bluuebunny/crossref_metadata_2025 huggingface dataset:
Dispersion polymerization of methyl methacrylate in supercritical carbon dioxide using a silicone‐containing fluoroacrylate stabilizer
Authors: Deniz Sennur , Baran Nil , Akgün Mesut , Uzun I Nimet , Dinçer Salih
Published: October 2005

Free radical dispersion polymerization of methyl methacrylate (MMA) was carried out in supercritical carbon dioxide (scCO2) using poly{(heptadecafluorodecyl acrylate)‐co‐3‐[tris(trimethylsilyloxy)silyl]propyl methacrylate} (p(HDFDA‐co‐SiMA)) as stabilizer. Dry, fine powdered spherical poly(methyl methacrylate) (pMMA) particles with well‐defined sizes were produced. The resulting high yield of spherical and relatively uniform micron‐size pMMA particles was formed utilizing various amounts of p(HDFDA‐co‐SiMA) random copolymer. The particle diameter was shown to be dependent on the weight percent of the stabilizer added to the system. The effects of varying the concentration of stabilizer (1–7 wt%), reaction time (4–12 h) and pressure (15–35 MPa) upon the polymerization yield, molar mass and morphology of pMMA were investigated. Copyright © 2005 Society of Chemical Industry
Properties of poly(ethylene terephthalate)–poly(ethylene naphthalene 2,6‐dicarboxylate) blends with montmorillonite clay
Authors: Sanchez‐Solis Antonio , Garcia‐Rejon Andres , Estrada Mirna , Martinez‐Richa Antonio , Sanchez Guadalupe , Manero Octavio
Published: October 2005

The production and properties of blends of poly(ethylene terephthalate) (PET) and poly(ethylene naphthalene 2,6‐dicarboxylate) (PEN) with three modified clays are reported. Octadecylammonium chloride and maleic anhydride (MAH) are used to modify the surface of the montmorillonite–Na+ clay particles (clay–Na+) to produce clay–C18 and clay–MAH, respectively, before they are mixed with the PET/PEN system. The transesterification degree, hydrophobicity and the effect of the clays on the mechanical, rheological and thermal properties are analysed. The PET–PEN/clay–C18 system does not show any improvements in the mechanical properties, which is attributed to poor exfoliation. On the other hand, in the PET–PEN/clay–MAH blends, the modified clay restricts crystallization of the matrix, as evidenced in the low value of the crystallization enthalpy. The process‐induced PET–PEN transesterification reaction is affected by the clay particles. Clay–C18 induces the largest proportion of naphthalate–ethylene–terephthalate (NET) blocks, as opposed to clay–Na+ which renders the lowest proportion. The clay readily incorporates in the bulk polymer, but receding contact‐angle measurements reveal a small influence of the particles on the surface properties of the sample. The clay–Na+ blend shows a predominant solid‐like behaviour, as evidenced by the magnitude of the storage modulus in the low‐frequency range, which reflects a high entanglement density and a substantial degree of polymer–particle interactions. Copyright © 2005 Society of Chemical Industry
Methacryloxyethyl phosphate‐grafted expanded polytetrafluoroethylene membranes for biomedical applications
Authors: Wentrup‐Byrne Edeline , Grøndahl Lisbeth , Suzuki Shuko
Published: October 2005

Expanded polytetrafluoroethylene (ePTFE) membranes were modified by graft copolymerization with methacryloxyethyl phosphate (MOEP) in methanol and 2‐butanone (methyl ethyl ketone (MEK)) at ambient temperature using gamma irradiation. The effect of dose rate (0.46 and 4.6 kGy h−1), monomer concentration (1–40 %) and solvent were studied and the modified membranes were characterized by weight increase, X‐ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM). XPS was used to determine the % degree of surface coverage using the CF (ePTFE membrane) and the CC (MOEP graft copolymer) peaks. Grafting yield, as well as surface coverage, were found to increase with increasing monomer concentration and were significantly higher for samples grafted in MEK than in methanol solution. SEM images showed distinctly different surface morphologies for the membranes grafted in methanol (smooth) and MEK (globular), hence indicating phase separation of the homopolymer in MEK. We propose that in our system, the non‐solvent properties of MEK for the homopolymer play a more important role than solvent chain transfer reactions in determining grafting outcomes. Copyright © 2005 Society of Chemical Industry
Effects of α‐form or β‐form nuclei on polymorphic crystalline morphology of poly(butylene adipate)
Authors: Wu Ming Chien , Woo EM
Published: October 2005

The effects of α‐form and β‐form nuclei on polymorphic morphology of poly(butylene adipate) (PBA) upon recrystallization from the molten state up to various Tmax values were examined by differential scanning calorimetry (DSC), wide‐angle X‐ray diffraction (WAXD) and polarized light microscopy (PLM). In this study, PBA with complex melting and polymorphism behaviour was used as a model for examining different types and extents of residual nuclei. As the PBA initially containing the sole α‐crystal was brought to a molten state of various Tmax, the extents of trace α‐form crystal nuclei varied and were dependent on Tmax. Furthermore, it did not matter whether, initially, the PBA contained α‐ or β‐form crystals (or both) because only a single type of α‐nuclei could be left upon treatment to the molten liquid state at Tmax. Therefore, only the α‐crystal in PBA had ‘memory capacity’ in the molten liquid state while the β‐crystal did not. This was so because the latter had been completely transformed into the solid state prior to being heated into a liquid. PBA crystallized before α‐nuclei could be packed into α‐crystal, regardless of the crystallization temperature (Tc). For recrystallization from molten PBA without any nuclei, the crystalline polymorphism was correspondingly influenced by Tc. Copyright © 2005 Society of Chemical Industry
The ligand effect in Ti‐mediated living radical styrene polymerizations initiated by epoxide radical ring opening. 2. Scorpionate and half‐sandwich LTiCl3 complexes
Authors: Asandei Alexandru D. , Moran Isaac W.
Published: October 2005

