bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended hemilaryngectomy for T3 GLOTTIC CARCINOMA WITH PRESERVATION OF SPEECH AND SWALLOWING
Authors: Pearson Bruce W. , Woods Robert D. , Hartman David E.
Published: October 2006

Total laryngectomy is often applied in the treatment of invasive squamous cell carcinomas that fix one side of the larynx. The major drawback, of course, is loss of the voice. In many instances, however, preservation of the uninvolved portion of the larynx is compatible with adequate tumor margins, and the preserved laryngeal remnant, although it cannot be reconstituted to allow breathing, can readily be used for voice.

The principle involved is the creation of a valved tracheopharyngeal shunt, which functions as a neoglottis during expiration but constricts to close during swallowing. To accomplish this the recurrent laryngeal nerve and the myomucosal segment of intrinsic glottic musculature to which it is attached is preserved on the uninvolved side. The myomucosal segment is formed into a mucosal lined tube by releasing the soft tissues from the cartilage. The diameter and flaccidity of the tube is augmented by incorporating a flap of hypopharyngeal mucosa. Safe performance of this operation depends on careful preoperative evaluation and laryngoscopic verification and a close‐working relationship with an interested surgical pathologist.

The first 7 consecutive cases in which this management program has been applied are presented in review. The patients, ranging in age from 58 to 69 years old, had T3 grade 2 or 3 invasive squamous cell carcinoma. The average hospitalization was 13 days. The longest follow‐up is 5 years.

Clear surgical margins, local control of the disease, and satisfactory voice without significant aspiration have been achieved thus far in each case. The average subglottic pressures measured at the tracheotomy were 25 ± 6 cm. of water (threshold opening) and 43 ± 20 cm. of water (for phonation).

Whether these encouraging initial results can be widely duplicated will probably depend on the care with which cases are selected. The dangers of applying this surgery to patients with extensive submucosal spread will be obvious to experienced laryngologists.
Thyroid carcinoma
Authors: Friedman Michael , Skolnik Emanuel M. , Baim Howard M. , Becker Stephen P. , Katz Arthur H. , Mantravadi Rao V. P.
Published: October 2006

Differentiated thyroid carcinoma was studied with regard to mode of presentation, initial findings, treatment and survival. The classic signs, symptoms, physical and scan findings were found to be present in approximately 70% of the patients. Thirty percent of the patients had either unusual presentations or findings.

Prognosis was found to be dependent on age of presentation more than any other factor. The effects of neck metastasis, extracapsular invasion and recurrent laryngeal nerve involvement on long‐term survival are studied in detail.

Patients with prior exposure to radiation were found to have more extensive disease and require more extensive surgery but ultimately had the same prognosis for 15‐year cure.

Treatment for distant metastatic disease by surgery, radioactice iodine and external radiation all resulted in long‐term survival in certain cases.
Immunosuppression and the development of malignancies of the upper airway and related structures
Authors: Harris Jeffrey P. , Penn Israel
Published: October 2006

In the general population, 90% of the malignancies developing in the upper respiratory tract are squamous cell carcinomas. Analysis of 1081 neoplasms in 1023 renal transplant patients reported to the Denver Transplant Tumor Registry indicates that squamous cell carcinoma reMayns the predominant malignancy which develops in the upper respiratory tract of immunosuppressed individuals. Comparing the incidence of cancers of the oral cavity (excluding lip cancers) in the immunosuppressed population with the general population it is rather similar (3.5% vs. 4%). When lip cancers are included, one sees a great excess of tumors developing in transplant patients (15% vs. 4.6%). Thus the excess of head and neck epithelial malignancies among these patients is confined to neoplasms of the lip.

Examination of the 25 patients reported in this study reveals an unusually young age of the patients, the average age being 41.8 years compared with the general population where most head and neck tumors occur in the 55‐65 age group. The average time posttransplantation when cancer developed was 5.3 years, supporting the concept that the more effective the immunosuppressive regimen for prevention of graft rejection, the greater the susceptibility for the development of cancer. Since 90% of transplant patients have serological or clinical evidence of active herpes virus infection, it is possible that this microorganism may play a role in the development of certain head and neck malignancies, especially those involving the lips.
High frequency conductive hearing loss: A case presentation
Authors: Mustain William D. , Hasseltine Hanley E.
Published: October 2006

High frequency conductive hearing loss can result from partial obstruction of the external auditory canal, ear canal “collapse,” or partial ossicular discontinuity. This report describes the evaluation and management of an unusual case of partial ossicular discontinuity with resultant high frequency conductive hearing loss.
The role of high resolution computerized tomography and standardized ultrasound in the evaluation of orbital cellulitis
Authors: Goodwin W. Jarrard , Weinshall Michael , Chandler James R.
Published: October 2006

We reviewed the records of 22 patients with orbital cellulitis to determine the value of high resolution computerized tomography (HRCT) and standardized ultrasound (US) in their management, In 13 patients, they demonstrated abscess formation and accurately defined its location and extent. The appearance of an abscess did not necessarily mandate immediate surgery. Three patients responded promptly to intensive antibiotic therapy and resolved despite a presumptive diagnosis of orbital abscess. The remaining 10 patients required surgical intervention and abscess formation was confirmed.

