bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Treatment Results for Floor‐of‐Mouth Cancer
Authors: Sessions Donald G. , Spector Gershon J. , Lenox Jason , Parriott Sarah , Haughey Bruce , Chao Clifford , Marks James , Perez Carlos
Published: November 2003

Objective This study reports the results of treating floor‐of‐mouth cancer with five different treatment modalities with long‐term follow‐up.

Study Design Retrospective study of 280 patients with floor‐of‐mouth cancer treated in the Department of Otolaryngology—Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994.

Methods Patients with biopsy‐proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance.

Results The overall 5‐year disease‐specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5‐year cumulative disease‐specific survival (CDSS) was 0.61 (Kaplan‐Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty‐eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers.

Conclusions Significantly improved 5‐year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5‐year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cN0) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.
Efficacy of Concomitant Chemoradiation and Surgical Salvage for N3 Nodal Disease Associated With Upper Aerodigestive Tract Carcinoma
Authors: Ahmed Khwaja A. , Robbins Kevin T. , Wong Frank , Salazar Jorge E.
Published: November 2003

Objectives/Hypothesis To determine whether an aggressive approach using trimodality therapy would improve the outcome in head and neck cancer patients with advanced (N3) nodal disease.

Study Design In this retrospective, nonrandomized review, we analyzed a subset of patients who were treated in a targeted chemoradiation therapy protocol, consisting of 31 patients who received treatment between June 1993 and June 1997.

Methods Patients received selective intra‐arterial infusions of cisplatin (150 mg/m2/wk for 4 weeks) and concomitant radiation therapy (2 Gy/fraction × 35 daily fractions over a 7‐wk period) to the primary and clinically positive nodal disease. The patients were re‐evaluated 2 months later and underwent salvage neck dissections if there was any residual disease.

Results Classification of disease in the primary site was as follows: T1 in 2 patients, T2 in 6 patients, T3 in 14 patients, and T4 in 9 patients. Among the 31 patients who were assessed for response at the nodal site, 4 of 31 (13%) had a complete response, 21 of 31 (68%) had a partial response, and 1 of 31 (3%) had no response. Excluding the 5 patients who could not be evaluated, 4 of 26 patients (15%) had a complete response, 21 of 26 (81%) had a partial response, and 1 of 26 (4%) had no response. Nineteen patients subsequently underwent neck dissection, and five patients had histological evidence of residual disease. The remaining seven patients included four who had a complete response in their necks and three who died of intercurrent disease before re‐staging. Among the 23 patients who were rendered disease free, there were no recurrences within the neck, whereas 1 patient had recurrence at the primary site and 11 patients had recurrence at distant sites. With a median follow‐up of 15 months (range, 4–41 mo), the 3‐year overall survival and disease‐specific survival were 41% and 43%, respectively.

Conclusions Targeted chemoradiation therapy followed by surgical salvage is a highly effective approach for regional control of patients with N3 nodal disease, whereas additional strategies are required to address the problem of distant metastases.
A Prospective Study of the Effects of Irradiation on the Carotid Artery
Authors: Muzaffar Kamil , Collins Sharon L. , Labropoulos Nicos , Baker William H.
Published: November 2003

Objectives/Hypothesis To prospectively assess the effects of irradiation on the carotid artery in patients with head and neck cancer, as a possibly relevant factor in cancer treatment planning.

Study Design Prospective study from a tertiary care academic setting on university (22 patients) and Veterans Affairs (14 patients) hospital patients; 1‐year follow‐up, including comparison of study data with age‐matched and sex‐matched control subjects from epidemiological studies.

Methods Thirty‐si‐ patients with head and neck cancer who underwent therapeutic neck irradiation were e‐amined by high‐resolution ultrasound before and 1 year after treatment. Twelve patients were also studied at 2 years. Measurements included the intima‐media thickness (IMT) of the carotid artery wall, the degree of stenosis as estimated from velocity measurements, and the presence and size of plaque.

Results The pretreatment carotid IMT at baseline was 0.68 mm and was comparable to age‐matched and se—matched control subjects. Significant increase in the IMT was observed on both the left (0.67 vs. 0.84 mm) and the right (0.7 vs. 0.87 mm) sides (P < .001) 1 year after irradiation. In 12 patients who completed 24 months of follow‐up the carotid IMT continued to significantly increase statistically compared with that at the first year after treatment (left side, 0.79 vs. 0.85 mm, P = .037; right side, 0.79 vs. 0.95 mm, P = .014). Statistically significant thickening of the carotid wall developed in all 36 patients by 1 year. Two patients experienced post‐treatment neurological events and an area of stenosis greater than 75%.

Conclusions Neck irradiation significantly increases the thickness of the carotid wall during the first year after treatment—on average, 21 times more than in epidemiologically matched control volunteers. This phenomenon should be taken into consideration when planning treatment for the node‐negative (N0) neck.
Tumor Growth and Audiometric Change in Vestibular Schwannomas Managed Conservatively
Authors: Massick Douglas D. , Welling D. Bradley , Dodson Edward E. , Scholfield Minka , Nagaraja Haikady N. , Schmalbrock Petra , Chakeres Donald W.
Published: November 2003

Objective To prospectively define the correlation between changes in tumor volume and audiometric function in vestibular schwannomas managed conservatively.

