bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous removal of two self-expanding stent grafts following failed deployment
Authors: Ferguson E. , Cwikiel W.
Published: September 2006

Insertion of self-expanding stent grafts was attempted in two patients with venous obstruction following unsuccessful venoplasty. One patient with end-stage renal disease had stenosis at the caudal end of the previously placed stent in the right external iliac vein. The second patient was treated for occlusion of multiple stents in the left iliac vein. Two of the stent grafts failed deployment and were subsequently removed percutaneously. New stent grafts were inserted in the intended positions. Despite additional venous access sites with large caliber sheaths, required for retrieval of the failed stent grafts, there were no major complications.
Adjusting the radioisotope tracer dose according to the body mass index does not enhance the visualization of axillary sentinel lymph nodes
Authors: Leikola J. P. , Leppänen E. A. , von Smitten K. A. J. , Leidenius M. H. K.
Published: September 2006

Purpose: To investigate whether the visualization of axillary sentinel nodes (SN) in the lymphoscintigraphy (LS) can be enhanced by adjusting the amount of radioactivity in accordance with the patient’s body mass index (BMI).

Material and Methods: Group I consisted of 356 consecutive breast cancer patients who underwent LS and SN biopsy after a single, intratumoral radioactive tracer injection with a median dose of 92 MBq. In group II (178 consecutive patients), the dose of the tracer was adjusted according to BMI; 80, 100, or 140 MBq.

Results: The visualization rate of axillary SN was 86% in group I and 83% in group II ( P = 0.303). In patients with BMI >30 with visualized axillary SN, the median number of SN was 1 (1–4) in group I and 3 (1–7) in group II ( P = 0.002).

Conclusion: Adjusting the tracer dose in accordance with patient BMI did not enhance the visualization rate of axillary SN in LS.
Static bone cavity of the mandible: computed tomography findings with histopathologic correlation
Authors: Minowa K. , Inoue N. , Izumiyama Y. , Ashikaga Y. , Chu B. , Maravilla K. R. , Totsuka Y. , Nakamura M.
Published: September 2006

Purpose: To review computed tomography (CT) findings of histopathologically examined static bone cavities in order to determine whether an additional pathogenesis may play a role in this disease.

Material and Methods: Four patients with histopathologically examined static bone cavities were included in this retrospective study. Location, appearance of bone remodeling, tissue characteristics, and contrast enhancement of the cavity were assessed on CT images. CT findings were then compared with the histopathological findings.

Results: Static bone cavity was found in the lingual molar region in three patients and in the lingual cuspid region of the mandible in one patient. Both fatty and soft tissues were present in the cavities of all four patients. Attenuation of the soft tissue in the cavities was found to be different from that of the submandibular gland. The soft tissue showed enhancement with contrast-enhanced CT in three patients. For all patients, the histopathologic content of the static bone cavity included fat, soft tissue, and abnormal vasculature. The thickened vein wall in the abnormal vasculature was observed. Aberrant tissue of the submandibular gland was not found in any of the static bone cavities.

Conclusion: Contrast enhancement of the soft tissue on the contrast-enhanced CT images suggests the presence of vasculature in the cavities. Histopathological examination confirmed the presence of fatty tissue and dilated abnormal vessels, and the absence of salivary gland tissue in the cavities. These findings show that vascular structures are prominent in tissues found in static bone cavities.
Spontaneous pneumorrhachis in bronchial asthma
Authors: Eesa M. , Kandpal H. , Sharma R. , Misra A.
Published: September 2006

We report on an 18-year-old male with bronchial asthma who presented with swelling over the neck and upper chest after a mild episode of bronchospasm. Physical examination was suggestive of subcutaneous emphysema, which was subsequently confirmed on a radiograph. Computed tomography in addition revealed pneumomediastinum and air within the epidural space of the spinal canal. Although spontaneous pneumomediastinum and subcutaneous emphysema have been described in a variety of situations, including patients with asthma, spontaneous pneumorrhachis in asthmatics is a very rare entity.
Thin-section axial multidetector computed tomography and multiplanar reformatted imaging of children with suspected foreign-body aspiration: is virtual bronchoscopy overemphasized?
Authors: Kocaoglu M. , Bulakbasi N. , Soylu K. , Demirbag S. , Tayfun C. , Somuncu I.
Published: September 2006

Purpose: To determine the added value of multidetector computed tomography (MDCT)-assisted virtual bronchoscopy (VB) to axial MDCT and multiplanar reformatted (MPR) imaging with respect to conventional bronchoscopy in the evaluation of children with suspected foreign-body aspiration (FBA).

Material and Methods: Twenty-one consecutive children (14 male, seven female, age 8 months–7 years, mean age 3.5 years) presenting with the suspicion of FBA were examined with 16-slice MDCT using 100–120 kV, 30–50 mA, 1-mm section thickness, 1.2 pitch ratio, and 0.6–1.0-mm reconstruction interval. Before CT examinations, chest radiographies were also obtained in all cases. VB and MPR imaging were carried out after MDCT examinations.

Results: Nine foreign bodies were identified by gold-standard conventional bronchoscopy. VB, thin-section axial MDCT, and MPR images identified eight of nine foreign bodies. CT scans with MPR images and VB did not reveal a chronic foreign body; and, in one patient, endobronchial mucous was diagnosed as the foreign body. The sensitivity, specificity, and accuracy of thin-section axial MDCT and MPR images alone in the diagnosis of FBA were 88.9%, 91.7%, and 90.5%, respectively. Results were the same as those obtained when VB was also included.