The ligand effect and the reaction conditions for the living radical polymerization of styrene initiated by epoxide radical ring opening was investigated in a series of piano‐stool, Ti(IV) scorpionate and, half‐sandwich metallocenes (LTiCl3; L = Tp, Cp*, Ind and Cp, where Tp = hydrotris(pyrazol‐1‐ylborato), Cp* = pentamethylcyclopentadienyl, Ind = indenyl and Cp = cyclopentadienyl). The polymerization is mediated by the reversible termination of the growing chains with Ti(III) species derived from Zn reduction of parent Ti(IV) derivatives. A poor performance was observed for TpTiCl3 because of probable over‐reduction. The strong electron donating effect of Cp* accounts for a strong CTi chain end bond and consequently, a living‐like process is observed only at T > 110 °C. However, both Ind and Cp ligands provide a linear dependence of Mn on conversion and narrow polydispersity over a wide range of experimental conditions. Investigation of the effect of temperature and reagent ratios generates an optimum for epoxide/CpTiCl3/Zn = 1/2/4 at 70–90 °C. On the basis of a combination of steric and electronic properties, the ligands rank as Cp ≥ Ind ≫ Cp* ≫ Tp. This trend is different from coordination polymerization, and in conjunction with our previous results on Cp2TiCl2, further supports a radical mechanism. © 2005 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 43: 6039–6047, 2005
Force measurements using capillary instabilities
Authors: Steiner Ullrich
Published: October 2005

This article reviews some recent experimental studies on film instabilities. Since surface instabilities of planar films are driven by destabilizing interfacial pressures, the patterns that form in thin films are a signature of these interfacial forces. The direct correspondence of pattern selection and the underlying destabilizing pressures provides a way to quantitatively determine these interface potentials. This principle is documented for three different film destabilization mechanisms: van der Waals forces, forces caused by an applied electric field, and forces that arise from the confinement of thermal molecular motion in the film. © 2005 Wiley Periodicals, Inc. J Polym Sci Part B: Polym Phys 43: 3395–3405, 2005
Orthogonal surface‐grafted polymer gradients: A versatile combinatorial platform
Authors: Bhat Rajendra R. , Tomlinson Michael R. , Genzer Jan
Published: October 2005

Orthogonal polymer brush gradients are assemblies of surface‐anchored macromolecules, in which two material properties of the grafted chains (e.g., grafting density, molecular weight) vary independently in orthogonal directions. Here, we describe the formation and applications of two such orthogonal assemblies, involving: (1) molecular weight and grafting density (MW/σ) gradients of a given polymer and (2) molecular weight gradients (MW1/MW2), of two different polymers. Each point on orthogonal gradient substrate represents a unique combination of the two surface properties being varied, thus facilitating systematic investigation of a phenomenon that depends on the two said properties. We illustrate this point by employing orthogonal structures to study systematically: (1) formation of polymer brush‐nanoparticle composite assemblies, (2) protein adsorption and cell adhesion, and (3) chain conformations in tethered diblock copolymers exposed to selective solvents. © 2005 Wiley Periodicals, Inc. J Polym Sci Part B: Polym Phys 43: 3384–3394, 2005
Electron spin resonance on carbon nanotubes–polymer composites
Authors: Chipara Mircea , Zaleski Jeffrey M. , Hui David , Du Chunsheng , Pan Ning
Published: October 2005

Electron spin resonance investigations on styrene–polyisoprene–polystyrene block copolymer loaded with various amounts of multiwalled carbon nanotubes are reported. The temperature dependence of resonance line parameters in the range 290–425 K was analyzed. It was proved that the main resonance line represents a bottleneck of localized and delocalized electrons residing on carbon nanotubes. The temperature dependence of the g‐factor and double integral of resonance spectra confirmed this interpretation. The temperature dependence of the resonance linewidth of composites containing various concentrations of nanotubes was explained by the thermally activated narrowing of the resonance spectra. © 2005 Wiley Periodicals, Inc. J Polym Sci Part B: Polym Phys 43: 3406–3412, 2005
National account measures and sustainability objectives: present approaches and future prospects
Authors: Clarke Matthew , Islam Sardar M. N.
Published: October 2005

A dominant objective within the public policies of all SE Asian countries has been the achievement of economic growth. The issue of sustainability has serious implications for this policy objective. Pursuit of economic growth is concerned solely with the present, whilst sustainability is concerned with ensuring the current generation meets its present needs without threatening future generations' ability to do likewise. National accounts, such as gross domestic product, can measure healthy economies, but they can not measure sustainability. This paper, however, sets out a conceptual approach that describes the misalignment of national accounting measures with sustainability objectives and provides empirical evidence of how this misalignment can bepartiallyovercome. An empirical approach is developed whereby certain adjustments to national accounts, based on normative social choice theory, are introduced to indicate how a partial measure of sustainability can be determined using national accounting aggregates as a base. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment.
Long‐term Follow‐up Outcome of Patients Undergoing Radiofrequency Ablation for Unresectable Hepatocellular Carcinoma
Authors: Machi Junji , Bueno Racquel S. , Wong Linda L.
Published: October 2005

