bluuebunny/crossref_metadata_2025 huggingface dataset:
Teacher Perceptions of Gifted Hispanic Limited English Proficient Students
Authors: Fernández Alberto T. , Gay Lorraine R. , Lucky Luretha F. , Gavilán Marisal Reyes
Published: November 2015

The purpose of this study was to determine (a) whether teachers' perceptions on the characteristics of gifted students in general differed from their perceptions of gifted students classified as Hispanic limited English proficient (LEP) and (b) whether these perceptions differed based on the teachers' ethnic backgrounds. There were 373 teachers from nine elementary schools in Dade County, Florida, who completed a 34-item Likert-type survey. Randomly, one-half of the teachers in each school received the survey labeled “Gifted Hispanic LEP,” and the other half received the survey labeled “Gifted.” Significant differences were found in responses by survey group and by ethnicity, and no significant interaction was found between group and ethnicity. Both survey groups perceived a similar order of importance for the characteristics. However, relative importance differed significantly in language-related items. There were also significant differences between the groups in the degree to which they rated the characteristics as important.
Action Research and Practical Inquiry: How Can I Meet the Needs of the High-Ability Student within My Regular Education Classroom?
Authors: Hughes Lynn
Published: November 2015

There may be many other teachers who are in the same situation as I am: trying to meet the needs of the high-ability student within the regular education classroom. In this paper, I present an action research project outlining the steps I took on an issue of importance to me and my students. Four techniques were shown to be useful: differentiated instruction, student choice, flexible groupings, and mixing enrichment with acceleration.
Renzulli's Philosophy and Program: Opening Doors and Nurturing Potential
Authors: Ford Donna Y.
Published: November 2015

For decades, educators have searched for answers to explain the persistent and pervasive underrepresentation of minority students in gifted education. In too many school districts, arbitrary cutoff scores on standardized tests and lack of teacher referral are major barriers to the participation of minority students in gifted education. School districts have several options and alternatives for increasing the participation on underrepresented groups in gifted education. One option is to adopt the Schoolwide Enrichment Model. With its focus on talent development, this philosophy and educational approach opens doors to minority students who—for too long—have been shut out of gifted education. The SEM is a model of opportunity, excellence, and equity.
Acute Neurotoxicity of Domoic Acid in the Rat
Authors: Tryphonas Leander , Truelove John , Nera Edwardo , Iverson Frank
Published: November 2015

A recent outbreak of human food poisoning, characterized by severe gastrointestinal and neurologic abnormalities, with a fatal outcome in 3 patients, was attributed to the consumption of poisonous mussels containing domoic acid at an abnormally high concentration. The purpose of the present study was to determine if domoic acid, a glutamate analogue extracted from poisonous mussel, was neurotoxic to rats. Groups of female Sprague-Dawley rats were dosed once intraperitoneally with 0, 1, 2, 4, or 7.5 mg domoic acid/kg of body weight and observed for a maximum period of 24 hr. Clinically, control rats and rats in the 1 mg/kg group were unremarkable. Seventy-five percent of the animals in the 2 mg/kg group had equivocal transient behavioral signs. One that was given 2 mg/kg and all rats given in excess of 4 mg/kg of body weight developed unequivocal behavioral and neurologic signs culminating in partial seizures and status epilepticus. Histopathologically, severely affected rats developed selective encephalopathy characterized by neuronal degeneration and vacuolation of the neuropil in the limbic and the olfactory systems, and retinopathy characterized by neuronal hydropic degeneration of the inner nuclear layer and vacuolation of the external plexiform layer. The results of this study suggest that domoic acid is excitotoxic and causes a characteristic syndrome with clinical signs and histopathologic lesions similar to those reported for kainic acid.
Parotid Lipomatosis in a 2‐Month‐Old Child
Authors: Adams George , Goycoolea Marcos V , Foster Craig , Dehner Louis , Anderson Richard D.
Published: November 2015

A case of parotid gland lipomatosis in a 2‐month‐old child is described. A review of the literature reveals that only three cases have been reported. Emphasis is placed on the importance of approaching a mass of this size via a postauricular approach rather than by a standard parotidectomy incision.
Sector Computerized Tomography of Temporal Bone and Base of Skull
Authors: Kinney Sam E. , Modic Michael T. , Weinstein Meredith , Duchesneau Paul M.
Published: November 2015

The field of computerized tomography (CT) scanning has been one of the great medical advances of the 20th century. The field is developing rapidly with new hardware and software becoming available on a monthly basis. At the Cleveland Clinic Foundation, patients have been studied by using a sector computerized tomography scanner that has the capability of not only improved spatial resolution but also software programs, with the ability to reconstruct data using different algorithms. This versatility in reconstructing the raw data has resulted in a remarkable improvement in the ability to study the temporal bone and the base of the skull.

