bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Anatomic Location and Distribution Pattern of Malignant and Premalignant Glottic Lesions
Authors: Shoffel‐Havakuk Hagit , Halperin Doron , Yosef Liron , Lahav Yonatan 
Published: September 2014

Objectives:(1) Describe the anatomic location and distribution pattern of glottic dysplasia and early glottic cancer over the vocal folds. (2) Better understand the anatomic locations where glottic carcinogenesis initiates.Methods:A cohort reviewing glottic dysplasia or carcinoma patients, in a referral center, between 2008 and 2013. Lesions were described in terms of location and size, and a novel grid system was used to map their anatomic distribution.Results:A total of 167 patients were included; 78 with dysplasia and 89 with T1 early glottic carcinoma. The medial aspect was found to be more involved than the superior aspect, 95% versus 71%, respectively (P <. 001). Using the grid system, the most involved area was the midpoint of the membranous vocal fold at the transition between the superior and medial aspects. Ninety‐seven percent of the lesions occupied this specific area, with no difference between smokers and nonsmokers. The vocal process mucosa was involved in 48 patients. Exclusive vocal process involvement was limited to 2 cases. All other 46 patients demonstrated extensive disease, encompassing more than half of the vocal fold's length. Carcinoma in situ and invasive carcinoma lesions tended to be larger and to involve the superior aspect, otherwise all lesion types showed similar pattern of distribution.Conclusions:Premalignant and malignant glottic lesions tend to involve the medial aspect of the vocal fold, and the midpoint of the membranous part in particular. This might correlate with the anatomic origin of glottic carcinogenesis.
Characteristics of Supraglottitis in Adults
Authors: Tamir Sharon‐Ovnat , Barbalat Irina , Marom Tal , Goldfarb Abraham , Roth Yehudah 
Published: September 2014

Objectives:Describe the demographics, clinical presentation, interventions, and outcomes of adult patients diagnosed with acute supraglottitis.Methods:We retrospectively identified adult patients with acute supraglottitis during the years 1990 through 2013 by using relevant International Classification of Disease codes. Data were extracted for demographic and clinical information.Results:A total of 288 eligible patients were enrolled. Diagnosis was made by either indirect or fiber‐optic laryngoscopy (or both modalities). The incidence rate of acute supraglottis was 4.3 out of 100,000 patients/year, with a steep rise during the years 1999 through 2013. A slight male predominance was observed (n = 160, 56%). The mean age was 50 ± 16 years, and 77% were 30 to 70 years old. Sore throat (94%) and dysphagia (88%) were the most common presenting symptoms, which had begun 2 days prior to hospitalization. Comorbidities were reported in 62% of the patients. Swabs were obtained in 17% of patients, of those 23% were positive. Patients were hospitalized either in the otolaryngology department (n = 255, 89%) or in the intensive care unit (ICU) (n = 33, 11%). Of the ICU patients, 19 (58%) had an airway securing intervention procedure (84% upon admission, 16% during initial 24 hours surveillance). Amoxicillin‐clavulanate was administered in 61% of patients. Intravenous and inhalational corticosteroids were administered in 190 (66%) patients. The mortality rate was 0.003%.Conclusions:The signs and symptoms of supraglottitis in adults are different from those in the pediatric population. Patients presenting with sore throat, dysphagia, or odynophagia should be cautiously suspected for supraglottitis until proven otherwise. Treatment includes intravenous antibiotics and steroids and outcomes are excellent.
Clinical Study of Postoperative Swallowing in Multiple System Atrophy
Authors: Ueha Rumi , Nito Takaharu , Yamauchi Akihito , Uranaka Tsukasa , Yamasoba Tatsuya 
Published: September 2014

