bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal quantitative MRI assessment of cortical damage in multiple sclerosis: A pilot study
Authors: Gracien René‐Maxime , Reitz Sarah C. , Hof Stephanie‐Michelle , Fleischer Vinzenz , Droby Amgad , Wahl Mathias , Steinmetz Helmuth , Groppa Sergiu , Deichmann Ralf , Klein Johannes C.
Published: February 2017

Purpose

Quantitative MRI (qMRI) allows assessing cortical pathology in multiple sclerosis (MS) on a microstructural level, where cortical damage has been shown to prolong T1‐relaxation time and increase proton density (PD) compared to controls. However, the evolution of these changes in MS over time has not been investigated so far. In this pilot study we used an advanced method for the longitudinal assessment of cortical tissue change in MS patients with qMRI in comparison to cortical atrophy, as derived from conventional MRI.

Materials and Methods

Twelve patients with relapsing‐remitting MS underwent 3T T1/PD‐mapping at two timepoints with a mean interval of 12 months. The respective cortical T1/PD‐values were extracted from the middle of the cortical layer and the cortical thickness was measured for surface‐based identification of clusters with increasing/decreasing values.

Results

Statistical analysis showed clusters with increasing PD‐ and T1‐values over time (annualized rate for T1/PD increase in these clusters: 3.4 ± 2.56% for T1, P = 0.0007; 2.3 ± 2.59% for PD, P = 0.01). Changes are heterogeneous across the cortex and different patterns of longitudinal PD and T1 increase emerged. Analysis of the cortical thickness yielded only one small cluster indicating a decrease of cortical thickness.

Conclusion

Changes of cortical tissue composition in MS seem to be reflected by a spatially inhomogeneous, multifocal increase of the PD values, indicating replacement of neural tissue by water, and of the T1‐relaxation time, a surrogate of demyelination, axonal loss, and gliosis. qMRI changes were more prominent than cortical atrophy, showing the potential of qMRI techniques to quantify microstructural alterations that remain undetected by conventional MRI.

Level of Evidence: 1

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2017;46:1485–1490.
HIV sequence diversity during the early phase of infection is associated with HIV DNA reductions during antiretroviral therapy
Authors: Wang Nidan , Li Yijia , Han Yang , Xie Jing , Li Taisheng
Published: February 2017

The association between baseline human immunodeficiency virus (HIV) sequence diversity and HIV DNA decay after the initiation of antiretroviral therapy (ART) remains uncharacterized during the early stages of HIV infection. Samples were obtained from a cohort of 17 patients with early HIV infection (<6 months after infection) who initiated ART, and the C2V5 region of the HIV‐1 envelope (env) gene was amplified via single genome amplification (SGA) to determine the peripheral plasma HIV quasispecies. We categorized HIV quasispecies into two groups according to baseline viral sequence genetic distance, which was determined by the Poisson–Fitter tool. Total HIV DNA in peripheral blood mononuclear cells (PBMCs), viral load, and T cell subsets were measured prior to and after the initiation of ART. The median SGA sequence number was 17 (range 6–28). At baseline, we identified 7 patients with homogeneous viral populations (designated the Homogeneous group) and 10 patients with heterogeneous viral populations (designated the Heterogeneous group) based on SGA sequences. Both groups exhibited similar HIV DNA decay rates during the first 6 months of ART (P > 0.99), but the Homogenous group experienced more prominent decay than the Heterogeneous group after 6 months (P = 0.037). The Heterogeneous group had higher CD4 cell counts after ART initiation; however, both groups had comparable recovery in terms of CD4/CD8 ratios and CD8 T cell activation levels. Viral population homogeneity upon the initiation of ART is associated with a decrease in HIV DNA levels during ART. J. Med. Virol. 89:982–988, 2017. © 2017 Wiley Periodicals, Inc.
Full genome analysis of rotavirus G9P[8] strains identified in acute gastroenteritis cases reveals genetic diversity: Pune, western India
Authors: Tatte Vaishali S. , Chaphekar Deepa , Gopalkrishna Varanasi
Published: February 2017

Group A rotaviruses (RVA) are the major enteric etiological agents of severe acute gastroenteritis among children globally. As G9 RVA now represents as one of the major human RVA genotypes, studies on full genome of this particular genotype are being carried out worldwide. So far, no such studies on G9P[8] RVAs have been reported from Pune, western part of India. Keeping in view of this, the study was undertaken to understand the degree of genetic diversity of the commonly circulating G9P[8] RVA strains. Rotavirus surveillance studies carried out earlier during the years 2009‐2011 showed increase in the prevalence of G9P[8] RVAs. Representative G9P[8] RVA strains from the years 2009, 2010, and 2011 were selected for the study. In general, all the G9 RVA strains showed clustering in the globally circulating sublineage of the VP7 gene and showed nucleotide/amino acid identities of 96.8‐99.7%/96.9‐99.8% with global G9 RV strains. Full genome analysis, of all three RVAs in this study indicated Wa‐like genotype constellation G9‐P[8]‐I1‐R1‐C1‐M1‐A1‐N1‐T1‐E1‐H1. Within the strains nucleotide/amino acid divergence of 0.1‐3.4%/0.0‐4.1% was noted in all the RVA structural and non‐structural genes. In conclusion, the present study highlights intra‐genotypic variations throughout the RVA genome. The study further emphasizes the need for surveillance and analysis of the whole genomic constellation of the commonly circulating RVA strains of other regions in the country for understanding to a greater degree of the impact of rotavirus vaccination recently introduced in India.
The clinical and phylogenetic investigation for a nosocomial outbreak of respiratory syncytial virus infection in an adult hemato‐oncology unit
Authors: Nabeya Daijiro , Kinjo Takeshi , Parrott Gretchen Lynn , Uehara Ayako , Motooka Daisuke , Nakamura Shota , Nahar Saifun , Nakachi Sawako , Nakamatsu Masashi , Maeshiro Sakuko , Haranaga Shusaku , Tateyama Masao , Tomoyose Takeaki , Masuzaki Hiroaki , Horii Toshihiro , Fujita Jiro
Published: February 2017

