bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinetically dominated FR II radio sources
Authors: Punsly Brian
Published: October 2006

The existence of Fanaroff–Riley class II objects that are kinetically dominated, the jet kinetic luminosity, Q, is larger than the total thermal luminosity (infrared to X-ray) of the accretion flow, Lbol, is of profound theoretical interest. Such objects are not expected in most theoretical models of the central engine of radio-loud active galactic nuclei. Thus, establishing such a class of objects is an important diagnostic for filtering through the myriad of theoretical possibilities. This Letter attempts to establish a class of quasars that have existed in a state of kinetic dominance, R(t) ≡Q(t)/Lbol(t) > 1, at some epoch, t. It is argued that the 10 quasars in this article with a long-term time-average , that exceeds LEdd are likely to have satisfied the condition R(t) > 1 either presently or in the past based on the rarity of Lbol > LEdd quasars. Finally, the existence of these sources is discussed in the context of the theory of the central engine.
Time Course of Changes in Nail Fold Microcirculation Induced by Acupuncture Stimulation at the Waiguan Acupoints
Authors: Hsieh Ching-Liang , Chang Yung-Ming , Tang Nou-Ying , Lin I-hsin , Liu Chung-Hsiang , Lin Jaung-Geng , Jin Rui
Published: October 2006

Acupuncture has been used widely to treat disease; however, the time course for acupuncture to have an effect remains unclear. Therefore, the aim of the present study was to investigate the time course of changes in nail fold microcirculation (NFM) induced by acupuncture stimulation (AS) at the right and left Waiguan acupoints (WAs). A total of 38 healthy female volunteers, age range from 21 to 33, were studied. We recorded NFM of the right middle finger before, and 5 min, 10 min, 15 min and 20 min after initiating AS; NFM was also recorded 5 min and 10 min after secessions of AS. Nitric oxide (NO) and endothelin-1 levels were measured from the left cubital vein, before AS and 10 min after stopping AS. The results indicated that capillary density of NFM increased 5 min after AS at the right Waiguan acupoint (WA); however, similar changes were not noted at the left WA. The capillary density decreased beginning 15 min after AS at the right and left WA. Capillary red blood cell velocity increased 5 min and 10 min after AS at the right and left WAs, but decreased 5 min and 10 min after stopping AS at the left WA. NO and endothein-1 levels were similar before AS and 10 min after stopping AS. Therefore, we suggest that a segmental effect of the spinal nerve contributes to the increasing capillary density of NFM induced by AS. The effect of acupuncture on NFM lasts about 10–15 min. The changes of balance between the sympathetic nerve activities and parasympathetic nerve activities may be induced by AS.
Ginger Significantly Decreased the Oral Bioavailability of Cyclosporine in Rats
Authors: Chiang Hsiu-Mei , Chao Pei-Dawn Lee , Hsiu Su-Lan , Wen Kuo-Ching , Tsai Shang-Yuan , Hou Yu-Chi
Published: October 2006

Ginger (roots of Zingiber officinale ROSCOE) is a popular spice and herbal medicine worldwide. Cyclosporine is clinically used as an important immunosupressant with narrow therapeutic index. This study attempted to investigate the effect of ginger juice on the pharmacokinetics of cyclosporine in rats. Rats were orally administered cyclosporine alone and in combination with ginger juice (5 ml/kg) concomitantly, as well as 2 hours after the ginger juice, respectively, in crossover designs. In addition, rats were intravenously administered cyclosporine with and without an oral dose of ginger juice (5 ml/kg). The blood samples were withdrawn via cardiopuncture at determined time points and cyclosporine concentrations were determined by a specific monoclonal fluorescence polarization immunoassay. The pharmacokinetic parameters of cyclosporine were calculated using a non-compartment model of WINNONLIN. The results indicated that concomitant intake of ginger significantly decreased Cmaxand AUC0–tof oral cyclosporine by 70.9% and 63.1%, respectively. The intake of ginger 2 hours before cyclosporine significantly decreased Cmaxand AUC0–tby 51.4% and 40.3%, respectively. In contrast, the pharmacokinetics of intravenous cyclosporine not altered by orally in combination with ginger juice. In conclusion, ginger significantly decreased the oral bioavailability of cyclosporine, and the interaction should occur at the absorption phase. Patients treated with cyclosporine should be discouraged from using ginger products to ensure the efficacy of cyclosporine.
Mechanisms of Pseudolaric Acid B-Induced Apoptosis in Bel-7402 Cell Lines
Authors: Wu Wan-Ying , Guo Hong-Zhu , Qu Gui-Qin , Han Jian , Guo De-An
Published: October 2006

