bluuebunny/crossref_metadata_2025 huggingface dataset:
Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation
Authors: Nair Satheesh , Verma Sumita , Thuluvath Paul J.
Published: February 2003

The objective of this study was to determine the impact of pretransplant renal function on graft and patient survival rates after orthotopic liver transplantation (OLT) using the United Network for Organ Sharing (UNOS) database for adults who underwent OLT between 1988 and 1996. Based on calculated creatinine clearance (CCr) at the time of OLT, patients were classified arbitrarily into those with normal renal function (>70 mL/min) and mild (40-69.9 mL/min), moderate (20-39.9 mL/min), and severe (<20 mL/min) renal insufficiency. Of the 20,281 patients who underwent transplantation, complete data were available for 19,261 patients. Of these, 12,778 (67%) had normal CCr (mean, 118 ± 50 mL/min) and 4,419 (22%) had mild (56 ± 8.5 mL/min), 1,560 (8%) had moderate (30 ± 5.7 mL/min), and 504 (3%) had severe (14 ± 3.6 mL/min) renal failure. UNOS status 1 was more common in patients with moderate and severe renal failure. Primary graft nonfunction and 30-day mortality rates were higher and 1-, 2-, and 5-year graft and patient survival rates were lower in patients with moderate or severe renal failure. Multiple regression analysis showed that renal failure was an independent predictor of 30-day and 2-year mortality after adjusting for the recipient's age, sex, etiology of liver disease, diabetes status, body mass index, cold ischemic time, and UNOS status. CCr less than 40 mL/min was associated with significantly lower short-term and long-term graft and patient survival rates. In conclusion, our findings suggest that when Mayo End-Stage Liver Disease (MELD) score is used to prioritize organ allocation, lower-than-expected graft and patient survival rates may be seen.
Molecular aspects of iron absorption: Insights into the role of HFE in hemochromatosis
Authors: Philpott Caroline C.
Published: February 2003

Hereditary hemochromatosis is the most common genetic disorder occurring in persons of northern European descent, and the clinical hallmark of the disease is the gradual accumulation of iron in internal organs, especially the liver, heart, and pancreas, which ultimately leads to organ failure. HFE, the gene that is defective in the majority of cases, was identified in 1996 and, although the exact role that HFE plays in the uptake and utilization of iron is not yet clear, important aspects of HFE function are emerging. Identification and studies of new proteins involved in the absorption of iron in the gut and in somatic cells has led to a clearer picture of how humans absorb iron from the diet and regulate this absorption to meet metabolic needs and to balance body iron stores. This review focuses on the molecular aspects of iron absorption and the role that HFE may play in these processes.
Detection and identification of bacterial DNA in patients with cirrhosis and culture-negative, nonneutrocytic ascites
Authors: Such José , Francés Rubén , Muñoz Carlos , Zapater Pedro , Casellas Juan A. , Cifuentes Ana , Rodríguez-Valera Francisco , Pascual Sonia , Sola-Vera Javier , Carnicer Fernando , Uceda Francisco , Palazón José M. , Pérez-Mateo Miguel
Published: February 2003

The current pathogenic theory of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites suggests that repeated episodes of bacterial translocation (BT) from intestinal lumen to mesenteric lymph nodes followed by systemic seeding are the key steps for the final development of infectious events. However, most of the episodes of systemic bacterial circulation remain undetected. Therefore, we investigated the hypothetical presence of bacteria in blood and/or ascitic fluid (AF) from patients with cirrhosis and sterile (culture negative) AF by means of bacterial DNA (bactDNA) detection and identification. Twenty-eight consecutively admitted patients with cirrhosis and presence of AF were included in the study. BactDNA was detected using a polymerase chain reaction (PCR)-based method. The corresponding bacteria were identified by nucleotide sequencing of purified PCR products. BactDNA was detected simultaneously in blood and AF in 9 patients (32.1%). DNA sequencing allowed the identification of Escherichia coli (n = 7) and Staphylococcus aureus (n = 2). In all cases, the similarity between the sequence found in AF and blood indicated that the bactDNA present in both locations originated from a single clone (single translocation event). Child-Pugh score and basic hemodynamic, clinical, endoscopic, and biochemical characteristics were similar among patients with or without the presence of bactDNA. In conclusion, we have detected bactDNA in serum and AF in 32% of all patients studied, and this likely represents single clone episodes of translocation and systemic seeding. E. coli is the most frequently identified bacteria.
Cyclophosphamide disrupts hepatic sinusoidal endothelium and improves transplanted cell engraftment in rat liver
Authors: Malhi Harmeet , annamaneni Pallavi , Slehria Sanjeev , Joseph Brigid , Bhargava Kuldeep K. , Palestro Christopher J. , Novikoff Phyllis M. , Gupta Sanjeev
Published: February 2003

