bluuebunny/crossref_metadata_2025 huggingface dataset:
Voice problems following limited surgical excision
Authors: Moore G. Paul
Published: September 2006

The published literature contains relatively few references to vocal rehabilitation for persons with partial laryngectomy. Articles on various types of surgery indicate that many individuals develop satisfactory voice following limited surgery, particularly supraglottic procedures. An informal questionnaire completed by 10 laryngologists who had had substantial experience with sub‐total laryngectomy revealed that an average of 25 percent of their patients with laryngeal cancer receive partial laryngectomy. Lesions limited to the epiglottis, supraglottic areas or one vocal cord are regularly treated by limited excision. Half of the questionnaires indicated that partial laryngectomy can be used for bilateral vocal cord lesions under certain circumstances. The questionnaire confirmed the published reports that most of the subsequent voices were satisfactory or good and many recover without special vocal retraining. None reported employment of partial laryngectomy for sub‐glottal cancer. Hemilaryngectomy and cordectomy frequently resulted in some impairment of voice. Speech therapy is often recommended when possible.

Therapy applicable to voice following partial laryngectomy combines five emphases: 1. strengthening glottic closure and loudness of the voice; 2. improving the efficiency of breath expenditure; 3. increasing the articulately skill and intelligibility of speech; 4. recognizing and compensating for hearing loss; and 5. aiding the patient to reduce detrimental environmental influences and to adjust to his environmental requirements.
Methods of restoring the voice after laryngectomy
Authors: Damstéa P. H.
Published: September 2006

The normal course of speech acquisition after laryngectomy is described, with emphasis on the initial stage. Factors that favor or thwart the training process are discussed and particular methods applied when functional or organic impediments deviate or block the development of esophageal speech. A few remarks are added on the rehabilitation after extended forms of surgery and on the use of the artificial larynxes.
Medial conchal excision in otoplasty
Authors: Mith Rays , Dickinson John T. , Teachey William S.
Published: September 2006

The most common cartilaginous deformities in protruding ears include an inadequate antihelical fold and an enlarged concha. We have employed medial conchal excision to correct deep conchas in 25 patients, all of whom were pleased with the postoperative result. Obvious wrinkling of the anterior skin occurred in four patients, and several patients displayed slight distortion of the helical crus. Medial conchal excision does not impede management of the antihelical fold with mattress sutures or by other means. We consider the risk of minor alterations of the concha justified if even slight distortion of the more conspicuous lateral auricle can be avoided.
Laryngofissure and cordectomy
Authors: Daly John F. , Kwok Francis N.
Published: September 2006

Laryngofissure and cordectomy is one of the first of the successful surgical procedures for the cure of cancer limited to the vocal cord. When the lesion is confined to the membranous cord and the motion of the cord is not impaired, cure rates ranging from 85 to 98 percent have been reported.

Decline in the use of the procedure is due to the success of radiation therapy in achieving comparable cure rates while preserving normal voice quality. Hemilaryngectomy procedures are now done where laryngofissure and cordectomy had previously been indicated. The more extensive procedure gives greater security due to wider margins of resection and increase applicability, particularly when the lesion involves the anterior commissure.

Although the indications for laryngofissure have diminished, the surgeon may use it when a simple, less extensive procedure is called for.
Effects of noise bands on contralateral pure tone adaptation
Authors: Meyer Robert C. , Schubert George W. , Holzwarth Ronald H.
Published: September 2006

The purpose of this study was to investigate the changes in threshold tone decay which result from contralaterally presented stimuli at an intensity less than interaural crossover. Five tone decay tests were administered at both 1,000 Hz and 2,000 Hz to 25 normal hearing adults.

At each test frequency five contralateral conditions (no competing noise, white noise, narrow band noise centered at the test frequency, narrow band noise centered below the test frequency, and narrow band noise centered above the test frequency), Avere presented at 40 db above detection threshold to the nontest ear.

Results showed a significant shift in tone decay scores when the conditions of white noise and narrow band noise centered around the test frequency were compared to the condition of no competing noise. A shift was seen at both frequencies but that occurring at 2,000 Hz was significantly greater than the shift at 1,000 Hz.

No significant increase in tone decay was found for contralateral noise bands above or below the test frequencies.
Vestibular involvement in bell's palsy
Authors: Rauchbach Erol , May Mark , Stroud Malcolm H.
Published: September 2006

Vestibular involvement in the acute phase of idiopathic facial paralysis (Bell's palsy) was observed in 22 percent of 14 patients. These patients were evaluated by history, physical examination and caloric tests with electronystagmography (ENG) employing the Cawthorne‐Hallpike technique. Bell's palsy has been considered a mononeuropathy limited to the facial nerve. Evidence of occasional involvement of other cranial nerves (Vth and/or VIIIth) suggests a polyneuropathy. Several theories have been advanced to explain the involvement of the vestibular nerve.

This is a report confirming, in part, previous observations.
Anticonvulsant‐induced lymphoma
Authors: Fried Marvin P. , Sunwoo Young
Published: September 2006

Patients with cervical adenopathy of obscure etiology may present a diagnostic problem to the otolaryngologist. The hydantoin family of anticonvulsants is a rare cause of adenopathy that may range from histologically simple lymphoid hyperplasia to true lymphoma. Between these two extremes is a benign clinical entity with the histologic characteristics of lymphoma.

