bluuebunny/crossref_metadata_2025 huggingface dataset:
Is the Recent Increasing Trend of Rainfall over Northeast Brazil Related to Sub-Saharan Drought?
Authors: Rao V. Brahmananda , Giarolla Emanuel , Kayano Mary T. , Franchito Sergio H.
Published: October 2006

In recent years, there has been an increase in rainfall over northeast Brazil (Nordeste), while over the sub-Saharan region there has been a drought. The correlation coefficients between the 11-yr running means of the rainfall series over the two regions are significant (at the 95% confidence level by a two-sided t test), suggesting that both trends are related. The rainfall variations over the two regions are connected to the position of the intertropical convergence zone (ITCZ) over the Atlantic. A more southward (northward) position of the ITCZ is favorable for higher than normal rainfall over Nordeste (sub-Sahara). The correlation coefficient between the position of the ITCZ over the Atlantic and the rainfall over Nordeste (sub-Sahara) is negative (positive) and highly significant, reaching values over 0.9. Thus, this study suggests that a more southward than normal location of the ITCZ in the Atlantic may be the cause for the recent increasing (decreasing) trend of rainfall over Nordeste (sub-Sahara).
Constraining Climate Sensitivity from the Seasonal Cycle in Surface Temperature
Authors: Knutti Reto , Meehl Gerald A. , Allen Myles R. , Stainforth David A.
Published: October 2006

The estimated range of climate sensitivity has remained unchanged for decades, resulting in large uncertainties in long-term projections of future climate under increased greenhouse gas concentrations. Here the multi-thousand-member ensemble of climate model simulations from the climateprediction.net project and a neural network are used to establish a relation between climate sensitivity and the amplitude of the seasonal cycle in regional temperature. Most models with high sensitivities are found to overestimate the seasonal cycle compared to observations. A probability density function for climate sensitivity is then calculated from the present-day seasonal cycle in reanalysis and instrumental datasets. Subject to a number of assumptions on the models and datasets used, it is found that climate sensitivity is very unlikely (5% probability) to be either below 1.5–2 K or above about 5–6.5 K, with the best agreement found for sensitivities between 3 and 3.5 K. This range is narrower than most probabilistic estimates derived from the observed twentieth-century warming. The current generation of general circulation models are within that range but do not sample the highest values.
Robustness of Tropospheric Temperature Trends from MSU Channels 2 and 4
Authors: Johanson Celeste M. , Fu Qiang
Published: October 2006

Tropospheric temperature trends based on Microwave Sounding Unit (MSU) channel 2 data are susceptible to contamination from strong stratospheric cooling. Recently, Fu et al. devised a method of removing the stratospheric contamination by linearly combining data from MSU channels 2 and 4. In this study the sensitivity of the weights of the two channels in the retrieval algorithm for the tropospheric temperatures to the choice of period of record used in the analysis and to the choice of training dataset is examined. The weights derived using monthly temperature anomalies are within about 10% of those obtained by Fu et al. irrespective of the choice of analysis period or training dataset. The trend errors in the retrieved global-mean tropospheric temperatures tested using two independent radiosonde datasets are less than about 0.01 K decade−1 for all time periods of 25 yr or longer with different starting and ending years during 1958–2004. It is found that the retrievals are more robust if they are interpreted in terms of the layer-mean temperature for the entire troposphere, rather than the mean of the 850–300-hPa layer. Because large spurious jumps remain in the reanalyses, especially prior to 1979, one should be cautious when using them as training datasets and in testing the trend errors.
Changes in Spread and Predictability Associated with ENSO in an Ensemble Coupled GCM
Authors: Wu Renguang , Kirtman Ben P.
Published: October 2006

The present study documents the influence of El Niño and La Niña events on the spread and predictability of rainfall, surface pressure, and 500-hPa geopotential height, and contrasts the relative contribution of signal and noise changes to the predictability change based on a long-term integration of an interactive ensemble coupled general circulation model. It is found that the pattern of the El Niño–Southern Oscillation (ENSO)-induced noise change for rainfall follows closely that of the corresponding signal change in most of the tropical regions. The noise for tropical Pacific surface pressure is larger (smaller) in regions of lower (higher) mean pressure. The ENSO-induced noise change for 500-hPa height displays smaller spatial scales compared to and has no systematic relationship with the signal change.

