bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of fetal heart block with maternal steroid therapy: case report and review of the literature
Authors: Breur J. M. P. J. , Visser G. H. A. , Kruize A. A. , Stoutenbeek P. , Meijboom E. J.
Published: August 2004

The presence of maternal autoantibodies to SS‐A/Ro and/or SS‐B/La is associated with the development of fetal heart block. There are data suggesting that maternal treatment with steroids might reverse heart block. We report on a pregnancy in a mother with secondary Sjögren syndrome and systemic lupus erythematosus with presence of autoantibodies to SS‐A/Ro and SS‐B/La, which was complicated by the development of incomplete fetal heart block. Oral dexamethasone treatment could not prevent progression to complete heart block and was associated with a number of complications.

A review of the literature revealed 19 studies (including ours) in which 93 cases of fetal heart block were treated with maternal steroid therapy. Complete heart block proved irreversible in all cases; and of 13 fetuses with incomplete heart block which received maternal steroid therapy, three had a reduction in their degree of block and one reverted to sinus rhythm. Maternal steroid therapy, initiated early in pregnancy and potentially preventing the onset of heart block, did not decrease the incidence of heart block in nine studies with 43 cases. Furthermore, the literature review revealed numerous serious side effects of maternal steroid administration during pregnancy. Data on these potential side effects are lacking in the 28 studies discussed in this review.

Maternal dexamethasone therapy to prevent or treat fetal heart block remains, in our opinion, a questionable intervention and can as yet not be recommended in the clinical situation. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Characteristics, associations and outcome of absent pulmonary valve syndrome in the fetus
Authors: Volpe P. , Paladini D. , Marasini M. , Buonadonna A. L. , Russo M. G. , Caruso G. , Marzullo A. , Arciprete P. , Martinelli P. , Gentile M.
Published: August 2004

Objectives

To assess in a population of 21 fetuses diagnosed with absent pulmonary valve syndrome (APVS) the accuracy of prenatal diagnosis, the incidence of extracardiac and chromosomal anomalies and the perinatal outcome.

Methods

This was a retrospective observational study of 21 fetuses with a confirmed diagnosis of APVS. All of them underwent fetal echocardiography and a detailed anatomical scan. Karyotyping was performed in 20/21 cases, with fluorescent in‐situ hybridization analysis to detect the 22q11 microdeletion performed in 16/21 cases. The following variables were retrieved from databases and evaluated: indication for referral, gestational age at diagnosis, presence of cardiomegaly, branch pulmonary dilatation, associated anomalies or intrauterine growth restriction, and fetal/neonatal outcome. Autopsy reports and postnatal surgical/medical files were available for confirmation in all cases.

Results

Prenatal diagnosis of APVS proved correct in all cases, with only three cases occurring not in association with tetralogy of Fallot. Additional cardiovascular anomalies were present in five cases (24%). Extracardiac anomalies were found in nine cases (42.8%), and were associated with chromosomal anomalies in five cases (24%). The 22q11 microdeletion was present in 4/16 cases (25%). Fetal/neonatal outcome was as follows: nine terminations of pregnancy, three intrauterine deaths, six postnatal deaths. The remaining three (14.3%) neonates were alive after surgery. Cardiomegaly and marked branch pulmonary dilatation were present in 16 and 15 cases, respectively, and were associated with bronchomalacia in virtually all cases.

Conclusions

APVS can be reliably diagnosed and characterized prenatally. The association with major chromosomal anomalies or 22q11 microdeletion is consistent with previous findings. The relatively poor survival rate is due to the high rate of terminations, associated genetic anomalies and bronchomalacia. Bronchomalacia is present in the overwhelming majority of cases featuring cardiomegaly and marked branch pulmonary dilatation. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
EDXRF and TXRF analysis of elemental size distributions and environmental mobility of airborne particles in the city of Riga, Latvia
Authors: Viksna Arturs , Selin Lindgren Eva , Standzenieks Paulis , Jacobsson Jan
Published: August 2004

Airborne particles were investigated in the central part of Riga during October 2000. Mass, black carbon and elemental concentrations of airborne particles were measured on Teflon filters from a dichotomous impactor, which samples fine (<2.5 µm) and coarse (2.5–10 µm) fractions of particles. In order to obtain more detailed information on the size distributions of different elements, a seven‐stage Batelle cascade impactor was used, in which quartz plates treated with silicone grease were utilized as backing for the different stages. Total reflection x‐ray fluorescence (TXRF) and energy‐dispersive x‐ray fluorescence (EDXRF) spectrometry were used for elemental analysis on the quartz plates and Teflon filters. The environmentally mobile part of the fine particle elements in the aerosol was determined by subtraction of x‐ray spectra measured before and after sequential leaching of the aerosol filters. The results of the different measurements show that naturally generated street dust and soil particles are dominant in coarse particles, whereas particles generated by human activities are dominant in the size fraction <0.5 µm. Copyright © 2004 John Wiley & Sons, Ltd.
Expression of polypeptide GalNAc‐transferases in hematopoietic stem/progenitor cells
Authors: Cheng Lamei , Wang Xianyou , Tan Mengqun , Zhou Xiaoying , Wang Qiru
Published: August 2004

