bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of antibody to hepatitis B surface antigen after liver transplantation for chronic hepatitis B
Authors: Lo Chung-Mau , Fung James Tak-Kwan , Lau George Ka-Kit , Liu Chi-Leung , Cheung Siu-Tim , Lai Ching-Lung , Fan Sheung-Tat , Wong John
Published: February 2003

Patients with chronic hepatitis B virus (HBV) infection have a defective HBV-specific immune response, and the spontaneous development of antibody against hepatitis B surface antigen (anti-HBs) after liver transplantation has not been observed. We report the spontaneous production of anti-HBs in 21 of 50 (42%) patients receiving lamivudine monoprophylaxis after liver transplantation. Seroconversion to anti-HBs status (>10 mIU/mL) was found at a median of 8 days (range, 1 to 43 days) after transplantation. In each case, serial serum samples showed a >100% increase in antibody titer as compared with that of day 7 after transplantation in the absence of any blood product transfusion. The anti-HBs titer increased to a maximum within 3 months, and the peak titer was <100 mIU/mL in 10 patients, 100 to 1000 mIU/mL in 5 patients, and >1,000 mIU/mL in 6 patients. In 12 patients, anti-HBs disappeared from serum at a median of 201 days (range, 24 to 414 days), whereas the other 9 patients remained positive for anti-HBs at a median of 221 days (range, 94 to 1,025 days) after transplantation. Patients in whom anti-HBs in serum developed had a more rapid clearance of serum hepatitis B surface antigen (HBsAg) (log rank test,P= .011). Using logistic regression analysis, the only predictor of anti-HBs production was an HBV-immune donor (odds ratio, 18.9; 95% confidence interval, 3.2 to 112.4;P= .001). In conclusion, patients who undergo liver transplantation for chronic hepatitis B using lamivudine prophylaxis may develop anti-HBs spontaneously. The antibody is likely to be of donor origin, suggesting the possibility of adoptive immunity transfer through a liver graft.
Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement
Authors: Albillos Agustín , de la Hera Antonio , González Mónica , Moya Jose-Luis , Calleja Jose-Luis , Monserrat Jorge , Ruiz-del-Arbol Luis , Alvarez-Mon Melchor
Published: February 2003

Intestinal bacterial overgrowth and translocation, both common in cirrhosis with ascites, may lead to the activation of monocytes and lymphocytes, increased levels of proinflammatory cytokines, and enhanced synthesis of nitric oxide present in cirrhosis. Bacterial endotoxin promotes the synthesis of lipopolysaccharide (LPS)-binding protein (LBP), and forms a LPS-LBP complex that binds to CD14. This study was designed to evaluate LBP levels and their correlation to the immune response and the hemodynamic status in cirrhotic patients. Plasma LBP, endotoxin, soluble CD14 (sCD14), cytokines, renin, nitrites, and systemic vascular resistance were determined before and 4 weeks after norfloxacin or placebo in 102 cirrhotic patients and 30 controls. LBP was elevated in 42% of ascitic cirrhotic patients (15.7 ± 0.7 versus 6.06 ± 0.5 μg/mL, P < .01). In 60% of high LBP patients, endotoxin was within normal range. Among ascitic patients, those with high LBP showed greater (P < .05) levels of sCD14, tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), nitrites + nitrates (NOx)/creatinine, and renin, and lower vascular resistance. In the cirrhotic patients with high LBP, norfloxacin normalized (P < .01) LBP (from 16.6 ± 0.5 to 5.82 ± 0.8 μ g/mL) and sCD14; reduced the level of cytokines, NOx/creatinine, and renin; and increased vascular resistance; but lacked effect in patients with normal LBP. Portal pressure was unchanged after norfloxacin in another group of 18 cirrhotic patients with high and 19 with normal LBP. In conclusion, the subset of ascitic cirrhotic patients with marked immune and hemodynamic derangement is identified by increased LBP levels. Amelioration of these abnormalities by norfloxacin suggests the involvement of enteric bacteria or their products in the triggering of the process.
Evolving trends in multiple-antibiotic-resistant bacteria in liver transplant recipients: A longitudinal study of antimicrobial susceptibility patterns
Authors: Singh Nina , Gayowski Timothy , Rihs John D. , Wagener Marilyn M. , Marino Ignazio R.
Published: February 2003

The incidence, sources, impact on outcome, and temporal trends in multiple-antibiotic-resistant bacteria in liver transplant recipients over the last decade (from 1990 through 1999) were assessed. Of 165 consecutive patients who underwent transplantation, 31% (51 of 165 patients) had at least 1 infection caused by multiple-antibiotic-resistant bacteria. Overall, 69% (66 of 96 infections) of all bacterial infections were multiple-antibiotic resistant. Ninety-one percent (45 of 49 isolates) of the Staphylococcus aureus isolates, 50% (6 of 12 isolates) of the enterococci, and 54% of the gram-negative bacteria (47%; 7 of 15 Pseudomonas aeruginosa, and 60%; 12 of 20 Enterobacteriaceae) were multiple-antibiotic resistant. A significant trend toward an increase in infections caused by multiple-antibiotic-resistant bacteria (P = .003), largely caused by an increase in gram-positive infections, was documented through the decade. There was a significant increase in infections caused by methicillin-resistant S aureus (P = .0001) and vancomycin-resistant enterococci (P = .04) over time. The proportion of gram-negative isolates that were multiple-antibiotic resistant (P = .447) did not increase significantly over time. However, a strikingly high frequency of resistance to piperacillin or ceftazidime suggests that extended-spectrum β-lactamase production in our Enterobacteriaceae may have been more prevalent than realized. Mortality at 1 year was significantly greater in patients with multiple-antibiotic resistant bacteria compared with all other patients (P = .001). These longitudinal trends have implications not only for guiding therapeutic practices, but ultimately for devising strategies to curtail multiple-antibiotic resistance in liver transplant recipients.
Intrahepatic expression of inducible nitric oxide synthase in acute liver allograft rejection: Evidence of modulation by corticosteroids
Authors: Romero Miriam , García-Monzón Carmelo , Clemente Gerardo , Salcedo Magdalena , Alvarez Emilio , Majano Pedro L. , Moreno-Otero Ricardo
Published: February 2003

