bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of a wireless telemedicine system in a hospital accident and emergency department
Authors: Tachakra Sapal , Banitsas Konstantinos A , Tachakra Farzahn
Published: October 2006

We developed a mobile, wireless videoconferencing system suitable for use in a hospital accident and emergency (A&E) department. Four consultants, eight junior doctors and 11 nurses working in the A&E department tested the system. Transmission of three types of data (audio, still images and video) was tested. The audio for the breath and heart sounds was judged to have some disturbance. One consultant rated the diagnostic quality as good and one rated it as fair. The quality of the still images was judged to be from fair to excellent. The quality of the video was rated as good. Possible interference between the wireless local-area network and various medical devices in the A&E department were examined, but none was detected. The four consultants who tested the system were very positive in their initial comments. Eight of the 11 nurses remained sceptical about its use. Of a total of 20 patients who answered a survey, 13 were slightly anxious about the use of the system to transmit their data to a distant point. Overall, the performance of the system was satisfactory for use in the A&E role.
A systematic review of the methodology of telemedicine evaluation in patients with postural and movement disorders
Authors: Huis In 't Veld M H A , van Dijk H , Hermens H J , Vollenbroek-Hutten M M R
Published: October 2006

We reviewed the methodology used in telemedicine research concerning patients with postural and movement disorders. Literature searches were performed using various computerized databases through to October 2005. Twenty-two studies met the criteria for review. Two broad models of telemedicine delivery were represented in the literature: (1) telemedicine between health-care professionals at each telemedicine site ( n = 16) and (2) telemedicine between health-care professionals and a patient at a remote site ( n = 6). Disparate research methodologies were used to investigate these two models. Most studies were limited to investigating the technical feasibility and acceptability of a telemedicine service rather than focusing on the overall effect of introducing the telemedicine service into routine health care. Nonetheless, it is possible to conclude that telemedicine is acceptable for both patients and professionals when used in rehabilitation. Since the two models of telemedicine evaluation tend to explore different outcomes (diagnostic accuracy versus health status), it is recommended that separate methodologies should be used. In contrast to evaluations of telemedicine model 2, randomized controlled trials appear to be less valuable for telemedicine model 1.
Validation of 12-lead tele-electrocardiogram transmission in the real-life scenario of acute coronary syndrome
Authors: Schwaab Bernhard , Katalinic Alexander , Richardt Gert , Kurowski Volkhard , Krüger Dietmar , Mortensen Kai , Lorenz Eduard , Sheikhzadeh Abdolhamid
Published: October 2006

A 12-lead electrocardiogram (ECG) recorded in patients with acute coronary syndrome (ACS) was transmitted to a call centre via telephone (tele-ECG). In 120 patients (mean age 64 years) referred to hospitals because of ACS, a standard 12-lead ECG and a tele-ECG recorded at the same time were compared by two cardiologists and one internist independently and blindly. Conduction times exhibited very good agreement between standard and tele-ECG with reliability coefficients ( R) of 0.91, 0.86 and 0.89 for the PQ-, QRS- and QT interval, respectively. Rhythm analysis was correct in 99% of the cases. Negative T waves, ST-segment elevation and depression were detected with very high agreement in the tele-ECG exhibiting kappa ( κ) coefficients between 0.75 and 0.96. The correct ECG diagnosis of ST-elevation myocardial infarction (STEMI) was possible with excellent agreement between standard and tele-ECG, showing κ coefficients of 0.96, 0.99 and 0.99, respectively, for three investigators. The 12-lead tele-ECG recorder proved accurate for the detection of acute STEMI.
Combinatorial Benders' Cuts for Mixed-Integer Linear Programming
Authors: Codato Gianni , Fischetti Matteo
Published: October 2006

Mixed-integer programs (MIPs) involving logical implications modeled through big-M coefficients are notoriously among the hardest to solve. In this paper, we propose and analyze computationally an automatic problem reformulation of quite general applicability, aimed at removing the model dependency on the big-M coefficients. Our solution scheme defines a master integer linear problem (ILP) with no continuous variables, which contains combinatorial information on the feasible integer variable combinations that can be “distilled” from the original MIP model. The master solutions are sent to a slave linear program (LP), which validates them and possibly returns combinatorial inequalities to be added to the current master ILP. The inequalities are associated to minimal (or irreducible) infeasible subsystems of a certain linear system, and can be separated efficiently in case the master solution is integer. The overall solution mechanism closely resembles the Benders' one, but the cuts we produce are purely combinatorial and do not depend on the big-M values used in the MIP formulation. This produces an LP relaxation of the master problem which can be considerably tighter than the one associated with original MIP formulation. Computational results on two specific classes of hard-to-solve MIPs indicate that the new method produces a reformulation which can be solved some orders of magnitude faster than the original MIP model.
A Piecewise-Diffusion Model of New-Product Demands
Authors: Niu Shun-Chen
Published: October 2006

