bluuebunny/crossref_metadata_2025 huggingface dataset:
Free Abdominal Fat Transfer for Reconstruction of the Total Parotidectomy Defect
Authors: Conger Bryant T. , Gourin Christine G.
Published: February 2009

Objectives: Free abdominal fat transfer (FAT) grafts have been used after superficial parotidectomy to restore facial contour. We reviewed our experience with the use of FAT reconstruction of total parotidectomy defects to determine the safety and efficacy of this procedure.

Study Design: Non‐randomized retrospective analysis.

Materials and Methods: The medical records of all patients who underwent total parotidectomy with the harmonic scalpel at the Medical College of Georgia from September 2004 to June 2007 were retrospectively reviewed. Patients with a prior bleeding disorder, facial nerve weakness, or who had undergone concurrent neck dissection were excluded.

Results: Twenty‐two patients met the study criteria; nine patients underwent FAT reconstruction. There was a greater percentage of malignancy in the FAT group (44%) compared with controls (15%), and a larger tumor size in the FAT group (3.8 ± 2.1 cm) compared with controls (2.6 ± 1.2 cm), but these differences did not achieve significance. FAT reconstruction was associated with increased length of surgery (324.6 ± 86.9 minutes vs. 206.6 ± 61.8 minutes for controls, P = .0013) and intraoperative blood loss (138.9 ± 95.3 mL vs. 50.1 ± 30.9 mL, P = .0052). There were no significant differences between FAT and control groups with respect to postoperative drain output (42.0 ± 35.0 mL vs. 52.5 ± 41.3, P > .05), duration of drainage (32.0 ± 12.0 h vs. 34.8 ± 15.1 h, P > .05), or facial nerve function. All patients who underwent FAT reconstruction were satisfied with their postoperative appearance, compared to 70% of control patients who reported some degree of dissatisfaction postoperatively.

Conclusions: FAT reconstruction of the total parotidectomy defect is associated with greater blood loss from the FAT donor site and increased surgical time, but is safe and highly effective. These data suggest that the benefits of FAT reconstruction outweigh the additional increment in operative time and blood loss observed.
The Effect of Occult Nodal Metastases on Survival and Regional Control in Patients With Head and Neck Squamous Cell Carcinoma
Authors: Gourin Christine G. , Conger Bryant T. , Porubsky Edward S. , Sheils W. Chris , Bilodeau Paul A. , Coleman Teresa A.
Published: February 2009

Objectives: To determine factors associated with disease‐free survival (DFS) and regional control in clinically node‐negative head and neck squamous cell cancer (HNSCC) patients with occult metastasis.

Study Design: Non‐randomized retrospective analysis.

Materials and Methods: Patients who underwent elective neck dissection (END) from 1985 to 2002 were analyzed.

Results: A total of 337 patients underwent END. The majority of patients (67%) had advanced stage disease (T3/T4). Occult metastases were present (pN+) in 168 patients (50%), with extracapsular spread (ECS) present in 72 patients (43%). Five‐year DFS for patients with histologically node negative necks was 62% versus 36% for pN+ patients (P < .0001). Postoperative radiation (XRT) did not significantly influence DFS for pN+ patients with less than three nodes involved, but had a significant association with DFS with three or more nodes involved (P < .0001). XRT showed a trend toward improved regional control rates in patients with less than three positive nodes (86% vs. 78%; P = .7579) and patients with three or more positive nodes (62% vs. 50%; P = .0014). When ECS was present, XRT did not affect DFS in patients with less than three nodes (36%), but had a significant effect on DFS in patients with three or more nodes (20% vs. 0%; P = .0075). Regional control rates were not improved with XRT in ECS‐positive patients with less than three nodes (62% vs. 75%) or with three or more nodes involved (43% vs. 50%; P = .0678).

Conclusions: There is a high incidence of occult metastases in clinically node‐negative patients which adversely affects survival, regardless of the use of adjuvant XRT. Postoperative XRT did not significantly affect regional control or survival rates in patients with <3 positive nodes. When ECS was present, survival was poor regardless of the number of nodes. These data emphasize the prognostic and therapeutic role of END and highlight the need for the development of novel therapeutic regimens to improve disease control and survival in HNSCC patients with nodal metastases.
Onset and Offset Phonation Threshold Flow in Excised Canine Larynges
Authors: Regner Michael F. , Tao Chao , Zhuang Peiyun , Jiang Jack J.
Published: February 2009

Objectives/Hypothesis: In this study, we examined the hypothesis that the minimum flow required for phonation onset, the onset phonation threshold flow (PTF), is greater than the minimum flow to sustain phonation, the offset PTF. We also explored the hypothesis that the ratio of these two (PTF offset divided by PTF onset) falls within [0.707, 1.0].

Study Design: This was a methodology study to measure onset and offset PTFs in 10 excised canine larynges; their ratio (PTF offset divided by PTF onset) was predicted to fall in a specific domain.

Methods: The onset and offset PTF and phonation threshold pressure (PTP) values were observed using 10 excised canine larynges mounted on a bench apparatus. The subglottal flow was increased until phonation was observed, and then decreased until phonation ceased; airflow and pressure measurements at critical conditions of phonation were observed as the PTF and PTP. Larynges with elongated vocal folds were then tested to observe PTF and determine if the hypothesis was observed in pathologic‐like larynges.

