bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental genomics of "Haloquadratum walsbyi" in a saltern crystallizer indicates a large pool of accessory genes in an otherwise coherent species
Authors: Legault Boris A , Lopez-Lopez Arantxa , Alba-Casado Jose Carlos , Doolittle W Ford , Bolhuis Henk , Rodriguez-Valera Francisco , Papke R Thane
Published: September 2006

Background

Mature saturated brine (crystallizers) communities are largely dominated (>80% of cells) by the square halophilic archaeon "Haloquadratum walsbyi". The recent cultivation of the strain HBSQ001 and thesequencing of its genome allows comparison with the metagenome of this taxonomically simplified environment. Similar studies carried out in other extreme environments have revealed very little diversity in gene content among the cell lineages present.

Results

The metagenome of the microbial community of a crystallizer pond has been analyzed by end sequencing a 2000 clone fosmid library and comparing the sequences obtained with the genome sequence of "Haloquadratum walsbyi". The genome of the sequenced strain was retrieved nearly complete within this environmental DNA library. However, many ORF's that could be ascribed to the "Haloquadratum" metapopulation by common genome characteristics or scaffolding to the strain genome were not present in the specific sequenced isolate. Particularly, three regions of the sequenced genome were associated with multiple rearrangements and the presence of different genes from the metapopulation. Many transposition and phage related genes were found within this pool which, together with the associated atypical GC content in these areas, supports lateral gene transfer mediated by these elements as the most probable genetic cause of this variability. Additionally, these sequences were highly enriched in putative regulatory and signal transduction functions.

Conclusion

These results point to a large pan-genome (total gene repertoire of the genus/species) even in this highly specialized extremophile and at a single geographic location. The extensive gene repertoire is what might be expected of a population that exploits a diverse nutrient pool, resulting from the degradation of biomass produced at lower salinities.
Optimized detection of circulating anti-nuclear envelope autoantibodies by immunofluorescence
Authors: Tsiakalou Vagia , Tsangaridou Elena , Polioudaki Hara , Nifli Artemissia-Phoebe , Koulentaki Meri , Akoumianaki Tonia , Kouroumalis Elias , Castanas Elias , Theodoropoulos Panayiotis A
Published: September 2006

Background

Antinuclear antibodies are useful diagnostic tools in several autoimmune diseases. However, the routine detection of nuclear envelope autoantibodies using immunofluorescence (IF) is not always easy to perform in patients' sera because of the presence of autoantibodies to other nuclear and cytoplasmic components which could mask the characteristic rim-like pattern of nuclear envelope autoantibodies. This is particularly common in sera from patients with primary biliary cirrhosis (PBC), which generaly have high titres of anti-mitochondrial antibodies. Therefore, we have assayed a number of commercial slides and alternative fixation conditions to optimize the detection of anti-nuclear envelope antibodies (ANEA) in PBC sera.

Methods

We have explored the presence of ANEA in 33 sera from patients with established PBC using three different Hep2 commercial slides and home-made slides with HeLa and Hep2 cells fixed with methanol, ethanol, 1% or 4% formaldehyde.

Results

We observed that the IF pattern was related to the cell type used (Hep2 or HeLa), the manufacturer and the cell fixation scheme. When both cell lines were fixed with 1% formaldehyde, the intensity of the cytoplasmic staining was considerably decreased regardless to the serum sample, whereas the prevalence of cytoplasmic autoantibodies was significantly lowered, as compared to any of the Hep2 commercial slide and fixation used. In addition, the prevalence of ANEA was importantly increased in formaldehyde-fixed cells.

Conclusion

Immunofluorescence using appropriately fixed cells represent an easy, no time-consuming and low cost technique for the routine screening of sera for ANEA. Detection of ANEA is shown to be more efficient using formaldehyde-fixed cells instead of commercially available Hep2 cells.
Open access and beyond
Authors: Mathur Shawn , Schmidt Christian , Das Chhaya , Tucker Philip W
Published: September 2006

Uncensored exchange of scientific results hastens progress. Open Access does not stop at the removal of price and permission barriers; still, censorship and reading disabilities, to name a few, hamper access to information. Here, we invite the scientific community and the public to discuss new methods to distribute, store and manage literature in order to achieve unfettered access to literature.
Antiepileptic drugs and bone metabolism
Authors: Valsamis Helen A , Arora Surender K , Labban Barbara , McFarlane Samy I
Published: September 2006

Anti-epileptic medications encompass a wide range of drugs including anticonvulsants, benzodiazepines, enzyme inducers or inhibitors, with a variety effects, including induction of cytochrome P450 and other enzyme, which may lead to catabolism of vitamin D and hypocalcemia and other effects that may significantly effect the risk for low bone mass and fractures. With the current estimates of 50 million people worldwide with epilepsy together with the rapid increase in utilization of these medications for other indications, bone disease associated with the use of anti-epileptic medications is emerging as a serious health threat for millions of people. Nevertheless, it usually goes unrecognized and untreated. In this review we discuss the pathophysiologic mechanisms of bone disease associated with anti-epileptic use, including effect of anti-epileptic agents on bone turnover and fracture risk, highlighting various strategies for prevention of bone loss and associated fractures a rapidly increasing vulnerable population.
Decreases in procalcitonin and C-reactive protein are strong predictors of survival in ventilator-associated pneumonia
Authors: Seligman Renato , Meisner Michael , Lisboa Thiago C , Hertz Felipe T , Filippin Tania B , Fachel Jandyra MG , Teixeira Paulo JZ
Published: September 2006

Introduction

This study sought to assess the prognostic value of the kinetics of procalcitonin (PCT), C-reactive protein (CRP) and clinical scores (clinical pulmonary infection score (CPIS), Sequential Organ Failure Assessment (SOFA)) in the outcome of ventilator-associated pneumonia (VAP) at an early time point, when adequacy of antimicrobial treatment is evaluated.