The long‐term outcome of radiofrequency thermal ablation (RFA) for unresectable hepatocellular carcinoma (HCC) has not been reported. This study was performed to evaluate the long‐term survival of patients with unresectable HCC after RFA and to identify possible factors that might affect survival. In this prospective study, 65 patients with unresectable HCC who underwent RFA were followed. A total of 84 RFA operations were performed percutaneously (n = 49), laparoscopically (n = 20), or by open surgery (n = 15), to ablate 191 tumors. Twenty‐two patients died within 16 months; otherwise, the follow‐up period was at least 16 months, up to 71 months, with median 20.0 months and mean (± standard deviation) 24.8 ± 18.4 months for all patients. Local tumor recurrence developed in 12 of 191 tumors (6.3%) in 11 of 84 operations (13.1%), or 11 of 65 patients (16.9%). New liver and/or extrahepatic recurrence developed in 48 operations (57.1%). The overall median, mean, and 5‐year survivals were 40.0 months, 33.7 ± 2.9 months, and 39.9%. The disease‐free survivals were 16.0 month, 32.9 ± 3.0 months, and 27.9%. Factors that had a significant effect on survival outcome after RFA were TNM cancer stage and the operative approach method employed for RFA. Age, gender, race, etiology, alpha‐fetoprotein, previous or subsequent treatment, and liver function (Child‐Pugh class) did not affect survival. For patients with unresectable HCC, RFA is an effective and repeatable local treatment that can afford long‐term survival, although often with disease recurrence.
Prospective Randomized Trial Comparing Billroth I and Roux‐en‐Y Procedures after Distal Gastrectomy for Gastric Carcinoma
Authors: Ishikawa Makoto , Kitayama Joji , Kaizaki Shoichi , Nakayama Hiroshi , Ishigami Hironori , Fujii Shin , Suzuki Hiroyuki , Inoue Tomomi , Sako Akihiro , Asakage Masahiro , Yamashita Hiroharu , Hatono Kenji , Nagawa Hirokazu
Published: October 2005

To determine the clinical efficacy of Roux‐en‐Y reconstruction (RY) after distal gastrectomy, we compared postoperative outcomes of patients who underwent RY or conventional Billroth I reconstruction (B‐I). A total of 50 patients were prospectively randomized to either B‐I or RY reconstruction, and complications, postoperative course, and nutritional status were compared. Bile reflux and inflammation in the remnant stomach and lower esophagus were evaluated by postoperative follow‐up endoscopy at 6 months. Operative time and blood loss as well as postoperative nutrition did not show significant differences between the two groups. As anticipated, 5 of 24 patients with RY reconstruction developed gastrojejunal stasis in the early postoperative period, which led to a longer postoperative hospital stay as compared with the B‐I group (mean ± S.D; B‐I; 19.0 ± 6.2, RY; 31.8 ± 21.7 days) (P < 0.05). Endoscopic examination revealed that the frequency of bile reflux (P < 0.01) and degree of inflammation in the remnant stomach (P < 0.05) were less in the RY group than in the B‐I group. However, inflammatory findings in the lower esophagus were observed in 7 (27%) of B‐I, and 8 (35%) of the RY group, suggesting that late phase esophagitis was not improved in the RY group. Roux‐en‐Y reconstruction was effective in preventing duodenogastric reflux and resulting gastritis, but it did not prevent esophagitis. Because RY reconstruction induces the frequent complication of Roux‐en‐Y stasis, causing longer postoperative hospital stay, this method has limited advantages over B‐I anastomosis after distal gastrectomy.
B7‐H1 (CD274) inhibits the development of herpetic stromal keratitis (HSK)
Authors: Jun Her , Seo Su K. , Jeong Hye-Young , Seo Hyoun-Mi , Zhu Gefeng , Chen Lieping , Choi In-Hak
Published: October 2005

The co‐signaling molecule B7‐H1 (CD274) functions as both a co‐inhibitor through programmed death‐1 (PD‐1) receptor and a co‐stimulator via an as‐yet‐unidentified receptor on T cells. We investigated the physiological role of endogenous B7‐H1 in the pathogenesis of herpetic stromal keratitis (HSK) caused by herpes simplex virus type 1 (HSV‐1). Following HSV‐1 infection of the cornea of mice, B7‐H1 expression was up‐regulated in the CD11b+ macrophage population in the draining lymph nodes (dLN) and in the inflamed cornea. In addition, HSV‐1 infection significantly increased PD‐1 expression on CD4+ T cells in the dLN and inflamed cornea. The administration of antagonistic B7‐H1 monoclonal antibody resulted in the proliferation of HSV‐specific CD4+ T cells that secreted interferon (INF)‐γ, and inhibited the apoptosis of HSV‐specific CD4+ T cells, which exaggerated HSK. These results strongly suggest that the B7‐H1 may be involved in suppression of the development of HSK.
Apical cell adhesion molecule, trophinin, localizes to the nuclear envelope
Authors: Aoyama Junya , Nakayama Yuji , Sugiyama Daijiro , Saburi Sakura , Nadano Daita , Fukuda Michiko N. , Yamaguchi Naoto
Published: October 2005

