bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transillumination‐Guided Endoscopic Endonasal Dacryocystorhinostomy: Approach to Revision Cases and Challenging Anatomy
Authors: Vazquez Alejandro , Blake Danielle M. , Langer Paul , Eloy Jean A. 
Published: August 2013

Objectives:Dacryocystorhinostomy (DCR) is a surgical procedure whereby a connection is established between the lacrimal sac and the nasal cavity in an effort to bypass an obstruction of the distal lacrimal apparatus. Endoscopic endonasal DCR (EEDCR) is a minimally invasive technique used to achieve this goal. In patients with altered anatomy, EEDCR can be challenging. Here, we describe the use of canalicular transillumination with EEDCR in two complicated cases and discuss the benefits of this technique compared to external DCR and standard EEDCR.Methods:Case series.Results:A 33‐year‐old woman suffered an iatrogenic skull base injury while undergoing right‐sided EEDCR. An intraoperative rhinologic consultation was requested from our service, and the patient underwent emergent endoscopic repair of a right skull base defect. Grossly abnormal endoscopic and radiographic anatomy was noted, and a diagnosis of ozena was ultimately established. Two years later, the patient underwent successful right‐sided transillumination‐guided EEDCR (TG‐EEDCR). A 71‐year‐old woman who had previously undergone a right‐sided open DCR developed recurrent epiphora. Attempts to recanalize the fistula under endoscopic visualization was challenging due to the abnormal anatomy and excessive scarring. TG‐EEDCR was performed successfully. In both of these described cases, a 20‐gauge vitreoretinal light pipe was used for canalicular transillumination.Conclusion:EEDCR with canalicular transillumination represents a feasible alternative approach for cases in which prior surgery, trauma or other sinonasal pathology have significantly altered the native sinonasal/lacrimal anatomy.
Clinical Predictors of Pediatric Obstructive Sleep Apnea/Hypopnea Syndrome
Authors: Lin Hsin‐Ching , Friedman Michael 
Published: August 2013

Objectives:Identify standard clinical parameters that may predict the presence and the severity of pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS).Methods:Eighty‐eight pediatric patients with habitual snoring who underwent a physical examination and full‐night polysomnography were included in this study. Severity of nasal obstruction (NO) and mouth breathing, modified Mallampati grade (aka updated Friedman's tongue position), tonsil size, and the body mass index (BMI) z‐score in the study population were recorded.Results:When physical parameters were correlated singly with the apnea/hypopnea index (AHI), we found that gender, severity of snoring, NO, and mouth breathing status were reliable predictors of pediatric OSAHS. When all important factors were considered in a multiple stepwise regression analysis, a significant correlation with pediatric OSAHS emerged by factoring the snoring VAS, NO, and BMI z‐score (Pediatric AHI = 0.108 + 0.103 Snoring VAS + 0.894 NO + 0.207 BMI z‐score).Conclusions:This study has identified those findings that predict OSAHS. There is a positive correlation between snoring VAS, NO, and BMI z‐score with levels of severity of OSAHS. The study can also help identify pediatric patients with habitual snoring who should be further evaluated for the presence of OSAHS.
Do Pharyngeal Surgeries for Treatment of Snoring and Sleep Apnea Have an Impact on Nasalance?
Authors: Karakoc Omer , Akcam Murat T. , Genc Hakan , Birkent Hakan , Binar Murat , Gerek Mustafa 
Published: August 2013

Objectives:Most of the surgeries used in the treatment of snoring and obstructive sleep apnea mainly target velopharyngeal structures, which play an important role in voice characteristics such as nasalance. The aim of this study is to assess the effect of different types of such surgical procedures including expansion sphincter pharyngoplasty, lateral pharyngoplasty, and anterior pharyngoplasty on nasalance.Methods:Forty‐four consecutive patients with primary snoring or obstructive sleep apnea (OSA) who underwent anterior palatoplasty, lateral pharyngoplasty, and expansion sphincter pharyngoplasty procedures were included in this study. All patients underwent a fully attended overnight polysomnography and detailed otolaryngologic examination. Nasalance studies were performed by using Nasometer II instrument (model 6400; Kay Elemetrics) preoperatively and 3 months after surgery.Results:The mean preoperative nasalance score for AP, LP, and SP groups were 49.06±10.72, 46.65±8.70, and 48±10.95, respectively. The mean postoperative nasalance score for AP, LP, and SP groups were 48.25±8.78, 46.82±5.2, and 49.36±10.81, respectively. There was no statistically significant difference in either group between preoperative and postoperative assessments of nasalance scores for all three passages. Seven patients experienced nasal regurgitation symptoms for fluids for a short time after LP, two patients after AP, and five patients after SP. None of these symptoms showed persistence, and they revealed at approximately 1‐month follow‐up.Conclusions:The results of this study showed that these surgical techniques did not lead to an objective velopharyngeal insufficiency, since no significant change in nasalance scores was observed.
Impact of Mandibular Advancement Devices on CRP Levels in Patients with Obstructive Sleep Apnea
Authors: Friedman Michael , Pott Thomas R. , Lundgren Mary E. 
Published: August 2013

