bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular pathologic study of human papillomavirus infection in inverted papilloma and squamous cell carcinoma of the nasal cavities and paranasal sinuses
Authors: Furuta Yashushi , Tanaka Katsuhiko , Inuyama Yukio , Shinohara Toshiya , Sano Kimiaki , Nagashima Kazuo , Inoue Kazuaki
Published: October 2006

Nasal inverted papilloma is a rare benign tumor occasionally associated with squamous cell carcinoma. To determine the etiological role of human papillomavirus in inverted papilloma, and to clarify the relationship between human papillomavirus and malignant transformation of this benign tumor, we retrospectively analyzed inverted papillomas from 26 patients, 7 of whom had squamous cell carcinoma.

We used an immunohistochemical method and molecular pathologic techniques, or dot‐blot hybridization of DNA extracted from paraffin‐embedded tissues, in situ hybridization, and polymerase chain reaction. Human papillomavirus was detected in 5 of 26 patients (19%), 3 patients with human papillomavirus 11 and 2 patients with human papillomavirus 16. The latter 2 patients had inverted papillomas associated with squamous cell carcinoma. We speculate that human papillomavirus may be related to the malignant transformation of inverted papillomas.
Facial nerve trauma: Optimal timing for repair
Authors: Barrs David M.
Published: October 2006

Due to the uncertainty of optimal timing for facial nerve repair after severe trauma, a study was designed to investigate facial nerve repair in micro‐pigs by grafting at intervals after nerve transection ranging from 0 to 90 days. Following adequate time for regeneration, it was possible to electrically stimulate across the nerve graft in all animals. No significant difference existed between operative groups for electrophysiologic testing. Axon counts demonstrated a trend toward a lower regeneration rate in more delayed grafts. This trend and the ease of grafting with less scar and nerve stump resection suggest that the best results may be obtained with grafting as early as possible. Grafting at 21 days, the peak of neuron cell‐body metabolic activity, did not produce better results. Since statistically significant differences do not exist between individual groups, grafting several months after trauma can be successful, if medically necessary.
Wide vertical hemipharyngolaryngectomy with immediate glottic and pharyngeal reconstruction using a radial forearm free flap: Preliminary results
Authors: Chantrain Gilbert , Deraemaecker Rika , Andry Guy , Dor Pierre
Published: October 2006

We propose a new technique of wide vertical hemipharyngolaryngectomy which combines resection of laterally localized extended pharyngolaryngeal tumors with immediate microsurgical reconstruction using a radial forearm free flap, including the tendon of the palmaris longus. It eliminates the limitations of resections, which are usually performed to avoid closure difficulties of the resulting defect.

In addition, the new technique avoids the use of tumor‐neighboring structures for closure, fulfilling the oncological principles of surgery performed in this region.

Our preliminary results show good restored deglutition and phonation. Postoperative irradiation does not seem to affect these results.
How i do it: Head and neck and plastic surgery: A targeted problem and its solution a method for the treatment of abductor spasmodic dysphonia with botulinum toxin injections: A preliminary report
Authors: Rontal Michael , Rontal Eugene , Rolnick Michael , Merson Richard , Silverman Bruce , Truong Daniel D.
Published: October 2006

A preliminary technical report of the effective treatment of abductor spasmodic dysphonia with botulinum toxin is presented. Our technique attempts to place the toxin close to the posterior cricoarytenoid muscle to allow diffusion of the material to the PCA. Our pilot study demonstrates that botulinum toxin is an effective approach for reducing or eliminating the abductor glottal spasms during phonation and, thereby, providing functional speech communication.
Cis‐Platinum ototoxicity in children
Authors: Weatherly Robert A. , Owens Judith J. , Catlin Francis I. , Mahoney Donald H.
Published: October 2006

Despite the recognized ototoxicity of cis‐platinum, a clinical outline for the audiologic evaluation of patients receiving this drug has not been clearly defined. In a practical approach to this problem, the audiograms of 48 pediatric patients referred for monitoring during planned cis‐platinum therapy were reviewed. Eleven patients tested with auditory brainstem response (ABR) audiometry demonstrated several limitations of this modality. Fourteen children underwent initial ABR testing followed by at least two pure‐tone audiograms. The remaining 23 patients had their hearing evaluated by pure‐tone audiometry only. Various factors such as patient age, cis‐platinum dosage, and cranial radiation exposure were analyzed for apparent effect. Younger patients tended to be more susceptible to audiologic changes with the administration of cis‐platinum. The proportion of patients who demonstrated a hearing loss increased with successive dosing as did the severity of the hearing loss. Prior exposure to cranial radiation was strongly linked to the development of hearing loss following cis‐platinum therapy. Guidelines are presented regarding the use of clinical audiometry in the screening of these pediatric oncology patients.
Repair of peripheral nerves of unequal diameters
Authors: Hinckley Daniel K. , Lyles C. Alan , Mattox Douglas E.
Published: October 2006

Four techniques for anastomosis were investigated for the anastomosis of a large proximal segment to a smaller distal segment of rat peripheral nerve with a size disparity of approximately 3 to 1. The techniques were perineural sutures (group I), KTP laser annealing (group II), collagen tubes with a 5‐mm gap between the nerve segments (group III), and collagen tubes without a gap between the nerve ends (group IV).

