bluuebunny/crossref_metadata_2025 huggingface dataset:
Candidate Gene Polymorphisms Do Not Differ Between Newborns With Stroke and Normal Controls
Authors: Miller Steven P. , Wu Yvonne W. , Lee Janet , Lammer Edward J. , Iovannisci David M. , Glidden David V. , Bonifacio Sonia L. , Collins Abigail , Shaw Gary M. , Barkovich A. James , Ferriero Donna M.
Published: September 2006

Background and Purpose—

Neonatal stroke is increasingly recognized with an estimated incidence of one in 4000 live births per year. Pathways involved in the pathophysiology of neonatal stroke are diverse and may include thrombosis and thrombolysis, vascular reactivity, and inflammation.

Methods—

We compared frequencies of polymorphisms in genes regulating thrombosis and thrombolysis, nitric oxide, cytokines, vascular tone, and cell adhesion in a hospital-based cohort of 59 newborns with stroke relative to a random sample of 437 California newborns.

Results—

Of the 31 polymorphisms evaluated, no variant allele was significantly more common than the reference allele in newborns with stroke than in the general population.

Conclusions—

Using a series of polymorphisms in pathways implicated in the etiology of stroke, newborns with stroke were not distinguished from a normal control group. Further studies are needed to determine the interaction of genetic polymorphisms with environmental risk factors in the pathogenesis of neonatal stroke.
Direct Demonstration That Repetitive Transcranial Magnetic Stimulation Can Enhance Corticospinal Excitability in Stroke
Authors: Di Lazzaro Vincenzo , Dileone Michele , Profice Paolo , Pilato Fabio , Cioni Beatrice , Meglio Mario , Capone Fioravante , Tonali Pietro A. , Rothwell John C.
Published: September 2006

Background and Purpose—

Preliminary studies suggest that electrical stimulation of the damaged cortex may be able to enhance motor recovery after stroke. The hypothesis has been that this increases cortical excitability, making it easier for the system to respond to and learn from conventional physiotherapy. However, there is no direct evidence that the cortex of patients with stroke can respond in this fashion; hence, the basis of these new approaches has been questioned.

Methods—

We had the opportunity to evaluate directly the effects of noninvasive cortical stimulation on the excitability of corticospinal output from the damaged hemisphere of a chronic stroke patient who had epidural electrodes implanted in the upper dorsal cord for treatment of pain.

Results—

We found that it was possible to enhance corticospinal activity evoked by single test stimuli.

Conclusions—

This study confirms directly that it is possible to noninvasively manipulate cortical excitability in stroke.
Economic Evaluation of Australian Stroke Services
Authors: Moodie Marjory , Cadilhac Dominique , Pearce Dora , Mihalopoulos Cathrine , Carter Robert , Davis Stephen , Donnan Geoffrey
Published: September 2006

Background and Purpose—

Level I evidence from randomized controlled trials demonstrates that the model of hospital care influences stroke outcomes; however, the economic evaluation of such is limited. An economic appraisal of 3 acute stroke care models was facilitated through the Stroke Care Outcomes: Providing Effective Services (SCOPES) study in Melbourne, Australia. The aim was to describe resource use up to 28 weeks poststroke for each model and examine the cost-effectiveness of stroke care units (SCUs).

Methods—

A prospective, multicenter, cohort study design was used. Costs and outcomes of stroke patients receiving 100% treatment in 1 of 3 inpatient care models (SCUs, mobile service, conventional care) were compared. Health-sector resource use up to 28 weeks was measured in 1999. Outcomes were thorough adherence to a suite of important clinical processes and the number of severe inpatient complications.

Results—

The sample comprised 395 participants (mean age 73 [SD 14], 77% first-ever strokes, males 53%). When compared with conventional care (n=84), costs for mobile service (n=209) were significantly higher (
P
=0.024), but borderline for SCU (n=102,
P
=0.08; $AUD12 251; $AUD15 903; $AUD15 383 respectively). This was primarily explained by the greater use of specialist medical services. The incremental cost-effectiveness of SCUs over conventional care was $AUD9867 per patient achieving thorough adherence to clinical processes and $AUD16 372 per patient with severe complications avoided, based on costs to 28 weeks.

Conclusions—

Although acute SCU costs are generally higher, they are more cost-effective than either mobile service or conventional care.
Plasma S100B Level After Acute Spontaneous Intracerebral Hemorrhage
Authors: Delgado Pilar , Alvarez Sabin Jose , Santamarina Esteban , Molina Carlos A. , Quintana Manuel , Rosell Anna , Montaner Joan
Published: September 2006

Background and Purpose—

We sought to determine plasma S100B level after acute (<24 hours) spontaneous intracerebral hemorrhage (ICH) and to study its relation with neurological outcome.

Methods—

We determined S100B concentration on plasma samples from 78 ICH patients on admission. Clinical (Glasgow Coma Scale and National Institutes of Health Stroke Scale [NIHSS] scores) and radiological information (ICH and perihematomal edema volumes) were collected at baseline and follow-up visits. Early neurological deterioration, defined as the increase of ≥4 points in the NIHSS score at 48 hours, and unfavorable outcome (modified Rankin Scale >2) at 3 months were also recorded.

