bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pterional-Transsylvian Approach: an Analytical Study
Authors: Gadelha Figueiredo Eberval , Deshmukh Pushpa , Zabramski Joseph M. , Preul Mark C. , Crawford Neil R. , Spetzler Robert F.
Published: October 2006

OBJECTIVE:

Splitting of the sylvian fissure (SF) improves exposure with the pterional (PT) approach. Traditionally, the choice of whether or not to split the SF and how far to open it has depended on the neurosurgeon's experience and preference rather than on quantifiable data. We undertook this study to evaluate the effects of progressive splitting of the SF on surgical exposure with the PT approach.

METHODS:

A PT craniotomy was performed on nine sides of cadaver heads. Splitting the SF was divided into four steps: 1) dissection of the basal cisterns, 2) dissection of the sphenoidal compartment, 3) dissection of the operculoinsular compartment to the anterior ascendant ramus, and 4) dissection progressing 2.0 cm distal to the anterior ascendant ramus. The degree of the retraction and the relative position of the brain retractors were kept constant. After each step, we used a computerized tracking system to measure the area of surgical exposure of the circle of Willis, the angles of approach to the carotid bifurcation, and the distance between the frontal lobe and skull base. @@RESULTS:@@ Exposure of the circle of Willis, angles of approach to the carotid bifurcation, and linear distance between the frontal lobe and skull base all increased significantly as splitting of the SF progressed from Steps 1 to 2 and from Steps 2 to 3. There was no significant difference between Steps 3 and 4.

CONCLUSION:

Exposure of the basal cisterns and circle of Willis by the PT approach is optimized when dissection of the SF reaches the anterior ascendant ramus. Further splitting of the SF provides no additional gain.
The Endoscopic Endonasal Approach to the Lateral Recess of the Sphenoid Sinus Via the Pterygopalatine Fossa: Comparison Of Endoscopic and Radiological Landmarks
Authors: Magro Francesco , Solari Domenico , Cavallo Luigi M. , Samii Amir , Cappabianca Paolo , Paterno Vincenzo , Lüdemann Wolf O. , Divitiis Enrico de , Samii Madjid
Published: October 2006

OBJECTIVE:

The endoscopic endonasal approach offers the opportunity to reach the ptery-gopalatine fossa, the lateral recess of the sphenoid sinus, and other areas of the cranial base through a minimally invasive approach. This study compares the anatomy of these areas when observed through an endoscopic endonasal view with the anatomy of the same regions as they appear in computed tomographic scans. The aim was to identify and correlate the corresponding anatomic structures, providing the surgeons with anatomic landmarks to guide them when operating in these areas through an endoscopic endonasal approach.

METHODS:

An anatomic dissection of six fixed cadaver heads was performed by an endoscopic endonasal approach. A step-by-step comparison of endoscopic and radiological images was made to identify the landmarks of the surgical field.

RESULTS:

The step-by-step comparison of endoscopic and radiological images acquired during the endoscopic endonasal approach to the lateral recess of the sphenoid sinus via the pterygopalatine fossa allowed the identification of all the relevant anatomic landmarks of the procedure.

CONCLUSION:

The endoscopic endonasal approach via the pterygopalatine fossa offers direct, minimally invasive access to the lateral recess of the sphenoid sinus, which can be monitored in each phase through consistent radiological imagery.
Surgical Endovascular Neuroradiology in the 21st Century: What Lies Ahead?
Authors: Prestigiacomo Charles J.
Published: October 2006

FEW COULD HAVE imagined the tremendous growth of endovascular surgery over the past 40 years. Endovascular therapy has greatly enhanced the care of the patient in neurosurgery, spine surgery, and head and neck surgery. Progress in technology and techniques continue to push forward the boundaries of what is deemed “treatable,” assuming acceptable risk. This article will briefly review the current state of endovascular surgery and speculate about what its role will be in the near and far future. Endovascular therapy provides a minimally invasive approach to the central nervous system and other systems via natural and, at times, highly selective pathways. Maximizing the accessibility of these routes to highly specific regions of the central nervous system provides an elegant and minimalist approach to treating diseases of the central nervous system with almost no “footprints” of ever having accessed the region. In the future, safe, efficient and intelligent delivery systems that may enhance or alter the tissue's response may result in successful treatment of cerebrovascular diseases, as well as other diseases of the craniospinal axis. The growth of nanotechnology, metallurgy, synthetic polymers, imaging, and training will all combine to help grow the technology and the science that is surgical endovascular neuroradiology.
Training Residents in Endovascular Neurosurgery
Authors: Harbaugh Robert E. , Agarwal Akash
Published: October 2006

