bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of H2 antagonists in perennial allergic rhinitis
Authors: Testa Benedetto , Mesolella Carlo , Filippini Pietro , Campagnano Nicola , Testa Domenico , Mesolella Massimo , Sagnelli Evangelista
Published: October 2006

The biological effects of anti‐H2 in allergic reactions are dose dependent: low doses enhance, and high doses significantly decrease the reaction of hypersensitivity. The administration of cimetidine H2 antagonist to 20 perennial allergic rhinitis patients brought about an abatement in the symptoms and a decrease in the total serum immunoglobulin E (IgE) levels in 72% of treated patients, but no variation was perceived in placebo‐treated patients. These results strengthen the hypothesis of anti–H2‐induced immunoregulatory effects and suggest a possible way of inhibiting IgE synthesis in vivo.
Effect of specific bacteria on lymphocyte proliferation in diseased and nondiseased tonsils
Authors: Koch R. James , Brodsky Linda
Published: October 2006

Tonsillar tissue lymphocyte (TTL) function as measured by lymphocyte proliferation was assessed in vitro in 38 tonsils–30 diseased and 8 normal controls. TTLs from diseased and control tonsils were challenged with intact, heat‐inactivated bacteria which may be found in the core of diseased tonsils; these bacteria were Streptococcus pyogenes and Hemophilus influenzae type B (HIB), as well as the dominant bacterium (DB) grown from that particular tonsillar core. The phytomitogen leukoagglutinin (LA) was used as a nonspecific activator. Lymphocyte proliferation was quantified and reported using a stimulation index (SI) which was based upon viable cell counts at 2, 4, and 6 days following inoculation.

Overall, the greatest degree of lymphocyte proliferation in diseased TTLs (SI = .91) was produced by HIB. However, both SP and HIB produced more lymphocyte proliferation in the nondiseased TTLs than in the diseased TTLs (P<.01). H influenzae (non‐B) and group A β‐hemolytic streptococci were the pathogens most frequently cultured as the dominant bacteria from the core of diseased tonsils; Streptococcus viridans was most frequently cultured in nondiseased tonsils. The DB caused greater TTL proliferation in diseased (SI = .89) versus control (SI = .63) TTLs (P<.001). These findings suggest a differential proliferative response in vitro for diseased and non‐diseased TTLs in response to specific bacteria. The role of possibly pathogenic bacteria and commensals, as well as the implications for clinical disease, are discussed.
Ossification patterns of the tympanic facial canal in the human fetus and neonate
Authors: Spector J. Gershon , Ge Xianxi
Published: October 2006

Dehiscences in the bony facial canal are comparatively common in the human adult. The highest incidence occurs in the tympanic segment of the facial nerve near the region of the oval window. Thirty‐three fetal temporal bones, ranging from 16 to 40 weeks' gestation, and four from 1, 2, 4 and 12 weeks' postpartum neonates, were studied to evaluate the normal patterns of ossification of the fallopian canal of the tympanic facial nerve segment in the human. The tympanic facial nerve segment elongates threefold during this period (from 1 mm to 3 mm). The ossification starts at 21 weeks' gestation anteriorly from apical otic ossification centers and at 26 weeks from canalicular ossification centers near the stapedius muscle. The ossification proceeds in an anterior‐to‐posterior direction as two periosteal shelves of bone surround the facial nerve. The superior periosteal bony ledge contributes 75% of the circumference of the fallopian canal. The anterior ossification center forms over 83% of the fallopian canal length. The two centers fuse post partum near the region of the oval window. The anatomic location of the facial nerve, nerve branching, and neural vasculature precede ossification. In 80% of the paired temporal bones, this ossification pattern appears to be symmetrical. The patterns and incidence of bony dehiscences within the tympanic fallopian canal segment can be explained by these observations. This study demonstrates that fallopian canal dehiscences are not congenital anomalies, but variations of normal developmental anatomic processes.
DNA‐and viral‐mediated gene transfer in follicular cells: Progress toward gene therapy of the thyroid
Authors: O'Malley Bert W. , Ledley Fred D.
Published: October 2006

The authors investigate the in vitro component of an ex situ strategy for gene transfer into the thyroid gland using DNA complex and retroviral vectors. Canine follicular cells harvested by unilateral lobectomy and grown in low‐serum media proliferated in culture and retained their differentiated state as evidenced by morphology and thyroglobulin expression. Transient and “stable” gene transfer in thyroid cells were evaluated by comparing DNA and retroviral transduction techniques. Effective gene transfer and expression was demonstrated by histochemical staining for the marker gene product β‐galactosidase. The efficiency of transduction was assessed using an amphotropic retroviral vector carrying the neomycin resistance gene and semiquantitative polymerase chain reaction (PCR) identification of integrated proviral sequences. This analysis demonstrated a proviral frequency in transduced cultures of 10% to 30%. Transduced cells showed no change in morphology or growth patterns and maintained differentiated function as assessed by antibody staining for thyroglobulin. The thyroid gland is an attractive target for somatic gene therapy because of its large protein‐synthetic capacity, sensitivity to hormonal regulation, and proportionately high blood flow. Follicular cell gene therapy may be useful not only for treating congenital or acquired diseases of the thyroid, but also disorders of circulating proteins such as hypopituitarism, hemophilia, and diabetes.
Meniere's syndrome: An atypical presentation of giant cell arteritis (temporal arteritis)
Authors: Mckennan Kevin X. , Nielsen Surl L. , Watson Craig , Wiesner Ken
Published: October 2006

The authors discuss three patients with biopsyproven giant cell arteritis (GCA) who experienced significant auditory and vestibular symptoms. Two of the patients who presented with audiovestibular symptomatology died as a direct result of GCA affecting the vertebral arteries. Postmortem findings are reported.

