bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathology of the Olfactory Epithelium: Smoking and Ethanol Exposure
Authors: Vent J , Robinson A M. , Gentry‐Nielsen M J. , Conley D B. , Hallworth R , Leopold D A. , Kern R C.
Published: July 2004

Objective: To investigate the effects of tobacco smoke on the olfactory epithelium. Cigarette smoking has been associated with hyposmia; however, the pathophysiology is poorly understood. The sense of smell is mediated by olfactory sensory neurons (OSNs) exposed to the nasal airway, rendering them vulnerable to environmental injury and death. As a consequence, a baseline level of apoptotic OSN death has been demonstrated even in the absence of obvious disease. Dead OSNs are replaced by the mitosis and maturation of progenitors to maintain sufficient numbers of neurons into adult life. Disruption of this balance has been suggested as a common cause for clinical smell loss. This current study will evaluate the effects of tobacco smoke on the olfactory mucosa, with emphasis on changes in the degree of OSN apoptosis.

Study Design: A rat model was used to assess the olfactory epithelium after exposure to tobacco smoke.

Methods: Rats were exposed to tobacco smoke alone (for 12 weeks), smoke plus dietary ethanol (for the final 5 weeks), or to neither (control). Immunohistochemical analysis of the olfactory epithelium was performed using an antibody to the active form of caspase‐3. Positive staining for this form of the caspase‐3 enzyme indicates a cell undergoing apoptotic proteolysis.

Results: Control rats demonstrated a low baseline level of caspase‐3 activity in the olfactory epithelium. In contrast, tobacco smoke exposure triggered a dramatic increase in the degree of OSN apoptosis that affected all stages of the neuronal lineage.

Conclusions: These results support the following hypothesis: smell loss in smokers is triggered by increased OSN death, which eventually overwhelms the regenerative capacity of the epithelium.
Skin Testing in Predicting Response to Nasal Provocation with Alternaria
Authors: Krouse John H. , Shah Anand G. , Kerswill Kristy
Published: July 2004

Objective: Examine the efficacy of epicutaneous and intradermal testing in predicting response to nasal provocation with Alternaria antigen.

Study Design and Setting: Prospective study. Subjects were tested with the Multi‐Test II (MT) epicutaneous testing device. Subjects with negative wheals were then tested with a 1:500 weight:volume intradermal injection of Alternaria. They had baseline assessment of nasal cross‐sectional area (CSA) using acoustic rhinometry and underwent nasal provocation with increasing Alternaria concentrations. CSA was assessed at each concentration. A nasal allergen provocation score (NAP) of nasal symptoms as well as a nasal visual analogue scale (VAS) were also completed with each concentration.

Results: Sensitivity and specificity of MT in predicting nasal response to Alternaria were poor at 42% and 44%, respectively. The addition of intradermal testing increased sensitivity only modestly to 58%. hierarchical linear modeling analysis demonstrated that subjects positive to Alternaria on skin testing did not show a significant reduction in nasal CSA on acoustic rhinometry or significant elevations in two nasal symptom scores with direct nasal provocation.

Conclusion and Significance: Skin testing with either epicutaneous or intradermal testing may not be an accurate or sufficient technique in the assessment of Alternaria reactivity. These results suggest that mold allergies may involve more complex immune mechanisms than simply an immunoglobulin (Ig)E mediated type I immediate hypersensitivity response alone. An alternate model for mold sensitivity, as well as modifications in testing methods, may be required in the evaluation of mold allergy.
The Resident 80‐Hour Work Week: How Has It Affected Surgical Specialties?
Authors: Chandra Rakesh K.
Published: July 2004

Objectives: To identify strategies employed by surgical departments to address recently implemented resident duty hour regulations, and to assess resident and faculty acceptance of these changes.

Methods: Attendees to the 2003 Residency Program Coordinator/Administrator Workshop for sub‐specialties (Denver, CO) were surveyed.

Results: The study population included 46 respondents spanning 9 surgical sub‐specialties. Forty‐eight percent of programs instituted at least 1 administrative change specifically to comply with duty hour regulations. The most commonly employed strategies were the hiring of nurse practitioners or physician assistants (30%) and the use of Internet‐based software to track resident duty hours (30%). Other changes included giving call responsibilities to residents on research rotations (19%), institution of home‐call (13%), and assignment of a night‐float resident (11%). Perceptions of program coordinators indicated that junior residents and junior faculty accepted changes better than did senior residents and senior faculty (P=.025).

Conclusion: The resident 80‐hour work week is a major health care policy change that has required academic sub‐specialty departments to make significant alterations in their administrative structure. Further study is necessary to determine how these changes affect both quality of training and patient care in the short and long term.
Nasopharyngeal Actinomycosis: A Rare Cause of Nasal Airway Obstruction
Authors: Daamen Nicole , Johnson Jonas T.
Published: July 2004

Nasopharyngeal actinomycosis is a rare clinical disease. It can occur after nasal trauma or surgical manipulation. It is also reported to occur without prior trauma, making diagnosis difficult. We report a case of nasopharyngeal actinomycosis that presented as nasal airway obstruction causing snoring and mimicking nasopharyngeal carcinoma. To our knowledge, only a few other cases of nasopharyngeal actinomycosis have previously been published, most coming after mucosal trauma. Diagnosis is made by observing the bacteria or its associated sulfur granules in the biopsy specimen. This anaerobic organism is difficult to culture. Treatment consists of wide debridement and prolonged antibiotic therapy, with good prognosis.
Chondroitin Sulfate Hydrogel and Wound Healing in Rabbit Maxillary Sinus Mucosa
Authors: Gilbert M Erik , Kirker Kelly R. , Gray Steven D. , Ward P Daniel , Szakacs Juliana G. , Prestwich Glenn D. , Orlandi Richard R.
Published: July 2004

