bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contralateral Maxillary Sinus Lesions in Patients with Nasal Cavity and/or Paranasal Sinus Carcinoma: Analysis of Computed Tomography Findings
Authors: Wang Jong Hwan , Lee Jeong Hyun , Han Ju Hee , Lee Bong-Jae , Jang Yong Ju 
Published: October 2014

Objectives: The incidence of bilateral maxillary sinus carcinoma is very low in patients with primary maxillary sinus carcinoma. However, surgeons should perform careful diagnosis of any contralateral maxillary sinus lesions to avoid missing a second primary maxillary sinus carcinoma. We therefore investigated the computed tomography (CT) findings of the contralateral maxillary sinus in patients with nasal cavity and/or paranasal sinus carcinoma. Methods: Between August 1994 and September 2006, 66 patients (41 male, 25 female; age range, 22 to 85 years; mean age, 56.9 years) with nasal and/or paranasal sinus carcinoma were treated. Preoperative and follow-up CT scans of their contralateral maxillary sinuses were retrospectively reviewed. Results: Of the 66 patients, 26 (39.4%) had rhinosinusitis, 6 (9.1%) had retention cysts, and 33 (50.0%) showed normal findings on CT. One patient (1.5%) had bilateral enhanced mass-like lesions. Both masses were diagnosed histologically as poorly differentiated squamous cell carcinoma. The rhinosinusitis findings included mucoperiosteal thickening, sclerotic bone thickening, hyperdense secretion, and an air-fluid level, in order of decreasing frequency. Twenty-three of the 32 patients with benign lesions were included in the follow-up CT analysis, ranging from 24 to 108 months (mean, 45 months). On the final CT scan, rhinosinusitis was aggravated in 5 of 19 cases and improved in 14 cases, and the size of the retention cyst decreased in 4 cases. During the follow-up period, no definite abnormality suggesting tumor development in the contralateral maxillary sinus was detected. Conclusions: Even though most contralateral maxillary sinus lesions are benign and the incidence of bilateral maxillary sinus carcinoma is very low, second primary maxillary sinus carcinoma should be kept in mind in the differential diagnosis of contralateral maxillary sinus lesions in patients with nasal cavity and/or paranasal sinus carcinoma.
Matrix Metalloproteinases 2 and 9 are Concentrated in the Luminal Aspect of the Cricoid Cartilage, Diminish with Loss of Perichondrium, and are Reinstated by Transforming Growth Factor Beta 3
Authors: Martinez-Alvernia Efrain A. , Mankarious Leila A. 
Published: October 2014

Objectives: We determined the location of matrix metalloproteinases (MMP) 2 and 9, and whether the luminal perichondrium or transforming growth factor (TGF) β3 influences the presence of MMP-2 and/or −9 within the chondrocytes of the cricoid cartilage. Methods: Subglottises from 15 neonatal mice were divided into group A (N = 5; luminal epithelium intact, grown in basic medium), group B (N = 5; epithelium-free, with sections of luminal perichondrium removed, grown in basic medium), and group C (N = 5; epithelium-free, with sections of luminal perichondrium removed, grown in basic medium with supplemental TGF-β3). Immunohistochemical analysis was done to identify MMP-2 and −9 distributions. Results: Group A demonstrated concentrations of MMP-2 and −9 in the luminal perichondrial and adjacent chondrocytes with a gradual decrease in signal intensity toward the outer perichondrium. Group B showed findings similar to those in group A, but in the region of removed perichondrium, the adjacent chondrocytes lost MMP-2 and −9 signal. The group C rings demonstrated reestablishment of MMP-2 and −9 signal in regions of luminal perichondrial loss. Conclusions: Localization of MMP-2 and −9 is predominantly in the luminal perichondrium and gradually decreases toward the outer perichondrium. The luminal perichondrium maintains expression of MMP-2 and −9 within the adjacent chondrocytes. Exogenous TGF-β3 reestablishes production of at least MMP-9, and probably MMP-2, in cricoid cartilages missing luminal perichondrium.
Malpractice Litigation Involving Iatrogenic Surgical Vocal Fold Paralysis: A Closed-Claims Review with Recommendations for Prevention and Management
Authors: Shaw Gary Y. , Pierce Elizabeth 
Published: October 2014

