bluuebunny/crossref_metadata_2025 huggingface dataset:
CO2 Laser as a clinical tool in otolaryngology
Authors: Lyons George D. , Lousteau Ray J. , Mouney Daniel F.
Published: October 2009

The CO2 laser has been used in a variety of lesions for two and one half years in areas other than the larynx. These lesions include viral papillomas, leukoplakias and erosive lichen planus in various otolaryngological sites. Laser therapy is compared with other modalities of treatment for similar lesions and the advantages and disadvantages of this type treatment is evaluated.
Microsurgical techniques in free flap reconstruction
Authors: Panje W. R. , Krause C. J. , Bardach J.
Published: October 2009

Free flap reconstruction is discussed with emphasis on microsurgical technique utilized in union of blood vessels 1 mm in external diameter. Proper microsurgical instrumentation, magnification and small vessel suture technique are all of importance in achieving a successful microvascu‐lar anastomosis. Technical maneuvers employed in identifying and avoiding small vessel thrombosis are presented. Surgical techniques, as presented here, have allowed us to successfully use free flaps to reconstruct large oral cavity defects following ablative cancer operations.
Mediastinal dissection — 1976: Indications and newer techniques
Authors: Sisson George A. , Bytell David E. , Becker Stephen P.
Published: October 2009

Head and neck neoplasms may invade the mediastinum by direct extension or metastases to the tracheoesophageal or jugulo‐subclavian lymph nodes. The clavicles and manubrium are a barrier to adequate resection in this type of disease. In 1962, the senior author reported six mediastinal dissections for stomal recurrences after laryngectomy.

Later techniques for staging the removal of manubrium and clavicles and preparing the regional flaps were devised to avoid major complications arising from operating in thin area which usually had prior treatment with radiation and/or surgery. Over 60 transsternal radical neck dissections have been performed in the past 20 years. We have in the past evaluated the morbidity and survivals in stomal cases and present here our revised indications and techniques.
Melanoma of the head and neck
Authors: Conley John , Hamaker Ronald C.
Published: October 2009

A retrospective review from 1935 to 1962 of 772 melanomas involving the head and neck seen at the Pack Medical Foundation (PMF) is presented with the main emphasis of 660 cutaneous and mucosal melanomas. Clark's levels for pathologic invasion are presented and correlated to 289 cases with 19 percent in Level II and 81 percent deeply invasive at Level III, IV, and V. The face was the most common location with the cheek alone accounting for 22.3 percent of all the cases. The male to female ratio was 1.5 to 1 with 76 percent of the cases being equally distributed among the fourth through the seventh decades. 55.9 percent were local disease, Stage I, with 33.5 percent, Stage II, and 10.6 percent, Stage III or distal disease.

The five‐year or greater absolute cure rate in positive nodal disease was 12.6 percent. Elective versus no elective neck dissection in Stage IA disease demonstrated a five‐year or greater absolute cure rate of 55 percent as compared to 38.5 percent. Distal metastases occurred in 30 percent of cases with elective neck dissection but in 70 percent of those cases with therapeutic neck dissection. The absolute five‐year or greater cure rate was able to be analyzed in 556 cases. The rate was 25.6 percent for the mucosal and cutaneous lesions combined; an 8 percent rate for mucosal alone and 27.8 percent for cutaneous melanoma. The five‐year or greater absolute cure rate for those cases treated totally at PMF was 35.4 percent.
The applied anatomy of thyroglossal tract remnants
Authors: Ellis Peter D. M. , Van Nostrand A. W. Peter
Published: October 2009

Recurrences after surgery for thyroglossal cysts and fistulas were common until, in 1920, Sistrunk described his technique for removing the whole thyroglossal tract. Since that time there has been considerable argument concerning the exact path taken by the tract particularly in relation to the hyoid bone.

In an attempt to elucidate this problem, studies have been made of embryos at varying stages of development, of serially step‐sectioned adult larynges and of surgical specimens. These studies suggest that the thyroglossal tract occupies a constant and embryologically predictable position in relation to the hyoid bone and they support the rationale of Sistrunk's procedure.
Percutaneous embolization to control intractable epistaxis
Authors: Wills Paul I. , Russell Rex D.
Published: October 2009

Recurrent epistaxis is a common manifestation of patients with a bleeding diathesis. Two patients with epistaxis secondary to a bleeding diathesis managed by local conservative techniques are reviewed. (A case of polycythemia vera and a case of liver failure secondary to hepatoma are reviewed.)

Recently bilateral, percutaneous carotid angiography examination was performed on a patient with a bleeding diathesis and intractable epistaxis. At the time of the angiographic examination, embolization of both internal maxillary arteries with Gelfoam particles was accomplished and dramatic control of the epistaxis was achieved.