This report illustrates the importance of maintaining a high index of suspicion of GCA in elderly patients who present with the acute onset of audiovestibular symptoms. These symptoms can be a herald of brain stem infarction if giant cell arteritis is the underlying cause. High‐dose prednisone and rheumatologic/neurologic consultation is required.
Determining the site of airway collapse in obstructive sleep apnea with airway pressure monitoring
Authors: Katsantonis George P. , Moss Kenneth , Miyazaki Soichiro , Walsh James
Published: October 2006

Twenty patients with obstructive sleep apnea (OSA) underwent complete polysomnography and simultaneous upper airway pressure monitoring with a custom‐made, soft silicone‐covered catheter measuring 2.3 mm in diameter. The catheter had four solid‐state microtip pressure sensors positioned in the posterior nasopharynx, immediately caudal to the tip of the uvula, at the level of the hyoid bone, and in the midesophagus. The level(s) of airway collapse was determined by changes in the pressure patterns between transducers. In 14 of the 20 patients, airway collapse was confined or initiated at the oropharyngeal region. The obstruction extended to the base of tongue in 7 and to the entire collapsible upper airway in 2 patients. Four patients had collapse at the base of the tongue and 2 had collapse at the hypopharynx. The site of airway collapse remained fairly constant through various sleep stages and positions. Uvulo‐palatopharyngoplasty (UPPP) and postoperative polysomnography were performed in 4 patients (2 with hypopharyngeal, 1 with base of tongue, and 1 with oropharyngeal airway collapse). Two patients had a favorable response to UPPP.
Outcome of sudden deafness with and without vertigo
Authors: Nakashima Tsutomu , Yanagita Noriyuki
Published: October 2006

The outcome of unilateral sudden deafness with and without vertigo was evaluated according to the severity of the initial hearing loss, the shape of the audiogram, and other variables. The subjects for this investigation were 1313 patients who had presented to the authors' university hospital from 1972 to 1990 within 2 weeks of the onset of hearing loss. Thirty percent of the patients had accompanying vertigo. Vertigo occurred frequently in patients with severe hearing loss in the high‐tone frequencies. Hearing recovery of high‐tone frequencies was worse in patients with vertigo than in those without vertigo even when the initial hearing loss was the same. It is hypothesized that these results can be explained by anatomical factors; the cochlear basal turn being more proximal to the vestibular apparatus than the upper turn.
Computer‐aided 3‐D reconstruction and measurement of the facial canal and facial nerve. I. cross‐sectional area and diameter: Preliminary report
Authors: Nakashima Shigeto , Sando Isamu , Takahashi Haruo , Fujita Shuji
Published: October 2006

Using a computer‐aided three‐dimensional (3‐D) reconstruction method, measurements were made at eight representative sites of diameters and the cross‐sectional area of the facial canal, facial nerve, and the space between the canal and nerve. Materials used were serial histology sections of seven normal human temporal bones obtained from individuals of different ages. Two areas of decreased cross‐sectional area of the facial canal were found: the proximal part of the labyrinthine portion and the middle part of the tympanic portion. These narrowings in the canal appeared to be correlated with decreased superior‐inferior diameter of the facial canal in those portions, espcially in adult temporal bones, and also with decreased cross‐sectional area, both of the nerve and of the space between the canal and the nerve, in these portions. The developmental etiology of these narrowings is speculated on, and their possible relationship to Bell's palsy is discussed.
Radiologic assessment of the early postoperative total‐laryngectomy patient
Authors: Moses Brett L. , Eisele David W. , Jones Bronwyn
Published: October 2006

Pharyngocutaneous fistula is a significant cause of postoperative morbidity following total laryngectomy. The records of 132 patients at the Johns Hopkins Hospital were reviewed retrospectively to determine the role of radiographic contrast studies in the early postoperative period after total laryngectomy. Radiographic studies were performed in 41 cases, of which 38 were cinepharyngoesophagograms.

Fistulae occurred postoperatively in 28 patients (21%). In patients with no clinical signs or symptoms suggestive of an impending fistula (fever, wound erythema, wound swelling, or persistent elevated neck drain output), there is no need to perform a cinepharyngoesophagogram before starting oral alimentation. The presence of soft‐tissue air in the neck seen on preliminary scout spot films, suggestive of an impending fistula seen in patients who also underwent a neck dissection, did not correlate with a clinical fistula if no extravasation of contrast was observed.
Use of the platysma myocutaneous flap for cervical trachea reconstruction: An experimental study in dogs
Authors: De Mello‐Filho Francisco Verissimo , Mamede Rui Celso Martins , Sader Albert Amin , Llorach Velludo Maria A. S. , De Andrade Vicente Walter Villela
Published: October 2006

Cervical trachea reconstruction with a non‐stented platysma myocutaneous door flap (NPMCF) was studied in 23 dogs. Window defects involving 5, 10, or 15 rings and the whole anterior tracheal wall were produced in 3 different groups of animals. A segmentary defect involving the resection of 3 tracheal rings but preserving the posterior membranous wall was created in another group. The results were evaluated by clinical follow‐up of up to 100 days, by tracheoscopy 1 week after surgery, and by macroscopic and microscopic examination after the animals' natural death or sacrifice.

