bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Strategies for Reduced Phosphorus Excretion and Improved Water Quality
Authors: Maguire R. O. , Dou Z. , Sims J. T. , Brake J. , Joern B. C.
Published: November 2005

Cost effective feeding strategies are essential to deal with P surpluses associated with intensive animal agriculture and the consequent impact on water quality. Reduction of P overfeeding, use of feed additives to enhance dietary P utilization, and development of high available phosphorus (HAP) grains have all been shown to decrease fecal P excretion without impairing animal performance. Much progress has been made, but more research will be needed to refine these strategies to maximize reductions in P excretion while maintaining animal performance. Recent research has focused on the impact of modifying dietary P on the forms of P excreted and the mobility of P in soils amended with these manures, with strong treatment trends becoming evident in the literature. In general, dietary strategies have been developed that can effectively reduce the total P concentration in manures produced, and combining strategies usually leads to greater reductions than individual practices. However, the impact of different approaches on the solubility of P in manures and amended soils has been more variable. Soluble P remains of particular concern due to links between solubility of P in manure and P losses from manure‐amended soils. In this paper, we outline the major strategies for reducing dietary P in different species, review the literature on the impact of these approaches on P forms in manures and amended soils, and discuss the potential beneficial effects on animal agriculture and the environment.
Can Constructed Wetlands Reduce the Diffuse Phosphorus Loads to Eutrophic Water in Cold Temperate Regions?
Authors: Braskerud B. C. , Tonderski K. S. , Wedding B. , Bakke R. , Blankenberg A.‐G. B. , Ulén B. , Koskiaho J.
Published: November 2005

Construction of wetlands is a possible supplement to best management practices (BMP) at the field level to mitigate phosphorus (P) pollution from agricultural areas. In this paper, annual results from 17 intensively studied wetlands in the cold temperate or boreal climatic zone are reported and analyzed. Surface areas varied from 0.007 to 8.7% of the catchment area. The average total phosphorus (TP) retention varied from 1 to 88%, and the dissolved reactive phosphorus (DRP) retention from −19 to 89%. Retention varied substantially from site to site, indicating the existence of site‐specific factors in the catchment and wetlands that influenced the P removal. Factors important for P retention in wetlands were evaluated through multiple statistical analyses by dividing P into two fractions: particulate phosphorus (PP) and DRP. Both relative (%) PP and DRP retention increased with wetland surface area. However, PP retention was not as sensitive as DRP in terms of wetland size and retention: specific PP retention (gram P retention per m2 and year) decreased as wetland area (Aw) increased, suggesting the existence of a site‐specific optimal wetland to catchment area (Ac) ratio. Particulate P retention decreased with increasing DRP to TP ratio, while the opposite was found for DRP. Dissolved reactive P retention was higher in new than in old wetlands, while increasing age did not influence PP retention negatively. Effective BMP in the catchment is important to keep the P loss low, because the outlet concentration of P from wetlands is often positively correlated to the input concentration. However, wetlands act as the last buffer in a catchment, since the retention often increases as the P concentration in streams increases.
Using Gypsum to Reduce Phosphorus in Runoff from Subcatchments in South Australia
Authors: Cox J. W. , Varcoe J. , Chittleborough D. J. , van Leeuwen J.
Published: November 2005

Concentrations of phosphorus (P) in runoff from agricultural catchments in southern Australia are high and well above national and international limits. Phosphorus was found to exit two subcatchments of 3.6 and 4.2 ha in the Adelaide hills via both overland flow and interflow. The subcatchments had texture‐contrast soils with high inputs of superphosphate and were openly grazed by cattle all year. Interflow at the boundary of the B and C soil horizons accounted for as much as half the total water flow that was measured (overland flow, A–B interflow, and B–C interflow). The average flow‐weighted concentration of total P within overland flow was as high as 0.25 mg L−1, and 0.05 mg L−1 in B–C interflow. In most years P loss was in the dissolved (<0.45 μm) form. In some years, interflow was the major pathway for P loss off these catchments. The B–C interflow cannot be discounted when searching for management options to reduce P loss from texture‐contrast soils to waterways. Preliminary laboratory experiments showed promise that gypsum could modify agricultural soils and reduce the concentrations of P (and dissolved organic C) in runoff before it enters public water supply reservoirs. In this study, gypsum, applied at a rate of 15 Mg ha−1 to the 4.2‐ha subcatchment, substantially modified the soil chemistry, and thereby soil structure. The size and stability of structural aggregates increased markedly and this change affected not only the A but also the upper B horizons, to a profile depth of approximately 50 cm. However, the impact of these physicochemical changes on P concentrations in runoff was not marked. Average profile P concentrations were only slightly lower in the runoff from the subcatchment following treatment. The high subsoil macroporosity of the gypsum‐treated subcatchment caused an increase in the proportion of runoff by interflow.
Soil Chemical Changes Resulting from Irrigation with Water Co‐Produced with Coalbed Natural Gas
Authors: Ganjegunte Girisha K. , Vance George F. , King Lyle A.
Published: November 2005

