bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous and Evoked Laryngeal Electromyography of the Thyroarytenoid Muscles: A Canine Model for Intraoperative Recurrent Laryngeal Nerve Monitoring
Authors: Scott Andrew R. , Chong Peter Siao Tick , Hartnick Christopher J. , Randolph Gregory W. 
Published: October 2014

Objectives: We sought to determine the feasibility of performing spontaneous and evoked intraoperative laryngeal electromyography (L-EMG) using nerve monitoring equipment and to compare recording electrode configurations and methods of recurrent laryngeal nerve (RLN) stimulation in dogs. Methods: Four beagles underwent crush injury of the left RLN, and 2 beagles underwent left RLN transection. Serial spontaneous and evoked L-EMG was recorded with the NIM-Response nerve monitoring system under sedation. Transesophageal, percutaneous, and direct open RLN stimulation was performed. Recordings of spontaneous and evoked responses were made with endotracheal tube surface electrodes and bipolar vocal fold needle electrodes. The L-EMG procedures were repeated every 1 to 2 weeks after injury, and intersubject and intertrial differences were evaluated. Results: Low-amplitude motor unit action potentials, polyphasic potentials, fasciculations, and fibrillations were detected in injured animals with bipolar needle recording electrodes with this system of spontaneous L-EMG. The surface recording electrodes did not detect pathologic waveforms. Percutaneous needle stimulation of the RLN is possible at currents slightly higher than those used for direct stimulation. Consistent, discrete, transesophageal stimulation of the RLN could not be reliably performed. Recording evoked responses with needle electrodes generated sharper waveforms, facilitating calculation of latency and wave duration. Evoked L-EMG utilizing surface recording electrodes limited the intertrial and intersubject variability of evoked amplitude. Conclusions: Typical patterns of nerve injury can be detected with this system of intraoperative L-EMG in a canine model. Quantitative measures of amplitude, latency, and wave duration in healthy and injured canine RLNs may be determined with this system.
Serum Fatty Acids and Cardiovascular Risk Factors in Sudden Sensorineural Hearing Loss: A Case-Control Study
Authors: Cadoni Gabriella , Scorpecci Alessandro , Cianfrone Francesca , Giannantonio Sara , Paludetti Gaetano , Lippa Silvio 
Published: October 2014

Objectives: We analyzed the relationships between sudden sensorineural hearing loss (SSNHL) and serum levels of fatty acids, total cholesterol, low-density lipoproteins (LDLs), and the antioxidant coenzyme Q10. Methods: Forty-three patients with SSNHL and 43 healthy subjects were enrolled in the study. The main outcome measures were serum levels of fatty acids, coenzyme Q10, total cholesterol, and LDLs. Results: On univariate logistic regression analysis, high levels of total cholesterol (p < 0.001), LDLs (p = 0.024), behenic acid (p < 0.001), docosahexaenoic acid (p < 0.001), linolenic acid (p = 0.017), and oleic acid (p < 0.001) and low levels of coenzyme Q10 (p < 0.001) and nervonic acid (p < 0.001) were associated with an elevated risk of SSNHL. On multivariate analysis, only hypercholesterolemia (p = 0.15) and low levels of coenzyme Q10 (p = 0.02) and nervonic acid (p = 0.005) were significantly associated with SSNHL. Conclusions: This is the first report of low serum levels of nervonic acid as an independent risk factor for SSNHL. Considering that hypercholesterolemia, high serum levels of LDL, and low serum levels of the antioxidant coenzyme Q10 were associated with SSNHL as well, we hypothesize that saturated fatty acids may play a role in determining the dysmetabolic state in a subset of SSNHL patients. Together, these findings suggest that not only total cholesterol and LDL levels, but also fatty acid determination, may help identify SSNHL patients with cardiovascular risk factors.
Mutations of GNAS and TSHR Genes in Subclinical Toxic Multinodular Goiter
Authors: Liu Chunbo , Wu Changjun , Wang Fengjun , Zhou Min 
Published: October 2014

