bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histologic Study of Perifascial Areolar Tissue Implanted in Rabbit Vocal Folds: An Experimental Study
Authors: Hachiya Adriana , Imamura Rui , Parra Edwin Roger , Sennes Luiz Ubirajara , Tsuji Domingos Hiroshi 
Published: May 2017

ObjectivesPerifascial areolar tissue (PAT) consists of loose areolar tissue with viscoelastic properties that are similar to those found in tissues in the superficial layer of the vocal fold. The aim of this study was to quantify the inflammatory process and the collagen content of the graft, as well as that of the host tissue, after placement of a strip of PAT into the rabbit vocal fold.MethodsSurgeries were performed on 30 rabbits. The grafts were implanted in pockets that were surgically created in the right vocal fold. The left vocal fold (control group) was subjected only to surgical manipulation. The animals were divided into 3 groups for evaluations at 15 days, 3 months, and 6 months, and their larynx tissues were subsequently reviewed by histology.ResultsThe grafts were characterized by disorganized and thick collagen bundles and were identified in all study groups. The collagen density stayed constant over time. There was an acute inflammatory response induced by the graft at 15 days that did not exist in the specimens taken at 3 and 6 months. Deposition of collagen fibers in the lamina propria was observed starting at 15 days after the operation and was more intense in the experimental vocal fold than in the control vocal fold.ConclusionsOur findings indicated that PAT has a low tendency for promoting an inflammatory response. However, there was a loss of the original architecture of the graft tissue and a greater deposition of collagen in the implanted vocal folds than in the control group.
Endoscopic Treatment of Adversely Located Osteomas of the Frontal Sinus
Authors: Sieśkiewicz Andrzej , Lyson Tomasz , Piszczatowski Bartosz , Rogowski Marek 
Published: May 2017

Objectives We assess the utility and limitations of an endoscopic technique in the treatment of osteomas that are considered difficult to manage endoscopically, ie, those located superiorly or laterally in the frontal sinus, extending beyond a virtual plane through the lamina papyracea, and we describe the principles of a surgical technique that facilitates removal of such tumors. Methods We performed a retrospective study on 8 patients with symptomatic frontal sinus osteomas, including tumors extending past the commonly recognized limits of endoscopic resection because of their size or site of attachment. Results All tumors were removed by a purely transnasal endoscopic approach. No major complications were observed during or after the operation. All patients experienced improvement or total regression of their symptoms. Conclusions With appropriate instruments and specific endoscopic techniques, it is possible to resect osteomas that not long ago were deemed inaccessible to endoscopic surgeons. The commonly recognized limits of endoscopic treatment of such tumors may be exceeded in some cases; however, favorable anatomic conditions are decisive for a successful operation.
The Ram Sign: Detecting Previously Undiagnosed Congenital Laryngeal Clefts in Adults
Authors: Weissbrod Philip A. , Inglis Andrew , Merati Albert L. 
Published: May 2017

Objectives We present the clinical characteristics of a case series of adult patients with type III laryngeal clefts according to the classification of Benjamin and Inglis, in an attempt to make practitioners aware of the “ram sign,” a clinical finding associated with laryngeal clefts in adults. Laryngeal clefts are uncommon defects that are nearly universally identified during infancy as a result of persistent aspiration and pneumonia. Undiagnosed laryngeal clefts in adults are extremely rare. Methods Three type III laryngeal clefts were identified in adults (29, 48, and 60 years of age) from one clinic over an 18-month period. The existing literature features only one type III cleft, to our knowledge. The 60-year-old patient represents the oldest person in the English-language literature to have a newly diagnosed laryngeal cleft. All three cases presented with various degrees of aspiration over an extended period. Results The computed tomographic imaging and endoscopic findings from these three patients were reviewed. The videolaryngoscopic images demonstrated that the “ram sign” — an endoscopic finding associated with redundant soft tissue overlying the arytenoid cartilages that prolapses into the cleft, creating the appearance of ram's horns — was a consistent and striking feature in all three patients. Conclusions Although rare, laryngeal clefts may represent an underdiagnosed entity in the adult population. With increased awareness, they may be identified more frequently as a treatable cause of aspiration and recurrent pneumonia.
Spectral- and Cepstral-Based Acoustic Features of Dysphonic, Strained Voice Quality
Authors: Lowell Soren Y. , Kelley Richard T. , Awan Shaheen N. , Colton Raymond H. , Chan Natalie H. 
Published: May 2017