The predictability for tropical rainfall and surface pressure displays obvious contrasts between the summer and winter over the Bay of Bengal, the western North Pacific, and the tropical southwestern Indian Ocean. The predictability for tropical 500-hPa height is higher in boreal summer than in boreal winter. In the equatorial central Pacific, the predictability for rainfall is much higher in La Niña years than in El Niño years. This occurs because of a larger percent reduction in the amplitude of noise compared to the percent decrease in the magnitude of signal from El Niño to La Niña years. A consistent change is seen in the predictability for surface pressure near the date line. In the western North and South Pacific, the predictability for boreal winter rainfall is higher in El Niño years than in La Niña years. This is mainly due to a stronger signal in El Niño years compared to La Niña years. The predictability for 500-hPa height increases over most of the Tropics in El Niño years. Over western tropical Pacific–Australia and East Asia, the predictability for boreal winter surface pressure and 500-hPa height is higher in El Niño years than in La Niña years. The predictability change for 500-hPa height is primarily due to the signal change.
Relationship between Shortwave Cloud Radiative Forcing and Local Meteorological Variables Compared in Observations and Several Global Climate Models
Authors: Stowasser Markus , Hamilton Kevin
Published: October 2006

The relations between local monthly mean shortwave cloud radiative forcing and aspects of the resolved-scale meteorological fields are investigated in hindcast simulations performed with 12 of the global coupled models included in the model intercomparison conducted as part of the preparation for Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report (AR4). In particular, the connection of the cloud forcing over tropical and subtropical ocean areas with resolved midtropospheric vertical velocity and with lower-level relative humidity are investigated and compared among the models. The model results are also compared with observational determinations of the same relationships using satellite data for the cloud forcing and global reanalysis products for the vertical velocity and humidity fields. In the analysis the geographical variability in the long-term mean among all grid points and the interannual variability of the monthly mean at each grid point are considered separately. The shortwave cloud radiative feedback (SWCRF) plays a crucial role in determining the predicted response to large-scale climate forcing (such as from increased greenhouse gas concentrations), and it is thus important to test how the cloud representations in current climate models respond to unforced variability.

Overall there is considerable variation among the results for the various models, and all models show some substantial differences from the comparable observed results. The most notable deficiency is a weak representation of the cloud radiative response to variations in vertical velocity in cases of strong ascending or strong descending motions. While the models generally perform better in regimes with only modest upward or downward motions, even in these regimes there is considerable variation among the models in the dependence of SWCRF on vertical velocity. The largest differences between models and observations when SWCRF values are stratified by relative humidity are found in either very moist or very dry regimes. Thus, the largest errors in the model simulations of cloud forcing are prone to be in the western Pacific warm pool area, which is characterized by very moist strong upward currents, and in the rather dry regions where the flow is dominated by descending mean motions.
Modeling Northern Hemisphere Summer Heat Extreme Changes and Their Uncertainties Using a Physics Ensemble of Climate Sensitivity Experiments
Authors: Clark Robin T. , Brown Simon J. , Murphy James M.
Published: October 2006

Changes in extreme daily temperature events are examined using a perturbed physics ensemble of global model simulations under present-day and doubled CO2 climates where ensemble members differ in their representation of various physical processes. Modeling uncertainties are quantified by varying poorly constrained model parameters that control atmospheric processes and feedbacks and analyzing the ensemble spread of simulated changes. In general, uncertainty is up to 50% of projected changes in extreme heat events of the type that occur only once per year.

Large changes are seen in distributions of daily maximum temperatures for June, July, and August with significant shifts to warmer conditions. Changes in extremely hot days are shown to be significantly larger than changes in mean values in some regions. The intensity, duration, and frequency of summer heat waves are expected to be substantially greater over all continents. The largest changes are found over Europe, North and South America, and East Asia. Reductions in soil moisture, number of wet days, and nocturnal cooling are identified as significant factors responsible for the changes.

Although uncertainty associated with the magnitude of expected changes is large in places, it does not bring into question the sign or nature of the projected changes. Even with the most conservative simulations, hot extreme events are still expected to substantially increase in intensity, duration, and frequency. This ensemble, however, does not represent the full range of uncertainty associated with future projections; for example, the effects of multiple parameter perturbations are neglected, as are the effects of structural changes to the basic nature of the parameterization schemes in the model.
Formation of CdSe Nanorod-assembled Microtubes in an Ethanolamine–PEG Solution
Authors: Fan Hai , Zhang Yuanguang , Liang Jianbo , Xi Baojuan , Luo Linbao , Qian Yitai
Published: October 2006

A large number of CdSe nanorod-assembled microtubes are prepared via a hydrothermal method in an ethanolamine–PEG solution. The tubes with inner diameters of 900 nm and lengths of 5–50 μm are composed of well-aligned nanorods around 300-nm long. It was found that both the solvent ethanolamine and surfactant PEG-20000 play a key role in the formation of nanorod-assembled microtubes. Ethanolamine as a mild reducing agent was used to reduce SeO2 to produce Se2−. The optimal conditions to produce CdSe microtubes are that the volume ratio of ethanolamine to water is 1:4 and that the quantity of PEG is 3.0 g. The possible formation mechanism of CdSe microtubes is also discussed.
An Efficient Ultrasound-enhanced Controllable Release of Biologically Active Trace Elements on Bioactive Silica-gel-based Material
Authors: Gou Zhongru , Weng Wenjian , Du Piyi , Han Gaorong
Published: October 2006

The multilayered Silica@Zn–Sr@Silica nanospheres were fabricated by a layer-by-layer (LbL) assembly route, and controlled release of active trace ions can be enhanced by low-frequency ultrasound, which is potentially advantageous not only to multicomponent administrating but also to elicit synergistic effect for promoting tissue regeneration combined the trace ion activity with ultrasound physical stimulus.
Electrochemical Detection of Short-lived Species Produced by Dye Sensitization Using TiO2/Au Mosaic Electrode Array
Authors: Harada Masahiro , Matsumoto Futoshi , Nishio Kazuyuki , Masuda Hideki
Published: October 2006

