bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in Beliefs and Attitudes toward the Improvability of Writing of Gifted Students Who Exhibit Mastery-Oriented and Helpless Behaviors
Authors: Clark Jolene , Tollefson Nona
Published: November 2015

Teachers classified students enrolled in middle/junior high school gifted programs into mastery-oriented, helpless, and neither mastery-oriented nor helpless (NMO/H) groups. Mastery-oriented students consistently scored higher than the helpless group on measures of ability to improve quality of writing, motivation to write, confidence in writing, and general attitude toward writing. The mean score of the students in the NMO/H group consistently fell between the mean scores of the mastery-oriented and helpless groups. The results of the study supported the hypothesized differences between the implicit theories of intelligence held by mastery-oriented and helpless students. Implications for the field of gifted education are discussed.
The Marland Report: Twenty Years Later
Authors: Harrington Joseph , Harrington Christopher , Karns Edward
Published: November 2015

In October, 1971, Commissioner of Education, Sidney P. Marland, submitted a report to Congress which concluded that the Federal government had provided virtually no services to meet the needs of gifted and talented students in America. During the following twenty years, Congress and the White House sought solutions to overcome this deficiency, but usually their interests conflicted sufficiently to keep Marland's observation intact. In 1988, Congress finally passed the Javits bill which implements the major recommendations of the Marland report, and which appears to be the first piece of legislation that has the tacit support of the White House. President Bush's desire to be the “Education President” implies that the federal government may finally assume a role in the education of gifted and talented youngsters.
Characteristics of Elementary Students Entering Gifted Programs: The Learning Outcomes Project at the University of Virginia
Authors: Cornell Dewey G. , Delcourt Marcia A. B. , Goldberg Marc D. , Bland Lori C.
Published: November 2015

This paper presents results from the first round of data collection for the Learning Outcomes Project at the University of Virginia, an ongoing, longitudinal investigation of over 1,100 elementary school children receiving different types of gifted services or regular classrooms. This initial report compares 5 types of services for gifted: within regular classrooms; through pull-out resource rooms; ability grouping in separate classes; special schools; no program offerings. Gifted students are also compared with two groups of students in regular classrooms: classmates of gifted students and students identified as gifted in schools without available gifted programs. Overall results indicate that students selected for all types of gifted services were well above grade level in academic achievement. There were significant differences in the achievement levels, self-concepts, and teacher ratings of students selected for different types of gifted services. These results have implications for both researchers and educators in comparing the effectiveness of different types of gifted service delivery options.
Keeping the Options Open: Curriculum at the Louisiana School for Math, Science and the Arts
Authors: Lewis Gail
Published: November 2015

The Louisiana School for Math, Science and the Arts combines a required core curriculum with specialized focus areas, providing breadth, depth and choice. Students at the school are carefully selected for academic and/or artistic talent from throughout the state of Louisiana during their sophomore year of high school and spend the remaining years prior to college in residence at the Louisiana School. Student perceptions of the curriculum were noted in a survey; results of the survey are reported and the curriculum is described in detail.
Personality Attributes of High IQ/High Achieving Gifted Adolescents: Implications of the Personal Styles Model
Authors: Holliday Gregory A. , Roller James R. , Kunce Joseph T.
Published: November 2015

The nonpathological personality characteristics of high IQ/high achieving high school students were assessed using the Personal Styles Inventory (PSI) and the 16PF. All PSI scales were significantly correlated with one or more of the 16PF scales. Basic personality characteristics of the High IQ/High Achieving students did not differ remarkably from students in general; and, in many instances, the PSI results were more suitable for describing normal personality characteristics and generating usable insights for the students. Implications for assessing normal personality correlates with the gifted are discussed.
The Validity of Portfolios in Predicting Performance in a Gifted Program
Authors: Johnsen Susan K. , Ryser Gail R.
Published: November 2015

The nation is moving toward more authentic assessment procedures such as product portfolios. This study examined the degree to which samples collected in product portfolios from 216 kindergarten through second-grade students were able to predict their successful performance in a gifted program four years later. Successful performance was determined by scores on achievement tests and teacher classroom ratings. Hypotheses were analyzed using descriptive and inferential statistics. This study found that students whose product portfolio scores are in the top quarter perform significantly better on math and reading achievement subtests, but their classroom performance is not rated significantly higher than students whose product portfolio scores are in the bottom quarter. No significant differences were found among racial or ethnic minority groups.
Ethnic and Gender Differences in Locus of Control in Children Referred for Gifted Programs: The Effects of Vulnerability Factors
Authors: McLaughlin Susan C. , Saccuzzo Dennis P.
Published: November 2015

The relationships among ethnicity, gender, and vulnerability factors and locus of control were investigated for gifted and nongifted children. Eight hundred five ethnically diverse, 5th- through 7th-grade children were evaluated for intellectual ability, locus of control, and the presence of vulnerability factors. A 2×2×4 ANOVA revealed significant (p < .01) main effects for Giftedness, Ethnic Background, and Vulnerability Factors and a significant Ethnic × Vulnerability Interaction (p < .038). In addition, a 2(Gender) × 2(Giftedness) × 4(Ethnic Background) ANOVA yielded a significant (p < .024) main effect for Gender. Overall, higher internal locus of control was associated with female Caucasians not at risk. Results confirm previous findings in showing a more internal locus of control in gifted children and further indicate that for gifted and intellectually bright non-Caucasians vulnerability is associated with, and may serve to strengthen, a greater internal locus of control.
Practical Matters
Authors: Peine Marie
Published: November 2015

