bluuebunny/crossref_metadata_2025 huggingface dataset:
Formoterol as needed with or without budesonide in patients with intermittent asthma and raised NO levels in exhaled air: a SOMA study
Authors: Haahtela T. , Tamminen K. , Malmberg L. P. , Zetterström O. , Karjalainen J. , Ylä-Outinen H. , Svahn T. , Ekström T. , Selroos O.
Published: September 2006

Patients with mild intermittent asthma sometimes show signs of inflammation, and guidelines suggesting bronchodilator therapy alone as needed may be questioned.

The current study compared as-needed use of a rapid-acting β2-agonist with as-needed use of a β2-agonist and corticosteroid combination as the only medication in asthma patients with intermittent symptoms. A total of 92 nonsmoking asthma patients (of 187 screened) using only an inhaled β2-agonist as needed (28 males, 64 females; mean age 37 yrs; mean forced expiratory volume in one second (FEV1) 101% predicted, mean reversibility 6.5% pred and fractional exhaled nitric oxide (FeNO) ≥20 parts per billion (ppb)) were randomised to treatment with formoterol (Oxis® Turbuhaler®) 4.5 μg as needed (n = 47) or budesonide/formoterol (Symbicort® Turbuhaler®) 160/4.5 μg as needed (n = 45) in a double-blind, parallel-group 24-week study.

The primary variable of efficacy was change inFeNO. BaselineFeNOwas 60 ppb and 59 ppb in the budesonide/formoterol and formoterol groups, respectively. Mean reductions inFeNOin the budesonide/formoterol and formoterol groups were 18.2 ppb and 2.8 ppb, respectively (95% confidence interval (CI) 7.5–23.5 ppb). The reduction in the budesonide/formoterol group occurred during the first 4 weeks of treatment and remained at this low level. Mean FEV1increased by 1.8% pred normal value in the budesonide/formoterol group and decreased by 0.9% pred normal value in the formoterol group (95% CI -4.7– -0.7). In the budesonide/formoterol group, use of ≥4 inhalations·day-1of study medication was seen on 21 treatment days compared with 74 in the formoterol group.

In conclusion, as-needed use of an inhaled corticosteroid together with a rapid-acting bronchodilator may be more beneficial than a β2-agonist alone in patients with intermittent asthma and signs of airway inflammation. The long-term benefits are unknown.
The validity and responsiveness of three quality of life measures in the assessment of psoriasis patients: results of a phase II study
Authors: Shikiar Richard , Willian Mary Kaye , Okun Martin M , Thompson Christine S , Revicki Dennis A
Published: September 2006

Background

Patient-reported outcome (PROs) measures are being used more frequently in investigational studies of treatments for moderate to severe plaque psoriasis. The objective of this study was to examine the relationships among the Dermatology Life Quality Index (DLQI), the Short Form 36 (SF-36), and the EuroQOL 5D (EQ-5D) and to assess their validity, responsiveness, and estimates of minimum important differences.

Methods

A Phase II, randomized, double-blind, parallel group, placebo-controlled, multi-center clinical trial assessed the clinical efficacy and safety of two doses of subcutaneously administered adalimumab vs. placebo for 12 weeks in the treatment of 147 patients with moderate to severe plaque psoriasis. This study provided the opportunity to evaluate the validity and responsiveness to change in clinical status of PROs instruments. Patients completed the DLQI, SF-36, and EQ-5D questionnaires at baseline and at 12 weeks. Blinded investigators assessed the Psoriasis Area and Severity Index (PASI) scores and the Physician's Global Assessment (PGA) scores of enrolled patients. The responsiveness of the measures to changes in the clinical endpoints from baseline to Week 12 was assessed. Estimates of minimum important differences (MID) were derived. All analyses were performed with blinded data; findings and conclusions were not biased based on treatment condition.

Results

The dermatology-specific DLQI was highly correlated to clinical endpoints at baseline and at Week 12, and was the most responsive PRO to changes in endpoints. Compared with the SF-36, the EQ-5D index score and VAS scores were generally more highly correlated with clinical endpoints, but displayed about the same degree of responsiveness. The most responsive SF-36 scales were the Bodily Pain and Social Functioning scales. Estimates of the MID for the DLQI ranged from 2.3–5.7 and for the SF-36 Physical Component Summary (PCS) score ranged from 2.5–3.9.

Conclusion

This study provides support for the continued use of the DLQI and SF-36 PCS in the assessment of treatments for psoriasis. On the basis of the results from this trial, the EQ-5D should be considered as a general PRO measure in future clinical trials of patients with moderate to severe plaque psoriasis.
Outcomes of thromboprophylaxis with enoxaparin vs. unfractionated heparin in medical inpatients
Authors: McGarry Lisa J , Stokes Michael E , Thompson David
Published: September 2006

Background

Clinical trials have shown low-molecular weight heparin (LMWH) to be at least as safe and efficacious as unfractionated heparin (UFH) for preventing venous thromboembolism (VTE) in acutely-ill medical inpatients.

Objective

To compare clinical and economic outcomes among acutely-ill medical inpatients receiving the LMWH enoxaparin versus UFH prophylaxis in clinical practice.

