bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipid Accumulation in Smooth Muscle Cells Under LDL Loading Is Independent of LDL Receptor Pathway and Enhanced by Hypoxic Conditions
Authors: Wada Youichiro , Sugiyama Akira , Yamamoto Takashi , Naito Makoto , Noguchi Noriko , Yokoyama Shinji , Tsujita Maki , Kawabe Yoshiki , Kobayashi Mika , Izumi Akashi , Kohro Takahide , Tanaka Toshiya , Taniguchi Hirokazu , Koyama Hidenori , Hirano Ken-ichi , Yamashita Shizuya , Matsuzawa Yuji , Niki Etsuo , Hamakubo Takao , Kodama Tatsuhiko
Published: October 2002

Objective—

The effect of a variety of hypoxic conditions on lipid accumulation in smooth muscle cells (SMCs) was studied in an arterial wall coculture and monocultivation model.

Methods and Results—

Low density lipoprotein (LDL) was loaded under various levels of oxygen tension. Oil red O staining of rabbit and human SMCs revealed that lipid accumulation was greater under lower oxygen tension. Cholesterol esters were shown to accumulate in an oxygen tension–dependent manner by high-performance liquid chromatographic analysis. Autoradiograms using radiolabeled LDL indicated that LDL uptake was more pronounced under hypoxia. This result holds in the case of LDL receptor–deficient rabbit SMCs. However, cholesterol biosynthesis and cellular cholesterol release were unaffected by oxygen tension.

Conclusions—

Hypoxia significantly increases LDL uptake and enhances lipid accumulation in arterial SMCs, exclusive of LDL receptor activity. Although the molecular mechanism is not clear, the model is useful for studying lipid accumulation in arterial wall cells and the difficult-to-elucidate events in the initial stage of atherogenesis.
Differential Accumulation of Proteoglycans and Hyaluronan in Culprit Lesions
Authors: Kolodgie Frank D. , Burke Allen P. , Farb Andrew , Weber Deena K. , Kutys Robert , Wight Thomas N. , Virmani Renu
Published: October 2002

Objective—

The importance of the extracellular matrix molecules versican, biglycan, decorin, and hyaluronan in plaque instability has not been recognized.

Methods and Results—

Coronary lesions with acute thrombi and stable plaques were examined for the accumulation and distribution of specific proteoglycans and hyaluronan at culprit sites. The cell surface receptor for hyaluronan, CD44, and smooth muscle (SM) cell maturation markers were also assessed. Proteoglycans and hyaluronan accumulated in distinct patterns depending on plaque type. The fibrous cap of stable lesions was enriched in versican and biglycan, with considerably less staining for decorin and hyaluronan, whereas picrosirius red revealed a heavy accumulation of collagen type I. In contrast, intense staining for hyaluronan and versican was found in erosions at the plaque/thrombus interface, with weak staining for biglycan and decorin; collagen content was predominantly type III. Rupture sites showed little immunoreactivity for proteoglycans or hyaluronan. CD44 was localized along the plaque/thrombus interface in erosions, whereas in ruptures and stable plaques, it was mostly confined to inflammatory cells. Positive immunostaining for immature SM cells (SM myosin heavy chain SM1 and SMemb) was present in stable and eroded plaques, whereas the presence of SM2 and smoothelin was weak or nonexistent.

Conclusions—

Specific accumulation of versican, hyaluronan, and CD44 at the sites of plaque erosion implicates an involvement of these molecules in events associated with acute coronary thrombosis.
Pulsatile Flow–Induced Angiogenesis
Authors: Cullen John P. , Sayeed Shariq , Sawai Rebecca S. , Theodorakis Nicholas G. , Cahill Paul A. , Sitzmann James V. , Redmond Eileen M.
Published: October 2002

Objective—

Angiogenesis plays a key role in the growth and function of normal and pathological tissues. We investigated the effect of pulsatile flow on endothelial cell (EC) in vitro angiogenic activity.

Methods and Results—

Bovine aortic ECs were exposed to “static” or “flow” (1.2 to 67.0 mL/min, shear stress 1.4 to 19.2 dyne/cm
2
) conditions for 2 to 24 hours. After exposure, angiogenesis was measured as tubule formation on Matrigel, and EC migration was assessed by filter migration assay. Pulsatile flow increased angiogenesis and EC migration in a temporal and force-dependent manner, with a maximal effect at 16 hours (13.2 dyne/cm
2
). Pertussis toxin completely inhibited the effect of pulsatile flow on angiogenesis and migration. Transfection of ECs with inhibitory mutants of the α subunit of G
i
1 or G
i
3, but not G
i
2, inhibited the flow-induced angiogenic response by 61±2% and 32±6%, respectively, whereas transfection with constitutively activated mutants of the α subunit of G
i
1 or G
i
3, but not G
i
2, increased the flow-induced response by 202±23% and 70±4%, respectively. In contrast, inhibition of Gβγ by the carboxy terminal fragment of β-adrenergic receptor kinase overexpression increased the flow-induced response by 82±8%.

Conclusions—

These results suggest that pulsatile flow stimulates angiogenesis and that this effect is mediated by activation of G
iα
1 or G
iα
3, but not Gβγ, subunits.
Characterization of Human Glycoprotein VI Gene 5′ Regulatory and Promoter Regions
Authors: Furihata Kenichi , Kunicki Thomas J.
Published: October 2002

Objective—

Platelet glycoprotein VI is a collagen receptor belonging to the immunoglobulin-like protein family that is essential for platelet interactions with collagen and is exclusively expressed in the megakaryocytic lineage. The objective of this study was to characterize the human glycoprotein VI gene (
GP6
) 5′ regulatory and promoter regions.