Although many reports have already shown RSV outbreaks among hemato‐oncology patients, genomic studies detecting similar RSV strains prior to an outbreak in the hospital are rare. In 2014, the University of the Ryukyus hospital hemato‐oncology unit experienced, and successfully managed, a respiratory syncytial virus (RSV) nosocomial outbreak. During the outbreak investigation, genotyping and phylogenetic analysis was used to identify a potential source for the outbreak. Nasopharyngeal swabs were tested for RSV using three tests: (1) rapid antigen test (RAT); (2) reverse transcriptase polymerase chain reaction (PCR); or (3) quantitative PCR (RT‐qPCR); a positive PCR reaction was considered a confirmed case of RSV. Phylogenetic analysis of the G protein was performed for outbreak and reference samples from non‐outbreak periods of the same year. In total, 12 confirmed cases were identified, including 8 hemato‐oncology patients. Patient samples were collected weekly, until all confirmed RSV cases returned RSV negative test results. Median time of suspected viral shedding was 16 days (n = 5, range: 8‐37 days). Sensitivity and specificity of the RAT compared with RT‐qPCR were 30% and 91% (n = 42). Phylogenetic analysis revealed nine genetically identical strains; eight occurring during the outbreak time period and one strain was detected 1 month prior. A genetically similar RSV detected 1 month before is considered one potential source of this outbreak. As such, healthcare providers should always enforce standard precautions, especially in the hemato‐oncology unit.
Catamenial‐like seizure exacerbation in mice with targeted ablation of extrasynaptic δGABA‐a receptors in the brain
Authors: Clossen Bryan L. , Reddy Doodipala Samba
Published: February 2017

Neurosteroids play a key role in catamenial epilepsy, a menstrual cycle‐related seizure clustering in women with epilepsy. While neurosteroids act on all GABA‐A receptor isoforms, they cause greater effects on extrasynaptic δGABA‐A receptors that mediate tonic inhibition in the brain. Previously, we identified a potential GABA‐A receptor mechanism for catamenial epilepsy. However, the precise functional role of extrasynaptic δGABA‐A receptors in the pathophysiology of catamenial epilepsy remains unclear. In this study, we utilized mice lacking extrasynaptic δGABA‐A receptors (δKO) to investigate whether reduction of tonic inhibition affects catamenial seizure susceptibility or intensity. Intact female wildtype (WT) and δKO mice were subjected to hippocampus kindling until they exhibited stage 5 seizures. Elevated gonadal hormone‐based neurosteroid levels were induced by standard gonadotropin regimen and neurosteroid withdrawal (NSW) was triggered by finasteride. NSW increased susceptibility to, as well the intensity of evoked catamenial‐like seizures in WT and δKO mice. However, fully kindled δKO mice exhibited an accelerated and augmented response to NSW, with a more rapid increase in seizure susceptibility and intensity than WT mice undergoing the NSW paradigm. Moreover, δKO mice in NSW showed reduced benzodiazepine sensitivity, but in stark contrast to the increased neurosteroid sensitivity observed in WT animals, δKO mice displayed no change in neurosteroid sensitivity in response to NSW. The increased catamenial seizure exacerbation and alterations in antiseizure drug responses are consistent with NSW‐induced changes in the abundance of δGABA‐A receptors. Collectively, these findings provide evidence of a potential protective role for extrasynaptic δGABA‐A receptors in catamenial‐like seizures. © 2017 Wiley Periodicals, Inc.
Holocene variability in sea ice cover, primary production, and Pacific‐Water inflow and climate change in the Chukchi and East Siberian Seas (Arctic Ocean)
Authors: Stein Ruediger , Fahl Kirsten , Schade Inka , Manerung Adelina , Wassmuth Saskia , Niessen Frank , Nam Seung‐Il
Published: February 2017

In this study, we present new detailed biomarker‐based sea ice records from two sediment cores recovered in the Chukchi Sea and the East Siberian Sea. These new biomarker data may provide new insights on processes controlling recent and past sea ice changes. The biomarker proxy records show (i) minimum sea ice extent during the Early Holocene, (ii) a prominent Mid‐Holocene short‐term high‐amplitude variability in sea ice, primary production and Pacific‐Water inflow, and (iii) significantly increased sea ice extent during the last ca. 4.5k cal a BP. This Late Holocene trend in sea ice change in the Chukchi and East Siberian Seas seems to be contemporaneous with similar changes in sea ice extent recorded from other Arctic marginal seas. The main factors controlling the millennial variability in sea ice (and surface‐water productivity) are probably changes in surface water and heat flow from the Pacific into the Arctic Ocean as well as the long‐term decrease in summer insolation. The short‐term centennial variability observed in the high‐resolution Middle Holocene record is probably related to solar forcing. Our new data on Holocene sea ice variability may contribute to synoptic reconstructions of regional to global Holocene climate change based on terrestrial and marine archives.
Nasal Airway Resistance Computer
Authors: Hamilton L. H. , Christman N. T.
Published: February 2017

