bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posturographic performance in patients with the potential for secondary gain
Authors: Gianoli Gerard , Mcwilliams Sean , Soileau James , Belafsky Peter 
Published: November 2005

OBJECTIVESTo determine the incidence of nonorganic sway patterns on computerized dynamic posturography (CDP) among patients with potential secondary gain compared with patients without any obvious secondary gain.METHODSA retrospective chart review of 100 patients who underwent clinical evaluation, audiometry, electronystagmography, and CDP was undertaken. Group 1 consisted of 50 patients who were randomly selected from a group who had pending lawsuits, worker's compensation claims, or disability claims. Group 2 consisted of 50 randomly selected patients who had no pending legal status, worker's compensation claims, or disability claims. Previously published criteria for nonorganic sway patterns were then applied to each group. Statistical analysis was performed.RESULTSThe average age of group 1 patients was 43.8 years compared with 63.2 years for group 2 patients (P < 0.0001). Among group 1 patients 50% had normal audiovestibular evaluations compared with only 4% of group 2 patients (P < 0.0001). Nonorganic sway patterns were found in 76% of group 1 patients, but only in 8% of group 2 patients (P < 0.0001).CONCLUSIONPatients who have the potential for secondary gain are generally younger and have a much higher prevalence of normal audiovestibular evaluations and a much higher prevalence of nonorganic sway patterns on CDP. A high degree of clinical suspicion should be maintained when evaluating the dizzy patient who has a pending lawsuit, worker's compensation claim, or disability claim. (Otolaryngol Head Neck Surg 2000;122:11‐8.)
Systematic management of chyle fistula: The Southwestern experience and review of the literature
Authors: Nussenbaum Brian , Liu James H. , Sinard Robert J. 
Published: November 2005

Postoperative cervical chyle fistula after neck dissection is a complication with potentially serious morbidity. Once it is recognized, treatment decisions to optimize patient care can be difficult. Different management strategies have been advocated on the basis of institutional and personal experience. In this study we comprehensively review the published protocols and retrospectively review our experience in the management of 15 patients with chyle fistula. All patients in this study were given a trial of nonoperative management with nutritional modification, pressure dressings, and closed drainage. Medical management ultimately failed in 3 patients (20%). Two patients had prolonged courses of medical management with associated complications. An analysis of our data supports early operative intervention if the peak 24hour drainage is greater than 1000 mL without a prompt response to medical management. Persistent low‐output drainage after 10 days is associated with a prolonged management course and treatment‐related complications. Optimal treatment of these patients is unclear. (Otolaryngol Head Neck Surg 2000;122:31‐8.)
Tonsillectomy in diagnosis of the unknown primary tumor of the head and neck
Authors: Randall David A. , Johnstone Peter A. S. , Foss Robert D. , Martin Peter J. 
Published: November 2005

OBJECTIVESThe purpose of this study was to discuss the experience of one tumor registry with performing tonsillectomy in the diagnostic approach to unknown head and neck primary tumors. It also describes the importance of including tonsillectomy in this evaluation algorithm.STUDY DESIGNA retrospective chart review was done of 68 patients with either tonsillar or unknown primary squamous cell carcinoma culled from 829 patients seen from 1956 to 1996 at the head and neck tumor registry at the Naval Medical Center San Diego.METHODSRecords from the head and neck tumor registry, radiation oncology service, and pathology department were reviewed with attention to presenting symptom, initial examination, diagnostic studies performed, and type and result of biopsies performed.RESULTSThirty‐four patients sought treatment for a neck lymph node metastasis of squamous cell carcinoma without an identifiable primary tumor site. Six of these (18%) had the primary site diagnosed by performing tonsillectomy ipsilateral to the presenting neck mass. Six of 14 T1 tonsillar carcinomas in this series had the primary site identified by tonsillectomy.CONCLUSIONSDespite a diligent search, a primary tumor site may not be found in the head and neck cancer patient. The tonsil may harbor an occult squamous cell carcinoma. The patient benefits from identification of the initial tumor site because postoperative irradiation ports may be reduced and because surveillance for recurrence may be improved. For these reasons, tonsillectomy should be performed ipsilateral to the presenting cervical metastasis if no other primary tumor site is identified. (Otolaryngol Head Neck Surg 2000;122:52‐5.)
Changing trends in neonatal subglottic stenosis
Authors: Choi Sukgi S. , Zalzal George H. 
Published: November 2005

