bluuebunny/crossref_metadata_2025 huggingface dataset:
Software for the calculation of isotope patterns in tandem mass spectrometry
Authors: Ramaley Louis , Herrera Lisandra Cubero
Published: August 2008

Software, available at no cost on the Internet, is described which uses polynomial expansion algorithms to calculate the isotope patterns for precursor ion, neutral loss, and MSn product ion tandem mass spectra. Such information is useful for determining product ion and neutral loss composition, identification of analytes in complex samples, deconvolution of overlapping spectra, and correction of peak heights or areas in quantitative analysis. The effect of less than unit mass resolution on the isotope patterns is described and experimental examples of the use of the software are presented. Copyright © 2008 John Wiley & Sons, Ltd.
Correction
Authors: Malec Donald J.
Published: August 2008

‘Small area random effect models for capture/recapture methods with applications to estimating coverage error in the U.S. Decennial Census’ by Donald J. Malec and Jerry Maples.

The paper contains two sets of equations that incorrectly specify a log‐linear model for the correct enumeration and match probabilities. A linear‐logistic model was actually used for these probabilities. Other parts of the paper correctly specify the linear‐logistic relationship and all results are based on the linear‐logistic model.

Specifically, equation (3) should be

and equation
(8) should be
Mixed treatment comparison with multiple outcomes reported inconsistently across trials: Evaluation of antivirals for treatment of influenza A and B
Authors: Welton N. J. , Cooper N. J. , Ades A. E. , Lu G. , Sutton A. J.
Published: August 2008

We present a mixed treatment meta‐analysis of antivirals for treatment of influenza, where some trials report summary measures on at least one of the two outcomes: time to alleviation of fever and time to alleviation of symptoms. The synthesis is further complicated by the variety of summary measures reported: mean time, median time and proportion symptom free at the end of follow‐up. We compare several models using the deviance information criteria and the contribution of different evidence sources to the residual deviance to aid model selection. A Weibull model with exchangeable treatment effects that are independent for each outcome but have a common random effect mean for the two outcomes gives the best fit according to these criteria. This model allows us to summarize treatment effect on two outcomes in a single summary measure and draw conclusions as to the most effective treatment. Amantadine and Oseltamivir were the most effective treatments, with the probability of being most effective of 0.56 and 0.37, respectively. Amantadine reduces the duration of symptoms by an estimated 2.8 days, and Oseltamivir 2.6 days, compared with placebo. The models provide flexible methods for synthesis of evidence on multiple treatments in the absence of head‐to‐head trial data, when different summary measures are used and either different clinical outcomes are reported or where the same outcomes are reported at different or multiple time points. Copyright © 2008 John Wiley & Sons, Ltd.
Simple tests for the external validation of mortality prediction scores
Authors: Stallard Nigel
Published: August 2008

This paper is concerned with methods for the external validation of the prognostic scores that predict the probability of some event such as death. The problem is similar to that of testing the goodness‐of‐fit of a logistic regression model, except that the prognostic scores are not estimated and validated using the same data. A number of methods for assessing logistic model goodness‐of‐fit have been proposed, and some of these can also be used in the setting considered. A simple test based on the likelihood ratio statistic is proposed, which does not require arbitrary choice of groups or smoothing parameters. In a simulation study, the proposed method is found to be as powerful as commonly used methods under the scenarios considered. Copyright © 2008 John Wiley & Sons, Ltd.
Modified PVA–Fe3O4 Nanoparticles as Protein Carriers into Sperm Cells
Authors: Makhluf Shirly Ben‐David , Abu‐Mukh Riam , Rubinstein Sara , Breitbart Haim , Gedanken Aharon
Published: August 2008

Magnetite nanoparticles conjugated to protein are developed in order to potentially serve as protein carriers into bovine sperm cells. The conjugate comprises iron oxide nanoparticles that are covalently bound to an anti‐protein kinase C (PKC)α antibody. This conjugate can serve for cellular PKC localization and the inhibition of its function. The surface of the nanoparticle is first modified with (3‐aminopropyl) thrimethoxysilane to form a self‐assembled monolayer, and subsequently conjugated with the antibody through amidation between the carboxylic acid end groups on the antibody and the amine groups on the surface of the nanoparticles. The anti‐PKCα localization is proven by fluorescent microscopy and iron staining. The activity of the anti‐PKCα conjugated with the nanoparticle is tested by recognizing PKCα using the Western blot method.
Towards an Ultrasensitive Method for the Determination of Metal Impurities in Carbon Nanotubes
Authors: Kolodiazhnyi Taras , Pumera Martin
Published: August 2008

Residual catalyst metal nanoparticles remain one of the major obstructions in the utilization of carbon nanotubes (CNTs) in many areas owing to their ability to participate in redox chemistry of biomarkers. Presented here is a comparative study of several techniques for quality control of carbon nanotubes in terms of metallic impurities, namely magnetic susceptibility, electron paramagnetic resonance, energy‐dispersive X‐ray spectrometry, X‐ray photoelectron spectroscopy, and thermogravimetric analysis. It is found that the dc magnetic susceptibility is the most sensitive method such that the difference between two CNT samples that underwent slightly different treatments can be detected, whereas the two samples are indistinguishable by other techniques. Therefore, it is suggested that the most accurate statistical method for quality control of carbon nanotubes is dc magnetic susceptibility, which allows the detection of traces of magnetic metal impurities embedded in purified carbon nanotubes, whereas other methods may provide false “impurity‐free” information.
Surgical Training in India
Authors: Udwadia Tehemton E. , Sen Gautam
Published: August 2008

Background

The quality of surgical training and competence defines the quality of patient care. The developed world evolved its surgical training over a long progressive period, whereas countries in the developing world, of which India is a reasonable example, were jettisoned into the waters, to hurriedly create their own training.