Land application of coalbed natural gas (CBNG) co‐produced water is a popular management option within northwestern Powder River Basin (PRB) of Wyoming. This study evaluated the impacts of land application of CBNG waters on soil chemical properties at five sites. Soil samples were collected from different depths (0–5, 5–15, 15–30, 30–60, 60–90, and 90–120 cm) from sites that were irrigated with CBNG water for 2 to 3 yr and control sites. Chemical properties of CBNG water used for irrigation on the study sites indicate that electrical conductivity of CBNG water (ECw) and sodium adsorption ratio of CBNG water (SARw) values were greater than those recommended for irrigation use on the soils at the study sites. Soil chemical analyses indicated that electrical conductivity of soil saturated paste extracts (ECe) and sodium adsorption ratio of soil saturated paste extracts (SARe) values for irrigated sites were significantly greater (P < 0.05) than control plots in the upper 30‐cm soil depths. Mass balance calculations suggested that there has been significant buildup of Na in irrigated soils due to CBNG irrigation water as well as Na mobilization within the soil profiles. Results indicate that irrigation with CBNG water significantly impacts certain soil properties, particularly if amendments are not properly utilized. This study provides information for better understanding changes in soil properties due to land application of CBNG water. These changes must be considered in developing possible criteria for preserving fragile PRB ecosystems.
Effect of High Influent Sulfate on Anaerobic Wastewater Treatment
Authors: Khanal Samir Kumar , Huang Ju‐Chang
Published: November 2005

A laboratory‐scale study was conducted using a completely mixed reactor with a constant influent‐total‐organic carbon (TOC) of 3750 mg/L to evaluate the effect of increasing influent‐sulfate levels on anaerobic‐treatment performance. The sulfate levels were increased stepwise from 333 to 666, 1000, 1333 and 1666 mg S/L. The results showed that an elevation of influent sulfate actually increased the TOC removal efficiency as long as the produced sulfide level did not induce toxicity. At 1333 mg S/L influent sulfate, the produced dissolved sulfide was 613 mg S/L (free sulfide = 228 mg S/L), which started to impose toxicity to the methane‐producing bacteria (MPB). It was also found that the percent electron flow to the sulfate‐reducing pathway increased with the increasing influent sulfate, but the direction toward the methanogenesis was correspondingly reduced. Nevertheless, under the experimental conditions tested, the majority of the influent organics was still degraded through the methanogenic pathway. Through this study, an oxidation–reduction‐potential (ORP)‐based oxygenation process was developed for online oxidation of sulfide in recirculating biogas. With controlled oxygen injection to raise the reactor's ORP by 25 mV, the residual sulfide in the reactor was almost totally eliminated. In case of over oxygenation, any excess oxygen was quickly consumed by the facultative organisms in the reactor, thereby imposing no toxicity to the MPB.
An Equilibrium Model for Chloride Removal from Recycled Cooling Water Using the Ultra‐High Lime with Aluminum Process
Authors: Abdel‐Wahab Ahmed , Batchelor Bill , Schwantes Jon
Published: November 2005

Removal of chloride from recycled cooling water is needed to reduce corrosion and prolong equipment life. Laboratory experiments have demonstrated that the ultra‐high lime with aluminum (UHLA) process has the ability to achieve high chloride removal efficiency from recycled cooling water. In an effort to further understand the behavior of chloride in the UHLA process, a fundamental model of the chemical processes was developed. The purpose of this paper is to describe this equilibrium model and present values for solubility products of precipitated solids that have not been investigated previously. The model was based on PHREEQC and a new program called INVRS K was integrated with PHREEQC to calculate values of unknown or poorly defined equilibrium or kinetic constants using a Gauss‐Newton nonlinear regression routine. Model predictions indicated that the results could be best described by assuming the formation of a solid solution of calcium chloroaluminate (Ca4Al2Cl2OH12), tricalcium hydroxyaluminate (Ca3Al2OH12), and tetracalcium hydroxyaluminate (Ca4Al2OH14).
Presence of Aeromonas spp in Water from Drinking‐Water‐ and Wastewater‐Treatment Plants in México City
Authors: Villarruel‐López Angélica , Fernández‐Rendón Elizabeth , Mota‐de‐la‐Garza Lydia , Ortigoza‐Ferado Jorge
Published: November 2005

The frequency of Aeromonas spp in three wastewater‐treatment plants (WWTPs) and two drinking‐water plants (DWPs) in México City was determined. Samples were taken throughout a year by the Moore's swab technique. A total of 144 samples were obtained from WWTPs and 96 from DWPs of both incoming and outflowing water. Aeromonas spp was isolated in 31% of the samples, from both kinds of sources. The technique used for the isolation of the pathogen was suitable for samples with high associate microbiota content and for those with a scarce microbial content. The presence of mesophilic‐aerobic, coliform, and fecal‐coliform organisms was investigated to determine whether there was any correlation with the presence of Aeromonas spp. Most samples from WWTP, which did not comply with the Mexican standards, had the pathogen, and some of the samples from the outflow of the DWP, which were within the limits set by the Mexican standards, also had Aeromonas spp.    Most samples containing Aeromonas spp. had concentrations below 0.1 ppm residual chlorine, and the strains were resistant to 0.3 ppm, which supports the recommendation to increase the residual chlorine concentration to 0.5 to 1.0 ppm, as recommended by the Mexican standards.
Effects of Retirement and Grandchild Care on Depressive Symptoms
Authors: Szinovacz Maximiliane E. , Davey Adam
Published: November 2005

This study explores how grandchild care in conjunction with grandparents' retirement affects depressive symptoms, using data from the Health and Retirement Survey. The findings demonstrate that retirement moderates the influence of grandchild care obligations on well-being, measured by depressive symptoms. For retired men, freedom from grandchild care obligations is associated with heightened well-being. Among women, continued employment seems to protect against potential negative effects of extensive grandchild care obligations on well-being. The results for men seem most in line with the argument that family care obligations spoil retirement, whereas the results for women suggest a scenario that is most compatible with the role enhancement thesis.
The Revised Ces-D Scale for Caregivers of the Elderly in India
Authors: Gupta Rashmi , Punetha Deepa , Diwan Sadhna
Published: November 2005

