bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of Skull Base Chondroblastoma
Authors: Kutz J Walter , Verma Sunil , Tan Hongying Tina , Lo William W. M. , Slattery William H. , Friedman Rick A. 
Published: April 2007

AbstractObjectives: Chondroblastoma is a rare tumor accounting for 1% of primary bone tumors. Chondroblastoma involving the skull base is exceedingly rare with approximately 60 cases reported. We reviewed our experience with chondroblastoma of the skull base with an emphasis on current lateral skull base approaches and long‐term tumor control.Study Design and Setting: A retrospective case review at a tertiary neurotology private practice group was performed over a 20‐year period. Five patients were identified with skull base chondroblastoma. All patients underwent surgical intervention, and success of surgery was determined by disease‐free status at last follow‐up. Mean follow‐up time was 5.8 years.Results: Two patients underwent gross tumor removal as primary therapy. One patient underwent partial tumor removal at an outside institution, and follow‐up magnetic resonance imaging demonstrated rapid growth of residual tumor. This patient was successfully treated with gross total removal of residual tumor with an infratemporal craniotomy approach. Near total tumor removal was performed in two patients because of intimate involvement of vital structures. At last follow‐up, no patient had radiographic evidence of tumor recurrence. There were no significant postoperative complications.Conclusions: Gross total or near total resection of skull base chondroblastomas through lateral skull base approaches results in long‐term tumor control and low complication rates.
Cholesteatoma in the Normal Hearing Ear
Authors: Smouha Eric E. , Javidfar Javanshir 
Published: April 2007

AbstractObjectives/Hypothesis: Surgical treatment of cholesteatoma in ears with normal or near‐normal hearing represents a challenge, in that complete removal of disease may require sacrifice of the ossicular chain. Our aim was to identify the predictive factors and surgical strategies that favor hearing preservation in these patients.Study Design: Retrospective case review.Methods: Fifty‐four procedures were performed in 50 patients with cholesteatoma and a preoperative speech reception threshold or pure‐tone average (PTA) of less than 25 dB. Complete audiometric data were available in 51 cases. All patients had complete surgical removal of cholesteatoma. Whenever feasible, ossicular reconstruction was performed at the time of the initial surgical procedure.Results: The median PTA changed by −3 dB, and hearing was preserved to within 10 dB of preoperative level in 72% of patients. An intact ossicular chain was found in 72% of the cases and could often be preserved at surgery. However, similar hearing outcomes resulted after intact versus reconstructed ossicular chains and in open versus closed mastoidectomies. The recidivism rate was 26%, and recidivistic cases had worse hearing outcomes. Congenital cholesteatomas and Prussak space cholesteatomas had better outcomes with respect to hearing preservation and recidivism.Conclusions: Cholesteatoma in the normal hearing ear should be treated with the same surgical priorities as all other cholesteatomas. Preventing recidivism has a significant effect on hearing preservation, whereas preserving an intact ossicular chain and maintaining an intact canal wall do not.
Clinical Aspects of Type 1 Posterior Laryngeal Clefts: Literature Review and a Report of 31 Patients
Authors: van der Doef Hubert P. , Yntema Jan Bart , van den Hoogen Frank J. , Marres Henri A. 
Published: April 2007

AbstractObjectives: The clinical relevance of posterior laryngeal clefts (PLCs) of type 1 has only recently been highlighted in the medical literature. We present a review of the literature and a report of a contributive series of 31 type 1 PLC patients.Study Design and Methods: We performed a MEDLINE search of studies published between 1966 and September 2005 and a retrospective cohort study in children aged 0 to 16 years.Results: In the reviewed articles as well as in the presented study, a high degree of comorbidity in patients with PLC type 1 is reported. The majority of patients (90%) with severe problems with oral feedings were treated conservatively by means of nasogastric tube feeding.Conclusions: Increased awareness improves the chances of an accurate diagnosis of type 1 PLC in patients with congenital stridor. Type 1 PLC may be present in all patients with congenital stridor and laryngomalacia, particularly when stridor is accompanied by symptoms such as feeding difficulties and choking.
Quantitative Analysis of Syndecan‐1 Expression in Dysplasia and Squamous Cell Carcinoma of the Oral Cavity
Authors: Jackson Lana L. , Wade Zane , Hessler Richard B. , Abdelsayed Rafik , Rogers Jeremy B. , Gourin Christine G. 
Published: April 2007