Methods

This prospective observational cohort study was conducted in a teaching hospital. The subjects were 75 patients consecutively admitted to the intensive care unit from October 2003 to August 2005 who developed VAP. Patients were followed for 28 days after the diagnosis, when they were considered survivors. Patients who died before the 28th day were non-survivors. There were no interventions.

Results

PCT, CRP and SOFA score were determined on day 0 and day 4. Variables included in the univariable logistic regression model for survival were age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, decreasing ΔSOFA, decreasing ΔPCT and decreasing ΔCRP. Survival was directly related to decreasing ΔPCT with odds ratio (OR) = 5.67 (95% confidence interval 1.78 to 18.03), decreasing ΔCRP with OR = 3.78 (1.24 to 11.50), decreasing ΔSOFA with OR = 3.08 (1.02 to 9.26) and APACHE II score with OR = 0.92 (0.86 to 0.99). In a multivariable logistic regression model for survival, only decreasing ΔPCT with OR = 4.43 (1.08 to 18.18) and decreasing ΔCRP with OR = 7.40 (1.58 to 34.73) remained significant. Decreasing ΔCPIS was not related to survival (p = 0.59). There was a trend to correlate adequacy to survival. Fifty percent of the 20 patients treated with inadequate antibiotics and 65.5% of the 55 patients on adequate antibiotics survived (p = 0.29).

Conclusion

Measurement of PCT and CRP at onset and on the fourth day of treatment can predict survival of VAP patients. A decrease in either one of these marker values predicts survival.
Biological markers of lung injury before and after the institution of positive pressure ventilation in patients with acute lung injury
Authors: Cepkova Magda , Brady Sandra , Sapru Anil , Matthay Michael A , Church Gwynne
Published: September 2006

Background

Several biological markers of lung injury are predictors of morbidity and mortality in patients with acute lung injury (ALI). The low tidal volume lung-protective ventilation strategy is associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. The primary objective of this study was to test whether the institution of lung-protective positive pressure ventilation in spontaneously ventilating patients with ALI exacerbates pre-existing lung injury by using measurements of biomarkers of lung injury before and after intubation.

Materials and methods

A prospective observational cohort study was conducted in the intensive care unit of a tertiary care university hospital. Twenty-five intubated, mechanically ventilated patients with ALI were enrolled. Physiologic data and serum samples were collected within 6 hours before intubation and at two different time points within the first 24 hours after intubation to measure the concentration of interleukin (IL)-6, IL-8, intercellular adhesion molecule 1 (ICAM-1), and von Willebrand factor (vWF). The differences in biomarker levels before and after intubation were analysed using repeated measures analysis of variance and a paired t test with correction for multiple comparisons.

Results

Before endotracheal intubation, all of the biological markers (IL-8, IL-6, ICAM-1, and vWF) were elevated in the spontaneously breathing patients with ALI. After intubation and the institution of positive pressure ventilation (tidal volume 7 to 8 ml/kg per ideal body weight), none of the biological markers was significantly increased at either an early (3 ± 2 hours) or later (21 ± 5 hours) time point. However, the levels of IL-8 were significantly decreased at the later time point (21 ± 5 hours) after intubation. During the 24-hour period after intubation, the PaO2/FiO2 (partial pressure of arterial oxygen/fraction of the inspired oxygen) ratio significantly increased and the plateau airway pressure significantly decreased.

Conclusion

Levels of IL-8, IL-6, vWF, and ICAM-1 are elevated in spontaneously ventilating patients with ALI prior to endotracheal intubation. The institution of a lung-protective ventilation strategy with positive pressure ventilation does not further increase the levels of biological markers of lung injury. The results suggest that the institution of a lung-protective positive pressure ventilation strategy does not worsen the pre-existing lung injury in most patients with ALI.
Control of NK cell functions by CD4+CD25+ regulatory T cells
Authors: Ralainirina Natacha , Poli Aurélie , Michel Tatiana , Poos Linda , Andrès Emmanuel , Hentges François , Zimmer Jacques
Published: September 2006

Regulatory T cells (Treg) are key players in the maintenance of peripheral tolerance. As a result of suppressive effects on CD4+ and CD8+ effector T cells, Treg control the adaptive immune system and prevent autoimmunity. In addition, they inhibit B lymphocytes, dendritic cells, and monocytes/macrophages. It is interesting that several recent papers show that CD4+CD25+ Treg are also able to inhibit NK cells. Thus, Treg exert their control on immune responses from the onset (triggering of innate immune cells) to the effector phase of adaptive immunity (B and T cell-mediated responses). That Treg inhibit NK cells suggests that their uncontrolled activation might break self-tolerance and induce “innate” autoimmune pathology. Conversely, Treg-mediated suppression of NK cell functions might have negative effects, as these cells are important in defense against infections and cancer. It is conceivable that Treg might dampen efficient activation of NK cells in these diseases.
Pharmacodynamic Studies of Gefitinib in Tumor Biopsy Specimens From Patients With Advanced Gastric Carcinoma
Authors: Rojo Federico , Tabernero Josep , Albanell Joan , Van Cutsem Eric , Ohtsu Atsushi , Doi Toshihiko , Koizumi Wasaburo , Shirao Kuniaki , Takiuchi Hiroya , Cajal S. Ramon , Baselga José
Published: September 2006

Purpose

Epidermal growth factor receptor (EGFR) is highly expressed in some gastric cancers and is implicated in cancer cell growth and proliferation. The objective of this study was to assess the in situ biologic activity of the EGFR tyrosine kinase inhibitor gefitinib in gastric tumor samples in a phase II study.

