bluuebunny/crossref_metadata_2025 huggingface dataset:
Perilymph fistulas: The house ear clinic experience
Authors: Rizer Franklin M. , House John W.
Published: November 2015

The diagnosis, evaluation, and surgical treatment of perilymph fistulas has recently been the focus of a great deal of attention in otology. Authors have focused on perilymph fistulas as the cause of hearing loss and vertigo in many diverse situations. Additionally, surgical repair has been suggested when there is little objective support for intervention. To address some of the problems inherent in the diagnosis and treatment of perilymph fistulas, records of patients operated on at the House Ear Clinic during the past 12 years were reviewed retrospectively. Eighty‐six patients were surgically explored for fistulas during this period. Thirty‐five (40.7%) fistulas were found, and 51 ears were patched whether fistulas were found or not. Of the 80 patients who were seen for follow‐up, 35 (43.8%) were subjectively better, and 45 (56.2%) were the same. Although the number of fistulas found and the number of patients improved were similar, the composition of the two groups was different. On the basis of audiometric results, improvement in hearing occurred in only 18.7% of the patients. None of the demographic factors or diagnostic tests were predictive of either the presence of a fistula or the therapeutic outcome. Further work is required to facilitate the preoperative diagnosis of fistulas and to design appropriate surgical Intervention.
Mechanism of action of some commonly used nasal drugs
Authors: Jackson Richard T.
Published: November 2015

This article provides a brief description of the mechanism of action of drugs commonly used in the treatment of nasal disorders. These include oral and topical vasoconstrictors, antihistamines, atropine‐like drugs, cocaine, topical corticosteroids, and mast‐cell stabilizers.
Skin grafting of the larynx
Authors: Olson Nels R.
Published: November 2015

Skin grafting as a method of restoring the lumen in cases of laryngeal stenosis has been promoted and practiced in the past. Lately, little has been heard of the method. I have personally used skin grafting in almost every case of repair of acute injury or chronic stenosis of the larynx in the last several years. The rationale for grafting is (1) to cover any areas of epithelial loss or dehiscence during the healing period, (2) to reduce the chance of prolonged granulation and subsequent contracture, and (3) to serve as a logical material to use as the interface between a stent and the lumen of the larynx. This report discusses the use of skin grafting in 20 cases of severe acute injury or chronic stenosis. Other procedures needed to enhance the stenotic lumen are also described. In this series, 17 patients are decannulated, one wears a plug continually, and two did not or could not complete the recommended therapy. Among those completing therapy, 100% are either decannulated or wear a plug.
Combined Approach For Lesions Involving the Cerebellopontine Angle and Skull Base: Experience with 20 Cases—Preliminary Report
Authors: Daspit C. Phillip , Spetzler Robert F. , Pappas Conrad T.E.
Published: November 2015

Skull base tumors involving the clivus, petrous bone, and adjacent areas can be formidable lesions to successfully remove without causing significant neurologic deficits. At our institution in the last 5 years, twenty patients out of 103 patients with skull base tumors have undergone the supratentorial‐infratentorial combined approach for removal of a neoplasm (nine schwannomas, six meningiomas, two epidermoids, one extensive basal cell carcinoma, one pontine cavernous malformation, and one basilar artery aneurysm). The average patient age was 43 years. The combined approaches in conjunction with the subtemporal exposure were retrosigmoid‐retrolabyrinthine, retrosigmoid‐translabyrinthine, or retrosigmoid‐transcochlear. The choice depended upon the type and location of the lesion and the deficits noted preoperatively. Basically, the approach allowed communication of the middle fossa and posterior fossa by totally dividing the tentorium as much as necessary for effective surgical manipulations. Both sigmoid and superior petrosal sinuses are divided. There were no deaths. Postoperative neurologic deficits included temporary seventh nerve paralysis, sixth nerve weakness, fifth nerve sensory deficits, cerebrospinal fluid leaks, and hydrocephalus requiring a shunt. Overall, the results were very gratifying, considering the difficulties encountered in the surgical removal of these lesions.
Hearing Threshold Difference between Ears and Risk of Acoustic Tumor
Authors: Mangham Charles A.
Published: November 2015

This study addresses the question, what difference in hearing between ears puts a patient at sufficient risk of acoustic tumor to warrant further diagnostic tests? The subjects were 210 patients with surgically confirmed unilateral acoustic tumors and a control group comprised of 112 patients referred for audiometry. Hearing thresholds were determined at octave intervals from 250 Hz to 8 kHz. The threshold in the nonsuspect ear was subtracted from the threshold in the suspect ear. The rank order in effectiveness for threshold difference was: 2 kHz, 4 kHz, 1 kHz, 8 kHz, 500 Hz, and 250 Hz. We found that the most effective diagnostic strategy was to refer patients for magnetic resonance imaging if their average threshold difference at 1 to 8 kHz was 20 dB or greater and refer patients for auditory brainstem response testing if their average threshold was 5 to 20 dB.
Acoustic Characteristics of Post‐Thyroplasty Patients
Authors: Lablance Gary R. , Maves Michael D.
Published: November 2015

