bluuebunny/crossref_metadata_2025 huggingface dataset:
Botulinum toxin treatment for symptomatic Frey's syndrome
Authors: Arad‐Cohen Abigail , Blitzer Andrew
Published: November 2005

Gustatory sweating, or Frey's syndrome, usually occurs after surgery or trauma to the parotid gland as a result of inappropriate parasympathetic cholinergic innervation of cutaneous sympathetic receptors. Numerous medical and surgical treatments have been proposed to prevent or treat this condition. The results, overall, have been unsatisfactory. Botulinum toxin is a relatively new treatment modality for Frey's syndrome. We review the literature and present our experience with 7 patients successfully treated with intradermal injections of botulinum toxin (Botox). Our technique and dosing are described. In all treated patients gustatory sweating ceased in the area injected with botulinum toxin. In 6 patients, symptoms reappeared, and additional injections were needed up to 4 times, at 6‐ to 8‐month intervals. All patients now have been free of symptoms for a long period of time (mean 12.1 months). We strongly recommend intradermal injections of botulinum toxin as a safe, efficacious treatment for gustatory sweating.
Effect of long‐term electrical stimulation on motor recovery and improvement of clinical residuals in patients with unresolved facial nerve palsy
Authors: Targan Robert S. , Alon GAD , Kay Scott L.
Published: November 2005

PURPOSE

This study investigated the efficacy of a pulsatile electrical current to shorten neuromuscular conduction latencies and minimize clinical residuals in patients with chronic facial nerve damage caused by Bell's palsy or acoustic neuroma excision.

SUBJECTS

The study group included 12 patients (mean age 50.4 ± 12.3 years) with idiopathic Bell's palsy and 5 patients (mean age 45.6 ± 10.7 years) whose facial nerves were surgically sacrificed. The mean time since the onset of paresis/paralysis was 3.7 years (range 1‐7 years) and 7.2 years (range 69 years) for the Bell's and neuroma excision groups, respectively.

METHOD AND PROCEDURES

Motor nerve conduction latencies, House‐Brackmann facial recovery scores, and a 12‐item clinical assessment of residuals were obtained 3 months before the onset of treatment, at the beginning of treatment, and after 6 months of stimulation. Patients were treated at home for periods of up to 6 hours daily for 6 months with a battery‐powered stimulator. Stimulation intensity was kept at a submotor level throughout the study. Surface electrodes were secured over the most affected muscles. Groups and time factors were used in the analyses of the 3 outcome measures.

RESULTS

No statistical differences were found between the two diagnostic groups with respect to any of the 3 outcome measures. Mean motor nerve latencies decreased by 1.13 ms (analysis of variance test, significant P = 0.0001). House‐Brackmann scores were also significantly lower (Wilcoxon signed rank test, P = 0.0003) after treatment. Collective scores on the 12 clinical impairment measures decreased 28.7 ± 8.1 points after 6 months [analysis of variance test, significant P = 0.0005). Eight patients showed more than 40% improvement, 4 better than 30%, and 5 less than 10% improvement in residuals score.

CONCLUSION

These data are consistent with the notion that long‐term electrical stimulation may facilitate partial reinnervation in patients with chronic facial paresis/paralysis. Additionally, residual clinical impairments are likely to improve even if motor recovery is not evident.
Head and neck squamous cell carcinoma: Better to be young
Authors: Lacy Peter D. , Piccirillo Jay F. , Merritt Michael G. , Zequeira Maria R.
Published: November 2005

Most head and neck squamous cell carcinoma patients are elderly, with few younger than 40 years. Controversy exists in the literature regarding outcomes for younger patients. The goal of this research project was to compare baseline features and outcomes for young patients (≤40 years), middle‐aged patients (41‐64 years), and old patients (≥65 years). To investigate the relationship between age and important presenting features and outcomes, 1160 recently diagnosed patients first treated at Washington University between 1980 and 1991 were identified from an existing database. Full 5‐year survival information was available for 1030 patients (89%). Overall, the 5‐year survival rate was 46% (478/1030); young patients (65%, 26/40) had a significantly better survival rate than middle‐aged (52%, 292/566) or old patients (38%, 160/424) (χ2 = 24.5; P = 0.001). Survival was also related to smoking, comorbidity, primary site, TNM stage, and nodal disease. Age remained a significant factor even after we controlled for these other factors. Young patients developed fewer recurrent and new primary tumors. We conclude that young patients have a much better overall prognosis than older patients. The reasons for this difference are unclear, but it appears that the impact of age goes beyond an actuarial effect.
Powered surgical instruments for laryngeal surgery
Authors: Flint Paul W.
Published: November 2005

Microlaryngeal surgery evolved with the development of suspension laryngoscopy and binocular microscopes for enhanced visualization. Development of microlaryngeal instrumentation followed rapidly to meet the demands of the Otolaryngology‐Head and neck surgeon. Advancement of laser technology further enhanced the surgeon's ability to sharply dissect tissue using a hands‐off approach and added hemostatic capability to the cutting edge. Similarly, endoscopic sinus surgery has evolved with application of minimally invasive instrumentation. The recent introduction of powered surgical instruments, combining cutting capability and suction, facilitates removal of diseased or anatomically variant tissue from sinus cavities.
Chest wall mass after pectoralis major myocutaneous flap reconstruction
Authors: Kandula Madan N. , Deschler Daniel G. , Hayden Richard E.
Published: November 2005

