Protein expression and oxygen consumption rate of early postmortem mitochondria relate to meat tenderness.

Oxygen consumption rate (OCR) of muscle fibers from bovine semimembranosus muscle of 41 animals was investigated 3 to 4 h and 3 wk postmortem. Significant relations (P < 0.05) were found between OCR measurements and Warner-Bratzler shear force measurement. Muscles with high mitochondrial OCR after 3 to 4 h and low nonmitochondrial oxygen consumption gave more tender meat. Tender (22.92 ± 2.2 N/cm2) and tough (72.98 ± 7.2 N/cm2) meat samples (4 samples each), separated based on their OCR measurements, were selected for proteomic studies using mitochondria isolated approximately 2.5 h postmortem. Twenty-six differently expressed proteins (P < 0.05) were identified in tender meat and 19 in tough meat. In tender meat, the more prevalent antioxidant and chaperon enzymes may reduce reactive oxygen species and prolong oxygen removal by the electron transport system (ETS). Glycolytic, Krebs cycle, and ETS enzymes were also more abundant in tender meat

Functional characterization of the S41Y (C2755A) polymorphism of tryptophan hydroxylase 2.

Human TPH2 (hTPH2) catalyzes the rate-limiting step in CNS serotonin biosynthesis. We characterized a single-nucleotide polymorphism (C2755A) in the hTPH2 gene that substitutes tyrosine for serine at position 41 in the regulatory domain of the enzyme. This polymorphism is associated with bipolar disorder and peripartum depression in a Chinese population. Recombinant h TPH2 human proteins were expressed in bacteria and also stably expressed in PC12 cells. Following bacterial expression and purification, the tyrosine for serine substitution at position 41 (S41Y) polymorphic enzyme displayed increased Vmax with unchanged Km values. By contrast, enzyme stability was decreased in vitro from 32 min to 4 min (37 °C) for the S41Y enzyme (as compared to the wild-type enzyme). The S41Y polymorphism decreased cyclic AMP-dependent protein kinase A-mediated phosphorylation ~ 50% relative to wild-type hTPH2, suggesting that the S41Y mutation may disrupt the post-translational regulation of this enzyme. Transfected PC12 cells expressed hTPH2 mRNA, active protein, and synthesized and released serotonin. Paradoxically, while S41Y-transfected PC12 cells expressed higher levels of hTPH2 than wild type, they synthesized less serotonin. These findings suggest a modified regulation of the S41Y gene variant leading to altered regulation and reduced neurotransmitter synthesis that may contribute to association of the polymorphism with bipolar disorder and depression. We report the functional implications of a polymorphic human tryptophan hydroxylase-2 gene associated with depression and bipolar disorder. The polymorphic enzyme (serine-41 converted to tyrosine) has increased activity, but decreased enzyme stability and serotonin production. Moreover, cyclic AMP-dependent protein kinase (PKA)-mediated phosphorylation of the mutant enzyme is decreased suggesting modified regulation of the S41Y variant leading to altered serotonin.

Phylogenetic relationships of chrysanthemums in Korea based on novel SSR markers.

Chrysanthemums are well known for their esthetic and medicinal values. Characterization of chrysanthemums is vital for their conservation and management as well as for understanding their genetic relationships. We found 12 simple sequence repeat markers (SSRs) of 100 designed primers to be polymorphic. These novel SSR markers were used to evaluate 95 accessions of chrysanthemums (3 indigenous and 92 cultivated accessions). Two hundred alleles were identified, with an average of 16.7 alleles per locus. KNUCRY-77 gave the highest polymorphic information content value (0.879), while KNUCRY-10 gave the lowest (0.218). Similar patterns of grouping were observed with a distance-based dendrogram developed using PowerMarker and model-based clustering with Structure. Three clusters with some admixtures were identified by model-based clustering. These newly developed SSR markers will be useful for further studies of chrysanthemums, such as taxonomy and marker-assisted selection breeding.