Results: The offset PTF was always less than the onset PTF (P ≪ .0001) and 80.0% of the observed onset‐offset PTF ratios were bound by [0.707, 1.0].

Conclusions: PTF onset or offset could be a useful diagnostic parameter of the voice, particularly when used in conjunction with PTP to describe laryngeal resistance and aerodynamic power. Further exploration of the relationship between onset and offset PTF values could augment clinical diagnostic ability and advance current theories on the physics of phonation.
Lingual Thyroid in Children: A Rare Clinical Entity
Authors: Rahbar Reza , Yoon Michelle J. , Connolly Leonard P. , Robson Caroline D. , Vargas Sara O. , McGill Trevor J. , Healy Gerald B.
Published: February 2009

Objectives/Hypothesis: To study the presentation, management, and long‐term outcome of children presenting with lingual thyroid.

Study Design: Institutional review board approved, retrospective study (1993–2004).

Methods: The study was conducted at a tertiary care pediatric medical center. The main outcomes measured were initial presentation, radiographic findings, endocrine evaluation, surgical outcome, pathologic features, complications, need for hormonal replacement.

Results: Four patients presented to the Department of Otolaryngology and Communications Enhancement, Children's Hospital Boston with lingual thyroid between 1993 and 2004. All patients were female, with an age range of 2 to 12 years (x = 6). All patients presented with a mass (1.4–3.5 cm) and most with respiratory or feeding difficulty. Magnetic resonance imaging was obtained in three patients and revealed a mass consistent with lingual thyroid. Thyroid scan confirmed the lingual thyroid as the only functioning thyroid in all four patients. None of the patients responded to hormonal replacement, and all underwent surgical excision of the mass. Surgical approach included midline glossotomy (n = 2) and CO2 laser excision (n = 2). Pathologic evaluation confirmed lingual thyroid in all four patients. No evidence of malignancy was seen in any patient. All four patients require lifelong hormonal replacement.

Conclusions: Lingual thyroid is a rare condition, with an incidence of 1:100,000. This infrequent congenital anomaly is often asymptomatic until a pathologic stress such as systemic disease or physiologic stress such as puberty causes enlargement of the ectopic tissue, leading to dysphagia, dysphonia, and dyspnea. The work‐up should include routine blood work including thyroid function tests thyrotropin, thyroxine, and thyroid hormone binding ratio; iodine thyroid scintigraphy; and computerized tomography or magnetic resonance imaging. The majority of patients require surgical excision of the symptomatic mass and, in case of absence of orthotopic thyroid tissue, long‐term thyroid hormone replacement.
Effects of Long‐Term Denervation on the Rat Thyroarytenoid Muscle
Authors: Miyamaru Satoru , Kumai Yoshihiko , Ito Takaaki , Yumoto Eiji
Published: February 2009

Objectives/Hypothesis: To determine the effects of long‐term denervation on the rat thyroarytenoid (TA) muscle and neuromuscular junctions.

Study Design: A quantitative histologic assessment of the TA muscle after long‐term denervation.

Methods: Thirty Wistar rats were euthanized 10, 18, 26, 42, and 58 weeks after left recurrent laryngeal nerve resection. The areas of the entire muscle and individual muscle fibers were evaluated using hematoxylin‐eosin staining, and neuromuscular junctions were detected by immunohistochemistry. Changes after denervation were evaluated by comparing the treated (T) and untreated (U) sides (T/U ratio). The ratio of the number of nerve terminals (NTs) to that of acetylcholine receptors (AChRs) (NT/AChR ratio) was also assessed.

Results: The average T/U ratio for the entire muscle area of the denervation groups ranged between 61.1% and 72.5% and did not differ significantly. Similarly, the T/U ratios for the individual muscle fiber area ranged between 45.0% and 51.9%, and the differences were not significant. The T/U ratio of AChRs at 58 weeks (35.3 ± 20.2%) was significantly lower than that at 10 weeks (76.3 ± 9.0%; P < .01). The NT/AChR ratios ranged between 30.3% and 35.6% and did not differ significantly among the denervation groups.

Conclusions: The entire TA muscle area, individual muscle fiber area, and NT/AChR ratio did not decrease with long‐term denervation. Thus, the TA muscle may retain an ability to receive regenerating nerve axons. However, the ability of the TA muscle to receive nerve axons may deteriorate after an excessively long denervation period because the T/U ratio of AChRs decreased with long‐term denervation.
Effect of Body Mass Index on Chemoradiation Outcomes in Head and Neck Cancer
Authors: McRackan Theodore R. , Watkins John M. , Herrin Amy E. , Garrett‐Mayer Elizabeth M. , Sharma Anand K. , Day Terry A. , Gillespie M Boyd
Published: February 2009

Objective: To investigate the association between initial body mass index (BMI) and chemoradiation therapy (CRT) outcomes in head and neck cancer patients.

Methods: Retrospective study of 72 patients with American Joint Committee on Cancer stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, or larynx treated with primary concurrent CRT with curative intent over a 5 year period. Logistic and Cox regression analyses were used to determine the association between initial BMI and percutaneous endoscopic gastrostomy tube dependence, tumor recurrence, disease‐free survival, and overall survival while controlling for the independent variables of age, sex, race, site, stage, and smoking and alcohol use.

