bluuebunny/crossref_metadata_2025 huggingface dataset:
Mass spectrometric characterization of naphthenic acids in environmental samples: A review
Authors: Headley John V. , Peru Kerry M. , Barrow Mark P.
Published: August 2008

There is a growing need to develop mass spectrometric methods for the characterization of oil sands naphthenic acids (structural formulae described by CnH2n+zO2 where n is the number of carbon atoms and “z” is referred to as the “hydrogen deficiency” and is equal to zero, or is a negative, even integer) present in environmental samples. This interest stems from the need to better understand their contribution to the total acid number of oil sands acids; along with assessing their toxicity in aquatic environments. Negative‐ion electrospray ionization has emerged as the analytical technique of choice. For infusion samples, matrix effects are particularly evident for quantification in the presence of salts and co‐elutants. However, such effects can be minimized for methods that employ chromatographic separation prior to mass spectrometry (MS) detection. There have been several advances for accurate identification of classes of naphthenic acid components that employ a range of MS hyphenated techniques. General trends measured for degradation of the NAs in the environment appear to be similar to those obtained with either low‐ or high‐resolution MS. Future MS research will likely focus on (i) development of more reliable quantitative methods that use chromatography and internal standards, (ii) the utility of representative model naphthenic acids as surrogates for the complex NA mixtures, and (iii) development of congener‐specific analysis of the principal toxic components. © 2008 Wiley Periodicals, Inc., Mass Spec Rev 28:121–134, 2009
A novel G6PD mutation leading to chronic hemolytic anemia
Authors: McDade Jenny , Abramova Tatiana , Mortier Nicole , Howard Thad , Ware Russell E.
Published: August 2008

Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency is an important cause of hemolytic anemia worldwide. Severely affected patients have chronic hemolysis with exacerbations following oxidative stress. Mutations causing severe chronic non‐spherocytic hemolytic anemia (CNSHA) commonly cluster in Exon 10, a region important for protein dimerization. An African‐American male presented at age 2 weeks with pallor and jaundice, and was found to have hemolytic anemia with G6PD deficiency. His severe clinical course was inconsistent with the expected G6PD A− variant. DNA sequencing revealed two common mutations (A−) and a third novel Exon 10 mutation. This inherited haplotype represents a novel triple G6PD coding mutation causing chronic hemolysis. Pediatr Blood Cancer 2008;51:816–819. © 2008 Wiley‐Liss, Inc.
Improved performance of first‐trimester combined screening for trisomy 21 with the double test taken before a gestational age of 10 weeks
Authors: Kirkegaard Ida , Petersen Olav Bjørn , Uldbjerg Niels , Tørring Niels
Published: August 2008

Objective

To evaluate if there is a performance difference in the combined screening for trisomy 21 between the double tests performed before and after 10 + 0 weeks of gestation.

Methods

The study included all 97 trisomy 21 cases from January 2004 to December 2007, in a screening program where the double test was measured in week 8 + 0 to 13 + 6 and the nuchal translucency in week 11 + 3 to 13 + 6.

Results

As many as 87 of the 97 cases were diagnosed in the screening program (detection rate = 90%). Among the 53 cases having the double test taken before 10 + 0 weeks, no cases were missed [detection rate (DR) = 100%, CI = 0.94–1.00] and among the 44 having the double test taken after 10 + 0 weeks, 10 cases were missed (DR = 77%, CI = 0.65–0.90). This difference in DR was highly significant (P = 0.0009). No difference was observed between false positive rates or median maternal age of the two groups.

Conclusion

A significantly higher DR was obtained when the double test was taken early in pregnancy (<10 + 0 weeks), than when it was taken later (≥10 + 0 weeks). The results could not be explained by a difference in either the false positive rate or the maternal age between the two groups. Copyright © 2008 John Wiley & Sons, Ltd.
Spatial and temporal evolution of the photoinitiation rate for thick polymer systems illuminated by polychromatic light: selection of efficient photoinitiators for LED or mercury lamps
Authors: Kenning Nicole Stephenson , Ficek Beth A , Hoppe Cindy C , Scranton Alec B
Published: August 2008

BACKGROUND: Four common free radical photoinitiators were evaluated for use in thick photopolymerizations illuminated with a medium‐pressure 200 W mercury–xenon arc lamp and a high‐intensity 400 nm light‐emitting diode (LED) lamp. For each photoinitiator/lamp combination, the spatial and temporal evolution of the photoinitiation rate profile was analyzed by solving the set of differential equations that govern the light intensity gradient and initiator concentration gradient for polychromatic illumination.

RESULTS: The simulation results revealed that two of the four photoinitiators evaluated were ineffective for photoinitiating thick polymer systems. The photoinitiator bis(2,4,6‐trimethylbenzoyl)‐phenylphosphine oxide, in combination with the 400 nm LED lamp, was shown to be the most efficient photoinitiator/light source combination for photoinitiation of thick systems.

CONCLUSION: The results show that some photoinitiators commonly used for photopolymerization of thin coatings are ineffective for curing thick systems. LED light sources provide advantages over traditional mercury lamps, and may have tremendous potential in the effective photoinitiation of thick polymer systems. Copyright © 2008 Society of Chemical Industry
Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature
Authors: Mosher Catherine E. , Redd William H. , Rini Christine M. , Burkhalter Jack E. , DuHamel Katherine N.
Published: August 2008

Objective: This article reviews recent literature on adults' quality of life following hematopoietic stem cell transplantation (HSCT).

