bluuebunny/crossref_metadata_2025_split huggingface dataset:
Locoregional Control of Clinically Diagnosed Multifocal or Multicentric Breast Cancer After Neoadjuvant Chemotherapy and Locoregional Therapy
Authors: Oh Julia L. , Dryden Mark J. , Woodward Wendy A. , Yu Tse-Kuan , Tereffe Welela , Strom Eric A. , Perkins George H. , Middleton Lavinia , Hunt Kelly K. , Giordano Sharon H. , Oswald Mary Jane , Domain Delora , Buchholz Thomas A. 
Published: October 2006

Purpose The purpose was to assess whether patients with clinical multifocal or multicentric (MFMC) breast cancer determined by mammogram, ultrasound, or physical examination have inferior outcome compared with patients with clinical unicentric lesions. Patients and Methods We retrospectively analyzed 706 consecutive patients with stages I-III breast cancer treated at the M.D. Anderson Cancer Center (Houston, TX) from 1976 to 2003 who received neoadjuvant anthracycline-based chemotherapy followed by breast conservation therapy (BCT), mastectomy alone, or mastectomy plus postmastectomy radiation therapy. Results The mean follow-up was 66 months. At presentation, 97 of 706 patients had clinically MFMC disease (13.7%). The 5-year rate of locoregional failure was 10% for unicentric disease compared with 7% for MFMC disease (P = .78). Subset analyses of patients by treatment groups confirmed no statistical difference in locoregional control regardless of the type of locoregional treatment. Among patients with multifocal disease treated with BCT, there were no in-breast recurrences and one supraclavicular recurrence. Five-year disease-free survival and overall survival was equivalent between patients with MFMC and unicentric breast cancers. Conclusion Patients with clinical MFMC breast cancer at the time of diagnosis treated with neoadjuvant chemotherapy followed by locoregional therapy have similar 5-year rates of locoregional control, disease-free survival, and overall survival as those with unicentric disease. Clinically detected MFMC disease did not predict for inferior outcome.
Prolonged intubation vs. tracheotomy: Complications, practical and psychological considerations
Authors: Astrachan David I. , Kirchner J. Cameron , Goodwin W. Jarrard 
Published: October 2006

AbstractThe charts of 52 adult patients who underwent tracheotomy (49 after intubation) were reviewed to identify early complications of both endotracheal intubation and tracheotomy. The complication rate of endotracheal intubation was 57%, and of tracheotomy, 14%. None of the complications of tracheotomy was serious.Sixty critical‐care nurses were surveyed about their attitudes regarding prolonged endotracheal intubation and tracheotomy. A large majority preferred tracheotomy for patients who require airway support, for several reasons. First, they felt that tracheotomy patients were more comfortable and, therefore, required less sedation and restraint. Second, the patients could communicate more effectively. Third, airway care was simplified. Ninety‐two percent of nurses stated that they would prefer a tracheotomy for themselves or a loved one if more than 10 days of ventilatory support were required.We conclude that tracheotomy can be performed safely in this group of patients, and that it offers significant practical and psychological benefits compared to prolonged endotracheal intubation.
Reflux as an etiological factor of carcinoma of the laryngopharynx
Authors: Ward Paul H. , Hanson David G. 
Published: October 2006

AbstractThis study examined charts and 16‐mm pictures or videotapes of 138 patients with carcinoma of the larynx treated during the last 10 years. Among these patients, 19 were nonsmokers and nondrinkers or only light social drinkers with moderate to severe gastroesophageal reflux (GER). Serial cinephotographs are presented with follow‐up of up to 10 years. The common presence of GER in these nonsmoking, nondrinking patients and the probable role of this chronic irritative disorder as a causative agent in carcinoma of the laryngopharynx are discussed.
Nerve transfer versus teflon® injection for vocal cord paralysis: A comparison
Authors: Crumley Roger L. , Izdebski Krzysztof , Mcmicken Berry 
Published: October 2006