An analogue computing system for the measurement of nasal airway resistance (Rn) has been developed. The instrument operates on the principle of measuring the transnasal pressure required to generate a measured nasal airflow rate. The system computes and displays inspiratory or expiratory nasal airway resistance measured at a preselected flow rate. The values are updated on a breath‐by‐breath basis and presented to a multi‐channel recorder and a digital panel meter for visualization. The continuous Rn (at all inspiratory and expiratory flow rates above zero) can also be recorded. Use of the instrument for the evaluation of nasal decongestants has been demonstrated.
“Practical Suggestions On Counseling How I Do It”
Authors: Kommers Mary S. , Sullivan Marsha D. , Yonkers Anthony J.
Published: February 2017

A laryngectomee's home environment may be a critical motivating factor for successful rehabilitation. Results from questionnaires to 45 wives of laryngectomees are discussed. The wives evaluated the adequacy of their preparation for the surgery and the type and severity of ensuing problems. Judgments as to the type and adequacy of counseling and the wives' factual understanding of the laryngectomy procedure and its consequences are reported.

Results of the survey underscored the need for more counseling before and after laryngectomy. Wives of older laryngectomees were more optimistic post‐operatively since their primary preoperative fear had been death. Younger wives' spirits were often lowest after surgery when the impact on daily living was more fully realized. The need for a team approach to total medical, speech, and vocational rehabilitation is indicated.
Aerodynamic Relationships Associated with Normal Phonation and Paralytic Dysphonia
Authors: Murry Thomas , Bone Robert C.
Published: February 2017

Physiological differences between normal speakers and those with unilateral vocal cord paralysis are presented. Pressure readings taken intraorally and subglotically are compared during phonation of consonants requiring laryngeal closure and those not requiring cord approximation. From our studies, it is apparent that: (1) a significant difference in air pressure patterns exists between normal speakers and those with vocal cord paralysis, (2) the respiratory apparatus tends to alter normally constant airflow in cases of vocal fold paralysis and (3) either voice therapy or teflon cord injection will significantly alter the aerodynamic relationships from the untreated paralyzed state.
“How I Do It” — Plastic Surgery Practical Suggestions on Facial Plastic Surgery
Authors: Webster Richard C. , Benjamin Barry J. , Smith Richard C.
Published: February 2017

Many surgeons have difficulty in cutting small split thickness skin grafts of consistent thickness and width. We demonstrate techniques using equipment and supplies almost always available for expeditious cutting and handling of small split thickness skin grafts. The methods suggested should allow surgeons to eliminate some of the problems that they have had with this basic technique of reconstruction.
Lymphoma of the Head and Neck
Authors: Fierstein Jeffrey T. , Thawley Stanley E.
Published: February 2017

The natural history of 88 cases of non‐Hodgkin's lymphoma of the head and neck were reviewed. An analysis is presented of the histopathologic, clinical, and prognostic features of these patients which presented to the Washington University Affiliated Hospitals between 1955–1975.

All biopsies were histologically classified according to the criteria of Rappaport and staged according to the Ann Arbor Classification. There were 38 histiocytic lymphomas, 29 poorly differentiated lymphocytic lymphomas, 16 well differentiated lymphocytic lymphomas, and 5 mixed lymphomas.

The lesions were equally divided between Waldeyer's ring and other head and neck sites. Most of the lymphomas were extranodal in presentation. Sixty‐one percent of all cases presented with disease localized to the site of origin; 17% had extension to regional nodes and 21% had generalized disease (Stage III and IV).

In terms of treatment, localized well differentiated lymphocytic lymphoma was treated with radiation therapy. Generalized well differentiated lymphocytic lymphomas were treated with radiation and chemotherapy. Most patients with histiocytic and poorly differentiated lymphocytic lymphoma limited to the site of origin were treated with radiation and all others with combined therapy. Over 90% of patients with Stage I disease were considered cured at the end of three years while the overall survival was 72%.
Total Laryngectomy and Reconstruction of a Pseudoglottis: Problems and Complications
Authors: Sisson George A. , Bytell David E. , Becker Stephen P. , McConnel Fred M.S. , Singer Mark I.
Published: February 2017

A modified procedure for the reconstruction of a pseudoglottis after total laryngectomy is examined. The history of this technique, including our experience, is reviewed with emphasis on problems and complications. Indications and justifications for surgery are discussed. Though we can only speculate on the basis of a few cases, we believe that a good voice can be obtained when a pseudoglottis is either primarily or secondarily constructed after laryngectomy. We acknowledge that perhaps the risk of liability tempers our approach and restricts our case selection which, no doubt, in part accounts for our modification of the procedure that was initially performed in Europe. We believe that continued careful application of this technique and its variations will improve the results of modern laryngeal surgery.
Bone‐Conduction Electrocochleography: Clinical Applications
Authors: Berlin Charles I. , Gondra Maria I. , Casey Dennis A. , Marks Herbert W. , Chicola Jeffrey P. , Garrett Maynard E. , Lyons George D.
Published: February 2017