Objectives/Hypothesis: Chondroitin sulfate (CS) is a glycosaminoglycan in the extracellular matrix of all vertebrates. A biocompatible, nonimmunogenic, pliable hydrogel preparation of CS has recently been produced and has shown benefit in wound healing in murine and porcine epidermis. The objective of the current experiment is to compare the wound healing properties of CS hydrogel versus no treatment in wounds of the maxillary sinus mucosa.

Study Design: Prospective investigation in an animal model.

Methods: A 6 mm wound was created in bilateral maxillary sinuses of 17 New Zealand white rabbits. CS hydrogel (case) and no dressing (control) were randomly assigned to one side each as wound treatment. Wounds were examined ex vivo at 2, 4, 6, 10, and 14 day postinjury intervals. Wound diameter was measured microscopically by a blinded investigator. Representative specimens were examined histologically.

Results: The CS disc was partially integrated into the wounds at the 4‐day interval and completely integrated by the 6‐day interval. The average wound diameters for the case versus control side were similar at 2 days (3.75 mm vs. 4.42 mm) but differed significantly at 4 days (2.86 mm. vs. 3.80 mm., P = .035). At 6 days, the wounds could not be discerned on either the case or control sides. However, histologic analysis revealed accelerated healing with the CS treatment. The treated wounds displayed respiratory epithelium as opposed to the squamous epithelium exhibited on the untreated sides.

Conclusions: Despite some limitations, the New Zealand white rabbit is an effective model for the study of sinonasal wound healing. CS hydrogel accelerates wound healing in sinonasal mucosa at a 4‐day endpoint. We propose that the CS hydrogel acts as a surrogate extracellular matrix, serving as a repository for cytokines and growth factors produced by the regenerating mucosa. It may also provide a structural framework for fibroblasts and epithelial regeneration. Further study is necessary to establish this relationship.
Is A Plexiform Neurofibroma Pathognomonic of Neurofibromatosis Type I?
Authors: Lin Vincent , Daniel Sam , Forte Vito
Published: July 2004

Objectives/Hypothesis: Several prominent textbooks have claimed that a plexiform neurofibroma is pathognomonic for neurofibromatosis type I. This is not in agreement with the National Institutes of Health criteria, which require two signs to be present, one of which can be a plexiform neurofibroma. Is a plexiform neurofibroma pathognomonic for neurofibromatosis type I?

Study Design: Retrospective chart review.

Methods: Fifty‐one patients with surgically resected plexiform neurofibromas between the years 1991 and 2001 were identified, and their charts reviewed. The presence and absence of any manifestation of neurofibromatosis type I as detailed in the National Institutes of Health criteria were recorded. The pathology database at the Hospital for Sick Children (HSC) was searched retrospectively.

Results: Five of the 51 patients had a single solitary plexiform neurofibroma. They were followed at the neurofibromatosis clinic at the HSC with regular detailed examinations and no other stigmata were found.

Conclusion: Although plexiform neurofibromas are highly suggestive of neurofibromatosis type I, they are not pathognomonic as claimed.
Cochlear Implantation for Children With GJB2‐Related Deafness
Authors: Cullen Robert D. , Buchman Craig A. , Brown Carolyn J. , Copeland Ben J. , Zdanski Carlton , Pillsbury Harold C. , Shores Carol G.
Published: July 2004

Objectives/Hypothesis: Mutations in GJB2 are a common cause of congenital sensorineural hearing loss. Many children with these mutations receive cochlear implants for auditory habilitation. The purpose of the study was to compare the speech perception performance of cochlear implant patients with GJB2‐related deafness to patients without GJB2‐related deafness.

Study Design: Retrospective case review.

Methods: Pediatric cochlear implant recipients who have been tested for GJB2 mutation underwent chart review. All patients received cochlear implantation at a tertiary referral center, followed by outpatient auditory habilitation. Charts were reviewed for cause and duration of deafness, age at time of cochlear implantation, intraoperative and postoperative complications, duration of use, and current age. Results of standard tests of speech perception administered as a part of the patients' auditory habilitation were reviewed.

Results: Twenty patients with GJB2 mutations were compared with 27 patients without GJB2 mutations. There was no statistical difference between patients with and without GJB2‐related congenital sensorineural hearing loss with regard to open‐set and closed‐set speech recognition performance at 12, 24, and 36 months after cochlear implantation. Surgical complications were uncommon.

Conclusion: Pediatric patients with congenital sensorineural hearing loss without other comorbid conditions (eg, developmental delay, inner ear malformations) perform well when they receive cochlear implantation and auditory habilitation. The presence or absence of GJB2 mutation does not appear to impact speech recognition performance at 12, 24, and 36 months after implantation.
Giant Cell Arteritis: A New Association with Benign Paroxysmal Positional Vertigo
Authors: Amor‐Dorado Juan C. , Llorca Javier , Costa‐Ribas Carmen , Garcia‐Porrua Carlos , Gonzalez‐Gay Miguel A.
Published: July 2004

Objective: To assess the incidence and characteristics of both benign paroxysmal positional vertigo (BPPV) and positional nystagmus in a series of patients with giant cell arteritis (GCA).