Objectives: This study aimed to detect the mutations of the GNAS and TSHR genes in subclinical toxic multinodular goiter (sTMG) and to evaluate the relationship between these mutations and sTMG. Methods: Forty-four patients with sTMG and 20 matched controls (multinodular goiter) were recruited into this study. All of the patients underwent subtotal thyroidectomy. Gene mutations were analyzed by direct DNA sequencing of the polymerase chain reaction—amplified part of exons. Results: In the sTMG group, 3 mutations of the GNAS gene were identified in 7 patients (15.9%), and 6 mutations of the TSHR gene were identified in 14 patients (31.8%). The mutation rate of the TSHR gene in patients with sTMG was significantly higher than that in the control group. Furthermore, in the sTMG group, statistical analysis indicated that mutations were significantly correlated with the serum level of thyroid-stimulating hormone for the TSHR gene, but no significant difference was found for the GNAS gene. Also, no significant difference was found in mutation positivity of the 2 genes between patients with nodules who were born before universal salt iodization and patients with nodules who were born afterward (p > 0.05). Conclusions: The results indicate that a mutation of the TSHR gene may be related to sTMG. The serum thyroid-stimulating hormone level plays an important role in the mutagenesis.
Histologic Study of Acute Vocal Fold Wound Healing after Corticosteroid Injection in a Rabbit Model
Authors: Campagnolo Andréa M. , Tsuji Domingos Hiroshi , Sennes Luiz Ubirajara , Imamura Rui , Saldiva Paulo H. N. 
Published: October 2014

Objectives: Injectable corticosteroids have been used in phonosurgery to prevent scarring of the vocal fold because of their effects on wound healing, and to ensure better voice quality. We histologically evaluated the effects of dexamethasone sodium phosphate infiltration on acute vocal fold wound healing in rabbits 3 and 7 days after surgically induced injury by quantification of the inflammatory reaction and collagen deposition. Methods: A standardized surgical incision was made in the vocal folds of 12 rabbits, and 0.1 mL dexamethasone sodium phosphate (4 mg/mL) was injected into the left vocal fold. The right vocal fold was not injected and served as the control. The larynges were collected 3 and 7 days after surgery. For histologic analysis, the vocal folds were stained with hematoxylin-eosin for quantification of the inflammatory response and with picrosirius red for quantification of collagen deposition. Results: There was no quantitative difference in the inflammatory response between vocal folds injected with the corticosteroid and control vocal folds. However, the rate of collagen deposition was significantly lower in the corticosteroid-treated group at 3 and 7 days after injury (p = 0.002). Conclusions: The present results suggest that dexamethasone reduces collagen deposition during acute vocal fold wound healing.
Imaging Evaluation in Otosclerosis: Single Photon Emission Computed Tomography and Computed Tomography
Authors: Berrettini Stefano , Ravecca Francesca , Volterrani Duccio , Neri Emanuele , Forli Francesca 
Published: October 2014

Objectives: The aim of our study was to demonstrate the utility of diphosphonate bone single photon emission computed tomography (SPECT) in diagnosing otosclerosis and to correlate the findings from SPECT with age, gender, and sensorineural hearing loss. We also evaluated the ability of high-resolution computed tomography (HR-CT) in detecting otospongiotic and otosclerotic foci and correlated the HR-CT findings with the SPECT results. Methods: Seventy-three subjects with surgically confirmed otosclerosis underwent SPECT, and 45 of the 73 patients also underwent HR-CT of the petrous bones. Results: In the patient sample examined in this study, SPECT demonstrated a sensitivity of 95.2% and a specificity of about 96.7%. By correlating the SPECT findings, we found an inverse relationship between bone radioactivity and age (ie, greater disease activity in younger patients) and a direct relationship between bone radioactivity and the severity of sensorineural impairment in younger patients. In the 45 patients who also underwent HR-CT, the sensitivity of HR-CT (58%) was lower than that of SPECT, and the comparison between SPECT activity and the HR-CT findings (fenestral or retrofenestral type) demonstrated a statistically significant correlation between the morphological finding of bone demineralization (pericochlear foci) and a high uptake index. Conclusions: The use of SPECT seems to be highly effective in differentiating normal from pathological petrous bone. It also provides a quantitative evaluation of disease activity and shows a significant correlation with bone demineralization revealed by HR-CT.
Relationship between Postoperative Recurrence Rate and Eosinophil Density of Nasal Polyps
Authors: Tosun Fuat , Arslan Hasan Huseyin , Karslioglu Yildirim , Deveci M. Salih , Durmaz Abdullah 
Published: October 2014

