bluuebunny/crossref_metadata_2025 huggingface dataset:
A pilot study of videoconferencing for an Internet-based weight loss programme for obese adults in Taiwan
Authors: Liou Tsan-Hon , Chen Chi-Hsien , Hsu Chien-Yeh , Chou Pesus , Chiu Hung-Wen
Published: October 2006

We conducted a pilot study of the feasibility of an Internet-based weight loss programme using videoconferencing to emulate face-to-face situations and a Web service to support self-monitoring. A pre–post test design was used to compare changes in bodyweight, metabolic variables and attendance rate. Nine subjects lost on average 5.9 kg (6.0% of body weight, P<0.001) over the course of the 12-week programme. Waist circumference was reduced significantly (10.2 cm, P=0.03). Total cholesterol, aspartate transferase (AST) and alanine transferase (ALT) significantly decreased. Eight participants completed a questionnaire after the intervention. Overall, responders were satisfied with the protocol and considered the Internet weight loss programme to be helpful to them. One technical problem was that Internet congestion could reduce the quality of audio and video. The Internet appears to hold promise as a medium to facilitate communication in weight loss programmes.
Economic evaluation of a tertiary telepsychiatry service to an island
Authors: Harley Jacqueline
Published: October 2006

The island of Jersey is located 160 km south of Britain and 23 km from northwest France. The island has well-established primary and secondary mental health services, but tertiary services have to be purchased from UK mainland service providers. A pilot study of telepsychiatry was conducted, using videoconferencing to access tertiary mental health services from the UK. During a six-month study period, five patient consultations and six specialist presentations were carried out. The total cost of using videoconferencing to deliver tertiary mental health services not ordinarily available in Jersey was £3483.06. The costs of using the traditional model instead would have been £12,975.00. The threshold at which videoconferencing became cheaper than travel was between five and six telemedicine episodes per year; the actual workload during the pilot study was 22 episodes per year. The study suggests that telemedicine is cost-effective for providing tertiary mental health services not ordinarily available in Jersey.
Perilymphatic fistula: An unusual cause of meniere's syndrome in a prepubertal child
Authors: Arenberg I.Kaufman , May Mark , Stroud Malcolm H.
Published: October 2006

Non‐traumatic, spontaneous perilymph fistula of the oval window is an unusual cause of Ménière's syndrome in a child. In this case, all of the audio‐vestibular criteria for a diagnosis of Ménière's syndrome (or clinical endolymphatic hydrops), including a temporary threshold shift after the glycerol test, were demonstrated. At exploratory tympanotomy, a perilymph fistula, demonstrated at the footplate margins was plugged with fat. There was significant immediate postoperative and six‐month follow‐up improvement in perception of pure tone, speech reception threshold (SRT) and discrimination score.
Depression of the evoked cortical potential by ethacrynic acid
Authors: Walloch Richard A. , Anthony Jonathan , Gibbons Nannette
Published: October 2006

The effect of a 45 mg/kg injection of Ethacrynic acid upon the threshold of the potential evoked from the guinea pig's auditory cortex was determined. Thirty minutes after the drug injection, the thresholds for the evoked potential at 0.5 and 1 kHz were depressed approximately 20 db, while the thresholds at 4 and 10 kHz were depressed approximately 40 db. Although not complete, substantial recovery of the evoked potential threshold was observed in all but one guinea pig two hours after the drug injection. The changes in the evoked potential threshold were the same order of magnitude as those previously reported for the cochlear microphonic and endolymphatic potential.
Evaluation and treatment of vocal cord paralysis
Authors: Maisel Robert H. , Ogura Joseph H.
Published: October 2006

One hundred eighty‐one patients with unilateral or bilateral vocal cord paralysis unrelated to laryngeal carcinoma or its therapy were studied. The orderly diagnostic profile used to delineate cause of the paralysis includes CBC, VDRL blood sugar profile, latex fixation and serum sampling for toxic heavy metals. The radiologic and endoscopic evaluation is done to completion unless contraindicated, to assess aspiration as well as to observe laryngopharyngeal structures which may cause the paralysis. This evaluative profile defined the etiology of cord paralysis in 80 percent of patients, despite exclusion of viral disease as a cause subsequent to upper respiratory infection. Blunt trauma and previous neck surgery each were responsible for 23 percent of the cases. Fifty‐four patients had bilateral paralysis of which 22 were post thyroidectomy. Surgical repair for cord paralysis was symptomatic, and included 28 successful teflon injected cords. Recurrent laryngeal nerve decompression was successful in four of five operations and arytenoidectomy was performed in 39 patients.
Diverting the paralyzed larynx: A reversible procedure for intractable aspiration.
Authors: Lindeman Roger C.
Published: October 2006

Some unfortunate patients suffer disorders which in one way or another, usually neurologically, severely restrict the larynx in its role as a protector of the lower airway. Aspiration ensues, and unless it can be successfully managed, repeated episodes of a violent pneumonitis may lead to terminal chest problems.

In some patients, even the cuffed tracheostomy tubes of new and improved design do not adequately prevent aspiration over an extended time interval, as evidenced by repeated bouts of aspiration pneumonia despite these cuffed tubes and despite optimal intensive care.

