bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of Surgical Therapy in Patients with Barrett’s Adenocarcinoma
Authors: Bonavina Luigi , Via Albert , Incarbone Raffaello , Saino Greta , Peracchia Alberto
Published: November 2003

The incidence of adenocarcinoma arising from Barrett’s esophagus is dramatically increasing in Western countries. The purpose of this study was to report our experience in the surgical management of these patients. Between November 1992 and December 2000, 330 consecutive patients with adenocarcinoma of the esophagogastric junction were observed in our institution. Of these, 105 (31.8%) had Barrett’s carcinoma. In 12 individuals (11.4%) adenocarcinoma was discovered during endoscopic surveillance for Barrett’s esophagus. Twelve patients with doubtful cleavage planes at preoperative investigation were treated with neoadjuvant chemotherapy. Overall, 80 patients (76.2%) underwent esophagectomy without operative mortality. The Ivor Lewis approach was used in 70 patients; of these, 31 underwent extended mediastinal lymph node dissection. Seventy‐four patients (92.5%) had R0 resection. The overall 5‐year survival rate was 48%. Survival was significantly associated with stage, lymph node status, and completeness of resection. Early diagnosis remains the prerequisite for curative treatment of esophageal carcinoma. An extended mediastinal lymphadenectomy does not increase morbidity, allows precise tumor staging, and may prove effective in preventing local recurrences. Neoadjuvant therapy requires major improvement before it can be unconditionally recommended outside clinical trials.
Introducing New Technologies: Protecting Subjects of Surgical Innovation and Research
Authors: McKneally Martin F. , Daar Abdallah S.
Published: November 2003

The system for protecting human research subjects is under increasing pressure. Under the currently dominant Regulatory Ethics Paradigm, clinical research protocols must be reviewed and approved by an institutional review board (IRB) or equivalent. Although the IRB was introduced into health care in part to protect patients and investigators from the inherent conflict between the best clinical interest of the individual patient and the interest of science and society in answering a clinical question, its rigorous standards and rigid framework discourage surgeons from seeking potentially valuable early IRB consultation. Most of the important advances in the history of medicine, such as anesthesia, appendectomy, antibiotics, intensive care, and immunization, were introduced through an informal, unregulated innovation process that has been enormously productive but can lead to ratification of ineffective or harmful treatment by credulous physicians and patients. We propose a surgical innovation ethics paradigm that is a more nimble, flexible source of institutional and public oversight and approval of innovations that are in the gray zone prior to their conversion to formal protocols that then require IRB approval. We also discuss the management of personal and institutional conflicts of interest.
Qualitative Research on Trauma Surgery: Getting Beyond the Numbers
Authors: Rich John A. , Grey Courtney M.
Published: November 2003

Qualitative research methods have a unique role to play in surgical research, revealing important contextual details about the causes and impact of surgical illnesses and treatment. The utility of qualitative methods is illustrated through results of a research study of young, black male victims of interpersonal violence. Narrative analysis of in‐depth interviews with 48 survivors of penetrating violence revealed the impact of these patients’ perceptions of post‐injury care on their pain, the central role of fear of death in their injury experience, and the transforming role providers can play in addressing patient fears of death. The study provides support for the notion that qualitative methods can be a useful approach to understanding marginalized individuals who become our patients after injury. Furthermore, potential applications of multimethod approaches to surgical research (qualitative research methods in combination with quantitative methods) for the study of trainee experiences, patient satisfaction, and racial disparities are recommended.
Priority Setting in Surgery: Improve theProcess and Share the Learning
Authors: Martin Douglas K. , Walton Nancy , Singer Peter A.
Published: November 2003

Surgeons and surgical programs encounter priority‐setting
challenges every day, such as in regard to purchasing new technologies or
managing waiting lists for elective surgery. The purpose of this paper was to
explore priority setting in surgery. Traditionally in surgery, priority‐setting
decisions for new technologies have been based on evidence of effectiveness and
cost‐effectiveness; and decisions about managing waiting lists for elective
surgery have been based on urgency rating scores. The fairness of
priority‐setting processes in surgical programs should be enhanced to permit
all relevant information and values to be considered. The quality of these
decisions can be improved by using an approach that captures and shares lessons
from each priority‐setting experience. The approach we propose in this
paper—describe,
evaluate, and improve using a leading conceptual framework for
priority setting, called “accountability for
reasonableness”—can be used by any surgical program to improve its
priority setting, share lessons with others, and develop an evidence base for
how these important health policy decisions should be made.
Salivary Gland Sparing and Improved Target Irradiation by Conformal and Intensity Modulated Irradiation of Head and Neck Cancer
Authors: Eisbruch Avraham , Ship Jonathan A. , Dawson Laura A. , Kim Hyungjin M. , Bradford Carol R. , Terrell Jeffrey E. , Chepeha Douglas B. , Teknos Theodore N. , Hogikyan Norman D. , Anzai Yoshimi , Marsh Lon H. , Ten Haken Randall K. , Wolf Gregory T.
Published: November 2003

