Search

Two taxonomic and nomenclatural issues in Lithospermum are addressed. The new combination L. thurberi based on Onosmodium thurberi is made, and L. macromeria (Macromeria viridiflora) is included as a heterotypic synonym. Lithospermum bejariense and Onosmodium bejariense are treated here as two distinct taxonomic entities.

Lithospermum (Boraginaceae) includes ca. 60 species and exhibits a wide range of floral, palynological, and vegetative diversity. Phylogenetic analyses based on 10 chloroplast DNA regions and 22 morphological characters were conducted in order to (i) examine evolutionary relationships within Lithospermum and among related genera of Boraginaceae, and (ii) investigate patterns of morphological evolution. Several morphological features, such as long-funnelform corollas, faucal appendages, reciprocal herkogamy, and evident secondary leaf venation, have evolved multiple times within the genus. In contrast, other morphological features, including the presence of glands and the position and number of pollen pores, are less plastic and tend to characterize larger clades. Some features, including the presence of glands, are interpreted as symplesiomorphic for Lithospermum, while others, such as evident secondary leaf venation, appear to have originated repeatedly. The range of structural diversity that occurs among the species of Lithospermum suggests the potential utility of this genus as a model for integrative studies of evolution, development, and molecular biology.© The Willi Hennig Society 2011.

Oreocarya crassipes, an endangered angiosperm native to the Trans-Pecos region in southern Brewster County, Texas, exhibits distyly, a breeding system that includes two floral morphs with reciprocal positioning of the anthers and stigmas. The long-style (LS) morph has stigmas above the anthers, and the short-style (SS) morph produces anthers above the stigmas. In the present study, multiple aspects of distyly were examined across four populations of O. crassipes including morph ratios, variation in floral morphology, and patterns of macroscopic and microscopic floral development of the morphs. Morph ratios vary among populations, but for all of the samples pooled the ratio was 1 LS:1 SS. Distyly was observed to be well established in the species, with stigma height, anther height, and stigma-anther separation significantly different between the two morphs. Floral developmental patterns are similar to those in related species, suggesting a conserved and similarly co-opted developmental pathway for the origin of distyly in the genus and relatives.

Pollen, the microgametophyte of seed plants, has an important role in plant reproduction and, therefore, evolution. Pollen is variable in, for example, size, shape, aperture number; these features are particularly diverse in some plant taxa and can be diagnostic. In one family, Boraginaceae, the range of pollen diversity suggests the potential utility of this family as a model for integrative studies of pollen development, evolution and molecular biology. In the present study, a comprehensive survey of the diversity and evolution of pollen from 538 species belonging to 72 genera was made using data from the literature and additional scanning electron microscopy examination. Shifts in diversification rates and the evolution of various quantitative characters were detected, and the results revealed remarkable differences in size, shape and number of apertures. The pollen of one subfamily, Boraginoideae, is larger than that in Cynoglossoideae. The diversity of pollen shapes and aperture numbers in one tribe, Lithospermeae, is greater than that in the other tribes. Ancestral pollen for the family was resolved as small, prolate grains that bear three apertures and are iso-aperturate. Of all the tribes, the greatest number of changes in pollen size and aperture number were observed in Lithospermeae and Boragineae, and the number of apertures was found to be stable throughout all tribes of Cynoglossoideae. In addition, the present study showed that diversification of Boraginaceae cannot be assigned to a single factor, such as pollen size, and the increased rate of diversification for species-rich groups (e.g. Cynoglossum) is not correlated with pollen size or shape evolution. The palynological data and patterns of character evolution presented in the study provide better resolution of the roles of geographical and ecological factors in the diversity and evolution of pollen grains of Boraginaceae, and provide suggestions for future palynological research across the family.

The Chihuahuan Desert includes many endemic angiosperm species, some having very restricted geographic ranges. One of these species is Oreocarya crassipes (I. M. Johnst.) Hasenstab & M. G. Simpson, an endangered distylous gypsophile from the Trans-Pecos region in southern Brewster County, Texas, USA. The species is known from 10 populations, and this small number of populations, human development in the area, a distylous breeding system, and edaphic requirements threaten the long-term viability of the species. Using both hundreds of single nucleotide polymorphisms identified via tunable genotyping-by-sequencing (tGBS) and 10 microsatellite loci, patterns of genetic diversity, demography, selection, and migration were examined for 192 individuals from four populations of O. crassipes. From the sampled individuals, two populations (clusters) were identified via multiple methodologies and with both types of data. With SNP data, population substructure was further resolved among one of these populations to identify two distinct groups of individuals. Multiple individuals recognized as having mixed ancestry, along with Fst values and AMOVA results, provide evidence of genetic exchange among populations, which is less common for gypsophiles than non-gypsophiles, and the rate of migration among populations has been increasing recently. The Fst values for O. crassipes are more similar to those of other rare species than to other gypsophiles. Additionally, while distyly specifically does not necessarily impact the population genetics of the species, allogamy, which is facilitated by distyly, seems to have played a role in the genetic structure of O. crassipes.

Lithospermum (Boraginaceae), a geographically cosmopolitan medium-sized genus, includes diverse floral morphology, with variation in corolla size and shape and in breeding system. Over the past decade, multiple studies have examined the evolutionary history of Lithospermum, with most utilizing DNA regions from the plastid genome and/or the nuclear ribosomal internal transcribed spacer. These studies have, in general, not resulted in well-resolved and well-supported phylogenies. In the present study, 298 nuclear DNA regions, amplified via target sequence capture, were utilized for phylogenetic reconstruction for Lithospermum and relatives in Boraginaceae, and patterns of floral evolution, species diversification, and biogeography were examined. Based on multiple phylogenetic methods, Lithospermum is resolved as monophyletic, and the New World species of the genus are also monophyletic. While minimal phylogenetic incongruence is resolved within the nuclear genome, incongruence between the nuclear and plastid genomes is recovered. This is likely due to incomplete lineage sorting during early diversification of the genus in the Americas approximately 7.8 million years ago. At least four shifts to longer corollas are identified throughout Lithospermum, and this may be due to selection for hummingbird-pollinated flowers, particularly for species in Mexico and the southwestern United States. In the New World, one clade of species of the genus diversified primarily across the United States and Canada, and another radiated throughout the mountains of Mexico.

