bluuebunny/crossref_metadata_2025 huggingface dataset:
MATHEMATICAL MODEL FOR THE RUPTURE OF CEREBRAL SACCULAR ANEURYSMS THROUGH THREE-DIMENSIONAL STRESS DISTRIBUTION IN THE ANEURYSM WALL
Authors: CHAUDHRY HANS R. , LOTT DAWN A. , PRESTIGIACOMO CHARLES J. , FINDLEY THOMAS W.
Published: October 2006

A mathematical model for the rupture of cerebral saccular aneurysms is developed through the analysis of three-dimensional stress distribution in the aneurysm wall. We assume in this paper that a saccular aneurysm resembles a thin spherical shell (a spherical membrane), and then develop a strain-energy function valid for finite strain to analyze three-dimensional stress distribution in the aneurysm wall. We find that rupture occurs when the ratio of the wall thickness to the radius of the aneurysm is 6.1 × 10-3. We also conclude from our analysis that rupture can occur when the ratio of thickness to radius of the parent aneurysm equals the ratio of thickness to radius of the daughter aneurysm. These findings may be helpful to the neurosurgeon for predicting the rupture potential in patients presenting with unruptured aneurysms.
The Impact of Glycosylation on the Biological Function and Structure of Human Immunoglobulins
Authors: Arnold James N. , Wormald Mark R. , Sim Robert B. , Rudd Pauline M. , Dwek Raymond A.
Published: October 2006

Immunoglobulins are the major secretory products of the adaptive immune system. Each is characterized by a distinctive set of glycoforms that reflects the wide variation in the number, type, and location of their oligosaccharides. In a given physiological state, glycoform populations are reproducible; therefore, disease-associated alterations provide diagnostic biomarkers (e.g., for rheumatoid arthritis) and contribute to disease pathogenesis. The oligosaccharides provide important recognition epitopes that engage with lectins, endowing the immunoglobulins with an expanded functional repertoire. The sugars play specific structural roles, maintaining and modulating effector functions that are physiologically relevant and can be manipulated to optimize the properties of therapeutic antibodies. New molecular models of all the immunoglobulins are included to provide a basis for informed and critical discussion. The models were constructed by combining glycan sequencing data with oligosaccharide linkage and dynamics information from the Glycobiology Institute experimental database and protein structural data from “The Protein Data Bank.”
TGF-β1 Polymorphisms and Risk of Myocardial Infarction and Stroke
Authors: Sie Mark P.S. , Uitterlinden André G. , Bos Michiel J. , Arp Pascal P. , Breteler Monique M.B , Koudstaal Peter J. , Pols Huibert A.P. , Hofman Albert , van Duijn Cornelia M. , Witteman Jacqueline C.M.
Published: October 2006

Background and Purpose—

Inflammation plays a pivotal role in the pathogenesis of atherosclerosis and of cardiovascular and cerebrovascular complications. Transforming growth factor-β1 (TGF-β1) is a pleiotropic cytokine with a central role in inflammation. Little is known of the relation of variations within the gene and risk of cardiovascular and cerebrovascular disease. We therefore investigated 5 polymorphisms in the TGF-β1 gene (−800
G
/
A
, −509
C
/
T
, codon 10 Leu/Pro, codon 25 Arg/Pro, and codon 263 Thr/Ile) in relation to the risk of myocardial infarction and stroke in a population-based study.

Methods—

Participants (N=6456) of the Rotterdam Study were included in the current study. Analyses of the relations of genotypes with the risk of myocardial infarction and stroke were performed according to Cox proportional-hazards methods. All analyses were adjusted for age, sex, conventional cardiovascular risk factors, and medical history.

Results—

We found no association with the risk of myocardial infarction. A significantly increased risk of stroke was found, associated with the
T
allele of the −509
C
/
T
polymorphism (relative risk, 1.26; (95% CI, 1.06 to 1.49) and the Pro variant of the codon 10 polymorphism (relative risk, 1.24; 95% CI, 1.04 to 1.48).

Conclusions—

No association between the TGF-β1 polymorphisms and myocardial infarction was observed; however, the −509
C
/
T
and codon 10 Leu/Pro polymorphisms were associated with the risk of stroke.
Is Bursaphelenchus mucronatus a weak pathogen to the Japanese red pine?
Authors: Futai Kazuyoshi , Kanzaki Natsumi
Published: October 2006

The pine wood nematode, Bursaphelenchus xylophilus, is the causal agent of pine wilt disease. It can invade healthy pine trees through the feeding wound of its vector beetle, Monochamus alternatus, and can enter a dead or dying tree through the vector's oviposition mark. By contrast, B. mucronatus, which is closely related to B. xylophilus but has been considered to have no pathogenicity to pine species, also invades living host trees through the same process as B. xylophilus, although the transmission efficiency is lower than that of B. xylophilus. In order to clarify the reason why Bursaphelenchus mucronatus invades a living host, we inoculated shaded and unshaded host seedlings of Pinus densiflora with B. mucronatus. Bursaphelenchus mucronatus displayed pathogenicity in the host seedlings but only with those that were shaded. In addition, B. mucronatus was recovered from the seedlings that had survived until the end of the experiment. Bursaphelenchus mucronatus seems to survive in the living healthy host tree without causing disease symptoms. These results suggest a mutualistic relationship between B. mucronatus and its vector beetle.
2-D X-ray Fluorescence Imaging of Cadmium Hyperaccumulating Plants by Using High-energy Synchrotron Radiation X-ray Microbeam
Authors: Hokura Akiko , Onuma Ryoko , Kitajima Nobuyuki , Terada Yasuko , Saito Hiroyuki , Abe Tomoko , Yoshida Shigeo , Nakai Izumi
Published: October 2006