Trophinin mediates homophilic and apical cell adhesion between trophoblastic cells and endometrial epithelial cells, which is potentially the initial attachment step in human embryo implantation. Since trophinin is an atypical membrane protein without the signal sequence, it is possible that trophinin localizes to the cytoplasm. By treating trophinin‐expressing trophoblastic cells with a series of detergents, we found significant levels of endogenous trophinin in the cytoplasm, particularly at the nuclear envelope (NE). Fluorescence photobleaching of GFP‐trophinin expressed in COS‐1 cells showed the stable association of trophinin with the NE, suggesting an additional role of trophinin besides apical cell adhesion.
Some effects of ultraviolet radiation and climate on the reproduction of Calanus finmarchicus (Copepoda) and year class formation in Arcto-Norwegian cod (Gadus morhua)
Authors: Skreslet Stig , Borja Angel , Bugliaro Luca , Hansen Georg , Meerkötter Ralf , Olsen Ketil , Verdebout Jean
Published: October 2005

Zooplankton sampling in 1997 identified the frontal zone of the Norwegian Coastal Current as a reproduction habitat for Calanus finmarchicus in June–August. This area is subject to considerable ultraviolet radiation (UVR), as calculated from satellite observations of ozone and cloudiness. While in situ experiments indicated UVR-induced mortality in reproducing C. finmarchicus, monthly UVR doses during the actual reproduction period did not appear to affect the abundance of the resulting generation of adolescent copepodites (CIV-V) that accumulated in a fjord habitat during October 1983–2000. Local UVR in the spawning grounds of Arcto-Norwegian cod at the Lofoten Islands in March–May was positively correlated with the stock's 0-group index, which resulted in the rejection of the hypothesis that local UVR leads to high mortality of cod eggs or reduces the abundance of prey for cod larvae. Rather, the result suggests an indirect positive effect of UVR on the survival of cod eggs and larvae, possibly by controlling harmful microbes.
The relationship between plankton, capelin, and cod under different temperature conditions
Authors: Orlova E.L. , Boitsov V.D. , Dolgov A.V. , Rudneva G.B. , Nesterova V.N.
Published: October 2005

On the basis of data from cold (1982 and 1987) and warm summers (1983, 1984, 1990, and 1992), we explore the relationship between the phytoplankton bloom and the timing and intensity of the zooplankton bloom. In warm years, there is more overlap in the time between the zooplankton and the phytoplankton bloom. In northern areas (76–78°N) with seasonal ice, the phytoplankton bloom and reproductive processes in Calanus finmarchicus and Calanus glacialis continue well into August, evidenced by the presence of an abundance of nauplii and younger copepodites. We analyse feeding intensity of capelin and its distribution relative to food availability and capelin abundance. The extent to which feeding areas of cod and capelin, its major prey, overlap is subject to the abundance of these species, distribution of zooplankton, and sea temperature in a given year.
Managing fish stocks under climate uncertainty
Authors: Rothschild Brian J. , Chen Changsheng , Lough R. Greg
Published: October 2005

The quantitative evaluation of the management of fish stocks under uncertainty requires a formal framework. Decision theory provides that framework. Application of decision theory to fishery management requires information about both the fish stock and the state of the environment. Using Georges Bank haddock as a case study, it is possible to determine the probability of good or poor recruitment using past data and a constant environment. Understanding the state of the environment is more difficult, however, because fixed levels of recruitment, in particular, are associated with different population characteristics, which drastically reduce the sample size for any particular recruitment–environment scenario. Decision theory challenges us to improve our capability of predicting the state of nature, and it appears that this can be accomplished best by reducing the length of the causal chain, a goal now made feasible by the availability of high-resolution, high-frequency ocean models.
I. Hypogastric artery ligation for intractable pelvic hemorrhage
Authors: Papp Z. , Tóth‐Pál E. , Papp C. , Sziller I. , Gávai M. , Silhavy M. , Hupuczi P.
Published: October 2005

Objective

To assess the outcomes of bilateral hypogastric (internal iliac) ligation performed to control intractable pelvic hemorrhage and avoid hysterectomy.

Methods

A review of indications and outcomes for 117 cases of bilateral hypogastric artery ligation over 15 years (1990–2004).

Results

Apart from a slight lesion to the hypogastric vein, no complications were observed. Hemorrhage was effectively controlled in all 37 obstetric cases. In 13 of these cases, the uterus was preserved even when there was cervical pregnancy, placenta previa, placental abruption, uterine atony, and uterine rupture, and 4 women were delivered of mature infants. Hemorrhage was effectively controlled in 41 of 80 gynecologic cases. Prophylactic reduction of pelvic blood flow was the indication for the procedure in 39 cases, 5 of whom involving Jehovah's Witnesses adverse to blood transfusion. The uterus was preserved in only a few of the 41 controlled cases, but one woman (so far) was delivered of a mature infant.

Conclusion

Hypogastric artery ligation was found to be indicated if (1) life‐threatening pelvic hemorrhage could not be controlled by conservative methods; (2) prophylactic reduction of pelvic blood flow was needed to prevent anticipated hemorrhage; and (3) preservation of reproductive function was desired. The procedure was found to be safe and usually effective and should be taught during obstetric and gynecologic training.
Effect of coffee intake on blood flow and maternal stress during the third trimester of pregnancy
Authors: Tsubouchi H. , Shimoya K. , Hayashi S. , Toda M. , Morimoto K. , Murata Y.
Published: October 2005

Objective: To investigate the effects of maternal ingestion of an ordinary dose of coffee on maternal stress and placental and fetal blood circulation during the third trimester of pregnancy. Methods: We performed a Doppler blood flow analysis for 10 women in the third trimester of pregnancy before and after they drank a cup of coffee. Salivary samples were collected from the 10 pregnant women and 14 nonpregnant controls just before coffee intake and 30 min later. Salivary cortisol levels and chromogranin A titers were determined. Results: Coffee intake had no effect on maternal or fetal blood flow. Among the pregnant women, Salivary cortisol levels were significantly reduced after coffee intake but salivary chromogranin A concentration was not significantly different before and after coffee intake. Conclusion: The reduced salivary cortisol levels suggest that coffee intake decreases maternal stress during pregnancy.
Safety of vaginal birth after cesarean delivery
Authors: Ghaffari Z. , Bener A. , Ahmed B.
Published: October 2005

Objective

To compare the outcomes of labor induction in women with a history of 1 cesarean section (CS) who undergo trial of labor.

