bluuebunny/crossref_metadata_2025 huggingface dataset:
Inducible Nitric Oxide Synthase Expression in Pharyngeal Squamous Cell Carcinoma: Relation to p53 Expression, Clinicopathological Data, and Survival
Authors: Pukkila Matti J. , Kellokoski Jari K. , Virtaniemi Jukka A. , Kumpulainen Eero J. , Johansson Risto T. , Halonen Pirjo M. , Kosunen Ari S. T. , Nuutinen Juhani , Kosma Veli‐Matti
Published: November 2003

Objective To investigate the expression of inducible nitric oxide synthase (iNOS) in oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC) and its relation to p53 expression, histologic differentiation, clinical data, and prognosis.

Study Design A retrospective survey.

Methods Primary tumors for analyses were obtained from 118 patients diagnosed with SCC of the oropharynx or hypopharynx between 1975 and 1998 in eastern Finland. Immunohistochemical analysis was used to evaluate the expression of iNOS and p53. The expression pattern of iNOS was related to p53 expression, clinical data, and survival.

Results High iNOS score was associated significantly with high nuclear p53 expression index (P = .006) and positive cytoplasmic p53 expression (P =.025). The score for iNOS expression was significantly lower in the largest (T4) tumors (P = .043). No association was seen between iNOS score and N or M class, tumor stage, or histologic differentiation. The score for iNOS expression was not related to overall survival.

Conclusions The expressions of iNOS and p53 seem to be inter‐related in pharyngeal SCC, although the causality remains to be clarified. The expression of iNOS shows no prognostic value in pharyngeal SCC.
Endoscopic Resection of the Submandibular Gland in a Porcine Model
Authors: Monfared Ashkan , SÁenz Yamil , Terris David J.
Published: November 2003

Objective To examine the feasibility of endoscopic resection of the submandibular gland in a porcine model.

Study Design Experimental, nonrandomized prospective study.

Methods Twelve endoscopic submandibular gland resections were performed on seven Yorkshire adult pigs using a combination of balloon dissection and low‐pressure CO2 insufflation. The operative time, blood loss, blood pressure, oxygen saturation, temperature, arterial blood gas values, and weight of the glands were measured.

Results All 12 submandibular gland resections were successfully performed endoscopically, and no conversions to open resection were necessary. The procedures lasted 42 to 140 minutes (median duration, 59 min). The median estimated blood loss was 15 mL. The submandibular glands weighed 13.3 ± 1.5 g. The arterial blood pH varied from a decrease of 0.08 to an increase of 0.09 units from the beginning to the end of the operation. Similarly, the arterial CO2 pressure at the end of the case varied from a decrease of 15.8 to an increase of 16.2 mm Hg from the starting value. The presence of normal glandular architecture and lack of trauma or thermal injury were confirmed histologically. There were no cases of pneumothorax or air embolism, and no animals had to be killed. In one animal, a modest amount of subcutaneous emphysema could be appreciated, which was confined to the area over the operative pocket.

Conclusion Endoscopic resection of the submandibular gland is possible by combining balloon dissection with low‐pressure CO2 insufflation, thereby avoiding complications of high‐pressure insufflation such as pneumothorax and air embolism.
Global Genetic Differences in Squamous Cell Carcinoma of the Head and Neck
Authors: Ell Stephen R. , Ashman James E. , Stafford Nicholas D. , Greenman John
Published: November 2003

Objectives/Hypothesis The objectives are to determine the frequency of chromosomal aberrations in 22 patients in the United Kingdom with head and neck squamous cell carcinoma and to compare our results with studies reported from western Europe and North America and highlight changes common to all groups, thus enabling focused study of important gene loci.

Study Design Prospective experimental, then comparative observational study.

Methods Comparative genomic hybridization was used to detect regions of chromosomal gain or loss across the entire genome. The aberration frequency was contrasted with other published series, and similarities and differences were highlighted.

Results The most common chromosomal gain in all studies was 3q (50% to 87%). Other common chromosomal gains varied considerably between centers. The most common loss was 3p in three of the studies; one group in the United States reported 19p loss most frequently. The frequency of other losses varied considerably.

Conclusions Comparative genomic hybridization has highlighted a number of common genetic events in head and neck squamous cell carcinoma. The prevalence of individual aberrations differed between centers. Further cooperative multicenter studies of this technique are warranted.
Stapedectomy Revision in Elderly Patients
Authors: Lippy William H. , Wingate Jennifer , Burkey John M. , Rizer Franklin M. , Schuring Arnold G.
Published: November 2003

Objective the objective was to determine the effectiveness of stapedectomy revision in patients 65 years of age or older. Although stapedectomy revision has been discussed in the literature, as well as primary stapedectomy surgery for elderly patients, we could find no study dedicated to stapedectomy revision in elderly patients.

Study Design Retrospective.

Methods One hundred twenty patients 65 years of age or older who had a stapedectomy revision between 1980 and 2001 were included. A randomly selected group of 120 patients younger than 65 years of age who had stapedectomy revision were included for comparison. Audiometric results were compared for the two groups. Surgical findings for each group are also discussed.

Results The mean pure‐tone average hearing improvement for each group was 17.6 dB. The success rate was 70.8% for the elderly group and 67.6% for the younger group. Surgical findings during revision in elderly patients were generally the same as those found for younger patients.

