bluuebunny/crossref_metadata_2025 huggingface dataset:
Sinonasal Papillomas: Clinicopathologic Review of 40 Patients With Inverted and Oncocytic Schneiderian Papillomas
Authors: Kaufman Matthew R. , Brandwein Margaret S. , Lawson William
Published: November 2003

Objective To evaluate the pathological features and variations of sinonasal inverted and oncocytic papillomas and correlate the microscopic findings with the clinical behavior.

Study Design A retrospective review and pathological assessment.

Methods A retrospective review and pathological assessment were performed on 40 patients with a diagnosis of inverted papilloma treated by the senior author (w.l.) between 1994 and 2001.

Results Forty cases were identified and reviewed. Seven patients developed recurrences (18%), and four underwent malignant transformations (10%). Pathological assessment revealed 34 (85%) inverted papillomas and 6 (15%) oncocytic schneiderian papillomas. Dysplasia was present in 26 cases (65%), including 9 cases (22%) of high‐grade dysplasia (moderate to severe). Metaplasia of the sinonasal mucosa adjacent to inverted papillomas and oncocytic schneiderian papillomas was seen in 18 (45%) cases. Recurrence developed in two patients with oncocytic schneiderian papillomas (33%) and five patients with inverted papillomas (15%). Four cases (10%) of carcinoma ex papilloma were seen; one arose from oncocytic schneiderian papilloma (17%), and three arose from inverted papilloma (9%). Oncocytic schneiderian papilloma was more often mixed with typical inverted papilloma, rather than presenting in its pure form.

Conclusions Although oncocytic schneiderian papilloma is uncommon relative to inverted papilloma, the results suggest that they have higher rates of both recurrence and malignant transformation. The common admixture of oncocytic schneiderian papilloma with inverted papilloma speaks for a common etiological factor of these two lesions. A larger number of cases for analysis would be necessary to confirm the trend noted in our data. Nonetheless, pathological findings consistent with oncocytic schneiderian papilloma should be explicit in any classification system and justify aggressive treatment and careful postoperative surveillance.
Spontaneous Tracheal and Subglottic Tears in Neonates
Authors: Kacmarynski Deborah S. F. , Sidman James D. , Rimell Frank L. , Hustead Virginia A.
Published: November 2003

Objectives/Hypothesis Spontaneous rupture of the trachea or subglottis as a complication of difficult delivery has not been reported in the United States literature. There have been a few cases reported in the European literature. The present report describes a series of newborns with this complication and discusses the signs and treatment options of this difficult, life‐threatening problem.

Study Design Retrospective review.

Methods Newborns born between 1996 and 2001 who were treated for spontaneous subglottic or tracheal rupture at a tertiary care children's hospital neonatal intensive care unit were reviewed.

Results Four cases of spontaneous subglottic rupture were seen at the hospital. In three of the four cases the tracheas were emergently intubated after subcutaneous air was noted in the anterior aspect of the neck. In the fourth patient the trachea was not intubated until the subglottic tear was visualized intraoperatively. Two of the four patients died. One died without securing of an airway; the other died of complications of prolonged hypoxia. Eight cases from European literature of spontaneous neonatal subglottic and tracheal tears are reviewed and are compared with the cases presented in the current report.

Conclusions Early detection of airway rupture by flexible endoscopy is essential for timely diagnosis and appropriate treatment. Standard endotracheal intubation can exacerbate the problem and should be deferred if possible until direct airway visualization can be accomplished. Signs associated with tracheal tears include subcutaneous emphysema, respiratory distress, pneumothorax, and pneumomediastinum. These should lead to emergent consultation with otolaryngologists for examination and securing of the airway.
Radiographic Comparison of Three Methods for Nasal Saline Irrigation
Authors: Olson David E. L. , Rasgon Barry M. , Hilsinger Raymond L.
Published: November 2003

Objective To compare intranasal distribution of saline solution delivered by three popular methods for nasal saline irrigation.

Study Design Prospective, controlled comparison.

Methods Eight healthy adult volunteers received nasal irrigation with 40 mL of isotonic, nonionic contrast material immediately before having coronal computed tomography to visualize distribution of solution in the paranasal sinuses. For each study subject, three methods of irrigation were used: irrigation using positive‐pressure irrigation, irrigation using negative‐pressure irrigation, and irrigation using a nebulizer. For each subject, three‐dimensional computer reconstructions of the irrigated paranasal sinus airspaces were used to compare contrast solution volume and distribution achieved by the three methods.

Results Of the three methods used, two methods, positive‐pressure and negative‐pressure irrigation, distributed contrast solution widely to ethmoid and maxillary sinuses, but distribution of contrast solution was more uniform using positive‐pressure irrigation than using negative‐pressure irrigation. The nebulization method distributed contrast solution poorly and resulted in a significantly lower volume of retained contrast solution (P <.05).

Conclusion Judged solely on the basis of solution distribution in the nasal sinuses, nasal irrigation is effective when either positive‐pressure or negative‐pressure irrigation is used but is ineffective when a nebulizer is used.
Fat Augmentation Following Microsurgical Removal of the Vocal Nodules
Authors: Hsiung Ming‐Wang , Chen Yen‐Yu , Pai Lu , Lin Yaoh‐Shiang , Kang Bor‐Hwang , Wang Hsing‐Won
Published: November 2003

Objectives Autogenous fat augmentation has been used as a treatment for glottic insufficiency. However, no information is available on the effectiveness of fat injection in patients with vocal nodules or recurrent vocal nodules after surgery.