The NPMCF proved to be adequate for the reconstruction of window defects limited to 5 and 10 rings, with success rates of 100% and 75%, respectively. The use of the NPMCF for tracheal reconstruction had the following main advantages: 1. relatively simple, easy, and expeditious surgery; 2. use of a single operative field; 3. availability of large amounts of donor tissue; 4. adequate thickness; 5. reliable irrigation; 6. resistance to environmental exposure as evidenced by absence of infection; and 7. 100% take rate with no granulomas or scar stenosis at the suture lines. However, luminal occlusion due to flap collapse was a 100% fatal complication when the NPMCP was used either for reconstruction of larger window tracheal defects (15 rings—group 3) or segmentary defects (group 4); this was the main limitation of the method, followed by hair growth with accumulation of secretions, which can be easily dealt with. It can be anticipated that this method has a potential for application in well‐selected patients.
Otitis media with effusion in head and neck cancer patients
Authors: Weiss Michael H. , Liberatore Lisa A. , Kraus Dennis H. , Budnick Amy S.
Published: October 2006

Fifty‐two patients who had otitis media with effusion associated with head and neck malignancies were identified and studied retrospectively. Forty‐three of the patients underwent myringotomy and tube for treatment of the effusion. Ten (23%) of the 43 patients had either multiple infections or continuous otorrhea necessitating tube removal. The patients identified as having the highest rate of serious complications following myringotomy and tube were those individuals who had nasopharyngeal carcinoma, with 6 (55%) of 11 patients in this group having suffered major infections during the study. Myringotomy and tube is a satisfactory treatment for most patients who have effusions as a result of non‐malignant etiologies; however, infections were more common and more severe in the study group than those anticipated in noncancer patients. Expectant management and the use of amplification in selected cases may prove to be a viable alternative in patients with unilateral effusion and/or relatively mild symptoms.
Preliminary data on the effect of pharyngeal flaps on the upper airway in children with velopharyngeal inadequacy
Authors: Witsell David L. , Drake Amelia F. , Warren Donald W.
Published: October 2006

Seven patients who received pharyngeal flaps for velopharyngeal incompetence (VPI) were studied to assess the effect of the procedure on nasal airway size. The findings suggest that the pharyngeal flap does not significantly decrease the upper airway in all patients. The effect of the flap did not correlate with the type of cleft, and was most pronounced in the inspiratory phase of the breathing cycle. Reasons for this variable effect, assumed to be related to an already impaired nasal airway in most cleft patients, are discussed.
The effect of unilateral chorda tympani damage on taste
Authors: Kveton John F. , Bartoshuk L. M.
Published: October 2006

Patients with localized damage to the taste system often experience no subjective change in real‐world taste experience. In an effort to understand this, eight patients who recently underwent acoustic neuroma removal were evaluated for taste loss. Localized taste testing showed that taste intensities decreased in the distribution of cranial nerve VII ipsilateral to tumor removal as expected, but asymmetries occurred for IX. Intensities were greater on the side contralateral to the tumor removal. In addition, palatal taste, also thought to be mediated by VII, was not totally abolished. It is concluded that cranial nerve IX is normally inhibited by cranial nerve VII in the taste network. When VII is damaged, this inhibition is abolished. This release of inhibition serves as a compensation mechanism that preserves normal taste experience.
Treatment of adductor laryngeal breathing dystonia with botulinum toxin type a
Authors: Grillone Gregory A. , Annino Donald J. , Blitzer Andrew , Brin Mitchell F. , Saint‐Hilaire Marie‐Helene
Published: October 2006

Adductor laryngeal breathing dystonia (ALBD) is a rare disorder in which patients have persistent inspiratory stridor, usually normal voice, and cough. Physical exam is characterized by paradoxical movement of the vocal cords on inspiration. These patients have involuntary action‐induced spasms of the adductor laryngeal muscles on inspiration. There has been no uniformly satisfactory treatment for the disease. Speech therapy, psychotherapy, and pharmacotherapy have all had limited success.

We report the successful use of botulinum toxin type A in seven patients with adductor laryngeal breathing dystonia. All patients received bilateral thyroarytenoid injections. All patients had toxin effect within 72 hours, reaching maximal effect within 2 weeks with sustained improvement for an average of 13.8 weeks. Adverse effects included breathy voice and mild choking on liquids. Both resolved, on average, within 2 weeks.

This retrospective study supports the safe and effective use of botulinum toxin type A in the treatment of adductor laryngeal breathing dystonia.
The intramuscular innervation of the human interarytenoid muscle
Authors: Mu Liancai , Sanders Ira , Wu Bei‐Lian , Biller Hugh F.
Published: October 2006

The nerve supply of the human interarytenoid (IA) muscle has been controversial for more than a century. In this study the contribution of the recurrent and superior laryngeal nerves to the IA was investigated in 10 adult human larynges. The larynges were obtained from autopsies and processed with the modified Sihler's technique which clears soft tissue while staining nerve. The IA muscles were dissected off the specimens and transilluminated to demonstrate their nerve supply. The results demonstrated that all 10 IA muscles were bilaterally innervated by both recurrent laryngeal nerves (RLNs) as well as branches of both superior laryngeal nerves (SLNs). These nerves combined within the IA muscles to form a dense anastomotic plexus which was highly variable between specimens. The exact nature of the internal SLN neurons, whether motor or sensory, their innervation targets, or their function, were not discernible. Additional anatomic findings were the presence of large neural communications directly between the SLN and RLN, and smaller neural connections from side to side. All of these results disagree with currently accepted descriptions of laryngeal neuroanatomy.
Cerebrospinal fluid leak following acoustic neuroma removal
Authors: Hoffman Ronald A.
Published: October 2006

