bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Hydrocephalus with Neural Tube Defect: Our Experience with the Surgical Treatment in One or in Two Operative Stages (on Separate Days)
Authors: Zabsonre D. Sylvain , Lankoande Henri , Zoungrana-Ouattara Chantal F.C. , Thiombiano Abdoulaye , Ouedraogo Soumaila , Sanou Abdoulaye , Yameogo Pacome , Kaboret-Douamba Sonia J.E. , Kabre Abel
Published: December 2018

Background: Neural tube defects (spina bifidas or cephaloceles) are congenital malformations that can be associated with hydrocephalus. Even if the surgical management of each of these pathologies separately is well established, this is not the case for a combination of these conditions. Aim: To report our results of simultaneous or separate surgery for the association of hydrocephalus with neural tube defect in the same patient. Methods: This was a retrospective study of the association of hydrocephalus with neural tube defect (spina bifida or cephalocele) managed over a period of 7 years at the Department of Neurosurgery, Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso. Results: Thirty-eight cases were included. The mean age was 8.1 months, and the sex ratio was 0.81. There were 27 cases of spina bifida and 11 cases of cephalocele associated with hydrocephalus. A cerebral CT scan was performed in all patients. In 30 cases, the operative management of these pathologies was performed at the same operative time. Eight cases were operated in 2 separate operative stages with a mean time of 30 days between the 2 operations. The course was favorable in 22 patients operated by the simultaneous approach and in 3 patients operated by the separate approach (p = 0.07). Conclusion: Surgical management of the association of hydrocephalus with neural tube defect in 1 or 2 operative stages gave similar clinical results. However, the treatment in 1 surgical stage would considerably reduce the charges.
Mechanisms of Etomidate-Mediated Decrease of Spontaneous Spike Activity of Mouse Cerebellar Purkinje Cells in vivo
Authors: Pan Wen , Wu Wen-Yuan , Bing Yan-Hua , Chu Chun-Ping , Jin Ri , Qiu De-Lai
Published: December 2018

Etomidate is an imidazole, nonbarbiturate hypnotic agent that is increasingly used in procedural sedation. However, the effects of etomidate on the spontaneous activity of cerebellar Purkinje cells (PCs) in living mouse have not been fully understood. In this study, we investigated the effects of etomidate on the spontaneous simple spike (SS) activity of PCs in urethane-anesthetized mice by cell-attached recording and pharmacological methods. Cerebellar surface application of etomidate (50 μmol\L) reduced the SS firing rate in a concentration-dependent manner (IC50: 43.4 µmol\L). Application of either a γ-aminobutyric acid type A (GABAA) receptor antagonist, SR95531 (20 μmol\L) or a glycine receptor antagonist strychnine (10 μmol\L) significantly attenuated but not abolished the etomidate-induced decrease in PC SS firing rate. However, co-application of SR95531 (20 μmol\L) and strychnine (10 μmol\L) abolished the etomidate-induced decrease in PC SS firing rate. Moreover, intraperitoneal injection of etomidate (3 mg/kg body weight) also induced a significant depression in PC SS firing rate, which was blocked by the co-application of SR95531 and strychnine on the cerebellar surface. These results indicate that both GABAA and glycine receptors are involved in the etomidate-induced decrease in PC SS firing rate in vivo in mice.
Diacronias e regimes discursivos da biografia intelectual
Authors: Broden Thomas F.
Published: December 2018

Pensando a biografia intelectual, como gênero, a partir das noções de diacronia e regimes discursivos, o artigo apresenta dois modelos diacrônicos clássicos para dar conta de uma transformação científica capital da trajetória de Greimas. Três categorias de enunciados que devem, pois, ser consultados e expostos são, então, identificadas – as pesquisas do cientista, os documentos de caráter arquivista e os testemunhos pessoais de natureza (auto)biográfica – para mostrar que cada uma delas, ao implementar uma prática enunciativa distinta que constrói suas próprias unidades e realiza um tipo discursivo diferente, permite obter, através do cruzamento dos resultados obtidos, novos fatos diacrônicos. A título de exemplos, esboça-se no texto a gênese do Dicionário de Semiótica (Greimas; Courtés, 1979) e indicação de como certas mudanças em Greimas reúnem fatores de ordem científica e biográfica.
Figurativo, figural e plástico nos textos literários. Ainda a propósito de Pinóquio
Authors: Lancioni Tarcisio
Published: December 2018

Partindo de uma detalhada discussão teórica sobre a problemática da figuratividade e do semissimbolismo nos textos literários, com base nos ensaios “Semiótica figurativa e semiótica plástica” de Greimas, publicado em 1984, e “A mitologia comparada”, de 1963, o artigo explora tais ideias na análise, revista e ampliada, de um trecho de Pinóquio, de Carlo Lorenzini (Collodi), para a qual interessam em especial os modos de articulação e de manifestação da dimensão figurativa, bem como os consequentes regimes de significação a partir daí produzidos.
Um terminal inaugural
Authors: Fabbri Paolo
Published: December 2018

O texto retoma o primeiro Dicionário de Semiótica, aquele publicado por Greimas e Courtés em 1979, e também o tomo II, para discutir a atualidade de suas contribuições no seio das ciências da linguagem. Tanto as bases do projeto que inspira a sua elaboração, quanto sua singularidade em relação às outras propostas, são então retomadas ao longo do artigo para lançar luz sobre o alcance metodológico da teoria e os avanços que permitiu no estudo dos processos de sentido.
A partir de Greimas: formação, atuação e pesquisa em semiótica
Authors: Sousa Silvia Maria de
Published: December 2018

