bluuebunny/crossref_metadata_2025 huggingface dataset:
A porcine model for multiple musculocutaneous flaps
Authors: Haughey Bruce H. , Panje William R.
Published: October 2006

The purpose of this study was to develop and describe in detail a reproducible porcine model for musculocutaneous flap study. The model was required to demonstrate the following: 1. consistent, easily identifiable anatomical landmarks for muscles and muscular vascular pedicles; 2. flap survival, consistent with the musculocutaneous perforator arrangement of blood supply; 3. ease of islanded‐or free‐flap formation; 4. arrangement of flaps on each animal, allowing paired studies of control and experimental flaps; and 5. a maximum number of flaps per animal, without undue morbidity or mortality.

Pilot dissections were made of the pectoralis, trapezius, latissimus dorai, gracilis, biceps femoris, and tensor fasciae latae muscles and their major vascular pedicles. After establishing the anatomical landmarks, we formed musculocutaneous flaps at each site to verify the above five requirements. A total of 72 muscle/vessel pedicle dissections were performed, incorporating formation of 61 island musculocutaneous flaps. The skin component overlying an islanded muscle block survived in 60 instances, confirming the reliability of the flap model.

We concluded that five pairs of musculocutaneous flaps could be fashioned on one pig, using the bilateral control/experimental paradigm if desired. The pectoralis, latissimus dorsi, trapezius, gracilis, and biceps femoris muscles were used. The ventral muscle group (pectoralis, gracilis) was raised in one operating session, and the lateral muscles (trapezius, latissimus dorsi, biceps femoris) were raised in one further session per side. Three new porcine flaps are described—the pectoralis, biceps femoris, and trapezius. Morbidity was confined to mild splinting of the limbs for one day.

This is also the first example of the use of ten musculocutaneous island flaps on one pig, and represents an opportunity for performing physiological, pathological, or pharmacological experiments on the musculocutaneous flap.
Speech tracking in the evaluation of a multichannel cochlear prosthesis
Authors: Jenkins Herman , Chmiel Rose , Jerger James
Published: October 2006

Individual speech tracking data were analyzed in relation to other variables in 11 adult users of the Nucleus multichannel cochlear implant. Patients were categorized according to postoperative speech tracking results. The resultant groups could also be differentiated on the basis of postoperative MAC scores, surgeon's rating of overall success, and duration of deafness before implantation. The speech tracking paradigm appears to be a useful technique for the evaluation of performance with a cochlear prosthesis.
Bacteriology of tonsil surface and core in children
Authors: Surow Jason B. , Handler Steven D. , Telian Steven A. , Fleisher Gary R. , Baranak Christine C.
Published: October 2006

The tonsils of 97 children undergoing tonsillectomy were studied to determine the correlation between surface culture swab and culture of tonsillar core. In many cases, pathogenic organisms were found in the tonsil core, despite the fact that surface cultures revealed only normal respiratory flora. The tonsil core cultures showed a high incidence of Hemophilus influenzae and Staphylococcus aureus, which was rarely reflected on surface culture.

The study indicates that pharyngeal swab cultures do not reliably reflect the presence of pathogens in the tonsil core. The value of parameters such as history of recurrent bouts of tonsillitis and presence of erythema or cryptic debris on physical examination for predicting the differential bacteriology of the tonsil is studied. The implications for treatment of children with adenotonsillar hypertrophy are discussed.
Fatal and major complications secondary to nasal and sinus surgery
Authors: Maniglia Anthony J.
Published: October 2006

The purpose of this study was to review 40 major or fatal complications secondary to nasal and sinus surgery that were referred to the author for consultation or other reasons. The most frequent complications were intracranial, which occurred in 13 cases, and resulted in four deaths. Blindness occurred in ten patients (two bilaterally). Three other fatalities resulted from internal carotid artery damage. Three patients died of anesthesia‐related problems and one survived malignant hyperthermia. In all, ten patients died as a result of intracranial catastrophe, hemorrhage, or general anesthesia complications. Although some complications are preventable, others may be unavoidable, even in the hands of well‐trained, experienced surgeons.
Preoperative assessment of parotid masses: A comparative evaluation of radiologic techniques to histopathologic diagnosis
Authors: Byrne Maria N. , Gershon J. Gershon , Garvin Charles F. , Gado Mokhtar H.
Published: October 2006

A double‐blind, retrospective analysis of 110 sequentially operated parotid masses compared the usefulness of preoperative radiologic evaluation to histopathologic diagnosis. The radiologic assessment included 25 sialograms, 162 computed tomography scans, and 10 nuclear magnetic resonance images.

The diagnosis is influenced by the following four parameters of computed tomography: tumor borders, density, homogeneity, and enhancement. Well‐defined borders, a homogeneous appearance, and high density strongly favor the diagnosis of a benign tumor or a low‐grade malignancy (96.7%). Ill‐defined tumor borders, heterogeneity, and high density indicate mainly a high‐grade or recurrent malignancy (68.8%). Ill‐defined borders, a heterogeneous appearance, and mixed density identify a lymphoepithelial lesion, lymphangioma, or sialoadenitis (100%).

