bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cochleovestibular Anomalies in Children With Cholesteatoma
Authors: Propst Evan J. , Blaser Susan , Trimble Keith , James Adrian , Friedberg Jacob , Papsin Blake C. 
Published: February 2009

AbstractObjective: To describe the cochleovestibular apparatus on computed tomography (CT) imaging in patients with cholesteatoma. We asked whether cochleovestibular anomalies coexist in individuals with cholesteatoma.Study Design: Randomized, controlled, prospective measurement.Methods: A database search yielded 145 children with cholesteatoma: 31 met inclusion criteria by not having sensorineural hearing loss, not having an associated syndrome, and having digitally stored temporal bone CT imaging available. Prospective measurement of 31 individuals (62 ears) with unilateral cholesteatoma and 32 normally hearing nonsyndromic controls (64 ears) was performed by a neuroradiologist blinded to the study objective. Twenty‐six temporal bone aspects on axial imaging were evaluated (16 measurement, 10 calculated from measurement).Results: The cholesteatoma group had a larger endolymphatic fossa and vestibular aqueduct, and there was a trend for the lateral semicircular canal vestibule to be smaller as compared with controls. Subgroup analysis revealed a gradient in prevalence of these findings being most common in the congenital cholesteatoma group, intermediate in the acquired cholesteatoma group, and least common in controls. There were no differences in measurements between ears with cholesteatoma and contralateral disease‐free temporal bones.Conclusions: Children with cholesteatoma have abnormal vestibular anatomy. The gradient in prevalence of these findings may suggest a relationship between congenital and acquired cholesteatoma. These may include a generalized temporal bone anomaly that predisposes to cholesteatoma formation, or a third variable such as genetic mutation may predispose to both anomalous cochleovestibular formation and cholesteatoma.
Does Tumor Depth Affect Nodal Upstaging in Squamous Cell Carcinoma of the Head and Neck?
Authors: Alkureishi Lee W. T. , Ross Gary L. , Shoaib Taimur , Soutar David S. , Robertson A G. , Sorensen Jens A. , Thomsen Jorn , Krogdahl Annelise , Alvarez Julio , Barbier Luis , Santamaria Joseba , Poli Tito , Sesenna Enrico , Kovács Adorján F. , Grünwald Frank , Barzan Luigi , Sulfaro Sandro , Alberti Franco 
Published: February 2009

AbstractPurpose: The aim of this study was to determine whether tumor depth affects upstaging of the clinically node‐negative neck, as determined by sentinel lymph node biopsy with full pathologic evaluation of harvested nodes including step‐serial sectioning (SSS) and immunohistochemistry (IHC).Patients and Methods: One hundred seventy‐two patients with cT1/2 N0 squamous cell carcinoma (SCC) of the oral cavity/oropharynx undergoing primary resection and either sentinel node biopsy (SNB) or SNB‐assisted neck dissection as a staging tool for the cN0 neck. Harvested nodes were examined with hematoxylin‐eosin staining, SSS, and IHC. Patients upstaged by SSS/IHC were denoted pN1mi.Results: One hundred one of 172 patients were staged pN0, with 71 (41%) patients upstaged. Increasing tumor depth was associated with higher likelihood of upstaging (P < .001). Tumor depth showed a positive correlation with nodal stage according to TNM classification (P < .001). Tumor depth greater than 4 mm appears to be the most appropriate cutoff for risk stratification, although tumors in the oropharynx may require a lower value.Conclusion: Tumor depth is an important prognostic factor for patients with SCC of the oral cavity or oropharynx. Tumors greater than 4 mm are associated with greater risk of upstaging; however, this optimum cutoff value may vary between primary tumor sites.
Selective Neck Dissection (IIA, III): A Rational Replacement for Complete Functional Neck Dissection in Patients With N0 Supraglottic and Glottic Squamous Carcinoma
Authors: Ferlito Alfio , Silver Carl E. , Rinaldo Alessandra 
Published: February 2009