Conclusion: MDCT with VB and axial/MPR images provide equally valuable information in children with suspected foreign-body aspiration and prevent unnecessary conventional bronchoscopic examinations. However, VB increases total examination time and cost, and it does not provide additional information over MPR images in the evaluation of foreign-body aspiration.
Thyroid ultrasound in diabetic patients without overt thyroid disease
Authors: Junik R. , Kozinski M. , Debska-Kozinska K.
Published: September 2006

Purpose: To assess thyroid volume and to evaluate possible lesions in the gland structure using thyroid ultrasound in patients with diabetes mellitus type 1 (DM1) and 2 (DM2) without overt thyroid disease.

Material and Methods: Consecutive adult patients with DM2 ( n = 98) and DM1 ( n = 30) without overt thyroid disease referred to our department because of poorly controlled disease and/or diabetic complications were prospectively analyzed. Thyroid volumes, gland echogenicity, thyroid nodules incidence, and TSH levels were compared with control groups ( n = 50 and 38) and matched according to sex and age.

Results: Significant increases in median thyroid volume were observed in both subjects with DM1 (17.3 cm3, interquartile range (IR) 13.9–21.6 cm3 versus 14.4 cm3, IR 11.3–18.3 cm3; P<0.05) and DM2 (20.5 cm3, IR 14.9–27.1 cm3 versus 14.1 cm3, IR 11.3–18.3 cm3; P<0.001) in comparison to their control groups. Moreover, in the population of type 2 diabetics, thyroid nodules (OR 2.37, 95% CI 1.14–4.93), parenchymatous goiter (OR 5.40, 95% CI 1.20–24.30), and all kinds of thyroid goiter according to the WHO definition (OR 4.18, 95% CI 2.02–8.66) were remarkably more frequent. In our patients, reduced (but within normal range) TSH level occurred in DM1 (median 0.97 mIU/l, IR 0.61–1.58 mIU/l versus median 1.66 mIU/l, IR 0.76–2.09 mIU/l; P<0.05). The presence of a negative linear correlation between thyroid volume and TSH concentration was noticed in patients with DM2 ( RS = −0.38, P<0.01).

Conclusion: In individuals with DM1 and DM2 treated for poorly controlled disease and/or diabetic complications, thyroid volumes were significantly higher than in the normal population. Moreover, nodular thyroid structure and parenchymatous goiter occurred more frequently in these type 2 diabetic patients.
The use of a polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt (TIPS): long-term follow-up of 100 patients
Authors: Rössle M. , Siegerstetter V. , Euringer W. , Olschewski M. , Kromeier J. , Kurz K. , Langer M.
Published: September 2006

Purpose: To retrospectively evaluate results and clinical outcome of transjugular intrahepatic portosystemic shunt (TIPS) after implantation of a polytetrafluoroethylene (PTFE)-covered stent graft.

Material and Methods: The stent graft was used in 112 patients with higher risk of primary (i.e. patients with Budd-Chiari syndrome) or secondary shunt failure (patients with occlusion of a previous uncovered stent), or a complicated TIPS procedure with an imminent technical complication requiring covered stent. Patients were scheduled at 3- to 6-month intervals for duplex-sonographic control of shunt function. Radiological revision was performed in patients with a decrease in shunt function by >25%, primary non-response, or relapse of the index symptom.

Results: Twelve patients were lost to follow-up, and 100 patients were followed for 22±15 months. The actuarial rates of shunt patency were 90, 84, and 74% at 1, 2, and 3 years of follow-up, respectively. Two patients developed early (within 1 month) and 14 patients late shunt failure. Except for one transient rise in liver enzymes due to outflow obstruction by the stent graft, no technical complications were seen. Primary response to treatment was seen in 97% of patients treated for variceal bleeding and 84% of patients treated for refractory ascites. A relapse of the index symptom was seen in 13% of bleeders and 9% of patients treated for refractory ascites.

Conclusion: TIPS created with a PTFE-covered stent graft showed favorable long-term results.
Multislice computed tomography coronary angiography at a local hospital: pitfalls and potential
Authors: Kolnes K. , Velle Ose H. , Hareide S. , Hegbom K. , Wiseth R.
Published: September 2006

Purpose: To evaluate whether the favorable results achieved with multislice computed tomography (MSCT) of coronary arteries at larger centers could be paralleled at a local hospital.

Material and Methods: Fifty consecutive patients with suspected coronary artery disease scheduled for invasive investigation with quantitative coronary angiography (QCA) at a university hospital underwent MSCT with a 16-slice scanner at a local hospital. Diagnostic accuracy of MSCT for coronary artery disease was assessed using a 16-segment coronary artery model with QCA as the gold standard.

Results: Segments with diameter <2 mm, as defined by QCA, segments distal to occlusions, and stented segments were excluded. Of the remaining 489 segments, 73 (15%) were not assessable with MSCT. Sensitivity, specificity, and positive and negative predictive values for significant (>50%) stenosis for the 416 assessable segments were 92%, 82%, 53%, and 98%, respectively.