The members of the UDP‐GalNAc:polypeptide N‐acetylgalactosaminyltransferase (pp‐GalNAc‐T) family, which transfer GalNAc to polypeptide serine and threonine residues, initiate mucin‐type O‐linked glycosylation. There are at least 13 functionally characterized members of this family in humans, but no studies have been reported of pp‐GalNAc‐T isoforms in hematopoietic cells. We isolated and purified CD34+ hematopoietic cells from adult bone marrow by magnetic cell sorting and induced them to differentiate into megakaryocytic lineage cells using an optimal combination of hematopoietic growth factors in serum‐free liquid medium. RT‐PCR revealed that CD34+ cells expressed pp‐GalNAc‐T1, T2, T3, T4, T6, T7, T10, T11 and T14, but not pp‐GalNAc‐T8, T9, T12 and T13. The megakaryocytic lineage cells showed significant increases in the expression of pp‐GalNAc‐T3, T8, T9, T10 and T13, but pp‐GalNAc‐T11 and T14 became undetectable. In summary, many pp‐GalNAc‐T isoforms were expressed in CD34+ cells but the expression pattern changed during differentiation into megakaryocytes. The expression patterns of pp‐GalNAc‐Ts may be necessary to ensure proper O‐glycosylation of mucin‐type proteins expressed in CD34+ and megakaryocytic cells.
Repetitive transcranial magnetic stimulation does not potentiate antidepressant treatment
Authors: Poulet E. , Brunelin J. , Boeuve C. , Lerond J. , D’Amato T. , Dalery J. , Saoud M.
Published: August 2004

In a double blind controlled study, rTMS results in a similar antidepressant effect to sham in combination with paroxetine. Both groups had the same delay in scale’s scores improvement. rTMS seems not to be efficient as an add-on treatment to pharmacological medication in non-resistant major depression.
An association study between polymorphisms in three genes of 14-3-3 (tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein) family and paranoid schizophrenia in northern Chinese population
Authors: Jia Yanbin , Yu Xin , Zhang Boyu , Yuan Yanbo , Xu Qi , Shen Yucun , Shen Yan
Published: August 2004

We performed an association study between three SNPs in the genes of 14-3-3 family and paranoid schizophrenia. SNP rs983583 G/A in the YWHAZ gene showed significant association with paranoid schizophrenia. Our study indicated that the YWHAZ gene was a potential susceptibility gene for paranoid schizophrenia in the population studied.
Heat shock protein‐90 dampens and directs signaling stimulated by insulin‐like growth factor‐1 and insulin
Authors: Meares Gordon P. , Zmijewska Anna A. , Jope Richard S.
Published: August 2004

Heat shock protein‐90 (Hsp90) buffers cells from genetic mutations and environmental stresses. To test if this capability reflects a normal physiological function of Hsp90 to buffer cellular signals, the effects of Hsp90 inhibition were measured on activation of Akt. Inhibition of Hsp90 with geldanamycin amplified Akt phosphorylation induced by insulin‐like growth factor‐1 (IGF‐1) or insulin, indicating that Hsp90 normally buffers these signals. Furthermore, with IGF‐1 stimulation Hsp90 inhibition increased p38 activation, produced additive activation of p90RSK, and slightly increased the duration of ERK1/2 activation. Hsp90 dampened Akt signaling by facilitating phosphatase‐mediated dephosphorylation of Akt. Thus, Hsp90 not only buffers the cellular effects of mutations and stresses, but also buffers the magnitude and duration of activation of proliferative and survival‐promoting signaling responses.
Cyanidin‐3‐glucoside regulates phosphorylation of endothelial nitric oxide synthase
Authors: Xu Jin-Wen , Ikeda Katsumi , Yamori Yukio
Published: August 2004

Dietary anthocyanins are widely distributed in fruits, vegetables and red wines, and there are several reports mentioning their beneficial effects. Previously we reported that cyanidin‐3‐glucoside (Cy3G) induced endothelial nitric oxide synthase (eNOS) expression and nitric oxide (NO) production in bovine vascular endothelial cells. In the present study, we show that Cy3G regulates phosphorylation of eNOS and Akt, affects the interaction between eNOS and soluble guanylyl cyclase, and increases cyclic guanosine monophosphate (cGMP) production. Our results suggest that Cy3G enhances vascular eNOS activity, and may help to improve vascular endothelial function.
Aging‐related increase in oxidative stress correlates with developmental pattern of beta‐secretase activity and beta‐amyloid plaque formation in transgenic Tg2576 mice with Alzheimer‐like pathology
Authors: Apelt Jenny , Bigl Marina , Wunderlich Patrick , Schliebs Reinhard
Published: August 2004

The molecular mechanisms of β‐amyloidogenesis in sporadic Alzheimer's disease are still poorly understood. To reveal whether aging‐associated increases in brain oxidative stress and inflammation may trigger onset or progression of β‐amyloid deposition, a transgenic mouse (Tg2576) that express the Swedish double mutation of human amyloid precursor protein (APP) was used as animal model to study the developmental pattern of markers of oxidative stress and APP processing. In Tg2576 mouse brain, cortical levels of soluble β‐amyloid (1–40) and (1–42) steadily increased with age, but significant deposition of fibrillary β‐amyloid in cortical areas did not occur before postnatal age of 10 months. The slope of increase in cerebral cortical β‐secretase (BACE1) activities in Tg2576 mice between ages of 9 and 13 months was significantly higher as compared to that of the α‐secretase, while the expression level of BACE1 protein and mRNA did not change with age. The activities of superoxide dismutase and glutathione peroxidase in cortical tissue from Tg2576 mice steadily increased from postnatal age 9–12 months. The levels of cortical nitric oxide, and reactive nitrogen species demonstrated peak values around 9 months of age, while the level of interleukin‐1β steadily increased from postnatal month 13 onwards. The developmental temporal coincidence of increased levels of reactive nitrogen species and antioxidative enzymes with the onset of β‐amyloid plaque deposition provides further evidence that developmentally and aging‐induced alterations in brain oxidative status exhibit a major factor in triggering enhanced production and deposition of β‐amyloid, and potentially predispose to Alzheimer's disease.
Beta‐human chorionic gonadotropin in cervicovaginal secretions and preterm delivery
Authors: Garshasbi A. , Ghazanfari T. , Faghih Zadeh S.
Published: August 2004

