bluuebunny/crossref_metadata_2025 huggingface dataset:
In vitro propagation for conservation of the rare date palm (Phoenix dactylifera L.) ‘Amri’ using immature inflorescence
Authors: Abd Elaziem Tamer Mahfouz , Ahmed Manal El-salato Ala El-naby , Abou El-Dis Gamil Rayan
Published: September 2022

Immature female inflorescence plays a significant role in date palm micropropagation because inflorescences are available with no practical limit as the source of explants. Moreover, using floral buds for propagation helps in the conservation of date palm biodiversity and the enhancement of socioeconomically valuable landraces. With the goal of avoiding undesirable genetic variability, the optimal combinations and concentrations of plant growth regulators and other medium compositions were investigated to achieve direct organogenesis and multiplication from the immature female inflorescence of date palm (Phoenix dactylifera L.) cultivar Amri. For the initiation stage, the best response was achieved using Murashige and Skoog (MS) medium containing 1.0 mg L−1 zeatin and 1.0 mg L−1 thidiazuron (TDZ) after 16 wk of culturing. For the multiplication stage, the best culture medium contained 0.5 mg L−1 TDZ solidified with GelriteTM, without activated charcoal for four subcultures, and then supplementing 30 mg L−1 glutathione to this medium composition for two additional subcultures. Plantlets were multiplied and grown for 12 wk on elongation medium and then transferred to the rooting stage in two steps. Compared with other treatments, foliar spraying and watering with 30 g L−1 sorbitol and 40 g L−1 salicylic acid twice a week yielded the best results in terms of survival percentage (95%), leaf width (2.9 cm), and growth vigor (4.4 lateral branch). This was the best combination of plant growth regulators and other medium compositions for micropropagation of date palm (Phoenix dactylifera L.) cultivar Amri without the need for callus formation to avoid undesirable genetic variability.
Maximum entropy networks for large scale social network node analysis
Authors: De Clerck Bart , Rocha Luis E. C. , Van Utterbeeck Filip
Published: September 2022

Recently proposed computational techniques allow the application of various maximum entropy network models at a larger scale. We focus on disinformation campaigns and apply different maximum entropy network models on the collection of datasets from the Twitter information operations report. For each dataset, we obtain additional Twitter data required to build an interaction network. We consider different interaction networks which we compare to an appropriate null model. The null model is used to identify statistically significant interactions. We validate our method and evaluate to what extent it is suited to identify communities of members of a disinformation campaign in a non-supervised way. We find that this method is suitable for larger social networks and allows to identify statistically significant interactions between users. Extracting the statistically significant interaction leads to the prevalence of users involved in a disinformation campaign being higher. We found that the use of different network models can provide different perceptions of the data and can lead to the identification of different meaningful patterns. We also test the robustness of the methods to illustrate the impact of missing data. Here we observe that sampling the correct data is of great importance to reconstruct an entire disinformation operation.
Measure-Theoretic Musings Cannot Salvage the Full Bayesian Significance Test as a Measure of Evidence
Authors: Ly Alexander , Wagenmakers Eric-Jan
Published: September 2022

Ly and Wagenmakers (Computational Brain & Behavior:1–8, in press) critiqued the Full Bayesian Significance Test (FBST) and the associated statistic FBST ev: similar to the frequentist p-value, FBST ev cannot quantify evidence for the null hypothesis, allows sampling to a foregone conclusion, and suffers from the Jeffreys-Lindley paradox. In response, Kelter (Computational Brain & Behavior:1–11, 2022) suggested that the critique is based on a measure-theoretic premise that is often inappropriate in practice, namely the assignment of non-zero prior mass to a point-null hypothesis. Here we argue that the key aspects of our initial critique remain intact when the point-null hypothesis is replaced either by a peri-null hypothesis or by an interval-null hypothesis; hence, the discussion on the validity of a point-null hypothesis is a red herring. We suggest that it is tempting yet fallacious to test a hypothesis by estimating a parameter that is part of a different model. By rejecting any null hypothesis before it is tested, FBST is begging the question. Although FBST may be useful as a measure of surprise under a single model, we believe that the concept of evidence is inherently relative; consequently, evidence for competing hypotheses ought to be quantified by examining the relative adequacy of their predictions. This philosophy is fundamentally at odds with the FBST.
Jugendliche Peergroups im Sport
Authors: Zander Benjamin
Published: September 2022

Obwohl die Peergroup als zentrale Sozialisationsinstanz des Jugendalters gilt, wurde bislang kaum erforscht, wie das Sporttreiben in der Schule und in der Freizeit von jugendlichen Peergroups kollektiv wahrgenommen und bewertet wird. Ausgehend von diesem Desiderat werden im Beitrag diese drei Forschungsfragen untersucht: Welche (sportiven) Themen sind für jugendliche Peergroups relevant? Inwieweit lassen sich kollektive Orientierungen des Handelns jugendlicher Peergroups in Schule und Freizeit identifizieren? Was kennzeichnet die Handlungspraxis jugendlicher Peergroups in Schule und Freizeit? Anhand von Daten aus einer qualitativen Längsschnittstudie zu Jugendlichen im Alter von ca. 12/13 Jahren und 14/15 Jahren, die mit dem Gruppendiskussionsverfahren erhoben und mit der dokumentarischen Methode ausgewertet wurden, ist das Anliegen des Beitrags, zu zeigen, wie sich das Verhältnis von Schule und Freizeit im Sport aus der kollektiv geteilten Perspektive jugendlicher Peergroups bestimmen lässt.
Modern Crack Detection for Bridge Infrastructure Maintenance Using Machine Learning
Authors: Munawar Hafiz Suliman , Hammad Ahmed W. A. , Waller S. Travis , Islam Md Rafiqul
Published: September 2022

