Heredofamilial paragangliomas account for less than 10% of those arising in the head and neck. Multiplicity, multicentricity, and bilaterality is roughly three times more common than in the spontaneous variety. Not unlike other hereditary neuroendocrine tumor syndromes, familial paragangliomas appear to follow an autosomal dominant transmission, with variable penetrance and expressivity. This article describes a surgical experience with nine bilateral, multicentric cervical paragangliomas (7 carotid body, 1 vagal, and 1 sympathetic) occurring in four siblings less than 35 years of age. The literature on familial paragangliomas of the head and neck is reviewed. The postulated genetic mechanisms accounting for these and other hereditary tumors are discussed. The clinical and surgical aspects of spontaneous and familial paragangliomas are compared.
Previous research on brainstorming and nominal group techniques has focused primarily on theirability to generate ideas without examining the impact of these procedures on actual group decision making. This experimental study found no difference in the decision quality of untrained, brainstorming, and nominal groups. However, brainstorming and nominal group members were more satisfied, felt their groups used a more effective process, andfelt they communicated more effectively than untrained groups. Such results suggest that the impact of these techniques goes beyond their ability to generate ideas by affecting group process and communication in positive ways.
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