The goals of this study were to facilitate sparing of the major salivary glands while adequately treating tumor targets in patients requiring comprehensive bilateral neck irradiation (RT), and to assess the potential for improved xerostomia. Since 1994 techniques of target irradiation and locoregional tumor control with conformal and intensity modulated radiation therapy (IMRT) have been developed. In patients treated with these modalities, the salivary flow rates before and periodically after RT have been measured selectively from each major salivary gland and the residual flows correlated with glands’ dose volume histograms (DVHs). In addition, subjective xerostomia questionnaires have been developed and validated. The pattern of locoregional recurrence has been examined from computed tomography (CT) scans at the time of recurrence, transferring the recurrence volumes to the planning CT scans, and regenerating the dose distributions at the recurrence sites. Treatment plans for target coverage and dose homogeneity using static, multisegmental IMRT were found to be significantly better than standard RT plans. In addition, significant parotid gland sparing was achieved in the conformal plans. The relationships among dose, irradiated volume, and the residual saliva flow rates from the parotid glands were characterized by dose and volume thresholds. A mean radiation dose of 26 Gy was found to be the threshold for preserved stimulated saliva flow. Xerostomia questionnaire scores suggested that xerostomia was significantly reduced in patients irradiated with bilateral neck, parotid‐sparing RT, compared to patients with similar tumors treated with standard RT. Examination of locoregional tumor recurrence patterns revealed that the large majority of recurrences occurred inside targets, in areas that had been judged to be at high risk and that had received RT doses according to the perceived risk. Tangible gains in salivary gland sparing and target coverage are being achieved, and an improvement in some measures of quality of life is suggested by our findings. Additional reduction of xerostomia may be achieved by further sparing of the salivary glands and the non‐involved oral cavity. A mean parotid gland dose of ≤ 26 Gy should be a planning objective if significant parotid function preservation is desired. The pattern of recurrence suggests that careful escalation of the dose to areas judged to be at highest risk may improve tumor control.
Contribution of Radiotherapy to Function Preservation and Cancer Outcome in Primary Treatment of Nasopharyngeal Carcinoma
Authors: Lee Anne W.M.
Published: November 2003

Development of primary treatment for nasopharyngeal carcinoma is summarized and the contribution of radiotherapy (RT) is reviewed. Accumulation of knowledge, together with technological advances, has led to significant improvement both for tumor control and organ preservation. With contemporary RT, it is possible to achieve a 10‐year disease‐specific survival of 47% with a severe late complication rate of 5%. Presenting stage is one of the most important prognostic factors, but unfortunately late presentation and delayed diagnosis remains a common problem. The average local control rate is 80% for tumor confined within the nasopharynx, but only 50% for those associated with erosion of the base of the skull or cranial nerve involvement. Nodal deposits from nasopharyngeal carcinoma are much more radiosensitive than those from other head and neck cancers. An average control rate of 75% can be achieved with RT alone, even in patients with nodes > 6 cm in diameter. Successful locoregional control is important, not only because it is crucial for survival but also because it is associated with a lower incidence of distant failure (29% versus 41%). Distant failure remains a sinister problem, especially for patients presenting with advanced T or N‐stage cancers. Randomized trials exploring the value of additional chemotherapy are reviewed. The significant improvement in 3‐year overall survival achieved by the addition of concurrent and adjuvant chemotherapy (78% versus 47%) recently reported is encouraging, but remaining uncertainties are also discussed.
Supracricoid Partial Laryngectomy with Cricohyoidopexy in the Management of Laryngeal Carcinoma
Authors: Brasnu Daniel F.
Published: November 2003

Supracricoid partial laryngectomy with cricohyoidopexy is a conservative laryngeal procedure indicated in selected cases of supraglottic and transglottic carcinoma. In this technique, the thyroid cartilage, the paraglottic space, the preepiglottic space, and the whole epiglottis are excised, whereas the hyoid bone, the cricoid cartilage, and one or two artenoid cartilages are preserved. A cricohyoidopexy is used for closure. The surgical principle is based on the preservation of at least one functional and mobile cricoarytenoid unit. This procedure is a true organ preservation technique, as it preserves physiological rehabilitation of speech, swallowing, and respiration without a permanent tracheostomy. Indications, contraindications surgical technique, postoperative care, complications, and functional and oncological results are presented and discussed.
Near‐field optical imaging of abasic sites on a single DNA molecule
Authors: Kim JongMin , Muramatsu Hiroshi , Lee HeaYeon , Kawai Tomoji
Published: November 2003

Scanning near‐field optical microscopy (SNOM) imaging was performed to allow for the direct visualization of damaged sites on individual DNA molecules to a scale of a few tens of nanometers. Fluorescence in situ hybridization on extended DNA molecules was modified to detect a single abasic site. Abasic sites were specifically labelled with a biotinlylated aldehyde‐reactive probe and fluorochrome‐conjugated streptavidin. By optimizing the performance of the SNOM technique, we could obtain high contrast near‐field optical images that enabled high‐resolution near‐field fluorescence imaging using optical fiber probes with small aperture sizes. High‐resolution near‐field fluorescence imaging demonstrated that two abasic sites within a distance of 120 nm are clearly obtainable, something which is not possible using conventional fluorescence in situ hybridization combined with far‐field fluorescence microscopy.
Peritraumatic versus persistent dissociation in acute stress disorder
Authors: Panasetis Paula , Bryant Richard A.
Published: November 2003