Methods

Using a large, multi-hospital, US database, we identified persons aged ≥40 years hospitalized for ≥6 days for an acute medical condition (including circulatory disorders, respiratory disorders, infectious diseases, or neoplasms) from Q4 1999 to Q1 2002. From these patients, those who received thromboprophylaxis with either enoxaparin or UFH were identified. Surgical patients and those requiring or ineligible for anticoagulation were excluded. We compared the incidence of deep-vein thrombosis (DVT), pulmonary embolism (PE), and all VTE (i.e., DVT and/or PE). Secondary outcomes were occurrence of side-effects, length of hospital stay and total costs. RESULTS: 479 patients received enoxaparin prophylaxis and 2,837 received UFH. The incidence of VTE was 1.7% with enoxaparin prophylaxis versus 6.3% with UFH (RR = 0.26; p < 0.001). Occurrence of side effects, length of stay (10.00 days with enoxaparin vs. 10.26 days with UFH; p = 0.348) and total costs ($18,777 vs. $17,602; p = 0.463) were similar in the 2 groups.

Conclusion

We observed a 74% lower risk of VTE among patients receiving enoxaparin prophylaxis versus UFH prophylaxis. There was no significant difference in side effects or economic outcomes. These results provide evidence that the LMWH enoxaparin is more effective than UFH in reducing the risk of VTE in current clinical practice.
Patterns of expansion and expression divergence in the plant polygalacturonase gene family
Authors: Kim Joonyup , Shiu Shin-Han , Thoma Sharon , Li Wen-Hsiung , Patterson Sara E
Published: September 2006

Background

Polygalacturonases (PGs) belong to a large gene family in plants and are believed to be responsible for various cell separation processes. PG activities have been shown to be associated with a wide range of plant developmental programs such as seed germination, organ abscission, pod and anther dehiscence, pollen grain maturation, fruit softening and decay, xylem cell formation, and pollen tube growth, thus illustrating divergent roles for members of this gene family. A close look at phylogenetic relationships among Arabidopsis and rice PGs accompanied by analysis of expression data provides an opportunity to address key questions on the evolution and functions of duplicate genes.

Results

We found that both tandem and whole-genome duplications contribute significantly to the expansion of this gene family but are associated with substantial gene losses. In addition, there are at least 21 PGs in the common ancestor of Arabidopsis and rice. We have also determined the relationships between Arabidopsis and rice PGs and their expression patterns in Arabidopsis to provide insights into the functional divergence between members of this gene family. By evaluating expression in five Arabidopsis tissues and during five stages of abscission, we found overlapping but distinct expression patterns for most of the different PGs.

Conclusion

Expression data suggest specialized roles or subfunctionalization for each PG gene member. PGs derived from whole genome duplication tend to have more similar expression patterns than those derived from tandem duplications. Our findings suggest that PG duplicates underwent rapid expression divergence and that the mechanisms of duplication affect the divergence rate.
High-resolution quantitative imaging of mammalian and bacterial cells using stable isotope mass spectrometry
Authors: Lechene Claude , Hillion Francois , McMahon Greg , Benson Douglas , Kleinfeld Alan M , Kampf J Patrick , Distel Daniel , Luyten Yvette , Bonventre Joseph , Hentschel Dirk , Park Kwon Moo , Ito Susumu , Schwartz Martin , Benichou Gilles , Slodzian Georges
Published: September 2006

Background

Secondary-ion mass spectrometry (SIMS) is an important tool for investigating isotopic composition in the chemical and materials sciences, but its use in biology has been limited by technical considerations. Multi-isotope imaging mass spectrometry (MIMS), which combines a new generation of SIMS instrument with sophisticated ion optics, labeling with stable isotopes, and quantitative image-analysis software, was developed to study biological materials.

Results

The new instrument allows the production of mass images of high lateral resolution (down to 33 nm), as well as the counting or imaging of several isotopes simultaneously. As MIMS can distinguish between ions of very similar mass, such as 12C15N- and 13C14N-, it enables the precise and reproducible measurement of isotope ratios, and thus of the levels of enrichment in specific isotopic labels, within volumes of less than a cubic micrometer. The sensitivity of MIMS is at least 1,000 times that of 14C autoradiography. The depth resolution can be smaller than 1 nm because only a few atomic layers are needed to create an atomic mass image. We illustrate the use of MIMS to image unlabeled mammalian cultured cells and tissue sections; to analyze fatty-acid transport in adipocyte lipid droplets using 13C-oleic acid; to examine nitrogen fixation in bacteria using 15N gaseous nitrogen; to measure levels of protein renewal in the cochlea and in post-ischemic kidney cells using 15N-leucine; to study DNA and RNA co-distribution and uridine incorporation in the nucleolus using 15N-uridine and 81Br of bromodeoxyuridine or 14C-thymidine; to reveal domains in cultured endothelial cells using the native isotopes 12C, 16O, 14N and 31P; and to track a few 15N-labeled donor spleen cells in the lymph nodes of the host mouse.