Metabolism of milk fat globule membrane components by nonstarter lactic acid bacteria isolated from cheese.

The objective of this study was to investigate how components present in the milk fat globule membrane (MFGM) may be used for growth and survival by cheese-ripening lactobacilli. This was achieved by analyzing metabolites produced during incubation on appropriate media. The lactobacilli investigated were able to utilize components from the MFGM throughout a 24-d incubation period. We observed an apparent connection between the higher proteolytic activity of Lactobacillus paracasei INF448 and its ability to grow in the MFGM media after depletion of readily available sugars. All the studied strains produced large amounts of acetate when grown on an acylated aminosugar, presumably from deacetylation of the monosaccharides. Growth of Lb. plantarum INF15D on D-galactose resulted in a metabolic shift, expressed as different fates of the produced pyruvate, compared with growth on the other monosaccharides. For Lb. plantarum INF15D, the presence of D-galactose also seemed to initiate degradation of some amino acids known to take part in energy production, specifically Arg and Tyr.

The emergent surgical airway: cricothyrotomy vs. tracheotomy.

The American Society of Anesthesiologists difficult airway algorithm identifies two acceptable emergency surgical airways in the 'cannot intubate, cannot ventilate' scenario: cricothyrotomy and tracheotomy. Little has been published regarding the emergency surgical airway practices at different institutions. The authors investigated whether the primary choice of emergency surgical airway at a major level I trauma centre was cricothyrotomy or tracheotomy. A retrospective chart review was conducted of emergency airways performed over 6 years using relevant current procedural terminology codes. The electronic medical records obtained were reviewed to ensure accurate coding and verify the emergent nature of the procedure. Over the study period, there were 4312 documented emergent airways. 3197 (74.1%) were field intubated by paramedics, 1081 (25.1%) were hospital intubated by anaesthesia, 34 (0.008%) required emergency surgical access of which 24 were tracheotomies and 10 cricothyrotomies. Despite the emphasis in resident training and Advanced Trauma Life Support, there was a paucity of cricothyrotomies during the study period. At the authors' institution, tracheotomy is preferentially used as the emergency surgical airway. A multicentre prospective study is recommended to evaluate current practice in emergency surgical airway and to include the emergency open tracheotomy in residency training and continuing education if needed.

Arginase II inhibition prevents nitrate tolerance.

BACKGROUND AND PURPOSE: Nitrate tolerance, the loss of vascular responsiveness with continued use of nitrates, remains incompletely understood and is a limitation of these therapeutic agents. Vascular superoxide, generated by uncoupled endothelial NOS (eNOS), may play a role. As arginase competes with eNOS for L-arginine and may exacerbate the production of reactive oxygen species (ROS), we hypothesized that arginase inhibition might reduce nitrate tolerance. EXPERIMENTAL APPROACH: Vasodilator responses were measured in aorta from C57Bl/6 and arginase II knockout (argII -/-) mice using myography. Uncoupling of eNOS, determined as eNOS monomer : dimer ratio, was assessed using low-temperature SDS-PAGE and ROS levels were measured using L-012 and lucigenin-enhanced chemiluminescence. KEY RESULTS: Repeated application of glyceryl trinitrate (GTN) on aorta isolated from C57Bl/6 mice produced a 32-fold rightward shift of the concentration-response curve. However this rightward shift (or resultant tolerance) was not observed in the presence of the arginase inhibitor (s)-(2-boronethyl)-L-cysteine HCl (BEC; 100 µM) nor in aorta isolated from argII -/- mice. Similar findings were obtained after inducing nitrate tolerance in vivo. Repeated administration of GTN in human umbilical vein endothelial cells induced uncoupling of eNOS from its dimeric state and increased ROS levels, which were reduced with arginase inhibition and exogenous L-arginine. Aortae from GTN tolerant C57Bl/6 mice exhibited increased arginase activity and ROS production, whereas vessels from argII -/- mice did not. CONCLUSION AND IMPLICATIONS: Arginase II removal prevents nitrate tolerance. This may be due to decreased uncoupling of eNOS and consequent ROS production.

