bluuebunny/crossref_metadata_2025 huggingface dataset:
Biochemical measures in a population-based study: effect of fasting duration and time of day
Authors: Emberson JR , Whincup PH , Walker M , Thomas M , Alberti KGMM
Published: October 2002

Background: Epidemiological studies generally aim to make simple but unbiased measurements of individuals. For this reason measurements of metabolic variables (including blood lipids, glucose and insulin) are usually carried out after a period of fasting. Few studies have examined the extent to which the use of a defined protocol for fasting in epidemiological studies abolishes the influence of fasting duration and time of day on biochemical measurements.

Methods: Cross-sectional survey of British Regional Heart Study participants (4252 men aged 60-79 years), in which men without diabetes were asked to provide a blood sample after fasting for at least 6 h. Serum total, HDL and LDL cholesterol, triglyceride and insulin, and plasma glucose concentrations were measured between 08:00 h and 18:00 h.

Results: Non-fasting men had lower mean LDL cholesterol and higher glucose, insulin and triglyceride levels than fasting men; these differences were more marked among diabetics. Among fasting men without diabetes, insulin and glucose levels were strongly related to time of day, falling gradually throughout the morning and remaining stable in the afternoon. Because of these relationships and the dependence of fasting duration on time of day, insulin and glucose displayed a periodic relation with fasting duration above 6 h. These associations were largely abolished by adjustment for time of day; associations with time of day were unaffected by adjustment for fasting duration. Triglyceride concentrations fell with increasing fasting duration. This relationship was also mediated through a gradual increase in triglyceride levels throughout the day. Adjustments to compensate for these variations are described.

Discussion: Even after fasting, biochemical measurements may still differ in relation to fasting duration and time of day. In epidemiological studies, it is important to standardize both the period of fasting and the time of day as much as possible, and make adjustments where necessary.
Free cortisol index as a surrogate marker for serum free cortisol
Authors: Le Roux Carel W , Sivakumaran Sivajenani , Alaghband-Zadeh Jamshid , Dhillo Waljit , Kong Wing May , Wheeler Michael J
Published: October 2002

Background: The biologically active component of a hormone is the unbound or free fraction. Changes in cortisol-binding protein could give misleading results if only total cortisol is measured for the interpretation of dynamic function tests.

Methods: This study aimed to measure serum free cortisol using a steady-state gel-filtration method and then to evaluate the correlation between the serum free cortisol and the free cortisol index (FCI), defined as serum total cortisol/cortisol-binding globulin (CBG).

Results: Forty-eight serum samples from healthy volunteers undergoing a short Synacthen test were analysed for total cortisol, free cortisol and CBG. The FCI correlated well with a previously established, but more complex, calculation of serum free cortisol ( R = 0·98, P <0·001) and with measured serum free cortisol ( R = 0·90, P < 0·001).

Conclusion: Free cortisol index is a reliable and user-friendly measure of serum free cortisol.
Primary tracheal leiomyosarcoma
Authors: Reichert Kathrin , Helling Kai , Menssen Hans Dietrich , Perez-Canto Alejandra , Scherer Hans
Published: October 2002

We present the clinical course of a 56-year-old female patient with a primary tracheal leiomyosarcoma. The diagnostic approach and pathological classification of this seldom described tumour remains extremely difficult. We discuss the symptoms as well as the diagnostic and therapeutic procedures, including multimodal chemotherapy with organ-preserving surgery leading to complete remission.
Extraskeletal Ewing’s sarcoma of the scalp
Authors: Chao Ting-Kuang , Chang Yih-Leong , Sheen Tzung-Shiahn
Published: October 2002

Extraskeletal Ewing’s sarcoma/primitive neuroectodermal tumour (EES/PNET) is a rare disease entity. Scalp EES/PNET has been reported rarely. We report a case of an 11-year-old boy who had painful and rapidly growing subcutaneous nodes over the scalp and neck. The final diagnosis was EES/PNET after biopsy and immunohistochemical assay. The patient underwent surgical excision, chemotherapy and radiotherapy with a dose of 2000 cGy. Now he has been free of disease for two years. Early awareness and treatment of this rare disease, and wide resection followed by chemotherapy and radiotherapy might improve patients’ long-term survival.
Otitic hydrocephalus of tubercular origin: a rare cause
Authors: Grewal  , Hathiram Bachi T. , Agarwal Ritu , Dwivedi Ashwin , Walvekar Rohan
Published: October 2002

Otitic hydrocephalus is characterized by increased intra – cranial pressure without focal signs of neurological dysfunction. It usually occurs secondary to lateral sinus thrombosis more commonly on the right side, but it can also occur without lateral sinus thrombosis. With the advent of new antibiotics there has been a spectacular decrease in the complications of otitis media. Otogenic intra – cranial hypertension, always an uncommon condition, is seen only very rarely nowadays. Tubercular otitis media still occurs in India, and due to delays in its diagnosis it usually presents with complications. We present three patients with otitic hydrocephalus of tubercular origin.
Effect of anaesthetic agents on tympanometry and middle-ear effusions
Authors: Fish B. M. , Banerjee A. R. , Jennings C. R. , Frain I. , Narula A. A.
Published: October 2002

Following informed parental consent 93 children underwent bilateral grommet insertion. Tympanometry was performed pre-operatively, and immediately prior to myringotomy. A standardized anaesthetic was used. At myringotomy the presence or absence of fluid was recorded, as well as the time since induction of the general anaesthetic.

