bluuebunny/crossref_metadata_2025_split huggingface dataset:
Matrix Metalloproteinases and VEGF: Potential Roles in Formation of High‐Flow Vascular Anomalies
Authors: Moak Teri N. , Miller Emily , Wei Ting , Klug Theodore D. , Suen James Y. , Richter Gresham T. 
Published: September 2014

Objectives:Arteriovenous malformations (AVMs) are congenital vascular malformations that result from a defect in vascular morphogenesis. These lesions are slow‐growing, infiltrative, and destructive resulting in significant morbidity associated with cardiac overload and increased susceptibility to massive bleeding. Recent evidence suggests a role of matrix metalloproteinases (MMPs), a family of enzymes functioning in tissue remodeling via degradation of extracellular matrix proteins and cleaving of surface molecules, in the pathogenesis of AVM development and rupture. This study sought to explore the role of MMPs, particularly MMP‐9, in AVM formation and progression.Methods:Serum samples from patients with AVM, hemangioma, and pyogenic granuloma were collected and isolated at various stages of development. Relative quantities of MMP‐2, MMP‐9, and VEGF in each group were calculated and analyzed using sandwich‐capture enzyme‐linked immunosorbent assay.Results:MMP‐2 concentrations were found to be decreased in AVM serum samples when compared with serum samples from the pyogenic granuloma controls (27.9 ± 5.97 vs 32.84 ± 2.20, P = 6.3 × 10–9); MMP‐9 concentrations were found to be increased in AVM serum samples when compared with hemangioma serum samples (1698.81 ± 410.86 vs 1105.02 ± 239.43, P <. 02); and VEGF concentrations were found to be decreased in AVM serum samples when compared with hemangioma serum samples (52.27 ± 63.02 vs 174.0 ± 9.84, P <. 05).Conclusions:The results of this study provide support for a role of MMP‐9 in AVM progression and recurrence. Specifically, an increase in MMP‐9 appears to be associated with AVM formation and may play an important role in its pathogenesis.
National Trends in Tongue Reduction Surgery for Macroglossia in Children
Authors: Patel Anju K. , Mader Nicholas S. , Scott Andrew R. 
Published: September 2014

Objectives:(1) Examine the frequency of partial glossectomy performed for the indication of macroglossia in the United States, assessing for any differences in rates of intervention across various demographics. (2) Identify potential morbidities associated with partial glossectomy in this population and determine how such factors may influence length of stay (LOS) and cost of admission following tongue reduction surgery.Methods:Retrospective cross‐sectional study using the 2006 and 2009 KidsTM Inpatient Databases (KID). During the 2‐year study period, partial glossectomy was performed in 80 children under 5 years with macroglossia.Results:A disproportionately higher rate of intervention was seen in whites (P =. 001) and patients in the highest socioeconomic quartile (P =. 007). Conversely, a lower rate of intervention was observed in black children (P =. 011). The average age at the time of partial glossectomy was 23 months (mode, 12 months). Patients were classified as isolated (n = 16, 20%) or syndromic macroglossia (n = 64, 80%) based on associated diagnoses. The average length of stay after partial glossectomy for macroglossia ranged from 5 to 11 days. Differences in LOS (mean, 9.5 days) and cost (mean, $9.8k) between isolated and syndromic macroglossia groups were not significant.Conclusions:Partial glossectomy for macroglossia is typically performed prior to age 2 years in the United States. Syndromic comorbidities do not seem to contribute to increased LOS or cost of admission. White children and affluent children appear to be undergoing partial glossectomy at a higher rate than their peers.
A Study of Aesthetic Outcomes of Primary Rhinoplasty in Crooked Nose Deformity
Authors: Yadav Samar Pal S. , Gulia Joginder S. , Aggrwal Arpit 
Published: September 2014