To determine whether disruption of the hepatic sinusoidal endothelium will facilitate engraftment of transplanted cells, we treated Fischer 344 (F344) rats lacking dipeptidyl peptidase IV (DPPIV) activity with cyclophosphamide (CP). Electron microscopy showed endothelial injury within 6 hours following CP, and, after 24 and 48 hours, the endothelium was disrupted in most hepatic sinusoids. CP did not affect Kupffer cell function. Similarly, CP had no obvious effects on hepatocytes. Intrasplenic transplantation of F344 rat hepatocytes followed by their localization with DPPIV histochemistry showed 3- to 5-fold increases in the number of transplanted cells in CP-treated animals. Transplanted cells integrated in the liver parenchyma more rapidly in CP-treated animals, and hybrid bile canaliculi developed even 1 day after cell transplantation, which was not observed in control animals. To demonstrate whether improved cell engraftment translated into superior liver repopulation, recipient animals were conditioned with retrorsine and two-thirds partial hepatectomy (PH), which induces transplanted cell proliferation. CP treatment of these animals before cell transplantation significantly increased the number and size of transplanted cell foci. In conclusion, disruption of the hepatic sinusoidal endothelium was associated with accelerated entry and integration of transplanted cells in the liver parenchyma. These results provide insights into hepatocyte engraftment in the liver and will help in optimizing liver-directed cell therapy.
Polymorphisms of microsomal epoxide hydrolase gene and severity of HCV-related liver disease
Authors: Sonzogni Laura , Silvestri Laura , De Silvestri Annalisa , Gritti Chiara , Foti Luciana , Zavaglia Claudio , Bottelli Riccardo , Mondelli Mario U. , Civardi Emilio , Silini Enrico M.
Published: February 2003

Factors influencing the progression of liver disease and the development of hepatocellular carcinoma (HCC) in chronic hepatitis C virus (HCV) infection are poorly understood. Inherited variations of drug-metabolizing enzyme (DME) activities may affect liver damage and cancer risk by modifying individual susceptibility to endogenous or exogenous toxic compounds. We investigated the association of liver disease severity with common alleles of microsomal epoxide hydrolase (mEH), an enzyme involved in the metabolism of highly reactive epoxide intermediates. Three polymorphisms (Tyr113His, His139Arg, and −613C/T) were analyzed by polymerase chain reaction (PCR) restriction fragment length polymorphisms (RFLPs) in 394 patients at different stages of disease, including 92 asymptomatic carriers, 109 patients with chronic hepatitis, 100 patients with cirrhosis, and 93 patients with HCC. Reference allele frequencies were obtained from 99 healthy blood donors. Allele distributions between categories were compared using the χ2 test; odds ratios (ORs) and 95% CI were calculated to express relative risks. Allele frequencies among 99 healthy controls were as follows: 15.1% for 113His/His, 4.0% for 139Arg/Arg, and 46.5% for −613C/T. mEH 113His/His homozygotes were overrepresented in advanced stages of disease, in particular among HCC patients (27.9%; P = .03; OR, 2.2; 95% CI, 1.0-4.6). Differences were more pronounced among men and between extreme patient categories. When mEH genotypes were combined to express a metabolic phenotype, very slow metabolizers were highly prevalent among cirrhotic and HCC patients (18% vs. 3.3% in carriers; P < .001). In conclusion, mEH gene polymorphisms were significantly associated with HCV-related liver disease severity and HCC risk. Men were at higher risk than women; this might be explained by hormonal regulation of gene expression or by differential exposure to environmental toxins.
Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients
Authors: Berenguer Marina , Prieto Martín , Juan Fernando San , Rayón José M. , Martinez Fernando , Carrasco Domingo , Moya Angel , Orbis Francisco , Mir José , Berenguer Joaquín
Published: February 2003

Recurrent hepatitis occurs in the majority of patients undergoing liver transplantation for hepatitis C virus (HCV) cirrhosis, with progression to cirrhosis in up to 30% after 5 years. Based on these data, a decrease in survival can be anticipated with prolonged follow-up. Furthermore, posttransplantation HCV-fibrosis progression has been shown in recent years to increase. Our aims were (1) to describe the natural history of HCV-infected recipients, particularly to determine whether survival has decreased in recent years; (2) to compare this outcome with that observed in non-HCV-infected cirrhosis controls; and (3) to determine the factors associated with disease severity and survival. Among 522 cirrhotic patients undergoing transplantation between 1991 and 2000, 283 (54%) were infected with HCV. Yearly biopsies were performed in these recipients and at 1 and 5 years in the remainder. With similar follow-up, the percentage of deaths in the HCV(+) group was significantly higher than in the HCV(−) group (37% vs. 22%, P < .001), and patient survival was lower (77%, 61%, 55% vs. 87%, 76%, 70% at 1, 5, and 7 years, respectively; P = .0001). Although survival has increased in the HCV(−) group in recent years, it has significantly decreased in HCV recipients (P < .0001). The main cause of death among the latter was decompensated graft cirrhosis (n = 23/105, 22%), whereas that of HCV(−) patients was infections (n = 10/52, 19%). Reasons for the recent worse outcome in HCV(+) recipients include the increased donor age and stronger immunosuppression. In conclusion, patient survival is lower among HCV(+) recipients than among HCV(−) ones and has been decreasing in recent years. The aging of donors is a major contributor to this worse outcome.
Recipient-derived hepatocytes in liver transplants: A rare event in sex-mismatched transplants
Authors: Fogt Franz , Beyser Kurt H. , Poremba Christopher , Zimmerman Robert L. , Khettry Urmila , Ruschoff Josef
Published: February 2003