Cases are presented which show the clinical utility of recording an electrocochleographic response to bone‐conducted stimuli. The procedure is fraught with problems of acoustic control and artifact generation, but has distinct although limited value in clarifying masking dilemmas in patients with bilateral hearing loss.
Fetal Respiratory Distress Causing CNS and Inner Ear Hemorrhage
Authors: Spector Gershon J. , Pettit W. Jay , Davis Gustave , Strauss Melvin , Rauchbach Erol
Published: February 2017

Fifty‐two consecutive temporal bones of infants who died neonatally, or in utero of natural causes, were studied. Complete autopsies were performed. Twenty‐eight infants had a variety of pulmonary disorders which resulted in severe respiratory distress prior to their death. Of these, the majority had bleeding intracranially and into the inner ear. There were five major pathways of central nervous system and subarachnoid hemorrhage involvement of the inner ear: 1) the modiolus, 2) cochlear aqueduct, 3) retrograde via the cochlear vein, 4) episodes of spontaneous bleeding into various compartments of the inner ear, and 4) hemorrhage via the otic capsule.

The remaining 24 infants died of other natural causes. Two had CNS bleeding with no extension to the inner ear.

We propose that there is a syndrome which consists of 1) neonatal respiratory distress, 2) intracranial hemorrhage, and 3) bleeding into the inner ear — an extension of a subarachnoid or subependymal matrix bleeding diathesis.
Tuberculous Otitis Media
Authors: Lucente Frank E. , Tobias Geoffrey W. , Parisier Simon C. , Som Peter M.
Published: February 2017

Tuberculous otitis media is a variable and puzzling infectious disease which may remain undiagnosed or confused with other acute or chronic middle ear conditions if appropriate diagnostic studies are not performed. Among the common clinical findings are insiduous onset of painless watery drainage, severe hearing loss, multiple perforations of the tympanic membrane and subsequent appearance of profuse granulation tissue. As the disease progresses destruction of the middle ear conductive apparatus, facial paralysis, cochlear involvement with labyrinthitis and further hearing loss, and finally intracranial dissemination of infection may occur. The case histories of two patients recently treated at Mount Sinai Hospital illustrate some of the clinical problems encountered with this disease.
Underrated Neurotologic Symptoms
Authors: Hoffman Ronald A. , Brookler Kenneth H.
Published: February 2017

Patients present themselves with neurotologic symptoms which may be early and subtle indicators of active vestibular pathology. The frequently slighted complaints of light‐headedness, imbalance and a floating sensation are as important as “true rotatory vertigo.” Ear fullness, the most underinvestigated of neurotologic complaints may be a cardinal symptom. Occipital headaches are a frequent complaint of the dizzy patient. Blurred vision, and, in some severe peripheral disorders, diplopia are symptoms referrable to oculovestibular interaction. Visual stimulation intensifies vestibular symptoms. Stress may precipitate or increase dizziness in patients who have partially compensated for a vestibular deficit. Anxiety, fatigue and systemic illness are exemplary. Patient histories are presented to emphasize clinical relevance and therapeutic modalities.
Human Incus Long Process Depressions in the Surface of the Normal Ossicle
Authors: Ghorayeb Bechara Y. , Graham Malcolm D.
Published: February 2017

Depressions in the bone surface of the normal human incus long process are found with great frequency. This paper reviews the frequency and distribution of these depressions, discusses their histologic appearance, and speculates upon their significance. While their clinical significance is unclear, they may be related to several conditions encountered in otologic practice.
Maximum Compliance and Ménière's Disease
Authors: Hall C. Mike
Published: February 2017

In this study an electroacoustic impedance bridge and an X–Y recorder were used to measure maximum compliance (Cm) in 53 patients symptomatic of Meniere's disease in only one ear. Various parameters of Meniere's disease were investigated by comparing Cm values between ears. The parameters which were investigated included: (1) Meniere's disease; (2) the symptom of fullness; (3) the length of disease; and (4) the degree of hearing loss.

The data were interpreted as demonstrating that there were differences in Cm which were indicative and consistent with what would be expected for mechanical changes in the inner ear associated with Meniere's disease.
Total Deafness With Chronic Propoxyphene Abuse
Authors: Harell Moshe , Shea John J. , Emmett John R.
Published: February 2017

Sensorineural hearing loss has not been known to be among the toxic effects of propoxyphene (sold under the trade name Darvon™ in the United States) overdosage. Recently a case was reported associated with moderate bilateral sensorineural hearing loss due to accidental overdosage of this drug. This paper presents a case of a progressive bilateral sensorineural hearing loss which resulted in total deafness, in a chronic propoxyphene abuser.
Metastatic Tumors to the Sphenoid Sinus
Authors: Barrs David M. , McDonald Thomas J. , Whisnant Jack P.
Published: February 2017

Patients with cranial nerve palsies and roentgenographic evidence of sphenoid sinus destruction present diagnostic problems. Although the presence of local primary neoplasms may be considered first, metastatic disease from distant sites also should be considered.

