bluuebunny/crossref_metadata_2025 huggingface dataset:
The interfacial processes on an entrapped saline wedge
Authors: Hamill G. A. , Donnelly B. , Robinson D. J. , Mackinnon P. A. , Johnston H. T.
Published: January 2007

When freshwater flows over saltwater, a density stratification can form. A semi-submerged weir in a river mouth, which is overtopped by high tides, can impound a saltwater wedge arrested by the weir. Stratification of this type can result in environmental damage to the impounded zone. A review of current methods for calculating the natural overflow entrainment of such an arrested wedge is presented. The erosion of such an arrested wedge was also investigated in the laboratory. These experimental investigations involved recording the variations in density and velocity profiles over time. Varying freshwater depths and velocities were used to assess their effect on impoundment erosion. Mixing across the interface was found to result in the formation of a third or interfacial layer that grows to a constant depth while maintaining constant density. Methods of calculating the mixing occurring and consequential erosion of the saline body are presented.
Linking Case Management and Community Development
Authors: Austin Carol D. , McClelland Robert W. , Gursansky Di
Published: January 2007

Case management, in various forms, is now institutionalized as a core part of policy and programs designed to deliver home- and community-based services to older adults. The case management role, in theory, requires attention to both client and system goals, although in practice the system goals that have received most attention have been gatekeeping and resource allocation. While case managers have been admonished to find and develop resources in the community, this has primarily taken the form of including informal services in individual client care plans. What has been missing is focused attention to the potential of the community as a nurturing environment with the capacity to support older adults and their caregivers. Sustainable care for older adults cannot be achieved by formal service and family support alone. This article proposes the creation of linkages between case managers, who build the service arrangements for older people, and community developers, who are responsible for building community capacity and social capital. It is argued that this linkage is essential for establishing the foundations of a caring community with the capacity to support older people.
EFFECTS OF TRAINING, PROMPTING, AND SELF‐MONITORING ON STAFF BEHAVIOR IN A CLASSROOM FOR STUDENTS WITH DISABILITIES
Authors: Petscher Erin Seligson , Bailey Jon S.
Published: January 2007

This study extended the limited research on the utility of tactile prompts and examined the effects of a treatment package on implementation of a token economy by instructional assistants in a classroom for students with disabilities. During baseline, we measured how accurately the assistants implemented a classroom token economy based on the routine training they had received through the school system. Baseline was followed by brief in‐service training, which resulted in no improvement of token‐economy implementation for recently hired instructional assistants. A treatment package of prompting and self‐monitoring with accuracy feedback was then introduced as a multiple baseline design across behaviors. The treatment package was successfully faded to a more manageable self‐monitoring intervention. Results showed visually significant improvements for all participants during observation sessions.
INCREASING DONATIONS TO SUPERMARKET FOOD‐BANK BINS USING PROXIMAL PROMPTS
Authors: Farrimond Samantha J. , Leland Louis S.
Published: January 2007

There has been little research into interventions to increase participation in donating items to food‐bank bins. In New Zealand, there has been an increased demand from food banks (Stewart, 2002). This study demonstrated that point‐of‐sale prompts can be an effective method of increasing donations to a supermarket food‐bank bin.
A PRELIMINARY EXAMINATION OF THE EVOCATIVE EFFECTS OF THE ESTABLISHING OPERATION
Authors: O'Reilly Mark F. , Sigafoos Jeff , Edrisinha Chaturi , Lancioni Giulio , Cannella Helen , Choi Ha Young , Barretto Anjali
Published: January 2007

We attempted to isolate the evocative effects of the establishing operation for positively reinforced problem behavior with 2 participants. The study consisted of three phases. First, a functional analysis identified tangible items (Participant 1) and attention (Participant 2) as maintaining problem behavior. Second, access to tangible items and attention was systematically controlled (continuous access vs. no access) immediately prior to functional analysis sessions in which these consequences were delivered contingent on problem behavior. Results of this phase indicated that problem behavior occurred at higher levels when access to tangible items and attention was restricted. In the third phase, prior access was again controlled, but problem behavior produced no consequences. Results of this final phase indicated that problem behavior occurred at higher levels during extinction sessions when participants did not have prior access to the reinforcers.
SOME DETERMINANTS OF CHANGES IN PREFERENCE OVER TIME
Authors: Hanley Gregory P. , Iwata Brian A. , Roscoe Eileen M.
Published: January 2007

Results of longitudinal studies suggest that the stability of preferences varies across individuals, although it is unclear what variables account for these differences. We extended this work by conducting periodic assessments of preference for leisure activities over 3 to 6 months with 10 adults with developmental disabilities. Although previous research has collectively shown that preferences identified via repeated assessment are highly variable, our results showed that preferences were relatively stable for the majority (80%) of participants. In an attempt to identify some environmental determinants of shifts in preference, we provided extended daily access to high‐preference items (preference‐weakening manipulation) and paired access to low‐preference items with social and edible putative reinforcers during brief sessions (preference‐strengthening manipulation). Preference assessments continued over the course of these manipulations with 2 participants. Results showed that changes in preference across time could be produced systematically and suggest that naturally occurring changes in establishing operations or conditioning histories contribute to temporal shifts in preference. Implications for preference assessments, reinforcer usage, and planned attempts to change preferences are discussed.
A COMPUTERIZED TEST OF SELF‐CONTROL PREDICTS CLASSROOM BEHAVIOR
Authors: Hoerger Marguerite L. , Mace F. Charles
Published: January 2007

