bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiographic and Micro—Computed Tomographic Imaging of Lipopolysaccharide-Mediated Bone Resorption
Authors: Nason Robert , Lee Dong H. , Jung Jae Y. , Chole Richard A. 
Published: October 2014

Objectives: Chronic otitis media and cholesteatomas cause hearing loss as a result of bony erosion. This bone resorption is known to be more aggressive when cholesteatomas become infected. The most common organism isolated from both diseases is the gram-negative bacterium Pseudomonas aeruginosa. Lipopolysaccharide (LPS), a major virulence factor found in the gram-negative bacterial cell wall, is well known to incite inflammatory bone resorption. The mechanisms underlying this process, however, are poorly understood. In this study, we developed a mouse model of calvarial osteolysis in which resorption was reliably imaged by plain radiography and micro–computed tomography (micro-CT). Methods: A murine calvarial model was developed to study bone resorption induced by P aeruginosa LPS. Calvariae from wild-type and knockout mice used in this model were imaged by plain radiography and micro-CT. Results: A high degree of correlation between plain radiography and micro-CT was identified (R2 = 0.8554). Furthermore, maximal LPS-induced bone resorption required functioning toll-like receptor (TLR) 2, TLR4, and myeloid differentiation factor 88 (MyD88). Conclusions: We have developed a successful model of inflammatory osteolysis in which plain radiography can reliably delineate induced bone resorption. In vivo, we have shown that P aeruginosa LPS signals via TLR2, as well as TLR4 through MyD88.
Dysplasia in Adults with Recurrent Respiratory Papillomatosis: Incidence and Risk Factors
Authors: Blumin Joel H. , Handler Ethan B. , Simpson C. Blake , Osipov Vladimir , Merati Albert L. 
Published: October 2014

Objectives: Recurrent respiratory papillomatosis (RRP) causes significant morbidity in laryngology. The incidence of dysplasia in adult patients with RRP has not been well described. In this study, the risk factors and incidence of RRP-associated dysplasia are investigated. Methods: Pathology specimens from patients with RRP over a 6-year period are reviewed, along with the patients' clinical and demographic information. Results: Fifty-two male and 21 female patients (mean, 50 years) with RRP were identified. Some degree of dysplasia was identified in 22 of 170 specimens (13%). Sixteen of the 73 patients (21.9%) were found to have dysplasia at some point during their clinical course. Although the patients with RRP-associated dysplasia were older (56.3 versus 48.3 years of age), this difference did not reach statistical significance (p < 0.09, unpaired t-test). There was a male preponderance in both dysplastic (10 of 16; 62.5%) and non-dysplastic (42 of 57; 73%) cases. The mean number of operations for RRP was 2.4 for patients without dysplasia and 3.2 for those with dysplasia; there was no significant difference between the groups. Seven of the 16 patients with dysplasia (44%) and 22 of the 57 patients without dysplasia (39%) had a history of tobacco use (p < 0.77, Fisher's exact test). Conclusions: Dysplasia was discovered in more than 20% of adult patients with RRP studied over a 6-year period. Age, gender, tobacco history, and operative frequency were not identifiable risk factors for the presence of dysplasia.
Diagnosis and Prognosis of Iatrogenic Injury of the Recurrent Laryngeal Nerve
Authors: Hydman Jonas , Björck Gunnar , Persson Jonas K. E. , Zedenius Jan , Mattsson Per 
Published: October 2014

Objectives: Following perioperative injury to a macroscopically intact recurrent laryngeal nerve (RLN), there are two possible intraneural injury types: 1) axonal injury, including disruption of axons, and 2) conduction block, only affecting the Schwann cells and the nodes of Ranvier. In this study, it was hypothesized that the functional outcome after RLN injury may depend on the type of nerve injury. Methods: Fifteen patients with acute postoperative unilateral RLN paralysis were prospectively studied. Electrophysiological examination (laryngeal electromyography) was used to differentiate between the two types of nerve injury. Vocal fold motions were monitored by repeated laryngoscopy during the study period (up to 6 months). Three of the patients with axonal injury were treated with the regeneration-promoting agent nimodipine. Results: The patients with conduction block all recovered normal vocal fold motion, whereas patients with axonal injury within the nerve had a significantly worse outcome. The 3 patients who were treated with nimodipine all recovered normal or near-normal vocal fold mobility despite the more severe axonal injury. Conclusions: In contrast to previous reports, our results show that laryngeal electromyography is a reliable tool for diagnosing the type of injury within the injured RLN, making it possible to predict the functional outcome in these patients. On the basis of the results, a future randomized study on nimodipine treatment for RLN axonal injury is suggested.
Microlaryngoscopic and Office-Based Injection of Bevacizumab (Avastin) to Enhance 532-nm Pulsed KTP Laser Treatment of Glottal Papillomatosis
Authors: Zeitels Steven M. , Lopez-Guerra Gerardo , Burns James A. , Lutch Matthew , Friedman Aaron M. , Hillman Robert E. 
Published: October 2014