Results: Patients with normal or low BMI (BMI ≤25 kg/m2) were significantly more likely to be percutaneous endoscopic gastrostomy dependent at last follow‐up (odds ratio 4.13; 95% confidence interval [CI] 1.3–12.9; P = .014). This group also had significantly earlier recurrence (hazard ratio 4.4; 95% CI 1.2–15.9; P = .026) and shorter overall survival (hazard ratio 3.6; 95% CI 1.04–12.6, P = .043).

Conclusions: The present study suggests that CRT patients with BMI greater than 25 have improved swallowing outcomes, longer time to disease recurrence, and improved survival when compared with similar patients with lower BMI. BMI at presentation may be an important clinical factor to consider when determining the optimal treatment modality for a head and neck cancer patient. Further investigation is required to determine whether primary surgery should be the preferred treatment in normal or low BMI patients.
Endoscopic Transnasal Craniotomy and the Resection of Craniopharyngioma
Authors: Stamm Aldo C. , Vellutini Eduardo , Harvey Richard John , Nogeira João Flávio , Herman Diego R.
Published: February 2009

Objectives/Hypothesis: To describe the utility of a large transnasal craniotomy and its reconstruction in the surgical management of patients with craniopharyngioma.

Study Design: Observational retrospective cohort study.

Methods: Retrospective review of patients treated in an academic neurosurgery/rhinology practice between 2000 and 2007. Patient characteristics (age, sex, follow‐up), tumor factors (size, position extension, previous surgery), type of repair (pedicled mucosal flaps, free mucosal grafts), and outcomes (visual, endocrine, and surgical morbidity) were defined and sought in patients who had an entirely endoscopic resection of extensive craniopharyngioma (defined as requiring removal of the planum sphenoidale in addition to sella exposure in the approach).

Results: Seven patients had an entirely endoscopic resection of extensive craniopharyngioma during the study period. Mean age was 23.4 years (standard deviation ± 16.3). Mean tumor size was 3.2 cm (standard deviation ± 2.0). The majority of these pathologies had extensive suprasellar disease, and two (28.6%) had ventricular disease. Cerebrospinal fluid leak rate was 29% (2 of 7). These leaks occurred only in reconstructions with free mucosal grafts. There were no cerebrospinal fluid leaks in patients who had vascularized pedicled septal flap repairs.

Conclusions: The endoscopic management of large craniopharyngioma emphasizes recent advancements in endoscopic skull base surgery. The ability to provide exposure through a large (4 cm+) transnasal craniotomy, near‐field assessment of neurovascular structures, and the successful reconstruction of a large skull defect have significantly advanced the field in the past decade. The use of a two‐surgeon approach and bilateral pedicled septal mucosal flaps have greatly enhanced the reliability of this approach.
Efficacy of Powered Intracapsular Tonsillectomy and Adenoidectomy
Authors: Tunkel David E. , Hotchkiss Karin S. , Carson Kathryn A. , Sterni Laura M.
Published: February 2009

Objectives/Hypothesis: We sought to determine the effectiveness of powered intracapsular tonsillectomy and adenoidectomy (PITA) in the treatment of children with moderately severe obstructive sleep apnea and to measure changes in quality of life that occur with such treatment.

Study Design: Prospective, nonrandomized clinical trial in an academic pediatric otolaryngology practice.

Methods: Convenience sample of children ages 3 to 12 years diagnosed with obstructive sleep apnea of moderate severity, defined as an apnea‐hypopnea index (AHI) between 5 and 20 on polysomnography. Children with recurrent streptococcal pharyngitis, chromosomal abnormalities, craniofacial abnormalities, neuromotor disease, sickle cell disease, obesity, or coagulopathy were excluded. PITA was performed by using the microdebrider. Polysomnography was performed before surgery and repeated 4 to 8 weeks after surgery. The Obstructive Sleep Apnea (OSA)‐18 questionnaire was completed at surgery and at the time of postoperative polysomnography to assess quality of life changes. The main outcome measure was cure of obstructive sleep apnea, as defined by a postoperative AHI of 1 or less for complete cure and less than 5 for partial cure. Improvements in quality of life were assessed by changes in the OSA‐18 questionnaire.

Results: Nineteen children underwent PITA for moderate obstructive sleep apnea syndrome (OSAS), and 14 completed postoperative polysomnography. All 14 subjects who completed the study achieved at least partial cure. Thirteen of 14 (93%) subjects had a complete cure of OSAS after PITA. The median preoperative AHI was 7.9, and the median AHI after surgery was 0.1. The mean number of arousals per hour before surgery was 9.5, and this was reduced to a mean of 5.6 after surgery. Quality of life measures on OSA‐18 also improved, with large improvements in total quality of life scores and in all five domains seen after surgery.

Conclusions: PITA cures otherwise healthy children with obstructive sleep apnea of moderate severity, at least in the short‐term, as documented by postoperative polysomnography. Improvements in quality of life measures, as documented by changes in OSA‐18, were seen in all children as well.
Endoscopic Treatment of Subcondylar Fractures
Authors: Ducic Yadranko
Published: February 2009

Objectives/Hypothesis: To evaluate the effectiveness of endoscopic treatment of subcondylar fractures, highlighting an improved technique of repair that facilitates ease of repair.

Study Design: A retrospective review.

Methods: All subcondylar fractures treated by the author with the improved endoscopic technique from 2001 to 2007 were reviewed.