Study Design: Patients diagnosed with GCA between June 1999 and May 2001 at the single hospital for a defined population were examined prospectively.

Method: Patients included in this study fulfilled the 1990 American College of Rheumatology classification criteria for GCA. Otologic and oculographic studies were performed. Type, frequency, and outcome of positional oculographic findings was assessed. Patients were required to have been examined within 1 week after the onset of corticosteroid therapy. Data found in GCA patients were compared with those observed in an age, sex, and ethnically matched control population. Further studies in patients and controls were performed 3 and 6 months later.

Results: Forty‐four patients and 44 matched controls were included in this study. Nine (20.5%) GCA patients fulfilled diagnostic criteria of BPPV compared with only 1 (2.3%) of the controls (P = .007). In seven of these nine GCA patients, BPPV was related to the posterior and two to the horizontal semicircular canals, respectively. Horizontal nystagmus was found in seven GCA patients who developed nystagmus in the head hanging position test compared with none in the controls (P = .006).

Conclusions: The present study shows a higher frequency of BPPV in GCA than in matched controls. Because most clinical manifestations in GCA are caused by ischemic complications, our results suggest an ischemic etiology as responsible for BPPV in these elderly patients. According to these results, GCA may constitute a new association with BPPV.
Histopathological Basis of Hearing Impairment in Wolf‐Hirschhorn Syndrome
Authors: Ulualp Seckin O. , Wright Charles G. , Pawlowski Karen S. , Roland Peter S.
Published: July 2004

Objectives/Hypothesis: To perform histological examination of temporal bones acquired from an infant with Wolf‐Hirschhorn syndrome with an emphasis on identifying abnormalities that might be responsible for hearing impairment in this disorder.

Study Design: Retrospective case review.

Methods: Temporal bones were taken at autopsy from a 10‐month‐old infant with Wolf‐Hirschhorn syndrome. The right‐side temporal bone was studied by microdissection. The middle ear was examined, and the inner ear sensory organs dissected for study by light microscopy. The left‐side temporal bone was embedded in celloidin, and sections were cut for microscopic examination.

Results: Chronic otitis media was observed in both ears. Inflammation, effusion, and adhesions were present in the middle ear space. The malleus was malformed, and the chorda tympani nerve was found to pass through the bone of the malleus bilaterally. There was an area of sharply defined outer hair cell loss in the lower basal turn of the right‐side organ of Corti, and defects were noted in the bone of the apical osseous spiral lamina in both cochleae.

Conclusion: In addition to the presence of otitis media, the likelihood of congenital abnormalities of the middle and inner ear should be considered in the assessment of patients with Wolf‐Hirschhorn syndrome with hearing impairment.
Effects of Long‐Term Nasal Continuous Positive Airway Pressure Therapy on Morphology, Function, and Mucociliary Clearance of Nasal Epithelium in Patients With Obstructive Sleep Apnea Syndrome
Authors: Bossi Roberto , Piatti Gioia , Roma Elisabetta , Ambrosetti Umberto
Published: July 2004

Objectives/Hypothesis:The objective was to investigate the possible modification of nasal mucosa function and mucociliary clearance in a group of patients with severe obstructive sleep apnea syndrome receiving mechanical ventilation with long‐term nasal continuous positive airway pressure (n‐CPAP), without nasal diseases.

Study Design:The study design was experimental. Eight (six male and two female) nonsmoker patients were selected on the basis of two sleep questionnaires, were identified as needing n‐CPAP therapy, and showed normal values of mucociliary transport time, ciliary beat frequency, and anterior rhinomanometry.

Methods:After a full polysomnographic examination, the authors recorded respiratory disturbance index (RDI), apnea/hypopnea index, nadir arterial oxygen saturation, and sleep stage. Every patient underwent pulmonary function test; arterial blood gas analysis; chest radiography; electrocardiography; ear, nose, and throat evaluation with rhinoscopy; anterior rhinomanometry; a saccharine test to measure the mucociliary transport time; and a brushing of nasal epithelium for study of ciliary beat frequency. All patients underwent polysomnographic examination in basal condition with overnight n‐CPAP (without humidifier) and repeated this examination after 1 and 6 months with Auto CPAP (Autoset Res Care, Sidney, Australia) to titrate n‐CPAP pressure and measure the new respiratory disturbance index.

Results:The mean basal respiratory disturbance index (number of respiratory events during sleep per hour of recording time) was 53.7 ± 21.5 events/h; after 6 months of n‐CPAP therapy (mean value, 7.5 ± 0.7 cm H2O) the respiratory disturbance index was 5.7 ± 3.76 events/h. Values for nasal resistance, mucociliary transport time, and ciliary beat frequency were normal before and after the ventilatory treatment.