NEUROSURGEONS HAVE A long history of treating cerebrovascular disease. Understanding the vascular anatomy and physiology of the nervous system and management of patients with abnormalities of theses vascular structures are vitally important aspects of neurosurgery resident training. Over the past decade, the treatment of cerebrovascular disease has been evolving toward endovascular strategies for many patients. Interventional neuroradiologists were the pioneers in developing this area of therapy, but the number of neurosurgical trainees in neuroendovascular treatment is increasing, and other specialties, including neurology, vascular surgery, and cardiology, are now entering the field of neuroendovascular treatment. The purpose of this article is to review the current credentialing guidelines for neurosurgeons to use endovascular techniques in the treatment of cerebrovascular disease and to consider options for resident training in the rapidly evolving field of endovascular neurosurgery.
The Role of Neuroendovascular Therapy for the Treatment of Brain Arteriovenous Malformations
Authors: Fiorella David , Albuquerque Felipe C. , Woo Henry H. , McDougall Cameron G. , Rasmussen Peter A.
Published: October 2006

NEUROENDOVASCULAR EMBOLIZATION REPRESENTS a critical component of the multidisciplinary management of cerebral arteriovenous malformations. Safe and effective embolization may be performed only in the context of a well-designed, rational treatment plan that is fundamentally based on a clear understanding of the natural history of the lesion, as well as the cumulative risks of multimodality treatment. This article outlines the role of neuroendovascular embolization in arteriovenous malformation therapy with a specific emphasis on decision making in the context of formulating a treatment plan. The authors also provide a summary of the available embolic agents and their technical application, potential intraprocedural and periprocedural complications, and postprocedural management.
Challenges in the Endovascular Treatment of Giant Intracranial Aneurysms
Authors: Gonzalez Nestor R. , Duckwiler Gary , Jahan Reza , Murayama Yuichi , Viñuela Fernando
Published: October 2006

OBJECTIVE:

Giant intracranial aneurysms present unique therapeutic intricacies. The purpose of this study was to evaluate the anatomic and hemodynamic characteristics of these lesions and the current endovascular and combined surgical and endovascular techniques available for their treatment.

METHODS:

A review of the literature and the personal experiences of the authors with endovascular treatment of giant aneurysms are presented. This review included anatomic and hemodynamic features and analysis of the diverse endovascular techniques that have been reported for the management of these aneurysms.

RESULTS:

Anatomic features that create particular challenges in the therapeutic approach of giant aneurysms include size, shape (saccular, fusiform, serpentine), neck dimensions, branch involvement, intraluminal thrombosis, and location. Hemodynamic characteristics that affect endovascular treatment are lateral or terminal aneurysm type of flow and embolic material placement (inflow versus outflow aneurysmal region). The current endovascular therapeutic approaches include parent artery occlusion, trapping, endosaccular embolization with or without adjunctive techniques such as balloon-assisted or stent placement, and combined surgical and endovascular approaches, mainly with surgical revascularization and endovascular occlusion.

CONCLUSION:

Although there are a wide variety of endovascular therapeutic options for the treatment of giant intracranial aneurysms, none of the current techniques is completely successful and free of complications in the management of these complex lesions. A detailed and individualized analysis of each case in conjunction with sufficient understanding of the anatomy and hemodynamics of a particular aneurysm should guide the therapeutic decision. Further research advances will assist in elucidating the factors predisposing to genesis, progression, and aggressive clinical manifestations of these giant lesions.
TfR2 localizes in lipid raft domains and is released in exosomes to activate signal transduction along the MAPK pathway
Authors: Calzolari Alessia , Raggi Carla , Deaglio Silvia , Sposi Nadia Maria , Stafsnes Marit , Fecchi Katia , Parolini Isabella , Malavasi Fabio , Peschle Cesare , Sargiacomo Massimo , Testa Ugo
Published: October 2006

Transferrin receptor 2 (TfR2) possesses a YQRV motif similar to the YTRF motif of transferrin receptor 1 (TfR1) responsible for the internalization and secretion through the endosomal pathway. Raft biochemical dissection showed that TfR2 is a component of the low-density Triton-insoluble (LDTI) plasma membrane domain, able to co-immunoprecipitate with caveolin-1 and CD81, two structural raft proteins. In addition, subcellular fractionation experiments showed that TfR1, which spontaneously undergoes endocytosis and recycling, largely distributed to intracellular organelles, whereas TfR2 was mainly associated with the plasma membrane. Given the TfR2 localization in lipid rafts, we tested its capability to activate cell signalling. Interaction with an anti-TfR2 antibody or with human or bovine holotransferrin showed that it activated ERK1/ERK2 and p38 MAP kinases. Integrity of lipid rafts was required for MAPK activation. Co-localization of TfR2 with CD81, a raft tetraspanin exported through exosomes, prompted us to investigate exosomes released by HepG2 and K562 cells into culture medium. TfR2, CD81 and to a lesser extent caveolin-1, were found to be part of the exosomal budding vesicles. In conclusion, the present study indicates that TfR2 localizes in LDTI microdomains, where it promotes cell signalling, and is exported out of the cells through the exosome pathway, where it acts as an intercellular messenger.
HIV-1 Nef upregulates CCL2/MCP-1 expression in astrocytes in a myristoylation- and calmodulin-dependent manner
Authors: Lehmann Michael H. , Masanetz Sabine , Kramer Susanne , Erfle Volker
Published: October 2006

