bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Topical Epinephrine on Peripheral Nerve Conduction
Authors: Miller Quintessa , Meekin Gregory , Murdock Cabot
Published: November 2003

Objective/Hypothesis The aim of the study was to determine the effect of direct application of epinephrine solution on peripheral nerve conduction latency and amplitude. It was hypothesized that epinephrine does not cause neurapraxia when a standard (1:10,000) solution is applied topically.

Study Design Eleven animals were divided into two groups of five and six. Group I had their left sciatic nerves and group II had their right sciatic nerves treated with epinephrine‐soaked patties. The contralateral nerves of each group served as controls.

Methods Nerve conduction studies were performed at baseline and immediately, at 1 minute, and at 5 minutes after patty application.

Results Latency was found to increase above baseline immediately after patty application (P = .003) for the epinephrine‐treated and saline‐treated groups. Furthermore, the amplitude at 5 minutes after patty application increased from baseline (P = .009) for both groups. These observed differences were below what is considered to be clinically significant.

Conclusion Topical epinephrine at a standard solution (1:10,000) does not lead to clinically significant nerve conduction abnormalities.
Isolated Inverting Papilloma of the Sphenoid Sinus
Authors: Lee Jivianne T. , Bhuta Sunita , Lufkin Robert , Castro Dan J.
Published: November 2003

Objectives/Hypothesis Primary inverting papilloma of the sphenoid sinus is rare. We present a case of inverting papilloma with isolated involvement of the sphenoid sinus and discuss the incidence, clinical presentation, radiographic features, histological findings, and management of patients with this disease.

Study Design Case report.

Methods The medical records, films, and pathology slides of a patient with isolated inverting papilloma of the sphenoid sinus seen at University of California Los Angeles Medical Center were reviewed. The clinical presentation, radiographic features, histopathological findings, treatment, and outcome of the case were examined.

Results A single case of inverting papilloma with isolated involvement of the sphenoid sinus is presented. Headache and diplopia were the presenting complaints, as is often seen with other isolated sphenoid sinus lesions. Endoscopic intranasal sphenoid sinusotomy was performed, and no evidence of recurrent disease has been seen after 6 months of follow‐up.

Conclusions Isolated inverting papilloma of the sphenoid sinus is a rare phenomenon. In contrast to the vast majority of cases that present with nasal complaints (i.e., unilateral nasal obstruction, epistaxis) because of involvement of the lateral nasal wall, the clinical presentation of inverting papillomas confined to the sphenoid sinus is often nonspecific and insidious, with visual deficits being the predominant feature. Nevertheless, functional endoscopic intranasal sphenoidotomy remains an effective mode of treatment for patients with these lesions.
Management of Cerebrospinal Fluid Leaks Involving the Temporal Bone: Report on 92 Patients
Authors: Savva Athanasia , Taylor Matthew J. , Beatty Charles W.
Published: November 2003

Objective To investigate the success of different surgical and nonsurgical techniques in the management of cerebrospinal fluid otorrhea or otorhinorrhea.

Study Design Retrospective case analysis.

Methods Ninety‐two patients with confirmed diagnosis of cerebrospinal fluid otorrhea or otorhinorrhea treated at our institution between 1976 and 1998 were followed up long‐term by retrospective chart review and patient interviews.

Results Conservative treatment was successful in most cases of cerebrospinal fluid otorrhea or otorhinorrhea resulting from head injury (26 of 29 patients). In contrast, surgical intervention was required in all but 1 of 53 patients with cerebrospinal fluid otorrhea or otorhinorrhea caused surgically. The primary operative success rate was 76.9%. When relapse occurred, the interval ranged from 0 days to 24 months (mean interval, 3.9 mo; median, 1.3 mo). All leaks requiring surgery eventually were closed successfully. Surgical results were chronologically dependent. Before 1989, 11 failures occurred in 37 primary procedures. After 1989, only 4 failures occurred in 28 primary procedures. Of seven patients undergoing primary dural closure alone, three (43%) had recurrence of the leak. Closure rates were highest among patients in whom a multilayer technique for leak closure was used: combining a primary graft or sealing material such as bone wax, free muscle, or fascia for closure of the defect with additional autologous free grafts or allogenic materials. This resulted in a 2‐year closure rate of 100% compared with a 2‐year rate of 75.4% for patients whose primary closure was supported by a single layer of autologous or allogenic material (P = .034). Fibrin glue with primary closure alone did not have additional benefit. Postoperative meningitis occurred in two patients and was treated without sequelae.

Conclusions Conservative treatment should be reserved for cerebrospinal fluid otorrhea or otorhinorrhea resulting from head injury. Postoperative and nontraumatic cerebrospinal fluid otorrhea or otorhinorrhea should have early operative intervention. A multilayer technique combining allogenic materials with free autologous grafts is recommended.
Predictive Value of Serum Thyroglobulin After Surgery for Thyroid Carcinoma
Authors: Hall Francis T. , Beasley Nigel J. , Eski Spiro J. , Witterick Ian J. , Walfish Paul G. , Freeman Jeremy L.
Published: November 2003

Objective To determine the relationship between stimulated serum thyroglobulin levels (taken 3 months after total thyroidectomy) and tumor stage and recurrence in patients with well‐differentiated thyroid carcinoma.

Study Design Retrospective chart review in a tertiary care institution.