We assessed choices on a computerized test of self‐control (CTSC) for a group of children with features of attention deficit hyperactivity disorder (ADHD) and a group of controls. Thirty boys participated in the study. Fifteen of the children had been rated by their parents as hyperactive and inattentive, and 15 were age‐ and gender‐matched controls in the same classroom. The children were observed in the classroom for three consecutive mornings, and data were collected on their activity levels and attention. The CTSC consisted of two tasks. In the delay condition, children chose to receive three rewards after a delay of 60 s or one reward immediately. In the task‐difficulty condition, the children chose to complete a difficult math problem and receive three rewards or complete an easier problem for one reward. The children with ADHD features made more impulsive choices than their peers during both conditions, and these choices correlated with measures of their activity and attention in the classroom.
GENERALIZATION OF TACTING ACTIONS IN CHILDREN WITH AUTISM
Authors: Williams Gladys , Carnerero José Julio , Pérez‐González Luis Antonio
Published: January 2007

This intervention compared the effects of two procedures on the generalization of a tacting repertoire (labeling) in 6 children with autism spectrum disorder. In one procedure the verbal antecedent stimulus “What is she doing?” appeared together with a person performing an action; in the other procedure, the antecedent stimulus was just the presence of the action. In initial tests, children emitted tacts only when the action was presented with the verbal antecedent. Thereafter, they learned to tact an action without the verbal antecedent and received tests to evaluate generalization to another action. Results indicated that in order to obtain generalization of tacting actions, it was necessary to learn to tact other actions without the verbal antecedent as well as learning to tact the action with the verbal antecedent. These findings have relevance for generalization of tacting actions from control by verbal antecedents to natural conditions and the production of spontaneous language.
AN EVALUATION OF COMPUTER‐BASED PROGRAMMED INSTRUCTION FOR PROMOTING TEACHERS' GREETINGS OF PARENTS BY NAME
Authors: Ingvarsson Einar T. , Hanley Gregory P.
Published: January 2007

Although greeting parents by name facilitates subsequent parent‐teacher communication, baseline measures revealed that 4 preschool teachers never or rarely greeted parents by name during morning check‐in. To promote frequent and accurate use of parents' names by teachers, the effects of a fully automated computerized assessment and programmed instruction (CAPI) intervention were evaluated in a multiple baseline design. The CAPI intervention involved assessment and training of relations among parents' and children's pictures and names, and produced rapid learning of parent names. The CAPI intervention also resulted in substantial improvements in the classroom use of parents' names for 3 of the 4 teachers; however, a supervisor‐mediated feedback package (consisting of instructions, differential reinforcement, and error correction) was necessary to maintain name use for 2 of those teachers. The practical strengths and limitations of computer‐based teacher training are discussed.
SOME EFFECTS OF STIMULANT MEDICATION ON RESPONSE ALLOCATION: A DOUBLE‐BLIND ANALYSIS
Authors: Kelley Michael E. , Fisher Wayne W. , Lomas Joanna E. , Sanders Roy Q.
Published: January 2007

Children who are diagnosed with attention deficit hyperactivity disorder (or who engage in behavior consistent with such a diagnosis) are often prescribed stimulant medications for hyperactive or inattentive behaviors. However, the mechanisms by which stimulant medications affect individuals' behavior are rarely evaluated. The purpose of the current study was to evaluate the effects of stimulant medication on response allocation when antecedents and consequences were held constant and equated. Results indicated that the presence of an amphetamine medication (Adderall®) influenced response allocation across two concurrently available responses while all other stimulus conditions were held constant.
THE EFFECTS OF GOAL SETTING ON RUGBY PERFORMANCE
Authors: Mellalieu Stephen D. , Hanton Sheldon , O'Brien Michael
Published: January 2007

Goal‐setting effects on selected performance behaviors of 5 collegiate rugby players were assessed over an entire competitive season using self‐generated targets and goal‐attainment scaling. Results suggest that goal setting was effective for enhancing task‐specific on‐field behavior in rugby union.
ASSESSMENT OF DEVIANT AROUSAL IN ADULT MALE SEX OFFENDERS WITH DEVELOPMENTAL DISABILITIES
Authors: Reyes Jorge R. , Vollmer Timothy R. , Sloman Kimberly N. , Hall Astrid , Reed Robert , Jansen Greg , Carr Sam , Jackson Kevin , Stoutimore Michael
Published: January 2007

Ten individuals, residing in a treatment facility specializing in the rehabilitation of sex offenders with developmental disabilities, participated in an arousal assessment involving the use of the penile plethysmograph. The arousal assessments involved measuring change in penile circumference to various categories of stimuli both appropriate (adult men and women) and inappropriate (e.g., 8‐ to 9‐year‐old boys and girls). This approach extends the existing assessment literature by the use of repeated measurement and single‐subject experimental design. Data from these assessments were analyzed to determine if clear and informative outcomes were obtained. Overall, three general patterns of results emerged. Some participants showed differentiated deviant arousal or higher levels of arousal to specific inappropriate stimuli (deviant is a term used in the existing sex‐offender literature to describe this type of arousal). Other participants showed undifferentiated deviant arousal, in which case they showed nonspecific arousal to inappropriate stimuli. The remaining participants showed no arousal to inappropriate stimuli but did show arousal to appropriate stimuli. Implications for assessment, treatment, and future directions are discussed.
ENHANCING FREQUENCY RECORDING BY DEVELOPMENTAL DISABILITIES TREATMENT STAFF
Authors: Mozingo Dennis B. , Smith Tristram , Riordan Mary R. , Reiss Maxin L. , Bailey Jon S.
Published: January 2007

