Recognition of script-typical versus script-atypical information: effects of cognitive elaboration.

Memory for script-atypical information has been shown to be superior to memory for script-typical information. Two explanations of this typicality effect are evaluated: (1) the attention-elaboration hypothesis (AEH) and (2) the script-copy-plus-tag hypothesis (SCTH). The AEH claims that atypical information is recognized better because it attracts more attention and cognitive elaboration. According to the SCTH, memory representations of script-based texts are established automatically and constitute a copy of the script plus tags for atypical events that facilitate later recognition. We investigated recognition memory and memory for the presentation form of typical and atypical items originally shown with versus without missing letters. Experiment 1 showed that presenting items in fragmentary form tends to improve recognition memory mostly for highly typical items. Experiment 2 revealed that the size of this missing-letters effect is affected by the presentation form of items preceding the target items during acquisition. For fragmented items preceded by other fragmented items, the typicality effect virtually disappeared. Memory for the presentation form of items was generally moderate. These results are readily explained within the AEH framework and pose some problems for the SCTH.

[Preliminary experiments on the correlation of speech errors and working memory]. / Erkundungsexperimente über den Zusammenhang von Versprechern und Arbeitsgedächtnis.

This article is based on the conjecture that a relation exists between the phonological loop, part of the working memory (Baddeley, 1997), and speech production. The influence of verbal material stored in the phonological loop on the frequency of slips during articulation was studied experimentally. The SLIP technique of inducing speech errors was used (Baars, 1992). Pairs of words are presented successively to the subjects for one second each. Some of the word pairs are to be spoken aloud. The articulation of these words can be influenced by preceding phonologically interfering words in such a way that the probability of exchanging the first phonemes of both words is increased (spoonerisms). In both exploratory experiments we performed, the time interval between the phonologically interfering information and the pairs of words which had to be spoken aloud was systematically manipulated. According to Baddeley's theory of working memory (1997) it was expected that phonological interference should be restricted to a time interval of about two seconds. This expectation was supported empirically.

[Slip technique, process dissociation model and multinomial modeling: new tools for experimental detection of "Freudian slips"]. / SLIP-Technik, Prozessdissoziationsmodell und multinomiale Modellierung: neue Werkzeuge zum experimentellen Nachweis "Freudscher Versprecher"?

The study reported here was conducted as a test of the so-called "weak Freudian hypothesis", which claims that unconscious thoughts are relevant for the generation of speech errors. Spoonerisms were induced experimentally using the so-called SLIP technique. Motley and Baars (1976) demonstrated an increase in speech error rates when spoonerisms were primed semantically. The extensively discussed problems of "unawareness" of briefly presented stimuli were circumvented by using a modified version of Jacoby's process dissociation technique which allows a model-based estimation of conscious and unconscious processes within a task. The two reported experiments combined a wordstem completion task for estimating probabilities of perceptual processes and a SLIP task under identical perceptual conditions. A joint multinomial model was constructed for data analysis. The SLIP technique was successfully applied using German stimuli, adequate experimental variations raised the error rate from 7% in experiment 1 to 19% in experiment 2. Neither the replication of Motley and Baars' results nor unconscious priming of speech errors were statistically confirmed. Despite this negative result, the descriptive pattern of parameter estimates is psychologically meaningful: primes that remained unconscious resulted in a higher speech error probability than primes that were perceived consciously. Conscious perception might trigger control processes that act in opposition of speech errors. Statistical problems of the particular multinomial model and possible solutions in future research are discussed.

Otolaryngologic manifestations of the mucopolysaccharidoses.

A retrospective review of 45 children with mucopolysaccharidoses was performed to determine the frequency of complications related to the head and neck. In this series, every patient had at least one complication involving the head and neck region, and in over half, operative intervention by the otolaryngologist was required. Upper airway obstruction occurred in 17 (38%) and necessitated a tracheostomy in 7 (16%). Cervical spine instability occurred in 8 (18%), making airway management difficult. Recurrent respiratory infections occurred in 17 (38%), and chronic recurrent middle ear effusions were noted in 33 (73%). This review demonstrates that children afflicted with the mucopolysaccharidoses frequently have otolaryngologic-related complications that are common throughout their life span and often the primary management issue in their continuing care. The otolaryngologic management of these patients is outlined based on the results of this study and review of the relevant literature.

Inflammatory torticollis in children.

Acute torticollis is commonly seen in the pediatric emergency department. It often results from an inflammatory process that irritates the cervical muscles, nerves, or vertebrae. Posturing of the head occurs with unilateral spasm of the sternocleidomastoid muscle such that the child will position the head with the occiput rotated to the affected side and the chin rotated to the contralateral side. We recently treated 26 children who presented to the emergency department with acute nontraumatic torticollis. The most common causes were upper respiratory infection, sinusitis, otomastoiditis, cervical adenitis, and retropharyngeal abscess or cellulitis. Four patients had subluxation of the atlantoaxial joint as a result of the inflammatory process. Children with acute torticollis need careful evaluation for either overt or occult otolaryngologic infections. Computed tomography and magnetic resonance imaging are helpful in determining the cause of the acute torticollis and in ruling out rotatory subluxation of the atlantoaxial joint.

Congenital muscular torticollis. A spectrum of disease.

