Chorda tympani nerve function after myringoplasty

This is a cross-sectional study design aimed to determine the prevalence of Chorda Tympani Nerve (CTN) injury and related symptoms following myringoplasty. Thirty patients were included in this study. The methods used were measuring taste thresholds using electrogustometer to map taste threshold on the anterior two-third of the tongue on the operated side with the non operated side as the control. Reading is taken when the subject experiences sour/metallic taste. All corresponding threshold values and findings were recorded and compared to control. Results showed 50% of patients had elevated threshold levels suggestive of CTN injury. However, none of the patients reported subjective taste loss. This study concludes that the prevelance rate of CTN injury in post myringoplasty patients is about 50% but this is not associated with altered taste sensation.

Medical decision-making capacity in patients with mild cognitive impairment

OBJECTIVES

To empirically assess the capacity of patients with amnestic mild cognitive impairment (MCI) to consent to medical treatment under different consent standards (Ss).

METHODS

Participants were 56 healthy controls, 60 patients with MCI, and 31 patients with mild Alzheimer disease (AD). Each participant was administered the Capacity to Consent to Treatment Instrument (CCTI) and a comprehensive neuropsychological battery. Group differences in performance on the CCTI and neuropsychological variables were examined. In addition, the capacity status (capable, marginally capable, or incapable) of each MCI participant on each CCTI standard was examined using cut scores derived from control performance.

RESULTS

Patients with MCI performed comparably to controls on minimal consent standards requiring merely expressing a treatment choice (S1) or making the reasonable treatment choice [S2], but significantly below controls on the three clinically relevant standards of appreciation (S3), reasoning (S4), and understanding (S5). In turn, the MCI group performed significantly better than the mild AD group on [S2], S4, and S5. Regarding capacity status, patients with MCI showed a progressive pattern of capacity compromise (marginally capable and incapable outcomes) related to stringency of consent standard.

CONCLUSIONS

Patients with amnestic mild cognitive impairment (MCI) demonstrate significant impairments on clinically relevant abilities associated with capacity to consent to treatment. In obtaining informed consent, clinicians and researchers working with patients with MCI must consider the likelihood that many of these patients may have impairments in consent capacity related to their amnestic disorder and related cognitive impairments.

Modified Mitchellson endoscope holder

Mitchellson's ear speculum holder has been modified to act as an endoscope holder, in order to be used in endoscopic surgery of the nose or ear.

Effects of temperature changes on nasal patency

INTRODUCTION

This study aims to assess the difference in nasal patency and resistance to temperature changes objectively and subjectively.

METHODS

This cross-sectional study involved 50 subjects without nasal obstruction. All these subjects were given a questionnaire to determine nasal obstruction subjectively on a visual analogue scale. Acoustic rhinometry was performed in all these subjects for objective measurement of nasal obstruction. The study was conducted in two separate rooms in the departmental laboratory where the temperatures were maintained at 30-33 degrees Celsius and an air-conditioned room at 18-22 degrees Celsius, respectively.

RESULTS

The objective measurement to two different temperature exposures showed differences in nasal patency and resistance. There was an increase in nasal resistance and a decrease in nasal patency to air-conditioned air compared to room temperature air. Subjective assessment also showed significant correlation to the two temperature exposures. However, independent sample test only showed significant difference in the subjective questionnaire (p-value equals 0.001). Objective acoustic rhinometry did not show significant difference.

CONCLUSION

There is no significant difference in objective acoustic rhinometry with regard to nasal resistance and patency with environmental temperature changes in the tropics.

Real-time cerebral angiography: sensitivity of a new contrast-specific ultrasound technique

BACKGROUND AND PURPOSE

To test a new contrast-specific sonography imaging method that offers visualization of the intracranial vasculature in a manner similar to that seen on angiography.