The pectoralis major myocutaneous flap has become a widely used means for the reconstruction of defects derived from the surgical removal of head and neck neoplasms. The most common complications arising from immediate reconstruction with the pectoralis major myocutaneous flap include flap necrosis, fistula, infection, dehiscence, and hematoma.1,2 Although the literature has focused primarily on the morbidity associated with the flap during the immediate postoperative period, little attention has been placed on the delayed postoperative complications of the pectoralis major myocutaneous flap. We present a report of a patient in whom a chest wall mass developed 4 months after tumor resection with immediate pectoralis major myocutaneous flap reconstruction.
Guillain‐Barré syndrome presenting as bilateral vocal cord paralysis
Authors: Yoskovitch ADI , Enepekides Daniel J. , Hier Michael P. , Black Martin J.
Published: November 2005

Guillain‐Barré syndrome (GBS), also known as acute idiopathic polyneuritis, is the most common acquired demyelinating neuropathy, characterized by muscular weakness and mild distal sensory loss. GBS presenting as bilateral vocal cord paralysis (BVCP) is extremely rare, with only 1 other case reported in the literature.1 The following is a case of BVCP as the presenting symptom of GBS in an elderly man.
Evaluation of implant losses and skin reactions around extraoral bone‐anchored implants: A 0‐ to 8‐year follow‐up
Authors: Reyes Ronaldo A. , Tjellström Anders , Granström Gösta
Published: November 2005

This is an 8‐year follow‐up of a group of 214 patients who underwent surgical insertion of titanium implants in the mastoid process for the retention of bone‐anchored hearing aids and auricular prostheses. The skin reactions around the implants and the various factors dealing with implant loss were evaluated. The number of patients who never had any episode of adverse skin reactions during the 8‐year period is 70% and is about the same as previously reported. The frequency and degree of adverse skin reactions were noted to be decreasing with time. The young age group had the highest incidence of adverse skin reactions, and this high frequency is consistent with results of earlier reports. None of the remaining group of patients (30%) who had 1 or more episodes of adverse skin reactions lost their implants because of this problem; most implant losses were primarily the result of loss of integration. The probability of losing an implant because of adverse skin reactions is quite low; however, these skin reactions, if left untreated, may eventually lead to implant loss or withdrawal.
Nasal polyposis: Role of subclinical delayed food hypersensitivity
Authors: Pang Yoke‐Teen , Eskici Orhan , Wilson Janet A.
Published: November 2005

Nasal polyposis is a common problem in otolaryngology. The cause remains unclear, and treatment with medication and surgery is often unsatisfactory. We present our controlled study, which suggests a strong association between food allergy and nasal polyposis. The study was conducted in 2 parts. A postal survey of 900 patients with nasal polyps showed 53 respondents (5.9%) had a known food allergy. In the prospective study, 80 nasal polyp patients and 36 control subjects completed intra‐dermal tests for food allergy. Sixty‐five nasal polyp patients (81%) and 4 control subjects (11%) had positive intradermal food test results. This is highly significant. We believe that food allergy may play a significant role in the pathogenesis of nasal polyposis and should be further studied.
Preoperative Hearing Predicts Postoperative Hearing
Authors: Blakley Brian W. , Kim Steve , VanCamp Mary
Published: November 2005

Optimal hearing is one goal of otologic surgery. It is generally presumed that hearing thresholds after tympanoplasty‐mastoidectomy surgery are determined by remaining anatomy. We assessed the effect of the disease process on hearing after surgery, and our data do not support this presumption. We studied the relationship between preoperative and postoperative hearing across tympanoplasties with differing anatomies in 124 patients without ossicular reconstruction with pros‐theses or bone. Our results indicate that poor hearing before surgery is associated with poor hearing after surgery, regardless of anatomy (type of tympanoplasty). This relationship holds for both the air‐bone gap and the speech‐reception threshold. When considering ossicular reconstruction, the surgeon should remember that the disease process itself affects hearing in addition to the physical attributes of the ear. These results should be considered in preoperative counseling, as well as in the interpretation of the otologic literature.
Epidermal Growth Factor and Transforming Growth Factor‐α in Middle Ear Effusion
Authors: Nassif Paul S. , Simpson Steven Q. , Izzo Angelo A. , Nicklaus Pamela J.
Published: November 2005

Epidermal growth factor (EGF) and transforming growth factor‐α (TGF‐α) promote the differentiation and proliferation of epithelia as well as the proliferation and chemotaxis of fibroblasts. Additionally, EGF promotes wound healing in tissues composed largely of epithelial cells and fibroblasts. We hypothesized that EGF and TGF‐α regulate the differentiation and proliferation of the epithelial lining and the migration and proliferation of fibroblasts in the subepithelial space of the middle ear mucosa in children with otitis media. As an initial test of this hypothesis, EGF and TGF‐α concentrations were measured in 82 middle ear effusions of children undergoing tympanostomy tube placement. EGF was present in 45% of these effusions, and TGF‐α was present in 6%. The mean concentration ± SEM values for EGF and TGF‐α were 19 ± 7.6 and 3.7 ± 7.9 pg/mL, respectively. In addition, neutrophils, macrophages, and lymphocytes in middle ear effusions stained for EGF by immunocytochemistry. We conclude that growth factors are frequently present in middle ear effusions of children with otitis media.
Experimental Model of Cisplatin Ototoxicity in Chinchillas
Authors: Janning Marty H. , Whitworth Craig A. , Rybak Leonard P.
Published: November 2005