Conclusion Advanced age should not be seen as a contraindication to stapedectomy revision.
No Effect of a Nasal Decongestant on Eustachian Tube Function in Children With Ventilation Tubes
Authors: van Heerbeek Niels , Ingels Koen J. A. O. , Zielhuis Gerhard A.
Published: November 2003

Objective The aim of the study was to assess the effect of a topical decongestant on eustachian tube function in children with ventilation tubes because of persistent otitis media with effusion.

Study Design A randomized, double‐blinded, placebo‐controlled study.

Methods At the outpatient departments of a secondary referral hospital and a tertiary referral hospital, eustachian tube function was measured before and after intranasal administration of five drops of 0.05% xylometazoline hydrochloride or placebo in 80 randomly selected children with ventilation tubes because of otitis media with effusion.

Results Xylometazoline nose drops had no effect on the ventilatory or the protective function of the eustachian tube.

Conclusions Topical decongestants do not have a positive effect on eustachian tube function in children. Therefore, the use of topical decongestants to prevent or treat otitis media with effusion in children is not justified and should be discouraged.
Cochlear Implantation With Large Vestibular Aqueduct Syndrome
Authors: Miyamoto Richard T. , Bichey Bradford G. , Wynne Michael K. , Kirk Karen I.
Published: November 2003

Objectives In this investigation, we report the outcomes of 14 adults (age >18 y) and 9 children (age <18 y) with radiographically proven large vestibular aqueduct syndrome (LVAS) who received cochlear implants at Indiana University School of Medicine.

Study Design This is a retrospective case‐control study detailing the outcomes of 23 patients with LVAS and 46 control patients implanted with Nucleus (Cochlear Corp., Englewood, CO), Clarion (Advanced Bionics Corp., Sylmar, CA), or Med‐El (MED‐EL Corp., Innsbruck, Austria) cochlear implants.

Methods Performance data on pure‐tone averages, speech detection thresholds, and a variety of auditory and speech recognition tasks from these patients with LVAS were compared with performance data obtained from a matched group of 46 cochlear implant users who did not have LVAS. Specific patient characteristics used in matching included the age of the patient, the age at implant of the patient, and whether the patient was pre‐ or postlingually deafened. Data for the adult group was analyzed using the Student t test, and data for the pediatric patient group was compared using a χ2 test.

Results The results indicated positive outcomes for both pediatric and adult groups. With both adult and pediatric groups, auditory and speech recognition performance did not differ significantly between those patients with LVAS and control subjects.

Conclusions This study adds further support for the use of cochlear implantation in patients with LVAS. Cochlear implantation is beneficial and can be offered as an eventual treatment of LVAS if hearing loss progresses to profound levels in these patients.
The Superior Turbinate as a Source of Functional Human Olfactory Receptor Neurons
Authors: Lane Andrew P. , Gomez George , Dankulich Tatyana , Wang Hongyan , Bolger William E. , Rawson Nancy E.
Published: November 2003

Objectives The function of human olfactory receptor neurons (ORNs) remains incompletely understood, in part because of the difficulty of obtaining viable olfactory tissue for study. During endoscopic sphenoidotomy, a portion of the superior turbinate is often removed to achieve wide and safe access to the sphenoid sinus. The purpose of this study was to determine whether functional olfactory mucosa could be obtained from such superior turbinate tissue.

Study Design/Methods Superior turbinate tissue was resected from 4 patients undergoing transnasal endoscopic approaches to the sphenoid sinus. The gross appearance of the turbinate mucosa was normal at the time of surgery. The specimens were placed directly into cold cell culture media and transferred to the laboratory. A portion of the mucosa was fixed and embedded for histology and immunohistochemistry. The remaining tissue was enzymatically dissociated, and the resulting cell suspension was either prepared for immediate calcium imaging or placed into cell culture. Cultured ORNs underwent calcium imaging after several weeks to assess their ability to respond to odorants.

Results Histologic analysis of superior turbinate tissue revealed the presence of patchy olfactory neuroepithelium staining positive for olfactory marker protein. Acutely dissociated ORNs were capable of generating calcium responses to odorant mixtures. ORNs could be maintained in mixed culture and retained their ability to respond to odorants.

Conclusions Superior turbinate tissue removed during endoscopic sphenoidotomy can provide a valuable source of human olfactory neuroepithelium for functional or histologic study. Superior turbinate tissue yields stem cells and immature neurons capable of differentiating into ORNs that retain many of their functional characteristics even after growth in culture.
Presence of Cysteinyl Leukotrienes in Asthmatic Patients With Chronic Sinusitis
Authors: Arango Pablo , Kountakis Stilianos E.
Published: November 2003

Introduction The association between asthma and sinusitis has long been recognized. Numerous studies point to a complex, yet undeniable relationship between asthma and chronic sinusitis and rhinitis. There have also been extensive attempts to characterize the inflammatory mechanisms of both disorders. Increasingly, the cysteinyl leukotrienes, a potent group of inflammatory mediators, have gained attention as important contributors to the manifestation of both disorders. Leukotriene production has been shown to be upregulated in the bronchial tissue of asthmatics. Our study sought to determine if leukotriene production was increased in the sinus mucosa of asthmatics with chronic sinusitis.

Study Design Prospective study.

Methods Nasal polyp tissue was evaluated from 27 consecutive patients undergoing elective polypectomy. The presence of asthma was determined by patient history, their medical record, and use of asthma medication. Sinus tissue was extracted during the course of endoscopic surgery. Cysteinyl leukotrienes (CysLT) were quantified by a sensitive competitive enzyme immunoassay, and the levels of CysLT were compared in the group with and without asthma.

