient outcomes and quality of life after osteoplastic frontal sinus obliteration. This retrospective study evaluates these outcomes in a postoperative review and questionnaire of 39 patients treated at the University of Washington from 1991 to 1994. Most patients were satisfied with the results of this procedure, had significant improvements in their Chronic Sinusitis Survey scores, and reported decreased clinic visits and antibiotic use. However, approximately half thought nonsurgical treatments were more effective and continued to require other medical therapy; 30% required additional surgical intervention. Such outcomes may reflect the ineffectiveness of frontal sinus obliteration to treat the chronic symptoms of patients affected by the refractory underlying disease process of chronic sinusitis; however, despite these mixed results, we found a significant decrease in annual days of lost work or activity in this study group after osteoplastic obliteration.
Growth of Keloid‐Producing Fibroblasts in Commercially Available Serum‐Free Media
Authors: Hong Raymond H. , Lum Joanne , Koch R. James
Published: November 2005

The purpose of this study was to update our in vitro serum‐free keloid fibroblast (KF) model by use of commercially available media. Prior evaluations of fibroblast characteristics in vitro, especially that of growth factor measurement, have been confounded by the presence of serum‐containing media. KFs were obtained from patients undergoing facial keloid removal. The 4 commercially available serum‐free media evaluated were AIM‐V (Gibco, Grand Island, NY), Fibroblast Growth Medium (FGM; Clonetics, San Diego, CA), HB GRO (Irvine Scientific, Santa Ana, CA), and UltraCULTURE (BioWhittaker Inc, Walkersville, MD). The main outcome measures were sustained KF growth and viability as compared with serum‐based models. The KFs in UltraCULTURE had a higher viability but did not grow as well as in FGM. The KFs in HB GRO and AIM‐V demonstrated significantly decreased viability. Because of FGM's satisfactory proliferative support and viability comparable with serum‐based medium, it is recommended for the in vitro propagation of keloid‐producing fibroblasts.
Long‐Term Follow‐Up of Submandibular Duct Rerouting for the Treatment of Sialorrhea in the Pediatric Population
Authors: Mankarious L A. , Bottrill Ian D. , Huchzermeyer Phillipa M. , Bailey C. Martin
Published: November 2005

OBJECTIVE

To determine the long‐term control of sialorrhea in children who underwent submandibular duct rerouting (SMDR) and to identify potential preoperative predictors of outcome.

DESIGN

Retrospective chart review of children who underwent SMDR; information updated by discussion with the permanent caregiver.

SETTING

Tertiary care center.

PATIENTS

Children who had significant sialorrhea resulting from a variety of neuromuscular disabilities between January 1980 and December 1995.

OUTCOME

We report the outcome on 59 patients who underwent SMDR for the treatment of sialorrhea. Patients were ascribed a preoperative sialorrhea and global neurologic deficit score. Postoperative outcome was scored as marked, moderate, no improvement, or worse. Twenty‐eight of 59 (47.4%), 28 of 59 (47.4%), and 3 of 59 (5.1%) of the patients had preoperative sialorrhea scores of 3 (profuse), 2 (moderate), and 1 (mild), respectively. Twenty of 59 (33.9%), 29 of 59 (49.2%), and 10 of 59 (16.9%) had preoperative scores of 3 (severe), 2 (moderate), and 1 (mild) neurologic impairment, respectively. Mean time to follow‐up of the 59 patients was 5.46 years. Postoperative improvement scores were as follows: 50.8% had marked, 28.8% had moderate, and 20% had no to minimal improvement in their sialorrhea. Two patients were transiently worse. A complication rate of 11.3% (9 of 79) was demonstrated: 7 ranulae, 1 transient swelling of the floor of the mouth, and 1 submandibular gland infection. The preoperative global neurologic deficit score was found to be more predictive of surgical outcome than sialorrhea score.
Botulinum Toxin Injection to Improve Tracheoesophageal Speech after Total Laryngectomy
Authors: Zormeier Michele M. , Meleca Robert J. , Simpson Mark L. , Dworkin James P. , Klein Roger , Gross Martin , Mathog Robert H.
Published: November 2005

