bluuebunny/crossref_metadata_2025 huggingface dataset:
George W. Bush's Signing Statements: The Assault on Deliberation
Authors: Birdsell David S
Published: July 2007

George W. Bush has issued hundreds of "signing statements" objecting to select provisions of legislation that he has nonetheless signed into law. While signing statements have been used by previous presidents, President Bush's signing statements are unique in their volume, their frequent lack of specificity, and the breadth of the power that they claim for the executive branch. His statements undermine the deliberative exchange between the president and the Congress mandated for traditional veto messages and sustained in most signing statements prior to the 43rd presidency. In doing so, they imperil the prospect for effective legislative oversight, particularly in areas related to national security and, by extension, the Iraq war.
Fighting Terror by Rite of Redemption and Reconciliation
Authors: Ivie Robert L
Published: July 2007

This essay examines the Bush administration's rhetoric of evil in the war on terror and invasion of Iraq by reframing the question of national security into one of a chosen people's recurring quest for redemption. As such, ritualized perceptions of peril are an engine of unreflective policy making. Yet the ritual of redemptive violence suggests a remedy from within war culture, which begins with reconsidering the function of the scapegoat vis-à-vis the articulation of categorical guilt. From there, the essay explores the notion of transforming the scapegoat mechanism through rehumanizing rituals into a peace-building, as opposed to enemy-making, salvation device.
Justifying the War in Iraq: What the Bush Administration's Uses of Evidence Reveal
Authors: Jamieson Kathleen Hall
Published: July 2007

This essay argues that, if carefully read, the public statements of the Bush administration in the run-up to the March 2003 U.S.-led military intervention in Iraq reveal that the available evidence did not warrant the administration's confident claims that Iraq possessed weapons of mass destruction (WMD). To support this argument, the essay explores the administration's verbal leakage and Freudian slips, shifts in the burden of proof, strategies that minimized evidentiary accountability, assertions of the presence of convincing evidence that could not be publicly revealed, and tacit concessions that the case for WMD was a patchwork.
Going Public, Crisis after Crisis: The Bush Administration and the Press from September 11 to Saddam
Authors: John Sue Lockett , Domke David Scott , Coe Kevin M , Graham Erica S
Published: July 2007

Political leaders craft public communications in a strategic manner and attempt to use mass media as a political resource. With this in mind, we argue that during summer and autumn 2002 President George W. Bush extended the September 11 crisis through emphasis in public communications on internal "homeland" security and an external "war on terror"—discourses into which Iraq was carefully inserted over time. These strategic communications allowed the president to significantly shape U.S. news coverage, helped Republicans gain control of Congress, and propelled the United States toward war with Iraq. Our analysis shows that Bush's emphasis on three themes in combination with a particular sequence of discourse facilitated a subtle shift from a focus solely on homeland security legislation to one that emphasized the dangers of Saddam Hussein's Iraq without substantive changes in the accompanying arguments. Further, analysis of U.S. news coverage during the same dates indicates that news media often followed the president's messages about these topics.
Rhetoric's Role in Context, Beginning with 9/11
Authors: Simons Herbert W.
Published: July 2007

This essay offers a dilemma-centered rhetorical history of the Iraq debacle, beginning with the president's melodramatic crisis narrative in the wake of the 9/11 attacks, continuing with the unraveling of that narrative in the run-up to war and during the prolonged occupation of Iraq, and culminating in situational entrapment, or quagmire, wherein the Bush administration's reputation for "staying on message" has lost its rhetorical glow.
Parallels in Preemptive War Rhetoric: Reagan on Libya; Bush 43 on Iraq
Authors: Winkler Carol
Published: July 2007

During the 1980s and the 1990s, scholars in the field of rhetorical studies presented presidential war rhetoric as a genre of public discourse. More recently, some have questioned the genre's continued relevance given the current challenges of U.S. warfare. This essay examines whether preemption conducted in the context of the war on terror alters or reinforces the conventional substantive and stylistic expectations of war rhetoric. Analyzing the public communication strategies of the Bush administration on Iraq and the Reagan administration on the bombing of Libya, it demonstrates that despite changes in the situational exigencies, the nation's leadership uses a heavy reliance on strategic misrepresentation to maintain compliance with the genre's expectations.
Making the Case for War: Colin Powell at the United Nations
Authors: Zarefsky David
Published: July 2007

The most fully articulated case for war in Iraq was presented in Secretary of State Colin Powell's February 5, 2003, speech to the United Nations Security Council. After establishing the context for the speech, this essay examines the strength of that case, focusing especially on structure, reasoning, and evidence. The structure was appropriate to the purpose, if somewhat unusual. Although the speech relied on argument from ignorance, this inference was reasonable in context. The fatal flaw in the speech was the unreliability of key evidence. More critical questioning of evidence at the time could have brought this problem to light and perhaps have avoided some of the consequences that followed.
A Generalized Relationship for Estimating Dielectric Constant of Soils
Authors: Bhat Ajaz Masood , B. Hanumantha Rao , Singh D. N.
Published: August 2007