Results Cysteinyl leukotrienes were detected in 23 of 27 patients. The average level of LTC4 in non‐asthmatic patients was 25.6 picograms (pg)/g. The average amount of LTC4 in asthmatic patients with sinusitis was 19.2 pg/g. There was no significant difference between the two groups (P = .64).

Conclusions The presence of asthma does not correlate with increased levels of leukotrienes in the sinus mucosa of patients with chronic sinusitis.
Inverted Papilloma of the Sphenoid Sinus Presenting With Auditory Symptoms: A Report of Two Cases
Authors: Eisen Marc D. , Buchmann Luke , Litman Richard S. , Kennedy David W.
Published: November 2003

Objectives The report aims to inform the reader of cases of inverted papilloma involving the sphenoid sinus presenting with auditory symptoms.

Study Design Case series.

Methods A retrospective medical record analysis was carried out to identify patients with inverted papilloma involving the sphenoid sinus that presented with a primary complaint of hearing loss or tinnitus, or both. Clinical records, including initial history and physical examination, audiologic and radiologic studies, and operative and histopathologic reports, were carefully examined. A complete literature review for relevant studies was performed to explore possible pathophysiologic factors and similar cases.

Results Two patients with inverted papilloma presenting with primary auditory complaints were identified. One patient had roaring tinnitus and sensorineural hearing loss demonstrated with audiologic assessment, whereas the other had pulsatile tinnitus. Both patients had biopsy‐proven inverted papilloma involving the sphenoid sinus, and both patients underwent endoscopic resection of the disease. No other cause or origin of their auditory symptoms was confirmed. The auditory symptoms of both patients improved markedly after excision of their inverted papillomas.

Conclusions Tinnitus with or without hearing loss is an unusual presentation of inverted papilloma of the sphenoid sinus. Sphenoid tumors should be considered in the workup of these symptoms.
Evaluation of Endotracheal Tube Safety for CO2 Laser Resurfacing
Authors: Ferguson John C. , Carr Rebecca T. , Chang Edward W. , Farrior Edward H.
Published: November 2003

Objectives The new generation carbon dioxide lasers have become popular as a result of their ease of use and consistent results. Their use is becoming widespread with both the experienced laser surgery clinician and those just venturing into the realm of laser resurfacing. The purpose of this study was to evaluate the safety of the common PVC endotracheal and one designed for laser procedures if contacted by the CO2 laser during resurfacing. In addition, the cost and efficacy of a simple covering to the PVC tube was assessed.

Study Design Endotracheal tubes were subjected to multiple passes of the Coherent Ultrapulse laser system while recording tube effect and intraluminal temperature.

Method With the highest energy densities used in our practice, multiple passes were made over both PVC and Xomed Laser‐Shield II endotracheal tubes with 100% intraluminal oxygen. Thermocouplers recorded both inflow and outflow temperatures. The procedure was repeated with PVC endotracheal tubes covered with saline‐soaked sponges held in place with netting.

Results Charring of the PVC tube occurred after 1 pass, and intraluminal smoke was present after 21.6 passes. The Laser‐Shield II and the wrapped PVC tube did not show significant charring or tube lumen breach after up to 200 passes. The prepared PVC tube was $105.14 less than the commercial tube.

Conclusions Our method of PVC endotracheal tube preparation provides a safe, inexpensive, reliable airway during CO2 laser resurfacing.
Argon Plasma Coagulation (APC) in Palliative Surgery of Head and Neck Malignancies
Authors: Hauser Ulrich , Hoffmann Thomas K. , Balló Hilmar , Bier Henning
Published: November 2003

Objectives Surgical reduction of bulky disease is an important treatment option in patients with incurable head and neck malignancies. In general, conventional tumor ablation is associated with significant hemorrhage, and the resulting tumorous wound surface entails aftercare problems. Argon plasma coagulation (APC) represents a novel technique providing effective hemostasis and wound sealing. Thus, APC features requirements of particular interest in palliative surgery of the head and neck.

Study Design Using APC, we performed 18 palliative tumor resections in a series of 8 consecutive patients with recurrent head and neck lesions. Five patients received repeated APC treatment up to five times.

Methods APC as non‐contact, high‐frequency electrosurgery under inert argon plasma atmosphere allows dissection, hemostasis, and desiccation of tumor tissue in a one‐step procedure. In consideration of the limited and heterogeneous group of patients, results are interpreted descriptively.

Results In every case of palliative surgery, APC caused efficient hemostasis, which helped significantly to reduce both time exposure of the operation and intraoperative loss of blood. Only one APC‐unrelated complication occurred (transient rhino‐liquorrhea), and none of the patients developed postoperative hemorrhage. Finally, APC produced dry and clean wound surfaces facilitating surgical aftercare. The achieved esthetic and functional improvements strengthened the patient's autonomy and social acceptance.

Conclusion APC is highly recommended for palliative surgery of head and neck malignancies.
Immune Reactivity Does Not Predict Chemotherapy Response, Organ Preservation, or Survival in Advanced Laryngeal Cancer
Authors: Wolf Gregory T. , Bradford Carol R. , Urba Susan , Smith Allison , Eisbruch Avraham , Chepeha Douglas B. , Teknos Theodoros N. , Worden Frank , Dawson Laura , Terrell Jeffrey E. , Hogikyan Norman D.
Published: November 2003

Objective To determine whether pretreatment lymphocyte subpopulations correlate with tumor response to induction chemotherapy as part of an organ preservation treatment approach in patients with advanced laryngeal cancer.