Previous studies have shown that pseudolaric acid B (PB) would cause apoptosis in human tumor cell lines. However, the mechanisms of PB induced apoptosis are still unclear. In the present study, the mechanisms of PB induced apoptosis in the human hepatocellular carcinoma Bel-7402 cell line were investigated by measuring cell viability, rate of apoptosis, cell cycle, detecting DNA fragmentation, and measuring caspase-3 activation. The results indicated that PB inhibited Bel-7402 cell viability and induced cell death by causing DNA fragmentation, up regulating the early and late apoptotic rates, activating caspase-3 protein, and detaining the cell cycle in the G2/M phases. Additionally, PB-induced apoptosis was a dose- and time-dependent manner. These observations suggest that PB-induced apoptosis occurs through a caspase-dependent pathway and detains the cell cycle in the G2/M phase.
TREATING DEEP-SEATEDMYCOBACTERIUM MARINUMINFECTION IN THE HAND: A REPORT OF THREE CASES
Authors: Rajesh Garg , Ip Wing-Yuk , Chow S. P. , Fung Boris Kwok-Keung
Published: October 2006

We report three cases of an unusual aggressive type of Mycobacterium marinum infection of the hand which had been a nightmare both for us and the patient. These were the patients in which even after repeated thorough surgical debridement and appropriate (drug sensitive) medical treatment over a period had resulted in amputation or devastation of the soft tissues so extensively that almost only the neurovascular bundle, bone and the skin were the only structures left (cosmetic fingers — no function) at the last debridement after which the infection has not recurred. By presenting this article we want to stress on certain points pertaining to diagnosis, management, varied presentation and of course the dreadful complications of deep-seated M. marinum infection.
Profiling Change
Authors: Ford Matthew W. , Greer Bertie M.
Published: October 2006

Profile analysis is proposed as a means for advancing empirical change process research. In the context of organizational studies, a profile can be viewed as a set of sequentially arranged factors that expresses the relative strength of individual factors and holistic patterns inside or between organizational entities. To demonstrate the utility of the approach in change process research, profile analysis was employed in a cross-sectional study. Hypotheses related to Lewin’s three-step model of change were tested using data obtained from managers involved in change implementation. Results confirmed a progression through Lewin’s unfreezing-movement-refreezing sequence during implementation. Profiles that reflected higher systematic use of change process factors were also found related to implementation success. Many future research opportunities are apparent, such as investigating interorganizational change profile types and using profile analysis to enhance longitudinal research designs.
Exploring the Efficacy of the Cook School District Simulation
Authors: Girod Mark , Girod Gerald
Published: October 2006

Cook School District is a Web-based simulation designed to allow teacher candidates an opportunity to explore connections between their actions as teachers and the learning and engagement of simulated students. The simulation provides a setting in which to practice the processes inherent in teacher work sample methodology (TWSM). The outcomes of TWSM include analyzing the context in which teaching and learning will occur; identifying outcomes to be learned; designing and administering a pretest to evaluate prior knowledge; designing and delivering instruction, differentiating curriculum, instruction, and/or assessment as appropriate; and postassessing student learning to determine the “value added” or teacher effects on learning and engagement. Quasi-experimental research demonstrates the efficacy of the simulation to (a) improve scores on a real teacher work sample, (b) improve field-based lesson teaching performance, and (c) affect users’ perceptions of their skillfulness and valuing of concepts underlying teacher work sample methodology.
The Political Paradox of Finance Capitalism: Interests, Preferences, and Center-Left Party Politics in Corporate Governance Reform
Authors: Cioffi John W. , Höpner Martin
Published: October 2006

A striking paradox underlies corporate governance reform during the past fifteen years: center-left political parties have pushed for pro-shareholder corporate governance reforms, while the historically pro-business right has generally resisted them to protect established forms of organized capitalism, concentrated corporate stock ownership, and managerialism. Case studies of Germany, France, Italy, and the United States reveal that center-left parties used corporate governance reform to attack the legitimacy of existing political economic elites, present themselves as pro-growth and pro-modernization, strike political alliances with segments of the financial sector, and appeal to middle-class voters. Conservative parties’ established alliances with managers constrained them from endorsing corporate governance reform.
General Strategy Concepts and the Ecology of Strategy Discourses: A Systemic-Discursive Perspective
Authors: Seidl David
Published: October 2006

Drawing on Wittgenstein, Lyotard and Luhmann the article develops a systemic-discursive perspective on the field of strategy and the respective role of general strategy concepts. The perspective suggests that the field of strategy should not be conceptualized as a unified field but rather as fragmented into a multitude of autonomous discourses. Owing to their autonomy, no transfer of strategy concepts across different discourses is possible. Instead, every single strategy discourse can merely construct its own discourse-specific concepts. Different discourses, however, draw on the same strategy labels, which leads to ‘productive misunderstandings’ (Teubner). On the basis of the particular perspective advanced here, the entire field of strategy is re-described as an ecology of strategy discourses.
Effect of Electrical Uncertainties on Resonant Piezoelectric Shunting
Authors: Andreaus U. , Porfiri M.
Published: October 2006