Total laryngectomy patients, after undergoing a tracheoesophageal puncture (TEP), may have poor TEP speech because of hypertonicity or spasm of the pharyngoesophageal segment (PES). Conventional treatment options include speech therapy, PES dilation, pharyngeal neurectomy, and myotomy. Botulinum toxin injection into the PES has recently been reported to be effective for this disorder. However, data accumulated were based primarily on subjective analyses. This prospective investigation used both qualitative and quantitative measures to assess the effects of videofluoroscopy‐guided botulinum toxin injection on TEP voice quality in laryngectomees with PES dysfunction. Patients underwent voice analyses, tracheal air pressure measures, and barium swallows before and after botulinum toxin injection. Seven of 8 patients had significant voice quality improvement, and tracheal air pressures normalized in 6 of 8 patients after injection. Videofluoroscopic botulinum toxin injection into the PES is efficacious, safe, and cost‐effective and should be considered as a first‐line therapy for the treatment of laryngectomees with poor quality TEP speech caused by PES dysfunction.
Symptoms as an Index of Biologic Behavior in Head and Neck Cancer
Authors: Pugliano Frederic A. , Piccirillo Jay F. , Zequeira Maria R. , Fredrickson John M. , Perez Carlos A. , Simpson Joseph R.
Published: November 2005

The TNM staging system for head and neck cancer is based on the morphologic description of the tumor and disregards the clinical condition of the patient. Cancer symptoms were evaluated as a biologic index of disease to improve survival estimates. The medical records of 1010 patients receiving initial cancer treatment between 1980 and 1991 were retrospectively reviewed. The mean survival duration was 62 months for the entire population. By use of SAS statistical software (SAS Institute, Cary, NC), 48 symptom variables were screened by univariate analysis, and 23 of these variables were selected for entry into a Cox proportional hazards model on the basis of survival duration. Dysphagia, otalgia, neck lump, and weight loss were identified as independent predictors of survival duration (P <0.01). A composite symptom‐severity staging system was created on the basis of the 4 symptoms. Mean survival duration (95% CI) by symptom‐severity stage was as follows: none, 74 months (70 to 79 months); mild, 56 months (51 to 61 months); moderate, 40 months (33 to 47 months); and severe, 31 months (22 to 41 months) (χ2 = 30.8, P = 0.0001). Survival duration by TNM stage was as follows: I, 89 months (82 to 95 months); II, 71 months (65 to 78 months); III, 53 months (47 to 59 months); and IV, 42 months (37 to 47 months) (χ2 = 56.2, P = 0.0001). When symptom‐severity stage was entered in a proportional‐hazards model along with TNM stage, comorbidity, age, and alcohol use, all 5 variables were independently predictive of survival duration (risk ratio: symptom severity 1.28, TNM 1.33, comorbidity 1.80, age 1.47, alcohol use 1.09). Appropriately defined symptom variables contain important prognostic information, which is independent of the TNM system. Therefore symptoms provide an index of biologic behavior in head and neck cancer.
Comparison of 3 Different Anesthetic Techniques on 24‐Hour Recovery after Otologic Surgical Procedures
Authors: Jellish W. Scott , Leonetti John P. , Fahey Karen , Fury Patricia
Published: November 2005

Intravenous propofol anesthesia is better than inhalational anesthesia for otologic surgery, but cost and intraoperative movement make this technique prohibitive. This study compares a propofol sandwich anesthetic with a total propofol or inhalational anesthetic for otologic surgery to determine which produces the best perioperative conditions and least expense. One hundred twenty patients undergoing ear surgery were randomly chosen to receive an anesthetic with either isoflurane (INHAL), total propofol (TPROP), or propofol used in conjunction with isoflurane (PSAND). Postoperative wakeup and the incidence and severity of nausea, vomiting, and pain were compared among groups. Antiemetic administration and discharge times from recovery and the hospital were also compared. The groups were similar, but anesthesia times were longer in the INHAL group. Emergence from anesthesia after PSAND or TPROP was more rapid than after INHAL. Recovery during the next 24 hours was associated with less nausea and vomiting with PSAND than with INHAL. The cost of the PSAND anesthetic was similar to that of INHAL, and both were less than TPROP. PSAND anesthesia may be similar to TPROP and better than INHAL for otologic procedures. PSAND was less expensive than TPROP and produced a similar recovery profile and anti‐emetic effect in the 24‐hour period after surgery.
Physical and Psychosocial Correlates of Head and Neck Cancer: A Review of the Literature
Authors: De Boer Maarten F. , McCormick Laura K. , Pruyn Jean F. A. , Ryckman Richard M. , van den Borne Bart W.
Published: November 2005

