bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials
Authors: Fisher Bernard , Anderson Stewart 
Published: December 2004

AbstractIn 1976 the National Surgical Adjuvant Breast and Bowel Project (NSABP) initiated a randomized trial (B‐06) to evaluate the worth of lumpectomy in the treatment of patients with stages I and II breast cancer. This report presents, for the first time, findings from that trial through 10 years of follow‐up relative to ipsilateral breast tumor recurrence (IBTR), distant disease‐free survival, and survival of patients who were treated by modified radical mastectomy, lumpectomy, or lumpectomy followed by breast irradiation. The report indicates that the incidence of IBTR observed in the B‐06 trial is decreased by effective systemic therapy as well. Also commented on are a number of issues regarding the use of lumpectomy that are of concern to clinicians. They relate to the need for tumor specimen margins, the size of tumors amenable to lumpectomy, treatment of breast tumor recurrence, lumpectomy in older women, and other concerns. No patient or tumor characteristics have been identified that preclude the use of lumpectomy and radiation therapy. All evidence continues to justify the use of lumpectomy and breast irradiation for the treatment of invasive breast cancer. In addition, we have noted findings that indicate the propriety of lumpectomy and breast irradiation for treatment of localized ductal carcinoma in situ.
Neck Mass Due to Thrombosis of the Jugular Vein in Patients with Cancer
Authors: Martins Mamede Rui Celso , De Oliveira Resende E Almeida Kalysta , De Mello‐Filho Francisco Veríssimo 
Published: December 2004

The hypothesis that jugular thrombosis (JT) may cause a mass in the cervical region is usually overlooked. The objective of the present study was to identify the characteristics of neck masses resulting from JT in cancer patients and to analyze the possible reasons for their formation. A retrospective study was conducted on 8 patients with JT affected by 3 types of neoplasia, ie, carcinomas (3 cases), adenocarcinomas (3 cases), and lymphomas (2 cases) located in the breast, digestive apparatus, lymphatic system (2 cases each), lung and an undetermined site (1 case each), diagnosed over the last 12 years. The most frequent symptom of JT was the presence of a mass in the supraclavicular space (62.5% of cases) deeply located on the anterior margin of the sternocleidomastoid muscle and diagnosed by computed tomography and ultrasound. The masses were slightly hardened, with a clearly defined upper limit and an imprecise lower limit and with an irregular surface. The patients also presented with cough, hoarseness, pain during movements, facial edema, and collateral circulation. In one of the patients with a lung cancer, JT symptoms preceded the symptoms of cancer by 2 months. Hypercoagulation, compression, and invasion of a vessel possibly explain the occurrence of JT in these patients.
Changes in Programming over Time in Postmeningitis Cochlear Implant Users
Authors: Eshraghi Adrien A. , Telischi Fred F. , Hodges Annelle V. , Odabasi Onur , Balkany Thomas J. 
Published: December 2004

OBJECTIVEAlthough successful cochlear implantation of patients with deafness following meningitis is expected, long‐term stability of electrical current requirements has not been systematically evaluated. This study evaluated changes in programming for patients deafened by bacterial meningitis and stability of auditory performance over time.STUDY DESIGN AND SETTINGIn this retrospective descriptive study, cochlear implant (CI) stimulation mode and performance of 14 patients deafened by meningitis were compared with those of an age‐matched control group of patients deafened by other causes.RESULTSThere were no significant differences in mean performance between the meningitis group and control group (P > 0.05). However, the postmeningitis group required progressively higher stimulation levels and higher programming modes over time as compared to the control group.CONCLUSIONSEven with deafness accompanied by labyrinthine ossification attributed to meningitis, neural elements were present and could be stimulated. Because increasing levels of stimulation were required over time, postmeningitic children with CIs, and those with cochlear ossification in particular, may need frequent programming adjustments to maintain performance.SIGNIFICANCEThese patients need close follow‐up of stimulation levels and programming modes post‐operatively in order to perform optimally with CIs. EBM rating: B‐3.
Age‐Related Histopathologic Changes in the Human Cochlea: A Temporal Bone Study
Authors: Kusunoki Takeshi , Cureoglu Sebahattin , Schachern Patricia A. , Baba Kazuyasu , Kariya Shin , Paparella Michael M. 
Published: December 2004