Sternocleidomastoid muscle fibrosis has been recognized for centuries, but its pathogenesis and treatment remains controversial. Pseudotumor of infancy is a firm fibrous mass in the sternocleidomastoid muscle appearing at 2 to 3 weeks of age. Congenital muscular torticollis is less common and appears later in life. Pseudotumor and congenital muscular torticollis probably represent different manifestations of sternocleidomastoid muscle fibrosis. Pseudotumor will usually resolve with conservative therapy; however, some patients will subsequently develop torticollis. Congenital muscular torticollis usually requires surgical release of the sternocleidomastoid muscle to achieve a good cosmetic result and to prevent plagiocephaly, facial asymmetry, and scoliosis. This report provides guidelines for the management of congenital muscular torticollis and pseudotumor of infancy based on the authors' experience and review of the medical literature. Representative case histories from the neonate through the adult are presented, and the pathogenesis, diagnosis, treatment, and prognosis are discussed.

Importance of iron repletion in the management of Plummer-Vinson syndrome.

Plummer-Vinson syndrome (PVS) is characterized by iron deficiency anemia, upper esophageal stricture, cervical dysphagia, and glossitis. The precise role of iron deficiency in PVS has yet to be defined and remains a subject of much debate. A 29-year-old woman with PVS is presented. The patient had a 4-year history of severe iron deficiency anemia, a 2-year history of progressive dysphagia and weight loss, and a greater than 90% benign upper esophageal stricture. Iron therapy alone resolved her dysphagia and anemia, and a follow-up esophagram 1 year later showed a residual stenosis of less than 30%. The development of severe iron deficiency anemia in this patient 2 years before the onset of dysphagia, as well as the response of the stricture to iron repletion, supports the theory that iron deficiency can cause dysphagia and upper esophageal strictures. The occurrence of glossitis, gastritis, and esophagitis in iron deficiency demonstrates the adverse effects of iron depletion on the rapidly proliferating cells of the upper alimentary tract.

Tonsillectomy under local anesthesia: a safe and effective alternative.

Tonsillectomy using local anesthesia (local tonsillectomy) is a safe and effective alternative to general anesthesia in the healthy cooperative teenage or adult patient. This retrospective analysis involved 64 local tonsillectomies performed over the past 7 years in a minor operating room using only local anesthesia with intravenous sedation. Operations were performed by residents in training as well as by experienced head and neck surgeons. Blood loss, morbidity, complications, and patient satisfaction were reviewed and compared with tonsillectomies done under general anesthesia. The average blood loss was 42 mL in the local tonsillectomy group with no cases of postoperative hemorrhage, compared with 198 mL in the general anesthesia group with two cases of postoperative hemorrhage. There was one major complication related to postoperative antibiotic use in the local anesthesia group, and follow-up interviews revealed that patients were satisfied with the procedure and would recommend and choose local anesthesia again. We conclude that local tonsillectomies have high patient acceptance and are associated with minimal morbidity and complications. Furthermore, they are cost-effective.

Lymphokine-activated killing of autologous and allogeneic short-term cultured head and neck squamous carcinomas.

Interleukin-2-(IL-2)-activated lymphocytes have been shown to kill a variety of continuously cultured allogeneic (nonself), natural killer cell-sensitive and resistant cell lines, and some autologous (self) tumor cells. Lymphokine-activated killer (LAK) cytotoxicity of autologous head and neck squamous cell carcinoma (HNSCC) cells has not been previously demonstrated, and efforts to demonstrate this have been hampered by the lack of a reliable and reproducible method of obtaining satisfactory tumor targets. In this study, fresh tumor cells were enzymatically dissociated, enriched by adherence to plastic, and used in a 3-hour chromium-51 cytotoxicity assay. Peripheral blood lymphocytes (PBLs) were incubated for 3 days with or without added IL-2. IL-2-activated PBLs showed significant cytotoxicity against autologous and allogeneic targets, while only low levels of tumor lysis occurred with unstimulated PBLs. These findings suggest the possible use of IL-2-activated lymphocytes in the adoptive immunotherapy of HNSCC patients.

Two-stage temporalis flap reconstruction for facial paralysis.

Treatment of the paralyzed face remains a challenging surgical problem. When facial nerve damage is irreparable or facial nerve grafting has failed, static and dynamic techniques must be considered. A two-staged modification of the dynamic muscle transfer using ipsilateral temporalis muscle is described. Initially, a free temporalis fascia graft, harvested from the contralateral scalp, is placed around the oral commissure of the paralyzed side of the face through an incision in the nasolabial crease. Several weeks later, an ipsilateral temporalis muscle and fascia transfer is made to the anterior face and attached to the previously placed fascia graft. Oral commissure grafting, as a first step, provides for a secure anchoring point for the temporalis flap, and achieves a more satisfactory correction of the oral commissure.

Maxillary ameloblastoma. A potentially lethal neoplasm.

Ameloblastomas are benign tumors derived from the odontogenic apparatus. Of these tumors, 80% originate in the mandible, while 20% originate in the maxilla. Six cases of maxillary ameloblastoma treated at the UCLA hospitals are presented; four of these cases showed extensive and destructive tumor growth involving vital structures, including the orbit, base of skull, and parasellar structures. Two of four patients with extensive disease died of their tumors, one, with extensive involvement of the base of the skull, became unavailable for follow-up, and, one year after diagnosis, one is alive with middle cranial fossa disease. A review of the medical literature provides further evidence of the locally aggressive behavior and potentially lethal nature of this tumor. No effective treatment has evolved for extensive ameloblastomas of the maxilla that have invaded surrounding vital structures. When tumor-free surgical margins are not possible, radiation therapy may offer palliation of disease.