bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper Mediastinal Node Dissection for Hypopharyngeal and Cervical Esophageal Carcinomas
Authors: Hirano Shigeru , Nagahara Kunihiko , Moritani Sueyoshi , Kitamura Morimasa , Takagita Shin-Ichi 
Published: October 2014

Objectives: Hypopharyngeal cancer (HPC) and cervical esophageal cancer (Ce) are aggressive tumors with a poor prognosis. Multiple lymph node metastases often occur in the upper mediastinum, as well as in the neck, and thus upper mediastinal dissection (MD) is crucial to improving the cure rate. However, excessive MD can increase postoperative morbidity and mortality, making it important to employ the proper technique and appropriate extent of dissection. In the present retrospective study we aimed to determine the proper extent of upper MD according to tumor site and stage. The benefit and risk of upper MD are also discussed. Methods: Chart review was completed for patients who underwent upper MD, including 64 patients with HPC, 21 patients with Ce, and 9 patients with Ce extending to involve the upper thoracic esophagus (Ce/Ut). The incidence and distribution of lymph node metastases in the upper mediastinum were assessed by postoperative histopathologic examination. Postoperative complications of upper MD, as well as the impact on survival and locoregional control, were also reviewed. Results: Upper mediastinal metastases were detected in 7.8% of HPC patients, 33.3% of Ce patients, and 55.6% of Ce/Ut patients. In HPC patients, mediastinal metastases were usually associated with T4 primary tumors (80%), whereas positive nodes in the upper mediastinum were detected regardless of T stage in both Ce and Ce/Ut. Only 1 Ce/Ut patient with a T4 tumor developed late nodal metastasis in the lower mediastinum. The 5-year disease-specific survival and locoregional control rates were 58.6% and 90.2% in HPC, 45.5% and 94.1% in Ce, and 38.9% and 77.7% in Ce/Ut, respectively. Rupture of the greater vessels after MD was observed in 5 cases (5.3%). Conclusions: The present results indicate excellent locoregional control rates following upper MD, while major complications such as arterial breakdown were rare. It is suggested that upper MD may be an essential and adequate procedure for patients with Ce or Ce/Ut tumors, and may also be required for cases of HPC with a T4 primary to improve locoregional control of the disease.
Laryngoscopies in the Obese: Predicting Problems and Optimizing Visualization
Authors: Hekiert Adrianna M. , Mandel Jeff , Mirza Natasha 
Published: October 2014

Objectives: This pilot study was designed to 1) identify predictors of difficult laryngeal exposure in obese patients, 2) develop strategies for efficient intubation and intraoperative visualization of the glottis, and 3) devise perioperative protocols for difficult laryngoscopies. Methods: We undertook a retrospective study over a 1-year period of 14 consecutive patients with a body mass index of more than 30 kg/m2 who underwent elective direct laryngoscopy under general anesthesia. Measurements of height, weight, neck circumference, Mallampati score, and Cormack-Lehane classification of the airway were recorded. Problems encountered during anesthesia induction and emergence were also noted. The laryngologist recorded on a visual analog scale the degree of difficulty encountered in obtaining a binocular stereoscopic view and magnification, illumination, and suspension. Results: Anatomic challenges during difficult laryngoscopy included decreased neck extension, redundant folds of tissue in the oropharynx and hypopharynx, and upper airway collapsibility. Overall, there was an association between the incidence of difficult laryngeal exposure and the Cormack-Lehane score (r = .57; p = .03), but the Mallampati score was of limited utility to the laryngologist. Neck size in female patients correlated with the Cormack-Lehane score (p = .02). Neither weight nor body mass index were predictive of a difficult laryngeal exposure. Straight blade laryngoscopes with a distal flange allowed greater depth of insertion and provided the best visualization of the glottis. Conclusions: An appropriate clinical examination may help predict a difficult airway. However, further studies are warranted to fully characterize the anatomic predictors of a difficult laryngeal exposure.
Phenotype Description of a Novel DFNA9/COCH Mutation, I109T
Authors: Pauw Robert J. , Huygen Patrick L. M. , Collin Rob W. J. , Cruysberg Johannes R. M. , Hoefsloot Lies H. , Kremer Hannie , Cremers W. R. J. 
Published: October 2014