Study Design The retrospective study reviews the efficiency of fat injection after surgery in patients with vocal nodules (n = 18) and recurrent vocal nodules (n = 5).

Methods The perceptual acoustic, phonatory function, and video laryngostroboscopic data were evaluated before and after surgery in 23 patients.

Results Mean follow‐up time was 7.5 months. Nineteen patients had excellent results. Two patients had improvement, and no change was observed in two patients. Phonatory function showed significant improvement in shimmer, harmonic‐to‐noiseratio (P <.05), maximum phonation time, grade, roughness, and breathiness (P <.001). Video laryngostroboscopic rating showed significant improvement in linearity of the vocal fold edge, amplitude of vocal fold vibration, and excursion of the mucosal wave (P <.001). Less improvement was observed in recurrent vocal nodules than in nonrecurrent vocal nodules.

Conclusions Fat injection is an effective autogenous implant and may be considered as an option in management of patients with vocal nodules after surgery. Recurrence of nodules is a problem, but the procedure may be repeated.
Apoptosis in the Aging Olfactory Epithelium
Authors: Robinson Alan M. , Conley D. B. , Shinners M. J. , Kern Robert C.
Published: November 2003

Objectives Olfactory receptor neurons undergo apoptosis at a baseline rate, probably secondary to environmental damage even in the absence of gross disease. The study demonstrates age‐related changes in expression of genes known to regulate apoptosis in the rat olfactory mucosa. These results are compared with gene expression in young rats and rats that have undergone surgical deafferentation of the olfactory receptor neurons.

Study Design The olfactory mucosae from three groups of rats were studied: young, normal rats (age, 12 wk); old, normal rats (age, 24 mo); and young rats 9 days after bilateral removal of the olfactory bulb. Bulbectomy is known to produce an initial wave of apoptotic cell death in the population of olfactory neurons. At 9 days after the injury, the olfactory mucosae consist of an enhanced population of regenerating neurons destined to also undergo apoptosis, since their synaptic target (bulb) has been removed.

Methods Ribonuclease protection assays and histological analysis of the three groups were performed.

Results Ribonuclease protection assay analysis indicates that age induces increases in the expression of pro‐apoptotic genes in the olfactory mucosae similar to the increase seen after deafferentation (bulbectomy). Specifically, the expression of procaspase‐3 and bax was increased in aged animals and bulbectomized animals when compared with young, normal animals.

Conclusions Aging induces changes in gene expression in the olfactory mucosae that appear to favor apoptosis, probably associated with increased fragility of olfactory receptor neurons in older animals. These changes may, at least in part, explain the age‐related decline in olfactory sensation and loss of olfactory receptor neurons seen in elderly patients.
Effects of Dexamethasone on Mucin Gene Expression in Cultured Human Nasal Epithelial Cells
Authors: Ishinaga Hajime , Takeuchi Kazuhiko , Kishioka Chikako , Yagawa Mayuko , Majima Yuichi
Published: November 2003

Objective To clarify 1) which mucin gene expression is influenced by glucocorticoid and 2) whether glucocorticoid influences steady‐state mucin expression or mucin gene expression induced by lipopolysaccharide.

Methods Dissociated cells obtained from nasal polys were cultured on a collagen gel substrate in an air‐liquid interface. Dexamethasone was added to the culture medium in the steady‐state and prior to the stimulation by LPS. RNAs were extracted from culture cells, and semiquantitative reverse transcriptase‐polymerase chain reaction was performed for MUC2, MUC5AC, MUC5B, MUC8, and β‐actin.

Results Dexamethasone did not influence steady‐state messenger RNA levels of either mucin gene. Dexamethasone suppressed lipopolysaccharide‐induced messenger RNA levels of MUC8.

Conclusion Glucocorticoid does not influence steady‐state mucin gene expression but suppresses mucin gene expression induced by secretagogues such as lipopolysaccharide.
Nonsyndromic Hearing Loss Caused by a Mitochondrial T7511C Mutation
Authors: Ishikawa Kotaro , Tamagawa Yuya , Takahashi Katsumasa , Kimura Hiroshi , Kusakari Jun , Hara Akira , Ichimura Keiichi
Published: November 2003

Objectives The aims of the present study were to identify a mutation in a Japanese family showing nonsyndromic sensorineural hearing loss and to relate the mutation to characteristics of patients, including audiovestibular findings.

Study Design Familial cohort study.

Methods Mutation analysis was performed using genomic DNA extracted from blood samples. Subjects underwent audiovestibular examinations, including pure‐tone audiograms, tympanometry, self‐recording audiometry, acoustic reflex threshold, speech discrimination testing, evoked and distortion‐product otoacoustic emissions, auditory brainstem responses, and caloric testing.

Results We identified a T7511C mutation in the mitochondrial tRNASer(UCN) gene previously reported in one other family. The degree of heteroplasmy for the T7511C mutation ranged from 84% to 92%, and did not correlate with age at examination or severity of hearing loss. Extensive audiologic evaluation suggested both cochlear and retrocochlear involvement.