AbstractIntroduction: Decreased expression of syndecan‐1 has been reported in dysplasia and squamous cell carcinoma (SCCA) of the oral cavity and appears to correlate with decreasing histological differentiation and poor clinical outcome. Assays of syndecan‐1 expression to date have utilized manual microscopic analysis with qualitative grading of immunohistochemical staining intensity, which may introduce observer bias. We evaluated syndecan‐1 expression in dysplasia and squamous cell carcinoma (SCCA) of the oral cavity, using a novel automated cellular imaging system that incorporates both staining intensity as well as the percentage of positively stained cells to yield a quantitative value for syndecan‐1 expression.Materials and Methods: We performed a quantitative immunohistochemical analysis of syndecan‐1 expression using an automated cellular image analysis system. We analyzed specimens from cases of mild dysplasia (N = 55), moderate dysplasia (N = 38), severe dysplasia (N = 25), carcinoma in situ (CIS) (N = 43), and SCCA of the oral cavity (N = 45), using normal mucosal epithelium (N = 21) as a positive control. The SCCA specimens were further subdivided by degree of differentiation. We retrospectively reviewed patient charts to identify tumor stage at diagnosis, recurrence, and disease‐specific survival.Results: Syndecan‐1 expression was significantly greater in normal controls than in specimens of mild, moderate, or severe dysplasia, CIS, or invasive SCCA (P < .05). Syndecan‐1 expression did not differ significantly among specimens of mild, moderate, or severe dysplasia, CIS or SCCA. There was no significant difference in syndecan‐1 expression between specimens from patients with no evidence of disease at 3 years follow‐up and patients with local, regional, or distant recurrence.Conclusions: Syndecan‐1 expression does not appear to be useful as a marker of differentiation or as a prognostic indicator in dysplasia and SCCA of the oral cavity. The search for a suitable and reliable marker of biological aggressiveness is ongoing.
Prolonged Allergen Challenge in Murine Nasal Allergic Rhinitis: Nasal Airway Remodeling and Adaptation of Nasal Airway Responsiveness
Authors: Nakaya Muneo , Dohi Makoto , Okunishi Katsuhide , Nakagome Kazuyuki , Tanaka Ryoichi , Imamura Mitsuru , Yamamoto Kazuhiko , Kaga Kimitaka 
Published: April 2007

AbstractBackground: Nasal airway remodeling exists in allergic rhinitis, but it appears to be far less extensive than in asthma. However, there has been little study about nasal airway remodeling and no study using mice models. It has been reported that airway hyperresponsiveness decreased after prolonged allergen challenge in a chronic murine asthma model together with the progression of remodeling. However, there has been no study of the relation of remodeling and airway responsiveness in nasal allergy. Therefore, we have undertaken this investigation to characterize nasal airway structural changes after prolonged allergen challenge and to examine the relationship between nasal airway hyperresponsivity and remodeling.Methods: We prepared murine allergic rhinitis for ovalbumin. Mice were subsequently challenged three times a week with ovalbumin from day 19 to days 53, 88, and 130. We examined allergen‐induced nasal symptoms and objective nasal hyperresponsiveness using the enhanced pause system. Moreover, the pathologic changes were investigated after allergen challenge.Results: The extended allergen challenge protocol caused significant nasal airway remodeling. Specifically, remodeling was characterized by goblet cell hyperplasia and deposition of collagen in the submucosal area. Allergen‐induced nasal hyperresponsiveness was first increased but gradually decreased in nasal symptoms and Penh after prolonged allergen challenge.Conclusions: We have demonstrated that a remodeling of nasal mucosa in a murine allergic rhinitis model prolonged allergen exposure. Moreover, prolonged allergen exposure induced a reduction of nasal hyperresponsiveness together with a progression of nasal remodeling.
Bilateral Myringoplasty in Chronic Otitis Media
Authors: Caye‐Thomasen Per , Nielsen Torfinnur Rubek , Tos Mirko 
Published: April 2007

