bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Clinical Classification System for Aberrant Internal Carotid Arteries
Authors: Pfeiffer Jens , Ridder Gerd J. 
Published: October 2008

AbstractObjectives/Hypothesis: Pronounced anatomic variations of the extracranial internal carotid artery (ICA) can be found in 5% to 6% of the general population. An aberrant ICA is at risk of injury during routine pharyngeal procedures if the vessel is placed into close relationship with the pharyngeal wall. The objective was to highlight the impact of parapharyngeal ICA aberrations and to analyze the clinical usefulness of the current anatomic classification system of these anomalies.Study Design: Prospective quality assessment study in an academic tertiary care medical center.Methods: A systematic clinicoradiological follow‐up study was performed over a period of 18 months. The ICA's course was classified according to Weibel and Fields in 21 consecutive patients with 35 pronounced parapharyngeal ICA aberrations. The vessels' minimum distance to the pharyngeal wall and the corresponding pharyngeal level was analyzed.Results: Tortuosity was found in 13, kinking in 18, and coiling in 4 aberrant ICAs. The vessel's minimum distance to the pharyngeal wall ranged from 0.8 to 17.9 mm (mean, 7.0 mm), but the currently used anatomic classification was inadequate to determine the risk potential for ICA injury in the given cases. We propose a clinicoradiological classification system, which considers the vessel's relation to the pharyngeal wall.Conclusions: Parapharyngeal ICA aberrations are common and probably under‐appreciated anatomic variations. The awareness of these anomalies is essential for clinicians. Since the current anatomic classification is insufficient to outline patients with an increased risk of ICA injury, a clinicoradiological graduation of cervical ICA aberrations may be of practical benefit.
The Clinical Significance of Coexpression of Cyclooxygenases‐2, Vascular Endothelial Growth Factors, and Epidermal Growth Factor Receptor in Nasopharyngeal Carcinoma
Authors: Pan Jianji , Kong Lin , Lin Senan , Chen Gang , Chen Qiang , Lu Jiade J. 
Published: October 2008

AbstractObjectives/Hypothesis: To investigate the inter‐relationship of the expressions of cyclooxygenases‐2 (COX‐2), vascular endothelial growth factors (VEGF), and epidermal growth factor receptor (EGFR) in nasopharyngeal cancer (NPC) cells, and their clinical significance in association with the extent of disease at diagnosis.Study Design: Prospective.Methods: Expressions of COX‐2, VEGF, and EGFR protein were detected using immunohistochemistry in 111 patients with pathologically confirmed stage II to IV nasopharyngeal carcinoma. The correlation between the expressions of the three tumor markers and the stages of disease at diagnosis were investigated.Results: COX‐2, VEGF, and EGFR were over‐expressed in 76.6, 66.7, and 73.9% of NPC cells, respectively. The staining patterns was cytoplasmic for VEGF, membranous for EGFR, and both cytoplasmic and membranous for COX‐2 in tumor cells. Linear associations were observed between the intensity of the expressions of COX‐2 vs. VEGF, COX‐2 vs. EGFR, or VEGF vs. EGFR. Furthermore, the intensity of the expressions of all three markers was significantly associated with the extent of the tumor measured by the Tumor, Node, Metastasis classification and staging grouping of the American Joint Committee on Cancer/International Union Against Cancer staging system.Conclusion: COX‐2, VEGF, and EGFR expressions in NPC cells were interrelated, and the intensity of the expressions of all three markers were significantly associated with the stage of the disease at diagnosis. Further investigation is needed to determine the clinical applications of COX‐2, VEGF, and EGFR in predicting the long‐term outcome of NPC after definitive therapy.
A Genomewide Screen for Chronic Rhinosinusitis Genes Identifies a Locus on Chromosome 7q
Authors: Pinto Jayant M. , Hayes M Geoffrey , Schneider Daniel , Naclerio Robert M. , Ober Carole 
Published: October 2008