Objectives:(1) Rhinoplasty is the treatment of choice for patients with crooked nose deformity. (2) Objective assessment of nasal and facial profile using digital photographs and computer software is an integral part of management. (3) Recognize that subjective evaluation of patient satisfaction regarding aesthetic improvement is an important aspect of rhinoplasty.Methods:A prospective study from January 2011 to September 2012. Crooked nose deformity in 20 cases of either sex in the age group of 18 to 40 years. Setting: Pt. BDS Post graduate Institute Medical Sciences Rohtak, India, a tertiary care center. Rhinoplasty was performed through the external approach, and aesthetic improvement was evaluated through photographic analysis. Patient satisfaction was also assessed using a visual analog scale of 1 to 100. Independent Variables: Age, sex, external nasal deformity, and nasal septum deviation.Results:Statistical analysis was done using IBM SPSS v.20 software by paired “t” test. The preoperative nasal deviation alignment angle was 13.76° ± 5.21° while in the postoperative period it was 3.07° ± 2.08° (P <. 001). Subjective assessment using visual analog scale showed an improvement from preoperative score of 47.6 ± 7.27 to 81.5 ± 10.69 postoperatively (P <. 001).Conclusions:Objective assessment and documentation of nasal deformities is an integral part of rhinoplasty. Subjective evaluation, on the other hand, is a useful tool to assess the degree of patient satisfaction.
An Objective, Anatomically Based Analysis of Pediatric Snoring
Authors: Brietzke Scott E. , Pusz Max D. 
Published: September 2014

Objectives:The implications and anatomical basis of pediatric snoring (PS) remain largely unknown. The objectives of this study are to: (1) Objectively assess PS using home sleep test (HST) technology. (2) Attempt to correlate the objective components of PS to upper airway anatomy. (3) Objectively measure the effects of adenotonsillectomy (±turbinoplasty) on PS.Methods:Pediatric patients with a chief complaint of snoring and probable obstructive sleep apnea underwent a HST (SNAP Diagnostics, USA) with a detailed acoustical analysis of snoring prior to adenotonsillectomy (±turbinoplasty). During surgery, detailed anatomical measurements were performed and correlated with snoring analysis results. After surgery, patients were offered another HST with snoring analysis. Data analysis was performed using descriptive statistics and statistical correlation with attention to the multiple comparisons paradox.Results:Twenty‐two patients (45% male; mean age, 5.4 years; range, 2.4‐8.4 years) completed the preoperative HST and intra‐operative measurements. Unlike typical adult snoring, only the minority of PS was from palatal flutter (mean palatal component = 24%, median = 10%). The resistance occurrence percentage (ROP, % of breathing events with snoring noise) was associated with body mass index (BMI; Spearmans Rho = 0.55, P =. 017), subjective turbinate size (0.54, P =. 032), lowest oxygen saturation (–0.46, P =. 043), and palatal obstruction (0.62, P =. 008) but not adenotonsillar hypertrophy. Ten patients (45%) completed a postoperative HST. The ROP was significantly reduced (median 20.5% vs 6.5%, P =. 006 Sign rank test) postoperatively. The magnitude of the ROP reduction was directly proportional to the measured volume of the removed tonsils (0.74, P =. 022).Conclusions:Pediatric snoring has different acoustical characteristics than adult snoring. Objective PS is associated with BMI, turbinate size, and palatal position/obstruction. Adenotonsillectomy (±turbinoplasty) significantly reduces objective PS.
Outcome of Tympanomastoidectomy in Children with Chronic Otitis Media
Authors: Bliss Morgan R. , Duval Melanie , Muntz Harlan R. 
Published: September 2014

Objectives:Analyze outcomes of tympanomastoidectomy for chronic otitis media in children at a tertiary care referral center with a high prevalence of patients with genetic syndromes, craniofacial anomalies, and medical comorbidities.Methods:A retrospective review of tympanomastoidectomy performed for chronic otitis media at a single pediatric tertiary care hospital from 1995 through 2013 was performed. Factors evaluated included presence of immunodeficiency or craniofacial anomaly, change in air‐bone gap and speech reception threshold, and need for additional otologic procedures.Results:Fifty‐six tympanomastoidectomies on 47 patients were evaluated. A total of 25% of the children had a genetic syndrome and 17% had an immunodeficiency. Average age at surgery was 7.5 years with an average duration of follow‐up of 2.7 years. Previous treatment included prolonged oral antibiotics (43), prolonged intravenous antibiotics (11), and middle ear irrigation and exchange of tympanostomy tube (7). Twenty‐nine ears had undergone 2 or more tympanostomy tube insertion. A total of 28 (50%) ears continued to have some otorrhea postoperatively. Complete audiologic data were available for 23 patients. Improvement in air‐bone gap was seen in 87% of cases, with an average improvement of 11.9 dB (P =. 01). Improvement in speech reception threshold was seen in 65%, with an average decrease in threshold of 10 dB (P =. 27). Of the cases, 8.9% required revision tympanoplasty following tympanomastoidectomy.Conclusions:Tympanomastoidectomy in children with severe chronic otitis media improves hearing function and may be beneficial in some patients to cease otorrhea. This should be considered as a treatment option in children that have failed previous conservative management.
Pediatric Head and Neck Complications of Invasive Streptococcus pneumoniae before and after PCV7 Vaccination
Authors: Pierce Matthew L. , Walls Andrew D. , Krishnan Nathan , Harley Earl H. 
Published: September 2014