Methods Two hundred thirteen consecutive patients with well differentiated thyroid carcinoma treated between 1983 and 1998 were identified. Data were collected on clinicopathological variables, stimulated serum thyroglobulin levels obtained 3 months after total thyroidectomy prior to 131I therapy and recurrence.

Results A high postoperative thyroglobulin level was significantly associated with advanced‐stage disease at presentation (P = .005, Kruskall‐Wallis) but not with any of the other clinicopathological variables. Patients with a thyroglobulin level greater than 20 pmol/L had a significantly increased risk of disease recurrence on univariate analysis (n = 213 [P = .0001, log rank test]), and in the Cox proportional‐hazards model, both advanced tumor stage (P = .001, relative hazard, 3.4 [95% confidence interval [CI]: 2.4–4.9]) and a thyroglobulin level greater than 20 pmol/L (P = .001, relative hazard, 5.1 [95% CI: 2.0–13.1]) were significant predictors of recurrence. No other variables significantly altered the hazards model.

Conclusions Advanced tumor stage at diagnosis and a stimulated thyroglobulin level greater than 20 pmol/L taken 3 months after total thyroidectomy were independent predictors of disease recurrence. Patients with a thyroglobulin level greater than 20 pmol/L are at increased risk of recurrence and may be candidates for more intensive follow‐up or additional treatment.
Roles of Hepatocyte Growth Factor and Transforming Growth Factor β1 in Production of Extracellular Matrix by Canine Vocal Fold Fibroblasts
Authors: Hirano Shigeru , Bless Diane , Heisey Dennis , Ford Charles
Published: November 2003

Background/Objectives When the lamina propria of the vocal fold is replaced by fibrosis after wound healing, it is difficult to restore an appropriate viscoelasticity of the vocal fold. To treat fibrotic scarring, material that reduces collagen deposition and increases soft amorphous substances, such as hyaluronic acid, is required. The potential use of hepatocyte growth factor (HGF) is intriguing. In this study, the authors examined canine vocal fold fibroblasts to determine how HGF contributes to the production of extracellular matrix. More specifically, the authors describe how the productions of hyaluronic acid, collagen type I, and fibronectin are associated with administration of HGF and transforming growth factor β1.

Study Design In vitro.

Methods Fibroblasts were collected from the lamina propria of the vocal folds of five Beagles and were cultured with and without HGF or transforming growth factor β1. The productions of hyaluronic acid, collagen type I, and fibronectin in supernatants culture were examined using ELISA.

Results Hepatocyte growth factor stimulated hyaluronic acid production, reduced collagen type I production, and did not affect fibronectin production, while transforming growth factor β1 stimulated the productions of all components.

Conclusions Collagen type I appears to be a major contributor in creation of fibrosis, and excessive fibronectin may stiffen the tissue. Since HGF reduced collagen type I production from fibroblasts and increased hyaluronic acid, HGF is considered to have therapeutic potential in prevention and treatment of the fibrosis of the vocal fold.
Nontuberculous Mycobacterial Cervical Adenitis: A Ten‐Year Retrospective Review
Authors: Panesar Jaswinder , Higgins Kevin , Daya Hamid , Forte Vito , Allen Upton
Published: November 2003

Objective To review the authors' institutional experience with nontuberculous mycobacterial cervical adenitis in children over a 10‐year period.

Study Design Retrospective chart review.

Methods The case histories of 79 children with nontuberculous mycobacterial lymphadenitis who presented to a large tertiary care referral center from 1989 to 1999 were retrospectively analyzed, and the demographics, clinical presentation, methods of diagnosis, and types of surgical intervention they underwent were reported.

Results The mean age at presentation was 3.6 years. The male‐to‐female ratio was 1:2, and the frequency of presentation was highest in the winter and spring months. The diagnosis was not immediately apparent to most primary health care physicians because there was a delay between the appearance of the lump and referral for treatment, which was in excess of 8 weeks. Involved nodes were mainly treated surgically. The recurrence rate of complete surgical resection was less than 1%.

Conclusion The study highlights the fact that a high index of clinical suspicion is needed to make an early diagnosis of nontuberculous mycobacterial lymphadenitis and lends further weight to the already existing evidence that surgical excision remains the mainstay of successful treatment for lymphadenitis caused by nontuberculous mycobacteria.
Quality of Life Assessment in Nonmelanoma Cervicofacial Skin Cancer
Authors: Rhee John S. , Loberiza Fausto R. , Matthews B. Alex , Neuburg Marcy , Smith Timothy L. , Burzynski Mary
Published: November 2003

Objectives/Hypothesis Health‐related quality of life (QOL) assessment of patients with nonmelanoma skin cancer is poorly understood. The objectives of the study were to determine the general QOL of patients with cervicofacial skin cancer and to identify patient, clinical, and preventive behavior variables associated with patients' QOL.

Study Design Cross‐sectional study of 121 consecutive patients (65 female and 56 male patients) presenting to a dermatological Mohs surgery clinic with nonmelanoma skin cancer of the head and neck.

Methods Quality of life assessment was performed before counseling or treatment. Measures included the Medical Outcomes Study Short Form 36‐item Health Survey (SF‐36) and the Functional Assessment of Cancer Therapy–General (FACT‐G).

