bluuebunny/crossref_metadata_2025 huggingface dataset:
Fragmentation characteristics of permethylated oligosaccharides using a matrix‐assisted laser desorption/ionization two‐stage time‐of‐flight (TOF/TOF) tandem mass spectrometer
Authors: Morelle Willy , Slomianny Marie‐Christine , Diemer Hélène , Schaeffer Christine , Dorsselaer Alain van , Michalski Jean‐Claude
Published: October 2004

Matrix‐assisted laser desorption/ionization two‐stage time‐of‐flight (MALDI‐TOF/TOF) tandem mass spectrometry (MS/MS) was applied to characterize permethylated oligosaccharides. Under these ionization conditions such derivatives yield intense signals corresponding to sodium‐cationized molecular species. A systematic study was conducted on a series of neutral and sialylated permethylated oligosaccharides to allow rationalization of the fragmentation processes. The major fragments observed in the MALDI‐TOF/TOF‐MS/MS spectra result from cleavage of glycosidic bonds, preferentially at N‐acetylhexosamine and sialic acid residues. The fragments originating from both the reducing and the non‐reducing ends of the glycan yield information on sequence and branching. Cross‐ring cleavages, which are very informative of the linkages of the monosaccharide residues constituting these oligosaccharides, and ‘internal’ cleavage ions which are derived from elimination of substituents from around the pyranose ring, were also observed. This extensive fragmentation was shown to be useful for the structural characterization of oligosaccharides. MALDI‐TOF/TOF‐MS/MS of permethylated oligosaccharides appears to be a powerful tool for carbohydrate structural analysis. Copyright © 2004 John Wiley & Sons, Ltd.
Glial fibrillary acidic protein (GFAP)‐like immunoreactivity in the visual system of the crab Ucides cordatus (Crustacea, Decapoda)
Authors: Da Silva Simone Florim , Corrêa Clynton Lourenço , Tortelote Giovane G. , Einicker‐Lamas Marcelo , Martinez Ana Maria Blanco , Allodi Silvana
Published: October 2004

Abstract Glial fibrillary acidic protein (GFAP) is the main intermediate filament protein used as a marker for the identification of astrocytes in the central nervous system of vertebrates. Analogous filaments have been observed in the glial cells of many mollusks and annelids but not in crustaceans. The present study was carried out to identify by light microscopy immunohistochemistry, immunoelectronmicroscopy and immunoblotting, GFAP‐like positive structures in the visual system of the crab Ucides cordatus as additional information to help detect and classify glial cells in crustaceans. Conventional electron microscopy, light microscopy of semithin sections and fluorescence light microscopy were also employed to characterize cells and tissues morphology. Our results indicated the presence of GFAP‐like positive cell processes and cell bodies in the retina and adjoining optic lobe. The labeling pattern on the reactive profiles was continuous and very well defined, differing considerably from what has been previously reported in the central nervous system of some mollusks, where a diffuse spotted fluorescence pattern of labeling was observed. We suggest that this glial filament protein may be conserved in the evolution of the invertebrate nervous systems and that it may be used as a label for some types of glial cells in the crab.
Reduction, integration and emergence in biochemical networks
Authors: Ricard Jacques
Published: October 2004

Abstract Most studies of molecular cell biology are based upon a process of decomposition of complex biological systems into their components, followed by the study of these components. The aim of the present paper is to discuss, on a physical basis, the internal logic of this process of reduction. The analysis is performed on simple biological systems, namely protein and metabolic networks. A multi‐sited protein that binds two ligands x and y can be considered the simplest possible biochemical network. The organization of this network can be described through a comparison of three systems, i.e. XY, X and Y. X and Y are component sub‐systems that collect states xi and yj, respectively, i.e. protein states that have bound either i molecules of x (whether or not these states have also bound y), or j molecules of y (whether or not these states have bound x). XY is a system made up of the specific association of X and Y that collects states xiyj. One can define mean self‐informations per node of the network, ,  and . Reduction of the system XY into its components is possible if, and only if, ,is equal to the sum of  and . If  is smaller than the sum of and , the system is integrated, for it has less self‐information than the set of its components X and Y. It can also occur that , be larger than the sum of  and . Hence, the system XY displays negative integration and emergence of self‐information relative to its components X and Y. Such a system is defined as complex. Positive or negative integration of the system implies it cannot be reduced to its components. The degree of integration can be measured by a function , called mutual information of integration. In the case of enzyme networks, emergence of self‐information is associated with emergence of catalytic activity. Moreover, if the enzyme reaction is part of a metabolic sequence, its mutual information of integration can be increased by an effect of context of this sequence.
Expression of PTHrP and the PTH/PTHrP receptor in growing red deer antler
Authors: Barling Peter Michael , Liu Hong , Matich Jessica , Mount Julia , Lai Ka Wai Angela , Ma Li , Nicholson Louise Frances Basford
Published: October 2004