We evaluated a staff training and management package for increasing accuracy of recording frequency of problem behavior in a residential care facility. A multiple baseline design across the first and second work shifts showed that 2 of 8 participants increased their accuracy following in‐service training, and all 8 improved during a condition with supervisor presence and feedback. Improvements were maintained when feedback was removed and generalized to activity periods when neither supervisor presence nor feedback was provided. Other staff behavior was not adversely affected by the intervention package.
THE EFFICACY OF NONCONTINGENT ESCAPE FOR DECREASING CHILDREN'S DISRUPTIVE BEHAVIOR DURING RESTORATIVE DENTAL TREATMENT
Authors: O'Callaghan Patrick M. , Allen Keith D. , Powell Shawn , Salama Fouad
Published: January 2007

We evaluated the effectiveness of a dentist‐implemented behavioral intervention in which brief escape from dental treatment was provided on a regular basis, independent of the child's behavior. Within a multiple baseline design across subjects, 5 children, ages 4 to 7 years, were provided with temporary escape from dental treatment on a fixed‐time schedule. The intervals were signaled by an electronic timer worn by the dentist. Clinically significant reductions were observed in physically disruptive behavior across all 5 children with the introduction of noncontingent escape, and verbally disruptive behavior was markedly reduced in 4 of the 5 children. In addition, the dental staff's use of physical restraint was reduced to near zero across all 5 children. The research extends the literature in both clinical dentistry and in applied behavior analysis by demonstrating that a dentist can easily and effectively implement noncontingent reinforcement to produce clinically significant and socially important changes in children's health behavior.
A PRELIMINARY ANALYSIS OF SELF‐CONTROL WITH AVERSIVE EVENTS: THE EFFECTS OF TASK MAGNITUDE AND DELAY ON THE CHOICES OF CHILDREN WITH AUTISM
Authors: Lerman Dorothea C. , Addison Laura R. , Kodak Tiffany
Published: January 2007

When faced with a choice between two aversive events, a person exhibits self‐control by choosing a smaller, more immediate aversive event over a larger, delayed aversive event. Task demands are often aversive to children with autism and other developmental disabilities. The purpose of this study was to evaluate behavioral sensitivity to differences in the amount and delay of tasks as part of a preliminary study on self‐control. Participants were 2 children with autism who engaged in problem behavior maintained by escape. Results indicated a lack of self‐control with respect to choosing between two aversive tasks and suggested potential strategies for increasing self‐control (i.e., choosing a small immediate task over a large delayed task).
Timing of seroconversion and acquisition of positive polymerase chain reaction assay results in calves experimentally infected with bovine leukemia virus
Authors: Nagy Dusty W. , Tyler Jeff W. , Kleiboeker Steven B.
Published: January 2007

Objective—To determine the interval to provirus and serum antibody detection (via PCR assay and ELISA, respectively) in calves after experimental inoculation with bovine leukemia virus (BLV).

Animals—8 colostrum-deprived, BLV-negative Holstein bull calves (≥ 6 weeks old).

Procedures—Via IM injection, each calf received a fresh whole-blood inoculum (day 0) calculated to contain 2 × 106 lymphocytes. Blood samples for the ELISA and PCR assay were collected from calves immediately prior to inoculation and weekly thereafter for 7 weeks. Mean and median number of weeks to PCR-detected conversion of BLV status and seroconversion were calculated. Point sensitivity and cumulative sensitivity of the 2 assays were calculated at each sample collection. At each sampling time, the proportion of calves identified as infected by the cumulative weekly ELISA and PCR assay results was compared by use of a Fisher exact test.

Results—In 5 calves, conversion of BLV status was detected via PCR assay before seroconversion was identified. However, seroconversion preceded PCR-detected conversion in 2 calves. In 1 calf, both assays yielded positive results at the same test date. These differences were not significant.

Conclusions and Clinical Relevance—In experimentally inoculated BLV-negative calves, conversion of BLV status was detected via PCR assay more quickly than via ELISA; this difference was not significant and probably not clinically important. The PCR assay may be useful as a confirmatory test in animals of exceptional value; tests based on viral identification may become critically important if vaccines against BLV infection are developed and marketed.
Evaluation of the efficacy of prophylactic hoof health examination and trimming during midlactation in reducing the incidence of lameness during late lactation in dairy cows
Authors: Hernandez Jorge A. , Garbarino Eduardo J. , Shearer Jan K. , Risco Carlos A. , Thatcher William W.
Published: January 2007

Objective—To assess the efficacy of prophylactic hoof health examination and trimming during midlactation at reducing the incidence of lameness during late lactation in dairy cows.

Design—Randomized field trial.

Animals—333 Holstein cows.

Procedures—Cows without apparent lameness were randomly allocated into 1 of 2 groups approximately 204 days after calving. Cows allocated to the treatment group (n = 161) were examined on a tilt table for diagnosis and underwent hoof-trimming procedures, if needed, for treatment of hoof disorders or lesions. Cows in the control group (n = 172) were not examined. Cows were assigned a locomotion score weekly for 28 weeks after allocation to a group. The number of cows classified as lame during late lactation (approx 205 to 400 days after calving) was compared between groups to assess the efficacy of prophylactic examination and trimming.

