bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Septodermoplasty and Potassium-Titanyl-Phosphate (KTP) Laser Therapy in the Treatment of Hereditary Hemorrhagic Telangiectasia-Related Epistaxis
Authors: Harvey Richard J. , Kanagalingam Jeeves , Lund Valerie J. 
Published: April 2008

Background A variety of modalities are available for the control of recurrent epistaxis in hereditary hemorrhagic telangiectasia (HHT). Laser ablation, in particular potassium-titanyl-phosphate (KTP), has gained popularity as it coagulates the telangiectasia with minimal peripheral tissue injury. Septodermoplasty (SDP) also can be performed in the day surgery setting. Telangiectasia recurred, necessitating repeated treatments. The frequency and interval between procedures is not well documented. The purpose of this study was to describe the frequency of surgical interventions for HHT patients and the impact of SDP. Methods A retrospective review was undertaken of procedures performed in a tertiary hospital unit during a 60-month period for HHT. The incidence of KTP laser and SDP, days between treatments, total number of interventions and perioperative hemoglobin (Hb) were audited. Patient groups were identified as definite or possible HHT according to the Curacao criteria. All suffered from epistaxis sufficient to seek medical treatment. Results Three hundred one procedures were performed on 131 patients during the study period. In total, 33 SDPs and 268 KTP laser treatments were performed; 78.3% of patients required three or less procedures. The mean time interval between treatments was 473 (±515 days) days. The rate of KTP after an SDP decreased from 1.83 (±1.99) to 0.78 (±0.85; p = 0.012). Hb level was not associated with treatments required. Conclusion Surgical interventions with laser and SDP in HHT are always time limited as recurrence of telangiectasia is inevitable. This study discusses the expectations of therapy, mainly frequency and duration of effect, along with the impact of SDP. The outcomes assist in better management of patient expectations.
Effects of Sinus Surgery on lung Transplantation Outcomes in Cystic Fibrosis
Authors: Leung Man-Kit , Rachakonda Leelanand , Weill David , Hwang Peter H. 
Published: April 2008

Background In cystic fibrosis (CF) patients who are candidates for lung transplant, pretransplant sinus surgery has been advocated to avoid bacterial seeding of the transplanted lungs. This study reviews the 17-year experience of pretransplant sinus surgery among CF patients at a major transplant center. Methods Retrospective chart review was performed in all CF patients who underwent heart-lung or lung transplantation at Stanford Medical Center between 1988 and 2005. Postoperative culture data from bronchoalveolar lavage (BAL) and sinus aspirates were evaluated, in addition to survival data. Results Eighty-seven CF transplant recipients underwent pretransplant sinus surgery; 87% (n = 59/68) of patients showed recolonization of the lung grafts with Pseudomonas on BAL cultures. The median postoperative time to recolonization was 19 days. Bacterial floras cultured from sinuses were similar in type and prevalence as the floras cultured from BAL. When compared with published series of comparable cohorts in which pretransplant sinus surgery was not performed, there was no statistically significant difference in the prevalence of Pseudomonas recolonization. Times to recolonization also were similar. Survival rates in our cohort were similar to national survival rates for CF lung transplant recipients. Conclusion Despite pretransplant sinus surgery, recolonization of lung grafts occurs commonly and rapidly with a spectrum of flora that mimics the sinus flora. Survival rates of CF patients who undergo prophylactic sinus surgery are similar to those from centers where prophylactic sinus surgery is not performed routinely. Pretransplant sinus surgery does not appear to prevent lung graft recolonization and is not associated with overall survival benefit.
Asthma Outcomes after Endoscopic Sinus Surgery in Aspirin-Tolerant versus Aspirin-Induced Asthmatic Patients
Authors: Awad Osama G. , Fasano Mary Beth , Lee John H. , Graham Scott M. 
Published: April 2008