This study investigated changes in voice quality after thyroplasty type I in eight adults with unilateral vocal fold paralysis. A silicone rubber implant was inserted through a window in the thyroid ala and placed between the inner and outer perichondrium to externally medialize the abducted vocal fold. Measures of fundamental frequency (vocal pitch), pitch range, maximum phonation time, s/z ratio, pitch perturbation (vocal jitter), and amplitude perturbation (vocal shimmer) were made 1 to 2 weeks preoperatively and 1 month postoperatively. Postoperative voice quality was characterized by an improved pitch range, phonation time, s/z ratio, and pitch and amplitude perturbation. No change was noted in fundamental frequency. Changes in postoperative voice quality were unrelated to the subjects' preoperative age, sex, etiology, and duration of the paralysis.
Comparison of the Vasoconstrictive and Anesthetic Effects of Intranasally Applied Cocaine vs. Xylometazoline/Lidocaine Solution
Authors: Campbell Jeffrey P. , Campbell Cherri D. , Warren Donald W. , Prazma Tamara U. , Pillsbury Harold C.
Published: November 2015

Cocaine solution has traditionally been the agent of choice for vasoconstriction and anesthesia when applied topically to the nasal mucosa during nasal operative procedures. Because of the relative scarcity and resulting expense of cocaine, there has arisen an impetus for an alternative intranasal solution for mucosal anesthesia and vasoconstriction. As a logical alternative, we have used a mixed solution of xylometazoline and lidocaine with reasonable results. No clinical studies comparing the efficacy of the two solutions exist, however, and there is presently no such solution commercially available. A double‐blind, randomized, placebo‐controlled study was undertaken to assess the relative efficacy of the preparations. Both solutions resulted in a marked and roughly equivalent degree of mucosal vasoconstriction (as evidenced by comparable increases in nasal airway cross‐sectional area). Subjective pain ratings of mucosal pin‐prick decreased a surprisingly small degree after application of both solutions. It appears that xylometazoline/lidocaine solution is comparable to cocaine solution for purposes of vasoconstriction and anesthesia during intranasal operative procedures.
Obstructive Sleep Apnea Syndrome: A Review of 306 Consecutively Treated Surgical Patients
Authors: Riley Robert W. , Powell Nelson B. , Guilleminault Christian
Published: November 2015

Three hundred six consecutively treated surgical patients with obstructive sleep apnea syndrome were evaluated from a group of 415 patients. One hundred nine patients were excluded because they failed to obtain a postoperative polysomnogram or were lost to followup. All patients received a physical examination, cephalometric analysis, fiberoptic examination, and polysomnography before treatment to document OSAS and determine the areas of obstruction. A two‐phase surgical protocol was used for the reconstruction of the upper airway. Phase I surgery consisted of a uvulopalatopharyngoplasty (UPPP) for palatal obstruction and genioglossus advancement with hyoid myotomy‐suspension for base of tongue obstruction. Failures of phase I were offered phase 2 reconstruction, which consisted of maxillary‐mandibular advancement osteotomy. One hundred twenty‐one patients were treated with nasal continuous positive airway pressure (CPAP) before surgery and this was the primary method of evaluating surgical success. Results were reported on the polysomnogram performed a minimum of 6 months after surgery and compared to the preoperative polysomnogram and the second night nasal CPAP study. The polysomnographic results included respiratory disturbance index (RDI), lowest oxyhemoglobin saturation (LSAT), and sleep architecture parameters. Surgery was considered a success if it was equivalent to nasal CPAP or the postoperative RDI was less than 20 with normal oxygenation. The overall success rate, which included patients that dropped from the protocol, was 76.5%, with a mean followup of 9.3 months (SD, 6.7). The preoperative RDI, nasal CPAP RDI, and postoperative RDI were 55.8 (SD, 26.7), 7.2 (SD, 5.4), and 9.2 (SD, 7.5), respectively. The preoperative LSAT, nasal CPAP LSAT, and postoperative LSAT were 70.5 (SD, 15.8), 86.7 (SD, 8.5), and 86.6 (SD, 4.1), respectively. Patients who proceeded to completion of the protocol had a success rate of more than 95%. This report has allowed us to conclude that a comprehensive presurgical evaluation allows a logical approach to reconstruction of the upper airway, and patients who complete the surgical protocol have a greater than 95% long‐term success rate, which is superior to any other treatment modality.
Mandible Fractures—Medical and Economic Considerations
Authors: El‐Degwi Ahmed , Mathog Robert H.
Published: November 2015

This article retrospectively evaluates 1278 mandibular fractures and compares intermaxillary fixation, plating, and interosseous wiring as to outcomes and cost‐effectiveness of treatment. The predominance of young men with personal altercations reflects the urban patient setting. The infection from plating exceeds other methods and this difference is also reflected in increased patient days (in the hospital) and an increased length of time for postoperative care. No significant differences are observed between treatments for malunion, malunion, facial nerve injury, or temporal mandibular joint problems. Other factors, such as site and severity of injury and experience of the surgeons are considered. Cost implications are important, but should be just one factor in evaluation for the best treatment for each patient.
Partial Thyroarytenoid Myectomy: An Animal Study Investigating a Proposed New Treatment for Adductor Spasmodic Dysphonia
Authors: Genack Sheldon H. , Woo Peak , Colton Raymond H. , Goyette Donna
Published: November 2015

