bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Intracranial Complications of Temporal Bone Trauma
Authors: Alvi Aijaz , Bereliani Arash
Published: November 2005

Temporal bone trauma can be disastrous for the individual and his or her family. With the increase in violent crime throughout our society, the number of intracranial complications associated with temporal bone injury has increased significantly. Although multiple reports concerning the diagnosis and management of temporal bone trauma have been published, few studies on its intracranial complications have been addressed. In this study, we assessed the cases of 43 patients treated for temporal bone fractures between January 1992 and December 1994. The number of temporal bone fractures increased from 6 in 1992 to 21 in 1994. Twenty‐one patients (49%) presented with decreased mental status. Significant alcohol and drug use was documented in 28% and 58% of patients, respectively. The most common radiologic finding was skull and intracranial injury. Thirty‐six patients (84%) had at least one abnormal intracranial finding; of these patients, 14 (39%) had more than one abnormal finding on computed tomography. Cerebral midline shift, subarachnoid hemorrhage, subdural hemorrhage, and cerebral edema were the most common radiologic findings. Nineteen patients (44%) required an open neurosurgical procedure, and almost all patients with more than one abnormal radiologic finding underwent neurosurgery (86%). Seven patients required further institutional care after discharge. Four patients died (9% mortality); all the deaths were neurologically related. Mean hospital charges increased from $30,900 in 1992 to $63,000 in 1994.
Plasmacytomas of the Head and Neck
Authors: Miller Frank R. , Lavertu Drs. Pierre , Wanamaker John R. , Bonafede Joseph , Wood Benjamin G.
Published: November 2005

Plasmacytomas are rare tumors that often appear in the head and neck region and are characterized by a monoclonal proliferation of plasma cells. On both clinical presentation and pathologic examination these tumors may be confused with more common tumors of the head and neck. The purpose of this article is to review our experience with these rare neoplasms, with emphasis on clinical, pathologic, and therapeutic features. On retrospective chart review, we identified 20 patients with the diagnosis of plasmacytoma of the head and neck region at the Cleveland Clinic Foundation between 1976 and 1993. Records were reviewed with regard to initial symptoms, location of the neoplasm, diagnostic evaluation, treatment modalities, and survival. Of the 20 cases we identified, the tumor arose in the sinonasal/nasopharyngeal region in 11 (55%). Two cases (10%) represented medullary plasmacytomas, arising in the clavicle and presenting as supraclavicular masses. The mean follow‐up was 60.2 months (range 6 to 131 months). In 15 of the 20 cases, immunohistochemistry staining for immunoglobulin light chain production was conducted. One of the two cases (50%) classified as medullary plasmacytoma demonstrated conversion to multiple myeloma, whereas only 2 of 18 cases of extramedullary plasmacytoma (11%) converted to multiple myeloma. The primary modality of treatment was radiation therapy with typical doses of 4500 to 6000 cGy. Kaplan‐Meier survival estimates demonstrated 95% survival at 1 year, 82% survival at 5 years, and 10‐year estimated survival of 72%. Plasmacytomas of the head and neck region are rare and on initial evaluation must be distinguished from multiple myeloma. The diagnostic evaluation includes appropriate radiologic and pathologic studies including immunohistochemistry. Despite the typical presentation as a locally destructive tumor, plasmacytomas are highly radiosensitive, and 70% to 80% survival may be obtained with the use of radiotherapy. Patients with plasmacytomas require long‐term follow‐up to detect conversion to multiple myeloma.
Computed Tomography in the Evaluation of Pediatric Neck Infections
Authors: Wetmore Ralph F. , Mahboubi Soroosh , Soyupak Sureyya K.
Published: November 2005

In children, infections involving both the superficial and deep neck spaces are common. Children so affected typically present with fever, neck mass, neck stiffness, and, occasionally, airway compromise. Radiologic modalities used in the evaluation of neck infections include plain lateral neck radiography, ultrasound, computed tomography, and magnetic resonance imaging. All these modalities have proved useful in the treatment of such infections, specifically the decision to perform incision and drainage. The charts of 66 patients—33 with superficial and 33 with deep neck infections—were analyzed with respect to symptoms, signs, computed tomography findings, and need for surgical intervention. Computed tomography was not particularly helpful in superficial neck infections with regard to the decision to perform surgical drainage; however, it did localize and demonstrate the extent of infection. In deep neck infections we found a 92% correlation between computed tomographic evidence of an abscess and surgical confirmation of one. Contrast‐enhanced computed tomography remains an excellent tool in the treatment of neck infections in children.
Immunotherapy for Allergic Fungal Sinusitis: Three Years' Experience
Authors: Mabry Richard L. , Marple Bradley F. , Folker Randy J. , Mabry Cynthia S.
Published: November 2005

Since August 1994, we have treated patients with histologically proven allergic fungal sinusitis with surgery followed by immunotherapy, employing fungal and nonfungal antigens to which hypersensitivity has been demonstrated. Our results continue to be encouraging. Not only have we encountered no indication that fungal immunotherapy has worsened these patients' condition or caused a recurrence of disease, we have confirmed dramatic improvement in these patients compared with the generally accepted course of this disease. Of 11 patients who have received immunotherapy for 1 to 3 years (mean 28 months), none has required regular or frequent treatment with a single brief course of systemic steroids, and only three are receiving topical nasal steroids. No repeat surgeries for recurrent allergic fungal sinusitis have been required in the treatment group. This combination of surgery and immunotherapy has continued to prove beneficial, and we urge others to consider this approach to therapy.
Article Commentary: Ethics of cochlear implantation in young children: A review and reply from a Deaf‐World perspective
Authors: Lane Harlan , Bahan Benjamin
Published: November 2005