Antler growth is highly co‐ordinated, so that trabecular bone and antler skin (velvet) develop together, at a rapid rate and in a manner reminiscent of their development in the fetus. Parathyroid hormone‐related peptide (PTHrP) is expressed in both bone and skin, and is therefore a candidate to effect co‐ordination between these tissues. The aim of this study was to localize the expression of PTHrP and its principal receptor, the parathyroid hormone/parathyroid hormone‐related peptide receptor (PTH/PTHrPR), in antler (“spiker”) of one‐year‐old red deer. Using immunohistochemistry and in situ hybridization, intense and overlapping expression of PTHrP and its receptor was seen in developing osseocartilaginous structures and in the underlying layers of velvet epidermis. PTHrP was located on both the cell surface and within the nuclei. Our results strongly suggest that PTHrP, acting via the PTH/PTHrPR and possibly other intracrine mechanisms, plays a central role in the co‐ordinated regulation of cell division and differentiation of developing antler bone and skin.
Can opioids prevent post‐operative chronic pain?
Authors: Stubhaug Audun
Published: October 2004

Chronic post‐operative pain is a major source of suffering and disability. Better standardisation for assessing and reporting chronic post‐operative pain is needed. Peripheral and central nervous plasticity seem to play a major role in the development of chronic post‐injury pain. Complex mechanisms, including several receptor systems and messenger systems are involved. Thus, it is unlikely that one single agent will solve the problem. Opioids have proven effect both in animal models, experimental human models, and in some clinical models. Timing and dose seem to be of importance. However, it is likely that polypharmacy and multi‐modal treatment is necessary to further improve the preventive strategy.
Family disruption, economic hardship and psychological distress in schizophrenia: can they be measured?
Authors: Madianos M. , Economou M. , Dafni O. , Koukia E. , Palli A. , Rogakou E.
Published: October 2004

This study examined the dimensions of burden perceived by key-relatives of patients suffering from schizophrenia spectrum disorder by the development of an instrument, the Family Burden Scale (FBS) and the underlying predictors. One hundred and seventy one primary caregivers, living with 158 patients suffering from chronic psychotic illness and maintained on community basis in Athens area, were interviewed by the use of FBS supplemented by the Family Atmosphere Scale and GHQ. Construction procedure and factor analysis of FBS produced a scale of 23 items in four factors, three of them measuring objective and the fourth one, subjective burden. The scale was also proved to be reliable and valid. Forty-five percent of primary caregivers reported high levels of burden. Psychological impairment (high GHQ scores) was related with high levels of burden and negative family atmosphere. Previous admissions and duration of illness were also found to predict burden. The results suggest that FBS differentiates objective from subjective burden. Psychological well being of carers is affected by the dimensions of perceived burden.
Appraisal of caregiving, burden and psychological distress in relatives of psychiatric inpatients
Authors: Östman Margareta , Hansson Lars
Published: October 2004

Appraisal of caregiving and its relationship to family burden and experienced mental health problems in the relatives were investigated as part of a multi-centre study of the quality of mental health services in Sweden performed in 1997. The sample was drawn from relatives of involuntarily and voluntarily admitted patients to acute psychiatric wards. The instrument used was a semi-structured questionnaire, interviewing relatives about the burden, experience of mental health problems and appraisal of the caregiving situation. The results showed a high proportion of relatives engaged in caregiving activities on a daily basis the month before the patient's admission to hospital and a high proportion of relatives appraising the caregiving activities negatively. The burden was more extensive if the relative and the patient were living together, had a longer duration of their relationship, if the relative was rendering caregiving on a daily basis and if the relative appraised caregiving negatively. The relatives' psychological distress was not related to their negative appraisal of caregiving, nor was patient characteristics, such as diagnosis and level of psychosocial functioning. The only factor found to influence the relatives' psychological distress was the duration of relationship to the patient. Interventions reducing psychological distress for relatives who have known the patients for more than 20 years, who live with the patient, who give care on a daily basis and who appraise their caregiving negatively are suggested.
Trends in the use of the Italian Mental Health Act, 1979–1997
Authors: Guaiana Giuseppe , Barbui Corrado
Published: October 2004

Italian statistics on psychiatric bed availability, voluntary and compulsory admissions were examined from 1979 to 1997. Although the number of psychiatric beds dropped by 62.5%, the absolute number of compulsory admissions has remained substantially stable. The proportion of all admissions that were compulsory decreased from 17.1% to 11%. This study shows that a shift to community care was not associated with an increase in compulsory admissions in Italy.
Dual signaling by mGluR5a results in bi‐directional modulation of N‐type Ca2+ channels
Authors: Sánchez-Prieto J. , Paternain A.V. , Lerma J.
Published: October 2004

We have studied how N‐type Ca2+ channels are modulated by the metabotropic glutamate receptor 5a (mGluR5a) in Xenopus oocytes. Stimulation of the receptor with glutamate initiated two parallel responses, a rapid inhibition followed by an upregulation of the Ca2+ current. Although a subsequent stimulation did not upregulate the Ca2+ current, it did still produce a reduction in the amplitude of the current. The upregulation of Ca2+ channels was prevented by the protein kinases inhibitor staurosporine and it was mimicked by the activation of PKC with phorbol esters. In contrast, the inhibition of the Ca2+ current was insensitive to staurosporine. These results show that mGluR5a exerts a bi‐directional influence on Ca2+ channels, which may explain how group I mGluRs facilitate and inhibit glutamate release at central synapses.
A GFP fluorescence‐based approach to determine detergent insolubility of the human serotonin1A receptor
Authors: Kalipatnapu Shanti , Chattopadhyay Amitabha
Published: October 2004