We report on eight patients with metastatic tumors to the sphenoid sinus seen at the Mayo Clinic from 1950 through 1976. Primary sites of the lesions included the breast, thyroid gland, lung, kidney, and prostate (two patients). Metastatic myeloma was seen in two patients. Symptoms resulted from involvement of the structures adjacent to the sphenoid sinus and in all patients included diplopia or decreased visual acuity. In four patients, these ocular symptoms were the first sign of disease, after which a complete general examination disclosed the occult primary sites.
Laryngotracheal Trauma: Observations on Its Pathogenesis and Its Prevention Following Prolonged Orotracheal Intubation in the Adult
Authors: Burns Hugh P. , Dayal Vijay S. , Scott Arthur , van Nostrand A. W. Peter , Bryce Douglas P.
Published: February 2017

The authors have clinically examined the larynges of 117 patients who were successfully extubated in a Respiratory Care Unit, and have examined the larynges at autopsy from an additional 68 patients who failed to survive in the same Respiratory Care Unit. Based on these observations, our understanding of the pathogenesis of laryngotracheal trauma has allowed us to modify our clinical management in order to minimize such damage. Influence of this study on the management of patients is described.
Tuberculous Otitis Media: A Series of 22 Patients
Authors: Windle‐Taylor Paul C. , Bailey C. Martin
Published: February 2017

A series of 22 cases of tuberculous otitis media is reviewed to assess the diagnostic features of the disease. Significant clinical features are the presence of abundant pale granulations, an unexpectedly severe hearing loss, facial paralysis, the presence of normal mastoid cellular development and a past or family history of tuberculosis of any site. The otoscopic appearances of the tympanic membrane, and the symptom of painless otorrhea are not considered suspicious features. Histological examination of operative material was the diagnostic procedure in 20/22 cases, thus underlining the difficulty of diagnosis in a non‐tuberculous general population. Treatment with antituberculous chemotherapy and surgery gives good results and recent indications are that tympanoplastic surgery may be useful.
Fibrinolytic Enzyme in Tracheobronchial Secretion of Rats: Existence of Plasminogen Activator
Authors: Kosugi Tadayoshi , Morimitsu Tamotsu , Matsuo Osamu , Mihara Hisashi
Published: February 2017

It is known that a plasminogen activator exists in the secretion of various organs, i.e., the existence of plasminogen activator in milk, tears, saliva, seminal fluids, urine and bile has been already demonstrated. However, the existence of the fibrinolytic enzyme in tracheobronchial secretions has not been known until this time.

We found a new method to collect the tracheobronchial secretion of rats, and succeeded in detecting the fibrinolytic activity in the tracheobronchial secretions. Furthermore, it was found that the substance exhibiting the fibrinolytic activity in this secretion was not protease but plasminogen activator. In addition, some chemical properties of this plasminogen activator are presented, and the physiological and pathophysiological significances of it are discussed in this paper.
Auditory Perceptual Problems in Children: Considerations for the Otolaryngologist and Audiologist
Authors: Musiek Frank E. , Geurkink Nathan A.
Published: February 2017

Five cases of children with auditory processing problems are presented. These children had essentially normal peripheral hearing and ENT exam, but were referred with a question of hearing loss. An auditory perceptual test battery including rapidly alternating speech (RASP), binaural fusion, low pass filtered speech (LPFS), competing sentences, staggered spondiac words (SSW), dichotic digits and frequency patterns was employed. Though some of these tests did not show a perceptual deficit, the majority did depict specific types of auditory processing problems. Based on the information provided by this test battery, appropriate diagnosis and therapy can be provided for the patient.
Central Auditory Testing and Dyslexia
Authors: Welsh Louis W. , Welsh John J. , Healy Michael P.
Published: February 2017

A group of dyslexic pupils with normal end organ function was studied by a central auditory battery to determine whether a hearing disability existed. The clinical features of dyslexia are presented with emphasis on the psychological developmental and functional disorders associated with this reading problem.

The central battery of Willeford was selected as the test medium and the results of the 77 dyslexic students were compared to the normative data.

The model proposed by Sparks, et al., is accepted as the mechanism for dichotic audition. Reference is made to the organic basis of reading disorders from lesion in the calcarine area to the angular gyrus.

The competing sentence test, binaural fusion, rapidly alternating speech perception, and filtered speech are described in detail and are organic foundation for the study.

The authors identified a high rate of failure in this investigation. Over 50% of the dyslexic students failed two of the four tests, and each of the 77 failed at least one component. The most sensitive tests were binaural fusion and filtered speech with less variation from the norm in the remaining two components.

The effect of maturation in central audition was measured in each of the four tests. The data suggest: 1. the scores are lower in the early ages in each test: 2. that rapidly alternating speech and competing sentences approach the normal range albeit somewhat delayed; and 3. that binaural fusion and filtered speech improve in score somewhat but rather moderately and never approach the normal range.

Based upon the central auditory data and in conjunction with the anatomical pathways of vision, the authors suggest the site of lesion to be in the temporo‐parietal cortex and the association fibers.
Partial Adenoidectomy
Authors: Shapiro Robert S.
Published: February 2017

Adenoidectomy in the presence of an inadequate palate may result in velopharyngeal insufficiency. When an adenoidectomy is indicated in a child whose palate is not fully adequate, a partial adenoidectomy may be considered. Partial adenoidectomy involves removing the upper part of the adenoid for relief of nasal obstruction while leaving the lower portion of the adenoid intact to ensure velopharyngeal competence.

Fifty‐eight children underwent partial adenoidectomy over a 4‐year period; 55 of these children had preoperative nasal obstruction; 49 had a tonsillectomy done at the same time; and 2 had had a previous T&A.

The rationale for retaining the lower portion of the adenoid includes a short soft palate, decreased palatal mobility, a mildsubmucous cleft palate, huge tonsils pushing the palate anteriorly, and a short hard palate.