Method

Surgical training is but part of the picture of any countries medical education. Keeping stastics to a bare minimum, an attempt is made to trace the evolution, progress and current state of surgical training in India. Shortcomings in the training program in a country with such a tremendously wide economic spectrum, and their possible solutions, are evaluated.

Results

In a country as vast, populous and complex as India no one article could even remotely do justice to this subject. What is lost in depth and pragmatism here is hopefully compensated, to some small degree, by the 50 year personal experience (and perhaps philosophy) of one of the authors (T.E.U.).

Conclusions

Surgical Training has to be tailored to the specific needs of each country. Surgery is a humanitarian science. The thrust of surgical training in India should be, and hopefully will be, not just to be on par with the developed world, but more important, to ensure good surgical care to all Indians, in all places.
Evolution of gamete size in primitive taxa without mating types
Authors: Togashi Tatsuya , Sakisaka Yukio , Miyazaki Tatsuo , Nagisa Masaru , Nakagiri Nariyuki , Yoshimura Jin , Tainaka Kei‐ichi , Cox Paul Alan , Bartelt John L.
Published: August 2008

An ESS model to better understand the evolutionary dynamics of a primitive non‐mating type gamete size was developed with reference to the PBS (Parker, Baker and Smith's) theory, which was based on total numbers of zygotes formed and the zygote survival rates. We did not include mating types since it has been suggested that primitive mating systems did not have mating types. As input parameters, we used experimental data on gamete motility of marine green algae. Based on hard sphere collision mechanics, we detailed the fertilization kinetics of gametes that swim in water prior to fusing with their partners through a set of coupled, non‐linear differential equations. These equations were integrated numerically using typical values of the constant parameters. To estimate the relative zygote survival rate, we used a function that is sigmoid in shape and examined some evolutionarily stable strategies in mating systems that depend on optimizing values of the invasion success ratio.
Congenital disorder of glycosylation type Id (CDG Id): phenotypic, biochemical and molecular characterization of a new patient
Authors: Rimella‐Le‐Huu A. , Henry H. , Kern I. , Hanquinet S. , Roulet‐Perez E. , Newman C. J. , Superti‐Furga A. , Bonafé L. , Ballhausen D.
Published: August 2008

Congenital disorders of glycosylation (CDG) are a family of multisystem inherited disorders caused by defects in the biosynthesis of N‐ or O‐glycans. Among the many different subtypes of CDG, the defect of a mannosyltransferase encoded by the human ALG3 gene (chromosome 3q27) is known to cause CDG Id. Six patients with CDG Id have been described in the literature so far. We further delineate the clinical, biochemical, neuroradiological and molecular features of CDG Id by reporting an additional patient bearing a novel missense mutation in the ALG3 gene. All patients with CDG Id display a slowly progressive encephalopathy with microcephaly, severe psychomotor retardation and epileptic seizures. They also share some typical dysmorphic features but they do not present the multisystem involvement observed in other CDG syndromes or any biological marker abnormalities. Unusually marked osteopenia is a feature in some patients and may remain undiagnosed until revealed by pathological fractures. Serum transferrin screening for CDG should be extended to all patients with encephalopathy of unknown origin, even in the absence of multisystem involvement.
Physico‐Chemical Characterization of Sesame Oil Derivatives
Authors: Zanardi Iacopo , Travagli Valter , Gabbrielli Alessandro , Chiasserini Luisa , Bocci Velio
Published: August 2008

Ozone treatment of commercially available vegetable oils gives rise to the formation of chemical species that are responsible for the therapeutic properties of ozonated oil derivatives in dermatological diseases. In the last years, these products have been successfully used as a topical disinfectant in a number of serious skin affections. The medical application of empirically prepared ozonated oil has yielded striking improvements with unexpected and rapid healing, compelling us to begin a long‐range study aiming first to define the main characteristics of the most common ozonated vegetable oils, about which there is usually no medical consensus because of the lack of standardization of their technological parameters. Sesame oil was selected because of its great amount of polyunsaturated acyl groups, as well as natural antioxidants. Moreover, we have determined the kinetics and optimal conditions of ozonation (e.g., ozone concentrations, time of exposure, temperature) for obtaining an ozonated oil characterized by well‐established technological and physico‐chemical properties, namely an accurate peroxide value determination. On the basis of the results, we have gained an understanding of the modifications of the vegetable oils during the ozonation process.
Nepmucin/CLM‐9, an Ig domain‐containing sialomucin in vascular endothelial cells, promotes lymphocyte transendothelial migration in vitro
Authors: Jin Soojung , Umemoto Eiji , Tanaka Toshiyuki , Shimomura Yoshimitsu , Tohya Kazuo , Kunizawa Keiji , Yang Bo-Gie , Jang Myoung Ho , Hirata Takako , Miyasaka Masayuki
Published: August 2008