Insolubility in non‐ionic detergents such as Triton X‐100 is a widely used biochemical criterion for characterization of membrane domains. We report here a novel green fluorescent protein fluorescence‐based approach to directly determine detergent insolubility of specific membrane proteins. We have applied this method to explore the detergent resistance of an important G‐protein coupled receptor, the serotonin1A (5‐HT1A) receptor. Our results show, for the first time, that a small yet significant fraction of the 5‐HT1A receptor exhibits detergent insolubility. These results are validated by control experiments involving fluorescent lipid probes and protein markers. Our results assume relevance in the context of localization of the 5‐HT1A receptor in membrane domains and its significance in receptor function and signaling.
UDP‐galactose 4‐epimerase from Kluyveromyces fragilis: existence of subunit independent functional site
Authors: Brahma Amrita , Bhattacharyya Debasish
Published: October 2004

UDP‐galactose 4‐epimerase from Kluyveromyces fragilis is a stable homodimer of 75 kDa/subunit with non‐covalently bound NAD acting as cofactor. Partial proteolysis with trypsin in the presence of 5′‐UMP, a strong competitive inhibitor, led to a degraded product which was purified. Results from SDS–PAGE, size‐exclusion (SE)‐HPLC and ultracentrifugation indicated its monomeric status and size between 43 and 45 kDa. `Two‐step assay' with UDP‐glucose dehydrogenase as coupling enzyme in the presence of NAD ensured epimerase activity of the monomer. The possibility of transient dimerization of monomeric epimerase during catalysis was excluded by SE‐HPLC in the presence of excess substrate and NAD. This truncated enzyme retained catalytic site related properties like K
m for UDP‐galactose, `NADH‐like coenzyme fluorescence' and `reductive inhibition' similar to its dimeric counterpart. Reversible reactivation of the monomer was achieved up to 95% within 3 min from 8 M urea induced unfolded state, indicating that the catalytic site could form independent of its quaternary structure. Equilibrium unfolding between 0 and 8 M urea indicated that the monomer was less stable compared to the dimer. Chemical modification of amino acids and reconstitution with etheno‐NAD suggested that the architecture around the catalytic site of the monomer was conserved. Specific modification reagents further confirmed that the cysteine residues required for catalysis and coenzyme fluorophore reside exclusively on a single subunit negating a `subunit sharing model' of its catalytic site.
Membrane‐permeabilizing motif in Semliki forest virus E1 glycoprotein
Authors: Nieva José L. , Sanz Miguel A. , Carrasco Luis
Published: October 2004

Cell infection by alphaviruses is accompanied by membrane permeability changes. New predictive approaches, including the computation of interfacial affinity and corresponding hydrophobic moments, suggest a segmented amphipathic‐at‐interface domain in the stem region of Semliki Forest virus fusion protein E1. Expression of E1 sequences in Escherichia coli cells confirmed that the membrane proximal plus transmembrane (TM) domain unit permeabilizes cells as efficiently as the 6K viroporin. Both our predictive and experimental data support the involvement of the E1 stem‐TM region in membrane insertion and permeabilization. We propose to combine Wimley–White hydrophobicity analysis with expression‐coupled permeability assays in order to identify viral products implied in breaching cell membrane barriers during infection.
The novel gene fad104, containing a fibronectin type III domain, has a significant role in adipogenesis
Authors: Tominaga Kei , Kondo Chiharu , Johmura Yoshikazu , Nishizuka Makoto , Imagawa Masayoshi
Published: October 2004

A novel gene named fad104 (factor for adipocyte differentiation‐104), whose expression level quickly increased in the early stage of adipogenesis, was isolated and characterized. The deduced amino acid sequence of fad104 revealed the possible presence of a fibronectin type III domain and transmembrane domain. The expression of fad104 was detected in adipocyte differentiable 3T3‐L1 cells but not observed in the non‐adipogenic cell line NIH‐3T3. Moreover, the ability of 3T3‐L1 cells to differentiate declined with the knockdown of fad104 by RNA interference, strongly indicating that fad104 functions as a positive regulator of adipogenesis.
Direct observation of the pH‐dependent equilibrium between L‐like and M intermediates of photoactive yellow protein
Authors: Imamoto Yasushi , Harigai Miki , Kataoka Mikio
Published: October 2004

Equilibrium between the photoproducts of photoactive yellow protein (PYP), present in a millisecond time scale, was studied. The near‐UV intermediate of PYP (PYPM) was red‐shifted by alkalization due to the deprotonation of the chromophore (pK
a=10.2). In addition, a small amount of red‐shifted intermediate coexisted with PYPM. Its spectral shape in the visible region agreed with that of PYPL, the precursor of PYPM. The fraction of PYPL‐like product was maximal at pH 10. It decays with a rate constant identical to that of PYPM. These results indicate that PYPL‐like product is in pH‐dependent equilibrium with PYPM and deprotonated PYPM.
Automated Selection of Transcription Factor Binding Sites
Authors: Sooter Letha J. , Ellington Andrew D.
Published: October 2004

