bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-Guided Needle Localization of Recurrent Paratracheal Thyroid Cancer
Authors: Fletcher Aaron M. , Preston Todd W. , Kuehn David M. , Clark Eve D. , Van Daele Douglas , Hoffman Henry 
Published: October 2014

Objectives: Ultrasound-guided needle localization techniques have been used to direct the resection of targeted axillary lymph nodes in the management of breast cancer. To date, there has been only one other description of this technique as a localization method to direct cancer resection in the neck. We offer further support for the broader application of this technique by reporting its use in the successful identification and resection of recurrent papillary thyroid cancer after a paratracheal node dissection failed to localize the cancer. Methods: We report a case and discuss the relevant literature regarding ultrasound-guided localization and resection of recurrent well-differentiated thyroid cancer. Results: We were able to achieve successful identification and resection of recurrent papillary thyroid cancer using this technique. Conclusions: This technique may be useful in the treatment of selected cases of recurrent thyroid cancer to increase the efficacy and safety of surgical resection.
Use of Nasal Septal Bone to Straighten Deviated Septal Cartilage in Correction of Deviated Nose
Authors: Jang Yong Ju , Kim Jun Mo , Yeo Nam-Kyung , Yoo Ji Hoon 
Published: October 2014

Objectives: Septoplasty for correction of deviated nose often requires removal of the deviated part of the quadrangular cartilage and the perpendicular plate of the ethmoid bone or vomer. In most cases, the removed bone is discarded. We describe our experience using septal bone for deviated nose correction, and analyze the postoperative results. Methods: A retrospective study was performed on 23 patients who underwent correction of deviated nose using nasal septal bone to straighten deviated septal cartilage from January 2004 to August 2008. The subjective satisfaction of patients was evaluated 6 to 12 months after rhinoplasty with a questionnaire. Aesthetic outcomes were evaluated by 2 independent rhinoplastic surgeons who compared preoperative and postoperative photographs. To evaluate outcomes objectively, we made anthropometric measurements of the deviated nose before and after surgery using facial photographs. Results: All patients indicated cosmetic satisfaction and improvement in nasal obstruction. The outcome analysis by 2 independent rhinoplastic surgeons indicated that 13 patients had excellent, 5 patients had good, and 5 had fair outcomes. Anthropometric measurements of the deviated nose showed that both the curved deviated angles and the linear deviated angle had improved (p < 0.05). Conclusions: Use of nasal septal bone to straighten deviated septal cartilage appears to be feasible in corrective rhinoplasty, and may be particularly beneficial in cartilage-depleted patients.
The Changing Face of Paranasal Sinus Fungus Balls
Authors: Robey Ashley B. , O'Brien Erin K. , Richardson Brynn E. , Baker John J. , Poage David P. , Leopold Donald A. 
Published: October 2014

Objectives: We describe the clinical, radiographic, and histopathologic characteristics of fungus balls. Methods: We performed a retrospective review of 24 consecutive patients with the diagnosis of a paranasal sinus fungus ball (mycetoma) from 2001 to 2008. Results: We found that 18 of the 24 primarily involved sinuses had bony thickening, and 13 of the 24 had notable dilatation of the ostium. Eleven of the 24 patients were found to have some degree of immunocompromise (from organ transplantation, diabetes, etc). The patient's immune status correlated with the type of fungus involved. (Mucor-like fungi were more common in immunocompetent patients, and aspergillus-like fungi were more common in immunocompromised patients.) Also, there was a predilection for immunocompetent patients to have dilatated ostia, whereas immunocompromised patients were more likely to have a nondilatated ostium (p = 0.019). Conclusions: Our series of paranasal sinus fungus balls defines a group of patients heretofore poorly described in the literature. Our data reveal an increased incidence in immunocompromised patients. We also found consistent radiographic patterns, correlations between immune status and the fungal pathogen, correlations between ostial enlargement and immune status, and the presence of cranial nerve pareses. These represent new findings that merit further study.
Bone-Anchored Hearing Aid Surgery in Older Adults: Implant Loss and Skin Reactions
Authors: de Wolf Maarten J. F. , Hol Myrthe K. S. , Mylanus Emmanuel A. M. , Cremers W. R. J. 
Published: October 2014