Conclusion Families with maternally transmitted nonsyndromic hearing loss should be investigated for mutations in the tRNASer(UCN) gene.
Temporary Intraoperative External Fixation in Mandibular Reconstruction
Authors: Ung Feodor , Rocco James W. , Deschler Daniel G.
Published: November 2003

Objectives To describe the use of a temporary intraoperative external fixation device to assist in the optimal bony reconstruction of the mandible in the setting of vascularized bone grafts.

Study Design A retrospective review of six patients who underwent composite resection of the mandible and subsequent reconstruction with osteocutaneous free tissue transfer in a tertiary care center.

Methods Six cases of mandibular reconstruction using an intraoperative external fixation system to assist the positioning of vascularized bone grafts are presented. All patients had composite resection of the mandible and subsequent reconstruction with either a scapula or fibula osteocutaneous flap. Follow‐up ranged from 2 to 16 months.

Results Successful reconstruction as defined by acceptable contour, occlusion, and condylar position was achieved in all cases. Complications were limited to a postoperative cerebrovascular accident requiring anticoagulation and subsequent neck hematoma.

Conclusions Use of intraoperative external fixation maintains the proper alignment of mandibular segments without the use of a bridging reconstruction plate. This technique is particularly valuable with tumors involving the outer cortex of the mandible.
On the Origin of Tonsillectomy and the Dissection Method
Authors: Koempel Jeffrey A.
Published: November 2003

Objectives To identify the person or persons responsible for the conception and description of the operation that we know of today as tonsillectomy and to determine whether this was accomplished by an American otolaryngologist(s) before the description by George Waugh of London in 1909.

Study Design A review of the English language medical literature from 1879 to 1910.

Methods Three hundred seventy‐five articles relating to tonsil surgery or instrumentation for tonsil surgery were identified. It was possible to obtain and review only 67 articles. In addition, 20 textbooks relating to the tonsils and tonsil surgery (published between 1880 and 1966) were identified and reviewed.

Results An attempt to remove the entire tonsil intact was described by Edwin Pynchon in 1890 with the use of galvanocautery. He recommended that only one tonsil be removed at one time with approximately 2 weeks between operations. In 1903, Charles Robertson advocated the removal of both tonsils at one operation using scissors but did not mention the capsule. J. Gordon Wilson published a description of the tonsillar capsule in 1906 but did not comment on tonsil surgery or the importance of any particular structure as a surgical landmark. In that same year, William Lincoln Ballenger of Chicago, Illinois, clearly recommended the complete removal of the tonsil with its capsule intact but commented that he usually used an écraseur‐tonsillotome to finally remove the tonsil. Also in 1906, Ovidus Arthur Griffin of Ann Arbor, Michigan, described the use of a knife and a specially designed pair of scissors to remove the tonsils in their entirety in one operation without the use of a guillotine or an automatic instrument.

Conclusion The operation that we know of today as tonsillectomy, the removal of the entire tonsil with the capsule intact, and the term tonsillectomy itself were conceived, described, and published by American otolaryngologists before the description by George Waugh of London in 1909.
Postnatal Development of the Eustachian Tube Glands
Authors: Orita Yorihisa , Sando Isamu , Hirsch Barry E. , Miura Makoto , Hasebe Seishi , Balaban Carey D.
Published: November 2003

Objective To delineate a possible difference in the function of the eustachian tube (ET) between infants and adults.

Study Design Morphometric and histopathological examination on the human temporal bones.

Methods The secretory glands in the ET were studied in serial histological sections through the cartilaginous portion of the human ET obtained from 32 individuals whose ages ranged from 1 day to 19 years. Of these, 26 were normal control cases and 6 were cases with otitis media (OM).

Results In both normal and OM groups, the distribution of the glands was predominantly in the medial side of the cartilaginous portion of the ET, and the volume of the ET glands was directly related to both the volume of the ET lumen and the patients' age. In normal cases, the relative proportion of the three types of acinar cells (mucous, serous, and mixed) varied among the different age groups. The cases in patients under 1 month of age had more mucous glands and fewer serous glands. In cases of the 1‐month‐old to 7‐year‐old age group, the three ET gland cell types came to be approximately equal. Relative proportion of the serous glands continuously increased with aging, and in cases of patients older than 7 years of age, serous glands were predominant over the other two components.

Conclusion It is assumed that the greater proportion of mucous glands and insufficient serous glands by 7 years of age reflects immature development, which may be one of the associated factors contributing to recurrent OM among infants.
The Nucleus Contour Electrode Array: An Electrophysiological Study
Authors: Pasanisi Enrico , Vincenti Vincenzo , Bacciu Andrea , Guida Maurizio , Bacciu Salvatore
Published: November 2003

Objective/Hypothesis Positioning intracochlear electrodes adjacent to the modiolus would lead to a reduction in threshold levels and latencies, as measured with electrically evoked auditory brainstems responses. Recently, Cochlear Corporation introduced a new perimodiolar array (Contour electrode) characterized by a platinum stylet inserted into the array's silicone carrier that keeps the electrode in a straightened configuration before insertion. After completion of the insertion, the withdrawal of the stylet allows the array to coil within the cochlea positioning electrodes closer to the modiolus. The purpose of the study was to analyze the stimulation properties of the Contour electrode by evaluating the effects of the withdrawal of the stylet on electrical auditory brainstem response (EABR) characteristics.

