bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of Tongue Movement During Vowels Production with Computer‐Assisted B‐Mode and M‐Mode Ultrasonography
Authors: Chiang Yuh‐Chyun , Lee Fei‐Peng , Peng Chien‐Lun , Lin Che‐Tong
Published: September 2022

OBJECTIVES

We sought to apply B‐ + M‐mode ultrasonography in combination with the cushion‐scanning technique (CST) in quantitative analysis of tongue movement during vowel articulation.

STUDY DESIGN AND SETTING

Twenty normal persons (10 women and 10 men) were enrolled in this study. Each individual was asked to enunciate 5 vowels:/e/, /i/, /al/, /o/, and /ju/. A noninvasive diagnostic technique, computer‐assisted B‐mode plus M‐mode ultrasonography, was used in combination with the CST to assess their tongue movement. The sonographic signals were recorded on a video recorder and then transferred to a personal computer via a frame grabber for digital assessment.

RESULTS

M‐mode images show an amplitude‐time diagram, whereas B‐mode images reveal midsagittal tongue configuration. The ranges of tongue movement in midsagittal plane in male speakers during production of the vowels /e/, /i/, /al/, /o/, and /ju/ were 8.29 ± 1.76,4.00 ± 0.78, 13.82 ± 2.86, 14.05 ± 1.63, and 6.72 ± 1.66 mm, respectively; for female speakers, the averages were 7.19 ± 0.92, 3.36 ± 1.31, 12.74 ± 2.16, 12.86 ± 2.18, and 7.11 ± 2.09 mm, respectively.

CONCLUSIONS

The computer‐assisted B‐mode plus M‐mode ultrasonography in combination with the CST provides a standardized and quantifiable ultrasonographic examination for the clinical investigation of tongue movement during vowel articulation. In our study group, there was no difference in the thickness of tongue or the range of tongue movement in midsagittal plane during articulation of the selected vowels between males and females. Further exploration can be extended in the field of speech research by this valuable tool.
Modalities of surveillance in treated nasopharyngeal cancer
Authors: Chao Siew‐Shuen , Loh Kwok‐Seng , Tan Luke K. S.
Published: September 2022

OBJECTIVE

We sought to assess the efficacy of different modalities in the detection of disease during the early posttreatment period of nasopharyngeal carcinoma (NPC).

STUDY DESIGN AND SETTING

We prospectively evaluated 57 patients with NPC who were treated with radiation. A postnasal space (PNS) biopsy, an endoscopic examination, and computed tomography (CT) scans were performed 4 months after treatment.

RESULTS

Four patients had evidence of disease in the PNS biopsy specimen. The sensitivity, specificity, and positive and negative predictive values of the endoscopic examination were 75%, 94.3%, 50%, and 98%, respectively, while those of the CT scan were 50%, 49.1%, 6.9%, and 92.9%, respectively.

CONCLUSION

In the early postradiation period for patients with NPC, an endoscopic examination is a suitable surveillance modality, but routine CT scanning has no added clinical benefit.

SIGNIFICANCE

When an endoscopic examination of the PNS yields normal results, a biopsy is not necessary because the likelihood of disease is low.
Triamcinolone acetonide aqueous nasal spray and fluticasone propionate are equally effective for relief of nasal symptoms in patients with seasonal allergic rhinitis
Authors: Berger William E. , Kaiser Harold , Gawchik Sandra M. , Tillinghast Jeffrey , Woodworth Thomas H. , Dupclay Leon , Georges George C.
Published: September 2022

OBJECTIVE

We compared 220 µg daily intranasal aqueous triamcinolone acetonide (TAA AQ) with 200 µg daily fluticasone propionate (FP) for relief of seasonal allergic rhinitis symptoms.

STUDY DESIGN AND SETTING

Randomized, parallel‐group, investigator‐blind study included patients with symptomatic seasonal allergic rhinitis. After a baseline period, TAA AQ or FP was taken for about 21 days. Nasal symptom (discharge, stuffiness, itching, sneezing) severity was recorded twice daily; total nasal symptom score was calculated. Health‐related quality of life was assessed by Rhinoconjunctivitis Quality of Life Questionnaire.

RESULTS

Reductions in individual symptoms and total nasal symptom score were statistically significant versus baseline and were equivalent between treatments: −3.15 ± 0.19 with TAA AQ (n = 148) and ∼3.17 ± 0.18 with FP (n = 147) (95% confidence interval for the difference, −0.7391 to 0.3693). Clinically and statistically significant improvements in Rhinoconjunctivitis Quality of Life Questionnaire scores were comparable.

CONCLUSION

TAA AQ and FP were equally efficacious in relieving seasonal allergic rhinitis symptoms and improving health‐related quality of life.

SIGNIFICANCE

Differences in molecular potency of intranasal steroids do not confer differences in efficacy.
Endoscope Affects Decision Making in Cholesteatoma Surgery
Authors: El‐Meselaty K. , Badr‐El‐Dine M. , Mandour M. , Mourad M. , Darweesh R.
Published: September 2022

OBJECTIVE

The aim of the present study was to evaluate the use of intraoperative otoendoscopy as a factor that could influence surgical decisionmaking in cholesteatoma surgery.

