bluuebunny/crossref_metadata_2025 huggingface dataset:
The CF-CIRC study: a French collaborative study to assess the accuracy of Cystic Fibrosis diagnosis in neonatal screening
Authors: Sermet-Gaudelus Isabelle , Roussel Delphine , Bui Stéphanie , Deneuville Eric , Huet Frédéric , Reix Philippe , Bellon Gabriel , Lenoir Gérard , Edelman Aleksander
Published: October 2006

Background

Cystic fibrosis (CF) is caused by mutations in the gene encoding for the CF transmembrane conductance regulator (CFTR) protein, which acts as a chloride channel after activation by cyclic AMP (cAMP). Newborn screening programs for CF usually consist of an immunoreactive trypsinogen (IRT) assay, followed when IRT is elevated by testing for a panel of CF-causing mutations. Some children, however, may have persistent hypertrypsinogenemia, only one or no identified CFTR gene mutation, and sweat chloride concentrations close to normal values. In vivo demonstration of abnormal CFTR protein function would be an important diagnostic aid in this situation. Measurements of transepithelial nasal potential differences (NPD) in adults accurately characterize CFTR-related ion transport. The aim of the present study is to establish reference values for NPD measurements for healthy children and those with CF aged 3 months to 3 years, the age range of most difficult-to-diagnose patients with suspected CF. The ultimate goal of our study is to validate NPD testing as a diagnostic tool for children with borderline results in neonatal screening.

Methods/Design

We adapted the standard NPD protocol for young children, designed a special catheter for them, used a slower perfusion rate, and shortened the protocol to include only measurement of basal PD, transepithelial sodium (Na+) transport in response to the Na+ channel inhibitor amiloride, and CFTR-mediated chloride (Cl-) secretion in response to isoproterenol, a β-agonist in a Cl- free solution.

The study will include 20 children with CF and 20 healthy control children. CF children will be included only if they carry 2 CF-causing mutations in the CFTR gene or have sweat chloride concentrations > 60 mEq/L or both. The healthy children will be recruited among the siblings of the CF patients, after verification that they do not carry the familial mutation.

Discussion

A preliminary study of 3 adult control subjects and 4 children older than 12 years with CF verified that the new protocol was well tolerated and produced NPD measurements that did not differ significantly from those obtained with the standard protocol. This preliminary study will provide a basis for interpreting NPD measurements in patients with suspected CF after neonatal screening. Earlier definitive diagnosis should alleviate parental distress and allow earlier therapeutic intervention and genetic counseling.
Nordic Walking and chronic low back pain: design of a randomized clinical trial
Authors: Morsø Lars , Hartvigsen Jan , Puggaard Lis , Manniche Claus
Published: October 2006

Background

Low Back Pain is a major public health problem all over the western world. Active approaches including exercise in the treatment of low back pain results in better outcomes for patients, but it is not known exactly which types of back exercises are most beneficial or whether general physical activity provide similar benefits.

Nordic Walking is a popular and fast growing type of exercise in Northern Europe. Initial studies have demonstrated that persons performing Nordic Walking are able to exercise longer and harder compared to normal walking thereby increasing their cardiovascular metabolism. Until now no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to low back pain.

The primary aim of this study is to investigate whether supervised Nordic Walking can reduce pain and improve function in a population of chronic low back pain patients when compared to unsupervised Nordic Walking and advice to stay active. In addition we investigate whether there is an increase in the cardiovascular metabolism in persons performing supervised Nordic Walking compared to persons who are advised to stay active. Finally, we investigate whether there is a difference in compliance between persons receiving supervised Nordic Walking and persons doing unsupervised Nordic Walking.

Methods

One hundred and fifty patients with low back pain for at least eight weeks and referred to a specialized secondary sector outpatient back pain clinic are included in the study. After completion of the standard back centre treatment patients are randomized into one of three groups: A) Nordic Walking twice a week for eight weeks under supervision of a specially trained instructor; B) Unsupervised Nordic Walking for eight weeks after one training session with an instructor; C) A one hour motivational talk including advice to stay active. Outcome measures are pain, function, overall health, cardiovascular ability and activity level.

Results

No results available at this point.

Discussion

This study will investigate the effect of Nordic Walking on pain and function in a population of people with chronic LBP.

Trial Registration

http://www.ClinicalTrials.govregistration # NCT00209820
Distribution of hepatitis C virus genotypes in patients infected by different sources and its correlation with clinical and virological parameters: a preliminary study
Authors: Kabir Ali , Alavian Seyed-Moayed , Keyvani Hussein
Published: October 2006

Background

Information about genotypes and associated risk factors in hepatitis C virus (HCV) infected patients in Iran is limited. The aim of this study was to identify the HCV genotypes and associated risk factors in a group of HCV infected patients from Iran.

Results

Genotyping analysis was performed in 156 patients with positive anti-HCV and HCV-RNA. Patients were questioned concerning documented risk factors. Genotypes 1 and 3 were found in 87 (55.8%) and 45 (28.8%) patients, respectively. The most frequent HCV subtype was 1a (37.8), followed by 3a (28.9%) and 1b (16.7%). There was no statistically significant difference between the risk factors analyzed and the acquisition of HCV infection. We further found that 18 (40%) and 17 (37.8%) patients that were intravenous drug users (IVDU) had genotype 1a and 3a respectively.