Manual investigation of damages incurred to infrastructure is a challenging process, in that it is not only labour-intensive and expensive but also inefficient and error-prone. To automate the process, a method that is based on computer vision for automatically detecting cracks from 2D images is a viable option. Amongst the different methods of deep learning that are commonly used, the convolutional neural network (CNNs) is one that provides the opportunity for end-to-end mapping/learning of image features instead of using the manual suboptimal image feature extraction. Specifically, CNNs do not require human supervision and are more suitable to be used for indoor and outdoor applications requiring image feature extraction and are less influenced by internal and external noise. Additionally, the CNN’s are also computationally efficient since they are based on special convolution layers and pooling operations that enable the full execution of CNN frameworks on several hardware devices. Keeping this in mind, we propose a deep CNN framework that is based on 10 different convolution layers along with a cycle GAN (Generative Adversarial Network) for predicting the crack segmentation pixel by pixel in an end-to-end manner. The methods proposed here include the Deeply Supervised Nets (DSN) and Fully Convolutional Networks (FCN). The use of DSN enables integrated feature supervision for each stage of convolution. Furthermore, the model has been designed intricately for learning and aggregating multi-level and multiscale features while moving from the lower to higher convolutional layers through training. Hence, the architecture in use here is unique from the ones in practice which just use the final convolution layer. In addition, to further refine the predicted results, we have used a guided filter and CRFs (Conditional Random Fields) based methods. The verification step for the proposed framework was carried out with a set of 537 images. The deep hierarchical CNN framework of 10 convolutional layers and the Guided filtering achieved high-tech and advanced performance on the acquired dataset, showing higher F-score, Recall and Precision values of 0.870, 0.861, and 0.881 respectively, as compared to the traditional methods such as SegNet, Crack-BN, and Crack-GF.
Treatment outcome of perforated peptic ulcer disease among surgically treated patients: A cross-sectional study in Adama hospital medical college, Adama, Ethiopia
Authors: Bejiga Gosa , Negasa Tolera , Abebe Alem
Published: September 2022

Abstract

Background

Perforation is a life threatening complication of peptic ulcer disease which requires emergency admission and almost always urgent surgical intervention. It is associated with 30% mortality and 50% morbidity. The aim of this study is to assess treatment outcome of perforated peptic ulcers and its associated factors among surgically managed patients.

Materials and methods

A 5 year, tertiary hospital-based, retrospective cross-sectional study was conducted on treatment outcome and associated factors among 106 patients operated for perforated peptic ulcers from 2015 to 2020. Omental patch, wedge excision and repair, and total gastrectomy were done by residents and/or consultants in 94, 11, and 1 patient respectively. Treatment outcome was considered favorable if the patient discharged improved and unfavorable if the patient developed complications/died. Logistic regression analysis was conducted to identify associated factors.

Result

Out of 106 patients studied male to female ratio was 9:1. The mean age of patients was 36.13 ± 15.6years. Seventy-five (70.8%) patients presented after 24h of onset of symptoms. Most perforations were located on the first part of duodenum in 86 (81.1%) patients. Postoperative complications were identified in 30(28.3%) patients. Being female, delayed presentation, hypotension, and perforation site were significantly associated with postoperative morbidity (P < 0.05). Fifteen (14.2%) patients died in the hospital. Mortality was significantly associated with intra-operative level of contamination and development of post-operative complications (P < 0.05).

Conclusion

postoperative morbidity and mortality were significantly associated with delayed presentation and postoperative complications.

Highlights
Plastipore Implants in the Surgical Treatment of Atrophic Rhinitis: Technique and Results
Authors: Goldenberg David , Danino Joshua , Netzer Aviram , Joachims Henry Zvi
Published: September 2022

BACKGROUND

Atrophic rhinitis is a distressing and socially crippling disease. Surgical treatment has been used for patients with severe disease that is unresponsive to medical therapy.

METHODS

Eight patients with primary atrophic rhinitis were treated surgically by narrowing of the nasal fossae with implantation of 2 Plastipore plates per affected side into submucosal pockets into the floor of the nose and septum, thus reducing the volume of the nasal fossae.

RESULTS

Excellent results were obtained in 6 patients, with complete resolution of symptoms and good results and only minor crusting in 2 patients. One implant was extruded spontaneously 18 months after implantation and was reimplanted. Results in this patient before and after reimplantation were excellent. There were no cases of infection and no other complications.