Nepmucin/CLM‐9 is an Ig domain‐containing sialomucin expressed in vascular endothelial cells. Here we show that, like CD31, nepmucin was localized to interendothelial contacts and to vesicle‐like structures along the cell border and underwent intracellular recycling. Functional analyses showed that nepmucin mediated homotypic and heterotypic cell adhesion via its Ig domain. Nepmucin‐expressing endothelial cells showed enhanced lymphocyte transendothelial migration (TEM), which was abrogated by anti‐nepmucin mAbs that block either homophilic or heterophilic binding. Notably, the mAbs that inhibited homophilic binding blocked TEM without affecting lymphocyte adhesion. These results suggest that endothelial nepmucin promotes lymphocyte TEM using multiple adhesion pathways.
5‐Hydroxytryptamine 2A receptor signaling cascade modulates adiponectin and plasminogen activator inhibitor 1 expression in adipose tissue
Authors: Uchida-Kitajima Shoko , Yamauchi Toshimasa , Takashina Youko , Okada-Iwabu Miki , Iwabu Masato , Ueki Kohjiro , Kadowaki Takashi
Published: August 2008

Knowledge of the regulatory factors associated with down‐regulation of adiponectin gene expression and up‐regulation of PAI‐1 gene expression is crucial to understand the pathophysiological basis of obesity and metabolic diseases, and could establish new treatment strategies for these conditions. We showed that expression of 5‐HT2A receptors was up‐regulated in hypertrophic 3T3‐L1 adipocytes, which exhibited decreased expression of adiponectin and increased expression of PAI‐1. 5‐HT2A receptor antagonists and suppression of 5‐HT2A receptor gene expression enhanced adiponectin expression. Activation of Gq negatively regulated adiponectin expression, and inhibition of mitogen‐activated protein kinase reversed the Gq‐induced effect. Moreover, the 5‐HT2A receptor blockade reduced PAI‐1 expression. These findings indicate that antagonism of 5‐HT2A receptors in adipocytes could improve the obesity‐linked decreases in adiponectin expression and increases in PAI‐1 expression.
Detection of higher‐order G protein‐coupled receptor oligomers by a combined BRET–BiFC technique
Authors: Gandia Jorge , Galino Jorge , Amaral Olavo B. , Soriano Aroa , Lluís Carme , Franco Rafael , Ciruela Francisco
Published: August 2008

MINT‐6700472:

A2A (uniprotkb:P29274), A2A (uniprotkb:P29274) and A2A (uniprotkb:P29274) physically interact (MI:0218) by bioluminescence resonance energy transfer (MI:0012)

MINT‐6699330:

A2A (uniprotkb:P29274) and A2A (uniprotkb:P29274) physically interact (MI:0218) by bimolecular fluorescence complementation (MI:0809)

MINT‐6699346:

A2A (uniprotkb:P29274) and A2A (uniprotkb:P29274) physically interact (MI:0218) by bioluminescence resonance energy transfer (MI:0012)
Crystal structure of the IL‐22/IL‐22R1 complex and its implications for the IL‐22 signaling mechanism
Authors: Bleicher Lucas , de Moura Patricia Ribeiro , Watanabe Leandra , Colau Didier , Dumoutier Laure , Renauld Jean-Christophe , Polikarpov Igor
Published: August 2008

MINT‐6693956:

Il22 (uniprotkb:Q9GZX6) and IL22R1 (uniprotkb:Q8N6P7) bind (MI:0407) by X-ray crystallography (MI:0114)
Inhibition of astrocytes promotes long‐distance growing nerve fibers in ventral mesencephalic cultures
Authors: af Bjerkén Sara , Marschinke Franziska , Strömberg Ingrid
Published: August 2008

Tyrosine hydroxylase‐positive nerve fiber formation occurs in two diverse morphological patterns in rat fetal ventral mesencephalic slice cultures; one is non‐glial‐associated and the other is glial‐associated. The aim of this study was to characterize the non‐glial‐associated nerve fibers and its relation to migration of astrocytes. Organotypic slice cultures were prepared from embryonic days 12, 14, and 18 rat fetuses and maintained for 5, 7 or 14 days in vitro. Inhibition of cell proliferation using cytosine β‐d‐arabinofuranoside was conducted in embryonic day 14 ventral mesencephalic cultures. The treatment impaired astrocytic migration at 7 and 14 days in vitro. The reduced migration of astrocytes exerted a negative effect on the glial‐associated tyrosine hydroxylase‐positive nerve fibers, reducing the outgrowth from the tissue slice. The non‐glial‐associated outgrowth was, however, positively affected by reduced astrocytic migration, reaching distances around 3 mm in 2 weeks, and remained for longer time in culture. Co‐cultures of fetal ventral mesencephalon and frontal cortex revealed the cortex as a target for the non‐glial‐associated tyrosine hydroxylase‐positive outgrowth. The age of the fetal tissue at plating affected the astrocytes such that older tissue increased the length of astrocytc migration. Younger tissue at plating promoted the presence of non‐glial‐asscociated outgrowth and long radial‐glia‐like processes, while older tissue promoted migration of neurons instead of formation of nerve fiber network. In conclusion, inhibition of astrocytic proliferation promotes the persistence of long‐distance growing tyrosine hydroxylase‐positive nerve fibers in ventral mesencephalic slices cultures. Furthermore, the long‐distance growing nerve fibers target the frontal cortex and are absent in cultures derived from older tissue.
Infection of the subcutis of the nose in a cat caused by Mucor species: Successful treatment using posaconazole
Authors: Wray Jonathan D. , Sparkes Andrew H. , Johnson Elizabeth M.
Published: August 2008