AbstractTeflon® injection for unilateral vocal cord paralysis frequently produces an improved yet breathy voice. Ansa hypoglossi‐recurrent laryngeal nerve anastomosis has been performed in five patients. In the four patients discussed in this paper, excellent phonatory quality has been achieved. Electroacoustic analysis indicates that this technique may produce normal phonatory function in paralyzed larynges.There have been no serious side effects or complications in our first five patients. Denervation of the sternothyroid muscle, which results from sectioning its nerve in preparation for suture to the RLN, appears to further improve the voice by medially positioning the vocal cord. Gelfoam® paste is injected at the time of nerve transfer to rehabilitate the voice during the 2 months required for nerve regeneration.For younger patients, or those with professional use of their voices, this technique offers superior speech results when compared with Teflon® injection.
Preoperative chemotherapy in advanced resectable head and neck cancer: Final report of the southwest oncology group
Authors: Schuller David E. , Stem David W. , Metch Barbara , Mattox Douglas , Mccracken Joseph D. 
Published: October 2006

AbstractIn 1980, the Southwest Oncology Group instituted a multi‐institutional, prospective, randomized phase III trial to evaluate whether inductive chemotherapy improved survival in patients with advanced stage resectable squamous cell carcinoma of the head and neck. From a group of 158 eligible patients, 76 were randomized to conventional treatment (surgery and postoperative radiotherapy), and 82 were assigned to experimental treatment (induction chemotherapy, surgery, postoperative radiotherapy). Median follow‐up for living patients was approximately 5 years. These analyses include chemotherapy responses and toxicities, surgical complications, radiotherapy toxicities, patient compliance, survival time, and patterns of treatment failure. Overall chemotherapy response was 0.70 (0.19 CR, 0.51 PR). The median survival time for conventional treatment was longer than the time for patients receiving preoperative chemotherapy, although the survival time differences were not statistically significant. This final analysis demonstrates no benefit in survival using preoperative chemotherapy for advanced stage, resectable head and neck squamous cell carcinoma.
Surgical management of recurrent nasopharyngeal carcinoma after radiation failure at the primary site
Authors: Fee Willard E. , Gilmer Patricia A. , Gopffinet Don R. 
Published: October 2006

AbstractNine patients have undergone transpalatal resection of recurrent nasopharynx cancer 10 to 56 months following a full course of external beam, irradiation. Seven patients were treated for cure, and two were treated palliatively because of nasal airway obstruction, recurrent epistaxis, and severe headaches. Of the patients treated for cure, five are living free of disease 6 to 48 months (mean, 22.2 months) after their surgery. Disease recurred in two patients at 5 and 7 months. Both underwent secondary procedures and are alive with disease at 25 months and 11 months, respectively. The mean hospital stay was 8.7 days (range, 2 to 30 days) for all patients. The average time to swallowing was 2 days (range, 1 to 3 days). Six patients required resection of their soft palate and a soft palate obturator; two patients had intact functioning soft palates without velopharyngeal insufficiency.Of the two patients treated for palliation, one patient died 1 year postoperatively and, although she received some benefit from the resection (diminished headaches), in retrospect, surgery was not worthwhile. The second patient is alive 3 years following her resection and remained symptom‐free for 2 years.
In search of missing links in otology. I. development of a collagen‐based biomaterial
Authors: Goycoolea Marcos V. , Muchow David C. , Scholz Matt T. , Sirvio Larry M. , Stypulkowski Paul H. 
Published: October 2006

AbstractExperiments leading to the development and use of a biomaterial based on reconstituted collagen for use in tympanoplasty are presented. A stable, even membrane with optimal strength and an organized matrix of collagen protein strands has been obtained. Biocompatibility was documented by subcutaneous implantation, cytotoxicity with agar overlay, cell contact, and cell‐growth inhibition studies. Experimental grafting in chinchillas with perforated tympanic membranes demonstrated that the collagen membrane performed well in all cases. Histopathological studies in chinchillas showed that the collagen membrane compared favorably with fascia grafts. Of significance is that: 1. The membrane has a matrix of microperforations that enhance tissue ingrowth, allow stable anchoring, and permit aeration of the middle ear cavity. 2. The membranes obtained are not exposed to aldehyde cross‐linking; therefore, tissue reaction due to aldehydes is avoided.
Efficacy of feedback training in long‐standing facial nerve paresis
Authors: Ross Brenda , Nedzelski Julian M. , McLean J. Arline 
Published: October 2006

