From the National Institute on Deafness and Other Communication Disorders.
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Biomedical subjects
Publications and source records attributed to J B Snow.
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Smell and taste disorders are common in the general population, yet little is known about their nature or cause. This article describes a study of 750 patients with complaints of abnormal smell or taste perception from the University of Pennsylvania Smell and Taste Center, Philadelphia. Major findings suggest that: chemosensory dysfunction influences quality of life; complaints of taste loss usually reflect loss of smell function; upper respiratory infection, head trauma, and chronic nasal and paranasal sinus disease are the most common causes of the diminution of the sense of smell, with head trauma having the greatest loss; depression frequently accompanies chemosensory distortion; low body weight accompanies burning mouth syndrome; estrogens protect against loss of the sense of smell in postmenopausal women; zinc therapy may provide no benefit to patients with chemosensory dysfunction; and thyroid hormone function is associated with oral sensory distortion. The findings are discussed in relation to management of patients with chemosensory disturbances.
This is a report of a 10-year median follow-up of a randomized, prospective study investigating the optimal sequencing of radiation therapy (RT) in relation to surgery for operable advanced head and neck cancer. In May 1973, the Radiation Therapy Oncology Group (RTOG) began a Phase III study of preoperative radiation therapy (50.0 Gy) versus postoperative radiation therapy (60.0 Gy) for supraglottic larynx and hypopharynx primaries. Of 277 evaluable patients, duration of follow-up is 9-15 years, with 7.6% patients lost to follow-up before 7 years. Loco-regional control was significantly better for 141 postoperative radiation therapy patients than for 136 preoperative radiation therapy patients (p = 0.04), but absolute survival was not affected (p = 0.15). When the analysis was restricted to supraglottic larynx primaries (60 postoperative radiation therapy patients versus 58 preoperative radiation therapy patients), the difference for loco-regional control was highly significant (p = .007), but not for survival (p = 0.18). In considering only supraglottic larynx, 78% of loco-regional failures occurred in the first 2 years. Thirty-one percent (18/58) of preoperative patients failed locally within 2 years versus 18% (11/60) of postoperative patients. After 2 years, distant metastases and second primaries became the predominant failure pattern, especially in postoperative radiation therapy patients. This shift in the late failure pattern along with the increased number of unrelated deaths negated any advantage in absolute survival for postoperative radiation therapy patients. The rates of severe surgical and radiation therapy complications were similar between the two arms. Because of an increased incidence of late distant metastases and secondary primaries, additional therapeutic intervention is required beyond surgery and postoperative irradiation to impact significantly upon survival.
The photochemical effect of low-intensity laser irradiation (LILI) on the maturation and regeneration of olfactory-immature estrus day 15 (E15) and olfactory-mature estrus day 22 (E22) rat fetuses was studied. Neuritic outgrowths of olfactory bipolar receptor cells were quantified in olfactory neuroepithelial explants. Explants in the experimental groups were irradiated with a helium-neon laser using different incident energy densities (IEDs). Explants in another group were exposed to fluorescent light. Control explants did not receive laser or fluorescent light irradiation. Neuritic outgrowths were analyzed on a regular basis for 12 days. Analysis of variance was used to evaluate the data. The parameters of neuritic outgrowth in E15 fetuses showed a significant increase of 30% to 50% vs. the control with a single laser irradiation of 0.5 J/cm2 IED. The rate of neuritic outgrowth observed in the E22 fetuses was less than in the E15 fetuses. The parameters of neuritic outgrowth in E22 fetuses showed a significant and substantially greater percentage increase than in the E15 fetuses with daily laser irradiations of 0.05 and 0.5 J/cm2 IED when compared to the control. The magnitude of these increases appears to be of biological significance as well as statistical significance.