OBJECTIVESTo determine whether there are any changes in the incidence and management of neonatal subglottic stenosis (SGS).METHODSA retrospective chart review of 416 infants who were admitted to the neonatal intensive care unit of the Children's National Medical Center between July 1, 1995, and June 30, 1996, was carried out. The incidence of airway obstruction requiring anterior cricoid split or placement of tracheotomy tube was determined and compared with the incidence studied 10 years ago at the same institution.RESULTSOne of 416 neonates required surgical intervention for airway obstruction caused by SGS, for an overall neonatal SGS incidence of 0.24%. When only the neonates who were intubated for 48 hours or longer were considered, the incidence of SGS was 0.49% (1/204). In neonates who were intubated for 48 hours or longer and survived, the incidence of SGS was 0.63% (1/160). This is in comparison with the incidences of 0.65% (3/462), 1.5% (3/195), and 1.9% (3/159), respectively, seen in a study done at the Children's National Medical Center 10 years ago. Five infants in this current study required placement of a tracheotomy tube for reasons other than SGS. Two infants needed tracheotomy tube placement for micrognathia, and 3 others for central hypotonia, an omphalocele that required multiple surgical procedures, and choanal atresia with a serious heart anomaly, which was a manifestation of CHARGE association. None of these 5 infants had evidence of SGS at rigid endoscopy preceding the tracheotomy tube placement.CONCLUSIONThe incidence and management of neonatal SGS remain unchanged during this study period when compared with those of 10 years ago. (Otolaryngol Head Neck Surg 2000;122:61‐3.)
ImmunoCAP and HY•TEC enzyme immunoassays in the detection of allergen‐specific IgE compared with serial skin end‐point titration by receiver operating characteristic analysis
Authors: Corey Jacquelynne P. , Mamikoglu Bulent , Akbar Imran , Houser Steven M. , Gungor Anil 
Published: November 2005

OBJECTIVESIn this study, we compared 2 different immunoassays, HY•TEC enzyme immunoassay (Hycor Biomedical Inc, Garden Grove, CA) and Pharmacia Upjohn ImmunoCAP (Pharmacia and Upjohn, Kalamazoo, MI) using skin end‐point titration as a gold standard by receiver operating characteristic analysis.MATERIALSOne hundred patients were enrolled in this study and were tested with the above 3 modalities. The results were analyzed by receiver operating characteristic analysis, in which the curves give a decision criterion for any diagnostic test relative to its sensitivity and specificity against an accepted gold standard test. Only inhalant allergens (Dermatophagoides pteronyssinus, Dermatophagoides farina, cat dander, giant ragweed, English plantain weed, timothy grass, Alternaria tenuis, Aspergillus fumigatus, meadow fescue, oak tree, white ash tree, and lamb's‐quarter weed) were studied.RESULTSThe results obtained with both ImmunoCAP and HY•TEC showed a good correlation with skin end‐point titration for D pteronyssinus, D farina, cat dander, giant ragweed, timothy grass, A tenuis, and meadow fescue, with sensitivities ranging from 71% to 88%. However, the sensitivity of both tests to English plantain weed, lamb's‐quarter weed, oak tree, and white ash tree was lower (66% down to 39%). Additionally, HY•TEC results were not satisfactory for detecting specific IgE to A fumigatus (30% sensitivity). The overall sensitivity for each test was 65.67% for the HY•TEC and 71.25% for the Immuno‐CAP.CONCLUSIONThe 2 in vitro testing systems are comparable for most of the allergens, except for A fumigatus, English plantain, lamb's‐quarter, and white ash tree; ImmunoCAP and HY•TEC would benefit from improved technology for detecting these specific IgE antibodies. The HY•TEC assay did not give acceptable results for A fumigatus. The overall assay characteristics were good to excellent for each system tested. (Otolaryngol Head Neck Surg 2000;122:64‐70.)
Effect of improved nasal breathing on obstructive sleep apnea
Authors: Friedman Michael , Tanyeri Hasan , Lim Jessica W. , Landsberg Roy , Vaidyanathan Krishna , Caldarelli David 
Published: November 2005

