bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of multifactorial idiopathic epilepsy in EL mice with caloric restriction and the ketogenic diet: role of glucose and ketone bodies
Authors: Mantis John G , Centeno Nicole A , Todorova Mariana T , McGowan Richard , Seyfried Thomas N
Published: October 2004

Background

The high fat, low carbohydrate ketogenic diet (KD) was developed as an alternative to fasting for seizure management. While the mechanisms by which fasting and the KD inhibit seizures remain speculative, alterations in brain energy metabolism are likely involved. We previously showed that caloric restriction (CR) inhibits seizure susceptibility by reducing blood glucose in the epileptic EL mouse, a natural model for human multifactorial idiopathic epilepsy. In this study, we compared the antiepileptic and anticonvulsant efficacy of the KD with that of CR in adult EL mice with active epilepsy. EL mice that experienced at least 15 recurrent complex partial seizures were fed either a standard diet unrestricted (SD-UR) or restricted (SD-R), and either a KD unrestricted (KD-UR) or restricted (KD-R). All mice were fasted for 14 hrs prior to diet initiation. A new experimental design was used where each mouse in the diet-restricted groups served as its own control to achieve a 20–23% body weight reduction. Seizure susceptibility, body weights, and the levels of plasma glucose and β-hydroxybutyrate were measured once/week over a nine-week treatment period.

Results

Body weights and blood glucose levels remained high over the testing period in the SD-UR and the KD-UR groups, but were significantly (p < 0.001) reduced in the SD-R and KD-R groups. Plasma β-hydroxybutyrate levels were significantly (p < 0.001) increased in the SD-R and KD-R groups compared to their respective UR groups. Seizure susceptibility remained high in both UR-fed groups throughout the study, but was significantly reduced after three weeks in both R-fed groups.

Conclusions

The results indicate that seizure susceptibility in EL mice is dependent on plasma glucose levels and that seizure control is more associated with the amount than with the origin of dietary calories. Also, CR underlies the antiepileptic and anticonvulsant action of the KD in EL mice. A transition from glucose to ketone bodies for energy is predicted to manage EL epileptic seizures through multiple integrated changes of inhibitory and excitatory neural systems.
Central Infusion of Agouti-Related Peptide Suppresses Pulsatile Luteinizing Hormone Release in the Ovariectomized Rhesus Monkey
Authors: Vulliémoz Nicolas R. , Xiao Ennian , Xia-Zhang Linna , Wardlaw Sharon L. , Ferin Michel
Published: October 2004

Agouti-related peptide (AGRP), an endogenous melanocortin receptor antagonist, is a powerful orexigenic peptide when infused centrally. AGRP and neuropeptide Y (NPY), another orexigenic peptide, are colocated within the same neurons in the arcuate nucleus. Both NPY and AGRP mRNA expression increases during food restriction, a condition that is known to suppress the GnRH pulse generator and reproductive function. Although NPY has been shown previously to suppress LH secretion in the ovariectomized monkey, data on AGRP are lacking. In this study, we examined the effect of AGRP infusion into the third ventricle on pulsatile LH release in five adult monkeys. The 8-h protocol included a 3-h intraventricular saline infusion to establish baseline pulsatile LH release, followed by a 5-h infusion of AGRP (83–132) [5 μg/h (n = 1) or 10 μg/h (n = 4)]. In separate experiments, each animal received an 8-h saline treatment as a control. Blood samples were collected every 15 min for LH measurements. Cortisol levels were measured every 45 min. AGRP infusion significantly decreased LH pulse frequency (from a baseline of 0.74 ± 0.07 pulse/h to 0.36 ± 0.12 during AGRP infusion; P < 0.01) and mean LH concentrations (to 41.1 ± 7.5% of baseline by h 5 of AGRP infusion; P < 0.001). LH pulse amplitude was not modified by AGRP treatment. AGRP infusion also significantly increased cortisol release, as previously reported. The data demonstrate that central administration of AGRP inhibits pulsatile LH release in the monkey and suggest that AGRP, like NPY, may mediate the effect of a negative energy balance on the reproductive system by suppressing the GnRH pulse generator.
Global Gene Expression Analysis of Estrogen Receptor Transcription Factor Cross Talk in Breast Cancer: Identification of Estrogen-Induced/Activator Protein-1-Dependent Genes
Authors: DeNardo David G. , Kim Hee-Tae , Hilsenbeck Susan , Cuba Valerie , Tsimelzon Anna , Brown Powel H.
Published: October 2004

There is a growing body of literature supporting estrogen’s ability to affect gene expression through a nonclassical pathway, in which estrogen receptor (ER) modulates the activity of other transcription factors such as activator protein (AP)-1, specificity protein (Sp-1), or nuclear factor-κB (NFκB). We hypothesized that many estrogen-induced genes are dependent on AP-1 for their expression and that these genes can be identified using genomic strategies. Using cells expressing an inducible cJun dominant negative, we studied the estrogen induction of genes under conditions in which AP-1 was normal or blocked. We show that the expression of AP-1-dependent genes was inhibited by the cJun dominant negative and that AP-1 blockade does not affect mRNA ERα expression or estrogen induction of estrogen-responsive element activity. Using a microarray approach, we then identified 20 new estrogen-induced/AP-1-dependent genes. These estrogen-induced/AP-1-dependent genes contain a higher frequency of consensus AP-1 sites in their promoters and have increased sensitivity to the AP-1 stimulant tetradecanoyl phorbol acetate when compared with estrogen-induced genes whose expression was not affected by AP-1 blockade. We also show estrogen and AP-1-dependent recruitment of ER, steroid receptor coactivator-1, and p300 to the promoter of these genes by chromatin immunoprecipitation. These studies demonstrate that microarrays can be used in a reverse genetics approach to predict the functional promoter structure of large numbers of genes that are regulated by multiple transcription factors.
Bypass Grafting and Revascularization in the Management of Posterior Circulation Aneurysms
Authors: Evans James J. , Sekhar Laligam N. , Rak Ramin , Stimac Dinko
Published: October 2004

OBJECTIVE:

To describe the bypass techniques, cranial base approaches, results of treatment, causes of failure, and lessons that are learned in patients with posterior circulation aneurysms requiring revascularization.