AbstractIntroduction: The purpose of this paper is to determine the optimal elective treatment of the neck for patients with supraglottic and glottic squamous carcinoma. During the past century, various types of necks dissection have been employed including conventional and modified radical neck dissection (MRND), selective neck dissection (SND) and various modifications of SND.Materials and Methods: A number of studies were reviewed to compare the results of MRND and SND in regional recurrence and survival of patients with supraglottic and glottic cancers, as well as the distribution of lymph node metastases in these tumors.Results: Data from seven prospective, multi‐institutional, pathologic, and molecular analyses of neck dissection specimens, obtained from 272 patients with laryngeal squamous carcinoma and clinically negative necks, revealed only four patients (1.4%) with positive lymph nodes at sublevel IIB. Data was also collected from three prospective, multi‐institutional, pathologic and molecular studies of neck dissection specimens which include 175 patients with laryngeal squamous carcinoma (only 2 with subglottic cancer) and clinically negative necks. Only six patients (3.4%) had positive nodes at level IV.Conclusions: SND of sublevel IIA and level III appears to be adequate for elective surgical treatment of theneck in supraglottic and glottic squamous carcinoma. Dissection of level IV lymph nodes may not be justified forelective neck dissection of stage N0 supraglottic and glottic squamous carcinoma. Bilateral neck dissection incases of supraglottic cancer may be necessary only in patients with centrally or bilaterally located tumors.
A Novel Controlled Local Drug Delivery System for Inner Ear Disease
Authors: Paulson David P. , Abuzeid Waleed , Jiang Hao , Oe Tomoyuki , O'Malley Bert W. , Li Daqing 
Published: February 2009

AbstractPurpose: Our goal is to develop a novel drug delivery system that can potentially improve clinical outcomes compared to current methods of dosing drugs such as dexamethasone or gentamicin. This system focuses on a single local application to the inner ear via the round window membrane.Hypothesis: A chitosan‐glycerophosphate (CGP)‐hydrogel based drug delivery system can be engineered to provide local and sustained drug release to the inner ear.Study Design: In vitro: drug release and (CGP)‐hydrogel matrix degradation were characterized using dexamethasone as a model drug. In vivo: dexamethasone laden CGP‐hydrogel was placed in the round window niche of mice. Perilymph samples were obtained from the oval window and analyzed for dexamethasone. The impact of CGP‐hydrogel on auditory function was evaluated.Results: In vitro: A CGP‐hydrogel was designed to release 92% of the dexamethasone load over 4 consecutive days with concurrent degradation of the hydrogel matrix. In vivo: After surgical placement of CGP‐hydrogel to the round window niche, we detected elevated levels of dexamethasone in perilymph for 5 days. Auditory function testing revealed a temporary hearing loss in the immediate postoperative period, which resolved by the 10th postoperative day.Conclusions: We report the development of CGP‐hydrogel, a biodegradable matrix that achieves local, sustained delivery of dexamethasone to the inner ear. There were no significant complications resulting from the surgical procedure or the administration of CGP‐hydrogel to our murine model.
Effect of Radiation Techniques in Treatment of Oropharynx Cancer
Authors: Rusthoven Kyle E. , Raben David , Ballonoff Ari , Kane Madeleine , Song John I. , Chen Changhu 
Published: February 2009

AbstractObjectives: To compare the toxicity and outcomes of three radiotherapy techniques—three‐dimensional conformal (3D‐RT), accelerated fractionation with concomitant boost (AFxCB), and intensity modulated radiotherapy (IMRT)—in the combined modality treatment of stage III–IV squamous cell carcinoma (SCC) of the oropharynx.Study Design: Retrospective review.Methods: Between 1998 and 2007, a total of 87 patients were treated; 23 were treated with 3D‐RT, 32 with AFxCB, and 32 with IMRT. Systemic therapy consisted of platinum‐based chemotherapy in 81 and anti‐epidermal growth factor receptor (anti‐EGFR)‐targeted therapy in 6 cases. Median radiotherapy doses were 70Gy with 3D‐RT, 72Gy with AFxCB, and 69.3Gy with IMRT. Locoregional control, survival outcomes, and feeding tube (PEG) dependence were compared using log‐rank method. The incidence of acute mucositis and skin reaction, and grade ≥2 xerostomia at 6, 12, and 18 months after radiotherapy was compared using Fisher's exact test.Results: Median follow‐up was 24 months (range 3 to 103 months) for living patients. Two‐year overall survival (OS), disease‐free survival (DFS), and locoregional control (LRC) were 77.3%, 69.5%, and 86.4%, respectively. There was a trend toward improvement in LRC in patients treated with IMRT. Acute grade ≥3 skin and mucosal toxicity were significantly lower with IMRT compared to AFxCB (P < .001). Grade ≥2 xerostomia was significantly reduced with IMRT compared to AFxCB and 3D‐RT (P < .001). There was no difference in the actuarial rate of PEG dependence (P = .96).Conclusions: Compared to AFxCB and 3D‐RT, IMRT confers an improvement in toxicity and appears to have similar efficacy in patients with SCC of the oropharynx.
Clinical Implications of Anterolateral Thigh Flap Shrinkage
Authors: Ng Raymond W. M. , Chan Jimmy Y. W. , Mok Vivian , Leung Mark S. C. , Yuen Anthony P. W. , Wei William I. 
Published: February 2009

