bluuebunny/crossref_metadata_2025 huggingface dataset:
Monocyte-derived macrophages and myeloid cell lines as targets of HIV-1 replication and persistence
Authors: Cassol Edana , Alfano Massimo , Biswas Priscilla , Poli Guido
Published: September 2006

HIV infection of mononuclear phagocytes (MP), mostly as tissue macrophages, is a dominant feature in the pathogenesis of HIV disease and its progression to AIDS. Although the general mechanism of infection is not dissimilar to that of CD4+ T lymphocytes occurring via interaction of the viral envelope with CD4 and a chemokine receptor (usually CCR5), other features are peculiar to MP infection. Among others, the long-term persistence of productive infection, sustained by the absence of substantial cell death, and the capacity of the virions to bud and accumulate in intracellular multivescicular bodies (MVB), has conferred to MP the role of “Trojan horses” perpetuating the chronic state of infection. Because the investigation of tissue macrophages is often very difficult for both ethical and practical reasons of accessibility, most studies of in vitro infection rely upon monocyte-derived macrophages (MDM), a methodology hampered by inter-patient variability and lack of uniformity of experimental protocols. A number of cell lines, mostly Mono Mac, THP-1, U937, HL-60, and their derivative chronically infected counterparts (such as U1 and OM-10.1 cell lines) have complemented the MDM system of infection providing useful information on the features of HIV replication in MP. This article describes and compares the most salient features of these different cellular models of MP infection by HIV.
Evaluating “ED STAT!”: A Novel and Effective Faculty Development Program to Improve Emergency Department Teaching
Authors: Sherbino Jonathan , Frank Jason , Lee Curtis , Bandiera Glen
Published: September 2006

Objectives Effective clinical teaching in emergency departments (EDs) presents unique challenges. No validated approaches to enhancing ED teaching have been reported. The authors evaluated the effectiveness of a novel one‐day evidence‐based, skills‐oriented faculty development course tailored to ED teachers (ED STAT!).

Methods The authors invited all inaugural course registrants to participate in this program evaluation study. The authors assessed participants' knowledge change and perceived change in teaching behavior using a multiple‐choice and short‐answer question examination, a teaching behaviors questionnaire, and a survey for satisfaction. Data were gathered before, immediately after, and one month after the course. Mean scores were compared using the Wilcoxon signed rank test, and qualitative results were analyzed via a grounded theory approach.

Results Thirty‐one individuals from a variety of academic and community EDs completed the May 2005 course; 28 participated in the pre‐evaluation and postevaluation, and 22 participated in the one‐month postevaluation. Multiple‐choice scores increased from pre‐evaluation to one‐month postcourse by 15.1% (p < 0.001, effect size large: d = 1.53). Short‐answer scores increased by 17.2% (p = 0.001, effect size large: d = 0.90). After one month, 55% of participants reported an increased amount of teaching, 86% perceived this teaching to be of a greater quality, and 82% had shared new strategies with colleagues. The course would be recommended to a colleague by 96.3% of respondents.

Conclusions ED STAT! improves participants' knowledge about ED‐specific teaching strategies, and this improvement is maintained at one month. Participants reported high satisfaction and a positive effect on teaching behavior.
Tumor Necrosis Factor-α Activates Transcription of Inducible Repressor Form of 3′,5′-Cyclic Adenosine 5′-Monophosphate-Responsive Element Binding Modulator and Represses P450 Aromatase and Inhibin α-Subunit Expression in Rat Ovarian Granulosa Cells by a p44/42 Mitogen-Activated Protein Kinase-Dependent Mechanism
Authors: Morales Victoria , Gonzalez-Robayna I. , Santana M. Pino , Hernandez Inmaculada , Fanjul Luisa F.
Published: September 2006

The proinflammatory cytokine TNFα has important actions at the level of the ovary, including inhibition of P450 aromatase (P450AROM) activity and the secretion of inhibin, two proteins that are markers of the granulosa cell’s differentiated status. Because the transcription of both P450AROM and inhibin α-subunit can be suppressed in the ovary by the inducible repressor isoform of cAMP-responsive element binding modulator (ICER), we have investigated whether TNFα and its intracellular messenger ceramide can induce ICER expression and the mechanisms whereby the induction is accomplished. ICER mRNA levels were assessed by RT-PCR in granulosa cells treated with TNFα, the ceramide-mobilizing enzyme sphingomyelinase (SMase), or C6-cer, a cell-permeant ceramide analog. Rapid (3 h) yet transient increases in the four isoforms of ICER were observed in response to all treatments. Likewise, ICER protein measured by immunoprecipitation with a specific antibody increases after TNFα, SMase, or C6-cer treatment. The mandatory phosphorylation of cAMP-responsive element binding was also observed in response to TNFα, SMase, or C6-cer and shown to be prevented by the p44/42 MAPK-specific inhibitor PD098059 but no other kinase blockers. Activation of p44/42 MAPK by the cytokine and its messenger was subsequently demonstrated as well as the inhibition of ICER expression by PD098059. Finally, the blocking of p44/42 MAPK activation prevented TNFα inhibition of FSH-dependent increases in P450AROM and inhibin α-subunit mRNA levels, thus indicating that p44/42 MAPK-mediated ICER expression may be accountable for the effects of TNFα on the expression of both proteins.
Estrogen Receptor-Mediated Rapid Signaling
Authors: Moriarty K. , Kim K. H. , Bender J. R.
Published: September 2006

