bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Strategy of Screening Multiple Anatomical Sites for Methicillin-Resistant Staphylococcus aureus at Admission to a Teaching Hospital
Authors: Eveillard Matthieu , Lassence Arnaud de , Lancien Evelyne , Barnaud Guilène , Ricard Jean-Damien , Joly-Guillou Marie-Laure
Published: February 2006

We compared the sensitivity of screening with nasal culture alone with that of a multiple-site screening method for the identification of carriers of methicillin-resistant Staphylococcus aureus at hospital admission. If nasal cultures alone had been used during the 1-year study, 27.0% of carriers of methicillin-resistant S. aureus would have been missed, which corresponds to 560 theoretical isolation days. If rectal screening had not been used, 431 theoretical isolation days would have been missed, and, if axillary screening had not been used, 99 theoretical isolation days would have been missed.
Methicillin-ResistantStaphylococcus aureusin Canadian Aboriginal People
Authors: Ofner-Agostini Marianna , Simor Andrew E. , Mulvey Michael , Bryce Elizabeth , Loeb Mark , McGeer Allison , Kiss Alex , Paton Shirley ,   Canadian Nosocomial Infection Surveillance Program, Health Canada
Published: February 2006

We describe 279 hospitalized Canadian aboriginals in whom methicillin-resistantStaphylococcus aureus(MRSA) was detected. They were identified in 38 Canadian hospitals from 1995 through 2002. Compared with nonaboriginals, aboriginals were more likely to be younger than 18 years of age (OR, 1.8;P<.0001), to have had an MRSA infection (OR, 3.8;P<.0001), and to have had MRSA isolated from specimens of skin or soft tissue (OR, 4.1;P= .016). The clinical features of MRSA infection in aboriginals are distinct from those in the general patient population with MRSA infection in Canadian hospitals, and the genetic background of MRSA isolates from aboriginals also varies from that of strains from the non-aboriginal population.
Prevalence of and Risk Factors for Carriage of Panton-Valentine Leukocidin–Positive Methicillin-ResistantStaphylococcus aureusAmong Residents and Staff of a German Nursing Home
Authors: Raab Ulla , Kahlau Dagmar , Wagenlehner Florian , Reischl Udo , Ehrenstein Vera , Lehn Norbert , Höller Christiane , Linde Hans-Jörg
Published: February 2006

The aims of this cross-sectional study were to determine the prevalence of and risk factors for carriage of Panton-Valentine leukocidin–producing methicillin-resistantStaphylococcus aureus(PVL-MRSA) in residents and personnel of a nursing home in Germany. In this study, PVL-MRSA carriage status among nursing home residents was associated with risk factors reflecting their dependence on nursing care. No specific risk factors were detected among staff.
Oxacillin-Resistant and Multidrug-Resistant Staphylococcus aureus in Lima, Peru
Authors: Seas C. , Hernandez K. , Ramos R. , Bazan E. , Rodriguez I. , Torres A. , Zamudio C. , Gotuzzo E.
Published: February 2006

In a hospital in Lima, Peru, a review of 103 Staphylococcus aureus infections was conducted during 2002. The prevalence of oxacillin-resistant S. aureus strains was 68%; 25% of strains were resistant to multiple drugs. Previous use of antibiotics and undergoing a surgical procedure during the current hospital stay were associated with the presence of an oxacillin-resistant S. aureus strain.
Impact of an Aggressive Infection Control Strategy on Endemic Staphylococcus aureus Infection in Liver Transplant Recipients
Authors: Singh Nina , Squier Cheryl , Wannstedt Cheryl , Keyes Lois , Wagener Marilyn M. , Cacciarelli Thomas V.
Published: February 2006

Background.

Methicillin-resistant Staphylococcus aureus has emerged as a leading pathogen in transplant recipients and has become endemic in many institutions where transplantation is performed. The role of active surveillance programs based on the detection of colonization in the prevention of S. aureus infection in liver transplant recipients has not been defined.

Methods.

A total of 47 consecutive patients who underwent liver transplantation during 1996-1999 were compared with 97 patients who received a liver transplant during 2000-2004 after implementation of an intensive intervention program that included use of surveillance cultures to detect nasal and rectal colonization, use of cohorting and contact isolation precautions, and decolonization with intranasal mupirocin therapy.

Results.

The rate of new acquisition of S. aureus colonization of nares after transplantation decreased from 45.6% (21 of 46 patients) during the preintervention period to 9.9% (9 of 91 patients) during the postintervention period (P< .001). An increased length of hospital stay (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P < .002) was associated with new carriage acquisition, and transplantation during the postintervention period (odds ratio, 0.21; 95% confidence interval, 0.08-0.51; P<.001) was independently protective against new carriage. The rate of infection due to S. aureus decreased from 40.4% (19 of 47 patients) during the preintervention period to 4.1% (4 of 97 patients) during the postintervention period (P<.001), and the rate of bacteremia decreased from 25.5% (12 of 47 patients) to 4.1% (4 of 97 patients), respectively (P< .001). Overall, S. aureus infections occurred more frequently among patients with new carriage than among patients who were carriers at the time of transplantation (P< .001) or patients who were noncarriers (P< .001).

Conclusions.