Results Both instruments demonstrated good internal consistency as measured by Cronbach's alpha (SF‐36, α = 0.45–0.91; FACT‐G, α = 0.61–0.90). The SF‐36 scores were similar to historical norms. Bivariate analysis indicated significant correlation coefficients between QOL and patients' coexisting illnesses and medical risk factors. Sun‐protective behaviors were associated with better QOL. The relationship appeared to be minimally influenced by patients' sociodemographic characteristics and disease‐related variables (size, location, extent).

Conclusions Sun‐protective behaviors were positively associated with certain QOL subscale scores in the population in the study. General QOL instruments demonstrated minimal impact of nonmelanoma skin cancer on patients at initial diagnosis. However, general measures may not be sensitive to the impact of nonmelanoma skin cancer. The development of a more disease‐specific instrument may be necessary to evaluate this disease process.
Interleukin‐1 Facilitates Airway Epithelial Migration in Response to Injury
Authors: Hicks Wesley , Hall Leon A. , Tristram Debra A. , Gardella Joseph A. , Bright Frank V. , Hard Robert , Sigurdson Lynn
Published: November 2003

Objective To test the hypothesis that interleukin (IL)‐1 plays a permissive role in respiratory epithelial cell migration and proliferation.

Study Design Primary cultures of porcine respiratory epithelial cells or tracheal organ explants were cultured in the presence or absence of function‐blocking antibodies to IL‐1. Areas of epithelial cell outgrowth were determined in control and antibody‐treated organ explants daily for 4 days. At intervals, cultured cells were collected for cell counting and viability determination. Time course and dose–response curves were constructed for control and antibody‐treated groups.

Results Interleukin‐1 secretion into culture supernatants increased sharply from days 3 to 7. Outgrowths from tracheal explants were reduced by greater than 60% by single antibody treatment, and by over 90% by treatment with antibodies to both IL‐1α and ‐1β by day 4 of culture. Function‐blocking antibodies to IL‐1 significantly reduced cell number by day 7 of culture.

Conclusions Interleukin‐1 is produced by respiratory epithelial cells in culture during log phase growth and plays a permissive role in cell migration and proliferation.
Ear, Nose and Throat Disorders in Children With Down Syndrome
Authors: Mitchell Ron B. , Call Ellen , Kelly James
Published: November 2003

ObjectiveTo document the reasons for which children with Down syndrome were referred to a pediatric otolaryngology practice, the underlying causes for these referrals, and the complications of routine surgical therapy.

Study DesignThe study is a retrospective review of children referred to the Pediatric Otolaryngology Clinic at the University of New Mexico Health Sciences Center (Albuquerque, NM) during a period of 2.5 years.

MethodsData were collected on 55 parameters related to ethnicity, demographics, diagnosis, surgical therapy, complications, and systemic comorbid conditions.

ResultsThe ethnicity of the study population was predominantly Hispanic or Latino (62%). The majority of children (76%) were referred for upper airway obstruction. Obstructive sleep apnea and laryngomalacia were the most common disorders in these children. An otological disorder was diagnosed in 70% of the children. Complications occurred after 27% of procedures for insertion of pressure equalization (PE) tubes to treat recurrent otitis media. Systemic comorbid conditions were present in 93% of the children, and the most common was gastroesophageal reflux disease.

ConclusionsObstructive sleep apnea and laryngomalacia were the most common reasons for referral of children with Down syndrome. Routine surgical procedures that required general anesthesia caused complications that are not common in other children. Treatment for systemic comorbid conditions should be considered as a component of therapy for otolaryngological disorders in children with Down syndrome.
Endoscopic Reconstruction of Anterior and Middle Cranial Fossa Defects Using Acellular Dermal Allograft
Authors: Lorenz Robert R. , Dean Robert L. , Hurley Daniel B. , Chuang James , Citardi Martin J.
Published: November 2003

Objective To report our experience in reconstructing defects of the anterior and middle cranial fossa skull base using endoscopic placement of acellular dermal allograft (AlloDerm, LifeCell Corp., The Woodlands, TX).

Study Design Retrospective chart review.

Methods In all cases, the skull base repair was completed with a similar technique. After identification of the defect boundaries, endoscopic transnasal repair was performed through placement of a layered reconstruction of acellular dermal allograft, septal bone/cartilage, and acellular dermal allograft, which were all placed on the intracranial side of the defect. A mucosal free graft was draped over the reconstruction. Fibrin glue was used to hold the mucosal graft in place, and the reconstruction was supported by both absorbable and nonabsorbable nasal packing.

Results Eight patients with nine skull base defects underwent the procedure for repair of cerebrospinal fluid rhinorrhea. All defects were successfully repaired. One patient underwent successful reconstruction of bilateral ethmoid roof defects that resulted from endoscopic resection of ethmoid adenocarcinoma. Twenty‐four patients underwent primary resection of hypophyseal adenomas. Twenty‐three patients had macroadenomas, and intraoperative cerebrospinal fluid leaks were noted in 11 patients. Sellar repairs after trans‐sphenoidal hypophysectomy were successful in 22 of 24 patients. One patient with hypophysectomy required reoperation (1 of 24 [4%]) for secondary closure of a cerebrospinal fluid leak. Serious complications were avoided in all patients. Patients were followed for a period ranging from 5 to 57 months (mean period, 34 mo).

