Faculty Bibliography

Cisplatin (cis-diamminedichloroplatinum(II) (CDDP)) is a widely used, highly effective, oncolytic agent that has serious ototoxic side-effects. To test the effectiveness of local delivery, of L-methionine (L-Met) as an otoprotective agent against CDDP ototoxicity, we used a rat model of a highly metastatic breast cancer tumor, i.e. Fisher 344 rats implanted with MTLn3 breast cancer cells. Four experimental groups were evaluated--I: untreated; II: CDDP-treated (three dosages); III: systemically-delivered L-Met + CDDP-treated; IV: locally delivered L-Met + CDDP-treated. The integrity of the outer hair cells (OHCs) was determined using scanning electron microscopy (SEM); hearing was assessed by recording auditory brainstem responses (ABRs) at multiple frequencies. The chemotherapeutic effectiveness of CDDP was quantified by measuring changes in tumor mass and the presence of tumor metastasis. L-Met provided otoprotection of the OHCs against CDDP toxicity in the cochleae of rats following either systemic (III) or local (IV) administration. The ABRs were unchanged in each of the L-Met protection Groups (III and IV) and in the untreated animals of Group I. Treatment with CDDP only (II) induced significant hearing losses at both 16 and 18 kHz when compared to ABRs of untreated rats(I). CDDP was effective in controlling the MTLn3 initiated breast cancer tumors in the CDDP-treated (II) and the local L-Met protection, CDDP-treated (IV) Groups. In contrast, the tumors in the systemic L-Met protection, CDDP-treated Group (III) were not controlled by the CDDP treatment regime. This study demonstrates that local delivery of L-Met to the scala tympani of the cochlea via the round window membrane (IV) provides effective protection against CDDP ototoxicity without compromising its ability to control a highly metastatic form of cancer.

Experience with rhinoplasty over time has shown that a detailed anatomic analysis of the nose is an essential first step in achieving a successful outcome. Failure to recognize a particular anatomic point preoperatively will often lead to a less than ideal long-term result. Deficiency in the radix is a commonly overlooked abnormality that may be found both in patients undergoing primary rhinoplasty and patients undergoing revision rhinoplasty after an overzealous bony hump removal. Whereas surgeons previously reduced the nasal dorsum down to the level of the radix on a routine basis, recent emphasis on a strong natural profile has focused attention on anatomic deficiency in the radix region. We describe a simple technique for treatment of the deep nasofrontal angle and present patient examples. Autologous cartilage grafts may be fashioned into a 'radix graft' and reliably used to augment the region either with a precise pocket approach or without when a precise pocket is not possible, achieving a natural aesthetic result

BACKGROUND: Head and neck cancer treatment with high-dose chemoradiation may cause xerostomia and affect the patient's perception of swallowing ability. METHOD: Whole saliva production was measured in 36 patients with advanced-stage cancer of the oropharynx before treatment and 3 months after treatment by weighing a 4 x 4 inch gauze before and after a 2-minute chewing period. Presence of multiple eating difficulties was measured by patient interview. Swallowing was examined videofluorographically (VFG). RESULTS: Saliva weight decreased from a mean (SEM) of 5.1 (0.5) g pretreatment to 1.4 (0.5) g after treatment (p<.0001). At 3 months, significantly more patients perceived difficulty swallowing, dry mouth, needing water while eating, food stuck in the mouth or throat, and change in taste. Saliva weight was not correlated with VFG measures of bolus transit or observations of residue. CONCLUSIONS: Chemoradiation treatment results in xerostomia and a significant increase in patient perception of swallowing difficulties. Saliva weight in patients who perceive swallowing problems was lower. Xerostomia did not affect the physiologic aspects of bolus transport. Xerostomia affected the sensory process and comfort of eating more than bolus transport