Use of active surveillance cultures to detect colonization and implementation of targeted infection control interventions proved to be effective in curtailing new acquisition of S. aureus colonization and in decreasing the rate of S. aureus infection that was endemic in our population of liver transplant recipients.
Posttraumatic Stress Disorder After Occupational HIV Exposure: Two Cases and a Literature Review
Authors: Worthington Michael G. , Ross John J. , Bergeron Ellen K.
Published: February 2006

Two healthcare workers developed disabling chronic posttraumatic stress disorder after needlestick exposures to blood from a patient infected with human immunodeficiency virus (HIV), even though both continue to test negative for HIV antibody more than 22 months after their exposures. We describe these 2 cases and review the relevant literature. Prospective studies of psychological morbidity after occupational needlestick injuries are required to determine the role of long-term psychological follow-up, counseling, and support.
Epidemiological Analysis of Methicillin-ResistantStaphylococcus aureusIsolates From Adult Patients With Cystic Fibrosis
Authors: Kidd T. J. , Coulter C. , Bell S. C.
Published: February 2006

Using pulsed-field gel electrophoresis, we genotyped 21 methicillin-resistantStaphylococcus aureusisolates from patients attending an adult cystic fibrosis unit. Eleven patients exhibited pulsotypes related to 2 locally endemic strains. Eleven chronically colonized patients were assessed over a period of up to 2 years, and all demonstrated a retention of strain type.
Management of Outbreaks of Methicillin-ResistantStaphylococcus aureusInfection in the Neonatal Intensive Care Unit: A Consensus Statement
Authors: Gerber Susan I. , Jones Roderick C. , Scott Mary V. , Price Joel S. , Dworkin Mark S. , Filippell Mala B. , Rearick Terri , Pur Stacy L. , McAuley James B. , Lavin Mary Alice , Welbel Sharon F. , Garcia-Houchins Sylvia , Bova Judith L. , Weber Stephen G. , Arnow Paul M. , Englund Janet A. , Gavin Patrick J. , Fisher Adrienne G. , Thomson Richard B. , Vescio Thomas , Chou Teresa , Johnson Daniel C. , Fry Mary Beth , Molloy Anne H. , Bardowski Laura , Noskin Gary A.
Published: February 2006

Objective.

In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistantStaphylococcus aureus(MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation.

Design.

Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices.

Setting.

Level III NICUs at Chicago-area hospitals.

Participants.

Neonates and healthcare workers associated with the level III NICUs.

Methods.

From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS.

Results.

Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA-positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs.

Conclusion.

The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.
Regulatory T Cells, a Potent Immunoregulatory Target for CAM Researchers: The Ultimate Antagonist (I)
Authors: Vojdani Aristo , Erde Jonathan
Published: February 2006

Over the past decade, great interest has been given to regulatory T (Treg) cells. A vast body of evidence has shown the existence and highlighted the importance of Treg cells in the active suppression of immune system responses. This form of immunoregulation is the dominant means utilized by the immune system to reach a harmony between reciprocal response processes in order to ensure adequate host defense with minimal host detriment. Therapeutically targeting Treg cells is a direct and powerful means to manipulate the immune system to achieve beneficial effects on various disease pathologies, including allergy, autoimmunity and cancer, as well as the facilitation of organ transplantation. This powerful target for immunoregulation is of much concern to practitioners and researchers of complementary and alternative medicine because it allows a great deal of control and certainty in dealing with the prevalence of debilitating immune system‐related disorders for which there has been little remedy outside of Western Medicine.
Primary Treatment of Ranula With Intracystic Injection of OK‐432
Authors: Roh Jong‐Lyel
Published: February 2006

Objective: Although surgery is the first choice of therapy for ranula, it was made a hypothesis that ranula can be primarily treated with sclerotherapy from prior evidence. This study examined the effectiveness of intracystic injection of OK‐432 for treatment of ranula.

Method: This prospective clinical study comprised a total of 26 patients with ranula (19 intraoral type; seven plunging type) treated with OK‐432 sclerotherapy. Aspirated mucus of ranula was replaced with an equal volume of OK‐432 solution of 0.01 mg/mL. The size of ranula was compared before and after sclerotherapy.

Results: Twenty of 26 patients (77%) showed a complete response after sclerotherapy: higher in plunging ranula (86%) than in intraoral ranula (74%). Rupture of ranula developed in seven of 19 patients (37%) with intraoral ranula within a few days after injection. The early rupture occurred more frequently in patients having a less‐than‐marked response and seemed to cause an increase in the total number of OK‐432 injections: seven ruptured cases versus 12 nonruptured cases (mean 3.6 versus 1.5, P < .001). Recurrence occurred in two patients during a median follow‐up period of 12 months (range, 9–22 mo) after the last injection. There were no major side effects, scarring, or increased morbidity to surgery of the OK‐432‐injected lesions.

Conclusion: The intracystic injection of OK‐432 is highly effective as a primary treatment modality of ranula.
Morbidity After Flap Reconstruction of Hypopharyngeal Defects
Authors: Clark Jonathan R. , Gilbert Ralph , Irish Jonathan , Brown Dale , Neligan Peter , Gullane Patrick J.
Published: February 2006

Objectives: Laryngopharyngeal reconstruction continues to challenge in terms of operative morbidity and optimal functional results. The primary aim of this study is to determine whether complications can be predicted on the basis of reconstruction in patients undergoing pharyngectomy for tumors involving the hypopharynx. In addition, we detail a reconstructive algorithm for management of partial and total laryngopharyngectomy defects.