Efforts were made in this study to develop a methodology for estimating the dielectric constant of the fine- and coarse-grained soils, based on their dielectric dispersion. A generalized relationship that can be employed for estimating the dielectric constant of any type of soil, corresponding to a given ac frequency and any compaction state, has been developed. The utility and efficiency of this relationship has been demonstrated based on the results reported in the literature for different types of soils and glass-beads.
Inverse magnetoelectric effects in a ferromagnetic–piezoelectric layered structure
Authors: Fetisov Y.K. , Petrov V.M. , Srinivasan G.
Published: August 2007

Measurements of inverse magnetoelectric (ME) effects in lead zirconate titanate (PZT)–Ni–PZT trilayers are reported. Traditional ME measurements involve the electrical response of a composite subjected to an alternating current (ac) magnetic field. In the case of an “inverse ME effect,” one measures the variation in the magnetic induction due to an external ac electric field applied to PZT. A pickup coil wound around the sample is used to measure the ME voltage due to the change in the magnetic induction in Ni. The measured static magnetic-field dependence of ME voltage has been attributed to the variation in the piezomagnetic coefficient for Ni. The frequency dependence of the ME voltage shows a resonance character due to radial acoustic modes in PZT. Theoretical estimates of ME susceptibility are in excellent agreement with values determined from data on induced voltage.
Low-frequency and resonance magnetoelectric effects in lead zirconate titanate and single-crystal nickel zinc ferrite bilayers
Authors: Gheevarughese V. , Laletsin U. , Petrov V.M. , Srinivasan G. , Fedotov N.A.
Published: August 2007

The nature of magnetoelectric (ME) interactions has been investigated in lead zirconate titanate (PZT) and (111) or (110) single-crystal nickel zinc ferrites. Data on the dependence of low-frequency ME voltage coefficients on static magnetic field orientation show (i) highest ME coefficients for bias field H along [100] and the smallest for H parallel to [110] and (ii) strongest ME interactions for transverse fields and for samples with Zn concentration of 0.3. Measurements on frequency dependence of ME coefficients reveal resonance enhancement due to bending and radial acoustic modes. The highest voltage coefficient is measured for radial modes in a sample with Zn concentration of 0.2. Theoretical estimates of low-frequency and resonance ME parameters are in very good agreement with data.
Structure and properties of multiferroic (1 − x)BiFeO3–xPbTiO3 single crystals
Authors: Zhu W-M. , Guo H-Y. , Ye Z-G.
Published: August 2007

Single crystals of the multiferroic (1 − x)BiFeO3–xPbTiO3 (BF–PT) solid solution with a nominal morphotropic phase boundary (MPB) composition were grown from flux. Structural characterization by x-ray diffraction shows the simultaneous existence of a tetragonal, an orthorhombic, and a rhombohedral perovskite phase in the crystals. A high ferroelectric Curie point of 660 °C was found in the BF–PT crystals by dielectric measurements. The variation of the magnetic moment as a function of temperature of the BF–PT crystals measured under zero field cooling mode reveals three anomalies with the highest one around 440 K, corresponding to the antiferromagnetic ordering temperatures of the rhombohedral, orthorhombic, and tetragonal phases, respectively. These results demonstrate the intrinsic relations between the MPB phase components and the macroscopic ferroic properties.
Influence of additional elements on the development of nanoscale heterogeneities in (TiCu)-based bulk metallic glasses with enhanced ductility
Authors: Zhang X.F. , Kim K.B. , Das J. , Yi S. , Eckert J.
Published: August 2007

The effect of additional elements on microstructure and mechanical properties of (TiCu)-based bulk metallic glasses (BMGs) has been systematically investigated. Based on the values of the heat of mixing between the additional elements and the major constituent elements Ti and Cu, small additions of elements having a positive heat of mixing with Cu and a negative heat of mixing with Ti are effective in forming nanoscale heterogeneities upon solidification and enhance the ductility. It is experimentally demonstrated that the selection of the minor elements in (TiCu)-based BMGs plays a crucial role to induce nanoscale heterogeneities and thus to control the deformation behavior of the bulk metallic glasses.
Phase development during mixed-oxide processing of a [Na0.5K0.5NbO3]1−x–[LiTaO3]x powder
Authors: Skidmore T.A. , Milne S.J.
Published: August 2007

Powders of the solid lead-free piezoelectric ceramic solution [Na0.5K0.5NbO3]1−x–[LiTaO3]x, x = 0.06, were produced using a mixed-oxide process. Phase analysis indicated the formation of an orthorhombic solid solution at 800 °C, which coexisted with intermediate binary niobate and tantalate phases. A tetragonal main-phase solid solution was formed at ⩾950 °C, along with minor quantities of a tungsten bronze phase. Addition of 3 wt% excess alkali carbonates to the starting powders allowed the orthorhombic solid solution to be retained to 1100 °C and prevented formation of the secondary tungsten bronze phase. Elemental chemical analysis confirmed changes in alkali oxide composition, consistent with volatilization losses, particularly of potassium and lithium oxides. Phase stability near the reported morphotropic phase boundary is shown to be sensitive to alkali oxide content.
Thermodynamic aspects of epitaxial self-assembly and magnetoelectric response in multiferroic nanostructures
Authors: Slutsker Julia , Tan Zhuopeng , Roytburd Alexander L. , Levin Igor
Published: August 2007