Objectives:Determine the effect non‐surgical treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) using an oral appliance has on C‐reactive protein (CRP) levels. Design: Retrospective case study.Methods:Patients with OSAHS, confirmed by apnea‐hypopnea index (AHI), and fitted with a custom oral appliance between December 2011 and November 2012 were reviewed. The non‐specific inflammatory marker CRP was determined prior to oral appliance fitting and after improvement of OSAHS symptoms determined by AHI.Results:Fifty consecutive patients (78.0% male, age 47.7±11.8 years, body mass index 29.5±5.1 kg/m2) were treated for moderate/severe OSAHS using a fitted oral appliance (mean initial AHI 33.3±21.7, mean initial oxygen saturation 85.2±5.9). Oral appliance treatment significantly improved patients’ AHI, reducing AHI by an average of 40.5% (follow‐up mean 11.9±22.1, p<0.001) as well as increasing average oxygen saturation (follow‐up mean 90.6±3.6). These patients initially had a relative elevation in CRP (mean initial CRP 2.5±1.8 mg/dL) that decreased following use of their fitted oral appliance, a significant reduction to an average of 1.9±1.3 mg/dL (p = 0.006).Conclusions:Elevated CRP levels, notably shown to be associated with increased risk of cardiovascular disease, were significantly decrease with oral appliance therapy. Oral appliance therapy achieves reasonable response and cure rates in patients with moderate/severe OSAHS, and as demonstrated by the case review, has the added benefit of reducing the risk cardiovascular events.
Upper Airway Stimulation in OSA Patients Resolves Multilevel Airway Collapse in a Dose‐Response Manner
Authors: Safiruddin Faiza , Vanderveken Olivier , Anders Clemens , Lee Kent , Maurer Joachim T. , Van de Heyning Paul , deVries Nico 
Published: August 2013

Objectives:Upper airway stimulation (UAS) is a potential therapy for continuous positive airway pressure (CPAP)–refractory obstructive sleep apnea by hypoglossal stimulation using an implantable, programmable neurostimulator. We tested the hypothesis whether changes in stimulation amplitude would modulate palatal and tongue‐base airway size during wakefulness and sedation.Methods:Fifteen patients underwent digital video laryngoscopy while awake and/or drug‐induced sleep (DISE) at least 3 months after UAS system implantation for CPAP‐refractory obstructive sleep apnea (Inspire Medical Systems, Minneapolis, MN). Neurostimulation was applied at four increasing amplitudes: first sensation, tongue movement, titrated therapeutic, and sub‐discomfort. Palatal and tongue‐base cross‐sectional area were measured and compared between periods with and without stimulation.Results:Twelve patients (all male, age: 51.2±9.0 years; AHI: 28.8±7.8/h) underwent DISE; fifteen patients (all male, age: 50.4±10.2 years; AHI: 29.3±7.5/h) underwent awake laryngoscopy and eleven patients and both. During both awake and DISE, higher stimulation amplitudes had a graded response in enlarging multi‐level airway dimensions, with a larger percent increase of airway size during DISE. While awake, palatal area increased between 5.0±24.0% at the lowest stimulation to 73.0±79.3% at the titrated amplitude (P = 0.01), and tongue‐base increased between 64.2±70.3% to 128.6±103.8% (P = 0.05). During DISE, palatal area increased from 9.3±30.4% to 215.4±305.2% (P = 0.09) and tongue‐base from 12.0±45.4% to 177.3±166.4% (P = 0.01).Conclusions:Upper airway stimulation increases airway size during awake surgery and improves airway collapse during sedation. Increasing stimulation amplitudes enlarges both retro‐palatal and retroglossal airway size. Increased multi‐level airway size is a potential therapy mechanism of upper airway stimulation when treating CPAP‐refractory OSA.
Quantification of Drying Effect of Water Soluble versus Petrolatum Products on Nasal Mucosa
Authors: Montag David T. , Odland Rick 
Published: August 2013