This article reviews recent literature on the physical and psychosocial correlates of head and neck cancer, with a focus on quality‐of‐life issues, rehabilitation outcomes, and changes in the literature from the previous decade. These studies have shown that head and neck cancer has an enormous impact on the quality of life of patients. The most important physical symptoms are speech problems, dry mouth and throat, and swallowing problems. Pain is also frequently reported. Disturbances in psychosocial functioning and psychological distress are reported by a considerable number of patients; worry, anxiety, mood disorder, fatigue, and depression are the main symptoms. Cancer of the head and neck has a negative effect on social, recreational, and sexual functioning. Despite a growing number of longitudinal studies, little is known about the rehabilitation outcomes over a longer period of time. Future research is necessary to form a consensus about the further development and use of specific instruments to study patients with cancer of the head and neck, to conduct more prospective studies, and to develop programs that are aimed at maximizing rehabilitation outcomes and evaluate these programs with randomized designs.
Malleus‐to‐Footplate Prosthetic Interposition: Experience with 265 Patients
Authors: Colletti Vittorio , Fiorino Francesco G.
Published: November 2005

Absence of the long process of the incus with or without absence of the stapes head accounts for more than 80% of ossicular discontinuities. Total or partial replacement prostheses, made of various materials, are interposed to restore the transfer function of the middle ear. To simplify ossicular reconstruction, reduce operative times and costs, improve functional outcomes, and avoid the risk of infections, we have adopted, during the past 10 years, a technique that makes use of a personally designed alloplastic prosthetic device. The prosthesis connects the malleus to the footplate, even in the presence of the stapes superstructure. This malleus‐to‐footplate prosthesis consists in a plastipore‐coated steel piston and hydroxyapatite head, complete with a groove. The groove is placed beneath the malleus neck after dissection of the tensor tympani tendon and the shaft of the piston on the footplate. Two hundred ninety primary ossiculoplasties with the malleus‐to‐footplate prostheses were performed in 265 patients from 1986 to 1995 in the ENT Department of the University of Verona. The average postoperative air‐bone gap at 0.5 to 3 kHz was 11 dB at 1 year and 14 dB at 5 years. These outcomes are significantly better than those personally obtained previously with ossicular or alloplastic prostheses. No extrusions occurred. The structural characteristics of the malleus‐to‐footplate prosthesis endow the prosthesis with a high degree of biocompatibility and stability and optimal sound‐transfer function. The rationale for this particular ossiculoplasty procedure is discussed.
Hearing Screening in the Newborn Intensive Care Nursery: Comparison of Methods
Authors: Rhodes Mark C. , Margolis Robert H. , Hirsch Judith E. , Napp Ann P.
Published: November 2005

Patients in the neonatal intensive care unit were tested by hearing screening tests including auditory brain stem response (ABR), transient and distortion‐product otoacoustic emissions (TEOAEs and DPOAEs), and acoustic stapedius reflex (ASR), and by middle ear function tests including multifrequency tympanometry and pneumatic otoscopy. Pass rates on hearing tests were 75% to 89%. TEOAEs produced the lowest pass rate, and DPOAEs the highest. TEOAE, DPOAE, or ASR testing followed by ABR testing of initial failures produced pass rates of about 90%. The most efficient combination was DPOAEs followed by ABR. Pass rates tended to decrease with age. Of patients who failed 226‐Hz and 678‐Hz tympanometry, 30% to 67% passed hearing tests, suggesting a high false‐positive rate for these immittance tests. The 3 ears that failed the 1000‐Hz tympanogram failed all hearing tests. Many ears were abnormal by pneumatic otoscopy but passed hearing tests, suggesting that the usual ear examination criteria may not apply to infants.
Oral and Oropharyngeal Squamous Cell Carcinoma in Young Adults: A Report on 13 Cases and Review of the Literature
Authors: Hart Anna Kristina E. , Karakla Daniel W. , Pitman Karen T. , Adams Janice F.
Published: November 2005

