bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of Postoperative Edema Following Laser‐Assisted Uvulopalatoplasty Using MRI and Polysomnography
Authors: Terris David J. , Clerk Alex A. , Norbash Alexander M. , Troell Robert J.
Published: November 2003

Laser‐assisted uvulopalatoplasty (LAUP) has been introduced as an alternative to uvulopalatopharyngoplasty for the treatment of snoring. Despite limited study, the use of this procedure has been expanded to include patients with obstructive sleep apnea syndrome. Although the potential cost‐savings of performing sleep apnea surgery on an outpatient basis are self‐evident, concern exists regarding the safety of this practice.

In an effort to characterize the risk of performing LAUP on an outpatient basis, eight patients with mild or no sleep apnea were identified and intensively studied before and after the first stage of LAUP to cure snoring. Assessment included preoperative magnetic resonance imaging (MRI) scans, polysomnography, and videoendoscopy. Each of these diagnostic studies was then repeated between 48 and 72 hours after LAUP. Complete polysomnographic data were available for seven of the eight patients.

The mean (±SD) preoperative respiratory disturbance index (RDI) was 11.3 ± 10.9, and the mean oxygen saturation nadir (LSAT) was 87.7 ± 6.2% (n = 7). The mean airway cross‐sectional area at the palate (by MRI) was 49.8 ± 22.8 mm2 (n = 8). After LAUP, the mean RDI nearly doubled to 21.7 ± 9.9 (P>.1). The apnea index increased fourfold from 3.3 ± 3.5 to 14.8 ± 10.9 (P<.03). The mean LSAT remained stable at 87.4 ± 4.1% (P>.5). The cross‐sectional area of the airway decreased to a mean of 47.9 ± 22.4 mm2 (P>.5).

These data suggest that LAUP may temporarily worsen obstructive sleep apnea. Although the clinical significance of this degree of worsening is uncertain, it would be prudent to consider perioperative use of nasal continuous positive airway pressure in patients with more than mild obstructive sleep apnea who undergo ambulatory LAUP.
Aggressive Papillary Tumors of the Temporal Bone
Authors: Levin Roger J. , Feghali Joseph G. , Morganstern Nora , Llena Josefina , Bradley Margaret K.
Published: November 2003

Aggressive papillary tumors of the temporal bone are neoplasms that are locally invasive and destructive. Previously classified on histologic study as middle ear adenomas or adenocarcinomas, observational evidence suggested that they arose from endolymphatic sac.

To evaluate this hypothesis, we established a tissue culture from cells derived from such a papillary tumor and compared immunohistochemical stains of the original tumor with stains on endolymphatic epithelium. Similarities in expression of neuroectodermal antigens were observed. Similar staining antigens in cells derived from tumor and the endolymphatic sac provide evidence that epithelium from endolymphatic sac is the site of origin for these aggressive neoplasms.

In tissue culture the cells remain contact inhibited and dependent on serum or growth factors with survival beyond the expected senescence at 30 to 50 generations. Therefore the cell culture technique provides a model for study of the disruption of growth control and invasive properties of this tumor.
Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck Region
Authors: Tavin Ellis , Persky Mark
Published: November 2003

Cutaneous squamous cell carcinoma has a relatively low metastatic rate (0.5% to 16%), but patients with the disease should always be evaluated for possible regional nodal involvement. We reviewed the records of 37 patients with metastatic disease among the 388 patients with head and neck cutaneous squamous cell carcinoma who were treated at New York University Medical Center between 1961 and 1992. In this group of patients the most common primary site was the cheek or preauricular region and the most common metastatic site was the level I neck lymph nodes. Seven patients (18%) had metastases at initial presentation. Among the remaining patients the average time to the development of metastases was 19 months. Nineteen patients (51%) had recurrence at the primary site before metastasis; 11 (30%) developed metastases with control of the primary tumor. Analysis of the records of 31 patients treated for cure revealed that 13 were treated by surgery, 2 by radiation therapy, and 16 by a combination of surgery and radiation therapy. During the mean follow‐up period of 49 months, 11 (35%) of these 31 patients died of their disease. Recurrence of the primary tumor appeared to increase the risk for nodal and distant metastases.
In Vitro and In Vivo Determination of the Thermal Effect of Middle Ear Endoscopy
Authors: Bottrill Ian , Perrault Donald F. , Poe Dennis
Published: November 2003

During middle ear endoscopy, patients frequently experience vertigo. We theorized that this effect is secondary to heat produced by the scope. We evaluated two Hopkins rods and two fiberoptic scopes to assess the temperature elevation at the lateral semicircular canal (LSCC) of temporal bones and in a live canine model. These results were compared to the results of a standard 44° C water caloric.

We demonstrated in both models that the temperature rise at the LSCC increased relative to the scope diameter and that the Hopkins rods produced the same or greater heating effect than a warm caloric. Direct exposure of the thermocouple to the light produced a greater temperature elevation.

We conclude that endoscopes produce sufficient heat to induce caloric stimulation of the LSCC. Care should be exercised to prevent the possibility of thermal injury.
Quantitative Analysis of Interleukin‐1‐Alpha Gene Expression in Middle Ear Cholesteatoma
Authors: Bujía J. , Kim C. , Boyle D. , Hammer C. , Firestein G. , Kastenbauer E.
Published: November 2003

Regardless of its origin, cholesteatoma is characterized by the presence of a keratinizing epithelium with an hyperproliferative behavior leading to a very important bone resorption. Previous studies have demonstrated overexpression of interleukin‐1 (IL‐1) protein in middle ear cholesteatoma by immunohistochemistry and enzyme‐linked immunosorbent assay, suggesting a significant role for IL‐1‐alpha.