Methods: We identified 22 prospective reports with at least 20 participants at baseline through a search of databases (Medline and PsycInfo) and handsearching of articles published from 2002 to October 2007. If longitudinal data were not available or were scarce for a particular topic or time point, cross‐sectional studies were reviewed.

Results: Although physical, psychological, and social aspects of quality of life tend to improve during the years following transplantation, a significant proportion of HSCT survivors experience persistent anxiety and depressive symptoms, fatigue, sexual dysfunction, and fertility concerns. Despite ongoing treatment side effects, the majority of HSCT survivors resume their work, school, or household activities.

Conclusion: We conclude that theory‐driven research with larger samples is needed to identify subgroups of HSCT survivors with adjustment difficulties. Such research would examine survivors' evolving standards and definitions of quality of life to improve the accuracy and meaningfulness of assessment and incorporate biological, psychological, and contextual factors that may contribute to positive adjustment. Copyright © 2008 John Wiley & Sons, Ltd.
Genetic algorithms and grid technologies in clustering, an example: Clustering of images
Authors: Robotka Zsolt , Zempléni András , Hajas Csilla , Seres Csaba , Balázs Sándor
Published: August 2008

In this paper we describe the development of an image retrieval system that is able to browse, cluster and classify large digital image databases. This work was motivated by the projects of the Visualization Centre of the Eötvös Loránd University, where such problems are to be solved. The system's functions are based on a Gaussian mixture model (GMM) representation of the images. Image matching is done by the distance measure of the representations, based on the approximation of the Kullback–Leibler divergence of the GMMs. The GMMs are estimated with an improved expectation maximization (EM) algorithm that avoids convergence to the boundary of the parameter space. These form the basis of the clustering, where a variant of a genetic algorithm is used. The suggested algorithm is able to work with a large number of images or objects, the grid technology is a useful tool for generating several runs simultaneously. Copyright © 2008 John Wiley & Sons, Ltd.
Proton collisions with the water dimer at keV energies
Authors: Quinet O. , Deumens E. , Öhrn Y.
Published: August 2008

Proton collisions with the water dimer are studied using a nonadiabatic, direct, time‐dependent approach called electron nuclear dynamics (END). Fragmentation of the water dimer in collisions with protons at energies of 5.0, 1.0 keV and 200 eV is the primary aim of this initial study of water clusters using END. We report on the initial fragmentation dynamic, that is, for times less than 200 fs. © 2008 Wiley Periodicals, Inc. Int J Quantum Chem, 2009
Oligosaccharide relative quantitation using isotope tagging and normal‐phase liquid chromatography/mass spectrometry
Authors: Ridlova Gabriela , Mortimer Jenny C. , Maslen Sarah L. , Dupree Paul , Stephens Elaine
Published: August 2008

The growing interest in the conversion of plant biomass into biofuels has recently highlighted the lack of analytical techniques that are able to profile the fine structures of plant cell‐wall polysaccharides. Here we present a new liquid chromatography/electrospray ionisation mass spectrometry (LC/ESI‐MS) platform called Oligosaccharide Quantitation using Isotope Tagging (OliQuIT) developed for profiling the oligosaccharides derived from glycosyl hydrolase digestion of polysaccharides. The method is demonstrated using different arabinoxylan‐derived oligosaccharide samples, which are reductively aminated with either the light (12C6) or heavy (13C6) form of aniline. The complex oligosaccharide mixtures are analysed by capillary normal‐phase (NP)‐LC and ESI‐MS. Importantly, arabinoxylan oligosaccharide isomers are separated by NP‐LC and their relative abundance in different samples can be determined from the intensities of ions labeled with the different isotopes. OliQuIT will be of use in multiple applications, including screening for plant varieties with improved saccharification properties, characterizing glycosyl hydrolase specificities and analysing plant glycosyl transferase mutants. Copyright © 2008 John Wiley & Sons, Ltd.
The utility of ultra‐performance liquid chromatography/electrospray ionisation time‐of‐flight mass spectrometry for multi‐residue determination of pesticides in strawberry
Authors: Taylor Michael J. , Keenan George A. , Reid Kirsty B. , Fernández Diana Uría
Published: August 2008

The utility of ultra‐performance liquid chromatography/orthogonal‐acceleration time‐of flight mass spectrometry (UPLC/TOFMS) for the rapid qualitative and quantitative analysis of 100 pesticides targeted in strawberry was assessed by comparing results with those obtained using a validated in‐house UPLC tandem mass spectrometry (MS/MS) multi‐residue method. Crude extracts from retail strawberry samples received as part of the 2007 annual UK pesticide residues in food surveillance programme were screened for the presence of pesticide residues using UPLC/TOFMS. Accurate mass measurement of positive and negative ions allowed their extraction following ‘full mass range data acquisition’ with negligible interference from background or co‐eluting species observed during UPLC gradient separation (in a cycle time of just 6.5 min per run). Extracted ion data was used to construct calibration curves and to detect and identify any incurred residues (i.e. pesticides incorporated in or on the test material following application during cultivation, harvest and storage). Calibration using matrix‐matched standards was performed over a narrow concentration range of 0.005–0.04 mg kg−1 with determination coefficients (r2) ≥0.99 for all analytes with the exception of malathion/fenarimol/fludioxanil (r2 = 0.98), quassia/pymetrazine (r2 = 0.97) and fenthion sulfone (r2 = 0.95). Residues found in selected samples ranged from 0.025–0.28 mg kg−1 and were in excellent agreement with results obtained using UPLC/MS/MS. Mass measurement accuracies of ≤5 ppm were achieved consistently throughout the separation, mass range and concentration range of interest thus providing the opportunity to obtain discrete elemental compositions of target ions. © Crown copyright 2008. Reproduced with the permission of Her Majesty's Stationery Office. Published by John Wiley & Sons, Ltd.
Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature
Authors: Gottschalk E. M. , Siedentopf J.‐P. , Schoenborn I. , Gartenschlaeger S. , Dudenhausen J. W. , Henrich W.
Published: August 2008