Pathogenic Yersinia bacteria, including Y. pseudotubuclosis Y. enterocolitica, and Y. pestis, contain the mosaic plasmid pYV that encodes for, among other things, a number of proteinaceous virulence factors. While the evolutionary histories of many of the biovars and strains of pathogenic Yersinia species are well documented, the origins of many of the individual virulence factors have not been comprehensively examined. Here, the evolutionary origins of the genes coding for a set of Yersinia outer protein (Yop) virulence factors were investigated through phylogenetic reconstruction and subsequence analysis. It was found that many of these genes had only a few sequenced homologs and none of the resolved phylogenies recovered the same relationships as was resolved from chromosomal analyses. Many of the evolutionary relationships differ greatly among genes on the plasmid, and variation is also found across different domains of the same gene, which provides evidence of the mosaic nature of the plasmid as well as multiple genes on the plasmid. This mosaic aspect also relates to patterns of selection, which vary among the studied domains.

Lithospermum L. (Boraginaceae) includes approximately 60 species of which 43 occur in Mexico, with 32 endemic to the country. Through morphological and molecular investigations, the species of the genus are taxonomically revised. A broad generic circumscription is recognized and includes species traditionally recognized as members of Lithospermum as well as other New World Lithospermeae. Three new species are described from northern Mexico—Lithospermum chihuahuanum J. I. Cohen, Lithospermum kelloggianum J. I. Cohen, and Lithospermum tenerum J. I. Cohen—and each is known from only its type specimen. Lasiarrhenum confundum B. L. Turner is transferred to Lithospermum confundum (B. L. Turner) J. I. Cohen on the basis of flowers similar to those of Lithospermum trinervium (Lehm.) J. I. Cohen. The type for Pentalophus A. DC. is designated. Lectotypes are designated for Lithospermum albicans Greene [= Lithospermum incisum Lehm.], Lithospermum approximatum Brand [= Lithospermum distichum Ortega], Lithospermum breviflorum Engelm. & A. Gray [= Lithospermum incisum Lehm.], Lithospermum cobrense Greene, Lithospermum cognatum Greene ex Spengle [= Lithospermum multiflorum Torr. ex A. Gray], Lithospermum euryphyllum Brand [= Lithospermum oblongifolium Greenm.], Lithospermum galeottii Brand [= Lithospermum calycosum (J. F. Macbr.) I. M. Johnst.], Lithospermum gentianoides Brand [= Lithospermum obovatum J. F. Macbr.], Lithospermum hoyasense Brand [= Lithospermum calcicola B. L. Rob.], Lithospermum laevigatum Sesse & Moc. [= Lithospermum distichum Ortega], Lithospermum madrense Brand [= Lithospermum calcicola B. L. Rob.], Lithospermum matamorense DC., Lithospermum nelsonii Greenm., Lithospermum obtusiflorum Sesse & Moc. [= Lithospermum discolor M. Martens & Galeotti], Lithospermum sordidum Brand [= Lithospermum distichum Ortega], and Lithospermum spathulatum M. Martens & Galeotti [= Lithospermum distichum Ortega]. Lithospermum viride Greene is neotypified.

Premise Morphometric analysis is a common approach for comparing and categorizing botanical samples; however, completing a suite of analyses using existing tools may require a multi-stage, multi-program process. To facilitate streamlined analysis within a single program, Morphological Analysis of Size and Shape (MASS) for leaves was developed. Its utility is demonstrated using exemplar leaf samples from Acer saccharum, Malus domestica, and Lithospermum. Methods Exemplar samples were obtained from across a single tree (Acer saccharum), three trees in the same species (Malus domestica), and online, digitized herbarium specimens (Lithospermum). MASS was used to complete simple geometric measurements of samples, such as length and area, as well as geometric morphological analyses including elliptical Fourier and Procrustes analyses. Principal component analysis (PCA) of data was also completed within the same program. Results MASS is capable of making desired measurements and analyzing traditional morphometric data as well as landmark and outline data. Discussion Using MASS, differences were observed among leaves of the three studied taxa, but only in Malus domestica were differences statistically significant or correlated with other morphological features. In the future, MASS could be applied for analysis of other two-dimensional organs and structures. MASS is available for download at https://github.com/gillianlynnryan/MASS.

Background: Recent field work in the Baviaanskloof, Eastern Cape, resulted in several collections of an unknown species of Lithospermum (Boraginaceae), a genus that is taxonomically relatively poorly understood in southern Africa. Objectives: To describe the Baviaanskloof collections and characterise them against currently known species of Lithospermum . Method: Relevant literature was surveyed and herbarium and fresh material was examined. Results: Recent collections of Lithospermum from the Baviaanskloof Mountains in Eastern Cape represent an undescribed species. Conclusion: Lithospermum sylvestre J.Cohen & J.C.Manning is a new species recognised by its well-branched stems with adpressed-scabrid pubescence, and relatively long-tubed flowers with long styles that are ± as long as the corolla tube and only shortly included within it.