Nox2 and Nox4 mediate tumour necrosis factor-α-induced ventricular remodelling in mice.

Reactive oxygen species (ROS) and pro-inflammatory cytokines are crucial in ventricular remodelling, such as inflammation-associated myocarditis. We previously reported that tumour necrosis factor-α (TNF-α)-induced ROS in human aortic smooth muscle cells is mediated by NADPH oxidase subunit Nox4. In this study, we investigated whether TNF-α-induced ventricular remodelling was mediated by Nox2 and/or Nox4. An intravenous injection of murine TNF-α was administered to a group of mice and saline injection was administered to controls. Echocardiography was performed on days 1, 7 and 28 post-injection. Ventricular tissue was used to determine gene and protein expression of Nox2, Nox4, ANP, interleukin (IL)-1ß, IL-2, IL-6, TNF-α and to measure ROS. Nox2 and Nox4 siRNA were used to determine whether or not Nox2 and Nox4 mediated TNF-α-induced ROS and upregulation of IL-1ß and IL-6 in adult human cardiomyocytes. Echocardiography showed a significant increase in left ventricular end-diastolic and left ventricular end-systolic diameters, and a significant decrease in the ejection fraction and fractional shortening in mice 7 and 28 days after TNF-α injection. These two groups of mice showed a significant increase in ventricular ROS, ANP, IL-1ß, IL-2, IL-6 and TNF-α proteins. Nox2 and Nox4 mRNA and protein levels were also sequentially increased. ROS was significantly decreased by inhibitors of NADPH oxidase, but not by inhibitors of other ROS production systems. Nox2 and Nox4 siRNA significantly attenuated TNF-α-induced ROS and upregulation of IL-1ß and IL-6 in cardiomyocytes. Our study highlights a novel TNF-α-induced chronic ventricular remodelling mechanism mediated by sequential regulation of Nox2 and Nox4 subunits.

Capillary ultrahigh performance liquid chromatography with elevated temperature for sub-one minute separations of basal serotonin in submicroliter brain microdialysate samples.

Improving the time resolution in microdialysis coupled to high performance liquid chromatography (HPLC) requires that the volume of the separation system be decreased. A low-volume separation permits smaller microdialysate volumes to be injected without suffering a sensitivity loss from dilution. Thus, improved time resolution can be achieved with offline analysis simply by decreasing the separations system volume. For online (near real-time) analysis, there is a further requirement. The separation speed must be at least as fast as the sampling time. Here, the combined use of high column pressures and temperatures, sub-2-µm stationary phase particles, capillary columns, and sensitive, low dead-volume detection resulted in a retention time for the neurotransmitter serotonin of less than 1 min in a 500 nL dialysate sample volume. Two sensitive detectors, photoluminescence following electron transfer (PFET) and electrochemical, were used for the detection of subnanomolar concentrations of serotonin in brain microdialysate samples. The general principles developed are applicable to a wide range of separations with the additional advantages of increases in sample throughput and decreases in mobile phase usage.

Association of acute ischemic stroke with the MTHFR C677T polymorphism but not with NOS3 gene polymorphisms in a Singapore population.

BACKGROUND AND PURPOSE: The association of polymorphisms in the nitric oxide synthase 3 (NOS3) gene (T-786C, variable number tandem repeats 4A/B/C, and G894T) and in the methylenetetrahydrofolate reductase (MTHFR) gene (C677T) with acute ischemic stroke have been reported. METHODS: First-time onset acute ischemic stroke patients (n = 120) and controls (n = 207) with no past history of stroke were compared. Allele specific gene amplification and restriction fragment length polymorphism (RFLP) analysis were used to determine the genotype and allelic frequencies in both groups. Plasma homocysteine (Hcy) and nitrite levels were measured. RESULTS: No significant association of NOS3 polymorphisms with ischemic stroke was noted. The TT genotype of the MTHFR C677T polymorphism was significantly associated with ischemic stroke (P = 0.004). Elevated plasma Hcy levels were also significantly associated with ischemic stroke (P = 0.001). CONCLUSIONS: The TT genotype of C677T polymorphism in the MTHFR gene contributes to genetic susceptibility of acute ischemic stroke in a Singapore population.