Criticism in gifted education focuses on two concepts that are central to the field: identification and programming. Who are the gifted? What are the most effective ways to meet their needs? In our deliberations about redefining the foundations of the field, we need to consider the ideas of all of the stakeholder groups. One perspective that has been absent in our discussions is that of the teacher who works with gifted students in grades K-12. This commentary is presented as an examination of critical concerns in our field as they impact the practical matters of the classroom for the gifted.
Learning to Play the Game: Female Students Discuss Their Success in High School
Authors: Rizza Mary G.
Published: November 2015

The importance of understanding student learning preferences is well established in the literature. Using qualitative methodology, this study examined learning through the eyes of 20 high-achieving female students enrolled in single-sex and coeducational secondary schools. Learning and success in school was described by the participants as the result of taking an active stance toward the material and understanding their style preferences, which included an inclination for learning within contexts and a tendency to study alone. Implications for classroom practice are included.
Rising Tides and Racing Torpedoes: Triumphs and Tribulations of the Adult Gifted as Illustrated by the Career of Joseph Renzulli
Authors: Sternberg Robert J.
Published: November 2015

Joseph Renzull's essay highlighting his major programmatic work of the past 25 years tells us far more about the real guts of giftedness than does any IQ score or any test score or set of scores at all. In his essay, Renzulli distinguishes between “schoolhouse giftedness” and “creative productive giftedness.” I do not know how Renzulli did in the schoolhouse, but I do know that he serves as an outstanding model of the kind of creative productive giftedness he discusses. But what actually goes into the creative-potential circle of Renzulli's (1978, 1986) Three-Ring Conception of Giftedness? Renzulli's essay tells us much in answer to this question, as could any autobiographical essay. The goal of this response will be to use Renzulli's essay as a case study of the components of creative productive giftedness. The framework I will use is that provided by our own investment theory of creativity (Sternberg & Lubart, 1995, 1996), although doubtless other models could be used as well.
Enzyme Histochemical Changes in an Acutely Induced Renal Papillary Necrosis
Authors: Gregg Neill J. , Courtauld Elizabeth A. , Bach Peter H.
Published: November 2015

Enzyme histochemistry was assessed in semi-thin glycolmethacrylate sections after 100 mg/kg 2-bromoethanamine (BEA) hydrobromide had been given ip to male Wistar rats to induce renal papillary necrosis. Changes in the proximal tubular marker enzymes alkaline phosphatase (Alk Phos), gamma-glutamyltranspeptidase (GGT) and adenosine triphosphatase (ATPase) were not apparent before 8 hr, but there was a progressive loss up to 144 hr. The proteinaceous PAS-positive casts in the loops of Henle and the collecting ducts stained for Alk Phos and GGT (from 12 hr) and for ATPase (from 18 hr). Acid phosphatase (Acid Phos) staining was increased in the proximal tubule lysosomes from 18 hr. There was a marked increase in Alk Phos in all hyperplastic upper urothelial cells from 8 to 24 hr, and a mosaic of staining remained in the pelvis adjacent to the necrosed papilla at 144 hr. At 12 hr, there was an increase in the staining of the pelvic, ureter and bladder vascular endothelial ATPase, the intensity and area of which increased progressively from 18 hr and almost occluded the capillary lumens in the worst affected areas by 144 hr. These data show several distinct series of pathological changes after the administration of BEA. The subtle degenerative changes in the proximal tubule followed the papillary lesion, but exfoliated brush border and proximal tubular cells were important components of the protein casts in the distal nephron. Similarly, the intense Alk Phos staining in the hyperplastic regions of the upper urothelium and the increased pelvic, ureteric and bladder endothelial ATPase staining suggested they develop as a consequence of the papillary lesion.
Growth, Body Weight, Survival, and Tumor Trends in (C57BL/6 X C3H/HeN) F1 (B6C3F1) Mice during a Nine-Year Period
Authors: Rao Ghanta N. , Haseman Joseph K. , Grumbein Sondra , Crawford Denise D. , Eustis Scot L.
Published: November 2015

Time trends for growth, body weight, survival and tumor prevalences in 121 diet control groups with a total of 4,636 male B6C3F1 mice and 123 diet control groups with a total of 4,758 female mice of NCI-NTP 2-yr chemical carcinogenicity studies started during a 9-yr period (1973 to 1981) in 11 laboratories were evaluated. Male and female mice did not show substantial changes in growth patterns. Both sexes had highly significant time trends with decreasing body weights in the more recent studies. This apparent trend was due to high body weights during the first 3 yr and highly significant interlaboratory variability. Time trends for survival of both sexes were not significant. Prevalences of liver tumors, lung tumors, and lymphoma in males and lung tumors in females did not show significant time trends. There were significant positive time trends for prevalences of liver tumors and lymphoma in female mice, but the trends were not significant when adjusted for interlaboratory variability. The positive time trend for anterior pituitary tumors of females was highly significant and may be due in part to an increase in the amount of pituitary tissue examined in the more recent studies. Histological reevaluation of liver and anterior pituitary tissue in 208–249 female mice at each of 4 different times periods did not substantially change the prevalences or the time trends. The major factor influencing time trends in mice appeared to be interlaboratory variability.
Characterization of the Early Ultrastructural and Biochemical Events Occurring in Dichloromethane Diphosphonate Nephrotoxicity
Authors: Alden Carl L. , Burns Janet L. , Parker Ron D. , Englehart Jan L. , Dennis Vincent W.
Published: November 2015

