bluuebunny/crossref_metadata_2025 huggingface dataset:
The Beautiful and the Damned
Authors: Dumont Guillaume
Published: January 2017

This article examines new media production in professional climbing through the prism of the work relationships between climbers and companies. The development of new media has driven significant transformations in the production, diffusion, and consumption of professional sports, notably in the relationships between athletes, companies, fans, and organizations. However, little is known on the influence of new media on the work of professional athletes and their relationships with companies. By drawing on ethnographic fieldwork conducted in Europe and the United States, I show that the production and diffusion of new media content have become key for professional rock climbers wishing to build their careers, and are complexly embedded in the organization of the labor market. This supports an understanding of the production of new media acknowledging the relationships between companies, athletes, and media producers. Indeed, producing and diffusing new media content have become a central part of the job of an athlete and brand ambassador for climbing companies.
Discovering Public Health Nurse–Specific Family Home Visiting Intervention Patterns Using Visualization Techniques
Authors: Monsen Karen A. , Peterson Jessica J. , Mathiason Michelle A. , Kim Era , Votava Brian , Pieczkiewicz David S.
Published: January 2017

Visualization is a Big Data method for detecting and validating previously unknown and hidden patterns within large data sets. This study used visualization techniques to discover and test novel patterns in public health nurse (PHN)–client–risk–intervention–outcome relationships. To understand the mechanism underlying risk reduction among high risk mothers, data representing complex social interventions were visualized in a series of three steps, and analyzed with other important contextual factors using standard descriptive and inferential statistics. Overall, client risk decreased after clients received personally tailored PHN services. Clinically important and unique PHN–client–risk–intervention–outcome patterns were discovered through pattern detection using streamgraphs, heat maps, and parallel coordinates techniques. Statistical evaluation validated that PHN intervention tailoring leads to improved client outcomes. The study demonstrates the importance of exploring data to discover ways to improve care quality and client outcomes. Further research is needed to examine additional factors that may influence PHN–client–risk–intervention–outcome patterns, and to test these methods with other data sets.
Quantification of Standards for Length‐of‐Stay Based upon Optimal Patient Care and Standard Medical Practice
Authors: Black F. Owen , Johnson Jonas , Myers Eugene N. , Perkun Olga
Published: January 2017

Length‐of‐stay criteria are being developed by the Allegheny Professional Standards Review Organization (APSRO) in western Pennsylvania. In order to statistically document the standard of practice at the Eye and Ear Hospital of Pittsburgh, a retrospective review of patients who underwent laryngectomy with or without radical neck dissection was performed. Results demonstrated that routinely allowing only one day preoperative assessment deviates significantly from optimal medical practice and may place some patients at increased risk, especially for postoperative complications. From a cost‐effective health care delivery point of view, abbreviated preoperative preparation contributes negatively to postoperative length‐of‐stay which was the most costly component of hospital health care for this group of patients. The development of appropriate standards of medical practice criteria using preexisting HEW mechanisms and scientifically designed prospective studies should be encouraged.
The Surgical Removal and Repair of Large Scalp Lesions
Authors: Flashman Thomas , Ward Paul H.
Published: January 2017

Cancer of the scalp usually presents itself as a superficial lesion which is first noticed by the patient. However, there is often a long delay on the part of the individual in seeking medical attention. When he finally does seek medical attention, his tumors are often undertreated and require multiple procedures. This paper discusses the surgical resection that depends upon the depth of tumor penetration, the modalities of reconstruction, and our experiences with CO2 laser resection of a large scalp lesion.
Antigenicity of Tympano‐Ossicular Homografts of the Middle Ear: Analyses of Immune Response to Viable and Preserved Grafts in Animal Models
Authors: Veldman Jan E. , Kuijpers Wim
Published: January 2017

Primary and secondary response transplantation experiments in allograft tympanoplasty reveal that after various preservation procedures at least part of the original histoincompatibility between donor and recipient still exists. Clinical pathologic data are in accordance with this phenomenon. The abolished immune reactivity in successful allograft‐tympanoplasty is placed in the light of acquired immunotolerance. The consequences of prior tissue‐typing are discussed.
Management of Buccal Space Masses
Authors: Gallia Louis , Rood Stewart R. , Myers Eugene N.
Published: January 2017

Lesions in the substance of the cheek—the buccal space—may present diagnostic and management difficulties. The buccal space, that potential fascia space lying within the bulk of the cheek, is anatomically described. While the history and physical characteristics of the buccal mass and selected radiographic and special procedures may suggest a specific cause, the diagnosis is often elusive and requires removal of the mass for histologic evaluation. The surgical approach to a mass in the cheek is governed by its location within the buccal space and by the index of suspicion of malignancy. The Preauricular, submandibular approach is the authors' choice for most buccal space lesions. Five case reports are presented to illustrate features in the diagnosis and management of a buccal space mass.
Fibromyxosarcoma of Maxillary Sinus: Report of a Case
Authors: Kadri Zain , Pratt Lindsay L.
Published: January 2017

Fibromyxosarcoma is extremely rare in the head and neck region. This mesenchymal neoplasm is locally aggressive with rapid growth and destruction of tissue but with limited metastatic potential. Histologically, it consists of fibrous and myxomatous elements that can create confusion and uncertainty in the diagnosis.
Dermal Graft for Protection of the Pharyngeal Suture Line in Cancer Surgery of the Head and Neck
Authors: Koltai Peter J. , Leipzig Bruce
Published: January 2017

