bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards a less conservative analysis of geometric tolerances
Authors: Nassef A O , ElMaraghy H A
Published: November 2003

The statistical analysis of geometric tolerances has been carried out, traditionally, by using either the Taylor series method or the Monte Carlo simulation. Although the Taylor series method is fast, it is not capable of analysing many highly non-linear cases of geometric tolerances, especially when several of them are specified for the same feature. Hence, the Monte Carlo simulation remains the most widely used method for the statistical analysis of geometric tolerances. Similarly to other methods, during each step of the Monte Carlo simulation, all features in the assembly are generated including random variations due to the manufacturing processes’ capabilities. If one of the features does not fall within the specified tolerance range, the whole instance of parts (i.e. the whole assembly) is rejected. This simulation is more conservative than a real assembly-inspection process. This paper presents an augmented Monte Carlo simulation in which assemblies are not rejected if one or more parts are rejected while other parts are within specifications. Instead, the in-spec parts are re-grouped with other acceptable parts of other simulations. This emulates the concept of parts interchangeability in real assembly processes. The results obtained by using the proposed approach are compared with those obtained from a standard Monte Carlo simulation tolerance analysis to demonstrate that the latter is unnecessarily conservative.
Advances in Paediatric Dentistry
Authors: Ashley Paul F , Roberts Graham J
Published: November 2003

The problems facing paediatric dentists have not changed over the years, management of caries and orodental trauma still takes up the greatest proportion of their time. What has changed are the treatments available and in this paper some of the more interesting recent developments in this field are summarised.
Understanding What's in a Brand Rating: A Model for Assessing Brand and Attribute Effects and Their Relationship to Brand Equity
Authors: Dillon William R. , Madden Thomas J. , Kirmani Amna , Mukherjee Soumen
Published: November 2003

Although brand ratings capture the favorability of brand associations, they often do not enable marketing managers to disentangle brand-specific associations from other effects. In this article, the authors present a decompositional model for analyzing brand ratings that addresses this nagging problem and provide insights for understanding the sources of brand equity. Starting with consumers' perceived level of a brand on an attribute, the authors decompose the rating into two components: brand-specific associations and general brand impressions. Brand-specific associations refer to features, attributes, or benefits that consumers link to a brand and that differentiate it from the competition. General brand impressions refer to general impressions about the brand that are based on a more holistic view of the brand. In this article, the authors focus on two principal issues: (1) How can the sources of bias that may be present in brand ratings be disentangled? and (2) Do these putatively biasing effects, if present, have any managerial implications for brand equity? The authors demonstrate the properties and advantages of the model in the context of three empirical applications.
The Value Relevance of Brand Attitude in High-Technology Markets
Authors: Aaker David A. , Jacobson Robert
Published: November 2003

The authors assess the extent to which brand attitude, a key component of brand equity, has value relevance—that is, helps predict future earnings and thus firm value—in high-technology markets. Using data for firms in the computer industries, the authors find that changes in brand attitude are associated contemporaneously with stock return and lead accounting financial performance. The study also provides insights into the drivers of brand attitude. The authors find that both product attributes and peripheral cues shape brand attitudes in high-technology markets.
Relationships between Gastric Development and Anatomic Bases of Radical Surgery for Cancer
Authors: Borghi Felice , Gattolin Andrea , Bogliatto Fabrizio , Garavoglia Marcello , Levi Alessandro Cesare
Published: November 2003

The aim of this study was to determine with all possible accuracy the processes of embryologic development of the stomach and its lymphatics in order to confirm their supposed link with the modern anatomic bases of gastric cancer surgery.
The knowledge of the anatomic behavior of the peritoneal folds and of the lymphatic drainage of the stomach is, in fact, considered the essential basis for the comprehension of the oncologic dissection of the stomach. The study was based on reconstruction of serial histologic sections of 9 human embryos and 8 human fetuses regarding the mesogastric area, as well as anatomic microdissection of 2 9‐month fetuses. The proximal part of the stomach is not involved in the rotation mechanism of the other portions; the lesser sac development follows cranial migration of the spleen; the cardiac (pars cardiaca gastris) area is in continuity with the zone of paraaortic lymph node development; lateral and posterior lymph nodes of the hepatoduodenal ligament do not take origin in the dorsal mesogastrium: they develop together with the common bile duct and the ventral pancreas inside the mesoduodenum; the fusion of the dorsal mesogastrium and the gastric fundus with the posterior abdominal wall appears late in development.
The embryologic study of the mesogastric area clarifies the real mechanism of development of the stomach and its lymphatic pathways with some differences from classic reports; these results agree with the more recent modification of the lymph nodes classification used in the radical treatment of gastric cancer.
Long‐term Results of Patients with pT2 Rectal Cancer Treated with Radiotherapy and Transanal Endoscopic Microsurgical Excision
Authors: Lezoche Emanuele , Guerrieri Mario , Paganini Alessandro M. , Feliciotti Francesco
Published: November 2003

