bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Estrogen on Rat Parotid Gland after Menopause
Authors: Tatlıpınar Arzu , Oysu Cagatay , Uslu Ünal , Yiğit Alev , egül Verim Ayş 
Published: February 2015

ObjectiveTo determine the histopathological changes of estrogen deficiency and estrogen replacement treatment in parotid gland of ovariectomized rats.MethodFemale albino rats were divided into 3 groups: sham, ovariectomized, and ovariectomized with estrogen replacement. Histopathological evaluation of rat parotid glands were done by using the diameter of acinus and striated duct (SD), height of SD, and interacinar connective tissue thickness. Apoptosis in parotid gland were examined by TUNEL staining.ResultsExcept interacinar connective tissue thickness, there were no significant differences between the sham‐operated control and ovariectomized group in terms of the diameter of acinus and striated duct (SD) and height of SD. Estrogen replacement resulted in significant increase in the height of SD and interacinar connective tissue thickness. Apoptotic index was higher in both ovariectomized and estrogen replacement group compared to sham‐operated control.ConclusionAlthough estrogen replacement did not reduce apoptotic index in parotid gland of overiectomized rat, it may have some positive influence on saliva secretion by increasing interaciner connective tissue thickness.
The Transfusion Dilemma in Free Tissue Transfer
Authors: Greene Scott M. , Shockley Ross L. , Rohde Sarah L. 
Published: February 2015

ObjectiveDespite the NIH recommendation for transfusions based on the individual patient, many microvascular surgeons continue to use a trigger point to guide transfusion criteria in patients undergoing free tissue transfer. Our objective is to learn the effects of blood transfusion on complications in free tissue transfer patients.MethodA retrospective study of patients undergoing free tissue transfer with and without blood transfusions from June 2005 through May 2011 at a single tertiary care center. Outcome measurements include flap failure, hematoma, fistula rate, respiratory failure and cardiovascular events.ResultsA total of 225 patients underwent free tissue transfer during the study period. One hundred twenty‐one patients received either intraoperative or postoperative blood products. When compared to a group of 100 patients similar in age, BMI and pre/post‐operative hematocrit levels, there was a statically significant difference in total hospital length of stay (7.8 vs 9.5 days, P =. 01) and total rate of complications (9 vs 33.8%, P =. 0002). Specific post‐operative complication rates were as follows; flap failure (2% vs 5.7% failure rate), respiratory failure (0 vs 12.6% patients required prolonged ventilatory support), and hematoma rates of 2% and 12%, respectively.ConclusionFor patients undergoing free tissue transfer, transfusion of blood products is associated with a statistically significant increase in postoperative morbidity. We propose basing transfusion criteria on an individual basis rather than by means of a trigger point.
Thyroid Papillary Carcinoma and Liver Fibrosis Interaction
Authors: Muhanna Nidal , Doron Sarit , Amer Johnny , Sichel Jean‐Yves , Safadi Rifaat 
Published: February 2015

ObjectiveA high prevalence of thyroid papillary cancer has been reported in Hepatitis C virus (HCV) positive patients. The aims of our study are to: 1) Investigate the mechanistic role of liver injury in thyroid malignancy progressions. 2) Study the immune‐modulatory interactions between thyroid papillary carcinoma and hepatic‐fibrosis.MethodIn vivo: Hepatic‐fibrosis and thyroid carcinoma cell line were induced in nude mice. Fibrotic profile was estimated using RT‐PCR and Western blots. Lymphocytes were stained for NK‐activity. Liver injury, tumor mass, serum VEGF, estradiol, and T4 levels were assessed. Ex‐vivo: Thyroid cell line was analyzed for proliferations by CFSE.ResultsTumor groups excreted higher serum T4 levels. Hepatic‐fibrosis increased tumor weight and size and serum T4 levels. In addition, animals with both tumor and hepatic‐fibrosis had increased NK activity. Therefore, animals with tumors increased fibrosis in spite of increased NK activity; probably due to a direct effect through increased serum‐free T4 excretions. Serum VEGF levels were significantly increased in the fibrotic groups. In vitro, lymphocytes harvested from fibrotic animals with thyroid tumors induction co‐cultured with tumor cells led to a decrease in their proliferations as compared to tumor cells alone. This decrease could be attributed to the increase in NK activity.ConclusionOur results propose immune‐modulatory interactions with hepatic fibrosis and T4 excreting thyroid tumor. Advanced fibrosis and tumor activity propagate each other in the presence of the anti‐ tumor and anti fibrotic effects of the increased NK activity. This interplay may explain increased risk of thyroid tumors in chronic HCV patients.
A Review of 2399 Ears for Postmyringotomy Tube Otorrhea
Authors: Chen Sharon , Cheng Leah , Chen Timothy , Cheng Jeremiah , Cheng Rebecca , Cheng David 
Published: February 2015