Objectives: To determine whether concentrations of β‐HCG in cervicovaginal secretions could predict spontaneous preterm birth (SPB) in asymptomatic high risk pregnancies. Methods: A cohort study was undertaken with cervicovaginal samples collected from 540 pregnant women between 20 to 28 weeks of gestation. Levels of β‐HCG were measured by ELISA test. Results: There was 3.2‐fold increase in cervicovaginal β‐HCG concentrations among patients with SPB vs. term delivery. A single cervicovaginal β‐HCG >77.8mIU/ml, between 20 and 28 weeks’ gestation, identified patients with subsequent SPB vs. term delivery with sensitivity of 87.5% (95% CI: 47.4–97.9) and a specificity of 97% (95% CI: 86.5–99.4) with positive and negative predictive values of 88.5% and 98%, respectively. Multiple logistic regression indicates that cervicovaginal β‐HCG level >77.8mIU/ml was an independent predictor of SPB (adjusted odds ratio 19.97, 95% CI: 10.65–37.45). Conclusions: Cervicovaginal β‐HCG is a sensitive and specific predictor of patients with subsequent preterm delivery.
Repeat induced abortions and contraceptive practices among unmarried young women seeking an abortion in China
Authors: Cheng Y. , Gno X. , Li Y. , Li S. , Qu A. , Kang B.
Published: August 2004

Objective

To determine the rates of repeated abortion and contraceptive use among unmarried young women seeking an abortion in China.

Methods

We used an anonymous self‐administered questionnaire at abortion clinics in Beijing, Changsha, and Dalian from January to September 2000.

Results

Of 4547 unmarried young women seeking an abortion, 33.0% reported having had one previous induced abortion. Of those who had had more than one abortion, only 29.7% used a contraceptive method at their first sexual intercourse after the procedure; and of the 446 women who chose contraception, 41.3% used the traditional methods of withdrawal or rhythm. Although 65.0% of the young women had used condoms at least once, only 9.6% did so consistently and correctly; 47.7% of the current pregnancies were associated with nonuse of any contraceptive, and 52.3% were related to contraceptive failure.

Conclusion

The rate of unmarried young women seeking repeated abortions was high in China on 2000. The rate of consistent condom use was low, and the rate of contraceptive failure was higher.
Expression of Human Telomerase Reverse Transcriptase in Laryngeal Tissues
Authors: Franco Ramon A , Wasinwong Yongyuth
Published: August 2004

Problem

Telomerase is believed to play a major role in transforming cells (immortalization) to carcinoma. Its activity has been detected in 90% of human cancers. We evaluated telomerase activity in laryngeal carcinoma patients who underwent surgery for cure through the immunohistochemical detection of human telomerase reverse transcriptase (hTERT). Telomerase activity is correlated to hTERT expression.

Methods

Patients were divided into 2 groups (those who were cured and those who had recurrences) and the (height) percentage of the thickness of the epithelium with hTERT positive cells and the percentage of hTERT positive cells per high‐powered field (HPF) was compared. Twenty‐three carcinoma specimens (14 cured and 9 recurrence) were stained with hTERT antibody.

Results

The positive hTERT expression (85.7%) in the cured specimens was not statistically significant when compared to the recurrence specimens (100%) (P = 0.50). The minimum height and minimum percentage of positive cells per HPF in the cured group was zero. However, the minimum height in the recurrence group was 55.0%, and the minimum percentage of positive cells per HPF was 52.3%. Furthermore, we evaluated the hTERT expression of the normal epithelium surrounding the carcinomas and found no differences between the cured and recurrence groups (P = 0.46).

Conclusion

In conclusion, although hTERT expression could not positively predict the patient's outcome (cure versus recurrence), those specimens with less than 50% height involvement or percentage of positive hTERT staining cells per HPF tended to be cured from the treatment. Larger sample sizes are necessary to establish the predictive ability of hTERT expression in cancer.

Significance

Telomerase activity has been detected in over 90% of all human cancers. hTERT and Telomerase levels may be predictive of cure in cancer. A multi‐institutional trial has been started to increase the number of samples to increase the statistical power and possibly arrive at a definitive answer to this important question.

Support

None reported.
Vocal Fold Mobility Following Anterior Cervical Disk Surgery: A Randomized Prospective Study
Authors: Artz Gregory James , Keane William M
Published: August 2004

Problem

The true incidence of vocal fold dysfunction following anterior cervical disk fusion (ACDF) is unknown, with few studies documenting laryngeal examination before and after surgery. Consequently, the effect of potential interventions such as limiting endotracheal tube cuff pressure and its effect on this incidence cannot be properly assessed.