Cisplatin is an important antineoplastic agent. Its ototoxicity has been well defined, both in human and animal studies. However, animal models of systemic cisplatin administration have been complicated by multiple toxic effects. We studied cisplatin ototoxicity in an animal model involving topical application of cisplatin to the round‐window membrane. Adult chinchillas were anesthetized with ketamine and pentobarbital, and auditory function was tested with the use of auditory brain‐stem responses to various stimuli (clicks and 8‐and 16‐kHz tone bursts). Each animal was used as its own control. The middle‐ear cavity was exposed through the bulla. In the experimental ear, a 25‐μl solution of 0.25 mg cisplatin/1.0 ml normal saline solution was applied to the round‐window membrane. In the control ear, 25 μl normal saline solution was applied to the round‐window membrane. Follow‐up auditory brain‐stem response testing was conducted 7 days after treatment. A significant increase in threshold in the experimental ears was seen on comparison with the control ears. This finding suggests that application of cisplatin to the round‐window membrane is a useful animal model in which to study cisplatin ototoxicity.
Fine‐Needle Aspiration Biopsy Diagnosis of Follicular Variant of Papillary Thyroid Cancer: Therapeutic Implications
Authors: Shemen Larry J. , Chess Quintus
Published: November 2005

OBJECTIVE

Frozen‐section analysis of follicular lesions is often inconclusive because capsular or vascular invasions are the hallmarks of malignancy with this technique and may not be seen in the particular field studied. Using preoperative fine‐needle aspiration biopsy specimens, we attempted to identify malignant follicular lesions and compare these results against frozen‐section analysis.

METHODS

A retrospective study of 1000 consecutive thyroid fine‐needle aspiration biopsy specimens was performed. Surgical pathologic correlation was available in 179 cases.

RESULTS

Fine‐needle aspiration biopsy yielded a suspicious or positive rate of 23%. Surgical pathology was available in 179 patients, of which 95% had thyroid cancer. The follicular variant of papillary cancer was identified in 26 cases, or 15% of the positive cases. Frozen‐section analysis yielded false‐negative results in 7 of these 26 cases (27%).

CONCLUSIONS

Preoperative recognition of the follicular variant of papillary cancer by fine‐needle aspiration biopsy may reduce the overall incidence of false‐negative frozen‐section findings.
Metachronous Cancer: Prognostic Factors Including Prior Irradiation
Authors: Dolan Robert , Vaughan Charles , Fuleihan Nabil
Published: November 2005

In this article we evaluate two factors that may be responsible for the reported increased mortality rate in metachronous cancers: prior radiation therapy and stage at presentation. A select group of 358 patients was split into three groups: no prior cancer (group 1), prior cancer treated with radiation therapy (group 2), and prior cancer treated with surgery alone (group 3). We compared survival among the three groups according to stage (T1 or T2 vs. T3 or T4) using the Lifetest procedure. Survival in patients with advanced (T3 or T4) cancers was uniformly poor, and survival in patients with low‐staged (T1 or T2) cancers was disproportionately poor only for patients in group 2. Metachronous cancers are not necessarily more lethal, except when the cancer arises within prior irradiated tissue. Initial treatment decisions for patients with primary cancers must always provide for the contingency of a metachronous cancer, and the judicious use of radiation therapy is essential.
Biomechanics of Combined Arytenoid Adduction and Medialization Laryngoplasty in an Ex Vivo Canine Model
Authors: Noordzij J. Pieter , Perrault Donald F. , Woo Peak
Published: November 2005

Arytenoid adduction (AA) and medialization laryngoplasty (ML) are being performed concurrently in patients with unilateral vocal fold paralysis with a large posterior glottal gap. The biomechanical effects of this combined procedure on the larynx have not been studied. An excised canine larynx model was used to study the effects of AA, ML, and combined AA and ML (AA‐ML) on vocal fold configuration (length and degree of medialization) and tension. AA‐ML lengthens the affected vocal fold relative to the opposite vocal fold, although both were slightly shortened compared with the control state (nonsignificant trends). AA‐ML medializes the entire length of the vocal fold more effectively than AA or ML alone. Midmembranous vocal fold tension did not increase with AA‐ML. With AA‐ML, the vocal process resisted significantly greater lateralizing forces than with the control state or ML. We conclude that in an excised canine model, AA‐ML combines the biomechanical properties of AA and ML. The larynx appears to be divided into 2 biome‐chanical subunits: membranous vocal fold (anterior) and arytenoid cartilage (posterior). When surgical rehabilitation of both laryngeal subunits is required, AA‐ML appears to be a better choice than AA or ML alone.
Efficacy of Laser‐Assisted Uvulopalatoplasty in Obstructive Sleep Apnea
Authors: Pribitkin Edmund A. , Schutte Sharon L. , Keane William M. , Mao Vivian , Cater Jacqueline R. , Doghramji Karl , Youakim James M. , Rosen Marc R. , Breuninger William
Published: November 2005

