bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Removal of a Giant Fibrovascular Polyp of the Esophagus
Authors: Pham Annette M. , Rees Catherine J. , Belafsky Peter C. 
Published: October 2014

Objectives: Giant fibrovascular polyps of the esophagus are rare benign tumors originating from the proximal esophagus. These pedunculated lesions can grow to “giant” proportions. Asphyxiation from aspiration of the regurgitated polyp is a well-described cause of death. Traditional excision has involved a transcervical vertical esophagotomy. This report describes the successful endoscopic removal of a giant fibrovascular polyp of the esophagus. Results: A 63-year-old man with dwarfism and obstructive sleep apnea was referred for evaluation of an esophageal mass that was intermittently regurgitated into the hypopharynx. Office esophagoscopy demonstrated a 10-cm giant fibrovascular polyp originating just below the cricoid cartilage. During endoscopic removal, the base of the lesion was exposed with a Weerda bivalved laryngoscope. Bipolar cautery combined with a snare was used to transect the base with excellent hemostasis. No esophageal leak was noted on an esophagogram on postoperative day 3. The patient then resumed a liquid diet and was discharged home, resuming a regular diet within a week. Conclusions: Giant fibrovascular polyps of the esophagus are life-threatening because of potential airway obstruction. This report describes the successful endoscopic removal of a giant fibrovascular polyp, avoiding the potential morbidity associated with a transcervical vertical esophagotomy.
In Situ Tissue Engineering of the Cricoid and Trachea in a Canine Model
Authors: Omori Koichi , Nakamura Tatsuo , Kanemaru Shinichi , Magrufov Akhmar , Yamashita Masaru , Shimizu Yasuhiko 
Published: October 2014

Objectives: The purpose of the current study was to demonstrate the efficacy of in situ tissue engineering of the cricoid and trachea in a canine model. Methods: Marlex mesh tube reinforced with polypropylene threads and covered by collagen sponge was used as a tissue scaffold for airway regeneration in 9 beagle dogs. The anterior half of the cricoid cartilage was resected in 5 dogs, whereas the cricoid cartilage and cervical trachea were simultaneously resected in 4 dogs. The tissue scaffold was implanted into the resultant defect. Results: Endoscopic examination showed no airway obstruction for a postoperative period of 3 to 40 months in all dogs. Granulation tissue was observed in 2 dogs, and slight mesh exposure in 1 dog, although all were asymptomatic. Light microscopy and electron microscopy showed the endolaryngeal and endotracheal lumen to be covered by ciliated epithelium. According to strain-force measurement, the framework was firmly supported by regenerated tissue, as well as the normal cricoid and trachea. Conclusions: Our current tissue scaffold provides a rigid framework for the airway, and the collagen coating invites tissue regrowth around the tube. This study presents the possibility of successful reconstruction of the cricoid and trachea with epithelial regeneration by means of in situ tissue engineering.
Abnormal Deviation of Subjective Visual Horizontal in Patients with Vestibular Schwannoma
Authors: Ushio Munetaka , Iwasaki Shinichi , Chihara Yasuhiro , Murofushi Toshihisa 
Published: October 2014

Objectives: This study was aimed to examine the correlation between the results of subjective visual horizontal (SVH) and other vestibular function tests in patients with untreated unilateral vestibular schwannoma (VS). Methods: The subjects comprised 40 consecutive patients (17 men, 23 women) with VS who underwent vestibular function tests before surgery and had surgically and histopathologically confirmed unilateral VS. The vestibular function tests included SVH, caloric, and vestibular evoked myogenic potential (VEMP) tests. Results: Of the 40 patients, 31 (77.5%) showed deviation of the SVH toward the affected side down. Especially in 8 patients (20.0%), abnormal deviation (more than 2.2°) toward the affected side down was seen. None of the patients showed abnormal deviation toward the unaffected side down. On the caloric test, the proportion of absent caloric responses and the percent canal paresis in patients with an abnormal SVH was significantly higher than those in patients with a normal SVH. The proportion of abnormal VEMP responses was higher and the percent VEMP asymmetry was smaller in patients with an abnormal SVH than in patients with a normal SVH; however, the differences were not significant. Conclusions: Abnormal results on the caloric test and/or VEMP test were more frequently seen in VS patients with abnormal deviation of the SVH.
Effect of Hepatocyte Growth Factor on Gene Expression of Extracellular Matrix during Wound Healing of the Injured Rat Vocal Fold
Authors: Ohno Tsunehisa , French Lesley C. , Hirano Shigeru , Ossoff Robert H. , Rousseau Bernard 
Published: October 2014