Resonant piezoelectric shunting is one of the most studied techniques for damping structural vibrations by using piezoelectric transducers in conjunction with passive electric networks. It is based on establishing an internal resonance between a mechanical system and an electrical circuit, which is comprised of a shunting impedance and the piezoelectric inherent capacitance. The problem of analyzing the effect of variations of the electrical impedance with respect to its optimal choice is investigated here. Simple closed-form formulas for quantifying the performance loss due to deterministic variations of the electrical elements are derived, and they are validated through numerical tests. The effect of stochastic perturbations is also considered, manageable formulas are provided, and validated by Monte Carlo simulations. The analyses focus on forced vibrations, and the arising H∞ optimization problem is solved by making use of fundamental properties of the system transfer function.
What Links the Chain: An Essay on Organizational Remembering as Practice
Authors: Feldman Regina M. , Feldman Steven P.
Published: October 2006

In this essay, we review, critique, and reconceptualize organization theory’s understanding of organizational memory. We find that organization theorists have underestimated the historicity of memory, its associative character, and social-psychological constitution. The critical impetus of the literature review translates in the body of the paper into an alternative perspective that posits organizational remembering as a collective, historically and culturally situated practice rather than as an object of cognition. Remembering is considered crucial to maintaining a sense of continuity and shared identity in organizations by actively constructing meaning. Our conceptualization of remembering focuses on the ‘softer’ qualities of the process such as culture, tradition, the person, emotion, and forgetting that traditionally were neglected or oversimplified in organization studies. Finally, we explore how a critical approach to the study of organizational remembering gives voice to socially contested issues such as power, morality, and reflexivity.
Protecting the environment: the role of environmental management systems
Authors: Watson Michael
Published: October 2006

Environmental management and auditing systems are increasingly important. They have significant roles to play in relation to environmental protection, workplace safety and public health. Businesses and non-commercial organisations adopt such systems for a variety of reasons. The extent to which they are used varies very considerably between developed countries. The effectiveness of national regulatory systems seems to be a major factor. In the United Kingdom environmental regulators have traditionally sought the voluntary compliance of businesses. This strategy is closely associated with the near absence of administrative penalties. It seems that a wide range of environmental administrative penalties will be introduced in the near future. This may greatly encourage more firms to introduce environmental management and auditing systems.
What is a Citation?
Authors: Sitze Adam
Published: October 2006

Philippe Nonet's “Antigone's Law” raises interesting questions for the philosophy of law. Nonet's text points to three problematics in particular: the relation of the unsayable to the unspeakable, the relation of law to its citations, and the relation of autonomy to heteronomy.
Who Designed the Westphalian System? Probing the Epistemology of the Westphalian Debates: “Moses was but a juggler and King James the new Solomon”
Authors: Harding Christopher , Harding Nicola
Published: October 2006

In the history of international law and relations, ‘Westphalian system’ is commonly used as shorthand to describe the ‘modern’ paradigm of international relations based on a system of exclusive authority vested in sovereign State actors, and evidenced in the Peace of Westphalia in 1648. The discussion here probes the way in which such ideas about governance took root and consolidated into a consensus among political leaders across seventeenth century Europe. What were the means of intellectual exchange and political discourse which facilitated the Westphalian sea-change? This study considers some media which may have been exploited in a significant way in early modern European society for the dissemination of argument and ideas about governance. Two major forms are of particular interest in this context: visual art, with its rich iconographical content; and various kinds of dramatic presentation capable of communicating with both elite and popular audiences.
Differential regulation of the zebrafish orthopedia1 gene during fate determination of diencephalic neurons
Authors: Del Giacco Luca , Sordino Paolo , Pistocchi Anna , Andreakis Nikos , Tarallo Raffaella , Di Benedetto Barbara , Cotelli Franco
Published: October 2006

Background

The homeodomain transcription factor Orthopedia (Otp) is essential in restricting the fate of multiple classes of secreting neurons in the neuroendocrine hypothalamus of vertebrates. However, there is little information on the intercellular factors that regulate Otp expression during development.

Results

Here, we identified two otp orthologues in zebrafish (otp1 and otp2) and explored otp1 in the context of the morphogenetic pathways that specify neuroectodermal regions. During forebrain development, otp1 is expressed in anterior groups of diencephalic cells, positioned in the preoptic area (PO) (anterior alar plate) and the posterior tuberculum (PT) (posterior basal plate). The latter structure is characterized by Tyrosine Hydroxylase (TH)-positive cells, suggesting a role for otp1 in the lineage restriction of catecholaminergic (CA) neurons. Disruptions of Hedgehog (HH) and Fibroblast Growth Factor (FGF) pathways point to the ability of SHH protein to trigger otp1 expression in PO presumptive neuroblasts, with the attenuating effect of Dzip1 and FGF8. In addition, our data disclose otp1 as a determinant of CA neurons in the PT, where otp1 activity is strictly dependent on Nodal signaling and it is not responsive to SHH and FGF.