The monochromatic X-ray (37 keV) focused to microbeam (3 × 3 μm2) with a Fresnel zone plate allows us for the first time to measure a cellular distribution of cadmium in the cadmium hyperaccumulating plant, Arabidopsis halleri ssp. gemmifera by detecting the Cd Kα line. The distribution of cadmium in the leaves was clearly observed by in vivo monitoring. It was found that cadmium had highly accumulated in certain parts of the trichomes.
Preservation of a radionecrotic larynx by excision of thyroid cartilage with flap coverage
Authors: Litton Ward B.
Published: October 2006

Necrosis of the larynx following radiation therapy is a rare complication leading to severe disability and even death. Generally accepted treatment has consisted of incision and drainage, debridement, and tracheotomy or even total laryngectomy.

One patient developed chondronecrosis of the thyroid cartilage and was treated by excision of the entire thyroid cartilage and overlying skin with subsequent coverage by a unipedicled cervicothoracic flap. The patient has had his tracheotomy corked or been decannulated for 11 months with preservation of a useable larynx.
Tuning fork decay
Authors: Miller Gale W.
Published: October 2006

Tuning fork tests are used routinely by many otologists. A different group of otologists find the tests inconsistent and unreliable. This controversy has probably developed because the audiometer has replaced the tuning fork in hearing measurement. As a result, the art of use of the tuning fork is poorly learned.

This study examines decay, one of the physical parameters of tuning forks. Measurements of acoustic (sound wave) and vibration (stem movement) decay were made. Alteration in decay due to pressure changes on the fork stem were studied. Acoustic signals were generated in an anechoic chamber. Vibration measurements were obtained using an artificial mastoid. Analysis of the signals was accomplished by a system of amplifiers, filters, tape recorders, and a graphic recorder.

Tuning fork sound decay is a property of the instrument which occurs every time the fork is struck. The decay is a constant in decibels per second. The acoustic mode and the vibration mode decay at similar rates for the same fork. The strike frequency (a higher frequency than the fundamental produced when the fork is struck) also has a constant decay rate in decibels per second, and it is reported here for the first time. Force of 800 gm. and less applied to the bottom of the stem in vibration measurement caused minimal decay constant changes.

When the physical parameters of the tuning fork (including this information on damping) are fully studied, tuning fork testing should become more of a science and less of an art.
Facial nerve function in 100 consecutive parotidectomies
Authors: Nichols Richard D. , Stine Patrick H. , Bartschi Larry R.
Published: October 2006

The risk of facial nerve paresis after parotidectomy is thought to be within acceptable limits, although it is difficult to find published data regarding the specific magnitude of this risk. This study reviews the subject and reports postoperative facial function in 100 consecutive patients who had parotidectomies at the Henry Ford Hospital during a 9‐year period. Permanent weakness of a major branch was identified in 2 of 77 patients having lateral lobectomy for parotid disease. Both patients demonstrated marginal mandibular paresis after surgery for adenolymphoma. No weakness was noted in 16 patients undergoing total parotidectomy. No unanticipated nerve disability was noted in 4 patients having partial nerve sacrifice in extended procedures; 3 patients had complete sacrifice of the nerve.
The treatment of subglottic stenosis in children by prolonged dilatation
Authors: Kotton Bernard
Published: October 2006

Laryngeal stenosis can present with recurrent lower respiratory tract infections, hoarseness, stridor or decreased exercise tolerance. Asphyxia and death may follow. One accepted method of treatment is to perform a tracheostomy, dilate the stricture and insert an obturator for 6 to 9 mo.

Ten children with a subglottic stenosis were treated by this technique and 7 completed the treatment. Results in 5 of these children were good, 1 was improved and 1 restenosed. These results compare favorably with those reported by others.

This form of treatment is indicated for unyielding but dilatable strictures which have failed to respond to other approaches. The choice, therefore, lies between resection and plastic repair or prolonged dilatation. Results are generally quite good for strictures near the vocal cords, but are variable for those well below the cords.

The manufacture and insertion of a prosthesis used in the above cases are described.
Brain stem auditory evoked potentials in determining site of lesion of brain stem gliomas in children
Authors: Nodar Richard H. , Hahn Joseph , Levine Howard L.
Published: October 2006

Brain stem auditory evoked potential (BAEP) test results are reported on seven children (2 1/2‐13 years) with brain stem neoplasms. In each case, the BAEP test results clearly indicated the site of lesion as determined by computerized tomography and observation during surgery. Seven criteria for the assessment of BAEP test results are also presented: 1. Peak latency, 2. Intra‐peak latency, 3. Inter‐peak latency, 4. Response stability, 5. Amplitude, 6. Waveshape, and 7. Peak presence. Six children had positive indications on at least four of the seven criteria described, while one child had two positive indications. However, dramatic abnormality on any single criterion warrants serious investigation.
Spatial anatomy of facial nerve fibers—a preliminary report
Authors: Crumley Roger L.
Published: October 2006

Horseradish peroxidase (HRP) was used to tag axons to the orbicularis oculi muscle in eight adult cats. Retrograde axonal transport in some animals resulted in fiber labelling such that the spatial anatomy of fibers was determined. In those few animals in which labelling occurred, a definite spatial orientation was retained in the extra‐temporal nerve.