Approximately 15% of women have a retroverted uterus prior to pregnancy, and retroversion occurs in 11% of women in the first trimester of pregnancy. However, the uterus usually moves to an upward position before 14 weeks' gestation. Incarceration and sacculation of a retroverted uterus occur in 1 in 3000 pregnancies and are difficult to diagnose. They have often been missed until shortly before delivery and can lead to serious obstetric emergencies such as labor dystocia, uterine rupture, retained placenta and uncontrollable postpartum hemorrhage. Performing a Cesarean section without correct diagnosis may cause difficulties in identifying the bladder and the cervix, and therefore in opening the lower uterine segment. This leads to bladder injuries, vaginal transsection and trans‐ or supracervical hysterectomy. Early diagnosis and detailed scanning are crucial for the obstetric management and operative approach.

We report a case of an incarcerated uterus in a patient presenting at 24 weeks' gestation with severe bilateral flank and lower abdominal pain. The symptoms were misdiagnosed as appendicitis. Digital examination revealed a ventralized vaginal axis. The cervix was not palpable. The clinical course, and two‐ and three‐dimensional ultrasound and magnetic resonance imaging findings, are presented. The delivery was performed by midline laparotomy Cesarean section. The management for different gestational ages and a review of the literature are discussed. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
Effects of α‐Tocopherol on Oxidative Stability and Phytosterol Oxidation During Heating in Some Regular and High‐Oleic Vegetable Oils
Authors: Tabee Elham , Azadmard‐Damirchi Sodeif , Jägerstad Margaretha , Dutta Paresh C.
Published: August 2008

The first part of this study evaluated oxidative stability in high‐oleic rapeseed oil, palm olein, refined olive oil, low erucic acid rapeseed oil and sunflower oil. The results showed oxidative stability in the order: palm olein > high‐oleic rapeseed oil > refined olive oil > low erucic acid rapeseed oil > sunflower oil, as determined by the Rancimat method. Addition of α‐tocopherol at high levels of up to 0.2% increased the oxidative stability of refined olive oil, whereas the opposite effect was generally observed in the other oil samples. In the second part of the study, high‐oleic rapeseed oil, palm olein, refined olive oil and refined olive oil containing 0.2% α‐tocopherol were heated for 3, 6, 9 and 12 h at 180 °C. The peroxide and p‐anisidine values generally increased over time in the samples, including olive oil containing 0.2% α‐tocopherol. High‐oleic rapeseed oil contained the highest amount of total sterols and total phytosterol oxidation products (POPs), but during heating the total POPs content increased moderately (~10%), in contrast to the threefold increase after 12 h of heating in palm olein and refined olive oil. Very high levels of 6‐hydroxy derivatives of brassicastanol, campestanol and sitostanol and of 7‐ketobrassicasterol were observed in high‐oleic rapeseed oil samples. Addition of 0.2% α‐tocopherol during heating significantly decreased POPs formation in refined olive oil (P < 0.05).
Modified Quantitative Testing and QoL in Allergic Rhinitis
Authors: Coffey Charles S. , Harvey Richard J. , Woody Jamie I. , Koepp Sarah K. , Sheahan Patrick , Schlosser Rodney J
Published: August 2008

Objective

(1) Assess the relationship between QoL, objective assessment and confounding factors. (2) Describe a model representing the severity of pathology and predicting potential responses from therapeutic interventions beyond Quality of Life measurements alone.

Methods

A cross‐sectional study of allergic rhinitis (AR) patients, from a teritary rhinology clinic in 2007, with Modified Quantitative Testing (MQT) and Mini‐Rhinoconjuctivitis Quality of Life Questionnaire (mRQLQ) assessments was performed. Correlation and regression analyses assessed the relationship of mRQLQ, MQT endpoints, and number of reactive antigens.

Results

47 patients (53% female, mean age 36.0 ± 16.3yrs) were assessed. Percentage of positive antigens was a significant factor that decreased mRQLQ (p=0.05). Maximal MQT endpoint (mMQT) correlates well to mRQLQ when controlled for percentage of positive antigens (p=0.038). In a regression analysis to predict mRQLQ, percentage of positive antigens and mMQT were good predictors (p=0.018 for percent positive antigens; p=0.038 for mMQT) and such a model was significantly linked to those factors (F=3.2, p=0.05).

Conclusions

Semi‐quantitative measurement by MQT correlates with symptom severity in AR when broad reactivity does not exist. Adaptation in QoL scores may occur with more atopic individuals. A model for predicting QoL and symptom severity as measured by mRQLQ based upon MQT is presented. Such systems may enhance our ability to predict clinical outcomes, compare research cohorts, and better educate patients on treatment benefits.
mRAST to Quantify Allergy and Initiate Immunotherapy
Authors: Lim Keng‐Hua , Leong Jern‐Lin
Published: August 2008

Objective

Aim to quantify mRAST by comparing it with skin testing (SPT and MQT) among patients with clinically diagnosed AR for both diagnosis of inhalant allergy and initiation of immunotherapy.