Nitric oxide (NO) has been proposed to have an important role in the immune response. Plasma nitrate levels increase during acute rejection and decrease after treatment with corticosteroids, but little is known about its potential cellular source. We studied inducible NO synthase (iNOS) expression in liver biopsy specimens of 12 patients with acute rejection compared with biopsy specimens from the same patients after treatment with high doses of intravenous corticosteroids. We also compared iNOS expression during acute rejection with a control group (9 patients without histological rejection). iNOS expression was assessed by immunohistochemistry. Intrahepatic iNOS expression was only observed in the cytoplasm of hepatocytes, which were diffusely distributed throughout hepatic lobules. iNOS expression could not be shown in portal tracts, inflammatory cells, or endothelial and sinusoidal lining cells. In patients with acute rejection, iNOS expression was significantly stronger than in the control group (2 ± 0.7 v 0.6 ± 0.7; P < .05). After treatment with corticosteroids, iNOS expression decreased significantly (2 ± 0.7 v 1.3 ± 0.9; P < .05). In conclusion, the findings of the present study show that during acute liver rejection, hepatocytes are the main cellular source for NO production and treatment with corticosteroids induces significant downregulation of intrahepatic iNOS expression.
Active Ion Secretion and Permeability of Rabbit Maxillary Sinus Epithelium, Impact of Staphylococcal Enterotoxin B
Authors: Yang Ping‐Chang , Liu Tao , Wang Chang‐Sheng , Zhang Nian‐Zu , Tao Zheng‐De
Published: February 2003

The aim of this study was to investigate the impact of staphylococcal enterotoxin B (SEB), a model superantigen, on the physiologic functions of rabbit maxillary sinus epithelium. Rabbit sinus mucosae were separated under a surgical microscope and mounted in Ussing chambers to record short‐circuit current, conductance, and permeability to horseradish peroxidase. The results showed that SEB evoked increases in sinus epithelial cell baseline short‐circuit current, conductance, and permeability to horseradish peroxidase. When tumor necrosis factor‐α (TNF‐α) was added to the Ussing chambers, we got results similar to those obtained by SEB stimulation in vitro; the effects of SEB on sinus epithelial cells could be blocked by pretreatment with anti‐TNF‐α antibody. These results demonstrate that SEB is able to alter the function of sinus epithelial cells and to affect the capability of the epithelial defensive barrier, which may be mediated by TNF‐α.
Recurrence of Attic Cholesteatoma: Different Methods of Estimating Recurrence Rates
Authors: Myers Eugene N. , Stangerup Sven‐Eric , Drozdziewicz Dominika , Tos Mirko , Hougaard‐Jensen Annette
Published: February 2003

One problem in cholesteatoma surgery is recurrence of cholesteatoma, which is reported to vary from 5% to 71%. This great variability can be explained by issues such as the type of cholesteatoma, surgical technique, follow‐up rate, length of the postoperative observation period, and statistical method applied. The aim of this study was to illustrate the impact of applying different statistical methods to the same material. Thirty‐three children underwent single‐stage surgery for attic cholesteatoma during a 15‐year period. Thirty patients (94%) attended a re‐evaluation. During the observation period of 15 years, recurrence of cholesteatoma occurred in 10 ears. The cumulative total recurrence rate varied from 30% to 67%, depending on the statistical method applied. In conclusion, the choice of statistical method should depend on the number of patients, follow‐up rates, length of the postoperative observation period and presence of censored data.
2[18F]‐Fluoro‐2‐Deoxy‐D‐Glucose Positron Emission Tomography is a Sensitive Tool for the Detection of Occult Primary Cancer (Carcinoma of Unknown Primary Syndrome) with Head and Neck Lymph Node Manifestation
Authors: Jungehulsing Markus , Scheidhauer Klemens , Damm Michael , Pietrzyk Uwe , Eckel Hans , Schicha Harald , Stennert Eberhard
Published: February 2003

BACKGROUND

The neck lymph nodes are a common site of metastases from carcinoma of unknown primary (CUP syndrome). 2[18F]‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography (18‐FDG‐PET) has been shown to be a sensitive tool for detecting primary malignant lesions as well as metastatic spread. We have prospectively investigated the sensitivity of 18‐FDG‐PET in detecting occult primary carcinomas with manifestation in the head and neck lymph nodes.

METHODS

From May 1994 to July 1998, in 723 patients a cancer of the head and neck was diagnosed at the University of Cologne ENT outpatient clinic. The routinely performed staging procedures were chest radiography; full blood count; cervical and liver ultrasound; endoscopy of the nasopharynx, oropharynx, hypopharynx, larynx, and esophagus; and laboratory analyses. After the staging workup, in 27 of 723 patients (3.7%) CUP syndrome had to be presumed because the primary cancer could not be detected. In these patients 18‐FDG‐PET was performed, and images were reconstructed with a transmission‐emission fusion technique.