A chelator, dichloromethane diphosphonate (Cl2MDP), used to treat for malignancy-induced hypercalcemia, has nephrotoxic potential. An acute animal model developed to examine the mechanism was used to further characterize the renal effects. NAG enzymuria appears to be an early premonitor of injury. Ultrastructurally, an increase in size and number of protein-containing phagolysosomal reabsorption droplets in proximal convoluted tubules associated with proteinuria precedes advent of tubular cell necrosis indicating these organelles to be a potential target site for Cl2MDP in the kidney. In vitro studies using rabbit cortical tubules and rat brush border membrane vesicle preparations suggest that the renal toxicity is not due to perturbation of phosphate transport or oxidative metabolism. An operational hypothesis emerges indicating that Cl2MDP may be protein bound affecting carrier protein charge facilitating glomeruler leakage with tubular accumulation via protein transport. Cl2MDP may induce critical cation perturbation at the subcellular level as the mechanism of cell death.
Sphenopalatine Artery Ligation for Epistaxis
Authors: McDermott Ailbhe M. , O’Cathain Eadaoin , Carey Brian William , O’Sullivan Peter , Sheahan Patrick
Published: November 2015

Objective

Sphenopalatine artery ligation is a commonly employed surgical intervention for control of posterior epistaxis unresponsive to nasal packing. The objective of the present study was to evaluate the outcome of sphenopalatine artery ligation for control of epistaxis at our institution and the impact of timing and other factors on outcome.

Study Design

Case series with chart review.

Setting

Academic tertiary referral center.

Subjects and Methods

Case notes were reviewed for 45 consecutive patients undergoing sphenopalatine artery ligation for control of epistaxis between October 2008 and October 2014.

Results

Forty‐one patients had nasal packing prior to sphenopalatine artery ligation, with 33 undergoing ≥2 packings. Postoperatively, 6 patients had rebleeding, which was treated with repacking (n = 4) and return to the operating room (n = 2). The overall success rate of sphenopalatine artery ligation was 87% (39 of 45). Rebleeding rate was not affected by concomitant septoplasty, anterior ethmoidal artery ligation, or postoperative nasal packing. Patients undergoing SPA ligation within the first 24 hours of admission had a significantly shorter hospital length of stay (3 vs 6 days, P =. 02) and treatment cost (€5905 vs €10,001, P =. 03). Length of stay was not influenced by sphenopalatine artery ligation after ≤1 nasal pack versus ≥2 packs. Timing of sphenopalatine artery ligation did not affect blood transfusion requirement (P =. 84).

Conclusion

Sphenopalatine artery ligation is an effective management strategy for surgical control of refractory epistaxis. Early timing of sphenopalatine artery ligation may lead to reductions in length of stay.
Combined Extracranial‐Intracranial Resection of a Maxillary Desmoid Tumor
Authors: Osguthorpe J. David , Adkins Warren Y. , Rawe Stephen E.
Published: November 2015

Desmoid tumors are a locally infiltrative, nonmetastasizing form of fibromatosis. Wide en bloc extirpation is the therapy of choice, with a high recurrence rate reported for lesser resections. The first case of a desmoid invading intracranially is reported, and the combined intracranial‐extracranial resection is described.
Laryngeal Acinic Cell Carcinoma Following Thyroid Irradiation
Authors: Reibel James F. , McLean W. Copley , Cantrell Robert W.
Published: November 2015

Only three examples of acinic cell carcinoma of the larynx or trachea are found in the recent literature. A case of acinic cell carcinoma of the subglottic larynx and trachea was diagnosed and treated at the University of Virginia Medical Center. To our knowledge this is the first such case with a prior history of radiation to the neck. The patient is a 56‐year‐old woman who was irradiated for hyperthyroidism 46 years ago. When seen she also had parathyroid hyperplasia and multiple thyroid adenomas, conditions that frequently follow irradiation of the thyroid in children. These findings in this case support the concept that radiation may be responsible for inducing this tumor, which otherwise rarely occurs in this location. The use of electron microscopy was extremely useful in the diagnosis of this tumor. She was treated with total laryngectomy and right neck dissection and is now free of disease one year after surgery.
The Effect of Vocal Cord Paralysis on the Cricoarytenoid Joint
Authors: Colman Marc F. , Schwartz Ilsa
Published: November 2015