Anterior resection and abdomino‐perineal resection are the surgical techniques used most frequently in the treatment of rectal cancer. Local recurrence rates of 10% to 14% are described after these conventional procedures. Preoperative neoadjuvant radiotherapy reduces local failure. Because local excision techniques can be applied to treat early rectal cancer in selected patients, we evaluated the results of preoperative high‐dose radiotherapy and transanal endoscopic microsurgical excision (TEM) in patients with T2 rectal cancer. All patients underwent preoperative irradiation with 5,040 cGy, divided over 5 weeks. Fourty days after completion of radiotherapy, the patients underwent complete full‐thickness local excision of the rectal lesion including adjacent perirectal fat by TEM. The patients were followed for up to 8 years. Thirty‐five patients, with pT2 rectal cancer as determined by pathological examination of the surgical specimen were enrolled in the present study. The tumors were responsive to preoperative radiotherapy in 82.8% of cases. No intraoperative complications and no conversion to open surgery were observed. No major complications and no mortality occurred during the 60‐day postoperative period. Minor postoperative complications were observed in 5 patients (14.3%). The median follow‐up of the patients was 38 months (range 24 to 96 months). One local recurrence (2.85%) was noted. The probability of surviving at 96 months after completion of treatment was 83%. Local excision by TEM combined with preoperative high‐dose radiotherapy can achieve results similar to those observed after conventional surgery in patients with pT2 rectal cancer.
Management of Appendiceal Masses in a Peripheral Hospital in Nigeria: Review of Thirty Cases
Authors: Okafor Pius I.S. , Orakwe Jideofor C. , Chianakwana Gabriel U.
Published: November 2003

The objective of this work was to conduct a truly rural‐based study to evaluate, from our own rural data devoid of influence from urban‐based studies, the management of appendiceal masses in a typical peripheral hospital in Nigeria. The study aimed to highlight the results of neglected appendicitis in our community and the occasional difficulty of making a correct preoperative diagnosis. It also sought to draw the attention of the health care practitioner in our community to the importance of continued enlightenment of the people regarding the need to seek medical treatment early. This was a retrospective study, with the setting at St. Victoria Specialist Hospital, Ekwulobia, Anambra State, Nigeria, a rural hospital serving its community. A series of 30 patients who were managed for an appendiceal mass between January 1, 1992 and December 31, 2001, a 10‐year period, were included in the study. We identified the cases by reviewing the surgical register. The relevant case notes were retrieved from the Records Department. The following data were extracted for each patient: age and sex; how early the patient presented; the history and presentation of the patient; whether the diagnosis was made before or during surgery; the treatment modality; length of hospital stay; and outcome. The results showed that 13 patients (43.3%) presented more than 1 week after the onset of symptoms. The age range was 15 to 60 years (average 27 years); 13 patients (43.3%) were in the age range of 40–49 years. Twenty men and ten women were treated, giving a male/female ratio of 2:1. The main clinical features were fever, anorexia, pain, tenderness, and a palpable mass in the right iliac fossa. The problem was diagnosed before surgery in 23 patients (76.7%) and during surgery in 7 (23.3%). Treatment modalities were conservative + interval appendectomy in 18 patients (60%); open and close + conservative + interval appendectomy in 3 patients (10%); immediate appendectomy without burying the stump in 2 cases (6.7%); right hemicolectomy (in one 40‐year‐old woman and one 55‐year‐old man); and incision and drainage of an appendiceal abscess in 5 patients (16.7%). No deaths were recorded. The study showed that appendical masses are most prevalent during the fifth decade of life and are rare before age 10 and after age 60. More men are affected than women, and most cases can be diagnosed before surgery, although some patients must await more sophisticated diagnostic tools or surgical exploration for diagnosis.
Transitional Cell Carcinoma in Renal Transplant Recipients
Authors: Kao Yu‐Lin , Ou Yen‐Chuan , Yang Chi‐Rei , Ho Hao‐Chung , Su Chung‐Kuang , Shu Kuo‐Hsiung
Published: November 2003

Renal transplantation (RTx) recipients have a high incidence of cancer, including transitional cell carcinoma (TCC). Posttransplantation urologic malignancies still present a challenge for transplant surgeons. Using the Dialysis and Transplant Registry of Taichung Veterans General Hospital, a total of 55 cancers were diagnosed in 52 RTx recipients between May 1983 and September 2001. Of these, 24 RTx recipients developing TCC were identified and presented the distinctly high percentage (43.6%) of TCC that were malignancies after RTx in Taiwan. The mean time between transplantation and initial diagnosis was 46 months in our series. Painless hematuria with pyuria is the most common mode of presentation. Transitional cell carcinoma of RTx recipients had multiple foci. Moreover, synchronous TCC in bilateral upper urinary tracts were confirmed in 9 (41%) recipients. The pathologic status of disease is invasive at diagnosis (pTa: 2, pT1: 7, pT2: 4, pT3: 6, pT4: 2, graft metastasis: 1 and distant metastasis: 2). Disseminated metastasis occurred in 6 recipients, all of whom died of their disease within 16 months. Five recipients received adjuvant chemotherapy and retained stable renal function. We conclude that RTx recipients have a markedly increased incidence of TCC in Taiwan, and that prophylactic bilateral nephroureterectomy of native kidneys with bladder cuff excision can be performed simultaneously in RTx recipients with TCC.
Selective Hepatic Vascular Exclusion versus Pringle Maneuver in Major Liver Resections: Prospective Study
Authors: Smyrniotis Vassilios E. , Kostopanagiotou Georgia G. , Contis John C. , Farantos Charalampos I. , Voros Dionisios C. , Kannas Dimitrios C. , Koskinas John S.
Published: November 2003