Conclusion

MIMS makes it possible for the first time to both image and quantify molecules labeled with stable or radioactive isotopes within subcellular compartments.
Thyroid Hormone Insufficiency during Brain Development Reduces Parvalbumin Immunoreactivity and Inhibitory Function in the Hippocampus
Authors: Gilbert M. E. , Sui L. , Walker M. J. , Anderson W. , Thomas S. , Smoller S. N. , Schon J. P. , Phani S. , Goodman J. H.
Published: September 2006

Thyroid hormones are necessary for brain development. γ-Amino-butyric acid (GABA)ergic interneurons comprise the bulk of local inhibitory circuitry in brain, many of which contain the calcium binding protein, parvalbumin (PV). A previous report indicated that severe postnatal hypothyroidism reduces PV immunoreactivity (IR) in rat neocortex. We examined PV-IR and GABA-mediated synaptic inhibition in the hippocampus of rats deprived of thyroid hormone from gestational d 6 until weaning on postnatal d 30. Pregnant dams were exposed to propylthiouracil (0, 3, 10 ppm) via the drinking water, which decreased maternal serum T4 by approximately 50–75% and increased TSH. At weaning, T4 was reduced by approximately 70% in offspring in the low-dose group and fell below detectable levels in high-dose animals. PV-IR was diminished in the hippocampus and neocortex of offspring killed on postnatal d 21, an effect that could be reversed by postnatal administration of T4. Dose-dependent decreases in the density of PV-IR neurons were observed in neocortex and hippocampus, with the dentate gyrus showing the most severe reductions (50–75% below control counts). Altered staining persisted to adulthood despite the return of thyroid hormones to control levels. Developmental cross-fostering and adult-onset deprivation studies revealed that early postnatal hormone insufficiency was required for an alteration in PV-IR. Synaptic inhibition of the perforant path-dentate gyrus synapse evaluated in adult offspring, in vivo, revealed dose-dependent reductions in paired pulse depression indicative of a suppression of GABA-mediated inhibition. These data demonstrate that moderate degrees of thyroid hormone insufficiency during the early postnatal period permanently alters interneuron expression of PV and compromises inhibitory function in the hippocampus.
Differential Regulation of Steroidogenesis by Bone Morphogenetic Proteins in Granulosa Cells: Involvement of Extracellularly Regulated Kinase Signaling and Oocyte Actions in Follicle-Stimulating Hormone-Induced Estrogen Production
Authors: Miyoshi Tomoko , Otsuka Fumio , Inagaki Kenichi , Otani Hiroyuki , Takeda Masaya , Suzuki Jiro , Goto Junko , Ogura Toshio , Makino Hirofumi
Published: September 2006

In the present study, we investigated the cellular mechanism by which oocytes and bone morphogenetic proteins (BMPs) govern FSH-induced steroidogenesis using rat primary granulosa cells. BMP-6 and BMP-7 both inhibited FSH- and forskolin (FSK)-induced progesterone synthesis and reduced cAMP synthesis independent of the presence or absence of oocytes. BMP-7 also increased FSH-induced estradiol production, and the response was further augmented in the presence of oocytes. In contrast, BMP-6 had no impact on estradiol synthesis regardless of the presence of oocytes. Because BMP-7 changed neither FSK- nor cAMP-induced estradiol production, the BMP-7 action was mediated through a FSH receptor signaling mechanism that was independent of cAMP-protein kinase A pathway. Treatment with FSH but not cAMP activated ERK1/2 phosphorylation in granulosa cells, which was further accelerated by oocytes. A specific ERK inhibitor, U0126, increased estradiol production and decreased FSH- and FSK-induced progesterone production and cAMP synthesis. This suggests that ERK activation is directly linked to inhibition of estradiol synthesis and amplification of cAMP. Moreover, FSH-induced ERK1/2 phosphorylation was inhibited by BMP-7 but not influenced by BMP-6. In contrast, BMP signaling including Smad1/5/8 phosphorylation and Id-1 transcription was up-regulated by FSH and oocytes in granulosa cells through inhibition of Smad6/7 expression. Collectively, oocytes enhance FSH-induced MAPK activation and BMP signaling in granulosa cells, which leads to differential regulation of steroidogenesis elicited by BMPs in the presence of FSH in developing follicles.
Intravascular Glucocorticoid Metabolism during Inflammation and Injury in Mice
Authors: Dover Anna R. , Hadoke Patrick W. F. , Macdonald Linsay J. , Miller Eileen , Newby David E. , Walker Brian R.
Published: September 2006

11β-Hydroxysteroid dehydrogenases (11βHSDs) catalyze interconversion of 11-hydroxy-glucocorticoids with inactive 11-keto metabolites. In blood vessel walls, loss of 11βHSD1 is thought to reduce local glucocorticoid concentrations, reducing the progression of atheroma and enhancing angiogenesis. Conversely, on the basis that 11βHSD1 is up-regulated approximately 5-fold by inflammatory cytokines in cultured human vascular smooth muscle cells, it has been proposed that increased 11βHSD1 during vascular inflammation provides negative feedback suppression of inflammation. We aimed to determine whether inflammation and injury selectively up-regulate 11βHSD1 reductase activity in vitro and in vivo in intact vascular tissue in mice. In isolated mouse aortae and femoral arteries, reductase activity (converting 11-dehydrocorticosterone to corticosterone) was approximately 10-fold higher than dehydrogenase activity and was entirely accounted for by 11βHSD1 because it was abolished in vessels from 11βHSD1−/− mice. Although 11βHSD1 activity was up-regulated by proinflammatory cytokines in cultured murine aortic smooth muscle cells, no such effect was evident in intact aortic rings in vitro. Moreover, after systemic inflammation induced by ip lipopolysaccharide injection, there was only a modest (18%) increase in 11β-reductase activity in the aorta and no increase in the perfused hindlimb. Furthermore, in femoral arteries in which neointimal proliferation was induced by intraluminal injury, there was no change in basal 11βHSD1 activity or the sensitivity of 11βHSD1 to cytokine up-regulation. We conclude that increased generation of glucocorticoids by 11βHSD1 in the murine vessel wall is unlikely to contribute to feedback regulation of inflammation.
The deaf
Authors: Wright John Dutton
Published: September 2006