Objectives:Nasal dryness can lead to quality of life issues or recurrent epistaxis. Nasal emollients have been used for its treatment, but few objective studies are available showing their ability to prevent mucosal dehydration. Due to rare reported complications with the use of petroleum, water‐based emollients were developed. Objectives: 1) Determine water loss of various nasal emollients exposed to flowing air. 2) Compare water loss from nasal mucosa that has been coated with various nasal emollients.Methods:Ongoing laboratory studies were performed in an academic setting beginning in October 2012. A setup consisting of two specimen chambers, a flow meter, an air source, and two humidity/temperature sensors was used to test the ability of various nasal emollients to prevent water loss. Water loss from the agents was calculated based on weight and humidity. Experiments were also performed using sheep nasal mucosa coated with the same emollients. Water loss was similarly determined for the mucosa. A literature review on complications of petroleum products was performed.Results:Water‐based nasal emollients lose more water and mass than petroleum‐based products (P =. 02). Nasal mucosa coated with water‐based products rather than petroleum also lost more water.Conclusions:Petroleum‐based nasal emollients are superior to water‐based emollients in terms of less dehydration of underlying mucosa. There are, however, rare complications associated with the use of petroleum products.
A Systematic Review of Simulation in Otolaryngology Residency Training
Authors: Tompkins Jared J. , Sebelik Merry E. 
Published: August 2013

Objectives:The central premise of our systematic review was to determine: Where does the field of otolaryngology stand in incorporating simulation into residency training? We believe there has been a profound increase in the use of simulation in otolaryngology residency training programs recently, which can be described by a simultaneous increase in the number of otolaryngology simulation‐based publications. Study Design: Systematic review. Data Sources: A literature search was performed using the Ovid Medline and PubMed search engines.Methods:Two independent reviewers separately evaluated the 142 articles for relevance using specific inclusion and exclusion criteria.Results:Sixty‐nine articles were included and broken down into number of publications produced per year, country of origin, resident training level targeted, the specific area being simulated, and the fidelity of the simulation. The number of simulation‐based publications has increased from 1996 through 2012. The United States has produced 61% of the articles, with another 8 countries also contributing. The simulated areas were temporal bone/ear (28), airway/endoscopy (19), sinus (15), head and neck cancer (2), and esophagus (1). The fidelity of these simulations was also described as high (55 articles, 80%), low (6 articles, 9%), or both (8 articles, 11%).Conclusions:Simulation‐based medical education in otolaryngology has grown tremendously since the 1990s with a corresponding increase in the number of publications. We anticipate this trend will continue, as simulation takes an increasingly important role in providing the innovative solutions to meet the challenges of training future otolaryngologists.
Treatment and Long‐term Follow‐up of Peritonsillar Abscess
Authors: Shaul Chanan , Rodriguez Mercedes , Schwarz Yehuda , Peleg Uri , Muhanna Nidal , Sichel Jean‐Yves 
Published: August 2013

Objectives:Study the therapeutic management, recurrence, and need of tonsillectomy in Peritonsillar abscess. Study design: Retrospective study and long term telephone survey. Setting: Otolaryngology Head and Neck Surgery Department at Shaare Zedek Medical Center, Jerusalem, Israel.Methods:Review of 117 files of patients diagnosed with peritonsillar abscess who underwent needle aspiration obtaining pus were hospitalized at our department between the years of 2004 to 2007, and were followed at least four years after their discharge date.Results:One hundred four patients (89%) improved without any other intervention. Thirteen patients (11%) underwent an additional procedure such as aspiration and/or incision and drainage. After the needle aspiration, the patients were treated with intravenous antibiotic treatment: penicillin or broad spectrum antibiotics, amoxicillin‐clavulanate, or a combination of metronidazole and cefuroxime. There was no clinical distinction between the various groups. A hundred and five patients (90%) were followed up by telephone call, obtaining the following information: 88 patients (84%) had no recurrence. The remaining 17 suffered recurrence; most of them, 9 patients, had only one. 18 patients underwent tonsillectomy; 13 due to recurrent peritonsillar abscess and 5 due to recurrent tonsillitis.Conclusions:1) Needle aspiration is an effective treatment for peritonsillar abscess. 2) The supplementary antibiotic treatment with penicillin was satisfactory, and no advantage was found to the broad‐spectrum antibiotic treatment. 3) A sweeping recommendation for tonsillectomy is not required after a single episode. Surgery should be recommended only after two or more episodes of peritonsillar abscess.
Assembling a Three‐Dimensional Computed Tomography Database
Authors: Ho Brian , Solares C. Arturo 
Published: August 2013