ObjectiveTo review consecutive myringotomy tube surgeries from 2005 to 2011.MethodRetrospective chart analysis of the last 2399 consecutive ears for myringotomy tube surgery from July 2005 to December 2011.ResultsOut of 2399 total ears reviewed, the total rate of otorrhea was 4.1% with 5.7% with no intervention developing immediate postmyringotomy tube otorrhea, 2.3% with ointment coated onto the tube developing otorrhea, 3.8% with ofloxacin instilled at time of surgery developing otorrhea, and 4.6% with cortisporin instilled at time of surgery developing otorrhea. Purulent middle ear effusions developed immediate postmyringotomy tube otorrhea in 7.3% of the ears, but no middle ear effusions developed otorrhea in only 2.8% of the ears. Sheehy collar button tube had the least amount of postmyringotomy tube otorrhea at 1.9%.ConclusionEarly postmyringotomy tube otorrhea is a frequent complication of myringotomy tube insertion with a rate of 4%, and the type of intervention at time of surgery with ointment or drops along with the type of tubes placed made a difference in the incidence of postmyringotomy otorrhea.
Transantral Approach to the Lateral Orbit
Authors: Van Rompaey Jason , Carrau Ricardo L. , Solares C. Arturo 
Published: February 2015

ObjectiveDepending on the type of pathology and location, various methods of access have been developed to overcome the obstacle of accessing the orbit. The endoscope provides minimally invasive surgical access to the medial and inferior orbit. Expanding endoscopic access to the lateral orbit transantrally could create a minimally invasive corridor.MethodUsing late injected cadavers, endoscopic dissections of the infero‐lateral orbit were undertaken. A sublabial transmaxillary ostomy was created and an endoscope was advanced into the sinus. The contents of the orbit were dissected laterally to the inferior optic nerve. Photographic evidence was obtained for review.ResultsA 45° endoscope was required to adequately visualize the anatomy. The perpendicular nature of the corridor necessitated the use of angled instrumentation. This also created a challenge as the dissections were completed superiorly. Dissection was found to be facile until revealing the lateral rectus muscle. Proceeding superiorly past this point was limited by the length of the instruments. Tools of dissection with greater length could possibly overcome this limitation. Overall the transantral endoscopic approach to the orbit provided an adequate surgical window inferiorly and to a limited extent laterally. The relevant anatomy was identified without difficulty.ConclusionAn endoscopic transantral approach to the infero‐lateral orbit is anatomically feasible. The morbidity associated with an open approach could possibly be avoided, improving patient outcomes. Further understanding of the endoscopic anatomy of the orbit can allow for advances in surgery with improved safety and efficacy.
Transhyoid Approach for Tongue Base Cancer
Authors: Cotulbea Stan , Marin Alin Horia , Lupescu Stelian , Balica Nicolae C. , Ruja Andreea S. 
Published: February 2015

ObjectiveCancer of the base of the tongue presents much less frequently than cancer of the mobile part of the tongue. Squamous cell carcinomas at the base of the tongue are usually diagnosed in advanced stages, and the optimal treatment has not been established.MethodRetrospective study from 1998 to 2007. A base of the tongue transhyoid resection was performed in 37 previously untreated patients. Epiglotectomy or horizontal supraglottic laryngectomy was also included in 14 cases (37.83%) and in 23 cases (62.17%). Bilateral neck dissections were performed in all cases. All of these patients underwent postoperative radiotherapy.ResultsThe postoperative and posttherapeutic evolution in 37 patients was favorable at 3 years (81.10%) and 5 years (75.67%), without signs of locoregional reccurences. The tumor‐specific 3‐ and 5‐year survival rates were: pT2 100%, pT3 87.5%, pT4a 71.42% and 57.14%, and pT4b 50%, respectively 25%. The stage‐specific 3‐ and 5‐year survival rates were: stage II 100%, stage III 85.71%, stage IVA 83.33%, and 79.16%, and stage IVB 50% and 25%, respectively.ConclusionWhile the prognosis for squamous cell carcinomas of the base of the tongue is poor, especially in advanced stages, cancer resection using the transhyoid approach is a feasible procedure which permits excellent tumor control over a long period of time with limited postoperative morbidity.
US‐FNA and CNB in Cervical Lymphadenopathy Diagnosis
Authors: Liao Li‐Jen , Wang Chi‐Te , Cheng Po‐Wen 
Published: February 2015