OBJECTIVESPrevious reports on aging of human cochlea included subjects with ear diseases or ototoxic drugs. We studied spiral ganglion cells, hair cells, and lateral wall of cochlea from subjects without ear disease or ototoxic drugs.STUDY DESIGNThis study included 39 temporal bones from 24 subjects aged 1 day to 86 years. We assessed standard cytocochleograms, mean loss of fibrocytes in spiral ligament, and areas of stria vascularis.RESULTSLosses of outer hair cells and fibrocytes were significantly greater in childern, adults, and the elderly compared with infants. Spiral ganglion cell loss was significantly greater in adults and elderly compared with infants and children. Areas of stria vascularis of infants were significantly larger than the elderly.CONCLUSIONSDegenerative changes of outer hair cells occur in children but spiral ganglion cells remain the same until around 20 years. Degeneration of stria vascularis due to aging appears to be slower than spiral ligament. EBM rating: C.
Radial Forearm Free Tissue Transfer Reduces Complications in Salvage Skull Base Surgery
Authors: Chepeha Douglas B. , Wang Steven J. , Marentette Lawrence J. , Thompson Byron G. , Prince Mark E. , Teknos Theodoros N. 
Published: December 2004

OBJECTIVEPatients who undergo skull base resection after prior surgery or radiation may be at high risk for complications when local flaps alone are used for reconstruction. To determine whether the complication rate could be reduced, fasciocutaneous free tissue transfer was used to reinforce the dural closure in patients who had prior skull base surgery or radiation.METHODSThis study is a case series of 20 patients (14 males, 6 females, aged 8–79 years of age with a mean of 47.7 years) from 1997 to 2001 who had prior skull base surgery or radiation, and underwent salvage skull base resection without large volume defects. All patients had a radial forearm free tissue transfer to reinforce the dural closure. Six patients had an osseous component to the forearm flap to provide vascularized bone to the orbital rim.RESULTSThe overall local complication rate was 35%. Three patients (15%) had major complications including 1 case of meningitis, 1 case of cerebrospinal fluid leak, and 1 case of a flap requiring venous salvage. There were no flap failures, 1 idiopathic median nerve palsy, and no pathologic radius bone fractures.CONCLUSIONReconstruction with fasciocutaneous free tissue transfer for high‐risk patients with low‐volume dural defects following skull base resection can minimize the risk of major postoperative complications. EBM rating: C.
Adenoid Cystic Carcinoma of the Submandibular Gland: A 35‐Year Review
Authors: Cohen Alen N. , Damrose Edward J. , Huang Robert Y. , Nelson Scott D. , Blackwell Keith E. , Calcaterra Thomas C. 
Published: December 2004

OBJECTIVESTo evaluate the treatment results of adenoid cystic carcinoma (ACC) of the submandibular gland at a single institution during a 35‐year period.STUDY DESIGN & SETTINGA retrospective review was performed by examining the records and reviewing the pathology of 22 patients with ACC of the submandibular gland treated at UCLA Medical Center from June 1963 to December 1997.RESULTSSeven men and 15 women with an age range of 23 to 85 years (median, 48 years) were treated. Surgical intervention was performed in 21 patients. All patients with advanced tumor size, perineural invasion, microscopically positive surgical margins, or regional neck metastases received postoperative adjunctive therapy, primarily radiotherapy. Follow‐up varied from 6 months to 181 months (median, 67 months). Disease‐free survival at 3, 5, and 10 years was 66%, 57%, and 41% respectively, whereas overall survival was 76%, 70%, and 37%, respectively (note: 5‐ and 10‐year survival rates are not statistically conclusive due to the small sample size).CONCLUSIONSWe report fairly high disease‐free survival rates in this patient population and a number of prognostic trends are evident. Early diagnosis, wide surgical intervention, and postoperative radiation are associated with a favorable prognosis. Advanced tumor size, positive surgical margins, perineural invasion, and local recurrence of the tumor are associated with an unfavorable prognosis. EBM rating: C.
Salvage of Partial Facial Soft Tissue Avulsions with Medicinal Leeches
Authors: Frodel John L. , Barth Patrick , Wagner Jon 
Published: December 2004

