bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative Analysis of OX62-Positive Dendritic Cell Distribution in the Rat Laryngeal Complex
Authors: Friedman Aaron D. , Dan Olivia , Drazba Judith A. , Lorenz Robert R. , Strome Marshall 
Published: October 2014

Objectives: Dendritic cells (DCs) are key instigators of rejection after transplantation. Their distribution has not been systematically characterized in all locations of the larynx and its surrounding tissues. Methods: Rat larynges were stained with monoclonal antibodies identifying DCs. These cells were then enumerated by a new combination of techniques including immunofluorescence, confocal microscopy, and imaging software. Results: The vast majority of DCs were located in the epithelium and subepithelium of the airway; the mean DC density ranged from 9 cells per square millimeter (0.2% of cells) to 645 cells per square millimeter (10.3% of cells). Their density in the epithelium was 3 to 11 times higher than that in the subepithelium. Non-airway sites (thyroid, parathyroid, muscle, fat) had mean DC densities varying from 3 cells per square millimeter (0.2%) to 57 cells per square millimeter (0.8%). No DCs were detected in cartilage. Conclusions: Dendritic cells are concentrated in the laryngotracheal epithelium and subepithelium and represent a much smaller proportion in the other sites studied. A baseline for laryngeal DC population studies has been established, and a computerized model for consistent quantitation using confocal microscopy has been developed. This unique method will serve as a foundation for investigating DC trafficking after rat laryngeal transplantation.
Multilevel Esophageal Biopsy in Children with Airway Manifestations of Extraesophageal Reflux Disease
Authors: Mitzner Ron , Brodsky Linda 
Published: October 2014

Objectives: Extraesophageal reflux disease (EERD) is a recognized cause of upper airway symptoms in children. Direct microlaryngoscopy and bronchoscopy (MLB) is performed for diagnostic information as to the extent and severity of the inflammation caused by gastric refluxate. Esophagoscopy with multilevel biopsy performed at the time of MLB may provide the clinician with additional information to assist in the management of EERD. We undertook to determine the role of multilevel esophageal biopsy in children who have airway manifestations secondary to EERD. Methods: We performed a retrospective chart review of 139 esophagoscopies with multilevel biopsy done at the time of MLB by a single provider for evaluation of symptoms highly associated with EERD at a tertiary care children's hospital. The histopathologic presence of esophagitis was analyzed by site and compared to the presence and location of tracheolaryngeal abnormalities. Results: Tracheolaryngeal abnormalities associated with EERD were found in 97% of patients when evaluated by MLB. Concomitant esophagitis was found in 59% of these patients. Of patients who had 0, 1, 2, 3, 4, or 5 positive findings on MLB, 75% (3 of 4), 58% (7 of 12), 57% (20 of 35), 62% (32 of 51), 56% (18 of 32), and 80% (4 of 5), respectively, had at least 1 positive biopsy. Conclusions: We found that EERD that affects the pediatric upper airway was associated with esophagitis in more than half of the patients. The usefulness of 4-level biopsies during esophagoscopy and concomitant airway endoscopy will be discussed.
Intraobserver and Interobserver Reliability in Laryngopharyngeal Sensory Discrimination Thresholds: A Pilot Study
Authors: Cunningham Jeffrey J. , Halum Stacey L. , Butler Susan G. , Postma Gregory N. 
Published: October 2014

Objectives: Laryngopharyngeal sensory discrimination threshold (LPSDT) testing is a method used to detect sensory deficits in patients in whom swallowing disorders are suspected. LPSDTs have been used to stratify patient risk status with regard to aspiration and to guide dietary management. The aim of this pilot study was to evaluate the intraobserver and interobserver reliability of LPSDT testing among a group of examiners with differing levels of testing experience. Methods: Twenty-seven healthy volunteers were enrolled in the study to elicit LPSDTs for intraobserver and interobserver reliability measurements. The examiners represented 3 levels of testing experience: An attending laryngologist, a laryngology fellow, and an otolaryngology resident. With the examiners blinded to test results, each subject was examined twice by one examiner and once by a different examiner in an alternating fashion. Results: Six subjects were unable to tolerate the examinations because of coughing and gagging. Spearman rank correlations revealed strong intraobserver reliability for the experienced endoscopists (ie, attending and fellow) but poor reliability for the novice endoscopist (ie, resident). Poor interobserver reliability regardless of endoscopy experience was found. Eighteen percent of the participants demonstrated LPSDTs of more than 4.0 mm Hg (above normal). Conclusions: 1) Intraobserver reliability was good for experienced endoscopists. 2) Interobserver LPSDT agreement between endoscopists was poor. 3) Eighteen percent of the subjects demonstrated elevated LPSDT thresholds of more than 4 mm Hg.
Tonsillectomy in the Anticoagulated Patient
Authors: Cole Stephanie M. , Patterson Matthew B. , Cupp Craig L. 
Published: October 2014