Objectives: We evaluated the clinical outcome measures of fixture loss and skin reactions in older-adult users of percutaneous bone-anchored hearing aids (BAHAs). Methods: We performed a retrospective analysis of 224 older adults (at least 60 years of age) who underwent implantation of 248 implants with the simplified Nijmegen surgical technique between January 1995 and May 2007. Results: During a mean follow-up of 39 months (range, 0 to 144 months), 16 of the 248 implants were lost (6.5%). The causes were failed osseointegration in 9 cases, trauma in 6 cases, and implant loss in irradiated bone in 1 case. There were no losses due to infection. Implant loss was not significantly correlated with age. In 40 implants (16.9%), severe skin reactions of Holgers grade 2 or more were observed. Skin revision surgery was performed around 6 implants (2.4%). None of the patients had an 8.5-mm abutment to overcome severe skin reactions. Conclusions: The outcome of BAHA surgery in older adults was favorable. The rate of implant loss was comparable with that in the overall population of BAHA recipients. There were low risks of severe skin reactions or developing thick skin around the implant.
Prostaglandin E2 Receptor EP2, EP3, and EP4 Agonists Inhibit Antigen-Induced Mucus Hypersecretion in the Nasal Epithelium of Sensitized Rats
Authors: Hattori Reiko , Shimizu Shino , Majima Yuichi , Shimizu Takeshi 
Published: October 2014

Objectives: Prostaglandin (PG) E2 is a potential anti-inflammatory mediator that attenuates airway inflammation. To elucidate the functions of the PGE2 receptors (EP1, EP2, EP3, and EP4) in allergic inflammation, we examined the in vivo effects of EP agonists on mucus hypersecretion and eosinophil infiltration in rat nasal epithelium. Methods: We induced hypertrophic and metaplastic changes in goblet cells in nasal epithelium of ovalbumin-sensitized rats by intranasal challenge with ovalbumin. The effects of subcutaneous injections of EP agonists on mucus production and eosinophil infiltration were examined. Results: The EP4 agonist (1 to 100 μg/kg) dose-dependently inhibited ovalbumin-induced mucus production. The EP2 and EP3 agonists (100 μg/kg) also significantly inhibited mucus production. The EP3 agonist inhibited antigen-induced eosinophil infiltration, whereas the EP1 agonist showed no effect. This suppression of mucus production by the EP4 agonist was only effective when the EP4 agonist was given in the effector phase; administration in the induction phase resulted in no effect. Conclusions: These results indicate that PGE2 acts as an anti-inflammatory mediator via the EP receptors of airways in allergic inflammation. Selective EP agonists may provide a new therapeutic strategy for airway mucus hypersecretion.
Monitored Anesthesia Care with Target-Controlled Infusion in Vibroplasty
Authors: Canale Andrea , Lacilla Michelangelo , Perotti Marco , Pallavicino Fabrizia , De Siena Luigi , Albera Roberto 
Published: October 2014

Objectives: Correct positioning of a floating mass transducer during middle ear implant surgery is often problematic. With the use of monitored anesthesia care (MAC), however, deep sedation is maintained during surgery, followed by conscious sedation in which the patient can respond to test questions that investigate correct device position and function. The main aim of this study was to determine whether intraoperative audiometric assessment was feasible with MAC with target-controlled infusion in vibroplasty. An additional aim was to determine whether MAC was sufficiently comfortable for patients during the procedure. Methods: The study group comprised 8 patients who underwent vibroplasty under sedation. Before suturing, audiometric assessment was done by stimulating the external auditory processor with pure tones at 0.5, 1, 2, and 4 kHz. Blood pressure, arterial oxygen saturation level, heart rate, and end tidal carbon dioxide level were monitored during the procedure and at awakening. Results: Audiometric assessment was successfully completed in all 8 patients. The selected parameters indicated that no patient experienced pain or discomfort during surgery; the absence of discomfort was confirmed 1 to 2 hours after the operation by simple questioning. Conclusions: We found MAC to be an efficient and relatively safe technique for verifying the correct coupling of the floating mass transducer with the middle ear during vibroplasty. The patients were able to respond appropriately to questions and commands; moreover, none reported having experienced pain or discomfort during the operation.
Comparison of Intraoperative Bleeding between Microdebrider Intracapsular Tonsillectomy and Electrocautery Tonsillectomy
Authors: Nguyen Carolyn V. , Parikh Sanjay R. , Bent John P. 
Published: October 2014