In a patient with severe epistaxis secondary to a bleeding diathesis that is unresponsive to local measures, percutaneous Gelfoam embolization offers substantial advantages over surgical intervention.
Giant cell tumor of the ethmoid sinuses: Diagnostic dilemma
Authors: Burnam J. Andrew , Benson Jerome , Cohen Isaac
Published: October 2009

Tumors originating in the ethmoid sinuses are rare. Carcinomas of the ethmoid sinus, for example, comprise only 2‐3% of all head and neck malignancies. Of this small sample, the ethmoid sinuses as the primary site varies from 5‐30%. This paper presents the 14th documented case of giant cell tumor originating in the ethmoid sinuses. The pathology became the diagnostic dilemma; the case was originally diagnosed as an angiofibroma, later a reparative granuloma, and finally accepted as a giant cell tumor. The rationale for diagnosis and therapy is discussed.
Bilateral longitudinal temporal bone fractures: A retrospective review of seventeen cases
Authors: Griffin James E. , Altenau Mark M. , Schaefer Steven D.
Published: October 2009

The types of temporal bone fractures, longitudinal and transverse, are reviewed. All cases of bilateral temporal bone fractures at Parkland Memorial Hospital in Dallas over a 10‐year period from 1968 to 1978 are reviewed and discussed by the authors. One hundred sixty patients with the diagnosis of base of skull fractures were studied. Fifty‐nine of these were temporal bone fractures and 17 of the 59 were bilateral. Of all the base of skull fractures, 10% were bilateral temporal bone fractures and 29% of all temporal bone fractures were bilateral. For each case the method of injury, the extent of damage to hearing and facial nerve function, presence of CSF otorrhea, X‐ray findings, and additional complications are summarized and the results discussed. The operative findings of facial nerve decompressions are carefully reviewed. The authors' method of caring for temporal bone fractures is presented.
Progressive sensorineural hearing loss and cochlear otosclerosis: A prospective study
Authors: Freeman Joseph
Published: October 2009

The association of otosclerosis with reduced bone conduction is well known but no experimental or valid clinical relationship has been established to confirm this relationship. The purpose of this presentation is to demonstrate a clinical relationship between otosclerosis and sensorineural hearing loss. Experimental proof will await the accumulation and study of temporal bones of those individuals who, in life, exhibited the clinical relationship to be developed in this dissertation.

The material presented is from the author's private practice during the years 1974, 1975 and 1976. Patients presenting the clinical problem of progressive sensorineural hearing loss were examined in depth including diagnostic audiology and polytomography of the petrosa.

This thesis shows that a high percentage of such diagnostic problems are due to cochlear otosclerosis, the diagnosis being clinically supported roentgenologically.
Eosinophilic granuloma in the temporal bone
Authors: Sweet Robert M. , Kornblut Alan D. , Hyams Vincent J.
Published: October 2009

Eosinophilic granuloma is an uncommon granulomatous disease which can affect the temporal bone. Although initially silent, the disease may erode the mastoid cortex, destroy the tegmen and extend into the cranial vault, as well as erode the semicircular canals or cochlea. These lesions almost always become infected and can be confused with chronic otomastoiditis. Equally important, temporal bone involvement may represent only one manifestation of a multifocal disease.

Between 1940 and 1978, 19 cases of eosinophilic granuloma involving the temporal bone have been recorded in the Armed Forces Institute of Pathology Registry. Most recently, a 24‐year‐old white boatswain's mate was sent to the National Naval Medical Center for treatment of unifocal disease which originated in his right mastoid bone. He subsequently underwent modified radical mastoidectomy and received 2500 R cobalt therapy to the temporal bone following surgery. His case history is detailed and the problem of eosinophilic granuloma in the temporal bone is reviewed in depth.
Avoidance of early complications following radical neck dissection
Authors: Camnitz Paul S. , Biggers W. Paul , Fischer Newton D.
Published: October 2009

Multiple factors are associated with the increased risk of postoperative complications following radical neck dissection. Most significant of these are preoperative radiation and entry into the pharynx. The most common of these complications are discussed, and following is a description of preoperative, intraoperative, and postoperative methods to reduce them.

Changes in operative methods and antibiotic coverage were associated with a decrease in wound infection and fistula formation. It is suggested that patients in high risk categories be covered with preoperative, prophylactic gram positive antibiotic coverage, along with Tobramycin.
Panel discussion: Glomus jugulare tumors of the temporal bone. Malcolm D. Graham, Ann Arbor, Mich., Moderator. Chemoreceptors of the head and neck
Authors: Shellhamer Robert
Published: October 2009

Glomus bodies of the temporal bone and base of the skull are examples of non‐chromaffin paraganglionic organs uncommonly observed in the head and neck, the largest of which is the carotid body or glomus caroticum. This paper reviewed observations on the gross and microscopic morphology of the carotid body, glomus jugulare, glomus vagale and glomus tympanicum. Historically, a review was given of the structure and location of those organs which have been documented in the literature and emphasized the associations observed between them and the vascular system (hence, glomi) and with nerves (hence, ganglia or paraganglia‐chromaffin and nonchromaffin). Conceptualization of these bodies on a functional basis has led to alternative use of less commonly used terms such as chemoreceptor cells and chemoreceptor bodies, APUD or Amine Precursor Uptake‐Decarboxylating cells). Receptor tissue paraganglia have been described which, when they occur as tumors at the skull base, involve cranial nerves (vagus, glossopharyngeal and branches), vascular structures such as the carotid and ascending pharyngeal arteries, the jugular veins and their branches and tributaries. Paraganglia also occur with intracranial, intratemporal and intracerebral extensions. The gross anatomy of the skull base—the pharyngeal wall and the nerves and vessels—was reviewed. Emphasis was placed on the anatomy of the jugular foramen, jugular bulb and posterior cranial fossa, and on the tympanic canaliculus and carotid canal and their respective contents. The potential for their association with the middle ear was cited.