This paper will present technical data in reference to this new generation of scanner and also show examples of the type of data that are becoming available to the otolaryngologist studying lesions of the base of skull and temporal bone.
Diagnosis of Cerebellopontine Angle Tumors with Small Quantities of Air
Authors: Penley Michael W. , Pribram Henry F. W.
Published: November 2015

Difficulty in detecting small acoustic neuromas has encouraged us to study patients suspected of having a tumor by air cisternography augmented with computed tomography. Ninety patients were examined without complication. Five cubic centimeters of air was introduced via lumbar puncture and manipulated into the cerebellopontine angle cisterns. Scanning is commenced immediately. Filling of both internal auditory canals and identification of the neurovascular bundle in the cerebellopontine angle cistern was possible in all patients except those with tumors. The diagnostic accuracy, speed, and lack of morbidity have made this procedure the initial radiologic examination at our institution for patients suspected of having acoustic neuroma.
Laryngeal Findings in Superior Laryngeal Nerve Paralysis: A Controversy
Authors: Abelson Tom I. , Tucker Harvey M.
Published: November 2015

The diagnosis of superior laryngeal nerve paralysis is infrequently made because of disagreement concerning the laryngeal findings in unilateral cricothyroid muscle dysfunction. Results of experimental unilateral superior laryngeal nerve paralysis in dogs and humans are shown with a review of the literature. The findings are documented by electromyographic studies and laryngeal photographs, and serve to clarify aspects of the functional anatomy of the cricothyroid muscle and the cricoid and thyroid cartilages.
Rhytidectomy Employing a Two‐Layered Closure: Improved Results with Hidden Scars
Authors: Matsunaga Ronald S.
Published: November 2015

The goal of a face‐lift procedure should be to obtain the maximal improvement with minimal morbidity. The author's technique is presented as an alternative technique to accomplish this goal. It is based on 427 face‐lift patients from 1973 to 1979. The technique employs defatting of the superficial musculoaponeurotic system and platysma muscle (which is not dissected free) and use of multiple plication sutures to create a second‐layer closure. This is in contrast to the standard face‐lift procedure, which employs a single‐layer closure whereby all the retraction tension is sustained by the skin flaps. With the author's technique, the complication rates are markedly reduced and satisfactory cosmetic results are obtained with “hidden” face‐lift incisions.
Epiglottitis in Children: Review of 24 Cases
Authors: Baugh Reginald , Baker Shan R.
Published: November 2015

Twenty‐four confirmed cases of acute epiglottitis in children are reviewed. Peak incidence occurred in the months of April and May. Referring physicians correctly diagnosed acute epiglottitis in 61% of cases. Respiratory distress in 24 patients (100%), stridor in 22 patients (92%), and fever in 22 patients (92%) were the most frequently encountered symptoms.
Adverse Effects of Tricyclic Antidepressants During Nasal Surgery
Authors: Schechter Gary L. , Brase David Arthur , Powell Jeffrey
Published: November 2015

This report describes four patients who had early reversal of local anesthetic and vasoconstrictor effects during nasal surgery. They were all taking tricyclic antidepressants. The basic physiology of adrenergic receptor sites and the pharmacology of tricyclic antidepressants as they relate to catecholamine uptake are presented. An explanation of the adverse effect of the tricyclics is presented based on the concept of “epinephrine‐reversal. “
Open Rhinoplasty: An Assessment
Authors: Anderson Jack R. , Johnson Calvin M. , Adamson Peter
Published: November 2015

The senior author (J.R.A.), having taught endonasal rhinoplasty for more than 25 years, felt obligated to evaluate so‐called open rhinoplasty. His experience, and that of his coauthors, indicates that, on balance, this technique offers more advantages than disadvantages; in fact, there is no reason why it should not be used routinely if the surgeon desires. However, while open rhinoplasty permits the surgeon to approach the correction with more confidence, visualization of the structures of the nose does not, of itself, guarantee a good result.
Giant Lymphoid Hyperplasia Presenting as a Highly Vascularized Parapharyngeal Mass
Authors: Lanier Brent J. , Cummings Charles W.
Published: November 2015

Giant lymph node hyperplasia is a rare, benign tumor infrequently occurring in the head and neck. A 31‐year‐old woman with this disorder, present as a large submucosal parapharyngeal mass, is presented and the literature reviewed.

Radiographic evidence of the extreme vascularity of this lesion was remarkable, emphasizing the value of arteriographic evaluation of masses located in this region. Preoperative embolization facilitated its complete resection, and follow‐up examination has shown no evidence of recurrence, which is commonly the course of the disease elsewhere in the body. Consideration of this rare entity is warranted in the work‐up of parapharyngeal masses.
The Use of Open Reduction with Compression Plates
Authors: Levine Paul A.
Published: November 2015

The treatment of maxillofacial trauma involves a choice of accepted therapy for most facial fractures. Experience with the application of the eccentric dynamic compression plate for the reduction of 19 fractures of the edentulous mandible has resulted in a 95% healing rate.
Facial Paralysis Resulting from Parotid Branchial Cyst
Authors: Pensak Myles L. , Casuccio J. Richard , Lesnick Thomas H. , Sasaki Clarence T.
Published: November 2015

Masses of the parotid gland are uncommonly related to branchiogenic origin. We report a case of complete facial paralysis caused by inflammation and infection of a branchial cyst of the parotid. The evaluative protocol and subsequent operative intervention are discussed.
Pigmented Villonodular Synovitis of the Temporomandibular Joint: A Case Report
Authors: Gallia Louis J. , Johnson Jonas T. , Myers Eugene N.
Published: November 2015