Problems with the HRP technique are discussed in the paper, and the literature is reviewed with regard to spatial orientation of facial nerve axons. This technique, previously used to label neurons in the facial nucleus, appears to be of value in labelling of the peripheral fibers as well.
Palliative orbital decompression for metastatic melanoma to the orbit
Authors: Sobol Steven , Druck Norman S. , Wolf Mitchell
Published: October 2006

Although relatively rare, metastatic carcinomas to the orbit are the second most common orbital neoplasm in the adult. There are only ten cases reported in the literature of cutaneous melanoma metastatic to the orbit and, of these, only two had disease involving both orbits. This paper presents the third case of bilateral orbital melanoma; however, in this case, the primary site was the uveal tract in the first eye, with contralateral involvement being a metastasis of the orbital primary. The patient developed severe unilateral proptosis in his only seeing eye with progressive loss of vision. A palliative orbital decompression was performed which successfully restored visual acuity for an extended period of time. A brief discussion of the rationale for this procedure in this type of case is presented.
Management of inverted papilloma of the nose and paranasal sinuses
Authors: Myers Eugene N. , Schramm Victor L. , Barnes E. Leon
Published: October 2006

Inverted papilloma of the nose and paranasal sinuses is a neoplastic growth of epithelium which inverts into the underlying stroma rather than proliferating outward from the surface. These neoplasms probably arise from the area of the lateral nasal wall. Inverted papilloma is characterized by its: A. capacity to destroy; B. tendency to recur; and C. association with malignancy.

During the past decade, we have come to understand better the histologic, biologic, and anatomic features of this tumor. More studies focusing on inverted papilloma have been published in recent years, and the authors of these reports have advocated more aggressive surgical procedures in the management of this tumor. The application of the technique of lateral rhinotomy and en bloc excision of the lateral nasal wall has dramatically decreased the recurrence rate while providing the patient with quite acceptable cosmetic and functional results. The surgical approach to inverted papilloma associated with squamous cell carcinoma varies with the extent of disease; but a good cure rate, especially with localized tumors, may be achieved with aggressive surgery combined with radiation therapy in these cases.

We present a series of 19 patients with inverted papilloma. In 6 of these 19 patients, squamous cell carcinoma was associated with the inverted papilloma; 13 of the patients with inverted papilloma and 3 of the patients with an associated malignancy underwent lateral rhinotomy with en bloc excision of the lateral nasal wall. The tumor did not recur in these patients. The rationale for this surgery, as well as the details of these patient's case histories, form the basis of this report.
The role of dynamic posturography in neurotologic diagnosis
Authors: Voorhees Richard L.
Published: October 2006

Electronystagmography and rotary vestibulnr testing are of definite but limited value in screening the dizzy patient. Objective identification of a vestibular abnormality is valuable, but there is an additional need to appraise the functional capacity of those suffering central or peripheral disorders causing spatial disorientation or disequilibrium. Records of 175 patients undergoing posturography in the author's practice over a 1‐year period were reviewed. Diagnosis was established by conventional neurotologic means including computerized electronystagmography. Abnormal results on posturography were identified by criteria established through the national users group of Equi‐Test participants. There were 112 peripheral cases with 50 (45%) abnormal on posturography, in contrast to 53 central patients with 38 (72%) abnormal. Posturography establishes a functional level of balance in certain peripheral and central disorders and provides limited but significant aid to assist in distinguishing between the two.
Loss of residual hearing after cochlear implantation
Authors: Boggess William J. , Baker Jane E. , Balkany Thomas J.
Published: October 2006

Many cochlear implant recipients have some measurable hearing prior to implantation. Animal studies have demonstrated some loss of viable neural elements resulting from both mechanical insertion trauma and long‐term electrical stimulation. The effect of implantation of a long intracochlear multichannel electrode array and subsequent electrical stimulation on residual hearing was evaluated.

Forty consecutive cochlear implant recipients were assessed by audiometry at the Colorado Ear Clinic between July 1985 and June 1988. Twelve of these patients (30%) had some measurable residual hearing before implantation, although all had profound hearing loss, with no understanding of speech. All patients received a multichannel cochlear implant with all 22 electrodes inserted in each patient by an experienced cochlear implant surgeon.