This article examines ethical dilemmas related to cochlear implant surgery in children. These dilemmas arise from the existence of a linguistic and cultural minority called the Deaf World. Organizations of culturally Deaf adults in the United States and abroad, as well as the World Federation of the Deaf, have, on ethical grounds, strongly criticized the practice of cochlear implant surgery in children. Three ethical dilemmas are examined. (1) The surgery is of unproven value for the main significant benefit sought, language acquisition, whereas the psychological, social, and linguistic risks have not been assessed. Thus the surgery appears to be innovative, but innovative surgery on children is ethically problematic. (2) It is now widely recognized that the signed languages of the world are full‐fledged natural languages, and the communities that speak those languages have distinct social organizations and cultures. Deaf culture values lead to a different assessment of pediatric cochlear implant surgery than do mainstream (hearing) values, and both sets of values have standing. (3) The fields of otology and audiology want to provide cochlear implants to Deaf children but also, their leaders say, want to protect Deaf culture; those appear to be conflicting goals in principle because, if there were perfect implants, the ranks of the Deaf World would diminish.
Tumor reduction in vivo after adenoviral mediated gene transfer of the herpes simplex virus thymidine kinase gene and ganciclovir treatment in human head and neck squamous cell carcinoma
Authors: Goebel Eric A. , Davidson Beverly L. , Graham Scott M. , Kern Jeffrey A.
Published: November 2005

Gene transfer offers the possibility of novel therapies for head and neck squamous cell carcinoma (HNSCC). To this end, we demonstrate that a replication deficient adenovirus vector (Ad.RSVlacZ) can efficiently transduce foreign genes into human HNSCC cell lines in vitro, and that adenoviral mediated transfer of herpes simplex virus thymidine kinase (Ad.RSVtk) followed by exposure to ganciclovir results in tumor cell killing in vitro and in vivo. Exposure to Ad.RSVlacZ resulted in lacZ expression at multiplicities of infection (MOIs) of 10 and 100 for the cell lines HEp‐2 and FaDu, respectively. This increased to 97% (HEp‐2) and 49% (FaDu) at an MOI of 10,000. For HEp‐2, maximum expression occurred during the first 48 hours after exposure (52% at 24 hours, 48% at 48 hours; MOI 500), then declined by 40% per day. This rapid decline may be caused by dilution of the gene through cell proliferation, because normalizing for the increase in total protein shows that the total number of cells expressing lacZ is stable from days 1 to 4. FaDu and HEp‐2 were then transduced by AD.RSVtk and exposed to 20 μM ganciclovir for 24 hours. Significant tumor cell killing, as measured by a colony forming assay, occurred at an MOI of 2 for HEp‐2 and 20 for FaDu. At an MOI of 200, 100% of HEp‐2 and 97% of FaDu cells were killed. Next, subcutaneous tumor nodules derived from FaDu and HEp‐2 were established in the flanks of SCID mice. Direct intratumoral injection of Ad.RSVtk followed by 7 days of ganciclovir therapy resulted in an adenovirus dose dependent reduction of tumor growth, and an actual size reduction of established tumor nodules at the highest does (1010 plaque forming units). In conclusion, an adenovirus vector can efficiently transduce HNSCC cell lines in vitro. Maximum marker gene expression occurred during the first 48 hours after transduction. Transduction by Ad.RSVtk followed by exposure to ganciclovir resulted in tumor cell killing in vitro and in vivo.
Early‐response cytokine expression in adult middle ear effusions
Authors: Ondrey F. G. , Juhn S. K. , Adams G. L.
Published: November 2005

Various cytokines are presently known to be associated with the regulation of inflammatory responses. In pediatric otitis media, cytokines that correlate with various degrees of inflammation are present in middle ear effusions as inflammatory mediators. The present study was undertaken to examine the potential role of the early‐response cytokines, interleukin‐1β and tumor necrosis factor‐ex, in adult otitis media. Fifty‐nine adults with otitis media underwent tympanocentesis, and the effusion specimens were analyzed for the presence of both cytokines by enzyme‐linked immunosorbent assay methods. Eighty‐eight percent of the effusions were serous in nature. Sixty‐seven percent of the patients had a known history of head and neck malignancy and radiation to the temporal bone. Twelve percent of the effusions were positive for interleukin‐1β expression, compared with 85% of effusions in children with otitis media. Eight percent of the effusions contained tumor necrosis factor‐α, compared with 85% of those collected in pediatric otitis media. All of the specimens that contained tumor necrosis factor‐α also contained interleukin‐ip. In the present study, there was no correlation with head and neck malignancy/radiation or the clinical degree of inflammation with the presence of either cytokine. We conclude that adult otitis media is associated with lower expression of an acute inflammatory response, as judged by the levels of interleukin‐1β and tumor necrosis factor‐α in the effusions. Additionally, adult otitis probably represents a less severe and more chronic inflammatory state in comparison with pediatric otitis media. Further analysis of inflammatory mediators in adult otitis media is necessary to evaluate the contribution of cytokines in relation to various etiologic factors.
Is postoperative intensive care monitoring necessary after uvulopalatopharyngoplasty?
Authors: Mickelson Samuel A. , Hakim Ishrat
Published: November 2005