Objectives: We describe the nature of malpractice claims filed involving surgical iatrogenic vocal fold paralysis, review surgical literature for recommendations for prevention of this complication, and suggest management of this complication. Methods: Data collection was made regarding any closed claims that involved vocal fold paralysis. The results were then analyzed and categorized. The PubMed literature regarding this complication was reviewed, and recommendations on prevention were compiled. Finally, suggestions regarding management based on the current literature and the senior author's 17-year experience in his laryngeal practice are offered. Results: From 1986 to 2007, 112 closed claims involving vocal fold paralysis were reported by the 16 largest malpractice insurers. More than US $10 million ($18 million adjusted for inflation [AJI]) has been paid thus far. The average indemnity was $285,000 ($513,000 AJI). The surgical physician defendants were from multiple specialties, including general surgery (31%), cardiothoracic surgery (12%), neurosurgery (12%), otolaryngology (10%), and orthopedic surgery (5%). The most common procedures were thyroid and parathyroid surgery (32%), cervical disc procedures (16%), thoracic procedures (12%), endarterectomy (9%), and open neck biopsy (6%). The most common claims cited were improper performance (61%), failure to recognize a complication (36%), and consent issues (19%). Conclusions: Vocal fold paralysis is a complication of many different surgical procedures across multiple specialty lines. Closed-claims analysis can offer a unique glimpse on what went wrong and why patients sue. Modification of techniques and incorporation of new technology may significantly reduce this complication. Preoperative written information on potential complications, and early referral to and management by laryngeal specialists, we believe, may significantly reduce malpractice litigation.
Inflammatory Cytokine Response to Injury in the Aging Rabbit Subglottis
Authors: Pires Valerie L. , Mankarious Leila A. 
Published: October 2014

Objectives: We performed a pilot study to determine whether there is an age-related change in inflammatory expression in the subglottic mucosa of rabbits in response to a one-time injury. Methods: Twenty-seven rabbits of 3 different ages meant to represent infant, adolescent, and adult stages underwent a unilateral, subglottic soft tissue injury. The animal groups were allowed to heal for 3 different durations to reflect the early, middle, and late stages of inflammation. Animal subglottises were then analyzed for quantitative differences in thickness and expression of multiple inflammatory cytokines within the soft tissue relative to the uninjured side. Results: The animals in the youngest age group demonstrated a thickened-tissue response to injury yet a lower level of inflammatory cytokines than did the older animals at the early and middle stages of healing. Conclusions: Pronounced tissue thickness was an unanticipated finding in the youngest age groups and suggests better regulatory control by older animals. Also, a developmental difference in the inflammatory response to injury is suggested by the data.
Safety and Feasibility of Balloon Sinuplasty for Treatment of Chronic Rhinosinusitis in Children
Authors: Ramadan Hassan H. 
Published: October 2014

Objectives: Balloon sinuplasty is a new technique that was recently introduced for the treatment of chronic rhinosinusitis (CRS). The initial experience in adults has been promising. The technique allows for restoring ventilation to the sinuses with minimal risk and trauma to the tissues. I present our initial experience of its use for treatment of CRS in children. Methods: I performed a prospective study of 30 children in whom medical therapy failed and who were scheduled for surgery. They were offered treatment with balloon sinuplasty of selected sinuses. The data collected included age, computed tomography score, and comorbid conditions. The primary outcome was the intraoperative success of dilation of the sinuses and the rate of adverse events due to the procedure. Results: The procedure was successful in 51 of 56 sinuses (91%) in 30 children. Five sinuses, of which 4 were hypoplastic maxillary sinuses and 1 was a frontal sinus, were not amenable to dilation. No complications or side effects were noted. Conclusions: The initial experience with balloon sinuplasty in children seems to be very encouraging. Because there is no bone or tissue removal, the procedure seems to be suitable for use in children. A hypoplastic sinus may not be amenable to balloon sinuplasty.
Postauricular Approach Atticotomy: A Modified Closed Technique with Reconstruction of the Scutum with Cymbal Cartilage
Authors: Pennings Ronald J. E. , Cremers W. R. J. 
Published: October 2014