Objectives: Photoangiolytic lasers effectively treat glottal papillomatosis, but do not reliably prevent recurrence. Therefore, sublesional injections of the antiangiogenic agent bevacizumab (Avastin) were given to assess the effect on disease recurrence and phonatory function. Methods: A retrospective investigation was done in a pilot group of 10 adult patients with bilateral glottal papillomatosis who had prior angiolytic laser treatment with established patterns of recurrence. The patients underwent 5 bevacizumab injections (5 to 10 mg) into the diseased vocal folds along with 532-nm pulsed KTP laser photoangiolysis treatments 4 to 6 weeks apart. Their disease resolution was compared to findings from prior laser treatment alone, and objective measures of vocal function (acoustic, aerodynamic, Voice-Related Quality of Life survey) were obtained. Results: All 10 patients had a greater than 90% reduction in recurrence. Four of the 10 had resolution. Four of the 10 have limited recurrent or persistent disease, receive injections of bevacizumab at 8- to 12-week intervals, and have not required laser treatment. Two of the 10 have ongoing periodic office-based KTP laser treatment along with bevacizumab injections. No patient has required microlaryngeal surgery with general anesthesia, and all 10 have had substantial improvement in vocal function. Conclusions: This pilot investigation provides preliminary evidence that bevacizumab injections enhance photoangiolytic laser treatment of glottal papillomatosis while enhancing phonatory function. Coupling an antiangiogenesis agent with pulsed KTP laser photoangiolysis is conceptually promising, since the mechanisms of action are complementary.
Implantation of an Atelocollagen Sheet for the Treatment of Vocal Fold Scarring and Sulcus Vocalis
Authors: Kishimoto Yo , Hirano Shigeru , Kojima Tsuyoshi , Kanemaru Shin-Ichi , Ito Juichi 
Published: October 2014

Objectives: The management of vocal fold scarring and sulcus vocalis is challenging. These disorders are thought to be fibroplastic anomalies in the cover portion of the vocal fold that cause deterioration of the vibratory properties of the vocal fold mucosa. Histologic studies have revealed disorganization of extracellular matrix that needs to be addressed in the treatment of scarred vocal folds. Replacement of scar tissues with an appropriate implant may lead to regeneration of the vocal fold mucosa and its tissue properties. This retrospective case study examined the feasibility of using an atelocollagen sheet as a regenerative implant. Methods: Six patients with a post-cordectomy scar or sulcus vocalis underwent implantation of an atelocollagen sheet into the lamina propria of the vocal folds. The procedure consisted of elevation of a microflap, dissection and removal of scar tissue, implantation of the material, and wound closure. Vocal function was evaluated before and after surgery by stroboscopic examination and by aerodynamic and acoustic analyses. Results: The postoperative changes of aerodynamic and acoustic parameters varied among patients; however, gradual improvement was seen in most cases over a year. Stroboscopic findings also revealed gradual improvement of vibratory properties in most cases. Conclusions: Implantation of an atelocollagen sheet may have restorative effects on vocal fold scarring and sulcus vocalis in terms of tissue properties and function of the mucosa.
Sphenopalatine and Anterior Ethmoidal Artery Ligation for Severe Epistaxis
Authors: Asanau Alexander , Timoshenko Andrei P. , Vercherin Paul , Martin Christian , Prades Jean-Michel 
Published: October 2014