A new surgical procedure with potential application for the treatment of adductor spasmodic dysphonia was performed on ten rabbits to assess surgical effects on laryngeal function. Using an external approach, partial unilateral thyroarytenoid (TA) muscle excision was performed through a thyroplasty cartilage window. The contralateral side was left undisturbed as a control. The animals were studied acutely and at 3 months using videolaryngoscopy. Electrophysiologic measurements were recorded at 3 months. The procedure was well tolerated by all animals, with no postoperative infection or aspiration. At 3 months, spontaneous and evoked (recurrent laryngeal nerve stimulation) TA muscle electromyographic potentials were measurable bilaterally. TA compound muscle action potential amplitudes were reduced on the side of myectomy. The threshold of recurrent laryngeal nerve stimulation needed to produce observable vocal fold adduction was increased on the side operated on. Perioperative and long‐term (3 months) videolaryngoscopy demonstrated preservation of laryngeal competence with good true vocal cord adduction. Histologic analysis with whole organ sections showed replacement of excised muscle with loose fibroareolar tissue. No evidence of muscle regeneration was observed. The vocal ligament and vocal fold mucosa were intact and undistorted in all specimens. This procedure is technically simple and appears to effectively result in a functional yet weakened TA muscle. Because myectomy includes motor unit end‐plate excision, problems associated with reinnervation may be circumvented. TA myectomy may be applicable in patients with focal laryngeal dystonia to decrease muscle spasm.
Wound Healing of KTP and Argon Laser Lesions in the Canine Nasal Cavity
Authors: Kass Edward G. , Massaro Bruce M. , Komorowski Richard A. , Toohill Robert J.
Published: November 2015

The potassium titanyl phosphate (KTP) and argon lasers are increasingly used in nasal and sinus surgery. Histologic effects of these lasers on living nasal tissue have not been investigated. Sixteen dogs underwent laser nasal surgery (eight for each laser). Flexible fiberoptic quartz fibers were used with both lasers to deliver the laser energy to the tissue. The dogs were allowed to heal and then underwent biopsy at 3, 7, 21, and 90 days postoperatively. The argon and KTP lasers had similar tissue effects. Histologically, a thin rim of coagulation necrosis and acute inflammation were seen at 3 days postoperatively. By 7 days, fibroblasts and granulation tissue were observed. At 21 days, fibroblast proliferation and re‐epithelialization with respiratory epithelium were the predominant findings. Finally, at 90 days postoperatively, respiratory epithelium and submucosal structures were found overlying a plug of scar filling the defect in the septal cartilage. This healing was consistent through a wide range of energy densities. These lasers are easily used with sinus endoscopes and the operating microscope to allow access to difficult areas. These factors and the wound‐healing characteristics noted in this study would seem to make them suited for use in rhinologic surgery.
Auditory Brainstem Implant: II. Postsurgical Issues and Performance
Authors: Shannon Robert V. , Fayad Jose , Moore Jean , Lo William W. M. , Otto Steve , Nelson Ralph A. , O'Leary Michael
Published: November 2015

The auditory brainstem Implant (ABI) restores some hearing sensations to patients deafened by bilateral acoustic tumors. Electrodes are stable for more than 10 years. In most cases nonaudltory side effects can be avoided by judicious selection of the stimulating waveform and electrode configuration. Most perceptual measurements demonstrate that the ABI produces psychophysical and speech performance similar to that of single‐channel cochlear implants. ABI patients receive suprasegmental Information in speech and significant enhancement of speech understanding when the sound from the ABI is combined with Ilpreading.
Dental Status and Oral Hygiene in Patients with Head and Neck Cancer
Authors: Maier Heinz , Zöller Joachim , Herrmann Achim , Kreiss Martin , Heller Wolf‐Dieter
Published: November 2015

Poor oral hygiene is believed to play a role as a risk factor for head and neck cancer, especially for oral cancer. Only few epidemiologic data exist about dental status and oral hygiene in these patients. We performed a case‐control study involving 100 patients with squamous cell carcinoma of the upper aerodigestlve tract and 214 age‐ and sex‐matched control subjects with no known tumorous disease. In the tumor patients, oral hygiene and dental status proved to be significantly worse: The majority of the tumor patients seldom or never brushed their teeth and the frequency of dental visits was significantly lower. Tartar of 3 mm or more was found in 40.9% of the tumor patients and in 22% of the control subjects. In the tumor group, the incidence of decayed teeth was significantly higher compared with the control subjects. Chronic Inflammation of the gingiva was observed in 28% of the tumor patients vs. 13.5% in the control gorup. Oral hygiene was negatively correlated with alcohol as well as with tobacco consumption. The social status of subjects also correlated with oral hygiene, which was found to be worst in subjects from the lower social strata. The present study revealed a poor dental status and oral hygiene in patients with head and neck cancer. The pathogenetic mechanism being associated with this suspected risk factor remains to be investigated.
Hearing Preservation Using the Modified Translabyrinthine Approach
Authors: McElveen John T. , Wilkins Robert H. , Molter David W. , Erwin Andrea C. , Wolford Robert D.
Published: November 2015