Objectives:Some patients with multiple system atrophy (MSA) require surgical management such as tracheostomy and laryngeal closure with the evolution of diseases such as severe dysphagia and/or respiratory disorder. There are few reports about the relationship between dysphagia and vocal cord paralysis (VCP) and about postoperative feeding in MSA patients. The aim of this study is to describe clinical management and outcomes of surgical treatment in MSA patients.Methods:From 2001 to 2013, 16 MSA patients (11 males) underwent surgical procedures. All cases were retrospectively evaluated for vocal fold fixed position, degree of dysphagia, the duration between the onset of dysphagia (or dyspnea) and surgery, and perioperative feeding.Results:The mean age was 64.3 years (range, 52‐76 years). Tracheostomy was made in 9 patients, and laryngeal closure was performed in 11 patients. Four of 7 patients underwent laryngeal closure (LC) 7.5 weeks (2 to 14) after tracheostomy. Eleven patients had severe dysphagia. The bilateral vocal folds were fixed in a median position in 13 patients. The duration from onset of MSA and surgery was 3 to 111 months (median 59 months). All patients with LC were preoperatively unable to take anything from mouth, but postoperatively all of them regained complete/partial oral intake.Conclusions:In MSA patients, a correlation between dysphagia and VCP is suggested, however it was revealed that dysphagia does not always precede VCP. This study also showed that LC enables patients to take food orally, regardless of severe dysphagia.
Effects of Effortful Swallow on Esophageal Function in Patients with Presumed Esophageal Motility Disorders
Authors: Kiell Eleanor P. , Lintzenich Catherine R. 
Published: September 2014

Objectives:(1) Describe the changes in esophageal amplitude and swallow duration during an effortful swallow in patients with esophageal pathology. (2) Understand the utility of the effortful swallow in rehabilitation of esophageal dysmotility disorders.Methods:Prospective case control study in which 10 patients referred for esophageal manometry were enrolled. Each participant performed 20 swallow trials (10 effortful and 10 normal) where amplitude and duration of swallow were measured at 4 different sensors (1 striated, 1 mixed, and 2 smooth muscle sites). The effects of the swallow condition (effortful vs noneffortful), sensor site, and sex on esophageal peak pressure and swallow duration were examined.Results:The study included 10 participants (8 females, 2 males). There were several patients in whom the effortful swallow showed a statistically significant increase in peak swallow pressure or duration of the measured swallow at a particular sensor. This was not consistent across all patients nor across a particular sensor. There were more statistically significant changes in males compared with females.Conclusions:Despite clear evidence in previous studies demonstrating that volitional manipulation of the oropharyngeal phase of swallowing affects esophageal physiology in healthy individuals, a small study of patients with esophageal pathology is unable to demonstrate similar results. In future studies, we will aim to include a greater number of patients with diagnosed esophageal dysmotility.
Extraesophageal Reflux in Patients Undergoing General Endotracheal Tube Anesthesia
Authors: Regenbogen Elliot , Oleszak Slawomir P. , Corrado Thomas , Shroyer Annie L. , Goldstein Jordan , Marzouk Mark , Pearl Michael L. 
Published: September 2014

Objectives:Explore hypopharyngeal exposure to abnormally high or low pH during surgery performed under general endotracheal tube anesthesia and to compare results to published normative 24‐hour data.Methods:Twenty volunteers for this prospective cohort study were recruited from June through September 2013. A wireless Dx‐pH monitoring system was used during surgery. A drop from baseline to pH <5.5 was defined as a hypopharyngeal event, with thresholds pH 4.0, 4.5, and 5.0 also examined. Results were compared with supine events published by Chheda et al in 2009.Results:The number and duration of hypopharyngeal events <15 minutes with pH below 4.0, 4.5, 5.0 and percentage of surgery time in hypopharyngeal events (from a pH = 5.5 to return to baseline) were similar to comparative data. However, including all duration events (> ≤ 15 minutes), the number and duration of events at all thresholds and the percentage of surgery time in hypopharyngeal events were consistently higher than comparative data. Most analyses with the potential predictive/confounding variables (ie, body mass index, Reflux Symptom Index, Voice Handicap Index‐10) yielded nonsignificant results.Conclusions:Extended pharyngeal exposure to moderately reduced pH levels (greater than sleeping or resting in a supine position) were documented. Approximately 20% of surgical patients may experience extensive exposure to pH <5.5 (over 1 hour, >30% of surgery time) and an additional 20% may experience moderate exposure to pH <5.5 (5‐20 minutes and/or 4% to 10% of surgery time). Additional studies are needed to predict which patients might be at elevated risk for this exposure as well as the impact of this exposure on clinical outcomes.
The Mayo Clinic Spasmodic Dysphonia Experience: A Demographic Analysis of 686 Patients
Authors: Patel Alpen B. , Pollei Taylor R. , Bansberg Stephen F. , Adler Charles H. , Lott David G. , Crujido Lisa R. 
Published: September 2014