AbstractObjective: To evaluate anterolateral thigh flap shrinkage after elevation and to develop a predictive model for flap design.Method: A prospective study was conducted in a university teaching hospital. The skin islands from anterolateral thigh flaps were outlined on a transparent sheet before and after the reconstruction procedure. Dimensions of the stretched flaps were also recorded. These three outlines were scanned and the surface areas computed and compared by tracing and use of AutoCAD. Age, sex, flap dimension, and flap thickness were investigated for association with flap shrinkage.Results: Forty‐five anterolateral thigh flaps harvested for head and neck soft tissue reconstruction after tumor resection were studied. Flap size ranged from 4 to 14 cm in width and 8 to 22 cm in length; flap area ranged from 30.6 to 151.0 cm2. On average, the flaps shrunk by 25.0% (6.2%–52.6%), a highly significant change (P < .01). Flap width and thickness correlated with the reduction in flap size. The average stretched‐flap area was 10.1% (0.4%–29.4%) less than the preflap area, a significant reduction (P < .01). The difference between stretched‐flap and preflap areas was independent of all variables. We developed a predictive model using a stepwise multiple linear regression method with a coefficient of determination of 0.495.Conclusions: Anterolateral thigh flaps shrink after harvesting, and flap width and thickness are significant contributing variables. These findings indicate that flap size must take shrinkage into account to ensure sufficient coverage.
Sentinel Node Mapping for Node Positive Oral Cancer: Potential to Predict Multiple Metastasis
Authors: Matsuzuka Takashi , Kano Makoto , Ogawa Hiroshi , Miura Tomohiro , Tada Yasuhiro , Matsui Takamichi , Yokoyma Shuji , Suzuki Yasushi , Suzuki Masahiro , Omori Koichi 
Published: February 2009

AbstractObjective: The objective of this study is to evaluate lymph node mapping for clinically positive neck metastasis using a sentinel node navigation technique.Methods: 99mTc‐labeled rhenium sulfide was injected as a radiotracer in 10 patients with squamous cell carcinoma of the tongue. After surgery, lymph nodes were classified into two categories according to the radioactive accumulation: nodes with radioactivity and nodes without radioactivity. The ratio of the metastatic area (RMA) of pathologically metastatic lymph nodes was measured.Results: In 5 of 10 cases, all of the metastatic nodes had radioactive accumulation. In one case with three metastatic nodes, radioactivity was not detected in one metastatic node, although it was detected in the other two nodes. In the other four cases, there were no radioactivities in any of the metastatic nodes. RMA of lymph nodes in which radioactivity was not detected was higher than that of lymph nodes in which radioactivity was detected. None of the nodes in which radioactivity was detected was fully occupied by metastatic carcinoma cells. In each case, in comparing the clinically positive lymph nodes, RMA of the nodes in which no radioactivity was detected was higher than that of the nodes in which radioactivity was detected.Conclusion: The principle behind the sentinel node technique is detection of the node that has the most lymph flow from the tumor through injection of the tracer into the circumference of the tumor. When no radioactive accumulation is found in clinically positive metastatic lymph nodes, the possibility of metastasis to other lymph nodes should be highly suspected.
Novel Adenoviral Gene Delivery System Targeted Against Head and Neck Cancer
Authors: Li Daqing , Guang Wei , Abuzeid Waleed M. , Roy Soumitra , Gao Guang‐Ping , Sauk John J. , O'Malley Bert W. 
Published: February 2009