Methods Electrical auditory brainstem response registrations were performed intraoperatively on three electrodes (1 apical, 1 medial, 1 basal) before and after the removal of the stylet in 10 patients implanted with the Nucleus 24 Contour device. A within‐patient comparison of EABR characteristics was performed. The Student t test was used to assess differences in EABR measures obtained before and after the stylet removal.

Results Mean EABR thresholds were significantly lower after the removal of the stylet than with the stylet in situ for all three electrodes tested. After the removal of the stylet, latencies of waves III and V significantly decreased, whereas amplitudes significantly increased.

Conclusion Reduction in EABR threshold levels and latencies as well as an increase in waves III and V amplitudes after the stylet removal all demonstrate the effectiveness of the Contour system in positioning intracochlear electrodes closer to auditory neurons.
Functional Study of GJB2 in Hereditary Hearing Loss
Authors: Choung Yun Hoon , Moon Sung‐Kyun , Park Hong‐Joon
Published: November 2003

Objectives/Hypothesis The gene GJB2 of the gap junction protein connexin 26 (Cx26) was found to be the main causative gene of autosomal recessive nonsyndromic hearing loss (DFNB1). Although 35delG has been known as the major mutation in Western countries, 235delC was reported to be a specific form of mutation in Asian populations. The objective of the study was to identify how 235delC and E114G changes found in the Korean population affected the function of GJB2 using molecular biological techniques.

Methods Genes containing 235delC and E114G were cloned into the pcDNA3 vector, and HeLa cells were transfected with the recombinant DNA samples by the liposome complex method. The expression and subcellular localization of Cx26 were determined, using antibodies against amino acid sequences in the intracellular loop (IL) and N‐terminal (NT) portions of Cx26. To analyze functions of the GJB2 as a gap junction channel, we examined Lucifer yellow dye transfer between cells with a scrape‐loaded technique. Wild‐type GJB2 (WT) with normal hearing was used as a positive control, and mock transfected cells were used as a negative control.

Results Immunocytochemical analysis showed that cells transfected with E114G and WT gave characteristic punctate patterns of reaction in the cell membrane with both antibodies. However, 235delC cells were not stained with anti‐IL antibody but stained slightly just around the nucleus only with anti‐NT antibody. In a functional study of GJB2, transfer of Lucifer yellow into contiguous cells was detected in both WT and E114G, but no transfer activity was observed in 235delC.

Conclusions The 235delC mutation showed a loss of targeting activity to the cell membrane and severe deterioration of gap junction activity. For the E114G, we did not find any difference from WT transfected cells.
Otogenic Sigmoid Sinus Thrombosis: What Is the Role of Anticoagulation?
Authors: Bradley Dewayne T. , Hashisaki George T. , Mason John C.
Published: November 2003

Objectives The treatment of otogenic sigmoid sinus thrombosis with surgery and antibiotics is well established. However, the role of anticoagulation remains unstudied. The study reviews the signs, symptoms, radiological evaluation, surgical treatment, and medical management of patients with otogenic sigmoid sinus thrombosis treated with or without anticoagulation.

Study Design Retrospective review of nine patients from 1995 to 2001 with sigmoid sinus thrombosis.

Methods Patients were identified by a review of all medical and radiological records. Signs, symptoms, diagnostic studies, treatments, and outcomes were recorded. In addition, telephone follow‐up was performed.

Results Nine patients were identified over a 6‐year period from 1995 to 2001. Patients had a mean follow‐up time of 9 months (range, 1–24 mo). Of the nine patients identified, eight patients (89%) had tympanostomy tube placement, six patients (67%) had canal wall intact mastoidectomy, and one patient (11%) had canal wall down mastoidectomy. Needle aspiration of the sinus was performed in four of nine patients (44%), and incision of the sinus in two of nine (22%). Treatment with broad‐spectrum antibiotics occurred in all patients with a mean duration of 12 days (range, 2–22 d) intravenously and 7 days (range, 0–21 d) orally. Sixty‐seven percent of patients (six of nine) were anticoagulated: Five patients received low‐molecular‐weight heparin, and one patient received heparin‐coumadin. No mortality occurred in either the anticoagulated or non‐anticoagulated group. One anticoagulated patient did have persistent headaches and otorrhea.

Conclusions Surgery and antibiotic therapy are the cornerstones of the management of otogenic sigmoid sinus thrombosis. However, the role of anticoagulation remains unclear. Because complications of embolization and persistent sepsis are low in otogenic sigmoid sinus thrombosis patients treated with or without anticoagulation, withholding anticoagulation in selected patients is reasonable. Serial imaging to monitor for thrombus progression is advisable.
Cavernous Hemangioma of the External Ear Canal
Authors: Reeck Jay B. , Yen Thomas L. , Szmit Andrew , Cheung Steven W.
Published: November 2003

Objective To document the occurrence of a cavernous hemangioma of the external ear canal and to review the relevant literature.

Study Design Case report and literature review.

Methods Review of a patient chart, imaging studies, operative report, and histologic findings.