Removal of an acoustic neuroma using the translabyrinthine approach has previously been considered “Incompatible” with hearing preservation. By modifying the approach and preventing the loss of endolymph, we have successfully removed two Intracanallcular acoustic neuromas that originated from the inferior vestibular nerves, and preserved serviceable hearing in the ears operated on. This report represents the preliminary findings using this particular technique in the management of Intracanallcular acoustic neuromas.
Patterns of hearing loss resulting from cis‐Platinum Therapy
Authors: Blakley Brian W. , Myers Steven F.
Published: November 2015

The purpose of this study was to provide a clinically useful classification of the hearing loss that occurs with chemotherapy using cis‐diamminedichloroplatinum (cis‐platinum). Serial audiometric testing was performed on 66 patients who underwent cis‐platinum chemotherapy (2 to 6 courses, 100 mg/m2). Subsequent hearing losses were classified according to (1) whether hearing loss occurred after the first or second course of chemotherapy, (2) the magnitude of loss, and (3) the frequencies affected. Of 39 patients who could be classified, 21 (54%) had no loss or mild loss, 14 (36%) had early loss, and 4 (10%) had late loss. Different patterns of hearing loss were observed. The observation that different patterns of hearing loss occur implies that different mechanisms of hearing loss exist. Some mechanisms must be more important in different patients. Our data are important with regard to continuation of chemotherapy treatment after hearing loss occurs. Most significant hearing loss (90%) occurred early or not at all. If early hearing loss occurred and treatment was continued, the speech frequencies were eventually affected in 71% of patients. Recognition of the patterns of hearing loss are important considerations when discontinuation of therapy is being considered. (OTOLARYNGOL HEAD NECK SURG 1993;109:385‐91.)
Autorotation test of the horizontal vestibulo‐ocular reflex in meniere's disease
Authors: Ng Matthew , Davis Linda L. , O'Leary Dennis P.
Published: November 2015

Sixty‐four patients with the diagnosis of Meniere's disease were tested at the House Ear Clinic with an active head‐rotation test system, the Vestibular Autorotation Test (VAT). The VAT is a portable, computerized test that measures the horizontal vestibulo‐ocular reflex (VOR) with the use of high‐frequency (2 to 6 Hz) active head movements to obtain gain and phase. The purpose of this study was to characterize the horizontal VOR at high frequencies in patients with Meniere's disease. At frequencies from 5 to 6 Hz, all patients demonstrated horizontal phase greater than 180 degrees and 85% showed abnormal VAT results. The most common patterns were decreased gain or increased phase values, or both, relative to normative data. No significant differences in the degree of abnormality in gain and phase were noted among groups of patients when the patients were clinically staged. We conclude that, in our test population of patients with Meniere's disease, the VAT shows common gain and phase patterns and abnormalities of the horizontal VOR. This may contribute to high retinal image velocities, which render the patient unable to stabilize retinal images during locomotion (visual field image slip), in as many as 85% of the patients tested, regardless of clinical stage. Such high‐frequency testing can reveal abnormalities of the horizontal VOR not apparent from conventional vestibular testing. Thus VAT provides additional information about the functioning VOR when combined with the present vestibular test battery. (OTOLARYNGOL HEAD NECK SURG 1993;109:399‐412.)
Intranasal histamine challenge in normality and allergic rhinitis
Authors: Birchall Martin A. , Phillips Ian , Fuller Rick W. , Pride Neil B.
Published: November 2015

A series of investigations was performed in which histamine challenge was used to compare nasal responsiveness in 20 normal subjects and 20 with allergic rhinitis. There was found to be a lower threshold of reactivity (D100) to histamine in allergic subjects as measured by resistance changes (geometric mean, 0.53 mg/ml; normal subjects, 2.15: p = 0.022). This may represent increased number or sensitivity of histamine receptors on the nasal capacitance vessels. The loss of a laser Doppler response to a supramaximal histamine stimulus (normal subjects, 102% increase in flux at 3 minutes; p < 0.05) was observed in patients with allergic rhinitis and indicates either a down‐regulation of the capillary system or an altered effect of histamine on superficial vessels, perhaps mediated by a shift in histamine receptor type. There was an observed increase in neutrophils at the mucosal surface under baseline conditions (rhinitis median, 49.6%; normal subjects, 32.72%: p < 0.05), which suggests an important primary role in the pathogenesis of this condition for this active cell. The observed increase in secretory volume response to histamine in allergic subjects, which persisted beyond 40 minutes after a single D100 challenge, may be related to an altered sensitivity of glandular tissue. There are important changes in nasal reactivity to histamine challenge in allergic rhinitis that may have implications for its pathogenesis. (OTOLARYNGOL HEAD NECK SURG 1993;109:450‐6.)
Ambulatory pediatric tonsillectomy and the identification of high‐risk subgroups
Authors: Rothschild Michael A. , Catalano Peter , Biller Hugh F.
Published: November 2015