Study Design A prospective clinical trial in patients with advanced laryngeal cancer was undertaken to determine whether the frequency of late salvage laryngectomy and overall survival could be improved using one cycle of neoadjuvant chemotherapy to select patients for organ preservation. Pretreatment peripheral blood lymphocyte subpopulations for CD3, CD4, CD8, NK, and B cells were correlated with tumor response to induction chemotherapy, larynx preservation, and survival, to determine whether immune parameters could be useful in patient selection.

Methods The study setting was a tertiary referral academic health center. Studied were 53 patients with stage III (42%) or IV (57%) larynx cancer. Most patients had supraglottic cancers (73%) and positive clinical nodes (51%). Sixty‐eight percent had greater than 50% tumor response after one cycle of induction chemotherapy and then received concurrent chemoradiation and two cycles of adjuvant chemotherapy. Lymphocyte subpopulations were measured in 39 patients. Mean follow‐up was 23.3 months (range, 5–61 mo).

Results A total of 18 (34%) patients underwent laryngectomy. Only 4 cases were late salvage resections (13–35 mo after treatment). Fourteen cases were planned surgery after initial chemotherapy. Of the lymphocyte subpopulations measured, CD8 levels were significantly lower in stage IV patients and tended to be lower in patients with successful organ preservation. However, no significant differences in lymphocyte subpopulations were found among responders and nonresponders to chemotherapy. Overall survival was 88%.

Conclusions One cycle of neoadjuvant chemotherapy was effective in selecting patients for organ preservation. The regimen of definitive concurrent and adjuvant chemotherapy was associated with an unexpectedly high 2‐year survival rate. Lymphocyte subsets were not significant predictors of responding patients or survival. Further study of other biological markers useful in selecting patients for organ preservation are needed.
High‐Dose‐Rate Brachytherapy in the Treatment of Recurrent and Residual Head and Neck Cancer
Authors: Glatzel Michael , Büntzel Jens , Schröder Dirk , Küttner Klaus , Fröhlich Dietmar
Published: November 2003

Objectives/Hypothesis Interstitial and endocavitary brachytherapy are well‐accepted kinds of radiotherapy that are commonly used in recurrent head and neck cancer. Most reports about brachytherapy in the successful treatment of head and neck tumors used low‐dose‐rate brachytherapy. There are only a few reports about high‐dose‐rate brachytherapy (HDRBT) in head and neck cancer patients.

Methods After 10 years of experience with HDRBT with Ir 192, we have analyzed the results regarding response rates, survival time, and side effects. Between 1991 and 2000, 90 consecutive patients (68 men, 22 women) were treated with interstitial (68 patients) or intracavitary (22 patients) HDRBT in the head and neck area. Primary tumor locations were as follows: oropharynx (n = 26), tongue/floor of mouth (n = 22), nasopharynx (n = 10), nose/paranasal sinuses (n = 9), salivary glands (n = 5), hypopharynx (n = 5), CUP syndrome (n = 5), and others (n = 8). High‐dose‐rate brachytherapy was administered in 51 patients with recurrent disease and in 32 patients with residual tumor after primary radiochemotherapy. Seven patients were given exclusive HDRBT in a primary palliative situation. The single dose per fraction ranged from 1.5 to 7.5 Gy (median value, 5 Gy), and the total HDRBT dose ranged from 4.0 to 42.0 Gy (median value, 17.5 Gy).

Results The overall remission rate was 81% with a 46% rate of complete remissions. We observed no change in or progression of tumor in 17 cases (19%). The rate of complete remissions (and median overall survival time) was different in the three therapy groups: in case of recurrent disease, 28% (6 mo); in case of residual tumor, 84% (25 mo); and in primary palliative brachytherapy, 0% (1 mo). Late toxicities III and IV (radiation treatment oncology group score) occurred in 6 of 90 (6.7%) patients.

Conclusions High‐dose‐rate brachytherapy proved to be an effective treatment modality in locoregional recurrent head and neck cancer. In cases with persistent or residual tumor after primary radiochemotherapy a local boost with brachytherapy can improve the chance of cure of tumor disease.
Congenital Tracheocutaneous Fistulas
Authors: Oxford Lance , Ducic Yadranko
Published: November 2003

Objective To outline two cases of congenital tracheocutaneous fistula and discuss the potential pathogenesis of this previously unreported developmental abnormality.

Methods Two cases of tracheocutaneous fistula evaluated at John Peter Smith Hospital (Fort Worth, TX) from May to October 2001 were reviewed. The surgical treatment of one infant is described.

Results Two infants were evaluated with a congenital fistula extending from the suprasternal region of the neck dorsally to the trachea in the midline. The infants were otherwise developmentally normal with unremarkable prenatal histories. Primary surgical closure of a fistula was accomplished without complication.

Conclusions Congenital tracheocutaneous fistula appears to be an isolated developmental abnormality not associated with the same degree of morbidity as acquired tracheocutaneous fistula. The development of a congenital tracheocutaneous fistula may be the result of abnormal epidermal migration secondary to a localized midline mesodermal defect. Congenital tracheocutaneous fistula may be successfully treated with primary closure. Observation and close follow‐up of asymptomatic fistulas may be reasonable.
Laryngeal Prostatic Cancer Metastases: An Underestimated Route of Metastases?
Authors: Prescher Andreas , Schick Bernhard , Stütz Arndt , Brors Dominik
Published: November 2003

Objective Despite the high rate of metastases in advanced prostatic cancer, only 12 reports with 13 cases of laryngeal metastases in prostatic cancer have been given in the literature since the first description by Schmorl in 1908. A histopathological study was undertaken to clarify the obvious controversial clinical experience of multiple metastases in prostatic cancer but rare observations of laryngeal involvement.