A 14-year-old neutered female domestic shorthair cat was presented for investigation of a non-painful subcutaneous swelling of the nasal dorsum at the site of a scratch injury. Cytological evaluation demonstrated a granulomatous reaction and many variably shaped organisms consistent with yeasts/fungi. Subsequent biopsy and culture yielded a pure growth of a Mucor species. The cat was treated with the second-generation triazole antifungal agent posaconazole for 5 months. Complete resolution was seen with no recurrence 12 months after discontinuing treatment.
Oropharyngeal Reconstruction for Advanced Cancer
Authors: Zafereo Mark E. , Weber Randal S , Lewin Jan S , Roberts Dianna B , Hanasono Matthew M
Published: August 2008

Objective

To assess perioperative morbidity, functional outcomes, and survival following microvascular and regional flap reconstruction of the oropharynx after advanced oncologic resection.

Methods

65 patients underwent oropharyngeal reconstruction for late stage primary (35.4%), second primary (10.8%), or recurrent (53.8%) oropharyngeal and oral cavity squamous cell carcinoma at a tertiary cancer center between 1997 and 2007. 50 (76.9%) males and 15 (23.1%) females with a median age of 59.2 years (range 28.6 to 76.1 years) were reconstructed with rectus myocutaneous free flaps (30.8%), anterolateral thigh free flaps (27.7%), radial forearm free flaps (20%), pectoralis myocutaneous pedicled flaps (15.4%), and fibula osseocutaneous free flaps (6.2%).

Results

The median follow‐up time following oropharyngeal reconstruction was 36.3 months (range 1.3 to 144.2 months). There were no complete flap failures and only 1 partial flap failure. 32 (49.2%) patients experienced postoperative complications including 11 wound infections/dehiscences, 7 fistulas, 7 donor site complications, and 11 postoperative pneumonias. Mean intensive care unit nights and total days hospitalized were 2.8 and 9.6, respectively. Of 56 patients undergoing a tracheostomy, 48 (73.8%) were decannulated a median of 13 days (range 5 to 426 days) following surgery. 42 (64.7%) remained at least partially feeding tube‐dependent, but 41 (63.1%) attained at least 80% oral speech intelligibility. 3‐and 5‐year overall survivals following reconstruction were 49.1% and 37.3%, respectively.

Conclusions

Selected patients who undergo reconstruction for extensive oropharyngeal defects following surgery for advanced cancer can attain long‐term survival. While most patients achieve decannulation and functional speech, almost 2/3rds remain feeding tube‐dependent.
Adult Tonsillectomy: Current Indications and Outcomes
Authors: Hoddeson Elizabeth Kathryn , Gourin Christine G.
Published: August 2008

Objective

With increased antibiotic usage, the indications for pediatric tonsillectomy have shifted from infection to treatment of airway obstruction. Limited data exists regarding the current prevalence of indications for tonsillectomy in adults. We sought to determine the indications for tonsillectomy in an adult population and identify factors associated with postoperative complications.

Methods

The medical records of all adult patients (18 or more years of age) who underwent tonsillectomy from 2001–2007 were reviewed. Patients who underwent concurrent procedures were excluded.

Results

A total of 361 patients met study criteria. Indications for surgery were chronic infection in 207 patients (57%), upper airway obstruction secondary to tonsillar hypertrophy in 98 patients (27%), and suspected neoplasm in 56 patients (16%). Postoperative complications occurred in 54 cases (15%) with hemorrhage in 19 patients (5%), followed by pain and dehydration in 16 patients (4%) and admission for postoperative oxygen desaturations in 11 patients (3%). Hospitalization beyond 24 hours occurred in 18 cases (5%), with emergency room visits for pain and dehydration in 16 patients (4%), and readmission for pain control in 17 cases (5%). Patients who underwent tonsillectomy for upper airway obstruction had an increased incidence of prolonged hospitalization or readmission (19% vs. 6%; P=0.01), while patients who underwent tonsillectomy for infection had an increased incidence of post‐operative bleeding (6% vs. 4%; p=0.02).

Conclusions

Chronic infection remains the most common indication for adult tonsillectomy, in contrast to the pediatric population. Complication rates vary according to the indication for surgery. These data may provide useful information for preoperative counseling.
Endoscopic Margins of Skull‐base Tumors: Oncologically Safe?
Authors: Cohen Marc A. , Liang Jonathan , O'Malley Bert W , Newman Jason G
Published: August 2008

Objective

1) Learn if margins of resection in anterior skull base tumors that are entirely or endoscopic‐assisted are comparable with those undergoing traditional craniofacial resection. 2) Understand if there is a difference in patient mortality with traditional CFR compared to endoscopic‐assisted surgery.

Methods

Retrospective review was conducted of patients undergoing surgery at our institution for malignant lesions of the anterior skull base between 2000–2006. 46 patients were identified. 20 underwent endoscopic‐assisted or total endoscopic resection. Margins were evaluated by the pathologist. Recurrence rates were calculated based on the presence or absence of recurrence at the last office visit. Follow‐up times ranged from 1 month to 5 years.

Results

Of the 20 patients undergoing endoscopic or endoscopic assisted CFR of anterior skull base lesions, 15/20 patients had negative margins (75%), 4/20 had positive margins (20%), and 1/20 had close margins (5%). In those patients undergoing traditional CFR, 17/26 patients had negative margins (65%), 8/26 had positive margins (30%), and 1/26 (4%) had close margins. Recurrence was noted in 9/26 (35%) of those who underwent traditional CFR and 6/20 (30%) of those with endoscopic assistance.

