bluuebunny/crossref_metadata_2025 huggingface dataset:
An indigenous role in partnerships for sustainable homelands occupation in Australia
Authors: Carter J. , Claudie D. , Smith N.
Published: December 2005

This project investigates partnerships for environmentally sustainable development (ESD) in a remote part of Australia, from the perspective of indigenous groups, through grounded research involving priority setting, implementation trials and evaluation. By exemplifying the role of the indigenous non‐government organizations (INGOs) and local clan representatives, recommendations for partnership design that enhance equity in partner engagement are suggested. Formalized roles for indigenous groups in communication, social planning and structural systems support can advance the social and cultural dimensions of ESD. Persons in communication roles might design communication tools and awareness raising material, or demonstrate technical equipment. Persons in social planning roles might coordinate and implement plans, and advise institutions about equitable programme design solutions. Persons in structural systems support roles could facilitate action learning, articulate citizen policy solutions and funding priorities and map spatial and structural boundaries and networks for environmental decision making. A person dedicated to each language group is advocated. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment.
Treatment of Mammary Duct Fistula by Fistulectomy and Saucerization
Authors: Beechey‐Newman N. , Kothari A. , Kulkarni D. , Hamed H. , Fentiman I. S.
Published: December 2005

This study was designed to assess the efficacy and long‐term outcome of fistulectomy and saucerization for treatment of mammary duct fistulae. Mammary fistula is a chronic condition that represents the final step in what has been termed “mammary duct associated inflammatory disease sequence.” The treatment is primarily surgical and may include healing by secondary intention or primary closure with or without antibiotics. Reported series are small and often include variable surgical strategies applied without consistency. A consecutive series of 53 patients who had 59 mammary duct fistulae were treated by fistulectomy with saucerization. The median age was 32 years. Wounds were allowed to heal by secondary intention and antibiotics were not used. We reviewed the case records to establish the incidence of recurrent fistula and the time to complete healing. The long‐term cosmetic outcome was determined by a postal survey. After a median follow‐up of 6 years there had been no relapse in 92%. There was significant delay in healing in six cases (range: 10 to 30 weeks). Thirty‐eight patients (83%) gave a definite history of regularly smoking between 10 and 20 cigarettes a day. Two thirds of the patients were either pleased or satisfied with the final cosmetic result of the surgery, but more than 90% said that it left them with some distortion of the nipple. Fistulectomy and saucerization achieves long‐term cure in the majority of patients with mammary duct fistula, but it results in some degree of distortion of the nipple. The strong relationship between smoking and the occurrence of mammary duct fistulae is again demonstrated.
Anticipated Detection of Imminent Surgeon–Patient Barrier Breaches. A Prospective Randomized Controlled Trial Using an Indicator Underglove System
Authors: Caillot Jean‐Louis , Paparel Philippe , Arnal Eric , Schreiber Vincent , Voiglio Eric J.
Published: December 2005

The double gloving indicator underglove system (IUS) is based on a colored detection of the outer glove perforation. Our objective was to determine the IUS efficiency to detect outer glove perforations and to reduce the risks of blood and body fluids exposure, warning the surgeon before the breach of the surgeon–patient barrier (SPB). A series of 100 visceral surgical procedures were randomly assigned to either double (IUS) or single gloving. The noticed glove perforations (using the water test method) and the IUS efficiency were analyzed in 99 procedures. In 49 single‐gloving procedures, 19 perforations were noticed: one was immediately perceived (perceived accidental exposure, PAE); 3 were discovered as the gloves were being removed, and 15 were undetected before the water test (unperceived prolonged contact, UPC). In 50 double‐gloving procedures (IUS), 16 perforations were noticed, all of them involving only the outer glove: the IUS allowed immediate detection of 3 perforations without any blood exposure; 13 other perforations went undetected but without any UPC. In conjunction with the protective quality of double gloving, the IUS allows detection of significant breaches of the outer glove before the breach of the SPB.
Early Presumptive Therapy with Fluconazole for Occult Candida Infection after Gastrointestinal Surgery
Authors: Shan Yan‐Shen , Sy Edgar D. , Wang Shan‐Tair , Lee Jenq‐Chang , Lin Pin‐Wen
Published: December 2005

The objective of this retrospective comparative study was to improve the outcome of patients with suspected occult Candida infection after gastrointestinal surgery by early presumptive therapy. It was conducted in the National Cheng Kung University Hospital in Taiwan. A total of 36 patients with prolonged ileus with fever after gastrointestinal tract surgery between January 1995 and December 2002 were examined for two time periods: those treated before and those treated after January 1999. One set of patients did not receive early presumptive therapy (EPT) until Candida infection was confirmed, and they were designated EPT(−). Another group of patients with suspected occult Candida infection received EPT and were designated EPT(+). Fluconazole, 400 mg/day, was given as EPT. Urine, wound, intraperitoneal drainage, and blood specimens were obtained from patients for fungus culture before starting treatment and weekly until symptoms subsided. The primary endpoints were the frequency of candidiasis and the persistence of candidemia; the secondary endpoint was the efficiency of EPT in the clinical outcome. There was no difference in Candida peritonitis, wound colonization, or urine colonization in the two treatment groups. Candida albicans accounted for 87.5%% of the isolated Candida species: 84.6%% in the EPT(+) group and 89.5%% in the EPT(−) group. In the EPT(+) group, the positive blood culture rate was 66.7%%. The fever subsided rapidly in 17 patients (94%%), the hospital stay and intensive care unit stay were shorter, and the mortality decreased significantly: 11%% vs. 78%%, P < 0.001. Persistent gastrointestinal ileus was the main cause of breakthrough candidemia. We concluded that EPT with fluconazole improves the prognosis of patients with occult Candida infection after gastrointestinal surgery. Surgical intervention was required in patients with breakthrough candidemia.
Technetium‐99m‐MIBI SPECT/CT in Primary Hyperparathyroidism
Authors: Krausz Yodphat , Bettman Lise , Guralnik Luda , Yosilevsky Galina , Keidar Zohar , Bar‐Shalom Rachel , Even‐Sapir Einat , Chisin Roland , Israel Ora
Published: December 2005