Conclusion: Our beginners' experience demonstrated favorable results regarding sensitivity and negative predictive value. The positive predictive value, however, was unsatisfactory. Calcifications were identified as the most important factor for false-positive results with MSCT. With widespread use of MSCT coronary angiography, there is a risk of recruiting patients without significant coronary artery disease to unnecessary and potentially harmful invasive procedures.
Systematic analysis of missed extremity fractures in emergency radiology
Authors: Wei C.-J. , Tsai W.-C. , Tiu C.-M. , Wu H.-T. , Chiou H.-J. , Chang C.-Y.
Published: September 2006

Purpose: To systematically analyze fractures in the extremities that were missed in the initial radiological report, primarily on plain radiographs, in the emergency department (ED).

Material and Methods: From January 2003 to June 2004, 2407 new patients were confirmed to have fractures in the extremities in the ED. A total of 3081 fractures were confirmed. In the initial radiological reports, 115 fractures in 108 patients were missed. One musculoskeletal radiologist and one emergency radiologist independently carried out a second review of these images. The easily missed fracture sites were recorded. The possible reasons for misinterpretation were determined by consensus.

Results: The most frequent location for missed fractures, expressed as a percentage of all fractures in the same location, was the foot (7.6%), followed by the knee (6.3%), elbow (6.0%), hand (5.4%), wrist (4.1%), hip (3.9%), ankle (2.8%), and shoulder (1.9%). The average percentage for all missed fractures was 3.7%. On the second review, 70% of the initially missed fractures were identified. Analysis of the possible reasons for missed fractures showed the most common reason was subtlety of the fracture.

Conclusion: The overall percentage of missed fractures in the extremities was 3.7%. Only 33% of the initially missed fractures were attributed to radiographically imperceptible lesions. Adequate training for physicians and radiologists in the ED may reduce the rate of missed fractures.
Detection of simulated microcalcifications in fixed mammary tissue: an ROC study of the effect of local versus global histogram equalization
Authors: Sund T. , Olsen J. B.
Published: September 2006

Purpose: To investigate whether sliding window adaptive histogram equalization (SWAHE) of digital mammograms improves the detection of simulated calcifications, as compared to images normalized by global histogram equalization (GHE).

Material and Methods: Direct digital mammograms were obtained from mammary tissue phantoms superimposed with different frames. Each frame was divided into forty squares by a wire mesh, and contained granular calcifications randomly positioned in about 50% of the squares. Three radiologists read the mammograms on a display monitor. They classified their confidence in the presence of microcalcifications in each square on a scale of 1 to 5. Images processed with GHE were first read and used as a reference. In a later session, the same images processed with SWAHE were read.

Results: The results were compared using ROC methodology. When the total areas AZ were compared, the results were completely equivocal. When comparing the high-specificity partial ROC area AZ,0.2 below false-positive fraction (FPF) 0.20, two of the three observers performed best with the images processed with SWAHE. The difference was not statistically significant.

Conclusion: When the reader's confidence threshold in malignancy is set at a high level, increasing the contrast of mammograms with SWAHE may enhance the visibility of microcalcifications without adversely affecting the false-positive rate. When the reader's confidence threshold is set at a low level, the effect of SWAHE is an increase of false positives. Further investigation is needed to confirm the validity of the conclusions.
Book Review
Authors: Tikkakoski Tapani
Published: September 2006

Imaging in Treatment Planning for Sinonasal Diseases. Edited by R. Maroldi and P. Nicolai. Berlin, Heidelberg, New York: Springer-Verlag, 2005. ISBN 3-540-42383-4. 304 pages. 620 figures. 14 tables. Price hardcover: EUR 99.95.
IndexToolkit: an open source toolbox to index protein databases for high-throughput proteomics
Authors: Li Dequan , Gao Wen , Ling Charles X. , Wang Xiaobiao , Sun Ruixiang , He Simin
Published: September 2006

Summary: A software package, IndexToolkit, aimed at overcoming the disadvantage of FASTA-format databases for frequent searching, is developed to utilize an indexing strategy to substantially accelerate sequence queries. IndexToolkit includes user-friendly tools and an Application Programming Interface (API) to facilitate indexing, storage and retrieval of protein sequence databases. As open source, it provides a sequence-retrieval developing framework, which is easily extensible for high-speed-request proteomic applications, such as database searching or modification discovering. We applied IndexToolkit to database searching engine pFind to demonstrate its effect. Experimental studies show that IndexToolkit is able to support significantly faster searches of protein database.

Availability: The IndexToolkit is free to use under the open source GNU GPL license. The source code and the compiled binary can be freely accessed through the website . In this website, the more detailed information including screenshots and documentations for users and developers is also available.

Contact:  dqli@jdl.ac.cn
PSoL: a positive sample only learning algorithm for finding non-coding RNA genes
Authors: Wang Chunlin , Ding Chris , Meraz Richard F. , Holbrook Stephen R.
Published: September 2006

Motivation: Small non-coding RNA (ncRNA) genes play important regulatory roles in a variety of cellular processes. However, detection of ncRNA genes is a great challenge to both experimental and computational approaches. In this study, we describe a new approach called positive sample only learning (PSoL) to predict ncRNA genes in the Escherichia coli genome. Although PSoL is a machine learning method for classification, it requires no negative training data, which, in general, is hard to define properly and affects the performance of machine learning dramatically. In addition, using the support vector machine (SVM) as the core learning algorithm, PSoL can integrate many different kinds of information to improve the accuracy of prediction. Besides the application of PSoL for predicting ncRNAs, PSoL is applicable to many other bioinformatics problems as well.

Results: The PSoL method is assessed by 5-fold cross-validation experiments which show that PSoL can achieve about 80% accuracy in recovery of known ncRNAs. We compared PSoL predictions with five previously published results. The PSoL method has the highest percentage of predictions overlapping with those from other methods.