In this study, the presence of IL‐1‐alpha messenger ribonucleic acid (mRNA) was quantified by in situ hybridization on frozen sections (n=10) and by computer‐assisted image analysis. Human skin obtained from the external ear canal (n=10) was used as the control. A higher percentage of cells hybridized for the antisense probes IL‐1‐alpha mRNA was found in cholesteatoma epithelium. Furthermore, keratinocytes of the suprabasal cell layers were also found to contain specific hybridizations. Some cells in cholesteatoma stroma also contained IL‐1‐alpha mRNA transcripts. The results of this study confirm the central role of IL‐1‐alpha in the epithelium hyperproliferation and bone resorption observed in middle ear cholesteatoma.
Cervical Thymic Cyst: Case Reports and Review of the Literature
Authors: Nguyen Quoc , deTar Michael , Wells Winfield , Crockett Dennis
Published: November 2003

Due to its rarity, cervical thymic cyst is seldom included in the differential diagnosis of a neck mass. Approximately 80 cases have been reported thus far, and most of these cases have occurred asymptomatically in children and adults. Only 5 cases have involved patients younger than 1 year of age.

The authors report four new patients with thymic cyst in the neck. Two of the patients were newborns in whom the cyst caused airway obstruction and dysphagia. All four patients underwent successful resection of the lesions, with complete resolution of symptoms.

The embryology, histopathology, and differential diagnosis of cervical thymic cysts are also reviewed. The authors recommend that despite its infrequent occurrence, cervical thymic cyst should be considered in the evaluation of neck masses in children.
Extranodal Rosai‐Dorfman Disease of the Head and Neck
Authors: Goodnight James W. , Wang Marilene B. , Sercarz Joel A. , Fu Yao S.
Published: November 2003

Rosai‐Dorfman disease is a rare, idiopathic, benign histiocytic proliferation usually seen in younger patients. Massive lymphadenopathy most commonly involves the cervical lymph nodes, with a predominant infiltration of sinusoidal histiocytes. Nearly half of the patients will have extranodal involvement, 75% occurring in sites in the head and neck. Three cases of extranodal Rosai‐Dorfman disease of the head and neck involving the nose, paranasal sinuses, and parotid gland are presented. The clinical presentation, histologic characteristics, radiographic findings, and treatment of the disease are discussed. Because of the scarcity of cases, the clinical and histopathologic features of this disease may be overlooked. Familiarity with its relatively frequent clinical manifestations in the head and neck, as well as with the diagnostic histopathology, should preclude confusion with other disease entities.
Advances in the Development of the Interferometric Otoscope
Authors: Parnes Steven M. , Cacace Anthony T. , Castracane James , Conerty Michelle , Gardner Glendon M.
Published: November 2003

Present measurement techniques for middle ear function have inherent limitations because they are either spatially insensitive (acoustic immittance) or descriptive and qualitative in nature (otoscopy). By integrating advances in electrooptic technology (fiber optics, miniature diode lasers, solid‐state detector arrays) and digital processing, further advances are possible. On the basis of measurements taken with electronic speckle‐pattern interferometry on human temporal bones and models, we demonstrate quantitative static and dynamic vibration/displacement characteristics of the tympanic membrane with high spatial resolution. Our presentation emphasizes advantages of optically based methods and demonstrates computerized signal processing capable of fringe localization, enhancement, and counting. Miniaturization and real‐time digital image processing in the clinical setting is the goal of this research.
The Effects of Keratinocyte Growth Factor on Healing of Tympanic Membrane Perforations
Authors: Clymer Mark A. , Schwaber Mitchell K. , Davidson Jeffrey M.
Published: November 2003

Tympanic membrane (TM) perforations heal by reepithelialization and fibrous layer proliferation. The rat TM model may be used to study growth factors that promote epithelialization and fibroblast proliferation, such as epidermal growth factor (EGF) and fibroblast growth factor (FGF). The authors previously evaluated the effects of FGF on tympanic membrane perforations and showed an enhanced rate of wound healing with preservation of normal structure and function. The same model was used to test keratinocyte growth factor (KGF, also called FGF‐7). This growth factor has been shown to stimulate the migration and proliferation of keratinocytes. This is the first study investigating KGF in the tympanic membrane perforation model. Our results show that in contrast to FGF and EGF, KGF does not enhance the rate of wound healing, but rather results in a more organized wound repair process.
Prediction of the Clinical Outcome of Acute Frontal Sinusitis With Ventilation Measurement of the Nasofrontal Duct After Trephination: A Long‐Term Follow‐up Study
Authors: Sipilä J. , Suonpää J. , Wide K. , Silvoniemi P.
Published: November 2003

Acute frontal sinusitis has become an increasing clinical problem in the region that is served by the hospital represented by the authors of this study. The standard surgical treatment protocol after the failure of conservative therapy has been to perform trephination of the involved frontal sinus. More sophisticated procedures have been used in patients with prolonged or recurrent disease.

The authors have developed a simple ventilation test of the nasofrontal duct that can be used to determine which patients require further surgery. In a long‐term follow‐up study of 85 patients, this ventilation test was shown to predict the cases that would heal uneventfully after trephination and the cases that would require further surgery because of an obstructed nasofrontal duct. The findings of this study are of special interest for modern functional endoscopic sinus surgery, the purpose of which is to open up the nasofrontal region.
Malignant Melanoma Metastatic to the Tonsil
Authors: Barlas Aydogan L. , Myers Jeffrey N. , Myers Eugene N. , Kirkwood John
Published: November 2003

Metastasis to the oral cavity from melanoma arising in distant sites is very rare. The authors present three cases of melanoma metastatic to the palatine tonsil: two were cutaneous melanomas and one arose from the mucous membrane of the hard palate. Fewer than 30 cases of metastatic melanoma to the palatine tonsil have been reported, and none have been from mucosal melanoma originating from another mucosal primary site in the head and neck. From this perspective, one of the cases in this article is unique.