Objectives: We describe the surgical treatment of severe epistaxis and evaluate the recurrence of bleeding in a nonrandomized retrospective trial. Methods: We performed a retrospective study comparing bilateral endoscopic ligation of the sphenopalatine artery alone (ELSPA) and bilateral endoscopic ligation of the sphenopalatine artery with concomitant bilateral external ligation of the anterior ethmoidal artery (ELSPEA) in the management of persistent epistaxis. Clinical and hematologic information, preoperative and surgical care, and short- and long-term outcomes were analyzed. The main outcome measure was recurrence of epistaxis in the short- and long-term follow-up periods. Results: Forty-five patients were enrolled in the study. There were 20 patients in group A (ELSPA) and 25 in group B (ELSPEA). Three patients in group A and no patients in group B had long-term (more than 2 weeks after surgery) re-bleeding. The difference between the two groups was not statistically significant (p > 0.05). Conclusions: We conclude that ELSPA and ELSPEA are effective, well-tolerated, reliable procedures if performed by an experienced surgeon. Their failure can be explained by anatomic lateral nasal wall variations and perioperative technical difficulties. They can be appropriate methods to treat severe recurrent epistaxis refractory to repeated nasal packing.
Thyroid Lymphosonography: A Novel Method for Evaluating Lymphatic Drainage
Authors: Curry Joseph M. , Ezzat Waleed H. , Merton Daniel A. , Goldberg Barry B. , Cognetti David M. , Rosen David , Pribitkin Edmund A. 
Published: October 2014

Objectives: We evaluated lymphosonography, or contrast-enhanced, ultrasonography (US)–guided sentinel lymph node (SLN) detection, as a technique for demonstrating the lymphatic drainage of the thyroid gland. Methods: In this prospective animal study, four 50-kg Yorkshire swine underwent transcutaneous injection of a US contrast agent and methylene blue dye into the thyroid gland. Contrast-enhanced US was used to identify draining lymphatic channels and SLNs. Sentinel node biopsy was conducted. Subsequently, bilateral neck and upper mediastinal dissection was carried out. Results: In 3 of 4 cases, a blue dye–positive and US contrast–positive SLN was identified. We identified SLNs in level IV in 2 cases. One case revealed 2 adjacent nodes in the superior mediastinum. In 1 case, a lymphatic channel was identified traveling into the mediastinum, but exposure of the SLN could not be obtained. No residual blue dye–positive or US contrast–positive nodes were identified on subsequent dissection. Conclusions: Lymphosonography of the thyroid gland in a porcine model correlates well with blue dye–guided sentinel node biopsy and is technically feasible, although in some cases access to the SLN may be difficult. This technique could potentially enable a detailed analysis of thyroidal lymphatic drainage if applied to humans.
Clinical and Electrophysiological Characteristics of Larynx in Myasthenia Gravis
Authors: Xu Wen , Han Demin , Hou Lizhen , Hu Rong , Wang Lei 
Published: October 2014

Objectives: We investigated the clinical and electrophysiological characteristics of the larynx in patients with myasthenia gravis (MG). Methods: Thirty-two cases of MG were analyzed. The laryngeal behaviors and characteristics of laryngeal electromyography were evaluated, and voice assessment and repetitive nerve stimulation (RNS) tests were conducted. Results: The initial symptoms of patients were ptosis and/or diplopia in 28, dysphagia and slurred speech in 3, and limb weakness in 1. Only 8 patients had slight hoarseness and vocal fatigue, and 4 patients had positive laryngeal signs. When compared with normal subjects, the patients with MG had worse results on the acoustic analysis of shimmer, their normalized noise energy was greater, and the harmonics-to-noise ratio and maximum phonation time were significantly lower. The RNS findings were positive in 28 patients and negative in 4 patients. The average (±SD) amplitude decrement was 31.9% ± 19.1%. The mean number of involved laryngeal muscles was 2.22 ± 1.35. Cricothyroid muscles were involved in 26 cases, thyroarytenoid muscles were involved in 14 cases, posterior cricoarytenoid muscles were involved in 6 cases, and lateral cricoarytenoid muscles were involved in 2 cases. Conclusions: Although few patients presented with laryngeal symptoms as their initial symptoms, most patients with MG exhibited asymmetry and abnormal findings on laryngeal electromyography. The RNS test for laryngeal muscles is a more sensitive indicator for the diagnosis of MG, especially in the cricothyroid muscle
Impact of Distant Metastasis in Patients with Cervical Lymph Node Metastases from Cancer of an Unknown Primary Site
Authors: Rödel Ralph M. W. , Matthias Christoph , Blomeyer Barbara D. , Wolff Hendrik A. , Jung Klaus , Christiansen Hans 
Published: October 2014