Objectives: The objectives of this study were to review perioperative bridging strategies for anticoagulated patients and to describe a novel bridging strategy for tonsillectomy in an anticoagulated patient that addresses both primary and secondary hemorrhage risks. Methods: A literature review and a case report are presented. PubMed was reviewed for evidence-based recommendations on perioperative management of anticoagulated patients. A case report is detailed of a 28-year-old woman with antiphospholipid syndrome on warfarin for high risk of venous thrombosis who underwent tonsillectomy. A perioperative bridging strategy incorporating outpatient low–molecular weight heparin and inpatient unfractionated heparin was implemented to minimize risks of thrombosis and primary and secondary posttonsillectomy hemorrhage. Results: Limited evidence supports a consensus on the best perioperative management of anticoagulated patients. Tonsillectomy in an anticoagulated patient has not been described previously. The patient in this case underwent successful tonsillectomy with no thrombosis or bleeding after 1 month of follow-up. Conclusions: Tonsillectomy can be done relatively safely in an anticoagulated patient at high risk for thrombosis. The perioperative bridging strategy should account for its unique risk of primary and secondary postoperative hemorrhage. A proposed algorithm for managing these competing risks is presented.
Expression of Neutrophil Gelatinase—Associated Lipocalin in Human Salivary Glands
Authors: Woo Jeong-Soo , Kim Kyoung-Min , Kang Jae Seong , Zodpe Prakash , Chae Sung-Won , Hwang Soon-Jae , Lee Heung-Man 
Published: October 2014

Objectives: We performed an observational study of RNA and protein expression in human tissue to examine the distribution of neutrophil gelatinase–associated lipocalin (NGAL) in normal and chronic inflammatory salivary tissues, and to investigate the expression level of NGAL in inflammatory conditions of salivary glands. Methods: Normal salivary gland tissues and tissue samples of salivary glands with chronic sialadenitis were obtained. Expression of NGAL was investigated by reverse transcriptase–polymerase chain reaction, and semiquantitative analysis of these results was also performed. The differential localization and amount of immunoreactivity to NGAL protein was evaluated by immunohistochemistry and Western blot analysis in normal salivary gland tissues and salivary glands with chronic sialadenitis. Results: NGAL messenger RNA transcripts were detected in the tissues from the salivary glands with chronic sialadenitis, but only a small amount was detected in the tissues from the normal salivary glands. A weak expression of NGAL protein was occasionally seen in a few ductal epithelial cells of normal salivary gland tissue. However, in tissue samples from glands with chronic sialadenitis, the NGAL protein was expressed strongly in ductal epithelial cells and infiltrating inflammatory cells. Conclusions: These results imply that NGAL is associated with the regulation of inflammation in salivary glands.
Nimodipine Improves Reinnervation and Neuromuscular Function after Injury to the Recurrent Laryngeal Nerve in the Rat
Authors: Hydman Jonas , Remahl Sten , Björck Gunnar , Svensson Mikael , Mattsson Per 
Published: October 2014