Sialography is cost effective in the evaluation of lymphoepithelial lesions. Computed tomography sialography offers no advantages over computed tomography with intravenous contrast. High‐resolution computed tomography with intravenous contrast is highly sensitive for tumor detection (97%). Magnetic resonance imaging is complementary or superior to computed tomography (100%).
Polymorphic reticulosis: A malignant lymphoma of b‐cell lineage
Authors: Lin Ching‐Zong , Shu Chih‐Hung , Lin Siu‐Huie , Yeh Hsin‐Mei , Chen Min‐Sun , Liu Shian‐Min , Chang Ping , Chen Po‐Min
Published: October 2006

Whether the pathogenesis of polymorphic reticulosis is from T cells, B cells, or histiocytes has been controversial. In this study, the Southern blot hybridization technique was used to analyze immunoglobulin and T‐cell receptor β‐chain genes and to perform the conventional surface marker analysis in two patients with polymorphic reticulosis. The immunophenotype demonstrated the presence of predominantly mature, activated T‐lymphocytes, minimal B‐cells, and no natural killer cells or monocytes/granulocytes. The mature T‐cell phenotype could be due to either inflammatory infiltrates or neoplastic cells of peripheral T‐cell type, because the two coexist in polymorphic reticulosis tumors. The value of surface marker examination is limited in the analysis of PMR tumors. However, genetic analysis revealed that only Ig genes were rearranged, with no rearrangement of the TCRβ gene. Rearrangement of immunoglobulin genes occurs in B‐lineage lymphoid neoplasms and is thought to be a criterion for diagnosis of lymphoid neoplasms. Based on genetic analysis and clinicopathologic information, this study concluded that polymorphic reticulosis is a malignant lymphoma of B‐cell lineage.
Rhinomanometry 1988: Practice and trends
Authors: Cole Philip
Published: October 2006

This report discusses characteristics and measurement of transnasal pressures and flow of respiratory air, indices of nasal airway patency, and components of contemporary rhinomanometric systems. Sources of error that can result from mucovascular fluctuation and from the use of face masks and nasal nozzles are delineated. Useful adjuncts to rhinomanometry include microcomputation and plethysmography. State‐of‐the‐art transducers and microcircuitry add reliability and economy. Aerodynamic parameters closely correlated with chronic obstructive nasal symptoms have yet to be determined. Nevertheless, resistance calculated from concomitant measurements of transnasal pressure and flow, as recommended by the International Committee on Standardization of Rhinomanometry, provides a practical index of nasal patency and aids the exchange of rhinological information.
Unusual presentations of lymphoma of the head and neck in childhood
Authors: Weisberger Edward C. , Davidson Darrell D.
Published: October 2006

Lymphoma of the head and neck in children can pose a significant diagnostic problem, especially when histologic analysis indicates non‐Hodgkin's lymphoma and the initial site of involvement is extranodal.

This report describes 15 pediatric cases of lymphoma seen from 1981 to 1987 with an initial presentation in the head and neck. Cervical lymph nodes represented the initial site of involvement in 10 of the cases. The other five cases presented with disease in the tonsillar fossa; maxillary sinus and mandible; parotid; pharyngeal wall; trachea and thyroid gland; and ethmoid sinus, sphenoid sinus, and anterior fossa. The histologic type was non‐Hodgkin's lymphoma in 12 cases and Hodgkin's lymphoma in 3 cases.

Our experience has shown that lymphoma of the head and neck in children presents a confusing clinical picture and was initially confused with inflammatory disease, polymorphic reticulosis, and other neoplasms such as rhabdo‐myosarcoma.

In one patient, Epstein‐Barr virus infection and an inherited immunodeficiency state probably played a role in the pathogenesis of the lymphoma.
Intranasal and transantral ethmoidectomy: A 20‐year experience
Authors: Friedman William H. , Katsantonis George P.
Published: October 2006

Ethmoidectomy is an operation that has engendered controversy concerning the best route of surgical access. The purpose of this study was to present the results of the authors' experience in more than 1300 intranasal spheno‐ethmoidectomies and transantral sphenoethmoidectomies performed over a 20‐year period. The authors contend that the most effective ethmoidectomy is the most complete ethmoidectomy and have previously presented a case for ethmoid marsupialization. Polyp recurrence rates of less than 20% and a major complication rate of less than 1% were reported in this study.
The use of fibrin glue in intracranial procedures: Preliminary results
Authors: Sierra David H. , Nissen Alan J. , Welch Joseph
Published: October 2006

Intracranial procedures always have the potential of cerebrospinal fluid (CSF) leakage postoperatively. Sealing all routes of CSF drainage to the outside of the intracranial contents is essential. This is usually achieved with muscle and fat plugs, homograft dura, fascia, and suture. The use of a fibrin glue might affect and lessen the likelihood of a CSF leak. Eight clinical cases of various intracranial procedures using a simple, two‐part patient autologous cryoprecipitate fibrinogen and bovine thrombin glue are described. Preliminary results of up to 1 year show no CSF leakage nor adverse reactions to the fibrin glue. The production method and material characteristics are briefly compared with other currently described autologous fibrin glue formulations. This version is similar in strength to other formulations, yet is simpler and more convenient to produce.

The use of this autologous fibrin glue appears to provide an adjunct to commonly employed packing techniques in a convenient and effective manner. With more experience, fibrin glue might become an even more important tool in intracranial procedures.
The functional result of mandibular reconstruction
Authors: Komisar Arnold
Published: October 2006

A study was performed to determine if patients who underwent mandibular reconstruction were functionally rehabilitated. Five parameters were evaluated: deglutition, mastication, cosmesis, diet, and the use of dentures.