Conclusion

Genotypes 3a and 1a in Iran are less prevalent in IVDU than in Europe and USA, but there is a high similarity between the pattern of genotype in IVDU in both Europe and United States, and Iran. However, in this case it can not be due to people migration among countries since history of travel abroad existed only in 6 cases (13.3%).
Inhibition of PP2A by LIS1 increases HIV-1 gene expression
Authors: Epie Nicolas , Ammosova Tatyana , Turner Willie , Nekhai Sergei
Published: October 2006

Background

Lissencephaly is a severe brain malformation in part caused by mutations in the LIS1 gene. LIS1 interacts with microtubule-associated proteins, and enhances transport of microtubule fragments. Previously we showed that LIS1 interacts with HIV-1 Tat protein and that this interaction was mediated by WD40 domains of LIS1. In the present study, we analyze the effect of LIS1 on Tat-mediated transcription of HIV-1 LTR.

Results

Tat-mediated HIV-1 transcription was upregulated in 293 cells transfected with LIS1 expression vector. The WD5 but not the N-terminal domain of LIS1 increases Tat-dependent HIV-1 transcription. The effect of LIS1 was similar to the effect of okadaic acid, an inhibitor of protein phosphatase 2A (PP2A). We then analyzed the effect of LIS1 on the activity of PP2A in vitro. We show that LIS1 and its isolated WD5 domain but not the N-terminal domain of LIS1 blocks PP2A activity.

Conclusion

Our results show that inhibition of PP2A by LIS1 induces HIV-1 transcription. Our results also point to a possibility that LIS1 might function in the cells as a yet unrecognized regulatory subunit of PP2A.
Individual freedom versus collective responsibility: too many rights make a wrong?
Authors: Looker Katharine J , Hallett Timothy B
Published: October 2006

Individuals might reasonably expect the freedom to make their own decisions regarding their health. However, what happens when an individual's wishes conflict with what is in that individual's best interests? How far should an individual's rights be restricted for his or her own benefit? Similarly, what limitations should be placed on an individual's behaviour when that person's wishes go against what is good for the population in general? Here we discuss the issues that can arise when the rights of individuals conflict with individual and population benefits in relation to infectious diseases.
Migration and health: fact, fiction, art, politics
Authors: Tam Clarence C
Published: October 2006

The recent Immigration Bill debate in the United States Congress has again re-ignited the polemic regarding immigration policy. In this essay, I argue that disputes surrounding the legality of migrant workers highlight chronic, underlying problems related to factors that drive migration. The public health field, although concerned primarily with addressing the health needs of migrant populations, cannot remain disengaged from the wider debates about migration. The health needs of migrants, although in themselves important, are merely symptoms of deeper structural process that are intrinsically linked to equity and human rights, and simply focusing on health issues will be insufficient to address these societal pathologies.
Mathematical modeling of tumor therapy with oncolytic viruses: effects of parametric heterogeneity on cell dynamics
Authors: Karev Georgy P , Novozhilov Artem S , Koonin Eugene V
Published: October 2006

Background:

One of the mechanisms that ensure cancer robustness is tumor heterogeneity, and its effects on tumor cells dynamics have to be taken into account when studying cancer progression. There is no unifying theoretical framework in mathematical modeling of carcinogenesis that would account for parametric heterogeneity.

Results:

Here we formulate a modeling approach that naturally takes stock of inherent cancer cell heterogeneity and illustrate it with a model of interaction between a tumor and an oncolytic virus. We show that several phenomena that are absent in homogeneous models, such as cancer recurrence, tumor dormancy, and others, appear in heterogeneous setting. We also demonstrate that, within the applied modeling framework, to overcome the adverse effect of tumor cell heterogeneity on the outcome of cancer treatment, a heterogeneous population of an oncolytic virus must be used. Heterogeneity in parameters of the model, such as tumor cell susceptibility to virus infection and the ability of an oncolytic virus to infect tumor cells, can lead to complex, irregular evolution of the tumor. Thus, quasi-chaotic behavior of the tumor-virus system can be caused not only by random perturbations but also by the heterogeneity of the tumor and the virus.

Conclusion:

The modeling approach described here reveals the importance of tumor cell and virus heterogeneity for the outcome of cancer therapy. It should be straightforward to apply these techniques to mathematical modeling of other types of anticancer therapy.

Reviewers:

Leonid Hanin (nominated by Arcady Mushegian), Natalia Komarova (nominated by Orly Alter), and David Krakauer.
Cartilage contact pressure elevations in dysplastic hips: a chronic overload model
Authors: Russell Mary E , Shivanna Kiran H , Grosland Nicole M , Pedersen Douglas R
Published: October 2006

Background

Developmental dysplasia of the hip (DDH) is a condition in which bone growth irregularities subject articular cartilage to higher mechanical stresses, increase susceptibility to subluxation, and elevate the risk of early osteoarthritis. Study objectives were to calculate three-dimensional cartilage contact stresses and to examine increases of accumulated pressure exposure over a gait cycle that may initiate the osteoarthritic process in the human hip, in the absence of trauma or surgical intervention.