The aim of this department of THE LARYNGOSCOPE will be to bring to the notice of its readers from month to month, facts that may be helpful to physician and patient in dealing with the life‐problems involved in deafness. Suggestions from readers will be gladly received and all questions answered to the best of our ability.
Roentgenology as an aid in the practice of Otology and Rhinology.
Authors: Hasty Frederick E.
Published: September 2006

1. Roentgenology can be so used as to lend great assistance to the otolaryngologist in the study of the anatomy of many of the structures with which he has to deal

2. While not infallible, Roentgenology is an indispensable aid in the study of the diseases in the bony cavities of the structures about the head

3. It is the duty of the otolaryngologist to interpret Roentgeno‐grams of his patients

4. Radiopaque solutions are indispensable in the radiographic study of the paranasal sinuses

5. In many instances disease in the paranasal sinuses is located beneath the lining membrane. Therefore, there is but little, if any, pus formation in the cavity

6. Good Roentgenograms of the ethmoid and sphenoid cells will outline the anatomy, and in many instances will give valuable information of the pathological changes in these structures

7. Roentgenology is indispensable in the practice of otolaryngology, but it should not be expected to prevail over the indications of a good examination and a carefully taken and dependable history.
Petrositis, meningitis (streptococcus beta); sulfanilamide, drainage, recovery; Report of case
Authors: Jackson C. C. Roe
Published: September 2006

Already, the number of cases of hemolytic streptococcic meningitis responding favorably to the therapeutic effect of sulfanilamide or its compounds and assisting factors is increasing daily. No attempt is herein made to review the literature, to group the cases collectively according to the mode of entry, or to embark upon any lengthy discussion. Suffice it to say, that there arises in each case, no matter how closely it may resemble some other reported one, an entirely different picture; and, again, we realize that every case is a law unto itself. Everyone is cognizant of the fact that the features bearing on this variability are involved with anatomical background and influenced by developmental and intercurrent phenomena, such as infection and immunity.
Recent experiences with closed wound suction in surgery of the head and neck.
Authors: von Leden Hans
Published: September 2006

Continuous closed wound suction provides an effective method for the postoperative drainage of major surgical procedures about the head and neck. This technique encourages primary approximation and early revascularization of large skin flaps, and eliminates the need for bulky pressure dressings.

A self‐contained portable kit for closed wound suction assures continuous even negative pressure, and permits early ambulation. A clinical review indicates a marked diminution in the incidence of wound infections and necrosis, and a corresponding decrease in the morbidity.

(A motion picture accompanied this presentation.)
The incus in middle ear surgery.
Authors: Moon Cary N.
Published: September 2006

Two methods of by‐passing the non‐functioning or missing incus have been described. In our experience the hearing gain resulting has been quite gratifying. We now feel that these somewhat unusual problems can be handled with the same expectation of success that routine stapedectomy for stapes fixation enjoys.
Experiences with interposition during partial stapedectomy.
Authors: Ruggles Richard L.
Published: September 2006

Eighty‐one cases of otosclerosis were operated upon, using the interposition of the posterior crus upon Gelfoam (R) from October 1960 to October 1961. The technique is described briefly and the results tabulated. Twenty‐four and eight‐tenths per cent of these had closure of the air‐bone gap, 54.4 per cent reached 10 db gap (total of 79.2 per cent); 7.2 per cent reached 15 db gap; 8.6 per cent reached 35 db gap; 3.7 per cent showed no gain; one case had a further conductive loss and one had a minimal cochlear loss. These last two had obliteration of the footplate by severe otosclerosis. One‐half of the 14.8 per cent revised were done with good improvement.

The advantages of the operation are several: Good hearing can be obtained, no permanent foreign substance is used, the stapedial tendon is still functional in preventing acoustic trauma and displacement of crus into the vestibule; there is no evidence of cochlear damage due to surgery.
Mediastinal dissection for recurrent cancer after laryngectomy
Authors: Sisson George A. , Straehley Clifford J. , Johnson Norman E.
Published: September 2006

A technique for radical dissection of the superior mediastinum which includes the repositioning of the trachea has been described with emphasis upon the importance of protecting the trachea from the great vessels. This procedure, as used upon six cases of recurrent stomal cancer after laryngectomy, is described in detail. The feasibility of adapting this technique to control and cure advanced subglottic lesions is suggested.
Tumors of the major salivary glands
Authors: Skolnik Emanuel M. , Friedman Michael , Becker Stephen , Sisson George A. , Keyes Geoffrey R.
Published: September 2006

Tumors of the major salivary glands are reviewed according to classification, location, surgical procedure and end results. Our data of the incidence of benign and malignant tumors show that the most commonly involved area is the parotid gland and the most frequent is of the mixed variety.

In the parotid region 80 percent are benign and 20 percent are malignant; whereas, in the submandibular gland, the malignant and benign tumors are equally distributed. The need for an extensive surgical attack and inclusion of contiguous structure is dictated by the nature of the malignant disease. The role of postoperative irradiation is discussed as is the indication for neck dissection.