Como parte das homenagens pelo centenário de nascimento de Algirdas Julien Greimas, o texto retoma um percurso de formação, atuação e pesquisa em semiótica. Busca-se compreender as consequências dessa tomada de posição na constituição de um perfil de pesquisador. A exposição desse percurso, feita de um ponto de vista em que escolhas e acasos são revisitados, é acompanhada por uma reflexão sobre a teoria e sobre um modo de conceber os Estudos de Linguagem.
Sobre o sentido cinquenta anos depois
Authors: Zinna Alessandro
Published: December 2018

O texto, ao traçar o projeto greimasiano para o estudo da significação, propõe uma leitura crítica e atualizada de Sobre o sentido, uma das principais obras de Algirdas Julien Greimas e que se apresenta como parte importante na história de construção da semiótica discursiva. Para além de uma descrição do conteúdo dos ensaios que compõem o livro, são mencionados os diálogos estabelecidos com as preocupações da época, e, sobretudo, as aberturas e as contribuições possíveis dessa teoria do sentido ao contexto de pesquisa contemporâneo.
Percepção e iconicidade, diagrama e mônada
Authors: Bordron Jean-François
Published: December 2018

O campo da semiótica se apresenta, em toda sua generalidade, como um conjunto de multiplicidades acompanhadas de diferentes regras destinadas a estabelecer o que não está contido em tal conjunto. A natureza dessas regras – eis a questão. Na medida em que uma semiose, na definição clássica, procede a um só tempo de uma enunciação (ou seja, de uma ação), de um sentido atrelado a uma expressão e de hipóteses propostas acerca daquilo que existe, real ou ficticiamente, pode-se pensar que a questão consiste em coordenar esses três infinitos sob a forma de um evento a cada vez atual. O fato semiótico revela, nesse particular, toda sua complexidade, mas também toda sua estranheza. Com efeito, como conceber que se possa, simultaneamente, diferenciar e coordenar localmente elementos tão díspares apenas por força de um pensamento? Proporemos conceber tal unidade sob a forma de um ícone. Peirce afirmou, certa vez, que tudo o que é icônico é possível. Sob esse ponto de vista, é legítimo considerar que a iconicidade é um traço essencial da realidade, assim como também o é de certos planos da expressão. Disso decorre que um ícone, ainda quando não corresponda a nada que tenha presença em nosso mundo, contentando-se, por assim dizer, em existir por si mesmo, indica todavia a possibilidade de algum tipo de mundo que se pode, por meio dele, explorar ou sonhar. Se isso puder ser admitido, um ícone deve poder reivindicar alguma forma de verdade. Esse é justamente o ponto que, percorrendo diferentes níveis de análise do ícone, procuraremos elucidar.
Fenomenologia da linguagem e enunciação
Authors: Marsciani Francesco
Published: December 2018

Uma teoria da enunciação de natureza semiótica requer uma radicalização das teses fenomenológicas sobre a produção do discurso. Nessa perspectiva, uma semiótica da subjetividade não pode prescindir de uma consideração convicta da dimensão intersubjetiva que representa, sob o prisma fenomenológico, a instância constitutiva do sentido do mundo. O texto discute, pois, como a teoria da significação ainda não se conciliou suficientemente com esta opção fundamental, buscando mostrar que a teoria da enunciação, por exemplo, se encontra até agora presa na alternativa entre uma percepção egológica da produção do sentido e uma concepção verdadeiramente intersubjetiva. Conclui-se, assim, que um entendimento propriamente intersubjetivo da constituição de sentido deve integrar, na teoria da enunciação, uma autêntica abordagem da alteridade, na qual se pode descrever a produção de intenções comunicativas a partir de uma intencionalidade transcendental mais fundamental.
Thienemanniella Kieffer from East Asia, with a systematic review of the genus (Diptera: Chironomidae: Orthocladiinae)
Authors: FU YUE , SÆTHER OLE , WANG XINHUA
Published: December 2018

The orthoclad genus Thienemanniella Kieffer in East Asia including 30 species is reviewed. Parsimony analyses of species of Thienemanniella and Onconeura Andersen et Sæther including Corynoneurella Brundin, Tempisquitoneura Epler and Ubatubaneura Wiedenbrug et Trivinho-Strixino are performed showing that Thienemanniella afra Lehmann belongs to Corynoneurella and that other Thienemanniella species with bare eyes may belong to Onconeura. Five new species: Thienemanniella absens sp. n., T. hainanensis sp. n., T. sichuana sp. n., T. triangula sp. n., and T. wuyiensis sp. n. are described and illustrated as adult males. Thienemanniella clavicornis Kieffer, T. ginzanquerea Sasa, Kitami et Suzuki, T. nipponica (Tokunaga), T. obscura Brundin, T. togamijika Sasa et Okazawa, T. tusimufegeai Sasa et Suzuki and T. xena (Roback) are reviewed for the Chinese specimens. The holotypes of 13 Japanese species: Corynoneura ginzanquinta Sasa et Suzuki, Thienemanniella chuzeduodecima Sasa, T. ginzanquerea Sasa et Suzuki, T. nagaramaculata Sasa, T. ogasaquardecima Sasa et Suzuki, T. ogasaquindecima Sasa et Suzuki, T. okigrata Sasa, T. oyabedilata Sasa, Kawai et Ueno, T. togamijika Sasa et Okazawa, T. tonewquerea Sasa et Tanaka, T. tusimuefea Sasa et Suzuki, T. tusimufegea Sasa et Suzuki, T. yakysetea Sasa et Suzuki are re-examined. Corynoneura ginzanquinta Sasa et Suzuki is transferred to the genus Thienemanniella. A key to the males of Thienemanniella so far known is provided.
Revisionary study of Pediella Roberts (Orthoptera: Acrididae: Melanoplinae) from the Andes Highlands
Authors: CIGLIANO M. M. , AMEDEGNATO C. , POCCO M. E. , LANGE C. E.
Published: December 2018