Cerebrospinal fluid (CSF) leak has been a constant and unresolved complication of acoustic tumor surgery. This study retrospectively reviews 381 primary acoustic tumor surgeries performed by a single, senior, neurotologist and neurosurgeon team from 1979 through 1991. There were 68 cerebrospinal fluid leaks in 66 patients (66/381; 17%). There was no significant difference in the incidence of CSF leak between the translabyrinthine group (21%) and the retrosigmoid transmeatal group (16%). Translabyrinthine leaks were evenly divided between rhinorrhea and the postauricular wound while retrosigmoid transmeatal leaks were predominantly rhinorrhea. Eleven of 14 translabyrinthine wound leaks responded to pressure dressing and suture. The remaining 3 ceased with continuous lumbar cerebrospinal fluid drainage. Ten of 14 cases of translabyrinthine rhinorrhea responded to continuous lumbar cerebrospinal fluid drainage, and those in whom it failed were cured with revision of the mastoidectomy/labyrinthectomy cavity. Twenty‐one of 28 cases of retrosigmoid transmeatal rhinorrhea responded to continuous lumbar cerebrospinal fluid drainage, and those in whom it failed were cured with extracranial, transmastoid revision. The incidence of cerebrospinal fluid leak was not influenced by age, sex, size of tumor, postoperative hydrocephalus, or the intraoperative use of autologous fibrin glue. Meningitis was an unusual complication, occurring in 3% of all patients.
Langerhans' cell histiocytosis in childhood: Management of head and neck manifestations
Authors: Irving R. M. , Broadbent V. , Jones N. S.
Published: October 2006

The authors carried out a retrospective analysis of 131 cases of Langerhans' cell histiocytosis treated at two centers over a 30‐year period. All those with head and neck manifestations have been reviewed with particular reference to management and outcome. The role of chemotherapy, radiotherapy, and surgery is discussed, and we present our results of the successful introduction of topical nitrogen mustard (Mustine®) ear drops for meatal skin involvement. During the period of the study our modus operandi has evolved from an aggressive medical and surgical approach, favored early in the series, to our present more conservative approach, with an attendant reduction in morbidity.
Epstein‐barr virus lytic cycle spreads via cell fusion in a nasopharyngeal carcinoma hybrid cell line
Authors: Seiki Motoharu , Sato Hiroshi , Takeshita Hazime , Yoshizaki Tomokazu , Takimoto Toru , Tanaka Saichiro , Furukawa Mitsuru
Published: October 2006

NPC‐KT cl.S61, a subclone derived from an epithelial‐nasopharyngeal carcinoma hybrid cell line NPC‐KT, showed extensive Epstein‐Barr virus (EBV) production and cell fusion when the EBV replicative cycle was induced by 5‐iodo‐2′‐deoxyuridine. On the contrary, parental NPC‐KT cells produced virus at a lower level and did not show cell fusion. Cell fusion in cl.S61 cells was blocked by 2‐deoxyglucose and acyclovir, inhibitors of glycosylation and EBV DNA polymerase, respectively, with a concomitant decrease in the number of cells expressing EBV growth‐associated antigens. However, the frequency of virus antigen expression in parental NPC‐KT cells was not significantly affected by these drugs. This result suggests that efficient production of EBV from cl.S61 cells is due to the spreading of viral replicative cycle via cell fusion. It was also demonstrated by in situ autoradiography that cl.S61 cells producing virus fused to not only EBV receptor/CR2 positive Raji and BJAB cells, but also to receptor‐negative Jurkat cells. The possible mechanism of EBV entry into cells devoid of virus receptor by cell fusion is discussed.
Blood transfusion and other prognostic variables in the survival of patients with cancer of the head and neck
Authors: Barzan Luigi , Maione Arturo , Pin Marco , Comoretto Roberto , Cadelano Andrea , Barra Salvatore , Franceschi Silvia
Published: October 2006

The clinical records of 207 patients with squamous cell carcinoma of the head and neck, diagnosed and surgically treated at the Otolaryngology Division of Pordenone General Hospital and Aviano Cancer Centre, northeast of Italy, from January 1982 to December 1987, were retrospectively reviewed to gather information on blood transfusions and other characteristics potentially related to survival. The group of patients (mean age = 59 years) included 85 cases (41%) of laryngeal cancer, 80 cases (39%) of oropharyngeal and hypopharyngeal cancer, and 34 cases (16%) of cancer of the oral cavity. Fifty‐five patients (27%) did not receive any blood transfusion while 152 patients were transfused with different amounts of blood. At the univariate analysis, nodal involvement, clinical stage, type of therapy, status of surgical margins, and metastatic spread beyond the nodal capsule appeared to be significantly linked to prognosis. After adjustment for other prognostic variables, transfused patients showed a twofold higher hazard ratio as compared to nontransfused patients, but such an unfavorable predictive value should be evaluated in the context of the other prognostic correlates of cancer of the head and neck.
Human papillomavirus types 11 and 16 detected in nasopharyngeal carcinomas by the polymerase chain reaction
Authors: Hørding Ulla , Nielsen Henrik Winther , Daugaard SØRen , Albeck Henrik
Published: October 2006

Most nasopharyngeal carcinomas (NPCs) are of the nonkeratinizing or undifferentiated types, which are consistently associated with Epstein‐Barr virus (EBV). The smaller group of highly differentiated, keratinizing NPCs seems to be only infrequently associated with EBV. In order to examine whether these rare tumors were related to another oncogenic virus, the authors used the polymerase chain reaction to examine paraffin‐embedded sections of 15 keratinizing NPCs for human papillomavirus (HPV) types 6, 11, 16, and 18 genomic sequences. HPV DNA was found in 4 tumors (1 HPV‐11‐positive, and 3 HPV‐16–positive tumors). None of 23 undifferentiated or nonkeratinizing NPCs harbored HPV DNA.