Conclusion:In the study group of patients with severe obstructive sleep apnea syndrome, the nocturnal use of n‐CPAP without humidifier did not modify the function and mucociliary clearance of nasal epithelium.
Nontuberculous Mycobacteria‐Induced Parotid Lymphadenitis Successfully Limited With Clarithromycin and Rifabutin
Authors: Shah Maulik B. , Haddad Joseph
Published: July 2004

Objectives/Hypothesis: Nontuberculous mycobacterial adenitis of the parotid gland is often difficult to diagnose. The rarity of these infections in the parotid region and the lack of specific guidelines pose a treatment challenge to the clinician. Three cases of nontuberculous mycobacterial adenitis are presented, with clinical response to antibiotics before surgery.

Study Design: Retrospective chart review was made of children up to 18 years of age presenting with a parotid mass diagnosed as nontuberculous mycobacterial infection.

Methods: Three patients (age range, 15 to 30 mo) with nontuberculous mycobacteria‐induced parotid lymphadenitis were treated with a combination antibiotic regimen of clarithromycin and rifabutin or with clarithromycin alone.

Results: All three patients responded clinically to the antibiotic treatment as evidenced by a smaller mass size and resolution of the overlying discoloration. Subsequent parotidectomy or biopsy appeared to be easier to perform because of decreased inflammation and edema and a more readily dissectible facial nerve.

Conclusion: Children with nontuberculous mycobacteria‐induced parotid lymphadenitis should be started on a trial of antibiotic treatment before surgery. Although surgery remains the definitive treatment modality, a larger study of preoperative antibiotic use against nontuberculous mycobacterial adenitis of the parotid in children is necessary.
Can Maximum Phonation Time Predict Voice Outcome after Thyroplasty Type I?
Authors: Lundy Donna S. , Casiano Roy R. , Xue Jun W.
Published: July 2004

Background: Thyroplasty type I, as introduced by Isshiki and colleagues almost 30 years ago, has become the gold standard of improving glottal incompetence caused by unilateral vocal fold paralysis. Intraoperative assessment of the adequacy of glottal closure is subjective and based on the perceptual judgment of vocal quality and degree of improvement in glottal gap size.

Objective/Hypotheses: The primary purpose of this study was to investigate whether the intraoperative measurement of maximum phonation time (MPT) is an adequate predictor of voice outcome after thyroplasty type I. To assess this possibility, it was necessary to evaluate the effect of body posture (seated vs. supine) and anesthesia (none vs. light sedation) on the measure of MPT.

Study Design: A prospective study of 20 individuals with unilateral vocal fold paralysis was undertaken.

Methods: Subjects were assessed at three time points: pre‐, intra‐, and postoperatively across parameters of breathiness rating, glottal gap size, glottal flow rate, and MPT.

Results: Results indicated that MPT was significantly lower in the supine versus seated position. In addition, light sedation resulted in a trend toward lower MPT that was not statistically significant. Finally, the intraoperative measurement of MPT, although lower than a 1‐month postoperative measurement, was significantly predictive of the outcome.

Conclusions: The intraoperative measure of MPT appears to be an adequate predictor of the postoperative outcome.
Retrosigmoid Versus Middle Fossa Surgery for Small Vestibular Schwannomas
Authors: Mangham Charles A.
Published: July 2004

Objectives/Hypothesis: The objective was to determine the effect of approach, middle fossa versus retrosigmoid, on the hearing and facial nerve outcome of surgery for small vestibular schwannomas.

Study Design: The study had two parts, a case study of patient data entered into a prospectively designed database at the author's institution, and a meta‐analysis of similar published data.

Methods: There were 73 of the author's private practice patients who met the inclusion criteria of intracanalicular vestibular schwannoma and total tumor removal by a retrosigmoid approach. American Academy of Otolaryngology—Head and Neck Surgery standardized hearing and facial nerve classifications of these patients and similar data from 11 other institutions were used to compare results of the two surgical approaches.

Results: Median facial nerve results for all institutions were significantly better with the retrosigmoid approach (grade I: 95% for retrosigmoid and 81% for middle fossa). Median hearing results trended toward better outcome with the middle fossa approach (same preoperative hearing class: 48% for middle fossa and 39% for retrosigmoid). Individual institution had an equal or greater effect on outcome than the choice of surgical approach.

Conclusion: Surgical team accounted for more variability in hearing and facial nerve outcome than did approach. Retrosigmoid approach yielded significantly better facial nerve outcome. The trend toward better hearing outcome with the middle fossa approach may never achieve statistical significance across institutions because of high variability among surgical teams and small numbers of teams reporting results.
Advantages of Cochlear Implantation in Prelingual Deaf Children before 2 Years of Age when Compared with Later Implantation
Authors: Manrique Manuel , Cervera‐Paz Francisco Javier , Huarte Alicia , Molina Maite
Published: July 2004

Objectives: To compare the auditory abilities and speech performance of children with a profound prelingual bilateral hearing‐impairment when subjected to a cochlear implant (CI) before or after 2 years of age. To analyze the complications that arose during, or as a result of, the implantation process in these groups.

Design: Prospective cohort single‐subject, repeated‐measures study of children with profound bilateral hearing impairment subjected to CI.

Setting: Tertiary referral center with a program of pediatric CI from 1991.

Patients: This study analyzed 130 children subjected to multichannel CI for profound prelingual bilateral hearing‐impairment in two age groups: 0 to 2 (n = 36) and 2 to 6 years of age (n = 94).

Interventions: The children were evaluated before, and each year after, the intervention (for up to 5 years) with both closed‐set and open‐set auditory and speech perception tests. Their speech ability was evaluated according to the Peabody Picture Vocabulary and Reynell general oral expression scales.

