Differential attrition rates and active parental consent.

Active parental consent in survey research poses ethical and practical concerns. One common argument against the requirement of active consent procedures is its effect on participation rates. There is additional concern that higher risk groups may be underrepresented in the final sample. Empirical support of differential attrition, however, is lacking. In the current multisite longitudinal study, passive consent procedures were approved for the collection of pretest data. For subsequent years of data collection, active parental consent procedures were required. In this article, we use the pretest data to examine demographic, attitudinal, and behavioral differences between those students for whom active consent was provided and those for whom active consent was either denied or for whom no response was received. The results indicate that active consent procedures produce deleterious effects on participation rates and lead to an underrepresentation of at-risk youth in the sample.

Normal CD4 T-cell receptor repertoire in tonsillar tissue despite perturbed repertoire in peripheral blood in HIV-1 infected individuals.

OBJECTIVE: To compare the T-cell receptor (TCR) repertoire of T-cell subsets in peripheral blood and lymphoid tissue from HIV-1 infected individuals. DESIGN: Biopsies of tonsillar tissue and samples of peripheral blood were obtained from 10, mostly treatment-naive, HIV-1-infected individuals. CD4 and CD8 T-cell subsets were quantified, the TCR repertoire was analysed within 'naive' and 'memory' subsets, and results compared between identical subsets in tonsillar tissue and blood. METHODS: Cell subsets were quantified by flow cytometry. CD4 T cells and CD8 T cells were isolated by immunomagnetic beads. Populations were in most cases further subdivided by immunomagnetic selection on the basis of CD45RO expression. TCR repertoire was studied by spectratyping of the TCR beta variable (BV) complementarity determining region 3 (CDR3) transcripts. RESULTS: Amongst CD4 T cells, an abnormal TCR repertoire was found in median 25% (range, 0-88%) of BV families in peripheral blood, but in 0% (0-7%) in tonsillar tissue (P<0.05). Large peaks suggestive of expanded clones were common within CD8 T-cells, both in peripheral blood and tonsillar tissue. However, the expanded clones were rarely identical in the two compartments. Expanded CDR3 peaks, suggesting the presence of clonally expanded cells, were observed within both CD45RO+ and CD45RO- cells from all T-cell subsets, but, again they were mainly of different lengths. CONCLUSION: CD4 T cells were preserved in number and TCR repertoire in tonsillar tissue compared with blood in HIV-1 infected individuals. T-cells collected from the peripheral blood may not be representative of those residing in lymphoid tissue.

Malignant epithelial tumours in the upper digestive tract: a dietary and socio-medical case-control and survival study.

OBJECTIVE: The aim of the present study was to elucidate the influence of social, dietary and environmental factors on the incidence of malignant epithelial tumours in the upper digestive tract and on the prognosis of patients with these cancers. DESIGN: A population-based case-control study was carried out, and the patients in the study were included in a survival analysis. SETTING: The study was carried out at the Department of Otorhinolaryngology at Ullevål University Hospital, Oslo, Norway. SUBJECTS: In the case-control study, 84 patients and 89 controls were included. Only the patients were included in the survival analysis. RESULTS: Smoking showed the highest odds ratio (OR) for morbidity (OR = 29). The patients had in general a lower social status, and a higher alcohol intake (OR = 6.6). For both beta-carotene and vitamin C, the ORs decreased with increasing intake (OR = 0.2 and 0.3, respectively). Increased ORs were associated with low values for haemoglobin, iron, TIBC, folic acid, magnesium and especially for albumin (OR = 14), and with high values for ferritin, vitamin B12 and thiocyanate (a marker for smoking). Stage of the disease was an important prognostic factor. The relative risk (RR) of dying for disseminated vs localised tumours being 3.2. A poorer prognosis was linked to higher age, to smoking vs no smoking (RR = 2.3), and to lower levels of haemoglobin, albumin, magnesium and thiocyanate. CONCLUSIONS: Strong beer, liquor, consumption of milk and table fat, low social status and smoking seemed to have a negative impact on both disease and survival. Fruit and vegetables might, however, reduce the risk. Whereas low serum albumin, iron and magnesium indicated a high OR for cancer, vitamin C and beta-carotene had the opposite implication. No significant implications on survival could be detected in blood chemistry beyond the stage of disease.

Cytologic features of fibromatosis colli of infancy.

OBJECTIVE: To present the characteristic cytologic features of fibromatosis colli in infancy. STUDY DESIGN: A series of 14 children with the typical clinical presentation of fibromatosis colli of infancy on whom fine needle aspiration had been performed. RESULTS: The cytologic features were identical in all cases. All samples contained degenerated muscle cells in varying numbers, including multinucleated cells with abundant cytoplasm. Fibroblasts appeared mainly as single cells but with admixed clusters of varying sizes. The cells were slender, spindle shaped or somewhat rounded, with benign nuclear characteristics. CONCLUSION: In the typical clinical setting and with the cytologic findings above, surgical biopsy of the lesion may be avoided.