Adequacy of terminology variously employed was discussed. The conclusion was made that, consistent with the relationship borne between these bodies and vessels, the use of the term glomus bodies (and their tumors), and described as well by location, e.g., glomus jugulare, glomus tympanicum is preferred. Consistent with the relationship borne between these bodies, and their tumors and nerves, the use of the term non‐chromaffin paraganglion (‐oma = the tumor) is appropriate and as described by location e.g., nonchromaffin paraganglioma vagale.
Panel discussion: Glomus jugulare tumors of the temporal bone. Radiation of glomus tumors of the temporal bone
Authors: Cole James M.
Published: October 2009

In a study done at the Geisinger Medical Center in 1976, the results of treatment of 30 cases of glomus tumors involving the ear were reviewed. All 8 cases of glomus tympanicum were controlled with surgery and all of the cases of glomus jugulare treated with high voltage radiotherapy were controlled for from 2 to 12 years. Currently, the length of control extends to 15 years and there have been no late recurrences. Three additional cases showing unusual features of glomus jugulare are presented.
Congenital cytomegalovirus and hearing loss: Clinical and experimental observations
Authors: Davis Gustave L.
Published: October 2009

The effects of congenital cytomegalovirus infection vary from severe central nervous system destruction to asymptomatic viuria. Yet children with the latter have a high incidence of unsuspected hearing loss. Histopathology of temporal bones from children who die with cytomegalic inclusion disease shows viral infected cells in non‐sensory endolabyrinthine epithelium. Experimental mouse cytomegalovirus causes an age related cranial neuronitis and perilabyrinthitis. Immunopathologic localization of different viral antigens in experimental inner ear infections shows differential vulnerability of labyrinthine structures to infections. Adaptation of such techniques to human temporal bone, pathology could yield information regarding pathogenesis of viral labyrinthitis. The development of a human cytomegalovirus vaccine may eliminate the risks of this congenital infection.
The surgical management of recalcitrant malignant external otitis
Authors: Raines John M. , Schindler Robert A.
Published: October 2009

Aggressive medical management and surgical debridement is curative in most cases of malignant external otitis. Recently, four patients with this condition were treated at the University of California, San Francisco, who did not respond to conventional therapy. In each case, appropriate intravenous antibiotics, diabetic management, and extensive excision of involved tissue failed to eradicate the infection. Progression of the disease was evidenced by any one of the following: 1. Persistence of granulation tissue in the external auditory canal, 2. Development of cranial neuropathies during treatment, 3. Other signs or symptoms of active infection for more than two weeks after institution of therapy. Any one of these criteria was considered an indication for more radical surgical intervention. In three patients, the operative procedure consisted of a subtotal temporal bone resection to gain access to the primary focus of infection and provide adequate drainage. The common finding in each case was an abscess cavity in the soft tissues at the base of the skull. A description of the clinical course and surgical management of malignant external otitis forms the basis of this communication.
Effectiveness of the CO2 laser in experimental tympanic neurectomy
Authors: Lima José A. , Wilpizeski Chester R.
Published: October 2009

As one of a series of investigations to evaluate the efficacy and safety of CO2 lasers in otologic microsurgery, squirrel monkeys were subjected to tympanic neurectomies by means of vaporizing Jacobson's nerve in the promontory region. Air and bone conduction hearing acuity was measured by computer‐averaged pure tone evoked responses and behavioral audiometry before and after laser surgery. A moderate (avoidable) conductive loss was found as a consequence of the surgical approach selected, but no significant sensorineural loss was apparent. Thus, there would appear to be no adverse cochlear side effects as a result of using this instrument in the middle ear. The laser neurectomy procedure, however, was no more effective for the clinical purposes for which it was proposed than those techniques reported by several other investigators.
Patterns of deafness in newborns
Authors: Simmons F. Blair
Published: October 2009

The Crib‐o‐gram neonatal hearing screening project has detected 42 babies with handicapping degrees of hearing loss, mainly sensorineural. In apparently normal newborns the incidence is 1:1000 births. For graduates of the sick baby (intensive care) nursery, it is 1:52. Intrauterine and neonatal anoxia occurred in 73% of the latter group and was clearly the most common risk factor. Aminoglycosides had no obvious effect. The correlation between specific items in the medical histories and threshold pure tone audiograms was poor and unpredictable for any individual child. In general, anoxia tends to be associated with increased high‐frequency hearing loss. Hearing losses were asymmetrical in 43% and probably progressive in 32% (average increase, 33 db). Only one child may have developed the hearing loss after hospital discharge, thus indicating that most, if not all, early childhood deafness is present in the neonatal period.
Electromyographic biofeedback training with patients exhibiting a hyperfunctional voice disorder
Authors: Stemple Joseph C. , Weiler Ernest , Whitehead William , Komray Raymond
Published: October 2009

Baseline EMG measures of general laryngeal area muscle tension while speaking and during silence were taken from a group of 21 normal subjects and 7 subjects diagnosed through indirect laryngoscopy as having vocal nodules. In an attempt to reduce their baseline scores, the vocal nodule patients underwent 8 EMG biofeedback training sessions followed by a 2‐week follow‐up session.