Objectives: Injury of the recurrent laryngeal nerve (RLN) is associated with a high degree of neuronal survival, but leads to various levels of vocal fold motion impairment or laryngeal synkinesis, which has been attributed to misdirected reinnervation of the target muscles in the larynx or aberrant, competing reinnervation from adjacent nerve fibers. The aim of the present study was to evaluate the impact of the regeneration-promoting agent nimodipine on reinnervation and neuromuscular function following RLN crush injury. Methods: Sixty adult rats were randomized into nimodipine-treated or untreated groups and then underwent RLN crush injury. Reinnervation of the posterior cricoarytenoid muscle (PCA) was assessed by electrophysiological examination, retrograde tracing of lower motor neurons before and after injury, and quantification of neuromuscular junctions in the PCA muscle. Results: At 6 weeks after injury, the nimodipine-treated animals showed significantly enhanced neuromuscular function and also demonstrated a higher number of motor neurons in the brain stem that had reinnervated the PCA, compared to the untreated animals. The somatotopic organization of ambiguus motor neurons innervating the larynx was similar before injury and after reinnervation. Conclusions: Nimodipine improves regeneration and neuromuscular function following RLN injury in the adult rat, and could be of use in future strategies following RLN injury.
Correlation of Bone SPECT Scintigraphy with Histopathology of the Ethmoid Bulla: Preliminary Investigation
Authors: Catalano Peter J. , Dolan Robert , Romanow John , Payne Spencer C. , Silverman Mark 
Published: October 2014

Objectives: Reports in the rhinology literature suggest that osteitis of the ethmoid bone may be responsible for refractory and/or recurrent sinusitis. If so, bone scanning technologies capable of detecting osteitis may be useful in diagnosing this condition and its response to treatment. The objective of this prospective cohort study was to determine the correlation of single photon emission computed tomography (SPECT) bone scintigraphy with the histopathology of the ethmoid bulla. Methods: Thirty-six patients with a diagnosis of chronic sinusitis who were scheduled to undergo sinus surgery underwent a presurgical SPECT bone scan using technetium 99m-methylene diphosphonate. All bone scans were done within 5 days of surgery. During the procedure, bone samples from the face of the ethmoid bulla were obtained and examined by a pathologist blinded to the bone scan result. In this study, histopathology consistent with osteitis was defined as a change from lamellar to woven bone. A positive bone scan was defined by the presence of increased radiotracer uptake in the ethmoid sinuses. Results: Thirty-two of the 36 patients had a positive bone scan on SPECT imaging, and 31 specimens demonstrated histopathologic bone changes consistent with osteitis, for a sensitivity of 93.9%. An additional 4 patients had a negative bone scan on SPECT imaging, and osteitis was identified in 2 of the 4. The specificity was 66.7%, and the positive predictive value was 96.9%. Conclusions: We found that SPECT bone scanning with technetium 99m-methylene diphosphonate is a highly sensitive test for identifying osteitis in patients with chronic rhinosinusitis. It may be a useful tool in the armamentarium of the otolaryngologist to better define this disease process.
Critical Look at the Surgical Approaches of Nasopharyngeal Angiofibroma Excision and “Total Maxillary Swing” as a Possible Alternative
Authors: Dubey Siba P. , Molumi Charles P. 
Published: October 2014

Objectives: We critically analyzed different surgical approaches used for the excision of nasopharyngeal angiofibroma (NPA) at our hospital in a 10-year period and proposed “total maxillary swing” as a possible alternative approach. Methods: Retrospective review of the clinical and operative records was done regarding 39 cases of NPA that were surgically managed from 1995 to 2005. The duration of the surgical procedures, amount of blood loss and transfusion, time to recurrence, frequency of recurrence, functional and cosmetic deformity, and complications of all surgical procedures were thoroughly analyzed. These parameters were compared with total maxillary swing, a new approach recently being used by us, for the one-time excision of NPA. Results: A total of 61 operations including revision surgeries for recurrences were done in the 39 cases of NPA. Conventional surgical approaches were performed in 37 cases, and the total maxillary swing approach was used in 2 cases. This new approach provided a wider surgical exposure for complete tumor resection and better hemostasis without any recurrence or major functional deformity, which were seen with some of the conventional approaches. Conclusions: We found total maxillary swing to be a relatively safe alternate approach for the resection of NPA. We removed the entire tumors in a wider surgical field under the microscope with reduced blood loss and minimal complications or chance of recurrences.
Comparison of Fundamental Frequency Nasalance between Trained Singers and Nonsingers for Sung Vowels
Authors: Fowler Linda P. , Morris Richard J. 
Published: October 2014