RESULTS

In 7 of 27 patients (26%) 18‐FDG‐PET revealed an unknown primary: in 2 a bronchial carcinoma, in 2 a nasopharyngeal carcinoma, in 1 a squamous cell carcinoma of the parotid gland, in 1 a squamous cell carcinoma of the hypopharynx, and in 1 a carcinoma of the tonsil. In 4 of 7 patients the occult primary tumor was removed surgically. In 8 of 27 patients therapeutic strategy was changed as a result of the 18‐FDG‐PET findings.

CONCLUSION

18‐FDG‐PET should be performed in all patients with CUP syndrome after conventional diagnostic workup fails to identify the primary.
Endoscopic Management of Foreign Bodies in the Tracheobronchial Tree: Predictive Factors for Complications
Authors: Zaytoun George M. , Rouadi Philip W. , Baki Dina Hamed A.
Published: February 2003

We reviewed the records of 504 patients admitted to the American University of Beirut Medical Center during a 10‐year period for treatment of aspiration of a foreign body into the tracheobronchial tree. All underwent rigid fiberoptic bronchoscopy for removal of the foreign body. Complications occurred in 42 patients (8%) and were classified as intraoperative (7 patients), postoperative (25 patients), and failure to retrieve the foreign body by bronchoscopy (9 patients). These complications included respiratory distress necessitating tracheotomy and/or assisted ventilation, bronchial pneumonia, pneumothorax, bradycardia, and cardiac arrest. Variables that were examined were the age and sex of the patient, history of multiple previous bronchoscopies, delay in diagnosis and/or treatment, duration of the procedure, type and location of the foreign body, and use of corticosteroids during surgery. The most important variables that were of value in predicting the occurrence of complications were the history of previous bronchoscopy, the duration of the procedure, and the type of foreign body. Age, sex, delay in diagnosis and treatment, and intraoperative use of corticosteroids, while important, had no predictive value. Detailed results with guidelines for prevention and management are presented.
Acoustic Rhinometry and Computed Tomography Scans for the Diagnosis of Nasal Septal Deviation, With Clinical Correlation
Authors: Mamikoglu Bulent , Houser Steven , Akbar Imran , Ng Bernard , Corey Jacquelynne P.
Published: February 2003

OBJECTIVE:

The aim in this study was to analyze the efficiency and reliability of acoustic rhinometry (AR) readings in recognition of nasal septal deviation.

METHOD:

We compared 24 patients' AR readings with their sinus CT scans. The patient data were analyzed by comparison with normative data, area, and percentage differences between the two sides. Additionally, the data further analyzed by receiver operating characteristic curve and Spearman correlation of CT and AR in determining nasal septal deviation.

RESULTS:

The sensitivity of AR in detecting anterior septal deviations was found to be 54%, with a specificity of 70%. A very highly significant correlation (P ≤ 0.001) was found between minimal cross‐sectional area (CSA) 1 values and CT results.

DISCUSSION:

In the interpretation of AR readings, comparison of each CSA value should be included, in addition to use of the total absolute CSA values.

CONCLUSION:

According to our findings the diagnosis of nasal septal deviation can be supported by AR readings. (Otolaryngol Head Neck Surg 2000; 123:61‐8.)
Middle Turbinate Medialization and Preservation in Endoscopic Sinus Surgery
Authors: Friedman Michael , Landsberg Roy , Tanyeri Hasan
Published: February 2003

OBJECTIVE/HYPOTHESIS:

Lateral synechia formation between the middle turbinate (MT) and the lateral nasal wall is the most common complication of endoscopic sinus surgery. In an attempt to prevent this complication, a simple technique to preserve and medialize the MT was studied.

METHODS:

Five hundred patients underwent endoscopic sinus surgery with MT medialization and preservation. The caudal end of the MT and the opposing septal mucosa were abraded with a microdebrider for controlled synechia formation in an attempt to avoid lateralization of the MT. Follow‐up ranged from 6 to 18 months, with a mean follow‐up of 10 months.

RESULTS:

Ninety‐three percent of the patients had successful MT medialization with a well‐defined synechia between the septum and the MT.

CONCLUSIONS:

MT medialization with a microde‐brider is simple, is reliable, and should be considered an alternative to turbinate resection or to other turbinate medialization techniques.
Endoscopic Optic Nerve Decompression for Traumatic Blindness
Authors: Kountakis Stilianos E. , Maillard Alberto A. J. , El‐Harazi Sherif M. , Longhini Luca , Urso Richard G.
Published: February 2003

OBJECTIVES:

The goal of this study was to compare the outcome of patients with traumatic optic neuropathy (TON) treated with high‐dose steroids with the outcome of patients with TON treated with endoscopic optic nerve decompression (EOND) after failing high‐dose steroid treatment.

METHODS:

During this retrospective review of patients with TON seen from 1994 to 1998, all patients were first treated with megadose methylprednisolone for 48 hours. Patients with no improvement or with worsening visual acuity were offered EOND.

RESULTS:

Eleven of 34 (32%) patients treated with high‐dose steroids showed improvement, and 23 (68%) did not. Seventeen of the 23 patients without improvement after high‐dose steroid treatment underwent EOND. Fourteen of 17 (82%) surgically treated patients had improved visual acuity, and 3 (18%) did not, with an overall improvement in 25 of 34 (74%) patients (χ2 = 11.338, P = 0.0007).