Objectives:Discuss pediatric head and neck complications of invasive pneumococcal infections including the incidence, mean hospital cost, length of stay, and admittance from the emergency department before and after the PCV7 vaccine.Methods:A retrospective cross‐sectional analysis of the National Inpatient Database yielded (N = 31,738) pediatric incident reports involving meningitis, mastoiditis, otitis media, periorbital cellulitis, sigmoid sinus thrombosis, and bezold abscess due to invasive Streptococcus pneumoniae infections. Each report was analyzed for incidence, length of stay, mean hospital cost, and admittance from the emergency room. Finally, we calculated the expected annual incidence of each complication via least squares analysis to determine the expected incidence if the vaccine was not administered.Results:We identified a significant decrease in the incidence of all described complications after the introduction of the PCV7 vaccine and also when compared to our predicted incidence calculations. Emergency department admittance for bezold abscess, periorbital cellulitis, mastoiditis, sigmoid sinus thrombosis and meningitis were significantly increased in the pediatric age group (ages 1‐4) (P <. 05). Furthermore, there was a significant increase the hospital charge to provide care for each of the described conditions (P <. 05).Conclusions:The PCV7 vaccine produced a measurable reduction in invasive pediatric pneumococcal complications of the head and neck. However, our data suggests these benefits were also met with increased emergency department admittance, hospital costs, and length of stay, each of which may be due to selection of a more invasive species.
A Revised CAO Staging Classification to Predict the Prognosis of Acquired Cholesteatoma in Children
Authors: Kuo Chin‐Lung , Shiao An‐Suey , Liao Wen‐Huei , Lien Chiang‐Feng 
Published: September 2014

Objectives:A CAO (cholesteatoma extent, atelectasis degree and ossicle involvement) staging system for cholesteatoma was described at the XIII World Congress of Otorhinolaryn‐gology in Florida in 1985. Because of 30 years of accumulated clinical data, we propose a revised and simplified model of stratification. This study aimed to investigate the prognosis of pediatric acquired cholesteatoma based on this revised staging system.Methods:Between 1982 and 2012, 132 ears in 128 children (≤18 years of age) with acquired cholesteatomas after primary surgery were included. Each case was scored for cholesteatoma extent, history of grommet insertion, age, ossicular destruction, and otorrhea. The total score classified the patients as stage I (5‐6 points), stage II (7‐9 points) or stage III (10‐12 points). The staging system was applied to the first (66 ears) and second (66 ears) halves of the cohort, and the entire cohort (132 ears). Differences between stages were compared using Kaplan‐Meier cumulative recidivism curves.Results:The mean follow‐up period was 12 years. The 15‐year cumulative recidivism rate was 19.6% overall, 0% in stage I, 10.4% in stage II, and 30.6% in stage III. The cumulative recidivism curves were well stratified by stage, with differences reaching statistical significance in the second half and entire cohort (P =. 048 and. 026, respectively).Conclusions:The proposed revised staging classification may adequately stratify patients regarding the prognosis, facilitating the identification of children at risk of recidivism. Further external validation on an independent data set is warranted before broad application can be recommended.
Revision Thoracic Slide Tracheoplasty for Congenital Tracheal Stenosis: Outcomes following Unsuccessful Prior Tracheal Reconstruction
Authors: Sidell Douglas R. , de Alarcon Alessandro , Manning Peter B. , Hart Catherine K. , Balakrishnan Karthik , Meinzen‐Derr Jareen , Rutter Michael J. 
Published: September 2014