Conclusions Acellular dermal allograft can be successfully used for the reconstruction of anterior and middle cranial fossa skull base defects. This allograft, which is easy to manipulate endoscopically, provides an effective seal and barrier in skull base reconstruction and avoids the need for a donor site.
Characterization of Vocal Fold Scarring in a Canine Model
Authors: Rousseau Bernard , Hirano Shigeru , Scheidt Troy D. , Welham Nathan V. , Thibeault Susan L. , Chan Roger W. , Bless Diane M.
Published: November 2003

Objective The objective was to assess the histological and viscoelastic shear tissue properties of the scarred vocal fold lamina propria at 2 and 6 months postoperatively in a canine model.

Study Design Experimental, nonrandomized prospective study.

Methods Six canine larynges were injured using a vocal fold stripping procedure. At 2 and 6 months postoperatively, histological analyses of the scarred and control lamina propria samples were completed for collagen, procollagen, elastin, and hyaluronic acid.

Results In canines killed at 2 months, scarred tissue samples contained increased procollagen and decreased elastin. Elastin fibers in the scarred lamina propria were characteristically tangled and disorganized. In canines killed at 6 months, scarred tissue samples showed decreased elastin and increased collagen. Collagen fibers formed thick, disorganized bundles, and elastin fibers were disorganized throughout the entire scarred vocal fold lamina propria. Viscoelastic shear tissue measurements revealed increased stiffness and viscosity in one of three cases at 2 months and in all three cases at 6 months, indicating increased stiffness and resistance to shear flow during oscillatory shear deformation for scarred tissue samples. No differences were observed between the two postoperative times.

Conclusions Results indicated that viscoelastic tissue changes may take place before scar maturation in the scarred vocal fold lamina propria and that, although abundant collagen deposition may influence viscoelastic shear tissue properties, disorganization of collagen and elastin fibers, thick bundle collagen formation, or the interplay of several of these factors might also play a contributing role.
Functional Results After External Vocal Fold Medialization Thyroplasty With the Titanium Vocal Fold Medialization Implant
Authors: Schneider Berit , Denk Doris‐Maria , Bigenzahn Wolfgang
Published: November 2003

Objectives/Hypothesis A persistent insufficiency of glottal closure is mostly a consequence of a unilateral vocal fold movement impairment. It can also be caused by vocal fold atrophy or scarring processes with regular bilateral respiratory vocal fold function. Because of consequential voice, breathing, and swallowing impairments, a functional surgical treatment is required. The goal of the study was to outline the functional results after medialization thyroplasty with the titanium vocal fold medialization implant according to Friedrich.

Methods In the period of 1999 to 2001, an external vocal fold medialization using the titanium implant was performed on 28 patients (12 women and 16 men). The patients were in the age range of 19 to 84 years. Twenty‐two patients had a paralysis of the left‐side vocal fold, and six patients, of the right‐side vocal fold. Detailed functional examinations were executed on all patients before and after the surgery: perceptive voice sound analysis according to the “roughness, breathiness, and hoarseness” method, judgment of the s/z ratio and voice dysfunction index, voice range profile measurements, videostroboscopy, and pulmonary function tests. In case of dysphagia/aspiration, videofluoroscopy of swallowing was also performed. The respective data were statistically analyzed (paired t test, Wilcoxon‐test).

Results All patients reported on improvement of voice, swallowing, and breathing functions postoperatively. Videostroboscopy revealed an almost complete glottal closure after surgery in all of the patients. All voice‐related parameters showed a significant improvement. An increase of the laryngeal resistance by the medialization procedure could be excluded by analysis of the pulmonary function test.

Conclusions The results confirm the external medialization of the vocal folds as an adequate method in the therapy of voice, swallowing, and breathing impairment attributable to an insufficient glottal closure. The titanium implant offers, apart from good tissue tolerability, the advantage of an easy, time‐saving, and individually adjustable application during the operation.
The Incudostapedial Joint Angle: Implications for Stapes Surgery Prosthesis Selection and Crimping
Authors: Skinner Margaret , Honrado Carlo , Prasad Mukesh , Kent H. Nelson , Selesnick Samuel H.
Published: November 2003

Objective To evaluate the role of the incudostapedial joint (ISJ) angle in stapes prosthesis size selection and crimping.

Methods The ISJ of 13 cadaveric human temporal bones were photographed, then measured using computer‐aided design software. The relationship of ISJ angle to prosthesis length was modeled. A literature review evaluated factors contributing to stapedectomy failure.

Results The mean ISJ angle was 93.0° (SD = 8.3°) (range, 75.0°–104.0°). The mean ISJ angle deviation from 90° was 7.35° (SD = 4.45°) (range, 0.3°–15.0°). The mean distance along the incus accessible for prosthesis placement was 3.21 mm (SD = 0.55 mm) (range, 2.00–4.00 mm).

Conclusions Significant deviation of the ISJ angle from 90° was found (P <.0001). The length along the incus accessible for prosthesis placement was sufficient to result in errors in prosthesis size selection and crimping with only small variations in the ISJ angle. Incorrect prosthesis sizing and crimping are frequently associated with stapedectomy failure. Variations in ISJ anatomy should be considered when selecting stapes prostheses lengths and may affect crimping technique.
Pneumatization of Turbinates
Authors: Braun Hannes , Stammberger Heinz
Published: November 2003

Objectives To present unusual computed tomography (CT) findings concerning huge pneumatization of turbinates and paranasal sinuses in one patient. In current world literature the authors only found nine reports of pneumatization of inferior turbinates, which, therefore, must be considered an extremely rare anatomical finding.

Study Design Case report and literature review.