Objectives Nasal polyps develop as a result of chronic inflammation, mostly accompanied by pronounced eosinophil leukocyte infiltration. In this study we aimed to investigate the relationship between eosinophil density in nasal polyps and the postoperative recurrence rate of this disease. Methods Forty-two patients who underwent endoscopic sinus surgery for massive nasal polyposis by one surgeon were included in the study. The eosinophil leukocyte densities in nasal polyps were determined retrospectively on histologic slides by use of computer-assisted image analysis software. The patients were assigned to group 1, in whom nasal polyps contained up to 3 eosinophils per 1,000 urn2, and group 2, in whom nasal polyps contained 4 or more eosinophils per 1,000 um2. The postoperative recurrence rates of nasal polyps were compared in the two groups. Results There were 20 patients in group 1 and 22 patients in group 2. Postoperative polyp recurrence was detected in 5 of 20 patients (25.0%) in group 1 and in 18 of 22 patients (81.8%) in group 2 during the 30-month postoperative follow-up period (p < 0.05). Conclusions The eosinophil density of nasal polyps can be used to get an estimate of the postoperative recurrence risk. Eosinophil-rich nasal polyps have a higher postoperative recurrence rate.
Good Manufacturing Practices—Grade Preformed Ossicular Prostheses from Banked Bone via Computer Numerically Controlled Micromilling
Authors: Berrettini Stefano , Bruschini Luca , Stefanini Cesare , D'Alessandro Delfo , D'Acunto Mario , Danti Serena 
Published: October 2014

Objectives: The aim of this study was the fabrication of ossicular replacement prostheses (ORPs) from decellularized banked cortical bone via computer numerically controlled (CNC) ultraprecision micromilling, in order to obtain preformed clinical-grade tissue products, reproducing shape, size, and details perfectly comparable to those of synthetic devices. Methods: Banked femoral compact bone was used to fabricate partial and total ORPs via CNC micromilling according to Good Manufacturing Practices procedures. Drawings of ORPs with different shapes and sizes were uploaded to the computer interface, and different surface-finish parameters were tested. The obtained products underwent dimensional, weight, and surface characterizations. A histologic analysis was pursued to compare the bone matrix compactness of the produced ORPs to that of the ear ossicles. Results: Banked-bone ORPs were produced with high dimensional accuracy. Partial ORP weights averaged (±SD) 31.2 ± 0.6 mg, and total ORP weights averaged 69.3 ± 0.7 mg. The best-finish mode allowed microscale or nanoscale roughness free from machinery textures to be obtained. Finally, the histologic analysis confirmed that the extracellular matrix compactness of the produced ORPs was suitable for ossicular chain replacement. Conclusions: This study assesses the fabrication feasibility of novel banked-bone ORPs of extremely high dimensional accuracy. Such devices are aimed at combining the most favorable aspects of both synthetic (reproducibility, convenience, and biosafety) and biological replacements (total biocompatibility).
Head and Neck Cancer Surgery in the Elderly: Outcome Evaluation with the McPeek Score
Authors: Sesterhenn Andreas M. , Schotte Tobias L. , Bauhofer Artur , Timmesfeld Nina , Wiegand Susanne , Werner Jochen A. , Ovassapian Andranik , Torossian Alexander 
Published: October 2014

Objectives: There is international consensus that elderly patients with head and neck cancer should be treated curatively, like younger patients. Because of common comorbidities in elderly patients, perioperative complications are likely. The McPeek postoperative outcome score was used to evaluate the success of surgical interventions in patients with head and neck cancer. Methods: We included 168 patients in the study (56 in the study group, 75 years of age or more; and 112 in the control group, less than 60 years of age). All patients underwent major surgery for head and neck cancer. Results: The median McPeek scores were 8 in the study group and 9 in the control group (p = 0.04). Regression analysis revealed that neither age (p = 0.085) nor the American Society of Anesthesiologists physical status score (p = 0.342) were independent predictors of the McPeek score. Synchronous surgical interventions (p = 0.00051) and duration of surgery (p = 0.0015) had a significant impact on McPeek score performance. Conclusions: The McPeek score seems to be an appropriate tool for comparing major surgeries for head and neck cancer in different age groups. It is possible to assess the influence of anesthetic and surgical interventions and complications that affect the length of hospitalization. The results confirm that the overall complication rate after surgery in elderly patients does not differ significantly from that in their younger counterparts. Therefore, extended surgical treatment should be offered to both age groups when no serious comorbidities are present. The postoperative outcome seems to depend on the duration and extent of the surgical intervention.
Adipose-Derived Mesenchymal Stem Cells in Collagen—Hyaluronic Acid Gel Composite Scaffolds for Vocal Fold Regeneration
Authors: Xu Wen , Hu Rong , Fan Erzhong , Han Demin 
Published: October 2014