The novel trend toward focused parathyroidectomy requires precise preoperative localization of the parathyroid adenoma in patients with primary hyperparathyroidism (PHPT). The present study evaluated the impact of hybrid single photon emission computed tomography/computed tomography (SPECT/CT), using 99mTc‐sestamibi (MIBI), on the surgical management of these patients. In a retrospective study of 36 patients with PHPT, SPECT/CT was undertaken when planar 99mTc‐MIBI scintigraphy was negative or when an ill‐defined focus in the neck or an ectopic site on planar views was visualized. Imaging data were compared with intraoperative findings, and the incremental value of SPECT/CT to lesion localization and surgical procedure was assessed. Three patients with both negative planar and SPECT/CT studies subsequently underwent bilateral neck exploration, with multiglandular hyperplasia diagnosed in two patients and a parathyroid adenoma in one. Of 33 patients with a positive MIBI study, parathyroid adenoma was confined to the neck in 23 patients and to the lower neck‐mediastinum in 10. SPECT/CT facilitated the surgical exploration of all 10 ectopic parathyroid adenomas and 4 of 23 cervical parathyroid adenomas, the latter four either at reexploration or in patients with nonvisualization of the thyroid after thyroidectomy. SPECT/CT contributed to the localization of parathyroid adenomas in patients with PHPT and to planning the surgical exploration in 14 of 36 (39%) patients, predominantly those with ectopic parathyroid adenomas or who had distorted neck anatomy.
Survival of Young Patients after Gastrectomy for Gastric Cancer
Authors: Llanos Osvaldo , Butte Jean Michel , Crovari Fernando , Duarte Ignacio , Guzmán Sergio
Published: December 2005

It has been suggested that gastric cancer has a worse prognosis in young patients, but the data are controversial. The aim of this study was to compare the 5‐year survivals after gastrectomy for gastric cancer in two groups of patients (those ≤45 years of age and those (>45 years) and to determine some of the prognostic factors. The 5‐year survival was significantly better for patients ≤45 years of age. Survival was also better for young patients with a curative resection and also for those with lymph node metastases. However, survival was not significantly different for the two groups when the resection was not curative and when the lymph nodes were not involved. Survival was no different for the two groups when compared at each stage, although a multivariate analysis showed that age >45 years, moderate or poor degree of differentiation of the tumor, advanced tumors, the presence of lymph node involvement, and a noncurative resection were independent negative prognostic factors. Long‐term survival after gastrectomy for gastric cancer depends on the stage of the disease; the age of the patient is not a decisive factor.
Successful Repair of Iatrogenic Rectourinary Fistulas Using the Posterior Sagittal Transrectal Approach (York‐Mason): 15‐Year Experience
Authors: Moro Fabrizio Dal , Mancini Mariangela , Pinto Francesco , Zanovello Nicola , Bassi Pier Francesco , Pagano Francesco
Published: December 2005

Introduction

Rectourinary fistulas (RUFs) represent a challenging clinical problem. Most RUFs are secondary to lower urinary or intestinal tract surgery. Several surgical approaches have been proposed. The aim of this study was to review a 15‐year experience using the York‐Mason posterior sagittal transrectal approach to iatrogenic RUFs.

Methods

Seven patients with RUFs secondary to urologic surgery were operated on with the York‐Mason technique at the Department of Urology, University of Padova, Italy between 1988 and 2003. The patients’ data have been collected and analyzed retrospectively.

Results

All the patients were treated successfully (100%). In one patient with Crohn’s disease the fistula recurred 11 years after the first surgery. One patient died for metastasis of prostate cancer 1 year after surgical repair of the RUF. A temporary colostomy was performed in five patients; the colostomies were subsequently closed, and the patients regained complete fecal continence with no postoperative anal strictures. The colostomy remained in place in one patient with Crohn’s disease and in another with ulcerative rectocolitis.

