bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subjective and Objective Parameters of the Adult Female Voice after Cricotracheal Resection and Dilation
Authors: Bryans Linda , Palmer Andrew D. , Schindler Joshua S. , Andersen Peter E. , Cohen James I. 
Published: October 2014

Objectives: We compared the voice outcomes after cricotracheal resection (CTR) and airway dilation in adult women. Methods: We performed long-term comprehensive voice assessments in 23 adult women treated for laryngotracheal stenosis, including acoustic and perceptual measurements of voice, videostroboscopy, the Voice Handicap Index, and an open-ended subjective questionnaire. Results: Voice measures were abnormal in both groups. Objective pitch and loudness measurements were significantly more impaired after CTR than after dilation. Perceptual ratings of voice were worse after CTR than after dilation, particularly with regard to breathiness, pitch, and loudness. The CTR group was more likely to report a voice disorder, reported significantly more voice symptoms, and had higher voice handicap scores. Videostroboscopy was frequently abnormal in both groups, with more evidence of vocal hyperfunction after CTR. Self-ratings of breathing and swallowing were generally high in both groups, but voice satisfaction was rated lower after CTR. Conclusions: Voice was more significantly negatively impacted by CTR than by dilation. Surprisingly, many individuals in both groups reported improvements — A finding that possibly highlights the impact of laryngotracheal stenosis on airflow and vocal function before surgery. The importance of patient selection and preoperative counseling is emphasized, along with the potential need for voice therapy.
Open Staple Diverticulectomy for a Large Recurrent Zenker's Diverticulum: Still a Valid Procedure
Authors: Courson Andy M. , Landry April M. , Lott David G. , Hinni Michael L. 
Published: October 2014

Objectives: We demonstrate indications for external mechanical stapler diverticulectomy in the modern era of endoscopic treatment. We review treatment of a large diverticulum and discuss considerations that should be made in deciding on the type of surgical treatment. Methods: The index case was in a 75-year-old man who had undergone open cricopharyngeal myotomy with diverticulopexy 35 years earlier. He presented with 25 years of recurrent symptoms. A swallow study showed a 6.5 × 5.0-cm diverticulum. The diverticulum was deemed too large for standard endoscopic myotomy, so diverticulectomy was performed with a stapler. Results: The patient was discharged on postoperative day 3 without complications. A swallow study on postoperative day 5 demonstrated no diverticulum or extravasation of barium. The patient resumed a normal diet with resolution of dysphagia. Two additional patients with large Zenker's diverticula that were managed similarly are also discussed. Conclusions: Although endoscopic laser cricopharyngeal myotomy and stapler diverticulostomy have become standard treatments for Zenker's diverticulum, this case of a large recurrent diverticulum illustrates a situation in which older techniques may be preferred. Use of the mechanical stapler allowed for a shorter surgery time than traditional suture techniques, and the potential for an earlier return to a normal diet.
Pneumomediastinum and pneumoperitoneum on computed tomography after peroral endoscopic myotomy (POEM): postoperative changes or complications?
Authors: Yang Shan , Zeng Meng-su , Zhang Zhi-yong , Zhang Hao-ling , Liang Liang , Zhang Xing-wei 
Published: October 2014

Background Many of the acute alterations after peroral endoscopic myotomy (POEM) may be of little clinical significance, while others may herald major clinical problems. The question whether pneumomediastinum/pneumoperitoneum is a normal postoperative finding after POEM, or should be regarded as a sign of a complication needs to be evaluated. Familiarity with these findings in computed tomography (CT) is essential for radiologists. Purpose To evaluate whether or not pneumomediastinum/pneumoperitoneum detected by chest CT is a sign of a complication after POEM using CO2 insufflation for esophageal achalasia. Material and Methods One hundred and eight patients with esophageal achalasia who underwent chest CT within 30 hours after POEM were included. CT findings were retrospectively reviewed by two radiologists in consensus. The correlation between pneumomediastinum and/or pneumoperitoneum shown on CT and the development of complications was analyzed. Results Abnormal findings were identified on post-treatment CT, including pneumomediastinum and/or pneumoperitoneum (53.7%, 58/108), pneumothorax (0.9%, 1/108), subcutaneous emphysema (29.6%, 32/108), pleural effusion (69.4%, 75/108), segmental atelectasis of lung tissue (29.6%, 32/108), minor inflammation of lungs (69.4%, 75/108), and ascites (0.9%, 1/108). Pneumomediastinum and pneumoperitoneum were observed simultaneously in 29 cases. The incidence rate of mild complications was high (79.6%, 86/108), while the rate of severe complications was low (2.8%, 3/108). There was no significant correlation between the occurrence of pneumomediastinum and/or pneumoperitoneum on CT and the development of complications ( P = 0.542), or the development of severe complications including delayed hemorrhage, esophageal perforation, and retroperitoneal abscess. Conclusion Pneumomediastinum and pneumoperitoneum detected by CT occur frequently after POEM and may be regarded as normal postoperative changes.
Ankle Fracture Spur Sign Is Pathognomonic for a Variant Ankle Fracture
Authors: Hinds Richard M. , Garner Matthew R. , Lazaro Lionel E. , Warner Stephen J. , Loftus Michael L. , Birnbaum Jacqueline F. , Burket Jayme C. , Lorich Dean G. 
Published: October 2014