The genus Pediella Roberts, described originally from the Venezuelan Páramos is reviewed. Three new species from the Peruvian Puna are described. The genus shows a striking disjunct distribution. It is the only Melanoplinae genus known to occur at the Páramos and Puna highlands above 3000 meters. Pediella exhibits a homogeneous morphology across species. Differences among species are rather small, observed mostly in the shape of the male cerci, phallic complex, and coloration of the hind tibiae. The edition of this paper has been formatted with embedded links to images of type specimens, maps based on geo referenced specimen data and species key available on the Orthoptera Species file online (http://orthoptera.speciesfile.org).
Records of Psocidae: Psocinae (Insecta: Psocoptera) from Sumatra, Indonesia
Authors: KENTJONOWATI ENDANG SRI , NEW T. R.
Published: December 2018

Twelve species of Psocidae: Psocinae are recorded from Sumatra. Two, Psocidus strictus Thornton and Atrichadenotecnum umbratum (New & Thornton), are the first records from Indonesia, whilst all others were known previously from eastern Indonesia. Distributions and affinities are discussed.
Systematics, natural history, and hemipenial morphology of Dendrophidion brunneum (Günther) (Serpentes: Colubridae), a poorly known snake from the Andes of Ecuador and Peru
Authors: CADLE JOHN E.
Published: December 2018

Systematic characters, distribution, natural history, and hemipenial morphology are described for Dendrophidion brunneum (Günther), a poorly known snake from Ecuador and Peru. It has 17 midbody scale rows; 145–165 ventrals; 135–158 subcaudals; a tail 38–44% of total length; a relatively uniform green to brown dorsum; and a maximum length of 1370 mm (700–800 mm SVL). The species occurs from northern Ecuador to 8° S latitude in Peru, primarily on the Pacific slopes of the Andes but with a few documented lowland localities in Peru. Dendrophidion brunneum is diurnal, terrestrial, heliophilic, and oviparous. It occurs in humid montane forests or mixed puna grassland/highland forest. Recorded prey are small terrestrial frogs but a large individual possibly consumed a lizard. Defensive mechanisms include a pseudautotomic tail and behaviors such as striking, biting, and neck inflation. The hemipenis has a short, narrow base, a greatly expanded distal region, and a simple, centrolineal sulcus spermaticus. The expanded region is ornamented with spines, distal to which two flounces completely encircle the organ and another extends partially around one side. The flounces are unusual in being thin, membranous structures and in having mineralized rods (reduced spinules) completely embedded within the membranes. The apex is nude except for a few vestigial calyces. Unusual hemipenial characters are discussed.
A new species of Proablepharus (Scincidae: Lygosominae) from Mt Surprise, north-eastern Queensland, Australia
Authors: COUPER PATRICK J. , LIMPUS COLIN J. , MCDONALD KEITH R. , AMEY ANDREW P.
Published: December 2018

Proablepharus barrylyoni sp. nov. is described from a single locality near Mt Surprise, north-eastern Queensland. It is distinguished from its congeners by the following character states: body longitudinally striped, four supraoculars, five supraciliaries, frontoparietals fused to interparietal, upper preocular well-developed, two postsupralabials, lamellae beneath digits of pes smoothly rounded. The species was last collected in 1981 and, using criteria prescribed in the Queensland Nature Conservation Act, Wildlife Regulation 1994, qualifies as Vulnerable.
First record and description of male of Metavargula adinothrix Kornicker, 1975 (Ostracoda: Myodocopina) from the Southern Ocean
Authors: CHAVTUR VLADIMIR G. , KEYSER DIETMAR , BASHMANOV ALEXANDER G.
Published: December 2018

Previously unknown male and some juveniles of Metavargula adinothrix Kornicker, 1975 were identified in material which was collected by Germany R/V Polarstern from bathyal and abyssal depth of the Atlantic Sector of the Southern Ocean. Diagnosis, description and detailed illustrations of male of this species are presented. Morphological comparison is made between male and female of this species. The distribution of M. adinothrix in the Antarctic and Subantarctic waters is shown.
Redescription of Astyanax stenohalinus Messner, 1962 (Characiformes: Characidae), a poorly known species from Argentina and Uruguay
Authors: ALMIRÓN ADRIANA E. , CASCIOTTA JORGE R. , DE LAS M. AZPELICUETA MARÍA , LOUREIRO MARCELO
Published: December 2018