In patients presenting with good visual acuity and some globe motion we recommended instituting intensive intravenous antibiotic therapy for 36 hours with close monitoring of visual acuity, avoiding surgery unless some impairment of vision is noted. The decision regarding surgery is then made on the time honored basis of response to therapy. Surgery is not necessary in those patients exhibiting prompt significant improvement in local inflammatory signs.
Aspergillosis of the nose and paranasal sinuses
Authors: Romett J. Lewis , Newman Richard K.
Published: October 2006

Aspergillosis is becoming an increasingly recognized pathogen in the sinonasal tract. The courses of two patients, one seemingly healthy and one with a terminal malignancy, are reviewed. These patients illustrate the clinical course, difficulties in diagnosis, and management of patients with aspergillosis of the sinonasal tract.

Aspergillus is a common endogenous contaminant of the upper respiratory tract; however, bacterial sinusitis may trigger its growth and proliferation. Aspergillus fumigatus is the most common species implicated in paranasal sinus disease in the United States. The maxillary antrum is the most commonly involved site in the paranasal sinuses. Originally, aspergillosis was described in healthy patients, but it has become increasingly recognized in the immunocompromised and the chronically debilitated. Paranasal sinus Aspergillus infections are classified as non‐invasive, invasive and fulminant. The treatment is primarily surgical. Antifungal chemotherapeutic agents are used in the treatment of central nervous system involvement and in the fulminant form of the disease.
Canine model of subglottic stenosis secondary to prolonged endotracheal intubation
Authors: Marshak Gabriel , Doyle William John , Bluestone Charles D.
Published: October 2006

Acquired subglottic stenosis is usually a consequence of prolonged endotracheal intubation. The present study describes a canine model of subglottic stenosis which is congruent with the known and suspected pathogenesis of the disease in man. Eighteen young pups (Canis familiaris) were used. A modified cuffed endotracheal tube was placed within the subglottis and secured by inflating the cuff. The capillary tube supplying the cuff was sealed and cut so as to lie below the epiglottis. Three animals died of tracheal rupture or collapse prior to or on the thirteenth day following intubation. In the remaining animals, the cuffed tube was removed and the subglottis was examined. All exhibited ulcerations and exuberant polyploid granulations at the level of the subglottis and trachea. A 4 mm uncuffed endotracheal tube was introduced and secured within the subglottis and trachea of a number of the pups to provide an airway. After a 3‐week period, the tube was removed and the dogs were sacrificed. Examination of the specimens showed various degrees of “hard” cicatricial stenosis of the subglottis and trachea. Histologic studies showed destruction of the cartilage with replacement by scar tissue and partial epithelialization. This model may be useful to investigations of the prevention and treatment of the disease.
Effect of sound deprivation on central hearing
Authors: Welsh Louis W. , Welsh John J. , Healy Michael P.
Published: October 2006

The authors have investigated the thesis that intermittent hearing impairment due to middle ear disease in the early years of life results in a central auditory disturbance which may persist in adulthood. The concept that, during the speech development years, auditory disturbances interfere with the normal maturation of central auditory processing appear to be clearly established.

Thirty‐five children, free of active ear disease and normally hearing by standard peripheral audiometry, are the basis for the study. The monotic tests employing temporal and frequency distortion and the dichotic challenges of competing stimuli and central integration provide the test data.

Approximately 75% of the study group fail at least 1 segment of the battery, beyond 2 standard deviations from the normal data. A decreasing percentage of the study group exceed the normative values in 2 or more of the test components.

In view of these data on aggressive program of auditory conservation is suggested during the early years of life.
Ultrastructure of human nasal mucosa
Authors: Jafek Bruce W.
Published: October 2006

This thesis describes the ultrastructure of human nasal mucosa, based upon surgical biopsy specimens. The intent of the study is to characterize the normal ultrastructure of human nasal mucosa with emphasis upon the difference between olfactory and respiratory epithelia. Other nasal epithelia (anterior, sinus, and posterior) are reviewed briefly for comparison only. Several pathological examples of the olfactory and respiratory epithelia are also briefly presented for contrast.
Pulmonary sequelae of intraparenchymal bismuth subgallate
Authors: Cozzi Laura M. , Megerian Cliff A. , Dugue Carlos , Barcello Mark , Abdul‐Karim Fadi W. , Arnold James E. , Maniglia Anthony J.
Published: October 2006

Bismuth subgallate (BSG) is a heavy metal compound which is effective in lowering the incidence of hemorrhage after adenotonsillectomy and has been demonstrated to activate Factor XII. In a minority of children, the paste has been suctioned from the cuffless oral endotracheal tube after adenotonsillectomy. No pulmonary sequelae have been noted in these patients. To assess the effect of BSG aspiration, 75 rats were divided into groups receiving either intratracheal BSG or saline. Early and late parenchymal effects were documented at 5 and 30 days following administration. Although there were no differences in the general well‐being, activity level, or weight in these rats, acute pneumonia followed by a histiocytic, foreign‐body response was noted in a significant number of rats in the BSG group. Although no clinical pulmonary sequelae of BSG use have been noted in our patients, this information should alert clinicians to the risks of BSG use in the pulmonary‐compromised patient, and encourage them to either employ all methods of preventing aspiration in such patients when using BSG, or to use another hemostatic modality for the utmost safety.
The suprahyoid approach for squamous cell carcinoma of the base of the tongue
Authors: Weber Peter C. , Johnson Jonas T. , Myers Eugene N.
Published: October 2006

The suprahyoid pharyngotomy is a well‐recognized surgical approach to the base of the tongue. However, its use has been widely criticized for squamous cell carcinomas. Some surgeons believe this approach offers limited exposure and that violating the preepiglottic space increases the risk of recurrence.