Results—

The median S100B level was higher than our laboratory reference values for healthy controls (103.6 versus 48.5 pg/mL;
P
<0.001) and a positive correlation was observed between S100B level and baseline ICH volume (
r
=0.45;
P
<0.0001). The median S100B level was higher in patients who deteriorated early (256.8 versus 89.7 pg/mL;
P
=0.001) and also in patients with an unfavorable outcome (136 versus 75.9 pg/mL;
P
=0.003). Multivariate analysis showed baseline ICH volume as the best predictor for both early neurological deterioration (odds ratio 15; 95% CI, 2.9 to 76.3) and unfavorable outcome at 3 months (odds ratio 17; 95% CI, 2.0 to 142).

Conclusion—

Increased S100B level is found after acute spontaneous ICH, in association with a worse early and late evolution, and closely related to initial hematoma volume.
Cost-Effectiveness of Recombinant Activated Factor VII in the Treatment of Intracerebral Hemorrhage
Authors: Earnshaw Stephanie R. , Joshi Ashish V. , Wilson Michele R. , Rosand Jonathan
Published: September 2006

Background and Purpose—

Intracerebral hemorrhage (ICH) is among the most costly and debilitating forms of stroke. Results from a recent Phase IIb clinical trial demonstrate that administration of recombinant activated factor VII (rFVIIa) reduces ICH mortality and improves functional outcome. In the current analysis, we examine the cost-effectiveness of early treatment with rFVIIa for ICH in the United States.

Methods—

A decision-analytic model was developed to estimate the lifetime costs and outcomes associated with rFVIIa treatment at doses of 40, 80 and 160 μg/kg compared with current standard of care in treating ICH, from a US third-party payer perspective. The patient population was similar to that of the Phase IIb clinical trial. Model structure and inputs were obtained from published literature, clinical trial data, claims databases, and expert opinion. All costs are presented in 2005 US dollars. Outcomes included incremental cost per life-year (LY) saved and incremental cost per quality-adjusted life-year (QALY) gained. Costs and outcomes were discounted at 3% annually. Univariate and multivariate sensitivity analyses were conducted to assess model robustness.

Results—

Compared with standard care, treatment with rFVIIa 40 μg/kg, and 160 μg/kg results in total lifetime cost-effectiveness ratios of $6308/QALY and $3152/QALY, respectively. Treatment with rFVIIa 80 μg/kg was found to be cost saving and a gain of 1.67 QALYs is achieved over a patient’s lifetime. These results are robust to changes in input parameters.

Conclusions—

Treatment of ICH with rFVIIa 40 μg/kg and 160 μg/kg appears to be cost-effective (≤$50 000/QALY). At the 80 μg/kg dose, rFVIIa was not only cost-effective, but also cost saving.
Seeing without Objects: Visual Indeterminacy and Art
Authors: Pepperell Robert
Published: September 2006

This article discusses the perceptual phenomenon of visual indeterminacy in an art-historical and scientific context and considers the phenomenon's role in certain heightened states of awareness. Further philosophical implications of the phenomenon are discussed, specifically the suggestion that visual indeterminacy may point to an inherent contradiction in the relationship between mind and world. This discussion is then related to a body of artwork produced by the author over some 20 years. The article concludes that visual indeterminacy is a fruitful subject for further interdisciplinary research, as it draws on ideas from the arts, sciences and humanities.
A Software Interface between Human and Computer Virtual Players for Music Performance in Concert
Authors: Viñao Alejandro , Cross Ian
Published: September 2006

The authors discuss the collaborative process of creating a computer interface to enable live musicians and computers to play together without compromising the integrity of the music or the performance.
Spatial Audio Measurement, Modeling and Composition
Authors: Murphy Damian
Published: September 2006

The author presents the results of an exploration of spatial composition through acoustic measurement and modeling techniques. He discusses the capture of actual acoustic spaces and the use of such captures to create virtual acoustic landscapes, and describes a series of sound-works composed using the acoustic captures.
Data Assimilation as Synchronization of Truth and Model: Experiments with the Three-Variable Lorenz System*
Authors: Yang Shu-Chih , Baker Debra , Li Hong , Cordes Katy , Huff Morgan , Nagpal Geetika , Okereke Ena , Villafañe Josue , Kalnay Eugenia , Duane Gregory S.
Published: September 2006

The potential use of chaos synchronization techniques in data assimilation for numerical weather prediction models is explored by coupling a Lorenz three-variable system that represents “truth” to another that represents “the model.” By adding realistic “noise” to observations of the master system, an optimal value of the coupling strength was clearly identifiable. Coupling only the y variable yielded the best results for a wide range of higher coupling strengths. Coupling along dynamically chosen directions identified by either singular or bred vectors could improve upon simpler chaos synchronization schemes. Generalized synchronization (with the parameter r of the slave system different from that of the master) could be easily achieved, as indicated by the synchronization of two identical slave systems coupled to the same master, but the slaves only provided partial information about regime changes in the master. A comparison with a standard data assimilation technique, three-dimensional variational analysis (3DVAR), demonstrated that this scheme is slightly more effective in producing an accurate analysis than the simpler synchronization scheme. Higher growth rates of bred vectors from both the master and the slave anticipated the location and size of error spikes in both 3DVAR and synchronization. With less frequent observations, synchronization using time-interpolated observational increments was competitive with 3DVAR. Adaptive synchronization, with a coupling parameter proportional to the bred vector growth rate, was successful in reducing episodes of large error growth. These results suggest that a hybrid chaos synchronization–data assimilation approach may provide an avenue to improve and extend the period for accurate weather prediction.
Observed Boundary Layer Wind Structure and Balance in the Hurricane Core. Part II: Hurricane Mitch
Authors: Kepert Jeffrey D.
Published: September 2006