Study Design Prospective longitudinal study.

Methods Twenty‐one patients (age range, 15–84 y; mean age, 63.3 y) with newly diagnosed vestibular schwannomas were enrolled between 1994 and 1999 in a protocol at The Ohio State University Hospital (Columbus, OH) to evaluate the correlation between tumor volume and audiometric change during a period of observation. Patients were evaluated yearly by clinical examination, a standardized internal auditory canal magnetic resonance imaging scan with gadolinium contrast for volumetric analysis, and audiometric function testing. Demographic data, historical features, neurofibromatosis type 2 (NF2) status, initial testing results, and serial testing results were recorded.

Results An increase in tumor volume occurred in 14 of the 21 patients (66%). The pattern of volumetric change was found to be e‐tremely variable. Multiple regression analysis revealed significant correlations of changes in tumor volume with changes in pure‐tone average and speech discrimination score (P < .0001 and P = .0021, respectively). Change in tumor volume had greater effect on pure‐tone average and speech discrimination score in patients initially with class D audiometric function when compared with those initially in class A (P = .0083 and P = .0245, respectively). The presence of NF2 had an independent protective effect against deterioration of the pure‐tone average when compared with patients without NF2 (P = .0125).

Conclusions This study demonstrated a significant correlation between a change in volume and auditory deterioration in vestibular schwannomas being managed with a trial of observation. A given change in tumor volume appeared to have a greater effect on pure‐tone average and speech discrimination score as initial auditory classification declined.
Developmental Expression of Aquaporin 2 in the Mouse Inner Ear
Authors: Merves Michele , Bobbitt Bradley , Parker Kenneth , Kishore Bellamkonda K. , Choo Daniel
Published: November 2003

Objectives The maintenance of endolymph homeostasis is critical for the inner ear to perform its functions of hearing and maintaining balance. The identification and cloning of aquaporins (a family of water channel proteins) has allowed the study of a novel cellular mechanism potentially involved in endolymph homeostasis. The objective of the present study was to define the developmental temporal and spatial e‐pression pattern of aquaporin 2 (Aqp2) in the developing mouse inner ear.

Study Design A systematic immunohistochemical study of Aqp2 protein e‐pression was performed on embryonic mouse inner ears ranging from embryonic day 10 (otocyst stage) to embryonic day 18 (just before birth).

Methods Serial cryosections of embryonic mouse inner ears were used for immunohistochemical e‐periments. A rabbit polyclonal antisera raised against a synthetic Aqp2 peptide was used with a standard nickel intensified 3,3‐diaminobenzidine reaction protocol for immunolocalization of Aqp2 in tissue sections.

Results Aquaporin 2 is e‐pressed diffusely in the early otocyst, then becomes progressively restricted as the inner ear matures. During early cochlear duct formation (embryonic days 12 and 13), e‐pression of Aqp2 is homogeneous; later, it becomes restricted to specific regions of the endolymphatic compartment (embryonic days 15 and 18). Similar restriction of e‐pression patterns could be noted for the vestibular structures. Endolymphatic duct and sac and stria vascularis e‐pression of Aqp2 was noted to occur fairly late during development but demonstrated a distinct pattern of immunolabeling.

Conclusions Aquaporin 2 shows an early and specific pattern of e‐pression in the developing mouse inner ear, suggesting a significant role for this water channel protein in the development of endolymph homeostasis and meriting further functional studies of Aqp2 in the inner ear.
Biodegradable External Tracheal Stents and Their Use in a Rabbit Tracheal Reconstruction Model
Authors: Robey Thomas C. , Eiselt Petra M. , Murphy Hedwig S. , Mooney David J. , Weatherly Robert A.
Published: November 2003

Objectives/Hypothesis To design and develop an e‐ternal biodegradable tracheal stent for use in airway reconstructive surgery.

Study Design E‐perimental model.

Methods Biodegradable e‐ternal tracheal stents were fabricated from polyglycolic acid and poly(D,L‐lactide‐co‐glycolide) (85:15). In vitro studies were performed to analyze the mechanical properties and degradative characteristics of these stents. Then the stents were tested in vivo in an anterior tracheal reconstruction model in New Zealand white rabbits.

Results The average dry modulus for the e‐ternal stents was 1800 kilopascal (kPa). All of the e‐ternal stents cracked by 4 weeks in buffer solution. Significant mass loss was not appreciated until after 10 weeks in solution, but by 20 weeks the stents were nearly 100% degraded . In the in vivo portion of the study, the attrition rate for the control group was 23.1% versus 50% for the external stent group. The stridor rate was approximately 38% for both groups . Of the rabbits that survived the entire 3 months of the study, the stented group, when measured by a balloon catheter method, had more patent airways than the control group, with an average stenosis of 27.8% versus 47.2%, respectively (P < .05). However, more accurate postmortem cast measurements of the internal airways did not confirm this.

Conclusions The e‐ternal biodegradable tracheal stent employed in this study degraded in a predictable fashion and may provide a new method to augment surgical reconstruction of the anterior tracheal wall.
Hearing Results After Primary Cartilage Tympanoplasty
Authors: Gerber Matthew J. , Mason John C. , Lambert Paul R.
Published: November 2003

Objectives/Hypothesis Cartilage–perichondrium grafting of the tympanic membrane has been used in an effort to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties. Few studies in the literature address hearing results after cartilage tympanoplasty. The purpose of this study was to investigate the hearing results after primary cartilage tympanoplasty and compare them with results after primary tympanoplasty with temporalis fascia.