For these patients with intractable aspiration, and in whom recovery is expected only after a prolonged period of time, we have suggested a diverting procedure which employs a tracheo‐esophageal anastomosis, as an effective yet reversible solution. Such an anastomosis with concomitant tracheostomy allows aspiration of saliva and even food to occur through the malfunctioning larynx but diverts it back into the esophagus through the tracheo‐esophageal anastomosis.

In normal mongrel dogs we demonstrated that an end‐to‐side tracheoesophageal anastomosis is well tolerated and can be performed without damage to the intrinsic larynx or recurrent laryngeal nerves. The tracheoesophageal lumen remained patent and the anastomosis intact for as long as these animals were observed prior to reconstruction.

The reversibility of the tracheo‐esophageal anastomosis was demonstrated in these dogs by excising the anastomosis, repairing the esophageal defect, and restoring the continuity of the trachea by end‐to‐end anastomosis. Vocal cord motion remained intact, the dogs ate normally, and barked once again.

A tracheo‐esophageal anastomosis was performed in a 60‐year‐old white female who had suffered lower cranial nerve damage as a result of a large acoustic tumor and the excision thereof. Despite every effort to control aspiration, pneumonitis occurred and became fulminant.

The diverting tracheo‐esophageal anastomosis was performed with relative ease and was well tolerated by the patient. Aspiration was totally and dependably controlled, and no further chest complications occurred. Her nasogastric feeding tube was removed, and she ate a regular diet with very little difficulty. She gained in strength, became much more alert mentally, and is now taking care of herself in a nursing home.

We are following her progress by indirect laryngoscopy and barium swallow examinations and at five months post anastomosis, we are possibly seeing the first signs of lower cranial nerve recovery. We hope that reconstruction and restoration of function will soon be possible.

We feel that the results to date of our animal experimentation and of our case report are satisfactory. Many questions remain unanswered, however, and for this reason we must emphasize a very conservative approach to the clinical application of this procedure.
Audiological evaluation following acupuncture for hearing loss
Authors: Davis James M. , Krapp Dwight E. , Wilder Martha L. , Lawrence Clifton F.
Published: October 2006

Six patients, diagnosed as having bilateral, sensori‐neural hearing losses received audiological evaluations before and after acupuncture treatments. A comparison of mean pre‐ and post‐treatment pure tone air conduction and speech reception thresholds indicated no significant improvement with respect to auditory acuity. Although most threshold shifts were within a ±5 db clinical error envelope, there was a general tendency for poorer hearing levels.
Arterial blood gas changes following nasal packing in dogs
Authors: Cavo John W. , Kawamoto Satoru , Berlin Barry P. , Zollinger William , Ogura Joseph H.
Published: October 2006

Previous clinical studies pertaining to blood gas changes following nasal packing have agreed that the packing is frequently followed by hypoxia but have found differing responses in arterial PCO2 to nasal packing. This is of more than incidental importance, because the mechanisms by which hypoxia develops should determine the method by which the hypoxia is treated.

The various causes of hypoxia are reviewed, and a method of instituting an indwelling systemic arterial catheter for the purpose of drawing sequential blood samples for gas determinations is described.

Using the indwelling arterial catheters, arterial blood was sampled from a series of awake, unsedated dogs before, during, and after the dogs were subjected to anterior and posterior nasal packing. Blood gas determinations showed significant depressions of PO2 and elevations of PCO2 during the period when the packing was in place. The altered blood gas values quickly returned to essentially normal (control) values after the packing was removed.

In order to help assess the degree of lower airway response to an upper airway stimulus as a cause of these blood gas changes, the protocol was repeated in previously laryngectomized dogs. In these animals no consistently significant change occurred in either the PO2 or PCO2 following either the packing or its removal. Our findings suggest that airway obstruction (and hypoventilation) rather than increased bronchomotor tone is the main cause of hypoxia in awake dogs with anterior and posterior packing. Because of the likelihood of hypoventilation and significant hypercarbia in patients in whom nasal packing is employed, we discourage the routine usage of oxygen, unless blood gas levels are checked prior to the institution of oxygen therapy.
Laryngopharyngeal injuries
Authors: Krekorian Edmund A.
Published: October 2006

The patient who sustains trauma to the neck may present with symptoms strongly suggesting an acute injury to the larynx. The laryngeal injury may be real or imagined; however, the clinical manifestations may be so overwhelmingly indicative of a laryngeal injury that a small tear in the adjacent upper gut may be overlooked. Failure to diagnose an upper gut injury can result in a confusing parade of symptoms and signs, great morbidity and even death.

Two cases are presented, each illustrating certain unique aspects of upper gut and laryngeal injuries. The history, diagnosis, operative management and clinical course of each patient are described. Attention is given to the unique facets of each case which make upper gut injury a fascinating and challenging surgical entity. Each case is discussed in terms of diagnostic and management errors or areas of controversy. Finally, certain general concepts of management of upper gut injuries are described.
Thin section computed tomography of the temporal bone
Authors: Shaffer Katherine A. , Haughton Victor M.
Published: October 2006

