bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of sudden sensorineural hearing loss: a consultant survey
Authors: Loughran
Published: October 2002

A questionnaire was sent to 100 consultant otolaryngologists from three selected health regions in the United Kingdom enquiring about their assessment and management of a patient presenting with sudden-onset sensorineural hearing loss. Seventy – six replied, of whom 42 stated a sub – specialist interest in otology. Seventy – eight percent of respondents would order routine blood tests including the erythrocyte sedimentation rate (ESR) and syphilis serology; in addition 38 per cent would order a magnetic resonance image (MRI) scan at the first presentation. The vast majority would treat such a patient (89 per cent), although the method and combination varied widely. A review of the literature confirmed that the level of evidence for treating this condition is limited and therefore the wide disparity in consultants’ practice is not surprising.
Clinically staged T3N0M0 laryngeal cancer: how is it best treated? Definitive radiotherapy with salvage surgery v/s combined surgery and radiotherapy
Authors: Thakar A. , Bahadur S. , Mohanti B. K. , Nivsarkar S.
Published: October 2002

Controversy surrounds the optimum treatment of T3N0 cancer larynx. Curative radiotherapy with salvage surgery in reserve is an accepted methodology as is also a combined protocol of surgery and radiotherapy. A retrospective analysis of the survival results of 119 cases of clinically staged T3N0 cancer larynx treated over a 14-year period at a single centre with either of the above two modalities has been undertaken. The selection of the treatment modality for an individual patient was decided jointly by the patient and the clinicians at a combined cancer clinic. The combined surgery plus radiotherapy treatment group was comprised of a relatively greater number of transglottic tumours while the curative radiotherapy group had a higher proportion of glottic tumours. Actuarial four-year disease-free survival rates were significantly better with combined treatment (79.3 per cent) than with radical radiotherapy and surgical salvage (65.3 per cent) − p value = 0.024. In the radical radiotherapy group, failure was almost always at the primary site and the probability of surviving with an intact larynx was approximately half of the total survival. As per this study, a policy of radical radiotherapy (with salvage surgery for failure) for unselected clinically staged T3N0 cancer larynx, does not provide for comparable cure rates or for satisfactory laryngeal preservation.
Head and neck schwannomas – a 10 year review
Authors: Colreavy M. P. , Lacy P. D. , Hughes J. , Bouchier-Hayes D. , Brennan P. , O’Dwyer A. J. , Donnelly M. J. , Gaffney R. , Maguire A. , O’Dwyer T. P. , Timon C. V , Walsh M. A.
Published: October 2002

Schwannomas of the head and neck are uncommon tumours that arise from any peripheral, cranial or autonomic nerve. Twenty-five to 45 per cent of extracranial schwannomas occur in the head and neck region and thus are usually in the domain of the otolaryngologist. They usually present insidiously and thus are often diagnosed incorrectly or after lengthy delays, however, better imaging and cytological techniques have lessened this to some degree more recently. For benign lesions conservative surgical excision is the treatment of choice bearing in mind possible vagal or sympathetic chain injury. Malignant schwannomas are best treated with wide excision where possible. The role of adjuvant therapy remains uncertain and irrespective of treatment modality prognosis is poor with an overall survival of 15 per cent. However, recent advances in ras oncogene inhibitors may hold hope for the future.
Thyroglossal duct remnants
Authors: Waddell A. , Saleh H. , Robertson N. , Khalil H. S. , Bridger M. W. M.
Published: October 2002

Thyroglossal duct remnants presenting as a lump in the neck are usually called thyroglossal cysts. Meticulous dissection of the cyst and duct, along with the body of the hyoid bone (Sistrunk’s operation) is necessary to avoid recurrence. The authors have reviewed the histology of 61 consecutive specimens diagnosed preoperatively as thyroglossal cysts and have found that a true cyst exists in only 46 per cent of cases.
Association of p53 expression with second primary tumour development in hypopharyngeal carcinoma
Authors: Hattori Kenji , Inohara Hidenori , Sawada Toru , Honjo Yuichiro , Yoshida Jun-Ichi , Kubo Takeshi
Published: October 2002

Abnormalities of p53 tumour suppressor gene are detected in a diversity of malignancies and play an important role in their pathogenesis. Hypopharyngeal carcinoma is the most morbid among head and neck squamous cell carcinomas because of the high incidence of treatment failures and because a biological marker predictive of the treatment failures remains elusive. The expression of p53 protein in 46 hypopharyngeal squamous cell carcinomas was examined histochemically and p53 immunoreactivity was found in 19 of 46 cases (41.3 per cent). The rate of second primary tumour development was significantly higher in the p53-positive group than in the p53-negative group (p = 0.039), whereas that of tumour recurrence was not significantly different between the two. Moreover, there was no statistically significant difference in either overall or disease-free survival between the p53-positive and -negative groups. These results indicate that although p53 expression significantly correlates with second primary tumour development in patients with hypopharyngeal squamous cell carcinomas, it is not predictive of the clinical outcome.
Brown tumour of hyperparathyroidism in the mandible associated with atypical parathyroid adenoma
Authors: Goshen Oran , Aviel-Ronen Sarit , Dori Shay , Talmi Yoav P.
Published: October 2002