CONCLUSION

We implanted Plastipore, a high‐density polyethylene sponge with micropores, which enables tissue ingrowth, anchoring the implants to the surrounding tissue. The surgical technique is performed with the patient under local anesthesia and is relatively easy and avoids complicated flap procedures, allogeneic bone harvesting, and the discomfort of nostril closure for prolonged periods.
Frameless Computer‐Aided Surgery System for Revision Endoscopic Sinus Surgery
Authors: Caversaccio Marco , Bächler Richard , Lädrach Kurt , Schroth Gerhard , Nolte Lutz‐Peter , Häusler Rudolf
Published: September 2022

To increase the intraoperative safety factor and to acquire anatomic assistance during revision endoscopic sinus surgery (RESS), we used an optical computer‐aided surgery (CAS) system that we developed collaboratively in Bern, Switzerland. During 1 year, 25 RESSs were performed with CAS: recurrent polyposis (n = 20), recurrent frontal recess stenosis (n = 3), and recurrent frontal recess stenosis with mucocele (n = 2). These patients were compared with a control group of 10 patients undergoing RESS without CAS. The same surgeon (M.C.) performed all operations, and there were no minor or major complications in either group. The clinical inaccuracy of our system is between 0.5 and 2 mm with paired‐point and surface matching. The navigation system is an important aid to surgeons in identifying anatomic landmarks that are typically difficult to visualize in this type of surgery, thus reducing the stress placed on the surgeon.
Percutaneous Bone‐Anchored Hearing Aids at a Pediatric Institution
Authors: Béjar‐Solar Ignacio , Rosete Marta , De Jesus Madrazo María , Baltierra Carmen
Published: September 2022

OBJECTIVES

The goals were to evaluate hearing, complications, and patient satisfaction with the percutaneous bone‐anchored hearing aid (BAHA) and to monitor long‐term successful use achieved by careful patient selection.

METHODS

This prospective longitudinal study included participants with inoperable congenital bilateral aural atresia, pure‐tone average (PTA) bone conduction less than 45 dB HL, prior use of a conventional bone‐conduction hearing aid (CBCA), and adequate intelligence, integration, and personal hygiene. Surgery for BAHA implantation was performed in two stages. Evaluation consisted of skin reactions, audiologic results with CBCA and BAHA, and patient satisfaction. Follow‐up was at least 24 months.

RESULTS

In 11 participants aged 5 to 17 years, the PTA free‐field air conduction improved 37%, and free‐field speech discrimination improved 23%. Successful integration and implant use were achieved in 10 cases but were lost in 1 case as a result of head trauma. All patients preferred the BAHA as opposed to the CBCA.

CONCLUSIONS

The BAHA is a valuable device that can improve hearing and provide significant parent and patient satisfaction. Careful selection appears to correlate with successful long‐term use.
Anterior Skull Base Surgery Without Prophylactic Airway Diversion Procedures
Authors: Gil Ziv , Cohen Jacob T. , Spektor Sergei , Shlomi Benjamin , Fliss Dan M.
Published: September 2022

OBJECTIVE

Although anterior skull base surgery has become a relatively safe and effective procedure, postoperative complications remain a serious problem. One of the most devastating complications of anterior skull base procedures is tension pneumocephalus (TP). In order to prevent TP, authors have recommended the use of prophylactic airway diversion procedures, such as prolonged endotracheal intubation or prophylactic tracheostomy. However, these procedures may mask neurologic deterioration, delay treatment, and prolong rehabilitation. The purpose of this study was to determine the need for airway diversion procedures in anterior skull base surgery.

STUDY DESIGN

Eighty‐five patients underwent anterior skull base operations through the subcranial approach without prophylactic airway diversion. Sixty‐four patients underwent resection of tumors, 12 patients underwent repair of cerebrospinal fluid leak, 6 patients underwent surgery due to anterior skull base fungal infections, and 3 patients underwent anterior skull base reconstruction procedures.

RESULTS

The complication rate of TP was 1.2% (1/ 85). This complication rate is similar to that previously reported for operations performed with airway diversion procedures.

CONCLUSION

Prophylactic airway diversion procedures are unnecessary in routine anterior skull base operations. Airway diversion should be indicated only when factors that might predispose the patient to risk of TP have been identified (ie, chronic cough or obstructive pulmonary diseases).
Radiologic Correlates of Symptom‐Based Diagnostic Criteria for Chronic Rhinosinusitis
Authors: Hwang Peter H. , Irwin Sande B. , Griest Susan E. , Caro James E. , Nesbit Gary M.
Published: September 2022

OBJECTIVE

In 1997, the Task Force on Rhinosinusitis (TFR) set forth symptom‐based diagnostic guidelines for chronic rhinosinusitis (CRS). In the present study, we examined radiologic correlates of the TFR diagnostic criteria for rhinosinusitis.

STUDY DESIGN AND SETTING

One hundred twenty‐five consecutive patients undergoing computed tomography (CT) scans of the sinuses were studied at Oregon Health and Science University. Patients were evaluated prospectively with a questionnaire based on the TFR criteria, and their CT scans were graded according to the Lund‐Mackay scoring system.

RESULTS

Of the 125 patients, 115 met the symptom criteria for CRS. However, 40 of 115 had negative scans (Lund‐McKay score, 0) despite meeting the diagnostic criteria for rhinosinusitis. Of 115, 75 had positive scans (Lund‐McKay score, >1). Of the 10 patients who had negative diagnoses for rhinosinusitis, 9 had a positive CT scan. The Kappa coefficient was −0.103 (±95% confidence interval, −0.201 to −0.004), indicating poor agreement between CRS positivity and CT positivity. The sensitivity of TFR criteria for detecting a positive scan was 89%, but the specificity was poor at only 2%.

CONCLUSION AND SIGNIFICANCE

Based on these pilot data, it appears that the specificity and predictive value of the current TFR criteria may not be adequate to serve as a diagnostic standard for rhinosinusitis. Additional validating data may provide guidance for improving the sensitivity and specificity of symptom‐based diagnostic instruments for rhinosinusitis.
Evaluation of Pediatric Lateral Oropharyngeal Trauma
Authors: Ratcliff Daniel J. , Okada Pamela J. , Murray Alan D.
Published: September 2022

OBJECTIVE

We reviewed the mechanism of injury, presentation, and evaluation of children with trauma to the lateral oropharynx.