Methods and Results—

We first used 5′ RACE to establish experimentally that the major transcription start site lies 28 bp upstream from the start codon. We next subcloned the 5′ regulatory region of
GP6
into pGL3-basic [pGL3(−1576)] and used deletion mutagenesis to identify important regulatory regions, comparing the activity of transiently expressed promoter-luciferase constructs in Dami and HeLa cells. We found that megakaryocyte lineage-specific transcription is largely controlled within the segment −191/−39. By site-directed mutagenesis, we confirmed that a GATA-1 site at −176 and an Ets-1 site at −45 play important roles in the regulation of
GP6
transcriptional activity.

Conclusions—

We have determined that the
GP6
sequence −191 to −39 represents the core promoter and that transcription is driven largely by GATA-1 (−176) and c-Ets-1 (−45) sites within this segment.
Association of C-Reactive Protein With Carotid Atherosclerosis in Men and Women: The Framingham Heart Study
Authors: Wang Thomas J. , Nam Byung-Ho , Wilson Peter W.F. , Wolf Philip A. , Levy Daniel , Polak Joseph F. , D’Agostino Ralph B. , O’Donnell Christopher J.
Published: October 2002

Objective—

The objective of this study was to examine the relationship between C-reactive protein (CRP) and carotid atherosclerosis.

Background—

Levels of CRP, a nonspecific marker of inflammation, predict risk for cardiovascular events. However, the association between CRP and direct measures of atherosclerosis is not well established.

Methods and Results—

Subjects (n=3173, 52% women, mean age 55) in the offspring cohort of the Framingham Heart Study received a CRP measurement and then underwent carotid ultrasonography 4 years later. Carotid stenosis (≥25%) was present in 24% of men and 14% of women. Age-adjusted odds ratios for carotid stenosis were 1.62 (95%CI 1.12 to 2.36) for men and 3.90 (CI 2.44 to 6.44) for women in the fourth quartile of CRP compared with those in the lowest quartile. After further adjustment for traditional cardiovascular disease risk factors, the odds ratio remained significant for women (2.97, CI 1.72 to 5.25) but not for men. Similarly, after multivariable adjustment, women in the fourth CRP quartile had a higher mean internal carotid intima-media thickness than those in the lowest CRP quartile (
P
≤0.001). There was no association between common carotid intima-media thickness and CRP.

Conclusions—

There is a graded association between CRP and carotid atherosclerosis in women but not in men. The significance of this difference between sexes merits further investigation.
Antioxidant Vitamins and Lipid Therapy
Authors: Brown B. Greg , Cheung Marian C. , Lee Andrew C. , Zhao Xue-Qiao , Chait Alan
Published: October 2002

During the past decade, the perception flourished that lipid and antioxidant therapy were 2 independent avenues for cardiovascular protection. However, studies have shown that commonly used antioxidant vitamin regimens do not prevent cardiovascular events. We found that the addition of antioxidant vitamins to simvastatin-niacin therapy substantially blunts the expected rise in the protective high density lipoprotein (HDL)2 cholesterol and lipoprotein(A-I) subfractions of HDL, with apparent adverse effects on the progression of coronary artery disease. To better understand this effect, 12 apolipoproteins, receptors, or enzymes that contribute to reverse cholesterol transport have been examined in terms of their relationship to HDL2 and lipoprotein(A-I) levels and the potential for antioxidant modulation of their gene expression. Three plausible candidate mechanisms are identified: (1) antioxidant stimulation of cholesteryl ester transfer protein expression/activity, (2) antioxidant suppression of macrophage ATP binding cassette transmembrane transporter A1 expression, and/or (3) antioxidant suppression of hepatic or intestinal apolipoprotein A-I synthesis or increase in apolipoprotein A-I catabolism. In summary, antioxidant vitamins E and C and β-carotene, alone or in combination, do not protect against cardiovascular disease. Their use for this purpose may create a diversion away from proven therapies. Because these vitamins blunt the protective HDL2 cholesterol response to HDL cholesterol–targeted therapy, they are potentially harmful in this setting. We conclude that they should rarely, if ever, be recommended for cardiovascular protection.
HIV Protease Inhibitor Ritonavir Induces Cytotoxicity of Human Endothelial Cells
Authors: Zhong Dian-sheng , Lu Xiang-huai , Conklin Brian S. , Lin Peter H. , Lumsden Alan B. , Yao Qizhi , Chen Changyi
Published: October 2002

Objective—

Although HIV protease inhibitors have been successfully used against HIV infection, many metabolic side effects and premature cardiovascular diseases are often associated with this therapy. The mechanisms of these complications are not clear. In this study, we investigated the effect of the HIV protease inhibitor ritonavir on human endothelial cell cultures.

Methods and Results—

By using nonradioactive cell proliferation and cytotoxicity assays, human endothelial cells treated with ritonavir showed a significant decrease in cell viability and an increase in cytotoxicity in a time- and dose-dependent fashion. Mitochondrial DNA was also substantially damaged with ritonavir treatment by long polymerase chain reaction analysis. In contrast, ritonavir had a very limited effect on endothelial apoptosis, as assessed by analyses of DNA fragmentation and cellular caspase-3 activity.