OBJECTIVE

Squamous cell carcinoma (SCC) of the head and neck is rare in patients younger than 45 years. Patients aged 18 to 45 years with SCC of the oral cavity (OC) and oropharynx (OP) were retrospectively compared with older control subjects.

METHODS

Twenty of 127 patients with OC/OP SCC were young adults. Thirteen patients (10 men) comprise the present series; 9 had OC lesions. Seven case controls were identified.

RESULTS

Overall, 15.75% of patients with OC/OP SCC were 18 to 45 years old. Seven OC lesions were early stage, and 2 were late stage; OP lesions were evenly divided. Eleven of 13 patients were disease free at the time of their last visit; 2 died of disease. Thirty‐one percent of young patients were heavy drinkers; 77% of them smoked.

CONCLUSIONS

Young adults' survival rate resembles that reported for all patients with head and neck cancer stage for stage. Tobacco and alcohol abuse prevention among young people is imperative. Health care providers who encounter a young patient with a suspicious head or neck lesion must include malignancy in their differential diagnosis.
Needs Assessment for an Undergraduate Otolaryngology Curriculum
Authors: Carr Michele M. , Brown Dale H. , Reznick Richard K.
Published: November 2005

A needs assessment was conducted to determine what family doctors need to know about otolaryngology. A survey was mailed to a group of community otolaryngologists and family doctors. They were asked to rate the importance of 46 otolaryngologic topics. A true needs assessment was carried out with a small group of family practice residents to examine which needs were perceived to be significantly different in importance between these 2 survey groups. A list of important topics was generated from the survey. There were many statistically significant differences between the survey groups, but only 2, vertigo and epistaxis, appeared to be potentially important. The family practice residents (n = 8) were asked to complete a short‐answer test about epistaxis management and then to demonstrate placement of an anterior nasal pack. Despite having already faced this problem in 50% of cases, the residents had average scores of less than 30%, indicating a lack of knowledge in this area.
Mucin Production in the Middle Ear in Response to Lipopolysaccharides
Authors: Hunter Shannon E. , Singla Aneesh K. , Prazma Jiri , Jewett Brian S. , Randell Scott H. , Pillsbury Harold C.
Published: November 2005

OBJECTIVE

This study examined the response of middle ear tissue to establish the lowest dose of lipopolysaccharide to induce mucin production in a rat otitis media model.

METHODS

Twenty‐six male Sprague‐Dawley rats' eustachian tubes were obstructed before transtympanic inoculation of the bulla tympanica with 35 μL of Krebs Ringer or 1, 10, 100, or 1000 μg/mL lipopolysaccharide. After 7 days the effusion and a lavage were collected for mucin ELISA measurement, and tissue was collected for histologic evaluation.

RESULTS

Mucin secretion was significantly increased in the 100 μg/mL 51.20 ± 13.6 μg/mL (SE) and 1000 μg/mL 69.42 ± 8.57 μg/mL groups when compared with the Krebs Ringer control group 1.84 ± 0.28 μg/mL (P < 0.05). Histologic evaluation shows goblet cell metaplasia and hyperplasia in the middle ear epithelium in the 1000 and 100 μg/mL groups.