In addition to nuclear-initiated (genomic) responses, estrogen receptors (ERs) have the ability to facilitate rapid, membrane-initiated, estrogen-triggered signaling cascades via a plasma membrane-associated form of the receptor. These rapid responses are dependent on assembly of membrane ER-centered multimolecular complexes, which can transduce ligand-activated signals to affect a variety of enzymatic pathways, often occurring in a cell-type-specific fashion with tissue-specific physiological outcomes. In some instances, cross-talk occurs between these membrane-initiated and nuclear responses, ultimately regulating transcriptional activation. The role of splice variants in membrane-initiated estrogen responses has been described, notably those within the vascular endothelium. In this review, we describe the evidence for membrane ERs, the molecular components of the aforementioned signaling complexes and pathways, the relevance of ER splice variants, and ER-mediated responses in specific tissues. Our growing understanding of ER-mediated actions at a molecular level will provide insight into the controversies surrounding hormone replacement therapy in postmenopausal women.
Taxes, Cigarette Consumption, and Smoking Intensity
Authors: Adda Jérôme , Cornaglia Francesca
Published: September 2006

This paper analyses the compensatory behavior of smokers. Exploiting data on cotinine concentration—a metabolite of nicotine—measured in a large population of smokers over time, we show that smokers compensate for tax hikes by extracting more nicotine per cigarette. Our study makes two important contributions. First, as smoking a given cigarette more intensively is detrimental to health, our results question the usefulness of tax increases. Second, we develop a model of rational addiction where agents can also adjust their intensity of smoking, and we show that the previous empirical results suffer from estimation biases.
The Speed of Learning in Noisy Games: Partial Reinforcement and the Sustainability of Cooperation
Authors: Bereby-Meyer Yoella , Roth Alvin E
Published: September 2006

In an experiment, players' ability to learn to cooperate in the repeated prisoner's dilemma was substantially diminished when the payoffs were noisy, even though players could monitor one another's past actions perfectly. In contrast, in one-time play against a succession of opponents, noisy payoffs increased cooperation, by slowing the rate at which cooperation decays. These observations are consistent with the robust observation from the psychology literature that partial reinforcement (adding randomness to the link between an action and its consequences while holding expected payoffs constant) slows learning. This effect is magnified in the repeated game: when others are slow to learn to cooperate, the benefits of cooperation are reduced, which further hampers cooperation. These results show that a small change in the payoff environment, which changes the speed of individual learning, can have a large effect on collective behavior. And they show that there may be interesting comparative dynamics that can be derived from careful attention to the fact that at least some economic behavior is learned from experience.
Speculative Growth: Hints from the U.S. Economy
Authors: Caballero Ricardo J , Farhi Emmanuel , Hammour Mohamad L
Published: September 2006

We propose a framework for understanding episodes of vigorous economic expansion and extreme asset valuations. We interpret this phenomenon as a high-valuation equilibrium with a low cost of capital based on optimism about future funding. The key ingredient for such equilibrium is feedback from increased growth to a decline in the long-run cost of capital. This feedback arises when an expansion comes with technological progress in the capital sector, when fiscal rules generate procyclical fiscal surpluses, when the rest of the world has lower expansion potential or high saving needs, and when financial constraints are relaxed by the expansion itself.
Shocks and Government Beliefs: The Rise and Fall of American Inflation
Authors: Sargent Thomas , Williams Noah , Zha Tao
Published: September 2006

We use a Bayesian Markov Chain Monte Carlo algorithm to estimate the parameters of a “true” data-generating mechanism and those of a sequence of approximating models that a monetary authority uses to guide its decisions. Gaps between a true expectational Phillips curve and the monetary authority's approximating nonexpectational Phillips curve models unleash inflation that a monetary authority that knows the true model would avoid. A sequence of dynamic programming problems implies that the monetary authority's inflation target evolves as its estimated Phillips curve moves. Our estimates attribute the rise and fall of post-WWII inflation in the United States to an intricate interaction between the monetary authority's beliefs and economic shocks. Shocks in the 1970s made the monetary authority perceive a tradeoff between inflation and unemployment which ignited big inflation. The monetary authority's beliefs about the Phillips curve changed in ways that account for former Federal Reserve Chairman Paul Volcker's conquest of U.S. inflation.
Stock Prices, News, and Economic Fluctuations
Authors: Beaudry Paul , Portier Franck
Published: September 2006