The applications of computed tomography (CT) in temporal bone studies have increased because of thin sections (< 2 mm), high spatial resolution (< 0.8 mm) and high resolution reconstruction algorithms. Thin section CT was performed in 56 patients suspected of having acoustic neuromas, other tumors, cholesteatomas or fractures. High resolution experimental image reconstruction was performed in some cases. In most cases, the pathologic process was demonstrated as well or better on CT scans than on complex motion tomograms. We concluded that high resolution, thin section CT is the technique of choice to evaluate patients with temporal bone tumors. CT is an effective means of studying patients with large cholesteatomas and fractures, although conventional tomography may be complementary in some cases. The value of CT in patients with otosclerosis and inflammatory disease of the middle ear should be evaluated more extensively.
Facial nerve paralysis secondary to mandibular fracture
Authors: Goin Donald W.
Published: October 2006

When facial nerve paralysis complicates a mandibular fracture, it may be difficult to locate the point of injury, since the nerve may be injured in the fallopian canal by a secondary temporal bone fracture or in soft tissue by mandibular fragments. Following a review of eight previously reported cases, this paper presents two additional cases, one with bilateral, complete paralyses and the other with a unilateral paresis. In the first, the condyles were driven posteriorly, resulting in bilateral temporal bone fractures, a unilateral external canal stenosis, and a unilateral sensorineural hearing impairment. Good functional return followed decompression of the intratemporal facial nerves. In the second patient, facial function returned spontaneously. When the temporal bone is fractured, therapy follows guidelines for facial paralysis associated with basilar skull fractures from other causes. If soft tissue injury is suspected, the decision must be made whether to explore the nerve or wait for spontaneous recovery.
Laryngeal angiomyoma (vascular leiomyoma): Clinicopathological findings
Authors: Shibata Koichi , Komune Shizuo
Published: October 2006

Two cases of laryngeal angiomyoma which developed in 51 and 52‐year‐old men are reported. One was a tumor found in the supraglottic area of the larynx and the other was in the subglottic space. Each was a spherical tumor with a smooth surface. The chief complaints of these patients were sudden dyspnea, hoarseness, and laryngeal pain. The tumors were removed through direct laryngoscopy under general anesthesia; but in both cases, considerable bleeding occurred during and after surgery.

Histological examination showed that the tumor was covered by squamous epithelium and a fibrous capsule. The parenchyma of the tumor was composed of proliferated fibers of smooth muscle, and dilated blood vessels in abundance. The tumor is of benign nature and recurrence is rare. For therapy, therefore, complete extirpation of the tumor is adequate, but the likelihood of profuse bleeding must be considered.
Are water and tympanotomy tubes compatible?
Authors: Jaffe Burton F.
Published: October 2006

Traditionally, patients with tympanotomy tubes are admonished not to get water in their ears so that ear infections will not occur. This study reviews 100 children during the past three years who were given instructions to allow bath and shower water to get into their ears, and who were allowed to swim as long as they used polymyxin/neomycin/hydrocortisone ear drops at night after swimming. Only rarely did problems arise, and these were easily managed. No long‐term harmful effects occurred. In addition, earplugs, swimming and shower caps, and special tympanotomy tubes are not needed to prevent ear infections.

Water and tympanotomy tubes are compatible.
Intranasal ethmoidectomy and concurrent procedures
Authors: Taylor J. S. , Crocker P. V. , Keebler J. S.
Published: October 2006

In this review of 526 intrnnasal ethmoidectomy procedures, there was a complication rate of 2.5% with no blindness, meningitis, or deaths. The rationale for associated concurrent procedures is presented. The use of an absorbable hemostntic sinus sponge and an easily removable Telfa® nasal packing made possible just a two‐night hospital stay in over 90% of these patients.
Sensorineural hearing loss: Infectious agents
Authors: Pappas Dennis G. , Mundy Martha R.
Published: October 2006

Twenty‐eight children with sensorineural hearing loss resulting from viral (17) or infectious (11) agents were analyzed according to the degree and stability of the loss and the age at identification. Early identification and determination of etiology is enhanced when a viral screen is performed in the nursery, and of questionable value when viral studies are done later. Eighty percent of the children who sustained a permanent loss as a result of meningitis had severe‐profound losses. Serial hearing testing should be done every 6 months for these children who are at risk for progression or fluctuations in their hearing loss.
Entomophthorales infection of the maxillofacial region
Authors: Nathan Marshall D. , Keller A. Paul , Lerner Charles J. , Davis Jefferson C.
Published: October 2006

Phycomycosis infections caused by the fungi Rhizopus and Mucor are commonly termed mucorinycosis. Mucormycosis infections exhibit a rapidly progressive course characterized by angioinvasion and necrosis. The rhinocerebral form has been described thoroughly in the literature. However, there exists another order of Phycomycetes, the Entomophthorales, which rarely cause clinical disease. Their infection is indolent and is associated with grunulomatous inflammation and a protracted clinical course.

Presented here is a rare case of suspected Canidiobolus coronato infection occurring in the maxillofacial region of a previously healthy male. The authors believe this to be the first reported case occurring in the United States. Because of the poorly documented natural history of this infection and the patient's relative intolerance to parenteral antifungal therapy, a multidisciplinary therapeutic approach was designed. It consisted of long‐term, low‐dosage amphotericin‐B, hyperbaric oxygen and sequential surgical debridements.