At 6 weeks there were no gross nerve distractions in groups I or IV. There were two failures in group II and three in group III. The percentage of fibers that crossed intact anastomoses were: group I, 89%; group II, 75%; group III, 115%; group IV, 125% (P<.05 for the collagen tube repairs).

Our results indicate that the suture technique is still the most reliable method of nerve repair. However, collagen tubes were effective in increasing the percentage of axons crossing the anastomosis.
Revision stapes surgery
Authors: Farrior Jay , Sutherland Alan
Published: October 2006

With the decline in primary cases of otosclerosis surgery, revision stapes operations are becoming a higher percentage of otosclerosis practice. Are the results from revision stapes surgery today comparable with those of surgeons trained prior to the present decline? A retrospective review of 559 consecutive stapes operations performed by the author revealed 109 revision operations. A retrospective review of these cases reveals that the most common cause for revision surgery was displaced prostheses and incus necrosis. The hearing results are dependent on the surgical pathology. In this series, the air‐bone gap was closed to less than 10 dB in 58% of cases, there were 64% of cases of displaced prostheses, and 57% of cases of incus necrosis, which is comparable with previously reported studies.
Ototoxicity of furosemide during development
Authors: Rybak Leonard P. , Whitworth Craig , Scott Vernedra , Weberg Aruna
Published: October 2006

The rat is an altricial animal which serves as a useful model for human auditory development. The purpose of the present study was to investigate the effects of furosemide on cochlear function and the stria vascularis ultrastructure at various postnatal ages. Rat pups anesthetized with ketamine hydrochloride/xylazine hydrochloride received furosemide 35 mg/kg intravenously (IV), and the endocochlear potential and compound action potential of the eighth nerve were recorded. The stria vascularis was removed and prepared for transmission electron microscopy. Rat pups 9 to 28 days of age had a much greater reduction of endocochlear potential and elevation of the compound action potential threshold than animals older than 30 days. These physiologic changes were accompanied by edema of the stria on transmission electron microscopy only in animals at susceptible ages. These findings support the concept of a critical period of susceptibility to ototoxic drugs during development and could have important clinical implications in premature infants.
Chloroaluminum sulfonated phthalocyanine versus dihematoporphyrin ether: Early vascular events in the rat window chamber
Authors: Stern Scott J. , Flock Stephen , Small Susan , Thomsen Sharon , Jacques Steve
Published: October 2006

The development of a simple and well‐tolerated rat window chamber has allowed direct comparison of the vascular effects of two photosensitizers, chloroaluminum sulfonated phthalocyanine (CASP) and dihematoporphyrin ether (DHE).

CASP and DHE were given 4 days after the implantation of the window chamber. Photodynamic therapy (PDT) with CASP was performed 24 hours after intravenous injection (10 mg/kg) with light at 675 nm (power density 200 mW/cm2, incident energy 100 J). DHE was given in a similar fashion (5 mg/kg intraperitoneally; light at 630 nm with matching power density and energy settings 24 hours after injection).

Using videomicroscopic and integrating sphere measurements, marked differences were noted in the vascular effects of these photosensitizers. DHE caused immediate hemorrhage and disruption of the postcapillary venules, while CASP induced vascular spasm starting 4 hours after the completion of PDT. Forty‐eight hours after PDT, both systems demonstrated a loss of chamber‐induced neovascularization.
Physiologic motion after vocal cord reinnervation: A preliminary study
Authors: Green David C. , Berke Gerald S. , Graves Michael C. , Natividad Manuel
Published: October 2006

This study attempted to reestablish physiologic vocal cord motion, rather than synkinesis, to a rein‐nervated vocal cord. One mongrel dog underwent a division and reanastomosis of the anterior branch of the right recurrent laryngeal nerve and simultaneous separation and reimplantation of a posterior division nerve‐muscle pedicle into the posterior cricoarytenoid muscle. After 21 weeks, spontaneous physiologic vocal cord movement and electromyographic (EMG) activity were recorded during respiratory obstruction and laryngeal mechanical stimulation. Acoustic measures and histologic data are also presented from the reinnervated and normal vocalis muscle and from the recurrent laryngeal nerve. This study demonstrated that physiologic vocal cord motion can be achieved after laryngeal reinnervation using this technique.
Nucleolar organizer regions in squamous cell carcinoma of the head and neck
Authors: Hirsch Steven M. , Ducanto James , Caldarelli David D. , Hutchinson James C. , Coon John S.
Published: October 2006

Nucleolar organizer regions are collections of nucleolar proteins associated with ribosomal genes that can be visualized in histologic sections using a silver colloid stain, thus the term silver‐staining nucleolar organizer region (AgNOR). In some tissues, the number of AgNORs per nucleus correlates with cellular proliferation and, independently, with malignant change. AgNORs were studied in 66 paraffin‐embedded head and neck squamous cell carcinomas and in 12 samples of normal tonsillar squamous epithelium. Carcinomas had a significantly higher mean AgNOR count than the benign epithelium (P <.0001). Among carcinomas, mean AgNOR count increased with stage of the disease (P <.001), but there was no significant correlation with histologic grade or DNA ploidy as determined by flow cytometry. These data suggest that AgNOR count should be evaluated as a possible aid in differentiating benign from malignant squamous epithelial proliferations in the head and neck, and also possibly as a prognostic marker in these carcinomas.
Analysis of risk factors for postoperative pulmonary complications in head and neck surgery
Authors: Rao Mohan K. , Reilley Thomas E. , Schuller David E. , Young Donn C.
Published: October 2006