Sophisticated listeners then judged the qualities of the voices produced during the baseline and follow‐up sessions. Measures of sound pressure levels for the speech samples were also taken to determine their effects on EMG scores.

Results of the statistical analyses revealed that significant differences in general laryngeal area muscle tension while speaking and in silence exist between normal and pathological subjects; and that subjects with vocal nodules could significantly reduce these tension levels with EMG biofeedback training.

A positive correlation was then found between the EMG measures and the judgments of voice qualities. No correlations were found between EMG measures and sound pressure levels.
Multiple oncocytic papillary cystadenomas of the larynx: A case report
Authors: Lejeune Francis E. , Putman Harrison C. , Yamase Harold T.
Published: October 2009

A patient had multiple oncocytic cysts of the larynx and, concurrently, epidermoid carcinoma of the larynx. Total laryngectomy for the epidermoid carcinoma made it possible to carefully examine and histologically document the multifocal and oncocytic nature of the lesions. The authors interpret the findings to represent both hyperplastic and metaplastic processes.
Traumatic pneumocephalus
Authors: Jacobs Joseph B. , Persky Mark S.
Published: October 2009

This paper presents an unusual case report and comprehensive review of pneumocephalus. The pathogenesis of this finding is explained with the intracranial variations in meningeal anatomy adjacent to the anterior and posterior paranasal sinuses. The effectiveness of prophylactic antibiotics in treating meningeal tears should not lead the physician into a false sense of security. The watchful waiting attitude must be tempered with the knowledge of increased morbidity and mortality in prolonged pneumocephalus. Statistics reinforce the policy of opting for surgical repair of persistent intracranial air after one week. The increasing role of the otolaryngologist and extracranial approaches to the base of the skull becomes evident in the management of these cases.
Unilateral hearing loss in children
Authors: Brookhouser Patrick E. , Worthington Don W. , Kelly William J.
Published: October 2009

Recent reports suggest that early onset, severe unilateral sensorineural hearing loss (USNHL) in children may be associated with significant deficits in auditory and psycholinguistic skills and school performance. This report reviews a consecutive series of 324 children and adolescents (202 males, 122 females) with documented USNHL evaluated at the Boys Town National Research Hospital. The left ear was affected in 168 (52%) and the right ear in 156 (48%). Based on speech frequency threshold averages (i.e., 500, 1000, and 2000 Hz), the losses were classified by severity as follows: borderline, 43 (13%); mild, 51 (16%); moderate, 40 (12%); severe, 19 (6%); profound, 31 (10%), and anacusic, 50 (15%). The remaining 90 children (28%) had high frequency losses (i.e, above 2000 Hz). The mean and median age of diagnosis were 8.78 years and 7.75 years. Temporal bone imaging studies, auditory brainstem responses (ABRs), and vestibular evaluations were performed on selected cases. Etiology was uncertain in 34.8% of cases, while hereditary factors (12.6%), head trauma (10.8%), and perinatal risk factors (10.7%) were the most commonly identified etiologies. Thirty‐one percent of the children had scholastic or behavioral problems in school. A concerted effort aimed at early identification and intervention in cases of USNHL is warranted.
Intraoperative infectious disease exposure to otolaryngology operating room personnel
Authors: Benninger Michael S. , Gupta Neeraj , Gilmore Kathleen
Published: October 2009

Health care workers are at risk of exposure to serious infectious diseases. Since the seroconversion rate is approximately 0.4% for human immunodeficiency virus and may be greater than 20% for hepatitis exposure, these risks are substantial. To assess body fluid exposure to otolaryngology operating room personnel, elective operations were prospectively analyzed over 2 months. Statistical evaluation was made between types of cases and length of procedures. Thirty‐eight contaminations occurred in 228 operations with 26 torn gloves, 1 soaked gown, 6 skin scratches, 4 skin punctures, and 1 ocular exposure. Exposure was more likely in cases longer than 3 hours. Independent of procedure length, head and neck operations carried the greatest risk, followed by otologic procedures, as compared to general, endoscopic, pediatric, and elective trauma cases. The impact of potential operative exposure and universal precautions is emphasized.
The learning curve in stapes surgery
Authors: Hughes Gordon B.
Published: October 2009

Fewer stapes operations are available to train residents and to maintain individual competence. Most residents in the United States perform 0 to 10 cases during training, and produce results which are not as good as expert results, even with close supervision. After graduation, fewer cases are available to achieve expert results in private or academic practice. The authors' conclusions and recommendations are based on his own learning curve. Residents who have below average skills in middle ear surgery, and residents who do not wish to practice otology, should watch but not perform stapes surgery. Program directors, collectively or separately, should develop more formal guidelines for teaching stapes surgery during residency.
Hearing loss and pneumococcal meningitis: An animal model
Authors: Bhatt Samir , Halpin Chris , Hsu Wen , Thedinger Britt A. , Levine Robert A. , Tuomanen Elaine , Nadol Joseph B.
Published: October 2009