Astyanax stenohalinus Messner, 1962 is redescribed based on type material and new specimens collected in many localities of Argentina and Uruguay. This species is distinguished by a combination of the following characters: possession of hooks in all fins of males, teeth not expanded distally, two or three maxillary teeth, 37–39 perforated scales in the lateral series, 25–30 branched anal-fin rays, and anal-fin origin located before a vertical through last dorsal-fin ray insertions.
Nine new Zonopimpla Ashmead (Hymenoptera, Ichneumonidae, Pimplinae) and key to species from Venezuela
Authors: VALERA NEICY , DÍAZ FRANCISCO
Published: December 2018

Zonopimpla Ashmead is an exclusively Neotropical genus with the greatest number of species in Central America. In order to better understand the Zonopimpla species occurring in Venezuela, samplings using Malaise traps were conducted at six-months intervals in Aragua, Lara and Merida states in Venezuela from 2001–2003. Specimens from three major entomological museums were also examined. Nine new Zonopimpla species are described and illustrated: Z. diazi sp. nov., Z. moralesi sp. nov., Z. pereirai sp. nov., Z. pseudoatriceps sp. nov., Z. rodriguezi sp. nov., Z. sebastiani sp. nov., Z. torrellasi sp. nov., Z. vasquezi sp. nov., and Z. victoriae sp. nov. A taxonomic key for the Venezuelan species of Zonopimpla is provided, including also Z. atriceps (Cresson) and Z. fasciata Townes.
A new species of the genus Tropidophorus Duméril & Bibron, 1839 (Squamata: Sauria: Scincidae) from Vietnam
Authors: NGUYEN TRUONG QUANG , NGUYEN TAO THIEN , SCHMITZ ANDREAS , ORLOV NIKOLAI L. , ZIEGLER THOMAS
Published: December 2018

A new species of the genus Tropidophorus is described from Hoang Lien Mountain, Sa Pa and Van Ban districts, Lao Cai Province, northern Vietnam. Tropidophorus boehmei sp. nov. is characterized by the combination of the following features: size relatively large (maximum SVL 103.5 mm); upper head scales smooth; frontonasal undivided; prefrontals very small, widely separated; loreals 2, anterior loreal undivided; supralabials 6; supraciliaries 7–8, supraciliary row completed along the entire length of the lateral edge of supraoculars; external ear opening present, tympanum superficial, tympanum diameter smaller than eye length; midbody scales in 30–32 rows; dorsal and lateral scales on body and tail smooth; paravertebral scales 60–69, not widened; scale rows at position of tenth subcaudal 17–18; ventral scales 56–66; medial subcaudals divided from first to fifth, remaining ones about 1.5 times wider than neighboring scales; 16–19 smooth lamellae under fourth toe; dorsum and tail base dark grey with light transverse bands and two dorsolateral rows of white dots from neck to tail base; body sides dark grey with irregular small white dots from behind the eye to tail base. In addition, previous records of Tropidophorus berdmorei from northern Vietnam are discussed.
Two new Diastylis (Cumacea: Diastylidae) from Antarctic waters: Diastylis andeepae and D. catalinae
Authors: ALBERICO NATALIA , MÜHLENHARDT-SIEGEL UTE
Published: December 2018

Two new deep-sea cumaceans, Diastylis andeepae and D. catalinae are described from the Weddell Sea. Diastylis andeepae n. sp. can be distinguished from other members of the genus by a combination of characters including: carapace with small tubercles all over and anterior part with an arched row of teeth extending from each side of the pseudorostrum and disappearing a short distance before reaching the inferior margin of the carapace, ischium of the pereopod 2 with four strong teeth, endopod uropod of two articles. Diastylis catalinae n. sp. is a closely related species to D. richardi Fage 1929 recorded from the Bay of Biscay, however D. catalinae can be easily separated from D. richardi by having: (1) on each side of the anterior part of the carapace several teeth arranged in two non-uniform rows (randomly distributed and with two antero−lateral horns in D. richardi); (2) clearly visible pereonites 1 and 2 in dorsal view (hardly visible in D. richardi); (3) one tooth on each postero−lateral angle of the pereonite 5 (without teeth in D.richardi); and (4) one minute simple seta on article 4 of the antenna 2 (a long setulate seta in D. richardi).
Liolaemus goetschi (Iguania: Liolaemidae): redescription and phylogenetic relationships within the L. boulengeri group
Authors: NORI JAVIER , ABDALA CRISTIAN SIMÓN , SCROCCHI GUSTAVO JOSÉ
Published: December 2018

The genus Liolaemus is a widely distributed and very diverse natural group of lizards. The L. boulengeri group is characterized by the presence of a patch of enlarged scales on the posterior medial surface of the thigh. Liolaemus goetschi, which belongs to this group, was described by Müller and Hellmich in 1938 based on few specimens collected from Laguna Playa (Río Negro Province, Argentina). Those specimens were deposited in museums in Munich (Germany) and Breslau (Poland). The type material of L. goetschi deposited in Poland was lost and because the material in Germany is of difficult access, many populatios of other species have been confused with L. goetschi in subsequent works. In this work, L. goetschi was redescribed by using the characters currently designated for the group and the known distribution of the species was extended. The taxonomic status and phylogenetic relationships of L. goetschi within the L. boulengeri clade was also analyzed, especially with respect to L. melanops and L. martorii.
On the type selection and re-typification of two monitor lizard taxa (Squamata: Varanidae): Monitor bivittatus celebensis Schlegel, 1844 and Monitor kordensis Meyer, 1874; with some comments and corrections on other name-bearing type specimens
Authors: BÖHME WOLFGANG , KOCH ANDRÉ
Published: December 2018