AbstractObjectives: The clinical applicability of adenovirus‐mediated gene therapy is limited by the lack of tumor‐targeted strategies. Ubiquitous expression of the coxsackie‐adenovirus receptor, the native binding site for adenovirus, broadens viral tropism and increases systemic toxicity. Adenoviruses can be genetically engineered to target tumor‐specific cell surface biomarkers. Here, we present a novel recombinant adenovirus vector (Ad5‐Flag‐LDS) that demonstrated a marked targeting bias against Hsp47, a biomarker for head and neck squamous cell carcinoma (HNSCC).Methods: Cell surface expression of Hsp47 was determined in six human HNSCC cell lines and in negative and positive control cells. Colocalization of LDS and Hsp47 was assessed by immunocytochemistry in Ad5‐Flag‐LDS‐transfected cells, and subsequent transgene expression was determined. The contribution of the Hsp47 biomarker in mediating targeted gene transfer was evaluated with a blocking assay. Ad5‐Flag‐LDS‐targeting efficacy in a mixed cell population was determined by immunofluorescence.Results: HNSCC cells had significantly higher Hsp47 biomarker density than control cell lines. After Ad5‐Flag‐LDS transfection, significant colocalization was found between the LDS peptide and Hsp47 biomarker, indicating that viral entry occurred via Hsp47‐LDS binding. This unique tumor‐targeted entry feature significantly enhanced gene transfer relative to an untargeted adenoviral vector. Blockade of Hsp47 biomarkers abrogated transgene expression, indicating that Hsp47 has a dominant role in Ad5‐Flag‐LDS targeting. Ad5‐Flag‐LDS‐targeting selectivity was maintained in a cell mixture, producing greater transgene expression in Hsp47‐expressing cells.Conclusions: The enhanced targeting achieved with Ad5‐Flag‐LDS highlights a potential strategy for clinically applicable targeted gene therapy against HNSCC or any tumor type expressing Hsp47.
Fabrication of a Neotrachea Using Engineered Cartilage
Authors: Weidenbecher Mark , Tucker Harvey M. , Awadallah Amad , Dennis James E. 
Published: February 2009

AbstractObjectives: Surgical management of long‐segment tracheal stenosis is an ongoing problem. Many types of tracheal prostheses have been tried but with limited success because of immune rejection, graft ischemia, or restenosis. Tissue engineered cartilage may offer a solution to this problem, although scaffolds, which are currently often used for support, can lead to biocompatibility problems. This study investigated the feasibility of scaffold‐free cartilage to tissue engineer a vascularized neotrachea in rabbits.Study Design: Animal study.Methods: Autologous neotracheal constructs were implanted in the abdomen of six New Zealand white rabbits. Auricular chondrocytes were used to engineer scaffold‐free cartilage sheets. A muscle flap raised from the external abdominal oblique muscle and the engineered cartilage were wrapped around a silicone stent to fabricate a vascularized neotrachea in vivo. In two of the six rabbits, a full thickness skin graft was used to create an epithelial lining. The constructs were harvested after either 6 or 10 weeks.Results: All neotracheal constructs were healthy with well‐vascularized and integrated layers. The implanted engineered cartilage underwent a remodeling process, forming a solid tracheal framework. Constructs harvested after 10 weeks proved to have significantly better mechanical properties than after 6 weeks and were comparable with the rabbit's native trachea.Conclusion: Scaffold‐free engineered cartilage can successfully fabricate a well‐vascularized, autologous neotrachea with excellent mechanical properties. The results suggest that this approach can be used to reconstruct tracheal defects in rabbits.
Neck Hematoma Caused by Spontaneous Common Carotid Artery Rupture
Authors: Pazardzhikliev Dimitar Dimitrov , Yovchev Ilya Petkov , Zhelev Drago Dragov 
Published: February 2009

AbstractWe present a case of an 83‐year‐old male without previous history who presented with a cervical hematoma, initially misdiagnosed as a neck phlegmona. In the course of the diagnostic workup, the hematoma enlarged, thereby causing respiratory distress because of upper airway compromise. The endotracheal intubation was lifesaving. Later, contrast enhanced computed tomography revealed hematoma in the region of the left common carotid artery. Emergency surgery evacuated the hematoma and repaired a slit‐like defect of the left common carotid 2 cm before bifurcation. The patient was discharged on the seventh postoperative day in good condition. We discuss four aspects of the case, namely, the rarity of the condition and the variety of causes, the diagnostic and treatment strategy, the uncertain reasons for spontaneous ruptures of the carotid, and the operative techniques for hematoma evacuation and definitive hemostasis. The optimal strategy for cases of cervical hematoma is the following: intubation, diagnosis, and surgery.
Increased Nerve Fiber Expression of Sensory Sodium Channels Nav1.7, Nav1.8, and Nav1.9 in Rhinitis
Authors: Keh Siew M. , Facer Paul , Simpson Karen D. , Sandhu Guri , Saleh Hesham A. , Anand Praveen 
Published: February 2009