MATERIALS AND METHODS

The material of this study included 82 ears with acquired cholesteatoma that were operated on. They were divided into 4 groups according to the surgical technique chosen and the use of the endoscope. Group I included 22 ears that underwent canal wall‐down (CWD) tympanomastoid surgery, group II included 20 ears that underwent CWD tympanomastoid surgery with intraoperative use of endoscopy, group III included 20 ears that underwent canal wall‐up (CWU) tympanomastoid surgery, and group IV included 20 ears that underwent CWU tympanomastoid surgery with intraoperative use of endoscopy. Endoscopy was used as a complementary tool to microscopy. The follow‐up period ranged from 12 to 48 months.

RESULTS

Intraoperative remnants of cholesteatoma matrix were detected during both CWU and CWD by the use of the rigid endoscope. However, its incidence was higher in the CWU group (50%) than in the CWD (30%) group. Most of these remnants were in the sinus tympani (37.5%). The mean duration of follow‐up was 18.19 (±8.7) months. Postoperative residual cholesteatoma was much higher in the CWU group (25%) than in the CWD group (5%). All residuals were from groups of patients in whom intraoperative endoscopy was not used in the primary surgery.

CONCLUSION

Our results showed that the use of the endoscope gave the surgeon better control over the pathology, thus achieving better eradication. Stated differently, the use of the endoscope raised the surgeon's confidence level about total removal and thus encouraged the surgeon to keep the canal wall intact while removing cholesteatoma in hidden areas. Therefore, the use of endoscope could be considered an additional tool that may affect decision‐making in cholesteatoma surgery.
Predictors of Survival in Early Oral Cancer
Authors: Sheahan Patrick , O'Keane Conor , Sheahan Jerome N. , O'Dwyer Tadhg P.
Published: September 2022

OBJECTIVE

Despite the substantial rate of neck conversion reported among patients with early oral cancer, a policy of routine elective neck dissection has been criticized on the grounds that it confers little survival advantage while subjecting many to potentially avoidable morbidity. However, the identification of factors predictive of survival may allow for the identification of those patients who are more likely to benefit from elective neck treatment.

STUDY DESIGN AND SETTING

The clinical and histologic material of 71 patients with stage I or II squamous carcinoma of the oral cavity were reviewed. Patients were followed up for a minimum of 3 years after their surgery, and the impact of these variables on 3‐year survival was assessed.

RESULTS

Increased tumor thickness was significantly predictive of decreased survival (P = 0.030). Although having no prognostic value alone, when combined with thickness, both pattern of invasion and gender increased the significance of the latter in predicting outcome.

CONCLUSION AND SIGNIFICANCE

Measuring tumor thickness and pattern of invasion in patients with early oral cancer may allow for the identification of those patients with more aggressive disease who are more likely to benefit from elective neck treatment.
Endoscopic Orbital Decompression Under Local Anesthesia
Authors: Metson Ralph , Shore John W. , Gliklich Richard E. , Dallow Richard L.
Published: September 2022

Orbital decompression for Graves' disease has traditionally been performed with the patient under general anesthesia. Endoscopic instrumentation allows for removal of the medial orbital wall and floor through an intranasal approach with local anesthetic techniques. Twelve endoscopic orbital decompressions were performed on awake patients with uncovered eyes so that vision could be monitored throughout the procedure. Simultaneous lateral decompressions were performed in 11 cases. No intraoperative or postoperative complications occurred. Visual acuity remained stable or improved in all cases. Proptosis was reduced an average of 5.5 ± 1.6 mm. In a comparable series of 29 endoscopic decompressions performed with patients under general anesthesia, proptosis was reduced an average of 4.8 ± 2.0 mm. Endoscopic orbital decompression with patients under local anesthesia appears to be an effective technique that may provide an additional margin of safety in prevention of injury to the optic nerve.
Sinus Disease in the Bone Marrow Transplant Population: Incidence, Risk Factors, and Complications
Authors: Shibuya Terry Y. , Momin Feroze , Abella Esteban , Jacobs John R. , Karanes Chatchada , Ratanatharathorn Voravit , Sensenbrenner Lyle L. , Lum Lawrence G.
Published: September 2022

BACKGROUND:

Fever associated with sinus disease in the immunocompromised bone marrow transplant recipient requires prompt evaluation and therapy. Very little is known about the incidence, risk factors, and sequelae of nonsurgically treated sinus disease in this population.

METHODS:

A retrospective review of 107 consecutive allogeneic and autologous bone marrow transplant recipients from August 1987 to July 1989 was performed to determine (1) the overall incidence of sinus disease; (2) factors that influence the development of sinus disease; and (3) the sequelae of sinus disease treated nonsurgically.

RESULTS:

Overall 33 (31%) of 107 bone marrow transplant recipients had sinus disease defined as a radiographic abnormality with clinical symptoms. Eleven (10%) of 107 recipients had preexisting sinus disease. Sinus disease developed in 22 (21%) of 107 recipients after bone marrow trans‐plantation. Sinus abnormalities were significantly higher among allografted bone marrow transplant recipients than among autografted recipients (p= 0.027). The diagnosis, stage of disease, cytoreductive regimen, or graft‐vs.‐host disease were not different between recipients in whom sinus disease did and did not develop. There were no deaths as a result of sinus complications.

