bluuebunny/crossref_metadata_2025 huggingface dataset:
Presumed reduction of vestibular function in unilateral Menière's disease with aminoglycoside eardrops
Authors: Bath Andrew P. , Walsh Rory M. , Bance Manohar L.
Published: November 2007

We report the first case in the world literature of deliberate ablation of vestibular function in unilateral Meniere's disease with aminoglycoside eardrops (Garasone).

These findings give conclusive proof that Garasone eardrops, and by implication, all topical aminoglycoside ear drops can be vestibulotoxic in the presence of a tympanic membrane defect. The lower concentration of gentamicin in Garasone, in comparison to the standard intratympanic preparations for chemical ablation of vestibular function, may also offer a reduction in the potential risk of cochleotoxocity.
Adjuvant radiotherapy for primary mucosal malignant melanoma of the larynx
Authors: Asare-Owusu L. , Shotton J. C. , Schofield J. B.
Published: November 2007

Primary mucosal malignant melanoma (PMML) of the larynx continues to be a rare entity. To date, there are few cases reported in the world literature consisting of mainly isolated case reports and literature reviews.

Traditionally believed to be radioresistant, we present a case of PMML of the right vocal fold managed with right cordectomy and adjuvant radiotherapy. The patient is well without any evidence of local recurrence or metastasis three years and four months from presentation.
A morphological and morphometric study of the peripheral process of the human vestibular nerve following posterior cranial fossa neurectomy
Authors: Kitamura Ken , Takahashi Katsumasa , Kakoi Hiroyuki , Sugimoto Taro , Silverstein Herbert
Published: November 2007

Three vestibular nerve specimens removed at transmeatal neurectomy were studied in order to understand better retrograde degeneration and regeneration after vestibular neurectomy in the posterior cranial fossa. In two cases this procedure followed retrolabyrinthine retrosigmoid posterior fossa vestibular neurectomy. The subjects, three patients with Menière's disease, were compared with one another and two autopsy controls with no known otological problem. The specimens were obtained at the distal end of the internal auditory canal and transversely sectioned. Many collapsed Schwann cell basement membranes were observed. The ratio of small-diameter nerve fibres increased significantly after neurectomy. Onion bulb formation around myelinated nerve fibres with small diameters and Schwann cell proliferation around the soma of vestibular ganglion cells reflected remyelination. We conclude that peripheral processes of vestibular nerve fibres can undergo retrograde degeneration and subsequent regeneration after transection of the central process.
Enhancing hearing preservation in endoscopic-assisted excision of acoustic neuroma via the retrosigmoid approach
Authors: Low W. K.
Published: November 2007

Surgeons using the operating microscope are able to make use of numerous landmarks described for the lateral limits of dissection to preserve hearing in acoustic neuroma surgery via the retrosigmoid approach. Similar landmarks for hearing preservation described specifically for the endoscopic-assisted technique, are lacking. By analysing computed tomography (CT) scans of temporal bones, it was observed that to reach within 3 mm of the lateral end of the internal auditory meatus (IAM) via a 3 cm retrosigmoid craniotomy, drilling should be up to about 3 mm medial to the opening of the vestibular aqueduct. It was hypothesized that in surgery, by keeping 3 mm medial to the opening of the vestibular aqueduct, the integrity of inner ear structures would be preserved. This hypothesis was tested in 30 temporal bones and was found to be true. In addition, the lateral end of the IAM up to the transverse crest could be viewed by the 30-degree rigid angled endoscope. This landmark could, therefore, be utilized in the endoscopicassisted technique to predict the optimal amount of bone to be removed at a stage before the internal auditory meatal dura is opened when the intact dura affords added protection to the meatal contents during drilling. Well designed dural flaps on the posterior petrous bone could be created by making a longitudinal incision not more than 7 mm from the superior border of petrous bone and a transverse incision at least 17 mm from sigmoid. These flaps minimize injury to the endolymphatic sac and protect the cochlear nerve and vasculature that when damaged, may result in hearing loss.
Echography of metastatic nodes treated by radiotherapy
Authors: Ahuja A. , Leung S. F. , Ying M. , Metreweli C.
Published: November 2007

The purpose of this study was to evaluate whether the ultrasonographic appearances of nodal metastases in nasopharyngeal carcinoma (NPC) revert to normal after radiotherapy.

Serial ultrasonography was performed in 18 patients with palpable nodal metastases in the neck who underwent radiotherapy for NPC. All patients had a pre-radiotherapy baseline and another study at least one year after radiotherapy. The largest node in each patient was evaluated for any change in the ultrasonographic features following radiotherapy.

One year after radiotherapy nodes returned to normal size for their respective areas, the shape of the node and the echogenic hilus also reverted to normal. However, the nodes are more echogenic than nodes in normal subjects. This distinguishes these nodes from nodes not affected by radiotherapy. The histological basis for this observation is presumed to be the result of fibrosis.