Results A cavernous hemangioma of the external ear canal not involving the tympanic membrane was surgically excised without complication. This is the third documented cavernous hemangioma of the external ear canal without tympanic membrane involvement in the English literature. Computed tomography scan is invaluable to narrow the differential diagnosis. Complete removal is curative.

Conclusions Cavernous hemangioma of the external ear canal with or without tympanic membrane involvement is a rare otologic entity amenable to surgical treatment. Temporal bone computed tomography scan imaging is an important preoperative diagnostic tool.
Modulation of Murine Allergic Rhinosinusitis by CpG Oligodeoxynucleotides
Authors: Hussain Iftikhar , Jain Vipul V. , Kitagaki Kunihiko , Businga Thomas R. , O'shaughnessy Patrick , Kline Joel N.
Published: November 2003

Background Allergic rhinosinusitis is characterized by eosinophilic inflammation of the upper airway, which is induced by TH‐2 cytokines. CpG oligodeoxynucleotides (ODN) are known to induce TH‐1 and to suppress TH‐2 cytokines in a variety of settings, including murine models of asthma.

Objective To examine the effect of CpG ODN in a murine model of upper airway allergic inflammation and to correlate with reduction of its manifestations of sneezing and nasal scratching.

Methods BALB/c mice were sensitized using Ovalbumin (Ova) intraperitoneally and challenged with aerosolized Ova. CpG ODN were administered at the time of Ova sensitization. Outcomes measured included nasal symptoms, submucosal eosinophilia in the areas lined by respiratory or olfactory epithelium, and bone marrow eosinophilia. To delineate the mechanism of CpG ODN‐induced suppression of eosinophilic inflammation, in vitro experiments were carried out to examine the effect of stimulation with Ova on splenocytes obtained from mice that were treated with CpG or control ODN (or no ODN) in vivo. Supernatant was collected after 72 hours of incubation and cytokines were measured by enzyme linked immunosorbent assay.

Results CpG ODN administered at the time of Ova sensitization effectively abrogated nasal symptoms and eosinophilic upper airway inflammation compared with mice treated with control ODN or with no ODN. Cytokine data revealed that Ova sensitization suppressed IFN‐γ and induced IL‐4 and IL‐5 compared with non‐sensitized mice. CpG ODN treatment reversed these effects.

Conclusion CpG ODN prevents the development of TH‐2‐mediated eosinophilic inflammation and symptoms in a murine model of allergic rhinosinusitis.
The Role of Acid and Alkaline Reflux in Laryngeal Squamous Cell Carcinoma
Authors: Galli J. , Cammarota G. , Calò L. , Agostino S. , D'Ugo D. , Cianci R. , Almadori G.
Published: November 2003

Hypothesis At present, main factors considered responsible for the onset of squamous cell carcinoma are tobacco smoking, alcohol abuse, and exposure to viral and toxic agents. In last years, great interest has been focused on gastroesophageal reflux as independent carcinogenic factor and co‐carcinogen in association with smoking and alcohol assumption.

Study Design Initially, the aim of this study was to objectively evaluate the presence of distal and proximal esophageal reflux with multielectrode pH measurement in patients with cancer of the larynx and/or hypopharynx (group A). However, in the course of the study, pharyngolaryngeal cancer was also observed in 4 patients with achlorhydria; therefore, the hypothesis that alkaline reflux might be involved in the onset of laryngeal cancer was tested (group B).

Methods Twenty‐one consecutive patients with laryngeal or hypopharyngolaryngeal squamous cell carcinoma (group A) entered the study. Twenty‐one patients without laryngo‐pharyngeal diseases were used as control subjects. A validated questionnaire of the clinical history was completed by all patients who underwent 24‐hour pH monitoring. Group B included 40 consecutive gastrectomized patients (28 males and 12 females) in whom biliary or alkaline reflux was directly consequent to Billroth I or Billroth II operation. The control group was composed of 40 non‐gastrectomized dyspeptic patients. The clinical history was controlled and obtained; EDGS and ENT examination with videolaryngoscopy was performed in all patients.

Results In group A, pH measurement showed pathological reflux in 80.9% (17 of 21) of patients with no typical symptoms in 63.7% of them. The difference was significant with respect to the control group. In group B, 6 of 40 (15%) had preneoplastic lesions or a history of laryngeal tumor. The difference was significant with respect to the control group. A total of 7.5% of group B patients had previously undergone CO2 laser cordectomy for laryngeal squamous cell carcinoma and 7.5% had leukoplakia. We found a significantly higher incidence (<.05) of neoplastic and preneoplastic disease of the larynx in patients undergoing Billroth II and total gastrectomy than in those undergoing Billroth I and Roux‐en‐Y resection. We also found a significant increase (<.01) in ENT lesions in the group of patients who had undergone gastrectomy more than 20 years previously.

Conclusions In agreement with literature reports, results obtained in group A confirmed that gastroesophageal reflux is often present in patients with neoplastic lesions of the pharynx and larynx. Furthermore, gastric resection is indicated for the first time as an additional risk factor or cofactor of precancerosis and squamous cell carcinoma of the pharynx or larynx. Further studies are necessary to establish the cause and effect relationship between biliary reflux and pharyngo‐laryngeal tumors.
Microvascular Free Tissue Transfer in Reconstructing Skull Base Defects: Lessons Learned
Authors: Teknos Theodoros N. , Smith Jonathan C. , Day Terry A. , Netterville James L. , Burkey Brian B.
Published: November 2003

Objective To demonstrate the effectiveness of microvascular free tissue transfer in reconstructing complex skull base defects.

