bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of hereditary hemorrhagic telangiectasia by ND‐YAG laser photocoagulation
Authors: Shapshay Stanley M. , Oliver Peter
Published: October 2006

Hereditary hemorrhagic telangiectasia (Rendu‐Osler‐Weber disease) is an inherited abnormality of the vasculature characterized by abnormal subepidermal vessels. Frequent, sometimes severe, epistaxis often requiring blood transfusions is present in most patients. Septal dermatoplasty and estrogen have proved to be the most successful therapies. However, the frequency of failure in treatment has stimulated a search for an alternative therapy.

The Nd‐YAG laser was used at low‐power settings (20‐25 W) to treat 6 patients with hereditary hemorrhagic telangiectasia, all of whom had been treated previously using other modalities. Laser photocoagulation diminished the frequency and severity of hemorrhage in 5 of 6 patients without complications (6 to 9 month follow‐up period). The Nd‐YAG laser may be used repeatedly when new accessible lesions arise, and it appears to be a useful therapeutic option for this disease that is difficult to treat.
Dissemination of squamous papilloma by surgical manipulation: A case report
Authors: Welsh Randall L. , Gluckman Jack L.
Published: October 2006

The occurrence of multiple squamous cell papilloma in the upper and lower aerodigestive tract is well documented. While apparent inoculation to other areas in the lower respiratory tract at the time of bronchoscopy or tracheotomy is a frequently described occurrence, there have, however, been no reports of transmission of papilloma outside the respiratory tract as a result of surgical manipulation.

The purpose of this paper is to report a case of squamous papilloma of the external auditory canal and tympanic membrane which resulted from apparent inoculation at the time of surgery for nasal cavity and nasopharyngeal papillomas together with myringotomies. This supports the hypothesis that an infectious agent, e.g., a virus could be the causative agent and that inoculation to other sites as a result of manipulation is possible.

In light of our experience with this case we recommend specific guidelines for the handling of these patients and the protection of surgeons, anesthesia and operating room personnel. Hopefully this report will heighten awareness of papillomas as a potentially transmittable entity to sites outside the respiratory tract, and encourage others to approach these clinical situations with caution.
Necrotizing fasciitis as a lethal complication of peritonsillar abscess
Authors: Wenig Barry L. , Shikowitz Mark J. , Abramson Allan L.
Published: October 2006

Abscesses of the peritonsillar region rarely lead to serious complications. Incision and drainage, antibiotic therapy, and subsequent tonsillectomy is the accepted method of treatment.

Two cases of fatal necrotizing fasciitis following peritonsillar abscess are presented. The entity of necrotizing fasciitis in the head and neck is discussed with respect to its presentation, diagnosis, and treatment.
Congenital laryngeal saccular cyst of the newborn
Authors: Abramson Allan L. , Zielinski Benjamin
Published: October 2006

Congenital laryngeal saccular cysts of the newborn frequently cause severe dyspnea and upper respiratory tract obstruction. When confronted with this emergency situation necessary therapeutic action may consist of intubation, puncture or incision to reduce the volume of the cyst or tracheotomy.

The CO2 laser was effectively used not only to incise the supraglottic saccular cyst but also to vaporize the lining.
Mandibulectomy without reconstruction can cause sleep apnea
Authors: Panje William R. , Holmes Douglas K.
Published: October 2006

Anterior mandibulectomy can precipitate the development of sleep apnea. All head and neck tumor patients having had extensive composite anterior oral cavity resections should be evaluated for sleep apnea before decannulation of their tracheostomy tube. Subsequent flap and/or rigid reconstruction of the lower jaw appears to prevent the development of sleep apnea. Fascial sling suspension of the lower lip does not appear to prevent sleep apnea.
Primary radiation therapy for juvenile nasopharyngeal angiofibroma
Authors: Cummings Bernard J. , Blend Ralph , Fitzpatrick Peter , Clark Roy , Harwood Andrew , Keane Thomas , Beale Francis , Garrett Peter , Payne David , Rider Walter
Published: October 2006

Evidence is presented of the effectiveness and relative lack of serious toxicity of external beam megavoltage radiation therapy (RT) as primary treatment for juvenile nasopharyngenl angiofibroma. The importance of careful radiological evaluation of tumor extent prior to irradiation is stressed, and only moderate dose RT is required.

Fifty‐five patients have been treated by RT and followed for from 3 to 26 years. Forty‐four of 55 patients (80%) had permanent tumor control following a single course of 3000 cGy to 3500 cGy over 3 weeks. Surgical resection or a second course of RT controlled the tumor in all 11 patients in whom regrowth occurred. Angiofibromas involute slowly after RT so that 50% of patients still had visible masses in the nasopharynx 12 months after treatment, but only 10% had any visible abnormality 36 months after RT. Retreatment was necessary only if symptoms recurred, and continued follow‐up showed that most asymptomatic nasopharyngeal masses resolved completely.

Acute and late toxicity rates were low. Two patients developed tumors in the head or neck following RT. There was no significant clinical impairment of growth or endocrine function.