Short-lived species of superoxide ion (O2−) produced by dye sensitization on dye (Rhodamine B: Rh-B)/TiO2 disks under irradiation were studied using a TiO2/Au mosaic electrode array. The oxidation current at the Au electrodes was found to increase upon irradiation of Rh-B on the TiO2 disks in an air-saturated neutral aqueous solution, indicating the detection of reaction products. The main reaction products were identified to be O2− by adding superoxide dismutase (SOD) to the solution, which rapidly decomposed O2− in the solution.
Giant Spherulite Formation in Amorphous Polyanion Membrane by Photopolymerization on Gelatin Matrix
Authors: Yao Bo-long , Song Hong-chang , Lu Lu-de , Chen Ming-qing , Kaneko Tatsuo , Akashi Mitsuru
Published: October 2006

In-bulk photopolymerization of 2-acylamido-2-methylpropanesulphonic acid (AMPS) on gelatin matrix was made by ultraviolet irradiation at room temperature to form the crystalline and flexible membranes with giant spherulites (maximal radius: 2.2 cm). Number- and weight-average molecular weights of PAMPS were 79,500 and 138,000, respectively. The melting point of the membrane was around 200 °C. The giant spherulite formation was discussed on the basis of the PAMPS chain formation and PAMPS/gelatin complexation.
Photoluminescent Surfactants: Mesostructured Organosilica Nanocomposites via Evaporation-induced Self Assembly (EISA)
Authors: Abdul Wahab M , Sellinger Alan
Published: October 2006

Two new photoluminescent (PL) surfactants consisting of hydrophobic/PL diphenylpyreneamine chromophores and hydrophilic oligo(ethylene glycol) segments have been synthesized and characterized. The PL surfactants induce the molecular self-assembly of hydrolyzed 1,2-bis(triethoxysilyl)ethane (BTSE) via evaporation induced self assembly (EISA) under mildly acidic conditions into PL mesostructured nanocomposites. The mesostructure forming capability for both PL surfactants were confirmed by XRD. PL spectra of the final functionalized nanocomposites suggest that the PL surfactants are confined within the nanometer regime of the rigid organosilica matrix.
Telepsychiatry improves paediatric behavioural health care in rural communities
Authors: Sulzbacher Stephen , Vallin Thomas , Waetzig Elizabeth Z
Published: October 2006

In the US, children with special health care needs are underserved by both the medical and educational systems. This problem is especially serious in rural states. Telemedicine is a technique that can reduce these gaps in service and help connect the two systems. The technology required has become cheaper and more accessible. Progress on reimbursement for such services has also been made. For some years, we have provided telepsychiatry for children in Washington State using videoconferencing. Interviews with families and service providers were conducted in Washington and Missouri. Some parents reported that their child actually preferred telepsychiatry to conventional consultation. The telepsychiatry service model was built on the existing system of outreach clinics, thus involving specialists who were familiar with the community and who were known and trusted by the community. Before starting, we ensured that all relevant service delivery agencies and providers were comfortable about using videoconferencing as a method of service delivery. In the 18-month period ending in March 2003, three providers in Seattle saw 159 patients by telepsychiatry and 210 patients face-to-face at the hospital clinic. The main barrier to further growth of the telepsychiatry service is the absence of reimbursement for telepsychiatry.
Defining the needs of a telemedicine service
Authors: Doolittle Gary C , Spaulding Ryan J
Published: October 2006

While telemedicine programme objectives, technologies and even philosophies will differ, certain common factors that enhance programme success can be identified. For example, a programme design which is driven by technological imperatives is likely to fail. It must also be recognized that telemedicine programmes cannot force remote sites to use their services. Thus developers must assess the needs for the proposed telemedicine service from a clinical, economic and technical perspective. From a clinical perspective, it is important to remember that certain clinical services can be provided via telemedicine while others cannot. Programme developers must recognize the significant role of the remote team in sustaining services; the on-site presenter is essential for the successful practice of telemedicine. Evaluating a telemedicine programme should be viewed as an integral step in its design and implementation. One site may define effectiveness in terms of access to services while another may measure success by cost savings. The success of future telemedicine programmes will be strongly related to their ability to recognize that they should be used to enhance current health-care delivery rather than to replace it.
Patient–nurse–doctor interaction in general practice teleconsultations – a qualitative analysis
Authors: Torppa Martina A , Timonen Olavi , Keinänen-Kiukaanniemi Sirkka , Larivaara Pekka , Leiman Mikael
Published: October 2006