A retrospective study of squamous cell carcinoma of the base of tongue was carried out to address these surgical concerns. Nineteen patients presented with T1 or T2 lesions, 13 of whom underwent suprahyoid pharyngotomy with neck dissection. Those with nodal disease underwent adjunctive irradiation therapy and those with extracapsular spread also received subsequent adjuvant chemotherapy. At present, all patients are disease free. The suprahyoid pharyngotomy is an ideal surgical approach in the management of T1 or T2 squamous cell carcinoma of the base of tongue.
Intracranial complications of mucormycosis: An experimental model and clinical review
Authors: Anand Vinod K. , Alemar Gilberto , Griswold John A.
Published: October 2006

The clinical course of patients with mucormycosis of the paranasal sinuses can be unpredictable and is often determined by intrinsic host factors. The degree to and mechanism(s) by which these factors influence a patient's ability to survive the disease are poorly understood. Extensions to orbital and intracranial structures occur in some patients with paranasal sinus mucormycosis despite aggressive treatment. Controversies persist over adequate anti‐fungal regimen, the precise role of hyperbaric oxygenation, and the appropriate extent of surgical debridement. We have developed an alloxan‐induced immunocompromised murine model of mucormycosis in mice. Deferoxamine iron chelation produced rhinocerebral mucormycosis in these animals when challenged intraethmoidally with Rhizopus spores. The implications of our experimental studies in the context of our clinical experience in managing patients with intracranial extensions of paranasal sinus mucormycosis are discussed.
Hearing prognosis and intraoperative guidance of brainstem auditory evoked potential in microvascular decompression
Authors: Sindou Marc , Fobé Jean‐Luc , Ciriano Daniel , Fischer Catherine
Published: October 2006

Intraoperative monitoring of brainstem auditory evoked potential (BAEP) was done in 34 patients submitted to microvascular decompression (MVD). Seventeen of these patients had trigeminal neuralgia, and 17 had hemifacial spasm. Transitory postoperative hearing loss was observed in 6 (18%) of the patients, and permanent hearing loss was observed in 2 (6%) of the patients. Wave I‐V interpeak latency (IPL) was calculated during each step of the MVD procedure in order to identify the dangerous steps of the surgery. Wave I‐V IPL abnormalities occurred more frequently during cerebellar retraction.

Of the 6 patients who had total loss of BAEP lasting throughout the surgery, 1 (17%) had definitive deafness. Ten of the 34 patients had an absence or partial diminution of BAEP without total normalization before the end of surgery. Among these 10 patients, 2 had transitory hearing loss and 1 had permanent hearing loss.
Predictive value of objective esophageal insufflation testing for acquisition of tracheoesophageal speech
Authors: Callaway Elizabeth , Truelson John M. , Wolf Gregory T. , Thomas‐Kincaid Lauren , Cannon Steve
Published: October 2006

This prospective study was undertaken to assess the predictive value of esophageal insufflation on the acquisition of tracheoesophageal (TE) speech. Fourteen total laryngectomy patients were evaluated prior to tracheoesophageal puncture (TEP) using objective esophageal pressure measurements. These patients then were followed prospectively for 6 to 13 months. Speech was assessed at the time of prosthesis fitting, at 1 month, at less than 6 months, and at greater than 6 months post‐TEP. No patient underwent pharyngeal myotomy. Pre‐TEP esophageal insufflation pressure was associated (P = .065) with successful TE speech at the time of prosthesis fitting, but was not associated with successful TE speech acquisition after 6 months. This study's results suggest that patients with poor pre‐TEP esophageal insufflation test results will usually obtain successful TE speech given adequate time and training, even without pharyngeal myotomy.
Facial electroneurography: Analysis of techniques and correlation with degenerating motoneurons
Authors: Coker Newton J.
Published: October 2006

Facial electroneurography is the one electrophysiologic test that quantifies the degree of nerve degeneration. This two‐part study establishes electroneurography (ENoG) as a reliable and valid system of measurement. Part I examines three different ENoG techniques in normal subjects and in patients with advanced paralysis. Myogenic compound action potential (CAP) absolute amplitudes differ according to methodology, site, and gender. Analyses of side‐to‐side and test‐retest GAP differences demonstrate optimized and standardized recording lead techniques to be comparable and consistent when CAPs are recorded in the midface. The most significant variable is time, i.e., the inconsistency of test‐retest results. The coefficient of reliability increases when averaging results of test sessions repeated at a similar point in time. Part II, an animal model, supports the correlation between ENoG predictions following facial nerve injury and the level of motoneuron degeneration, as assessed by retrograde transport of horseradish peroxidase to the somata of the facial motor nucleus and by peripheral axon counts.
Facial nerve regeneration through semipermeable chambers in the rabbit
Authors: Spector J. Gershon , Lee Patty , Derby Albert , Frierdich G. , Burke J. J. , Vogler George P. , Roufa D. G.
Published: October 2006