Method: A retrospective review was performed of 153 patients undergoing flap reconstruction for 85 partial and 68 circumferential pharyngectomies at a single institution over a 10‐year period. There were 118 males and 35 females, the median age was 62 years, and mean follow up was 3.1 years. Pharyngectomy was performed for recurrence after radiotherapy in 80 patients and as primary surgery in 73. Free flap reconstruction was used in 42%, with 30 jejunal, 15 radial forearm, 11 anterolateral thigh, five rectus abdominis, and three gastro‐omental flaps. Gastric transposition and pectoralis major pedicle flap was used in 14% and 44% of patients, respectively. Morbidity was analyzed according to extent of defect, regional versus free flap, enteric versus fasciocutaneous free flap reconstruction, and the effect of laparotomy.

Results: The total operative morbidity and mortality rate was 71% and 3%, respectively. The most common complications were hypocalcemia in 45%, pharyngocutaneous fistula in 33%, and wound complications in 25%. The late complication and stricture rate was 26% and 15%, respectively. On univariate analysis, circumferential defects were associated with increased total (P = .046) and flap‐related morbidity (P = .037), hypocalcemia (P < .001), late complications (P = .003), and stricture (P = .009). Gastric transposition had increased total (P = .007), flap‐related (P = .035), late complications (P = .034), and hypocalcemia (P = .001). Pharyngocutaneous fistula was increased in patients undergoing salvage pharyngectomy for radiation failure (P = .048) compared with primary surgery. On multivariate analysis, gastric transposition independently predicted for wound complications (P = .014) and fistula (P = .012). Circumferential defects predicted for flap‐related morbidity (P = .030), hypocalcemia (P = .017), and late complications (P = .042). Tracheoesophageal speech was the method of voice restoration in 44% of patients. Oral diet was achieved in 93% of patients; however, 16% required gastrostomy tube feeds for either total or supplemental nutrition.

Conclusion: The operative morbidity associated with pharyngeal reconstruction is substantial in terms of early and late complications. We were able to predict morbidity by defect extent and reconstruction type and initial treatment modality. Swallowing function is acceptable; however, less than half of the patients undergoing pharyngectomy had tracheoesophageal puncture voice restoration.
The Edwin Smith Papyrus: The Birth of Analytical Thinking in Medicine and Otolaryngology
Authors: Stiefel Marc , Shaner Arlene , Schaefer Steven D.
Published: February 2006

The Edwin Smith Papyrus, discovered in 1862 outside of Luxor, Egypt, is the oldest known surgical text in the history of civilization. The surviving scroll, a copy of an earlier text from around 3,000 B.C., gives us remarkable insight into the medical practice of ancient Egyptians in the Nile River bed during the dawn of civilization. The Papyrus is divided into 48 cases, most of which describe traumatic injuries. The text instructs the physician to examine the patient and look for revealing physical signs that may indicate the outcome of the injury. Although in modern medicine we take for granted that the use of physical examination and rational thinking lead to an accurate conclusion, 5,000 years ago, this was extraordinary. The Edwin Smith Papyrus cast aside the prevailing magic and mysticism of that time in favor of logic and deductive reasoning. As Egyptian civilization declined during the next millennium, the teachings of the Papyrus would be lost. It would not be until 300 B.C. when Hippocrates and his disciples in ancient Greece would once again revive logic in medical thinking and teaching. It is believed that the ancient Greeks had knowledge of the contents of the Edwin Smith Papyrus and its teachings and used them as the basis for their writings. As Europe entered the Dark Ages, so did medicine yet again, reverting to spells and prayers instead of judgment and reason. Although Hippocrates teachings were recognized by some scholars during the Middle Ages, they did not make up the basis for mainstream medical knowledge. With the dawn of the Renaissance, medicine would finally purge itself of its past supernatural foundation. Hippocratic teachings were used to form the basis of modern medicine, and medical pioneers in the 17th century studied the ancient Greek texts as the origin for their ideas. Many of the concepts physicians and patients today take as common knowledge originated in the Edwin Smith Papyrus. The authors attempt to uncover some of these fundamental ideas and trace them through time until their incorporation in our modern medical knowledge base. It is the rational, logical, and advanced thinking exhibited in the Edwin Smith Papyrus that mandates its respect from modern otolaryngologists and all physicians alike.
Signaling Pathways in Interleukin‐1β‐Mediated Middle Ear Mucin Secretion
Authors: Kerschner Joseph E. , Yang Chris , Burrows Amy , Cioffi Joseph A.
Published: February 2006

Objectives: The objectives of this study were to investigate the role of the phosphatidylcholine‐specific phospholipase C (PC‐PLC), protein kinase C (PKC), and nitric oxide synthase (NOS) pathways during upregulation of mucin secretion by middle ear epithelium after exposure to interleukin‐1β and to examine the ability of a specific interleukin‐1 receptor antagonist (IL‐1βra) to block this increased secretion.

Materials and Methods: Primary chinchilla middle ear epithelial cultures were established and exposed to IL‐1β. Specific inhibitors of calmodulin, PC‐PLC, PKC, and NOS pathways were used to investigate the potential role of these pathways leading to increased epithelial mucin secretion after exposure to IL‐1β. Mucin secretion was characterized by exclusion chromatography and liquid scintillation.