The purpose of this article is to empirically determine the factor structure of the original Radloff's (1977) Center for Epidemiological Studies-Depression Scale (CES-D), on Indian caregivers of the elderly population. The CES-D was administered to 255 caregivers via face to face interviews. The confirmatory factor analysis results did not support the original four-factor theoretical structure, but did suggest a three-factor model. In addition the three-factor version showed high internal consistency among the sub scales. The results of the present study indicate that the revised CES-D scale reflects the difference in the manifestation of depression in caregivers of the elderly in the Indian community in Allahabad, India. This scale should be validated further by replication. Implications for future research are presented.
The role of developmental assets in predicting academic achievement: A longitudinal study
Authors: Scales Peter C. , Benson Peter L. , Roehlkepartain Eugene C. , Sesma Arturo , van Dulmen Manfred
Published: November 2005

A sample of 370 students in the 7th–9th grades in 1998 was followed for 3 years through the 10th–12th grades in order to investigate the relation of “developmental assets”—positive relationships, opportunities, skills, values, and self‐perceptions—to academic achievement over time, using actual GPA as the key outcome variable. The greater the number of developmental assets students reported in the 7th–9th grades, the higher their GPA in the 10th–12th grades. Students who stayed stable or increased in their asset levels had significantly higher GPAs in 2001 than students whose asset levels decreased. Increases in assets were significantly associated with increases in GPA. Experiencing in 1998 clusters of specific assets increased by 2–3 times the odds of students having a B+ or higher GPA in 2001. The results offer promising evidence that a broad focus on building the developmental nutrients in young people's lives may contribute to academic success.
A tRNAGlu that uncouples protein and tetrapyrrole biosynthesis
Authors: Levicán Gloria , Katz Assaf , Valenzuela Patricio , Söll Dieter , Orellana Omar
Published: November 2005

Glu‐tRNA is either bound to elongation factor Tu to enter protein synthesis or is reduced by glutamyl‐tRNA reductase (GluTR) in the first step of tetrapyrrole biosynthesis in most bacteria, archaea and in chloroplasts. Acidithiobacillus ferrooxidans, a bacterium that synthesizes a vast amount of heme, contains three genes encoding tRNAGlu. All tRNAGlu species are substrates in vitro of GluRS1 from A. ferrooxidans.
urn:x-wiley:00145793:media:feb2s0014579305012780:feb2s0014579305012780-math-si11
that fulfills the requirements for protein synthesis, is not substrate of GluTR. Therefore, aminoacylation of
urn:x-wiley:00145793:media:feb2s0014579305012780:feb2s0014579305012780-math-si12
might contribute to ensure protein synthesis upon high heme demand by an uncoupling of protein and heme biosynthesis.
Ontogenetic profile of ectonucleotidase activities from brain synaptosomes of pilocarpine‐treated rats
Authors: de Paula Cognato Giana , Bruno Alessandra Nejar , Vuaden Fernanda Cenci , Sarkis João José Freitas , Bonan Carla Denise
Published: November 2005

Adenosine, a well‐known neuromodulator, can act as an endogenous anticonvulsant via the activation of adenosine A1 receptors. This adenine nucleoside can be produced in the synaptic cleft by the ectonucleotidase cascade, which includes the nucleoside triphosphate diphosphohydrolase (NTPDase) family and ecto‐5′‐nucleotidase. It has been previously reported that ectonucleotidase activities are increased in female adult rats submitted to the pilocarpine model of epilepsy. Several studies have suggested that the immature brain is less vulnerable to morphologic and physiologic alterations after status epilepticus (SE). Here, we evaluate the ectonucleotidase activities of synaptosomes from the hippocampus and cerebral cortex of male and female rats at different ages (7–9, 14–16 and 27–30‐day old) submitted to the pilocarpine model of epilepsy. Our results show that ATP and ADP hydrolysis in the hippocampus and cerebral cortex were not altered by the pilocarpine treatment in female and male rats at 7–9, 14–16 and 27–30 days. There were no changes in AMP hydrolysis in female and male rats submitted to the model at different ages, but a significant increase in AMP hydrolysis (71%) was observed in synaptosomes from the cerebral cortex of male rats at 27–30 days. Pilocarpine‐treated male rats (60–70‐day old) presented an enhancement in ectonucleotidase activities in the synaptosomes of the cerebral cortex (33, 40 and 64% for ATP, ADP and AMP hydrolysis, respectively) and hippocampus (55, 98 and 101% for ATP, ADP and AMP hydrolysis, respectively). These findings highlight differences between the purinergic system of young and adult rats submitted to the pilocarpine model of epilepsy.
Cartilaginous Choristoma of the Bony External Auditory Canal: A Study of 36 Cases
Authors: Lee Fei‐Peng
Published: November 2005

OBJECTIVE

The study goal is to present the clinical data of 36 cases of heterotopic cartilaginous mass in the bony external auditory canal and to clarify the terminology used to describe this clinical entity.

STUDY DESIGN AND SETTING

We conducted a medical record review of 36 consecutive patients with lesions (26 of which were excised) seen at two Departments of Otolaryngology in Taiwan.

RESULTS

Histopathological examination revealed that all 26 excised lesions were composed of mature hyaline cartilage, and on this basis, cartilaginous choristoma was diagnosed.