Laser‐assisted uvulopalatoplasty (LAUP) enlarges the oropharyngeal airway by reshaping the uvula, soft palate, and tonsillar pillars. In contrast to a uvulopalatopharyngoplasty performed in the operating room, LAUP is staged over several office visits, is less costly, is bloodless, and is not associated with velopharyngeal insufficiency or stenosis. Previous studies have documented the efficacy of LAUP in the treatment of snoring. We explore the efficacy of LAUP in the treatment of obstructive sleep apnea. Forty‐eight patients comprised the study group. Each patient snored, exhibited > 50% palatal collapse on Müller's maneuver, and had nocturnal polysomnography showing a respiratory disturbance index (RDI) > 10. Each patient underwent LAUP until he or she reported that snoring had ceased. Of the 29 patients who underwent post‐LAUP nocturnal polysomnography, 7 had RDIs < 10, oxygen saturation > 86%, and no cardiac arrhythmias. LAUP reduced RDI to < 10 in patients with pre‐LAUP apnea indexes < 3 (P = 0.05) or pre‐LAUP RDIs < 30 (P = 0.01). The following variables did not correlate with the success of LAUP in treating obstructive sleep apnea: age, sex, pre‐LAUP weight, pre‐LAUP body mass index, perioperative weight change, perioperative body mass index change, pre‐LAUP snoring, and post‐LAUP snoring. We conclude that LAUP is an effective means of treating patients with RDIs < 30.
Effects of Middle Ear Effusion on the Vestibular System in Children
Authors: Golz Avishay , Netzer Aviram , Angel‐Yeger Batia , Westerman S. Thomas , Gilbert Liane M. , Joachims Henry Z.
Published: November 2005

Vertigo and dizziness are not common in childhood, but are probably present more often than was formerly thought. These symptoms caused mainly by otitis media and middle ear effusion, two of the most common diseases in children, have been neglected for a long time, both in the literature and in practice, until recently. The purpose of this study was to determine objectively the incidence of balance‐related symptoms in children with long‐lasting middle ear effusion and to discover whether these symptoms resolve after the insertion of ventilation tubes. One hundred thirty‐six children, ages 4 to 9 years, were given electronystagmographic tests and the Bruininks‐Oseretsky tests for motor proficiency before and after tube ventilation of the middle ear. The results were compared with those in 74 healthy children with no history of middle ear diseases. Pathologic findings were found in 58% of the children with chronic middle ear effusion, as compared with only 4% of the control group. The symptoms and signs of balance disturbances resolved in 96% of the children after ventilation tube insertion. The results of this study indicate that balance‐related symptoms often encountered in young children may result from chronic middle ear effusion and that these symptoms will resolve after evacuation of the effusion and ventilation of the middle ear.
Sodium nitroprusside/nitric oxide causes apoptosis in spiral ganglion cells
Authors: Msiv Namrata Pai , Zdanski Carlton J. , Gregory Christopher W. , Prazma Jiri , Carrasco Vincent
Published: November 2005

OBJECTIVE

In the cochlea, excitatory amino acid receptor overstimulation induces toxicity in spiral ganglion neurons by an unknown mechanism. In the central nervous system, excitatory amino acid‐induced toxicity is mediated by nitric oxide, which induces apoptosis in neurons. This study tested the hypothesis that cochlear nitric oxide‐mediated toxicity is the result of induction of apoptosis in spiral ganglion neurons.

METHODS

The cochleas of 15 gerbils randomly assigned to different groups were perfused for 30 minutes with a test solution of 1 mmol/L sodium nitroprusside, a nitric oxide donor, or a control solution of artificial perilymph. Animals were killed at varying times, including 2, 3, 4, 8, and 18 hours after perfusion. DNA fragmentation or in situ terminal deoxynucleotidyl transferase‐mediated deoxyuridine triphosphate‐biotin nick end‐labeling analysis was done on cochleas for detection of apoptosis.

RESULTS

Analysis by both techniques demonstrated marked apoptotic cell changes in spiral ganglion neurons of sodium nitroprusside‐treated cochleas evident 4 to 8 hours after perfusion, as compared with minimal to no evidence of apoptosis in spiral ganglion neurons of control specimens.

CONCLUSIONS

Exposure to high levels of nitric oxide induces apoptosis in spiral ganglion neurons. Because apoptosis is a delayed, potentially reversible cell death pathway, this may present an opportunity for intervention to prevent or attenuate hearing damage induced by excitotoxic stimuli.
End‐to‐side neurorraphy: A long‐term study of neural regeneration in a rat model
Authors: Tarasidis Gregory , Watanabe Osamu , Mackinnon Susan E. , Strasberg Suzanne R. , Haughey Bruce H. , Hunter Daniel A.
Published: November 2005

This study evaluated long‐term reinnervation of an end‐to‐side neurorraphy and the resultant functional recovery in a rat model. The divided distal posterior tibial nerve was repaired to the side of an intact peroneal nerve. Control groups included a cut‐and‐repair of the posterior tibial nerve and an end‐to‐end repair of the peroneal nerve to the posterior tibial nerve. Evaluations included walking‐track analysis, nerve conduction studies, muscle mass measurements, retrograde nerve tracing, and histologic evaluation. Walking tracks indicated poor recovery of posterior tibial nerve function in the experimental group. No significant difference in nerve conduction velocities was seen between the experimental and control groups. Gastrocnemius muscle mass measurements revealed no functional recovery in the experimental group. Similarly, retrograde nerve tracing revealed minimal motor neuron staining in the experimental group. However, some sensory staining was seen within the dorsal root ganglia of the end‐to‐side group. Histologic study revealed minimal myelinated axonal regeneration in the experimental group as compared with findings in the other groups. These results suggest that predominantly sensory regeneration occurs in an end‐to‐side neurorraphy at an end point of 6 months.
Analysis of protease activity in human otitis media
Authors: Avidano Michael A. , Cotter Cheryl S. , Stringer Scott P. , Schultz Gregory S.
Published: November 2005