AbstractObjective: A theoretical risk of iatrogenic sensorineural hearing loss (HL) during surgery has induced a reluctance to perform bilateral myringoplasty/tympanoplasty type I among some otosurgeons. This paper presents results of bilateral surgery in 26 patients.Material and Methods: Twenty‐six patients with bilateral, dry tympanic membrane perforations caused by chronic otitis media were selected prospectively for bilateral myringoplasty/tympanoplasty type I (52 ears) at a tertiary referral center. All patients had a HL corresponding to the size and localization of the perforation (no suspicion of ossicular chain defect or other pathology). Mean age was 13.3 years, and the male to female ratio was 1.36. All but one ear were operated through a transcanal approach, and the onlay technique was used most frequently (83%), with use of fascia (56%), tragal perichondrium (38%), or cartilage palisades (6%) as graft material. Follow‐up examination and hearing tests (pure tone and speech audiometry) were performed at a mean of 13.8 months after surgery.Results: Perforation closure was obtained in 49 (94%) of the 52 ears. Hearing improved significantly, and the air‐bone gap was significantly reduced. The air‐bone gap was closed to within 10 dB in 92% and within 20 dB in 100% of the ears. Surprisingly good hearing was found during postoperative, bilateral ear canal gauze packing. Iatrogenic sensorineural HL did not occur.Conclusions: We conclude that bilateral myringoplasty is safe, with good results, reduces costs, and leaves the patient satisfied. The hearing impairment during postoperative ear canal packing is surprisingly modest and readily acceptable by the patients.
Upper Airway Mucin Gene Expression: A Review
Authors: Ali Mahmoud S. , Pearson Jeffrey P. 
Published: April 2007

AbstractIntroduction: The gel‐like properties of mucus depend primarily on its content of mucins. The protein backbones of mucins are encoded by mucin genes. Of the currently known 20 mucin genes that encode protein backbone of mucins, 16 have been identified in the airways.Method: We explored the current knowledge about upper airway mucin expression in health and disease conditions using a Medline search. We have also studied upper airway mucin gene expression and compared our results with the results from other studies.Results: MUC5AC, MUC5B, and MUC2 are the principal gel‐forming mucins secreted in the airway. However, the spectrum of mucin expression in chronic upper airway diseases such as nasal polyps, chronic sinusitis, middle ear effusion, and cystic fibrosis is generally wide and variable.Discussion: The wide spectrum of upper airway mucin expression is possibly caused by various anatomic and histologic features as well as physiologic and pathologic variables. These variables have not been fully explored yet, and the majority of airway mucin expression studies used small numbers of samples.Conclusion: Studies including adequate numbers of samples (patients) are more likely to reveal a clearer profile and more precise expression patterns. Generating a clear profile of mucin expression patterns in health and disease requires the analysis of different variables, which can alter that expression. It is also essential to understand the various molecular mechanisms controlling mucin gene and protein expression. This could lead to the invention of novel therapeutic modalities to treat upper airway diseases.
Cost‐Effective Diagnosis of Ingested Foreign Bodies
Authors: Shrime Mark G. , Johnson Paul E. , Stewart Michael G. 
Published: April 2007

AbstractObjectives: To compare the cost effectiveness of plain film radiography, computed tomography (CT), and endoscopy as initial diagnostic modalities in adult patients complaining of retained ingested foreign bodies.Design: A systematic literature review was conducted to determine key statistics for the analysis, such as prevalence of disease, prevalence of complications, and the sensitivity and specificity of each diagnostic modality. Costs were estimated using 2006 Medicare reimbursement for hospital and professional fees. A deterministic cost‐effectiveness analysis was then conducted using decision analysis software and a decision tree model to evaluate the various diagnostic strategies. After identifying initial results, we also performed sensitivity and threshold analysis to assess the strength of the recommendations.Results: We reviewed 316 abstracts, identified 16 pertinent studies that included a total of 7,088 patients with possible foreign bodies, and extracted key statistics from those papers. Decision analysis showed that CT scanning as an initial diagnostic strategy proved more cost effective than plain film or operative endoscopy. The incremental cost of immediate endoscopy for every additional correctly diagnosed patient was $5,238. Plain radiography was more costly and less effective, even with the addition of confirmatory CT scanning after a negative plain film. Sensitivity and threshold analyses demonstrated that these results are robust.Conclusions: Patients presenting with a complaint of a retained ingested foreign body are most cost‐effectively managed with CT scan, after history and physical. Immediate endoscopy may be considered if CT is not available, although it adds significant cost. Plain films are dominated by these two diagnostic strategies.
Systemic complications after head injury: a clinical review
Authors: Lim H. B. , Smith M. 
Published: April 2007