We studied the effect of free buried dermal grafts to primary pharyngeal closures among 24 nonirradiated patients undergoing radical head and neck surgery to determine if this technique would reduce the incidence of postoperative pharyngocutaneous fistula. For a control group we selected 23 patients who had undergone similar operations as the patients in the study group, but who did not have dermis used for pharyngeal protection. Our results indicate that dermal grafts do not alter the incidence of fistulization following cancer surgery of the head and neck.
Intracranial Aneurysm Occurring as Sensorineural Hearing Loss
Authors: Colclasure Joe B. , Graham Sharon S.
Published: January 2017

Reports of sudden hearing loss as the first sign of an intracranial aneurysm are sparse and published primarily in the neurologic literature. A case report is presented in which the initial signs and symptoms of a lobular aneurysm in the posterior communicating artery were the sudden onset of bilateral sensorineural hearing loss, tinnitus, and headache. Following evaluation and identification of the aneurysm, this patient underwent a craniotomy with clipping of the aneurysm; hearing sensitivity improved dramatically following surgery. The world literature is reviewed for cases in which aneurysms have initially occurred as hearing loss, tinnitus, or both. Intracranial aneurysm is discussed as a rare, potential source of a sudden sensorineural hearing loss.
Use of the Shaw Scalpel in Head and Neck Surgery
Authors: Fee Willard E.
Published: January 2017

Fifty patients undergoing a variety of head and neck surgical procedures were used to study a new thermally activated scalpel. No electric current passes through the patient and, thus, no ground pad is needed. Subjective equipment evaluation resulted in mean scores of 3.8 (1 = worthless and 5 = excellent) for effectiveness of hemostasis and 4.1 for blade sharpness. The Shaw scalpel system is a worthwhile surgical tool 70% of the time. It is excellent for raising flaps and for use in precise surgery where small capillary bleeding typically obscures visibility (ie, parotid surgery).
Prostaglandin E2, Collagenase, and Protease Levels in Culture of Rat Tumor
Authors: Huang Cheng Chun
Published: January 2017

The production of collagenase, protease, leucine aminopeptidase, and prostaglandin E2 by rat tumor increased with the growth of tumor. The syntheses of collagenase, protease, and leucine aminopeptidase were significantly inhibited by indomethacin. Inhibition of collagenase, protease, and leucine aminopeptidase syntheses was overcome by the addition of prostaglandin E2 at a concentration equivalent to the endogeneous level of prostaglandin E2 in rat tumor. These findings suggested that prostaglandin E2, possibly derived from tumor cells, was involved in stimulating the tumor connective tissue stroma to produce collagenase, protease, and leucine aminopeptidase, which promoted tumor cell invasion.
Recurrent Benign Mixed Tumor of Lacrimal Gland: Report of a Case with Intracranial Extension
Authors: Ossoff Robert H. , Jones James A. , Bytell David E.
Published: January 2017

A 66‐year‐old man with benign mixed tumor of the lacrimal gland underwent an excisional biopsy in 1966. Three recurrences subsequently developed, which resulted in an orbital exenteration. In 1979 he came to us. We discovered radiographic evidence and surgical confirmation of recurrent disease involving the lesser wing of the sphenoid and dura in the floor of the anterior cranial fossa. The natural history and management of this tumor is discussed and the relevent literature is reviewed.
Cis‐Diamminedichloroplatinum (II) Ototoxicity in the Guinea Pig
Authors: Estrem Scott A. , Babin Richard W. , Ryu Jai H. , Moore Kenneth C.
Published: January 2017

Cochleas from 12 guinea pigs were evaluated using light, scanning, and transmission electron microscopy after systemic administration of cis‐diamminedichloroplatinum (cis‐DDP). Administration of cis‐DDP resulted in loss of the Preyer reflex and degeneration of outer hair cells (OHC) with increased dose. The OHC degeneration was most pronounced in the basal turns of the cochlea with greatest severity in the inner row. Ultrastructural evidence of OHC degeneration included dilatation of the parietal membranes, softening of the cuticular plate, increased vacuolization and increased numbers of lysosome‐like bodies in the apical portion of the cell. Supporting cells appeared more sensitive than OHC. Alteration of supporting cell ultrastructure preceded detectable change in OHC. Injury to the supporting cells was noted with intracellular vesiculation and increased autophagocytosis.
Waardenburg's Syndrome: Variations in Expressivity
Authors: Wang Louis , Karmody Collin S. , Pashayan Hermine
Published: January 2017

Twenty‐seven subjects with a family history of Waardenburg's syndrome were examined with respect to 18 specific characteristics of the syndrome, with particular emphasis in identifying the spectrum of the phenotypic expression of affected persons. Our results indicate that patients with the syndrome may have a variety of clinical signs, and an accurate diagnosis will therefore depend on a thorough and pertinent family history and physical examination.
Methods of Shortening the Operative Time of a Total Face‐Lift
Authors: Dicker Ralph L.
Published: January 2017