Double-stranded DNA binding sites that bound with high affinity to the nuclear factor kappa B (NFκB) p50 homodimer were selected using a Tecan Genesis workstation. The adaptation of the Tecan to automated selection required the integration of multiple devices and modifications to standard selection protocols, and resulted in a significant increase in throughput. The sequences obtained by automated selection strongly correlated with the well-known family of natural NFκB double-stranded DNA binding sites and with previous manual selection experiments. In addition, the selection experiments better defined the contributions of residues outside of the well-known, decameric core binding site for NFκB.
Laboratory Automation Curriculum at Keck Graduate Institute
Authors: Sterling James D.
Published: October 2004

A novel curriculum in laboratory automation and high-throughput technologies has been developed at the Keck Graduate Institute (KGI) over the past five years as part of the professional masters degree program in applied life sciences. The goal of this curriculum has been four-fold: (1) motivate study by describing the need for automation through several example problems in combinatorial biological discovery, (2) provide elements of fundamental engineering science that are required for the development of the technologies and tools that enable automation, (3) provide opportunities for the students to see and use state-of-the-art instruments, learn about existing industry standards, and to visit integrated laboratories that perform high-throughput research, and (4) introduce scientific discoveries and new technologies that could have future impact on laboratory automation and discuss current trends, and project future trends in this field.
Fully Controllable Microfluidics for Molecular Computers
Authors: Noort Danny van , Tang Zhongliang , Landweber Laura F.
Published: October 2004

Automation will be a necessary step for the success of molecular computing. Here we have applied microfluidic technology to DNA computers, with a sample application towards solving Boolean logic problems.
Micro-Parallel Liquid Chromatography for Analysis of Peptides and Proteins
Authors: Rajan Aruna , Mullen Johanna , Bhatnagar Neelima , Dubey Ananya , Niemz Angelika , Chakravarti Bulbul , Chakravarti Deb N.
Published: October 2004

The present study evaluates the application of Nanostream Inc.'s Veloce micro-parallel liquid chromatography (μPLC) system, a high-throughput microfluidic liquid chromatography (LC) system, for the analysis of peptides and proteins. Using the Veloce system, as well as traditional high-performance liquid chromatography (HPLC) systems, we performed separations and analyses of (1) a mixture of peptide standards, (2) crude and semipure synthetic peptides, and (3) peptide components of a protein digested with trypsin. In all these studies, the Veloce system was evaluated by comparison to a traditional HPLC system for the number of peaks, their resolution, retention time, shape, and width. When similar columns were used, the performance of the Veloce system was comparable to that of traditional HPLC systems. In general, the Veloce system offers several advantages over traditional HPLC systems, such as the ability to analyze samples in a high-throughput manner with significantly lower consumption of samples and solvents.
Cell Physiometry Tools Based on Dielectrophoresis
Authors: Pethig Ronald , Lee Richard S. , Talary Mark S.
Published: October 2004

A cell physiometry system is described for characterizing and separating cells, and performing cell-based assays, using dielectrophoresis (DEP). Cells, or mixtures of cells, are suspended in a chamber containing an array of microelectrodes located on the chamber's bottom surface. A sequence of radio frequency signals is automatically applied to the microelectrodes, and images of the DEP-induced motions of the cells are captured and analyzed to determine a characteristic parameter known as the DEP cross-over frequency. Once a cell population has been characterized in this way, the same apparatus can be used to selectively isolate cells for additional biochemical, physical, or genetic analysis. Biochemical labels or bioengineered tags such as fluorescent markers or antibody-coated beads are not required. Cell separations are achieved by “electronically tuning” into the different cell types by superimposing different signal frequencies onto the microelectrodes, using both stationary and traveling wave DEP signals. Examples of separating different types of blood cell are given, together with descriptions of cell-based bioassays that monitor physiological changes that accompany trans-membrane signaling events, apoptosis, and the aging of cell cultures.
Closed Multiple Tendinous Rupture of Flexors and Extensors of Hand: A Case Report
Authors: SHAHRIAR KAMRANI REZA , AFSHIN TAHERI , SHAHRIAR JALALI MAZLOUMAN
Published: October 2004

Multiple ruptures of the extensor and flexor tendons of the fingers, thumb and wrist at the musculotendinous junctions are reported after a blast injury.
The Use of Chloramphenicol Ointment as an Adhesive for Replacement of the Nail Plate after Simple Nail Bed Repairs
Authors: PASAPULA C. , STRICK M.
Published: October 2004

Fingertip injuries are common and are often repaired. The nail plate is replaced to protect the repair and maintain the alignment of the nail bed edges after repair. Once replaced, this can be secured by any means and often a suture is used. We advocate that a small bleb of chloramphenicol provides a simple method of securing the nail plate. It is fast, easy and secure. In addition it provides an antibacterial effect, which may be of some benefit.
Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture
Authors: Anitua Eduardo , Andí Isabel , Sanchez Mikel , Azofra Juan , del Mar Zalduendo Ma , de la Fuente María , Nurden Paquita , Nurden Alan T.
Published: October 2004