BACKGROUNDMedicinal leeches have been demonstrated to be extremely useful and safe in the salvage of venous outflow compromised tissue, particularly in digit replants and various forms of flaps.OBJECTIVETo demonstrate the utility of medicinal leeches in the salvage of venous outflow‐compromised traumatic soft tissue avulsions in key facial structures.METHODSA retrospective review of 4 cases involving the external ear, nose, lip, and scalp in which apparent venous outflow compromise was present. Medicinal leeches were applied acutely in each of these 4 cases, salvaging each of the partially avulsed soft tissue segments.RESULTSComplete or near complete salvage of each soft tissue segment after using medicinal leeches.CONCLUSIONSAlthough it is unusual for a partial soft tissue avulsion of the face to require medicinal leech therapy, situations may occur in which there is adequate arterial inflow but inadequate venous outflow. In such cases, medicinal leeches may play a very important role in salvaging the soft tissue segment. This is particularly important in vital structures such as the ear, nose, lip, and eyelid in which acute or secondary reconstruction is complex. EBM rating: C.
Diagnosis of Middle Ear Disease using Tympanograms and Digital Imaging
Authors: Aronzon Anna , Ross Adam T. , Kazahaya Ken , Ishii Masaru 
Published: December 2004

OBJECTIVEThe study investigates the ability of physicians with different levels of training to accurately identify middle ear (ME) pathology using tympanograms and tympanic membrane (TM) digital photographs.STUDY DESIGN AND SETTINGGroups of medical students, internal medicine residents, and attending and resident otolaryngologists were presented with a set of 50 matched tympanograms and photographs of TMs. The physicians were asked to differentiate between a normal and an abnormal‐appearing TM. The sensitivity and specificity of diagnosis of ME pathology by physicians were compared with the gold standard, examining the ME cavity for pathology during myringotomy.RESULTSThe sensitivity did not vary among physicians with different levels of training; however, specificity improved with an increase in physician experience.CONCLUSIONS AND SIGNIFICANCEThis study establishes a baseline for accuracy of diagnosis of ME pathology using tympanograms and photographs of TMs as compared with binocular otomicroscopy and the gold standard, myringotomy. EBM rating: B‐2.
Software‐Enabled CT Analysis of Optic Nerve Position and Paranasal Sinus Pneumatization Patterns
Authors: Batra Pete S. , Citardi Martin J. , Gallivan Ryan P. , Roh Hwan‐Jung , Lanza Donald C. 
Published: December 2004

OBJECTIVEDelineate the relationships among the optic nerve (CN II), the sphenoid sinus, and the sphenoethmoid cell.STUDY DESIGNHigh‐resolution CT scans of 64 frozen human cadavers were obtained on a Siemens VolumeZoom CT scanner (Munich, Germany) and transferred to a CBYON Suite Doctor Station version 2.6 (CBYON, Mountain View CA) for standardized review.RESULTSPneumatization around CN II was categorized into 5 types: no adjacent pneumatization (type 0), pneumatization adjacent to CN II (type 1), adjacent pneumatization with indentation (type 2), pneumatization of <50% CN II circumference (type 3), and pneumatization of >50% CN II circumference (type 4). The prevalence of types 0 to 4 CN II position relative to the sphenoid sinus was 4.7%, 25.8%, 39.8%, 14.1%, and 15.6%, respectively. The prevalence of sphenoethmoid cells was 28.1%. The prevalences of types 0, 1, 2, 3, and 4 CN II positions relative to the sphenoethmoid cell was 5.6%, 58.3%, 25%, 2.8%, and 8.3% respectively.CONCLUSIONSSoftware‐enabled CT review facilitated precise study of the anatomic relationships of CN II. Caution must be exercised during sinonasal surgery to minimize the risk of inadvertent CN II injury. EBM rating: D.
A Comparison of Polysomnography and a Portable Home Sleep Study in the Diagnosis of Obstructive Sleep Apnea Syndrome
Authors: Su Stephanie , Baroody Fuad M. , Kohrman Michael , Suskind Dana 
Published: December 2004