PURPOSE: In the current study, we measured threshold duration required to perform the tasks of letter identification, letter detection, grating orientation discrimination, and symmetry detection of targets presented as a function of retinal eccentricity. METHODS: Targets were presented in the nasal visual field on the horizontal meridian at eccentricities ranging from 0 degree to 22 degrees. Threshold duration was calculated using a modified staircase procedure. RESULTS: We found that for the task of letter identification, the rate of duration sensitivity loss was independent of the letter size. In contrast, for the tasks of letter detection, grating discrimination, and symmetry detection, the rate of loss was greater for smaller targets than for larger targets. CONCLUSION: At equivalent target sizes, letter identification always demonstrated the steepest decline in duration sensitivity with increasing eccentricity. This might be the case if the final stages of the identification process are rate limiting. It was hoped that by quantifying duration sensitivity of the peripheral retina, more appropriate temporal stimuli could be used in rehabilitation programs that train reading using eccentric preferred retina loci in patients with advanced macular disease

PURPOSE: This study identified the terminal temporal and zygomatic branches of the facial nerve as they enter the orbicularis oculi muscle and related these branches to identifiable surface markings. MATERIALS AND METHODS: The temporal and zygomatic branches of the facial nerve were dissected from 5 preserved cadavers (10 sides). The most superior temporal branch entering the orbicularis oculi muscle was identified and related to the lateral canthus of the eye. A vertical line was passed through this point so that the line was equidistant from the nasal tip and chin point. A line perpendicular to the vertical line through the lateral canthus served as the horizontal scale. Vertical and horizontal lines through the lateral canthus were used to establish the anatomic relationship between the lateral canthus and the branch of the temporal nerve entering the orbicularis oculi muscle. RESULTS: The temporal branch was an average of 2.85 +/- 0.69 cm superior to the lateral canthus and an average of 2.54 +/- 0.43 cm lateral to the lateral canthus as it courses into the orbicularis oculi muscle. At the lateral border of the orbicularis oculi muscle, where the temporal and zygomatic nerves insert into the muscle, the mean vertical distance between the temporal and zygomatic nerves was 1.72 +/- 0.62 cm. CONCLUSION: Incisions superior or inferior and parallel to the course of the facial nerve, can provide access to the fronto zygomatic suture and the superior and lateral orbit without damaging its branches

Rejuvenation of the midface is a challenge in facial plastic surgery. To this end, several techniques have been developed to address the changes seen in the midface with aging. Specifically, ptosis of the malar fat pad and deepening of the nasolabial fold contribute to the aesthetic changes that characterize midfacial aging. The history of modern facelifts and deep-plane facelift techniques to correct the nasolabial fold are presented

This paper considers the information transmitted in absolute judgments as encoded in a stimulus-response matrix (e.g., see Garner and Hake, 1951). When transmitted information is plotted against the number of stimulus categories in the matrix, one obtains a curve that increases monotonically toward a plateau, which is the maximum information transmittable per stimulus for the particular range of stimuli employed. We demonstrate that although the maximum information transmitted is an attribute of the stimulus continuum itself, the shape of the curve is an empirical property of the stimulus-response matrix, which is determined, in part, by maintaining a constant stimulus category width. Therefore, in principle, each curve of information transmitted vs number of stimulus categories can be determined by a single point: the rightmost point on the graph.

Leptospirosis is an often severe disease which requires prompt treatment. Laboratory testing is required to reach a valid diagnosis. An agglutination assay for the detection of Leptospira-specific antibodies consisting of individually wrapped agglutination cards containing a stable, dried detection reagent is evaluated. The assay is simply performed by suspending the dried reagent with a drop of serum. The result is obtained within 30 s. The sensitivity of the assay varied with the stage of the disease and was 72.3% for samples collected during the first 10 days of the illness and 88.2% for samples collected at a later stage. The specificity was 93.9% and 89.8%, respectively. These characteristics make the test ideal for use in areas where the disease is common and where laboratory support is not routinely available

This study examined two possible reasons underlying longitudinal increases in vowel identification by cochlear implant users: improved labeling of vowel sounds and improved electrode discrimination. The Multidimensional Phoneme Identification (MPI) model was used to obtain ceiling estimates of vowel identification for each subject, given his/her electrode discrimination skills. Vowel identification scores were initially lower than the ceiling estimates, but they gradually approached them over the first few months post-implant. Taken together, the present results suggest that improved labeling is the main mechanism explaining post-implant increases in vowel identification