Objectives:Over the past decade, thoracic slide tracheoplasty (TST) has become the principal operation in the management of congenital tracheal stenosis. The purpose of this report is to (1) describe our experience with revision TST following unsuccessful prior tracheal reconstruction and (2) compare our outcomes with primary TST.Methods:Patients undergoing TST on cardiopulmonary bypass between January 2005 and 2014 were reviewed. Patients with a history of prior airway surgery were extracted for further analysis. Preoperative patient variables and postoperative outcomes were evaluated.Results:A total of 108 patients were reviewed over the study period. Twenty‐two revision patients (20 referrals, 2 primary patients) met inclusion criteria. Eighteen patients had a history of complete tracheal rings and 4 patients had cartilaginous deficiency. A total of 35 tracheoplasties (rib graft = 6; slide tracheoplasty = 5; pericardial patch = 4; homograft = 3;resection = 1; cricoid split = 1; combined tracheal reconstruction = 15) had been performed prior to revision TST. Following revision TST, additional endoscopic interventions were required in 5 patients (23%). Twelve balloon dilations (average 2.4 per child) and 4 endoscopic stent placements were performed in these 5 patients. The majority (68%) of children required <48 hours of ventilator support following revision. There was one nonsurgical postoperative mortality.Conclusions:Despite some differences in the postoperative management when compared to nonrevision cases, revision TST can be successfully performed after prior tracheal reconstruction with good postoperative outcomes.
3D‐CT Comparison of the Stylohyoid Chain in Eagle's Syndromes, Glossopharyngeal Neuralgia, and Asymptomatic Controls
Authors: Kent David T. , Rath Tanya J. , Snyderman Carl H. 
Published: September 2014

Objectives:(1) Describe 3‐dimensional (3D) computed tomography (CT) anatomic features of the stylohyoid chain in Eagle's syndrome patients (ES), glossopharyngeal neuralgia patients (GPN), and normal asymptomatic controls (NC). (2) Understand 3D‐CT features findings associated with Eagle's syndrome.Methods:Retrospective chart review from November 2000 to November 2013. 3D shaded surface display CT reconstructions of the stylohyoid chain were generated for 10 ES patients, 16 GPN, and 15 NC patients. Demographic and clinical symptom data were recorded. Anatomic data collected from CT scans included: length of ossified styloid process, anterior‐posterior (APA) and medial‐lateral (MLA) styloid process angulation, ossification pattern of the stylohyoid chain, and minimum distances between the styloid process and the internal carotid artery, C1 transverse process, and tonsillar fossa.Results:The average distance from the styloid process tip to the tonsillar fossa was found to be significantly shorter in ES patients (12.7 mm) compared with GPN (21.4 mm; P <. 05) or NC (24.8 mm; P <. 001) patients. No other measured variables were found to be significantly different between groups, including average styloid process length (ES: 48.0 vs GPN: 40.3 vs NC: 40 mm; P >. 05).Conclusions:The styloid process was found to be significantly closer to the tonsillar fossa in ES patients as compared to GPN and NC patients by 3D‐CT reconstructions. No significant differences were found in other measures, including styloid process length. Distance to the tonsillar fossa may be a more appropriate diagnostic criterion for ES than styloid process length, and may contribute to the pathophysiology of ES.
The Role of Tympanostomy Tubes in Surgery for Acquired Retraction Pocket Cholesteatoma
Authors: Govil Nandini , Stapleton Amanda L. , Yellon Robert F. 
Published: September 2014