The putatively oncogenic HPV type 16 may thus be involved in the carcinogenesis of some EBV‐negative keratinizing squamous cell nasopharyngeal carcinomas.
Photodynamic therapy and the treatment of neoplastic diseases of the larynx
Authors: Biel Merrill A.
Published: October 2006

Photodynamic therapy (PDT) is an innovative treatment involving the use of light‐sensitive drugs to selectively identify and destroy diseased cells. Therefore, photodynamic therapy has the potential to treat and cure precancerous and early cancerous lesions (carcinoma in situ [CIS], T1 and T2) of the larynx while preserving normal tissue.

Eleven patients with recurrent leukoplakia and carcinomas of the larynx were treated with PDT with follow‐up to 27 months. One patient with a Tl verrucous carcinoma, 5 patients with T1 squamous cell carcinomas of the vocal cord failing radiotherapy, 1 patient with a T2 squamous cell carcinoma of the vocal cord failing radiotherapy, and 3 patients with CIS and severe atypia were treated with PDT and obtained a complete response and are disease free. One patient with a T3 carcinoma of the larynx was treated with PDT but died 4 weeks post‐treatment of unrelated causes and could not be assessed.

Photodynamic therapy is a promising therapy for treatment of precancerous and cancerous lesions of the larynx. This therapy may be particularly beneficial for the treatment of recurrent carcinomas of the larynx that have failed conventional radiotherapy, thereby preserving voice and eliminating the need for destructive laryngeal surgery.
A review of revision functional endoscopic sinus surgery
Authors: King Jeffrey M. , Caldarelli David D. , Pigato Joseph B.
Published: October 2006

For some patients, traditional or functional endoscopic sinus surgery (FESS) fails to relieve persistent or recurrent sinus disease. This subset of patients may require revision surgery. The objective of this study was to define and evaluate which features of sinus disease and prior treatment were characteristic of patients requiring revision FESS. Within a series of 295 consecutive FESS procedures, 43 patients who had prior sinus surgery and required revision FESS were studied and followed for a mean 14.1‐month period. The characteristics of 13 patients with persistent disease following revision FESS and the potential technical risks and complications encountered were also evaluated. This study concludes that revision FESS is a safe technique that was effective in 69.8% of the patients, and that certain factors may predict a poor surgical outcome.
Awake evoked electromyography recording from the chronically implanted rat
Authors: Widick Mark H. , Tanabe Tetsuya , Fortune Scott , Zealear David L.
Published: October 2006

Investigation of the effects of various factors on nerve regeneration has been compromised by the lack of an accurate and objective technique which can monitor dynamic changes in the status of nerve‐muscle innervation over the entire course of regeneration. The approach of evoked electromyography (EEMG) was adopted to obtain temporal and quantitative data during nerve regeneration. Initially, transcutaneous nerve stimulation and percutaneous muscle recording was performed, but the approach was abandoned because of the high intertest variability (20% average deviation) and requirement for anesthesia during testing. A new approach using chronically implanted stimulation and recording electrodes was adopted in an attempt to circumvent these problems. Initial acute studies performed in the hindlimb of the anesthetized rat identified stable EEMG recording sites with sciatic nerve stimulation. In a second study conducted in chronically implanted unanesthetized unrestrained animals, EEMG recording from these sites demonstrated remarkable stability with an average intertest variability of only 5%. Preliminary results have been obtained with this technique in monitoring the progression of hindlimb reinnervation following crush and transection nerve injuries.
Glomus vagale: Paraganglioma of the vagus nerve
Authors: Urquhart Andrew C. , Johnson Jonas T. , Myers Eugene N. , Schechter Gary L.
Published: October 2006

Review of the experience of a single institution with a rare tumor may give inadequate and biased information. In an effort to better understand issues related to diagnosis and subsequent management of paraganglioma of the vagus nerve, review of the experience at two university medical centers was undertaken.

A review of the records of all patients with a diagnosis of vagal paraganglioma at the University of Pittsburgh and the Eastern Virginia Medical School was undertaken. Presenting signs and symptoms, treatment, and subsequent outcome were assessed.

Data on 19 patients with vagal paraganglioma were available. The most common initial finding was a neck mass. Forty‐seven percent (9/19) had vocal cord paralysis at presentation. Angiography was beneficial in helping to make the diagnosis and in identifying synchronous tumors. History of familial paraganglioma was present in 47% (9/19). Multiple paragangliomas were diagnosed in 53% (10/19) cases in our study. Of the patients with familial vagal paraganglioma, 89% (8/9) had multiple paraganglioma. All patients treated with surgery had postoperative vocal cord paralysis.