PREMISE Distyly, a plant breeding system characterized by two floral morphs that have reciprocal positioning of anthers and stigmas, is known from at least 27 angiosperm families, making it an excellent example of convergent evolution. The various manners in which patterns of floral development produce the distinct anther and stigma heights in each morph remain largely unexplored from developmental and evolutionary perspectives. METHODS In 15 species representing at least 12 origins of distyly, heights and lengths of floral organs in each morph throughout development were examined using light microscopy. Patterns of floral organ development were determined and compared among species. Family-level phylogenies of distylous species and relatives were reconstructed, and patterns of ancestral herkogamy were resolved. RESULTS Differences in floral development between morphs resulted in 12 patterns leading to the anther and stigma positions characterizing distyly. Distylous species evolved from ancestors with different types of herkogamy, with approach herkogamy and lack of herkogamy resolved most frequently. CONCLUSIONS Seven of the 12 patterns of floral development are known from only one species, with three other patterns described among pairs of close relatives. The most common pattern of floral development, described from at least seven genera, involves for anther heights, distinct intermorph growth rates and for stigma heights, growth rates that differ between morphs only during later development. This pattern is common among subclass Lamiidae, suggesting canalized development within the taxon. Among distylous species, the same type of ancestral herkogamy can give rise to different patterns of floral development.

In Lithospermum (Boraginaceae), floral diversity is quite large, with variation in individual quantitative and qualitative traits as well as suites of floral characteristics. The present study utilizes phylogenetic, morphometric and developmental methodologies to investigate patterns of floral evolution, of individual and suites of traits, in the genus and among related genera. The evolutionary patterns of eight quantitative and five qualitative traits were reconstructed, and morphometrics and the evolution of floral morphospace were examined in the genus. Floral developmental patterns were established with light and scanning electron microscopy. Phylogenetic analyses provided evidence that derived flower types have each evolved multiple times, with differences in the manner in which these flower types arose. Floral morphospace has increased throughout the evolution of Lithospermum. Floral developmental patterns and cell lengths of floral organs at anthesis provided evidence that, in Lithospermum, an increase in the length of the sexual organs of flowers involves both longer cells and a greater number of mitotic divisions, but an increase in the length of the corolla is primarily a result of a larger number of cell divisions. © 2015 The Linnean Society of London, Botanical Journal of the Linnean Society, 2015, ●●, ●●–●●.

Recent phylogenetic evidence suggests that Cynoglossum (Boraginaceae), a cosmopolitan genus, is not monophyletic, but relationships among members of the genus remain uncertain. This is particularly the case for North American species of Cynoglossum. Utilizing DNA sequence data, a phylogeny has been reconstructed to investigate the evolutionary relationships among the New and Old World species of Cynoglossum and other members of Boraginaceae. The resulting phylogeny resolved that North American species of Cynoglossum are members of a clade distinct from the Old World species, and these North American species belong to two distinct lineages. Cynoglossum occidentale and C. virginianum are sister species, and C. grande is a member of a separate group. Given these evolutionary relationships in conjunction with diagnostic morphological features, two new genera are proposed for these species, Andersonglossum and Adelinia, with four name transfers: Andersonglossum boreale, Andersonglossum occidentale, An...

We studied the natural life cycle of Amblyomma inornatum and its vector potential in South Texas. This tick is distributed throughout South Texas and most of Central America. A. inornatum represented 1.91% of the ticks collected by carbon dioxide traps during a study of free-living ticks in the Tamaulipan Biotic Province in South Texas. The life cycle of A. inornatum in South Texas showed a clear seasonal pattern consistent with one generation per year. Nymphs emerged in the spring with a peak in February through May. Adults emerged in the summer with a peak in July through September. Detection of A. inornatum larvae was negatively correlated with saturation deficit and positively correlated with rain in the previous few months. Adult activity was positively correlated with temperature and rain in the previous five weeks. Using PCR we detected the presence of species related to Candidatus Borrelia lonestari, Borrelia burgdorferi, Rickettsia species (Candidatus Rickettsia amblyommii), Ehrlichia chaffeensis, and another Ehrlichia related to Ehrlichia ewingii. Finally we sequenced the mitochondrial 16S rRNA genes and found that A. inornatum is most closely related to Amblyomma parvum. This is the first report of the life cycle, vector potential and phylogeny of A. inornatum.

Background The purpose of this study was to compare long-term functional and quality of life (QOL) outcomes after total laryngectomy with primary closure and those who underwent reconstruction with noncircumferential radial free forearm tissue transfer (RFFTT). Methods Sixty-seven patients were identified by chart review and underwent long-term follow-up using QOL surveys and standardized interviews. Results The RFFTT group had significantly higher rates of chemotherapy, gastric tube (G-tube) at surgery, and postoperative stricture. At follow-up, most patients (88%) had a tracheoesophageal prosthesis (TEP) and were using it as their primary communication method. Diet and swallowing outcomes were comparable and no one had a G-tube. Device life and TEP complications did not differ significantly. Only voice-related QOL differed significantly between the RFFTT group and those who had undergone total laryngectomy without adjuvant treatment. Conclusion Despite more extensive treatment, the reconstructed group achieved comparable outcomes to those who had undergone total laryngectomy with adjuvant treatment.

Lappula Moench includes ca. 70 species and exhibits a wide range of nutlet variation. Currently, the evolutionary relationships among species of Lappula have not been examined; therefore, to elucidate phylogenetic relationships and morphological evolution within Lappula and related genera, we conducted phylogenetic analyses with matrices that include 48 species as well as four DNA regions (ITS, trnL-trnF, rpS16 and psbA-trnH) and 18 morphological characters. These matrices were analyzed using maximum parsimony, maximum likelihood, and Bayesian inference methods. Analyses of the combined molecular and morphological data result in a phylogeny that is better resolved than that based solely on molecular sequence data. Phylogenetic results suggest that the current infrageneric classification of Lappula, at least at the subsectional and series level, is artificial. The evolutionary patterns of 18 morphological characters are investigated in a phylogenetic context. In Lappula, nutlet homomorphism and small corollas are resolved as ancestral, while nutlet heteromorphism and larger corollas are derived.