We conducted a retrospective review of 347 consecutive patients who underwent surgical treatment for obstructive sleep apnea syndrome. We analyzed perioperative data to identify the nature and rate of complications in an attempt to determine whether intensive care unit monitoring is needed after uvulopalatopharyngoplasty (UPPP) and associated procedures including septoplasty, tonsillectomy, turbinate reduction, geniohyoid advancement, and tracheostomy. In the 347 cases, 14 complications occurred (4%), including 5 involving the airway, 5 postoperative hemorrhages, and 4 complications classed as “other,” including dehiscence of a tracheostomy flap, abdominal ileus, urine retention, and increased creatinine concentration. We found no difference between preoperative lowest oxygen saturation and oxygen‐saturation readings in the postoperative period and no correlation between complication rate and apnea severity. An association was detected between multiple simultaneous procedures and the development of complications: 50% of the patients in whom complications developed had undergone nasal procedures along with UPPP, compared with only 15% of the patients without complications. Except for one patient, all complications that occurred on the surgical ward were treated without transfer to the intensive care unit. Although surgery on the upper airway must be performed with caution in patients with sleep apnea, our findings suggest that UPPP is a safe procedure and that postoperative monitoring in an intensive care setting is not necessary for most patients.
Microscopic examination of routine tonsillectomy specimens: Is it necessary?
Authors: Alvi Aijaz , Vartanian A. John
Published: November 2005

Controversy continues to exist regarding the routine histologic examining of tonsillectomy specimens. Proponents suggest that among other reasons, missing an important diagnosis such as occult malignancy or granulomatous disease and possible medicolegal consequences argue in favor of routine histologic examination. Others state that we should consider the very low yield of significant histologic findings in routine tonsillectomy specimens and its added cost. We performed a retrospective evaluation of all cases of patients who underwent tonsillectomy with or without adenoidectomy between January 1992 and July 1996. Two hundred eighty‐eight charts were evaluable. Group 1 consisted of all tonsillectomy specimens that were subjected to gross examination only. Group 2 consisted of all tonsillectomy specimens that were subjected to gross examination as well as microscopic examination. In group 1, no abnormal gross findings were noted. Group 2 consisted of specimens from an older population with a mean age of 21.6 years. There were 43 patients older than 20 years old in group 2, and in all cases except four the preoperative clinical impression correlated with the microscopic findings. Occult malignancy was found in only one of these four patients. No cases of granulomatous disease were discovered. Overall, no patients except one had any change in postoperative treatment on the basis of the results of microscopic examination. We believe that routine microscopic examination of tonsillectomy specimens results in unnecessary cost and consumption of resources and time. Microscopic examination should be done in only selected cases such as in patients with grossly asymmetric tonsils or in patients with a history of malignancy.
Ultra high resolution nonenhanced fast spin echo magnetic resonance imaging: Cost‐effective screening for acoustic neuroma in patients with sudden sensorineural hearing loss
Authors: Daniels Robert L. , Shelton Clough , Harnsberger H. Ric
Published: November 2005

The financial burden for the evaluation of patients for acoustic neuroma in an otolaryngology practice is substantial. Patients with sudden sensorineural hearing loss represent a portion of that population seen with unilateral, asymmetric auditory symptoms who require investigation for acoustic neuroma. For these patients, gadolinium‐enhanced magnetic resonance imaging is the diagnostic gold standard. Auditory brain stem response testing has been used in the past as a screening test for acoustic neuroma, but its apparent sensitivity has fallen as the ability to image smaller acoustic neuromas has improved. Fast spin echo magnetic resonance imaging techniques without gadolinium have been shown to be as effective in the detection of acoustic neuroma as contrast‐enhanced magnetic resonance imaging. Limited nonenhanced fast spin echo magnetic resonance imaging now provides an inexpensive alternative for high‐resolution imaging of the internal auditory canal and cerebellopontine angle. Fast spin echo magnetic resonance imaging can now be done at a cost approximating auditory brain stem response testing while providing the anatomic information of contrast‐enhanced magnetic resonance imaging. Cost analysis was done in the cases of 58 patients with sudden sensorineural hearing loss by comparing the costs for routine workup and screening of acoustic neuroma with the cost of fast spin echo magnetic resonance imaging with the use of screening protocols based on literature review. The potential cost savings of evaluating patients with sudden sensorineural hearing loss with fast spin echo magnetic resonance imaging for acoustic neuroma was substantial, with a 54% reduction in screening costs. In an era of medical economic scrutiny, fast spin echo magnetic resonance imaging has become the most cost‐effective method to screen suspected cases of acoustic tumors at our institution by improving existing technology while reducing the cost of providing that technology and eliminating charges for impedance audiometry, auditory brain stem response testing, and contrast‐enhanced magnetic resonance imaging.
Revision stapedectomy for incus erosion: Long‐term hearing
Authors: Krieger Lawrence W. , Lippy William H. , Schuring Arnold G. , Rizer Franklin M.
Published: November 2005