A pre-operative type B tympanogram predicted a middle-ear effusion at myringotomy in 92 per cent of patients. A pre-operative type C2 tympanogram predicted a middle-ear effusion at myringotomy in 39 per cent of patients. Sixty tympanograms (30 per cent) changed following a general anaesthetic. Fourteen type B tympanograms changed to type A and eight of these had effusions. The duration of the general anaesthetic did not influence the probability of a middle-ear effusion being present at myringotomy. A pre-operative type B tympanogram is a good predictor of middle-ear fluid. The duration of the general anaesthetic is not significant in predicting the presence of a middle-ear effusion.
Submandibular hydatid cyst caused by Echinococcus oligarthrus
Authors: Sahni J. K. , Jain M. , Bajaj Yogesh , Kumar Virender , Jain Anubhav
Published: October 2002

An unusual case of Echinococcus oligarthrus infestation of the submandibular salivary gland is reported. Echinococcus oligarthrus is a rare variant of the Echinococcus species affecting humans. To the best of our knowledge only one case of submandibular hydatid cyst caused by Echinococcus oligarthrus has been reported. A 28-year-old female patient was admitted with a progressively increasing swelling in the left submandibular region of four years’ duration. There was no pulmonary or hepatic involvement. The present case of submandibular hydatid cyst caused by Echinococcus oligarthrus is of interest because of the unusual site of the disease.
History of the technological development of air conduction hearing aids
Authors: Mudry Albert , Dodelé Léon
Published: October 2002

This was a study of the history of the technological development of air conduction hearing aids, and a review of international literature on the subject. The technological evolution of amplification devices, from their origin to the present day, can be divided into seven distinct periods: the period of sound collectors, the period of hearing devices constructed from carbon, the period of vacuum tubes, the transistor period, the period of integrated circuits, the microprocessor period and the period of digital hearing instruments. Throughout these different stages, hearing instruments have progressively developed reaching their present state.

The current era is itself undergoing constant development and change. With the introduction of new technologies, we expect that the rate of change will increase rapidly in the future.
Long-term middle-ear effects of middle-ear/eustachian tube packing after translabyrinthine surgery
Authors: Wareing Michael J. , O’Connor Alec Fitzgerald
Published: October 2002

The purpose of this study was to evaluate the long-term effect on middle ear and eustachian tube function following the packing of the middle-ear space to prevent cerebrospinal fluid rhinorrhoea at the termination of translabyrinthine vestibular schwannoma removal.

This was an observational study of a sample of 14 patients examined between two and five years postoperatively. Photo-otoscopy and tympanometry were performed bilaterally to evaluate appearance and function.

All operated middle ears were air-containing although eight out of 14 showed scarring as evidence of operative intervention. There were no drum retractions. Ten out of 14 middle-ear compliance peaks were lower in the operated ear with four flat traces. Two out of 14 were the same and two out of 14 showed high compliance. The middle-ear pressure was always within the normal range when determinable.

This technique appears to have no detrimental effects on the middle ear and does not permanently obliterate the eustachian tube. The reduced compliance in the majority of cases is probably a result of scarring and fibrosis. When drum hypermobility is seen this is accounted for by incus removal.
Presumed laryngo-pharyngeal reflux: investigate or treat?
Authors: Fraser Alan G. , Morton Randall P. , Gillibrand Jeanette
Published: October 2002

A review of a combined gastroenterology and laryngology clinic was conducted to determine the effectiveness of treatment and the predictive value of clinical findings and investigations.

Data were collected prospectively. Investigations were performed according to clinical criteria. Patients with symptoms suspected to be due to laryngopharyngeal reflux (based on a positive oesophageal pH test and/or changes on videolaryngoscopy consistent with posterior laryngitis) were treated with omeprazole for at least two to three months.

There were 87 patients; the most common symptoms were cough (38 per cent) and hoarseness (36 per cent); 77 per cent had some symptoms suggestive of gastro-oesophageal reflux. Sixty-seven patients were given omeprazole. A good response to laryngo-pharyngeal symptoms was seen in 37 patients (55 per cent). The presence of reflux symptoms was not a predictor of a good response. Increasing severity of oesophageal acid exposure over the 24 hours of pH testing was associated with a better symptom response (Spearman rank correlation, p = 0.01). Posterior laryngitis was not associated with the response to treatment, although there was a trend towards an association between improvement in laryngitis (after treatment) and improvement in symptoms (p = 0.08).