Audiometric testing was repeated between 2 and 24 months after implantation. Pure‐tone threshold responses in the implanted ear were significantly reduced postimplant, while puretone threshold responses in the nonimplanted ear were stable.
Freeze‐Dried microarterial replacement allografts in rabbits
Authors: Pratty Michael F. , Bank Harvey L. , Schmehl Marcia , Horton William D.
Published: October 2006

Microvascular techniques offer important alternatives for reconstructive head and neck surgery. To test the viability of freeze‐dried allografts, a pilot experimental study was performed using the rabbit model. Freeze‐dried preserved arterial allografts were implanted into femoral artery defects in eight subjects. After 6 weeks, all grafts were harvested and prepared for histologicol and electron microscopic analysis. Immediate patency was 100%. One subject was excluded on the third postoperative day. Of the seven remaining grafts, three (43%) were patent at 6 weeks. These results are comparable to previous data obtained using freeze‐dried arterial allografts in the some animal model. Although further investigation is required, this pilot study suggests possible future application of cryopreserved vascular micrografts.
Transarterial embolization to control posterior epistaxis
Authors: Hicks Julius N. , Vitek George
Published: October 2006

Posterior nasal epistaxis is a challenging problem for the oto‐laryngologist, particularly when patients are critically ill after significant blood loss. The purpose of this paper is to describe a new radiologic technique designed to enhance the treatment of acute nasal hemorrhage. Seven patients with posterior nasal epistaxis underwent portable, computerized, digital subtraction angiography before embolization. Results are presented, and the advantages and limitations of this approach are compared and contrasted with those of nasal packing and arterial ligation. We conclude that this new procedure permits rapid location of the bleeding source and safe, rapid placement of a maxillary arterial catheter for hemostasis by embolization.
Hearing preservation in vestibular neurectomy
Authors: De LaCruz Antonio , McElveen John T.
Published: October 2006

The goal of vestibular neurectomy is to control disabling vertigo while preserving hearing in patients with nonhydropic intractable peripheral vertigo or in patients with Meniere's disease in which an endolymphatic sac procedure has failed.

Labyrinthectomy continues to be used to treat patients with intractable vertigo and serviceable hearing. We feel that a labyrinthectomy is contraindicated when any useful hearing remains. Vestibular neurectomy affords the surgeon a means to eliminate the abnormal vestibular input without sacrificing hearing.

Two approaches have been used to section the vestibular nerves: the middle fossa approach since 1961 and the retrolabyrinthine approach more recently. Both approaches are effective in relieving vertigo while preserving hearing. This paper presents a statistical analysis of these two approaches. Although differences did exist, both were found to be highly successful in alleviating incapacitating vertigo and preserving hearing in a large percentage of patients.
Transient hearing loss with metrizamide
Authors: Grant Monica G. , Weiss Kenneth S. , Novak Michael A. , Tobin W. Dennis
Published: October 2006

Two case studies are reported in which transient low frequency scnsorincural hearing loss was experienced following myelography and CT scanning with metrizamide. Low frequency sensorineural hearing loss is considered to be the result of increased stiffness of one or both of the inner ear membranes. A review of the literature regarding an osmotic relationship between blood, cerebrospinal fluid, and the inner car fluids attempts to explain how this phenomenon may have occurred with metrizamide. The transient sensorineural loss observed in the case studies presented is compared to the pathophysiology attributed to the formation of endolymphatic hydrops.
Osteomyelitis of the head and neck: Sequential radionuclide scanning in diagnosis and therapy
Authors: Kaufman Raymond A. , Strauss Melvin , Baum Sheldon
Published: October 2006

Sequential technetium and gallium scans of the head and neck were used to confirm the diagnosis of osteomyelitis and us an important therapeutic aid to delineate the transformation of active osteomyelitis to inactive osteomyelitis in 11 cases involving sites in the head and neck. Illustrative cases are presented of frontal sinus and cervical spine osteomyelitis and laryngeal osteochondritis.
Cholesteatoma surgery: The influence of the canal wall
Authors: Smyth Gordon D. L.
Published: October 2006

Although there is an increasing awareness of the risks of complications following intact canal wall tympanoplasty (ICWT) for cholesteatoma, long‐term evidence to support a preference for alternative techniques in which the canal wall having been removed, the resultant cavity is obliterated, is comparatively scarce. In order to clarify this uncertainty, long‐term results with both operations have been analyzed to determine incidence rates for postoperative complications and functional results.

Recurrent cholesteatoma (retraction pocket) has occurred in 14% of ICWT ears and 1% of erars with mastoid obliteration and tympaine rerconstruction. The incidence of clinically defected residual disease with both operations has been extremly low so far, in spite of greater than 20% incidence of epithelial pearls at the second stage of sepearate planned two‐stage procedures with each technique. It is concluded that reduction to the greater degree possible of cholesteatomatous complications from tympanoplasty accessitates removal of the canal wall.
Invasive aspergillus of the head and neck
Authors: Colman Marc F.
Published: October 2006

Invasive fungal infections of the head and neck are uncommon. The most common organism is Mucor which is classically seen in diabetic individuals in or immediately after a bout of ketoacidosis. This report outlines our experience of four cases of invasive fungal disease caused by the Aspergillus species. All four patients in this series were profoundly granulocytopenic. Three of the four patients remained profoundly immunocompromised and succumbed to infections. One patient recovered immune competence and became a long term survivor after antifungal chemotherapy and debridement of necrotic tissue. The literature on invasive Aspergillus of the head and neck is reviewed. Some recent insights in the medicine literature concerning the epidemiology of the more common pulmonary form of this invasive disease are also discussed.
Electronystagmography and audio potentials in space flight
Authors: Thornton William E. , Thagard Norman E. , Biggers W. Paul , Pool Sam L. , Thomas W. Grady
Published: October 2006