A single course of external beam megavoltage radiation to 3000 cGy in 3 weeks is an effective first treatment for patients with juvenile nasopharyngeal angiofibroma.
Medical and legal management of adult acute epiglottitis
Authors: Mcnelis Francis L.
Published: October 2006

A case of acute epiglottitis without prior treatment in a 64‐year‐old hypertensive alcoholic male is reported. A correct diagnosis was made in the emergency room and tracheostomy deferred as airway seemed adequate. A trial course of medical therapy under close observation was felt indicated. A detailed history up to the time of death, 8 hours after admission, will be presented as well as the findings at post mortem.

Nine months later the executor of the estate filed a S2 million malpractice suit against the defendant doctor and the defendant hospital for wrongful death. A pretrial deposition was held followed by an offer to settle. This was refused and a trial date set in Superior Court. One week before trial another offer to settle was mode by the plaintiff for S12,500 from each of the two defendants. This offer was accepted.
Hearing loss in early infancy: Incidence, detection and assessment
Authors: Riko Krista , Hyde Martyn L. , Alberti Peter W.
Published: October 2006

Auditory evoked potential techniques have revitalized programs for early detection, quantification, and management of hearing loss. Some issues underlying the need for such programs, and their structure, are reviewed with reference to recently‐published guidelines. The prevalence of hearing loss in infancy is poorly understood; estimates depend on the type and degree of loss, the tests used, and their timing. Evidence that significant hearing loss can escape early detection continues to accumulate; delays are attributable to many factors, including insufficient awareness and deficiencies in conventional tests. High‐risk registers are valuable but imperfect tools, and should not be the sole avenue of early detection. Electrophysiologic tests, especially the auditory brain stem response, have a major role in early assessment. Attention to many technical and patient‐related factors is required, and frequencyspecific testing is feasible and informative.
The pectoralis myocutaneous flap for salvage of necrotic wounds
Authors: Price John C. , Davis R. Kim , Koltai Peter J.
Published: October 2006

The authors have utilized six pectoralis major myocutnneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull‐up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis.

These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means.

This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. We conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.
Immediate reconstruction after total laryngopharyngoesophagectomy and mediastinal dissection
Authors: Krespi Yosef P. , Wurster Carl F. , Sisson George A.
Published: October 2006

Advanced or recurrent carcinoma surrounding the tracheostoma in a previously laryngectomized patient is most effectively treated with transsternal radical dissection of the upper mediastinum and relocation of the trachea to the upper chest. The use of the pectoralis major myocutaneous flap, now enables the head and neck surgeon to perform immediate reconstruction and provide protection for the great vessels after mcdiastinal dissection for stomal recurrence. Formerly, patients with stomal recurrence also involving the cervical or upper thoracic esophagus were poor surgical candidates. Frequently, patients succumbed to their disease before the continuity of the digestive tract could be re‐established.

Currently, at our institution, this vexing reconstructive problem is solved with immediate, one‐stage reconstruction. The esophagus is replaced by transposing the stomach through the posterior mediastinum and anastomosing to the tongue base, “gastric pull‐up.” The mediastinal defect is closed with the concomitant use of the pectoralis myocutaneous flap. The muscular portion of the myocutaneous flap provides excellent coverage for the great vessels of the upper mediastinum. Our experience with 39 patients who underwent this procedure between 1979 and 1983 is presented.
Clinician reliability in rating voice improvement after laryngeal nerve section for spastic dysphonia
Authors: Sapir Shimon , Aronson Arnold E.
Published: October 2006

A recent study by Aronson and DeSanto (1983) showed that, although section of the recurrent laryngeal nerve to relieve adductor spastic dysphonia effected considerable improvement in nearly 100% of the voices immediately after surgery, within the next 3 years 64% had returned to their preoperative status or worse. These findings were based on ratings by one speech pathologist, and the study was not designed to measure the reliability of the rater's judgments.

The experiment reported here was designed to repeat the Aronson and DeSanto study, with three raters instead of one and under more experimentally controlled conditions. Results show high intrajudge and interjudge reliability within and between the two studies. It is concluded that Aronson and DeSanto's original findings were reliable.
Tongue flap repair of postlaryngectomy hypopharyngeal stenosis
Authors: Calcaterra Thomas C.
Published: October 2006

Hypopharyngeal stenosis after total laryngectomy has been reported as high as 40%. The most consistent and important causal factor is the extent of the pharyngeal resection since cancers of the pyriform sinus and postcricoid region have the highest incidence of stenosis.

Dilation is frequently unsuccessful in the management of postlaryngectomy hypopharyngeal stenosis probably because of its excessive length. The laterally‐based tongue flap is effective for repair of these stenoses because of its proximity, epithelial compatibility, and ample length. The technique, details, and successful use in three patients are presented.
Upper aerodigestive neoplasm perpetuated in the nude mouse
Authors: Fantozzi Richard , Bone Robert , Fernsten Philip , Walker Leslie
Published: October 2006