The brown tumour of hyperparathyroidism is a localized bone tumour and an uncommon manifestation of hyperparathyroidism. A 27-year-old woman presented with a mandibular 8 × 10 cm solid mass diagnosed as central giant cell granuloma. Chemical blood analysis revealed increased serum calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124 pg/dL. The patient underwent surgery with removal of a parathyroid mass. Histologically, this parathyroid tissue was seen to be limited by a fibrous capsule with morphological features consistent with atypical parathyroid adenoma. The mandibular tumour has receded and the patient declined further procedures. This is the first case reported of brown tumour as the primary manifestation of an atypical parathyroid adenoma, a lesion that shares some features with parathyroid carcinoma without the unequivocal properties of malignancy.
Defects of the external auditory canal: a new reconstruction technique
Authors: Anand V. T. , Latif M. A. , Smith W. P.
Published: October 2002

This report describes the clinical and radiographic findings together with surgical management of temporomandibular joint contents herniation through the tympanic plate of the external auditory canal. Two patients are reported. A review of the literature is presented, including a brief discussion of the embryological development of the external auditory canal. Excluding infection, trauma or neoplasm, the defect in the tympanic plate of the external auditory canal represents a developmental aberration with failure of the foramen of Huschke to close during development.

A pre-auricular approach with insertion and fixation of an onlay polyethylene implant to prevent prolapse of the peri-articular tissues into the ear canal is presented and described.
Abscess formation in the temporomandibular joint as a complication of otitis media
Authors: Takes R. P. , Langeveld A. P. M. , de Jong R. J. Baatenburg
Published: October 2002

A case of an eight-month-old girl with an abscess in the temporomandibular joint as a complication of acute otitis media is described. The complications of acute otitis media in general and the probable explanation for the development of this complication are discussed.
Angiosarcoma of the maxillary sinus
Authors: Velegrakis George A. , Panayiotides John G. , Skoulakis Charalambos E. , Papadakis Chariton E. , Papadakis Dimitrios G. , Bizakis John G. , Helidonis Emmanuel S.
Published: October 2002

Angiosarcomas are rapidly growing malignant neoplasms arising from the vascular endothelial cells. Most common sites are the extremities and the retroperitoneal space, with only four per cent of angiosarcomas arising in the head and neck area, whilst the paranasal sinuses are one of the rarest locations. We report the case of a maxillary sinus angiosarcoma in a 72-year-old male patient. The first biopsy was inconclusive, whereas the second revealed an angiosarcoma. Medial maxillectomy was performed with subsequent external irradiation.
Risk management of asymmetrical hearing impairment in an armed forces population
Authors: Caldera S. R. M. , Pearson C. R.
Published: October 2002

The prevalence of asymmetrical hearing impairment in the entire service population (1490 individuals) of a Royal Air Force flying station was estimated from routine audiometric testing recorded in individuals’ medical records. Criteria for magnetic resonance imaging (MRI) scanning to exclude the possibility of vestibular schwannoma were determined in accordance with the risk management principle that the cost of the screening should not exceed the value of the likely benefit. MRI scanning should be carried out in the presence of an asymmetrical sensorineural hearing impairment of (a) 15 dB or more at two adjacent frequencies, or (b) 15 dB or more averaged over 0.5, 1, 2, 3, 4, 6 and 8 kHz.
Aryepiglottoplasty for laryngomalacia: 100 consecutive cases
Authors: Toynton S. C. , Saunders M. W. , Bailey C. M.
Published: October 2002

A retrospective review of the notes of 100 consecutive patients who had undergone aryepiglottoplasty for laryngomalacia, at Great Ormond Street Hospital for Children, was undertaken. Fifty-six were male, 44 female and 47 were under three months of age. Indications for surgery were oxygen desaturation below 92 per cent and feeding difficulties causing failure to thrive. Forty-seven patients had other pathology contributing to their airway compromise or feeding problems. Improvement in stridor after one month was achieved in 86/91 (94.5 per cent) being abolished completely in 50/91 (55 per cent). Of the 25 per cent of patients whose symptoms took more than one week to resolve, 16/22 (63.6 per cent) were later found to have a serious neurological condition. Feeding was improved in 42 of 58 patients (72.4 per cent) who had a pre-operative feeding difficulty. The complication rate was low, with only five out of 86 (10 per cent) experiencing initial worsening of the airway and six per cent having aspiration of early feeds before improvement occurred.

Endoscopic aryepiglottoplasty remains the operation of choice for patients with severe laryngomalacia, however, in the presence of neurological disease surgery is less likely to be successful.
Neurofibromatosis Type 1 of the head and neck: dilemmas in management
Authors: Rapado Fernando , Simo Ricard , Small Mike
Published: October 2002

Neurofibromatosis type 1 (NF 1) or Von Recklinghausen’s disease is an autosomal dominant condition characterized by multiple skin cafe´-au-lait lesions and multiple neurofibromas. In the head and neck neurofibromas have a predilection to arise in th deep planes of the neck. Surgical management is nearly always required for functional or cosmetic reasons or to exclude the possibility of malignant transformation. We present four cases of neurofibroma of the head and neck and illustrate the difficulties inherent in managing this condition, particularly the age range in which it may occur, the risk of malignant transformation, the possibility of abnormal bleeding and the morbidity that may be associated with the surgical resection. The role of magnetic resonance (MR) scan in the assessment and monitoring of these lesions is highlighted. We also report a unique association of a pharyngeal pouch with NF 1 in a young (25-year-old) patient.
Ischaemic optic neuropathy following bilateral neck dissection
Authors: Fenton S. , Fenton J. E. , Browne M. , Hughes J. P. , Connor M. O. , Timon C. I.
Published: October 2002