Methods

Patients with previously treated stage IV adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to receive gefitinib (250 or 500 mg/d). Tumor biopsies, obtained at screening and on day 28 of treatment, were assessed for biomarker expression using immunohistochemistry and analysis of apoptosis.

Results

One hundred sixteen tumor samples from 70 patients were available, 70 were baseline and 46 were on-therapy biopsies. At baseline, levels of EGFR expression significantly correlated with levels of phosphorylated EGFR (pEGFR; P < .001) and Ki67 expression (P = .011), but not with phosphorylated mitogen-activated protein kinase (pMAPK). After gefitinib treatment, levels of pEGFR in tumor cells were significantly reduced (P = .001); this was not the case for pMAPK and phosphorylated Akt (pAkt). However, in some cases gefitinib inhibited pAkt and these tumors had enhanced apoptosis. Likewise, there was a significant correlation between increased exposure to geftinib and enhanced apoptosis.

Conclusion

Gefitinib reached the tumors at concentrations sufficient to inhibit EGFR activation in advanced gastric carcinoma patients, although this did not translate into clinical benefit. Overall, intratumoral phosphorylation of MAPK and Akt was not significantly inhibited by gefitinib. However, the finding that decreases in pAkt correlated with enhanced apoptosis deserves further exploration.
Prediction of Breast Tumor Progression by Integrity of Free Circulating DNA in Serum
Authors: Umetani Naoyuki , Giuliano Armando E. , Hiramatsu Suzanne H. , Amersi Farin , Nakagawa Taku , Martino Silvana , Hoon Dave S.B.
Published: September 2006

Purpose

Cell-free DNA circulating in serum is a candidate molecular biomarker for malignant tumors. Unlike uniformly truncated DNA released from apoptotic cells, DNA released from dead cancer cells varies in size. Serum DNA integrity, the ratio of longer fragments to total DNA, may be clinically useful for detecting breast cancer progression.

Patients and Methods

Serum samples from 51 healthy females and 83 females with primary breast cancers (eight American Joint Committee on Cancer stage 0, 24 stage I, 27 stage II, 21 stage III, and three stage IV) were assessed preoperatively. Serum DNA integrity was assessed by fragment length-dependent quantitative real-time polymerase chain reaction of ALU DNA repeats.

Results

Mean serum DNA integrity was significantly higher in patients with stage II, III, and IV breast cancers than in healthy females (P = .005, P < .0001, and P = .002, respectively). The receiver operating characteristic (ROC) curve for discriminating patients with stage II or more advanced breast cancers from healthy females had an area under the curve (AUC) of 0.79 (95% CI, 0.70 to 0.86). Mean serum DNA integrity was positively correlated to size of invasive cancers (r = 0.48; P < .0001) and significantly higher in the presence of lymphovascular invasion (LVI; 0.25 ± 0.02 v 0.17 ± 0.02; P < .0001) or lymph node (LN) metastasis (0.27 ± 0.02 v 0.14 ± 0.02; P < .0001). The ROC curve for discriminating LN metastasis had an AUC of 0.81 (95% CI, 0.72 to 0.89). Serum DNA integrity and LVI were significant for predicting LN metastasis in a multivariate analysis (P = .0002 and P < .0001, respectively).

Conclusion

Integrity of serum circulating DNA is a promising molecular biomarker for detecting breast cancer tumor progression and regional LN metastases.
High Expression of the ETS Transcription Factor ERG Predicts Adverse Outcome in Acute T-Lymphoblastic Leukemia in Adults
Authors: Baldus Claudia D. , Burmeister Thomas , Martus Peter , Schwartz Stefan , Gökbuget Nicola , Bloomfield Clara D. , Hoelzer Dieter , Thiel Eckhard , Hofmann Wolf K.
Published: September 2006

Purpose

In adult T-lymphoblastic leukemia (T-ALL) disease-free survival remains limited to 32% to 46%. The adverse prognosis in T-ALL has not been attributed to cytogenetic or molecular aberrations. We have determined the prognostic impact of the oncogenic transcription factor ERG in T-ALL.

Patients and Methods

ERG expression was analyzed by real-time polymerase chain reaction (PCR) in 105 adults with newly diagnosed T-ALL treated on the German ALL protocols. Patients were dichotomized at ERG′s median expression into low (n = 52) and high (n = 53) expressers. Homeobox (HOX) 11 and HOX11L2 expression was determined by real-time PCR.