A patient on diphenylhydantoin (Dilantin) therapy developed bilateral true vocal cord paralysis and cervical adenopathy. On pathological examination the lesion was interpreted first as malignant lymphoma and later as hydantoin‐induced pseudolymphoma. He has now been followed for over two years.

Hydantoin‐induced adenopathy may vary clinically from a benign condition to a true lymphoma. The malignant form may present long after the anticonvulsant treatment is discontinued. A 10‐fold increase in the expected incidence of malignant lymphoma in epileptic patients on hydantoin therapy has been reported; therefore, these patients required long‐term follow‐up.

The otolaryngologist should be aware of this rare clinical entity as an unusual cause of cervical adenopathy associated with vocal cord paralysis.
Laryngeal structure following microcauterization
Authors: Kirchnbr Fernando R.
Published: September 2006

This paper supports and reaffirms the objectives of contemporary laryngology in the treatment of cancer of this organ. These objectives are, first and foremost, the eradication of the tumor, and second, the preservation of function. A relatively recent contribution to the “state of the art” has been the development of the field of microlaryngology. The introduction of the surgical microscope has provided the laryngologist with better means to judge the type, localization and extent of neoplastic lesions.

In a selected number of these patients radical surgery has been prevented by treating these recurrent tumors with the microcautery. Some of these patients, so treated, have been free of disease for more than three years after their recurrent tumors were destroyed with the microcautery. During this time these patients have enjoyed adequate voices.

Reports indicate that superficial limited carcinomas of the larynx with good vocal cord mobility can be successfully treated by vocal cord stripping and/or radiotherapy. This paper presents the serious challenge posed by these limited tumors when they recur after radiotherapy.

Extensive studies that have been performed in dogs with the microcautery indicate that

a. An excellent recovery of the larynx is the rule, if microcauterization is carried out superficially. These initial experiments were performed on 10 dogs, duplicating the type and extension of microcauterization, as this procedure is usually performed clinically in the treatment of patients.

b. The anterior and posterior commissures of the larynx were found understandably vulnerable to severe degrees of cauterization.
“Smokers' larynx” and carcinoma of the larynx in syrian hamsters exposed to cigarette smoke
Authors: Homburger Freddy
Published: September 2006

Several groups of investigators have recently produced carcinoma of the larynx in Syrian hamsters. This study reports on the effects of cigarette smoke from Kentucky reference cigarettes in an inbred strain (BIO 15.16) of Syrian hamsters. After “smoking” five days each week for two years, 20 percent of the surviving animals had cancer of the larynx; 40 percent had severe epithelial changes.

These observations emphasize the role of cigarette smoke in the genesis of laryngeal cancer and respiratory tract cancer in general. An experimental method is now available for comparative studies of cigarettes and as a guide toward less hazardous smoking materials.
Symposium: Contraindications to tympanoplasty: IV. Contraindications to tympanoplasty
Authors: Storrs Lloyd A.
Published: September 2006

Aural and non‐aural disorders that are relative or are absolute contraindications to tympanoplasty surgery are discussed. Particular attention is focused on non‐aural convert general medical conditions that may escape the otologist's attention as he is not daily concerned in the management of such conditions. The aural contra‐indications are dealt with briefly because of the obvious and well known disorders that are familiar to all otologists.
Ossicular reconstruction in tympanoplasty — mobile stapes without crural arches, fixed stapes with and without crural arches
Authors: Moon Cary N.
Published: September 2006

A description of ossicular reconstruction in problems with the stapes using autograft and/or homograft ossicles is given.

The inverted stapes is employed for otosclerosis and tympanosclerosis. The two ossicle reconstruction is used in cases of a mobile footplate with absent crural arches. The reshaped incus is repositioned between the malleus handle and oval window when the stapes is fixed and there also exists a lateral ossicular chain defect.

Loose connective tissue is an effective seal for the oval window and is a means of stabilizing ossicular functions.
Facial nerve grafting
Authors: Alford Bobby R.
Published: September 2006

The extratemporal part of the facial nerve and its primary branches may be successfully reconstructed with a suitable nerve graft obtained from the upper cervical region. Special attention to meticulous suturing of the nerve graft to the main trunk of the facial nerve and the branches to the eye and lips should result in satisfactory restoration of facial function in most patients.
The effect on perilymph of the alteration of serum glucose or calcium concentration
Authors: Juhn S. K. , Youngs John N.
Published: September 2006

In the experimentally‐induced hyper‐ or hypoglycemic state, perilymph glucose concentration paralleled the blood concentration, although a delay of about one hour was observed between the time of maximum concentration of glucose in perilymph and its concentration in blood.

In hypercalcemia, perilymph calcium concentration steadily increased over a three‐hour period, although blood calcium concentration fluctuated during this time. After an initial increase in the CSF calcium concentration, there were insignificant changes during the second and third hours. In animals with thyrocalcitonin‐induced hypocalcemia, although blood calcium concentration steadily decreased, its concentration in perilymph and CSF remained practically constant.