Genes controlling the morphological, micromorphological, and physiological components of the breeding system distyly have been hypothesized, but many of the genes have not been investigated throughout development of the two floral morphs. To this end, the present study is an examination of comparative transcriptomes from three stages of development for the floral organs of the morphs of Lithospermum multiflorum. Transcriptomes of flowers of the two morphs, from various stages of development, were sequenced using an Illumina HiSeq 2000. The floral transcriptome of L. multiflorum was assembled, and differential gene expression (DE) was identified between morphs, throughout development. Additionally, Gene Ontology (GO) terms for DE genes were determined. Fewer genes were DE early in development compared to later in development, with more genes highly expressed in the gynoecium of the SS morph and the corolla and androecium of the LS morph. A reciprocal pattern was observed later in development, and many more genes were DE during this latter stage. During early development, DE genes appear to be involved in growth and floral development, and during later development, DE genes seem to affect physiological functions. Interestingly, many genes involved in response to stress were identified as DE between morphs.

Although the incidence of carotid blowout has decreased with the advent of better reconstructive techniques, it remains a real risk after major head and neck surgery, especially in an irradiated field. A systematic, multidisciplinary approach incorporating appropriate history and physical examination, adequate resuscitation, diagnostic computed tomography, and diagnostic and therapeutic angiography can manage most of these patients in a safe and effective manner. Surgery has a limited role in acute management, although surgical techniques are useful both for prevention of this problem and for wound management after carotid blowout.

In order to investigate the genetic diversity and influence of climate oscillations on evolutionary processes of organisms in Northwest China, we selected Hexinia polydichotoma, a species endemic to China, and examined the phylogeographic structure and historical factors that influenced the evolutionary history of this species in its entire cover range, Tarim Basin and adjacent areas. In the study, 17 haplotypes were identified in H. polydichotoma on the basis of two chloroplast DNA sequences (trnH–psbA and ycf6–psbM). Shown in the network, the two common haplotypes, A and D, respectively, mainly distribute along the northern and southern rims of the basin. The analyses of molecular variance analysis suggest that genetic variation primarily occurs among populations, and all populations were subdivided into five groups by SAMOVA. Geographic range expansion along the southern and northern rims of the basin was supported by the significant value for Tajima’s D and by the unimodal mismatch distribution. It is possible that during the interglacial period of the middle Pleistocene, a large amount of snow and glacial ice melted from the mountains surrounding Tarim Basin. This increased water, the expanding desert, and the dispersal ability of H.polydichotoma were important factors driving not only geographic range expansion, but also the current phylogeographic structure of this species. It is possible that during the middle Pleistocene, the climatic fluctuations resulted in expansion and contraction cycles of river systems and oases, and may consequently have caused population fragmentation.

The present study comprises an analysis of six different scoring schemes and eight different types of analytic methods aiming to investigate the evolution of a continuous character (i.e. corolla tube length) in Lithospermum L. (Boraginaceae). Corolla tube length in the genus is quite variable, ranging from 1 mm to 75 mm, and the length of the corolla tube has implications for pollination biology, such as longer corolla tubes (> 25 mm in length) being pollinated by hummingbirds or moths. In general, the various methods resolve similar ancestral character states; however, different states are reconstructed at nodes in which the descendants greatly differ in corolla tube length. Additionally, it is suggested that all of the variation of a continuous character should be included in analyses, and this may necessitate multiple analyses with different partitions of the data. The various analyses provide evidence that two maximum parsimony methods, linear parsimony and the TNT method, minimize the number of different rates of evolution. In Lithospermum, six origins of corolla tubes > 20 mm in length are resolved, and these origins occurred at two different times periods: (1) in the shadow of hummingbird diversification in North America (approximately 6–8 Mya) and (2) more recently (approximately 1–1.5 MyA). Four substantial decreases in corolla tube length also are reconstructed, and these may be associated with the origin of self-pollination. © 2012 The Linnean Society of London, Biological Journal of the Linnean Society, 2012, ••, ••–••.

Premise of the study The evolution and development of floral developmental patterns were investigated in three heterostylous and three homostylous species of Lithospermum to determine whether species that independently acquired the same floral form follow the same pattern of development or different patterns. Methods Using light and scanning electron microscopy, we observed developmental patterns in flowers at different stages of maturity. These patterns were compared within individual species, between heterostylous morphs, and among heterostylous and homostylous species. Key results Although heterostyly has been determined by phylogenetic analysis to have originated independently in each of the heterostylous species, flowers of the long-style morph of each species follow similar patterns of gross development, as do those of the short-style morph. In addition, the flowers of each morph develop in a manner similar to those of their respective homostylous, herkogamous relatives. However, the developmental patterns of the stylar epidermal cells differ among these species and between heterostylous and homostylous species. Conclusions Floral developmental patterns in homostylous species provide evidence that modification of specific traits, such as patterns of stylar growth, can lead to the evolution of heterostyly. The developmental changes that affect the positions of the stigmas and anthers in each morph likely involve either temporal or spatial modifications of gene function. The floral developmental patterns described here and the occurrence of multiple types of herkogamy within some species of Lithospermum provide evidence that heterostylous species in the genus have originated via distinct evolutionary developmental pathways.

