bluuebunny/crossref_metadata_2025_split huggingface dataset:
Venous Outflow Obstruction in Myocutaneous Flaps: Changes in Microcirculation Detected by the Perfusion Fluorometer and Laser Doppler
Authors: Liu Alfred J. , Cummings Charles W. , Trachy Ronald E. 
Published: November 2015

The effects of venous occlusion on the perfusion of porcine myocutaneous groin flaps were studied by means of the laser Doppler and the dermofluorometer. A consistent decrease in fluorometer readings following venous clamping with rebound to original or greater levels after unclamping was noted. A similar pattern was noted in laser Doppler studies. However, flow as measured by the Doppler remained significant (>100 mV) even with venous outflow occlusion. It is hypothesized that the Doppler is more prone than the dermofluorometer to reflect non‐nutritive flow in the flap during the early period following flap construction and, therefore, may be less accurate in the evaluation of actual flap microperfusion. The fluorometer was determined to be the more desirable instrument in monitoring the microcirculatory status of myocutaneous flaps during the immediate period after flap elevation and transposition.
Defective Immunoregulation in Children with Chronic Otitis Media with Effusion
Authors: Bernstein Joel M. , Park Byung H. 
Published: November 2015

Otitis media and middle ear effusions (MEE) are most common clinical problems in early childhood, for which an estimated one million tympanostomies are performed each year in the United States. Although many factors have been associated with MEE (age, sex, genetics, otitis media, socioeconomic status, feeding style, atopy or hypersensitivity, certain bacteria and viruses), a defective immunoregulatory mechanism in the host may also contribute to the pathogenesis. During the past 2 years, we have evaluated immune function in 90 randomly selected children who underwent repeated tympanostomy for persistent MEE. The T‐cell subset ratio (OKT‐4/OKT‐8) was reduced (below 1.25) In 16%. In 33 children, generation of T‐cell growth factor (IL‐2) by peripheral blood lymphocytes (PBL) was evaluated and found to be decreased in 11. The mitogenic response of PBL to phytohemaglutinin (PHA) and pokeweed mitogen (PWM) stimulation was abnormal in almost half of the cases. Imbalance of T‐cell subsets and decreased production of IL‐2 indicate defective immunoregulatory function in some of these children, which may play a role in the pathogenesis of persistent MEE.
Oral steroid therapy for chronic middle ear perfusion: A double‐blind crossover study
Authors: Lambert Paul R. 
Published: November 2015

A prospective, double‐blind crossover study design was used in the evaluation of the role of prednisone in the treatment of a chronic middle ear effusion. Sixty children with an effusion—of at least 2 months’ duration—randomly received either prednisone or placebo for 2 weeks. One week later they were re‐evaluated. If the effusion had resolved, they were followed periodically; if the effusion persisted, they were given the crossover regimen and reevaluated. Sixty percent of the patients’ effusions cleared, but there was no statistical difference between the prednisone and placebo groups. The amount of hearing recovery was also the same for both treatment regimens. Subdividing the patients on the basis of effusion duration, unilateral vs. bilateral effusions, or history of ventilation tubes or antibiotics failed to identify a subgroup of individuals who might benefit from a short‐term course of oral steroids.
The ossicle‐cup prosthesis: Five years later
Authors: Schuring Arnold G. , Lippy William H. 
Published: November 2015

The osslcle‐cup prosthesis is a semibiologic prosthesis that incorporates a synthetic portion into the remaining (or transplant) ossicle. This assembly is positioned on the stapes capitulum, with the synthetic cup forming a dynamic joint. During 1978, 114 patients underwent surgical procedures in which an ossicle cup prosthesis was used. After I year 84% of these patients were within 20 dB of their preoperative bone hearing levels. Patients with a concurrent mastoidectomy did worse than those who underwent only a tympanoossiculoplasty. Five years later, 74% of the successful cases were still within 20 dB of the preoperative hearing levels. Eighteen patients underwent a revision surgical procedure to regain hearing. The postoperative hearing results at 1 year were 50% within 20 dB. The causes of failure included further ossicle necrosis (28%), a laterally healed tympanic membrane (39%), and fixation of the prosthesis (33%). Extrusion of the prosthesis during the 5‐year period was between 1% and 2%. Overall, the ossicle cup prosthesis has proved to be a stable assembly, easy to revise, and longlasting. Once successful, three of four cases will retain successful hearing for more than 5 years.
A universal ossicular replacement prosthesis: Clinical trials of 152 cases
Authors: Black Bruce 
Published: November 2015