METHODS:

Retrospectively, 19 patients with posterior fossa aneurysms requiring revascularization procedures operated on between 1991 and 2002 were reviewed. Preoperative and postoperative clinical information, neurological examinations, imaging data, and updated follow-ups were reviewed. Patient outcome is reported as the most current Karnofsky Performance Scale score.

RESULTS:

A total of 22 arterial bypasses were performed in 19 patients for posterior fossa circulation aneurysms between 1991 and 2002. The mean follow-up was 41 months. Total graft patency rate (including patients requiring reoperation) was 86.4% (before) and 100% (after) salvage procedures. Patient outcome was 84.2% with Karnofsky Performance Scale score 80 to 90, and three deaths occurred perioperatively. Only one death could be attributed to the failure of the radial artery graft because of spasm and subsequent rupture during angioplasty.

CONCLUSION:

Certain graft selection criteria and technical considerations contribute to the success or failure of bypass grafts in the management of posterior circulation aneurysms. Bypass procedures remain an important method of management of complex posterior circulation aneurysms, in addition to endovascular procedures.
Pretreatment with the Free Radical Scavenger Edaravone Prevents Cerebral Hyperperfusion after Carotid Endarterectomy
Authors: Ogasawara Kuniaki , Inoue Takashi , Kobayashi Masakazu , Endo Hidehiko , Fukuda Takeshi , Ogawa Akira
Published: October 2004

OBJECTIVE:

Cerebral hyperperfusion syndrome after carotid endarterectomy (CEA) is a rare but potentially devastating complication. The purpose of the present study, which was not a randomized controlled trial but a case cohort study with historical control, was to determine whether pretreatment with a novel free radical scavenger, edaravone, could prevent occurrence of cerebral hyperperfusion after CEA.

METHODS:

Fifty patients with ipsilateral internal carotid artery stenosis (≥70%) underwent CEA with administration of edaravone before internal carotid artery clamping. Preoperative cerebral blood flow and cerebrovascular reactivity (CVR) to acetazolamide were assessed with single-photon emission computed tomography (SPECT). Cerebral blood flow also was measured immediately after CEA and on the 3rd postoperative day.

RESULTS:

Cerebral hyperperfusion (cerebral blood flow increase ≥100% compared with preoperative values) was revealed by SPECT performed immediately after CEA in only one patient (2%), who also exhibited reduced preoperative CVR. The incidence of post-CEA hyperperfusion as revealed by SPECT in the control group (51 CEA patients without administration of edaravone) was significantly higher (16%) (P= 0.0310, control versus treatment group). In addition, in a subgroup of patients with reduced preoperative CVR, the incidence of post-CEA hyperperfusion as revealed by SPECT in the edaravone group (7%) was significantly lower than that in the control group (67%) (P= 0.0029). Logistic regression analysis demonstrated that reduced preoperative CVR and absence of pretreatment with edaravone were significant independent predictors of post-CEA hyperperfusion as revealed by SPECT.

CONCLUSION:

Pretreatment with edaravone can prevent occurrence of cerebral hyperperfusion after CEA.
Chemical Meningitis after Cerebral Aneurysm Treatment Using Two Second-generation Aneurysm Coils: Report of Two Cases
Authors: Meyers Philip M. , Lavine Sean D. , Fitzsimmons Brian-Fred , Commichau Chris , Parra Augusto , Mayer Stephan A. , Solomon Robert A. , Connolly E Sander
Published: October 2004

OBJECTIVE AND IMPORTANCE:

In the quest for effective and durable endovascular aneurysm treatment, second-generation aneurysm coils endeavor to increase the biological healing response to the implanted material. We report two cases of large cerebral aneurysms treated concurrently with both available second-generation aneurysm coils and the subsequent development of symptomatic nonbacterial meningitis.

CLINICAL PRESENTATION:

Two previously healthy patients underwent endovascular treatment for large (≥2 cm) cerebral aneurysms. Both aneurysms were treated using multiple Hydrogel coils (MicroVention, Inc., Aliso Viejo, CA) and Matrix coils (Boston Scientific/Target, Fremont, CA). Careful aseptic technique was observed throughout each procedure, and prophylactic intravenous antibiotics were administered during the perioperative period to both patients. Treatment proceeded uneventfully in both cases with excellent aneurysm occlusion and no immediate postoperative neurological deficits.

INTERVENTION:

In both cases, the patients were discharged from hospital but quickly were readmitted with stigmata of meningitis. Imaging demonstrated durable occlusion of the aneurysms in both patients and also abnormalities indicative of perianeurysmal and diffuse intracranial inflammatory response. Complete septic workup failed to identify an organism in either patient. Both patients responded to treatment with corticosteroid medication used to modulate the inflammatory response induced by the coil implants.