AbstractObjective/Hypothesis: Chronic rhinosinusitis (CRS) is an important public health problem with substantial impact on patient quality of life and health care costs. We hypothesized that genetic variation may be one factor that affects this disease.Study Design: Identification of genetic variation underlying susceptibility to CRS using linkage analysis in a founder population.Methods: We studied a religious isolate that practices a communal lifestyle and shares common environmental exposures. Using physical examination, medical interviews, and a review of medical records, we identified eight individuals with CRS of 291 screened. These eight individuals were related to each other in a single 60 member, nine generation pedigree. A genome‐wide screen for loci influencing susceptibility to CRS using 1123 genome‐wide markers was conducted.Results: The largest linkage peak (P = .0023; 127.15 cM, equivalent to limit of detection = 2.01) was on chromosome 7q31.1–7q32.1, 7q31 (127.15 cM; 1‐limit of detection support region: 115–135 cM) and included the CFTR locus. Genotyping of 38 mutations in the CFTR gene did not reveal variation accounting for this linkage signal.Conclusions: Understanding the genes involved in CRS may lead to improvements in its diagnosis and treatment. Our results represent the first genome‐wide screen for CRS and suggest that a locus on 7q31.1–7q32.1 influences disease susceptibility. This may be the CFTR gene or another nearby locus.
Cochlear Implantation in Infants: Special Surgical and Medical Aspects
Authors: Migirov Lela , Carmel Eldar , Kronenberg Jona 
Published: October 2008

AbstractObjective: To present medical and surgical aspects of cochlear implantation (CI) in infants and to compare the rate of complications of CI in infants with that of older children.Design: Retrospective study.Method: Fifteen infants and 57 children aged 1 to 2 years at the time of CI with a follow‐up of at least 12 months were studied.Results: Major complications (requiring explantation or revision surgery) occurred in 6.7% infants vs. 17.5% toddlers, P = .297. The rates for minor postoperative problems were 13.3% vs. 21.1%, respectively, P = .502. There were no incidents of surgery‐ or anesthesia‐related complications in the present study. Device failure was found as a most common complication in older children (10.5%). Such patient‐related complications as foreign body reaction, protrusion of the positioner and recurrent otitis media can result in device malfunction. Indeed, the rate of major complications supposed to increase with long‐term follow‐up.Conclusions: The surgical procedure for CI in infants is feasible and patient‐related complications are usually minor and may be managed conservatively. Because most postoperative major problems are implant‐related, improving cochlear implant technology can enhance the reliability of the devices and prevent untoward events that need for explantations and reimplantations. To reduce the risk of general anesthesia in infants we recommended the presence of pediatric anesthesiologist at surgery. Shortening time of surgery with using of nonmastoidectomy techniques for CI can reduce the time of bacterial exposure of the wound and prevent surgical complications related to the facial nerve and chorda tympani damage as well as electrode misplacement.
Cutaneous Squamous Cell Carcinoma Metastatic to Parotid‐Area Lymph Nodes
Authors: Hinerman Russell W. , Indelicato Daniel J. , Amdur Robert J. , Morris Christopher G. , Werning John W. , Vaysberg Mikhail , Kirwan Jessica , Mendenhall William M. 
Published: October 2008

AbstractIntroduction: Metastatic spread to parotid‐area lymph nodes (PALN) occurs in 1% to 3% of patients with cutaneous squamous cell carcinoma of the head and neck. Presented herein is the University of Florida experience using radiation therapy (RT) to treat patients with PALN metastases from a skin primary.Methods and Materials: From November 1969 to February 2005, 121 parotids in 117 patients received irradiation for nonmelanotic skin carcinoma metastatic to PALN. Patients were staged by the O'Brien staging system. Of the 121 parotids receiving RT, 17 (14%) were treated preoperatively, 87 (72%) postoperatively, and 17 with RT alone.Results: Five‐year actuarial probabilities of local (parotid) control, local‐regional control, disease‐free survival and overall survival were 78%, 74%, 70%, and 54%, respectively. When patients were separated by O'Brien P‐stage, statistically significant differences were seen among the groups for local (parotid) control, local‐regional control, and disease‐free survival. A statistically significant decrease in local control was seen in patients treated with positive surgical margins (92% vs. 76%) and in local‐regional control for patients treated with preoperative RT or RT alone when compared with postoperative RT (59% and 47% vs. 83%, respectively). The 5‐year actuarial probability of freedom from distant metastases was 92%. Three (2.6%) patients suffered severe complications.Conclusions: PALN metastases from a cutaneous head and neck primary site are best treated with surgery and postoperative RT. Our data support the hypothesis that the O'Brien staging system is superior to the American Joint Committee on Cancer system for the staging of cutaneous metastases to PALN. Positive surgical margins confer a worse prognosis in terms of local‐regional control and disease‐free survival. Patients treated with preoperative RT seem to have a worse prognosis than those treated postoperatively, likely a result of patient selection and the surgeon's inability to accurately assess viable tumor extent after preoperative RT. Severe complications are uncommon after surgery and RT for PALN metastases.
Development of the Small Parts Cylinder: Lessons Learned
Authors: Milkovich Scott M. , Altkorn Robert , Chen Xiao , Reilly James S. , Stool Daniel , Tao Luke , Rider Gene 
Published: October 2008