Objectives: We performed a prospective, sham-controlled animal study to investigate the effects of hepatocyte growth factor (HGF) manipulation of the extracellular matrix on vocal fold gene expression during acute injury. Methods: Bilateral vocal fold wounds were created in 40 rats. The rats were randomly assigned to 1 of 2 groups (sham treatment or HGF treatment) and received treatment of the injured area at the time of wounding and on alternate post-treatment days. The injured vocal fold specimens were harvested on post-treatment days 1, 3, 7, and 14. We used real-time reverse transcription polymerase chain reaction to quantify messenger RNA expression of transforming growth factor (TGF)–β1, procollagen types I and III, hyaluronan synthase (HAS)–1, HAS–2, and HAS-3. Results: A multivariate analysis of variance revealed a significant interaction between treatment group and post-treatment day for TGF-β1, procollagen type I, procollagen type III, and HAS-2. Post hoc testing revealed significantly lower expression of procollagen type III and significantly higher expression of HAS-2 on post-treatment day 14 in the HGF treatment group than in the sham treatment group. Conclusions: Results provide evidence of HGF treatment effects on procollagen type III and HAS-2 gene expression pathways.
Hylan B Gel Restores Structure and Function to Laser-Ablated Canine Vocal Folds
Authors: Jahan-Parwar Babak , Chhetri Dinesh K. , Ye Ming , Hart Steven , Berke Gerald S. 
Published: October 2014

Objectives: We evaluated cross-linked hyaluronic acid (hylan B gel) as a scaffold for tissue regeneration and mucosal wave restoration in carbon dioxide laser–ablated canine vocal folds. Methods: Five beagles underwent stroboscopy before ablation of the left vocal fold with a carbon dioxide laser. Four weeks later, stroboscopy was repeated before and after submucosal injection of hylan B gel into the left vocal fold of 4 animals and of saline solution in 1 animal. Stroboscopy was repeated 12 weeks later, and histologic analysis was performed. Results: Four weeks after laser ablation, all animals had soft tissue defects and absence of mucosal waves. Hylan B injection restored mucosal waves, and saline injection did not. Twelve weeks after injection, hylan B–injected larynges had tissue regeneration and mucosal waves, and the saline-injected larynx had neither. Histology showed regenerated lamina propria with residual foci of hylan B in the hylan B–injected larynges and dense submucosal scar in the saline-injected animal. Conclusions: Submucosal hylan B gel injection in laser-ablated canine vocal folds restored tissue volume and mucosal waves and facilitated functional tissue regeneration over 12 weeks. Hylan B gel may have utility as a soft tissue scaffold for rehabilitation of phonatory function in vocal folds with lamina propria defects.
Plasma 25-Hydroxyvitamin D Levels in Young Children Undergoing Placement of Tympanostomy Tubes
Authors: Linday Linda A. , Shindledecker Richard D. , Dolitsky Jay N. , Chen Tai C. , Holick Michael F. 
Published: October 2014

Objectives: We report the plasma 25-hydroxyvitamin D [25(OH)D] levels of 16 young children who were undergoing ambulatory surgery for placement of tympanostomy tubes. Methods: We previously obtained blood samples from young children who were undergoing ambulatory surgery and reported that they had lower blood levels than adults of eicosapentaenoic acid (an omega-3 fatty acid), vitamin A, and selenium. Plasma frozen continuously at −80°C was available from 16 subjects who were undergoing placement of tympanostomy tubes. Results: The mean (±SD) age of the patients was 3.7 ± 1.6 years (median, 2.9 years; range, 1.9 to 7.4 years). Sixty-two percent were male; half were white, and half were Hispanic. Sixty-two percent were private patients; the parents reported that half were taking vitamin supplements. None had a history of rickets. None had 25(OH)D levels less than 10 ng/mL; 50% had 25(OH)D levels less than 20 ng/mL (deficient in adults); another 31% had levels from 21 to 29 ng/mL (insufficient in adults). Conclusions: Vitamin D is essential for the production of endogenous antimicrobial peptides, and has been linked to seasonal, epidemic influenza A. However, the level of 25(OH)D needed to prevent infection with various human pathogens has not been defined. In view of increasing bacterial resistance and emerging new pathogens, further research on the relationship of infection to 25(OH)D and other nutritional factors is warranted.
Improvement of Olfaction after Endoscopic Sinus Surgery in Smokers and Nonsmokers
Authors: Danielides Vassilios , Katotomichelakis Michael , Balatsouras Dimitrios , Riga Maria , Tripsianis Gregory , Simopoulou Maria , Nikolettos Nikolaos 
Published: October 2014