Objectives: We studied the results of postauricular approach atticotomy in patients with cholesteatoma of the anterior epitympanum. Methods: Twenty-six patients were selected for removal of cholesteatoma of the anterior epitympanum by postauricular approach atticotomy, a closed transcanal procedure that is used to expose and remove cholesteatoma. After removal of cholesteatoma, reconstruction of the scutum is performed with cymbal cartilage. Results: Postauricular approach atticotomy can be performed as part of a canal wall–up procedure in selected cases in which cholesteatoma invades the anterior epitympanum. Especially if the ossicular chain is intact and if there is an anteriorly curved medial outer canal wall, this technique is useful in avoiding an open technique. A second-look procedure is recommended because of a relatively high percentage of recurrent and residual disease. Conclusions: Postauricular approach atticotomy with reconstruction of the scutum is a useful technique to remove cholesteatoma from the anterior epitympanum.
Ropivacaine Peritonsillar Infiltration for Analgesia after Adenotonsillectomy in Children: A Randomized, Double-Blind, Placebo-Controlled Study
Authors: Gemma Marco , Piccioni Lucia Oriella , Gioia Luigi , Beretta Luigi , Bussi Mario 
Published: October 2014

Objectives: Our randomized, double-blind, placebo-controlled study evaluates the possible benefit of peritonsillar infiltration with 0.75% ropivacaine hydrochloride on the pain level after adenotonsillectomy in 3- to 7-year-old children. Methods: We randomly administered intraoperative peritonsillar infiltration with 0.2 mL/kg ropivacaine 0.75% (group R) or 0.2 mL/kg saline 0.9% (group F) to sixty 3- to 7-year-old children (ASA 1 or 2) who were undergoing adenotonsillectomy. Postoperative pain was assessed 6 and 24 hours after surgery by a 6-face Faces Pain Scale that allowed quantification of pain on a 100-mm horizontal line (0 = no pain). The number of rectal doses of acetaminophen-codeine required during the first postoperative day was recorded. Results: The pain scores did not differ between the groups, either 6 or 24 hours after surgery (group F, 43 ± 26, versus group R, 29 ± 23, and group F, 24 ± 23, versus group R, 30 ± 28, respectively). Acetaminophen-codeine doses were similarly required in the two groups. Conclusions: Peritonsillar infiltration with 0.75% ropivacaine does not provide any major postoperative analgesic effect in 3- to 7-year-old children after adenotonsillectomy. A possible clinically minor analgesia 6 hours after surgery is suggested.
Role of Otolaryngologists in Health Care for the Homeless
Authors: Gurgel Richard K. , Lund Glen , Gundlapalli Adi V. 
Published: October 2014

Objectives: This study describes the prevalence of head and neck disease in patients seen at an urban, federally qualified clinic for those experiencing homelessness and determines the need for otolaryngologists in providing health care for the homeless. Methods: All adult patient visits from 2000 to 2004 were reviewed for ICD-9 diagnostic codes representing otolaryngological diseases. Chart review was performed for patients referred to a volunteer otolaryngologist to confirm diagnoses and referrals. Results: During the study period, the clinic served 11,690 unique patients in 59,060 patient visits. Otolaryngological diagnoses accounted for 8,959 of these total visits (15.2%), 94% of which were managed by primary care providers. The most common diagnoses were “upper respiratory infections,” “symptoms, signs, and ill-defined conditions of the head and neck, cough, dysphagia,” “other diseases of upper respiratory tract,” and “disorders of the ear/mastoid process.” An on-site volunteer otolaryngologist provided consultation on 6% of all patients with otolaryngological diagnoses, averaging 108 consultations per year; 39 patients were subsequently referred to community specialists for surgery and audiology services. Conclusions: There is a small but significant need for otolaryngologists in providing health care for homeless individuals in an urban setting. The authors encourage otolaryngologists and homeless health-care clinics to establish a relationship for volunteer services.
Unilateral Vocal Fold Paralysis in Premature Infants after Ligation of Patent Ductus Arteriosus: Vascular Clip versus Suture Ligature
Authors: Spanos William C. , Brookes James T. , Smith Mark C. , Burkhart Harold M. , Bell Edward F. , Smith Richard J. H. 
Published: October 2014