Objectives:It is important for surgery to keep up with new technologies. Current skull‐base techniques use stereotactic navigation, assisted by magnetic resonance (MRI) and computed tomography (CT) compilation. Our objective is to assemble a normalized CT database for three‐dimensional (3D) endocranial renderings. This database can provide preoperative information for assistive mapping and intraoperative land marking during procedures.Methods:222 CT studies were pooled between October 2011and December 2012. These studies were then deidentified and loaded into third party software, Osirix (Pixmeo, Switzerland), and reconstructed into 3D renderings. The Osirix program is a freeware‐based Apple‐only‐program capable of volumetric analysis, metrics, and 3D space manipulation. The database was then encrypted for patient information protection.Results:A total of 179 studies(101 males and 78 females) were ultimately used. Two‐hundred gigabytes of hard‐disk space was used. An Apple (Cuptertino, CA) laptop, running Mac OSX, was used for computation. The Osirix software was downloaded as freeware, requiring no payment. The hard‐disk was purchased at a local electronics store for $100.00 USD. The computer was approximately $1300.Conclusions:Radiologic imaging drives preoperative surgical planning. This can be augmented by new technology and creative applications of current innovations. There has not been an explanation process on how to assemble this data for departments and individuals. We provide a simple, reproducible, and inexpensive guide to CT head databases. Once the database is assembled, it may be used for such projects as mapping the parapharyngeal carotid, estimating endocranial volumes, and surgical diagrams.
Correlation between Growth Pattern of MicroPTC without Extrathyroidal Extension and Central Lymph Node Metastasis
Authors: Lee Yoon‐Se , Lim Yun‐Sung , Woo Chang‐Ki , Lee Won‐Yong , Wie Chan‐Eun , Wang Soo‐Geun , Lee Byung‐Joo 
Published: August 2013

Objectives:Although prognostic significance of central lymph node (CLN) metastasis in micropapillary thyroid cancer (microPTC) is controversial, thorough removal of metastatic LN may reduce the recurrence rate. Histological or clinical predicting factors for CLN metastasis have been studied to determine the adequate surgical extent or postoperative adjuvant therapy to eradicate metastatic LN. However, histological features inside primary tumor were not considered as a predicting factor for metastasis. In this study, we evaluated the relationship between specific histological findings of microPTC and CLN metastasis.Methods:We reviewed patients who underwent total thyroidectomy and central lymph node (CLN) dissection for microPTC from January to December 2011. Fibrotic change, growth pattern and architecture of tumors were used as histological factors. Histologic findings were classified according to the degree of fibrosis (<10%, 10‐50%, >50%) and growth pattern (well‐defined/extracapsular spread (ECS)/spiculated or infiltrative). The relationship between CLN metastasis and those histological or clinical factors were analyzed.Results:Of 353 patients, 162 had CLN metastasis (45.9%). Chi‐square test showed that age, gender, and tumor size were not related to CLN metastasis. Well‐defined tumor (n = 28) had lower rate of CLN metastasis (14.3%) than tumor with ECS (46.5%) or infiltrative pattern (32.8%, P = 0.019). Multivariate analysis showed that growth pattern was only risk factor for CLN metastasis (odds ratio = 1.972, P = 0.022).Conclusions:Follicular or infiltrative growth pattern of microPTC is an independent risk factor for CLN metastasis. This report suggests that tumor behavior in the primary tumor plays an important role in CLN metastasis.
Cotinine Level in Head and Neck Cancer Patients: An Objective Measure of Tobacco Use
Authors: Hatcher Jeanne L. , Weaver Kathryn , Tooze Janet , Sterba Katherine , Day Terry A. , Sullivan Christopher A. 
Published: August 2013