Conclusions

The posterior sagittal transrectal approach provided easy access and identification of RUFs and good surgical exposure, with no subsequent strictures or fecal incontinence. Our data show that the York‐Mason technique alone is a highly effective option for treating an iatrogenic postoperative RUF.
Surgical Management of Small Gastrointestinal Stromal Tumors of the Stomach
Authors: Iwahashi Makoto , Takifuji Katsunari , Ojima Toshiyasu , Nakamura Masaki , Nakamori Mikihito , Nakatani Yoshihiro , Ueda Kentaro , Ishida Koichiro , Naka Teiji , Ono Kazuo , Yamaue Hiroki
Published: December 2005

Small gastrointestinal stromal tumors (GISTs) (<3 cm) occasionally are found in the stomach during endoscopy. There is no consensus about the surgical management of these small tumors, although this clinical issue is crucial because some of the tumors show unexpected malignant behavior. In this study, we evaluated the clinical management of patients with gastric GISTs who underwent surgical resection. Altogether, 31 patients with gastric GISTs were examined retrospectively. Surgical resection was fundamentally indicated for the patients with gastric GISTs suspected to be malignant by endoscopy or endoscopic ultrasonography (EUS). The malignant grade of the GISTs was evaluated by the mitotic rate, tumor size, and MIB‐1 index. EUS was useful for differentiating benign from malignant GISTs; but by limiting the study to patients with small tumors (<3 cm), the diagnostic value of EUS was not satisfactory for defining the surgical indication. Tumors that were <50 mm were successfully treated by laparoscopic surgery. Of the 31 patients, 4 had a relapse of the disease, and 1 of those 4 patients had a small tumor (30 mm). All of the recurrences were classified in the high risk category. Surgery is indicated for gastric GISTs that are ≥20 mm or are suspected to be malignant based on EUS findings. Laparoscopic resection is feasible and is recommended as the treatment of choice for patients with tumors < 50 mm. Risk assessment can be most useful for predicting recurrence.
Role of Interval Appendectomy in the Management of Complicated Appendicitis in Children
Authors: Vane Dennis W. , Fernandez Nathanial
Published: December 2005

Introduction

The aim of this study was to ascertain the optimal treatment for children with complicated appendicitis. We reviewed an inception cohort of children with documented complicated appendicitis to develop criteria for interval appendectomy. We compared the outcomes of two treatments: immediate operation and interval appendectomy.

Methods

Children with complicated appendicitis were separated into two groups. Group 1 patients had had symptoms of complicated appendicitis for less than 72 hours or appeared toxic. Group 2 patients had had symptoms of complicated appendicitis for longer than 72 hours and did not appear toxic. Group 1 underwent immediate operation treated by criteria previously published. Group 2 patients were treated in hospital with triple antibiotics until they were afebrile, had normal white blood cell counts, tolerated an oral diet, and had adequate pain control. They were discharged on oral metronidazole or metronidazole plus Bactrim for 6 weeks and then underwent interval appendectomy.

Results

A total of 86 children had complicated appendicitis; 59 were operated on immediately, and 27 underwent an interval appendectomy. Complications included one wound infection and two intraabdominal abscesses (all in group 1). There was one death (group 1). The length of stay for the immediate operation group was 4.9 ± 1.7 days; the initial‐admission length of stay for the interval appendectomy group was 4.1 ± 1.0 days with a subsequent postoperative stay of 0.9 ± 0.8 days. One patient in the interval appendectomy group was treated off protocol.

Conclusions

Treating selected children with interval appendectomy led to a decrease in complications and a shorter length of stay in this limited population. Interval appendectomy is a safe, cost‐effective, useful adjunct treatment for children with complicated appendicitis.
Prognostic Factors for Sporadic Medullary Thyroid Carcinoma
Authors: Gülben Kaptan , Berberoğlu Uğur , Boyabatlı Mustafa
Published: December 2005

Introduction

Medullary thyroid carcinoma (MTC) originates from the thyroid parafollicular cells and accounts for 3% to 10% of all thyroid malignancies. Approximately 84% of cases are sporadic. The aim of this study was to evaluate the outcomes of treatment for sporadic medullary thyroid carcinoma (SMTC) and define the prognostic factors for overall survival.

Methods

The records of 32 SMTC patients treated at Ankara Oncology Education and Research Hospital between September 1993 and April 2003 were retrospectively evaluated. The effects of age, gender, tumor localization, extent of the primary surgical resection, tumor size, capsule invasion, lymph node metastasis, extranodal extension, tumor stage, local recurrence, and distant metastasis on the overall survival rate were evaluated by univariate and multivariate analyses.

Results

There were 32 patients (19 females, 13 males) with a median age of 45 years (21–76 years). Altogether, 22 patients had undergone complete resection and 10 patients incomplete resection. The median follow‐up was 48 months (9–111 months), and the overall 5‐year survival rate was 51%. Based on the univariate analysis, the extent of primary surgical resection, pathologic tumor size, capsule invasion, lymph node invasion, extranodal extension, tumor stage, local recurrence, and distant metastasis were factors that significantly affected survival. In the multivariate analysis, however, only the extent of the primary surgical resection, capsule invasion, and distant metastasis were found to be statistically significant factors.

Conclusions

The extent of the primary surgical resection significantly influences the survival of patients with SMTC. Capsule invasion and distant metastasis were additional factors affecting the prognosis.
Complications Following D3 Gastrectomy: Post Hoc Analysis of a Randomized Trial
Authors: Wu Chew‐Wun , Chang I‐Shou , Lo Su‐shun , Hsieh Mao‐Chin , Chen Jen‐Hao , Lui Wing‐Yiu , Whang‐Peng Jacqueline
Published: December 2005

Introduction

A single institutional surgical trial for gastric cancer had demonstrated increased morbidity but not mortality. This report analyzes risk factors affecting morbidity.

Methods

Risk factors for morbidity in 221 patients treated with curative intent were evaluated in a prospective randomized trial comparing D1 and D3 surgery for curable gastric cancer.