ObjectiveWe aimed to characterize sonographic findings of various malignant cervical lymphdenopathy (MCL) and to compare the effectiveness between ultrasound‐guided fine‐needle aspiration(US‐FNA) and core‐needle biopsy (US‐CNB) in achieving their diagnosis.MethodA total of 113 MCL patients, receiving real‐time US‐FNA or US‐CNB, were rectrospectively reviewed from July 2007 to Dec 2011. Results of FNA cytology and CNB pathology were categorized as being false negative, suspicous, and positive for malignancy. The US features, time from needle biopsy to diagnosis were also recorded and compared statistically.ResultsThe US‐FNA with false‐negative rate 50% (7/14) for lymphomatous nodes (LYM) was significantly higher than those of nonthyroid primary carcinoma (META; 0%; 0/60), papillary thyroid carcinoma (PAP; 8.3%;1/12), and US‐CNB for LYM (0%; 0/13) and META (0%;0/14). Comparing time from needle procedure to diagnosis among META‐FNA, LYM‐FNA, PAP‐FNA, META‐CNB, and LYM‐CNB, US‐FNA had the longest time to diagnosis (P <. 01, Log‐rank test). Discriminating US indicators included internal echo, S‐axis/L‐axis ratio, hilar echogenicity, calcification, and cystic formation.ConclusionSonographic finding are valuable for MCL diagnosis and in deciding whether US‐FNA or US‐CNB should be done. US‐FNA can be a diagnostic tool for most MCL. US‐CNB, however, should be performed if malignant lymphoma is suspected.
A Survey of Steroid Use in Otolaryngology
Authors: Govil Nandini , Paul Benjamin , Amin Milan R. , Branski Ryan C. 
Published: February 2015

ObjectiveGlucocorticoids are commonly used treatments in otolaryngology, but guidelines about their use are vague and irregular. We sought to assess clinical practices with regard to glucocorticoid use for patients with laryngeal disease and to ascertain factors driving clinician drug choice.MethodA web‐based survey was distributed to otolaryngologists via email using the Ear, Nose, and Throat (ENT) Journal database. This survey was composed of 20 questions and collected the following data from respondents: 1) indications for the use of glucocorticoids in their practice, 2) decision‐making process influencing the choice of glucocorticoid, 3) background and demographics.ResultsTwo hundred eight otolaryngologists completed the survey, with 99% (n = 196) reporting that glucocorticoids were valuable to their practice. “Previous experience/results,” “familiarity,” and “use in practice” (n = 144, 114, and 79, respectively) were commonly cited reasons for choosing a particular glucocorticoid, whereas pharmacokinetic profile and “academic literature” were infrequently cited concerns. Only 54.4% (n = 106) of respondents said that they were more likely to prescribe glucocorticoids for vocal performers as compared to other patients. Additionally, most respondents said side effects only “occasionally” prevented them from prescribing glucocorticoids to patients.ConclusionThese results suggest that glucocorticoid prescription practices vary greatly between otolaryngologists, and drug choice is driven primarily by clinician preference rather than more objective factors. These findings indicate a need for further research about this powerful class of drugs, and the importance of establishing clear, appropriate guidelines regarding their use.
Validating Tobacco Use with Cotinine in Cancer Patients
Authors: Hatcher Jeanne L. , Tooze Janet , Sterba Katherine , Weaver Kathryn , Day Terry A. , Sullivan Christopher A. 
Published: February 2015