Contact:  srholbrook@lbl.gov

Supplementary information: Supplementary data are available at Bioinformatics online.
Long‐Term Comparison Between Submucosal Cauterization and Powered Reduction of the Inferior Turbinates
Authors: Joniau Sander , Wong Ian , Rajapaksa Suresh , Carney Simon A. , Wormald Peter‐John
Published: September 2006

Objectives/Hypothesis: To evaluate the results of powered turbinoplasty and to compare these with submucosal cauterization of the inferior turbinates.

Study Design: Prospective, randomized, comparative surgical trial.

Methods: Nineteen patients with medication‐resistant chronic nasal obstruction caused by inferior turbinate hypertrophy were randomized to undergo powered turbinoplasty on one side and submucosal cauterization on the other. For each side, an extensive assessment (symptom scoring, endoscopic scoring, and acoustic rhinometry) was recorded preoperatively and on week 1, week 3, month 3, year 1, and year 5 postoperatively.

Results: Powered turbinoplasty was superior to submucosal cauterization on all aspects of the assessment. A significant difference (P < .05) was noted for postoperative crusting, endoscopical scoring of turbinate size, and acoustic rhinometry measurements of nasal cavity volume and mean area at the level of the nasal valve. In addition, the results of powered turbinoplasty were still apparent on long term follow‐up, whereas submucosal cauterization was associated with a recurrence of turbinate hypertrophy.

Conclusion: Performing a powered turbinoplasty leads to decreased patient morbidity during the postoperative healing and to a better control of long‐term results when compared with submucosal cauterization.
Modern Management of Laryngotracheal Stenosis
Authors: Herrington Heather C. , Weber Stephen M. , Andersen Peter E.
Published: September 2006

Objectives: Laryngotracheal stenosis is a complex problem resulting most often from intubation, trauma,or autoimmune disease. Management options include dilation or airway reconstruction including laryngotracheoplasty (LTP), cricotracheal resection (CTR), and tracheal resection (TR). We describe our experience with management of this difficult problem.

Study Design: Retrospective chart review of patients treated for laryngotracheal stenosis between January 1995 and July 2005 at an academic, tertiary referral center.

Methods: A total of 127 patients were treated during the study period. Patients were followed, and hospital records were reviewed.

Results: There were 38 male and 89 female patients with an average age of 55.5 years treated for laryngotracheal stenosis resulting from intubation (64), idiopathic (25) or autoimmune disease (18), radiation (9), trauma (5), prior surgery (4), and relapsing polychondritis (2). Thirty‐three percent were treated for grade I stenosis, 44% grade II, 19% grade III, and 4% grade IV. Seventy percent of patients undergoing initial dilation required a subsequent procedure. LTP, CTR, or TR was performed in 43%, 48%, 71%, and 100% of patients with grade I through IV stenosis, respectively. Among 76 patients undergoing LTP, CTR, or TR, 24 (32%) required a subsequent intervention. Among 36 patients treated with primary LTP, CTR, or TR, only 10 (28%) required further therapy. Twenty‐two of 35 (63%) tracheostomy‐dependent patients were ultimately decannulated. Three patients died in the immediate postoperative period.

Conclusions: Patients undergoing dilation for laryngotracheal stenosis require multiple procedures. However, major reconstructive procedures are well tolerated and currently represent a viable primary treatment for laryngotracheal stenosis.
Methacholine Challenge Testing in the Diagnosis of Paradoxical Vocal Fold Motion
Authors: Guss Joel , Mirza Natasha
Published: September 2006

Objective: The purpose of this study was to determine whether methacholine challenge testing (MCT) combined with serial laryngoscopy could elicit and visualize paradoxical vocal fold motion (PVFM) during asymptomatic periods and suggest laryngeal dysfunction as an etiology of episodic dyspnea.

Study Design: A retrospective study of seven adult patients.

Methods: Medical records of seven adult patients who were referred to an otolaryngology clinic with recurrent episodes of dyspnea or choking and underwent bronchoprovocation testing were reviewed. After initial fiberoptic laryngoscopy and pulmonary function testing (PFT), bronchoprovocation was performed using aerosolized methacholine at increasing concentrations. Each administration was followed by repeated laryngoscopy and PFT. A positive endoscopic test was marked by the visualization of paradoxical adduction of the true vocal folds during inspiration. A positive bronchoprovocation test was marked by a 20% or greater decline in the forced expiratory volume.

Results: All seven patients demonstrated normal upper airway anatomy and function on initial laryngoscopy. In three patients, a positive endoscopic examination demonstrating PVFM was elicited during MCT. In three, the bronchoprovocation test was positive, and asthma was diagnosed. In one patient, both tests were negative. PVFM was seen in all patients whose chief complaint was choking (n = 2) but in only one of five patients whose chief complaint was dyspnea.

Conclusions: PVFM may be elicited and observed during MCT coupled with serial laryngoscopy. This test holds promise in differentiating vocal cord dysfunction from asthma during asymptomatic periods in patients who present with recurrent episodes of refractory dyspnea.
Repair of Motor Nerve Gaps With Sensory Nerve Inhibits Regeneration in Rats
Authors: Brenner Michael J. , Hess Jason R. , Myckatyn Terence M. , Hayashi Ayato , Hunter Daniel A. , Mackinnon Susan E.
Published: September 2006

Objective: Sensory nerve grafts are often used to reconstruct injured motor nerves, but the consequences of such motor/sensory mismatches are not well studied. Sensory nerves have more diverse fiber distributions than motor nerves and may possess phenotypically distinct Schwann cells. Putative differences in Schwann cell characteristics and pathway architecture may negatively affect the regeneration of motor neurons down sensory pathways. We hypothesized that sensory grafts impair motor target reinnervation, thereby contributing to suboptimal outcomes. This study investigated the effect of motor versus sensory grafts on nerve regeneration and functional recovery.