Peripheral neural regeneration, over a 10‐mm transectional gap, was determined in 70 rabbit buccal divisions of the facial nerve using two entubational systems (semipermeable and impermeable silicone chambers) prefilled with three natural occurring media (serum, blood, and saline) during a 5‐week period. The number of myelinated axonal regenerates at the midchamber and at 2 mm in the distal transected neural stump were counted in each group and compared to pooled myelinated axonal counts in 9 normal rabbit buccal divisions of the facial nerve. Semipermeable porous chambers had an overall greater regeneration success rate (75% vs. 42.8%) and regained, on the average, a higher number of myelinated axons (51.4% vs. 26.1%) than silicone chamber regenerates. Semipermeable chambers prefilled with serum or blood had significantly higher regeneration success rates, myelinated axonal counts, and percentages of neural innervation of the distal transected neural stump. Both entubational systems produced similar axonal counts with intraluminal saline. The highest overall success rate (93.7%) and average number of myelinated axons per chamber (3072) were achieved in semipermeable chambers prefilled with serum. The greatest variability in myelinated axonal counts (0 to 3266 axons) and percentage of distal stump innervation (5.5% to 98.1%) was seen in silicone chambers filled with saline. The percentage of myelinated axons from the midchamber that innervated the distal stump was greater in semipermeable chambers with blood (73%) and serum (54%) than in silicone saline chambers (43%). On the average, the distal stumps from semipermeable chambers filled with serum (47%) and blood (33.5%) regained a higher percentage of normal myelinated axonal counts than silicone‐saline chambers (12.5%). These results suggest that both the construction of entubational chamber and the intraluminal medium can have significant influence on neurite regeneration. Semipermeable chambers prefilled with serum have a strong neurite‐promoting potential in peripheral neural regeneration of rabbit facial nerves.
Granular cell tumors of the trachea
Authors: Burton Deborah Mitchell , Heffner Dennis K. , Patow Carl A.
Published: October 2006

In contrast to the relative frequency of granular cell tumors (GCT) in the larynx and bronchi, the occurrence of these tumors in the trachea is rare. A 50‐year review of the English‐language literature disclosed only 24 described cases of tracheal GCT. This report reviews the clinicopathologic data from those 24 cases, along with the data from 2 cases obtained via a personal communication and the data from 4 previously unpublished cases obtained from a 30‐year review of the Armed Forces Institute of Pathology archives. Tracheal resection was the predominant mode of therapy and often was performed as a salvage procedure for failed endoscopic excisions. Recommendations for a more uniform approach to surgical management are provided.
Promontory electrical stimulation in postoperative acoustic tumor patients
Authors: Lambert Paul R. , Ruth Roger A. , Thomas Jean E
Published: October 2006

Complete deafness can follow acoustic tumor surgery and results from labyrinthine injury, auditory nerve trauma, and/or vascular compromise. A central auditory prosthesis is one potential rehabilitative strategy in such patients. Anatomical studies suggest that some spiral ganglion cells may survive after vascular occlusion, and we have demonstrated responses to electrical stimulation in patients after labyrinthectomy. It was thus hypothesized that patients deafened after a hearing conservation attempt, but maintaining an intact auditory nerve, could utilize an intracochlear implant. To investigate this possibility, promontory electrical stimulation was performed on three patients who had tumors less than 2 cm and who had serviceable preoperative hearing, but no responses postoperatively. Behavioral responses and electrically evoked auditory brainstem and middle latency responses were obtained from two patients, one of whom was 6 years postsurgery. These data indicate that a cochlear implant may be possible after acoustic tumor surgery.
Thin malignant melanomas of the head and neck
Authors: Fisher Samuel R. , Langford F. P. Johns , Molter David W. , Seigler Hilliard F.
Published: October 2006

Historically, Breslow classified thin melanomas as invasive lesions less than 0.76 mm in depth with rare instances of recurrence and mortality. From 1970 to 1990, 87 patients with thin head and neck melanoma were treated at Duke Medical Center. A computer'aided retrospective analysis was performed. Recurrence occurred in 30% of these patients; however, of the 66 patients seen at this institution prior to recurrence, only 8% recurred. Recurrence significantly shortened survival. Compared to an overall 84% 5‐year survival, there was less than a 50% 5‐year survival after recurrence. For thin melanomas, thickness did not affect survival. There was no difference in survival between thin melanomas and those ranging from 0.76 to 1.5 mm. A multivariate analysis was performed. The data suggest that thin melanomas of the head and neck may recur at a higher rate than previously reported and in addition, that they can be lethal.
Results of endoscopic sinus surgery for the treatment of inverted papillomas
Authors: Waitz Gerhard , Wigand Malte Erik
Published: October 2006

Fifty'one patients suffering from inverted papillomas of the nose and paranasal sinuses were reexamined in a retrospective study. Thirty'five had undergone surgery by an intranasal endoscopic approach and 16 had undergone surgery by an extranasal approach. The recurrence rate following endoscopic interventions was 17% (6/35), as compared to 19% (3/16) after extranasal operations.

Endoscopic surgery proved to be successful even in the treatment of large lesions affecting the posterior ethmoidal sinus, the nasofrontal duct, or the sphenoidal sinus. Its indication thus no longer needs to he restricted to limited lesions of the anterior nasal cavity.