Background: The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated “spur sign” or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture. Methods: Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed. Results: The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively. Conclusion: The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern. Level of Evidence: Level III, retrospective comparative study.
X-Ray Optics for Better Diagnostic Imaging
Authors: MacDonald C. A. , Gibson W. M. , Peppler W. W. 
Published: October 2014

Polycapillary x-ray optics provide an innovative new way to control x-ray beams. Placing these optics after the object to be imaged provides very efficient rejection of Compton scatter, while allowing image magnification without loss of resolution, image demagnification, or image shaping to match with digital detectors. Measured scatter rejection optics had primary transmissions greater than 50% and scatter transmission of less than 1%. For a 5-cm thick Lucite phantom, this resulted in a contrast enhancement of nearly a factor of two at 20 keV and three at 40 keV. The magnification from the tapered capillary optics improved the MTF at all frequencies out to 1.8 times the original system resolution. Increases below the system resolution are most important because clinically relevant structures generally occupy lower spatial frequencies. Alternatively, placing a collimating optic and diffracting crystal before the patient provides sufficient monochromatic beam intensity for medical imaging. Contrast, resolution, and intensity measurements were performed with both high and low angular acceptance crystals. At 8 keV, contrast enhancement was a factor of 5 relative to the polychromatic case, in good agreement with theoretical values. At 17.5 keV, monochromatic subject contrast was more than a factor of 2 times greater than the conventional polychromatic contrast. An additional factor of two increase in contrast, for a total factor of four, is expected from the removal of scatter in a large beam clinical system. The measured angular resolution after the crystal was 0.4 mrad for a silicon crystal.
The Role of Proteomics in the Diagnosis and Outcome Prediction in Colorectal Cancer
Authors: Steinert R. , Buschmann T. , van der Linden M. , Fels L. M. , Lippert H. , Reymond M.A. 
Published: October 2014

Colorectal cancer is the second most frequent cancer in Western countries. Exogenous factors play a major role in the aetiology of sporadic colorectal cancer representing about 90% of all cases, hereditary cancers accounting for about 10% of patients. Thus, in the large majority of cases, cell dysfunction in CRC results from multiple rather than single, gene interactions. Numerous cellular events and environmental influences modify gene expression or post-translational protein modifications. Changes like glycosylation of proteins and lipids which are a common feature in colorectal cancer and influence cancer cell behaviour, cannot be directly detected by genetic studies. Better than genomics studies, functional proteomics studies allow the investigation of environmental factors over time, allowing the monitoring of metabolic responses to various stimuli. However, proteomics studies also have several drawbacks: a) current tools only allow narrow-range analyses, b) identification of proteins of interest remains cumbersome, c) protein studies address multiple compounds of high complexity, d) large amount of proteins are necessary to allow analysis, e) protein research require specific tools, e.g. tagged antibodies, that first have to be developed. Some protein tests are already in application for CRC: a classical prognostic test in colorectal cancer is based on the detection and quantification of a single protein (CEA) in body fluids. Recently, a screening assay based on APC protein truncation test has also been proposed. However, studies linking large protein expression patterns with clinical outcome in colorectal cancer are still in their infancy. To be able to predict occurrence of disease, and treatment outcome, more studies on genotype-phenotype correlations are needed both in sporadic and in hereditary colorectal cancer.
Factors Controlling Electropermeabilisation of Cell Membranes
Authors: Rols M. P. , Golzio M. , Gabriel B. , Teissié J. 
Published: October 2014