Influence of pH of TSI medium on the detection of hydrogen sulfide production by Campylobacter hyointestinalis.

AIMS: To examine the influence of pH of triple sugar iron (TSI) agar medium on the detection of hydrogen sulfide (H(2)S) production in Campylobacter hyointestinalis ssp. hyointestinalis (CHH). METHODS AND RESULTS: TSI medium was adjusted by the addition in HCl or NaOH to cover a pH 6.0-9.0. One loopful of bacterial growth of CHH strain ATCC 35217 was inoculated into each different pH medium, and incubated at 37 degrees C under micro-aerobic conditions. The H(2)S production was not detectable even after incubation for 72 h in acidic medium pH; however, TSI with alkaline pH (8.0-9.0) allowed detection as early as 3 h of incubation. A total of 20 CHH strains from various animal sources were examined for the detection of H(2)S production in TSI medium with pH 9.0. The H(2)S was detected in all the strains examined within 12 h, and the judgment was unambiguous. CONCLUSION: The results showed that the detection of H(2)S production by CHH was influenced by medium pH, and TSI with alkaline condition is highly sensitive. SIGNIFICANCE AND IMPACT OF THE STUDY: The findings of the present study suggest that TSI medium with alkaline pH contributes to fast detection and led to unambiguous judgment of H(2)S production by CHH.

Association analysis of endothelial nitric oxide synthase gene polymorphism with primary hypertension in a Singapore population.

Vascular endothelial cells produce nitric oxide (NO), which contributes to the regulation of blood pressure and regional blood flow. Endothelial nitric oxide synthase (eNOS) gene polymorphisms are associated with coronary artery disease, but their linkage with primary hypertension is controversial. A total of 103 individuals with primary hypertension and 104 normotensive control subjects were studied in Singapore. The specific genotypes for G894T missense variant in exon 7, variable number tandem repeats (VNTR) in intron 4 (eNOS 4A/B/C) and T-786C in the promoter were isolated using allele-specific gene amplification and restriction fragment length polymorphism to examine the association of genotype and allelic frequency in both groups. Logistic regression analysis was also used to detect the association between genotypes and hypertension. Five genotypes of intron 4 VNTR (AA, AB, BB, AC and BC) were observed. Intron 4 B/B genotype was significantly associated with the hypertension group (P = 0.035), but disequilibrium of G894T and T-786C was absent between the two groups (P = 0.419 and P = 0.227), respectively. The overall distribution of allelic frequency differed significantly between the two groups, with four-repeat allele (4A) of intron 4 more frequent in the normotensive group than the hypertensive group (P = 0.019). Logistic regression analysis showed that intron 4 B/B genotype was significantly associated with systolic blood pressure of individuals with body mass index greater than 25 kg/m2 (P = 0.04). In conclusion, the eNOS 4 B/B genotype is a genetic susceptibility factor for primary hypertension in a Singapore population.

Differential upregulation of Nox homologues of NADPH oxidase by tumor necrosis factor-alpha in human aortic smooth muscle and embryonic kidney cells.