The Bass Model (BM) is a widely-used framework in marketing for the study of new-product sales growth. Its usefulness as a demand model has also been recognized in production, inventory, and capacity-planning settings. The BM postulates that the cumulative number of adopters of a new product in a large population approximately follows a deterministic trajectory whose growth rate is governed by two parameters that capture (i) an individual consumer's intrinsic interest in the product, and (ii) a positive force of influence on other consumers from existing adopters. A finite-population pure-birth-process (re)formulation of the BM, called the Stochastic Bass Model (SBM), was proposed recently by the author in a previous paper, and it was shown that if the size of the population in the SBM is taken to infinity, then the SBM and the BM agree (in probability) in the limit. Thus, the SBM “expands” the BM in the sense that for any given population size, it is a well-defined model. In this paper, we exploit this expansion and introduce a further extension of the SBM in which demands of a product in successive time periods are governed by a history-dependent family of SBMs (one for each period) with different population sizes. A sampling theory for this extension, which we call the Piecewise-Diffusion Model (PDM), is also developed. We then apply the theory to a typical product example, demonstrating that the PDM is a remarkably accurate and versatile framework that allows us to better understand the underlying dynamics of new-product demands over time. Joint movement of price and advertising levels, in particular, is shown to have a significant influence on whether or not consumers are “ready” to participate in product purchase.
Quality Cycles and the Strategic Manipulation of Value
Authors: Caulkins Jonathan P. , Feichtinger Gustav , Haunschmied Josef , Tragler Gernot
Published: October 2006

We present a two-state, one-control model of a seller's decision about how good a “deal” to give customers when price and quantity are observable, but the customer does not observe quality until after committing to the transaction, so the quality of the bargain affects future demand only indirectly by influencing the reputation of the seller. This situation describes well the markets for many illicit drugs. Analysis reveals two optimal strategies: converging to a unique steady state with a positive sales volume or exploiting the initial customer base by selling cut-rate products until the seller's reputation is so bad that sales go to zero. Numerical analysis with parameters based on the U.S. cocaine market shows that there is a so-called Dechert-Nishimura-Skiba (DNS) curve in the state space, where the seller is indifferent between these two strategies. Convergence to the steady state with positive sales is oscillatory. Because different sellers may be at different phases of the oscillation at any given time, this oscillation implies that a population of homogenous sellers can generate dispersion in market prices—a phenomenon characteristic of drug markets that has been difficult to explain.
Planning Machine Maintenance in Two-Machine Shop Scheduling
Authors: Kubzin M. A. , Strusevich V. A.
Published: October 2006

We consider the two-machine open shop and two-machine flow shop scheduling problems in which each machine has to be maintained exactly once during the planning period, and the duration of each of these intervals depends on its start time. The objective is to minimize the maximum completion time of all activities to be scheduled. We resolve complexity and approximability issues of these problems. The open shop problem is shown to be polynomially solvable for quite general functions defining the length of the maintenance intervals. By contrast, the flow shop problem is proved binary NP-hard and pseudopolynomially solvable by dynamic programming. We also present a fully polynomial approximation scheme and a fast 3/2-approximation algorithm.
THROMBOSIS OF THE SUPERIOR PETROSAL SINUS AND MENINGITIS FOLLOWING ACUTE MASTOIDITIS
Authors: Meleney Henry E.
Published: October 2006

1. A case is described in which meningitis terminated an apparently convalescent case of acute otitis media and mastoiditis.

2. At necropsy a partly organized, partly septic thrombus was found in the superior petrosal sinus adjacent to the involved tympanic cavity, but no direct connection was found between the primary infection and either the thrombosis or the meningitis.

3. No case of otitis media or mastoiditis is free from the possibility of cerebral complication until it is entirely healed

4. It is suggested that the physical signs which were interpreted as those of brain abscess were possibly due to irritation of the cranial nerves which lay close to the inflammed region, and that this irritation was caused by the same inflammatory process which produced the thrombosis of the superior petrosal sinus.
Report of board of trustees of research fund
Authors: Rae John B. , Wilson J. Gordon
Published: October 2006

The Annual Meeting of the Trustees of the Research Fund was held at the Academy of Medicine, 2 East 103rd street, New York, on Saturday, Jan. 9, 1937.
Report of the chicago committe on otitic meningitis. part II
Authors: Hagens Elmer W.
Published: October 2006

Dr. Lawrence R. Boies showed motion pictures of operations on “Tumors of the Nose and Throat.”
Intrathoracic lesions of clinical and pathologic interests
Authors: Hart V. K.
Published: October 2006

Report of a Small Series Including: 1. Ganglioneuroma of Mediastinum. 2. Endobronchial Adenoma. 3. Endobronchial and Extrabronchial Adenoma. 4. Total, Permanent, Benign, Obstructive, Unilateral Atelectasis. 5. Cyst of Mediastinum.
Unusual foreign body in the esophagus
Authors: Lerner Sidney S.
Published: October 2006

A case is presented in which part of a denture was broken off and produced obstruction of the esophagus. Esophagoscopic extraction was not possible without serious injury because of the presence of pointed metallic clasps. The object was gently eased down into the stomach and was passed per rectum without complication.
Diagnosis, prevention and treatment of hereditary sensorineural hearing loss
Authors: Proctor Conrad
Published: October 2006

In the past several years it has become apparent that hearing loss is the most common chronic disability facing Americans today, afflicting 66 persons in each 1000. In the past 10 years many dramatic and important discoveries in the field of genetics, physiology, micropathology and biochemistry have demonstrated that many types of sensorineural hearing loss are now preventable and even treatable.