Methods Computed tomography findings in a 35‐year‐old white woman with nasal obstruction are presented; and the authors describe this additional case of pneumatization of an inferior turbinate, as well as other variants. The literature and nomenclature are reviewed.

Results Besides the rare anatomical finding of a pneumatized inferior turbinate, in addition, both patient middle and superior turbinates were pneumatized bilaterally. Frontal and sphenoid sinuses were huge, with pneumatization of the crista galli and the posterior parts of the septum. The floor of the orbit presented with an orbitoethmoid (Haller) cell on one side. Thus, five of the six turbinates present were pneumatized. To the authors' knowledge, no other case of such extreme pneumatization has been published in world literature to date.

Conclusions Whereas pneumatization of the ethmoturbinals is a frequent finding on sinus computed tomography scans, pneumatization of the maxilloturbinal remains an extremely rare anatomical variant. Pneumatization of ethmoid cells and secondary sinuses is considered an active achievement of nasal and sinus mucosa during fetal development and adolescence. The underlying mechanisms of this process are not yet understood. The inferior turbinate is the least likely to present with pneumatization. In clinical practice, the pneumatization status should well be studied on the scans before any sinus and turbinate surgery is undertaken.
A Possible Role of Helicobacter pylori in Chronic Rhinosinusitis: A Preliminary Report
Authors: Özdek Ali , Çirak Meltem Yalinay , Samįm Erdal , Bayiz Ünal , Safak Mustafa Asim , Turet Sevgi
Published: November 2003

Objective The objective was to investigate the presence of Helicobacter pylori with polymerase chain reaction in the sinonasal mucosa of patients with or without chronic rhinosinusitis (CRS).

Study Design A prospective clinical trial.

Methods Mucosal tissue samples were collected from ethmoid cells of 12 patients with CRS and the removed mucosal part of the middle concha of 13 patients with concha bullosa who were treated surgically in our institution. DNA extracted from these samples was used for the amplification of 16S ribosomal RNA gene of H pylori by nested polymerase chain reaction.

Results Helicobacter pylori DNA was detected in 4 of 12 patients with CRS, but it was not detected in patients with concha bullosa. Three of four patients with positive results for H pylori had gastroesophageal reflux–related complaints.

Conclusions It is possible to detect H pylori in the sinus mucosa of some patients with CRS. However, whether H pylori is a causative agent for CRS or a result of CRS is not known.
The Role of Laser Vascular Targeting and Retinoic Acid in Oral Cancer Inhibition
Authors: Polavaram Raju , Fuentes Cesar F. , Shapshay Stanley M. , Wang Zhi
Published: November 2003

Objectives/Hypothesis The study examines the role of the pulsed‐dye laser at 585 nm, coupled with retinoic acid at therapeutic dose of 5.0 mg/kg body weight, in inhibiting chemically induced tumor growth in the hamster cheek pouch to determine whether pulsed‐dye laser therapy can inhibit tumor growth and whether a combination of pulsed‐dye laser and retinoic acid has a synergic effect on treatment efficacy.

Study Design Randomized, prospective study of hamster model.

Methods Forty‐eight male golden Syrian hamsters were painted with 0.5% solution of 9,10‐dimethyl‐1,2‐benzanthracene in acetone for 6 weeks to induce dysplasia in both sides of the cheek pouches. The hamsters were then randomly divided into four groups of 12 hamsters each as follows: (1) control group, (2) pulsed‐dye laser treatment only (8.0 J/cm2 and two pulses), (3) retinoic acid treatment only (5.0 mg/kg/d by intraperitoneal injection), and (4) combined pulsed‐dye laser and retinoic acid treatment. The treatment period was 40 days. Tumors were measured throughout the study.

Results The results indicated that retinoic acid and pulsed‐dye laser each significantly delay tumor growth and reduce tumor volume when used alone. Tumor volumes were statistically different among the treatment groups. There was also a statistical difference in tumor volume between the retinoic acid treatment group and the combined pulsed‐dye laser and retinoic acid treatment group.

Conclusions The study demonstrated the greater advantage of combining pulsed‐dye laser with retinoic acid over using either retinoic acid or pulsed‐dye laser alone for delay of oral cancer progression. Clinical trials are warranted to establish efficacy in humans.
Functional Outcomes Following Nonsurgical Treatment for Advanced‐Stage Laryngeal Carcinoma
Authors: Meleca Robert J. , Dworkin James Paul , Kewson Danny T. , Stachler Robert J. , Hill Samuel L.
Published: November 2003

Objectives Objectives were 1) to provide comprehensive evaluations of functional outcomes using perceptual and objective measures of patients treated nonsurgically for stages III and IV laryngeal squamous cell carcinoma and 2) to propose a standard battery of tests that can be used for appraising functional outcomes in this patient population.

Study Design Retrospective study of 14 patients.

Methods Perceptual measures of voice were obtained using blinded expert listener impression ratings and a validated quality of life questionnaire (Voice Handicap Index). Objective data included acoustic, speech aerodynamic, and videostroboscopic evaluations. Patients were also assessed relative to stability of the airway, secretion control, and ability to tolerate oral diet without aspiration symptoms.