The response to proton pump inhibitors was lower than other published results. Oesophageal pH monitoring may have a role in predicting which patients will respond to proton pump inhibitors. This study does not support the decision to treat with anti-secretory therapy, based only on the presence of posterior laryngitis.
Oesophageal perforation during stapling of a pharyngeal pouch: adverse clinical incident report
Authors: Hilton M. , Brightwell A. P.
Published: October 2002

Endoscopic stapling is a relatively new surgical technique for the treatment of pharyngeal pouch. We present a serious complication of the technique, resulting in a large perforation of the posterior pharyngeal wall, and discuss possible causes.
Dual infection with atypical mycobacteria and Mycobacterium tuberculosis causing cervical lymphadenopathy in a child
Authors: Ganesan S. , Thirlwall A. , Brewis C. , Grant H. R. , Novelli V. M.
Published: October 2002

The most common presentation of mycobacterial infection encountered in otolaryngological practice is cervical lymphadenitis. We report a child with an unusual cause of cervical lymphadenopathy, i.e. dual tuberculous infections. This had clinical ramifications as, initially Mycobacterium avium-intracellulare was grown in culture and was resistant to standard anti-tuberculous agents, and hence treated with excision of the lymph node. However, the cultures from the excised lymph node grew out Mycobacterium tuberculosis that was sensitive to standard anti-tuberculous drugs. To our knowledge, no such presentation has been reported previously. We also review the literature on cervical lymphadenitis due to atypical mycobacteria and Mycobacterium tuberculosis , with particular emphasis on clinical presentation, diagnosis and management.
Ear injuries caused by lightning: report of 18 cases
Authors: Glunčić Ivo , Roje Željka , Glunčić Vicko , Poljak Kolja
Published: October 2002

The clinical management and long-term outcome in lightning survivors with subsctantial ear damage treated at the Department of Otorhinolaryngology, University Hospital Split during the 1984–1999 period are reviewed. Results of clinical management and outcomes of lightning ear damage in 18 patients (mean age 35.3 ± 5 years) were retrospectively analyzed. On admission, all patients complained of severe pain, tinnitus and hearing impairment. Otomicroscopy revealed tympanic membrane rupture in 12 patients. The active therapeutic approach included immediate otomicroscopy, aseptic aspiration toilet, and eversion of perforation edges. In all patients, the ruptures healed well, and restitution of the hearing function was achieved. Follow-up examination performed in 1999 (13.2 ± 2.9 years later) in 11 patients (mean age 52.3 ± 6.1 years) revealed an almost identical audiogram as on discharge from the hospital, however, neuropsychological testing revealed numerous sequelae. Tympanic injury caused by lightning should be actively treated. Lightning survivors require additional psychotherapeutic treatment.
Epidemiology of basal cell carcinoma and squamous cell carcinoma of the pinna
Authors: Ahmad Ijaz , Gupta A. R. Das
Published: October 2002

This is a retrospective study designed to compare the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in the head and neck skin area with special reference to the pinna.

The results showed 426 patients had 460 cutaneous malignancies in the head and neck area, managed by four specialities (ENT, Dermatology, General Surgery and GPs) over the period 1994–99. The lesions comprised 375 (80.47 per cent) BCC and 85 (18.47 per cent) SCC. In cases of BCC the facial areas were commonly involved (88 per cent), whilst SCC was almost equally distributed between the most (face, forehead and nose) and least exposed areas (pinna and scalp). The overall ratio of BCC to SCC remained four to one in the head and neck area. In 41 patients with 51 lesions over the pinna there were 29 (56.8 per cent) BCC and 22 (43.1 per cent) SCC hence the ratio was 1.3 to 1 for this site.

We conclude that in the case of a suspicious lesion over the pinna, the risk of SCC is comparatively much higher. With increasing awareness of early and quick diagnosis of cancer cases, it is recommended that these patients should be referred urgently to prevent the significant morbidity associated with invasive SCC.
Osseous haemangioma of inferior turbinate
Authors: Fahmy F. F. , Back G. , Smith C. E. T. , Hosni A.
Published: October 2002

We present a case of osseous haemangioma arising within the inferior turbinate.
Nerve origin of the acoustic neuroma
Authors: Komatsuzaki Atsushi , Tsunoda Atsunobu
Published: October 2002

Two hundred and seventy-one Japanese patients who underwent surgical removal of neuroma from the cerebello-pontine angle using the translabyrinthine approach were retrospectively reviewed in order to investigate the nerve origin on an anatomical basis. In 269 out of the 271 cases, the origin of the neuromas was identified. Among these cases, 84.8 per cent of tumours originated from the inferior vestibular nerve (IVN), followed by the superior vestibular nerve (SVN) (8.9 per cent). Of the 5.6 per cent of tumours arising from the vestibular nerve, however, it could not be determined whether they originated from the SVN or IVN. Two cases of neuromas originating from the facial nerve were seen (0.7 per cent). No neuroma arose from the cochlear nerve.