One of the most common ossicular problems in revision stapedectomy is the eroded incus. Revision surgery has been reported as successful in 70% to 80% of cases at 1 year. Little is written about long‐term results or the association of erosion with various prostheses. We evaluated 83 cases from 1 to 20 years, including multiple revisions. In 23 cases the erosion was seen at initial stapedectomy. Surgery was performed with the patient under local anesthesia, with the use of the Lippy modified prosthesis. Initial success was seen in 72% (41/57), satisfactory results in 90%, no change in 5%, and none worse. At 10 years, success had declined to 50% (7 of 14), with 80% satisfactory. The numbers for multiple revisions were lower. Success in nonrevision cases was 90% (21 of 23), dropping to 86% at 10 years, with satisfactory results in 100%. The type of prosthesis associated with erosion was a crimped wire in 34% (24 of 70), a plastic strut in 23%, and a Robinsion prosthesis in 17%. We conclude that the risk of incus erosion appears less with the Robinson prosthesis. The Lippy modified prosthesis yields good long‐term results, particularly when erosion is seen at initial stapedectomy. Results worsen with subsequent revision.
Isolated mucoepidermoid carcinoma in the neck
Authors: Wani Manish K. , Robbins K. Thomas , Wong Frank S. H. , Stiles Todd E.
Published: November 2005

Mucoepidermoid carcinoma is a common type of salivary gland malignancy with metastasis to the cervical lymph nodes occurring in up to 29% of patients.1 We describe three patients presenting with isolated mucoepidermoid carcinoma in a cervical lymph node without an obvious primary site of origin.
Otolaryngologic manifestations of acquired syphilis
Authors: Kleidermacher Paul , Vito Kenneth J. , Strome Marshall
Published: November 2005

Patients with syphilis may go to an otolaryngologist for their initial evaluation. Given that the incidence of syphilis is increasing, otolaryngologists should be aware of the various presenting signs and symptoms. We describe here two patients who had oral manifestations of syphilis at presentation and review the natural history of the disease and the associated diagnostic and treatment options.
Differential expression of the murine Ly‐6A/E antigen homolog of human squamous cell carcinoma antigen E48 during malignant transformation and tumor progression of squamous cell carcinoma line Pam 212
Authors: Kato Taiji , Dong Gang , Loukinova Elena , Chen Zhong , Waes Carter Van
Published: November 2005

The mRNA differential display method detected increased expression of the mRNA of an immune recognition antigen known as Ly‐6A/E after malignant transformation of the murine squamous cell carcinoma line Pam 212. Subsequent loss of expression of Ly‐6A/E occurred with metastatic tumor progression of Pam in vivo. Ly‐6 molecules have been implicated in immune cell recognition and signal transduction and are homologous to the human E48 SCC antigen that has been shown to be involved in cell‐cell recognition. These observations suggest that loss of Ly‐6A/E antigen may contribute to tumor progression and metastasis of squamous cell carcinoma through decreased tumor‐lymphocyte or tumor‐tumor recognition.
Phonatory results after laser surgery for glottic carcinoma
Authors: Sittel Christian , Eckel Hans‐Edmund , Eschenburg Claudia
Published: November 2005

OBJECTIVE

To identify the influence of type and extent of surgery on postoperative voice parameters after endoscopic laser resection for glottic carcinoma.

SETTING AND DESIGN

A multidisciplinary university‐based head and neck cancer center. Objective and subjective measures of voice were correlated with type and extent of surgery following a standardized classification in a prospective study including 80 patients.

SUBJECTS AND METHOD

The postoperative mechanism of phonation was assessed by videostroboscopy 6 months after surgery at the earliest. A phonetogram was produced, and its area was calculated (relative phonetogram [RP]) in relation to a gender‐different normal phonetogram. Two speech therapists (ST) and a trained otolaryngologist (TO) rated each voice independently for communication ability in a grade from 1 (poor) to 5 (near normal).

RESULTS

After simple cordectomy the means were as follows: RP = 24.8%, TO = 3.26, and ST = 3.33. When the anterior commissure was completely preserved, mean results were better (RP = 34%, TO = 3.92, ST = 3.83). Results were worse after extended cordectomy (RP = 14.7%, TO = 2.82, ST = 3.00) and transglottic resection (RP = 13.7%, TO = 2.30, ST = 2.86) but were similar within these two groups. The parameters RP, TO, and ST do not differ significantly between the group who had speech therapy after surgery (n = 33) and the group who did not (n = 47). Voice production at glottic level yields better results for every parameter than supraglottic substitute phonation. The amount of tissue removed was less significant.

CONCLUSION

Postoperative phonatory results correlate with the postoperative mechanism of phonation. There is no linear correlation with the amount of tissue removed. Comparison of similar types of resection preservation of the anterior commissure plays a key role. From the data in this study, there is no evidence for a significant benefit from speech therapy. The parameter RP is an effective and relatively simple parameter to complete auditory voice assessment.
Kinetics of gentamicin uptake in the inner ear of Chinchilla langier after middle‐ear administration in a sustained‐release vehicle
Authors: Balough Ben J. , Hoffer Michael E. , Derin Wester , O'Leary Michael J. , Brooker Charles R. , Mark Goto
Published: November 2005

