bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Hemostasis Rate following Tonsillectomy at a Singapore Pediatric Tertiary Hospital
Authors: Ibrahim Shahrul I. , Low David Y. M. , Ang Annette H. C. , Balakrishnan Abhilash , Tan Henry K. K. 
Published: August 2013

Objectives:Tonsillectomies and adenotonsillectomies are among the most common procedures to be carried out in children throughout the world. Postoperative hemorrhages have previously been reported to be at a maximum expected rate of 13.9% with a mean of 4.5%. This study reports the postoperative hemostasis rate at the KK Women's and Children Hospital, Singapore, a tertiary pediatric hospital.Methods:Retrospective study of tonsillectomy and adenotonsillectomy cases done on children up to 16 years of age from the end of January 2007 till early January 2013. The number of postoperative bleeds that required return to the operating room for hemostasis was recorded.Results:In total there were 2322 tonsillectomy cases. 1581 were adenotonsillectomies, and 741 were bilateral tonsillectomies only (without adenoidectomy). There were 33 cases that required return to the operating room for hemostasis, giving a postoperative hemostasis rate of 1.42%. There were no cases of bleeding from adenoidectomy. All 2322 cases were done with monopolar diathermy. Hemostasis intraoperatively was also done with monopolar diathermy. The operating surgeons ranged from first year residents to senior consultants.Conclusions:The postoperative hemostasis rate following tonsillectomy and adenotonsillectomy at KK Women's and Children's Hospital is 1.42%, comparable to the best rates quoted in the literature.
Sleep Apnea in Children with Down Syndrome and Laryngomalacia: Objective Outcomes after Supraglottoplasty
Authors: Sawyer Stephen W. , Stoner Julie A. , Digoy G. Paul 
Published: August 2013

Objectives:Examine the effect of supraglottoplasy in children who have Down Syndrome and findings suggestive of state‐dependent laryngomalacia (SDL) on measures of obstructive sleep apnea syndrome (OSAS) including the number of obstructive events per hour, apnea hypopnea index (AHI), and the minimum oxygen saturation.Setting:Tertiary care children's hospital. Study design: A retrospective review of 11 pediatric patients with DS, OSAS, and SDL between 2006 and 2012. The diagnosis of SDL was made via sleep endoscopy under light general anesthesia. All patients underwent pre‐ and postoperative polysomnography.Results:The number of obstructive events per hour (OAI) decreased following supraglottoplasy for 9 (82%, 95% CI: 48% to 98%) of the 11 patients, which was a statistically significant reduction in the number of events (P = 0.05). AHI and minimum oxygen desaturation was not statistically different after supraglottoplasty. Snoring improved or ceased in 60% of patients. Coughing associated with eating was worse in 2/10 patients postoperatively.Conclusions:Children with DS, OSAS, and SDL statistically improved after supraglottoplasty, though not in all measures. This response is less significant than in children without DS. Furthermore, this population may have increased risk of postoperative aspiration. Larger series in children with OSAS, SDL, and DS are needed to confirm these findings.
Trends and Comparison of Children Hospitalized for Retropharyngeal and Parapharyngeal Abscesses 2003‐2009
Authors: Smith Aaron M. , Cash Elizabeth , Myers John , Smith Michael , Navale Suparna , Woods Charles , Chandran Swapna K. 
Published: August 2013