Recognizing the need to reduce the usual lengthy operating time of face‐lift surgery with its inherent risks and to make possible the combining of multiple operative procedures of the face, the author explains a technique for shortening the face‐lift procedure without sacrificing important steps to produce an effective, long‐lasting result. Some of these steps include rapid, but careful administration of sedation, expeditious administration of local anesthesia through preplaced spinal needles, effective illumination of the field, particularly beneath the skin flaps, for rapid hemostasis with use of electrocautery, a safe and swift method of extensive undermining, strategic use of subcutaneous suspension sutures for plication, application of temporary anchor sutures in the rotation of skin flaps, the use of skin clamps for rapid closure, and a Hemovac for postoperative control of bleeding.
Progressive Neonatal Airway Obstruction Secondary to Cervical Thymic Cyst
Authors: Raines John M. , Rowe Lee D.
Published: January 2017

Cervical thymic cysts are extremely unusual neoplasms that only rarely produce signs and symptoms of upper airway tract compromise. Less than 7% of patients initially have dyspnea or hoarseness. We report the first known case of progressive neonatal airway obstruction secondary to a rapidly enlarging cervical thymic cyst. Because one half of these benign tumors may demonstrate mediastinal extension, computed axial tomography or B‐mode ultrasonography or both is recommended prior to surgical excision. Review of the literature confirms that the majority are successfully removed via a transcervical approach without recurrence.
Surgically Correctable Causes of Sleep Apnea Syndrome
Authors: Olsen Kerry D. , Suh Ku W. , Staats Bruce A.
Published: January 2017

This report presents six cases of obstructive sleep apnea associated with discrete anatomic abnormalities of the upper airway tract. All patients were relieved of their sleep apnea by surgical correction of the airway obstruction, and therefore permanent tracheotomy was avoided. The obstructive causative factors were nasal septal deformity, adenoidal hypertrophy, nasopharyngeal stenosis, lingual cyst, lingual tonsillar hypertrophy, and laryngeal cyst. The last‐named four conditions have not previously been reported as correctable causes of sleep apnea.
Anesthesia for Carbon Dioxide Laser Microsurgery of the Larynx
Authors: Ruder Chunilal B. , Rapheal Naomi L. , Abramson Allan L. , Oliverio Robert M.
Published: January 2017

Jet ventilation via the Sanders injector during intravenous general anesthesia provides excellent operative conditions for CO2 laser microsurgery of the larynx. This technique, which includes complete muscle relaxation, is superior to traditional methods of anesthesia because the endotracheal tube is eliminated, thus improving the surgical field and reducing burn hazards owing to ignition of the tube.

The laryngoscope has been modified to carry multiple ports into which a 14‐gauge needle is inserted and the tip advanced just distal to the vocal cords. This needle is securely attached to the injector and pressure from the oxygen source is adjusted according to the patient's build and total compliance.

Satisfactory arterial blood gases, superb operating conditions, safety, and rapid awakening make this the method of choice for most patients.
Primary T‐Cell Lymphoma of Oral Cavity
Authors: Mikaelian Diran O. , Harris Canaan L. , Scherr Stuart A. , Kostianovsky Mery , Chirife Ana Maria
Published: January 2017

Immunopathologic studies classify lymphoma under the T‐cell or B‐cell groups. Such a classification gives a better indication for prognosis and treatment of lymphomas, with the T‐cell group having the worse prognosis.

A patient with a T‐cell lymphoma of the oral cavity is presented. The diagnostic features and management are discussed.
Myelin and Axon Degeneration following Direct Current Peripheral Nerve Stimulation: A Prospective Controlled Experimental Study
Authors: Hughes Gordon B. , Bottomy Michael B. , Jackson C. Gary , Glasscock Michael E. , Sismanis Aristides
Published: January 2017

A previous study by the authors compared pathologic changes in the mouse sciatic nerve following prolonged continuous stimulation with either pulsed or direct current. The pulsed current stimulator was found as equally effective yet far safer than the direct current (DC) stimulator. In an attempt to reproduce more accurately the clinical setting, the Ear, Nose, and Throat Device Classification Panel of the Food and Drug Administration requested a prospective, controlled study of repeated DC stimulation at one or more sites along a peripheral motor nerve. Again, repetitive DC stimulation both at one site and at multiple sites of the same nerve produced significant myelin and axon degeneration. The authors conclude that even routine use of the DC stimulator carries with it the potential for permanent nerve damage and muscle paralysis.
The Elective Surgeon's Personality and Role Confusion
Authors: Wright Mary Ruth
Published: January 2017

This study explores the interrelationships of certain characteristics associated with the elective surgeon's personality. Findings indicate that the very characteristics that distinguish the surgeon's expertise also make it difficult for him to accept the changes that have occurred in the spectrum of modern medicine and the resulting role confusion. Rather than reacting defensively or negatively, this work recommends that the surgeon take an affirmative, assertive approach to the problem.
Organelle Regeneration: Cilia vs Microvilli in Human Nasal Mucosa following Use of Topical Decongestant
Authors: Dudley James P. , Beydler Sara A. , Cherry James D.
Published: January 2017