The eighth known case of pigmented villonodular synovitis of the temporomandibular joint is presented. Pigmented villonodular synovitis is a benign but locally destructive lesion of obscure cause. In the temporomandibular joint, this lesion is characterized by the insidious onset of a mildly symptomatic preauricular mass. The treatment of choice is complete excision.
Paraganglioma of the Sphenoid Sinus Appearing as Labile Hypertension
Authors: Koecel Lawrence , Levine Howard L. , Waldman Steven R.
Published: November 2015

Paragangliomas, also known as glomus tumors, are unusual, generally benign tumors most commonly found in association with major vessels and cranial nerves. Only a small number of these tumors have been described arising in the paranasal sinuses, and none of these has been physiologically active. The following case report describes a metabolically active paraganglioma arising in the sphenoid sinus.
Culture of Human Laryngeal Papilloma Cells in Vitro
Authors: Steinberg Bettie M. , Abramson Allan L. , Meade Raymond P.
Published: November 2015

Human laryngeal epithelial cells have been grown in tissue culture in a hydrated collagen gel containing Nutrient Mixture F12 (Gibco) supplemented with 15% fetal calf serum and 10μg//mL hydrocortisone. Primary cells often remain viable in culture for more than six months. They can be serially transferred two to four times before senescence. Cells derived both from normal epithelium and from laryngeal papilloma have been successfully cultured. Papilloma cells appear to contain more perinuclear granules and form fewer tight junctions than normal cells.
The Obtuse Angle Tongue Depressor: Physl Ologic Advantages in Throat Surgery and Lesions of the Hypopharynx
Authors: Swenson Rudolph E.
Published: November 2015

The original purpose of the obtuse angle tongue depressor was to open the mouth much wider than the right angle tongue depressor and to expose the lower pole of the tonsil for more complete surgical treatment. However, the later discovery of the physiologic advantages of the obtuse angle tongue blade in opening the mouth became very important. The obtuse angle tongue blade pulls the tongue forward so that benign lesions can be excised as well as adequate biopsies of malignant tumors obtained in most of the hypopharynx. The clinical finding of the small amount of pressure on any part of the tongue when the obtuse angle tongue depressor is used indicates minimum trauma to the patient.
Retrolabyrinthine Vestibular Neurectomy
Authors: Silverstein Herbert , Norrell Horace
Published: November 2015

Vestibular neurectomy performed through the middle fossa or retrolabyrinthine approach is an effective method of denervating the labyrinth while preserving residual hearing. In the authors’ opinion, the retrolabyrinthine approach is easier to perform, takes less time, and places the facial nerve in less jeopardy than the middle fossa procedure. The results of 26 cases of retrolabyrinthine vestibular neurectomy followed from six to 26 months indicate an 85% (22/26) cure rate of vertigo and a 79% (21/26) rate of hearing unchanged or improved.
Septic Necrosis of the Internal Carotid Artery: A Complication of Peritonsillar Abscess
Authors: Blum Daniel J. , McCaffrey Thomas V.
Published: November 2015

Septic necrosis of the internal carotid artery is a major complication of peritonsillar abscess. Although once a common complication, its occurrence is rare since the introduction of antibiotics. A 12‐year‐old girl was referred to our institution after a false aneurysm of the internal carotid artery had been entered during routine tonsillectomy for a peritonsillar abscess. Review of the literature and features of the present case demonstrate the following findings suggestive of erosion of the internal carotid artery as a result of peritonsillar abscess: (1) spontaneous hemorrhage from a peritonsillar abscess, (2) persistent peritonsillar swelling after resolution of symptoms of peritonsillar abscess, (3) ipsilateral Horner's syndrome, and (4) otherwise unexplained cranial nerve palsies (nerves IX, X, XI, and XII).
Factors Affecting the Growth of Head and Neck Squamous Carcinoma Cell Lines
Authors: Virolainen E. , Carey T.E. , Wicha M. , Krause C.J.
Published: November 2015

Cell plating density influences the growth pattern of human squamous cell carcinoma (SCC) cell lines in culture. SCC lines were used to study factors responsible for these effects. Experiments in which the medium was changed daily or in which conditioned medium was used showed that the growth‐supporting factors were not found in the media. However, when cells were plated in dishes in which the same cell line had been grown to confluence and removed by scraping, logarithmic growth began immediately. The effect was not seen on areas of the plate that had been covered with coverslips or in dishes where fibroblasts had been cultured. Antibodies to fibronectin, laminin, and a variety of epidermal cell antigens were used to determine the nature of the growth‐stimulating substances remaining on the dish following cell removal. Results indicate that an extracellular matrix with similarities to basement membranes was present on the conditioned dishes.
First Branchial Cleft Anomalies and the Facial Nerve
Authors: McRae Robert G. , Lee K.J. , Goertzen Eugene
Published: November 2015

First branchial cleft anomaly is an uncommon clinical problem that can be difficult to diagnose and treacherous to treat. It is generally believed that branchial anomalies arise from incomplete resolution of branchial cleft remnants. They may be a fistulous tract or cystic lesions, and they may be found in all age groups. This article presents three cases of first branchial cleft anomaly and offers an overview of the regional embryology and guidelines for surgical management and facial nerve preservation.
Response of Vascular Lesions of the Head and Neck to Argon Laser Radiation
Authors: DiBartolomeo Joseph R.
Published: November 2015