Methods

A prospective observational study of 702 pregnant women who had 1 previous CS was conducted at Women's Hospital, Hamad Medical Corporation, Doha, Qatar, between April 2003 and April 2004. Those with no history of vaginal delivery were assigned to one group and those with a history of vaginal delivery were assigned to another group, and the latter group was then divided into 2 subgroups according to the results of trial of labor.

Results

Of these 702 women with a history of 1 CS, 62.4% also had a history of vaginal delivery. After trial of labor, vaginal delivery occurred more often among women with no history of vaginal delivery (64.8%). Moreover, trial of labor resulted in a vaginal delivery more often in women who were delivered only once and by CS (87.7%) than in women who also had a history of vaginal delivery (79.2%).

Conclusion

These findings indicate that women who have had a CS should strongly consider natural delivery for subsequent pregnancies.
Posturographic Evidence of Nonorganic Sway Patterns in Normal Subjects, Patients, and Suspected Malingerers
Authors: Goebel Joel A. , Sataloff Robert T. , Hanson Jason M. , Nashner Lewis M. , Hirshout Debra S. , Sokolow Caren C.
Published: October 2005

During the last 10 years, computerized dynamic posturography has yielded various patterns of sway on the sensory organization test and the motor control test that have been associated with a variety of organic balance disorders. Some aspects of performance during computerized dynamic posturography, however, are under conscious control. Voluntary movements not indicative of physiologic response to balance system stimulation can also affect computerized dynamic posturography results. Quantification of nonorganic or “aphysiologic” response patterns in normal subjects, patients, and suspected malingerers is crucial to justify use of computerized dynamic posturography for identification of physiologically inconsistent results. For this purpose the computerized dynamic posturography records of 122 normal subjects, 347 patients with known or suspected balance disorders, and 72 subjects instructed to feign a balance disturbance were critically evaluated by use of seven measurement criteria, which were postulated as indicating aphysiologic sway. Each criterion was scored with a standard calculation of the raw data in a random, blinded fashion. The results of this multicenter study show that three of the seven criteria are significantly different in the suspected “malingerer” group when compared with either the normal or patient group. The relative strength of each criterion in discerning organic from nonorganic sway provides the examiner with a measure of reliability during platform posture testing. This study demonstrates that computerized dynamic posturography can accurately identify and document nonorganic sway patterns during routine assessment of posture control.
Hemifacial Spasm: Endoscopic Vascular Decompression
Authors: Magnan J. , Caces F. , Locatelli P. , Chays A.
Published: October 2005

Sixty patients with primitive hemifacial spasm were treated by means of a minimally invasive retrosigmoid approach in which endoscopic and microsurgical procedures were combined. Intraoperative endoscopic examination of the cerebellopontine angle showed that for 56 of the patients vessel‐nerve conflict was the cause of hemifacial spasm. The most common offending vessel was the posterior inferior cerebellar artery (39 patients), next was the vertebral artery (23 patients), and last was the anterior inferior cerebellar artery (16 patients). Nineteen of the patients had multiple offending vascular loops. In one patient, another cause of hemifacial spasm was an epidermoid tumor of the cerebellopontine angle. For three patients, it was not possible to determine the exact cause of the facial disorder. Follow‐up information was reviewed for 54 of 60 patients; the mean follow‐up period was 14 months. Fifty of the patients were in the vessel‐nerve conflict group. Forty of the 50 were free of symptoms, and four had marked improvement. The overall success rate was 88%, and there was minimal morbidity (no facial palsy, two cases of severe hearing loss).
Comparative Value of Facial Nerve Grading Systems
Authors: Rickenmann Jürg , Jaquenod Claude , Cerenko D. , Fisch Ugo
Published: October 2005

The Fisch Detailed Evaluation of Facial Symmetry (DEFS) and House‐Brackmann grading system (HBGS) were compared by statistical examination for their reliability and interob‐server variability. Furthermore, the correlation and agreement with a standard global evaluation were compared. Therefore 47 patients with facial palsy of different cause have been evaluated with the two systems, and the global overall evaluation was done by five otolaryngologists familiar with facial palsy. The DEFS showed a high reliability of 0.93 compared with a reliability of 0.77 with the HBGS (international standard requires a reliability of at least 0.8). The mean interobserver variability is 5.24% (SD = 3.2%) with the DEFS and 9.26% (SD = 5.0%) with the HBGS; with a confidence interval of 95%, it is 11.6% and 19.26%. The correlation of both gradings with the global evaluation was high, with r = 0.98 and r = 0.97. The DEFS shows an excellent agreement with the global overall evaluation in 41 (87%) of 47 cases and the HBGS in 32 (66%) of 47 cases.
Conservative Subtraction‐Addition Rhinoplasty
Authors: Younger Ritchie A. L.
Published: October 2005