Conclusions

There does not appear to be increased risk of positive margins or recurrence in those undergoing endscopic or endoscopic‐assisted resection. Endoscopy may aid in identifying margins of tumor in the anterior skull base, leading to a greater likelihood of cure. Endoscopic resections have the potential to avoid morbity and should be considered oncologically sound in the appropriate patient with a skull base lesion.
Lymph Node Clustering in Head and Neck Squamous Cell Cancer
Authors: Lee Kimberly J. , Kirsch Claudia , Sayre James William , Bhuta Sunita , Abemayor Elliot
Published: August 2008

Objective

Detection of early regional metastasis of head and neck carcinoma is critical for tumor staging, prognosis, and treatment strategies. Clustered cervical lymphadenopathy portends a worse prognosis than isolated lymphadenopathy, but studies analyzing its effect are lacking. Key objectives include: 1) to establish criteria for lymph node clustering and 2) to assess the predictive value of lymph node clustering for metastasis.

Methods

This study retrospectively reviewed preoperative radiographic images of 29 patients with histopathologically proven metastatic head and neck squamous cell carcinoma between January 2006 and December 2007. Patients who had previous radiation or chemotherapy were excluded. CT, MRI, and PET CT images were assessed for lymph node size and number, neck level, and clustering, with respect to primary tumor location and size. A cluster was defined as 3 or more abutting nodes with no definable intervening fat planes.

Results

Statistics comparing histopathologic proven metastatic lymphadenopathy and radiographic clustering of nodes in each neck level were used to elucidate the positive predictive value via logistic regression analysis. Analysis revealed a positive predictive value for clustering of nodes greater than 1 cm to be 82.9%, with a negative predictive value of 100% in the level II region (p<0.05). Nodes in the remaining levels demonstrated less predictive values.

Conclusions

Clustered lymph nodes greater than 1cm in the level II region in head and neck squamous cell carcinoma have a high predictive value, suggesting that clustering is not only an important prognostic indicator but also an important radiographic feature that may assist surgeons in preoperative surgical planning.
Recurrent Papillary Thyroid Cancers: An Evolving Paradigm
Authors: Ondik Michael P. , Dezfoli Seper , Lipinski Lindsay , Ruggiero Francis P , Goldenberg David
Published: August 2008

Objective

Improved diagnostic techniques are changing the paradigm of recurrent thyroid cancer detection. High resolution ultrasound techniques, recombinant thyroglobulin assays and fused PET/CT imaging are detecting small recurrent thyroid cancers and prompting earlier surgical intervention. Our study seeks to identify the surgical outcomes in one of the largest series of recurrent papillary thyroid cancers.

Methods

A retrospective chart review identified 48 patients who underwent central and/or lateral neck dissections for recurrent papillary thyroid disease at our institution between 1999 and 2007. All of the patients had previously undergone primary thyroid surgery.

Results

There were 36 females, 12 males and the mean age of first recurrence was 49.8 years. 11 recurrences were identified by screening thyroglobulin, 10 had positive ultrasound findings, and 11 presented with a cervical mass. 14 patients underwent PET/CT scans and 28 had fine needle aspirations as part of their workup. No patients (0%) acquired permanent vocal cord paralysis and two (4.2%) developed hypoparathyroidism as a result of their initial reoperation for recurrent disease. 10 patients had a second recurrence.

Conclusions

Recurrent papillary thyroid cancer is a challenging dilemma for the thyroid surgeon. Improved surveillance techniques are allowing the earlier diagnosis of recurrence. While reoperative thyroid surgery carries many risks, our series demonstrates that it can be done with minimal complications. The long‐term implications of early intervention in this setting are still largely unknown and will warrant future research.
Thyroid Gland Management in Total Laryngectomy: Meta‐analysis
Authors: Mendelson Asher Aron , Al‐Khatib Talal Ahmed , Julien Marilyse , Hier Michael P
Published: August 2008

Objective

1. Review the incidence of thyroid gland invasion by squamous cell laryngeal carcinoma in the literature. 2. Correlate thyroid gland invasion with anatomical characteristics of the laryngeal tumor. Do laryngeal tumors which invade the thyroid gland share certain characteristics which can aid in determing the management of the thyroid gland during total laryngectomy?

Methods

Systematic review of MEDLINE (1967–2007) and EMBASE (1980–2007) for all total laryngectomy series which commented on thyroid gland invasion according to tumor subsite and pathological characteristics. These results were supplemented with 61 patients from our centers who underwent total laryngectomy with hemi‐ or total thyroidectomy. Eleven series in total (n = 535) were included in the meta‐analysis (fixed effects model).

Results

Thyroid gland invasion was present in 47 laryngectomy specimens (9%); the main method of invasion of the gland was by direct extralaryngeal extension. Subglottic extension > 10mm (OR 6.27 [2.16 to 18.19]; p = 0.0007), subglottic subsite (OR 4.32 [1.53 to 12.19]; p = 0.006), and transglottic subsite (OR 4.10 [1.75 to 9.57]; p = 0.001) were significantly correlated with thyroid gland invasion. Cartilagenous invasion by tumor was not a significant predictor of thyroid gland invasion (p>0.05).