Currently, the diagnosis of acoustic neuromas is best made with Gd-enhanced magnetic resonance imaging (MRI). However, our data indicate that the development of a functional test of the individual IVN can be useful for screening most cases of acoustic neuroma and in facilitating their early diagnosis.
Supracricoid partial laryngectomy for non-squamous cell carcinoma of the larynx
Authors: Veivers David , de Vito Andréa , Luna-Ortiz Kuauhyama , Brasnu Daniel , Laccourreye Ollivier
Published: October 2002

The objective of this paper was to evaluate the potential utility of supracricoid partial laryngectomies (SCPLS) for non-squamous cell carcinoma of the larynx. To illustrate our management of such tumours we present a case series based on six patients. Local control was achieved in five patients, with the sixth being salvaged by total laryngectomy and post-operative radiation therapy. Three of the six patients died of distant metastases. We concluded that supracricoid partial laryngectomies should become part of the armamentarium of the otolaryngologist - head and neck surgeon for non-squamous cell carcinoma of the larynx.
Reasons for success or failure in surgical voice restoration after total laryngectomy: an Australian study
Authors: Frowen Jacqui , Perry Alison
Published: October 2002

Over the past 20 years, use of tracheo-oesophageal puncture (TEP) speech after total laryngectomy has resulted in reported success rates of 90-93 per cent worldwide. Despite this, data collected from major acute hospitals in Victoria, Australia indicated that, of 38 patients who underwent total laryngectomy in 1997, only 10 (26 per cent) were using TEP speech as their primary mode of communication at 12 months post-operatively. This paper describes how a quantitative research methodology was used to investigate why so few patients in Victoria were successfully using TEP speech as their chosen mode of rehabilitation after total laryngectomy. Patients, speech pathologists and ENT surgeons were interviewed. Their thoughts and beliefs regarding speech rehabilitation were mapped, and themes were identified, coded and analysed. This paper describes and discusses the results of this research and its possible implications for future patient management, through establishing a model for ‘ideal’ speech rehabilitation.
A hoarse voice: atypical mycobacterial infection of the larynx
Authors: McEwan J. A. , Mohsen A. H. , Schmid M. L. , McKendrick M. W.
Published: October 2002

Myobacterium malmoense is a non-tuberculous mycobacterium that most commonly causes pulmonary infection, particularly in patients with underlying pulmonary disease or immunodeficiency. We describe a case of Mycobacterium malmoense infection of the larynx in a previously well middle-aged woman, which has previously not been reported. The case highlights the importance of considering atypical mycobacterial infection in the differential diagnosis of laryngeal lesions.
Palliative tracheal stenting in invasive papillary thyroid carcinoma
Authors: Hopkins C. , Stearns M. , Watkinson A. F.
Published: October 2002

Malignant tracheal stenosis presents a considerable challenge to the head and neck surgeon. The use of intraluminal stents has been previously described, but current literature notes a paucity of supportive physiological data. We describe the use of a self-expanding metallic Wallstent in the palliation of a case of papillary thyroid carcinoma. This is accompanied by significant improvement in quantitative pulmonary function.
Adult-onset otitis media with effusion: results following ventilation tube insertion
Authors: Yung M. W. , Arasaratnam R.
Published: October 2002

The outcome of otitis media with effusion (OME) in children is generally good. However, it is less clear in adults. All adult patients who had a ventilation tube inserted for OME at the Ipswich Hospital between 1996 and 1997 were studied. Of 53 patients studied, 28 had had a previous history of ventilation tube insertion. Furthermore, at 15–27 months following ventilation tube insertion, the ventilation tube had already extruded in 31 patients and the OME had already recurred in 19 of these. Endoscopic examination revealed that many patients still had evidence of inflammation at the lateral nasal wall (26.4 per cent) and at the eustachian tube orifice (51 per cent). There is also a strong history of atopy in the studied group and the skin prick test was positive in 57 per cent of the patients. This study shows that many patients with adult-onset OME have underlying pathology that could lead to recurrence of OME following ventilation tube extrusion.
A novel approach to the removal of superglue from the ear
Authors: Persaud Ricardo
Published: October 2002

The ability of superglue (a cyanoacrylate adhesive) to bond strongly and quickly to skin presents considerable problems when it is inserted into the ear. A case of a patient who inadvertently self-administered Bostik superglue into her left external auditory meatus is reported. The superglue was removed successfully, in the form of a cast, with warm three per cent hydrogen peroxide without damaging the meatus or the typanic membrane. The use of hydrogen peroxide to remove superglue from the ear has not been described previously.
A case of buccal abscess; originating from an ectopic accessory parotid gland?
Authors: Lee Dong-Hee
Published: October 2002

We report a case of an abscess from an ’ectopic’ accessory parotid gland in the cheek demonstrated by sialography and computed tomography (CT). The accessory parotid gland was ectopically located anterolateral to the masseter muscle and isolated from the main parotid gland. The orifice and ductal system of the ectopic accessory parotid gland were separated from those of Stensen’s duct. The abscess developed from this ectopic accessory gland, and the main parotid gland was free of inflammation. Using sialography and CT, we confirmed the presence of this ectopic accessory gland.
Accessory nerve monitoring and stimulation during neck surgery
Authors: Midwinter Katie , Willatt David
Published: October 2002

Iatrogenic injury to the spinal accessory nerve following surgical procedures in the neck is well recognized in causing significant morbidity to patients, with shoulder pain and loss of function being particularly problematic. We have used a Magstim Neurosign 100 peripheral nerve monitor, that is most often used in our practice to monitor the facial nerve during middle ear and parotid surgery, to monitor the accessory nerve during neck surgery. Ten patients undergoing accessory nerve-sparing neck dissection, or excision biopsy of neck mass had their accessory nerve monitored during the procedure. No patient suffered injury of the nerve. In several cases the nerve closely adhered to the tissue being resected, and in two cases, the nerve bifurcated or gave off branches. We found that the monitor aided identification and preservation of the nerve.
Coblation tonsillectomy: a double blind randomized controlled study
Authors: Timms M. S. , Temple R. H.
Published: October 2002