Clinical studies of predisposing factors in the development of hearing loss secondary to bacterial meningitis have produced conflicting results. An animal model of meningogenic labyrinthitis was developed for more precise study of these parameters. Rabbits were inoculated intrathecally with 105 pneumococci to induce meningitis. Hearing thresholds were measured using auditory‐evoked responses to 1 kHz, 10 kHz, and click stimuli before infection and every 12 hours thereafter. Profound deafness occurred in all subjects at an average of 48 hours following infection. The incidence and severity of hearing loss was strongly correlated with the duration of meningitis. Temporal bone histology revealed acute inflammation of all perilymphatic spaces including the cochlear aqueduct. This model demonstrated that the risk and severity of hearing loss increase with the duration of meningitis and suggested that the cochlear aqueduct is an anatomic pathway for the extension of infection from the cerebrospinal fluid to the cochlea. The implications for therapy in humans is discussed.
Magnetic field changes associated with caloric stimulation of the human vestibular organ
Authors: Michelson Robin P. , Vincent Wilbur R.
Published: October 2009

Caloric stimulation of the ear produces a shift of the vestibular resting potential. The current produced by the change in this potential produces a corresponding change in the associated magnetic field. A sensitive magnetic detector (second‐derivative gradiometer) was used to detect a large shift in the magnetic field close to the ears of two normal subjects who underwent cold thermic ear stimulation. The shift in the magnetic field tracked the reflex responses in both individuals. This technique could offer a noninvasive direct measure of end‐organ function.
On the pathomechanism of cochlear dysfunction in experimental perilymph fistulas
Authors: Böhmer Andreas
Published: October 2009

The mechanism leading to hearing impairment in perilymph fistulas was investigated in guinea pigs with perforated round window membranes (RWM) by analyzing alterations of inner ear fluid pressure, changes of auditory function following manipulations to get presumed air bubbles out of the cochlea (“positional audiometry”), and temporal bone sections. The instantaneous loss of normal positive inner ear fluid pressure after RWM perforation had no immediate effect on auditory function. Inner ear pressure was restored 4 days following RWM perforation. “Positional audiometry” was negative in guinea pigs with perforated RWM. All ears in which auditory thresholds had increased had additional iatrogenic lesions at the spiral lamina. Fistulas in the RWM per se do not affect auditory thresholds. The question of the surgical repair of fistulas was not directly addressed; it only can be concluded that there are no direct sequelae of an isolated fistula which induce auditory impairment and which could be prevented by surgical repair of the fistula.
A model for multidisciplinary data collection for cervical metastasis
Authors: Domanowski Gerard F. , Vaughan Charles W. , Zeitels Steven M. , Vincent Miriam E. , Malhotra Chandler
Published: October 2009

A system for multidisciplinary data collection for metastatic neck disease is discussed. Information from 87 neck dissections and 3218 lymph nodes is reported to illustrate the strength of the model. Clinical (endoscopic) assessment under general anesthesia, surgical assessment during the neck dissection, and radiographic (computed tomographic scan) assessment were compared with the pathological evaluation. All disciplines stratified the necks by region and node size. This model provides an effective stratagem for multi‐institutional studies.
Nonpalpable occult and metastatic papillary thyroid carcinoma
Authors: Witterick Ian J. , Abel Sharon M. , Noyek Arnold M. , Freeman Jeremy L. , Chapnik Jerry S.
Published: October 2009

The results of palpation, ultrasound, and detailed pathology were compared in 50 patients undergoing total thyroidectomy. Of the 211 nodules recognized by pathology, palpation detected 24% and ultrasound detected 43%. There were 14 patients with palpable papillary carcinomas, and 12 of these 14 had metastatic foci in other portions of the gland. Metastatic foci would have been left in 10 patients if only a lobectomy had been performed and would have been left in 6 patients if only a subtotal thyroidectomy (as defined in this report) had been performed. Of the 33 patients with benign palpable nodules, 5 had occult papillary carcinomas. In 2 of those 5 patients, the occult carcinomas would not have been removed if a less‐than‐total thyroidectomy had been performed. The significance of these occult and metastatic papillary carcinomas is discussed.
Easy bruisability, aspirin intolerance, and response to DDAVP®
Authors: Lekas Mary D. , Crowley James P.
Published: October 2009

Easy bruisability raises the issue of bleeding during otolaryngological surgery. Ten female patients with easy bruisability were evaluated by aspirin challenge; clinical history and screening coagulation studies in these patients had revealed no evidence of a bleeding disorder. The baseline Ivy bleeding time (BT) test (4.5 to 9.5 minutes) was found to be normal in 6 patients and prolonged in 4 patients. Following treatment with aspirin, the bleeding time prolonged significantly in the three groups evaluated: normal controls (6.0 ± 1.5 minutes vs. 8.4 ± 2.0 minutes), patients with easy bruisability and a normal baseline (7.8 ± 1.3 minutes vs. 12.0 ± 1.6 minutes), and patients with easy bruisability and an abnormal baseline (11.0 ± 0.7 minutes vs. 14.5 ± 0.9 minutes). Administration of DDAVP® (desmopressin acetate) 0.3 μg/kg normalized the prolonged bleeding times in all groups after 7 days of daily aspirin therapy. Performing bleeding times before aspirin challenge, after aspirin challenge, and after DDAVP therapy following aspirin challenge is both a useful way of confirming aspirin sensitivity in patients with easy bruisability as well as a useful way of documenting improved hemostasis after DDAVP administration.
Nerve excitability testing: Technical pitfalls and threshold norms using absolute values
Authors: Gates George A.
Published: October 2009