Results: A total 34 subcondylar fractures were initially treated with the outlined technique. Thirty‐three of 34 were successfully managed with the endoscopic technique alone. There were no instances of facial nerve paralysis or palsy noted. There were two instances of malocclusion that were believed to be minor in the 27 of 34 patients who made themselves available for 6 week follow‐up. Both of these patients had associated multiple maxillofacial fractures repaired. Average operative time from ramus incision start to completion of plate fixation for the subcondylar fracture was 32 (range, 21–49) minutes.

Conclusions: The outlined technique results in improved ease of rigid endoscopic fixation of subcondylar fractures in the majority of patients.
Airway Management in Anaplastic Thyroid Carcinoma
Authors: Shaha Ashok R.
Published: February 2009

Objectives/Hypothesis: In patients who present with advanced anaplastic thyroid cancer, airway management is difficult because of bilateral vocal cord paralysis or tracheal invasion by the tumor. Airway management can be extremely complex in these patients.

Study Design: This is the author's 25 year experience with 30 patients who presented with anaplastic thyroid cancer and acute airway problems.

Methods: The patients' airway issues developed soon after presentation or a few months after treatment. Ten patients presented with initial symptoms of acute airway distress. All of these patients were treated with tracheostomy or cricothyrotomy.

Results: The 10 patients who presented with initial symptoms of acute airway distress died within 4 months. Eight of the remaining 20 patients developed bilateral vocal cord paralysis. Airway management for these patients depended on the extent of distant disease and the family's understanding of the advanced nature of the disease and the palliative efforts. The remaining patients had a palliative and supportive approach.

Conclusions: Airway management was the most critical issue in patients who presented with anaplastic thyroid cancer and initial airway distress. Cricothyrotomy was helpful in avoiding acute airway catastrophe. It is important to distinguish between poorly differentiated and anaplastic thyroid cancer and lymphoma for appropriate airway management.
Gefitinib (Iressa) Potentiates the Effect of Ionizing Radiation in Thyroid Cancer Cell Lines
Authors: Lopez Jay Patrick , Wang‐Rodriguez Jessica , Chang Catherine Y. , Sneh Gabriel , Yu Michael Andrew , Pardo Francisco S. , Aguilera Joseph , Ongkeko Weg M.
Published: February 2009

Objectives/Hypothesis: To determine whether inactivation of epidermal growth factor receptor (EGFR) kinase activity will sensitize thyroid cancer cell lines to ionizing radiation‐induced death.

Study Design: Established human thyroid cancer cells lines were studied.

Methods: Colony formation assay was used to determine the effect of Gefitinib, a small molecule inhibitor of EGFR, on anaplastic (ARO) and follicular (WRO) thyroid cancer cell lines. In addition, colony formation assay was used to determine the effect of ionizing radiation in the presence or absence of Gefitinib. EGFR protein expression on the cell lines and inactivation of EGFR kinase by Gefitinib was analyzed by Western blot. Immunohistochemistry was performed on archived thyroid cancer tissue to demonstrate expression of EGFR.

Results: Incubation with Gefitinib caused decreased phosphorylation of EGFR protein in established thyroid cancer cell lines as measured by Western blot. Inhibition of EGFR kinase activity by Gefitinib resulted in a dose‐dependent decrease in colony formation in both ARO and WRO thyroid cancer cell lines. Addition of Gefitinib in combination with ionizing radiation reduced cell proliferation in ARO (P = .0084) and WRO (P = .0252) as measured by colony formation assay.

Conclusions: Inactivation of the EGFR kinase by Gefitinib potentiates the ionizing radiation‐induced inhibition of cell proliferation in thyroid cancer cell lines. Use of this combination treatment of Gefitinib and ionizing radiation may be a promising therapy for anaplastic thyroid and metastatic follicular thyroid cancer and should be extended into animal models.
Tumor Volume as a Prognostic Factor in Oropharyngeal Squamous Cell Carcinoma Treated With Primary Radiotherapy
Authors: Been Mark J. , Watkins Joanna , Manz Ryan M. , Gentry Lindell R. , Leverson Glen E. , Harari Paul M. , Hartig Gregory K.
Published: February 2009

Objectives/Hypothesis: Tumor volume has been demonstrated to play a prognostic role in many head and neck cancers. The purpose of this study was to conduct an institutional review analyzing the correlation between tumor volume and locoregional control of oropharyngeal squamous cell cancer treated with primary radiotherapy.

Study Design: Retrospective institutional chart analysis.

Methods: Seventy‐nine patients from 1991 to 2005 with primary T1 to T4 oropharyngeal squamous cell carcinoma (base of tongue, n = 31; soft palate, n = 1; tonsils, n = 47) were treated with primary radiotherapy. Tumor volumes were measured from pretreatment computerized tomography scans by two observers. Three‐dimensional tumor volumes were calculated using a computer digitizer for each computed tomography slice showing the primary lesion. Survival analysis, using the methods of Kaplan and Meier, was performed to assess whether tumor volume, Tumor, Node, Metastasis classification, tumor stage, or location were associated with locoregional failure.