OBJECTIVETo validate the role of a portable sleep monitor device (SNAP) in the diagnosis of obstructive sleep apnea syndrome (OSAS). Inter‐reader variability was also assessed for both PSG and SNAP.STUDY DESIGN AND SETTINGSixty consecutive adults referred for PSG at The University of Chicago Sleep Disorder Clinic were prospectively enrolled.RESULTSThere was no significant difference between total number of apnea and hypopnea, respiratory disturbance index (RDI), and minimum oxygen obtained by PSG and SNAP, but there was a significant difference between sleep time and mean oxygen. Pearson's correlation coefficient for RDI ≥ 15 was 0.92.CONCLUSIONThere was a significant correlation of RDIs between SNAP and PSG. SNAP has good sensitivity, specificity, positive and negative predictive values. Differences between SNAP and PSG could be attributed to inter‐reader variability and not necessarily due to technical limitations of SNAP. SNAP is an excellent tool for the diagnosis of OSAS in the laboratory setting. Future studies should be performed to evaluate SNAP's accuracy in the home setting in the diagnosis of OSAS. EBM rating: B‐2. (Otolaryngol Head Neck Surg 2004;131:844–50.)
High‐Frequency Ultrasound in the Measurement of Pediatric Craniofacial Integrity
Authors: Knott P. Daniel , Hazony Dov , Karafa Matthew , Koltai Peter J. 
Published: December 2004

OBJECTIVEThis study evaluates the use of high‐frequency ultrasound in the measurement of the material nature of the pediatric craniofacial skeleton.STUDY DESIGN AND SETTINGThree desiccated human skulls, aged 1 year, 5 years, and adult, underwent ultrasonic evaluation at 6 sites on each hemicranium.RESULTSThe overall mean signal reflection coefficients for the infant, child, and adult skulls are 98.8 mV (13.75 mV SD), 172mV (24.5 mV SD), and 230 mV (23.5 mV SD), respectively. The mean signal reflection coefficient is positively correlated with increasing chronological age. Comparison of intra‐subject signal patterns suggests bone density fields, which vary as a function of growth.CONCLUSIONHigh‐frequency ultrasound provides accurate measurements of the osseous impedance of the craniofacial skeleton. Pattern analysis suggests increases in skull density with greater growth and age.SIGNIFICANCEAlthough further testing must be performed in vivo, high‐frequency ultrasound may accurately measure the osseous impedance of the pediatric craniofacial skeleton. EBM rating: C.
Paleoenvironment of the Folsom archaeological site, New Mexico, USA, approximately 10,500 14C yr B.P. as inferred from the stable isotope composition of fossil land snail shells
Authors: Balakrishnan Meena , Yapp Crayton J. , Meltzer David J. , Theler James L. 
Published: December 2004

Well-preserved aragonitic land snail shells (Vallonia) from late Pleistocene Eolian sediment in the Folsom archaeological site in New Mexico exhibit an overall decrease of δ18OPDB from maximum values of +2.7‰ (more positive than modern) to younger samples with lower average values of about −3.6‰ (within the modern range). The age of the samples (approximately 10,500 14C yr B.P.) suggests that the decrease in δ18O may manifest climatic changes associated with the Younger Dryas. Some combination of increased relative humidity and cooler temperatures with decreased δ18O of precipitation during the times of snail activity can explain the decrease in shell δ18O. A well-known Paleoindian bison kill occurred at the Folsom site during this inferred environmental transition.Average δ13C values of the aragonite shells of the fossil Vallonia range from −7.3 to −6.0‰ among different archaeological levels and are not as negative as modern values. This suggests that the proportion of C4 vegetation at the Folsom site approximately 10,500 14C yr B.P. was greater than at present; a result which is consistent with other evidence for higher proportions of C4 plants in the region at that time.
Le ‘Monstre d'Or’ de Mallarmé
Authors: Monson Don A. 
Published: December 2004

Abstract

Interprété le plus souvent comme un ornement, le ‘monstre d'or’ évoqué au début de
Toast funèbre
de Mallarmé est en fait une image eucharistique intimement liée aux principaux thèmes de l'œuvre. Fondée sur une combinaison complexe de procédés syntaxiques et rhétoriques, cette image sert à nier la ‘présence réelle’ du Christ lors de la célébration de la messe. Par ce moyen, Mallarmé exprime son refus du christianisme et de l'espoir qu'offre cette croyance d'une survie de l'âme dans l'au‐delà.