Study Design Retrospective chart review.

Methods A retrospective chart review was conducted identifying patients with anterior or lateral skull base defects, or both, who underwent microvascular free flap reconstruction. Appropriate demographic, pathological, and preoperative and postoperative clinical data were collected and analyzed.

Results Thirty‐five patients with skull base defects were identified, including 8 women (Mean age, 43.9 y; age range, 28–75 y) and 27 men (mean age, 57.9 y; age range, 19–85 y). Defects were secondary to trauma in two cases, whereas the remaining 33 cases were secondary to ablative procedures for a variety of malignant tumors, of which squamous cell carcinoma was the most common (n = 18). The average defect surface area was 89.3 cm2, and 36 free flaps were used. The most commonly used flap was the rectus myocutaneous (n = 20); however, six different flap types were employed, including three radial forearm fascial flaps. In all, there were seven flap‐related complications and there was one total flap loss. A total of 43 postoperative complications occurred in 23 patients, with the most common complications being grouped as intracranial (n = 10), orbital (n = 9), and cardiac (n = 9). The perioperative mortality rate was 5.7%, and the average hospital stay was 13.5 days (range, 7–37 d).

Conclusions The use of microvascular free tissue transfer for reconstruction of complex skull base defects has proven highly successful in the large series presented in the current study. The versatility and reliability of free flaps for such reconstruction are discussed, and helpful hints are given to minimize the complication rate.
Relative Risk of Stroke in Head and Neck Carcinoma Patients Treated With External Cervical Irradiation
Authors: Haynes Jeffrey C. , Machtay Mitchell , Weber Randal S. , Weinstein Gregory S. , Chalian Ara A. , Rosenthal David I.
Published: November 2003

Objective To determine the rate of cerebrovascular events (stroke) in patients irradiated to high doses for squamous cell carcinoma of the head and neck.

Study Design Retrospective chart review of 413 patients treated from 1987 to 2000 with squamous cell carcinoma of the head and neck was performed to determine the risk of stroke compared with the expected rate.

Methods Surgical, radiotherapeutic, radiological, and clinical or office records of 413 patients were analyzed, and data were collected regarding clinical risk factors for stroke, irradiation parameters, and follow‐up on whether or not a stroke event occurred. The actuarial risk of stroke for this population was calculated and compared with expected risk from population‐based data.

Results Of the 413 patients, 20 had strokes in follow‐up, occurring between 2 and 146 months after radiotherapy. The 5‐year actuarial rate of stroke was 12%, which corresponded to a relative risk of 2.09 (P = .0007) compared with the population‐based “expected” data. Median radiation therapy dose was 64 Gy; there was no correlation between radiation therapy dose and stroke risk. No correlation was identified between surgery near the carotids and stroke risk.

Conclusions An association between high‐dose cervical irradiation for squamous cell carcinoma of the head and neck and stroke is demonstrated. Although the relative risk is approximately doubled, the absolute risk is modest in comparison to the risk of cancer recurrence. Further study of this association and possible interventions is warranted.
Aesthetics and the Hispanic Rhinoplasty
Authors: Leach Joseph
Published: November 2003

Objectives/Hypothesis Current aesthetic standards for rhinoplasty have been formulated for an Anglo‐American population. Nevertheless, these standards vary, and it is doubtful that these norms are universally applicable to Anglo populations, much less Hispanic ones.

Study Design A retrospective study was carried out to determine how the Western norms apply to rhinoplasty populations of Anglo and Hispanic background. The effectiveness of rhinoplasty techniques used in Hispanic rhinoplasty were assessed.

Methods The open approach was used frequently to augment the nasal skeleton in this population with thick skin. Techniques were primarily aimed at achieving symmetry, straightening the dorsum, and improving projection, since these Hispanic patients were less interested in tip definition or alar base narrowing.

Results Hispanics were significantly more likely to have dorsal humps, saddle deformities, dependent alae, retracted columellae, and poor tip projection. The nasolabial (columellar‐labial) angle method of assessing tip rotation was not accurate in the Hispanic population. Tip definition was better in Anglos, and skin thickness and base width were greater among Hispanics. Rhinoplasty can be effective in achieving aesthetic norms: As a group, the Hispanic profile was brought into greater conformity with the aesthetic norms than their Anglo counterparts who did not have surgery.

Conclusions Thick nasal skin does not adapt well to a small osteocartilaginous framework, and it is better to augment and strengthen the skeleton with cartilage grafts. Even among Anglos, the Western artistic canons are merely guidelines. Good communication with the patient is more important than adhering to aesthetic norms.
The Clinical Value of Image Cytometry DNA Analysis in Distinguishing Branchial Cleft Cysts From Cystic Metastases of Head and Neck Cancer
Authors: Nordemar Sushma , Högmo Anders , Lindholm Johan , Tani Edneia , Sjöström Björn , Auer Gert , Munck‐Wikland Eva
Published: November 2003

Objectives/Hypothesis A branchial cleft cyst presents as a lump in the neck that, generally, is easily cured by surgical excision. The preoperative diagnosis is based on clinical examination and, especially in the Scandinavian countries, fine‐needle aspiration cytology. However, at times, the histopathological analysis of the excised cyst reveals a cystic metastasis of squamous cell carcinoma of the head and neck. If adequate diagnosis could be obtained preoperatively, patients would most likely fare better. The study was performed to investigate whether the diagnostic accuracy for these lesions could be improved preoperatively by image cytometry DNA analysis of the fine‐needle aspiration cytology specimen.