Conclusion

In this study, we pinpoint the evolutionary importance of otp1 transcription factor in cell states of the diencephalon anlage and early neuronal progenitors. Furthermore, our data indicate that morphogenetic mechanisms differentially regulate otp1 expression in alar and basal plates.
Gene expression in TGFbeta-induced epithelial cell differentiation in a three-dimensional intestinal epithelial cell differentiation model
Authors: Juuti-Uusitalo Kati M , Kaukinen Katri , Mäki Markku , Tuimala Jarno , Kainulainen Heikki
Published: October 2006

Background

The TGFβ1-induced signal transduction processes involved in growth and differentiation are only partly known. The three-dimensional epithelial differentiation model, in which T84 epithelial cells are induced to differentiate either with TGFβ1 or IMR-90 mesenchymal cell-secreted soluble factors, is previously shown to model epithelial cell differentiation seen in intestine. That model has not been used for large scale gene expression studies, such as microarray method. Therefore the gene expression changes were studied in undifferentiated and differentiated three-dimensional T84 cultures with cDNA microarray method in order to study the molecular changes and find new players in epithelial cell differentiation.

Results

The expression of 372 genes out of 5188 arrayed sequences was significantly altered, and 47 of them were altered by both mediators. The data were validated and the altered genes are presented in ontology classes. For the genes tested the expressions in protein level were in accordance with the mRNA results. We also found 194 genes with no known function to be potentially important in epithelial cell differentiation. The mRNA expression changes induced by TGFβ1 were bigger than changes induced by soluble factors secreted by IMR-90 mesenchymal cells. The gene expression data was depicted in already known signaling pathway routes.

Conclusion

Our results reveal potential new signaling pathways and several new genes affected by TGFβ in epithelial cell differentiation. The differentiation induced by TGFβ1 appears to be more potent than the differentiation induced by mesenchymal cells. This study indicates that our cell culture model is a suitable tool in studying regulatory mechanisms during epithelial cell differentiation in intestine. Furthermore the present results indicate that our model is a good tool for finding new players acting in the differentiation of epithelial cells.
Uncertainty, regulation and psychiatry
Authors: Subotsky Fiona
Published: October 2006

There is much uncertainty in psychiatry, particularly because of conflicting values. Awareness and tolerance of ambiguity are necessary for a psychiatrist, but they do not obviate the need for improved regulation, both at the level of the protocol and for overseeing performance. The professional should not to be free from regulation but should be an active participant in developing and improving it.
A new specialty of acute in-patient psychiatry?
Authors: Middleton Hugh
Published: October 2006

Luiz Dratcu makes a case for a new specialty of acute inpatient psychiatry; Frank Holloway argues otherwise. In neither instance are the arguments at all surprising, and in both they are eloquently expressed. The case for a new specialty is based upon recognition of a continuing need for acute psychiatric in-patient services, and recognition that these services require particular skills and facilities which are likely to be most efficiently and effectively provided when interests and activities are focused upon them. The case against does not deny the need for attention to widely acknowledged shortcomings of many acute psychiatric in-patient services, but it does ask the questions ‘what should constitute a specialty?’ and ‘what benefit would flow from having a specialty and for whom?’
Copying letters to families: attitudes and experiences of child and adolescent psychiatrists
Authors: Combe Gillian , Short Clare , Stephens Helen
Published: October 2006

Aims and Method

A national survey of consultants in child and adolescent psychiatry was conducted to explore their attitudes to copying correspondence to patients and their families and the impact of recent national guidelines on practice.

Results

Of the 290 respondents, 261 (90%) agreed in principle with copying letters to patients but only two-thirds (n=186) were routinely doing so. Nearly half (n=139, 48%) had changed their practice as a consequence of the guidelines. The majority (n=160, 55%) felt that the guidelines lacked clarity with regard to the complexities of child psychiatry and a third (n=93, 32%) had experienced difficulties when copying letters to patients.

Clinical Implications

This survey highlights some of the benefits and risks involved in child and adolescent psychiatry when letters are routinely shared with families. Increased openness and transparency can enhance the therapeutic relationship; however, given the complexities and sensitivities implicit in child psychiatry, there is a risk of jeopardising engagement and alienating the family.
The use of literary analysis in advanced communication
Authors: Wallang Paul
Published: October 2006

Narrative medicine is a well established academic field and has been shown to increase clinical skill and improve the therapeutic relationship of those who study its principles (Banks et al, 1995; Jones, 1999). Literary analysis is a convenient means of fostering advanced communication skills. Moreover, the skills gained from such an education are highly applicable to everyday psychiatric practice. The evidence for the efficacy of narrative medicine is well established, and on this basis a strong argument can be made for its inclusion as a compulsory part of the current MRCPsych course.
Residual carcinoma of the larynx
Authors: Brandenburg James H. , Rutter Stephen W.
Published: October 2006

Two hundred forty‐nine patients with squamous cell carcinoma seen and treated at University of Wisconsin Hospitals from 1960‐1972 were analyzed as to recurrence rates, with emphasis on specific sites of recurrence, salvage rates, and end results. Each case was carefully staged according to the TNM classification as set forth by the American Joint Committee for Cancer Staging and End Results Reporting (Revised, 1972).