Cronic otitis media is a common problem associated with a nonintact tympanic membrane frequently involving Staphylococcus aureus and Pseudomonas aeruginosa. The virulence of Pseudomonas bacteria is related to the production of two matrix metalloproteinases, elastase and alkaline protease. Serine proteases, such as neutrophil elastase, are produced by the host inflammatory response. These proteases are thought to contribute to tissue destruction and assist bacterial invasion during infection. This preliminary study was done to identify protease activity in otorrhea samples from patients with otitis media and a nonintact tympanic membrane and to examine the ability of selective protease inhibitors to decrease protease activity. Ilomostat (galardin) is a synthetic, specific inhibitor of matrix metalloproteinases including P. aeruginosa elastase and alkaline protease, where‐as α1‐antitrypsin inhibits serine proteases including neutrophil elastase. Samples were collected and cultured from 20 patients with otorrhea resulting from tympanic membrane perforations or pressure‐equalization tubes. A protease assay that used azocasein as the substrate was used to quantify protease activity, with and without addition of selective protease inhibitors. Cultures revealed P. aeruginosa alone in 7 samples, P. aeruginosa plus other organisms in 10, and S. aureus alone in 3. Protease activity was detected in 15 (75%) of the samples. A statistically significant (p < 0.05) decrease in protease activity was seen with the addition of α1‐antitrypsin or Ilomostat plus α1‐antitrypsin, but not with Ilomostat alone. Analyzing the 10 samples with the highest protease activity, a statistically significant decrease in activity was seen with Ilomostat or αα1‐antitrypsin alone and with both Ilomostat and α1‐antitrypsin together. Bacteriologic type, source of sample, age and gender of the subject, and duration of infection were not significantly related to protease activity. This is the first study to quantify protease activity and inhibition by selective protease inhibitors in human otorrhea. Protease inhibitors effectively decrease protease activity in most cases and in addition to standard antibiotic therapy might prove beneficial in the treatment of otitis media with a nonintact tympanic membrane. This study supports future clinical investigations into the role of proteases and inhibition of protease activity in the treatment of otitis media.
Sinusitis in neurologically impaired children
Authors: Brook Itzhak , Shah Kiran
Published: November 2005

The microbiologic features of infected sinus aspirates in nine children with neurologic impairment were studied. Anaerobic bacteria, always mixed with aerobic and facultative bacteria, were isolated in 6 (67%) aspirates and aerobic bacteria only in 3 (33%). There were 24 bacterial isolates, 12 aerobic or facultative and 12 anaerobic. The predominant aerobic isolates were Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus (2 each) and Proteus mirabilis, Pseudomonas aeruginosa, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae (1 each). The predominant anaerobes were Prevotella sp. (5), Peptostreptococcus sp. (4), Fusobacterium nucleatum (2), and Bacteroides fragilis (1). β‐Lactamase‐producing bacteria were isolated from 8 (89%) patients. Organisms similar to those recovered from the sinuses were also isolated from tracheostomy site and gastrostomy wound aspirates in five of seven instances. This study demonstrates the uniqueness of the microbiologic features of sinusitis in neurologically impaired children, in which, in addition to the organisms known to cause infection in children without neurologic impairment, facultative and anaerobic gram‐negative organisms that can colonize other body sites are predominant.
Role of antral puncture in the treatment of sinusitis in the intensive care unit
Authors: Ramadan Hassan H. , Owens Robert M. , Tiu Christopher , Wax Mark K.
Published: November 2005

OBJECTIVE

The objective of this study was to determine whether maxillary sinus puncture caused an alteration in antibiotic treatment and thus affected the outcome of sinusitis in the intensive care unit.

STUDY DESIGN

A retrospective review was done of cases of maxillary sinus puncture between 1991 and 1994.

RESULTS

Forty‐two patients were identified. All patients had findings suggestive of sinusitis on plain sinus films or CT scans of the sinuses. Twenty‐five punctures (60%) recovered pus, of which 80% grew organisms. Fourteen patients (33%) had a negative lavage, and 12% of these samples grew organisms (p = 0.001). Sixty‐eight percent of the cultures identified a single organism compared with 32% with multiple organisms. Gram‐negative organisms were found most commonly, followed by anaerobes. In 57% of the cases antibiotic therapy was changed. In 77% of the cases the change was directed by the culture result and in 35% the therapy was changed despite a negative culture result (p = 0.002). Resolution of symptoms occurred in 83% of patients who had antibiotics changed whereas with no change in antibiotics only 42% had resolution (p = 0.001).