SummaryNon‐neurological organ dysfunction is common after traumatic brain injury and is an independent contributor to morbidity and mortality. It represents a risk factor that is potentially amenable to treatment, and early recognition and prompt intervention may improve outcome. This article reviews the current evidence for the mechanisms and treatment of non‐neurological organ dysfunction after head injury.
Manual displacement of the uterus during Caesarean section
Authors: Kundra P. , Khanna S. , Habeebullah S. , Ravishankar M. 
Published: April 2007

SummaryNinety ASA 1 and 2 pregnant women with term singleton pregnancies and no maternal and fetal complications, scheduled for elective or emergency Caesarean section, were randomly allocated to group LT (15° left lateral table tilt, n = 45) and group MD (leftward manual displacement, n = 45). Subarachnoid block was established with a 25‐gauge spinal needle at the L3‐L4 interspace using 1.5 ml of 0.5% hyperbaric bupivacaine. A median sensory level of T6 was observed in both groups but the incidence of hypotension was markedly lower in group MD when compared to group LT (4.4% vs 40%; p < 0.001) with a significant reduction in mean (SD) ephedrine requirement (6 (0) vs 11.3 (4.9) mg; p < 0.001). The mean (SD) fall in systolic blood pressure was 28.8 (7.3) mmHg in group LT and 20 (12.7) mmHg in group MD. The time to maximum fall in systolic blood pressure was similar in both groups (4.5 min). We conclude that manual displacement of the uterus effectively reduces the incidence of hypotension and ephedrine requirements when compared to 15° left lateral table tilt in parturients undergoing Caesarean section.
An evaluation of the filtration performance of paediatric breathing system filters at low flows
Authors: Malan C. A. , Wilkes A. R. , Hall J. E. , Gildersleve C. 
Published: April 2007

SummaryThe filtration performance of five different types of filter intended for use in paediatric anaesthesia was measured. A total of 120 unused filters (24 samples of each filter type) were evaluated. The pressure drop and filtration performance, using challenges of sodium chloride particles, were measured for each filter at 3 l min−1 and 15 l min−1. The pressure drop was less at the lower flow; there was a wide variation in the pressure drop across some filters. The filtration performance of all filter types showed an improvement at 3 l min−1 compared to 15 l min−1. Four filter types had filtration efficiencies greater than 95% at 15 l min−1 and greater than 99% at 3 l min−1. The remaining filter type had a filtration efficiency less than 90% at 15 l min−1 and greater than 95% at 3 l min−1. These levels of performance are comparable to that of breathing system filters intended for use in adult anaesthesia using flows representing mean inspiratory flow.
SLCO1B1 521T→C functional genetic polymorphism and lipid‐lowering efficacy of multiple‐dose pravastatin in Chinese coronary heart disease patients
Authors: Zhang Wei , Chen Bi‐Lian , Ozdemir Vural , He Yi‐Jing , Zhou Gan , Peng Dao‐Di , Deng Sheng , Xie Qi‐Ying , Xie Wei , Xu Lin‐Yong , Wang Lian‐Ci , Fan Lan , Wang An , Zhou Hong‐Hao 
Published: April 2007