Results: Epithelial cultures exposed to IL‐1β demonstrate an increase in mucin secretion that is blocked by specific inhibitors of PC‐PLC, PKC, and NOS, but not by inhibitors of calmodulin. In addition, mucin secretion stimulated by IL‐1β was reversible with use of a specific IL‐1βra.

Conclusions: IL‐1β stimulates mucin secretion from middle ear epithelium and its effects can be reversed by IL‐1βra. PC‐PLC, PKC, and NOS pathways play a role in the increased secretion of mucin in middle ear epithelial cells after exposure to IL‐1β.
Cranial Bone Regeneration Using a Composite Scaffold of Beta‐Tricalcium Phosphate, Collagen, and Autologous Bone Fragments
Authors: Kishimoto Masanao , Kanemaru Shin‐ichi , Yamashita Masaru , Nakamura Tatsuo , Tamura Yoshihiro , Tamaki Hisanobu , Omori Koichi , Ito Juichi
Published: February 2006

Objective: The aim of our study was to examine the tissue response and new bone formation induced by β‐tricalcium phosphate (β‐TCP), collagen, and autologous bone fragments with fibrin glue implanted into a cranial bone defect.

Materials and Methods: Granulated β‐TCP and collagen from porcine skin were mixed and freeze‐dried. The weight ratio of both materials was 98:2. The composite scaffold for bone regeneration was composed of this artificial material and autologous bone fragments. Five adult beagle dogs were used. A cranial bone defect (2 cm × 2 cm) was created in each dog. The animals were divided into two groups. In group 1 (n = 3), the cranial bone defect was closed by replacing the original free bone flap, and the residual fissure and burr holes were filled with the composite scaffold with fibrin glue. In group 2 (n = 2), the bone defect was closed only by replacing the original free bone flap. Three months after the treatment, computed tomography and histologic examinations were done in all animals.

Results: In all dogs in group 1, the defects were almost closed by new bone; whereas in group 2, the defects were filled with fibrous tissues instead of bone.

Conclusion: This study showed that the composite scaffold made of β‐TCP, collagen, and autologous bone fragments with fibrin glue enabled reconstruction of cranial bone defects without the usual fixation materials.
Incidence of Inverted Papilloma in Recurrent Nasal Polyposis
Authors: Garavello Werner , Gaini Renato Maria
Published: February 2006

Objectives: A diagnosis of inverted papilloma in apparently normal bilateral polyps is a possible albeit rare event. The frequency of this diagnosis varies between 0.00% and 0.92%. There are no studies evaluating whether this possibility is significantly different in patients operated for recurrence when compared with those undergoing first surgery. The aim of this study is to evaluate the frequency of inverted papilloma in a series of histologic specimens obtained from patients undergoing surgery for recurrent nasal polyposis.

Methods: The authors conducted a retrospective chart and pathologic review of data from 1887 surgical interventions for removal of unremarkable bilateral nasal polyps. Frequency of inverted papilloma was assessed.

Results: Five cases of inverted papilloma were identified. The incidence of this diagnosis was thus 0.26% (95% confidence interval, 0.08–0.62%). Age, gender, and number of recurrences did not influence the frequency of this diagnosis.

Conclusions: The occurrence of inverted papilloma in unremarkable recurrent cases of nasal polyps is rare. This rate is similar to the one observed in patients undergoing first surgery.
Comparative Proteomics Analysis of the Proteins Associated With Laryngeal Carcinoma‐Related Gene 1
Authors: Zhang Xiaopeng , Xiao Zhiqiang , Chen Zhuchu , Li Cui , Li Jianling , Yanhui Yu , Yang Fang , Yang YiXuan , Oyang Yongmei
Published: February 2006

Objectives: A novel gene, laryngeal carcinoma‐related gene 1 (LCRG1), had the characteristics of tumor‐suppressor genes. It was cloned in our laboratory. The objective was to find and characterize the proteins related to LCRG1 and to elucidate the molecular mechanism of LCRG1.

Study Design: We used the established cell lines of Hep‐2/LCRG1 (Hep‐2 cells transfected by recombinant plasmid pcDNA3.1[+]/LCRG1) and Hep‐2/pcDNA3.1(+) (Hep‐2 cells transfected by control vector pcDNA3.1[+]) as cell models.

Methods: Two‐dimensional gel electrophoresis (2‐DE) technology was performed to separate the proteins of Hep‐2/LCRG1 and Hep‐2/pcDNA3.1(+) cell lines, respectively. The differential protein spots were analyzed by software analysis, subject to in‐gel digestion, and identified by Matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF‐MS) and electrospray ionization–quadruple time‐of‐flight MS/MS (ESI‐Q‐TOF MS/MS). Then the differential expression levels of partial identified proteins were determined by Western blotting analysis and quantitative real‐time reverse transcriptase–polymerase chain reaction.