Selective hepatic vascular exclusion (SHVE) and the Pringle maneuver are two methods used to control bleeding during hepatectomy. They are compared in a prospective randomized study, where 110 patients undergoing major liver resection were randomly allocated to the SHVE group or the Pringle group. Data regarding the intraoperative and postoperative courses of the patients are analyzed. Intraoperative blood loss and transfusion requirements were significantly decreased in the SHVE group, and postoperative liver function was better in that group. Although there was no difference between the two groups regarding the postoperative complications rate, patients offered the Pringle maneuver had a significantly longer hospital stay. The application of SHVE did not prolong the warm ischemia time or the total operating time. It is evident from the present study that SHVE performed by experienced surgeons is as safe as the Pringle maneuver and is well tolerated by the patients. It is much more effective than the Pringle maneuver for controlling intraoperative bleeding, and it is associated with better postoperative liver function and shorter hospital stay.
Barrett’s Esophagus: Environmental Influences in the Progression of Dysplasia
Authors: Boulton Ralph A. , Usselmann Bernhard , Mohammed Imtiyaz , Jankowski Janusz
Published: November 2003

Barrett’s esophagus (BE) is composed of multiple lineages including Paneth cells and endocrine cells in addition to gastric and intestinal cells. Although the origin of the BE stem cell is a matter of conjecture, the stem cells are clearly multipotent, and therefore the phenotype is restricted by genomic imprinting (termed restricted potency). Recent evidence suggests that the microenvironment may select various lineages. In this regard the proportion of gastric and specialized intestinal metaplastic cells has been attributed to the composition of the refluxate, acid or bile, respectively. Experimental evidence also implicates specific xenobiotics in this process, including bile acids. In particular we discuss the potential biologic roles of bile acids in epithelial adaptation from in vivo and in vitro models.
Current Status of Neoadjuvant Therapy for Adenocarcinoma of the Distal Esophagus
Authors: Zacherl Johannes , Sendler Andreas , Stein Hubert J. , Ott Katja , Feith Marcus , Jakesz Raimund , Siewert J. Rüdiger , Fink Ulrich
Published: November 2003

Prospective studies dealing with preoperative therapy in adenocarcinoma of the esophagus alone are rare. The interpretation of the preferential phase II trials and a few phase III trials is complicated, as most studies include adenocarcinoma of the esophagus (i.e., Barrett’s carcinoma), adenocarcinoma of the esophagogastric junction (including cardia carcinoma and subcardia carcinoma), or squamous cell carcinoma. Preoperative chemotherapy, generally well tolerated, cannot decrease the incidence of local failure beyond the level achieved with surgery alone, but it might delay systemic relapse. Preoperative radiotherapy can enhance local control, but it fails to improve overall survival. Neoadjuvant chemoradiation was demonstrated in only one randomized trail to have a survival benefit, but survival in the surgery‐alone group was unusually low. Generally, survival was ameliorated in patients responding to neoadjuvant treatment. However, preoperative chemoradiation was often accompanied by a remarkable increase in postoperative morbidity and mortality. Nonresponding patients have, in this respect, a worse prognosis than responders after resection. The prediction of responding patients to neoadjuvant therapy as well as the early identification of patients who will not respond is of utmost clinical importance. Today, there is no absolute evidence that neoadjuvant treatment for patients with potentially resectable Barrett’s cancer prolongs survival. In patients with locally advanced, presumably not completely resectable adenocarcinoma of the esophagus, preoperative treatment appears to increase the chance for a curative resection and enhance survival in responding patients. Neoadjuvant treatment of adenocarcinoma of the esophagus, as a consequence, is currently not the standard treatment and should be performed only within controlled clinical trials.
Evolution of Neck Dissection for ImprovedFunctional Outcome
Authors: Samant Sandeep , Robbins K. Thomas
Published: November 2003

Neck dissection plays a crucial role in the management of
metastatic neck disease. Until recently, radical neck dissection has been the
standard treatment for malignant cervical adenopathy irrespective of the nodal
staging. However, in recent years, there has been a trend toward the
development of more conservative operations, wherein certain nonlymphatic
structures and lymph node groups can be selectively preserved. Radical neck
dissection still remains the surgical standard against which various
modifications must be compared. The need to perform more conservative surgery
comes from the realization that the radical operation is attended by
significant postoperative morbidity, and that some of the structures removed in
the course of this operation can actually be preserved without any compromise
in oncologic safety. The purpose of this article is to discuss the evolution of
conservation surgery in the management of metastatic neck disease, define the
clinical applications of various types of neck dissection, and evaluate the
implications of these conservation approaches on preservation of
function.
Scintigraphic Evaluation of Jejunal Interposition after Distal Esophageal Resection for Early Barrett’s Carcinoma
Authors: Stier Albrecht W. , Feith Marcus , Weigel Christiane , Schwaiger Marcus , Heidecke Claus D. , Stein Hubert J.
Published: November 2003