Of the cases treated initially with radiation, 58 percent developed recurrences in the larynx, and 5 percent developed surgical lymph node me‐tastases. Of the cases treated initially by surgery, 13 percent demonstrated local recurrences and 15 percent cervical lymph node metastases. Twenty‐six of 86 initial therapy failures were salvaged with further treatment, giving a salvage rate of only 29 percent. The overall recurrence free rates, including cases salvaged, were Tl, 91 percent; T2, 86 percent; T3, 68 percent; and T4, 44 percent.
Histiocytosis X of the ear and temporal bone: Review of 22 cases
Authors: Mccaffrey Thomas V. , Mcdonald Thomas J.
Published: October 2006

Histiocytosis X encompasses three syndromes characterized by the idiopathic proliferation of histiocytes: eosinophilic granuloma, Hand‐Schuller‐Christian syndrome, and Letterer‐Siwe disease. At the Mayo Clinic between 1926 and 1978, 22 patients with histiocytosis X had involvement of the ear or temporal bone. These patients comprised 15% of all patients with histiocytosis X seen during that period. The ages at onset of the disease ranged from 2 months to 49 years. The most frequent otologic symptom was aural discharge (15 patients), followed in frequency by swelling in the temporal region (11 patients), vertigo (6 patients), and deafness (5 patients). Clinical findings included otitis media (13 patients), otitis externa with or without granulation tissue (10 patients), and osteolytic lesions of the temporal bone (9 patients). A high index of suspicion is required to recognize the otologic manifestations of histiocytosis X for two reasons: the systemic manifestations of the disease are often so dramatic that the ear findings are overlooked, and the otologic findings of histiocytosis X can mimic more common diseases, including simple otitis externa, aural polyps, acute mastoiditis, chronic otitis media, and metastatic lesions.
Extramastoid cholesteatoma in chronic ear disease: A report of two cases
Authors: Luetje Charles M.
Published: October 2006

Two patients who had undergone radical mastoid surgery developed an isolated focus of cholesteatoma embedded in the sternomastoid muscle just below the mastoid tip. In one instance the etiology was felt to be iatrogenic implantation of squamous epithelium. In the second, unrecognized extension from the mastoid tip probably occurred.

The purpose of this paper is to describe and discuss in detail the clinical and pathological features of these two cases.
Tonsillectomy and adenoidectomy in the one and two‐year‐old child
Authors: Helmus Christian
Published: October 2006

In an effort to substantiate the efficacy of adenotonsillectomy in very young children, 108 procedures in one and two‐year‐old children were reviewed. After rigid preoperative criteria are met, a meticulous, conservative adenotonsillectomy is performed. A review of all hospital and office records shows the procedure can be safely and simply performed without significant complications. Seventy‐nine parents were questioned regarding postoperative problems and results. Of the parents, 96% were satisfied and would have the procedure done again if they had the chance. Eighty‐four referring physicians were polled and 87% thought the procedure solved the children's problem altogether or mostly. In conclusion, the results of this study show that, in carefully selected young children using expert anesthesia and atraumatic surgical technique, adenotonsillectomy under the age of three is a safe and gratifying procedure.
Heterotopic salivary tissue in the neck
Authors: Singer Mark I. , Applebaum Edward L. , Loy Kyle D.
Published: October 2006

Six cases of heterotopic salivary gland tissue in the anterolateral neck are presented with a review of their clinical and histopathologic characteristics. Neoplastic transformation, fistulization, and isolated rests represent a spectrum of these uncommon lesions. The embryologic derivation of salivary tissue and close association with the branchial apparatus are discussed. The significance of salivary carcinoma presenting in the neck is reinterpreted in light of the embryogenesis of these heterotopias.
Pharyngoceles of the hypopharynx
Authors: Norris Charles W.
Published: October 2006

The differential diagnosis of the complaint of dysphagia is extensive; however, a search of the literature gives the impression that pharyngocele as a cause of dysphagia is relatively infrequent, since only 18 well‐documented cases have been reported. On the other hand, the author's experience reveals that pharyngocele occurs more commonly than indicated in the literature as, over the past 2 years, 24 patients with pharyngocele have been personally observed.

This thesis is divided primarily into three sections: 1. a review of the physiology and anatomy involved in the swallowing mechanism; 2. a review of the English literature regarding pharyngocele, and 3. an evaluation of the author's 24 cases, allowing for discussion and conclusions. It is noted that laryngocele is frequently mistaken for pharyngocele; however, it is pointed out that a correctly performed barium swallow roentgenogram differentiates one from the other. Symptoms of laryngocele, Zenker's diverticulum and pharyngocele can be quite similar. Frequently, pharyngocele can be demonstratd by the Valsalva maneuver.

Surgical repair is indicated when the symptoms are severe. Standard pharyngeal mucous membrane closure similar to the procedure utilized in the repair of Zenker's diverticulum should result in resolution of the problem.
Mechanisms of synkinesis
Authors: Crumley Roger L.
Published: October 2006

When the facial nerve is injured, changes occur in muscle, proximal nerve, distal nerve, and the cell body in the nucleus. All of these changes contribute to the quality of regeneration and repair. This paper describes the usual processes of neuronal regeneration with the objective of a better understanding of why some injuries inevitably result in poor return of motion and synkinesis, while others recover completely.