The present findings suggest that the chemical composition of perilymph can be altered by changing the blood concentration of glucose or calcium. The marked difference of behavior noted between glucose and calcium in these experiments would indicate the existence of different mechanisms for maintaining the homeostatic state for these two substances.
Prosthetic rehabilitation of large midfacial defects
Authors: Beumer John , Calcaterra Thomas C.
Published: September 2006

Advanced tumors of the midfacial region often require removal of the nose, upper lip, portions of the maxilla, and other adjacent structures. When the resultant defects do not lend themselves to surgical reconstruction, prosthetic appliances may be used successfully to restore the functions of speech and swallowing to near‐normal levels. The degree of success depends upon the nature of the previous treatment, the existing surgical defect, and the adaptability of the patient. The most important anatomical consideration is the form and amount of the remaining maxilla.

Recent advances in the development of the polyurethanes have resulted in lighter, more flexible, and, therefore, better tolerated prostheses. Close cooperation between the surgeon and the prosthodontist is necessary if successful rehabilitation of these patients is to be achieved.
Nasopharyngeal angiofibroma
Authors: Boles Roger , Dedo Herbert
Published: September 2006

Nasopharyngeal angiofibromas have traditionally been difficult tumors to manage. Their extreme vascularity has led to excessive bleeding during surgical removal, which often obscured the surgical field and contributed to high recurrence rates because of incomplete removal. High recurrence rates have also been clue to failure to recognize the full size and extent of these tumors preoperatively by routine physical examination and X‐ray techniques.

A combined experience of the authors with over 45 cases from the University of Michigan and the University of California, San Francisco, is presented to review the problems in management of these tumors and to present techniques of diagnosis and management which have been used to overcome some of these problems. The most important advances in diagnosis have been the radiographic techniques of laminagraphy and carotid angiography. Previously unrecognized tumor extensions into the areas surrounding the nasopharynx have been quite clearly demonstrated by these techniques. Improved surgical treatment of these tumors by wider surgical exposure and removal, utilizing multiple approaches when necessary, and by better control of bleeding by ligation and embolization of the main arterial supply, has led to fewer recurrences.
The thyroid and audition
Authors: Meyerhoff William L.
Published: September 2006

Hearing loss, both congenital and acquired, can be associated in a more than happenstance manner with disorders of almost every organ system; the thyroid gland being no exception. Although the literature is replete with speculations and observations, complete understanding of the thyroid gland‐auditory system relationship is lacking. Several known syndromes, seemingly unrelated except for the association of hearing loss and thyroid abnormalities, have been described and, from the standpoint of hearing loss, may be conveniently divided into four groups: 1. non‐genetic congenital; 2. non‐genetic acquired; 3. genetic congenital; and 4. genetic delayed.
Facial rehabilitation: Surgical reconstruction following temporal bone resection
Authors: Berkowitz Wallace P. , Miller David W. , Alonso William A.
Published: September 2006

Facial reconstruction and cosmetic surgery following extensive bone and soft tissue resection for carcinoma of the ear has not been emphasized in the past. Poor long term survival and local recurrence rates previously precluded considering extensive rehabilitative effort. A patient is presented, illustrating the problems resulting from major ablative surgery of the temporal bone. The surgical concepts and techniques used in this patient's facial rehabilitation are enumerated and described from both the functional and cosmetic aspect. The necessity for developing an innovative surgical approach is enhanced by improved long term patient survival. Application of the principles used to other aspects of facial reconstruction are mentioned.
Cytology of nasal secretions: Further diagnostic help
Authors: Bickmore John T. , Marshall Mary L.
Published: September 2006

Nasal cytograms, as an aid to diagnosis of pathological conditions of the nose and paranasal sinuses, have not been adopted by the majority of otolaryngologists. This situation exists because of technical problems with the preparation of a slide and the difficulty in finding someone competent and interested in its interpretation.

The work of the Bryans has provided an analysis of the cytology of nasal secretions. Adopting their methods, we have been using the nasal cytogram in clinical practice and find it helpful in determining appropriate therapy for problems encountered in otolaryngological practice.

In the authors' experience, profuse nasal mastocytosis is a consistent finding in cytograms from patients having varied symptoms that are associated with hypersensitivities that are not accompanied by positive objective findings. This is especially true in patients with constantly recurring headaches and those with a chronically obstructed nose. Once many mast cells are found by the cytogram, attempts are made to relieve these patients by selective dietary restrictions. These attempts are often successful.