Electric field pulses are a new approach for drug and gene delivery for cancer therapy. They induce a localized structural alteration of cell membranes. The associated physical mechanisms are well explained and can be safely controlled. A position dependent modulation of the membrane potential difference is induced when an electric field is applied to a cell. Electric field pulses with an overcritical intensity evoke a local membrane alteration. A free exchange of hydrophilic low molecular weight molecules takes place across the membrane. A leakage of cytosolic metabolites and a loading of polar drugs into the cytoplasm are obtained. The fraction of the cell surface which is competent for exchange is a function of the field intensity. The level of local exchange is strongly controlled by the pulse duration and the number of successive pulses. The permeabilised state is long lived. Its lifetime is under the control of the cumulated pulse duration. Cell viability can be preserved. Gene transfer is obtained but its mechanism is not a free diffusion. Plasmids are electrophoretically accumulated against the permeabilised cell surface and form aggregates due to the field effect. After the pulses, several steps follow: translocation to the cytoplasm, traffic to the nucleus and expression. Molecular structural and metabolic changes in cells remain mostly poorly understood. Nevertheless, while most studies were established on cells in culture ( in vitro), recent experiments show that similar effects are obtained on tissue ( in vivo). Transfer remains controlled by the physical parameters of the electrical treatment.
Digression on Membrane Electroporation for Drug and Gene Delivery
Authors: Neumann Eberhard , Kakorin Sergej 
Published: October 2014

Membrane electroporation (ME) defines an electrical technique to render lipid membranes porous and permeable, transiently and reversibly, by external voltage pulses. Although there are numerous applications of ME to manipulate cells, organelles and tissues in cell biology, biotechnology and medicine, yet the molecular mechanism of ME is only slowly being understood. A general chemical-thermodynamical approach for the quantitative description of cell membrane electroporation has been developed to provide the framework to quantitatively rationalize electroporative cell transformation and electroporative uptake of drug-like dyes into cells, as well as electrolyte efflux from salt-filled electroporated vesicles. Mechanistically, the electroporative transfer of gene and drug-like dyes involves the coupling between an interactive contact formation of the permeates with the cell surface membrane and the structural electroporation-resealing cycle [Formula: see text] where C is the closed and (P) represents a number of different porated membrane states, respectively. The experimentally accessible concentration fraction fp = [(P)] /([C] + [(P)]) of porous states is related to thermodynamic and electro-mechanic parameters such as temperature and the electric field strength, membrane rigidity or curvature. The results of the theoretical approach, mainly based on electrooptical data of lipid vesicles, have been successfully used to analyze single cells and to specify conditions for the practical purpose of direct electroporative gene transfer and drug delivery, in particular in the new medical disciplines of electroporative chemotherapy and electroporative gene vaccination.
Photodynamic Therapy (PDT) in Esophageal Cancer: A Surgical View of its Indications Based on 14 Years Experience
Authors: Moghissi K. , Dixon Kate 
Published: October 2014

The aim of this paper is to present the updated experience of the Yorkshire Laser Centre in PDT for esophageal cancer and to identify its role in specific subsets of patients. Also, in the light of this experience, to compare and contrast the results of PDT with appropriate subsets of patients treated in my esophageal surgery practice. 102 consecutive patients; 84 with advanced (Group A) and 18 with early (Group E) stage esophageal cancer undergoing endoscopic PDT were entered into a prospective study. Every patient had standard work up including clinical staging. PDT protocol was intravenous administration of Photofrin 2mg/kg body weight followed 24–72 hours later by endoscopic illumination using 630 nm laser light. Assessment of results was made on the basis of mortality, morbidity, patient satisfaction to treatment, symptom relief and survival. For comparison of PDT role with non PDT treated patients, reference is made to 3 previous publications comprising over 1100 patients [Moghissi, K., Br. J. Surg. 79, 935–937 (1992) (ref. 1); Sawant, D., Moghissi, K. Eur. J. Cardio-Thorac. Surg. 8, 113–117 (1994) (ref. 2); Sharpe, D. A. C., Moghissi, K. Eur. J. Cardiothorac. Surg. 10, 359–364 (1996) (ref. 3)]. There was no mortality associated with PDT. All patients expressed satisfaction to treatment. Post PDT complications consisted of photosensitivity skin reaction (sunburn) in 5 patients (5%) and esophageal stricture in 8 (8%) patients. Group A: There was significant symptom and dysphegia grade improvement. Mean survival was 9.5 months. Group E: There were no significant symptoms pre or post PDT and mean survival was 60.5 months. Comparison of PDT results in Group A with results of other palliative treatment methods, indicates that palliation can be achieved in all intraluminal cancer using PDT which is at least as good as other treatments. There is, in addition, advantage over other methods in patients with cervical esophageal cancer and in cases with re-growth of tumor obstructing previously placed stents. In early cases PDT appears capable of replicating surgical results in selected cases. PDT is an effective and safe treatment method in esophageal cancer. In advance disease it improves swallowing. In early stage disease it offers long survival and the prospect of cure in some patients. At present the role of PDT in early stage cancer should be limited to patients who are unsuitable for surgical resection. Therefore, PDT should be considered as a valid oncological option to be applied in selected cases.
High Dose Rate Brachytherapy: Its Clinical Applications and Treatment Guidelines
Authors: Nag Subir 
Published: October 2014