Results

The surgeon’s experience after 25 nodal dissections had no influence on surgical or overall complications, nor did the patients’ co‐morbidity (e.g., respiratory system disease, cardiac disease, diabetes mellitus). Distal pancreatectomy negatively affected surgical morbidity [relative risk (RR) 6.21, 95% confidence interval (CI) 1.869–20.626] and overall morbidity (RR 5.50, 95% CI 1.671–18.082). All of the patients with a distal pancreatectomy underwent concomitant splenectomy. Multivariate analysis found splenectomy and nodal dissection to be the only two independent risk factors adversely affecting operative morbidity. The RR of splenectomy for surgical complications was 4.19 (95% CI 1.327–13.208), and for overall complications it was 3.88 (95% CI 1.259–11.973). The RR of nodal dissection for surgical complications was 2.51 (95% CI 1.336–4.730), and for overall complications it was 1.93 (95% CI 1.149–3.255).

Conclusions

Splenectomy (with or without pancreatectomy) and nodal dissection are risk factors for operative morbidity but not mortality.
Effects of Peritoneal Lavage with Scolicidal Agents on Survival and Adhesion Formation in Rats
Authors: Topcu Omer , Kuzu Isinsu , Karayalcin Kaan
Published: December 2005

Intraoperative irrigation of the peritoneal cavity with scolicidal agents is frequently recommended when dealing with traumatic or spontaneous rupture of hydatid cysts. The present experimental study was designed to examine the influence of various scolicidal agents on adhesion formation and survival. A total of 149 rats were randomly allocated to nine groups. Peritoneal lavage through a median laparotomy was performed with the following scolicidal agents. Group 1 (0.9% saline: controls), group 2 (20% hypertonic saline), group 3 (0.04% chlorhexidine gluconate), group 4 (3% hydrogen peroxide), group 5 (0.5% silver nitrate), group 6 (1% polyvinylpyrrolidone‐iodine, or PVP‐I ), group 7 (5% PVP‐I), group 8 (0.5% cetrimide/0.05% chlorhexidine), and group 9 (10% PVP‐I). The surviving animals were sacrificed on postoperative day 15. Adhesion formation was macroscopically graded by the Nair criteria. The severity of adhesion formation was evaluated microscopically using the fibrosing scoring criteria and the strain test. Group 9 (10% PVP‐I) was excluded from the adhesion evaluation because all of the rats died in this group. The mortality rate was significantly higher in groups 5 and 7 than in groups 1, 2, 3, 4, 6, and 8. Adhesion scores were significantly lower in groups 1, 2, 3, and 4 than in groups 5, 6, 7, and 8. The lowest adhesion score was found in group 3 and the highest in the group 7. These results indicate that 0.04% chlorhexidine gluconate, the most potent scolicidal agent in vitro and in vivo, was associated with the lowest adhesion formation and mortality among various scolicidal agents in this experimental study.
Clinical Characteristics and Prognosis of Pediatric Hepatocellular Carcinoma
Authors: Yu Seung‐Beom , Kim Hyun‐Young , Eo Hong , Won Jae‐Kyung , Jung Sung‐Eun , Park Kwi‐Won , Kim Woo‐Ki
Published: December 2005

Introduction

Hepatocellular carcinoma (HCC) is a rare pediatric malignancy that is usually advanced at diagnosis, with a relatively poor prognosis. Extensive treatment, including complete tumor resection, is believed to be necessary for cure. This study was performed to analyze treatment results and to search for prognostic factors of pediatric HCC.

Methods

Between March 1982 and February 2004 a total of 16 children had been diagnosed as having HCC in our institution, and a retrospective analysis was performed.

Results

The median age at diagnosis was 10.5 years, and the male/female ratio was 11:5. As a predisposing condition, hepatitis B virus (HBV) infections were present in 11 (68.8%) and liver cirrhosis in 8 (50.0%). Including 1 patient with a liver transplant, 4 patients (25.0%) underwent a primary operation with complete tumor resection, and 11 (68.8%) received neoadjuvant chemotherapy because of their inoperable state at diagnosis. After neoadjuvant chemotherapy, complete tumor resection was performed in four (36.4%). Thus complete resection was undertaken in a total of eight patients (50.0%). The estimated 5‐year survival rate of all patients was 27.3%. The 5‐year survival rate for patients who underwent complete tumor resection was 62.5%, and for those who underwent palliative resection or no operation it was 0%. The statistically significant prognostic factors were tumor stage, presence of metastasis, and complete tumor resection.

Conclusions

This study confirmed that complete tumor resection is essential for cure in pediatric patients with HCC, and neoadjuvant chemotherapy improves the tumors’ resectability.
Adjunctive topiramate in ultradian cycling bipolar disorder: case report with 3-year follow-up
Authors: Karama Sherif , Lal Samarthji
Published: December 2005

A patient with a treatment-refractory bipolar disorder with ultradian cycling responded to adjunctive topiramate. Response was maintained during 3-year follow-up.
Randomised clinical trial comparing oral versus depot formulations of zuclopenthixol in patients with schizophrenia and previous violence
Authors: Arango C. , Bombín I. , González-Salvador T. , García-Cabeza I. , Bobes J.
Published: December 2005

Objective

The aim of this longitudinal study was to determine whether the depot formulation of an antipsychotic reduces violence in outpatients with schizophrenia as compared to oral administration of the same antipsychotic.

