bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyoid Bone Syndrome: A Retrospective Review of 84 Patients Treated with Triamcinolone Acetonide Injections
Authors: Stern Noah , Jackson-Menaldi Cristina , Rubin Adam D. 
Published: August 2015

Objectives: We present a cohort of patients with hyoid bone syndrome who were treated with injections of triamcinolone acetonide (40 mg/mL), in order to raise awareness of this condition, validate its existence, and demonstrate the efficacy of this treatment. Methods: We performed a retrospective chart review of patients who were given a diagnosis of and treated for hyoid bone syndrome by the senior author (A.D.R.) between 2006 and 2009. Results: Eighty-four patients met the inclusion criteria. All patients presented with throat pain and had tenderness of 1 (63%) or both (38%) greater cornua of the hyoid bone. Seventy-four percent of the patients had complete resolution of symptoms with injection of the affected side(s), 15% had a partial response, and 10% had no response. One patient had a recurrence at 3 months and chose not to receive another treatment. Forty-five of the 62 patients with a complete response required only 1 injection. Forty-three patients (51%) also complained of dysphonia, only 5 of whom had additional laryngeal disorders that accounted for the dysphonia. Conclusions: Hyoid bone syndrome should be considered in patients who present with throat pain. Injection of triamcinolone into the affected greater cornu can confirm the diagnosis and resolve symptoms. A positive response to triamcinolone injection may obviate the need for additional testing and procedures.
The Upper Esophageal Sphincter is Not Round: A Pilot Study Evaluating a Novel, Physiology-Based Approach to Upper Esophageal Sphincter Dilation
Authors: Belafsky Peter C. , Plowman Emily K. , Mehdizadeh Omid , Cates Daniel , Domer Amanda , Yen Kaicheng 
Published: August 2015

Objectives: Recent basic science investigations have suggested that the upper esophageal sphincter (UES), in cross section, is not round, but that it more closely approximates a kidney shape. Dilation with simultaneous use of two cylindrical dilators provides a novel, physiology-based approach to UES distention. We evaluated the initial safety and efficacy of UES dilation with simultaneous use of two controlled radial expansion balloon dilators. Methods: Using a computerized database, we reviewed the charts of all persons who underwent UES dilation with simultaneous use of two radial expansion balloon dilators between December 1, 2011, and March 15, 2012. Information regarding patient demographics, indications, technique, and complications was abstracted. Self-reported swallowing impairment was assessed with the validated 10-item Eating Assessment Tool (EAT-10). Results: Ten individuals underwent simultaneous dilation with two dilators. Their mean age was 65 years (SD, 14 years), and 7 (70%) of them were male. The indications for dilation were radiation-induced UES stenosis (50%), cricopharyngeus muscle dysfunction (30%), upper esophageal web (10%), and anastomotic stricture (10%). After the double-balloon dilation, no complications were reported. The mean EAT-10 score improved significantly, from 34.3 (SD, 13.5) to 16.7 (SD, 8.4), after the simultaneous dilation (p = 0.003). Conclusions: Pilot data suggest that simultaneous dilation of the UES with two controlled radial expansion balloon dilators is feasible, safe, and effective. Future investigation is necessary to confirm the safety of this technique in a larger cohort and to use objective measures of efficacy to compare the technique to conventional dilation with a single dilator.
Role of Computerized Dynamic Posturography in Evaluating Sinugenic Vertigo
Authors: Gavriel Haim , Shlamkovitch Nathan , Kessler Alex , Eviatar Ephraim 
Published: August 2015