The possible mechanisms of synkinesis include: imperfect regeneration due to axonal misdirection, demyelination, microglial scarring in the facial nucleus, neuron depopulation, multiple axon sprouting, and misdirection of regenerating axons via vertical anastomotic filaments.
Facial paralysis of neoplastic origin: Diagnosis and management
Authors: Jackson C. Gary , Glasscock Michael E. , Hughes Gordon , Sismanis Aristides
Published: October 2006

The individual with a progressive (weeks to months) facial weakness should be considered to have a tumor involving the facial nerve until proved otherwise.

All individuals experiencing a facial paralysis must undergo a thorough neurotologic evaluation to establish the etiology. Bell's palsy is a diagnosis by exclusion. While computerized axial tomography (CAT) scans, polytomography and arteriograms are extremely helpful, these studies very often fail to demonstrate intrinsic tumors involving the facial nerve. For this reason all individuals experiencing a progressive facial paralysis should have an exploration of their facial nerve from the internal auditory canal (IAC) through the stylomastoid foramen into the parotid gland.

The purpose of this paper is to present a series of cases of facial paralysis having as their etiology intrinsic or extrinsic neoplasms. Clinical patterns are established, diagnostic protocols formulated and the results of surgical management reviewed.
Subepithelial space in otitis media.
Authors: Paparella Michae L. , Sipila Pekka , Juhn S. K. , Jung Timothy T. K.
Published: October 2006

The role of the subepithelial space (SES) has not received sufficient attention in assessing pathogenesis, pathology, and, therefore, clinical diagnosis and treatment of the various forms of otitis media (OM). Temporal bones from patients with OM were classified as cases of acute purulent (POM), serous (SOM), mucoid or secretory (MOM), or chronic otitis media (COM). Controlled morphometric studies were made of cellular components of the SES, along with studies of the epithelium and middle car space. Corollary studies of biochemistry, cellular components, and prostaglandins (PGs) were done on fluid from the human middle ear. Middle ear effusions (MEE) from animal models of SOM, MOM, and POM were analyzed biochemically. Findings are surprising in that the SES was more actively involved in all forms of OM than had been thought, especially in MOM and COM. Implications are discussed.
The masticator space: The influence of ct scanning on therapy
Authors: Doxey G. Paul , Harnsberger H. Ric , Hardin Carl W. , Davis R. Kim
Published: October 2006

The masticator space is an important suprahyoid tissue compartment bounded by the superficial layer of the deep cervical fascia, enclosing the ramus of the mandible plus the masseteric and pterygoid muscles. Pathology of this space has been clinically difficult to diagnose and treat.

Twenty‐five patients with either tumor or infection involving the masticator space who underwent CT scanning were evaluated retrospectively. Ten patients had infection and 15 had tumor.

CT was influential in directing appropriate biopsies or therapy in 24 of 25 patients. It misguided therapy once. The gross anatomic and CT appearance of the normal and the diseased masticator space is described along with pictures of representative cases. A discussion is given of the advantages, disadvantages, and pitfalls of computerized tomography of the masticator space.
Predictive value of müuller maneuver in selection of patients for uvulopalatopharyngoplasty
Authors: Sher Aaron E. , Thorpy Michael J. , Spielman Arthur J. , Shprintzen Robert J. , Burack Bernard , Mcgregor Peter A.
Published: October 2006

Uvulopalatopharyngoplasty (UPPP) is an effective treatment for some patients with obstructive sleep apnea syndrome (OSAS). A major difficulty has been to select those patients who will have a good response to UPPP.

Fiberoptic nasopharyngoscopy with Müller Maneuver (FNMM) was applied in preoperative evaluation of patients with OSAS to identify those in whom greatest pharyngeal collapse was in the region of the tonsillar fossae and soft palate. Those with pharyngeal changes on FNMM who were considered most likely to respond to surgery underwent UPPP.

Comparison of pre and postoperative polysomnography reveals significant (p<.001) improvement in indices of severity of OSAS. The mean apnea index (apneas per hour) was diminished by 72%. Eighty‐seven percent of patients had greater than 50% reduction in apnea index.

Preoperative selection of OSAS patients by FNMM increases the likelihood of success of UPPP.
Delayed vertigo and profound sensorineural hearing loss
Authors: Lambert Paul R.
Published: October 2006

Episodic vertigo, similar to that of Meniere's disease, can occasionally develop years to decades after an ear has suffered a profound sensorineural hearing loss. Although the pathogenesis of this process is unknown, it is theorized that delayed endolymphatic hydrops develops. An inflammatory reaction could cause obstruction of the endolymphatic duct or interfere with venous drainage from the region of the endolymphatic sac, leading to hydrops. This condition is reviewed, and two adult patients with severe episodic vertigo and a unilateral profound sensorineural hearing loss which occurred in childhood are presented. Their evaluation and management are discussed.
Frequency selectivity in patients with acoustic neuroma
Authors: Papsin Blake C. , Abel Sharon M. , Nedzelski Julian M.
Published: October 2006