Methods

This study was a randomized, prospective clinical trial performed at an academic institution. Over a 4‐year time period, patients undergoing primary ACDF surgery volunteered to participate. Preoperative and postoperative laryngeal endoscopy was performed. Recorded examinations were reviewed by independent laryngologists for determination of vocal fold mobility. Patients were randomized intraoperatively into 2 groups: a control group and an intervention group. Patients in the intervention group had endotracheal tube cuff pressures maintained below 20 mmHg throughout the surgical procedure.

Results

One hundred patients were studied and randomized into 2 groups of 50 patients each. In the acute postoperative period, vocal cord paresis was seen in 8% and paralysis in 4% of studied patients. There was no significant difference in paresis or paralysis rates of the vocal fold on the side of surgery between the control and intervention groups.

Conclusion

Vocal cord dysfunction is a common complication of ACDF surgery that can result in significant patient morbidity. Manipulating endotracheal tube cuff pressures did not decrease the risk of intraoperative recurrent laryngeal nerve injuries.

Significance

This study demonstrates the true incidence of vocal fold dysfunction after ACDF surgery and that this incidence is unaltered by intraoperative interventions such as reducing endotracheal tube cuff pressures.

Support

None reported.
Brachytherapy as Adjunctive Therapy in Subglottic Stenosis
Authors: Pogodzinski Matthew S , Garces Yolanda , Kruse Jon , Thompson Dana M , Cheville John , Kasperbauer Jan L
Published: August 2004

Problem

New technique for treating subglottic stenosis.

Methods

A blinded, randomized, controlled study was performed using a dog model of subglottic stenosis. Standardized methods were used to induce and dilate the stenoses. When they required dilation, dogs were randomized to a brachytherapy arm, which delivered 20 gray to the subglottis, and a control arm. Dogs were followed for 21 days after randomization. Data points included the number of subsequent airway dilations, final airway size, as well as histological and growth factor differences between the groups. All data were gathered in a blinded fashion. The Rank Sum test was used to evaluate clinical results.

Results

There was a trend for increased airway size in the radiated group with an average size of 5.5 ET tube versus 4.6 for the control group. Also, one dog required redilation from the radiated group while 2 dogs from the control group required redilation. These trends did not reach statistical significance when using the Wilcoxon Rank Sum test.

Conclusion

There were trends for improved airway size in the brachytherapy arm. Statisitcal significance was not reached owing to small numbers or restenosis overall.

Significance

This is the first controlled study looking at use of radiation as a potential treatment for subglottic stenosis. Brachytherapy could be a helpful adjuvant treatment for subglottic stenosis in adults.

Support

Nucletron Corporation provided a partial grant and free equipment for this experiment.
Parental Satisfaction with Ambulatory Surgery
Authors: Song Christopher S , Habib Ramez , Rosenfeld Richard M
Published: August 2004

Problem

Patient satisfaction is an important aspect of modern health care. Few studies have specifically addressed parental satisfaction with pediatric ambulatory surgery and no validated surveys exist.

Methods

Parents of children aged 6 months to 12 years completed the AmbSurg Survey, an 18‐item self‐administered measure of satisfaction using a 7‐point scale. Additional data collected included casemix variables and validated measures of child health‐related quality of life (PedsQL 4.0 survey), positive response bias (Marlowe‐Crowne Social Desirability Scale), and satisfaction with the decision to have surgery (Satisfaction with Decision Scale). Approximately 2 to 4 weeks after surgery, parents rated the degree of clinical change in their child and their satisfaction with this change.

Results

We enrolled 152 parents (median age, 35) and children (median age, 4.8). Seven items were eliminated from the AmbSurg Survey because they were unclear, unimportant, or had poor test‐retest reliability. The final 11‐item survey had good test‐retest reliability (r =. 73), internal consistency (alpha =. 88), and construct validity (r =. 32 to. 59). Factor analysis revealed subscales relating to medical care (4 items), nursing care (2 items), and communication (5 items). Survey scores were significantly associated with surgeon used, parental anxiety, child general quality of life, and parental satisfaction with the decision to have surgery. Stepwise regression, however, identified satisfaction with decision as the only significant predictor (35% of variance). AmbSurg Survey scores did not correlate with clinical change or satisfaction with change reported by parents after a median 24 days.

Conclusion

Parent satisfaction with their child's ambulatory experience can be measured efficiently with the AmbSurg survey, and correlates with satisfaction reported about the initial decision to undergo surgery.

Significance

The AmbSurg Survey is a valid and reliable 11‐item measure of parental satisfaction with ambulatory surgery. The ease of use and clinically relevant subscales make the survey ideal for practice audit, quality assurance endeavors, and health services research.

Support

None reported.
Spectrometric Measurements in Laryngeal Cancer
Authors: Arens Christoph , Glanz Hiltrud Katharina
Published: August 2004

Objectives

Direct and indirect autofluorescence endoscopy of the larynx have proven to facilitate the detection and delineation of precancerous lesions, carcinoma in situ and cancer. The aim of the study is to evaluate spectrometric changes during autofluorescence examination in laryngeal dysplasia and cancer.

Methods

In a prospective study, 42 patients with suspected precancerous or cancerous lesions were investigated during microlaryngoscopy. Autofluorescence was induced by filtered blue light (375‐440 nm) of a xenon short are lamp and processed by a CCD camera system (D‐light‐AF‐system).

Autofluorescecne images were gathered in a contact mode. For spectrometric measurements, an optical multi channel analyzer (AVS‐USB200) was applied. Results were compared to pathohistological findings.