Subtotal esophagectomy still is the major treatment for early Barrett’s carcinoma. The inevitable loss of the gastric reservoir leaves an unresolved functional problem. Distal esophageal resection combined with a short jejunal interposition might be a safe alternative with the advantage of better functional results. In this series, 12 or more months after limited surgery for early Barrett’s carcinoma 8 patients underwent functional investigation by alimentary scintigraphy. The activity of a technetium‐labeled bolus passing through the esophagus and the jejunal interposition into the stomach was consecutively measured. Compared to 11 healthy controls the transit through the tubular esophagus showed no significant delay; transit time, however, increased with a bolus‐induced dilation of the jejunal interposition. The length of the transit time through the jejunal interposition correlated with the length of the jejunal segment. The delay of bolus passage into the stomach did not result in substantial symptoms in jejunal segments shorter than 12 cm. Propulsive activity within the jejunal interposition resulted in a bolus transport into the stomach without any reflux to the esophagus. These data demonstrate good transport function and reflux prevention of short jejunal segments interposed between the esophagus and the stomach.
Effects of trauma‐focused research on recent domestic violence survivors
Authors: Johnson Lesley E. , Benight Charles C.
Published: November 2003

This study investigated the impact of trauma‐focused research on domestic violence survivors. At the end of a survey assessing psychological distress, abuse severity, coping self‐efficacy (CSE), and cognitions, questionnaire items were utilized to assess participants' levels of gain, unexpected upset, and regret of participation. Participants were 55 women who had recently experienced abuse by a partner. Forty‐five percent reported positive gain from participation, 25% reported they were more upset than anticipated, and a minority of women (6%) expressed regret for participation. Results indicated that women who were more upset than expected scored significantly higher on depression, PTSD, and number of lifetime traumas, and significantly lower on CSE. Implications for enhancement of consent form documents and debriefing procedures are addressed.
Predictors of nonpathological dissociation in Northern Ireland: The affects of trauma and exposure to political violence
Authors: Dorahy Martin J. , Lewis Christopher Alan , Millar Robert G. , Gee Travis L.
Published: November 2003

Recent work has identified an empirical distinction between pathological and nonpathological dissociation. This study examined the correlates of nonpathological dissociation in a Northern Irish sample. The Dissociative Experiences Scale, the Traumatic Experiences Checklist, the Guilt Inventory, and the General Health Questionnaire, as well as two open‐ended questions assessing exposure to political violence were completed by 119 participants. Nonpathological dissociation was predicted by age, perceived impact of traumatic events, and adherence to moral standards. Moreover, dissociation was found to be significantly higher in those exposed directly to political violence and those experiencing childhood emotional abuse. Results are consistent with previous theoretical and empirical work and it is proposed that nonpathological dissociation is related to traumatic experience in Northern Ireland.
Disgust Processing in Phobia of Blood-Injection-Injury
Authors: Schienle Anne , Schäfer Axel , Stark Rudolf , Walter Bertram , Kirsch Peter , Vaitl Dieter
Published: November 2003

Abstract An elevated disgust sensitivity (DS) is considered to be a vulnerability factor for the development of a blood-injection-injury (BII) phobia. Within the present functional Magnetic Resonance Imaging (fMRI) study, 12 female BII phobics were scanned while viewing alternating blocks of 40 disgust-inducing, 40 fear-inducing, and 40 affectively neutral pictures. Each block lasted 60s and was repeated six times during the experiment. All scenes were phobia-irrelevant. Afterwards, the subjects gave affective ratings for the pictures and described their DS on a self-report measure for different areas (e.g., poor hygiene, unusual food, death/deformation). The responses were compared with those of 12 nonphobic females. The BII phobics showed a stronger occipital activation within the right cuneus and lingual gyrus during the first viewing of the disgusting pictures. Aside from this finding, which could be interpreted as reflecting increased attention, there was little evidence for a generally elevated DS in BII phobia. On the DS questionnaire, the patients had indicated a greater reactivity only for disorder-relevant contents (death/deformation). Further, both groups gave similar disgust ratings for the pictures and showed comparable brain-dynamic responses over all blocks of the disgust condition, which included the activation of both amygdalae and the left inferior frontal gyrus.
Laser‐Assisted Uvulopalatoplasty for Obstructive Sleep Apnea
Authors: Mickelson Samuel A.
Published: November 2003

Laser‐assisted uvulopalatoplasty (LAUP) can reduce snoring by sequentially removing excessive vibratory tissue of the velopharynx. The procedure can be performed under local anesthesia in an office setting. Since the appearance of the soft palate is similar after both LAUP and uvulopalatopharyngoplasty, LAUP may also be efficacious in the management of obstructive sleep apnea syndrome (OSAS).

LAUP was performed in 34 consecutive prospectively evaluated patients with OSAS. Of the 34 patients, 28 (82%) were male; the mean age was 53 years, and the mean body mass index was 31.1. In the study population of 13 patients who completed preoperative and postoperative sleep studies, the apnea index decreased from 19.4 to 4.2 (P=.006), the respiratory disturbance index (RDI) decreased from 31.2 to 15.7 (P=.092), and mean lowest oxyhemoglobin saturation increased from 82.3% to 85.0% (P=.581). The RDI fell to 10 or lower in 38.5.% of patients and was reduced by at least 50% in 53.8% of the study group. Snoring was significantly reduced in 92.3% of patients (P<.001). These early results suggest that LAUP may be efficacious in the management of OSAS.
Outcome of Pyriform Sinus Cancer
Authors: Marks Steven C. , Lolachi Christopher M. , Shamsa Falah , Robinson Kevin , Aref Amr , Jacobs John R.
Published: November 2003

Pyriform sinus cancer remains one of the most lethal of human diseases. Regardless of approach attempted significant enhancement of survival has not been realized. In this study a retrospective single institutional review of all patients diagnosed with pyriform sinus cancer during the 1980s was conducted. The results in 93 patients show an overall determinant 5‐year survival of 14.3%. Of patients undergoing surgery, median determinant survival was 37 months and 5‐year survival was 34.6%. In resectable patients treated with radiation with or without chemotherapy, median determinant survival was 13 months with 5‐year survival of 7.1% (P<.01). Surgical salvage was attempted in 8 patients without success.