CONCLUSION

The presence of a heterotopic cartilaginous mass in the bony external ear canal is not as rare as it was once thought to be. The descriptive term “cartilaginous choristoma” rather than “chondroma” may be more appropriate for these lesions.
The Feasibility of the Retrofacial Approach to the Pediatric Sinus Tympani
Authors: Chen Bin , Yin Shankai , Shen Pingjiang
Published: November 2005

OBJECTIVE

To investigate the feasibility of the retrofacial approach to the pediatric sinus tympani (ST).

STUDY DESIGN AND SETTING

Five pediatric cholesteatoma cases, 10 pediatric and 24 adult normal specimens were studied retrospectively using high‐resolution CT measurements in our university hospital. The normal pediatric and adult specimens also underwent temporal bone dissections. CT measurements included the depth (d‐ST) and the width (w‐ST) of ST, the distance (F‐PSC) from the facial canal to the posterior semicircular canal, and the distance (P‐ST) from the depth of ST on a line perpendicular to the F‐PSC line.

RESULTS

There were no significant differences in any measurements between pediatric and adult normal specimens and between pediatric diseased and normal specimens (P> 0.05). The retrofacial approach performed in pediatric specimens was no more complex than in adult specimens. F‐PSC>3.0 mm and P‐ST<2.0 mm provided an accessible approach to the pediatric ST.

CONCLUSION

The retrofacial approach can be used in selected pediatric cases.

SIGNIFICANCE

This approach plays its individual role to eradicate cholesteatoma in a difficult‐to‐reach pediatric ST.
Prevalence of Menière's Disease in General Population of Southern Finland
Authors: Havia Mari , Kentala Erna , PyykkÖ Ilmari
Published: November 2005

OBJECTIVE

To study the prevalence of Menière's disease (MD) in the general population of Southern Finland.

STUDY DESIGN AND SETTING

Prospective study based on population register data. A questionnaire was sent to 5000 randomly selected persons aged 12 years or more living in the Helsinki University Hospital area. We enquired about whether recipients had experienced vertigo associated with a moving sensation, hearing loss, or tinnitus. For exclusion purposes, we also asked about general illnesses, ear infections, former head and ear traumas, noise exposure, medication, and use of tobacco and alcohol. To assess the validity of the population‐based study, we randomly selected a sample of 100 people among those reporting vertigo. They were clinically examined at our vestibular unit. The clinical examination was supplemented by audiologic and otoneurologic tests.

RESULTS

The response rate was 63%. In the final study sample of 3116 people, 216 reported the triad of vertigo, hearing loss, and tinnitus. By using the most recent criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology–Head and Neck Surgery, we were able to identify 16 definite MD patients from the total sample, yielding a prevalence of 513 of 100,000 persons. Among the 16 MD subjects, 9 patients had already been diagnosed with MD and 1 patient was diagnosed during the clinical examination. A peak prevalence of 1709 of 100,000 was seen in the age group 61 to 70 years.

CONCLUSIONS

Our population‐based estimate of MD prevalence is much higher than in previous reports.
Lipid‐based Nose Ointment for Allergic Rhinitis
Authors: Geisthoff Urban Wilhelm , Blum Andreas , Rupp‐Classen Marianne , Plinkert Peter‐Karl
Published: November 2005

OBJECTIVE

To assess the efficacy of a lipid‐based nose ointment in treating allergic rhinitis.

STUDY DESIGN AND SETTING

Prospective, open, randomized, controlled clinical study in the outpatient departments of 2 tertiary care centers.

RESULTS

No specific adverse effects were observed. The nose ointment under investigation led to a significant improvement in sneezing and nasal itching (17 patients). There was no significant change for nasal congestion and rhinorrhea in the intention‐to‐treat sets. However, there was still a significant drop of the mean relative total symptom score derived from the individual scores. All scores remained unchanged in the untreated control group (16 patients).

CONCLUSION

Topical application of the nose ointment as a supportive treatment leads to a significant improvement of symptoms in allergic rhinitis.

SIGNIFICANCE

The prevalence of allergic rhinitis is about 10% to 20% in the population. Our study results are encouraging and should be assessed in further research because changes in the therapeutic guidelines may be suggested.
Quality of Life in Prosthetic Voice Users
Authors: Gerwin John M. , Culton Gerald L.
Published: November 2005

OBJECTIVE

This study was designed to measure the efficacy of prosthetic voice restoration for laryngectomees in relation to various quality‐of‐life parameters.

STUDY DESIGN AND SETTING

The University of Washington Quality of Life Scale, the Functional Assessment of Cancer Therapy Scale, and a demographic data form of our own design were completed by 16 laryngectomees who had undergone prosthetic voice restoration in our private practice by Blom‐Singer methodology.

RESULTS

More than 80% of the respondents were positive in their assessment of each category on all three surveys.

CONCLUSION

Prosthetic voice restoration in private practice resulted in achieved expectations, satisfaction with speech, and good quality of life as measured by physical, functional, social, and emotional well‐being parameters.

SIGNIFICANCE

Laryngectomees may be offered prosthetic voice restoration with a high likelihood that they will be satisfied.
The Use of the Ligasure Vessel Sealing System in Parotid Gland Surgery
Authors: Prokopakis Emmanuel P. , Lachanas Vassilios A. , Helidonis Emmanuel S. , Velegrakis George A.
Published: November 2005

OBJECTIVE

To evaluate the role of the Ligasure™ Vessel Sealing System (LVSS; Valleylab, Boulder, CO) in parotid surgery.