At first glance the post-radiotherapy nodes may resemble normal nodes, however subtle changes within the node and adjacent soft tissues can be recognized on ultrasonography. During long-term follow-up, the appearance of nodes at sites previously uninvolved or any change in the appearance of nodes should alert the sonologist to the possibility of recurrence.
An unusual cause of nasal septum perforation
Authors: Umaria N. , Chavda S. V. , Pahor A. L.
Published: November 2007

We present a case where the use of magnetically held earring clips in the nose led to an unfortunate series of events resulting in perforation of the nasal septum.
Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy
Authors: Verse Thomas , Pirsig Wolfgang
Published: November 2007

At 65 years of age, a former coal miner, now 72-years-old, developed a progressive loss of concentration with daytime sleepiness and sleep disturbances. Work-up in pneumological and medical sleep centres resulted in diagnosis of chronic obstructive pulmonary disease (COPD), borderline obstructive sleep apnoea syndrome and, later, upper airway resistance syndrome. In addition, there was evidence of reduced efficiency of sleep. Neither the initial administration of theophylline nor the later use at night of hyperbaric respiration led to improvement in the patient's symptoms. Instead, the patient developed loud snoring, as well as the inability to sleep while in a lying position.

At age 71 years, otorhinolaryngological examination resulted in findings of age-related changes in the epiglottis, that completely blocked the hypopharynx upon inspiration. Polysomnography, which was possible only in a half-seated position, revealed reduction in deep sleep, with a maximum oxygen saturation of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8.

Partial resection of the epiglottis with laser surgery resulted in complete improvement of diurnal drowsiness and reduced stamina. Sleeping in a supine position again became possible. Polysomnography revealed normalization of sleep architecture, but unchanged, low efficiency of sleep.

This case underscores the importance of an interdisciplinary approach to the treatment of sleep-related breathing disorders.
Electrode complications in 100 adults with multichannel cochlear implants
Authors: Stoddart R. L. , Cooper H. R.
Published: November 2007

At switch-on (first post-operative stimulation of the implant) and during subsequent reprogramming, electrodes can, in some patients, be found to be non-functional or to be performing sub-optimally for a number of reasons. This paper examines the reasons for the poor performance of these electrodes by means of a retrospective analysis of 100 patient records. All of these patients received the Nucleus multichannel device.

The most common reason for an electrode to require de-activation was found to be facial nerve stimulation, with poor sound quality and pain also being very common. Other reasons included absence of auditory stimulation, vibration, reduced dynamic range, throat sensations, absence of loudness growth or dizziness. The occurrence of these reasons along the electrode array was examined, more basal electrodes being found to be non-functional as a result of having a small dynamic range or poor sound quality. Pain and vibration were found to occur throughout the array and the more apical electrodes were found to be non-functional as a result of facial nerve stimulation. It is suggested that the electrodes at the basal end of the array are likely to be extra-cochlear or are at the site of the most cochlear damage, whereas the more apical electrodes lie in closer proximity to the facial nerve.
Treatment of advanced squamous cell caricinomas of the head and neck with initial combination chemotheraphy prior to surgery and/or radiotheraphy: five-year survival data
Authors: Shaw H. J. , Price L. A. , Hill Bridget T.
Published: November 2007

One hundred and thirty-nine patients with advanced head and neck cancer were treated with a combination of vincristine, bleomycin, methotrexate with a folinic acid rescue, 5-fluorouracil and hydrocortisone given over 24 hours, as initial therapy on days one and 14 prior to conventional local therapy on day 28. One hundred and thirty-six patients were assessed for chemotherapy response on day 28. Ninety-one patients (67 per cent) had an objective response and 45 (33 per cent) were classed as non-responders, although 13 had a minimal (20–30 per cent) response. The complete remission rate following local therapy was significantly greater in chemotherapy responders (76 per cent) than in non-responders (54 per cent) p<0.05. Toxicity was minimal, provided standard medical precautions were observed, and 87 patients (63 per cent) reported no side-effects. There was 100 per cent patient compliance. Sex or histological grade did not significantly influence response to chemotherapy. Oral cavity or nasopharyngeal tumours responded better than other sites (p<0.05). Patients under 49 were more likely to respond to chemotherapy than older patients (p<0.01). Survival data are available for a mean follow-up time of 48 months (range 12–78 months). Chemotherapy responders have a longermedian survival than non-responders, 33 versus 20 months (p<0.05). Patients who achieve a complete remission after local therapy live significantly longer than those with residual disease, median durations of survival being 52.4 and 7.8 months respectively (p<0.001). Actuarial analyses indicate that at five years 46 percent of patients in complete remission are alive, compared with only 9 per cent with residual disease. Since chemotherapy responders are significantly more likely to achieve a complete remission than non-responders (p<0.05), objective response to this schedule of chemotherapy is a good prognostic sign.
Long-term results of bilateral stapedectomy
Authors: Faye-Lund H. , Stangeland Nils , Røhrt Thor
Published: November 2007

Bilateral stapedectomy was performed in 122 cases of bilateral otosclerosis at Ulleval Hospital between 1960 and 1978. Ninety-six patients (192 ears), or 79 per cent, were re-examined in 1980. The long-term results showed that the air/bone gap was closed to within 10 db. in 142 ears (74 per cent). Twenty-four patients (25 per cent) used a hearing aid at the time of the examination, mainly because of presbyacusis.