The deviated external nose remains a difficult technical challenge to even the most masterful rhinoplastic surgeon. The classic septorhinoplasty approach to the deviated nose demonstrated a 9.8% revision rate in this study. During a 2‐year period, the conservative subtraction‐addition rhinoplasty procedure was developed, which subsequently reduced the revision rate to 1.3%. Conservative subtraction‐addition rhinoplasty foregoes aggressive septal surgery and equalizes and enhances the airway through asymmetric turbinate volume reduction. Minimal bony and upper lateral work through rasping, soft tissue removal, and/or cartilage grafting allows for external nasal alignment. Both internal and external conservative subtraction‐addition rhinoplasty components thus maintain perioperative structural stability and ensure long‐term nasal symmetry.
A Comparison of the Nasal Cross‐Sectional Areas and Volumes Obtained with Acoustic Rhinometry and Magnetic Resonance Imaging
Authors: Corey Jacquelynne P. , Gungor Anil , Nelson Robert , Fredberg Jeff , Lai Vincent
Published: October 2005

Acoustic rhinometry (AR) evaluates the geometry of the nasal cavity with acoustic reflections and provides information about nasal cross‐sectional areas (CSA) and nasal volume within a given distance. The accuracy of the information obtained by AR was compared with that of magnetic resonance imaging (MRI) of the nasal cavity. Five healthy subjects were evaluated with AR and the MRI before and after the application of a long‐acting nasal decongestant spray, to eliminate possible interference of the nasal cycle with both measurement techniques. The MRI images of 2 mm coronal sections of the nasal cavity were traced by three independent observers and the CSAs were calculated by computer‐aided imaging digitization, to be compared with the calculated CSAs obtained with the AR at the corresponding distance from the nasal tip. Digitized data from the MRI images were also used to calculate the nasal volume within the first 6 cm from the nasal tip and compared with the AR volume measurements. The interobserver variation of digitized MRI data predecongestant and postdecongestant was not significant. The correlations of CSA and volume measurements between the AR and MRI were high (0.969) after the application of the decongestant. The correlation between the AR and MRI measurements before the decongestant was low (0.345). This may have been the result of interference of the nasal cycle during the long MRI measurements (1 hour) or other unknown factors. We conclude that AR measurements of nasal CSAs and volumes provide accurate information when compared with the MRI of the decongested nasal airway.
Immunotherapy for Allergic Fungal Sinusitis: The Second Year
Authors: Mabry Richard L. , Mabry Cynthia S.
Published: October 2005

Since August 1994 we have followed a protocol of treating patients with histologically proven allergic fungal sinusitis with surgical extirpation of the involved sinuses, followed by immunotherapy using both fungal and nonfungal antigens to which hypersensitivity is demonstrated by in vitro and skin testing methods. Despite predictions to the contrary, we have encountered no evidence that these injections have worsened the condition of any patients. Rather, we have noted a marked decrease in nasal crusting in all patients, with a minimum amount of recurrent polypoid mucosa and a lessened or absent requirement for corticosteroids (systemic or topical). Two patients treated with immunotherapy required systemic corticosteroids and subsequent revision surgery for residual disease that was present before the start of immunotherapy, and they have done well since. Our experience indicates that the triad of adequate surgery, frequent follow‐up and medical management, and immunotherapy with relevant fungal and nonfungal antigens represents an effective means of treating patients with allergic fungal sinusitis. Nevertheless, an even longer period of study will be necessary to provide the final answer regarding the role of immunotherapy in the treatment of allergic fungal sinusitis.
The Effects of an Outpatient Practice Guideline at a Teaching Hospital: A Prospective Pilot Study
Authors: Stewart Michael G. , Harrill Willard C. , Ohlms Laurie A.
Published: October 2005

Practice guidelines (PGs) are becoming increasingly important in modern medicine. To study the effects of a PG, we performed a pilot study at a large, urban, public teaching hospital according to a prospective, observational research design with both concurrent and historic controls. Specifically, we studied the effects of a multidisciplinary PG for pediatric outpatient tonsillectomy and adenoidectomy on the process of health‐care delivery. Variables in the health‐care process included patient compliance with clinic and surgery appointments, surgery time, operating room turnover, time in recovery room, unplanned admission rate, patient compliance with postoperative follow‐up, provider compliance with guidelines, and hospital charges. Patients in the PG were found to have fewer preoperative laboratory tests, decreased duplication of services, and shorter operating room turnover times. Provider compliance with the PG varied by service and was intermittent at first but improved gradually. There was a trend toward improved compliance with postoperative follow‐up in patients in the PG. Provider opinions concerning the guideline were positive. This pilot study demonstrates several advantages and disadvantages of the use of PGs in the outpatient setting and in a teaching hospital.
Effects of Topical Otic Preparations on Hearing in Chronic Otitis Media
Authors: Özagar Altĝ , Koç Ahmet , Çiprut Ayça , Tutkun Alper , Akdaş Ferda , Šehitoĝlu Mehmet Ali
Published: October 2005

Most of the topical otic preparations have been shown to cause ototoxicity. In this study ciprofloxacin hydrochloride, a relatively new topical agent, and gentamicin sulfate were studied in two groups of 20 patients with chronic otitis media. Patients were randomly selected to receive either ciprofloxacin (200 μg/ml) or gentamicin sulfate (5 mg/ml) locally, five drops three times a day for 10 days. Clinical response was seen in 20 of 20 patients in the ciprofloxacin group compared with 6 of 20 patients in the gentamicin group. Audiometric evaluation revealed no significant ototoxic effect in either group. In fact, hearing thresholds were slightly better than pretreatment levels in both groups.
Fatal Meningitis and Brain Abscess Resulting from Foreign Body‐Induced Otomastoiditis
Authors: Goldman Steven A. , Ankerstjerne Jennifer K. B. , Welker Keith B. , Chen Douglas A.
Published: October 2005