Results: The results showed the attained 2‐DE patterns of the two cell lines were well‐resolved and reproducible. There were 1075 ± 43 and 1027 ± 23 protein spots observed in Hep‐2/LCRG1 and Hep‐2/pcDNA3.1(+) cell lines, respectively. The average matching rate of the two cell lines was 91%. Twenty‐six differentially expressed protein spots were identified (twenty spots for MALDI‐TOF‐MS, six spots for ESI‐Q‐TOF MS/MS). Most of the characterized proteins were characterized as the members of enzymes (phosphoglycerate mutase, manganese superoxide dismutase, and so on), transcription proteins (rho gdp dissociation inhibitor), and so on. Those identified proteins might contribute to the tumor‐suppressive function of LCRG1. The differential expression levels of the partial proteins were confirmed by real‐time polymerase chain reaction and Western blotting.

Conclusions: We tentatively proposed those differentially expressed proteins were involved in the tumor‐suppressive process related to LCRG1. These data will be helpful to elucidate the molecular mechanism of LCRG1.
The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery
Authors: Farrag Tarik Y. , Samlan Robin A. , Lin Frank R. , Tufano Ralph P.
Published: February 2006

Objective: The objective of this study was to evaluate the utility of screening laryngoscopic examination in evaluating vocal fold (VF) mobility before thyroid surgery.

Methods: The authors conducted a retrospective chart review of 340 patients who have undergone thyroid surgery from January 1998 to June 2005 and had preoperative laryngoscopy by mirror, fiberoptic, or videostroboscopic examination. Reports of preoperative voice change or complaint and reports of preoperative VF examination, including the method of examination, were recorded. For patients with VF motion impairment, reports of the intraoperative condition of the recurrent laryngeal nerve (RLN), preoperative diagnosis based on fine needle aspiration, and final postoperative histopathologic examination results were recorded.

Results: Twenty‐two patients were found to have preoperative VF motion impairment, of which seven (32%) patients were asymptomatic with no detectable subjective or objective voice problems. This differs significantly from the hypothesis that patients with VF motion impairment are always symptomatic (P = .009). Using voice symptoms as a screening test to predict VF motion impairment in 340 patients reveals that the sensitivity was 68%, specificity was 91%, positive predictive value (PPV) was 31%, and negative predictive value (NPV) was 98%. Among the 22 patients with preoperative VF motion impairment, five (72%) of the seven asymptomatic patients had benign, slowly progressive disease on their final histopathology reports. Six of these asymptomatic patients had their preoperative VF evaluation by fiberoptic examination, whereas one patient had indirect mirror laryngoscopy. Of 22 patients with preoperative VF motion impairment, five (22.5%) patients had abnormal VF mobility contralateral to the thyroid lesion on their preoperative evaluation, and only two of them had nerve injury reported after a previous thyroid surgery. This result differs significantly from the hypothesis that impaired mobility is ipsilateral to the side of the lesion (P = .05).

Conclusions: Patients without voice complaints can have VF motion impairment. Patients can also have VF motion impairment contralateral to the thyroid lesion. Preoperative VF examination helps counsel patients appropriately about the risks of surgery and helps outline a plan for the extent of surgery while minimizing the medicolegal ramifications of iatrogenic RLN injury.
Immunoglobulins and Inflammatory Cytokines in Nasal Secretions in Humoral Immunodeficiencies
Authors: Rose Markus A. , Schubert Ralf , Schmitt‐Grohe Sabina , Reichenbach Janine , Zielen Stefan
Published: February 2006

Objective: Chronic respiratory tract infections are a common problem in patients with severe humoral immunodeficiency despite intravenous immunoglobulin therapy (IVIG), often presenting as rhinosinusitis.

Methods: Because it is unclear whether IVIG is a good substitute at the mucosal surface, we analyzed immunoglobulin levels and inflammatory cytokines (ECP, IL‐8, and TNF‐α) in nasal secretions of 13 patients with common variable immunodeficiency (CVID) and in 10 patients with IgA deficiency.

Results: In patients with CVID, median IgG and IgM levels did not differ significantly from controls, whereas inflammatory cytokines were markedly elevated, reflecting persistent inflammation at the mucosal site. In contrast, patients with IgA deficiency showed significantly raised IgG and IgM levels, whereas ECP and TNF‐α were only slightly increased.

Conclusion: Low levels of SIgA might be compensated locally at the mucosal site by high levels of IgM and IgG. Our findings implicate that adequate IVIG is not sufficient to prevent chronic inflammation of the sinuses in patients with severe humoral immunodeficiency.
A Double‐Blind, Randomized, Placebo‐Controlled Trial of Macrolide in the Treatment of Chronic Rhinosinusitis
Authors: Wallwork Ben , Coman William , Mackay‐Sim Alan , Greiff Lennart , Cervin Anders
Published: February 2006

Objectives: The antiinflammatory effect of macrolide antibiotics has been well‐established, as has their role in the treatment of certain disorders of chronic airway inflammation. Several studies have suggested that long‐term, low‐dose macrolides may be efficacious in the treatment of chronic rhinosinusitis; however, these studies have lacked a control group. To date, this effect has not been tested in a randomized, placebo‐controlled study.

Method: The authors conducted a double‐blind, randomized, placebo‐controlled clinical trial on 64 patients with chronic rhinosinusitis. Subjects received either 150 mg roxithromycin daily for 3 months or placebo. Outcome measures included the Sinonasal Outcome Test‐20 (SNOT‐20), measurements of peak nasal inspiratory flow, saccharine transit time, olfactory function, nasal endoscopic scoring, and nasal lavage assays for interleukin‐8, fucose, and a2‐macroglobulin.