ObjectiveTobacco use may be a risk factor for poor outcomes following surgery for head and neck cancer patients. We sought to determine the prevalence of tobacco exposure prior to head and neck surgery using both patient report and urinary cotinine.MethodPatients with squamous cell carcinoma of the upper aerodigestive tract undergoing a major head and neck procedure were recruited from 2 academic medical centers from 2011 to date. We assessed preoperative tobacco use by self‐report and by cotinine level, a nicotine metabolite, in urine using a semiquantitative test strip.ResultsWe have recruited 49 patients to date (mean age, 60 years), 71.4% male, 85.7% non‐Hispanic white, 60.0% stages III‐IV. In the 48 hours before surgery, 11 patients (22.5%) reported tobacco use; 18 (36.7%) were identified by intraoperative urine cotinine. In sum, 57.1% of women and 28.6% of men tested positive for cotinine (P =. 06). Of those who denied tobacco use, 7 out of 38 (18.4%) were positive for cotinine (>2); sensitivity for self‐report was 61.1%. Secondhand exposure was reported by 6 of 38 (15.8%) nonusers, 2 being cotinine positive. There was no association between secondhand exposure and positive cotinine (Fisher’s Exact, P =. 30).ConclusionTobacco is a major risk factor for head and neck cancer. The use of a urine cotinine screening test demonstrated that self‐report may fail to identify a significant number of tobacco users. Implementation of cotinine screening could facilitate precise understanding of tobacco use patterns and opportunities for intervention.
Acute Tonsillitis: Do We Always Need a Monospot?
Authors: El‐Shunnaz Suliman , Holmes Holly , Stobbs Emily , Salem Hesham 
Published: February 2015

ObjectivePatients presenting with tonsillitis are tested for glandular fever. Studies suggest a high lymphocyte–white cell ratio is a useful screening test for glandular fever. The purpose of our study was to ascertain the usefulness of testing patients for glandular fever if they have normal lymphocyte counts and blood films.MethodRetrospective review of blood results and discharge summaries of all patients presenting to a university teaching hospital with a diagnosis of acute tonsillitis or peritonsillar abscess over a 3‐year period from 2008 to 2011. Data were collected for age, sex, blood results, and EBV testing and analyzed in Excel.ResultsSeven hundred forty‐three patients were identified with a diagnosis of tonsillitis or peritonsillar abscess. Four hundred seventy‐two (63.5%) were tested for glandular fever, and of those tested, 32 (6.78%) patients tested positive. Thirty (93.8%) of the confirmed glandular fever patients had deranged lymphocytes.ConclusionPatients with acute tonsillitis presenting without a lymphocyte derangement on blood film are unlikely to test positive for glandular fever. However, given the clinical implications of a positive glandular fever test, it is advisable to perform a monospot test in all patients presenting with tonsillitis.
Initial Dosing of Botox A in Adductor Spasmodic Dysphonia
Authors: Rosow David E. , Vivero Richard J. , Parikh Punam , Casiano Roy R. , Lundy Donna 
Published: February 2015

Objective1) Assess effect on voice improvement and duration of breathiness based on initial dose of BotoxA in management of adductor spasmodic dysphonia. 2) Compare voice outcomes for initial bilaterally injected doses of 1.25 units Botox A (Group A) versus 2.5 units (Group B).MethodA retrospective chart review was undertaken of all adductor spasmodic dysphonia patients treated at a tertiary care facility between 1990 and 2011. Demographic data (age and sex), voice rating, duration of voice improvement, and breathiness were evaluated and compared between Groups A and B using Student’s t test and chi‐square analysis.ResultsOf 478 patients identified, 305 (group A: 223; group B: 82) patients met inclusion criteria. The average age of group A was 56.2 years and group B was 57.4 years (P =. 5). The female/male ratio was 2.91 for group A versus 3.56 for group B (P =. 61). Good voice outcomes (grade 3 or 4) were reported by 91% of group A patients versus 94% of group B (P =. 75). The average duration of voice improvement was 99.7 days for group A and 108.3 for group B (P =. 54). The average duration of breathiness was 10.88 days for group A versus 15.42 for group B (P =. 02).ConclusionPatients injected with 1.25 units bilaterally had a statistically significant shorter duration period of breathiness without a statistically significant difference in clinical effectiveness or voice outcome. It is therefore recommended that a relatively low initial Botox dose be used with subsequent titration to achieve improved voice outcomes.
Laryngeal EMG for Unilateral Vocal Fold Paralysis
Authors: Wang Chen‐Chi , Chang Ming‐Hong 
Published: February 2015