CONCLUSION:

Second-generation aneurysm coils were developed to promote more durable occlusion of cerebral aneurysms by promoting more complete volumetric aneurysm occlusion or by eliciting a more prolific inflammatory response. The concurrent use of Hydrogel and Matrix coil systems in large aneurysms may cause an exuberant inflammatory response with both local and systemic manifestations. Although vigilant evaluation and treatment for presumptive bacterial meningitis is required in all such cases, patients respond to immunomodulatory therapy with corticosteroids. More information to understand better the interaction of Hydrogel and Matrix coils is needed.
Routine Cerebral Angiography after Surgery for Saccular Aneurysms: Is It Worth It?
Authors: Kivisaari Riku P. , Porras Matti , Öhman Juha , Siironen Jari , Ishii Keisuke , Hernesniemi Juha
Published: October 2004

OBJECTIVE:

The objective of this study was to determine whether an angiographically proven rate of saccular intracranial aneurysm occlusion after surgical clipping suggests that postoperative angiography should continue to be used routinely or should be supplanted by intraoperative angiography. These data also should establish a basis for comparing surgery with new endovascular methods of treatment.

METHODS:

During a 3.5-year period, a consecutive series of 622 patients (955 aneurysms, 808 of which were surgically clipped) who underwent postoperative angiography were studied retrospectively. This series comprised 493 ruptured and 315 unruptured aneurysms.

RESULTS:

Complete aneurysm closure was achieved in 88% of aneurysms, a neck remnant was discovered in 9%, and a fundus remnant was revealed in 3%. Of 493 ruptured aneurysms, 86% were completely occluded. Of 315 unruptured aneurysms, 91% were completely occluded. The results for clipping of complex aneurysms, i.e., posterior circulation or large to giant aneurysms, were significantly inferior to those for small and anterior circulation aneurysms. In one-third of the large and giant aneurysms, a part of the base was left intentionally because of calcifications or strong wall or to prevent occlusion of any branches. In the series, a significant 5% complication rate of major vessel occlusion was detected.

CONCLUSION:

Our retrospective analysis revealed that ruptured, posterior circulation, and large/giant aneurysms are more prone to incomplete clipping. Therefore, these aneurysms require postoperative if not intraoperative evaluation with angiography. Many clippings of anterior circulation aneurysms experience unexpected failures, which suggests that intraoperative angiography could be beneficial. This series, which has no selection bias, can be used as a basis to compare the results of other series reporting surgical or endovascular treatment.
Vagus Nerve Stimulation Therapy after Failed Cranial Surgery for Intractable Epilepsy: Results from the Vagus Nerve Stimulation Therapy Patient Outcome Registry
Authors: Amar Arun Paul , Apuzzo Michael L.J. , Liu Charles Y.
Published: October 2004

OBJECTIVE:

To determine the effectiveness of vagus nerve stimulation (VNS) therapy among patients with persistent or recurrent seizures after lobar resection, callosotomy, and other cranial operations for intractable epilepsy.

METHODS:

Data were obtained from the VNS therapy patient outcome registry, which was established after United States Food and Drug Administration approval of the VNS device in 1997 as a means of capturing open-label clinical data outside of protocol. The integrity of the systems for collecting and processing registry data was authenticated by an independent auditing agency. The effect of potential selection bias, however, remains uncertain.

RESULTS:

Two nonconsecutive cohorts were compared: patients tracked in the registry who had previously undergone cranial surgery for epilepsy (CS group, n = 921) and those who had not (non-CS group, n = 3822). For the CS group, the median reduction in seizure frequency was 42.5% after 3 months of VNS therapy, 42.9% at 6 months, 45.7% at 12 months, 52.0% at 18 months, and 50.5% at 24 months. For the non-CS group, analogous rates were 47.0%, 52.9%, 60.0%, 62.7%, and 66.7%, respectively. In the CS group, seizures were reduced by at least 50% in 55.1% of patients, at least 75% in 31.4% of patients, at least 90% in 17.3% of patients, and 100% in 5.1% of patients after 24 months of VNS therapy. Response rates were more pronounced in the non-CS group: at least 50% in 62.2% of patients, at least 75% in 43.7% of patients, at least 90% in 26.8% of patients, and 100% in 8.3% of patients. Patients in both groups experienced marked improvements in quality of life parameters.

CONCLUSION:

The effectiveness of VNS is maintained during prolonged stimulation, and overall seizure control continues to improve with time. Patients in whom prior cranial surgery had failed did not respond as favorably as all other patients receiving VNS therapy. Nonetheless, many of the former group improved substantially. Thus, on the basis of these open-label data, VNS therapy represents a potentially palliative treatment option for patients with refractory seizures after failed cranial surgery.
Anteroinferior Cerebellar Artery Aneurysms: Surgical Approaches and Outcomes—A Review of 34 Cases
Authors: Gonzalez L Fernando , Alexander Michael J. , McDougall Cameron G. , Spetzler Robert F.
Published: October 2004

OBJECTIVE:

Anteroinferior cerebellar artery (AICA) aneurysms are rare lesions whose treatment requires expertise in vascular, endovascular, and cranial base surgery. This article presents the largest series treated at one center.

METHODS:

We retrospectively analyzed presenting symptoms, aneurysm characteristics, surgical approaches, postoperative outcomes, and the application of endovascular techniques.

RESULTS:

We found 32 patients with 34 AICA aneurysms (11 men and 21 women; age range, 6–77 yr; mean age, 51 yr). Twenty-one aneurysms had ruptured; 13 were unruptured. Seven of the unruptured aneurysms presented with brainstem compression, and six were found incidentally. Surgical approaches included the retrosigmoid, far-lateral transcochlear, translabyrinthine, and orbitozygomatic. Eighteen patients (56%) had neurological complications. Thirty aneurysms were at proximal locations, and four were distal. Intraoperative hypothermic cardiac arrest was used to clip eight giant aneurysms. Follow-up was available in 56% of the patients for a mean of 41 months. The mean Glasgow Outcome Scale scores at discharge were not significantly different from the patients' status at their initial assessment.