The ability to study and characterize squamous cell cancer of the upper aerodigestive system would be greatly facilitated by an in vivo model. The subsequent opportunity to observe cellular kinetics, membrane antigenicity and hence, potential response to chemotherapy, immunotherapy, radiotherapy, or a combination of these treatment modalities would most likely have early and significant clinical relevance. A multidisciplinary team of basic scientists and clinicians have developed a nude mouse colony for such investigational research. Melanoma and pulmonary squamous and pulmonary adenocarcinoma have been grown and successfully transferred. In addition, head and neck squamous cell carcinoma from multiple sites have also been successfully colonized. We present our experience with this interesting in vivo model and discuss problems in creating a nude mouse colony, techniques of successful tumor inoculation, ongoing maintenance of successful cell lines, and theoretical advantages for potential clinical investigations using this dynamic biologic system.
Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure
Authors: Schaefer Steven D. , Close Lanny G. , Brown Orval E.
Published: October 2006

Stenosis of the posterior laryngeal commissure with arytenoid fixation following intubation trauma or laryngeal fracture poses a treatment dilemma. Over the past 2 1/2 years we have managed four patients with this problem by mobilization of the fixated cricoarytenoid joint, arytenoid‐pharyngeal mucosal advancement flap, brief splinting of the arytenoids in the fully abducted position, and early speech therapy. As of this time, three of the four patients have been both decannulated and have achieved adequate to near normal voices. Most significantly, the previously fixated arytenoids are now mobile, confirming the efficacy of the principles presented herein.
Solitary (unicameral) cysts involving the temporal bone
Authors: Nager George T.
Published: October 2006

The primary unicameral cyst which involves the temporal bone is very rare. Only about 30 patients have been reported in the literature during the past ten decades. The lesion is most frequently encountered in the first and second decade of life. In contrast to the other locations in the skeleton, it usually remains asymptomatic for a long time until it causes a deformity or dysfunction. The etiology has so far remained obscure. Its occasional association with malformations of the ears and nasopharynx and other developmental anomalies, its incidental bilateral occurrence, and certain histological aspects may suggest a congenital origin or a localized defect in bone formation and remodeling.
Cholesteatoma staging
Authors: Meyerhoff William L. , Truelson John
Published: October 2006

Manuscripts reporting results of surgery for chronic otitis media would be more meaningful if standardized nomenclature were used in describing the type of surgery performed and if standardized classifications were used for the disease process. Standardized nomenclature for surgery type and classifications for chronic otitis media exist. A classification for cholesteatoma, based on pathophysiology, location, eustachian tube function, ossicular defects, and presence or absence of complications is proposed. Congenital cholesteatoma is that which has its nidus of trapped squamous epithelium present at birth. Primary acquired cholesteatoma is associated with a defect in the pars flaccida, while secondary acquired cholesteatoma is associated with a defect in the pars tensa. Tertiary acquired cholesteatoma is defined as that which occurs behind a normal appearing tympanic membrane as the result of implantation or an antecedent middle ear inflammation.
Testing ciliary activity in patients with chronic and recurrent infections of the upper airways: Experiences in 68 cases
Authors: Burgersdijk Francis J. A. , De Groot John C. M. J. , Graamans Kees , Rademakers Louk H. P. M.
Published: October 2006

The clinical use of various tests of ciliary activity is uncertain and the purpose of this study is to assess the practical significance of the most current methods. Therefore, biopsy specimens of the nasal mucosa were investigated by means of phase contrast microscopy in 68 patients with chronic and recurrent infections of the upper airways. In 19 cases an absent or extremely weak ciliary activity could be demonstrated. Ultrastructurally, a characteristic pattern of defective dynein arms as observed in primary ciliary dyskinesia, was evident in only 3 out of these 19 patients. Measurements of the mucociliary transport velocity by means of intranasal Tc 99m labeled particles appeared to be unreliable in cases of severe nasal obstruction.

In this study, phase contrast microscopy of biopsy material from the nasal respiratory epithelium appeared to have the most advantages: It is a practical and rather simple screening test in the assessment of ciliary activity.
Advances in oto‐immunology: New trends in functional pathology of the temporal bone
Authors: Veldman Jan E. , Meeuwsen Frits , Huizing Egbert H.
Published: October 2006

By using monoclonal and polyclonal antibodies against cell‐membrane receptors and cytoskeletal proteins, the cellular and tissue composition of any organ can be far better determined. This is illustrated in the tympanic membrane, middle ear mucosa, and cholesteatoma. Immunotechnology applied to the temporal bone is shown with an animal‐ototoxicity model. Antibodies to keratin and vimentin (i.e., to proteins of the fibrillar components that make up the cytoskeleton) stain specific tissue compartments. Langerhans' cell and T‐lymphocyte subsets predominate in a cholesteatoma. The normal human tympanic membrane is devoid of these cells. Gentamicin can be traced with a polyvalent anti‐gentamicin antiserum in serial sections of the cochlea and kidney. The drug accumulates in the outer hair cells and proximal tubular cells, respectively.

A new technique of CT‐scanning, microslicing, plastic embedding, and semithin sectioning of undecalcified human temporal bone is described. Perspectives in applying immunotechnology to this method of human temporal bone processing are discussed.
Postoperative risks of pediatric tonsilloadenoidectomy
Authors: Carithers Jeffrey S. , Gebhart Don E. , Williams Jill A.
Published: October 2006

Tonsilloadenoidectomy is performed over 340,000 times per year in the United States, usually as a same day admission procedure with a postoperative overnight stay. Because of the current emphasis on reducing health care costs, many insurers are requiring the procedure of tonsilloadenoidectomy be performed on an outpatient basis, even though there is a lack of data supporting the safety of such a requirement.