CONCLUSIONS

The histology and ELISA results suggest that a middle ear effusion is generated with a dose of lipopolysaccharide as low as 100 μg/mL.
Signal Transduction Pathway in Human Middle Ear Cholesteatoma
Authors: Myers Eugene N. , Park Keehyun , Chun Young‐Myoung , Lee Dong‐Hoon , Hwang Sung Chul
Published: November 2005

Phospholipase C‐γ1 plays a central role in signal transduction, and it is important in cellular growth, differentiation, and proliferation. Human cholesteatoma in the middle ear is characterized by the presence of a keratinizing epithelium that is believed to have hyperproliferative properties. The purpose of this study is to elucidate the distribution of phospholipase C‐γ1 in cholesteatoma matrix and deep meatal skin with Western blot analysis and immuno‐histochemistry. In conclusion, overexpression of phospholipase C‐γ1 in cholesteatoma matrix suggests a possible derangement of enhanced growth signal transduction in keratinocytes.
URBAN HEALTH AND PHARMACEUTICAL CONSUMPTION IN DELHI, INDIA
Authors: DAS VEENA , DAS RANENDRA K.
Published: November 2005

This paper interrogates the routine and unproblematic use of terms such as ‘self-medication’ in biomedical and anthropological discourse. A typical depiction of the social factors that explain the practice of ‘self-medication’ in India is to put together the supply side factors (such as protection offered by the government for the production of generic drugs, especially in the small scale sector, and expansion of the number of drug store outlets), with the increasing demand for allopathic drugs. The paper provides an ethnographic account of the intricate connections between households and biomedical practitioners in urban neighbourhoods in Delhi. It breaks away from the conventional opposition drawn between the practices of physicians and the beliefs of their patients, and suggests that what constitutes the medical environments of these neighbourhoods is the product of medical practices, household economies and concepts of disease. Thus pharmaceutical use is determined as much by practices of dispensation and by how practitioners understand what constitutes therapy as by household understanding of the normal and the pathological. This paper uses both quantitative data and narrative interviews to provide an in-depth understanding of the circulation of pharmaceuticals within the life worlds of the urban poor.
ABSTAIN OR DIE: THE DEVELOPMENT OF HIV/AIDS POLICY IN BOTSWANA
Authors: HEALD SUZETTE
Published: November 2005

This paper traces the development of policies dealing with HIV/AIDS in Botswana from their beginning in the late 1980s to the current programme to provide population-wide anti-retroviral therapy (ARV). Using a variety of source material, including long-term ethnographic research, it seeks to account for the failure of Western-inspired approaches in dealing with the pandemic. It does this by looking at the cultural and institutional features that have created resistance to the message and inhibited effective implementation. The negative response to the first educational campaign stressing condom use is described and contextualized in terms of Tswana ideas of morality and illness. Nor, as was initially expected, did the introduction of free ARV therapy operate to break the silence and stigma that had developed around the disease. Take-up was very slow, and did not operate to encourage widespread testing. In 2003, key policymakers in Botswana began to argue for a break with the AIDS ‘exceptionalism’ position, with its emphasis on voluntarism, confidentiality and the human rights of patients. This resulted in routine testing being introduced in 2004. This links to a major argument running through the paper which is that the failure of policy cannot be attributed solely to the nature of local populations. Western cultural assumptions about ‘good practice’ also require critical examination.
Exchange Rates, Monetary Policy, and Interest Rates in the Dominican Republic during the 1990s Boom and New Millennium Crisis
Authors: SÁNCHEZ-FUNG JOSÉ R.
Published: November 2005

This article gives an account of the developments in the Dominican Republic's economy from the 1990s boom to the crisis of the new millennium, focusing on the monetary and exchange rate dynamics behind that transition. It is argued that the liberalisation of interest rates in the 1990s, together with an appreciated real exchange rate and weak bank supervision, led to the dollarisation of the banking system. These and other structural imbalances exacerbated the impact of a series of adverse shocks on the economy at the beginning of the millennium, including a banking crisis costing approximately 20 per cent of gross domestic product in 2003.
Cuba–Soviet Relations in the Gorbachev Era
Authors: BAIN MERVYN J.
Published: November 2005