Frequency selectivity was compared in subjects with hearing loss due to acoustic neuroma and cochlear pathology, and normal listeners. A particular interest was the role of probe tone parameters on the shape of the tuning curve. Psychophysical tuning curves (PTCs) were measured for each of two equal energy 2000‐Hz probe tones (10 dB SL/300 msec and 17 dB SL/60 msec), using simultaneous 1/3‐octave narrowband noise maskers centered at 1, 1.25, 1.6, 2.5, 3.15, and 4 kHz. The results showed that the critical masker levels obtained for impaired listeners were significantly greater than those from normal subjects. The slope of the low‐frequency limb of the PTC was steeper for normal compared to hearing‐impaired listeners but there was no difference due to site of lesion. In all three groups, the critical masker levels obtained with the short probe were significantly greater than those for the long probe, negating the hypothesis that equal energy probes would yield the same outcomes. Tuning in listeners with hearing loss was highly correlated with audiometric threshold but not with tumor size, width of the internal auditory canal, or tumor location within the cerebellopontine angle. The main conclusion was that cochlear and retrocochlear hearing loss are similar with respect to their effect on frequency selectivity.
The natural history of untreated acoustic neuromas
Authors: Strasnick Barry , Glasscock Michael E. , Haynes David , Mcmenomey Sean O. , Minor Lloyd B.
Published: October 2006

The emergence of magnetic resonance imaging with gadolinium has dramatically enhanced our ability to accurately detect the presence of acoustic tumors as small as 2 mm in diameter. Early diagnosis and improved surgical techniques continue to reduce the morbidity associated with surgical removal of these lesions. There exists, however, a select group of patients in whom no treatment may be the most appropriate management. Since 1979, a total of 51 patients with radiographic evidence of an acoustic neuroma have been prospectively followed for tumor growth and progression of symptoms. Patients were chosen for this conservative approach on the basis of age, medical condition, tumor size, audiometric data, and patient preference. This study reveals that a significant number of patients with acoustic tumors can be safely followed with regular imaging studies and may never require treatment. Discussed are tumor growth rates, epidemiology, and the impact of these factors on patient management.
Otoacoustic emissions: An approach for monitoring aminoglycoside‐induced ototoxicity
Authors: Hotz M. A. , Harris Frances P. , Probst R.
Published: October 2006

Ototoxic drugs, such as aminoglycosides, affect outer hair cell integrity in the inner ear. Transiently evoked otoacoustic emission (TEOAE) characteristics are related to outer hair cell function and can be expected to reflect the influence of ototoxic agents. Transiently evoked otoacoustic emissions were measured during amikacin sulfate therapy in nine patients. The duration of treatment for individual patients ranged from 9 to 33 days. A reversible decrease of overall TEOAE level, occurring after a treatment period longer than 16 days, was found in the majority of patients. The monitoring of TEOAEs is proposed as a method for early identification and, as a result, prevention of aminoglycoside‐induced ototoxicity.
Activation and coordination patterns of the suprahyoid muscles during swallowing
Authors: Spiro Jeffrey , Rendell Jill K. , Gay Thomas
Published: October 2006

This study was undertaken to determine the activation and coordination patterns of the three suprahyoid muscles—geniohyoid, mylohyoid, and anterior belly of the digastric muscle—in elevating the larynx during swallowing. Electromyographic activity was also recorded from two intrinsic laryngeal muscles (vocalis and lateral cricoarytenoid) and the anterior genioglossus. Ten adults served as participants. Each participant produced 15 swallows of 15 mL of tap water both normally and with a 12‐mm bite block placed between the molars. The electromyographic data were ensemble‐averaged with a laboratory computer. Analyses showed that the three suprahyoid muscles were used selectively by different participants. Some participants used all three muscles for hyoid elevation, while others used different pairs of two of the muscles. The activation patterns of the suprahyoid muscles during swallowing also varied with respect to each other and the onset of the laryngeal constrictor muscles; however, use of at least one suprahyoid muscle always preceded the onset of the laryngeal adductors, indicating that larynx elevation consistently preceded glottal adduction. The way in which the muscles responded to the bite block varied considerably both within and among participants. Some maintained temporal stability but increased overall muscle activity; others reorganized temporal relations either with or without corresponding muscle activity adjustments. These findings suggest that the laryngeal elevation system is an adaptive function rather than an immutable action.
Influence of Socioeconomic Status on Childhood Acute Lymphoblastic Leukemia Treatment in Indonesia
Authors: Mostert Saskia , Sitaresmi Mei N. , Gundy Chad M. , Sutaryo  , Veerman Anjo J. P.
Published: October 2006

OBJECTIVE. A major reason for poor survival of childhood acute lymphoblastic leukemia in developing countries is treatment refusal or abandonment. This can be associated with parental socioeconomic status and attitudes of health care providers. Our study examined the influence of 2 socioeconomic status determinants, parental income and education, on treatment in an Indonesian academic hospital.