This unusual disease entity must now be considered in the differential diagnosis of granulomatous disorders of the head and neck.
Gingival and mandibular metastases from rectal adenocarcinoma: Case report and 20 year review of the english literature
Authors: Rentschler Robert E. , Thrasher Thais V.
Published: October 2006

Gingival metastases from non‐oral malignancies are very uncommon. The case is presented of a man with rectal adenocarcinoma, whose first clinical evidence of metastatic disease was a gingival metastasis. Although the prognosis of patients with gingival metastases is felt to be poor, prompt initiation of appropriate therapy may afford significant palliation. A 20‐year literature review of uncommon metastatic sites for rectal adenocarcinoma and non‐oral malignancies which can metastnsize to gingiva is briefly presented. Gingival metastasis should be included in the differential diagnosis of a gingival lesion in a patient with prior or current malignancy.
Myofibroblasts in chronic otitis media
Authors: Berlinger Norman T. , Schachern Patricia
Published: October 2006

Cells which may be tentatively described as myofibroblasts have been identified by transmission electron microscopy from samples of inflammatory tissue present in the tympanic cavity of ears demonstrating clinical chronic otitis media. These cells possess the ultra‐structural characteristics of a markedly indented nucleus, well organized bundles of cytoplasmic microfilaments, and plasmalemma specializations resembling desmosomes. Myofibroblasts are contractile cells which are present in a number of pathological conditions characterized by tissue contraction or distortion such as hepatic cirrhosis, Dupuytren's contracture, and hypertrophic scars. It is possible to hypothesize that myofibroblasts in chronic otitis media may exert synchronized contractile forces which distort the tympanic membrane or ossicular chain and thus lead to conductive hearing loss.
Avulsion of the anomalous facial nerve at stapedectomy
Authors: Welling D. Bradley , Glasscock Michael E. , Gantz Bruce J.
Published: October 2006

Injury to the facial nerve in an anomalous location overlying the oval window at the time of stapedectomy has rarely been reported. The authors recently have encountered three patients with such injuries. The facial nerve was found at the time of reexploration to run directly over the oval window. A fourth patient was explored primarily for a conductive hearing loss and the same anomalous course was discovered. The purpose of this report is to alert the otologic surgeon to this rare but potentially catastrophic anomaly and to review the pertinent embryology and management of these malformations.
Intraoperative measurement of the elastic modulus of the vocal fold. Part 1. Device development
Authors: Berke Gerald S.
Published: October 2006

Although the concept of manipulating laryngeal biomechanics to improve vocal function is not new, there has been a recent proliferation in surgical techniques used to affect laryngeal function. These include methods which increase the stiffness of the vocal folds, medialize the vocal folds, alter the pitch by changing the tension of the vocal folds, and augment the tissues using injection of alloplastic materials. Despite these new and possibly revolutionary methods, no means are presently available to surgeons to intraoperatively evaluate and optimize results of a surgical intervention. This study involved the development of a device to measure the in vivo elastic modulus of the vocal folds.
Intraoperative measurement of the elastic modulus of the vocal fold. Part 2. Preliminary results
Authors: Berke Gerald S. , Smith Marshall E.
Published: October 2006

This paper presents initial clinical experience using a device capable of measuring the transverse elastic modulus of the vocal fold. These initial results indicated that the device may be useful in determining stiffness inequalities between the vocal folds.
Comparison of vasoconstrictors for functional endoscopic sinus surgery in children
Authors: Riegle Elaine V. , Gunter Joel B. , Lusk Rodney P. , Muntz Harlan R. , Weiss Karen L.
Published: October 2006

Three different vasoconstricting agents were evaluated during functional endoscopic sinus surgery (FESS) in 57 children. Oxymetazoline hydrochloride 0.05%, phenylephrine hydrochloride 0.25%, or cocaine 4% was applied to the nasal mucosa in a prospective, randomized, double‐blind fashion. Heart rate and blood pressure changes were recorded 5 and 10 minutes after application of the study vasoconstrictor to each nostril. The surgeon's subjective impressions of bleeding and visualization were recorded for each side of the nose, as were total blood loss and anesthesia time. Although all three vasoconstrictors were tolerated well by the children, there was a suggestion that heart rate decreased more at 5 minutes with phenylephrine than with oxymetazoline or cocaine (P = .08) and that blood pressure increased more at 10 minutes with phenylephrine than with oxymetazoline or cocaine (P = .1). No arrhythmias were noted. Subjective scoring for bleeding showed that children receiving oxymetazoline were less likely to receive scores of “more” bleeding than usual (3/38 vs. 10/34 for phenylephrine and 10/35 for cocaine, P<.02). Subjective scoring for visualization showed that children receiving oxymetazoline were also less likely to receive scores of “worse” visualization than usual (3/38 vs. 12/38 for phenylephrine and 9/35 for cocaine, P<.01). There was no difference in surgical bleeding or visualization between children receiving phenylephrine and children receiving cocaine. In our institution, 0.05% oxymetazoline is the preferred vasoconstrictor for FESS in children.
Biodistribution of rhodamine‐123 in nude mice heterotransplanted with human squamous cell carcinomas
Authors: Castro Dan J. , Haghighat Shaghayegh , Saxton Romaine E. , Reisler Emil , Jongwaard Neva , Castro Donna J. , Ward Paul H. , Lufkin Robert B.
Published: October 2006