Objectives: The aim of this prospective study was to examine the short-term benefit of endoscopic sinus surgery (ESS) on the olfactory function of patients operated on for nasal polyposis. We also studied the predictive value of smoking for the recovery of the olfactory function in these patients. Methods: We studied 116 patients with nasal polyposis who underwent ESS. Olfactory testing was performed with the Sniffin' Sticks test before operation and 1, 3, and 6 months after operation. Results: All patients achieved a statistically significant stepwise increment of all of the indices of olfactory function over time. The composite threshold-discrimination-identification score was lower in smokers than in nonsmokers in all testing sessions, but none of these differences reached statistical significance. After adjustment for preoperative olfactory measures and all other potential confounders, the effect of smoking on the 6-month postoperative measurement was not significant. However, we did find a statistically significant adverse effect of the quantity of smoking on the olfactory threshold scores. Conclusions: Both smokers and nonsmokers achieve a highly significant improvement on their olfactory function from ESS. Although smoking is not a major predictive factor for the short-term outcome of the olfactory function after ESS, a greater quantity of smoking may have an effect on the 6-month postoperative odor thresholds.
Efficacy and Safety of Adenotonsillectomy for Pediatric Obstructive Sleep Apnea in Prader-Willi Syndrome
Authors: Tanna Neil , Choi Sukgi S. 
Published: October 2014

Objectives: We performed a retrospective analysis in a tertiary care children's hospital to evaluate the efficacy and safety of adenotonsillectomy for the treatment of pediatric obstructive sleep apnea (OSA) in Prader-Willi syndrome (PWS). Methods: We studied all PWS patients who underwent adenotonsillectomy to treat OSA from January 1, 2004, to December 31, 2005. The main outcome measures were 1) preoperative and postoperative full overnight polysomnography and 2) postoperative complications. Results: Three PWS patients were identified, including female twins and 1 boy. All patients had preoperative evidence of OSA without central apnea. Resolution of OSA after adenotonsillectomy was variable. The patient with the highest body mass index and tonsil size had the least residual OSA after adenotonsillectomy. No perioperative complications or adverse events were observed. Conclusions: Adenotonsillectomy did not consistently improve OSA in this population of patients with PWS. No perioperative complications were noted. Postoperative polysomnography should be considered for evaluation of possible residual OSA, as additional interventions may be warranted.
Prevalence of Vitamin D Deficiency among Patients Attending a General Otolaryngology Clinic in South Auckland
Authors: Bartley Jim , Reid David , Morton Randall P. 
Published: October 2014

Objectives: We performed a prospective observational study to estimate the prevalence of vitamin D deficiency in patients attending a general otolaryngology clinic in South Auckland, New Zealand. Methods: From July 21, 2008, to August 7, 2008, all new patients presenting to otolaryngology clinics at which one of the authors (D.R.) was present had their vitamin D status assessed by measurement of their plasma 25-hydroxyvitamin D [25(OH)D] level. Results: Of 48 patients, 2% had 25(OH)D levels of 17.5 nmol/L or less (a level associated with osteomalacia), 58% had 25(OH)D levels of 50 nmol/L or less (a level associated with vitamin D deficiency), and 100% had 25(OH)D levels of 80 nmol/L or less. Conclusions: Most of the patients attending a general otolaryngology clinic in South Auckland are vitamin D–deficient. It is unclear whether low vitamin D levels are associated more directly with otolaryngological disorders or skin type, because the small size of this study and the broad range of conditions seen precluded a meaningful statistical analysis. Further research into the relationship of vitamin D to specific otolaryngological presentations is required.
ProEx C Stain Analysis in Recurrent Respiratory Papillomatosis
Authors: Bhandarkar Naveen D. , Sims H. Steven , David Odile 
Published: October 2014