Study Design: The authors conducted a prospective, randomized, controlled animal study.

Methods: Fifty‐six Lewis rats were randomized to seven groups of eight animals each. Five‐millimeter tibial nerve defects were reconstructed with motor or sensory nerve grafts comprised of single, double, triple, or quadruple cables. Tibial nerve autografts served as positive controls. Three weeks after reconstruction, nerves were harvested for histologic examination and quantitative histomorphometric analysis. Wet muscle masses provided an index of functional recovery.

Results: Nerve regeneration was significantly greater across motor versus sensory nerve grafts independent of graft cross‐sectional area or cable number. Motor grafts demonstrated increased nerve density, percent nerve, and total fiber number (P < .05). Normalized wet muscle masses trended toward improved recovery in motor versus sensory groups.

Conclusions: Reconstruction of tibial nerve defects with nerve grafts of motor versus sensory origin enhanced nerve regeneration independent of cable number in a rodent model. Preferential nerve regeneration through motor nerve grafts may also promote functional recovery with potential implications for clinical nerve reconstruction.
Radiographic and Histologic Analysis of the Bone Underlying Inverted Papillomas
Authors: Chiu Alexander G. , Jackman Alexis H. , Antunes Marcelo B. , Feldman Michael D. , Palmer James N.
Published: September 2006

Introduction: Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumor. Those localized to the maxillary sinus or medial maxillary wall have classically been removed through an external approach. In recent years, endoscopic removal has been advocated as an effective, minimally invasive approach. Successful endoscopic management is based on accurate intraoperative identification and complete resection of the tumor. The surgical management of the bone underlying the surface of an IP is less clearcut. Controversy exists as to whether the bony undersurface of an IP should be removed. In this article, histopathologic specimens and preoperative radiologic studies are prospectively examined to better understand the involvement of the bone underlying an inverted papilloma.

Materials and Methods: A prospective study of patients with maxillary sinus IP treated with endoscopic or endoscopic‐assisted resection over a 12‐month period was conducted. Intraoperatively, the site of tumor attachment was identified, and a 1‐ to 2‐cm wedge of bone with overlying tumor was removed en bloc and analyzed under light microscopy. Preoperative radiographic studies were analyzed with respect to bony changes in the area of the tumor pedicle.

Results: On histopathologic analysis, the bony surf/ce underlying the IP was irregular with multiple bony crevices in all nine cases. In two cases (22% of specimens), an isolated rest of normal‐appearingsalivary gland and/or mucosal tissue was seen embedded in the underlying bone. Radiographic osteitic bony changes were seen at site of tumor attachment in 100% of cases.

Conclusion: The irregularity of the bony surface may hinder complete tumor removal because microscopic rests of mucosa can be hidden within the bony crevices. Intraoperative removal of the bony surface at the site of tumor attachment may ensure a more complete removal.
The Impact of Endoscopic Cultures on Care in Rhinosinusitis
Authors: Cincik Hakan , Ferguson Berrylin J.
Published: September 2006

Objectives: The objectives of this retrospective, observational study were primarily to analyze endoscopically guided culture results (EGCRs) from an office setting in patients with subclassifications of chronic rhinosinusitis (CRS) and to determine the frequency EGCR‐altered patient management; and secondarily to determine whether purulent secretions are more likely to be positive for a bacterial pathogen.

Methods: Consecutive symptomatic patients with nasal secretions not currently on antibiotics were cultured endoscopically. Patients were classified as chronic rhinosinusitis (CRS; n = 41) or acute exacerbation of chronic rhinosinusitis (AECRS; n = 27). Initial therapy was individualized and 32 of 68 (47%) had an antibiotic initiated before availability of the EGCR. Patients were reassessed 2 to 4 days later, and therapy was continued or altered based on clinical course and EGCR.

Results: EGCRs were positive in 41 of 68 (60.2%) of all patients. Incidence of positive cultures was not statistically different between CRS (21 of 41 [51%]) and AECRS (20 of 27 [74%]) patients. Initial therapy was changed in 45 of 68 (66%) patients. In 35 of 68 (51.4%), the change was directed by EGCR; in 11 of 77 (14.2%), the change was unsubstantiated by EGCR, and in no cases was an antibiotic initiated inappropriate to EGCR. The frequency of pathogens in the subgroups of CRS and AECRS, respectively, were Staphylococcus aureus (9 of 41 [22%]; 9 of 27 [33%]), acute pathogens (6 of 41 [14.6%], 7 of 27 [25.9%]), and Pseudomonas aeruginosa (5 of 41 [12%], 5 of 27 [18.5%]) and were not statistically different between subgroups. Purulent cultures were not significantly more likely to be Gram stain‐positive than nonpurulent cultures (12 of 34 [35%] compared with 6 of 34 [17.6%], respectively; P = .1). Purulent cultures were more likely to be culture‐positive (25 of 34 [73.5%]) compared with nonpurulent secretions (17 of 34 [50%]; P < .05). AECRS was significantly more likely to be purulent (21 of 27 cases) compared with CRS (13 of 41 cases, P < .001).