[Serum proteins in patients with recently discovered cancer in the oral cavity/throat. What experiences were gained by measurements of concentration and electrophoresis?]. / Serumproteiner hos pasienter med nyoppdaget kreft i munnhule/svelg. Hvilken laerdom gav konsentrasjonsmåling og elektroforese?

84 patients with cancer of the upper digestive tract and 89 matched controls were examined. Lower than normal albumin concentrations were observed with an odds ratio for disease of 14 (95% confidence interval 4.5-46). Among the patients, low concentrations of serum total protein and albumin were also associated with a higher risk of dying. An essential finding was an electrophoretic serum pattern of "active process" without the production of gammaglobulins occurring in about half of the patients. This observation, when lasting for several months, seems to indicate a possible malignancy. However, one fifth of the patients had normal electrophoresis. On the other hand, 15% of the controls also had an "active process" pattern-with or without the production of immunoglobulins. With regard to the participants' patient-versus-control status, the electrophoretic serum protein pattern was of greater predictive importance than information concerning high or low erythrocyte sedimentation rate.

[Fine needle aspiration of tumors of the salivary glands]. / Finnålsaspirasjon av tumorer i spyttkjertler.

Tumours in the large salivary glands i.e. glandula submandibularis and glandula parotis are easily accessible by fine needle aspiration. Because of the great variation in morphology, diagnosis is difficult and requires a high level of experience. In this study, which lasted for 4.5 years, 343 fine needle aspiration were carried out on 343 patients. Cytological diagnoses were made in 336 lesions and histological diagnosis in 113. Four false positives and one false negative resulted in a sensitivity of 96.9% and a specificity of 95.3% with respect to malignancy. All aspirations were carried out by experienced cytopathologists, in close cooperation with an attendant ear, nose and throat specialist.

[Combined embolization and surgery of paragangliomas of the glomus caroticum. Report of a case and review of literature]. / Kombinert embolisering og kirurgi ved glomus caroticum-paragangliomer. En kasuistikk og litteraturoversikt.

Carotid body paragangliomas are rare, and are generally benign tumours that grow slowly. Extirpation of carotid body paragangliomas is well documented as the best curative treatment, but can be accompanied by complications such as peroperative bleeding, stroke and injury to cranial nerves. Accurate preoperative diagnosis and evaluation are important, and preoperative carotide angiography is essential to confirm the diagnosis. In this case report, a patient with large carotid body paraganglioma underwent preoperative selective embolization of the major afferent arteries. The vascularity of the paraganglioma was reduced substantially, and complete extirpation was accomplished without complications. Blood loss was negligible and the postoperative course was uneventful. The patient had no cranial nerve or cerebral dysfunction after operation. In cases with angiographically distinct feeding arteries, in addition to satisfactory cerebral perfusion, preoperative selective embolization can be an important supplementary treatment.

Patient self-reported and clinician-rated quality of life in head and neck cancer patients: a cross-sectional study.

One to six years after treatment for head and neck cancer, 68 patients were asked to fill in a questionnaire at home with a subsequent examination at the out-patient clinic of the Ullevål University Hospital. 50 patients (74%) both answered the questionnaire (the EORTC QLQ-C30, a diagnosis specific questionnaire module, the GHQ-20, and two questions from a population survey) and presented for examination where the clinician rated side effects after treatment, and filled in the Karnofsky Performance Status and the Spitzer's Quality of Life index. No patients had relapse or second primary tumours at the time of examination but a variety of post-treatment side effects were recorded. The patients appeared to report lower quality of life including more post-treatment side effects compared with the clinician's assessments. The cost-benefit of the standard clinical follow-ups in terms of increased survival may be questioned. Patients seem to need better support in coping with the physical and psychosocial problems which often appear.

[Puncture cytology in tumors of the head and neck region]. / Punksjonscytologi ved tumorer i hode- og halsregionen.

In a series of fine needle aspirations performed in 541 patients with visible and/or palpable lesions in the head and neck, histological results were available in 205 the of cases. The cytological and histological diagnoses were compared. In three of the 205 cases the smears were inadequate for diagnosis. Discrepancies were noted in 18 cases (8.7%), and ten false negatives (specificity 91.2) and eight false positives (sensitivity 92.5). The main diagnostic problem was to differentiate between malignant lymphoma and benign lymphadenopathy. Biopsy is therefore recommended when malignant lymphoma is suspected. In this series both the aspirations and the subsequent evaluation of the smears were carried out by a cytopathologist. We conclude that this model increases the accuracy and reliability of fine needle aspiration in head and neck tumours by reducing the number of non-representative smears.

