bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurological soft signs in adolescents with first episode psychosis
Authors: Zabala Arantzazu , Robles Olalla , Parellada Mara , Moreno Dolores Maria , Ruiz-Sancho Ana , Burdalo Maite , Medina Oscar , Arango Celso 
Published: December 2005

AbstractThe purpose of this study is to determine the decrease of neurological soft signs (NSS) during adolescence and to compare this evolutionary process in two groups of adolescents with first episode psychosis: a) schizophrenia and b) non-schizophrenia patients. The structured neurological evaluation scale (NES) was administered to 24 adolescents with first episode psychosis. The number of NSS, the total and subscales scores were correlated with age in patients and in 39 healthy controls. Adolescents with first-episode psychosis had a higher prevalence of NSS than healthy controls; the schizophrenia patients (N = 9) scored higher than non-schizophrenia patients (N = 15). The number of NSS, total score and the scores on three of the four NES subscales correlated inversely with age in the healthy control group. No correlation was found for the schizophrenia group. For the non-schizophrenia group, a significant negative correlation was found only in one subscale. The decrease of NSS during adolescence in the healthy population but not in the patient groups with psychosis may be an indicator of a disturbance of brain processes that occurs during development. We did not find a clear pattern of NSS that distinguished schizophrenia from other psychoses.
Modeling of residential structure fire response: Exploring the hyper‐project
Authors: Simpson N.C. 
Published: December 2005

AbstractEmergency service systems such as community fire departments respond to and resolve unplanned events within a given service area. A review of the literature addressing such systems indicates that existing research is almost exclusively focused on higher level planning issues such as facility location and resource allocation. In contrast, this study addresses the operational level of such a system, an existing fire department's response to residential structure fire. Such a response exhibits many of the elements of traditional project management, such as distinctly defined tasks and significant predecessor relationships. However, the defining characteristic of these projects is not simply expediency, but the fact that the structure of the project can change if the preceding project structure does not complete some aspect of its task sequence within an interval of time dictated by some external pacing function. What emerges is a unique and intriguing class of project, dubbed the hyper‐project in this study. The concept of the hyper‐project is discussed both in its general form and with respect to the aforementioned case study example. Readily transferable to non‐emergency applications, the hyper‐project typifies and unites a heretofore unrecognized family of operations, highlighting the opportunities for future research.
Erbium: Yttrium‐Aluminum‐Garnet Laser Application in Stapedotomy
Authors: Galli Jacopo , Parrilla Claudio , Fiorita Antonella , Marchese Maria Raffaella , Paludetti Gaetano 
Published: December 2005

OBJECTIVETo assess clinical safety and efficacy of the erbium: yttrium‐aluminum‐garnet (Er:YAG) laser in the stapes surgery; to define and optimize parameters that render the procedure safe for the inner ear.STUDY DESIGNRetrospective study.MATERIAL AND METHODSA microscope‐integrated Er: YAG laser stapedotomy was performed on 29 patients and a conventional stapedotomy on 41 patients. An early (within 1 to 3 days after stapes surgery) and late (at least 6 weeks) pure‐tone bone‐conduction threshold audiogram was obtained.RESULTSNo statistically significant differences were found by Student's t test over all measured frequencies between pre‐ and postoperative bone‐conduction thresholds in each group. There was no statistically significant difference for all frequencies between early (3 days) and late postoperative mean bone‐conduction thresholds.CONCLUSIONSThe results of our preliminary clinical study showed that erbium laser poses no risk to inner ear function. However, the lack of standardization obliges further investigation to establish safe clinical parameters of the Er:YAG laser.EBM RATINGB‐3
Is Routine Frozen Section Necessary for Parathyroid Surgery?
Authors: Dewan Anil K. , Kapadia Silloo B. , Hollenbeak Christopher S. , Stack Brendan C. 
Published: December 2005