The DSM‐IV definition of acute stress disorder (ASD) regards dissociation that occurs during a trauma (peritraumatic dissociation) comparably to persistent dissociation. This study investigated the relative contributions of peritraumatic dissociation and persistent dissociation to acute posttraumatic stress reactions. Civilian trauma (N = 53) survivors with either acute stress disorder (ASD), subclinical ASD, or no ASD were administered modified versions of the Peritraumatic Dissociative Experiences Questionnaire that indexed both dissociation during the trauma and dissociation at the time of assessment. Persistent dissociation was more strongly associated with ASD severity and intrusive symptoms than peritraumatic dissociation. These results are consistent with the proposition that persistent, rather than peritrumatic, dissociation is associated with posttraumatic psychopathology.
Long‐term effects of the Dresden bombing: Relationships to control beliefs, religious belief, and personal growth
Authors: Maercker Andreas , Herrle Johannes
Published: November 2003

Aftereffects of the Dresden bombing of February 1945 on 47 survivors were investigated using a comprehensive framework of trauma sequelae including pathogenetic, salutogenetic, and further mediating or moderating variables. A relatively low rate of PTSD symptomatology was noted. Traumatic exposure was related to current PTSD symptoms and to personal growth, with no systematic relationships between the 2 outcome variables. PTSD symptoms were primarily related to external control, whereas personal growth was primarily associated with internal control. Religious belief in the afterlife moderated effects between exposure and posttraumatic avoidance or personal growth. Furthermore, belonging to particular age groups at traumatization (adolescents, middle‐aged adults) was associated with increased posttraumatic intrusions at the time of data collection.
Health effects of war stress on Norwegian World War II resistance groups: A comparative study
Authors: Major Ellinor F.
Published: November 2003

The main aim of this study was to investigate the extent to which adverse long‐term health effects of World War II stress exposure were present in 3 groups of resistance veterans. The groups had been exposed to different types of war stressors: concentration camp incarceration, resistance participation within the illegal press, and a secret military organization. With the differences in war stressors as a basis, we assumed that those incarcerated in a concentration camp would display more adverse health effect compared to the resistance veterans. The findings point to a relationship between the severity of war stressors and postwar health in all 3 groups.
Faster Choice-Reaction Times to Positive than to Negative Facial Expressions
Authors: Leppänen Jukka M. , Tenhunen Mirja , Hietanen Jari K.
Published: November 2003

Abstract Several studies have shown faster choice-reaction times to positive than to negative facial expressions. The present study examined whether this effect is exclusively due to faster cognitive processing of positive stimuli (i.e., processes leading up to, and including, response selection), or whether it also involves faster motor execution of the selected response. In two experiments, response selection (onset of the lateralized readiness potential, LRP) and response execution (LRP onset-response onset) times for positive (happy) and negative (disgusted/angry) faces were examined. Shorter response selection times for positive than for negative faces were found in both experiments but there was no difference in response execution times. Together, these results suggest that the happy-face advantage occurs primarily at premotoric processing stages. Implications that the happy-face advantage may reflect an interaction between emotional and cognitive factors are discussed.
“Decadose” Effects of Cisplatin on Squamous Cell Carcinoma of the Upper Aerodigestive Tract. II. Clinical Studies
Authors: Robbins K. Thomas , Storniolo Anna Maria , Hryniuk William M. , Howell Stephen B.
Published: November 2003

There is evidence that solid tumors rapidly acquire cellular resistance to cisplatin. This resistance is usually mild to moderate and could be circumvented with higher concentrations of drug exposure if ancillary methods were available to avoid systemic cytotoxicity. The purpose of this study was to determine whether a tenfold increase in dose (decadose) would overcome cisplatin resistance.

In a clinical trial, response effects of cisplatin at dose intensities ranging from 32.5 to 200 mg/m2 per week, which were delivered by highly selective intra‐arterial infusions with a simultaneously administered intravenous neutralizing agent, were measured in 31 patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract (UADT). The overall response rate (complete response [CR] and partial response [PR]) to cisplatin therapy at dose intensity intervals of 0 to 74, 75 to 149, and 150 to 200 mg/m2 per week were 45.5%, 72.7%, and 100%, respectively. The average received dose intensities for nonresponders and responders (CR and PR) were 57.8 and 120.7 mg/m2 per week, respectively (P = .031).

The results indicate that resistance to standard doses of cisplatin by SCC of the UADT, both previously untreated and recurrent, can be substantially overcome with “decadose” cisplatin therapy. Progress toward improving survival of patients with head and neck cancer, and possibly other site‐specific malignancies, may be achieved by incorporating decadose cisplatin therapy into a multimodality treatment plan.
Bilateral Sensorineural Hearing Loss Associated With the Point Mutation in Mitochondrial Genome
Authors: Oshima Takeshi , Ueda Narihisa , Ikeda Katsuhisa , Abe Koji , Takasaka Tomonori
Published: November 2003

Mitochondrial DNA (mtDNA) mutation associated with sensorineural hearing loss (SNHL) has previously been described in MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke‐like episodes) and in aminoglycoside‐induced deafness. The authors of this study report three cases of SNHL associated with mtDNA mutation (3243A→G). They examined the clinical features of this type of SNHL by audiologic studies and examined the mtDNA mutation by the polymerase chain reaction technique.