NADPH oxidases are important sources of vascular superoxide, which has been linked to the pathogenesis of atherosclerosis. Previously we demonstrated that the Nox4 subunit of NADPH oxidase is a critical catalytic component for superoxide production in quiescent vascular smooth muscle cells. In this study we sought to determine the role of Nox4 in superoxide production in human aortic smooth muscle cells (AoSMC) and embryonic kidney (HEK293) cells under proinflammatory conditions. Incubation with tumor necrosis factor-alpha (TNF-alpha, 10 ng/ml) for 12 h increased superoxide production in both cell types, whereas angiotensin II, platelet-derived growth factor or interleukin-1beta had little effects. Superoxide production was completely abolished by the NADPH oxidase inhibitors diphenyline iodonium and apocynin, but not by inhibitors of xanthine oxidase, nitric oxide synthase or mitochondrial electron transport. TNF-alpha upregulated the expression of Nox4 in AoSMC at both message and protein levels, while Nox1 and Nox2 were unchanged. In contrast, upregulation of Nox2 appeared to mediate the enhanced superoxide production by TNF-alpha in HEK293 cells. We suggest that Nox4 may be involved in increased superoxide generation in vascular smooth muscle cells under proinflammatory conditions.

Orbital tumors.

Neoplasms involving the orbit are divided into primary and secondary types. Primary orbital tumors are rare, include a wide variety of histopathologic types, are usually benign, and most often are managed surgically. Secondary orbital tumors are most often malignant, arise from the paranasal sinuses, and are managed with multiple modalities in a planned fashion. This article discusses primary and secondary orbital tumors, including their evaluation and management.

Urinary free cortisol and sleep under baseline and stressed conditions in healthy senior women: effects of estrogen replacement therapy.

The purpose of this study was to examine the effects of a mild 24-h stress (indwelling IV catheter) on cortisol and sleep in postmenopausal women, and to evaluate differences due to estrogen replacement therapy (ERT) status. This study, conducted in the General Clinical Research Center at the University of Washington Medical Center, examined sleep, cortisol and sleep-cortisol relationships in both baseline and stress conditions, and compared women on ERT with women not on ERT. Forty-two women (age=69.6 +/- 6.2 years [SD]), of whom 20 were on ERT, participated. Urinary free cortisol (UFC) levels and sleep polysomnography were measured over both 24-baseline and stress condition. Sleep was impaired in the stress condition for both groups; mean UFC levels were higher, sleep efficiency and minutes of stages 2, 3 and 4 sleep were reduced, and morning risetime was earlier in the stress than baseline condition. For the combined groups, age-controlled correlations between 24-h UFC and sleep were significant in both conditions: at baseline, UFC levels were associated with earlier time of rising and less REM sleep, and under stress with reduced sleep efficiency, there was reduced minutes of stages 2, 3, 4 sleep, reduced REM sleep, and an earlier risetime. The pattern of negative significant correlations between UFC and sleep/sleep timing remained when plasma estrogen was statistically controlled; however, when groups were examined separately, the significant negative UFC-sleep relationships were confined to the non ERT group. Elevated 24-h UFC is associated with impaired sleep and earlier awakening in older women not on ERT, but not in women on ERT.

Treating age-related changes in somatotrophic hormones, sleep, and cognition.

Many of the body's systems that function to maintain optimal health and well-being decline with advancing age. Aerobic capacity, muscle mass, and strength all progressively decline. Significant sleep disturbances are associated with increases in morbidity and mortality. Cognition declines, impacting an older individual's ability to function independently. Interventions that could at least stabilize or possibly improve functional capacity, sleep quality, and cognitive function have the theoretical potential to prolong an older individual's ability to live independently, and interest in their possible utility is growing rapidly. One such intervention may be stimulation of the "somatotrophic" axis via growth hormone-releasing hormone (GHRH). Here we review the evidence for such somatotrophic interventions. We also report preliminary findings on the effects of chronic GHRH treatment on the somatotrophic hormones, body composition, functional status, sleep, and cognitive function of healthy older men and women from two major GHRH intervention studies, one recently completed and the other ongoing.

Resorbable fixation in facial plastic and head and neck reconstructive surgery: an initial report on polylactic acid implants.