OBJECTIVESuccessful parathyroidectomy requires identification and excision of 1 or more abnormal parathyroid glands. The pathologist confirms or refutes the intraoperative presence of parathyroid tissue in excised material. With the advent of radionuclide scanning and rapid parathyroid hormone assays, the role of routine frozen section (FS) has once again been called into question. Our aim was to assess the need for routine FS in tissue identification during parathyroidectomy in a series of 50 consecutive cases.METHODSWe analyzed 50 consecutive parathyroidectomies performed by a single surgeon from December 2002 to August 2003. Diagnoses on gross examination (GE) of both the surgeon and the pathologist were recorded, cytologic smears made, and FSs performed. A cost analysis was also performed.RESULTSOf the 50 parathyroidectomies performed (35 adenoma and 15 hyperplasia), both surgeon and pathologist's opinions on GE were concordant. Incorrect gross identification occurred by both in 6% (3) of the cases. GE is a cost‐effective means of identifying parathyroid tissue.CONCLUSIONSExperienced parathyroid surgeons need not routinely request FS examination. The decision to omit intraoperative FS examination must be balanced against the potential implications of misdiagnosis and a repeat operative procedure.EBM RATING:C
The Association of Tongue Scalloping With Obstructive Sleep Apnea and Related Sleep Pathology
Authors: Weiss Todd M. , Atanasov Strahil , Calhoun Karen H. 
Published: December 2005

OBJECTIVEThe association between OSAS and patient history and physical exam findings is previously established; however, to our knowledge there are no studies that evaluate the role of tongue scalloping as a reliable clinical indicator for OSA, snoring, or the presence of other sleep pathology as evidenced by polysomnography. This study evaluates the hypothesis that such an association exists.SUBJECTS AND METHODSSixty‐one otolaryngology clinic patients were evaluated by history and physical exam for the presence and degree of tongue scalloping, snoring, and other previously established clinical indicators for sleep‐disordered breathing and obstructive apnea. Twenty‐five of the 61 study patients were additionally evaluated by overnight polysomnography to provide conclusive diagnosis of sleep pathology. The degree of tongue scalloping was graded from 0 to 3 and its significance as a screening, diagnostic, and predictive factor for sleep pathology was then statistically determined.RESULTSTwenty‐seven patients (44%) had known or newly documented OSA and 47 (77%) had a history of snoring. Twenty‐seven patients (44%) had some degree of tongue scalloping (1‐3) and 74% of these patients were male. The presence of any degree of tongue scalloping (grade 1‐3) in patients with known or newly documented OSA showed sensitivity, specificity, PPV, and NPV of 52%, 68%, 70%, and 50% respectively. The presence of tongue scalloping in patients with either known snoring history or newly documented snoring showed sensitivity, specificity, PPV, and NPV of 47%, 64%, 81%, and 26% respectively. Presence of tongue scalloping was 71% specific for abnormal sleep efficiency (<85%), 70% specific for abnormal AHI (>5), and 86% specific for nocturnal desaturation >4% below baseline. Presence of tongue scalloping also showed PPV of 67% for abnormal AHI, 89% for apnea or hypopnea, and 89% for nocturnal desaturation. Presence and severity of tongue scalloping showed positive correlation with increasing Mallampati and modified Mallampati airway classification.CONCLUSIONSIn high‐risk patients we found tongue scalloping to be predictive of sleep pathology. Tongue scalloping was also associated with pathologic polysomnography data and abnormal Mallampati grades. We feel the finding of tongue scalloping is a useful clinical indicator of sleep pathology and that its presence should prompt the physician to inquire about snoring history.EBM RATINGC
Septopalatal Protraction for Correction of Nasal Septal Deformity in Cleft Palate Infants
Authors: Moore Corey C. , MacDonald Ian , Latham Ralph , Brandt Michael G. 
Published: December 2005

OBJECTIVEIt is proposed to test the practicality of septopalatal protraction in the unilateral cleft palate infant for purposes of straightening the nasal septum and thus relieving nasal airflow obstruction and its detrimental sequelae.METHODSAlternate infants affected with complete unilateral palatal clefts had septopalatal protraction for a period of 6 to 8 weeks (protraction group; n = 4). Septal deviation was measured by a standardized technique that used computed tomography scans. The remaining infants had no protraction and served as controls (nonprotraction group; n = 5). Septal deviation was measured in the nonprotraction group from palatoseptal dental molds.RESULTSA total of 9 patients were studied. All patients in the nonprotraction group had worsening of nasal septal deviation over a period of 8 weeks compared with the protraction group, which had complete nasal septal straightening. Differences in septal angle deviation between the protraction group and nonprotraction group at the end of the study were statistically significant (P ≤ 0.01) as measured by the paired Student t test.CONCLUSIONSSeptopalatal protraction in the newborn appears to provide a means for correcting nasal septal deviation in complete unilateral cleft palate infants. Septopalatal protraction in the newborn is relatively easy and safe.EBM RATING: B‐2
The Efficacy of Computer Assisted Surgery in the Endoscopic Management of Cerebrospinal Fluid Rhinorrhea
Authors: Tabaee Abtin , Kassenoff Tali L. , Kacker Ashutosh , Anand Vijay K. 
Published: December 2005