Cuba–Soviet relations are examined in the period that Mikhail Gorbachev was leader of the Soviet Union, focusing on the Cuban perception of the effects of the Soviet reforms on the relationship, in the light of the campaign of rectification of errors. It is concluded that the Cuban leadership kept a surprisingly united front in this period; the year 1989 and repercussions of the August 1991 coup were vital; but the Cuban reaction was not more critical due to diplomatic constraints and the hope that a semblance of the relationship could continue, despite the situation within the Soviet Union.
Influence of volcanic shards on foraminiferal Mg/Ca in a core from the Galápagos region
Authors: Lea David W. , Pak Dorothy K. , Paradis Georges
Published: November 2005

Variability in the Mg, Fe, Al, Mn, and U to Ca composition of the planktonic foraminifera G. ruber in core TR163‐22, an 8.8 m long piston core from just northwest of the Galapagos Islands, reveals distinct patterns of downcore behavior. Mg/Ca data follow a general climatic trend, with lower values during cold intervals (i.e., marine isotope stages (MIS) 2–4) and higher values during warm intervals (i.e., MIS 1 and 5). Fe/Ca and Al/Ca data reveal distinct intervals in which concentrations are elevated tenfold or more over baseline values, with highly variable elemental ratios in these intervals. The Mg/Ca data are highly correlated with the Fe/Ca and Al/Ca data in these intervals, with slopes of 1.13 ± 0.03 and 0.66 ± 0.07 mole/mole, respectively. Examination of the sediments from these intervals reveals that they are rich in volcanic debris that is likely derived from Galápagos volcanic rocks. The presence of small amounts of this volcanic debris can bias shell Mg/Ca to elevated values. Attempts to use enhanced cleaning to remove the volcanic particles were largely unsuccessful. The most successful strategy is to use the Fe/Ca and Al/Ca from the shell digests along with the Fe to Mg ratio of the volcanic debris to correct the Mg/Ca data for Al‐silicate contamination, in which case the corrected data more clearly reveal the primary climatological patterns. Mn/Ca and U/Ca data are characterized by cycles of 20–200 cm length, with Mn/Ca having a distinct trend toward higher values between the core top and 200 cm. These trends appear to be related to diagenetic coatings on the foraminifera shells, most likely in the form of Mn‐carbonates.
A field‐scale analysis of the dependence of wind erosion threshold velocity on air humidity
Authors: Ravi Sujith , D'Odorico Paolo
Published: November 2005

The wind‐forced detachment and movement of soil particles, is known for having important regional and global implications on climate change and biogeochemical cycles. The wind erosion process occurs when wind speed exceeds a certain threshold value, which depends on a number of factors, including surface soil moisture. In arid regions changes in atmospheric humidity contribute to most of the variability in surface soil moisture, which, in turn, has a significant influence on wind erosion threshold. This paper investigates the dependence of wind erosion threshold on air humidity in two arid regions in North America, the Mojave Desert (CA) and Canyonlands (UT). Field data are used to test existing models relating the threshold velocity for wind erosion to atmospheric conditions. The threshold velocity is found to be significantly dependent on the atmospheric relative humidity (RH) and to exhibit a well‐defined maximum for RH ≈ 35%. This result validates at the field scale recent theories and laboratory‐scale experimental results.
Arctic Ocean gravity, geoid and sea‐ice freeboard heights from ICESat and GRACE
Authors: Forsberg R. , Skourup H.
Published: November 2005

ICESat laser measurements provide a high‐resolution mapping of the sea‐ice surface of the Arctic Ocean, which can be inverted to determine gravity anomalies and sea‐ice freeboard heights by a “lowest‐level” filtering scheme. In this paper we use updated terrestrial gravity data from the Arctic Gravity Project in combination with GRACE gravity field models to derive an improved Arctic geoid model. This model is then used to convert ICESat measurements to sea‐ice freeboard heights with a coarse lowest‐level surface method. The derived freeboard heights show a good qualitative agreement to the coverage of multi‐year sea‐ice; however, comparison to an airborne lidar underflight north of Greenland shows that the lowest‐level filtering scheme may introduce a bias. We finally use the ICESat and GRACE results to derive new gravity anomalies by Fourier inversion. The satellite‐only gravity field shows all major tectonic features of the Arctic Ocean, and has an accuracy of 6 mGal compared to recent airborne gravity data, illustrating the usefulness of ICESat data for gravity field determination.
Effects of atmospheric sphericity on stratospheric chemistry and dynamics over Antarctica
Authors: Kurokawa Jun‐ichi , Akiyoshi Hideharu , Nagashima Tatsuya , Masunaga Hirohiko , Nakajima Teruyuki , Takahashi Masaaki , Nakane Hideaki
Published: November 2005