Rhodamine‐123 uptake and release was determined in nu/nu mice heterotransplanted with P3 human squamous carcinomas to assess its value as an in vivo laser photosensitizer for treatment of solid tumors. Following intraperitoneal injection of Rh‐123 (1 μg/g of body weight), mice were killed at 2, 4, 6 and 24 hours, and 3 and 7 days postinjection. The peak concentrations of Rh‐123 per milligram of tissue measured by fluorescence spectrophotometry was distributed as follows: kidneys>spleen>intestine> stomach>liver>tumor>skin>skeletal muscles> lung>heart>blood>brain. No preferential uptake or retention of Rh‐123 by tumors was observed. However, a longer retention with higher concentrations of the dye was seen in normal skin as opposed to P3 tumors from 4 hours to 7 days postinjection with Rh‐123. The elimination of Rh‐123 was rapid, with the dye falling to less than 2% of peak concentration at 7 days postinjection. Knowledge of Rh‐123 biodistribution in tumors and other tissues suggests that optimal timing after injection of this dye may allow selective photodiagnosis and photodynamic therapy of tumors with the argon laser.
Postoperative radiation therapy for cervical lymph node metastases from an occult squamous cell carcinoma
Authors: Maulard C. , Housset M. , Brunei P. , Huart J. , Ucla L. , Rozec C. , Delanian S. , Baillet F.
Published: October 2006

One hundred thirteen patients with cervical metastases from a squamous cell carcinoma and no evidence of the primary tumor were treated for cure by surgery and routine large'field postoperative irradiation. Patients were staged according to the 1987 American Joint Committee on Cancer (AJCC) classification. There were 24 N1, 54 N2, 29 N3, and 6 Nx lesions. One hundred four patients underwent cervical lymph node dissection and 9 had adenectomy. All patients received postoperative external beam therapy to the entire naso'oro‐pharyngo'larynx and all cervical lymphatics. The overall nodal failure rate was 13.7%. Nodal failure was significantly correlated with N staging (P = .01) and with the number of histologically involved nodes (P = .05). Nodal failure was 21% when nodes were initially fixed versus 7.5% when they were not (P = .07) and 18% when there was extracapsular spread versus 4.3% when the capsule was intact (P = .11). Eleven patients (9.7%) developed a subsequent primary lesion. In 3 patients (2.6%), this primary was located in the previously irradiated area and, in 2 cases, under the anterior block of lateral fields. Metastases occurred in 18 patients (16%). The five'year overall survival rate was 38%. Survival was correlated with N staging (P > .02), nodal fixation (P = .05), extracapsular spread (P = .01) and loosely with the number of histologically involved nodes (P = .08). On the contrary, histological differentiation did not influence the local control rate, nor the development of metastases or subsequent primary lesions. Large'field prophylactic radiation therapy appears to be effective in preventing the emergence of initially occult primary lesions. However, control of disease in the neck and survival remain disappointing in patients with advanced nodal disease, even after combined surgery and radiation therapy.
Neoplastic infiltration of laryngeal cartilages: Histocytochemical study
Authors: Gallo A. , Mocetti P. , De Vincentiis M. , Simonelli M. , Ciampini S. , Bianco P. , Bonucci E.
Published: October 2006

The relationship between cartilage and invading neoplastic cells was studied in 32 cases of laryngeal cancer by histological and cytochemical methods. Cartilage invasion was present in 12 cases, 10 of which were in proximity or in contact with areas of calcification and ossification. It was significantly correlated only to tobacco consumption (P <.05) and, in regard to glottic tumors, to tumor diameter greater than 3 cm (P <.01). Histologically, neoplastic invasion in cartilage was massive in 2 cases, occurred in areas of ossification in 4, between cartilage and bone in 4, and in epiglottic cartilage in 2. In 3 of the cases with bone invasion, there was also new bone formation. Hyaline cartilage and bone resorption was due to tartrate'resistant acid phosphatase (TRAP)‐positive giant cells; in epiglottic cartilage only mononuclear cells were present, some of which were TRAP'positive. These results show that neoplastic cells can promote not only resorption and formation of bone, but also resorption of cartilage, which is considered resistant to neoplastic invasion. The different types of resorbing cells in contact with hyaline cartilage and bone in laryngeal cancer, and elastic cartilage in epiglottic cancer, suggest that the structure of the tissue being resorbed can influence the type of resorbing cells.
Innervation of the paralyzed laryngeal muscles by phrenic motoneurons. A quantitative study by light and electron microscopy
Authors: Baldissera F. , Tredici G. , Marini G. , Fiori M. G. , Cantarella G. , Ottaviani F. , Zanoni R.
Published: October 2006

In the cat, inspiratory opening of the paralyzed glottis recovered after unilateral or bilateral reinnervation of the posterior cricoarytenoid (PCA) muscles by phrenic axons. The morphometric analysis of the regenerated recurrent laryngeal nerves (RLNs), showed that proliferation was abundant; 4 months after the nerve anastomosis, more than 500 myelinated axonal branches repopulated the RLNs. The mean diameter of motor axons (3.5 to 5.0 μm) was lower than in normal phrenic and RLN (8 to 10 μm), and the mean internode length was about half that of the normal RLN. Histochemical examination of the PCA muscle revealed that muscle fiber composition (44% type I and 56% type II muscle fiber) was fairly similar to that of normal PCA. The contraction time of the reinnervated muscles was as long as 60 msec at the time of movement recovery, but it shortened to 25 to 30 msec when the reinnervation time increased. These anatomical and functional results support the choice of the phrenic nerve for laryngeal reinnervation.
Immunohistochemical study of c‐erbB‐2 oncoprotein overexpression in human major salivary gland carcinoma: An indicator of aggressiveness
Authors: Sugano Sumio , Mukai Kiyoshi , Tsuda Hitoshi , Hirohashi Setsuo , Furuya Shuichiro , Shimosato Yukio , Ebihara Satoshi , Takeyama Isamu
Published: October 2006