We show that the joint behavior of stock prices and TFP favors a view of business cycles driven largely by a shock that does not affect productivity in the short run – and therefore does not look like a standard technology shock – but affects productivity with substantial delay – and therefore does not look like a monetary shock. One structural interpretation for this shock is that it represents news about future technological opportunities which is first captured in stock prices. This shock causes a boom in consumption, investment, and hours worked that precedes productivity growth by a few years, and explains about 50 percent of business cycle fluctuations.
Good Principals or Good Peers? Parental Valuation of School Characteristics, Tiebout Equilibrium, and the Incentive Effects of Competition among Jurisdictions
Authors: Rothstein Jesse M
Published: September 2006

In a multicommunity model, high-income families cluster together in any equilibrium, and cluster near effective schools if effectiveness is an important component of community desirability. Governmental fragmentation facilitates this residential sorting. Thus, if parents prefer effective schools, income correlates with effectiveness in high-choice-market equilibrium. I examine the distribution of student background and test scores across schools within metropolitan areas that differ in the structure of educational governance. I find little indication of the “effectiveness sorting” that is predicted if parents choose neighborhoods for the efficacy of the local schools. This suggests caution about the productivity implications of school choice policies.
What Mean Impacts Miss: Distributional Effects of Welfare Reform Experiments
Authors: Bitler Marianne P , Gelbach Jonah B , Hoynes Hilary W
Published: September 2006

Labor supply theory predicts systematic heterogeneity in the impact of recent welfare reforms on earnings, transfers, and income. Yet most welfare reform research focuses on mean impacts. We investigate the importance of heterogeneity using random-assignment data from Connecticut's Jobs First waiver, which features key elements of post-1996 welfare programs. Estimated quantile treatment effects exhibit the substantial heterogeneity predicted by labor supply theory. Thus mean impacts miss a great deal. Looking separately at samples of dropouts and other women does not improve the performance of mean impacts. We conclude that welfare reform's effects are likely both more varied and more extensive than has been recognized.
Healthy mental ageing
Authors: Flicker Leon , Lautenschlager Nicola T , Almeida Osvaldo P
Published: September 2006

Healthy mental ageing may be defined as the absence of the common disabling mental health problems of older people, especially cognitive decline and depression, accompanied by the perception of a positive quality of life. Older people are particularly prone to negative effects on mental health due to poor physical health. Modifiable aspects of lifestyle have been shown to be associated with healthy mental ageing. These include increased physical activity, intellectual stimulation (including education), avoidance of smoking and various aspects of diet. There is reasonably strong evidence that the treatment of hypertension will decrease the risk of cognitive impairment, and moderate alcohol intake may also have some benefits on cognition. These modifiable lifestyle factors may benefit from deliberate individual and population health promotion strategies to maximize mental health in old age, although to date intervention trials have not been performed to support the evidence obtained from observational studies.
Adjuvant aromatase inhibitors and bone health
Authors: Chowdhury Simon , Pickering Lisa M , Ellis Paul A
Published: September 2006

Adjuvant hormonal therapy results in substantial improvements in disease-free and overall survival for women with operable breast cancer. Use of an aromatase inhibitor (AI) is expected to replace tamoxifen as standard care for many patients. Aromatase is the enzyme responsible for the final step in estrogen biosynthesis. This is the conversion of the androgens testosterone and androstenedione to the estrogens estrone and estradiol. AIs are potent inhibitors of estrogen production and thus one of the major concerns over their use is their effect on bone health and their potential to increase the incidence of osteoporosis and risk of fracture. The American Society of Clinical Oncology has recognized that these patients are at high risk of developing osteoporosis and has published guidelines to aid in their management. These recommend that all patients have an initial dual-energy X-ray absorptiometry (DEXA) bone scan to assess bone mineral density and are offered calcium and vitamin D supplements as well as lifestyle advice. Patients with osteoporosis should be treated with a bisphosphonate to reduce the incidence of fracture. Osteonecrosis of the jaws is a recently described adverse side-effect of bisphosphonate therapy and has been described in women with metastatic breast cancer. Oversuppression of bone turnover is probably the primary mechanism for the development of this condition. The degree of risk for osteonecrosis with bisphosphonates is uncertain and warrants careful monitoring.
Exercise for women in the earlypostmenopausal years
Authors: Brockie Janet
Published: September 2006

Exercise has many benefits throughout life but in later life in particular it will protect against cardiovascular disease, obesity, diabetes and cancer, and preserve musculoskeletal health and psychological wellbeing. Women as they get older are at increasing risk of osteoporosis and the aim of exercise is to slow these skeletal changes. The early postmenopausal years in particular are associated with a rapid loss of bone mass, together with a loss of aerobic fitness and muscle strength. Therefore an evidence-based exercise regime to protect against these problems is essential, so that the exercise is of the appropriate quantity, duration and intensity for the required outcome.
Migraine and the menopause
Authors: MacGregor E Anne
Published: September 2006

The prevalence of migraine peaks during the 40s and an increased association between migraine and menstruation is often noted. Migraine generally improves after the menopause. Although menstrual irregularity, hot flushes and other climacteric symptoms may warrant management with hormone replacement therapy (HRT), there has been some concern that HRT may aggravate migraine and potentially increase the risk of ischaemic stroke. This evidence-based review concludes that migraine is not a contraindication for HRT but continuous-release transdermal estrogen, in the lowest effective dose, is recommended.
Non-surgical treatment for detrusor overactivity
Authors: Slack R Alexander , Jackson Simon
Published: September 2006