We comment on a recently published checklist of the extant monitor lizards (Varanidae) by De Lisle (2009) which aimed also to give the repositories and catalogue numbers of name-bearing type specimens. In two out of 28 cases (i.e., Monitor bivittatus celebensis Schlegel, 1844 and Monitor kordensis Meyer, 1874) where the onomatophores could not be traced, he decided to designate a lectotype and a neotype, respectively, which, however, was not in accordance with the International Code of Zoological Nomenclature (ICZN). Therefore, we regard these designations as invalid and discuss and clarify the status of further type material listed by De Lisle (2009).  Moreover, we make some additional corrections in his list.
A Demographic Analysis of Racial/Ethnic Minority Enrollment Into HVTN Preventive Early Phase HIV Vaccine Clinical Trials Conducted in the United States, 2002-2016
Authors: Huamani Katherine Foy , Metch Barbara , Broder Gail , Andrasik Michele
Published: December 2018

Objectives:

Racial/ethnic minority communities in the United States are overrepresented among new HIV diagnoses, yet their inclusion in preventive HIV vaccine clinical trials is inadequate. An analysis of enrollment demographic characteristics from US preventive HIV vaccine clinical trials from 1988 through 2002 showed that enrollment of racial/ethnic minority groups increased. We analyzed enrollment in preventive HIV vaccine clinical trials from 2002 through 2016 and compared our data with data from the previous study, described demographic characteristics of trial participants, and assessed how well this distribution reflected the racial/ethnic distribution of new HIV diagnoses in the United States.

Methods:

We examined data on demographic characteristics from 43 Phase 1 and Phase 2A preventive HIV vaccine clinical trials conducted in the United States and compared the results with those of the previous study. We also compared racial/ethnic distributions from 2011 through 2015 with Centers for Disease Control and Prevention data on the number of new HIV diagnoses during the same period.

Results:

Of 3469 participants, 1134 (32.7%) identified as a racial/ethnic minority, a 94% increase from the previous period (634/3731; 17.0%). Percentage annual enrollment of all racial/ethnic minority participants fluctuated from 17% to 53% from mid-2002 to 2016. Percentages of new HIV diagnoses among the general population were 1.9 to 2.9 times the percentage enrollment of black participants and 1.3 to 6.6 times the percentage enrollment of Hispanic/Latino participants in clinical trials for the same period.

Conclusions:

Although enrollment of racial/ethnic minority groups into HIV vaccine clinical trials has increased, it is not proportional to the number of new HIV diagnoses among these groups. To enhance recruitment of racial/ethnic minority groups, the HIV Vaccine Trials Network has prioritized community partnerships and invested resources into staff training.
The Limited Rationality of Technology
Authors: Agassi Joseph
Published: December 2018

Ingemar Nordin’s Using Knowledge: On the Rationality of Science, Technology, and Medicine is a critical rationalist examination of medicine as a social system, largely science-based, but including quackery. Thus rationality is limited, as befits the author’s fallibilism.
Verdict Pending: Understanding Leadership Role Identity for North Carolina Judges and Lawyers
Authors: Jacobson Willow S. , Paynter Sharon R.
Published: December 2018

This article examines precursors to leadership practice, specifically through the lens of role identity. The assumption explored is that people are unlikely to engage in the hard work of leadership if they do not see that challenge as part of who they are and what they do, especially collaborative or system-level leadership. Role identity is, then, a critical building block in developing a deeper understanding of leadership intentions and actions especially in collaborative settings. Multiple judicial players, termed here “public service lawyers,” are investigated in this single-state case study that examines individuals’ view of their role and primary focus. Factors are examined that contribute to the construction of role perception. Results reveal that leadership training, the position one holds, and motivational orientation all influence the extent to which public service lawyers develop a view of their role that includes a broader system or collaborative orientation.
Invasive Fungal Laryngopharyngitis Resulting in Laryngeal Destruction with Complete Laryngotracheal Separation: Report of a Case
Authors: Swiss Tyler , Cervantes Sergio Santino , Hinni Michael , Lott David G.
Published: December 2018

As the treatment of hematopoietic cancers evolves, otolaryngologists will see a higher incidence of opportunistic infections. We discuss a case of invasive fungal disease that invaded the larynx, pharynx, trachea, and pulmonary parenchyma after chemotherapy. The patient, a 46-year-old woman, presented 1 week after undergoing induction chemotherapy. Her initial symptoms were odynophagia and dysphagia. Despite encouraging findings on physical examination, her health rapidly declined and she required an urgent tracheotomy and multiple operations to address spreading necrosis. Because of her inability to heal, she was not a candidate for laryngectomy, so she was treated with conservative management. The patient was then lost to follow-up, but she returned 5 months later with laryngeal destruction and a complete laryngotracheal separation. While noninvasive fungal laryngitis is routinely encountered, its invasive counterpart is rare. The literature demonstrates that some cases completely resolve with medical therapy alone but that surgery is necessary in others. We recommend surgical debridement of all necrotic tissue.
Use of Sialendoscopy as an Aid to Identify a Large Retained Foreign Body
Authors: Britt Christopher J. , Hyman David , Hartig Gregory K.
Published: December 2018