Two cases of ischaemic optic neuropathy, which occurred as a complication of oncological neck surgery, are reported. These cases are submitted because of the apparent scarcity in the literature of this complication after head and neck surgery. They are also unusual because they presented with different clinical manifestations of ischaemic optic neuropathy after separate forms of bilateral neck dissection. A literature review identifies a small number of similar cases and risk factors and preventative measures are discussed.
In vitro study of a multi-layer piezoelectric crystal attic hearing implant
Authors: Mills R. P. , Wang Z. G. , Abel E. W.
Published: October 2002

We have developed a prototype middle-ear hearing implant which uses a multilayer piezoelectric actuator. In this series of experiments the actuator was attached to the medial wall of the attic so that it makes contact with the body of the incus. Initial in vitro evaluation has been carried out using a laser vibrometer (Polytec CLV) to measure stapes velocity. Stapes displacement is calculated by mathematical integration. The device used in this way is particularly effective at transmitting high frequency sound to the stapes. When switched off the actuator impairs the transmission of sound to the ossicular chain at low frequencies, but this effect is only 7 dB at most. The stapes displacements resulting from the action of the implant have a linear relationship with the voltages used to drive the system. The high capacitance of the present actuator means that its power requirements are higher than that of other comparable devices. An optimal method of coupling the device to the incus has yet to be identified.
Endoscopy in the assessment of children with nasal obstruction
Authors: Kubba Haytham , Bingham Brian J. G.
Published: October 2002

Nasal obstruction is common in children, and is often attributed to adenoid enlargement. This prospective study was performed to determine whether routine nasal endoscopy is of value for children undergoing surgery for nasal obstruction. Forty-eight children aged two to nine years undergoing adenoidectomy, and six normal controls, were examined under general anaesthesia with a 4 mm rigid endoscope. A video of the endoscopy was subsequently assessed independently by an observer blinded to the original findings and the presence of nasal symptoms.

The endoscopist and independent assessor were in agreement regarding 86 per cent of the findings. Three quarters of the children had abnormalities on endoscopy in addition to enlarged adenoids, and in 23 per cent these were potentially of major clinical significance (unsuspected foreign body, gross septal deviation, gross hypertrophy of the turbinates). Endoscopy produced no post-operative complications and was possible in children as young as two years of age, without decongestants.

Nasal endoscopy is a safe, objective and useful means of identifying potentially significant abnormalities in children with nasal obstruction.
What is the value of ENT specialist outreach clinics?
Authors: Ayshford  , Johnson  , Chitnis
Published: October 2002

Ear, nose and throat (ENT) specialist outreach clinics, in which hospital-based consultants hold clinics in general practice surgeries, have been popular with general practitioners (GPs) and patients. This prospective study recorded data on 1155 consecutive patients seen by one ENT surgeon in two GP surgeries. At each consultation, a record was kept of the requirement for further investigations that would normally be done at the same time as the consultation in a hospital department. The results showed that 76 per cent of patients needed an investigation, which would be readily available in a hospital but not in a GP surgery (audiometry, endoscopy, microscopy of the ear, a minor procedure or X-ray). This study indicates that despite the apparent convenience of outreach ENT clinics to patients and GPs, patients may need to spend more time being assessed than they would if they were investigated in one visit to a hospital department. Unless an outreach clinic is used frequently, it is difficult to justify the cost of equipping it to the same level as a hospital department. Limited resources would be better spent providing good access to well-equipped regularly-used hospital ENT outpatient departments.
Artificial tympanic membrane and ossiculoplasty
Authors: Raut  , Kerr
Published: October 2002

We report an unusual case of a subjective hearing improvement, confirmed by audiometry, in a patient using a paper towel prosthesis.
Tuberculous meningitis presenting as sensorineural hearing loss
Authors: Kotnis Rohit , Simo Ricard
Published: October 2002

We report a 60-year-old male who presented to the Otorhinolaryngology department with an acute unilateral sensorineural hearing loss associated with fever and night sweats. The diagnosis of tuberculous meningitis was made. Unilateral sensorineural hearing loss as a presenting symptom of tuberculous meningitis has not been previously reported.
Quality of life in laryngectomees: a post-treatment comparison of laryngectomy alone versus combined therapy
Authors: Paleri Vinidh , Stafford Frank , Leontsinis Timothy , Hildreth Antony
Published: October 2002

Patients with advanced and recurrent laryngeal and hypopharyngeal cancer often need combined therapy, which is associated with greater morbidity than single modality treatment. The aim of this study was to assess the quality of life in laryngectomees and to assess whether differences exist between the irradiated and the non-irradiated patients. The University of Michigan Head and Neck Quality of Life questionnaire, a validated instrument for assessing the head and neck cancer related functional status and well-being, was used for this purpose. Subjects for the study included patients who had undergone total laryngectomy for laryngeal or hypophyarngeal squamous cancer. No significant difference between the groups was evident in the various domain scores, although a trend towards higher scores was seen in the combined therapy group. This study suggests that long-term side effects induced by radiotherapy do not adversely affect the quality of life in laryngectomised patients.
Blood splash and tonsillectomy: an underestimated hazard to the otolaryngologist
Authors: Keogh Ivan , Hone Stephen , Colreavey Michael , Walsh Michael
Published: October 2002