Part I of this paper presented a detailed analysis of the boundary layer of Hurricane Georges (1998), based mainly on the newly available high-resolution GPS dropsonde data. Here, similar techniques and data are used to study Hurricane Mitch (1998). In contrast to Hurricane Georges, the flow in the middle to upper boundary layer near the eyewall is found to be strongly supergradient, with the imbalance being statistically significant. The reason for the difference is shown to be the different radial structure of the storms, in that outside of the radius of maximum winds, the wind decreases much more quickly in Mitch than in Georges. Hurricane Mitch was close to inertially neutral at large radius, with a strong angular momentum gradient near the radius of maximum winds. Kepert and Wang predict strongly supergradient flow in the upper boundary layer near the radius of maximum winds in this situation; the observational analysis is thus in good agreement with their theory. The wind reduction factor (i.e., ratio of a near-surface wind speed to that at some level further aloft) is found to increase inward toward the radius of maximum winds, in accordance with theoretical predictions and the analysis by Franklin et al. Marked asymmetries in the boundary layer wind field and in the eyewall convection are shown to be consistent with asymmetric surface friction due to the storm’s proximity to land, rather than to motion. The boundary layer flow was simulated using Kepert and Wang’s model, forced by the observed storm motion, radial profile of gradient wind, and coastline position; and good agreement with the observations was obtained.
Hypusination of eukaryotic initiation factor 5A (eIF5A): a novel therapeutic target in BCR-ABL–positive leukemias identified by a proteomics approach
Authors: Balabanov Stefan , Gontarewicz Artur , Ziegler Patrick , Hartmann Ulrike , Kammer Winfried , Copland Mhairi , Brassat Ute , Priemer Martin , Hauber Ilona , Wilhelm Thomas , Schwarz Gerold , Kanz Lothar , Bokemeyer Carsten , Hauber Joachim , Holyoake Tessa L. , Nordheim Alfred , Brümmendorf Tim H.
Published: September 2006

Inhibition of BCR-ABL tyrosine kinase with imatinib represents a major breakthrough in the treatment of patients with chronic myeloid leukemia (CML). However, resistance to imatinib develops frequently, particularly in late-stage disease. To identify new cellular BCR-ABL downstream targets, we analyzed differences in global protein expression in BCR-ABL–positive K562 cells treated with or without imatinib in vitro. Among the 19 proteins found to be differentially expressed, we detected the down-regulation of eukaryotic initiation factor 5A (eIF5A), a protein essential for cell proliferation. eIF5A represents the only known eukaryotic protein activated by posttranslational hypusination. Hypusination inhibitors (HIs) alone exerted an antiproliferative effect on BCR-ABL–positive and –negative leukemia cell lines in vitro. However, the synergistic dose-response relationship found for the combination of imatinib and HI was restricted to Bcr-Abl–positive cells. Furthermore, this synergistic effect was confirmed by cytotoxicity assays, cell-cycle analysis, and CFSE labeling of primary CD34+ CML cells. Specificity of this effect could be demonstrated by cotreatment of K562 cells with imatinib and siRNA against eIF5. In conclusion, through a comparative proteomics approach and further functional analysis, we identified the inhibition of eIF5A hypusination as a promising new approach for combination therapy in BCR-ABL–positive leukemias.
CD33 responses are blocked by SOCS3 through accelerated proteasomal-mediated turnover
Authors: Orr Selinda J. , Morgan Nuala M. , Elliott Joanne , Burrows James F. , Scott Christopher J. , McVicar Daniel W. , Johnston James A.
Published: September 2006

CD33 is a member of the sialic acid–binding immunoglobulin-like lectin (Siglec) family of inhibitory receptors and a therapeutic target for acute myeloid leukemia (AML). CD33 contains a cytoplasmic immunoreceptor tyrosine-based inhibitory motif (ITIM), which can recruit SHP-1 and SHP-2. How CD33 expression is regulated is unclear. Suppressor of cytokine signaling 3 (SOCS3) is expressed in response to cytokines, LPS, and other PAMPs, and competes with SHP-1/2 binding to ITIMs of cytokine receptors, thereby inhibiting signaling. In this study, using peptide pull-down experiments, we found that SOCS3 can specifically bind to the phosphorylated ITIM of CD33. Additionally, following cross-linking SOCS3 can recruit the ECS E3 ligase resulting in accelerated proteasomal degradation of both CD33 and SOCS3. Our data suggest that the tyrosine motifs in CD33 are not important for internalization, while they are required for degradation. Moreover, SOCS3 inhibited the CD33-induced block on cytokine-induced proliferation. This is the first receptor shown to be degraded by SOCS3 and where SOCS3 and its target protein are degraded concomitantly. Our findings clearly suggest that during an inflammatory response, the inhibitory receptor CD33 is lost by this mechanism. Moreover, this has important clinical implications as tumors expressing SOCS3 may be refractory to α-CD33 therapy.
Parental smoking increases exhaled nitric oxide in young children
Authors: Franklin P. J. , Turner S. , Mutch R. , Stick S. M.
Published: September 2006

The present study investigated the association between reported parental smoking and exhaled nitric oxide fraction (FeNO) in young children.