STUDY DESIGN

A prospective study was conducted on 12 consecutive patients undergoing superficial parotidectomy, performed by using the LVSS device as the primary means of ligation. Inclusion criteria included parotid mass with no preoperative suspicion of malignancy, and no extension to the deep lobe of the parotid gland. Efficacy of hemostasis, cut‐closure time, and postoperative complications were assessed. Results were compared with a historical control group, including cases on which the LVSS was not available.

RESULTS

LVSS proved effective in providing ligation and hemostasis. There was a mean time gain of 52 minutes, compared with our historical control group. No postoperative bleeding, seroma, salivary fistula, or Frey syndrome were observed. One case of transient facial weakness occurred, which was completely resolved within 6 months.

CONCLUSION

LVSS is a safe device for parotid gland surgery, providing sufficient hemostasis and reducing operative time.
Spectrum and Management of Deep Neck Space Infections: An 8‐Year Experience of 234 Cases
Authors: Ridder Gerd JÜRgen , Technau‐Ihling Katja , Sander Anna , Boedeker Carsten Christof
Published: November 2005

OBJECTIVE

To study the clinical course and outcome of deep neck infections (DNI), with special emphasis on microbiology and histopathology.

STUDY DESIGN

Two hundred thirty‐four patients with DNIs were included in this study. Patients with peritonsillar or dental infections, infections arising from salivary glands, as well as subjects with abscesses caused by neck trauma were excluded.

METHODS

Clinical analysis of all patients with DNIs who were treated between January 1, 1997 and May 31, 2005 in a single center.

RESULTS

In 13 patients, the DNI was the first manifestation of a malignant tumor. In 17 cases, the DNI was associated with cat‐scratch disease (CSD). Six patients suffered from tuberculosis, and in another 7, an infected lateral cleft cyst was found. In 176 patients, the origin of DNI remained unclear.

CONCLUSIONS

Our results demonstrate that CSD, tuberculosis, and malignant tumors must be considered as possible causes of DNIs. The current study represents one of the largest series of DNIs in the modern medical literature.
Hemorrhage Risk After Quinsy Tonsillectomy
Authors: Giger Roland , Landis Basile Nicolas , Dulguerov Pavel
Published: November 2005

BACKGROUND

The goal of the study was to evaluate the incidence and possible predictive factors of post‐tonsillectomy hemorrhage (PTH) in patients with peritonsillar abscess, treated by acute abscess tonsillectomy.

METHODS

A retrospective cohort study was performed on 205 patients who underwent bilateral abscess tonsillectomy under general anesthesia. Age, sex, smoking habits, history of recurrent tonsillitis or prior peritonsillar abscess, current medical treatment, side of the peritonsillar abscess, initial treatment, surgeon's experience, procedure duration, intra‐ and postoperative anti‐inflammatory medications, and side of bleeding were analyzed.

RESULTS

Bleeding occurred in 27 patients (13%). Ipsilateral hemorrhage was observed in 8 patients (4%) and contralateral hemorrhage in 19 patients (9%). The higher incidence of PTH in the side contralateral to the abscess was found to be statistically significant (P = 0.02). Male gender (P = 0.042), smoking (P = 0.009), and aspirin intake (P = 0.008) were statistically significant factors associated with an increased PTH risk.

CONCLUSION

The risk of bleeding following abscess tonsillectomy seems higher than reported in elective tonsillectomy. This high incidence is mainly due to patients with prior aspirin intake or to bleeding in the side contralateral to the abscess. Postoperative bleeding could be reduced by performing a unilateral acute abscess tonsillectomy in selected patients. An algorithm is proposed for the management of peritonsillar abscess based on age, prior history of pharyngo‐tonsillar infections, aspirin intake, and clinical improvement after initial drainage and antibiotherapy.
Dentigerous Cysts Presenting as Head and Neck Infections
Authors: Smith Joseph L. , Kellman Robert M.
Published: November 2005

OBJECTIVE

To describe dentigerous cysts presenting as head and neck infections.

STUDY DESIGN AND SETTING

Retrospective analysis of 327 charts with an admitting diagnosis of head and neck infection, deep neck space infection, and dentigerous cysts treated at a tertiary care hospital between 1975 and 2004. RESULTS: Seven patients were identified who had dentigerous cysts that presented as head and neck infections. Six of these patients had recurrent infections at the same site and one was diagnosed with a submasseteric space abscess. The incidence of head and neck infections with dentigerous cysts as the underlying causative pathology was 2.1%.

CONCLUSION

Head and neck infections with dentigerous cysts as underlying pathology are more common than perceived.

SIGNIFICANCE

Typically not considered as sources of infection, dentigerous cysts must be considered in cases of head and neck infection.
Management of Bilateral Benign Paroxysmal Positional Vertigo
Authors: Kaplan Daniel M. , Nash Michel , Niv Alexander , Kraus Mordechai
Published: November 2005

Objective

To describe a series of patients with bilateral benign paroxysmal positional vertigo (BiBPPV), with respect to demographics, management, and outcome.

Methods

All patients who were identified and treated for BiBPPV in a previous 36‐month period with a minimal follow‐up period of 6 months were included. Patients were treated with Epley's maneuver (EM) on the side that was more symptomatic and that had a greater velocity and amplitude of tortional nystagmus. Patients were re‐treated according to symptoms and findings on follow‐up visits.