In order to analyze the correlation between immunohistochemical positivity for c‐erbB‐2 oncoprotein and prognosis in patients with malignant salivary gland tumors, 59 cases of malignant tumors of the major salivary glands, including 35 parotid gland, 20 submaxillary gland and 4 sublingual gland tumors, were studied immunohistochemically using a polyclonal antibody against c‐erbB‐2 oncoprotein. Positive staining was observed in 13 (22%) of the 59 cases. Interestingly, positive results were obtained only in adenocarcinoma (6/20) and carcinoma in pleomorphic adenoma (7/15), and not in any other histological types such as adenoid cystic carcinoma, mucoepidermoid tumor, and squamous cell carcinoma. There was no correlation between the degree of differentiation of adenocarcinoma and c‐erbB‐2 positivity. Since the carcinoma in pleomorphic adenoma positive for c‐erbB‐2 oncoprotein was adenocarcinoma, adenocarcinoma and adenocarcinoma in pleomorphic adenoma were placed together (n = 33), and the presence or absence of c‐erbB‐2 oncoprotein in this group was examined for correlation with patients' survival and other clinicopathological features, including clinical stage, tumor size, surgical margins, and lymph node status. The c‐erbB‐2‐positive tumors tended to be more advanced and larger than negative tumors. Similarly, c‐erbB‐2‐positive tumors were difficult to resect completely, were associated with lymph node metastasis more frequently, and showed lower disease'free survival than negative cases (P <.05). We conclude that immunohistochemical positivity for c‐erbB‐2 is an indicator of aggressiveness in both adenocarcinoma and adenocarcinoma in pleomorphic adenoma of the major salivary glands.
Juvenile nasopharyngeal angiofibroma contain an angiogenic growth factor: Basic FGF
Authors: Schiff Maurice , Gonzalez Ana'Maria , Ong Michael , Baird Andrew
Published: October 2006

The presence of an angiogenic protein basic fibroblast growth factor (FGF) was established in juvenile nasopharyngeal angiofibroma (JNF). Extracts of these tumors have the capacity to stimulate endothelial cell proliferation. This activity is indistinguishable from basic FGF. The biological activity contained in the extracts binds to heparin'Sepharose columns and is eluted with a characteristic 2 mol sodium chloride. The exact fraction of the biological activity corresponds to the location where an inununoreactive basic FGF can be detected by radioimmunoassay. These same fractions contain an 18,000‐d molecule which is identified by sodium dodecyl sulfate'polyacrylamide gel electrophoresis (SDS'PAGE) and immunoblotting with an antibody to basic FGF. Indeed, immunohistochemical studies localize the growth factor to the endothelium of JNF. Although these findings do not establish that basic FGF mediates the development of this angiofibroma, they do support the possibility that the pathogenesis of JNF is associated with the presence of angiogenic factors like basic FGF. If this is the case, a comprehensive study of the etiology of JNF may lead to a better understanding of how locally produced growth factors mediate proliferative disease and how its modification might lead to better treatment on a biological basis.
Percutaneous endoscopic gastrostomy in the management of head and neck carcinoma
Authors: Gibson Sharon , Wenig Barry L.
Published: October 2006

In patients undergoing resection of head and neck malignancies, structural and functional deficits commonly preclude adequate oral nutrition and prolong hospital stay. To address this issue, the benefit of routine preoperative placement of percutaneous endoscopic gastrostomy (PEG) was studied in a group of these patients. The postoperative course of 89 patients undergoing primary resection of advanced (stage III and IV) squamous cell carcinomas of the upper aerodigestive tract was examined. The hospital stay was reduced by up to 61% with PEG compared to hospital stay with standard nasogastric tube (NGT) alimentation. The difference was statistically significant for primary sites involving the larynx and pharynx, but not for lesions of the oral cavity. For tongue base tumors, there was a trend toward reduced hospitalization which did not reach statistical significance. The fistulization rate was unchanged. The complication rate for PEG was 5%, and morbidity was less with PEG than with NGT. The authors recommend the preoperative placement of PEGs for all patients with advanced carcinomas of the larynx, hypopharynx, and oropharynx.
Nasal airway dilation and obstructed breathing in sleep
Authors: Metes Agnes , Cole Philip , Hoffstein Victor , Miljeteig Harald
Published: October 2006

Nasal respiratory airflow resistances of awake snorers averaged 0.188 ± 0.165 Pa/cm3/s (N = 306) and were not elevated beyond the normal range (< 0.25 Pa/cm3/s). Resistances were decreased substantially from a mean of 0.164 ± 0.128 to 0.065 ± 0.037 Pa/cm3/s (N = 72) by a nasal vestibular dilator (Nozovent). Effects of the dilator on breathing disorders in sleep were determined by polysomnography recordings that included frequency, duration and intensity of snoring, apneas, hypopneas, and oxygen saturation in 10 heavy snorers while asleep with and without the dilator in situ over periods of several hours. No significant changes were detected in these parameters in any stage of sleep.
Malignant parotid tumors in 110 consecutive patients: Treatment results and prognosis
Authors: Pedersen Dorte , Overgaard Jens , Søgaard Helmer , Elbrønd Ole , Overgaard Marie
Published: October 2006