Elective management of patients with bilateral vagal paraganglioma is a special dilemma. Radiation therapy of selected “operable” patients may be indicated because of the potential for bilateral vocal cord paralysis in these patients and its attendant sequela.
Intraoperative monitoring of auditory function: Experimental observations and new applications
Authors: Wazen Jack J.
Published: October 2006

The three different methods of intraoperative monitoring, namely, auditory brainstem response evaluation (ABR), electrocochleography (ECoG), and direct eighth nerve compound action potentials monitoring are reviewed. Both ECoG and direct eighth nerve monitoring surpass the ABR in their ability to provide fast, almost instantaneous, large, reproducible potentials in response to click stimuli. Changes in the amplitude and the latency of these potentials alert the surgeon of an impending eighth nerve injury. Human clinical observations revealed instances of persistence of the ECoG despite a total eighth nerve section in the cerebellopontine angle. Animal and human experiments were conducted to evaluate the effectiveness of ECoG and direct eighth nerve monitoring in hearing preservation. Twelve cats underwent progressive sectioning of the eighth nerve with simultaneous monitoring of changes in their ECoG and direct eighth nerve potentials. ECoG thresholds were obtained intraoperatively in eight patients undergoing surgery for conductive hearing loss. The results of these experiments suggest that recording directly from the eighth nerve is a more accurate technique during cerebellopontine angle and eighth nerve surgery. ECoG, however, appears to have a promising role in the intraoperative monitoring of middle ear reconstruction procedures under general anesthesia.
Carcinoma in situ of the glottic larynx
Authors: Myssiorek David , Vambutas Andrea , Abramson Allan L.
Published: October 2006

Carcinoma in situ (CIS) is part of the histopathologic spectrum of laryngeal disorders where invasive squamous cell carcinoma is the endpoint of cellular disarray. Few reports consider prognostic indicators that predict which lesions become invasive. Forty‐one patients with CIS of the glottic larynx were analyzed for risk factors that would predict invasive cancer. Anterior commissure involvement by CIS resulted in 92% conversion to invasive squamous cell cancer compared to 17% of lesions limited to the mobile fold. Epidermal growth factor receptors were also analyzed and were found not to be helpful in predicting invasion. Lesions of the mobile fold should be removed endoscopically and the patient should be observed closely for recurrence. Anterior commissure involvement that is inaccessible to complete laser ablation should be radiated, and the patient should be observed carefully.
Functional loss of the horizontal doll's eye reflex following unilateral vestibular lesions
Authors: Foster Carol A. , Foster Brian D. , Spindler John , Harris Jeffrey P.
Published: October 2006

The doll's eye reflex represents the vestibulo‐ocular reflex (VOR) elicited by high‐acceleration head rotation. After complete unilateral vestibular lesions, the ipsilateral, horizontal doll's eye reflex is replaced by a series of “catch‐up” saccades. These cause permanent symptoms of blurred vision and dizziness during ipsilateral turns. We compared normal controls and patients with complete surgical lesions or canal paresis of up to 9 years duration via electronystagmography (ENG) to determine the usefulness of the doll's eye test as a diagnostic test for complete vestibular lesions. This test was found to be more sensitive in diagnosis of such lesions than head‐shaking nystagmus, rotatory directional preponderance, and spontaneous nystagmus. It is also useful to document VOR function in patients in whom caloric irrigation is contraindicated.
DNA Content and regional metastases in patients with advanced laryngeal squamous carcinoma
Authors: Wolf Gregory T. , Fisher Susan G. , Truelson John M. , Beals Theodore F.
Published: October 2006

Abnormal DNA content of cancer cells in a primary tumor is thought to reflect the altered proliferative capacity of that cancer and overall patient prognosis. Recently, increased DNA content has been associated with early tumor recurrence in patients with advanced laryngeal cancer. To determine if DNA content correlates with a tumor's metastatic behavior, 94 previously untreated patients with stage III (n = 54) or stage IV (n = 40) squamous carcinoma of the larynx were prospectively studied. The adjusted DNA index (aDI) of the primary tumor was measured by computerized cytomorphometry, and correlations with regional metastases, number of positive nodes, extracapsular spread, and pattern of relapse were determined. Median follow‐up was 35 months. Of 94 patients, 73 underwent neck dissection. Positive nodes were found in 51 patients (70%) and three or more positive nodes were found in 31 patients (42%). High aDI (>.024) was significantly associated with the presence and number of histologically positive nodes (P = .016). Among patients with high aDI, 19 (50%) of 38 had three or more nodes positive compared to 12 (21%) of 56 of those with low aDI. Median aDI levels in patients with three or more nodes were significantly higher than in patients with 1 or 2 nodes (P = .003). Time to recurrence was shorter in patients with high aDI (P = .0078). These findings provide further evidence that increased DNA content is associated with more aggressive laryngeal cancers having high rates of multiple lymph node metastases and worse overall prognosis.
Voice changes in acromegaly
Authors: Williams R. G. , Richards S. H. , Mills R. G. , Eccles R.
Published: October 2006