The search for a safe, effective treatment for the vertigo associated with Meniere's disease has long been an important topic in otolaryngology. In recent years many groups have begun using intratympanic gentamicin to treat this vertigo. Although reported cure rates are as high as 90%, many questions remain regarding this type of treatment. Current limitations are the necessity for repeated treatments and a lack of clear dosing guidelines. In addition, the gentamicin must be delivered in a manner that allows maximal vestibulotoxic effect without injury to hearing. Until investigators can control the exact amount of medicine that is placed in the ear and have an understanding of the kinetics of gentamicin absorption, adequate dosing guidelines will be difficult to establish, and therapy will continue to rely on empiric data. We describe the use of a fibrin‐based sustained‐release vehicle, impregnated with gentamicin, injected into the middle ear of chinchillas. This allows for a prolonged effect without repeated dosing. Using this model, we studied the absorption kinetics of gentamicin at time points ranging from 8 hours to 1 week after injection. We used our findings to create a kinetics curve of gentamicin absorption. We discuss the shape and characteristics of this kinetics curve and examine the effects of the fibrin‐based sustained‐release vehicle and gentamicin on the middle ear. We noted no absorption in the contralateral (untreated ear) or blood. Through better understanding of the actions of gentamicin in this animal model, we hope to facilitate safer use of intratympanic medicines in our patient population and initiate programs for the use of this sustained‐release vehicle in human beings.
Symptoms in early head and neck cancer: An inadequate indicator
Authors: Dolan Robert W. , Vaughan Charles W. , Nabil Fuleihan
Published: November 2005

Screening programs show promise in increasing the rate of early detection of head and neck cancers in high‐risk populations. Prout et al (Otolaryngol Head Neck Surg 1997;116:201–8) examined the usefulness of a large‐scale screening program for head and neck cancer in an inner city population by primary care physicians. Symptom assessment was based on the American Cancer Society's “Seven Warning Signs for Cancer,” (Cancer manual. 8th ed. Boston: American Cancer Society, Massachusetts Division; 1990. p. 40–64) 4 of which are relevant to the head and neck. However, these signs may be insufficient for detection of early head and neck cancer. We analyzed these and other typical symptoms to determine their role in early detection. Coincident medical problems, tobacco abuse, and alcohol abuse were also analyzed. Our findings indicate that no symptom or symptom complex is strongly correlated with early head and neck cancer for any subsite except the glottis. Symptom duration is an unreliable indicator of the duration of disease. However, patients under medical supervision are more likely to have their cancers detected early, supporting the value of surveillance by the primary care physician. The absence of definite early warning signs for most head and neck cancers suggests the need to develop essential screening criteria. Defining the population that is at high risk for head and neck cancer and subjecting it to an aggressive screening protocol is essential.
Ibuprofen for tonsillectomy pain in children: Efficacy and complications
Authors: Harley Earl H. , Dattolo Robert A.
Published: November 2005

We designed a prospective, randomized, double‐blind study to test the efficacy and safety of ibuprofen compared with acetaminophen with codeine for pediatric posttonsillectomy/adenotonsillectomy patients. Twenty‐seven children, aged 6 to 16 years, were enrolled. We collected information on pain control, return to normal sleep pattern, return to normal diet, and duration for which medication was required. Coagulation profiles were measured before surgery and on postoperative day 3. Acetaminophen with codeine was more effective in controlling pain on days 1 and 3 (p = 0.0475 and 0.0328, respectively). However, we detected no difference between the treatment groups (p = 0.2216) with regard to pain control on day 5. The ibuprofen group required medication for a longer period (p = 0.0464). We detected no statistically significant differences between groups with regard to return to normal diet (p = 0.2346) and return to normal sleep pattern (p = 0.9554). The postoperative hemorrhage rate was 0% in the acetaminophen‐with‐codeine group and 12.5% in the ibuprofen group. The ibuprofen group demonstrated a mean increase in bleeding time of 2.07 minutes on the third postoperative day (p = 0.0379). The mean change in postoperative bleeding time between the two groups was statistically significant (p = 0.0140). We found no statistically significant differences in prothrombin time and partial thromboplastin time between groups. On the basis of the findings of this pilot study, we conclude that acetaminophen with codeine is safer and more efficacious than ibuprofen in the management of posttonsillectomy/adenotonsillectomy pain in children.
Obstructive sleep apnea in women
Authors: Halvorson David J. , Porubsky Edward S.
Published: November 2005

Obstructive sleep apnea is a complex disorder characterized by periodic cessation of breathing during sleep. Classically, men exclusively have been evaluated for mode of presentation or associated morbidity that accompanies obstructive sleep apnea; minimal investigation has been undertaken with regard to the female population. Recent literature indicates that obstructive sleep apnea is much more prevalent in women than previously recognized and is increasingly underdiagnosed. We present a review of a large cohort of women with obstructive sleep apnea, with specific attention to presenting symptoms, coexisting medical problems, and surgical efficacy. The study group comprised 58 women with the diagnosis of obstructive sleep apnea; we analyzed the group for presentation, polysomnographic findings, and therapeutic management. We reviewed cases for medical management or surgical intervention. In the surgery group, each patient was evaluated with polysomnography before and after surgery. Significant coexisting medical problems were identified in both groups. We address the success of surgical intervention.
Pollutants in our water: Effects on human health and the environment
Authors: Hicks Julius N.
Published: November 2005