In total, 78 children (24 females, mean age 51.3 weeks) were recruited. Fourteen lived with one smoking parent and eight with two smoking parents.FeNOwas measured using the modified single-breath technique.

Mean±sdFeNOlevels were 33.0±18.9, 38.3±15.0 and 48.3±14.7 ppb for children with no, one and two smoking parents, respectively. There was a significant linear trend across the groups and, after controlling for other relevant factors, a significant difference between the groups.

In the present study, exposure to environmental tobacco smoke was associated with increased exhaled nitric oxide fraction in young children. Furthermore, there was evidence of a dose–response relationship between childhood exhaled nitric oxide fraction and the number of smoking parents.
Advances in the diagnosis and management of chronic pulmonary aspiration in children
Authors: Boesch R. P. , Daines C. , Willging J. P. , Kaul A. , Cohen A. P. , Wood R. E. , Amin R. S.
Published: September 2006

Chronic pulmonary aspiration (CPA) in children is an important cause of recurrent pneumonia, progressive lung injury, respiratory disability and death. It is sporadic, intermittent and variable, and often occurs in children with complicated underlying medical conditions and syndromes that produce symptoms indistinguishable from CPA. For most types of aspiration there is no gold-standard diagnostic test. The diagnosis of CPA is currently made clinically with some supporting diagnostic evaluations, but often not until significant lung injury has been sustained. Despite multiple diagnostic techniques, the diagnosis or exclusion of CPA in children is challenging. This is of particular concern given the outcome of unrecognised progressive lung injury and the invasiveness of definitive therapies.

Although new techniques have been introduced since the 1990s and significant advances in the understanding of dysphagia and gastro-oesophageal reflux have been made, characterisation of the aspirating child remains elusive.
Massive cavitary pulmonary rheumatoid nodules in a patient with HIV
Authors: Khazeni N. , Homer R. J. , Rubinowitz A. N. , Chupp G. L.
Published: September 2006

The case of a 52-yr-old female with rheumatoid arthritis and HIV who developed massive, progressive, cavitary pulmonary nodules is described.

Multiple diagnostic bronchoscopies and lung biopsies failed to demonstrate the presence of any microorganisms. Pathological analysis showed palisading histiocytes with necrobiosis consistent with rheumatoid nodules.

The effect of co-existing HIV infection on the course and prognosis of rheumatoid arthritis is discussed, and it is concluded that the complex relationship between these two disease processes warrants further investigation.
Genome-wide prediction of transcriptional regulatory elements of human promoters using gene expression and promoter analysis data
Authors: Kim Seon-Young , Kim YongSung
Published: September 2006

Background

A complete understanding of the regulatory mechanisms of gene expression is the next important issue of genomics. Many bioinformaticians have developed methods and algorithms for predicting transcriptional regulatory mechanisms from sequence, gene expression, and binding data. However, most of these studies involved the use of yeast which has much simpler regulatory networks than human and has many genome wide binding data and gene expression data under diverse conditions. Studies of genome wide transcriptional networks of human genomes currently lag behind those of yeast.

Results

We report herein a new method that combines gene expression data analysis with promoter analysis to infer transcriptional regulatory elements of human genes. The Z scores from the application of gene set analysis with gene sets of transcription factor binding sites (TFBSs) were successfully used to represent the activity of TFBSs in a given microarray data set. A significant correlation between the Z scores of gene sets of TFBSs and individual genes across multiple conditions permitted successful identification of many known human transcriptional regulatory elements of genes as well as the prediction of numerous putative TFBSs of many genes which will constitute a good starting point for further experiments. Using Z scores of gene sets of TFBSs produced better predictions than the use of mRNA levels of a transcription factor itself, suggesting that the Z scores of gene sets of TFBSs better represent diverse mechanisms for changing the activity of transcription factors in the cell. In addition, cis-regulatory modules, combinations of co-acting TFBSs, were readily identified by our analysis.

Conclusion

By a strategic combination of gene set level analysis of gene expression data sets and promoter analysis, we were able to identify and predict many transcriptional regulatory elements of human genes. We conclude that this approach will aid in decoding some of the important transcriptional regulatory elements of human genes.
Evaluation of BacLite Rapid MRSA, a rapid culture based screening test for the detection of ciprofloxacin and methicillin resistant S. aureus (MRSA) from screening swabs
Authors: Johnson Gemma , Millar Michael R , Matthews Stuart , Skyrme Margaret , Marsh Peter , Barringer Emma , O'Hara Stephen , Wilks Mark
Published: September 2006

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. The need for accurate and rapid screening methods to detect MRSA carriers has been clearly established. The performance of a novel assay, BacLite Rapid MRSA (Acolyte Biomedica, UK) for the rapid detection (5 h) and identification of hospital associated ciprofloxacin resistant strains of MRSA directly from nasal swab specimens was compared to that obtained by culture on Mannitol salt agar containing Oxacillin (MSAO) after 48 h incubation.