MATERIALS AND METHODS

Thirty patients (35 sonography studies total) were included in the study after they provided written informed consent. The patients were scanned through the temporal bone window from both sides after intravenous injection of an ultrasound contrast agent (UCA; perflexane lipid microspheres [Imagent]). The goal was to visualize the intracranial arteries, including the middle (M1-M3), anterior (A1 and A2), and posterior (P1-P3) cerebral arteries, using an axial scanning plane. The studies were performed using a contrast-specific imaging mode, based on a phase inversion technique (transcranial ultrasound angiography [tUSA]). For sensitivity, the results were compared with x-ray angiography as the "gold standard." For interobserver reliability, 24 of 35 sonography studies were evaluated by 2 physicians with little training in transcranial sonography and by a seasoned sonographer.

RESULTS

The sensitivity of tUSA ranged between 0.778 (95% confidence interval [CI] of 0.577-0.914) and 0.963 (95% CI of 0.810-0.999). The sensitivities were similar among physicians with little training in transcranial sonography and the seasoned sonographer, indicating high inter-rater reliability. Overall, tUSA provided high anatomic resolution and vascular delineation even of small vessels in the millimeter range. At peak intensity, no UCA-related artifacts were observed.

CONCLUSION

tUSA provides images of the intracranial arteries similar to those obtained at angiography with high anatomic resolution, reasonable sensitivity, and interobserver reliability.

Epithelial Migration in Open Mastoidectomy Cavities

OBJECTIVE

To study the rate and pattern of epithelial migration in 18 dry, open mastoidectomy cavities.

METHODS

This was a prospective study of 19 patients who had undergone mastoidectomy at a secondary (state) hospital and a tertiary referral centre at least 6 months previously and whose mastoid cavities were dry and not infected. Their mastoidectomy cavities were cleaned and India ink dots applied in its medial aspect under microscope. The patients were followed up at 1 or 2 weekly intervals for a minimum of 3 months or until the dots disappeared, whichever came first. On follow-up, the cavities were examined under microscope. If migration was observed, the rate and pattern were noted.

RESULTS

Most (94.4%) of the cavities were noted to have epithelial migration laterally. No migration was observed in 5.6%. The start of migration of ink dots was noted in the 2nd week in 53% of the cavities, with a mean of 3.05 weeks. The mean rate of migration was 0.68 mm/week.

CONCLUSION

Epithelial migration appears to be predominantly lateral (94.4%), with onset in the 2nd week (53%) at a rate of 0.68 mm/week. Epithelial migration might not play an important role in accumulation of wax in open mastoidectomy cavities.

Efficient generation of closed magnetic flux surfaces in a large spherical tokamak using coaxial helicity injection

A method of coaxial helicity injection has successfully produced a closed flux current without the use of the central solenoid in the NSTX device, on a size scale closer to a spherical torus reactor, for a proof-of-principle demonstration of this concept. For the first time, a remarkable 60 times current multiplication factor was achieved. Grad-Shafranov plasma equilibrium reconstructions are used to verify the existence of closed flux current. In some discharges the generated current persists for a surprisingly long time approximately 400 ms.

Plasma homocysteine and total thiol content in patients with exudative age-related macular degeneration

PURPOSE

Exudative age-related macular degeneration (ARMD) is one of the debilitating ocular complications, which results in permanent blindness. Elevated homocysteine (Hcys) levels have been associated in the development of several vascular diseases. Vascular and oxidative stress theories have been implicated for the development of choroidal neovascularization in exudative ARMD. The aim of the present study was to investigate the possible role of plasma Hcys and thiol content (tSH) as a risk factor for the development of exudative ARMD.

METHOD

A total of 16 patients with exudative ARMD and 20 age-matched controls were recruited for the study. Plasma Hcys levels were analysed using Reverse Phase High Performance Liquid Chromatography. Plasma glutathione (GSH) content was determined using o-phthalaldehyde (OPA) derivatization and subsequent detection by fluorimeter. Plasma tSH levels were determined by using thiol-specific reagent dithionitrobenzoic acid (DTNB) spectrophotometrically.