In conclusion, due to the apparent survival advantage for surgical patients, the low rate of surgical salvage, and the relatively low rate of organ preservation in prospective trials, pyriform sinus cancer is a poor site for organ preservation. Surgery followed by radiation therapy should remain the standard of care for pyriform sinus cancer.
Choanal Atresia
Authors: Brown Orval E. , Pownell Patrick , Manning Scott C.
Published: November 2003

The anatomic classification of choanal atresia is commonly quoted as 90% bony and 10% membranous. This incidence is from a review by Fraser in 1910 of 115 cases, “many of which were insufficiently described.” We have reviewed 47 computed tomography scans of choanal atresia from the literature and 16 from our clinical experience, and classified the anatomy as bony, mixed bony‐membranous, or pure membranous. Our results reveal a combined incidence of 18 (29%) pure bony, 45 (71%) mixed bony‐membranous, and no pure membranous atresia. We propose a new classification of choanal atresia to include bony, mixed, and membranous to accurately reflect the anatomic abnormalities. Our series of 11 patients under‐going transnasal microsurgical repair, a critical review of the literature, and the implications of the anatomic classification on the choice of surgical procedure are presented.
Holmium
Authors: Metson Ralph
Published: November 2003

Although surgical lasers were introduced to the field of otolaryngology more than 20 years ago, their use in rhinologic surgery has remained relatively limited. With the development of the holmium:yttrium‐aluminum‐garnet (YAG) laser, a device is now available that offers those features necessary for effective sinus surgery: precise bone ablation, efficient soft tissue coagulation, and fiberoptic transmission. This solid‐state laser of 2.1‐μm wavelength can be coupled with endoscopic instrumentation for the surgical treatment of sinus disease.

This study was conducted to determine the clinical efficacy of the holmium:YAG laser for endoscopic sinus surgery. A microscopic analysis of laser‐treated sinus tissue was also performed in an attempt to determine the histologic basis of the observed clinical findings.

In a prospective, randomized, controlled, single‐blinded study, 32 consecutive patients underwent endoscopic sinus surgery using the holmium:YAG laser on one side of the nose and conventional endoscopic instrumentation on the other side. Patients rated symptoms for each side of the nose at 1 week, 1 month, 3 months, 6 months, and 2 years after surgery. Healing parameters were similarly rated by the surgeon. Until the study was completed, patients were not told which side of the nose had been treated with laser surgery.

No intraoperative complications occurred. The mean intraoperative blood loss was 24.6 mL less on the laser‐treated side of the nose than on the conventionally treated side (P<.001). At 1 week after surgery, there was increased mucosal edema on the laser‐treated side (P<.01). Crust formation was greater on the conventionally treated side at 1 week and was greater on the laser‐treated side at 1 month (P<.01). Improvements in symptoms of pain, congestion, and drainage were equivalent for both treatment modalities (P<.001).

Microscopic analysis demonstrated the ability of the holmium:YAG laser to remove tissue in relatively thin layers with ablation depths of 260±8.2 μm, 286±9.4 μm, and 341±20.4 μm per pulse at energy levels of 0.5, 1.0, and 1.5 J, respectively. A zone of thermal necrosis extending up to 1 mm beyond the site of laser impact was thought to correlate with the increased postoperative edema observed on the laser‐treated side.

Endoscopic sinus surgery with the holmium:YAG laser is as effective as nonlaser techniques in relieving the symptoms of chronic sinusitis. Laser surgery offers improved intraoperative hemostasis, but it causes increased postoperative tissue edema. The holmium:YAG laser provides the surgeon with an additional tool for the performance of safe, effective sinus surgery.
Inhibition of Head and Neck Tumor Cell Growth With Arachidonic Acid Metabolism Inhibition
Authors: Ondrey Frank G. , Juhn Steven K. , Adams George L.
Published: November 2003

Head and neck tumors are known to synthesize arachidonic acid metabolites. The authors have postulated that these substances may confer growth advantage to cancer cells, and by interfering with arachidonic acid metabolism squamous cancer growth may be altered. The tongue derived squamous carcinoma cell line, SCC‐25, was treated with three leukotriene synthesis inhibitors and indomethacin. A dose‐dependent decrease in DNA synthesis occurred with leukotriene inhibition, but not prostaglandin inhibition. All leukotriene synthesis inhibitors produced a dramatic and immediate effect (>70% inhibition by 4 hours) without cytotoxicity (>90% trypan blue exclusion). Cell populations at 96 hours were decreased when compared to control populations. In conclusion, leukotrienes or other lipoxygenase products may play a role as growth factors for squamous cell carcinoma, and arachidonic acid inhibition may be a novel target for chemotherapeutic intervention.
Comparison of Labyrinthectomy and Vestibular Neurectomy in the Control of Vertigo
Authors: Gacek Richard R. , Gacek Mark R.
Published: November 2003