Objectives: This is a report of the audiological and vestibular characteristics of a Dutch DFNA9 family with a novel mutation, I109T, in the LCCL domain of COCH. Methods: From the family with the novel I109T COCH mutation, audiometric data were collected and analyzed longitudinally. Results were compared to those obtained in previously identified P51S, G88E, and G87W COCH mutation carriers. Special attention was also given to a comparison of age-related features such as progressive hearing loss and vestibular impairment. Results: A novel mutation (I109T) in COCH segregates with hearing impairment and vestibular dysfunction in the present family. Pure tone thresholds, phoneme recognition scores, and vestibular responses of the I109T mutation carriers were essentially similar to those previously established in P51S, G87W, and G88E mutation carriers. Deterioration of hearing in the I109T mutation carriers started at 43 years of age, and vestibular function deteriorated at least 7 years later. Conclusions: The phenotype associated with the novel COCH (I109T) mutation is largely similar to that associated with P51S and G88E mutation carriers. However, subtle differences in terms of onset age and rate of progression seem to exist.
Comparative Neuromuscular Histopathology of Cricopharyngeal Achalasia Patients with and without Previous Botulinum Toxin Treatment
Authors: Merati Albert L. , Tseng Jeffrey , Blumin Joel H. , Toohill Robert J. , Jaradeh Safwan 
Published: October 2014

Objectives: Botulinum toxin injection (BTX) and cricopharyngeal (CP) myotomy are performed in the treatment of CP achalasia (CA). The objective of this study was to examine the effects of BTX on neuromuscular histopathologic findings and to make direct comparisons between specimens of muscle from CA patients who had received BTX to the upper esophageal sphincter and from CA patients who had no previous exposure to BTX. Methods: We performed a retrospective review (2001 to 2005) of CP muscle specimens from all patients who underwent myotomy for CA. Cases of Zenker's diverticulum were excluded. Patient demographics, clinical course, and neuromuscular pathology findings were noted from the chart. Results: Nineteen patients with CA were identified: 10 male and 9 female, with a mean age of 57 years. Eleven had no prior BTX (6 male and 5 female; mean age, 62 years); 8 had previous treatment with BTX (4 male and 4 female; mean age, 51 years). Eight of the 11 BTX-naive patients revealed predominantly myopathic changes on histology. Those with previous BTX tended to be younger; 6 of the 8 had a clinical benefit from their BTX and ultimately went on to myotomy. The CP muscle specimens featured both mixed and neurogenic pathologic changes in 5 of the 8 patients with BTX. Although these findings suggest some impact of BTX on the CP muscle, the difference between the groups was not statistically significant (p < 20, x2 test). Conclusions: Treatment with BTX may have some clinical and histopathologic impact on the upper esophageal sphincter of patients with CA. Although neuropathic changes were noted in the CP muscle of previously injected patients at the time of their CP myotomy, the neuromuscular pathologic findings overall were not significantly different from those of BTX-naive patients.
Microbiology of Acute Sinusitis of Odontogenic Origin Presenting with Periorbital Cellulitis in Children
Authors: Brook Itzhak 
Published: October 2014

Objectives: This study was undertaken to evaluate the aerobic and anaerobic microbiology of acute maxillary sinusitis of odontogenic origin presenting with periodontal infection in children. Methods: Aspirates of 18 acutely infected maxillary sinuses that were associated with odontogenic infection in children who presented with periorbital cellulitis were processed for aerobic and anaerobic bacteria. Results: A total of 54 isolates were recovered (3.0 per specimen): 13 aerobic and facultative (0.7 per specimen) and 41 anaerobic (2.3 per specimen). The number of isolates per specimen varied from 1 to 4. Aerobic and facultative organisms alone were recovered in 2 specimens (11%), anaerobes only in 7 (39%), and mixed aerobic and anaerobic bacteria in 9 (50%). The predominant aerobic and facultative organisms were α-hemolytic streptococci (4), microaerophilic streptococci (3), and Streptococcus pyogenes and Staphylococcus aureus (2 each). The predominant anaerobic bacteria were anaerobic gram-negative bacilli (17), Peptostreptococcus spp (11), Fusobacterium spp (8), and Propionibacterium acnes (2). Twelve β-lactamase-producing bacteria were recovered from 9 specimens (50%). Conclusions: This study demonstrates the unique aerobic and anaerobic microbiological features of acute maxillary sinusitis of odontogenic origin presenting with periorbital cellulitis in children.
Reliability of the Pharyngeal Squeeze Maneuver
Authors: Rodriguez Kimsey H. , Roth Carole R. , Rees Catherine J. , Belafsky Peter C. 
Published: October 2014