Deglutition was not improved in patients who had mandibular continuity restored. Problems with deglutition were related to soft tissue resection. Mastication was poorer in the reconstructed group due to scarring, loss of the muscles of mastication, and inhibition of compensatory mandibular motion. Cosmesis was improved in patients who had immediate restoration of mandibular continuity. Cosmesis was not improved in patients with delayed mandibular reconstruction due to previous scarring. Prosthetic rehabilitation was poor in both groups of patients.

Reconstructed patients had a greater number of hospi‐talizations due to management of, or complications from reconstructive surgical procedures. The results of this study suggests that restoration of mandibular continuity does not enhance the functional rehabilitation of the majority of patients with oral‐pharyngeal malignancy.
Tolerance of gastric mucosal flap to postoperative irradiation
Authors: Devineni V. Rao , Hayden Richard , Fredrickson John , Sicard Gregorio
Published: October 2006

When malignant lesions of the oral cavity, base of tongue, and oropharynx are treated with radical resection, adequate reconstruction is required. The free gastric mucosal flap with microvascular transfer is being used with increasing frequency at Washington University Medical Center. Because of the advanced nature of the primary lesions, most patients also require postoperative radiation therapy. In this paper the tolerance of the gastric mucosal flap to postoperative radiation therapy is reviewed. The changes resulting from radiation therapy in the mucosal flap were found to be acceptable, and no major complications were encountered.
Basement‐membrane thickening of the vocal cords in sudden infant death syndrome
Authors: Shatz Anat , Hiss J. , Arensburg B.
Published: October 2006

Sudden infant death syndrome remains the leading cause of death in infants between the ages of 1 month and 1 year. Diagnosis at autopsy is usually reached by process of elimination, as no obvious cause of death is recognized. The larynges of 23 sudden infant death syndrome victims, as well as 6 infants and 3 fetuses who died of other known causes, were examined in this study. While thickening of the basement membrane of the vocal cords was apparent in all sudden infant death syndrome victims, no such finding was present in the larynges of infants and fetuses dying of other causes. Thus, it is suggested that basement‐membrane thickening may serve as a diagnostic tool for identification of sudden infant death syndrome at autopsy.
Correlations between histopathological and biological findings in nasopharyngeal carcinoma and its prognostic significance
Authors: Gallo Oreste , Gallina Ezio , Libonati Giacinto Asprella , Fini‐Storchi Omero , Bianchi Simonetta , Giannini Augusto
Published: October 2006

Forty‐five consecutive cases of nasopharyngeal carcinoma were morphologically and immunocyto‐chemically studied using monoclonal (anti‐B and anti‐T cell) and polyclonal (anti‐SlOO protein and antilysozyme) antibodies with the peroxidase‐anti‐peroxidase method to identify infiltrating lymphocytes (T and B cell) and histiocytes (monocytic/mac‐rophagic and dendritic cells) in nasopharyngeal carcinoma.

A variable density of dendritic cells was found within the tumor nests in 22 (49%) of 45 nasopharyngeal carcinomas examined; infiltrating mac‐rophages were demonstrated in 15 (33%) specimens and around the tumor in almost all cases. Cases with moderate or marked density of dendritic cells (S100 + ) survived longer than those without such infiltration (mean 5‐year survival rates of 31%, 55%, or 64% in patients with absent, moderate, or marked densities, respectively; P<0.05).

A significant relationship between monocytic/ macrophagic cells (lysozyme +) within the tumor and survival was also found (mean 5‐year survival rate of 27% or 61% in patients with absent, moderate, or marked densities, respectively).

However, lymphocy tic infiltration was not statistically related to a better survival. Analyzing lympho‐cytic infiltration, we found a large prevalence of T cells in the neoplastic tissue without any prognostic significance.

These data were correlated to different histo‐logical subtypes according to the principal histologi‐cal classifications of nasopharyngeal carcinomas (Micheau, et al.; World Health Organization; Cologne University) to individualize the scheme which correlates best with prognosis and biological features of nasopharyngeal carcinomas.

Our data suggest that, considering dendritic cells and macrophages within cancer nests, nasopharyngeal carcinoma histiotypes can be correlated to patient prognosis.
Localization of glucocorticoid receptors and glucocorticoid receptor mRNAs in the rat cochlea
Authors: Ten Cate W‐J. F. , Curtis L. M. , Rarey K. E. , Small G. M.
Published: October 2006

The distribution of glucocorticoid (GR) receptor messenger RNAs (mRNAs) and GR receptors was studied by in situ hybridization histochemistry and immunocytochemistry, respectively. In situ hybridization histochemistry was performed with a biotin‐labeled riboprobe complementary to rat GR receptor mRNA. GR receptor mRNAs were demonstrated in spiral ligament cells, spiral limbus cells, and spiral ganglion cells. GR receptor mRNAs were demonstrated neither in cells of the stria vascularis nor in cells of the organ of Corti region. With the use of a monoclonal and a polyclonal antibody, GR receptors were observed in the spiral ligament cells, stria vascularis cells, spiral limbus cells, and spiral ganglion cells by immunocytochemistry. Binding of anti‐GR‐receptor antibodies to a lesser extent was observed in the organ of Corti region; however, cellular distribution of the GR receptors could not be resolved with the applied techniques. These results suggest that the GR receptor is expressed differently in the heterogeneous cochlear tissues.
Functional endoscopic surgery in children: A retrospective analysis of results
Authors: Parsons David S. , Phillips Scott E.
Published: October 2006