An ossicular replacement prosthesis is described that advances implant design in several respects. The head is a flattened egg shape, which eliminates pressure points against the pars tensa and provides balance on the stapes. Dense hydroxylapatite ceramic provides maximal biocompatibility. The shaft, of either Teflon or Plastipore, is easily cut to size and is replaceable to minimize wastage. Interchangeable partial or total shaft variants are provided. Trials in more than 200 patients have produced optimal results. Among 152 mature patients in 85% of the good‐risk cases, the air‐bone gap closed to within 20 dB and in 65% to within 10 dB; in 69% of all cases the gap closed to within 20 dB. Extrusion rates were 5% in good‐risk cases and 7% overall. Long‐term extrusions have not occurred. Inasmuch as cartilage interpositioning is unnecessary, the prosthesis is rapidly prepared and implanted by an easily mastered technique.
A functional evaluation of ansa cervicalis nerve transfer for unilateral vocal cord paralysis: Future directions for laryngeal reinnervation
Authors: Green David C. , Berke Gerald S. , Graves Michael C. 
Published: November 2015

There are a variety of methods for treating unilateral vocal cord paralysis, but to date there are few objective studies that evaluate the functional results of nerve transfer from the ansa cervicalis. Six dogs underwent unilateral recurrent laryngeal nerve section with immediate reanastamosis to the sternothyroid branch of the ansa cervicalis. After 5 to 6 months, measurements of vocal efficiency and acoustic parameters, videolaryngoscopy, videostroboscopy, and evoked electromyography were performed. Identical measurements were made in eight control dogs during normal electrically induced phonation and a simulated unilateral recurrent laryngeal nerve paralysis. Histologic analysis of both vocalis muscles, recurrent laryngeal nerves, ansa cervicalis, and the ansa‐recurrent laryngeal nerve anastomosis site was performed. Evidence of reinnervation was found in all of the animals that underwent nerve transfer. The vocal efficiency and acoustic quality after ansa cervicalis nerve transfer were dependent on the degree of electrical stimulation from the transferred nerve to the reinnervated cord during phonation. In the absence of electrical stimulation to the nerve transfer, physiologic vocal cord motion could not be elicited from the reinnervated cord.
Middle meatus anstrostomy: Patency rates and risk factors
Authors: Davis William E. , Templer Jerry W. , Lamear William R. , Davis William E. , Craig Stefan B. 
Published: November 2015

Two hundred patients with chronic sinusitis were operated on using functional endoscopic sinus surgery (FESS) techniques. These patients were followed closely over 3 years. Patency of the endoscopic middle meatotomy was recorded using actuarial life‐table methods. The overall patency rate of the endoscopic middle meatotomy was 93.55%, and the actuarial patency rate at 36 months was 87.47%. The presence of seasonal allergy with nasal polyps was the most important variable in predicting closure. Middle turbinectomy was the most important variable in predicting patency. Symptoms were evaluated by questionnaire at 1 year. Questionnaire data indicate that 96% of these patients are improved or asymptomatic.
The effects of adenotonsillectomy on growth in young children
Authors: Williams Edwin F. , Woo Peak , Miller Robert , Kellman Robert M. 
Published: November 2015

A history of poor weight gain can often be elicited in young children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy. A series of 41 consecutive children under 3 years of age, who underwent inpatient adenotonsillectomy, were reviewed for changes in weight and height. Thirty‐seven patients had adequate long‐term followup. Of these, many had dramatic improvements in growth after adenotonsillectomy. Indications for surgery in this group were recurrent infection in three patients (7%), unilateral tonsillar mass in one patient (3%), and upper airway obstruction in 37 patients (90%). A clear history of sleep apnea was elicited in 59%. At the time of surgery, 19 of 41 patients (46%) were of the fifth percentile or lower for age‐corrected weight. The inpatient hospital stay averaged 3.2 days. The postoperative complication rate was 27%, with postoperative stridor as the most common complication. After surgery, 28 children (75%) showed a change to a higher percentile for weight. Twenty‐four (65%) had percentile changes of 15% or more. This change is significant according to results of the Wilcoxon signed‐rank test (p < 0.001). We conclude that a relationship exists between improved growth rate and adenotonsillectomy in our study group. The rapid improvement in growth appears to be most obvious in children with upper airway obstruction resulting from adenotonsillar hypertrophy. Upper airway obstruction (including andenotonsillar hypertrophy) should be suspected as a possible cause in the workup of children with suboptimum growth.
Pathogenesis of tympanosclerosis
Authors: Bhaya Mahesh H. , Schachern Patricia A. , Morizono Tetsuo , Paparella Michael M. 
Published: November 2015