Results—Incidence of lameness during late lactation was 24% in cows in the control group and 18% in cows in the treatment group.

Conclusions and Clinical Relevance—The 25% decrease in number of new cases of lameness in cows undergoing prophylactic hoof health examination and trimming during midlactation may be relevant for the well-being of dairy cows and should not represent a major economic burden to producers.
Detection of Rhinovirus in Turbinate Epithelial Cells of Chronic Sinusitis
Authors: Jang Yong Ju , Kwon Hyun-Ja , Park Hyung-Wook , Lee Bong-Jae
Published: December 2006

Background

In contrast to the well-established association of rhinovirus (RV) with acute sinusitis, little is known about the role of RV infections in the pathogenesis of chronic sinusitis. Therefore, we assayed the nasal cavity mucosae of chronic sinusitis patients lacking signs of acute viral infection for the presence of RV.

Methods

Nasal lavage fluids and turbinate epithelial cells from 39 sinusitis patients and 27 control subjects were tested. Turbinate epithelial cells were collected using a Rhino-probe mucosal curette. Picornavirus was assayed by an initial reverse-transcription polymerase chain reaction (PCR), and picornavirus-positive samples were assayed by nested reverse-transcription PCR to detect RV.

Results

All lavage fluids from both groups, as well as control epithelial cells, were negative for picornavirus. In contrast, 8 of 39 (21%) epithelial cell samples from sinusitis patients were positive for picornavirus. RV-specific nested-PCR revealed that all eight of these samples were positive for RV.

Conclusion

The detection of RV in the turbinate epithelial cells of chronic sinusitis patients suggests that RV may be important in the pathogenesis of chronic sinusitis.
Topical Steroid Drops for the Treatment of Sinus Ostia Stenosis in the Postoperative Period
Authors: DelGaudio John M. , Wise Sarah K.
Published: December 2006

Background

Chronic oral steroid use causes significant morbidity, including osteoporosis, immunosuppression, and adrenal insufficiency. Refractory chronic rhinosinusitis patients often take repeated oral steroid courses to treat polypoid disease or sinus ostia stenosis. This study evaluated topical steroid drop efficacy in treating recurrent sinus ostia stenosis in the postoperative period.

Methods

The 5-year single institution experience with topical steroid drop use after endoscopic sinus surgery (ESS) was evaluated by retrospective review. Patients were included if they began topical dexamethasone ophthalmic, prednisolone ophthalmic, or ciprofloxacin/dexamethasone otic intranasally (used off-label) within 3 months after ESS. Outcomes (i.e., ostia patency, oral steroid use, revision surgery, and complications) were assessed for a 6-month period after steroid drop initiation.

Results

Thirty-six patients met inclusion criteria. Forty-four surgeries were performed during the study period; 67 sides were treated postoperatively with topical steroid drops. In 86.6% of cases, steroid drops were used to treat frontal ostium stenosis or frontal recess edema; 93.2% of surgeries were revision procedures. Sixty-four percent of sinuses were treated successfully with topical steroid drops, 14.9% remained stable, and 20.9% failed. Reasons for failure included persistent/worsening edema, scarring, or noncompliance. Ten patients (27.8%) required oral steroids and 4 patients (6%) underwent revision surgery during the study period. One case of adrenal suppression occurred.

Conclusion

Topical steroid drops are beneficial in preventing sinus ostia stenosis in the postoperative period and may decrease the propensity toward repeated oral steroid therapy. This is particularly noteworthy in this challenging cohort, largely composed of revision frontal sinus surgery patients.
Brain Perfusion Single Photon Emission Computed Tomography Findings in Patients with Posttraumatic Anosmia and Comparison with Radiological Imaging
Authors: Eftekhari Mohammad , Assadi Majid , Kazemi Majid , Saghari Mohsen , Mojtahedi Alireza , Fard-Esfahani Armagan , Sichani Babak Fallahi , Beiki Davood
Published: December 2006

Background

Different techniques in neuroimaging have been proposed for assessment of olfactory dysfunction but they are not without limitations. Recently, some studies showed the usefulness of single photon emission–computed tomography (SPECT) in evaluation of patients with posttraumatic anosmia. This study was designed to assess the possible diagnostic value of SPECT findings in patients with posttraumatic anosmia in comparison with magnetic resonance imaging (MRI)/CT imaging.

Methods

Sixteen patients who had head trauma and consequently anosmia, which was defined according to Cain's identification test, were included in this study. Two nonanosmic groups, traumatic patients and nontraumatic healthy individuals, were selected as control groups for this study. Qualitative and semiquantitative brain perfusion SPECT was performed by measuring the uptake ratio of the orbital frontal cortex to occipital pole in the sagittal projections (uptake index). All 16 target patients had a previous CT scan and/or MRI. Semiquantitative and qualitative brain perfusion SPECT were compared with radiological imaging.

Results

Semiquantitative assessment of brain perfusion SPECT revealed remarkable orbital frontal hypoperfusion as compared with two control groups. 87.5% of anosmic patients showed orbital frontal hypoperfusion (≥2 SD below the lowest level in healthy controls). In addition, the semiquantitative SPECT method detected more orbitofrontal abnormality than the qualitative method or radiological imaging (MRI and/or CT).