Results Patients demonstrated functional but abnormal voice, speech, and swallowing abilities after treatment. More specifically, patients were judged to have moderately deviant biomechanical findings on videostroboscopy that did not improve with longer time intervals after treatment. These findings helped to explain the moderately abnormal acoustic and aerodynamic measurements revealing high values for jitter, shimmer, noise, airflow, glottal resistance, and subglottal pressures and substantially lower than normal maximum phonation times. Expert listeners were in agreement with the objective findings. However, patients rated themselves as only mildly impaired with regard to the emotional, physical, and functional handicapping effects of treatment, difficulties that were judged to improve with longer time intervals after treatment. Swallowing function showed a trend toward improvement for patients with time intervals of more than 12 months since completion of therapy.

Conclusions Patients demonstrated variable degrees of laryngeal dysfunction as evidenced by perceptual and objective measures. Patients rated themselves to be only mildly handicapped with regard to voice quality. A methodology and battery of tests are proposed to help standardize outcome data collection for this patient population.
The Management of Idiopathic Olfactory Hallucinations: A Study of Two Patients
Authors: Majumdar S. , Jones N. S. , McKerrow W. S. , Scadding G.
Published: November 2003

Objectives/Hypothesis Idiopathic olfactory hallucination is a rare condition. We report two cases of idiopathic olfactory hallucination and a review of the literature that relates to this condition.

Study Design A retrospective case study of two patients with idiopathic olfactory hallucination.

Methods Records of two patients were retrospectively reviewed.

Results The diagnosis of idiopathic olfactory hallucination was confirmed after excluding any intranasal disease or any central nervous system disorder discernible by an electroencephalogram and magnetic resonance imaging. Both patients were successfully treated with sodium valproate. One patient stopped taking sodium valproate because of side effects, only for the symptoms to return, but these were then controlled by phenytoin sodium. The mean patient follow‐up time was 3 years 5 months.

Conclusions The symptoms of some cases of idiopathic olfactory hallucination may be controlled by sodium valproate or phenytoin sodium. We hypothesize that this disorder may be a central phenomenon attributable to reverberating circuits.
Impact of Positron Emission Tomography on the Initial Staging and Therapy in Locoregional Advanced Squamous Cell Carcinoma of the Head and Neck
Authors: Schmid Daniel T. , Stoeckli Sandro J. , Bandhauer Florian , Huguenin Pia , Schmid Stephan , von Schulthess Gustav K. , Goerres Gerhard W.
Published: November 2003

Objective To evaluate the impact of 18F‐fluoro‐deoxy‐glucose positron emission tomography after standard diagnostic workup in patients with advanced head and neck squamous cell carcinoma on staging and radiation treatment planning.

Study Design Prospective controlled study.

Methods Forty‐eight patients (42 men and 6 women; mean age, 61 y; age range, 35–85 y) with histologically confirmed, advanced‐stage (any T, N≥N2 or T≥T3, any N) mucosal head and neck squamous cell carcinoma underwent positron emission tomography. The routine workup consisting of physical examination, panendoscopy, chest x‐ray film, and contrast‐enhanced high‐resolution helical computed tomography scan (HRCT) was used for comparison. End points were the extent of lymph node disease, distant metastases, and second primary tumors.

Results In 41 of 48 patients (85%) the lymph node findings between HRCT and positron emission tomography were concordant. In three patients positron emission tomography led to an upstaging of the tumor in its N category, and in four patients positron emission tomography underestimated lymph node involvement. Positron emission tomography revealed more difficulties in delineating lymph node metastases adjacent to the primary tumor than did HRCT, but was superior for the detection of distant and contralateral lymph node metastases. Positron emission tomography suggested distant metastatic lesions in 6 of 48 patients (13%). Cytological workup confirmed distant metastases in two (4%) and second primary tumors in another two patients (4%). Positron emission tomography results were false‐positive in two (4%) patients because of inflammatory changes.

Conclusions Whole‐body PET is able to assess lymph node involvement, distant metastases, and second primaries in a single study. Even after a routine clinical staging, positron emission tomography leads to a change of treatment in approximately 8% of patients.
Endoscopic Staple Diverticulostomy for Zenker's Diverticulum: Review of Literature and Experience in 159 Consecutive Cases
Authors: Chang Christopher Y. , Payyapilli Rose J. , Scher Richard L.
Published: November 2003

Objectives/Hypothesis Several reports since the early 1990s have advocated a minimally invasive technique, endoscopic staple diverticulostomy (ESD), to treat Zenker's diverticulum. However, long‐term results and comparisons with the reported experience with external or other endoscopic approaches have been lacking in the literature. We present follow‐up on our experience with ESD since 1995 and compare it with the results obtained by other endoscopic or external techniques for treatment of Zenker's diverticulum.

Study Design Retrospective review of 159 consecutive ESD procedures performed on 150 unique patients with Zenker's diverticulum between March 1995 and August 2002. Telephone interviews of patients were conducted to assess long‐term treatment outcome. Review of the literature was performed by Ovid MEDLINE search for all reports on the surgical treatment of Zenker's diverticulum in the English language between January 1990 and August 2002.

Methods Data were retrospectively reviewed and information was tabulated for age, sex, size of diverticulum, symptoms, duration of symptoms, operative time, length of hospital stay, time before oral intake, complications, and relief of symptoms at first postoperative visit. Follow‐up interviews of patients were conducted to assess current status of symptoms and, if any symptoms returned, how many months after the procedure they recurred. All case series in the literature in the English language since 1990 that were found in the Ovid MEDLINE database and referenced from identified articles were also tabulated for the same information.