We describe the novel use of sialendoscopy in a 51-year-old man to identify a large and long-standing foreign body (wood) within the facial soft tissues that had eluded detection on previous imaging and surgical exploration. The identification of this foreign body was elusive on both computed tomography and magnetic resonance imaging, illustrating the limitations of imaging in identifying vegetable matter within soft tissues.
Modified Two-Handed Transnasal Endoscopic Surgery: Innovative Instrument Design and an Experimental Canine Study
Authors: Feng Guodong , Gao Zhiqiang , Tian Xu , Zhuang Yuan , Lv Wei
Published: December 2018

This study was conducted to design new instruments to solve the current issues of one-hand control and the obscuring of the endoscope by blood during transnasal endoscopic surgery. An endoscope holder and an electronically controlled irrigation-suction system were designed and manufactured. The feasibility and effectiveness of the designed instruments and operation models were verified in a model transnasal endoscopic surgery procedure performed on a mongrel dog. During the operation, one hand was used to perform the operation and move the endoscope, and the other hand was used for irrigation and suction to keep the surgical field and the endoscope clear. The combined use of an endoscope holder and an electronically controlled irrigation-suction system facilitates single-surgeon bimanual transnasal endoscopic surgery in a model surgical procedure. The clinical value of this technique warrants further research.
Cerebrospinal Fluid Leak during Stapes Surgery: Gushing Leaks and Oozing Leaks, Two Different Phenomena
Authors: Quesada Juan Luis , Cammaroto Giovanni , Bonanno Lilla , Galletti Francesco , Quesada Pedro
Published: December 2018

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients—23 men and 15 women, aged 23 to 71 years (mean: 47)—who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.
Intracapsular Tonsillectomy for Keratosis Pharyngeous: A Pilot Study of Postoperative Recovery and Surgical Efficacy
Authors: Gaudreau Philip A. , Gessler Eric M.
Published: December 2018

Our objective was to perform a pilot study comparing intracapsular radiofrequency ablation tonsillectomy with subcapsular tonsillectomy in adult patients with keratosis pharyngeous. Patients diagnosed with keratosis pharyngeous between December 2010 and February 2013 were randomized to undergo either intracapsular or subcapsular tonsillectomy using radiofrequency ablation. Postoperative pain scores and amount of pain medication taken were recorded for 2 weeks. A 6-month follow-up questionnaire was used to assess efficacy of the procedure. Twenty-two patients completed the initial 2-week questionnaire. Eighteen completed the 6-month follow-up questionnaire. The amount of pain medication consumed on postoperative days 8 (p = 0.0293), 9 (p = 0.0146), and 10 (p = 0.035) was significantly less in the intracapsular group. Risk of recurrence of tonsilloliths was significantly greater at the 6-month follow-up in the intracapsular cohort (p = 0.0291). Based on these findings, in patients undergoing tonsillectomy for keratosis pharyngeous, intracapsular radiofrequency ablation tonsillectomy may result in decreased pain medication consumption compared with subcapsular tonsillectomy. Intracapsular tonsillectomy, however, resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication may be offset by the greater likelihood for symptoms to recur. Larger studies are needed to confirm these findings.
Managing Head and Neck Malignancy Arising in a Field of Crohn Disease Inflammation: Report of a Case
Authors: Yver Christina , Jhala Darshana , Muir Amanda , Basu Devraj
Published: December 2018

Some of the clinical characteristics of Crohn disease of the head and neck overlap those of squamous cell carcinoma of the head and neck. We describe the diagnostic and therapeutic complexities we encountered in an unusual case of piriform sinus cancer that had arisen in a field of pharyngeal Crohn disease. Based on our initial failure to recognize the predominant inflammatory component of the lesion, we discuss the special considerations that must be made for the detection, staging, and management of head and neck cancer in Crohn disease patients. We further describe the multiple potential interactions among smoking, inflammation, and immunosuppression therapy in the colocalized pathogenesis of the two disease states.
Nasal Smear Eosinophils and Allergic Rhinitis
Authors: Pal Indranil , Babu Anindita Sinha , Halder Indranil , Kumar Saumitra
Published: December 2018

Our aim was to find out the association between nasal smear eosinophil count and allergic rhinitis (AR) and to determine a cutoff value that is significant for a diagnosis of AR. We also wanted to determine whether this count is related to the predominant symptoms, duration, or type and severity of AR, or to the presence of coexisting asthma. We selected 100 patients with a clinical diagnosis of allergic rhinitis across all age groups and an equal number of age- and sex-matched controls for the study. Their nasal smear eosinophil counts were recorded in terms of the number of eosinophils per high-power field (HPF). All patients were then clinically assessed for asthma and underwent spirometry. The data were recorded and appropriate statistical analysis done. The difference in the mean eosinophil counts of patients with AR and controls was found to be statistically significant (p = 0.000). A nasal smear eosinophil count of >0.3 per HPF had a 100% specificity and a 100% positive predictive value for AR. Asthma was associated with allergic rhinitis in 40% of patients; an association was not found between nasal smear eosinophil count and the symptoms, duration, type, and severity of allergic rhinitis or coexistent asthma. We conclude that an eosinophil count of >0.3 per HPF in nasal smears is a highly specific criterion for the diagnosis of AR. However, nasal smear eosinophil counts are poor indicators of the degree, duration, or type of upper or associated lower airway inflammation due to allergy.
Correlation between Sensorineural Hearing Loss and Chronic Otorrhea
Authors: Dobrianskyj Fernanda Martinho , Gonçalves Ísis Rocha Dias , Tamaoki Yumi , Mitre Edson Ibrahim , Ribeiro Fernando A. Quintanilha
Published: December 2018