Conclusions

Thyroid gland invasion is not a general feature of squamous cell laryngeal carcinoma. When present, it is strongly associated with anteroinferior spread of laryngeal tumors. Thyroidectomy should only be performed during total laryngectomy for transglottic tumors, subglottic tumors, and tumors with subglottic extension >10mm. In these cases, total thyroidectomy is warranted to maximize locoregional control.
A New Role of Staged Tympanoplasty for Cholesteatoma
Authors: Hinohira Yasuyuki , Yanagihara Naoaki , Hato Naohito
Published: August 2008

Objective

1) Investigate a correlation between pathological findings at the 2nd stage operation and long‐term outcomes in a staged canal wall‐up tympanoplasty (SCUT) for middle ear cholesteatoma. 2) Advocate a new role of the staged manner based on the study.

Methods

SCUT was performed on 90 ears with cholesteatoma involving both the ossicles and the mastoid cavity. The 1st stage operation included scutum plasty and mastoid cortex plasty with bone pate following removal of cholesteatoma and ossicles involved. The 2nd stage operation records were reviewed regarding the pathological findings associated with retraction pocket (RP) and residual cholesteatoma (RC) formation. The scutum defect was revised with auricular cartilage, and the mastoid cortex plasty was again performed after removal of RC. Postoperative follow‐up with endoscopic observation and CT was performed for all patients.

Results

At the 2nd stage, RP was seen in 15 ears (16.7%) which all showed partial or total absorption of the scutum reconstructed. Aeration grade of the mastoid cavity reconstructed did not correlate with RP or RC formation. RC was found in 28 ears (31.1%) regardless of RP formation. The long‐term follow up study revealed that the statistically higher incidence of RP re‐formation (26.7%) and RC (3.2%) was seen in ears which had been identified at the 2nd stage, respectively.

Conclusions

The present study showed that the long‐term outcomes after SCUT were correlated with RP and RC formation at the 2nd stage. This indicates the 2nd stage operation has a role of the long‐term prognosis in addition to exploration of RC.
Complications in Pediatric Cochlear Implants
Authors: Jeyakumar Anita , Clary Randall A
Published: August 2008

Objective

Be able to retrospectively review the complications of pediatric patients undergoing cochlear implantation at a tertiary referral center.

Methods

IRB permission was obtained. Retrospective analysis of all children who underwent cochlear implantation from January 2001 to December 2005 at a major academic cochlear implantation center. The patients were reviewed for demographic information, type of hearing loss, cochlear implant device, and complications, including implant failure, meningitis, hematomas (intracranial and extracranial), implant extrusion, cerebrospinal fluid leaks, facial palsy, and wound infections.

Results

A total of 165 patients records were reviewed. 53.5% of the patients were male. The most common device used was the Freedom NucleusTM (60%). The most common etiology of hearing loss was non‐syndromic, non‐genetic, congenital sensorineural hearing loss (60.6%) All patients had a follow‐up of at least 1 year. The most common complication seen was device failure (3.0%), followed by flap infections (2.6%), and immediate postoperative hematomas (1.9%). There was no difference between the kind of device which failed, statistically. There was only one case of Ps. aeruginosa meningitis in a child with a Mondini deformity, who had the implant removed.

Conclusions

Cochlear implantation in children continues to be reliable and safe, with a low percentage of severe complications, in experienced hands. The patients should have lifetime follow‐up.
Otologics Fully Implantable Hearing Device Phase II Results
Authors: Horlbeck Drew M , Jenkins Herman A , Balough Ben J , Hoffer Michael E
Published: August 2008

Objective

The efficacy of the Otologics Fully Implantable Hearing Device (MET) was assessed in adult patients with bilateral moderate to severe sensorineural hearing loss.

Methods

Surgical insertion of this totally implanted system was identical to the Phase I study. A repeated‐measures within‐subjects design assessed aided sound field thresholds and speech performances with the subject's own, appropriately fit, walk‐in hearing aid(s) and the Otologics Fully Implantable Hearing Device.

Results

Six‐ and 12‐month Phase II data will be presented. Ten patients were implanted and activated as part Phase II clinical trial. Three patients were lost to long term follow‐up due to two coil failures and one ossicular abnormality preventing proper device placement. No significant differences between preoperative (AC = 59 dB, BC = 55 dB) and postoperative (AC = 61 dB, BC = 54 dB) unaided pure tone averages were noted (p < 0.05). Pure tone average implant aided thresholds (41 dB) were equivalent to that of walk‐in‐aided (37 dB) condition with no significant difference (p < 0.05) between patients’ walk‐in‐aided individual frequency thresholds and implant‐aided thresholds. Word recognition scores and hearing in noise scores were similar between the walk‐in‐aided and for the implant‐aided condition. Patient benefit scales will be presented at all end points.

Conclusions

Results of the Otologics MET Fully Implantable Hearing Device Phase II trial provide evidence that this fully implantable device is a viable alternative to currently available hearing aids in patients with sensorineural hearing loss.
Simulator Enhances Drilling Skills in Inexperienced Surgeons
Authors: Samy Ravi N , Murugappan Shanmugam , Stredney Don , Wiet Gregory
Published: August 2008

Objective

1) Validate whether a PC‐based simulation program can be used to enhance temporal bone skills in those without any anatomical knowledge or surgical experience. 2) Understand the complexities of adapting simulator technology to educate novice and experienced temporal bone surgeons.