Deafness or serious sensori-neural loss ascribed to the operation was found in 21 ears (11 per cent). Immediate deafness occurred in three ears (1.5 per cent), and in seven ears (3.7 percent) the patient became deaf later. Eleven ears (5.8 per cent) had marked sensori-neural losses, but with some speech comprehension. None of the patients had bilateral deafness, but one patient was deaf in one ear, with a sensori-neural loss of 80 db. in the other.

Eleven patients (13 ears) who had undergone previous stapediolysis or crurotomy, were treated as a separate group, and their results were compared with those obtained in the other patients.

We have also tried to find out if there is any difference between the long-term results of surgery in the first and in the second ear.
Nasal Polyps
Authors: Drake-Lee A. B. , Barker T. H. W. , Thurley K. W.
Published: November 2007

(1) Summary

Nasal polyps are grossly oedematous tissue which has undergone considerable shrinkage when processed for scanning electron microscopy (SEM), converting the normally smooth surface into one with undulations. This shrinkage resulted in variable degrees of loss of the surface epithelium and thus gave rise to artifact. In its severest form, the entire surface epithelium was removed and the basement membrane exposed; lesser damage resulted in exposure of the basal cells, giving the previously described ‘cobblestone’ appearance. When the epithelium was intact, it was typical respiratory in type.
Inverted papilloma of the nose
Authors: Majumdar B. , Beck S.
Published: November 2007

A study of 43 cases of inverted papilloma of the nose has been made. These cases, arising from a moderately well-defined geographical area, were seen between 1955 and 1980. A detailed clinical and histological review was made in each case. No correlation has been found between any of the variable histological features and the potential of a particular popilloma to recur. The overall incidence of transformation to carcinoma is low, even after multiple recurrences. The findings suggests that there may be an extrinsic factor contributing to the causation of these tumours.
Cholesteatoma of the maxillary sinus
Authors: Paaske Peter B.
Published: November 2007

A rare case of a cholesteattoma of the maxillary sinus is presented, together with a brief discussion of its aetiology.
Substance P-like immunoreactivity in the rabbit inner ear
Authors: Ylikoski Jukka , Eränkö Liisa , Päivärinta Heikki
Published: November 2007

Abstract The auditory and vestibular sense-organs of the rabbit were examined for the presence of substance P(SP) by an immunohistochemical technique using a monoclonal SP-antibody. Between 30 and 40 per cent of the cells of the vestibular ganglia and about 50 per cent of the spiral ganglion cells innervating the extreme basal part of the cochlea showed SP-like immunoreactivity. The neural elements in the vestibular sensory epithelia, notably the calyx-formed nerve terminals of type 1 sensory cells of the maculae, also showed strong SP-like immunoreactivity. The findings suggest the possibility of a modulator or transmitter role for SP in the inner ear function.
Otolaryngological complications in infectious mononucleosis
Authors: Johnsen T. , Katholm M. , Stangerup S.-E.
Published: November 2007

Otolaryngological complications occurred in 5 per cent of 467 patients with infectious mononucleosis admitted consecutively to the ENT-department during the period 1 April 1969 to 30 June 1981. Four patients had peritonsillar abscess and five patients developed potentially lethal obstruction of the upper airway. Such complications require intervention and, as the latter condition probably is the most frequent fatal complication of IM, we find it important that patients with even slight respiratory embarassment in infectious mononucleosis should be observed and treated in an ENT-department.
Voice changes following cricothyroidotomy
Authors: Gleeson M. J. , Pearson R. C. , Armistead S. , Yates A. K.
Published: November 2007

Twenty-four patients underwent crico-thyroidotomy at Guy's Hospital between 1977 and 1981. Of these, 13 died during admission or shortly after discharge as a result of their primary disease and three were unsuitable for further examination. The eight remaining patients were examined to assess the effect of crico-thyroideotomy on the laryngeal function of voice production. Assessment was made both subjectively and objectively by laryngography. Objective findings were correlated with structural changes seen by indirect laryngoscopy. Six of the eight patients examined had both subjective and objective disturbance of voice production. We report our experience with the surgical procedure of cricothyroidotomy which, in addition to a high incidence of vocal disturbance, includes one case of subglottic stenosis secondary to granulation tissue.
Choanal Atresia
Authors: Strome Marshall , Hengerer Arthus S.
Published: November 2007

Taking cognizance of the embryology and newer diagnostic techniques, the trans-palatal route is strongly recommended as the optimal surgical procedure for the management of choanal atresia. It should be performed as soon as general anesthesia can be safely administered. In selected instances, but particularly when a patient is at increased surgical risk, necessitating surgical brevity, the endonasal puncture technique should be considered as the initial procedure. Parents must be appraised of the potential for subsequent growth deficiencies, mental retardation, and crossbite.
Serum immunoglobulins in patients with chronic tonsillitis
Authors: Lal Harbans , Sachdeva O. P. , Mehta H. R.
Published: November 2007