Conclusions—

These data demonstrate, for the first time, that the HIV protease inhibitor ritonavir at concentrations near clinical plasma levels is able to directly cause endothelial mitochondrial DNA damage and cell death mainly through necrosis pathways but not through apoptosis. This study suggests that HIV protease inhibitor–mediated endothelial injury may contribute to its cardiovascular complications.
In Vivo Estrogen Manipulations on Coronary Capillary Network and Angiogenic Molecule Expression in Middle-Aged Female Rats
Authors: Jesmin Subrina , Sakuma Ichiro , Hattori Yuichi , Kitabatake Akira
Published: October 2002

Objective—

Estrogen replacement therapy (ERT) ameliorates symptoms in postmenopausal women with syndrome X. We hypothesized that estrogen deprivation and replacement may modulate coronary expressions of angiogenic molecules, thereby modifying the coronary capillary network in perimenopausal women.

Methods and Results—

Middle-aged (40-week-old) female rats were subjected to sham surgery, ovariectomy, or ovariectomy with ERT. Using immunohistochemical and in situ hybridization techniques, we showed that protein and gene expressions of estrogen receptor β, but not α, in coronary vessels were regulated by in vivo estrogen manipulations. Morphometric analysis showed a reduction in total coronary capillary density with decreased arteriolar capillaries after ovariectomy. ERT resulted in normalization of total capillary number with increased venular capillaries. Coronary expressions of vascular endothelial growth factor (VEGF) and its angiogenic receptor (fetal liver kinase-1) were diminished after ovariectomy, and ERT restored it to intact levels. Higher expressions of VEGF and fetal liver kinase-1 in middle-aged compared with young female rats were associated with an accumulation of hypoxia-inducible factor-1 protein, which was highly expressed in middle-aged female rats.

Conclusions—

The coronary capillary network in middle-aged women may be regulated by physiological angiogenesis via VEGF, and reduction in coronary VEGF expression by estrogen deficiency could play a role as a molecular pathogenesis in the development of coronary heart disease in postmenopausal women.
Estrogen Regulation of Endothelial and Smooth Muscle Cell Migration and Proliferation
Authors: Geraldes Pedro , Sirois Martin G. , Bernatchez Pascal N. , Tanguay Jean-François
Published: October 2002

Objective—

Restenosis is a major limitation of percutaneous coronary intervention. Migration and proliferation of vascular cells remain a cornerstone in neointimal formation. The cardioprotection of estrogen is well recognized, but the intracellular mechanisms related to these beneficial effects are not completely understood.

Methods and Results—

We investigated the effects of 17β-estradiol (17βE) on mitogen-activated protein kinase (MAPK) activity and the migration and proliferation of porcine aortic endothelial cells (PAECs) and porcine smooth muscle cells (PSMCs). Treatment with 17βE (10
−8
mol/L) abrogated p38 and p42/44 MAPK phosphorylation mediated by platelet-derived growth factor-BB as well as the migration and proliferation of PSMCs. In contrast, treatment with 17βE (10
−8
mol/L) induced the phosphorylation of p38 and p42/44 MAPK and the migration and proliferation of PAECs. Interestingly, the effects of 17βE on PSMCs and PAECs were reversed by selective estrogen receptor antagonists (tamoxifen, 4-OH-tamoxifen, and raloxifen). These results suggest that in PSMCs, 17βE inhibits chemotactic and mitogenic effects of platelet-derived growth factor-BB as well as p38 and p42/44 MAPK phosphorylation. In contrast, 17βE promotes in PAECs the phosphorylation of p42/44 and p38 MAPK as well as the migration and proliferation of these cells.

Conclusions—

Treatment with 17βE has a dual beneficial effect: the improvement of vascular healing and the prevention of restenosis after angioplasty.
Lysophosphatidylcholine Stimulates Monocyte Chemoattractant Protein-1 Gene Expression in Rat Aortic Smooth Muscle Cells
Authors: Rong James X. , Berman Joan W. , Taubman Mark B. , Fisher Edward A.
Published: October 2002

Objective—Monocyte chemoattractant protein (MCP)-1 is a proatherogenic factor that is responsible for ≈60% of plaque macrophages in mouse models of atherosclerosis. We investigated whether lysophosphatidylcholine (LPC), enriched in oxidized low density lipoprotein, can modulate the expression of MCP-1 in arterial wall cells.

Methods and Results—LPC induced a 3-fold increase in MCP-1 mRNA in rat vascular smooth muscle cells (VSMCs) in a time- and dose-dependent manner. Nuclear runon analysis showed that this increase was attributable to increased MCP-1 gene transcription. There was a 2-fold increase in MCP-1 protein in the conditioned media of cells treated with LPC. LPC-associated increases of MCP-1 mRNA and protein were similar to those produced by platelet-derived growth factor-BB, a known inducer of MCP-1. Analyses of the MCP-1 promoter in transiently transfected VSMCs indicated an LPC-responsive element(s) between base pairs −146 and −261 (relative to transcription initiation). Further studies suggested that LPC-induced MCP-1 expression partially involves mitogen-activated protein kinase/extracellular signal–regulated kinase, a tyrosine kinase(s), and (to a lesser extent) protein kinase C but not the activation of the platelet-derived growth factor receptor.

Conclusions—LPC stimulates MCP-1 expression at the transcriptional level in VSMCs, suggesting a molecular mechanism by which LPC contributes to the atherogenicity of oxidized low density lipoprotein.
Bone Marrow–Derived Progenitor Cells Modulate Vascular Reendothelialization and Neointimal Formation
Authors: Werner Nikos , Priller Josef , Laufs Ulrich , Endres Matthias , Böhm Michael , Dirnagl Ulrich , Nickenig Georg
Published: October 2002

Objective—

Atherosclerosis and restenosis after vascular injury are both characterized by endothelial dysfunction, apoptosis, inappropriate endothelialization, and neointimal formation. Bone marrow–derived endothelial progenitor cells have been implicated in neovascularization, resulting in adult blood vessel formation. Despite the anticipated stem cell plasticity, the role of bone marrow–derived endothelial progenitor cells has not been clarified in vascular lesion development.

