High-capacity auditory memory for vocal communication in a social songbird.

Effective vocal communication often requires the listener to recognize the identity of a vocalizer, and this recognition is dependent on the listener's ability to form auditory memories. We tested the memory capacity of a social songbird, the zebra finch, for vocalizer identities using conditioning experiments and found that male and female zebra finches can remember a large number of vocalizers (mean, 42) based solely on the individual signatures found in their songs and distance calls. These memories were formed within a few trials, were generalized to previously unheard renditions, and were maintained for up to a month. A fast and high-capacity auditory memory for vocalizer identity has not been demonstrated previously in any nonhuman animals and is an important component of vocal communication in social species.

CT features of plexiform neurofibroma of the submandibular gland.

Plexiform neurofibroma of the submandibular gland is an extremely rare tumor. We report the CT findings in a 6-year-old girl with type 1 neurofibromatosis who had a histopathologically proven submandibular gland plexiform neurofibroma. A "branching" hypodense mass was noted on the CT scan infiltrating the submandibular gland and the adjacent spaces of the neck. CT could be extremely valuable in suggesting the diagnosis.

Cystic hygroma/lymphangioma: a rational approach to management.

OBJECTIVE: To outline a rational approach to the management of cystic hygroma based on the authors' experience, the natural history of the disease, and the results of surgical treatment. STUDY DESIGN AND METHODS: A retrospective review of all patients with the diagnosis of lymphangioma or cystic hygroma from 1958 to 2000 was performed. RESULTS: Seventy-four patients were identified with 46 cases confined to the cervicofacial region. Surgical excision was performed on 60 of the 74 cases involving all regions of the body and 34 of the 46 patients with head and neck lesions. The location of the malformation is the most important determinate for surgical success. While surgical excision was the main treatment modality, 11 of 12 untreated patients were noted to improve, with 8 patients showing complete resolution. CONCLUSIONS: In the treatment of lymphangiomas, the physician should be experienced in the management of such lesions, be aware of spontaneous resolution, and recognize the limitations and potential harm of surgery in certain instances.

Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis.

OBJECTIVE: To explore the possible role of gastroesophageal reflux (GER) in children with chronic sinus disease (CSD). DESIGN: A descriptive prevalence study of the frequency of GER and nasopharyngeal reflux in children with CSD. SETTING: Pediatric otolaryngology and gastroenterology outpatient clinics of a regional medical center. PATIENTS AND OTHER PARTICIPANTS: Consecutive children aged 2 to 18 years referred for evaluation of CSD from December 1, 1996, through April 30, 1998. INTERVENTIONS: Participants underwent 24-hour monitoring with dual pH probes, and participants (or their parents) completed questionnaires before treatment and at specific intervals after treatment. MAIN OUTCOME MEASURES: Prevalence of GER and nasopharyngeal reflux in children with CSD, and the response of sinusitis to treatment in those diagnosed with GER. RESULTS: Nineteen (63%) of 30 patients demonstrated esophageal reflux, which is well above the expected prevalence of GER in the healthy general population. Six (32%) of these 19 patients demonstrated nasopharyngeal reflux. Fifteen (79%) of 19 patients improved after treatment for GER. CONCLUSIONS: The children in this population had a prevalence of GER that was significantly higher than expected. Furthermore, most children with GER demonstrated improvement of sinus disease after treatment of GER. We recommend that children with CSD refractory to aggressive medical management be evaluated for GER and, if GER is present, be treated accordingly, before sinus surgery is considered.

The effect of topical ciprofloxacin on postoperative otorrhea after tympanostomy tube insertion.

OBJECTIVE: This study aimed to evaluate the effectiveness of prophylactic ciprofloxacin drops in decreasing the incidence of otorrhea after tympanostomy tube insertion. STUDY DESIGN: The study design was a single-blind, randomized clinical trial. SETTING: The study was conducted at a tertiary care referral center. PATIENTS: One hundred fifty-four patients aged 6 months to 14 years undergoing tympanostomy tube insertion participated. INTERVENTION: For each subject, one ear was randomly assigned to receive topical ciprofloxacin, placed in the middle and external ear after surgery, while the contralateral ear served as a control. MAIN OUTCOME MEASURE: Posttympanostomy otorrhea occurring during the period from 24 hours after surgery until 2 weeks after surgery was measured. RESULTS: Topical ciprofloxacin application after tympanostomy tube insertion was associated with a significantly lower incidence of early posttympanostomy otorrhea. The rates of otorrhea for control and treatment ears were 9.1% and 3.9%, respectively (p = 0.029). CONCLUSIONS: The topical administration of a single dose of ciprofloxacin solution after surgery is an effective treatment for the prevention of early posttympanostomy otorrhea.