Bone marrow-derived stem cells have been shown to engraft and populate native tissues during repair and in transplanted animal tissues. Very few studies have been performed in humans to evaluate the possibility of stem cell engraftment in transplanted tissues. In human renal transplants, recipient cells have been demonstrated within vascular and interstitial structures. In a previous study of patients with hepatic transplants, hepatocytes with XY chromosome patterns have been detected in sex-mismatched female to male transplanted livers in a small number of cases. Because of the possibility of Y chromosome microchimerism of females with male offspring, we analyzed the presence of X and Y chromosomes in liver biopsies of 13 patients with sex-mismatched liver transplants (8 female to male, 5 male to female) and long transplant to biopsy intervals (1.2 to 12 years; mean, 4.5 years). We were able to detect recipient-specific sex chromosomal patterns in inflammatory cells by fluorescent in situ hybridization/immunohistochemistry combination within the liver parenchyma but not within hepatocytes. In conclusion, recipient engraftment of stem cells may be an early feature in liver transplant but may be an infrequent persistent feature in long-term grafts.
Transferrin receptor gene expression and transferrin-bound iron uptake are increased during postischemic rat liver reperfusion
Authors: Tacchini Lorenza , Poli Daniela Fusar , Bernelli-Zazzera Aldo , Cairo Gaetano
Published: February 2003

Iron-catalyzed production of reactive oxygen species is a cause of liver injury after ischemia/reperfusion (I/R). The aim of the present study was to address the regulation of transferrin receptor (TfR), which mediates cellular iron uptake, during I/R. The molecular mechanisms controlling TfR gene expression in vivo during I/R of rat liver were investigated by molecular biology procedures. We also analyzed transferrin-bound iron uptake into surviving liver slices. Increased amounts of TfR protein and messenger RNA (mRNA) were found 2 to 6 hours after reestablishment of blood supply. RNA bandshift analysis showed that iron regulatory protein (IRP) activity was decreased in the first hours of reperfusion, thus indicating that IRP-mediated mRNA stabilization was not involved in early TfR upregulation. On the contrary, increased transcription of the TfR gene in isolated nuclei was observed during reperfusion; during the ischemic phase this was preceded by enhanced binding of hypoxia inducible factor (HIF-1) to a DNA sequence derived from the TfR promoter. TfR2 mRNA levels were also enhanced after reperfusion. The increased expression of TfR at the cell surface resulted in increased uptake of transferrin-bound-iron into surviving liver slices; however, iron was not incorporated into ferritin. In conclusion, HIF-1 mediated activation of TfR gene transcription and IRP-mediated increase of TfR mRNA stability ensure a steady induction of TfR, and hence higher iron uptake in reperfused rat liver. TfR-mediated entry of the metal into liver cells may represent a source of catalitically active iron, which may play a role in reperfusion damage.
Liver transplantation for primary biliary cirrhosis: A long-term pathologic study
Authors: Khettry Urmila , Anand Namrata , Faul Peter N. , Lewis David W. , Pomfret Elizabeth A. , Pomposelli James , Jenkins Roger L. , Gordon Fredric D.
Published: February 2003

Although recurrent primary biliary cirrhosis (PBC) after liver transplantation (LT) has been reported, the full spectrum of changes and progression to fibrosis and cirrhosis is not yet established. We performed a detailed retrospective clinicopathologic analysis of 43 patients who underwent LT for PBC. Eight patients (18.6%) had definite recurrent PBC with florid duct lesions, 5 patients (11.6%) had recurrence with features of autoimmune liver disease, not otherwise specified (AILD-NOS), 7 patients (16.3%) had plasmacytosis only, 4 patients (9.3%) had chronic rejection, 18 patients (41.9%) have no recurrence at present, and 1 patient (2.3%) had acquired hepatitis C. Although definite diagnoses of PBC and AILD-NOS recurrences (n = 13) were made 1 month to 14 years (median, 4 years) post-LT, all patients had plasmacytosis in their earlier biopsy specimens. Also, these patients showed similar pre-LT and post-LT clinical features, with progressive fibrosis in 4 of 8 and 2 of 5 patients, respectively. Four of 13 patients with definite recurrence and 14 of 18 patients with no recurrence were administered azathioprine (AZA) as part of their post-LT therapy (P = .01). Six of 13 and 16 of 18 patients currently are alive, with median follow-ups of 11 and 5 years, respectively. No significant differences were seen with donor-recipient group A, group B, group O blood type, sex, or HLA mismatches; native liver histological characteristics; or tacrolimus-based therapy. In conclusion, recurrent autoimmune liver disease was seen in 30% of patients after LT for PBC and had features of PBC and/or AILD-NOS. Progression seen in 46% of patients was associated with late graft failure. Patients with no recurrent disease had shorter follow-up periods and more frequent immunosuppression, including AZA; some may still develop recurrence with longer follow-up.
Prostaglandin E1 improved the function of transplanted fatty liver in a rat reduced-size-liver transplantation model under conditions of permissible cold preservation
Authors: Morioka Daisuke , Kubota Toru , Sekido Hitoshi , Matsuo Kenichi , Saito Shuji , Ichikawa Yasushi , Endo Itaru , Togo Shinji , Shimada Hiroshi
Published: February 2003