Methods

A prospective randomized controlled study was designed to recruit patients with allergic rhinitis selected for screening for the initiation of immunotherapy from our outpatient clinic. Multi‐testTM skin prick testing (SPT), modified quantitative testing (MQT) and blood taken for mRAST was performed on all recruited subjected at the same setting. SPT, MQT and mRAST grading of common allergens were tested for their correlations.

Results

21 patients (12 male, 9 female) were recruited between May 2006 and Dec 2007. After comparing results from all 3 tests, 262 sets of allergens were available for analysis. We found that there was significant correlation between SPT and mRAST results (r=0.504, p<0.01). Similarly mRAST grading also correlated significantly with MQT grading ((r=0.51, p<0.01).

Conclusions

With good correlations between mRAST grading and MQT grading, in vitro testing could be the preferred mode of quantification for vial preparation during initiaition of immunotherapy. Patient would experience less pain and had no anaphylaxis risk. Both initiation and follow‐up of patient undergoing immunotherapy would be easier.
Anterolateral Thigh Flap for Skull Base Reconstruction
Authors: Hanasono Matthew M , Goel Neha , Ayad Martina , Skoracki Roman , Sacks Justin Michael
Published: August 2008

Objective

1) Review our experience with the anterolateral thigh (ALT) free flap in skull base reconstruction. 2) Describe reconstructive techniques for skull base defects and dural coverage with simultaneous facial reanimation.

Methods

A retrospective review was performed for 25 consecutive patients with defects of the skull base who were reconstructed with the ALT free flap.

Results

Reconstructed sites consisted of 2 anterior, 7 lateral, and 16 posterior skull base defects. Neoadjuvant and adjuvant radiotherapy (RT) was administered to 32% and 36% of the patients, respectively. The overall complication rate was 36% (66% recipient site and 34% donor site). One patient developed a CSF leak and one a nasocutaneous fistula. RT was associated with a two‐fold increase in wound complications relative to controls. There were no flap losses and no long‐term donor site probleMS 3 nerve grafts using the lateral femoral cutaneous nerve and 12 static slings for facial reanimation using the tensor fascia lata were performed simultaneously with free flap reconstruction from the same donor site. 4 gold eyelid weights, 2 lateral canthoplasties, and 3 direct browlifts were also performed simultaneously.

Conclusions

The ALT free flap provides reliable and versatile reconstruction of skull base defects. Primary advantages of this flap reside in the ability to harvest variable amounts of skin and vastus lateralis muscle along with nerve and fascial grafts from the same operative site, minimizing operative time and donor site morbidity. In our practice, the ALT flap represents a first‐line option for composite skull base defects.
Endonasal Access to the Orbital Floor for Blowout Fractures
Authors: Hinohira Yasuyuki , Shiraishi Atsushi , Hato Naohito , Komori Masahiro
Published: August 2008

Objective

1) Describe how to endonasally access the inferior orbital wall for the reduction surgery using endoscope. 2) Show the usefulness of the endoscopic endonasal approach for alternative to the current approaches.

Methods

Between 1997 and 2007, 41 patients with isolated inferior blowout fractures not involving the medial wall underwent surgery. The surgical treatment was determined due to persisting diplopia for 2 to 4 weeks after the trauma. In 38 of the 41 patients the reduction surgery was completed using only the endoscopic endonasal approach. To achieve the endoscopic endonasal reduction surgery, via the middle nasal meatus, septoplasty was supplemented in 7 patients and sub‐mucous conchotomy in 36. In 16 patients the inferior antrostomy was additionally required to reach the fracture site. The bone fragments entrapping the orbital content were carefully removed. An ophthalmologist verified the ocular motility improvement by eye traction test. No permanent supporting material except temporary balloon fixation was used.

Results

No surgical complications were encountered in any of the patients. Postoperatively, diplopia disappeared in 32 of the 35 patients (91.4%) followed over 6 months. No patients complained of postoperative buccal paresthesia or enophthalmos.

Conclusions

An endoscopic endonasal reduction surgery for isolated blowout fractures has so far been considered as technically difficult. Our procedure to access the inferior orbital wall comprise sinonasal surgery techniques that have been conventionally used. We conclude that the endoscopic endonasal approach can be an alternative to the extranasal methods because of safety and usefulness.
Management of Combined Deviated and Saddle Nose
Authors: Jin Hong‐Ryul , Won Tae‐Bin , Lee Hyeon‐Jong
Published: August 2008

Objective

To present the surgical algorithm and key maneuvers that were successfully applied in the correction of post‐traumatic combined deviated and saddle nose deformity.

Methods

25 consecutive patients who had undergone primary rhinoplasty in a tertiary hospital for a post‐traumatic combined deviated and saddle nose were enrolled in the study. The patterns of deformity, surgical maneuvers applied, surgical results, and complications were analyzed with chart review, interview with patients, and evaluation of the patient photographs. Mean follow‐up period was 19 months.