CONCLUSION:

We recommend the standard retrosigmoid approach for treating small to medium aneurysms involving the lower two-thirds of the clivus or distal AICA aneurysms. Cranial base approaches are recommended for large or giant aneurysms or for those proximal to the emergence of the AICA from the basilar trunk. Hypothermic cardiac arrest facilitates dissection of giant aneurysms. Endovascular treatment is a useful adjunct for treating residual aneurysms but did not provide definitive treatment in any of our patients.
Traumatic Venous Varix Causing Sciatic Neuropathy: Case Report
Authors: Maniker Allen H. , Thurmond James , Padberg Frank T. , Blacksin Marcia , Vingan Roy
Published: October 2004

OBJECTIVE AND IMPORTANCE:

Sciatic neuropathy rarely presents in nonpenetrating trauma because of protection of the nerve by the pelvis, the gluteal muscles, and the tissues in the posterior thigh. We present the case of a patient who fell and subsequently developed a traumatic venous varix of the inferior gluteal vein that caused compression sciatic neuropathy.

CLINICAL PRESENTATION:

Seven days after a fall onto her right buttock, the patient developed a painful burning paresthesia in her leg and numbness on the dorsum of her foot. Numerous studies ruled out lumbar spine pathological abnormalities as the cause of the pain. Conventional magnetic resonance imaging revealed a lesion adjacent to the sciatic nerve. Gradient echo and two-dimensional time-of-flight magnetic resonance imaging sequences confirmed this to be a vascular lesion originating from the inferior gluteal vein and compressing the sciatic nerve.

INTERVENTION:

Operative resection obliterated the venous varix, thereby relieving the patient's pain and neurological deficit.

CONCLUSION:

No case of a traumatic venous varix of the inferior gluteal vein compressing the sciatic nerve has been reported to date. Surgical resection was successful in obliterating the lesion and relieving the symptoms.
Laboratory Assessment of Oxygenation in Methemoglobinemia
Authors: Haymond Shannon , Cariappa Rohit , Eby Charles S , Scott Mitchell G
Published: October 2004

Background: This case conference reviews laboratory methods for assessing oxygenation status: arterial blood gases, pulse oximetry, and CO-oximetry. Caveats of these measurements are discussed in the context of two methemoglobinemia cases.

Cases: Case 1 is a woman who presented with increased shortness of breath, productive cough, chest pain, nausea, fever, and cyanosis. CO-oximetry indicated a carboxyhemoglobin (COHb) fraction of 24.9%. She was unresponsive to O2 therapy, and no source of carbon monoxide could be noted. Case 2 is a man who presented with syncope, chest tightness, and signs of cyanosis. His arterial blood was dark brown, and CO-oximetry showed a methemoglobin (MetHb) fraction of 23%.

Issues: Oxygen saturation (So2) can be measured by three approaches that are often used interchangeably, although the measured systems are quite different. Pulse oximetry is a noninvasive, spectrophotometric method to determine arterial oxygen saturation (SaO2). CO-oximetry is a more complex and reliable method that measures the concentration of hemoglobin derivatives in the blood from which various quantities such as hemoglobin derivative fractions, total hemoglobin, and saturation are calculated. Blood gas instruments calculate the estimated O2 saturation from empirical equations using pH and Po2 values. In most patients, the results from these methods will be virtually identical, but in cases of increased dyshemoglobin fractions, including methemoglobinemia, it is crucial that the distinctions and limitations of these methods be understood.

Conclusions: So2 calculated from pH and Po2 should be interpreted with caution as the algorithms used assume normal O2 affinity, normal 2,3-diphosphoglycerate concentrations, and no dyshemoglobins or hemoglobinopathies. CO-oximeter reports should include the dyshemoglobin fractions in addition to the oxyhemoglobin fraction. In cases of increased MetHb fraction, pulse oximeter values trend toward 85%, underestimating the actual oxygen saturation. Hemoglobin M variants may yield normal MetHb and increased COHb or sulfhemoglobin fractions measured by CO-oximetry.
Latex Immunoturbidimetric Assay for Soluble Fibrin Complex
Authors: Hamano Akiei , Umeda Mamoru , Ueno Yukiko , Tanaka Seiji , Mimuro Jun , Sakata Yoichi
Published: October 2004

Background: Soluble fibrin complex (SFC), composed of fibrin monomer and fibrinogen derivatives, is known to exist in the circulating blood in patients with thrombosis. Its detection and quantification are useful for obtaining information about the condition and degree of intravascular coagulation in early-stage thrombosis, but there is no rapid method to measure SFC in plasma for clinical use.

Methods: We obtained a monoclonal antibody that specifically reacts with SFC, with desAA-fibrin as the immunogen, and developed a rapid and sensitive latex immunoturbidimetric assay (LIA) using latex-immobilized anti-SFC monoclonal antibody. The assay system was based on the increase in turbidity induced by the reaction of the latex-immobilized anti-SFC monoclonal antibody with SFC in plasma, and the assay procedure was fully automated on a Hitachi 911 analyzer.

Results: The method had an analytical range of 3–300 mg/L. Intra- and interassay precision studies indicated that this system provided reproducible data (CVs <3.0% and <2.0%, respectively). The assay detection limit was <0.5 mg/L. There was no interference from bilirubin (up to 440 mg/L), hemoglobin (up to 9.6 g/L), Intralipid (up to 10%), D-dimer (up to 200 mg/L), and rheumatoid factor (up to 470 000 IU/L). SFC concentrations in plasma from patients with thrombotic diseases [mean (SD), 48.9 (57.6) mg/L; n = 160) were significantly higher than those in plasma from healthy individuals [1.8 (2.1) mg/L; P <0.001; n = 304].