Serum immunoglobulin (IgG, IgA and IgM) levels were determined in patients with chronic tonsillitis before and one month after tonsillectomy. The preoperative levels of serum IgG, IgA and IgM were significantly higher when compared with the controls. The increase may be due to repeated antigenic stimulation. The post-operative levels for the three immunoglobulins were decreased; however, a significant reduction was observed for IgG only where the mean value was comparable with the control group. The data confirm that tonsillectomy does not disturb the humoral immune system of the body.
Effects of amiloride on the endolymphatic sac
Authors: Takumida M. , Bagger-Sjöbäck D.
Published: November 2007

The effect of amiloride on the murine endolymphatic sac was investigated. The amiloride caused collapse of the lateral intercellular spaces in the endolymphatic sac epithelium and a subsequent mild endolymphatic hydrops. These changes indicated a decreased absorption of endolymph in the endolymphatic sac. Amiloride is known to inhibit the transcellular fluid transport without inducing any changes in the paracellular fluid transport. It is therefore suggested that amiloride specially inhibits the fluid and ion exchange in the apical portion of the epithelial cells resulting a decrease in transcellular fluid transport across the endolymphatic sac epithelium. The transcellular fluid transport seems to be one of the main mechanisms in the endolymphatic sac fluid exchange system.
Subtotal laryngectomy with myomucosal shunt
Authors: Chandrachud H. R. , Chaurasia M. K. , Sinha K. P.
Published: November 2007

This is a modified subtotal laryngectomy. On the tumour-free side of the larynx, some posterior structures, with their neurovascular supply are preserved. The endolaryngeal mucosa is tubed in continuity with the trachea below and projects into the pharynx above. Thus a myomucosal shunt is formed. Air is directed into it by finger occlusion of the tracheal stoma.

The voice production is highly satisfactory. Aspiration is prevented by constriction of the thyroarytenoid muscle which provides a valved upper end of the tube.

The possibility of leaving tumour in the laryngeal remnant is eliminated by careful selection of patients, and re-confirmation of tumour extent intra-operatively and a frozen section.

Eleven such operations have been performed since October 1983 for squamous cell carcinoma, some previously irradiated. None of the patients had local recurrence. Only one had an aspiration problem which later resolved. All acquired a satisfactory voice
Neuroendocrine carcinoma of the lip (Merkel Cell tumour) examined by electron microscopy and immunohistochemistry
Authors: Boysen M. , Wetteland P. , Hovig T. , Brandtzaeg P.
Published: November 2007

A definite diagnosis of neuroendocrine carcinoma of the skin is seldom made on initial histological examination; the tumour is usually reported as a poorly differentiated or anaplastic carcinoma. By applying electron microscopy and immunohistochemistry, a correct diagnosis can be made. The ultrastructural examination shows dense-core membrane-bound granules, intermediate perinuclear filaments and desmosome-like junctions. Immunohistochemistry reveals positive staining for neuron-specific enolase and keratin, the latter in a characteristic paranuclear distribution. Confronted with an unusual clinical picture or indefinite histological diagnosis, tissue specimens should be secured for the above mentioned ancillary procedures.
Spontaneous perforation of cervical oesophagus associated with oesophageal web
Authors: Beggs D. , Morgan W. E.
Published: November 2007

A case is described, of a patient who sustained a spontaneous perforation of the cervical oesophagus in association with a ongenital oesophageal web.
Parental perceptions of grommet insertion in children with cleft palate
Authors: Greig A. V. H. , Papesch M. E. , Rowsell A. R.
Published: November 2007

Otitis media with effusion is almost universal in children with cleft palate and can delay speech, language and educational development by causing hearing loss. Grommet insertion at the time of cleft palate repair is common. There is debate about whether the benefits of grommets outweigh the risk of complications. A postal questionnaire was used to investigate parental perceptions of middle-ear ventilation via grommet insertion in children attending the multidisciplinary cleft palate clinic. These children's case notes were reviewed. Many children had speech and language delay, but parents thought this improved after grommet insertion. Overall parents were pleased with the results. This confirms that grommets have an important part to play in the management of children with cleft palate.
Compartmentalized maxillary sinus mucocele
Authors: Tsang Raymond K. Y. , Woo John K. S. , van Hasselt C. Andrew
Published: November 2007

A rare case of compartmentalized maxillary sinus mucocele 12 years after a Caidwell-Luc operation is reported. The two separate mucoceles were drained intranasally by endoscopic sinus surgery. The clinical features of this mucocele are presented and the incidence, presentation and theories on formation of post-operative mucoceles are reviewed.
Acute inspiratory stridor: a presentation of myasthenia gravis
Authors: Matin Mohammad Abdul , Alam Khurshid , O'Driscoll Kieran , Murphy P. J.
Published: November 2007

We present a rare presentation of myasthenia gravis as acute inspiratory stridor in a 16-year-old girl. Prompt diagnosis and medical treatment avoided the need for tracheostomy. Although an uncommon cause, myasthenia gravis should be included in the differential daignosis of stridor.
Spontaneous resolution of internal jugular vein thrombosis in aSalmonellaneck abscess patient
Authors: Lin Chang-Hsi , Chou Jih-Chyun , Lin Tarng-Lieh , Lou Pei-Jen
Published: November 2007