Objectives: We investigated risk factors associated with unilateral iatrogenic vocal fold paralysis (IVFP) in the context of ligation of patent ductus arteriosus (PDA) and compared the rates of paralysis between vascular clip and suture ligation procedures. Methods: We performed a prospective examination of infants with isolated PDA treated surgically during 1995 to 2005. Statistical significance was determined with a 2-tailed t-test. Results: Of 68 PDA ligations, 13 cases of left-sided IVFP were diagnosed, for an overall incidence of 19%. All cases of IVFP occurred in 55 infants who weighed less than 1 kg at birth. Suture ligature was used in 60% of all PDA ligation patients, and vascular clips in 40%. The incidence of IVFP in patients with vascular clips (19%) was similar to the incidence in those with suture ligature (20%). Hoarseness or stridor was present in 69% of patients with IVFP, compared to 17% of normal controls (p < 0.001). The rate of aspiration was not increased in the IVFP group; however, 15% of the patients with IVFP had episodes of decreased oxygen saturation, versus 7% of infants with normal vocal fold mobility. Conclusions: A hoarse infant with a birth weight of less than 1 kg who has undergone PDA ligation should be examined for unilateral IVFP. Vascular clips and suture ligature are associated with similar rates of IVFP.
Long-Term Acoustic Comparison of Thyroplasty versus Autologous Fat Injection
Authors: Hartl Dana M. , Hans Stephane , Crevier-Buchman Lise , Vaissière Jacqueline , Brasnu Daniel F. 
Published: October 2014

Objectives: Medialization by thyroplasty or intracordal autologous fat injection provides voice improvement in patients with unilateral vocal fold paralysis. Thyroplasty is considered a “permanent” medialization, whereas fat injection is considered “temporary” because of reabsorption. The objective of this study was to compare the evolution of acoustic parameters for these procedures over 1 year and to evaluate the results of fat injection at 2 years. Methods: From 1994 to 1998, 46 consecutive patients (17 women and 29 men) were treated exclusively by intracordal injection of autologous fat, and then from 1999 to 2002, 48 consecutive patients (19 women and 29 men) were treated with the Montgomery Thyroplasty Implant System or Gore-Tex thyroplasty. Each patient's voice was prospectively recorded before operation and at 1, 3, 12, and 24 months after operation. Six patients (13%) in the injection group underwent a second injection, and 1 patient (2%) in the thyroplasty group underwent revision surgery. Jitter, shimmer, and noise-to-harmonics ratio (NHR) were calculated for a 1,000-ms midvowel segment of the vowel / a/. Results: One month after operation, jitter, shimmer, and NHR were significantly improved in both groups (Wilcoxon's test, p < 0.05 in all cases). Jitter and shimmer did not change significantly between 1 and 3 months or between 1 and 12 months (p > 0.05). The NHR had improved at 12 months in both groups (injection, p = 0.0004; thyroplasty, p = 0.0178) and at 24 months in the injection group (p = 0.0076). No significant difference was noted between the two techniques before operation or at 1, 3, or 12 months after operation (Mann-Whitney test, p > 0.05). Jitter and shimmer had not changed significantly after 24 months in either group. At 24 months, there was no difference in acoustic parameters between the two treatment groups. Conclusions: The two techniques provided comparable objective acoustic voice improvement. At 2 years, autologous fat injection provides long-term acoustic voice improvement comparable to that of thyroplasty, but it has a higher rate of revision surgery.
Anatomy of the Optic Canal: A Computed Tomography Study of Endoscopic Nerve Decompression
Authors: Hart Catherine K. , Theodosopoulos Phillip V. , Zimmer Lee A. 
Published: October 2014