Results

High ERG expressers compared with low ERG expressers had an inferior overall survival (OS, P = .02; 5-year OS: high ERG 26% v low ERG 58%) and relapse-free survival (RFS, P = .003; 5-year RFS: high ERG 34% v low ERG 72%). On multivariable analysis high ERG expression (P = .005), immunophenotypic subgroups (early v mature v thymic T-ALL; overall P = .04), HOX11L2 positivity (P = .055), and absence of HOX11 (P = .017) were independent adverse risk factors predicting RFS. Patients with high ERG expression had a hazard ratio (HR) for relapse of 3.2. Within the good prognostic subgroup of thymic T-ALL (n = 57), high ERG (HR, 4.1; P = .02) and presence of HOX11L2 (HR, 6.6; P = .008) were independent adverse factors for RFS.

Conclusion

High expression of ERG is an adverse risk factor in adult T-ALL. Within thymic T-ALL, otherwise classified as standard-risk, high ERG expression-identified patients that were four times more likely to fail long-term RFS. The prognostic impact of ERG may assist treatment stratification and suggest the need of alternative regimens.
Hyperinsulinemia, Impaired Glucose Tolerance, and Diabetes Mellitus in Survivors of Childhood Cancer: Prevalence and Risk Factors
Authors: Neville Kristen A. , Cohn Richard J. , Steinbeck Katharine S. , Johnston Karen , Walker Jan L.
Published: September 2006

Context: Hyperinsulinism and its associated metabolic abnormalities, including diabetes mellitus (DM), have been reported in long-term survivors of childhood cancer, mainly after bone marrow transplant (BMT); however, the predisposing factors are unclear, and early markers have not been identified.

Methods: The prevalence of overweight/obesity, abdominal adiposity and hyperinsulinemia (HI), impaired glucose tolerance (IGT), or DM was examined prospectively in 248 survivors of childhood cancer (36 prepubertal, 88 pubertal, and 124 adult subjects; 67 BMT) at a median of 12.9 yr (2.3–33.6) after diagnosis and compared with healthy controls. Potential risk factors for the development of HI, IGT, or DM were sought.

Results: Overweight/obesity was not increased when comparing subjects with controls; however, the prevalence of abdominal adiposity in prepubertal and pubertal subjects was roughly doubled (P ≤ 0.04). Fasting insulin concentrations were higher in prepubertal and pubertal subjects compared with their controls (P < 0.001) and were similar in adult and pubertal subjects. HI, IGT, or DM was detected in 39 of 212 (18%) pubertal or adult subjects (23 BMT). Ten of 88 (11%) pubertal and 14 of 124 (11%) adult subjects had IGT/DM (vs. 0 and 4.9% controls, respectively; P < 0.001). Total body irradiation, untreated hypogonadism, and abdominal adiposity emerged as independent risk factors for the development of HI, IGT, or DM in multivariate regression analysis.

Conclusions: The risk factors identified suggest the need for reconsideration of BMT protocols and regular screening of survivors. The increased prevalence of abdominal adiposity among prepubertal subjects, none of whom had developed HI/IGT/DM, suggests that a waist to height ratio greater than 0.5 has potential as a clinical screening tool.
Expression of HIF-1α, HIF-2α (EPAS1), and Their Target Genes in Paraganglioma and Pheochromocytoma with VHL and SDH Mutations
Authors: Pollard Patrick J. , El-Bahrawy Mona , Poulsom Richard , Elia George , Killick Pip , Kelly Gavin , Hunt Toby , Jeffery Rosemary , Seedhar Pooja , Barwell Julian , Latif Farida , Gleeson Michael J. , Hodgson Shirley V. , Stamp Gordon W. , Tomlinson Ian P. M. , Maher Eamonn R.
Published: September 2006

Context: Activation of the hypoxia-inducible transcription factors HIF-1 and HIF-2 and a HIF-independent defect in developmental apoptosis have been implicated in the pathogenesis of pheochromocytoma (PCC) associated with VHL, SDHB, and SDHD mutations.

Objective: Our objective was to compare protein (HIF-1α, EPAS1, SDHB, JunB, CCND1, CD34, CLU) and gene (VEGF, BNIP3) expression patterns in VHL and SDHB/D associated tumors.

Results: Overexpression of HIF-2 was relatively more common in VHL than SDHB/D PCC (12 of 13 vs. 14 of 20, P = 0.02), whereas nuclear HIF-1 staining was relatively more frequent in SDHB/D PCC (19 of 20 vs. 13 of 16, P = 0.04). In addition, CCND1 and VEGF expression (HIF-2 target genes) was significantly higher in VHL than in SDHB/D PCC. These findings suggest that VHL inactivation leads to preferential HIF-2 activation and CCND1 expression as described previously in VHL-defective renal cell carcinoma cell lines but not in other cell types. These similarities between the downstream consequences of VHL inactivation and HIF dysregulation in renal cell carcinoma and PCC may explain how inactivation of the ubiquitously expressed VHL protein results in susceptibility to specific tumor types. Both VHL and SDHB/D PCC demonstrated reduced CLU and SDHB expression. SDHB PCC are associated with a high risk of malignancy, and expression of (proapototic) BNIP3 was significantly lower in SDHB than VHL PCC.