HIV-associated dementia (HAD) correlates with infiltration of monocytes into the brain. The accessory HIV-1 negative factor (Nef) protein, which modulates several signaling pathways, is constitutively present in persistently infected astroctyes. We demonstrated that monocytes responded with chemotaxis when subjected to cell culture supernatants of nef-expressing astrocytic U251MG cells. Using a protein array, we identified CC chemokine ligand 2/monocyte chemotactic protein-1 (CCL2/MCP-1) as a potential chemotactic factor mediating this phenomenon. CCL2/MCP-1 upregulation by Nef was further confirmed by ribonuclease protection assay, RT-PCR and ELISA. By applying neutralizing antibodies against CCL2/MCP-1 and using CCR2-deficient monocytes, we confirmed CCL2/MCP-1 as the exclusive factor secreted by nef-expressing astrocytes capable of attracting monocytes. Additionally, we showed that Nef-induced CCL2/MCP-1 expression depends on the myristoylation moiety of Nef and requires functional calmodulin. In summary, we suggest that Nef-induced CCL2/MCP-1 expression in astrocytes contributes to infiltration of monocytes into the brain, and thereby to progression of HAD.
Thea3 isoform of V-ATPase regulates insulin secretion from pancreatic β-cells
Authors: Sun-Wada Ge-Hong , Toyomura Takao , Murata Yoshiko , Yamamoto Akitsugu , Futai Masamitsu , Wada Yoh
Published: October 2006

Vacuolar-type H+-ATPase (V-ATPase) is a multi-subunit enzyme that has important roles in the acidification of a variety of intracellular compartments and some extracellular milieus. Four isoforms for the membrane-intrinsic subunit (subunit a) of the V-ATPase have been identified in mammals, and they confer distinct cellular localizations and activities on the proton pump. We found that V-ATPase with the a3 isoform is highly expressed in pancreatic islets, and is localized to membranes of insulin-containing secretory granules in β-cells. oc/oc mice, which have a null mutation at the a3 locus, exhibited a reduced level of insulin in the blood, even with high glucose administration. However, islet lysates contained mature insulin, and the ratio of the amount of insulin to proinsulin in oc/oc islets was similar to that of wild-type islets, indicating that processing of insulin was normal even in the absence of the a3 function. The insulin contents of oc/oc islets were reduced slightly, but this was not significant enough to explain the reduced levels of the blood insulin. The secretion of insulin from isolated islets in response to glucose or depolarizing stimulation was impaired. These results suggest that the a3 isoform of V-ATPase has a regulatory function in the exocytosis of insulin secretion.
Fission yeast Tor2 promotes cell growth and represses cell differentiation
Authors: Álvarez Beatriz , Moreno Sergio
Published: October 2006

The fission yeast Schizosaccharomyces pombe is an excellent model system in which to study the coordination of cell growth and cell differentiation. In the presence of nutrients, fission yeast cells grow and divide; in the absence of nutrients, they stop growing and undergo cell differentiation. The molecular mechanisms underlying this response are not fully understood. Here, we demonstrate that Tor2, a fission yeast member of the TOR protein kinase family, is central to controlling the switch between cell growth and cell differentiation in response to nutrient availability. Tor2 controls cell growth and ribosome biogenesis by regulating ribosomal protein gene expression. We have found that Tor2 has an additional function in repressing sexual differentiation. Tor2 overexpression strongly represses mating, meiosis and sporulation efficiency, whereas Tor2 inactivation has the opposite effect, leading to cell differentiation, regardless of the nutritional conditions. This newly revealed function of Tor2 appears to operate by interfering with the functions of the transcription factor Ste11 and the meiosis-promoting RNA-binding protein Mei2. Thus, our data reveal a unique regulatory function of the Tor pathway – ensuring that growth and cell differentiation become mutually exclusive and that the choice between them depends on environmental conditions.
Starvation drives a threshold triggering communication
Authors: Mailleux Anne-Catherine , Detrain Claire , Deneubourg Jean-Louis
Published: October 2006

The decision for an ant forager to launch recruitment is governed by an internal response threshold. Here, we demonstrate that this threshold (the desired volume) triggering trail-laying increases under starvation. As a consequence, highly starved foragers lay a recruitment trail and bring back to the nest higher quantities of food from large unlimited resources. In contrast, when the volume of the food source is under their crop capacity, the percentage of trail-communicating foragers is lower following a prolonged period of starvation. Such starvation-dependent changes in the `desired volume' threshold explain how ants optimize recruitment and select liquid food resources in order to prevent collective exploitation of low profitability.
Anatomical and functional recovery of the goldfish (Carassius auratus) ear following noise exposure
Authors: Smith Michael E. , Coffin Allison B. , Miller Diane L. , Popper Arthur N.
Published: October 2006