Preoperative pulmonary function tests (PFTs) are unproven in their predictive value for postoperative pulmonary complications. There is a lack of prospective outcome studies upon which to form an opinion, particularly regarding noncavitary surgery.1 Seventy‐three head and neck surgery patients were prospectively evaluated with preoperative PFTs, arterial blood gas analysis (ABG), medical history, and physical examination. Age, anesthesia duration, forced expiratory volume in 1 second (FEV1), peak flow (PF), PaO2, Roizen class, and pack years of smoking were significantly correlated with postoperative pulmonary complications. As similar studies in head and neck surgery patients have not been previously taken, it is hoped that these results will serve as a basis for future endeavors.
Hyperbaric oxygen therapy: Effect on middle ear and eustachian tube function
Authors: Fernau James L. , Hirsch Barry E. , Derkay Craig , Ramasastry Sai , Schaefer Susan E.
Published: October 2006

Hyperbaric oxygen therapy (HBO) involves intermittent inhalation of 100% oxygen under a pressure greater than 1 atm. It is an important mode of adjuvant therapy for disease processes such as decompression sickness, osteomyelitis, carbon monoxide poisoning, and poorly healing wounds. Patients undergoing this therapy often complain of ear pain and/or fullness which can be transient or long standing. This prospective study objectively measured the changes in eustachian tube function before and after HBO treatment in 33 adult patients by the 9‐step inflation‐deflation test described by Bluestone. The results show 15 of the 33 patients (45%) had evidence of eustachian tube dysfunction after treatment was initiated. Of these, 15 (100%) developed the sensation of fullness, 13 (87%) developed serous otitis media, and 7 (47%) required tympanostomy tubes.

The overall incidence of middle ear problems was 27 patients (82%) experiencing a sensation of fullness, 17 (52%) developing serous otitis media, and 8 (24%) requiring tympanostomy tubes. The middle ear complications reported in this study are much higher than those in previous reports in the literature. Twelve of 33 patients presented with a subjective history of eustachian tube dysfunction, and all 12 (100%) developed fullness in their ears and serous otitis media during the course of the treatment. The findings reveal that patients manifesting eustachian tube dysfunction after their first HBO treatment were at significantly greater risk toward developing symptoms of fullness and serous otitis media, often requiring tympanostomy tube placement. In addition, a history of eustachian tube dysfunction accurately predicted the development of fullness and serous otitis media.
Nuclear morphometry and stereology in nasopharyngeal carcinoma
Authors: Reifen Ella , Noyek Arnold M. , Mullen J. Brendan M.
Published: October 2006

The prognostic value of nuclear morphometry in nasopharyngeal carcinoma (NPC) was investigated in 28 patients. Seven morphometric nuclear variables were measured on 100 randomly selected tumor cells in nasopharyngeal biopsies from 18 patients with NPC confined to the nasopharynx. The same variables were measured in 6 patients with metastatic NPC, as well as in lymph node biopsies from 4 patients with metastatic NPC. Nuclear area, nuclear perimeter, long and short nuclear axes, nuclear form factor, nucleolar area, and the ratio of nucleolar area to nuclear area were all measured. Volume‐weighted mean nuclear volume was also obtained.

Tumor cells from patients with NPC confined to the nasopharynx had significantly larger mean nuclear areas, perimeters, and volume‐weighted mean nuclear volumes but significantly smaller nucleolar to nuclear area ratios than tumor cells from patients with nodal metastases. Assessment of nuclear form factor and diameters did not differentiate the two groups.
Vasoactive therapy versus placebo in the treatment of sudden hearing loss: A double‐blind clinical study
Authors: Kronenberg Jona , Almagor Moshe , Bendet Erez , Kushnir Dana
Published: October 2006

Twenty‐seven patients suffering from sudden sensorineural hearing loss (SHL) were randomly assigned to one of two groups: a treatment group (n = 13) receiving intravenous procaine and low‐molecular‐weight dextran, and a placebo control group (n = 14). The effect of treatment was analyzed by means of an analysis of variance and covariance procedures. Results indicated nonsignificant differences between the groups on all outcome indices measured. Sex, age, time since the onset of symptoms to the initiation of therapy, audiogram configuration, and initial severity of hearing loss did not significantly affect the results. These findings suggest that the therapeutic effects of this vasodilator are not superior to a placebo.
The controversial treatment of anterior commissure carcinoma of the larynx
Authors: Zohar Yuval , Rahima Menashe , Shvili Yitschak , Talmi Yoav P. , Lurie Hedy
Published: October 2006

There are two basic approaches to the appropriate therapy for carcinoma of the anterior commissure. The dilemma of whether to treat by primary irradiation or by conservative surgery is not yet solved. In this study, 67 patients were treated between 1967 and 1987 for anterior commissure carcinoma of the larynx. Radiation was used with 47 patients and conservation surgery with 20 patients. Initial lesion control was achieved with 72% of the patients treated by primary irradiation. Conservation surgery, when used as a primary treatment modality, achieved local control in 90% of the patients. The new techniques of reconstruction of the larynx enhance the surgeon's ability, strengthen his conviction to proceed to enlarged partial laryngectomies, and thus improve the oncologic control of the anterior commissure carcinoma as well.
Laser dyes for experimental phototherapy of human cancer: Comparison of three rhodamines
Authors: Haghighat Shaghayegh , Castro Dan J. , Lufkin Robert B. , Fetterman Harold R. , Castro Donna J. , Soudant Jacques , Ward Paul H. , Saxton Romaine E.
Published: October 2006