Methods and Results—

We investigated vascular lesion formation in mice after transplantation of bone marrow transfected by means of retrovirus with enhanced green fluorescent protein. Carotid artery injury was induced, resulting in neointimal formation. Fluorescence microscopy and immunohistological analysis revealed that bone marrow–derived progenitor cells are involved in reendothelialization of the vascular lesions. Treatment with rosuvastatin (20 mg/kg body wt per day), a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, enhanced the circulating pool of endothelial progenitor cells, propagated the advent of bone marrow–derived endothelial cells in the injured vessel wall, and, thereby, accelerated reendothelialization and significantly decreased neointimal formation.

Conclusions—

Vascular lesion development initiated by endothelial cell damage is moderated by bone marrow–derived progenitor cells. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibition promotes bone marrow–dependent reendothelialization and diminishes vascular lesion development. These findings may help to establish novel pathophysiological concepts and therapeutic strategies in the treatment of various cardiovascular diseases.
Donor-lymphocyte infusion induces transplantation tolerance by activating systemic and graft-infiltrating double-negative regulatory T cells
Authors: Young Kevin J. , Yang Liming , Phillips M. James , Zhang Li
Published: October 2002

Donor-lymphocyte infusion (DLI) before transplantation can lead to specific tolerance to allografts in mice, nonhuman primates, and humans. We and others have demonstrated a role for regulatory T cells in DLI-induced, donor-specific transplantation tolerance, but it is not known how regulatory T cells are activated and where they execute their function. In this study, we observed, in both transgenic and normal mice, that DLI before transplantation is required for activation of αβ-T-cell-receptor–positive, CD3+CD4−CD8− double-negative (DN) regulatory T cells in the periphery of recipient mice. More interestingly, DLI induced DN regulatory T cells to migrate preferentially to donor-specific allogeneic skin grafts and to form a majority of graft-infiltrating T cells in accepted skin allografts. Furthermore, both recipient-derived peripheral and graft-infiltrating DN T cells were able to suppress and kill antidonor CD8+ T cells in an antigen-specific manner. These data indicate that DLI may induce donor-specific transplantation tolerance by activating recipient DN regulatory T cells in the periphery and by promoting migration of regulatory T cells to donor-specific allogeneic skin grafts. Our results also show that DN regulatory T cells can eliminate antidonor T cells both systemically and locally, a finding suggesting that graft-infiltrating T cells can be beneficial to graft survival.
Comparison of cardiac troponin T and I and CK-MB for the detection of minor myocardial damage during interventional cardiac procedures
Authors: Harris B M , Nageh T , Marsden J T , Thomas M R , Sherwood R A
Published: October 2002

A number of cardiac interventional procedures are available for the treatment of angina, including percutaneous transluminal coronary angioplasty (PTCA), stent insertion and rotational atherectomy (RA). Variable degrees of myocardial cell injury during PTCA and stent insertion have been observed, based on rises in creatine kinase MB isoenzyme (CK-MB) and cardiac troponin T (cTnT) 6-24 h post-procedure. As there are many variations in technique within each procedure it would be helpful to be able to determine objectively the degree of myocardial damage in order to optimize technique. We measured CK-MB, cTnT and cardiac troponin I (cTnI) to ascertain which is the most sensitive marker for minor myocardial damage in this setting. Blood samples were taken both before and 6, 14 and 24 h after the procedure in 109 patients (77 men) with angina, 42 of whom had unstable angina. Of the 109 patients, 86 had a stent inserted (21 as a primary stent), nine had PTCA, eight had RA and six intracoronary brachytherapy. Using the manufacturers' recommended cut-offs - CK-MB 4 µg/L, cTnI and cTnT 0·1 µg/L - five patients were excluded from further analysis as all three markers were raised pre-procedure. Post procedure all three markers were in agreement for 68 patients (44 all normal, 24 all raised). Overall, CKMB was raised in 28 patients, cTnT in 38 and cTnI in 58. In 19 patients CK-MB and cTnT were normal, but cTnI was raised (15 between 0·11 and 0·30 µg/L). cTnI was the most sensitive indicator of minor myocardial damage, but at the recommended cut-off of 0·1 µg/L may be overly sensitive. We await the results of our follow-up study to determine the clinical implications of these small rises in cTnI.
Alkaline phosphatase isoenzymes and clinical features in hypophosphatasia
Authors: Iqbal S J , Davies T , Holland S , Manning T , Whittaker P
Published: October 2002

SUMMARY. Hypophosphatasia is an hereditary disease characterized by low activity of total serum alkaline phosphatase (TALP) accompanied by a range of skeletal diseases. We have measured the main circulating alkaline phosphatase isoenzymes - bone (BALP), liver (LALP), intestinal (IALP), placental (PALP) - in six families with hypophosphatasia, using kinetic and electrophorectic methods. Our observations show that patients with skeletal disease tend to have a very low BALP activity. Patients even with undetectable LALP activity do not appear to manifest any clinical complications. Patients also showed proportionately high IALP activity. Since the production of significant IALP activity is not a constant feature in all healthy individuals, it remains to be established whether the survival of one of these patients (IALP > 80% of TALP) depended on the presence of circulating IALP.
Interference in spectrophotometric analysis of cerebrospinal fluid by haemolysis induced by transport through a pneumatic tube system
Authors: Wenham Philip R , Hanson Tamara , Ashby J Peter
Published: October 2002