Conclusion: EGCR directed a change in therapy in 35 of 68 (51.4%) patients with CRS. The pathogens isolated from CRS and AECRS were similar and predominately S. aureus, acute pathogens, and P. aeruginosa. Purulent secretions are more frequently bacteriologically positive than nonpurulent secretions and more common in AECRS than CRS.
Diagnosis and Management of Skull Base Osteoradionecrosis After Radiotherapy for Nasopharyngeal Carcinoma
Authors: Huang Xiao‐Ming , Zheng Yi‐Qing , Zhang Xiang‐Min , Mai Hai‐Qiang , Zeng Liang , Liu Xiang , Liu Wei , Zou Hua , Xu Geng
Published: September 2006

Objective: The objective of this study was to investigate the diagnosis and management of skull base osteoradionecrosis (ORN) after radiotherapy for nasopharyngeal carcinoma (NPC).

Methods: The general information, clinical manifestations, and treatment outcomes were retrospectively evaluated in 15 patients with skull base ORN after radiotherapy for NPC.

Results: The common symptoms of skull base ORN included foul odor, headache, and epistaxis. Endoscopic examination showed exposed bone or sequestration in the nasopharynx. The characteristic findings according to computed tomography included the following: bone was destroyed extensively and symmetrically or regionally; bone was exposed to the air cavity; sequestration can be observed; and small air bladder was present in the parenchyma. There were nine patients regional skull base ORN receiving surgery, two of whom died of postradiation temporal lobe necrosis and seven of whom survived for 2 to 7 years. Conservative treatments were provided to six patients, including five patients with extensive skull base ORN and one patient with regional ORN, among which three patients died of nasopharyngeal bleeding, one patient died of exhaustion, and two patients survived for 3 to 5 years.

Conclusions: Clinical diagnosis of skull base ORN was based on symptoms, computed tomography, or magnetic resonance imaging and endoscopy. The final confirmation was according to pathologic examination. Surgery had the best effect. Extensive ORN accompanied by radiation brain damage or cranial nerves damage had poor prognosis. Nasopharyngeal bleeding and exhaustion were the main causes of death.
General and Rhinosinusitis‐Related Quality of Life in Patients With Wegener's Granulomatosis
Authors: Srouji I A. , Andrews P , Edwards C , Lund V J.
Published: September 2006

Objectives: The objectives of this cross‐sectional study were to outline the pattern of sinonasal morbidity and determine its effects on the quality of life (QOL) of patients with Wegener's granulomatosis (WG).

Methods: The authors conducted a survey of 199 patients with WG, including two validated (QOL) instruments to assess general (SF‐36) and rhinosinusitis‐specific quality of life (Sinonasal Outcome Test [SNOT‐22]).

Results: Patients with WG who have sinonasal involvement reported significantly lower general QOL scores than their unaffected counterparts (P = .000006–0.04) for all SF‐36 subsets except for emotional role. WG‐related sinonasal morbidity was comparable to the high levels previously demonstrated in the general rhinosinusitis population. A total of 38.2% of all patients with WG reported a nasal symptom as their most troublesome from a list of nasal and constitutional symptoms. Twenty‐three percent of all patients with WG rated nasal crusting and 17% rated epistaxis as one of their top three most troublesome symptoms even in the setting of multisystem disease. The inclusion of crusting, bleeding, and nasal deformity in the SNOT scoring significantly increased average scores of patients with WG (P = .024, paired t test).

Conclusions: Sinonasal involvement impacts significantly on the general QOL of patients with WG and is at least as significant as that of the general rhinosinusitis population. Nasal symptoms that are of particular relevance to this patient group include nasal crusting and epistaxis.
Continuous Intraoperative Facial Nerve Monitoring in Predicting Postoperative Injury During Parotidectomy
Authors: Meier Jason D. , Wenig Barry L. , Manders Ernest C. , Nenonene Emmanuel K.
Published: September 2006

Objectives/Hypothesis: To assess whether the use of continuous intraoperative f/cial nerve monitoring correlates to postoperative facial nerve injury during parotidectomy.

Study Design: A retrospective analysis.

Methods: Forty‐five consecutive parotidectomies were performed using an electromyograph (EMG)‐based intraoperative facial nerve monitor. Of those, 37 had complete data for analysis. Intraoperative findings and final interpretation of the EMGs were analyzed by a senior neurologist and neurophysiologist. All patients were analyzed, including those with preoperative weakness and facial nerve sacrifice.

Results: The overall incidence of facial paralysis (House‐Brackmann scale > 1) was 43% for temporary and 22% for permanent deficits. This includes an 11% incidence of preoperative weakness and 14% with intraoperative sacrifice. An abnormal EMG occurred in only 16% of cases and was not significantly associated with permanent or temporary facial nerve paralysis (χ2, P < 1.0; Fisher's exact P < .68). Of the eight patients with permanent paralysis, only two had abnormalities on the facial nerve monitor. Also, only one of five patients with intraoperative sacrifice of the facial nerve had an abnormal EMG. Factors significantly associated with the incidence of facial paralysis include malignancy, advanced age, extent of parotidectomy, and dissection beyond the parotid gland (χ2 and Fisher's, P < .05).