One of the greatest challenges facing todays otolaryngologists is that of alerting audiologists, other health professionals and the general public to the importance of a complete otolaryngological workup in all persons with hearing loss.

Since there are more than 1000 genetic syndromes, many of which are associated with hearing loss, it becomes almost impossible for the clinician to be well versed in more than a few of these conditions. It is most important for the otolaryngologist to be able to recognize the more common familial syndromes associated with deafness, and to be especially aware of those conditions for which prevention or treatment is now available.

The more common syndromes associated with sensorineural hearing loss include diabetes mellitus (11/1000), familial hyperlipoproteinemias (10/1000), cochlear otosclerosis (5/1000), Rh incompatibility (.6/1000), Paget's disease (.5/1000), congenital rubella (.2/1000), retinitis pigmentosa (.05/1000), and Pendred's syndrome (.05/1000). Combining these 8 syndromes, we can account for 27 of the 66 persons that have a significant hearing loss among each 1000 persons in the general population of the United States.

When the genetic aspects of noise‐induced hearing loss and the pharmacogenetics of ototoxicity and drug reaction are better understood, we will be able to relate over 50% of all forms of deafness to genetic predispositions.

There are over 30 treatable or preventable diseases with inborn errors of metabolism, including Wilson's syndrome, gargoylism, Tay‐Sachs' syndrome, and Refsum's syndrome which are combined with hearing loss.

The problem of diagnosing hereditary hearing loss is a complex and challenging one. Many forms of it do not develop until adulthood and the hereditary factors are often concealed. The importance of a careful history and thorough physical exam are stressed. Special diagnostic tests, many recently developed, are invaluable in diagnosing these conditions. A plea is made for the temporal bones of more of these patients, with special attention to the new micropathological techniques.

Undoubtedly the next generation will see even greater change in the field of hereditary hearing loss, as more and more of these disorders become diagnosable and treatable.
E.N.T. manifestations of von recklinghausen's disease
Authors: Holt G. Richard
Published: October 2006

Von Recklinghausen's Disease (VRD) is a neurocutaneous, systemic disease characterized by CNS tumors and disorders, cafe‐au‐lait spots, generalized cutaneous neurofibromata, skeletal deformities, and somatic and endocrine abnormalities. It is an autosomal dominant, hereditary disorder found in approximately 1:2500 to 3300 births. There are many manifestations of this disease in the head and neck region of interest to the otolaryngologist.

Case reports of three patients with multiple ENT involvements are detailed. A review of the literature is presented with a brief discussion of diagnosis and treatment.

The most common intracranial tumor in the adult is the acoustic neuroma, usually bilateral, while in the child it is the astrocytoma. A defect in the sphenoid bone is common and may produce temporal lobe herniation into the orbit causing pulsatile exophthalmos. Involvement of the facial bones usually causes radiolucent defects secondary to neurofi‐bromata within nerve pathways, and a variety of asymmetrical changes, especially within the mandible. “Elephantiasis” of the face is a hypertrophy of the soft tissues overlying a neurofibroma, often quite extensive and disfiguring. Laryngeal and neck involvement may compromise the airway and early and repeated surgical intervention is required. The overall malignancy rate approaches 30%, indicating that the patient with VRD may be predisposed to developing a malignancy. There appears to be an increased surgical risk in these patients, with some demonstrating abnormal responses to neuromuscular blockade.
Pediatric tracheostomy and associated complications
Authors: Gaudet Paul T. , Peerless Alter , Sasaki Clarence T. , Kirchner John A.
Published: October 2006

A retrospective analysis of 123 pediatric tracheostomies reveals an overall complication rate of 33%. Immediate complications were present in 12% or 15 patients. The most frequent immediate complications were pneumomediastinum and pneumothorax. Delayed complications occurred in 24% or 30 patients. The most frequent delayed complications were subglottic stenosis, fused vocal cords, and tracheal granuloma. Four patients died because of tracheostomy‐related complications. Age, underlying disease, and prior endotracheal intubation had a high degree of correlation with complications. The use of a mechanical respirator following tracheostomy did not appear to be significantly related to complications. Fifty percent of the delayed complications in this series were regarded as being unrelated to the tracheostomy or the trachesotomy tube itself.
Surgical treatment of tympanosclerosis
Authors: Emmett John R. , Shea John J.
Published: October 2006

During the 5‐year period (1971‐1976), 45 patients at the Shea Clinic underwent reconstructive surgery for tympanosclerosis. The most common ossicular chain problem was found to be malleus and incus fixation (33%); malleus, incus, and stapes fixation (22%); and stapes fixation (13%). The most successful reconstructive approaches included removal of tympanosclerosis from tympanic membrane or isolated plaque from ossicular chain, the use of the Partial Ossicular Replacement Prosthesis (PORP), and the Total Ossicular Replacement Prosthesis (TORP).
Testing for food allergy: A statistical comparison of cytotoxic and intracutaneous tests
Authors: King William P.
Published: October 2006

This study presents a comparison of in vitro cytotoxic food allergy test results with those of in vivo intracutaneous food allergy testing by both objective serial dilution titration and subjective provocation. During the study the cytotoxic test was utilized as a screening device for follow‐up Lee intracutaneous testing, the latter providing statistics for both noted in vivo intracutaneous tests.