Study Design A retrospective review of all ear surgeries using cartilage between 1994 and 1999 was performed.

Methods Only primary cases in which the ossicular chain was intact and no mastoid surgery was performed were included. Indications for surgery included tympanic membrane perforation, retraction, and cholesteatoma. Pre‐ and postoperative speech reception thresholds and air–bone gaps at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz were compared.

Results Eleven patients comprised the cartilage study group, and there were 11 age‐ and temporally matched control subjects. The mean improvement in speech reception threshold for both the study group and the control group was 10 dB. The majority of patients in both groups had ABG closure to within 10 dB at all frequencies examined. There were no statistically significant differences in speech reception threshold improvement or air–bone gap closures between the two groups.

Conclusions These results demonstrate that hearing results after cartilage tympanoplasty are comparable to those after temporalis fascia tympanoplasty. Therefore, when indicated, a cartilage–perichondrium graft can be used for prevention of disease recurrence or progression without fear of impairing hearing.
Evaluating the Effects of Oral Prednisolone on Recovery After Tonsillectomy: A Prospective, Double‐Blind, Randomized Trial
Authors: Palme Carsten E. , Tomasevic Predrag , Pohl David V.
Published: November 2003

Objectives To investigate the role of a 7‐day course of oral prednisolone on recovery from tonsillectomy.

Study Design Double‐blind, randomized, placebo‐controlled trial of 50 consecutive patients, aged 5 years and older, who had no previous or known contraindications to steroid therapy.

Method The patients were randomized at the time of surgery to either a 7‐day course of daily placebo or prednisolone (dosage: 10 mg per day in patients aged 5–11 y, 0.5 mg/kg in those aged 12 and older). Age, sex, weight, diagnosis, tonsil size (in cm2), additional adenoidectomy, performing surgeon, method of dissection, length of procedure, total blood loss, intraoperative fluid requirement, and length of hospitalization were documented for each patient. During the first postoperative day, morning pain score, paracetamol use, oral fluid intake, temperature, presence of nausea and vomiting, level of activity (low, moderate, or normal), and type of diet (liquid, soft, or normal) were recorded.

Results The steroid group consisted of a greater number of diathermy dissection cases and had significantly less intraoperative blood loss (P value = .022 and .017, respectively). On postoperative days 4 to 7, the steroid group experienced less nausea and vomiting (P value = .01, .04, .04, and .04, respectively). Paracetamol use was less in the steroid group on days 2, 7, and 8 (P value = .03, .02, and .02, respectively). There was no difference between the two groups for the other data measured.

Conclusion A 7‐day course of corticosteroids may play a limited role in patients' recovery from tonsillectomy.
Endoscopic Staple‐Assisted Esophagodiverticulostomy: An Excellent Treatment of Choice for Zenker's Diverticulum
Authors: Cook Raymond D. , Huang Patti C. , Richstmeier William J. , Scher Richard L.
Published: November 2003

Objectives The objectives of the present study are to review the technique of endoscopic staple‐assisted esophagodiverticulostomy (ESED) for the treatment of Zenker's diverticulum and to describe our e‐perience and modifications with ESED and the advantages of ESED over previous treatments of Zenker's diverticulum.

Study Design Retrospective review of 74 cases of ESED performed for the treatment of Zenker's diverticulum.

Methods Patient's records were retrospectively reviewed and tabulated for age, se‐, size of diverticulum, symptoms, duration of symptoms, operative time, length of postoperative hospital stay, oral intake, complications, and relief of symptoms.

Results The senior author (r.l.s.) previously reported results in 36 cases of ESED performed in 34 patients with Zenker's diverticulum. We have performed an additional 38 cases of ESED in 37 patients between March 1997 and August 1999. The rate of success of ESED was similar between the two series. The average perioperative time, time until oral intake, and length of postoperative hospital stay decreased in the second series. Overall, there were no mortalities and few complications with ESED. Compared with other forms of treatment of Zenker's diverticulum, such as Dohlman's procedure, diverticulectomy, and diverticulopexy, ESED has a similar rate of success, decreased perioperative time, decreased convalescence, and decreased mortality and complications.

Conclusions Cost‐effectiveness, safety, and efficacy of ESED offer new advantages over previously used treatments for Zenker's diverticulum. These results continue to support the use of ESED as the initial treatment of choice for patients with Zenker's diverticulum.
Investigative Modalities of Mandibular Invasion by Squamous Cell Carcinoma
Authors: Acton Caroline H. C. , Layt Craig , Gwynne Ray , Cooke Robin , Seaton David
Published: November 2003

Objectives/Hypothesis To compare preoperative investigations with histological findings in squamous cell carcinoma (SCC) of the oral mucosa that abuts the mandible. Both clinical and radiological examinations fail to predict accurately invasion of the mandible by intraoral SCC.

Study Design This two‐part, prospective study is of a consecutive series of patients whose first malignancy of the upper aerodigestive tract abutted the lingual surface of the mandible.