Objectives: Endoscopic optic nerve decompression has variable success rates. Our goal was to further delineate the radiographic anatomy of the optic canal to determine whether the variable success can be explained on anatomic principles. Methods: The optic canal dimensions and the degree of optic canal exposure to the sphenoid sinus were measured on sinus computed tomography images of 96 patients. Results: A total of 191 optic canals were analyzed (111 female subjects and 80 male subjects). The average medial canal wall length was 1.48 cm (range, 0.7 to 2.3 cm). The length in male subjects was 1.61 cm (range, 1.1 to 2.3 cm), as compared to 1.39 cm (range, 0.7 to 2.0 cm) in female subjects (p < 0.001). Onodi cells and pneumatized anterior clinoid processes were present on 14 and 16 images, respectively. The average degree of exposure of the optic canal to the sphenoid sinus in optic canals without Onodi cells or clinoid pneumatization was 99.3°, and in optic canals with both Onodi cells and clinoid pneumatization it was 117.7°. The potential area of canal exposed was 0.66 cm2, or 28% of the total surface area. Conclusions: A wide variation in medial canal wall length and exposure of the optic canal to the sphenoid sinus exists on computed tomography images. Variation in medial canal wall length and optic canal exposure may limit the surface area of nerve available for endoscopic optic nerve decompression.
Relationship between Squamous Cell Carcinoma Antigen and the Clinical Severity of Allergic Rhinitis Caused by Dermatophagoides Farinae and Japanese Cedar Pollen
Authors: Suzuki Kumiko , Inokuchi Akira , Miyazaki Junji , Kuratomi Yuichiro , Izuhara Kenji 
Published: October 2014

Objectives: Allergic rhinitis is known to be related to the Th2-type immune response, but no sensitive biomarker of severity yet exists. Serum squamous cell carcinoma antigen (SCCA) is clinically used as a popular tumor biomarker. We have demonstrated that SCCA is related to allergic diseases such as asthma. The purpose of the present study was to clarify the relationship between allergic rhinitis and SCCA, which had not yet been investigated. Methods: We compared the serum SCCA levels in patients with allergic rhinitis due to Japanese cedar pollen and Dermatophagoides farinae with those in normal subjects. Thereafter, the correlations between the clinical severity of allergic rhinitis and the serum levels of SCCA were investigated. Furthermore, the influence of 8 variables (serum levels of SCCA, immunoglobulin E, eosinophil cationic protein, and eosinophils; age; gender; oral administration of antiallergic or antihistaminic agents; and use of nasal drops) in regard to the severity of allergic rhinitis was studied by a multiple regression analysis. Results: The SCCA levels of the D farinae group were statistically higher than those of the control group, and they correlated with the severity of rhinitis. Among the 8 variables, only the SCCA level was found to be a predictive factor of severity on a multiple regression analysis. No relationship between SCCA level and Japanese cedar pollen allergy was demonstrated. Conclusions: These results suggest that the serum SCCA level may be a useful biomarker to evaluate the severity of allergic rhinitis caused by D farinae.
Effects of Gold Laser on the Avian Chorioallantoic Membrane
Authors: Rees Catherine J. , Allen Jacqueline , Postma Gregory N. , Belafsky Peter C. 
Published: October 2014

Objectives: Office-based lasers have revolutionized the treatment of laryngeal disease. The 980-nm Gold laser is a device that may offer some practical advantages over other office lasers. The chick chorioallantoic membrane has been proposed as a model for predicting the effects of photoangiolytic lasers on vocal fold microvasculature. We sought to evaluate the effects of the Gold laser in this model. Methods: Vascular reactions in first-order vessels were determined for the Gold laser with both 0° straight and 30° angled laser fibers. Vessels were treated at 15 W and a 500-ms pulse interval, with a 1-mm working distance. Pulse widths of 300 ms and 500 ms were evaluated. All vessels were treated until selective coagulation or vessel rupture. Results: We performed 60 trials on 30 embryos. The mean energy delivered was 33.7 J for the straight fiber and 51.2 J for the angled fiber. The laser achieved selective vessel coagulation without rupture in 100% (30 of 30) of straight fiber trials and in 100% (30 of 30) of angled fiber trials. In 6.7% (2 of 30) of straight fiber and 10% (3 of 30) of angled fiber trials, it caused minor injury to the surrounding albumin as indicated by white coagulum outside the vessel. Conclusions: The Gold laser effectively coagulates small vessels without rupture at a working distance of 1 mm and settings of 15 W, 500-ms pulse interval, and 300- to 500-ms pulse width.