bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of Vocal Fold Nodule Size in Children and Perceptual Assessment of Voice Quality
Authors: Nuss Roger C. , Ward Jessica , Huang Lin , Volk Mark , Woodnorth Geralyn Harvey 
Published: May 2017

Objectives We examined the relationship between the size of vocal fold nodules and perceptual rating of voice quality in children. Methods We carried out an Institutional Review Board-approved retrospective study in a voice clinic within a tertiary-care pediatric medical center. We studied children seen between 2000 and 2009 with a primary diagnosis of vocal fold nodules as the cause of their voice disturbance. Pediatric vocal fold nodule size was rated with a published validated scale, and voice quality was rated on the Consensus Auditory-Perceptual Evaluation of Voice scale. Results One hundred forty-five patients met the inclusion criteria. Small nodules were noted in 23% of patients, medium nodules in 39%, and large nodules in 37%. Univariate and multivariate analyses demonstrated a statistically significant relationship (p < 0.05) between vocal fold nodule size and rated perceptual qualities of overall severity of voice disturbance, roughness, strain, pitch, and loudness. With the exception of loudness, as vocal fold nodule size increased, the mean value of perceptual characteristics became larger. The age of the patient was a significant factor associated with the overall severity of the voice disturbance and roughness. Conclusions The overall severity of a child's voice disturbance and qualities of roughness, strain, pitch, and loudness have a strong correlational relationship with pediatric vocal fold nodule size, which is suggestive of causality.
Obstructive Sleep Apnea Syndrome: A Child is not Just a Small Adult
Authors: Choi Ji Ho , Kim Eun Joong , Choi June , Kwon Soon Young , Kim Tae Hoon , Lee Sang Hag , Lee Heung Man , Shin Choi , Lee Seung Hoon 
Published: May 2017

ObjectivesPediatric obstructive sleep apnea syndrome (OSAS), like adult OSAS, is characterized by intermittent upper airway collapse during sleep and is associated with anatomic and neuromuscular factors. However, the clinical manifestations, diagnostic criteria, and Polysomnographic findings of OSAS in children are likely to be different from those in adults. The purpose of this study was to identify the characteristics that distinguish the clinical manifestations and Polysomnographic findings of OSAS in children from those in adults.MethodsThe study population consisted of 34 children (mean age, 7.6 years; range, 4 to 16 years) with OSAS and 33 adults (mean age, 40.1 years; range, 18 to 58 years) with OSAS. We compared various clinical manifestations, such as body mass index, tonsil size, severity of symptoms and signs, and Polysomnographic data, between these groups.ResultsObesity was more common among the adults, whereas tonsillar hypertrophy was more common among the children. There were significant differences between the groups in the severity of symptoms and signs, including witnessed apnea, daytime sleepiness, morning headache, memory reduction, and daytime fatigue. In the children with OSAS, slow-wave sleep was relatively well preserved, and respiratory events such as apnea and hypopnea occurred mainly during rapid eye movement sleep.ConclusionsThe clinical manifestations and Polysomnographic findings in children with OSAS differ from those in adults with OSAS.
Cooling the “Oven”: A Temperature Study of Air and Glottal Tissue during Laser Surgery in an Ex Vivo Calf Larynx Model
Authors: Burns James A. , Lopez-Guerra Gerardo , Heaton James T. , Kobler James B. , Kraas Julie , Zeitels Steven M. 
Published: May 2017

Objectives Endoscopic microlaryngeal laser surgery performed with general anesthesia through a laryngoscope speculum generates heat that accumulates at the distal lumen, creating an “oven” effect and potentially causing bystander thermal damage to nontarget tissue such as the contralateral vocal fold. We report the effects of cooling on air and tissue temperatures that occurred during simulated laryngeal laser surgery with KTP and thulium lasers in an ex vivo calf model. Methods Ten fresh excised calf larynges were studied at room temperature. Laser energy was applied to one vocal fold for 2 minutes, with or without cooling, while temperatures were monitored with sensors placed within the glottal lumen or inserted superficially into the contralateral vocal fold. A pulsed KTP laser (525 mJ) was used for 5 larynges, and a thulium laser (7 W, continuous) was used for the other 5 larynges. Results Heating was slightly greater for the KTP laser than for the thulium laser with use of these parameters. The lumen temperatures for both lasers increased an average of 13.2°C without cooling, but only 6.7°C with cooling (p < 0.05). The contralateral vocal fold (subepithelial space) temperature increased an average of 6.8°C without cooling, but only 4.2°C with cooling (p > 0.05). Conclusions Cooling with room-temperature air during laryngeal laser surgery reduces luminal air and contralateral vocal fold temperatures. This effect is believed to be due to elimination of the plume of steam and smoke that significantly heats surrounding structures.
Transoral Robotic Cordectomy for Early Glottic Carcinoma
Authors: Kayhan Fatma Tülin , Kaya Kamil Hakan , Sayin Ibrahim 
Published: May 2017