Vocal cord reinnervation using neuromuscular pedicle techniques have met with variable success. One of the limiting factors in this type of surgery is the status of the cricoarytenoid joint. In this pilot study we studied the effect of immobilization secondary to deinnervation in the rat. There were no significant joint changes in the animals operated on after periods of up to 11 months. This agrees well with reported successes of reinnervation procedure 20 years after laryngeal paralysis.
Chronic Otitis Media with Effusion and Allergy: Modified Rast Analysis of 119 Cases
Authors: McMahan John T. , Calenoff Emanuel , Croft D. James , Barenholtz Lawrence , Weber Larry D.
Published: November 2015

Chronic otitis media with effusion is a serious widespread disease—the cause of which is unclear. We present evidence that IgE‐mediated atopic disorders play a major role in the etiology of the disease and that when these disorders are treated concomitantly, the duration and severity of the disease is decreased significantly.
Adjunctive Procedures to Maximize the Result of Cosmetic Eyelid Surgery
Authors: Dicker Ralph L. , Syracuse Victor R.
Published: November 2015

The cosmetic blepharoplasty should be complemented by surgical procedures that augment the favorable aesthetics of the blepharoplasty. A blepharoplasty is frequently not fully satisfying to the patient or the surgeon. The plastic surgeon must recognize the need for adjunctive procedures such as eyebrow lift, blepharocanthoplasty, malar implants, dermal abrasion, chemosurgery, and temporoauricular lift to fulfill the more ideal expectations of both surgeon and patient.

Evaluation of the aesthetic requirements for youthful restoration around the eye and the need for additional surgical techniques to enhance the beauty of the eye are discussed. Included in the discussion are the techniques used for the various procedures, the complications that can arise, and the reward of surgery performed in conjunction with the routine blepharoplasty or instead of it.
The Hyoid Bone Syndrome
Authors: Lim Romeo Y.
Published: November 2015

Various causes of head and neck pain have been described in the literature. In 1954 Brown1 described a so‐called hyoid bone syndrome, ie, tenderness at the site of the greater cornu of the hyoid bone. His paper, however, did not offer any definitive treatment. In 1968 Steinmann1 reported the hyoid bone syndrome as a form of “insertion tendinosis,” for which he recommended the use of procaine hydrochloride injection with corticosteroid at the tip of the greater hyoid cornu for relief of pain. The relief, however, was temporary. The purpose of this paper is to present the symptom complex of the hyoid bone syndrome, its diagnosis by exclusion, and excision of the greater cornu in 18 patients for permanent relief of head and neck pain.
A Surgical Approach to Chordomas at the Base of the Skull
Authors: Miller Robert H. , Woodson Gayle E. , Neely J. Gail , Murphy Edward C.
Published: November 2015

Chordoma of the skull base has a poor prognosis because of the proximity of vital structures as well as the difficulty encountered in attempting complete surgical excision. This paper presents a case of massive recurrent chordoma involving the intracranial cavity, nasal cavity, and maxillary antrum. The tumor was debulked and decompressed via a transantral approach to the pterygomaxillary fossa and the base of the skull. This technique is recommended because it achieves immediate decompression and provides a space into which the inevitable regrowth of the tumor may extend.
Malignant External Otitis: A Dangerous Misnomer?
Authors: Lucente Frank E. , Parisier Simon C. , Som Peter M. , Arnold Leon M.
Published: November 2015

Review of our experience in treating 16 patients with malignant external otitis, along with survey of the compromised defense mechanisms of diabetic patients, confirms the need for immediate, intense, and vigilant therapy. Radioisotope scans, high‐resolution computed tomography scans, and multidirectional tomograms are used to delineate the extent of the disease. Therapy includes intravenous aminoglycosides and penicillin derivatives, limited surgery, and hyperbaric oxygenation. In view of the tendency for this infection to extend beyond the external auditory canal and to produce an invasive lethal osteomyelitis, we feel that the tendency to classify this disease as a variant of diffuse external otitis may foster undertreatment.
Cricopharyngeal Myotomy: Management of Cervical Dysphagia
Authors: Ross Eugene R. , Green Robert , Auslander Miles O. , Biller Hugh F.
Published: November 2015

Cricopharyngeal myotomy has gained widespread acceptance as surgical treatment for various forms of cervical dysphagia. The case records of 33 patients who underwent cricopharyngeal myotomy for dysphagia originating from varying underlying diseases are reviewed. The majority of these patients were able to resume oral feeding following myotomy. Analysis of preoperative pharyngoesophageal manometry and contrast radiography identified diagnostic criteria for appropriate case selection.
The Cochlear Nuclei Revisited
Authors: Dublin William B.
Published: November 2015

The cochlear nuclei (CN) in man consist of the dorsal (DCN), superior ventral (SVCN), and inferior ventral (IVCN). The CN is located on the dorsolateral surface of the brain stem at the junction of the medulla with the pons. The DCN curves over the inferior cerebellar peduncle and forms part of its dorsolateral surface. The IVCN is found beneath the lateral portion of the DCN. The SVCN is for the most part covered by the inferior portion of the middle cerebellar peduncle.