Blood platelets become activated and aggregate at the site of vessel injury. Upon activation by thrombin, platelets release storage pools of proteins and growth factors (GFs), including those involved in tissue repair. Our goal was to evaluate the potential beneficial effect of proteins released from platelet‐rich clots on tendon healing. PDGF, TGF‐β‐1, IGF‐I, HGF, VEGF and EGF were measured in human platelet‐poor plasma (PPP) and in the releasates collected from either platelet‐poor or platelet‐rich clots prepared in vitro. We then studied the effects of the releasates on human tendon cells in culture. Releasates from both platelet‐rich and platelet‐poor clots stimulated tendon cell proliferation, in contrast to un‐clotted PPP. The mitogenic activity of the supernatants was not decreased by the thrombin inhibitor, hirudin. Cultured tendon cells synthesise VEGF and HGF in the presence of PPP‐clots and PRP‐clot releasates, thus the synthesised amount was significantly higher with supernatants from platelet‐rich clots than supernatants from a platelet‐poor clot (p < 0.05). These results suggest that administering autologous platelet‐rich clots may be beneficial to the treatment of tendon injuries by inducing cell proliferation and promoting the synthesis of angiogenic factors during the healing process. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.
Hearing Loss in Steelband Musicians
Authors: Juman Solaiman , Karmody Collin S. , Simeon Donald
Published: October 2004

OBJECTIVE

To determine the difference in hearing between a group of steelband musicians (pannists) and a control group.

DESIGN, SETTINGS, AND SUBJECTS

We conducted a controlled cross‐sectional pilot study consisting of 29 steelpan players and 30 control subjects from a steelpan orchestra (steelband) in the Otolaryngology Department of the Eric Williams Medical Sciences Complex.

RESULTS

Significantly more steelpan players had a hearing loss than the control subjects at 3000 Hz, 4000 Hz, and 6000 Hz (P < 0.01). χ2 testing for trend demonstrated that the longer a steelpan player played his instrument the greater the hearing loss.

CONCLUSION

These results indicate that pannists suffer permanent auditory damage from high‐in‐tensity sound levels and that preventative measures are required to prevent this hearing loss, particularly in younger players.
Status of Internal Jugular Veins in Patients with Carcinomas of the Head and Neck Area
Authors: Prim M. P. , De Diego J. I. , Moreno P. , Madero R. , Gavilan J.
Published: October 2004

OBJECTIVE

To assess the status of internal jugular veins (IJV) in patients with head and neck carcinomas.

STUDY DESIGN AND SETTING

This study included 108 IJV of 54 cancer patients who were prospectively evaluated between September 1994 and February 1997. Patency, presence of thrombosis, characteristics of vein wall, compressibility, area of the veins both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were registered in all cases. Also, 30 IJV of 15 normal volunteers were used as a control group. The study was performed in a tertiary care referral center.

RESULTS

Right expiratory flow speed was higher in volunteers (P = 0.0280), and left basal area was bigger in oncologic patients (P = 0.0394). No significant changes were found between cancer patients and controls in the remaining parameters (P > 0.05).

CONCLUSIONS AND SIGNIFICANCE

According to these results, head and neck carcinomas do not seem to affect the ultrasonographic characteristics of IJV. Thus, preoperative evaluation of IJV is not mandatory in these patients.
Small and Large Middle Meatus Antrostomies in the Treatment of Chronic Maxillary Sinusitis
Authors: Albu Silviu , Tomescu Ermil
Published: October 2004

OBJECTIVE

The study goal was to compare the postoperative endoscopic appearance of the middle meatus antrostomy with symptomatic relief in patients undergoing endoscopic endonasal sinus surgery for chronic maxillary sinusitis.

STUDY DESIGN

We conducted a prospective randomized study encompassing 133 patients with chronic rhinogenic maxillary sinusitis who underwent endoscopic ethmoid surgery and middle meatal antrostomies. One of the tasks was to compare small‐sized (less than 6 mm) antrostomies with large‐sized (more than 16 mm) antrostomies in relieving the symptoms of chronic maxillary sinusitis. During follow‐up an attempt was made to correlate endoscopic findings with symptomatic failure.

RESULTS

We could not demonstrate a statistically significant correlation between the degree of improvement of the main sinusitis symptoms (obstruction, headache, and nasal discharge) and the post‐operative size of the antrostomy. Nevertheless, persistent accessory maxillary ostia, scarring within the ethmoid were statistically significant predictors of poor surgical outcome.

CONCLUSION

We conclude from this study that the size of the middle meatal antrostomy has no influence on the outcome of endonasal surgery for chronic rhinogenic maxillary sinusitis.
Diagnostic, Pathophysiologic, and Therapeutic Aspects of Benign Paroxysmal Positional Vertigo
Authors: Korres Stavros G. , Balatsouras Dimitrios G.
Published: October 2004

Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Canalolithiasis of the posterior semicircular canal is considered the most convincing theory of its pathogenesis and the development of appropriate therapeutic maneuvers resulted in its effective treatment. However, involvement of the horizontal or the anterior canal has been found in a significant rate and the recognition and treatment of these variants completed the clinical picture of the disease. This paper describes the advances in understanding how this disease is generated and discusses the current therapeutic modalities.
Long‐Term Otological Outcome of Hamular Fracture During Palatoplasty
Authors: Sheahan Patrick , Miller Ian , Sheahan Jerome N. , Earley Michael J. , Blayney Alexander W.
Published: October 2004

OBJECTIVE

It has been suggested that fracture of the hamulus during palatoplasty in children with cleft palate may lead to adverse otological sequelae, however, there is little evidence to support this.