This article describes a rare case ofSalmonellaneck abscess complicated by internal jugular vein thrombosis in a 51-year-old patient with previously undiagnosed diabetes. The patient was discharged without any complications after a combination of medical and surgical treatment. Also discussed here are the clinical manifestations, imaging findings, and spontaneous resolution of the internal jugular vein thrombosis. Being immunocompromised is a critical predisposing factor forSalmonellaneck abscess. Patient recovery is largely determined by proper incision, drainage of pus and adequate intravenous antibiotics according to bacterial sensitivity tests. Detection of an internal jugular vein thrombosis does not signify a poor prognosis. Spontaneous resolution of thrombosis is encountered after treating the infection.
Antibiotic choice in acute and complicated sinusitis
Authors: Mortimore S. , Wormald P. J. , Oliver S.
Published: November 2007

The microbiology of 87 patients admitted to hospital, over a five-year period, with acute sinusitis was retrospectively analysed. Sixty-three patients had one or more of an orbital, intracranial, soft tissue or bony complication. Eighty-four patients had maxillary sinus washouts, while 48 required a surgical procedure to their sinuses, and 33, drainage of an empyema.Streptococcus milleri and Haemophilus influenzaewere the commonest organisms isolated from sinus aspirates (44 per cent), with a noticeable absence ofStreptococcus pneumoniae(10 per cent). Organisms cultured from intracranial, soft tissue or orbitral empyemas were predominantlyStreptococcus milleri(50 per cent) andStaphylococcus aureus(25 per cent) with an absence ofHaemophilus influenzae(four per cent) andStreptococcus pneumoniae(four per cent). Ampicillin is an appropriate first line antimicrobial agent in patients with acute complicated sinusitis with the addition of cloxacillin in cases with an empyema. Chloramphenicol or ceftriaxone is used in cases with an intracranial complication.
Submandibular gland excision: a five-year review
Authors: Goh Y. H. , Sethi D. S.
Published: November 2007

Excision of the submandibular gland is a surgical procedure often undertaken. The procedure is the treatment of choice for patients with neoplasm of the submandibular gland and those with non-neoplastic submandibular disorders which are not controlled with conservative medical measures. Extirpation of the submandibular gland may also be undertaken for diagnostic purposes.

This retrospective study of 93 consecutive patients who underwent excision of the submandibular gland in the Department of Otolaryngology, Singapore General Hospital over a five-year period was undertaken to study the indications of surgery, the pathology of the excised submandibular gland and the demographic profile of patients.

Fifty-six (60.2 per cent) patients underwent submandibular gland excision for non-neoplastic salivary gland disease while 37 (39.8 per cent) had neoplastic submandibular gland disorders. The commonest pathology encountered was sialadenitis/sialolithiasis (53.76 per cent) followed by pleomorphic adenoma (33.33 per cent). Fine needle aspiration cytology (FNAC) was a valuable pre-operative investigation with a sensitivity and specificity of 94.7 per cent and 100 per cent respectively for neoplastic diseases. The morbidity rate for this surgery was 4.3 per cent.
Kaposi's sarcoma masquerading as pyogenic granuloma of the nasal mucosa
Authors: Wyatt M. E. , Finlayson C. J. , Moore-Gillon V.
Published: November 2007

Kaposi's sarcoma (KS) is a neoplastic vascular disorder characterized by multiple reddish blue nodules which, according to the original description (Kaposi, 1872), usually present on the skin of the upper and lower extremities. It is not until the disease progresses that nodules appear on the skin of the head and neck, on mucosal membranes and as visceral lesions. However, with the large increase in the incidence of this tumour associated with the acquired immune deficiency syndrome (AIDS) epidemic, there have been increasing numbers of cases of Kaposi's sarcoma presenting primarily on the skin or mucosa of the head and neck. The most common sites reported are within the oral cavity, particularly on the palate. Other mucosal sites are rare. We present an unusual case where the primary manifestation of the Kaposi's sarcoma was in the nasal mucosa and stress the importance of this diagnosis not being overlooked.
Solitary fibrous tumour of the larynx: report of a case
Authors: Benlyazid Adil , Lescanne Emmanuel , Lefrancq Thierry , Fetissoff Franck , Beutter Patrice
Published: November 2007

Solitary fibrous tumour is a particular kind of mesenchymal tumour, classically arising in the pleura. We report the first case arising in the larynx, associated with a metastasizing adenocarcinoma. The diagnosis is mainly histopathological, especially when strong immunoreactivity for the CD34 antibody is present.
Proliferating cell nuclear antigen in laryngeal cancer
Authors: Kręcicki Tomasz , Jeleń Michal
Published: November 2007

The expression of proliferating cell nuclear antigen in paraffin sections from 154 cases of laryngeal squamous cell carcinoma were examined. There was significant difference in PCNA expression between the control group and cancer patients (p<0.001). The mean score of PCNA was higher in patients with poor prognosis than in patients with satisfactory outcome after treatment (p<0.05). There was no significant correlation between the PCNA count and the patient's age and sex, T and N stage and site of the tumour.