Management of the facial nerve, relative to malignant tumors of the parotid gland, is considered in detail.
Oral manifestations of herpes simplex virus infections
Authors: Birt Derek , From Lynn , Main James
Published: September 2006

Most individuals are infected with Herpes Simplex in childhood usually suffering a mild febrile illness of no consequence. Later some individuals suffer recurrent infections which appear as cold sores on the lip while others intermittently shed virus in the oro‐pharygeal secretions. Adults uninfected in childhood may be exposed to viruses for example by kissing and develop an acute primary herpes with fever and gingivo‐stomatitis occasionally requiring hospital admission.

Awareness of this condition is required for diagnosis after which the majority of patients seen in otolaryngological practice need only supportive therapy, explanation and reassurance. Recurrent cold sores are no more than a nuisance in most patients, but occasionally they are severe and in others the cold sore may precipitate oral erythema multiforme. Unfortunately the treatments available for recurrent cold sores are rather unsatisfactory.
Facial injuries in hockey players
Authors: Rontal Eugene , Rontal Michael , Wilson Kent , Cram Barclay
Published: September 2006

As otolaryngologists become more involved with maxillofacial trauma, we are encountering an increasing number of athletic injuries. Ice hockey accounts for a large number of these facial injuries. The fast moving and random nature of the game, frequent body and equipment contact and lack of protective devices, predisposes the hockey player to facial injury. Because of the roughly tenfold increase in hockey participation over the last decade, the problem of facial injury prevention has become a significant public health problem in North America.

Review of the medical literature shows a paucity of interest in the subject of facial injury prevention in hockey. Several articles have dealt with ocular injury, while other articles have dealt with the general subject of hockey injury with only scant attention paid to the facial area.

A retrospective study was carried out to more clearly define the scope of the facial injury problem. Four levels of hockey play were examined. Individuals from the youngest and most inexperienced to seasoned professionals were studied. An individually completed questionnaire was received from players in each group. It is the purpose of this paper to indicate the rates of injury for the various types of facial trauma, present their mechanisms of occurrence and discuss means of preventing facial injury in hockey players.
Fractures of the orbital floor
Authors: Crumley Roger L. , Leibsohn Joel , Krause Charles J. , Burton Thomas C.
Published: September 2006

The charts of 324 patients treated for 363 orbital floor fractures between 1965 and 1973 were reviewed retrospectively. Of these, 38 (11 percent) were isolated floor fractures, 27 (8 percent) were rim and floor fractures, 168 (46 percent) were trimalar fractures and 130 (35 percent) were associated with complex facial fractures.

On initial examination, 31 percent of the patients were found to have diplopia and 4 percent enophthalmos. Orbital prolapse was suspected in 31 percent of the patients. Thirty‐seven percent of the patients had demonstrable ocular injury at the time of initial examination.

Treatment was surgical in 336 of the fractures and non‐surgical in 29. Of the surgical patients 140 had no support placed, 120 had antral support only, 51 had both antral support and orbital implant, and 20 had an orbital implant only.

Postpperatively the incidence of diplopia was 8 percent in all patients, and 7 percent had enophthalmos. A smaller group followed for more than five months were found to have diplopia in 17 percent and enophthalmos in 11 percent. Of the 29 patients treated non‐surgically, none had persistent diplopia.
Mucous glands in the developing human rhinopharynx
Authors: Tos Mirko
Published: September 2006

In 42 fetuses and prematures, the entire mucosa from the rhinopharynx was stained by various whole‐mount methods. The development, growth, spread, distribution, situation, and size of the glands were determined. The development starts in the 11th week below the tubal orifice, whence the glands spread to the entire rhinopharynx. The number increases gradually by about 60‐70 glands a week. By the 23rd week, there are 1,100‐1,200 glands in the rhinopharynx. After that juncture, there is presumably no further new formation. The density and size of the glands were at a maximum in Rosenmiiller's recess, below the tubal orifice, and in the salpingo‐pharyngeal fold, least anterior to the tubal orifice and at the junction to the pharynx. The role of the sero‐mucous glands in the rhinopharynx under normal and abnormal conditions is discussed.
Malignant melanoma of conjunctiva metastatic to parotid gland. reports of cases and discussion of surgical management
Authors: Travis Lawrence W. , Rice Dale H. , Mcclatchey Kenneth D. , Wallace S. Willard
Published: September 2006

Invasive malignant melanoma of the conjunctiva is a rare neoplasm fatal in 40% of cases. Accepted techniques of surgical management include wide local excision, conjunctivectomy, and exenteration. Recently lymphatic dissections have been proposed, but not described, for invasive conjunctival melanoma. We present five cases of invasive conjunctival melanoma, including two with intraglandular parotid metastases. The surgical management of these patients is presented, and a proposal is made for radical bloc dissection of the orbital contents and regional lymphatics. The histology of conjunctival melanoma is discussed, and a classification proposed to assist the head and neck surgical team in the management of this disease.
Comparison of caloric and sinusoidal tests in the vestibulotoxic cat
Authors: Reder Michael S. , Mathog Robert H. , Capps Mary Jayne
Published: September 2006

In order to evaluate the relative sensitivity of caloric and sinusoidal angular acceleration tests, thermal and rotational stimuli were administered to cats rendered vestibulotoxic with streptomycin sulfate. Three groups of six cats each, receiving daily subcutaneous injections of saline, 100 mg/kg streptomycin or 200 mg/kg streptomycin, were administered optokinetic, caloric and sinusoidal stimuli. Vestibular responses were evaluated by changes in the total slow phase displacement of the eyes and frequency of nystagmic beats.