Methods

In this prospective, pilot study, individuals performed a craniectomy (measuring approximately 1”x2”) from the squamosa of cadaveric temporal bone specimens using typical otologic drills and instrumentation; the goals were to remove the bone, create straight lines along the edges of the craniectomy, and perform dural decompression without violating the dura. After performing this, the individuals then spent the next 2 weeks performing virtual temporal bone surgery on the OSC/OSU simulator. The individuals then performed the craniectomy a second time. A blinded observer (neurotologist) then assessed performance on the pre‐ and post‐simulation tested bones.

Results

In all 6 sets of bones (12 bones total), the blinded observer was able to correctly determine which was the presimulation temporal bone and the post‐simulation temporal bone. This was based primarily on the objective criteria of adequacy of dural decompression and the avoidance of dural tears. The assessment of linear edges of the craniectomy was not felt to be of sufficient importance.

Conclusions

The temporal bone simulator was able to improve the surgical skills in individuals with no prior temporal bone surgical experience or anatomy knowledge. The preliminary data from this study will be extended to a larger study group for statistical significance. Additional performance measures will need to be created to improve objective evaluation.
Single Vertical Incision for BAHA: Preliminary Results
Authors: Wilkinson Eric P , Luxford William M , House John W , De la Cruz Antonio , Slattery William H , Fayad Jose N
Published: August 2008

Objective

A single vertical skin incision with subcutaneous tissue undermining is a cosmetic alternative to standard dermatome skin graft elevation for bone anchored hearing aid (BAHA) placement. A vertical incision minimizes alopecia and simplifies wound closure, while maintaining thin skin flaps. We aimed to determine the preliminary complication rate using a 4cm skin inicsion with 4⋉4 cm of subcutaneous tissue removal.

Methods

A retrospective chart review of patients undergoing BAHA placement from January 2006 to August 2007 was performed. This search was filtered to include only vertical incision BAHA patients. Complications including skin irritation or infection, skin overgrowth, and implant extrusion were tallied. Pertinent patient risk factors were identified. 71 patients underwent vertical incision surgery, with a mean followup time of 6.8 months. 50 patients had sensorineural hearing losses and 21 had conductive hearing losses.

Results

No patient had spontaneous extrusion of the titanium abutment. There were 5 minor complications (skin irritation 3, wound infection requiring oral antibiotics 1, postoperative hematoma 1) and 7 major complications (irritation requiring abutment removal 1, skin overgrowth or infection requiring flap revision 6). Total complication rate was 16% and major complication rate was 9.8%.

Conclusions

A single vertical incision for BAHA placement has a similar complication rate to traditional dermatome use in this preliminary study, though more follow‐up is necessary to identify cases of late skin overgrowth. Patients with thick scalps or risk factors for hypertrophic scarring may require placement of longer abutments.
Drainage Post‐TGD Remnant Surgery: Source and Analysis
Authors: Bakar Saraiza Abu , Mankarious Leila A , Martinez‐Alvernia Efrain A
Published: August 2008

Objective

Mucopurulent drainage following thyroglossal duct remnant (TGD) surgery can occur in spite of meticulous technique. We hypothesize that there may be some patients whereby the drainage is due to transected, normal salivary tissue located within the posterior tongue base, close to the hyoid. 1) To establish the distance between tongue base salivary tissue and hyoid. 2) To identify tissue‐specific markers of TGD remnants as well as salivary tissue in order to distinguish drainage source.

Methods

Pilot study/tertiary care facility. The anterior neck block was obtained from 10 adult cadavers with no known TGD remnant. The distance between the normal salivary tissue and hyoid was measured. Immunohistochemistry (IHC) was performed on 5 archived tissue blocks from pediatric patients with post‐Sistrunk mucopurulent drainage to identify the presence of amylase and MUC 7 (a mucin specific to salivary tissue) within the excised specimen.

Results

Average distance between salivary tissue and the hyoid within cadavers was 3.3mm (range 1.0–4.2mm). IHC revealed all 5 excised TGD remnants contained amylase; however, none (2 specimens with high background signal) contained MUC 7. Both amylase and MUC 7 were present within adjacent salivary tissues.

Conclusions

Normal salivary tissue of the tongue base normally resides an average of 3.3mm from the hyoid within the adult. Preliminary IHC indicates that MUC 7 may be a sensitive and tissue‐specific marker of drainage due to transected salivary tissue. Testing for amylase does not appear to provide any tissue‐specific information as to the source of post‐Sistrunk mucopurulent drainage.
Pediatric Tympanoplasties: Anatomical and Functional Results
Authors: Ribeiro João , Cerejeira Rui , Soares Vera , Gapo Carla , Romao Jose , Paiva Antonio‐Manuel D
Published: August 2008

Objective

The purpose of this study was to analyze the anatomical and functional results in 167 tympanoplasties performed in children.

Methods

A retrospective study of the anatomical and functional results of 167 tympanoplasties in children was performed. 91 ears had full records and were included in the study. Age, gender, size and site of perforation, status of operated and contralateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels, postoperative follow‐up time, and postoperative complications were recorded. Hearing results were reported using a 5‐frequency (500,1,000, 2,000, 3,000, 4000 Hz) pure‐tone average air‐bone gap.

Results

Anatomical success was achieved in 85% of cases. 71% of the reperforations occurred during the first year of follow‐up. The anatomical and functional success was 76% after a mean follow‐up of 26.4 ± 16.2 months. The mean postoperative air conduction threshold significantly improved in the successful cases, with a mean audiological improvement of 12.54 ±7.3dB (p<0.05). The maximum mean postoperative gain was seen at 500 Hz 14.9 ±10.1 dB (P<.05). No postoperative sensorineural hearing loss was observed. 18% of minor postoperative complications were seen. Surgeon experience, intact and mobile ossicular chain, dry ear, and follow‐up longer than 12 months (p<0.05) improves functional outcome.