We analysed the interaction in doctor–nurse–patient teleconsultations in primary care. A qualitative analysis was performed of 30 primary care teleconsultations in northeastern Finland. The male doctor was the same in all consultations. One of the trained nurses appeared in 27 consultations. The analysis followed the methodological principles of the grounded theory approach. The interaction in the doctor–nurse–patient triad was complex. The doctor had to concentrate on many things at the same time and undivided attention to the patient was not always possible. The nurse assumed an active role and was a facilitator of the interaction, an advocate for the patient, a secretary for the doctor and a mediator of the doctor's therapeutic influence. The patients frequently turned to the nurse for information. The role of interpersonal dynamics in telemedical encounters is important. Both the doctor and the nurse need to learn new skills to perform teleconsultations jointly.
An Economic Analysis of Interconnection Arrangements Between Internet Backbone Providers
Authors: Tan Yong , Chiang I. Robert , Mookerjee Vijay S.
Published: October 2006

Transit and peering arrangements among Internet backbone providers (IBPs) are essential for the global delivery of communication services on the Internet. In addition, to support delay-sensitive applications (e.g., streaming and multimedia applications) it is important for IBPs to maintain high service quality even if the network is congested. One promising approach is to establish interconnection agreements among providers to dynamically trade network capacity. To make such interconnections possible in a competitive setting, we propose a pricing scheme that considers factors such as network utilization, link capacity, and the cost structure of the interconnecting participants. Our analyses show that the common sender keeps all (SKA) mode of settlement does not provide adequate incentives for collaboration; rather, the provider that delivers the packets should be suitably compensated at an equilibrium price. Two price equilibria are identified: The first favors slower IBPs, whereas the other is congestion based and can be more beneficial for faster IBPs. When cost asymmetries exist, the lower cost IBP needs to offer a price discount to induce participation. We show that a usage-based, utilization-adjusted interconnection agreement could align the costs and revenues of the providers while allowing them to meet more stringent quality of service requirements.
Performance Analysis and Evaluation of Assemble-to-Order Systems with Stochastic Sequential Lead Times
Authors: Zhao Yao , Simchi-Levi David
Published: October 2006

We consider the multiproduct and multicomponent assemble-to-order (ATO) systems where the replenishment lead times of the components are stochastic, sequential, and independent of the system state. The component inventories are either controlled by the continuous-time base-stock policies, namely, a base-stock ATO system, or by the continuous-time batch-ordering policies, namely, a batch-ordering ATO system. This paper develops the following results: First, for a base-stock ATO system with a single end product and renewal demand arrivals, we characterize the probability distribution of the delivery lead time, i.e., the time it takes to satisfy a demand. The exact analysis allows us to provide simple proofs for the important system properties. Second, for a base-stock ATO system with multiple end products and demand following independent Poisson processes, we characterize the dependence among the stockout delays of the components. We show that a multiproduct ATO system can be decomposed into multiple single-product subsystems with each subsystem corresponding to one product. The analysis allows us to develop two numerical methods to evaluate the performance of the base-stock ATO systems of medium to large sizes. A hypothetical example inspired by a real-world problem is presented. Third, for a batch-ordering ATO system, we develop efficient numerical methods for performance evaluation based on Monte Carlo simulation. Given the sample size, the number of products, and the reorder points, the computational complexity of the methods is no more than that of sorting a set of real numbers, where the set size equals to the sum of the batch sizes of all components. Finally, we characterize the impact of the dependence among the components on various ATO systems, and discuss the limits of the approach.
The Network Packing Problem in Terrestrial Broadcasting
Authors: Mannino Carlo , Rossi Fabrizio , Smriglio Stefano
Published: October 2006

The introduction of digital terrestrial broadcasting all over Europe requires a complete and challenging replanning of in-place analog systems. However, an abrupt migration of resources (transmitters and frequencies) from analog to digital networks cannot be accomplished because the analog services must be preserved temporarily. Hence, a multiobjective problem arises, in which several networks sharing a common set of resources have to be designed. This problem is referred to as the network packing problem. In Italy, this problem is particularly challenging because of a large number of transmitters, orographical features, and strict requirements imposed by Italian law. In this paper, we report our experience in developing solution methods at the major Italian broadcaster Radiotelevisione Italiana (RAI S.p.A.). We propose a two-stage heuristic. In the first stage, emission powers are assigned to each network separately. In the second stage, frequencies are assigned to all networks so as to minimize the loss from mutual interference. A software tool incorporating our methodology is currently in use at RAI to help discover and select high-quality alternatives for the deployment of digital equipment.
War surgery: Plastic operations of the face by means of fat grafts.
Authors: Roy J. N.
Published: October 2006

(Original Communications arc received with the understanding that they arc contributed exclusively to The Laryngoscope.)
Results obtained from one year's use of the audiometer in the otological clinic
Authors: Deaan L. W. , Bunch M. R. C. C.
Published: October 2006

(Original Communications are received with the understanding that they arc contributed exclusively to The Laryngoscope.)
Lingual thyroid
Authors: Buckman Lewis T.
Published: October 2006

The purpose of the thesis is to present an analysis of the cases of lingual thyroid or goitre reported to date, together with a citation of representative articles dealing with the embryology, the anatopathologic features, and the treatment of the condition. Finally is added a personal case with clinical history and photomicrographs of the sections from the tumor.
Tuberculosis associated with esophageal obstruction
Authors: Mosher Harris P.
Published: October 2006