Study Design Postmortem laryngeal examination in advanced prostatic cancer.

Methods Six patients with prostatic cancer and tumor spread to different organs but without clinical symptoms of laryngeal involvement were available for postmortem analysis. Gross anatomical inspection of the inner and outer surfaces of the removed larynx, horizontal slices of the larynx, and subsequent histological investigations including immunohistochemical analysis were used to search for metastases.

Results Macroscopic evaluation of the whole‐larynx specimens did not lead to suspicion of laryngeal metastases. Interestingly, in all six larynx specimens of patients with metastatic prostatic cancer, laryngeal tumor infiltration was detected by macroscopic inspection of horizontal slices and proven histologically. Tumor infiltration ranged from focal micrometastases in the hematopoietic tissue of the ossified laryngeal skeleton to partial destruction of the external and/or internal osseous or cartilaginous lamina of the laryngeal skeleton.

Conclusions The larynx is more often affected in metastatic prostatic cancer disease than is suggested by clinical experience. Because prostatic cancer metastasis starts in the hematopoietic areas of the ossified laryngeal skeleton, macroscopic evaluation of the whole larynx fails to detect metastases. Detecting laryngeal involvement requires horizontal slices and histological analysis.
Intermittent Pressure Therapy of Intractable Ménière's Disease Using the Meniett Device: A Preliminary Report
Authors: Gates George A. , Green J. Douglas
Published: November 2003

Hypothesis Treatment with the Meniett device, which applies intermittent micropressure pulses to the inner ear through a tympanostomy tube, is effective in controlling vertigo in people with intractable Ménière's disease.

Study Design Short‐term, preliminary descriptive report.

Methods Ten patients with intractable vertigo despite adequate medical therapy elected to use the Meniett device. After placement of a standard tympanostomy tube, the patient self‐administers the Meniett device three times daily.

Results The follow‐up ranged from 3 to 11 months with an average of 8 months. All 10 patients responded to the therapy with vertigo control in 9 of 10 and a 50% reduction in the 10th case. There was a mean hearing gain of 6 dB, which was statistically significant. There were no major complications. Two subjects required tube reinsertion during the 8 months of follow‐up.

Conclusions Use of the Meniett device is an effective and safe option for people with intractable vertigo from Ménière's disease.
Measurement of Facial Muscle Strength in Normal Subjects
Authors: Neely J. Gail , Pomerantz Rebecca G.
Published: November 2003

Objectives Muscle strength is a fundamental measure of function for neuromuscular systems; however, mimetic facial muscle strength has never been recorded. The objective of the present feasibility project was to measure facial muscle strength.

Study Design The study design was a prospective experimental trial in 10 normal subjects. Descriptive statistics, t tests, and analysis of variance were used to summarize and compare data.

Methods Subjects were selected by convenience following submission and approval of a prospectively designed protocol and consent form to the Human Studies Committee. Application of a force transducer to the central eyebrow and commissure during eyebrow raising, eyelid closing, smiling, and puckering was performed by two methods: surface adhesion method (n = 5) and direct probe application method (n = 5). Data were recorded in pounds. Three repetitions of each movement were made.

Results Rank order of muscle strengths (in pounds) by the surface adhesion technique was as follows: brow, 0.758; eye, 0.549; pucker, 0.387; and smile, 0.307. By direct probe application the rank order of muscle strengths was as follows: eye, 0.880; brow, 0.773; and smile, 0.730.

Conclusions Objective measures of facial motion are crucial for quantitative investigations of preventative, therapeutic, reconstructive, and rehabilitative interventions for facial nerve and muscle lesions. Until the present, objective measures required cross‐correlations with current standards that were subjective. This is the first time an actual physical measure of facial muscle function has been performed. The purpose of presenting this preliminary work is to stimulate advancement along this line of research.
The Treatment of Facial Verrucae With the Pulsed Dye Laser
Authors: Vargas Hannah , Hove Christopher R. , Dupree Marsha L. , Williams Edwin F.
Published: November 2003

Objectives/Hypothesis To evaluate the treatment of facial verrucae with the pulsed dye laser.

Study Design A prospective, nonrandomized, nonblinded pilot study evaluating the treatment of facial verrucae with the pulsed dye laser.

Methods Twelve patients with facial verrucae (four recalcitrant) were identified and followed in the study in the setting of a tertiary referral center. The treatment consisted of the flash‐lamp pumped pulsed dye laser (585 mn) with a spot size of 5 mm at fluences between 9.0 and 13 J/cm2. Each lesion received one or two pulses with 2 mm of surrounding normal skin included in the treatment. One patient had paring prior to pulse treatment. The patients were examined 3 to 4 weeks after each procedure, and clinical assessment of the lesion was documented.

Results Patient ages ranged from 18 to 47 years. Four patients had refractory lesions, and eight patients had never undergone previous treatment. All 12 patients had full resolution of their facial warts after one to three treatment sessions. No complications such as scarring, alopecia, or recurrence were encountered. Follow‐up ranged from 10 to 33 months.