Objectives:(1) Review demographic data collected over a 23‐year experience of 686 patients with spasmodic dysphonia (SD) who have been treated with onabotulinum toxinA (onaBTX‐A). (2) Compare demographic trends surrounding SD with previously published data.Methods:A retrospective chart review was conducted. A total of 686 patients with SD were treated with 6345 onaBTX‐A injections at Mayo Clinic Arizona between 1989 and 2013. Demographic data were compiled and analyzed. Patients were subdivided based on type of SD, presence of vocal tremor (VT), and presence of neurologic disorders. Family history of neurological disorders was also recorded.Results:In 686 patients, 432 patients were female (63.0%) and 254 patients were male (37.0%). A total of 630 patients (91.8%) were of the adductor type (AdSD) and 56 patients (8.2%) were of the abductor type (AbSD). AdSD patients noted symptom onset and began injections at an older age than AbSD patients (52.5; 60.6 years vs 43.7 years; 50.0 years, respectively). A total of 374 patients (54.5%) had VT, with 355 AdSD patients and 19 AbSD patients. A total of 45 patients (6.6%) had other movement disorders, such as blepharospasm (1.5%), torticollis (2.3%), limb dystonia (1.0%), or oromandibular dystonia (1.8%). Family history of SD was positive in 4 patients (0.6%) and of other dystonias in 9 patients (1.3%).Conclusions:Spasmodic dysphonia is a chronic and potentially disabling laryngeal dystonia resulting from disrupted motor control of the laryngeal musculature during phonation. This large series adds new insight and contributes to the current literature regarding the clinical scope and nature of SD.
Prevalence and Impact of Swallowing Disorders among United States Adults
Authors: Bhattacharyya Neil 
Published: September 2014

Objectives:(1) Determine the prevalence of swallowing problems and reported etiologies and (2) understand their impact among United States adults.Methods:The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for swallowing problems, diagnoses given, and severity of the swallowing problem were analyzed. The relationship between swallowing problems and lost workdays was investigated.Results:An estimated 9.44 ± 0.33 million adults (mean age 52.1 years; 60.2 ± 1.6% female) reported a swallowing problem (4.0 ± 0.1%). Overall, 22.7 ± 1.7% saw a health care professional for their swallowing problem and 36.9 ± 0.1.7% were given a diagnosis. Females were more likely than males to report a swallowing problem (4.7 ± 0.2% versus 3.3 ± 0.2%, P <. 001). A total of 31.7% and 24.8% reported their swallowing problem to be a moderate or a big/very big problem, respectively. Stroke was the most commonly reported etiology (422 ± 77 thousand cases; 11.2 ± 1.9%), followed by other neurological cause (269 ± 57 thousand; 7.2 ± 1.5%) and head and neck cancer (185 ± 40 thousand; 4.9 ± 1.1%). The mean number of days affected by the swallowing problem in the past year was 139 ± 7 days. Respondents with a swallowing problem reported 11.6 ± 2.0 lost workdays in the past year versus 3.4 ± 0.1 lost workdays for those without (contrast, +8.1 lost workdays, P <. 001).Conclusions:Swallowing problems affect 1 in 25 adults annually. A relative minority seek health care for their swallowing problem, even though the subjective impact and associated workdays lost with the swallowing problem are significant.
Redesign of the Microsurgical Interface with a Novel, Computer‐Assisted “Virtual Microscope” System in Laser Phonomicrosurgery
Authors: Guastini Luca , Matos Leonardo , Deshpande Nikhil , Ortiz Jesus , Mora Francesco , Peretti Giorgio 
Published: September 2014