Conclusion: In terms of linearity, precision, and sensitivity, the LIA, performed on a Hitachi 911 automated analyzer, may be useful for measurement of SFC in plasma.
Evidence That the Amino-Terminal Composition of Non-(1–84) Parathyroid Hormone Fragments Starts before Position 19
Authors: D’Amour Pierre , Brossard Jean-Hugues , Räkel Agnès , Rousseau Louise , Albert Caroline , Cantor Tom
Published: October 2004

Background: Non-(1–84) parathyroid hormone (PTH) fragments are large C-terminal fragments of PTH with a partially preserved N-terminal structure. They differ from other C-terminal PTH fragments, which do not have an N-terminal structure and do not react in intact PTH assays. We aimed to identify the minimal N-terminal structure common to all non-(1–84) PTH fragments.

Methods: Sera obtained from six healthy individuals and six patients with primary hyperparathyroidism, and six serum pools from dialysis patients with different PTH concentrations were fractionated by HPLC and analyzed by four different PTH assays. Each assay was characterized by saturation analysis of its detection antibody and capacity to react with different PTH fragments. Human PTH(1–84) [hPTH(1–84)] calibrators were normalized to an in-house hPTH(1–84) calibrator.

Results: The cyclase-activating PTH (CA-PTH) assay had an early (1, 2,) epitope and reacted only with hPTH(1–84). The other assays had epitopes in region (13–34). Total and intact PTH assays had epitopes proximal to position 18 and reacted equally well with hPTH(1–84) and hPTH(7–84), and the Elecsys PTH assay had an epitope distal to position 19, being saturable by hPTH(18–48) and also reacting with [Tyr34]hPTH(19–84). The HPLC profiles obtained with these assays showed that non-(1–84) PTH fragments did not react in the CA-PTH assay, as expected. The amount of non-(1–84) PTH detected by the other three assays was similar when the assay results were normalized to a common calibrator.

Conclusions: The results suggest that the amount of non-(1–84) PTH detected by epitopes proximal or distal to position 19 of the PTH structure is identical, indicating a common minimum structure starting before position 19. This in turn points to a probable high-affinity interaction with the C-PTH receptor, as observed previously with [Tyr34]hPTH(19–84) in various cell lines and in mouse osteocytes with PTH/PTHrP type I receptor ablation.
Ein Hindernisvermeidungssystem für ein Autonomes Unterwasserfahrzeug (An Obstacle Avoidance System for an Autonomous Underwater Vehicle)
Authors: Eichhorn Mike
Published: October 2004

In diesem Artikel wird ein System zum Ausweichen von Hindernissen für das autonome Unterwasserfahrzeug DeepC vorgestellt. Bei Auswahl und Entwicklung der eingesetzten Strategien wurden die besonderen Anforderungen in der Unterwasserwelt und die im Fahrzeug zur Verfügung stehende Rechenleistung und Sensorik sowie dessen Manövrierfähigkeit berücksichtigt. Anforderungen in der Unterwasserwelt sind die Einbeziehung der Strömungsinformation, die Berücksichtigung von bewegten Objekten, ein Ausweichen im 3-D Raum sowie ein begrenzter Auffassbereich durch das Sonar.
Charakterisierung von OLED-Schichten mittels Spektral-Ellipsometrie (Characterization of OLED Layers by Spectroscopic Ellipsometry)
Authors: Hartmann Elmar
Published: October 2004

Das optische Absorptionsverhalten organischer Schichten, die für organische Leuchtdioden (OLEDs) verwendet werden, bestimmt entscheidend die Leuchteffizienz des fertigen Bauelements. Gleichzeitig soll die Dicke von Einzelschichten oder von ganzen Schichtsystemen kontrolliert werden können. Die spektroskopische Ellipsometrie ist ein zerstörungsfreies und berührungsloses Verfahren, mit dem sich simultan strukturelle und optische Materialeigenschaften routinemäßig erfassen lassen.
Entwicklung eines Fokussensors und Integration in die Nanopositionier- und Nanomessmaschine (Development of a Focus Sensor and its Integration into the Nanopositioning and Nanomeasuring Machine)
Authors: Mastylo Rostyslav , Manske Eberhard , Jäger Gerd
Published: October 2004

Ein Fokussensor auf der Basis einer Hologramm-Laser-Unit wurde entwickelt und in einer Nanopositionier- und Nanomessmaschine als Nullindikator erfolgreich getestet. Die Messungen wurden im dynamischen Modus mit permanenter Differenzbildung zwischen dem Ausgangssignal des Fokussensors und dem Längenwert des Z-Interferometers der Nanopositionier- und Nanomessmaschine durchgeführt. Die Messergebnisse und Messmöglichkeiten sind dargestellt.
Schaumcharakterisierung mit optischen Messtechniken und PC-gestützter Bildverarbeitung (Foam Characterization by Optical Measuring Techniques and Computer-Aided Image Processing)
Authors: Haß Ernst-Christoph , Ottensmeyer Ralph , Wittstock Arne
Published: October 2004