The nasal cytogram is also used to help explain periodic symptom flares in the long term allergy patient undergoing immunotherapy for inhalants, by identifying superimposed viral and bacterial infections.
Aspiration cytology of salivary gland tumors: Diagnostic experience from six years of routine laboratory work
Authors: Lindberg Lars GÖRan , Åkerman MÅNs
Published: September 2006

Fine‐needle aspiration cytology has been used as a routine diagnostic instrument in patients with salivary gland lesions during 1966–1972. A retrospective analysis of the primary cytologic reports correlated with the revised final diagnoses in 461 patients where a pathologic report is available, shows exact agreement in 63 percent, good and not misleading agreement in a further 18 percent, while false reports were initially given in 8 percent, and unsatisfactory specimens were obtained in 11 percent of the patients. On revision of the false reports it is found that with the present experience acquired over several years these can be reduced to under 5 percent. This analysis has also given indications upon which types of specimens are likely to cause diagnostic difficulties.
Nonunion of the mandible
Authors: Mathog Robert H. , Boies Lawrence R.
Published: September 2006

Nonunion of the mandible was evaluated over a five‐year period (1968–1973). Fourteen cases were noted out of 577 mandibular fractures for an incidence of 2.4 percent.

Causes of the complications were determined by a careful review of the poorly healing and successfully treated cases of mandibular fracture. The most important feature in nonunion cases was the large proportion of edentulous patients. In these cases immobilization appeared difficult, especially when only one form of fixation was used to stabilize the fracture, Other suspected causes of nonunion were postoperative trauma and osteomyelitis. These factors were most prevalent in the lower socio‐economic groups.

Factors which did not appear important were sex, age and cause of the fracture. Analysis of the site of injury, combinations of sites, timing of treatment, periosteal stripping and general health of the patient failed to demonstrate any predisposition to the complication.

Treatment of nonunion was confined to standard techniques of debridement, antibiotic therapy and further immobilization. Although most patients responded to this therapy, six patients required closure of the deficit by bone grafting.

On the basis of accumulated data, it was possible to clarify the factors in the development of nonunion. It was also possible to recommend methods of prevention of the complication and to substantiate the success of several forms of therapy.
The protean clinical features of polymorphic reticulosis (lethal midline granuloma)
Authors: McDonald Thomas J. , Deremee Richard A. , Harrison Edgar G. , Facer George W. , Devine Kenneth D.
Published: September 2006

Confusion surrounds the entity known as “lethal midline granuloma.” Partly responsible is the lack of specificity in this term. “Polymorphic reticulosis” has been used as a term to describe the morphology of the disease.

Thirty‐two cases illustrate the protean features of this disease. Although it commonly presents in the head and neck, other sites such as the lungs, kidneys, skin, and gastrointentinal tract may be involved, either alone or in conjunction with lesions of the head and neck. Clinically, it is easily confused with Wegener's granulomatosis. Histopathologic differentiation, however, is both feasible and important. Wegener's granulomatosis is treatable with steroids with or without cyclophosphamide; polymorphic reticulosis confined to one site responds to irradiation.

In polymorphic reticulosis, the best results of treatment are obtained in localized lesions of the upper airway treated early with irradiation; a poorer outcome is associated with multifocal involvement, which necessitates systemic therapy.
Malignancies of the ear
Authors: Conley John , Schuller David E.
Published: September 2006

Cancer of the ear is an uncommon occurrence and rarely diagnosed early in its development. Routine biopsy of all granulomatous and neoplastic diseases of the ear is essential to early diagnosis. Polytomography is an aid in documenting the extent of the disease in bone. The surgical anatomy of the region of the ear imposes special disadvantages upon any type of surgical technique employed and supervoltage irradiation given. Temporal bone resection and its modifications, combined with irradiation, enhance the cure rate in the advanced cases and add significantly to the local control of this disease. A review of 273 cases is presented.
The human external auditory canal secretory system — an ultrastructural study
Authors: Main Thomas , Lim David
Published: September 2006

Human external auditory canal skin, with a special emphasis on the secretory system, was studied by light, transmission electron and scanning electron microscopy. Two types of secretory glands were observed: modified apocrine (ceruminous) and sebaceous. The sebaceous secretory cells showed a typical holocrine mode of secretion, and its secretory vacuoles were homogeneous; on the other hand, modified apocrine secretory cells contained heterogeneous secretory granules. They were ither dark granules or light granules. In addition to these granules there were secretory vesicles. Evidence to support both the apocrine as well as the eccrine mode of secretion was noted in the modified apocrine gland. This finding is partly in agreement with early reports based on light microscopy which suggested only an apocrine mode and data based on transmission electron microscopy which showed only the eccrine mode. Significance of the secretion by the external ear canal and its role in a local immune defense system is discussed.
The role of aminopeptidases in inflammatory and neoplastic tissues
Authors: Spector Gershon J.
Published: September 2006

The role of leucine and alanine aminopeptidases is studied in three different biologic systems: experimental wound healing in the rat, experimental carrageenan induced intradermal granulomas in the rat, and human laryngeal carcinomas.

The wound healing experiments indicate that the proliferating granulation tissue has high quantities of aminopeptidase activity which is residing primarily intracellularly in granulocytes, macrophages, mast cells, fibroblasts, and new budding vessels. The quantitative levels of tissue aminopeptidases correlate positively with the degree of cellularity of the wound and fibroblastic activity. Some aminopeptidases (isoenzymes) are secreted or released by the fibroblasts into the blood serum. Starch gel electrophoretic analysis demonstrates that in fibroblasts there are at least three groups of aminopeptidases with different concentrations and migration rates. Two are probably released or secreted into the serum, and the third is membranous bound in the cytoplasm (lysosomal).