The authors present clinical histories of the three cases of melanoma metastatic to the palatine tonsil. Two patients were still alive a substantial time after treatment. The case presentations indicate that careful examination of the head and neck should be part of the routine follow‐up examination in all melanoma patients.
Wound Healing: Effects of Closing Tension, Zyplast™, and Platelet‐Derived Growth Factor
Authors: Tzikas MAJ Thomas L. , Burgess LTC Lawrence P. A. , Pickett MAJ Bradley P. , Brammer Robert E. , Vossoughi Jafar
Published: November 2003

Previous studies have shown that beginning 5 to 7 days from wounding, the tensile strength of wounds closed under tension in rats is significantly higher than the tensile strength of wounds closed without tension. This study evaluated the effects of increased closing tension, zyplast implant (ZI), and human recombinant platelet‐derived growth factor (PDGF) on the tensile strength of wounds. Six groups of 12 rats each were divided into two main subsets: wounds were closed without tension in three groups and with high tension of approximately 100 g in the three other groups. In both no‐tension and high‐tension groups, one subgroup received no intervention (controls), one subgroup received ZI (zyplast controls), and one subgroup received ZI‐PDGF (ZI used as a carrier for PDGF). Healing was evaluated by tensile strength determinations at 5 days.

For the controls, wounds closed under tension showed a trend toward higher tensile strength, but statistical significance was not reached. Compared with controls, tensile strength was 45% lower in the wounds with ZI and closure with tension (P = .0063) and 38% lower in the wounds with ZI and closure without tension (P = .007). Treatment with ZI‐PDGF resulted in 69% higher tensile strengths (P = .049) as compared with ZI controls for wounds closed with tension. This study demonstrated the beneficial effect of PDGF in accelerating healing in wounds closed under tension. Although ZI was able to deliver PDGF to the wound, the use of this substance as a carrier is questioned since it was detrimental to healing.
Risk of Transmission of Human Immunodeficiency Virus Infection During Tympano‐ossicular Homograft: An Experimental Study
Authors: Meylan Pascal R.A. , Duscher Alexandre , Mudry Albert , Monnier Philippe
Published: November 2003

It is generally agreed that middle ear reconstructive surgery performed with tympano‐ossicular homografts produces superior functional results compared with prosthetic material, especially with respect to extrusion rate. The use of homografts, though, has been seriously hampered recently by the fear of transmission of human immunodeficiency virus (HIV) infection. In HIV‐infected patients, the virus is primarily found in the cells of the lymphoid and monocytic lineage. The nature of the tissues in the eardrum and ossicles, mostly fibrous tissue and compact bone without marrow, suggests that little virus load should be found in homografts. Indeed, culturing minced homograft tissue from two HIV‐infected donors with acquired immune deficiency syndrome(AIDS) in a sensitive culture system with PHA‐stimulated lymphoblasts produced no virus. Before use, homografts undergo a fixation procedure in 5% formaldehyde and then are kept in a solution containing Cialit as a preservative. The authors therefore examined the capacity of formaldehyde and Cialit to reduce the infectivity of HIV in models of infected tissue as measured in vitro. The reduction of in vitro infectivity due to these treatments was at least 105‐fold and 102‐fold, respectively. Coupled with the low virus burden in tympano‐ossicular tissue, our data suggests that the fixation procedure affords such a reduction in infectivity that the risk of HIV transmission, even from an HIV‐infected donor, is vanishingly low.
SPECT Gallium Scintigraphy in Malignant External Otitis: Initial Staging and Follow‐up. Case Reports
Authors: Stokkel Marcel P.M. , Boot Ina C.N. , van Eck‐Smit Berthe L.F.
Published: November 2003

Malignant external otitis (MEO) is a recognized entity characterized by a stubborn Pseudomonas external otitis; it has been most frequently observed in elderly diabetic patients. Early diagnosis is necessary for successful treatment but, despite a widespread inflammatory response, routine plain x‐ray studies and computed tomography (CT) scanning show no abnormalities in its early stage. In this report, the clinical value of gallium 67 (Ga 67) single photon emission CT (SPECT) is studied in three patients suspected of having MEO, and the results are compared with findings on CT scan and laboratory tests. These results confirm that the high sensitivity of Ga 67 SPECT in the initial recognition of MEO provides a more adequate technique than CT scan. Furthermore, Ga 67 scintigraphy appears to be highly accurate for follow‐up evaluation of these patients.
Laparoscopic Gastrostomy Versus Open Gastrostomy in Head and Neck Cancer Patients
Authors: Lydiatt Daniel D. , Murayama Kenric M. , Hollins Ronald R. , Thompson Jon S.
Published: November 2003