Results: Auditory and speech perception tests improved significantly in all children after CI, regardless of the follow‐up time. The infant's performance was better the earlier the implant was performed. Speech tests showed that the development of children treated before 2 years of age was similar to normal children, and no additional complications were observed when compared with CI in older children.

Conclusions: When performed before 2 years of age, CI offers a quicker and better improvement of performance without augmenting the complications associated with such an intervention.
Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea and Skull Base Defect: Ten‐Year Experience
Authors: Lee Ta‐Jen , Huang Chi‐Che , Chuang Chi‐Cheng , Huang Shiang‐Fu
Published: July 2004

Objectives/Hypothesis:Many reports have advocated the feasibility of using an endoscope for the treatment of cerebrospinal fluid (CSF) rhinorrhea and skull base defect, and diversified endoscopic techniques and repairing materials have recently been proposed. This study determined the effectiveness of endoscopic repair of CSF leaks and interpreted the indications of the lumbar drain.

Study Design:Retrospective follow‐up.

Methods:A total of 39 patients with CSF rhinorrhea (20 traumatic, 13 iatrogenic, and 6 spontaneous) were treated in one institution over a 10‐year period. An underlay procedure was used to make eight (20.5%) repairs by way of a turbinate composite graft (4 patients), turbinate mucosa graft (3 patients), or the Dura Substitute (Preclude) (1 patient). A free turbinate graft with the applied fibrin glue was used to repair the defect by way of an overlay procedure in 23 (59.0%) lesions. Abdominal fat was used to repair the other eight (20.5%) lesions.

Results:Defects in the cribriform plate and anterior ethmoid sinus comprised the majority (61.5%) of all lesions. The successful rates for overlay, underlay, and fat obliteration procedures were 91.3% (21/23), 87.5% (7/8), and 100% (8/8), respectively. There were no statistical difference between underlay and overlay techniques (P= .792, Student's t test). Lumbar drainage was performed in 18 of 39 (46.2%) cases. Most patients required nasal packing (89.7%) and prophylactic parenteral antibiotics (97.4%). CSF rhinorrhea was resolved during the first attempt in 36 of 39 (92.3%) patients. All leaks were successfully repaired after a second attempt. No major complications were encountered.

Conclusion:The endoscopic approach is safe and effective for the treatment of CSF rhinorrhea, even in the cases not successfully treated by previous neurosurgical approaches. Lumbar drain was suggested for defects in the frontal and sphenoid sinus and defects associated with meningocele or encephalocele. Complete exposure of the defect, appropriate selection of a fitting graft, as well as accurate placement and stabilization of the graft are critical to the success of repair.
Treatment of a Proximal Accessory Nerve Injury with Nerve Transfer
Authors: Novak Christine B. , Mackinnon Susan E.
Published: July 2004

Objective and Hypothesis: This study presents a case report of a patient who sustained an iatrogenic proximal accessory nerve injury that was treated with a medial pectoral to accessory nerve transfer.

Study Design: Case study.

Materials and Methods: Chart of one patient who was treated with a medial pectoral to accessory nerve transfer was reviewed.

Results: Five months after excision of a branchial cyst that resulted in a very proximal injury to the accessory nerve, this patient underwent a medial pectoral to accessory nerve transfer. At final follow‐up, 3 years after surgery, the patient had full abduction overhead with some residual shoulder/scapular discomfort and mild scapular winging.

Conclusion: The medial pectoral to accessory nerve transfer provides a viable surgical option with good reinnervation of the trapezius muscle in patients with a proximal accessory nerve injury where standard nerve repair or graft techniques are not feasible.
Impact of Anterior Commissure Involvement on Local Control of Early Glottic Carcinoma Treated by Laser Microresection
Authors: Steiner Wolfgang , Ambrosch Petra , Rödel Ralph M.W. , Kron Martina
Published: July 2004

Objectives: To analyze the impact of anterior commissure involvement on local control, survival, and laryngeal preservation in patients with early glottic cancer (pT1a–pT2a) treated with unimodality laser microsurgical resection.

Study Design: Retrospective review of 263 patients with early glottic cancer treated between 1986 and 1996.

Methods: Data on local control and overall survival rates were analyzed and calculated by the Kaplan‐Meier method; the larynx preservation rates were given absolutely.

Results: Among 158 patients presenting with T1a glottic cancer, the anterior commissure was involved in 28 cases; the 5‐year local control rate was 84%, and the larynx preservation rate was 93%. In the 130 cases without anterior commissure involvement, the 5‐year local control rate was 90.0% and the corresponding larynx preservation rate 99%. In the T1b category consisting of 30 patients, anterior commissure involvement was observed in 16 patients; the 5‐year local control rate was 73%, and the larynx preservation rate was 88%. In the 14 cases without anterior commissure involvement, the 5‐year local control rate was 92% and the corresponding larynx preservation rate 100%. Seventy‐five patients had T2a glottic carcinomas, with normal vocal cord movement. The anterior commissure was involved in 45 cases; the 5‐year local control rate was 79%, and the larynx preservation rate was 93%. In the 30 cases without anterior commissure involvement, the 5‐year local control rate was 74.0% and the corresponding larynx preservation rate 97%.