Conclusion: Although inactivation of VHL and SDHB/D may disrupt similar HIF-dependent and HIF-independent signaling pathways, their effects on target gene expression are not identical, and this may explain the observed clinical differences in PCC and associated tumors seen with germline VHL and SDHB/D mutations.
ER stress-induced apoptosis and caspase-12 activation occurs downstream of mitochondrial apoptosis involving Apaf-1
Authors: Shiraishi Hiroshi , Okamoto Hideaki , Yoshimura Akihiko , Yoshida Hiroki
Published: September 2006

Accumulation of unfolded proteins induces endoplasmic reticulum (ER) stress. Excessive and prolonged stresses lead cells to apoptosis. However, the precise molecular mechanisms of ER stress-induced apoptosis have not been fully elucidated. We investigated the involvement of the apoptosome in ER stress-induced cell death pathway using mouse embryonic fibroblasts (MEFs) and mice deficient for Apaf-1. Apaf-1-deficient MEFs showed more resistance to ER stress-inducing reagents as compared with wild type cells. Despite comparable induction of ER stress in both wild type and Apaf-1-deficient cells, activation of caspase-3 was only observed in wild type, but not Apaf-1-deficient, MEFs. Under ER stress conditions, BAX translocated to mitochondria and cytochrome c was released from mitochondria. We also demonstrated that caspase-12 was processed downstream of Apaf-1 and caspase-3, and neither overexpression nor knockdown of caspase-12 affected susceptibility of the cells to ER stress-induced cell death. Furthermore, in the kidneys of Apaf-1-deficient mice, apoptosis induced by in vivo administration of tunicamycin was remarkably suppressed as compared with wild type mice. These data collectively demonstrated that Apaf-1 and the mitochondrial pathway of apoptosis play significant roles in ER stress-induced apoptosis.
Planned pre‐operative irradiation for carcinoma of the larynx and laryngopharynx treated by total and partial laryngectomy.
Authors: Biller Hugh F. , Ogura Joseph H. , Davis William H. , Powers William E.
Published: September 2006

Planned pre‐operative irradiation for large laryngeal and laryngopharyngeal cancers has been adopted by many surgeons.
Superiorly based pharyngeal flap.
Authors: Skolnik Emanuel M. , Saberman Mark N. , Meyers Robert M. , Ross Joel C.
Published: September 2006

Velopharyngeal incompetence may be either congenital or acquired in origin. Congenital defects not only exist as an obvious cleft in the palate but the incompetence may also be a result of more subtle defects such as submucous cleft, platybasia, congenital short palate, or cervical spine deformity. Acquired defects are usually more obvious. Postinflammatory or postirradiation cicatrization and defects after surgical resection are the usual causes, but palate paralysis secondary to neurologic disease and palatal incompetency following adenoidectomy, should also be considered.
Cervical vertigo.
Authors: Jongkees L. B. W.
Published: September 2006

It has been known for decades that movements of the neck can provoke eye movements. Barany1 and Voss2 demonstrated them in newborn children; de Kleyn,3 in rabbits. A sustained torsion of the neck in these circumstances leads to a sustained compensatory eye deviation interrupted by nystagmus beats. In mature humans, turning of the neck causes eye movements only in a patient whose eyes are closed or who are examined in the dark.4,5,6,7,8 Though the combination of compensatory eye movements and nystagmus is found again in this case, the sustained deviation of the eyeball during sustained deviated positions of the neck is not found. Not only neck torsion, but even torsion of the thorax or the pelvis in respect to the adjacent parts of the spine, suffices to elicit nystagmus,4,5 and it must be kept in mind that the angles over which neck, thorax or pelvis must be rotated in order to provoke eye movements need not be extreme. Rotations of 90° or even less, in general, suffice.
Meckel's cartilage remnant?
Authors: Zonis Richard D.
Published: September 2006

CASE REPORT. A 12‐year‐old, full blood Pima Indian boy was referred to the otology clinic of the Phoenix Indian Hospital complaining of “something in my ear” found on routine physical examination. The boy had no past or present symptoms related to either ear. On physical examination the right ear was normal. The left revealed a slender, firm, skin‐covered process extending from the anterior canal wall bulge, tapering to a narrow insertion on the malleus, just inferior to the short process (Fig. 1). The tympanic membrane was otherwise normal and moved well on pneumo‐massage. Audiogram was normal (Fig. 2), as were X‐rays of the mandible and temporo‐mandibular joints. Although the boy was asymptomatic, it was felt that the chance of difficulty with accumulation of debris medial to this process was sufficient to advise surgical removal. On December 27, 1967, under general anesthesia, the attachment to the malleus was severed with a sickle knife and the anomalous process removed with a curette. It was softer in consistency than expected. Pathologic examination revealed normal cartilage (Fig. 3). Postoperative course was uneventful. The tympanic membrane was not disturbed. Hearing was unchanged.
Delayed management of facial fractures
Authors: Bernstein Leslie
Published: September 2006

It is generally agreed that best results in the treatment of facial fractures may be expected if the reduction is done within the first few days after the injury; unfortunately, due to a number of factors, this is not always possible. Excluding inevitable delay associated with distance from a suitable medical unit, and failure of complete diagnosis and appreciation of the facial injury, the most frequent reasons for delaying the treatment of facial fractures are serious concomitant injuries which take precedence in management. The most common of these, and certainly the most serious, is a cerebral injury; yet, despite the fact that neurologic levels usually become stable within 10 days after injury, some of these accident victims continue to receive attention to their more obvious injuries, and repair of the facial skeleton is frequently postponed too long, and thus, for one reason or another, delay in specific treatment is not an uncommon sequence following admission to hospital.
Importance of vestibulography in the acoustic neurinoma test battery
Authors: Janeke Johan B. , Sommerville Suzanne , Maddox H. Edward , Battin R. Ray
Published: September 2006