The mitochondrial dye Rhodamine 123 (Rh‐123) has been shown to be an effective photosensitizer for argon‐laser irradiation of some types of human cancer cells in vitro. We reported that 514.5‐nm laser illumination of Rh‐123 sensitized human melanoma, and squamous carcinoma cells strongly inhibited tumor‐cell proliferation as measured by decreased3H‐thymidine (3H‐T) uptake in vitro and may eradicate some tumors when grown as transplants in nude mice. However, several other human tumors were resistant to Rh‐123 laser therapy in vitro and in vivo. In the current study, it was possible to obtain 100‐ to 1000‐fold increased sensitivity to 514.5‐nm laser illumination by replacement of Rh‐123 with the cationic rhodamine dyes Rh‐3G and Rh‐6G. Cell viability was decreased over 95% and3H‐T incorporation reduced at least 80% by laser phototherapy after sensitizing tumor cells with 1 μg/mL Rh‐123, 0.01 μg/mL Rh‐3G, or 0.001 μg/mL Rh‐6G. However, Rh‐123 alone did not decrease3H‐T uptake significantly unless present at over 10‐ to 100‐fold higher levels than Rh‐3G, respectively. The tumor cell dye uptake level was measured by N‐butanol extraction and absorption scans at 400 to 600 nm. The results revealed that dye uptake was more rapid, and retention of Rh‐3G and Rh‐6G was 5‐ to 10‐fold higher than for Rh‐123 in the human tumor cells. The data suggest that Rh‐3G and Rh‐6G may be highly sensitive chromophores for laser phototherapy of human cancer cells.
Different options for treatment of inverting papilloma of the nose and paranasal sinuses: A report of 41 cases
Authors: Dolgin Sanford R. , Zaveri Vijay D. , Casiano Roy R. , Maniglia Anthony J.
Published: October 2006

Forty‐two cases of inverting papilloma of the nose and paranasal sinuses were reviewed from 1972 to 1989. Forty‐one patients underwent surgical excision. Of those patients followed up for at least 6 months, lateral rhinotomy was performed in 14 patients and midfacial degloving in 9 patients. The recurrence rates were 29% and 22%, respectively. The other 10 patients underwent excision through an external ethmoidectomy, Caldwell‐Luc operation, or intranasal approach.

There were five patients (12%) diagnosed with squamous cell carcinoma associated with inverting papilloma. The correlation of malignancy with proptosis, visual changes, infraorbital hypesthesia, and skull base involvement on presenting symptomatology is noted.

Inverting papilloma is a benign neoplastic lesion that shows variable aggressiveness. A computed tomography (CT) scan evaluation is very important for the work‐up. An aggressive wide surgical excision is best performed through an open approach. The approach for surgical removal should be based on the location and extension of the lesion. A graduating approach from a lesser to a more major excision is advocated even though a risk exists of having to reoperate in about one fifth of the patients who experience a recurrence. A secondary surgical excision, even with craniofacial resection, is essential to eradicate disease in cases of recurrence. Close follow‐up is necessary. Further surgery may be indicated. Postoperative radiation therapy is recommended if malignancy is indeed present.
Surgical considerations in tracheal stenosis
Authors: Anand Vinod K. , Alemar Gilberto , Warren E. Taliaferro
Published: October 2006

From 1969 to 1990, 43 patients with tracheal stenosis were treated at the University of Mississippi Medical Center. Seventy‐four percent of these patients (n = 32) had intrinsic tracheal stenosis, most frequently as a complication of prolonged endotracheal trauma. A total of 41 distinctly separate stenotic segments were identified in the 32 patients. The stenoses were considered moderate or severe in 33 (80%) of the 41 cases and the length of the stenotic segment was greater than 1 cm in 23 (56%) of the cases. An overall 70% success rate was achieved following 93 surgical procedures in this group. The concurrent presence of glottic/subglottic stenosis, multiple segments of stenosis, bilateral vocal cord paralysis, tracheoesophageal fistula, and a tendency to marked hypertrophic scar formation were found to be significant factors in the surgical management of this patient group.
Postoperative Radiographic Evaluation After Acoustic Neuroma and Glomus Jugulare Tumor Removal
Authors: Thedinger Britt A. , Glasscock Michael E. , Cueva Roberto A. , Jackson C. Gary
Published: October 2006

The role of postoperative radiographic follow‐up of patients after acoustic neuroma or glomus jugulare tumor removal is unclear and not standardized. The incidence of both lesions is rare and recurrence thought to be unusual. However, a patient with an acoustic neuroma arising in the same ear afflicted with a glomus jugulare tumor removed 5 years earlier prompted a retrospective review of 999 acoustic neuroma and 98 glomus jugulare tumor patients. This review helps to determine the role and frequency of postoperative follow‐up, not only to assess recurrence of these lesions but to monitor for the possible development of potential clinically silent new lesions.
The intramuscular nerve supply of the posterior cricoarytenoid muscle of the dog
Authors: Diamond Andrew Jay , Goldhaber Neil , Wu Bei Lian , Biller Hugh , Sanders Ira
Published: October 2006

The paired posterior cricoarytenoid (PCA) muscle has three separate muscle bellies that differ in muscle fiber type (percentage of fast vs. slow twitch) and electromyelographic activity, and, in addition, produce different movements of the arytenoids when stimulated. An investigation of the innervation of the muscle was undertaken to demonstrate the existence of separate functional units.