The charts of 2,944 pediatric patients who underwent tonsillectomy and/or adenoidectomy from January 1, 1983 to December 31, 1984 were reviewed. Analyses revealed predictive variables that could be used to identify patients with a low risk of complications. Nineteen percent of the patients could be released 4 hours postoperatively with an 8.1% chance of subsequent complications. No patients who underwent the combined procedure of tonsillectomy and adenoidectomy were in this group. Of the remaining patients, 0.4% could be released 6 hours after surgery, or 85.9% could be released 8 hours after surgery, or 98.2% could be released 10 hours after surgery, all with a less than 10% chance of subsequent complications. This study supports keeping tonsilloadenoidectomy patients at least 8 hours and possibly 10 hours after surgery to minimize the risk of complications after discharge.
The efferent supply of the trapezius muscle: A neuroanatomic basis for the preservation of shoulder function during neck dissection
Authors: Weisberger Edward C.
Published: October 2006

The hypothesis that there is an alternative motor input to the trapezius muscle through cervical spinal nerves is evaluated through a review of the literature and through experimental studies performed by the author.

Electrophysiologic testing of the spinal accessory nerve and of the ventral rami of the cervical spinal nerves was performed in cats and humans. These studies indicated that motor potentials recorded in the trapezius muscle after stimulation of the ventral rami of cervical spinal nerves in general represented the spread of current to the contiguous portions of the spinal accessory nerve or directly to the trapezius muscle. Rarely did there seem to be evidence of motor innervation to the upper and lower trapezius by fibers conveyed by the ventral rami of cervical spinal nerves. The predominant motor input to the trapezius muscle is through the spinal accessory nerve.

Subjective evaluation, objective strength testing, and electromyographic evaluation were performed on patients who had undergone neck dissections. Three types of neck dissection were employed. These were modified neck dissection with preservation of the spinal accessory nerve, radical neck dissection with sacrifice of the spinal accessory nerve, and reconstruction using a cable graft and classical radical neck dissection. Regarding all of the methods of evaluation and comparison, the patients who retained function of the spinal accessory nerve in the postoperative period fared better than those who had a classical radical neck dissection with sacrifice of the spinal accessory nerve. This again supports the concept that the most important and predominant motor supply to the trapezius muscle is through the spinal accessory nerve.

All of this information was used to construct a model of the spinal portion of the accessory nerve and of the innervation of the trapezius muscle. The clinical implications of this model are stated.
Pharyngoesophageal myotomy for vocal rehabilitation of laryngectomees
Authors: Mahieu Hans F. , Annyas Albert A. , Schutte Harm K. , van der Jagt Eric J.
Published: October 2006

Pharyngoesophageal myotomy, performed in 16 laryngectomees to improve vocal rehabilitation, proved to have some negative side effects. Although no failures of speech rehabilitation using a button were consequently found, a considerable number of button assisted esophageal speakers had a breathy voice. Also, the number of poor injection‐esophageal speakers was much higher than in the group of nonmyotomized laryngectomees.

A “normal” pseudoglottis could only rarely be identified by fluoroscopy in the myotomized group. A significantly lower intratracheal pressure appeared to be required for tracheo‐esophageal phonation after myotomy. To improve the slightly disappointing voice rehabilitation results of the myotomized laryngectomees, a modified myotomy is proposed.
Current concepts in neuroradiological diagnosis of acoustic neuromas
Authors: Mikhael Michael A. , Wolff Allan P. , Ciric Ivan S.
Published: October 2006

Two hundred twenty‐one cases with clinical suspicion of a cerebellopontine angle (CPA) and/or internal auditory canal (IAC) lesions were evaluated in our hospital in the last 2 1/2 years by various radiological modalities. Fifty‐two tumors were diagnosed and surgically removed; 48 were acoustic neuromas (33 large tumors and 15 intracanalicular small tumors) and 4 meningiomas.

Polytomography detected 10 lesions out of 15 (66.7%) with 5 false‐negative (33.3%) and 4 false‐positive (26.7%) studies. Routine CT scan visualized large and enhancing lesions (37 out of 52), but missed the small intracanalicular tumors (15 tumors) which were only visualized by CT scan combined with cisternography or magnetic resonance imaging (MRI). MRI diagnosed 23 lesions out of 23 (100%) with no false‐positive or negative studies, including 8 intracanalicular small tumors missed on the routine CT scans. MRI is far more reliable in the radiological diagnosis of CPA and IAC lesions.
Efficacy of acoustic otoscope in detecting middle ear effusion in children
Authors: Oyiborhoro John M. A. , Olaniyan Sunday O. , Newman Craig W. , Balakrishnan Saidapet L.
Published: October 2006

The sensitivity and specificity of the acoustic otoscope in detecting middle ear effusion (MEE) was determined for 200 children. Based upon results from otoscopy, tympanometry, pure tone audiometry, and myringotomy, 100 of the children (175 ears) had MEE. The remaining 100 (200 ears) had no MEE. Using acoustic otoscope reflectivity (AOR) units 4 through 9 to indicate pathologic ears, its sensitivity and specificity were found to be 93.14% and 83%, respectively. These findings led to the conclusion that the acoustic otoscope may provide a simple and cost‐effective way of detecting MEE in children. Suggestions are provided for improving the effectiveness of this new device as a clinical tool.
Laser applications in the trachea and bronchi: A comparative study of the soft tissue effects using contact and noncontact delivery systems
Authors: Shapshay Stanley M.
Published: October 2006