Mucocutaneous exposure is an important route of transmission of hepatitis viruses and HIV in healthcare workers. Few data exist in the literature on the risk of transconjunctival exposure during many surgical procedures. We investigated the use of eye protection during tonsillectomy and measured the incidence of potential eye splash. No otolaryngologist surveyed routinely used eye protection during tonsillectomy. Splash events occurred in 23 out of 103 tonsillectomies. In all cases the surgeon was unaware of the splash. Splash events were significantly more likely to occur during adult tonsillectomy (p < 0.05). We strongly advise the routine use of eye protection during tonsillectomy.
Sudden onset bilateral sensorineural hearing loss: a manifestation of occult breast carcinoma
Authors: Uppal H. S. , Ayshford C. A. , Wilson F.
Published: October 2002

Diffuse infiltration of the meninges by metastatic carcinoma (meningeal carcinomastosis) is a potential complication of systemic malignancy. It may present with a variety of neurological symptoms as any aspect of the neuraxis can be affected. Often there is a history of pre-existing malignancy.

The authors describe a case with an initial presentation of sudden onset profound bilateral sensorineural hearing loss. The underlying pathology was found to be an occult breast carcinoma, a previously unreported finding.

The role of cerebrospinal fluid cytology and radio-imaging in diagnosis is discussed. All previously reported cases of sudden hearing loss and meningeal carcinomatosis are reviewed.
Metastatic malignant melanoma of the larynx
Authors: Pau H. , De S. , Spencer M. G. , Steele P. R. M.
Published: October 2002

Metastatic malignant melanoma of the larynx is considered to be extremely rare by most authors. This paper describes a 78-year-old patient, previously treated for cutaneous malignant melanoma and intestinal fibrosarcoma, who presented with stridor due to a metastatic melanoma in the larynx. It was a pedunculated lesion and surgical excision of the lesion was accomplished with a tonsillar snare. This paper further discusses the evolving history, diagnosis and treatment of this metastatic tumour, and reviews the literature regarding previously reported cases.
First case of full-thickness palatal necrotizing sialometaplasia
Authors: Daudia A. , Murty G. E.
Published: October 2002

Necrotizing sialometaplasia is an uncommon, benign, self-limiting condition which can stimulate malignancy. The commonest site of occurrence is the hard palate. We report the first case with full thickness palatal involvement. The clino-pathological features of this condition are discussed.
Parapharyngeal space tumours: an 18 year review
Authors: Pang Kenny Peter , Goh Christopher H. K. , Tan How Ming
Published: October 2002

Parapharyngeal space tumours account for only 0.5 per cent of all head and neck tumours. Due to their inherent location, they present with varied non-specific signs and symptoms, resulting in a delay in diagnosis and unnecessary procedures, such as a ‘tonsillectomy’ or ‘incision and drainage’ of a ‘quinsy’. Thirty-one patients, operated on over an 18-year period (1981 to 1998), in the Department of Otolaryngology, Singapore General Hospital, are presented. Their ages ranged from 21 to 86 years, with a mean of 52 years, with equal sex distribution. The commonest aetiology was a deep lobe of parotid tumour (44 per cent), followed by neurilemmomas (18 per cent), there was only one paraganglioma. The transcervical and transparotid approaches were the commonest used. The mean surgical time was three hours, mean hospital stay was 5.3 days and post-operative complications were minimal. The average follow-up time was 5.6 years. Although parapharyngeal space tumours are uncommon, recognizing them would enable the correct sequence of investigations, instead of unnecessary procedures resulting in an increased morbidity for the patient.
Functional endoscopic sinus surgery in the treatment of massive polyposis in asthmatic patients
Authors: Uri Nechama , Cohen-Kerem Raanan , Barzilai Geva , Greenberg Elhanan , Doweck Ilana , Weiler-Ravell Daniel
Published: October 2002

The association between asthma and sinonasal disease has been known for years. Effective treatment of sinonasal disease, which is one of the factors that exacerbate asthma, may also improve and stabilize the asthmatic condition. This study examines the outcome of functional endoscopic sinus surgery (FESS) on asthmatic patients with massive nasal polyposis. Thirty-four asthmatic patients were included in the study. All were operated on in our department and were analysed for pre-operative data regarding their asthma and sinonasal disease. A questionnaire regarding subjective evaluation of asthma and sinonasal status was presented to the patients, and objective evaluations, including nasal endoscopy and spirometry, were performed. Follow-up endoscopy revealed satisfactory results in 88 per cent, with positive correlation to the patients‘ subjective assessment of nasal status. No such correlation was found with regard to subjective and objective assessment of asthma: a small group of patients had completely clean sinonasal cavities with no perceived improvement in their asthmatic condition. The use of prednisolone and bronchodilators was significantly reduced post-operatively. However, in a subgroup of 13 patients followed at the asthma clinic, who had adequate pre-operative and post-operative data, there was no difference in their pre- and post-operative asthma condition. Seven had minimal improvement and in six there was a definite worsening of their asthma; nevertheless, nasal breathing and quality of life improved in most patients. The mean follow-up was 2.1 years. Thus, we conclude that in this study FESS does not improve asthma, but does improve the quality of the life of the patient.
Prescription of binaural hearing aids in the United Kingdom: a knowledge, attitude and practice (KAP) study
Authors: Dutt Sunil N. , McDermott Ann-Louise , Irving Richard M. , Donaldson Ivor , Pahor Ahmes L. , Proops David W.
Published: October 2002