OBJECTIVETo determine the outcome of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea with and without computer assisted surgery.STUDY DESIGNA review of all patients undergoing endoscopic closure of CSF rhinorrhea at a tertiary care medical center between 1994 and 2003. Charts from the 24 patients were reviewed for indications, location of leak, type of surgical closure, number of prior closure attempts, graft materials, use of computer assisted surgery, complications, and need for revision surgery. Analysis was performed to determine a possible correlation between success of CSF leak repair and use of computer assisted surgery.RESULTSThe etiology of the leak was previous sinus surgery in 10 patients (41.7%), trauma in 5 patients (20.8%), spontaneous leak in 5 patients (20.8%), and skull base surgery in 4 patients (16.7%). The most common sites of leak were the fovea ethmoidalis in 10 patients (41.7%), cribriform plate in 8 patients (33.3%), and sphenoid sinus in 6 patients (25%). Image guidance was employed in 66.7% (16 patients) of our first attempted repairs. Six patients underwent a total of 9 revision procedures. At last follow‐up, 96% of patients had no evidence of CSF rhinorrhea. A comparison of patients in the 2 groups failed to reveal a statistically significant difference in the rate of CSF leak closure.CONCLUSIONEndoscopic closure of CSF rhinorrhea represents a minimally invasive and highly successful procedure. The use of computer assistance may improve the confidence of the surgeon and is a valuable adjunct in this procedure. Our study, however, did not demonstrate an improvement in the rates of successful closure with the use of computer assistance.EBM RATINGC
Transtympanic Gentamicin and Fibrin Tissue Adhesive for Treatment of Unilateral Menière's Disease: Effects on Vestibular Function
Authors: Casani Augusto , Nuti Daniele , Franceschini Stefano Sellari , Gaudini Elisa , Dallan Iacopo 
Published: December 2005

OBJECTIVETo determine the effects of transtympanic injections, with a mixture composed of gentamicin and fibrin tissue adhesive (FTA), on vestibular function of patients with intractable unilateral Menière's disease.STUDY DESIGNThis was an open, prospective study.SETTING AND PATIENTSThe study was performed at 2 tertiary referral centers. Twenty‐six patients affected by “definite” unilateral Menière's disease, unresponsive to medical therapy for at least 6 months, were enrolled.INTERVENTIONA buffered gentamicin solution mixed with FTA was injected in the middle ear until the development of bedside vestibular hypofunction signs and/or caloric weakness in the treated ear.MAIN OUTCOME MEASUREVestibular function was evaluated by 3 bedside vestibular tests (observation of spontaneous nystagmus, head shaking test, and head thrust test) and by a caloric test. Tests were performed on days 10 and 30 after completion of treatment. Tests were also performed 3, 6, and 12 months from completion of the gentamicin‐FTA protocol. The effects of treatment were also assessed in terms of hearing levels, control of vertigo, and disability status.RESULTSIn 22 of the 26 patients, only 1 gentamicin‐FTA injection was necessary to obtain 1 or more signs indicating a reduction of the vestibular function in the treated ear. Four patients needed another treatment because of the persistence of their incapacitating symptoms during the follow‐up. Four patients needed more than 1 injection to obtain a vestibular hypofunction. None of the patients who received 1 or 2 injections presented hearing loss in direct temporal relationship to the treatment.CONCLUSIONSA mixture of gentamicin and fibrin glue makes it possible to considerably reduce the number of administrations in patients with intractable unilateral Menière's disease. Spontaneous nystagmus, post head shaking nystagmus, and a head thrust sign are the clinical signs that indicate onset or progression of unilateral vestibular hypofunction. These signs were obtained with only 1 injection in 81% of patients.EBM RATINGC
Bipolar Radiofrequency Dissection Tonsillectomy: A Prospective Randomized Trial
Authors: Ragab Sameh M. 
Published: December 2005