Conclusions: The results suggest that abnormalities on the intraoperative continuous facial nerve monitor during parotidectomy do not predict facial nerve injury. The incidence of permanent and temporary facial nerve paralysis compare favorably with the literature given that this study includes patients with revision surgery, intraoperative sacrifice, and preoperative paralysis. Standard of care implications will be discussed.
Transnasal Endoscopic Surgery of the Pituitary: Modifications and Results Over 10 Years
Authors: Kelley Richard T. , Smith Joseph L. , Rodzewicz Gerald M.
Published: September 2006

Objective: A 10‐year retrospective review of three endoscopic approaches used by the authors for pituitary gland surgery is presented. We review our results and complications and outline the advantages and disadvantages of each. The variations in nasal anatomy that factor in the endoscopic approach are tabulated and discussed.

Methods: A chart review and examination of computed tomography and magnetic resonance imaging scans of patients who have had endoscopic pituitary surgery by the authors was performed. We gathered specific details of the operative approach, nasal‐sinus anatomy, tumor location, required ancillary nasal procedures, and postoperative complications.

Results: Ninety patients had endoscopic pituitary surgery. Operative reports and review of radiographic studies were possible for 75 patients. The surgical approach progressed over 10 years from endoscopic transseptal (42) to bilateral transostial (13) to unilateral transostial (20). Adequate exposure for the degree of resection was achieved in all patients. Complications included hemorrhage requiring return to the operating room (1), transient visual field loss (2), and transient diabetes insipidus (7). Four patients subsequently had craniotomy to resect suprasellar tumor extension. The average follow‐up was 6 years. One patient required revision endoscopic resection 3 years later for tumor recurrence. Anatomic findings included nasal septal deflections in 36 (48%) of the patients, abnormalities of the turbinates in 42 (56%), and variances of the sphenoid sinus septum in 59 (79%) of the patients. In the unilateral transostial approach, the operative side was often determined by anatomic factors.

Conclusion: The authors have exclusively used endoscopic surgery of pituitary gland tumors for over 10 years. Modifications to the approach have occurred as a result of increased surgeon experience and improved technology. The unilateral transostial approach is safe, effective, and recommended.
Is Lack of Placement of Drains After Thyroidectomy With Central Neck Dissection Safe? A Prospective, Randomized Study
Authors: Lee Seung Won , Choi Eun Chang , Lee Yong Man , Lee Jae Yong , Kim Shi Chan , Koh Yoon Woo
Published: September 2006

Objective: Selective use of drains after thyroidectomy has been suggested in the literature. Although the safety of thyroidectomy without drains has been reviewed, there is little specific data available to identify the safety of thyroidectomy combined with central neck dissection (CND) without drains. This study aims to determine the feasibility and safety of thyroidectomy without drains, especially in cases of combined CND.

Study Design: Prospective, randomized study.

Materials and Methods: One hundred ninety‐eight consecutive thyroidectomized patients were enrolled in this study. Drain group (n = 101) consisted of 41 hemithyroidectomies (HT), 28 total thyroidectomies (TT), and 32 total TT with CND. No‐drain group (n = 97) consisted of 42 HT, 18 TT, and 37 TT with CND. The following variables were examined: perioperative complications (hemorrhage, hematoma, seroma), intraoperative bleeding, operation time, volume of resected thyroid gland, time of hospital discharge after operation, duration of drain placement, and total amount of drainage (drain group).

Results: There were no significant differences in age, sex, volume of resected thyroid gland, types of operation, operation time, and histopathlologic diagnosis between two groups. In the drain group, overall perioperative complications occurred in seven (7/101, 6.9%) patients. In the no‐drain group, overall perioperative complications occurred in nine (10/97, 10.3%) patients. There was no significant difference in overall perioperative complications between the drain and no‐drain groups, even in cases of performing CND. Time of hospital discharge after operation was significantly shorter in the no‐drain group than the drain group (P < .05).

Conclusions: We conclude that thyroidectomy without drains is safe and effective even in combination with CND and appears to confer several advantages over the routine drainage method. In addition, we achieved significant reduction of hospital stay, which led to a reduction in costs for the patients.
Does Induction Chemotherapy Still Have a Role in Larynx Preservation Strategies? The Experience of Institut Catala d'Oncologia in Stage III Larynx Carcinoma
Authors: Majem Margarita , Mesia Ricard , Mañós Manel , Gomez Joaquin , Galiana Ramon , Cardenal Felipe , Juan Amparo , Montes Ana , Perez Francisco Javier , Nogues Julio , Llluch Josep Ramon Germa
Published: September 2006

Background: Radiotherapy with concurrent cisplatin is the standard alternative to total laryngectomy for patients with locally advanced laryngeal cancer. The value of induction chemotherapy in larynx‐preservation therapies remains unknown. Hyperfractionation radiotherapy might improve disease‐free survival.

Methods: From August 1993 to August 2004, 71 patients with T3N0–1 larynx tumors and eligible for total laryngectomy received induction chemotherapy with three cycles of cisplatin plus fluorouracil. Clinical tumor response was assessed by indirect laryngoscopy and computed tomography scan. Patients with complete response received hyperfractionation radiotherapy, whereas those without complete response were proposed for total laryngectomy.