Results: There were statistically significant improvements in SNOT‐20 score, nasal endoscopy, saccharine transit time, and IL‐8 levels in lavage fluid (P < .05) in the macrolide group. A correlation was noted between improved outcome measures and low IgE levels. No significant improvements were noted for olfactory function, peak nasal inspiratory flow, or lavage levels for fucose and a2‐macroglobulin. No improvement in any outcome was noted in the placebo‐treated patients.

Conclusion: These findings suggest that macrolides may have a beneficial role in the treatment of chronic rhinosinusitis, particularly in patients with low levels of IgE, and supports the in vitro evidence of their antiinflammatory activity. Additional studies are required to assess their place in clinical practice.
Epiglottic and Base‐of‐Tongue Prolapse in Children: Grading and Management
Authors: Yellon Robert F.
Published: February 2006

Objectives: A distinct entity of airway obstruction from epiglottic and base‐of‐tongue (EBT) prolapse in the pediatric population is defined. Laryngopharyngeal findings, swallowing dysfunction, and gastroesophageal reflux disease are described in a group of children with EBT prolapse. A new grading system is also presented.

Study Design: A prospective study was conducted of laryngopharyngeal findings in children with EBT prolapse, a description of a new grading system, and review of the pediatric literature.

Methods: Fourteen children with EBT prolapse were prospectively studied with flexible fiberoptic nasopharyngolaryngoscopy. A new grading system for EBT prolapse was developed. Grade 0 is a normal airway. Grade 1 is prolapse of the epiglottis against the posterior pharyngeal wall but with normal position of the tongue. Grade 2 is prolapse of the epiglottis and base of tongue with only the epiglottic tip visible. Grade 3 is glossoptosis with no portion of the epiglottis visible. The diagnostic modalities and treatments for EBT prolapse are reviewed.

Results: Of the 14 children studied, seven (50%) had grade 1, four (29%) had grade 2, and three (21%) had grade 3 EBT prolapse. Swallowing dysfunction (five of 14, 38%) and gastroesophageal reflux disease (13 of 14, 93%) were also prevalent.

Conclusion: The new grading system was applied successfully to describe the severity and sites of airway obstruction in 14 children with EBT prolapse. Swallowing dysfunction and gastroesophageal reflux disease occur in this population. Although surgical therapies are sometimes effective, lack of consistent success and the risk of aspiration with procedures other than tracheotomy may lead some to conclude that continuous positive airway pressure or tracheotomy are the safest options.
Polyester Wax: A New Embedding Medium for the Histopathologic Study of Human Temporal Bones
Authors: Merchant Saumil N. , Burgess Barbara , O'Malley Jennifer , Jones Diane , Adams Joe C.
Published: February 2006

Background: Celloidin and paraffin are the two common embedding mediums used for histopathologic study of the human temporal bone by light microscopy. Although celloidin embedding permits excellent morphologic assessment, celloidin is difficult to remove, and there are significant restrictions on success with immunostaining. Embedding in paraffin allows immunostaining to be performed, but preservation of cellular detail within the membranous labyrinth is relatively poor.

Objectives/Hypothesis: Polyester wax is an embedding medium that has a low melting point (37°C), is soluble in most organic solvents, is water tolerant, and sections easily. We hypothesized that embedding in polyester wax would permit good preservation of the morphology of the membranous labyrinth and, at the same time, allow the study of proteins by immunostaining.

Methods: Nine temporal bones from individuals aged 1 to 94 years removed 2 to 31 hours postmortem, from subjects who had no history of otologic disease, were used. The bones were fixed using 10% formalin, decalcified using EDTA, embedded in polyester wax, and serially sectioned at a thickness of 8 to 12 μm on a rotary microtome. The block and knife were cooled with frozen CO2 (dry ice) held in a funnel above the block. Sections were placed on glass slides coated with a solution of 1% fish gelatin and 1% bovine albumin, followed by staining of selected sections with hematoxylin and eosin (H&E). Immunostaining was also performed on selected sections using antibodies to 200 kD neurofilament and Na‐K‐ATPase.

Results: Polyester wax–embedded sections demonstrated good preservation of cellular detail of the organ of Corti and other structures of the membranous labyrinth, as well as the surrounding otic capsule. The protocol described in this paper was reliable and consistently yielded sections of good quality. Immunostaining was successful with both antibodies.

Conclusion: The use of polyester wax as an embedding medium for human temporal bones offers the advantage of good preservation of morphology and ease of immunostaining. We anticipate that in the future, polyester wax embedding will also permit other molecular biologic assays on temporal bone sections such as the retrieval of nucleic acids and the study of proteins using mass spectrometry–based proteomic analysis.
Three‐Week Thyroxine Withdrawal: A Thyroid‐Specific Quality of Life Study
Authors: Davids Taryn , Witterick Ian J. , Eski Spiro , Walfish Paul G. , Freeman Jeremy L.
Published: February 2006

Objectives/Hypothesis: The purpose of this study is to determine the impact of a 3‐week T4 withdrawal test on the quality of life (QOL) of patients undergoing investigation for residual/recurrent well‐differentiated thyroid cancer.

Study Design: Prospective survey study.