Results: Tumor volume did not significantly correlate with locoregional failure (observer 1, P = .6244; observer 2, P = .5612). There was a high interobserver correlation (r = 0.98970). Univariate analysis did, however, demonstrate a significant difference in locoregional failure between T4 tumors and all other T stages (T1 vs. T4, P = .0107; T2 vs. T4, P = .0004; T3 vs. T4, P = .0155). Nodal status, tumor stage, and location did not significantly correlate with locoregional failure rate.

Conclusions: Tumor volume does not appear to play a significant role in predicting locoregional recurrence for patients with primary squamous cell cancer of the oropharynx treated with primary radiotherapy. However, T4 status was predictive of poor locoregional control.
Reconstruction of the Through‐and‐Through Anterior Mandibulectomy Defect: Indications and Limitations of the Double‐Skin Paddle Fibular Free Flap
Authors: Deleyiannis Frederic W.‐B. , Rogers Carolyn , Ferris Robert L. , Lai Stephen Y. , Kim Seungwon , Johnson Jonas
Published: February 2009

Objectives/Hypothesis: The purpose of this report is to describe our recent experience using a double‐skin paddle fibular free flap (DSPFFF) for reconstruction of the through‐and‐through anterior mandibulectomy defect and to present a reconstructive algorithm based on the extent of lip and mental skin resection.

Study Design: Retrospective review of 10 consecutive patients with through‐and‐through anterior mandibulectomy defects.

Methods: Outcomes that were examined included methods of reconstruction based on the cutaneous defect, flap complications, fistula rate, and donor site complications.

Results: Seven patients were reconstructed with a DSPFFF. For lip reconstruction, two patients were also concomitantly reconstructed with Karapandzic or lip advancement flaps. Three patients were reconstructed with both a fibular free flap and a second free flap (1 radial forearm fasciocutaneous flap and 2 anterolateral thigh flaps). The transverse dimensions of the DSPFFFs were as great as 15 cm. None of the patients developed a fistula. All free tissue transfers were successful. One patient developed partial loss of the fibular skin paddle used for submental skin replacement.

Conclusions: DSPFFF is a safe and reliable way to reconstruct an anterior through‐and‐through mandibular defect. Indications for using a DSPFFF are 1) a cutaneous defect that lies at or below the plane of the reconstructed mandible, 2) a transverse width of the oral mucosa and cutaneous defect that does not exceed 15 cm (the approximate distance from the mid‐calf to the anterior midline), and 3) a lip defect that, if present, can be reconstructed with local flaps.
Life‐Threatening Posttonsillectomy Hemorrhage
Authors: Windfuhr Jochen P. , Schloendorff Georg , Baburi Diwa , Kremer Bernd
Published: February 2009

Objectives/Hypothesis: In rare cases, the intensity of posttonsillectomy hemorrhage (PTH) may become life‐threatening requiring major surgical means and intensive care. This study was conducted to assess the outcome of life‐threatening PTH and its clinical features in a larger patient population.

Study Design and Methods: Cases occurring during the clinical career of the authors were collected and added by own expert reports to lawsuits and professional boards in cases who had undergone tonsillectomy elsewhere. PTH resulting in hemorrhagic shock requiring resuscitation, ligature of greater arteries in the neck, tracheotomy, packing of the pharynx, embolization, and/or blood transfusions were labeled as life threatening.

Results: Seventy‐nine patients had experienced life‐threatening PTH between 1980 and 2006, comprising 36 children and 39 adults (age not stated for 4 patients). There were 42 female and 34 male patients (gender not stated for 3 patients). Only nine patients experienced primary bleeding, secondary PTH clearly prevailed (n = 70; 89.6%) in this patient population. Single episodes of life‐threatening PTH were reported for 11 cases including two patients with and nine without remaining neurological sequelae. Three of the 11 patients were children (age not stated for 2 patients). Repeated episodes of life‐threatening PTH occurred in 68 patients (32 children) including eight with remaining sequelae.

Conclusions: Life‐threatening PTH is an apparently rare, most commonly unpredictable state of emergency requiring a clear management protocol. However, repeated episodes of bleeding classified most clinical courses and should alert the medical staff. Although the bleeding rate after tonsillectomy in children is generally acknowledged to be very low, the rate of life‐threatening PTH is apparently higher than in adults. Gender seems not to be a risk factor. Secondary PTH can no longer be assessed to be less dangerous than primary PTH.
Impact on Quality of Life After Mastoid Obliteration
Authors: Dornhoffer John L. , Smith Jason , Richter Gresham , Boeckmann Jacob
Published: February 2009

Objectives/Hypothesis: To understand the long‐term impact on quality of life (QOL) in patients undergoing mastoid obliteration surgery for a chronically draining cavity, using the Glascow Benefit Inventory (GBI) QOL survey, and to correlate these findings to perceived changes in drainage and hearing.

Study Design: Retrospective chart review.

Methods: Adult patients undergoing mastoid obliteration and restoration of the middle ear space with cartilage reconstruction of the tympanic membrane, with at least 3‐year follow‐up, were contacted by phone to solicit participation. Those who agreed to participate were mailed the GBI and consent documents with a prepaid self‐addressed envelope.

Results: Of 80 patients meeting the inclusion criteria, 37 were successfully contacted and agreed to participate, yielding 23 returned questionnaires. The vast majority (19 of 23; 83%) reported improved QOL after surgery, with the most positive effects seen on confidence and social situations, and patients experiencing less inconvenience, self‐consciousness, and embarrassment. Eighty‐three percent reported a perceived improvement in hearing; 74% reported an improvement in drainage. Over 90% would recommend the procedure to a family member. The average score on the GBI was 28.9, and a two‐tailed one‐sample t test showed that mastoid obliteration significantly improved QOL in our patients (t = 4.65, P < .001). There was a fairly good correlation between the perceived improvement in QOL with improvement in hearing and/or drainage.