The aim of this study was to determine whether the minimum necessary volume of a moderate fatty liver graft was similar to the normal liver volume and to elucidate means for improving the function of the transplanted fatty liver if it were inferior in volume to a normal liver under conditions of permissible cold preservation. Nine-week-old male Wistar rats were used. Normal rat chow was fed to the normal liver group, and fat-enriched rat chow was fed to the fatty liver group for 4 weeks to induce a moderately fatty liver. Liver transplantation with various volumes of reduced-size grafts, including whole liver graft (100%LT), 70% volume graft (70%LT), and 30% volume graft (30%LT), was performed with both groups of rats as donors. All procedures were performed under the conditions of 2-hour cold preservation. All rats with an implanted normal liver were surviving at 7 days after the operation regardless of the graft volume (100%LT, 5 of 5; 70%LT, 5 of 5; 30%LT, 5/5). In contrast, the survival rates decreased according to the graft volume in rats implanted with fatty livers (100%LT, 8 of 8; 70%LT, 5 of 8; 30%LT, 2/8). To improve the survival of 30%LT with fatty liver, we employed two potent inhibitors of ischemia-reperfusion injury: FK506 and prostaglandin E1. Though FK506 had no advantageous effect, prostaglandin E1 significantly improved the survival rate and diminished serum levels of alanine aminotransferase and hyaluronic acid. In conclusion, the volume of graft necessary for successful transplantation is larger in fatty livers than in normal livers in permissible cold preservation. Also, prostaglandin E1 protects grafts against ischemia-reperfusion injury and improves the functioning of a transplanted fatty liver.
A United States compassionate use study of lamivudine treatment in nontransplantation candidates with decompensated hepatitis B virus-related cirrhosis
Authors: Hann Hie-Won L. , Fontana Robert J. , Wright Teresa , Everson Gregory , Baker Alfred , Schiff Eugene R. , Riely Carolyn , Anschuetz Gaya , Gardner Stephen D. , Brown Nathaniel , Griffiths Dorothea
Published: February 2003

Patients with hepatitis B-related decompensated cirrhosis have limited treatment options. This prospective, multicenter study assessed lamivudine in 75 patients with decompensated cirrhosis, the majority of whom (93%) were not candidates for liver transplantation. At baseline, all 75 patients tested positive for hepatitis B surface antigen [HBsAg (+)] and 62% tested positive for hepatitis B e antigen [HBeAg (+)]. Hepatitis B virus (HBV) DNA levels were detectable in 64% of patients by the branched chain DNA (bDNA) assay. Patients received lamivudine 100 mg once daily (median duration, 12.7 months; range, 0.5 to 33 months). In patients with detectable HBV DNA pretreatment, the virus became undetectable by the bDNA assay in 69% of patients with ≥ 6 months treatment and in 64% overall. Alanine aminotransferase (ALT) level improved in 90% and normalized in 55% of patients with ≥ 6 months treatment and in 48% overall. Improvements in bilirubin and albumin levels occurred throughout treatment. The median Child-Pugh score improved from a baseline of 10 to 8 at last visit, with 31% (23/75) having an improved score of ≥ 2 points, 57% (43/75) unchanged (< 2 points), and 12% (9/75) worsened (≥ 2 points). A virologic breakthrough developed in eight of 41 patients (18%) after a median of 13.1 months of treatment. Tyrosine-methionine-aspartate-aspartate (YMDD) variant HBV was detected in three of four patients tested. Nevertheless, at last visit, ALT, albumin, and bilirubin levels were similar for patients with and without breakthrough. Lamivudine treatment can lead to significant improvements in liver disease severity in nontransplantation candidates with advanced disease. Additional studies of lamivudine in combination with other antivirals are indicated for the large population of patients worldwide with advanced HBV-related cirrhosis and inadequate access to liver transplantation.
Presence of methylated arginine derivatives in orthotopic human liver transplantation: Relevance for liver function
Authors: Martín-Sanz Paloma , Olmedilla Luis , Dulin Elena , Casado Marta , Callejas Nuria A. , Pérez-Peña José , Garutti Ignacio , Sanz Javier , Calleja Javier , Barrigón Santos , Boscá Lisardo
Published: February 2003

Orthotopic liver transplantation (OLT) is a frequent option in the treatment of liver diseases. During the cold ischemia period of the donor liver, there is an accumulation of metabolites that are potent inhibitors of the cytokine-inducible and endothelial nitric oxide synthase isoenzymes. We identified the presence of l-N-monomethylarginine and asymmetric dimethylarginine (ADMA) as the main inhibitors by means of analytic high-pressure liquid chromatography and mass spectrometry techniques. An average ADMA concentration of 450 μmol/L was measured in the preservation medium of donor livers with poor outcomes after OLT. A statistically significant relationship was observed between the concentration of methylated arginine derivatives in the graft and liver function after OLT. These data suggest that measurement of methylated arginine, released after liver protein catabolism, might provide an indication of functional status of the liver that can help the development of strategies intended to improve graft viability.
Longitudinal assessment of mortality risk among candidates for liver transplantation
Authors: Merion Robert M. , Wolfe Robert A. , Dykstra Dawn M. , Leichtman Alan B. , Gillespie Brenda , Held Philip J.
Published: February 2003