Patients with inverted papillomas will benefit from this surgical technique which remains minimally invasive and thus retains the paranasal bony framework, preserves unaffected mucosa capable of recovery, and prevents damage to the patients' cosmetic features.
The sensitivity of auditory brainstem response testing in small acoustic neuromas
Authors: Wilson David F. , Hodgson Richard S. , Gustafson Margaret F. , Hogue Susan , Mills Leigh
Published: October 2006

Auditory brainstem response (ABR) testing is a reliable and sensitive test for retrocochlear pathology in neurotologic diagnosis. Several investigators have reported the sensitivity of ABR testing as 95% or greater. 3–5 Fifty‐one consecutive patients with surgically confirmed acoustic neuromas were examined. Forty patients had sufficient hearing preoperatively for assessment with ABR. In addition, all had been evaluated with gadolinium‐enhanced magnetic resonance imaging and conventional electronystagmography. Overall, 34 of 40 patients (85%) had abnormal ABRs. One of 25 patients with extracanalicular tumors had a normal ABR for a false‐negative rate of 4%; however, 5 of 15 patients with intracanalicular tumors had normal ABRs for a false‐negative rate of 33%. Tumor size and nerve of origin were important factors affecting the ABR sensitivity. The ABR was less sensitive in detecting intracanalicular tumors than in detecting extracanalicular tumors.
Human papillomavirus in sinonasal papillomas and squamous cell carcinoma
Authors: Kashima Haskins K. , Kessis Theodore , Hruban Ralph H. , Wu T. C. , Zinreich S. James , Shah Keerti V.
Published: October 2006

The diagnostic and prognostic relevance of human papillomavirus (HPV) types 6, 11, 16, and 18 in squamous papilloma, inverted papilloma, and squamous carcinoma of the sinonasal epithelium was examined using the polymerase chain reaction (PCR) technique. Four (15%) of 26 squamous papillomas, 7 (24%) of 29 inverted papillomas, and 1 (4%) of 24 squamous carcinomas were positive for HPV when examined using the PCR amplification technique.

Human papillomavirus 6 was present in 5 specimens (3 squamous and 2 inverted papillomas); HPV‐11 was present in 6 specimens (1 squamous and 5 inverted papillomas); and HPV‐18 was present in 1 of 24 squamous carcinomas. HPV‐16 was not identified in any specimen. The proportion of tissue samples showing HPV presence, and the association of HPV types 6 and 11 with benign lesions and HPV‐18 with malignant lesions, are both in accord with findings from prior investigations.

Two major questions regarding nasal papilloma are the probability for lesion recurrence after surgical excision and the risk for malignant transformation. There is no unanimity of opinion regarding the prognostic value of histopathologic dysplasia to forecast these outcomes. HPV is etiologically related to a subset of sinonasal papillomas and squamous carcinoma, and those with benign and malignant clinical course are separable on basis of HPV type. Because of the paucity of these nasal lesions, a multi‐institutional prospective collaborative study is the ideal way to address these questions.
Cochleovestibular nerve compression syndrome. I. Clinical features and audiovestibular findings
Authors: Schwaber Mitchell K. , Hall James W.
Published: October 2006

Cochleovestibular nerve compression syndrome (CNCS) is the term used to describe a group of audiovestibular symptoms thought to be due to a vessel compressing the cochleovestibular nerve. These symptoms include recurrent vertigo, continuous disequilibrium and acquired motion intolerance. Recently, Moller reported that CNCS can be diagnosed based on abnormalities in the auditory brainstem response (ABR).

After specifically excluding all other vestibular disorders, 63 patients with symptoms suggestive of CNCS were identified. These patients were systematically evaluated with a standard neurotologic test battery, and the results were reviewed retrospectively. Hearing loss was found in 51 (81%) of 63 cases, including 33 cases of unilateral high‐frequency loss and 14 cases of middle‐frequency loss. ABR data were interpreted with respect to Moller's criteria, and abnormal studies were found in 42 (75%) of 56 cases. Abnormal electronystagmograms were found in 57 (93%) of 61 cases. Thirteen of the patients subsequently underwent a posterior fossa procedure for vertigo and, vessels were found in contact with the cochleovestibular nerve in 11 of 13 cases.

The results of this study suggest that the majority of CNCS patients have neurotologic test findings that suggest an abnormality of the cochleovestibular nerve. The results and their implications are discussed.
Hydroxylapatite ossicular replacement prostheses: Results in 157 consecutive cases
Authors: Goldenberg Robert A.
Published: October 2006

The use of hydroxylapatite for ossicular chain reconstruction is increasing. In this study, hearing results and extrusion rate for 157 consecutive patients receiving hydroxylapatite prostheses were evaluated. Results were compared to those of a control group of patients who had received either homograft hone or Plasti‐Pore prostheses.