The results demonstrated that the saline treated animals had a decrease in response consistent with habituation; whereas, experimental animals showed a marked, rapid abolition of eye movement. The decrease in response was greater for the larger dose of streptomycin. Caloric or sinusoidal acceleration tests were equally sensitive in monitoring the degree of nystagmic depression. The data suggested that sinusoidal acceleration tests could be easily applied to the clinical vestibular assessment of ototoxicity.
Audiograms derived from the brain stem response
Authors: Mitchell Curt , Clemis Jack D.
Published: September 2006

Nineteen normal and 22 hearing impaired subjects were used in this study. Thresholds were determined by the following methods: 1. behavioral continuous tone, 2. behavioral tone burst, and 3. the brain stem electric response (BER) with tone bursts. A comparison of the BER thresholds with the behavioral thresholds are made for each subject. The difference between these three measures of threshold suggests that audiograms can be derived from the brain stem response threshold. The derived audiogram compares favorably with conventional audiograms. However, it must be remembered that the brain stem response is not hearing.
Postinflammatory osteogenic fixation of the stapes
Authors: Shea M. Coyle
Published: September 2006

Stapes fixation existing with chronic otitis media has been attributed usually to either tympanosclerosis or concomitant otosclerosis. A different type of stapes fixation has been encountered which the author has termed “post‐inflammatory osteogenic stapes fixation.” One thousand five hundred and two surgical procedures for chronic otitis media were reviewed with 112 rigid stapes fixations found of which 19 were classified as postinflammatory osteogenic stapes fixation. Surgical techniques were discussed, case histories were presented, and photomicrographs were shown illustrating two varieties of post‐inflammatory osteogenic stapes fixations classified according to the side of the fixing lesion. The etiology and pathogenesis of this condition were felt to have a direct relationship to infection and prior surgery. Post‐inflammatory osteogenic stapes fixation probably occurs more frequently than realized. Further research is needed to evaluate this type of stapes fixation.
EPIDEMIOLOGY OF OTITIS MEDIA—AN INTERRACIAL STUDY
Authors: Griffith Thomas E.
Published: September 2006

An epidemiologic study was done comparing blacks versus whites with regard to the incidence of altered middle ear function or otitis media. Three separate groups were evaluated. All variables were controlled except for race. There appears to be statistically significant less otitis media or altered middle ear function in the black race than the white race.
Brain stem electric response audiometry in the differential diagnosis of acoustic tumors
Authors: Clemis Jack D. , Gee Therese Mc
Published: September 2006

A brief history of the advances made in acoustic tumor diagnosis and treatment is presented indicating the benefits derived therefrom over the past 15 years. The recent application of brain stem electric response audiometry (BERA) as related to tumors affecting the auditory nerve is reviewed. Patients were considered to have a positive test result for tumor detection (abnormal BER) when their responses showed one of three characteristics: 1. wave V latencies were significantly different from the normal mean, 2. the interaural latency difference (ILD) was greater than .3 msec. (.4 msecs when the hearing loss was greater than 65 db HL), or 3. no response could be recognized at suprathreshold levels. An abnormal BER result was observed in 92.6% of 27 surgically proven tumors in this study. Two patients with surgically proven tumors had a false‐negative test. In a series of 115 nontumor patients with asymmetric sensorineural hearing losses of multiple etiology, one in three had an abnormal BER result. All conductive losses increased wave V latency values. The authors have concluded that an abnormal ILD is far from pathogmonic for a tumor affecting the auditory nerve; interpretive caution is recommended with even small conductive hearing losses. False‐negative responses are few, false‐positive responses are common (relative to tumor diagnosis). BERA is the most efficient audiometric test available today in our search for tumors affecting the auditory nerve. As such, this test probably heralds a new era in diagnostic audiology.
The endolymphatic sac: Anatomical considerations
Authors: Shea Donald A. , Chole Richard A. , Paparella Michael M.
Published: September 2006

Since Portmann suggested surgical drainage of the endolymphatic sac in 1927, several similar procedures have been described. These procedures all share a common problem: the endolymphatic sac must be identified without injuring the labyrinthine structures or the facial nerve.

Anson and Donaldson have provided the otologist with a detailed and accurate description of the anatomy of the endolymphatic sac but did not provide the surgeon a convenient and reliable way of safely locating this structure through Trautmann's triangle via a mastoidectomy approach.

Forty normal temporal bones were examined and measurements obtained. In 20 temporal bones, the vestibular portion of the endolymphatic duct was injected with dye, and a complete mastoidectomy was performed. Accurate measurements were obtained. In addition, 20 normal temporal bones were sectioned down to the inferior‐most extent of the endolymphatic sac, and measurements from local landmarks were obtained.

