bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis and Reactivity of Tris(7-azaindolyl)boratoruthenium Complex. Comparison with Poly(methimazolyl)borate Analogue
Authors: Saito Tomoyuki , Kuwata Shigeki , Ikariya Takao
Published: October 2006

A reaction of [Cp*RuCl]4 (Cp* = η5-C5(CH3)5) with K[HB(aza)3] (aza = 7-azaindolyl) afforded the first organometallic HB(aza)3− complex [Cp*Ru{HB(aza)3-κ3H,N,N′}], which lost one of the aza-units coordination upon treatment with carbon monoxide to give the mono(carbonyl) complex [Cp*Ru{HB(aza)3-κ2H,N}(CO)]. The crystal structures of these complexes have been determined by X-ray crystallography.
Preparation of Nanoleaf-like Single Crystals of Anatase-type TiO2 by Exfoliation and Hydrothermal Reactions
Authors: Wen Puhong , Itoh Hiroshi , Feng Qi
Published: October 2006

Nanoleaf-like single crystals of anatase were prepared by hydrothermal treatment of a layered titanate nanosheet colloidal solution at 135 °C. The single crystals have high crystallinity and prefer to expose (010) or (100) plane. The surface of the nanocrystals showed a high photocatalytic activity for degradation of Methylene Blue.
Transition-metal-doped ZnO Nanowire Arrays Embedded in Anodic Alumina Membrane by a Sol Precipitation Method
Authors: Wang Ming , Cao Xueli , Wang Huixin , Hua Guomin , Lin Yongxing , Zhang Lide
Published: October 2006

We report the synthesis of transition-metal (Co2+)-doped ZnO nanowire arrays embedded in anodic alumina membrane (AAM) by a sol precipitation method. The direct synthetic method ensures the successful doping of cobalt in the ZnO nanocrystals and exhibiting bivalent state.
Fabrication of Magnetic Core–Shell CoFe2O4/Al2O3 Nanoparticles as Immobilized Metal Chelate Affinity Support for Protein Adsorption
Authors: Tang Dian Quan , Zhang Da Jun , Tang Dian Yong , Ai Hua
Published: October 2006

This study introduced the fabrication of core–shell magnetic CoFe2O4/Al2O3 nanocomposites as the immobilized affinity support for the detection of interleukin-6, as a model protein, in clinical immunoassay.
Substituent Effects on Two Orthogonal π-Systems in Pseudopericyclic Ring-opening Reactions of 5-Alkoxy-2-aminooxazoles
Authors: Fukushima Kazuaki , Iwahashi Hideo
Published: October 2006

Using the density functional theory calculations, the nature of the effects of electron-donating substituents on pseudopericyclic ring-opening reactions of oxazole derivatives have been explained. The reactions involve interactions in two kinds of orthogonal π-systems at the transition states. A 2-amino group interacts with a horizontal π-system at the transition state, while a 5-alkoxy group interacts with a vertical one. Owing to these substituent effects, the barrier of the ring-opening reactions are reduced cumulatively.
Osmium Complex Grafted on a Carbon Electrode Surface as a Mediator for a Bioelectrocatalytic Reaction
Authors: Tsujimura Seiya , Katayama Aya , Kano Kenji
Published: October 2006

A novel electrochemical modification method of carbon electrodes with redox active amines is proposed for mediated electron transfer between enzymes and electrodes. Histamine-coordinated Os complex was synthesized as a model redox amine. The electro-oxidation of the complex generated a stable covalent linkage between the nitrogen atom of the amino group and the carbon atom of the electrode surface. The covalent-linked Os complex on the electrode showed a good redox response and a high activity as an electron-transfer mediator between the electrode and a model enzyme: PQQ-dependant water-soluble glucose dehydrogenase.
Consultation times in emergency telemedicine using realtime videoconferencing
Authors: Ellis David G , Mayrose James , Phelan Michael
Published: October 2006

We reviewed 2135 consecutive emergency teleconsultations, which were received at an academic emergency department from state correctional facilities. During the 52-week study period, an average of 5.8 video-consultations per day were performed. A total of 1522 consultations (71%) had complete start and end consultation times, and were included in the analysis. Of these, 923 were managed primarily by emergency medicine residents and physician assistants, while the remaining 599 were managed by attending physicians alone. Following consultation, the disposition of the patients included 940 who were transported to the emergency department, 351 who were discharged to the general facility population and 193 who were admitted to the local infirmary. Overall, 38% of patients avoided a journey to the emergency department. The average consultation time was 17 min (95% confidence interval [CI], 10–24). The average consultation time for residents and physician assistants was 16 min (95% CI, 8–24) and it was 19 min (95% CI, 11–27) for attending physicians. Consultation time for patients not transported to the emergency room was 21 min (95% CI, 13–29), while for patients transferred to an emergency department, consultation time was 15 min (95% CI, 9–21). These results may assist in planning the workforce requirements for emergency department-based telemedicine services.
Joint Inventory Replenishment and Pricing Control for Systems with Uncertain Yield and Demand
Authors: Li Qing , Zheng Shaohui
Published: October 2006