Objectives: Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the integrity of laryngopharyngeal sensory and motor components. The pharyngeal squeeze is a maneuver used during fiberoptic endoscopic evaluation of swallowing with sensory testing to assess pharyngeal motor function. Although the pharyngeal squeeze manuever has been used in numerous scientific publications, its reliability has not been critically evaluated. Therefore, we sought to evaluate the reliability of the pharyngeal squeeze maneuver. Methods: Forty individuals who were undergoing fiberoptic laryngoscopy for various reasons were instructed to perform the pharyngeal squeeze maneuver. Three different clinicians reviewed the videotape on 4 separate occasions. The clinicians were first asked to rate each side of the pharynx as normal, diminished, or absent. They were then instructed to simply rate the maneuver as normal or abnormal. The interobserver and intraobserver reliability of the pharyngeal squeeze maneuver were assessed with the kappa coefficient. Results: The mean age of the cohort was 58 years. Fifty-eight percent (23 of 40) were male. When the clinicians were instructed to rate each side of the pharynx as normal, diminished, or absent, the interobserver and intraobserver reliabilities were poor (63% to 68% agreement; kappa = 0.18 to 0.67). When the clinicians were asked to rate the pharyngeal squeeze maneuver as normal or abnormal, both interobserver and intraobserver reliabilities were excellent (85% to 98% agreement; kappa = 0.75 to 0.95). Conclusions: The pharyngeal squeeze maneuver displayed poor reliability when motor function was classified into unilateral or bilateral normal, diminished, and absent categories. The pharyngeal squeeze maneuver was very reliable when simply graded as normal or abnormal. Clinicians could not reliably distinguish between diminished and absent pharyngeal motor functions.
Creation and Validation of the Singing Voice Handicap Index
Authors: Cohen Seth M. , Jacobson Barbara H. , Garrett C. Gaelyn , Noordzij J. Pieter , Stewart Michael G. , Attia Albert , Ossoff Robert H. , Cleveland Thomas F. 
Published: October 2014

Objectives: We developed and validated a disorder-specific health status instrument (Singing Voice Handicap Index; SVHI) for use in patients with singing problems. Methods: Prospective instrument validation was performed. Of 81 original items, those with poor statistical validity were eliminated, resulting in 36 items. The ability to discriminate dysphonic from normal singers, test-retest reliability, internal consistency, and construct validity were assessed. Results: We included 112 dysphonic and 129 normal singers, professional and nonprofessional, of classical, country, rock, choral, and gospel repertoire. Dysphonic singers had worse SVHI scores than normal singers (p ≤ .001, rank sum test). Test-retest reliability was high (Spearman correlation, 0.92; p ≤ .001). Internal consistency demonstrated a Cronbach's α of 97, and the correlation between the SVHI and self-rated singing voice impairment was .63 (p ≤ .001, Spearman correlation). Conclusions: The SVHI is a reliable and valid tool for assessing self-perceived handicap associated with singing problems.
Bilateral Sudden Profound Hearing Loss and Vertigo as a Unique Manifestation of Bilateral Symmetric Inferior Pontine Infarctions
Authors: Bovo Roberto , Ortore Rocco , Ciorba Andrea , Berto Anna , Martini Alessandro 
Published: October 2014

Objectives: We present a case of sudden bilateral profound deafness and vertigo, without any accompanying neurologic signs, secondary to bilateral infarctions of the cochlear and vestibular nuclei. Methods: Vertigo, vomiting, tinnitus, and bilateral profound deafness suddenly developed in a 65-year-old woman without any accompanying neurologic signs. In particular, she did not present dysarthria, numbness, cranial nerve palsies, or visual or cerebellar signs. Results: Magnetic resonance imaging of the brain revealed 2 fresh infarctions of 8 to 10 mm symmetrically localized in the posterolateral bulbopontine junction. Angiography revealed a complete occlusion of the basilar artery, with a well-represented backward flow of its distal portion from the carotid artery via posterior communicating arteries. Excluding a transient ischemic attack that occurred 16 days after the acute episode, the patient had had no other neurologic events at 8 months of follow-up. Conclusions: Acute vertigo and sudden deafness in a patient with known cerebrovascular occlusive disease may represent the warning signs of an impending brain stem or cerebellar infarction, even when other neurologic signs are absent. These events are fortunately very rare, but should be considered by clinicians who see patients with vertigo.
Liposarcoma of the Larynx
Authors: Powitzky Rosser , Powitzky Eric S. , Garcia Rafael 
Published: October 2014