Objectives: We sought to assess the quantity of intraoperative bleeding from microdebrider intracapsular tonsillectomy (IT) relative to electrocautery tonsillectomy (ET). Methods: Intraoperative tonsil bleeding was measured prospectively for all children younger than 19 years of age who underwent primary tonsillectomy for recurrent tonsillitis or adenotonsillar hypertrophy at a tertiary care academic children's hospital. We performed IT in 57 patients (33 male, 24 female; mean age, 64.3 months) and ET in 51 patients (20 male, 31 female; mean age, 92.4 months). Results: Microdebrider IT resulted in more intraoperative bleeding than ET (27.9 versus 8.7 mL, p = 0.003; and 1.2 versus 0.2 mL/kg, p < 0.001). The median and maximum blood losses, respectively, were 0.6 and 9.5 mL/kg for IT and 0 and 2.0 mL/kg for ET. Blood loss for ET was not related to whether a resident versus an attending physician was the operating surgeon (p = 0.11). A linear regression model did not demonstrate greater bleeding with recurrent tonsillitis (IT, p = 0.39; ET, p = 0.89) or with increased patient age (IT, p = 0.08; ET, p = 0.62). Conclusions: Microdebrider IT produces more intraoperative bleeding than ET. The difference in blood loss is statistically but not clinically significant. Microdebrider IT causes bleeding within acceptable limits, and thus patients and physicians should not be discouraged from choosing this procedure solely on the basis of the amount of intraoperative blood loss.
Mycobacterium Chelonae Infections Involving the Head and Neck
Authors: Mullin David , Jothi Sumana , Healy David 
Published: October 2014

Objectives: We describe the manifestations, diagnosis, and treatment of rare head and neck infections caused by Mycobacterium chelonae, including a case of maxillary osteitis and skull base osteomyelitis. Methods: A comprehensive literature search (MEDLINE from 1951; BIOSIS from 1969; EMBASE from 1980) was performed for the presentation, diagnostic evaluation, and outcomes of patients with M chelonae infections. Results: We report 4 cases of M chelonae infection, including a nasal abscess following septorhinoplasty with a cartilaginous graft, a case of chronic unilateral nasal obstruction, and the first reported cases of skull base osteomyelitis and maxillary osteitis secondary to M chelonae. All 4 cases involved immunocompetent individuals. Conclusions: Mycobacterium chelonae should be considered in cases of abscesses that persist despite broad-spectrum intravenous antibiotics, and in cases of maxillary sinusitis with bony involvement that do not respond to traditional treatment methods.
Tracheal and Tracheostomal Hypergranulation and Related Stenosis in Long-Term Cannulated Patients: Does the Tracheostomy Procedure Make a Difference?
Authors: Ledl Christian , Mertl-Roetzer Marion 
Published: October 2014