Alimentation in the surgically treated head and neck cancer patient frequently requires bypassing the upper aerodigestive tract. The laparoscopic gastrostomy fulfills this criterion. The authors compared 25 laparoscopic gastrostomies (group 1) with 18 open gastrostomies (group 2) performed on head and neck cancer patients. The length of operation, morbidity, mortality, and cost were evaluated. Operative time was significantly shorter in group 1 (40± 2 minutes) than in group 2 (56 ± 4 minutes), with P=.003. The major complication rate was 9% for group 1 and 11% for group 2. There was no procedure‐related mortality in group 1, but 1 patient died in the immediate postoperative period in group 2. The cost was not significantly different. It is concluded that the laparoscopic gastrostomy is a safe and cost‐effective alternative to open gastrostomy in this patient group.
Galvanic‐Induced Postural Movements As a Test of Vestibular Function in Humans
Authors: Cass Stephen P. , Redfern Mark S. , Furman Joseph M. , DiPasquale James J.
Published: November 2003

Galvanic stimulation produces postural sway and eye movements in humans. Since galvanic currents are thought to exert their effect at the trigger zone of the vestibular nerve, an intact vestibular nerve should be necessary to produce a response. We have used galvanic stimulation in humans to test the hypothesis that intact vestibular nerve fibers are required to obtain a postural sway response. Experimental subjects included normal subjects, patients who had undergone resection of an acoustic neuroma, and patients who had undergone vestibular neurectomy and surgical labyrinthectomy. Our results support the hypothesis that an intact vestibular nerve is necessary to produce a response. Moreover, two patients with recurrent vertigo following vestibular neurectomy and labyrinthectomy, who had absent ice‐water caloric test responses in the operated ears, were found to have a positive galvanic response. This result suggested that their recurrent vertigo was based on intact residual vestibular nerve fibers. Although previous research has not yielded a routine clinical use for galvanic stimulation, our results suggest that galvanic stimulation of the vestibular system can provide unique and valuable diagnostic information.
Epidermal Growth Factor Receptor Expression by Acoustic Neuromas
Authors: Sturgis Erich M. , Woll Sandra S. , Aydin Faruk , Marrogi Aizen J. , Amedee Ronald G.
Published: November 2003

Antibodies directed against epidermal growth factor receptor (EGFr) impede proliferation and induce differentiation of EGFr‐positive cancers. To explore the effectiveness of anti‐EGFr monoclonal antibodies on acoustic neuromas (ANs), we first sought to evaluate EGFr expression by ANs. The records of all patients with the diagnosis of AN at our institution from January 1989 to July 1994 were reviewed.

Immunohistochemical analysis for EGFr was performed on formalin‐fixed, paraffin‐embedded archival surgical specimens. Skin, liver, and placenta were used as positive tissue controls. Purified rabbit immunoglobulin G replacing the experimental antibody acted as a negative control, and normal eighth cranial nerve was evaluated for background staining. Slides were scored as 0,+, ++, or +++ and for percentage of positive cells by two pathologists, with Antoni A and Antoni B areas scored separately. Results demonstrate that most tumors are revealed to be EGFr positive with a mild degree of staining. Antoni A areas generally have greater staining than Antoni B regions, while normal eighth cranial nerves demonstrate minimal background staining. These results suggest that ANs express low levels of EGFr, with Antoni A areas having the highest levels. While further studies may more accurately quantitate EGFr levels in these tumors, the clinical efficacy of anti‐EGFr‐based therapies for ANs seems doubtful.
Epidermal Differentiation in the Human External Auditory Meatus
Authors: Vennix P.P.C.A. , Kuijpers W. , Peters T.A. , Tonnaer E.L.G.M. , Ramaekers F.C.S.
Published: November 2003

The differentiation of epidermis in the various parts of the human ear canal was documented on the basis of cytokeratin (Ck) expression patterns. Immunohistochemistry was performed on cryostat sections of normal meatal skin using a comprehensive panel of monospecific Ck antibodies representing the main lines of epithelial differentiation.

The epidermis of the cartilaginous part showed a Ck profile characteristic of normal skin type differentiation. The deep meatal skin, including the tympanic membrane, showed a peculiar type of differentiation: in addition to epidermal Cks, hyperproliferation‐associated Cks 6, 16, and 17 were expressed in the suprabasal cells, while the simple epithelial cell marker Ck 19 was found in the basal cells.

The presence of hyperproliferative Cks in the deep meatal skin could only partly be related to areas of proliferative activity. Keratinocytes, which express markers of hyperproliferation, are migratory. Therefore, their presence in the meatal skin is likely to be related to the peculiar pattern of keratinocyte migration, the purpose of which is to keep the meatus free from desquamation products.
Regeneration of the Damaged Endolymphatic Sac Epithelium
Authors: Takahashi Mitsuaki , Tomiyama Shun‐ichi
Published: November 2003

The regeneration of endolymphatic sac (ES) epithelium after epithelial damage was examined using 5‐bromo‐2′‐deoxyuridine (BrdUrd). Guinea pigs and anti‐BrdUrd, antikeratin, and anti‐basement membrane (BM) component antibodies were used. Animals were sacrificed at 3, 7, and 14 days following an immune injury of the ES. The animals were sacrificed after an administration of BrdUrd at the designated times. Decalcified temporal bones were examined immunohistochemically. At day 3, epithelial loss without subepithelial BM was seen in the region of marked cell infiltration. BrdUrd‐positive cells could be detected in the epithelium at the edge of the wound. At day 7, cell infiltration decreased, and the epithelial lining with BM was repaired. These results reveal that the epithelium of the ES can regenerate within 7 days after an immune injury.