Results At the time of initial follow‐up after ESD, 98% of patients reported complete or improved symptoms. Average hospital stay was 0.76 days, with a diet started on postoperative day 0.25. There was a 2.0% significant complication rate without mortality. Further follow‐up (average, 32.2 mo) identified a recurrence rate of 11.8%. On review of the literature, patients who underwent ESD had shorter perioperative courses, quicker return to diet, and lower complication and mortality rates compared with external procedures. ESD had comparable operative times and mortality rates, but fewer complications and more rapid convalescent times compared with other endoscopic procedures. Recurrence rates were found to be variable.

Conclusions Overall, ESD is an outpatient procedure with few complications. The technique has a faster operative and convalescence period with fewer complication rates compared with other endoscopic or external transcervical approaches. The results in the present study and those reported in the English language literature advocate that ESD be the initial preferred treatment for Zenker's diverticulum.
Fibronectin and Adhesion Molecules on Canine Scarred Vocal Folds
Authors: Hirano Shigeru , Bless Diane M. , Rousseau Bernard , Welham Nathan , Scheidt Troy , Ford Charles N.
Published: November 2003

Objective To examine the expressions of fibronectin and other adhesion molecules on the scarred vocal folds in a short‐ and long‐term animal model.

Study Design Animal model.

Methods Six beagles' vocal folds were stripped unilaterally and left untreated. After wounding the vocal folds were harvested from three dogs at 2 months and three dogs at 6 months. The untouched vocal fold was used as a control, and the stripped vocal fold as scarred. Subsequently, the expressions of fibronectin, cadherin, syndecan‐1 and syndecan‐4 on both vocal folds were examined by immunohistochemical and image analysis.

Results Compared with the control vocal folds, fibronectin significantly increased in the superficial layer of the lamina propria on the scarred vocal folds at both 2 and 6 months. Co‐deposition of collagen was observed only at 6 months. Syndecan‐4 was significantly overexpressed at the basal layer cells of the epithelium at both 2 and 6 months. No significant expression of either cadherin or syndecan‐1 was detected.

Conclusions Scar characteristics at 2 and 6 months are not identical, suggesting that a 2‐month period may not be a sufficient to study vocal fold scarring. Adhesion molecules are important in reorganization of extracellular matrix during wound healing because of their binding and adhesion characteristics. The results indicate that fibronectin might be important in providing a scaffold for the deposition of other proteins such as collagen, and the binding characteristics might affect the stiffness of the scarred vocal fold. Prolonged expression of syndecan‐4 may reflect the role of focal adhesion during the assembly of scar structure. Ultimately, better understanding of the histological features of the scarred vocal fold might lead to new approaches to treatment.
Immunohistochemical Characterization of the Epidermoid Formation in the Middle Ear
Authors: Liang Jianning , Michaels Leslie , Wright Anthony
Published: November 2003

Objective To study the incidence, size, and origin of epidermoid formations after accurately characterizing them by cytokeratin immunohistochemical analysis.

Study Design A strategy of screening sections for possible epidermoid formations in the entire eardrum area in paraffin‐embedded, serially sectioned developing temporal bones was used. Unstained adjacent sections were subjected to immunohistochemical staining, to provide accurately identified epidermoid formations for a study of their appearance and size in relation to age.

Methods The immunohistochemical expression patterns for epidermoid cytokeratins of several antibodies at different gestational ages were determined. Then, epithelial structures suspected as epidermoid formations were characterized as epidermoid with age‐appropriate antibodies in 36 paraffin‐embedded temporal bones from 19 cases with an age range of 6 gestational weeks to 15 months postpartum using a novel method of antigen retrieval by heating sections in a 70°C water bath.

Results Each of 22 temporal bones ranging in age from 16 weeks gestation to 8 months postpartum contained one or more, often numerous, epidermoid formations. Sizes of epidermoid formations increased significantly with increasing age. The formations were found anywhere in the annular lateral wall region of middle ear, but the majority were in the anterosuperior region. A further study of the interface between annular external canal epidermis and middle ear epithelium in a larger group suggested that epidermoid formations arise at approximately 16 gestational weeks from the external canal epidermis.

Conclusion The findings indicate that epidermoid tissue in the middle ear normally originates from external canal epidermis at approximately the 16th gestational week and grows before disappearing.
Hereditary Paraganglioma Due to the SDHD M1I Mutation in a Second Chinese Family: A Founder Effect?
Authors: Lee Soo‐Chin , Chionh Siok‐Bee , Chong Siew‐Meng , Taschner Peter E. M.
Published: November 2003

Objectives/Hypothesis Hereditary paraganglioma is a rare condition that is inherited in an autosomal‐dominant fashion. Four distinct loci have been associated with hereditary paraganglioma, including the SDHD, SDHC, and SDHB genes and a locus at 11q13. The SDHD, SDHC, and SDHB genes code for subunits of succinate dehydrogenase, which forms part of the mitochondrial respiratory chain. SDHD mutations are widely distributed along the gene with no apparent hot spots, although a founder effect has been described in the Dutch population.

Methods Following a prior report of the SDHD M1I mutation in an Australian Chinese family, a second Chinese family with the same mutation is reported. The proband developed bilateral head and neck paragangliomas at age 34 years and a functioning adrenal pheochromocytoma and two extra‐adrenal abdominal paragangliomas 7 years later. His brother had unilateral head and neck paraganglioma at age 39 years. Given the multicentricity of the proband's tumor and the familial clustering of paragangliomas, a clinical diagnosis of hereditary paraganglioma was made, and the proband was tested for a mutation in the SDHD gene.