Objectives:Following the peritonsillar space, two confluent spaces house the majority of pediatric deep neck space infections, the retropharyngeal and parapharyngeal sites. Surgical drainage and conservative antibiotic management exist as treatment options.Methods:We queried the Kid Inpatient Database identifying all cases of International Classification of Disease, ninth revision, clinical modification (ICD‐9‐CM) codes 478.22, parapharyngeal abscess (PPA), and 478.24, retropharyngeal abscess (RPA) for 2003, 2006, and 2009. Comparisons were made between population level estimates using Statistical Analysis Software.Results:The incidence (0‐20yo) of both RPA (0.67 to 0.81/100000population) and PPA (1.46 to 1.84/100000) increased slightly. Males were more likely than females to be afflicted (60% vs 40%). The median age for RPA was younger (4yo vs 5yo, P < 0.001). Median total charges increased (for RPA $12217 to $14453, P <0.01, for PPA $13184 to $19177, P < 0.01) with no cost difference between them (P = 0.055). Median length of stay (LOS) remained constant (3 d). Surgical drainage occurred more often for PPA (43% vs 37%, P < 0.01); however, LOS increased when an RPA was surgically drained (4 vs 3 days, P < 0.01).Conclusions:These national population‐based estimates show a similar demographic stratification for RPA and PPA. Incidence has increased slightly with RPA occurring more often and at a younger age. Costs per hospitalization increased, but lengths of stay were constant. Surgery occurred more often for PPA but increased LOS for RPA. Surgery increased overall costs; however, cost and resource use were similar for both infections.
AMPK Inhibits TGF‐β1–Induced Extra Cellular Matrix Production in Nasal Polyp‐Derived Fibroblast
Authors: Lee Heung M. , Park Il‐Ho , Cho Jung‐Sun , Um Ji‐Young 
Published: August 2013

Objectives:Adenosine monophosphate‐activated protein kinase (AMPK) is known to inhibit fibrogenic responses in many cells by targeting TGF‐Î21‐Smad signaling. The purpose of this study was to investigate the effect of AMPK on TGF‐Î21‐induced myofibroblast differentiation and ECM production and to determine the underlying mechanism for the action of AMPK in nasal polyp‐derived fibroblasts (NPDFs).Methods:NPDFs were incubated with TGF‐β1 and treated with the activator of AMPK (metformin) or inhibitor of AMPK (compound C). To determine the proliferation rate of nasal fibroblasts, MTT assay was performed. The expression levels of α‐smooth muscle actin and fibronectin were determined by reverse transcription polymerase chain reaction (RT‐PCR), Western blotting and immunofluorescent staining. Phosphorylation of AMPK and phosphorylation of Smad2/3 were evaluated by Western blot analysis.Results:In TGF‐β1‐induced NPDFs, metformin inhibited the expression of α‐SMA and fibronectin, as confirmed by both RT‐PCR and Western blotting analysis. Metformin increased the phosphorylation of AMPK and expression levels of α‐SMA and fibronectin, and compound C reversed these effects. Metformin inhibited TGF‐β1‐induced phosphorylation of Smad2/3.Conclusions:This study showed that AMPK inhibited TGF‐β1‐induced ECM production in NPDFs via the Smad2/3 pathway. AMPK can be a therapeutic target for the prevention of ECM remodeling in nasal polyps.
Baseline Characteristics of the Sinonasal Tract in Wild‐Type and Innate Immunity Knockout Mice
Authors: Rassouli Alipasha , Desrosiers Martin Y. , Ryan Allen F. , Hamid Qutayba , Tewfik Marc A. 
Published: August 2013

Objectives:1)I Investigate the baseline histological characteristics of sinonasal tissue in wild‐type mice. 2) Observe the effects of knocking out various genes involved in innate immunity on the inflammatory cell infiltrates and mucosal architecture of murine sinonasal epithelium.Methods:Unchallenged wild‐type C57‐BL6 mice, as well as knockouts for the innate immunity genes NOD‐1, NOD‐2, RIP‐2, TLR‐2 and MYD88, were sacrificed at age of maturity. The heads were decalcified and sinuses serially cut at 5 micrometer thickness. Three sections of the nasal cavity (anterior, mid, and posterior) were selected and examined under H&E and immunohistochemical staining conditions. Goblet cells, basement membrane thickness, neutrophil, macrophages, and eosinophils were evaluated and counted under high‐power field and compared using one‐way analysis of variance multiple comparison (SPSS 20).Results:Average cell counts per mm2 for wild‐type mice were 16.3 +‐ 1.5 macrophages, 2.0 +‐ 0.5 neutrophils, 0 eosinophils, and 2152.4 +‐ 572.4 goblet cells; basement membrane thickness was 3.1 +‐ 1.5 micro meter. There were no significant differences between the wild‐type and the knockout groups.Conclusions:The current study suggests that innate immunity gene knockouts had little effect on the sinonasal epithelium of unchallenged mice. Disruption of innate immune effector genes is not sufficient in and of itself to cause a rhinosinusitis phenotype in mice, but may still cause an inability to mount an appropriate host immune response to microbial pathogens.
Central Giant Cell Reparative Granuloma of the Maxillary Sinus: Endoscopic Resection and Intranasal Calcitonin Therapy
Authors: Vazquez Alejandro , Blake Danielle M. , Eloy Jean A. , Kalyoussef Evelyne 
Published: August 2013