Financial and utilization concerns have focused on reducing hospitalization costs for many procedures, including tonsillectomy. However, the safety of ambulatory tonsillectomy for all patients remains questionable. At our institution, tonsillectomy has essentially been an inpatient procedure by policy. We have reviewed the charts of 153 consecutive patients under 19 years of age who underwent this procedure between 1989 and 1990, in an attempt to identify “high‐risk” subgroups. Variables examined were: indication for surgery, hours to adequate oral intake and to discharge, age, sex, surgeon status, underlying medical condition, complications, and concomitant procedures. Statistically significant differences [p < 0.05) were found in the time to adequate oral intake and discharge for children under 4 years of age as compared to older patients. Furthermore, 7% of patients with a preoperative diagnosis of obstructive sleep apnea showed clinical evidence of significant airway compromise postoperatively. No patient in the study group experienced postoperative bleeding before discharge. Our results have identified high‐risk subgroups of children undergoing tonsillectomy who are at greater risk for these complications, and therefore may benefit from an inpatient setting.
Dimethyl sulfoxide increases the survival of primarily ischemic island skin flaps
Authors: Carpenter Robert J. , Angel Michael F. , Morgan Raymond F.
Published: November 2015

There is ample evidence of the involvement of free radicals in mediating skin flap necrosis. Dimethyl sulfoxide (DMSO) is a well‐tolerated, safe drug that is a powerful scavenger of the hydroxyl free radical. The current study investigated the effect of DMSO on the survival of 9 × 4 cm skin flaps based on the epigastric vessels subjected to primary venous occlusion. Forty‐seven skin flaps were elevated and the epigastric vein was occluded by a microvascular clamp for 8 hours. Group 1 received DMSO (1.5 gm/kg) intraperitoneally at reperfusion. Group 2 received saline solution, group 3 received DMSO at reperfusion and every day for 5 days, group 4 received DMSO preoperatively and then as in group 3, and group 5 was the saline solution control for groups 3 and 4. DMSO did not increase percent flap survival when given as a single dose at reperfusion (40.6% ± 42.7%) compared with saline solution (33.7% ± 41.2%). When DMSO was continued in the postoperative period, group 3 (86.2% ± 25.8%) and group 4 (78.0% ± 32.5%) had significantly better survival than the saline solution control group (32.6% ± 39.8%) (p < 0.01 and p < 0.03, respectively). There was no significant difference between groups 3 and 4. DMSO administered at reperfusion and postoperatively for 5 days significantly increased flap survival. It is hypothesized that this occurs through scavenging deleterious free radical species. This effect may have clinical significance.
Efficacy of surgical treatments for squamous cell carcinoma of the temporal bone: A literature review
Authors: Prasad Sanjay , Janecka Ivo P.
Published: November 2015

A review of ail publications dealing with surgical treatment for squamous cell carcinoma of the temporal bone was performed. No randomized or nonrandomized control studies were identified. All studies were case series without control subjects. Twenty‐six of 96 publications, which contained information on 144 patients, were analyzed. Several inferences are suggested by the available evidence; however, these areas should be investigated by properly designed randomized clinical trials: (1) patients with carcinoma that is confined to the external auditory canal have similar survival, regardless of whether mastoidectomy, lateral temporal bone resection (TBR), or subtotal TBR is performed: the addition of radiation therapy to lateral TBR does not appear to improve survival; (2) when disease extends into the middle ear, survival of patients treated with subtotal TBR appeared to be improved over those treated with lateral TBR or mastoidectomy: it remains uncertain if the addition of radiation therapy to mastoidectomy improves survival; (3) the value of surgical resection when carcinoma extends to involve the petrous apex remains unclear; (4) resection of involved dura mater does not appear to Improve survival; however, Incomplete data regarding margins of resection were reported; and (5) determination of the value of resection of involved brain parenchyma or internal carotid artery will require further study.
Carotidynia: An unusual pain in the neck
Authors: Cannon C. Ron
Published: November 2015

Described by Fay in 1927, carotidynia has not received much attention in the otolaryngology‐head and neck surgery literature. This unusual entity is characterized by ipsilateral neck pain in the region of the carotid artery near its bifurcation. The differential diagnosis is extensive and includes thyroiditis, migraine headache, aneurysm of the carotid system, temporomandibular joint syndrome, giant cell arteritis, and head and neck neoplasms. A correct diagnosis is usually achieved by careful review of the history and physical examination. Laboratory studies are obtained primarily to exclude other causes. Successful treatment is most often effected with the use of nonsteroidal antiinflammatory drugs, although other treatment modalities may be needed. A series of 25 patients treated during the past 10 years is presented. The symptoms, physical findings, appropriate laboratory studies, and a treatment protocol for this uncommon entity are detailed.
A randomized, controlled assessment of the canalith repositioning maneuver
Authors: Blakley Brian W.
Published: November 2015

The efficacy of the canalith repositioning maneuver in the treatment of benign positional vertigo was assessed in this controlled, randomized trial of 38 subjects. Treated subjects underwent the maneuver and control subjects did not. All were reevaluated 1 month after treatment. The number of persons experiencing subjective improvement was not statistically significantly different between the treatment and control groups. All patients, in both experimental and control groups, in this study experienced substantial improvement. Although the maneuver is safe it does not have treatment benefit for benign positional vertigo.
Anemia in cardiac surgery: next target for mortality and morbidity improvement?
Authors: Padmanabhan Hari , Aktuerk Dincer , Brookes Matthew J , Nevill Alan M , Ng Alex , Cotton James , Luckraz Heyman
Published: November 2015

Objective

To assess the effects of preoperative anemia on outcomes of cardiac surgery and to explore the trend in mortality over an 8-year period.