CONCLUSIONS:

Sinus disease developed in 21% of the studied population after bone marrow transplantation. Allogeneic recipients had a higher incidence of sinus disease than autologous recipients. There were no deaths attributed to sinus complications. All sinus disease in this bone marrow transplant population was treated medically. No patient required surgical intervention either before or after bone marrow transplantation.
Symptom outcome after functional endoscopic sinus surgery in patients with cystic fibrosis: A prospective study
Authors: Nishioka Gary J. , Barbero Giulio J. , König Peter , Parsons David S. , Cook Paul R. , Davis William E.
Published: September 2022

Twenty‐nine consecutive patients with cystic fibrosis were offered functional endoscopic sinus surgery. Twenty‐six of these patients underwent surgery. A symptom questionnaire was obtained from the patient or parent before surgery. At the end of the study this symptom questionnaire was again administered to the same individual, and 21 completed it. There were 14 male and 7 female patients, with a mean age of 12.3 years and a median age of 8.7 years. Mean follow‐up was 34.3 months. Results for the following symptoms were significant: nasal airway obstruction was improved (p < 0.0002), olfactory function was improved (p < 0.0037), purulent nasal discharge was decreased (p < 0.001), and activity level was increased (p < 0.001). Other parameters are also reported in the text. In summary, this study prospectively studies the effects of functional endoscopic sinus surgery on symptoms in patients with cystic fibrosis. The study points out several significant areas of symptom improvement and supports the selective use of functional endoscopic sinus surgery in patients with cystic fibrosis. Indications for surgery are provided.
Aphysiologic Performance on Dynamic Posturography
Authors: Cevette Michael J. , Puetz Becky , Marion Mitchell S. , Wertz Max L. , Muenter Manfred D.
Published: September 2022

The remarkable ability of the body to maintain balance is the result of central nervous system integration of sophisticated inputs from the vestibular, visual, and somatosensory systems. Strategies by patients with balance dysfunction are aphysiologic when their performance is relatively better on more difficult conditions of sensory conflict than on easier ones. Twenty‐two aphysiologic patterns on computerized dynamic posturography were compared with age‐matched normal and vestibular patterns. The aphysiologic group performed significantly better than the patients in the vestibular dysfunction group on the most difficult subtests of computerized dynamic posturography, conditions 5 and 6, yet significantly poorer on the easier subtests, conditions 1 through 4. In addition, patients in the aphysiologic group tended to show greater intertrial variability compared with patients in both normal and vestibular system dysfunction groups. A stepwise linear discriminant analysis was used to determine a set of conditions that had significant value in discriminating between the three patient groups. Case studies are presented to further illustrate the clinical usefulness of computerized dynamic posturography testing in the evaluation of patients suspected of having a functional component to their on‐feet balance problems.
Use of the Guinea Pig Flank Flap in Skin Flap Research
Authors: Hirigoyen Martin B. , Zhang Wen X. , Lin Derrick , Weinberg Hubert , Mark L. Urken
Published: September 2022

A variety of flaps in laboratory animals have been designed that propose to parallel the behavior of human skin under different experimental conditions. In the search for a readily available and affordable island skin flap model that combines reliable anatomy with a pedicle of substantial size, we have designed in the guinea pig a cutaneous flap based on the superficial circumflex iliac artery and vein. In 22 adult female Hartley guinea pigs, an 8 × 4 cm flank flap based on the superficial circumflex iliac pedicle was raised, and its characteristics were evaluated for applications to skin flap research. Dermofluorometric studies were performed that confirm the vascularity of this flap, and 100% survival of the flap was seen 5 days after surgery in all animals. Of particular benefit was the demonstration that both afferent and efferent blood samples can be taken from the pedicle directly, which allows for the direct quantification of plasma markers after physiologic insults to the skin flap, such as burn or ischemia. This anatomically reliable and easily dissected flap lends itself well to preliminary skin flap research and may contribute to standardization of a model for further studies examining the behavior of skin microcirculation under adverse physiologic conditions.
Head‐shake vestibulo‐ocular reflex testing: Comparison of results with rotational chair testing
Authors: Goebel Joel A. , Hanson Jason M. , Langhofer Laurn R. , Fishel Douglas G.
Published: September 2022

The currently accepted “gold standard” for rotational testing of the vestibulo‐ocular reflex uses a servo‐controlled chair for sinusoidal whole‐body rotation. Previous work in our laboratory has shown good concordance between conventional rotational chair testing and head‐on‐body (or “head‐shake”) testing for gain and phase values of the vestibulo‐ocular reflex as recorded and analyzed on our rotational chair system's software. In this article we describe results obtained from 10 normal subjects and 20 patients with reduced caloric responses using a portable system being developed in our laboratory that allows an examiner to generate both whole‐body and head‐on‐body rotational stimuli. Test frequencies within the range 0.25 to 1.0 Hz were chosen for comparison with results obtained by conventional rotational chair testing. Visual conditions for all tests included both visually enhanced vestibulo‐ocular reflex (real earth‐fixed target) and mentally enhanced vestibulo‐ocular reflex (imagined earth‐fixed target, in darkness or with vision obscured) paradigms. Our results show general agreement between head‐shake and rotational chair testing and both manual whole‐body rotation and head‐shake testing on our portable system for vestibulo‐ocular reflex gain and phase testing, with the largest differences noted at 1.0 Hz. Portable rotational testing was well tolerated by young and elderly subjects alike. We expect manual whole‐body rotation and head‐shake testing will be useful adjuncts for examining vestibulo‐ocular reflex function when more formal rotational chair testing is not possible.
Analysis of the pharyngoesophageal pressure profile in amyotrophic lateral sclerosis
Authors: MacDougall Gillian , Wilson Janet A. , Pryde Anne , Grant Robin
Published: September 2022