Objectives We sought to determine whether spectral- and cepstral-based acoustic measures were effective in distinguishing dysphonic-strained voice quality from normal voice quality and whether these measures were related to auditory-perceptual ratings of strain severity. Methods Voice samples from 23 speakers with dysphonia characterized predominantly by strained voice quality and 23 speakers with normal voice were acoustically analyzed. Measures related to the prominence of the cepstral peak and the ratio of low- to high-frequency spectral energies, as well as the variation of each, were computed from continuous speech and a sustained vowel. Correlations to perceptually rated strain severity were determined. Results Measures related to the cepstrum were the strongest discriminators between dysphonic-strained voice and normal voice. Variation in the ratio of low- to high-frequency spectral energies also significantly differentiated the two speaker groups. All measures were significantly correlated with perceptually rated strain severity, including an acoustic severity index that incorporated both cepstral- and spectral-based measures. Conclusions Cepstral- and spectral-based measures that have been previously studied in dysphonia characterized by breathiness and roughness are effective in distinguishing strained dysphonia from normal voice quality. The utility of these acoustic measures is supported by their moderate-to-high relationship with perceptually rated strain severity.
Ethnic Disparity in Skin Complications following Bone-Anchored Hearing Aid Implantation
Authors: Zeitler Daniel M. , Herman Bjorn S. , Snapp Hillary A. , Telischi Fred F. , Angeli Simon I. 
Published: May 2017

Objectives Sound processor loading after implantation of a bone-anchored hearing aid is often delayed by skin-site complications. This study examined the frequency of skin-site complications in various ethnic groups and determined factors that may lead to higher rates of skin-site complications resulting in delayed processor loading. Methods Adult, English-speaking patients who underwent implantation of a bone-anchored hearing aid between 2007 and 2010 were reviewed. Demographic data including ethnicity, tobacco use, diabetes mellitus, immunosuppression, and long-term steroid use were determined. Major and minor skin-site complications and the time to processor loading were recorded. Results The mean time to processor loading was 9.5 weeks, and the mean follow-up time was 23 months. There were no cases of osseointegration failure. African American patients had a significantly higher rate of major skin-site complications (p < 0.005) and a longer time to processor loading (mean, 17.6 weeks; p < 0.05) than the other ethnic groups. There was no significant difference in minor skin complication rates. There was no correlation between diabetes mellitus, long-term immunosuppression, or tobacco use and skin-site complications. Conclusions Skin complications can delay processor loading following implantation of a bone-anchored hearing aid. There is a higher rate of major skin-site complications in African American patients, and these often delay processor loading. The risk of skin-site complications is not correlated with smoking, diabetes mellitus, or immunosuppression. An increased risk of skin-site complications is an important consideration for preoperative counseling.
A word about … Reframing soul competency in terms of the “capable self” in Nussbaum, Sen, and Ricoeur
Authors: Stiver Dan R. 
Published: May 2017

