bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection in Singapore Is Usually “Healthcare Associated”
Authors: Tambyah Paul A. , Habib Abdulrazaq G. , Ng Toon-Mae , Goh Helen , Kumarasinghe Gamini 
Published: March 2006

AbstractObjecttve:To assess the frequency of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections.Setting:A teaching hospital in Singapore.Methods:Prospectively collected surveillance data were reviewed during a 1-year period to determine the extent and origin of community-acquired MRSA infections.Results:Whereas 32% of 383 MRSA infections were detected less than 48 hours after hospital admission and would, by convention, be classified as “community acquired,” all but one of these were among patients who had been exposed to outpatient centers including dialysis or chemotherapy clinics, visiting nurses, community hospitals, or all three.Conclusions:With health care increasingly being delivered in an outpatient setting, community-acquired MRSA infections are often acquired in hospital-related sites and most may be more accurately described as “healthcare acquired.” Infection control measures need to move beyond the traditional paradigm of acute care hospitals to effectively control the spread of resistant pathogens.
Rates of Carriage of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus in an Outpatient Population
Authors: Kenner Julie , O'Connor Tasha , Piantanida Nicholas , Fishbain Joel , Eberly Bardwell , Viscount Helen , Uyehara Catherine , Hospenthal Duane 
Published: March 2006

AbstractObjectives:To assess the prevalence of and the clinical features associated with asymptomatic Staphylococcus aureus colonization in a healthy outpatient population, and to compare the characteristics of colonizing methicillin-resistant S. aureus (MRSA) strains with those of strains causing infection in our community and hospital.Setting:Outpatient military clinics.Methods:Specimens were obtained from the nares, pharynx, and axillae of 404 outpatients, and a questionnaire was administered to obtain demographic and risk factor information. MRSA strains were typed by pulsed-field gel electrophoresis (PFGE) and evaluated for antibiotic susceptibility. Antibiograms of study MRSA strains were compared with those of MRSA strains causing clinical illness during the same time period.Results:Methicillin-susceptible S. aureus (MSSA) colonization was present in 153 (38%) of the 404 asymptomatic outpatients, and MRSA colonization was present in 8 (2%). Detection of colonization was highest from the nares. No clinical risk factor was significantly associated with MRSA colonization; however, a tendency was noted for MRSA to be more common in men and in those who were older or who had been recently hospitalized. All colonizing MRSA strains had unique patterns on PFGE. In contrast to strains responsible for hospital infections, most colonizing isolates of MRSA were susceptible to oral antibiotics.Conclusions:MRSA and MSSA colonization is common in our outpatient population. Colonization is best detected by nares cultures and most carriers of MRSA are without apparent predisposing risk factors for acquisition. Colonizing isolates of MRSA are heterogeneous and, unlike nosocomial isolates, often retain susceptibility to other non-beta-lactam antibiotics.
Minimally Invasive Thyroidectomy: Basic and Advanced Techniques
Authors: Terris David J. , Gourin Christine G. , Chin Edward 
Published: March 2006

AbstractObjective: Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. We advocate at least two distinct approaches, depending on the disease process and multiple patient factors. The technical aspects are explored in depth with liberal use of videographic demonstration.Methods: The authors conducted a comparison of two distinct surgical techniques with photographic and videographic documentation of two distinct minimal access approaches to the thyroid compartment termed minimally invasive thyroidectomy (MITh) and minimally invasive video‐assisted thyroidectomy (MIVAT). Both historic and previously unpublished data (age, gender, pathology, incision length, and complications) are systematically analyzed.Results: Patients who underwent minimally invasive thyroidectomy (n = 31) had a mean age of 39.4 ± 10.7 years; seven were male and 24 were female. The most common diagnosis was follicular or Hürthle cell adenoma (29%), followed by papillary or follicular cancer (26%). The mean incision length was 4.9 ± 1.0 cm. One patient developed a hypertrophic scar and one patient developed thrombophlebitis of the anterior jugular vein. There were 14 patients in the MIVAT group with a mean age of 43.7 ± 11.4 years; one was male and 13 were female. The majority of patients had follicular adenoma (42.9%) or papillary carcinoma (21.4%) as their primary diagnosis. The mean incision length was 25 ± 4.3 mm (range, 20–30 mm), and there were no complications.Conclusions: Two distinct approaches to minimal access thyroid surgery are now available. The choice of approach depends on a number of patient and disease factors. Careful patient selection will result in continued safe and satisfactory performance of minimally invasive thyroid surgery.
Heme Oxygenase (HO)‐1 Is Upregulated in the Nasal Mucosa With Allergic Rhinitis
Authors: Elhini Ahmed , Abdelwahab Soha , Ikeda Katsuhisa 
Published: March 2006