Objectives: Long-term cannulated patients are at risk of developing tracheal and tracheostomal hypergranulation. This study evaluated the incidence of hypergranulation and related tracheal stenosis in long-term cannulated patients. The relation between hypergranulation, specific tracheostomy techniques, and the duration of cannulation was investigated. Methods: A prospective observational study was conducted to analyze tracheostomal and tracheal hypergranulation in long-term cannulated patients. We compared complication rates in 344 postacute patients. Tracheas and tracheostomas were inspected visually and endoscopically at admission and at regular tube changes every 2 weeks until decannulation or discharge. Results: Hypergranulation appeared 3 times as often in the tracheostoma (n = 338) as in the trachea (n = 109). There was no influence of the tracheostomy procedure on the frequency (p = 0.931), location (tracheostoma, p = 0.947; trachea, p = 0.918), or severity (stenoses grade I, p = 0.910; grade II, p = 0.649; grade III, p = 0.304) of the hypergranulation. The main factors to account for hypergranulation were the duration of cannulation (p < 0.001) and age (p = 0.033). Conclusions: There was no influence of tracheostomy techniques on hypergranulation. Its development depends on the duration of cannulation. It is recommended to keep the duration of cannulation as short as possible with respect to the underlying neurologic impairment.
Local Neurotoxins for Prevention of Laryngeal Synkinesis after Recurrent Laryngeal Nerve Injury
Authors: McRae Bryan R. , Kincaid John C. , Illing Elisa A. , Hiatt Kelly K. , Hawkins Jan F. , Halum Stacey L. 
Published: October 2014

Objectives: Persistent vocal fold motion impairment after recurrent laryngeal nerve (RLN) injury is not characteristically due to absent reinnervation, but often results from spontaneous aberrant reinnervation (synkinesis). We administered local neurotoxins to selected laryngeal muscles after RLN injury to determine whether aberrant reinnervation could be selectively inhibited. Methods: Unilateral RLN transection was performed in 24 male rats. Three weeks later, the denervated laryngeal adductor complex was injected with phenol, high- or low-dose vincristine sulfate (VNC), or saline solution. One month later, rat larynges were evaluated via videolaryngoscopy and laryngeal electromyography (LEMG). Larynges from euthanized animals were analyzed via immunofluorescent staining for the presence of reinnervation. Results: One animal that received phenol and 3 animals that received high-dose VNC died of toxicity-related complications. In the surviving neurotoxin-treated animals, videolaryngoscopy showed increased lateralization of the immobile vocal fold. Only 1 phenol-injected rat had adductor complex motor recruitment (score of 3+) with LEMG. The other neurotoxin-treated animals demonstrated an absence of adductor complex reinnervation, with only insertional activity and fibrillations (no motor units/recruitment). Spontaneous ipsilateral abductor reinnervation was not affected by the adductor injections. Conclusions: Low-dose VNC injections appear to be relatively safe and effective in selectively inhibiting spontaneous aberrant reinnervation after RLN injury in an animal model.
Level of Complete Dissection of the Ethmoid Sinuses with a Computed Tomographic Image Guidance System
Authors: Rawlings Brad A. , Han Joseph K. 
Published: October 2014

Objectives: We sought to determine the adequacy of endoscopic total ethmoidectomy with the use of a computed tomographic (CT) image guidance system. Methods: Endoscopic ethmoid sinus dissections were performed on cadavers by otolaryngologists. All cadavers were scanned before dissection. On each side of the cadaver, the ethmoid sinuses were examined independently. A complete endoscopic ethmoidectomy was performed with a CT image guidance system. After the endoscopic ethmoidectomy, the cadaver underwent a postdissection CT scan. The postdissection CT images were then evaluated for the level of complete dissection of the anterior and posterior ethmoid sinuses. Results: There were 18 ethmoid sinuses in the study. One specimen underwent a complete total ethmoidectomy with no residual cells. There were 4 complete anterior ethmoidectomies and 5 complete posterior ethmoidectomies. Overall, the average numbers of residual anterior ethmoid and posterior ethmoid air cells were 1.39 and 1.22, respectively. This difference was not statistically significant. The skull base was dissected more completely than the lamina papyracea, with a significant difference (p = 0.03). There was no difference in terms of residual cells between the left and right ethmoid sinuses (p > 0.05). Conclusions: Even with the use of a CT image guidance system, a complete ethmoidectomy was still difficult to achieve. Residual ethmoid sinus cells were more commonly found along the lamina papyracea than along the skull base.
Functional Results of Reinke's Edema Surgery Using a Microdebrider
Authors: Honda Keigo , Haji Tomoyuki , Maruyama Hagino 
Published: October 2014