Argon laser radiation is used to treat congenital and acquired vascular lesions of the head and neck. Thirteen patients requiring a total of 36 treatments were followed up for a minimum of 1 year to assess the response of the vascular lesion to argon ion radiation. Of the 13 patients, 10 had an excellent result, with the lesion no longer being identifiable. Three of the patients had residual but minimal color remaining in the lesion. There were no complications or hypertrophic scars after 1 year of follow‐up. The laser parameters used and the surgical technique followed are outlined.
Changing Patterns of Otosclerosis Surgery in Teaching Institutions
Authors: Chandler James R. , Rodriguez‐Torro Osvaldo E.
Published: November 2015

The rapidly dwindling number of patients with otosclerosis suitable for surgery has made a severe impact on this aspect of training and experience in our medical centers. Results secured in the past and expected in the future are now difficult to achieve. This trend has been analyzed with particular reference to the experience in the last 3 years at the University of Miami‐Jackson Memorial Hospital‐Veterans Administration Hospital Medical Center. The analysis of results and complications also compared patients operated on by residents vs. faculty. Hearing loss as a consequence of improperly performed stapes surgery or complications thereof can seldom be salvaged. Stapes surgery should be performed in medical centers and community hospitals only by designated “stapes surgeons.”
Pharyngoesophageal Perforations after Blunt Trauma to the Neck
Authors: Hagan Warren E.
Published: November 2015

The neck with cartilaginous framework left intact still requires a high index of suspicion of a pharyngoesophageal perforation after blunt trauma. If the diagnosis is missed and/or prompt surgical drainage of the perforation is delayed, increased morbidity from deep neck abscesses and/or death may result. This is the first reported series of pharyngoesophageal perforations that follow blunt trauma. On the basis of this clinical experience and the literature, I have formulated a treatment protocol for upper aerodigestive tract perforations secondary to blunt trauma.
Induction Chemotherapy with Vinblastine, Bleomycin, and cis‐Diamminedichloroplatinum in Squamous Cell Carcinoma of the Head and Neck
Authors: Davis R. Kim , Perry David J. , Zajtchuk Joan T.
Published: November 2015

The results of induction chemotherapy with vinblastine, bleomycin, and cis‐platinum II are reported. No survival advantage was seen when the entire treatment group was compared with an historical control group. Special attention is directed to the meaning of complete response and the potential treatment options and survival advantages of the complete responders subgroup.
Steroids and Idiopathic Facial Paralysis
Authors: Stankiewicz James A.
Published: November 2015

The face proclaims to the world an individual's identity and as such is the most conspicuous part of his anatomy. No wonder, then, that idiopathic facial paralysis is a frightening experience for the patient. Ever since it was first noted, all manners of measures have been used to bring about early and full recovery. Unfortunately, none of these treatments is effective. Following Rothendler's case description in 1951, a multitude of papers have appeared, evaluating the effectiveness of steroids in idiopathic facial paralysis. This article evaluates 92 of these papers. Only a few properly controlled, randomized prospective studies were available. Their main conclusion was that steroid treatment was not more beneficial than conventional treatment. But several less valid prospective and retrospective studies have suggested that steroid treatment is beneficial. The definitive, statistically valid study of the benefits of steroids in treating has yet to be performed. Until then steroid treatment of this condition will continue to be controversial.
Evoked Electromyography and Idiopathic Facial Paralysis
Authors: May Mark , Klein Susan R. , Blumenthal Frank
Published: November 2015

The purpose of this study was to standardize and evaluate the results of evoked electromyography (EEMG) in normal patients and in patients with acute idiopathic facial paralysis. A comparison of the amplitude of response to EEMG from one side of the face to the other in 288 normal patients yielded a great variability in results. The amplitude difference was not greater than 50%, and therefore a difference of less than 50% was considered normal. Test‐retest variability of the percentage difference in amplitude in 10 subjects showed a 10% variation in seven patients and up to a 20% variation in the remaining three patients. Fifty patients with acute idiopathic facial paralysis were seen within 14 days of onset. A favorable prognosis was based on an EEMG amplitude of more than 25% of the normal side. With this criterion EEMG was accurate in predicting complete recovery in 36 (92%) of 39 patients. When EEMG was 25% of normal or less, incomplete recovery occurred in 9 (82%) of 11 patients. The response was 0% to 10% in six patients; four had a poor recovery and the remaining two had a fair recovery. The technique, interpretation of results, avoidance of pitfalls, and shortcomings of this test are discussed.
Videoendoscopic Determination of the Mechanism of Obstruction in Obstructive Sleep Apnea
Authors: Rojewski Thomas E. , Schuller David E. , Clark Robert W. , Schmidt Helmut S. , Potts Robert E.
Published: November 2015

Six patients with obstructive sleep apnea were studied with our system of simultaneous video recording of the polysomnographic record and the endoscopic image from the pharyngeal airway. Preoperative and postoperative recordings were made during sleep in each patient. Tracheotomized patients recreated their preoperative laryngeal inlet obstruction and its immediate cessation by alternately opening and closing the tracheotomy tube. This demonstration coupled with the physical examination findings of “disproportionate anatomy,” leads to the determination that the mechanism of obstructive sleep apnea is twofold: (1) an underlying CNS propensity to hypotonia of pharyngeal musculature during sleep and (2) either an isolated obstructive upper airway lesion or a combination of alterations in normal relationships within the upper airway that cause a passive narrowing of the upper airway. This combination of altered relationships is collectively referred to as “disproportionate anatomy.”
Acoustic Reflex Testing in Otoneurology
Authors: Clemis Jack D.
Published: November 2015