In diesem Beitrag wird ein optisches Mess- und Aufnahmeverfahren mit anschließender automatischer Bildverarbeitung am PC zur Charakterisierung stabiler und zerfallender Schäume beschrieben, die Aussagen über deren Morphologie, Poren- bzw. Blasengrößenverteilung, Zerfallsprozess, Alterungseigenschaften usw. zulässt. Hierzu wird eine Messanordnung verwendet, die aus einer hoch auflösenden monochromen CCD-Kamera mit einem telezentrischen Objektiv, einer koaxialen, diffusen Beleuchtung mit optionaler Blitzlichtsteuerung und einer schnellen Framegrabber-Karte besteht. Die Bilder werden automatisch am PC mit einer speziell von uns entwickelten Software hinsichtlich folgender Charakteristika ausgewertet: (a) fraktale Dimensionen von Schäumen, die deren Körnigkeit und somit ihre Morphologie kennzeichnen, (b) Flüssigkeitsanteil beim Zerfallsprozess instabiler Schäume durch Auswertung zeitlich aufeinander folgender Schaumbilder und (c) Änderung der Blasengrößenverteilungen bei Alterung des Schaums.
Evaluation of Oral and Nasal Odor in Patients with and without Cleft Lip and Palate: Preliminary Report
Authors: Monteiro-Amado Flávio , Chinellato Luiz Eduardo Montenegro , Tárzia Olinda , de Rezende Maria Lúcia Rubo
Published: October 2004

Objective

To evaluate oral and nasal halitosis parameters in patients with and without clefts.

Design

Randomized and prospective study. Patients with and without clefts were evaluated as to oral and nasal halitosis.

Setting

University of São Paulo, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil.

Patients

Twelve patients with clefts and 12 without clefts were evaluated, and no exclusion criteria were followed.

Interventions

Nasal and oral halitosis were measured with the use of a portable sulfide monitor during a single visit.

Results

One hundred percent of the patients with clefts had altered values for volatile sulfur compounds. Only 33.3% of the patients without clefts had at least one strong value for nasal halimeter measurements, and 58.3% of these patients showed alteration in the nasal values. Statistical evaluation, made using the Mann-Whitney U test, classifying the nasal halimeter values as normal, weak, and strong, showing a statistical significant group difference (p = .003). There was no significant difference in the oral halimeter values between the two groups.

Conclusions

Patients with cleft lip and palate had a tendency to present higher values for the nasal halimeter measurements, when compared with patients without clefts.
The Prevalence of Caries in Children with a Cleft Lip and/or Palate in Southern Vietnam
Authors: Besseling Sjobbe , Dubois Leander
Published: October 2004

Objective

The aim of this study was to investigate the prevalence of caries in South Vietnamese children with a known oral cleft.

Setting

The children were screened at local dental hospitals in five different cities in southern Vietnam.

Participants

One hundred fifty-four children aged 4 to 6, 11 to 13, and 14 to 16 years old with a cleft lip, cleft palate, or both were included in the study.

Outcome Measurements

For every age group, clefts were divided in four types. The dmft/DMFT was specified according to criteria of the World Health Organization (1997).

Results

The mean number of teeth affected by caries was 9.95 for 4- to 6-year-old children, 2.97 for 11- to 13-year-old children, and 4.93 for 14- to 16-year-old children, respectively. Four- to 6-year-old children with a unilateral or bilateral cleft lip and palate had significantly more caries and a higher dmft (decayed, missing, and filled teeth index) than children of the same age with only a cleft lip or a cleft lip and alveolus.

Conclusions

Vietnamese children with an oral cleft have high numbers of teeth affected by dental caries, and special attention will be necessary for their oral health.
The Use of Spanish Language Educational Materials by American Cleft Palate–Craniofacial Association Teams
Authors: Edwards Paul D. , Bonilla Zobeida E.
Published: October 2004

Objective

The goals of this study were to assess U.S.-based American Cleft Palate–Craniofacial Association (ACPA) teams’ use and perceived need for Spanish-language educational materials and to evaluate trends in number of Spanish-speaking patients treated.

Methods

A facsimile survey was sent to U.S.-based teams listed in the ACPA 1999 to 2000 and 2001 to 2002 Team Directories. Questions addressed demographics for Spanish-speaking patients/families and use of Spanish-language educational materials. Teams with a recent increase in Spanish speakers, 25% or more Spanish speakers, or both received a more in-depth follow-up survey.

Results

Response rate to the initial survey was 71%. Almost 16% of teams reported having greater than 25% primarily Spanish speakers. Forty-four percent of responders saw an increase in Spanish speakers over the past 5 years, and 41% of responders used Spanish-language materials of some type. Fifty-seven teams were sent a follow-up survey and 29 (51%) teams responded. Teams reported a need for more Spanish-language educational materials on specific craniofacial conditions, and many expressed frustration in communication and interaction with Spanish speakers.

Conclusions

Many U.S.-based ACPA teams reported an increase in primarily Spanish speakers and expressed a need for more Spanish-language educational materials in different formats. Consideration of the diverse dialectic, cultural, and literacy needs of U.S. Spanish speakers can contribute to more effective educational efforts and improved care of the increasing number of Latinos treated by ACPA teams.
Does Repairing a Cleft Lip Neonatally Have Any Effect on the Longer-Term Attractiveness of the Repair?
Authors: Goodacre Tim E. E. , Hentges Françoise , Moss Tony L. H. , Short Vicky , Murray Lynne
Published: October 2004

Objective

To determine whether attractiveness and success of surgical outcome differ according to the timing of cleft lip repair.

Design

Three experiments were conducted: (1) surgeons rated postoperative medical photographs of infants having either neonatal or 3-month lip repair; (2) lay panelists rated the same photographs; (3) lay panelists rated dynamic video displays of the infants made at 12 months. Normal comparison infants were also rated. The order of stimuli was randomized, and panelists were blind to timing of lip repair and the purposes of the study.

Setting

Four U.K. regional centers for cleft lip and palate.

Participants

Infants with isolated clefts of the lip, with and without palate.

Intervention

Early lip repair was conducted at median age 4 days (interquartile range [IQR] = 4), and late repair at 104 days (IQR = 57).