Of five types of nerve cells found in the CN in man, spheroid cells appear especially in the SVCN. They are the second‐order neurons of the main ascending neural auditory pathway. Their injury forms the basis for hearing loss of central type. The SVCN can be mapped into estimated frequency strata progressing from low frequencies ventral to high frequencies dorsal. Spheroid cells are susceptible to injury notably by anoxia and especially centering around an estimated 4,000 Hz frequency level in the SVCN. The pattern of injury of spheroid cells can be displayed in comparison with audiometric tracing on a standard audiogram chart.
Observations on Tonotopic Organization within the Rat Inferior Colliculus Using 2‐Deoxy‐D[1‐3H] Glucose
Authors: Coleman James R. , Campbell Maurice , Clerici William J.
Published: November 2015

Tonotopic organization is a major feature of central auditory structures. The tritiated 2‐deoxyglucose metabolic marking technique is demonstrated to be useful for visualizing isofrequency contours in the rat inferior colliculus. Following pure‐tone stimulation, the central nucleus of the inferior colliculus shows discrete, prominent banding patterns and a well‐organized tonotopic arrangement.
Stapedectomy revision of the wire‐Gelfoam prosthesis
Authors: Lippy W.L. , Schuring A.G.
Published: November 2015

Revision procedures in which a vein graft with a Robinson stapes prosthesis was used are reviewed in 100 patients. In all cases a wire‐Gelfoam stapes prosthesis had been used initially. The surgical findings were prosthesis malfunction, 48%; eroded incus, 16%; negative findings, 14%; footplate not removed, 11%; oval window fistula, 7%; and incus problems, 4%. Postoperatively, hearing in 70.5% of the patients with conductive hearing loss was within 10 dB and 84.5% within 20 dB. The high success rate is affected by the fact that patients with conductive hearing loss were separated from those with sensorineural hearing loss, a piston prosthesis on tissue was used in the revision surgical procedure, and patients with otosclerosis regrowth did not undergo revision. Surgical directives to minimize hearing loss included use of a tissue seal over the oval window; not reopening the oval window; monitoring the patient for dizziness; performing audiometric tests during surgery; leaving the wire in place in certain cases; and not revising the prosthesis in patients with otosclerosis regrowth.
Immunology of the inner ear: Response of the inner ear to antigen challenge
Authors: Harris Jeffrey P.
Published: November 2015

The relationship of the inner ear to host immunity and the immunoresponsiveness of the inner ear to antigen challenge were investigated. A radioimmunoassay was used to quantitate antibody titers to keyhole‐limpet hemocyanin generated in the serum, perilymph, and CSF of guinea pigs following systemic or inner ear immunizations. The results of these experiments demonstrate (1) the blood‐labyrinth barrier is analogous to the blood‐brain barrier with respect to immunoglobulin equilibrium, (2) the inner ear is capable of responding to antigen challenge, and (3) the inner ear is an effective route for systemic immunization.
A study of the high‐risk registry for sensorineural hearing impairment
Authors: Pappas Dennis G.
Published: November 2015

In the medical evaluation, rehabilitation, and education of the hearing impaired, the first line of defense is the high‐risk factor screening for sensorineural damage of all neonates. The most efficacious means of neonatal screening for those factors affecting sensorineural hearing damage is the employment of a high‐risk registry. Based on a retrospective study of 109 children with sensorineural loss, high‐risk factors and how improved use of the high‐risk registry permits earlier detection (and statistically more successful rehabilitation) for such auditory‐impaired children are discussed. The importance of pediatric screening of all neonates for hearing loss, in addition to use of the high‐risk registry, is evidenced by the fact that only 46% of the children retrospectively identified in our study would have routinely appeared among the high‐risk infants were the registry used alone.
Sonne observations on the localizing significance of ear‐dependent positional nystagmus
Authors: Althaus Sean R. , Gutierrez Jesus A.
Published: November 2015

Seventy‐one patients who demonstrated unilateral ear‐dependent positional nystagmus and unilateral labyrinthine weakness were studied to test the hypothesis that ear‐dependent positional nystagmus almost always occurs on the side of unilateral labyrinthine impairment. Little, if any, correlation was found between these two parameters. The results of this study with regard to the critical question of selecting the correct ear for surgery in patients with incapacitating benign paroxysmal postural vertigo are discussed.
Elevated Serum Secretory Immunoglobulin a Levels in Patients with Head and Neck Carcinoma
Authors: Watanabe Tsuneo , Iglehart J. Dirk , Bolognesi Dani P. , Cox Edwin B. , Vaughn Anna , Hudson William R.
Published: November 2015

Secretory immunoglobulin A (SlgA) is a major component of the secretory immune system and has been demonstrated in the sera of patients with various pathologic conditions. Current studies were undertaken to quantitate secretory components (SC) in sera of patients with squamous cell carcinoma in the head and neck region by means of a sensitive double‐antibody radioimmunoassay. Patients with head and neck carcinoma were found to have threefold higher levels of SC (1.54 ± 0.74 mg/ml) compared to normal controls (0.51 ± 0.22mg/ml, P <. 0001). Of interest was that the sera of patients who had successfully been treated 2 to 6 months prior to the study demonstrated statistically lower levels than those of patients with untreated carcinoma or recurrent disease. SC in sera appears to be in the form of SlgA. The origin and diagnostic significance of SC are briefly discussed.
Predictive Factors of Cricoid Ring Size in Adults in Relation to Acquired Subglottic Stenosis
Authors: Koufman James A. , Fortson James K. , Strong M. Stuart
Published: November 2015