The intramuscular nerve supply of the PCA from five sacrificed dogs were microdissected. The intramuscular nerves of three additional dogs were removed and stained for acetylcholinesterase, which differentiates axons bound for fast‐ and slow‐twitch muscle, and sensory end organs.

Three separate fascicles are described entering the PCA muscle from a single branch of the recurrent laryngeal nerve. The three fascicles differ in axon type composition and in sensory, autonomic, and motor percentages, with the ratio of fast twitch to slow twitch varying from 0.78 to 1.5 to 1.7 (P <.05). This variation supports separate functional capabilities for the three muscle bellies of the PCA.
Is outpatient tonsillectomy appropriate for young children?
Authors: Tom Lawrence W.C. , Dedio Robert M. , Cohen David E. , Wetmore Ralph E. , Handler Steven D. , Potsic William P.
Published: October 2006

The current literature suggests that outpatient tonsillectomy is a safe, cost‐effective procedure. These reports have based their conclusions on the low rates of postoperative bleeding and dehydration. Generally, they have not examined other factors that may influence the postoperative course or identified groups of patients in whom outpatient management may not be appropriate. The literature regarding tonsillectomy in young children is conflicting. A retrospective analysis of the records of 223 children, 36 months of age and younger who had tonsillectomies, was performed. Postoperative airway complications including oxygen desaturation and airway obstruction developed in 115 patients. Seventeen (7.6%) children required postoperative care in an intensive care unit while an additional 117 (52.5%) patients received more than standard management. Preoperative apnea, an age of less than 12 months, and the presence of accompanying medical conditions were associated with a higher incidence of postoperative airway complications. It is recommended that tonsillectomy in patients under 36 months of age be planned as an inpatient procedure.
Positron emission tomography: A new, precise imaging modality for detection of primary head and neck tumors and assessment of cervical adenopathy
Authors: Bailet Jeffrey W. , Abemayor Elliot , Jabour Bradley A. , Hawkins Randall A. , Ho Carl , Ward Paul H.
Published: October 2006

Positron emission tomography (PET) has been shown to be effective in detecting intracranial malignancies based on cerebral glucose metabolism. To evaluate the ability of PET to detect extracranial head and neck neoplasms and cervical metastases, 16 patients with primary squamous cell carcinomas were examined. All patients received preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) scans and underwent PET evaluation using intravenous 18F‐2‐fluoro‐2‐deoxy‐D‐glucose (FDG). Histopathologic analysis compared tumor invasion and positive lymph nodes with findings on MRI, CT, and PET images. All primary tumors were delineated by PET, while MRI and CT failed to detect one superficial tumor involving the anterior tongue. Ten nodes were detected by CT and MRI versus 12 nodes demonstrated by PET. PET is highly effective in detecting head and neck carcinomas as well as metastatic cervical lymph nodes. In addition, PET may be useful in evaluating postsurgery and postradiotherapy patients for recurrent and new primary tumors.
Noise exposure in the rural setting
Authors: Holt James J. , Broste Steven K. , Hansen Donald A.
Published: October 2006

Noise levels of 155 tractors on 36 farms were studied. The range of noise levels at the driver's ear level with radios off and windows closed (if so equipped) was from 78 to 103 dB. Seventy‐five percent of tractors without cabs had noise levels in excess of 90 dB, compared to only 18% of tractors with cabs. The use of a radio adds an average of 3.1 dB of noise. When some cab windows are open and the radio is on, an average of 4.2 dB is added to the cab noise. From the results of this study, the authors recommend hearing protection when time on a tractor with a cab approaches 3 to 4 hours and when time on a tractor without a cab approaches 1.5 to 2 hours. Limited use of the radio is also recommended.
Does early expansion surgery have a role in the management of congenital subglottic stenosis?
Authors: Rosenfeld Richard M. , Bluestone Charles D.
Published: October 2006

To better define the clinical course of congenital subglottic stenosis, the authors reviewed a cohort of 27 children managed with long‐term tracheotomy and interval bronchoscopy. Rates of spontaneous resolution were 19% at 6 months, 39% at 12 months, and 69% at 18 months (Kaplan‐Meier survival analysis). Children older than 4 months of age at tracheotomy tended to have more rapid resolution of their stenoses (P = .08). Overall, the median time to decannulation was 15.8 months (95% confidence interval, 13.9 to 17.6 months). One death was possibly tracheotomy‐related, and 12 (44%) of the children experienced complications or sequelae resulting in new or extended hospitalization. Considering the prolonged cannulation necessary for spontaneous resolution of congenital subglottic stenosis, the role of long‐term tracheotomy as the sole form of management may be limited. Once the need for intervention is apparent, the authors recommend early consideration of cricoid split or laryngotracheoplasty as alternatives to long‐term tracheotomy.
Serum and acute phase protein modulation of the effector phase of lymphokine‐activated killer cells
Authors: Dayman Gary L. , Taylor Dorothy L. , Liu Frank J. , Lavedan Pierre , Savage Howard E. , Schantz Stimson P.
Published: October 2006

An understanding of the role that immunomodulatory factors play in the effector phase of lymphokine‐activated killer (LAK) activity is essential for the development of biologic response modifiers for use in the treatment of advanced carcinoma. Fifteen head and neck cancer patients were studied. Single‐donor killer cells activated by recombinant interleukin‐2 (10 U/mL) and induced in either a complete medium or complete medium plus a 10% autologous serum solution were used. Effector phase solutions of 25% autologous serum were used in chromium 51 release assays to determine sera immunomodulation of LAK cell cytotoxicity. Both K562 and squamous carcinoma (MDA686‐Ln) tumor cell lines were tested.