We study the joint inventory replenishment and pricing problem for production systems with random demand and yield. More specifically, we analyze the following single-item, periodic-review model. Demands in consecutive periods are independent random variables and their distributions are price sensitive. The production yield is uncertain so that the quantity received from a replenishment is a random variable whose distribution depends on the production quantity. Stockouts are fully backlogged. Our problem is to characterize the optimal dynamic policy that simultaneously determines the production quantity and the price for each period to maximize the total discounted profit. We show that the optimal replenishment policy is of a threshold type, i.e., it is optimal to produce if and only if the starting inventory in a period is below a threshold value, and that both the optimal production quantity and the optimal price in each period are decreasing in the starting inventory. We further study the operational effects of uncertain yield. We prove that, in the single-period case, the threshold of replenishment is independent of the yield variability, and, in the multiperiod case, it is higher in a system with uncertain yield than in one with certain yield. In addition, the system with uncertain yield always charges a higher price.
Incorporating Multiprocess Performance Standards into the DEA Framework
Authors: Cook Wade D. , Zhu Joe
Published: October 2006

Data envelopment analysis (DEA) is a mathematical approach to measuring the relative efficiency of peer decision-making units (DMUs). It is particularly useful when no a priori information is available on the trade-offs or relationships among various performance measures. A shortcoming of the DEA model, however, is its inability to provide a measure of absolute performance for the DMUs under investigation. Traditionally, in the service sector, this has not been an issue that one could address, because performance standards in that sector have been difficult to establish. However, in those settings where it has become feasible to develop such standards, it is desirable to build these into DEA performance evaluation, thereby enhancing the capability of the tool. While there have been some attempts to incorporate standards into the DEA structure, these approaches have generally been indirect, in the sense that they have focused primarily on restricting the DEA dual multipliers. This paper introduces a new way of building performance standards into the model. Utilizing the conventional DEA framework and a set of activity matrices, a set of standard DMUs can be generated and incorporated directly into the analysis. We show that under normal circumstances, these generated DMUs are efficient relative to the normal ones, and therefore form a type of outer frontier against which regular units can be evaluated. The proposed approach is applied to a sample of 100 branches of a major Canadian bank, where time standards are used to generate a set of standard bank branches.
Solving Nonlinear Single-Unit Commitment Problems with Ramping Constraints
Authors: Frangioni Antonio , Gentile Claudio
Published: October 2006

We present a dynamic programming algorithm for solving the single-unit commitment (1UC) problem with ramping constraints and arbitrary convex cost functions. The algorithm is based on a new approach for efficiently solving the single-unit economic dispatch (ED) problem with ramping constraints and arbitrary convex cost functions, improving on previously known ones that were limited to piecewise-linear functions. For simple convex functions, such as the quadratic ones typically used in applications, the solution cost of all the involved (ED) problems, consisting of finding an optimal primal and dual solution, is O(n3). Coupled with a special visit of the state-space graph in the dynamic programming algorithm, this approach enables one to solve (1UC) with simple convex functions in O(n3) overall.
Controlled Sequential Bifurcation: A New Factor-Screening Method for Discrete-Event Simulation
Authors: Wan Hong , Ankenman Bruce E. , Nelson Barry L.
Published: October 2006

Screening experiments are performed to eliminate unimportant factors so that the remaining important factors can be more thoroughly studied in later experiments. Sequential bifurcation (SB) is a recent screening method that is well suited for simulation experiments; the challenge is to prove the “correctness” of the results. This paper proposes controlled sequential bifurcation, a procedure that incorporates a hypothesis-testing approach into SB to control error and power. A detailed algorithm is given, conditions that guarantee performance are provided, and an empirical evaluation is presented.
Optimizing Strategic Safety Stock Placement in Supply Chains with Clusters of Commonality
Authors: Humair Salal , Willems Sean P.
Published: October 2006

Multiechelon inventory optimization is increasingly being applied by business users as new tools expand the class of network topologies that can be optimized. In this paper, we formalize a topology that we call networks with clusters of commonality (CoC), which captures a large class of real-world supply chains that contain component commonality. Viewed as a modified network, a CoC network is a spanning tree where the nodes in the modified network are themselves maximal bipartite subgraphs in the original network. We first present algorithms to identify these networks and then present a single-state-variable dynamic program for optimizing safety stock levels and locations. We next present two reformulations of the dynamic program that significantly reduce computational complexity while preserving the optimality of the resulting solution. This work both incorporates arbitrary safety stock cost functions and makes possible optimizing a large class of practically useful but previously intractable networks. It has been successfully applied at several Fortune 500 companies, including the recent Edelman finalist project at Hewlett Packard described in detail in Billington et al. (2004).
Induced nystagmus in monkeys following peripheral vestibular lesions (with clinical correlations)
Authors: Northington Page , Barrera S. E.
Published: October 2006

In a previous report1 we related some observations on induced nystagmus in monkeys, along with the general effects on the animals following unilateral and bilateral labyrinthectomy and intracranial section of the VIIIth nerve. Studies of the effects of similar vestibular lesions in monkeys have been continued since that time and some observations that seemed to us of clinical importance here are reported.
The use of curare drugs in endoscopy
Authors: Sadove M. S. , Gittelson L. A. , Wyant G. M. , Kretchmer H. E. , Holinger P. H.
Published: October 2006

The basic purpose of curare and curare‐like drugs is to produce muscular relaxation and facilitate endoscopy. The use of these drugs is discussed. The necessary cautions in the preparation of the patient and the precautions to take in case of emergency are enumerated. A technique of administration is suggested. The pharmacologic properties of d‐tubocurarine, Di‐methyl tubocurarine iodide, decamethonium bromide and flaxidil are compared.