Fishes can regenerate lateral line and inner ear sensory hair cells that have been lost following exposure to ototoxic antibiotics. However,regenerative capabilities following noise exposure have not been explored in fish. Moreover, nothing is known about the functional relationship between hair cell damage and hearing loss, or the time course of morphological versus functional recovery in fishes. This study examines the relationship between hair cell damage and physiological changes in auditory responses following noise exposure in the goldfish (Carassius auratus). Goldfish were exposed to white noise (170 dB re. 1 μPa RMS)for 48 h and monitored for 8 days after exposure. Auditory thresholds were determined using the auditory evoked potential technique, and morphological hair cell damage was analyzed using phalloidin and DAPI labeling to visualize hair cell bundles and nuclei. A TUNEL assay was used to identify apoptotic cells. Following noise exposure, goldfish exhibited a significant temporary threshold shift (TTS; ranging from 13 to 20 dB) at all frequencies tested(from 0.2-2 kHz). By 7 days post-exposure, goldfish hearing recovered significantly (mean TTS<4 dB). Increased apoptotic activity was observed in the saccules and lagenae between 0 and 2 days post-exposure. Immediately after noise exposure, the central and caudal regions of saccules exhibited significant loss of hair bundles. Hair bundle density in the central saccule recovered by the end of the experiment (8 days post-exposure) while bundle density in the caudal saccule did not return to control levels in this time frame. These data demonstrate that goldfish inner ear epithelia show damage following noise exposure and that they are capable of significant regenerative responses similar to those seen following ototoxic drug treatment. Interestingly, functional recovery preceded morphological recovery in the goldfish saccule, suggesting that only a subset of hair cells are necessary for normal auditory responses, at least to the extent that hearing was measured in this study.
Ex vivo rheology of spider silk
Authors: Kojic N. , Bico J. , Clasen C. , McKinley G. H.
Published: October 2006

We investigate the rheological properties of microliter quantities of the spinning material extracted ex vivo from the major ampullate gland of a Nephila clavipes spider using two new micro-rheometric devices. A sliding plate micro-rheometer is employed to measure the steady-state shear viscosity of ∼1 μl samples of silk dope from individual biological specimens. The steady shear viscosity of the spinning solution is found to be highly shear-thinning, with a power-law index consistent with values expected for liquid crystalline solutions. Calculations show that the viscosity of the fluid decreases 10-fold as it flows through the narrow spinning canals of the spider. By contrast, measurements in a microcapillary extensional rheometer show that the transient extensional viscosity (i.e. the viscoelastic resistance to stretching) of the spinning fluid increases more than 100-fold during the spinning process. Quantifying the properties of native spinning solutions provides new guidance for adjusting the spinning processes of synthetic or genetically engineered silks to match those of the spider.
PKCγ knockout mouse lenses are more susceptible to oxidative stress damage
Authors: Lin Dingbo , Barnett Micheal , Lobell Samuel , Madgwick Daniel , Shanks Denton , Willard Lloyd , Zampighi Guido A. , Takemoto Dolores J.
Published: October 2006

Cataracts, or lens opacities, are the leading cause of blindness worldwide. Cataracts increase with age and environmental insults, e.g. oxidative stress. Lens homeostasis depends on functional gap junctions. Knockout or missense mutations of lens gap junction proteins, Cx46 or Cx50, result in cataractogenesis in mice. We have previously demonstrated that protein kinase Cγ (PKCγ) regulates gap junctions in the lens epithelium and cortex. In the current study, we further determined whether PKCγ control of gap junctions protects the lens from cataractogenesis induced by oxidative stress in vitro, using PKCγ knockout and control mice as our models. The results demonstrate that PKCγ knockout lenses are normal at 2 days post-natal when compared to control. However, cell damage, but not obvious cataract, was observed in the lenses of 6-week-old PKCγ knockout mice,suggesting that the deletion of PKCγ causes lenses to be more susceptible to damage. Furthermore, in vitro incubation or lens oxidative stress treatment by H2O2 significantly induced lens opacification (cataract) in the PKCγ knockout mice when compared to controls. Biochemical and structural results also demonstrated that H2O2 activation of endogenous PKCγ resulted in phosphorylation of Cx50 and subsequent inhibition of gap junctions in the lenses of control mice, but not in the knockout. Deletion of PKCγaltered the arrangement of gap junctions on the cortical fiber cell surface,and completely abolished the inhibitory effect of H2O2on lens gap junctions. Data suggest that activation of PKCγ is an important mechanism regulating the closure of the communicating pathway mediated by gap junction channels in lens fiber cells. The absence of this regulatory mechanism in the PKCγ knockout mice may cause those lenses to have increased susceptibility to oxidative damage.
Hot bumble bees at good food: thoracic temperature of feedingBombus wilmattaeforagers is tuned to sugar concentration
Authors: Nieh James C. , León Adolfo , Cameron Sydney , Vandame Rémy
Published: October 2006