Univariate analysis revealed that the PCNA score correlated with the patients' survival rates. In multivariate analysis the prognostic value of PCNA was on the statistical borderline (p= 0.049). In our study clinical features like N and T status had a more important influence on survival rate. Nevertheless it appears that the immunohistological examination of PCNA in paraffin section could be a complementary prognostic tool for laryngeal carcinoma. PCNA expression may also be a valuable tool for differentiating malignant from benign laryngeal epithelium.
Developmental nasal anomalies
Authors: Morgan D. W. , Evans J. N. G.
Published: November 2007

Despite the complex embryological development of the nose and surrounding structures, significant developmental nasal anomalies are rare. We therefore present our experience in the management of such anomalies (excluding choanal atresia) over the past 10 years.

Fifty cases were surgically treated; two nasopharyngeal cysts, four hairy polyps, two meningoencephalo coeles, seven gliomata, 20 dermoids, two capillary haemangiomata, four fibromas, one fibromyxyoma, one mucocoele, one granuloma, one lipoma, two nasal aplasias, two nasal clefts and one nasal web. All cases presented with nasal obstruction and/or as a nasal mass. Computerized tomography and magnetic reson ance imaging aided diagnosis determining the extent of intracranial involvement. Various surgical tech niques were used ranging from simple excision to the lateral rhinotomy and Goodman's external rhinoplasty approach. Only five patients (10 per cent) suffered complications; two CSF leaks and three recurrences, all treated successfully.
Long distance travel by children for tonsillectomy: experience of the ORL department at Princess Alexandra Hospital (PAH), Royal Air Force, Wroughton, Swindon
Authors: Nofal F. , Moran Air-Vice Marshal M.
Published: November 2007

An audit was carried out to assess the acceptability of long distance travel for elective tonsillectomy and adenoidectomy. Seventy nine children travelled 70 miles with their father or mother to P. A. H. from Mid Glamorgan where the E.N.T. waiting list delay for tonsillectomy was some two years.

Most of the families who were offered the travel arrangements agreed and from the results of the questionnaires answered by the first 50 families, it was shown to be a successful exercise as both the children and parents were very happy with the arrangements and there were no complications.
Salivary duct carcinoma with comedonecrosis in the mobile portion of the tongue
Authors: Suzuki Mitsuya , Suzukawa Keigo , Ogawa Maki , Suzuki Tsunemichi
Published: November 2007

We present a patient suffering from salivary duct carcinoma in the mobile portion of the tongue, arising from a minor salivary gland; this condition is extremely rare. The patient was a 64-year-old woman who presented with a nonpainful, hard mass in her tongue. An aspiration smear showed cells with very scant cytoplasm and pale oval nuclei containing small, single nucleoli. Scattered clusters of small cells had darkly stained nuclei. Neither necrosis nor cribriform areas were seen. The smears suggested a salivary gland neoplasm; however, definitive diagnosis of salivary duct carcinoma remained difficult. Partial glossectomy was performed with a wide margin. Macroscopic examination revealed an unencapsulated, submucosal tumour infiltrating underlying muscle. Microscopic examination revealed a salivary duct carcinoma with comedonecrosis and relatively few cribriform and papillary areas. This case suggests that it may not be easy to establish a definitive diagnosis of salivary duct carcinoma from an aspiration smear if the salivary duct carcinoma is composed of comedonecrosis surrounded by solid tissue in a noncribriform pattern.
Lipoma of the parapharyngeal space
Authors: McNeill E J M , Samuel P R , England S
Published: November 2007

A 75-year-old gentleman presented to our department with dysphagia, nocturnal cough and dysphonia. Clinical examination revealed a large parapharyngeal mass extending from the left nasopharynx to the glottis. A magnetic resonance imaging scan confirmed the lipomatous nature of the lesion and elegantly demonstrated its anatomy. We discuss the aetiology and management of such lesions and focus on the diagnostic radiology of the parapharyngeal space.
The Mughals, the Sufi Shaikhs and the Formation of the Akbari Dispensation
Authors: ALAM MUZAFFAR
Published: November 2007

This essay places Mughal–Sufi relationship within a larger sixteenth century context, focusing on the strategies the early Mughals adopted to build their power in India. It reviews the positions of the two important sufi groups, the Indian Chishtis and the Central Asian Naqshbandis, juxtaposing the political benefits or the loss that the Mughals saw in their associations with them. While the Naqshbandi worldview and the legacy of the legendary Ubaid Allah Ahrar clashed with their vision of power, in the Chishti ideology, on the other hand, they found a strong support for themselves. The Chishtis then had an edge at the time of Akbar. But the Naqshbandis under Khwaja Baqi Billah (d. 1603) continued in their endeavour to reinstate their place in Mughal India. The paper thus provides a backdrop and makes a plea for re-evaluating the debate on the ideology and politics of Shaikh Ahmad Sirhindi (d. 1624).
Predicting young adult social functioning from developmental trajectories of externalizing behaviour
Authors: Bongers I. L. , Koot H. M. , van der Ende J. , Verhulst F. C.
Published: November 2007

Background

The long-term consequences of child and adolescent externalizing problems often involve a wide spectrum of social maladaptation in adult life. The purpose of this study was to describe the predictive link of child and adolescent externalizing developmental trajectories to social functioning in adulthood.