Methods All patients presented to the Queensland Radium Institute Head and Neck Clinic between 1993 and 1997 with a biopsy‐proven SCC that abutted the mandible. These tumors were investigated clinically, radiologically, and histologically. Sensitivity, specificity, and predictive values were calculated for various approaches. In the second part of the study, single photon emission computed tomography (SPECT) bone scans were included. Quantification ratios of bone scans compared the average counting statistics in visually identified mandibular abnormal uptake with normal cervical spine and jaw.

Results Sixty‐seven patients were followed for 55 months and assessed with orthopantomogram (OPG), computed tomography (CT) scans, and, in the second part of the study, SPECT bone scans. Thirty‐six tumors showed histological evidence of bony invasion. Bony involvement was suggested by OPG in 36 and confirmed histologically in 27 patients. CT scans showed evidence of bone invasion in 22 cases, with 18 of these histologically confirmed. Technetium 99m methylene diphosphonate (MDP) bone scans with planar imaging and SPECT were performed in 24 patients, and histological appearance was suitable for analysis in 14. Three patients with tumor (cervical spine ratios greater than 1.5 predicting malignant involvement) had this confirmed histologically.

Conclusions The first part of the study confirms our hypothesis that currently used investigations, as well as clinical assessment, fail to predict accurately invasion of the mandible by intraoral SCC. The second part suggests that SPECT scanning with high quantification ratios is promising in the prediction of tumor involvement.
The Relationship Between Microvessel Density, the Expression of Vascular Endothelial Growth Factor (VEGF), and the Extension of Nasopharyngeal Carcinoma
Authors: Guang‐Wu Huang , Sunagawa Masanori , Jie‐En Li , Shimada Seiji , Gang Zeng , Tokeshi Yoshihiro , Kosugi Tadayoshi
Published: November 2003

Objective The present study was aimed at clarifying whether the microvessel density (MVD) and the e‐pression of vascular endothelial growth factor (VEGF) were related to the degree of local invasion and metastasis in nasopharyngeal carcinoma (NPC).

Study Design We measured the MVD and examined whether VEGF was expressed in NPC tissue using histological study combined with immunohistochemistry.

Methods MVD and VEGF expression was measured in 73 specimens of NPC, 15 benign tumors of nasopharyngeal region, and 20 nasopharyngeal tissue without tumor. MVD and VEGF expression in NPC was compared between a metastasis group (49 specimens) and a non‐metastasis group (24 specimens).

Results Both MVD and VEGF expression were markedly increased in NPC tissue as compared with those in benign tumors of nasopharyngeal region. Both MVD and VEGF expression in NPC tissue with metastasis were statistically significantly increased as compared with those in NPC without metastasis. Therefore, the invasion and metastasis of NPC cells were closely related to MVD and the expression of VEGF in NPC tissue.

Conclusion The metastatic potency of NPC tissue and the prognosis of the patients with NPC can be estimated by measuring MVD and the expression of VEGF in NPC tissue. Drugs that have inhibitory actions on angiogenesis could be useful to prevent metastasis of NPC cells in the patients.
Bone Involvement in Sinusitis: An Apparent Pathway for the Spread of Disease
Authors: Perloff Joel R. , Gannon Frank H. , Bolger William E. , Montone Kathleen T. , Orlandi Richard , Kennedy David W.
Published: November 2003

Objectives/Hypothesis To study the effects of bone involvement in experimentally induced sinusitis and the effect of involved bone on the overlying mucosa.

Study Design Animal study.

Methods Sinusitis was induced unilaterally with Pseudomonas aeruginosa in the maxillary sinus of 19 New Zealand white rabbits. At 6 weeks, the pathogenic organism was confirmed by culture, and a segment of the bone from the medial wall of the sinus implanted in a submucosal pocket in the opposite sinus. The rabbits were killed at predetermined time intervals up to 13 weeks from sinusitis induction, and en bloc sinus sections were decalcified and stained.

Results The implanted bone reabsorbed partially or totally in all specimens. However, the study revealed clear histological evidence of bone involvement adjacent to the infected sinuses and the bony changes extended to the noninfected side in all specimens. The histological findings were identical to those seen in chronic osteomyelitis.

Conclusions This study demonstrates the ability for pseudomonal sinusitis, at least in the presence of surgical intervention, to involve bone at a distance from the site of primary infection in the absence of intervening mucosal disease. If confirmed with additional organisms and models, these findings have significant implications for the therapeutic management of chronic sinus disease.
The Diagnosis of a Conductive Olfactory Loss
Authors: Seiden Allen M. , Duncan Heather J.
Published: November 2003

Objectives/Hypothesis Two of the most common causes of olfactory loss include upper respiratory infection (URI) and nasal or sinus disease. The etiology of most URI‐related losses is thought to be viral and, as yet, there is no available treatment. In contrast, nasal or sinus disease produces an obstructive or conductive loss that often responds dramatically to appropriate therapy. Therefore, the distinction is important but in many cases may be difficult because such patients often present with no other nasal symptoms, and routine physical findings may be nonspecific. The purpose of this report is to characterize those aspects of the history and physical examination that will help to substantiate the diagnosis of a conductive olfactory loss.

Study Design A retrospective, nonrandomized study of consecutive patients presenting with a primary complaint of olfactory loss.