The ability of bees to generate metabolic heat plays an important role in their ability to forage and pollinate because they must achieve a minimum temperature to activate their flight muscles. In honey bees and stingless bees, the thoracic temperature of feeding foragers is correlated with the caloric value of sucrose solution provided at feeders outside the nest. We provide the first detailed data showing that this phenomenon also occurs in the closely related bumble bee and thus may be homologous in all social bees of the Apidae. Using infrared thermography, we measured Tth for Bombus wilmattae foragers (mass 0.17±0.11 g, length 15.0±1.5 mm) from six wild colonies,foraging on a range of sucrose concentrations (0.5-2.5 mol l-1,16-65% by mass) in foraging arenas. For all colonies, we measured significant increases in ΔTth (P<0.0001) with increasing sucrose concentration, with significant differences(P<0.0001) between colonies due to different linear regression slopes (0.28-2.4) and y-intercepts (2.7-5.5). We suggest that this modulation of pitching Tth to sucrose concentration is a general phenomenon in all social bees and may be a widespread adaptation facilitating rapid food collection in flying Hymenoptera.
Performance and laser Doppler anemometry experimental investigation of squirrel cage fans with half-cone rotors
Authors: Niya S. M Rezaei. , Montazerin N , Damangir A , Dehkordi A. H.
Published: October 2006

Squirrel cage fans with non-cylindrical rotors, shaped as frustums of right circular cones, are compared with a similar fan but with a cylindrical rotor. Performance measurements for cone angles ranging from -10° to +10° showed that for positive angles, which means that a larger diameter at the rotor inlet decreases towards the back plate, it was possible to have higher fan efficiencies for a similar head. Alternatively, at negative cone angles, the head coefficient could be superior for a similar efficiency. The optimum angles were different for each case. These statements are true for the working part of the performance curves, which is located to the right of the maximum head coefficient. The velocity profiles at selected circumferential positions at the rotor exit showed that the flow did not spread evenly round the rotor when fan geometry was changed or the fan was throttled. If air flowed out of the rotor at a position closer to the fan exit, this flow then travelled a shorter distance inside the volute. A smaller loss and, therefore, a higher efficiency ensued. This pattern was true for both cylindrical and conical rotors and, therefore, the better efficiency for the positive half-cone rotor was a result of the way the rotor and volute combination guided the flow. The negative cone rotor had a higher head as the rotor diameter was larger where the flow passed through the blades.
The role of law and policy in tele-monitoring
Authors: Akalu Rajen , Rossos Peter G , Chan Christopher T
Published: October 2006

This commentary examines the impact and limitations of existing legal policy as it relates to tele-monitoring, and considers the extent to which it serves to promote or impede remote monitoring technologies in the context of chronic illness.
Digital imaging to assist preoperative planning for ipsilateral rotational autokeratoplasty
Authors: Bower Kraig S , Mines Michael J , Stutzman Richard D
Published: October 2006

A 14-month-old child with a central corneal scar underwent rotational autografting of his cornea to clear his visual axis. This was accomplished through eccentric trephination and 180 degree rotation of the central cornea. A preoperative image of the patient's cornea was manipulated digitally using a common commercial image-processing software package. This allowed accurate prediction of the best trephine size and location prior to surgery. Digital imaging played an important role in preoperative surgical planning and demonstrates the potential for tele-ophthalmology.
A pilot study of nurse-led, home monitoring for patients with chronic respiratory failure and with mechanical ventilation assistance
Authors: Vitacca M , Assoni G , Pizzocaro P , Guerra A , Marchina L , Scalvini S , Glisenti F , Spanevello A , Bianchi L , Barbano L , Giordano A , Balbi B
Published: October 2006

We assessed the feasibility of telemedicine for home monitoring of 45 patients with chronic respiratory failure (CRF) discharged from hospital. The patients transmitted pulsed arterial saturation (pSat) data via a telephone modem to a receiving station where a nurse was available for a teleconsultation. A respiratory physician was also available. Scheduled and ad hoc appointments were conducted. Thirty-five patients were on home mechanical ventilation, 13 with invasive and 22 with non-invasive devices. The main diagnosis was chronic obstructive pulmonary disease (COPD). The follow-up period was 176 days (SD 69). In all, 376 calls for scheduled consultations were received and 83 ad hoc consultations were requested by the patients. The actions taken were: 55 therapy modifications, 19 hospitalizations in a respiratory department for decompensated CRF, three hospitalizations in an intensive care unit (ICU), 22 requests for further investigations, 25 contacts with the general practitioner (GP), 66 demands for respiratory consultations and 10 calls for the emergency department. The mean time recorded for the 459 calls was 16 min/patient/week. In 82% of calls, a pSat recording was received successfully. The nurse time required to train the users in the operation of the pSat instrument was high (mean time 30 min). However, the results showed that home monitoring was feasible, and useful for titration of oxygen, mechanical ventilation setting and stabilization of relapses.
Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial
Authors: Hui Elsie , Lee Patricia S C , Woo Jean
Published: October 2006

We compared telemedicine with a conventional outpatient continence service (CS) in community-dwelling older women with urge or stress incontinence. After an initial biofeedback-assisted pelvic floor muscle training session, subjects were randomized to behavioural training for eight weeks via the CS ( n = 27) or a telemedicine continence programme (TCP) ( n = 31). Participants in both treatment groups experienced significant improvement in their symptoms, namely, a reduction in the number of daily incontinence episodes ( P<0.001) and voiding frequency ( P<0.001), while the volume of urine at each micturition increased ( P<0.005). Pelvic floor muscle strength as measured by the Oxford Score also improved ( P<0.005). There were no significant differences in outcomes between the two groups. Thus our findings suggest that videoconferencing is as effective as conventional methods in the management of urinary incontinence.
Estimation of dietary nutritional content using an online system with ability to assess the dieticians' accuracy
Authors: Aoki Takeshi , Nakai Shigeru , Yamauchi Kazunobu
Published: October 2006