The American Academy of Otolaryngology–Head and Neck Surgery has concerns about the effects of our environment on human health. In this review we evaluate waterborne biologic organisms, microorganisms, and other disease‐causing agents that might pollute our drinking water. Next, we evaluate chemical toxins that might pollute our drinking water. Then we examine our drinking water and wastewater treatment systems. Finally, we discuss management strategies.
Prognostic factors in supraglottic laryngeal carcinoma
Authors: Carmelo Morales‐Angulo , Fernando Val‐Bernal , Luis Buelta , Fidel Fernandez , García ‐Castrillo , Julio Rama
Published: November 2005

We carried out a retrospective study of patients with supraglottic carcinomas who were treated surgically at the Marques de Valdecilla Hospital (Santander, Spain) between 1978 and 1987 and who were followed up for at least 5 years. The Kaplan‐Meier survival curves were calculated for 24 clinical, histologic, and morphometric parameters. Multivariate analysis was then performed by means of the Cox regression model. In the univariate analysis, survival was related to presence of capsule rupture of the involved lymph nodes (p= 0.00001), number of metastatic lymph nodes (p= 0.0002), postoperative TNM stage (p= 0.004), grade of cell differentiation (p= 0.001), presence of intratumoral necrosis (p= 0.01), and type of invasion (p= 0.04). The nuclear area did not have an influence on survival. Only the presence or absence of capsule rupture of the metastatic lymph nodes and the grade of cell differentiation were included in the final Cox model and proved to be parameters with independent prognostic significance. (Otolaryngol Head Neck Surg 1998;119:548–53.)
Dynamic modelling of a 3-DOF parallel manipulator using recursive matrix relations
Authors: Staicu Stefan , Zhang Dan , Rugescu Radu
Published: November 2005

In this paper, a simple and convenient method – Recursive Matrix method – is proposed for kinematic and dynamic analysis of all types of complex manipulators. After addressing the principle of the method, an example – a 3-DOF parallel manipulator with prismatic actuators – is demonstrated for the efficiency of the method in solving kinematic and dynamic problems of complex manipulators. With the inverse kinematic solutions, the inverse dynamic problem is solved with the virtual powers method. Matrix relations and graphs of the acting forces and powers for all actuators are analysis and determined. It is shown that the proposed method is an effective mean for kinematic and dynamic modelling of parallel mechanisms.
Effects of Inhibitors of Δ24(25)-Sterol Methyl Transferase on the Ultrastructure of Epimastigotes ofTrypanosoma cruzi
Authors: Braga Marina V. , Magaraci Filippo , Lorente Silvia Orenes , Gilbert Ian , de Souza Wanderley
Published: November 2005

Trypanosoma cruziis the ethiological agent of Chagas disease. New compounds are being developed based on the biosynthesis and function of sterols, becauseT. cruzihas a requirement for specific endogenous sterols for growth and survival. Sterol biosynthesis inhibitors (SBIs) are drugs commonly used against fungal diseases. These drugs act by depleting essential and specific membrane components and/or inducing the accumulation of toxic intermediary or lateral products of the biosynthetic pathway. In this work we present the effects of WSP488, WSP501, and WSP561, specific inhibitors of Δ24(25)-sterol methyl transferase, on the ultrastructure ofT. cruziepimastigotes. All three drugs inhibited parasite multiplication at low concentrations, with IC50values of 0.48, 0.44, and 0.48 μM, respectively, and induced marked morphological changes including (a) blockage of cell division; (b) swelling of the mitochondrion, with several projections and depressions; (c) swelling of the perinuclear space; (d) presence of autophagosomes and myelin-like figures; (e) enlargement of the flagellar pocket and of a cytoplasmic vacuole located in close association with the flagellar pocket; (f) detachment of the membrane of the cell body; and (g) formation of a vesicle at the surface of the parasite between the flagellar pocket and the cytostome. Our results show that these drugs are potentin vitroinhibitors of growth ofT. cruzi.
Interaction of Oxide Surfaces with Water: Environmental Transmission Electron Microscopy of MgO Hydroxylation
Authors: Gajdardziska-Josifovska Marija , Sharma Renu
Published: November 2005

Environmental transmission electron microscopy (ETEM) is opening an important window forin situstudies of interaction of water with oxides. Studies of MgO smoke nanocrystals under partial pressures of water ranging from 10 mTorr to 10 Torr found their {100} neutral surfaces to be extremely resistant to dissociative adsorption of water and hydroxylation, in agreement with recent theoretical predictions. ETEM observations of electron irradiation driven MgO smoke nanocrystal hydroxylation displayed the anticipated volume expansion, but revealed complex shape changes with elongations toward oxide corners. The reaction rate was found to increase with electron flux at constant water pressure.In situselected area diffraction studies of MgO single crystals showed that the hydroxide grows with its basal (0001) plane parallel to the polar MgO (111) planes. This is the same crystallographic relationship as in dehydroxylation experiments, but with four variants. Electron energy loss spectroscopy found oxygen K-edge changes consistent with bulk hydroxylation.
Ultrastructure, Histochemistry, and Mineralization Patterns in the Ecdysial Suture of the Blue Crab,Callinectes sapidus
Authors: Priester Carolina , Dillaman Richard M. , Gay D. Mark
Published: November 2005