Significant effector phase inhibition (EPI) of cytotoxicity occurred in 40% of studied patients. Seventy percent of patients with stage III or IV or recurrent disease exhibited EPI, whereas only 20% of patients with stage I or II disease and 30% of controls did so. EPI of cancer patient serum correlated directly with α1‐antitrypsin, α1‐acid glycoprotein, and C‐reactive protein (CRP) levels (MDA686‐Ln targets) (r = 0.6, 0.7, and 0.6, respectively) (P<.02). Neither EPI against K562 targets nor EPI in control patients correlated with acute phase protein levels. These findings suggest that advances in in vivo immunomodulatory therapy will be dependent upon further elucidation of serologic inhibition of the effector phase of the LAK cell phenomenon. The relationship between LAK cell recognition and EPI requires further investigation.
Sudden hearing loss induced by acoustic neuroma: Significance of small tumors
Authors: Yanagihara Naoaki , Asai Masanori
Published: October 2006

In our series of 111 patients operated on for acoustic neuroma from 1972 to 1990, 21 (18.9%) had sudden hearing loss. The 21 tumors involved were comprised of 9 small, 5 medium, and 7 large tumors. Emphasis is placed on the fact that even a small tumor has the potential to produce sudden hearing loss (SHL) and that the possibility of seeing patients with SHL is increasing thanks to advances in imaging diagnosis. Recognition of SHL as an initial symptom of acoustic tumor is considered essential to detect small acoustic neuroma.
Histological study of the healing of traumatic tympanic membrane perforation after basic fibroblast growth factor application
Authors: Mondain Michel , Ryan Allen
Published: October 2006

Basic fibroblast growth factor (bFGF) can stimulate the proliferation and differentiation of keratinocytes, fibroblasts, and endothelial cells. These cells are involved during the healing of tympanic membrane (TM) perforations. Light and electron microscopy examinations were used to study the histology of TM healing after application of 400 ng of bFGF on the perforation. The progress of healing is accelerated, but the basic healing process is unchanged, i.e., epithelial proliferation first closes the perforation and is then followed by connective tissue growth. There is more connective tissue in the TM receiving bFGF, and extracellular fibers are better oriented. No significant increase of neoangiogenesis was detected in the treated TM. In the nonperforated area of treated TM, an extensive hyperplasia of the submucosal connective tissue is observed. These results demonstrate that bFGF can produce a TM scar containing more connective tissue, which may be of benefit in the prevention of atrophic healed TM.
Photodynamic therapy of human squamous cell carcinoma in vitro and in xenografts in nude mice
Authors: Megerian Cliff A. , Zaidi Syed I. A. , Sprecher Robert C. , Setrakian Sebouh , Stepnick David W. , Oleinick Nancy L. , Mukhtar Hasan
Published: October 2006

Photodynamic therapy (PDT) of cancer is an experimental tumor therapy which is based on the combined use of a systemically administered photo‐sensitizer to a tumor‐bearing host and local illumination of the lesion by a high‐intensity visible light source, typically a tunable argon dye laser. Human squamous cell carcinoma (HSCC) is the most frequently encountered malignancy of the head and neck. In this study, responses of HSCC cells to PDT were examined in in vitro and in vivo systems. In in vitro studies, the HSCC cells showed a positive photodynamic response with Photofrin‐II® (Pf‐II), chloroaluminum phthalocyanine tetrasulfonate (AIPcTS), and a newly synthesized silicon phthalocyanine (SiPc IV). Single cell suspension of HSCC injected subcutaneously on the back of athymic nude mice resulted in a well‐circumscribed tumor mass. The animals required a low tumor dose for the successful establishment of a tumor. The tumor was minimally immunogenic and showed neither macroscopic signs of early metastasis to lung, kidney, liver, or spleen nor evidence of surrounding erythema, fluctuation, or tenderness until the late stages of necrosis. Intraperitoneal administration of AlPcTS or SiPc IV to tumor‐bearing mice resulted in rapid uptake of the photosensitizers in liver, skin, and tumor tissue. Twenty‐four hours following the intraperitoneal administration of AlPcTS or SiPc IV to tumor‐bearing animals, the tumor to normal skin ratio of the photo‐sensitizer was 1.6 or 1.5, respectively. Administration of Pf‐H (5 mg/kg) to tumor‐bearing animals followed 24 hours later by irradiation of the tumor (135 J/cm2, 630 nm light from an argon pumped‐dye laser) resulted in greater than 80% ablation in tumor volume 24 hours post‐PDT. These characteristics make this tumor model system suitable for PDT studies of human tumor cells in vitro as well as in vivo.
Treatment of an acoustic neuroma in an only‐hearing ear: Case reports and considerations for the future
Authors: Thedinger Britt A. , Cueva Roberto A. , Glasscock Michael E.
Published: October 2006