The study is presented in two stages. The first stage documents almost 6000 comparison test results on 300 consecutive food‐allergic otolaryngology patients. Thirty‐four of the more frequently offending foods were utilized. Of the cytotoxic tests, 86% resulted in positive reactions. Of the positive cytotoxic reactors, 74% were intracutaneously rechecked. Only those negative cytotoxic reactors suspected of false negativity were so challenged, affording comparison statistics for a smaller 21% of the negative reactors. Poor correlation statistics for this select negative reacting group prompted a follow‐up 30‐patient study on 11 foods that appeared to possess a lesser potential for hypersensitivity production. The second stage emphasizes similar test comparisons on the negative cytotoxic reactors.

The study concludes that no correlation exists between in vitro cytotoxic test determinations and those of in vivo intracutaneous testing by objective serial dilution titration or subjective provocation. Because most allergic individuals have multiple food allergies, clinical success utilizing the information obtained from any or all of these procedures may rely significantly on the tests' inherent tendency to identify multiple guilty foods for ultimate treatment.
Speech rehabilitation of a laryngectomized‐glossectomized patient
Authors: Anderson Jack D. , Thomas Susan
Published: October 2006

A 58‐year‐old English speaking female, who underwent total laryngectomy and glossectomy and subsequently learned to communicate verbally via various phonatory and articulatory compensations, is described in this report. Radiologic study and empirical observation showed her to be using the inhalation method to achieve esophageal air charge. Her articulatory compensations were typical of those used by other glossectomized patients. The extent of her recovery of verbal communication skills through alaryngeal speech suggests that glossectomized‐laryngectomized patients with similar impairment might benefit from speech rehabilitation where prognosis and general health permit.
Small cell anaplastic (oat cell) carcinoma of the larynx: Report of a case and review of the literature
Authors: Myerowitz Richard L. , Barnes E. Leon , Myers Eugene
Published: October 2006

The fifth reported patient with primary laryngeal oat cell carcinoma is described. Electron microscopy of tumor cells revealed typical neurosecretory‐type granules similar to those described for pulmonary oat cell carcinoma. Analysis of clinical data from all five reported patients revealed that this neoplasm is a virulent one which spreads early and rapidly and kills quickly. Combination chemotherapy and/or radiotherapy, which has significantly prolonged life in patients with oat cell carcinoma of lung, may be indicated as an adjunct to surgery for this rare malignant tumor of the larynx.
Symposium: Adjuvant cancer therapy of head and neck tumors. The use of postoperative irradiation — its goals and 1978 attainments
Authors: Byers Robert M.
Published: October 2006

The use of postoperative irradiation as an adjunctive measure for better control of local and regional disease after a surgical procedure has been used at the Anderson Hospital since approximately 1965. The common clinical setting occurs in those patients in whom, after surgical ablation of the tumor, there are microscopic foci of residual disease at the margins, perineural invasion, histologically a very poorly differentiated carcinoma, dermal lymphatic involvement, multiple nodes in the neck or very large nodes in which the tumor has broken through the nodal capsule and entered the connective tissue. We have been applying this criterion for the treatment of salivary gland malignancies, squamous carcinomas of the hypopharynx and supraglottic larynx, and all sites in the head and neck in which there was extensive cervical nodal metastasis. The results of this therapeutic approach will be reported and discussed.
Linear nevus sebaceous of jadassohn
Authors: Marlowe Frank I. , Cron Charles
Published: October 2006

Though the described lesion is uncommon, it is nevertheless important to recognize for several reasons. Its rapid growth during certain phases makes early recognition and surgical excision mandatory to preclude cosmetic deformity. In addition, its significant tendency for malignant degeneration makes early excision the preferred treatment.
The ultrastructural cytochemistry of peroxisomes in the guinea pig cochlea: A metabolic hypothesis for the stria vascularis
Authors: Spector Gershon J. , Carr Charles
Published: October 2006

The roles of catalase and α‐hydroxyacid oxidase activities are studied in the peroxisomes of the guinea pig inner ear. The major activities are located primarily in the intermediate cells of the stria vascularis. The peroxisomes of the stria vascularis behave cytochemically in a similar fashion to those found in the proximal convoluted tubules of the kidney.