In spite of the wealth of information on the clinical, histologic, and pathologic aspects of tympanosclerosis, the pathogenesis of tympanosclerosis is still unclear. In an attempt to understand the pathogenesis, 319 human temporal bones from 196 individuals with otitis media were studied. The extent and nature of tympanosclerosis and the characteristics of the otitis media associated with it were studied. Forty‐five temporal bones from 35 individuals with otitis media were found to have tympanosclerosis, giving an incidence of 14.1%. It was seen most commonly in individuals over 40 years of age (86.7%). The male‐to‐female ratio was 1.6:1. The most common site of occurrence was the tympanic membrane (88.9%). Tympanosclerosis was seen more often in the anterior and posterior inferior quadrants of the tympanic membrane and that, too, in a central position. Tympanosclerosis was seen more commonly in temporal bones with irreversible inflammatory changes, and in this group, late plaques were more commonly seen than early or intermediate plaques. Audiometric charts failed to show any direct relationship between extent of tympanosclerosis and the severity of hearing loss. The only audiometric finding of any consequence was a mixed hearing loss in the presence of middle ear tympanosclerosis. (OTOLARYNGOL HEAD NECK SURG 1993;109:413‐20.)
Management of laryngotracheal stenosis on the basis of site and severity
Authors: McCAffrey Thomas V. 
Published: November 2015

Seventy‐five cases of laryngotracheal stenosis treated between 1981 and 1991 were reviewed to determine the effectiveness of surgical treatment on the basis of site and severity of stenosis. Decannulation and absence of exertional dyspnea were the criteria of successful management. The treatment methods used were endoscopic laser incision and dilatation, expansion laryngotracheoplasty, and segmental resection. Endoscopic procedures were effective in treating thin (< 1 cm) stenoses in the subglottis and trachea. Laryngotracheoplasty was most effective in treating thick stenoses of the glottis and subglottis. Tracheal stenoses were most effectively treated by segmental resections. The probability for decannulation decreased with longer narrower stenoses and with increasing clinical stage. (OTOLARYNGOL HEAD NECK SURG 1993;109:468‐73.)
Extramedullary plasmacytomas of the head and neck
Authors: Wax Mark K. , Yun K. John , Omar Rawhi A. 
Published: November 2015

Extramedullary plasmacytomas are solitary tumors consisting of neoplastic plasma cell proliferations that occur in locations other than bone. On initial presentation they must be differentiated from multiple myeloma. This may prove to be difficult because a varying percentage may be associated at a later date with the development of multiple myeloma. Solitary extramedullary plasmacytomas represent up to 4% of nonepithelial lesions of the upper respiratory tract. From 1970 to 1990, at West Virginia University Hospitals, seven patients with solitary extramedullary plasmacytoma were identified. In four of these patients the tumor was located in the head and neck, with one tumor located in each of the following sites: temporoparietal scalp, maxillary sinus, nasopharynx, and cervical region. One patient had extensive destruction of the temporal bone, with extension intracranially to the middle cranial fossa. No patient had multiple myeloma, nor did any develop. Diagnosis was based on a combination of histology along with special immunoperoxidase staining for Ig lambda and kappa light chains. This will be demonstrated and discussed. Treatment consisted of radiotherapy in three cases, with doses ranging from 3175 to 6000 rad. One patient, treated with surgical excision, experienced a relapse at a distant site 6 years later. All patients have maintained local control and have been followed for a minimum of 1 1/2 years, with an average of 3 years. We describe our experience with these tumors and present a pertinent review of the literature. While these tumors may present as aggressive locally destructive lesions, their management should be as organ‐sparing as possible because excellent control can be achieved in the majority of cases. Patients should be followed for life because multiple myeloma may develop in a significant number.
Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment
Authors: Sterkers Jean‐Marc , Morrison Gavin A. J. , Sterkers Olivier , El‐Dine Mohamed M. K. Badr 
Published: November 2015