Objectives: We evaluated the presence and pattern of ProEx C stain, a marker for the proliferative capacity of cells, in laryngeal tissues, including benign, malignant, and recurrent respiratory papilloma (RRP) specimens, and compared it to hematoxylin and eosin staining for the presence of dysplasia. Methods: We performed a retrospective study with chart review. Results: A total of 26 specimens (9 benign, 7 malignant, 10 RRP) representing 21 patients were stained. ProEx C stained positive in the nuclei of laryngeal tissue, consistent with its localization in cervical cytology specimens. Seven of 9 benign and 7 of 10 RRP specimens stained positive. The benign specimens were mostly polyps. The malignant specimens were either well or moderately differentiated squamous cell carcinoma, and they stained strongly and diffusely. In benign and RRP specimens, the basal layer typically stained positive. Other areas of epithelium stained weakly in benign specimens and variably in RRP specimens. Current analysis of hematoxylin and eosin—stained RRP specimens revealed that 30% of specimens had at least moderate dysplasia and 80% exhibited viral changes (koilocytosis). Conclusions: ProEx C is a clean and reliable stain in laryngeal tissue, and stains positive in RRP. This study could not definitively correlate positive ProEx C staining in areas of greater dysplasia, although a trend was observed. Further studies are necessary to determine whether ProEx C can be used in triage of cases of clinically aggressive RRP for closer follow-up or frequent operative intervention.
Age-Specific Size of the Upper Airway Structures in Children during Development
Authors: Songu Murat , Adibelli Zehra H. , Tuncyurek Ozum , Adibelli Hamit 
Published: October 2014

Objectives: The purpose of this study was to establish the largest magnetic resonance imaging study so far, by including 292 cases in a prospective fashion, to investigate the normative values of the upper airway and surrounding tissues during development. Methods: We enrolled in the study 448 children who underwent cranial magnetic resonance imaging. We included 292 patients who had no sleep disorders or any associated symptom that could be related to breathing disorders. Using midsagittal and axial images, we evaluated the variations in size of the upper airway tissues. Results: On images from the midsagittal plane, the normative values of the length and the thickness of the soft palate, the length and height of the tongue, the distance between the mental spine and the clivus, the thickness of the adenoid pad and the nasopharyngeal area, the adenoid pad oblique width, the soft palate oblique width, and the tongue oblique width were obtained for several age groups. Using images from the axial plane at the level of maximal tonsillar cross-sectional area, we measured the normative values of the mean tonsillar width and intertonsillar space. Conclusions: Magnetic resonance imaging is an excellent method of assessing upper airway structures. Knowledge of variations in size of the upper airway and surrounding tissues is essential in determining the significance of incidental findings in this area.
Predictors of Aspiration Pneumonia following Radiotherapy for Head and Neck Cancer
Authors: Purkey Michael T. , Levine Marc S. , Prendes Brandon , Norman M. Frank , Mirza Natasha 
Published: October 2014

Objectives: Aspiration following radiotherapy for head and neck cancer (HNC) is a common event, but not all patients with aspiration will develop pneumonia. Our aim was to identify predictors of pneumonia in patients with aspiration following radiotherapy for HNC. Methods: We performed a retrospective study of 52 patients referred for modified videofluoroscopic barium swallow (MVBS) testing at our institution from 2003 to 2007 in order to identify clinical variables associated with the diagnosis of aspiration pneumonia. Results: Independent risk factors for the development of pneumonia were tracheobronchial aspiration on MVBS testing (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.2 to 20.5; p = 0.025), malnutrition (OR, 4.4; 95% CI, 1.3 to 14.7; p = 0.018), and smoking history (OR, 1.04 per pack-year; 95% CI, 1.01 to 1.07; p = 0.011). Through logistic regression analysis, we developed a bivariate predictive model with a sensitivity of 58%, a specificity of 90%, a positive predictive value of 79%, and a negative predictive value of 77% for the development of aspiration pneumonia in our patient population. Conclusions: Depth of aspiration on MVBS testing, malnutrition, and smoking history were strongly associated with the development of aspiration pneumonia in our patient population. The use of clinical variables to determine the risk of aspiration pneumonia is feasible and may help identify high-risk patients.
Endonasal Repositioning of the Upper Lateral Cartilage and the Internal Nasal Valve
Authors: Stupak Howard D. 
Published: October 2014