Results

Deviated nose combined with minor saddling that had sufficient septal support was most commonly encountered (n=18, 72%) and were treated by straightening the nose and septum, followed by simple onlay grafts. Five patients had combined deviated and saddle nose with loss of septal support (n=5, 20%) and needed septal replacement to facilitate other procedures for correction. In 2 patients (8%) showing deviation with generalized saddling with loss of septal support, an integrated dorsal graft with columellar strut was performed, bypassing the major septal reconstruction. The key maneuvers for correction were septal reconstruction (92%), bilateral osteotomies (84%), and dorsal onlay grafts (100%). No major complications were found. Objective evaluation showed complete correction of the deviation and saddling in 84%, persistent deviation but less than before surgery in 12%, mild residual saddle in 4%.

Conclusions

Establishing a straight and firm septum supporting the overlying nasal structures is the most important step in correction of post‐traumatic combined deviated and saddle nose.
Novel STSG Donor Site for Forearm Flaps: Radial Skin Paddle
Authors: Ghanem Tamer Abdel‐Halim , Wax Mark K
Published: August 2008

Objective

Split thickness skin grafts (STSG) harvested from the thigh are often utilized to provide coverage for radial forearm donor sites. To eliminate the morbidity of the thigh STSG donor site, we assessed the feasibility of harvesting the STSG from the radial.

Methods

Prospective data was collected from patients undergoing forearm free flap reconstruction at a tertiary medical center in a 6‐month period. The radial forearm free flap (RFFF) harvesting procedure was modified to incorporate STSG harvest from the paddle site as the first step after arm tourniquet activation.

Results

There were 27 patients in this cohort, with mean age of 68.2. There were 24 fasciocutaneous RFFF, 2 osteocutaneous RFFF, and 1 ulnar flap. The indications for free tissue transfer were as follows: intraoral defects (n=13), pharyngeal patch repair (n=8), total laryngopharyngectomy (n=1), external skin coverage (n=5). The mean forearm defect was 41.2 cm2 (24–77 cm2). 22 out of 27 skin grafts were non‐meshed. Harvesting from the forearm skin paddle was successful in 25 patients (93%). Two patients required a thigh STSG; both patients were octagenerians with frail skin. All the forearm donor sites healed well, except one patient required a later revision procedure for exposed tendon.

Conclusions

Based on this study, the thigh STSG donor site can be eliminated in 9 out of 10 patients undergoing radial forearm free flaps. This translates to decreased risk of pain, infection, and wound oozing. Older patients with frail skin and atrophied forearm muscles were likely to require a thigh donor site.
Ocular Outcomes after Gold Weight and Facial Nerve Resection
Authors: Razfar Ali , Afifi Ahmed , Manders Ernest Kelvin , Myers Eugene N , Johnson Jonas T , Deleyiannis Frederic
Published: August 2008

Objective

1) To assess the effectiveness of acute gold weight placement following facial nerve resection. 2) To determine the role of concomitant lower eyelid procedures.

Methods

22 patients who received an upper eyelid gold weight at the time of parotidectomy and facial nerve resection were retrospectively reviewed (mean follow‐up: 23 months). Outcomes included the assessment of eye closure, gold weight complications (i.e., extrusion, need to upsize weight), ectropion, and need for tarsal strip procedure.

Results

The range of gold weight size used was 1–1.4 (g), where 1.2 g was the predominant size used (18/22). 12 patients (12/22, 54.5%) presented with ocular symptoms following gold weight placement. Within these 12 patients, 9 presented with lower lid ectropion, 5 with lagopthalmos, and 6 with corneal exposure. 9 of the 12 patients subsequently received a tarsal strip procedure. The mean time to lower eyelid procedure was 14.2 months (range: 0–61) following gold weight placement. 6 patients, in addition to a gold weight, also underwent a static sling to the midface at the time of facial nerve resection. None of these 6 patients received subsequent lower eyelid procedure. Two patients required gold weight upsizing. Two patients required weight removal because of exposure.

Conclusions

Insertion of 1.2 gm upper eyelid weight with concomitant placement of midface sling is recommended at the time of acute facial nerve resection. Due to the need to tighten the lower eyelid in a majority of patients, we now also recommend performing a tarsal strip procedure at the time of facial nerve resection.
TGF‐β1 Modulates HGF/SF in Keloid Fibroblast Cell Culture
Authors: Naim Ramin , Naumann Andreas , Barnes James , Sauter Alexander , Hormann Karl , Bloching Marc
Published: August 2008

Objective

Abnormal wound healing processes can result in hypertrophic scars and keloids. TGF‐β1 and HGF/SF are biphasic growth factor cytokines in physiological and pathophysiological conditions. TGF‐β1 has been found to be pivotal in the formation of keloid tissue and therefore neutralising antibodies may allow wound healing without keloid formation. TGF‐β1 has been reported to be antagonised by HGF/SF. Some authors have reported that exogenous administration of HGF/SF prevented scar formation. Hence in this study, we targeted TGF‐β1 and determined the levels of HGF/SF in fibroblast cell culture.

Methods

Keloid tissue was taken from 7 patients while another 7 patients with mature non‐hypertrophic scar served as controls. All tissues were cultured and fibroblast cultures were used for further experiments. TGF‐β1 antisense was administered at 3 and 6 μmol/ml and HGF/SF levels were determined after 16, 24 and 48 hours of incubation.

Results

The levels of HGF/SF showed significant differences after incubation with antisense oligonucleotides. The increasing antisense levels resulted in increased HGF/SF levels (up to 87.66pg/ml after 48 hours of incubation).