AbstractBackground: Heme oxygenase (HO) is considered to be an antioxidant enzyme that catabolizes heme to produce carbon monoxide (CO) and biliverdin. Three isoforms of HO have been discovered. Recently, HO‐1 has been found to be upregulated after allergic inflammations of the lower airway.Objective: The objective of this study was to address the expression of HO isoenzymes 1 and 2 in the nasal mucosa of patients with allergic rhinitis as well as normal control subjects.Methods: Nasal mucosa from 30 patients with persistent allergic rhinitis as well as from 10 normal volunteers was used in this study. We used immunofluorescent technique, Western blotting, and real‐time quantitative polymerase chain reaction to localize and quantify the expression of these isoenzymes in normal and allergic human nasal tissues.Results: We found that HO‐1 is expressed in the epithelial cells of seromucinous glands and macrophages with significant upregulation of its glandular expression in allergic rhinitis but with no difference in its macrophage expression between the study groups in contrast to HO‐2 that is expressed in the vascular endothelial lining cells as well as macrophages with no marked difference between the study groups.Conclusion: We demonstrated that expression of HO‐1, but not HO‐2, was upregulated within the nasal tissues in allergic rhinitis inflammation, and understanding the induction of HO‐1 expression may provide for better management of allergic rhinitis that involves oxidative stress.
Factors Associated with Long‐Term Complications after Repair of Mandibular Fractures
Authors: Furr Andrea Marie , Schweinfurth John M. , May Warren L. 
Published: March 2006

AbstractEducational Objective: At the conclusion of this paper, the participants should be able to identify, compare, and discuss the natural history of complications of mandible fractures and repair.Objectives: To analyze factors affecting the incidence of long‐term complications after the repair of mandible fractures. To determine whether the use of antibiotics at any time in the course of treatment impacted the development of complications.Study Design: Retrospective medical record review.Methods: Medical records for patients with mandibular fractures treated surgically over a 5 year period were reviewed for demographics, history of substance abuse, etiology, location of fracture, any associated facial injury, type and timing of repair, pre‐, peri‐, and postoperative antibiotic treatment, length of hospitalization, and lag time to repair. The development of infectious and other complications after surgery, specifically, the development of abscesses, fistulae, mal/nonunion, hardware exposure, or extrusion, were recorded.Results: Of 273 subjects, 56 fractures were repaired using open reduction internal fixation (ORIF) alone, 112 mandibulomaxillary fixation (MMF), and 105 with a combination of MMF and ORIF. Eighteen (6.6%) patients developed an infectious or related long‐term complication. These included abscess (n = 4), infected hardware (n = 1), mal/nonunion (n = 8), and hardware exposure/extrusion (n = 9). Smoking and alcohol abuse (P = .021) and the use of plating techniques (P = .04) correlated with a higher incidence of long‐term complications. Patient age, sex, location and etiology of fracture, associated facial injury, lag time to repair, length of hospitalization, and the use of antibiotics at any time after injury or repair were unrelated to the development of complications.Conclusions: The development of infection, nonunion, and related complications after the repair of mandibular fractures correlates with a history of tobacco and alcohol use and ORIF of multiple fractures, but there were no statistically significant relationships to patient demographics, fracture site, lag time to repair, length of hospitalization, or the use of antibiotics. In this series, antibiotic therapy appears to have had no impact on the development of postoperative complications.
Olfactory Dysfunction in Leprosy
Authors: Mishra Anupam , Saito Kenji , Barbash Scott E. , Mishra Nimisha , Doty Richard L. 
Published: March 2006