Objectives: Collapse of the upper lateral cartilage (ULC) is associated with narrowing of the internal nasal valve (INV). The goal of this article is to describe a novel procedure that repositions the ULC, opening the INV, without implants, grafts, or permanent sutures. Methods: Before-and-after digital photographs of patients with ULC and INV collapse who underwent endonasal ULC repositioning were analyzed. The surgical procedure consists of an intercartilaginous incision and the creation of a surface that permits scarification upon cartilage reapproximation. Precise placement of a support apparatus permits the ULC to heal into a position in direct contact with the lower lateral cartilage, thus dilating the INV. The percentage of collapse of the ULC (PCULC), determined by ULC shape measurements made with computer-aided design software, was compared on before- and-after photographs by use of Student's t-test (paired). Results: The study included 52 patients (79 procedures) followed for 1 to 18 months after surgery in the period 2007 to 2009. There were no complications or revision surgeries. The preoperative mean PCULC was 58.6%. The postoperative mean PCULC was 5.7% (p < 0.0001). Conclusions: Repair of the INV via ULC repositioning is a simple, relatively safe procedure that produces a statistically significant improvement in the PCULC. The functional change at the INV may be inferred from the ULC shape, but further prospective clinical studies are required.
School Performance and Behavior of Korean Elementary School Students with Sleep-Disordered Breathing
Authors: Kim Jin Kook , Lee Ji Hye , Lee Seung-Hoon , Hong Seok-Chan , Cho Jae Hoon 
Published: October 2014

Objectives: It is known that children with sleep-disordered breathing (SDB) often have accompanying growth retardation and learning and behavior disabilities. However, these results are based mainly on studies of children from European and North American countries. The objective of this study was to investigate the school performance and behavior of Korean children with SDB. Methods: We enrolled 302 third-grade elementary students from an elementary school in Seoul. A survey was conducted, using information from the children's parents for the diagnosis of SDB. The children's height, weight, midterm examination scores, and behavioral disturbances were analyzed. Results: Overall, 299 parents returned the survey. Of the 299 students, 29 (9.7%) were considered to have SDB. They showed no difference from the control in terms of body mass index. The mean examination score was higher in the control group than in the SDB group. However, there was a statistical difference only in social science. The prevalences of students who were inattentive (58.6% versus 23.7%) and lacking in self-control (44.8% versus 14.1%) were significantly higher among students with SDB. Conclusions: SDB is not closely associated with poor school performance among Korean elementary students. However, behavioral disturbance is more frequent among the students with SDB than in those without.
Acute Supraglottitis in Adults
Authors: Riffat Faruque , Jefferson Niall , Bari Noor , McGuinness John 
Published: October 2014

Objectives: Adult supraglottitis is a potentially life-threatening airway infection. We reviewed the management and outcome of supraglottitis in 169 adults admitted to Liverpool Hospital between 1999 and 2009. Methods: A retrospective review was conducted of all admissions with supraglottitis in patients at least 18 years of age. The diagnosis was confirmed by fiberoptic nasolaryngoscopy or direct laryngoscopy under general anesthesia. The main outcome measure was the need for intubation or tracheotomy. Univariate analysis was performed to determine factors that led to a worse outcome. Results: There were 80 men and 89 women in the cohort, with a median age of 51 years. Of these, 140 patients were admitted to the intensive care unit for a mean duration of 2 days. The common symptoms and signs at presentation were odynophagia and dysphagia (94%), dysphonia (65%), and stridor (33%). Endotracheal intubation was performed in 16 patients, and an awake tracheotomy was required in 4 patients. Dexamethasone acetate was used in 103 patients. Thirty-five patients had diabetes mellitus as a comorbidity. The presence of diabetes was predictive of the need for intubation or tracheotomy (p < 0.05), and the use of steroids was predictive of an intensive care unit stay of 24 hours or less (p < 0.05). Conclusions: Fiberoptic laryngoscopy is the gold standard for diagnosis of supraglottitis, and close airway monitoring is crucial. Conservative management of the airway is a viable option, but the presence of diabetes makes airway intervention more likely. The use of steroids aids in symptom alleviation and hastens resolution of airway swelling, with no negative sequelae.