Methods

Forty-six previously violent patients with schizophrenia were randomised to receive treatment with oral or depot zuclopenthixol for 1 year. Clinicians interviewed patients at baseline and every month thereafter to assess treatment adherence. An interviewer blinded to treatment assignments interviewed an informant about any violent behaviour during the previous month.

Results

Violence during the follow-up year was inversely proportional to treatment adherence, better compliance, and greater reduction of positive symptoms. Lower frequency of violent acts was observed in the depot group. The level of insight at baseline was not significantly associated with violence recidivism. Regardless of route of administration, treatmentnon-adherence was the best predictor of violence.

Conclusions

Some patients with schizophrenia and prior violent behaviour may benefit from the depot formulation of antipsychotic medication.
Neurological soft signs in adolescents with first episode psychosis
Authors: Zabala Arantzazu , Robles Olalla , Parellada Mara , Moreno Dolores Maria , Ruiz-Sancho Ana , Burdalo Maite , Medina Oscar , Arango Celso
Published: December 2005

The purpose of this study is to determine the decrease of neurological soft signs (NSS) during adolescence and to compare this evolutionary process in two groups of adolescents with first episode psychosis: a) schizophrenia and b) non-schizophrenia patients. The structured neurological evaluation scale (NES) was administered to 24 adolescents with first episode psychosis. The number of NSS, the total and subscales scores were correlated with age in patients and in 39 healthy controls. Adolescents with first-episode psychosis had a higher prevalence of NSS than healthy controls; the schizophrenia patients (N = 9) scored higher than non-schizophrenia patients (N = 15). The number of NSS, total score and the scores on three of the four NES subscales correlated inversely with age in the healthy control group. No correlation was found for the schizophrenia group. For the non-schizophrenia group, a significant negative correlation was found only in one subscale. The decrease of NSS during adolescence in the healthy population but not in the patient groups with psychosis may be an indicator of a disturbance of brain processes that occurs during development. We did not find a clear pattern of NSS that distinguished schizophrenia from other psychoses.
Hand Injuries at a British Military Hospital on Operations
Authors: ANAKWE R. E. B. , STANDLEY D. M.
Published: December 2005

The nature of military medical support necessarily changes in the transition from war fighting to the post-conflict phase. This paper examines the activity in the only British Military Hospital serving a multi-national divisional area in Iraq over 2004 during this post-conflict phase. Hand injuries were common and formed a large proportion of the workload seen at the military field hospital on operations. The overwhelming majority of hand trauma resulted in soft tissue injury. There was a clear predisposition to hand trauma for males, manual workers, combat soldiers and engineers/mechanics. While most hand injuries do not require surgical intervention, they impact on the effectiveness of the military population as a result of the large proportion of patients who are placed on restricted duties following hand trauma, 157 of 241 in this study, and the number of soldiers who require aeromedical evacuation for further treatment, 38 of 360 in this study. These injuries require that military surgeons and emergency physicians should be experienced in the initial management of hand trauma and hand trauma should be a core component of their training. The skills of the specialist hand surgeon may be required for definitive management of these injuries at a later stage.
Modeling of residential structure fire response: Exploring the hyper‐project
Authors: Simpson N.C.
Published: December 2005

Emergency service systems such as community fire departments respond to and resolve unplanned events within a given service area. A review of the literature addressing such systems indicates that existing research is almost exclusively focused on higher level planning issues such as facility location and resource allocation. In contrast, this study addresses the operational level of such a system, an existing fire department's response to residential structure fire. Such a response exhibits many of the elements of traditional project management, such as distinctly defined tasks and significant predecessor relationships. However, the defining characteristic of these projects is not simply expediency, but the fact that the structure of the project can change if the preceding project structure does not complete some aspect of its task sequence within an interval of time dictated by some external pacing function. What emerges is a unique and intriguing class of project, dubbed the hyper‐project in this study. The concept of the hyper‐project is discussed both in its general form and with respect to the aforementioned case study example. Readily transferable to non‐emergency applications, the hyper‐project typifies and unites a heretofore unrecognized family of operations, highlighting the opportunities for future research.
Erbium: Yttrium‐Aluminum‐Garnet Laser Application in Stapedotomy
Authors: Galli Jacopo , Parrilla Claudio , Fiorita Antonella , Marchese Maria Raffaella , Paludetti Gaetano
Published: December 2005

OBJECTIVE

To assess clinical safety and efficacy of the erbium: yttrium‐aluminum‐garnet (Er:YAG) laser in the stapes surgery; to define and optimize parameters that render the procedure safe for the inner ear.

STUDY DESIGN

Retrospective study.

MATERIAL AND METHODS

A microscope‐integrated Er: YAG laser stapedotomy was performed on 29 patients and a conventional stapedotomy on 41 patients. An early (within 1 to 3 days after stapes surgery) and late (at least 6 weeks) pure‐tone bone‐conduction threshold audiogram was obtained.

RESULTS

No statistically significant differences were found by Student's t test over all measured frequencies between pre‐ and postoperative bone‐conduction thresholds in each group. There was no statistically significant difference for all frequencies between early (3 days) and late postoperative mean bone‐conduction thresholds.

CONCLUSIONS

The results of our preliminary clinical study showed that erbium laser poses no risk to inner ear function. However, the lack of standardization obliges further investigation to establish safe clinical parameters of the Er:YAG laser.