STUDY DESIGN AND SETTING

The otological records of 42 children with repaired cleft palate (excluding submucous cleft palate) aged 8 years old or older were examined. A questionnaire regarding the incidence, treatment, and outcome of middle ear problems was completed by the parents of 68 children with repaired cleft palate, aged 9 years old or older.

RESULTS

There was no significant difference between children who did and did not undergo hamular fracture with regard to tympanic membrane appearance, audiometry, history of ear problems (P = 1.000), ear infections (P = 0.622), ventilation tube insertion (P = 0.532), or surgery for chronic otitis media (P = 1.000). Parents of children not undergoing hamular fracture reported a higher incidence of below normal hearing (P = 0.023).

CONCLUSION AND SIGNIFICANCE

There is no evidence that hamular fracture during palatoplasty affects long‐term otological outcome in cleft palate.
Salvage Surgery for Locally Recurrent Nasopharyngeal Carcinoma—A 10‐Year Experience
Authors: Chang Kai‐Ping , Hao Sheng‐Po , Tsang Ngan‐Ming , Ueng Shir‐Hwa
Published: October 2004

OBJECTIVE

To evaluate the result of salvage surgery for patients with primary recurrence of nasopharyngeal carcinoma (NPC) after radiation therapy.

STUDY DESIGN AND SETTING

Prospective cohort at a tertiary referral center.

PATIENTS AND METHODS

Thirty‐eight consecutive patients with primary recurrence of NPC after radiation failure underwent salvage surgery for curative intention via the facial translocation approach from July 1993 to December 2002. The follow‐up time ranged from 2 to 88 months. Twelve patients with intracranial and skull base invasion needed a combined neurosurgical approach. Eight patients had additional postoperative radiation therapy.

RESULTS

The actuarial 3‐year survival and local control rate was 60% and 72.8%, respectively. Ten (83.3%) of 12 patients with intracranial and skull base invasion achieved local control. There was no surgical mortality, and the morbidity rate was only 13.2%.

CONCLUSION AND SIGNIFICANCE

The results of this study reveal better outcome of salvage surgery than that of most published literature of reirradiation for recurrent NPC. With the adequate exposure provided by the facial translocation approach, an integrated concept of skull base surgery, and the collaboration of neurosurgeons, we can extend our surgical indications of salvage surgery and resect many advanced lesions with acceptable mortality and morbidity.
Parotidectomy for Primary Nonparotid Diseases
Authors: Plopper Caio , Cernea Claudio Roberto , Ferraz Alberto Rosetti , Dos Santos Luiz Roberto Medina , Regis Adrian Berenguer
Published: October 2004

OBJECTIVE

To analyze the indications and results of parotid gland resections for patients with primary nonparotid diseases.

STUDY DESIGN AND SETTING

Retrospective analysis of 442 consecutive parotidectomies (76 for primary nonparotid disease) in a referral head and neck surgery service, tertiary care university hospital.

RESULTS

Skin cancer (mainly squamous cell and basal cell carcinomas) was the most common indication for parotidectomy. Superficial parotidectomy with preservation of the facial nerve was the most commonly performed operation (61.8%), with some form of nerve sacrifice necessary in 31.6%. Parotid gland parenchyma and/or lymph nodes were pathologically positive in 46 cases. Neck dissections were carried out in conjunction with parotidectomy in 42 patients (1 patient had had previous neck dissection), of which 16 turned out to be pN+.

CONCLUSION

Parotidectomy should be considered as part of the surgical treatment of tumors whenever oncologically necessary for appropriate margins, lymph node dissection, and for proper identification and preservation of the facial nerve.
An Objective Assessment of the Advantages of Retrograde Parotidectomy
Authors: Bhattacharyya Neil , Richardson Marc E. , Gugino Laverne D.
Published: October 2004

OBJECTIVE

This study was undertaken to determine whether the retrograde parotidectomy approach is more efficient than standard anterograde parotidectomy without compromise of surgical effectiveness.

METHODS

A retrospective analysis of patients undergoing parotidectomy was conducted. Cases were divided into those undergoing retrograde facial nerve dissection and those undergoing standard anterograde facial nerve dissection. From the review of medical records, standard demographic information, surgical time, histopathology, estimated blood loss, and use of facial nerve monitoring were determined. Pathology was reviewed to determine the size of the overall resection specimen as well as the size of the lesion excised and margin status. Postoperative complications were also recorded. Statistical comparisons were conducted between these 2 approaches for these clinical variables such as surgical time, blood loss, tumor margin status and relative volume of tissue removed during parotidectomy.

RESULTS

45 patients undergoing parotidectomy met inclusion criteria. The average patient age was 50.8 years with a female preponderance (73%). There were 19 standard parotidectomies and 26 retrograde approaches. Compared to standard parotidectomy, retrograde parotidectomy consumed less operative time (3.2 versus 1.8 hours, respectively), decreased intraoperative blood loss (67.9 cc versus 40.3 cc, respectively), and resulted in less removal of normal parotid tissue (volume of normal parotid tissue removed in excess of tumor: 23.0 cc versus 6.0 cc, respectively). No significant difference in surgical margin status was noted between anterograde and retrograde parotidectomy (P = 0.452).