Between March 1966 and September 1992, 1400 acoustic neuromas were treated in Paris, France, by surgical excision. The findings over the last 7 years are presented. The translabyrinthine approach has been used in more than 85% of cases. Where hearing preservation is attempted, the middle fossa approach has been adopted for intracanilicular tumors and the retrosigmoid approach for small tumors extending into the cerebellopontine angle, in which the fundus of the internal meatus is free of tumor. The main goal is to achieve a grade I or II result in facial function within 1 month of surgery. Results improved during 1991 after the introduction of continuous facial nerve monitoring and the use of the Beaver mini‐blade for dissection of tumor from nerve. With these techniques, facial function at grade I or II at 1 month improved from 20% to 52% for large tumors (larger than 3 cm), from 42% to 81% for medium tumors (2 to 3 cm), and from 70% to 92% for small tumors (up to and including 2 cm extracanalicular). The facial nerve was at greater risk using the retrosigmoid or middle fossa approaches than by the translabyrinthine route. Since 1985, success in hearing preservation has changed little, with useful hearing being preserved in 38.2% of cases operated on by means of the retrosigmoid route and 36.4% of cases after the middle fossa approach. In older patients with good hearing and small tumors, observation with periodic MRI scanning is recommended. Despite earlier diagnosis, the number of patients suitable for hearing preservation surgery remains very limited and careful selection is required. Trigeminal nerve signs were present in 20% of cases preoperativey, in 10% postoperatively, and recovered spontaneously. Palsies of the other cranial nerves after surgery were much rarer and were as follows: sixth nerve (abducens), 0.5%; ninth nerve (glossopharyngeal), 1.4%; and tenth nerve (vagus), 0.7%. The importance of preservation of function of the nervus intermedius of Wrisberg is stressed. These results emphasize the advantages of the translabyrinthine approach, offering greater security to the facial nerve and lower morbidity.
Determination of palpebral closure using a hall sensor magnet pair
Authors: Hamiel Steven R. , Tubach Martin R. , Bleicher Joel N. , Cronan James C. 
Published: November 2015

A small device that can detect eyelid closure was designed using a Hall sensor and magnet. The ability of the sensor to differentiate blinks from saccadic motion is of vital interest in development of a device to alleviate complications of facial nerve paralysis. Twelve physically normal human subjects were used in this study. A small Hall sensor (3 × 2.5 × 1.1 mm), a device that detects magnetic fields, was attached to the lower eyelid near the lid margin, and an opposing small magnet (3 × 2 × 1 mm) was attached to the upper eyelid, also near the lid margin. Output potentials from the Hall sensor were monitored during eye blinks and saccadic eye movements to correlate sensor potentials with eye movements. Results indicate that the Hall sensor is effective at determining palpebral closure and discriminating eye closure from other eye movements. Therefore, we conclude that the Hall sensor is a reliable means for determining palpebral closure and is ideally suited for use in a facial prosthesis that uses the normal blink as a trigger to reanimate the contralateral paralyzed eyelid.
Expression of cytokeratins 13 and 16 in middle ear cholesteatoma
Authors: Sasaki Hiroyuki , Huang Cheng‐Chun 
Published: November 2015