Conclusion

Findings suggest that by using SPECT, posttraumatic anosmia corresponds to the hypoperfusion in the orbital frontal cortex in a great number of patients. Because of its availability, rather low cost, technical ease, and possibility to obtain objective quantitative information, brain perfusion SPECT can be complementary to other diagnostic techniques in the evaluation of olfactory function, although additional neurophysiological and imaging studies are needed.
The Relationship between Atopy and Chronic Rhinosinusitis
Authors: Robinson Simon , Douglas Richard , Wormald Peter-John
Published: December 2006

Background

The aim of this study was to determine whether atopy influences either clinical and radiological severity or surgical revision rates in patients with chronic rhinosinusitis (CRS).

Methods

Patients who had been scheduled for endoscopic sinus surgery were classified as having CRS or nasal polyposis. Their atopic status was determined by ImmunoCAP testing. Disease severity was assessed clinically by the Lund symptom and Sino-Nasal Outcome Test 20 (SNOT-20) quality-of-life scores and radiologically by the Lund-Mackay CT score.

Results

One hundred ninety-three consecutive patients with rhinosinusitis were included in the study. The prevalence of atopy in this group was found to be 30%. No association was found between atopic status and Lund symptom scores. Analysis of the SNOT-20 scores indicated that atopic patients had higher sneezing scores (p < 0.03), reduced productivity (p < 0.01), and reduced concentration (p < 0.01). The mean CT score was significantly higher in the atopic patients than in nonatopic patients overall (14.2 ± 1.6 versus 12.2 ± 1.3; p = 0.05), although within each of the clinical subgroups no statistically significant relationship was observed between a patients’ atopic status and their CT scores. The rate of revision surgery was not significantly different between atopic and nonatopic patients.

Conclusion

These results suggest that atopic status has minimal impact on the severity of CRS.
Do Nasal Polyps and Inverted Papilloma have Similar Disorders in Cell Cycle Regulation?
Authors: Robinson Simon , Tan Lor-Wai , James Craig , Karakousis Angelo , Wormald Peter-John
Published: December 2006

Background

The aim of this study was to determine the expression of cell cycle regulation genes in patients with inverted papilloma (IP) and compare this with expression in patients with nasal polyps (NPs).

Methods

Tissue from 18 patients with IP and 5 patients with NPs were stained by immunohistochemistry techniques for p53 and p27. Measurement of the gene expression was performed by three assessors, who we blinded with respect to the specimens.

Results

The mean score for p53 expression (3.33) was significantly higher in the IP group than the NP group (1.46). The mean difference between IP and NPs was 1.80 (CI, 1.15–2.46; p = 0.003). Additionally, we showed in a number of individuals variation in the p53 expression within the same specimen. There was no difference in the mean scores for p27, with the mean difference 0.79 (CI, 0.30–1.89; p = 0.147).

Conclusion

Our study established a significantly increased expression of p53 in IP when compared with NPs. Additionally, there appear to be two different cell populations identified within the same specimens, which exhibited variation in their p53 expression.
Long-Term Effect of Stenting after an Endoscopic Modified Lothrop Procedure
Authors: Banhiran Wish , Sargi Zoukaa , Collins William , Kaza Sarita , Casiano Roy
Published: December 2006

Background

The aim of this study was to study the effect of stenting with a silastic sheet on the long-term patency of the common frontal ostium after an endoscopic modified Lothrop procedure (EMLP).

Methods

A retrospective analysis was performed of prospectively collected data at an academic tertiary referral center, where 72 patients underwent an EMLP between 1996 and 2003. Patency of the common frontal ostium was studied as an ordinal variable with three classes (patent, stenotic, and closed).

Results

A common ostium was endoscopically visualized in 94% of the patients (61.1% patent and 33.3% stenotic). Symptoms improved in 75% of the patients. A significant positive correlation was found between ostium patency and symptom improvement. Twenty-five patients were stented postoperatively. There was no statistical difference between the stented and the nonstented groups with regards to ostium patency and symptoms improvement.

Conclusion

Short-term stenting does not appear to reduce the rate of postoperative stenosis of the common frontal ostium after an EMLP.
Medical and Surgical Considerations in Patients with Samter's Triad
Authors: McMains K. Christopher , Kountakis Stilianos E.
Published: December 2006

Background

The aim of this study was to report on objective and subjective outcomes of patients with Samter's triad (ST) treated with functional endoscopic sinus surgery (FESS), and correlate these results with aspirin desensitization (DS) in patients.

Methods

We performed a retrospective analysis of prospectively collected data in 15 patients requiring revision FESS after failing maximum medical therapy and prior sinus surgery for chronic rhinosinusitis in the context of ST. Five patients underwent aspirin DS and 10 patients did not (non-DS). These patients represent a subset of patients previously reported who were treated in a tertiary rhinology setting over a 3-year period (1999–2001). CT scans were graded according to the Lund-Mackay grading scale and symptom scores were assessed using the Sino-Nasal Outcome Test (SNOT-20). Endoscopy was scored according to the Rhinosinusitis Task Force methodology. All patients had a minimum 2-year follow-up.