Methods

Patient-specific, non-linear, contact finite element models, constructed from computed tomography arthrograms using a custom-built meshing program, were subjected to normal gait cycle loads.

Results

Peak contact pressures for dysplastic and asymptomatic hips ranged from 3.56 – 9.88 MPa. Spatially discriminatory cumulative contact pressures ranged from 2.45 – 6.62 MPa per gait cycle. Chronic over-pressure doses, for 2 million cycles per year over 20 years, ranged from 0.463 – 5.85 MPa-years using a 2-MPa damage threshold.

Conclusion

There were significant differences between the normal control and the asymptomatic hips, and a trend towards significance between the asymptomatic and symptomatic hips of patients afflicted with developmental dysplasia of the hip. The magnitudes of peak cumulative contact pressure differed between apposed articular surfaces. Bone irregularities caused localized pressure elevations and an upward trend between chronic over-pressure exposure and increasing Severin classification.
The Creation of Emergency Health Care Standards for Catastrophic Events
Authors: Wise Robert A.
Published: October 2006

The creation of health care standards by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in a defined area with known events follows a predictable process. A problem area (e.g., hand hygiene) is identified from multiple sources. The JCAHO then calls together experts from around the country, and through debate and the comparison of positions of various people within the health care arena, a new standard informed by these views can be developed. Once developed, it is vetted and becomes established as a Joint Commission standard. But what happens when an event has never happened, cannot be reliably predicted, and, one hopes, will never come to pass? How can one create any meaningful standards? This is the situation when considering a number of scenarios related to disasters and mass casualty events.
The Art and Science of Surge: Experience from Israel and the U.S. Military
Authors: Tadmor Boaz , McManus John , Koenig Kristi L.
Published: October 2006

In a disaster or mass casualty incident, health care resources may be exceeded and systems may be challenged by unusual requirements. These resources may include pharmaceuticals, supplies, and equipment as well as certain types of academic and administrative expertise. New agencies and decision makers may need to work together in an unfamiliar environment. Furthermore, large numbers of casualties needing treatment, newer therapies required to care for these casualties, and increased workforce and space available for these casualties all contribute to what is often referred to as “surge.” Surge capacity in emergency care can be described in technical, scientific terms that are measured by numbers and benchmarks (e.g., beds, patients, and medications) or can take on a more conceptual and abstract form (e.g., decisions, authority, and responsibility). The former may be referred to as the “science” of surge, whereas the latter, an equal if not more important component of surge systems that is more conceptual and abstract, can be considered the “art” of surge. The experiences from Israel and the U.S. military may serve to educate colleagues who may be required to respond or react to an event that taxes the current health care system. This report presents concrete examples of surge capacity strategies used by both Israel and the U.S. military and provides solutions that may be applied to other health care systems when faced with similar situations.
Hemorrhage into the esophagus at birth and in the adult.
Authors: Mosher Harris P.
Published: October 2006

The esophagus may be infected before birth. Periesophageal hemorrhage has been found in premature babies born dead.

In babies dying with hemorrhagic disease of the newborn, periesophageal hemorrhage has been found, as well as subepithelial hemorrhage in the esophagus and the stomach.

Extensive intramuscular and periesophageal hemorrhage has been found in a baby which lived 36 hours and died of intracranial hemorrhage; in a baby whose mother had toxemia of pregnancy, and in a baby born with congenital syphilis, which died of sepsis from ulcerative tonsillitis and pharyngitis.

The hemorrhages were found to come from the smallest of the capillaries.

The hemorrhage in babies dead at birth is probably due to pre‐birth toxemia.

Hcmorrhagic disease of the newborn is probably due to prebirth toxemia.

Infection of the gall bladder, one the commonest of abdominal diseases, often is associated with infection of the terminal portion of the esophagus. By causing adhesions it is one cause of cardiospasm. Very extensive intramuscular and periesophageal hemorrhage has been found associated with acute cholecystitis and jaundice.

Associated with fibrosis of the facial edge of the crura, narrowing of the crural opening and constriction of the esophagus has been found.

Two cases of peri‐ and intraesophageal hemorrhage have been found in adults, one associated with acute infection (cholecystitis), and the other with chronic infection (multiple lung abscess).

828 Beacon Street.
Nasopharyngeal irradiation and hearing acuity: A follow‐up study of children.
Authors: Guild Stacy R.
Published: October 2006

The title of today's Symposium stresses the irradiation aspect of the basic topic, which is lymphoid tissue in the nasopharynx. The data of the follow‐up study of school children reported above yield information about the broad aspect of the relation of nasopharyngeal lymphoid tissue to hearing acuity as well as information about the effect on hearing thresholds of treatment of this tissue by irradiation.