Cervical thymic anomalies.

Because of its infrequent occurrence, cervical thymic tissue is rarely considered in the differential diagnosis of neck masses. Consequently, diagnosis is most often made by pathologic examination of the excised specimen. The preponderance of reported patients have been children and adolescents, typically asymptomatic. The clinical presentation, evaluation and surgical management of five new cases of cervical thymic anomalies ranging from infancy to adulthood are described. The authors also review the embryology and histopathology of these lesions and discuss their recommended approach to the evaluation and management of cervical thymic anomalies.

Infantile subglottic hemangioma: a review and presentation of two cases of surgical excision.

Subglottic hemangioma in infants is a well-defined entity with which otolaryngologists should be familiar. Although benign lesions with a natural history of regression, they may demand the attention of an otolaryngologist to maintain a secure airway. Throughout the years, multiple treatment options have been proposed and utilized for subglottic hemangioma. As of yet, however, there is no consensus as to the best treatment. Surgical excision is one treatment option available to the otolaryngologist which has previously received less attention. We review treatment options and report two cases of surgical excision of infantile subglottic hemangioma. Both patients were extubated by postoperative day number three and have remained symptom free. We support surgical excision as a valuable treatment option.

Congenital esophageal webs.

Congenital esophageal webs are rare entities. These lesions generally occur in the upper one third of the esophagus and present symptomatically in early childhood. Dysphagia and 'feeding' difficulties are characteristic presenting symptoms. Radiographic studies generally reveal a normal appearing esophageal lumen with the exception of a single thin indentation of the esophageal lumen that is located either anteriorly or circumferential in nature. We describe two children with congenital esophageal webs and review the pathophysiology, diagnosis and management of these unusual lesions.

Traumatic herniation of the buccal fat pad: a report of two cases and a review of the literature.

Two cases of injury resulting in traumatic herniation of the buccal fat pad into the oral cavity are described. A review of the literature reveals that almost all reported cases of traumatic herniation of the buccal fat pad occurred in young children. The majority of cases resulted from penetration of the buccal mucosa and buccinator muscle by a foreign object in the mouth. Treatment generally consisted of excision of the mass followed by primary closure.

Identification of metabolites of azaperone in horse urine.

Two metabolites of the tranquilizer azaperone were extracted from alkalinized horse urine after treatment with beta-glucuronidase/sulfatase from limpets (Patella vulgata). The metabolites were identified by a combination of independent chemical synthesis and GC/MS and 1H NMR analysis. The metabolites were identified as 1-(fluorophenyl)-4-[4-(5-hydroxy-2-pyridinyl)-1-piperazinyl]-1-butanol, designated as 5'-hydroxy-azaperol, and 1-(fluorophenyl)-4-[4-(5-hydroxy-2-pyridinyl)-1-piperazinyl]-1-butanone, designated as 5'-hydroxyazaperone. A TLC screening test was developed for detecting both metabolites in basic extracts of horse urine treated with beta-glucuronidase/sulfatase. The screening test was used to detect azaperone metabolites in extracts of horse urine collected for 24 h after intravenous administration of azaperone. The administration of azaperone to horses was confirmed by GC/MS identification of 5'-hydroxyazaperone and 5'-hydroxyazaperol from basic extracts of horse urine treated with beta-glucuronidase/sulfatase. The extracted metabolites were treated with bis(trimethylsilyl)acetamide to produce trimethylsilyl (TMS) ether derivatives, and mass spectra and retention times were compared to those of the synthesized metabolites treated in the same manner.

Role of TSH measurements in predicting the outcome of treatment for Graves' disease following drug therapy.