The purpose of this paper is to report three cases of tuberculosis, two being of the chest and one of the abdomen, all three associated with obstruction at the terminal portion of the esophagus. Also, I wish to put on record the autopsy findings in the esophagus of a patient who died of pulmonary tuberculosis. The central portion of this esophagus for some five inches showed a moderate spindle‐shaped dilatation with marked thinning of the esophageal wall. Above and below the thin portion the musculature was of normal thickness. Small glands about the size of half a pea (3‐4 mm.) were found at the top, the bottom and the middle of the specimen adherent to the esophageal wall. These showed giant cells and tubercles. Vertical rougae were present at the top and at the bottom of the specimen where the thickness of the esophageal wall was normal. They were absent over the thin portion. The surface of this was perfectly smooth (see Figs. 1, 2, 3 and 4).

The three cases will be reported and discussed in the order just given.
Report of the chicago committee on otitic meningitis
Authors: Lewy Alfred , Hagens Elmer W.
Published: October 2006

In considering the diagnosis of meningitis for the purpose of treatment, we are confronted with the fact, first, that it may be of nonsurgical type, meningococcic, tubercular, influenzal, aseptic lymphogenous, or due to encephalitis or neoplasm. Secondly, if associated with a discharging ear, in which event, unless promptly proved otherwise, we assume for purposes of treatment that the suppurating ear is causative, we still do not know whether the meningitis is generalized (by which I mean that viable organisms may be cultured from the spinal fluid), or still localized and secondary to sinus thrombosis, extradural abscess or brain abscess, or merely so‐called meningismus (a term that I deplore), thus offering hope for successful surgery. We, therefore, recommend the following procedure:
Principles of therapy in otitis externa
Authors: Mclaurin J. W.
Published: October 2006

The treatment of otitis externa should be a matter of principles rather than of the use of special agents. Once principles are established and understood, other therapeutic details fall into their proper relationship. The best results are secured by otologists who limit themselves to a few agents, select them because of their antibacterial or fungicidal effects, employ them for as brief a period as the necessities of the case permit, and supplement them by thorough cleansing of the external auditory canal and by measures for the relief of discomfort
Are surgical experiments on human subjects necessary?
Authors: Békésy G. V.
Published: October 2006

This paper does not contain anything new, it only analyzes the scientific value of surgical experiments done on human beings versus animal experiments. In my opinion the simple fact that in animal experiments we start from a well defined healthy specimen results in more reliable experiments than those done on patients; furthermore, in experiments on patients we have simultaneously to take into account two different goals: 1. to cure the patient; 2. to acquire the scientific data. This double aim may present a handicap. As an example I tried to illustrate why animal experiments are of great importance in the case of otosclerosis surgery.
Cerebrospinal otorrhea and recurring meningitis: Report of three cases
Authors: Harris Herbert H.
Published: October 2006

Recurrent attacks of meningitis occurring independent of a systemic bacterial infection should be considered as a cerebrospinal leak either otorrhea or rhinorrhea. Three cases each with a different cause were diagnosed chiefly on the basis of the history and a bulging noninflammatory eardrum. Subsequent use of fluorescein intrathecally not only helped to confirm the diagnosis but was very useful at surgery in locating the leak in the dura of the oval window of the ear.

Many materials have been used but autogenous temporal fascia or fascia lata seemed to be most effective in these cases. The sandwiching of the dura between two pieces of fascia is not only realistic but was found to be very effective. One piece of fascia between the arachnoid and dura and another between the dura and bone give a tight seal.
Head and neck manifestations of histiocytic medullary reticulosis
Authors: Kornblut Alan D. , Gadek James E. , Fauci Anthony S. , Wolff Sheldon M.
Published: October 2006

Histiocytic medullary reticulosis represents a proliferation of malignant histiocytes which produce pancytopenia through marrow involvement and the phagocytosis of granulocytes, leukocytes and platelets. The disease is typically characterized by a fulminant febrile course which results in death from a variety of complications due to pancytopenia or intercurrent infections. Its diagnosis is based on bone marrow aspiration or tissue section in which large histiocytes can be demonstrated phagocytizing red or white blood cells and platelets. Therapy has included irradiation, steroids, antibiotics, antimetabolites, and the like, but with poor results.