Objectives:Central giant cell reparative granuloma (CGCRG) is an uncommon, nonneoplastic, osteolytic lesion that can display locally aggressive behavior. CGCRG most often involves the mandible. Lesions arising within the paranasal sinuses are far less common. Treatment has historically consisted of surgical excision, typically via open approaches. Recently, calcitonin has been proposed as therapy for CGCRG. We present the case of a young woman with an extensive, aggressive CGCRG of the maxillary sinus who underwent total endoscopic resection followed by adjuvant therapy with intranasal calcitonin.Methods:Case report.Results:A 19‐year‐old woman presented with a 3‐month history of progressively worsening left‐sided malar pain and hypesthesia. Physical exam revealed hyperglobus; loose maxillary dentition; a soft, compressible bulge in the left hard palate; and a large mass occupying the left nasal cavity. Computed tomography and magnetic resonance imaging showed a 4 x 4 x 4.8 cm mass within the left maxillary sinus which had eroded the hard palate and inferior orbital wall and displaced the orbital contents superiorly. Biopsy of the lesion was consistent with CGCRG. The patient underwent complete resection via a modified endoscopic, endonasal medial maxillectomy approach. Adjuvant therapy with intranasal calcitonin is underway, and the patient is doing well 3 months post‐excision.Conclusions:In this report, we demonstrate a safe, effective, entirely endoscopic resection of an extensive CGCRG. We advocate prompt surgical management of these lesions given their potential for local destruction. Although evidence regarding the use of calcitonin is limited, we suggest considering its use as adjuvant therapy.
Clinical Aspect of Concha Bullosa of Middle Turbinate and Nasal Septal Deviation
Authors: Cho Jin‐Hee , Kim Young‐Ha 
Published: August 2013

Objectives:Concha bullosa (CB) with nasal septal deviation (NSD) can be the cause of postoperative functional failure if not corrected during surgery.Methods:All the paranasal computed tomography scans (CTs) taken in a tertiary hospital from May 2011 to October 2012 were analyzed. Cases with history of nasal surgery and nasal trauma were excluded due to the possibilities of nasal anatomical changes.Results:520 CTs were included in this study, from 550 CTs analyzed. 331 males and 189 females were included, and the ages of patients ranged from 2 to 87. 444 patients (85.38%) had NSD. The age distributions of CB were as follows: in the age group of 0~15, 0%; 16~30,.70%; 31~45, 40%; 46~60, 33.14%; and over 60 years, 25%. In 444 patients with NSD, bilateral CBs were observed in 93, unilateral CBs in wide nasal cavity in 47, and narrow nasal cavity in 7. When 269 CBs were classified as true, lamella, or bullous type, the average measured pneumatization areas were statistically wider in true type (p=0.008). When comparing the maximum pneumatization areas of CB in coronal CT of patients with NSD, the CB area of wide side nasal cavity was statistically wider than that of narrow side nasal cavity (P = 0.000).Conclusions:CBs are clinically thought to be formed in those over 15 years old. CBs are formed mainly in wider nasal cavity, and especially larger in true type, so they should be removedin surgery.
Complications of Endoscopic and Conventional Dacryocystorhinostomy (External) in Chronic Dacryocystitis
Authors: Venegas Monica M. H. , Morante Juan C. C. , Cruzado‐Sanchez Deivy , Valdivia Victor , Chang Jorge H. 
Published: August 2013