Objectives/Hypothesis: To investigate 1) whether the Provox ActiValve results in increased device-life in individuals with below average device-life, 2) whether it is cost-effective, and 3) whether it has any impact on voice-related quality of life. Study Design: Prospective study. Methods: Individuals who experienced below-average tracheoesophageal prosthesis (TEP) life were studied. Results: Individuals with persistent below-average TEP life were enrolled in the study and underwent periodic re-evaluation. The majority (73%) experienced significant improvement as a result of use of the device. Those who continued to wear the device were followed for an average of 30.45 months (range, 14.70–43.49 months) and wore a total of 31 devices over this time. They demonstrated an average increase in device-life of more than 500%, going from an average of 1.93 months with a traditional indwelling device to 10.30 months with the ActiValve. The majority of individuals found that voicing with the ActiValve was either the same or better than with their previous indwelling TEP. Voice-related quality of life was not significantly different from that of a group of controls. Overall satisfaction with the device was high, and the majority would have chosen the ActiValve in the future. Overall, there were estimated to be cost savings to third-party payers through use of the ActiValve in this population. Conclusions: The ActiValve is effective in increasing device-life in selected patients who have failed conservative measures. Our protocol for use of the device requires individuals to meet several usage criteria before initial placement and to return for periodic monitoring.

PREMISE OF THE STUDY Research on the subject of heterostyly is often traced back to 1877 when Charles Darwin published the landmark book The Different Forms of Flowers on Plants of the Same Species. This book synthesized heterostyly research at the time, much of which Darwin conducted, and it continues to be a major contribution to the study of the breeding system. In this book, Darwin discussed the ecology, morph-specific differences, self- and intramorph-incompatibility, evolution and origin, and floral development of heterostyly. Many of the hypotheses he proposed have been and continue to be tested. KEY RESULTS Throughout the 20(th) and 21(st) centuries, researchers have continued to identify new and different morph-specific floral characters, discover the mechanisms that underlie heteromorphic self-incompatibility, use phylogenies to examine the evolution of heterostyly, and determine novel floral developmental patterns in heterostylous species. From all of these studies, we have learned a great deal about the function, evolution, and development of heterostyly. CONCLUSIONS However, almost 150 years after Darwin's publications on the subject of heterostyly, we still have a great deal to learn concerning the breeding system, and new technologies and techniques are allowing for new advances in heterostyly research to occur.

Acute suppurative thyroiditis (AST) resulting from a bacterial infection is an infrequent but potentially life-threatening endocrine emergency. Traditional management of this disease has been surgery in conjunction with targeted antibiotic therapy. Recent nonrandomized reports of small series have demonstrated good outcomes using less invasive approaches. No randomized clinical trials have been performed. Here, we provide a review of the literature and an approach to this problem based on expert opinion.The literature was reviewed utilizing PubMed, and a representative case of AST was presented to a panel of experts. Endocrinology, surgery, and infectious disease experts responded to a series of questions regarding diagnosis, management, prognosis, and harm.Combining a broad spectrum of clinical expertise and the published literature, the authors suggest a clinical algorithm as a guide to management, addressing both diagnosis and acute and long-term management.Published studies indicate a trend toward less invasive management during active inflammation and infection and regarding definite therapy. Remaining questions are presented to foster an evidence-based approach to this disease. Ideally, future randomized, controlled trials will provide data to improve the therapy and outcome of AST.

OBJECTIVE. Minimally invasive directed parathyroidectomy has replaced conventional surgical techniques aimed at exploring all four glands in the bilateral neck. These changes have created the need for better preoperative imaging localization techniques. In this article, we describe the CT imaging characteristics of surgically confirmed adenomas and review anatomy and embryology to aid the radiologist in successfully identifying adenomas using contrast-enhanced CT.CONCLUSION. Knowledge of normal CT appearance, contrast enhancement, and expected location are critical to correct interpretation of parathyroid adenoma at CT.

Lithospermum (Boraginaceae) comprises approximately 40 species in both the Old and New Worlds, with a center of diversity in the southwestern United States and Mexico. Using ten cpDNA regions, a phylogeny of Lithospermum and related taxa was reconstructed. Lithospermum (including New World and Old World species) and related New World members of Lithospermeae form a monophyletic group, with Macromeria, Onosmodium, Nomosa, Lasiarrhenum, and Psilolaemus nested among species of Lithospermum. New World Lithospermeae also is a monophyletic group, with Eurasian species of Lithospermum sister to this group. Because Lithospermum is not monophyletic without the inclusion of the other New World genera, species from these genera are transferred to Lithospermum, and appropriate nomenclatural changes are made. New combinations are Lithospermum album, Lithospermum barbigerum, Lithospermum dodrantale, Lithospermum exsertum, Lithospermum helleri, Lithospemum leonotis, Lithospermum notatum, Lithospermum oaxacanum, Lithospermum pinetorum, Lithospermum rosei, Lithospermum trinverium, and Lithospermum unicum; new names are Lithospermum chiapense, Lithospermum johnstonii, Lithospermum macromeria, Lithospermum onosmodium, Lithospermum rzedowskii, and Lithospermum turneri.