What is already known about this subject • Both oral clearance as well as delivery of pravastatin to its molecular targets in hepatoctyes are greatly influenced by the organic anion transporting polypeptide 1B1 (OATP1B1), encoded by SLCO1B1.• The role of genetic factors that determine the marked interindividual variability in lipid‐lowering efficacy of pravastatin in Chinese patients is not known.• The present study was designed to evaluate the impact of a common functional genetic polymorphism in SLCO1B1 (521T→C: Val174Ala) on pravastatin efficacy in Chinese patients with coronary heart disease. What this study adds 521T→C functional genetic polymorphism of SLCO1B1 is significantly associated with an attenuated total cholesterol‐lowering efficacy of pravastatin in Chinese patients with coronary heart disease.AimsPravastatin is a 3‐hydroxy‐3‐methylglutaryl coenzyme A (HMG‐CoA) reductase inhibitor, which is widely used both in primary and secondary prevention of coronary heart disease (CHD). Pravastatin is not subject to metabolism by cytochrome P450s, but it is actively transported from blood into target tissues (e.g. hepatocytes in the liver) by the organic anion transporting polypeptide 1B1 (OATP1B1), encoded by SLCO1B1. The aim of the present study was to evaluate the impact of SLCO1B1 521T→C (Val174Ala) functional genetic polymorphism on the lipid‐lowering efficacy of multiple‐dose pravastatin in Chinese patients with CHD.MethodsForty‐five hospitalized patients with CHD prospectively received pravastatin as a single‐agent therapy (20 mg day−1 p.o.) for 30 days. Serum triglycerides, total cholesterol, low‐density lipoprotein‐cholesterol and high‐density lipoprotein‐cholesterol concentrations were determined before and after pravastatin treatment.ResultsPravastatin treatment significantly decreased plasma lipids in all patients (P < 0.001). Importantly, we showed an attenuated pravastatin pharmacodynamic effect on total cholesterol in patients with 521TC heterozygote genotype (from 5.52 ± 0.51 mmol l−1 to 4.70 ± 0.35 mmol l−1, % change  −14.5 ± 6.6%, N = 9) compared with 521TT homozygote genotype (from 5.47 ± 1.15 mmol l−1 to 4.21 ± 0.89 mmol l−1, % change −22.4 ± 10.3%, N = 36) (mean ± SD, P = 0.03, two‐tailed test with α set at 5%). SLCO1B1 521T→C functional polymorphism did not significantly influence pravastatin pharmacodynamics on other plasma lipids (P > 0.05).ConclusionsThe 521T→C polymorphism of SLCO1B1 appears to modulate significantly the total cholesterol‐lowering efficacy of pravastatin in Chinese patients with CHD. Further studies are warranted to determine the extent to which SLCO1B1 genetic variation may contribute to resistance to pravastatin in Asian patients treated with standard doses of pravastatin.
Pharmacokinetics of inhaled monodisperse beclomethasone as a function of particle size
Authors: Esposito‐Festen J. E. , Zanen P. , Tiddens H. A. W. M. , Lammers J.‐W. J. 
Published: April 2007

What is already known about this subject • For asthmatic adults, bronchodilators with a MMAD between 3 and 6 µm were shown to give the best improvement in lung function and the least systemic side‐effects.• It is not known, however, what is the most efficacious particle size for inhaled steroids in asthmatic adults. Clinical efficacy and systemic side‐effects of inhaled steroids should be measured to define the optimal particle size. What this study adds • Our study investigated the systemic absorption of inhaled steroids. We found that a particle size of 2.5 µm and 4.5 µm gave a higher pulmonary bioavailability compared with the 1.5 µm monodisperse aerosols in adults with mild asthma and therefore were more likely to elicit systemic adverse effects.AimsFor optimal efficacy, antiasthma drugs should be delivered to the desired region in the airways. To date, the optimal particle size for steroids in adults is not known. The aim of the study was to evaluate the pulmonary bioavailability for inhaled beclomethasone dipropionate (BDP) aerosols of different particle sizes.MethodsIn a randomized single‐blind crossover trial, 10 mild asthmatic patients inhaled monodisperse BDP aerosols with mass median aerodynamic diameters (MMADs) of 1.5, 2.5 and 4.5 µm. Gastrointestinal absorption was blocked by activated charcoal. Plasma concentrations of 17‐beclomethasone monopropionate (17‐BMP) were measured by liquid chromatography plus mass spectrometry.ResultsAerosols with MMADs of 1.5 µm, 2.5 µm, and 4.5 µm gave mean maximum concentrations (Cmax) of 17‐BMP of 475 pg ml−1, 1300 pg ml−1, and 1161 pg ml−1, respectively. The area under the curve (AUC) values of 17‐BMP for MMADs of 1.5 µm, 2.5 µm, and 4.5 µm were 825 pg ml−1 h, 2629 pg ml−1 h, and 2276 pg ml−1 h, respectively. The mean terminal half‐time of 17‐BMP for all three aerosol sizes was around 1.5 h.ConclusionsMonodisperse BDP aerosols with a MMAD of 1.5 µm gave two‐three fold lower values for Cmax and AUC than those with MMADs of 2.5 and 4.5 µm.