Laryngoscope, 106:619‐623, 1996
Influence of Chemical Allograft Preservation Procedures on the Human Immunodeficiency Virus
Authors: Bujía Jesús , Wilmes Eberhard , Kastenbauer Ernst , Gürtler Lutz
Published: November 2003

Since chemically preserved allogenic transplants have an established place in reconstructive procedures, the possibility of transferring the human immunodeficiency virus (HIV) with these transplants has been intensively discussed. In this study the authors obtained brain and spleen samples from six HIV‐infected cadavers and preserved them with Merthiolate, Cialit, and formaldehyde. After preservation, the tissues were examined for proviral HIV‐1 DNA (gag, pol, env) using the polymerase chain reaction. Proviral sequences were clearly demonstrated after the preservation procedure.

The results of this study indicate that HIV remains in tissues that have been treated with Merthiolate, formaldehyde, or Cialit. Further investigations are necessary to determine if the virus is in an inactivated or activated form. It can be concluded that, because of the possible transmission of HIV by chemically preserved homografts, serologic screening of donors should be mandatory.

Laryngoscope, 106:645‐647, 1996
General Anesthesia With and Without Nitrous Oxide (N2O) and the Weight of Middle Ear Effusion in Children Undergoing Adenoidectomy and Tympanostomy
Authors: Koivunen Petri , Alho O‐P. , Uhari M. , Partanen A. , Luotonen J.
Published: November 2003

This study was designed to explore the effect of nitrous oxide (N2O) on the amount of middle ear effusion. Seventy‐six children referred for adenoidectomy or tympanostomy tube placement were divided into two groups in the basis of the method of anesthesia. One group of 39 children was ventilated with a mixture of 30% oxygen and 70% nitrous oxide, while the other group of 37 patients was ventilated with a mixture of oxygen and air. The amounts of middle ear effusion obtained in myringotomy were weighed and compared between these groups. Preoperative and perioperative tympanograms were performed.

Ventilation with nitrous oxide caused a distinct rise in middle ear pressure. The amount of the middle ear effusion, however, remained the same in the two groups. It is concluded that the operating surgeon can rely on the myringotomy finding even when nitrous oxide anesthesia is used.
Predicting Distant Failure in Nasopharyngeal Cancer
Authors: Koukourakis Michael I. , Whitehouse Routh M. , Giatromanolaki Alexandra , Saunders Mark , Kaklamanis Loukas
Published: November 2003

In a prospective study of 78 patients with nasopharyngeal cancer, we examined the prognostic significance of T stage, histology, parapharyngeal involvement, and lymph node dimensions, size, and level concerning distant metastasis. All patients were treated with radical radiotherapy alone and completed 3 to 7 years of follow‐up. In univariate analysis of time to metastasis, there was a significant difference stratifying for T stage (T1 and 2 versus T3 and 4), node dimensions (less than 6 versus more than or equal to 6 cm), neck level (above versus below the thyroid notch), and parapharyngeal involvement, but not for bilaterality of lymphadenopathy. Histology was an important prognostic factor related to distant metastasis since none of the 24 World Health Organization class I cases showed distant metastasis versus 14 (26%) of 54 patients with World Health Organization class II/III carcinoma. A multivariate duration model of time to metastasis within the later histologic group suggested that lymph node dimensions, node level, and T stage were the most important factors related to distant metastases, with the hazard ratios being 3.98, 3.23, and 1.76, respectively. Multivariate analysis within the T3‐ to T4‐stage group showed that node dimension was the only significant variable, with an associated hazard ratio of 4.09. Cases with upper‐neck lymphadenopathy and node dimensions of less than 6 cm had a distant metastasis rate of <5%. We conclude that adjuvant chemotherapy for nasopharyngeal cancer is justified in T3‐ and T4‐staged cases with nonkeratinizing or undifferentiated histology and with lymph nodes larger than 6 cm and/or located below the thyroid notch.
Evaluation of a New Laser‐Resistant Fabric and Copper Foil‐Wrapped Endotracheal Tube
Authors: Sosis Mitchel B. , Braverman Berton , Caldarelli David D.
Published: November 2003

The risk of an endotracheal tube's combustion during laser airway surgery necessitates the use of special anesthetic techniques and equipment to prevent this complication. This study was designed to evaluate the Laser‐Trach™, a new laser‐resistant rubber endotracheal tube for use during laser airway surgery.

The Laser‐Trach endotracheal tubes that were evaluated were size 6.0 mm internal diameter (ID) red rubber endotracheal tubes which had been commercially wrapped by Kendall‐Sheridan (Mansfield, Mass.) with copper foil tape and overwrapped with fabric. The fabric layer was saturated with water prior to our tests, as recommended by the manufacturer. The Laser‐Trach endotracheal tubes were compared with plain (bare) size 6.0 mm ID Rusch red rubber endotracheal tubes. The tubes under study were positioned horizontally on wet towels in air and had 5 L•min−1 of oxygen flowing through them. They were subjected to continuous laser radiation at 40 W from either a CO2 or an Nd‐YAG laser. The Nd‐YAG laser was propagated via a 600‐μm fiber bundle. Each laser was directed perpendicularly at the shaft of the endotracheal tube being studied, and its output was continued until a blowtorch fire occurred or 60 seconds had elapsed.

Sixty seconds of CO2 laser fire did not ignite any of the eight Laser‐Trach endotracheal tubes tested. However, blowtorch ignition of all eight bare rubber tubes tested occurred after 0.87 ± 0.21 (mean ±SD) seconds of CO2 laser fire. Nd‐YAG laser contact with the Laser‐Trach endotracheal tubes caused the perforation and blowtorch ignition of all eight tubes tested after 18.79 ± 7.83 seconds. This was a significantly (P<.05) longer time than the 5.45 ± 4.75 seconds required for the blowtorch ignition of all eight plain rubber endotracheal tubes tested with the Nd‐YAG laser.