Percutaneous stimulation of the facial nerve is used widely in tests to judge the severity and prognosis of facial paralysis. Several test paradigms are used including nerve excitability threshold (NET), the maximum stimulation test (MST), and electroneuronography (EnoG). Consistent technique and careful control of variables are essential to achieve accurate test results. The sources of variability examined in this study were age, gender, body weight, and the use of electrode paste; the NET was used as the test method. The facial NET in 120 adults without a history of facial paralysis increased linearly with age (P = .0004) and with body weight (P < .0001) and was higher in men than in women adjusted for age and weight (P = .0001). The mean NET ± SD was 0.7 ± 0.27 mA in the upper division using the eyelid twitch as an end point, and 1.2 ± 0.40 mA in the lower division. There was no statistically significant difference in the results between sides. The NET was falsely elevated by the use of electrode paste, presumably due to current shunting away from the nerve.

Based on the technique described herein, an absolute NET of ≥ 1.25 mA in the upper division or an absolute NET ≥ 2.0 mA in the lower division of the human facial nerve is statistically abnormal. These norms are not applicable to grossly obese patients or patients with facial edema or inflammation. Statistical norms allow the NET results to be reported on a continuous scale rather than the dichotomous scale used in the past. The predictive power of the NET will be greatly enhanced by basing test interpretation on both statistical and clinical significance.
Significance of tumor thickness in soft palate carcinoma
Authors: Baredes Soly , Leeman Daniel J. , Chen Thomas S. , Mohit‐Tabatabai Mirseyed A.
Published: October 2009

Tumor thickness is an important prognostic factor in tumors outside of the upper aerodigestive tract, such as cutaneous melanoma, colorectal carcinoma, and cervical carcinoma. Some studies have also suggested that tumor thickness may have similar prognostic value in the upper aerodigestive tract. This study examined the relationship between tumor thickness (measured with an ocular micrometer) and nodal disease and that between tumor thickness and survival in 44 patients with soft palate epidermoid carcinoma. There was a significant correlation between tumor thickness and nodal disease. None of the 24 lesions less than or equal to 2.86 mm had cervical adenopathy. All of the 15 lesions greater than or equal to 3.12 mm had palpable adenopathy. Tumor thickness correlated more directly with nodal disease than did T stage. Thicker lesions were associated with poorer survival. Tumor thickness is an important parameter in the head and neck and deserves further study.
The effects of cyclosporin a on transplanted rat allografts
Authors: Strome Marshall , Strome Scott , Darrell Judith , Wu Justin , Brodsky Gilbert
Published: October 2009

Since 1983, Cyclosporin A (CsA) has been the most successful primary drug in preventing rejection of organ transplants. This study was designed to determine the efficacy and dose response of CsA in preventing rejection of LBNF‐1 rat allografts to Lewis recipients.

Four groups of animals were studied. Group I served as the control, and groups II, III, and IV were given daily intramuscular doses of CsA for 1 month. The groups were given doses of 5 mg/kg, 7.5 mg/kg, and 10 mg/kg, respectively. Sixty‐eight animals were transplanted to get eight viable transplanted animals at 1 month in each CsA group. Laryngeal viability was assessed with both clinical and histological parameters. Groups II, III, and IV had representative clinically viable larynges. The histology varied and had some correlation with CsA dosage. Group II evidenced changes ranging from mild to severe rejection. Group III was more homogeneous with the most severe change being characterized as mild‐to‐moderate rejection. Group IV was the most uniform with all representative specimens showing only limited infiltration of inflammatory cells with intact mucosa and submucosal glands (mild rejection). None of the CsA groups evidenced the squamous metaplasia characteristic of the control group. CsA can prevent rejection of laryngeal allografts from LBNF‐1 donors to Lewis recipients.
Vascular decompression surgery for severe tinnitus: Selection criteria and results
Authors: Møller Margareta B. , Møller Aage R. , Jannetta Peter J. , Jho Hae Dong
Published: October 2009

Seventy‐four patients were operated on within a period of 10 years to treat incapacitating tinnitus; 72 underwent microvascular decompression (MVD) of the intracranial portion of the auditory nerve, and 2 underwent section of the eighth nerve close to the brain stem. Of those who underwent MVD, 2 had no change in symptoms and later also underwent section of the eighth nerve near the brain stem. Two patients did not return for follow‐up. Of the 72 remaining patients, 13 (18.1%) experienced total relief from tinnitus, 16 (22.2%) showed marked improvement, 8 (11.1%) showed slight improvement, 33 (45.8%) had no improvement, and 2 (2.8%) became worse. The patients who experienced total relief and those who showed marked improvement had experienced their tinnitus for an average of 2.9 years and 2.7 years, respectively; those who showed slight improvement and those who had no improvement had experienced their tinnitus for a longer time before the operation (mean, 5.2 and 7.9 years, respectively). Of the 72 patients who were operated on and followed, 32 were women. Of these, 54.8% experienced total relief from tinnitus or marked improvement, while only 29.3% of the men showed such relief or improvement.