Urinary incontinence is a common but under-reported condition. Approximately 17% of women are affected by detrusor overactivity at some time in their lives. Pharmacological treatment of this condition used to be severely limited by the side-effects of the drugs and the associated poor patient compliance. Recently, however, the tolerability and effectiveness of pharmacotherapy have been improved by the introduction of new drugs and alternative methods of drug delivery. This review assesses the effectiveness and tolerability of these new treatments. Anticholinergic agents, botulinum toxin and neuromodulation are also discussed.
A 10-year follow-up of postmenopausal women on long-term continuous combined hormone replacement therapy: update of safety and quality-of-life findings
Authors: Heikkinen Jorma , Vaheri Raija , Timonen Ulla
Published: September 2006

Objective: To assess the safety and health-related quality of life (HRQOL) of continuous combined hormone replacement therapy (ccHRT) with estradiol valerate/medroxyprogesterone acetate (E2V/MPA) over nine years and at follow-up one year after discontinuation.

Study design: A total of 419 women were randomized to one of four treatments: once-daily 1 mg E2V/2.5 mg MPA (1 + 2.5 group); 1 mg E2V/5 mg MPA daily (1 + 5 group); 2 mg E2V/2.5 mg MPA daily (2 + 2.5 group); 2 mg E2V/5 mg MPA daily (2 + 5 group) (Indivina, Orion Pharma). For the last six months, all received the 1 + 2.5 dosage. The 2 + 2.5 dosage was discontinued at the end of year 7. A total of 198 women continued after year 7.

Results: Annualized percentage rates for cardiovascular, stroke, breast and endometrial cancer events were below national rates for Finland and those reported for the Women's Health Initiative. There were no serious events with the 1 + 2.5 dosage or after ccHRT discontinuation. Climacteric symptoms remained significantly below baseline values after dosage reduction; some symptoms recurred after discontinuation of ccHRT. HRQOL ratings improved with ccHRT, irrespective of dosage, including depressed mood, anxiety, health perception and sexual interest. Scores on a scale assessing daily functioning and enjoyment (Q-LES-Q) improved from year 7 to year 9. They deteriorated during follow-up in women not continuing ccHRT.

Conclusions: Lower dosages of HRT were as effective as higher doses in improving climacteric symptoms and HRQOL ratings and had fewer safety concerns. Following discontinuation of ccHRT, patient satisfaction was variable, with 15% electing to continue or restart HRT and 7% resuming at follow-up. This supports the need for an individualized approach to therapy recommendations.
Project Assignments When Budget Padding Taints Resource Allocation
Authors: Arya Anil , Mittendorf Brian
Published: September 2006

This paper shows that rotation programs can be an effective response to concerns of employee budget padding. Rotation programs naturally create a “portfolio” of assignments for each manager, and the resulting diversification can reduce the downside of resource rationing. In particular, the production versus rents trade-off linked with adverse selection problems can be more efficiently carried out when the firm faces two managers with average information advantages, rather than one with a large advantage and one with a small advantage. Roughly stated, rotation of project assignments is a way of smoothing information across managers. On the other hand, if a firm places a premium on treating different types of projects in distinct ways, specialized assignments can be preferred due to the ability to confine project types to individual managers.
Discounting by Intervals: A Generalized Model of Intertemporal Choice
Authors: Scholten Marc , Read Daniel
Published: September 2006

According to most models of intertemporal choice, an agent's discount rate is a function of how far the outcomes are removed from the present, and nothing else. This view has been challenged by recent studies, which show that discount rates tend to be higher the closer the outcomes are to one another (subadditive discounting) and that this can give rise to intransitive intertemporal choice. We develop and test a generalized model of intertemporal choice, the Discounting By Intervals (DBI) model, according to which the discount rate is a function of both how far outcomes are removed from the present and how far the outcomes are removed from one another. The model addresses past challenges to other models, most of which it includes as special cases, as well as the new challenges presented in this paper: Our studies show that when the interval between outcomes is very short, discount rate tends to increase with interval length (superadditive discounting). In the discussion we place our model and evidence in a broader theoretical context.
Methodologies and Algorithms for Group-Rankings Decision
Authors: Hochbaum Dorit S. , Levin Asaf
Published: September 2006

The problem of group ranking, also known as rank aggregation, has been studied in contexts varying from sports, to multicriteria decision making, to machine learning, to ranking Web pages, and to behavioral issues. The dynamics of the group aggregation of individual decisions has been a subject of central importance in decision theory. We present here a new paradigm using an optimization framework that addresses major shortcomings that exist in current models of group ranking. Moreover, the framework provides a specific performance measure for the quality of the aggregate ranking as per its deviations from the individual decision-makers’ rankings.