Tonsillectomy has been performed by a number of techniques. This double blind randomizedcontrolled study compares the technique of tissue coblation with bipolar dissection for the removal of tonsils in 10 adult patients with a history of chronic tonsillitis. A significant reduction in post-operative pain and more rapid healing of the tonsillar fossae were found in the side removed by tissue coblation. There were no episodes of primary or secondary haemorrhage on either side. This new technique for tonsil removal warrants further study.
The use of a nasal obturator in hereditary haemorrhagic telangiectasia: an alternative to Young’s procedure
Authors: Woolford T. J. , Loke D. , Bateman N. D.
Published: October 2002

Epistaxis associated with hereditary haemorrhagic telangiectasia (HHT) is a challenging condition. Septodermoplasty, electrocautery and laser treatment often provide short-term relief only. The surgical closure of the nostrils (‘Young’s procedure’) represents a longer term solution but has the disadvantage of causing permanent complete nasal obstruction. A Silastic™ obturator has the advantage of being a non-surgical intervention and allows temporary relief of the nasal obstruction. We present the cases of three patients with HHT who used the obturator with good clinical effect, suggesting that this is a realistic non-surgical alternative to Young’s procedure for patients with HHT.
Paediatric acute mastoiditis: the Alder Hey experience
Authors: De S. , Makura Z. G. G. , Clarke R. W.
Published: October 2002

Acute mastoiditis was a common condition in the pre-antibiotic era, but has become rare now with the widespread use of antibiotics.

A retrospective study was carried out of patients with acute mastoiditis who were seen at Alder Hey Children’s Hospital, Liverpool over a five-year period. Their case records were identified and details of gender, age at presentation, symptoms, signs and clinical management were noted and analysed.

Twenty-one patients who presented with acute mastoiditis were identified. The patients’ age at presentation ranged from three months to 14 years. Five cases out of 21 (23.8 per cent) were under one year of age.Eighteen cases (85.7 per cent) presented with post-aural swelling while 12 (57.1 per cent) had aural discharge.

All patients were treated with intravenous antibiotics and only five patients (23.8 per cent) required surgical intervention in the form of a cortical mastoidectomy with, or without, myringotomy.

A significant number of cases can be treated conservatively with intravenous antibiotics. Surgery in the form of cortical mastoidectomy can be reserved for complicated cases and in those in whom conservative treatment has failed.
Posterior fossa vestibular neurotomy as primary surgical treatment of Menière’s disease: a re-evaluation
Authors: Pareschi R. , Destito D. , Falco Raucci A. , Righini S. , Colombo S.
Published: October 2002

Fifty-eight patients underwent vestibular neurotomy via the posterior fossa approach between September 1992 and December 1998 at the ENT department of Legnano. All patients presented a history of disabling unilateral Menière’s disease and underwent complete neuro-otologic evaluation following the 1985 American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) guidelines. All patients underwent MRI imaging, ABR and electronystagmographic testing before surgery. Objective analysis of results is reported using the criteria published by the Committee on Hearing and Equilibrium of the AAO-HNS in 1985. According to the AAO formula, 52 patients obtained a score of 0, indicating complete control of major vertigo spells, while four were classified within the ’substantial control’ group. Immediate hearing results indicated that 93 per cent of the patients maintained a level within 10 dB from the preoperative level. Only one patient experienced a subtotal hearing loss yet retained measurable hearing. No major complications were reported. We conclude that a retrosigmoid approach to vestibular neurotomy can be considered a safe and effective procedure in relieving medically refractory vertigo in Menière’s disease while preserving the hearing. Tinnitus and long-term hearing deterioration are not influenced by the procedure.
Treatment of epistaxis in Accident and Emergency departments in the UK
Authors: Wild D. C. , Spraggs P. D. R.
Published: October 2002

This study aims to investigate the facilities available in Accident and Emergency (A&E) departments and the education of casualty officers in the treatment of epistaxis in the UK. Fifty departments were chosen at random and a telephone survey undertaken. The results show a paucity of facilities and inadequate training of A&E officers in a majority of departments. Recommendations for treatment standards are made.
Obstructive endotracheal lesions of thyroid cancer
Authors: Ahmed Mohammed , Saleem Muhammad , Al-Arifi Abdullah , Almahfouz Abdulraof , Mahasin Zeyad , Al-Sobhi Saif , Ingemansson Stig , Taibah Khalid
Published: October 2002