Liver allocation policy recently was modified to use the Model for End-Stage Liver Disease (MELD) for patients with chronic liver disease to stratify potential recipients according to risk for waitlist death. In this study, a retrospective cohort of 760 adult patients with chronic liver disease placed on the liver transplant waitlist between January 1995 and March 2001 and followed up for up to 74 months was studied to assess the ability of the MELD to predict mortality among waitlisted candidates and evaluate the prognostic importance of changes in MELD score over time. Serial MELD scores predicted waitlist mortality significantly better than baseline MELD scores or medical urgency status. Each unit of the 40-point MELD score was associated with a 22% increased risk for waitlist death (P < .001), whereas medical urgency status was not a significant independent predictor. For any given MELD score, the magnitude and direction of change in MELD score during the previous 30 days (ΔMELD) was a significant independent mortality predictor. Patients with MELD score increases greater than 5 points over 30 days had a threefold greater waitlist mortality risk than those for whom MELD scores increased more gradually (P < .0001). We conclude that mortality risk on the liver transplant waitlist is predicted more accurately by serial MELD score determinations than by medical urgency status or single MELD measurements. ΔMELD score over time reflects progression of liver disease and conveys important additional prognostic information that should be considered in the further evolution of national liver allocation policy.
Health-related quality of life in pediatric liver transplant recipients: A single-center study
Authors: Bucuvalas John C. , Britto Maria , Krug Susan , Ryckman Frederick C. , Atherton Harry , Alonso Maria P. , Balistreri William F. , Kotagal Uma
Published: February 2003

The goals of the present study were (1) to measure health-related quality of life (HRQOL) in pediatric liver transplantation (LT), (2) to identify demographic and clinical factors that correlate with HRQOL, and (3) to compare two instruments that have been used to measure HRQOL in children and adolescents. We conducted a single-center cross-sectional study of 77 pediatric LT recipients ages 5 to 18 years, all of whom had had LT at least 6 months previously. We used the Child Health Questionnaire Parent Form 50 (CHQPF50) and the PedsQL4.0 to determine measured dimensions of physical and psychosocial health from the parents’ perspective. Individual scale scores range from 0 to 100, with higher scores reflecting better health. Data on demographics, clinical status at transplantation, posttransplantation clinical course, and graft function were collected to identify predictors of posttransplantation HRQOL. Fifty-three percent of the liver transplant recipients had biliary atresia, 78% were white, and 61% were female. The mean age at LT was 3.8 ± 3.6 years, and the range of time since LT was 1 to 15 years. HRQOL in pediatric liver transplant recipients was lower than that reported for healthy children but similar to that for children with other chronic illness. Age at transplantation, the time elapsed since transplantation, hospitalizations within the previous year, maternal education, and race were significant predictors of physical health. Age at transplantation and maternal education predicted psychosocial function. HRQOL was decreased in a population of pediatric liver transplant recipients compared with the general population and similar to that for children with chronic illness. Prospective longitudinal studies will permit us to define predictors of HRQOL at different periods of time after transplantation. The information gained from this study will help us to better define expectations and the clinical course after liver transplantation to patients and their families.
A Prospective Randomized Controlled Study of Fixation of Long Oblique and Spiral Shaft Fractures of the Proximal Phalanx: Closed Reduction and Percutaneous Kirschner Wiring Versus Open Reduction and Lag Screw Fixation
Authors: HORTON T. C. , HATTON M. , DAVIS T. R. C.
Published: February 2003

Patients with an isolated spiral or long oblique fracture of the proximal phalanx were randomized into two groups. One was treated by closed reduction and Kirschner wire fixation and the second treated by open reduction and lag screw fixation. An independent observer assessed function, pain, movement, grip strength and intrinsic muscle function. X-rays were assessed for malunion. Thirty-two patients were entered the study and 15 in the Kirschner wire and 13 in the lag screw group were reviewed at a mean follow-up of 40 months. There was no significant difference in the functional recovery rates or in the pain scores for the two groups. X-rays showed similar rates of malunion and there were no statistically significant differences in range of movement or grip strength.
Irreducible Tuft Fractures of the Distal Phalanx
Authors: AL QATTAN M. M. , HASHEM F. , HELMI A.
Published: February 2003

Two tuft fractures of the distal phalanx had a unique fracture pattern with significant displacement of the proximal fracture fragment into the pulp of the finger. Both fractures were irreducible by closed means, probably due to entrapment of bony spikes within the fibrous septa of the pulp or overlapping of the proximal and distal fracture fragments.
Wrist Function After Excision of the Pisiform
Authors: LAM K. S. , WOODBRIDGE S. , BURKE F. D.
Published: February 2003

The pisiform bone may provide mechanical stability to the ulnar column of the wrist by preventing triquetral subluxation. Thus, surgical excision of the pisiform might cause loss of function to the wrist. We performed a functional evaluation of 20 hands in 20 patients who had undergone pisiformectomy for pisotriquetral joint dysfunction. At a mean follow-up of 65 months, 15 patients had complete relief of symptoms and five continued with mild discomfort. Compared with the unaffected wrist, there were no significant differences in grip strength and wrist movement, static strength and dynamic power. We conclude that pisiformectomy for pisotriquetral joint dysfunction can be safely recommended because restoration of function with a painless wrist is the normal outcome.
Anterior Subfascial Transposition of the Ulnar Nerve
Authors: TEOH L. C. , YONG F. C. , TAN S. H. , ANDREW CHIN Y. H.
Published: February 2003