Our results show that under the conditions of this study, the shafts of the Kendall‐Sheridan Laser‐Trach endotracheal tubes were resistant to the CO2 laser. However, this endotracheal tube is not recommended for use with the Nd‐YAG laser.

Laryngoscope, 106:842‐844, 1996
Neonatal Mesenchyme Temporal Bone Study: Typical Receding Pattern Versus Increase in Potter's Sequence
Authors: Piza Jorge E. , Northrop Clarinda C. , Eavey Roland D.
Published: November 2003

The fate of mesenchyme, which lines the fetal and newborn bony middle ear, is not well understood. The authors wished to test previous observations that a greater amount of mesenchyme was found in Potter's sequence (renal anomalies, pulmonary hypoplasia, and oligohydramnios). Using celloidin‐embedded neonatal temporal bones (68 cases, 123 ears), with clinical and autopsy information, middle ear volumes were compared among diagnostic groups using analysis of variance. In 16 ears of Potter's sequence cases the volume of mesenchyme increased in proportion to the size of the middle ear. Conversely, in all other cases the volume of mesenchyme remained constant compared to increasing middle ear size. Both the volume of the bony middle ear and the volume of the air cavity increased at 15 mm3/500 g of body weight (gbw). Mesenchyme percentage decreased by 2%/500 gbw.

Middle ear mesenchyme appears to recede rather than reabsorb. However, in Potter's sequence cases the volume of mesenchyme increases, raising issues of a missing renal signal that inhibits mesenchymal growth under normal circumstances.

Laryngoscope, 106:856‐864, 1996
The Incidence of Micrometastases in Neck Dissection Specimens Obtained From Elective Neck Dissections
Authors: van den Brekel Michiel W.M. , van der Waal Isaäc , Meijer Chris J.L.M. , Freeman Jeremy L. , Castelijns Jonas A. , Snow Gordon B.
Published: November 2003

Although modern imaging techniques become more accurate for the assessment of lymph node metastases in the neck as criteria and technology evolve, micrometastases remain occult with any technique. Even the routine histopathological examination of neck dissection specimens is unable to detect all micrometastases. Because knowledge on the incidence of micrometastases in the clinically N0 neck might be of importance for decision making regarding elective treatment, a retrospective study on 96 elective neck dissections was conducted. Meticulous histopathological examination of the neck dissection specimens yielded 3092 lymph nodes of which 67 (2.2%) were tumor‐positive. Twenty‐six of these 67 lymph node metastases were micrometastases. Of the 36 tumor‐positive neck dissection specimens, 21 contained micrometastases. In 9 tumor‐positive specimens only micrometastases were found. This high incidence of micrometastases has important implications for the diagnostic work‐up, the treatment, and histopathological examination of the N0 neck.
Reduction of Endotoxin‐Induced Inflammation of the Middle Ear by Polymyxin B
Authors: Darrow David H. , Keithley Elizabeth M.
Published: November 2003

Endotoxin (ET) is an aggregate of lipo‐oligosac‐charide and protein found in the cell wall of gramnegative bacteria. A potent mediator of inflammatory responses, ET has been detected in middle ear effusions from patients with otitis media with effusion and chronic suppurative otitis media and used to induce inflammation of the middle ear mucosa and disruption of mucociliary transport in experimental animals.

Polymyxin B, a polypeptide antibiotic, has been shown to bond to and inactivate the ET molecule. This study investigated the efficacy of polymyxin B as a modulator of the inflammatory response to endotoxin in the middle ear. In a guinea pig model, cellular infiltrate, effusion volume, and mucosal edema in response to ET were reduced in the presence of polymyxin B. These results suggest a potential role for the use of polymyxin B in the management of middle ear effusion.
Apneic Anesthesia With Intermittent Ventilation for Microsurgery of the Upper Airway
Authors: Weisberger Edward C. , Emhardt John D.
Published: November 2003

Apneic anesthesia with intermittent ventilation (AAIV) has been used in 250 procedures on the larynx and trachea at Indiana University Medical Center since October 1989. Initially employed for laryngeal papilloma removal in children, this anesthetic technique is now used for other procedures and in adult patients. The advantages of AAIV include improved visualization of the airway, absence of combustible material, and lack of vocal cord motion during surgery.

No significant complications have occurred with AAIV. The high degree of safety for this anesthetic technique relates largely to the constant monitoring of oxygen saturation using pulse oximetry and the periodic measurement of end‐tidal carbon dioxide (CO2) levels. Contraindications to AAIV are age less than 2 years, significant cardiopulmonary disease, and any hypermetabolic state. Relevant pulmonary physiology includes the unique aspects of oxygen and CO2 metabolism in children.
Projected Societal Needs in Pediatric Otolaryngology
Authors: Zalzal George H.
Published: November 2003

With the recent increase in pediatric otolaryngology fellowship training programs, fellows are being trained in record numbers and there is concern about the possibility that the supply of these physicians will soon exceed societal needs. This study was conducted to determine the number of fellowship‐trained pediatric otolaryngologists that would meet the needs of society and when this need will be met. Information was collected from national organizations and from a survey of fellowship training programs. A hospital‐based practitioner model was used to predict societal needs based on the anticipated changes in patient care, mainly managed‐care capitated systems. The projected societal need is 382 pediatric otolaryngologists. If current fellowship training levels continue, this need will be met in just over 7 years.
Efficacy of Transcutaneous Computed Tomography‐Guided Fine Needle Aspiration Biopsy in Patients With Laryngeal Squamous Cell Carcinoma, Probable Failed Radiation Therapy, and Negative Transmucosal Biopsies
Authors: Citardi Martin J. , Abrahams James J. , Flynn Stuart , Sasaki Clarence T.
Published: November 2003

For patients with suspected recurrent/persistent laryngeal squamous cell carcinoma (SCC) after external beam radiotherapy (EBRT), routine transmucosal biopsies obtained during direct laryngoscopy may fail to reveal active carcinoma. We evaluated transcutaneous computed tomography‐guided fine needle aspiration (CTGFNA) in three consecutive patients who had a persistently fixed true vocal fold after EBRT that had been administered for laryngeal SCC and who had multiple negative transmucosal laryngeal biopsies. All three CTGFNA biopsies were positive, but final pathology confirmed invasive SCC in only one of the three patients. Despite its theoretical advantages, CTGFNA in its present form requires further assessment and/or modification.