Main Outcome Measures

Ratings of surgical outcome (Experiment 1 only) and attractiveness (all experiments) on 5-point Likert scales.

Results

In Experiment 1 success of surgical outcome was comparable for early and late repair groups (difference = −0.08; 95% confidence interval [CI] = −0.43 to 0.28; p = .66). In all three experiments, attractiveness ratings were comparable for the two groups. Differences were, respectively, 0.10 (95% CI = −2.3 to 0.44, p = .54); −0.11 (95% CI = −0.42 to −0.19, p = .54); and 0.08 (95% CI = −0.11 to 0.28, p = .41). Normal infants were rated more attractive than index infants (difference = 0.38; 95% CI = 0.24 to 0.52; p < .001).

Conclusion

Neonatal repair for cleft of the lip confers no advantage over repair at 3 months in terms of perceived infant attractiveness or success of surgical outcome.
Magnetic Resonance Imaging of the Levator Veli Palatini Muscle before and after Primary Palatoplasty
Authors: Kuehn David P. , Ettema Sandra L. , Goldwasser Michael S. , Barkmeier Joseph C.
Published: October 2004

Objective

To explore the application of magnetic resonance imaging (MRI) in the evaluation of patients with cleft palate before and after primary palatoplasty with particular attention focused on the levator veli palatini muscle.

Design

Prospective study using MRIs of subjects before and after primary cleft palate surgery.

Setting

Hospital and university based.

Patients

One female infant with normal anatomy. Three male and four female infants with cleft palate of varying severity.

Intervention

Furlow double-opposing Z-plasty and V-Y palatoplasty.

Main Outcome Measures

Magnetic resonance images.

Results

It was found that the levator veli palatini muscle can be imaged before and after palatal surgery in infants using MRI. The muscle may have sufficient volume, proportionate to a normal infant or adult, in infants born with cleft palate. If retrodisplaced properly, the muscle is likely to be steeper (more vertical) from its origin at the base of the skull to its insertion into the velum following palatoplasty, thus providing a more favorable angle for elevating the velum. Following palatal surgery, the levator muscle mass may not be as cohesive across the velar midline, compared with normal musculature.

Conclusion

MRI is a viable imaging modality for the evaluation of the anatomy of the levator veli palatini muscle before and after primary palatoplasty in infants born with cleft palate.
Predisposing Factors to Formation of Cleft Lip and Palate: Inherited Craniofacial Skeletal Morphology
Authors: Chatzistavrou Evangelia , Ross R. Bruce , Tompson Bryan D. , Johnston Malcom C.
Published: October 2004

Objective

To identify inherited craniofacial morphologic features in individuals at high risk for cleft of the lip, cleft palate, or both.

Subjects

Twins without cleft from 33 pairs of monozygotic twins discordant for cleft lip, cleft palate, or both were studied. There were 17 males and 16 females of Caucasian origin, ranging from 3 to 18 years (15 with cleft lip and palate [CLP], 10 with cleft lip [CL], and 8 with cleft palate [CP]), collected from five craniofacial centers (United States and Canada).

Design

The twin without cleft (noncleft) from each set was compared with an age- and sex-matched control individual from the Burlington Growth Centre, Toronto, Ontario. Posteroanterior and lateral cephalograms were traced and digitized using a computer custom analysis. Descriptive statistics, Student's t tests, and analysis of variance were used to test 40 variables in a pilot study comparing the noncleft twin groups with the controls. Preliminary analysis permitted pooling of the CLP and CL groups (n = 25). To minimize false-positive significance, only 14 variables (from the maxillofacial area) were tested.

Results

Using the raw probabilities, eight variables showed significant differences between the pooled noncleft CLP and CL (CL[P]) twin group and the controls. However, when the level of significance was adjusted, only four (nasal width [p < .01], cranial base length [p < .05], cranial base width/length ratio [p < .001], and maxillary width/length ratio [p < .05]) were significantly different. No significant differences were confirmed between the noncleft CP twin group and the controls.

Conclusions

The noncleft member of a discordant monozygotic pair has a number of facial characteristics that differ from the general population. These may predispose to the formation of a cleft lip or palate and may result from a deficiency or distortion of the mesenchyme that forms the craniofacial structures.
Lymphatic Malformation of the Sphenoid Sinus in a Pediatric Patient
Authors: Bennett Garrett , April Max , Huvos Andrew G.
Published: October 2004

Lymphatic malformation is a benign vascular lesion resulting from lymphatic tissue being isolated from the remainder of the lymphatic system. They are present at birth and up to 90% are diagnosed by 2 years of age. More aggressive lesions are usually diagnosed earlier, with low‐grade lesions presenting later with fewer complications. These lesions are hamartomas and not true neoplasms. The term hamartoma is used to describe an abnormally large mass of histologically normal tissue in a normal location. The lymphatic malformation is composed of lymph‐filled channels lined with a single layer of flat endothelial cells on a basement membrane. They present with either generalized edema and poorly defined borders (microcystic) or a localized area of multilocular cysts (macrocystic). The term lymphatic malformation has replaced many other outdated terms, such as lymphangioma, cystic hygroma, lymphangioma circumscriptum, and lymphangiomatosis. In this study, we present a case report of a pediatric lymphatic malformation of the sphenoid sinus. To our knowledge, this lesion has not been described in the pediatric population and has been described only once in an adult in the German literature.1 EBM rating: C.
Persistent Cough: Prevalence of Gastroesophageal Reflux and Study of Relevant Laryngeal Signs
Authors: El Din M. El Hennawi Diaa , Iskander Nagy M. , Hassan Ibrahim Ibrahim , Hamid A. Serwah Abdel
Published: October 2004