CONCLUSION

A sinus puncture seems to be helpful in patients with fever and positive findings on sinus films. If pus is obtained by maxillary puncture, a positive culture may be found in 80% of the cases. Changes in antibiotic regimen on the basis of culture findings seem to give a better outcome.
Overlay grafting for lateral nasal wall concavities
Authors: Gilbert Scott E.
Published: November 2005

One of the most difficult maneuvers in rhinoplasty is achieving a straight dorsum in the patient with a crooked nose. Often this deformity is a result of trauma involving the bony and cartilaginous vaults, resulting in nasal bone fractures and avulsion of the lateral cartilages into the nasal airway. Reduction of nasal bone fractures is fairly straightforward, but the repair of nasal cartilage trauma is more problematic. The cartilage of the nasal vault possesses fibrous attachments, which when disturbed, are difficult to reestablish. Overlay grafts are known to be effective in filling these defects and creating the illusion of a straight nose. In this series, during an 8‐year period, 89 grafts were placed over lateral nasal wall concavities during rhinoplasty. Results after a minimum of 1 year follow‐up are reviewed, as well as technique, materials, complications, revision rate, and patient satisfaction.
Normative standards for nasal cross‐sectional areas by race as measured by acoustic rhinometry
Authors: Corey Jacquelynne P. , Gungor Anil , Liu Xiling , Nelson Robert , Fredberg Jeffrey
Published: November 2005

Acoustic rhinometry evaluates the geometry of the nasal cavity with acoustic reflections and provides information about nasal cross‐sectional area and nasal volume within a given distance. Variations in internal nasal diameters have attracted increased interest since the advent of endoscopic surgical techniques. Race is known to be one of the most important factors affecting the nasal structure. In this study, we evaluated 106 healthy adult volunteers with acoustic rhinometry to determine internal nasal diameters and volumes and obtained normative data for four racial/ethnic groups. The data were analyzed with regard to race, sex, height, and weight. All measurements were made before and after the application of a topical nasal decongestant so that the effects of the nasal cycle were eliminated by decongestion.
Model for optimal space and staff efficiency in an otolaryngology clinic
Authors: Benninger Michael S. , Strode Steven R.
Published: November 2005

Maximizing efficiency of staff and resources is one method of reducing costs without affecting quality. Using a methodology similar to that used to maximize efficiency of airline‐gate use, we developed a model with which to evaluate nursing support staff and clinical examining‐room resources in a general otolaryngology clinic. For 144 patients over 7 consecutive clinic days, with four otolaryngologists and various combinations of support staff and examining rooms, we measured space and staff resource use, including total clinic time, number of patients seen, patient waiting time, physician and nurse productivity, and examining‐room use. A simulation model was used as the medium of analysis to define parameters of the patient encounter. We identified optimal efficiency when there were three examining rooms and one and one‐half nursing staff per physician or five examining rooms and three nursing staff for two simultaneously practicing physicians. Compared with a model of two rooms and one nursing staff member, our ideal model increased the percentage of the physicians' time spent in direct contact with patients from 84% to 92%. Visit length decreased from 81 minutes to 57 minutes, the average time from check‐in to examination decreased from 47 to 16 minutes, and it became possible for three additional patients to be seen each day. Additional rooms and support staff, in comparison with the optimally efficient distribution, did not significantly affect these parameters. Maximizing efficiency with the use of this methodology can decrease waiting times for patients, resulting in greater patient satisfaction, improved physician productivity, total number of patients seen, and increased total contact time between physicians and patients.
Cellular immune defect caused by postsurgical radiation therapy in patients with head and neck cancer
Authors: Tisch Matthias , Heimlich Florίan , Daniel Volker , Opelz Gerhard , Maier Heinz
Published: November 2005

The effects of locoregional postoperative radiation therapy (60 Gy on average) on cellular immunity were investigated in 11 patients with squamocellular carcinomas of the oral cavity, pharynx, or larynx. During radiation treatment, the total lymphocyte counts, CD8+ T‐lymphocyte count, and especially CD4+ T‐lymphocyte count decreased significantly. The mean CD4+ T‐lymphocyte counts dropped from an average of 739/μl to 183/μl (p <0.001), and the CD4+/CD8+ quotient also decreased significantly. Not only the lymphocyte counts but also the in vitro lymphocyte stimulation responses to several mitogens decreased, with reductions averaging 10% to 50% of normal responses by the end of radiation therapy. Within 3 to 4 weeks after radiation therapy, the CD4+ T‐lymphocyte counts and the in vitro lymphocyte stimulation responses showed a tendency toward normalization. This study shows that postoperative locoregional radiation therapy in patients with head and neck cancer induces a severe generalized impairment of cellular immunity.
Hearing results in pediatric patients after canal‐wall‐up and canal‐wall‐down mastoid surgery
Authors: Murphy Terrence P. , Donna Lynn Wallis
Published: November 2005

Hearing results were studied in pediatric patients after canal‐wall‐up and canal‐wall‐down mastoid surgery in a private practice setting. A retrospective chart review was performed on 69 patients who underwent surgery from 1991–1995. Twenty‐six patients underwent canal‐wall‐up mastoidectomies, and 43 patients underwent canal‐wall‐down mastoidectomies. Various types of ossicular reconstruction were performed in patients in both groups. Hearing was evaluated for preoperative and postoperative pure‐tone averages, speech‐reception thresholds, and air‐bone gaps for the various types of ossicular reconstruction. Patients with canal‐wall‐up mastoidectomies and an intact ossicular chain had an average postoperative air‐bone gap of 15 dB, whereas reconstruction of the ossicular chain (regardless of technique) resulted in an average postoperative air‐bone gap of 19 dB. Patients with canal‐wall‐down mastoidectomies and an intact ossicular chain had an average air‐bone gap of 15 dB, while all techniques of ossicular reconstruction had an average air‐bone gap of 29 dB. Canal‐wall‐up and canal‐wall‐down mastoid surgeries in pediatric patients have similar hearing results. Variables other than hearing should be used to make treatment decisions regarding the canal wall in pediatric candidates for mastoid surgery.
Intratemporal complications of acute otitis media in infants and children
Authors: Goldstein Nira A. , Casselbrant Margaretha L. , Bluestone Charles D. , Marcia Kurs‐Lasky
Published: November 2005