Regeneration of cilia after injury has been assumed but not proved. Using scanning electron microscopy, the presence of many organelles shorter and thinner than cilia on topical decongestant damaged nasal mucosa was noted. Their similarity to microvilli and the failure to demonstrate any cilia except those of standard length, would appear to make it unlikely that cilia regrowth occurs after chronic use of topical decongestants.
Immediate Mandibular Reconstruction: Human Experience with Autogenous Frozen Mandibular Grafts
Authors: Leipzig Bruce , Cummings Charles W.
Published: January 2017

Autogenous mandibular grafts that have been cryosurgically devitalized and reimplanted have been studied in the canine. Initial investigations have lent impetus to further application in human cancer surgery. Six patients underwent immediate autogenous mandibular graft reconstruction. All failed because of intraoral complications and decreased vascularization in the midportion of the bone graft. None evidenced recurrence of tumor in bone, although two patient's grafts failed on the basis of tumor recurrence in the adjacent soft tissue.
Sleep Apnea Syndrome Associated with a Neck Mass
Authors: Koopmann Charles F. , Feld Robert A. , Coulthard Stanley W.
Published: January 2017

Sleep apnea is an entity that is becoming more commonly diagnosed as the signs and symptoms are becoming better understood. In this report, the first known case of sleep apnea secondary to a lipoma of the submandibular area of the neck is presented. A brief discussion of the types of sleep apnea, along with the most common signs and symptoms of the entity, are reported. The diagnostic workup, operative findings, and postoperative results in this patient are discussed.
Mixed Tumor of the Epiglottis: Case Report
Authors: Tobin Howard A.
Published: January 2017

A case of mixed tumor of the epiglottis, which was treated surgically, is presented. Delay in diagnosis contributed to the patient's death. This case represents the second reported case of mixed tumor of the epiglottis.
The Incidence of Hypopharyngeal Stenosis after Surgery for Laryngeal Cancer
Authors: Kaplan Jory N. , Dobie Robert A. , Cummings Charles W.
Published: January 2017

Hypopharyngeal stenosis is a frequent complication of laryngectomy and radiotherapy in patients treated for carcinoma. In a retrospective study of patients treated in the University of Washington Affiliated Hospitals, hypopharyngeal stenosis was more frequent after laryngectomy with partial pharyngectomy than after laryngectomy alone and occurred more commonly in lesions of the pyriform fossa than in glottic tumors. Neck disease and inclusion of radical neck dissection were both significant factors in the development of hypopharyngeal stenosis. Recurrent tumor was significantly more prevalent in these patients.
Composite Myocutaneous Flaps
Authors: Shapiro Myron J.
Published: January 2017

In the past few years myocutaneous (MC) flaps have, to a large extent, replaced other flaps. Because of axial blood supply, they may be used without delay. The MC flaps, useful in head and neck reconstruction, are based on the latissimus dorsi, the pectoralis major, the sternomastoid, and the trapezius. All have discrete independent vasculature that acts as a pedicle for the muscle and skin flap. The sternomastoid MC flaps have limited range and only special areas of usefulness. The latissimus dorsi flap, because it requires special positioning of the patient, has not been as popular as the pectoralis major flap, but both have excellent blood supplies and will reach almost any area of the face and neck to fill defects and cover internal or external surfaces. In addition, the pectoralis major MC flap may be able to carry a segment of rib as a bone graft. The trapezius MC flap does not have as great a range as the others and has a long vascular pedicle that must be carefully handled, but it has the distinct advantage of being able to carry viable bone from the scapular spine to the mandible.
Carcinoma of the Tonsillar Region: A Comparison of Radiation Therapy with Combined Preoperative Radiation and Surgery
Authors: Shrewsbury Donald , Adams George L. , Duvall Arndt J. , Maisel Robert H. , Haselow Robert E.
Published: January 2017

Ninety‐six patients with cancer of the tonsillar region in all stages were studied to compare full‐course radiation therapy with surgical salvage to planned combined radiation and surgery. Full‐course radiation therapy was effective in controlling T1 and T2 tumors without neck node involvement. Combined therapy was much more effective in treating T3 tumors with neck node disease. Patients with T4 tumors did poorly regardless of therapy.
Ototoxicity of Kanamycin Sulfate and the Barriers in the Inner Ear
Authors: Komune Shizuo , Snow James B.
Published: January 2017

The effect of kanamycin sulfate administered by three routes on the function of the stria vascularis was monitored electrophysiologically in guinea pigs. The three routes were intramuscular injection, perilymphatic perfusion, or endolymphatic perfusion. Neither systemic administration of 500 mg/kg of body weight per day for 7 to 12 days nor perilymphatic perfusion of 10‐3 M kanamycin affected the endocochlear dc potential (EP). However, with perfusion of kanamycin 10‐3 in the endolymphatic space, the EP declined severely. Moreover, the decline in the EP was greater with higher concentrations of kanamycin in the endolymphatic perfusate. Furosemide given by each of the three routes produced an approximately equal decrease in the EP. The effects of kanamycin on the cells of the stria vascularis and the evidence for the perilymphatic‐endolymphatic and blood‐cochlear barriers are discussed.
Immunologic Studies on Cancer of the Upper Aerodigestive Tract
Authors: Gustafson Ray O. , Neel H. Bryan , Pearson Gary R.
Published: January 2017