AbstractLeprosy (Hansen's disease) is associated with a high incidence of nasal pathology. Despite this fact, the influence of this disorder on the sense of smell is poorly understood. In this study, we administered a standardized 12‐item odor identification test to 77 patients with three types of leprosy: tuberculoid (n = 9), borderline (n = 42), and lepromatous (n = 26). All three types exhibited significantly lower test scores than their respective age‐, sex‐, and smoking–habit‐matched controls. Patients with lepromatous leprosy exhibited significantly lower test scores than those with the other two types. Only patients with lepromatous leprosy exhibited meaningful improvement in smell function after treatment. No association between disease duration, per se, and the severity of the olfactory deficit was present. Overall, 100% of the patients exhibited olfactory dysfunction, suggesting that earlier prevalence estimates based on nonstandardized olfactory testing have underestimated the prevalence of this problem.
Cyclin D1 and D3 Expression in Vestibular Schwannomas
Authors: Neff Brian A. , Oberstien Elly , Lorenz Mark , Chaudhury Abhik R. , Welling D Bradley , Chang Long‐Sheng 
Published: March 2006

AbstractObjectives: The G1 regulators of the cell cycle, cyclin D1 and D3, have been implicated in the regulation of Schwann cell proliferation and differentiation. The purpose of this study is to evaluate cyclin D1 and D3 protein expression and the corresponding clinical characteristics of vestibular schwannomas.Study Design and Methods: Tissue sections of 15 sporadic vestibular schwannomas were prepared. Immunohistochemical analysis of the vestibular schwannomas was performed with anticyclin D1 and anticyclin D3 antibodies. The immunoreactivity was evaluated in comparison with adjacent vestibular nerves. Tissue sections of breast carcinoma and prostate carcinoma were used as positive controls for cyclin D1 and D3 staining, respectively. Patient demographics, tumor characteristics, and cyclin D expression were reviewed, and statistical analysis was performed.Results: While the breast carcinoma control expressed abundant cyclin D1 protein, none of the 15 vestibular schwannomas showed detectable cyclin D1 staining. In contrast, seven of 15 vestibular schwannomas stained positive for the cyclin D3 protein. Cyclin D3 staining was taken up in the nucleus of schwannoma tumor cells in greater proportion than Schwann cells of adjacent vestibular nerve. Although sample size was small, no significant difference in the average age of presentation, tumor size, and male to female ratios for the cyclin D3+ or cyclin D3− groups was found.Conclusion: The Cyclin D1 protein does not appear to play a prominent role in promoting cell cycle progression in vestibular schwannomas. In contrast, cyclin D3 expression was seen in nearly half of the tumors examined, suggesting that it may have a growth‐promoting role in some schwannomas. Further studies are needed to define its cellular mechanism.
Up‐Regulation of MUC5AC and MUC5B Mucin Genes in Nasopharyngeal Respiratory Mucosa and Selective Up‐Regulation of MUC5B in Middle Ear in Pediatric Otitis Media with Effusion
Authors: Elsheikh Mohamed Nasser , Mahfouz Magdy ElSayed 
Published: March 2006

AbstractObjectives: Mucins are the major component responsible for the gel‐like properties of mucus secretion. Currently, little is known about the regulation of mucins in otitis media with effusion (OME). We investigated the expression of MUC5AC and MUC5B mucin gene messenger (m)RNAs in middle ear effusions as well as in tissue biopsies of the respiratory mucosa of the nasopharynx by means of reverse‐transcription polymerase chain reaction (RT‐PCR).Study Design: A prospective, controlled, clinical trial.Methods: The study group consisted of 25 children with a diagnosis of OME who were to undergo bilateral ventilation tube insertion with adenoidectomy. A sample of middle ear effusion (n = 50) as well as tissue biopsy from nasopharyngeal respiratory mucosa (n = 25) were obtained from each patient. For the nasopharyngeal mucosal biopsies, two control groups were made up from 30 children with healthy ears who underwent tonsillectomy ± adenoidectomy operation; control A, 15 children with adenoid hypertrophy, and control B, 15 children with healthy nasopharynx. RNAs were extracted from effusion and tissue samples, and semiquantitative RT‐PCR was performed for MUC5AC and MUC5B to investigate their expression.Results: In the middle ear effusions, MUC5B mRNA expression was detected in 48 (96%), whereas MUC5AC mRNA was detected in 8 (16%). On semiquantitative analysis, MUC5AC/glyceraldehyde 3‐phosphate dehydrogenase (GAPDH) and MUC5B/GAPDH mRNA ratios in the study group were significantly increased compared with those in both control groups (P < .05).Conclusions: The results suggest that the middle ear has a unique mucin gene expression pattern when compared with that of the nasopharynx. Up‐regulation of MUC5B in the ear may play an important role in the pathogenesis of middle ear effusions.
Treatment of Contralateral N0 Neck in Early Squamous Cell Carcinoma of the Oral Tongue: Elective Neck Dissection versus Observation
Authors: Lim Young Chang , Lee Jin Seok , Koo Bon Seok , Kim Se‐Heon , Kim Young‐Ho , Choi Eun Chang 
Published: March 2006