Results

Autofluorescence spectra of normal laryngeal mucosa demonstrated peaks at 475, 510, 550, 600, and 630 nm. Highest intensity was observed in the green spectrum resulting in green autofluorescence images. In precancerous and cancerous alterations of the mucosa the autofluorescence signal changed from green fluorescence to a reddish‐violet color. Highest loss of intensity was observed at 510 nm.

Conclusions

According to our results, the autofluores‐cence spectroscopy of the larynx seems to be a promising diagnostic tool for the early detection of laryngeal cancer and its precursor lesions. A difference between precancerous and cancerous laryngeal mucosa could not be detected. Scarring, marked hyperkeratosis and inflammation can limit the predictive value of the method.
Impact of Vocal Fold Medialization on Pharyngeal Transit Time and Incidence of Aspiration
Authors: Yip Helena T , Leonard Rebecca , Kendall Katherine A
Published: August 2004

Objectives

Little objective data exists to support the belief that medialization of a paralyzed vocal fold (VF) decreases the risk of aspiration. On the other hand, an association between increased risk of aspiration pneumonia and a prolonged bolus pharyngeal transit time has been documented. This study assesses the impact of medialization on the incidence of aspiration and duration of pharyngeal transit.

Methods

Two groups of patients (1996‐2000) with unilateral VF paralysis were identified. One group (n = 12) had isolated VF paralysis due to recurrent laryngeal nerve injury. A second group (n = 7) had multiple cranial neuropathies secondary to skull base surgery or strokes. All patients underwent VF medialization with pre‐ and postmedialization videofluoroscopic swallow studies.

Results

Prior to medialization, aspiration occurred in 33% (4/12) of the patients with isolated VF paralysis, and in 100% of the multiple cranial neuropathy group (overall incidence 58%). Both groups demonstrated prolonged pharyngeal transit (overall mean = 1.3 seconds) compared to controls (mean = 0.84 seconds) (P < 0.0001). Postmedialization, aspiration in the isolated VF paralysis group decreased to 16% (2/12) and to 57% (4/7) in the multiple cranial neuropathy group (overall incidence 32%). Pharyngeal transit time did not improve after medialization (1.2 seconds) (P < 0.0001).

Conclusions

Aspiration occurs in patients with isolated unilateral VF paralysis or with multiple cranial neuropathies, although the incidence is higher in the second group. VF medialization reduces the incidence of aspiration by 50% but does not eliminate it. Prolonged pharyngeal transit following medialization suggests that the risk of aspiration pneumonia is not eliminated even when aspiration is not identified.
Validation of the Reflux Finding Score (RFS) for Chronic Laryngopharyngitis
Authors: Ivey Chandra M , Welge Jeffrey , Steward David L
Published: August 2004

Objectives

To externally validate the reliability of the Reflux Finding Score (RFS), a recently published laryngeal grading system, in a cohort of subjects with chronic laryngopharyngitis thought secondary to acid reflux disease.

Methods

Two blinded otolaryngologists independently graded 66 videostrobe laryngeal examinations of 33 patients with chronic symptoms of laryngopharyngitis before and 2 months after treatment. The raters evaluated the examinations on 2 separate occasions at least 24 hours apart, blinded to the previous evaluation. Linear correlation was performed to assess inter‐ and intrarater reliability using the total reflux finding score.

Results

Intrarater reliability was very good for both raters for the total reflux finding score (r = 0.87, P < 0.0001, intercept P = 0.37; and r = 0.93, P < 0.0001, intercept P = 0.51). Interrater reliability was also good between raters (r = 0.71, P < 0.0001) but raised the possibility of bias between raters (intercept = 2.4, std error = 1.4, P = 0.08). Among the individual component scores for interrater reliability, true vocal fold edema demonstrated good correlation without bias, while diffuse laryngeal edema and posterior commisure hypertrophy demonstrated good correlation with significant interrater bias. Ventricular obstruction demonstrated moderate correlation with significant bias. Thick endolaryngeal mucous demonstrated fair correlation and subglottic edema poor correlation. Granuloma showed no correlation due to low prevalence.

Conclusions

The total reflux finding score demonstrates very good intrarater and good interrater correlation in this cohort of subjects with symptoms of chronic laryngopharyn‐gitis. Individual component scores demonstrate variable cor‐relation and significant bias between raters.
Endoscopic Transnasal Approach to Sphenoid and Clivus
Authors: Ruggeri Carlos Santiago , Lella Federico A Di , Parisini Cecilla
Published: August 2004

Objectives

The purpose of this study is to evaluate the efficacy of the endoscopic transnasal approach to sphenoid sinus and clivus, for the treatment of isolated inflamatory pathology, tumor biopsy, and excision of pituitary tumors.

Methods

A retrospective review of 18 patients that were treated during the last 6 years in the Italian Hospital of Buenos Aires with transnasal technique, using a 30 degree rigid endoscope.

Results

Three patients with sphenoid inflamatory pathology: cronic sinusitis, mucocele (2), 1 with CN VI paresis, were cured (normal postoperative CT after 3 years). Seven were benign tumors biopsies: fibrous dysplasia, meningioma (3), prolactin cell adenomas (3). In one patient a mucosal flap of nasopharynx was performed and a clivus biopsy was obtained, resulting a metastasis carcinoma of cervix. Seven were hipophysis approaches: adenomas (6) and craniopharyngioma. The total or partial resection of the middle or superior turbinate was not necessary. There were no complications and postoperative morbidity was minimal.