A thermodynamic approach was used to describe the formation and magnetoelectric response of composite multiferroic films. Experimental and theoretical results that address the origins of different phase morphologies in epitaxial spinel-perovskite nanostructures grown on differently oriented substrates are presented. A theoretical model of magnetoelectric coupling in multiferroic nanostructures that considers a microscopic mechanism of magnetization in single-domain magnetic nanorods is described. This model explains a discontinuous electromagnetic coupling, as observed experimentally, and predicts a hysteretic behavior of magnetization under external electric fields.
Thickness control of solution deposited YBCO superconducting films by use of organic polymeric additives
Authors: Morlens S. , Romà N. , Ricart S. , Pomar A. , Puig T. , Obradors X.
Published: August 2007

We show that the thickness of yttrium–barium–copper–oxide (YBCO) superconducting films grown from trifluoroacetate precursors can be strongly modified using polymeric additives, while deposition conditions by spin or dip coating remain unchanged. A screening of different families of organic additives has been performed, and the best results have been achieved using polymers having an oxygen functionalized backbone. Two different polymeric additives, polyvinyl pyrrolidone (PVP) and poly(ethylene glycol) (PEG), have been more thoroughly investigated, and thermal analysis suggests that PEG is the most promising alternative because the pyrolysis step of the new complex precursors remains sharp and narrow and hence the final homogeneity of the film is preserved. The combination of anhydrous trifluoroacetic acid (TFA) solutions and poly(ethylene-glycol) (PEG8000) as additive can produce an increase of the YBCO film thickness up to 300%, while keeping a fast pyrolysis process and high critical current densities.
Magnetic characterization of polyvinyl alcohol ferrogels and films
Authors: Hernández Rebeca , López German , López Daniel , Vázquez Manuel , Mijangos Carmen
Published: August 2007

This study elucidates the tunability of the magnetic properties of cobalt spinel ferrites embedded in a polyvinyl alcohol (PVA) hydrogel by changing the structure of the polymer network. We report on the preparation and characterization of sPS-CoFe2O4 ferrofluid and PVA/sulfonated polystyrene (sPS)-CoFe2O4 ferrogels obtained by submitting the samples to a different number of freezing–thawing (F–T) cycles. The magnetic properties were evaluated and interpreted as a function of the PVA/sPS-CoFe2O4 composition and final structure of the ferrogels.
Lapatinib-Associated Toxicity and Practical Management Recommendations
Authors: Moy Beverly , Goss Paul E.
Published: August 2007

Learning Objectives

After completing this course, the reader will be able to: Discuss lapatinib-associated toxicities and provide practical management recommendations based on available data.Describe the mechanism of action of lapatinib.Discuss the breast cancer clinical trial data for lapatinib.

CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com
Erlotinib in Non-Small Cell Lung Cancer Treatment: Current Status and Future Development
Authors: Gridelli Cesare , Bareschino Maria Anna , Schettino Clorinda , Rossi Antonio , Maione Paolo , Ciardiello Fortunato
Published: August 2007

Learning Objectives

After completing this course, the reader will be able to: Describe the molecular mechanism of action of erlotinib.Define clinical and molecular predictors of response to erlotinib.Describe the clinical trials performed with erlotinib in NSCLC and underline future clinical development of this drug in the treatment of NSCLC.

CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com
Soybean Root Distribution Related to Claypan Soil Properties and Apparent Soil Electrical Conductivity
Authors: Myers D. Brenton , Kitchen Newell R. , Sudduth Kenneth A. , Sharp Robert E. , Miles Randall J.
Published: July 2007

Soybean [Glycine max (L.) Merr.] yield in claypan soils varies systematically with soil properties and landscape position. This is likely caused by soil interactions with soybean roots. Field observations of soybean root distribution are needed to reveal its effect on yield variability. This study examined profile distributions of soybean root length density (RLD) and average root diameter (ARD) as a function of landscape position, depth to claypan (DTC), apparent soil electrical conductivity (ECa), clay‐maximum translated depth (Dt), and other soil properties. A landscape of claypan soils was sampled postharvest at two sites near Centralia, MO, in 2001. Roots were washed from soil cores in 15‐cm layers (15–120 cm) and measured with image analysis. Root length density and ARD were significantly related to landscape position, DTC, Dt, and ECa Predictions of RLD and ARD were best from 15 to 60 cm, the depths with the greatest influence from claypan soil morphology. Soil profile distributions of base cations, P, and pH matched root density profiles. Soybean roots were inhibited in E horizons above the claypan and stimulated 20 to 40 cm below it. Soybean roots below the claypan had about 20 to 30% smaller diameter. We conclude that DTC and rapid estimators of claypan morphology, such as ECa, can be used to predict soybean root distribution in claypan soil landscapes.
Genetic Analysis of Indirect Selection for Winter Wheat Grain Yield Using Spectral Reflectance Indices
Authors: Prasad B. , Carver B. F. , Stone M. L. , Babar M. A. , Raun W. R. , Klatt A. R.
Published: July 2007