AbstractObjectives/Hypothesis: Prophylactic treatment of contralateral N0 neck in early squamous cell carcinoma (SCC) of the oral tongue is a controversial issue. The aim of this study was to analyze the rates of occult metastases and their prognostic effects in stage I and stage II SCC of the oral tongue, and to compare the results of elective neck dissection to observation of the contralateral N0 neck in the treatment of these patients.Study Design: Retrospective review.Methods: We reviewed the medical records of 54 patients who were treated at Severance Hospital from 1992 to 2003 and had been diagnosed with stage I or stage II SCC of the oral tongue and had not received prior treatment. All patients underwent an ipsilateral elective neck dissection simultaneously with the primary lesion. The management of the contralateral N0 necks involved “watchful waiting” in 29 patients and elective neck dissection in 25 patients. Surgical treatment was followed by radiotherapy in 20 patients. Of these, seven patients belonged to the “observation” group who did not receive contralateral elective neck dissection. The follow‐up period ranged from 3 to 110 months, with a mean of 56.3 months. Data were analyzed using the Kaplan‐Meier method, the log‐rank test, and the ξ2 test.Results: Fifteen patients (28%, 15 of 54) had occult metastases. Of these, 14 patients (26%, 14 of 54) had ipsilateral pathologic metastases. The remaining case (4%, 1 of 25) had the only contralateral level II occult neck metastasis without ipsilateral metastasis. Disease recurred in 17 of 54 patients (31%). Of these, eight cases (47%, 8 of 17) had regional recurrences. All regional recurrences developed in the ipsilateral neck; there were no cases of contralateral neck recurrence. The 5‐year actuarial disease‐free survival rates were 82% for the “observation” group and 68% for the elective neck dissection group. This difference was not statistically significant (P = .182). The 5‐year actuarial disease‐free survival rates were 83% for the “observation” group when those patients who underwent radiotherapy were excluded (n = 22) and 68% for the elective supraomohyoid neck dissection group (n = 25), which showed no statistically significant difference (P = .127).Conclusions: This study showed that ipsilateral elective neck management is indicated for stage I and II SCC of the oral tongue. On the other hand, our series suggests that contralateral occult lymph node metastasis was unlikely in early‐stage oral tongue SCC, and that there was no survival benefit for patients who underwent elective neck dissection in place of observation. Thus, it may not harmful to observe the contralateral N0 neck in the treatment of early oral tongue cancer.
Acoustic Analysis of Snoring Sounds by a Multidimensional Voice Program
Authors: Hara Hirotaka , Murakami Naoko , Miyauchi Yuji , Yamashita Hiroshi 
Published: March 2006

AbstractObjectives: This prospective study aimed to determine whether the acoustic characteristics of snoring sounds differed between simple snorers and patients with obstructive sleep apnea syndrome (OSAS) by using a multidimensional voice program (MDVP) that analyzes various aspects of voice.Methods: Fifty‐eight patients (48 men, 10 women) with a history of snoring were included in the study. All patients underwent conventional polysomnography (PSG). Twelve subjects were diagnosed as simple snorers and 46 subjects were diagnosed with OSAS. The mean body mass index (BMI) of simple snorers was 24.7 kg/m2 and that of patients with OSAS was 25.8 kg/m2. Natural overnight snoring was recorded from each subject while they slept during PSG. Using the multiple token protocols of MDVP, 30 snores from each subject were analyzed automatically. For data analysis, four markers were used: peak frequency, soft phonation index (SPI), noise to harmonics ratio (NHR), and power ratio.Results: The Mann‐Whitney U test revealed significant differences between the SPI, NHR, and power ratio of simple snorers and patients with OSAS. Simple snorers had a high SPI value. OSAS‐related snorers demonstrated a high NHR and low power ratio.Conclusions: MDVP can be used for snoring sound analysis as a noninvasive examination of sleep‐related breathing disorders for differential diagnosis. However, a suitable option that is rapid and has an easy‐to‐use interface would be more advantageous for analyzing snoring sounds.
Breath Actuated Device Improves Delivery to Target Sites Beyond the Nasal Valve
Authors: Djupesland Per Gisle , Skretting Arne , Winderen Mette , Holand Trond 
Published: March 2006