Methods This study reviewed 428 patients seen at a university‐based taste and smell clinic from July 1987 through December 1998. Of this total, 60 patients were determined to have a conductive olfactory loss. All patients were referred specifically because of a primary chemosensory complaint. The University of Pennsylvania Smell Identification Test (UPSIT; Sensonics, Inc., Haddon Heights, NJ) was administered in all cases.

Results The most commonly diagnosed etiologies of olfactory loss were head injury (18%), upper respiratory infection (18%), and nasal or sinus disease (14%). Of the 60 patients with a conductive loss, only 30% complained of nasal obstruction, whereas 58% described a history of chronic sinusitis. Only 45% reported that their olfactory loss at times seemed to fluctuate in severity. Anterior rhinoscopy failed to diagnose pathology in 51% of cases, whereas nasal endoscopy missed the diagnosis in 9%. Systemic steroids elicited a temporary reversal of conductive olfactory loss in 83% of patients who received them, offering a useful diagnostic maneuver, whereas topical steroids did so in only 25%.

Conclusions The etiology for olfactory loss can in many cases be difficult to determine, but it is important to establish prognosis and to predict response to therapy. Diagnosis requires a thorough history, appropriate chemosensory testing, and a physical examination that should include nasal endoscopy. A trial of systemic steroids may serve to verify that the loss is indeed conductive.
Local Vasodilator Response to Mobile Phones
Authors: Paredi Paolo , Kharitonov Sergei A. , Hanazawa Toyoyuki , Barnes Peter J.
Published: November 2003

Objectives The use of mobile phones with the resulting generation of potentially harmful electromagnetic fields (EMF) is the focus of public interest. Heat generation and the activation of the inducible form of nitric oxide (NO) synthase may be possible causes of the biological effects of EMF exposure. We investigated if a mobile telephone conversation can modify skin temperature, NO, and nasal resistance.

Methods We studied the effect of an EMF (900 MHz) generated by a commercially available cellular phone during a 30‐minute telephone conversation on skin temperature, nasal NO measured by chemiluminescence, and nasal minimal cross‐sectional area (MCA) measured by rhinometry. Eleven normal subjects (mean age ± standard error of mean [SEM], 32 ± 5 y; 10 male) were studied.

Results There was a similar and significant increase in skin temperature of the nostril and occipital area on the same side as the telephone (maximal increase 2.3 ± 0.2°C at 6 min) as well as a tendency for higher nasal NO levels (maximal increase 12.9 ± 4.9% at 10 min), whereas the MCA was significantly reduced (maximal decrease ‐27 ± 6% at 15 min). Such changes were not recorded when an earpiece was used to avoid the direct exposure to the electromagnetic field. There were no changes in the skin temperature and nasal NO measured on the opposite side to the mobile phone, whereas the MCA was significantly increased (38 ± 10%).

Conclusions Exposure to EMF produced by a mobile phone produces biological effects that can be easily measured. Microwaves may increase skin temperature and therefore cause vasodilation and reduce MCA. Further studies are needed to study the long‐term effects of mobile phone use and the relation among NO production, vasodilation, and temperature.
Botulinum Toxin: Basic Science and Clinical Uses in Otolaryngology
Authors: Blitzer Andrew , Sulica Lucian
Published: November 2003

The role of botulinum toxin as a therapeutic agent is expanding rapidly in otolaryngology. Botulinum toxin is a protease that blocks the release of acetylcholine from nerve terminals. Its effects are transient and nondestructive, and largely limited to the area in which it is administered. These effects are also graded according to dose, allowing for individualized treatment of patients and disorders. Botulinum toxin has been used primarily to treat disorders of excessive or inappropriate muscle contraction. In the field of otolaryngology, these include spasmodic dysphonia, oromandibular dystonia, and blepharospasm; vocal tics and stuttering; cricopharyngeal achalasia; various tremors and tics; hemifacial spasm; temporomandibular joint disorders; and a number of cosmetic applications. Botulinum toxin treatment has recently begun to show some benefit in the control of pain from migraine and tension headache. It may also prove useful in the control of autonomic dysfunction, as in Frey syndrome, sialorrhea, and rhinorrhea. In over 20 years of use in humans, botulinum toxin has accumulated a considerable safety record, and in many cases represents relief for thousands of patients unaided by other therapy.
Immune Dysfunction in Refractory Sinusitis in a Tertiary Care Setting
Authors: Chee Lincoln , Graham Scott M. , Carothers Daniel G. , Ballas Zuhair K.
Published: November 2003

Objective To examine the contribution of the primary immunodeficiency states, which are uncommon in the general population, to refractory sinusitis.

Study Design We retrospectively reviewed the charts of 316 patients with sinusitis who were referred to the Allergy and Immunology Clinic for immunological evaluation from 1991 to 1997.

Methods Of the 316 patients, 79 were selected for further study. Inclusion criteria included at least one sinus surgery and/or sinusitis diagnosed by endoscopy and/or computed tomography (CT) scan at least three times in the previous year. Patients with human immunodeficiency virus (HIV), allergic fungal sinusitis, cystic fibrosis, and primary ciliary dyskinesia were excluded. The results of their immunological evaluation for atopy, T‐lymphocyte function, and immunoglobulin levels were examined.