Airway invasion is a life-threatening complication of thyroid cancer. An important issue that deserves better attention is the differentiation between the clinical features of tracheal wall invasion versus those of an obstructive endotracheal lesion. We present information on the clinical course, diagnostic modalities utilized, management instituted, along with the prognosis, and follow-up data on a group of patients presenting with obstructive endotracheal lesions of thyroid cancer. Two thousand four hundred and eighty-nine thyroid cancer patients were seen at our institution from December 1975 to May 2000. Thirteen patients presented with symptoms of respiratory distress related to obstructive endotracheal lesions. At presentation, 11 patients underwent endoscopic examination. Imaging studies consisting of I123 whole body scan (WBS), computed tomography/magnetic resonance imaging (CT/MRI) of neck and chest, whole body positron emission tomography using 18-fluoro-2-deoxy-D-glucose (FDGPET) were done, as also was determination of the tumour markers, serum thyroglobulin (TG) and calcitonin. Patients were followed for one to 108 months after the initial presentation. Intraluminal tracheal obstruction was severe in eight patients; five had near-total-occlusion. Paralysis of the vocal folds was present in five. Evidence of metastatic disease was present in most patients. Dissociation between iodine uptake and TG synthesis was evident in five patients during follow-up. Four patients died of cancer. Of the nine living patients; cancer persisted in six, recurred in two patients, and remitted in one. This study has identified obstructive endotracheal lesion of thyroid cancer as a distinct entity apart from tracheal wall disease. These data provide evidence that intraluminal tracheal invasion of thyroid cancer is an ominous sign and a frequent cause of morbidity.
Treatment of chondrodermatitis nodularis with removal of the underlying cartilage alone: retrospective analysis of experience in 37 lesions
Authors: de Ru J. A. , Lohuis P. J. F. M. , Saleh H. A. , Vuyk H. D.
Published: October 2002

Most otolaryngologists treat patients with chondrodermatitis nodularis (CDN) by wedge excision. Although the results of this technique are generally good, it can leave the patient with an asymmetric, deformed ear.

In the dermatological literature, a relatively straightforward technique has been described for the treatment of CDN by smoothing only the underlying cartilage. This is based on the assumption that CDN is caused by pressure necrosis of protuberant cartilage, and thus is primarily not a skin disease. Reports on this technique claim excellent cosmetic results with only a small chance of recurrence.

In the present study we analyse the application of this technique to 34 patients with 37 CDN lesions. All patients were symptom-free with a minimum follow-up of three months according to their medical reports.

Seventeen patients with 19 lesions were interviewed later by telephone. In a mean follow-up of 30.7 months, 34 of these patients remained symptom-free and only one required revision surgery. The authors recommend this safe and simple technique to other physicians who treat patients with CDN.
Treatment outcomes of primary and recurrent inverted papilloma: an analysis of 96 cases
Authors: Yoon Joo-Heon , Kim Chang-Hoon , Choi Eun Chang
Published: October 2002

This series was undertaken to investigate the incidence of associated polyps and the recurrence rates of inverted papillomas with, or without, malignancies, as well as the treatment outcomes of the recurred cases.

A retrospective study evaluating the pathology, associated polyps, types of operation, recurrence rate after original operation, and surgical outcomes of recurred cases was conducted upon 96 patients diagnosed with inverted papilloma.

The overall malignancy rate was 11.5 per cent with synchronous tumours accounting for 9.4 per cent and metachronous for 2.1 per cent. Inflammatory polyps were found in association with inverted papilloma in 21.9 per cent. In cases without malignancies, the recurrence rate after the original conservative procedure was 33.9 per cent, compared to 14.3 per cent after a medial maxillectomy. In cases with malignancies, the recurrence rate after the original surgical procedure was 22.2 per cent.

Our study indicates that more aggressive and bolder surgical resection of inverted papilloma should be undertaken as a primary treatment method, or as a treatment for recurrent cases to reduce the recurrence rate of inverted papilloma with, or without, malignancy.
Estimates of appropriate number of rats: interaction with housing environment
Authors: Mering S. , Kaliste-Korhonen E. , Nevalainen T.
Published: October 2002

An extensive list of physiological parameters from previous experiments was re-analysed in order to evaluate the effects of enrichment, cage type and group size on the within-group variation and hence on the number of animals needed in studies using Wistar rats. The independent factors studied in these experiments included the provision of aspen gnawing blocks for enrichment, solid bottom cages (SBCs) and grid floor cages (GFCs) and animal number per cage (varied from 1-4). SOLO power analysis was used to calculate the smallest number of animals ( n) needed to detect an arbitrarily chosen 20% effect size, when significance was set at P = 0.05 and statistical power at 0.90. N ratios ( nlarger/ nsmaller) were calculated for the effect of enrichment, cage type and group size to compare the 'treatment group' with the 'control group'. The n values of adrenal gland, interscapular brown adipose tissue (BAT) and epididymal adipose tissue (EAT) weights seemed to vary most, whereas final body weight (FBW) and growth seemed to be the least variable ones. According to one-sample t-test, the N ratios of most physiological parameters differed significantly from zero (except the ones of FBW) indicating that n values in 'treatment' and 'control' groups were unequal. The results indicate that some of the physiological parameters are susceptible to variability attributable to environmental modifications in general whereas some are not. Furthermore, they suggest that the variation of different parameters may vary from one experiment to another and between different environments thus hindering the estimations of appropriate number of animals.
Circadian temperature rhythms in rabbit pups and in their does
Authors: Jilge B. , Kuhnt B. , Landerer W. , Rest S.
Published: October 2002