Treatment of dysphagia resulting from bulbar amyotrophic lateral sclerosis has included cricopharyngeal myotomy for many years but is successful in only a minority of cases. The purpose of this study was to explore the rationale for this procedure with modern manometric techniques. The results of pharyngoesophageal manometry in 13 patients with amyotrophic lateral sclerosis were compared with 13 age‐ and sex‐matched healthy volunteers by Mann‐Whitney analysis. There was no significant difference between patients and control subjects in distal esophageal or lower esophageal sphincter motility nor any pressure parameter of pharyngoesophageal motility. Separate analysis of the seven significantly dysphagic subjects showed a significantly reduced upper esophageal sphincter after‐contraction amplitude during water and bread swallows in patients than in control subjects. These data suggest that the dysphagia of amyotrophic lateral sclerosis is not due to upper esophageal sphincter spasm and that treatment by cricopharyngeal myotomy may be inappropriate.
Propofol‐based anesthesia as compared with standard anesthetic techniques for middle ear surgery
Authors: Jellish W. Scott , Leonetti John P. , Murdoch John R. , Fowles Susan
Published: September 2022

OBJECTIVE

To determine whether a totally intravenous technique with propofol and fentanyl is superior to isoflurane anesthesia in patients undergoing middle ear surgery.

DESIGN

Prospective randomized study.

SETTING

Inpatient otolaryngology service at a university medical center.

PATIENTS

Physical status 1 and 2 nonobese patients with no significant history of diabetes, chronic cholecystitis, neuropathy, or neuromuscular disorders that could produce delayed gastric emptying. One hundred two patients were admitted to the study and randomly divided into three equal groups.

INTERVENTIONS

Intravenous thiopental, 5 mg/kg, was administered for induction of anesthesia followed by 60% air/O2 with isoflurane, 1% to 2% end tidal, for maintenance anesthesia (group 1), The same anesthetic with the addition of droperidol, 25 μg/kg, was given after induction (group 2). Propofol, 2 mg/kg, was administered intravenously for induction of anesthesia and followed by propofol, 50 to 250 μg/kg/min, for maintenance anesthesia. All groups received fentanyl, 3 μg/kg intravenously, after induction.

MEASUREMENTS AND MAIN RESULTS

Surgical duration, induction, maintenance, and total anesthesia times were recorded together with eye opening and extubation. Intergroup comparisons of postoperative nausea, vomiting, and pain, and recovery scores, we made by use of the Steward system. Patients receiving propofol, compared with the isoflurane‐only group, had significantly less nausea (4/34 vs 12/34 patients, respectively; p < 0.05) and as vomiting (2/34 vs 8/34 patients, respectively; p < 0.05). Immediate recovery scores were significantly better for propofol compared with the isoflurane‐droperidol group. Recovery scores at 30 minutes were also faster with propofol compared with isoflurane or isoflurane‐droperidol (5.7 ± 0.1 vs 5.1 ± 0.2 and 5.2 ± 0.2; p < 0.05).
Vestibular neuritis
Authors: Nadol Joseph B.
Published: September 2022

Because the cause of vestibular neuritis is unknown, this disorder is best understood as a constellation of characteristic clinical symptoms and signs. The differential diagnosis includes peripheral otologic disorders, including Meniere's disease, perilymph fistula, and vestibular atelectasis; and central disorders, including vascular insufficiency, acoustic neuroma, migraine equivalent, paraneoplastic syndrome, metastatic carcinoma, and multiple sclerosis. The site of lesion, as evaluated by clinical signs and symptoms, is controversial because concomitant central nervous system abnormalities have been described. The histopathology of temporal bones from persons who in life had symptoms characteristic of vestibular neuritis demonstrates degeneration of branches of the vestibular nerve and the neuroepithelium of vestibular end organs. Possible causes of vestibular neuritis include viral or other infectious agents and vascular or immune‐mediated disorders. The natural history of this disorder is variable. In some patients complete recovery of acute signs and symptoms, including loss of vestibular response, is seen, whereas in others permanent changes have been reported. Initial treatment is generally symptomatic only. Patients with poor recovery may benefit from vestibular rehabilitation or, occasionally, from surgical intervention. The elucidation of the pathogenesis of vestibular neuritis and the development of logical guidelines for individual rehabilitation are needed.
Clinical pathophysiology of vestibular neurectomy
Authors: Böhmer Andreas , Fisch Ugo
Published: September 2022

This study attempts to characterize the residual vestibular function remaining after incomplete supralabyrinthine vestibular neurectomy performed for disabling vertigo. Patients with bilateral vestibular neurectomy had preserved horizontal vestibulo‐ocular reflexes in response to high angular accelerations with gain enhancement over time. A torsional down‐beating spontaneous nystagmus and an important tilt of the subjective vertical were observed when the remaining eighth nerve was sectioned after homolateral incomplete supralabyrinthine vestibular neurectomy. These findings suggest that a reorganization of vestibular reflexes may occur after incomplete supralabyrinthine vestibular neurectomy if afferents of the inferior vestibular branch are partially spared. The vestibular function after incomplete supralabyrinthine vestibular neurectomy does not affect the postoperative control of vertiginous attacks and may have positive effects in case of deterioration of the contralateral inner ear.
Lung (Agricultural/Rural)
Authors: do Pico Guillermo A.
Published: September 2022