The ecdysial suture is the region of the arthropod exoskeleton that splits to allow the animal to emerge during ecdysis. We examined the morphology and composition of the intermolt and premolt suture of the blue crab using light microscopy and scanning electron microscopy. The suture could not be identified by routine histological techniques; however 3 of 22 fluorescein isothiocyanate-labeled lectins tested (Lens culinarisagglutinin,Vicia fabaagglutinin, andPisum sativumagglutinin) differentiated the suture, binding more intensely to the suture exocuticle and less intensely to the suture endocuticle. Back-scattered electron (BSE) and secondary electron observations of fracture surfaces of intermolt cuticle showed less mineralized regions in the wedge-shaped suture as did BSE analysis of premolt and intermolt resin-embedded cuticle. The prism regions of the suture exocuticle were not calcified. X-ray microanalysis of both the endocuticle and exocuticle demonstrated that the suture was less calcified than the surrounding cuticle with significantly lower magnesium and phosphorus concentrations, potentially making its mineral more soluble. The presence or absence of a glycoprotein in the organic matrix, the extent and composition of the mineral deposited, and the thickness of the cuticle all likely contribute to the suture being removed by molting fluid, thereby ensuring successful ecdysis.
Characterization of Hydroxyapatite by Electron Microscopy
Authors: Rodríguez-Lugo V. , Hernández J. Sanchez , Arellano-Jimenez Ma. J. , Hernández-Tejeda P.H. , Recillas-Gispert S.
Published: November 2005

The obtention of hydroxyapatite (HAp) is reported using brushite
(CaHPO4·2H2O) and the skeleton of a starfish
(Mellita eduardobarrosoi sp. nov.), primarily composed of magnesian
calcite ((Ca,Mg)CO3) as precursors. Stoichiometric amounts of
both were reacted under hydrothermal conditions: a pressure of 5.8 MPa and
a temperature of 200°C for 2, 4, 6, 8, 10, and 20 h of reaction times.
The samples obtained were characterized by means of scanning electron
microscopy, X-ray diffraction, infrared spectroscopy, and transmission
electron microscopy. Two defined populations of HAp fibers were found: A
bundle of fibers 75 μm in length and 1–13 μm in diameter,
and a second bundle of fibers 5 μm in length and less than 0.5 μm
in diameter. Furthermore, an increase in HAp formation and a Ca/P
ratio as a function of reaction time were observed. The growth mechanism
of HAp is also discussed.
AES Investigation of Inhomogenous Metal-Insulator Samples
Authors: Dobos Gábor , Vida György , Tóth Zoltán , Josepovits Katalin
Published: November 2005

In this article, the secondary electron-emission properties of both
vertically and laterally inhomogeneous samples are discussed. To study the
effect of surface coverage, the total electron-emission yield of tungsten
and niobium samples was measured as a function of primary electron energy
and oxide thickness. A method is suggested to avoid charging difficulties
during AES measurements of samples that consist of both metal and various
insulator parts.
Inelastic Mean Free Path Data for Si Corrected for Surface
Excitation
Authors: Orosz Gábor Tamás , Gergely György , Gurbán Sándor , Menyhard Miklós , Jablonski Aleksander
Published: November 2005

Surface-sensitive electron spectroscopies, like Auger electron
spectroscopy, X-ray photoelectron spectroscopy and elastic peak electron
spectroscopy (EPES) are suitable techniques to investigate surfaces and
thin layers. A theoretical model for electron transport is needed to
process the observed electron spectra. Electron transport descriptions are
based on the differential elastic cross sections for the sample atoms and
the inelastic mean free path (IMFP) of backscattered electrons. An
electron impinging on the sample can lose energy either due to surface or
volume excitations. In the present work a Monte Carlo (MC) simulation of
the elastic peak of Si, Ag, Ni, Cu, and Au for surface analysis is
presented. The IMFP of Si was determined applying the EPES method. The
integrated elastic peak ratio of Si with the standard metal reference
samples corrected for surface excitation provided IMFP values of Si in the
energy range E = 0.2–2.0 keV. Experiments were made with
the ESA 31 HSA (ATOMKI) and with the DESA-100 (Staib) spectrometers.
Surface correction was based on the application of Chen's model and
material parameters. The Monte Carlo simulations of elastically
backscattered electron trajectories were made using new EPESWIN software
of Jablonski. An improvement of IMFP experimental results was achieved
applying the presented procedure.
Towards a benchmark for land surface models
Authors: Abramowitz Gab
Published: November 2005

This paper addresses the question of how well we should expect a land surface model to perform. A statistically‐based artificial neural network is used as a de facto land surface model and its results used to benchmark the performance of a traditional physically‐based land surface model. This provides us with a measure of land surface model performance relative to the information contained in the meteorological forcing about the surface fluxes. Further, it is a benchmark that is independent of the measure of model performance. The technique is used to benchmark three models at three observational sites, with results showing that for the most part, the models under‐utilise the information available to them. This suggests that there are considerable opportunities for model improvement.
Effects of cold microphysical processes on the surface precipitation variability of nonsquall tropical oceanic convection
Authors: Wang Jianzhong , Georgakakos Konstantine P.
Published: November 2005

