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Infection of the middle ear along with fluid collection is a common occurrence among babies and children. When fluid collection persists for three months or more, it is considered chronic effusion. This chronic condition can affect development of language, reduce hearing ability, and cause learning, social, and emotional problems. The symptoms of this chronic condition are often vague (fullness in the ear and passing hearing loss) and may go undetected, especially in babies and young children. Protracted vomiting is not usually associated with chronic middle ear effusion, but in babies, this vomiting is a major diagnostic problem. Three cases are presented of babies with severe and persistent vomiting, which resulted in failure to thrive. The babies were 8, 9, and 10 months of age. They were admitted to the hospital for failure to thrive, and underwent extensive testing. Each child had a chronic middle ear effusion that was the cause of the persistent vomiting. When myringotomy tubes were inserted to chronically drain the fluid from the ear, rapid improvement followed; vomiting stopped and progressive weight gain began. In each case, on examination the typical signs of chronic middle ear effusion were noted, but the treating physician was reluctant to consider this as the cause of the severe vomiting and failure to thrive. Better awareness of the fact that chronic otitis media with effusion can cause persistent vomiting should result in earlier diagnosis and treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

The detection of metastatic lymph nodes in cancer patients is essential for determining the cancer stage, and thus, the therapeutic modalities. However, very small lymph nodes can easily be missed during routine examination. We described a ''Lymph Node Revealing Solution'' (LNRS) that helps to detect tiny lymph nodes in neck dissection specimens. Twenty-one consecutive specimens of neck-dissection were investigated. The entire surgical specimen, fixed at first in formalin, was searched for lymph nodes by the traditional method. These were excised and sent for processing. The remaining tissue was immersed for 24 hours in LNRS. The lymph nodes stood out as white chalky nodules on the background of the yellow fat. They were then excised, and examined. A total of 227 lymph nodes were detected by the traditional method; 38 (17%) were positive for metastasis. Using the LNRS method, an additional 72 nodes were identified, among them 8 (11%) were positive for metastases and 2 cases were upstaged. LNRS is an inexpensive and easy method of detecting tiny lymph nodes; it enhances significantly the yield of normal and metastatic nodes of neck-dissection specimens and helps to establish a more accurate staging. (Otolaryngol Head Neck Surg 2001;124:72-5)

Down-regulation of receptor tyrosine kinase activity plays an essential role in coordinating and controlling cellular growth/differentiation. Ca2+/calmodulin-dependent kinase II (CaM kinase II)-mediated phosphorylation of threonine 1172 in the cytoplasmic tail of HER2/c-erbB2 can modulate tyrosine kinase activity and consensus phosphorylation sites are also found at serines 1046/1047 in the structurally related epidermal growth factor receptor (EGFR). We show that serines 1046/1047 are sites for CaM kinase II phosphorylation, although there is a preference for serine 1047, which resides within the consensus -R-X-X-S-. In addition, we have identified major phosphorylation sites at serine 1142 and serine 1057, which lie within a novel -S-X-D- consensus. Mutation of serines 1046/1047 in full-length EGFR enhanced both fibroblast transformation and tyrosine autokinase activity that was significantly potentiated by additional mutation of serines 1057 and 1142. A single CaM kinase II site was also identified at serine 744 within sub-kinase domain III, and autokinase activity was significantly affected by mutation of this serine to an aspartic acid making this site appear constitutively phosphorylated. We have addressed the mechanism by which CaM kinase II phosphorylation of the EGFR might regulate receptor autokinase activity and show that this modification can hinder association of the cytoplasmic tail with the kinase domain to prevent an enzyme-substrate interaction. We postulate that the location and greater number of CaM kinase II phosphorylation sites in the EGFR compared with HER-2/c-erbB2, leading to differential regulation of autokinase activity, contributes to differences in the strength of downstream signaling events and may explain the higher relative transforming potential of HER-2/cerbB2.

The detection of markers associated with malignancy will help in the early identification of tumors and assessment of the success of treatment in patients suffering from carcinoma. Three characteristics investigated in this study were found to differentiate a premalignant inverted papilloma from a benign simple nasal polyp.

The autonomic nervous system (ANS) is a mixed nervous system. There are two divisions of the ANS: the parasympathetic autonomous nervous system (PANS), and the sympathetic autonomic nervous system (SANS). The PANS plays a role in the conservation and homeostasis of bodily functions. The cells giving rise to parasympathetic fibers are situated at three different levels of the central nervous system: the midbrain, the medulla oblongata, and the sacral region of the spinal cord. The parasympathetic fibers leave the brain in the facial (VII CN), glossopharyngeal (IX CN), and vagus (X CN) nerves. The postganglionic parasympathetic fibers of the VII CN enter the sublingual and submanidublar glands and the minor salivary glands of the mucous membrane of the mouth, pharynx and nasopharynx, and those of the IX CN converge into the parotid gland. Parasympathetic postganglionic cholinergic nerve fibers supply cells of both the secretory end-piece and ducts and stimulate the rate of salivary secretion, inducing the formation of large amounts of a low-protein, serous saliva. Parasympathetic denervation of the major salivary glands leads to an immediate reduction of salivary secretion.

Salivary gland tumors are the most common primary lesions that occur in the parapharyngeal space. The current accepted approach to most deep-lobe tumors is the transparotid. For tumors of non-parotid origin, the preferred approach is transcervical. In cases in which the transparotid approach is insufficient, a transcervical, transmandibular approach is safe and offers excellent visualization.

Drooling is the end result of excessive production of saliva, the inability to retain oral secretions, or the outcome of deglutition problems. Mentally retarded children are frequently affected. Although medically managable, surgical correction is recommended. The classic surgical technique is Wilkie's procedure, consisting of retropositioning of the parotid ducts into the tonsillar fossae region along with bilateral submandibular gland resection. Modifications include transposition (instead of resection) of the submandibular gland ducts, ligation (instead of repositioning the parotid ducts) along with the usual submandibular gland resection and other variants. Surgical results are usually beneficial and are associated with relatively insignificant complications and side effects.

We retrospectively evaluated the management of supraglottic carcinoma at our centre during the last 35 years to determine the preferred mode of treatment. A review of the medical records yielded 114 patients with supraglottic T1and T2carcinoma who were diagnosed and treated in the Departments of Otolaryngology, Head and Neck Surgery, and Oncology between 1959 and 1993. Of these, 47 (41.2%) had T1carcinoma (stage I) and 67 (58.8%) T2(stage II). Treatment varied among radiotherapy, surgery, or combined radiotherapy and surgery. Twelve patients underwent elective neck dissection, one of whom (8.3%) was found to have occult metastases. Local failures were noted in 22 patients (11 T1: 11 T2), three of whom also had neck metastases. All except one T2patient received radiotherapy. Radiotherapy yielded the best survival rates for T1disease as combined therapy did for T2. Five-year recurrence rates for T1patients were 35% for those treated by radiotherapy and 42% for those treated with combined therapy; corresponding figures for T2patients were 39% and 28%. We suggest that patients with T1supraglottic carcinoma be managed with radiotherapy and patients with T2with combined therapy. We believe there is no need for elective neck dissection, especially in T1.