Baptists are commonly considered to have a distinctive emphasis on the priesthood of all believers, which came to be translated early in the twentieth century by the premier Baptist theologian E. Y. Mullins as “soul competency” ( Axioms of Religion, chap. 3). Mullins’s version has fallen on hard times as he has been criticized in Baptist life from both the right and the “moderate” sides as too individualistic and captive to American culture. This article revisits soul competency in light of the more recent emphases on the “capable self” in the philosophers Martha Nussbaum, Amartya Sen, and Paul Ricoeur. Nussbaum’s approach concerns human capabilities in terms of global political distribution of goods ( Creating Capabilities) as well as does Sen ( The Idea of Justice); Ricoeur considers the capable self in ethical, political, and religious terms (“ Asserting Personal Capacities and Pleading for Mutual Recognition” and “ Religious Belief” in A Passion for the Possible). In contrast to Mullins’s more modernistic optimism about the self, Nussbaum, Sen, and Ricoeur consider the suffering self along with their emphasis on the powers of the self; as such, in the light of their thought, soul competency or capability could be seen to presuppose not the autonomous Enlightenment self but a thoroughly situated self immersed in social bonds with other people. Such a dialogue, I propose, can inject fresh twenty-first century meaning into Mullins’s ideas of a century ago. Although the ideas of the priesthood of all believers and soul competency have been distinctively Baptist emphases, they are certainly not uniquely Baptist nor even of Baptist origin; their understanding has ramifications far beyond Baptists. In that sense, their revivification can have reverberations beyond Baptist life. In addition, such a dialogue injects a religious dimension into the wider global and philosophical discussions of Nussbaum, Sen, and Ricoeur.
Surgical Treatment of Acute Manifestations of Crohn's Disease during Pregnancy
Authors: Hill Chm J , Clark A , Scott Na 
Published: May 2017

When requiring surgery, acute exacerbations of Crohn's disease in pregnancy have been reported to carry high maternal and fetal mortality. We report six cases. The women presented at 30, 28, 12, 11, 31 and 25 weeks' gestation and all proved to have intraperitoneal sepsis. In three, the acute symptoms were the first indication of Crohn's disease. All the women recovered and five had healthy babies; the other had a miscarriage when a colonic anastomosis dehisced. In pregnant women with Crohn's disease, the indications for surgery are the same as in non-pregnant patients. For acute manifestations we recommend removal of the source of the sepsis and exteriorization of the bowel ends.
Four Years' Experience of an Undergraduate Medical Nutrition Course
Authors: Powell-Tuck J , Summerbell Carolyn , Holsgrove G , Garrow J S 
Published: May 2017

In 1992 the medical colleges of The Royal London and St Bartholomew's hospitals launched a new curriculum in which basic medical sciences were to be integrated with early exposure to clinical medicine in the first phase. The curriculum was to be modular and integrative, combining clinical and medical-science-based teaching of body systems, rather than the traditional teaching by departmental discipline. We describe the inception, content and evaluation of a 7-day course on nutrition which was developed as part of this curriculum. It was rated highly by the students, whose feedback led to important modifications. The programme works well in practice, and could provide a useful guide for other schools about to set up nutrition courses for medical students.
Chronic Fatigue Syndrome: Sufferers' Evaluation of Medical Support
Authors: Ax Susanne , Gregg Vernon H , Jones David 
Published: May 2017

In response to reports of negative cooperation between sufferers of chronic fatigue syndrome (CFS) and their doctors, semi-structured interviews were conducted with sufferers from two different patient samples. Satisfaction with support received and with medical professionals in general was low. Sufferers complained about insufficient informational as well as emotional support from their doctors, and as a consequence most opted for alternative or complementary forms of treatment. In addition, disagreements over illness aetiology and treatment precluded effective cooperation. If satisfaction and compliance are to improve, sufferers will need more information about CFS and more support.
Effect of Anorectal Eversion on Long-Term Clinical outcome of Restorative Proctocolectomy
Authors: Defriend D J , Mughal M , Grace R H , Schofield P F 
Published: May 2017

Eversion of the rectum during restorative proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA) remains a controversial surgical manoeuvre because of concern that it may impair anal sphincter function and adversely affect outcome. We have reviewed the long-term results in 41 patients whose operation included formation of a 20 cm J-pouch with stapled IPAA by the technique of rectal eversion. At median follow-up of 4 years (range 1–6 years), 4 pouches (10%) had been removed (2 for pelvic sepsis, 1 for rectovaginal fistula and 1 for Crohn's disease). In 34 patients with functioning pouches in situ, median stool frequency was 5 per 24 h (range 2–10). 11 patients (33%) regularly had to evacuate their pouch at night and 4 (12%) used antidiarrhoeal medication. No patients reported major incontinence; 2 (6%) had minor leakage, and in another 2 minor leakage had now ceased. 4 patients had had episodes of pouchitis. These favourable results offer no support for the contention that rectal eversion substantially worsens the long-term results of restorative proctocolectomy.
Neuropathy in Non-Freezing Cold Injury (Trench Foot)
Authors: Irwin Michael S , Sanders Roy , Green Colin J , Terenghi Giorgio 
Published: May 2017