Three parameters of the acoustic reflex have been used in otoneurologic diagnosis: threshold (ART), decay (ARD), and latency (ARL). Each test is defined, put in historical perspective, and discussed in relation to diagnostic implications. We recommend that these three tests‐ART, ARD, and ARL‐be used as a group and describe how they are implemented in the audiologic diagnosis of acoustic tumors and other lesions affecting the auditory system in the cerebellopontine angle and brain stem.
Hearing Conservation in Acoustic Tumor Surgery: Pro's and Con's
Authors: Clemis Jack D.
Published: November 2015

This article presents an overview of the points to be made both for and against the consideration of hearing conservation in acoustic tumor surgery based on current available data in the literature. Age, general health, tumor size, and hearing‐in the tumor ear and in the contralateral ear as well as the interaural relationship‐are the presurgical factors discussed. Either the middle fossa or posterior fossa approach may be utilized for hearing conservation. The technical factors relating to surgical anatomy, specific risks, and the probability that hearing may be preserved by these approaches have been abstracted from a review of the literature. Finally, the patient's considerations and his need for the conservation of his hearing are presented, including realistic alternatives to surgical conservation.
Is it Possible to Totally Resect an Acoustic Tumor and Conserve Hearing?
Authors: Neely J. Gail
Published: November 2015

Over the last 19 years there has been increasing interest in the conservation of hearing while acoustic tumors are being resected. As enthusiasm has increased for the conservation surgery, so has controversy. The key to the controversy is a dissociation between gross anatomic and histologic observations. The purpose of this paper is to summarize our laboratory experiments and clinical observations in three areas: (1) Our experiments and observations suggest that it is probably not possible to totally resect an acoustic tumor medial to Scarpa's ganglion and conserve hearing. (2) It has not been possible to predict from preoperative auditory and vestibular function tests the number of fibers present within the cochlear and vestibular nerves lateral to the tumor, nor the number of fibers in small aggregates that may pass the tumor periphery. (3) If microscopic amounts of tumor are left behind, is that significant? It is too early to answer this question.
Hearing Conservation in Acoustic Neurilemmoma Surgery via the Retrosigmoid Approach
Authors: Smith Mansfield F.W. , Lagger Raymond L.
Published: November 2015

Hearing conservation in acoustic neurilemmoma surgery is possible in approximately 50% of patients whose tumors measure 15 mm or less in size (medial to the porus acusticus) and whose speech discrimination score in the ear with the tumor is 80% or better. The concepts of total tumor removal and maximum sparing of adjacent normal neural tissue are consistent with efforts to retain cochlear function. A retrosigmoid approach is favored over the middle cranial fossa approach because of the superior exposure and less morbidity. An operating table capable of 35‐degree side rotation is used. It allows the majority of patients with acoustic neurilemmoma to be operated on in the horizontal supine position. The posterior lip of the internal auditory canal is removed to within approximately 1.5 mm of the falciform crest. Tumors not extending to the fundus afford an ideal situation for total removal, early identification of the seventh cranial nerve, and conservation of hearing. The CO2 laser is a useful surgical tool with its properties of vaporization, cutting, and coagulation.
Hearing Preservation—Posterior Fossa Approach
Authors: Cohen Noel L. , Ransohoff Joseph
Published: November 2015

In patients with acoustic neurinomas protruding less than 2 cm from the porus acusticus and free of the brain stem, hearing can often be preserved. Our neurosurgical/otologic team uses the combined suboccipital/transmeatal approach with the patient in the seated position. This operation has been attempted on 21 patients from 1974 to 1982. Nine had tumors larger than 2 cm that touched the brain stem; one had useful hearing preserved. Of the 12 patients with tumors smaller than 2 cm, hearing at or near the preoperative level was preserved in seven. In one patient, hearing was improved. There have been up to 7 years of follow‐up with no recurrences of the neurinomas or diminution of hearing evident on computed tomographic scan. All had preservation of the seventh cranial nerve, while complications were mild and comparable to the remainder of our 101 patients operated on during the same period. We will review the surgical technique and audiologic results in detail.
Calcium Sulfate as a Mandibular Implant
Authors: McKee J. Cooper , Bailey Byron J.
Published: November 2015

Mandibular reconstruction has posed significant problems, particularly when dealing with loss of mandibular substance. Various implant substances have been utilized in attempts to repair mandibular defects. These have included metals, synthetic material, and organic substances. All have posed significant problems, particularly with rejection and inability of the implant to develop a stable fusion with the surrounding bone. Recently, calcium sulfate has been successfully used as an implant in frontal sinuses, mastoid cavities, and, in one report, as a mandibular implant. The present study looks at the ability of calcium sulfate to induce osteoneogenesis in canine mandibles with and without the presence of a periosteal covering around the implant. Infection somewhat limited the success of the study, but in those animals without major infections, successful replacement of the calcium sulfate by normal bone occurred both with and without the presence of periosteum.
Thyroid Surgery
Authors: Greisen O. , Petersen S. Vang
Published: November 2015