The hypothesis that sending blood-stained cerebrospinal fluid (CSF) through a pneumatic tube causes in vitro haemolysis has been tested. Spectrophotometric scanning of CSF supernatants demonstrated a significantly greater absorbance at 415nm in those CSF samples that had been sent through the tube system compared to those that had not ( P=0·0034). It is concluded that passage of blood-stained CSF down a pneumatic tube system causes in vitro haemolysis, accompanied by the release of oxyhaemoglobin from the lysed cells into the surrounding CSF. In view of this observation, it is recommended that CSF samples requiring spectrophotometric analysis, as part of the investigation of subarachnoid haemorrhage, should not be transported via a pneumatic tube system.
Anaphylactic reaction to intravenous sinistrin (Inutest)
Authors: Chandra Rama , Barron Jeffrey L
Published: October 2002

Inulin clearance is the 'gold standard' for the determination of glomerular filtration rate, This is the first report of anaphylaxis following intravenous administration of inulin.
Apolipoprotein A-I concentration in tears in diabetic retinopathy
Authors: Kawai S , Nakajima T , Hokari S , Komoda T , Kawai K
Published: October 2002

Background Apolipoprotein concentrations in reflex tears from healthy and noninsulin-dependent diabetes mellitus (NIDDM) subjects were measured and correlated with the stage of diabetic retinopathy. Methods and results The apolipoprotein A-I (apo A-I) concentrations in the tears from NIDDM patients with retinopathy were significantly higher than those from patients with no or negligible retinopathy ( P < 0·05), and apo A-I was not detected in healthy subjects by Western blotting. No reactive band was detected on apo A-I by Western blotting for nitrotyrosine, a marker for peroxynitrite oxidation of the tear proteins. Apo A-I concentration in tears was significantly correlated with the stage of retinopathy ( r = 0·598, n = 59, P < 0·001). No apo A-I gene expression was detected in the conjunctiva by reverse transcription polymerase chain reaction. Conclusions We conclude that there is increased secretion of native apo A-I from the main lacrimal gland in patients with advanced diabetic retinopathy.
Parathyroid hormone: what are we measuring and does it matter?
Authors: Blumsohn Aubrey , Hadari Amna Al
Published: October 2002

Immunometric assays claiming to determine intact parathyroid hormone (PTH) generally cross-react with N-truncated forms such as PTH(7-84). Laboratories need to examine the relevance of new assays with probable PTH(1-84) specificity. It is logical that assays should measure what they state they do. However, it seems unlikely that use of older 'intact' PTH assays will affect the clinical interpretation of results in primary hyperparathyroidism or vitamin D deficiency. It is plausible that appropriate application of new PTH assays could improve outcome in chronic renal failure. However, it has never been suggested that straightforward replacement of existing assays with new PTH(1-84) assays will lead to this improved outcome. A better understanding of PTH fragments and their interaction with PTH receptors may shed light on the relevance of different PTH assays. In the meantime, older technologies will continue to work well for the vast majority of patients.
Mould constituents in the middle ear, a hearing-aid complication
Authors: Hof J. R. , Kremer B. , Manni J. J.
Published: October 2002

During the placement of a mould for a hearing-aid by a hearing-aid dispenser, moulding material entered the middle ear through pre-existent perforations in the tympanic membrane in both ears. Besides hearing loss, there were no other symptoms. Surgical removal of the moulding material by tympanotomy was necessary, and was complicated by encirclement of the ossicles by the material. All the material could be removed and the hearing was saved. Recommendations for an improved procedure of mould-making are made including more detailed information of the otoscopic findings at the prescriptions for hearing-aid moulds.
Congenital cholesteatoma of the mastoid region
Authors: Cüreoglu Sebahattin , Osma Üstün , Oktay M. Faruk , Nazaroglu Hasan , Meric Faruk , Topçu Ismail
Published: October 2002

Congenital cholesteatoma may arise in the petrous apex, mastoid, middle ear, or external auditory canal. The least common site being the mastoid process. We present one case of primary mastoid cholesteatoma confirmed by clinical examination, surgical findings and radiological evaluation.
Management of pain in peritonsillar abscess
Authors: Nwe Thin Thin , Singh Bharath
Published: October 2002

A prospective study was undertaken in 75 patients with peritonsillar abscess to determine the treatment that was most effective in relieving the excruciating pain associated with the condition. The patients were divided into three treatment groups: intravenous antibiotic, aspiration, and incision and drainage. The effect of treatment on pain was objectively assessed by serially measuring the upper to lower incisor distance and by giving the patient water to drink at regular intervals to determine the point at which swallowing was pain-free. The improvement of the mean upper to lower incisor distance 15 minutes after the initial treatment was five per cent in the intravenous antibiotic group, 38 per cent in the aspiration group, and 100 per cent in the incision and drainage group. None of the patients in the intravenous antibiotic group was able to swallow water two hours after the initial treatment. In the same time interval two patients (eight per cent) in the aspiration group and 23 patients (92 per cent) in the incision and drainage group were able to swallow water. The conclusion derived from this study is that incision and drainage is superior to intravenous antibiotic and aspiration in relieving the pain associated with peritonsillar abscess.
Pharyngocutaneous fistula and total laryngectomy: possible predisposing factors, with emphasis on pharyngeal myotomy
Authors: İkiz A. Ö. , Uça M. , Güneri E. A. , Erdağ T. K. , Sütay S.
Published: October 2002