The impact of chronic sinusitis on children has become more apparent as the awareness of the disease has increased. Consequently, the knowledge of its effect in the pediatric patient has expanded dramatically. Functional endoscopic sinus surgery (FESS) has become the primary surgical modality for treatment of this illness in children who have not responded to optimal medical management. A retrospective study was conducted in patients from 7 months to 17 years of age who were treated with FESS for chronic sinusitis refractory to medical therapy. Using a comprehensive parental questionnaire and a review of the medical charts, results were analyzed from these post‐FESS children. Parents of the children were interviewed with a mean follow‐up time of 21.8 months postoperatively. Factors discussed included chronic nasal obstruction, purulent nasal discharge, postnasal drip, chronic cough, halitosis, headaches, behavioral problems, allergies, and asthma symptoms. This preliminary investigation suggests that FESS is effective in treating medically recalcitrant severe chronic sinusitis in children.
Configuration of the glottis in laryngeal paralysis. II: Animal experiments
Authors: Woodson Gayle E.
Published: October 2006

It is widely believed that in isolated recurrent laryngeal nerve paralysis, the paralyzed vocal fold assumes a median or paramedian position, due to the action of the cricothyroid muscle. A review of the literature reveals that support for this theory is not conclusive and, in particular, experiments indicate that the cricothyroid muscle does not appreciably affect vocal fold position in acute paralysis. The research in this study compares the configuration of the glottis in chronic unilateral recurrent laryngeal nerve paralysis in cats, with and without concomitant denervation of the cricothyroid muscle. Results indicate that vocal fold position is not determined by the cricothyroid muscle. Incomplete denervation of intrinsic laryngeal muscles as well as synkinetic reinnervation appear to be significant factors in determining vocal fold position in chronic laryngeal paralysis.
Effects of acid on the larynx of the maturing rabbit and their possible significance to the sudden infant death syndrome
Authors: Wetmore Ralph F.
Published: October 2006

Sudden infant death syndrome (SIDS) has been shown to result from a variety of causes. One group of neonates at high risk for SIDS includes those who develop apnea secondary to gastroesophageal reflux (GER). Reflux has been shown to produce apnea in infants, and aggressive treatment results in significant improvement in symptoms.

Because it is a site of resistance in the airway, the larynx plays an important role in the development of apnea. Through its sensory innervation, the larynx also serves as the afferent limb for reflexes that regulate respiration. In order to investigate the relationship between obstructive apnea and central apnea induced by the instillation of acid on the larynx, simulating GER, a rabbit model was developed. Maturing rabbits at 15‐day intervals up to 60 days of age were studied using saline and acid solutions. Acid solutions produced obstructive apnea in all age groups. With acid solutions, central apnea occurred in all age groups but had a peak incidence at 45 days. Gasping respirations were seen in all groups but were most common at 30 days of age. Although obstructive and central apnea occurred together as mixed apnea, both types of apnea were seen independently of each other.

Acid instilled on the larynx of maturing rabbits resulted in significant obstructive, central, and mixed apnea. Gasping respirations and frequent swallowing were frequent associated symptoms. Acid‐induced obstructive apnea in rabbits mirrors symptoms seen in human infants with GER. Central apnea in infants with GER is seen less commonly; however, central apnea as the result of laryngeal stimulation has been demonstrated repeatedly in several animal models. Central apnea, culminating in fatal asphyxia, has been described in several animal models. The larynx appears to play a pivotal role in the development of apnea in susceptible infants with GER.
Indications for the ao plate with a myocutaneous flap instead of revascularized tissue transfer for mandibular reconstruction
Authors: Disher Michael J. , Esclamado Ramon M. , Sullivan Michael J.
Published: October 2006

Our preferred technique for mandibular reconstruction uses a revascularized osseomyocutaneous flap. However, to reconstruct small lateral defects in dentulous patients, the AO mandibular reconstruction plate (MRP) is used. Its advantages include quick, reliable placement without a donor site or the need for advanced technical training.

This review examines 16 patients who underwent primary mandibular reconstruction after ablative oncologic surgery using an AO MRP without a bone graft. The average follow‐up was 32 months. Twelve patients (75%) had successful reconstructions, while 4 (25%) developed serious complications resulting in failure of the MRP. The most significant factor limiting rehabilitation was disease progression, affecting 12 (75%) of the 16 patients.

In this subgroup of selected patients with small (<6 cm) lateral mandibular defects, useful dentition, and advanced disease, or whose general medical condition precludes prolonged general anesthesia, primary mandibular reconstruction using an AO MRP and a myocutaneous flap without a bone graft is a viable reconstructive alternative.
Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and children
Authors: Monnier Philippe , Savary Marcel , Chapuis Germain
Published: October 2006

Fifteen infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary tracheal anastomosis. The etiology of the stenosis was congenital in 3 cases and was acquired after prolonged intubation in 12. Fourteen patients were tracheotomy dependent at the time of surgery, and 13 (87%) of the 15 were classified grade III (7 cases) and IV (6 cases) according to Cotton. The resection included the cricoid only in 5 cases and the cricoid and a segment of trachea (1 to 4 rings) in 10 cases.

Decannulation was achieved after a single open procedure in 14 (93%) of the cases. The authors encountered no lesion of the recurrent laryngeal nerves and no fatalities. There was, however, 1 restenosis. Twelve cases were decannulated within 6 months, most of them at 2 months. The postoperative voice is normal in 10 cases, and a slight dysphonia is present in 4 cases. Twelve patients show no exertional dyspnea, and 2 exhibit a slight stridor while practicing sports. Ten of 14 cases have been followed for more than 5 years, with the longest follow‐up now being 14 years. In all cases, the laryngotracheal development is normal.