Results The average age of these 79 patients was 44 years (± 14.5 standard deviation [SD]). They had, on average, 2.94 (± 2.19 SD) previous operations and had mean sinus CT scores (Lund‐McKay) of 11.2 (± 5.0 SD). Forty of 79 (50.6%) patients had at least one positive result on skin test to an aeroallergen. Delayed hypersensitivity skin testing revealed that 22 of 55 patients (40%) were anergic. Of the 60 patients with in vitro T‐lymphocyte function testing, 54.8% showed abnormal proliferation in response to recall antigens, 11.3% had decreased response to alloantigen, and 26.3% demonstrated decreased response to T‐cell mitogens. Determination of quantitative immunoglobulins showed low immunoglobulin G in 14 of 78 patients (17.9%), low immunoglobulin A in 13 of 78 (16.7%), and low immunoglobulin M in 4 of 78 (5.1%). Common variable immunodeficiency (CVID) was diagnosed in 9.9% of patients, and selective IgA deficiency was found in 6.2%.

Conclusions This retrospective review reveals an unexpectedly high incidence of immune dysfunction. These results suggest that immunological testing should be an integral part of the evaluation of patients with refractory sinusitis.
Quantitative Analysis of Mucin and Lectin in Maxillary Sinus Fluids in Patients With Acute and Chronic Sinusitis
Authors: Shinogi Jun , Harada Teruhiko , Nonoyama Tsutomu , Kishioka Chikako , Sakakura Yasuo , Majima Yuichi
Published: November 2003

Objectives Sinusitis is characterized by quantitative and qualitative changes in mucus biosynthesis that contribute to sinus disease. In general, patients with acute sinusitis complain of purulent rhinorrhea, whereas those with chronic sinusitis complain of mucoid or mucopurulent rhinorrhea. Locally produced mucin largely contributes to the high viscoelasticity of mucus in sinusitis. In this study, the authors attempt to quantify the concentrations of mucin and lectin in the maxillary sinus fluids from these patients.

Study Design To assess the concentrations of mucin and lectin in aspirates of 11 acutely and 11 chronically inflamed maxillary sinuses, the concentration of mucin was measured by enzyme‐linked immunosorbent assay (ELISA) and that of lectin by sandwiched enzyme‐linked lectin assay (ELLA).

Results The concentrations of mucin and lectin that were measured using monoclonal antibodies (HCS 4, HCS 14, and HCS 18) and Ulex europaeus agglutinin‐1 (UEA‐1) in chronic sinusitis were higher than those in acute sinusitis. The concentration of total protein in chronic sinusitis was lower than that in acute sinusitis. Each mucin and lectin versus total protein ratio in chronic sinusitis was higher than that in acute sinusitis.

Conclusions These data suggest that hypersecretion in chronic sinusitis may result from locally increased mucin production. Comprehension of this mechanism may be a strategy to prevent the viscous cycle of paranasal sinus fluids in chronic sinusitis.
Specificity of Parotid Sialendoscopy
Authors: Marchal Francis , Dulguerov Pavel , Becker Minerva , Barki Gerard , Disant François , Lehmann Willy
Published: November 2003

Objective To present our initial experience with sialendoscopy of the parotid duct.

Study Design: Methods Diagnostic and interventional sialendoscopy procedures were performed in 79 and 55 cases, respectively. Diagnostic sialendoscopy was used to classify ductal lesions into sialolithiasis, stenosis, sialodochitis, and polyps. Interventional sialendoscopy was used to treat these disorders. The type of endoscope used, the type of sialolithiasis fragmentation and/or extraction device used, the total number of procedures, the type of anesthesia, and the number and size of the sialoliths removed were the dependent variables. The outcome variable was the endoscopic clearing of the ductal tree and resolution of symptoms.

Results Diagnostic sialendoscopy was possible in all cases, with an average duration of 26 ± 14 minutes and no complications. Interventional sialendoscopy was successful in 85% of cases, with an average duration of 73 ± 43 minutes (± standard deviation). Multiple procedures were performed in 45% of cases, general anesthesia was used in 24%, and parotidectomy in 2%. Multiple sialoliths were found in 58% of ducts and associated with more procedures under general anesthesia and longer operations. The average size of sialoliths was 3.2 ± 1.3 mm; larger stones were associated with more procedures under general anesthesia, longer and multiple procedures, use of fragmentation, and sialendoscopy failures. Sialolithiasis fragmentation was required in 10% of cases, with a success rate of 70%. Semirigid sialendoscopes performed better than flexible ones. Complications were mostly minor but were encountered in 12% of cases.

Conclusions Diagnostic sialendoscopy is a new technique for evaluating salivary duct disease, a technique which is associated with low morbidity. Interventional sialendoscopy allows the extraction of sialoliths in most patients, preventing open gland excision.
The Anatomical Basis of the Abbé Flap
Authors: Schulte Douglas L. , Sherris David A. , Kasperbauer Jan L.
Published: November 2003

Objectives Objective of the study were 1) to determine the course, including specific relationship to the vermilion border, free margin of the lip, and orbicularis oris and number of the superior and inferior labial arteries, and 2) to discuss the relevance of this anatomy to design of the Abbé flap.