The carrageenan intradermal granuloma demonstrates a different inflammatory reaction which is rich in macrophages and produces a different pattern of aminopeptidase activity. Macrophages produce a high tissue level of aminopeptidase activity which is intracellularly bound and not readily leached out into the serum. Gel electrophoretic studies of amino‐peptidases produced by the granuloma demonstrate that the tissue bound enzyme is the main component. In addition, there appears to be a mechanism, which is not understood, for specific induction or activation of lysosomal proteolytic and carbohydrase enzymes. This mechanism is dependent on the nature and composition of the injuring agent.

Laryngeal carcinomas demonstrate high tissue homogenate levels and normal serum levels of aminopeptidase activities. These enzymes are located in the tumor stroma. They are not directly related to tumor invasiveness but to the degree of stromal proliferation. The tumor stroma behaves as though it were a non‐healing wound constantly secreting proteolytic enzymes (aminopeptidases).

A major problem that needs to be resolved is to find the operating mechanism by which malignant cells interact with their constantly proliferating fibroblastic stroma.
Fractures of the edentulous maxilla and mandible
Authors: Welsh Louis W. , Welsh John J.
Published: September 2006

An evaluation and treatment of fracture of the edentulous maxilla and/or mandible is presented. The LeFort classification of maxillary fractures is the foundation for the program of care. Immobilization techniques are based upon the support of a fracture by suspension from the adjacent stable segments to the modified prosthesis. The mandibular fractures are repaired by interosseous wire fixation in the body and symphysis region, the other fracture sites are supported by circumferential wiring to the prosthesis for immobilization.

General principles of time of repair, diet, types of healing factors are reviewed.
Medullary carcinoma of the thyroid gland
Authors: Shapiro Myron J.
Published: September 2006

Endocrine as well as oncologic attributes mark this rare tumor as unique. It is derived from “C cells” resembling the parafollicular cells of lower animals; these cells elaborate Calcitonin which acts as a sensitive signal of the presence of the tumor. Other endocrinopathies are present in 70 percent of cases so that the tumor may present as part of a complex but increasing well known clinical picture. In 10 percent the tumor occurs as an autosomal dominate trait; in the remainder, the occurrence is sporadic. As expected the lesions are “cold” on I131 scan. The histologic appearance of amyloid is characteristic. Regional lymph node metastasis occurs early.

The tumor deserves appropriate aggressive management. Essentially surgical therapy should begin early and vigorously; the minimum procedure should be total thyroidectomy. Frequent lymph node metastasis speaks for the need for radical neck dissection which should be extended into the superior mediastinum. Management should also include the frequently associated endocrinopathies, particularly pheochromocytomas which must be suspected and eradicated prior to treatment of the thyroid tumor. A genetic workup should be included.

Six cases are described, ranging in age from the third to the eighth decade. Only two were free of disease at this writing, two were alive with their disease and two were dead of their disease. All were of the sporadic group, and only one had associated endocrinopathies. None of these cases were diagnosed preoperatively.
The role of cellular degeneration in the normal development of (rat) otocyst
Authors: Marovitz William F. , Shugar Joel M. A. , Khan Khalid M.
Published: September 2006

From day 12 to 16 of gestation a highly circumscribed zone of cellular degeneration has been observed in the otocyst of more than 50 normal rats. This zone appears to be produced by selective or programmed cell death, and results in the elimination of unneeded cellular elements. That cells in this zone are also selectively destroying subcellular organelles as a first step in specialization is also discussed.

Programmed cellular death has long been known in other systems and is often an obligatory companion to cellular specialization. The ear now joins the long list of organs which demonstrate this phenomenon.
Physician and patient‐induced diseases in otolaryngology office practice
Authors: Schramm Victor L.
Published: September 2006

“Theragenic” diseases produce common ENT complaints. They are frequently and predictably induced by self or physician treatment. Fifteen percent of first office visits in various practice situations stem from ther‐apeutically‐induced disease. Self treatment by cotton tip applicator ear cleaning, nasal decongestants, mouth washes, and lozenges produce symptoms which mimic other etiologies. Prescription medications produce diseases with ENT symptoms which are based on pharmacologic toxicity, multiple drug therapy, drug intolerance, and occasional idiopathic hyper‐sensitivity. The treatment of these diseases is simple and effective once their etiology is discovered.
Computerized tomography (ct) in otolaryngology
Authors: Wortzman G. , Holgate R. C.
Published: September 2006

Computerized tomography (CT) of the brain has been available since 1973 and has changed neurological, neurosurgical and radiological practice beyond recognition. A rapid growth of literature has documented its role in the diagnosis of intracranial hematoma, cerebral atrophy, brain tumor, orbital lesions and postoperative tumor evaluation.

This computerized method of image reconstruction is now also being applied to the rest of the body and to other diagnostic modalities such as isotopes and ultrasound.

The initial impact of CT scanning in otolaryngology is largely in four areas:

Facial deformities either acquired or congenital as hypertelorism, fibrous dysplasia, ossifying fibroma and Crouzon's disease.

Tumors involving sinuses primarily or by secondary invasion.