Selection criteria that can facilitate grain yield improvement would be considered important plant breeding tools. We assessed the value of spectral reflectance indices (SRI) as indirect selection tools for grain yield improvement in winter wheat (Triticum aestivum L.). The objectives of this study were to estimate genetic correlation between SRI and grain yield, heritability, response to selection, correlated response of grain yield, and relative selection efficiency of SRI for grain yield improvement. Three field experiments consisting of 25 winter wheat cultivars and 2 sets of 25 recombinant inbred lines were conducted in the Oklahoma State University Agronomy Farm for 2 yr. Eight SRI were calculated at three growth stages (booting, heading, and grain‐filling). The water‐based indices (water index and normalized water indices) showed moderate to high heritability and higher genetic correlations with grain yield compared to the commonly used vegetation‐based indices (normalized difference vegetation index and simple ratio). The water‐based indices also showed higher correlated response than direct response for grain yield. Up to 83% of the top 25% highest‐yielding genotypes were selected by the two newly developed water‐based indices (normalized water index 3 [NWI‐3] and normalized water index 4 [NWI‐4]). These results suggest the strong genetic basis of NWI‐3 and NWI‐4 as potential selection tools for winter wheat grain yield improvement under Great Plains conditions.
Characterization of Pigmentation and Cellulose Synthesis in Colored Cotton Fibers
Authors: Hua Shuijin , Wang Xuede , Yuan Shuna , Shao Mingyan , Zhao Xiangqian , Zhu Shuijin , Jiang Lixi
Published: July 2007

Naturally colored cotton (Gossypium hirsutum L.) fibers (CCFs) are of interest in the textile industry because they require little dyeing and result in less environmental pollution. Pigmentation is one of the most important factors that differentiate CCFs from white cotton fiber (WCF) during fiber maturation. Many factors are involved in pigmentation, some of which we compared between CCFs and WCF with isogenetic backgrounds. These included the type of pigment, the activity of phenylalanine ammonia lyase (PAL), the concentration of total carbohydrates, and the type of soluble saccharide. We aimed to determine the causes of different fiber colors and found that flavonoids were the dominant type of pigment in the CCFs. At maturity (50 d post anthesis [DPA]), the WCF had only about 1/3 the amount of flavonoids as the brown cotton fiber (BCF) and 1/10 that of the green cotton fiber (GCF). During the course of fiber maturation (in particular, the stage before 8 DPA), CCFs had much higher PAL activity than the WCF. Of the fibers, the GCF had the highest concentration of carbohydrates over the course of maturation. However, higher concentrations of total carbohydrates did not always lead to higher concentrations of cellulose. This was very likely due to the synthesis of flavonoids and their derivatives consuming a large amount of carbohydrates that otherwise might be used for the synthesis of cellulose.
Evaluating stakeholder involvement in river basin planning: a Scottish case study
Authors: Blackstock Kirsty L. , Richards Caspian
Published: July 2007

River basin management demonstrates the increasing importance of active stakeholder involvement within environmental governance, whereby planning and implementation relies on outcomes from collective reasoned discussion. However, claims that stakeholder involvement improves environmental governance are rarely subject to critical examination. This lack of evaluation is problematic for several reasons including: lack of reflection on the purpose of involvement processes or their limitations; a poor conceptualisation of who should be defined as a stakeholder; how different knowledge claims should be treated; and how power relationships affect the process dynamics. This paper engages with the theoretical claims for active involvement and uses a Scottish case study to illustrate to what extent these claims were met during a river basin planning process. The evaluation highlights lessons for policy makers designing river basin management plans, particularly in the context of the pressing timetable for the implementation of the European Water Framework Directive. These lessons include how to maximise these benefits whilst proactively managing conflicts that occur, particularly when trying to sustain a coalition of individuals representing broader organisations and constituencies in a time-consuming and challenging process.
Sink or Swim? Water security for growth and development
Authors: Grey David , Sadoff Claudia W.
Published: July 2007

Achieving basic water security, both harnessing the productive potential of water and limiting its destructive impact, has always been a societal priority. To capture this duality, water security is defined here as the availability of an acceptable quantity and quality of water for health, livelihoods, ecosystems and production, coupled with an acceptable level of water-related risks to people, environments and economies. This paper looks broadly at those countries that have achieved water security, the paths they chose and the costs they paid, and those countries that have not achieved water security and how this constrains economies and societies. It defines three typologies: countries that have harnessed hydrology, those hampered by hydrology and those that are hostage to hydrology. It finds that countries remaining hostage to hydrology are typically among the world's poorest. They face “difficult” hydrologies often characterized by high inter- and intra-annual rainfall and runoff variability, where the level of institutional and infrastructure investment needed is very high and the ability to invest is low.

This paper seeks to capture the dynamics of achieving water security in a hypothetical water and growth “S-curve”, which illustrates how a minimum platform of investments in water institutions and infrastructure can produce a tipping point beyond which water makes an increasingly positive contribution to growth and how that tipping point will vary in different circumstances. As there are inevitable trade-offs, achieving water security is never without social and environmental costs; in some countries these are significant, often unforeseen and even unacceptable. This brief analysis suggests that the only historically demonstrated path to achieving water security at the national level has been through investment in an evolving balance of complementary institutions and infrastructure, but that lessons exist for following this basic path in more sustainable and balanced ways. Insights are provided for balancing and sequencing investments, adapting to changing values and priorities, and pushing down the social and environmental costs.