Current options regarding the treatment of acoustic neuroma in an only‐hearing ear include: observation, attempted hearing preservation surgery, and stereotactically guided radiation therapy. A patient who had a left labyrinthectomy for Meniere's disease presented 15 years later with a large right acoustic neuroma. Due to anticipated profound deafness, he fit the criteria for cochlear implantation. Promontory stimulation of the left ear was positive. He underwent successful left cochlear implantation with the Nucleus® 22‐channel device and was successfully rehabilitated. He then underwent translabyrinthine removal of his right‐sided 2.5‐cm acoustic neuroma. This case is used to illustrate a new option available to those faced with treating a patient with acoustic neuroma in an only‐hearing ear. How this approach may fit in with other available options will be discussed.
Coronal CT scan abnormalities in children with chronic sinusitis
Authors: April Max M. , Zinreich S. James , Baroody Fuad M. , Naclerio Robert M.
Published: October 2006

Coronal computed tomography (CT) scans are currently the optimal study to display the normal and abnormal anatomy in children with chronic and recurrent acute sinusitis after failure of medical therapy. To assess the extent and distribution of disease as well as associated anatomic abnormalities in this pediatric population, 74 coronal CT scans of children with continued symptoms of sinusitis after failure of extensive medical therapy were reviewed retrospectively. Twelve children with cystic fibrosis showed the characteristic features of medial displacement of the lateral nasal wall in the middle meatus and uncinate process demineralization, creating the appearance of a maxillary sinus mucocele. Nine of these 12 children had increased attenuation in the maxillary sinus on soft‐tissue windows. In the remaining 62 children, a significantly greater frequency of disease, when compared with that reported for adults, was seen in the maxillary, anterior ethmoid, posterior ethmoid, and frontal sinuses. Children with asthma (n = 33) had more extensive disease. Bony anatomic abnormalities were similar to those reported for adults, except for a lower incidence of septal deformity.
Immunoperoxidase study of the endolymphatic sac in meniere's disease
Authors: Dornhoffer John L. , Waner Milton , Arenberg I. Kaufman , Montague Donna
Published: October 2006

A growing body of evidence suggests that some cases of Meniere's disease may be mediated by immune mechanisms. Because endolymphatic sac dysfunction is believed to be an underlying cause of Meniere's disease, this study used immunohistochemical techniques to demonstrate the presence of immune complex deposition in the sacs of patients with Meniere's disease. Positive immunoglobulin G (IgG) staining was noted in 10 of 23 sac biopsies from Meniere's patients, with 2 specimens showing perivascular deposition. Only 1 of 5 control specimens was only slightly positive for IgG. Clinical correlation showed a statistically significant increase in disease bilaterality (P<.05), larger summating potential/ action potential (SP/AP) ratios with electrocochleography (ECoG), and a tendency toward worse hearing and more progressive disease among the immunopositive Meniere's patients. The results provided histological evidence of immune injury in the endolymphatic sacs of patients with Meniere's disease.
An analysis‐by‐synthesis approach to the estimation of vocal cord polyp features
Authors: Koizumi Takuya , Taniguchi Shuji , Itakura Fumitada
Published: October 2006

This paper deals with a new noninvasive method of estimating vocal cord polyp features through hoarse‐voice analysis. A noteworthy feature of this method is that it enables us not only to discriminate hoarse voices caused by pathological vocal cords with a single golf‐ball–like polyp from normal voices, but also to estimate polyp features such as the mass and dimension of polyp through the use of a novel model of pathological vocal cords which has been devised to simulate the subtle movement of the vocal cords. A synthetic hoarse voice produced with a hoarse‐voice synthesizer is compared with a natural hoarse voice caused by the vocal cord polyp in terms of a distance measure and the polyp features are estimated by minimizing the distance measure. Some estimates of polyp dimension that have been obtained by applying this procedure to hoarse voices are found to compare favorably with actual polyp dimensions, demonstrating that the procedure is effective for estimating the features of golf‐ball–like vocal cord polyps.
Facial nerve near the external auditory meatus in man: Computer reconstruction study—Preliminary report
Authors: Yasumura Satsuki , Takahashi Haruo , Sando Isamu , Aoki Hajime , Hirsch Barry E.
Published: October 2006

The anatomy of the facial nerve relative to its intratemporal and extratemporal courses varies over time with developmental changes. Otologic and parotid surgery in infants and children demands detailed knowledge of the precise anatomy of the facial nerve with respect to the tympanic ring and external auditory canal, The authors analyzed this area using our three‐dimensional (3‐D) computer‐aided reconstruction and measurement method studying the spatial relations of the facial nerve to the tympanic ring and stylomastoid foramen. Temporal bones from five normal individuals aged 36 gestational weeks, 3 months, 8 months, 4 years, and 17 years were retrieved from the temporal bone collection stored at the Elizabeth McCullough Knowles Otopathology Laboratory in Pittsburgh. Three‐dimensional reconstruction of the facial nerve comparing the developmental anatomy across the various age groups provides the surgeon with the technical information necessary to address problems in this area.
Ionized serum calcium levels following combined treatment for cancer of the head and neck
Authors: Talmi Yoav P. , Wolf Gregory T. , Esclamado Ramon , Carroll William R. , Sassler Alfred M.
Published: October 2006