Results

A total of 1382 nasal screening swabs were tested by multiple operators. The BacLite Rapid MRSA test detected 142 out of the 157 confirmed MRSA that were detected on MSAO giving a diagnostic sensitivity of 90.4, diagnostic specificity of 95.7% and a negative predictive value of 98.7%. Of the 15 false negatives obtained by the BacLite Rapid MRSA test, seven grew small amounts (< 10 colonies of MRSA) on the MSAO culture plate and five isolates were ciprofloxacin sensitive. However there were 13 confirmed BacLite MRSA positive samples, which were negative by the direct culture method, probably due to overgrowth on the MSAO plate. There were 53 false positive results obtained by the BacLite Rapid MRSA test at 5 h and 115 cases where MRSA colonies were tentatively identified on the MSAO plate when read at 48 h, and which subsequently proved not to be MRSA.

Conclusion

The Baclite MRSA test is easy to use and provides a similar level of sensitivity to conventional culture for the detection of nasal carriage of MRSA with the advantage that the results are obtained much more rapidly.
Analysis of in vitro replicated human hepatitis C virus (HCV) for the determination of genotypes and quasispecies
Authors: Revie Dennis , Alberti Michael O , Braich Ravi S , Chelyapov Nickolas , Bayles David , Prichard John G , Salahuddin S Zaki
Published: September 2006

Isolation and self-replication of infectious HCV has been a difficult task. However, this is needed for the purposes of developing rational drugs and for the analysis of the natural virus. Our recent report of an in vitro system for the isolation of human HCV from infected patients and their replication in tissue culture addresses this challenge. At California Institute of Molecular Medicine several isolates of HCV, called CIMM-HCV, were grown for over three years in cell culture. This is a report of the analysis of CIMM-HCV isolates for subtypes and quasispecies using a 269 bp segment of the 5'UTR. HCV RNA from three patients and eleven CIMM-HCV were analyzed for this purpose. All isolates were essentially identical. Isolates of HCV from one patient were serially transmitted into fresh cells up to eight times and the progeny viruses from each transmission were compared to each other and also to the primary isolates from the patient's serum. Some isolates were also transmitted to different cell types, while others were cultured continuously without retransmission for over three years. We noted minor sequence changes when HCV was cultured for extended periods of time. HCV in T-cells and non-committed lymphoid cells showed a few differences when compared to isolates obtained from immortalized B-cells. These viruses maintained close similarity despite repeated transmissions and passage of time. There were no subtypes or quasispecies noted in CIMM-HCV.
Plasma levels of leptin and mammographic density among postmenopausal women: a cross-sectional study
Authors: Stuedal Anne , Ursin Giske , Veierød Marit B , Bremnes Yngve , Reseland Janne E , Drevon Christian A , Gram Inger T
Published: September 2006

Introduction

Obesity has been linked to increased risk of breast cancer in postmenopausal women. Increased peripheral production of estrogens has been regarded as the main cause for this association, but other features of increased body fat mass may also play a part. Leptin is a protein produced mainly by adipose tissue and may represent a growth factor in cancer. We examined the association between leptin plasma levels and mammographic density, a biomarker for breast cancer risk.

Methods

We included data from postmenopausal women aged 55 and older, who participated in a cross-sectional mammography study in Tromsø, Norway. Mammograms, plasma leptin measurements as well as information on anthropometric and hormonal/reproductive factors were available from 967 women. We assessed mammographic density using a previously validated computer-assisted method. Multiple linear regression analysis was applied to investigate the association between mammographic density and quartiles of plasma leptin concentration. Because we hypothesized that the effect of leptin on mammographic density could vary depending on the amount of nondense or fat tissue in the breast, we also performed analyses on plasma leptin levels and mammographic density within tertiles of mammographic nondense area.

Results

After adjusting for age, postmenopausal hormone use, number of full-term pregnancies and age of first birth, there was an inverse association between leptin and absolute mammographic density (Ptrend = 0.001). When we additionally adjusted for body mass index and mammographic nondense area, no statistically significant association between plasma leptin and mammographic density was found (Ptrend = 0.16). Stratified analyses suggested that the association between plasma leptin and mammographic density could differ with the amount of nondense area of the mammogram, with the strongest association between leptin and mammographic absolute density in the stratum with the medium breast fat content (Ptrend = 0.003, P for interaction = 0.05).

Conclusion

We found no overall consistent association between the plasma concentration of leptin and absolute mammographic density. Although weak, there was some suggestion that the association between leptin and mammographic density could differ with the amount of fat tissue in the breast.
Facial nerve problems: Including Remarks on Bell's Palsy.
Authors: Deweese David D.
Published: September 2006

Paralysis of the facial nerve, whether spontaneous or traumatic, can be improved in the majority of instances with proper management.

Traumatic injury of the facial nerve is caused most often by operations on the temporal bone. Injury of the facial nerve during operation can usually be avoided by recognition of well‐established anatomic landmarks. The most important of these are: 1. the horizontal semicircular canal of the labyrinth; 2. the digastric crest; 3. the stylomastoid foramen.

Continuity of the injured facial nerve can be re‐established successfully in a large percentage of patients by means of end‐to‐end suture or with a fresh graft. The length of the graft is of less importance than precise approximation. Function following repair is usually better when the injury has occurred outside the temporal bone than when it has taken place inside the temporal bone.