Industrialization of farming, animal raising, and forestry has added chemical and mechanical hazards that need to be recognized and prevented. Lung disease among farmworkers can result from a wide variety of hazardous exposures, which include organic dusts, allergens, chemicals, toxic gases, and infectious agents. In addition to nonspecific symptoms of mucous membrane irritation, farmworkers can experience occupational asthma or bronchitis, organic dust toxic syndrome, hypersensitivity pneumonitis, silo filler's disease (toxic hemorrhagic pulmonary edema), and neuromuscular respiratory failure. At risk are farmworkers and those involved in the processing, stocking, transportation, handling, and inspection of unprocessed agricultural, animal, and forestry products; veterinarians; gardeners; game, river, and forest keepers; persons involved in building, supplying, or servicing farm operations; and residents of rural communities. Worker education on the risks of environmental exposures, adherence to safety regulations, and increased knowledge of the cause and prevention of environmental diseases will reduce their prevalence and their adverse human and animal health and socioeconomic effects.
International Medicine and Air Pollution
Authors: Scott John Kimball
Published: September 2022

Environmental pollution worldwide has been increasing rapidly as a result of massive increases in industrial production, especially since 1950. Although the United States has begun to address the problem, many nations have not been able to, such as those formerly part of the Communist bloc and many emerging nations. The International Society of Doctors for the Environment was established to promote the information flow about environmental impacts on health. The National Association of Physicians for the Environment is a member of that Organization.
Development of a Sensitive Clinical Facial Grading System
Authors: Ross Brenda G. , Fradet Gaeton , Nedzelski Julian M.
Published: September 2022

Clinicians require a reliable and valid method of evaluating facial function after facial nerve injury. This tool should be clinically relevant and easy to administer, provide a quantitative score for reporting purposes, and be sensitive enough to detect clinically important change over time or with treatment. The proposed facial grading system has all essential information, including precise definitions for each item, presented on one page. The facial grading system is based on the evaluation of resting symmetry, degree of voluntary excursion of facial muscles, and degree of synkinesis associated with specified voluntary movement. Different regions of the face are examined separately with the use of five standard expressions. All items are evaluated on point scales, and a cumulative composite score is tabulated. Construct validity was addressed by comparing the proposed facial grading system to prerehabilitation and postrehabilitation treatment scores of 19 patients with varying degrees of facial nerve injury. All patients had documented change in a controlled study of feedback training. The proposed system reports results in a more continuous manner with a wider response range than the House‐Brackmann grades. Each component of the grading system is sensitive to change and individually contributes to a change in the composite score. Tests of interrater reliability are currently near completion.
Comparison of Nuclear DNA Content in Locally Invasive and Noninvasive Papillary Carcinoma of the Thyroid Gland
Authors: Stern Yoram , Lisnyansky Ilya , Shpitzer Thomas , Nativ Ofer , Medalia Ora , Feinmesser Raphael , Aronson Moshe
Published: September 2022

Extrathyroidal invasion of papillary carcinoma of the thyroid gland has a very bad prognosis. A retrospective study was performed on 40 specimens from patients with papillary carcinoma of the thyroid gland to find out whether DNA ploidy correlated with aggressive tumor behavior. The nuclear DNA content of 20 locally aggressive papillary thyroid carcinomas was studied by flow cytometry. The results were compared with those of a matched control group of 20 patients with noninvasive papillary tumors. Forty percent of the tumors with spread to extrathyroid tissue were aneuploid, whereas all the tumors without such extension were diploid. This difference was statistically significant (p < 0.003). The data suggest that the differentiation of locally noninvasive and invasive papillary thyroid carcinomas may be potentially possible by nuclear DNA determination.
Cerebrospinal Fluid Fistulae in a Canine Model
Authors: Syms Charles A. , Syms Mark J. , Murphy Terrence P. , Massey Samuel O.
Published: September 2022

Various diagnostic techniques currently are used to detect the presence of a cerebrospinal fluid fistula. High resolution computerized tomography scanning with the instillation of an intrathecal nonionic contrast medium yields the most accurate diagnostic results. Occasionally, even with optimal conditions, little information is gained other than the confirmation of the presence of a fistula. Intrathecal fluorescein can provide accurate information on the exact location of the fistula. The current study was designed to refine the clinical examination for cerebrospinal fluid fistulae with the use of intrathecal fluorescein. The canine model that we used also served as a vehicle to investigate the histopathologic effects of fluorescein on the central nervous system. We modified a commonly used xenon light source to enable examination with 490 nm light. In the canine model, this allowed accurate visualization of surgically created fistulae using very low doses of intrathecal fluorescein. An examination of the histopathologic features of the central nervous system of the canine model after acute instillation of a higher dose of fluorescein revealed microscopic changes consistent with the introduction of an irritant material. The changes induced by the chemical trauma may explain the serious neurologic sequelae sometimes seen in patients after the instillation of intrathecal fluorescein. Recommendations on the correct dosage of intrathecal fluorescein for diagnosis of cerebrospinal fluid fistulae are proposed.
Hemangioma of the Middle Ear
Authors: Teknos Theodoros N. , Megerian Cliff A. , Rauch Steven D.
Published: September 2022