Subglottic stenosis secondary to endotracheal intubation is a distinct clinical entity. Prolonged intubation is an important causative factor, but even short‐term endotracheal intubation with too large a tube can damage the cricoid sufficient to cause delayed subglottic stenosis. After studying cricoid size and other factors in 130 adult laryngectomy and autopsy specimens, the following conclusions were reached: (1) The subglottic cricoid is the smallest, fixed cross section in the upper airway. (2) Even if height is comparable, women have smaller cricoid diameters than men. (3) Height is the best predictor of cricoid size. (4) Weight and race are not accurate predictors. (5) Third finger length and cricoid size correlate well, particularly in men. (6) Thus height and third finger length can be used to choose the proper endotracheal tube for adults.
Fiberoptic Fluorometer for Skin Flap Assessment
Authors: Weisman Robert A. , Silverman David G.
Published: November 2015

The fiberoptic fluorometer permits quantitative measurement of fluorescence after intravenous administration of fluorescein. Accurate assessment of tissue fluorescence can be made at any time after the injection, and both uptake and elimination of fluorescein can be followed. The instrument provides instantaneous digital readout of the fluorescence measured in dye fluorescence (DF) units and an index predictive of viability called the dye fluorescence index (DFI). The unit is portable, can be sterilized for operating room use, and can be operated by paramedical personnel with ease. We have used the instrument extensively in clinical and laboratory investigations, where it has been highly reliable in predicting survival and necrosis of a wide variety of flaps. Little or no operating time is added, and serial, low‐dose fluorescein injections may be used to monitor a flap in the recovery room or at the bedside in the early postoperative period.
Transtympanic Eustachian Tuboplasty and Tolerance of Stenting Materials
Authors: Parkin James L. , Johnson Leland P. , Stringham James C.
Published: November 2015

The purpose of this study was to evaluate various eustachian tube stenting materials in an attempt to develop a successful transtympanic eustachian tuboplasty technique. Eustachian tube mucosa was removed transtympanically in 40 feline ears. Ten ears were used as controls. Polyethylene, Silastic, and polyurethane stents were placed in 30 ears, 10 ears with each material. The ears were evaluated after a minimum of 8 weeks and the stents were removed. Eight weeks after stent removal the ears were assessed visually, tympanometrically, and by biopsies of the osseous eustachian tube mucosa. Inadequate middle ear ventilation as evidenced by persistent otitis media, persistent tympanic membrane perforations, or type B or type C tympanograms was found in 60% of control, 30% of Silastic‐stented, 60% of polyurethane‐stented, and 0% of polyethylene‐stented ears. Small polyethylene stents were most successful in reestablishing eustachian tube function in this experiment.
Clinical Experience with the Silicone Tracheal Cannula in Obstructive Sleep Apnea
Authors: Orsini Michael A. , Conner George H. , Cadieux Roger J. , Kales Anthony
Published: November 2015

The surgical and postoperative course was evaluated in 20 patients with severe obstructive sleep apnea who underwent tracheostomy in which a silicone tracheal cannula was used. The cannula has been introduced recently by Dr. William Montgomery for use in a variety of clinical settings. Our findings indicate that the silicone tracheal cannula is a simple and reliable method of maintaining the tracheal airway in patients with severe sleep apnea. There were infrequent complications and a high degree of patient acceptance with this surgical procedure. Advantages of the silicone tracheal cannula include ease of insertion (especially in the often obese neck of the patient with sleep apnea), the inconspicuous nature of the cannula itself, the ease of care, and the maintenance of speech. Thus our clinical experience with this new tracheal cannula in the treatment of certain types of sleep‐related breathing disorders indicates that it has a number of advantages as well as infrequent complications.
Labyrinthine Cryosurgery for Meniere's Disease‐Present Status
Authors: Wolfson Robert J.
Published: November 2015

When surgery is required to control attacks of vertigo caused by Meniere's disease, total labyrinthectomy performed by the transcanal or transmastoid approach is the procedure of choice when the disease is unilateral and has permanently damaged hearing to the point that only a distorted remnant remains and amplification would not be effective. For patients with bilateral Meniere's disease or unilateral cases with sufficient hearing to warrant its preservation, a surgical procedure is required that eliminates the vertigo and either improves or at least does not adversely affect the hearing. Labyrinthine cryosurgery has been used clinically since 1965 in an attempt to achieve this goal. The results of 225 procedures followed for 1 year or longer indicated that vertigo is controlled in 73% but not in the remaining 27%. Hearing seemed unaffected by cryosurgery. If hearing fluctuated prior to surgery, it generally continued to fluctuate afterward. Improved or decreased hearing could therefore not be interpreted as a direct result of surgery but rather as a continuation of the fluctuation in hearing that commonly occurs in this disorder.
Attachment of Streptococcus Pneumoniae to Human Pharyngeal Epithelial Cells in Vitro—Mechanism of Binding
Authors: Andersson B , Fogh A , JØRgensen F. , Larsson S , Leffler H , Magnusson G , Nylén O. , Südow C.V. , Edén C. Svanborg
Published: November 2015