Objectives: We sought to characterize the changes in the extracellular matrix (ECM) of the lamina propria following the implantation of autologous adipose-derived mesenchymal stem cells (ADSCs) in composite scaffolds in a rabbit vocal fold wound model. Methods: The ADSCs were co-cultured with collagen or hyaluronic acid gel. Each vocal fold was injured by localized resection and injected with ADSC complexes, ADSCs, or scaffolds or left untreated. From 15 days to 12 months, the vocal fold shape and the characteristics of the ECM components were analyzed. Results: With implantation of the ADSC complexes, the collagen content was significantly increased and had a disorderly distribution at 3 months. Subsequently, it began to decrease and reached close to normal by 12 months. The hyaluronic acid content was increased at 40 days, but it was reduced to normal levels and was limited to the superficial and middle layers of the lamina propria over the following 12 months. Fibronectin continued to be scattered in the lamina propria, at peak levels at 40 days, and then decreased over the following 12 months to reach near-normal levels. At 12 months, the vocal folds had a normal surface. Conclusions: ADSC complexes can play a facilitatory role in vocal fold regeneration, regulating the generation and orderly distribution of ECM.
Phenotypes of Two Dutch DFNA3 Families with Mutations in GJB2
Authors: Weegerink Nicole J. D. , Pennings Ronald J. E. , Huygen Patrick L. M. , Hoefsloot Lies H. , Cremers W. R. J. , Kunst Henricus P. M. 
Published: October 2014

Objectives: We describe the phenotype of 2 Dutch DFNA3 families with mutations in the GJB2 gene. Methods: Two patients from family 1 and one isolated patient from family 2 were studied. The audiometric examination consisted of pure tone and speech audiometry. Two patients underwent vestibular testing and high-resolution computed tomographic scanning of the temporal bone. Mutation analysis of GJB2 and GJB6 was performed. Results: All 3 patients had severe to profound sensorineural hearing impairment. Cochlear implantation was performed in 2 patients, and their phoneme recognition scores were good. Mutation analyses revealed a p. Arg184Gln mutation in GJB2 in family 1 and a p. Arg75Trp mutation in GJB2 in family 2. No mutations in GJB6 were identified. Vestibular function tests and computed tomographic scans yielded normal findings in the examined subjects. Conclusions: Severe to profound sensorineural hearing impairment was found in these DFNA3 patients, and was well rehabilitated with cochlear implantation. A thorough genotype-phenotype correlation is difficult because of the small number of affected patients and the limited clinical data of these patients. More clinical data on DFNA3 families need to be published in order to create a reliable and precise phenotype characterization.
Morphology of Human Fungiform Papillae after Severing Chorda Tympani Nerve
Authors: Saito Takehisa , Narita Norihiko , Yamada Takechiyo , Manabe Yasuhiro , Ito Tetsufumi 
Published: October 2014

Objectives: We aimed to clarify the postoperative morphology of the fungiform papillae (FP) of the tongue in patients who recovered gustatory function after the chorda tympani nerve was severed during middle ear surgery. Methods: Fifty-four patients with normal preoperative gustatory function measured by electrogustometry (EGM) were included. The proximal and distal stumps of the severed nerves were re-adapted or re-approximated during surgery to promote regeneration of the nerve. The EGM thresholds over 2 years after surgery were compared with preoperative values. At the same time, the morphological characteristics of the FP in the midlateral region of the tongue were recorded with a digital microscope. Results: One month after surgery, EGM showed no response in any patients. At a time point of more than 2 years, the FP showed complete atrophy and no response to EGM on the surgical side in 21 of the 54 patients. In 16 patients who showed complete recovery of the EGM threshold (below 20 μA), the FP showed an almost normal appearance, and the mean number of FP was 77.5% (10 ± 4.1 papillae per square centimeter) of that on the contralateral side (12.9 ± 4.9 papillae per square centimeter; p > 0.05). Conclusions: The morphology of the FP was maintained in patients who recovered gustatory function after the chorda tympani nerve was severed. Because the results indicate regeneration of the taste buds, further observation is needed to detect regenerated taste buds in the FP.
Novel Model to Assess Laryngeal Function, Innervation, and Reinnervation
Authors: Old Matthew O. , Oh Sang Su , Feldman Eva , Hogikyan Norman D. 
Published: October 2014