AbstractObjectives/Hypothesis: The Consumer Product Safety Commission mandates federal child choking prevention standards in the United States. Consumer Product Safety Commission utilizes the small parts cylinder (SPC), a 31.75‐mm inside‐diameter cylinder with a slanted bottom and depth ranging from 25.4 to 57.1 mm. The SPC was developed with very limited clinical data, and the effectiveness of the SPC remains controversial. Small parts ingestions remain among the most common causes of injury and fatality to preschool children. This study reviews the history, medical basis, and effectiveness of the SPC and provides recommendations for prevention of choking and airway fatalities.Study Design: Retrospective case series, 48 tertiary care pediatric hospitals (1989–2004) and historical review (1972–2007).Methods: American Academy of Pediatrics and Consumer Product Safety Commission documents and published reports. Forty‐eight children's hospital medical records were reviewed by ICD‐9 and current procedural terminology codes for injury or fatality data from foreign bodies (FBs) involved in airway obstruction or esophageal injury. All FBs dimensions were measured and statistically analyzed.Results: Twenty‐three percent of fatalities resulting from small parts over the study period involve objects that pass SPC evaluation and over 90% of FBs between 27.9 and 30.5 mm involved in nonfatal incidents pass SPC evaluation. Many objects involved in fatal and nonfatal injury pass because of the slanted bottom.Conclusions: Over one‐fifth of injuries and fatalities to children could be prevented if a standard more stringent than the SPC were in use. Alternative gauges and broader age guidelines are recommended. We propose a 38.1‐mm diameter open‐bottom gauge for nonspherical FBs and a similar 44.5 mm gauge for spherical FBs. We suggest that this new standard would have prevented all small‐parts fatalities to children (including children 3 years of age and older) and the overwhelming majority of nonfatal injuries.
Dexamethasone Base Conserves Hearing from Electrode Trauma‐Induced Hearing Loss
Authors: Vivero Richard J. , Joseph Debbie E. , Angeli Simon , He Jiao , Chen Shibing , Eshraghi Adrien A. , Balkany Thomas J. , Van De Water Thomas R. 
Published: October 2008

AbstractObjective/Hypothesis: Local treatment of the cochlea after electrode insertion trauma with dexamethasone base conserves hearing against trauma‐induced loss.Study Design: Laboratory animal study.Methods: A guinea pig model of electron insertion trauma (EIT)‐induced hearing loss (HL) used 44 guinea pigs sub‐divided into four groups: 1) unoperated, controls (Controls, n = 44); 2) EIT, untreated (EIT, n = 15); 3) EIT plus artificial perilymph (EIT + AP, n = 15); and 4) EIT plus dexamethasone base (EIT + DXMb, n = 14). Cochleae that received EIT were randomly selected with contralateral, unoperated cochleae as internal controls. Auditory brainstem responses (ABRs) in response to 0.5 to 16 kHz pure tones were obtained before surgery, immediately after surgery (0 day), and on post‐EIT days 3, 7, 14, and 30. Hair cell counts were obtained from stained organ of Corti specimens from all four groups (n = 3/group). Data were analyzed using analysis of variance and a Tukey‐Kramer honestly significant difference post hoc test with significance alpha set at <0.05 (hearing) and <0.001 (hair cells).Results: There were significant differences (<0.05) between the ABR thresholds of unoperated (control) and contralateral operated (experimental) ears of EIT and of EIT + AP groups for all tested frequencies. There was no statistical difference (>0.05) in ABR thresholds in the EIT + DXMb versus control groups for 0.5 to 4 kHz tones. DXMb treatment protected hair cells from EIT‐induced damage and loss while AP treatment did not.Conclusion: The absence of significant differences in hearing thresholds between the EIT + DXMb group and control ears in response to 0.5 to 4 kHz tones demonstrates that DXMb is as effective as the aqueous form of dexamethasone in conserving hearing against EIT‐induced loss.
Keloid Banding Using Suture Ligature: A Novel Technique and Review of Literature
Authors: Parikh Dhavan A. , Ridgway James M. , Ge Norman N. 
Published: October 2008