The relief of nasal obstruction was excellent. There were no primary postoperative hemorrhages, and none of the 58 children developed velopharyngeal insufficiency following partial adenoidectomy.
The Relationship Of Idiopathic Sudden Hearing Loss To Diabetes Mellitus
Authors: Wilson William R. , Laird Nan , Soeldner J. S. , Moo-Young George , Kavesh Debra A. , Macmeel J. W.
Published: February 2017

A diabetic subgroup identified from a base population who have experienced idiopathic sudden hearing loss (ISHL) has been studied. In order to assess the relationship between diabetes and ISHL, two non‐diabetic control groups were formed, and a comparision of the audiological data between the diabetic and non‐diabetic ISHL patient was made. Mean degree of hearing loss and recovery, as well as the mean hearing level of the contralateral ear were analyzed. No statistically significant differences were noted in the audiological pattern of ISHL in diabetics and controls. A similar incidence of recovery was noted for the two groups throughout the mid frequencies; however, diabetic ISHL patients fail to recover as well as in the high frequencies. Preliminary data, while not statistically significant, suggest an increased hearing loss in both the affected and unaffected ear of the older diabetic patient.

Additional diagnostic testing, including ENG, BSERA, and diabetic retinopathy examinations were performed but, with the exception of ENG results, did not appear to be clinically significant.
Adenine Nucleotides of The Organ of Corti Under Metabolic Stress
Authors: Thalmann I. , Marcus N. Y. , Thalmann R.
Published: February 2017

The purpose of the reported experiments was to measure the concentrations of adenosine triphosphate (ATP), adenosine diphosphate (ADP), and adenosine monophosphate (AMP) in the organ of Corti in order to arrive at estimates of three commonly used adeny late ratios. Under normal conditions the concentrations of ATP, ADP, and AMP amounted to 15.8, 3.9, and 0.53 mmoles/kg dry weight, respectively. Of the three substances, AMP is the most sensitive indicator of metabolic stress, since ischemia of 65 seconds leads to an increase of 155%. Under normal conditions the adenylate energy charge, the energy status, and the phosphorylation state amounted to 0.83, 4.1, and 2.5 gram wet weight/µmole, respectively. Within 10 minutes of ischemia the energy charge had declined by 26%, the energy status by 50%, and the phosphorylation state by 76%. The apparent equilibrium constant of adenylate kinase of the organ of Corti was found to be 0.55. The potential significance of these data and their relationship to the situation in the stria vascularis are discussed.
Diagnosis and Treatment of Spontaneous Cerebrospinal Fluid Otorrhea
Authors: Neely J. Gail , Neblett Charles R. , Rose James E.
Published: February 2017

Two consecutively operated‐on adult cases with spontaneous cerebrospinal fluid otorrhea were reviewed. Three meningoencephaloceles through tegmental defects were found. Each cele was peduculated through a small dural dehiscence partially obstructed by herniated brain. The otic capsule was normal in both cases.

Bipolar cautery was used to reduce the size of the meningoencephalocele and to allow this tissue to assist in the closure of the defect. Conchal cartilage was placed through the tegmental defect to act as a self maintaining intracranial repair of the bony dehiscence. These cases and the literature suggest that fistulization of dura is more frequently the cause of spontaneous cerebrospinal fluid otorrhea in adults than is a defect in the otic capsule. Thus, direct surgical inspection of these areas is required.
Diagnosis and Management Decisions in Infections of the Deep Fascial Spaces of the Head and Neck Utilizing Computerized Tomography
Authors: Endicott James N. , Nelson Robert J. , Saraceno Carmelo A.
Published: February 2017

Infections of the deep spaces of the head and neck may still result in major consequences despite the advent of antibiotics. Abscesses in these areas merit special consideration by today's head and neck surgeon because of their relative rarity and the life‐threatening complications that may follow inadequate treatment.

Diagnosis and management decisions are enhanced by use of computerized tomography (CT) as an adjunctive study. The EMI scan may demonstrate either cellulitis of the neck requiring no surgery or a space abscess displacing the adjacent structures thus requiring surgical drainage.

Anatomy of the significant fascial planes and spaces of the neck will be reviewed employing CT utilizing 3 mm cuts. Specific case presentations feature early diagnosis and management.
Demonstration of Papillomavirus Antigen in Paraffin Sections of Laryngeal Papillomas
Authors: Braun Lundy , Kashima Haskins , Eggleston Joseph , Shah Keerti
Published: February 2017

A papillomavirus antigen has been identified in tissue sections of laryngeal papillomata removed at endoscopic operations. The demonstration of the papillomavirus antigen was achieved using the peroxidase‐anti‐peroxidase test of Sternberger after a broadly cross‐reactive rabbit antiserum to the papillomavirus capsid antigen was incubated with the tissue sections.

The antigen was detected in specimens from 7 of 15 patients with juvenile‐onset laryngeal papillomas, but could not be demonstrated in the specimens from 6 patients with adult‐onset papillomas. In all, 73 biopsy specimens from 21 patients were selected for study; 18% (11/61) of the sections from the juvenile‐onset patients and 0% (0/12) of the sections from the adult‐onset patient specimens exhibited the papillomavirus antigen.

The presence of the virus antigen did not correlate with the stage of disease, nor with the duration or severity of the illness.