Non-freezing cold injury (trench foot) is characterized, in severe cases, by peripheral nerve damage and tissue necrosis. Controversy exists regarding the susceptibility of nerve fibre populations to injury as well as the mechanism of injury. Clinical and histological studies (n=2) were conducted in a 40-year-old man with severe non-freezing cold injury in both feet. Clinical sensory tests, including two-point discrimination and pressure, vibration and thermal thresholds, indicated damage to large and small diameter nerves. On immunohistochemical assessment, terminal cutaneous nerve fibres within the plantar skin stained much less than in a normal control whereas staining to von Willebrand factor pointed to increased vascularity in all areas. The results indicate that all nerve populations (myelinated and unmyelinated) were damaged, possibly in a cycle of ischaemia and reperfusion.
Trends in Self-Poisoning: Admissions to a Central London Hospital, 1991–1994
Authors: Mcevedy Christopher J B 
Published: May 2017

Self-poisoning is a common reason for admission to hospital; and, although most patients admitted do not have a psychiatric disorder, as a group they are at greatly increased risk of completed suicide. Admissions to a hospital in Central London over a four-year period were examined with special attention to patients admitted more than once. From 1991 to 1994 admissions for self-poisoning rose by 108%, with larger increases in the younger age groups of both sexes. 9% of patients were admitted more than once, the mean interval to repetition being three months. A third of the repeaters were readmitted within one month. The increase in admissions for self-poisoning, which has been noted elsewhere in the UK, is unlikely to be due wholly to changes in clinical practice. In view of the relation between parasuicide and suicide, further research and analysis is urgently needed.
Extreme Attitudes to Body Shape, Social and Psychological Factors and a Reluctance to Breast Feed
Authors: Barnes J , Stein A , Smith T , Pollock J I , Study Alspac 
Published: May 2017

Despite widespread advocacy of breast feeding, many babies are breast fed only briefly, if at all. Mothers' decisions on how to feed are often made before the birth; so we have sought demographic, social and psychological factors that might be amenable to intervention during pregnancy. In the Avon Longitudinal Study of Pregnancy and Childhood about 12000 women completed questionnaires in pregnancy. Univariate analyses were carried out to establish which factors were related to breast feeding intentions. All significant factors in univariate analyses were entered into logistic regression analyses. Demographic characteristics independently related to intentions to breast feed included older maternal age, more maternal education, primiparity and not smoking; in previous work all these had been associated with actual feeding behaviour. Social relationship variables had a small influence. Of the psychological variables, a notable finding was that women who were preoccupied with their body shape and those who expressed controlling, less child-centred, responses to managing an infant in the postnatal months were less likely to express intentions to breast feed. Depression did not predict breast feeding intentions once the other factors had been taken into account. Health care professionals may be able to intervene to increase breast feeding by making routine enquiries during antenatal care and targeting appropriate subgroups.
Home Artificial Nutrition in Advanced Cancer
Authors: Pironi Loris , Ruggeri Enrico , Tanneberger Stephan , Giordani Stefano , Pannuti Franco , Miglioli Mario 
Published: May 2017