OBJECTIVES: The purpose of this study was to evaluate and report our initial experience with a resorbable fixation system in facial cosmetic and head and neck reconstructive surgery. The specific goals were to determine in which settings the absorbable system could be used, to evaluate the outcome of its use, to detail complications that occurred, and to report our observations on advantages and disadvantages of the system compared with traditional methods of osteosynthesis and fixation. STUDY DESIGN: A retrospective review of the initial 30 consecutive patients at the University of California, San Diego Division of Head and Neck Surgery who received polylactic acid (PLA) implants. SETTING: Academic tertiary referral/level I trauma center. METHODS: Criteria for inclusion into the study were any patient over age 18 who underwent a procedure involving the use of a PLA implant between March 1999 and October 2000. In addition to the typical indications for metal plate or mesh implantation, PLA was used for "protected bone regeneration." Detailed records were kept of all patients in whom PLA implants were used, including the exact procedure and type of implant. All patients were operated by the authors. Operative reports, hospital charts, and office records were analyzed for any perioperative or postoperative complications. The attending surgeon noted advantages and disadvantages of the system. Patients have been followed from 2 to 18 months at the time of this report and are part of an ongoing long-term follow-up study. RESULTS: PLA implants were used in 35 procedures on 30 consecutive patients (multiple unilateral fracture repairs were counted as a single procedure). Uses included fixation of craniofacial fractures (zygomaticomaxillary, orbit floor, frontal bone [N = 9]; fixation of craniofacial osteotomy [N = 8]; protected bone regeneration [N = 3]; mandible, cranial bone donor site [N = 2]; bone grafting [N = 2]; craniectomy reconstruction [N = 2], and soft tissue suspension [endoscopic browlifting, N = 6, static facial suspension, N = 1]). There were 4 complications in this series: 2 partial flap losses, 1 in a patient who had had preoperative radiation and the other in a heavy smoker; 1 infected cranial bone flap in a patient who had had two prior surgeries and radiation; and 1 wound dehiscence over a plate that was improperly contoured. Advantages noted by the surgeons were ease of contouring the mesh or plates, including in situ reshaping, apparent decrease in operative time, low implant profile, minimal soft tissue reaction, and radiolucency of the system, allowing postoperative imaging without metallic artifact. CONCLUSIONS: We found the PLA system to be highly effective, and noted no absolute contraindications to its use compared with standard metal plating systems. The 11% incidence of complications in this series was acceptable and probably not the result of the PLA implant material, although further experience is needed to determine the role of PLA implants in radiated tissue. The primary advantages to PLA appear to be its ease of use, radiolucency, eventual resorption, and, possibly, improved precision of reduction. The use in protected bone regeneration may also be an advantage, but long-term follow-up of our population will be needed to determine this. Based on short-term outcome analysis of our initial experience with PLA implantation, it appears to be an efficacious and safe technology for applications in head and neck and facial plastic surgery.

Estrogen replacement therapy moderates the sleep disruption associated with nocturnal blood sampling.

STUDY OBJECTIVES: To determine whether chronic oral estrogen replacement therapy (ERT) (1) improves the sleep of older, non-symptomatic postmenopausal women; and (2) reduces the sleep disruption associated with a stressor (frequent remote nocturnal blood-sampling through an intravenous catheter). DESIGN: Descriptive, cross-sectional, secondary analysis of a larger study. SETTING: The General Clinical Research Center at the University of Washington Medical Center. PARTICIPANTS: Women aged 57-80 (mean age = 70) at least 5 years past menopause were recruited from the community. Hot flashes and significant sleep difficulties were exclusion criteria. The ERT group (n=37) consisted of women on chronic oral ERT for > or = 2 years. The NERT group (n=56) consisted of women not using estrogen (NERT) for > or = 2 years. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Following an adaptation night, polysomnographic measures were collected for 2 consecutive nights. A blood sample was collected every 20 minutes for the last 24 hours (including Night 2), through an intravenous catheter. The only group difference in sleep on the baseline (non-catheter) night was that NERT women had a shorter sleep latency. Sleep on the catheter night was characterized by increased wakefulness, longer sleep latency, and decreased REM sleep for both groups relative to the baseline. However, the impact of nocturnal blood sampling was much greater for NERT than for ERT women: they experienced significantly greater percent changes in more sleep-wake variables, particularly slow-wave sleep (SWS). CONCLUSIONS: In this cross-sectional study, the use of chronic oral ERT was associated with little effect on the sleep of older postmenopausal women not experiencing hot flashes, except in the presence of a challenge to sleep. ERT ameliorated the disruptive effect of nocturnal blood sampling on both objectively assessed and subjectively assessed sleep.