The paper concludes that most water-insecure countries today face far greater challenges than those that achieved water security in the last century and are wealthy countries today. They face more difficult hydrologies and a greater understanding of and therefore greater responsibility for, the social and environment trade-offs inherent in water management. As the costs of poor countries not achieving water security, in terms of human suffering, sustained poverty, constrained growth and social unrest, would be very high, achieving water security is a challenge that must be recognized and must be met.
Determination of norfloxacin in pharmaceuticals, human serum, and urine using a luminol—dissolved oxygen chemiluminescence system
Authors: Shao X. , Liu H. , Gao X. , Chen W. , Song Z.
Published: August 2007

A sensitive chemiluminescence method, based on the enhancive effect of norfloxacin on the reaction between luminol and dissolved oxygen in a flow injection system, was proposed for the determination of norfloxacin. The increment of the chemiluminiscence intensity was proportional to the concentration of norfloxacin, giving a calibration graph linear over the concentration from 0.4 ng mL−1 to 400.0 ng mL−1 (r 2 = 0.9988) with the detection limit of 0.1 ng mL−1 (3 × σ noise). At the flow rate of 2.0 mL min−1, a complete determination of norfloxacin, including sampling and washing, could be accomplished in 30 s with the relative standard deviation lower than 3.0 %. The proposed method was applied successfully to determine norfloxacin in pharmaceuticals, human urine, and serum. Possible mechanism of the reaction was also discussed.
The Upper Airways: Interface between the Lungs and the Ambient Air
Authors: Proctor Donald F.
Published: July 2007

The upper airways provide access for ambient air to the lungs, and the nasal passages carry out physiologic functions both different from and supplemental to those of the lower conducting airways. They are the first target of and the first line of defense against airborne disease. For their protection, it is important to understand those environmental factors that may lead to their injury.
Antihistamines: Findings in Clinical Trials Relevant to Therapeutics
Authors: Connell John T. , Howard J. Campbell , Dressier William , Perhach James L.
Published: July 2007

Antihistamine therapy reduces hay fever symptoms 50–60% within 5 hours after the first dose. Treatment for 9 days maintains but does not reduce symptoms further. Patients treated with placebo for 8 days and then treated with chlorpheniramine obtained as much relief by the 5th hour after treatment as those treated with chlorpheniramine for 9 days. Increasing the dose of any antihistamine we tested over that necessary for maximal relief produces no greater benefit. Antihistamine treatment doses currently recommended may be greater than necessary for most patients. Antihistamines do not reduce nasal congestion and are not decongestants.
The use of Silastic Prosthetics in the Reconstruction of Nasal Facial Deformities
Authors: Moore Gary F. , Howe C. Scott , Yonkers Anthony J.
Published: July 2007

Maxillofacial deformities resulting from the loss of tissue from the midfacial region may cause serious disfigurement. Modern facial plastic reconstructive techniques have been able to produce satisfactory results in the reconstruction of many of these facial deformities. There are specific indications where the use of a silastic prosthetic device may have a distinct advantage over a surgical reconstruction. Shortened hospitalization, early rehabilitation, decreased morbidity, and an excellent access to the surgical site for follow-up of cancer resection patients are important advantages when considering prosthetic rehabilitation. This technique does not supplant established surgical facial reconstructive methods, but offers a valuable adjunct for reconstruction of extensive lesions caused either by trauma or surgical resection.
Systemic Diseases Associated with Nasal Symptoms
Authors: Settipane Guy A.
Published: July 2007

Many systemic diseases are associated with nasal symptoms, Rhinitis associated with asthma is probably the most common with leprosy and fungal infections being the rarest.

A careful history and nasal examination in a patient with rhinitis may lead to the discovery of more significant systemic diseases. Proper treatment of systemic disease will often cure or improve the associated rhinitis. Similarly, appropriate treatment of the rhinitis/sinusitis may reduce systemic complaints such as asthma. At times, identification of the cause of rhinitis as in CSF rhinorrhea, Wegeners’ syndrome, etc., alerts one to a life-threatening entity.

Thus, it is apparent that the nose is an excellent mirror of some systemic diseases and identifying and understanding the differential diagnosis of nasal symptoms may be a tremendous help in diagnosing the disease and treating the whole patient.
The Influence of Evolution upon the Functional Development of the Lateral Wall of the Nose
Authors: Smersh Thomas C.
Published: July 2007

The nose has played a surprisingly critical role repeatedly in adaptation and survival of the vertebrate family line, in olfaction to detect food and predators, in respiration in adaptation to terrestrial existence, and in preservation of homeostasis in severe climatic changes as in the great ice ages that destroyed the giant reptiles. Most importantly to us, the study of evolutionary development will provide insight into human anatomy and physiology and is an aid in the management of medical and surgical treatment of nasal disease.
Complications of Endoscopic Nasal Surgery: Occurrence and Treatment
Authors: Stankiewicz James A.
Published: July 2007

A consecutive series of 80 patients undergoing endoscopic nasal sinus surgery was reviewed. There were 25 complications (31%) in 19 patients in this group. Eight complications (10%) including CSF leak, temporary blindness, and hemorrhage were considered major with the latter occurring most commonly. Synechiae were the most commonly occurring minor complication.