Ninety-two total laryngectomy cases were investigated with reference to post-laryngectomy fistula formation. Fistula was observed in eight cases (8.69 per cent). There were no statistically significant differences between the fistula group and the non-fistula group with regard to pre-operative tracheotomy, tumour differentiation, positive surgical margins, concurrent neck dissection, previous radiotherapy, T stage of the tumour, presence of extended hypopharyngeal mucosal excision, and placement of nasogastric tube. The only statistically significant positive association was found with primary pharyngeal myotomy. Myotomy was performed in six of the fistula patients and in two cases a technical error was observed. In these cases myotomy was performed adjacent to the edge of hypopharyngeal mucosa resulting in a weakened area of pharyngeal closure, possibly contributing to the fistula. This should be kept in mind and avoided at all costs during the performance of myotomy. Since it was not possible to find out any specific causal relationship with myotomy in four other cases, further studies are needed to establish the association of myotomy with pharyngocutaneous fistula.
Endoscopic ligation of anterior ethmoidal artery in treatment of epistaxis
Authors: Jones N. S. , Woolford T. J.
Published: October 2002

Arterial ligation of the anterior ethmoidal artery may be required in cases of persistent epistaxis and conventional techniques involving open surgery carry a recognized morbidity. We describe an endoscopic, intranasal technique for ligation of the anterior ethmoidal artery. This technique was performed in a patient who had a severe epistaxis following nasal trauma. Her epistaxis persisted in spite of anterior and posterior nasal packing. Endoscopy showed the bleeding to originate high and lateral to the middle turbinate. Endoscopic exploration defined the frayed end of the anterior ethmoidal artery. A ligaclip was placed with immediate and persistent arrest of her epistaxis. No further nasal packs or treatment were required.
Epley’s manoeuvre: treatment of choice for benign paroxysmal positional vertigo
Authors: F.C.P.S. Najam-Ul-Hasnain Khan , Mujeeb Mohammad
Published: October 2002

Benign paroxysmal positional vertigo (BPPV) is one of the commonest causes of peripheral vestibular disorders. In this prospective study 21 patients with BPPV were treated by Epley’s manoeuvre. All patients had an immediate improvement in their symptoms. Recurrence was noted in three patients who required further treatment sessions with resultant improvement in all. However, one patient who originally had suffered from Me´nie`re’s disease involving the same ear for more than 14 years developed another recurrence which was treated successfully by further application of Epley’s manoeuvre. This study supports the usefulness of Epley’s manoeuvre for the treatment of BPPV.
Optimum imaging for mucoceles
Authors: Lloyd Glyn , Lund Valerie J. , Savy Lloyd , Howard David
Published: October 2002

A mucocele is an epithelial lined mucus-containing sac completely filling a paranasal sinus and capable of expansion. They are relatively unusual, occurring most frequently in the fronto-ethmoidal region. The imaging features on plain X-ray, computerized tomography and magnetic resonance imaging are relatively characteristic allowing distinction of the lesion from other pathologies in this area although the mucoceles may occur in association with other pathologies such as nasal polyposis and neoplasia.
A national survey of disinfection techniques for flexible nasendoscopes in UK ENT out-patient departments
Authors: Banfield G. K. , Hinton A. E.
Published: October 2002

Flexible fibre-optic nasendoscopes have become a ubiquitous ENT out-patient tool for the inspection of the nasopharynx, larynx and hypopharynx. Disinfection of the instrument between patient use is important to prevent potential spread of infection but the methods used vary considerably. We designed a questionnaire which was piloted and then sent to 115 UK ENT out-patient departments to establish current UK practice. Most units (67 per cent) use a chemical soak system but the type of chemical disinfectant, the method of delivery and the duration of soak varied considerably. A few hospitals use a disposable plastic sheath system and others simply wipe the instrument with an alcohol swab in between patient use. The protocols for disinfection after high risk patients e.g. human immunodeficiency virus (HIV), hepatitis B varied from hospital to hospital.

The results demonstrate a lack of standard practice that is wasteful of financial resources and may expose patients to unnecessary risk. There is a need for an authoritative ENT body to publish national guidelines as may be found in other specialities and other countries.
De novo laryngeal carcinoma in childhood
Authors: McDermott Annlouise , Raj Prabhakaran , Glaholm John , Pearman Kenneth , Macnamara Marcelle
Published: October 2002

Numerous factors contribute towards a late diagnosis of laryngeal malignancy in childhood. These include its rarity, the similarity of its early symptoms to those of other benign, common childhood conditions as well as the relative difficulty encountered during paediatric laryngeal examination.

We believe that these cases are of sufficient interest when they occur to warrant reporting since the consequences of late diagnosis in these young patients can be serious.