In the three cases described, the SNHL had an adult onset and was bilateral and symmetrical. All patients had adult‐onset diabetes mellitus. Audiologic studies revealed that the SNHL in all patients derived from the cochlea rather than from retrocochlear sites. It is presumed that mtDNA mutation results in mitochondrial dysfunction in cochlear tissues (i.e., hair cells and stria vascularis) and in neurons of the auditory pathway. Genetic analysis of mtDNA offers new insight into the diagnosis and treatment of SNHL.
Nasal and Nasopharyngeal Angiocentric T‐Cell Lymphomas
Authors: Davison Steven P. , Habermann Thomas M. , Strickler John G. , DeRemee Richard A. , Earle John D. , McDonald Thomas J.
Published: November 2003

Thirty patients (24 men and 6 women) with a median age of 44.5 years who had angiocentric T‐cell lymphoma were studied. The neoplastic cells in each had a T‐cell phenotype. Epstein‐Barr virus RNA was detected in the neoplastic cells in 29 of 30 patients. The most common presenting symptom was nasal obstruction followed by purulent rhinorrhea. Patients with early presentation had only a friable nasal or nasopharyngeal mucosa; late clinical signs included septal perforation in 40%. Twenty‐one of 30 patients received radiation therapy as initial treatment; 22 of 30 patients achieved a complete remission. Fifteen patients relapsed: 10 with local recurrence and 5 with systemic disease. In long‐term follow‐up, 10 patients were alive and disease free, 6 patients died of unrelated causes, and 12 patients died of disease.
Visual Loss Reversed After Treatment of Acute Bacterial Sinusitis
Authors: Galati Lisa T. , Baredes Soly , Mauriello Joseph , Frohman Larry
Published: November 2003

Visual loss is a rare complication of acute bacterial sinusitis (ABS). Very few cases have been reported in the literature. Only two cases of visual loss reversed after treatment of ABS are found in the English‐language literature. We present three cases in which significant visual loss was reversed after treatment of ABS. The experience with visual loss associated with ABS is small; therefore, no definitive statement about treatment can be made. However, on the basis of our experience, it appears that immediate surgical drainage with antibiotic therapy may be important in restoring vision.
Foot and Ear Disease‐The Dermatophytid Reaction in Otology
Authors: Derebery M. Jennifer , Berliner Karen I.
Published: November 2003

Chronic otitis externa (COE) is occasionally refractory to treatment and may persist for years. In such cases, a dermatophytid (id) reaction from a fungal infection in a remote location should be suspected. Immunotherapy with dermatophyte (Trichophyton, Oidiomycetes, and Epidermophyton [T.O.E.]) extracts and dust mite, based on serial endpoint titration skin test results, as well as a yeast elimination diet is the treatment of choice.

Fourteen cases of id reaction are described. The primary fungal source was not always obvious, but immunotherapy and diet led to complete resolution of the COE in 8 cases (57.1%) and improvement in another 3 cases (21.4%). Some case reports illustrate presentation, treatment, and outcome.
Experimentally Induced Polyps in the Sinus Mucosa
Authors: Norlander Tomas , Westrin Karl Magnus , Fukami Masaya , Stierna Pontus , Carlsöö Bengt
Published: November 2003

To document polyp formation in the sinus mucosa, the authors of this study subjected New Zealand white rabbits to different modes of manipulation intended to induce inflammation of the maxillary sinus. These manipulations included a combination of bacterial infection and mechanical trauma, the deposition of agarose into the sinus cavity, and the deposition of N‐formyl‐methionyl‐leucyl‐phenylalanine, a chemotactic peptide, into the sinus cavity. A majority of animals developed polyps, which were examined by light and electron microscopy.

Polyp formation appears to involve epithelial disruption and the migration of immature branching epithelium. While part of the migrating epithelium eventually covers the mucosal defect, other branches spread into the underlying connective tissue, where intraepithelial microcavities with a differentiated, ciliated lining are formed. Fusing cavities separate the developing polyp body from the adjacent mucosa. With the described method, mucosal polyps can be induced with high reproducibility.
Laser Photochemotherapy With Anthracyclines on Cultured Human Squamous Carcinoma Cells
Authors: Paiva M. B. , Saxton R. E. , Letts G. St. A. , Chung P. S. , Soudant J. , Vanderwerf Q. , Castro Dan J.
Published: November 2003

A new treatment for cancer has been tested in vitro using light‐sensitive anthracyclines followed by laser photoactivation, as described by several investigators. We previously reported 10‐fold enhanced laser killing after 2 hours of incubation with daunomycin by cultured human carcinoma cells. This short‐term uptake leads to drug localization in cytoplasmic and membrane sites prior to nuclear accumulation and topoisomerase inhibition. In the present study, daunomycin was incubated for 2 or 24 hours with P3 squamous carcinoma cells to directly compare cytoplasmic vs. nuclear drug targeting before and after KTP‐532 laser activation. Monolayer cultures of the P3 cells sensitized with daunomycin for 2 hours, then chilled (4°C), and exposed to the KTP laser (532 nm, 94.2 J/cm2) had a 2‐ to 10‐fold increased therapeutic response compared with drug or laser alone when measured by MTT tetrazolium assays. After 24 hours of incubation with daunomycin, the chemotherapeutic response of P3 tumor cells was amplified 2‐fold by laser exposure. The results suggest that daunomycin and laser treatment can be combined for improved therapy of human cancer.
Pulmonary Atelectasis After Reconstruction With a Latissimus Dorsi Myocutaneous Flap
Authors: Wax Mark K. , Hurst Janis
Published: November 2003

Atelectasis is the most common postoperative complication encountered in head and neck surgery. Risk factors include preexisting pulmonary disease, type of surgery performed, and the length of anesthetic. It is controversial whether reconstruction of defects with regional myogenous flaps predisposes to atelectasis. The latissimus dorsi myocutaneous flap requires the patient to be placed on his side for a period of time. Whether it is the position or the surgery that contributes to the development of atelectasis has not been examined.