CONCLUSION:

EOND is an appropriate treatment technique for patients with TON in whom high‐dose steroid treatment has failed. (Otolaryngol Head Neck Surg 2000;123:34‐7.)
Tympanic Membrane and Middle Ear Pathologic Correlates in Mucoid Otitis Media
Authors: Tekin Muhammet , Mutlu Cemil , Paparella Michael M. , Schachern Patricia A. , Jaisinghani Vikram J. , Le Chap T.
Published: February 2003

OBJECTIVE

The goal of this study was to correlate tympanic membrane (TM) and middle ear (ME) pathologies in mucoid otitis media (MOM).

METHODS AND MATERIAL

Forty ears with MOM and 56 control ears were retrospectively evaluated for TM and ME pathologies. Comparisons of TM thicknesses in MOM versus control ears were correlated with the Student t test; χ2 analysis was used to correlate pathologic findings of the TM and ME.

RESULTS

Thicknesses in all quadrants except the umbo were increased in MOM because of infiltration of inflammatory cells and fibrosis. The most common ME pathologies were granulation tissue and fibrosis. Significant correlations included (1) TM retraction and ME granulation tissue and fibrosis and (2) pars flaccida, posterosuperior, and anteroinferior thickness and ME granulation tissue and fibrosis.

CONCLUSION

TM changes are likely to occur in patients with otitis media with effusion (MOM), and their presence is a strong indication of underlying ME pathology.
Influence of Height on the Spatial Orientation and Equilibrium of the Body
Authors: Nakahara Haruka , Takemori Setsuko , Tsuruoka Hisashi
Published: February 2003

The sway of the center of gravity for 30 seconds with a stabilometer was examined in 30 volunteers under 3 visual conditions (eyes open with and without fixation and eyes closed) at heights of 0, 1, and 2 m and under 2 visual conditions (eyes open with fixation and eyes closed) at a height of 10 m 22 cm. Eight of the subjects had acrophobia. The sway worsened at 10 m 22 cm but showed no change at 1 or 2 m. The acrophobic group became clearly worse at 10 m 22 cm. In another group of 12 volunteers, the subjects were guided to the roof with the eyes closed, and sway was measured. Sway was also measured with the eyes uncovered and open and again with the eyes closed. The first measurement with the eyes closed showed worse sway, and the second with the eyes open was better, except in 2 subjects who were acrophobic. (Otolaryngol Head Neck Surg 2000;123:501‐4.)
Quantification of Rebound Edema After Steroid Treatment
Authors: Odland Rick , Wigley Terry , Kim Tom , Kizziar Ron , Davamony David
Published: February 2003

OBJECTIVE:

Return of edema after abrupt discontinuation of steroid treatment has never been studied or quantified. The purpose of this study was to measure the effect of abrupt cessation and tapering doses of steroids on tissue water content (TWC) in a rat skin flap model.

DESIGN:

A randomized controlled animal trial was designed to study the effects of discontinuation of steroid on skin flap edema. The animals were assigned to a control group (C), a steroid group (S), an abrupt steroid cessation (SC) group, or a tapering steroid (ST) group.

MAIN OUTCOME MEASURES:

In each group the skin flaps were biopsied at 30 and 36 hours. TWC was determined by a biopsy‐drying technique.

RESULTS:

A significant difference (P = 0.05) was found between the C and S groups and between the SC and S groups at both 30 and 36 hours, with the C group having the highest TWC. No significant difference was noted between the SC and C groups. The ST group had significantly less edema than the C group and similar TWC to that of the S group.

CONCLUSION:

Edema rebounded in the skin flaps after abrupt cessation of steroids (SC was not different from C), presumably because of destabilization of inflammatory mediators. The rebound effect was not observed in the ST group. The control of rebound edema by a tapering steroid protocol may be important in skin flap survival and may have implications for the management of airway edema.
Squamous Cell Carcinoma of the Anterior Nasal Cavity: A Dual Institution Review
Authors: Fornelli Rick A. , Fedok Fred G. , Wilson Ewain P. , Rodman Susan M.
Published: February 2003

Thirty‐two patients with squamous cell carcinoma of the anterior nasal cavity were identified at two university hospitals. A retrospective review was conducted to identify clinical presentation, initial therapy, recurrence rates, and factors affecting survival. Treatment included surgery (n = 15), radiation therapy (n = 9), or combination therapy (n = 8). The primary lesions involved either the septum, vestibule, columella, anterior floor, or a combination of these subsites. The primary tumor involved a single nasal subsite in 22 patients and multiple nasal subsites in 10 patients. All patients had de novo squamous lesions, and all tumors were staged N0 at initial diagnosis. Six patients received prophylactic neck irradiation, and none underwent elective neck dissection. Overall, 18 (56%) patients had recurrent disease after primary therapy (5 local and 13 regional). The 5‐year disease‐free survival was 42%, and the 5‐year overall survival was 50%. None of the patients receiving prophylactic neck irradiation had a regional recurrence. Involvement of 2 or more nasal subsites significantly decreased survival (P < 0.05). Squamous cell carcinoma of the anterior nasal cavity is an aggressive disease, and combined therapy initially with strong consideration for prophylactic radiation to the facial and cervical lymphatics is advocated.
Use of the Laryngeal Mask Airway for Laser Treatment of the Subglottis
Authors: Jameson John J. , Moses Robert D. , Vellayappan Usha , Lathi Kishor G.
Published: February 2003

A technique for treating subglottic lesions with the intubating laryngeal mask airway is described. It provides unhampered exposure of the subglottis and upper trachea, excellent airway control, and a means of access for ablation with flexible laser bronchoscopy.
Analysis of the Human Neurofibromatosis Type 2 Gene Promoter and its Expression
Authors: Welling D. Bradley , Akhmametyeva Elena M. , Daniels Robert L. , Lasak John M. , Zhu Lingyun , Miles‐Markley Beth A. , Chang Long‐Sheng
Published: February 2003

OBJECTIVE

It is hypothesized that transcriptional regulation plays an important role for neurofibromatosis type 2 (NF2) expression in Schwann cells and other cell types. The objective of this study is the isolation and characterization of the transcriptional regulatory elements of the NF2 gene.