We reviewed our experience with 100 children admitted to Children's Hospital of Pittsburgh between 1980 and 1995 with an intratemporal complication of acute otitis media. Seventy‐two patients were treated for acute mastoiditis. Of these 72 children, 54 (75.0%) were treated conservatively with broad‐spectrum intravenous antibiotics and myringotomy. Eighteen (25.0%) required mastoidectomy for treatment of a subperiosteal or Bezold's abscess or cholesteatoma, or because of poor response to conservative therapy. Twenty‐two children presented with facial paralysis, complete in 5 (22.7%) and incomplete in 17 (77.3%). Eighteen (81.8%) were treated conservatively, but four required mastoid surgery. Nineteen patients had adequate follow‐up; of these, 15 recovered normal facial function but 4 were left with partial paralysis. Three patients presented with serous labyrinthitis and recovered completely with conservative therapy. Of the two patients who presented with suppurative labyrinthitis, one was treated conservatively, but the other required tympanomastoidectomy with cochleotomy; both patients had permanent, profound sensorineural hearing loss in the affected ear. Four patients presented with acute petrositis, and in all four it resolved with mastoidectomy. In the antibiotic era, intratemporal complications of acute otitis media still occur in otherwise healthy children, often after inadequate treatment of acute otitis media.
Quantitative biochemical analysis of samples from squamous cell carcinoma
Authors: C. David Ross , Medina Jesus E.
Published: November 2005

Samples of tumor, tumor stroma, and mixed tumor and stroma were microdissected from three squamous cell carcinomas, as well as from adjacent nontumor tissue and assayed for malate dehydrogenase or lactate dehydrogenase activity as indicators of the relative contribution of aerobic and anaerobic processes, respectively, to energy metabolism. Malate and lactate dehydrogenase activities were greater in tumor tissue than in tumor stroma in all three tumors. However, the magnitudes of malate and lactate dehydrogenase activities were different among the tumors, suggesting that tumors vary in the degree to which aerobic and anaerobic reactions contribute to energy production. These results indicate that a quantitative assessment of enzymes involved in energy production may be a useful probe in the understanding of tumor metabolism.
Facial nerve monitoring in parotid surgery: The standard of care?
Authors: Witt Robert L.
Published: November 2005

Recent reports have suggested that the incidence of permanent facial nerve paralysis or paresis after surgery for benign parotid tumors is between 3% and 5%. The intraoperative use of nerve‐integrity monitors has been advocated to reduce the incidence of facial nerve paralysis. The purpose of this study was to compare postoperative facial nerve function after monitored and unmonitored parotid surgical procedures. The charts of 69 consecutive patients with parotid lesions who underwent surgery from 1987 to 1996 were retrospectively surveyed. Sixteen high‐risk patients were excluded from the study. The study group consisted of 53 patients (33 unmonitored and 20 monitored) who underwent lateral parotidectomy for mobile tumors of the superficial lobe of the parotid gland. No patient demonstrated permanent facial paralysis. In 9 patients (17%), transient nerve paralysis developed: 5 (15%) of the 33 patients who underwent lateral parotidectomy without the use of a nerve‐integrity monitor and 4 (20%) of the 20 patients who underwent lateral parotidectomy with the use of a nerve‐integrity monitor. Nerve‐integrity monitoring is optional for mobile parotid tumors of the superficial lobe.
Basaloid squamous carcinoma: A clinical comparison of two histologic types with poorly differentiated squamous cell carcinoma
Authors: Winzenburg Sandra M. , Niehans Gloria A. , Evan George , Kathleen Daly , Adams George L.
Published: November 2005

Basaloid squamous carcinoma (BSC) of the head and neck has been shown to have a poor prognosis when compared with conventional squamous cell carcinoma (SCC). Pathologically, specimens determined to be BSC can have nearly pure basaloid features (group 1) or a mixture of basaloid and squamous features (group 2). The clinical behavior in these 2 subgroups has not been compared previously. BSC is also commonly confused histologically with poorly differentiated SCC (PDSCC). A retrospective comparison of disease stage at presentation, rate of distant metastasis, rate of local recurrence in those offered surgical resection, and rate of survival is made to compare outcomes of the 2 BSC groups and the PDSCC group. The presence of particular histologic features may be associated with poorer outcomes. Patients with BSC have advanced disease at presentation. Survival in the BSC group was less than half that in the PDSCC groups. Statistical analysis shows the 2 groups to be well matched with regard to stage and site of disease. Presence of neck nodal disease on presentation predicts poor survival. In this study distant metastases occurred in 52% of patients with BSC and in 13% of patients in the PDSCC group. The local recurrence rate is comparable for BSC and conventional SCC, with even early tumors in the BSC group recurring distantly rather than locally or regionally. Considering the high distant metastatic rate of BSC and poorer overall survival rate, a more extensive metastatic survey is indicated in these patients before surgery is recommended. We recommend that patients with a diagnosis of BSC not be included with conventional SCC groups in prospective randomized cancer protocols.
Impact of endoscopic sinus surgery on global health perception: An outcomes study
Authors: Welby Winstead , Barnett Susan N.
Published: November 2005