Conclusions Pulsed dye laser therapy is highly effective and safe therapy for facial verrucae. This method appears to selectively destroy warts without damaging surrounding skin.
Tumor Necrosis Factor‐α, an Initiator, and Etanercept, an Inhibitor of Cochlear Inflammation
Authors: Satoh Hitoshi , Firestein Gary S. , Billings Peter B. , Harris Jeffrey P. , Keithley Elizabeth M.
Published: November 2003

Objectives/Hypothesis The inner ear rapidly mounts an immune response that can lead to cochlear degeneration and permanent hearing loss. Identification of proinflammatory cytokine expression during the initiation of the response should lead to rational therapeutic strategies that block the response, reducing damaging sequelae.

Study Design A cochlear immune response to keyhole limpet hemocyanin (KLH) injected into the inner ear or subarachnoid space of sensitized animals was created. Etanercept was administered to a group of animals to blunt the immune response.

Methods Cochleae were immunoassayed for expression of interleukin‐1β, tumor necrosis factor‐α, and interleukin‐6 and evaluated for the amount of cochlear‐infiltrated cells.

Results Tumor necrosis factor‐α and interleukin‐1β were expressed by infiltrated cells shortly after KLH injection. Tumor necrosis factor‐α was expressed whether the antigen was introduced with or without surgical trauma. Interleukin‐1β was also expressed by the cochlear fibrocytes during the immune response and in surgical control animals, but not after intrathecal injection of antigen. Interleukin‐6 expression was minimal during the response. Based on this observation, animals were treated with systemic injection of Etanercept, which reduced cochlear infiltrating cell number and cochlear fibrosis.

Conclusion Interleukin‐1β expression is a general cochlear response to trauma, whereas tumor necrosis factor‐α expression in the infiltrated immunocompetent cells is the cytokine that induces amplification of the response that leads to cochlear disease.
In Vivo Characteristics of HPV‐Immortalized and Carcinogen Transformed Oral Keratinocytes
Authors: Yoo George H. , Piechocki Marie P. , Lonardo Fulvio , Meng Hong , Kewson Danny , Shibuya Terry Y. , Kim Harold , Stachler Robert , Ensley John F.
Published: November 2003

Purpose To characterize in vivo features of HPV‐immortalized and carcinogen transformed oral keratinocytes.

Methods The growth and squamous differentiation of IHGK (immortalized human gingival keratinocyte with HPV), IHGKN [4‐(methylnitrosamino)‐1‐(3‐pyridyl)‐1‐butanone, (NNK)]‐carcinogen transformed keratinocytes, and two head and neck squamous cell carcinoma (HNSCC) cell lines, HN30 and HN12, were tested by injecting these cells into SCID mice. The growth, histological features, and expression of PCNA, Involucrin, and high molecular weight keratin of the tumors formed were compared among these cell lines.

Results All cell lines formed a palpable lesion at 2 weeks; however, only HN30 continued to grow. IHGK and IHGKN cells formed palpable nodules within 2 weeks with no further growth after 4 to 5 weeks, and no regression of the nodule was noted at 12 weeks. HN12 cells did not form tumor nodules unless these cells were co‐injected with immortalized fibroblasts. Both IHGK and IHGKN cells formed a well‐circumscribed epithelial lesion with islands of differentiated squamous cells bound by a myxoid matrix. Nests of basal‐horny squamous cells centrally differentiated into anucleate squamous cells. IHGK and IHGKN nodules had more squamous differentiation than HN12 and HN30 and further differentiated over time. IHGK and IHGKN cells expressed differentiation (involucrin and high molecular weight keratin) and proliferation (PCNA) markers that suggest that IHGK and IHGKN behave as well‐differentiated squamous lesions when compared with malignant HN12 and HN30 nodules. IHGK and IHGKN cells showed an initial growth phase followed by terminal differentiation, and then a phase characterized by regression and host inflammatory stage.

Conclusions The growth, histology, and expression of differentiation and proliferation markers of IHGK and IHGKN lesions into SCID mice demonstrate that these cells are endowed with a limited malignant potential. Our in vivo model with these intermediate cell lines can provide a short‐term analysis for studying the biology of HNSCC progression and the activity of chemoprevention agents.
The Influence of Radiotherapy on the Lifetime of Silicone Rubber Voice Prostheses in Laryngectomized Patients
Authors: Elving G. Jolanda , van Weissenbruch Ranny , Busscher Henk J. , van der Mei Henny C. , Albers Frans W. J.
Published: November 2003

Objectives To establish a relationship between voice prosthetic lifetime in laryngectomized patients and the irradiation dose applied to the neck node levels (field of the neck) in which the major salivary glands are partially included. Furthermore, a possible relationship between voice prosthetic lifetime and the irradiation dose applied to the primary tumor site was studied.

Study Design A retrospective analysis was performed on 101 patients after laryngectomy.

Methods The records of 101 patients who underwent total laryngectomy between January 1993 and November 1999 at the Department of Otorhinolaryngology, University Hospital Groningen, The Netherlands, were analyzed. The following parameters were obtained: age, sex, radiotherapy, radiation fields, irradiation dose per field, tumor site, TNM classification, and valve insertion.

Results Irradiation to extensive neck fields, including the submandibular glands, did not influence the voice prosthetic lifetime after laryngectomy. However, primary tumor doses exceeding 60 Gray significantly shortened the mean voice prosthetic lifetime per patient.