OBJECTIVESThe goal was to compare the effect of an improved nasal airway on obstructive sleep apnea (OSA) by use of subjective and objective measures.METHODSA prospective study of 50 consecutive patients with nasal airway obstruction and OSA was carried out.RESULTSSubjectively, nasal breathing improved in 49 (98%) patients, whereas snoring decreased or disappeared in 17 (34%); the remaining 33 (66%) patients did not notice any significant change in their snoring. Daytime energy levels increased in 39 (78%) patients and remained unchanged or worsened in 11 (22%). In review of the polysomno‐graphic data, the group overall did not have significant changes in respiratory disturbance index (RDI) or lowest oxygen saturation levels (LSaO2). Continuous positive airway pressure (CPAP) levels required to correct OSA decreased after nasal surgery (P < 0.01). Patients with mild OSA showed significant worsening in RDI (P < 0.05), whereas LSaO2 levels were improved in the group with moderate OSA (P < 0.05). In patients with severe OSA neither the RDI levels nor the LSaO2 changed, but CPAP levels required to alleviate the obstruction after surgery were reduced (P < 0.01).CONCLUSIONSMost patients report improvement in nasal and sleep symptoms after correction of nasal airway obstruction. However, nasal surgery alone does not consistently improve OSA when measured objectively. Depending on the severity of OSA, nasal airway reconstruction may contribute to a decrease in CPAP level and improvement in oxygen saturation. Correction of the obstructed nasal airway should certainly be included in the overall treatment plan for OSA. (Otolaryngol Head Neck Surg 2000;122:71‐4.)
Tumor thickness as a predictor of cervical lymph node metastasis in squamous cell carcinoma of the lower lip
Authors: ÖNerci Metin , Yilmaz Taner , Gedikoğlu GÖKhan 
Published: November 2005

Tumor thickness is a relatively new prognostic factor that has been investigated for lower lip cancer. This study was performed in 27 patients, 13 of whom had histopathologically confirmed cervical metastasis, to investigate whether tumor thickness could be used as a predictor of cervical lymph node metastasis. The mean tumor thickness of those cases with neck metastasis was 5.60 mm (SD = 2.24), and the mean thickness of cases without neck metastasis was 3.79 mm (SD = 1.68). The difference between tumor thicknesses of both groups was found to be statistically significant (P < 0.05). The tumor thickness of 5 mm was determined as a cutoff point, above which the cervical lymph node metastasis rate was significantly increased. As a conclusion, tumor thickness is an objective histopathologic factor that is easily reproducible; it significantly influences cervical lymph node metastasis in lower lip cancer, and it may be used in the assessment of prognosis. (Otolaryngol Head Neck Surg 2000;122:139‐42.)
Thermal myringotomy for eustachian tube dysfunction in hyperbaric oxygen therapy
Authors: Potocki Stanley E. , Hoffman Douglas S. 
Published: November 2005

Otolaryngologists are frequently asked to manage eustachian tube dysfunction (ETD) in patients undergoing hyperbaric oxygen therapy (HBO). HBO patients with intractable ETD currently are treated by tympanostomy tube placement; typically, these tubes are indwelling far longer than is required by the duration of HBO. Also, tubes in this population are associated with higher complication rates of persistent perforation and otorrhea. We investigated the use of thermal myringotomy as an alternative to tympanostomy tube placement in this clinical setting. Potentially, thermal myringotomy avoids the risks and complications associated with indwelling tympanostomy tubes and would be a temporally more appropriate treatment during short‐and intermediate‐term HBO. In this study 13 patients undergoing HBO who would have required tympanostomy tube placement instead underwent bilateral thermal myringotomies. At the fifth postoperative week, 96% of myringotomies were patent; this duration is adequate for most HBO courses. No patient required a second myringotomy for premature closure. The persistent perforation rate was 15% (at the end of 6 months), which compares favorably with the rate observed with tympanostomy tubes in this unique population of poor wound healers. Only 1 patient had otorrhea; this resolved with dry ear precautions. This study demonstrates thermal myringotomy to be an effective technique for middle ear ventilation in patients undergoing HBO in whom ETD develops.
Impact of resistant pneumococcus on rates of acute mastoiditis
Authors: Antonelli Patrick J. , Dhanani Nadeem , Giannoni Carla M. , Kubilis Paul S. 
Published: November 2005