Study Design Detailed anatomical dissections of the mid and lower face of injected cadaver heads.

Methods Sixteen superior labial arteries and 15 inferior labial arteries in 9 adult cadaver heads ranging in age from 41 to 90 years were studied.

Results The superior labial artery was a single vessel in all cases. At the oral commissure the vessel was superior to the vermilion border in 94% of the dissections. At the midline the vessel was within the vermilion border in 75% of dissections. The vessel was found within the orbicularis oris in 19% of dissections and between the mucosa and the orbicularis oris in 81% of dissections. The inferior labial artery was a single vessel in all dissections. Its course was variable in position relative to the vermilion border and to its take‐off from the facial artery. In the central portion of the lip the vessel was found within the orbicularis oris in 13% of dissections and between the mucosa and the orbicularis oris in 87% of dissections.

Conclusions The superior labial artery is found within 10 mm of the free margin of the upper lip. The inferior labial artery is variable in its course, varying up to 15 mm from the free margin of the lower lip.
The Predictive Value of Serum Interleukins in Recurrent Respiratory Papillomatosis: A Preliminary Study
Authors: Snowden R. Todd , Thompson Jerome , Horwitz Edwin , Stocks Rose Mary
Published: November 2003

Objective IL‐2 is the primary interleukin responsible for activation of the cell‐mediated (Th1) arm of the immune response. Our objective was to determine whether a correlation existed between circulating levels of interleukin‐2 as well as its soluble receptor (sIL‐2R) and the clinical course of recurrent respiratory papillomatosis.

Methods and Materials Fifteen children with a histological diagnosis of RRP were recruited. Age at the time of study, time since first diagnosis, and number of surgical interventions were recorded. The number of surgically treated recurrences per year was then calculated. We obtained serum samples from each of these 15 children and from 10 normal control subjects. We then performed in vitro determination of serum IL‐2 and soluble IL‐2 receptor levels using enzyme‐linked immunosorbent assay (ELISA) techniques.

Results IL‐2 was significantly lower (136.6 vs. 199.9 pg/mL, P = .035) in papilloma patients than in control subjects. IL‐2R was also lower in papilloma patients (531.7 vs. 785.8 U/mL, P = .025). There was no statistical age difference between the papilloma and control groups. Among patients with papillomatosis, IL‐2 and sIL‐2R levels were significantly higher in those with aggressive disease (>4 surgically treated recurrences per year) versus non‐aggressive disease (179.2 vs. 99.2 pg/mL, P = .024; and 697 vs. 387 U/mL, P = .022). Age was also significantly lower in the aggressive papilloma group (P = .002).

Conclusions Levels of interleukin‐2 and IL‐2 receptor were significantly lower in patients with recurrent respiratory papillomatosis compared with normal children. These data support the presence of an aberrant cell‐mediated immune response in children with recurrent respiratory papillomatosis.
Computed Tomographic and Anatomical Analysis of the Basal Lamellas in the Ethmoid Sinus
Authors: Kim Sung‐Shik , Lee Jeung‐Gweon , Kim Kyung‐Su , Kim Hyun Ung , Chung In Hyuk , Yoon Joo‐Heon
Published: November 2003

Objectives To investigate the exact anatomical structure of the lamellas in the ethmoid sinus by computed tomography (CT) and anatomical analysis.

Study Design Cadaver dissections and CT scans were used to compare lamellar structures and their radiological images.

Methods Anatomical microdissection of 100 midsagittal sections from adult cadaver head specimens were examined and compared with those of sagittal CT scans at 1‐mm intervals.

Results The posteroinferior end of the uncinate process attaching to the inferior turbinate divided the fontanelle into the anterior and posterior portions in the majority of cases. The basal lamellas of the bulla ethmoidalis were subdivided into three major types. The posteroinferior portion of its basal lamella was connected to the lower horizontal portion of the third basal lamella in all cases. The anterior indentation of the third lamella was identified in nine cases, but there was no indentation in the posterior direction. The basal lamella of the superior turbinate was attached to the skull base superiorly either separately or fused to the third lamella, and its posteroinferior portion was attached to the lowest portion of the anterior wall of the sphenoid sinus. The supreme turbinate existed in 50 cases; however, its basal lamella was identified in only 15 cases.

Conclusions Our results indicate that the lamellas of the ethmoid sinus have relatively uniform patterns, although there is variability in shape. It is hoped that this study will provide surgeons with a more detailed structure of the basal lamellas for better surgical results and lower complication rates.
Frequency and Localization of the Putative Vomeronasal Organ in Humans in Relation to Age and Gender
Authors: Knecht Michael , Kühnau Dorit , Hüttenbrink Karl‐Bernd , Witt Martin , Hummel Thomas
Published: November 2003

Objectives/Hypotheses In many species the vomeronasal organ (VNO) serves as a chemosensory organ in addition to the olfactory system. The present investigation was undertaken to study 1) the frequency of monolateral or bilateral detection of the putative VNO (pVNO) in humans, 2) its localization in humans, and 3) whether detectability of the pVNO varies with age or gender.

Study Design Prospective.

Methods A total of 173 subjects participated in this study (88 women and 85 men; age range, 2–91 y). Inspection of the nose was performed with a speculum and a 30° endoscope. The exact localization of the VNO was measured with custom‐built rulers.