STUDY DESIGN AND SETTING

A bacterial artificial chromosome library and a partial genomic DNA library were used to isolate the human NF2 gene; NF2 promoter‐luciferase constructs were generated, and promoter activities were assayed. This study was carried out in a molecular biology laboratory.

RESULTS

A bacterial artificial chromosome clone with an approximately 100‐kilobase insert containing nearly the entire human NF2 gene has been isolated. An additional 5’ NF2 sequence has also been cloned. Transient transfection experiments demonstrate strong promoter activity from the NF2 5’ flanking DNA.

CONCLUSIONS

The NF2 gene is approximately 100 kilobases long. Both positive and negative regulatory elements are present in NF2 5’ flanking regions.

SIGNIFICANCE

Better understanding of the NF2 gene and its regulation will improve molecular diagnostics and ultimately treatment of patients with NF2.
Adjuvant Radiotherapy Influences the Survival of Patients with Squamous Carcinoma of the Head and Neck who Have Poor Prognoses
Authors: De Stefani Antonella , Magnano Mauro , Cavalot Andrea , Usai Antonio , Lerda Walter , Mola Patrizia , Albera Roberto , Ragona Riccardo , Gabriele Pietro , Bussi Mario , Cortesina Giorgio
Published: February 2003

The treatment of carcinoma of the head and neck in recent years has improved significantly, chiefly thanks to progress in surgery and radiotherapy. Despite these advances, the survival statistics reported in the literature show no appreciable evidence of radical improvement. The aims of this study were to evaluate the impact on survival achieved with the combination of surgical and postoperative radiotherapy in patients with advanced head and neck carcinomas and to identify the prognostic value of several host‐ and tumor‐related factors that can influence the results of combined treatment. We retrospectively reviewed the medical records of 394 patients with stage III and IV carcinoma of the head and neck, of whom 170 (43%) underwent surgery alone and 224 (57%) received combined surgery and postoperative radiotherapy. The 394 patients were stratified for a set of variables including the patient's condition, the characteristics of the tumor, and the modality of treatment. Univariate analysis revealed that coexistent medical diseases, the size and site of the primary lesion, the stage of the tumor, and certain pathologic features had a negative impact on survival. Multivariate analysis showed that the removal of lymph nodes and postoperative radiotherapy can have a positive influence and can improve the prognosis. We compared the survival rates of the patients treated with surgery alone with those of the patients who underwent combined treatment, and we observed that the two survival curves were comparable, even if there was a bias because the combined treatment group consisted of patients with negative prognostic factors. The meaning of these results, compared with data from the literature, has been discussed.
Reconstruction of Tracheal Defects with Dehydrated Human Costal Cartilage: An Experimental Study in Rats
Authors: Dal Teoman , Demirhan Beyhan
Published: February 2003

Reconstruction of tracheal defects continues to be a difficult problem in head and neck surgery. In this study, to evaluate the outcomes of tracheal reconstruction with a nonautogenous material, we used solvent‐dehydrated human costal cartilage in 3 different forms: graft, neovascularized graft, and prefabricated free flap. Thirty‐five Sprague‐Dawley rats were distributed into 3 groups with 10 animals in groups 1,10 in group 2, and 15 in group 3. Surgically created tracheal defects were repaired with a free cartilage graft in group 1, and a piece of cartilage was neovascularized for 3 weeks in the inguinal region and then used as a fibrovascular tissue‐coated cartilage graft in group 2. In group 3, the neovascularized cartilage was transferred to the defect as a prefabricated free flap based on a vascular pedicle containing femoral vessels. Four weeks later, the tracheal reconstruction specimens were evaluated with light microscopy to determine cartilage survival, infection, and epithelial regrowth. The most favorable outcomes were obtained in group 3, where the material was used as a prefabricated neovascularized free flap.
Computed Tomography Stage, Allergy Testing, and Quality of Life in Patients with Sinusitis
Authors: Krouse John H.
Published: February 2003

BACKGROUND

Chronic rhinosinusitis is a common disease associated with significant morbidity. CT has been a poor predictor of the extent of symptoms among these patients. Allergic rhinitis is frequently associated with chronic rhinosinusitis. This study examines CT stage, allergic sensitivity, and sinus‐related symptoms.

METHODS

Forty‐eight patients with chronic rhinosinusitis underwent CT scanning and skin end‐point titration (SET). They also completed the Rhinosinusitis Disability Index (RSDI), a measure of sinus‐related disability.

RESULTS

No association was noted between CT stage and severity of sinus‐related symptoms. There was a significant correlation between CT stage and SET mean end point and between SET mean end point and RSDI physical scale score, as well as between significance on the RSDI emotional scale score and overall score.

CONCLUSION

The degree of allergic disease is a better indicator of symptom severity and impairment in quality of life among patients with chronic rhinosinusitis than CT stage. Careful evaluation and treatment of allergic disease is critical in the treatment of chronic rhinosinusitis.
Numerical Densities of Myonuclei and Satellite Cells in Muscle Fiber Types in the Aging Human Thyroarytenoid Muscle: An Immunohistochemical and Stereological Study Using Confocal Laser Scanning Microscopy
Authors: Malmgren Leslie T. , Fisher Patricia J. , Jones Christine E. , Bookman Linda M. , Uno Toshiyuki
Published: February 2003

OBJECTIVE

This study determines the role of changes in numerical densities of myonuclei and satellite cells in age‐related remodeling of the thyroarytenoid muscle (TA).