The purpose of this questionnaire study was to evaluate the existing knowledge of binaural hearing and the attitudes and practices of prescribing bilateral hearing aids amongst otolaryngologists in the United Kingdom. Of the 950 questionnaires sent to the current members of the British Association of Otolaryngologists and Head and Neck Surgeons (BAO-HNS), there were 591 respondents (62 per cent). The true response rate with completed questionnaires was 59 per cent. Eighty-one per cent of the respondents were aware of the importance of binaural hearing and had a positive attitude towards binaural fitting. The practice of bilateral hearing aid prescriptions was found to be poor amongst all grades on the NHS (less than 10 per cent of all hearing aid prescriptions). This practice in the private sector was variable, dependent largely on patient preference and affordability. The practice of binaural prescription was higher for patients in the paediatric age group than amongst adults. Two common indications for hearing aid prescriptions for unilateral deafness were otitis media with effusion in children (23 per cent of respondents) and for tinnitus masking in adults (12 per cent of respondents). Many otolaryngologists believed that there was not enough evidence to support bilateral bone-anchored hearing aid implantation and bilateral cochlear implantation. Ninety-four per cent of the respondents believed that binaural hearing was as important as binocular vision.
Emotional investments in surgical decision making
Authors: Kerr Alan G.
Published: October 2002

Gordon Smyth had a deep emotional investment in closed cavity surgery for cholesteatoma but, nonetheless, later acknowledged that he believed that he had been mistaken. Emotional investments create problems for all surgeons. Sometimes they have difficulty in recognizing that they need to change what they are doing. This is especially important in the management of Ménière’s disease where unproven surgical procedures are often perpetuated. Surgery on the endolymphatic sac is of doubtful value but still continues to be the most frequently performed operation for this condition. Surgeons need to reconsider the evidence and question the appropriateness of these operations.
Assessment of patency of the internal jugular vein following neck dissection and microvascular flap reconstruction by power Doppler ultrasound
Authors: de Bree Remco , van den Berg Fred G. , van Schaik Cors , Beerens Aad-Jan F. , Manoliu Radu A. , Castelijns Jonas A. , Snow Gordon B. , Leemans C. René
Published: October 2002

The objective of this study was to assess patency of the internal jugular vein following modified radical or selective neck dissection and microvascular flap reconstruction by power Doppler ultrasound and its impact on free flap survival. In 23 patients who underwent selective or modified radical neck dissection and microvascular flap reconstruction the patency of the internal jugular vein was examined by power Doppler ultrasound on the first post-operative day and after follow-up of at least four months. On the first post-operative day in one patient partial thrombosis was found, while in the other 22 patients the internal jugular vein was normal patent. During follow-up in 17 (74 per cent) patients a normal patent internal jugular vein was found, while partial and complete thrombosis were found in three (13 per cent) patients each. On the first post-operative day 22 of the 23 (96 per cent) free flap veins were visualized. There was no free flap loss during follow-up. Power Doppler ultrasound is a valuable diagnostic technique for determination of internal jugular vein patency and may be useful as screening method or in case of clinical suspicion of thrombosis to determine internal jugular vein patency. Late internal jugular vein thrombosis may probably not effect free flap survival due to neovascularization.
Cervical necrotizing fasciitis with thoracic extension after total laryngectomy
Authors: Beerens Aad J. , Strack van Schijndel Rob J. , Mahieu Hans F. , Leemans Charles R.
Published: October 2002

Cervical necrotizing fasciitis (CNF) with thoracic extension is rare. It has never been reported in laryngectomized patients. A case of fatal CNF in a laryngectomized patient equipped with a voice prosthesis is presented. Diagnosis and treatment are discussed. CNF with thoracic extension was diagnosed on clinical picture, computed tomography (CT) and biopsies were taken just above the tracheostoma. Antibiotic treatment was started and extensive debridement of the affected tissues performed. A minor extension to the left pleura was considered irresectable. Irradical debridement and the impossibility of administering hyperbaric oxygen therapy caused death within two day after presentation. CNF is a rare disease and to our knowledge, has never been reported after total laryngectomy. This case emphasizes the need for early antibiotic treatment and radical surgical resection of the affected tissues.
Dehiscence of the bony roof of the superior semicircular canal in the middle cranial fossa
Authors: Tsunoda Atsunobu , Terasaki Omi
Published: October 2002

Spontaneous dehiscence of the superior semicircular canal (SSC) in the middle cranial fossa is rare and may cause clinical problems. This dehiscence was investigated in cadaveric and dried temporal bone specimens. One cadaveric specimen showed a spontaneous defect: the dehiscence was a symmetrical, elongated ellipse with smooth margins. Four of 244 dry bone specimens showed bony defects in the roof of the SSC, however, only one specimen was thought to have a spontaneous defect. Based on computer-simulation models, we hypothesized that spontaneous defects of the SSC may arise during the fetal period. Although rare, this defect may cause problems in middle cranial fossa surgery and may relate to certain vertiginous disorders.
Effect of Ringer-Lactate and isotonic saline solutions on mucociliary clearance of tracheal epithelium: an experimental study in rats
Authors: Ünal Murat , Seymen Hakki Oktay
Published: October 2002