We developed an online system for estimating dietary nutritional content. It also had the function of assessing the accuracy of the participating dieticians and ranking their performance. People who wished to have their meal estimated (i.e. clients) submitted images of their meal taken by digital camera to the server via the Internet, and dieticians estimated the nutritional content (i.e. calorie and protein content). The system assessed the accuracy of the dieticians and if it was satisfactory, the results were sent to the client. Clients received details of the calorie and protein content of their meals within 24 h by email. A total of 93 dieticians (71 students and 22 licensed practitioners) used the system. A two-way analysis of variance showed that there was a significant variation ( P=0.004) among dieticians in their ability to estimate both calorie and protein content. There was a significant difference in values of both calorie ( P=0.02) and protein ( P<0.001) estimation accuracy between student dieticians and licensed dieticians. The estimation accuracy of the licensed nutritionists was 85% (SD 10) for calorie content and 78% (SD 17) for protein content.
The inverted schneiderian papilloma: A clinical and pathological study.
Authors: Vrabec Donald P.
Published: October 2006

Inverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainty surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill‐defined clinical approach to their management.

The designation Inverted Schneiderian Papilloma is suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character.

The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm.

The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach.

A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision to split the upper lip and reflect the cheek flap as is customarily done with the Weber‐Fergusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma.

An associated malignancy was found in 12.5 percent of the cases.

A uniform system of classification is proposed in which the tumors are placed into one of three categories: 1. those which appear typical; 2. those which contain atypical features; and 3. those which contain an associated malignancy. With the uniform system of classification, reliable data may be compiled and factual correlations established between the clinical and pathologic features of the inverted Schneiderian papilloma.
The investigation of horace green
Authors: Snyder Charles
Published: October 2006

Horace Green is often regarded as the “Father of American Laryngology.” Original in his thinking, innovative in his methods, outspoken in support of his views, Green was often violently criticized by his contemporaries. One medical society attempted to force his resignation as a member. In 1855, the New York Academy of Medicine ordered an investigation of Green and his methods. Honest to the core of his being, Green welcomed the investigation and cooperated in every way possible. Although the investigators' findings were inconclusive, time did bring vindication to Green and to some of his views.
Secondary intention healing as an adjunct to the reconstruction of mid‐facial defects
Authors: Panje William R. , Bumsted Robert M. , Ceilley Roger I.
Published: October 2006

Facial skin cancer has a high incidence during later life. The majority of our patients had been previously treated by a number of different modalities. The recurrence or persistance of their cutaneous neoplasm was often quite extensive and thus required a rather large excision to eradicate the disease. Employment of a number of small operations under local anesthesia in which the patients could return to their home environment provided for a potential reduction in psychological and physical morbidity. The use of delayed healing often allowed reconstruction with a local flap or skin graft that if reconstructed primarily would have necessitated a more extensive operative procedure. Use of local flaps and/or skin grafts avoided excessive blood loss and long periods of immobilization associated with larger regional and distant flaps. Finally the denial of reconstructive surgery because of age should be condemned since fairly small operations in conjunction with delayed wound healing can provide acceptable cosmetic and functional results.
Stapedectomy in children
Authors: House John W. , Sheehy James L. , Antunez Juan Carlos
Published: October 2006

The records of 34 children and teenagers with a conductive hearing impairment and an intact and mobile tympanic membrane have been reviewed; 20 patients had a congenital hearing impairment. Stapedectomy was performed on 13 patients with satisfactory results in 12. In 3 cases the operation was terminated because of oval window or facial nerve abnormalities. In 4 cases there was no evidence of an ossicular problem, a so‐called inner ear conductive hearing loss.

Fourteen patients had otosclerosis, the youngest being 9 years old. Twenty‐four stape‐dectomies were performed on this group with satisfactory results in 22.

We conclude that the results of stapedectomy in children appear to be as satisfactory as results in adults.
Schwannomas of the head and neck in children
Authors: Hawkins Donald B. , Luxford William M.
Published: October 2006

Schwannomas are relatively rare tumors that arise from Schwann cells of the sheaths of peripheral nerves. They may be found in any portion of the body. In reported series of schwannomas, the percentage of tumors in the head and neck varies from 16% to 45%. Usually demonstrating slow growth, they often have a history of long duration, and are most often diagnosed in adults. Approximately 10% of schwannomas are diagnosed in patients under 21 years of age.