STUDY DESIGN AND SETTING

We conducted a retrospective review of patients in an urban pediatric emergency department with trauma to the lateral oropharynx over a 5‐year period.

RESULTS

Forty‐eight patients were identified with documented injuries of the lateral oropharynx placing the internal carotid artery at risk of injury. The average age was 42 months, with a male‐to‐female ratio of 1.5:1. Seventy‐seven percent of patients had a documented neurologic examination. Examinations were normal in all cases. Computed tomography scans were obtained in 14 patients, identifying 3 patients with carotid abnormalities. Angiography subsequently diagnosed intimal injuries in 2 of the 3 patients. There were no known cases of neurovascular compromise.

CONCLUSION

Contrast‐enhanced computed tomography may be an effective screening examination in this patient population, helping to determine which children should be admitted for angiography and observation.
The Lateral Crural J‐flap Repair of Nasal Valve Collapse
Authors: O'Halloran Laurence R.
Published: September 2022

OBJECTIVES

Nasal valve collapse is a common cause of nasal airway obstruction. Although many techniques have been devised to correct both the functional and aesthetic aspects of this problem, none is uniformly successful. I propose that the true locus and solution to the problem lies lateral to the nasal valve angle in the fibroareolar tissue that connects the lateral aspect of the lateral crus to the bony pyriform aperture. Age‐related or surgically induced weakening and loosening of these structurally important, fibroareolar connections result in a prolapse of the lateral aspect of the lateral crura away from the pyriform margin and toward the septum with a consequent narrowing of the nasal valve region. A new method of repair is described.

METHODS

Bilateral marginal incisions are made following the curvature of the palpated caudal edge of the lower lateral cartilage starting at the dome region medially. The incision is extended laterally until the entire lateralmost aspect of the lateral crus is freed, generating a J‐shaped chondrocutaneous flap that is medially and superiorly based. Following this, supraperichondrial dissection of the lateral crus is carried out, exposing the dome region and the upper lateral cartilage. The J‐flap is then pulled caudally and laterally, and the excess overlapping tissue is evaluated. Two composite strips of vestibular skin and cartilage are resected: one parallel to the marginal incision and the second at the lateral edge of the J‐flap. The flap is transposed and sutured into position, pulling open the nasal valve angle.

RESULTS

Preliminary results are presented for 18 patients who underwent 19 lateral crural J‐flap repairs of nasal valve collapse. Nine patients underwent concomitant septal, sinus, or turbinate procedures. Two patients underwent unilateral J‐flap repair. One patient required revision. Eighty‐nine percent of patients reported markedly improved nasal airway patency and elimination of the subjective sensation of inspiratory collapse. Mean time to follow‐up was 257 days. There has thus far been no noticeable decrement in benefit over time.

CONCLUSION

This new technique for the treatment of nasal valve collapse may offer a simple and effective approach to the problem of nasal valve collapse with minimal morbidity and a high rate of success. The technique is based on a new view of the structural etiology of nasal valve collapse.
An Alternative Surgical Procedure for the Treatment of Vocal Fold Retention Cyst
Authors: Chang Hsin‐Pin , Chang Shyue‐Yih
Published: September 2022

OBJECTIVE

Enucleation is the standard surgical procedure for vocal fold retention cyst, but it is sometimes technically challenging when the cyst is large. A simple alternative procedure, which evolved from the concept of marsupialization of cystic lesions, is presented, and the treatment results are reported.

METHODS

Termed the “wide‐opening method,” this technique involves the removal of the medial half of the cyst with its overlying mucosa, which creates a large opening that prevents content retention. Twenty‐one consecutive patients with a cyst with a diameter of greater than 2 mm were treated by this method. Videostroboscopy and voice function assessments were performed preoperatively and postoperatively.

RESULTS

The procedure was completed on all patients without difficulty. Voice function assessments showed statistically significant improvement postoperatively. Videostroboscopy showed improved vocal fold vibration postoperatively in all patients, although in 9 patients the postoperative wound with mild local stiffness was observable. Recurrence was noted in 1 patient.

CONCLUSIONS

The wide‐opening method is simple in technique, especially when the cyst is large. Voice improvement can be achieved postoperatively, and the recurrence rate is low.
Evaluation of Sinusitis in the Intensive Care Unit Patient
Authors: Skoulas Ioannis G. , Helidonis Emmanuel , Kountakis Stilianos E.
Published: September 2022

OBJECTIVE

The purposes of this study were to evaluate the effectiveness of radiologic studies in diagnosing sinusitis in the intensive care unit (ICU) patient and to compare it with the effectiveness of endoscopic examination of the middle meatus.

METHODS

We conducted a prospective collection of data in 141 ICU patients consulted for sinusitis over a 5‐year period beginning in the 1994.

RESULTS

Antral lavage was performed at least unilaterally in 112 patients, with a total of 195 lavages performed. Plain films and computer tomography scans predicted purulence in 41% (χ2 = 2.9, P = 0.09) and 47% (χ2 = 2.2, P = 0.14) of the cases, respectively, whereas the presence of purulence in the middle meatus as seen on endoscopy predicted purulence in the maxillary sinus in 78% of the lavages (χ2 = 28.9, P = 8 × 10‐8). When there was no evidence of purulence in the middle meatus on endoscopy, 73% of the lavages were negative.