Clinically and experimentally, Di‐methyl tubocurarine iodide is the drug of choice
Tragal perichondrium and cartilage in reconstructive ear surgery
Authors: Eviatar Abraham
Published: October 2006

Two hundred and fifty‐five ear operations using tragal perichondrium and cartilage for reconstruction are presented. Of these, 108 were myringoplasties, 137 were tympanoplasties with ossicular reconstruction performed by nine different methods, and 10 were tympanoplasties with reconstruction of posterior canal wall defects left by radical mastoid surgery.

The method presented in this study of using the tragal perichondrial graft is well suited for myringoplasty and can be used where the drum remnant is very small or the anulus is missing. The natural angle of the tragal perichondrium can take the place of the missing anulus anteriorly, interiorly or posteriorly. Myringoplasty graft survival at one year follow‐up was 92%, and 76% had hearing within 10 db of bone conduction.

In tympanoplasty, the tragal perichondrium was used en bloc with its cartilage for reconstruction of the ossicular chain where suited. The malleus was used to reconstruct the ossicular chain in different variations. Other methods used are fully described. At one year follow‐up the rate of grafting success for tympanoplasties was 91%, and 78% had hearing within 10 db of bone conduction.

A method for reconstruction of the posterior canal wall and tympanoplasty after radical mastoidectomy is presented. It uses tragal cartilage and perichondrium en bloc. At one year follow‐up, eight of ten cases operated on by this method had an intact drum and posterior canal wall, one had an intact drum but the posterior canal collapsed into the mastoid, and one had an intact canal wall but the eardrum re‐perforated. Nine had postoperative hearing within 10 db of bone conduction.

A randomly selected group of 100 tympanoplasties was examined for postoperative gain in hearing according to the speech reception threshold, a more practical criterion of surgical success than 10 db air‐bone gap. Although the total number showing improvement was similar to the number gaining hearing within 10 db of pure tone bone conduction (76% vs. 78%), when changes of 5 db were discounted, only 56% were improved (and 33% had a significant gain in hearing).
Labyrinthine trauma during ear surgery
Authors: Jahrsdoerfer Robert A. , Johns Michael E. , Cantrell Robert W.
Published: October 2006

Surgical trauma inflicted upon the membranous labyrinth is an uncommon, but often catastrophic, complication of chronic ear surgery. Areas most vulnerable to injury are the oval window and the lateral semicircular canal. Methods of injury include subluxation of the footplate, fracture of the lateral canal by drill or chisel, and accidental opening of a fistula.

Three cases of labyrinthotomy of the lateral canal during ear surgery are presented. Two occurred while drilling, and the other was associated with a dehiscence of the bony and membranous labyrinth from a cholesteatoma. The cases are documented by pre and postoperative audiograms, vestibular function tests, and photographs.

Of interest is the fact that in none of these cases was cochlear function compromised. In one case the hearing actually improved. The dictum that an accidentally opened labyrinth will automatically result in a dead ear is shown to be not necessarily true. Possible explanations for this phenomenon are discussed.
Symposium: Adjuvant cancer therapy of head and neck tumors. Predefinitive and postdefinitive chemotherapy for locally advanced squamous carcinoma of the head and neck
Authors: Kirkwood John M. , Miller Daniel , Weichselbaum Ralph , Pitman Susan W.
Published: October 2006

Advanced squamous carcinoma of the head and neck remains refractory to the best combinations of surgery and radiotherapy. Weekly methotrexate in high doses with leucovorin “rescue” is able to produce significant remissions in a majority of patients treated palliatively for recurrent disease yet is associated with little or no toxicity. We have attempted to improve the cure of patients with advanced disease by the use of high dose methotrexate (3‐7.5 g/M2) and leucovorin prior to and following definitive surgery and/or radiotherapy. In a series of 24 patients we have achieved a response rate of 52%, with minimal toxicity during chemotherapy, and no apparent potentiation of toxicity with radiotherapy. Survival free of disease appears to be prolonged in patients with response to this chemotherapy. Multimodality approaches to locally advanced squamous carcinoma of the head and neck may soon yield improved cure rates.
The transseptal approach to lesions of the pituitary and parasellar regions
Authors: Kern Eugene B. , Pearson Bruce W. , Mcdonald Thomas J. , Laws Edward R.
Published: October 2006

In a series of 505 consecutive procedures, the transseptal‐transsphenoidal pituitary operation has proved safe and effective. The overall mortality in this series is 1.39%. A wide variety of sphenoid and sellar lesions and nearly every pituitary adenoma have been found suitable for the exposure provided through the sublabial‐transseptal approach. This statement rests on the premise that both the rhinologist's and the neurosurgeon's skills are optimally applied to each case. The role of the otorhinolaryngologist is defined in this paper, and the benefits of the team approach are explored.