In Bell's palsy the percentage of complete recoveries and the degree of partial recovery can be improved by surgical decompression of the facial nerve. The rate of recovery, or lack of it, plus results of electrical tests, assist the physician in determining when or whether decompression should be undertaken. In certain patients the best final results can be achieved only by surgical decompression.
Subarachnoid shunt for drainage of endolymphatic hydrops. a preliminary report.
Authors: House William F.
Published: September 2006

Excessive endolymphatic pressure, established as a feature of Ménière's disease by recent experiments and probably due to disturbed absorption, may be corrected by drainage of the endolymphatic sac. By use of the operating microscope, diamond dental drill and continuous irrigation, the endolymphatic sac can be accurately identified and opened under direct vision. Continuous drainage of endolymph is maintained by creating a shunt into the subarachnoid space through a silicone rubber tube inserted into the sac.

Seven patients, observed for two to six months, showed relief of most symptoms of Ménière's disease, with improvement of hearing in the majority. Although a larger series of patients and a longer follow‐up period will be required for conclusive evaluation, these early results indicate that continuous drainage of endolymph is an effective treatment of Ménière's disease.
From draining ear to tympanoplasty.
Authors: Kramer Bernard M.
Published: September 2006

Inasmuch as the preferred candidate for tympanoplasty has a dry ear, the object of all preoperative care is to control infection and drainage before definitive surgery is undertaken. In our desire to perform this exacting surgery, we must realize that not all patients with chronic otitis media are candidates nor can they all be converted to candidates despite our best efforts. If we are as careful in our preoperative care and selection of tympanoplasty candidates as we are when performing the surgery, then this most valuable procedure will attain the status we feel it deserves. Specific reference is made to para‐otitic disease, tubal disease, and middle ear and mastoid disease.
Reverse vein graft tympanoplasty
Authors: Lebo Charles P.
Published: September 2006

A modification of the vein graft tympanoplasty technique described by Shea and by theTabb is presented. This innovation, designated a reverse vein grafting, has been used by the author in 12 cases and has proved to be advantageous.
Tympanic grafts: Personal experiences with surgical repair of tympanic perforations
Authors: Guilford Frederick R.
Published: September 2006

The complications that occur after use of split‐thickness and full‐thickness postauricular skin for tympanic grafts are discussed and the results stated. The use of the vein graft, the combination of canal skin and vein grafts, and vein graft stapediopexy are discussed, and the improved results with these measures are noted. Attention is called to the difficulties in complete reporting of any subject as complex as tympanoplasty.
Management of lacerations and scars
Authors: Farrior Richard T.
Published: September 2006

The purpose of this paper is to review and update the subject of management of scars and lacerations. The surgeon who accepts responsibility for management of soft tissue injuries must be aware of fundamental surgical principles as well as detailed technique. Knowledge of basic anatomy and wound physiology is utilized and applied.

Emphasis is placed on management of the total patient. The specialist must accept the role of team captain and establish an order of priority in management and in wound analysis. By having a basic knowledge of wound healing and the lines of favorable contracture, one is better able to prognosticate the eventual healing of the wound after proper management. By being able to predict wound contracture and scar maturation, the patient can be better informed as to what to expect during the period of healing. With lacerations immediate repair is carried out. With scars there is more time for planning and photographic analysis. The contracting forces will by this time have identified themselves and the degree of release of the contracture or camouflage can be determined.

Specific wound management emphasizes meticulous closure in layers and the use of skin hooks with the interrupted subcuticular suture. Skin sutures with both the continuous subcuticular suture and interrupted sutures of monofilament nylon using the spring‐loop are described. Emphasis is placed on the preparation of the skin margins with slight beveling of the skin edges and undermining with precise even thickness of the skin especially at the wound margin. For scar revisions a minimum time of six months should elapse, and 12‐18 months is better.

Complications include infection, hematoma, wound separation, and rejection of suture materials. Keloids are disciissed briefly, particularly regarding the use of intralesional injection of steroids.

Broken line camouflage techniques are discussed with regard to breaking up contracture without lengthening. Lengthening either existing or anticipated contractures is accomplished with Z‐plasty. The multiple Z‐plasty, W‐plasty, and Zig‐Zag plasty are aimed towards creating a less conspicuous scar and creating some diffusion of the forces of contracture. A technique for a “practical Z‐plasty” is described.

Both free grafts and skin flaps sometimes must be utilized to fill tissue defects and break up lines of contracture.

The materials presented and conclusions drawn are based on 25 years of active emergency room coverage and long term follow‐up of treated patients. It is the responsibility of the physician to act within the first few hours and to take the time necessary for accurate approximation and realignment of both soft tissue and bone injuries. Minimal scarring depends on accurate approximation of skin margins without tension. The need for early meticulous repair, so that unsightly scars and disfigurements may be prevented, cannot be overemphasized.
Nasofrontal‐ethmoidal injuries
Authors: May Mark
Published: September 2006

Our experiences in managing 17 patients with nasofrontal‐ethmoidal injuries is reviewed. The treatment of frontal sinus injuries, cerebrospinal fluid leaks, and psoudohypertelorism is discussed.
Dental aspects of maxillofacial injuries
Authors: Keyes Kenneth S.
Published: September 2006

The chief progress of maxillofacial surgery in recent years has been the preservation and the retention of functional tissue. The recent advances in microvascular and reimplantation surgery are examples. Similarly the preservation of the masticatory apparatus is best served by the retention of all viable components. Additional benefits derived from this approach include the facilitation with alignment of the bony fragments, proper occlusion of the teeth and maintenance of the vertical relationship between the upper and lower jaws; in addition to the restoration of appearance and the functions of mastication and speech. Although injuries of the teeth and their supporting structures at first glance may seem to be simple problems, frequently they turn out to be complicated.