Background Certain diseases affect both upper and lower airways. Aspirin-induced asthma (AIA) is a clinical entity characterized by asthma, nasal polyposis, and aspirin intolerance. To understand the response of the lower airway to surgical treatment of the sinuses, we examined asthma outcomes in AIA compared with a second group of aspirin-tolerant asthmatic (ATA) patients to establish if there were any differences between the two groups after endoscopic sinus surgery (ESS). Methods A retrospective record review was performed of 91 asthmatic subjects with chronic rhinosinusitis. Forty-one subjects had AIA and 50 subjects had ATA. Subjective and objective asthma outcome parameters were used to compare between the two groups at three time points: immediately before ESS and 6 and 12 months after ESS. Results Preoperatively, AIA patients had significantly higher asthma severity (p < 0.0001) and lower forced expiratory volume in 1 second values (p = 0.04). At 12 months after ESS, a statistically significant difference between the two groups with better results in AIA patients was seen in asthma severity improvement (p = 0.010) and in the decrease of ICS doses (p < 0.0001), without significant differences between the two groups in other asthma outcome parameters. Conclusion AIA patients usually present with more severe asthma. The asthmatic complaints of AIA and ATA patients continue to improve significantly over 6 and 12 month after ESS. Although ESS helped both groups of patients, AIA had statistically significant better results compared with ATA patients in asthma severity scores and decreased need for ICS.
Outcomes of Posterior Lacrimal Sac Approach in Endoscopic Dacryocystorhinostomy: Review of 35 cases
Authors: Lee Kyung Chul 
Published: April 2008

Background The purpose of this study was to describe the posterior lacrimal sac approach in endoscopic dacryocystorhinostomy (DCR) performed at our institute and report perioperative results achieved with this procedure. Methods A prospective clinical study was performed of 35 adult patients with nasolacrimal duct obstruction who underwent posterior lacrimal sac approach DCR from March 1998 to May 2005. Follow-up period ranged from 13 to 30 months (average, 17.5 months; SD, 6.8 months). “Surgical success” was defined as complete relief of epiphora and patent surgical ostium on endoscopic assessment. Results Surgical success was achieved in 30/35 (85.7%) patients after the primary surgery. Of 5 unsuccessful patients who complained of occasional epiphora, 4 patients had formed stenosis and 1 patient had granulation around the surgical opening, and all had revision surgery. Four of 5 (80.0%) patients achieved surgical success. Thus, including the result of revision surgery, 34/35 (97.1%) patients were successful. Conclusion Posterior lacrimal sac approach in endoscopic DCR has several advantages: good sac accessibility, a low complication rate, and a relatively high success rate. Therefore, the posterior lacrimal sac approach appears to offer a useful alternative approach for the surgical treatment of nasolacrimal duct obstruction.
Utility of Preoperative High-Resolution CT and Intraoperative Image Guidance in Identification of Cerebrospinal Fluid Leaks for Endoscopic Repair
Authors: Zuckerman Jodi D. , DelGaudio John M. 
Published: April 2008

Background Endoscopic repair of cerebrospinal fluid (CSF) leaks is a well-established procedure. The radiological workup and use of intraoperative image guidance (IGS), lumbar drain (LD), and intrathecal fluorescein (IF) are less universally accepted. This study examines endoscopic repair of CSF leaks using preoperative high-resolution CT (HRCT) and intraoperative IGS without IF or LD. Methods Retrospective review was performed of a single surgeon experience between September 2002 and January 2007. Results Forty-two anterior skull base defects in 40 patients were repaired endoscopically. The etiology of CSF leaks was traumatic in 5, spontaneous in 12, and iatrogenic in 25 defects (15 from endoscopic sinus surgeries and 10 from neurosurgical procedures). Fifty-two percent of defects presented with a meningoencephalocele. Defect location was sphenoid sinus (17 defects), ethmoid roof (14 defects), cribriform plate (9 defects), and frontal sinus (2 defects). Defect size ranged from 1 X 1 mm to 2 X 2 cm. Follow-up ranged from 8 to 46 months. All defects were identified preoperatively on HRCT with successful intraoperative IGS localization. No patients required IF for identification of CSF leak. Overall successful repair was achieved in 40 (95%) defects after initial repair, and 100% after revision. Seven patients had LD, 6 patients were early in the series. Twenty-three patients were discharged the day after surgery and 6 patients were discharged on day 2. Conclusion Using preoperative HRCT for diagnosis and intraoperative IGS for localization, even small skull base defects can be definitively identified. High success rates and early discharges are achieved without additional procedures such as IF or LD. This is a less invasive and more cost-efficient method of repairing CSF leaks.
Serum Inflammatory Protein Profiles in Patients with Chronic Rhinosinusitis Undergoing Sinus Surgery: A Preliminary Analysis
Authors: Becker Adam M. , Das Subinoy , Xia Zhongsheng , Liu Zhongmin , Adam Bao-Ling , Kountakis Stilianos E. 
Published: April 2008