CONCLUSION

The most important predictor of a positive antral lavage in the ICU patient with suspected sinusitis is evidence of purulence on endoscopic examination of the middle meatus.
Nonmelanoma Cutaneous Malignancy with Regional Metastasis
Authors: Chu Angela , Osguthorpe J. David
Published: September 2022

OBJECTIVE AND STUDY DESIGN

We performed a retrospective study of 28 patients to evaluate the management and outcome of regional metastasis from nonmelanoma cutaneous malignancies.

RESULTS

There were 25 squamous cell, 1 basal cell, and 2 eccrine carcinomas. The most common primary locations were the temple, ear, and cheek. Median interval from primary resection to regional metastasis was 9 months, and such were commonly of the parotid, level IB, and level IIA nodes. Twenty‐four patients underwent parotidectomy and/or neck dissection; 19 patients, postoperative radiation. Ten patients (36%) died from the disease, 2 patients (7%) have persisting disease, 5 (18%) have died from intercurrent disease, and 11 (39%) have no evidence of disease (minimum follow‐up, 22 months; median, 34 months).

CONCLUSIONS AND SIGNIFICANCE

Nonmelanoma cutaneous malignancies with regional metastasis have a poor prognosis despite aggressive therapy. When high‐risk characteristics are detected, examination of the nearest “sentinel node,” prophylactic lymphadenectomy, and/or regional irradiation might be justified; further study is warranted.
Clinical Associations Between Tinnitus and Chronic Pain
Authors: Isaacson Jon E. , Moyer Matthew T. , Schuler H. Gregg , Blackall George F.
Published: September 2022

OBJECTIVE

We sought to estimate the prevalence and severity of tinnitus in patients with chronic pain.

STUDY DESIGN AND SETTING

We conducted a prospective nonrandomized study in which a survey and the Tinnitus Handicap Inventory (THI) were distributed at a tertiary chronic pain clinic.

RESULTS

Seventy‐two patients participated. 50 women (mean age, 53 years) and 22 men (mean age, 47.5 years); 54.2% reported having tinnitus. There was an even distribution of patients reporting the onset of tinnitus as before versus after the onset of pain. Four patients reported a direct association between tinnitus and pain. The mean THI score was 27 (of 100) (n = 35). Fifteen subjects scored less than 16, indicating no handicap, and 4 scored over 58, indicating a severe handicap.

CONCLUSION: The study results suggest a high incidence of tinnitus within this population. There were few strong associations between pain and tinnitus. Tinnitus does not significantly handicap the majority of these patients.

SIGNIFICANCE

Tinnitus is a common symptom in the chronic pain population but is not a significant problem for these patients.
Allergic Rhinitis: Broader Disease Effects and Implications for Management
Authors: Baroody Fuad M.
Published: September 2022

Allergic rhinitis is a burdensome disease for a significant part of the population in both adults and children. Poorly controlled allergic rhinitis can trigger exacerbations of asthma, sinusitis, and otitis media, diseases with which it shares common pathophysiologic elements. Consequently, early diagnosis and treatment should be a priority for patients and physicians, not only to control the symptoms of allergic rhinitis but also to improve the management of associated diseases. Several pharmacologic therapies can be considered in an armamentarium that includes antihistamines (intranasal and systemic), intranasal cromolyn, intranasal anticholinergic agents, intranasal steroids, systemic steroids, immunotherapy, and, most recently, leukotriene receptor antagonists. Often, combinations of these treatments are used to maximize control of refractory symptoms.
Intralesional Cidofovir for the Treatment of Severe Juvenile Recurrent Respiratory Papillomatosis: Long‐Term Results in 4 Children
Authors: Milczukm Henry A.
Published: September 2022

OBJECTIVE

We sought to determine the efficacy of intralesional injection of cidofovir in improving resolution of recurrent respiratory papillomatosis (RRP).

STUDY DESIGN AND SETTING

We conducted a prospective, observational trial at an academic tertiary children's hospital.

RESULTS

Four children with RRP requiring more than 6 surgical excisions per year were treated with intralesional cidofovir. Cidofovir (5 mg/mL) was injected into airway sites where papillomas had just been excised using sharp technique. Each patient had 6 treatments performed 6 to 8 weeks apart. Biopsies confirmed benign papilloma lesions in all cases. During treatment with intralesional cidofovir there was diminished growth of the papillomas in each patient. Once cidofovir treatment was stopped, the rate of regrowth and frequency of surgical excision returned to pretreatment levels in 3 of the 4 patients.

CONCLUSIONS

Intralesional cidofovir may provide benefit in reducing the rate of RRP growth while under treatment, but RRP severity returned to pretreatment levels once cidofovir treatment was stopped using this treatment program.
Cricothyroid Approximation and Thyroid Chondroplasty: A Patient Survey
Authors: Matai Vandana , Cheesman Anthony D. , Clarke Peter M.
Published: September 2022

OBJECTIVE

Cricothyroid approximation is performed in male‐to‐female transsexuals to raise the pitch of the voice often accompanied by a thyroid chondroplasty, an aesthetic reduction of the thyroid cartilage. The survey was conducted to ascertain patient satisfaction with the procedures.

STUDY DESIGN AND SETTING

Fifty‐four patients had the procedures performed in our department over an 8‐year period; 45 patients were sent postal questionnaires to evaluate patient satisfaction with the appearance of the laryngeal prominence, pitch of the voice, and which they found more beneficial, the surgery or speech therapy.