The fundamental frequency of 14 patients undergoing hypophysectomy was studied. Eight patients had acromegaly, 3 had a prolactinoma, and 3 had nonfunctioning adenomas. The fundamental frequency of 22 normal, healthy volunteers was measured for comparison. In addition, the external size of the larynx of all patients and volunteers was measured and a relationship between external laryngeal size and the mean fundamental frequency was identified in the volunteers. The mean fundamental frequency in patients with acromegaly was significantly lower than the other 6 patients undergoing hypophysectomy and, in addition, was also lower than the 22 normal volunteers. Postoperatively the fundamental frequency of the acromegalic patients increased rapidly to within the expected normal range. Patients with acromegaly have a lowered fundamental frequency which is most likely due to altered vocal cord mass and elasticity, which is a reversible change. Patients with acromegaly can expect a rapid and complete return of normal fundamental frequency within 2 weeks of surgery to remove the pituitary adenoma.
Trends in the management of alcohol withdrawal syndrome
Authors: Newman James P. , Terris David J. , Moore Michelle
Published: October 2006

Alcohol use among head and neck cancer patients is common. Alcohol withdrawal (especially delirium tremens) poses significant potential morbidity to postsurgical patients. Treatment with newer benzodiazepines (BZDs) such as lorazepam and midazolam has become more widespread, and mortality rates from severe alcohol withdrawal have decreased in recent years.

The authors retrospectively studied 102 patients with a diagnosis of alcohol withdrawal, including 20 patients undergoing surgery for cancer of the head and neck. There were 81 men and 21 women, with a mean (± standard deviation [SD]) age of 52.3 (±16.1) years. Many of these patients (46%) were treated with more than one BZD or other neuroleptic, while 49% received single agent therapy of either chlordiazepoxide (26%) or lorazepam (23%). Delirium tremens occurred in 12% of all patients undergoing withdrawal and in 10% of head and neck cancer patients, with a mortality rate of 9% and 0%, respectively.

Single agent use was successful in greater than 95% when either lorazepam or chlordiazepoxide was used. Instances of combination treatment where older BZDs were used yielded a 69% success rate. The higher complication rate and lower treatment success with combination treatment was multifactorial.

Optimal management of the alcohol withdrawal syndrome requires an understanding of its pathophysiology and the principles of its prevention along with a familiarity of BZD pharmacokinetic drug profiles. The authors present a treatment plan which is cost‐effective, keeps morbidity low, and should allow a continued decreasing trend in mortality rates from delirium tremens.
Management of traumatic hypopharyngeal injuries
Authors: Fetterman Bruce L. , Shindo Maisie L. , Stanley Robert B. , Armstrong William B. , Rice Dale H. , Armstrong William B.
Published: October 2006

Violation of the hypopharynx by external penetrating trauma is an uncommon occurrence that may lead to life‐threatening infectious complications if not recognized promptly and treated appropriately. A retrospective review of 48 such injuries seen during a 10‐year period showed that flexible fiberoptic endoscopic examination is the best screening tool for recognition of a possible hypopharyngeal mucosal violation. Direct laryngopharyngoscopy is the best method of definitively diagnosing the injury. Size of the visualized mucosal violation alone is not sufficient information on which to base the decision for medical management versus surgical intervention (i.e., immediate exploration and drainage). Rather, the size, exact site of injury, and mechanism of the injury must be considered to have equal importance. Associated vertebral body fractures may negatively influence acute outcome if diagnosis and treatment of the hypopharyngeal injury are delayed by the cervical spine injury.
A tissue‐culture model for the study of canine vocal fold fibroblasts
Authors: Broadley Caroline , Gonzalez Debra A. , Nair Rhada , Koriwchak Michael J. , Ossoff Robert H. , Davidson Jeffrey M.
Published: October 2006

A tissue‐culture model has been developed for the study of fibroblasts from the canine vocal fold. Laryngeal tissue (lamina propria) obtained from euthanized dogs is rinsed, cut into 1‐mm3 pieces, and incubated in 5% carbon dioxide at 37° C. A confluent monolayer is established within several days. Detectable levels of elastin in the tissue culture supernatant are measured by an indirect enzyme‐linked immunosorbent assay. Various external agents have been shown to affect elastin production. The effects of KTP laser irradiation, hydrocortisone (1.3 μmol/L), transforming growth factor‐β (10 ng/mL), and human leukocyte elastase have been measured. Thus the canine vocal fold fibroblast tissue culture is established as a model for further investigations to improve wound healing and to understand the wound‐healing process following laryngeal microsurgery.
Amplification of mitochondrial DNA from archival temporal bone specimens
Authors: Simpson Thomas A. , Smith Richard J. H.
Published: October 2006

Archival temporal bone collections are an invaluable resource for studying the molecular genetics of many types of otopathology. The irreplaceable nature of temporal bone sections makes efficiency of DNA extraction of paramount importance. Several protocols are available for extracting DNA from fresh and preserved tissue. To establish the best protocol for reliably extracting DNA from celloidin‐embedded temporal bone sections, a variety of DNA extraction techniques were tested. Using the optimum protocol, mitochondrial DNA fragments ranging in size from less than 100 base pairs to more than 400 base pairs were amplified, and the authenticity of polymerase chain reaction (PCR) products was confirmed through comparative sequence analysis.
Endoscopic diode laser welding of mucosal grafts on the larynx: A new technique
Authors: Wang Zhi , Pankratov Michail M. , Rebeiz Elie E. , Perrault Donald F. , Shapshay Stanley M.
Published: October 2006