Cerebello‐pontine angle lesions as meningiomas, acoustic neuromas, and glomus jugulare tumors. The larger acoustic neuroma is well visualized by this technique rendering contrast myelography unnecessary.

In CT scanning, subtle differences in position and an increase in density before contrast enhancement should allow a differentiation of angle meningiomas from acoustic neuromas; in addition, CT scanning has a very important role in the postoperative assessment of angle tumors.

Infections as cerebral abscess or cerebritis secondary to sinus or mastoid disease.

The future holds changes that will allow much finer detail, re‐orientation of the horizontal information into any plane, and much more accurate differentiation of tissue density.

The principle of CT image reconstruction is being; applied to both isotope and ultrasound scanning and should improve their accuracy and yield. If the rapid growth of the new technology over the past two years continues, even greater usefulness can be anticipated.
Red chorda tympani nerve in herpes zoster oticus
Authors: May Mark
Published: September 2006

A red chorda tympani nerve was previously reported as a finding limited to patients with Bell's palsy. This is a report of red chorda tympani nerve observed in 3 of 10 patients with Herpes Zoster oticus in whom the chorda tympani was visible. It is speculated that the red discoloration is due to a viral inflammatory process and, therefore, when this sign is present in a patient with idiopathic peripheral facial paralysis, a viral neuropathy should be suspected.
Flap reconstruction in major surgery of the head and neck
Authors: Skolnik E. M. , Yee K. F. , Keyes G. R.
Published: September 2006

The challenging restoration of form and function in radical surgery of the head and neck demands sound concepts and proper execution in reconstruction. Flaps are most frequently employed in reconstruction, following major surgery because of their rich blood supply and cosmetic superiority. Of the many types of flaps known, the midline forehead flap, tem‐poroforehead flap, mastoid‐occipital flap, tongue flap, and deltopectoral flap have enjoyed most popularity. The design and application of these flaps are discussed. Our techniques in reconstruction of the oral cavity, hypopharynx, esophagus, nose, Andy‐Gump deformities (anterior jaw complex resection), pharyngo‐orocutaneous fistulas, and radionecrosis of the mandible are presented.
Reconstruction of Identity After Brain Injury
Authors: Ylvisaker Mark , Feeney Timothy
Published: September 2006

Following severe traumatic brain injury, difficulty with behavioural adjustment and community reintegration is common. A potential contributor to this difficulty is a sense of personal identity that is inconsistent with the restrictions on activity and need for effortful compensation imposed by persistent impairment. We summarise an information processing framework within which the impact of schematic mental models of self is explained and present intervention procedures designed to help individuals with traumatic brain injury reconstruct an organised and positive sense of personal identity. We conclude the paper with three instructive case illustrations.
Language Disabilities, Comorbid Developmental Disorders and Risk for Drug Abuse in Adolescence
Authors: Snow Pamela
Published: September 2006

This paper deals with research which makes links between developmental problems such as language-learning disorders, attentional disorders, and behaviour disturbance on the one hand, and risk for misuse of alcohol and other drugs (AOD) in adolescence on the other. Poor academic performance is frequently cited as a risk for adolescent AOD misuse, however few workers have critically examined the role of linguistically-based academic sub-skills (e.g., oral and written language competence; strong social skills) which normally contribute to academic success, and hence operate as protective factors with respect to risk for AOD misuse. Studies which specifically address language skills and their association with risk for AOD misuse are reviewed, as are investigations which deal with patterns of comorbidity which are typically evident in clinical populations. Particular emphasis is placed on comorbidities between language-learning difficulties on the one hand, and behavioural or attentional disorders, on the other. It is argued that more explicitly investigating and intervening at the level of core language/social skill competencies might serve to strengthen protective factors in vulnerable groups. It is also noted that comorbid problems need to be considered as important covariates in studies of language disordered children and adolescents, rather than being treated as exclusionary criteria.
First do no Harm. Culturally-Appropriate Neuropsychological Assessment for Indigenous People: A Position Paper
Authors: Ogden Jenni A.
Published: September 2006

This paper outlines some of the issues that arise when neuropsychologists, usually white, are faced with carrying out neuropsychological assessments on indigenous people. Whilst the focus is on the New Zealand situation and the assessment of Maori, it is suggested that some of the issues and possibly some of the solutions will provide a useful starting point for other countries, including Australia, where indigenous people have been colonised and as a result are over-represented in many of the negative statistics. New Zealand is in a transition stage where the number of indigenous clinical psychologists and neuropsychologists is growing but is still very small. Even when there are enough Maori neuropsychologists to serve the needs of Maori clients, there will still be situations when Maori prefer to be seen by a white neuropsychologist, or when a white neuropsychologist is the only professional available with the appropriate expertise related to the assessment of a particular disorder. It is therefore our professional responsibility to develop knowledge and skills that will assist us to carry out culturally-fair assessments which can lead to a better outcome for the client, and at the very least can reduce the harm done by an insensitive and invalid assessment.
Recovery Profiles of Cognitive-Sensory Modalities in Patients in the Minimally Conscious State Following Traumatic Brain Injury
Authors: Smith Vanessa H. , Taylor Christine M. , Lammi Michele H. , Tate Robyn L.
Published: September 2006