One hundred twenty‐six patients who were treated with labyrinthectomy (81 patients) or vestibular neurectomy (45) between the years 1979 and 1994 were reviewed. The cause for vertigo in 124 of the 126 patients was Meniere's disease (89 patients), labyrinthitis (15), delayed endolymphatic hydrops (8), vestibular neuritis (7), and failed labyrinthectomy (5). In the remaining 2 patients, a normal labyrinth was sacrificed to fistulize a petrous apex cyst. Both procedures were equally effective in relieving vertigo (labyrinthectomy 98.8%; neurectomy 97.8%), but the length of hospitalization, length of disability before return to work, and cost were twice as great with vestibular neurectomy than with labyrinthectomy. More patients exhibited prolonged ataxia following neurectomy (5 patients) than after labyrinthectomy (2). Vestibular neurectomy was associated with several serious complications: reversible facial paresis (15 patients), meningitis (1), cerebrospinal fluid leak (1), and epidural hematoma (1). Labyrinthectomy was complicated by postoperative hyponatremia in 1 patient. Selective vestibular neurectomy preserved hearing in 32 (82%) of 39 patients. Criteria for recommending either ablation procedure are discussed. The incidence of sequential involvement of the contralateral ear was 1.5%.
Elevated Arginine Vasopressin Levels in Squamous Cell Cancer of the Head and Neck
Authors: Talmi Yoav P. , Wolf Gregory T. , Hoffman Henry T. , Krause Charles J.
Published: November 2003

The reported effectiveness of single tumor markers (TMs) associated with squamous cell cancer of the head and neck ranges from 15% to 71%, with most studies reporting sensitivity no higher than 50%. An increased incidence of the syndrome of inappropriate secretion of antidiuretic hormone or arginine vasopressin (SIADH) in patients with head and neck cancer has been reported. Serum arginine vasopressin (AVP) was studied as a possible TM in these patients. Sixty‐three patients with squamous cell carcinoma of the head and neck determined as potentially curable were prospectively evaluated before treatment and compared to 17 patients with apparent cure of head and neck squamous cell cancer who served as controls. Serum AVP levels were obtained and determined by radioimmunoassay in the preoperative period and 1 week postoperatively in 15 patients. Thirty‐four patients were staged as T4, 26 as T3, and 3 as T2. Twenty‐one (33%) of the 63 patients had no neck involvement. Twenty‐four (38%) of 63 patients had elevated serum AVP levels corrected for serum osmolarity. Of the 15 patients evaluated before and after surgery, 8(53%) had elevated serum AVP levels preoperatively. Of these 8 patients, 3 had reduction in AVP levels and 5 had complete normalization after 1 week. The results obtained for serum AVP do not exceed results of other TMs reported. AVP may also not be as specific as other TMs for cancer of the head and neck. Our group with AVP sampled postoperatively is too small for us to draw conclusions, but reduction of its levels after treatment in all patients may be significant. These preliminary results indicate that further evaluation of AVP during the posttreatment course in a larger number of cases, and perhaps with other TMs as well, is warranted.
Quantification of Videostrobolaryngoscopic Findings‐Measurements of the Normal Glottal Cycle
Authors: Woo Peak
Published: November 2003

Videostrobolaryngoscopic (VSL) images of vocal fold behavior in 32 male and 33 female normal speakers were analyzed by computer. Image analysis software enhanced the glottal image, allowing extraction of the glottal area. Frame‐by‐frame analysis produced 20 glottal area values for each glottal cycle. The glottal area waveform (GAW) plots these values. From the GAW, features such as peak glottal area, duration of opening and closing, and rates of vocal fold opening and closing were measured. Acoustic measures of sound pressure level(SPL) and fundamental frequency were used to compare changes in GAW with changes in loudness and pitch.

Analysis of the data showed significant differences between the sexes in GAW, peak glottal area, closed period, closing slope, and size and incidence of the posterior glottal gap. Intensity and frequency changes significantly affected GAW. Intensity variations affected the steepness of the closing phase and the duration of the closed period. Frequency changes affected the open period and the relative duration of opening vs. closing.

This study provides quantitative measures of the VSL image that supplement and corroborate perceptual observations. These measures provide normative data against which similar measures of dysphonic larynges can be compared.
A Positional Maneuver for Treatment of Horizontal‐Canal Benign Positional Vertigo
Authors: Lempert Thomas , Tiel‐Wilck Klaus
Published: November 2003

Horizontal‐canal benign positional vertigo (HC‐BPV) is characterized by brief attacks of intense vertigo that are induced by mainly rolling over in bed. Examination shows a burst of purely horizontal nystagmus beating toward the undermost ear when the head is turned from supine to either lateral position. Two patients with typical HC‐BPV were treated by a new positional procedure that aims to clear particles from the affected canal. The maneuver starts with the patient in the supine position and consists of three 90‐degree head rotations toward the unaffected ear. Both patients had immediate and sustained relief of their attacks. No positional nystagmus could be elicited after the maneuver. The rapid cessation of positional vertigo and nystagmus adds evidence that HC‐BPV is caused by dense particles that move within the canal whenever its orientation toward gravity is changed.
Effect on the Nasal Mucosa of Long‐Term Treatment With Oxymetazoline, Benzalkonium Chloride, and Placebo Nasal Sprays
Authors: Graf Peter , Hallén Hans
Published: November 2003

A parallel, randomized, double‐blind study was performed in 30 healthy subjects to investigate the effects on the nasal mucosa of a 1‐month treatment with nasal sprays. Ten subjects received oxymetazoline nasal spray; 10 subjects used a nasal spray containing the preservative benzalkonium chloride, and the others were treated with a placebo nasal spray. The three variables that were studied‐nasal mucosal swelling, symptom scores, and nasal reactivity‐were estimated by histamine challenge before and after 28 days of treatment. Rhinostereometry was used to measure nasal mucosal swelling and nasal reactivity.