The shortest interval between the first and the last hearing tests of the children in this study was six years, the average interval was slightly over 61/2 years, both for the treated and for the untreated children. The average age of the children at the time of the first examination was 91/2 years; the age range at that time was from 8 to 13 years.

In a group of 259 children (518 ears) whose hearing was good at the first examination and who had no throat treatment, either irradiative or operative, during the entire period of the study, a slight average gain in hearing acuity occurred for low tones, as measured by audiometric air‐conduction thresholds, and on the average a slight loss occurred for high tones. The gain for low tones occurred consistently in each of the subgroups based on the four possible combinations of normal or of abnormal tubal orifices at the beginning and at the end, respectively, of the period of observation. One subgroup, however, had on the average no loss for high tones; it consists of 53 children (106 ears) whose tubal orifices were abnormal in appearance, on nasopharyngoscopic inspection, at both the first and the last examinations. The greatest average loss for high tones occurred in the subgroup of 63 children who had normal appearing tubal orifices at the beginning and at the end of the study.

A group of 95 ears of children who had impaired hearing only for high tones, either bilaterally or unilaterally, and who were treated by irradiation of the nasopharyngeal lymphoid tissue, showed an average gain for low tones similar to that in the untreated children, in whom it is regarded as normal for the age period, and a slight additional loss for high tones. In no instance of the 52 ears that had an “abrupt” type of high‐tone loss was the highest tone that was well heard of a higher frequency at the last examination than it was at the first examination.

A group of 24 ears that had a moderate impairment of hearing for allt ones — “flat” audiograms at the 25 to 40 db. level — had, as a group average, real improvements in hearing acuity for all tones, after irradiation of the nasopharynx. About half of them, however, showed either very little or no improvement in hearing acuity.

The broad conclusion is reached that previous ideas, widely prevalent, of the effect of nasopharyngeal lymphoid tissue on hearing and of the effect of nasopharyngeal irradiation on impaired hearing, need to be revised.
Observations through cochlear fenestra
Authors: Perlman H. B.
Published: October 2006

Direct measurement of some of the physical properties of the cochlea and observations of the cochlea during acoustic stimulation is possible with modern techniques and offers new important information about the physical processes in cochlear function.
Suggestions for determining the mobility of the stapes by means of an endotoscope for the middle ear
Authors: Békésy Georg V.
Published: October 2006

This paper describes a method for the measurement of the transmission loss in anatomical preparations. If a patient's hearing loss is known, and it is possible, at a postmortem examination, to measure the conductive loss, then the difference between the two values is a measure of the nerve deafness. In this way we can separate the conduction loss from the nerve loss and express each in decibels. This makes it possible to determine the importance of different histological findings in the etiology of transmission deafness and nerve deafness.

Four cases of stapes fixation were measured. The decrease in mobility of the stapes for tones of 1000 cps was correlated with a decrease in the mobility of the stapes for static deformations.

For accurate diagnoses it seems possible to introduce into the middle ear a small endotoscope through a perforation of 1 to 2 mm. diameter in the eardrum. With this special endotoscope the mobility of the stapes could be observed, as has been demonstrated on anatomical preparations. It is supposed that this method will prove valuable in the diagnosis of the causes of hearing loss. The small dimensions of the endotoscope make it possible to observe parts of the ear canal that are usually inaccessible. For the examination of the ear canal of experimental animals (guinea pigs, rats, etc.) this endotoscope proved to be indispensable.
Embryonic hearing organs after maternal rubella.
Authors: Schall Leroy A. , Lurie M. H. , Kelemen G.
Published: October 2006

Three temporal bones of two four‐month embryos, operatively removed from mothers who suffered rubella in the second month of pregnancy, were histologically examined. Hyperemia and free hemorrhages were seen, while the nervous elements of the inner ear were found to be in a condition corresponding to the fetal age.

This being the period in which the organ of Corti is differentiating along the basilar membrane, any possible disturbance in the delicate mechanism of adjustment, e.g., the lagging behind of certain sections, has to be closely watched as a possible source of hearing defects.

The specific infectious agent causes arrest of development of the end‐organ in the most critical period and vascular damage, possibly the latter being the primary change. Vulnerability of the vessels shows up at the end of the pregnancy in an increased tendency for birth injuries. This way a series of factors collaborate to produce the picture of defective hearing in the progeny, after rubella of the mother.

As far as a survey can be given today, there are two ways in which damage results by exposure to the virus of rubella: One being arrest of development, the other vascular changes. The two can be formulated into a monistic theory by assuming that the vessels are the first to suffer, and lack in nutrition is then followed by developmental arrest. Here is a field of research of rare interest with many problems unsolved. The first decade after the basic discovery of Gregg yielded a rich crop of investigative results, among which, however, pathological findings are negligible. Aycock said that rubella now takes on the status of a disease worthy of the best in diagnosis, treatment, prevention and research. In attacking the problem of the pathology of aural damage it is desirable that the otologist should assume the leading rǒle before the initiative is definitely lost to borderline disciplines
Laryngologic experience in bulbar poliomyelitis
Authors: Lebo Charles P.
Published: October 2006

“When you know a thing, to hold that you know it; and when you do not know a thing, to allow that you do not know it: this is knowledge.” Confucius, Analects, Book II, Chap. XVII.
Facial palsy: Unusual Etiology
Authors: Breadon George. E. , Cody D. Thane R. , Weilandz Louis H.
Published: October 2006

This is a report of three patients who presented at the Mayo Clinic over a two‐year period. All were initially diagnosed as having Bell's palsy but were later found to have a malignant neoplasm causing the paralysis. Two of the patients had breast carcinoma metastases involving the mastoid portion of the facial nerve. The third patient had an adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen.