An interpretive history of the transsphenoidal approach is presented, and the evolution of the transseptal technique developed at the Mayo Clinic from 1972 to 1978 is reviewed. Emphasizing the rhinologic aspects, all details of the surgical technique are described and illustrated. Our experience with the special endocrine syndromes is also reviewed to spotlight clinical features that require individual consideration by the rhinologic surgeon.
The drooling patient: Evaluation and current surgical options
Authors: Crysdale W. S.
Published: October 2006

Drooling is a common stigmatizing problem necessitating increased care in the neurologically damaged child or adult. Appropriate physiotherapy frequently reduces drooling but rarely eliminates it. The goal of surgical therapy is to minimize drooling while specifically avoiding the complication of xerostomia. During the past 4 years, 37 of 46 patients assessed have undergone surgery specifically intended to reduce drooling. Good results have been obtained with bilateral transtympanic neurectomy procedures; it is the surgical procedure of choice in the more retarded patient. Encouraging results have been obtained in six patients with bilateral submandibular duct relocation; because of increased operative morbidity, it is the procedure of choice in the less retarded child.
Qualitative and morphometric evaluation of vocal cord lesions produced by the carbon dioxide laser
Authors: Stern Lawrence S. , Abramson Allan L. , Grimes Gary W.
Published: October 2006

The canine larynx was studied to obtain qualitative and quantitative data accurately defining the destructive effects of the carbon dioxide laser on epithelial tissue by administering doses of varied energy to the dorsal surface of the vocal cords. Resultant lesions subsequently were analyzed by light, transmission, and scanning microscopy. Three major morphologic patterns of vocal cord lesions were observed: 1. cup shape, 2. doughnut shape and, 3. complex star shape. The patterns produced in the laryngeal tissue reflect the operative mode (energy distribution within the focused spot of energy) of the laser at the time of surgery. The mode resulting in the doughnut shaped pattern (energy distribution around the periphery of the spot) produced deepest lesions, with minimal thermal conduction laterally, whereas the mode resulting in the cup‐shaped pattern (energy distribution uniform throughout the spot) produced at comparable doses shallower lesions with larger diameter. Too few star‐shaped patterns were observed to permit meaningful morphometric analysis.
Treatment of subglottic hemangioma with the carbon dioxide laser
Authors: Healy Gerald B. , Fearon Blair , French Ronald , Mcgill Trevor
Published: October 2006

Congenital subglottic hemangioma is a potentially life‐threatening lesion usually presenting in the first three months of life.

Over the years, multiple treatment modalities have been advocated. However, none has been uniformly successful, and morbidity and mortality remain high.

With the advent of the carbon dioxide surgical laser, it soon became apparent that this was an ideal tool for the pediatric larynx. The already documented properties of the laser have led to the application of this form of tissue destruction in 11 patients with subglottic hemangioma.

This modality has proven to be a safe, effective and rapid means of treating this trouble‐some lesion.
Tympanostomy tubes in the otitis media prone child.
Authors: Gebhart Don E.
Published: October 2006

Otitis media has long been recognized as one of the most common diseases of childhood. A prospective randomized study was designed with patients who had multiple episodes of acute purulent otitis media. Comparison of infection rates was made between patients treated with conventional antibiotic therapy for each episode and patients who had tympaYESstomy tubes placed. Placement of tympanostomy tubes significantly decreased the number of episodes of acute purulent otitis media and was shown to be an effective method of prophylaxis in the “otitis prone” child.

Immunoglobulin levels in the middle ear in this group of patients were found to be similar to those levels in patients with otitis media with effusion. This supports the hypothesis that a dynamic relationship between the different clinical entities of otitis media exists.
Malignant external otitis: Early histopathologic changes and pathogenic mechanism.—MALIGNANT EXTERNAL OTITIS
Authors: Ostfeld Ervin , Segal Michael , Czernobilsky Bernard
Published: October 2006

The histopathologic changes during the early stage of malignant external otitis (MEO) were studied in two patients, one a non‐diabetic. The specimens were obtained by an en bloc excision of the diseased tissue of the external ear canal through a retroauricular approach. The most prominent histologic features of the early stage of MEO consist of a thick layer of almost acellular, partly degenerated, collagen extending from the cartilage into the dermis, which most likely existed prior to the penetration of the microorganism. This finding supports our concept that MEO is a disease which develops as a result of invasion of opportunistic organisms into tissues previously devitalized, probably due to vascular compromise and that these latter features constitute the basic mechanism of the entire disease process.
Sinus infection and adenotonsillitis in pediatric patients.
Authors: Paul Dharam
Published: October 2006

A number of children who suffer from tonsillitis and adenoids hypertrophy also have associated sinus infection. These patients, who are widely treated, have varied responses; hence a correlation has been sought between the two ailments. A study of 100 children between 1‐12 years of age was undertaken to provide a correlation. Therapeutic response to the treatment of sinusitis, vis‐a‐vis adenotonsillitis, was noted. This work has been supplemented by experimental studies on dogs and conclusion has been drawn.
Steep gradients of amino acids between cochlear endolymph and perilymph
Authors: Thalmann R. , Comegys T. H. , Demott J. E. , Thalmann I.
Published: October 2006