Results

Ten patients were identified with BiBPPV. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 54 years. There was a positive history of recent head trauma in 4 of the patients. All patients recovered after performing a mean of 2.6 EMs during a 3‐month period. One patient experienced unilateral recurrence and was re‐treated successfully.

Conclusion

BiBPPV has typical characteristics and can be managed successfully with EM, performed on the more symptomatic side, followed by repeated treatments as needed.

Ebm Rating: C

© 2005 American Academy of Otolaryngology‐Head and Neck Surgery Foundation, Inc. All rights reserved.
PPAR Activation and Decreased Proliferation in Oral Carcinoma Cells With 4‐HPR
Authors: Harris George , Ghazallah Raed Abu , Nascene David , Wuertz Beverly , Ondrey Frank G.
Published: November 2005

OBJECTIVE

To explore whether the mechanism of action of 4‐hydroxyphenylretinamide (4‐HPR, fenretidine), a synthetic retinoid, involves the functional activation of the nuclear hormone receptor class known as PPARs (peroxisome proliferator‐activated receptors). Also, to examine whether anti‐proliferative effects of this agent in head and neck cancer cells occur at biologically relevant concentrations.

STUDY DESIGN/METHODS

CA 9–22, NA, and UM SCC 11B cells were treated with 4‐HPR during their log phase growth and functional activation of PPAR γ was evaluated by plate luminometry. Cellular proliferation was analyzed by standard MTT cell proliferation assays and cell counting. Student'sttests were performed for all experiments.

RESULTS

Significant dose‐dependent increases in PPAR γ activation occurred in response to 4‐HPR treatment. Proliferation was significantly inhibited by 4‐HPR in a dose‐dependent manner as judged by MTT and cell counting assays. These effects occurred at equimolar concentrations in both types of experiments within a range of clinically achievable doses (1–4 μM) of 4‐HPR.

CONCLUSIONS

4‐HPR can functionally activate PPAR γ at clinically achievable doses. Decreased cancer cell proliferation secondary to PPAR γ activation has been observed in other malignancies as well as upper aerodigestive cancer. PPAR γ activation by 4‐HPR represents another potential anti‐cancer mechanism of action for this drug.

CLINICAL SIGNIFICANCE

PPAR γ activation represents a novel target for anti‐cancer therapy for head and neck cancer and the current level of clinical toxicity of 4‐HPR would be judged acceptable to utilize this agent alone or in combination chemotherapy.
Postlaryngectomy Pharyngocutaneous Fistula: Incidence, Predisposing Factors, and Therapy
Authors: Galli Jacopo , De Corso Eugenio , Volante Mariangela , Almadori Giovanni , Paludetti Gaetano
Published: November 2005

OBJECTIVE

The pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy, and its etiology is not well understood yet. The aim of our study was to evaluate predisposing factors, incidence, and management of this complication.

STUDY DESIGN AND SETTING

This was a retrospective study of 268 patients who underwent total laryngectomy in our clinic (January 1990‐December 2001). A number of factors potentially predisposing to PCF formation were evaluated.

RESULTS

A PCF was observed in 16% of patients. Systemic diseases, previous radiotherapy, supraglottic origin of tumor, and concurrent radical neck dissection were significantly associated with PCF. Spontaneous closure was noted in 28 patients, whereas a surgical closure was necessary in 15 patients.

CONCLUSIONS

In presence of a specific risk factor, PCF can be expected; nevertheless, its prevention remains very difficult. Moreover, given the high percentage of spontaneous closure, we suggest the “wait and see” approach for 28 days before proceeding with a surgical approach.
Short Hospital Stay After Neck Dissection
Authors: Ha Patrick K. , Couch Marion E. , Tufano Ralph P. , Koch Wayne M. , Califano Joseph A.
Published: November 2005

OBJECTIVE

Cervical lymphadenectomy is a common adjunctive therapy for the treatment of head and neck malignancies. Postoperative care of otherwise healthy patients with isolated neck dissection or in combination with other procedures often requires limited nursing attention after the first postoperative day. At our institution, patients are often taught to manage their drains and discharged home. Therefore, we sought to characterize the subset of patients who will require only overnight hospital care after neck dissection.

STUDY DESIGN

We retrospectively reviewed our experience in a tertiary academic medical center over the past 6 years with patients who underwent neck dissection, isolated or with other procedures, and were sent home by postoperative day 1.

RESULTS

In all, 23 of 260 patients were identified (8.8%). Two patients were noted to have postoperative seromas, with no other complications noted.

CONCLUSION

We conclude that short hospital stay after neck dissection is reasonable for the motivated patient without significant comorbidities.

SIGNIFICANCE

This is the first study to examine the feasibility of short hospital stay after neck dissection.
Proton Pump (H+/K+‐ATPase) Expression in Human Laryngeal Seromucinous Glands
Authors: Altman Kenneth W. , Waltonen Joshua D. , Hammer Neal D. , Radosevich James A. , Haines G. Kenneth
Published: November 2005

OBJECTIVE

Recent pilot research suggested that the H+/K+‐ATPase (proton pump), which is the target of pharmacotherapy for laryngopharyngeal reflux disease (LPRD), is associated with human laryngeal submucosal glands. The hypothesis of this study is that proton pump is expressed in the human larynx, and is not solely associated with the parietal cells of the stomach.

METHODS

Fifteen surgical larynx subjects (27 pathologic specimens) containing seromucinous glands from banked tissue were retrospectively obtained after approval from Human Subjects Committee. Banked human stomach tissue was also obtained for comparative positive and negative controls. Sections were immunostained with two monoclonal antibodies selectively reactive with alpha or beta subunits of the H+/K+‐ATPase (proton) pump.