Over the past two decades there has been an increasing number of patients surviving severe traumatic brain injury and entering rehabilitation facilities at an earlier phase in their recovery. These patients often present in a minimally conscious state and are difficult to objectively assess. As a result, a number of batteries have been developed targeting this population. The Western Neuro Sensory Stimulation Profile (WNSSP) was used in the present study to identify patterns in recovery of cognitive-sensory modalities. The WNSSP records of 25 patients in a minimally conscious state were examined and profiles of recovery over four test occasions of a subset of 12 patients were examined in detail. Results demonstrated that within this highly heterogeneous group, Object Manipulation was an early emerging skill, and trends to significance were also observed in Auditory Response, Visual Tracking and Olfactory Response. A case study is presented to illustrate how the WNSSP results can be utilised to direct individualised treatment planning.
Transcranial Magnetic Stimulation over Sensorimotor Cortex Disrupts Anticipatory Reflex Gain Modulation for Skilled Action
Authors: Kimura Toshitaka , Haggard Patrick , Gomi Hiroaki
Published: September 2006

Skilled interactions with new environments require flexible changes to the transformation from somatosensory signals to motor outputs. Transcortical reflex gains are known to be modulated according to task and environmental dynamics, but the mechanism of this modulation remains unclear. We examined reflex organization in the sensorimotor cortex. Subjects performed point-to-point arm movements into predictable force fields. When a small perturbation was applied just before the arm encountered the force field, reflex responses in the shoulder muscles changed according to the upcoming force field direction, indicating anticipatory reflex gain modulation. However, when a transcranial magnetic stimulation (TMS) was applied before the reflex response to such perturbations so that the silent period caused by TMS overlapped the reflex processing period, this modulation was abolished, while the reflex itself remained. Loss of reflex gain modulation could not be explained by reduced reflex amplitudes nor by peripheral effects of TMS on the muscles themselves. Instead, we suggest that TMS disrupted interneuronal networks in the sensorimotor cortex, which contribute to reflex gain modulation rather than reflex generation. We suggest that these networks normally provide the adaptability of rapid sensorimotor reflex responses by regulating reflex gains according to the current dynamical environment.
Winter Cereal Cover Crop Mulches and Inter‐Row Cultivation Effects on Cotton Development and Grass Weed Suppression
Authors: Vasilakoglou I. , Dhima K. , Eleftherohorinos I. , Lithourgidis A.
Published: September 2006

A field experiment was conducted under Mediterranean conditions to study the effects of two barley (Hordeum vulgare L.), six triticale (X Triticosecale Wittmack) cultivars and three rye (Secale cereale L.) populations, used as cover crop mulches on the development of barnyardgrass [Echinochloa crus‐galli (L.)], bristly foxtail [Setaria verticillata (L.) P. Beauv.], large crabgrass [Digitaria sanguinalis (L.) P. Scop.], and cotton (Gossypium hirsutum L.). Cotton was grown with cereal mulches alone or in treatment combinations that included inter‐row cultivation, herbicide (quizalofop) application, or both. Three weeks after cotton planting, barnyardgrass, bristly foxtail, and large crabgrass emergence in mulched treatments was 28 to 69%, 33 to 57%, and 35 to 83% lower, respectively, than emergence in mulch‐free treatments. On the contrary, cotton emergence was not significantly affected by any of the cover crop mulches. Shoot number and fresh weight of the three weeds were in most cases decreased in cereal‐mulched treatments and were less in inter‐row cultivated treatments compared to those in uncultivated treatments. Cotton lint yields in cereal mulched‐inter‐row‐cultivated treatments were 28 to 84% greater than that in the corresponding mulch‐free treatments. However, cotton produced more lint yield when the three grasses had been controlled by quizalofop. The results of this study indicated that some winter cereals have the ability to suppress germination of annual grass weeds and in combination with inter‐row cultivation could increase cotton yield. However, herbicide usage is essential to maximize cotton yield and consequently to satisfy cotton producers.
Assessment of the Amino Sugar–Nitrogen Test on Iowa Soils: I. Evaluation of Soil Sampling and Corn Management Practices
Authors: Barker D. W. , Sawyer J. E. , Al‐Kaisi M. M.
Published: September 2006

A soil N test capable of measuring the soil organic N fraction that contributes to plant available N would be useful to corn (Zea mays L.) producers as they make N fertilizer rate decisions. The objectives of this study were to evaluate the effects of soil sampling time, sampling depth, long‐term crop rotation, and long‐term N fertilizer application on the amino sugar–N test (ASNT). Soil samples from 43 N rate trials were analyzed using the ASNT procedure. The ASNT was also determined on soil samples from two sites having several crop rotations and N fertilizer rates in place for the past 18 and 24 yr. The ASNT results were consistent over time but show variation from week to week and were more variable at sites with high soil organic C or manure application history. Amino sugar–N test values from the 0‐ to 15‐cm soil depth were usually greater than the 15‐ to 30‐cm or 0‐ to 30‐cm depths. Crop rotations that included alfalfa (Medicago sativa L.) resulted in greater ASNT values than continuous corn and corn rotated with soybean [Glycine max (L.) Merr.]. Therefore, sampling depth and rotation should be taken into consideration when calibrating the ASNT. Long‐term N fertilization rate did not consistently influence ASNT values. Differences between soils had larger effects on the ASNT than corn management practices. Sampling before N application in the fall, early spring before planting, or late spring during the growing season should provide similar ASNT results and flexibility in sample collection before N application.
Assessment of the Amino Sugar–Nitrogen Test on Iowa Soils: II. Field Correlation and Calibration
Authors: Barker D. W. , Sawyer J. E. , Al‐Kaisi M. M. , Lundvall J. P.
Published: September 2006