The course of the facial paralysis in the two patients with the metastatic breast disease was almost identical. It consisted of episodes of pain in the mastoid area, generally in the late evening or during the night, often awakening the patient from sleep. This was then followed by peripheral facial‐nerve paralysis, sometimes partial and at other times complete. These episodes lasted from 10 minutes to several hours and then resolved completely. They recurred over several months. The patients were completely asymptomatic and normal on examination in the intervals between episodes of paralysis until it became permanent.

Metastatic lesions causing facial paralysis are extremely rare in the literature. In those cases that have been reported, the paralysis was progressive from the start and in the vast majority of cases was either painless or associated with other aural symptoms such as otorrhea, hearing loss, and periauricular swelling.

There are two unusual features of these two cases: 1. the initial presentation of a breast metastasis as a facial paralysis; in the first case there were no other metastatic lesions present at diagnosis, whereas the second patient had other, asymptomatic, metastatic nodules; and 2. the multiple, brief, recurring episodes of facial paralysis, which have not previously been reported as a mode of presentation of metastatic disease.

The third patient was diagnosed as having Bell's palsy. A facial nerve decompression was performed, and the nerve apparently looked normal. The paralysis failed to resolve. He was later found to have adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen. A report of only one similar case could be found in the literature.

The sequence of events in these three cases emphasizes the importance of submitting a patient suspected of having Bell's palsy to a thorough otoneurologic examination.
Anaerobic isolates in hemovac lines
Authors: Yoder Milton G. , Silva Joseph
Published: October 2006

Seventeen of 68 patients (25 percent) who required the use of hemovac drainage system after major head and neck procedures had positive anaerobic isolates. Co‐isolation of aerobic (94 percent) and other anaerobic (29 percent) microorganisms are common. There was an increased rate of positive anaerobic isolates with procedures requiring exposure of mucosa. Radiotherapy, except in doses greater than 6,800 rads, did not affect the culture rate. Eight of 17 patients (47 percent) with positive anaerobic isolates had infectious‐related complications while five of 51 patients (10 percent) with negative cultures had similar complications. Positive anaerobic isolates in hemovac lines can be correlated with pathogens isolated from subsequent complications.
Orotracheal intubation in the newborn
Authors: Conner George H. , Maisels M. Jeffrey
Published: October 2006

One hundred consecutive cases of orotracheal intubation in the premature and term newborn at the Hershey Medical Center were studied retrospectively. The reason for intubation was for respiratory failure most commonly associated with hyaline membrane disease. The duration of intubation ranged from six hours to 63 days. Seventy‐nine percent required intubation for more than 24 hours and 28 percent required intubation for more than one week. No tracheotomies were performed.

There were 56 survivors, 50 of which were seen in follow‐up examination at three, six or 18‐month intervals. There were no cases of clinically evident upper airway damage or obstruction in this group. Post mortem examinations were carried out on 35 infants with tracheal necrosis found in one case. The authors feel that orotracheal intubation is superior to nasotracheal intubation and tracheotomy in this age group. This method of management should be carried out where there is adequate trained personnel and professional staff and equipment capable of proper orotracheal tube placement and management.
The significance of negative middle ear pressure
Authors: Cooper J. C. , Langley Lynn R. , Meyerhofp William L. , Gates George A.
Published: October 2006

An increasing body of experience is defining the value of the impedance bridge for the detection and diagnosis of otologic disorders. In this study the audiometric status of 1,133 ears is correlated with the tympanometric configuration and middle ear pressure. It is noted that the air‐bone gap systematically increases as the middle ear pressure decreases from 0 to — 400 mm H2O. Mildly negative middle ear pressure (Jerger's Type A Tympanogram) produces air‐bone gaps statistically greater than at atmospheric pressure. These data demonstrate the magnitude of the adverse effect of negative middle ear pressure upon middle ear auditory function.
The posterior scalping flap
Authors: Arena Sebastian
Published: October 2006

The posterior scalping flap is described. Hopefully, it brings another alternate method of facial reconstruction and obviates some of the problems previously existing. It is capable of resurfacing any part or the whole of the hemiface or forehead. It offers an excellent method for facial resurfacing. Further refinements and sophistications are necessary.
External marking in rhinoplasty planning
Authors: Webster Richard C. , Davidson Terence M. , Smith Richard C.
Published: October 2006

Photographs, drawings, and examination at consultation have value in rhinoplastic planning. However, the surgeon is not operating on photographs, drawings, or an alert sitting or standing patient; he is operating on a nose with what was forward now facing upward. We find it most helpful to plan and mark almost the entire procedure on the external nose and surrounding structures just before the patient is put supine and sedated or anesthetized.