The results of this small series compare favorably with those of laryngotracheoplasty procedures usually performed for subglottic stenosis in infants and children. In the future, partial cricoid resection with primary tracheal anastomosis should be considered as an important treatment option for severe subglottic stenoses in infants and children.
Cochlear implantation in young children: Histological studies on head growth, leadwire design, and electrode fixation in the monkey model
Authors: Burton M. J. , Shepherd R. K. , Xu S. A. , Xu J. , Franz B.K‐H.G. , Clark G. M.
Published: October 2006

For safe cochlear implantation in children under 2 years of age, the implant assembly must not adversely affect adjacent tissues or compromise head growth. Furthermore, growth changes and tissue responses should not impair the function of the device.

Dummy receiver‐stimulators, interconnect plugs, and leadwire‐lengthening systems were implanted for periods of 36 months in the young monkey to effectively model the implantation of the young child. The results show that implanting a receiver‐stimulator package has no adverse effects on skull growth or the underlying central nervous system. The system for fixing the electrode at the fossa incudis proved effective. There was marked osteoneogenesis in the mastoid cavity, resulting in the fixation of the lead‐wire outside the cochlea.

This study provides evidence for the safety of cochlear implantation in young subjects.
Sensorineural hearing loss from quinolinic acid: A neurotoxin in middle ear effusions
Authors: Yellon Robert F. , Rose Elizabeth , Kenna Margaret A. , Doyle William J. , Casselbrant Margaretha , Diven Warren F. , Whiteside Theresa L. , Swarts J. Douglas , Heyes Melvyn P.
Published: October 2006

Quinolinic acid (QUIN) is an endogenous metabolite that exerts a neurotoxic effect by binding to specific neuronal receptors. Studies involving a broad spectrum of infectious and inflammatory central nervous system diseases have suggested a role for QUIN in causing neuronal injury. Since there is evidence for presence of the QUIN receptor in mammalian cochleas, QUIN was measured in middle ear effusions (MEEs). Gas chromatography/mass spectrometry detected QUIN in each of 65 diluted human MEEs, with a mean of 482 ± 75 (SEM) nmol/L and a range from 15 to 2667 nmol/L. QUIN was also detected in each of 197 chinchilla MEEs from five different models of otitis media, with a mean of 10.6 ± 1.3 (SEM) μmol/L and a range from 0.23 to 146.0 μmol/L (corrected for dilution).

To determine whether QUIN causes sensorineural hearing loss (SNHL), QUIN solutions were placed on round window membranes (RWM) for 20 to 240 minutes, in 20 chinchillas. SNHL was detected by electocochleography in QUIN‐exposed animals, but not in saline controls. We conclude that QUIN is present in MEEs and that QUIN in the middle ear has the potential to cross the RWM and cause sensorineural hearing loss, possibly by binding to specific neuronal receptors in mammalian cochleas.
Cytokines in experimental otitis media with effusion
Authors: Johnson Michael D. , Fitzgerald John E. , Leonard Gerald , Burleson Joseph A. , Kreutzer Donald L.
Published: October 2006

Studies in the authors' laboratory have recently demonstrated the presence of potent inflammatory cytokines such as interleukin‐1β (IL‐1β), interleukin‐6 (IL‐6), and tumor necrosis factor‐α (TNFα) in human middle ear effusions. The clinical significance of this finding has not been fully elucidated because of the limitations of human studies. We hypothesized that the chinchilla model of otitis media may be an appropriate system with which to study the role of cytokines in otitis media with effusion. To begin to investigate this possibility, 30 chinchillas underwent surgical blockage of the eustachian tube (ET) to promote effusion development. After 2 weeks, examination by otoscopy demonstrated 27 ears to have developed an effusion. Next, all middle ear clefts, in random manner, were either injected with heat‐killed Streptococcus pneumoniae 1 × 106 in 0.1 mL normal saline, injected with 0.1 mL normal saline alone, or received no injection at all. Middle ear effusions were obtained and analyzed for IL‐1β and TNFα by enzyme‐linked immunosorbent assay (ELISA). This study demonstrated a significant correlation between IL‐1β and the presence of an effusion (P<.001). Additionally, increased TNFα levels correlated with bacterial component presence (P<.001), i.e., mean TNFα level was 108, 10.8, and 0 pg/mL in bacteria, normal saline, and noninjected ears, respectively. These findings would suggest that cytokine expression may relate to specific pathological conditions and that the chinchilla model for otitis media with effusion (OME) could be used to further explore the role of cytokines in OME.
Reflex laryngospasm induced by stimulation of distal esophageal afferents
Authors: Bauman Nancy M. , Sandler Anthony D. , Schmidt Charles , Maher James W. , Smith Richard J. H.
Published: October 2006