Herein we report what we believe to be the only published case of an intracranial complication of otomastoiditis resulting from foreign‐body material. The presence of a foreign body must be ruled out in any chronically draining ear, and all foreign material must be removed. The key to minimizing the morbidity of complications of infectious ear disease is early recognition and treatment. Early symptoms of complication include vertigo, new onset of headache or otalgia, or worsening headache or otalgia. Fever, malodorous ear drainage, and the presence of granulation tissue are warming findings. A high index of suspicion of infectious complications must be maintained in evaluating all patients with ear disease.
Stapedectomy in Military Aircrew
Authors: Thiringer Jon K. , Arriaga Moises A.
Published: October 2005

Stapedectomy in military aircrew is generally considered to be the end of an aviation career. Perilymphatic fistulae, prosthesis dislodgement, and perforation of the vestibule are recognized complications of stapedectomy. Consequently, barotrauma, G forces, and otherwise hostile conditions and their effects on the poststapedectomy ear are usually cited as reasons for grounding. Data supporting such a restrictive policy, however, are limited. This study examined the aeromedical outcome of 16 U.S. Air Force aircrew members who returned to flight duty after stapedectomy between 1965 and 1992. Selected patients were subjected to centrifuge and altitude chamber testing before they returned to flight duty. No episodes of sudden hearing loss or vestibulopathic conditions have occurred in the entire study group. Guidelines for surgical technique, reconstruction materials, and postoperative aeromedical testing are proposed for evaluating selected stapedectomy patients before their return to flight status.
Efficacy of Vestibular Rehabilitation
Authors: Cowand Jennifer L. , Wrisley Diane M. , Walker Martha , Strasnick Barry , Jacobson John T.
Published: October 2005

The purpose of this study was to determine significant changes in the Dizziness Handicap Inventory (DHI) scores in patients before and within 1 year after a vestibular rehabilitation program. Efficacy of a vestibular rehabilitation program was tested retrospectively in 37 patients by comparison of pretreatment and posttreatment DHI scores. A significant improvement in test scores was found, indicated by the Sign test at the 0.05 level after vestibular rehabilitation. This difference is evident in the total score and in the functional and physical subscore component. Prerehabilitation and postrehabilitation differences among diagnostic categories were analyzed by using the Kruskal‐Wallis test. Patients with peripheral lesions demonstrated greater improvement in the emotional component of the DHI as compared with patients with central or mixed lesions. The Wilcoxon two‐sample test assessed the influence of compliance with a home exercise program after discharge from a vestibular physical therapy program. There was no significant difference in improvement between patients who performed home exercises for at least a month after discharge and those who did not.
A New Anesthetic System for Microlaryngeal Surgery
Authors: Brooker Charles R. , Hunsaker Darrell H. , Zimmerman A. Andrew
Published: October 2005

Anesthesia for microlaryngeal surgery creates many obstacles for the anesthesiologist and otolaryngologist. Anesthetic techniques developed to improve surgical exposure have been met with significant limitations and are difficult for the anesthesiologist to monitor. A new subglottic jet ventilation anesthesia system is introduced that meets the needs of the otolaryngologist and the anesthesiologist. This new system is made up of two components: (1) The Hunsaker Mon‐Jet tube is a laser‐safe, subglottic jet ventilation tube constructed of a nonflammable fluoroplastic material. It allows monitoring of tracheal pressure and end tidal carbon dioxide, and it is designed with a basket‐shaped distal extension to align the jet port away from the tracheal mucosa and to prevent trauma and submucosal injection of jetted gas. (2) An automatic jet ventilator, which has an adjustable respiratory rate, inspiratory/expiratory ratio, and flow rate, also monitors expiratory end peak airway pressures and has an automatic shutdown feature if either of these pressures are exceeded. This system was successfully used in 36 patients undergoing microlaryngeal surgery.
Accuracy of Clinical Evaluation in Pediatric Obstructive Sleep Apnea
Authors: Wang Robert C. , Elkins Tina P. , Keech Daniel , Wauquier Albert , Hubbard Douglas
Published: October 2005

Eighty‐two children underwent polysomnography (PSG) for symptoms suggestive of obstructive sleep apnea (OSA). Symptoms reported included snoring, witnessed apneic episodes, daytime somnolence, mouth breathing, and enuresis. Tonsillar size, nasal airway patency, and percentile weight were recorded. OSA was diagnosed on PSG when obstructive events were noted and apnea + hypopnea index was five or more per hour. The overall predictive accuracy of clinical suspicion of OSA was 25 (30%) of 82. Predictive accuracies (as a percentage of those with symptoms/signs who have OSA) and prevalences (as a percentage of those with OSA who have the symptom/sign), respectively, were for moderate snoring 29% (12 of 41), 48%; loud snoring 31% (11 of 35), 44%; witnessed apneas 32% (22 of 69), 88%; enuresis 46% (11 of 24), 44%; 2+ tonsillar size 37% (21 of 57), 84%; 3+ tonsillar size 33% (3 of 9), 12%; 90th percentile weight or greater 26% (7 of 27), 28%; 10th percentile weight or less 33% (5 of 15), 20%. Multiple regression analysis did not reveal a significant association between clinical parameters and the presence of OSA as defined by PSG.
Vagus Nerve Imaging with Ultrasound: Anatomic and in Vivo Validation
Authors: Knappertz Volker A. , Tegeler Charles H. , Hardin Sharon J. , McKinney William M.
Published: October 2005