AbstractAn efficacious treatment has not been available to patients with aberrant regeneration of the facial nerve as a result of Bell's palsy or after acoustic neuroma excision. This prospective controlled trial examines the efficacy of electromyographic feedback versus mirror feedback as treatment strategies for patients suffering from long‐standing (18 months minimum) facial nerve paresis. Twenty‐five patients were randomly assigned to electromyography with mirror feedback or mirror feedback alone. Seven rural patients who did not undergo treatment served as controls. At 0,6, and 12 months, facial motor function was objectively quantified by linear measurement of facial movement, visual assessment of voluntary movement, and electrical measurement of facial nerve response to maximal stimulation. Statistically significant improvements were noted in both electromyography and mirror‐feedback groups with respect to symmetry of voluntary movement (P < .03) and linear measurement of facial expression (P < .01). The positive results of this controlled trial demonstrate that feedback training in combination with a structured home rehabilitation program is a clinically efficacious treatment for patients with facial nerve paresis.
Detection of intraoperative laser injury to the facial nerve by electromyographic monitoring of facial muscles
Authors: Wiegand David A. , Mertz Pamela S. , Latz Barbara 
Published: October 2006

AbstractInjury to the facial nerve is a significant risk during resection of cerebellopontine angle tumors. To minimize the risk of facial nerve injury, intraoperative electromyographic monitoring of facial musculature is frequently used. However, the reliability of such monitoring systems for detection of thermal nerve injury resulting from the use of carbon dioxide lasers has not been systematically evaluated. We determined the sensitivity of a computerized electromyographic monitor for detection of laser facial nerve injury in an anesthetized rat model. The mandibular and buccal branches of the facial nerve were isolated in 12 rats. A carbon dioxide laser was used to create controlled sites of thermal injury to both nerves over a 3‐hour period. When a laser injury was created distal to previous injury sites, electromyographic discharge was noted in 72% to 82% of injuries. Laser injury proximal to previous injury sites was detected with 33% efficiency. These detection rates did not change significantly over a 3‐hour period. This preliminary data suggests that electromyographic monitoring of facial musculature allows detection of facial nerve injury caused by carbon dioxide lasers.
Uvulopalatopharyngoplasty: Evaluation of postoperative complications, sequelae, and results
Authors: Zohar Yuval , Finkelstein Yehuda , Talmi Yoav P. , Bar‐Ilan Yakov 
Published: October 2006

AbstractA study of 71 patients with obstructive sleep apnea syndrome was performed to evaluate the effectiveness, complications, and late sequelae of uvulo‐palatopharyngoplasty. Postoperative immediate complications were of minor importance. In 96% of the patients, the snoring was improved; it was completely resolved in 48%. The postoperative apnea index remained pathologic in all patients who underwent postoperative polysomnography, although mild improvement was noted. Seventy‐four percent of our patients felt a subjective postoperative improvement which was not always confirmed by the polysomno‐graphic examination. A record of improvement was obtained in 64% of the operated patients. Our results establish the beneficial effect of uvulopalatopharyn‐goplasty, which is the recommended surgical procedure for obstructive sleep apnea syndrome.
Transoral approach to the upper cervical spine
Authors: Merwin Gerald E. , Post J. Christopher , Sypert George W. 
Published: October 2006

AbstractThe transoral approach to pathology of the upper cervical spine is logical, but it is seldom used due to concerns about exposure and infection. The authors report on 16 consecutive patients requiring exposure from clivus through C3 for pathology, including spinal cord compression by rheumatoid pan‐nus, craniovertebral anomalies, and tumor. Exposure was obtained using a Dingman mouth gag and soft palate retraction with silicone rubber sheeting. A horizontal “H” incision was made in the posterior pharyngeal wall creating three layers, closed separately, with attention to a watertight closure of the final mucosal layer. In no case was it necessary to divide the mandible, tongue, soft palate, or uvula. There were no deaths, wound breakdowns, infections, or persistent cerebrospinal fluid leakage. Patients with neurological indications improved postopera‐tively, and all tumors were grossly resected.Combined otolaryngology/neurosurgical exposure and treatment of pathology involving the upper cervical spine via the transoral approach is safe and effective. Functional results have been excellent, and no major complications were encountered.
Anatomic considerations in botulinum toxin type a therapy for spasmodic dysphonia
Authors: Castellanos Paul F. , Gates George A. , Esselman Gregory , Song Felix , Vannier Michael W. , Kuo Michael 
Published: October 2006