A comparative study of laser soft tissue effects using carbon dioxide (CO2 ) and neodymiumyttrium aluminum garnet (Nd‐YAG) lasers in contact and noncontact endoscopic delivery systems was done in the canine tracheobronchial tree to determine the best laser system for the specific disease. The CO2 laser bronchoscopic coupler, CO2 laser waveguide, Nd‐YAG laser fiber, and Nd‐YAG laser contact probe were used. A 5 mm diameter soft tissue injury exposing tracheal cartilage was made, and the power density for each laser modality was measured. Soft tissue effects were documented histologically using routine techniques and scanning electron microscopy acutely and at 1 week and 2 weeks after injury. The effects were similar with the CO2 laser coupler and the CO2 laser waveguide with comparable power densities. Compared with the CO2 laser, the Nd‐YAG laser fiber caused more extensive and more difficult to control thermal damage in tissue. The Nd‐YAG laser contact probe was capable of precise soft tissue ablation with minimal surrounding tissue damage and was associated with the most rapid healing.

This study concluded that high power density with short exposures is desirable when treating benign disorders, such as tracheal stenosis, making the CO2 laser or Nd‐YAG laser contact probe application a good choice. On the other hand, malignant turmores with a potential for hemorrhage are best treated with the Nd‐YAG laser noncontact fiber system because of its superior coagulative effects.
A study of potential vestibulotoxic effects of once daily versus thrice daily administration of tobramycin
Authors: Proctor Leonard , Thakor Ruchira , Glackin Robert , Shimizu Hiroshi , Petty Brent , Lietman Paul
Published: October 2006

Tobramycin 5.1 mg/kg/day was administered for 9 days to 20 healthy human volunteers to determine the potential vestibulotoxicity of once daily versus thrice daily treatment regimens. Vestibular function was tested carefully before, during, and following drug administration, using a battery of postural and caloric tests.

Although subjects receiving the once daily regimen performed better on the postural tests, we feel this does not necessarily indicate an adverse effect in either group. The caloric test was the primary measure of vestibular function in this experiment, and this test appeared to demonstrate a slight adverse effect during drug administration of equal magnitude in both treatment groups.

The results of this experiment indicate that there is no significant difference in the risk of adverse vestibular effects between once daily and thrice daily tobramycin administration.
Prognostic value of vocal cord fixation with respect to treatment in cancers of the supraglottis and pyriform sinus
Authors: Spaulding Cynthia A. , Gillenwater Ann , Hahn Seung Shin , Constable William C. , Ronald Kersh C.
Published: October 2006

Vocal cord fixation in supraglottic and pyriform sinus cancers has, in the past, precluded management by radiotherapy alone. Ninety‐eight patients were reviewed to determine the prognostic effect of vocal cord fixation. The predictive value of cord mobility status after 50 Gy was evaluated with respect to treatment modality.

For patients treated with radiotherapy alone, cord mobility status was predictive of recurrence, yielding 3 year recurrence rates of 33.3% (mobile) versus 80% (fixed) [p = 0.04]. Mobile cords after 50 Gy had similar recurrence rates (33.3% vs. 40.0%, p = 0.60) whether treated by radiotherapy or radiotherapy/surgery.

Radiotherapy alone may be used in cases when fixed cords become mobile after 50 Gy without compromising cure rates or laryngeal function. Combined modality provides the best results when cords remain fixed.
Total pharyngolaryngectomy and cervical esophagectomy with jejunal autotransplant reconstruction: Complications and results
Authors: Ferguson Jonathan L. , Desanto Lawrence W.
Published: October 2006

Eighteen patients underwent pharyngoesophageal reconstruction with a free jejunal autotransplant in a one‐stage procedure after circumferential resection for cancer of the pharynx and cervical esophagus. Of these, six had minor complications (fistulas) and six had major complications including abdominal bleeding, cervical bleeding, graft failure, and one surgical death. The mean survival was 427 days after resection and reconstruction (range, 120 to 866 days). Ten patients died of their disease, and four died of other causes. The site of failure was local in five and distant in five. In view of this high complication rate and unimpressive survival rate, the use of other lower‐morbidity reconstructive options or staged procedures may need to be considered in poor surgical candidates.
Tissue expansion and cutaneous blood flow
Authors: Goding George S. , Cummings Charles W. , Trachy Ron E.
Published: October 2006

The effect of controlled skin expansion in blood flow was investigated using the dermofluorometer. Twenty‐eight subcutaneous pockets in seven pigs were divided into three groups. Group 1: subcutaneous pockets with a gradually inflated 200‐cc tissue expander over 12 days, then deflated and observed for 6 days. Group 2: subcutaneous pockets with a noninflated 200‐cc tissue expander. Group 3: subcutaneous pockets elevated without placement of a tissue expander.