Method

Social functioning was predicted from developmental trajectories of parent-reported aggression, opposition, property violations and status violations that were defined in a longitudinal multiple birth cohort study of 2076 males and females aged 4–18 years. Social functioning was assessed using self-reports by young adults aged 18–30 years. Linear and logistic regression analyses were used to describe the extent to which developmental trajectories are prospectively related to social functioning.

Results

Children with high-level trajectories of opposition and status violations reported more impaired social functioning as young adults than children with high-level trajectories of aggression and property violations. Young adults who showed onset of problems in adolescence reported overall less impaired social functioning than individuals with high-level externalizing problems starting in childhood. Overall, males reported more impaired social functioning in adulthood than females. However, females with persistent high-level externalizing behaviour reported more impairment in relationships than males with persistent high-level externalizing behaviour.

Conclusion

The long-term consequences of high levels of opposition and status violations in childhood to serious social problems during adulthood are much stronger than for individuals who show only high levels of aggressive antisocial behaviours.
Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires
Authors: Patel V. , Araya R. , Chowdhary N. , King M. , Kirkwood B. , Nayak S. , Simon G. , Weiss H. A.
Published: November 2007

Background

Screening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires.

Method

Adult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R).

Results

Complete data were available for 598 participants (participation rate 99.3%). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51% to 77% at the optimal cut-off scores.

Conclusions

There is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.
Experiential features used by patients with schizophrenia to differentiate ‘voices’ from ordinary verbal thought
Authors: Hoffman R. E. , Varanko M. , Gilmore J. , Mishara A. L.
Published: November 2007

Background

Determining how patients distinguish auditory verbal hallucinations (AVHs) from their everyday thoughts may shed light on neurocognitive processes leading to these symptoms.

Method

Fifty patients reporting active AVHs (‘voices’) with a diagnosis of schizophrenia or schizo-affective disorder were surveyed using a structured questionnaire. Data were collected to determine: (a) the degree to which patients distinguished voices from their own thoughts; (b) the degree to which their thoughts had verbal form; and (c) the experiential basis for identifying experiences as voices versus their own verbal thoughts. Six characteristics of acoustic/verbal images were considered: (1) non-self speaking voice, (2) loudness, (3) clarity, (4) verbal content, (5) repetition of verbal content, and (6) sense of control.

Results

Four subjects were eliminated from the analysis because they reported absent verbal thought or a total inability to differentiate their own verbal thoughts from voices. For the remaining 46 patients, verbal content and sense of control were rated as most salient in distinguishing voices from everyday thoughts. With regard to sensory/perceptual features, identification of speaking voice as non-self was more important in differentiating voices from thought than either loudness or clarity of sound images.

Conclusions

Most patients with schizophrenia and persistent AVHs clearly distinguish these experiences from their everyday thoughts. An adequate mechanistic model of AVHs should account for distinctive content, recognizable non-self speaking voices, and diminished sense of control relative to ordinary thought. Loudness and clarity of sound images appear to be of secondary importance in demarcating these hallucination experiences.
Estimating disease prevalence using census data
Authors: CHOY M. , SWITZER P. , De MARTEL C. , PARSONNET J.
Published: November 2007

We describe a method of working on publicly available data to estimate disease prevalence in small geographic areas using Helicobacter pylori as a model infection. Using data from the Third National Health and Nutrition Examination Survey, risk parameters for H. pylori infection were obtained by logistic regression and validated by predicting 737·5 infections in an independent cohort with 736 observed infections. The prevalence of H. pylori infection in the San Francisco Bay Area was estimated with the probabilities obtained from a predictive logistic model, using risk parameters with individual-level 1990 U.S. Census data as input. Predicted H. pylori prevalence was also compared to gastric cancer incidence obtained from the Northern California Cancer Center and showed a positive correlation with gastric cancer incidence (P<0·001, R2=0·87), and no statistically significant association with other malignancies. By exclusively using publicly available data, these methods may be applied to selected conditions with strong demographic predictors.
Multilevel analysis of risk factors for Salmonella shedding in Ontario finishing pigs
Authors: POLJAK Z. , DEWEY C. E. , FRIENDSHIP R. M. , MARTIN S. W. , CHRISTENSEN J.
Published: November 2007

The objectives of this study were to identify factors associated with Salmonella status at the farm, pen, and pig level; explore the nature of variation in the association between the pen-level Salmonella status and pen-level covariates, and pig-level Salmonella status and pig- and pen-level covariates; and to identify the relative importance of factors operating at geographical, farm, and pen level for Salmonella shedding of pigs. For these purposes, samples from 799 pigs and 374 pens on 80 farms in Ontario in 2004 were collected and bacteriologically tested in a cross-sectional study. Census division was the least variable level, and farm the most variable level for shedding. Increased frequency of disinfection and washing with cold water were positively associated with Salmonella positivity, whereas liquid and mash feed and completely closed barns were sparing factors. After farm, pen was the second most variable level for shedding. However, no measured pen-level variables were associated with Salmonella status of pigs or pens. The shedding of Salmonella at the pig level tended to be associated with pig weight, and there was no random variation around this association. Results of this study suggest that a herd test based on bacteriological culture would probably have higher sensitivity if growing animals of lower weight were sampled instead of market weight animals, and this might be beneficial for Salmonella monitoring.
The GRM ‘beyond the walls’?
Authors: Barrachina Solange , Saint Martin Dominique
Published: November 2007