RESULTS

A response rate of 93% was obtained; 86% of patients thought their laryngeal profile had improved, 79% thought their voice had improved, and 55% thought that surgery and 21% thought that speech therapy had helped more in improving the voice. Overall, 79% were satisfied with the results of the surgery.

CONCLUSIONS

Cricothyroid approximation and thyroid chondroplasty have a high patient satisfaction rate.
Opening Plugged Tympanostomy Tubes: Effect of Tube Composition
Authors: Tsao Benjamin A. , Stevens Gary R. , Antonelli Patrick J.
Published: September 2022

OBJECTIVE

We sought to determine if tympanostomy tube (TT) composition impacts the rate of clearing mucoid plugs.

DESIGN

The study used an ex vivo model.

METHODS

TTs with a standard shaft length and inner diameter, varying only by composition materials, were studied. Thirty TTs of each biomaterial (stainless steel, titanium, silicone, fluoroplastic, ion‐bombarded silicone, and phosphorylcholine‐coated fluoroplastic) were plugged with middle‐ear mucus and placed in a model ear chamber. Ofloxacin otic solution was instilled into the chamber to cover the plugged TT. Time to clear each plug was recorded.

RESULTS

Ion‐bombarded silicone TTs cleared more rapidly than plain silicone TTs (P=0.0042), but no other statistically significant difference among TT materials was observed.

CONCLUSIONS

TT composition does not significantly affect the rate or “ease”with which TTs may be opened after they become plugged with mucus ex vivo. The higher rate of plug clearance observed with ion‐bombarded silicone relative to untreated silicone suggests that improvements may be possible with alterations in either TT composition or surface preparations.
Second primary malignancies in patients with cancer of the head and neck
Authors: Vaamonde Pedro , Martin Carlos , Del Rio Maria , Labella Torcuato
Published: September 2022

OBJECTIVE

Clinical study of second primary malignancies (SPM) in patients with cancer of the head and neck (HNC).

STUDY DESIGN AND SETTING

Retrospective study over 48 patients with SPMs culled from 636 with HNC seen in 122 months. The minimum follow‐up was 18 months, and the setting for the study was the institutional referral center.

RESULTS

There was association between the sites of first and second tumor. The SPMs were diagnosed with a constant rate throughout the period of study. Five year‐survival rate was 29%. SPM in an advanced stage either outside of the head and neck or synchronous had poor survival.

CONCLUSION

The SPMs are a growing problem with better survival after treatment of the first malignancy.

SIGNIFICANCE

Regular follow‐up is necessary in HNC patients to improve their survival, giving special attention to the development of SPM.
Psychosocial adjustment in patients surgically treated for laryngeal cancer
Authors: Ramirez Maria Jose Ferrer , Ferriol Enrique Estelles , Domenech Fernando Guallart , Llatas Marina Carrasco , Suarez‐Varela Maria Morales , Martinez Ramon Lopez
Published: September 2022

OBJECTIVE

To assess the psychosocial adjustment in 62 patients surgically treated for cancer of the head and neck.

STUDY DESIGN AND SETTING

Forty‐one patients were grouped as having had radical surgery (total laryngectomy) and 21 as having had functional surgery (horizontal supraglottic laryngectomy or partial vertical surgery). The Psychosocial Adjustment to Illness Scale‐Self Report (PAIS‐SR) was used for the evaluation.

RESULTS

No significant differences were found between groups when global adjustment or domain adjustment was compared. Patients did not consider the permanent stoma and voice loss to be the most important determinant of quality of life. Work and family relationship were the domains with poorest adjustment.

CONCLUSION

Social and medical support are important factors in improving patients' self‐confidence and satisfaction, playing an important role in recovering useful phonation, psychological adjustment, and global quality of life.

SIGNIFICANCE

Information collected in this way may facilitate improved rehabilitation and thus better quality of life.
Effect of amoxicillin or clindamycin on the adenoids bacterial flora
Authors: Brook Itzhak , Shah Kiran
Published: September 2022

OBJECTIVE

We sought to compare the effect on the adenoid bacterial flora of patients with recurrent otitis media of antimicrobial therapy with amoxicillin (Am) or clindamycin (C).

PATIENTS AND METHODS

Forty‐five children scheduled for elective adenoidectomy participated in a prospective randomized study. They were divided into 3 groups of 15 each to receive either no therapy (control) or 10 days of therapy with Am or C. Core adenoid tissues was quantitatively cultured for aerobic and anaerobic bacteria.

RESULTS

Polymicrobial aerobic‐anaerobic flora were present in all instances. The predominant aerobes in all groups were α‐hemolytic and γ‐hemolytic streptococci, Haemophilus influenzae, Staphylococcus aureus, group A β‐hemolytic streptococci, and Moraxella catarrhalis. The prominent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium spp. The number of isolates was significantly reduced in those treated with Am (n = 110, P < 0.05) or C (n = 58, P < 0.001) compared with control (n = 148). The number of bacteria per gram/tissue was lower in those treated with either antibiotics. The number of potential pathogens was lower in those treated with C compared with the other 2 groups (P < 0.001). The number of β‐lactamase‐producing bacteria was lower in those treated with C than in those treated with Am (P < 0.025) or control (P < 0.001).

CONCLUSIONS

These data illustrate the ability of C and, to a lesser degree, of Am to reduce the bacterial load as well as potential pathogens and β‐lactamase‐producing bacteria from the adenoids of children with recurrent otitis media.
Tympanic Membrane Metalloproteinase Inflammatory Response
Authors: Wilmoth Jason G. , Schultz Gregory S. , Antonelli Patrick J.
Published: September 2022

OBJECTIVE

The goal of this study was to determine whether expression of matrix metalloproteinases (MMP) in tympanic membranes (TM) is stimulated by host tumor necrosis factor‐± (TNF‐±) and bacterial toxin (lipopolysaccharide, LPS), which may play a role in the pathogenesis of cholesteatoma.