Results The proband was found to be heterozygous for the SDHD MII mutation that removes the start codon, and his brother subsequently tested positive for the same mutation. The family is not related to the Australian Chinese family.

Conclusion The finding suggests the possibility of a founder effect in the Chinese population and warrants further investigation.
Bile Acid Induces Cyclo‐Oxygenase‐2 Expression in Cultured Human Pharyngeal Cells: A Possible Mechanism of Carcinogenesis in the Upper Aerodigestive Tract by Laryngopharyngeal Reflux
Authors: Sung Myung‐Whun , Roh Jong‐Lyel , Park Bum Jung , Park Seok Woo , Kwon Tack‐Kyun , Lee Sang Joon , Kim Kwang Hyun
Published: November 2003

Objectives/Hypothesis Laryngopharyngeal reflux is a common event in patients with head and neck cancer. Bile acid is known to be related to tumor formation in the esophagus through the overexpression of cyclo‐oxygenase‐2 (COX‐2), an enzyme that produces prostanoids. To better understand the mechanism of the laryngopharyngeal reflux–cancer connection, we examined COX‐2 expression by bile acid in cultured human pharyngeal mucosa cells.

Methods COX‐2 expression induction by various combinations of chenodeoxycholate and acidity was observed by Western blotting and reverse transcriptase–polymerase chain reaction. COX‐2 promoter activity was also measured by luciferase promoter assay.

Results Chenodeoxycholate, one of the bile acid components, was found to induce COX‐2 expression in human pharyngeal cells. Moreover, the induction of COX‐2 by chenodeoxycholate was enhanced by acidity in a dose‐dependent manner, and the promoter activity of COX‐2 was increased by chenodeoxycholate in SNU‐1041, a human laryngeal cancer cell line, whereas the transcription of COX‐2 was inhibited by actinomycin‐D.

Conclusion Bile salts or acidic conditions, or both, can induce COX‐2 expression in normal pharyngeal mucosa, which implies that laryngopharyngeal reflux has a role in the tumorigenesis of the upper aerodigestive tract.
Noise in Magnetic Resonance Imaging: No Risk for Sensorineural Function But Increased Amplitude Variability of Otoacoustic Emissions
Authors: Wagner Wolfgang , Staud Irene , Frank Gerhard , Dammann Florian , Plontke Stefan , Plinkert Peter K.
Published: November 2003

Objectives Objectives were to perform exact measurements of the noise exposure in a magnetic resonance imager and to investigate the effects of magnetic resonance imaging (MRI) noise on hearing sensitivity, which are still controversial, in a large number of patients.

Study Design Prospective trial.

Methods Acoustic noise during seven different MRI sequences was measured using a custom‐made microphone containing no ferromagnetic parts. In 244 ears of 126 patients, pure‐tone audiometry was performed once before and once after MRI noise, and distortion product otoacoustic emissions were measured once before and three times after MRI.

Results The sound pressure level (SPL) at the patient's ear (with consideration of the sound‐damping effect of the head support) ranged from 79.5 to 86.5 dB (A), depending on the MRI sequence, with brief sound pressure peaks up to 120 dB SPL. No significant incidence of temporary threshold shift and no reduction of mean distortion product otoacoustic emission amplitude were apparent. However, a significant increase in distortion product otoacoustic emission amplitude variability after noise exposure with equal distribution of increased and decreased amplitudes was observed. This variability showed a maximum at 15 minutes after noise, as demonstrated by continuous measurements.

Conclusions First, MRI noise does not impose a risk to hearing function under the measurement condition of a sound‐damping head support or ear protectors. Second, a subtle effect is demonstrated by increased distortion product otoacoustic emission amplitude variability. Third, the increased otoacoustic emission amplitude variability is an audiometric parameter that is extremely sensitive to effects of acoustic stimulation, indicating more discrete changes in cochlear activity than pure‐tone audiometry or otoacoustic emission amplitude reduction. A shift of the operation point (OP) of the outer hair cell (OHC) between basilar membrane and tectorial membrane is suggested as underlying cause.
Preliminary Results With the Use of AlloDerm in Chronic Otitis Media
Authors: Fayad Jose N. , Baino Tony , Parisier Simon C.
Published: November 2003

Objectives/Hypothesis AlloDerm, an acellular dermal graft, has been used successfully as a material for soft tissue implantation. The authors report their experience with the use of AlloDerm in the reconstruction of the tympanic membrane.

Study Design Case review study.

Methods Charts were reviewed for all patients who underwent tympanoplasty with and without mastoidectomy between June 1999 and June 2002 in whom AlloDerm was used as a grafting material. There were 24 patients, 17 with simple perforations (8 revisions) and 7 with chronic otitis media with cholesteatoma (6 revisions). Success was defined as closure of the tympanic membrane perforation.

Results Closure of the perforation using AlloDerm was achieved in 87.5% of the patients (ie, in all but three patients). Another patient developed serous otitis media and required a myringotomy tube in the postoperative period.

Conclusions The success rate for AlloDerm in tympanoplasty was similar to that of temporalis fascia in the authors' experience. AlloDerm can provide a suitable grafting material when fascia is not available or when the size of the defect precludes the use of fascia.