Levels of 19 free amino acids in cochlear endolymph and perilymph of scala vestibuli of the guinea pig were determined using reverse phase high performance liquid chromatography (HPLC) of the o‐phthaldialdehyde‐ethanethiol derivatives with fluorescence detection. Aspartate and glutamate were found to be significantly higher in endolymph than in perilymph, confirming results from another study using a different analytical method. The remaining 17 amino acids were significantly lower in the endolymph, in many cases by an order of magnitude. The data are compared with results on utricular endolymph and vestbular perilymph obtained by HPLC in another study from our laboratory. Possible implications and interpretations of the results are discussed.
Clinical electroneurography: Statistical analysis of controlled measurements in twenty‐two normal subjects
Authors: Hughes Gordon B. , Josey Anne Forrest , Glasscock Michael E. , Jackson C. Gary , Ray Wayne A. , Sismanis Aristides
Published: October 2006

Electroneurography, an objective electrophysiologic measurement of a muscle compound action potential, is used to assess the integrity of a peripheral motor nerve. This paper describes how to perform electroneurography with particular attention to control of patient and instrumentation variables. Twenty‐two normal adult subjects were tested in a balanced, designed experiment. The resultant average difference between the right and left halves of the face was not significant. The standard deviation of this difference was divided into three components: test‐retest, daily, and intersubject. The data suggest that the most significant source of error in electroneurography is test‐retest variability (p < 0.05) and that repeated and averaged measures on a given patient will increase the precision of the test. As further understanding and experience are gained, electroneurography measurements should be interpreted in light of clinical findings and more traditional tests.
The eleventh nerve in radical neck surgery
Authors: Brandenburg James H. , Lee Carlton Y. S.
Published: October 2006

The greatest morbidity associated with the radical neck dissection has been the “shoulder syndrome” due to the sacrifice of the spinal accessory nerve. Despite the fact that the XIth nerve can be spared by a careful dissection of the postcervical triangle, to do so remains a controversial issue.

The 125 radical neck dissections performed at the University of Wisconsin Clinical Science Center from 1970 through 1975 were carefully evaluated to determine the incidence of recurrent tumor in the operated‐on neck. In 60 cases the spinal accessory nerve was resected with the neck specimen, and in 65 cases the nerve was preserved. A second study was then undertaken involving 245 neck dissections performed from 1975‐1978 in the Wisconsin Head and Neck Cancer Control Network Hospitals. In 69 instances the spinal accessory nerve was spared.

The total number of neck dissections (370 cases) from both studies were analyzed. The overall rate for recurrent tumor in the neck with the classical neck dissection was 12%. When the spinal accessory nerve was spared, the recurrent rate was 6%.

On the basis of these observations we propose that the classical neck dissection can be modified to preserve the spinal accessory nerve without jeopardizing the chances for a cure in elective neck dissections and selected therapeutic neck dissections.
Identification of the motor laryngeal nerves — a new electrical stimulation technique
Authors: Spahn James G. , Bizal John , Ferguson Steve , Lingeman Raleigh E.
Published: October 2006

Head and neck surgeons are familiar with the technique of identifying motor nerves in the head and neck region by using electrical stimulation especially in the identification of the facial and the spinal accessory nerves. The identification of the motor laryngeal nerves by electrical stimulation intra‐operatively has been described; but, the difficulty of visualization of intrinsic laryngeal muscle movement has prevented the wide spread use of this technique. This paper will introduce a simple, safe and reliable method to allow the surgeon to recognize true vocal cord movement while stimulating the recurrent laryngeal nerve. The movement of a two inch 27 gauge needle placed through the cricothyroid membrane into the ipsilateral true vocal cord permits identification of intrinsic laryngeal muscle movement during electrical stimulation of the recurrent laryngeal nerve. This method has been successfully used in confirming conductivity of the laryngeal nerve during thyroid surgery, Zenker's diverticulum surgery, cricotracheal trauma and recurrent nerve neurectomy for spasmodic dysphonia.
Stylohamular dissection: A new method for en bloc resection of malignancies of the infratemporal fossa
Authors: Friedman William H. , Katsantonis George P. , Cooper Margaret H. , Lee Jong M. , Strelzow Victor V.
Published: October 2006

This study is a description of the “stylohamular” dissection, a technique for the en bloc resection of the infratemporal fossa. The medial plane of this dissection extends from the styloid process to the hamulus of the pterygoid just lateral to the foramen lacerum, allowing the surgeon to spare the internal carotid artery. The foramen ovale and foramen spinosum are routinely exposed during this procedure. Medially, the pterygoid musculature serves as the margin of the cancer block. Posteriorly, the mastoid tip may be included in this resection. Anteriorly, the lateral pterygoid plate is resected making it the anterior vertical plane of the dissection. Laterally, skin and mandible are the block margins. In the last three years, this approach has been utilized in eight patients with advanced malignancies involving the infratemporal fossa. The results are encouraging. Five patients have remained well and free of disease for a maximum of three years postoperatively. Two patients have had recurrence of their tumor from six months to one year postoperatively. Palliation in all patients was excellent. The literature on various infratemporal dissections and their results is reviewed.
Frontal sinus ablation for frontal osteomyelitis
Authors: Mohr Rose M. , Nelson Louis R.
Published: October 2006

Frontal sinusitis with frontal osteomyelitis is a potentially life threatening disease. Diagnostic and therapeutic errors occur frequently because of antibiotic masking of already silent frontal lobe complications or lack of suspicion on the part of the otolaryngologist or the neurosurgeon. Frontal sinus infection and/or trauma frequently require otoneuro cooperation for care. Four cases of complications of frontal sinus infection with osteomyelitis are discussed. Three had epidural empyemas and one had a subdural emypema with an anterior 1/3, superior sagittal sinus thrombosis and multiple brain abscesses.