The influence of cold microphysical processes on surface precipitation variability is investigated for a nonsquall cluster and a scattered convective event that occurred over the tropical Pacific Ocean during the KWAJEX Experiment period. The MM5 model high‐resolution simulations of surface rainfall and ice concentrations are validated with available data from the experiment in terms of the ability to reproduce the character of variability. The validated model is then used to perform a number of sensitivity analyses pertaining to the dependence of simulated surface precipitation on various microphysical factors associated with cold microphysical processes. It is found that the graupel‐related processes in the model microphysics scheme modify both the magnitude and the spatial variability of surface precipitation. The maximum precipitation simulated by the warm rain scheme is double the one simulated by including ice microphysics. The sizes of mean convective precipitation cells in the warm rain simulation are 48% and 41% larger than those in the ice microphysics simulation for the nonsquall and scattered convective events, respectively. Further investigation points to the different treatment of supercooled raindrops in these two microphysics schemes being responsible for significant differences in the simulated maximum precipitation and spatial variability for the two rain events. Dividing the simulated precipitation into convective and stratiform portions on the basis of simulated radar reflectivity shows that the nonsquall cluster produces more convective rainfall (68%) than the scattering convection event (46%). A microphysical diagnosis of the causes is performed for each event. The findings have significant implications for the vertical profiles of atmospheric heating in the tropics.
Present Status of Magnetic Resonance Imaging and Spectroscopy in Animal Stroke Models
Authors: Weber Ralph , Ramos-Cabrer Pedro , Hoehn Mathias
Published: November 2005

Magnetic resonance imaging (MRI) is based on a wide variety of physical parameters, which, in principle, can all influence the image contrast conditions. As these diverse variables are validated by independent physiological, metabolic, hemodynamic, and histological techniques, a physiological MRI evolves. This imaging modality has been successfully applied to experimental stroke studies, covering a broad range of raised questions. In the present review, we present an overview of possible physiological criteria to be studied by in vivo MRI and magnetic resonance spectroscopy, and critically analyze the present limits and future potential of the imaging technique for experimental stroke investigations. The documented applications cover the spectrum from morphological-structural details of the lesion to hemodynamic and metabolic alterations, inflammatory reaction, evaluation of thrombolytic treatment, studies on recovery of functional brain activation by functional MRI, and, finally, the most recent applications of exploring stem cells for regenerative therapy.
Five-nanometer thick silicon on insulator layer
Authors: Elmasry N. A. , Hunter M. , ElNaggar A. , Bedair S. M.
Published: November 2005

Silicon on insulator (SOI) has been achieved using epitaxially grown Si∕Y2O3∕Si structure. Silicon film as thin as 5nm was achieved. Pulsed laser deposition technique was used for the epitaxial deposition of both the Y2O3 and silicon. The growth conditions were adjusted to achieve two-dimensional growths of single crystal silicon films on Y2O3. No dislocations were observed in these silicon epitaxial films. This approach will allow the independent thickness control of both silicon and the oxide in the nanometer range. Si∕CeO2∕Si SOI structure was not as successful due to the formation of an amorphous oxide film at the interfaces.
Adsorption of semiflexible block copolymers on homogeneous surfaces
Authors: Cerdà J. J. , Sintes T. , Sumithra K.
Published: November 2005

We present the results of extensive numerical off-lattice Monte Carlo simulations of semiflexible block-copolymer chains adsorbed onto flat homogeneous surfaces. We have compared the behavior of several chain structures, such as homopolymers, diblocks, (AαBα) block copolymers, and random heteropolymers. In all the cases studied, we have found the adsorption process to be favored with an increase of the chain rigidity. Particularly, the adsorption of diblock structures becomes a two-step process characterized by two different adsorbing temperatures that depend on the chain stiffness κ, the chain length N, and the adsorbing energies ϵA and ϵB. This twofold adsorbing process changes to a single one for copolymers of reduced block size α. Each block of the stiff copolymer chain is found to satisfy the classical scaling laws for flexible chains, however, we found the scaling exponent ϕ to depend on the chain stiffness. The measurement of the radius of gyration exhibits a typical behavior of a polymer chain composed of N∕lp blobs whose persistence length follows lp∼(κ∕kBT)0.5 for large stiff chains.
Stochastic transition states: Reaction geometry amidst noise
Authors: Bartsch Thomas , Uzer T. , Hernandez Rigoberto
Published: November 2005

Classical transition state theory (TST) is the cornerstone of reaction-rate theory. It postulates a partition of phase space into reactant and product regions, which are separated by a dividing surface that reactive trajectories must cross. In order not to overestimate the reaction rate, the dynamics must be free of recrossings of the dividing surface. This no-recrossing rule is difficult (and sometimes impossible) to enforce, however, when a chemical reaction takes place in a fluctuating environment such as a liquid. High-accuracy approximations to the rate are well known when the solvent forces are treated using stochastic representations, though again, exact no-recrossing surfaces have not been available. To generalize the exact limit of TST to reactive systems driven by noise, we introduce a time-dependent dividing surface that is stochastically moving in phase space, such that it is crossed once and only once by each transition path.
On the connectivity of seams of conical intersection: Seam curvature
Authors: Yarkony David R.
Published: November 2005

The seam of conical intersection of two electronic states is said to be curved when the span of the basis vectors describing the branching plane varies along the seam. In this work degenerate perturbation theory is used to determine an approximately diabatic Hamiltonian that can reliably reproduce the potential-energy surfaces in the vicinity of a point of conical intersection. This Hamiltonian provides a rigorous description of seam curvature, and a means for obtaining the full (Nint−2)-dimensional seam of conical intersection connected to a point of conical intersection.