An 80‐year‐old woman was referred to the Massachusetts Eye and Ear Infirmary by her primary care physician for evaluation of a red mass behind her right tympanic membrane. The patient gave a history of a long‐standing, stable, right‐sided hearing loss and denied all other aural symptoms, including tinnitus, vertigo, otorrhea, and otalgia. Her past otolaryngologic history was significant for a transcanal excision of a hemangioma originating in the right epitympanum in 1953.
Are Acoustic Neuromas Encapsulated Tumors?
Authors: Kuo Timothy C. , Jackler Robert K. , Wong Kondi , Blevins Nikolas H. , Pitts Lawrence H.
Published: September 2022

In articles and chapters on the subject of acoustic neuroma, it is almost invariably stated that they are well‐encapsulated tumors. During surgical procedures, blunt mechanical dissection defines a natural subsurface cleavage plane that leaves intact a several millimeter thick rind of tumor surface. Occasionally, as a concession to neural integrity, less than complete resection is elected, leaving behind this “capsular” remnant. To clarify the nature of the surface of acoustic neuromas and to test whether this long held description is indeed correct, a microscopic analysis of 10 surgical specimens was performed. A wedge was harvested from the free surface of the tumor in the mid cerebellopontine angle that included a large, undisturbed section of the tumor surface. Histologic analysis showed that for most of the tumor surface only an extremely thin (3 to 5 μm) layer of connective tissue envelops the tumor. Neoplastic Schwann cells, which extend essentially to the margin of the tumor, were found to be somewhat flattened and compressed in the vicinity of the surface. Although acoustic neuromas are surrounded by a continuous layer of connective tissue, it is so exceptionally thin (on average less than the diameter of a red blood cell) that its edge cannot be visualized intraoperatively by a surgeon. Because the pathologic definition of a capsule is a thick, enveloping layer of connective tissue that is both micro‐ and macroscopically evident, it must be concluded that acoustic neuromas are nonencapsulated, at least in the conventional sense of the term. The surface peel observed intraoperatively is surgically produced during tumor debulking by cleaving of the looser central component from the more compressed portion of neoplastic cells that lies immediately beneath the free margin of the lesion.
Value of Preoperative Prothrombin Time/Partial Thromboplastin Time as a Predictor of Postoperative Hemorrhage in Pediatric Patients Undergoing Tonsillectomy
Authors: Howells R. charles , Wax Mark K. , Ramadan Hassan H.
Published: September 2022

OBJECTIVE

Hemorrhage after tonsillectomy is a potentially lethal complication. Preoperative assessment consisting of prothrombin time (PT) and activated partial thromboplastin time (PTT) has been used to identify patients at risk for hemorrhage after tonsillectomy and adenoidectomy. We sought to assess the value of PT/PTT screening as a predictor of posttonsillectomy hemorrhage.

DESIGN

A retrospective chart review was carried out with a minimum of 1 month follow‐up.

SETTING

Tertiary academic referral center.

PATIENTS

Between January 1992 and June 1995, 382 patients undergoing tonsillectomy were examined; 339 patients with a minimum of 1 month follow‐up were reviewed for this study.

MAIN OUTCOME MEASURE

Normal and prolonged PT/PTT values were examined. Bleeding in the intraoperative, immediate postoperative, and delayed phases of healing was examined.

RESULTS

Two‐hundred and twenty‐two patients had normal PT/PTT, 39 had prolonged PT/PTT, and 78 had no preoperative studies performed. Bleeding occurred in 2.7%, 2.6%, and 3.3%, respectively, of patients. Eight patients had positive family histories of bleeding tendencies. One patient (12.5%) with a normal PT/PTT experienced a delayed posttonsillectomy bleed. Of 39 patients with abnormal coagulation studies, 30 were borderline elevations with no repeat studies done; one patient experienced postoperative hemorrhage. Nine abnormal results were repeated; three returned to normal, three remained prolonged but underwent tonsillectomy with no intervention, and three received hematology consultations. One patient had lupus anticoagulant, one had Hageman Factor deficiency, and one was cleared for surgery with no diagnosis. All patients underwent tonsillectomy with no episodes of postoperative bleeding.

CONCLUSIONS

Preoperative PT/PTT provides no additional information than does a bleeding history for the general pediatric population undergoing tonsillectomy. This should only be done in selective cases where warranted by history.
The use of lidocaine in microvascular reconstruction
Authors: Chafin J. Brett , Wax Mark K. , Johnstone Robert , Bishop David
Published: September 2022

Vasospasm is known to have an adverse effect on the survival of free tissue transfers. Prolonged vasoconstriction decreases blood flow to the flap and promotes thrombosis at the anastomotic site. Because of its wide availability and rapid effect, topically applied lidocaine is used by many surgeons to prevent and correct vasospasm. Mucosal absorption of lidocaine is known to be rapid. Absorption by the surgical bed during microvascular reconstruction has not previously been determined. We had three specific aims: (1) to determine whether systemic absorption occurs, (2) if so, to determine the degree of absorption, and (3) to determine whether the type of reconstruction affects the degree of absorption. Twelve consecutive patients were entered into the study, four in a myocutaneous reconstructive group and eight in a fasciocutaneous group. Baseline serum lidocaine levels were drawn. After the initial application of lidocaine, levels were drawn every 30 minutes. Final levels were drown 120 minutes after the last application. The total amount of lidocaine used ranged from 720 mg to 2600 mg. Application ranged from 7.5 mg/minute to 34.7 mg/minute (2 to 9 times the estimated toxic dose of 4 mg/minute for a patient weighing 70 kg). Results ranged from undetectable (<0.5 μg/ml) to minimal therapeutic levels (1.6 μg/ml). Toxic levels (>6.0 μg/ml) were not encountered. Significant (p < 0.05) differences were found between the fasciocutaneous group, which generally had no detectable serum levels, and the myocutaneous group, which had detectable subtherapeutic to minimally therapeutic levels. Doses considered toxic by intravenous or mucous membrane application may safely be applied topically. Greater absorption was found in the myocutaneous group, which is believed to be a result of the richer absorption surface provided by the muscular tissue. (Otolaryngol Head Neck Surg 1997;117:93–8.)
Pediatric Otolaryngology, 3rd Edition
Authors: Tunkel David E. , Kosko James R.
Published: September 2022