Isotonic saline solution is frequently used in nasal and tracheal lavage. In a previous clinical study, it was found that Ringer-Lactate solution, as a nasal lavage, was better for mucociliary clearance function than isotonic saline solution after nasal septal surgery. In this experimental study, the effects of Ringer-Lactate and isotonic saline solutions on mucociliary clearance of healthy rat tracheal epithelium were investigated by measuring the transport of carbon particles. We found that tracheal segments that were irrigated with Ringer-Lactate had better mucociliary transport than those irrigated with isotonic saline (p = 0.035).
Spontaneous CSF rhinorrhoea from separate defects of the anterior and middle cranial fossa
Authors: Raghavan U. , Majumdar S. , Jones N. S.
Published: October 2002

Multiple congenital dehiscence of the skull base is rare and can give rise to spontaneous CSF rhinorrhoea. A search of the world literature revealed only five reports of CSF leak with more than one concomitant skull base defect. When treating a patient with spontaneous CSF rhinorrhoea the possibility of its originating from the middle ear and eustachian tube should be considered. An intrathecal injection of fluorescein is useful in establishing the site of a CSF leak especially when a computed tomography scan (CT) or magnetic resonance image (MRI) has not localized the site. We discuss a case of a 72-year-old lady presenting with CSF rhinorrhoea, who had an anterior skull base defect localized with the help of intrathecal fluorescein and repaired surgically. Subsequent to this she had a further episode of CSF rhinorrhoea that originated from a middle-ear meningocele that was then repaired.
Minimally invasive tongue base surgery for obstructive sleep apnoea
Authors: Terris David J. , Kunda Larisa D. , Gonella Marie C.
Published: October 2002

Moderate to severe obstructive sleep apnoea is usually associated with multiple levels of pharyngeal airway collapse, including tongue base obstruction. A new technique has recently been introduced that improves the nocturnal retro-lingual airway. This study was a prospective, non-randomized single-institution evaluation of a recently introduced surgical technique. Nineteen consecutive patients with previously untreated moderate to severe obstructive sleep apnoea underwent tongue suspension using the Respose™ system and concomitant palatopharyngoplasty (multilevel pharyngeal surgery). The patient demographics and treatment outcomes were prospectively collected and retrospectively analysed.

There were 16 men and three women, with a mean (±SD) age of 44.9 years (±14.2) and a mean pre-operative apnoea-hypopnoea index (AHI) of 42.8 ± 24.8. Twelve of the 19 patients (63.2 per cent) have had post-operative polysomnography; eight of these 12 (67 per cent) met the standard criteria for surgical response. Among these eight patients, the AHI improved from 32.4 to 14.4 (p < 0.01); the individual scores fell by a mean of 51.7 per cent. The apnoea index improved from 7.4 to 0.9 (p < 0.01), with the individual scores falling by a mean of 81.4 per cent. There was anatomic and radiographic evidence of multilevel upper airway enlargement. Notably, the body mass index remained essentially unchanged (31.5 ± 7.2 to 31.2 ± 7.6, p > 0.5). Subjectively, the mean Epworth sleepiness scale score fell from 11.0 ± 5.4 to 5.4 ± 3.8 (p < 0.005). Four patients suffered transient velopharyngeal insufficiency, and two patients complained of limited anterior excursion of the tongue. There were no serious, long-term complications.

The tongue suspension procedure represents a minimally invasive technique for improving the nocturnal retro-lingual airway in patients with obstructive sleep apnoea. It is easily performed by otolaryngologists, distinguishing it from other established techniques designed to address tongue base obstruction.
Molecular indicators (biomarkers) of past life
Authors: Simoneit Bernd R.T.
Published: October 2002

Biomarkers in geological samples on Earth are products derived from biochemical precursors (i.e., natural products) by reductive and oxidative alteration processes (e.g., cholestanes from cholesterol). Generally, lipids, pigments, and some biomembranes are preserved best over longer geological times, and labile compounds such as amino acids, sugars, etc. are useful biomarkers for recent times. Thus, the detailed characterization of biomarker composition permits the assessment of the major contributing species of extinct and/or extant life. Nonbiomarkers and abiogenic organic compounds are also discussed. In the case of the early Earth, work has progressed to elucidate biomarker structures and carbon isotopic signals preserved in ancient sedimentary rocks. In addition, the combination of bacterial biochemistry with the organic geochemistry of contemporary and ancient hydrothermal ecosystems permits the modeling of the nature, behavior, and preservation potential of primitive microbial communities. This approach entails combined molecular and isotopic analyses to characterize lipids and biopolymers produced by cultured bacteria (representative of ancient strains) and to test a variety of culture conditions that affect their biosynthesis processes. In regards to Mars, the biomarkers from lipids and biopolymers would be expected to be preserved best if life flourished there during its early history (3.5–4 × 109 years ago). Both oxidized and reduced products would be expected. This is based on the inference that hydrothermal activity occurred during that time, with the concomitant preservation of biochemically‐derived carbonaceous matter. Known biomarkers (i.e., as elucidated for early terrestrial samples and for primitive terrestrial microbiota) as well as novel, potentially unknown compounds, should be characterized Anat Rec 268:186–195, 2002. © 2002 Wiley‐Liss, Inc.
Coil–helix transition of ι‐carrageenan as a function of chain regularity
Authors: van de Velde Fred , Rollema Harry S. , Grinberg Natalia V. , Burova Tatiana V. , Grinberg Valerij Ya. , Tromp R. Hans
Published: October 2002