The UICC 1987 classification system was used to retrospectively analyze the treatment results and prognostic factors in 110 consecutive patients. All of the patients had malignant parotid tumors which had been diagnosed and treated during the period from 1970 to 1986. Treatment consisted of surgery, radiotherapy, or a combination. Malignant mixed tumors were seen in 28% of the patients, mucoepidermoid tumors in 18%, adenoid cystic tumors in 15%, acinic tumors in 13%, undifferentiated tumors in 11%, adenocarcinomas in 10%, and other types in 5%. Ten‐year corrected survival rate was 52%, and significant differences of survival were found between: 1. patients with disease stages I through IV (I: 85%; II: 69%; III: 43%; IV: 14%); 2. those with local tumor extension (34%) and without local tumor extension (79%); 3. patients with facial nerve palsy (0%) and without facial nerve palsy (57%); and 4. those with low‐ or intermediate‐grade malignant tumors (69% combined) and those with high‐grade malignant tumors (30%). After primary treatment, 45% of the patients were cured, and, additionally, 22% were salvaged after local or neck node recurrences.

It is concluded that there is a good correlation between TNM classification of UICC 1987 (stage and local extension of tumor) and prognosis, and that facial nerve palsy and grade of malignancy are important prognostic factors.
Preservation of hearing and facial nerve function in resection of acoustic neuroma
Authors: Nadol Joseph B. , Chiong Charlotte M. , Ojemann Robert G. , Mckenna Michael J. , Martuza Robert L. , Montgomery William W. , Levine Robert A. , Ronner Steven F. , Glynn Robert J.
Published: October 2006

The surgical results in 78 recent cases of total removal of unilateral acoustic neuroma in which an attempt was made to preserve cochlear function have been added to the authors' previous series of 66 cases to evaluate the factors influencing the ability to preserve useful hearing. Useful hearing was defined by speech reception threshold no poorer than 70 dB and a discrimination score of at least 15%. Analysis using a logistic regression model showed that certain preoperative clinical parameters such as tumor size, speech discrimination score, and gender were significantly correlated with hearing outcome. Favorable outcome was significantly correlated with smaller tumor size, higher preoperative speech discrimination score, and male sex. From this data, an explicit formula was devised for predicting hearing outcome for an individual patient. In four cases with useful hearing preserved, there was improvement of greater than 15 percentage points in speech discrimination scores.

While preoperative auditory brainstem responses were not predictive of hearing preservation, monitoring of intraoperative auditory evoked potentials was predictive of hearing outcome in selected cases. Specifically, when wave V was unchanged at the end of the operation, even if it may have been transiently lost during surgery, useful hearing was invariably preserved.
Same‐day‐stay head and neck surgery
Authors: Helmus Christian , Grin Mina , Westfall Rolleen
Published: October 2006

The purpose of this study was to determine if selective head and neck surgical procedures on a same‐day basis are justifiable. Two hundred consecutive head and neck same‐day procedures were reviewed, including 84 parotidectomies and 116 other procedures previously managed as inpatients. Of the 200 patients, 36 (18%) were admitted, 33 for overnight observation, and 164 (82%) were discharged the same day. There were no complications reported in the discharged patients and a later questionnaire showed that 97% of the patients were satisfied. The advantages of selective same‐day procedures outweigh the disadvantages for otolaryngologist and patient.

The study shows that same‐day‐stay head and neck surgery for selective procedures is safe, reasonable, and cost‐effective, but the combined efforts of the otolaryngologists, nurses, and administrators are required. Because of rising healthcare costs, experts are predicting a significant increase in the next few years of outpatient surgery, including surgery of the head and neck.
Classification of laryngotracheal stenosis
Authors: V. McCaffrey Thomas
Published: October 2006

Seventy‐two cases of laryngotracheal stenosis treated from 1981 through 1991 were reviewed to develop a system of classification which wouldbe useful in predicting the outcome of treatment. Decannulation and absence of dyspnea after exertion were the criteria of successful management. The probability of decannulation over time was computed using the Kaplan‐Meier technique. Cox multiple regression analysis was used to determine the effects of independent variables (age, sex, etiology, site of stenosis, length of stenosis, diameter of stenosis, and surgical technique) on treatment success. The only factors with a significant effect on the outcome were site of stenosis and diameter of stenosis. A classification into four clinical stages of stenosis based on site of lesion was shown to effectively predict the likelihood of successful decannulation.
The management of subglottic stenosis in patients with wegener's granulomatosis
Authors: Lebovics Robert S. , Hoffman Gary S. , Leavitt Randi Y. , Kerr Gail S. , Hallahan Claire , Rottem Menachem , Fauci Anthony S. , Travis William D. , Kammerer William
Published: October 2006