Objectives: Vertigo associated with rhinosinusitis has seldom been reported, and the pathophysiologic mechanism is still vague. Our aim was to evaluate sinugenic vertigo with computerized dynamic posturography (CDP) and suggest a possible pathophysiologic mechanism. Methods: We conducted a prospective study of 16 patients with a clinical and radiologic diagnosis of rhinosinusitis made between January 2007 and December 2008. All patients underwent CDP on the first 2 days after diagnosis. Patients with abnormal CDP results and/or complaints of vertigo underwent follow-up CDP when healthy. Results: Five patients complained of a new onset of vertigo. The CDP demonstrated a combined disorder in 3 of them, even though the vestibular signs were intact. On follow-up examination, all 3 patients were asymptomatic, and the follow-up CDP values were normal. Conclusions: We report a surprising 20% prevalence of sinugenic vertigo associated with abnormal results on CDP. Our results might possibly indicate that the somatosensory system of the paranasal sinuses plays a major role in the pathophysiologic mechanism of sinugenic vertigo.
Robot-Assisted Neck Dissection Through a Modified Facelift Incision
Authors: Albergotti William G. , Byrd James K. , Nance Melonie , Choi Eun Chang , Koh Yoon Woo , Kim Seungwon , Duvvuri Umamaheswar 
Published: August 2015

Objectives: The aim of this study is to describe the feasibility as well as oncologic outcomes of robot-assisted neck dissection (RAND) through a modified facelift incision in an American population. Study Design: Retrospective case series. Setting: University tertiary care hospital. Methods: All patients who underwent RAND between November 2012 and December 2014 were included. Medical records were reviewed for demographics, medical histories, staging, operative information, postoperative hospital course and complications, and oncologic outcomes. Results: There were 11 RANDs identified among 10 patients. Five patients had known nodal metastasis at the time of surgery. Two patients had been previously irradiated. The average time of surgery was 284.4 ± 72.3 minutes, including other associated procedures. The average lymph node yield was 28.5 ± 9.3 nodes. There were no major complications. Average follow-up was 19.4 months. There was 1 supraclavicular recurrence in a previously irradiated patient. All patients are currently alive and without evidence of disease. Conclusions: Robot-assisted neck dissection is a safe and feasible procedure that can be performed by surgeons with familiarity with neck dissection and robot-assisted surgery and who have been trained in RAND. Appropriate oncologic outcomes can be obtained in a patient wishing to avoid a noticeable scar.
The Effect of Alpha‐Adrenergic Stimulation and Blockade on Perfusion of Myocutaneous Flaps
Authors: Moore Grant K. , Trachy Ronald E. , Cummings Charles W. 
Published: August 2015

A porcine myocutaneous flap model was utilized to assess the development of denervation adrenergic hypersensitivity and to determine the effects of the alpha‐adrenergic blocking agent—phenoxybenzamine—on flap blood perfusion. During intravenous administration of norepinephrine, blood flow to the flaps and control skin was monitored simultaneously, using laser Doppler velocimetry and dermofluorometry. A relative decrease in myocufaneous flap blood flow, as compared to control skin in response to norepinephrine infusion, was observed at between 2 and 7 days following flap elevation. This is the same time period during which norepinephrine content of skin flaps is diminished, and suggests development of an increased sensitivity to adrenergic stimulation. Administration of phenoxybenzamine blunted norepinephrine‐induced pressor responses and blocked development of adrenergic hypersensitivity in the porcine myocufaneous flap model. Phenoxybenzamine significantly increased flap blood perfusion (as measured by dermofluorometry).
Vestibular Evoked Potentials in Response to Direct Unilateral Mechanical Stimulation
Authors: Coale Franklin S. , Walsh Edward J. , McGee JoAnn , Konrad Horst R. 
Published: August 2015