A series of ι‐carrageenans containing different amounts of ν‐carrageenan (0–23 monomer %) have been prepared from neutrally extracted carrageenan of Eucheuma denticulatum. ν‐Carrageenan is the biochemical precursor of ι‐carrageenan. The conformational order–disorder transition and rheological properties of these carrageenans were studied using optical rotation, rheometry, size exclusion chromatography coupled to multiangle laser light scattering, and high‐sensitivity differential scanning calorimetry. The helix forming capacity of ι‐carrageenan turns out to decrease monotonously with increasing amount of ν‐units. In contrast, the rheological properties of ι‐carrageenan are remarkably enhanced by the presence of a small amount of ν‐units, yielding a maximum twofold increase in G′ at 3% ν‐units. It is concluded that the structure‐forming capacity of ι‐carrageenan, containing a small amount of ν‐carrageenan, is significantly higher than that of pure ι‐carrageenan. This phenomenon is explained in terms of the balance between the helical content and the number of cross‐links between chains, taking into consideration the fact that ν‐units introduce “kinks” in the chain conformation enabling neighboring chains to connect. Increasing amounts of ν‐units increase the number of cross‐links in the network, resulting in increased gel strength. On the other hand, a reduced length of the helical strands weakens the cross‐links between the different chains and, consequently, the gel. © 2002 Wiley Periodicals, Inc. Biopolymers 65: 299–312, 2002
Perfusion MR imaging with pulsed arterial spin‐labeling: Basic principles and applications in functional brain imaging
Authors: Yang Yihong
Published: October 2002

Basic principles of the arterial spin‐labeling perfusion MRI are described, with focus on a brain perfusion model with pulsed labeling. A multislice perfusion imaging sequence with adiabatic inversion and spiral scanning is illustrated as an example. The mechanism of the perfusion measurement, the quantification of cerebral blood flow, and the suppression of potential artifacts are discussed. Applications of the perfusion imaging in brain activation studies, including simultaneous detection of blood flow and blood oxygenation, are demonstrated. Important issues associated with the applications such as sensitivity, quantification, and temporal resolution are discussed. © 2002 Wiley Periodicals, Inc. Concepts Magn Reson 14: 347–357, 2002
An approach to evidence‐based therapeutic apheresis
Authors: McLeod Bruce C.
Published: October 2002

This review is derived from a memorial lecture honoring Dr. Francis Morrison, a former President of the American Society For Apheresis (ASFA). The author had numerous professional contacts with Dr. Morrison through ASFA in the early 1990s, having served with him on the Board of Directors and followed him as President, and also came to know him well on a personal level. Professionally, Dr. Morrison stood out as a courtly gentleman with a marvelous baritone voice whose ability to facilitate organization contributed to a growing sense of dignity and purpose in the affairs of the society. On the personal side, however, there wasn't an ounce of pretension in him. He was accessible and down‐to‐earth; a genuine character with an active and appealing sense of humor. Not surprisingly, he seemed to have a wealth of insight and “common sense,” and since the topic of this study is a kind of common sense approach to assessing the effectiveness of therapeutic apheresis, it seems a fitting way to honor his memory. J. Clin. Apheresis 17:124–132, 2002. © 2002 Wiley‐Liss, Inc.
Increased selectivity in inflammatory site identification via labelling of IgG with N‐succinimidyl‐4‐[125I]iodobenzoate
Authors: Beiki Davood , Shahhosseini Soraya , Khalaj Ali , Eftekhari Mohammad
Published: October 2002

Human nonspecific polyclonal IgG was labelled with 125I through direct and indirect labelling methods using chloramine‐T and a nonphenolic radioiodinated intermediate N‐succinimidyl‐4‐[125I]iodobenzoate (125I‐SIB), respectively. Tissue distribution of radioiodinated IgG was assessed in normal and induced inflammation mice. Although, radioiodinated IgG accumulated in the inflammatory area, results showed decreased thyroid and stomach activity and improved inflammatory thigh‐to‐normal tissue ratios with the indirect labelling method (125I‐IB‐IgG) compared with the direct labelling method (125I‐IgG), indicating reduced in vivo deiodination. These results indicate that the 125I‐SIB is probably a preferable approach for labelling antibodies with iodine radioisotopes. Copyright © 2002 John Wiley & Sons, Ltd.
New and convenient synthesis of a tritiated photoactivatable nicotinic agonist: [3H]–AC5
Authors: Mourot A. , Kotzyba‐Hibert F. , Doris E. , Goeldner M.
Published: October 2002

A new synthesis of a tritiated photosensitive nicotinic agonist ([3H]–AC5), which uses [3H2] as the source of radioactivity, is described. Several improvements have been introduced to establish a reliable five‐step synthesis displaying satisfactory overall yields (45%) and requiring a single purification (HPLC) in the final step. This photosensitive radiolabelled probe will enable us to undertake a time‐resolved photolabelling study on the nicotinic acetylcholine receptor in order to analyze at the molecular level the allosteric transitions occurring after agonist stimulation. Copyright © 2002 John Wiley & Sons, Ltd.
Investigations into the regioselective C‐deuteriation of enolates using a diisopropylammonium salt
Authors: Coumbarides Gregory S. , Eames Jason , Weerasooriya Neluka
Published: October 2002