The most common injury is partial avulsion of the alveolar bone with loss of attached teeth, which may produce a severe defect in the jaw bone. During healing there is additional resorbtion of alveolar bone, which is quite a normal physiologic phenomenon. Therefore, the eventual defect is likely to be more severe yet. For this reason more concern should be shown for these lesser injuries.
Mandibular fractures: A review of 156 consecutive cases
Authors: Bernstein Leslie , Mcclurg F. L.
Published: September 2006

This report deals with a consecutive series of 156 mandibular fractures that were managed during a three‐year period. The age and sex incidence are presented and the causative factors of the trauma are discussed. The fractures are classified according to anatomic site and laterality.

The majority of the patients were treated with closed reduction techniques and the reasons for open reduction are tabulated. The results and complications of the treatment are enumerated. A conservative technique is described for open reduction of fracture‐dislocations of the condylar head.
Proboscis lateralis: Case report and embryologic analysis
Authors: Rontal Michael , Duritz Gilbert
Published: September 2006

A child with a lateral trunk replacing one side of the external nose is presented with a detailed X‐ray study of the deformed head. In the explanation of the etiology and teratogenesis of this facial anomaly, the modern embryologic development of the head is reviewed and correlated with the findings of this anomaly. It is felt that the lesion responsible for a proboscis lateralis involves the organizer tissue for the naso‐face. As a secondary phenomenon, the development of the maxillary process is retarded and a spectrum of defects, common to many mid‐face derangements, is identified and explained.
Treatment of alopecia in temporal region following rhytidectomy procedures
Authors: Parkes Morey L. , Kamer Frank M. , Bassilios Maurice I.
Published: September 2006

Satisfactory treatment of alopecia following rhytidectomy is discussed using the punch graft technique. In spite of the presence of scar tissue following rhytidectomy, this procedure has been quite successful because of the rich blood supply in that area.
Surgical obliteration and silastic arthroplasty of the canine cricoarytenoid joint
Authors: Miller David W. , Spector Gershon J.
Published: September 2006

The effects of surgical trauma on the cricoarytenoid joint were analyzed using canine models. The cricoarytenoid joints of seven dogs were surgically disrupted. In four of the dogs an arthroplasty with silastic implantation was simultaneously performed. The histologic findings and the unsuccessful functional results are presented and discussed.
Infiltrating lipomata of the head and neck
Authors: Bennhoff David F. , Wood James W.
Published: September 2006

This Paper was not recevied for Publication.
Audiological and vestibular function tests in hypothyroidism
Authors: Bhatia P. L. , Gupta O. P. , Agrawal M. K. , Mishr S. K.
Published: September 2006

A battery of audiological and vestibular function tests have been performed in 72 cases of confirmed hypothyroidism. The severity of hypothyroidism was graded as mild, moderate or severe depending upon serum protein‐bound iodine estimation. The incidence of hearing impairment, tinnitus and vertigo was correlated with the severity of the disease process. The site of lesion causing sensorineural hearing impairment in 25 cases was pinpointed audiologically.
Facial plexiform neurofibroma
Authors: Smith Richard F. , Toomey James M. , Snyder G. Gordon
Published: September 2006

Facial plexiform neurofibroma is a relatively rare manifestation of Von Recklinghausen's neurofibromatosis. Two patients with extensive facial tumor involvement are presented, each having undergone wide local resection after multiple previous local excisions had failed to control the tumor and its locally deforming and destructive effects. A discussion of the problem, its etiology, pathogenesis, natural history, prognosis and suggested treatment is presented.
Cholesteatoma surgery: Management of the labyrinthine fistula—A report of 97 cases
Authors: Sheehy James L. , Brackmann Derald E.
Published: September 2006

Preoperative, operative and postoperative findings in 97 cases of labyrinthine fistula are presented.

Most of these patients had had symptoms of chronic otitis media for 20 years or more and manifested some degree of sensorineural hearing impairment. Two‐thirds had experienced dizziness.

The fistula was limited to the lateral semicircular canal in 83 cases and involved the labyrinth more extensively in 14 instances. The intact canal wall technique was used in less than 60% and an open cavity technique in 25% of the cases.

Severe or total sensorineural hearing impairment developed postoperatively in 8% of the lateral canal cases and in over half of the extensive fistula cases. Five percent had incapacitating dizziness for up to six months postoperatively.