Conclusions This study identified an association between radiation on the primary tumor site with a dose equal to or more than 60 Gray and limited lifetimes of voice prostheses.
Optimizing Treatment of Nasal Fractures
Authors: Staffel J. Gregory
Published: November 2003

Objectives/Hypothesis A graduated protocol involving closed reduction, septoplasty, osteotomies, upper lateral cartilage release, anterior perpendicular plate fracture, and camouflaging cartilage grafts yields a higher percentage of straight noses in cases of acute fracture than treatment with closed reduction alone.

Study Design Retrospective chart and literature review followed by a prospective, non‐randomized sequential trial.

Methods Closed reduction was performed on 26 cases of acute nasal fracture and the results were compared with a subsequent series of 79 cases treated using a more complete protocol.

Results The cases treated with the more complete protocol yielded straighter noses. The difference was statistically significant using Wilcoxon rank sum analysis at the P = .028 level.

Conclusions Treatment of the acutely fractured nose involving an individually tailored protocol of closed reduction, septoplasty, osteotomies, release of the upper lateral cartilages, fracture of the anterior extension of the perpendicular plate of the ethmoid, and camouflaging cartilage grafts yields straighter noses than treatment by closed reduction alone.
Biophysics of Cochlear Implant/MRI Interactions Emphasizing Bone Biomechanical Properties
Authors: Sonnenburg Robert E. , Wackym Phillip A. , Yoganandan Narayan , Firszt Jill B. , Prost Robert W. , Pintar Frank A.
Published: November 2003

Objective/Hypothesis The forces exerted during a 1.5‐Tesla MRI evaluation on the internal magnet of a cochlear implant (CI) raise concern about the safety for CI recipients. This study determines the magnitude of force required to fracture the floor of a CI receiver bed.

Method Recessed CI beds were drilled to maximum uniform thinness into formalin‐fixed and fresh–frozen human calvaria specimens. A Med‐El stainless steel CI template mounted to the piston of an electrohydraulic testing device was used to fracture the floor of the implant beds. Force and displacement were measured as a function of time using a digital data acquisition system.

Results Mean force to first failure, displacement to first failure, and minimum thickness, respectively, were: group 1 (formalin‐fixed, 0.3–0.4‐mm thick [n = 22]), 34.08 N (8.21–59.64 N, standard deviation [SD] 15.41 N), 1.09 mm (0.40–2.16 mm, SD 0.51 mm), 0.36 mm (0.3–0.4 mm, SD 0.05 mm); group 2 (formalin‐fixed, 0.5–0.9 mm thick [n = 21]), 52.82 N (20.28–135.53 N, SD 25.29 N), 1.08 mm (0.50–2.28 mm, SD 0.47 mm), 0.58 mm (0.5–0.9 mm, SD 0.12 mm); group 3 (fresh–frozen [n = 9]), 134.13 N (86.44–190.70 N, SD 34.92 N), 1.96 mm (1.47–2.46 mm, SD 0.35 mm), 0.42 mm (0.3–0.6 mm, SD 0.11 mm).

Conclusions The mean magnitude of force required to fracture the floor of a CI bed is significantly greater than those that are generated when a Med‐El Combi 40+, CII Bionic Ear CI, or Nucleus Contour CI is placed into a 1.5‐Tesla MRI unit.
Acoustic Properties of Different Cartilage Reconstruction Techniques of the Tympanic Membrane
Authors: Mürbe Dirk , Zahnert Thomas , Bornitz Matthias , Hüttenbrink Karl‐Bernd
Published: November 2003

Objectives/Hypothesis The use of cartilage in reconstruction of the tympanic membrane has been established especially in cases such as tubal dysfunction and adhesive processes. Cartilage offers the advantage of higher mechanical stability compared with membranous transplants but may alter the acoustic transfer characteristics of the graft. Apart from material properties, it can be assumed that, also, the microsurgical reconstruction technique might influence the sound transmission properties of the reconstructed tympanic membrane. The purpose of the study was to investigate the acoustic transfer characteristics of different cartilage transplants being typically used in different reconstruction techniques of the tympanic membrane.

Methods Cartilage plates of different thicknesses (1.0, 0.7, 0.5, and 0.3 mm), cartilage palisades, and cartilage island transplants of varying size were investigated by means of an ear canal–tympanic membrane model. In contrast to former single‐point measurements, sound‐induced vibrational amplitudes of the entire transplant were measured by scanning laser Doppler vibrometry (measuring points, n = 133) (PSV‐200, Polytec, Waldbronn, Germany). Frequency response functions (displacement vs. sound pressure) of all measured points were determined in the frequency range of 200 Hz to 4 kHz for the different transplants.

Results Cutting thick cartilage transplants into thin plates or palisades decreased the first resonance frequency and increased its amplitude, reflecting improved sound transmission properties of the transplant. From an acoustical point of view, the 0.5‐mm cartilage plate seems preferable compared with the palisade technique. Cartilage island techniques showed vibration characteristics superior to plate or palisade techniques.

Conclusions Apart from material characteristics, the sound transmission properties of the reconstructed tympanic membrane are strongly influenced by the reconstruction technique. The choice of the surgical technique should consider requirements based on mechanical stability and acoustic transfer characteristics of the transplant.
Submandibular and Intracranial Hydatid Cyst in an Adolescent
Authors: Guney Onder , Ozturk Kayhan , Kocaogullar Yalcn , Eser Olcay , Acar Osman
Published: November 2003

Objectives An unusual case of hydatid disease is reported. Review of the pertinent literature did not reveal any hydatid disease located simultaneously in both the intracranial and submandibular glands. This is the first case with hydatid disease occurring in both locations at the same time.