Conclusion

The endoscopic transnasal approach to sphenoid is a fast and secure technique for the otorhinolaryngologists who are trained in endoscopic surgery. We consider this is the technique of choice for the treatment of localized sphenoid inflamatory disease and tumor biopsy. It provides significant advantages for safe excision of pituitary tumors.
Laryngotracheal Reconstruction with Prefabricated Composite Forearm Flaps
Authors: Maier Wolfgang , Schipper Jorg , Ridder Gerd J , Horch Raymund E.
Published: August 2004

Objectives

To demonstrate the impact of modern prelamination and preconditioning techniques for manufacturing a stable flap for laryngotracheal reconstruction after subtotal laryngectomy.

Methods

In 2 patients who had undergone subtotal laryngectomy with partial resection of the upper trachea and postoperative irradiation for extended laryngeal cancer, we formed a bilaterally epithelisized forearm flap under application of vacuum‐assisted prelamination technique. Stabilization of the flap was achieved by insertion of rib cartilage during the preconditioning period. In a second surgical session, the flap was transferred to the throat and vascularized by microvascular anastomosis to cervical vessels.

Results

In both patients, surgery was successful and resulted in closure of the tracheostoma, and in speech and swallowing rehabilitation. The neolarynx remained stable during the follow‐up period of 12 months.

Conclusion

Subtotal laryngectomy requiring a permanent laryngostoma or tracheostoma is associated with severe impairment of the patient and lifelong reduction of his quality of life. Reconstructive methods after subtotal anterior laryngotracheal resection published so far have not really been convincing. We present a successful method, combining the modern surgical and biomedical techniques of prelamination and preconditioning for extended laryngotracheal reconstruction, resulting in the restoration of a stable neolarynx and upper trachea. Our report indicates that previous or subsequent irradiation is no contraindication to this reconstruction procedure.
Impact of Rehabilitation Facility on Outcomes in Head and Neck Surgical Patients
Authors: Bhatia Nitin , Shah Rahul K , Villacorta Marlon , McQuillan Racheal , Annino Donald J , Rebeiz Elie E
Published: August 2004

Objectives

To determine the significance of in‐hospital rehabilitation facility versus distant rehabilitation facilities in the outcomes and complications of postoperative head and neck surgical patients.

Methods

Retrospective review of head and neck surgical patients over a 5‐year period at a tertiary care medical center.

Results

Fifty patients met criteria for this study (35 males, 15 females). Forty‐two patients had a primary squamous cell carcinoma, and 8 patients had other primary malignancy of the head and neck. Thirty‐two patients were placed in an in‐hospital rehabilitation facility, and 18 patients were placed in distant rehabilitation facilities (average distance 40.9 miles; range 2‐250 miles). Seventeen patients (34%) had complications including infection/drainage (7 patients), fistula (6 patients), pneumonia (2 patients), wound dehiscence (2 patients), bleeding from carotid stump, fluctuance, exudate, ulcer, eschar, delay in Blom‐Singer valve teaching and displacement. The difference between the rate of complications among the 2 groups was not statistically significant (37.5% in‐hospital rehabilitation, 27.8% distant rehabilitation; P = 0.496). The difference between the rate of hospital readmission was not statistically significant either (25% for in‐hospital rehabilitation patients and 16.7% for distant rehabilitation patients; P = 0.505). The average length of stay of patients without complications was 18.5 days (SD = 17) for in‐hospital rehabilitation and 12.9 days (SD = 5.8) for distant rehabilitation. This difference was not statistically significant (P = 0.346).

Conclusion

One third of postoperative head and neck surgical patients developed complications while in a rehabilitation facility. The length of stay, hospital re‐admission rate, and frequency of complications does not correlate with the distance of the rehabilitation facility from the treating institution.
Variations in Osteo‐Meatal Drainage and Its Clinical Implications
Authors: Haider Haula Faruk , Branco Gabriel , Oliveira E Carmo Diogo , Cacador Maria , Paco Joao
Published: August 2004

Objectives

The authors suggest a systematization of osteo‐meatal drainage based on nonselected consecutive observations of sinus CT scans. The maxillary drainage is classically described as a mucociliar activity converged to the maxillary ostium (natural ostium), nevertheless there might be accessory ostiuns.

Methods

The authors observed 50 consecutive sinus CT scans (high spatial resolution 2.5 mm coronal plans). We also used virtual endoscopy and compared the findings with microscopic and endoscopic observation of anatomic human specimen in cadavers.

Results

The maxillary drainage area is usually observed in 3 continuous plans: Segment 1, anterior or ethmoidomaxillary channel (consists of a long channel that communicates maxillary sinus with the anterior ethmoidal complex). Segment 2: Medium or labial (consists of the horizontal portion of uncinate process that acts like a vertical wall separating infundibular lumen from middle meatus). Segment 3: Posterior or direct meatal (corresponds to the most posterior and horizontal portion of uncinate process, communicating directly to the middle meatus). This is the most inconstant of the 3 segments. The results are equally comparable to those achieved in anatomic human specimen in cadavers.

Conclusion

Based on facts achieved by virtual endoscopy we conclude that maxillary drainage is done through a cleft or multiple, continuous ostiuns. This clinical systematization has implications in a clinical and surgical perspective, permits to explain why in cases of massive ethmoidal inflammatory disease, maxillary sinus remains intact since one of the drainage segments is not blocked. Otherwise, if those segments are blocked there is maxillary disease.
Laryngostroboscopy: Perceptual and Acoustic Evaluation of Male Smokers
Authors: Dedivitis Rogerio , Queija Debora S , Barros Ana P B. , Corazza Vera R , Silva Vanessa F , Rezende Wilma T M
Published: August 2004

Objectives

The objective of this study was to evaluate the conventional laryngoscopy, laryngostroboscopy, perceptual and acoustic evaluation of 28 male chronic smokers.