After anterior subfascial transposition, the ulnar nerve lies superficial to the flexor-pronator muscle group but deep to its fascia. Eight patients with cubital tunnel syndrome were treated with this method and reviewed retrospectively. The average age at the time of operation was 52 years. All patients had severe cubital tunnel syndrome based on Dellon’s classification. The average follow-up period was 2 years and 9 months. Post-operative outcome assessment was based on the modified Bishop rating system. Six patients had excellent and two had good outcomes. All were back at work by the 5th post-operative week. There were no complications or recurrence of symptoms. Anterior subfascial transposition of the ulnar nerve is an effective method of surgical treatment for patients with severe cubital tunnel syndrome.
Task Performance in Stapedotomy: Comparison Between Surgeons of Different Experience Levels
Authors: Rothbaum Daniel L. , Roy Jaydeep , Hager Gregory D. , Taylor Russell H. , Whitcomb Louis L. , Francis Howard W. , Niparko John K.
Published: February 2003

OBJECTIVES

Two steps in stapedotomy are particularly challenging: (1) micropick fenestration of the stapes footplate (SF) and (2) crimping of the stapes prosthesis (SP) to the incus. We conducted trials to determine if experience correlates with differences in performance for these tasks.

METHODS

In a surgical model of stapedotomy, performance was measured for 3 experienced and 3 novice surgeons. For fenestration, we measured ability to target the fenestration and force applied to the SF. For crimping, we measured crimp quality, movement of the SP during crimping, and force applied to the SF.

RESULTS

Experienced surgeons demonstrated significantly better ability to target the fenestration and, during crimping, caused less SP movement and a significantly lower rate of SP dislodgment.

CONCLUSIONS

Clear differences in task performance are measurable between more and less experienced surgeons during critical steps of stapedotomy.

CLINICAL SIGNIFICANCE

The observed differences in task performance may contribute to an understanding of maneuvers that increase the risk of inadequate prosthesis placement and cochlear trauma—factors likely responsible for variable hearing results with strapedotomy.
Complications of Mandibulotomy: Midline Versus Paramidline
Authors: Dai Tsung‐Sung , Hao Sheng‐Po , Chang Kai‐Ping , Pan Whei‐Lin , Yeh Hwey‐Chin , Tsang Ngan‐Ming
Published: February 2003

OBJECTIVE

Mandibulotomy is an important surgical approach to oral cavity and oropharynx. The objective of this study was to evaluate the related complications of 2 common mandibulotomies: midline (osteotomy between 2 central incisors) and paramidline (osteotomy between lateral incisor and canine).

STUDY DESIGN

Ninety‐six patients who had cancer in the oral cavity or oropharynx had preoperative evaluation of the mandible with panoramic films. Among them, 42 patients underwent mandibulotomies: midline for 19 patients and paramidline for 23.

RESULTS

Twenty (47.6%) of 42 patients had mandibulotomy‐related complications, including 9 (21.4%) minor complications and 11 (26.2%) major complications. There were 6 (31.6%) major and 4 (21.1%) minor complications in the midline mandibulotomy and both 5 (21.7%) major and minor complications in the paramidline mandibulotomy.

CONCLUSION

There was no significant difference in the mandibulotomy‐related complication rate between midline and paramidline mandibulotomies. Paramidline mandibulotomy, which preserves the geniohyoid and genioglossus muscles, should be a better function‐preserving operation than midline mandibulotomy.
Image‐Guided Sinus Surgery: Lessons Learned from the First 1000 Cases
Authors: Metson Ralph
Published: February 2003

OBJECTIVE

To study physician utilization and experience with image‐guidance technology for sinus surgery.

STUDY DESIGN AND SETTING

Retrospective review of the first 1000 image‐guided sinus operations performed by 42 surgeons at an academic medical center.

RESULTS

Utilization of image‐guidance systems showed a dramatic increase in both number of cases performed and surgeons who used this equipment (70.6% and 92.8%, respectively) during the first 2 years of its availability. Surgical volume subsequently decreased by a mean of 9.3% per year, whereas the number of surgeons using this technology plateaued. The majority of surgeons continued to perform image‐guided surgery throughout the study period for selected cases. The knowledge base gained from this experience can best be summarized as a series of lessons learned.

CONCLUSION

It is likely that the availability and utilization of image‐guidance systems for sinus surgery will continue to increase in the future. Physicians who learn to use this new technology must do so with an appreciation for both its potential benefits and pitfalls.
Quality of Life for Children with Persistent Sinonasal Symptoms
Authors: Kay David J. , Rosenfeld Richard M.
Published: February 2003

OBJECTIVE

The goal was to validate the SN‐5 survey as a measure of longitudinal change in health‐related quality of life (HRQoL) for children with persistent sinonasal symptoms.

DESIGN AND SETTING

We conducted a before and after study of 85 children aged 2 to 12 years in a metropolitan pediatric otolaryngology practice. Caregivers completed the SN‐5 survey at entry and at least 4 weeks later. The survey included 5 symptom‐cluster items covering the domains of sinus infection, nasal obstruction, allergy symptoms, emotional distress, and activity limitations.