Results are reported on the regioselective C‐deuteriation of 2‐methyl tetralone using a series of diisopropylamine derived D‐sources. The results presented further aid the understanding of kinetic deuteriation of both ‘base‐containing’ and ‘base‐free’ enolates. Copyright © 2002 John Wiley & Sons, Ltd.
Synthesis of [11C] N‐(2‐chloro‐5‐thiomethylphenyl)‐N′‐(3‐methoxyphenyl)‐N′‐methylguanidine ([11C]GMOM): a candidate PET tracer for imaging the PCP site of the NMDA ion channel
Authors: Waterhouse Rikki N. , Dumont Filip , Sultana Abida , Simpson Norman , Laruelle Marc
Published: October 2002

The N‐methyl‐D‐aspartate (NMDA) ion channel plays an important role in a number of neurodegenerative disorders including stroke, Parkinson's disease, Huntington's Chorea, Alzheimer's disease, schizophrenia and epilepsy. To provide effective radioligands for imaging the PCP binding site of the NMDA ion channel, we synthesized and characterized in vitro the candidate PCP site ligand N‐(2‐chloro‐5‐thiomethylphenyl)‐N′‐(3‐methoxyphenyl)‐N′‐methylguanidine (GMOM: Ki = 5.2 ± 0.3 nM, log P = 2.34). The corresponding PET radiotracer [11C]GMOM was synthesized with a radiochemical yield of 8.4 ± 3.2% EOS and with a specific activity of 1.23 ± 0.25 Ci/μmol EOS (n = 5). The average time required for synthesis, purification and formulation was 52 ± 5 min. The final product was prepared in a sterile saline solution suitable for in vivo use. Copyright © 2002 John Wiley & Sons, Ltd.
Structural requirements of nociceptin antagonist Ac‐RYYRIK‐NH2 for receptor binding
Authors: Kawano Michiaki , Okada Kazushi , Honda Takeshi , Nose Takeru , Sakaguchi Kazuyasu , Costa Tommaso , Shimohigashi Yasuyuki
Published: October 2002

Ac‐RYYRIK‐NH2 is a peptide isolated from the peptide library as an antagonist that inhibits the biological activities of nociceptin, a hyperalgesic neuropeptide. In order to clarify the structural requirements of this peptide for binding to the nociceptin receptor ORL1, systematic structure–activity studies were carried out. The result of Ala‐scanning indicated that the N‐terminal tripeptide RYY(=Arg‐Tyr‐Tyr) is crucially important for binding to the ORL1 receptor. Residual truncations from the N‐ or C‐terminus revealed the special importance of the N‐terminal Arg residue. The removal of protecting groups indicated that the N‐terminal acetyl group is essential, but the C‐terminal amide group is insignificant. These results indicated the conspicuous importance of acetyl‐Arg at position 1 of Ac‐RYYRIK‐NH2 as a key structure allowing binding to the receptor. To investigate the binding site of this peptide in the ORL1 receptor, we synthesized and assayed a series of analogues of the nociceptin dibasic repeat region, residues 8–13 of RKSARK. None of the derivatives were active. Ac‐RYYRIK‐NH2 was inactive for the µ opioid receptor to which nociceptin binds with considerable strength. All the results suggested that the mode of binding between Ac‐RYYRIK‐NH2 and the ORL1 receptor is different to that between the ORL1 receptor and nociceptin, and that it may consist of interaction with the receptor site to which nociceptin(1–7) or ‐(14–17) binds. Copyright © 2002 European Peptide Society and John Wiley & Sons, Ltd.
Hormonal and behavioral correlates of estrus in captive giant pandas
Authors: McGeehan Laura , Li Xuebing , Jackintell Lori , Huang Shiqiang , Wang Aiping , Czekala Nancy M.
Published: October 2002

Variability in female estrus expression has been identified as a barrier to captive panda reproduction [Lindburg and Millard, 1995]. In China, researchers have reported that 80% of female giant pandas in captivity exhibit “weak estrus,” or “the absence of overt estrous behavior” [Shuling et al., 1997]. Previous research on the reproductive endocrinology and behavior of female giant pandas has been limited to one to three animals, limiting understanding of the causal factors related to variable estrous expression in captive animals. In 1997 a study was initiated to evaluate the reproductive biology and behavior of one of the largest captive populations of female giant pandas in China. A checksheet was developed to track the presence or absence of 13 behavioral and physiological indices of estrus in six captive females. Daily urine samples were analyzed for estrogens and progestins by enzyme‐immunoassay to determine whether ovulation took place. The behavioral and physiological indicators were aligned to the estrogen peak to examine the relationship between behavior of and ovarian hormones. Analyses of urinary ovarian hormones indicated that all females ovulated during the study. The data revealed that behavioral and physiological indices differed in their temporal relationship to ovarian hormones. Scent‐marking was present 6 days before the estrogen peak, but not afterwards. Bleat and chirp vocalizations were closely associated with the estrogen peak; however, receptive behaviors, such as lordosis and “tail up when touched,” were most closely associated with falling estrogens. Although all females displayed some type of estrous behavior during the study, individual females varied in the presence or absence of attractive, proceptive, and receptive behaviors. Despite the variation in the behavior of individual females, the hormonal data suggest that the variability in estrous expression in this population was not hormonally based. Zoo Biol 21:449–466, 2002. © 2002 Wiley‐Liss, Inc.