Selection of the patients for operation was mainly based on patient history and, to some extent, on auditory test results (brainstem auditory evoked potentials [BAEP], acoustic middle ear reflexes, and audiometric data).
Atypical hearing loss in acoustic neuroma patients
Authors: Selesnick Samuel H. , Jackler Robert K.
Published: October 2009

Audiologic data from 126 patients treated at the University of California, San Francisco for newly diagnosed acoustic neuromas (ANs) from 1986 to 1990 were reviewed. Subjectively normal hearing was present in 15% of patients and was most frequent in patients with small (<1 cm) tumors. Only 4% had objectively normal hearing on the basis of speech reception threshold (SRT), speech discrimination score (SDS), and high‐frequency pure‐tone loss. This was most frequent in patients with <1 cm tumors. Abnormal but symmetrical hearing is usually not considered to be indicative of a unilateral AN. In the present series, 7% of patients with ANs possessed symmetrical hearing. High‐frequency asymmetry was a more sensitive indicator of the presence of an AN than differences in either SRT or SDS. The clinician must be aware of the relatively high incidence of atypical audiologic findings in acoustic tumor patients.
Facial neuroma of the cerebellopontine angle and the internal auditory canal
Authors: Fagan Paul A. , Misra Sanjay N. , Doust Bruce
Published: October 2009

Four cases of facial neuroma confined to the cerebellopontine angle and internal auditory canal are presented. Prior to surgery, three of these were diagnosed as an acoustic tumor. At operation the true diagnosis of facial neuroma was made. The operative procedure was recorded on film and videotape. The magnetic resonance imaging (MRI) and computed tomography (CT) scans were reviewed retrospectively. In the first three cases the tumor was not centered on the axis of the internal auditory canal (IAC), as would be typical of an acoustic neuroma, but instead occupied a position eccentric to this axis. In one case, this eccentricity was marked. A similar appearance in the fourth case enabled the true diagnosis of facial neuroma to be made before surgery. The postoperative behavior of the tumors was unpredictable. The patient with the largest tumor, which was debulked at operation, did not develop a facial palsy. However, a patient with a small tumor which was not biopsied, developed a delayed but complete paralysis from which she subsequently recovered. This small series suggests that it may be possible, by use of the appropriate imaging technique, to diagnose, preoperatively, a cerebellopontine angle facial neuroma which is otherwise indistinguishable from an acoustic neuroma.
Resistance to respiratory airflow of the extrapulmonary airways
Authors: Cole Philip , Savard Patrick , Miljeteig Harald , Haight James S. J.
Published: October 2009

Resistances to respiratory airflow of nasal, pharyngeal, laryngeal, and tracheobronchial airway segments were determined by computer processing of digitized differential pressure and flow signals in four healthy, awake, male adults seated and breathing spontaneously at rest, exclusively through decongested noses. Resistances of the nasal and pharyngeal segments in Pa/cm3 per second averaged 0.139 (SD ± 0.044) and 0.081 (SD ± 0.051), respectively, with no resistive evidence of compliance with airflow pressures. The laryngeal segment exhibited the reciprocal of compliance, expiratory resistances exceeded those of inspiration, averaging 0.125 (SD ± 0.037) and 0.035 (SD ± 0.013), respectively (.005 < P < .01). Tracheobronchial resistances during spontaneous resting breathing were too small to record reliably at the calibration used, and values augmented by voluntary hyperventilation averaged only 0.012 (SD ± 0.004). Laryngeal expiratory resistance approximated one fifth of the sum total of respiratory airflow resistances (including the pulmonary airways) and the authors suggest that, in addition to contributing to expiratory airflow braking, partial laryngeal closure induces orifice flow. This nonlaminar flow regime promotes the mucosal contact and mixing that enables greater than 30% of heat and water to be recovered from expiratory air by the human pharynx and nose.
Advantages of mandibular reconstruction with the titanium hollow screw osseointegrating reconstruction plate (THORP)
Authors: Koch Wayne M. , Yoo George H. , Goodstein Matthew L. , Eisele David W. , Richtsmeier William J. , Price John C.
Published: October 2009

Alloplastic reconstruction following segmental mandibulectomy is a simple way to maintain mandibular segmental relationships, partially preserving form and function for many patients. This study is a retrospective review of 40 patients who had mandibular reconstruction with metal plates over a 6‐year period (April 1986 through August 1992). The results of reconstruction with titanium hollow‐screw osseointegrating reconstruction plates (THORP [n = 12]) and solid screw (SS) steel and titanium plates (n = 28) are compared. One THORP has been removed as compared to 14 SS plates. While the improved results with THORP may be attributable in part to its advanced design, the success of soft‐tissue reconstruction and tumor extirpation are important factors in the early outcome seen in this series. Longer follow‐up is needed to determine if THORP can serve as a permanent implant. THORP is the authors' method of choice for alloplastic mandibular reconstruction.
Surgical management of congenital aural atresia
Authors: Chang Sun O , Min Yang‐Gi , Kim Chong Sun , Koh Tae‐Yong
Published: October 2009

Congenital aural atresia is a relatively common anomaly in otology. It requires an early assessment of hearing status and an early evaluation of the degree of atresia. Its surgical management is aimed at obtaining hearing gain and at establishing appropriate auditory canal status for the application of hearing aids.