Thyroid-stimulating hormone (TSH) levels obtained one month after the cessation of anti-thyroid drug treatment were assessed retrospectively for possible use in predicting outcome in 50 patients with a clinical diagnosis of Graves' disease. Thirty-four patients remained in remission at the end of the follow-up period and 16 patients relapsed. Although a TSH level of < 1.2 mU/1 did not discriminate between the two groups, none of the 24 patients who had TSH levels of > 1.2 mU/1 relapsed during the follow-up period, making early discharge from the thyroid clinic possible for these patients.

Prompting for cost-effective test ordering: a randomized controlled trial.

This randomized, controlled trial tests the efficacy of a computerized prompting system for test ordering. The system, makes use of the sensitivity, specificity, positive and negative predictive values of tests. It was tested using clinical vignettes in an academic family medicine center with first and second year residents. We found that there was a 38% decrease in the numbers of tests ordered (p < .01) and a 12% decrease in the costs of tests ordered by using the prompting system. We suggest that when used at the point of the patient encounter, this system has the potential for promoting more appropriate test ordering and for saving considerable health care dollars.

Prompting physicians for cost-effective test ordering in the low prevalence conditions of family medicine.

We have developed a computerized prompting system for test ordering which we feel will decrease the cost of investigations and at the same time promote an evidence based learning approach to test ordering. Prompting systems have been shown to be cost-effective but suffer from many disadvantages in the family practice setting. They tend to be difficult to modify by the user and contingent on an inflexible rule based structure. Many suggestions are ignored implying that they are not relevant. In family practice most conditions are of low prevalence. Prompting for test ordering where the pre-test likelihood of disease is small will result in a large number of false positives and many unnecessary repeat or confirmatory investigations and attendant anxiety unless the prompting system is specifically designed to be used in a low prevalence environment. PROMPTOR-FM (PRObabilistic Method of Prompting for Test ORdering in Family Medicine) was developed to overcome these perceived difficulties. It allows the physician to rapidly calculate the positive and negative predictive values of a test being considered based on the clinical index of suspicion. The physician is able to repeat the calculations and compare the results with previous calculations. By using PROMPTOR-FM repetitively, the clinician can learn to balance the risk of "missing" a rare but serious condition against the risk of falsely identifying disease with its downstream hazards and costs of further investigation. Prompting for test ordering is therefore uniquely tailored to each patient's situation.

A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations.

STUDY OBJECTIVE: To compare the tissue adhesive Histoacryl Blue with suturing in the repair of pediatric facial lacerations. DESIGN: Prospective, randomized controlled trial. SETTING: Emergency department of a pediatric teaching hospital. PARTICIPANTS: Eighty-one children presenting with clean facial lacerations less than 4 cm in length and 0.5 cm in width. INTERVENTIONS: Patients were allocated randomly to have their lacerations repaired with sutures or Histoacryl Blue. RESULTS: The two groups were similar for demographic and clinical characteristics. Photographs taken at three months were rated by two plastic surgeons blinded to the method of closure. There was no difference between groups for appearance scores on a visual analog scale (60.5 mm for Histoacryl Blue versus 57.2 mm for suture, P = .45) or on a categorical scale (Histoacryl Blue versus sutures: unacceptable, 11% versus 13%; acceptable, 59% versus 71%; excellent, 30% versus 16%; P = .76). Measures of observer agreement produced Pearson correlations of .72 and .94 on the visual analog scale and kappa coefficients of .46 and .73 on the categorical scale. Histoacryl Blue was assessed as less painful on a visual analog scale (24.7 versus 43.7 mm, P < .01) and faster (7.9 versus 15.6 minutes, P < .001). CONCLUSION: Histoacryl Blue is a faster and less painful method of facial laceration repair that has cosmetic results similar to the use of sutures.

Variables affecting silicone-polymethyl methacrylate interfacial bond strengths.