Objectives: We evaluated the functional results of Reinke's edema surgery using a microdebrider. Methods: In this prospective nonrandomized study from 2004 through 2008, functional surgery using a microdebrider was performed on patients with severe Reinke's edema. Comparisons were conducted for preoperative and postoperative phonatory function using both subjective grade (G), roughness (R), breathiness (B), asthenia (A), and strain (S) scoring and objective Multi-Dimensional Voice Program parameters. Statistical analysis was done by paired t-test, and a p value of less than 0.05 was considered significant. Results: Seventeen patients were enrolled in this study, with a median age of 56 years and a median observation period of 129 days. The male-to-female ratio was 1 to 2.4. No major complications were observed in the perioperative period. Significant improvement was observed in the subjective values of G, R, B, and S. Improvement was also observed in the fundamental frequency, pitch perturbation quotient, and amplitude perturbation quotient calculated by the Multi-Dimensional Voice Program. Conclusions: The microdebrider is a useful tool in functional surgery for severe Reinke's edema and gives good functional outcomes. Surgeons can swiftly complete the key steps of removing pathological submucosal tissue and preserving the normal epithelium with an excellent surgical view.
Age Sensitivity in the Acquisition of Lexical Tone Production: Evidence from Children with Profound Congenital Hearing Impairment after Cochlear Implantation
Authors: Lee Kathy Y. S. , van Hasselt Charles Andrew , Tong Michael C. F. 
Published: October 2014

Objectives: This study investigated the effects of implant experience and age at implantation on the Cantonese tone production of children with cochlear implants. The study also examined whether there was a particular age at which children were more responsive to acquiring tones. Methods: The study included 45 children who had received unilateral cochlear implants at a mean age of 65.56 months. The subjects were grouped according to their age at cochlear implantation and were assessed annually for 5 years thereafter. A picture-naming task was used to measure their tone production performance. Results: A simple effect of age at implantation was significant at all testing intervals except at the preoperative data point. Children who were younger than 4 years of age when they received their implants scored significantly higher than did the 2 older groups at various testing intervals. A significant simple effect of implant experience was also found. Progress was most striking in children who received their implants before the age of 4 years. Conclusions: For the most effective acquisition of Cantonese lexical tones, children should undergo early cochlear implantation. For children who receive implants before the age of 4 years, benefits are noted in tone production ability in terms of a faster rate of improvement within a shorter period of time.
Bone-Anchored Hearing Aids in Patients with Acquired and Congenital Unilateral Inner Ear Deafness (Baha CROS): Clinical Evaluation of 56 Cases
Authors: Hol Myrthe K. S. , Kunst Sylvia J. W. , Snik Ad F. M. , Bosman Arjan J. , Mylanus Emmanuel A. M. , Cremers Cor W. R. J. 
Published: October 2014

Objectives We performed an evaluation of the audiological and subjective benefits of the bone-anchored hearing aid (Baha) as a device for transcranial routing of sound (Baha CROS) in 56 patients with unilateral inner ear deafness. Methods We performed a prospective clinical follow-up study in a tertiary referral center. Previously reported results of 29 patients were supplemented with a second series of 30 patients with unilateral inner ear deafness; 3 patients dropped out during the evaluation. Audiometric measurements were taken before and after Baha CROS fitting. Subjective benefits were quantified with 4 different patient questionnaires. Results The sound localization results in a well-structured test setting were not differentiable from chance. The 5 patients with congenital hearing loss showed better scores in the unaided sound localization measurements. Overall, most patients reported some subjective improvement in their capacity to localize sounds with the Baha CROS in daily life. The main effect of the Baha CROS was to alleviate the head shadow effect during the speech-in-noise test. Conclusions Poor sound localization in this larger series of patients confirms the findings of previous studies. Improvements in the speech-in-noise scores corroborated the efficacy of the Baha CROS in alleviating the head shadow effect. The 4 different patient questionnaires revealed subjective benefit and satisfaction in various domains.