METHODS. Medical charts of 164 patients who received a diagnosis of acute lymphoblastic leukemia between 1997 and 2002 were abstracted retrospectively. Data on treatment results and parental financial and educational background were collected. Open interviews were conducted with parents and health care providers.

RESULTS. Of all patients, 35% refused or abandoned treatment, 23% experienced treatment-related death, 22% had progressive or relapsed leukemia, and 20% had an overall event-free survival. Treatment results differed significantly between patients with different socioeconomic status; 47% of poor and 2% of prosperous patients refused or abandoned treatment. Although poor and prosperous patients used the same protocol, the provided treatment differed. Poor patients received less individualized attention from oncologists and less structured parental education. Strong social hierarchical structures hindered communication with doctors, resulting in a lack of parental understanding of the necessity to continue treatment. Most poor patients could not afford treatment. Access to donated chemotherapy also was inadequate. Treatment refusal or abandonment frequently resulted. There was no follow-up system to detect and contact dropouts. Health care providers were not fully aware that their own attitude and communication skills were important for ensuring compliance of patients and parents.

CONCLUSIONS. Children's survival of acute lymphoblastic leukemia in developing countries could improve if problems that are associated with parental financial and educational background and medical teams' attitudes to treatment and follow-up could be addressed better.
Elevated Serum Interleukin‐6 (IL‐6) in Solid‐Organ Transplant Recipients Is Positively Associated With Tissue Destruction and IL‐6 Gene Expression in the Periodontium
Authors: Ioannidou Effie , Kao David , Chang Nancy , Burleson J. , Dongari‐Bagtzoglou Anna
Published: October 2006

Background:The number of transplanted solid organs and life expectancy after transplantation are steadily rising worldwide. Inflammation is widely recognized as playing a pivotal role in transplant rejection, and several studies have shown that serum interleukin‐6 (IL‐6) levels can identify individuals who are at greater risk for rejection. Given the known association between IL‐6 and chronic periodontitis, the aim of our study was to assess the periodontal status of solid‐organ transplant subjects compared to systemically healthy controls, to quantify the IL‐6 levels in the serum and periodontal tissues, and to explore their association.

Methods:Forty‐seven heart and kidney transplant and 18 systemically healthy age‐matched individuals were recruited. Subjects received a complete periodontal examination, and blood and periodontal tissue samples were collected for quantification of IL‐6 protein and mRNA levels, respectively.

Results:Transplant subjects had significantly higher serum IL‐6 levels and slightly but statistically significantly increased mean probing depths than healthy controls. Multivariable linear regression analysis adjusting for gender, diabetes, smoking, and immunosuppressant dose showed that the mean probing depth, number of missing teeth, and mean percentage of sites with ≥4 mm attachment loss were independent predictors for elevated serum IL‐6 levels. Transplant subjects with chronic periodontitis had higher mean serum IL‐6 levels than those without chronic periodontitis, and there was a positive correlation between periodontal IL‐6 gene expression levels and serum IL‐6 protein levels.

Conclusions:Periodontal tissue destruction and local IL‐6 synthesis are associated with elevated serum IL‐6 levels in transplant recipients. This may have serious implications in solid‐organ transplant deterioration and chronic rejection.
Periodontitis as a Manifestation of Chronic Benign Neutropenia
Authors: Zaromb Allison , Chamberlain Darren , Schoor Robert , Almas Khalid , Blei Francine
Published: October 2006

Background: A subcategory of chronic neutropenia is chronic benign neutropenia, which is characterized by a prolonged non‐cyclic neutropenia as the sole abnormality, with no underlying disease to which the neutropenia can be attributed. Chronic neutropenia is defined as a low absolute neutrophil count for >6 months. In this presentation, periodontitis seems to be the sole manifestation of a juvenile patient with chronic benign neutropenia. A 7‐year‐old white male presented with periodontitis of the primary dentition and early tooth loss. His medical and dental history was otherwise unremarkable. Suspecting some systemic illness as the underlying cause, the patient was referred for a medical consultation and a series of blood tests.

Methods: Blood analyses included a complete blood count (CBC), sequential multiple analyzer 24 (SMA 24), glycated hemoglobin levels, and screening for anti‐white blood cell antibodies. Blood levels of calcium, vitamin D, dihydroxyvitamin‐D, phosphorus, and alkaline phosphatase were also measured. Liver function tests were performed.

Results: Following analysis of recent and previous blood test results, a diagnosis of chronic benign neutropenia was assigned. The patient's periodontal condition was treated with scaling and root planing, oral hygiene instruction, and antimicrobial mouthrinses. Three‐month recall visits were recommended as a follow‐up protocol.

Conclusions: This case represents the importance of diagnosing periodontal disease as a possible indicator of underlying systemic disease. When a patient presents with an unusual, generalized form of periodontal disease, screening for systemic disorders is required, as the oral condition may be the first or only manifestation of a systemic abnormality. This case also illustrates the reason for the change in classification of such a condition to periodontitis as a manifestation of systemic disease. This condition was previously classified as prepubertal periodontitis, a disease diagnosis that focused on the patient's age at the onset of the disease rather than the etiology.