Objectives We assessed the feasibility, safety, and efficacy of transoral cordectomy performed for early glottic cancer with the da Vinci Surgical System. Methods Subjects with early cancer of the vocal cords who were treated with transoral robot-assisted cordectomy were included for study. Data regarding the ability to perform robot-assisted resection, volume of blood loss, robotic operating time, pathological margin status, postoperative extubation, complications, length of hospitalization, duration until start of oral nutrition, and need for a tracheotomy were evaluated. Results Ten men with T1 glottic carcinoma underwent successful transoral robotic cordectomy with negative margins. The mean total robotic surgery time was 21.6 ± 6.75 minutes (range, 10 to 31 minutes). In all cases, the total blood loss was less than 20 mL. One subject needed a short-term tracheotomy and a nasogastric tube. The other 9 subjects started oral nutrition 6 to 24 hours after operation. The mean duration of hospitalization was 4.1 ± 2.23 days. Conclusions Transoral robotic cordectomy with the da Vinci Surgical System was found to be feasible, relatively safe, and effective. The lower morbidity rate was an advantage of this method. Transoral robotic surgery provides better exposure, visualization, and access than does transoral laser microsurgery. Cordectomy with transoral robotic surgery should be an alternative to external-approach cordectomy and transoral laser microsurgery.
Primary Sclerosing Paraganglioma of the Thyroid Gland: A Case Report
Authors: Evankovich John , Dedhia Raj C. , Bastaki Jassem M. , Tublin Mitchell , Johnson Jonas T. 
Published: May 2017

Objectives Paragangliomas are neuroendocrine tumors derived from extra-adrenal paraganglionic cells of the autonomic nervous system. Paragangliomas of the thyroid are rare, with only 28 cases reported in the literature. The sclerosing paraganglioma variant, characterized by marked stromal sclerosis and hyalinization, has scarcely been reported. Methods A 36-year-old woman with a history of a 1-cm vagal schwannoma followed with serial magnetic resonance imaging presented with a new solitary 2.5-cm enhancing soft tissue mass in the left thyroid. Results Ultrasound examination of the thyroid revealed a hypoechoic, hypervascular, malignant-appearing mass. Two fine-needle aspirations were insufficient for diagnosis, and the mass was deemed a lesion of undetermined significance with subsequent indeterminate molecular testing. A diagnostic left thyroid lobectomy was performed, and pathologic examination revealed a lesion consistent with a sclerosing paraganglioma. Conclusions Sclerosing paragangliomas are rare tumors, and only 1 case involving a primary thyroid mass has been reported in the literature. Although the sclerosing variant has features suggestive of malignancy, the true incidence of malignancy is unknown, given the rarity of its presentation. However, given the overall benign nature of paragangliomas, the sclerosing variant is also likely benign, despite its malignant features on ultrasound and histopathologic examination.
Serious Complications during Aural Impression-Taking for Hearing Aids: A Case Report and Review of the Literature
Authors: Leong Samuel C. , Banhegyi Gyorgy , Panarese Alessandro 
Published: May 2017