Conclusions

In conclusion, targeting TGF‐β1 resulted in significantly increased levels of HGF/SF. The clinical relevance could include the use of locally administered HGF/SF in protein or gene form to minimise keloid formation. Nevertheless, wound healing is the result of many interacting cytokines and therefore neutralising or targeting one protein could result in no significant effect.
Electrocautery Adenoidectomy Outcomes: A Metaanalysis
Authors: Reed Jeremy T. , Sridhara Shankar K. , Brietzke Scott E
Published: August 2008

Objective

Review and assess the current published literature regarding clinical outcomes of suction electrocautery adenoidectomy (ECA) in pediatric patients.

Methods

The MEDLINE database was systematically reviewed for articles reporting on the use of ECA. Inclusion criteria included English language, sample size greater than 5, and presentation of extractable data regarding pediatric outcomes with ECA. Random effects modeling was used to estimate summary outcomes.

Results

9 studies met the inclusion criteria. There were 2 level 1b studies, 2 level 3b studies, and 5 level 4 studies. The mean sample size was 276 patients with a grand mean age of 6.0 years. Random effects modeling of summary estimates of intra‐operative hemorrhage (4.1 cc vs. 24.0 cc 95% CI of difference = 16.5–23.1, p<0.001) and operative time (10.0 minutes vs. 11.9 minutes 95% CI of difference=0.82–2.90, p<0.001) favored ECA vs. traditional curette adenoidectomy. Subjective success was reported in 95.0% (95% CI=92.7–97.3%, p<0.001) of ECA patients with a grand mean of 5.8 months of postoperative follow‐up and a grand mean lost to follow‐up rate of 23.2%. Adenoid regrowth was evaluated objectively (endoscopy or X‐ray) in only 116 of 2,132 (5.4%) total patients with an observed regrowth rate of 2.8% (95% CI=0–5.5%, p=0.052) with 846 total person years of follow‐up.

Conclusions

The preponderance of evidence favors ECA versus curette adenoidectomy in terms of decreased intraoperative hemorrhage and decreased operative time. Long‐term outcomes data for ECA are scarce, despite the fact that the procedure is likely performed hundreds of times each day, but suggest a low regrowth rate.
Is Surgical Innovation Reduced with More Strict Regulations?
Authors: Rosow David E , Likhterov Ilya , April Max M , Stewart Michael G
Published: August 2008

Objective

With ever‐increasing regulatory requirements on human subject research, we postulated that there would be a corresponding decline in the number of published reports of surgical innovation in the otolaryngology literature.

Methods

We defined innovations as new procedures, techniques, or approaches that should require IRB approval in 2007, and modifications as non‐substantive changes in existing procedures or techniques that should not require IRB approval. We reviewed every abstract from 4 months of the years 1988 and 2006, from the journals Laryngoscope, Oto‐HNS, and Archives. After identifying information was concealed, abstracts were reviewed and classified independently by two authors, for innovation, modification, or neither. All disagreements were judged by a third author, who reviewed the entire article. Proportions were compared using chi‐square analysis.

Results

There were 367 publications reviewed from 1988, and 548 from 2006. The proportion of articles representing either innovation or modification was significantly lower in 2006 than 1988: 59/548 (10.8%) vs. 67/367 (18.3%), p<0.001. Eliminating radiology and pathology quiz cases yielded similar results: 11.1% vs. 18.9%, p<0.001. Very few articles (4 total) were classified as innovation.

Conclusions

The proportion of published studies describing surgical innovations and modifications was significantly lower in 2006 than in 1988. One cause of this decrease in innovation could be increased barriers for research approval in the current era. However, other explanations are plausible, such as increased publication of other study types, e.g., basic research. While our analysis does not prove cause and effect, it is an important finding that deserves further study.
Post‐Tonsillectomy Hemorrhage Diagnosis and Management
Authors: Morris Michael S
Published: August 2008

Objective

1) Better recognize pathophysiology of postoperative tonsillectomy hemorrhage. 2) Be able to better differentiate the different types of post‐tonsillectomy hemorrhage based upon understanding the vascular physiology and adjust management accordingly.

Methods

Post‐tonsillectomy complications in children and adults were reviewed. 7 cases of hemorrhage, including 5 deaths, were carefully reviewed. Patients ranged between 2–40 years of age. This represents the largest series of post‐tonsillectomy deaths reported to date. All postoperative deaths were due to bleeding and cardiopulmonary arrest. Post‐mortem analysis was undertaken on those patients. CT angiography was reviewed in one surviving patient and the utility of this type of scanning is discussed.

Results

Post‐tonsillectomy bleeding is one of the most worrisome otolaryngology concerns. Patients with bleeding on postoperative days 2–3 reported episodic bleeding stopping spontaneously. In these patients, the episode of unobserved bleeding signaled a vascular spasm with a likehood of recurrence. When the bleeding recurred it was massive and occured in a uncontrolled setting, leading to a poor outcome. Vascular trauma and spasm is likely.

Conclusions

Postoperative tonsillectomy bleeding is better managed by differentiating those patients with early stage bleeding on postoperative days 2–3. Direct examination of the operative field is imperative. Ancillary testing including CT angiograpy is helpful in the evaluation.
Cell Penetrating Peptide Uptake by Human Tissue
Authors: Vorasubin Nopawan , Nguyen Quyen To , Olson Emilia , Aguilera Todd A , Jiang Tao , Tsien Roger Y
Published: August 2008

Objective

1) Assess activatable cell penetrating peptide (ACPP) uptake by human tissue. 2) Compare ACPP uptake in normal and cancer tissue.