Immediate interpretation of FNA smears from the head and neck region.

FNA smears from 540 patients, investigated for visible and/or palpable lesions in the head and neck, examined immediately during consultation have been compared with the final cytologic diagnoses and, when possible, with histologic results. Preliminary and final cytologic diagnoses differed in 25 cases (4.6%). Major discrepancies as to whether a lesion was benign or malignant occurred in 15 cases (2.8%). Histologic follow-up was available for 188 lesions (35%). There were 5 false-positive (2.6%) and 9 false-negative (4.7%) diagnoses, giving a sensitivity of 90.6% and a specificity of 94.6%. The main diagnostic problem was benign, reactive lymphadenitis versus malignant lymphoma, which was responsible for 11 of 14 erroneous cytologic diagnoses (3 false-positive and 8 false-negative smears).

Zygomatico-maxillary fractures. Late results after traction-hook reduction.

A simple, closed method for zygomatico-maxillary fracture treatment is described i.e. replacement by the use of a traction bone-hook. After X-ray and clinical examination had excluded undisplaced fractures, blow out fractures and comminuted fractures, the postreduction stability was assessed peroperatively and again one week after. Sophisticated preoperative fracture-classifications predicting postoperative stability appeared redundant. In the present study, this procedure could be performed in 55.4% of the total fractures which needed to be reduced. At re-evaluation, two to eight years later, the results remained satisfactory. The method appeared, in addition to its simplicity, to require less complicated postoperative care and, therefore, a short hospitalization.

Cholesteatomas of the temporal bone. Preoperative C-T versus peroperative findings.

In a series of 25 ears with chronic otitis media the correlation between findings obtained by preoperative C-T of the temporal bone and observations made at surgery was evaluated. The study was performed "blindly", i.e., neither the radiologist nor the surgeon had any knowledge of the other's findings. Cholesteatoma prediction varied with location. Similar observations were made in respect to granulation tissue and erosions. A relatively high percentage of false positives and false negatives was found even in this rather small sample. To obtain better results by C-T, close co-operation and exchange of information between clinician and radiologist appears necessary, along with an explorative attico-antrotomy as a regular part of the operation.

Facial skeletal dimensions in patients with nasal septal deviation.

The anatomy and the concomitant function of the face seem to be reciprocal issues. Previous studies have shown that stenosis in the posterior part of the nose, hampering nasal air flow, is associated with a retrognathic face and a posterior rotation of the lower jaw, i.e. components of the adenoid syndrome. The present study examines facial cephalometric morphology in adults with a deviated nasal septal cartilage, i.e. an anteriorly positioned nasal stenosis. Compared to a group of unafflicted individuals, also with regard to rhinomanometric resistance, a significantly smaller posterior facial height, smaller height of the anterior nasal aperture, a posterior rotation of the lower jaw and a shorter nasal floor and ceiling were found. This may mean that growth of the nasal septal cartilage and growth of the surrounding skeletal areas are out of step. A relatively undersized skeletal frame, in the sagittal plane, may have led to the buckled non-fitting septal cartilage, with increased air flow resistance as a secondary effect. If this interpretation is correct, an early cautious surgical correction of the septal deviation, also balancing this growth incongruence, might be worth serious consideration.

Experimental septoplasty in the growing cat. A histological study.

Surgery on the nasal septum of a child is still a controversial issue, due to the fear of nasal growth inhibition. To elucidate the role that the Cottle premaxilla approach septoplasty play in the long term result, an operation using this technique was done in the growing cat, but no nasal packing nor stenting was applied. In several cases postoperative sequelae occurred, such as septal perforations, synnechia and thickening of the septum, due to dislodged cartilages. The complications were judged to be minor relative to the overall results. They have, however, to be carefully considered and weighed against the benefit of the operation.

Experimental nasal septoplasty; influence on nasomaxillary development. A roentgen cephalometric study in growing domestic cats.

The fear of destroying an anticipated growth centre has, with time, induced the postponement of nasal septal operations until adult age. Underdevelopment of the nose and middle face is otherwise believed to be the long-term result. In order to test this hypothesis, subepichondrial surgery was performed in growing domestic cats. The technique resembled modern corrective interventions for septum deviations in humans. Based on cephalometry, i.e. measurements on lateral skull radiograms, no significant influence could be found regarding ultimate nasal or mid-facial dimensions. The findings tentatively intimate that septal surgery might be carried out at a much earlier age than hitherto assumed.

Concomitant transverse growth of the maxillary base and dental arch in experimental submucous mid-palatal clefts. A biometrical study in the domestic cat.