Each patient was approached through a frontal craniotomy and the frontal sinus posterior plate examined from behind. Each had posterior dehiscences. Follow‐up of osteomyelitis requires multiple tests including computerized tomography, polytomography and possibly bone or gallium scans. Twenty year or more follow‐up is essential.
Laryngeal reinnervation
Authors: Rice Dale H.
Published: October 2006

In the past, numerous experiments have been performed to attempt reinnervation of the paralyzed larynx. None have been consistently successful. Two experiments were performed in this study, one to restore abduction of a paralyzed vocal cord and one to restore adduction. To paralyze the vocal cord, the recurrent laryngeal nerve was sectioned in all dogs in both experiments.

The first experiment was to restore abduction and was performed as follows. An intralaryngeal dissection was performed to separately identify the abductor and adductor branches of the recurrent laryngeal nerve. The adductor branch was sectioned and ligated. Next the phrenic nerve was identified and sectioned. In the dog, the phrenic nerve will not reach the abductor branch of the recurrent laryngeal nerve, so it was sutured to the main trunk of the recurrent laryngeal nerve. Since the adductor branch was severed, regenerating fibers from the phrenic nerve could only grow into the abductor branch and thus to the posterior cricoarytenoid muscle. This experiment produced excellent return of abduction synchronous with inspiration.

The second experiment was to restore adduction and was performed as follows. Intralaryngeal dissection was again done to identify the abductor and adductor branches of the recurrent laryngeal nerve. In addition, the motor branch of the superior laryngeal nerve was identified and transected as it entered the cricothyroid muscle. This branch was then anastomosed to the adductor branch of the recurrent laryngeal nerve. The results of this experiment led to chronic adduction of the vocal cord throughout the respiratory cycle.

Suggestions for future research include anastomosis of the ansa cervicalis to the abductor branch of the recurrent laryngeal nerve and anastomosis of the main trunk of the vagus nerve to either the abductor or adductor branches of the recurrent laryngeal nerve.
Malleus teflon piston prosthesis.
Authors: Shea John J.
Published: October 2006

The malleus Teflon piston prosthesis is very useful to reconstruct the sound conducting mechanism of the middle ear in absent or inadequate incus, congenital malformation of the middle ear, and epitympanic fixation of the incus and/or malleus. It has a thin‐walled loop at its upper end to lessen the tendency for ulceration of the overlying drum with an inside diameter of 1 mm to fit around the mid portion of the handle of the malleus at an angle of 30° to the shaft of the prosthesis. There is a cut in the distal part of the loop through which it is snapped onto the handle of the malleus after it is separated from the drum. Examples of the various situations in which this prosthesis has been used will be shown together with the results regarding hearing gain, complications, and other problems. Those situations in which the prosthesis was used in 1972 will be reviewed to give a 10‐year follow‐up, plus some notable examples of other uses of the prosthesis from other times.
Relationships of labyrinthine fluid pressures and blood flow.
Authors: Carlborg Björn , Farmer Joseph C.
Published: October 2006

Control of labyrinthine blood flow analogous to the autoregulation of cerebral blood flow has been suggested but not experimentally demonstrated.

This study concerns the influence of systemic arterial pressure changes on the perilymph and CSP pressures in cats with the cochlear aqueduct (CA) blocked. No direct correlation was found between changes in arterial and CSF pressure. This seemed to be due to the efficient autoregulation of the global cerebral blood flow — a main factor for CSF pressure regulation. The CSF and central venous pressures induced little and much delayed influence on the perilymph pressure when the CA was blocked. However, there was a direct correlation between changes in systemic arterial pressure and the perilymph pressure. This relationship seemed to be mediated via changes in local labyrinthine blood flow. The study indicated a lack of autoregulation of labyrinthine blood flow and a direct correlation between labyrinthine fluid pressure and blood flow when the CA was obstructed.
Endolymphatic subarachnoid shunt operation for idiopathic endolymphatic hydrops.
Authors: Cody D.Thane R. , Mcdonald Thomas J.
Published: October 2006

In 1974 we reported on 92 patients who had endolymphatic subarachnoid shunt surgery for idiopathic endolymphatic hydrops. That group had a follow‐up of at least 5 years, and only 41% had satisfactory control of vertigo. The purpose of this paper is to describe the results after a larger postoperative follow‐up (12 1/2 years, with a range of 68 to 182 months), and to discuss some additional observations regarding endolymphatic sac operations.

Two patients have died of unrelated causes, one in the 115th postoperative month and the other in the 124th postoperative month. Eight patients have been lost to follow‐up.