Conclusions: This study shows the effectiveness of laser microsurgery for early glottic carcinoma regardless of anterior commissure involvement at presentation. This method can be performed as an outpatient procedure, even when conducting reresections.
Medicolegal Analysis of Injury During Endoscopic Sinus Surgery
Authors: Lynn‐Macrae Alastair G. , Lynn‐Macrae Rebecca A. , Emani Janaki , Kern Robert C. , Conley David B.
Published: July 2004

Objectives:To survey the causes, characteristics, and outcomes of malpractice litigation resulting from injuries sustained during endoscopic sinus surgery (ESS).

Study Design:A retrospective analysis of United States state and federal civil litigation involving injuries resulting from ESS.

Methods:Sources were state and federal court decisions and jury verdict reports accessed through a computerized legal database. The 41 cases were decided or settled between 1990 and 2003. The cases and reports were analyzed for pertinent data regarding plaintiffs, defendants, allegations of wrongdoing, resulting injury, expert witnesses, and resulting verdict or settlement. Correlation between severity of injury and case outcome was analyzed.

Results:All suits reviewed involved ESS. Many cases included multiple causes of action, or types of malpractice, including negligent technique, 31 (76%); lack of informed consent, 15 (37%); and wrongful death, 2 (5%). The defendant‐physician specialty was overwhelmingly otolaryngology, 40 (98%). The most common presenting complaint, or indication for surgery, was chronic sinusitis, 30 (73%). The injuries caused by surgery were frequently multiple, including cerebrospinal fluid (CSF) leak, 10 (24%); brain damage, 6 (15%); diplopia, 7 (17%); and death, 2 (5%). The majority of cases reviewed (83%) resulted in a verdict rather than settlement. The result of the verdict or settlement was 17 (41%) in favor of the plaintiff, 23 (56%) in favor of the defendant, and 1 (2%) unknown. The average award was $751,275, with a median of $410,239 and a range of $61,000 to $2,870,000.

Conclusions:This is the first study to review malpractice litigation resulting from injuries sustained during ESS and shows a hitherto unexpected pattern between severity of injury and case outcome.
MUC4 and ErbB2 Expression in Squamous Cell Carcinoma of the Upper Aerodigestive Tract: Correlation With Clinical Outcomes
Authors: Weed Donald T. , Gomez‐Fernandez Carmen , Yasin Mohammed , Hamilton‐Nelson Kara , Rodriguez Michael , Zhang Jin , Carraway Kermit L.
Published: July 2004

Objectives/Hypothesis: Expression of the membrane mucin MUC4 has been associated with a variety of malignancies, including squamous cell carcinoma of the upper aerodigestive tract. MUC4 modulates cell signaling pathways as an intramembrane ligand of ErbB2. The hypotheses of the study were that MUC4 expression would correlate with ErbB2 expression and that MUC4 expression would correlate with clinical outcomes in squamous cell carcinoma of the upper aerodigestive tract.

Study Design: Retrospective chart review was combined with immunohistochemical analysis of paraffin‐embedded tumor specimens from patients treated with initial definitive surgical resection at an academic tertiary care medical center.

Methods: MUC4 and ErbB2 receptor expression was localized by immunohistochemical studies using archival formalin‐fixed and paraffin‐embedded tissue. A limited number of fresh‐frozen tissues were further analyzed by Western blot. Clinical outcomes and histopathological parameters were determined by retrospective chart review and correlated with immunohistochemical findings.

Results: One hundred fifty‐four patients were analyzed with a median follow‐up of 12 months among 54 patients who died and 49 months among 100 surviving patients. Membrane expression of MUC4 and ErbB2 was seen in 12% and 13% of tumors, respectively. MUC4 expression was not correlated with pathological grade. A significant correlation was found between MUC4 expression and ErbB2 expression. Multivariate survival analyses revealed that patients whose tumors exhibited MUC4 membrane expression had statistically significant improvement in survival and longer time to recurrence compared with patients whose tumors did not express MUC4 as defined by immunohistochemical staining patterns. No correlations between ErbB2 expression and survival or recurrence were observed.

Conclusion: Patients with tumors that retain MUC4 expression exhibit improved survival and decreased recurrence in squamous cell carcinoma of the upper aerodigestive tract. Correlations between MUC4 expression patterns and ErbB2 expression are also observed, suggesting that MUC4‐ErbB2 mediated cell signaling pathways may provide insights into this clinical result.
Higher IL‐10 levels are associated with less effective clearance of Plasmodium falciparum parasites
Authors: Hugosson E. , Montgomery S. M. , Premji Z. , Troye‐Blomberg M. , Björkman A.
Published: July 2004

The implications of high levels of the immune regulatory cytokine IL‐10 in Plasmodium falciparum malaria are unclear. IL‐10 may down‐regulate pro‐inflammatory responses and also exacerbate disease by inhibiting anti‐parasitic immune functions. To study possible inhibiting effects on parasite clearance, IL‐10 plasma levels were determined in 104 Tanzanian children, 1 to 4 years old, with acute uncomplicated P. falciparum malaria, and analysed for association with parasite densities during 3 days of anti‐malarial treatment. Higher baseline IL‐10 plasma levels were associated with statistically significantly higher parasite densities after 24, 48 and 72 h of treatment. These associations could not be explained by differences in initial parasitaemia, temperature, age, sex or type of treatment. Induction of high IL‐10 production might be a direct or indirect mechanism whereby the parasite evades the immune response.
Monoclonal antibodies against a 62 kDa proteinase of Trichomonas vaginalis decrease parasite cytoadherence to epithelial cells and confer protection in mice
Authors: Hernández H. , Sariego I. , Garber G. , Delgado R. , López O. , Sarracent J.
Published: July 2004