Many studies have attempted to correlate chronic otorrhea in children and in adults with the sensorineural hearing loss in the affected ear, with contradictory results. This loss might be the result of the likely toxicity of the bacteria involved, effects of inflammatory cytokines, or constant use of ototoxic antibiotics. All studies evaluated to date compared the affected ear with the normal contralateral ear. From the digitized archive of otologic surgery files of the Department of Otorhinolaryngology at Santa Casa de São Paulo School of Medical Sciences, the ears of patients with chronic otorrhea were evaluated visually and compared with the normal contralateral ears. Ears with otorrhea were also compared with ears of other patients with dry tympanic perforation. Ears with suppuration were evaluated for cholesteatoma. The duration of otorrhea was considered. The sensorineural hearing threshold was evaluated for the frequencies of 500, 1,000, 2,000, and 4,000 Hz. A total of 98 patients with chronic otorrhea and 60 with dry tympanic membrane perforation were evaluated. A correlation between sensorineural hearing loss and chronic otorrhea was observed when compared with both contralateral normal ears and dry perforated ears of other patients. No relationship between hearing loss and the duration of suppuration or cholesteatoma was found. Sensorineural hearing loss occurs in ears with chronic otorrhea. The duration of otorrhea and the etiology of suppuration did not influence the hearing loss.
Boomerang-Shaped vs. Shield-Shaped Chondroperichondrial Cartilage Grafts for Type 1 Tympanoplasty in Children: A Study of 121 Patients
Authors: Özbay Can , Soy Fatih Kemal , Kulduk Erkan , Dundar Riza , Yükkaldiran Ahmet , Güler Osman Kadir , Koç Ertan
Published: December 2018

Many techniques and graft materials have been used for the reconstruction of the tympanic membrane. We conducted a retrospective study to compare anatomic and functional outcomes of type 1 tympanoplasty that we performed with boomerang-shaped chondroperichondrial cartilage grafts (BSGs) and shield-shaped chondroperichondrial cartilage grafts (SSGs) in pediatric patients. Our study population was made up 121 patients—61 boys and 60 girls, aged 7 to 16 years (mean: 12.4)—who had undergone a type 1 tympanoplasty. Patients were divided into two groups according to the grafting technique used; there were 59 patients in the BSG group and 62 patients in the SSG group. Ear examinations were performed at postoperative months 3, 6, 12, and 24, and pure-tone average (PTA) for air-conduction threshold values and air-bone gaps (ABGs) were evaluated at 0.5, 1.0, 2.0, and 4.0 kHz at the same visits. We also investigated the impact of the graft material on functional graft success and intergroup differences (if any) in surgical success. Mean postoperative follow-up periods were 30.5 and 30.2 months in the BSG and SSG groups, respectively. We found that the success rates for tympanic membrane reconstruction were not significantly different in the two groups (91.5 and 88.7%). Postoperatively, the mean PTA and ABG values in both groups at 3, 6, 12, and 24 months were significantly lower than the preoperative values (p < 0.05). There were no significant differences in mean PTA values between the two groups at 3, 6, 12, and 24 months. However, the extent of the decrease in PTA values in the BSG group at 3 months was significantly greater than that of the SSG group (p < 0.05). There were no significant differences in mean ABG values between the two groups at 3, 6, and 12 months, but at 24 months, the value was significantly higher in the BSG group (p < 0.05). Finally, the extent of the decrease in ABG in the BSG group at both 3 and 6 months was significantly greater than that of the SSG group (p < 0.05). We conclude that the BSG procedure is a reliable and safe method of performing pediatric tympanoplasty.
The Value of Assr Threshold-Based Bilateral Hearing Aid Fitting in Children with Difficult or Unreliable Behavioral Audiometry
Authors: Vlastarakos Petros V. , Vasileiou Alexandra , Nikolopoulos Thomas P.
Published: December 2018

We conducted an analysis to assess the relative contribution of auditory brainstem response (ABR) testing and auditory steady-state response (ASSR) testing in providing appropriate hearing aid fitting in hearing-impaired children with difficult or unreliable behavioral audiometry. Of 150 infants and children who had been referred to us for hearing assessment as part of a neonatal hearing screening and cochlear implantation program, we identified 5 who exhibited significant discrepancies between click-ABR and ASSR testing results and difficult or unreliable behavioral audiometry. Hearing aid fitting in pediatric cochlear implant candidates for a trial period of 3 to 6 months is a common practice in many implant programs, but monitoring the progress of the amplified infants and providing appropriate hearing aid fitting can be challenging. If we accept the premise that we can assess the linguistic progress of amplified infants with an acceptable degree of certainty, the auditory behavior that we are monitoring presupposes appropriate bilateral hearing aid fitting. This may become very challenging in young children, or even in older children with difficult or unreliable behavioral audiometry results. This challenge can be addressed by using data from both ABR and ASSR testing. Fitting attempts that employ data from only ABR testing provide amplification that involves the range of spoken language but is not frequency-specific. Hearing aid fitting should also incorporate and take into account ASSR data because reliance on ABR testing alone might compromise the validity of the monitoring process. In conclusion, we believe that ASSR threshold-based bilateral hearing aid fitting is necessary to provide frequency-specific amplification of hearing and appropriate propulsion in the prelinguistic vocalizations of monitored infants.
The Incidence of Revision Adenoidectomy: A Comparison of four Surgical Techniques over a 10-year Period
Authors: Bhandari Nipun , Don Debra M. , Koempel Jeffrey A.
Published: December 2018