Four (2.6%) cases of extrusion have occurred. Hearing success was defined as a postoperative pure‐tone average air‐bone gap of ≤ 15 dB for incus prostheses and partial ossicular replacement prostheses (PORPs) or ≤ 25 dB for incus‐stapes prostheses and total ossicular reconstruction prostheses (TORPs). Overall success rate in the hydroxylapatite group was 51.4% for the 140 patients with postoperative data (mean follow‐up, 11.5 months) and 46.7% for 90 patients who were followed for more than 6 months (mean follow‐up, 16 months). PORP results were significantly poorer than those of the other prostheses. The success rate for the control group was 58.6% for 58 patients. The difference between hydroxylapatite and control group success rates appears to be due to the poorer results of the hydroxylapatite PORP.
Posttympanostomy otorrhea: The efficacy of canal preparation
Authors: Scott Bruce A. , Strunk Chester L.
Published: October 2006

Otorrhea is the most common posttympanostomy complication. This study is designed to determine the efficacy of canal preparation prior to tympanostomy tube placement.

One hundred thirty ears were prospectively randomized into prepared (Betadine and alcohol) and nonprepared (control) groups. Cultures obtained before, during, and after preparation were analyzed to determine the external canal flora and effectiveness of sterilization. Prepared ears and nonprepared control ears were examined for relation to otorrhea.

Forty percent of the canals were sterile before preparation, and only 8% harbored suspected pathogenic organisms. Canal preparation successfully sterilized only 33% of the ears that contained bacteria. There was no difference in the otorrhea incidence among treatment groups (9.8%). Based on these bacteriologic and clinical findings, it is concluded that canal preparation with Betadine and alcohol does not reduce posttympanostomy otorrhea.
H‐Index: A new measure of glottal efficiency for the pathologic voice
Authors: Shoji Kazuhiko , Regenbogen Elliot , Yu Jong Daw , Blaugrund Stanley M.
Published: October 2006

Taking advantage of the extended dynamic range of digital analysis of voice the H‐Index represents the first proposed acoustical measure of glottal efficiency. “Hi” /hai/ was chosen to evaluate glottal efficiency since it provides an excellent test of glottal transformation from voiceless to voiced sound energy, the upper vocal tract having a neutral effect. Fifteen individuals with normal voices and 30 patients with hoarse voices were asked to say “hi.” The power ratio of /h/ to /a/ was calculated from peak power of each measure from the power envelope. Voice quality had a highly significant effect on measured values (P<.001). A high degree of correlation (P<.001) was found with the AC/DC ratio, a standard aerodynamic measure of glottal efficiency. The results indicate that the H‐Index represents an excellent measure of glottal efficiency, obviating the need of invasive techniques or expensive, highly specialized equipment.
Some forms of tinnitus may involve the extralemniscal auditory pathway
Authors: Møller Aage R. , Møller Margareta B. , Yokota Masashi
Published: October 2006

It has previously been shown that the click‐evoked responses recorded from the intracranial portion of the eighth nerve in patients with incapacitating tinnitus are not abnormal, nor is the latency of peak III of the click‐evoked brainstem auditory‐evoked potentials significantly altered; however, the latency of peak V is slightly (but significantly) shortened in comparison to that of patients with the same degree of hearing loss but no tinnitus. In this study the hypothesis that the extralemniscal auditory system is involved in the generation of tinnitus is tested. We made use of the fact that neurons of the extralemniscal auditory system also receive input from the somatosensory system, and that stimulation of the somatosensory system can influence the processing of auditory information in the extralemniscal system. In 4 of 26 patients with mild‐to‐severe tinnitus whose median nerve was stimulated electrically, the tinnitus increased noticeably during stimulation, in 6 the intensity of the tinnitus decreased noticeably, and in the remaining 16 there was no noticeable change in the tinnitus. In some of the patients the character of the tinnitus changed in a complex way. There were no significant differences in hearing thresholds in these three groups of patients. Electrical stimulation of the median nerve in 12 individuals with normal hearing who did not have tinnitus either had no effect on the loudness of sounds or it caused a slight increase in the loudness.
Hearing preservation following surgical removal of meningiomas affecting the temporal bone
Authors: Nassif Paul S. , Shelton Clough , Arriaga Maj Moises
Published: October 2006

It is a common clinical impression that preservation of hearing is more often achieved when removing a meningioma than a similarly sized acoustic tumor. However, relatively few reports have focused on postoperative hearing results after meningioma removal, and detailed audiometric data are not commonly provided, particularly in the neurosurgical literature.

During the past 16 years, 56 meningiomas affecting the temporal bone have been surgically removed at the House Ear Clinic. Hearing preservation was attempted in 16 (29%) of the 56 cases, and these were the focus of this study. The primary presenting symptom was otologic in 67% of these cases, including hearing loss as the primary symptom in 27%.

Measurable postoperative hearing was present in 11 (92%) of 12 patients with postoperative audiograms available, and 8 (67%) of 12 patients had good hearing postoperatively. Hearing was preserved near the preoperative level (within 10 dB speech reception threshold and 15% speech discrimination) in 75% of cases.
Baclofen-Induced Psychosis
Authors: Chawla Jatinder Mohan , Rao Ravindra , Sagar Rajesh
Published: October 2006

Objective:

To report a case of psychosis induced by therapeutic doses of baclofen.

Case Summary:

A 32-year-old Hindu man was prescribed oral baclofen 10 mg twice daily for relief of muscular spasms secondary to tetanus. After 4 weeks of baclofen use, he presented to the psychiatry emergency facility with a 4 day history of third-person auditory hallucinations and persecutory and referential delusions without underlying mood symptoms. These symptoms resolved within 1 week of discontinuing baclofen. Rechallenge with baclofen resulted in reemergence of psychotic symptoms, which disappeared after discontinuing baclofen.