Methods

Volunteer sample of 28 male smokers whose ages averaged 53 years. Smoking habit varied from 96 to 720 months. Standard transoral rigid videolaryngoscopy with stroboscopy was performed. The examinations were recorded on videotape (video home system format). The recorded material was analyzed by a physician according to Hirano & Bless protocol (1993). A grading system described by Yonekawa (1983) was used in order to assess the severity of the Reinke edema (RE). The subjective judgment of the voice quality was carried out by 5 experienced speech‐language pathologists. The GRBAS system was used to describe the voice quality. For the acoustic assessment, the following factors were analyzed: fundamental frequency; jitter; shimmer; NNE; and HNR.

Results

The conventional laryngoscopy was able to identify RE in 9 patients. In the laryngostroboscopy, RE was identified in 16 examinations with prevalence of type II. Besides it, 1 polyp, 1 leucoplakia; 1 bilateral angiodisgenesia and 1 vocal fold scar were described. The perceptual evaluation presented revealed prevalence of strainless and roughness. The acoustic analysis demonstrated higher rates of fundamental frequency, shimmer, and HNR. The jitter rates were lower than the normal.

Conclusion

A rate of 57% of chronicle male smokers presented RE with no significant vocal repercussion. The perceptual evaluation showed alterations in larger scale related to the vocal tract ressonance and all the acoustic rates alterated.
Sympathetic Chain Paragangliomas of the Parapharyngeal Space
Authors: Shiley Samuel Gardner , Kim Jason , Robinson Jaime , Wax Mark K
Published: August 2004

Objectives

The parapharyngeal space is a complex anatomical feature of the head and neck that contains many important anatomic structures. Masses of the parapharyngeal space have an extensive differential diagnosis. Because of the vascular nature of some of the lesions that can occur in the parapharyngeal space, familiarity with a complete differential diagnosis, as well as radiologic investigation, is of paramount importance.

Methods

We present a series of patients who had sympathetic schwannomas and presented with neck masses. Setting: Tertiary academic referral center at Oregon Health and Sciences University.

Results

From 1998 to 2003, a series of 5 patients presented to the Otolaryngology Department with head and neck schwannomas of the sympathetic chain. The majority
Temporal Mandibular Joint Reconstruction Using Vascularized Bone Graft with Alloderm
Authors: Khariwala Samir , Chan James , Alam Daniel
Published: August 2004

Objectives

Vascularized free bone grafts have been used extensively for reconstruction of the mandible. When surgical resection includes the temporal mandibular joint, definitive management remains controversial. We describe a novel technique that involves the use of a fibula free flap with alloderm to reconstruct the lateral hemimandible and temporal mandibular joint capsule.

Methods

Retrospective case series at an academic center. Patients undergoing composite resection of the lateral hemimandible including the condyle, or with disruption of the temporal mandibular joint were evaluated in this study.

Results

There were 6 patients (5 male, 1 female) with a mean age of 53.7 years. Indications for surgery were carcinoma (n = 4) and osteoradionecrosis (n = 2). Mean follow‐up was 12 months. All patients reported improved facial symmetry, decreased trismus, adequate jaw opening, and improved occlusion. The majority of patients demonstrated good postoperative speech and swallowing. All but one patient was able to chew and tolerate a normal diet. There were no flap failures, infections, or complications.

Conclusion

The lateral hemimandible and temporal mandibular joint can be resected and successfully reconstructed using a fibula free flap with alloderm. Improved cosmesis, decreased trismus, adequate jaw opening, minimal jaw drift, and the ability to chew were achieved in the majority of patients treated in this manner.
Alternative Medication and Nutritional Supplement Use in the Otolaryngology Patient
Authors: Mehta Vishvesh M , Lim Jessica W
Published: August 2004

Objectives

The use of nutritional supplements and herbal medications in the United States is becoming increasingly popular. Otolaryngology patients may not report nutritional supplement or alternative therapy use when asked during the medical history. However, its use may have adverse effects, such as interfering with prescribed medications or causing coagulation abnormalities. The objectives of this study are to make otolaryngologists aware of the potential effects of alternative therapies and nutritional supplements commonly used by patients.

Methods

Surveys were completed by otolaryngology patients in the clinic and private offices. This study was conducted at the University Hospital and its affiliates. Additional case examples were included and a literature review was performed.

Results

Numerous nutritional, herbal, and alternative therapies were used. The treatments were usually not considered a “medication” by the patient. The products used were both for health maintenance and treatment of disease. Salicylate derivatives were one of the most common ingredients in nutritional supplement mixtures.

Conclusion

Nutritional supplements and alternative therapies may not be elicited in the medical history or reported as medication by the patient. The otolaryngologist needs to be more aware of the use of alternative and complementary medicines to prevent adverse effects of treatment.
Tissue Model and Preliminary Analysis of Microdebriders Used in Endoscopic Sinus Surgery
Authors: Dave Sandeep , Casiano Roy R
Published: August 2004

Objectives

In 1999, Ferguson reported the first and only quantitative analysis of microdebriders used in ESS. The purpose of our study was to establish a standardized in vitro model and compare the newer “next‐generation” microdebriders to determine which device and combination of tissue type, blade, and suction strength was most efficient for this model.