Endoscopic nasal sinus surgery performed by inexperienced operators carries with it the same risks and complications as traditional intranasal sinus surgery. Any surgeon who does not routinely perform traditional intranasal ethmoidectomy should accrue endoscopic experience through appropriate didactic training and multiple cadaver dissections (akin to otologic training).
Mediators of Anaphylaxis, Anaphylactoid Reactions, and Rhinitis
Authors: Mathews Kenneth P.
Published: July 2007

Besides histamine, a large and increasing number of mediators of allergic reactions are being found to be released by mast cells or basophils during anaphylactic reactions. Many of these same substances are released by stimuli other than allergen-IgE interactions, and this type of phenomenon (anaphylactoid or pseudo-allergic reaction) may account for some nasal symptoms that simulate allergy. In addition to rapidly developing reactions of these types, numerous recent investigations have emphasized the importance of late-phase reactions that occur as a consequence of the immediate reactivity. Besides mast cells and/or basophils, these late effects seem to involve a complex network of cellular interactions, which may include neutrophils, eosinophils, lymphocytes, macrophages, and platelets.

Studies of nasal washings following allergen challenges in humans have provided cogent in vivo support of earlier hypotheses about mediator release based on in vitro experimentation.
Epiphora: The Role of Rhinitis
Authors: Kubba Haytham , Robson Andrew K. , Bearn Michael A.
Published: July 2007

Inflammation in the nasal mucosa may lead to epiphora by causing edema around the orifice of the nasolacrimal duct. We present and discuss three cases where simple treatment of rhinitis led to the resolution of the presenting symptom of epiphora, avoiding the need for surgery. A randomized prospective trial of topical nasal corticosteroids in the management of epiphora associated with rhinitis is in progress.
Brompheniramine Maleate: A Double-Blind, Placebo-Controlled Comparison with Terfenadine for Symptoms of Allergic Rhinitis
Authors: Thoden William R. , Druce Howard M. , Furey Sandy A. , Lockhart Earle A. , Ratner Paul , Hampel Frank C. , van Bavel Julius
Published: July 2007

This was a double-blind, randomized, placebo-controlled, multicenter, parallel study comparing the effectiveness, at recommended doses, of an extended-release formulation of brompheniramine maleate and terfenadine in the treatment of allergic rhinitis. Subjects with symptoms of seasonal and/or perennial allergic rhinitis received brompheniramine 12 mg (n = 106), 8 mg (n = 105), terfenadine 60 mg (n = 106), or placebo (n = 53) twice daily for 14 days. On treatment days 3, 7, and 14, symptom severity ratings (i.e., rhinorrhea, sneezing, nasal congestion, itchy nose, eyes or throat, excessive tearing, postnasal drip) were completed by the physician; subjects and physicians each completed a global efficacy evaluation. Brompheniramine 12 mg and 8 mg and terfenadine were more effective than placebo (p ≤ 0.05) on the physicians’ global; brompheniramine 12 mg was more effective than terfenadine (p ≤ 0.05) on days 7 and 14 and brompheniramine 8 mg on day 3. On the subjects’ global evaluation, brompheniramine 12 mg and 8 mg and terfenadine were more effective than placebo (p ≤ 0.05); brompheniramine 12 mg was more effective than terfenadine (p ≤ 0.05) on days 7 and 14 and brompheniramine 8 mg on day 3. In general, brompheniramine 8 mg was comparable to terfenadine. On days 3 and 7, the total symptom and total nasal symptom severity scores for subjects receiving brompheniramine 12 mg were significantly more improved than for placebo (p < 0.05); terfenadine was not different from placebo; brompheniramine 12 mg was significantly better than terfenadine on day 7 (p < 0.05) for reducing total symptom severity and on days 3, 7, and 14 for reducing total nasal symptom severity. Adverse experiences were reported by 155 (41.9%) of the 370 subjects enrolled in the study. The overall rate of adverse experiences in the brompheniramine 12 mg treatment group (57.5%) was significantly greater (p < 0.05) than for brompheniramine 8 mg (38.1%), terfenadine (31.1%), and placebo (39.6%). In conclusion, an extended-release formulation of brompheniramine 12 mg or 8 mg bid alleviates allergic rhinitis symptoms and brompheniramine 12 mg provides significantly better relief of these symptoms than terfenadine 60 mg bid.
A Study of the Association between Epistaxis and the Severity of Hypertension
Authors: Lubianca-Neto José F. , Bredemeier Markus , Carvalhal Eduardo F. , Arruda Cristina A. , Estrella Eduardo , Pletsch Aline , Gus Miguel , Lu Leonard , Fuchs Flávio D.
Published: July 2007

Hypertension (HTN) has frequently been cited as a general risk factor for epistaxis. However, studies dealing with this association have yielded equivocal results. In this study, a sample of 121 hypertensives (blood pressure ≥ 140/90 mmHg) was selected to evaluate the association between the severity of HTN and a previous history of epistaxis. Patients with an average blood pressure ≥ 160/100 mmHg were classified as suffering from a more severe form of HTN and were compared with those with a less severe form of the disease (160/100 mm Hg ≤ blood pressure ≥ 140/90 mm Hg). The frequency of epistaxis did not differ among patients categorized by the severity of HTN. Users of aspirin were found to be twice as likely to have a history of epistaxis. In addition, there was a statistical tendency for an association between a history of epistaxis and the duration of hypertension. We conclude that the severity of HTN and a history of epistaxis were not associated in a cohort of hypertensive patients. The identification of other risk factors for epistaxis, including the duration of HTN, deserves further study.
Rhinocerebral Mucormycosis Caused by Apophysomyces Elegans
Authors: Brown Sheldon R. , Shah Ifat A. , Grinstead Marie
Published: July 2007