Methods

During the study period (2005–2012), all 1170 patients undergoing elective or urgent cardiac surgery and classed as anemic were included. A matched group of non-anemic 1170 patients was used as a control group. Postoperative outcomes were compared between the 2 groups. The association between preoperative anemia and postoperative outcomes was analyzed using a logistic regression model.

Results

Compared with patients without anemia, the need for airway support (15% vs. 12%, p = 0.05), renal replacement therapy (13% vs. 8%, p < 0.01) and the rate of in-hospital surgical site infection (9% vs. 7%, p = 0.05) were higher in the anemic group. Anemia was associated with greater need for renal replacement therapy (odds ratio = 1.76, confidence interval: 1.21–2.37, p = 0.002) and prolonged (> 7 days) hospital stay (odds ratio = 1.21, confidence interval: 0.97–1.51, p = 0.08). The blood transfusion rate (54% vs. 33%, p < 0.01) and hospital mortality (5.6% vs. 3.5%, p = 0.02) were higher in the anemic group. Over the 8-year period, there was a significant improvement in mortality in the non-anemic group (from 6.5% to 1.6%) but less so in the anemic group (from 6.7% to 4.7%).

Conclusion

Anemia impacts significantly on morbidity and mortality after cardiac surgery, with less improvement over time compared to patients without anemia. Preoperative correction of anemia, when feasible, could potentially help to improve cardiac surgery outcomes.
The role of initial attack and performer expertise on instrument identification
Authors: Cassidy Jane W. , Schlegel Amanda L.
Published: November 2015

The purpose of this study was to examine the role initial attack and expertise play in the identification of instrumental tones. A stimulus CD was made of 32 excerpts of instrumental tones. Sixteen possible combinations of the variables of initial attack (present or absent), expertise (beginner versus professional), and timbre (flute, clarinet, alto sax, trumpet) were recorded twice, once on B-flat4 and once on F4. After listening to the excerpts, music major ( n = 100) and non-major participants ( n = 112) identified the instrument that was performed in the excerpt and the expertise level of the performer of the excerpt. A list of possible instruments was provided that included the four stimulus instruments as well as four distractor instruments. Data analysis revealed initial attack presence had a significant main effect on instrument identification, especially for music majors’ identification of performer expertise. Results suggest presence and possibly quality of the initial attack affect timbre identification and tone quality assessment.
Socio-economic Principles in Contemporary Islamic and Judeo-Christian Thought
Authors: Beed Clive , Beed Cara
Published: November 2015

Principles applicable to socio-economic life contained in two modern interpretations of Islamic economic thought, and in two modern Judeo-Christian interpretations are compared. The relevance of this investigation is that these two religious systems encompass over fifty percent of the world’s population, and the percentage is believed to be increasing gradually. The four interpreters claim that each of their belief frameworks is replete with normative theological principles of direct implication to contemporary socio-economic life. As such, the two religions pose a challenge to secular economic frameworks of thought that eschew religious or theological input. The four interpreters are all economists who profess allegiance to their systems of belief. The comparison reveals a marked similarity in normative theological socio-economic principles between Islam and Judeo-Christianity, as interpreted by the authors examined. Seven comparable principles are derived from the four interpreters in the second section of the paper, ranging from their conjoint emphasis on the necessity for employment to be provided to all people, to their focus on the importance of an equitable distribution of the fruits of production. Two of the principles are investigated more closely in the third section. The first relates to the participatory nature of work and the ways in which it might contribute to people becoming economically independent. The second concerns the stress on reducing inequalities in the distribution of wealth and income, and to the way in which the reform of employment organisation can contribute to this end.
Book Review: Growth in Isolation
Authors: Amini Amin
Published: November 2015

Growth in Isolation Review of Growth Fetish by Clive Hamilton
A New Enlightenment and Education Towards a Bioeconomic Society
Authors: Angel Jose , Herrerias López
Published: November 2015

The change of century with a new millennium means the conscious beginning of a crucial ”axial time”. The characteristics of this axial time are: (a) the collective conscience born from the global interplanetary knowledge that the world suffers from lack of ethics together with situations characterised by exclusion, violence, exploitation and the need for human rights. (b) at the same time there is an increasing awareness of the need to demand respect and application of other values and attitudes between people and groups co-participating in the global affairs.

