The early history and development of functional endoscopic sinus surgery.

BACKGROUND: The concept of endoscopic diagnosis and procedures on the nasal cavity had been investigated for several decades in Europe in the early part of the twentieth century. It was Prof Walter Messerklinger and his assistant, Heinz Stammberger, with US colleague, David Kennedy, who brought the science and technique of functional endoscopic sinus surgery to the wider world. METHODS: The author, an English-speaking surgeon, was present at this movement from the commencement of its propagation, and has recorded the remarkable ascendency of this technique throughout the world. CONCLUSION: The technique revolutionised the diagnosis and management of intranasal, sinus and intracranial conditions.

Psychological features in persons at risk for familial Alzheimer's disease.

Persons at risk for inherited neurodegenerative diseases may experience symptoms of anxiety and depression because of concern over the possibility of developing the disease in the future. The purpose of this study was to assess psychological and emotional symptoms in persons at the age of risk for developing early-onset familial Alzheimer's disease (FAD). Their responses on a psychiatric rating scale (SCL-90-R) were compared with four groups: patients with mild FAD; head injury patients; patients with clinically diagnosed depression; and healthy control subjects. Mean scores of the at-risk FAD group were not statistically different than those of the controls. In contrast, the head injury and depressed groups had significantly elevated scores across the clinical scales. These results suggest that depression and anxiety are not prominent features in persons at genetic risk for early-onset familial Alzheimer's disease. Similar results have been found in studies of persons at risk for developing Huntington's disease, another autosomal dominant neurodegenerative disease.

Familial Alzheimer's disease: site of mutation influences clinical phenotype.

Alzheimer's disease (AD) is caused by multiple genetic and/or environmental etiologies. Because differences in the genetically determined pathogenesis may cause differences in the phenotype, we examined age at onset and age at death in 90 subjects with dominantly inherited AD due to different mutations (amyloid precursor protein, presenilin-1, and presenilin-2 genes). We found that among patients with dominantly inherited AD, genetic factors influence both age at onset and age at death.

Predictive value of the intracarotid amobarbital test in bihemispheric seizure onset.

The intracarotid amobarbital test (IAT) is used to lateralize language function and assess hemispheric memory. In this study 23 non-lesional epileptic patients were evaluated. The magnitude of the difference in IAT scores between the two hemispheres was significantly greater in the patients whose seizures lateralized on scalp or intracranial EEG than in patients with bihemispheric seizure onset. This suggests that the IAT is useful not only in predicting lateralized seizure focus, but bihemispheric onset as well.

Delayed recall in dementia: sensitivity and specificity in patients with higher than average general intellectual abilities.

OBJECTIVE: Distinguishing early dementia from normal aging is especially difficult in patients with higher than average intellectual abilities. To find signs useful in determining that the elderly "worried and well" are not in an early phase of dementia, we compared the neuropsychological test performance of demented patients, patients who were not found to be demented, and control subjects. METHOD: A retrospective study of neuropsychological test results from persons over 50 years of age who had an age-adjusted verbal intelligence quotient (VIQ) greater than or equal to 110. Analysis of covariance (using age and education as covariates) was used to compare the normal, no dementia, and dementia groups. Significant differences were further analyzed using Tukey's post hoc procedure. Tests on which the three groups differed at ap < 0.01 level were included in multivariate analyses. RESULTS: The no dementia patient group performed at functional levels comparable to those of the control group. By contrast, patients with dementia showed significant impairment on tests of memory, naming, and visuospatial function compared with both the control and no dementia groups. Immediate and delayed paragraph recall classified groups with a 96% specificity and 80% sensitivity in the multivariate discriminant analysis. CONCLUSIONS: These results suggest that in patients with higher than average intelligence, the absence of a significant dementing process (as well as its presence) can be determined with reasonable probability.

Recirculation of mucus as a cause of persistent sinusitis.

Recirculation of mucus between adjacent openings into the maxillary antrum is a relatively common cause of persistent sinusitis in either the pre- or postsurgical patient. It is particularly common after FESS when the new middle meatal antrostomy has been sited too far posteriorly behind an existing natural maxillary ostium. The condition is easily diagnosed with the nasal endoscope and the surgical remedy of joining the separate openings into one larger antrostomy is readily carried out under local anesthesia in the rhinologist's office.

Behavioral slowing with age: boundary conditions of the generalized slowing model.

One hundred and twenty-two adults ranging in age from 20 to 83 years participated in this study of visual discrimination and recognition. The simultaneous-matching-to-sample (discrimination) and delayed-matching-to-sample (recognition) paradigms used identical stimuli for spatial frequency, luminance, spatial localization, orientation, pattern, trajectory, and velocity matching. Linear regression analyses indicated that increased age slowed reaction time on the simultaneous-matching tasks. This relationship was not found, however, when subjects were required to match the stimuli after a delay. When older adults' reaction times were regressed on those of adults in their 20s, very different patterns of age-related slowing emerged from the data as a function of task requirements. The results from the simultaneous-matching paradigm replicate previous reports of general slowing on nonlexical tasks, but this was not true for the results from the delayed-matching paradigm, which used similar stimuli but also involved short-term memory.

Aneurysmal bone cyst of maxilla.

A case of aneurysmal bone cyst of the maxilla is reported. The clinical and radiological feautres, histopathology and treatment, are described in detail. Although the pathogenesis is still obscure, surgical excision is considered to be the treatment of choice.