Objectives: The purpose of this study was to determine the effect of vocal training on fundamental frequency nasalance measures under selected vowel and frequency conditions. Methods: Fundamental frequency nasalance measures were reported for 2 groups of women: 36 trained singers and 36 nonsingers. Each group sang and sustained the vowels (/i/, /æ/, /u/, /a/) for 6 seconds' duration at 3 frequency levels. A 3-second segment from the middle of each vowel was measured to generate fundamental frequency nasalance scores. Results: No significant differences were found in the mean fundamental frequency nasalance scores between the trained singers and the nonsingers. The fundamental frequency nasalance scores were significantly higher for front vowels for both groups. Additionally, both groups displayed a pattern of producing significantly higher fundamental frequency nasalance scores at lower fundamental frequencies than at higher fundamental frequencies. Conclusions: These findings support the practice of training singers to elevate the velum when singing at high frequencies but not when singing at low ones.
Sleep-Related Deglutition in Children
Authors: Sato Kiminori , Nakashima Tadashi 
Published: October 2014

Objectives: Clearance of the pharynx by deglutition is important in protecting the airway. The pattern of deglutition during sleep was investigated in children. Methods: Ten normal human children (8.6 ± 2.9 years) were examined via time-matched recordings of polysomnography and of surface electromyography (EMG) of the thyrohyoid and suprahyoid muscles. Results: During sleep, deglutition was episodic, and it was absent for long periods. The mean number of swallows per hour (±SD) during the total sleep time was 2.8 ± 1.7 per hour. The mean period of the longest absence of deglutition was 59.7 ± 20.3 minutes. Most deglutition occurred in association with spontaneous electroencephalographic arousal in rapid eye movement (REM) and non-REM sleep. Deglutition was related to sleep stage. The mean number of swallows per hour was 27.4 ± 27.4 during stage 1 sleep, 3.1 ± 3.5 during stage 2 sleep, 2.8 ± 3.3 during stage 3 sleep, and 0.9 ± 0.8 during stage 4 sleep. The deeper the sleep stage became, the lower the mean deglutition frequency became. The mean number of swallows per hour was 2.2 ± 2.1 during REM sleep. The EMG amplitude dropped to the lowest level of recording during REM sleep. Conclusions: Deglutition, a vital function, is infrequent during sleep in children.
Intra-Arterial Chemotherapy Less Intensive Than RADPLAT with Concurrent Radiotherapy for Resectable Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Study
Authors: Yoshizaki Tomokazu , Wakisaka Naohiro , Murono Shigeyuki , Kondo Satoru , Shimizu Yoshinori , Takanaka Tsuyoshi , Sanada Jun-Ichiro , Terayama Noboru , Matsui Osamu , Furukawa Mitsuru 
Published: October 2014

Objectives: This study was designed to evaluate the efficacy and feasibility of our intra-arterial chemotherapy protocol with a lower amount and frequency of cisplatin delivery than in RADPLAT for the treatment of resectable advanced head and neck cancer. Methods: Fifty-one patients with advanced squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx were included in this prospective study. The patients were treated with 3 courses of cisplatin (100 mg at 1 treatment, intra-arterial) and sodium thiosulfate (28 g at 1 treatment, intravenous) once every 2 weeks during concurrent radiotherapy (66 to 70 Gy, 2 Gy per fraction, daily for 5 days over 7 weeks). Nodal metastases larger than 3 cm in diameter were treated with an additional 50 mg of cisplatin. The patients with less than 50% tumor reduction after 40 Gy and 2 courses of chemotherapy were treated with surgery. Results: The protocol was completed for 49 patients. All living patients had a minimum follow-up period of 2 years. Including the 3 patients with salvage surgery, local disease-free control was achieved in 39 patients (80%). For 36 patients (73.5%), disease-free primary organs were preserved at 2 years after treatment. Locoregional disease-free control for 2 years was obtained for 38 patients (77.6%), in 30 of them without salvage surgery. The patients treated with surgery had an overall survival rate similar to that of the patients with a complete response (80% and 84.6%, respectively). The patients with a partial response had a worse prognosis (40%; p = 0069). Conclusions: This treatment regimen is feasible and effective for advanced resectable head and neck cancer.
Development of Endoscopic Arytenoid Adduction Using Cricoid Implant
Authors: Kwon Tack-Kyun , Jeong Woo-Jin , Sung Myung-Whun , Kim Kwang Hyun 
Published: October 2014