From the pedagogical point of view this is a problem relating to the cultural reality and the psychological dominance and their relationship from the cultural to the psychic and vice versa. A typology of these realities makes us aware of four models: modernity, post-modernity, ultra-modernity and meta-modernity. Here the meta-modernity is defined as the psycho-cultural pedagogic alternative based on other values and in the new systems of rules generating identities, which make possible responses capable of overcoming the conflicts of the new and complex ”axial time”. Bioeconomics as a science and as a pedagogic tool is well placed in this model.
Sustainability and Human Security: Challenges for the Twenty-First Century
Authors: Redclift Michael
Published: November 2015

Examining the concepts of ‘security’ and ‘sustainability’, as they are employed in contemporary environmental discourses, the paper argues that although the importance of the environment has been increasingly acknowledged, since the 1970s, there has been a failure to incorporate other discourses surrounding ‘nature’. The implications of the ‘new genetics’, prompted by research into recombinant DNA, suggest that future approaches to sustainability need to be more cognisant of changes in ‘our’ nature, as well as those of ‘external’ nature, the environment. This broadening of the compass of ‘security’ and ‘sustainability’ discourses would help provide greater insight into human security, from an environmental perspective.
The costs of the economic crisis: which scenario for the European regions?
Authors: Capello Roberta , Caragliu Andrea , Fratesi Ugo
Published: November 2015

Although the crisis is a world phenomenon, its impact is not at all spatially invariant. The aim of the article is to analyse the spatial effects of the crisis, doing so through a scenario-building exercise in which policies are kept constant, and economic growth is mainly driven by macroeconomic and supply side trends on the assumption that the crisis will end in 2015. The final goal is to raise awareness of policy makers on the costs of the present economic crisis and on their spatial impacts, so as to direct growth policies towards more targeted interventions. Our results show that the crisis produces structural breaks in local economy growth patterns; after years of convergence, regional disparities will rise due to an increase in intra-regional disparities, only partially limited by international convergence, strongly reduced in the years of crisis. The scenario is developed thanks to the MASST3 model, a regional growth forecasting model recently updated and enlarged to be able to forecast the impact of the crisis.
Bundling the procurement of sports infrastructure projects: How neither public nor private actors really benefit
Authors: van den Hurk Martijn
Published: November 2015

Public-private partnerships for infrastructure development are often conceived as puzzling governance tools. A peculiar case in Belgium has been the procurement of multiple similar projects to single private sector partners who design, build, finance and maintain infrastructure for a fixed period— bundled procurement. Under the umbrella of the Flemish Sports Infrastructure Program, several of these bundles were tendered, particularly in order to achieve economies of scale. However, bundled procurement came at a price. This article scrutinizes its tense relationship with local governments' interests and competitive tendering. It shows that competition was hampered to a certain extent, but an equally important role in this respect was played by high contractual demands. As for local interests, in some cases the voice of local governments was given too much weight during the procurement phase. Consequently, political interests intervened and uncertainty arose.
Effects of 24-Hour Hypothermic Storage on Isolated-Perfused Canine Heart-Lungs
Authors: Hajjar Gail , Toledo-Pereyra Luis H , MacKenzie Gerald H
Published: November 2015

Isolated-perfused canine heart-lungs were used as a model to measure the effects of 24-hour hypothermic storage on cardiopulmonary function and metabolism. Heart-lungs were stored at 4–7°C in Euro-Collins solution ( n = 6) or TP-V ( n = 6). a hyperosmolar colloid solution containing dextrose, sucrose. ATP and MgCl2. Lung inflation was maintained with 100% nitrogen. Following preservation, the heart-lungs were perfused with an albumin-mannitol perfusate for three hours at 37°C. for functional and laboratory determinations. Cold storage with TP-V soiution resulted in significantly lower enzyme activity for CPK ( p < 0·0005) and LDH ( p < 0·01) at 0, 1, and 3 hours of normothermic isolated perfusion. A significant reduction in lactate production ( p < 0·001) was also seen in the heart-lungs stored in TP-V. No apparent differences were seen in the pH, PCO2. and PO2 among the two groups, nor were there any significant haemodynamic changes. Histological specimens revealed that TP-V was less damaging to both cardiac and pulmonary tissue, as only moderate oedema and congestion was apparent. These results indicate that 24 hour hypothermic storage with TP-V may be a more appropriate preservation solution for canine heart-lungs.
Empowering Victims of Organized Crime: On the Concurrence of the Palermo Convention with the Un Declaration on Basic Principles of Justice for Victims
Authors: Van Dijk Jan J.M.
Published: November 2015

In the year 2003 the United Nations Convention against Transnational Organised Crime and its protocol against Trafficking in Persons will come into force and create new obligations for State Parties. Both legal instruments contain specific provisions on the rights of victims of organised crime and corruption and of trafficking in persons respectively. An analysis is made of the concurrence of these provisions with the United Nations Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power, adopted by the General Assembly in 1985.

Several of the main principles of justice for victims, such as the right to be protected against offenders, to claim compensation from the offender and to present views in court are honoured by the new legally binding instruments. The Convention and its protocol will give a new global impetus to criminal justice reform on behalf of victims. The right to claim compensation and express views are especially important for representatives of collective interests, such as NGO's supporting victims of trafficking. Such victim representation has become a regular feature of anti-Mafia trials in Italy.