Measurements taken 30 to 45 minutes after partial inflation of the tissue expander showed a decrease in blood flow while blood flow was increased 30 to 45 minutes after deflation of the tissue expander. The increase in blood flow, however, was not evident 6 days after the expander in group 1 was deflated.
Elective resection of the internal carotid artery without reconstruction
Authors: De Vries Egbert J. , Sekhar Laligam N. , Schramm Victor L. , Janecka Ivo P. , Horton Joseph A. , Eibling David E.
Published: October 2006

Curability of skull base tumors is related to the ability to achieve a complete resection. Resection of the internal carotid artery with the tumor puts the patient at risk for catastrophic cerebral injury. Autogenous vein grafting is not always technically or physiologically possible.

We present eight patients with tumors eroding the cranial base who underwent safe resection or occlusion of the internal carotid artery as predicted by three tests: 1. carotid arteriography, 2. temporary balloon occlusion of the internal carotid artery, and 3. xenon computerized tomography cerebral blood flow mapping. No patient suffered permanent central nervous system injury.
Gastroesophageal reflux as an etiologic factor in laryngeal complications of intubation
Authors: Gaynor Edward B.
Published: October 2006

Significant complications are encountered in some patients as a result of prolonged endotracheal intubation. The finding of low gastric pH values at postmortem examination in patients whose larynx was severely traumatized after endotracheal intubation suggested that gastroesophageal reflux (GER) is an important factor in the pathogenesis of these problems.

To evaluate the occurrence and character of GER as well as its effects upon the larynx and trachea of intubated patients, clinical observations and several animal models were employed. Monitoring of pH values for GER was performed in intubated patients both in the operating room and the intensive care unit with a 40% incidence of GER in ICU patients not receiving antacid therapy. After exposure to gastric juice, marked inflammation and necrosis were observed in the larynx of rabbits, and a significant reduction of mucociliary flow was found to occur in the dog's trachea. The physiology and mechanisms of these events are discussed and indicate that GER may play an important role in the development of permanent laryngeal and tracheal injury in the intubated patient.

It is recommended that pharyngeal pH be monitored in intubated patients because their altered state of consciousness may predispose to gastric reflux. When GER is encountered, initiation of treatment should be undertaken because prevention is considerably more effective than subsequent treatment.
Prostaglandins, leukotrienes, and other arachidonic acid metabolites in the pathogenesis of otitis media
Authors: Jung Timothy T. K.
Published: October 2006

Among the various inflammatory mediators of otitis media (OM), metabolites of arachidonic acid (AA) such as prostaglandins (PGs) and leukotrienes (LTs) appear to play an important role in the pathogenesis of otitis media. In an effort to investigate the role of AA metabolites on the pathogenesis of otitis media, concentrations of AA metabolites were measured in middle ear effusion (MEE) from human and paralleling animal models of otitis media and the effects of inhibitors of AA metabolism, antibiotics, and tympanostomy tube (TT) on the outcome of animal models of OM were studied.

Concentrations of AA metabolites in MEE were higher in the younger age group. Levels of PGE and LTB in MEE seem to represent the degree of inflammation of OM best. Lipoxygenase products seem to be associated with the mucoid type of MEE. In the study of animal models of OM, combined models and ears with TT showed more inflammation than single models and ears without TT. Study of the therapeutic use of inhibitors of AA metabolism, penicillin, and TT showed that lipoxygenase products may be more important in the pathogenesis of OM than the cyclo‐oxygenase products, and that the use of a combination of penicillin and corticosteroid produces the best results.

It is clear from these studies that arachidonic acid metabolites are important inflammatory mediators in the pathogenesis of otitis media.
Motor‐evoked potentials of facial musculature in dogs
Authors: Estrem Scott A. , Dvm Siavash Haghighi , Wertheimer Richard , Levy Walter J. , Kendall Mary
Published: October 2006

Motor responses of limb musculature have been elicited by transcranial brain stimulation using electrical and magnetic stimulation. Recording from muscles innervated by cranial nerves has not previously been reported.

A unilateral hemispheric craniotomy was performed in 24 dogs. An electric stimulus was delivered directly to the exposed motor cortex via surface electrodes. Evoked electromyographic responses to motor cortex stimulation were recorded from the contralateral orbicularis oculi and orbicularis oris muscles.

Preliminary investigation into the use of magnetic stimulation of the motor cortex is compared to direct electrical cortical stimulation. This study demonstrates the potential for magnetic stimulation in the intraoperative and outpatient clinical evaluation of facial nerve disorders. It appears possible, for the first time using magnetic stimulation, to noninvasively stimulate these nerves proximal to the point of injury and to evaluate more central conduction pathways.
Submandibular gland excision
Authors: Crabtree Gary M. , Yarington C. T.
Published: October 2006

A review of 107 submandibular gland excisions was made to determine the relative frequency of neoplastic versus non‐neoplastic disease. The results show a preponderance of non‐neoplastic pathology. Benign tumors were found in 6% of glands, primary glandular and metastatic carcinoma in 3%. Timely treatment of a submandibular gland mass is indicated due to the relatively aggressive behavior of malignancies originating in this location.
Use of bacitracin for neurotologic surgery
Authors: Kartush Jack M. , Cannon Steven C. , Graham Malcolm D. , Bojrab Dennis I. , Schmaltz Steven , Kemink John L.
Published: October 2006

Wound infection, cerebrospinal fluid leak, and meningitis are serious potential complications of neurotologic procedures that transgress the posterior cranial fossa dura. A study of 236 patients was made to determine the effect of perioperative intravenous antibiotics and topical bacitracin irrigation on the incidence of these complications. Of the 236 patients, 170 (72%) underwent translabyrinthine resection of acoustic tumors, while 66 (28%) underwent retrolabyrinthine vestibular nerve section. Patients were divided into four groups: those who received no antibiotics, those who received perioperative intravenous antibiotics only, those who received topical bacitracin irrigation only, and those who received a combination of perioperative intravenous antibiotics and topical bacitracin irrigation.