Conclusions: The GBI is a valuable tool for evaluating patient satisfaction after revision surgery for a draining cavity. This information is helpful in understanding the impact of a draining cavity on an individual's life and may be beneficial in preoperative selection and counseling.
Treatment of Base of Tongue Cancer With Paclitaxel, Ifosfamide, and Cisplatinum Induction Chemotherapy Followed by Chemoradiotherapy
Authors: Hancock Samuel Brandon , Krempl Greg A. , Canfield Vikki , Bogardus Carl , Kojouri Kiarash , Kaneaster S K. , Medina Jesus E.
Published: February 2009

Objectives/Hypothesis: To assess the efficacy of paclitaxel, ifosfamide, and cisplatinum induction chemotherapy plus concurrent chemoradiation in the treatment of stage III and IV base of tongue cancer.

Study Design: Subgroup analysis of patients with base of tongue cancer enrolled in a single‐institution prospective phase II trial, evaluating an organ‐preservation approach in the treatment of locally advanced head and neck cancer.

Methods: Eighteen patients with tumors ranging from stage T2–T4, any N, or M0 were treated with a protocol of induction chemotherapy, with Taxol, ifosfamide, cisplatin every 21 days for up to three cycles. If the primary tumor exhibited a complete or partial response, patients were treated with radiation and weekly taxol and carboplatin for 7 weeks. Surgery was used for those with less than partial response or disease progression. Neck dissection was performed in cases with clinical or radiological evidence of persistent disease in the neck 6 to 8 weeks after completion of treatment.

Results: Sixteen patients were male and two were female; the average age was 55 years (range, 43–65). Fifteen patients had stage IV disease and three had stage III disease. Of the 18 patients initially enrolled, 17 patients had a complete response. All 17 patients had no evidence of loco‐regional disease at a median follow‐up of 29.6 months. Only 1 of them developed distant metastases 30 months after completion of treatment. Three patients required permanent percutaneous endoscopic gastrostomy tubes because of severe dysphagia associated with concurrent chemoradiation.

Conclusions: The treatment regimen studied is remarkably effective in stage III and IV base of tongue cancer with 100% of patients completing the protocol alive to date. Although some patients required persistent percutaneous endoscopic gastrostomy use, no patient experienced significant enough toxicity during the protocol to delay or withdraw from treatment.
Cyclic Adenosine Monophosphate Regulation of Ion Transport in Porcine Vocal Fold Mucosae
Authors: Sivasankar Mahalakshmi , Nofziger Charity , Blazer‐Yost Bonnie
Published: February 2009

Objectives/Hypothesis: Cyclic adenosine monophosphate (cAMP) is an important biological molecule that regulates ion transport and inflammatory responses in epithelial tissue. The present study examined whether the adenylyl cyclase activator, forskolin, would increase cAMP concentration in porcine vocal fold mucosa and whether the effects of increased cAMP would be manifested as a functional increase in transepithelial ion transport. Additionally, changes in cAMP concentrations following exposure to an inflammatory mediator, tumor necrosis factor‐α (TNFα) were investigated.

Study Design: In vitro experimental design with matched treatment and control groups.

Methods: Porcine vocal fold mucosae (N = 30) and tracheal mucosae (N = 20) were exposed to forskolin, TNFα, or vehicle (dimethyl sulfoxide) treatment. cAMP concentrations were determined with enzyme‐linked immunosorbent assay. Ion transport was measured using electrophysiological techniques.

Results: Thirty minute exposure to forskolin significantly increased cAMP concentration and ion transport in porcine vocal fold and tracheal mucosae. However, 30‐minute and 2‐hour exposure to TNFα did not significantly alter cAMP concentration.

Conclusions: We demonstrate that forskolin‐sensitive adenylyl cyclase is present in vocal fold mucosa, and further, that the product, cAMP increases vocal fold ion transport. The results presented here contribute to our understanding of the intracellular mechanisms underlying vocal fold ion transport. As ion transport is important for maintaining superficial vocal fold hydration, data demonstrating forskolin‐stimulated ion transport in vocal fold mucosa suggest opportunities for developing pharmacological treatments that increase surface hydration.
Meta‐analysis: nitroglycerin for prevention of post‐ERCP pancreatitis
Authors: BANG U. C. , NØJGAARD C. , ANDERSEN P. K. , MATZEN P.
Published: February 2009

Background  Acute pancreatitis after ERCP is a severe side effect.

Aim  To evaluate the preventive effect of nitroglycerin on post‐ERCP pancreatitis by a meta‐analysis of randomized clinical studies.

Methods  We searched on Pubmed, Embase, Cochrane Library and all abstracts presented at Digestive Disease Week and United European Gastrointestinal Week from 2004 to 2008. We used the MeSH terms ‘pancreatitis’ together (AND) with the terms: ‘glyceryl trinitrate’, ‘glyceryl dinitrate’, ‘isosorbide dinitrate’ or ‘nitroglycerin’.