Objectives:1) Compare the prevalence of tobacco use in preoperative head and neck cancer patients as assessed by urinary cotinine and self‐report. 2) Consider the importance of accurate measurement of tobacco use in pre‐operative head and neck cancer surgical patients and potential implications for clinical interventions.Methods:Patients with squamous cell carcinoma of the upper aerodigestive tract undergoing a major head and neck surgical procedure were recruited from two academic medical centers from May 2011 to November 2012. We assessed preoperative tobacco exposure by self‐report and urinary cotinine using a semiquantitative test strip.Results:We recruited 112 patients (mean age 59); 72.3% male, 82.1% white, 76.5% stages III‐IV. The prevalence of tobacco use in the 48 hours prior to surgery was higher when assessed by urinary cotinine (41.1%) when compared to self‐report (25.9%) (McNemar's exact test, P < 0.0001). Sensitivity of self‐reported tobacco use was 60.9% and specificity was 98.5%. Of those who denied tobacco use prior to surgery (N = 83), 18 (21.7%) had a positive urinary cotinine and 14 (16.9%) reported second‐hand smoke exposure. There were no significant associations between second‐hand exposure, gender, cancer stage, or prior treatment and positive cotinine.Conclusions:Accurate measurement of tobacco use is critical to care provision and intervention development for head and neck cancer patients. Self‐report may fail to identify a significant number of tobacco users. Future analysis in this study will examine relationships among self‐reported tobacco use, cotinine level, and postoperative outcomes including length of stay and wound infection.
Retrograde mechanico-chemical endovenous ablation of infrageniculate great saphenous vein for persistent venous stasis ulcers
Authors: Sullivan Leo P , Quach Giang , Chapman Tina 
Published: August 2013

Objective To present the use of retrograde mechanico-chemical endovenous ablation for ablating the remaining below-knee great saphenous vein in patients with venous stasis ulcers persisting after above-knee great saphenous vein ablation. Methods This small study includes six patients with persistent C6EpAsPr ulcers following above-knee great saphenous vein ablation with no incompetent perforators. They were treated using retrograde mechanico-chemical endovenous ablation approach followed by Unna therapy, followed up on post op days 3 and 30 with ultrasound, and subsequent weekly visits until the wound healed. Results Six patients (four men and two women), have average ulcer size of 4.1 cm2. There was no nerve injury or other complications after mechanico-chemical endovenous ablation. These patients had an average of 28 ± 11 days healing time, compared with a mean of five months in traditional method. Conclusion Mechanico-chemical endovenous ablation can be safe and effective in the treatment of patients with below-knee great saphenous vein insufficiency with venous ulcers.
Variations in ultrasound scanning protocols in the UK for suspected deep vein thrombosis in outpatients
Authors: Shahi F , Murali K 
Published: August 2013

Aims To assess current ultrasound scanning protocol in outpatients with suspected deep vein thrombosis (DVT), in particular whether practitioners routinely scanned calf veins. Methods A standard questionnaire was sent out via post to all radiology departments in the United Kingdom (UK) and via the British Medical Ultrasound Society (BMUS) website in 2010. Responses were entered into Access® and database queries were run to analyse responses. Free-text comments were taken into account in our analysis. Results A total of 277 responses (50 through the BMUS website) were received (46% postal response rate). Of them, six were excluded as these were incomplete. Thus, 97 (36%) were consultants, 13 (5%) accredited vascular scientists (AVSs), 153 (56%) sonographers and six (2%) higher radiology trainees. All AVSs scanned the whole limb and used all three modalities of compression, colour and pulse wave Dopplers. Practice across other healthcare professionals varied. In all, 120/176 (68%) of other health-care professionals trained in vascular ultrasound scanned the whole limb routinely and 82/120 of these used all three scanning modalities. Trained sonographers scanned the whole limb significantly more than the medical cohort (P = 0.017). The use of all three modalities varied significantly between AVS and the non-AVS trained professionals (P = 0.0194), the trained medical cohort of consultants and sonographers (P = 0.0001), and trained and non-trained respondents (P = 0.0113). The commonly chosen reason for not scanning the whole limb was that it had poor sensitivity for calf vein DVTs. Free-text reasons for not scanning the whole limb routinely included local protocols prohibiting it. Conclusions There is a discrepancy between the scanning protocols of medically trained and allied health-care professionals, trained or otherwise in vascular ultrasound, and between these groups and AVSs. This is likely to have an impact on clinical governance.