The implications of the findings are discussed.
Pseudocarcinomatous Hyperplasia of the Larynx Due to Candida Albicans
Authors: Hicks Julius N. , Peters Glenn E.
Published: February 2017

A female patient presented with hoarseness. Findings on physical examination showed whitish true vocal cords. Laryngeal biopsies were performed on two occasions. On the first biopsy a histopathological diagnosis of Candida albicans and acanthosis was controversial because the acanthosis resembled squamous cell carcinoma. On the second biopsy, several months later, the diagnosis of acanthosis was again controversial, but a diagnosis of pseudocarcinomatous hyperplasia was not determined until several months later. Finally, we can point out that pseudocarcinomatous hyperplasia can be associated with primary candidiasis and state that hoarseness, whitish true vocal cords, and pseudocarcinomatous hyperplasia can masquerade as squamous cell carcinoma of the larynx.
Carcinoma of the Base of the Tongue: Results of Radical Irradiation with Surgery Reserved for Irradiation Failure
Authors: Parsons James T. , Million Rodney R. , Cassisi Nicholas J.
Published: February 2017

Between 1964 and 1977, 95 previously untreated patients with squamous cell carcinoma of the base of the tongue received treatment with curative intent at the University of Florida. Eighty‐six of the 95 patients (91%) had Stage III or IV disease at presentation. Eighty‐nine patients received radical courses of irradiation to the primary with or without neck dissection(s), with surgery reserved for salvage of irradiation failure. Six patients underwent planned combined treatment to the primary lesion. Of the 89 patients whose primary lesions were radically irradiated, failure at the primary site occurred in 24% of those with T1–3 lesions and 78% with T4 lesions. Control results were related to irradiation treatment technique. None of the 9 patients with Stage I–II disease died of the cancer. Actuarial survival at 5 years for Stage III patients was 46%. Within the Stage IV population there is a subgroup of patients with highly treatable and curable disease. The addition of a neck dissection following irradiation of N2–N3 neck disease decreased the incidence of failure in the neck. No patient developed severe soft tissue necrosis or required mandibulectomy for bone exposure following irradiation.
Sarcoidosis of the Nose and Paranasal Sinuses
Authors: McCaffrey Thomas V. , McDonald Thomas J.
Published: February 2017

Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non‐caseating granulomatous inflammation of various organs. The records of 2319 patients with the diagnosis of sarcoidosis were reviewed to determine the incidence of nasal involvement. Seventeen patients or approximately 1% of the patients with sarcoidosis had histologically proven nasal mucosa involvement. These patients had symptoms of nasal crusting, congestion, epistaxis, pain, or anosmia. The clinical findings in these patients included friable nasal mucosa, nasal polyps, or a characteristic submucosal nodularity. Most patients also had abnormal sinus roentgenograms with either thickening of the sinus mucosa or opacification of the sinuses. Involvement of the nasal mucosa by non‐caseating granulomas in sarcoidosis is an infrequent manifestation of the disease. Biopsy of the nasal mucosa shows typical non‐caseating granulomas, but care must be exercised to exclude other causes of granulomatous inflammation of the nasal mucosa including tuberculosis, fungal infections, and other idiopathic granulomatous diseases such as Wegener's granulomatosis and Churg‐Strauss syndrome. The treatment of nasal sarcoidosis has consisted of systemic steroids and in some cases topical beclomethasone dipropionate.
Nasopharyngeal Angiofibroma Presenting As Adult Osteomalacia: Case Report and Review of the Literature
Authors: Linsey Michael , Smith Wynn , Yamauchi Hiroshi , Bernstein Leslie
Published: February 2017

This is a report of a 54‐year‐old woman who presented with unexplained osteomalacia, which proved to be due to a nasopharyngeal angiofibroma. A summary of published case reports is presented and postulated mechanisms of oncogenic osteomalacia are reviewed.
Postoperative Radiotherapy for Persistent Tumor at the Surgical Margin in Head and Neck Cancers
Authors: Mantravadi Rao V. P. , Haas Richard E. , Skolnik Emanuel M. , Liebner Edwin J. , Applebaum Edward L.
Published: February 2017

Seventy‐two patients with a carcinoma of the head and neck, who were treated with surgery and postoperative irradiation, were reviewed to determine the local recurrence rates and survival in patients with inadequate surgical margins. Tumor recurrence rate was 31% for patients with microscopic tumors at resection margins and 50% for those with macroscopic tumor. Actuarial 3‐year survival for these patients was 71% and 43%, respectively. All 4 patients who were irradiated later than 6 weeks after surgery developed recurrent malignancy despite the resection margins being free of tumor. Excluding these patients the 3‐year survival for R0 patients was similar to that of R1 patients. It is concluded that postoperative irradiation is effective in patients with tumor at the surgical margins. It is suggested that the time interval between surgery and radiation therapy be limited to less than 6 weeks. Radiation dose prescriptions for various clinical situations are discussed.
Retreatment of Recurrent Carcinoma of the Head and Neck by Afterloading Interstitial 192IR Implant
Authors: Emami Bahman , Marks James E.
Published: February 2017

From January 1975 to December 1980, 25 patients with persistent or recurrent carcinomas of the head and neck were retreated for palliation at the Division of Radiation Oncology, Mallinckrodt Institute of Radiology. These patients had all undergone extensive previous treatment by surgery and/or radiation. All were retreated with 192Ir interstitial implant with or without external radiation and/or surgical excision. Of 25 patients, 13 had complete response (CR) and 6 had partial response for a follow‐up period of 1 to 7 years. Of 13 patients with CR, 6 are alive with no evidence of disease (NED) and two died NED. We present detailed results and discuss our new strategy for such patients.
Autoimmune Reactivity in Meniere'S Disease: A Preliminary Report
Authors: Hughes Gordon B. , Kinney Sam E. , Barna Barbara P. , Calabrese Leonard H.
Published: February 2017

Autoimmune inner ear disease was first described by McCabe in 1979. The diagnosis is supported by cell mediated immune responses to inner ear membrane antigen stimulation. Meniere's disease consists of episodic vertigo, fluctuating sensorineural hearing loss, tinnitus and often aural pressure. Although most clinicians feel that Meniere's disease has no known cause, recently several researchers have suggested that some cases of Meniere's disease may be autoimmune in origin.