There were no untoward effects of either perioperative intravenous antibiotics or topical bacitracin. The results indicate that bacitracin irrigation reduced the incidence of wound infection from 9% to 2% (p<0.05); of cerebrospinal fluid leak from 12% to 5% (p<0.04); and of all targeted complications combined from 22% to 9% (p<0.006). Furthermore, the topical bacitracin irrigation only group showed a statistically significant reduction in wound infections compared to the perioperative intravenous antibiotic only group (p<0.02). The incidence of meningitis was statistically unaffected by any of our treatment protocols.
Superficial extending carcinoma of the larynx
Authors: Sulfaro Sandro , Volpe Rachele , Querin Francesco , Comoretto Roberto , Barzan Luigi , Lutman Mario , Carbone Antonino
Published: October 2006

Superficial extending carcinoma of the hypopharynx is a recently recognized form of carcinoma regarded as a possible pharyngeal counterpart to early gastric cancer and superficial esophageal carcinoma. In this study we report the radiological, clinical, and pathological features of three carcinomas of the larynx, which show architectural and histopathological features similar to those previously described in superficial extending carcinoma of the hypopharynx. These cases were singled out from a series of 37 consecutive laryngectomy specimens of primary infiltrating laryngeal carcinomas that were uniformly studied by means of a whole‐organ sections technique. Pathologically, these cases showed a clearly invasive growth through the basal membrane into the lamina propria and an entire or predominant, extensive, superficial type of spread; infiltration of underlying muscle or gland structures was restricted to a few microscopic foci, regardless of the presence of lymph node metastases. The present study demonstrates that infiltrating carcinomas with a preferential superficial type of growth may also be encountered in the larynx. Differences between the histological features of these carcinomas of the larynx and the histopathologic spectrum of so‐called early laryngeal cancer are emphasized.
Endoscopic paranasal sinus surgery: Indications and considerations
Authors: Schaefer Steven D. , Manning Scott , Close Lanny G.
Published: October 2006

Recently, American otolaryngologists have become increasingly interested in endoscopic paranasal sinus surgery. This trend has been beneficial, because it has enhanced the understanding of the anatomy and pathophysiology of the sinuses. However, as with the introduction of any new surgical technique, it takes both time and experience to acquire the skills necessary to perform this procedure. To evaluate the state of endoscopic sinus surgery, we analyzed the experience of one of the authors with 100 consecutive patients undergoing therapeutic endoscopic sinus surgery over 23 months. With an average follow‐up of 5 months (range: less than 1 month to 20 months), 14 patients had minor complications. The most common complication was synechia between the middle turbinate and the lateral nasal wall (six patients), resulting in revision surgery in four patients. Eighty‐three patients were judged as having significantly improved after surgery, while ten were improved but had one episode of sinusitis postoperatively. The results of this series suggest that endoscopic paranasal sinus surgery is an efficacious advance in the treatment of sinusitis, given the limitations discussed in this report.
Space‐occupying orbital lesions: Can critical increases in intraorbital pressure be predicted clinically?
Authors: Stanley Robert J. , Mccaffrey Thomas V. , Desanto Lawrence W. , Offord Kenneth P.
Published: October 2006

Thirteen cadaver orbits were studied to determine whether noninvasive clinical measurements of globe excursion could be used to predict intraorbital pressure. Intraorbital pressure measurements, exophthalmometry, and orbitonometry (which measures resistance to globe retrodisplacement) were performed at 1‐ml increments to 12 ml of added orbital volume. Orbitonometry, performed with forces of 100, 200, and 300 g, yielded both E (global position) and Y (retrodisplacement) values. Plots of orbital pressure against percentage of excursion, a function of orbital retrodisplacement (that is, orbital pressure versus [(E0 ‐ E300)/E0] × 100), for 131 paired values over all orbits yielded a function with low percentage of excursion values associated with high intraorbital pressures. This relationship reflected both the proptosis and the increased orbital tension produced by added volumes. Comparison of clinical oribtonometry data with such experimental data may allow predictions about which patients are threatened by critical intraorbital pressure levels and may benefit from orbital decompression surgery to preserve vision.
Congenital nasal pyriform aperture stenosis
Authors: Brown Orval E. , Manning Scott C. , Myer Charles M.
Published: October 2006