Objectives: To compare electromyographic (EMG) amplitude changes in extremity and laryngeal muscles after vecuronium administration and study the effects of topical lidocaine on laryngeal EMG in a swine model. Study Design: Prospective animal study. Methods: Electrically evoked EMG activities were recorded from the vocalis muscles (directly and via an EMG endotracheal tube) and from the flexor digitorum muscles before and after intravenous vecuronium administration. EMG amplitudes were followed for 30 minutes after vecuronium injection together with monitoring of limb twitches to train-of-four stimulation. The testing was repeated after a 30-minute wash-out period and with topical lidocaine. Results: EMG amplitude recovery occurred sooner and more quickly in flexor digitorum muscle than in vocalis muscles. Reappearance of four twitches corresponded to EMG amplitude recovery to about 80% of the baseline in flexor digitorum muscles and to about half-baseline size in vocalis muscles. EMG amplitudes were generally lower at the start of the second round testing than the first round, with somewhat slower recovery in vocalis muscles. Conclusions: In contrast to reports by others in human studies, extremity muscles seem to be more resistant to vecuronium at 0.1 mg/kg than laryngeal muscles in the swine. Reappearance of four twitches corresponds to 50% of laryngeal EMG recovery and indicates adequate condition for monitoring electrically evoked laryngeal EMG activities. This study is inconclusive regarding the effects of topically applied lidocaine on laryngeal EMG amplitudes. Translation of these data to humans should be done with caution.

Although thyroid nodules are a common clinical entity, few (5% to 10%) are malignant and require surgical treatment. Most nodules are discovered incidentally in patients undergoing surveillance for medical reasons unrelated to thyroid disorders. Therefore, a systematic approach to their evaluation is important to avoid unnecessary surgery. High-resolution ultrasonography and fine-needle aspiration have resulted in substantial improvements in diagnostic accuracy, cost reductions, and higher malignancy yield at the time of surgery. In this article, the authors present practical guidelines and a suggested management strategy for the effective diagnosis and management of incidentally discovered thyroid nodules.

Context: Although commonly performed, data are lacking regarding efficacy and safety of lymph node dissection (LND) for recurrent/persistent papillary thyroid cancer (PTC). Objective: Evaluate the efficacy and morbidity of LND in recurrent/persistent PTC. Design: Retrospective review of central or lateral LND performed for persistent/recurrent PTC between January 2004 and March 2006. Setting: Multidisciplinary thyroid cancer clinic with a single surgeon at an academic medical center. Participants: Seventy-five patients who underwent 79 LND for persistent/residual PTC. Safety analysis included all 79 resections. Exclusion criteria for the efficacy analysis were factors prohibiting evaluation of thyroglobulin (Tg) response. Forty-one resections were included in the efficacy analysis. Intervention: Selective LND per standard of care. Main Outcome Measure: Primary outcome was the Tg response to LND. Secondary outcomes were surgical complications. Results: Thirty-nine of the 41 evaluable resections also had Tg data allowing classification of Tg response. Of 39 classifiable resections, 16 (41%) resulted in undetectable postoperative stimulated Tg levels. An additional 12 resections resulted in significant (≥50%) reductions in suppressed or stimulated Tg levels for an overall improvement rate of 72%. Of all 79 resections, 25 (32%) resulted in minor and 7 (9%) resulted in major complications. Conclusions: LND for persistent/recurrent PTC is a relatively safe procedure in experienced hands. It can lead to an undetectable Tg in 41% of cases and produce a major Tg reduction in an additional 31%. Its efficacy in short-term follow-up is comparable with that reported for I-131, and it should be considered in the management of persistent/recurrent PTC.

Objective The objective of this study was to demonstrate extended thymectomy via the transcervical route. Methods With the use of the Rultract retractor (Rultract, Cleveland, OH), videothoracoscopy and single-lung ventilation allowed complete thymectomy. Results This article demonstrates complete resection of all the thymus from the anterior and superior mediastinum. Conclusions In selected patients, the transcervical route can used to completely resect the thymus, avoiding the morbidity of sternotomy.

A phylogenetic analysis of monocots and related dicots was conducted, using a four-gene matrix consisting of two genes from the plastid genome (matK and rbcL) and two from the mitochondrial genome (atpA/atp1 and cob). The taxon sample includes 101 monocots and 36 dicots, and all four genes were sampled for all 137 taxa. Jackknife support was assessed for clades resolved by the four-gene analysis, and compared to support for the same clades by each of the four three-gene subset matrices, in order to quantify the degree to which each gene contributed to or detracted from support for each clade. Instances of positively and negatively correlated support for clades by genes of the same and different genomes were observed. In particular, the placement of Acorus within a clade that also includes Tofieldiaceae, Araceae, and Alismatales s.s., as opposed to its frequent placement as sister of all other monocots, is supported by atpA and matK. The results indicate that genes from the mitochondrial genome provide a unique test of relationships that have been inferred with plastid-encoded genes.

Introduction/Methods: Traditional surgical management of mediastinal parathyroid adenomas has required mediastinal exploration via sternotomy or thoracotomy. By contrast minimal access approaches to the mediastinum via videoscopic transthoracic or transcervical approaches can offer equivalent visualization, patient safety and decreased patient morbidity. The availability of sternal retractor systems, the rapid parathyroid hormone (PTH) assay for intraoperative confirmation of cure, recurrent laryngeal nerve monitoring technique and video-assisted thoracic surgery (VATS) instrumentation have made this possible. The purpose of this article is to discuss these approaches and the results with their application in five consecutive patients. Results: Five consecutive patients underwent mediastinal exploration of which three were performed transcervically and three transthoracically (one patient underwent both procedures). One patient had a negative thoracic exploration; one patient's course was complicated by transient recurrent laryngeal nerve injury which resolved spontaneously. Conclusion: Transcervical approaches for resection of anterior mediastinal parathyroid adenomas are possible with the use of the Rultract Skyhook™ Retractor without the need for sternotomy. VATS provides excellent visualization of the middle and posterior mediastinum avoiding the morbidity of thoracotomy.