Methods

The Gyrus‐Diego‐Powered‐Dissector and Xomed‐XPS‐3000‐Powered‐ENT‐System were compared using a soft tissue model consisting of raw oysters (nasal polyps) and a firm‐tissue model consisting of scallops mixed with eggshells (nasal/sinus tissue). In addition, the effect of blade type (straight/60) and suction strength (wall‐suction/liposuction) on aspiration efficiency was evaluated. Aspiration efficiency was quantified by 3 outcomes (tissue aspiration, clog‐frequency, and clearance time).

Results

For the “head‐to‐head” comparison, Xomed was statistically superior for soft tissue/oyster aspiration when using the straight blade regardless of suction strength and when using the angled blade with liposuction. Although not statistically significant, several trends were observed in our analysis. First, Gyrus appeared to be superior to Xomed for firm‐tissue/scallop aspiration, clog‐frequency, and clearance time. In addition, straight blades appeared to be superior to angled blades for overall tissue aspiration, clog frequency, and clearance time. Finally, liposuction appeared to be superior for both soft tissue/oyster and firm tissue/scallop aspiration, but wall‐suction demonstrated less clogging and clearance time.

Conclusion

The tissue model presented appears to be both reliable and reproducible. Only 2 statistically significant results were observed, however, several trends toward significance were noted. A second study with a larger sample size and more advanced statistical analysis is needed to better delineate these trends.
The small chemical vacuolin‐1 inhibits Ca2+‐dependent lysosomal exocytosis but not cell resealing
Authors: Cerny Jan , Feng Yan , Yu Anan , Miyake Katsuya , Borgonovo Barbara , Klumperman Judith , Meldolesi Jacopo , McNeil Paul L , Kirchhausen Tomas
Published: August 2004

Resealing after wounding, the process of repair following plasma membrane damage, requires exocytosis. Vacuolins are molecules that induce rapid formation of large, swollen structures derived from endosomes and lysosomes by homotypic fusion combined with uncontrolled fusion of the inner and limiting membranes of these organelles. Vacuolin‐1, the most potent compound, blocks the Ca2+‐dependent exocytosis of lysosomes induced by ionomycin or plasma membrane wounding, without affecting the process of resealing. In contrast, other cell structures and membrane trafficking functions including exocytosis of enlargeosomes are unaffected. Because cells heal normally in the presence of vacuolin‐1, we suggest that lysosomes are dispensable for resealing.
Reduction of dislocations in GaN epilayers grown on Si(111) substrate using SixNy inserting layer
Authors: Lee Kang Jea , Shin Eun Ho , Lim Kee Young
Published: August 2004

High-quality GaN films have been grown on Si(111) substrate by metalorganic chemical vapor deposition using a SixNy inserting layer. Due to the large difference of lattice constant and thermal expansion coefficient between GaN and Si,GaN growth on Si(111) substrate usually leads to an initially high dislocation density and cracks. It is found that the SixNy inserting layer plays a very important role in the enhancement of crystal quality and surface morphology of GaN films. The crystalline quality of overlying GaN layer grown on SixNy inserting layer depends on the deposition time of SixNy inserting layer. The high-resolution x-ray diffraction results show that the dislocation density in GaN epilayer decreases with increasing SixNy growth time. It was confirmed that the misfit dislocations in the GaN films with 5min deposition time for SixNy inserting layer almost stop at the SixNy inserting layer by transmission electron microscope measurements.
Vortex–antivortex pair driven magnetization dynamics studied by micromagnetic simulations
Authors: Lee Ki-Suk , Kang Byoung-Woo , Yu Young-Sang , Kim Sang-Koog
Published: August 2004

Magnetization dynamics approaching an equilibrium vortex state from an initial nonequilibrium state under zero magnetic field has been studied in a circular-shaped Fe disk with a thickness of 5nm and a diameter of 1200nm using micromagnetic simulations. Upon starting from the initial random configuration of in-plane magnetizations, a great number of vortex (V)–antivortex (V¯) pairs are generated at a lot of nucleation sites where both types of V and V¯ are energetically favorable to form. The V and V¯ are propagated and then annihilated by their attractive interactions during the relaxation dynamic process. These results reveal that temporal magnetization evolutions can be dominated by the nucleation of V–V¯ pairs, followed by their propagation and annihilation. The dynamic process driven by V–V¯ pairs can play a significant role in various magnetization reversals.
Thermoelectric properties–texture relationship in highly oriented Ca3Co4O9 composites
Authors: Guilmeau E. , Funahashi R. , Mikami M. , Chong K. , Chateigner D.
Published: August 2004

The correlation between thermoelectric properties and texture strength is discussed within the framework of Ca3Co4O9 textured ceramics. Based on an innovative method of x-ray diffraction analysis, the distribution density (i.e., the degree of orientation) of composite material composed of Ca3Co4O9 powder and single crystals was determined. Electrical resistivity of the prepared composites was shown to be reduced with increasing single crystals weight ratios and, in parallel, was directly correlated to an improvement of grain alignment. The incorporated single crystals help the texture development of the powder via an enhanced stacking of grains and fulfill a role as bypasses of the grain boundaries. This letter highlights the value of quantitative texture analysis to explain the evolution of anisotropic physical properties, as demonstrated here concerning textured thermoelectric materials.