Vestibular, audiological and X‐ray findings on 25 surgically confirmed neurinoma cases were reviewed to determine the diagnostic sensitivity of each in the neurinoma test battery. A comprehensive, retrocochlear audiological and vestibular work‐up was run. X‐ray procedures included posterior fossa myelograms in all but one instance, with all of the patients complaining of some auditory difficulties; progressive hearing loss and tinnitus were the most common complaints with tinnitus as the earliest symptom. Thirty‐six percent of the cases had a retrocochlear audiological pattern, while 60 percent manifested a mixed cochlear and retrocochlear pattern, the remaining 4 percent presented cochlear findings. A correlation between audiological findings and standard X‐ray views revealed that 32 percent of the cases presented equivocal audiometric and negative X‐ray findings, while myelogram were performed on 24 percent of the patients, and all but two. cases were positive. One of these cases revealed negative findings, and the other was equivocal. Our clinical findings indicated that a routine vestibular work‐up provided the indication for a more progressive neurinoma evaluation.
Symposium on meniere's disease.: Iv. Antigenic excitation in meniere's disease
Authors: Wilson William H.
Published: September 2006

Decision as to the presence of Ménière's disease requires strict adherence to established diagnostic criteria. An etiologic diagnosis becomes mandatory upon determining existence of the disorder. Among several etiologic factors to be considered is antigenic excitation of labyrinthine dysfunction.

A primary patho‐physiologic process in Ménière's disease is probably often an abnormal response of select, genetically predisposed cochlear arterioles to systemic stress. Local hypoxia resulting from arteriolar constriction through abnormal catacholamine stimuli may induce a persisting neosynthesis of histamine at the precapillary loop sphincters, as described by Schayer.3 Majno, et al.,4 have demonstrated that the ensuing dilation of the precapillary loops causes an increase in capillary and venule volume with stasis, endothelial cell separation and greater permeability of capillary and venule walls to plasma protein and fluid. Imbalance of circulatory homeostasis in stria vascularis conceivably could result in auditory and vestibular dysfunction. The role antigenic excitation may play in this perverse vascular response deserves exploration.
Symposium on meniere's disease.: Iv. Treatment of meniere's disease by apposition of sodium chloride crystals on the round window
Authors: Arslan Michele
Published: September 2006

The apposition of a saturated solution of NaCl into the middle ear of a cat or guinea pig provoked a biphasic vestibular spontaneous picture, which is composed of a first phase of “irritative” signs (nystagmus beating toward the injected side, etc.) and a second phase of “paralytic” signs (nystagmus beating toward the non‐injected side, etc.).

Starting from these postulates assumed from our experiments, a new attempt in the treatment of Ménière's disease was deemed justified; and the first cases, which were operated upon in 1968, produced favorable results.

The results obtained in 145 cases are reported. The principle upon which this new procedure is based can be defined as follows: by introduction of very small, sterilized NaCl crystals, into the round window niche, an outflow of perilymph through the round window membrane is produced. As a result, an acute ionic and osmotic imbalance between perilymph and endolymph is induced, with a subsequent effect on the endolymphatic hydrops. The technique is described.
Symposium on trauma in otolaryngology. II. Facial fractures related to the orbit.
Authors: Montgomery William W.
Published: September 2006

The diagnosis and management of facial fractures, which are related to the orbit are discussed with special reference to their complications.

Uncomplicated fractures of the frontal sinus without displacement require no specific therapy. Open reduction is required for depressed fractures of the anterior frontal sinus wall. Cerebrospinal fluid rhinorrhea associated with a frontal sinus fracture can be diagnosed by X‐ray findings and/or the fluorescein test. The direct approach of the osteoplastic frontal sinus operation has been successfully employed for the repair of these dural defects.

The diagnosis and various methods for reduction of the zygomatic fracture are discussed. The technique of open reduction and interossius wire fixation has been the technique most frequently employed.

Fractures of the ethmoid sinuses are treated expectantly unless complicated by persistent orbital emphysema, hemorrhage, or cerebrospinal fluid rhinorrhea. The spinal fluid rhinorrhea from the roof of the ethmoid or cribform plate is repaired, using the septal mucosal flap technique.

The diagnosis of maxillary sinus fractures (blow‐out fractures) is discussed with special reference to a comparison between the infraorbital and Caldwell‐Luc approaches.
Symposium on trauma in otolaryngology. III. Fractures of the nose.
Authors: Hinderer Kenneth H.
Published: September 2006

The prominent position of the nose makes it one of the most frequently injured structures of the body. Most physicians are not trained to recognize and treat these injuries.

A review of the literature gives very few details as to the technique of handling these injuries or the long term functional problems. Attempts are made at closed reduction and usually the result is far from satisfactory. Many patients are told that nothing can be done at the time, but if they so desire, a corrective operation can be done later.

Evaluation and extent of the injury is important for proper approach to the problem. Early prevention of swelling and ecchymosis with restoration of contour, is the key to successful long term results.

Anatomically, the nose is made up of four major parts: the bony pyramid, the cartilaginous vault, the lobule and the septum, and are joined together with different kinds of soft tissues which make up a functioning organ. The understanding of this normal anatomy will help to visualize what happens when a severe blow changes these relationships.