Two patients with head and neck manifestations of histiocytic medullary reticulosis are described in detail. It is felt that refinements in diagnosis must still be made, since any patient survival may well be predicated by the early initiation of aggressive cytotoxic therapy.
O.P.S.C.: Improving delivery of otolaryngological surgical care
Authors: Bailey H. A. Ted , Pappas James J. , Gay Ellery C.
Published: October 2006

Results of over two years' experience with an outpatient surgical center within a private otolaryngology clinic have demonstrated several advantages. Discussed herein are the history of outpatient surgical centers, and the development of our within clinic O.P.S.C. (Outpatient Surgery Center). Developmental stages described include investigation of liability exposure, securing state health department approval, enactment of state legislation, staffing, equipment, and obtaining third party carrier approval. Advantages to the patient, otolaryngologist, community, and third party carriers are enumerated. Statistics regarding types and numbers of procedures performed and types of anesthesia used are included. Experience with the O.P.S.C. indicates that it is a means of improving the delivery of otolaryngological surgical care.
Intramural diverticulosis of the esophagus
Authors: Van Overbeek Jos J.M. , Edens Enje T H. , Göukemeijer Jan D. M. , Bröuker Frits H. L.
Published: October 2006

A description is given of the etiology and pathology of intramural esophageal diverticulosis as so far discussed in the literature. In view of the course and the clinical findings in two young patients in whom this diagnosis was established, it is suggested that intramural diverticulosis develops as a result of a developmental disorder in the autonomic nervous system.
Efficacy of preoperative laryngogram for localization of the ventricle at the anterior commissure
Authors: Tokita Nobuhiro , Daly John F.
Published: October 2006

The localization of the ventricle exactly above the anterior commissure of the vocal cords is important in performing supraglottic laryngectomy. The lateral projections of pre‐operative laryngograms are examined and the following two dimensions are measured on the film: (1) distance between the bottom of the thyroid notch and the inferior border of the thyroid cartilage and (2) distance between the anterior part of the ventricle and the inferior border. The ratio of these two distances is obtained and is designated as distance ratio (DR). The DR is similarly calculated from the actual measurements of the laryngeal specimens and is compared with the DR based on the laryngograms. Differences between these two DR's are nonsignificant (0.5 <p <0.6). Also, there is a high degree of relationship between these two DR's (P <0.001). Thus, the DR based on the laryngogram is an accurate index to determine the level of the ventricle just above the anterior commissure in performing a transection of the thyroid cartilage. When the thyroid cartilage is exposed completely during surgery a measurement between the bottom of the thyroid notch and the inferior border is made. Actual distance between the inferior border and the anterior part of the ventricle can be calculated by the DR obtained from the preoperative laryngogram. This method ensures that neither anterior commissure nor pre‐epiglottic space is violated when the thyroid cartilage is transected.
Mediastinal goiter and superior vena cava syndrome
Authors: Steenerson Ronald Leif , Barton Richard Thomas
Published: October 2006

Mediastinal goiter as a cause of superior vena cava syndrome and tracheal compression is rare. A case is presented, the literature is reviewed and the otolaryngologic implications are emphasized.
Symposium: Adjuvant cancer therapy of head and neck tumors. Increased survival with surgery alone vs. Combined therapy
Authors: Schuller David E. , McGuirt W. Fred , Krause Charles J. , McCabe Brian F. , Pflug Brian K.
Published: October 2006

Recent investigations have questioned the efficacy of a combined therapy regimen with irradiation. The purpose of this study was to compare the survivals with surgery alone versus combined therapy (pre‐op irradiation) and to analyze any apparent differences to identify the source(s) of failure. Two and five‐year determinate survivals for this group were found to be significantly better for surgery alone. There is no instance where combination therapy is found to be statistically superior. An analysis of treatment failures showed that distant metastases occurred at a greater rate in the combined therapy patients than they did with those treated by surgery alone. The advisability of combined therapy using preoperative irradiation with its increased cost and morbidity to the patient is questioned if it does not improve survival over surgery used as a single modality.
Health care costs of laryngeal surgery
Authors: Thawley Stanley E. , Ogura Joseph H.
Published: October 2006

The total costs of various laryngeal surgeries were considered from initial visit through one year postoperatively. For the four most widely used procedures, average costs were: laryngoscopy with biopsy, $1,000.00; hemilaryngectomy, $5,035.00; total laryngectomy, $6,010.00; and supraglottic laryngectomy and neck dissection, $12,096.00. Most ancillary service charges decrease as length of hospitalization increases except for pharmacy and respiratory therapy. Physicians whose decisions affect health care should also take cognizance of health care costs.
Effect of prophylactic antibiotics in radical head and neck surgery
Authors: Goode Richard L. , Abramson Norton , Fee Willard E. , Levine Paul
Published: October 2006

One hundred major head and neck operations performed on 77 patients were evaluated regarding the effectiveness of an aminoglycoside and cephalosporin antibiotic combination given prophylactically to prevent postoperative infection. The postoperative infection incidence was 6%, significantly lower than that reported in similar series where no antibiotics were used. The addition of the aminoglycoside did not appear to provide any additional protection compared with the use of cephalosporin alone.
Glottic reconstruction after near total laryngectomy
Authors: Tucker Harvey M. , Wood Benjamin G. , Levine Howard , Katz Robert
Published: October 2006

It is generally accepted that vertical partial laryngectomy can yield satisfactory cure rates in properly selected glottic carcinomas. Several authors have discussed different reconstructive techniques following extended vertical partial laryngectomy. These have included the use of stents, keels, various soft tissue “free” grafts, or muscle transplants. All of the above require prolonged tracheostomy and staged surgical procedures with the resultant upper airway sometimes being less than satisfactory.