Background The specific aim of this study was to evaluate surface-enhanced laser desorption/ionization time-of-flight mass spectroscopy (SELDI-TOF-MS) as a clinical screening tool in differentiating patients with chronic rhinosinusitis (CRS) from healthy control patients. Methods Serum samples were prospectively collected at a tertiary care academic medical center from 96 CRS patients who underwent functional endoscopic sinus surgery (FESS) and 38 control volunteers who were negatively screened according to the Rhinosinusitis Task Force guidelines on CRS. SELDI-TOF-MS was performed on serum samples to detect protein profiles in the range of 1-100 kDa. Analysis of spectral data was performed to determine the sensitivity and specificity of SELDI-TOF-MS in distinguishing patients with CRS requiring FESS from healthy controls and to determine potential markers for protein purification. Results Serum protein profiles generated from SELDI-TOF-MS in the range of 1-100 kDa were analyzed. Classification and regression tree analysis based on peak expression correctly classified patients with CRS with 77.1% sensitivity and 65.8% specificity, a positive predictive value of 88%, and a negative predictive value of 53%. Underexpression of a protein peak at 8.4 kDa was associated with CRS in 77% of cases. Conclusion SELDI-TOF-MS serum protein profile analysis is able to distinguish CRS patients requiring FESS from healthy, negatively screened controls with a sensitivity of 77.1% and specificity of 65.8%. Additional investigation is required to determine if SELDI-TOF-MS will make an effective clinical tool.
The use of Portable Intraoperative Computed Tomography Scanning for Real-Time Image Guidance: A Pilot Cadaver Study
Authors: Das Subinoy , Maeso Patricia A. , Figueroa Ramon E. , Senior Brent A. , Delgaudio John M. , Sillers Michael J. , Schlosser Rod J. , Kountakis Stilianos E. 
Published: April 2008

Background This study was performed to assess the feasibility of using intraoperative computed tomography (CT) to provide real-time updates to image guidance systems (IGSs) during surgery. Methods The xCAT ENT portable intraoperative CT scanner (Xoran Technologies, Ann Arbor, MI) was used to acquire scans before, midway, and at the end of six cadaver dissections during the Southern States Rhinology Course, Augusta, GA, in October 2006. These scans were used to recalibrate three different IGSs used during the dissection. Time measurements were recorded and dosimetry was obtained from the cornea, sphenoid sinus (near the optic chiasm), and from the operative field during acquisition of the images. IGS accuracy was determined at the skull base and lamina papyracea. Surgeons were interviewed on benefits of real-time updates to the IGS after completion of dissections. Results The xCAT ENT scanner was compatible with all three IGS platforms. The average time to update the IGS was 13 minutes. Radiation doses to the cornea were 620 mrad per scan, and optic chiasm was 800 mrad/scan. The accuracy at the anterior skull base improved from 1.58 to 0.62 mm (p = 0.026). The accuracy at the posterior skull base improved from 1.46 to 0.71 mm (p = 0.014). The accuracy at the lamina was not significantly changed. Conclusion Intraoperative portable CT scanning with real-time IGS updates is feasible and likely would add little additional time. Accuracy is improved at the skull base. Prospective studies on actual patients are warranted.
Use of Intraoperative CT Scanning in Endoscopic Sinus Surgery: A Preliminary Report
Authors: Jackman Alexis H. , Palmer James N. , Chiu Alexander G. , Kennedy David W. 
Published: April 2008