The technological changes of the twentieth century obliged research institutes to rethink their role in society. A place for invention and reflection, and a centre for the preservation of our musical heritage, the Groupe de Recherches Musicales must open its doors from now on and increase its collaboration with other bodies in an enlarged form: an extended ‘group’, extramural, which shares its tools and thoughts with others.
Wie soll ich messen? Operationalisierung von patienten-orientierten Zielgrößen in klinischen Studien
Authors: Klaghofer  , Puhan
Published: November 2007

In klinischen Studien möchte man oft patienten-orientierte Zielgrößen (Outcomes) wie Symptome oder Einschränkung im Alltag erfassen. Dabei stellt sich die oft schwierige Frage, wie diese Patientenmerkmale gemessen werden sollen. Es ist wichtig, Messinstrumente zu verwenden, welche die Patientenmerkmale möglichst unmissverständlich (Objektivität) und verlässlich (Reliabilität) messen. Zusätzlich muss für die Messinstrumente auch gezeigt werden, dass sie wirklich diejenigen Patientenmerkmale messen, die von Interesse sind (Validität). Vollstandardisierte Fragebögen erfüllen diese Messkriterien meist am besten und sind am leichtesten einer statistischen Analyse zugänglich. Es solle aber auch darauf geachtet werden, dass diese Messkriterien in der Sprache überprüft wurden, in der das Messinstrument verwendet wird. Um sicher zu gehen, dass man ein validiertes Messinstrument verwendet, stehen öffentlich zugängliche Datenbanken zur Verfügung, die eine Gewähr für die Qualität der dort angebotenen Messinstrumente bieten.
Pflegediagnosen, -interventionen und -ergebnisse – Anwendung und Auswirkungen auf die Pflegepraxis: eine systematische Literaturübersicht
Authors: Müller-Staub Maria , Lavin Mary Ann , Needham Ian , van Achterberg Theo
Published: November 2007

Dieser Artikel beschreibt eine systematische Literaturübersicht zu den Auswirkungen der Pflegediagnostik. Es werden Auswirkungen auf die Qualität des Pflegeassessments sowie auf die Häufigkeit, Genauigkeit und Vollständigkeit von Pflegediagnosen und auf die Kohärenz zwischen Pflegediagnosen, -interventionen und -ergebnissen aufgezeigt, wie sie in Patientenakten2 dokumentiert werden. Steigende Kosten machen es erforderlich, den Beitrag der Pflege zur Gesundheitsversorgung zu bestimmen. Dies wird durch den Einsatz standardisierter Terminologien erleichtert. Zwar liegen Studien vor, in denen eine standardisierte Dokumentation von Pflegediagnosen und ihre Beziehung zu Pflegeinterventionen und Pflegergebnissen evaluiert wurden, eine systematische Übersicht fehlte jedoch bislang. Es wurde eine Suche in MEDLINE, CINAHL und der Cochrane Database (1982–2004) durchgeführt und durch Grundlagenartikel und Tagungsberichte erweitert. Einschlusskriterien wurden bestimmt und umgesetzt. Anschließend sind sechsunddreißig Artikel ausgewählt und einer thematischen Inhaltsanalyse unterzogen worden. Zudem wurden die Evidenz- und die Empfehlungsstufen auf Grundlage der Qualität der Studiendesigns bestimmt. Die Einführung von Pflegediagnosen verbesserte die Qualität dokumentierter Patienten-Assessments (n = 14 Studien), das Erkennen häufig auftretender Diagnosen in ähnlichen Settings (n = 10) und die Kohärenz zwischen Pflegediagnosen, -interventionen und -ergebnissen (n = 8). In vier Studien wurde eine Fortbildungsintervention eingesetzt, und es zeigten sich signifikante Verbesserungen der Dokumentation von Pflegediagnosen, -interventionen und -ergebnissen. Allerdings wurde auch über Schwächen bei der diagnostischen Genauigkeit, bei der Dokumentation von Zeichen/Symptomen und bei den ursächlichen Einflussfaktoren berichtet (n = 14 Studien). Trotz unterschiedlicher Resultate zeigte sich, dass die Pflegediagnostik sowohl die Assessment-Dokumentation als auch die Qualität der dokumentierten Interventionen und die erreichten Patientenergebnisse verbessern kann. Die Studie deckte Defizite in der Dokumentation von Zeichen/Symptomen und Einflussfaktoren auf. Daher werden Weiterbildungen für Pflegende empfohlen, um die diagnostische Genauigkeit zu erhöhen. Weitere Studien über Zusammenhänge zwischen der Qualität der Pflegedokumentation und der Pflegepraxis werden angeregt.