Results  Five clinical studies evaluating the incidence of post‐ERCP pancreatitis after administration of nitroglycerin were identified. Meta‐analysis including all five studies showed a relative risk (RR) of 0.61 (95% CI; 0.44, 0.86) with the number needed to treat (NNT) of 26 (95% CI: 16, 82). Three studies evaluated nitroglycerin administered by a dermal patch reaching together an RR of 0.66 (95% CI; 0.43, 1.01). The use of nitroglycerin is associated with a significantly increased risk of hypotension (RR 2.25) and headache (RR 3.64). No difference in mortality was observed.

Conclusions  Overall, our meta‐analysis supports the use of nitroglycerin in the prevention of post‐ERCP pancreatitis, but administration of nitroglycerin by the dermal route, which is the preferred route of administration, did not reach statistical significance.
Diversity, ecology and evolution of groundwater copepods
Authors: GALASSI DIANA M. P. , HUYS RONY , REID JANET W.
Published: February 2009

1. With few exceptions, copepods dominate over other crustacean and non‐crustacean invertebrate groups in ground water. They have colonised a vast array of habitats in continental ground waters, where they are represented by over 1000 species in six orders: Platycopioida, Misophrioida, Calanoida, Cyclopoida, Harpacticoida, Gelyelloida. However, members of only the last four orders entered genuine fresh ground water.

2. Stygobiotic copepods show a wide range of morphological and physiological adaptations to different groundwater habitats. They frequently exhibit simplifications in body plans, including reductions in appendage morphology, which is regarded as a result of paedomorphic heterochronic events.

3. Copepod distributions at small spatial scales are most strongly affected by habitat type and heterogeneity, with sediment grain size and availability of organic matter being important habitat characteristics. Large‐scale spatial distributions (biogeographical) are mainly related to past geological, climatic and geographical processes which occurred over medium to long time scales.

4. Such processes have affected colonisation patterns and diversification of copepods in ground water, leading to a number of phylogenetic and distributional relicts and a high degree of endemism at different taxonomic levels. This is reflected in the composition of groundwater copepod communities characterised by distantly related species in the phylogenetic tree.

5. Copepods dominate the species richness of groundwater fauna in all regions and on all continents where more than cursory surveys have been carried out, i.e. in Europe, North and Latin America as well as in Australia.

6. Species‐specific microhabitat preferences, high proportions of local endemics, high proportions of phylogenetic and distributional relicts, and higher‐level taxonomic diversity are all factors suggesting that copepods are a useful indicator group of overall species richness for defining conservation priorities in ground water.
Deadly combination of genes and drought: increased mortality of herbivore‐resistant trees in a foundation species
Authors: STHULTZ CHRISTOPHER M. , GEHRING CATHERINE A. , WHITHAM THOMAS G.
Published: February 2009

Current climate models predict a shift to warmer, drier conditions in the southwestern US. While major shifts in plant distribution are expected to follow these climate changes, interactions among species and intraspecific genetic variation rarely have been incorporated into models of future plant distributions. We examined the drought‐related mortality of pinyon pine (Pinus edulis) in northern Arizona focusing on trees that showed genetically‐based resistance or susceptibility to a nonlethal herbivore, the shoot‐boring moth, Dioryctria albovittella. Because moth resistant trees have outperformed susceptible trees during 20 years of study, and herbivory has been shown to increase drought related mortality, we expected higher mortality rates in susceptible trees. However, our field observations and greenhouse experiments showed several unexpected patterns relevant to understanding the consequences of climate change: (1) The mortality of adult P. edulis resistant to the moth was three times higher than the mortality of trees susceptible to the moth. (2) Over a few years, differential mortality caused a shift in stand structure from resistant dominated to equality (3 : 1 resistant : susceptible to 1 : 1). (3) Adult moth resistant trees suffered significantly greater water stress than adult moth susceptible trees, suggesting that variation among the two groups in drought tolerance may be a mechanism for differential mortality. (4) When grown under drought conditions in the greenhouse, seedlings from resistant mothers died sooner than seedlings from susceptible mothers. These data support the hypothesis that drought can act as an agent of balancing selection and that drought resistance is a heritable trait. Taken together, our findings suggest that genetic variation in a population can be an important factor in determining its response to future climate change, and argue for the inclusion of genetics into models developed to understand the consequences of climate change.
Using functional traits to predict grassland ecosystem change: a mathematical test of the response‐and‐effect trait approach
Authors: KLUMPP KATJA , SOUSSANA JEAN‐FRANÇOIS
Published: February 2009

The role of plant community structure and plant functional traits for above‐ and belowground carbon (C) fluxes was studied for 2 years in a mesocosm experiment with grassland monoliths, using continuous gas exchange measurements and soil analyses. Here we test the response‐and‐effect trait hypothesis, by applying a mathematical framework used to predict changes in C fluxes after a change in disturbance through the community response (R) and effect (E) traits. Monoliths were extracted from two contrasted long‐term field treatments (high vs. low grazing disturbance) and exposed to both low and high (simulated grazing) disturbance during a 2 years experiment. Carbon dioxide exchanges were measured continuously in an open flow system. Net ecosystem productivity and ecosystem C balance were positively correlated at low disturbance with plant species richness. Aboveground net primary productivity (ANPP) and soil C sequestration were, however, unrelated to these variables. Community aggregated leaf (specific leaf area, leaf dry‐matter content) and root and rhizome (specific length, tissue density, diameter) traits responded (R) significantly to changes in disturbance, indicating an increased dominance of conservative plant growth strategies at low compared with high disturbance. Applying the mathematical framework, ANPP was predicted by distribution of leaf traits within the community (functional divergence), while mean root and rhizome traits had significant effects (E) on soil C sequestration, irrespective of the experimental disturbance and of the year. According to highly significant linear regression models, between 6% and 61% of the transient changes in soil C sequestration resulted from community root and rhizome (response‐and‐effect) traits after a change in disturbance.
Factors affecting between‐lake variation in the occurrence of epidermal papillomatosis in roach,Rutilus rutilus(L.)
Authors: Korkea‐aho T L , Vainikka A , Kortet R , Taskinen J
Published: February 2009