In primary rhinoplasty, it is possible to mark essentially all skeletal anatomy within 1 mm tolerances by palpation, pushing the tip up and back, observing the changes from the outside, and looking at the inside. We believe that the anatomy and planned changes can and should be depicted by appropriate marks put on the skin. The mere act of drawing in the procedure forces us to think it through from beginning to end, a most worthwhile endeavor. Moreover, we learned very shortly after we began forcing ourselves to quantitate the anatomy and proposed changes, that we ran into fewer and fewer surprises as we worked.

Photographs taken of the markings become by far the best “operative note” we can have. Comparison of these with the patient or his photographs showing the result allow us to make accurate judgments about long term effects of each surgical maneuver. Much that seemed mysterious before is found to be quite scientifically explainable.

We do not propose in this short report to show how we mark every nose. Rather we shall show with drawings and a few examples how we go about marking a nose. The reader may use the suggested marking techniques or may evolve his own. The important thing is that he work out a system meaningful to him. It will be noted that we have used differing techniques for depicting similar concepts from case to case. In other words, we have not settled immutably on one system because we are still searching for the best.
Carcinoma in situ of the larynx
Authors: Doyle Patrick J. , Flores A. , Douglas G. S.
Published: October 2006

A retrospective study of carcinoma in situ of the larynx at the British Columbia Cancer Institute indicates that radiotherapy, using a tumoricidal dose of Co 60, is the treatment of choice for this condition.

Between 1940 and 1972, 43 patients with carcinoma in situ of the vocal cords were seen. A follow‐up of five years or more was possible in 28 of these cases. Twenty‐two were treated primarily with a tumoricidal dose of radiotherapy. Twenty‐one of the 22 were free of disease for at least five years.

This study, therefore, shows a five‐year cure rate of almost 100 percent for patients treated with radiotherapy. It also brings out two further points regarding carcinoma in situ of the larynx; namely, an apparent increase in its incidence, and the presence of co‐existing invasive carcinoma in some cases. We feel that since the incidence of laryngeal carcinoma has not increased, this apparent increase probably represents a greater awareness by both the pathologist and the clinician. We have also achieved more accurate diagnosis since the introduction of routine microlaryngoscopy. The single radiotherapy failure in our series was due to failure to diag: Nose co‐existing invasive carcinoma. This would seem to be the most likely cause of similar failures reported in the literature.

Carcinoma in situ should be managed as follows:

Any patient found to have carcinoma in situ on laryngeal biopsy must have careful microlaryngoscopy with examination of the hypopharynx, larynx, subglottic larynx, and upper trachea.

If the lesion is small and confined to one cord, complete stripping of that cord is indicated.

If both cords are abnormal, stripping and/or careful multiple biopsies are essential.

If a small localized lesion is found, repeat cord stripping is performed in one month.

If any biopsy reveals invasive carcinoma, the patient must not be classified as a case of carcinoma in situ.
Unusual parotid tumors
Authors: Parkin James L. , Stevens Michael H.
Published: October 2006

The patient presenting with a mass lesion of the parotid gland is frequently found to have a mixed tumor of salivary tissue origin. However, less common lesions occur in the anatomical region of the parotid gland. These pathological entities deserve consideration in the differential diagnosis.

This report presents nine patients with unusual lesions occurring in the parotid region. These lesions include cervicofacial actinomycosis, branchial cleft cyst, parapharyngeal tumors, bony lesion of the mandible, non‐parotid origin malignant tumor, and metastatic malignant tumors. Each class of lesions demonstrated is also discussed.
Surgical management of airway obstructions during sleep
Authors: Simmons F. Blair , Guilleminault C. , Dement W. C. , Tilkian Ara G. , Hill M.
Published: October 2006

Anatomical or physiological airway obstructions during sleep, of which the patient is unaware, cause daytime sleepiness at first, then signs of decreasing mental function, and eventually in some individuals, pulmonary and systemic hypertension. A few of these patients had been recognized before, the Pickwickian syndrome and in children with cardiac problems and large tonsils. The majority, however, present as sleep disorders. This paper describes our surgical experience with improving the airways of 19 children and adults with daytime somnolence.
Cranial neuropathies in sinus disease
Authors: Weisberger Edward C. , Dedo Herbert H.
Published: October 2006

To study the problem of cranial neuropathies in sinus disease the in‐patient experience at the University of California, San Francisco, and San Francisco General Hospitals was reviewed. The incidence of cranial nerve involvement in acute and chronic sinus inflammations was low (8 percent and 4 percent respectively). The incidence in neoplastic disease of the sinuses was considerably higher (32 percent). Cranial neuropathies occurred in inflammatory disease more frequently when associated with mucopyocele, mucormycosis, and orbital cellulitis. In both inflammatory and neoplastic disease, when cranial nerve deficits occurred, there was a high predelication for sphenoid sinus involvement. Several instructive case histories are included. The important anatomy of the cavernous sinus region and of the orbital apex as it pertains to this problem is discussed.
Glandular tumors of the external auditory canal
Authors: Pulec Jack L.
Published: October 2006