Objectives: Treatment methods for patients with cervical cancer of an unknown primary site (CUP) are still under discussion. The purpose of this retrospective study was to analyze the oncological follow-up of 58 patients treated for cervical CUP. Methods: From 1986 to 2006, 58 patients with cervical CUP were treated at the authors' institution. Treatment consisted of neck dissection alone in 8, irradiation or chemoradiation in 5, combined surgery and radiotherapy in 28, and surgery and radiochemotherapy in 17. Results: The 3-year and 5-year overall survival rates for all patients were 52.9% and 40.9%, respectively. The 3-year and 5-year disease-specific survival rates were 50.9% and 39.7%, respectively. The 3-year and 5-year neck control rates were 73.7% and 67.3%, respectively. Neck dissection followed by radiochemotherapy was associated with the best 3-year and 5-year locoregional control rates. Extracapsular extension was a predictor of survival, but not of neck control. Distant metastases developed in about one third of all patients and were the most frequent cause of tumor-related death in cases of advanced neck disease. Conclusions: Despite the fact that regional control can be achieved in many cases, survival rates may be limited by distant metastasis, especially in patients with advanced neck disease.
Influence of Anxiety and Depression on the Predictive Value of the Reflux Symptom Index
Authors: Oyer Samuel L. , Anderson Lauren C. , Halum Stacey L. 
Published: October 2014

Objectives: Although the Reflux Symptom Index (RSI) is a validated laryngopharyngeal reflux (LPR) outcomes tool, its predictive value for LPR is controversial. Because psychiatric problems may lead to exaggerated patient-perceived symptoms and RSI values, the aim of this study was to determine whether the positive predictive value of the RSI for pH probe–documented LPR is influenced by anxiety and depression. Methods: We reviewed the charts of all patients who underwent pH probe testing for LPR between January 2006 and July 2008 at our institution. The RSI, Reflux Finding Score (RFS), medical history, and pH probe findings were recorded. Patients with anxiety or depression were included in the psychiatric disorder (+PSY) group, and those without anxiety or depression comprised the non–psychiatric disorder (–PSY) group. Predictive values of the RSI for pH probe–documented LPR were determined for each group. Results: We included 51 patients: 30 patients (59%) in the –PSY group and 21 patients (41%) in the +PSY group. The mean RSI of the +PSY group was higher than that of the –PSY group (p < 0.05), but the +PSY patients actually had a lower incidence of abnormal probe studies (p < 0.02). The positive predictive value of an elevated RSI for an abnormal pH probe study was poor in the +PSY patients (p = 0.495), but strong in the –PSY group (p = 0.004). Conclusions: The presence of anxiety and depression impairs the predictive value of the RSI for LPR. This finding potentially explains some of the controversy over the diagnostic utility of the RSI.
Safety of Ethmoid Sinus Drug-Eluting Catheter Insertion
Authors: Melroy Christopher T. , Kuhn Frederick A. 
Published: October 2014

Objectives: We sought to evaluate an instrument that allows a drug-eluting catheter to be inserted into the ethmoid sinuses and to demonstrate its safety and reproducibility in a cadaver model. Methods: A drug-eluting catheter was placed into 12 cadaveric anterior and posterior ethmoid sinuses by use of a trocar-based insertion device. The device's position was analyzed with computed tomographic scans, and postprocedural dissection was performed. Results: The drug-eluting catheter system was successfully inserted in all ethmoid sinuses without injury to the medial orbital wall, skull base, or sphenoid face. The final position of the distal tip of the catheter averaged 8.1 mm (root mean square [RMS], 3.3 mm) from the skull base, 5.6 mm (RMS, 3.5 mm) from the sphenoid face, and 5.0 mm (RMS, 3.5 mm) from the lamina papyracea; the proximal tip was at the face of the ethmoid bulla and 17.1 mm (RMS, 3.5 mm) below the skull base. Conclusions: A trocar-based instrument can relatively safely and reproducibly introduce a drug-eluting catheter into the ethmoid sinuses without injuring the skull base, lamina papyracea, or sphenoid face. This device may allow safe topical drug delivery into the ethmoid sinuses and serve as a vehicle to treat chronic ethmoid sinusitis with direct and sustained topical therapy.
Effect of Peroxisome Proliferator—Activated Receptor Gamma Agonists on Myofibroblast Differentiation and Collagen Production in Nasal Polyp—Derived Fibroblasts
Authors: Lee Heung-Man , Kang Hee Jun , Park Hyo Hun , Hong Seok-Chan , Kim Jin-Kook , Cho Jae Hoon 
Published: October 2014