Laryngoscope, 106:1244‐1247, 1996
Histopathology of Idiopathic Chronic Recurrent Vertigo
Authors: Ishiyama Akira , Ishiyama Gail P. , Lopez Ivan , Eversole Lewis R. , Honrubia Vicente , Baloh Robert W.
Published: November 2003

Vestibular neuritis is a degenerative neuropathy of the peripheral vestibular system. The etiology of this condition is uncertain, although it is generally believed to be viral. A small percentage of patients with vestibular neuritis have chronic recurrent episodes of vertigo. Detailed cytologic descriptions of acute or chronic vestibular neuritis are lacking, and no previous studies have reported evidence of chronic inflammation in human temporal bone specimens.

The authors of this study examined temporal bone specimens from three patients with a history of chronic recurrent vertigo of unknown cause. Varying degrees of inflammation and destruction were seen in the vestibular system, and mild involvement of the cochlear system was noted. These findings are consistent with postinfectious inflammatory changes of the cochlear‐vestibular system analogous to a postinfectious syndrome involving the central nervous system.
The Loss of Heterozygosity in Retinoblastoma and p53 Suppressor Genes As a Prognostic Indicator for Head and Neck Cancer
Authors: Gleich Lyon L. , Li Ya‐Qin , Biddinger Paul W. , Gartside Peter S. , Stambrook Peter J. , Pavelic Zlatko P. , Gluckman Jack L.
Published: November 2003

Inactivation of tumor suppressor genes, including p53 and retinoblastoma(Rb), are commonly found in all cancers, including head and neck squamous cell carcinoma. Alterations at either p53 or Rb, however, are only weakly associated with tumor aggressiveness. In many cancers loss of heterozygosity (LOH) at multiple loci is associated with decreased survival. The polymerase chain reaction and highly informative microsatellite markers were used to compare DNA from matched sets of 63 head and neck squamous cell cancers and normal tissue for LOH at the p53 and Rb loci. At p53, 50 were informative, with LOH occurring in 19 (38%). Of the 57 that were informative at Rb, LOH occurred in 21 (37%). Of the 46 that were informative at both p53 and Rb, LOH occurred in 10 (22%) at both loci. When LOH for p53 and Rb individually was compared to stage, differentiation, and survival, there was no correlation. However, the patients with LOH at both loci had a significantly poorer survival (P = .009). This strongly supports the contention that simultaneous alterations of these two tumor suppressor genes favor tumor aggressiveness and can be used as a prognostic indicator.
Quantitative Cytology of Nasal Secretions and Scrapings in Japanese Cedar Pollinosis Patients
Authors: Takeuchi Kazuhiko , Ukai Kotaro , Lee Hwa Sik , Majima Yuichi , Sakakura Yasuo
Published: November 2003

To explore the dynamics of the cellular response to natural allergen exposure, the authors of this study performed quantitative cytology in both the nasal secretions and nasal scrapings of 16 normal control subjects and 23 Japanese cedar pollinosis patients before and during the pollen season. In nasal scrapings, the number of metachromatic cells increased significantly during the pollen season, although there was no significant difference between the normal subjects and the preseason pollinosis patients. The cell differential count in the patients with pollinosis showed that lymphocytes were predominant in scrapings; however, the majority of inflammatory cells in the nasal secretions were neutrophils before the season and eosinophils during the season. The study findings suggest that the appearance of metachromatic cells in nasal scrapings is specific to the pollen exposure and that the cytology in nasal secretions is significantly different from that in nasal scrapings.
The Effect of Overall Treatment Time of Radiation Therapy on Local Control of T1‐Stage Squamous Call Carcinoma of the Glottis
Authors: Hayakawa Kazushige , Mitsuhashi Norio , Akimoto Tetsuo , Maebayashi Katsuya , Ishikawa Hitoshi , Hayakawa Kayoko , Sakurai Hideyuki , Takahashi Takeo , Kamei Tamio , Niibe Hideo
Published: November 2003

From 1975 to 1990, 72 patients with T1 glottic cancer, excluding a verrucous type of carcinoma, were treated with radiation therapy (RT). All treatments were given with a standard fractionation of 2 Gy per day. The total dose to the tumor ranged from 60 to 70 Gy. Six patients received a split‐course RT. The overall local control rate was 87% at 5 years. Forty‐one patients who completed RT in 45 days or less had a 5‐year local control rate of 95%. Sixteen patients who completed a treatment course in 46 to 49 days had a local control rate of 81%. Fifteen patients with a treatment course of more than 50 days had a local control rate of 73%. There was a statistically significant difference in local control rates among the three groups (P<.05). The split‐course RT group had a 5‐year local control rate of 50%; that rate was statistically significantly inferior to that of the continuous course group (P<.001). Multivariate analysis also showed that an interruption of the treatment course was an important parameter in relation to the local control. The prolongation of standard RT schedules adversely affected local control of T1 glottic carcinoma and, therefore, should be avoided whenever possible.
Differential Expression of Transthyretin in Papillary Tumors of the Endolymphatic Sac and Choroid Plexus
Authors: Megerian Cliff A. , Pilch Ben Z. , Bhan Atul K. , McKenna Michael J.
Published: November 2003