STUDY DESIGN

Gerbil TMs (n = 48) were cultured in the presence of either TNF‐± or LPS. Quantitative analysis of TNF‐± and MMPs was performed on both the homogenized TMs and the culture media supernatant.

RESULTS

Levels of TNF‐± and MMPs did not increase significantly in TMs with exposure to inflammatory mediators. TNF‐± levels in supernatant were elevated (P < 0.007) with more concentrated LPS exposure. Supernatant levels of MMP2 were increased (P < 0.007) at most concentrations of LPS and TNF‐±.

CONCLUSION

Cultured TMs expressed MMPs in response to bacterial and host inflammatory mediators. These findings support a link between inflammation and the secretion of potentially destructive MMPs in the TM, which may contribute to the pathogenesis of cholesteatoma.
Comparisons of two Intranasal Corticosteroid Preparations in Treating Allergic Rhinitis
Authors: TAI Chih‐Jaan , Wang PA‐Chun
Published: September 2022

OBJECTIVES

Intranasal corticosteroid preparations can relieve symptoms of allergic rhinitis. Different aqueous corticosteroid forms have been developed for intranasal use. The objectives of this study were to compare efficacy and safety between fluticasone propionate and budesonide in the treatment for patients with allergic rhinitis.

METHODS

The study was conducted in a prospective and randomized manner; a total of 24 adult patients were enrolled. All patients received MAST allergen test at entry and again at 2 months after treatments. Fourteen patients received fluticasone propionate 200 μg once daily, and 10 patients received budesonide 200 μg twice daily. To investigate the efficacy of fluticasone propionate and budesonide, a subjective scoring system was designed to evaluate the symptom improvement of patients. Adverse events were recorded on a diary card then were analyzed. Mann‐Whitney U test and Kruskal‐Wallis 1‐way analysis of variance were used for statistical analysis.

RESULTS

Analysis on patient‐based symptom scores revealed that both fluticasone propionate and budesonide were equally efficacious in improving the symptoms of nasal blockage, sneezing, nasal itching, and watery rhinorrhea. There were no significant side effects reported for both groups during this follow‐up period. However, analysis showed that the fluticasone propionate group demonstrated significantly greater improvement in some MAST allergen tests (Candida, mite, house dust; P < 0.05).

CONCLUSION

Clinically, fluticasone propionate 200 μg once daily was efficacious as budesonide 200 μg twice daily in the relief of allergic rhinitis symptoms. However, fluticasone propionate can achieve greater immunologic improvement. Both preparations showed no evidence of short‐term side effects.
Comparing a Mechanical Device with Medicinal Leeches for Treating Venous Congestion
Authors: Hartig Gregory K. , Connor Nadine P. , Heisey Dennis M. , Conforti Michael L.
Published: September 2022

OBJECTIVE

To compare mechanical device therapy to medicinal leech therapy for treating venous congestion.

STUDY DESIGN

Fasciocutaneous flaps of 9 × 7‐cm (porcine model, n = 11) were elevated and the associated veins clamped for 15 hours. Device‐treated flaps (n = 6) were treated with up to 3 devices/flap. Leech‐treated flaps (n = 5) were treated with 75 leeches/flap (5 leeches/hour). Treatment evaluation parameters included: blood volume removed, skin color, surface perfusion, tissue oxygen tension, and endpoint histology.

RESULTS

No significant differences were seen in blood volume removed, surface perfusion, and oxygen tension. However, significant differences were seen in skin color change over time. Histological assessment showed mild congestion in 5/5 leech‐treated flaps and 2/6 device‐treated flaps.

CONCLUSION

Device therapy was comparable to leech therapy for decongesting a 9 × 7‐cm flap over a 15‐hour period. However, digital images and significant differences in skin color change over time demonstrate that device therapy promotes more global decongestion versus leech therapy.
Thyroid Function Studies in Patients with Cancer of the Larynx: Preliminary Evaluation
Authors: Aimoni C. , Scanelli G. , D'Agostino L. , Pastore Antonio
Published: September 2022

OBJECTIVE

Our goal was to evaluate thyroid function before and after surgery only or radiotherapy plus surgery for laryngeal neoplasms.

STUDY DESIGN AND SETTING

The study group consisted of a total of 30 patients with laryngeal cancer (22 treated with surgery only and 8 treated with surgery plus radiotherapy) who were evaluated by ultrasensitive thyroid‐stimulating hormone, free T4, and antithyroid antibodies both preoperatively and at 6 and 12 months after surgery.

RESULTS

All patients had normal thyroid function before treatment (1 patient had elevated antithyroid autoantibodies); after 1 year, 4 (13.34%) patients were hypothyroid. In 3 patients, it was sub‐clinical (ie, elevated thyroid‐stimulating hormone with normal free T4), and in 1 patient, it was symptomatic.

CONCLUSION

Our preliminary data suggest that hypothyroidism occurs in a small but substantial proportion of patients undergoing surgery with or without adjuvant radiotherapy for laryngeal cancer.