Objectives:(1) Determine whether intraoperative tympanostomy tubes (TT) during surgery for acquired retraction pocket cholesteatoma (ARPC) results in improved hearing outcomes or decreased recurrence of ARPC. (2) Determine the need for subsequent TT in children that did not receive TT at initial surgery.Methods:Institutional review board–approved retrospective review of children 4 to 18 years, who underwent primary surgery (tympanoplasty or tympanomastoidectomy) for ARPC at a tertiary care children's hospital from January 1, 2000, to December 31, 2012. Audiometry, operative reports, office findings, TT, and recurrence data for ARPC were analyzed. The chi‐square test was used for statistical analysis.Results:Preoperative Mills staging for extent of cholesteatoma was similar for both groups. A total of 24 patients had TT at initial surgery (TT Group) and 34 patients did not (no TT Group). The average preoperative and postoperative SRT were 23dB and 25dB, respectively, for the TT Group, and 31 dB and 31 dB for the no TT Group. The recurrence rate for ARPC was 29% for the TT Group versus 41% for the no TT Group (P =. 35). Thirty‐five percent of patients in the no TT Group required TT at a subsequent surgery.Conclusions:There was no statistical difference in recurrence or audiometric outcomes between patients who underwent TT insertion versus those who did not during initial surgery for ARPC. However, since the incidence of recurrent ARPC was 12% lower when TT were placed, and since the rate of subsequent TT was 35% in the no TT Group, a larger, prospective study of TT at initial surgery for ARPC is needed.
Airway Management in Severe Combat‐Related Maxillofacial Trauma
Authors: Keller Matthew W. , Han Peggy P. , Galarneau Michael R. , Brigger Matthew T. 
Published: September 2014

Objectives:Airway stabilization is critical in combat‐related maxillofacial injury as normal anatomical landmarks can be obscured by blood and debris. The objective of this study was to characterize the epidemiology of airway management in maxillofacial trauma.Methods:A total of 1345 military personnel with combat‐related maxillofacial injuries were retrospectively identified from the Expeditionary Medical Encounter Database using ICD‐9‐CM diagnostic codes. Maxillofacial injury severity was quantified with the Abbreviated Injury Scale (AIS). Service members with maxillofacial injury and severe combat trauma were included in the analysis (n = 239). Study variables included the frequency and timing of intubation, presence and severity of burn injury, frequency of tracheostomy, and presence of inhalational injury.Results:A total of 239 severe maxillofacial injuries were identified. The most common mechanism of injury was Improvised Explosive Device (IED) (66%), followed by gunshot wounds (8%), mortar (5%), and landmines (4%). A total of 51.0% of the subjects required intubation on their initial presentation to triage facilities. Field surgical airways were rare, but demonstrated a 75% success rate. Of the patients who underwent bronchoscopy, 65.2% were found to have airway inhalational injury. There was a significant relationship between the severity of facial injury and the need for intubation on initial presentation (P =. 0027). Of the subjects, 19.7% had tracheostomy performed. Furthermore, 12.3% of the study subjects required surgical neck explorations.Conclusions:There is a high incidence of airway injury in combat‐related maxillofacial trauma, which may be underestimated. Airway management in this population requires a high degree of suspicion and low threshold for airway stabilization.
The Association between Airline Flight Time and Sinus Disease
Authors: Shargorodsky Josef , Zheng Laura , Stillman Frances , Navas‐Acien Ana , Reh Douglas D. 
Published: September 2014

Objectives:Airplane cabin supply air has been shown to have multiple possible respiratory irritants. In addition, changes in barometric pressure in flight may contribute to some respiratory conditions. Therefore, there may be an association between commercial airline flight and sinus disease.Methods:Participants of the Secondhand‐Smoke, Air Quality and Respiratory Health Among Flight Attendants study cohort were mailed a questionnaire pertaining to their flight experience and respiratory health. Working years, working days per month, and number of trips per month were quantified, as well as smoking exposure history and self‐reported physician diagnoses of sinusitis, asthma, and rhinitis. The sinonasal outcomes were quantified using a Respiratory Questionnaire Score (RQS). Multivariable analyses were performed to analyze the associations between flight time and sinus disease.Results:A total 579 participants met the inclusion criteria, with cohort prevalence of sinusitis, asthma, and rhinitis of 24.8, 13.1, and 20.4%, respectively. There was a significant trend of increasing odds ratios (OR) of sinusitis and rhinitis with increasing working years tertiles (P <. 01 and P =. 016, respectively). Increasing tertiles of working days per month were associated with higher RQS scores (P, trend <.01). Individual symptoms significantly associated with increasing number of working days per month included need to blow nose, sneezing, and thick nasal discharge, among others.Conclusions:This is the first study to analyze the relations between airline flight time and sinonasal disease. Sinusitis diagnosis, numerous sinonasal symptoms, and cumulative symptom scores were all shown to be significantly associated with flight time.