Distal esophageal sensory nerves were stimulated in 17 anesthetized dogs divided into three age groups to determine the laryngeal, cardiovascular, and respiratory effects. Group I puppies were 5 to 6 weeks of age, group II puppies were 8 to 19 weeks of age, and group III animals were adult dogs. Marked laryngeal adductor activity and laryngospasm were observed in group II puppies, while no or minimal laryngeal adduction was seen in younger puppies and adult dogs. Mean arterial pressure and heart rate increased significantly in groups II and III (P<.005) but remained unchanged in group I animals (P>.4). This response is distinctly different from the laryngeal chemoreflex because central apnea, hypotension, and bradycardia were absent. The afferent limb of the response is mediated by the vagus nerve as bilateral transthoracic truncal vagotomy eliminated the reflex. The laryngeal response observed following stimulation of distal esophageal afferent fibers may be important in the mechanism of apparent life‐threatening events (ALTEs) and the sudden infant death syndrome (SIDS) associated with gastroesophageal reflux disease.
The effect of nifedipine on skin flap survival in rats
Authors: Bailet Jeffrey W. , Hoffman Larry F. , Trachy Ronald E. , Weymuller Ernest A.
Published: October 2006

Maintaining the viability of an extended skin flap remains one of the continuing challenges in reconstructive surgery. As flaps lengthen, viability becomes more unpredictable and necrosis of distal segments can occur. The specific mechanisms involved in determining flap survival remain unclear, but vasoconstriction within the flap microcirculation appears to play a significant role in regulating flap viability. Vasodilators have been used, with limited success, in an attempt to improve survival of ischemic skin flaps in rats. One such agent, nifedipine, a calcium channel blocker, demonstrated conflicting results when used to improve rat skin flap survival, despite its potent vasodilating properties. A standard rat flap model was used to help clarify the potential of nifedipine to salvage ischemic skin flaps. Alterations in flap perfusion were assessed using a laser Doppler flowmeter and dermofluorometry in an attempt to characterize nifedipine's mechanism of action on flap preservation. Increased flap survival was demonstrated in treatment animals when compared to controls. Despite significant improvement in flap viability, perfusion measurements failed to confirm increased flow within the flap microcirculation. Although the mechanisms of action remain speculative, nifedipine may have important therapeutic potential in improving skin flap survival in a clinical setting.
Elective carotid artery resection for advanced squamous cell carcinoma of the neck
Authors: Brennan Joseph A. , Jafek Bruce W.
Published: October 2006

The authors performed a retrospective review of their 10‐year experience of carotid artery resection without revascularization for advanced squamous cell carcinoma of the neck. From 1982 to 1991, seven patients underwent elective carotid artery resection without reconstruction at the University of Colorado Health Sciences Center in Denver. A vascular clamp with gradual carotid occlusion was placed preoperatively on four patients and awake temporary balloon occlusion of the carotid was used on three patients. The primary lesions were three laryngeal carcinomas, two oral cavity carcinomas, and two hypopharyngeal carcinomas. All seven resected specimens showed invasion of the carotid fascia on pathological exam, while five specimens exhibited actual destruction of the arterial wall. Cerebrovascular accidents occurred in two patients (one immediate and one delayed), and the perioperative mortality was 29% (one cerebrovascular accident and one gastrointestinal bleed). The five remaining patients died of locoregional recurrence or metastatic disease within 1 year after their carotid artery resection.

Resection of the common or internal carotid artery without reconstruction has a significant morbidity and mortality. This operation did not improve the long‐term survival in our limited series of patients who presented with histologically proven invasion of the carotid artery.
Noninvasive optical diagnosis of bacteria causing otitis media
Authors: Werkhaven J. A. , Reinisch L. , Sorrell M. , Tribble J. , Ossoff R. H.
Published: October 2006

Currently, the identification of the bacteria responsible for acute otitis media requires a painful invasive procedure: tympanocentesis. To develop a rapid and noninvasive technique for bacterial diagnosis, the fluorescence profiles of four common pathogens and the optical characteristics of the tympanic membrane have been investigated. Each bacterium produces a unique in vitro fluorescence profile when measured in a saline suspension. Also, spectrally resolved transmission measurements from the chinchilla tympanic membrane demonstrate an optical window that will transmit sufficient light for in vivo measurement of the fluorescence profiles. Thus, we have established the precept for a fluorescence‐based bacterial diagnosis technique to be used in otitis media. This paper presents the theory, optical data, and a discussion of the device engineering involved in the technique.
Otopathology in a case of multichannel cochlear implantation
Authors: Nadol Joseph B. , Ketten Darlene R. , Burgess Barbara J.
Published: October 2006

The histopathology of the temporal bones of a patient who died of unrelated causes 10 weeks following cochlear implantation using a Richards Ineraid® device is presented. Deafness was caused by a prolonged course of intravenous gentamycin therapy 5 years prior to implantation.

The electrode array of the cochlear implant was left in situ throughout histologic preparation and sectioning. Despite displacement and disruption of supporting structures of the inner ear, particularly in the 6‐to‐15‐mm range as measured from the round window, there was no significant difference in the mean densities of spiral ganglion cells in the implanted and unimplanted sides.