Mucormycosis is an uncommon fungal disease and one of the most fulminant infections known. This is the second report of rhinocerebral mucormycosis caused by Apophysomyces elegans, a newly recognized genus and species classified in the family Mucoraceae. The patient was a 54-year-old man being treated for a severe sinus infection with antibiotics and oral steroids. Recovery occurred in our patient after prompt surgical debridement and drainage of his maxillary sinuses. This case fits the reported characteristics of other A. elegans infections including warm climate, intimate contact with the soil, and an incubation period measured in days. Several reported cases indicate A. elegans can cause mucormycosis in immunocompetent individuals with no underlying medical problems.
Endoscopically Guided Cultures in Chronic Sinusitis
Authors: Nadel Douglas M. , Lanza Donald C. , Kennedy David W.
Published: July 2007

In chronic sinusitis, culture-directed antibiotics are often recommended as a cornerstone of treatment. The significance of Gram-negative rods (GNRs), coagulase-negative Staphylococci (SCN), and Staphylococcus aureus has been controversial. In an effort to determine host factors which correlate with culture results, 507 endoscopically-guided cultures are reviewed from 265 patients. A history of asthma, allergic rhinitis, prior sinus surgery, and the concurrent use of antibiotics, steroids, and irrigations were some of the host factors compared by X2. The results were compared to a control group of 50 cultures from healthy volunteers. SCN, S. aureus, P. aeruginosa, and Streptococcus were the most common isolates. GNRs were present in 27% of cultures and were more common in patients who had prior sinus surgery or were using irrigations. P. aeruginosa was more common in patients taking systemic steroids. SCN occurred with the same incidence in patients and control subjects but was more prevalent in cultures obtained intraoperatively and in patients taking systemic steroids. No identifiable host factor was associated with S. aureus. S. aureus occurred at similar rates in patients and control subjects but grew heavily in patients and exhibited only light growth in controls. Topical nasal steroids appear to have no statistically significant effect on bacterial cultures. Findings from this study further our understanding of chronic sinusitis and may help guide practitioners in the treatment of this disease.
Functional Endoscopic Sinus Surgery: Do Ratings of Appropriateness Predict Patient Outcomes?
Authors: Jones Michele L. , Piccirillo Jay F. , Haiduk Andrea , Thawley Stanley E.
Published: July 2007

Sinus surgery appropriateness ratings were recently developed by Value Health Sciences in cooperation with AAO-HNS. The goal of this study was to assess the relationships among three ratings of sinus surgery appropriateness (Appropriate, Inappropriate, or Equivocal) and symptom response. The enrolled population included 49 patients who completed the Sino-Nasal Outcome Test-20 (SNOT-20) presurgery and 6 months postsurgery. The SNOT-20 is a patient-based measure of sinusitis-related health status and quality of life. Overall, the mean percent difference (Δ%) between pre- and postsurgery SNOT scores was 38%, a statistically and clinically significant improvement. However, there was no relationship between the appropriateness rating for the surgery and the Δ% SNOT score (F = 1.83, p-value = 0.171); 20 patients with an Equivocal rating demonstrated the greatest Δ% (49%), 20 patients with an Appropriate rating showed the least Δ% (26%), and 9 patients with an Inappropriate rating had an intermediate Δ% (39%). Furthermore, those patients having an Appropriate rating at the time of surgery reported a greater persistence of bothersome symptoms at 6 months (p-value = 0.02) then patients in either the Equivocal or Inappropriate rating. These results suggest that appropriateness ratings may not predict which patients will obtain the greatest symptom improvement from sinus surgery.
Transnasal Endoscopic Approach to the Sella Turcica
Authors: Aust Michelle R. , McCaffrey Thomas V. , Atkinson John
Published: July 2007

The transseptal/transsphenoidal approach to the pituitary gland has been the most commonly used approach for resection of pituitary adenomas for the last 50 years. This procedure has a low morbidity and provides direct midline access to the sella and pituitary gland. Recent advancements in endoscopic surgery, however, suggest that a lower morbidity approach to the sella would be possible via transnasal endoscopic route. Prior reports have confirmed effectiveness of this approach to the pituitary gland and we report here an early series of endoscopic transnasal pituitary surgery from our institution. We report seven cases of transnasal endoscopic pituitary surgery. Our technique consists of endoscopic exposure of the sphenoid ostium unilaterally, excision of the posterior septum anterior to the rostrum of the sphenoid sinus with resection of the sphenoid rostrum for bilateral exposure of the sphenoid sinus. A specially designed nasal speculum is positioned to displace the posterior septum and lateralize the middle turbinates, permitting direct midline exposure of the sphenoid sinus and sella. We have progressively modified the technique over the seven cases that we present and will discuss our specific instrumentation, indications, and technique for this procedure. We have encountered one cerebrospinal fluid leak in this series. Patient satisfaction has been high and hospitalization is less than with the conventional transseptal approach, averaging 1 day. Our impression is that the transnasal endoscopic approach to pituitary adenomas is a safe technique with reduced morbidity permitting shortened hospital stay.
Comprehensive Management of Allergic Fungal Sinusitis
Authors: Marple Bradley F. , Mabry Richard L.
Published: July 2007