Discussion:

Reemergence of psychotic symptoms after rechallenge with baclofen suggests baclofen-induced psychosis. Use of the Naranjo probability scale indicates a probable association of baclofen with this patient's psychosis. The absence of underlying mood disorder makes this case different from previously reported ones.

Conclusions:

Baclofen may be associated with the occurrence of psychosis. Clinicians should consider baclofen-induced psychosis as a differential diagnosis in patients presenting with psychosis during treatment with this drug.
Peritoneal Fluid Penetration of Tigecycline
Authors: Scheetz Marc H , Reddy Pavani , Nicolau David P , Noskin Gary A , Postelnick Michael J , Stosor Valentina , Zembower Teresa R
Published: October 2006

Objective:

To describe the peritoneal fluid penetration of tigecycline.

Case Summary:

A 33-year-old critically ill man who had undergone orthotopic liver and cadaveric renal transplant presented with sepsis. The patient required empiric antimicrobial coverage, continuous veno–venous hemofiltration, prolonged mechanical ventilation, tracheostomy placement, and maintenance immunosuppressive therapy. After multiple infections with multidrug-resistant pathogens, the patient developed vancomycin-resistant Enterococcus faecium peritonitis. Tigecycline 50 mg was administered every 12 hours, and ascites fluid drug concentrations were obtained. Drug concentrations in the peritoneal fluid were determined by high-performance liquid chromatography and revealed a tigecycline concentration of 0.074 μg/mL Despite aggressive measures, the patient's condition continued to decline; he died 2 weeks after tigecycline initiation.

Discussion:

As of October 3, 2006, these are the first data to describe tigecycline peritoneal fluid penetration. Tigecycline was aggressively administered at twice the recommended dosage for overt liver failure in light of the severity of this patient's condition. A tigecycline peritoneal fluid concentration of 44–54% of serum concentration was calculated based on the patient's peritoneal fluid drug concentration and previously published serum concentrations from a similar population.

Conclusions:

Peritoneal penetration of tigecycline was approximately 50% in this critically ill patient. Establishment of site-specific breakpoints for tigecycline may be necessary. Future studies will need to evaluate the penetration of tigecycline into peritoneal fluid and other tissues.
A Myoclonic Reaction with Low-Dose Hydromorphone
Authors: Patel Seema , Roshan Veda R , Lee Kelly C , Cheung Rebecca J
Published: October 2006

Objective:

To report a case of myoclonus associated with the use of a low dose of the opioid analgesic hydromorphone.

Case Summary:

A 55-year-old white man with a history of nonobstructive hypertrophic cardiomyopathy was hospitalized for treatment of severe chest pain. On hospital day 1, intravenous hydromorphone (6 doses, total dose of 4 mg) was administered. The pain continued and, on day 2, the dose was increased, with a total of 6 mg administered on day 2. The patient developed uncontrollable jerking movements of the head, neck, arms, and legs after he received the hydromorphone. The myoclonic movements stopped within a few hours following discontinuation of hydromorphone and did not recur.

Discussion:

Myoclonus is a neuroexcitatory symptom that has been reported with chronic, high-dose administration of hydromorphone in patients with impaired renal function. The hydromorphone-3-glucuronide metabolite is devoid of analgesic activity and has been shown to cause neuroexcitatory effects. This patient's symptoms appeared soon after hydromorphone was initiated and resolved in a timely manner after the medication was discontinued. Based on the patient's presentation and course of therapy, it is probable, as indicated by the Naranjo probability scale, that the myoclonic symptoms were induced by hydromorphone. This case was unique, however, in that the patient received hydromorphone for only a short duration and did not have impaired renal function.

Conclusions:

Neuroexcitatory effects of hydromorphone may occur at relatively low doses in patients without renal dysfunction. Early recognition and intervention are required to achieve resolution of these symptoms and prevent further sequelae to the patient.
Structural Localization and Expression of CXCL12 and CXCR4 in Rat Heart and Isolated Cardiac Myocytes
Authors: Segret Audrey , Rücker-Martin Catherine , Pavoine Catherine , Flavigny Jeanne , Deroubaix Edith , Châtel Marc-Antoine , Lombet Alain , Renaud Jean-François
Published: October 2006

CXCL12 (SDF-1), which binds CXCR4, is involved in several physiological and pathophysiological processes. In heart, this axis seems to play a key role in cardiogenesis and is involved in the neovascularization of ischemic tissues. Rats have three known CXCL12 mRNA isoforms, of which only α and γ are present in the normal heart. However, little is known about CXCL12 protein expression and localization. We investigated the pattern of protein expression and the localization of both CXCR4 and CXCL12 in the heart, using isolated cardiomyocytes and a rat myocardial infarction model. Western blots showed that cardiomyocytes contained a specific 67-kDa CXCR4 isoform and a 12-kDa CXCL12 isoform. Confocal and electron microscopy clearly showed that CXCR4 was present at the plasmalemma and CXCL12 in continuity of the Z-line, in the proximal part of T-tubules. In conclusion, we provide the first description of the expression and fine localization of CXCR4 and CXCL12 proteins in normal rat heart and cardiomyocytes. These results suggest that the CXCL12/CXCR4 axis may be involved in cardiomyocyte calcium homeostasis regulation. Our work and the well-known chemoattraction properties of the CXCL12/CXCR4 axis highlight the importance of deciphering the function of this axis in both normal and pathological hearts.
Definability results for the Poisson equation
Authors: Kaiser Tobias
Published: October 2006