This case is presented as evidence that despite significant disruption of supporting elements of the inner ear, which is common during cochlear implantation, there appears to be little effect on the residual spiral ganglion cell count, at least in the short term.
Bacteriology of antrum in adults with chronic maxillary sinusitis
Authors: Erkan Mustafa , Aslan Tahsin , Özcan Mustafa , Koç Nedret
Published: October 2006

Swabs of 126 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria during endoscopy. Bacterial growth was present in 113 of 126 specimens (90%). Anaerobic bacteria were isolated in 100 of 113 culture‐positive specimens (88%). Anaerobes only were recovered in 59 cases (52%) and, in 41 (36%), they were mixed with aerobic or facultative bacteria. Aerobic or facultative bacteria were present in 13 cases (12%). A total of 323 isolates (2.8 per specimen), 228 (2.3 per specimen) anaerobes and 95 (1.7 per specimen) aerobes or facultatives, were isolated. The predominant anaerobic organisms were anaerobic cocci and Bacteroides species; the predominant aerobes or facultative bacteria were Streptococcus species and Staphylococcus aureus. These findings indicate the major role of anaerobic organisms in chronic sinusitis.
Laryngeal microsurgery under general anesthesia using small‐bore endotracheal tubes: Blood gas analysis
Authors: Altissimi Guido , Gallucci Luigi , Prattichizzo Lidia , Arcamone Dorina , Monacelli Carla
Published: October 2006

This study reports variations observed under general anesthesia through small‐bore endotracheal tubes in Po2, Pco2, Hco3, percentage saturation of O2, and pH levels in 39 patients who underwent laryngeal microsurgery lasting from 10 to 100 minutes. The tendency to an increase in Pco2 levels reached statistical significance only at the 100th minute but did not constitute a risk for patients as values remained within the limits of “permitted hypercapnia.” Po2, percentage saturation of oxygen, and Hco3 levels did not vary significantly. pH values tended to fall (respiratory acidosis) in correlation to the increase in Pco2. Small‐bore endotracheal tubes can safely be used for laryngeal microsurgery when operating times are not longer than 100 minutes.
Warthin's tumor: A 40‐year experience at the johns hopkins hospital
Authors: Yoo George H. , Eisele David W. , Driben Jeffrey S. , Johns Michael E. , Askin Frederic B.
Published: October 2006

Warthin's tumor previously has been thought to occur much more commonly in men than in women and rarely in African Americans. One hundred thirty‐two cases of Warthin's tumor treated at The Johns Hopkins Hospital from 1952 to 1992 were retrospectively reviewed. There were 90 (68%) men and 42 (32%) women, with an overall man‐to‐woman ratio of 2.2:1. The number and percentage of women with Warthin's tumor increased over each consecutive decade: 1952 to 1962, 5 (21%); 1963 to 1972, 6 (29%); 1973 to 1982, 11 (31%); and 1983 to 1992, 20 (39%). A positive smoking history was found in 88% of the men and in 89% of the women with a Warthin's tumor. Eleven (8%) African Americans and 1 (0.75%) Asian American were diagnosed to have a Warthin's tumor. Also, the incidence of African Americans with a Warthin's tumor increased over each decade: 0 (0%), 1 (4.8%), 2 (5.5%), and 8 (16%). This study's results indicate a progressive increase in the occurrence of this tumor in women and in African Americans and a higher overall incidence in African Americans than previously reported.
The effect of blood on laser‐resistant endotracheal tube combustion
Authors: Sosis Mitchel B. , Pritikin Jordan B. , Caldarelli David D.
Published: October 2006

The protection afforded against CO2 laser‐induced combustion by five different types of tracheal tubes or protective foil wraps was evaluated. They were compared before and after the application of human blood to their external surfaces. The tracheal tubes tested were polyvinylchloride (PVC) tubes wrapped with VentureTM copper (Cu) foil tape, 3MTM aluminum (A1) foil tape, and the Laser‐GuardTM protective coating. The Xomed Laser Shield IFTM and Mallinckrodt Laser‐FlexTM tracheal tubes were also tested. A CO2 laser set to 38 W in the continuous mode was directed at the shaft of the tracheal tube under study, which had 5 L/min of oxygen flowing through it. The laser was actuated for 90 seconds or until combustion or melting occurred.

The copper foil‐wrapped and aluminum foil‐wrapped PVC tracheal tubes were unaffected by 90 seconds of laser fire in five trials with each type of tape. However, the application of blood to the foil wrapped PVC tracheal tube shafts resulted in combustion in 3 of 5 copper foil‐wrapped tubes and melting of the underlying tracheal tube shaft in 3 of 5 aluminum foil‐wrapped PVC tracheal tubes. Blood did not affect the protection afforded by the Laser‐GuardTM coating when it was applied to the shafts of PVC tracheal tubes. Similarly, the Xomed Laser Shield IFTM tracheal tube's shaft offered good protection from the laser both before and after application of blood. Combustion occurred in 1 of 4 Mallinckrodt Laser FlexTM tracheal tubes studied prior to the application of blood. The application of blood resulted in almost immediate combustion in all 4 Mallinckrodt Laser FlexTM tracheal tubes tested.

The presence of blood on the surface of metallic foil‐wrapped or special tracheal tubes may make laser‐induced combustion more likely during airway surgery. However, the Laser‐GuardTM protective coating and the Xomed Laser‐Shield IFTM tracheal tube provide good protection even when covered with blood.
Effect of anesthetic gas on middle ear fluid
Authors: Tom Lawrence W. C. , Tsao Francis , Marsh Roger R. , Kessler Alex , Konkle Dan F.
Published: October 2006