OBJECTIVETo determine whether the rate of acute mastoiditis is rising, specifically as a result of antibiotic‐resistant strains of Streptococcus pneumoniae.METHODSA retrospective chart review of all patients with a discharge diagnosis of acute mastoiditis between July 1, 1987, and June 30, 1997, was performed at our academic, tertiary‐care medical center. There were no interventions, and the main outcome measures included the number of cases of acute or coalescent mastoiditis, stratified by pathogen, per year.RESULTSThe rate of acute mastoiditis as a proportion of yearly otorhinolaryngology admissions increased linearly over time (P = 0.024). Pneumococcal‐related rates of acute mastoiditis, expressed as a proportion of yearly hospital and otorhinolaryngology admissions, increased linearly over time (P = 0.002, P = 0.002). All but 1 case of pneumococcal mastoiditis during the past 3 years were caused by penicillin‐resistant strains.CONCLUSIONSThe emergence of antibiotic‐resistant S pneumoniae may be responsible for an increasing rate of acute mastoiditis.
Clinical and histologic evaluation of an indwelling, inflatable, long‐term laryngeal stent in the canine model
Authors: Milo Anton G. C. , Eliachar Isaac , Lane Charles J. , Myles Jonathan L. , Munoz‐Ramirez Hector 
Published: November 2005

OBJECTIVEThe goal was assessment of a revolutionary approach to laryngeal stenting. A radically designed, atraumatic, inflatable, low‐pressure, high‐volume, endoscopically inserted laryngeal stent for effective intralaryngeal support or long‐term prevention of aspiration was prospectively evaluated in a canine model to reveal any significant short‐and long‐term anatomic and functional changes in the larynx.METHODSA self‐sustaining, tube‐free, long‐term flap tracheostomy was performed in 14 dogs, followed by endoscopic laryngeal stent insertion. The stents were inflated, and their intraluminal pressures were monitored daily. The stenting period ranged between 3 and 46 days (mean 27.4 days). The animals were then euthanized, and total laryngectomy was performed. The larynges underwent gross and microscopic examinations, and a grading scale of reactive changes caused by the stent placement was created on the basis of the findings.RESULTSDye studies for aspiration were negative in all animals. Gross findings consisted of varying degrees of small ulceration, localized polypoid lesions, and granulomas. Grossly, 9 dogs exhibited small superficial ulceration of the true vocal cords and posterior commissure. Six dogs developed minor polyps or polypoid changes and/or granulomas, respectively. No gross changes were seen in 2 of the dogs. Histopathologically, 10 dogs demonstrated grade I or II histopathologic changes. Only 4 of the dogs exhibited inflammation extending into the underlying cartilages, grade III. One dog did not complete the observation period.CONCLUSIONThis new stent demonstrated safety and biocompatibility with minimal local tissue reaction to its extended long‐term placement. Good tolerance to the stent was documented, with minimal side effects similar to those that would be observed in human subjects after endotracheal intubation. When followed up in human patients, such minimal lesions have not resulted in significant long‐lasting functional impairments. These initial results would indicate that this stent is well tolerated for long‐term application and qualify as the preferred device for both management of aspiration and postoperative endolaryngeal bolstering support.
Facial nerve function after partial superficial parotidectomy: An 11‐year review (1987‐1997)
Authors: Witt Robert L. 
Published: November 2005