When a labyrinthine fistula is encountered in an only hearing ear we usually recommend a classical modified radical mastoidectomy. In other instances the procedure performed will vary with the status of the opposite ear, the extent of the fistula, the sensorineural function of the involved ear and the size of the mastoid.
Mucoepidermoid carcinoma of the air passages: Report of three cases
Authors: Kaznelson Dan J. , Schindel Jehuda
Published: September 2006

A review of the literature on tumors of the small salivary and mucous glands reveals that mucoepidermoid carcinoma of the upper respiratory system is a very rare occurrence. Three such cases are reported in detail, representing 3% of all tumors of small salivary and mucous gland origin recorded by the authors over a period of 20 years. This incidence is high. Follow‐up was from 3 to 12 1/2 years.
Transbronchial drainage of pulmonary abscesses with the flexible fiberoptic bronchoscope
Authors: Rowe Lee D. , Keane William M. , Jafek Bruce W. , Atkins Joseph P.
Published: September 2006

Flexible fiberoptic bronchoscopy with multiplanar flouroscopic control is shown to be effective in the transbronchial drainage of pulmonary abscesses. A new technique which permits the intracavitary placement of brush forceps and fine arterial catheters is described. This has facilitated the rapid defervescence of fever and established immediate endobronchial drainage. Seventy percent of patients had complete radiographic closure of their abscess cavities at three months. Clinical findings are presented and the role of aspiration in pathogenesis of pulmonary abscess is stressed.
Surgical pathology of middle ear implants
Authors: Schuknecht Hahold F. , Shi Shan‐Rong
Published: September 2006

During the past 15 years a series of 25 middle ear implants was removed at the time of revision surgery and prepared for histological study. These revision operations were performed because of failure to control the disease and/or persistent or recurring hearing loss. The ossicular and cortical bone autografts showed similar behavior in that they underwent creeping substitution with vitalized bone in amounts varying from 0% to 83%. There was no correlation to duration of implantation. The four cartilage grafts, on macroscopic evaluation, showed a loss of rigidity. Two of three cartilage autografts showed a high rate of survival of chondrocytes. The two TORP prostheses showed extensive invasion of their porous spaces with foreign body giant cells. One of the latter, implanted for over four years showed fibrous replacement of plastic material. The two polyethylene tubes showed intraluminal foreign body reaction and new bone formation.
Basal lamina breaks in the histogenesis of cholesteatoma
Authors: Chole Richard A. , Tinling Steven P.
Published: September 2006

Aural cholestentomas may arise in the middle ear by a variety of mechanisms; in some cases it appears that cholesteatomas arise within or behind an intact tympanic membrane. We have observed that microcholesteatomas arise within the tympanic membrane of mongolian gerbils which have keratin accumulations on the lateral surface of the tympanic membrane. An ultrastructural study of the keratinizing epithelium of these animals showed that breaks in the basal lamina allow pseudopods of epithelial cells to extend into the lamina propria and form epithelial cones. The basal lamina later reconstituted itself. Keratinization may occur within these ingrowing cones forming microcholesteatomas. This sequence of events may explain the occurrence of intratympanic cholesteatomas in humans in the absence of invagination or perforation.
Glomus jugulare tumors revisited: A ten‐year statistical follow‐up of 231 cases
Authors: Brown James S.
Published: September 2006

Glomus jugulure tumors are rather common in the middle ear and temporal bone. They are usually easy to diagnose and surgically remove.

However, there are a comparatively large number of these growths which not only cause extensive local destruction, but can spread distally and even have endocrine manifestations. This group is difficult to diagnose and manage despite recent advances in diagnostic procedures and the advent of skull base surgery. There is a void in the literature of a large series of cases being followed for a long period of time.

This paper presents a comprehensive detailed statistical ten‐year follow‐up of 231 glomus jugulare tumors. The results suggest that our present diagnostic procedures often are inadequate in finding small tumors, and our treatment and follow‐up are lacking because these tumors tend to recur often at a late date and in a different form.

A comprehensive method of approach of diagnosis and treatment is described to manage all cases of glomus jugulare.
Prostaglandins in squamous cell carcinoma of the head and neck: A preliminary study
Authors: Jung Timothy T. K. , Berlinger Norman T. , Juhn S. K.
Published: September 2006

It has already been demonstrated in human and animal systems that PGE2 is a suppressor signal For many immune functions. These include T‐lymphocyte blastogenesis, natural killer cell activity, and cytolytic T‐lymphocyte activity. These functions are important for destruction of tumor cells. Conceivably, suppression of these functions by excessive PGE2 restricts tumor cell kill, and reversal of suppression by an inhibitor of prostaglandin synthesis such as indomethacin could increase tumor cell kill. The purpose of this study was to determine the kind of prostaglandins (PGs) produced by tissues with squamous cell carcinoma of head and neck and to measure the concentrations of PGE2, 6‐keto‐PGF1a, and thromboxane (Tx) B2 in the tumor tissue and in the corresponding control tissue.

Tumor and normal control tissues at the margin of the resection were obtained from surgical specimens. The production of PGs was determined by incubation of tissue homogenates with 14C‐arachidonic acid, by thin layer chromatography, autoradiography, and scintillation counting. Concentrations of PGs were measured by radioimmunoassay. Tumor tissues produced PGD2, E2, TxB2, F2a, and 6‐keto‐F1a, and 15‐, 12‐, and 5‐monohydroxyeicosatetraenoic acid (HETE). Concentrations of PGE2 were four times higher in the tumor tissues compared to those in control tissues. There was no difference between the levels of TxB2 and 6‐keto‐PGF1a in the tumor tissues and those in control tissues.

The results of this study will serve as basic information necessary for the potential use of inhibitors of PG‐synthesis in the treatment of head and neck carcinoma.