Natural killing (NK) may play an important role in immunosurveillance against virus‐infected and malignant cells. This study has demonstrated that the NK susceptibility of Epstein‐Barr virus (EBV)‐related cell lines increases with increased viral expression within the cells. This finding has implications for surveillance against, and treatment of, EBV‐related disease. Additionally, preliminary studies of the NK status of head and neck cancer patients reveal a distinct clustering of the patients into either groups of high or low NK reactivity. This clustering phenomenon may have a correlation with patient prognosis.
Pindborg Tumor of the Mandible
Authors: Leipzig Bruce , Yau Pak C.
Published: January 2017

Calcifying epithelial odontogenic tumor, or Pindborg tumor, is the rarest of odontogenic tumors of the mandible. The tumor is distinct from ameloblastoma histologically, as well as by its less aggressive clinical behavior. Treatment must consist of complete excision—to include a rim of bone surrounding the lesion—to prevent recurrence. No instance of metastasis from this neoplasm has been reported.
Carcinoma of the Nasal Septum: Experience with 85 Cases
Authors: Beatty Charles W. , Pearson Bruce W. , Kern Eugene B.
Published: January 2017

A review of 85 Mayo Clinic patients with carcinoma of the nasal septum revealed squamous cell carcinoma (58 patients) to be the predominant cell type, with adenocarcinoma (12 patients) and malignant melanoma (7 patients) being next in frequency. Twenty‐five (29%) of the 85 patients had metastatic disease. Twenty percent (17) of the patients had another malignancy at some time during their lives. The study suggests that tobacco smoking may have a role in the etiology of squamous cell carcinomas of the nasal septum. In most patients, wide surgical excision was the initial choice of treatment.
Pharyngocutaneous Fistula after Laryngeal Surgery: The Role of the Barium Swallow
Authors: Giordano Anthony M. , Cohen Jamie , Adams George L.
Published: January 2017

Pharyngocutaneous fistula is one of the major complications following laryngeal surgery. Prior to 1979, patients undergoing laryngectomy at the University of Minnesota were not fed until 9 or 10 days postoperatively if unirradiated and 12 to 14 days If irradiated. Most fistulas were apparent by 14 days postoperatively, but occasionally a patient would develop a fistula as late as a month postoperatively. Starting in 1979, in an attempt to decrease the length of hospitalization as well as prevent fistula formation, routine barium‐swallow videoesophagograms were obtained 7 days postoperatively in all laryngectomy patients. If the results were considered normal, the nasogastric tube was removed and oral feedings were started. Of a total of 45 patients undergoing wide‐field laryngectomy, there were three clinical fistulas and three radiologic fistulas. Following this protocol, we shortened the average postoperative hospitalization by 2 days without an increase in the rate of fistulization.
Selective Absorption and Control of Thermal Effects: A Comparison of the Laser Systems Used in Otology and Neurotology
Authors: Clark W. Craig , Robertson Jon H. , Gardner Gale
Published: January 2017

The surgical lasers available for use by the otologist and neurosurgeon include the CO2, argon, and neodymium:yittrium‐aluminum‐garnet (Nd:YAG). Selection of a laser should be based on the principles of power density, radiant exposure, and selective absorption, with a particular application in mind. The history of and relevant literature on lasers in otology are reviewed, and basic research findings are presented. Our conclusions are that (1) lasers are viable for many neurotologic applications; (2) the effect of the CO2 laser is purely thermal at the tissue surface; (3) the argon and Nd:YAG lasers, both pigment‐dependent, may penetrate tissues to variable levels before absorption and conversion to thermal energy; (4) the CO2 laser can achieve much higher power densities than the argon or Nd:YAG lasers; (5) since there is a discrepancy between focused spot size and actual lesion size, with the argon effect being approximately 5× and the CO2 effect about 2×, the resulting lesions are essentially equal in size; and (6) no laser is best for all neurotologic procedures and should be evaluated based on the laser's basic physical principles to exploit the advantages and minimize the disadvantages.
Muscle Transposition for Facial Reanimation: Indications and Results
Authors: May Mark
Published: January 2017

Temporalis muscle transposition was used as an effective technique to reanimate the paralyzed face. It was employed under the following general conditions: (1) the peripheral facial neuromuscular system was unsuitable; (2) the central stump was not available for grafting and the patient elected not to have another cranial nerve sacrificed; (3) the hypoglossal‐facial anastomosis was contraindicated; and (4) unsatisfactory results were achieved with grafting or following a hypoglossal‐facial anastomosis. The technique described by Rubin and Baker and Conley has been modified to achieve reproducible, reliable, and satisfying results. The main modifications include (1) muscle lengthening with attached periosteum; (2) attaching muscle to the mucous membrane‐mucocutaneous junction of the upper lip; (3) creating a wide cheek tunnel to allow the temporalis muscle to lie flat, which minimizes the bulge in the cheek region; and (4) implanting a Silastic block only in selected cases.
Microsurgical Reconstruction of the Posterior Circulation
Authors: Ausman James I. , Diaz Fernando G.
Published: January 2017