RESULTS

Plasma Hcys levels in exudative ARMD were elevated three-fold (18+/-5.0 microM) when compared to healthy controls (6.7+/-1.8 microM). There was a two-fold decrease in the GSH and tSH in exudative ARMD when compared with controls. Negative correlation was observed between diminished tSH and Hcys levels (r=-0.4837, P=0.05). Similarly plasma Hcys levels negatively correlated with GSH content (r=-0.6620, P<0.05).

CONCLUSION

Results from our present study revealed that there is an elevated Hcys level and diminished thiol pool content in exudative ARMD that are significant.

A high-density consensus map of barley linking DArT markers to SSR, RFLP and STS loci and agricultural traits

BACKGROUND

Molecular marker technologies are undergoing a transition from largely serial assays measuring DNA fragment sizes to hybridization-based technologies with high multiplexing levels. Diversity Arrays Technology (DArT) is a hybridization-based technology that is increasingly being adopted by barley researchers. There is a need to integrate the information generated by DArT with previous data produced with gel-based marker technologies. The goal of this study was to build a high-density consensus linkage map from the combined datasets of ten populations, most of which were simultaneously typed with DArT and Simple Sequence Repeat (SSR), Restriction Enzyme Fragment Polymorphism (RFLP) and/or Sequence Tagged Site (STS) markers.

RESULTS

The consensus map, built using a combination of JoinMap 3.0 software and several purpose-built perl scripts, comprised 2,935 loci (2,085 DArT, 850 other loci) and spanned 1,161 cM. It contained a total of 1,629 'bins' (unique loci), with an average inter-bin distance of 0.7 +/- 1.0 cM (median = 0.3 cM). More than 98% of the map could be covered with a single DArT assay. The arrangement of loci was very similar to, and almost as optimal as, the arrangement of loci in component maps built for individual populations. The locus order of a synthetic map derived from merging the component maps without considering the segregation data was only slightly inferior. The distribution of loci along chromosomes indicated centromeric suppression of recombination in all chromosomes except 5H. DArT markers appeared to have a moderate tendency toward hypomethylated, gene-rich regions in distal chromosome areas. On the average, 14 +/- 9 DArT loci were identified within 5 cM on either side of SSR, RFLP or STS loci previously identified as linked to agricultural traits.

CONCLUSION

Our barley consensus map provides a framework for transferring genetic information between different marker systems and for deploying DArT markers in molecular breeding schemes. The study also highlights the need for improved software for building consensus maps from high-density segregation data of multiple populations.

A high-density consensus map of barley linking DArT markers to SSR, RFLP and STS loci and agricultural traits

BACKGROUND

Molecular marker technologies are undergoing a transition from largely serial assays measuring DNA fragment sizes to hybridization-based technologies with high multiplexing levels. Diversity Arrays Technology (DArT) is a hybridization-based technology that is increasingly being adopted by barley researchers. There is a need to integrate the information generated by DArT with previous data produced with gel-based marker technologies. The goal of this study was to build a high-density consensus linkage map from the combined datasets of ten populations, most of which were simultaneously typed with DArT and Simple Sequence Repeat (SSR), Restriction Enzyme Fragment Polymorphism (RFLP) and/or Sequence Tagged Site (STS) markers.

RESULTS

The consensus map, built using a combination of JoinMap 3.0 software and several purpose-built perl scripts, comprised 2,935 loci (2,085 DArT, 850 other loci) and spanned 1,161 cM. It contained a total of 1,629 'bins' (unique loci), with an average inter-bin distance of 0.7 +/- 1.0 cM (median = 0.3 cM). More than 98% of the map could be covered with a single DArT assay. The arrangement of loci was very similar to, and almost as optimal as, the arrangement of loci in component maps built for individual populations. The locus order of a synthetic map derived from merging the component maps without considering the segregation data was only slightly inferior. The distribution of loci along chromosomes indicated centromeric suppression of recombination in all chromosomes except 5H. DArT markers appeared to have a moderate tendency toward hypomethylated, gene-rich regions in distal chromosome areas. On the average, 14 +/- 9 DArT loci were identified within 5 cM on either side of SSR, RFLP or STS loci previously identified as linked to agricultural traits.