Results

Preoperative CT scores were 20.1 ± 1.9 for non-DS patients and 20.4 ± 2.0 for DS patients (p = NS). Preoperative and postoperative SNOT-20 scores for non-DS patients were 31.8 ± 3.9 and 8.8 ± 1.7, respectively, as compared with 32.0 ± 3.6 and 7.3 ± 1.7 for DS patients (p = NS). Preoperative and postoperative endoscopy scores for non-DS patients were 7.6 ± 1.2 and 2.0 ± 0.4, respectively, as compared with 7.6 ± 1.3 and 1.1 ± 0.4 for DS patients (p = NS). Of DS patients, none required additional surgery whereas 8 of 10 non-DS patients required additional revision during the follow-up period (p = 0.003).

Conclusion

Revision FESS benefits patients with ST; however, the addition of aspirin DS decreases the likelihood that patients with ST will require additional surgical intervention over a 2-year period.
Role of FEF25–75 as an Early Marker of Bronchial Impairment in Patients with Seasonal Allergic Rhinitis
Authors: Ciprandi Giorgio , Cirillo Ignazio , Klersy Catherine , Marseglia Gian Luigi , Vizzaccaro Andrea , Pallestrini Eugenio , Tosca Mariangela
Published: December 2006

Background

Allergic rhinitis may be associated with asthma. Forced expiratory flow between 25 and 75% of vital capacity (FEF25–75) is a measure of small airways narrowing. The aim of this study was to evaluate whether patients with seasonal allergic rhinitis (SAR) without symptoms of asthma might, nevertheless, have airways obstruction both in and out of the pollen season.

Methods

Fifty patients (mean age, 23.7 ± 4.9 years) with SAR were evaluated both during and outside the pollen season. All of them had moderate–severe grade of nasal obstruction. Total symptom score, rhinomanometry, nasal lavage, nasal scraping, spirometry, and methacholine (MCH) bronchial challenge were assessed in all subjects.

Results

Although data on forced vital capacity and response to MCH were similar in and out of the pollen season, all other parameters were markedly different. The major finding of the study was that FEF25–75 was significantly associated with nearly all of the parameters considered, including bronchial hyperreactivity, with Pearson R ranging from 31 to 75% and differences in mean FEF25–75 ranging between 14.5 and 16.5% of predicted. The more significant association was with nasal airflow in the pollen season (R = 82.8%; p < 0.001). A significant association persisted for all parameters while controlling for season.

Conclusion

This study highlights the link between upper and lower airways and the role of FEF25–75 as an early marker of bronchial impairment in those patients with SAR alone.
An Assessment of Sinus Quality of Life and Pulmonary Function in Children with Cystic Fibrosis
Authors: Friedman Ellen M. , Stewart Michael
Published: December 2006

Background

Treatment of patents with cystic fibrosis (CF) is primarily directed at the lungs. However, there is a growing feeling that the status of the sinuses may have a profound influence on the status of the lungs in these patients. A number of investigators have demonstrated a relationship among coexisting rhinitis, sinusitis, other upper airway conditions, and lung disease. Several studies have shown that treatment and resolution of sinusitis results in an improvement in a number of pulmonary conditions. We hypothesize that pulmonary function test scores will be lower in patients with CF with more severe sinusitis.

Methods

Consecutive CF patients were asked to complete a sinus-specific quality-of-life instrument, the 16-item Sino-Nasal Outcome Test (SNOT-16), and these scores, were compared to FEV1 scores.

Results

Univariate analysis revealed a significant correlation between SNOT-16 and FEV1 in patients under the age of 12. There was a trend toward significance in the older children and evaluation of the raw data shows that children with the highest FEV1 had the lowest SNOT-16.

Conclusion

This study indicates that the severity of sinus disease correlates with the severity of pulmonary disease in CF patients under the age of 12. We plan to use the SNOT-16 to assess sinus interventions on pulmonary status.
Differential Effects of Insulin-Like Growth Factors on Scratch Wound Repair in Respiratory Epithelial Cells
Authors: Adams Damian H. , McIntosh David , Wormald Peter-John , Cowin Allison J.
Published: December 2006

Background

Insulin-like growth factors (IGFs) I and II, being potent promoters of cellular growth and differentiation, were investigated for their effectiveness in improving the rate of scratch closure in human respiratory epithelium in vitro.

Methods

Human epithelial cell lines from the nasal, bronchial, and tracheal regions were analyzed for their response to IGF-I and IGF-II, in a confluent monolayer scratch assay. IGF-binding proteins (IGFBPs) produced by certain cells are able to reduce the effectiveness of the IGFs. Consequently, the analogues LongR3 IGF-I, Des1–3 IGF-I and Arg3 IGF-I were investigated also because of their lower affinity for the IGFBPs, while still retaining unaffected affinity for the IGF-I receptor.

Results

All growth factors that were analyzed significantly improved the rate of scratch closure in bronchial and tracheal epithelial cells (p ≤ 0.05). In comparison, scratch closure was markedly slower in nasal epithelial cells and IGF-I was the most effective growth factor at effecting scratch closure in these cells. The IGF-I analogues did not significantly improve scratch closure compared with IGF-I, despite the presence of IGFBP-3 in nasal, bronchial, and tracheal epithelial cells.