Thirty‐four patients with vertebrobasilar Insufficiency (VBI) were evaluated between 1974 and 1982. Twenty‐two presented with transient VBI and 12 with residual strokes. The frequency of preoperative symptoms varied from once or twice a month to multiple daily events. Four patients with high‐grade vertebral stenosis were treated by local vertebral endarterectomy at the C1 level. Seven patients underwent an anastomosis of the occipital artery to the posterior inferior cerebellar artery for distal vertebral basilar junction stenosis or occlusion. Three patients underwent anastomosis of the occipital artery to the anterior inferior cerebellar artery for vertebral basilar junction occlusion. Twenty patients underwent anastomosis of the superficial temporal to the superior cerebellar artery for distal vertebrobasilar junction stenosis or occlusion or midbasilar occlusive lesions. In 26 of 27 patients (95%), the anastomoses were patent. Two patients died, one from congestive heart failure and one from a brain stem infarct. Immediate complications included meningitis, CSF leaks, temporal lobe swelling, and seizures. Although the early surgical morbidity is high, it is only transient. Twenty‐six patients have had complete resolution of their symptoms, and three have minor residual dizziness. Long‐term morbidity has been limited to a patient with residual Wallenberg's syndrome secondary to the surgical occlusion of the vertebral artery, a patient who remained in a locked‐in syndrome as before surgery, and a patient who developed Brown‐Séquard syndrome. No further VBI symptoms occurred in one patient who died 4 years after surgery of a myocardial infarction. We believe the surgical approach to the vertebrobasilar area is feasible and can lead to the ultimate recovery of most patients.
Photodocumentation of laser microsurgery: Preoperative, intraoperative, and postoperative techniques for still and video photographs
Authors: Selkin Stuart G.
Published: January 2017

Photodocumentation of preoperative, intraoperative, and postoperative findings serves to enhance and complement the study of normal and pathologic anatomy and physiology. Such documentation is invaluable for the teaching of medical students, physicians in the same or in other specialties, and allied health personnel. A surgeon may review and refine surgical technique, and colleagues around the world may study the situation from the same vantage point after surgery has been completed. Referring physicians may be kept graphically informed of the findings and progress of their patients. With the development of such modern technologies as laser microsurgery, an objective means of assessing ablation of disease and healing of surgical wounds is now available, and many of the extravagant claims of “no bleeding, and no edema during or after surgery” may be confirmed or refuted. I shall describe techniques for endoscopic examination and photodocumentation of the ears, anterior and posterior nares, nasopharynx, hypopharynx, and larynx in the preoperative, intraoperative, and postoperative patient. Techniques for obtaining high‐quality color transparencies and color and sound videotapes will be presented. Equipment is simple and relatively inexpensive, and no special knowledge of photography is required. Examples of benign and malignant disease of the ears, nose, nasopharynx, and larynx will be shown before, during, and at regular intervals after microsurgery with the CO2 laser.
Mesenchyme Remaining in Human Temporal Bones
Authors: Takahara Tetsuo , Sando Isamu , Hashida Yoshie , Shibahara Yoshihiro
Published: January 2017

This study was conducted in order to gain basic information about mesenchyme remaining in the middle ear cleft in normal infants. Because no previous report has objectively described the quantity or quality of such postnatal remnants in normal infants, it has not been possible to accurately evaluate the significance of mesenchyme remaining in the middle ears of infants with pathologic conditions, such as otitis media and congenital anomalies. Thus, 53 temporal bones obtained from 41 individuals reported upon here—from 26 weeks' gestation to 8 years of age—will be controls for future studies of pathologic conditions. The children from whom these temporal bones were obtained had no anomalies of the ear (or any other known part of the body); nor did they have any pathologic conditions in the ear. The temporal bones were prepared for histologic study with hematoxylin and eosin staining and were examined under the light microscope. After areas of the mesenchyme in the histologic sections were projected and illustrated for each of 19 portions in the middle ear cleft under the microprojector, those areas were measured by compensating polar planimetry. The findings obtained in this study were as follows: (1) The amount of mesenchyme remaining in the days after birth seemed to gradually decrease in volume with increased maturity and had nearly disappeared within the first year in normal infants. Where mesenchyme was noted in the temporal bones of infants over 1 year of age, it was usually present only in small niches. (2) Most mesenchyme found in temporal bones of normal infants was seen in the mastoid antrum; it was also found in the aditus ad antrum, the epitympanum, the hypotympanum, the sinus tympani, the round window niche, the oval window niche, and the mesotympanum.
The Expression of Intermediate Filaments and MAM‐6 Antigen in Relation to the Degree of Morphologic Differentiation of Carcinoma of the Head and Neck: Diagnostic Implications
Authors: Henzen‐Logmans S.C. , Balm A.J.M. , Van Der Waal I. , Mullink H. , Snow G.B. , Meyer C.J.L.M.
Published: January 2017

In this study, the immunoreactivity of several cytokeratin antibodies; 115 D8, a monoclonal antibody against MAM‐6, an epithelial membrane antigen; and two vimentin antibodies, is examined in relation to the degree of morphologic differentiation in carcinomas of the head and neck. The results indicate that a relationship exists between the degree of morphologic differentiation and the expression of cytokeratin, MAM‐6, and vimentin, as detected by polyclonal antikeratin, 115 D8 and anti‐vimentin. Expression of cytoketatin and MAM‐6 is reversely related to vimentin. Polyclonal antikeratin; CAM 5.2, a monoclonal antibody against cytokeratin 8, 18 and 19; and 115 D8, used in combination, were still able to identify the epithelial nature of undifferentiated/spindle cells. Since these immunohistochemical markers precede light microscopic detectable signs of epithelial differentiation, they can be used for the identification of the epithelial nature of undifferentiated/spindle tumors of the head and neck.
Management of Vertigo in Patients with Syphilis: Is Endolymphatic Shunt Surgery Appropriate?
Authors: Shih Lucy , McElveen John T. , Linthicum Fred H.
Published: January 2017