Objectives:Describe the complications of endoscopic and conventional dacryocystorhinostomy (external) in chronic dacryocystitis (CDC) in a public hospital.Methods:Case series. We evaluated 39 patients who were treated surgically of CDC by endoscopic or conventional dacryocystorhinostomy between January 2006 and December 2011 at the Arzobispo Loayza National Hospital, Lima, Peru. We evaluated the complications associated with the treatment received.Results:Of the 39cases, 29 (74.4%) were women, and the average age was 54.9 years. The mean disease duration was 29.7 months. The affected side was the right in 59%, and the most common symptom was epiphora (84.6%), followed by secretion (7.7%) and tumor (5.1%). 56.4% of the surgeries were made by conventional technique. The most common complication was the post‐surgical removal of the probe in 4 patients, 3 (7.7%) by the conventional and 1 (2.5%) by the endoscopical technique. Other complications were reocclusion (5.2%), abscess (2.6%), and epistaxis (2.6%), all for the conventional technique. By the endoscopical technique, just the infection (5.2%) and synechiae (2.6%).Conclusions:Complications associated with the conventional technique were expulsion of the probe (7.7%), reocclusion (5.2%), abscess (2.6%), and epistaxis (2.6%), while complications with the endoscopic technique were removal of the probe (2.5 %), infection (5.2%), and synechiae (2.6%).
Confirmation of Tolosa‐Hunt Syndrome via Endoscopic Endonasal Biopsy of the Orbital Apex
Authors: Takashima Masayoshi , Richter Amy L. 
Published: August 2013

Objectives:1) Review the criteria for diagnosing Tolosa‐Hunt Syndrome (THS), a rare cause of painful ophthalmoplegia due to idiopathic granulomatous inflammation of the orbital apex or cavernous sinus. 2) Review the literature of THS and other surgical techniques used previously in the setting of THS.Methods:We present a literature review of THS, focusing on the surgical approaches to and findings in the cavernous sinus and orbital apex. We report a recent case of unilateral vision loss and painful ophthalmoplegia where endonasal endoscopic biopsy of the orbital apex was performed after initial evaluation failed to yield a diagnosis. We present the pre‐operative imaging, intra‐operative observations, and pathologic results of this patient with THS.Results:In our review of THS, there are no other documented reports of endonasal endoscopic biopsy of the orbital apex. There are few reports of variable neurosurgical approaches used previously in THS. In our case, endoscopic biopsy yielded pathologic evidence of granulomatous inflammation without evidence of infectious or neoplastic disease. The patient received intravenous steroids, and symptoms improved within 72 hours, confirming THS.Conclusions:THS is an extremely rare cause of painful ophthalmoplegia. Traditionally, THS is a diagnosis of exclusion without tissue confirmation, as biopsies are difficult to perform. This may delay diagnosis of a neoplasm. We present a single case of THS where endonasal endoscopic biopsy of the orbital apex confirmed granulomatous inflammation, suggesting that endoscopic techniques may be used as a safe, minimally invasive approach to the orbital apex in the setting of painful ophthalmoplegia.
Efficacy and Safety of Sublingual Immunotherapy in Children with Allergic Rhinitis: 2‐Year Follow‐up
Authors: Shin Jae‐Min , Park Il‐Ho , Lee Heung‐Man 
Published: August 2013