Trichomonas vaginalis infects the epithelium of the genital tract. The mechanism by which it invades the tissue leading to the disease is not thoroughly understood. However, results of several studies seem to agree that parasite adhesion to epithelium cells is the initial step leading to infection in women. T. vaginalis is associated with high levels of proteolytic activity. The role of some of these proteinases in the development of infection has been demonstrated. The current study establishes the role of a 62 kDa excretion–secretion proteinase in parasite cytoadherence. Monoclonal antibodies (MAbs) against this enzyme were tested for their ability to inhibit this process. Three stable hybrid producers of IgG1class MAbs (4D8, 1A8, 3C11) against the 62 kDa proteinase were obtained. Two of them (4D8 and 1A8) showed parasite recognition by immunofluorescence. Parasite cytoadherence to a monolayer of HeLa cells was inhibited by the 4D8, 1A8 and 3C11 antibodies. MAb 4D8 administered 24 h before a challenge with T. vaginalis by the intraperitoneal route was able to protect the majority of mice. Nitric oxide levels in the serum of animals inoculated with MAb 4D8 and challenged with the parasite were significantly different from those recorded in mice treated with an unrelated MAb. These studies show that an appropriate antibody against 62 kDa proteinase can help the host resist a challenge by the intraperitoneal route with T. vaginalis.
Th1 and Th2 immunological profile induced by cysteine proteinase in murine leishmaniasis
Authors: Alves C. R. , Benévolo‐de‐Andrade T. C. , Alves J. L. , Pirmez C.
Published: July 2004

This study evaluated the immune response to three synthetic peptides (pI, VMVEQVICFD; pII, VGGGLCFE; pIII, PYFLGSIMNTCHYT) from the COOH‐terminal region of Leishmania amazonensis cysteine proteinases, in BALB/c‐ and CBA‐infected mice with this parasite. Only BALB/c mice, previously inoculated with pI, showed a distinct exacerbation of the lesion. Blastogenesis assays were performed with lymph node cells from the group of mice infected with L. amazonensis, but not inoculated with the peptides, and we detected lymphoproliferative responses in BALB/c and CBA mice with a 5·0×and 2·5×stimulation index, respectively. Cell phenotypes were evaluated and in both mouse strains CD8+cells proliferated more extensively than CD4+cells. INF‐γ and nitric oxide were detected only in supernatants obtained from CBA mouse lymph node cell cultures, whereas IL‐4 was detected in supernatant cultures from both strains of mice. Our results indicate a preferential stimulation of CD8+T‐cell subsets by the pI cysteine proteinase peptide and the induction of both Th1 and Th2 phenotypes during L. amazonensis infections in both BALB/c and CBA mice. We suggest that the pI peptide from the COOH‐terminal region of the cysteine proteinase induces immune responses different from those elicited by the whole molecule.
Inhibition of neutrophil recruitment by ES of Nippostrongylus brasiliensis
Authors: Keir P. A. , Brown D. M. , Clouter‐Baker A. , Harcus Y. M. , Proudfoot L.
Published: July 2004

It has been reported that excretory–secretory (ES) material from the parasitic nematode Nippostrongylus brasiliensis has potential modulatory effects on the host's immune system. We observed that intratracheal instillation of ES from the L3 stage of the parasite reduced neutrophil numbers in LPS‐induced inflammation as assessed by bronchoalveolar lavage.
Infection of BALB/c mice with Angiostrongylus costaricensis decreases pulmonary inflammatory response to ovalbumin
Authors: Pinto L. A. , Pitrez P. M. C. , Fontoura G. R. , Machado D. C. , Jones M. H. , Graeff‐Teixeira C. , Stein R. T.
Published: July 2004

The prevalence of asthma in developing countries is lower than in developed countries. Viral, bacterial and parasitic infections may be associated with this discrepancy. The relationship between parasitic infection and asthma prevalence is not clear. Previous controversial data have demonstrated that parasitic infection may either predispose or protect against the development of asthma. The aim of this study is to determine whether infection with Angiostrongylus costaricensis (A. costaricensis) decreases inflammatory lung response to ovalbumin (OVA) in mice. Seven BALB/c mice were infected with A. costaricensis by orogastric gavage (10 larvae/mouse) on day (D) 0. The mice were immunized against OVA by intraperitoneal injection on D 5 and D 12 and received an intranasal OVA challenge (40 µL) on D 15 and D 17. On D 19 bronchoalveolar lavage (BAL) was performed. Six BALB/c mice (control group) were immunized with OVA using the same protocol, but were not infected with A. costaricensis. Interleukin (IL)‐1β and IL‐6 levels were measured in the BAL fluid by using commercial ELISA assays. Total cell counts and differential cell counts were performed in the BAL fluid samples. The group infected with A. costaricensis had lower total cell count in the BAL fluid when compared with the control group (0·11 × 106cells/mL and 0·3 × 106cells/mL, respectively; P = 0·013). BAL fluid IL‐1β levels in the infected group were significantly lower than in the control group (P = 0·008). IL‐6 levels in BAL fluid were not different between the groups studied. We conclude that Angiostrongylus costaricensis infection in mice decreases pulmonary inflammatory response to OVA.
Can biological control benefit from genetically‐modified crops? Tritrophic interactions on insect‐resistant transgenic plants
Authors: Poppy Guy M. , Sutherland Jamie P.
Published: July 2004