Endolymphatic shunt surgery has been suggested as a means to relieve vertigo caused by syphilis in patients unresponsive to conventional medical therapy. We reviewed results of endolymphatic shunt surgery on vertigo and hearing in six patients with syphilis. We found no relief of vertigo in four patients who qualified for this measure and no improvement in hearing. Histologic review of temporal bones from three patients with syphilitic hydrops revealed syphilitic involvement of the endolymphatic duct system. This may explain why endolymphatic shunt surgery may not be beneficial.
Palatal extension of middle meatal antrostomy
Authors: Friedman William H. , Katsantonis George P. , London Alexander
Published: January 2017

The palatine bone is an Important posterior landmark in the performance of ethmoldectomy. This usually unrecognized structure forms the posterior one third of the lateral nasal wall. Resection of a portion of the palatine bone completes the marsupialization of the sphenoethmoidal recess and medial maxilla. It is a major landmark for localization of the sphenopalatine artery at its entrance into the nose. Middle meatal antrostomy is enhanced by removal of the part of the palatine bone that forms the posterior medial wall of the maxillary sinus. In 1110 consecutive sphenoethmoldectomles, marsupialization of the maxillary sinuses has included partial removal of the perpendicular plate of the palatine bone. Patency has been maintained in all of these antrostomies. Pertinent anatomy and surgical technique are reviewed.
Effect of irradiation on guinea pig ABR thresholds
Authors: Greene J. Scott , Giddings Neil A. , Jacobson John T.
Published: January 2017

A significant number of patients undergo Irradiation to the temporal bone for malignancies. Conflicting reports exist regarding the effects of irradiation on hearing thresholds. Although radiation‐induced otitis media and osteoradionecrosis of the ossicles with resultant conductive hearing loss are well‐documented, there is disagreement regarding the effect of irradiation on sensorineural hearing. Previous animal models, relying only on behavioral tests and reflex thresholds, have failed to reveal consistent threshold shifts after irradiation. However, with the advent of auditory brainstem response (ABR) testing, a reliable objective measurement of hearing in animals is available. Hearing thresholds were determined bilaterally by ABR testing in 21 albino guinea pigs. The left temporal bones of sixteen animals were then Irradiated with a total dose ranging from 5750 to 7000 cGy over 7 weeks. The right ears of these animals, plus both ears of five nonlrradlated guinea pigs, served as controls. Follow‐up threshold ABRs were obtained immediately post‐irradlation (RT), and at 6 and 12 months post‐RT. Average thresholds in all groups increased over time: 60 dB in the control group; 53 dB in the control ears of the Irradiated animals; and 46 dB in the Irradiated ears. There were no statistically significant increases in ABR thresholds for Irradiated ears vs. control ears. At the 6‐month followup, hearing was actually better in the Irradiated ears than the control ears and this difference between ears was significantly greater than the difference at baseline (p < 0.026). Overall, there was no evidence that irradiation produces changes in ABR thresholds.
Diagnosis and management of sinusitis in the allergic patient
Authors: Calhoun Karen
Published: January 2017

Allergy is often associated with sinusitis because the inflamed nasal mucosa may block ostial drainage from the sinus and the resulting stasis in the sinuses encourages development of infection. The new fools of nasal evaluation, endoscopy and computed tomographic scanning, are becoming essential in the evaluation of patients who have acute and chronic sinusitis. Nasal endoscopy provides a view of the nose, nasopharynx, sphenoethmoidal recess, and middle meatus to detect areas of inflammation or pathologic drainage. This examination should be followed by computed tomographic scanning, which reveals the fine structures and disease of the area. First‐line treatment includes antibiotics and decongestants to control the infection, reduce tissue edema, facilitate drainage, and maintain ostial patency. Topical steroids (or cromolyn sodium) are helpful to reduce the mucosal swelling, particularly in allergic patients. Antihistamines are indicated to reduce the rhinorrhea in allergic patients but not in those with suppurative sinusitis. Functional endoscopic sinus surgery to facilitate drainage and permit appropriate ventilation should be reserved for patients no longer responsive to pharmacotherapy and those with anatomic deformities.
Corticosteroids in the management of upper respiratory allergy: The emerging role of steroid nasal sprays
Authors: Mabry Richard L.
Published: January 2017

Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis, not just those of atopic origin. However, this potent class of drugs also has the greatest potential for adverse effects and complications. Proper use requires that they be used only after failure of more conservative measures, at the smallest effective dose, for the shortest possible time, and preferably should be administered by the topical intranasal route. Topical corticosteroids, concentrated at the area involved, offer significant relief to patients with allergic rhinitis, and although only a relatively small amount of drug is taken up systemically, cautions for proper use are important. Topical steroids should be used only after accurate diagnosis. They must adequately contact the nasal mucosa, and patients should be properly instructed in their use and monitored for local and systemic side effects. Currently available topical preparations–dexamethasone, beclomethasone, flunisolide, and triamcinolone–have differing characteristics. The use of a preparation with a high margin of safety reduces the risk of undesirable systemic effects.
Peasants and Politics: Re-thinking the British Imaginative Geography of the Balkans at the Time of the First World War
Authors: Perkins James
Published: January 2017

This article examines British representations of the Balkans in the late nineteenth and early twentieth centuries. It does so through focusing on records of political activism and humanitarianism, offering a counterpoint to the key studies of this subject in the 1990s that were based primarily on analysis of travel writing and literary texts. The subjectivities of the political culture that inspired engagement with Balkan questions are scrutinized, exposing the complexity of British perspectives on the region and highlighting intersections between international and domestic debates. Attention is drawn in particular to the idealization of Balkan peasant society and the ‘village community’ in British Liberal political discourse. This is related to tensions around land reform at home, and to the perceived impact of industrialization and urbanization on British society and citizenship. Reassessing the complex imaginative geography of the Balkans in this way provides a fresh transnational perspective on aspects of British domestic political history. It also raises broader arguments about the need to integrate historical analysis of the ‘cultural’ and ‘political’ aspects of British encounters with foreign lands and peoples in the era of the First World War.
War Veterans and Fascism during the Franco Dictatorship in Spain (1936–1959)
Authors: Alcalde Ángel
Published: January 2017

This article argues that analysis and contextualization of the history of the Francoist veterans of the Spanish Civil War (1936–39) leads to an understanding of Franco’s dictatorship as a fascist regime typical of the late 1930s and early 1940s. It reveals the congruence of the regime with the phenomenon of neo-fascism during the Cold War era. Drawing on a large range of archival and published sources, this article examines the history of the main Francoist veterans’ organization, the Delegación Nacional de Excombatientes (DNE) of the Falange Española Tradicionalista y de las JONS (FET-JONS), between 1939 and 1959. The evolution of the Francoist veterans’ organizational structures and political discourses can be understood as part of a process of fascistization and defascistization, which provides rare insights into the overall relationship between fascism and war.
Ethics and the clinician: the daily experience with motor neurone disease
Authors: Carroll-Thomas Susan
Published: January 2017

Ethical issues in health care are typically perceived as arising from extreme situations which do not usually confront the average clinician. However, knowingly or otherwise, clinicians working with motor neurone disease deal daily with ethical issues in the form of value judgements, the application of choice limiting principles and the language of clinician-patient interaction.
Ethical issues in palliative care - an overview
Authors: Oliver David
Published: January 2017

There are many ethical decisions to be made during palliative care of a patient with motor neurone disease. These may concern the physical and psychosocial care of the patient and will become highlighted when death approaches. By close involvement of the patient and his/her family with the interdisciplinary team the most appropriate decisions on the patient's care can be made.
Coping with motor neurone disease — an analysis using self-regulation theory
Authors: Earll Louise , Johnston Marie , Mitchell Elspeth
Published: January 2017

Medicine and environmental changes have had tremendous success in controlling the infectious diseases that were the major causes of death in the last century. However, the consequential extension of life has been accompanied by an increase in the number of persons living with and dying of chronic illness.1 Despite these changes and their implications, the means by which people cope with such illnesses has only recently begun to receive the attention the subject warrants. 2,3 Such diseases have a high prevalence in the population and self-detection and self-management are critical to the treatment and control of chronic disease and disability.4

This paper examines how people cope with motor neurone disease and sets this in the context of earlier research on psychological aspects of chronic disease and current theoretical approaches to coping with long-term ill health.
Breaking bad news in amyotrophic lateral sclerosis
Authors: Meininger V.
Published: January 2017

There are many difficulties of communication with patients with amyotrophic lateral sclerosis (motor neurone disease). In France, most physicians have a policy of keeping the fact of this diagnosis from both patients and relatives. This paper describes an alternative approach based on open communication, and applies that principle to handling issues of communication associated with various aspects of four different topics: the diagnosis itself, the development of handicap, swallowing difficulties, and respiratory difficulties.
Decision-making in the respiratory care of amyotrophic lateral sclerosis: should home mechanical ventilation be used?
Authors: Oppenheimer Edward Anthony
Published: January 2017

As respiratory function starts to deteriorate in those with amyotrophic lateral sclerosis, one of the principal questions that has to be answered is whether it is appropriate to provide ventilatory support. Although expensive, it is perfectly feasible to provide this at home, and this article examines many of the issues surrounding home mechanical ventilation.
Victim Participation in Proceedings and Sentencing in Europe
Authors: Joutsen Matti
Published: January 2017

The article reviews the different ways in which victims can influence the course and outcome of criminal proceedings in different European criminal justice systems. The range is from some jurisdictions (such as Greece, the Netherlands and Portugal) where the victim can appear only in the capacity as witness, to others (such as Finland) where there is a general right to prosecute. Even in the systems providing victims with the greatest opportunity for participation, the victim in practice generally leaves prosecution to the public prosecutor. The article concludes by arguing that no one system is ideal from the point of view of the victim.