Congenital nasal pyriform aperture stenosis is an unusual and previously undescribed cause of nasal airway obstruction in the newborn. The nasal pyriform aperture is narrowed due to bony overgrowth of the nasal process of the maxilla. This anomaly may produce signs and symptoms of nasal airway obstruction in newborns and infants similar to those seen in bilateral posterior choanal atresia. Computed tomography confirms the diagnosis and delineates the anomaly. A series of six patients with nasal pyriform aperture stenosis is presented. Four patients were treated with surgical enlargement of the nasal pyriform aperture via a sublabial approach. One patient was repaired via a transnasal approach, and one patient did not undergo surgical intervention. Follow‐up reveals normal nasal airway and facial growth in all patients. Mildly symptomatic patients with congenital nasal pyriform aperture stenosis may be treated expectantly, while severely symptomatic patients benefit from repair via the sublabial approach.
Double-Stranded RNA-Dependent Protein Kinase Is Involved in 2-Methoxyestradiol—Mediated Cell Death of Osteosarcoma Cells
Authors: Shogren Kristen L , Turner Russell T , Yaszemski Michael J , Maran Avudaiappan
Published: October 2006

We studied the involvement of interferon-regulated, PKR on 2-ME–mediated actions in human osteosarcoma cells. Our results show that PKR is activated by 2-ME treatment and is necessary for 2-ME–mediated induction of osteosarcoma cell death.

Introduction: Osteosarcoma is the most common primary bone tumor and most frequently develops during adolescence. 2-Methoxyestradiol (2-ME), a metabolite of 17β-estradiol, induces interferon gene expression and apoptosis in human osteosarcoma cells. In this report, we studied the role of interferon-regulated double-stranded (ds)RNA-dependent protein kinase (PKR) protein on 2-ME–mediated cell death in human osteosarcoma cells.

Materials and Methods: Western blot analyses were used to measure PKR protein and phosphorylation levels. Cell survival and apoptosis assays were measured using trypan blue exclusion and Hoechst dye methods, respectively. A transient transfection protocol was used to express the dominant negative PKR mutants.

Results and Conclusions: PKR was increased in 2-ME–treated MG63 cells, whereas 17β-estradiol, 4-hydroxyestradiol, and 16α-hydroxyestradiol, which do not induce cell death, had no effect on PKR protein levels. Also, 2-ME treatment induced PKR kinase activity as indicated by increased autophosphorylation and phosphorylation of the endogenous substrate, eukaryotic initiation factor (eIF)-2α. dsRNA poly (I).poly (C), an activator of PKR protein, increased cell death when osteosarcoma cells were treated with a submaximal concentration of 2-ME. In contrast, a serine-threonine kinase inhibitor SB203580 and a specific PKR inhibitor 2-aminopurine (2-AP) blocked the 2-ME–induced cell death in MG63 cells. A dominant negative PKR mutant protein conferred resistance to 2-ME–induced cell death to MG63 osteosarcoma and 2-ME–mediated PKR regulation did not require interferon gene expression. PKR protein is activated in cell free extracts by 2-ME treatment, resulting in autophosphorylation and in the phosphorylation of the substrate eIF-2α. We conclude from these results that PKR is regulated by 2-ME independently of interferon and is essential for 2-ME–mediated cell death in MG63 osteosarcoma cells.
Cumulative Index of Exposure to Hypocarbia and Hyperoxia as Risk Factors for Periventricular Leukomalacia in Low Birth Weight Infants
Authors: Shankaran Seetha , Langer John C. , Kazzi S. Nadya , Laptook Abbot R. , Walsh Michele ,   for the National Institute of Child Health and Human Development Neonatal Research Network
Published: October 2006

BACKGROUND. Hypocarbia and hyperoxia are risk factors for periventricular leukomalacia in low birth weight infants. The association of a cumulative index of exposure to hypocarbia and hyperoxia and periventricular leukomalacia has not been evaluated.

OBJECTIVE. Our goal was to examine the relationship between cumulative index of exposure to hypocarbia and hyperoxia and periventricular leukomalacia during the first 7 days of life in low birth weight infants.

METHODS. Blood gas results were recorded in 6-hour intervals among low birth weight infants in a prospective data registry. Cumulative index of exposure to hypocarbia was calculated as the difference between arterial carbon dioxide level and 35 mmHg multiplied by the time interval in hours for each 6-hour block in a 24-hour day for the first 7 days of life. Cumulative index of exposure to hyperoxia was calculated in the same manner for arterial oxygen level >80 mm Hg. The relationship between exposure to hypocarbia, hyperoxia, and periventricular leukomalacia was examined in 778 infants with blood gas and cranial sonography data.

RESULTS. Twenty-one infants had periventricular leukomalacia. Hypocarbia occurred in 489 infants and hyperoxia in 502 infants. Infants with periventricular leukomalacia were more likely to have a lower gestational age and to require delivery room resuscitation than those without periventricular leukomalacia. More infants in the highest quartile of exposure to hypocarbia had periventricular leukomalacia compared to those with no hypocarbia. Risk of periventricular leukomalacia was increased in infants with the highest quartile of exposure to hypocarbia after adjusting for maternal and neonatal variables, none to be associated with periventricular leukomalacia. Cumulative index exposure to hyperoxia was not related to periventricular leukomalacia.

CONCLUSIONS. Cumulative exposure to hypocarbia and not hyperoxia was independently related to risk of periventricular leukomalacia in low birth weight infants.