Objectives:Sublingual immunotherapy is currently accepted as a suitable alternative to subcutaneous immunotherapy because of its easy and painless administration and improved safety. Many clinical trials have demonstrated that sublingual immunotherapy is an effective and safe treatment for pollen or mite allergic rhinitis. However, there have been very few studies overall on children with allergic rhinitis who are sensitized to house‐dust mites in Asia. The purpose of the present study was to investigate the efficacy and safety of sublingual immunotherapy in children with allergic rhinitis to house‐dust mites.Methods:A total of 112 patients under the age of 15 who had allergic rhinitis to Dermatophagoides pteronyssinus and Dermatophagoides farinae were included. All patients were treated with sublingual immunotherapy (Staloral®). Symptom scores and quality of life were evaluated by questionnaires. The medication score was assessed monthly using a diary medication card, and serologic tests were evaluated before and 24 months after treatment. Adverse effects and compliance were also investigated.Results:All nasal and non‐nasal symptoms and quality of life were significantly improved after treatment. The total medication score was decreased significantly after sublingual immunotherapy. There was no significant change in serologic tests. Some minor adverse effects were reported; however, there were no systemic reactions. The drop‐out rate was 46%.Conclusions:Sublingual immunotherapy is a valuable therapy for the treatment of allergic rhinitis in Asian children sensitized to house‐dust mites.
Endoscopic Endonasal Approach to Meckel's Cave
Authors: Karkas Alexandre , Keller Jeffrey T. , Theodosopoulos Philip , Zimmer Lee A. 
Published: August 2013

Objectives:External approaches to Meckel's Cave (MC) and petrous carotid artery offer excellent exposure but are associated with neurological‐cosmetic‐functional morbidities. Our aim is to describe an endoscopic approach to MC while providing anatomical relationships, predictable morbidities, and clinical applications.Methods:Four cadaveric heads (8 sides) were dissected with 0° endoscopy through transnasal‐transmaxillary‐transsphenoid‐transpterygoid approach.Results:A large maxillary antrostomy was performed and the sphenopalatine artery identified; the posterior and superior walls of maxillary sinus were removed, the pterygopalatine fossa (PPF) exposed, and the internal maxillary artery and maxillary nerve (V2) entering foramen rotundum identified. Lateral to pterygoid buttress, medial attachments of lateral pterygoid muscle were dissected, and the mandibular nerve (V3) in the infratemporal fossa (ITF) entering foramen ovale was exposed. A large sphenoidotomy was performed and cavernous carotid artery located. The Vidian was followed retrogradely until identifying foramen lacerum and then petrous carotid artery. The ophthalmic nerve (V1) was identified in the superior orbital fissure and Gasserian ganglion (GG) in MC in the petrous apex. The GG was followed posteriorly to the retrogasserian root and porus trigeminus.Conclusions:The described endoscopic approach affords the same exposure as external approaches with less morbidity. Indications include lesions of MC, PPF, ITF with minimal intracranial extension and biopsy of suspected malignant tumors in these areas. Limitations of the technique are massive intracranial tumor extension and difficulties to control bleeding in a narrow space. Morbidity will be discussed based on anatomical dissection. Illustrative clinical cases with videos will be presented to support this approach.
Endoscopic Surgical Management of Dacryocele
Authors: Morante Juan C. C. , Venegas Monica M. H. , Morante Angel C. , Valdivia Victor , Cruzado‐Sanchez Deivy , Chang Jorge H. 
Published: August 2013

Objectives:1) Report our experience and surgical treatment of the unilateral giant dacryocele using the endoscopic technique. 2) Improve the lacrimal sac treatment with endonasal surgery, thus avoiding external dacryocystorhinostomy and its sequelae.Methods:We present the case of an adult patient with chronic dacryocystitis of 1 year of evolution, treated by endoscopic endonasal surgery (endoscopic dacryocystorhinostomy) in July 2012 at the Arzobispo Loayza National Hospital, Lima, Peru. The computed tomography described a giant mucocele of the right lacrimal sac. The technique was done entirely endoscopically, opening the lacrimal bone and the lacrimal sac with mucosal content and using a silicone probe. Nasal packing was placed for 3 days, and endoscopic control was carried out.Results:This patient was followed endoscopically each week, testing the permeability of the fistula, moving the probe, and checking the opening hole during the 6 months after surgery. There were no recurrences and no complications.Conclusions:Endoscopic dacryocystorhinostomy has become a very safe method to resolve lacrimal sac pathologies. It is a reliable and secure and has less sequelae than external dacryocystorhinostomies.
Eosinophilic Inflammation of Chronic Rhinosinusitis with Nasal Polyps Is Related to OX40 Ligand Expression
Authors: Garzaro Massimiliano , Boita Monica , Raimondo Luca , Riva Giuseppe , Cerutti Marta , Rolla Giovanni , Pecorari Giancarlo 
Published: August 2013