Methods

ACPPs are peptides that become activated for cellular uptake by cleavage in the presence of specific proteases. Fluorescently tagging ACPPs and designing a cleavage site recognized by proteases abundant in cancer allows for selective uptake and imaging. Cleavable ACPPs consist of L‐amino acids linkers, while uncleavable linkers consist of corresponding D‐isomers. To assess ACPP uptake by human tissue, we imaged freshly ressected surgical specimens following incubation with ACPP. Uptake was analyzed by measuring average fluorescent intensities (AFI) for histologically identified areas of cancer and normal tissue. Standardized uptake value (SUV) measurements, which represents fluorescence uptake per given tissue weight, and zymography were also performed.

Results

Average cancer‐to‐normal AFI ratio when treated with cleavable ACPP was 2.6±0.6 (p=0.003) and with uncleavable control was 1.4±0.5 (p=0.5). Considering cancer tissue alone, average AFI was 22.5 ±2.2 when treated with cleavable and 11.4 ±1.2 when treated with uncleavable ACPP (p=0.004). Tissue SUV when treated with cleavable ACPP was 2.5±0.8mg‐1, whereas tissue treated with control ACPP was 1.7±1.0mg‐1 (p=0.24). Zymography results show that inactive protease is ubiquitous in cancer and normal tissue while active form is more abundant in cancer.

Conclusions

In freshly resected human cancer tissue, uptake of cleavable ACPP is ∼2‐fold greater than that of uncleavable ACPP. Furthermore, cleavable ACPP uptake is ∼2.5‐fold greater in cancer compared to normal tissue. This differential uptake can potentially be used for in vivo imaging of cancer to guide surgical resection.
Defining Success of Parathyroidectomy in Hyperparathyroidism
Authors: Dolev Yalon , Black Martin J , Hier Michael P , Tamilia Michael , Payne Richard J
Published: August 2008

Objective

To clearly define what constitutes successful parathyroidectomy in patients with primary hyperparathyroidism and to review our institution's results.

Methods

A retrospective chart review was conducted for consecutive patients who underwent parathyroidectomy at a university‐affiliated tertiary care center between January 1998 and February 2006. Intraoperative pre‐ and post‐excision PTH levels were recorded. PTH and calcium levels were recorded at 3 – 6 month intervals in the first 2 years and then yearly.

Results

84 patients were analyzed. 50 (60%) had normal calcium and normal PTH levels following surgery, 28 (33%) had normal calcium and elevated PTH following surgery, and 6 (7%) had both elevated calcium and PTH. The mean follow‐up time was 2.23 years, with a range of 0.25 to 5 years.

Conclusions

Surgery was successful, as indicated by normocalcemia, in 78 patients (93%). Of these 78 patients, 28 (33%) developed persistent PTH elevation without developing hypercalcemia. Other studies have studied this subgroup of patients with normalized post‐operative calcium and consistently elevated PTH levels and noted that these new set points persist. Consequently, successful parathyroidectomy should be defined by serum calcium and not PTH levels.
Efficacy of Flutamide in Nasopharyngeal Angiofibroma
Authors: Thakar Alok , Gupta Gaurav , Seith Ashu
Published: August 2008

Objective

To assess the efficacy and safety of Flutamide (androgen receptor blocker) as an adjuvant therapy for presurgical tumor volume reduction in cases of Juvenile Nasopharyngeal Angiofibroma (JNA).

Methods

Therapeutic trial, Janurary‐December 2007. 10 previously untreated cases of JNA (Radkowski stage IIC‐IIIB) were administered Flutamide (10 mg/kg in 3 divided doses) for 6 weeks prior to surgical excision. Pre‐ and post‐therapy tumor volume assessment undertaken by MR Imaging. All cases had periodic liver function tests and assessment of primary and secondary sexual characteristics continuing till 6 months post‐therapy.

Results

Pre‐pubertal cases had inconsistent and minimal responses to Flutamide. All 7 post‐pubertal cases (as indicated by age and serum testosterone levels) however, demonstrated consistent tumor volume reduction ranging from 6% to 35% (mean 16.6 %). Two cases with optic nerve compression had significant improvements in visual acuity and visual fields. No adverse effect was noted excepting for mild and transient breast tenderness.

Conclusions

Preoperative use of Flutamide is safe and leads to partial tumor regression in post‐pubertal patients. The regression of the tumor away from adjacent vital structures may facilitate surgical excision and limit complications.
Hemorrhagic Shock and Death following Tonsillectomy
Authors: Windfuhr Jochen P. , Schloendorff Georg , Baburi Diwa , Kremer Bernd
Published: August 2008

Objective

Evaluate the incidence and clinical course of serious bleeding complications following tonsillectomy, in terms of hemorrhagic shock and death.

Methods

Cases with lethal outcome or presenting with hemorrhagic shock, requiring resuscitation or major medical treatment between 1980 and 2007, were collected based on personal experiences and material collected after a plea published in a national journal.

Results

113 cases were eligible for further analysis, comprising 30 cases with lethal outcome (19 children, 11 adults). 83 patients had experienced serious bleeding complications (36 children and 43 adults; age not stated for 4 patients). Of the 133 patients, only 10 experienced primary bleeding (<24 h) including one case with lethal outcome. Repeated episodes of PTH occurred in 91 patients, including 19 cases with lethal outcome.