Fractures of the nose are caused by any type of object. The direction and intensity determines the type and extent of the deformity. This can be illustrated as seen in fist fights, where this is a direct blow, a right or left hook, or an upper cut. Nasal fractures vary greatly in their characteristics, and may be classified as simple, comminuted and compound or a combination of the latter two, and invariably involve the septum. The importance of the septum is that it divides the nose into two air chambers and any change in relationship to the other structures with affect the breathing pattern.
Burkitt's lymphoma, nasopharyngeal carcinoma, infectious mononucleosis and the epstein‐barr virus
Authors: Strauss Melvin
Published: September 2006

The Epstein‐Barr virus (EBV) is the most recently discovered member of the herpesvirus family. This virus has been found to be associated with three well recognized disease entities: Burkitt's lymphoma (BL), nasopharyngeal carcinoma (NPC), and infectious mononucleosis (IM). Each of these may manifest itself in a fashion which involves the clinical area of interest of the otolaryngologist. A brief summary of the pertinent clinical aspects and the research findings of the past seven years which have implicated the EBV will be reviewed.
Augmentation mentoplasty — Reflections
Authors: Tresley Ira J. , Kaufman Arenberg I. , Polterock Jerrold
Published: September 2006

Various aspects of augmentation mentoplasty are considered: esthetic considerations and philosophy, psychological considerations, common presenting deformities, and useful grafts and implants. Dr. Tresley's techniques and main complications encountered as well as examples of his results are presented.

(This is a review of the philosophy, esthetic judgments, and basic techniques of the late Ira J. Tresley. This manuscript was in preparation by the authors just prior to Dr. Tresley's untimely death and is presented as his last academic work.) (Ed.)
Adenoid hypertrophy, cyanosis and cor pulmonale, in children with congential heart disease
Authors: Freeman William J.
Published: September 2006

Two cases of cyanosis and cor pulmonale are presented due to upper airway. Obstruction from enlarged adenoids and to congenital heart disease in order to point up the critical importance of recognizing adenoid hypertrophy in addition to congenital heart disease as a possible cause of cyanosis. In an effort to supply adequate tissue oxygenation for these two growing babies, a cardio‐respiratory system already heavily taxed by severe congenital heart disease, was further chronically compromised by upper airway obstruction from enlarged adenoids. Cardiac operations to relieve the cyanosis, hypoxia, and right ventricular failure were unsuccessful. Simple adenoidectomy accomplished this and thus enhanced the probabilty of survival in these two patients.
Age‐related wave‐form changes OF VIIIth nerve action potentials in rats
Authors: Crowley David E. , Schramm Victor L. , Swain Ronie E. , Swanson Sylvia N.
Published: September 2006

Examination of click‐evoked VIIIth nerve actio potentials (AP) recorded from the round windw of anesthetized rats at ages of one, six, 12, 18 and 24 months reveals that: 1. Visual detectio levels for AP increase by 17.5 db from six to 24 months of age; 2. N1 voltage increases to a maximum at six or 12 months, depending on click level, and then declines to 24 months; 3. N2 voltage increases from one to six months but does not show a regular decline thereafter: 4. The voltage of the positive peak separating N1 from N2 shows irregular age changes; 5. N1 latency does not change significantly with advancing age; and 6. N1‐N2 latency is reduced between one and 12 months but remains relatively stable thereafter.
Symposium on tympanoplasty. III. Tympanoplasty: Ossicular chain reconstruction
Authors: Pulec Jack L. , Sheehy James L.
Published: September 2006

Permanent restoration of hearing with neither conductive nor sensorineural impairment is the goal of functional reconstruction in tympanoplasty. Many changes and modifications of technique have occurred to accomplish these ends in the past 10 years.1,2

The purpose of this paper is to present the technique used by members of the Otologic Medical Group and to comment on the use of homograft ossicles in over 700 cases.
Subglottic hemangioma in infants
Authors: Feuerstein Sidney S.
Published: September 2006

A series of seven cases of subglottic hemangioma in infants ranging in age from three weeks to 18 months is being presented. These cases were treated between 1958 and 1972. There was no sexual preponderance, four cases being male and three female. All cases presented with severe upper respiratory obstruction requiring immediate tracheoscopy and tracheotomy. Two cases presented with simultaneous cutaneous hemangiomata of the back. Careful post‐tracheotomy observation is stressed to insure adequate pulmonary ventilation. Repeat bronchoscopy for aspiration of retained secretions and removal of a polyp at the tracheostomy was necessary in one case. Blood gas analysis for PCO2 and Po2 to determine extent of chronic hypoxia is recommended; also chest X‐rays may reveal evidence of cardio‐megaly, especially of the right ventricle as seen in chronic pulmonary hypertension secondary to alveolar hypoventilation.

Gradual involution of the hemangioma after 12 months of age is to be expected. In those cases with associated cutaneous lesions, the resolution of the skin lesion may be used as a guide to determine the extent of resolution of the tracheal lesions. Lateral X‐rays of the trachea and barium studies of the upper esophagus are helpful to demonstrate the extent of the subglottic mass and also the degree of involvement of the party wall between the esophagus and trachea.

One dose of radiotherapy was administered in only one case.

Careful repeat tracheoscopy is recommended prior to decannulation to insure an adequate airway. Cortico‐steroids and cryotherapy were not used in these cases.