Atmospheric sphericity is an important factor that must be considered in order to evaluate an accurate ozone loss rate in the polar stratosphere. The built‐in plane‐parallel radiative transfer scheme of a nudging chemical transport model (CTM) and an atmospheric general circulation model (AGCM) with coupled chemistry is modified by a pseudospherical approximation. The plane‐parallel atmosphere radiative transfer version (PPA version) is compared with the pseudospherical atmosphere radiative transfer version (SA version) for both the nudging CTM and AGCM. The nudging CTM can isolate the chemical effects for a given dynamical field, while the interaction among the chemical, radiative, and dynamical processes can be studied with the AGCM. The present analysis focuses on Antarctica during an ozone hole period. In the ozone loss period over Antarctica, ozone starts to decrease earlier and minimum value of total ozone becomes lower in the SA versions of both the nudging CTM and the AGCM than in the corresponding PPA versions. The ozone mixing ratio decreases earlier in the SA version because of an earlier increase of ClO concentration initiated by the upward actinic flux at solar zenith angles greater than 90°. Dynamics plays an important role as well as the chemical processes. During the ozone recovery period, the ozone distribution becomes almost the same in the SA and PPA versions of the nudging CTM, while in the AGCM the ozone amount in the SA version remains at lower values compared to those of the PPA version. In the AGCM, a decrease of ozone over Antarctica enhances the latitudinal gradient of temperature and thus strengthens the polar vortex in the SA version. A resultant delay of the polar vortex breakup causes the delay of the ozone recovery. For the AGCM, ensemble runs are performed. The ensemble experiment exhibits large ozone variances after the middle of December, when the ozone recovery is dynamically controlled. Most ensemble members of the AGCM show a delay of the polar vortex breakup in the SA version, while a few members show opposite results. In the latter members, the polar vortex breakup is strongly affected by the enhanced EP flux from the troposphere around 100 hPa, which causes the variances in the ozone recovery period. Most members, however, do not show large statistical variances; that justifies the conclusions from the ensemble means.
Specific heat of NH4Br and NH4BrxCl1−x crystals close to the antiferroelectric transition
Authors: Yurtseven H. , Yanik A.
Published: November 2005

We calculate the specific heat CVI of NH4Br and mixed crystals of NH4BrxCl1−x using the Ising model for the transition between the disordered (D) and antiferro- (AF) electric phases in these crystalline systems. Our CVI values, which we calculated for xBr=1, 0.26, and 0.51 are in good agreement, both below and above TC, with the observed CP data from the literature. Our value of ɑ≅0.1 (TTC) for the critical exponent of the specific heat agrees with the value of 0.125 predicted by a three-dimensional Ising model.
Dissociation processes of Kr2+ and Kr3+ studied by threshold photoelectron-photoion coincidence measurements
Authors: Yoshii H. , Tsukamoto K. , Hayaishi T. , Aoto T. , Ito K. , Morioka Y.
Published: November 2005

A time-of-flight (TOF) ion mass spectrum in coincidence with threshold photoelectrons was measured in the photon energy region between the first and second dissociation limits of Kr2+ to examine the decay processes of the Kr2+ II(1∕2u) state. The measured TOF spectrum reveals that Kr+ fragment ions are produced through dissociation of the repulsive I(1∕2g) state, which can be formed by the decay process of the II(1∕2u) state accompanied with emission of photons. The potential-energy curve of the I(1∕2g) state is deduced with detailed analysis of the observed TOF spectrum, in which the radiative lifetime of the II(1∕2u) state was also derived to be 2.5μs. Additionally, evidence of the dissociation process of Kr3+ ions was obtained in the same photon energy region, where the dominant channel is Kr3+→Kr2++Kr.