RESULTS

In the human larynx, positive staining was seen in 14 of 15 subjects. Twenty‐six specimens showed consistent staining in the seromucinous cells and ducts for the alpha subunit, and 23 specimens for the beta subunit. Stomach parietal cells exhibited strongly positive staining for both the alpha and beta subunits of the proton pump. There was no staining in stomach cells that were not morphologically consistent with the parietal cell.

CONCLUSION

The H+/K+‐ATPase (proton) pump is present in seromucinous cells and ducts in the human larynx, with some variable expression noted. Proton pump involvement in human laryngeal seromucinous glands may explain heightened laryngeal sensitivity in those patients with chronic laryngitis believed to have LPRD. Also, proton pump inhibitor pharmacotherapy may have a site of action in the human larynx, explaining some of the controversies attributable to LPRD.
Arterial Embolization in the Management of Posterior Epistaxis
Authors: Christensen Nathan P. , Smith Dana S. , Barnwell Stanley L. , Wax Mark K.
Published: November 2005

OBJECTIVES

Treatment of severe epistaxis can encompass many modalities. Control rates with all treatments are good. Morbidity among treatment groups varies. Angiographic embolization is one such method that has a very low complication rate. Over the last 10 years, it has become the preferred treatment at our institution.

STUDY DESIGN

Tertiary medical referral centers: OHSU, Portland VAMC.

MATERIALS AND METHODS

Retrospective review of 70 patients transferred or admitted with posterior epistaxis and treated with selective angiographic embolization from 1993 to 2002.

RESULTS

Patients had bleeding for a median of 4.5 days prior to admission. 79% were unilateral. Etiology of bleeding was: idiopathic (61%), previous surgery (11%), anticoagulants (9%), trauma (7%), and other causes (12%). 30% required blood transfusions prior to admission to OHSU (average 4.4 units). No patient required a transfusion postoperatively following angiographic embolization or during their hospitalization. The internal maxillary artery (IMAX) was embolized in 94% (47% unilateral or bilateral IMAX only, 47% unilateral or bilateral IMAX in combination with other vessels, 6% other vessels besides the IMAX). Mean length of stay was 2.5 days. 86% had minor or no complications after the embolization and were discharged within 24 hours. 13% had a major rebleed that required surgical intervention within 6 weeks of the embolization. One patient had a serious neurological complication. Using the data available on 68 of 70 patients, the cost of hospitalization averaged $18,000 with direct costs of embolization averaging $11,000. CONCLUSIONS: Angiographic embolization is a clinically effective treatment for severe epistaxis.
Clinical Prognostic Factors in Malignant Parotid Gland Tumors
Authors: Lima Roberto A. , Tavares Marcos R. , Dias Fernando L. , Kligerman Jacob , Nascimento Marilene F. , Barbosa Mauro M. , Cernea Claudio R. , Soares Jose R. , Santos Izabella C. , Salviano Scheylla
Published: November 2005

OBJECTIVE

To analyze the factors in parotid malignant epithelial tumors influencing recurrences and disease‐specific survival.

METHODS

We retrospectively reviewed the files of 150 patients treated at our institution, from 1974 to 1998. Twenty‐four patients were not treated by surgery and were excluded from this study. The remaining 126 patients were treated with surgery and 74 patients had postoperative radiotherapy. Thirty‐three patients were treated with parotidectomy plus neck dissection. Neck lymph node metastasis was found in 22 patients, 5 patients had occult neck metastasis, and 4 periparotid lymph nodes metastasis. The mean age was 49 years old. According to the UICC/1997 TNM Classification, 49 patients were stage I, 27 stage II, 22 stage III, and 28 stage IV. The influence of selected factors on the 10 year disease‐specific survival was analyzed using the Kaplan‐Meier actuarial method and the log‐rank test.

RESULTS

Forty patients had mucoepidermoid carcinoma, 18 patients adenocarcinoma NOS, 18 patients acinic cell carcinoma, 15 patients adenoid cystic carcinoma, 11 patients malignant mixed tumor, 11 patients salivary duct carcinoma, and 13 patients other pathology. Twenty‐five patients had recurrences: 17 had local recurrences, 4 patients had neck recurrences, and 4 were loco‐regional recurrences. Five factors influenced negatively the prognosis: 1) T stage (p.00001), 2) grade (p.00001), 3) + lymph nodes (p.0007), 4) facial nerve dysfunction (p.0001), and 5) age (p.004). Patients with high‐grade tumors and high‐stage tumors had the worst prognosis according to the multivariate analysis. The 10‐year disease‐specific survival was 97% for stage I, 81% for stage II, 56% for stage III, and 20% for stage IV.

CONCLUSION

The grade of the tumor and stage were the most important prognostic factor.
Voice Restoration With the Advantage Tracheoesophageal Voice Prosthesis
Authors: Leder Steven B. , Acton Lynn M. , Kmiecik Joann , Ganz Cindy , Blom Eric D.
Published: November 2005

OBJECTIVES

To determine whether the Blom‐Singer indwelling Advantage tracheoesophageal voice prosthesis (TEP) extends prosthesis life span significantly in patients with documented premature device failure due to fungal colonization.