Evoked potentials produced by direct unilateral mechanical stimuiation of the cannulated horizontal semicircular canal were investigated parametrically in anesthetized adult cats (40 mg/kg pentobarbital). Stimuli were fluid pressure pulses in a closed hydraulic system (no net flow), which was coupled to the lateral semicircular canal near the ampulla. Hydraulic waveform output and fluid pressure was monitored In situ via a parallel hydraulic circuit during experiments. Maximum fluid displacement at the level of the horizontal canal was 0.025 microliters. The intensity, duration, and presentation rate of the stimulus were varied during experiments. Field potentials were recorded differentially using subdermal electrodes, with the active lead in the region of the mastoid referenced to a distant nasal site. A total of 256 trials was accumulated for each run using an averaging computer. Evoked responses were physiologically vulnerable and reproducible, with little variance among animals. Response amplitude Increased monotonically until saturation was noted and responses followed the temporal structure of the pressure wave. Polarity reversal with differir electrode placement suggests that the generator site lies within the mastoid. Buhner, intense broadband acoustic stimuli and eighth nerve sectioning did not affect the vestibular evoked potentials, but could be shown to abolish the auditory evoked potentials. Results of these experiments support the notion that vestibular evoked potentials are related to the first derivative of the pressure pulse waveforms. Future experiments will be directed toward the assessment of vestibular physiology and pharmacology with this evoked response method.
Glottic Closure during Swallowing in the Recurrent Laryngeal Nerve‐Paralyzed Cat
Authors: Shin Takemoto , Umezaki Toshiro , Maeyama Tadatsugu , Morikawa Ikuro 
Published: August 2015

Glottic closing pressure and time were quantitatively analyzed during deglutition and in reflex glottic closure elicited by superior laryngeal nerve stimulation by means of a catheter pressure transducer in the cat. Duration and peak pressure of glottic closure during deglutition were 322.6 ± 32.2 msec (mean ± SE) and 57.5 ± 6.0 mmHg, respectively, whereas peak pressure of the reflex glottic closure was 21.7 ± 6.1 mmHg in control animals. When the recurrent laryngeal nerve was denervated unilaterally, decrease in peak glottic closing pressure on swallowing was only about 36%, whereas the peak pressure of reflex glottic closure was markedly diminished to 4.5 ± 4.6%. When bilateral recurrent laryngeal nerves denervated, decrease in peak pressure during deglutition showed no greater significance than It did after unilateral denervation. Inferior constrictors myotomy in addition to bilateral recurrent laryngeal nerve denervation reduced peak pressure to nearly zero. These results indicate that on swallowing, the inferior constrictors cooperate with the intrinsic laryngeal adductors, thus playing a very important role in reinforcing glottic closure, a function that is unlikely during reflex glottic closure.
The Narrow Internal Auditory Canal in Children: A Contraindication to Cochlear Implants
Authors: Shelton Clough , Luxford William M. , Tonokawa Lisa L. , Lo William W. M. , House William F. 
Published: August 2015

We suggest a new explanation for the lack of auditory response to electric stimulation in children with cochlear implants: The very narrow internal auditory canal, 1 to 2 mm in diameter, and the probable absence of the cochlear nerve. This defect can be seen on high‐resolution computed tomographic x‐ray studies and may represent aplasia of the auditory‐vestibular nerve. We report on eight children with this anomaly, three of whom have received implants and failed to respond with a sensation of sound. Identification of this problem on screening x‐ray films is a contraindication to cochlear Implantation for auditory stimulation.
Electrically Stimulated Increases in Cochlear Blood Flow: I. Frequency and Intensity Effects
Authors: Sillman Jonathon S. , LaRouere Michael J. , Masta Robert I. , Miller Josef M. , Nuttall Alfred L. 
Published: August 2015

Charge‐balanced, sinusoidal current was passed differentially between the apex and round window of the guinea pig cochlea. Cochlear blood flow was measured using a laser Doppler flow monitor. Systemic blood pressure was monitored from a cannula within the common carotid artery. Electrical stimulation increased cochlear blood flow, while systemic blood pressure was unaffected. A cochlear blood flow response parameter, normalized for transient changes in systemic blood pressure, was defined. The magnitude of the response parameter was found to be frequency selective and was also found to be an increasing function of current intensity, with maximum responses obtained with 500 Hz sinusoids. This cochlear blood flow response was not observed in dead animals; was present in preparations paralyzed with gallamine hydrochloride; and was correlated with an increase in cochlear red blood cell velocity, as directly observed by intravital microscopy. These observations imply that electrical stimulation induces a local vasodilation within the temporal bone. The fact that decreased cochlear blood flow was never observed with current injection implies that ischemia is not a likely mechanism of electrically induced tissue damage within the inner ear. The mechanism of this cochlear blood flow response is addressed in a companion report.
Lymphedema: Anatomy, Physiology and Pathogenesis
Authors: Szuba Andrzej , Rockson Stanley G 
Published: August 2015