In this paper two children with large schwannomas of the head and neck are reported. In both, the symptoms were of relatively short duration, but physical findings suggested that the tumors had been present much longer. One patient was a 10‐year‐old female with a schwannoma filling the anterior and posterior triangles of the left side of her neck and extending superiorly to the base of the skull. The tumor intimately involved the vagus, spinal accessory, and hypoglossal nerves. The other patient was a 12‐year‐old female with a nasal tumor filling the right naris and nasopharynx. Our management of these patients is discussed.
Anti‐EBV serologic tests for nasopharyngeal carcinoma
Authors: Neel H. Bryan , Pearson Gary R. , Weiland Louis H. , Taylor William F. , Lanier Anne P. , Huang Andrew T. , Goeppert Helmut H. , Hyams Vincent J. , Pilch Ben Z. , Levine Paul H. , Henle Gertrude , Henle Werner
Published: October 2006

Sixty‐three serum specimens from American patients with nasopharyngeal carcinoma were examined for antibodies to antigens associated with Epstein‐Barr virus (EBV) and compared with 98 specimens from patients with other head and neck cancers, 133 from patients with benign head and neck diseases, and 96 from healthy donors. The level of antibody titers to EBV‐associated antigens was correlated with nasopharyngeal carcinoma. The anti‐EBV profile of elevated antibody titers directed against viral capsid antigen and early antigen was seen in undifferentiated and nonkeratinizing tumors but usually not in squamous cell tumors. Titers tended to rise with large increases in total tumor burden caused by distant metastases, often before clinical evidence of metastases. At the time of diagnosis, antibody‐dependent cellular cytotoxicity testing was performed on serum samples from 46 of the patients with nasopharyngeal carcinoma. Pretreatment titers were usually low in patients in whom recurrence developed and were high in most of the patients who had a good response to treatment and have remained free of recurrence.
Traumatic facial arteriovenous malformations
Authors: Holt G. Richard , Holt Jean Edwards , Cortez Edwin A. , Thornton William R. , Young William C.
Published: October 2006

Traumatic arteriovenous malformations (AVM) represent an abnormal communication between arteries and veins and are usually complex. They occur most commonly in the extremities and are noted most often in military casualties. In the literature there are approximately 25 cases of traumatic AVM of the facial region which are angiographically documented. To these are added five documented cases from this paper, one which was proven at surgery, and one which was suspected from classical signs and symptoms but not diagnosed.

The trauma leading to the AVM may be: penetrating, blunt, postsurgical, or inflammatory. A swelling of the face, pulsatile tinnitus, throbbing headache and bleeding comprise the main presenting symptoms. A bruit and thrill are usually present. Doppler ultrasonography and selective arteriography will provide the essential diagnostic information. Embolization therapy may be a helpful preoperative adjunct or may be the total therapy if surgery cannot be performed. Proper identification of the feeder vessels, surgical control of these vessels, total excision of the AVM with functional and cosmetic reconstruction of the tissue defect remain the basic principles of therapy.
Particulate cancellous marrow crib graft reconstruction of mandibular defects
Authors: Giordano Anthony , Brady Dennis , Foster Craig , Adams George
Published: October 2006

Between 1969 and 1978 more than 1000 mandible fractures were treated by the otolaryngology services at the University of Minnesota and affiliated hospitals. Most were successfully treated but 17 patients had significant loss of mandibular bone resulting in a much more difficult management problem. The loss of bone was usually due either to the initial injury such as a gunshot wound or was secondary to the complications of nonunion or osteomyelitis. Particulate cancellous marrow grafts within a Vitallium® or titanium mesh crib (PCM crib graft) were used to reconstruct the mandibular defects. One patient had bilateral defects requiring 2 PCM crib grafts. Thus, 18 grafts spanning defects 2 to 12 cm were performed. Success was measured by a stable mandible with satisfactory occlusion and he ability to chew, swallow and articulate satisfactorally. Of 18 grafts, 15 met these requirements. Several factors important to successful mandibular reconstruction included adequate immobolization, intraoral soft tissue coverage, external skin cover and tension‐free closure and optimal intraoral hygiene.

The crib used to hold the particulate cancellous marrow in position during the healing phase has been removed in three otherwise successful cases because of intraoral mucosal tenting or dehiscence or to allow adequate fitting of dentures. In our experience, the use of autogenous cancellous bone and marrow in metallic mesh has been a successful means of restoring function and stability to mandibular defects.
Otitis media with perforation of the tympanic membrane: A longitudinal experimental study
Authors: Goycoolea Marcos V. , Paparella Michael M. , Juhn S. K. , Carpenter Anna‐Mary
Published: October 2006

Despite the high incidence and prevalence of otitis media, its pathogenesis is not thoroughly understood. In an effort to provide a better understanding of this disease, experimental animal models have been developed which corroborate the changes observed in humans. In this study a new factor was added: tympanic membrane perforation 1 week after Eustachian tube obstruction. Twelve cats were divided in 4 even groups, and sacrificed at 1 and 2 weeks, 1 and 3 months after perforation, and their temporal bones were studied.

Findings revealed an early massive reaction of the mucoperiosteum with granulation and polypoidal tissue formation which filled a considerable portion of the middle ear cavity. Polypoidal changes involved the stapediovestibular joint, possibly explaining the cases of stapes fixation found at tympanomastoidectomy procedures for chronic otitis media.