CONCLUSION

Our barley consensus map provides a framework for transferring genetic information between different marker systems and for deploying DArT markers in molecular breeding schemes. The study also highlights the need for improved software for building consensus maps from high-density segregation data of multiple populations.

Reliability of a tympanic thermometer in measuring temperatures in children after minor ear surgery

AIM

To evaluate the reliability of infrared tympanic thermometry in children who have undergone myringotomy with grommet insertion.

METHOD

Forty children who had undergone myringotomy with at least one grommet insertion had the tympanic temperature of each ear and the axillary temperature measured on admission and 30 minutes post-operatively.

RESULT

No difference was found between the pre- and post-operative temperatures measured by either method (p > 0.05, paired t-test, hypothesized difference of 0).

CONCLUSION

Infrared tympanic thermometry is reliable in monitoring body temperature in children who have had minor ear surgery.

Comparative study of bacteriology in recurrent tonsillitis among children and adults

INTRODUCTION

Diagnosis and treatment of acute tonsillitis are one of the most common problems seen at an otorhinolaryngology clinic in both adult and paediatric populations. Much has been written about bacteriology of recurrent tonsillitis but it remains a controversial topic. Despite the fact that tonsillitis is so common, consensus seems to be lacking as to the main causative organism and the differences between children and adults. The tonsillar core bacteriology of 233 patients with recurrent tonsillitis who underwent tonsillectomy from January 2000 to June 2003 is presented.

METHODS

The patient population was divided into two groups, namely: the paediatric group and the adult group. 132 patients, whose age was more than 12 years, were in the adult group. 101 patients aged between two and 12 years, were in the paediatric group. The bacteriology of the children and adults were tabulated according to their species, and were compared.

RESULTS

138 patients grew single pathogenic bacteria in their tonsillar core culture, 52 grew two different pathogenic bacteria, and the rest (43) grew normal bacterial flora. Staphylococcus aureus was the most commonly-isolated bacterium and accounted for 40.9 percent of the total cultures isolated; its prevalence was the same in the adults and children. Beta-haemolytic Streptococcus was isolated in 23 percent of subjects, and was predominantly from group A (Streptococcus pyogens). Group A beta-haemolytic Streptococci was more prevalent in children. Pseudomonas aeruginosa, which rarely cause pathogenicity in tonsils, was cultured from nine (3.8 percent) of our study subjects.

CONCLUSION

This study showed that Staphylococcus aureus is the most common pathogenic bacteria cultured both in adults and children. Klebsiella pneumonia, Streptococcus pneumonia, Escherichia coli and Enterobacter are more prevalent in adults. Haemophilus influenza and Streptococcus pyogens are more prevalent in children. Pseudomonas aeruginosa is not a rare causative organism in recurrent tonsillitis. Since the mechanism of activation of infection in recurrent tonsillitis is unknown, knowing the bacteriology does not help us to treat the disease. However, it may be a stepping stone to eventually understanding whether the bacteria play a role in reactivating recurrent infections. From previous and current studies, there is no relationship between bacteriology and recurrent infections.

Prospective reliability of the STRokE DOC wireless/site independent telemedicine system

The authors evaluated a site-independent telemedicine system. Telemedicine may be limited by the need for fixed connectivity. Wireless and site-independent technologies eliminate this limitation. Twenty-five stroke patients underwent evaluations by remote and bedside examiners. Ten of 15 (67%) NIH Stroke Scale and 9 of 11 (82%) Modified NIH Stroke Scale items showed excellent interrater reliability. Spearman correlations were > or =0.93. This Internet system is reliable and valid. Further studies should assess its use in acute stroke.

Tracheal stent in the treatment of tracheal stenosis

The use of airway stents for the treatment of benign airway stenosis is increasingly advocated. However, the long-term safety and efficiency of these devices has not been established. We present a case of tracheal stenosis. which persisted despite open surgical and laser correction. The patient required tracheal stent insertion and is currently well with no respiratory difficulty. The use of metallic or silicon intraluminal stent remains appropriate in cases in which there is defined and relative short-term end point of treatment.