In a 5‐year period we treated 233 patients referred to us with a thyroid swelling. Among them, 39 patients (17%) had a malignant tumor. Seventy‐eight percent of the patients were women. The preoperative examination procedure is discussed. Preoperatively, recurrent nerve palsy was found in 2.6% of patients with benign tumors and in 28% of patients with malignant tumors. The histologic features of the benign and the malignant tumors are described. The operative procedure in the benign group consisted of enucleation, resection, or lobectomy. In the patients with malignant tumors a radical operation was performed, consisting of lobectomy (unilateral or bilateral) when possible, eventually combined with radical neck dissection. The operative complications are discussed.
The Interferons
Authors: Richtsmeier William J.
Published: November 2015

The interferons (IFNs) are a group of proteins produced by cells of all vertebrate animals in response to a variety of stimuli. The ability to stimulate antiviral resistance, which was the first observed property of the IFNs, is still of great interest and remains the basic criterion by which the interferons are measured1 (even into the most recent era of radioimmunoassay systems). It is the recent clinical uses of these substances as antineoplastic agents that has brought them to the attention of clinicians and the public in general. The IFN molecules exert their effects, much as hormones do, by attaching to specific receptors on other cells of the same species. Once attached, the IFNs induce cells to undergo a series of biochemical changes that renders them resistant to further virus propagation. To be an IFN, a substance must be a protein devoid of accompanying nucleic acid or endotoxin (both of which are interferon inducers). Treated cells must undergo de novo RNA and protein synthetic activity to acquire antiviral resistance.
Comparison of Symptoms and Laboratory Findings in Unilateral Vestibular Dysfunction
Authors: Keim Robert J.
Published: November 2015

Although vertigo is the expected symptom of unilateral vestibular disease, exceptions have been observed. To determine the relative frequency of this observation, a retrospective study of patients seen over a 1‐year period was done. Of the 126 patients found to have unilateral labyrinthine impairment with bithermal caloric testing, only 58 (46%) characterized their symptoms as vertigo. The ramifications of these findings are discussed, and a question is raised as to the propriety of reserving vestibular testing for only those patients describing vertigo.
Injuries to the Bronchi and Lungs Caused by Laser‐Ignited Endotracheal Tube Fires
Authors: Duncavage James A. , Ossoff Robert H. , Rouman William C. , Toohill Robert J. , Almagro Urias A. , Carl Greg A. , Aronson Sol
Published: November 2015

A CO2 laser attached to an operating room microscope was used to produce extraluminal and intraluminal ignition of various endotracheal tubes in dogs. Extraluminal ignition was produced in Silastic and red rubber endotracheal tubes. The red rubber tube ignited before the tube lumen was penetrated. The Silastic tube failed to ignite while the cuff was inflated. When the cuff was deflated, ignition occurred before the lumen was penetrated. No lung or bronchial injuries were detected in the red rubber or Silastic endotracheal tube extraluminal fires. Intraluminal fires were produced in Silastic, red rubber, and polyvinylchloride (PVC) endotracheal tubes. Microscopic examination of the bronchi and lungs revealed severe injuries in dogs intubated with the PVC and red rubber endotracheal tubes. No injuries to the bronchi and lungs were detected in the Silastic tube group, although the potentially toxic effects of silica ash require further investigation.
Positional Nystagmus
Authors: Barber Hugh O.
Published: November 2015

Positional nystagmus may be persistent or transitory. Of the persistent forms, type I refers to nystagmus changing direction in different head positions and type II to nystagmus beating in a single direction. Both types may denote either peripheral or central abnormality. Transitory, or paroxysmal, positional nystagmus is classified as type III, and the history and physical and electronystagmographic features of its accompanying vertigo and nystagmus permit subdivision into typical and atypical forms. Guidelines are given for the differentiation of typical and atypical forms. In the great majority of cases type III positional nystagmus denotes a harmless inner ear disturbance, but the occasional serious intracranial lesion is also causative. Most instances of the latter, but not all, will fit in the atypical group. A case is reported of vermis metastasis with presenting features of postural vertigo and paroxysmal downbeat positional nystagmus.
Results of Sinusoidal Harmonic Acceleration Test in One Thousand Patients: Preliminary Report
Authors: Hamid Mohamed A. , Hughes Gordon B. , Kinney Sam E. , Hanson Maurice R.
Published: November 2015

One thousand patients with dizziness were tested by sinusoidal harmonic acceleration with frequencies of. 01,. 02,. 04,. 08, and. 16 Hz. Two hundred fifty (25% of data base) were randomly selected for this study. One hundred forty‐eight diagnoses were confirmed: 66 (45%) patients had a clinical diagnosis of peripheral vestibular dysfunction, 28 (19%) had central vestibular dysfunction, and 53 (36%) had dizziness of undetermined cause. This preliminary study investigated the response patterns of phase (latency), asymmetry (slow phase preponderance), and gain (output/input) as they correlated with each of the above patient groups. The main response pattern was a varying degree of asymmetry with normal or abnormal latency. Persistent abnormal phase pattern indicated permanent vestibular damage and could not be used reliably to differentiate peripheral from central vestibular dysfunction. Asymmetry changed with time and correlated with patients' symptoms. The dynamic pattern of asymmetry could be used to differentiate peripheral from central vestibular dysfunction. Gain was a reliable and essential measure of the sensitivity of the vestibular system and the validity of the rotational response.
Acoustic Neuroma Presenting as Sudden Hearing Loss with Recovery
Authors: Berg Howard M. , Cohen Noel L. , Hammerschlag Paul E. , Waltzman Susan B.
Published: November 2015