Objectives:Investigate whether OX40 Ligand is more expressed in sinus tissue from subjects with CRSwNP, compared to chronic rhinosinusitis without nasal polyps (CRSsNP) and whether OX40L expression is related to eosinophilic sinus infiltration.Methods:In 2011, 20 patients with CRS (11 CRSwNP, 9 CRSsNP) were recruited for FESS, and 7 subjects who underwent cosmetic rhinoplasty and served as control group, were consecutively enrolled. Messenger RNA expression for thymic stromal lymphopoietin (TSLP), TSLP Receptor, OX40L was analyzed by real time PCR in sinus biopsies of all patients. Immunoreactivity score (IRS) for OX40L and eosinophil count by Wright‐Giemsa staining were obtained in sinus biopsies of the same patients.Results:The mRNA expression of OX40L was higher in CRSwNP (2.4 ± 0.26) compared to CRSsNP (1.38 ± 0.19, p<0.05) and controls (0.49 ± 0.14), P < 0.001. The mRNA expression of TSLP and TSLPR was significantly higher in CRSwNP compared to controls (2.5 ± 0.32 vs 0.98 ± 0.17, P < 0.01 and 1.42 ± 0.31 vs 0.25 ± 0.07, P < 0.001, respectively) but not significantly higher compared to CRSsNP. IRS for OX40L was significantly higher in CRSwNP as compared to CRSsNP (P < 0.05) and controls (P <0.001), and there was a significant correlation between the OX40L IRS, as well the number of OX40L positive cells, and the number of eosinophils in sinus biopsies (r=0.69; p<0.0001 and r=0.52, p=0.007 respectively).Conclusions:TSLP/OX40L axis is upregulated in CRSwNP and it is related to the intensity of eosinophilic inflammation. Whether these costimulatory molecules present new therapeutic targets require further investigation.
Is High Blood Sugar a Risk Factor for Paranasal Sinus Fungus Ball?
Authors: Chusakul Supinda 
Published: August 2013

Objectives:1) Examine the risk factors for having paranasal sinus fungus ball with high blood sugar. 2) Describe the clinical features of the patients’ diagnoses as paranasal sinus fungus ball (SFB).Methods:A tertiary care hospital based match case‐control study was conducted from December 2007 to December 2011. The matching criteria were age and gender. Fifty cases with chronic rhinosinusitis with SFB were identified from medical records, and 45 chronic rhinosinusitis without SFB served as controls. The cases and controls were placed into 3 groups depending on fasting blood sugar (FBS) levels (normal: FBS less than 100 mg/DL; impaired: FBS (100‐125 mg/DL); and diabetics: FBS>125 mg/DL). Patients with FBS >100 mg/DL were determined as high blood sugar. Demographic data, clinical symptoms, and findings on imaging were records. The main outcome measure was matched odd ratio and 95% confidence interval of high blood sugar associated with paranasal sinus fungus ball.Results:Patients with high FBS had an odds ratio of 1.15 (95% confidence interval, 0.6‐2.19) when compared with patients with normal FBS. Seventy percent of chronic rhinosinusitis with SFB are female, and 94% of SFB are older than 40 years old. The most common presentation is nasal discharge/post‐nasal drip (33/50 cases). The maxillary sinus is the most commonly involved sinus (46%), followed by the sphenoid sinus (30%).Conclusions:This study has not found that having high fasting blood sugar is linked with a higher risk of getting fungus ball of paranasal sinuses.