Ten near total laryngectomies with epiglottic laryngoplasty have been performed by members of the Cleveland Clinic Department of Otolaryngology. Preserving only the body of one arytenoid and bilateral posterior thyroid alar struts, this technique permits the surgeon to successfully reconstruct the larynx, utilizing the epiglottis, as a one stage procedure. In general, this approach has resulted in prompt decannulation, an excellent upper airway, transient minor aspiration, and a good functional voice.
Impulsive and sinusoidal rotatory testing: A comparison with results of caloric testing
Authors: Baloh Robert W. , Sills Andrew W. , Honrubia Vicente
Published: October 2006

The usefulness of rotatory testing (impulsive and sinusoidal) as an indicator of impaired horizontal semicircular canal function was evaluated in 63 patients with unilateral and bilateral decreased caloric responses. The rotatory stimuli were precisely controlled over a large magnitude range and EOG recorded nystagmus responses were quantified using digital analysis techniques. Rotatory testing was consistently abnormal in patients with complete unilateral caloric paralyses but was normal in over one‐half of the patients with significant but less than complete unilateral caloric paralyses. The difference in maximum slow component velocity (SVMX) of induced nystagmus after the largest rotatory stimuli was the best indicator of unilateral impaired function. The patients with bilateral decreased caloric responses demonstrated three categories of rotatory response: 1. normal at all magnitudes of stimulation, 2. decreased but present after large magnitude stimuli, and 3. absent responses. It is concluded that although rotatory testing cannot replace caloric testing it can provide useful clinical information particularly in patients suspected of having bilateral vestibular disease.
Calibrated otoplasty
Authors: Smith Howard W.
Published: October 2006

The number of patients seeking correction of abnormally protruding ears has decreased in the past ten years because of changing hairstyles and concepts of body image. During the same time there has been an increase in the number of surgeon and surgical disciplines seeking to perform cosmetic otoplasty. To compensate for this deficit in total volume experience of the individual operator and to insure patients of a consistently acceptable cosmetic result, the concept of calibrated otoplasty is presented.

A study was made of a large number of ears which appeared to be esthetically in harmony with each other and with the side of the head. The distance relationships obtained from this study were applied not only to the creation of a new antihelix in the first ear but the degree to which the ear projects from the side of the head. At the conclusion of the first ear operation, careful measurements were taken for use in the second ear operation to insure its being as near normal as the first in form and degree of projection of the ear from the head. This concept of calibrated otoplasty is explained in detail with illustrations of all required measurements plus a series of surgical illustrations showing application of the technique.
Chronic candidiasis of the oral cavity and esophagus
Authors: Scherr Stuart A. , Nespeca John A. , Mikaelian Diran O. , Simonian Simon K.
Published: October 2006

Chronic candidiasis of the oral cavity and esophagus may present with a varying clinical picture. Three cases of this entity are presented. Infection occurs when the ecologic balance of normal flora and local factors are upset. Predisposing factors are listed. The different presentations, methods of evaluation, diagnosis, treatment alternatives, and immunologic applications are discussed. The problems of the chronic form of the disease, with it becoming deeply ingrained and recurrent, are stressed.
Transverse myelitis
Authors: Black Martin J. , Motaghedi Bijan , Robitaille Y.
Published: October 2006

Transverse myelitis is a known complication of radiation treatment for carcinoma of the head and neck. Otolaryngologists treat patients who receive radiotherapy and should be familiar with this complication.

During the past ten years there has been little or no mention made of this problem in the ENT literature. In a five year period, 1970 to 1975, 120 patients with head and neck cancer received radiation as part of their treatment in this hospital. A review of the records of these patients showed only two cases of myelitis, an incidence of about 2%.

This paper reviews the clinical syndrome; treatment and preventive measures are discussed and a survey of the literature is presented.
Paper patch repair of blast rupture of the tympanic membrane
Authors: Merwin Gerald E. , Boies Lawrence R.
Published: October 2006

An hotel explosion provided a need to treat five blast ruptured tympanic membranes in four firemen. Treatment consisted of early debridement and eversion of tympanic membrane flaps, Gelfoamr̀ to support these flaps and the placement of a paper patch for immediate closure of the drumhead defect and to provide a plane for epithelial growth. Pre and postsurgical audiometry demonstrate the immediate rehabilitation of conductive hearing in these patients. In all cases, immediate improvement in symptoms of aural fullness occurred. Tympanic membrane defects healed with minimal scarring in each case. Early debridement and paper patch repair are recommended for blast‐ruptured tympanic membranes.
Method of reconstruction or preservation of external auditory canal
Authors: Brockman Seymour J.
Published: October 2006

A brief summary of methods for reconstruction of the external auditory meatus for whatever reason, which have been recommended and used by a number of authors, is presented. Recurrence of the atretic problem occurs in a great percentage of individuals necessitating further attempts with an even greater failure rate.