Permanent facial nerve dysfunction is a potential complication of every parotid surgery. Partial superficial parotidectomy, a conservative resectioning that requires neither dissection of the full facial nerve nor excision of the superficial lobe, produces lower rates of facial nerve dysfunction and soft tissue deformity than the traditional method. This report describes a single surgeon's experience with partial superficial parotidectomy from 1987 to 1997. Fifty‐nine patients with mobile, benign, and low‐grade malignant tumors, limited to the superficial lobe, underwent partial superficial parotidectomy with selective nerve dissection. Adequate margins were obtained, based on the premise that the tumor‐to‐nerve margin is often the true one. No patients had permanent nerve paralysis or paresis, and only 10 incurred transient facial nerve paresis. Age, histology, and sex were not significant factors in postoperative facial nerve function. No patients had recurrences.
Training the physician‐scholar in otolaryngology‐head and neck surgery
Authors: Nadol Joseph B. ,   Resident Education Committee of the Society of University Otolaryngologists
Published: November 2005

The Resident Education Committee of the Society of University Otolaryngologists constructed a questionnaire for young academic otolaryngologist‐head and neck surgeons to better understand their training background and to garner their opinions concerning adequacy or deficiencies in various aspects of that training. The questionnaire was mailed to 145 individuals who were in academic posts for 5 years or fewer in 1997. There was an overall response rate of 88.3%. Of the 128 respondents, 89% identified additional training, most commonly a clinical fellowship, in preparation for an academic career. The median number of hours per week devoted to professionally related activity was 61, of which two thirds was spent in direct patient care. The most common source of funds to pursue research activities was intradepartmental resources. Most individuals were satisfied with their jobs, although one quarter were considering leaving academic practice within the year. The single most important reason motivating selection of an academic career was a desire to teach. Details of the specific training and competencies and recommendations for improvement in resident training were obtained. Specific recommendations were generated for improving the training of future academic otolaryngologists; these recommendations include clarity of job description, a single track for clinical training for academicians and nonacademicians, more training in pertinent skills including research training, protected time for research, and amelioration of some of the downsides of academic life.
Effects of vasoactive topical agents on the survival of dorsal skin flaps in rats
Authors: Smith Daniel K. , Dolan Robert W. 
Published: November 2005

OBJECTIVETo evaluate 3 vasoactive topical agents regarding their ability to improve the survival of random skin flaps in rats.METHODThirty‐five adult Sprague‐Dawley rats had a single 9 × 2 cm random skin flap raised with topical application of a white petroleum ointment (control group), prostaglandin E2, minoxidil, or nitroglycerin to the flap. The effect of the agents on the viability of the flaps was evaluated.RESULTSThe control group had an average survival area of 60.8% ± 7.9%. The nitroglycerin and minoxidil groups were not significantly different, with an average area of survival of 60.1% ± 8.1% and 63.3% ± 4.7%, respectively. The prostaglandin E2 group had average area of survival of 74.2% ± 10.5% (P = 0.002).CONCLUSIONProstaglandin E2 demonstrated a significant increase in flap survival. Nitroglycerin ointment and minoxidil had no beneficial effects when compared with control.
Transplanted fetal fibroblasts: Survival and distribution over time in normal adult dermis compared with autogenic, allogenic, and xenogenic adult fibroblasts
Authors: Hebda Patricia A. , Dohar Joseph E. 
Published: November 2005

Cell therapy is a widely applicable therapeutic approach using cells and cell elements, frequently from fetal or young animals, for their beneficial effects. This study evaluated the host response to and tolerance of transplanted fetal skin fibroblasts. Cultured fibroblasts from adult rabbit skin (autogenic and allogenic), 21 ‐day fetal rabbit skin (allogenic), and adult pig skin (xenogenic) were labeled with a fluorescent vital dye CM‐Dil, injected intradermally into the dorsal skin of adult rabbits at multiple sites and then biopsied over an 8‐week period. Each cell type showed a biphasic distribution curve with an early phase (0 to 28 days) and a late phase (28 to 56 days). In the early phase, cells showed a rise and fall in total cell density (reflecting an increase and then a decrease in total cell number), followed by a slow decrease in cell density with cells still detectable at 56 days. Fetal cells showed the highest survival at the end of the study. None of the groups showed clinical or histologic signs of acute inflammation or rejection. This study demonstrated that (1) transplanted fibroblasts are well tolerated by an immunologically competent host, (2) CM‐Dil‐labeled cells are detectable in vivo for at least 8 weeks, and (3) fetal fibroblasts have a distribution and survival profile that is distinct from that of adult fibroblasts.