CONCLUSIONS

In appropriately selected cases, compared with standard anterograde parotidectomy, retrograde parotidectomy is more efficient and spares normal parotid tissue without compromising surgical margins. Facial nerve monitoring provides a useful adjunct for retrograde dissection.
Surface Electromyographic Studies of Swallowing in Normal Subjects: A Review of 440 Adults. Report 1. Quantitative Data: Timing Measures
Authors: Vaiman Michael , Eviatar Ephraim , Segal Samuel
Published: October 2004

OBJECTIVE

Surface electromyographic studies were performed on 440 normal adults to establish normative database for duration of muscle activity during swallowing and drinking clinically useful for outpatient ENT department.

STUDY DESIGN

Prospective observational study of healthy volunteers.

METHODS

Parameters evaluated during swallowing include the timing of activity of the orbicularis oris, masseter, submental, and infrahyoid muscle groups covered by platisma. Five tests were examined including voluntary single swallows of saliva (“dry” swallow), voluntary single water swallows as normal, voluntary single swallows of excessive amount of water (20 mL), continuous drinking of 100 mL of water (duration and number of swallows), monitoring of spontaneous swallowing of saliva during 1 hour period. The duration of oral, pharyngeal, and initial esophageal stages of swallowing (mean + SD) were measured for groups of adults of different age (18–30, 31–40, 41–50, 51–60, 61–70, 70+ years old).

RESULTS

Normative data for duration of muscle activity during single swallowing and continuous drinking are established for healthy adults. The duration of swallows and drinking in all tests showed insignificant increase with the age except for the geriatric group, in which this tendency is statistically significant (1‐dimensional analysis of variance, SPSS, Chi‐square criterion, 95% confidence interval). There was no statistically significant difference between male and female adults duration of muscle activity during single swallowing and continuous drinking in all age groups (P ≥ 0.05). The relevance and clinical utility of new and alternative measures, in particular, are discussed.

CONCLUSION

Surface EMG of swallowing is a simple and reliable noninvasive method for screening evaluation of swallowing with low level of discomfort during the examination. Stage‐by‐stage evaluation of duration can be very important for topical diagnosis of etiology of dysphagia. The normative timing of events data can be used for evaluation of complaints and symptoms, as well as for comparison purposes in preoperative and postoperative stages and in EMG monitoring during ENT treatment. These parameters represent stages required for normal deglutition, and can be used to identify abnormalities in ENT patients, and provide a basis for comparison of swallowing performance both within and between patients.
Factors Associated with Failure of Frontal Sinusotomy in the Early Follow‐Up Period
Authors: Chandra Rakesh K. , Palmer James N. , Tangsujarittham Thianchai , Kennedy David W.
Published: October 2004

OBJECTIVES

To understand factors associated with failure of endoscopic frontal sinusotomy.

METHODS

Retrospective review of 130 consecutive frontal sinusotomies. The preoperative extent of disease was graded radiologically in each frontal sinus as total opacification, partial opacification, or mucosal thickening. Records were also reviewed to determine the incidence of comorbid conditions.

RESULTS

Patency at most recent follow‐up was observed in 117/130 (90%). Patency was achieved after our first procedure in 107 sinusotomies. These were considered successes. Ten required revision surgery, and an additional 13 were not patent at last follow‐up. These 23 sinusotomies were considered failures. Among those failing our initial surgery, 19/23 (83%) were partially or totally opacified preoperatively. In contrast, only 47/107 (44%) in the success group contained partial or total opacification preoperatively (P = 0.003), with the majority exhibiting mucosal thickening only. Mean follow‐up was 8.3 months for the successes and 10.7 months for the failures (P = NS). No significant differences were observed between the success and failure groups with respect to the prevalence of asthma, aspirin sensitivity, or allergic fungal disease. Patients in the failure group, however, had a higher mean number of prior surgeries before undergoing frontal sinusotomy at our institution (1.8 vs 0.9, P = 0.033).

CONCLUSIONS

During the early follow‐up period, failure of endoscopic frontal sinusotomy is associated with advanced degrees of preoperative disease within the sinus and is also more likely in patients who have failed prior surgical management.
Vocal Fold Augmentation with Calcium Hydroxylapatite
Authors: Belafsky Peter C. , Postma Gregory N.
Published: October 2004

OBJECTIVES

Voice disorders affect more than 3% of the general population. Vocal fold atrophy is a part of the normal aging process, with up to 60% of 60‐year‐old individuals displaying evidence of glottal insufficiency. A safe, effective, and durable substance for injection augmentation of the vocal folds is not currently available. The purpose of this investigation was to describe our preliminary experience with calcium hydroxylapatite (CaHA) for vocal fold augmentation.

METHODOLOGY

All patients undergoing injection augmentation of the vocal folds with CaHA between January 1, 2002 and June 1, 2003 were pro‐spectively evaluated. Data concerning indications, technique, functional outcome, and complications were collected. In addition, the larynx donated from a woman who underwent vocal fold augmentation with CaHA and subsequently died from terminal cancer was histologically examined.

RESULTS

A total of 39 vocal folds in 23 individuals were injected with CaHA. The mean age of the cohort was 62. Fifty‐two percent were male. The indications for augmentation were unilateral vocal fold paralysis (9/23), unilateral vocal fold paresis (5/23), presbylarynx (3/23), Parkinson's (3/23), bilateral vocal fold paresis (2/23), and abductor spasmodic dysphonia (1/20). There were no adverse reactions. All individuals reported improvement on a self‐administered disease‐specific outcome measure (P < 0.001). The pathology from the donated larynx 3 months after injection revealed intact CaHA spherules in good position with a minimal, monocellular inflammatory reaction to the gel carrier and no evidence of implant rejection.