The accumulation of keratinizing epithelium in the middle ear cavity is a crucial factor in the pathogenesis of cholesteatoma. We hypothesize that keratinocytes from the skin of the ear canal migrate and hyperprollferate in response to Inflammation in the middle ear cavity to cause accumulation of keratin debris. In the present study, we Investigated the expression of specific cytokeratins (CKs) in the cholesteatoma matrix to determine whether cholesteatoma is a hyperproliferative disease. Cytokeratin expression was examined in cholesteatoma, meatal skin, and tympanic membrane with two monoclonal antibodies, one for both cytokeratins 13 and 16 (antibody K8.12), and another for cytokeratin 13 only (antibody K5‐1A3). CK 13 (MW 51 KD) Is a marker of differentiation and CK 16 (MW 48 KD) is a marker of hyperproliferatlon of keratinocytes. The use of immunoblot probes showed that CKs 13 and 16 were present in cholesteatoma. Immunofluorescenf staining showed the presence of CK 16 In the suprabasal layer of cholesteatoma, which was located near the external ear canal. CK 16 was also localized in the suprabasal layer of meatal skin and tympanic membrane. CK 13 was localized in the basal layer of the cholesteatoma, distal to the external ear canal, but not in the meatal skin and tympanic membrane. Taken together, the present data suggest that cholesteatoma is a hyperprollferative disease and that cholesteatoma expresses CK 16 near the external ear canal and transforms to express CK 13 during growth distally.
Interlaboratory variability of rotational chair test results
Authors: Goebel Joel A. , Hanson Jason M. , Fishel Douglas G. ,   THE INTERLABORATORY ROTATIONAL CHAIR STUDY GROUP
Published: November 2015

Test‐retest reliability of rotational chair testing for a single facility has previously been examined by others. The actual data analysis methods, however, have received far less attention. The variety of both hardware and software currently used theoretically may affect the results for a given subject tested at different facilities. The purposes of this study were, first, to quantify the amount of variability in the analysis of Identical raw data files at multiple rotational chair testing facilities by using automated analysis; second, to evaluate the effect of operator intervention on the anaiysis; and third, to identify possible sources of variability. Raw data were collected from 10 normal subjects at 0.05 Hz and 0.5 Hz (50 degrees per second peak velocity). Diskettes containing raw electro‐oculogram data files were then distributed to eight participating laboratories for analysis by two methods: (1) using automated analysis algorithms and (2) using the same algorithms but allowing operator intervention into the analysis. Response parameters calculated were gain and phase (re: velocity). The SD of gain values per subject for automated analysis ranged from 0.01 to 0.32 gain units and of phase values from 0.4 to 13.7 degrees. For analysis with operator Intervention, the SD of gain values ranged from 0.02 to 0.10 gain units and of phase values from 0.4 to 4.4 degrees. The difference between automated analysis and analysis with operator intervention was significant for gain calculations (p < 0.02) but not for phase calculations (p > 0.05). This study demonstrates significant variability in automated analysis of rotational chair raw data for gain and phase. Operator intervention into the analysis significantly reduces variability for gain but not for phase.
Results of Cleft Palate Repair with the Double‐Reverse Z‐Plasty Performed by Residents
Authors: Mann Eric A. , Sidman James D. 
Published: November 2015

The double‐reverse Z‐plasty (Furlow) repair of soft palate clefts has the advantages of lengthening the soft palate while reconstructing the palatal muscle sling to optimize velopharyngeal function. Because soft tissue from the hard palate is not mobilized to lengthen the soft palate, this technique has an additional theoretic advantage of minimizing disturbances of maxillofacial growth. Cited disadvantages of the technique include increased technical difficulty and operating time compared with other procedures. We performed a retrospective study of 20 consecutive Furlow repairs of the soft palate performed by residents under supervision of one attending surgeon between 1989 and 1992. All children had complete cleft of the soft palate; 14 had incomplete cleft and six had complete cleft of the hard palate, which were repaired by a modified Von Langenbeck technique or with vomer flaps. Mean age of patients was 15 months, and mean operating time (including placement of pressure‐equalizing tubes) was 162 minutes, with an average estimated blood loss of less than 25 ml. Average time until adequate oral intake was achieved was 1.7 days, and duration of hospitalization averaged 2.4 days. Immediate postoperative complications included transient tongue edema in one patient and atelectasis and pneumonia in one patient with multiple congenital anomalies. Delayed postoperative complications included symptoms of sleep apnea in four patients, which subsequently improved after tonsillectomy and/or superior adenoidectomy. Fistulas occurred in two patients (10%), which compares favorably with published results of other techniques. Preliminary functional evaluations reveal that all repairs appear to have adequate length and good mobility; speech evaluations are in progress. Thus the double‐reverse Z‐plasty technique can be effectively taught to residents, and acceptable complication rates and functional results can be achieved.