PURPOSE: This study investigated the effects of various polymerization methods and of various types of silane coupling agents on the interfacial bond strengths of Molloplast-B and of two types of heat-processed polymethyl methacrylate (PMMA). MATERIALS AND METHODS: Standardized blocks of PMMA were processed and stored in 100% humidity for 14 days. Silicone of equal dimensions was flasked and processed with premixed and fresh-mixed silane coupling agents interposed. Processing utilized both a typical heated-water system and a dry-heat oven. Following recovery, the specimens were peel-tested at an angle of 180 degrees in an Instron machine. RESULTS: There was no significant difference between the test variables of Lucitone (Dentsply/York Division, York, PA) versus Lucitone 199 (Dentsply/York Division), nor with wet versus dry heat polymerization methods. However, the mean bond strengths for premixed silane improved slightly in a wet polymerization environment. Conversely, fresh-mixed silane's mean bond strength increased slightly with dry-heat polymerization. CONCLUSIONS: The bond strength between a methyl methacrylate denture base and a silicone soft liner varies only slightly when either Lucitone, Lucitone 199, or polymerization in a wet or dry environment is used. Under the conditions of this study, a fresh-mixed silane coupling agent produced a distinctly superior bond strength.

Moderation of morbidity following tonsillectomy and adenoidectomy: a study of awareness under anesthesia.

Sixty-seven children between the ages 3 and 10, undergoing tonsillectomy and adenoidectomy, were randomly assigned to one of 3 groups. Therapeutic suggestions recited in English (n = 31), French (n = 19), or continuous white noise (n = 18) were repetitively administered by means of earphones in a double blind design. Randomization to the English condition was associated with a more favorable outcome with respect to all parameters evaluated by physicians and nurses. However, statistical significance could not be demonstrated. Should this observed favorable outcome be legitimate, cortical interpretation of language context was inferred as recovery was not influenced by randomization into the French or white noise conditions. Preoperative behavior, as defined by preoperative upset and cooperation scores, may be predictive of postoperative convalescence. The favorable outcome imparted by the English condition appeared most significant with respect to those patients at highest risk for poor convalescence i.e. poor status preoperative patients.

Spinal manipulation for low-back pain: an office procedure.

In properly selected patients, spinal manipulation is an alternative to the standard conservative approach to low-back pain. In this paper, an approach to the patient with low-back pain emphasizes the importance of a thorough history, physical examination, and diagnosis prior to manipulation. In addition to listing indications and contraindications, the authors discuss the process of selecting patients for manipulation according to pain and range of motion. Two manipulative techniques which can be easily learned and performed in the office by the family physician are described.

Intraocular extension of optic nerve meningioma in a case of neurofibromatosis.

A case of intraocular extension of primary optic nerve meningioma occurred in a 13-year-old girl with neurofibromatosis. An anomalous disc in the involved blind eye was diagnosed as optic nerve glioma at 2 1/2 years of age. The aggressive nature of meningiomas in the young and the long time period involved account for this rare occurrence of direct intraocular extension.

Cyclic AMP levels during induction and repression of cellulase biosynthesis in Thermomonospora curvata.

Specific cellulase production rates (SCPR) were compared with intracellular cyclic AMP (cAMP) levels in the thermophilic actinomycete, Thermomonospora curvata, during growth on several carbon sources in a chemically defined medium. SCPR and cAMP levels were 0.03 U (endoglucanase [EG] units) and 2 pmol per mg of dry cells, respectively, during exponential growth on glucose. These values increased to about 6 and 25, respectively, during growth on cellulose. Detectable EG production ceased when cAMP levels dropped below 10. Cellobiose (usually considered to be a cellulase inducer) caused a sharp decrease in cAMP levels and repressed EG production when added to cellulose-grown cultures. 2-deoxy-D-glucose, although nonmetabolizable in T. curvata, depressed cAMP to levels observed with glucose, but unlike glucose, the 2DG effect persisted until cells were washed and transferred to fresh medium. SCPR values and cAMP levels in cells grown in continuous culture under conditions of cellobiose limitation were markedly influenced by dilution rate (D). The maxima for both occurred at D = 0.085 (culture generation time of 11.8 h). When D was held constant and cellobiose concentration was increased over a 14-fold range to support higher steady state population levels, SCPR values decreased about fivefold, indicating that extracellular catabolite accumulation may be a factor in EG repression. The role of cAMP in the mechanism of this repression appears to be neither simple nor direct, since large changes (up to 200-fold) in SCPR accompany relatively small changes (10-fold) in cellular cAMP levels.