Beginning with the fourth flight of the Space Transport System (STS‐4), objective measurements of inner ear function were conducted in near‐zero G conditions in earth orbit. The problem of space motion sickness (SMS) was approached much like any disequilibrium problem encountered clinically. However, objective testing techniques had built‐in limitations superimposed by the strict parameters inherent in each mission. An attempt was made to objectively characterize SMS, and to first ascertain whether the objective measurements indicated that this disorder was of peripheral or central origin. Electronystagmography and auditory brain stem response recordings were the primary investigative tools. One of the authors (W.E.T.) was a mission specialist on board the orbiter Challenger on the eighth shuttle mission (STS‐8) and had the opportunity to make direct and personal observations regarding SMS, an opportunity which has added immeasurably to our understanding of this disorder. Except for two abnormal ENG records, which remain to be explained, the remaining ENG records and all the ABR records made in the weightless environment of space were normal.
Lymphoepithelioma (undifferentiated carcinoma) of the laryngohypopharynx
Authors: Stanley Robert J. , Weiland Louis H. , Desanto Lawrence W. , Neel H. Bryan
Published: October 2006

Lymphoepithelioma (World Health Organization type 3, undifferentiated carcinoma of the nasopharyngeal type) is an extremely rare cancer in the laryngohypopharyngeal regions. We found reports of only 6 such tumors in the English language medical literature; 1 of the 6 was from our institution. We report four additional cases seen at the Mayo Clinic. Radiotherapy controlled disease at the primary site in three of the four cases. The neoplasm has a propensity for early, widespread dissemination. Three of our four patients died of extensive visceral and nodal metastases. One patient has survived eight years without a recurrence.
Retrolabyrinthine vestibular nerve section: Analysis of results
Authors: Kemink John L. , Hoff Julian T.
Published: October 2006

The retrolabyrinthine section of the vestibular nerve is an effective procedure for the ablation of unilateral vestibular function while preserving hearing. Although this procedure has been most frequently used for the control of unilateral Meniere's disease, it may also be effective in the control of unilateral vestibular dysfunction of other etiologies. A 2‐year experience with the indications for and the surgical results in a series of patients who underwent this procedure is presented. Brief case histories of a variety of etiologies of unilateral vestibular dysfunction are discussed.
Electrophysiologic monitoring of facial nerve during temporal bone surgery
Authors: Harner Stephen G. , Daube Jasper R. , Ebersold Michael J.
Published: October 2006

Monitoring of peripheral nerves during surgical procedures decreases trauma to the nerve, which may preserve function. During 1984, electrophysiologic monitoring of the facial nerve was used during 32 operative procedures in and around the temporal bone. The largest group were for cerebellopontine angle tumors. Clinically, monitoring appeared to be helpful by providing objective evidence of trauma to the facial nerve and a method of demonstrating integrity of the nerve. However, review of this series did not reveal objective evidence of improved facial nerve preservation compared to results in a similar group of patients operated on without monitoring. We think that the monitoring is best done by personnel experienced with the technique.
Prognostic significance of tumor growth during radiation therapy
Authors: Jacobs John R. , Binns Philip , Kinzie Jeannie , Evans Richard , Weaver Arthur
Published: October 2006

A retrospective review of 282 consecutive patients with squamous cell carcinoma of the head and neck that were seen in the Radiation Oncology Department from January 1, 1980, through December 31, 1983, was performed. From this population a subgroup of six patients was identified that experienced growth of tumor in the radiation field during treatment. All except one of these patients expired from progression of cancer within 16 months. At the time of writing, the one remaining patient has progressive cancer in spite of additional therapy.

Growth of cancer in the radiation field during therapy is unusual. It appears to be associated with a very poor prognosis even with aggressive salvage therapy. This observation should be taken into consideration in the medical/surgical management of these patients.
Treatment results for simultaneous primary squamous cell carcinomas of the head and neck
Authors: McCollough W. Mark , Million Rodney R. , Mendenhall William M. , Parsons James T. , Cassisi Nicholas J.
Published: October 2006

Forty patients with simultaneous multiple primaries of the head and neck were treated with curative intent between June 1964 and April 1983. The primary sites were treated with radiation therapy alone or in combination with surgery. Surgery was used to salvage local failures of radiation treatment. Neck disease was treated with radiation therapy alone or with neck dissection added after completion of radiation therapy to the primary lesions. Minimum follow‐up was 2 years with a range of 2 to 20 years. For the 32 patients whose primary tumors were treated with radiation alone, the 2‐year local control rates for the 53 individual tumors evaluated were as follows: T1, 18/21; T2, 16/23; and T3‐T4, 1/9. In the T3‐T4 group, there was only one successful surgical salvage. Local control rates for disease at all primary sites in each patient according to highest T‐stage were as follows: T1, 4/5; T2, 9/15; and T3‐T4, 1/9. Eight patients whose primary tumors were treated with radiation and surgery are discussed. The absolute disease‐free survival rate at 2 years for 40 patients was 42%. Complications of treatment are described.
Postsurgical follow‐up study of patients with severe polypoid degeneration
Authors: Lumpkin Samuel M. M. , Bennett Suzanne , Bishop Sandra G.
Published: October 2006