The theory of island biogeography predicts that the probability of a species occupying an island depends on a dynamic equilibrium between extinction and colonization. Epidermal papillomatosis is a disease manifesting as skin tumours on fish. We studied the factors affecting the occurrence of the disease in roach,Rutilus rutilus(L.), in 34 lakes. The results of discrimination analysis suggest that maximum depth, percentage of the drainage area of the lake covered by lakes in the vicinity and altitude best identified diseased lakes. Comparison of diseased and non‐diseased lakes revealed that lake area could also be regarded as a variable contributing to the occurrence of the disease. The sampling date, proportion of males and mean length of fish did not discriminate between the lakes. The probability of the disease occurring was highest in large, deep, low‐altitude lakes which had a high percentage of lakes in their vicinity. Thus, the results indicate that the colonization and extinction processes probably contribute to the occurrence of papillomatosis in roach, as predicted by the theory. Furthermore, the large natural variation in the occurrence of the disease could mask possible environmental effects and between‐lake comparisons should be interpreted with caution when using the fish‐papillomatosis system as an indicator of environmental stress.
Antibody response of two populations of common carp, Cyprinus carpio L., exposed to koi herpesvirus
Authors: St‐Hilaire S , Beevers N , Joiner C , Hedrick R P , Way K
Published: February 2009

Common carp, Cyprinus carpio L., exposed to koi herpesvirus (KHV) may become persistently infected and populations containing such virus‐infected individuals may transmit the virus to other fish when co‐habited. Detection of virus‐infected fish in a population is thus critical to surveillance and control programmes for KHV. A study was therefore designed to detect anti‐KHV serum antibodies, with an enzyme‐linked immunosorbent assay, in common carp following experimental exposures to KHV under varying environmental conditions. The study determined that a proportion of fish within a population experimentally exposed to KHV (at least 10–25%) develop high antibody titres (1/1600 or greater) to the virus, and this immunological response was detectable for several months (observed at the termination of the experiments at 65, 46 and 27 weeks post‐exposure). Furthermore, this response was detected in one population of fish that did not succumb to a high level of mortality when maintained at water temperatures that were non‐permissive for KHV. Elevating the water temperatures to permissive conditions for KHV resulted in recurrence of disease despite the presence of anti‐virus antibodies, suggesting that serum antibodies alone are not protective under the conditions of our trials.
Methods of gastric electrical stimulation and pacing: a review of their benefits and mechanisms of action in gastroparesis and obesity
Authors: Hasler W. L.
Published: February 2009

Abstract  Development of gastric electrical stimulation techniques for treatment of gastric dysmotility syndromes and obesity has been a long‐standing goal of investigators and clinicians. Depending on stimulus parameters and sites of stimulation, such methods have a range of theoretical benefits including entrainment of intrinsic gastric electrical activity, eliciting propagating contractions and reducing symptomatology in patients with gastroparesis and reducing appetite and food intake in individuals with morbid obesity. Additionally, gastric stimulation parameters have extragastrointestinal effects including alteration of systemic hormonal and autonomic neural activity and modulation of afferent nerve pathways projecting to the central nervous system that may represent important mechanisms of action. Numerous case series and smaller numbers of controlled trials suggest clinical benefits in these two conditions, however better controlled trials are mandated to confirm their efficacy. Current research is focusing on novel stimulation methods to better control symptoms in gastroparesis and promote weight reduction in morbid obesity.
The role of parasite persistence in pathogenesis of Chagas heart disease
Authors: GUTIERREZ F. R. S. , GUEDES P. M. M. , GAZZINELLI R. T. , SILVA J. S.
Published: February 2009

Chagas disease (CD) is caused by the infection with the protozoan haemoflagellate Trypanosoma cruzi. This disease is still a great menace to public health, and is largely neglected as it affects mostly the poorest populations of Latin America. Nonetheless, there are neither effective diagnostic markers nor therapeutic options to accurately detect and efficiently cure this chronic infection. In spite of the great advances in the knowledge of the biology of natural transmission, as well as the immunobiology of the host–parasite interaction, the understanding of the pathogenesis of CD remains largely elusive. In the recent decades, a controversy in the research community has developed about the relevance of parasite persistence or autoimmune phenomena in the development of chronic cardiac pathology. One of the most notable aspects of chronic CD is the progressive deterioration of cardiac function, derived mostly from structural derangement, as a consequence of the intense inflammatory process. Here we review the evidence supporting the multifactorial nature of Chagas heart disease comprising pathogen persistence and altered host immunoregulatory mechanisms.