To colonize mucosal surfaces and to invade underlying tissues, bacteria need to bind to components of the mucosa. Unattached bacteria are transported away from the surface with the fluid flow. By binding to the nasopharyngeal mucosa, Streptococcus pneumoniae causing otitis media may persist at the site of infection. High binding capacity of the bacterium and increased receptivity of the epithelial cells for attaching bacteria may both contribute to the susceptibility of patients prone to otitis. Thus, epithelial cells from children with frequent episodes of otitis bind attaching bacteria more readily than do cells from age‐matched controls. The binding mechanism probably involves bacterial surface proteins and epithelial cell surface glycoconjugate receptors. Evidence is presented that phosphorylcholine, a component of the bacterial surface, as well as epithelial cell receptor analogues, that is, natural or synthetic saccharides analogous to the lactoneoseries of glycolipids, inhibits pneumococcal attachment. Inhibition of bacterial binding in vivo may be a new approach to prophylaxis against otitis media.
Endolaryngeal Devices for Perioperative Identification and Functional Testing of the Recurrent Nerve
Authors: Hvidegaard Torkil , Vase Poul , Dalsgaard Stig C. , JØRgensen Karsten
Published: November 2015

It has previously been shown that identification of the recurrent laryngeal nerves reduces the risk of injury to the nerves during thyroid surgery. To facilitate identification and to test the conductivity of the recurrent nerves we have used electrical stimulation of the nerves and simultaneous recording of the vocal cord movements with two different endolaryngeal devices. The experience gained with these devices indicates that it is possible to reduce the frequency of injury to the nerves, and the method accelerates the progress of the operation, especially in cancer surgery and repeat operations.
Fine‐Needle Aspiration Biopsy of the Thyroid Gland
Authors: Petersen S. Vang , Greisen O.
Published: November 2015

Fine‐needle aspiration biopsy is a diagnostic procedure used routinely in the evaluation of patients referred with a thyroid swelling. The technique and the results in our series of 233 patients, which included 39 carcinomas, are presented. A relatively high diagnostic specificity of 81% was found, whereas the diagnostic sensitivity was considerably lower (58%). It is concluded that fine‐needle aspiration biopsy is a valuable diagnostic procedure in the preoperative assessment of patients with thyroid swellings. A definitive treatment, however, must never be based entirely on the results of a fine‐needle aspiration biopsy. It is concluded that the results can be improved if the procedure is performed by a few highly skilled clinicians and pathologists.
Evacuation of the Middle Ear by Sniffing: A Cause of High Negative Pressure and Development of Middle Ear Disease
Authors: Falk Bernt , Magnuson Bengt
Published: November 2015

Previous research on eustachian tube function has been devoted mainly to the study of the tubal opening ability and pressure equalization. This article summarizes a series of experimental studies focusing on the closing ability of the tube. Results support the belief that the purpose of the tube should be seen primarily as protecting the middle ear from the extensive pressure variations that physiologically take place in the nasopharynx. A number of studies of diseased ears have shown that tubal malfunction was characterized mainly by a reduced ability to withstand negative pressure in the nasopharynx. Sniffing can evacuate the middle ear, causing high negative intratympanic pressure. It seems likely that this mechanism is involved in the development of middle ear effusion and manifest retraction‐type middle ear disease.
Adaptation in the Function of Pharyngeal Constrictor Muscles
Authors: Rowe Lee D. , Miller Arthur J. , Chierici G. , Clendenning D.
Published: November 2015

The palatopharyngeus and pharyngeal constrictor muscles were studied by electromyography (EMG) and by direct observation with a flexible fiberoptic scope in the anesthetized as well as in the alert rhesus monkey. The muscles were monitored to determine the change in their discharge with nasal obstruction, head posture, head extension, and swallowing. The results indicated that certain regions of the middle and inferior pharyngeal constrictors never discharged during deglutition. Extending the head could induce a tonic discharge in fibers of the middle pharyngeal constrictor for the duration of head extension. Placement of water in the hypopharynx not only induced a sustained laryngospasm but also a tonic discharge in the select fibers of the superior and middle pharyngeal constrictors. Changing from a supine to an upright posture, or obstructing the nasal cavity, could induce a rhythmic discharge. These studies indicate that there are functional components of fibers within each of the anatomically recognized pharyngeal constrictors.
Prospective Crossover Evaluation of Four Methods of Clinical Management of Tinnitus
Authors: Mehlum David , Grasel George , Fankhauser Charles
Published: November 2015

This article summarizes data obtained from 34 tinnitus‐afflicted patients who participated in and completed a prospective crossover evaluation of four methods of clinical management of tinnitus. The methods included a 2‐week trial with each of the following: a tinnitus masker, a tinnitus instrument (a combination device consisting of a tinnitus masker and a hearing aid), a hearing aid, and conventional environmental controls. The relative effectiveness of each method of treatment was assessed by interview. The data presented summarize respondents' preferences for each method of treatment. Use of a tinnitus masker, tinnitus instrument, and hearing aid is related to stability of auditory thresholds. Comments are made on our experience with clinical management of the patient afflicted with tinnitus, and observations are offered on continued investigation in this area.
Tympanic Membrane Changes Secondary to Tympanostomy Tube Insertion in Chinchillas
Authors: Meyerhoff William L. , Shea Donald A.
Published: November 2015