Abstract.  The use of recombinant DNA technology to develop genetically‐modified crops is considered as a major breakthrough for agriculture by many scientists. However, some scientists, and an even larger proportion of the general public, are sceptical about the advantages and are even more concerned about the potential risk of this new technology. To evaluate this novel technology, cost‐benefit analyses are needed in which the real risks are measured and judged against the benefits. A tiered risk assessment scheme is described herein. This allows comparisons to be made with other insect‐control technologies (e.g. insecticides) and risks to be determined, rather than only hazards being identified. Recombinant DNA technology could allow plants to be designed that are well suited for use alongside biological control programmes. Unfortunately, plant breeders have continued to attempt to breed for total resistance, and biocontrol specialists have ignored the role of the plant in ensuring successful foraging behaviour by insect natural enemies. Although some scientists have highlighted the need to consider both the bottom‐up (plant defence) and top‐down (biocontrol) control of insect pests, there have been few serious attempts to combine these approaches. As more is understood about the proximate and ultimate causes of direct and indirect defences, the potential exists for engineering plants that combine both strategies. This new possibility for controlling insect pests, which will combine both ‘nature’s' own defences with man's ingenuity, may stack the odds in our favour in the continual struggle against insect pests.
Modelling insect diseases as functional predators
Authors: Boots Michael
Published: July 2004

Abstract.  Many larval diseases of insects allow no recovery once infected. Furthermore, infected individuals are not able to develop into adults and will not therefore reproduce. A simple modelling approach emphasizes the fact that, accordingly, the agents that cause these diseases are functionally predators. It is important to make this distinction and to be cautious in applying inference drawn from models of parasites to these diseases. Sublethal effects are well known in these insect larval diseases, and models show that they have important dynamical implications. Sublethal effects have received less attention in predator–prey interactions, but their functional relationship with insect diseases emphasizes that nonmortality effects of predators may have correspondingly important dynamical implications.
Insect pathogenicity islands in the insect pathogenic bacterium Photorhabdus
Authors: Waterfield Nicholas R. , Daborn Phillip J. , Ffrench‐Constant Richard H.
Published: July 2004

Abstract.  Genomic islands are regions of the bacterial genome responsible for unique aspects of bacterial behaviour, such as host symbiosis and pathogenicity. Where such regions are involved in pathogenesis, they are termed pathogenicity islands (PAIs). Photorhabdus luminescens is an insect pathogen that spends part of its life in symbiosis with a nematode and part of its life as an insect pathogen. Here, several novel PAIs from P. luminescens ssp. akhurstii strain W14 are described that encode factors involved apparently in both nematode symbiosis and insect pathogenicity. The structures of these islands are compared with those found in mammalian pathogens, and the potential cross‐talk between virulence factors used against invertebrates and those used against vertebrates is discussed.
Almost Boolean Functions: The Design of Boolean Functions by Spectral Inversion
Authors: Clark John A. , Jacob Jeremy L. , Maitra Subhamoy , Stănică Pantelimon
Published: July 2004

The design of Boolean functions with properties of cryptographic significance is a hard task. In this paper, we adopt an unorthodox approach to the design of such functions. Our search space is the set of functions that possess the required properties. It is “Boolean‐ness” that is evolved.
Detecting New Forms of Network Intrusion Using Genetic Programming
Authors: Lu Wei , Traore Issa
Published: July 2004

How to find and detect novel or unknown network attacks is one of the most important objectives in current intrusion detection systems. In this paper, a rule evolution approach based on Genetic Programming (GP) for detecting novel attacks on networks is presented and four genetic operators, namely reproduction, mutation, crossover, and dropping condition operators, are used to evolve new rules. New rules are used to detect novel or known network attacks. A training and testing dataset proposed by DARPA is used to evolve and evaluate these new rules. The proof of concept implementation shows that a rule generated by GP has a low false positive rate (FPR), a low false negative rate and a high rate of detecting unknown attacks. Moreover, the rule base composed of new rules has high detection rate with low FPR. An alternative to the DARPA evaluation approach is also investigated.
Automated Design of Security Protocols
Authors: Hao Chen , Clark John A. , Jacob Jeremy L.
Published: July 2004

Security protocols play an important role in modern communications. However, security protocol development is a delicate task, and experience shows that computer security protocols are notoriously difficult to get right. Recently, Clark and Jacob provided a framework for automatic protocol generation based on combinatorial optimization techniques and the symmetric key part of BAN logic. This paper shows how such an approach can be further developed to encompass the full BAN logic without the loss of efficiency and thereby synthesize public key protocols and hybrid protocols.
Finding Efficient Distinguishers for Cryptographic Mappings, with an Application to the Block Cipher TEA
Authors: Hernandez Julio C. , Isasi Pedro
Published: July 2004

A simple way of creating new and very efficient distinguishers for cryptographic primitives, such as block ciphers or hash functions, is introduced. This technique is then successfully applied over reduced round versions of the block cipher TEA, which is proven to be weak with less than five cycles.