Objectives: We investigated the effect of transforming growth factor-β1 (TGF-β1) on the differentiation of nasal polyp–derived fibroblasts (NPDFs) and on their production of collagen, and investigated the effect of peroxisome proliferator-activated receptor γ (PPARγ) agonists on the effects of TGF-β1. Methods: Primary fibroblast lines were established from 5 human nasal polyp tissues. We activated the NPDFs with TGF-β1 and exposed them to the PPARγ agonists ciglitazone and 15-deoxy-A-prostaglandin J2. The expression of α-smooth muscle actin (α-SMA) and collagen was measured by reverse transcriptase–polymerase chain reactions, immunocytochemical staining, and collagen assays. Results: The treatment with TGF-β1 increased the expression of α-SMA and collagen, and expression was markedly attenuated by the PPARγ agonists. Conclusions: PPARγ agonists inhibit the differentiation of TGF-β1–activated NPDFs and their production of collagen.
Fusion as an Evolutionary Principle of the Vertebrate Labyrinth
Authors: Gacek Richard R. 
Published: October 2014

Objectives: This study was undertaken to demonstrate changes in the innervation of vestibular and auditory sense organs with the evolutionary ascent of the vertebrate labyrinth. Methods: Dissected labyrinths and their nerve supply prepared by the Sudan black B technique of Rasmussen were examined and photographed with a Canon A100 camera interfaced with a Zeiss operating microscope. Results: In lizards and alligators, the utricular sense organ is represented by 2 small maculae, each with a separate nerve branching off the ampullary nerves to the anterior and lateral canal cristae. These 2 maculae fuse into a bilobed macula with ascent in frogs and pigeons, eventually becoming a single large macula with its nerve supply from the superior vestibular division in guinea pigs, cats, lions, monkeys, and humans. Along with these changes, there is a fusion of the lateral and anterior canal ampullary nerves and of the bifurcating branches of the vertical canal ampullary nerves. The saccular macula is single, but receives a dual innervation from the superior division (anterior ramus) and the inferior division (posterior ramus) of the eighth nerve in alligators, pigeons, guinea pigs, cats, lions, monkeys, and humans. The main innervation is usually from the inferior division; however, saccular innervation is from the inferior division in lizards and from the superior division in frogs. The auditory sense organ is represented by a curved tube with a low-frequency receptor (lagena) at its distal end in lizards, alligators, and pigeons. In mammals, in which there is a coiled cochlea with a variable number of turns, low frequencies are recorded at the apical turn. This configuration may represent fusion of the lagena into the apical end of the auditory sense organ. Conclusions: Fusion of sense organs and of their nerve supply appears to be an evolutionary principle in the vertebrate labyrinth.
Study of Vestibular Evoked Myogenic Potentials in Patients Affected by Meniere's Disease Treated with Endolymphatic Mastoid Shunt
Authors: Salvinelli Fabrizio , Miele Angela , Rinaldi Vittorio , Pappacena Marco , Trivelli Maurizio 
Published: October 2014

Objectives: We recorded and compared the vestibular evoked myogenic potentials (VEMPs) before use of an endolymphatic mastoid shunt (EMS) and 1, 12, and 48 months after placement of the shunt. Methods: Air-conducted VEMPs were recorded in 28 patients affected by intractable Meniere's disease and treated with placement of an EMS. Results: One month and 12 months after the surgery, VEMPs were not detectable in the operated ear in 100% and 86% of the patients, respectively. Forty-eight months after the surgery, they were elicited in 79% of the patients. Conclusions: We conclude that VEMPs are a clinically useful tool in the postoperative follow-up of patients with an EMS.
Endoscopic Balloon Dilation Sinuplasty Including Ethmoidal Air Cells in Chronic Rhinosinusitis
Authors: Kutluhan Ahmet , Bozdemir Kazim , Çetin Hüseyin , Yalçiner Gökhan , Şalviz Mehti , Sari Neslihan , Deǧer Hasan Mervan , Bilgen Akif Sinan 
Published: October 2014

Objectives: We present the results of our experience with balloon catheter sinusotomy (BCS) in patients who had chronic rhinosinusitis. Methods: The medical records of 30 patients who were treated for chronic sinusitis with the BCS technique between April 2007 and February 2008 were reviewed retrospectively. Preoperative and postoperative assessments were performed by endoscopic endonasal examination and Lund-Mackay radiologic staging of paranasal sinus computed tomography scans. The symptom scoring was performed with the Sino-Nasal Outcome Test–20 (SNOT-20). The postoperative follow-up period was at least 12 months. Results: We performed BCS in 151 sinuses, excluding 2 maxillary and 2 frontal sinuses. No major complication attributable to BCS was observed. After operation, suctioning and crust removal was not needed in the area operated on in BCS patients. Revision surgery was needed in 2 patients after 6 months. From before to after operation, the SNOT-20 values and Lund-Mackay scores decreased significantly. Conclusions: We conclude that BCS helps to dilate the sinus ostia properly and effectively in the management of chronic rhinosinusitis. It can also be performed in the ethmoidal air cell area.