The new model for the group-ranking problem presented here is based on rankings provided with intensity—that is, the degree of preference is quantified. The model allows for flexibility in decision protocols and can take into consideration imprecise beliefs, less than full confidence in some of the rankings, and differentiating between the expertise of the reviewers. Our approach relaxes frequently made assumptions of: certain beliefs in pairwise rankings; homogeneity implying equal expertise of all decision makers with respect to all evaluations; and full list requirement according to which each decision maker evaluates and ranks all objects. The option of preserving the ranks in certain subsets is also addressed in the model here. Significantly, our model is a natural extension and generalization of existing models, yet it is solvable in polynomial time. The group-rankings models are linked to network flow techniques.
Chronic suppurative otitis media and the pathologic labyrinthine fistula
Authors: Ritter Frank N.
Published: September 2006

Chronic suppurative otitis media is a dangerous illness. By location, it jeopardizes the middle ear ossicles, the facial nerve, the inner ear, and endocranially, the dural vessels, meninges and brain parenchyma. It is a regard for this infection and the prevention of these complications that dictates an eradication of the illness by surgical intervention; yet, on occasion, one or more of these complications occur and while the proper way to handle most of them has been stressed periodically in the recent literature, one complication, the labyrinthine fistula, has received little attention since the pre–antibiotic days;1,2 thus, surgery has a two–fold function, being therapeutic for the infection and prophylactic for the complications.
Actinomycosis of tongue as pseudotumor
Authors: Sodagar R. , Kohout E.
Published: September 2006

Actinomycosis or ray fungus was first described in 1877 by Bollinger, and in 1885, its pathogenesis in humans was reported by Israel.

The organism causing this disease is mycelium forming and living in the soil or plant.

Human infection may start from endogenous infection. These microorganisms can be isolated from the mouth, tonsil and GI tract, and the anaerobic type which is responsible for human infection lives in the mouth. Sixty percent of actinomycotic infection appears in cervicofacial form, which starts as a very slow growing induration and in the later stage there is multiple sinus formations which drain a seropurulent discharge containing the characteristic sulphur granules.

In the tongue actinomycosis in early stages may mimic malignancy. Two patients have been seen in our hospital with a small tumor located in the lateral border of the tongue, of about six weeks' duration. These masses were deeply seated in tongue tissue in the anterior two‐thirds; they were slightly painful and were adherent to the muscles.

They were excised and appeared to be actinomycotic. Choice of treatment in actinomycotic infection, is a high dosage of penicillin.
Fundamental aspects of incus transplantation
Authors: Kuijpers W. , Van Der Broek P.
Published: September 2006

In the present study, the results of experimental incus transplantations performed in a large number of rats are reported. The behavior of fresh autologous and homologous incudes and of incus grafts denatured by boiling or by preservation in alcohol, were studied up to survival times of more than two years. The incudes were transplanted orthotopically in the middle ear and heterotopically in the musculus tibialis anterior.

Both fresh autologous and homologous incus grafts appeared to be well tolerated by the middle ear, although a substantial loss of osteocytes, most marked in the homografts, was observed after two years. No clear signs pointing to a transplantation reaction were observed in the homologous series. The denatured incudes appeared to retain their original shape in the middle ear after an observation period of more than two years, while in 40 percent of those incudes preserved in alcohol, new bone formation was observed.

After heterotopical transplantation in muscle a clear transplantation reaction toward the fresh homologous incudes was found, while the autologous ossicles grossly retained their original shape and vitality. Extensive resorption was observed in the denatured incudes, although in the case of alcohol preserved ossicles, all specimens also showed areas of new bone formation.

These experiments confirm the clinical evidence that the middle ear can be considered as one of the privileged sites of the body where transplantation reactions are absent or at least mitigated. Besides this, the results obtained with denatured incudes strongly suggest that new bone formation in the ossicles seems dependent not only upon the transplantation of osteogenic cells, but presumably also on the condition of the ground substance and or the presence of certain enzymes in the ossicle.
Radiologic changes in the formation of frontal sinus — muco‐pyocele
Authors: Pastore Peter N.
Published: September 2006

The history, the gradual evolution of soft tissue changes as revealed by roentgenography and the gross and microscopic changes in the lining muco‐periosteums of two frontal sinuses which had been resected surgically, are presented.

On the basis of these reports and that of past experience, the following generalizations in respect to these two cases seem valid:

1. Radiographic mucosal changes in a frontal sinus may exist months or years without subjective symptoms.

2. Obstruction of the fronto‐nasal opening with a subsequent gradually progressive increase in volume and pressure of the fluid contents of the sac or sinus, may eventually result in pressure absorption of the bony walls of the sinus.

3. A mucocele does not cause sudden or acute symptoms, such as pain or fever, but objective signs such as a soft swelling above the eyebrow or the dislocation of the globe in the orbit, may appear and slowly increase.

4. When in the presence of acute infection of the upper respiratory tract acute subjective or objective frontal sinus symptoms and signs become evident without previously recalled sinus disease or trauma and where prior radiographic study of the area has not been made, one cannot be certain that slowly developing changes of the sinal muco‐periosteum have not been present for a long time, and such pre‐existing disease might not have led to confused interpretation of the radiologic pictures, to misinterpretation of symptoms and signs and to a faulty diagnosis.