This study indicates that the stria vascularis may behave as a compartmentalized metabolic system.
Malignant tumors of salivary glands. A university experience
Authors: Boles Roger , Raines John , Lebovits Marc , Fu Karen K.
Published: October 2006

The management of salivary gland neoplasms continues to be a challenging clinical problem. Despite recent advances in histopathological classification, agreement among head and neck surgeons concerning optimum treatment is lacking. In attempts to eradicate the more malignant varieties of these tumors, surgeons have performed radical and multilating surgery. Radiation therapy has not been considered efficacious in many centers. A review of 93 maligant salivary gland tumors from 1955 to 1973 at the University of California, San Francisco, suggests that these tumors may be more radiosensitive than once thought. Radiation therapy combined with conservative surgical procedures may be as successful and perhaps more rational treatment than radical surgery alone.
Hyperbaric oxygen in the treatment of rhinocerebral mucormycosis
Authors: Price Ltc. John C. , Stevens Ltc. Dennis L.
Published: October 2006

Hyperbaric oxygen therapy was utilized in a case of fulminant mucormycosis of the maxilla, orbit and temporal bone. The patient had refused radical surgery and death seemed iminent in spite of aggressive medical management of diabetic ketoacidosis, amphotericin B and wide surgical drainage of the maxillary and ethmoid sinuses with orbital decompression. Hyperbaric oxygen was instituted on the following theoretical premises: 1. It would provide oxygenation of tissues distal to occluded arteries, thereby increasing local survival and decreasing acidosis, 2. resultant lessening of acidosis would slow or inhibit rapid growth of the organism, and 3. oxygen in sufficient concentration is fungicidal.

The rapid progress of the mucormycosis was arrested. Cultures of tissue prior to hyperbaric oxygen treatment produced heavy growth of Rhizopus, and tissues cultured after therapy grew only bacterial contaminants. The patient survived for 3 mo. only to succumb to Pseudomonas meningitis secondary to necrotic bone and epidural abscess of the middle cranial fossa.

Rhinocerebral mucormycosis is a fulminant and frequently fatal disease. No survivors were reported before extensive surgical debridement was utilized. Survival improved to 50% with the addition of amphotericin B. Early diagnosis and correction of underlying acidosis has further improved this to 85%.

The response to hyperbaric oxygen in this case report possibly introduces a promising new adjunct to therapy of this serious disease.
Diagnosis and management of long‐standing benign oral ulceration.
Authors: Birt Derek , From Lynn , Main James
Published: October 2006

The authors formed a Mouth Clinic at Sunnybrook Hospital in 1973 since when there have been 3025 patient visits. Those patients with chronic ulceration present a challenge, the diagnosis sometimes being difficult and therapy not rapidly effective. The differential diagnosis includes lichen planus, pemphigus vulgaris, benign mucous membrane pemphigoid, discoid lupus erythematosus, erythema multiforme, aphthous ulcers, Behcets disease, periadenitis mucosa necrotica recurrens, specific infections and iatrogenic causes. It is possible to reach a definite diagnosis in virtually every case by means of a good history and careful clinical examination supplemented by biopsies and in some cases direct and indirect immunofluorescent studies. Treatment emphasizes scrupulous attention to oral hygiene with baking soda mouthwashes and careful teeth cleaning to minimize the accumulation of dental plaque. Specific therapy includes topical steroids in lichen planus, intra muscular gold in benign mucous membrane pemphigoid, a previously unreported treatment which considerably improved seven out of ten patients, and tetracycline mouthwashes in aphthous ulcers.
Diagnosis and management of acute epiglottitis — report of 90 consecutive cases
Authors: Bottenfield Gerald W. , Arcinue Edgardo L. , Sarnaik Ashok , Jewell Marvin R.
Published: October 2006

Ninety children with acute epiglottitis were admitted from 1971 – 1977. Lateral extended neck radiograph was found to be a quick, safe and reliable way to establish the diagnosis. Out of 79, 77 (97%) had blood cultures yielding Hemophilus influenzae type b. Immediate institution of airway and antibiotics were the mainstay of treatment. All patients in the series survived. For short‐term airway management, as in acute epiglottitis, nasotracheal intubation under general anesthesia was found to be the airway of choice.
Pectus excavatum: Resolution after surgical removal of upper airway obstruction
Authors: Olsen Kerry D. , Kern Eugene B. , O'Connell Edward J.
Published: October 2006

A six‐year‐old child with obstruction of the upper airway and a pectus excavatum defect (“funnel chest”) is presented. Correction of the funnel‐chest deformity was observed four years after the performance of a tonsillectomy and adenoidectomy to relieve the obstruction of the upper airway. The relationship between chronic upper‐airway obstruction and a pectus excavatum deformity is discussed, and the reversibility of such a deformity is documented.
Frontal sinus trephination: A new technique for office procedure
Authors: Fry Terry L. , Biggers W. Paul , Fischer Newton D.
Published: October 2006

A new office technique for frontal sinus trephination is described. The procedure is simple, expedient, and inexpensive. Our experience with 16 patients suggests that this procedure is reasonably safe and, in addition, avoids the often‐seen complications of supra‐trochlear nerve injury and persistent noticeable scar.
Instrumental perforation of the esophagus
Authors: Behnke Ernest E. , Gadlage Robert , Turner John S.
Published: October 2006