This report summarizes our experiences with 23 women whose bilateral severe polypoid degeneration was managed surgically and who have been followed over a 2‐ to 7‐year postoperative period. In our study group, polypoid degeneration did not reappear if the patient stopped smoking and practiced healthy vocal hygiene. About 25% of those who continued to smoke after surgery evidenced return of the disease, usually within 2 to 3 years. Reappearance of polypoid degeneration appeared most strongly related to the smoking variable alone or in combination with vocal abuse and/or medications that can cause edema. Neither vocal abuse nor medications appeared to be primary causal factors. The return of polypoid degeneration, in its earliest stages, was detected first via laryngeal examination.
Extracapsular spread of squamous cell carcinoma in neck lymph nodes: Prognostic factor of laryngeal cancer
Authors: Hirabayashi Hideki , Koshii Eenji , Uno Kohei , Ohgaki Haruyuki , Nakasone Yasuji , Fujisawa Tutomu , Syouno Noboru , Hinohara Tadashi , Hirabayashi Kaoru
Published: October 2006

Fifty‐two patients with laryngeal cancer who underwent radical neck dissections were studied to provide further information on the prognosis of various clinical and histopathological parameters.

Extracapsular spread (ECS) was found in 31% of patients with Nl nodes, and in 60% of patients with histopathologically positive nodes.

The 5‐year survival rate of histopathological findings was as follows: patients with no pathological evidence of neck metastasis (81%), patients with neck metastasis confined to the lymph node (no ECS) (76%), and patients with ECS (17%). The difference in survival rate between patients with no ECS and patients with ECS was statistically significant (P = .001).

Staging classification, T‐stage classification, the number of malignant nodes, the diameter of malignant nodes, and combined therapy had no prognostic importance. The most significant factor was the presence of extracapsular spread.
Intraoperative radiotherapy of skull base cancer
Authors: Freemany Stephen B. , Hamaker Ronald C. , Singer Mark I. , Pugh Newell , Garrett Peter , Ross David
Published: October 2006

As the head and neck surgeon expands the boundaries of resectability into the skull base, the margin of tumor clearance diminishes. Intraoperative radiotherapy (IORT) can be used as an adjunct to skull base surgery and external beam radiation to enhance local control in areas with close margins or remaining microscopic disease.

During the period from May 1982 to May 1988, 25 patients underwent IORT of the skull base following resection and prior to closure to treat microscopic disease in 9 patients, sterilize close margins in 14 patients, and attempt to eliminate remaining gross disease in 2 patients. The types of tumors treated were 13 squamous cell carcinomas, 4 adenoid cystic carcinomas, 3 high‐grade mucoepidermoid carcinomas, 3 sarcomas, 1 malignant mixed tumor, and an oncocytic adenocarcinoma. The majority of the tumors either originated in the sinuses or were skull base extensions of oral cavity or oropharyngeal cancers. In 22 patients with 1‐year follow‐up, IORT prevented local recurrence in 14 (64%) patients. This may represent improved control of local disease in patients who historically have a very dismal prognosis.

The indications, techniques, and complications of this exciting therapeutic modality are also reviewed.
Glomus tympanicum tumors: A clinical perspective
Authors: O'Leary Michael J. , Shelton Clough , Giddings Neil A. , Kwartler Jed , Brackmann Derald E.
Published: October 2006

Since Guild first discovered glomus bodies in the middle ear, the diagnostic evaluation and therapy of glomus tympanicum tumors have remained challenging. This study describes 73 cases diagnosed as glomus tympanicum tumors over the past 30 years. During this period, imaging techniques have markedly improved, and surgical approaches have evolved and been refined. These 73 cases were reviewed from a clinical perspective involving presentation, diagnostic evaluation, and therapeutic management.

Pulsatile tinnitus was the primary symptom in over half the patients, followed by hearing loss in one third. The physical exam rarely revealed a circumferential view of the lesion, emphasizing the necessity of further diagnostic evaluation. High‐resolution computerized tomography (CT) is currently the radiographic study of choice. A transmastoid surgical approach with extended facial recess was most commonly employed. Extension to the jugular bulb or internal carotid was rare, and no intraoperative complications of catecholamine secretion were noted. Postoperative complications were few, and the overall residual/recurrence rate was less than 5%. Additional clinical insights may assist in the management of these rare but fascinating tumors.
Temporal bone histopathology 14 years after cytomegalic inclusion disease: A case study
Authors: Rarey Kyle E. , Davis Larry E.
Published: October 2006

Temporal bones were examined from a 14‐year‐old male who died of sequelae of congenital cytomegalic inclusion disease (CID). Cytomegalovirus (CMV) was not isolated from inner ear fluid or multiple systemic tissues at the time of death. Examination of temporal bones revealed chronic pathology of both cochlear and vestibular sensory and nonsensory tissues. Endolymphatic hydrops was observed in the basal turn of the cochlear duct, while Reissner's membrane was collapsed in the more apical turns. Strial atrophy and a loss of cochlear hair cells were observed along the entire length of the basilar membrane. Vestibular neuroepithelial regions were degenerated and fibrosis was seen within the vestibular perilymphatic tissue spaces, suggesting prior labyrinthitis within the perilymph compartment in addition to the more typical pattern of endolabyrinthitis associated with human CMV infection. Distention of the saccular membrane was evident. In both cochlear and vestibular tissues, there were isolated regions of calcifications that appeared characteristic to that reported in other organ systems of individuals with CID. Collectively, these chronic, pathological findings in this case of CID demonstrate more extensive injury than has been identified in the previously reported acute temporal bone pathology of CID.
Microbial colonization of blom‐singer prostheses in postlaryngectomy patients
Authors: Palmer M. D. , Elliott T. S. J. , Johnson A. P.
Published: October 2006

The microbial colonization of 44 Blom‐Singer valves obtained from 16 patients over an 11‐month period was investigated both by standard microbial culture methods and scanning electron microscopy (SEM). The valves were all removed from the patients after failure to function correctly. The microbiology cultures revealed that Candida species and Staphylococcus aureus were present either individually or in combination on 43 valves. SEM showed yeast hyphae attached to and penetrating the surfaces of the 5 valves examined. Colonies of staphylococci were also seen on 2 of these 5 valves.