Conclusion

Addition of IGF-I to wounded nasal epithelial cells increases the rate of scratch closure and therefore may have potential for improving the healing of the nasal mucosa.
The Role of Mitomycin C in Surgery of the Frontonasal Recess: A Prospective Open Pilot Study
Authors: Amonoo-Kuofi Kwame , Lund Valerie J. , Andrews Peter , Howard David J.
Published: December 2006

Background

Mitomycin C (MMC) inhibits fibroblast proliferation. The objective of this study was to determine the efficacy of MMC in reducing frontal ostium stenosis after endoscopic sinus surgery.

Methods

A prospective open pilot study was conducted in 28 patients who had undergone one or more previous surgical interventions for frontal sinusitis. MMC solution was applied to the frontal ostial region via an endoscopic or combined endoscopic and external approach. Patency of the frontal ostium was evaluated endoscopically during regular follow-up. If restenosis was observed further, endoscopic application of MMC was undertaken.

Results

There were 17 men and 11 women (mean age, 51.7 years; range, 26–86 years). Mean number of applications was 1.5 (range, 1:3). Mean follow-up was 19 months (range, 6–32 months). Patency rate was 86%.

Conclusion

Mitomycin appears to have an important role in reducing postoperative scarring, which may obviate the need for repeated and more extensive surgery.
The Up-Regulated Expression of Tenascin C in Human Nasal Polyp Tissues is Related to Eosinophil-Derived Transforming Growth Factor β1
Authors: Liu Zheng , Lu Xiang , Wang Heng , Gao Qixue , Cui Yonghua
Published: December 2006

Background

Tissue remodeling is an important characteristic of nasal polyps (NPs). However, the mechanisms underlying the remodeling processes are poorly defined. This study investigated the role of transforming growth factor (TGF) β1 and eosinophils in the expression of tenascin C (Tn-C), an extracellular matrix glycoprotein, in NPs.

Methods

The protein expression of Tn-C and TGF-β1 was examined by means of immunohistochemistry in NPs and normal control inferior turbinate tissues. Furthermore, cell culture, quantitative RT-PCR, and in situ immunocytofluorescence techniques were used to investigate the direct effect of TGF-β1 and eosinophils on Tn-C production in primary nasal epithelial cells.

Results

Tn-C protein expression was significantly up-regulated in NP tissues and correlated with TGF-β1+ eosinophils. TGF-β1 and eosinophils dramatically induced Tn-C mRNA and protein expression in nasal epithelial cells. The effect of eosinophils could be inhibited partly by a neutralizing antibody to TGF-β1.

Conclusion

Eosinophil-derived TGF-β1 may contribute, at least in part, to the tissue remodeling in NPs.
The role of Accompanying Sinonasal Abnormalities in the Outcome of Endonasal Dacryocystorhinostomy
Authors: Eyigör Hülya , Ünsal A. İpek , Ünsal Alparslan
Published: December 2006

Background

Acquired nasolacrimal duct obstruction may occur simultaneously and possibly as a consequence of sinonasal disease, because the nasolacrimal system is anatomically related to important nasal and sinus structures.

Methods

Thirty-seven patients with nasolacrimal canal obstruction (42 eyes) were evaluated with paranasal sinus computerized tomography (CT) to determine the presence of sinonasal abnormalities if any. All of the patients underwent endoscopic dacryocystorhinostomy (end-DCR) and accompanying sinonasal pathology was treated also in the same session.

Results

Paranasal sinus CT examinations revealed one or more sinonasal abnormalities in 26 (73.3%) patients. The postoperative success rate of end-DCR procedure in patients with sinonasal abnormalities was 82.8%, whereas this figure increased to 92.3% in patients without additional sinonasal disease. However, additional rhinological surgery did not affect the success rate of end-DCR procedure significantly (p = 0.640).

Conclusion

These data establish a positive correlation between sinonasal abnormalities and the presence of nasolacrimal outflow obstruction, but the additional rhinological surgery does not significantly affect the results of the end-DCR procedure.
Making the Call: The Diagnosis of Acute Community-Acquired Bacterial Sinusitis
Authors: Le Annie V. , Simon Ronald A.
Published: December 2006

Background

Although one of the most common illnesses encountered in the primary care setting, acute community-acquired bacterial sinusitis (ACABS) can be a challenge to diagnose.

Methods

Existing diagnostic modalities ranging from clinical history to imaging studies used to diagnose ACABS are discussed.

Results

Numerous methods exist but they do not distinguish well between viral and bacterial illness.

Conclusion

Diagnosis of ACABS should primarily be made based on the clinical history. Other modalities provide useful information in select cases.
Invasive Fungal Rhinosinusitis: What is the Appropriate Follow-Up?
Authors: Otto Kristen J. , DelGaudio John M.
Published: December 2006

Background

Early detection and aggressive surgical and medical management have been associated with higher overall survival rates among patients with invasive fungal rhinosinusitis (IFS). With improved survival comes the question of how to appropriately manage these patients once disease stability has been achieved. Previous reports suggest follow-up only as long as the patients remain immunocompromised. This study attempts to answer the question of long-term clinical follow-up and suggests a regimen suitable for ensuring minimal posttreatment complications.

Methods

A retrospective review included all patients diagnosed with IFS between 1988 and 2004. The study group included patients who survived the initial treatment course, with at least 30 days of posttreatment follow-up of their IFS. Patient records were reviewed for significant complications, evidence of chronic sinus disease, the clinical status of their underlying medical comorbidities, and frequency and mode of follow-up.