Our data show that 35% of the patients have had satisfactory control of their vertigo: 23% have had no vertigo, and 12% have had the vertigo improved by at least 75%. The remaining patients had improvement in vertigo but not to a satisfactory degree, had pronounced improvement in vertigo, but with subsequent recurrence of severe attacks of dizziness, or had no improvement at all. In addition, there has been a steady deterioration in the success rate with increased time of observation.

Nineteen percent of the patients showed significant improvement in hearing after surgery, 47% demonstrated no change in hearing, and 34% had a moderate to profound decline in hearing postoperatively.

Of 17 patients who had socially adequate hearing in the afflicted ear preoperatively, 12 showed deterioration in hearing to the point that air‐conduction thresholds were below the socially adequate level.

Six patients with bilateral endolymphatic hydrops who had almost identical auditory acuity in each ear underwent a unilateral shunt operation. In each of these patients, the unoperated‐on ear had better results from the hearing standpoint.

The data show, therefore, that control of vertigo with the endolymphatic subarachnoid shunt operation was not only disappointing initially, but as the patients were followed over a longer time, the percentage of patients with satisfactory vertigo control declined. Additionally, one‐third of the patients experienced further moderate to profound sensorineural deafness, either as a result of surgery or because the operation failed to control the disease process. Last, it is obvious that the endolymphatic subarachnoid shunt operation did not preserve hearing, even when the operation was performed early in the course of the disease.
Adenoma of the middle ear.
Authors: Jahrsdoerfer Robert A. , Fechner Robert E. , Moon Cary N. , Selman John W. , Powell Ii James B.
Published: October 2006

Benign adenoma of the middle ear emerged as a distinct entity following a review of 20 cases as reported from the Armed Forces Institute of Pathology in 1976. We report 4 additional cases and note that the pathologic diagnosis is not so clear cut. Benign primary adenoma may be confused with adenocarcinoma, ceruminoma, and glomus tumor. The otologic surgeon must take a hard look at the clinical signs and symptoms to determine if they are compatible with the diagnosis of primary middle ear adenoma. While middle ear adenoma has recently been implicated as a cause of facial paralysis (including a case herein), bone destruction should never be found in concert with this neoplasm.
Early recognition and treatment of postintubation dysphonia
Authors: Feder Robert J.
Published: October 2006

The most common complication of prolonged endotracheal intubation is vocal change. This dysphonia is a result of the laryngeal pathology produced by the recurrent frictional irritation of the endotracheal tube with each respiratory exchange.

The purpose of this paper is to present three representative cases, stress early recognition, and outline a course of vigorous early treatment which has proved to be successful in alleviating and reducing the prolonged symptoms of this iatrogenic dysphonia.
An evaluation of bera for hearing screening in high‐risk neonates
Authors: Alberti Peter W. , Hyde Martyn L. , Riko Krista , Corbin Hollis , Abramovich Solomon
Published: October 2006

Brain stem electric response audiometry (BERA) is evaluated for early detection of hearing loss in high‐risk newborns selected from a general hospital population. They receive screening BERA in the nursery and detailed frequency‐specific BERA in the Audiology clinic, just before discharge. Three months later, testing is repeated and recommendations are made.

From 1364 assessments, 321 at‐risk babies were identified; 234 received predischarge tests, and 200 had follow‐up tests. Screening BERA with 40 dB nHL clicks is appropriate in the nursery. Screening sensitivity is good, and only 8% of babies failed. Several of these had mild hearing loss, resolving in the first trimester. Follow‐up BERA confirmed hearing loss in 8 babies.

Parental compliance is high, and the program is well‐accepted. In conjunction with the high‐risk register, BERA is useful both for screening and for quantitative audiometry in the infant.
Reconstruction of the mandible
Authors: Maisel Robert H. , Hilger Peter A. , Adams George L. , Giordano Anthony M.
Published: October 2006

Forty‐five patients were evaluated for reconstruction of the mandible. Thirty‐four patients had a particulate cancellous bone and marrow (PCM) crib graft placed. Thirty of 34 were successful at the primary operation producing a success rate of 88%. By using secondary procedures all 33 patients repaired to date have been rehabilitated. A dynamic bendable defect bridging plate with cancellous cortical graft (DBDB plate with CCG) was used in 7 patients, 4 of whom had tumor surgery and 3 of whom were operated on after trauma to the anterior mandible. All 7 cases were successfully rehabilitated in achieving a stable, functioning mandibular arch.