Unlike similar investigations on other voice prostheses, Saureus colonization was associated with Candida colonization and valve failure.
Differences in dendritic cells in congenital and acquired cholesteatomas
Authors: Frankel Sarah , Berson Shelley , Han Jin C. , Parisier Simon C. , Godwin T.
Published: October 2006

Cholesteatomas are histologically benign, though biologically invasive lesions that arise from the migration of squamous epithelium of the ear. Acquired cholesteatomas usually arise in an antigenically active environment, i.e., a chronically and/or recurrently inflamed middle ear. In contrast, congenital cholesteatomas occur in an uninflamed environment. The potential role of dendritic cells (DCs) in the evolution of this lesion has not been thoroughly studied. By staining for S‐100 protein, the authors evaluated the presence and distribution of DCs in cholesteatomas.

Sixteen cases of cholesteatomas diagnosed from 1987 to 1989 were selected for this study. The formalin‐fixed, paraffin‐embedded sections were processed by a standard avidin‐biotin peroxidase‐antiperoxidase method for S‐100 protein and for leukocyte common antigen (LCA). The presence and distribution of S‐100 protein‐positive DCs was evaluated and compared to canal wall skin. DCs were present in all cases. Nine acquired cholesteatomas had 5 to 16 epithelial DCs per high‐power field (HPF). Seven congenital cholesteatomas were examined. Four with isolated congenital pearl‐like cholesteatomas had 1 to 3/HPF epithelial DCs. In contrast, the three inflamed congenital cholesteatomas had 6 to 12/HPF DCs. The control uninflamed canal wall skin had only 1 to 3/HPF DCs. All DCs were LCA negative, as expected.
Factors associated with recurrence and voice quality following radiation therapy for T1 and T2 glottic carcinomas
Authors: Benninger Michael S. , Gillen John , Thieme Paul , Dragovich Jadranka , Jacobson Barbara
Published: October 2006

Evaluation of 63 patients undergoing primary radiation therapy for treatment of T1 and T2 glottic carcinomas was undertaken to evaluate the success of primary treatment and to identify factors which might influence recurrence or voice quality. Twelve patients (19%) recurred following radiation therapy, with ultimate salvage in 11, for a 3‐year survival rate of 98%. Voice preservation was achieved in 83%. Continued smoking after radiation therapy was associated with significantly greater risk of recurrence. Stage of tumor and anterior commissure involvement were not associated with increased recurrences. Sixty‐seven percent of patients who did not recur had good voice quality after treatment. Vocal fold stripping or excisional biopsy rather than limited biopsy for initial diagnosis, complications of treatment, and continued smoking after treatment were all significantly associated with an increased risk of poorer voice quality after treatment while bilateral vocal fold tumors were associated with risks that approached significance. Voice analysis of five patients revealed that objective changes in voice can be detected after radiation therapy in those with associated risk factors but may be normal in those without these risk factors.
Tumor‐Associated glycoprotein expression in salivary gland mucoepidermoid carcinomas: An immunohistochemical study using the monoclonal antibody B72.3
Authors: Roa R. Arturo , Hruban Ralph H. , Mckenzie Pearline , Richtsmeier William
Published: October 2006

The monoclonal antibody B72.3 recognizes a mucin‐like glycoprotein which is expressed in a variety of human malignancies including adenocarcinomas of the breast, colon, lung, endometrium, pancreas, and ovary. The antibody, an immunoglobulin G (IgG1) subclass monoclonal antibody, was generated from membrane‐enriched fractions of metastatic mammary carcinoma. Because the antigen detected by B72.3 is expressed in a broad spectrum of human neoplasms, B72.3 is a potentially useful marker for glandular neoplasms. Despite its potential usefulness, there is only one previous comprehensive study which has examined the distribution of the tumor‐associated glycoprotein (TAG‐72), as detected by B72.3, in salivary neoplasms. We examined 21 mucoepidermoid carcinomas with the antibody. Twenty (95%) of the 21 carcinomas stained positively. The only carcinoma that did not stain was initially thought to be a high‐grade mucoepidermoid carcinoma based on immunohistochemical staining. Further review, however, indicated that this lesion was most likely a pure squamous cell carcinoma, and the absence of TAG‐72 antigen expression was helpful in this regard. Among those neoplasms which stained with B72.3, the strongest staining was seen in the low‐grade carcinomas. These results suggest that B72.3 may be a useful marker for glandular differentiation in mucoepidermoid carcinomas.
Effect of acquired cisplatin resistance on the response of a xenografted human hypopharynx carcinoma to concurrent radiochemotherapy with cisplatin
Authors: Jäckel Martin , Tausch‐Treml Robert , Köpf‐Maier Petra
Published: October 2006