The distance between the short process of the incus and the bottom of the otic capsule of the posterior semicircular canal is 10.4 mm (range 9.5 to 11.5 mm), and the distance from the tip of the short process of the incus to the inferior‐most point of the endolymphatic sac is 16.9 mm (range 13.0 to 19.0 mm). Hence, the distance from the otic capsule of the posterior canal to the bottom of the sac is 4.3 mm (range 1.9 to 6.6 mm). Therefore, the conservative surgeon can approach the endolymphatic sac below the level of the posterior semicircular canal and minimize risk of injury to that structure.
The ultrastructure of the endolymphatic sac in ménière's disease
Authors: Schindler Robert A. , Horn Karl L. , Jones Patricia Leake , Maglio Maria
Published: September 2006

Meniere's disease is a well recognized clinical entity, yet the etiology and pathophysiology of the disease is not fully understood. Impaired endolymphatic sac function resulting in faulty reabsorption of endolymph has been implicated in the production of the disease. The histopathological findings from biopsied sac specimens and observed by transmission (TEM) and scanning (SEM) electronmicroscopy in two patients with early Meniere's disease are presented and discussed. Extensive subepithelial fibrosis with loss of vascularity and obliteration of portions of the lumen of the endolymphatic sac by an ingrowth of collagen is noted in both specimens. The implications of these findings are discussed and the need for more TEM and SEM studies of inner ear disorders is stressed.
Tympanoplasty: Torps and porps
Authors: Brackmann Derald E. , Sheehy James L.
Published: September 2006

We reviewed 106 cases in which PlastiPoreTM prostheses were used for ossicular reconstruction. In all cases a piece of cartilage was interposed between the prosthesis and the tympanic membrane graft to prevent the potential problem of prosthesis extrusion.

With total ossicular replacement prostheses (TORPs) 55% closed to within 10 db and 85% closed to within 20 db of the bone conduction level. Closure to within 10 db of the bone conduction level was accomplished in 64% of partial ossicular replacement prostheses (PORPs) cases. These results are better than obtained previously with either ossicles or cartilage alone.
Spasmodic dysphonia: Abductor type: A clinical report of acoustic, aerodynamic and perceptual characteristics
Authors: Merson Richard M. , Ginsberg Anne Plummer
Published: September 2006

Two case studies of spasmodic dysphonia (abductor type) are presented with acoustic and aerodynamic documentation. The abductor type is characterized clinically as exhibiting intermittent moderate to severe breathiness accompanied by sudden drops in pitch. These phenomena are interpreted as intermittent abductor vocal fold spasms. Complete case histories including voice therapy and their results are presented.
Idiopathic ulceration of the hypopharynx
Authors: Harrison Donald F. N.
Published: September 2006

At least three clinical variations of idiopathic ulceration of the oropharyngeal cavity are recognized. Major (or giant) aphthous ulceration is uncommon but may affect the hypopharynx producing severe pain, dysphagia, and severe scarring. Healing with systemic prednisolone may require large and prolonged dosage. In 7 out of 14 patients with hypopharyngeal ulceration gastrostomy was performed to assist nutrition and by‐pass the cricopharyngeal region in an attempt at reducing subsequent scarring.
Cranio‐facial approach to ossifying fibromas
Authors: Janecka Ivo P. , Housepian Edgar
Published: September 2006

A cranio‐facial approach to ossifying fibromas of the orbit and the anterior cranial base is described. Ten patients with a documented ossifying fibroma were operated on utilizing this surgical modality. Eight tumors were completely removed and two were subtotally resected. The surgical defects were reconstructed either with an autogenous bone graft or an aluminum/acrylic cranioplasty. Our surgery for ossifying fibromas accomplished a significant reduction or an elimination of ocular displacement as well as the reestablishment of cranial symmetry.
Oncogenes: Their presence and significance in squamous cell cancer of the head and neck
Authors: Friedman William H. , Rosenblum Barry N. , Katsantonis George , Thornton Helen , Loewenstein Paul , Green Maurice
Published: September 2006

DNA extracted from squamous cell carcinomas of the larynx and tongue has been shown to contain cellular transforming genes characterized by their ability to transform mouse fibroblasts into malignant foci of cells which, when subsequently cloned and grown to volume, have been found to contain human DNA sequences. This DNA has been serially passaged through subsequent populations of NIH/3T3 mouse fibroblasts. Higher malignant transformation efficiencies have been observed and reported with serial passage. Of greater significance is the repeated identification of oncogenes of identical characteristics on electrophoretic radioisotope analysis.
Safety of 125iodine and 192iridium implants to the canine carotid artery: Preliminary report
Authors: Fee Willard E. , Handen Cynthia , Goffinet Don R. , Fajardo Luis F. , Guthaner Diana
Published: September 2006

Thirty‐nine healthy dogs underwent a simulated radical neck dissection followed by implantation of either 125Iodine (125I) or 192Indium (192Ir) in various dose regimes randomized prospcctively from 3,000 to 30,000 rad. Bilateral selective carotid angiography was performed immediately postoperatively and at six months and one year. No significant effects occurred to the animals who received 15,000 rad 125I or 6,000 rad 192Ir. In the higher dosed animals the 125I treated group fared better than the 192Ir treated group, probably due to the lower dose rate delivery. All surviving animals will be maintained an additional year to determine the late effects of brachytherapy irradiation to the carotid artery.
Biologically aggressive papillomas of the nasal cavity: The role of radiation therapy
Authors: Mendenhall William M. , Million Rodney R. , Cassisi Nicholas J. , Pierson K. Kendall
Published: September 2006

Five patients were irradiated at the University of Florida for advanced and/or recurrent papillomas of the nasal cavity and paranasal sinuses from December 1969 through December 1981. Three patients were irradiated either before or after resection and two patients were treated with radiation therapy alone. Two patients had pure inverted papilloma, one patient had inverted papilloma associated with a focus of squamous cell carcinoma, and two patients had cylindrical cell papillomas. Four patients are alive and continuously disease free at 3, 3, 4, and 11 years following treatment. One patient died of intercurrent disease nine years following treatment without evidence of recurrent tumor.
The movable stent in choanal atresia
Authors: Birck Herbert G. , Parrish Robert T.
Published: September 2006