Tympanometry was performed before (preoperative) and after (intraoperative) the administration of inhalation anesthesia including nitrous oxide and halothane on 109 children undergoing myringotomy with pressure equalization tube insertion. A total of 213 preoperative tympanograms were compared with their intraoperative counterparts and the presence or absence of middle ear effusion at myringotomy. When preoperative tympanograms were consistent with pneumatized middle ears, intraoperative findings demonstrated a mean middle ear pressure increase of +147 daPa. When preoperative tympanometry suggested middle ear effusion, less than 1% demonstrated intraoperative tympanometric changes and/or findings at surgery that would support anesthesia clearing middle ear effusion. Preoperative tympanometric data were poor predictors of the presence or absence of effusion at myringotomy. The relationship between inhalation anesthetics (i.e., nitrous oxide and halothane) and middle ear fluids, and the reliability of tympanometry to predict middle ear effusion are discussed.
The effect of human olfactory biopsy on olfaction: A preliminary report
Authors: Lanza Donald C. , Deems Daniel A. , Doty Richard L. , Crawford Donah , Carter Rowley J. , Kennedy David W. , Sajjadian Ali , Moran David
Published: October 2006

Normal human olfactory function is subject to a wide variety of factors. Although biopsy of human olfactory neuroepithelium has been reported by several researchers, there are no studies which have evaluated the effect of this procedure on olfactory function. In this retrospective study, we sought to determine if tissue removal from the olfactory cleft has an adverse influence on the sense of smell. Nineteen subjects underwent bilateral olfactory testing and subsequent endoscopic olfactory mucosal biopsy. All subjects were retested 6 weeks to 1 year after olfactory neuroepithelial biopsy. No statistical difference was found between olfactory tests performed before or after biopsy. These data suggest that biopsy of human olfactory neuroepithelium has no discernible adverse effect on the ability to smell.
Ultrasonography for evaluation of the carotid artery in head and neck cancer
Authors: Mann Wolf J. , Beck Alain , Schreiber Joerg , Maurer Jan , Amedee Ronald G. , Gluckmann Jack L.
Published: October 2006

The dynamic relationship of lymph node metastases to surrounding vascular structures in the neck is important for preoperative patient assessment. When carotid artery involvement is suspected, this relationship often determines whether or not to operate. In the case of adhesive neck metastases along the internal jugular vein, it becomes possible to predict preoperatively if the integrity of this vein may be preserved. Ultrasonography has the ability to differentiate subtle from gross adherence, or simple compression from vascular invasion. This is done by manually palpating the tumor mass and asking the patient to perform various maneuvers while observing on a monitor the relationship of the tumor mass to the nearby artery. This article correlates the preoperative computed tomography/magnetic resonance imaging (CT/MRI) and ultrasound findings in 41 patients with large nodal metastases which were subsequently confirmed during surgery. In case of positive ultrasonographic invasion of the carotid artery, a transcranial Doppler ultrasonography (TCD) exam was performed to confirm adequate crossflow. Our experience with ultrasonography and TCD in patients with suspected involvement of the carotid artery shows reliable results and obviates in our hands the routine need for more complex, invasive, and expensive tests.
Clinical results for the digisonic multichannel cochlear implant
Authors: Chouard C. H. , Meyer B. , Fugain C. , Koca O.
Published: October 2006

The DIGISONIC is a digitized 15‐channel cochlear implant. A special version of this implant has been designed for use in the totally obstructed cochlea. This device has 10 separate electrodes that may be inserted, one by one, into 10 different holes drilled in the bony cochlea. The device's 128‐point Fast Fourier Transform analysis supplies the patient with the entire set of the sound information between 100 and 7800 Hz. The stimulation rhythm is set at a programmable frequency among 125 and 400 Hz or slaved to the fundamental pitch frequency. The flexibility of the microprocessor makes it possible to select the best width and mean value of each frequency band for each electrode. Many speech‐coding strategies may be easily programmed as a function of scientific desiderata. The authors present clinical results for the first 28 patients they treated with this cochlear implant.
Neuroendocrine neoplasms of the larynx
Authors: Overholt Samuel Mark , Donovan Donald T. , Schwartz Mary R. , Laucirica Rodolfo , Green Linda K. , Alford Bobby R.
Published: October 2006

Neuroendocrine neoplasms of the larynx are a rare group of tumors that include carcinoid tumor, atypical carcinoid tumor, and small cell carcinoma. These neoplasms pose interesting diagnostic, prognostic, and therapeutic dilemmas, and they are, as a whole, aggressive tumors with a tendency for local and distant spread.

The authors of this study examined six new cases of laryngeal neuroendocrine neoplasms. One case manifested itself as a primary atypical carcinoid tumor and caused a “carcinoid syndrome.” The remaining five cases were small cell carcinomas of the larynx. Histologic, immunocytochemical, DNA flow cytometric, and p53 studies were performed on all cases. The expression of neuron‐specific enolase and chromogranin were the most useful markers in this group of tumors. Overexpression of p53 protein was present in the majority of cases, including the atypical carcinoid tumor. The implications of these studies for diagnosis, classification, and treatment are discussed.
Metastatic basal cell carcinoma of the head and neck
Authors: Tavin Ellis , Persky Mark S. , Jacobs Joseph
Published: October 2006

Metastases are occasionally associated with cutaneous squamous cell carcinoma but only rarely with basal cell carcinoma. There are approximately 200 cases of metastases from basal cell carcinoma reported in the world literature. We describe 6 additional cases. All of our patients demonstrated recurrence at the primary site before they developed their metastases. Metastases presented in subcutaneous tissue, cervical lymph nodes, bone, and lung between 1.5 and 14 years after initial treatment of the primary lesion. The long interval seen in these patients between the initial treatment of the primary and the development of metastases underscores the need for long‐term follow‐up in what is often thought to be a nonaggressive, nonmetastasizing malignancy.