Circadian rhythms of mammals are generated endogenously, the master oscillator system residing in the suprachiasmatic nuclei (SCN). Previous experiments have indicated that the rabbit has a feeding entrainable circadian oscillator (FEO) which is supposed to be of greatest importance during the early infancy of the rabbit. Here we report the course of telemetrically monitored core body temperature of rabbit pups and of their does. Temperature increased from 37.6 ± 0.3 °C on day 2 to 39.5 ± 0.1 °C on day 28 of life. The pups showed a 24 h temperature rhythm even during their first days of life. Temperature increased 2½-3 h prior to nursing for 0.4-0.8 °C and rose for an additional 0.4-0.6 °C immediately after milk ingestion. The anticipatory, but not the postprandial component persisted when nursing was skipped twice. The persistence of a rhythm in the absence of any entraining agent is crucial for its endogenous generation. In the doe, the core body temperature gradually decreased during the last 2/3 of pregnancy. During parturition it steeply rose for 1.5-1.7 °C and attained a plateau of 39.7 ± 0.2 °C during lactation. The circadian rhythm persisted during the whole course of pregnancy and lactation. Thus, in the rabbit an endogenous, feeding entrainable circadian oscillator appears to operate from the first days of life. It is of functional significance in that it alerts the pup in time so that it is able to utilize the singular short presence of the doe for maximal milk intake.
Use of allometry in predicting anatomical and physiological parameters of mammals
Authors: Lindstedt S. L. , Schaeffer P. J.
Published: October 2002

One challenge for veterinarians, animal facilities and research scientists is the making of physiological estimates appropriate to a variety of species for which data are often either completely lacking or are incomplete. Our intent in compiling the data in this paper is to provide the best possible database of normal physiological and anatomical values primarily (though not exclusively) for four common mammalian model species: mouse, rat, dog and man. In order to make those data as accessible and applicable as possible, we have presented the results of this study in the form of body-size dependent allometric equations in which some variable ( Y) is expressed as a dependent function of body mass ( M) in the power-law equation, Y = aMb. By compiling these data, it is apparent that the resultant equations are quantitatively grouped (with similar slope or 'b' values). These emergent patterns provide insights into body-size dependent 'principles of design' that seem to dictate several aspects of design and function across species among all mammals. In general, the weights of most individual organs scale as a constant fraction of body mass (i.e. the body mass exponent, b ≅ 1.0). Biological rates (e.g. heart rate, respiratory rate) scale as b ≅ -1/4. Finally, volume-rates (the product of volume and rate) such as cardiac output, ventilation and oxygen uptake vary as b ≅ 3/4.
Improving housing conditions for laboratory mice: a review of 'environmental enrichment'
Authors: Olsson I. Anna S. , Dahlborn Kristina
Published: October 2002

Laboratory animal facilities have been designed to provide a standard environment where animals can be kept in good physical health at the same time as economic and ergonomic considerations are met. Recognizing the potential welfare problem associated with behavioural restriction in such housing systems, a number of attempts have been made to improve this environment, generally described under the term 'environmental enrichment'. Modifications of cages for mice usually consist of providing material for nest building and structures which can serve as hiding places and/or for climbing. We have reviewed 40 studies carried out between 1987 and 2000, in which preferences as well as the effect of housing modifications have been studied. Mice will work for access to nesting material and make use of this material to make nests in which they rest. They prefer a more complex cage to the standard cage and will also work for access to cages with shelter and raised platforms. On the basis of present knowledge, it is recommended that mice should have access to nesting material. Strategies for future research are outlined in the article.
Impact on Health Authorities of the introduction of Primary Care Groups and Trusts
Authors: Leese Brenda
Published: October 2002

The National Tracker Survey of Primary Care Groups (PCGs) and Trusts (PCTs) in the UK has provided evidence about how PCGs and Health Authorities managed the transition to PCTs. This was a major challenge for both organizations. Devolution of responsibilities was dependent on the capacity and readiness of PCGs to take on their new roles. The development of good working relationships between the principal parties was critical to this process. Health Authorities started to let go and all put in place basic mechanisms for holding PCGs to account in their first year. However, a number of PCGs regarded their Health Authority as authoritarian. Most Health Authorities were found to have started to provide information to support PCGs in their core functions, but resources were frequently problematic. It will be important for Health Authorities and PCG/Ts to negotiate a shared view of their respective roles and responsibilities. The future role of Health Authorities in providing strategic leadership for their local health economies was not sufficiently well defined or understood.
Managing the 'seamless service': Primary Care Groups in the new NHS
Authors: Willcocks S. , Conway A.
Published: October 2002

This paper reports on empirical work examining the conseqences for the development of the role of Primary Care Groups of the shift from competition (in the internal market) to relationships based on collaboration and partnership. Previous work (Conway and Willcocks, 1998; Willcocks and Conway, 1999) firstly developed a conceptual framework emphasizing the development of relationships between Primary Care Groups and their key stakeholders (for example, Health Authorities, Local Authorities and Trusts) and, secondly, sought to test this framework empirically through case study analysis of two Primary Care Groups in the north of England. This paper takes the research further and focuses on one of these Primary Care Groups, providing an in-depth analysis of particular issues such as the rationale for the particular configuration of this organization and the chosen working arrangements, the role and function of the Board and individual members, and the problems encountered in the first year of operation.
Using performance indicators to improve health care quality in the public sector: a review of the literature
Authors: Freeman Tim
Published: October 2002