Thirty‐seven cases of ceruminous gland tumors of the external auditory‐canal are presented. These are rare tumors, each of which has different clinical characteristics. Six adenomas are reported which are benign and require only local excision for long‐term cure. Two muco‐epidermoid carcinomas, a type not previously reported, are presented. The muco‐epidermoid carcinoma tends to iecur locally and radical excision is necessary for control. The most common glandular tumor of the external auditory canal is the adenoid cystic carcinoma. Twenty‐four are reported. Pain is the hallmark of this tumor. The long clinical course ultimately results in death if the tumor is not radically removed at the earliest possible time. Radiation is ineffective. Treatment recommended is (1) wide excision of the external auditory canal, (2) extensive radical mastoidec‐tomy, and (3) total parotidectomy and mandibular condylectomy.

Five cases of adenocarcinoma are presented. Four were dead from local invasion and distant metastasis within four years, and the fifth was lost to follow‐up.

Careful histologie evaluation and classification of the type of tumor is necessary to predict the natural history and select the proper treatment. Local excision is curative for the benign adenoma. For the three types of carcinoma described, the surgeon must not hesitate to do the radical operation for the early lesion, because it is in the early stages that the opportunity to produce the cure exists.
Radiation induced carcinoma of the temporal bone
Authors: Ruben Robert J. , Thaler Seth U. , Holzer Neri
Published: October 2006

This report presents a case of squamous cell carcinoma of the temporal bone induced by high dose radiation therapy. Several important surgical techniques are stressed which serve to make this procedure far safer in the avoidance of catastrophic hemorrhage.
Allergy in ménière's disease related fluctuating hearing loss preliminary findings in a double‐blind crossover clinical study
Authors: Endicott James N. , Stucker Fred J.
Published: October 2006

Several clinical reports suggest allergy as a causative or associated factor in the etiology of Ménière's Disease or endolymphatic hydrops. The A.A.O.O. subcommittee reported in 1972 its criteria for a therapeutic improvement in Ménière's Disease. This important report allows for clinical studies to proceed in a scientific manner using the subcommittee's criteria to evaluate the results. In an ongoing study utilizing a double‐blind crossover technique, fourteen Ménière's patients have been evaluated for allergies utilizing the Rinlde and Lee techniques for inhalent and food allergies. Several cases directly relate their symptoms to specific food in‐gestion and were given challenge food tests.
Endolymphatic sac surgery
Authors: Edward Maddox H.
Published: October 2006

There is a disturbing variation in the reported success rate in Endolymphatic Sac Surgery in the literature. Relatively long‐term (24 months to 10 years) follow‐ups are given in a series of 66 patients in this paper. Results reveal only a 55% long‐term relief of veitigo in these patients. Only 30% of this series of cases had any improvement in cochlear function. There was a definite trend to Awards recurrence of vertigo in the longer follow‐up cases.

It is concluded that Endolymphatic Sac Surgery still is important in the treatment of idiopathic endolymphatic hydrops, but is of questionable value early in the course of the disease. Total removal of the endolymphatic system remains the best single surgical approach in a large number of patients with Ménière's disease.
The deviated nose—its correction
Authors: Johnson Galvin M. , Anderson Jack R.
Published: October 2006

The deviated nose remains a challenge to any rhinoplastic surgeon. The authors approach this problem via a one‐stage septorhinoplasty based on the fundamental anatomic deformity present. The technique involves taking the nose apart, realigning the building blocks, and carefully splinting of the nose for proper realigning.
Mucocutaneous lymph node syndrome: A new clinical entity
Authors: Gross Charles W. , Chamberlain Morrow
Published: October 2006

A six‐year‐old black male presented to the Otolaryngology service with fever, sore throat and an inflammatory mass in the left neck. Forty‐eight hours later he developed the full blown clinical picture of mucocutaneous lymph node syndrome (MLNS). This is a relatively new clinical entity, well known in Japan, but only recently described in the English literature.

The following case report and discussion will serve to alert the otolaryngologist to this disease.
Morphologic analysis of tympanic membrane grafts
Authors: Lyons George D. , Dyer Robert F. , Ruby John R.
Published: October 2006

Many materials are presently used for repair of tympanic membrane defects. Since the microscopic organization of these tissues may play a role with respect to the suitability of replacement of one with the other, a comparative electron microscopic study of temporalis fascia, fresh and preserved amniotic membrane was undertaken. An effort was made to determine the similarities and differences of these tissues and our clinical experience with their use is presented.
Presbycusis: What is it?
Authors: Lowell Seth H. , Paparella Michael M.
Published: October 2006

The history and current misusage of the term presbycusis is discussed and current knowledge of pathology associated with presbycusis and aging are reviewed. A study involving retrospective analysis of audio‐metric data and clinical information on three groups was performed. Results suggest that a group of individuals previously identified as “presby‐cusic” probably represent undiagnosed cases of familial or genetic related hearing loss. We urge as thorough an identification of correct diagnosis as possible, thus reserving the term “presbycusis” for those rare, solely age‐related cases of sensorineural loss.
Oncocytic lesions of the larynx
Authors: Oliveira Carlos A. , Roth James A. , Adams George L.
Published: October 2006

True laryngeal adenomas are considered extremely rare and some doubt their existence. Laryngeal lesions having oncocytes as the predominant cell type have been described in the literature under a variety of different names: oncocytoma, oncocytic papillary cystadenoma, papillary cystade‐noma, oxyphilic granular cells adenoma, etc. The oncocytes originate from changes in normal acinic and ductal cells. The significance of these changes is controversial. Whether the oncocytic laryngeal lesions represent true neoplasms or are degenerative in nature remains to be determined.