DESIGN

Changes in numerical densities (NV) and ratios (NN) of myonuclei and satellite cells were estimated for the entire TA by use of stereological techniques.

RESULTS

There was no age‐related change or difference between fiber types for NV myonucleus, fiber' but Nv myonucleus, fiber increased with decreasing fiber diameter. There was a trend toward a decrease in Nv satellite cell, fiber and a decrease in NN satellite cell, myonucleus. Nv satellite cell, fiber was higher for type 1 than for type 2 fibers, and type 1 satellite cells increased disproportionately with increasing total satellite cell numerical density.

CONCLUSION

Decreased satellite cell proliferation may contribute to age‐related fiber loss and atrophy in the TA.

SIGNIFICANCE

Therapeutic techniques based on activation of satellite cells may block age‐related fiber loss and atrophy in the TA.
Common Myths About Electrosurgery
Authors: Zinder Daniel J.
Published: February 2003

The electrosurgery device market is lucrative and highly competitive. Several device manufacturers exist, and many creative techniques are used to differentiate products. Some device manufacturers make claims in marketing campaigns that are difficult to reconcile with the laws of physics or basic physiology. The variety of claims may be confusing to surgeons desiring to purchase new electrosurgical products. Understanding a few basic principles of electrosurgery physics can allow a surgeon to be a more informed consumer of electrosurgical products. This article discusses the basic physics of electrosurgery and then addresses several common misconceptions about electrosurgery and electrosurgical devices. (Otolaryngol Head Neck Surg 2000;123:450‐5.)
Prevalence of Reflux in 113 Consecutive Patients with Laryngeal and Voice Disorders
Authors: Koufman James A. , Amin Milan R. , Panetti Marguerite
Published: February 2003

OBJECTIVES

The goal was to estimate the prevalence of laryngopharyngeal reflux (LPR) in patients with laryngeal and voice disorders.

STUDY DESIGN AND SETTING

This was a prospective study of 113 unselected, new patients with laryngeal and voice disorders. Patients completed an extensive medical history form including a reflux symptom profile. A comprehensive otolaryngologic examination was performed with photographic transnasal fiberoptic laryngoscopy. Patients with both symptoms and findings of LPR (78/133, 69%) underwent ambulatory 24‐hour double‐probe pH monitoring.

RESULTS

Seventy‐three percent (57/78) of patients undergoing pH testing had abnormal studies. Thus 50% (57/113) of the entire the study population had pH‐documented reflux. Of the diagnostic sub‐groups studied, the highest incidence of reflux was found in patients with vocal cord neoplastic lesions (88%) and patients with muscle tension dysphonias (70%). LPR was infrequently found in patients with neuromuscular disorders.

CONCLUSION

LPR occurs in at least 50% of all patients at our center with laryngeal and voice disorders at presentation.
Outcomes and Quality of Life in Conductive Hearing Loss
Authors: Stewart Michael G. , Coker Newton J. , Jenkins Herman A. , Manolidis Spiros , Bautista Marilyn H.
Published: February 2003

OBJECTIVE

The goal was to measure quality of life (QOL) and hearing‐specific functional status before and after treatment of conductive hearing loss (CHL).

STUDY DESIGN AND SETTING

A prospective, longitudinal, outcomes‐based study was performed at an academic medical center.

RESULTS

Mean baseline QOL scores in CHL patients were comparable with those of the general population. Audiometric studies indicated significant improvements in hearing threshold in all treated patients. There was no significant improvement in mean global QOL scores after treatment of CHL, although there was little room for improvement over baseline. The hearing‐specific instrument did demonstrate significant improvements in emotional and social/situational hearing status after treatment. Patients treated with hearing aids had poorer baseline QOL and hearing status than patients treated with surgery and tended to show declines in QOL and only partial improvement in hearing‐specific functional status after treatment.

CONCLUSIONS

Treatment of CHL resulted in improvements in hearing‐specific functional status, although changes were difficult to detect with a global QOL instrument.
Carcinoma of the Buccal Mucosa
Authors: Chhetri Dinesh K. , Rawnsley Jeffrey D. , Calcaterra Thomas C.
Published: February 2003

OBJECTIVE

The goal was to analyze the outcome of surgical therapy for buccal carcinoma.

STUDY DESIGN

A retrospective chart review was done.

SETTING

The study took place in a major tertiary‐care hospital.

RESULTS

Twenty‐seven patients received first‐time surgical therapy for buccal carcinoma. Treatment was surgery alone in 15 and surgery followed by radiation therapy in 6 patients. Six additional patients received surgical salvage for radiation therapy failure. Composite resection of the tumor was performed in 16 patients (59%). Five‐year observed actuarial survival rates were 100%, 45%, 67%, and 78%, and locoregional recurrence rates were 0%, 27%, 44%, and 0% for stages I to IV, respectively. The 5‐year actuarial survival rates were 80% after surgery and 82% after surgery and postoperative radiation therapy. Patients who underwent surgical salvage after radiation therapy failure had a 1‐year survival rate of 0%.

CONCLUSION

Aggressive surgical treatment of buccal carcinoma may result in better survival rates.