AbstractChemodenervation by injection of botulinum toxin type A into the vocal fold(s) has become the preferred treatment for patients with adductor spasmodic dysphonia. Injection may be done either perorally or transcutaneously; each method has its advocates and advantages. The authors have used the transcutaneous transcricothyroid membrane route exclusively with satisfactory results in more than 50 patients. Temporary breathiness and aspiration are common.The preferred injection site should be as close as possible to the motor end plates of the affected muscle. The thyroarytenoid muscle end plates are distributed throughout the muscle, whereas in the lateral cricoarytenoid muscle they are located in band in the center of the muscle. The transcutaneous injection site is below and posterior to the midpoint of the vibrating vocal fold as visualized by indirect laryngoscopy. The proximity of this site to the lateral cricoarytenoid muscle suggests that postinjection breathiness and aspiration may be related to spread of botulinum toxin type A to the lateral cricoarytenoid muscle. However, it is likely that thyroarytenoid muscle paresis is mainly responsible for this side effect and that the rapid clearing of the breathy dysphonia in the face of prolonged relief of spasmodic dysphonia symptoms suggests the action of an adaptive neural response, such as axonal sprouting. Further research of this subject is warranted.
A Comparison of preservation techniques in a vascularized rat laryngeal transplant model
Authors: Strome Marshall , Wu Justin , Strome Scott , Brodsky Gilbert 
Published: October 2006

AbstractIn earlier laryngeal transplantation studies by Takenouchi, et al.,1 the longest ischemic interval tolerated was 45 minutes. A new animal model and enhanced preservative solutions made reassessment timely. This study evaluated two determinants of graft viability: 1. the duration of ischemia and 2. the composition of the preservative media. Three groups of viable transplants were assessed. Groups I and II were preserved with iced heparinized saline with respective ischemic intervals of 3 and 6 hours. Group III was preserved with the Wisconsin solution during a 20‐hour ischemic interval. All animals were sacrificed at 24 hoursRepresentative sections of group I confirmed viability whereas group II exhibited both clinical and histologic evidence of irreversible vascular change. In contrast, most representative sections in group III had little demonstrable change. These data suggest that laryngeal allografts can endure prolonged ischemic intervals if properly maintained.
Inner ear hair cell regeneration in a mammal: Identification of a triggering factor
Authors: Lambert Paul R. 
Published: October 2006

AbstractRecent observations have shown that mammals possess a limited capacity for regeneration of inner ear sensory epithelia. It is clear, however, that a mitogenic growth factor will be necessary to up‐regulate this capacity before clinical application becomes feasible. This study used in vitro cultures of adult mouse vestibular organs for assessing the mitogenic effect of transforming growth factor alpha (TGF‐α). Sixty‐one utricles and cristae were maintained in culture for 7 to 8 days. Neomycin was used to damage the hair cells. Autoradiography permitted identification of any cell which had undergone mitosis during the culture period. The proliferative response was compared in organs exposed to TGF‐alpha and those maintained in the basic culture medium only. The results demonstrated that TGF‐alpha significantly increased cell proliferation in the sensory epithelia and also in the marginal zones surrounding them. This finding provides a scientific basis for the concept that inner ear hair cell damage in humans may someday be reversible pharmacologically.
The efficacy of topical antibiotic prophylaxis for contaminated head and neck surgery
Authors: Grandis Jennifer R. , Vickers Richard M. , Rihs John D. , Yu Victor L. , Wagner Robin L. , Kachman Kimberly K. , Johnson Jonas T. 
Published: October 2006