Instrumental perforation of the esophagus occurred in a 55‐year‐old man who underwent esophagoscopy. The complication occurred when the esophagoscope broke during the procedure to remove a bolus of food. After the scope was withdrawn and examined, a defect was seen in its side where a weld on the light carrier had broken, causing a ribbon of mucosa and muscularis to be impinged in this defect. The esophagus was reexamined with a new esophagoscope. A nasogastric tube was passed into the stomach, and antibiotics were administered. Although the dangers of endoscopy are well documented and are decreasing, complications occur in up to 1% of the cases. Early diagnosis and prompt treatment, regardless of the site of perforation, continue to be the critical factors in reduction of the morbidity and mortality of this iatrogenic injury.
Tongue strength: Part II: In artificial alaryngeal speech
Authors: Hartman David E. , Dworkin James P. , Keith Robert L.
Published: October 2006

Tongue strength does not appear to be reduced in proficient esophageal speakers. However, no data exist on tongue strength for laryngectomized subjects who have not developed esophageal speech. Anterior and lateral tongue strength measures were obtained from 13 laryngectomized subjects who used an artificial larynx and 15 normal subjects by means of a pressure transducer and recording device. The results indicated that laryngectomized subjects had significantly weaker tongues in two of three directions measured. It was concluded that laryngectomy may affect tongue strength, but that the method of alaryngeal speech utilized postoperatively influences the return to normal.
Tympanic membrane perforations secondary to ventilation devices special considerations.
Authors: Wilson David F.
Published: October 2006

Tympanic membrane perforations are uncommon following the use of ventilation devices; however, persistent perforations should be given special attention for squamous epithelial growth through the perforation to the undersurface of the tympanic membrane. Surgical management is indicated in these cases. Tympanic membrane grafting procedures are adequate for early involvement. Successful grafting depends on excision of the tympanic membrane involved with the undersurface growth of squamous epithelium. Mastoid extension of the squamous tissue ingrowth requires greater surgical exposure. Cases and their management are presented.
Syphilis: An otolaryngologic perspective.
Authors: Mcnulty John S. , Fassett Richard L.
Published: October 2006

Early syphilis incidence has been increasing in the United States for the past several years. The post‐antibiotic generation of physicians has generally been inadequately trained to recognize the varied manifestations of this disease, yet can expect to encounter it on a more frequent basis in the near future. A literature review of otolaryngologic presentations and the problems of diagnosis and treatment are presented as an aid to the recognition and management of this disease.
Malignant hyperpyrexia: An update for the otolaryngologist.
Authors: Schvaneveldt J. A. , Stankiewicz J. A.
Published: October 2006

Malignant hyperpyrexia (MH) is a syndrome with a mortality of 60%, triggered by a broad variety of anesthetic agents. The most significant recent advance influencing the clinician's ability to safely manage MH individuals is the emergence of dantrolene sodium as both a prophylactic and a therapeutic agent. The purpose of this presentation is to review recent clinical and laboratory studies and advances which are the basis for establishing the pathophysiology of this syndrome and pharmacology of treatment. The FDA has recently approved intravenous Dantrium® for treatment of malignant hyperpyrexia. Intravenous and oral Dantrium® has much theoretical support and experimental evidence which suggests it will significantly reduce the mortality previously associated with this syndrome.
External septorhinoplasty: A tool for teaching and for improved results
Authors: Wright William K. , Kridel Russell W. H.
Published: October 2006

The external septorhinoplasty incision is basically a 5 mm. incision across the columella connecting a left and right alar margin incision. This allows retraction of the dorsal skin to expose the entire dorsal skeletal structure. It has great advantage to both surgeon and assistant for teaching and studying deformed nasal anatomy, and for improved rhinoplasty results because it allows binocular visual monitoring of surgery, the use of both hands, control of bleeding by electrocautery, accurate diagnosis of revisional surgery, and the use of permanent sutures to fix and approximate the various surgically modified nasal structures so that postoperative distortion from healing does not occur. If grafts or implants are needed they can be accurately modelled and sutured in place to prevent postoperative wobbling. The columellar scar if properly closed becomes inconspicuous in a few months, and even early in the healing process it is not noticed because the observer is viewing it at a very oblique angle. It is felt that this operation will be a very valuable addition to everyone doing rhinoplasties and septoplasties.
Malignant external otitis: The diagnostic value of bone scintigraphy.
Authors: Ostfeld Ervin , Aviel Aharon , Pelet Deborah
Published: October 2006

Technetium00mMethylene Diphosphate bone scintigraphy (BS) of the skull was performed in three patients with malignant external otitis (MEO). Pathological uptake of the radioisotope in the mastoid region was found during the early stages of MEO updating radiologic findings. The extent of the radioisotope accumulation during the early stages of MEO indicates that the actual tissue damage exceeds the clinical estimation. The follow‐up BS findings correlate well with the clinical course of MEO indicating either healing or extension to the base of skull.
Electroglottographic studies of staffieri neoglottis
Authors: Lecltjse Frans L. , Tiwari Ram. M. , Snow Gordon B.
Published: October 2006