To obtain information on correlated growth of the maxillary base and dental arch in submucous mid-palatal clefts, such clefts were surgically created in 18 domestic cats. The growth ratios of the dento-maxillary complex were then compared with corresponding parameters in 18 unoperated controls. When fully grown, the operated cats had developed a significant hypoplasia of the maxillary base. Also the upper dental arch in these cats showed a slight reduction in width, but significantly so only in the posterior region. The results obtained seemed to demonstrate a mutual dependence in growth of these two parts of the dento-maxillary complex, but to a limited degree. Whereas the maxillary base was significantly influenced by the altered morphology in the mid-palatal area, the dental arch growth and its final dimension seemed to be more responsive to compensatory mechanisms.

Growth of the dental arches after ablation of the mid-palatal suture. A study in the domestic cat.

The present investigation comprises a group of 18 domestic cats with surgically created, and finally histologically verified, submucous mid-palatal clefts. In addition 18 unoperated control animals were examined, along with 12 sham-operated cats, the latter serving as controls on the effect of the surgical soft tissue trauma applied. Measurements were made in regard to width and length of the dental arches, starting at the age of 2 1/2 months, ending at 12 2/3 months, i.e. throughout both the deciduous and the permanent dentition. Data of existing dimensions and growth were obtained. The statistical analysis revealed a significant reduction in final transverse dimensions in the posterior regions of both the upper and the lower dental arches in the deciduous and permanent dentition, in animals where the mid-palatal suture was missing. The soft tissue trauma did not seem to interfere significantly with normal growth.

Compensatory growth of the dental arches in hypoplasia of the maxillary base. A biometrical analysis in the domestic cat.

When two opposing layers of mucoperiosteum are used to cover experimental mid-palatal clefts in growing cats, bone bridges regularly form between the palatal halves. This results in significantly smaller transverse dimensions of the hard palate, in a hypoplastic maxillary base. The present investigation analysed the concurrent enlargement of the dental arches in such animals. Compared with un- and sham-operated controls, no significant divergencies could be found. The cat has a deep scissor bite. A reasonable interpretation of the findings might therefore be that mandibular dental arch growth is transmitted 'orthodontically' to the maxillary teeth, through the occlusion. In cleft lip and palate patients operated on with conventional methods, similar bone bridges are frequently found, but also a favourable effect of orthodontic treatment on co-existing dental malocclusions. To some extent the findings of the present study appear to coincide with those of the clinic. The results seem to indicate that adjustment of dental arch dimensions in disproportionate jaw bases may be due more to conductible compensatory dental arch growth than to forcibly induced movements of jaw segments.

Bony or connective tissue union of operated experimental palatal clefts: implications on growth of the dentomaxillary complex. A biometrical study in the domestic cat.

Operated human cleft palates heal with formation of bone and/or connective tissue in the mended defect (Prydsö, Holm, Dahl & Fogh-Andersen, 1974; Enemark & Jörgensen, 1978). In domestic cats with experimental palatal clefts, reparation by hard or soft tissue appears to be conditioned by the type of palatoplasty applied (Freng, 1979a; 1979b;). Both tissue responses led to reduced transversal growth of the maxillary base (Freng, 1979c; 1981). As regards the concurrent dental arch growth, however, no difference from unoperated controls was found in individuals with bone postoperatively bridging the palatal mid-line (Freng & Voss, 1982). A submucous cleft led to a significant reduction in transversally directed arch development (Voss & Freng, 1982). The present study aimed to find out if these observations could be due to a relatively smaller width of the maxillary base in operated cleft palates healing with connective tissue. However, no significant difference in maxillary base width appeared when the two groups were compared. To some extent, the effect of the cat's scissor bite, on the dental occlusal relationship, may simulate the effect of orthodontic appliances in humans by transmitting mandibulary growth into laterally directed movement of the upper jaw's teeth. The difference in dental arch growth between the two groups might therefore be interpreted either as expressing a better preservation of obtained compensatory transversal maxillary teeth movements in palates healing with bone bridges, or a tendency for the upper dental arch to collapse in cases with submucous mid-palatal clefts.

Mid-facial sagittal growth following resection of the nasal septum-vomer: a roentgencephalometric study in the domestic cat.

The surgical correction of nasal septal deviation observed in children is usually postponed until adult age presumably on the assumption of interference with facial growth. In order to elucidate this hypothesis, the entire basis of the cartilaginous nasal septum and vomer was extirpated in a group of growing domestic cats. The operation resulted in a basally unsupported septum being separated from the palatal halves by loose connective tissue. The sagittal mid-facial growth in these animals was then compared with that of sham-operated and unoperated controls. From measurements on lateral skull radiograms, taken at the start and end of the experiment, no difference in sagittal mid-facial development could be found among the three groups. The findings suggest that growth of the nasal septum/vomer, at least at its basal parts, is not involved in facial development during the period from infancy to adulthood.