Objectives: Laryngeal paralysis remains an unsolved problem, and the behavior of the laryngeal muscles following injury to the native innervation appears to be a function of denervation and reinnervation. The aim of the present study was to develop a reliable, accurate, and multifaceted animal model for study of laryngeal function, innervation, and reinnervation. Methods: A spontaneous-breathing anesthesia technique, suspension laryngoscopy, endoscopic evaluation of the rat larynx, and transoral injection of a retrograde neuronal tracer, hydroxystilbamidine (FluoroGold), were developed. We submitted 14 rats to the developed technique to map the brain stem projections of the superior laryngeal nerve and the recurrent laryngeal nerve and to determine the feasibility and accuracy of the endoscopic injection technique. Results: This endoscopic technique provided full evaluation of the rat larynx. We performed transoral endoscopic injection of FluoroGold and transcervical application of the tracer to transected superior laryngeal and recurrent laryngeal nerves in 14 different rats and successfully created a neural projection map for the superior laryngeal nerve, the recurrent laryngeal nerve, and the cervical ganglia. Conclusions: A reliable, accurate model for the characterization of laryngeal function, routes of innervation, and sources of spontaneous reinnervation following recurrent laryngeal nerve resection has been developed. This stable and reproducible model can serve as a dependable tool in future investigations of laryngeal nerve injury and recovery.
Pharyngocutaneous Fistula after Total Laryngectomy: Less Common with Mechanical Stapler Closure
Authors: Calli Caglar , Pinar Ercan , Oncel Semih 
Published: October 2014

Objectives: The aim of the study was to compare the incidences of pharyngocutaneous fistula after total laryngectomy between patients who underwent manual and mechanical suturing for pharyngoesophageal closure. Methods: In a retrospective and prospective nonrandomized clinical study conducted at a single tertiary medical center between May 2002 and April 2009, we compared the incidence of pharyngocutaneous salivary fistula between two groups of patients after total laryngectomy. Sixty-one consecutive patients who underwent mechanical suturing with a 60-mm linear stapler (group A) were prospectively enrolled, and 121 patients who had undergone manual suturing (group B) were retrospectively reviewed. Results: The groups were similar in terms of age, gender, comorbidities, TNM (tumor, node, metastasis) stage, and laryngeal tumor extension. The incidence of pharyngocutaneous salivary fistula was 4.9% in group A and 19.8% in group B (p = 0.014). Conclusions: Mechanical stapler closure of the pharynx after total laryngectomy was associated with a significant reduction in the incidence of pharyngocutaneous fistula compared with manual suture in selected cases.
Radiolocalization of Sentinel Lymph Nodes in Clinically N0 Laryngeal and Hypopharyngeal Cancers
Authors: Hu Guohua , Zhong Shixun , Xiao Qing , Li Zhongwan , Hong Suling 
Published: October 2014

Objectives: We sought to analyze the characteristics of radioactive lymph nodes with metastatic disease and to explore methods for the localization of sentinel lymph nodes (SLNs) with radionuclide in clinically N0 laryngeal and hypopharyngeal cancer. Methods: Forty-five patients with T1–T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient, a peritumoral submucosal injection of 99mTc-labeled sulfur colloid was administered, and lymph node mapping was performed by lymphoscintigraphy 2 hours after injection. The SLNs were localized during operation by a handheld gamma probe 10 to 12 hours after the injection, and we defined the radioactive counts from the parotideomasseteric region as background values. All lymph nodes that had accumulated radioactivity were harvested and initially termed as SLNs. Selective neck dissection was performed in all patients. The SLN specimens were sent for formal paraffin–embedded sectioning, serial sectioning, and immunohistochemical assay. The results were compared to those for the remaining lymphadenectomy specimen. Resection of the primary tumor depended on its location and the T classification. Results: Sentinel lymph nodes were identified in 41 of 45 patients (51 necks). Sentinel lymph nodes with occult metastases were found in 13 patients (15 necks). In a false-negative case, metastasis was found in a nonsentinel lymph node in 1 of the neck specimens. The SLN identification rate was 92.7%, the sensitivity was 93.7%, the false-negative rate was 6.3%, and the accuracy was 98.0%. In 11 of the 15 necks (73.3%) with pathologically positive SLNs, metastasis was found in the node with the highest radioactivity. Harvesting the first 3 nodes with the highest radioactive counts may identify patients with occult metastatic disease. Conclusions: Excision of the first 3 SLNs with the highest radioactive counts can be used to accurately identify the status of cervical lymph node metastases in patients with clinically N0 laryngeal or hypopharyngeal cancer.