Epithelial coverage of a laryngotracheal wound is an important factor in preventing stenosis, and endoscopic transplantation of a free mucosal graft without stents or sutures would be a significant therapeutic advance. In vitro and in vivo canine studies were performed to explore the feasibility of transplantation with a low‐power diode laser (400 mW) enhanced by indocyanine green dye‐doped albumin. The tensile strength of graft adherence in 10 cadaver larynges was strong (35.25 ± 10.39 g). Survival studies in live canine models with a specially designed endoscopic instrument set showed excellent healing at 6, 14, and 28 days. Healing was documented with photography and by histologic examination. Successful endoscopic transplantation of a free mucosal graft should improve results of treatment for laryngotracheal stenosis and laryngeal reconstructive surgery.
How I do it: Head and neck and plastic surgery: Surgical management of the head and neck cancer patient following concomitant multimodality therapy
Authors: Panje William R. , Namon Ari J. , Vokes Everett , Haraf Daniel J. , Weichselbaum Ralph R.
Published: October 2006

The simultaneous use of chemotherapy and radiotherapy (concomitant therapy) has exceptional promise in the treatment of head and neck cancer. In this limited review, seven head and neck cancer patients who underwent prior concomitant therapy and subsequent surgery developed wound‐healing complications that were delayed (22‐day average) in onset. Paranasal sinus and base of skull operations had less significant wound morbidity than those cases requiring simultaneous transgression of the neck and upper aerodigestive tract. The use of arterialized flaps did not in itself prevent wound breakdown. The formation of controlled fistulae, delay of reconstruction, and avoidance of simultaneous neck and upper aerodigestive tract entry are important considerations in avoiding wound‐healing complications after concomitant therapy. In this select group of patients, surgery should be approached with extreme caution and conservatism.
The effect of botulinum toxin type a injection on compound muscle action potential in an in vivo rat model
Authors: Cichon John V. , Mccaffrey Thomas V. , Litchy William J. , Knops Joost L.
Published: October 2006

Serial measurements were performed on the compound muscle action potential (CMAP) amplitude and the force generated by the rat lower hind limb flexors to investigate the time course of intramuscular injections of botulinum toxin type A (BOTOX®). Thirty animals were used in this in vivo rat model. CMAP amplitude and muscle force were measured at predetermined intervals for 28 weeks.

Compound muscle action potential amplitude and force declined markedly the first 5 to 7 days after injection of BOTOX but recovered in a near linear manner. The response magnitude and recovery rate were dose‐dependent. Recovery of CMAP amplitude preceded recovery of muscle force. No clear evidence of a systemic effect on the untreated leg or a concentration effect was found. CMAP amplitude may be useful in determining optimal timing of repeat injections in treating neuromuscular disorders.
Reconstruction of suboccipital craniectomy defects with hydroxyapatite cement: A preliminary report
Authors: Kveton John F. , Friedman Craig D. , Piepmeier Joseph M. , Costantino Peter D.
Published: October 2006

Hydroxyapatite cement, a new biomaterial presently under clinical investigation, has been demonstrated to have potentially wide application in cranial reconstruction. We describe our experience with this biologic bone cement in the reconstruction of suboccipital craniectomy defects in seven patients after vestibular schwannoma removal. With up to 2‐year follow‐up, cranial bone integrity has been reestablished in five patients. Dissolution of cement has occurred in dependent areas and appears to be technique related. Cranial bone contour appears dependent on the amount of cement used. The frequency of debilitating postoperative headache was reduced in these patients when compared to patients who had no reconstruction of the craniectomy defect. Reconstruction of the bony defect after suboccipital craniectomy with hydroxypatite cement is not only useful to restore cranial contour, but also appears to reduce some of the functional deficits attributed to this surgical approach.
Laryngopharyngoesophagectomy for advanced hypopharyngeal and esophageal squamous cell carcinoma: The yale experience
Authors: Sasaki Clarence T. , Salzer Stephen J. , Cahow C. Elton , Son Yung , Ward Barbara
Published: October 2006

The 5‐year survival rate for patients with hypopharyngeal squamous cell carcinoma invading the upper esophagus is below 25% regardless of therapy. Most patients with advanced disease—unable to eat or breathe—die within 18 months of diagnosis. Because these patients, on average, have a limited time to live, surgical treatment should aim to maximize the quality of remaining life. Essential to this goal are complete tumor removal and rapid return to oral feeding. Furthermore, short hospital stay and low perioperative morbidity are especially important in these patients.

We performed total laryngopharyngoesophagectomy (LPE) with gastric transposition in 34 patients with hypopharyngeal and cervical esophageal squamous cell carcinoma. There has been one perioperative death (3%) and 1 temporary fistula (3%). No major mediastinal or intrathoracic complication occurred. On average, patients began oral feeding by postoperative day 10, with return to a full diet and discharge home within 16 days, maximizing both quality and quantity of time remaining outside the hospital.
Nasal inflammation in patients with obstructive sleep apnea
Authors: Rubinstein Israel
Published: October 2006

The purpose of this study was to determine whether nasal inflammation is present in patients with obstructive sleep apnea (OSA). The number of polymorphonuclear leukocytes (PMNs) and the concentrations of bradykinin and vasoactive intestinal peptide (VIP) were quantified in nasal lavage fluid of eight nonsmoking patients with OSA and in six matched controls before sleep and the next morning. The total number of cells and the percentage of PMNs was significantly higher in patients with OSA in comparison to controls before and after sleep (P<.05). Likewise, bradykinin and VIP concentrations were significantly higher in patients with OSA in comparison to controls before and after sleep (P<.05). These findings indicate that nasal inflammation is present in patients with OSA. We suggest that nasal inflammation plays a role in upper airway obstruction in OSA.