OBJECTIVESTo conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra‐operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage.MATERIALS AND METHODSFrom January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intraoperative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with.RESULTSThere was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT (P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters (P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications.CONCLUSIONBRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra‐operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy.EBM RATINGA
Thyroid Lymphoma: A Single Institution's Experience
Authors: Ruggiero Francis P. , Frauenhoffer Elizabeth , Stack Brendan C. 
Published: December 2005

BACKGROUNDPrimary lymphoma of the thyroid gland is uncommon.METHODSThe tumor registry at the Penn State Milton S. Hershey Medical Center was searched for all patients carrying a diagnosis of thyroid lymphoma. All available records for these patients were examined and information regarding patient and tumor characteristics, clinical presentation, interventions, and survival were tabulated.RESULTSThe average age of patient in our series was 67.5 years. There was a 2.7:1 female to male preponderance. Thirteen (60%) patients presented with thyroid nodule(s). Eleven (50%) presented with aerodigestive tract obstructive symptoms. Sixteen (73%) patients had no pre‐existing history of thyroid disease; none had known pre‐existing Hashimoto's thyroiditis.CONCLUSIONSThe typical thyroid lymphoma patient is female and elderly with painless thyroid enlargement. Compressive symptoms of the aerodigestive tract are common at presentation and may require urgent intervention. Treatment modalities (XRT, CHOP chemotherapy) and outcomes are distinct from other thyroid malignancies.EBM RATINGC
The Sternomastoid Branch of the Occipital Artery: A Surgical Landmark for the Spinal Accessory Nerve in Selective Neck Dissections
Authors: Rafferty Mark A. , Goldstein David P. , Brown Dale H. , Irish Jonathan C. 
Published: December 2005

OBJECTIVETo evaluate the anatomic relationship between the spinal accessory nerve (SAN) and the sternomastoid branch of the occipital artery (SBOA) and its utility as a surgical landmark during a selective neck dissection (SND).STUDY DESIGN AND SETTINGSConsecutive patients undergoing SND for squamous cancer from October 1, 2004 to February 28, 2005 were enrolled in this study. During surgery the distance between the SBOA and the point of insertion of the SAN into the sternomastoid muscle (SMM) was measured.RESULTSTwenty‐four patients underwent 33 SND. The distance between the SBOA and SAN ranged between 1 and 11 mm, with a mean of 6.2 mm and a median of 6 mm.CONCLUSIONThe relationship between these 2 structures has a range and constancy that is acceptable as a landmark.SIGNIFICANCEThis article presents a useful adjunct for location of the SAN in the anterior neck during SND.EBM RATINGC
The Importance of Long‐term Follow‐up of Head and Neck Cancer Patients for Reliable Survival Analysis
Authors: Priante Antonio Vitor Martins , Carvalho André Lopes , de Cássia Braga Ribeiro Karina , Contesini Hirde , Kowalski Luiz Paulo 
Published: December 2005

OBJECTIVEAnalyze the influence of patients lost to follow‐up in estimated survival rates calculated by the Kaplan‐Meier method.STUDY DESIGNOnly patients with previously untreated squamous cell carcinoma of the upper aerodigestive tract were selected. For the patients lost to follow‐up anytime, the last medical evaluation date was collected to calculate the “estimate A” survival time. If the same patient returned to our outpatient clinic or further health information was obtained, the updated last information/evaluation date was also collected to calculate “estimate B” survival time. The survival curves considering “estimate A” and “B” survival rates were compared.RESULTSThe overall 5 and 10‐years survival rates for all patients calculated for “estimate A” were 54.0% and 46.0%, respectively; compared with 42.8% and 28.2% when were calculated considering “estimate B” (P < 0.001).CONCLUSIONClose follow‐up of the head and neck cancer patients is essential for an accurate estimate of survival by KaplanMeier method.EBM RATINGC
Facial Nerve Outcomes in Middle Cranial Fossa vs Translabyrinthine Approaches
Authors: Isaacson Brandon , Telian Steven A. , El‐Kashlan Hussam K. 
Published: December 2005