Conclusions

Repeated episodes of bleeding classified the majority of the clinical courses studied. Only few cases experienced bleeding complications in the early phase after surgery. It appears as if children are over‐represented in our study, suggesting that they are more at risk to experience serious bleeding complications. Gender appears not to be a risk factor. Secondary post‐tonsillectomy hemorrhage (>24h) can no longer be assessed to be less dangerous than primary bleeding.
Improved Quality of Life in Patients Treated with ChemoIMRT
Authors: Mowry Sarah , Sadeghi Ahmad , Tang Christopher , Wang Marilene B
Published: August 2008

Objective

To identify differences in quality of life between patients with advanced oropharyngeal cancer following traditional opposed port chemoradiation (CRT) vs. chemotherapy with intensity modulated radiation therapy (CIMRT).

Methods

A cohort study from academic tertiary referral center was performed. 50 patients were identified from an institutional database of patients who had undergone primary chemotherapy and radiation (traditional or IMRT) for advanced oropharyngeal carcinoma. Patients responded via mail using the University of Washington quality of life instrument version 4 (UW‐QOLv4). Data was analyzed using chi‐square and Wilcoxon tests.

Results

17 CRT patients responded (57%), and 14 CI‐MRT patients responded (70%). Patients completed the survey between 9 and 44 months following end of treatment. When adjusted for tumor stage and time since treatment, CIMRT patients reported improved appearance (p = 0.05), chewing (p = 0.02), and mood (p = 0.01). There was a trend toward significance for improved activity (p = 0.07), recreation (p = 0.07), and anxiety (p = 0.08). There were no differences between the 2 groups for saliva, taste, shoulder function, speech, and swallowing. There was a trend for significance for improved overall quality of life in patients who had undergone CIMRT (p = 0.06).

Conclusions

Many patients with advanced oropharyngeal carcinoma are being treated with primary chemoradiation. CIMRT results in improved quality of life for some domains but surprisingly not for swallowing or saliva. Patients undergoing CIMRT also report slightly better quality of life overall when compared to patients receiving more traditional forms of radiation therapy.
Micropapillary Thyroid Carcinoma and Hashimoto's Thyroiditis
Authors: Pakdaman Michael Navid , Hier Michael P , Black Martin J , Tamilia Michael , Payne Richard J
Published: August 2008

Objective

An increase in papillary thyroid carcinoma in patients with Hashimoto's thyroiditis has been described. We have yet to find literature discussing a relationship with micropapillary thyroid carcinoma(MPC). Our objective is (1) to assess the relationship between Papillary Microcarcinoma and Hashimoto's Thyroiditis in thyroids without malignant disease, (2) compare effect of the presence of Hashimoto's on prognostic factors in patients.

Methods

Pathology reports were reviewed for consecutive patients undergoing total thyroidectomy over a 6‐year period from 2002 to 2007. Patients with benign pathologies were included. Patients with MPC and no other malignancy were also included. This lead to a cohort of 314 patients. Statistical significance was calculated using Fisher's exact test and a chi‐squared analysis.

Results

Out of the 314 patients, 98 were positive for Hashimoto's thyroiditis on biopsy of the removed thyroid. 58% of the patients with Hashimoto's thyroiditis had an incidental MPC, as compared to 42% of patients where Hashimoto's was not found. Additionally, in Hashimoto patients, 61% of the MPCs were multifocal versus 43% multifocal in the non‐Hashimoto group (p‐value <0.05 in each comparison). Bilaterality of MPC was also increased in patients with Hashimoto's (22% vs 39%).

Conclusions

Patients with Hashimoto's thyroiditis in this study had an incidence of MPC of 58%, which is significantly greater than the 42% in those without. Hashimoto's was also associated with an increased risk of bilaterality and multifocality. Studies are needed to further corroborate these findings.
Minimally Invasive Video‐assisted Thyroidectomy: 2 Yrs Work
Authors: Snissarenko Eugene P. , Kim Grace H , Simental Alfred A , Zwart Jon E. , Ransbarger Darron M. , Kim Paul Dae‐Gwon
Published: August 2008

Objective

The minimally invasive video‐assisted thyroidectomy (MIVAT) technique was first pioneered in Europe in the 1990s. It has shown to have comparable results to traditional thyroidectomy and additional advantages such as better cosmetic results as well as faster recovery. This project aims to analyze the results from the MIVAT procedure utilizing a 2‐person technique over the initial 2 years of inception at an academic training center.

Methods

Retrospective review of 170 cases between May 2006 and September 2007 at LLUMC. The demographic and clinical data collected includes age, sex, incision, operative times, hospitalization, identification of recurrent laryngeal nerves, pathology, size of the dominant nodule and entire gland, and postoperative complications.

Results

23 male and 147 female patients underwent MIVAT by a single surgeon; of those, 59 total thyroidectomies and 111 hemithyroidectomies were performed. The mean incision length was 3.5cm. The average weight/volume on pathology was 19.25g/19cm3, 21.03g/22cm3 and 31.29g/40cm3 for the right lobe, left lobe, and entire gland respectively. Average nodule size was 3.6cm3. The mean surgical time was 91.7 minutes and the mean blood loss was 31cc. Average hospitalization stay was 1.43 days. 17 patients experienced temporary hypocalcemia, and 1 patient remained hypocalcemic for more then 6 months. Two patients experienced transient pitch problems, 7 patients experienced temporary unilateral vocal cord paresis, and 1 patient experienced mild diplophonia.

Conclusions

While enabling smaller surgical access for thyroidectomy, 2‐surgeon technique MIVAT can be performed safely and quickly. Voice problems were the most common complications that usually resolved in 8 weeks.