The authors analyzed the preoperative otologic findings, surgical findings, postoperative complications, and postoperative hearing results of 25 ears in 21 patients with congenital aural atresia. From January 1987 to February 1992, 24 of these ears were surgically corrected by anterior approach; the remaining 1 was corrected by transmastoid approach. Postoperative audiologic follow‐up ranged from 8 months to 4 years (N = 21).

A new modification of anterior approach is introduced. The final average air‐bone gap was 30 dB, in contrast to preoperative 53 dB (N = 21). The final air‐bone gap was improved to a level within 30 dB in 52% of the patients. Meatal stenosis was the most frequent postoperative complication and was seen in 12 patients in primary operation (N = 25). There was no postoperative facial nerve palsy and no sensorineural hearing loss. There was little difference in postoperative hearing among the various types of congenital aural atresia and the type of tympanoplasty that had been performed.
Superior laryngeal nerve evoked potentials: An experimental study in the rabbit
Authors: Montalt J. , Basterra J. , Armengot M. , Barona R.
Published: October 2009

An experimental model is described for recording laryngeal evoked potentials at the brainstem level through electrical stimulation of the superior laryngeal nerve. Rabbits were divided into two groups according to age: Group 1 consisted of 20 adults (over 6 months old), while group 2 was comprised of 1‐month‐old rabbits. Under general anesthesia, the superior laryngeal nerve was electrically stimulated and the corresponding evoked potentials were recorded by needle electrodes placed close to the dorsal and ventral aspects of the brain stem. Clear age‐related differences were observed for latency, amplitude, and morphology of the potentials. This fact suggests postnatal maturation of the nerve structures, both peripheral and central. Sectioning the superior laryngeal nerve abolished all responses. Adduction of both vocal cords was observed in conjunction with the use of stimulation.
Return on experience: A mind‐set for learning leadership at work
Authors: Yip Jeffrey
Published: October 2009

Studies have shown that ongoing, on‐the‐job learning is an essential ingredient for long‐term leadership success. But to maximize the learning and development potential that hides within work experience, you need a plan. By adopting a return‐on‐experience mind‐set, you can actively seek out the three keys to learning from experience: mastery, versatility, and impact.
Berechnung der Wöhler‐Linie für Aluminium‐Gusslegierungen aus dem statischen Zugversuch und dem Dendritenarmabstand
Authors: Stroppe H.
Published: October 2009

Es wird ein bruchmechanisches Materialermüdungsmodell entwickelt, mit dem die Wöhler‐Linie für Aluminium‐Gusslegierungen aus den Kenngrößen des statischen Zugversuchs 0,2 %‐Dehngrenze, Zugfestigkeit und Elastizitätsmodul sowie auch aus dem sekundären Dendritenarmabstand des Gussgefüges berechnet werden kann.
Study on laser‐tungsten inert gas hybrid welding of dissimilar Mg alloy and steel with Ni as interlayer
Authors: Liu L. M. , Shan Ch.
Published: October 2009

Dissimilar Mg alloy and Q235 steel lap joints are produced by Laser‐ tungsten inert gas (TIG) hybrid welding with Ni as an interlayer. Fe and Ni are joined together in the form of solid solution, while Mg alloy and Ni foil are joined together by intermetallic compound Mg2Ni. During tensile testing, the joints fail at the interface between Ni foil and Mg alloy. The shear strength of the Mg/Steel joints with Ni as interlayer is 170 MPa, which is higher than that without interlayer 120MPa.
J‐integral in the description of fatigue crack growth rate induced by different ratios of torsion to bending loading in AlCu4Mg1
Authors: Rozumek D. , Macha E.
Published: October 2009

The paper presents the results of tests on fatigue crack growth under proportional torsion with bending in AlCu4Mg1 aluminium alloy. Specimens with rectangular cross‐sections and stress concentrator in the form of external one‐sided sharp notch were used. The tests were performed under the different ratios of torsion to bending moments. The results of the experimental tests have been described by a nonlinear formula based on ΔJ‐integral range. The tests have shown that the change of ratio of torsion to bending moments from 0.58 to 1.73 caused an increase in crack growth rate. It has been shown that at the constant loading and the change of stress ratio (R) from ‐ 1 to 0, the fatigue crack growth rate also increases.
Automatic identification of functional kinematic bone features from MRT segmentation for gait analysis
Authors: Tang Z. , Pauli J.
Published: October 2009

We present a method for the segmentation of human leg bones and extraction of functional parameters of the femur using MRT images. The novelty consists in the use of dynamic models which will be adapted to the images of individual patients both globally to a whole leg bone and locally to individual parts of a bone. Thresholding and region growing procedures are applied for pre‐processing the images. For some parts of bones, for example the femur ball, we use a three dimensional VRML‐based (Virtual Reality Modelling Language) femur model as a reference in order to make the segmentation method more robust. Based on the segmentation and the 3D VRML model, we can extract functional (biomechanical) femur parameters which are needed for gait analysis.