Eighteen patients underwent latissimus dorsi myocutaneous flap reconstruction following major ablative procedures for head and neck cancer. The cutaneous area transferred ranged from 70 to 225 cm2 (mean, 128 cm2). The flap size ranged from 7 × 10 to 15 × 15 cm. The majority of flaps were 10 × 15 cm or greater. These patients were compared to 18 patients who did not undergo pedicled myocutaneous chest flap reconstruction. Patients were matched for age, sex, length of operation, site of primary, and stage of disease.

Postoperative atelectasis was radiographically detected in 89% of flap patients vs. 79% of controls. Major atelectasis was encountered in 16% of patients undergoing flap surgery vs. 11% of patients in the control group. Patients with large cutaneous paddles on their flaps (>120 cm2) had significantly more atelectasis than patients with smaller cutaneous paddles (P<.05, chi‐squared).

The incidence of radiographic postoperative atelectasis in patients having a latissimus dorsi myocutaneous flap is high. The size of the skin paddle harvested as well as the position change may contribute to this.
Development of the 12‐Item Cross‐Cultural Smell Identification Test(CC‐SIT)
Authors: Doty Richard L. , Marcus Avron , William Lee W.
Published: November 2003

The development of the 12‐item Cross‐Cultural Smell Identification Test(CC‐SIT), based upon items from the University of Pen.sylvania Smell Identification Test (UPSIT), is described. In developing this test, the authors initially selected UPSIT items that are familiar to most persons from North American, European, South American, and Asian cultures. The CC‐SIT was then administered to 198 people ranging in age from 5 to 96 years, and the test scores were compared to analogous items from UPSITs administered to 198 age‐, sex‐, race‐, and smoking‐habit‐matched control subjects. Since the pattern of test scores did not differ for the two groups, the authors developed normative data for the 12‐item test using equivalent UPSIT items sampled from a database containing UPSIT scores for 3760 subjects. Norms are provided for determining the percentile ranks of a given patient's score as a function of age and gender. The CC‐SIT provides, for the first time, a self‐administered means for reliably assessing olfactory function in less than 5 minutes.
Erbium Laser in Middle Ear Surgery: In Vitro and In Vivo Animal Study
Authors: Shah Udayan K. , Poe Dennis S. , Rebeiz Elie E. , Perrault Donald F. , Pankratov Michail M. , Shapshay Stanley M.
Published: November 2003

Cadaveric human temporal bones, cadaveric rabbits, and live rats were used to demonstrate the utility and safety of the erbium:yttrium‐scandium‐gallium‐garnet (Er:YSGG) laser for otologic applications. The shallow penetration in water of this wavelength and its ability to ablate bony tissue with minimal collateral thermal effects spare underlying and adjacent structures and make it appealing for stapedotomy. The authors were able to satisfactorily perform small fenestra stapedotomy, atticotomy, facial nerve decompression, and mastoidectomy. Temperature measurements from the round window area during Er:YSGG stapedotomy recorded an elevation of less than 2°C, which is well within acceptable limits. An acoustic shock produced at the impact site is the major disadvantage and requires further in vivo investigation of the transient and sustained deleterious effects away from the application site. This work supports further investigation into potential applications of the Er:YSGG laser in otology.
Quantitative Assessment of the Variation Within Grades of Facial Paralysis
Authors: Neely J. Gail , Joaquin Allen H. , Kohn Luci A. , Cheung John Y.
Published: November 2003

A completely objective, unambiguous outcome measure of facial function is now available. A new automated computer‐assisted clinimetric system combines the crucial detection capabilities of the human observer and the unique capacity of the computer to quantify the image light reflectance difference observed during facial expression.

The new system was applied to 27 patients with a variety of diseases affecting the facial nerve. All subjects could be individually and objectively ranked, and disease‐specific profiles could be constructed. These tasks are not possible with the House‐Brackmann scale, because of the wide variation within grades and the ambiguity between grades. With the automated objective, unambiguous outcome measure, it may be possible to define individual case progression, recovery, and outcome over the course of disease.
Enhanced Magnetic Resonance Imaging and Subtraction Techniques in the Postoperative Evaluation of Craniofacial Resection for Sinonasal Malignancy
Authors: Lund Valerie J. , Lloyd Glyn A.S. , Howard David J. , Cheesman Anthony D. , Phelps Peter D.
Published: November 2003

The use of magnetic resonance imaging (MRI) enhanced with gadolinium and diethylenetriamine pentaacetic acid (DTPA) in the preoperative evaluation of sinonasal malignancy is well established and has an accuracy of over 98%. Since 1979, 208 patients have undergone craniofacial resection at London's Institute of Laryngology & Otology, primarily for sinonasal neoplasia affecting the anterior skull base. Thirty‐five “high‐risk” patients had MRI at follow‐up. The MRI scans were assessed before the patients were examined under anesthesia.