Cough is one of the atypical manifestations of gastroesophageal reflux disorder (GERD). The aim of this study was to evaluate the prevalence of GERD among patients presenting with persistent cough. The study included 80 patients over a period of 3 years. The inclusion criteria were nonsmoker adults with normal chest radiograph whose chief complaint was cough for at least 4 weeks duration. All patients included were subjected to nasal endoscopy, laryngoscopy, and 24‐hour pH monitoring. Reflux was recorded in the different positions. Laryngeal signs of reflux were traced for and their significance was calculated. Patients who proved to have GERD received antireflux treatment with a follow‐up of 3 months. The response to antireflux treatment was assessed according to subjective and objective improvement. Relapse in the follow‐up period occurred in 9% of patients. It is concluded that laryngeal signs of GERD should be well known to diagnose and properly manage persistent cough.
Selective Neck Dissection for Clinically N0 Neck in Laryngeal Cancer: Is Dissection of Level IIb Necessary?
Authors: Coskun H. Hakan , Erisen Levent , Basut Oguz
Published: October 2004

The most common morbidity associated with selective neck dissection (SND; II–IV) is spinal accessory nerve dysfunction and related shoulder disability. Nerve dysfunction is usually attributed to stretching of the nerve during clearance of lymph nodes lying posterior and superior to the spinal accessory nerve (level IIb). If these lymph nodes were left in place and not removed, stretching of the spinal accessory nerve during neck dissection and postoperative shoulder disability could be avoided. 113 SNDs (II–IV) performed on clinically N0 necks of patients with laryngeal carcinoma were enrolled in this prospective study. During SND, level IIb was separately removed and processed. Mean number of lymph nodes in level IIb was 6.26 (range, 0‐19). In none of the 113 SND (II‐IV) specimens did level IIb contain metastases, thus providing an oncological basis that leaving these lymph nodes in place is an oncologically safe approach, probably avoiding postoperative shoulder disability.
Preliminary Functional Results of Tympanoplasty with Titanium Prostheses
Authors: M Menéndez‐Colino L. , Bernal‐Sprekelsen M. , Alobid I. , Traserra‐Coderch J.
Published: October 2004

OBJECTIVE

To assess the use of titanium prostheses in tympanoplasty for reconstruction of the sound pressure and to evaluate the audiometric results obtained.

STUDY DESIGN AND SETTING AND PATIENTS

Retrospective chart review in a tertiary referral center. Between September 1998 and October 2000, 23 titanium middle ear implants (23 TORP) were used for reconstruction of the ossicular chain after tympanomastoidectomy. Preliminary functional results were obtained in 23 cases.

RESULTS

Average follow‐up time was 18 months (range, 12‐40) and no adverse reactions or extrusions occurred. Seven of 16 canal wall down tympanoplasties (43.7%), and 3 of 7 canal wall up tympanoplasties performed (42.9%) had a postoperative air‐bone gap of between 0 and 10 dB.

CONCLUSIONS

Preliminary results show that titanium prosthesis provide a promising hearing result after total ossicular reconstruction, although long‐term results are not yet available. The low weight of these prostheses may be the reason for the decrease in the air‐bone gap.
Recurrent Pneumoparotid: Cause and Treatment
Authors: Han Sehjin , Isaacson Glenn
Published: October 2004

OBJECTIVE

To document the etiology and successful treatment of severe recurrent pneumoparotid.

STUDY DESIGN

Computed tomography, ductal measurement by probe size, surgical treatment.

RESULTS

We performed a superficial parotidectomy for a 13‐year‐old with a history of recurrent parotitis. He subsequently developed recurrent pneumoparotid in the contralateral gland with subcutaneous dissection of air into the face, neck, and mediastinum. At surgery, Stensen's ducts were measured and found to be abnormally patent bilaterally compared to standardized norms. Parotid duct ligation, commonly used for sialorrhea, was employed as a novel treatment and was curative.

CONCLUSION

Insufflation of air into the parotid duct system can trouble woodwind instrument players, can complicate dental procedures, or can be self‐induced. It is generally a benign condition requiring no therapy. Occasionally, pneumoparotid can be recurrent and lead to inflammation and infection of the parotid or subcutaneous emphysema.

SIGNIFICANCE

In selected cases of recurrent pneumoparotid, ductal ligation may be curative.
Pseudoaneuploid Subpopulations Detected in Normal Upper Aerodigestive Tract Mucosa Consistent with Physiological Apoptosis in Normally Differentiating Squamous Mucosa
Authors: El‐Rayes Bassil F. , Korkmaz Hakan , Maciorowski Zosia , Sakr Wael , Jacobs John R. , Ensley John F.
Published: October 2004

OBJECTIVES

While evaluating the validity of using normal human mucosal cells from the upper aerodigestive tract as diploid standards for DNA content studies of squamous cell cancer of head and neck by flow cytometry, pseudoaneuploidy was frequently detected. The purpose of this study was to further evaluate these DNA content abnormalities encountered in normal human mucosal cells and correlate them to physiological apoptosis.

STUDY DESIGN

Thirty‐two specimens of upper areodigestive tract mucosa from 18 surgical resections, 11 fresh autopsies, and 3 buccal scrapings were examined for DNA content by flow cytometry.

RESULTS

Pseudoaneuploidy, which ranged from sub‐G0/G1 peaks to hyperdiploid peaks with increased 90° light scattering properties was found in 60% of these specimens. Fluorescent microscopic examination of the sorted DNA pseudoaneuploid cells demonstrated cells undergoing apoptosis.

CONCLUSION

This unexpected pseudoaneuploidy in normal mucosal cells was a result of physiological apoptosis, a normal component of squamous differentiation. EBM rating: B‐2.