All infants survived, and two of the more recent cases have not been de‐cannulated to date.
Postoperative problems of tracheal resection
Authors: Rabuzzi Daniel D. , Halsey William S. , Ikins Philip M. , Reed George F.
Published: September 2006

With the advent of the intermittent positive pressure breathing apparatus and cuffed endotracheal tubes, the problem of tracheal stenosis has increased in both incidence and severity. The lesion may be at the tracheotomy stoma or at the site of the tracheal tube cuff, or both. Treatment of severe cases revolves around primary tracheal resection and anastomosis, often with laryngeal release procedures. This report reviews all cases of tracheal stenosis and resection at the Upstate Medical Center, and presents postoperative problems of significance.

Twenty‐three consecutive cases of tracheal stenosis were found, 20 of which followed tracheotomy. These were equally prevalent at both stomal and cuff sites, contributing factors being infection and mechanical ventilators, respectively, Eighteen patients were operated upon, all but two undergoing direct resection with end‐to‐end anastomosis. Laryngeal release was performed simultaneously in seven patients.

Despite particular postoperative care, 50 percent (9/18) developed significant complications after surgery, including re‐stenosis and/or granulation tissue formation, aspiration, innominate artery hemorrhage, and vocal cord paralysis. These problems ensued despite neck bracing, antibiotics and steroids, and meticulous surgical technique. Two of the patients with re‐stenosis could be controlled only by another tracheal resection.

The control of superimposed infection, painstaking surgical manipulation, and relaxation of all tension on the anastomosis line by extensive tracheal mobilization are all methods used to circumvent these problems. Although laryngeal release will allow increased tracheal mobility in and of itself, it also may cause deglutitive dysfunction, as seen in several of our patients and should be used with discretion.
Audiometry and tympanometry in relation to middle ear effusions in children
Authors: Bluestone Charles D. , Beery Quinter C. , Paradise Jack L.
Published: September 2006

In a group of 84 children with concurrent or recent middle ear disease, tympanometry and air‐conduction audiometry were compared in their ability to predict whether or not middle ear effusion was present. In addition, in children with effusions, correlations were sought between audiometric and tympanometric measurements, and the viscosity of liquids found at myringotomy.

The clinical descriptions of effusions matched, in general, measurements of their viscosity.

Effusions were found at myringotomy almost as often in ears with average air‐conduction thresholds below 25 db as in those with higher thresholds; in both groups an appreciable proportion of the effusions was of high viscosity.

Tympanometric patterns, representing tympanic membrane compliance and middle ear air pressure, were of five general types. Effusions were found at myringotomy in most of the ears with low tympanic membrane compliance, but were not found when both tympanic membrane compliance and middle ear air pressure were normal.

Sixteen ears with average air‐conduction thresholds below 25 db, but found to contain effusions at myringotomy, also had received pre‐operative tympanometry: in each instance tympanic membrane compliance had been abnormally low.

The existence of negative middle ear air pressure suggests the possibility of Eustachian tubal obstruction, but the definition and conditions of abnormal levels in children remain to be established. Children with high negative middle ear air pressure should probably be considered at otologic risk.

Tympanometry appears to be a reliable method for detecting the presence of middle ear effusion in children, and, therefore, should prove valuable for screening.
Loose areolar connective tissue: A graft for otologic surgery
Authors: Moon Cary N.
Published: September 2006

Loose connective tissue is available through a superior auricular incision, or through an endaural or postauricular approach. Storrs1 described use of fascia for tympanoplasty and stapedectomy. Goodman2,3 reported his experiences with areolar tissue grafts for tympanoplasty and stapedectomy. Farrior4 illustrates the use of loose connective tissue in the Atlases, Tympanoplasty in 3‐D, and in the movie “Modern Ear Surgery.” Moon5 reported on use of areolar connective tissue closure of the oval window in stapedectomy.

Loose connective tissue originates from the mesenchyma. The histology and functions of loose connective tissue are such as to support its suitability for grafting in middle ear and mastoid surgery. The operative technique of obtaining this graft is described. Loose connective tissue has been used in stapedectomy, tympanoplasty, and mastoidectomy with satisfactory results.
Surgical management of chronic paranasal sinusitis
Authors: Eichel Berkley S.
Published: September 2006

An attempt is being made to try to standardize an approach to surgical problems involving the paranasal sinuses, excluding malignancies. This is being done in conformity with a definition proposed by Ferris Smith in 1934 along with certain up‐to‐date modifications.

There are five basic surgical operations commonly and effectively utilized in approaching these sinus problems. Three of these procedures, namely, the nasal antral window, the Caldwell‐Luc, and the intranasal ethmoidectomy, are felt to be best utilized in the primary approach to the majority of inflammatory problems. The remaining two procedures, the fronto‐ethmo‐sphenoid sinusotomy and the osteoplastic frontal flap, are advocated primarily in approaching space occupying lesions, excluding polyps, and secondarily where attempts to manage the problem by the first three lesser surgical procedures have been unsuccessful.

The merits, goals, and indications of all five procedures are discussed. In many instances two procedures may have equal effectiveness in handling a patient's particular problem, and the procedure of choice rests with the personal preference of the individual surgeon. At other times an inappropriate procedure may not benefit the patient while a properly selected operation could readily enable a cure. It is in this latter area of selecting the appropriate surgical procedure to attack a particular problem that a serious deficit now exists in the practice of otolaryngology. It is the further contention of this presentation that these five basic procedures can effectively handle the majority of chronically diseased paranasal sinusitis problems. It is unfortunate that the one procedure that is the most effective and the most physiological in handling the majority of the more difficult problems, namely, the intranasal ethmoidectomy, was allowed to fall into near disrepute by a historical misunderstanding.0