Large vestibular aqueduct syndrome

Large Vestibular Aqueduct Syndrome is a congenital malformation of the temporal bone characterised by early onset of sensorineural hearing loss and vestibular disturbance. Familial large vestibular aqueduct syndrome suggests autosomal recessive or X-linked inheritance and accounts for non-syndromic sensorineural hearing loss in these patients.

Molecular characterization and mapping of ALMT1, the aluminium-tolerance gene of bread wheat (Triticum aestivum L.)

The major aluminum (Al) tolerance gene in wheat ALMT1 confers. An Al-activated efflux of malate from root apices. We determined the genomic structure of the ALMT1 gene and found it consists of 6 exons interrupted by 5 introns. Sequencing a range of wheat genotypes identified 3 alleles for ALMT1, 1 of which was identical to the ALMT1 gene from an Aegilops tauschii accession. The ALMT1 gene was mapped to chromosome 4DL using 'Chinese Spring' deletion lines, and loss of ALMT1 coincided with the loss of both Al tolerance and Al-activated malate efflux. Aluminium tolerance in each of 5 different doubled-haploid populations was found to be conditioned by a single major gene. When ALMT1 was polymorphic between the parental lines, QTL and linkage analyses indicated that ALMT1 mapped to chromosome 4DL and cosegregated with Al tolerance. In 2 populations examined, Al tolerance also segregated with a greater capacity for Al-activated malate efflux. Aluminium tolerance was not associated with a particular coding allele for ALMT1, but was significantly correlated with the relative level of ALMT1 expression. These findings suggest that the Al tolerance in a diverse range of wheat genotypes is primarily conditioned by ALMT1.Key words: aluminum, tolerance, genetic marker, Triticum aestivum, QTL, deletion mapping.

Delayed complication of radiotherapy: laryngeal fibrosis and bilateral vocal cord immobility

Radiotherapy is the accepted treatment for early laryngeal carcinomas with the advantage of voice preservation. It is however, not without complications. We report a case of bilateral vocal cord immobility 15 years after radiotherapy. This appears to be due to ankylosis of cricoarytenoid joint and fibrosis of the larynx.

Revision of cemented hip arthroplasty using a hydroxyapatite-ceramic-coated femoral component

We report the clinical and radiological outcome of 86 revisions of cemented hip arthroplasties using JRI-Furlong hydroxyapatite-ceramic-coated acetabular and femoral components. The acetabular component was revised in 62 hips and the femoral component in all hips. The mean follow-up was 12.6 years and no patient was lost to follow-up.

The mean age of the patients was 71.2 years. The mean Harris hip and Oxford scores were 82 (59 to 96) and 23.4 (14 to 40), respectively. The mean Charnley modification of the Merle d’Aubigné and Postel score was 5 (3 to 6) for pain, 4.9 (3 to 6) for movement and 4.4 (3 to 6) for mobility. Migration of the acetabular component was seen in two hips and the mean acetabular inclination was 42.6°. The mean linear polyethylene wear was 0.05 mm/year. The mean subsidence of the femoral component was 1.9 mm and stress shielding was seen in 23 (28%) with bony ingrowth in 76 (94%). Heterotopic ossification was seen in 12 hips (15%). There were three re-revisions, two for deep sepsis and one for recurrent dislocation and there were no re-revisions for aseptic loosening. The mean EuroQol EQ-5D description scores and health thermometer scores were 0.69 (0.51 to 0.89) and 79 (54 to 95), respectively. With an end-point of definite or probable loosening, the probability of survival at 12 years was 93.9% and 95.6% for the acetabular and femoral components, respectively. Overall survival at 12 years, with removal or further revision of either component for any reason as the end-point, was 92.3%.

Our study supports the continued use of this arthroplasty and documents the durability of hydroxyapatite-ceramic-coated components.