SIGNIFICANCE

Thyroid hormone dosing should be routinely included in the assessment of patients with laryngeal cancer, because it is simple and inexpensive and may allow the early diagnosis and management of hypothyroidism. (Otolaryngol Head Neck Surg 2003;129:733‐8.)
Surgical Management of Amiodarone‐Induced Thyrotoxicosis
Authors: Franzese Christine B. , Fan Chris Y. , Stack Brendan C.
Published: September 2022

OBJECTIVE

Amiodarone can cause thyroid dysfunction in patients with or without previous thyroid disease. With increased use from its placement in advanced cardiac life support guidelines and cardiac transplant programs, the incidence of amiodarone‐induced thyrotoxicosis (AIT) will likely increase. Medical management is complex and nonuniform and frequently fails. This study investigates the role of surgery in AIT and proposes indications for surgical management.

STUDY DESIGN AND SETTING

Two AIT case reports at a tertiary care institution and 31 surgical AIT cases in the world literature are reviewed.

METHODS

The 2 AIT cases involved patients with cardiomyopathy and resistant arrhythmias. Despite medical therapy, both patients' conditions failed to improve. Thirty‐one surgical cases of AIT in the literature are evaluated with respect to symptoms and onset, medical therapy, AIT classification, pathology, perioperative management, and complications.

RESULTS

Both patients underwent total thyroidectomy without difficulty or complication, one as an overnight stay and one as an inpatient with an intraaortic balloon pump. One patient received a successful cardiac transplant and the other remains a viable candidate. In the literature, the majority (80%) of surgical cases are AIT type II (less common type) with no underlying thyroid disease. Range and duration of symptoms varied, in addition to type and duration of medical management. Almost all patients underwent total thyroidectomy, and all were successful with no mortality and minimal morbidity.

CONCLUSION

AIT can develop in any patient during or after amiodarone therapy. Medical management is extremely difficult due to the absence of a proven therapeutic armamentarium, and surgery offers a safe, viable option. Surgical management should play a larger role in treatment algorithms and should be strongly considered for patients whose conditions necessitate continuation of amiodarone, or with severe symptoms resistant to medical therapy.
Voice Failure after Tracheoesophageal Puncture: Management with Botulinum Toxin
Authors: Blitzer Andrew , Komisar Arnold , Baredes Soly , Brin Mitchell F. , Stewart Celia
Published: September 2022

Primary or secondary tracheoesophageal puncture with a speaking prosthesis has provided rehabilitation of speech in most patients after total laryngectomy. Persistent constrictor spasm is thought to be responsible for a small percentage of these patients' inability to speak with the prosthesis. Management of these patients has included bougienage and pharyngeal myotomy and/or pharyngeal neurectomy. Botulinum toxin injections of the cricopharyngeus muscle complex in six patients have been successfully used diagnostically and therapeutically for tracheoesophageal puncture failures. The assessment, technique, and results are discussed.
Effect of Epidermal Growth Factor on Tympanic Membranes with Chronic Perforations: A Clinical Trial
Authors: Ramsay Hans A. , Heikkonen Erkki J. , Laurila Pekka K.
Published: September 2022

Epidermal growth factor is an important modulator of cell growth, and its role in normal wound healing is well documented. Epidermal growth factor receptors have been identified in tympanic membranes of different animals. The ability of epidermal growth factor to promote healing of tympanic membrane perforations has recently been shown in experimental animals. We performed a double‐blind, placebo‐controlled study of the effect of epidermal growth factor applied locally on the tympanic membrane for 1 week in patients with chronic perforations. Seventeen adult patients took part in the study, eight in the epidermal growth factor group and nine in the placebo group. Three placebo‐treated patients were later treated with epidermal growth factor, and five patients received repeated epidermal growth factor treatment. Perforation size was measured as a percentage of the tympanic membrane area before and at least 1 month (mean, 2.6 months) after treatment. One perforation in the placebo group healed completely, but none of the epidermal growth factor‐treated perforations closed. Perforations became slightly smaller in both groups (mean decrease, 0.3% and 2.7% for epidermal growth factor and placebo, respectively), but these changes in size were not statistically significant for either group. At otomicroscopy, a proliferation reaction with thickening of the tympanic membrane and pseudomembrane formation at the perforation edge could be seen in some ears. Histologically, a sample from one epidermal growth factor‐treated ear demonstrated signs of hypertrophic epithelium when compared with the morphology of a placebo‐treated tympanic membrane. The only complications were two mild infections in the placebo group. Hearing remained stable after epidermal growth factor treatment.
Surgical treatment of cholesteatoma in children
Authors: Mutlu Cemil , Khashaba Ahmad , Saleh Essam , Karmarkar Sandeep , Bhatia Sanjaya , Dedonato Giuseppe , Russo Alessandra , Sanna Mario
Published: September 2022

Treating cholesteatoma in children is still controversial. This article reviews 93 cases of pediatric cholesteatoma operated on from 1983 to 1991 in the Gruppo Otologico, Piacenza, Italy, and details the results in 83 children who underwent the intact canal wall technique. During second‐stage surgery, residual cholesteatoma was detected in 38% of patients. Recurrent cholesteatoma was detected in 10% of patients treated with the intact canal wall technique. Residual cholesteatoma was seen in the middle ear cleft in 63%, in the epitympanum in 26%, and in the mastoid in 11% of cases. Social hearing level (< 25 dB) was achieved in 85% of cases with suprastructure, whereas only 53% of patients without suprastructure had these levels. In the treatment of cholesteatoma in children by use of the intact canal wall technique, a preplanned second‐look operation is mandatory to eradicate the disease.