MRI was assessed before examination under anesthesia and the results compared with histologic findings demonstrating a reasonable degree of positive correlation but one which is inferior to that found preoperatively (80%). An extension of this technique using the subtraction of T1‐weighted MRI with Gd‐DTPA highlights areas of increased vascularity, which significantly improves the ability to predict recurrence at the skull base and above the surgical repair in the anterior cranial fossa (94%).

Laryngoscope, 106:553‐558, 1996
Three‐Dimensional Computed Imaging Using a Personal Computer for Nasal Surgery
Authors: Tsunoda Atsunobu , Komatsuzaki Atsushi , Yamada Mari , Terasaki Omi
Published: November 2003

Three‐dimensional (3‐D) computed imaging was applied before surgery in 16 patients with nasal or paranasal disease. The images obtained by computed tomography (CT) were scanned by a personal computer. The contours of the organs were outlined on the scanned images, and the images were then reconstructed using 3‐D imaging software. The resulting 3‐D images were evaluated and compared with actual surgical images.

The 3‐D images were found to be useful for surgical procedures, because they facilitated recognition of the topologic relation between structure and lesion. Although this method requires a personal computer and an image scanner, it is cheaper than, and in some respects even superior to, a 3‐D CT system.

Laryngoscope, 106:584‐588, 1996
Human Nasal Epithelium Adsorbs Complement C3‐Related Fragments and Expresses Cell Membrane Complement Regulatory Proteins
Authors: Varsano Shabtai , Frolkis Inna , Shapiro Hava , Ophir Dov
Published: November 2003

Recent evidence suggests that complement is activated in human nasal airways in inflammatory states. Activated complement protects the nasal mucosa against microorganisms, but also has the potential to lyse the host's normal cells. Complement‐mediated cell lysis depends on adsorption of complement to the cell membrane and on uninterrupted activation of the complement cascade upon the same cell membrane. In the present study, the authors investigated first whether key complement components, C3‐related fragments, are adsorbed to nasal epithelial cell membrane. Second, we investigated whether nasal epithelium expresses cell membrane complement regulatory proteins that are known as interruptors of complement activation.

Studies were done using fresh nasal mucosa obtained at turbinectomies from allergic rhinitis and vasomotor rhinitis patients. In addition, in order to establish an in vitro model, studies were also done using primary cell cultures of nasal epithelium. We have found that complement C3‐related fragments are present on cell membranes of fresh nasal epithelium and that C3‐related fragments are adsorbed to the epithelial cell membrane in nasal mucosa tissue segments and in cell cultures that were incubated with autologous serum. Adsorption of C3‐related fragments to the cell membrane of cultured nasal epithelial cells was found by flow cytometry analysis to be concentration‐dependent. In addition, we found that nasal epithelium in fresh tissue and in cell culture express three cell membrane complement regulatory proteins: membrane cofactor protein (MCP, CD46), decay‐accelerating factor(DAF, CD55), and CD59. Our findings in fresh nasal epithelium suggest that complement activation may occur upon the nasal epithelial cell membrane during inflammation in vivo and that nasal epithelium might regulate this complement activation. Our in vitro cell culture model will allow further investigations of complement activation and regulation upon the human nasal epithelial cell membrane.

Laryngoscope, 106:599‐604, 1996
Effects of Oral and Systemic Immunization on Nasopharyngeal Clearance of Nontypeable Haemophilus influenzae in BALB/c Mice
Authors: Kurono Yuichi , Shigemi Hideo , Kodama Satoru , Mogi Goro
Published: November 2003

BALB/c mice were immunized orally or subcutaneously with formalin‐killed nontypeable Haemophilus influenzae (NTHi). Salivary immunoglobulin A (IgA) antibody titers against NTHi were significantly increased by oral immunization, but not by subcutaneous immunization. Both immunization procedures remarkably increased the levels of serum antibody activities of both IgA and immunoglobulin G.

Live NTHi were then inoculated into the nasopharynx, and the clearance of the pathogen from the nasopharynx was observed. Significantly fewer bacteria were present in the nasopharynx of the orally immunized mice than in the control mice. However, there was no significant difference between the subcutaneously immunized mice and the control mice. The results indicate that oral immunization can enhance the ability of mice to clear NTHi from the nasopharynx.

Laryngoscope, 106:614‐618, 1996
Brain‐Derived Neurotrophic Factor and Peripheral Nerve Regeneration: A Functional Evaluation
Authors: Shirley Diane M. , Williams Sherri A. , Santos Perry M.
Published: November 2003

The potential benefit of brain‐derived neurotrophic factor (BDNF) on motor‐nerve regeneration after transection injury in 24 adult rats was evaluated after entubulation repair. Gait analysis for ankle angle and tension transduction device (TTD) strain‐gauge measurements yielded functional evaluation of regeneration. The BDNF (15 mg/mL) or phosphate buffered saline(control) was injected into the silicone elastomer (Silastic®) channel. Gait analysis performed 0, 2, 4, 6, 10, and 12 weeks after injury demonstrated a significant difference between uninjured and injured legs of 23 and 43 degrees, respectively (P<.001, analysis of variance). The TTD evaluation 13 weeks after injury demonstrated a significant decrease in force development of injured compared to uninjured legs, 148 and 58 g, respectively (P<.001). No functional benefits were demonstrated between BDNF‐treated versus control‐treated animals in either model for a single exposure to BDNF.