Objectives:(1) Augment surgeon skills through gesture scaling and magnified visualization. (2) Eliminate extensive training using intuitive stylus‐based manipulation. (3) Perform active constraints intraoperative planning assisting the surgeon.Methods:The virtual microscope elements system are: Motorized Micromanipulator, Graphics Stylus with Tablet, Virtual Microscope (VM), Configuration Interface (CI). The apparatus has been implemented and tested between July and December 2013 by resident surgeons and medical students. The surgeon performs the surgical tasks in the VM interface, consisting of modified head‐mount display and HD cameras attached to a microscope. The CI includes different categories: in‐surgery messages, choosing assistive features, system configuration, etc. The assistive features in the VM include: Precise aiming and incision with laser, defining virtual scan patterns allowing incision and ablation planning for automatic execution, defining regions where the laser is active (safe area), or inactive (dangerous area). The apparatus was compared with the state‐of‐the‐art Lumenis AcuBlade (AB) interface. Average path outcome measurements following error and statistical subjective evaluations of usability were made.Results:The average path following error (root mean square error value) was 0.25 mm while maximum error was 0.66 mm. VM is more accurate and superior to AB, which provided values of 0.51 mm and 1.20 mm, respectively, in earlier trials. The subjective evaluations of usability gave a score of 88.3 for the VM. Earlier trials with AB provided a score of 65.56. VM interface is simple, usable, easy to learn, and appropriate.Conclusions:The VM was created to provide improved precision, safety, and better ergonomics for microsurgery procedures. The system provides enhanced 3D visualization and allows delicate maneuvers.
Spasmodic Dysphonia: A 20‐Year Experience of Injecting Botulinum Toxin
Authors: Namin Arya W. , Christopher Kara , Eisenbeis John F. 
Published: September 2014

Objectives:(1) Report the initial dosing for adductor and abductor spasmodic dysphonia (ADSD, ABSD). (2) Identify trends in dosing for patients with SD over extended time.Methods:A retrospective review of the medical records of 149 patients who received 2484 Botox injections from the same physician at a tertiary medical center between January 1993 and December 2012. The location and dose of injection, age of the patient at injection, and the interval in days between injections were recorded.Results:There were 13 ABSD patients and 136 ADSD patients. The initial dose injected into each vocal fold for patients with ABSD (mean = 2.8 units) was significantly higher than for patients with ADSD (mean = 1.52; t = 4.46; P <. 001). Seventy patients received 10 or more injections during the study period (range, 1‐92 injections). Sixty‐six patients have been followed for greater than 5 years. There appear to be several trends which determine the proper dose for management of vocal cord spasms. One group establishes a stable dose with minimal side effects and adequate interval of normal phonation. A second group tends to have variability in the tolerance of side effects and voice results from each injection and requires dose modification continually over time.Conclusions:Analysis of this patient cohort receiving a high number of injections over an extended period of time reveals variable dosing patterns. This may represent subjective differences in patients’ ability to tolerate side effects of Botox treatment. It may also indicate variability in the etiology and pattern of this neurologic disease.
Utility of High‐Dose Corticosteroids in the Treatment of ACE‐Inhibitor–Induced Angioedema
Authors: Bangiyev John N. , Kieu Monica C. Q. , Ray Amrita , Cavaliere Salvatore , Amjad Esmael H. 
Published: September 2014