Results The study revealed the following major results: 1) A pVNO is detectable in approximately two‐thirds of the population and bilateral pVNOs are present in approximately 40% of investigated subjects, 2) its localization on the left and right nasal septum is almost symmetrical, and 3) and detectability of the pVNO is not related to age or gender.

Conclusions The present data indicated that the pVNO is present in approximately two‐thirds of the population. This value may be biased by methodological or biological factors; nevertheless, it indicates that the pVNO is not observed in all humans regardless of age and gender. Thus, considering its variability in shape and immunohistochemical characteristics and the missing nerval connections between the peripheral “organ” and the central nervous system, the present results are not suited to argue for a functional significance of the pVNO in humans.
Modulation of Myosin Heavy Chains in Rat Laryngeal Muscle
Authors: Shiotani Akihiro , Nakagawa Hideki , Flint Paul W.
Published: November 2003

Objectives To test the hypothesis that myosin heavy chain (MHC) composition is a biological marker indicative of appropriate and functional reinnervation.

Study Design Age‐matched adult rats were randomized for prospective study under three experimental conditions.

Methods In adult rats, three e‐perimental conditions were surgically created, including transient recurrent laryngeal nerve (RLN) crush injury, RLN transection and repair, and cricoarytenoid joint fi‐ation with intact RLN. Animals were survived for 30, 90, and 180 days. At each interval, vocal fold mobility was assessed by rigid microlaryngoscopy. Laryngeal electromyography (EMG) was performed before euthanasia. The thyroarytenoid and posterior cricoarytenoid muscles were then e‐cised, each muscle was processed for sodium dodecyl sulfate–polyacrylamide gel electrophoresis, and MHC composition was determined.

Results Thirty days after nerve crush injury, three of six animals regained vocal fold mobility and normal MHC composition. Impaired vocal fold motion in three of six animals was associated with MHC composition characteristic of denervation. At 90 and 180 days, normal vocal fold motion and normal MHC composition were observed in all animals. Following nerve transection and repair, impaired vocal fold motion and MHC composition characteristic of denervation were observed in all animals, despite evidence of reinnervation on EMG. Following joint fixation, alteration in MHC composition consistent with denervation was observed only at 30 days, as was evident in the nerve crush model.

Conclusion Temporary injury and vocal fold immobilization result in transient shifts in MHC composition. Nerve transection and repair result in persistent alteration of MHC composition and vocal fold dysfunction. The expression of normal MHC composition is dependent on the condition of appropriate neural contact and functional reinnervation.
A Prospective Study on Pros and Cons of Electrodissection Tonsillectomy
Authors: Blomgren Karin , Qvarnberg Yrjö H. , Valtonen Hannu J.
Published: November 2003

Objective Hemorrhages are main complications after tonsillectomy, whatever technique is used. This prospective study aimed at revealing pros and cons associated with monopolar electrodissection tonsillectomy.

Study Design A prospective study.

Methods A prospective study on all patients undergoing tonsillectomy or adenotonsillectomy in Central Hospital of Central Finland in 1997. Operation time and bleeding, as well as perioperative and postoperative complications, were recorded.

Results Inpatient tonsillectomy was performed in 440 patients (mean age, 17.9 y). Primary post‐tonsillectomy hemorrhage (within 24 h) occurred in 2.3%. A total of 15.9% of patients searched for medical help because of secondary post‐tonsillectomy hemorrhage, 7.7% receiving active treatment and 8.2% not. Post‐tonsillectomy hemorrhages proved to be most common in older patients and when peritonsillar abscess was in patient history.

Conclusions Monopolar electrodissection tonsillectomy was fast and resulted in little intraoperative bleeding. However, postoperative hemorrhages were common, and the mean use of analgesics was for more than 10 days. Preoperative counseling must be thorough and realistic. Our results indicate that better methods for tonsillectomy still need to be developed.
Endoscopic and Endoscopic‐Assisted Surgery for Juvenile Angiofibroma
Authors: Carrau Ricardo L. , Snyderman Carl H. , Kassam Amin B. , Jungreis Charles A.
Published: November 2003

Objectives/Hypothesis The mainstay treatment for juvenile angiofibromas is surgery. Endoscopic techniques have been applied to the resection of juvenile angiofibromas. The aim of the study is to establish the efficacy of endoscopic and endoscopic‐assisted techniques for the removal of juvenile angiofibromas.

Study Design Retrospective review.

Methods Retrospective review was made of all patients with juvenile angiofibromas who were treated with endoscopic and endoscopic‐assisted surgery from January 1994 to July 1999.

Results Fifteen tumors in 13 patients were removed using endoscopic or endoscopic‐assisted surgeries. In 11 patients, endoscopic surgery or endoscopic‐assisted surgery (or both) was successful and the patients remained without evidence of disease at a median follow‐up of 34 months. In two patients tumor persisted, which was detected during routine follow‐up less than 6 months after the initial surgery. These tumors were managed with a second endoscopic or endoscopic‐assisted surgery, and patients remained without evidence of disease. We encountered one postoperative complication, a progressive optic neuropathy that was successfully managed with endoscopic decompression.

Conclusions Endoscopic and endoscopic‐assisted surgery is a feasible alternative or adjunct to traditional techniques.