In our series of patients operated on for acoustic neuromas at New York University Medical Center between 1974 and 1983, 13% (17 of 133) had sudden hearing loss. Of these, approximately 23% (four of 17) had recovered auditory function before acoustic neuroma extirpation. Three patients spontaneously recovered, while one improved with steroid therapy. Contrast computerized tomography demonstrated a widened internal auditory canal and evidence of cerebellopontine angle tumor, respectively, in 88% and 59% of patients with sudden hearing loss and acoustic neuroma. Clinical characteristics suggesting acoustic neuroma as the cause of sudden hearing loss with or without auditory recovery could not be identified in our series. Our data support the rationale that patients with unilateral sudden hearing loss, even with recovery, must be evaluated for a possible cerebellopontine lesion.
Assessment of Facial Reinnervation by use of Chronic Electromyographic Monitoring
Authors: Anonsen C. K. , Trachy R. E. , Hibbert J. , Cummings C. W.
Published: November 2015

The study of muscle reinnervation has been difficult because of lack of an accurate, reproducible method to monitor return of function. Visual assessment relies on subjective interpretation. Histology provides anatomic, not functional, information. Electromyography and anatomic tracing have been most effective in evaluating physiologic return of muscle function. It has been difficult to assess the timing of functional return electromyographically because measurements are intermittent and electrode placement varies. A method was designed to allow long‐term monitoring of electromyographic (EMG) activity in the facial musculature of the rabbit. Sixteen rabbits were monitored for at least 1 month or until return of normal EMG activity was identified. Various levels of injury (nerve crush, transection without repair, and transection with immediate end‐to‐end anastomosis) were evaluated. EMG evidence of reinnervation was seen in all animals with nerve crush injuries as well as those with anastomoses. Physiologic continuity of the nerves was then evaluated by retrograde transport of horseradish peroxidase. All muscles showing return of EMG activity had uptake of HRP into the appropriate brain stem motor neurons. The denervated muscles showed no HRP uptake. The information gained in this study shows potential for use of this technique in comparing functional return of muscle activity between different reinnervation methods.
Cochlear Implantation in Children: The Problem of Head Growth
Authors: O'Donoghue Gerard M. , Jackler Robert K. , Jenkins William M. , Schindler Robert A.
Published: November 2015

Successful implantation in children requires that provision be made for later head growth. The timing and magnitude of this growth was determined by measurements made from high‐resolution computerized tomographic images of developing temporal bones. The temporal bone scans of 103 children of varying ages were studied. The development of the petrous and squamous portion of the temporal bone was at its greatest in the first 2 years of life. The order of magnitude of growth varied with the different axes measured.
A Preliminary Study of Injectable Collagen in Human Vocal Fold Augmentation
Authors: Ford Charles N. , Bless Diane M.
Published: November 2015

Soluble bovine collagen was injected for vocal fold augmentation in 27 patients with glottic insufficiency. Preliminary observations show that glottic closure was enhanced in all patients with no serious complications. Subjective and objective measures of vocal efficiency indicated improvement with reduction in airflow, improved glottic closure, and increased vocal intensity. Recent studies that reveal distant migration of injected Teflon suggest the need for the development of a safe biologic material for soft tissue augmentation. Collagen appears to satisfy criteria as an ideal bioimplant, tends to soften scar tissue, and is structurally similar to natural collagen in the human vocal fold. Further longitudinal studies and the development of potentially more stable cross‐linked collagen preparations seem indicated.
Endoscopic Endonasal Surgery—Concepts in Treatment of Recurring Rhinosinusitis. Part II. Surgical Technique
Authors: Stammberger H.
Published: November 2015

Our endoscopic endonasal surgery, under the guidance of rigid endoscopes, aims at the primary focuses in the anterior ethmoid, clearing stenotic clefts and infected ethmoidal cells of diseased mucosa. The maxillary ostium is enlarged into the anterior nasal fontanelle to provide drainage and ventilation. There is no need for any fenestration into the inferior nasal meatus. Once the ethmoidal focus is cleared, the dependent larger sinuses usually heal without having been touched—even if their mucosal pathologies seemed almost irreversible. The endoscopic procedure, which except in children is carried out under local and surface anesthesia, is described in detail. Excellent results with this method, developed by Messerklinger, indicate that there is seldom need for a Caldwell‐Luc operation as the state‐of‐the‐art procedure in chronic recurring sinusitis.
Safety Precautions for Bronchoscopic Nd‐YAG Laser Surgery
Authors: Shapshay Stanley M. , Beamis John F.
Published: November 2015