Laryngoscope, 106:629‐632, 1996
Indications and Variations of Transcochlear Exposure of the Ventral Brainstem
Authors: Arriaga Moises A. , Gorum Michael
Published: November 2003

The transcochlear exposures represent a spectrum of three approaches(transotic to transcochlear to transpetrous) that provide progressively wider lateral skull base exposure. The approaches all combine the translabyrinthine approach with removal of the cochlea. The facial nerve remains in situ in the transotic approach. The facial nerve is mobilized posteriorly in the transcochlear approach, and the transpetrous exposure adds resection of the petrous apex with carotid artery mobilization.

This report focuses on the indications for each of the variations of transcochlear exposure. These lateral skull base exposures can be individualized to the needs of each patient.

Laryngoscope, 106:639‐644, 1996
Triosite Implants and Fibrin Glue in the Treatment of Atrophic Rhinitis: Technique and Results
Authors: Bertrand Bernard , Doyen Anne , Eloy Philippe
Published: November 2003

Nine patients with primary or secondary atrophic rhinitis were treated by narrowing of the nasal fossae using a new surgical technique (derived from the Eryes procedure) in which a Triosite® and fibrin glue mixture is implanted via the labial vestibule route. The results were good or excellent in seven patients. No rejections occurred. Osseocoalescence, as evaluated by computed axial tomography at 6 months, was good. Inspiratory intrasnasal pain in patients with postsurgical atrophic rhinitis improved following the operation.

The surgical technique, which is quick and easy to perform, avoids the discomfort of nostril closure or the implantation of grafts from other parts of the body. Complicated flap procedures are also avoided.

Laryngoscope, 106:652‐657, 1996
Distortion Generated by the Ear: Its Emergence and Evolution During Development
Authors: Tubach Martin , McGee JoAnn , Walsh Edward J.
Published: November 2003

Physiologically vulnerable active mechanics associated with the transduction of sounds in adults distort cochlear output. Specifically, frequencies not present in the incoming acoustic signal are represented in its output (i.e., the spike trains of auditory nerve fibers). The purpose of this investigation was to study the appearance and evolution of intermodulation distortion during development.

Established surgical and electrophysiologic techniques were used to record the extracellular electrical activity of individual auditory nerve fibers from developing kittens. Discharge‐rate or synchrony‐based responses to two tones(f1 and f2) presented simultaneously at various ratios of f2/f1 were recorded. The cubic distortion product (CDP; 2f1‐f2, where f1<f2) and the difference tone(f2‐f1) were the intermodulation distortion products (DPs) emphasized in the investigation.

CDPs were first observed nearly 10 days after the earliest auditory nerve fiber responses to simple tone‐burst stimuli could be elicited in neonatal cats. Furthermore, the spectrum of DPs generated in the cochlea changed dramatically during the second postnatal week and achieved adultlike characteristics after the first postnatal month.

Findings reported here support the notion that cochlear transduction is initially linear in neonatal cats, possibly representing a critical period of auditory development, and that the content of distortion‐related spectral information carried in auditory nerve fiber spike trains increases during development, in concert with other peripheral auditory attributes.

Laryngoscope, 106:822‐830, 1996
Stapedectomy in Profound Cochlear Loss
Authors: Glasscock Michael E. , Storper Ian S. , Haynes David S. , Bohrer Pamela S.
Published: November 2003

Stapedectomy can be used in certain patients with profound sensorineural hearing loss and stapes fixation to improve hearing to a level at which a hearing aid may be effective. This study reviews the outcomes of 11 patients with profound cochlear loss secondary to otosclerosis who underwent stapes surgery performed by the senior author (M.E.G.) over a 25‐year period.

Postoperative hearing aid usage was effective in 9 of 11 patients. Preoperatively, these patients derived no benefits from hearing aids. Stapedectomy may be of immense value in patients with the proper history and profound cochlear loss.

Laryngoscope, 106:831‐833, 1996
Metastatic Neoplasms to the Larynx: Report of Three Cases
Authors: Nicolai Piero , Puxeddu Roberto , Cappiello Johnny , Peretti Giorgio , Battocchio Simonetta , Facchetti Fabio , Antonelli Antonino Roberto
Published: November 2003

Metastatic involvement of the larynx by distant malignancies is a rare event that can occur by hematogenous or lymphogenous spread through a retrograde or anterograde route. Only 143 cases of secondary laryngeal tumors have been reported in the literature. Metastases from cutaneous melanoma and renal carcinoma are the most common, whereas only sporadic cases stemming from lung and colon adenocarcinoma have been documented. The authors report a case of lung adenocarcinoma and two cases of colonic adenocarcinoma metastatic to the larynx and discuss the problems related to the pathogenesis, diagnosis, and management of secondary laryngeal neoplasms.