After 28 days of use, benzalkonium chloride spray alone induced an increase in nasal mucosal swelling. At the end of the month, the score for nasal stuffiness was significantly higher for the group treated with oxymetazoline than for those treated with benzalkonium chloride. Oxymetazoline nasal spray induced a pronounced increase in nasal reactivity, which was significantly greater than that induced in the placebo group. Long‐term use of placebo and benzalkonium chloride nasal sprays also caused an increase in nasal reactivity, but not to the same extent as with the nasal sprays containing oxymetazoline.

The authors concluded that long‐term use of oxymetazoline induces a sensation of nasal stuffiness, which may be due to unconscious exaggeration of the degree of nasal stuffiness, induced nasal hyperreactivity, or a combination of both. These factors are probably the main reasons for the prolonged use of nasal decongestive sprays and the development of rhinitis medicamentosa. Benzalkonium chloride induces mucosal swelling, which explains why the presence of this preservative in a decongestant spray aggravates rhinitis medicamentosa.

Laryngoscope, 106:605‐609, 1996
Predictive Value of Facial Nerve Electrophysiologic Stimulation Thresholds in Cerebellopontine‐Angle Surgery
Authors: Selesnick Samuel H. , Carew John F. , Victor Jonathan D. , Heise Carl W. , Levine Jennifer
Published: November 2003

The predictive value of intraoperative stimulation thresholds for facial nerve function, using a constant‐current system, was examined in 49 patients undergoing resection of cerebellopontine‐angle tumors. Immediately after surgery, 75% of the 0.1‐mA threshold group, 42% of the 0.2‐mA group, and 18% of the 0.3‐mA or greater group had good (grade I or II) facial nerve function. One year after surgery, 90% of the 0.1‐mA group, 58% of the 0.2‐mA group, and 41% of the 0.3‐mA or greater group had grade I or II function.

A statistically significant breakpoint of 0.2 mA was found to predict good postoperative facial function. Delayed facial paralysis occurred in 22% of patients, but the prognosis for these patients was favorable. Both current stimulation threshold and duration are necessary for a meaningful comparison of data between investigators.

Laryngoscope, 106:633‐638, 1996
Quantitative Criteria for Predicting Thyroplasty Type I Outcome
Authors: Omori Koichi , Slavit David H. , Kacker Ashutosh , Blaugrund Stanley M.
Published: November 2003

The purpose of this study was to ascertain the relation between preoperative glottal gap and postoperative vocal function in thyroplasty type I. Twenty‐two of 64 patients who underwent thyroplasty type I between 1987 and 1994 were studied. In preoperative digitized laryngostroboscopic images, the glottal‐gap width (GGW), shape, and area were examined at the maximum closure of vibration and normalized by membranous vocal‐fold length (MVFL). Postoperative vocal function analysis was performed with aerodynamic and acoustic measurements and compared with preoperative videostroboscopic images. In patients with preoperative posterior GGW of less than 10% of MVFL, postoperative vocal function was significantly better than in other patients. Although thyroplasty type I is an excellent medialization technique, it may need to be combined with a posterior closure procedure in patients with large posterior gaps.
Growth Rate Characteristics of Acoustic Neuromas Associated With Neurofibromatosis Type 2
Authors: Abaza Mona M. , Makariou Erini , Armstrong Mark , Lalwani Anil K.
Published: November 2003

Neurofibromatosis type 2 (NF2) is a dominantly inherited disorder characterized by the occurrence of bilateral acoustic neuromas (ANs) and other central nervous system tumors. Magnetic resonance images and audiologic data on 22 patients with NF2 who underwent multiple studies at the National Institutes of Health between 1983 and 1993 were reviewed to determine the growth characteristics of ANs in these patients.

The average growth rate of ANs in NF2 patients was 0.30 cm3 per year and was significantly higher in older patients (0.75 cm3 per year) than in younger ones (0.12 cm3 per year). Larger ANs were more commonly found in patients with concomitant spinal tumors or meningiomas. NF2 patients with spinal tumors but not meningiomas demonstrated faster growth rates than patients without additional tumor burden. The data from this study suggest that older patients or patients with associated spinal tumors have faster growing ANs and therefore should be followed closely and treated aggressively.
Laser‐Assisted Uvulopalatoplasty: Postoperative Complications
Authors: Walker Regina Paloyan , Gopalsami Chellam
Published: November 2003

Laser‐assisted uvulopalatoplasty (LAUP) has become a widely used procedure for the treatment of snoring and mild sleep apnea in the United States. Between July 1993 and December 1994, the authors of this study prospectively evaluated 541 consecutive patients referred to their hospital for possible LAUP to treat loud disruptive snoring.