EBM RATING

B‐3
Is Routine Frozen Section Necessary for Parathyroid Surgery?
Authors: Dewan Anil K. , Kapadia Silloo B. , Hollenbeak Christopher S. , Stack Brendan C.
Published: December 2005

OBJECTIVE

Successful parathyroidectomy requires identification and excision of 1 or more abnormal parathyroid glands. The pathologist confirms or refutes the intraoperative presence of parathyroid tissue in excised material. With the advent of radionuclide scanning and rapid parathyroid hormone assays, the role of routine frozen section (FS) has once again been called into question. Our aim was to assess the need for routine FS in tissue identification during parathyroidectomy in a series of 50 consecutive cases.

METHODS

We analyzed 50 consecutive parathyroidectomies performed by a single surgeon from December 2002 to August 2003. Diagnoses on gross examination (GE) of both the surgeon and the pathologist were recorded, cytologic smears made, and FSs performed. A cost analysis was also performed.

RESULTS

Of the 50 parathyroidectomies performed (35 adenoma and 15 hyperplasia), both surgeon and pathologist's opinions on GE were concordant. Incorrect gross identification occurred by both in 6% (3) of the cases. GE is a cost‐effective means of identifying parathyroid tissue.

CONCLUSIONS

Experienced parathyroid surgeons need not routinely request FS examination. The decision to omit intraoperative FS examination must be balanced against the potential implications of misdiagnosis and a repeat operative procedure.

EBM RATING:

C
The Association of Tongue Scalloping With Obstructive Sleep Apnea and Related Sleep Pathology
Authors: Weiss Todd M. , Atanasov Strahil , Calhoun Karen H.
Published: December 2005

OBJECTIVE

The association between OSAS and patient history and physical exam findings is previously established; however, to our knowledge there are no studies that evaluate the role of tongue scalloping as a reliable clinical indicator for OSA, snoring, or the presence of other sleep pathology as evidenced by polysomnography. This study evaluates the hypothesis that such an association exists.

SUBJECTS AND METHODS

Sixty‐one otolaryngology clinic patients were evaluated by history and physical exam for the presence and degree of tongue scalloping, snoring, and other previously established clinical indicators for sleep‐disordered breathing and obstructive apnea. Twenty‐five of the 61 study patients were additionally evaluated by overnight polysomnography to provide conclusive diagnosis of sleep pathology. The degree of tongue scalloping was graded from 0 to 3 and its significance as a screening, diagnostic, and predictive factor for sleep pathology was then statistically determined.

RESULTS

Twenty‐seven patients (44%) had known or newly documented OSA and 47 (77%) had a history of snoring. Twenty‐seven patients (44%) had some degree of tongue scalloping (1‐3) and 74% of these patients were male. The presence of any degree of tongue scalloping (grade 1‐3) in patients with known or newly documented OSA showed sensitivity, specificity, PPV, and NPV of 52%, 68%, 70%, and 50% respectively. The presence of tongue scalloping in patients with either known snoring history or newly documented snoring showed sensitivity, specificity, PPV, and NPV of 47%, 64%, 81%, and 26% respectively. Presence of tongue scalloping was 71% specific for abnormal sleep efficiency (<85%), 70% specific for abnormal AHI (>5), and 86% specific for nocturnal desaturation >4% below baseline. Presence of tongue scalloping also showed PPV of 67% for abnormal AHI, 89% for apnea or hypopnea, and 89% for nocturnal desaturation. Presence and severity of tongue scalloping showed positive correlation with increasing Mallampati and modified Mallampati airway classification.

CONCLUSIONS

In high‐risk patients we found tongue scalloping to be predictive of sleep pathology. Tongue scalloping was also associated with pathologic polysomnography data and abnormal Mallampati grades. We feel the finding of tongue scalloping is a useful clinical indicator of sleep pathology and that its presence should prompt the physician to inquire about snoring history.

EBM RATING

C
Septopalatal Protraction for Correction of Nasal Septal Deformity in Cleft Palate Infants
Authors: Moore Corey C. , MacDonald Ian , Latham Ralph , Brandt Michael G.
Published: December 2005

OBJECTIVE

It is proposed to test the practicality of septopalatal protraction in the unilateral cleft palate infant for purposes of straightening the nasal septum and thus relieving nasal airflow obstruction and its detrimental sequelae.

METHODS

Alternate infants affected with complete unilateral palatal clefts had septopalatal protraction for a period of 6 to 8 weeks (protraction group; n = 4). Septal deviation was measured by a standardized technique that used computed tomography scans. The remaining infants had no protraction and served as controls (nonprotraction group; n = 5). Septal deviation was measured in the nonprotraction group from palatoseptal dental molds.

RESULTS

A total of 9 patients were studied. All patients in the nonprotraction group had worsening of nasal septal deviation over a period of 8 weeks compared with the protraction group, which had complete nasal septal straightening. Differences in septal angle deviation between the protraction group and nonprotraction group at the end of the study were statistically significant (P ≤ 0.01) as measured by the paired Student t test.

CONCLUSIONS

Septopalatal protraction in the newborn appears to provide a means for correcting nasal septal deviation in complete unilateral cleft palate infants. Septopalatal protraction in the newborn is relatively easy and safe.