Pediatric Otolaryngology, 3rd edition, edited by Charles D. Bluestone, Sylvan E. Stool, and Margaret A. Kenna. 1677 pages with illustrations. W.B. Saunders, Philadelphia, 1996. $330.00.
Low‐Velocity Gunshot Wounds to the Paranasal Sinuses
Authors: Lee Dennis , Nash Michael , Turk Jon , Har‐El Gady
Published: September 2022

There are more than 200 million private firearms in the United States today. Firearm‐associated deaths are the second leading cause of mortality for men 1 to 38 years of age. There are many studies in the literature concerning the management of high‐velocity gunshot injuries to the head and neck. However, there are no studies in the English language literature concerning the management of isolated low‐velocity gunshot wounds to the paranasal sinuses. We retrospectively reviewed 35 patients treated for low‐velocity gunshot wounds of the paranasal sinuses between 1985 and 1994 at Kings County Hospital Center. The injuries sustained by these patients were less severe than previously reported for high‐velocity missile or shotgun injuries. The management of these injuries is outlined with emphasis on (1) indications for angiographic studies, (2) airway management, and (3) indications for operative removal of bullet fragments.
A Comparison of the Biocompatibility of three Absorbable Hemostatic Agents in the Rat Middle Ear
Authors: Liening Douglas A. , Lundy Larry , Silberberg Boris , Finstuen Kenn
Published: September 2022

Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgery. Although the sponge is generally well tolerated, fibrosis occasionally forms in the mesotympanum; some studies indicated that the absorbable gelatin sponge may be responsible. Many of these studies lack statistical analysis. We prospectively studied three absorbable hemostatic agents in the middle ear of adult male Sprague‐Dawley rats to determine which promotes fibrosis to the greatest degree: absorbable gelatin sponge (Gelfoam), absorbable gelatin sheet (Gelfilm), or absorbable collagen sheet (Instat). The materials were implanted in the middle ear through a post‐auricular approach and the temporal bones were serially harvested at different time intervals so we could examine histologic changes. The nonimplanted ear served as surgical control. Examination of the specimens at 6, 8, and 10 weeks by light microscopy revealed that although absorbable gelatin film and collagen‐absorbable hemostat are well tolerated in this animal model, absorbable gelatin sponge promoted the presence of fibrosis to a significantly greater degree, (p = 0.0344). We conclude that absorbable gelatin sponge promotes fibrosis more frequently than do collagen‐absorbable hemostat and absorbable gelatin film in this animal model.
Acute Mastoiditis in Children: A 12‐Year Retrospective Study
Authors: Harley Earl H. , Sdralis Theo , Berkowitz Robert G.
Published: September 2022

We undertook a retrospective study to examine our experience with acute mastoiditis over a 12‐year period. Fifty‐eight cases were identified in children aged 3 months to 15 years. Acute mastoiditis was the first evidence of otitis media in 54% of our patients. Pain and fever lasting for more than a median period of 4 days were most likely to be the harbingers of incipient acute mastoiditis. Streptococcus pneumoniae was the most common organism recovered from the cultures. All children were treated with intravenous antibiotics; 41 children were managed with an adjunctive drainage procedure. No statistically significant differences were observed between the cure rates and failure rates for children treated surgically with myringotomies with or without tubes and children managed more aggressively with mastoidectomies. One infant had bacterial meningitis. Cholesteatoma was diagnosed in two children. We conclude from our study that acute mastoiditis occurs mainly in young children and may be the first evidence of ear disease. Pain and fever that persist despite appropriate treatment for acute otitis media are the two most important symptoms. Intravenous antibiotics combined with myringotomy with or without tube insertion are as appropriate as intravenous antibiotics with mastoidectomy for initial management of acute mastoiditis in the absence of a subperiosteal abscess or central nervous system extension.
Predictive Value of an Adherence Test for Acute Otitis Media
Authors: Danino Joshua , Joachims Henry Z. , Barak Mira
Published: September 2022

The predictive value of an in vitro adherence test of the bacterium Streptococcus pneumoniae for the development of recurrent otitis media was calculated 5 years after the initial test. Nasopharyngeal cells from 56 children suffering from acute otitis media (AOM) and from healthy children were tested for adherence of a standard pneumococcal type (capsular serotype 6). The average adherence of the bacteria to epithelial cells from the group suffering from AOM was greater than the average adherence in the control group (p < 0.005), both when adherence was counted microscopically and radioactively. Subjects were followed up periodically over a 5‐year period. Four out of 5 healthy children who had high mean adherence values experienced AOM during the 5 years, and 1 child classified as AOM‐prone was found to be healthy. Based on the retrospective data, the positive predictive value of this test was 98.2%, and the negative predictive value was 90.7%.
Conceptual design and application research of a corrugated flexible skin with high bending stiffness
Authors: Lei P. , Li Y. , Li D. , Li B.
Published: September 2022