5. The variation in the mucosal histological findings and sac or contents noted at the time of surgery will be those related to the nature of the causative or related organism, the degree of activity, the development time factor or duration of the condition, the effect of pressure on soft tissue surrounded by bone, and the circumstances precipitating the need for surgical treatment.

6. Regardless of the origin, the muco‐pyocele of many years' duration under constant slowly expanding pressure may eventually result in sterile contents and loss of the original identity of the mucosal structure, making an exact disease classification difficult or impractical.

7. The new although admittedly imaginative hypothesis that a previously undescribed type of disease of the frontal sinus of unknown etiology, may be present, is presented.

8. This type of disease of the frontal sinus may be present more frequently than is reported, because of a “low‐index of suspicion” on the part of the rhinologist, because of the absence of signs and symptoms in the absence of infection and the lack of a history of (frequently hypothetical) trauma or infections in the past, such as are usually mentioned in the anamnesis of symptom producing unilateral frontal sinus disease.
Laser surgery of the vocal cordsAn experimental study with carbon dioxide lasers on dogs
Authors: Jako Geza J.
Published: September 2006

In experiments on dogs, a focused beam from a continuous wave surgical carbon dioxide laser integrated with an operating microscope was used selectively to evaporate predetermined amounts of normal vocal cord tissue through a laryngoscope. This mode of tissue removal was precise, rapid and practically bloodless. Microscopic laryngoscopy examinations and histological work‐up one, two and three weeks postoperatively indicated normal healing similar to that of clean surgical wounds.
Total glossectomy for advanced carcinoma of the base of the tongue
Authors: Sessions Donald G. , Stallings James O. , Brownson Richmond Jay , Ogura Joseph H.
Published: September 2006

The treatment of patients with advanced carcinoma of the base of the tongue is difficult. Selected patients with this lesion can be aided by an aggressive therapeutic approach to this problem. Combined therapy consisting of irradiation therapy followed by composite resection of the entire tongue and larynx and neck dissection may offer the best opportunity for cure or palliation in these patients. Reconstruction of the defect with a non‐delayed full forehead flap has provided a very satisfactory floor of the mouth. The postoperative functional abilities of these patients have clearly been compatible with useful life.
Disseminated coccidioidomycosis presenting as facial granulomas in pregnancy: A report of two cases and a review of the literature
Authors: Hadsall Franklin Job , Acquarelli Mario J.
Published: September 2006

The diagnosis of disseminated coccidioidomycosis was made in two pregnant women by the biopsy of facial granulomas. The unusual presentation and the problems associated with the management of this disease in pregnancy stimulated a literature review and a report of these two cases.

The history of the discovery and elucidation of this disease is reviewed. Documentation of interhuman transmission of coccidioidomycosis by fomites is presented. Previous reports of disseminated coccidioidomycosis being found in the endolarynx, epiglottis and region of the head and neck are cited. The high incidence of fetal wastage, the high maternal mortality associated with dissemination and the role of Amphotericin B in the therapy of the disseminated disease are discussed.
The identification and protection of the laryngeal motor nerves during thyroid and laryngeal surgery: A new microsurgical technique
Authors: Kratz Robert C.
Published: September 2006

Surgery in the area of the larynx often demands identification of laryngeal motor nerves. Stimulation of the recurrent laryngeal nerve caused observable movement of the mobilized larynx in 56 exposures on the right side and 52 exposures on the left, except in two cases. Failure of the larynx to move in two cases was explained by fixation of the larynx due to cancer in one case and fixation due to scar in the other. The use of the operating microscope and electrical stimulator is recommended as an improvement in the technique for the identification of the laryngeal motor nerves. A color motion picture with sound is presented in conjunction with this paper to demonstrate the technique.
Chemodectomas of the nasopharynx. An unusual case associated with unilateral ocular proptosis
Authors: Smith Curran J. , Kohut Robert I. , Million Rodney R.
Published: September 2006

The case report of a 66‐year‐old female with a chemodectoma involving the nasopharynx was presented. The unusual initial presentation of ocular proptosis was described and the possible origin of this tumor from the paraganglioma ciliare in the orbit discussed. The histologic response to radiotherapy was demonstrated by photomicrographs.
Tympanoplasty: Long‐term hearing results with incus grafts
Authors: Cody D Thane R. , Taylor William F.
Published: September 2006

The purpose of this study was to analyze long‐term hearing results in 122 tympanoplasties with incus repositioning and in 64 tympanoplasties using a homograft incus. The mean postoperative follow‐up period in the autograft incus group was 56 months (range 18 to 95 months) and in the homograft incus group 54 months (range 28 to 87 months). Results were compared after incus placement between the tympanic membrane‐malleus complex and stapes head and placement between the tympanic membrane‐malleus complex and stapes footplate. In each group, hearing results tended to be better after malleus‐to‐stapes head placement. There was no statistically significant difference in the results achieved when similar incus placements in the two groups were compared. When the data on malleus‐to‐stapes head tympanoplasty (152 patients) and malleus‐to‐stapes footplate tympanoplasty (34 patients) in each group were combined, the results with malleus‐to‐stapes head placements were considerably better (P = 0.01). The best hearing results were not satisfactory, however, with only 54 percent of the malleus‐to‐stapes head placements achieving a socially adequate hearing level and the air‐bone gap being closed to within 15 db on only 32 percent.