EBM RATING: B‐2
The Efficacy of Computer Assisted Surgery in the Endoscopic Management of Cerebrospinal Fluid Rhinorrhea
Authors: Tabaee Abtin , Kassenoff Tali L. , Kacker Ashutosh , Anand Vijay K.
Published: December 2005

OBJECTIVE

To determine the outcome of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea with and without computer assisted surgery.

STUDY DESIGN

A review of all patients undergoing endoscopic closure of CSF rhinorrhea at a tertiary care medical center between 1994 and 2003. Charts from the 24 patients were reviewed for indications, location of leak, type of surgical closure, number of prior closure attempts, graft materials, use of computer assisted surgery, complications, and need for revision surgery. Analysis was performed to determine a possible correlation between success of CSF leak repair and use of computer assisted surgery.

RESULTS

The etiology of the leak was previous sinus surgery in 10 patients (41.7%), trauma in 5 patients (20.8%), spontaneous leak in 5 patients (20.8%), and skull base surgery in 4 patients (16.7%). The most common sites of leak were the fovea ethmoidalis in 10 patients (41.7%), cribriform plate in 8 patients (33.3%), and sphenoid sinus in 6 patients (25%). Image guidance was employed in 66.7% (16 patients) of our first attempted repairs. Six patients underwent a total of 9 revision procedures. At last follow‐up, 96% of patients had no evidence of CSF rhinorrhea. A comparison of patients in the 2 groups failed to reveal a statistically significant difference in the rate of CSF leak closure.

CONCLUSION

Endoscopic closure of CSF rhinorrhea represents a minimally invasive and highly successful procedure. The use of computer assistance may improve the confidence of the surgeon and is a valuable adjunct in this procedure. Our study, however, did not demonstrate an improvement in the rates of successful closure with the use of computer assistance.

EBM RATING

C
Transtympanic Gentamicin and Fibrin Tissue Adhesive for Treatment of Unilateral Menière's Disease: Effects on Vestibular Function
Authors: Casani Augusto , Nuti Daniele , Franceschini Stefano Sellari , Gaudini Elisa , Dallan Iacopo
Published: December 2005

OBJECTIVE

To determine the effects of transtympanic injections, with a mixture composed of gentamicin and fibrin tissue adhesive (FTA), on vestibular function of patients with intractable unilateral Menière's disease.

STUDY DESIGN

This was an open, prospective study.

SETTING AND PATIENTS

The study was performed at 2 tertiary referral centers. Twenty‐six patients affected by “definite” unilateral Menière's disease, unresponsive to medical therapy for at least 6 months, were enrolled.

INTERVENTION

A buffered gentamicin solution mixed with FTA was injected in the middle ear until the development of bedside vestibular hypofunction signs and/or caloric weakness in the treated ear.

MAIN OUTCOME MEASURE

Vestibular function was evaluated by 3 bedside vestibular tests (observation of spontaneous nystagmus, head shaking test, and head thrust test) and by a caloric test. Tests were performed on days 10 and 30 after completion of treatment. Tests were also performed 3, 6, and 12 months from completion of the gentamicin‐FTA protocol. The effects of treatment were also assessed in terms of hearing levels, control of vertigo, and disability status.

RESULTS

In 22 of the 26 patients, only 1 gentamicin‐FTA injection was necessary to obtain 1 or more signs indicating a reduction of the vestibular function in the treated ear. Four patients needed another treatment because of the persistence of their incapacitating symptoms during the follow‐up. Four patients needed more than 1 injection to obtain a vestibular hypofunction. None of the patients who received 1 or 2 injections presented hearing loss in direct temporal relationship to the treatment.

CONCLUSIONS

A mixture of gentamicin and fibrin glue makes it possible to considerably reduce the number of administrations in patients with intractable unilateral Menière's disease. Spontaneous nystagmus, post head shaking nystagmus, and a head thrust sign are the clinical signs that indicate onset or progression of unilateral vestibular hypofunction. These signs were obtained with only 1 injection in 81% of patients.

EBM RATING

C
Bipolar Radiofrequency Dissection Tonsillectomy: A Prospective Randomized Trial
Authors: Ragab Sameh M.
Published: December 2005

OBJECTIVES

To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra‐operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage.

MATERIALS AND METHODS

From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intraoperative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with.

RESULTS

There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT (P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters (P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications.

CONCLUSION

BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra‐operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy.

EBM RATING

A
Thyroid Lymphoma: A Single Institution's Experience
Authors: Ruggiero Francis P. , Frauenhoffer Elizabeth , Stack Brendan C.
Published: December 2005

BACKGROUND

Primary lymphoma of the thyroid gland is uncommon.

METHODS

The tumor registry at the Penn State Milton S. Hershey Medical Center was searched for all patients carrying a diagnosis of thyroid lymphoma. All available records for these patients were examined and information regarding patient and tumor characteristics, clinical presentation, interventions, and survival were tabulated.

RESULTS

The average age of patient in our series was 67.5 years. There was a 2.7:1 female to male preponderance. Thirteen (60%) patients presented with thyroid nodule(s). Eleven (50%) presented with aerodigestive tract obstructive symptoms. Sixteen (73%) patients had no pre‐existing history of thyroid disease; none had known pre‐existing Hashimoto's thyroiditis.