Wegener's granulomatosis (WG) is a multisystem inflammatory disease characterized by vasculitis, granuloma formation, and necrosis. Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life‐threatening. Sixteen (80%) of 20 patients with fixed SGS required surgical intervention, including manual dilations, carbon‐dioxide laser resections, and laryngotracheoplasty (LTP). LTP was performed with and without microvascular reconstruction. Thirteen of the patients required tracheostomy and all 13 were ultimately decannulated. Five patients who repeatedly failed dilations and/or endoscopic laser surgery underwent LTP. Since 1987, two patients have undergone LTP with microvascular free flaps. Both patients were subsequently decannulated. The authors' experience demonstrates that management of SGS in WG is complex, requiring individualized frequent multimodality interventions to achieve satisfactory results. Microvascular laryngotracheal reconstruction should be considered in the surgical armamentarium for patients with persistent stenoses.
Surgical management of the thyroid nodule: Patient selection based on the results of fine‐needle aspiration cytology
Authors: Bouvet Michael , Feldman Jeffrey I. , Nahum Alan M. , Robbins K. Thomas , Gill Gordon N. , Dillmann Wolfgang H. , Russack Valentina
Published: October 2006

To determine whether the routine use of fine‐needle aspiration (FNA) cytology reduces the rate of unnecessary surgery, the surgical pathology of 54 thyroidectomy patients who had preoperative FNA was compared to the results obtained with 24 thyroidectomy patients who did not have preoperative FNA.

Twenty‐nine (85.3%) of the 34 patients who had a positive FNA were confirmed by histology to have a thyroid neoplasm; in 24 patients, the neoplasm was malignant. Two of the 17 patients who had a negative FNA but underwent thyroidectomy based on other factors were found to have thyroid cancer. Only 8 (33.3%) of the 24 surgical specimens of patients who did not have an FNA were found to be malignant. FNA had a sensitivity of 93.5% and a specificity of 75.0%.

The results indicate that the routine use of FNA for patients with thyroid nodules reduces the incidence of unnecessary surgery. Furthermore, FNA alone is sufficient to identify most patients at risk and is, therefore, cost‐effective. However, the presence of other findings suspicious of malignancy should preclude clinical decision making based on FNA alone.
Petrous apex cholesteatoma: Diagnostic and treatment dilemmas
Authors: Atlas Marcus D. , Moffat David A. , Hardy David G.
Published: October 2006

The diagnosis and treatment of petrous apex cholesteatoma is a difficult surgical challenge. This study is a review of 14 cases of cholesteatoma involving the petrous apex. These cholesteatomas originated as a congenital primary lesion or secondary to an acquired lesion. The cases were evaluated according to the clinical features, the intraoperative findings, the radiological findings, and the surgical approaches. In this series, 83% of the patients presented with hearing loss and 50% presented with facial nerve weakness or paralysis ←House grade II to VI→. Intraoperative and radiological features revealed frequent direct labyrinthine and supralabyrinthine cell spread. The transpetrous surgical approach was used in all cases. The main factors affecting the surgical approach to be adopted are the inaccessible nature of the petrous apex, the extent of disease, the degree of facial nerve function, and the need for the prevention of cerebrospinal fluid leaks and the recurrence of the lesion.
Amyloid of the facial nerve
Authors: Braganza Rabindra A. , Tien Robert , Hoffman Henry T. , Haghighi Parviz H.
Published: October 2006

Although facial nerve paralysis has been reported in association with amyloidosis, histologic confirmation of facial nerve involvement with amyloid has not been previously demonstrated. A case of localized primary amyloidosis of the facial nerve is presented, and a new magnetic resonance technique for imaging the facial nerve is described.
Complementary and Alternative Therapies for the Management of Dyslipidemia
Authors: Nies Leslie K , Cymbala Alicia A , Kasten Sheila L , Lamprecht Donald G , Olson Kari L
Published: October 2006

Objective:

To review the literature on select alternative therapies for the management of dyslipidemia.

Data Sources:

Searches of MEDLINE and PubMed (1965–March 2006) were conducted using the key terms omega-3-fatty acids, policosanol, plant stands and sterols, flaxseed, red yeast rice, guggulipid, garlic, fiber, almonds, and cholesterol and/or lipids.

Study Selection and Data Extraction:

Meta-analyses, published in English and involving adults, that incorporated randomized, controlled trials on alternative therapies for dyslipidemia were reviewed. Additionally, trials published subsequent to the meta-analyses were reviewed. Articles deemed relevant were included in this review.

Data Synthesis:

Of the aforementioned alternative therapies, randomized controlled trials were found for omega-3-fatty acids, policosanol, plant stanols and sterols, flaxseed, red yeast rice, guggulipid, garlic, fiber, almonds, and soy. Studies for each of these agents report varying degrees of lipid reduction. Based on published data, effective therapeutic options for lipid-lowering include intake of fiber, intake of plant stanols/sterols, replacement of animal protein with soy protein, and substitution of foods high in saturated fat with those with monounsaturated fatty acids (eg, dry roasted almonds). Adding omega-3-fatty acids is effective for reducing triglycerides in patients with hypertriglyceridemia. Well-designed studies with long-term outcome data are necessary to further define the role for guggul, red yeast rice, policosanol, garlic, and flaxseed in the management of dyslipidemia.

Conclusions:

Alternative therapeutic approaches with complementary therapies are becoming increasingly popular among patients. It is important for healthcare providers to be familiar with the safety and efficacy of these agents to facilitate optimal outcomes for patients with dyslipidemia.