Among several methods of surgical restoration of voice which were introduced in the last two decades, the one of Staffieri has so far been most successful, though perfection with this technique still remains to be achieved. Question has always been raised as to the nature of function of the neoglottis in the production of voice in these patients. An attempt has been made to study this function with the aid of electroglottography. Results show that the neoglottis functions in some ways similar to the normal human glottis, and as the source of vibrations in these laryngectomized subjects.
The use of rare‐earth magnet couplers in cochlear implants
Authors: Dormer Kenneth J. , Nordquist Robert E. , Richard Gordon L. , Hough J. V. D.
Published: October 2006

The cochlear implant is an electronic auditory prosthesis gaining widespread acceptance as a means of restoring partial hearing to the totally deaf. A number of engineering and biological hurdles remain toward the improvement of existing implantable systems and development of multichannel systems. One hurdle concerns reliable transcutaneous coupling of the external electrical signal to the implanted device. To date this has been accomplished by inductive means through coils which were mechanically held in place. The incorporation of small, permanent, rare‐earth (SmCo5) magnets with the coil assemblies has eliminated the unreliable mechanical supporting devices. Magnetic attachment was simulated in dogs to examine for biological compatibility. Electron micrographs indicated normal subcellular structures in tissue exposed for 10 weeks. Five patients were implanted with magnet‐modified coil assemblies and tested for the proper alignment and support of the external coil assembly, as well as efficiency of inductive coupling. Electromagnetic coupling was not interferred with and mechanical support was adequate. We conclude that rare‐earth magnets provide an effective means for supporting and positioning in place medical devices, such as the cochlear implant.
Repair of orbital blowout fractures with marlex mesh and gelfilm
Authors: Burres Steven A. , Cohn Arnold M. , Mathog Robert H.
Published: October 2006

Thirty patients with surgically treated blowout fractures are reviewed. Of these, 3 had Caldwell‐Luc procedures with antral packing, 23 had allograft implantation over the orbital floor fracture, and 4 required neither implantation nor antral packing. In 11 patients, with extensive defects, Marlex® mesh was employed as the only support. Gelfilm® implants were placed in 7 patients with relatively smaller defects. Three patients had Silastic® implants and 2 had Mersilene® allografts. There were no major complications in any of the 30 patients in the series, and overall results with allograft implants were satisfactory. Properties of the various allografts and indications for their use are discussed.
The free jejunal graft in head and neck reconstruction
Authors: Gluckman Jack L. , Mcdonough John , Donegan J. Oliver , Crissman John D. , Fullen William , Shumrick Donald A.
Published: October 2006

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Over the past 2 years the free jejunal graft with microvascular anastomosis has been used in 12 consecutive cases. Careful follow‐up included not only clinical assessment, but regular radiographic evaluation, as well as fiberoptic esophagoscopy and biopsy of the jejunum.

In our experience the indications for this procedure can be classified as follows: 1. Total laryngopharyngectomy and partial esophagectomy for malignancy. 2. Radical pharyngeal resection for stomal recurrence after previous failed total laryngectomy (including mediastinal dissection). 3. Persistent benign pharyngeal stricture refractory to conservative management. 4. Second‐stage pharyngeal reconstruction in patients with a pharyngostome and esophagostome.

Aspects of the technique will be presented, as well as an analysis of the results. These results have proved most encouraging with only one absolute failure. Major advantages are a significant shortening of hospital stay and a much earlier and easier rehabilitation as compared to other methods of reconstruction. The only other significant complications in the series were stricture at the lower anastomosis and a temporary pharyngocutaneous fistula in one case.

In conclusion, we at the University of Cincinnati Medical Center are of the opinion that free jejunal graft offers an excellent safe and relative easy method of pharyngeal and cervical esophageal reconstruction with significant advantages over other techniques.
Subtotal laryngectomy
Authors: Pearson Bruce W.
Published: October 2006

A subtotal laryngectomy may meet the requirements of adequate tumor resection in many patients who normally would undergo total laryngectomy. The uninvolved column of innervated endolarynx sacrificed at total laryngectomy to separate the airway and the food way can be preserved to valve a speaking shunt. Such a shunt remains patent and sphincteric without the use of a prosthesis and offers consistent advantages over “post‐total” laryngectomy reconstructions.

This report describes the principles of subtotal laryngectomy applied in 16 patients with laryngeal or pharyngeal carcinoma. The technique ensures entry into the larynx through tumor‐free soft tissues and keeps the tumor margins under direct vision thereafter. During follow‐up ranging from 6 months to 6 years, fistula speech has been retained and no local tumor has recurred.
Nasal dermal sinuses — New concepts and explanations
Authors: Sessions Roy B.
Published: October 2006

Utilizing a series of 13 consecutive patients with nasal dermal sinus‐cyst (NDSC) as a basis for study, this area of embryopathology was reexamined in light of the known and also the speculative knowledge available. Four of these patients had NDSC that involved the intracranial cavity and these served as a basis for correlating preoperative radiologic findings with what was actually found at the time of surgery. In so doing, we have been able to show that the pathogenesis of these lesions is consistent and the predictability of their intracranial involvement is based on this consistency. The repeated penetration through the prenasal space and into the foramen cecum is accompanied by a characteristic deformity of the base of the skull that is entirely recognizable radiographically. A protocol of findings has been developed, therefore, that allows the surgeon to be forewarned regarding the depths to which NDSC extends, and as such to design the surgical procedure to fit the lesion.