Aggressive papillary tumors of the temporal bone, occurring sporadically or as part of von Hippel‐Lindau disease, have been shown to originate within the endolymphatic sac or duct. Also implicated as a potential precursor from which some of these tumors may arise is ectopic choroid plexus epithelium. To aid in the differentiation between papillary tumors of endolymphatic sac and duct origin and those arising from choroid plexus, an immunohistochemical study using stains for transthyretin (TTR), cytokeratins, S‐100 protein, epithelial membrane antigen (EMA), and glial fibrillary acidic protein (GFAP) was carried out on archival specimens of normal and neoplastic endolymphatic sac and duct and choroid plexus epithelium. Transthyretin, a marker for choroid plexus epithelium, was found to show differential expression between choroid plexus papillomas and aggressive papillary tumors of the endolymphatic sac or duct. Therefore the use of TTR in concert with other immunohistochemical stains appear to aid in the differentiation between intracranial and intratemporal papillary tumors arising from choroid plexus and endolymphatic sac or duct epithelium.
Tubeless Laryngotracheal Surgery in Infants and Children via Jet Ventilation Laryngoscope
Authors: Grasl Matthaeus C. , Donner Andrew , Schragl Eva , Aloy Alexander
Published: November 2003

We present the first use of tubeless superimposed combined high‐ and low‐frequency jet ventilation (SHFJV) with a jet laryngoscope in laryngotracheal surgery in infants and children. Twenty‐eight patients underwent 53 operative procedures. The average age of the patients was 7.3 years. The most common diagnoses were laryngeal papillomatosis and subglottic stenosis. The duration of jet ventilation averaged 33 min. The gas exchange was sufficient in each case. The advantages of SHFJV in the surgery of the laryngotracheal area in infants and children are optimal view at the larynx and trachea, maximum space for the handling, application of the laser without risks, no time limitation, suitability for stenosis, and neither anesthetic nor surgical complications.
KTP Laser and Neutral Red Phototherapy of Human Squamous Cell Carcinoma
Authors: VanderWerf Quinten M. , Castro Dan J. , Nguyen Richard D. , Paiva Marcos B. , Chao Kuo H. , Santillanes Mario E. , Saxton Romaine E.
Published: November 2003

Neutral red (NR) is a cationic, nontoxic vital dye employed as a histologic stain for proliferating cells; it has been used clinically for photodynamic treatment of herpes simplex virus lesions. NR is selectively taken up and concentrated by mitotic cells, an important characteristic for more effective antineoplastic agents. In the present study, UCLA‐SO‐P3 human squamous carcinoma cells displayed minimal toxicity when incubated with up to 50 μg/ml NR in the absence of light. However, cells incubated with greater than 0.5μg/ml NR followed by exposure to KTP laser light at 532 nm exhibited nearly 100% tumor cell death. The degree of cell toxicity was proportional to NR dose and laser light fluence. This study demonstrates that NR is an excellent cancer cell photosensitizer in vitro, and, after adding additional in vivo preclinical testing, may prove to be a useful agent in photodynamic destruction of head and neck tumors.
High Jugular Bulb and Conductive Hearing Loss
Authors: Weiss Robert L. , Zahtz Gerald , Goldofsky Elliot , Parnes Harold , Shikowitz Mark J.
Published: November 2003

A high jugular bulb is often discovered as an incidental finding that is asymptomatic. Conductive hearing loss in association with this anomaly may occur, but has been reported infrequently in the literature. We report five cases of high jugular bulb and associated conductive hearing loss. Mechanisms to explain the conductive hearing loss include contact of the jugular bulb with the tympanic membrane, interference with the ossicular chain, and obstruction of the round window niche. The operative findings, radiographic and audiometric data that support these mechanisms of conductive hearing loss are presented.
Expression of the Opioid Growth Factor, [Met5]‐Enkephalin, and the Zeta Opioid Receptor in Head and Neck Squamous Cell Carcinoma
Authors: Levin Roger J. , Wu Yan , McLaughlin Patricia J. , Zagon Ian S.
Published: November 2003

Despite the prevalence of cancers of the head and neck, survival rates have not changed in the past few decades. Recent work has implicated peptide growth factors and their receptors in the genesis and progression of head and neck squamous cell carcinoma. Opioid growth factor (OGF, [Met5]‐enkephalin) is a tonically active, autocrine and/or paracrine produced, inhibitory factor that influences the growth of normal and abnormal cells and tissues. This peptide interacts with the zeta (ζ) opioid receptor to modulate cellular proliferation, migration, and survival. Both OGF and the ζ receptor are present in mammalian tongue epithelium and skin, and modulate DNA synthesis. In the present study we examined the presence and distribution of OGF and theζ opioid receptor in the head and neck squamous cell carcinomas from seven individuals. All specimens expressed this growth factor and its receptor regardless of tumor stage, location, and histologic grade. Immunoreactivity for both OGF and the ζ receptor were associated with the cytoplasm but not the nucleus in cells of each of these carcinomas. Our findings that a potent negative growth regulator and its receptor are present in head and neck squamous cell carcinoma lead us to suggest that OGF may modulate the growth of these types of cancers.