SIGNIFICANCE

The article analyzes buccal carcinoma in regards to the patterns of presentation, treatments rendered, and patterns of failure.
Pharyngocutaneous Fistula as a Complication of Total Laryngectomy: Review of the Literature and Analysis of Case Records
Authors: Cavalot Andrea L , Gervasio Carmine‐Fernando , Nazionale Giuseppe , Albera Roberto , Bussi Mario , Staffieri Alberto , Ferrero V. , Cortesina G.
Published: February 2003

Pharyngocutaneous fistula is the most common complication of total laryngectomy. The management of this problem increases hospitalization time and delays initiation of postoperative radiotherapy, where indicated. To identify factors predisposing to the development of pharyngocutaneous fistula, we reviewed the postoperative courses of 293 patients who underwent total laryngectomy at our clinic. General factors taken into account were concurrent diseases such as diabetes, liver diseases, or chronic anemia; local factors included radiotherapy before and after surgery, preoperative tracheostomy, type of cervical lymph node removal, and method of pharyngeal closure. We then compared our data with those reported in the literature by other authors. Last, we applied the Fisher exact test to a correlation we found between the higher incidence of fistula in patients with diabetes, liver diseases, or anemia. The local factor that turned out to be statistically most significant for the development of fistula was preoperative radiotherapy.
Ultrasound‐guided fine‐needle aspiration and thyroid disease
Authors: Newkirk Kenneth A. , Ringel Matthew D. , Jelinek James , Mark Alexander , Wartofsky Leonard , Deeb Ziad E. , Sessions Roy B. , Burman Kenneth D.
Published: February 2003

BACKGROUND:

Fine‐needle aspiration represents a critical diagnostic test in determining proper management of thyroid disease and the use of ultrasound‐guided fine‐needle aspiration (USGFNA) has increased over the years.

METHODS:

A retrospective chart review of patients undergoing USGFNA. Two hundred fifteen patients underwent 234 procedures with 362 nodules aspirated within a 2 ½‐year period.

RESULTS:

The mean ages of women and men were 51.9 and 57.8, respectively. The average size of nodules was 2.1 cm. A difficult to assess gland or nodule was the most common indication for USGF‐NA (33%). The sensitivity was 88.2%, specificity was 80.0%, the PPV was 65.2%, the negative predictive value was 94.1%, and the accuracy was 82.5%. The cancer yield, inadequacy, and complication rates were 44%, 10.5%, and 8.5%, respectively.

CONCLUSIONS:

USGFNA aspiration is a safe and effective diagnostic modality in the management of thyroid disease, especially for nodules that are difficult to palpate.
Botulinum toxin type A (BOTOX) for treatment of migraine headaches: An open‐label study
Authors: Binder William J. , Brin Mitchell F. , Blitzer Andrew , Schoenrock Larry D. , Pogoda Janice M.
Published: February 2003

OBJECTIVE:

The object of this clinical experience was to evaluate the correlation between pericranial botulinum toxin type A (BOTOX, Allergan Corp, Irvine, CA) administration and alleviation of migraine headache symptoms.

STUDY DESIGN AND SETTING:

A nonrandomized, open‐label study was performed at 4 different test sites. The subjects consisted of 106 patients, predominantly female, who either (1) initially sought BOTOX treatment for hyperfunctional facial lines or other dystonias with concomitant headache disorders, or (2) were candidates for BOTOX treatment specifically for headaches. Headaches were classified as true migraine, possible migraine, or nonmi‐graine, based on baseline headache characteristics and International Headache Society criteria. BOTOX was injected into the glabellar, temporal, frontal, and/or suboccipital regions of the head and neck. Main outcome measures were determined by severity and duration of response. The degrees of response were classified as: (1) complete (symptom elimination), (2) partial (≥50% reduction in headache frequency or severity), and (3) no response [neither (1) nor (2)]. Duration of response was measured in months for the prophylactic group.

RESULTS:

Among 77 true migraine subjects treated prophylactically, 51% (95% confidence interval, 39% to 62%) reported complete response with a mean (SD) response duration of 4.1 (2.6) months; 38% reported partial response with a mean (SD) response duration of 2.7 (1.2) months. Overall improvement was independent of baseline headache characteristics. Seventy percent (95% confidence interval, 35% to 93%) of 10 true migraine patients treated acutely reported complete response with improvement 1 to 2 hours after treatment. No adverse effects were reported.

CONCLUSIONS:

BOTOX was found to be a safe and effective therapy for both acute and prophylactic treatment of migraine headaches. Further research is needed to explore and develop the complete potential for the neuroinhibitory effects of botulinum toxin.
Chronic rhinosinusitis: Allergy and sinus computed tomography relationships
Authors: Emanuel Ivor A. , Shah Saurabh B.
Published: February 2003

The management of chronic or recurrent rhinosinusitis problems is multifaceted and should include consideration of contributory and potentially correctable medical and anatomic factors. To date, the relationship between allergy and rhinosinusitis has not been clearly defined. The purpose of this study is to improve understanding of the relative roles of perennial and seasonal allergens in the cause of chronic rhinosinusitis. A retrospective review of 200 consecutive patients was carried out on patients who had chronic rhinosinusitis refractory to medical therapy and who subsequently underwent functional endoscopic sinus surgery. All of these patients had allergy testing for common perennial and seasonal inhalant allergens before surgery. Each patient had sinus CT imaging before undergoing the surgery. The CT scans of each patient were staged according to a validated, standardized grading system by investigators blinded to allergic profile. Allergy testing indicated that 84% of all patients tested positive for allergies. Moreover, 60% of all patients had significant allergic sensitivity; 52% of all patients had multiple allergen sensitivities. Furthermore, there was a predominance of perennial allergens, especially house dust mite over seasonal allergens. The vast majority of our patients undergoing functional endoscopic sinus surgery had concomitant allergy. This study highlights the potential contribution of perennial allergies to the development of rhinosinusitis. Given this direction, future studies may reveal that in the care of patients with perennial allergic rhinitis, early intervention with identification of the offending allergen(s), and subsequent treatment through avoidance, pharmacotherapy, and/or immuno‐therapy may help in the prevention of recurrent and chronic rhinosinusitis.
Lymphatic malformation: Predictive factors for recurrence
Authors: Fliegelman Lawrence J. , Friedland David , Brandwein Margaret , Rothschild Michael
Published: February 2003