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The measurement of quality of medical care has always been a topic of concern to physicians and other health care professionals. During an age of increasing competitiveness in the health care environment, the ability to assess accurately the quality of the care delivered has become increasingly important. The head and neck surgeons within the Radiation Therapy Oncology Group have examined this problem and have developed an evaluation tool that was then applied retrospectively in an attempt to evaluate the quality of surgery performed in a randomized study. The analysis of the results suggested that the retrospective approach to surgical quality control is fraught with hazards and is unlikely to fulfill the goals set for it.
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The immunohistochemical characteristics of the human olfactory system were (OMP). OMP was detected in the olfactory receptor neurons and processes extending from the olfactory neuroepithelium to the olfactory bulb. The olfactory receptor cells located close to the epithelial surface also contained OMP. In severely degenerate regions, only a few OMP-containing cells were observed. Differences in OMP-staining intensity were noted among the olfactory receptor cells. The thick neuroepithelium. Proliferating olfactory neuroepithelium contained OMP reactive and nonreactive olfactory receptor cells. The presence of OMP reactive and nonreactive olfactory neurons indicates the coexistence of two functionally different phases of olfactory neurons. These findings suggest that continuous cell turnover is occurring in human olfactory neuroepithelium.
The magnitudes of the endocochlear dc potential (EP) during adequate ventilation and during five minutes of anoxia were recorded in control guinea pigs and guinea pigs administered various dosages of kanamycin sulfate. The magnitudes of the EP after five minutes of anoxia were -44.6 +/- 5.9 mV in the controls and +26.6 +/- 9.9 mV in the guinea pigs that received kanamycin for seven or ten days. This change occurred after five or six days of administration of kanamycin. However, there was no significant change in the magnitude ot the EP with adequate ventilation with kanamycin intoxication. There is a significant correlation between the magnitude of the negative EP and the maximum output of the cochlear microphonics (r = -.770, P less than .001). These results suggest that the EP may not be the mathematical summation of the positive electrogenic potential and the negative diffusion potential. The mechanism for generating the negative EP during anoxia may have some relationship to hair cell integrity.
There are numerous surgical procedures for the treatment of Meniere's disease, and the current status of their efficacy is controversial. A review of the literature is presented as a basis for the evaluation of the relative merit of these procedures. Emphasis is placed on endolymphatic sac procedures, sacculotomy, vestibular neurectomy and labyrinthectomy. Vestibular neurectomy and surgical labyrinthectomy provide high rates of improvement in vertigo. The hearing is frequently made worse by vestibular neurectomy. Endolymphatic sac procedures result in improvement in vertigo less frequently. They are most likely to improve hearing. Although sacculotomies are associated with improvement in vertigo in approximately 80% of patients, they are associated with high rates of hearing loss.
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The relationship between the calculated value of the effective electrical resistance of the cochlear partition and the distance between the electrode for measuring the EP and the stimulating electrodes has been studied. The calculated value of the effective electrical resistance of the cochlear partition declines linearly with increasing distance between these electrodes. The correlation coefficient (r) is -0.806. In calculations of the effective electrical resistance of the cochlear partition, attention must be paid to the distance between the microelectrodes.
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Hypocalcemia, although a relatively uncommon sequela of operations for carcinoma of the larynx and pharynx, often presents as an acute medical emergency. In its chronic form, hypocalcemia may be a difficult disorder to control. Understanding the etiologic basis of hypocalcemia secondary to operations for carcinoma of the head and neck requires knowledge of the pathophysiology of the preoperative and postoperative factors affecting calcium homeostasis. These factors include thyroidectomy, hypoparathyroidism, hypomagnesemia, anticonvulsant therapy, estrogen replacement therapy, oral contraceptives, blood transfusions, hyperventilation alkalosis, hypoalbuminemia, corticosteroid therapy, depression, emotional stress and diet. Often the onset of symptoms and signs of hypocalcemia occurs within 24 to 48 hours after the operation. The symptoms may include mental depression, headache, tingling of the hands and perioral region and abdominal pain. Unrecognized chronic hypocalcemia may lead to the development of cataracts, convulsions and psychosis.
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