Background Image-guided functional endoscopic sinus surgery (IG- FESS) using preoperatively acquired CT images for navigation has been proven to facilitate complicated endoscopic sinus procedures and decrease the need for revision procedures. However, this system does not render the intraoperative anatomic changes that occur throughout the procedure. The purpose of this study is to show the technical feasibility and the potential impact of intraoperative CT scanning in conjunction with real-time update of computer-assisted navigation during ESS. Methods Intraoperative CT scanning was performed in selected patients undergoing FESS. A scan was taken before the conclusion of surgery performed by skilled endoscopic sinus surgeons. The scans were evaluated for residual disease or cellular partitions. Where indicated, intraoperative scan was then loaded into the image guidance system and intraoperative scans were then used for additional IGS. The scan findings were documented. Results Intraoperatively acquired CT scans were obtained successfully in <40 seconds and able to be loaded into the image guidance system within minutes. All surgeries were preformed without complication. New information obtained from the intraoperative CT scan led to alteration in the surgical plan in 30% of patients. Conclusion Intraoperative CT scanning can be preformed with currently available technology and has the potential to improve the extent of surgery in patients with complicated anatomy and extensive disease.
In Vitro Effects of Preservatives in Nasal Sprays on Human Nasal Epithelial Cells
Authors: Ho Ching-Yin , Wu Meng-Chuan , Lan Ming-Ying , Tan Ching-Ting , Yang An-Hang 
Published: April 2008

Background The preservatives benzalkonium chloride and potassium sorbate are widely used in nasal drops and sprays. Recently, side effects resulting from mucosal damage caused by benzalkonium chloride and potassium sorbate were reported. Methods We investigated the toxicity of benzalkonium chloride and potassium sorbate on human nasal epithelial cells in vitro. Using primary human nasal epithelial cells, different concentrations of benzalkonium chloride, potassium sorbate, or phosphate-buffered saline (PBS; control group) solutions were cocultured with nasal epithelial cells for 15 minutes. Then, the viability of the cells and the cell morphology were assessed. Results Nasal epithelial cells were more severely damaged with use of clinical preparations or higher concentrations of benzalkonium chloride than in the control group. In addition, nasal epithelial cell membrane lysis was seen on electronic microscopy in the benzalkonium chloride groups. In contrast, there was no significant cell damage seen in the potassium sorbate groups compared with the control group, even with higher concentrations than clinically used. Conclusion Potassium sorbate appears to be a relatively safer preservative than benzalkonium chloride for use in nasal sprays and drops in vitro study.
Functional Endoscopic Dilatation of the Sinuses: Patient Satisfaction, Postoperative Pain, and Cost
Authors: Friedman Michael , Schalch Paul , Lin Hsin-Ching , Mazloom Narges , Neidich Marci , Joseph Ninos J. 
Published: April 2008

Background The purpose of this study was to determine how functional endoscopic dilatation of the sinuses (FEDS) compares with functional endoscopic sinus surgery (FESS) in a select group of patients with respect to (1) elimination of symptoms, (2) patient satisfaction, (3) postoperative narcotic use, and (4) cost. A retrospective study was performed of 70 patients with chronic rhinosinusitis who underwent FEDS or FESS as primary or revision treatment. Methods Symptoms and satisfaction based on the Sino-Nasal Outcome Test (SNOT-20) questionnaires and global patient assessment, postoperative narcotic use, and costs were compared after 3-month follow-up. Results SNOT-20 change scores indicated that both FEDS and FESS had clinically meaningful treatment responses. Patient satisfaction was higher and postoperative narcotics usage was less with FEDS. The cost for primary procedures was similar, whereas the cost for revision surgery using FEDS was considerably less. Turbinate lateralization and scarring was more common in the FEDS group, particularly early in the study. The incidence of recurrent sinus infections during the follow-up period was similar for both groups. Only one patient in the FEDS group required a repeat intervention within the short-term follow-up period. Conclusion Both FEDS and FESS resulted in significant improvement in SNOT-20 scores for selected patients with mild disease. Patient satisfaction and postoperative narcotic use of FEDS compare favorably with FESS. Cost of FEDS was comparable with FESS for primary procedures but was less than FESS for revision procedures. Long-term efficacy and final cost of FEDS remain to be addressed, taking into account the need for revision procedures after initial FEDS, by means of long-term studies and objective outcome measures.
Long-Term Endonasal Endoscopic Review of Successful Duraplasty after Endonasal Endoscopic Skull Base Surgery
Authors: El-Banhawy Omar A. , Halaka Ahmed N. , Ayad Heshmat , El-Altuwaijri Mohammed , El-Sharnoby Mohamed M. 
Published: April 2008