STUDY DESIGN AND SETTING

Data were collected in a prospective manner on a total of 42 standard indwelling TEP users who exhibited early device failure, that is, between 2 weeks and 6 months, due to fungal colonization of the flap valve despite appropriate use of oral antifungal agents. There were 29 men and 13 women, whose ages ranged from 36 years 10 months to 86 years 8 months.

METHODS

Baseline data were derived from the average number of days 3 previous standard indwelling prostheses functioned before leaking. An Advantage indwelling TEP was placed after the third change, oral antifungal agents stopped, and routine care implemented, that is, flush and brush the device in situ twice each day. Each participant was assigned to 1 of 3 groups. Group 1 had device failure equal to or less than 2 months (n = 12). Group 2 had device failure between 2 and 4 months (n = 19). Group 3 had device failure between 4 and 6 months (n = 11).

RESULTS

Groups 1 and 2 exhibited significantly longer device life span, that is, 77 and 82 days, respectively (P < 0.01), and group 3 exhibited device life span that was longer but not significantly so, that is, 12 days (P > 0.05), after the change from standard to Advantage TEP. Individual data indicated that the majority of participants, that is, 32 of 42 (76.2%), experienced longer device life span after changing to the Advantage prosthesis. Specifically, 9 of 12 (75.0%) users in group 1, 17 of 19 (89.5%) users in group 2, and 6 of 11 (54.5%) users in group 3 exhibited longer device life span. The combination of using an Advantage TEP, discontinuing oral antifungal agents, and reducing the number of both TEP changes and clinic visits resulted in overall cost benefits for both the user and the health care system. The cost benefit for group 1 was $520.00; group 2, $393.00; and group 3, $204.25.

CONCLUSIONS

The Advantage TEP extended device life span significantly for standard indwelling device users with documented premature device failure due to fungal colonization, reduced costs associated with tracheoesophageal voice restoration rehabilitation, and enhanced user satisfaction by eliminating use of oral antifungal agents and reducing clinic visits.

SIGNIFICANCE

Use of an Advantage indwelling voice prosthesis is warranted from both cost and user satisfaction perspectives when early and repeated device failure occurs as a result of fungal colonization.
Vegetation Change in the Coastal-Lowland Rainforest at Avai'o'vuna Swamp, Vava'u, Kingdom of Tonga
Authors: Fall Patricia L.
Published: November 2005

Avai'o'vuna Swamp, a small coastal wetland in Vava'u, Kingdom of Tonga, produced a 4500-year pollen and sediment record. Results are: (1) a mid-Holocene sea level highstand is confirmed for Tonga between about 4500 and 2600 14C yr B.P.; marine clay contains pollen from mangroves (Rhizophora mangle), coastal forest trees (Barringtonia asiatica and Cocos nucifera), and rainforest trees (Alphitonia, Rhus, Hedycarya and Calophyllum). (2) Microscopic charcoal first appeared at 2600 14C yr B.P., coincident with the arrival of Polynesians. (3) Cocos, Pandanus, Excoecaria, Macaranga, and Elaeocarpaceae pollen reflects the establishment of a mixed coastal-lowland rainforest in the last 2500 years. (4) The loss of Hedycarya, Elaeocarpus, Calophyllum, and Guettarda and the reduction of Terminalia and taxa in the Papilionaceae family by about 1000 years ago may be due to habitat destruction and the loss of dispersal capabilities of some species through the extinction of the two largest pigeons in Tonga.
A 23,000-yr Pollen Record from Lake Euramoo, Wet Tropics of NE Queensland, Australia
Authors: Haberle Simon G.
Published: November 2005

A new extended pollen and charcoal record is presented from Lake Euramoo, Wet Tropics World Heritage rainforest of northeast Queensland, Australia. The 8.4-m sediment core taken from the center of Lake Euramoo incorporates a complete record of vegetation change and fire history spanning the period from 23,000 cal yr B.P. to present. The pollen record is divided into five significant zones; 23,000–16,800 cal yr B.P., dry sclerophyll woodland; 16,800–8600 cal yr B.P., wet sclerophyll woodland with marginal rainforest in protected pockets; 8600–5000 cal yr B.P., warm temperate rainforest; 5000–70 cal yr B.P., dry subtropical rainforest; 70 cal yr B.P.–AD 1999, degraded dry subtropical rainforest with increasing influence of invasive species and fire.

The process of rainforest development appears to be at least partly controlled by orbital forcing (precession), though more local environmental variables and human activity are also significant factors. This new record provides the opportunity to explore the relationship between fire, drought and rainforest dynamics in a significant World Heritage rainforest region.
Unrecognized Benign Paroxysmal Positional Vertigo in Elderly Patients
Authors: Oghalai John S. , Manolidis Spiros , Barth Justine L. , Stewart Michael G. , Jenkins Herman A.
Published: November 2005

Balance disorders in elderly patients are associated with an increased risk of falls but are often difficult to diagnose because of comorbid chronic medical problems. We performed a cross‐sectional study to determine the prevalence of unrecognized benign paroxysmal positional vertigo (BPPV) and associated lifestyle sequelae in a public, inner‐city geriatric population. Dizziness was found in 61% of patients, whereas balance disorders were found in 77% of patients. Nine percent were found to have unrecognized BPPV. Multivariate analysis demonstrated that the presence of a spinning sensation and the absence of a lightheadedness sensation predicted the presence of unrecognized BPPV. Patients with unrecognized BPPV were more likely to have reduced activities of daily living scores, to have sustained a fall in the previous 3 months, and to have depression. These data indicate that unrecognized BPPV is common within the elderly population and has associated morbidity. Further prospective studies are warranted.