In some other respects, however, these instruments fall short of the UN standards. The rights to be informed, to receive legal assistance, to privacy protection and to state compensation are all notably absent. The Conference of State Parties which will oversee the implementation of the Convention and its protocol should critically assess the practical impact of the victim provisions and make proposals for improvements where appropriate.
Abuse and Violence against Businesses: A Study of the Triggers and Processes of Incidents
Authors: Hopkins Matt
Published: November 2015

It is recognised that certain business types attract and generate high rates of abuse and violence against their employees. Whilst previous research identifies that business types such as public houses and off licences experience a high prevalence rate of abuse and violence, little research has considered how incidents of abuse and violence are generated within business premises. This paper presents the initial findings of a piece of ongoing research that begins to explore how incidents are triggered within the business environment and how the processes of incidents generate specific results.2 First, the paper develops a hypothetical framework for understanding the triggers and processes of violence against businesses. Second, a number of case studies are used to highlight how the framework may help to explore incidents of abuse and violence, and finally, it is considered what future research needs to be conducted to further develop this framework. Overall, the paper shows that though far from perfect, the framework has considerable potential in helping us to gain a more thorough understanding of the triggers and process of abuse and violence against businesses.
Victims' Perspectives on Restorative Justice: How Much Involvement Are Victims Looking For?
Authors: Wemmers Jo-Anne , Cyr Katie
Published: November 2015

There is considerable debate among both academics and professionals about whether restorative justice offers victims a better deal than the traditional criminal justice system. Advocates of restorative justice argue that restorative justice, which focuses on reparation of the harm suffered by the victim, is undoubtedly better equipped to respond to victims' needs than contemporary criminal justice systems. Failure by victims' advocates to embrace restorative justice has been criticised as a disservice to victims. However, victims' rights advocates are wary of the possibility that restorative justice programs are insensitive to the needs of crime victims and that they will place an additional burden on victims. Who is right? Do victims want to participate in the criminal justice process and if so, how? As Fattah (2001) suggests, the only way to resolve this debate is to ask crime victims. In this paper we present data from a study of victims of crime who were invited to participate in victim—offender mediation. In addition, procedural justice theory, which offers a theoretical framework for understanding the role that victims prefer to play in criminal justice procedures, will be presented. The paper closes with recommendations for a victim-oriented approach to criminal justice.
Victims and Victimology: The Facts and the Rhetoric
Authors: Fattah Ezzat A.
Published: November 2015

The paper traces the history of the young discipline of victimology and the transformation it underwent with the advent of victimization surveys. The surveys revealed striking similarities between the offender and victim populations. Examples of these similarities are given and their possible explanations are discussed. The empirical findings on crime victims are contrasted to the rhetoric of victim advocates. An attempt is made to explain the emergence of the victim cause as a political issue and the ensuing crisis in victimology. A call is made for separating science from politics and for differentiating the role of the scholar from that of the lobbyist. This leads to a distinction between scientific and humanistic victimology and to the possible way in which a clash between the humanists and the scientists could be avoided.
Naturally Occurring Lethal Parvovirus Infection of Juvenile and Young-Adult Rats
Authors: Coleman G.L. , Jacoby R.O. , Bhatt P.N. , Smith A.L. , Jonas A.M.
Published: November 2015

A lethal disease characterized by hemorrhage and necrosis of the brain, testes, and epididymides developed in young adult rats housed in specific pathogen free quarters. Morphological, virological, and serological investigations of the outbreak indicated that the probable causative agent was rat virus (Kilham), a common parvovirus of rats that usually Induces persistent, asymptomatic infection in adult rats.
Sovereignty and Citizenship in Contemporary US Foreign Economic Policy
Authors: Geske Mary B.
Published: November 2015

So we have to face the choice of fact versus fear…. Will we hunker down and say, my goodness, we're going to be overcome by a trade agreement with Mexico, a country with an economy only five percent as big as ours; or are we going to reach out to the rest of the world and say we can compete and win again[?] … When the moment of decision comes, I believe ordinary working Americans will agree with every living President, every living Secretary of State, every living Secretary of the Treasury, every living Nobel Prize-winning economist, and over 40 of the 50 governors, that NAFTA means expanding markets. And we have to have expanding markets, not shrinking horizons. Our jobs and our children's jobs depend on it.1
The Boot Camp Program for Offenders: Does the Shoe Fit?
Authors: Mathlas Rudolf E. S. , Mathews James W.
Published: November 2015

In the war on crime creation of boot camps for offenders had been widely heralded as the latest weapon to attack the problem of substance abuse. This new correctional program makes a frontal attack on the behavior pattern of the offender to pave the way toward rehabilitation and achievement of constructive social values. In the armed services the boot camp program had been reported to have shown success in rehabilitating offenders in short order and returning them to military service. The use of different boot camp programs in state and county correctional systems has produced a wide variety in design, scope, strategy and reported results. Serious risks inherent in programs whch demean offenders are discussed. There are significant differences between rehabilitation of a selected group and return to active military duty versus obstacles facing released offenders in their return to community life.
The Shoshenqs of Egypt and Palestine
Authors: Kitchen K.A.
Published: November 2015

Contrary to Frank Clancy's recent paper (‘Shishak/Shoshenq's Travels’, JSOT 86 [1999], pp. 3–23), the stela of a king Shoshenq found at Megiddo belongs, and can only belong, to Shoshenq I—it has nothing to do with Shoshenq IV (different car-touches) or any other Shoshenq. Shoshenq I indubitably reigned in the third quarter of the tenth century BCE, and no way as late as 800 BCE (as claimed in cranky literature). The campaign (and its date in Rehoboam's fifth year) remains historical fact, not merely a literary theme, and its geography clearly reached as far as Megiddo and Beth-Shan.