Laryngoscope, 106:851‐855, 1996
Determination of the Efficacy of Topical Oral Pilocarpine for Postirradiation Xerostomia in Patients With Head and Neck Carcinoma
Authors: Hamlar David D. , Schuller David E. , Gahbauer Reinhard A. , Buerki Robert A. , Staubus Alfred E. , Hall Jeff , Altman Jerald S. , Elzinga Darryl J. , Martin Melanie R.
Published: November 2003

Pilocarpine hydrochloride suspended in a candylike pastille was evaluated as a topical treatment for radiation‐induced xerostomia in head and neck cancer patients. This local delivery system, which differs from systemically administered pilocarpine preparations, was developed to hopefully maximize the local response and minimize the systemic side effects. A prospective, randomized, double‐blind, placebo‐controlled trial was undertaken to determine objective and subjective efficacy in reversing the decrease in salivation. Forty previously irradiated patients received increasingly higher pilocarpine dosages in pastilles for 5 successive weeks. At each successive dose of pilocarpine, no significant increased salivation was noted. However, 25 (74%) of 34 patients reported that pilocarpine alleviated their subjective xerostomia. Topical pilocarpine administration has shown similar results to previous systemic delivery methods for radiation‐induced xerostomia, but with improved patient tolerance.
Safety Awareness for the Otolaryngologist Caring for the HIV‐Positive Patient
Authors: Kantu Sanjay , Lee Dennis , Nash Michael , Lucente Frank E.
Published: November 2003

The alarming increase in human immunodeficiency virus (HIV) infection, expected to reach 40 million cases worldwide by the year 2000, has enormous impact on the otolaryngologist, since up to 70% of HIV‐positive patients present with head and neck symptoms. Parenteral and nonparenteral acquisition of HIV has been documented with seroconversion from needle sticks estimated at 1 for every 200 exposures. The rate of compliance with universal precautions is found to be reported as low as 16%. In 1993, over 1400 patients with HIV were admitted to Kings County Hospital Center. There were 165 reported cases of sharp injuries of which 4 were scalpel related and 17 were suture needle related. We surveyed HIV safety experiences at five hospitals emphasizing operating room procedures, including instrument handling, gloving, elimination of excess equipment and personnel, utilization of nonsharp instruments, and team discipline. Preventive measures are recommended to help minimize inadvertent sharp injuries.
Nitric Oxide: A Mediator of Endotoxin‐Induced Middle Ear Effusions
Authors: Ball Steven S. , Prazma Jiri , Dais C.G. Dean , Rosbe Kristina W. , Pillsbury Harold C.
Published: November 2003

Using a rat model, the authors investigated the role of nitric oxide (NO) in endotoxin‐induced middle ear effusion (MEE). After the eustachian tube was obstructed, the middle ear was transtympanically injected with 35μL of either 1 mg/mL lipopolysaccharide (LPS) or LPS and 1 mmol/L N‐nitro‐L‐arginine methyl ester (L‐NAME), a competitive inhibitor of NO synthase. Over the next 6 hours, the fluid within the middle ear was collected every 2 hours, and the quantity of albumin in the fluid, an index of vascular leakage, was determined using enzyme‐linked immunosorbent assay.

L‐NAME significantly reduced LPS‐induced vascular extravasation into the middle ear. Inoculation of the ear with L‐arginine, the substrate for NO synthase, reversed the effects of L‐NAME. These results indicate that NO is a mediator of LPS‐induced MEE. Therefore, inhibition of NO synthase may represent a novel approach to the treatment of otitis media with effusion.
Laser‐Assisted Tympanostomy
Authors: Silverstein Herbert , Kuhn Jeffery , Choo Dan , Krespi Yosef P. , Rosenberg Seth I , Rowan Philip T.
Published: November 2003

Laser‐assisted tympanostomy (LAT) was performed in 70 ears to ventilate the middle ear space without using a pressure‐equalizing tube. Using a CO2 laser attached to an operating microscope with a Microslad (microscope laser adaptor device), tympanostomies of 1.0 to 3.0 mm (average, 1.6 mm) in diameter were created and remained patent for an average of 3.14 weeks. Patency time was directly related to the size of the opening. Nearly all (97.9%) of the tympanostomies healed with no noticeable scarring and no persistent perforations. Seventy‐eight percent of patients at the Florida Ear & Sinus Center (FESC, Sarasota, Fla.) and 84% of patients at the Head & Neck Surgery Group (New York) showed no evidence of recurrent effusion after a minimum follow‐up of 3 months. LAT appears to be a safe, cost‐effective procedure which can easily be performed in an office setting when bloodless opening in the tympanic membrane is needed for either treatment or diagnosis using endoscopes.
Recognition and Surgical Management of the Upper Airway Resistance Syndrome
Authors: Newman James P. , Clerk Alex A. , Moore Michelle , Utley David S. , Terris David J.
Published: November 2003

Patients with upper airway resistance syndrome (UARS) have clinical signs and symptoms of excessive daytime somnolence (EDS) in the absence of obstructive sleep apnea. These patients have increased upper airway resistance, reflected by an elevated intrathoracic pressure measurement, despite a normal respiratory disturbance index (RDI). Physical findings often include excessive palatal tissue and narrowing of the oropharynx and hypopharynx.

Nine patients with UARS who received surgical treatment were prospectively evaluated. The four men and five women had signs of EDS, with or without snoring. The mean (±standard deviation) RDI was 2.1 (±1.2), and the mean esophageal pressure recording during polysomnography was ‐36.7 (±16.2) cm H2O. The Epworth sleepiness scale was used to quantify EDS. The preoperative score of 12.0 (±6.6) decreased to 3.4 (±1.9) (P=.001) after surgical treatment. A variety of procedures, all including some type of palatal surgery, were performed. No treatment complications occurred.

The recognition of UARS and an understanding of the mechanisms responsible for the progressive development of obstructive sleep apnea syndrome may facilitate the prompt identification and treatment of such patients. The pathophysiology of UARS and a preliminary report of its surgical treatment are discussed.