Faculty Bibliography

BACKGROUND: Diagnostic stress testing of ulnar collateral ligament (UCL) injuries of the thumb metacarpophalangeal (MCP) joint is pivotal to determining treatment. Comparison to the uninjured extremity and fluoroscopy-assisted examination are readily available modalities in the assessment of these patients, with 5-10 degrees differences impacting treatment. Comparative examination, however, assumes that both extremities are normally equal, which has never been verified experimentally. Comparison of clinical and fluoroscopic examination has also never been scrutinized. METHODS: One hundred asymptomatic participants underwent both fluoroscopic and traditional stress examinations to determine maximum passive radial deviation at neutral MCP flexion. RESULTS: Absolute clinical vs. fluoroscopic differences demonstrated a significant difference of 5.6 degrees (SD 5.1 degrees ). Absolute variability between left-to-right measurements was 4.5 degrees (SD 4.1 degrees ) and increased significantly as baseline stress deviation increased (R = 0.43; p < 0.001). Left-to-right difference exhibited no correlation to age, gender, or BMI. CONCLUSIONS: The current investigation demonstrates right-left differences and differences between clinical and fluoroscopic testing of which practitioners should be aware when making treatment decisions for UCL injury of the thumb MCP joint.

PURPOSE OF REVIEW: To review current literature regarding the use and utility of nasal saline irrigation in nasal and sinus diseases. RECENT FINDINGS: Nasal irrigations, in various forms, are a widely used and accepted means of treatment of the symptoms of chronic rhinosinusitis and other sinonasal disease processes. Over the past two decades, significant research has been done to evaluate the role of nasal irrigations in the treatment of sinonasal disease. The use of a high-volume, low-pressure system like a squeeze bottle remains the optimal delivery device. Although additional research is required for many of the additives discussed, the use of xylitol in chronic rhinosinusitis and topical fluconazole in allergic fungal sinusitis appear promising. SUMMARY: Use of nasal saline irrigations can improve symptoms of sinonasal disease and may improve outcomes in certain settings. Ongoing research will continue to shape and optimize understanding of maximally effective nasal irrigations.

Background: Invasion is a dominant escape mechanism following angiogenic blockade in glioblastomas (GBM). Lithium has shown anti-invasive activity in glioma cells by inhibiting Glycogen Synthetase Kinase -3. This phase II study evaluated the safety and efficacy of using lithium and bevacizumab (BEV) in newly diagnosed GBM. Methods: From 2010 through 2012, 20 GBM patients with residual disease after surgery were treated with involved-field radiation therapy to 5940 cGy and concomitant temozolomide (TMZ) (75 mg/m2 daily for 42 days) along with BEV (10 mg/kg every 2 weeks), starting 29 days after surgery. This was followed by six 28-day cycles of TMZ (150 mg/m2 on days 1-7, BEV (10 mg/kg) on days 8 and 22, and lithium 300 mg BID. Lithium was increased every 7 days up to 600 mg BID with a serum lithium goal level of 0.8 to 1.2 mEq/L. Results: The median follow-up was 9.9 months (range 1.9-24.5). Fourteen patients (70.0%) received at least one dose of lithium and three patients completed the entire course of therapy. The median number of BEV infusion was 9 (range 2-19). Five patients discontinued trial due to skin sensitivity (n = 2), pulmonary embolism (n = 1), infection (n = 1), and hematological toxicity (n=1). Two patients experienced dose limiting lithium toxicity which included drowsiness (n = 1) and tremor (n = 1). No patients experienced grade 3/4 intra-cranial hemorrhage. The median progression free survival (PFS) was 9.3 months. The 12-month PFS and OS were 31.9% and 59.3% respectively. For the 14 patients who received lithium, the 12-month PFS and OS were 42.9% and 69.2% respectively. Conclusions: The strategy of targeting angiogenesis and invasion simultaneously in newly diagnosed GBM is effective and feasible

This article outlines how to perform a standard comprehensive extraoral and intraoral examination and the existing commercially available adjunctive techniques for the early detection of oral cancer and premalignant lesions. Visualization-based techniques (e.g., autofluorescence and chemiluminescence), toluidine blue vital staining, cytopathologic tests and high-risk human papillomavirus testing are discussed in detail, including the indications and protocols for use, their advantages and disadvantages and clinical cases.

The term "formant tuning" is generally used for the case that one of the lowest formant frequencies coincides with the frequency of a source spectrum partial. Some authors claim that such coincidence is favorable and belongs to the goals of classical opera voice training, whereas other authors have found evidence for advising against it. This investigation analyzes the relationships between formant frequencies and partials in professional singers, who sang scales on the vowels /a/, /u/, /i/, and /ae/ in a pitch range including the passaggio, that is, the fundamental frequency range of approximately 300-400Hz, applying either of the two singing strategies that are typically used (1) in classical and (2) in nonclassical singing, respectively. Formant frequencies of each note in the scales were measured by inverse-filtering the acoustic signal. In the classical style, the first formant tended to be lower than in the nonclassical style. Neither the first nor the second formant tended to change systematically between scale tones, such that on some scale tones either or both formants was just below, just above, or right on a spectrum partial. In many cases, singers produced similar spectrum characteristics of the top tones of the scales with different first and second formant frequencies. Regardless of whether the first formant was slightly lower, slightly higher, or right on a partial, the properties of the voice source did not seem to be affected.

OBJECTIVES/HYPOTHESIS: To report the long-term outcomes of radiation therapy (RT), and the impact of fractionation size and RT duration on HIV patients with Benign Lymphoepithelial Cysts (BLEC) of the parotid glands. METHODS: From January 2000 to 2011, 30 patients were eligible for our single institution retrospective study. Both parotids were treated with 24 Gy via RT. The median age at RT, HIV diagnosis, and duration of HIV seropositive was 45 years (28-64), 38 years (23-53), and 11 years (6-35), respectively. Patients were stratified into two groups. Group A and B received 2Gyx12 and 1.5Gyx16, respectively. RESULTS: After a median follow-up of 66 months (12-141), the overall response (OvR) was 93% of the patients. Specifically, complete response (CR) and partial response (PR) were 80% and 13%, respectively. In group A, 100% had CR. Treatment failure was 7% and all were in group B, which was mainly due to poor compliance. A Chi-square test showed significant relationship between OvR and RT duration (P <0.001), and a positive trend between CR and fraction size of 2 Gy (P = 0.053). All acute toxicities were grade