Conclusions

We conclude that tympanoplasty in children is safe with anatomical and functional results comparable to that reported for adults. Dry ear over 6 months, surgeon experience, intact and mobile ossicular chain and follow‐up >12 months significantly improves functional outcome.
Severe OSA and Prolonged PICU Admissions after Tonsillectomy
Authors: Anstead Amy S. , Wong Hau Sin , Schroeder James W.
Published: August 2008

Objective

Determine the factors that increase the rate of a complicated postoperative course for children undergoing adenotonsillectomy for polysomnogram (PSG) proven severe OSA.

Methods

A retrospective chart review of children with PSG‐verified severe OSA admitted to PICU after adenotonsillectomy was completed for the years 2002–2006. Data gathered: complications, style of tonsillectomy, direct laryngoscopy and bronchoscopy (DLB) findings, length of stay in PICU and hospital, age, co‐morbidities, American Society of Anesthesiologists (ASA) grading, PSG indices: AI, RDI, ETCO2, and nadir O2. Two groups were separated and compared: those that remained intubated after surgery and those extubated and managed with conservative postoperative airway intervention.

Results

70 children with PSG‐verified severe OSA were admitted to PICU after adenotonsillectomy. 53 children were extubated postoperatively. 43% of these children required oxygen supplementation, BiPAP or CPAP, and none required re‐intubation. 17 children remained intubated postoperatively. The style of tonsillectomy and all of the PSG indices were not significantly different between the two groups. Postoperative complication rates among children who remained intubated was 47%, compared to children who were not intubated at 2%. Intubated children's PICU and total hospital stay was longer. They were younger, and their ASA grading was higher. All of these differences were statistically significant.

Conclusions

Children who remain intubated after adenotonsillectomy have more postoperative complications and stay in the hospital longer. Every attempt should be made to extubate children postoperatively and manage them with conservative airway management after tonsillectomy.
The Microbiology of Complicated Pediatric Rhinosiniusitis
Authors: Gaines Ryan , Weatherly Robert A , Harrison Christopher Joseph
Published: August 2008

Objective

To determine the pathogens causing complicated rhinosinusitis over 10 years at a tertiary pediatric hospital, with a focus on methicillin‐resistent Staphylococcus aureus (MRSA).

Methods

Chart review for patients admitted for complicated rhinosinusitis from 1997–2007.

Results

179 patients were diagnosed with complicated rhinosinusitis. Of those, 67(37.4%) required surgical treatment in addition to antimicrobials. 51 surgical cultures (76.1%) were positive. Single organisms were isolated from 28 cultures (54.9%), while 23 of 51 were polymicrobial. The most frequently isolated pathogen was from the Streptococcus anginosus/milleri/constellatus group, comprising 29.4% of positive cultures. Anaerobes were identified in 23.5% of cultures and group A streptococcus in 19.6%. Organisms common to normal human oral flora accounted for 80.3% of isolates. Staphylococci were isolated from 17 cultures (33.3%). Three (5.8%) of 51 isolates were MRSA. No MRSA isolate was part of a polymicrobial infection. All occurrences of MRSA were within the last 2 years of the review.

Conclusions

At our institution, MRSA accounted for 5.8% of culture positive complicated rhinosinusitis cases in the last 10 years, but all presented within the last 2 years. This suggests a potential recent increase in MRSA prevalence in this clinical presentation. Therefore, MRSA should be considered as a potential pathogen in these children, although the overall 10‐year frequency is low. Most pathogens were common oral commensal organisMS This suggests that host factors play an important role in the pathogenesis of complicated rhinosinusitis.
Device‐Related Risk of Airway Fire in Oropharyngeal Surgery
Authors: Smith Lee P. , Roy Soham
Published: August 2008

Objective

Intraoperative fires are a well‐described and devastating complication of oropharyngeal and airway surgery. We utilized a physical model to study the fire risk for an electrosurgical device (Bovie) as compared to a bipolar radio‐frequency ablation wand (Coblator)

Methods

A 6.0 endotracheal tube was inserted into the cranial end of a degutted whole raw chicken through which 100% oxygen was piped at 10 L/min. Three tonsil sponges were placed inside the cavity. An electrosurgical device (15 watts, coagulate mode) and bipolar radiofrequency ablation wand (9, 7 and 3 in ablate mode; 5 and 3 in coagulate mode) were activated in the central cavity of the chicken through its caudal opening. All experimental conditions were tested for 4 minutes, or until a positive result was achieved. All trials were repeated in another chicken to ensure accuracy.

Results

Ignition of the tonsil sponges and endotracheal tube was obtained with a sustained fire in the cavity of the chicken when using the electrosurgical device for between 45 and 80 seconds. Under all 5 experimental conditions, no ignition or sustained fire could be produced using the radiofrequency plasma ablation wand. After 20 sustained minutes of continuous plasma ablation in the chicken cavity without ignition, the electrosurgical device was able to ignite a fire within 45 seconds in the same cavity.

Conclusions

While electrosurgical devices present a significant risk of fire during open cavity surgery in oxygen‐enriched environments, that risk appears to be eliminated with bipolar radiofrequency plasma ablation. Compelling video and photographic evidence will be provided.