The authors review the current understanding of lymphatic anatomy and physiology, and the pathophysiology of lymphedema. The skin lymphatic system consists of the initial lymphatics, which converge into lymphatic precollectors, collectors and lymphatic ducts; these in turn convey the lymph to the regional lymph nodes. Interstitial fluid and particles enter the initial lymphatics through interendothelial openings and by vesicular transport. Lymphatic uptake is enhanced by external compression. Lymphatic transport depends greatly on contraction of lymphangions, which generate the suction force that promotes absorption of interstitial fluid and expels lymph to collecting ducts. In lymphedema, various types of congenital and acquired abnormalities of lymphatic vessels and lymph nodes have been observed. These often lead to lymphatic hypertension, valvular insufficiency and lymphostasis. Accumulation of interstitial and lymphatic fluid within the skin and subcutaneous tissue stimulates fibroblasts, keratinocytes and adipocytes eventuating in the deposition of collagen and glycosaminoglycans within the skin and subcutaneous tissue together with skin hypertrophy and destruction of elastic fibers.
Electronic Health Records and Interruptions: The Need for New Interruption Management Strategies
Authors: Benda Natalie C. , Meadors Margaret L. , Hettinger A. Zachary , Fong Allan , Ratwani Raj M. 
Published: August 2015

Background: Interruptions have been widely studied in the health care domain, yet the nature of work in healthcare is changing with the pervasive use of electronic health records (EHRs). It is unclear how interruptions are changing with the introduction of new technology. Method: This study examines the nature of interruptions experienced by emergency medicine physicians before and after the transition from a home grown EHR to a commercially available system with electronic nursing documentation and computerized physician order entry (CPOE) capabilities. A minute-by-minute paper-based observation template was utilized to record the type of tasks interrupted (patient room, computer, verbal communication or paper charts/labs) as well as who initiated the interruption. Results: There was a significant difference in the type of tasks performed between the preimplementation and post-implementation (go-live) phase. Physicians spent less time on paper-related tasks (p < 0.01) and more time on computer-related tasks (p < 0.01) in the go-live phase. With the shift in task composition, physicians experienced a significantly higher rate of interruptions of computer tasks (p = 0.05), and a significantly lower rate of interruptions to of paper-based tasks (p < 0.01). There were no significant differences in the source of the interruption between the two phases. Discussion: Given the shifts in the types of tasks interrupted after the implementation of a commercially available system with CPOE, it is important to develop new interruption coping strategies. These strategies might include interface design principles to facilitate interruption recovery, less disruptive tactics for the person initiating the interruption, and providing the physicians with training on test systems with realistic data prior to using the new system to care for patients. Conclusion: It was demonstrated that EHRs change the nature of interruptions experienced during the immediate go-live period. Going forward, exploring methods for mitigating harm associated with this change will be critical in preserving patient safety.
Pleural Effusion Size as Prognostic Marker in Patients With Malignant Pleural Effusion
Authors: Montero-Arias Felicia , Cartin-Ceba Rodrigo , Rojas-Solano Jose , Ugalde-Gamboa Luis , Ramos-Esquivel Allan 
Published: August 2015