Objectives Complications during aural impression-taking for hearing aids are relatively rare. We present a case to highlight the need for vigilance when taking an aural impression and review the literature to identify other cases in order to assess the range of complications encountered and the sequelae of this potentially serious problem. Methods We present a case report and a review of the literature. Results The most common complication was the entry of mold material into the middle ear cavity. This frequently occurred in patients with a preexisting perforation of the tympanic membrane, although traumatic perforation occurred in 5 cases. Spread of the mold material within the middle ear cavity was frequently extensive, with 46% of cases involving the eustachian tube. There were 6 cases of ossicular chain involvement: encasement of the ossicles in 5 and extensive ossicular erosion in 1. The extent of the surgical procedures performed varied widely, ranging from simple removal of the foreign body in the mastoid cavity to tympanomastoidectomy with a facial recess approach and ossiculoplasty. In 50% of cases, the patient recovered without any complication. However, further hearing loss was observed in 36% of cases. Conclusions When mold material is impacted in the ear canal and visualization of the middle ear is obscured, we advise against simple piecemeal removal. Such cases are best managed by an experienced otologist.
Bilateral Duplicated Internal Carotid Arteries Presenting as Middle Ear Masses: A Case Report and Review of the Literature
Authors: Gartrell Brian C. , Kennedy Tabassum A. , Gubbels Samuel P. 
Published: May 2017

Objectives We seek to describe an individual with bilateral duplicated internal carotid arteries (ICAs) presenting as middle ear masses, to discuss the anatomy and characteristic imaging findings associated with this condition, and to familiarize clinicians with effective methods to prevent and manage complications related to this entity. Methods The clinical presentation of an individual with this unusual vascular anomaly was reviewed. A literature search was then performed to identify previously reported studies describing aberrant ICAs in order to characterize the presentation, anatomy, imaging findings, and management of this condition. Results An aberrant ICA presenting as a middle ear mass is uncommon; there are only approximately 45 reported cases to date. The majority of these cases presented as a unilateral anomaly without a duplication, were associated with pulsatile tinnitus and hearing loss, and were diagnosed during middle ear procedures. Bilateral aberrant ICAs are exceedingly rare, with only 14 existing reports. Only 1 of these cases presented with duplicated ICAs. Our report demonstrates an unusual presentation of aberrant ICAs, as pulsatile tinnitus was absent and previous middle ear surgery had been performed without establishing this diagnosis and without any resulting complications. Furthermore, this case represents the first known instance of a bilateral duplicated ICA system without persistent stapedial arteries. Although vascular middle ear anomalies are unusual, complications of surgical manipulation have been documented. Conclusions The clinician must have a high index of suspicion for vascular lesions in patients presenting with a retrotympanic mass. Appropriate diagnostic imaging studies should be performed to exclude this diagnosis before middle ear exploration. Should injury to the carotid artery occur, surgeons should follow specific guidelines to avoid potentially serious complications.
Adjuvant Chemotherapy with an Oral Fluoropyrimidine, S-1, following Reduced Radplat in Advanced Laryngeal Cancer
Authors: Wakisaka Naohiro , Kondo Satoru , Endo Kazuhira , Murono Shigeyuki , Yoshizaki Tomokazu 
Published: May 2017

Objectives Radiation Therapy Oncology Group study 91-11 found that in resectable advanced laryngeal cancer, the locoregional control rate achieved with reduced intra-arterial cisplatin and concurrent radiotherapy (RADPLAT) was comparable to that of a concurrent chemoradiotherapy arm, with reduced toxicities. However, distant metastases were more frequent. Our study retrospectively evaluated the efficacy and feasibility of adjuvant chemotherapy with S-1, an oral fluoropyrimidine, for distant metastases following reduced RADPLAT. Methods We analyzed 61 patients who were treated with reduced RADPLAT and achieved a complete response at the primary site. After the use of reduced RADPLAT, 24 patients were administered S-1 for 2 weeks followed by 1 week of rest, and the cycle was repeated for 6 months (S-1+ group). Thirty-seven patients were not administered S-1 (S-1-group). Results The hazard ratio for distant metastases in the S-1+ group was 0.114 (95% confidence interval, 0.015 to 0.881; p = 0.0374). There was a significant difference in disease-free survival in favor of the S-1+ group (p = 0.0455). Nineteen patients (79.2%) in the S-1+ group received S-1 according to the planned schedule and dose. Grade 3 toxicities were observed in 2 patients (8.3%), but there was no grade 4 event. Conclusions In resectable advanced laryngeal cancer, S-l adjuvant chemotherapy is an effective and feasible treatment option to control distant metastases following reduced RADPLAT.
Preparation and characterization of calcium carboxymethyl cellulose/chitosan blend nonwovens for hemostatic agents
Authors: Kim Ga Hee , Im Jung Nam , Kim Tae Hee , Lee Gyu Dong , Youk Ji Ho , Doh Song Jun 
Published: May 2017