The Medical Outcome Study Short‐Form 36‐item Health Survey (SF‐36) was used to prospectively assess outcomes after endoscopic sinus surgery. Our study found that chronic rhinosinusitis has a significant adverse impact on patient‐perceived functional status and quality of life. Endoscopic sinus surgery resulted in statistically significant improvement in both disease‐specific symptoms and patient‐perceived global health status at 6 and 12 months of follow‐up. The SF‐36 is recommended for use as the global health monitor in outcomes evaluation for chronic rhinosinusitis.
Design and tests of a three finger hand with 1-DOF articulated fingers
Authors: Ceccarelli Marco , Rodriguez Nestor Eduardo Nava , Carbone Giuseppe
Published: November 2005

This paper presents the design of a new low-cost, easy operation hand having three 1-dof anthropomorphic fingers of a human size. Experimental results on human cylindrical grasping have been used for designing a 1-dof anthropomorphic finger of a human size. The mechanical design of this finger has been mainly focused on a suitable articulated mechanism. This mechanism transmits the power to the phalanxes for a human-like grasping motion and it can be embedded in the body of the finger itself. The design of a three finger hand has been presented as based on the designed finger module. Experimental tests on a built hand prototype have been carried out in order to show the feasibility of the proposed design and validate its operation.
Misidentification of Major Constituents by Automatic Qualitative
Energy Dispersive X-ray Microanalysis: A Problem that Threatens the
Credibility of the Analytical Community
Authors: Newbury* Dale E.
Published: November 2005

Automatic qualitative analysis for peak identification is a standard
feature of virtually all modern computer-aided analysis software for
energy dispersive X-ray spectrometry with electron excitation. Testing of
recently installed systems from four different manufacturers has revealed
the occasional occurrence of misidentification of peaks of major
constituents whose concentrations exceeded 0.1 mass fraction (10 wt%).
Test materials where peak identification failures were observed included
ZnS, KBr, FeS2, tantalum-niobium alloy, NIST Standard Reference
Material 482 (copper–gold alloy), Bi2Te3,
uranium–rhodium alloys, platinum–chromium alloy, GaAs, and
GaP. These misidentifications of major constituents were exacerbated when
the incident beam energy was 10 keV or lower, which restricted or excluded
the excitation of the high photon energy K- and L-shell X-rays where
multiple peaks, for example, Kα (K-L2,3)–Kβ
(K-M2,3); Lα (L3-M4,5)–Lβ
(L2-M4)–Lγ (L2-N4),
are well resolved and amenable to identification with high confidence.
These misidentifications are so severe as to properly qualify as blunders
that present a serious challenge to the credibility of this critical
analytical technique. Systematic testing of a peak identification system
with a suite of diverse materials can reveal the specific elements and
X-ray peaks where failures are likely to occur.
Atomic Structure of β-Tantalum Nanocrystallites
Authors: Tillmann Karsten , Thust Andreas , Gerber Andreas , Weides Martin P. , Urban Knut
Published: November 2005

The structural properties of β-phase tantalum nanocrystallites
prepared by room temperature magnetron sputter deposition on amorphous
carbon substrates are investigated at atomic resolution. For these
purposes spherical aberration-corrected high-resolution transmission
electron microscopy is applied in tandem with the numerical retrieval of
the exit-plane wavefunction as obtained from a through-focus series of
experimental micrographs. We demonstrate that recent improvements in the
resolving power of electron microscopes enable the imaging of the atomic
structure of β-tantalum with column spacings of solely 0.127 nm with
directly interpretable contrast features. For the first time ever, we
substantiate the existence of grain boundaries of 30° tilt type in
β-Ta whose formation may be well explained by atomic agglomeration
processes taking place during sputter deposition.
Microwave Processing for Sample Preparation to Evaluate
Mitochondrial Ultrastructural Damage in Hemorrhagic Shock
Authors: Josephsen Gary D. , Josephsen Kelly A. , Beilman Greg J. , Taylor Jodie H. , Muiler Kristine E.
Published: November 2005

This is a report of the adaptation of microwave processing in the
preparation of liver biopsies for transmission electron microscopy (TEM)
to examine ultrastructural damage of mitochondria in the setting of
metabolic stress. Hemorrhagic shock was induced in pigs via 35% total
blood volume bleed and a 90-min period of shock followed by resuscitation.
Hepatic biopsies were collected before shock and after resuscitation.
Following collection, biopsies were processed for TEM by a rapid method
involving microwave irradiation (Giberson,
2001). Samples pre- and postshock of each of two animals were
viewed and scored using the mitochondrial ultrastructure scoring system
(Crouser et al., 2002), a system used to
quantify the severity of ultrastructural damage during shock. Results
showed evidence of increased ultrastructural damage in the postshock
samples, which scored 4.00 and 3.42, versus their preshock controls, which
scored 1.18 and 1.27. The results of this analysis were similar to those
obtained in another model of shock (Crouser et al.,
2002). However, the amount of time used to process the samples was
significantly shortened with methods involving microwave irradiation.