To provide the anatomic basis and demonstrate the reproducibility of ultrasound studies for the identification of the vagus nerve within its course in the carotid sheath in the neck, cadaveric and in vivo imaging studies were conducted. On transverse B‐mode images of the neck, there is a centrally hypoechoic and peripherally hyperechoic structure between the common carotid artery and the jugular vein inside the carotid sheath. This structure was also identified in a fresh, nonpreserved cadaver and was marked with a hypodermic needle by means of a transdermal approach. Neck dissection was performed leaving the carotid sheath intact. B‐mode imaging yielded detailed anatomic information about the structures in the carotid sheath. Further dissection showed the vagus nerve as the target of the needle. One hundred consecutive transverse carotid scans were reviewed, and the characteristic echo patterns of the vagus nerve were identified in 97 instances. A distinct and reproducible, round, hypoechoic structure was defined adjacent to the common carotid artery and jugular vein as the vagus nerve. On the basis of this study, a new, noninvasive, and highly reproducible method to locate the vagus nerve in the carotid sheath is introduced. This may lead to further clinical application such as presurgical localization or ultrasound‐guided needle studies. Stimulation of the vagus nerve has been proposed for seizure therapy. The diagnosis of vagus nerve tumors may be improved.
Relationship between Progression of Disease and Immunoglobulin A‐anti‐Fab‐/F(ab')2 Autoantibodies in Patients with Head and Neck Cancer
Authors: Lorenz K. J. , Susal C. , Opelz G. , Maier H.
Published: October 2005

Patients with malignant tumors of the head and neck often have immune defects. Higher serum immunoglobulin (Ig)A levels were reported in this group of patients. We investigated whether IgA‐anti‐Fab‐ or IgA‐anti‐F(ab')2 autoantibodies, which have been shown to correlate with severe dysfunction of the immune system, also appear in patients with head and neck cancer. Sera of 110 patients with squamous cell carcinoma (SCCHN), eight patients with adenoid cystic carcinoma, and 57 healthy control subjects were tested by enzyme‐linked immunosorbent assay for IgA‐anti‐Fab autoantibody activity. Patients with head and neck cancer showed a higher IgA‐anti‐Fab activity (optical density (OD) = 399; n = 118) than did healthy control subjects (OD = 84; n = 57; p < 0.0001). An association between stage of disease and IgA‐anti‐Fab activity could be established in patients with SCCHN. Patients with stage IV disease had a significantly higher IgA‐anti‐Fab activity (OD = 538; n = 51) than had patients with stage I disease (OD = 283; n = 18; p < 0.05). Patients with stage II (OD = 293; n = 13) or stage III (OD = 379; n = 28) disease had intermediate activity. Also a higher IgA‐anti‐Fab activity than in healthy control subjects could be shown in the eight patients with adenoid cystic carcinoma (OD = 314; n = 8; p < 0.01). The highest IgA‐anti‐Fab activity was observed in eight patients with SCCHN who died within 6 months after testing (OD = 1004; n = 8), suggesting an association between autoimmunity and final desintegration of physiologic body functions. The occurrence of IgA‐anti‐Fab/IgA‐anti‐F(ab')2 autoantibodies might be interpreted as an aspect of immune deficiency in patients with malignant tumors of the head and neck.
The oldest rocks of Greece: first evidence for a Precambrian terrane within the Pelagonian Zone
Authors: ANDERS B. , REISCHMANN T. , KOSTOPOULOS D. , POLLER U.
Published: October 2005

The Pelagonian Zone in Greece represents the westernmost belt of the Hellenide hinterland (Internal Hellenides). Previous geochronological studies of basement rocks from the Pelagonian Zone have systematically yielded Permo-Carboniferous ages. In this study we demonstrate, for the first time, the existence of a Precambrian crustal unit within the crystalline basement of the Pelagonian Zone. The U–Pb single-zircon and SHRIMP ages of these orthogneisses vary from 699 ± 7 Ma to 713 ± 18 Ma, which identify them as the oldest rocks in Greece. These Late Proterozoic rocks, which today occupy an area of c. 20 × 100 km, are significantly different from the neighbouring rocks of the Pelagonian Zone. They are therefore interpreted as delineating a terrane, named here the Florina Terrane. During the Permo-Carboniferous, Florina was incorporated into an active continental margin, where it formed part of the basement for the Pelagonian magmatic arc. The activity of this arc was dated in this study by single-zircon Pb/Pb ages as having taken place at 292 ± 5 Ma and 298 ± 7 Ma. During the Alpine orogeny, Florina, together with the Pelagonian Zone, eventually became a constituent of the Hellenides. Geochemically, the Florina orthogneisses represent granites formed at an active continental margin. Because of the Late Proterozoic ages, this Late Proterozoic active continental margin can be correlated to a Pan-African or Cadomian arc. As the gneisses contain inherited zircons of Late to Middle Proterozoic age, the original location of Florina was probably at the northwestern margin of Gondwana. Similar to other Gondwana-derived terranes, such as East Avalonia, Florina approached the southern margin of Eurasia during Palaeozoic times, where it became part of an active continental margin above the subducting Palaeotethys. These interpretations further indicate that terrane accretion was already playing an important role in the early pre-alpine evolution of the Hellenides.