Cholesterol granulomas with the classic characteristics as described in humans were observed in all animals at 3 month periods. These were preceded by clefts in the effusions, at 1 month, containing red blood cells. These clefts were considered as probable precursors of cholesterol granuloma formation. The association of endolymphatic hydrops, round window membrane changes, and otitis media without purulent labyrinthitis was observed; however, it was felt that the paucity of animals precluded any definite conclusions.
Metastatic malignant disease to the parotid gland
Authors: Yarington C. Thomas
Published: October 2006

A survey of over 250 consecutive parotidectornies performed at The Mason Clinic indicates a surprising incidence of metastatic malignant disease to the parotid gland. Four percent of all parotidectornies performed indicated a metastatic focus of malignancy from an unsuspected primary outside areas of the head and neck usually implicated in parotid disease. Twenty‐five percent of all cancer discovered at parotidectomy was metastatic malignant disease to the parotid gland. The most common site was the lung. A high index of suspicion, evaluation of pathologic specimens by electron microscopy, and detailed metastatic work‐up for patients with malignant disease in parotid lymph nodes are recommendations which should be considered by the surgeon performing parotid procedures.
Perilymph fistulas
Authors: Althaus Sean R.
Published: October 2006

A perilymph fistula is an abnormal communication between the fluids surrounding the membranous labyrinth and the middle ear space. Because of the potential hazards of meningitis, permanent hearing loss, and occasionally incapacitating vestibular symptoms, early recognition and prompt repair of the perilymph leak is important.

One hundred thirty three cases of perilymph fistulas are presented, stressing the clinical characteristics, evaluation, and management of patients with this otologic entity. The historical and contemporary literature on this subject is reviewed. A pathophysiological basis for perilymph fistula formation is presented, based upon certain anatomic, physiologic and mechanical principles involving the temporal bone and surrounding structures.

For the purpose of publication, the Materials and Methods and Evaluation sections of the paper have been omitted. These are available from the author upon request in mimeographed form. The interested reader may wish to refer to items 80 and 133 in the Bibliography, previous publications by the author in which the bulk of the data used in the omitted sections can be found.
Cervical nodal metastases of unknown origin
Authors: Leipzig Bruce , Winter Mark L. , Hokanson James A.
Published: October 2006

A study of 48 patients with metastatic carcinoma in the neck from an unknown primary site has revealed several facts. Among patients with squamous cell carcinoma, the three‐year survival rate was 40%. Whether treated with surgery (radical neck dissection) or with radical irradiation alone, the response of these tumors was similar in smaller N1 nodes; when treated with a combined therapeutic approach, they responded well in larger (N2 and N3) cervical nodes. Whether or not the primary tumor was found did not affect survival rates; the stage of the presenting nodal metastases did not appear to correlate with survival.

A large group of patients with adenocarcinoma metastatic to cervical lymph nodes all died of the disease within two years. All appeared with metastases in the supraclavicular fossa; no modality of treatment to the neck, whether by surgery or irradiation, was effective.
Laryngeal reconstruction by composite nasal mucoseptal graft after partial laryngectomy.three years follow‐up
Authors: Laurian N. , Zohar Y.
Published: October 2006

We have used autogenous nasal mucoseptal (NMS) graft for the reconstruction of the larynx after partial laryngectomy in glottic carcinoma invading the anterior commissure, for the past three years.

The composite graft, readily available and obtained without sequela, provides satisfactory and large enough replacement tissue. It provides both a dependable rigid cartilaginous wall and a respiratory mucous lining of the lumen. The method was found to be simple and effective in bridging the laryngeal defect.

The free NMS graft was used for reconstruction after extended frontal and frontolateral laryngectomy in 10 patients. The patients were successfully decannulated within 4 to 6 days after the operation and in none of the cases was nasogaptric feeding tube or laryngeal stenting necessary. In eight patients anatomical and functional results were achieved; the neolarynx prevented a permanent tracheostomy and a fair voice was obtained.
Mononuclear phagocyte function in head and neck cancer: NBT‐dye reduction, maturation and migration of peripheral blood monocytes
Authors: Balm Fons J. M. , Drexhage Hemmo A. , Von Blomberg Mary E. , Snow Gordon B.
Published: October 2006

The number of blood monocytes, their ability to mature into macrophages, their NBT‐dye reduction capacity and their migration towards casein were studied in 29 patients with squamous cell carcinoma of the larynx, 12 patients with squamous cell carcinoma at other sites within the head and neck and two groups of male controls, one of 29.7 yrs. ± 7.2 (SD) and the other of 71.4 yrs ± 6.8 (SD). An age dependency of monocyte function in healthy individuals was established. Increased numbers of monocytes per ml blood were found in the older men. These cells showed an enhanced migration toward casein. Their maturation capacity was decreased.

A clear impairment of migration toward casein was found in the two groups of carcinoma patients. The number of monocytes was only marginally affected. The maturation was found to be enhanced. An impaired recruitment of mononuclear phagocytes at the site of malignant growth due to diminished migratory capacities might be important for failing immune surveillance.