The lateral transorbital canthopexy for correction and prevention of ectropion: report of a procedure, grading system, and outcome study.

BACKGROUND: There are numerous approaches to correcting laxity of the lateral canthal tendon, each with advantages and drawbacks. Critical evaluation of these techniques is not possible, however, as there is no grading system currently in use to describe this condition or to report outcomes, and prospective trials are lacking. OBJECTIVES: To report and assess a new procedure for repair of the lateral canthus (lateral transorbital canthopexy) and to describe the Ectropion Grading Scale (EGS), with a prospective outcome analysis of their use. DESIGN: Prospective outcome study of 15 consecutive patients (16 procedures). SETTING: Tertiary referral center in Zurich, Switzerland. PATIENTS: Consecutive sample of patients referred for treatment of ectropion of various causes. INTERVENTIONS: Preoperative and postoperative EGS grades were recorded, a preoperative and postoperative patient-based questionnaire was administered, and lateral transorbital canthopexy was performed. MAIN OUTCOME MEASURES: Outcome was determined by improvement in EGS grade and results of the patient-based symptom questionnaire. RESULTS: There were no surgical failures or complications in the study. An average of 83% reduction in patient-reported discomfort was achieved. Two patients with facial paralysis needed medial canthal repositioning. The EGS allowed clear recording of lower eyelid position before and after lateral transorbital canthopexy, and the procedure was uncomplicated to perform. CONCLUSIONS: Lateral transorbital canthopexy is an effective technique for the correction of lower eyelid laxity and appears to allow refined, durable adjustment of the lateral canthus. Self-reported patient satisfaction confirmed the high rate of success of the procedure in this study. The EGS permits critical evaluation and reporting of results and may assist in predicting which patients will need concomitant correction of the medial canthus. Arch Facial Plast Surg. 2000;2:9-15

Quality of life in patients cured from a carcinoma of the head and neck by radiotherapy: the importance of the target volume.

PURPOSE: To assess the health-related quality of life (QOL) of long-term survivors of carcinomas of different subsites of the head and neck following curative radiotherapy (RT). PATIENTS AND METHODS: Patients continuously free from recurrence or second primary tumors treated 1988-1994 were contacted 5.1 to 5.9 years after RT and asked to fill in the EORTC QLQ-C30 core questionnaire and the H&N cancer module. RT had been restricted to the glottis (group A; carcinomas of the vocal cord T1-2 N0), or had included bilateral neck nodes and the primary tumor outside the nasopharynx (group B; AJC Stage II to IV) or within the nasopharynx, respectively (group C; Stage II to IV). Response rate was 97% (group A; n = 41), 69% (group B; n = 26) and 71% (group C; n = 12), respectively. The groups were different with respect to age (older in group A), alcohol consumption (absent in group C) and proportion of females (more in group C). RESULTS: Patients with nasopharyngeal cancer reported the highest morbidity on the H&N module (dry mouth, sticky saliva, trismus, problems with teeth, trouble eating). However, these symptoms did not have a high impact on global QOL or function scores on the QLQ-C30 core questionnaire. Patients in group B reported a lower global QOL but less severe symptoms on the module. CONCLUSION: The high morbidity of patients treated for a nasopharyngeal cancer may be explained by the location of the target volume which included the bilateral temporo-mandibular joints and the salivary glands. These patients require appropriate care during follow-up and will probably profit most from new RT techniques with sparing of normal tissues.