In 13 cases with this problem, including congenital agenesis and/or atresia of the external auditory canal, exostectomies, and postsurgical stenosis, I have found that surgery with concomitant use of Merocel® wicks has given a “cure rate” of better than 90%. The first patient in this group has been followed for approximately two years.
Multichannel cochlear implants. Current status and future developments.
Authors: Michelson Robin P. , Schindler Robert A.
Published: October 2006

The University of Califorina, San Francisco has been active in the development of the multichannel cochlear implants for rehabilitation of total sensory deafness for the past 8 years. Patients implanted with experimental prototypes of the devices now in use have demonstrated that speech discrimination of 40% to 50% is possible for common everyday words and sentence material. These devices provide the same stimulation to each of the 8 bipolar pairs in the cochlea. They have an internal disconnect device which allows for replacement and upgrading of implanted receiver‐drivers without disturbing the scala tympani electrodes. Application of these devices in a larger deaf population is currently underway. The present report discusses the current status of implants and the future developments we feel are necessary to achieve improved speech discrimination.
Synchronous tuberculous involvement of both ears and the larynx in a patient with active pulmonary disease.
Authors: Anderson Craig W. , Stevens Michael H.
Published: October 2006

Since the incidence of pulmonary tuberculosis in the United States has declined dramatically, this diagnosis is often overlooked in the differential diagnosis of puzzling extrapulmonary disease. Recent publications emphasize that tuberculosis still needs to be considered in patients with chronic ear, nose, and throat complaints. A patient with tuberculosis involving both middle ears, the larynx, and the lung was correctly diagnosed only after a prolonged delay and several visits for chronically draining ears. As a result of the infection, subtotal bilateral tympanic membrane perforations and a profound hearing loss in both ears occurred. This case emphasizes the importance of a high index of suspicion in the evaluation and treatment of patients with symptoms of chronic disease who fail to respond to conventional therapy.
The effect of hemolyzed erythrocytes in the virulence of escherichia coli and of normal human oral flora in a mouse model.
Authors: Hoffman Henry T. , Davidson Terence M. , Fierer Joshua
Published: October 2006

Hemoglobin enhances the virulence of E. coli in the peritoneum. This study investigates the effect of blood on the virulence of E. coli and human oral anaerobes in the mouse neck. E. coli neck infectivity is significantly enhanced by blood. Oral anaerobic infections are not affected.
Indications and methods for performance of osteoplastic‐obliterative frontal sinusotomy with a description of a new method and some remarks upon the present state of the art of external frontal sinus surgery.
Authors: Guggenheim Paul
Published: October 2006

The Goodale‐Montgomery osteoplastic obliterative frontal sinusotomy has been the ultimate resource in America for the most difficult and intractable cases of frontal sinusitis. This operation respects the integrity of the frontal floor and is based upon a concept with which the author disagrees: that the frontal sinus may be treated as an entity quite separate from the ethmoid. Macbeth, who does not obliterate, avails himself of the excellent transfrontal approach to the ethmosphenoids, but breaches the frontal floor in so doing. American surgeons have not followed his lead. The pros and cons of obliteration are discussed, reviewing relevant clinical and experimental data. The author believes that Macbeth's operation is more rational and effective than Goodale's. In an effort to utilize it and have the benefits of an obliterative technique, he employs a composite fat‐fascia lata graft which prevents prolapse of fat down into nose and ethmoid. Three cases are briefly reported.
Surgery of the crooked nose.
Authors: Patterson Carl N.
Published: October 2006

The approach to surgery of the crooked nose has changed significantly in the last two decades due in a large measure to a better understanding of the growth, anatomy, and physiology of the nose.

The crooked nose often presents a challenging problem to the surgeon because of the multiplicity of deformities. In most cases, deformities of the external bony and cartilaginous nose, septum and turbinates must all be corrected simultaneously in order to obtain a satisfactory and lasting restoration of the nasal airway as well as of the external nasal configuration.
Head and neck involvement with malignant histiocytosis: Case report and literature review.
Authors: Luedke Susan L. , Luedke Dan W. , Mccabe Kevin
Published: October 2006

Malignant Histiocytosis (MH) is a disease being recognized with greater frequency. A case is reported together with a literature review to determine the frequency of this occurrence. Of the 108 case reports of MH reviewed, 43 (39%) had head and neck involvement described, with 22 (20%) having extranodal disease. Nine (40%) of the 22 cases with extra‐nodal disease had primary involvement with an apparent survival advantage over the 13 (60%) with secondary involvement (12 mo. vs. 4 mo.). Although those with primary involvement may have apparently localized disease, systemic spread was eventually described in all case reports. Based on the above, MH should be considered as a diagnostic possibility in patients with head and neck lesions, and when diagnosed, systemic therapy should be administered even when the disease is apparently localized.
Temporary artificial obstruction of the nose and changes in gas exchange in the blood.
Authors: Cvetnic Vladimir , Cvetnic Sopija , Grbac Ivan
Published: October 2006

A group of 31 subjects were subjected to complete artificial obstruction of the nose for a period of one hour. Their ages ranged from 14 to 16 years. Prior to the experiment the subjects were found to be healthy. During the nasal obstruction there was a fall in pO2 and an increase in pCO2 due to the hindered ventilation.