The purpose of this paper is to report our experience in the surgical management of choanal atresia. All of the patients in our series have been treated by endonasal puncture and application of a movable stent. Seventeen patients were operated on using this technique between July 1978 and January 1984. Eleven of the 17 were bilateral atresias and the remaining 6 were unilateral. All 17 cases were successfully treated using this technique. Based on our experience, we believe the key to successful repair of choanal atresia lies not in the method of opening the atretic plate, but in providing a stent that is movable and will thus reduce the occurrence of restenosis. At the same time, we propose a simple method of diagnosis.
Latissimus dorsi myocutaneous‐iliac bone flap for reconstruction of massive defects of mandible and oral basis
Authors: Mogi Goro , Fujiyoshi Tatsuya , Kurono Yuichi , Kawauchi Hideyuki
Published: September 2006

Recent advances in reconstructive surgery for head and neck cancer have improved the cure rate of advanced carcinoma, and the function of the organ. However, it still remains difficult to repair the mandible and oral floor. We devised a combined flap of myocutaneous latissimus dorsi and iliac bone, and applied it to two patients with advanced carcinoma of the oral cavity that invaded to the mandible (T4N3M0). Each patient received preoperative irradiation, totalling 30 Gy and 40 Gy. Two weeks before the extensive resection, a sufficient bony mass for the presumed mandibular defect was taken from the iliac crest and transplanted beneath the latissimus dorsi muscle. Defects of the mandible and oral floor were reconstructed using this combined flap immediately after the resection. The patients began to eat 2 weeks after surgery.
New clinical finding in vestibular neuritis: High‐frequency audiometry hearing loss in the affected ear
Authors: Rahko Tapani , Karma Pekka
Published: September 2006

Twenty‐one patients with established vestibular neuronitis were examined otoneurologically and audiologically. High‐frequency audiometry up to 20,000 Hz was performed on all the patients. In 17 cases a high‐frequency hearing loss was greater in the ear with vestibular neuritis. The mean hearing loss difference varied from 14 dB to 24 dB, depending on the frequency. Our results reveal that in most cases of vestibular neuritis there are no isolated vestibular lesions, but most cases also involve an auditory end‐organ lesion. This finding is in unison with the anatomic conditions of the cochlea and the vestibular end‐organ.
Osteolytic sinusitis and pneumomediastinum: Deceptive otolaryngologic complications of cocaine abuse
Authors: Schweitzer Vanessa G.
Published: September 2006

Recreational cocaine abuse via intranasal “snorting,” “free‐base” smoking, “body‐packing,” or intravenous injection can be lethal. Increasing illicit use of cocaine hydrochloride and the misuse of legal over‐the‐counter (OTC) nasal drugs are known causative agents of nasal septal perforation with loss of taste and smell. Although 2 to 3 mg/kg is the recommended maximum dose for topical anesthesia, cocaine snorters may use 1,000 mg or more daily on a “run.” Furthermore, the newer route of smoking the extracted volatile “free‐base” form of the adulterated street drug provides a plasma concentration producing the same physiological and subjective effects of intravenous cocaine. Presented are two cases exemplifying unusual complications of cocaine abuse: 1. total nasal septal bony and cartilaginous necrosis with resultant saddle‐nose deformity and osteolytic sinusitis secondary to chronic intranasal “snorting” and 2. tracheobronchial rupture with pneumomediastinum secondary to smoking “free‐base” cocaine.
Transoral approach to fractures of the mandible
Authors: Dierks Eric J.
Published: September 2006

The transoral approach to open reduction of mandibular fractures has gained popularity but remains controversial. This report reviews 37 consecutive transoral open reductions of various mandibular fractures performed in 32 patients over a 2‐year period. The fracture site most often addressed transorally was the symphysis and parasymphysis area. A 19% complication rate and an 11% infection rate were observed.
Human leukocytic antigens in autoimmune sensorineural hearing loss
Authors: Bowman Carol A. , Nelson Ralph A.
Published: September 2006

Susceptibility to many autoimmune diseases is associated with inheritance of certain Human Leukocytic Antigens (HLA), determinants which have become diagnostic or prognostic markers. In this study of HLA antigen frequencies among patients with autoimmune sensorineural hearing loss, 39 patients with this otologic disorder were typed for HLA‐A, B, C, and DR antigens. A significant increase of Cw7 occurred in 51% of patients compared to 21% of 627 matched controls (relative risk, 3.95). Trends towards increased frequencies of Cw4, B35 and reduced frequency of DR4 were also observed. These data suggest a possible immunogenetic predisposition to this otologic disorder. The presence of Cw7 may facilitate the diagnosis of autoimmune sensorineural hearing loss.
Stapedectomy and round window closure
Authors: Shea John J. , Farrior Jay B.
Published: September 2006

Round window closure is an uncommon complication of advanced otosclerosis found in 1% of 30,000 stapedectomy cases. A review of 81 patients representing 110 operation cases was made to determine what factors may alert the otologic surgeon to the patient with round window closure and what factors may identify the patient who will achieve the greatest benefit from stapedectomy.