RESULTS

Good test‐retest reliability (R = 0.70) was obtained for the overall SN‐5 score and the individual survey items (R ≥ 0.58). The mean baseline SN‐5 score was 3.8 (SD, 1.0) of a maximum of 7.0, with higher scores indicating poorer HRQoL. All SN‐5 items had adequate correlation (R ≥ 0.36) with external constructs. The mean change in SN‐5 score after routine clinical care was 0.88 (SD, 1.19) with an effect size of 0.74 indicating good responsiveness to longitudinal change. The change scores correlated appropriately with changes in related external constructs (R ≥ 0.42).

CONCLUSIONS

The SN‐5 is a valid, reliable, and responsive measure of HRQoL for children with persistent sinonasal symptoms, suitable for use in outcomes studies and routine clinical care.
Significance of Empty Sella in Cerebrospinal Fluid Leaks
Authors: Schlosser Rodney J. , Bolger William E.
Published: February 2003

OBJECTIVE

The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group.

METHODS

We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author.

RESULTS

Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant (P = 0.01). The spontaneous group consisted primarily of obese, middle‐aged females (13 of 16 patients).

CONCLUSION

Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.
Establishment of Normative Cochlear and Vestibular Measurements to Aid in the Diagnosis of Inner Ear Malformations
Authors: Purcell Derk , Johnson Jacob , Fischbein Nancy , Lalwani Anil K.
Published: February 2003

OBJECTIVE

We sought to establish normative measurements of the inner ear using computed tomography (CT) of the temporal bone to aid in the diagnosis of inner ear malformations.

STUDY DESIGN AND SETTING

Prospective measurements of the inner ear structures were made on axial and coronal temporal bone CT scans on 15 patients with normal hearing and 15 patients with sensorineural hearing loss.

RESULTS

The vertical height of the cochlea on coronal scan and the size of the central bony island within the lateral semicircular canal on axial scan along with visual inspection identified 7 inner ear abnormalities in 6 patients: 5 cases of lateral semicircular canal dysplasia and 2 cases of cochlear hypoplasia. In contrast, visual inspection alone identified only 4 of the 7 abnormalities.

CONCLUSIONS AND SIGNIFICANCE

Routine measurement of the cochlear height and bony island of the lateral semicircular canal, in conjunction with visual inspection of CT images, will increase recognition of common inner ear malformations.
The Association between Laryngopharyngeal Sensory Deficits, Pharyngeal Motor Function, and the Prevalence of Aspiration with Thin Liquids
Authors: Setzen Michael , Cohen Manderly A. , Perlman Philip W. , Belafsky Peter C. , Guss Joel , Mattucci Kenneth F. , Ditkoff Michael
Published: February 2003

OBJECTIVE

The study goal was to evaluate the association among laryngopharyngeal sensory deficits, pharyngeal motor function, and the prevalence of aspiration with thin liquids.

STUDY DESIGN AND SETTING

We conducted a prospective study of 204 consecutive patients undergoing flexible endoscopic evaluation of swallowing with sensory testing and an assessment of pharyngeal motor function (pharyngeal squeeze). Patients were divided into 6 groups depending on the results of sensory and motor testing in the laryngopharynx. Subjects were given 5 mL of thin liquid, and the prevalence of aspiration in each group was compared.

RESULTS

The mean age of the entire cohort was 65 years (58% female). The prevalence of aspiration in patients with intact laryngopharyngeal sensation was 2% (3 of 137) in persons with intact pharyngeal motor function and 29% (2 of 7) when pharyngeal motor function was impaired (P < 0.05). The prevalence of aspiration in patients with a moderate decrease in laryngopharyngeal sensation was 0% (0 of 9) in persons with intact pharyngeal motor function and 67% (2 of 3) when pharyngeal motor function was impaired (P < 0.05). The prevalence of aspiration in patients with severely diminished or absent laryngopharyngeal sensation was 15% (5 of 33) in persons with intact pharyngeal motor function and 100% (15 of 15) when pharyngeal motor function was impaired (P < 0.05).

CONCLUSION

Patients with severely diminished laryngopharyngeal sensation and pharyngeal motor function are at an extremely high risk of aspirating thin liquids (100%). Moderate sensory deficits only appear to influence the prevalence of thin liquid aspiration in the presence of pharyngeal motor dysfunction. Severe laryngopharyngeal sensory deficits are associated with the aspiration of thin liquids regardless of the integrity of pharyngeal motor function. We assume that all persons with an insensate laryngopharynx aspirate thin liquids until proved otherwise. These results emphasize the relationship between laryngopharyngeal sensation and pharyngeal motor function in the evaluation of patients for suspected aspiration.
The Role of Rhinitis in Chronic Otitis Media
Authors: Mion Olavo , De Mello João Ferreira , Lessa Marcus Miranda , Goto Elder Yoshimitsu , Miniti Aroldo
Published: February 2003

OBJECTIVE

We investigated the role of allergic rhinitis in chronic otitis media (otitis media with effusion [OME] and chronic perforation of the tympanic membrane) in São Paulo, Brazil and whether there is any association between these diseases.