Results

Thirteen patients were included. The average follow-up time was 633 days. Significant complications included one patient with acute bacterial sinusitis with resultant visual loss and one patient with chronic osteomyelitis of the orbit and skull base. Six of 13 patients had persistent chronic bacterial rhinosinusitis with crusting and bone sequestration. All complications were noted to occur after initial IFS eradication was thought to have taken place.

Conclusion

Significant complications of IFS can occur after medical remission and recovery of immune competence. Patients with IFS should be followed long term until remucosalization of the sinuses, resolution of crusting, and cessation of bony sequestration has occurred.
Respiratory Epithelial Adenomatoid Hamartomas and Chondroosseous Respiratory Epithelial Hamartomas of the Sinonasal Tract: A Case Series and Literature Review
Authors: Roffman Eric , Baredes Soly , Mirani Neena
Published: December 2006

Background

Respiratory epithelial adenomatoid hamartomas (REAH) and chondroosseous respiratory epithelial (CORE) hamartomas are rare sinonasal/nasopharyngeal lesions first characterized in 1995. Although REAH and CORE hamartomas are benign, nonneoplastic lesions, awareness and recognition of these lesions are important because they can be confused grossly and microscopically with more threatening sinonasal tumors.

Methods

This report presents two cases of REAH and one case of a CORE hamartoma. The literature regarding REAH and CORE hamartomas is reviewed, and their distinction from related entities of the sinonasal tract and nasopharynx is discussed.

Conclusions

Misdiagnosing REAH or CORE hamartoma as either inverted papilloma or adenocarcinoma may lead to far more aggressive surgical intervention then is necessary.
A Multicenter Evaluation of the Safety of Gore-Tex as an Implant in Asian Rhinoplasty
Authors: Jin Hong-Ryul , Lee Joo-Yeon , Yeon Je-Yeob , Rhee Chae-Seo
Published: December 2006

Background

A retrospective multicenter study examined the safety of Gore-Tex as a nasal implant in rhinoplasty.

Methods

This study involved 853 patients (656 primary surgeries and 197 secondary surgeries) who had undergone rhinoplasty and used Gore-Tex either at the dorsum or at the nasal tip. Data were extracted from the medical records by surgeons and entered on a standard form. Data included the information about the demographics and history of the patient, method and results of surgery, complications, follow-up, and various factors believed to predispose to complications.

Results

The average follow-up period was 18 months. Overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases; 2.1%) followed by two cases of seroma and one case of persistent nasal swelling. Among the 21 suffering complications, 19 patients (91%) needed graft removal. Nine cases of infection developed in primary surgeries (1.4%) and nine cases developed in secondary surgeries (4.6%), which represented a statistically higher complication rate in those undergoing secondary surgery (p = 0.0062). Infections developed within 1 month in five cases and nine cases developed infection >6 months postoperatively. Other complications including esthetic problems were identified in 16 cases (1.9%).

Conclusion

Gore-Tex should be used judiciously in rhinoplasty because of a 2.1% infection rate, a risk that is higher still after secondary surgery; moreover, once infected, Gore-Tex implants usually require removal.
High-Resolution Computed Tomography Analysis of the Greater Palatine Canal
Authors: Das Subinoy , Kim Doil , Cannon Trinitia Y. , Ebert Charles S. , Senior Brent A.
Published: December 2006

Background

The greater palatine foramen injection is effective for minimizing bleeding during sinus surgery. The correct depth is important to minimize risk of orbital penetration. This study analyzed the length of the greater palatine canal using high-resolution computed tomography (HRCT).

Methods

HRCT sinus scans from 100 adults were analyzed. One thousand two hundred measurements were performed by three observers.

Results

The mean distance of the greater palatine foramen to the orbital floor was 40 ± 3 mm in men and 37 ± 3 mm in women (range, 32–46 mm). The mean distance of the greater palatine foramen to the sphenopalatine foramen was 28 ± 2 mm in men and 27 ± 2 mm in women (range, 23–33 mm).

Conclusion

The greater palatine foramen injection is an appropriate method to minimize bleeding during endoscopic sinus surgery. The authors recommend an injection depth of 25 mm in adults to minimize the risk of intraorbital complications.
Polymorphism at the Glutathione S-Transferase P1 Locus in Korean Patients with Perennial Allergic Rhinitis
Authors: Chung Yoo-Sam , Cha Heung-Eog , Kang Il-Gyu , Hwang You-Jin , Kim Seon-Tae
Published: December 2006

Background

Oxidative stresses, which induce the reactive oxygen species (ROS), can cause airway inflammation. The glutathione S-transferases (GSTs) protect cells against the effects of ROS. GSTP1 polymorphism may have some effect on allergic rhinitis. Therefore, we have compared the effects of GSTP1 polymorphisms on the perennial allergic rhinitis in Koreans.

Methods

Patients with perennial allergies (149 patients) were selected. The control group included 156 healthy people. Genotypes were evaluated via polymerase chain reaction and restriction fragment length polymorphism, using the Alw26I restriction enzyme.

Results

There was no significant difference between groups in the proportions of the Ile/Ile (wild type) and Ile/Val (heterozygote) genotypes. However, the Val/Val (mutant type homozygote) was expressed in only one case (0.7%) in the perennial allergic rhinitis group, as compared with 11 cases (7.1%) in the controls (p < 0.05).

Conclusion

Our results indicate that the Val/Val genetic polymorphism of GSTP1 may exert some protective effects in allergic inflammation.