Hearing results were also analyzed for three subgroups. The autograft and homograft incus groups were combined. The first subgroup consisted of 30 patients who had no additional surgery other than ossicular chain reconstruction; the second subgroup consisted of 53 patients who in addition to ossicular chain reconstruction had closure of the tympanic membrane perforation; the third subgroup consisted of 103 patients who in addition to ossicular chain reconstruction had tympanic membrane perforation repair and mastoidectomy. There was no statistically significant difference in the hearing results among the three subgroups.

Eleven percent of the autograft incus group and 13 percent of the homograft incus group initially had excellent hearing results and then, at various times after the operation, developed gradual deterioration in auditory acuity, which eventually resulted in an unsatisfactory hearing level. In revision operations, the most common cause of failure was non‐attachment of the incus to the head of the stapes. Second in frequency was fixation of the ossicular chain by fibrous tissue and impaction of the incus against the posterior bony annular rim. The most serious complication was depression in cochlear reserve, which occurred in 5 percent of the 186 tympanoplasties. This analysis of the long‐term hearing results achieved with incus grafts revealed that the results were far from satisfactory.
Dentoalveolar fistulas of the cervical region
Authors: Singleton Earl F.
Published: September 2006

The otolaryngologist is very familiar with inflammatory lesions occurring in the head and neck. The chronic draining fistula is somewhat less common, and its origin may be obscure. A case presentation illustrates some of the typical problems of a fistula in the submandibular triangle which proved to be of dental origin. Knowledge of the spread of periapical infection helps to understand the development and location of cutaneous, dentoalveolar fistulas. Recognition of the source of the fistula is essential as treatment must be directed primarily to the underlying dental infection.
Gold foil closure of oroantral fistulas
Authors: Meyerhoff William , Christiansen Thomas , Rontal Eugene , Boerger William
Published: September 2006

A variety of surgical procedures have been devised for the closure of the oroantral fistula. The majority of these methods have employed buccal or palatal mucoperiosteal flaps or combinations of both. Though generally successful in closing the oroantral fistula, these flap procedures occasionally fail, especially in those cases with unusually large openings. These flaps may also alter the intra‐oral anatomy making the construction of intra‐oral appliances difficult. After eliminating those failures due to persistant infection or inadequate drainage of the maxillary sinus, there remains that group of patients whose oroantral fistula closure fails, due to inherent inadequacies of the procedure used; therefore, we have endeavored to find a surgical technique that will give us more reliable results.

Through our endeavors we found a simplified technique for the closure of oroantral fistulas using gold foil, a method recently advocated in the dental literature. The surgical procedure consists of denuding the margins of the oroantral fistula of all mucoperiosteum and covering the opening with an overlapping margin of 36‐gauge gold foil. The mucoperiosteal flaps elevated to expose the bony margins of the fistula are then sutured loosely over the foil to act as an envelope holding the gold in place. Mucosa from the maxillary sinus migrates across the inner surface of the foil providing closure on one side. Gradually, the mucoperiosteal flap retracts, exposing the gold foil but still maintaining it in its proper position. After several weeks the foil is removed, showing an intact sinus mucosal lining. In an additional few weeks the mucoperiosteum grows over the sinus mucosa giving a two‐layered closure. We have had successful results in seven patients treated by this method, some of whom were failures of a standard flap technique and all of which were quite large. The advantages of this procedure are that it is a safe, simple and physiologic method of closing oroantral fistulas without distorting intra‐oral anatomy, and we feel that it should receive wider attention by otolaryngologists in the future.
Selection of patients and choice of operation for orbital decompression in graves' ophthalmopathy
Authors: Desanto Lawrence W. , Gorman Colum A.
Published: September 2006

Until the fundamental cause of the orbital problem associated with Graves' disease is better understood and can be prevented or reversed, some patients will need palliative orbital decompression. Of the available methods of orbital enlargement, the transantral ethmoidal decompression and the transfrontal operation seem most useful because of the amount of bone that can be removed by either approach.

Transantral decompression is an appropriate operation for those patients with serious bilateral disease who would otherwise be treated systemically with corticosteroids. It also is of value as a preliminary step to extraocular muscle surgery after the orbital process has stabilized in those patients with exophthalmos and extraocular muscle myopathy and diplopia. Cosmetic decompression by this route is practical but total rehabilitation may also require upper lid and rectus muscle surgery.

Forty patients with Graves' ophthalmopathy were treated by transantral decompression in the period July, 1969, to July, 1972. Seventeen of these had optic nerve dysfunction and visual field defects, papilledema, or choroidal folding. Fourteen patients had proptosis without optic neuropathy and six of these had corneal ulceration. Five patients had decompression specifically as a preliminary to eye muscle surgery and four patients had decompression for purely cosmetic reasons.