Methods: 181 patients with well‐differentiated thyroid cancer were surveyed using a thyroid‐specific QOL‐thyroid survey at three times throughout the study: prior to T4 withdrawal, after the 3‐week withdrawal period, and 4 weeks after resuming T3/T4 combination therapy.

Results: A very small, though statistically significant, reduction was observed in the four domains of QOL defined by the QOL‐thyroid survey from baseline values to 3 weeks after T4 withdrawal. The maximal difference was 2.04 (fatigue), out of a possible 10 point score, in the physical well‐being category.

Conclusions: The thyroid‐specific QOL questionnaire demonstrates a statistically significant though very small and probably not clinically significant reduction in the QOL of thyroid cancer patients undergoing an induced 3‐week hypothyroid state. Three‐week T4 withdrawal is a simple, cost‐effective, and readily available test.
Treatment of Chronic Posterior Laryngitis With Esomeprazole
Authors: Vaezi Michael F. , Richter Joel E. , Stasney C Richard , Spiegel Joseph R. , Iannuzzi Ralph A. , Crawley Joseph A. , Hwang Clara , Sostek Mark B. , Shaker Reza
Published: February 2006

Objective: To evaluate the efficacy of acid‐suppressive therapy with the proton pump inhibitor esomeprazole on the signs and symptoms of chronic posterior laryngitis (CPL) in patients with suspected reflux laryngitis.

Study Design: Prospective, multicenter, randomized, parallel‐group trial that compared twice‐daily esomeprazole 40 mg with placebo for 16 weeks.

Methods: Eligible patients had a history of one or more CPL symptoms (throat clearing, cough, globus, sore throat, or hoarseness) and laryngoscopic signs indicating reflux laryngitis based on CPL index (CPLI) scores measured during a screening laryngoscopy. Patients were randomized to treatment if their 7‐day screening diary‐card recordings showed a cumulative primary symptom score of 9 or higher and they had 3 or more days with moderately severe symptoms based on a 7‐point scale. Efficacy was assessed by changes in symptoms as recorded by patients and investigators and by changes in CPLI scores based on laryngoscopic examinations.

Results: The patients' primary CPL symptom at final visit (primary efficacy end point) was resolved in 14.7% (14/95) and 16.0% (8/50) of patients in the esomeprazole and placebo groups, respectively (P = .799). Esomeprazole and placebo were not significantly different for change from baseline to the final visit in mean total CPLI (–1.66 ± 2.13 vs. –2.0 ± 2.55, respectively; P = .446) or any other secondary efficacy end points based on patient diary card or investigator assessments.

Conclusion: This study provides no evidence of a therapeutic benefit of treatment with esomeprazole 40 mg twice daily for 16 weeks compared with placebo for signs and symptoms associated with CPL.
Safety and Efficacy of Nasal Application of CpG Oligodeoxynucleotide as a Mucosal Adjuvant
Authors: Kodama Satoru , Abe Nobuyuki , Hirano Takashi , Suzuki Masashi
Published: February 2006

Objectives: Nasal vaccination is an effective regimen to prevent upper respiratory infections. An appropriate adjuvant is required for the development of a nasal vaccine. The safety and efficacy of CpG oligodeoxynucleotide (ODN) as a mucosal adjuvant was examined.

Methods: Mice were nasally administered various doses of CpG ODN weekly, a total of three times. Histologic changes in the spleen and the nasal mucosa were examined, and the alterations in cell subpopulations were analyzed by flow cytometry. In addition, the mice were nasally immunized with P6 outer membrane protein of nontypeable Haemophilus influenzae (NTHi) and CpG ODN, and P6‐specific immune responses were examined.

Results: No inflammation or tissue damage was observed locally or systemically after nasal administration, even with a high dose of CpG ODN. A high dose of CpG ODN induced an increase in CD8+ T cells in the nasal mucosa and B cells in the spleen. When CpG ODN was coadministered with P6, P6‐specific mucosal and systemic immune responses were effectively induced, since high levels of the specific IgA and IgG were detected in the nasal wash and serum, respectively.

Conclusions: These findings suggest that CpG ODN is a safe and effective mucosal adjuvant. Further, nasal vaccination with P6 and CpG ODN might be an effective regimen to prevent upper respiratory infections.
Upregulation of Surfactant Protein A in Chronic Rhinosinusitis
Authors: Lee Heung‐Man , Kang Hee Joon , Woo Jeong‐Soo , Chae Sung Won , Lee Sang Hag , Hwang Soon Jae
Published: February 2006

Objectives: Surfactant protein A (SP‐A) is protein that appears to play an important role in mammalian first‐line host defense. However, the presence of SP‐A in the human paranasal sinus mucosa is not well known. The purpose of this study was to investigate the expression of SP‐A protein in human paranasal sinus mucosa and to compare the expression of SP‐A mRNA between normal paranasal sinus mucosa and paranasal sinus mucosa with chronic rhinosinusitis.

Methods: Paranasal sinus mucosa samples from 10 patients who underwent surgery for chronic rhinosinusitis without polyps and 10 normal control subjects were used. Reverse transcriptase polymerase chain reaction was done to detect SP‐A mRNA. The expression level of SP‐A transcripts was semiquantified with desitometry. Cellular localization of SP‐A was sought by using immunohistochemistry.