STUDY DESIGN AND SETTING

We studied 51 patients followed in the otologic group of the Otorhinolaryngology Division of the University of São Paulo Hospital. The patients were divided into 3 groups: allergic rhinitis, nonallergic rhinitis with eosinophils syndrome (NARES), and patients with types of rhinitis or without rhinitis. We analyzed the age, gender, intensity of the nasal disease, surgical procedure, and surgical results in each group.

RESULTS

We found about 50% of patients presenting with nasal disease and nasal eosinophilia (33.33% of allergic and 15.69% of NARES).

CONCLUSION

Nasal disease has an impact on otologic middle ear disease, considering that the normal nasal mucosa do not have eosinophils.
Management of Osteomyelitis of the Anterior Skull Base and Craniovertebral Junction
Authors: Ducic Yadranko
Published: February 2003

OBJECTIVES

The study goals were to determine the patient demographics, identify predisposing factors, and determine efficacy of treatment for nonotologic osteomyelitis of the skull base and craniovertebral junction.

STUDY DESIGN

All patients with a biopsy‐proven diagnosis of osteomyelitis of the skull base treated by the author from 1997 through 2001 were retrospectively evaluated.

RESULTS

Six patients were identified on review. The average age at presentation was 56.7 years (age range, 38 to 70 years), and all except one patient had an underlying immunocompromising condition (diabetes mellitus, human immunodeficiency virus infection, steroid use). Most presented with neurologic deficits associated with a destructive lesion of the osseous skull base. Aggressive debridement of involved bone enabled through the use of broad field standard skull base approaches was associated with clinical resolution of symptoms in each case. Systemic antibacterial/antifungal therapy and medical optimization remain important adjuncts in the treatment of this group of patients.

CONCLUSION

The diagnosis of this entity may be difficult to discern from neoplastic involvement of the skull base. Standard skull base approaches are useful for both the diagnosis and the treatment of nonotologic osteomyelitis.
Toward a Received History of the Holocaust
Authors: Young James E.
Published: March 2003

In this article, I examine both the problem of so‐called postmodern history as it relates to the Holocaust and suggest the ways that Saul Friedlander's recent work successfully mediates between the somewhat overly polemicized positions of “relativist” and “positivist” history. In this context, I find that in his search for an adequately self‐reflexive historical narrative for the Holocaust, Hayden White's proposed notion of “middle‐voicedness” may recommend itself more as a process for eyewitness writers than as a style for historians after the fact. From here, I look at the ways Saul Friedlander's reflections on the historian's voice not only mediate between White's notions of the ironic mode and middle‐voicedness, but also suggest the basis for an uncanny history in its own right: an anti‐redemptory narrative that works through, yet never actually bridges, the gap between a survivor's “deep memory” and historical narrative.

For finally, it may be the very idea of “deep memory” and its incompatibility to narrative that constitutes one of the central challenges to Holocaust historiography. What can be done with what Friedlander has termed “deep memory” of the survivor, that which remains essentially unrepresentable? Is it possible to write a history that includes some oblique reference to such deep memory, but which leaves it essentially intact, untouched and thereby deep? In this section, I suggest, after Patrick Hutton, that “What is at issue here is not how history can recover memory, but, rather, what memory will bequeath to history.” That is, what shall we do with the living memory of survivors? How will it enter (or not enter) the historical record? Or to paraphrase Hutton again, “How will the past be remembered as it passes from living memory to history?” Will it always be regarded as so overly laden with pathos as to make it unreliable as documentary evidence? Or is there a place for the understanding of the witness, as subjective and skewed as it may be, for our larger historical understanding of events?

In partial answer to these questions, I attempt to extend Friedlander's insights toward a narrow kind of history‐telling I call “received history”—a double‐stranded narrative that tells a survivor‐historian's story and my own relationship to it. Such a narrative would chart not just the life of the survivor‐historian itself but also the measurable effect of the tellings—both his telling and mine—on my own life's story. Together, they would compose a received history of the Holocaust and its afterlife in the author's mind—my “vicarious past.”
Why People Turn to Religion: A Motivational Analysis
Authors: REISS Steven
Published: March 2003

The Reiss Profile of Fundamental Goals and Motivational Sensitivities, a standardized psychological measure that assesses 15 fundamental desires, was administered to college students (n= 214) and to mental retardation service providers (n = 344), total N = 558, who rated themselves as “very,”“somewhat,” and “not” religious. How religious a person rated himself, call dereligiosity, was associated with high desire scores for honor and family, and with low desire scores for vengeanceand independence. The investigation provided evidence that the desire for dependence on God is unrelated to any desire for psychological weakness (submission to another person or political leader.)
Religion, Plausibility Structures, and Education's Effect on Attitudes Toward Elective Abortion
Authors: Petersen Larry R.
Published: March 2003

This study tests three hypotheses derived from Berger's (1967) plausibility theory. The first hypothesis states that among people who attend church frequently, education's liberalizing effect on attitudes toward elective abortion is weakest among conservative Protestants and Catholics, intermediate among moderate Protestants, and strongest among liberal Protestants and Jews. Hypotheses 2 states that education's effect is weaker among frequent than infrequent attenders in all religious groups except liberal Protestants and Jews, and Hypothesis 3 states that education's effect does not vary by religious group among infrequent attenders. Using General Social Survey data, I found strong support for Hypotheses 1 and 2 and partial support for Hypothesis 3. I discuss the implications of the findings for plausibility theory.