Brachytherapy has the advantage of delivering a high dose to the tumor while sparing the surrounding normal tissues. With proper case selection and delivery technique, high-dose-rate (HDR) brachytherapy has great promise, because it eliminates radiation exposure, allows short treatment times, and can be performed on an outpatient basis. Additionally, use of a single-stepping source, allows optimization of dose distribution by varying the dwell time at each dwell position. However, when HDR brachytherapy is used, the treatments must be executed carefully, because the short treatment times do not allow any time for correction of errors, and mistakes can result in harm to patients. Hence, it is very important that all personnel involved in HDR brachytherapy be well trained and be constantly alert. It is expected that the use of HDR brachytherapy will greatly expand over the next decade and that refinements will occur primarily in the integration of imaging (computed tomography, magnetic resonance imaging, intraoperative ultrasonography) and optimization of dose distribution. It is anticipated that better tumor localization and normal tissue definition will help to optimize dose distribution to the tumor and reduce normal tissue exposure. The development of well-controlled randomized trials addressing issues of efficacy, toxicity, quality of life, and costs-versus-benefits will ultimately define the role of HDR brachytherapy in the therapeutic armamentarium.
Image Quality Assessment via Segmentation of Breast Lesion in X-ray and Ultrasound Phantom Images from Fischer's Full Field Digital Mammography and Ultrasound (FFDMUS) System
Authors: Suri Jasjit , Guo Yujun , Coad Cara , Danielson Tim , Elbakri Idris , Janer Roman 
Published: October 2014

Fischer has been developing a fused full-field digital mammography and ultrasound (FFDMUS) system funded by the National Institute of Health (NIH). In FFDMUS, two sets of acquisitions are performed: 2-D X-ray and 3-D ultrasound. The segmentation of acquired lesions in phantom images is important: (i) to assess the image quality of X-ray and ultrasound images; (ii) to register multi-modality images; and (iii) to establish an automatic lesion detection methodology to assist the radiologist. In this paper we developed lesion segmentation strategies for ultrasound and X-ray images acquired using FFDMUS. For ultrasound lesion segmentation, a signal-to-noise (SNR)-based method was adapted. For X-ray segmentation, we used gradient vector flow (GVF)-based deformable model. The performance of these segmentation algorithms was evaluated. We also performed partial volume correction (PVC) analysis on the segmentation of ultrasound images. For X-ray lesion segmentation, we also studied the effect of PDE smoothing on GVF's ability to segment the lesion. We conclude that ultrasound image qualities from FFDMUS and Hand-Held ultrasound (HHUS) are comparable. The mean percentage error with PVC was 4.56% (4.31%) and 6.63% (5.89%) for 5 mm lesion and 3 mm lesion respectively. The mean average error from the segmented X-ray images with PDE yielded an average error of 9.61%. We also tested our program on synthetic datasets. The system was developed for Linux workstation using C/C++.
Precautions in the Use of Intensity-Modulated Radiation Therapy
Authors: Welsh James S. , Limmer Jeffery P. , Howard Steven P. , Diamond David , Harari Paul M. , Tomé Wolfgang 
Published: October 2014

Intensity-modulated radiation therapy (IMRT) represents a significant technological advancement in the ability to deliver highly conformal radiation therapy. Thanks to increased availability, general clinical implementation has become progressively more common. However, there are several precautions worthy of comment regarding the clinical applications of IMRT. In theory, the increased irradiated volume and leakage radiation that occasionally accompanies IMRT could contribute to unanticipated complications and safety concerns. The protracted delivery time of IMRT with the associated increased linac monitor units can result in photoactivation of elements within the linac collimator, thereby inadvertently increasing radiation exposure to patients and staff when high-energy photons are used. The increased volumes of normal tissue exposed to lower doses of radiation through IMRT theoretically could promote carcinogenesis and complications due to the bystander effect, low-dose hyper-radiosensitivity, and diminished repair of double strand DNA breaks at very low doses. Tumor control may be adversely affected by the lower radiation dose-rates of delivery sometimes associated with IMRT as well the occasionally seen low dose “cold shoulder” on the dose-volume histograms. Unusual clinical reactions can appear as a result of the complex, unfamiliar dose-distributions occasionally generated by IMRT treatment planning. Here we discuss some of the precautions worthy of consideration when using IMRT and how these might be addressed in routine practice.