The transfrontal decompression is ideal for patients with unilateral exophthalmos and when orbital exploration is needed. The transfrontal operation can salvage vision in the occasional patient with serious disease that is not palliated by transantral decompression.

Orbital decompression is a more conservative approach to palliation than is high‐dose long‐term systemic steroid therapy. Orbital decompression has effectively controlled the optic neuropathy of Graves' disease without serious complications from the operation and without risking the potential side‐effects of long‐term high‐dose steroid therapy.
Argon laser microsurgery: Its advantages and applications in otolaryngology
Authors: Hobeika Claude P. , Rockwell R. James
Published: September 2006

Pulsed lasers and continuous wave lasers were used experimentally in our laboratories. Because of their characteristics lasers are best suited for microsurgery. The Argon laser offers definite advantages: 1. a very small spot size; 2. selective destruction of tissues with red pigments; 3. in depth effect; and 4. it can be incorporated into the optical system of a standard operating microscope.

The vocal cords of 24 mongrel dogs were exposed to different doses of argon laser irridation. The animals were sacrificed at intervals of up to 45 days. In all animals the destructive lesion was dose related, predictable and well circumscribed. Minimal edema followed the irradiations. Healing was complete by the third post irradiation week. The vocal cords were covered with normal looking mucosa. Scarring was minimal and muscle fibers and cartilage unaffected.
Evaluation of the air caloric test as a routine examination procedure
Authors: Capps Mary Jayne , Preciado Manuel C. , Paparella Michael M. , Hoppe Wayne E.
Published: September 2006

The nystagmus responses of normal subjects to air and water caloric irrigations of comparable temperatures were compared. Irrigations of 0° air for 60 sec were found to produce nystagmus responses equal in amplitude, frequency and eye‐speed to those evoked by irrigations of 5 cc of ice water. Ice water produced significantly longer responses than did 0° air (mean difference = 11.6 sec). Responses to bithermal air stimuli of 24° C and 50° C were compared to those produced by 30°C and 44° C water. No significant differences were found between the cool stimuli for any of the measures. The warm stimuli produced responses of equal eye‐speed, but the water responses were significantly greater than those of air when the measures of total amplitude, frequency and duration were compared; thus, air stimulation was the preferred method of performing the standard caloric test, since the air responses were equal in reliability to those of water and because of the advantages of the use of air, which include greater convenience, patient tolerance, applicability, and flexibility.
The placement of middle ear ventilation tubes: Some indications and complications
Authors: Pratt Lindsay L. , Murray John
Published: September 2006

Are they necessary? What are the indications? Does fluid necessitate tubes? A plea for conservatism? Complications? Answers to these questions are presented by an objective evaluation of patients.
Cryosurgery of respiratory structures. I. Cryonecrosis of trachea and bronchus
Authors: Neel H. Bryan , Farrell Kenneth H. , Desanto Lawrence W. , Payne W. Spencer , Sanderson David R.
Published: September 2006

Although extirpative surgery is the mainstay of treatment of tumors of the trachea and bronchial tree, other methods for cure or palliation of neoplasms in these structures should be explored. The present study was designed to assess, in dogs, 1. the pathophysiologic effects of complete circumferential cryonecrosis of a segment of trachea, and 2. the feasibility of performing cryosurgery within the distal tracheobronchial tree through a bronchoscope.

Eleven mongrel dogs weighing 16 to 20.5 kg were used. Each dog was anesthetized with intravenous pentobarbital. Under clean conditions, a segment of cervical trachea consisting of 10 rings (two through 12) was exposed and completely mobilized through a midline incision in eight dogs. A segment of trachea consisting of five to six tracheal rings was frozen by applying the probe tip to the anterior and lateral surfaces of the trachea and by suspending the posterior wall on the shaft of the cryoprobe tip. Each probe application lasted two minutes. This effected cryonecrosis of the entire circumference of a 15 to 18 mm segment of trachea. The probe was applied to the same site three times (repetitive freezing) and complete thawing was allowed between freezes. Copper constantan needle thermocouples embedded in 25‐gauge needles were inserted into the tracheal wall, and recordings of temperature changes within the target areas were made continuously with a penline recorder during freezing and thawing.

A probe 0.6 cm in diameter and 55 cm long was developed for transbronchoscopic cryosurgery. In three dogs, several focal areas including the anterior and posterior trachea, carina, main stem, and segmental bronchi were frozen. Each site was frozen repetitively (three times for two minutes each).

All 11 dogs survived the procedures and resumed normal activity within 12 hours of operation. Necrosis was localized, reproducible, and followed by prompt regeneration of mucosa. The gross architecture of the trachea and bronchus was not permanently altered, and there was no local or regional infection, except in one dog in which a tracheal stricture developed. This was attributed to persistent infection around a permanent suture placed at operation for the endoscopic identification of the target area. The study indicates that trachea and bronchi may be safely frozen by application of a cryoprobe either to the external surface or to the mucosal surface.