Objectives: The objective was to review the presentation, diagnosis, treatment, and prognosis of patients with laryngeal liposarcoma (LLS). A case is reported, and a retrospective review of the English-language literature is presented. Methods: All published cases of LLS with adequate histopathologic documentation and clinical information were included for review. Results: Thirty cases of LLS have been reported. A majority of these patients are men between 40 and 70 years of age. The most common location of the tumor is the supraglottis, and the presenting complaints are similar to those of other laryngeal neoplasms. Although these neoplasms recur often and can cause significant morbidity, they are typically of low grade and rarely metastasize. The outcomes of this disease are generally good when it is treated with wide surgical excision. Conclusions: Cases of LLS are extremely rare. Because the histologic changes are frequently subtle, LLS can be easily mistaken for a benign tumor. As a result, the diagnosis requires a high index of suspicion and diligence in examining biopsy specimens. Computed tomography and magnetic resonance imaging can assist in the diagnosis and surgical approach. Genetic and immunostaining analysis techniques may also prove to have valuable prognostic, diagnostic, and therapeutic implications for this disease. Wide surgical excision is the mainstay of treatment. The use of radiotherapy and chemotherapy in treating this cancer remains experimental, but might be considered on a case-to-case basis for palliation or to treat aggressive variants of the disease.
Role of Vascular Endothelial Growth Factor a in Children with Acquired Airway Stenosis
Authors: Rahbar Reza , Brown Lawrence F. , Folkman Judah , McGill Trevor J. , Healy Gerald B. , Liu Guanmei , Vargas Sara O. 
Published: October 2014

Objectives: Vascular endothelial growth factor A (VEGF-A) is important in the angiogenic response for wound healing. This study investigated whether VEGF-A may play a role in the pathogenesis of acquired airway stenosis. Methods: Eight lesions from 5 pediatric patients with subglottic stenosis after airway reconstruction (N = 4) or prolonged intubation (N = 1) and normal laryngeal tissue from 5 autopsy patients were included. Formalin-fixed sections of subglottic tissue from each patient were examined by in situ hybridization for the presence of messenger RNA (mRNA) for VEGF-A, vascular endothelial growth factor receptor 1 (VEGFR-1), and vascular endothelial growth factor receptor 2 (VEGFR-2). Results: Strong expression of VEGF-A mRNA was noted in hyperplastic squamous epithelium overlying granulation tissue. Strong expression of VEGFR-1 and VEGFR-2 was noted in the endothelial cells within granulation tissue. No strong labeling of VEGF-A mRNA or its receptors was noted in 2 specimens with mature scar tissue or in the control specimens. Conclusions: The angiogenic growth factor VEGF-A is strongly expressed in hyperplastic epithelium overlying granulation tissue in airway stenosis. Also, VEGFR-1 and VEGFR-2 mRNAs are strongly expressed in the endothelial cells of granulation tissue. This finding suggests an important role of VEGF-A in the pathogenesis of airway scar formation and stenosis.
Upper Displacement of the Anterior Commissure: Experimental Study of a New Phonosurgical Approach to Raising Vocal Pitch
Authors: Chung Daniel , Tsuji Domingos Hiroshi , Sennes Luiz Ubirajara , Imamura Rui 
Published: October 2014

Objectives: The present study assessed the effects of a unique pitch-raising surgical technique designated upper displacement of the anterior commissure (UDAC), comparing the results with those obtained through cricothyroid approximation (CTA). Methods: Vocal fold vibration was artificially evoked in 20 excised human larynges through tracheal injection of compressed air. Vocal fold length, fundamental frequency, and videokymography parameters were determined preoperatively, post-CTA, and post-UDAC. In UDAC, a bilateral incision was made between the middle and anterior thirds of the thyroid cartilage. The inferiormost portion of the anterior thyroid cartilage (anterior to the cartilaginous incision) was sutured to the superiormost portion of the posterior thyroid cartilage (posterior to the cartilaginous incision). The anterior commissure was thus moved upward and forward, ensuring increased vocal fold tension. Results: The mean vocal fold length was 16.88 mm preoperatively, 20.02 mm post-CTA, and 18.67 mm post-UDAC (p < .05). The mean fundamental frequency was 151.60 Hz preoperatively, 271.10 Hz post-CTA, and 239.30 Hz post-UDAC (p < .05). The post-CTA and post-UDAC vibration amplitudes were significantly lower than the preoperative values (p < .05). Conclusions: Vocal fold length and fundamental frequency increased significantly after UDAC (p < .05), although to a lesser degree than after CTA.
Association of Anxiety and Depression with Reported Disease Severity in Patients Undergoing Evaluation for Chronic Rhinosinusitis
Authors: Wasan Ajay , Fernandez Ephrem , Jamison Robert N. , Bhattacharyya Neil 
Published: October 2014