Cette lecture de l'image est appuyée par de nombreux éléments thématiques et stylistiques semés à travers le poème. Dans la première partie de l'œuvre, diverses images chrétiennes traditionnelles sont subverties par inversion ironique pour devenir leur contraire, un peu comme le dieu dans la coupe est dépeint comme un monstre. Dans la seconde partie, cette même imagerie chrétienne est déployée à nouveau, mais cette fois‐ci à l'appui de la religion personnelle de Mallarmé, le culte de l'art. L'œuvre poétique se présente comme la seule chose capable de survivre au néant de la mort. Remplaçant l'eucharistie que refuse le poète, c'est aussi le rite qui célèbre cette survie. Théophile Gautier, à qui le poème est dédié, serait exemplaire pour avoir subordonné tout désir d'immortalité personnelle à son devoir de perpétuer la beauté de ce monde en la préservant à travers la poésie.
La musique et les lettres chez Barthes
Authors: Dayan Peter 
Published: December 2004

Abstract

Dans ses écrits sur la musique, dès l'époque des
Mythologies
et jusqu'à la fin de sa vie, Barthes répète le geste symboliste, mallarméen, qui consiste à définir la littérature (voire l'art en général) à travers les caractéristiques propres à la musique. La musique serait un phénomène sensible, inconcevable en dehors de son rapport au corps, et qui ne peut s'épuiser dans le mouvement de la signification; de même la littérature. L'analyse de ce geste aide à voir comment et pourquoi Barthes maintient sa foi en l'existence d'un art
haut
(par opposition à l'art bourgeois), en la littérature (par opposition au discours non littéraire), en une ‘essence’ du chant ou de la photographie. Mais si la littérature, chez Barthes, se définit à travers une analogie avec la musique, l'inverse est tout aussi vrai: la musique est dite lettre, texte, prosodie; Barthes affirme qu'il faut que le chant
écrive
. En effet, la critique barthésienne doit évaluer chaque art en fonction de ce qu'il n'est pas; car ‘s'il y a une signification des phénomènes sensibles, c'est toujours dans le déplacement, la substitution, bref, en fin de compte,
l'absence
, qu'elle se manifeste avec le plus d'éclat’ (‘Le Chant romantique’).
L'Économie du don et le mécénat: les formes de l'Échange dans une épître de clément Marot
Authors: Skenazi Cynthia 
Published: December 2004

Abstract

Dans l'épître de Clément Marot
Au Roy pour avoir esté desrobé
, un poète de cour exploite de façon ironique les conditions de production et de communication de son œuvre. Du don au vol et au prêt, diverses formes d'échanges gouvernés par l'argent, et qui paraissent à première vue distinctes, se révèlent étroitement liées à la pratique du mécénat. Les rapports du poète et de son protecteur renvoient ainsi à un ensemble complexe de valeurs sociales, morales, chrétiennes, économiques, qui prennent toute leur portée en fonction du contexte historique du règne de François I
er
. Le poète établit à cet égard des homologies ludiques entre la circulation du langage et de l'argent.
Tense, Orality and Narration: The Case of the
Néo‐Conte
Authors: Carruthers Janice 
Published: December 2004

Abstract

The relationship between tense and orality has been of major interest to linguists working on tense, aspect and discourse in a number of languages, and illuminating, if highly controversial, parallels have been drawn between the patterns found in various different types of oral narration. In the case of French, much research has been done on conversational narration, and connections have been made between contemporary temporal patterning (notably as regards tense switching) and that found in medieval data. Yet the term ‘oral narration’ is not synonymous here; the medieval narrations represent highly crafted performances, while the conversational data is spontaneous and informal. This paper proposes an analysis of tense switching in a contemporary performed variety of oral narration, the
néo‐conte
. While many of the functions of tense switching in discourse prove to be relatively familiar, the patterns found in the
néo‐conte
reveal complex — and at times apparently contradictory — influences from both spoken French and literary norms. Along with other types of discourse such as newspaper French, the patterns in oral story‐telling pose questions for contemporary models of the French tense system, especially those based on a fundamental binary divide, such as written versus spoken discourse,
monde raconté
versus
monde commenté
or
histoire
versus
discours
.