In the present study, 10 patients with bilateral Meniere's disease were studied prospectively for autoimmune inner ear disease using both cellular and humoral immune tests. Results were compared with normal control subjects. One additional patient with Meniere's disease was identified retrospectively to have positive autoimmune test results. Preliminary conclusions suggest that at least some cases of presumed idiopathic Menlere's disease are autoimmune in origin.

Therapeutic implications are significant: the addition of steroids, cytotoxic drugs and/or apheresis to conventional treatment may help prevent total deafness which otherwise might be inevitable.
Transoral Partial Supraglottic Resection Using The CO2 Laser
Authors: Davis R. Kim , Shapshay Stanley M. , Strong M.Stuart , HYMS VINCENT J.
Published: February 2017

Transoral epiglottis resection or partial supraglottic resection was done with the CO2 laser in 20 highly selected patients. Visualization was best accomplished using the Lynch suspension system, but was satisfactory with the Jako‐Pilling laryngoscope. The best indications for this procedure were: 1. for visualization of the true vocal cords in previously treated cancer patients whose epiglottis obstructed indirect mirror examination, 2. for removal of obstructing benign epiglottic lesions, 3. as an excisional biopsy in limited epiglottic cancer, especially of the suprahyoid epiglottis.

No major complications or operative morbidity occurred. This approach obviated the potential morbidity of external surgical procedures in a select group of patients. Shortened hospitalization, avoidance of tracheotomy, minimal postoperative discomfort and edema, and excellent wound healing were additional advantages seen.
Primary Cutaneous Mucoepidermoid Carcinoma Of The Anterior Neck
Authors: Wenig Barry L. , Sciubba James J. , Goodman Roy S. , Platt Norbert
Published: February 2017

Cutaneous mucoepidermoid carcinoma is quite rare. We describe a case of extrasalivary cutaneous mucoepidermoid carcinoma in the head and neck region. The theories dealing with the origin of these tumors in the sweat and salivary glands are discussed, and the literature concerning these lesions reviewed. We believe this to be the first description of an extrasalivary mucoepidermoid carcinoma in the head and neck region or other sites that normally contain mucous glands.
Better than Perfect: A Cause of Overutilization
Authors: Weisskopf Alex
Published: February 2017

There has been an overwhelming increase in scientific methods which has improved the practice of medicine. On the other hand, the costs have sky‐rocketed to a point that we must ask ourselves,“Is this procedure sufficiently beneficial to warrant the expense?”

Serious ethical and moral, as well as therapeutic, issues are involved.
Calcifying Epithelial Odontogenic Tumor (Pindborg Tumor): An Unusual Case
Authors: Baunsgaard Philip , Løntoft Erik , Sørensen Mogens
Published: February 2017

A case of the rare calcifying epithelial odontogenic tumor is reported. The tumor was situated high in the left maxillary antrum, bulging into the nasal cavity. The presenting signs were homolateral nasal stenosis and bulging of the lateral nasal wall. The clinical appearances and histological findings are submitted and compared with those in cases described previously.

Treatment and prognosis are discussed. From the present case it is apparent that despite its odontogenic nature the tumor may occur so far from the teeth that clinically it may be mistaken for a tumor of the nasal cavity.
A New Distending Laryngoscope for Diagnosis and Microsurgery of the Larynx
Authors: Weerda H. , Pedersen P. , Meuret G.
Published: February 2017

A new laryngoscope was developed in order to improve visualization of the larynx and to better adapt the instrument to individual clinical circumstances. As such, the Kleinsasser laryngoscope was divided into two parts, with the width between the two halves changed by adjustment of a screw. The lower part of the instrument can also be moved to provide more space near the larynx. Since the laryngoscope is open laterally, there is more space for the operator, and shorter instruments can be used for endolaryngeal manipulations. The endoscope can be used for intubation as well as for injection. With the new instrument the advantages of the Kleinsasser laryngoscope with the Killian suspension endoscope have been combined.
Muscle‐Nerve Pedicle Laryngeal Reinnervation
Authors: May Mark , Beery Quinter
Published: February 2017

A muscle‐nerve pedicle implantation to the lateral cricoarytenoid muscle as described by Tucker is an alternative to Teflon® injection for treating dysphonia due to vocal cord palsy. Improvement in voice was noted in 19 of the 20 (95%) selected patients who were treated by muecle‐nerve pedicle reinnervation. These patients have been followed for 6 months to 10 years. Changes in the voice were documented through assessment of high‐quality audio tape recordings by three speech pathologists, results of a patient questionnaire, and evaluation by the surgeon. The improvement in voice quality was attributed to reestablishment and maintenance of vocal cord tone and mass, without the vocal cord stiffness usually associated with Teflon® injection. The improvements in quality of voice with pedicle implantation are natural and lasting. This technique Is proposed as an alternative to Teflon® injection in selected cases.