CONCLUSIONS

Initial experience with vocal fold augmentation using CaHA is promising. Long‐term safety and efficacy needs to be established.
Safety of Outpatient Tonsillectomy in Children: A Review of 6 Years in a Tertiary Hospital Experience
Authors: Granell Jose , Gete Pilar , Villafruela Miguel , Bolaños Caridad , Vicent Juan Jose Alvarez
Published: October 2004

OBJECTIVE

We present our experience with outpatient tonsillectomy in children and critically review safety to support the outpatient policy.

STUDY DESIGN AND SETTING

We conducted a retrospective chart review from January 1995 through December 2000 in the pediatric otolaryngology unit of a tertiary care university hospital.

RESULTS

One thousand two hundred forty‐three patients were accepted in the outpatient program with permissive criteria. Postoperative observation time ranged from 3 to 5 hours (median, 4.5 hours). The overall rate of complications was 9.3% (n = 116). Primary and secondary bleeding rates were 6.27% (n = 78) and 0.48% (n = 6), respectively. Thirty‐six children (2.9%) had major bleeding; 2 of them were not identified in day‐hospital (0.16%). Discharge was delayed in 103 patients (8.3%), and 13 patients showed complications after discharge (about 1% readmission rate).

CONCLUSION

Our program outcomes support safety. Outpatient surgery is meant to provide comfort to the patient and efficiency to the health care system, without impairing safety; in our experience, most tonsillectomies in children comply with these objectives.

SIGNIFICANCE

Outpatient tonsillectomy in children may be safe even with permissive criteria, when an appropriate setting is available.
Revision Cochlear Implant Surgery: Causes and Outcome
Authors: Fayad Jose N. , Baino Tony , Parisier Simon C.
Published: October 2004

OBJECTIVE

To review experience with cochlear implant reimplantations, including effect of reinsertion on audiological performance.

STUDY DESIGN AND SETTING

Retrospective review of cochlear implant reinsertions in patients seen in a private tertiary neurotologic practice. Forty‐three patients (8 adults and 35 children) underwent revision cochlear implant surgery for device failure or upgrade. Findings at initial and repeat operations were noted, including number of electrodes inserted, and speech perception performance data were obtained when available.

RESULTS

Five complications occurred in the reinsertion operations, 2 (6%) intraoperative cerebral spinal fluid leaks and 3 (7%) postoperative flap break‐downs with implant extrusion. Number of electrodes inserted was unchanged in 40/43 patients. Speech perception abilities remained stable or improved.

CONCLUSION

Cochlear reimplantation is technically feasible and allows for continued auditory stimulation.

SIGNIFICANCE

Patients facing reimplantation must be aware of the possibility of differences in sound quality and speech recognition performance with their replacement device, but speech perception ability will typically remain the same or improve.
Harmonic Scalpel versus Cold Knife Dissection in Superficial Parotidectomy
Authors: Blankenship D. Russ , Gourin Christine G. , Porubsky Edward A. , Porubsky Edward S. , Klippert Frederick N. , Whitaker Elizabeth G. , Terris David J.
Published: October 2004

OBJECTIVES

Use of the Harmonic Scalpel has recently been described in thyroid surgery, in which it appears to result in decreased operative time and blood loss without increasing the incidence of nerve injury when compared to conventional techniques of vessel ligation and tissue division. We sought to determine whether the use of the Harmonic Scalpel in superficial parotidectomy was associated with a difference in operative time, blood loss, or facial nerve injury compared with conventional techniques.

STUDY DESIGN AND SETTING

The medical records of all patients who underwent superficial parotidectomy for benign parotid pathology at the Medical College of Georgia and Veterans Affairs Hospital of Augusta, Georgia, from 1999 to 2002 were retrospectively reviewed. Patients were excluded if they had a history of a bleeding disorder, prior facial nerve weakness, prior parotid surgery, malignant pathology, or required total parotidectomy.

RESULTS

Forty‐two patients were eligible for inclusion. Nineteen patients underwent Harmonic Scalpel parotidectomy (HS) and 21 patients underwent conventional parotidectomy (control group). There were no significant differences between the 2 groups with respect to demographic data, pathology, or tumor size. Use of the Harmonic Scalpel was associated with a significant reduction in length of surgery (167.5 ± 42.6 min vs. 195.5 ± 37.4 min for controls, P = 0.03) and intraoperative blood loss (37.5 ± 25.8 mL vs. 60.0 ± 37.1 mL for controls, P = 0.03). There were no significant differences between the HS or control groups with respect to postoperative drain output (48.7 ± 33.8 mL vs. 48.0 ± 22.9 mL, respectively, P > 0.05) or facial nerve function.

CONCLUSION

Use of the Harmonic Scalpel for superficial parotidectomy is safe and may result in reduced operative time and blood loss compared with conventional techniques.

SIGNIFICANCE

A safe alternative to cold knife superficial parotidectomy is presented with the potential benefits of reduced operative time and blood loss demonstrated.