There has been growing interest in using the amino sugar–nitrogen test (ASNT) to improve N fertilization of corn (Zea mays L.). The ASNT is intended to measure the soil organic N fraction that contributes to plant available N. The objectives of this study were to correlate the ASNT to corn N response measures and calibrate the test to Iowa soils and climatic conditions. Soil samples were collected in the fall, early spring, and late spring at the 0‐ to 15‐cm and 0‐ to 30‐cm sample depths. No significant correlation could be found between the ASNT and relative leaf chlorophyll meter value, relative grain protein, relative grain yield, grain yield response to applied N, and economic optimum N rate (EONR). The ASNT was not able to differentiate sites that were responsive or nonresponsive to N fertilization and could not be calibrated to EONR. There were strong linear correlations between the ASNT and total soil N (TSN), hydrolyzable NH4–N, and hydrolyzable NH4 + amino sugar–N. The ASNT was not significantly correlated to hydrolyzable amino sugar–N. The soils tested in this study had large amounts of hydrolyzable NH4–N relative to hydrolyzable amino sugar–N, which may partially explain the poor results with the ASNT. Also, liberation of a constant proportion of TSN by the ASNT procedure explains the inability of the test to estimate a specific portion of soil N that contributes to plant available N. Based on the results of this work, the ASNT is not recommended in Iowa for estimating corn N responsiveness or adjusting N application rate.
On the Other Side
Authors: Bohjanen Sara
Published: March 2024

In this narrative medicine essay, a medical student participating in a study learns she has Lynch syndrome, setting off a cascade of emotions of dread, fear, and some hope in diagnostic plans and future breakthroughs in cancer treatment.
Russia’s Denial of Health Care as a Weapon of War in Occupied Ukrainian Territories
Authors: Poltavets Uliana , DeVos Christian , Heisler Michele
Published: March 2024

This Viewpoint discusses Russia’s mandate that Ukrainian citizens adopt Russian nationality and acquire Russian passports as a precondition for gaining access to health care.
Folic Acid–Fortified Iodized Salt and Serum Folate Levels in Reproductive-Aged Women of Rural India
Authors: Pattisapu Jogi V. , Manda Vijayasekhar V. , Kottakki Madhu Narayana Rao , Kajana Phani Madhavi , Kancherla Vijaya , Bhaganagarapu Hayagriva Rao , Veerappan Vigneshwar , Ediga Achuith , Mannar Venkatesh , Diosady Levente , Oakley Godfrey P.
Published: March 2024

Importance

India has a disproportionately high prevalence of neural tube defects, including spina bifida and anencephaly (SBA), causing a high number of stillbirths, elective pregnancy terminations, and child mortality; India contributes a large proportion of the global burden of SBA. Thirty years after folic acid was shown to be effective in reducing SBA prevalence, only about one-quarter of such births are prevented globally through cereal grain fortification.

Objective

To determine the association of folic acid–fortified iodized salt with serum folate concentrations among nonpregnant and nonlactating women of reproductive age.

Design, Setting, and Participants

This nonrandomized controlled trial using a preintervention and postintervention design was conducted in 4 rural villages in Southern India from July 1 to November 30, 2022. All households in the villages agreed to participate in the study. Preintervention and postintervention serum folate levels were analyzed among study participants at baseline and after 4 months, respectively.

Intervention

Consumption of approximately 300 µg/d of folic acid using double fortified salt (folic acid plus iodine). Median serum folate concentrations were assessed at baseline and 4 months.

Main Outcomes and Measures

Change in median serum folate levels between baseline and study end point as the primary outcome of the study.

Results

A total of 83 nonpregnant nonlactating women aged 20 to 44 years (mean [SD] age, 30.9 [5.1] years) were eligible for the study and provided serum samples for analysis at baseline and the end point of the intervention. The median serum folate concentration increased from 14.6 (IQR, 11.2-20.6) nmol/L at baseline to 54.4 (IQR, 43.5-54.4) nmol/L at end of study, a 3.7-fold increase from baseline to study end point. Two-tailed Wilcoxon signed rank test showed the median difference in preintervention and postintervention serum folate concentrations to be highly significant (P < .001). The participants found the salt acceptable in color and taste.

Conclusions and Relevance

Use of folic acid–fortified iodized salt was associated with increased serum folate concentrations in women of reproductive age. This novel evidence can inform public health policy to accelerate SBA prevention.

Trial Registration

ClinicalTrials.gov Identifier: NCT06174883