The more basic findings for this study relate to the demonstration in human embryos of an anatomic reason why intracranial dermal cysts grow in the manner in which they do, i.e., in the substance of the falx cerebri; and even more basically, with additional human embryo studies we have been able to demonstrate a neuroectodermal pathway through the prenasal space, thus definitively confirming previous speculated embryomorphologic information. By corroborating the placement of the dermal displacement in the prenasal space, we have speculated that the NDSC is often but one disorder in a spectrum of aberrations which involves not only dermal and neural displacement, but also cranial floor deformities.
Bronchopulmonary dysplasia (or subglottic stenosis?)
Authors: Mann Douglas G. , Kirchner John A.
Published: October 2006

Bronchopulmonary dysplasia has now become the most common chronic lung disease of early childhood, and is a sequel of neonatal intensive care. The condition is characterized by interstitial fibrosis, agenesis of pulmonary alveoli, and distension of the remaining lung tissue. The resultant stiffness of the lung leads to noisy, labored respiration with retraction of the soft tissues of the thorax during inspiration which may easily be mistaken for the signs of subglottic stenosis.

Two cases which illustrate the problem are presented. The mechanism underlying the clinical picture is discussed.
The anatomic limitations of co2 laser cordectomy
Authors: Kim Davis R. , Jako Geza J. , Hyams Vincent J. , Shapshay Stanley M.
Published: October 2006

The anatomical limitations of CO2 laser cordectomy in an experimental setting with maximal exposure are presented. The major limitation is the thyroid cartilage. This is reached in the area of anterior commissure tendon by removal of only 2 to 3 mm of soft tissue. Most posteriorly in the larynx, the distance to the thyroid cartilage becomes progressively greater, being 5.3 mm at mid‐cord and 9.0 mm at the anterior end of the vocal process of the arytenoid. The inferior limitation is the cricothyroid membrane. Anteriorly this is avoided by not extending laser excision more inferiorly than 5 mm's. Posterolaterally, the limitation is the para‐arytenoid musculature. Excisional biopsy or staging with the laser must be within the framework of these limitations.
Cochleosaccular degeneration of the inner ear and progressive cataracts inherited as an autosomal dominant trait
Authors: Nadol Joseph B. , Burgess Barbara
Published: October 2006

A new syndrome of cataracts and progressive sensorineural hearing loss, inherited as an autosomal dominant trait, is described. The histopathology of the inner ears in the proband demonstrated severe degeneration limited to the cochlea and saccule. This case represents the second reported example of genetically determined cochleosaccular degeneration in man.

The cochleosaccular pattern of histopathology is found in both man and animals and may be the end result of prenatal dysplasia or postnatal degeneration. It also appears that cochleosaccular dysplasia and degeneration may be the result of genetically determined or acquired defects. Previously reported examples of cochleosaccular dysplasia and degeneration are reviewed including human cases in which the histopathology is similar to, but not characteristic of, the cochleosaccular pattern.
Transantral ligation of the internal maxillary artery
Authors: Nair Krishanan K.
Published: October 2006

Transantral internal maxillary ligation for epistaxis is becoming more and more popular. The intention of this paper is to bring home three points: 1. only the arterial trunk need be ligated to obtain the anticipated results, 2. by following certain guidelines the operating time can be cut down by at least 45 minutes, and 3. if the procedure is carried out in time, it can be cost‐effective. As time goes on, more and more patients will be added to this analysis and eventually reported.
Cellular DNA amounts of squamous cell carcinomas of the head and neck region in relation to prognosis
Authors: Holm Lars‐Erik
Published: October 2006

Cytophotometric measurements of Feulgen DNA content were made in individual tumor cells from 45 patients with squamous cell carcinomas of the head and neck region. Eleven carcinomas were found to have a predominantly diploid distribution of DNA values, while the remaining 34 carcinomas were non‐diploid. In 11 of the tumors — not entirely identical with the diploid tumors — 50% or less of the malignant cells had DNA values exceeding the modal diploid value (DNAG1 + 2 S.D.), whereas 34 had higher DNA values.

The non‐diploid carcinomas and those where >50% of the cells had DNA values >DNAG1 + 2 S.D. showed more advanced clinical stage, due to the presence of regional metastases. They were also associated with a poorer prognosis than the diploid carcinomas or those with ≤50% of the cells with DNA values >DNAG1 + 2 S.D. Cellular DNA amounts seemed to be of greater prognostic value than type of ploidy. The study indicates that DNA analysis may contribute important information on the biological behavior and prognosis of squamous cell carcinomas of the head and neck region.
Trauma and meniere's syndrome.
Authors: Paparella Michael M. , Mancini Fernando
Published: October 2006

Thirty‐seven patients who developed Meniere's syndrome following acoustic (18) and physical (19) trauma are described and discussed. Histopathologic characteristics, which appear identical to idiopathic Meniere's disease, are described in a gentleman who developed Meniere's syndrome after head trauma. Concepts of cause and effect relationships and pathogenesis are discussed.