In little more than a decade, allergic fungal sinusitis has gone from a medical curiosity to one of the more perplexing problems to challenge the otorhinolaryngologist. These patients are typically immunocompetent adolescents or young adults with pansinusitis (unilateral and bilateral) and polyposis, atopy, and characteristic radiographic findings. Allergic mucin contained within the sinuses demonstrates numerous eosinophils and Charcot-Leyden crystals, and fungal stains show the presence of noninvasive hyphae. Fungal cultures may or may not be positive. We have found the following approach to allergic fungal sinusitis to be most effective: 1) Adequate preoperative evaluation and medical preparation; 2) Meticulous exenterative surgery; 3) Closely supervised immunotherapy with relevant fungal and non-fungal antigens; 4) Medical management including topical and systemic corticosteroids as needed; 5) Irrigation and self-cleansing by the patient; and 6) Close clinical follow-up with endoscopically guided debridement when necessary.
Chronic Sinusitis: A Sequela of Inferior Turbinectomy
Authors: Berenholz Leonard , Kessler Alex , Sarfati Shlomo , Eviatar Ephraim , Segal Samuel
Published: July 2007

Inferior turbinectomy has generated a great deal of controversy among rhinologic surgeons. Proponents of partial and total inferior turbinectomy cite numerous studies of large numbers of patients with subjective relief of nasal obstruction after turbinectomy. Clinical studies critical of turbinectomy have focused on complications such as hemorrhage, crusting, adhesions, and atrophic rhinitis. Our study was undertaken to evaluate the incidence of chronic sinusitis post inferior turbinectomy. Postoperative evaluation by history, physical examination, and computerized tomography of the paranasal sinuses revealed that a significant number of patients who underwent inferior turbinectomy developed sinusitis. Patients evaluated in our clinic for nasal obstruction underwent a detailed history, physical examination along with nasal endoscopy and coronal computerized tomography of the paranasal sinuses. Those patients with nasal obstruction not responsive to medical treatment and without evidence of sinusitis underwent submucous resection and inferior turbinectomy. The incidence, cause, and possible prevention of post inferior turbinectomy sinusitis is discussed in this article.
Antimicrobial Resistance in Bacterial Chronic Sinusitis
Authors: Hsu John , Lanza Donald C. , Kennedy David W.
Published: July 2007

Recent reports describe the emergence of antimicrobial resistant bacteria in acute sinusitis and an increased incidence of enteric gram negative bacilli in chronic sinusitis. The objective of this cross sectional study is to identify the emergent resistance patterns in bacterial chronic sinusitis. Specifically, this article seeks to characterize the bacteriology of outpatient chronic sinusitis, then to compare the antimicrobial susceptibilities of the bacterial isolates with standard culture data from a tertiary care center. Between March and August, 1994, 113 new outpatients presented with chronic sinusitis at a major teaching institution. Of these patients 34 underwent endoscopically guided aerobic culture of the paranasal sinuses and nasal cavities. Of the 48 total cultures, there were 43 positive cultures yielding 72 isolates. Thirty-eight cultures had two or fewer isolates; four cultures had three plus isolates, and one culture grew out normal flora. The most frequently isolated organisms were coagulase negative Staphylococcus (SCN), 20 (28%); Pseudomonas aeruginosa, 12 (17%); and Staphylococcus aureus, 9 (13%). Within the limited sample size for each isolate, Staphylococcus coagulase negative, Pseudomonas, and Pneumococcus demonstrated higher antimicrobial resistance compared to the medical center's corresponding nonurinary isolates. Additionally, three of six patients with Pseudomonal aeruginosa (50%) had a quinolone resistant strain. These preliminary data suggest that both an increased incidence of antimicrobial resistance and of enteric gram negative bacilli may exist in these outpatient, tertiary care center patients with chronic bacterial sinusitis.
Effects of IL-1β, TNF-α, and TGF-β on Proliferation of Human Nasal Epithelial Cells in Vitro
Authors: Min Yang-Gi , Rhee Chae-Seo , Kwon Sam-Hyun , Lee Kang Soo , Yun Ja Bock
Published: July 2007

Previous reports suggest that cytokines may be involved in proliferation of the epithelium. The aim of this study was to determine the effects of cytokines, IL-1β, TNF-α, and TGF-β on proliferation of human nasal epithelial cells (HNECs) in vitro. Primary cells were cultured from HNECs on collagen gel matrix. Subcultured HNECs were incubated in a medium with recombinant human (rh) cytokines, rhIL-1β, rhTNF-a, and rhTGF-β at different concentrations of 0.01 ng/mL, 0.1 ng/mL, 1 ng/mL, 10 ng/mL, and 100 ng/mL. After 2-day incubation with these cytokines, daily cell proliferation was measured by MTT assay for 6 days. While rhIL-1β inhibited proliferation of HNECs in concentration-dependent and time-dependent manners, rhTNF-a stimulated HNEC growth at concentrations ranging from 0.01 ng/mL to 10 ng/mL in concentration-dependent and time-dependent manner. In contrast, rhTGF-b inhibited HNEC growth irrespective of concentration and incubation time. This study suggests that IL-1β, TNF-α, and TGF-β may have an important role in the repair of the nasal mucosa by regulating proliferation of the nasal epithelium.