Results: A total of 71 consecutive patients were included. Thirty‐three patients achieved complete response to induction chemotherapy (46.5%), four of them presented a tumor relapse, and all underwent salvage surgery. Seventy‐six percent of surviving patients preserved a functional larynx. Despite not achieving complete response, 15 patients refused total laryngectomy and received hyperfractionation radiotherapy. Seven patients presented a tumor relapse and salvage surgery was performed in three of them. Fifty percent of surviving patients preserved a functional larynx. Twenty‐two patients without complete response underwent total laryngectomy; three of them presented a tumor relapse but none could be rescued. With a median follow up of 68 months, 5 five‐year overall survival, 5‐year disease‐free survival, and 5‐year larynx function preservation survival rates were 68% (confidence interval [CI], 57–80), 75% (CI, 64–87), and 42% (CI, 29–54), respectively. No differences in overall survival were observed between groups. Five‐year disease‐free survival of patients without complete response who received hyperfractionation radiotherapy was significantly lower than that of the other two groups (P < .02). Ten patients with larynx preservation and no tumor relapse had chronic toxicity that caused the loss of larynx function: seven patients required permanent tracheotomy, two died from pneumonia, and one patient died as a result of a laryngeal necrosis.

Conclusions: Patients with complete response to induction chemotherapy in laryngeal carcinoma have a high probability of cure after hyperfractionation radiotherapy. However, hyperfractionation radiotherapy induces a high degree of toxicity that reduces the laryngeal function preservation rate and may jeopardize overall survival.
Auditory Brainstem Implant in a Child with Severely Ossified Cochlea
Authors: Sanna Mario , Khrais Tarek , Guida Maurizio , Falcioni Maurizio
Published: September 2006

Objective: The hearing outcome after implanting a severely ossified cochlea has always been less satisfactory than implanting a patent one. The aim of our study is to present a case where brainstem implantation was successfully performed as an alternative to cochlear implantation in a child with bilateral severe ossification of the cochlea.

Study Design: Case presentation. This study was conducted at Gruppo Otologico, Rome, Italy, a private referral center for neurotology and skull base surgery.

Methods: The subject of our study was a 12‐year‐old female child with postmeningitic deafness and bilaterally ossified cochleae. This case is the first brainstem implantation performed at our center with the indication of severe ossification of the cochlea.

Results: Successful brainstem implantation of a device was carried out, and the hearing of the patient was restored to the degree that she can freely use the telephone after 8 months of implantation.

Conclusion: Although more cases are needed before establishing the exact outcome of brainstem implantation in cases of deafness in the presence of severe bilateral cochlear ossification, preliminary results show the superiority of brainstem implants to conventional or even customized cochlear implants.
Postobstructive Pulmonary Edema After Laryngospasm in the Otolaryngology Patient
Authors: Mehta Vishvesh M. , Har‐El Gady , Goldstein Nira A.
Published: September 2006

Context: Post‐obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II).

Objective: To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea.

Design: Retrospective case series of 13 otolaryngology patients from 1996 to 2003.

Setting: Tertiary care teaching hospital and its affiliates.

Patients: 13 patients (4 children, 9 adults, 5 males, 8 females) ranging in age from 9 months to 48 years.

Results: Operative procedures included adenoidectomy, tonsillectomy, removal of an esophageal foreign body, microlaryngoscopy with papilloma excision, endoscopic sinus surgery, septorhinoplasty, and thyroidectomy. Six patients required reintubation. Treatment included positive pressure ventilation, oxygen therapy, and diuretics. Seven patients were discharged within 24 hours and the others were discharged between 2 and 8 days postoperatively. There were no mortalities.

Conclusion: Laryngospasm resulting in PPE may occur in both children and adults after various otolaryngologic procedures. Among the subgroup of children, our study is the first to report its occurrence in healthy children without sleep apnea undergoing elective surgery.
In Vivo Detection of Head and Neck Cancer Orthotopic Xenografts by Immunofluorescence
Authors: Rosenthal Eben L. , Kulbersh Brian D. , Duncan Ryan D. , Zhang Wenyue , Magnuson J Scott , Carroll William R. , Zinn Kurt
Published: September 2006

Purpose: To determine whether Cy5.5‐labeled antiepidermal growth factor (EGFR) antibody could be used to detect head and neck squamous cell carcinoma (HNSCC) xenografts in vivo.

Methods: AntiEGFR antibody (cetuximab) was labeled with Cy5.5, a fluorophore with emission in the near infrared range. The cetuximab‐Cy5.5 conjugate was systemically administered in subtherapeutic doses (50 μg) to mice bearing orthotopically xenografted HNSCC cell lines (SCC1, CAL27, and FaDu). As a control, isotype‐matched human immunoglobulin (Ig)G1k antibody labeled with Cy5.5 was systemically injected in parallel experiments. All tumor regions (n = 6) were imaged by fluorescent stereomicroscopy at 0, 6, 24, 48, or 72 hours. Tumor size was measured by high‐frequency ultrasonography at 72 hours. Transcervical partial and near‐total resections were then performed with stereomicroscopic imaging after each resection. The mandible and associated structures were then resected, paraffin embedded, and then serial sectioned for analysis.

Results: Tumors could be clearly visualized by near infrared fluorescent stereomicroscopy at 48 and 72 hours after systemic administration of cetuximab‐Cy5.5 but not after administration with the labeled isotype control antibody, IgG1k‐Cy5.5. Ultrasound measurement of tumors (n = 5) correlated with fluorescent measurements of tumor (Spearman's coefficient, 0.92, P ≤ .01). When fluorescent stereomicroscopic findings were correlated with histologic findings in near‐total resections, this technique could accurately identify residual tumor less than 1 mm in size.

Conclusion: Fluorescent immunoguided neoplasm detection may be used as a diagnostic tool and to guide surgical therapy by providing real‐time imaging information about the extent of disease or the presence of residual disease.