OBJECTIVETo compare the final facial nerve outcomes between middle cranial fossa (MCF) vs translabyrinthine (TL) resection of size‐matched vestibular schwannomas.STUDY DESIGN AND SETTINGRetrospective case review at a tertiary care hospital. All patients who underwent resection utilizing either MCF or TL approaches with tumors 18 mm or smaller and complete data were included in the analysis. One hundred twenty‐four patients were identified meeting the above criteria, with sixty‐three in the translabyrinthine group and sixty‐one in the middle fossa group. One‐week‐postoperative and final facial nerve examinations were compared in the two surgical groups. Patients were separately analyzed in subgroups: tumors smaller than 10 mm and those that were between 10 and 18 mm.RESULTSThe tumor size range for the MCF group was 3‐18 mm while it was 4‐18 mm for the TL group. No statistically significant difference was found in facial nerve outcomes between the two surgical groups, at the first postoperative visit week and at last follow‐up.CONCLUSIONFacial nerve outcomes are similar using TL and MCF approaches for resection of vestibular schwannomas up to 18 mm in size.SIGNIFICANCEPatients undergoing the MCF approach for hearing preservation can be counseled that there is no increased risk of permanent facial nerve weakness, compared to the TL approach.EBM RATING: B‐3
Magnetic Airway Implants for the Treatment of Obstructive Sleep Apnea Syndrome
Authors: Nelson Lionel M. , Boucher Ryan P. , Stevens Sheila S. 
Published: December 2005

OBJECTIVETo evaluate repelling magnetic implants to treat obstructive sleep apnea (OSA) using a canine model.STUDY DESIGN AND SETTINGMagnetic forces equivalent to effective CPAP were estimated with benchtop studies. An acute canine model was used to simulate pharyngeal collapse. Tolerance, safety, and stability of the implants were evaluated in a chronic series of 10 dogs observed over 6 months.RESULTSEquivalence to CPAP (10‐12 cm H20) was achieved with low‐force (<10 g/cm length), light (approximately 2 gram) implants. Magnetic implants prevented airway collapse in the acute canine. Normal behavior, swallowing, and oral intake were noted in the chronic canine over 6 months. Implant extrusion was 10%. Histology showed fibrous encapsulation without chronic inflammation.CONCLUSIONSRepelling magnets successfully maintained a patent airway and were well tolerated in the canine.SIGNIFICANCERepelling magnets could represent an implantable alternative to CPAP if human studies reveal similar findings.
Sinonasal Distribution of Topically Applied Particles: Computerized Tomographic Detection and the Effects of Topical Decongestion
Authors: Senocak Dogan , Senocak Mustafa , Bozan Serkan 
Published: December 2005

OBJECTIVEDetermine the efficacy of computerized tomography (CT) in detecting the intranasal distribution of sprayed radio‐enhanced particles and the effects of topical decongestion on particle distribution.STUDY DESIGNSinonasal distribution of a radio‐enhanced spray solution was studied using CT imaging in 14 adults with no sinonasal symptoms. One nostril was sprayed with oximetazoline 5 minutes prior to particle application. Serial CT imaging of the sinonasal cavity in approximately 11 minutes was carried out to detect particle distribution into the nasal vestibule, turbinate surfaces, middle meatus and osteomeatal complex area, and the nasopharynx.RESULTSParticle detection within the nasal vestibule was possible in all cases while distribution into the anterior nasal chamber was visible in 22 cases. Particles could be detected on the inferior turbinate in 7 nasal cavities (25%) and in only 2 cases on the middle turbinate (7.5%). Particles were detected in the middle meatus in 1 case and in no instances in the osteomeatal complex area. Oximetazoline application reduced the amount of particle deposition on the inferior turbinate but did not enhance distribution on the middle turbinate or into the middle meatus.CONCLUSIONDetection of radio‐enhanced sprayed particles within the sinonasal cavity using CT imaging can be a reliable method to study the principles of intranasal particle distribution. Our study failed to show particle distribution into OMC, or any positive effects of nasal decongestion on particle distribution.EBM RATINGC