In this paper, sliding panels are used to increase the bending stiffness of the classic corrugated flexible skin, and the corresponding application procedure for aircraft structures is developed. After the conceptual design of the corrugated flexible skin with sliding panels is proposed, the analytical models to calculate the equivalent tensile and bending properties are investigated. At the same time, its flexibility in the corrugation direction and the load-bearing capacity (is proportional to the bending stiffness) in the direction perpendicular to corrugation are studied by numerical simulation and experiment. The application procedure is established based on geometric analysis and strain definition, and according to this procedure, the corrugated flexible skin with sliding panels is applied to the drooping leading edge to eliminate the gap on the upper skin. The results show that the corrugated flexible skin with sliding panels has more bending stiffness than the classic corrugated flexible skin in the direction perpendicular to corrugation while maintaining the deform ability in the corrugation direction, and the application procedure is effective and can be applied to other parts of the aircraft structure.
Diversity of protein food sources, protein adequacy and amino acid profiles in Indonesia diets: Socio-Cultural Research in Protein Transition (SCRiPT)
Authors: Khusun Helda , Monsivais Pablo , Anggraini Roselynne , Februhartanty Judhiastuty , Mognard Elise , Alem Yasmine , Noor Mohd Ismail , Karim Norimah , Laporte Cyrille , Poulain Jean-Pierre , Drewnowski Adam
Published: September 2022

The ongoing nutrition transition in lower- and middle-income countries (LMIC) in South East Asia may have a positive impact on protein nutrition. This study assessed the diversity of plant and animal protein food sources in relation to essential amino acid (EAA) adequacy in a population-based sample (N1665) in Indonesia. Dietary intakes from in-person 24 h recalls provided data on energy and protein intakes (in g/d) from plants (grains, legumes), meat, poultry and fish, and eggs and dairy. Protein diversity scores were based on the number of protein food sources over 24 h. EAA scores were the ratio of amino acid intakes to recommended values. Protein diversity and EAA scores were then compared across multiple socio-demographic indices. Analysis of variance andχ2tests were used to test for differences among groups. Energy intakes were 1678 kcal/d for men and 1435 kcal/d for women. Average protein intakes (and prevalence of inadequacy) were 59⋅4 g/d (41⋅7 %) for men and 51⋅5 g/d (51⋅1 %) for women. In regression analyses, higher protein diversity scores were associated with higher protein intakes, more animal protein and less plant protein and with higher EAA scores. Lower protein diversity scores were associated with lower intakes of lysine, leucine and valine relative to requirements, as well as with lower EAA, rural settings, less wealth and less modernisation. Greater diversity of animal protein food sources, observed among groups of higher socio-economic status, was linked to better amino acid adequacy and protein nutrition.
A Bayesian multifactor spatio-temporal model for estimating time-varying network interdependence
Authors: Liu Licheng , Pang Xun
Published: September 2022

This paper proposes a Bayesian multilevel spatio-temporal model with a time-varying spatial autoregressive coefficient to estimate temporally heterogeneous network interdependence. To tackle the classic reflection problem, we use multiple factors to control for confounding caused by latent homophily and common exposures. We develop a Markov Chain Monte Carlo algorithm to estimate parameters and adopt Bayesian shrinkage to determine the number of factors. Tests on simulated and empirical data show that the proposed model improves identification of network interdependence and is robust to misspecification. Our method is applicable to various types of networks and provides a simpler and more flexible alternative to coevolution models.
Keeping it in the family: Relationships between Polar medallists
Authors: Dartnall Herbert J. G.
Published: September 2022

During the 19th century, members of British Arctic expeditions received one of two silver Arctic medals. In 1904, the British Polar Medal was established in both silver and bronze to returning members of the British National Antarctic Expedition. Subsequently awarded to members of both Arctic and Antarctic expeditions, the medal in silver is still awarded today. This paper explores the family links of the recipients from 1904 to the present. Polar medallists related by blood comprise five pairs of brothers, five father-and-son pairs, one grandfather-and-grandson pair, one uncle-and-nephew pair and six pairs of cousins including one male-to-female pair. A female-to-female link has yet to be recorded. Family links resulting from marriage include six husband-and-wife pairs and four pairs of brothers-in-law.
Fuzzy radial-based impedance controller design for lower limb exoskeleton robot
Authors: Zhang Peng , Zhang Junxia , Elsabbagh Ahmed
Published: September 2022

The lower extremity rehabilitation exoskeleton is mainly used to help patients with movement disorders complete rehabilitation training. For the human-machine interaction problem of the lower limb rehabilitation exoskeleton, a fuzzy radial-based impedance (RBF-FVI) controller is proposed in this study. A six degree of freedom (DOF) lower extremity rehabilitation exoskeleton was developed, and the human-machine coupling dynamics model was established. To realize the compliance control of the human-machine coupling system, a novel RBF-FVI controller is designed, which includes an inner-loop fuzzy position control module and an outer-loop impedance control module. The inner-loop fuzzy position control module is mainly used to achieve the tracking control of the desired training trajectory and position adjustment amount. The outer-loop impedance control module regulates the impedance parameters and compensates for the uncertainty terms. The superiority of the proposed controller in trajectory following is verified through simulation and comparison tests. The hardware test of the human-machine coupling system was carried out, and the test results showed that the subject and the exoskeleton system could realize a coordinated and smooth movement.