Of the 541 patients, 275 patients had a total of 754 LAUP procedures. There were 26 complications (3.45%). These complications included postoperative hemorrhage in 16 patients (2.12%), local infection in 4 patients (0.53%), temporary palatal incompetence in 4 patients (0.53%), and temporary loss of taste in 2 patients (0.27%). None of the 16 patients with postoperative hemorrhage required a blood transfusion. Only 10 patients (1.3%) had hemorrhage that required medical attention; in the other patients, the bleeding stopped spontaneously. There were no cases of hypernasal speech, permanent palatal incompetence, nasopharyngeal stenosis, airway compromise, or death.

Laryngoscope, 106:834‐838, 1996
Thermal Injury Patterns and Tensile Strength of Canine Oral Mucosa After Carbon Dioxide Laser Incisions
Authors: Speyer Matt , Joe John , Davidson Jeffrey M. , Ossoff Robert H. , Reinisch Lou
Published: November 2003

The amount of collateral damage in laser surgery is affected by the precision of the beam delivery. To test a new control system, the authors of this study produced surgical incisions in the canine oral mucosa and then documented histologic and tensile strength changes during the wound healing process. The incisions were made by three different methods: scalpel, manually controlled carbon dioxide (CO2) laser, and computer‐controlled CO2 laser.

Both types of laser incisions took longer to heal than the scalpel incisions. The laser incisons were accompanied by a zone of thermal damage lateral to the incision. With the computer‐controlled laser incision, the area of thermal damage was reduced, the laserinduced delay in wound healing was less, and tensile strength was relatively greater. The data indicate that surgical performance is improved by critical beam control.

Laryngoscope, 106:845‐850, 1996
Genotype‐Phenotype Correlations in Type 1 Waardenburg Syndrome
Authors: Lalwani Anil K. , Mhatre Anand N. , San Agustin Theresa B. , Wilcox Edward R.
Published: November 2003

Type 1 Waardenburg syndrome (WS1) is an autosomal dominant disorder characterized by dystopia canthorum, sensorineural deafness, and pigmentary disturbances. Previous work has linked the disease to PAX3, a transcription factor with two highly conserved DNA binding motifs: a paired box and a homeobox. Several mutations within the paired box of PAX3 have been reported. We have identified the first two mutations within the homeobox in two different families. Herein, we report the phenotypic expression of WS1 in these two families and explore the implications for possible genotype‐phenotype correlations. The phenotypic expression was variable within and between the families. Sensorineural hearing loss was present in 71% of affected individuals. Spectrum of hearing loss included unilateral high frequency(>4000 Hz), profound unilateral hearing loss, and bilateral profound hearing loss. The severity of hearing impairment varied significantly within and among families. Phenotypically, these two WS1 families with mutations within the PAX3 homeobox could not be differentiated from those families with paired box mutations. More precise genotype/phenotype correlation may be possible when additional mutations are described throughout the PAX3 gene.

Laryngoscope, 106:895‐902, 1996
Familial Large Vestibular Aqueduct Syndrome
Authors: Griffith Andrew J. , Arts H. Alexander , Downs Catherine , Innis Jeffrey W. , Shepard Neil T. , Sheldon Susan , Gebarski Stephen S.
Published: November 2003

The large vestibular aqueduct syndrome (LVAS) is a distinct clinical entity characterized by stepwise progressive sensorineural hearing loss associated with isolated enlargement of the vestibular aqueduct.

A correlative clinical, audiologic, vestibular, cytogenetic, and radiographic analysis of a family with inherited LVAS was performed. The male proband and his affected brother are offspring of unaffected parents, and have no other abnormalities. Pedigree analysis suggests autosomal recessive or X‐linked inheritance with variable expressivity of LVAS in this family.

This study is the first description of familial inheritance of LVAS. LVAS may account for a significant number of patients with nonsyndromal, genetic sensorineural hearing loss. Future molecular analyses of this study family may identify the causative gene(s) in LVAS.
Transnasal Endoscopic Repair of Cranionasal Fistulae: A Refined Technique With Long‐term Follow‐up
Authors: Burns James A. , Dodson Edward E. , Gross Charles W.
Published: November 2003

Although the management of cranionasal fistulae has historically plagued otolaryngologists, recent reports of endoscopic techniques for repair of these lesions offer promising results. We present our series of 42 patients whose cranionasal fistulae were managed endoscopically between December 1989 and August 1995. Follow‐up ranged from 5 to 68 months, thereby including long‐term results from our previously reported series of 29 cases. Resolution of cerebrospinal fluid rhinorrhea was achieved in 35 (83.3%) of 42 patients with one endoscopic procedure, and 3 patients had successful closure at a second surgery. All five cephaloceles were successfully treated with one procedure. We have refined our technique to include specific indications for the use of free grafts depending on the location and size of the cranionasal fistula.
Cochlear Implantation in a Pacemaker Patient
Authors: Triglia Jean‐Michel , Beliaeff Michel , Faugere Gerard
Published: November 2003

The authors present their experience with cochlear implantation in a 22‐year‐old patient who had a cardiac pacemaker because of complete atrioventricular block. The question of compatibility between the cochlear implant (multichannel Digisonic DX10Æ®) and the pacemaker (Biotronik Nanos‐01Æ®) was raised. After consulting the two manufacturers regarding the risk of electrical interference, the authors decided to program the pacemaker in a locked mode (VOO) and then perform cochlear implantation. When the cochlear implant was switched on for the first time, electrocardiograms were obtained to ensure that the two devices were compatible. Absolutely no interference was detected. After a 3‐year follow‐up, cochlear implant performance remains excellent.