Wet-laid blend nonwovens of calcium carboxymethyl cellulose fibers and chitosan powder were prepared as a new efficacious hemostatic agent, and their water absorption behavior, rupture strength in the dry and wet states, blood clotting properties, calcium ion release behavior, and cytotoxicity were investigated. The calcium carboxymethyl cellulose and chitosan nonwovens lost their structural integrity in the wet state due to water absorption and subsequent gelation, whereas the calcium carboxymethyl cellulose/chitosan blend nonwovens maintained their structural integrity. The formation of polyelectrolyte complexes between calcium carboxymethyl cellulose and chitosan after the absorption of water is believed to have contributed to the structural integrity in the wet state. In the in vitro blood clotting tests, the calcium carboxymethyl cellulose/chitosan blend nonwovens immediately absorbed blood and exhibited efficacious blood clotting characteristics. The calcium carboxymethyl cellulose/chitosan blend nonwovens were not cytotoxic. Considering both the structural stability in the wet state and blood clotting performance, calcium carboxymethyl cellulose/chitosan (7/3 w/w) blend nonwoven was found to be the most effective hemostatic agent of those assessed in this study, and has good potential for commercial application.
Communication and Choice in Dying from Heart Disease
Authors: Mccarthy M , Addington Hall J , Ley M 
Published: May 2017

In heart disease palliative care has received less attention than in cancer. In the Regional Study of Care for the Dying, carers of a random sample of deaths in 20 English health districts were interviewed about 10 months after the death. There were 675 respondents for patients dying with heart disease, and we report data on 600 deaths that were not sudden. 54% of patients died in hospital, 30% in their own home, 11% in a nursing or residential home, and 4% in other places. Half the patients were said to have known, or probably known, that they were likely to die; of these, 82% were said to have worked this out for themselves rather than been told by a doctor or nurse. More than one-third of patients (39%) died without an informal carer present. Respondents said that a quarter of the patients had wanted to die earlier: this desire was associated with older age and the number and severity of symptoms. The study suggests the need for health services to give greater attention to palliative care for patients dying with heart disease.
Chronic Coronary Occlusions: Age, Morphology and Chance of Reopening
Authors: Vallbracht Christian , Unverdorben Martin , Kadel Christoph , Oster Hartmut , Otto Jens , Kober Gisbert , Kaltenbach Martin 
Published: May 2017

In chronic coronary occlusions the chance of successful reopening by angioplasty can be judged from the age of the occlusion. Often, however, time since occlusion cannot be accurately assessed. Therefore we determined whether the chance of reopening can be predicted from angiographic morphology. In cineangiograms from 60 consecutive patients with chronic coronary occlusions morphological details in at least two projections were evaluated in relation to the rate of success and the estimated age of occlusion. Morphological features associated with a higher rate of success (type A) were a clearcut proximal stump, absence of side branches at the site of occlusion, absence of bridging collaterals, and only slight filling of the distal part of the vessel. Features associated with a low success rate (type B) were absence of proximal stump, side branches at the site of occlusion, bridging collaterals, and rapid high-contrast filling of the distal part of the vessel. 48/60 (80%) of occlusions could be classified as type A or type B. The success rate was 17/21 (81 %) in type A versus 5/27 (18.5%) in type B (P < 0.0002). The estimated age of type B occlusions was higher than that of type A—medians 8 and 4 months (P < 0.002). Thus in chronic coronary occlusions the likelihood of successful reopening can be judged in many patients from morphological features.
Risk Factors for Ischaemic Heart Disease in Patients with Dermatitis Herpetiformis
Authors: Lear J T , Neary R H , Jones P , Fitzgerald D A , English J S C 
Published: May 2017

For reasons that are unclear, patients with dermatitis herpetiformis (DH) have a lower than expected mortality rate from ischaemic heart disease. We have compared risk factors for ischaemic heart disease (lipids, fibrinogen levels, smoking history and social class) in 29 DH patients and 57 controls matched for age and sex. Patients with DH had significantly lower cholesterol, triglycerides, apolipoprotein B and fibrinogen and higher HDL2; they also smoked less and were of higher social class. The mechanisms underlying these observations merit further investigation. Intestinal abnormalities or gluten-free diet may account for differences in lipid fractions, and the immunomodulatory properties of cigarette smoke may protect against the development of DH.
Complications of 1303 Central Venous Cannulations
Authors: Yilmazlar A , Bilgin H , Korfali G , Eren A , Özkan U 
Published: May 2017