The application of the neodymium‐yttrium aluminum garnet (Nd‐YAG) laser in bronchoscopy originated in Europe in 1981 and is now widespread in the United States. Transmissible through flexible fiberoptic quartz fibers and an efficient coagulator of tissue, the Nd‐YAG laser deeply penetrates tissue not readily predictable by the endoscopist. Dangers associated with the Nd‐YAG laser include complications secondary to inadvertent exposure to normal tissues or structures, tracheobronchial accidents (perforation, hemorrhage, fire), and complications related to anesthetic technique (respiratory depression). Hypoxemia related to persistent hemorrhage, accumulation of secretions or debris or both, or anesthesia‐induced respiratory depression is the common denominator of most intraoperative and postoperative complications. Careful selection of patients, intraoperative monitoring of ventilation and blood gases, and techniques of rigid bronchoscopy are stressed to avoid complications.
Management of Substernal and Intrathoracic Goiters
Authors: Cho Hyun T. , Cohen Jason P. , Som Max L.
Published: November 2015

Goiters that descend into the mediastinum can cause respiratory embarrassment, dysphagia, vascular compression, vocal cord paralysis, and sudden death. Although many such goiters remain clinically silent, their ability to produce sudden and unpredictable respiratory distress is well known. The condition was not considered uncommon in the first half of the twentieth century; some authors reported series of hundreds of thyroidectomies for Intrathoracic goiter. Though seen less frequently today, the only effective treatment for mediastinal goiter is surgical removal. We report our experience with the management of 70 consecutive patients with substernal or intrathoracic goiters. The clinical presentation, preoperative evaluation, operative technique, and results and complications of therapy are discussed. Consideration is also given to the pathogenesis of Intrathoracic extension. The transcervical approach for resection is emphasized—even goiters extending to the aortic arch were safely removed without requiring sternotomy. A multidlsciplinary team approach, including the surgeon, anesthesiologist, and endocrinologist, is essential. Because of more conservative trends in the selection of patients for thyroidectomy, the Incidence of mediastinal goiter may be increasing.
Facial Reanimation with the VII–XII Anastomosis: Analysis of the Functional and Psychologic Results
Authors: Pensak Myles L. , Jackson C. Gary , Glasscock Michael E. , Gulya Aina Julianna
Published: November 2015

The VII‐XII anastomosis has been employed for more than a decade by The Otology Group, P.C., In the facial reanimation of patients undergoing extirpation of tumors involving the cerebellopontine angle and the skull base. A retrospective review based upon a detailed questionnaire and submitted photographic documentation from 61 patients forms the basis for this review. Details and analysis of the functional results include (1) onset of function, (2) synkinetic activity, (3) corneal irritation and associated ophthalmologic problems, (4) facial tone and symmetry, and (5) volitional mimetic function. From a psychosocial perspective, evaluation was made regarding (1) workplace and home acceptance, (2) self consciousness, (3) adaption, and (4) overall satisfaction. Because of the nature of its technical performance and reliability, the VII‐XII anastomosis is an important technique for the otolaryngologist to be familiar with. Cognizance of the functional and psychologic results with this procedure will ensure optimal (yet realistic) rehabilitation for this patient population.
Soft‐Wall Reconstruction of the Posterior External Ear Canal Wall
Authors: Smith Peter G. , Stroud Malcolm H. , Goebel Joel A
Published: November 2015

A simple method of reconstructing a previously removed posterior ear canal with an autogenous, bilaminar membrane is described. The resulting air‐filled mastoid cavity is an anatomic extension of the middle ear cleft and is separated from the ear canal by a functional barrier that is continuous with the tympanic membrane. The acoustic characteristics of an associated tympanoplasty are not significantly altered, and many of the problems that are associated with an exteriorized cavity are avoided. In contradistinction to other methods of mastoid obliteration or reconstruction, the semitransparent nature of the soft canal wall allows inspection of the underlying cavity for residual or recurrent disease. The technique can be used to repair either a newly created cavity or a previous radical (or modified radical) mastoidectomy defect. The functional results of thirty ears reconstructed in this fashion are detailed. A variable amount of soft‐wall retraction was noted postoperatively in 47% of the ears; however, the long‐term functional results in these cases remain satisfactory.
Pseudocyst of the Auricle: A Review of 21 Cases
Authors: Lazar Rande H. , Heffner Dennis K. , Hughes Gordon B. , Hyams Vincent K.
Published: November 2015

Pseudocyst of the auricle (benign idiopathic cystic chondromalacia) is rare. Only 20 cases have been previously reported in the literature. Our study retrospectively reviews 21 additional cases. We conclude that idiopathic cystic chondromalacia can occur in both sexes, in all races, and at any age. The differential diagnoses for idiopathic cystic chondromalacia are relapsing polychondritis and chondrodermatitis nodularis chronica helicis. Recurrence of idiopathic cystic chondromalacia is uncommon following adequate local treatment.
Long‐Term Intracochlear Implantation in Man
Authors: Miyamoto Richard T. , Robbins Amy McConkey , Myres Wendy A. , Pope Molly L. , Punch Jerry L.
Published: November 2015

Whether long‐term intracochlear implantation and direct electrical stimulation of the acoustic nerve will induce intracochlear bone growth or cause further degeneration of a severely compromised auditory system is an important clinical consideration. Thinsection CT evaluations of the cochleas of six subjects who have used their cochlear implant devices on a daily basis for 3 or more years demonstrated no evidence of osteoneogenesis of the cochlea in the vicinity of the active electrode. No corrosion of the electrode or insulation material was noted on electron microscopy of an explanted electrode system. Electrical threshold and dynamic range measurements have remained stable or even improved during the period of observation. Performance measures using a variety of audiologic tests and speech‐tracking scores have demonstrated stability of performance.