Objectives: We sought to develop a less-invasive alternative to conventional arytenoid adduction using a cricoid implant. Methods: We performed a preliminary study with excised human and canine larynges. A nail-shaped stainless steel rod and an insertion device were designed for an in vivo animal trial. After unilateral recurrent laryngeal denervation surgery in 5 adult mongrel dogs, the implants were inserted endoscopically through a small mucosal incision over the cricoarytenoid joint. Acoustic and aerodynamic data were obtained from each animal before serial euthanasia followed by examination of the excised larynges. Results: The canine cricoid cartilage demonstrated adequate marrow space for implantation. We found that the arytenoid cartilage was successfully medialized and tightly fixed over a sufficient period of time just by inserting an implant in the cricoid cartilage. The animal study showed that the implantation procedure was relatively easy and relatively safe. Acoustic and aerodynamic studies confirmed the functional improvement of the voice. Histopathologic study revealed a favorable tissue response to the implant. Conclusions: Endoscopic arytenoid adduction using a cricoid implant is feasible and could be a noninvasive surgical option for the treatment of unilateral vocal fold paralysis.
Drilling Simulated Temporal Bones with Left-Handed Tools: A Left-Hander's Right?
Authors: Torgerson Cory S. , Brydges Ryan , Chen Joseph M. , Dubrowski Adam 
Published: October 2014

Objectives: Left-handed trainees can be at a disadvantage in the surgical environment because of a right-handed bias. The effectiveness of teaching left-handed trainees to use an otologic drill designed for their dominant hand versus the conventional right-handed drill was examined. Methods: Novice medical students were recruited from the university community. Twenty-four subjects were left-handed, and 12 were right-handed. Eight left-handed surgeons also participated. A randomized controlled trial was conducted to compare the performance of left-handed trainees using novel left-handed drills to that of left-handed trainees using right-handed tools and to that of right-handed trainees using right-handed tools. The evaluation consisted of 3 phases: Pretest, skill acquisition, and 2 post-tests. The measurement tools included expert assessment of performance, and subjective and objective final product analyses. Results: An initial construct validity phase was conducted in which validity of the assessment tools was ensured. Both the left-handers using left-handed tools and the right-handers using right-handed tools significantly outperformed the left-handers using right-handed tools at pretest, immediate posttest, and delayed posttest. All participants improved their performance as a function of practice. Conclusions: The left-handed trainees learned bone drilling better with tools designed for the left hand. These tools may be incorporated into residency training programs for the development of surgical technical skills. Future studies should assess skill transfer between the left-handed and right-handed drills.
Prevalence of Upper Airway Tumors and Cysts among Patients Who Snore
Authors: Suzuki Masaaki , Saigusa Hanako , Chiba Shintaro , Hoshino Tadahiko , Okamoto Makito 
Published: October 2014

Objectives: Sleep specialists usually do not pay much attention to the upper airway in patients who snore, because they can make the diagnosis of sleep-disordered breathing without performing nasopharyngeal endoscopy if they have the Epworth Sleepiness Scale scores and the results of polysomnography. The purpose of this study was to determine the prevalence of benign and malignant tumors and cysts in the upper airway in patients who snore. Methods: A retrospective multicenter trial was performed in 4 sleep laboratories. Adult male and female patients whose chief complaint on their first visit was witnessed snoring were enrolled in this study. All of the patients were evaluated by otolaryngologists using nasopharyngeal endoscopy to detect organic diseases in the upper airway. Results: Among 2,923 patients, 2 patients had malignant tumors, 5 had benign tumors, and 2 had cysts in the upper airway. The prevalence of upper airway benign and malignant tumors and cysts among adult male and female patients was 0.24%. Conclusions: Routine detailed nasopharyngeal endoscopy should be carried out in each institution so as not to overlook organic diseases in the upper airway among patients who snore.