Study Design Image cytometry DNA analysis was performed on the preoperative fine‐needle aspiration cytology specimen and the surgical specimens from 51 patients with solitary cysts in the lateral region of the neck. Thirty‐six patients were selected because there was a discrepancy between findings on fine‐needle aspiration cytology and the final histopathological diagnosis or an uncertain cytological diagnosis. There were 25 metastatic squamous cell carcinomas and 3 thyroid cancers, there was 1 lymphoma and 1 sialoadenitis, and there were 21 branchial cleft cysts.

Methods The cytodiagnostic Giemsa‐stained slides were destained in Methanol and then stained with Schiff's reagent. The paraffin‐embedded material from excised cysts were cut and deparaffinized and then stained with Schiff's reagent. Ahrens image analysis was used for DNA analysis and lymphocytes were used as control cells. DNA valves exceeding 5c was regarded as aneuploid.

Results Image cytometry DNA analysis of the preoperative cytological specimen was possible in 41 of 51 patients. We found that in 53% of the cases with cystic metastasis, image cytometry DNA analysis, when possible, revealed aneuploidy, thus indicating malignancy. DNA analysis showed diploidy in all benign cases.

Conclusions Aneuploidy is highly specific for malignancy. Image cytometry DNA analysis increases the diagnostic sensitivity for malignant cystic metastasis and therefore is a valuable supplement to conventional cytological study for these lesions.
A Lack of Association Between p53 Mutations and Recurrent Nasopharyngeal Carcinomas Refractory to Radiotherapy
Authors: Chang Kai‐Ping , Hao Sheng‐Po , Lin Shinn‐Yn , Tsao Kuo‐Chien , Kuo Tseng‐tong , Tsai Ming‐Hsui , Tseng Chen‐Kan , Tsang Ngan‐Ming
Published: November 2003

Objective The object of this study was to determine the incidence of p53 mutation in recurrent nasopharyngeal carcinoma refractory to radiotherapy.

Study Design Prospective study.

Methods There were 31 patients enrolled in this study between 1995 and 1998. All patients had received radiotherapy but none of them had undergone chemotherapy or local salvage surgery previously.

Results The p53 status of each tumor was analyzed by polymerase chain reaction and by sequencing of exons 5 to 8 (codons 126–306). Five (16.1%) of 31 patients had mutations in the p53 gene, of which 2 were non‐sense mutations, 2 were transition mutations, and 1 was a frameshift deletion mutation. The majority of the p53 mutations were found in exon 5. There is no significant difference in the incidence of p53 mutation compared with that of the previous reports for the primary disease. Based on the clinicopathologic data, there was no specific difference found between these 5 patients and the others.

Conclusions This study shows that p53 mutation is an infrequent event and may have no essential role in recurrent nasopharyngeal carcinomas.
Stapedectomy Versus Stapedotomy: Comparison of Results With Long‐Term Follow‐up
Authors: House Howard P. , Hansen Marlan R. , Dakhail Abdul Aziz A. Al , House John W.
Published: November 2003

Objective/Hypothesis To compare the effectiveness and long‐term stability of hearing results between stapedectomy and small fenestra stapedotomy in patients with conductive hearing loss due to otosclerosis.

Study Design Retrospective review of prospectively collected audiometric data.

Methods The hearing results and complication rates of 209 ears with long‐term follow‐up that underwent either stapedectomy or stapedotomy by the senior author (h.p.h.) between 1961 and 1989 were compared. Forty‐two patients underwent stapedectomy in one ear and stapedotomy in the opposite ear, permitting a paired case review of the results in these patients. The techniques were compared with respect to initial and late hearing results and change of the results over time.

Results Patients undergoing stapedectomy and stapedotomy were followed for an average of 11.5 and 6.0 years, respectively. There were no statistically significant differences in initial or late postoperative pure‐tone average (PTA), PTA air–bone gap, speech discrimination scores, or incidence of sensorineural hearing loss between the two groups. Ears treated by stapedotomy showed statistically better initial and late postoperative 4‐kHz air‐conduction threshold and initial 4‐kHz air–bone gap, but the gap difference was not significant with late follow‐up. There was no significant difference in the percentage of patients with air–bone gap closure within 10 dB for any frequency other than 4 kHz at the initial postoperative test. Importantly, the successful outcomes in both groups were stable over long‐term follow‐up. Results were the same when comparing the two procedures in patients having undergone both.

Conclusion These results show that, in the hands of an experienced surgeon, either technique provides satisfactory and stable long‐term results.
A New Ventilation Tube for Long‐Term Middle Ear Ventilation
Authors: Bonvin P. , Hansen B. Bakke , Hentzer E.
Published: November 2003

Objectives The treatment of secretory otitis media often requires repeated tubulation of the tympanic membrane as the standard ventilation tubes are extruded before the disease of the middle ear has remitted. The T‐tube and its modification have been developed to remain longer in situ, often requiring surgical removal. The rates of subsequent persisting tympanic membrane perforations and granulations around the tube have been unacceptably high. In the search for a long‐term ventilation tube with fewer complications, the Duravent tube (Smith and Nephew) has been developed. The aim of the study was to estimate duration in situ and observe complications in using the Duravent tube compared with standard tubes and T‐ tubes.