Objectives/Hypothesis: High-resolution ultrasound and sestamibi scanning are regarded as the first-line methods for preoperative localization of parathyroid adenomas. The utility of ultrasound in reoperative cases has been questioned because of concern that scarring will obscure normal tissue planes and vascularity that are critical to identification of an adenoma using this imaging modality. The purposes of the study were to evaluate the ability of high-resolution ultrasound to accurately localize parathyroid adenomas in the reoperative exploration and to identify any factors that influence its accuracy Study Design: Retrospective chart review at a tertiary care academic medical center. Methods: All patients seen in referral for parathyroid surgery between May 1994 and September 2002 underwent high-resolution ultrasound as their initial diagnostic test. Patients who subsequently underwent exploration were included in the study. Intraoperative and ultrasound findings were compared. Results: One hundred forty-two patients were included, 116 without and 26 with prior exploration. The sensitivity and positive predictive value of ultrasound were 86.9% and 89.1%, respectively. These data were not significantly different in patients without (88.2% and 90%) and in patients with (80% and 84.2%) prior thyroid or parathyroid surgery. The overall accuracy was 79% with a false-negative rate of 11.3%. Thyroid nodularity was significantly more common (81.8%) in patients who had a false-positive or false-negative finding on ultrasound than in the total population (61.3%). Conclusion: High-resolution ultrasound is an accurate method for localizing parathyroid adenomas even in patients who have previously undergone parathyroid exploration. However, the presence of thyroid nodules can interfere with its accuracy.

The purpose of this report is to summarize existing literature with respect to carotid artery blowout and to present an up-to-date algorithm for its management that incorporates recent advances with respect to its diagnosis and treatment.Although once thought as one entity, carotid blowout is now considered to be a syndrome with clinical manifestations ranging from acute hemorrhage to asymptomatic exposure of a carotid artery. As a result, carotid blowout syndrome can present as one of three separate entities: threatened, impending, and acute carotid blowout. In recent years newer approaches to management have centered around the use of diagnostic angiography followed by definitive therapy with either carotid occlusion by coils, detachable balloons, or endovascular stents. Overall morbidity of management has decreased.Interventional radiologic techniques have revolutionized the treatment of carotid blowout syndrome, allowing more accurate diagnosis and lower treatment morbidity.

Objectives/Hypothesis An immediate method of accurately predicting postoperative hypocalcemia after total thyroidectomy would allow for selective early discharge of patients at low risk. The objective of the study was to determine the utility of perioperative parathyroid hormone measurement in predicting postoperative hypocalcemia after a thyroid surgery that places total parathyroid function at risk. Study Design Prospective case series. Methods Twenty-seven patients undergoing total or completion thyroidectomy had three blood samples drawn for parathyroid hormone measurement before dissection, 10 minutes after specimen removal, and in the recovery room. Serial ionized calcium levels were measured in the postoperative period. Preoperative, postresection, and recovery room levels were compared with postoperative ionized calcium levels. Results The average values before resection, after resection, and in the recovery room were 69.3 (range, 13–163), 42.3 (range, 0–120), and 37.4 (range 7–79) pg/mL, respectively. The incidence of hypocalcemia was 11% (3 of 27 patients). The rate of hypocalcemia was significantly higher (50%) in patients with recovery room parathyroid hormone values of 10 pg/mL or less relative to patients with recovery room parathyroid hormone values greater than 10 pg/mL (4%) in this setting (P = .01). Among patients with a parathyroid hormone value of less than 15 pg/mL in the recovery room, an increasing parathyroid hormone level in the recovery room relative to the level after resection predicted normocalcemia without calcium supplementation on χ2 analysis (P = .01). Conclusion The study demonstrated that perioperative parathyroid hormone values can help predict patients who are at highest risk for postoperative hypocalcemia after thyroid surgery.

Background. Glutathione S-transferase T1 detoxi- fies some environmental carcinogens while activating others and is deleted in 15% to 38% of humans. We sought to determine whether GSTT1 genotype and genotypes of several related genes are associated with risk of squamous cell carcinoma of the head and neck (HNSCC). Methods. Somatic genotypes for GSTT1, GSTM1, GSTP1, and CYP1A1 were determined in 283 individuals with HNSCC and 208 population-based controls. Results. The OR for presenceof GSTT1 was 1.6 (CI, 1.1-2.5, p = .03). HNSCC risk was not associated with GSTM1 null genotype, the presence of the GSTP1 Val/Val genotype, or the Val/Val homozygous genotype for CYP1A1. Stratified analysis revealed disparate ORs for women (OR, 3.0; CI, 1.5-6.3) and men (OR, 1.2; CI, 0.7-2.1) for the presence of GSTT1. Conclusions. In this population, the presence of GSTT1 gene was associated with a significant increase in the risk of HNSCC. This association was particularly robust in women. B 2004 Wiley Periodicals, Inc. Head Neck 26: 63-70, 2004

Background. Parathyroid carcinoma is rare and accounts for approximately 1% of patients with hyperparathyroidism. It is a slowly progressive disease with frequent recurrence and high incidence of local metastasis. Because of the rarity of this tumor, little is known about the pattern of lymph node metastasis. Methods. A case of retropharyngeal lymph node metastasis found 2 years after initial diagnosis of parathyroid carcinoma is presented and discussed. Results. A 67-year-old man initially was seen with asymptomatic hypercalcemia, and a 1.7-cm mass was removed along with the left hemithyroid. The mass was found to be parathyroid carcinoma. Serum calcium was again elevated 1 year later, and left neck lymph node dissection revealed an upper jugular lymph node containing parathyroid carcinoma. The patient continued to have an elevated serum calcium level, and a retropharyngeal lymph node was found by MRI and removed the following year. The patient is now without evidence of hyperparathyroidism or recurrent disease at 2-year follow-up. Conclusions. Persistent parathyroid carcinoma is often a clinical challenge because of the difficulty in localizing recurrent tumor. Retropharyngeal lymph nodes should be considered as a possible site of metastasis in patients with parathyroid carcinoma. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 000–000, 2003