CONCLUSIONS

The typical thyroid lymphoma patient is female and elderly with painless thyroid enlargement. Compressive symptoms of the aerodigestive tract are common at presentation and may require urgent intervention. Treatment modalities (XRT, CHOP chemotherapy) and outcomes are distinct from other thyroid malignancies.

EBM RATING

C
The Sternomastoid Branch of the Occipital Artery: A Surgical Landmark for the Spinal Accessory Nerve in Selective Neck Dissections
Authors: Rafferty Mark A. , Goldstein David P. , Brown Dale H. , Irish Jonathan C.
Published: December 2005

OBJECTIVE

To evaluate the anatomic relationship between the spinal accessory nerve (SAN) and the sternomastoid branch of the occipital artery (SBOA) and its utility as a surgical landmark during a selective neck dissection (SND).

STUDY DESIGN AND SETTINGS

Consecutive patients undergoing SND for squamous cancer from October 1, 2004 to February 28, 2005 were enrolled in this study. During surgery the distance between the SBOA and the point of insertion of the SAN into the sternomastoid muscle (SMM) was measured.

RESULTS

Twenty‐four patients underwent 33 SND. The distance between the SBOA and SAN ranged between 1 and 11 mm, with a mean of 6.2 mm and a median of 6 mm.

CONCLUSION

The relationship between these 2 structures has a range and constancy that is acceptable as a landmark.

SIGNIFICANCE

This article presents a useful adjunct for location of the SAN in the anterior neck during SND.

EBM RATING

C
The Importance of Long‐term Follow‐up of Head and Neck Cancer Patients for Reliable Survival Analysis
Authors: Priante Antonio Vitor Martins , Carvalho André Lopes , de Cássia Braga Ribeiro Karina , Contesini Hirde , Kowalski Luiz Paulo
Published: December 2005

OBJECTIVE

Analyze the influence of patients lost to follow‐up in estimated survival rates calculated by the Kaplan‐Meier method.

STUDY DESIGN

Only patients with previously untreated squamous cell carcinoma of the upper aerodigestive tract were selected. For the patients lost to follow‐up anytime, the last medical evaluation date was collected to calculate the “estimate A” survival time. If the same patient returned to our outpatient clinic or further health information was obtained, the updated last information/evaluation date was also collected to calculate “estimate B” survival time. The survival curves considering “estimate A” and “B” survival rates were compared.

RESULTS

The overall 5 and 10‐years survival rates for all patients calculated for “estimate A” were 54.0% and 46.0%, respectively; compared with 42.8% and 28.2% when were calculated considering “estimate B” (P < 0.001).

CONCLUSION

Close follow‐up of the head and neck cancer patients is essential for an accurate estimate of survival by KaplanMeier method.

EBM RATING

C
Facial Nerve Outcomes in Middle Cranial Fossa vs Translabyrinthine Approaches
Authors: Isaacson Brandon , Telian Steven A. , El‐Kashlan Hussam K.
Published: December 2005

OBJECTIVE

To compare the final facial nerve outcomes between middle cranial fossa (MCF) vs translabyrinthine (TL) resection of size‐matched vestibular schwannomas.

STUDY DESIGN AND SETTING

Retrospective case review at a tertiary care hospital. All patients who underwent resection utilizing either MCF or TL approaches with tumors 18 mm or smaller and complete data were included in the analysis. One hundred twenty‐four patients were identified meeting the above criteria, with sixty‐three in the translabyrinthine group and sixty‐one in the middle fossa group. One‐week‐postoperative and final facial nerve examinations were compared in the two surgical groups. Patients were separately analyzed in subgroups: tumors smaller than 10 mm and those that were between 10 and 18 mm.

RESULTS

The tumor size range for the MCF group was 3‐18 mm while it was 4‐18 mm for the TL group. No statistically significant difference was found in facial nerve outcomes between the two surgical groups, at the first postoperative visit week and at last follow‐up.

CONCLUSION

Facial nerve outcomes are similar using TL and MCF approaches for resection of vestibular schwannomas up to 18 mm in size.

SIGNIFICANCE

Patients undergoing the MCF approach for hearing preservation can be counseled that there is no increased risk of permanent facial nerve weakness, compared to the TL approach.

EBM RATING: B‐3
Magnetic Airway Implants for the Treatment of Obstructive Sleep Apnea Syndrome
Authors: Nelson Lionel M. , Boucher Ryan P. , Stevens Sheila S.
Published: December 2005

OBJECTIVE

To evaluate repelling magnetic implants to treat obstructive sleep apnea (OSA) using a canine model.

STUDY DESIGN AND SETTING

Magnetic forces equivalent to effective CPAP were estimated with benchtop studies. An acute canine model was used to simulate pharyngeal collapse. Tolerance, safety, and stability of the implants were evaluated in a chronic series of 10 dogs observed over 6 months.

RESULTS

Equivalence to CPAP (10‐12 cm H20) was achieved with low‐force (<10 g/cm length), light (approximately 2 gram) implants. Magnetic implants prevented airway collapse in the acute canine. Normal behavior, swallowing, and oral intake were noted in the chronic canine over 6 months. Implant extrusion was 10%. Histology showed fibrous encapsulation without chronic inflammation.

CONCLUSIONS

Repelling magnets successfully maintained a patent airway and were well tolerated in the canine.

SIGNIFICANCE

Repelling magnets could represent an implantable alternative to CPAP if human studies reveal similar findings.