We present a case of an 11-year-old boy with advanced squamous cell carcinoma of the larynx (T3N0M0), who was successfully treated with primary total laryngectomy and bilateral selective neck dissections to avoid the potential additional morbidity of radical radiotherapy.
The future of radiotherapy and chemotherapy in head and neck cancer
Authors: Bridgewater Caroline H. , Spittle Margaret F.
Published: October 2002

For the 40 per cent of patients with head and neck cancer who present with stage I and II disease either radiotherapy or surgery can be curative. The remaining 60 per cent have advanced loco-regional disease and even when treated with surgery and radiotherapy the five-year survival is less than 30 per cent. Most patients with relapse have loco-regional disease and second primary tumours have an incidence of three per cent a year.1 Current attempts to improve prognosis include the addition of chemotherapy, the use of brachytherapy and accelerated radiotherapy regimes such as continuous hyperfractionated accelerated radiotherapy (CHART).
Stapedotomy in osteogenesis imperfecta patients
Authors: Ferekidis E. , Stavroulaki P. , Vossinakis I. , Yiotakis J. , Manolopoulos L. , Adamopoulos G.
Published: October 2002

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by osseous fragility, blue sclerae and hearing loss. In order to assess the impact of stapedotomy on improving hearing on OI, a retrospective, one-group, pre-test-post-test design was used to compare the pre-operative and postoperative audiograms of nine OI patients, treated with stapedotomy for their mixed hearing loss. Operative findings included fixation or thickening of the stapes footplate with normal superstructure configuration and hypervascularization of the promontory mucosa. Immediate post-operative results showed a significant improvement (p<0.05) from 250–4000 Hz in air conduction and from 250–2000 Hz in bone conduction. A significant closure of the air-bone gap between 250–2000 Hz was also achieved (p<0.05). The long-term results remained satisfactory with a mean threshold shift of 8 dB HL and an almost unchanged air-bone gap. These satisfactory results and the lack of complications make stapedotomy an appealing method for the management of OI-associated hearing loss.
Lemierre’s syndrome: a complication of acute oropharyngitis
Authors: Agarwal R. , Arunachalam P. S. , Bosman D. A.
Published: October 2002

Lemierre’s syndrome is a recognized but infrequently seen complication of acute oropharyngitis. In this case report the patient presented with acute sore throat that led to a bacteraemia with internal jugular vein thrombosis and subsequent cranial nerve palsies.
Eosinophilic angiocentric fibrosis
Authors: Matai V. , Baer S. , Barnes S. , Boxer M.
Published: October 2002

Eosinophilic angiocentric fibrosis (EAF) is a rare inflammatory fibrosing condition of unknown aetiology that involves the nose or larynx producing mucosal thickening and severe obstructive symptoms. We report the first case affecting a male. He presented with nasal obstruction requiring septoplasty. The clinical and histopathological features of the condition are discussed and a comparison is made with the seven previous reported cases.
‘A parent’s kiss’: evaluating an unusual method for removing nasal foreign bodies in children
Authors: Botma Marissa , Bader Roxana , Kubba Haytham
Published: October 2002

Nasal foreign bodies are a common problem in children. Various techniques have been described for removing the offending articles. Positive pressure techniques have long been described, and have many potential advantages, but are not yet in widespread use. The aim of this study was to evaluate the efficacy, safety and acceptability of a technique of mouth-to-mouth blowing. Of 19 children with intranasal foreign bodies, the technique was successful in 15 (79 per cent). The procedure caused little or no distress to the child, and no complications were encountered. All parents found the technique acceptable. This technique for nasal foreign body removal is, as far as we are aware, the first to be subjected to any prospective evaluation of effectiveness. We suggest that it should be used as the first line management for removing nasal foreign bodies in young children.
Arcuate eminence in Caucasian populations
Authors: Tsunoda Atsunobu
Published: October 2002

The arcuate eminence (AE) was studied in 21 Caucasian cadavers (42 temporal bones), with particular reference to its relationship to the superior semicircular canal (SSC) and the temporal lobe. An arc-like eminence was observed in over 80 per cent of specimens, however, they did not exactly correspond to the SSC and such eminences corresponded to the sulci of the temporal lobe. The round and domed eminence corresponded to each SSC in seven temporal bones. The distances between the SSC and the middle cranial fossa were varied (0–2.5 mm, mean: 1.2 mm+± 0.6 mm) whereas distances between the lateral semicircular canal and tympanic cavity were relatively consistent (0.6–1.4 mm, mean: 1.0 mm ± 0.2 mm).

These data indicate that the AE is trace of the temporal lobe and the SSC gave little effect to the surface of the middle cranial fossa. These findings could well be applicable to all humans.
Landmarks for parotid gland surgery
Authors: De Ru J. Alexander , Van Benthem Peter Paul G. , Bleys Ronald L.A.W. , Lubsen Herman , Hordijk Gert-Jan
Published: October 2002

Many surgical landmarks have been suggested to help the surgeon identify the facial nerve when performing parotid gland surgery. There is no conclusive evidence that any one landmark is better than the rest. In this study distances from the most frequently used surgical landmarks to the main trunk of the facial nerve were measured in 30 halves of cadaver heads. Two ENT surgeons assessed the best landmark in each case. The tympanomastoid suture was nearest to the main trunk and was therefore considered the most reliable landmark. Its average distance to the main trunk of the facial nerve was 2.7 mm. This result was consistent with the subjective best score given by two ENT surgeons.
Severe audiovestibular loss following ear syringing for wax removal
Authors: Bapat Urmi , Nia Jon , Bance Manohar
Published: October 2002

Syringing of the ear is one of the commonest procedures performed for cleaning cerumen from the external auditory canal. Common complications following syringing are pain, external auditory canal trauma and otitis externa. Hearing and vestibular loss are often mentioned as a complication in descriptions of this technique, but we have not been able to find a reported case of such an occurrence. We report one such a case.
Myringoplasty in children: anatomical and functional results
Authors: Pignataro Lorenzo , Grillo della Berta Lorenzo , Capaccio Pasquale , Zaghis Arturo
Published: October 2002