Study Design Retrospective study.

Methods In all, 51 patients have been treated with the Duravent tube over a 2‐year period. In all, 72 Duravent tubes have been inserted. All patients were subsequently invited for a follow‐up examination at a median time of 28 months (range, 11–43 mo) after the tube insertion and were followed up for 5 years.

Results The duration in situ was optimal with a median duration of 17 months. The Duravent tube was extruded spontaneously in all but four cases in which surgical removal was necessary. The rate of persisting perforations of the tympanic membrane was low (4.2%) compared with 24% after the use of the T‐tube. Likewise, the usual complications connected with long‐term ventilation tubes were less frequent (14% compared with 35% when using the T‐tube).

Conclusions In the present study, the Duravent tube has proved superior to other known long‐term ventilation tubes. The problem of granulations, otorrhoea, and tube occlusion was significantly less than reported in other studies using the T‐tube.
Radiofrequency Ablation for the Treatment of Mild to Moderate Obstructive Sleep Apnea
Authors: Blumen Marc Bernard , Dahan Serge , Fleury Bernard , Hausser‐Hauw Chantal , Chabolle Frederic
Published: November 2003

Objectives/Hypothesis Obstructive sleep apnea syndrome is due to pharyngeal obstructions, which can take place at the level of the soft palate. Temperature‐controlled radiofrequency ablation has been introduced as being capable of reducing soft tissue volume and excessive compliance. The aim of the study was to evaluate prospectively the possible efficacy of temperature‐controlled radiofrequency ablation applied to the soft palate in subjects with mild to moderate obstructive sleep apnea syndrome.

Study Design Twenty‐nine patients with a respiratory disturbance index between 10 and 30 events per hour, body mass index equal to or less than 30 kg/m2, and obstruction at the level of the soft palate were included in a pilot, prospective nonrandomized study.

Methods Snoring and daytime sleepiness were evaluated subjectively. Treatment (maximum of three sessions) was discontinued when the bed partner was satisfied with the snoring level. A full night recording was performed at least 4 months after the last treatment.

Results Mean snoring level decreased significantly from 8.6 ± 1.3 to 3.3 ± 2.5 on a visual analogue scale (0–10). Daytime sleepiness decreased nonsignificantly. Mean respiratory disturbance index decreased significantly from 19.0 ± 6.1 events per hour to 9.8 ± 8.6 events per hour. Mean lowest oxygen saturation value increased nonsignificantly from 85.3% ± 4.1% to 86.4% ± 4.4%. Of the patients, 65.5% were cured of their disease.

Conclusions Temperature‐controlled radiofrequency ablation was effective in selected patients with mild to moderate obstructive sleep apnea syndrome. A full‐night polysomnography is required after completion of treatment to rule out residual disease.
Hurthle Cell Neoplasms of the Thyroid
Authors: Dahl Linda D. , Myssiorek David , Heller Keith S.
Published: November 2003

Objectives/Hypothesis Hurthle cell tumors are a variant of follicular cell neoplasms. The purpose of the study was to determine the reliability of intraoperative frozen‐section analysis for diagnosing Hurthle cell carcinoma and Hurthle cell neoplasm and to evaluate age, gender, and tumor size differences in the incidence of Hurthle cell carcinoma.

Study Design Retrospective chart review.

Methods The records of all patients undergoing thyroid surgery at Long Island Jewish Medical Center (Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, NY) from 1990 to 2000 were reviewed. Patients were identified whose final pathological finding was Hurthle cell neoplasm or Hurthle cell carcinoma. Age at diagnosis, gender, tumor size, and correlation between frozen‐section analysis and final pathological finding was determined.

Results One hundred sixteen patients had Hurthle cell tumors on final pathological finding (49 had Hurthle cell carcinoma and 67 had Hurthle cell neoplasm). Eleven of these patients had incidental papillary carcinoma. There were 24 men and 92 women. Sixty‐seven percent of the men (16 of 24) and 36% of the women (33 of 92) had Hurthle cell carcinoma on final pathological finding. The mean ages for Hurthle cell neoplasm and Hurthle cell carcinoma groups were 53 (median age, 50 y) and 58 years (median age, 61 y), respectively. One hundred eleven patients had intraoperative frozen‐section analysis. Of the 49 patients with Hurthle cell carcinoma, 9 (19%) were diagnosed by frozen‐section analysis, 36 (75%) had indeterminate frozen‐section analysis, 3 (6%) were discovered to have papillary carcinoma on frozen‐section analysis, and 1 did not have a frozen‐section analysis. Multivariate analysis indicated that size correlated with malignancy and that gender did not (P = .0015).

Conclusions In the study population, only 19% of patients were discovered to have Hurthle cell carcinoma on frozen‐section analysis. Sixty‐seven percent of men with Hurthle cell neoplasm had malignancies, compared with 36% of women, and this difference was statistically significant.