Study Design The case of an 18‐year‐old is presented; the symptoms, findings, methods of diagnosis, and our approach for treatment are discussed; and the literature is reviewed.

Results The intracranial lesion was completely excised by left‐sided frontoparietal craniotomy, and the mass in the right side of the submandibular gland was removed through a submandibular approach at the same session. The intact cyst was completely excised. Histological examination of both lesions confirmed the diagnosis of hydatid cyst by Echinococcus granulosus. Postoperative recovery was uneventful, and the patient was discharged on the seventh day.

Conclusions Hydatid cyst should be suspected during the evaluation of cervical masses, particularly in endemic regions. Hydatid disease infestations are best treated with complete excision of the intact cyst.
Intraoperative Parathyroid Hormone Levels in Thyroid and Parathyroid Surgery
Authors: Warren Frank M. , Andersen Peter E. , Wax Mark K. , Cohen James I.
Published: November 2003

Objective To determine the utility of intraoperative parathyroid hormone measurement in predicting postoperative hypocalcemia after thyroid and parathyroid surgeries that places total parathyroid function at risk.

Study Design Retrospective case review.

Methods The case records of 23 patients undergoing total or completion thyroidectomy and 30 patients undergoing parathyroid exploration were reviewed. All patients had intraoperative parathyroid hormone levels measured. Samples were taken before dissection and 10 minutes after the resection was completed. Serial ionized calcium levels were measured in the postoperative period. Percentages of reduction in PTH levels from preoperative to postresection levels were calculated. Percentages of reduction in PTH level and the absolute value of the intraoperative PTH values were compared with postoperative ionized calcium levels.

Results In the 23 patients who underwent thyroid surgery, the average preoperative and postoperative PTH values were 50 pg/mL (range, 17–87 pg/mL) and 34 pg/mL (range, 4–93 pg/mL), respectively. The average decrease in PTH was 39% (range, 39%–90%). The incidence of hypocalcemia was significantly higher in patients with intraoperative PTH levels less than 15 pg/mL relative to patients with PTH levels greater than 15 pg/mL in this setting (P = .006). In the 30 patients who underwent parathyroid exploration, average preoperative and postoperative PTH levels were 291 pg/mL (range, 65–1675 pg/mL) and 113.8 pg/mL (range, 6.5–1263 pg/mL) respectively. The intraoperative PTH level did not correlate with postoperative calcium levels in the parathyroid group. Percentages of decrease in PTH levels greater than 60% was statistically associated with surgical cure in this population.

Conclusions The study demonstrates that intraoperative PTH levels greater than 15 pg/mL after total or completion thyroidectomy indicate a low risk of postoperative hypocalcemia and that these patients may be candidates for outpatient surgery. In the parathyroid group, intraoperative PTH levels do not correlate well with postoperative calcium levels.
Obstructive Congenital Epulis: Prenatal Diagnosis and Perinatal Management
Authors: Kumar Pankaj , Kim Harold Hyon Soo , Zahtz Gerald D. , Valderrama Elsa , Steele Andrew M.
Published: November 2003

Objective To describe a multidisciplinary approach for delivery room management of congenital epulis.

Study Design Case reports.

Methods Reporting of two cases of congenital epulis and review of the literature.

Results Antepartum ultrasonography demonstrated massive intraoral masses in two fetuses whereby concerns regarding the patency of the airway at birth necessitated development of a multidisciplinary team of maternal–fetal medicine, neonatal–perinatal medicine, anesthesiology, and otolaryngology. Surgical excision was performed before delivery in one infant and after complete delivery in the other without a need for endotracheal intubation and general anesthesia. Feeding was started early, and both infants were discharged after brief hospital stays. Pathological findings were consistent with congenital epulis. Differential diagnosis and options for surgical intervention are discussed, including ex utero intrapartum treatment.

Conclusions A multidisciplinary approach to antenatally identified congenital intraoral masses facilitates care at birth. Surgical treatment in this milieu may be simple and complete at the time of delivery.
Wegener's Granulomatosis of the Orbit: A Clinicopathological Study of 15 Patients
Authors: Fechner Frank P. , Faquin William C. , Pilch Ben Z.
Published: November 2003

Objectives Wegener's granulomatosis is a granulomatous and necrotizing vasculitis that classically involves the respiratory and renal systems. The goal of the study was to define clinical and pathological characteristics in a subgroup of patients with the changes of Wegener's granulomatosis involving the orbit.

Study Design Retrospective study.

Methods A database search identified 15 patients with the histological changes of Wegener's granulomatosis of the orbit presenting over a 23‐year period. A review of the histological specimens, radiological studies, and patient charts was performed. Additional follow‐up data were obtained through patient interviews.

Results Of 15 patients (median age, 54 y) with Wegener's granulomatosis of the orbit identified, the disease was limited to the orbit in 12 patients; 3 patients had additional sinonasal involvement. All patients underwent various surgical procedures followed by medical treatment (cyclophosphamide and prednisone). Specimens showed characteristic histopathological features of Wegener's granulomatosis. Follow‐up data were available for 12 patients with a median period of 5 years. In the group with only orbital involvement, none of the patients developed systemic progression of Wegener's granulomatosis. Only one patient had multiple local recurrences and later developed contralateral orbital Wegener's granulomatosis.

Conclusions Wegener's granulomatosis limited to the orbit is a localized form of the disease without systemic progression. Diagnostic surgical procedures followed by aggressive medical treatment results in good outcome, although local recurrence may occur.