Given the increasing importance of performance indicators in current UK health policy, this paper provides a systematic review of empirical and theoretical writings concerning their use to improve health care quality. The paper outlines potential problems and explores how best to derive, implement and use performance indicator data, presenting results thematically. The two principal uses of indicator systems are as summative mechanisms for external accountability and verification, and as formative mechanisms for internal quality improvement. In the UK, the use of performance indicators in assurance and performance management systems has heavily influenced debate over their value. Major problems reported include the potential to undermine the conditions required for quality improvement, perverse incentives and the difficulty of using data to promote change. Technical problems include indicator selection; the availability, validity and reliability of data; confounding; and problems with robustness, sensitivity and specificity. Factors that help in the derivation, implementation and use of indicator systems include clear objectives, involvement of stakeholders in development, and use of 'soft' data to aid interpretation.
Seronegative HIV-2 carriers in India
Authors: Kageyama S , Maniar J K , Iwasaki M , Zhang J , Saple D G , Tsuchie H , Tanabe-Tochikura A , Taniguchi K , Shiraki K , Kurimura T
Published: October 2002

The discordant cases of seronegative, but culture and proviral HIV-2 DNA positive were found in Mumbai, India. This was corroborated by the successful isolation of HIV-2-RNA in culture medium, HIV-2 cDNA sequence determination and the detection of the antigen. The sequence of the isolated HIV-2 genomic RNA does not seem to be altered to the extent that the change will alter antibody binding. Furthermore, antibody from the same individual (even at 8 months from initial sampling) from whom HIV-2 was isolated did not react with the antigen of this strain. Those evidences imply that extremely low or non-production of the antibody may be due to suboptimal immune stimulation due to extremely slow HIV-2 replication. This low virus-load may be responsible for the negative antibody results in the HIV-2 carriers.
Indinavir use: associated reversible hair loss and mood disturbance
Authors: Harry Tubonye C. , Matthews Mime , Salvary Ingrid
Published: October 2002

We present the case of a 55-year-old heterosexual man who had a generalized alopecia and mood changes associated with the antiretroviral protease inhibitor; indinavir within 6 months of use. This was reversed within 3 months of change of therapy to the protease inhibitor, nelfinavir with demonstrable changes in his Hospital Anxiety and Depression (HAD) scale scores.
Vulvar vestibulitis: aetiology, diagnosis and treatment
Authors: Rogstad K E
Published: October 2002

Chronic vulval pain can have multi-factorial causes. One of its leading causes, vulvar vestibulitis, is reviewed. A study of vulvar vestibulitis-its epidemiology, aetiology, histopathology, diagnosis and treatment is undertaken. More research is needed on this condition as it is important to make an accurate diagnosis and thus raise awareness before providing proper treatment.
Rapid development of Epstein–Barr virus-associated Hodgkin's disease after cessation of foscarnet therapy in an HIV-infected patient
Authors: Schramm Christoph , Schlaak Jörg F , Galle Peter R
Published: October 2002

Epidemiological features suggest a link between Hodgkin's disease (HD) and Epstein-Barr virus (EBV) infection1. Indeed, EBV genome and expression of latent antigens can be found in Reed-Sternberg cells. In the majority of cases HD in HIV patients seems to be EBV-associated. We report on a 51-year-old HIV-infected patient in whom EBV-positive HD of mixed cellularity rapidly developed within one month after cessation of treatment with intravenous foscarnet.
Participants in HIV clinical trials in Europe
Authors: Schrooten W. , Borchert M. , Dreezen C. , Baratta C. , Smets E. , Kosmidis J. , Goebel F. D. , Wilkins E. G. , Colebunders R.
Published: October 2002

In recent years an increasing number of antiretrovirals have become available. In order to define the optimal treatment regimens an increasing number of clinical trials are needed.

Our objective was to study the profile of participants in HIV clinical trials in Europe and learn from their experience and views. Between August 1996 and September 1997, self-administered anonymous questionnaires were distributed to people with HIV infection at inpatient and outpatient clinics in 11 European countries. One thousand three hundred and sixty-six people completed the questionnaire (50% response rate). Four hundred and twenty (31%) of the respondents reported that they had previously participated in at least one HIV clinical trial. The percentage of people who had taken part in a clinical trial varied widely between the different centres, from 12% in Athens to 61% in Antwerp and Brussels. A significantly higher participation rate was observed in the northern and central part of Europe compared with the south (respectively 40% vs 18%) and also among people with a higher income. Most people (92%) stated that they were 'well' or 'very well' informed prior to enrolment in the trial. However, 4% reported that they had not given written approval and 22% felt that they were pushed into participating. Only 21% stated that they were informed about the outcome of the study on its completion. The most important reason for non-participation (37% of the non-participants) was because a clinical trial had never been proposed. In conclusion, a majority of people with HIV infection in European HIV treatment reference centres were willing to participate in clinical trials. HIV clinical trials in Europe should adhere more strictly to universal ethical standards.