Attitudes to home artificial nutrition (HAN) in cancer vary greatly from country to country. A 6-year prospective survey of the practice of HAN in advanced cancer patients applied by a hospital-at-home programme in an Italian health district was performed to estimate the utilization rate, to evaluate efficacy in preventing death from cachexia, maintaining patients at home without burdens and distress and improving patients' performance status, and to obtain information about costs. Patients were eligible for HAN when all the following were present: hypophagia; life expectancy 6 weeks or more, suitable patient and family circumstances; and verbal informed consent. From July 1990 to June 1996, 587 patients were evaluated; 164 were selected for HAN (135 enteral and 29 parenteral) and were followed until 31 December 1996. The incidence of HAN per million inhabitants was 18.4 in the first year of activity and 33.2–36.9 in subsequent years, being 4–10 times greater than rates reported by the Italian HAN registers. On 31 December 1996, 158 patients had died because of the disease and 6 were on treatment. Mean survival was 17.2 weeks for those on enteral nutrition and 12.2 weeks for those on parenteral nutrition. Prediction of survival was 72% accurate. 95 patients had undergone 155 readmissions to hospital, where they spent 15–23% of their survival time. Burdens due to HAN were well accepted by 124 patients, an annoyance or scarcely tolerable in the remainder. The frequency of major complications of parenteral nutrition was 0.67 per year for catheter sepsis and 0.16 per year for deep vein thrombosis. Karnofsky performance score increased in only 13 patients and body weight increased in 43. The fixed direct costs per patient-day (in European Currency Units) were 14.2 for the nutrition team, 18.2 for enteral nutrition and 61 for parenteral nutrition. The results indicate that definite entry criteria and local surveys are required for the correct use of HAN in advanced cancer patients, that HAN can be applied without causing additional burdens and distress, and that its costs are not higher than hospital costs.
Common Mental Disorders, Explanatory Models and Consultation Behaviour among Indian Women Living in the UK
Authors: Jacob K S , Bhugra D , Lloyd K R , Mann A H 
Published: May 2017

Women of Indian origin are said to have a lower rate of recognized common mental disorders and a higher frequency of consultation in primary care than white British. The aim of this study was to evaluate factors, including explanatory models (patient perspectives) of illness, associated with common mental disorders and with frequency of consultation among women of Indian origin in primary care. The investigation was conducted in a general practice in West London with a large Indian population. Consecutive woman attenders of Indian descent were screened with the General Health Questionnaire-12 to identify probable cases of psychiatric morbidity. 100 patients were interviewed with the Revised Clinical Interview Schedule (CIS-R), a specific tool for the diagnosis of common mental disorders, and the Short Explanatory Model Interview, which elicits the individual's conceptualization of his or her illness. Those patients who satisfied CIS-R criteria were classified as ‘cases’, the others as ‘controls’. Common mental disorders were documented in 30% of patients. The general practitioner's diagnosis of common mental disorders had a sensitivity of 17% and a specificity of 91%. Individuals with common mental disorders had a higher frequency of consultation (P=0.017), were less likely to see depression as an indication for medical intervention and were more likely to withhold some of their concerns from the general practitioner. Incorrect diagnosis by the GP was most likely to occur when patients did not disclose all their complaints. These associations were all statistically significant after adjustment for possible confounders by multiple linear and logistic regression. Women of Indian origin in this sample had rates of common mental disorders similar to those in other UK populations. Differing conceptualizations of common mental disorders may contribute to their underrecognition in women of Indian origin.
Does ‘healing’ benefit patients with chronic symptoms? A quasi-randomized trial in general practice
Authors: Dixon Michael 
Published: May 2017

This study was designed to examine the effects of a healer seeing chronically ill patients in a large semirural practice. The 57 patients were allocated alternately either to receive ten weekly healing sessions or to become waiting-list controls. Two weeks after completion of ‘healing’ 22 (81%) of the 27 study patients thought their symptoms had improved and 15 of these thought they had improved substantially. Study patients scored better than controls on both measures of symptoms (P < 0.05, P < 0.01), on anxiety and depression ratings (P < 0.01, P < 0.05) and on general function measured by the Nottingham Health Profile (P < 0.01). Treatment differences were still evident three months later for one of the measures of symptom change (P <0.05) and for both anxiety and depression ratings (P < 0.01, P < 0.05). The percentages of natural killer cells (CD16, CD56) did not change greatly in either group. These results suggest that healing may be an effective adjunct for the treatment of chronically ill patients presenting in general practice. They do not distinguish between any specific effects of spiritual healing and non-specific effects such as relaxation; for further investigation, randomized controlled trials will be needed.