Objective1) Examine the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of using laryngeal electromyography (LEMG) to predict the prognosis of unilateral vocal fold paralysis (UVFP). 2) Provide better evidence support for using LEMG to predict the prognosis of UVFP via a prospective long‐term study.MethodSixty‐six patients with UVFP were prospectively collected from 2007 to 2011. LEMG findings were dichotomized to negative (good prognosis) or positive (poor prognosis). The motions of paralyzed vocal folds were followed by videolaryngoscopy at least 3 months after LEMG. and the association with LEMG findings were analyzed.ResultsThe mean duration of LEMG after symptoms onset and follow up after LEMG were 3.4 months and 12 months, respectively. Fifty‐seven patients had positive findings (less than 80% of normal motor unit recruitment or presence of fibrillations) in LEMG and 55 patients remained UVFP in the follow‐up. Nine patients had negative findings (80%‐100% motor unit recruitment) in LEMG and 3 patients recovered vocal fold motion. LEMG findings are significantly associated with the outcome of UVFP (P =. 016; Fisher’s exact test). The accuracy, sensitivity, specificity, PPV, and NPV of LEMG were 87.9%, 90.2%, 60%, 96.5%, and 33.3%, respectively.ConclusionThis study confirms that LEMG can reliably offer prognostic information for UVFP. Especially for patients with positive finding of LEMG, the chance of recovery of vocal fold motion will be very low.
Low‐Fidelity Simulation of Airway Emergencies
Authors: Ramakrishnan Yujay , McNeill Emma , Killick Neil , O’Neill Suzanne 
Published: February 2015

ObjectiveJunior trainees are commonly expected to manage airway emergencies with very little prior experience. The aim of this simulation training is to: 1) Be able to increase the confidence of participants in managing airway emergencies with respect to tracheostomies. 2) Learn the principles of performing a surgical cricothyroidomy.MethodDesign: Survey. Tertiary otolaryngology center. Junior doctors otolaryngology and anaesthesia. A half‐day program in managing airway emergencies. Surgical cricothyroidotomy was taught (Killick artificial larynx). Algorithms on 2 complete airway scenarios (blocked/displaced tracheostomy and “can’t intubate, can’t ventilate”) were completed. Confidence in managing airway emergencies was evaluated (Likert scale).ResultsPrevious exposure to airway emergencies was variable between the trainees. Universally, the trainees described a marked improvement in confidence following the practical and moulage sessions. Videos from these sessions will be available online to serve as a future teaching resource. The low‐fidelity airway simulation has since been rolled out through regional hospitals led by senior residents, highlighting the utility of delivering basic airway training in a cost‐effective manner.ConclusionA low‐fidelity simulation‐based training of airway emergencies can be effective in improving junior otolaryngology residents’ confidence, knowledge and technical skills. Further reinforcement of clinical and decision‐making skills in realistic training scenarios may be achieved through high‐fidelity simulation training.
Analgesic Regimen and Readmission following Tonsillectomy
Authors: Kishikova Lyudmila , Smith Matthew D. , Fleming Jason 
Published: February 2015

ObjectiveTo define the analgesic regimen given following tonsillectomy in a large otolaryngology center and correlate this with readmission for secondary complications.MethodCase notes for patients undergoing tonsillectomy were collected between February and August 2011. Information was collated and entered into a database including age, gender, operation type, indication, medications on discharge, and details of readmission. Data were assessed for correlations, particularly that between readmission and analgesic regimen given following tonsillectomy.ResultsOne hundred twenty‐five patients underwent tonsillectomy during the six‐month period (mean age of 13.8 years, range 3 months to 65 years). The most common indication for surgery was recurrent tonsillitis and with most carried out by bipolar dissection. A total of 64.8% of patients were discharged as day cases. Seventeen different postoperative analgesic regimens were identified with the most common being acetaminophen and ibuprofen in combination (26.4%). Of the patients, 20.0% had no documented analgesia on discharge. Thirteen patients (10.4%) were readmitted following discharge from hospital postoperatively, 4 (3.2%) for issues related to pain. There was no correlation between analgesic regimens and readmission, including those without formal analgesic prescriptions.ConclusionNo apparent link between readmission and analgesic regimen was identified. The lack of opioid analgesics does not appear to affect readmission rates. However the vast variation of analgesic regimens and lack of formal instructions for those advised over‐the‐counter analgesics has prompted development of a formal step‐based protocol.