To assess the results of myringoplasty in children and determine the factors influencing post-operative results a retrospective study of the anatomical and functional results of 41 myringoplasties in children was performed, considering only the cases of uncomplicated perforation that did not require ossiculoplasty or mastoidectomy. The overall success rate was 80.5 per cent after a mean follow-up of 39 months. The mean post-operative air conduction threshold significantly improved in the successful cases with a mean audiological improvement of 11 dB (p<0.05). No post-operative sensorineural hearing loss was observed. There was a significant statistical association between the presence of a dry ear at the time of surgery and good surgical results (p<0.01). Surgical outcome was not affected by the patient’s age, the site and size of the perforation, previous adenoidectomy, surgical technique (overlay vs underlay), or the status of the contralateral ear. Our findings suggest that myringoplasty is a valid procedure in the paediatric population that gives good anatomical and functional results. The status of the middle ear (i.e. the presence of a dry ear), significantly improves surgical outcome; and so careful inflammatory changes in the middle-ear mucosa should be evaluated and medical treatment considered before surgery.
Long-term clinico-radiological assessment of endoscopic stapling of pharyngeal pouch: a series of cases
Authors: Jaramillo Mario , McLay Kenneth , McAteer Dypmna
Published: October 2002

The endoscopic division of the pharyngeal pouch wall with a mechanical stapling device has become increasingly popular. When compared to open excision, the reduced operative time, early resumption of oral intake, and short in-patient stay with no early recurrence of symptoms, are the proposed advantages. Small pouches or thick walled pouches are not suitable for stapling. From December 1996 to December 1999, 32 patients were admitted to the Aberdeen Royal Infirmary for endoscopic stapling of a pharyngeal pouch. Five patients were unsuitable for stapling. In addition, three patients were treated for pouch recurrence after an external approach. Two patients required repeat stapling at a later date. Our results are encouraging in terms of short operation time and hospital admission, improvement of symptoms and minimal complication rate. Fifteen patients were assessed 24 months after the procedure with satisfaction surveys and contrast swallow X-rays. Subjective improvement was sustained throughout this period, despite radiological evidence of persistence of the pharyngeal pouch.
Oro-facial granulomatosis: a laryngeal presentation
Authors: Ward V. M. M. , Dua S. , Morrison G. A.
Published: October 2002

We report the first case of oro-facial granulomatosis (OFG) presenting in pregnancy with laryngeal manifestations.
Focal myositis of the neck with idiopathic orbital myositis
Authors: Dhanasekar G. , Rajan M. S. , Nirmal Kumar B. , Watson S. D.
Published: October 2002

Focal myositis (of Heffner) in the right trapezius and paraspinal muscles accompanied by a pseudotumour of the left orbit has not been reported previously. The clinical, pathological and radiological features of these unusual benign pseudotumours of the head and neck are discussed. Computerized tomography (CT) scan of the neck and orbital ultrasound were suggestive of an inflammatory process without an abscess formation. This was followed by fine needle aspiration cytology (FNAC), which confirmed the diagnosis. The patient was treated with intravenous steroids and antibiotics, that led to complete resolution of symptoms, and there was no recurrence at six months follow-up. This report highlights the importance of imaging in inflammatory neck swellings.
The cause of death in patients with head and neck squamous cell carcinoma
Authors: Coatesworth A. P. , Tsikoudas A. , MacLennan K.
Published: October 2002

For patients with head and neck squamous cell carcinoma the cause of death is not well described in world literature. We report data on 106 patients diagnosed with head and neck squamous cell carcinoma who subsequently died. The literature related to this topic is discussed, and recommendations are made for data collection.
Waiting times during the management of head and neck tumours
Authors: Jones T. M. , Hargrove O. , Lancaster J. , Fenton J. , Shenoy A. , Roland N. J.
Published: October 2002

The waiting times incurred during the management of 75 consecutive head and neck oncology patients attending for post-treatment follow-up were reviewed. Data were gleaned from general practitioner (GP) referral letters, patient case-notes as well as radiology and histology reports. The mean time for GP referral to ENT was 5.1 weeks. From ENT to endoscopy was 3.1 weeks, to histology 3.5 weeks, to computed tomography (CT) scan 5.6 weeks, to magnetic resonance scan (MR) 4.1 weeks, to primary radiotherapy 10.3 weeks and to surgery 5.5 weeks. The mean symptom duration prior to referral was 4.9 months.

Our results compare unfavourably with the standards recommended by the BAO-HNS. Local modifiations may improve matters, but significant increases in funding, manpower and equipment are required to achieve the stipulated standards. Moreover, criteria for referral have to be re-emphasized and patient education has to be addressed as these appear to contribute the longest delay in the diagnosis of head and neck tumours.
Scottish Intercollegiate Guidelines Network (SIGN) guidelines on tonsillectomy: a three cycle audit of clinical record keeping and adherence to national guidelines
Authors: Williams Alun , Lee Patrick , Kerr Alastair
Published: October 2002

Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the indication for tonsillectomy in the management of sore throat were published in January 1999. To determine adherence to these guidelines in our unit, clinical records were examined on admission for tonsillectomy. Three cohorts were analysed. The first listed prior to SIGN, the second after SIGN and the third after presentation of the results of cohorts 1 and 2. The records were examined for documentation of the number of attacks of tonsillitis in the preceding year. The first cohort revealed poor documentation of attacks of tonsillitis (30 per cent). Thesubsequent cohorts showed progressive improvement in record keeping (74 per cent and 96 per cent). The adherence to SIGN guidelines for those with adequate documentation also improved (75 per cent, 80 per cent, 93.5 per cent). The importance of adequate record keeping to enable audit of practice and the impact of national guidelines on practice are discussed.