AbstractIntroduction: Voltage‐gated sodium channels Nav1.7, Nav1.8, and Nav1.9 are involved in nerve action potentials and have been proposed to underlie neuronal hypersensitivity. We have therefore studied their levels in allergic and nonallergic rhinitis.Materials and Methods: Inferior turbinate biopsies from 50 patients (n = 18 controls, n = 20 allergic, and n = 12 nonallergic rhinitis) were studied by immunohistology using antibodies to Nav1.7, Nav1.8, and Nav1.9, the structural nerve marker (protein gene product [PGP]9.5), nerve growth factor (NGF), mast cells (c‐kit), macrophages (CD68), and T cells (CD3). Sodium channel‐positive nerve fibers were counted per millimeter length of subepithelium, and immunoreactivity for inflammatory cell markers PGP9.5 and NGF were image analyzed.Results: All three sodium channel‐immunoreactive nerve fiber numbers were significantly increased in allergic (Nav1.7, P = .0004; Nav1.8, P = .028; Nav1.9, P = .02) and nonallergic (Nav1.7, P = .006; Nav1.8, P = .019; Nav1.9, P = .0037) rhinitis. There was a significant increase of subepithelial innervation (PGP9.5, P = .01) and epithelial NGF immunoreactivity (P = .03) in nonallergic rhinitis, comparable with our previous report in allergic rhinitis. Inflammatory cell markers were significantly increased in allergic (mast cells, P = .06; macrophages, P = .044; T cells, P = .007) but not nonallergic rhinitis.Conclusion: The increased levels of sensory sodium channels in allergic and nonallergic rhinitis may contribute to the hypersensitive state, irrespective of the degree of active inflammation. Selective blockers of these sodium channels, administered topically, may have therapeutic potential in rhinitis.
Image‐Guidance for Endoscopic Sinus Surgery
Authors: Fried Marvin P. , Parikh Sanjay R. , Sadoughi Babak 
Published: February 2009

AbstractObjectives/Hypothesis: Image‐guided surgery (IGS) is a critical tool. However, its clinical validity remains controversial. A review of indications and a consensus based on literature are presented.Methods: Literature review.Results: Traditional indications remain valid. Novel applications have emerged, and the reliability of IGS has been consistently endorsed. Although evidence is based on scattered reports and expert opinions, the use of IGS in approved instances is regarded as the state of the art.Conclusions: IGS is reliable, and a scientific validation of outcomes would entail unethical strategies. An expanding spectrum of indications is anticipated, although IGS does not replace proper training.
Day Float: An Alternative to the Night Float Coverage System for Residency Programs
Authors: Suryadevara Amar C. , Zandifar Hootan , Guyer Marci , Kellman Robert M. 
Published: February 2009

AbstractObjectives: The Accreditation Council for Graduate Medical Education (ACGME) has mandated an 80‐hour work week that has resulted in changes to many residency programs. In otolaryngology, most programs have switched to either home call or night float systems. Our department covers all of the maxillofacial trauma and backup airway calls, which has made it difficult to employ a home call system. Instead of a night float coverage system, our program implemented a day float coverage system that allows the residents to participate in a 24‐hour call period. After call and sign‐out, the residents go home; however, their clinical duties are covered by the day float resident.Study Design: A brief review of the literature pertaining to call coverage systems followed by a description of our day float system. Residents who have participated in either night float, day float, or both systems were then surveyed regarding their experiences or perceptions of both systems.Methods: A nine‐question survey was handed out to our otolaryngology residents and their responses were recorded.Results: The averaged responses strongly favored the day float over the night float coverage system regardless of the level of training and the systems in which the residents have participated.Conclusions: The day float coverage system is favored by residents in our program. It allows for a more attending‐like 24‐hour period of call, continuity of care, attendance at educational activities, and more time with family. In addition, it eliminates a prolonged period devoid of clinical activities.