Results:
SP‐A mRNA and protein were expressed in the human paranasal sinus mucosa. SP‐A/GAPDH mRNA ratio in the paranasal sinus mucosa with chronic rhinosinusitis was greater compared with that in normal paranasal sinus mucosa (P < .05). Immunohistochemical staining revealed SP‐A immunoreactivity in the epithelial cells and submucosal glands of paranasal sinus mucosa in both control subjects and chronic sinusitis patients. Stronger immunoreactivity was observed in chronic rhinosinusitis mucosa as compared with normal paranasal sinus mucosa.

Conclusion: SP‐A mRNA and protein are present in both normal and diseased human paranasal sinus mucosa. These results may provide potential targets for novel therapy of chronic rhinosinusitis.
Level IIb Lymph Node Metastasis in Laryngeal Squamous Cell Carcinoma
Authors: Lim Young Chang , Lee Jin Seok , Koo Bon Seok , Choi Eun Chang
Published: February 2006

Objectives: Selective neck dissection, despite preservation of the spinal accessory nerve, can lead to some degree of postoperative shoulder dysfunction as a result of removal of level IIb lymph nodes. The aim of this study was to determine whether level IIb lymph nodes can be preserved in elective or therapeutic neck dissection as a treatment for patients with laryngeal squamous cell carcinoma (SCC).

Study Design: This was a prospective analysis of a case series.

Methods: A prospective analysis of 65 patients with laryngeal SCC who underwent surgical treatment of the primary lesion with simultaneous neck dissection from January 1999 to December 2002 was performed. During the neck dissection, the contents of the level IIb lymph nodes were dissected, labeled, and processed separately from the remainder of level II nodes and the main neck dissection specimen. The incidence of pathologic metastasis to level IIb lymph nodes and the regional recurrence within this area were evaluated. In addition, several potential risk factors for metastatic disease in the level IIb lymph nodes such as sex, age, cT stage, cN stage, and the presence of other positive lymph nodes were also evaluated.

Results: A total of 125 neck dissections were performed in this series. Of these dissections, 102 (82%) were elective and 23 (18%) were therapeutic. The prevalence of metastases in the level IIb lymph nodes was 1% (one of 46) and 0% (zero of 56) in clinically node‐negative (N0) ipsilateral and contralateral necks, respectively, and 37% (seven of 19) and 0% (zero of four) in clinically node‐positive ipsilateral and contralateral necks, respectively. There was a statistically significant association between level IIb metastases and clinically positive N stage (P < .001). The presence of other positive lymph nodes was also shown to have a statistically significant association with metastasis in the level IIb lymph nodes (P = .001). Only two of 46 patients (4%) with clinically N0 necks developed a regional recurrence. However, three of eight cases (38%) with positive pathologic level IIb lymph nodes developed regional recurrence.

Conclusion: Level IIb lymph node pads may be preserved in elective neck dissection in patients with laryngeal SCC. However, this area should be removed thoroughly during therapeutic neck dissection in the treatment of clinically node‐positive necks.
Methicillin‐Resistant Staphylococcus aureus Infections in Acute Rhinosinusitis
Authors: Huang Wei‐Hsiung , Hung Pei‐Kai
Published: February 2006

Objective/Hypothesis: Methicillin‐resistant Staphylococcus aureus (MRSA) has recently become a serious problem in various fields of medicine. However, it has rarely been studied in acute rhinosinusitis. The aim of this study was to identify the clinical manifestations and treatment outcome of community‐acquired methicillin‐resistant S. aureus in acute rhinosinusitis.

Study Design: This was a prospectively collected case series.

Methods: Since 2000, we have launched a prospective long‐term study for bacteriology, drug susceptibility, and their changing trend in acute rhinosinusitis. Patients with the diagnosis of acute rhinosinusitis were enrolled from October 2000 through March 2003. Their middle meatus discharge was taken for aerobic culture. Antibiotic sensitivity test was performed for each isolate.

Results: A total of 601 patients with the diagnosis of acute rhinosinusitis were included in this study. MRSA was isolated in 16 specimens. Its prevalence rate in acute rhinosinusitis was 2.7% (16 of 601). Multiple pathogens were more frequently found in children with MRSA infection. Five of seven adults had previous nasal procedures. Eight of nine children had a history of antibiotic use. Except for two patients without follow up, the remaining 14 patients resolved after receiving oral antibiotics according to culture results.

Conclusions: The incidence of MRSA infection in acute rhinosinusitis was 2.7% in our study. The most important risk factor was nasal surgeries in adults and previous antibiotic use in children. The treatment outcome of community‐acquired MRSA was excellent with oral antibiotics.
Stridor and Dysphagia in Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Authors: Castellano Dominic M. , Sinacori John T. , Karakla Daniel W.
Published: February 2006

As otolaryngologists, we are the first consulted for stridor and dysphagia. One must consider both extrinsic and intrinsic etiologies in the differential diagnosis of these symptoms. We report a series of patients with diffuse idiopathic skeletal hyperostosis (DISH) who presented with stridor or dysphagia. We describe the initial presenting symptoms, physical examination/radiographic findings, and discuss the management options. Traditional teaching is that surgery is rarely indicated for DISH of the cervical spine. Recommendations regarding the role of surgery as well as a review of our surgical experience are discussed.