AbstractThis study was undertaken to determine the feasibility of using perioperative topical antibiotics in contaminated head and neck surgery and to standardize the culture methodology (both qualitative and quantitative) which could serve as bacteriologic endpoints for evaluation. Following preliminary studies to establish oral cavity indicator organisms and the impact of a single antibiotic mouthwash dose on oral microflora, 10 consecutive patients undergoing contaminated head and neck surgery were recruited into a clinical trial where clindamycin mouthwash and intraoperative irrigation containing clindamycin were used instead of traditional parenteral antibiotics. The bacteriologic efficacy of topical clindamycin was assessed by comparing the presence of four indicator microorganisms (two aerobic and two anaerobic) cultured from two oral cavity culture sites before and after antibiotic prophylaxisThe patients included in the study underwent total laryngectomy plus neck dissection(s) for laryngeal or hypopharyngeal carcinoma from 1991 to 1992 at a large university hospital specializing in head and neck cancer surgery. The main outcome measures used were the development of a postoperative wound infection and quantitative and qualitative bacteriology of the intraoperative neck wound and postoperative oral cavityTwo aerobic and two anaerobic organisms proved useful as a practical indicator for bacteriologic efficacy. Preoperative mouthwash resulted in a 99% reduction of both aerobic and anaerobic bacteria in intraoperatively cultured neck sites. Irrigation during surgery with the clindamycin solution further reduced the bacterial neck counts by an additional 90%. There was a consistent overgrowth of Hemophilus species on postoperative oral cavity cultures. No patient developed a postoperative wound infectionA topical prophylactic antibiotic alone was efficacious and safe for patients undergoing major contaminated head and neck surgery. Culture methods for assessment of bacteriologic efficacy were reproducible and cost‐effective. This pilot study furnishes the ethical and scientific basis for large‐scale prospective trials comparing topical versus parenteral antimicrobial agents.
Tinnitus suppression by electrical stimulation of the cochlear wall and by cochlear implantation
Authors: Ito Juichi , Sakakihara Junji 
Published: October 2006

AbstractSome recent studies have reported on tinnitus suppression by electrical stimulation of the cochlear wall and by cochlear implant. In the present study, the degree of tinnitus in cochlear implant candidates was determined and the effects of promontory stimulation and cochlear implantation on tinnitus were investigatedOf the cochlear implant candidates, all of whom were either severely hearing impaired or totally deaf, 87% experienced tinnitus. When electrical stimulation was applied to the cochlear wall (promontory stimulation test), tinnitus was abolished in 23% and improved in 46% of the patients. Thus, electrical stimulation of the cochlear wall effectively suppressed tinnitus in 69% of the patients. Following cochlear implantation, tinnitus was abolished in 35% and decreased in 42%. Thus, intracochlear electrical stimulation was effective for treatment of tinnitus in 77% of the patients. The suppression of tinnitus continued for several hours after the patients switched off the implant device. In 60% of the patients whose tinnitus was suppressed or abolished after the cochlear implant surgery, tinnitus was also suppressed in the contralateral ear.
Aneurysm of the common iliac artery presenting as a lumbosacral plexopathy
Authors: Gardiner M. D. , Mangwani J. , Williams W. W. 
Published: October 2006

We describe a case of lumbosacral plexopathy caused by an isolated aneurysm of the common iliac artery. The patient presented with worsening low back pain, progressive numbness and weakness of the right leg in the L2-L4 distribution. This had previously been diagnosed as sciatica. A CT scan showed an aneurysm of the right common iliac artery which measured 8 cm in diameter. Despite being listed for emergency endovascular stenting, the aneurysm ruptured and the patient died. It is important to distinguish a lumbosacral plexopathy from sciatica and to bear in mind its treatable causes which include aneurysms of the common and internal iliac arteries.
Tendon retracts more than muscle in experimental chronic tears of the rotator cuff
Authors: Meyer D. C. , Lajtai G. , von Rechenberg B. , Pfirrmann C. W. A. , Gerber C. 
Published: October 2006

We released the infraspinatus tendons of six sheep, allowed retraction of the musculotendinous unit over a period of 40 weeks and then performed a repair. We studied retraction of the musculotendinous unit 35 weeks later using CT, MRI and macroscopic dissection. The tendon was retracted by a mean of 4.7 cm (3.8 to 5.1) 40 weeks after release and remained at a mean of 4.2 cm (3.3 to 4.7) 35 weeks after the repair. Retraction of the muscle was only a mean of 2.7 cm (2.0 to 3.3) and 1.7 cm (1.1 to 2.2) respectively at these two points. Thus, the musculotendinous junction had shifted distally by a mean of 2.5 cm (2.0 to 2.8) relative to the tendon. Sheep muscle showed an ability to compensate for approximately 60% of the tendon retraction in a hitherto unknown fashion. Such retraction may not be a quantitatively reliable indicator of retraction of the muscle and may overestimate the need for elongation of the musculotendinous unit during repair.