Background: Inconsistent results have been reported regarding mortality predictors of malignant pleural effusion (MPE). Objective: We aim to describe prognostic features of MPE in patients evaluated over 5 years in a referral center. Methods: All consecutive MPEs (confirmed by pleural cytology or biopsy) from January 2009 to July 2014 were included in this retrospective cohort study. Clinical data were collected from medical registries. Overall survival (OS) rate was calculated with Kaplan-Meier method and compared by the log-rank test. Hazard ratios (HRs) were calculated by the Cox proportional regression model. Results: A total of 110 patients were identified. Mean OS was 8.3 months (range: 25-426 days). No difference in OS was noted based on tumor type. Patients with MPE <50% had a significant better survival than those with malignant pleural effusion ≥50% (median OS: 15.7 vs 5.7 months; HR: 1.71; 95% confidence interval [CI]: 1.06-2.78; P = .0026). After adjusting for confounding variables, MPE size was independently associated with mortality (HR: 1.78; 95% CI: 1.11-2.91; P < .001). No association between glucose or pH in pleural fluid and OS was noted. Conclusion: Our study showed that MPE size, as determined by chest X-ray, is significantly associated with mortality.
Enamel Surface Roughness of Preferred Debonding and Polishing Protocols
Authors: Webb Brian J. , Koch Jacob , Hagan Joseph L. , Ballard Richard W. , Armbruster Paul C. 
Published: August 2015

Objective This study investigated the surface roughness of enamel after debonding and instrumentation with commonly used methods. Methods Part I: a survey was sent to active members of the American Association of Orthodontists to determine popular bonding, debonding, and polishing protocols. Part II: brackets were bonded to the buccal surface of 30 extracted human premolar teeth. After debonding, residual adhesive was removed with 12-, 16-, and 20-fluted titanium carbide burs as based upon the survey results. The teeth were scanned with a surface profilometer for surface roughness. Part III: the teeth were further polished using a Reliance Renew polishing point or a prophy cup with pumice and rescanned for surface roughness. Results Part I: the majority of respondents used a generic bracket-removing plier to remove fixed appliances (53%) and a high-speed handpiece for adhesive removal (85%). The most popular bur was a 12-fluted carbide bur without water spray. The majority of respondents used pumice paste and/or Reliance Renew points after adhesive removal. Part II: there was a significant difference in enamel surface roughness when 12-, 16-, and 20-fluted carbide burs were compared via surface profilometry. Part III: further polishing with a Reliance Renew point or a prophy cup and pumice did not provide a significantly smoother surface. Conclusions The results show large variation in debonding and polishing techniques. Creating a smooth enamel surface is equally possible with 12- or 20-fluted carbide burs. Further polishing with pumice and prophy cup or Renew point does not provide an enamel smoother surface.
Retinal imaging with en face and cross-sectional optical coherence tomography delineates outer retinal changes in cancer-associated retinopathy secondary to Merkel cell carcinoma
Authors: Mesiwala Nisreen K , Shemonski Nathan , Sandrian Michelle G , Shelton Ryan , Ishikawa Hiroshi , Tawbi Hussein A , Schuman Joel S , Boppart Stephen A , Labriola Leanne T 
Published: August 2015

Abstract

Background
The study aims to correlate Fourier-domain optical coherence tomography (FD-OCT) with Goldmann visual field (GVF) to show the photoreceptor (PR) structure and function relationship in the first described case of cancer-associated retinopathy (CAR) from Merkel cell carcinoma.

Findings
A case study of a patient with CAR who was imaged with serial GVF and FD-OCT over a 2-year period was carried out. En face images were created using a custom algorithm from the volumetric Fourier-domain OCT scans at the PR level. The areas of decreased PR reflectivity on the en face images were compared with GVF obtained at the same time point. Regions of reduced signal on en face scans corresponded with the position and shape of the GVF scotomas. Initially, the vision improved without PR changes. Cross-sectional OCTs showed early recovery of the outer nuclear layer and later improvement in the nerve fiber layer. Worsening vision corresponded with recurrence of the underlying cancer. Progressive global retinal atrophy was seen over time.

Conclusions
Merkle cell carcinoma can cause CAR. Retinal function recovered without structural PR recovery. Transient vision improvements in treated CAR patients may be due to layers other than the PRs, but eventual vision decline results from significant progressive retinal atrophy.