Approximately 130,000 adenoidectomies are performed each year in the United States. Few studies have examined adenoid regrowth and the incidence of revision surgery or have compared four different surgical instruments commonly used for adenoid surgery within the same institution. This study aimed to determine the incidence of revision adenoidectomy after the use of microdebrider, Coblation, suction cautery, and curette instruments over a 10-year period at a single major tertiary children's center in the United States. A retrospective chart review was performed for all patients who underwent primary and/or revision adenoidectomy at the Children's Hospital Los Angeles (CHLA) between August 2004 and August 2014. During the 10-year study period, a microdebrider was used in 212 cases, Coblation in 382, suction cautery in 1,926, and curette in 3,139 adenoidectomies. The percentages of revision adenoidectomy were 1.42% (3 patients) for microdebrider, 0.79% (3 patients) for Coblation, 0.36% (7 patients) for suction cautery, and 0.03% (1 patient) for curette. The cumulative incidence of revision adenoidectomy for initial surgeries performed at CHLA was 0.2% for the 10-year study period. Pearson chi-square analysis showed statistically significant differences between the surgical techniques (p < 0.0001). In conclusion, regrowth of adenoid tissue requiring revision surgery occurs very infrequently irrespective of the instrument used for the primary procedure, and the most common indication for revision adenoidectomy is to improve eustachian tube dysfunction rather than nasal obstruction due to adenoid hypertrophy.
A Rare Case of Odontoameloblastoma in a Geriatric Patient
Authors: Yalamanchi Pratyusha , Coblens Orly , Ahn Meejin , Cannady Steven B. , Newman Jason G.
Published: December 2018

Odontoameloblastoma is an extremely rare tumor derived from odontogenic epithelium and mesenchyme. In the fewer than 20 reported cases, odontoameloblastoma is described as occurring in the maxilla or mandible of young men with a history of unerupted teeth. Here we report a case of a 73-year-old woman who presented to the dentist for routine cleaning and x-rays, which displayed a mandibular lesion. After referral to multiple providers, a biopsy of two involved teeth was obtained and computed tomography of the neck was performed, revealing a large, destructive lesion of the mandible. Histology was consistent with odontoameloblastoma. The patient underwent wide segmental mandibular resection and scapula tip free flap reconstruction. She recovered uneventfully and continues to have close follow-up, given the risk of recurrence. To the best of our knowledge, this is the first reported case of odontoameloblastoma in a patient over age 50. The goal of the authors is to raise awareness of this rare pathology and its diagnostic and management modalities.
Renal Cell Carcinoma Metastatic to the Sinonasal Cavity: A Review and Report of 8 Cases
Authors: Bastier Pierre-Louis , Dunion Dorothée , de Bonnecaze Guillaume , Serrano Elie , de Gabory Ludovic
Published: December 2018

Renal cell carcinoma (RCC) metastatic in the sinonasal cavity is rare. In many cases, it represents the initial presentation of RCC. We conducted a retrospective chart review to report the clinical presentation, imaging, and treatment of RCC metastases in the sinonasal cavity at two tertiary care referral centers. Our population was made up of 8 patients—6 men and 2 women, aged 55 to 86 years (mean: 66.9; median: 63.5)—who had been diagnosed with cancer in the sinonasal cavity. The most common complaints were epistaxis, nasal obstruction, and diplopia. Cancers were located in the ethmoid sinus (n = 3), nasal cavity (n = 2), sphenoid sinus (n = 2), and maxillary sinus (n = 1). Local treatment involved resection and adjuvant radiotherapy in 4 patients, surgery alone in 2 patients, and radiotherapy alone in the other 2. The lesion was embolized before surgery in 4 cases. We also performed a critical review of similar published cases. Our literature review covered 53 cases of RCC metastatic to the sinonasal cavity, including ours. Metastases were the first presentation of RCC in 24 of these cases (45.3%); in our series, the metastases led to the diagnosis of the primary RCC in 3 cases (37.5%). In the 53 reported cases, metastatic resection was performed on 35 patients (66.0%). Survival data were available for 22 of these operated patients, and 17 of them achieved a complete local response. Adjunctive radiotherapy was not associated with a better local response. Overall survival was significantly better in patients who had an isolated metastasis rather than multiple metastases (p = 0.013). There was no difference in overall survival between patients whose metastasis represented the initial presentation of RCC and those whose metastasis did not (p = 0.95). We recommend that sinonasal metastasis be suspected in the event of unilateral nasal bleeding or nasal obstruction in patients diagnosed with RCC. Embolization may prevent abundant bleeding during removal. Surgery may improve the quality of life of these patients while decreasing nasal obstruction and bleeding.
Primary parapharyngeal Leiomyosarcoma: A Case Report
Authors: Locatello Luca Giovanni , De Cesare Jano Maria , Taverna Cecilia , Gallo Oreste
Published: December 2018

Leiomyosarcoma is a rare malignant soft-tissue tumor whose cells resemble smooth-muscle tissue. It has been reported to arise in different areas of the head and neck region. Primary leiomyosarcoma of the parapharyngeal space, however, is extremely rare, as only 4 cases have been previously reported to date. We describe the somewhat urgent case of a primary leiomyosarcoma of the right parapharyngeal space in a 30-year-old man. We also review the diagnostic and therapeutic challenges that clinicians face in managing this rare tumor.