The optimum integration of chemotherapy and irradiation is of potential clinical significance in the treatment of advanced head and neck carcinomas. In the present study, the interaction of cis‐diamminedichloroplatinum(II) (cisplatin) with fractionated radiotherapy was investigated in a human hypopharynx carcinoma and a cisplatin‐resistant subline of this tumor, both growing in athymic mice. Two radiochemotherapy schedules which tested single as well as combined‐modality treatments were applied. After therapy, the tumor sizes were measured three times per week in order to determine growth delay and treatment:control (T/C) ratios. The results revealed approximately additive effects of both agents in the parent hypopharynx carcinoma. In the resistant subline, such an interaction did not appear after treatment with any of the investigated schedules. However, a significant cross‐resistance between cisplatin and radiation was detectable. It can be concluded that multiple courses of a platinum‐based induction chemotherapy may be disadvantageous, since the treated tumors may develop drug resistance which obviously limits the effectiveness of a subsequent combined‐modality approach.
Cervical necrotizing fasciitis
Authors: Maisel Robert H. , Karlen Richard
Published: October 2006

Nine cases of cervical necrotizing faciitis are presented. Five were odontogenic, three were pharyngeal in origin, and one developed from a soft‐tissue spider bite. The bacteriology represented a polyculture of gram‐positive, gram‐negative, as well as anaerobic bacteria, and initial medical treatment by third‐generation cephalosporin and metronidazole or clindamycin was successful and is recommended. Airway control is necessary early, as is a wide exploration of the fascial spaces of the neck, with frequent reexploration in either the operating room or at the bedside to evaluate the effects of treatment and to prevent further progression of the disease. Intensive medical support is crucial, and hyperbaric oxygen is advised for patients who are deteriorating under standard therapy.
Patency of the internal jugular vein following modified radical neck dissection
Authors: Cotter Cheryl S. , Stringer Scott P. , Landau Steven , Cassisi Nicholas J. , Mancuso Anthony A.
Published: October 2006

Although the internal jugular vein is commonly preserved in modified radical neck dissections, the English literature contains only a single study assessing postoperative vein patency including only 13 patients. The present study was instituted to better determine the patency of the internal jugular vein following modified radical neck dissection and to identify factors associated with venous occlusion. Preoperative and postoperative computed tomography or magnetic resonance imaging was performed on 69 patients undergoing 79 vein sparing neck dissections. Sixty‐eight veins (86%) were patent postoperatively. A retrospective chart review revealed that compression by either a musculocutaneous flap or recurrent carcinoma in the neck was associated with venous occlusion. We conclude that the internal jugular vein is likely to remain patent after modified radical neck dissection with vein preservation.
Mucociliary activity and histopathology of sinus mucosa in experimental maxillary sinusitis: A comparison of systemic administration of antibiotic and antibiotic delivery by polylactic acid polymer
Authors: Min Yang‐Gi , Kim Young‐Ki , Choi Young‐Seok , Shin Jin‐Sung , Juhn Steven K.
Published: October 2006

To evaluate the efficacy of antibiotic delivered by polyactic acid (PLA) polymer in sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by occluding the sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae. The rabbits were divided into three groups consisting of group 1 (control group, 8 rabbits), which was treated only by reopening the ostium; group 2, which was treated by both reopening the ostium and injecting ampicillin intramuscularly (40 mg/kg/day in three divided doses, 12 rabbits); and group 3 (12 rabbits) in which a piece of PLA‐polymer ampicillin (0.326 mg) sheet (1.5 × 1.5 cm) was placed within the sinus after re‐establishing ostial patency.

The light microscopic findings such as epithelial ulceration, loss of cilia, infiltration of inflammatory cells, and edema were less pronounced in group 2 and minimal in group 3. The electron microscopic findings such as swelling of mitochondria and endoplasmic reticulum and protruded cytoplasm were severest in the control group, followed by groups 2 and 3. The mucociliary transport speed measured at the medial wall of the maxillary sinus was highest in group 3. The results of this study suggest that treatment with PLA‐polymer ampicillin may have a better efficacy in maxillary sinusitis than that with systemic administration of ampicillin.
Management of carotid artery rupture by monitored endovascular therapeutic occlusion (1988‐1994)
Authors: Citardi Martin J. , Chaloupka John C. , Son Yung H. , Ariyan Stephan , Sasaki Clarence T.
Published: October 2006

The reported mortality (40%) and neurologic morbidity (25%) rates for carotid rupture remain unacceptably high. This study was conducted to assess the impact of endovascular detachable balloon occlusion and the changing characteristics of carotid rupture in head and neck surgery. Between January 1, 1988, and June 30, 1994, 18 carotid ruptures were identified in 15 patients. Etiologic factors included radical surgery, radiation therapy, wound complications, and recurrent or persistent carcinoma. In 15 of 18 instances of carotid rupture, patients survived without major neurologic sequelae. After the introduction of endovascular techniques in 1991, the 12 patients whose hemorrhage was definitively managed through permanent balloon occlusion survived without significant neurologic sequelae. Endovascular occlusion techniques in the monitored patient may significantly improve the outcome after carotid rupture.