Thyroid function may be reduced after treatment of cancer of the head and neck, and hypothyroidism is much more common after combination therapy. Whether hypoparathyroidism and subsequent hypocalcemia also occur after such treatment is unknown. Few related studies have been published in which changes in total serum calcium have been studied after cancer treatment with radioactive iodine or external radiation. Twenty‐two disease‐free head and neck cancer patients were studied, 1 to 3 years after multimodal treatment, to determine if changes in serum ionized calcium levels or thyroid function were present. Our results suggest that parathyroid function, as represented by ionized calcium levels remains normal after multimodality (surgery, radiation and/or chemotherapy) combined treatment.
Increased cytotoxicity of squamous cell carcinoma of the head and neck by combining cisplatin with VP‐16 and ciprofloxacin
Authors: Haller Jeffrey , Burgess Robert , Dawson Douglas
Published: October 2006

Chemotherapeutic treatment of squamous cell carcinoma (SCC) of the head and neck has been largely ineffective because of tumor cell resistance. This study examined combinations of cisplatin, 4′ demethylepipodophyllotoxin ethylidene D‐glucoside (VP‐16), and ciprofloxacin, a quinolone antibiotic. VP‐16 and ciprofloxacin were used in an effort to inhibit DNA repair and increase cytotoxicity. Chemotherapeutic agents often have a direct damaging effect on cellular DNA. Cytotoxicity may be the result of incomplete DNA repair mechanisms; whereas tumor cell resistance to drugs may be due to efficient DNA recovery. A nuclear enzyme especially important to DNA repair and cell growth is topoisomerase II (topo II). Targeted inhibition of topo II by VP‐16 and ciprofloxacin may cause increased cisplatin cytotoxicity. SCC cell lines of head and neck origin were treatd with a combination of cisplatin, VP‐16, and/or ciprofloxacin with cell viability being assessed by the MTT colorimetric assay. Four of five SCC lines examined demonstrated significant augmentation of cisplatin cytotoxicity with the addition of both VP‐16 and ciprofloxacin. These in vitro data suggest methods may exist for improving the chemotherapeutic treatment of SCC of the head and neck.
Acoustic neuroma volume: MRI‐based calculations and clinical implications
Authors: Long Steven A. , Arriaga Moises , Nelson Ralph A.
Published: October 2006

This study developed a technique for magnetic resonance imaging (MRI)‐based volume calculation and defined the specific volume‐diameter relationship in acoustic neuromas (AN). Computer‐assisted measurement calculated the area of tumor in each MRI slice. Volume was determined by multiplying area by slice interval. The technique was validated by imaging known volumes of gadolinium. The precision was greater than 95%.

Our volume calculations revealed a specific volume‐diameter relationship in ANs. The following conclusions can be drawn: 1. our technique can accurately determine AN tumor volume; 2. the AN volume‐diameter relationship is a specific function and cannot be predicted by assumptions of tumor shape; 3. the volume‐diameter relationship should be combined with clinical data to determine the “break point” at which small increments of diameter produce significant clinical sequelae.
Long‐term surgical results for congenital aural atresia
Authors: Shih Lucy , Crabtree James A.
Published: October 2006

Thirty‐nine primary surgical cases for correction of congenital aural atresia were reviewed for complications and long‐term hearing results. Hearing averages of 25 dB for mild atresia, 40 dB for moderate atresia, and 46 dB for severe atresia were obtained. Serviceable hearing was achieved in 64% of the cases. The two most frequent complications were stenosis and recurrent infections of the cavity and canal skin, with an incidence of 33% and 31%, respectively. Use of split‐thickness instead of full‐thickness skin graft was associated with fewer complications. The goal of this review is also to share the experience of the senior author in the management of this complex problem.
The galvanically‐induced vestibulo‐ocular reflex in the cat
Authors: Storper Ian S. , Honrubia Vicente , Beykirch Karl A. , Hoffman Larry F.
Published: October 2006

Rotatory vestibular input is processed by receptor organs and relayed along the vestibular nerves to a central processor, whence the vestibulo‐ocular reflex (VOR) is generated. Electrical stimuli applied to the labyrinth can bypass receptors and stimulate the nerve directly, thereby generating horizontal eye movements (EVOR). It was our purpose to mathematically relate the EVOR to the VOR in an effort to generate a parameter by which the experimental effects of ototoxins on the inner ear can be evaluated.

A feline preparation was created in which the VOR and EVOR were measured in response to various sinusoidal stimuli. A detailed comparison between VOR and EVOR with respect to gain and phase was performed. From analysis of the data, the differential sensitivity to rotatory amplitude with respect to electrical amplitude was proposed as this parameter.
Long‐term results of mastoid cavities grafted with cultured epithelium prepared from autologus epidermal cells to prevent chronic otorrhea
Authors: Premachandra D. J. , Woodward Barbara , Milton Catherine M. , Sergeant R. J. , Fabre J. W.
Published: October 2006

Chronic otorrhea and recurrent infection from open mastoid cavities are common and troublesome clinical problems for which there is no very satisfactory treatment. The authors have previously described a simple procedure to solve this problem, using autologous cultured keratinocyte layers grafted onto the unepithelialized open mastoid cavities. All procedures are carried out on an outpatient basis without anesthesia, except for local anesthesia for the skin biopsy. Twenty‐six patients with 28 “difficult” mastoids, in which otorrhea had been present from 2 to 32 years, have been grafted with a follow‐up period varying from 10 to 18 months. Seventeen mastoid cavities became symptom‐free as a result of this technique. There were 4 failures, and partial success was shown in 7 cavities as judged by both the patient and by clinical examination.