Background This study was performed to examine the long-term endonasal endoscopic morphological appearance of successful duraplasty after endoscopic skull base surgery for different pathology. Methods This study included 65 patients who underwent endonasal endoscopic surgery for different skull base lesions with successful duraplasty. Forty patients had pituitary adenomas, 25 with macroadenomas and 15 with microadenomas. Twenty patients with cerebrospinal fluid rhinorrhea of different etiologies and three patients with meningoencephalocele were included. There were two patients with skull base meningiomas, 1 with an extensive greater wing meningioma reaching the nasal cavity and the 1 with recurrent olfactory groove meningioma. Different types of autologous materials were used in reconstructing the skull base defect. Clinical follow-up with endoscopic nasal examination was done routinely 1, 3, 6, and 12 months after surgery. CT and MRI were performed when indicated. The follow-up period ranged from 6 months to 8 years. Results Starting from 3 months after surgery to the rest of the follow-up period, endonasal endoscopic view of the site of duraplasty showed that with small skull base defect (<5 mm), there was neither dural pulsation nor prolapse. With moderate-size defect (5-10 mm) there was dural pulsation without prolapse. With larger defect (>10 mm) there was dural pulsation and prolapse. These findings were constant regardless of the etiology of the lesion and the reconstruction material used. Conclusion This long-term study showed that dural pulsation and prolapse at the site of the successful duraplasty is a function of the size of the bony defect and does not depend on the pathology of the lesion or the autologous material used for reconstruction. For any future endonasal procedure for these patients, the surgeons should be fully aware of the state of duraplasty to avoid any complication.
Sinusitis in Pilots of Different Aircraft Types: Is Allergic Rhinitis a Predisposing Factor?
Authors: Ulanovski David , Barenboim Erez , Raveh Eyal , Grossman Alon , Azaria Bella , Shpitzer Thomas 
Published: April 2008

Background Despite the high association of allergic rhinitis and acute sinusitis, their exact relationship remains unclear, especially in pilots. The purpose of this study was to analyze the possible relationship of a history of allergic rhinitis with the occurrence of acute sinusitis in Israeli air force pilots. A comparative case series was conducted. Methods Events of acute sinusitis were compared between Israeli air force pilots with (n = 54) and without (n = 82) allergic rhinitis who presented for their annual physical examination. Results Previous episodes of acute sinusitis were noted in 33% of the pilots with allergic rhinitis and 21% of the control group (p = 0.09). A separate analysis of young pilots (<26 years old) yielded corresponding rates of 57% versus 29% (p < 0.001). When the groups were divided by type of pilot, the results showed that 54% of the transport pilots, 34% of the fighter pilots, and 13% of the helicopter pilots with rhinitis also suffered from acute sinusitis, as opposed to 28, 15, and 15%, respectively, of the control group. Conclusion Despite careful selection, allergic rhinitis is still a very common disease in pilots and may pose a risk of acute sinusitis. The lower prevalence of acute sinusitis in combat than in transport pilots with rhinitis may be explained by vasoconstriction due to psychological and physiological stress during flight missions.
Food Security in Older Adults: Community Service Provider Perceptions of Their Roles
Authors: Keller Heather H. , Dwyer John J.M. , Edwards Vicki , Senson Christine , Edward H. Gayle 
Published: April 2008

ABSTRACTFood insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as “the need for personalization of service”. Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.
Reasons Young Adults Visit (and Do Not Visit) Impaired Grandparents
Authors: Boon Susan D. , Shaw Megan J. 
Published: April 2008

ABSTRACTThis study explored the value undergraduate students (N = 138) attach to relationships with impaired grandparents by examining some of the reasons they visit (and do not visit) grandparents who live with conditions limiting their cognitive, physical, or psychological well-being. As part of a larger study, participants completed two checklists to indicate their reasons for visiting and not visiting their affected grandparents. Reward-based reasons were endorsed more frequently as motives for visiting than were reasons based on external constraints, family difficulties, guilt, or wanting to take advantage of the time left with their grandparents. Barriers that restricted opportunities to visit were endorsed more frequently as explanations for participants' failure to visit than were problems in the relationship itself, guilt, or severity of impairment.