Objectives/Hypothesis: Studies of immediate postoperative facial nerve function following parotidectomy focus on benign disease. The purpose of the study was to compare facial nerve function with regard to benign or malignant disease in patients undergoing superficial parotidectomy. Study Design: Retrospective cohort study of consecutive patients undergoing parotidectomy between 1995 to 2002. Methods: House-Brackmann (HB) grade was recorded or assigned at the first postoperative visit. For patients with HB grade of III or greater, final resolution of facial nerve function was recorded. A X 2 analysis for independence was conducted between patients with HB grade of II or less and those with HB grade of III or greater and final pathological finding (benign vs. malignant disease). Mean and median times to resolution were determined for patients with HB grade of III or greater. Times to resolution for benign and malignant disease for those with HB grade of III or greater were compared (Kaplan-Meier method). Results: Sixty-seven patients with benign disease and 52 with malignant disease were included. Ninety-four percent of patients with benign disease had HB grade of II or less at first postoperative visit (mean period, 11.6 d) compared with 76.9% of patients with malignant disease (mean period, 12.4 d). A X 2 analysis found this difference significant (X 2 = 7.36, P =.0067). Time to resolution for HB grade of III or greater was 253.8 days (±168.2 d) with median time of 229.5 days for benign disease and 182.4 days (±134.6 d) with median time of 138 days for malignant disease. Kaplan-Meier comparison found no significant differences in time to final resolution (P =.83). Three patients in the group with malignant disease had unresolved dysfunction (one patient for >2 y). Conclusions: Patients with benign disease have a greater chance of having HB grade of II or less immediately following surgery; however, whether the disease is benign or malignant, long-term final facial nerve function is the same.

Objectives/Hypothesis: There are many treatments available for advanced oropharyngeal cancer. Organ-sparing protocols reserve surgery for salvage and are thought to provide adequate rehabilitation. Surgical resection with free tissue transfer may also provide adequate functional rehabilitation. The objective was to describe swallowing status and time to decannulation in a series of patients treated with combined-modality therapy that included free flap reconstruction. Study Design: Retrospective chart review. Methods: Patient data were obtained from medical records of 20 patients with stage III or IV oropharyngeal carcinoma, who were consecutively treated with surgical tumor extirpation, free flap reconstruction, and postoperative irradiation at a tertiary academic center from 1985 to 2002. The following variables were identified: patient and tumor characteristics, free flap type, irradiation data, and airway and swallowing status before and after treatment. Results: One patient underwent total laryngopharyngectomy, and the remaining 19 patients underwent tracheotomy at the time of definitive surgery. Free flap reconstructions included 1 ulnar and 15 radial forearm fasciocutaneous flaps and 4 fibula osteocutaneous flaps. Postoperatively, all 19 tracheotomized patients had successful decannulation. Average time to decannulation was 15 days (range, 3-42 d). After surgery and before irradiation, 13 patients initiated oral intake, on average, at 19.5 days (range, 7-28 d); 6 patients required no additional supplementation. By 4 months after surgery, having completed radiation therapy, 10 patients were consuming all nutrition orally; the other 10 patients still required tube-feed supplementation, although 6 of these patients were also eating by mouth. Conclusion: Combined-modality treatment that includes free flap reconstruction for advanced-stage oropharyngeal cancer may provide reasonable functional rehabilitation with respect to postoperative airway and swallowing.

Objectives To summarize the findings relevant to otolaryngology from the annual meeting of the Blood–Brain Barrier Disruption Consortium in Gleneden Beach, Oregon, March 10, 2001. Study Design Summaries are provided by the speakers, as well as related data from the published literature. Findings in otology and oncology regarding ototoxicity that were discussed at the meeting are included. Results Data considered included physiological research, animal studies, and clinical trials that relate to platinum-based chemotherapy and prevention of toxicity. Conclusions The dose-limiting side effects of platinum-based chemotherapy are preventable, but questions about the effect of the protective agents on oncological efficacy remain. Strategies for prevention of chemotherapy-induced toxicity include temporal or anatomical separation of cisplatin or carboplatin from sodium thiosulfate, D-methionine, or N-acetyl-cysteine. Clinical application of these methods has begun. The mechanisms presumably involve free radicals or drug conjugation, or both. Understanding the role of free radicals in medicine is likely to become important in the future.

Introduction. First bite syndrome (FBS) is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space. The cause is not clear but has been proposed to involve a loss of sympathetic nerve function to the parotid, causing a denervation supersensitivity of salivary gland myoepithelial cells. The purpose of this study was to review the records of 12 patients with FBS to determine any common features of the operations performed that would support this theory of parotid sympathectomy as an etiologic factor of FBS. Methods. Retrospective review of 12 patients with FBS managed at two tertiary care centers. Results. Twelve patients were diagnosed with FBS after surgery involving the parapharyngeal space. All patients had most of their parotid gland preserved. Six patients exhibited a postoperative Horner's syndrome, suggesting sympathetic chain interruption. The six patients without Horner's syndrome were found to have undergone external carotid artery ligation inferior to the parotid gland, suggesting an interruption of sympathetic innervation to the parotid gland itself. Conclusions. Preservation of parotid gland tissue and a loss of its sympathetic nerve supply, whether by disruption of the cervical sympathetic chain as evidenced by a Homer's syndrome or more selective denervation by ligation of the external carotid artery with its accompanying sympathetic nerve plexus, were common features of all patients. This series supports the concept of parotid sympathectomy as an etiologic factor in FBS.