Tympanostomy tubes were inserted in 16 chinchillas to study the effect on tympanic membrane morphology. Tympanic membranes were examined with an operating microscope after 72 hours and at weekly intervals thereafter. Three ears developed postoperative otorrhea. Except for the ears with otorrhea, all tympanic membranes remained gray and translucent. Histologically, granulation tissue and polymorphonuclear leukocyte infiltration occurred around the tympanostomy tube by 7 days. With time this was replaced by a mature fibrous ring, which explained the tissue band observed otoscopically. In those tympanic membranes where the tympanostomy tube had extruded, healing occurred with an overly developed membrana propria. The middle ears of all experimental animals remained free of pathologic changes except for the three ears with otorrhea.
Fibrous Dysplasia of the Temporal Bone: The use of Computerized Tomography
Authors: Lambert Paul R. , Brackmann Derald E.
Published: November 2015

Fibrous dysplasia of the temporal bone is a rare condition characterized histologically by proliferation of fibrous tissue with scattered trabeculae of immature bone. Eighteen cases of monostotic fibrous dysplasia of the temporal bone have been reported in the literature. The clinical course of temporal bone fibrous dysplasia is unpredictable. Potential complications include cholesteatoma, recurrence, and malignant transformation. Surgery has been the recommended treatment, but the indications, approach, and extent have not been clearly established. The introduction of computerized tomography with high‐resolution bone reconstruction is a significant advance in the therapeutic approach to temporal bone fibrous dysplasia. It accurately defines the extent of the disease within the temporal bone, and periodic scanning will reveal any progression. This information can be used to resolve many surgical dilemmas and to minimize secondary complications. This article includes a comprehensive review of the literature on temporal bone fibrous dysplasia and summarizes a case in which computerized tomography was used.
The Extratemporal Facial Nerve
Authors: Proctor Bruce
Published: November 2015

The extratemporal course of the facial nerve must be completely understood if surgery is required for the removal of parotid and other tumors in the infratemporal space and skull base or if the nerve itself must be exposed when it has been severed. The key to mastering this surgery is to understand the anatomy of the parotid space and its relations to surrounding structures so that the facial nerve can be found during surgery and preserved intact. Tumor masses or scar tissue may distort normal structures and relations to adjacent structures; this must be kept in mind while operating in this complicated anatomic area.
Neuropathologic Changes Following Direct‐Current Stimulation of the Rat Sciatic Nerve
Authors: Chase Stephen G. , Hughes Gordon B. , Dudley Alden W.
Published: November 2015

Peripheral nerve stimulators can be of value in surgical dissections. Recent investigations have questioned the safety of direct‐current nerve stimulators, while verifying the safety of pulsed‐current nerve stimulators. However, the studies failed to adequately simulate the routine clinical setting in which a nerve stimulator was used. Therefore, an experiment was designed to approximate as closely as possible – given the limitations of the animal model – the use of a direct‐current peripheral nerve stimulator in a surgical dissection. The results of this study did not show a difference between experimental and control groups. We conclude that direct‐current nerve stimulation is safe when used judiciously and appropriately.
Safe Instrumentation in Laser Surgery
Authors: Ossoff Robert H. , Karlan Marc S.
Published: November 2015

Safe instrumentation in laser surgery involves three basic principles. First, the armamentarium used in conjunction with the operative procedure should be nonflammable. Second, the surfaces of instruments should be nonreflective. Finally, there must be a provision for adequately evacuating smoke and steam from the operative field. This article discusses these principles and reviews instrumentation currently used in microlaryngeal and bronchoscopic laser surgery that satisfies these standards.
Resistance of the Auditory Brain Stem Response to High Barbiturate Levels
Authors: Marsh Roger R. , Frewen Timothy C. , Sutton Leslie N. , Potsic William P.
Published: November 2015

In the comatose patient the auditory brain stem response may be one of the few indices of CNS function available. Because barbiturates may be administered to control intracranial pressure and its sequelae, demonstration of the effect of barbiturates on the brain stem response is desirable. In cats preloaded with 63 mg/kg of pentobarbital, intravenous injection of an additional 60 mg/kg reduced, but did not abolish, the later waves of the response. One cat that survived a cumulative dose of 183 mg/kg continued to show a well‐defined brain stem response. Even doses of barbiturate nearly incompatible with survival do not abolish this response.
Chondrosarcoma of the Skull Base
Authors: Kveton John F. , Brackmann Derald E. , Glasscock Michael E. , House William F. , Hitselberger William E.
Published: November 2015

Chondrosarcoma of the skull base is an uncommon neoplasm that comprises 0.15% of all intracranial tumors and 6% of skull base lesions. Compression of vital neurologic structures by tumor expansion as well as the histologic characteristics contribute to the malignant potential of these neoplasms. Tumor recurrence has been associated with incomplete resection in this traditionally surgically inaccessible region. This review of five cases of chondrosarcoma of the skull base examines the surgical approaches to resection in a chronologic fashion to emphasize that total gross resection of these lesions has become possible through the evolution of lateral skull base techniques. The difficulty in pathologic diagnosis and the efficacy of postoperative radiotherapy in enhancing survival are also addressed.