We show that the solution of the Poisson equation with subanalytic data on a bounded subanalytic domain in the plane without isolated boundary points exists and we prove that the solution is definable in the o-minimal structure ℝan; exp, provided that the domain has smooth boundary. Moreover, we investigate whether the solution is again subanalytic. At the end, we study polygons as examples of domains with nonsmooth boundary.
First steps towards a rhetorical psychology of literary interpretation
Authors: Allington Daniel
Published: October 2006

This paper asks what the familiar conception of literary interpretation as socially situated and rhetorical might mean on the cognitive level. Rejecting the prescriptiveness, individualism, and use of invented examples that theorisations of reading based on so-called “cognitive linguistics” have involved, it attempts to develop Michael Billig's model of thought as argument into a theory of interpretation adequate to the complexities of actual reader discourse within one particular social context (academia). A detailed intertextual analysis is carried out to provide qualitative empirical support for this theory, showing how four critics read Joseph Conrad's Heart of Darkness by debating its correct interpretation.
(Re)thinking world-building: Locating the text-worlds of Canadian lyric poetry
Authors: Lahey Ernestine
Published: October 2006

As interest in Text World Theory continues to grow, the need to test the boundaries of Text World Theory's practical capabilities is urgent if the theory is to have integrity as a cohesive explanatory and analytical tool in the study of discourse. This article discusses findings which challenge Text World Theory's account of the world-building process. Drawing on my analysis of the construction of text-world location in Canadian poetry, I argue that Werth's explanation of the role of noun phrases in the world-building process is flawed, and his distinction between world-building and function-advancing is likewise ill-conceived and at odds with the central philosophical commitments of the theory as Werth himself sets them out.
Stereociliary Myosin-1c Receptors Are Sensitive to Calcium Chelation and Absent from Cadherin 23 Mutant Mice
Authors: Phillips Kelli R. , Tong Song , Goodyear Richard , Richardson Guy P. , Cyr Janet L.
Published: October 2006

The identities of some of the constituents of the hair-cell transduction apparatus have been elucidated only recently. The molecular motor myosin-1c (Myo1c) functions in adaptation of the hair-cell response to sustained mechanical stimuli and is therefore an integral part of the transduction complex. Recent data indicate that Myo1c interactsin vitrowith two other molecules proposed to be important for transduction: cadherin 23 (Cdh23), a candidate for the stereociliary tip link, and phosphatidylinositol 4,5-bisphosphate (PIP2), which is abundant in the membranes of hair-cell stereocilia. It is not known, however, whether these interactions occur in hair cells. Using anin situbinding assay on saccular hair cells, we demonstrated previously that Myo1c interacts with molecules at stereociliary tips, the site of transduction, through sequences contained within its calmodulin (CaM)-binding neck domain, which can bind up to four CaM molecules. In the current study, we identify the second CaM-binding IQ domain as a region of Myo1c that mediates CaM-sensitive binding to stereociliary tips and to PIP2immobilized on a solid support. Binding of Myo1c to stereociliary tips of cochlear and vestibular hair cells is disrupted by treatments that break tip links. In addition, Myo1c does not bind to stereocilia from mice whose hair cells lack Cdh23 protein despite the presence of PIP2in the stereociliary membranes. Collectively, our data suggest that Myo1c and Cdh23 interact at the tips of hair-cell stereocilia and that this interaction is modulated by CaM.
Spatial and Temporal Properties of Cone Signals in Alert Macaque Primary Visual Cortex
Authors: Conway Bevil R. , Livingstone Margaret S.
Published: October 2006

Neurons in the lateral geniculate nucleus cannot perform the spatial color calculations necessary for color contrast and color constancy. Under neutral-adapting conditions, we mapped the cone inputs (L, M, and S) to 83 cone-opponent cells representing the central visual field of the next stage of visual processing, primary visual cortex (V1), to determine how the color signals are spatially transformed. Cone-opponent cells, constituting ∼10% of V1 cells, formed two populations, red–green (L vs M; 66 of 83) and blue–yellow (S vs L+M; 17 of 83). Many cone-opponent cells (48 of 83) were double-opponent, with circular receptive-field centers and crescent-shaped surrounds (0.63° offset) that had opposite chromatic tuning to the centers and a time-to-peak 11 ms later than the centers. The remaining cone-opponent cells were either spatially opponent in only one cone system (20 of 83) or lacked spatial opponency (15 of 83). Cells lacking spatial opponency had smaller receptive fields (0.5–0.7°) than spatial-opponent cell centers (∼1°). We found that red–green cells received S-cone input, which aligned with M input, and, unlike blue–yellow cells, red–green cells gave push–pull responses: receptive-field centers of red-ON cells were excited by both L increments (bright red) and M decrements (dark red) and were suppressed by both L decrements (dark green) and M increments (bright green). Excitatory responses to decrements were slightly larger than to increments, which may account for the lower detection and discrimination thresholds of decrements shown psychophysically. By virtue of their specialized receptive fields, the neurons described here spatially transform the cone signals and represent the first stage in the visual system at which spatially opponent color calculations are made.