An osteomyocutaneous flap was planned to reconstruct the anterior mandible in 4 cases; 1 in this group was not reconstructed. The PCM graft has been our first line approach to the mandibular non‐union but with experience we are beginning to rely on the DBDB plate with CCG for large bony defects after both trauma and secondarily after tumor surgery. When indicated, the osteomyocutaneous flap has been eminently successful in restoring function and form in the tumor patient.
Solving ossicular problems in tympanoplasty
Authors: Schuring Arnold G. , Lippy William H.
Published: October 2006

Four troublesome problems encountered in ossicular reconstruction are: low profile stapes, lateral tympanic membrane, remaining stapes crura, and absent stapes capitulum. The design advantages and modifications of the semibiological ossicle cup and ossicle columella prostheses ore given to solve these problems. The hearing results are completely satisfactory.
Congenital bilateral recurrent nerve paralysis and ptosis: A new syndrome?
Authors: Tucker Harvey M.
Published: October 2006

Bilateral vocal cord paralysis is a rare, but not unheard of, occurrence in the perinatal period. It is often incompatible with life unless the problem is recognized promptly, the child intubated, and — following this — a tracheotomy performed. Bilateral congenital ptosis is a very rare occurrence and is almost always associated with either significant central nervous system deficit or with other oculomotor problems. The combination of congenital bilateral recurrent nerve paralysis and congenital ptosis has not been previously reported in the English language literature. The author has had the opportunity to manage two patients, a father and his daughter, both of whom manifested this unusual combination of symptoms. Detailed case histories are presented. Both of the patients were successfully managed by temporary tracheotomy followed by reinnervation of the larynx, with eventual extubation and satisfactory day‐to‐day airway. Although only two cases represent an inadequate number to determine a new syndrome, these striking findings in a father and his only offspring suggest the possibility that this may, indeed, represent a new symptom complex of congenital origin.
Acquired immune deficiency syndrome presenting as oral pharyngeal and cutaneous kaposi's sarcoma
Authors: Napier Bradford L. , Mctighe Arthur H. , Snow Jon F. , Czako Robert G. , Leavitt Richard D. , Blanchard Cyrus L.
Published: October 2006

A 25‐year‐old black male homosexual with AIDS presented with Kaposi's sarcoma of the tongue, palate and skin.

The definition, epidemiology, diagnosis, treatment and prognosis of AIDS are discussed. The role of the otolaryngologist‐head and neck surgeon in diagnosing this disease is outlined.
Incidence of hypothyroidism following multimodality treatment for advanced squamous cell cancer of the head and neck
Authors: Posner Marshall R. , Ervin Thomas J. , Fabian Richard L. , Weichselbaum Ralph R. , Miller Daniel , Norris Charles M. , Rose Christopher
Published: October 2006

The incidence of chemical hypothyroidism, as manifested by elevated thyroid stimulating hormone (TSH) levels, has been estimated to be as high as 25% after radiation therapy and 45% after radiation therapy and surgery to the neck for treatment of nodal metastases from squamous carcinoma of the head and neck. We prospectively evaluated 43 previously untreated patients seen in the Dana Farber Cancer Institute Interdisciplinary Head and Neck Service who were treated with aggressive combination chemotherapy in addition to standard surgery and/or radiotherapy. All patients were serially monitored for serum TSH, serum T4, and clincial evidence of hypothyroidism. Following cis‐platinum, bleomycin, and methotrexate chemotherapy and subsequent surgery and/or radiotherapy, decreased thyroid reserve appeared in 37% of patients at a median follow‐up of 9 months. Thirty percent of patients receiving radiotherapy alone and 43% of patients receiving surgery and radiotherapy developed elevated TSH levels. Only one patient developed clinical symptoms. Other patients were asymptomatic despite persistently elevated TSH levels. Abnormalities appeared within the first 4 months after completion of all therapy and were slowly progressive. The addition of combination chemotherapy does not appear to increase the incidence or severity of thyroid dysfunction following radiation therapy and surgery to the neck. In view of the extended survival seen in patients treated with interdisciplinary regimens, we recommend that all patients receiving irradiation to the neck – particularly those patients having neck dissections or total laryngectomies – have routine thyroid function studies performed following the cessation of treatment.
Excisional biopsy in the selective management of T1glottic cancer: A three‐year follow‐up study
Authors: Blakeslee Don , Vaughan Charles W. , Simpson George T. , Shapshay Stanley M. , Strong M. Stuart
Published: October 2006

Transoral excisional biopsy has been used in the evaluation and management of 103 Tl glottic cancers. A 3‐year follow‐up on these patients indicates that excisional biopsy unequivocally established the diagnosis and stage of the disease and that it is adequate treatment for micro and mini squamous cell cancers of the glottis in which the margins of excision are clear.

Excisional biopsy with positive margins and larger Tl tumors establishes the absolute need for radiotherapy. Excisional biopsy is ideal for the diagnosis and management of verrucous carcinoma and spindle cell carcinoma. Recurrent/residual squamous cell carcinoma after radiotherapy should be explored by excisional biopsy which may be curative or will establish the need for partial or total laryngectomy.

The appropriate use of excisional biopsy in the selective management of early T1 glottic cancers requires attention to detail by the surgeon and the pathologist and sound clinical judgment.
Tonsillectomy — Some like it hot
Authors: Mann Douglas G. , St. George C. , Scheiner E. , Granoff D. , Imber P. , Mlynarczyk F. A.
Published: October 2006

Methods of tonsillectomy using electrocautery for dissection and hemostasis are gaining popularity. A prospective, controlled, randomized, single blind study was designed to compare this method to tonsillectomy performed by scissor dissection with suture hemostasis.

In general, tonsillectomy by electrocoagulation was found to reduce operative time and blood loss, and to increase postoperative pain and prolong healing. Overall morbidity in the study was low, and no significant differences in complications, e.g., bleeding, were noted.