We present clinical and histopathological details of four cases of oncocytic lesions of the larynx and compare their histology with microscopic findings in 30 cases filed as laryngeal cysts at the Minneapolis V.A. and University of Minnesota Hospitals. While the controversy regarding the neoplastic versus degenerative etiology of these lesions could not be resolved from a histopathological standpoint, their clinical behavior is that of a benign neoplasm. We review the literature on the subject and suggest a course of treatment for these lesions.
Unrelated sensorineural hearing loss in patients with otosclerosis: A report of three cases
Authors: Linthicum Fred H. , Gail Nebly J.
Published: October 2006

Although it is generally accepted that 20% or more of patients with clinically manifest otosclerosis have a concomitant sensorineural hearing loss,1 it is still debated whether otosclerosis is the cause of the neural loss.2

Three cases are presented of other causes of sensorineural loss in oto‐sclerotic patients who underwent stapes surgery.

One of these cases, the Mondini malformation, is discussed in detail.
Neurilemmoma of the auricle: A case report
Authors: Fodor Raymond I. , Pastore Peter N. , Frable Mary Ann
Published: October 2006

A report of a case of a solitary benign neurilemmoma of the auricle is presented. It is believed to be the first such documented case. Its nature, histology, and differential diagnosis is reviewed. It is suggested that “neu‐rogenic tumors” be added on to the current classification of auricular masses.
Modifications of the fomon technique in the approach to the lower lobule
Authors: Parkes Morey L. , Kamer Frank M. , Merrin Michael L.
Published: October 2006

The advantages of the Fomon technique modifications in rhinoplasty are outlined. The importance of these adaptations is emphasized.
Melanoma and the differential diagnosis of oral pigmented lesions.
Authors: Powell Jeffrey P. , Cummings Charles W.
Published: October 2006

There are many pathologic processes that occur in the mouth which have various intraoral manifestations. The differential diagnosis of pigmented lesions of the oral cavity takes on a high degree of significance because therapy may span such a wide range from no treatment at all to massive radical resection for melanoma. A thorough understanding of pigmented lesions of the oral cavity would assist the clinician in establishing a diagnosis and subsequent treatment plan. A comprehensive review of the literature and a discussion of oral pigmented lesions including infiltrative malignant melanoma is presented.
Etiologic factors in hypocalcemia secondary to operations for carcinoma of the pharynx and larynx.
Authors: Isaacson Steven R. , Snow James B.
Published: October 2006

Hypocalcemia, although a relatively uncommon sequela of operations for carcinoma of the larynx and pharynx, often presents as an acute medical emergency. In its chronic form, hypocalcemia may be a difficult disorder to control.

Understanding the etiologic basis of hypocalcemia secondary to operations for carcinoma of the head and neck requires knowledge of the pathophysiology of the preoperative and postoperative factors affecting calcium homeostasis. These factors include thyroidectomy, hypoparathyroidism, hypomagnesemia, anticonvulsant therapy, estrogen replacement therapy, oral contraceptives, blood transfusions, hyperventilation alkalosis, hypoalbuminemia, corticosteroid therapy, depression, emotional stress and diet.

Often the onset of symptoms and signs of hypocalcemia occurs within 24 to 48 hours after the operation. The symptoms may include mental depression, headache, tingling of the hands and perioral region and abdominal pain. Unrecognized chronic hypocalcemia may lead to the development of cataracts, convulsions and psychosis.

Management requires an appreciation of the etiologic factors as well as the complications of vitamin D therapy.
The otolaryngologic manifestations of multiple myeloma.
Authors: Creston James E.
Published: October 2006

The purpose of this paper is to present the precursors and complications of multiple myeloma as manifested in Otolaryngology. The modern Otolaryngologist is well aware that systemic disease may manifest itself in our specialty. Multiple myeloma is a distinctive form of plasma cell dyscrasia which often manifests itself in Otolaryngology. For example, patients may present with epistaxis, hoarseness, asymmetry of the face, swelling of the palate, nasal obstruction and a multiplicity of other symptoms. Therefore, the practicing Otolaryngologist must maintain a high index of suspicion that a seemingly simple sign or symptom may represent one small facet of a generalized condition. The paper emphasizes that in many instances a slight extension of our history taking may provide us with information leading to the diagnosis of this systemic disease.

Cases seen by the author are reviewed and the relevant clinical features are presented.