Central venous catheterization (CVC), now a common procedure, has several major complications. We assessed their incidence in a prospective study of 1303 cannulations done in the intensive care unit or operating theatre. Chest radiographs were obtained to verify proper catheter placement and to detect pneumothorax. Complications were arterial puncture in 68 (5.2%) patients, arrhythmias in 21 (1.6%), cardiopulmonary arrest in 1 (0.1%), and pneumothorax in 5 (0.5%). The tip of the CVC was incorrectly located in 149 (11.2%). The chest radiograph was a valuable method for detecting complications of central venous catheterization.
Validation of Current Practice and a near Patient Testing Method for Oral-Anticoagulant Control in General Practice
Authors: Seamark David A , Backhouse Susan , Barber Paul , Hichens John , Lee Richard , Powell Roy 
Published: May 2017

When oral anticoagulant control is monitored in general practice, venous blood samples are usually transported to a central laboratory for determination of international normalized ratio (INR). An alternative is near patient testing by a commercial method. In a rural general practice 27 km from a central haematology laboratory, whole blood samples were drawn from patients receiving oral anticoagulants and analysed by three methods: after centrifugation, plasma separated and frozen in liquid nitrogen, transported to the laboratory, thawed and immediately analysed (control); courier transport of citrated sample to the laboratory for analysis (routine); near patient testing of whole blood sample (NPT). Maximum temperature achieved and time to analysis for routine samples were recorded. 306 complete sets of data were obtained. Comparison between the routine method and the control method revealed acceptable agreement. On multiple regression analysis, maximum temperature achieved did not contribute to differences observed but time to analysis of over 5 hours did make a significant contribution. Comparison between the NPT method and control method showed acceptable agreement, with persistent under-recording by the NPT method. The routine method for INR determination was validated as robust and reproducible with the proviso that needle-to-analysis time should be kept below 5 hours. The NPT method was valid under conditions of normal general practice. Strict quality control of NPT methods is essential if performance is to be comparable with that of established methods.
Prevalence and Mechanisms of Gastro-Oesophageal Reflux in Adult Cystic Fibrosis Patients
Authors: Ledson M J , Tran J , Walshaw M J 
Published: May 2017

Gastro-oesophageal reflux (GOR) occurs frequently in children with cystic fibrosis (CF) but has not been studied in adult CF. We surveyed such symptoms by structured questionnaire in 50 adult CF patients (mean age 26 years, range 16–50; 24 male) and performed oesophageal manometry and 24-hour pH recording in 10 who had reflux symptoms (mean age 28 years, range 21–35; 8 men). 47 patients (94%) had upper gastrointestinal symptoms: 40 (80%) heartburn (27 worse when supine); 26 (52%) regurgitation; and 28 (56%) dyspepsia. At oesophageal manometry, lower oesophageal sphincter barrier pressure (LOSBP) was subnormal in 6 of the 10 patients and 3 had uncoordinated peristalsis in the mid oesophagus. 8 patients had raised DeMeester scores, indicating significant GOR. Those patients with a LOSBP <5mm Hg had a higher DeMeester score (mean 81.0, range 47.9–128.8) than the patients with a normal LOSBP (26.9, 8.7-56.5; p< 0.002). These results show that adult CF patients have high rates of GOR symptoms, diminished LOSBP, and acid reflux.
Direct Ophthalmoscopy versus Slit Lamp Biomicroscopy in Diagnosis of the Acute Red Eye
Authors: Anderson D F , Sullivan P M , Luff A J , Elkington A R 
Published: May 2017

The causes of red eye range from trivial to life-threatening, and many general practitioners are uncertain of their ability to diagnose them with the aid of an ophthalmoscope. We tested the hypothesis that, in the assessment of a patient with red eye, a doctor using a slit lamp biomicroscope would not differ in diagnostic accuracy from a doctor using a direct ophthalmoscope. A cross-over study was conducted in 98 patients newly attending an eye casualty department. 71% of diagnoses agreed exactly, and all potentially sight-threatening lesions were either diagnosed correctly or managed appropriately by doctors using an ophthalmoscope. We conclude that the initial diagnosis and management of patients with an acute red eye is not prejudiced by the lack of a slit lamp biomicroscope.