AbstractObjectives: The objective was to compare nasal deposition patterns achieved with a conventional hand actuated spray pump and a novel breath actuated bidirectional prototype device housing the same spray pump (OptiMist™, OptiNose AS, Oslo, Norway).Study Design and Methods: The bidirectional delivery device exploits the posterior connection between the nasal passages persisting when the velum automatically closes during oral exhalation. The deposition and clearance patterns achieved with the two devices were compared in nine healthy subjects by scintigraphy after administration of 99mTc‐aerosols.Results: Compared with traditional spray pump delivery, the OptiMist device provided significantly (P < .004) larger initial and cumulative deposition (area under the deposition vs. time curve) in the upper posterior segment of the nasal passage, housing the sinus ostia and the olfactory region, and significantly lower deposition (P < .004) in the anterior segment, lined by nonciliated squamous epithelium. Furthermore, intersubject reproducibility of the initial and cumulative deposition was higher for the OptiMist™ device both in the upper posterior segment and the entire nose.Conclusions: Compared with a spray pump, the novel breath actuated bidirectional device provides significantly larger deposition in the clinically important regions beyond the nasal valve and reduced anterior deposition. These striking differences provide new opportunities for improved therapy of chronic rhinosinusitis and polyposis as well as extended use of the nose for delivery of drugs from the nose into the brain.
Sublingual Gland Resection in Squamous Cell Carcinoma of the Floor of Mouth: is it Necessary?
Authors: Clark Jonathan R. , Franklin Jason H. , Naranjo Natalie , Odell Michael J. , Gullane Patrick J. 
Published: March 2006

AbstractObjectives Little evidence exists to guide surgeons in the management of the sublingual glands (SLG) not macroscopically involved by squamous cell carcinoma of the floor of mouth and oral tongue. This study aims to determine the frequency with which the SLG is invaded, to identify variables predicting for SLG invasion and the morbidity associated with it's resection in entirety.Study design: Retrospective cohort study.Methods: A review of 164 patients treated for oral cavity cancer at a tertiary institution with a large volume of head and neck malignancy was performed. Demographic data, rates of surgical complications and follow up information was recorded. Pathologic review of resected material in this group yielded 134 specimens in the region of the SLG. A detailed analysis of 63 specimens in which the SLG was included was carried out.Results: The median age was 58 years, mean follow up was 2.2 years, and there were 44 males and 19 females. Seventeen cases (27%) demonstrated histopathological SLG invasion. In patients with SLG involvement, this was evident at the time of surgery in 15 patients (88%). Microscopic SLG invasion, without macroscopic evidence at surgery, was present in only 4.2% of patients undergoing SLG resection. Clinical and pathological T stage (p = 0.023 and 0.005) and tumor thickness (p = 0.015) predicted for SLG invasion. Total SLG resection significantly increased the post‐operative wound complication rate from 14% in patients without SLG resection to 25% (p = 0.05).Conclusion: Total SLG resection in early stage and thin squamous cell carcinoma of the floor of mouth and oral tongue provides minimal oncologic benefit and is associated with increased perioperative morbidity due to neck wound complications.
Operative Management of a Posterior Semicircular Canal Dehiscence
Authors: Mikulec Anthony A. , Poe Dennis S. 
Published: March 2006

AbstractObjective: The objective of this study was to describe the operative management of posterior canal dehiscence.Methods: A transmastoid approach to and plugging of the posterior canal was performed for posterior semicircular canal dehiscence (PSCD).Results: Postoperatively, the patient exhibited improvement in conductive hearing loss and vestibular symptoms.Conclusions: PSCD can cause symptoms identical to that of superior semicircular canal dehiscence. Successful PSCD plugging can be performed without visualization of the actual area of dehiscence.