Objectives: We sought to determine the impact of psychiatric comorbidity on symptom density and resource utilization in chronic rhinosinusitis (CRS). Methods: A prospective cohort of patients who sought evaluation of CRS was studied with the Rhinosinusitis Symptom Inventory and the Hospital Anxiety and Depression Scale. Data concerning symptom scores, symptom domains, and psychiatric comorbidity were analyzed to determine the interactions among psychiatric comorbidity, symptom reporting, and resource utilization in CRS. Results: We studied 143 patients (mean age, 43.4 years). Low, moderate, and high levels of anxiety were reported by 48.3%, 25.9%, and 25.9% of patients, respectively. Low, moderate, and high levels of depression were reported by 76.2%, 9.1%, and 14.7%. For the combined psychopathology group, 43.3%, 25.9%, and 30% had low, moderate, and high levels. Patients with high anxiety levels reported significant elevations of oropharyngeal symptoms (p = .013) and total symptoms (p = .030) in comparison with the low group. Patients with high depression levels reported higher oropharyngeal (p = .003), systemic (p = .001), and total symptom (p = .003) scores than did the low group. High combined psychopathology scores were associated with elevated facial, oropharyngeal, and systemic scores (p < .05). Regarding medical utilization, high anxiety levels or high combined psychopathology scores were associated with more frequent physician visits (p < .05). A high level of depression was associated with increased antibiotic use, missed workdays, and physician visits (p < .05). Conclusions: High levels of anxiety and depression are common in patients who undergo evaluation for CRS. Psychiatric comorbidity is associated with increased symptoms in CRS and increased health-care utilization. Anxiety and depression should be identified in these patients to structure appropriate treatment.
Effects of Cochlear Implantation on Gustatory Function
Authors: Mueller Christian A. , Khatib Saher , Temmel Andreas F. P. , Baumgartner Wolf-Dieter , Hummel Thomas 
Published: October 2014

Objectives: Because of the anatomic position of the chorda tympani in the tympanic cavity, the nerve is at risk during cochlear implantation. The aim of this study was to assess changes in taste sensitivity and in self-ratings of gustatory function after surgery. Methods: Twenty-four patients (mean age, 54 years) who underwent cochlear implantation were investigated. Taste function was tested with a validated test for regional quantitative assessment of sweet, sour, salty, and bitter tastes on each side of the tongue before and 4 days after surgery. Results: The mean taste score was 10.0 (SD, 4.0) before and 8.0 (SD, 4.1) after surgery on the side of the tongue ipsilateral to the operated ear (p = .004). However, only 1 patient reported subjective taste loss due to surgery. Taste testing of the side of the tongue contralateral to the operated ear yielded a score of 10.0 (SD, 4.1) before and 10.9 (SD, 4.5) after surgery (p = .037). Self-ratings of gustatory function did not change significantly as a consequence of the procedure. Conclusions: Our results indicate that cochlear implantation is a relatively safe procedure regarding taste function. Preoperative testing of gustatory function is recommended, at least in those patients who already have undergone operation on the contralateral ear.
Sphenoid Sinus Fungal Balls
Authors: Bowman James , Panizza Benedict , Gandhi Mitesh 
Published: October 2014

Objectives: We sought to examine the nature of fungal balls of the sphenoid sinus, in particular the exposure of adjacent skull base structures and the potential for surgical morbidity. Methods: We retrospectively reviewed our series of 17 cases of sphenoid sinus fungal balls seen between 1998 and 2005 with reference to their diagnosis, radiologic changes, histopathology, and surgical management. Results: Exposed structures included the pituitary fossa, cavernous sinus, and cavernous internal carotid artery, but this exposure did not result in an increase in perioperative complications. Sclerotic thickening of the sinus walls persisted, probably representing a chronic osteitis in response to concurrent bacterial infection. This appeared to be protective against further sinus wall erosions. Wall erosions did not heal. One patient demonstrated what appeared to be invasive fungal disease from a fungal ball. Conclusions: Sphenoid sinus fungal balls can occur with minimal symptoms in a mainly elderly population and require surgical removal. Sphenoid sinus fungal balls have a low rate of operative morbidity and should be effectively managed by transnasal endoscopic sphenoidotomy alone.