Objectives:Airway compromise is a common and dangerous presenting sign of ACE‐inhibitor–induced angioedema (AIIA). After a definitive airway is obtained, there is minimal evidence‐based data for the effectiveness of commonly used medical intervention. While dosing protocols for the treatment of AIIA vary between institutions, they usually contain a corticosteroid, H1‐blocker, and an H‐2 blocker. The aims of the study were: (1) Define ACE‐inhibitor‐induced angioedema. (2) Describe common upper aerodigestive subsites of involvement. (3). Discuss the role of corticosteroids in the management of ACE‐inhibitor–induced angioedema.Methods:We retrospectively reviewed 200 patient charts from a tertiary care center with diagnosed AIIA to determine the effectiveness of medications utilized in AIIA treatment. These patients were all admitted to the intensive care unit for airway monitoring. The intervention group (n = 100) received high dose steroids, H‐1 and H‐2 blockers IV. The control group (n = 100) received low dose or no steroids with or without H‐1 and H‐2 blockers. Outcome measures included length of hospital stay, length of ICU stay, emergent airway intervention, surgical airway intervention, and time intubated.Results:Preliminary data analysis supports a role for high dose corticosteroids in shortening length of stay (P <. 05) and decreasing surgical airway intervention (P <. 03). There is a trend for corticosteroids in reducing time intubated.Conclusions:These findings indicate that there is a role for medical management of upper aerodigestive AIIA with corticosteroids. These findings may ultimately help with the delineation of a standard protocol for AIIA.
Head and Neck Reconstruction with Chimeric Anterolateral Thigh Free Flap: Indications, Outcomes, and Technical Considerations
Authors: Lawson Bradley R. , Moreno Mauricio A. 
Published: September 2014

Objectives:Chimeric anterolateral thigh (ALT) free flaps are comprised of multiple skin paddles or muscular components, which allow for the reconstruction of complex 3‐dimensional defects. There is a paucity of data in the literature regarding the outcomes with this reconstructive option. We sought to describe our results with this technique and identify outcome predictors.Methods:Retrospective review of 24 patients undergoing reconstruction with a chimeric ALT free flap at an academic tertiary institution between 2009 and 2013. Demographics, indications, comorbidities, flap and functional outcomes were retrieved from the medical records and review of intraoperative photography. SPSS was used for data analysis.Results:The mean age was 57 years and the cohort primarily consisted of males (87.5%). The most frequent defects were: through‐and‐through pharyngoesophageal, n = 12 (50%) and skull base, n = 6 (25%). The flap consisted of double skin paddles in 11 cases (45.3%) and a skin paddle with an independent muscular component in 13 (54.7%). The mean skin paddle area was 62 cm2. There were no total flap losses; partial loss (secondary skin paddle) was observed in 3 cases and was related to severe congestive heart failure (P =. 005) and malnutrition (P =. 002). Postoperative fistula was associated to immunodeficiency (P =. 02) and malnutrition (P =. 004). All except one patient who underwent pharyngeal reconstruction resumed oral diet. The mean time to resume diet was 27 days.Conclusions:Chimeric ALT flaps represent an excellent alternative for reconstruction of complex defects. Patients with congestive heart failure, with immunodeficiency, and who are malnourished are at higher risk of partial flap loss. A second muscle paddle might be indicated in these cases.
Dizziness Profile and Clinical Features: A Population‐Based Survey in São Paulo City, Brazil
Authors: Oiticica Jeanne , Bittar Roseli S. M. , Mezzalira Raquel , Grasel Signe S. 
Published: September 2014

Objectives:In clinical practice, knowing the epidemiology of dizziness is essential. The aim of the study was to estimate the prevalence of dizziness among the adult population of the city of São Paulo, Brazil and describe the clinical features and level of discomfort.Methods:A cross‐sectional epidemiological survey was conducted in São Paulo, Brazil between April and October 2012. In this field study, 1960 household interviews were completed. The following variables were assessed: sex, age, clinical characteristics of dizziness, and dizziness disability index. Chi‐square test, Student t test, Tukey test, and logistic regression were used for statistical analysis (95% confidence interval).Results:The dizziness prevalence was 42%. Among 2 age groups, peaks of dizziness were observed: 49% among the 46 to 55 years old and 44% among the elderly subjects (>65 years old). Vestibular vertigo was estimated in 8.3% with a strong female preponderance (P <. 001). Symptoms caused disability in 27% of the affected respondents and were more frequent among women (P <. 001), who sought medical care more frequently (P <. 001). The dizziness disability index was significantly higher (P =. 0165) among subjects with lower educational level. There was no correlation between dizziness discomfort and the type of job.Conclusions:The prevalence of dizziness in São Paulo, Brazil, was established in 42%. Among the symptomatic subjects, 67% reported interruption of daily activities, but only 46% of them sought medical attention.