OBJECTIVE:

Although lymphatic malformations are often found to be well circumscribed when surgery is undertaken in early childhood, complete surgical excision can be difficult when the lesion is infiltrative. This study retrospectively evaluates these patients in an attempt to identify prognostic factors that may predict recurrence.

STUDY DESIGN AND SETTING:

A retrospective chart review was conducted covering the years 1991 to 1998. Seventeen patients were identified having undergone 32 surgical resections of tumors described as lymphatic malformations. Data abstracted from the charts included the site of the lesion, surgical and histologic assessment of encapsulation, and status at follow‐up examination.

RESULTS:

Six of 17 patients developed a recurrence after surgery. Correlation between recurrence and histologic or operative impressions of encapsulation was significant by χ2 analysis (P < 0.01).

CONCLUSION:

On the basis of the findings of this case series, lymphatic malformations that are found to be nonencapsulated and infiltrative by intraoperative or histologic assessment are more likely to recur.
Bone‐screw mandible fixation: An intraoperative alternative to arch bars
Authors: Vartanian A. John , Alvi Aijaz
Published: February 2003

OBJECTIVES:

Bone‐screw mandible fixation (BSMF) is evaluated as an alternative to intraoperative arch‐bar maxillomandibular fixation before plating of mandibular fractures. BSMF is achieved by wire ligation of opposing bone‐screws placed in the maxilla and mandible.

METHODS:

A retrospective evaluation of 23 patients with 40 mandibular fractures who underwent man‐dibular fracture repairs. BSMF was used instead of arch bars to ensure proper dental occlusion. All fractures were then plated, after which BSMF was removed before termination of anesthesia.

RESULTS:

Normal occlusion was observed in 21 patients (91.3%), Class II malocclusion was noted in 1 patient (4.3%), and 1 patient was edentulous. No complications related to the use of BSMF were observed.

CONCLUSION:

BSMF can serve as a viable alternative to arch‐bar maxillomandibular fixation for obtaining temporary intraoperative occlusion. BSMF produces acceptable malocclusion rates and offers the advantages of decreased intraoperative time, lower risk for percutaneous and mucosal wire punctures, and ease of use.
Apoptosis in the developing human cricoid cartilage: A pilot study
Authors: Mankarious Leila , Ansley John
Published: February 2003

Apoptosis is widely recognized as a major phenomenon in normal development. Deficiencies in this process may lead to developmental abnormalities such as congenital subglottic stenosis. We studied apoptosis using in situ end labeling of the 3'‐OH ends of fragmented DNA in 5 progressively older, normal, human cricoid cartilage specimens. Results show that apoptosis is a very active process in fetal and neonatal tissue. The process gradually slows with advancing age. In the 4‐ and 13‐year‐old specimens, minimal to no apoptosis was seen. We conclude that apoptosis plays a critical role in the intraluminal and extraluminal expansion of the cricoid cartilage.
Submucosal Radiosurgical Uvulopalatoplasty for the Treatment of Snoring: Is the Monitoring of Tissue Impedance and Temperature Necessary?
Authors: Taliaferro Cort
Published: February 2003

OBJECTIVE

To determine the safety and efficacy of submucosal radiofrequency uvulopalatoplasty. This procedure uses fixed, predetermined parameters of application without the concomitant monitoring of tissue impedance and temperature in the submucosal radiofrequency induced ablation and volumetric reduction of the soft palate as a treatment of chronic socially disruptive snoring.

DESIGN

This nonrandomized prospective study used preoperative and postoperative questionnaires and visual analogue scales to evaluate snoring and postoperative pain.

SETTING

Treatments were performed on an outpatient basis in a community‐based clinic.

PATIENTS

Nineteen patients sought treatment for chronic socially disruptive snoring, without complaints of excessive daytime somnolence, who met the predetermined criteria of a respiratory distress index of less than 20.

INTERVENTION

Radiofrequency energy (3.8 MHZ) was applied to the submucosal tissues of the soft palate through a specially designed needle electrode with a predetermined wattage and treatment time. The number of treatments ranged from 1 to 6 (mean, 3.1). Resolution of snoring or diminution of snoring, to the point where it was no longer bothersome to the patients' bedmate, was considered the successful endpoint of the treatments.

RESULTS

Sixteen patients were successfully treated and satisfied with the results. Three patients had only mild or moderate improvement in snoring despite multiple treatments. Postoperative pain was rated as mild (≤3 on the visual analogue scale) in 86% of treatments. In 8 (14%) of 58 treatments,

mucosal injury was inadvertently sustained, but all healed without complications.

CONCLUSION

Submucosal radiofrequency uvulopalatoplasty, using the described technique, appears to be a safe, effective, and well‐tolerated treatment for chronic socially disruptive snoring. These initial results indicate that the concomitant monitoring of tissue impedance and tissue temperature during radiofrequency ablation and volumetric reduction of the soft palate is not necessary and adds significantly to the cost of the procedure. (Otolaryngol Head Neck Surg 2001;124:46‐50)