AbstractIntroduction:Successful wound healing represents the coordinated response of cellular, cytokine, and growth factor mechanisms involved in tissue recovery. Disruptions in transforming growth factor‐β signaling, senescence/apoptosis, keratinocyte‐fibroblast interactions, and other regulatory cascades can lead to the production of hypertrophic scar or keloid tissue formation. Current clinical investigations support surgical excision, meticulous closure, postoperative steroid injections, and postprocedural pressure dressings in the treatment of keloid tissue formation. Unfortunately, a universal approach in keloid therapy has yet to be identified. Here we offer a novel banding technique using suture ligature for the removal of these tissues.Methods:Using a suture ligature, keloid tissues were banded along their base for a 5‐week period. Tissue evaluation and additional suture banding was performed on a weekly basis until complete mummification and spontaneous removal of ligated tissues. No additional pressure dressings were placed after tissue removal as treated sites had essentially undergone pressure therapy from the banding treatment.Results:Keloid tissues from multiple sites of the head and neck were effectively removed without complication using the suture banding technique. During a follow‐up period of 12 months, no evidence of keloid tissue recurrence was observed.Conclusion:Keloid tissue formation remains a formidable challenge for the patient and physician alike. The application of a simple tissue banding technique holds promise in the direct and preventative treatment of keloid tissue formation whereas the end results merit further clinical and laboratory investigation.
Delineating the Hearing Loss in Children With Enlarged Vestibular Aqueduct
Authors: Zhou Guangwei , Gopen Quinton , Kenna Margaret A. 
Published: October 2008

AbstractObjective/Hypothesis: To explore the clinical characteristics and audiologic outcomes in children with enlarged vestibular aqueduct (EVA).Study Design: Retrospective study in a pediatric tertiary care facility.Methods: A total of 54 cases (82 ears) of children with EVA were identified with complete records, including otologic evaluation, imaging studies, and audiologic assessments. The diagnosis of EVA was confirmed by computerized tomography scan/magnetic resonance imaging of the temporal bone. Hearing status was assessed using behavioral testing or auditory brainstem response (ABR). Tympanometry, acoustic reflex, and vestibular evoked myogenic potential (VEMP) testing were also performed when appropriate.Results: Fifty‐two percent of our EVA cases showed bilateral involvement, and 43% of all ears with EVA also had cochlear malformations, such as Mondini dysplasia. Sensorineural HL was initially diagnosed in 16 ears (20% of the total) with EVA whereas conductive or mixed HL was found in 66 ears (80% of the total). Further review of all EVA cases with sensorineural HL showed lack of proper bone conduction testing, so air‐bone gaps were missed. Despite air‐bone gaps in EVA ears, middle ear pressure and mobility were usually normal, along with present acoustic reflexes. VEMP responses were present with abnormally low thresholds.Conclusions: Air‐bone gap(s) can be found in most ears with EVA if both air and bone conduction thresholds are properly tested. Normal tympanometry, presence of acoustic reflex and low threshold VEMP responses suggest that the air‐bone gap in EVA is due to an inner ear anomaly, similar to the “third” labyrinthine window syndrome.
Undergraduate Otolaryngology Education in Canadian Medical Schools
Authors: Campisi Paolo , Asaria Jamil , Brown Dale 
Published: October 2008

AbstractObjectives: To examine the quantity and nature of undergraduate otolaryngology instruction in the Canadian medical school system and to present the management of the undergraduate otolaryngology curriculum at the University of Toronto medical school with a yearly enrolment of 224 students.Study Design: Survey questionnaire and narrative description.Methods: A structured one‐page survey was administered to the education directors of all 16 Canadian medical schools. The administration of core learning material, scheduling, patient encounter logging, and student and instructor evaluations with computerized, on‐line systems at the University of Toronto was described.Results: Rotations in otolaryngology were highly variable across medical schools. Mandatory rotations in otolaryngology were identified in only 6 of the 16 undergraduate curricula. The average length of clinical experience in schools with mandatory rotations was 4.6 days.Conclusions: The majority of Canadian medical graduates complete their undergraduate training with minimal clinical experience in otolaryngology. There is a clear discrepancy between the quantity and perceived need for training. To provide a thorough and equitable exposure to otolaryngology, a curriculum with standardized lectures and evaluation procedures is required.
Contralateral Incipient Posterior Canal Benign Positional Paroxysmal Vertigo: Complication After Epley Maneuver
Authors: Leong Annabelle C. , Golding‐Wood David 
Published: October 2008

AbstractBackground: Particle repositioning procedures give consistent results for the treatment of benign positional paroxysmal vertigo (BPPV). However, little consideration has been given to the possibilities of bilateral disease.Objective/Hypothesis: To report contralateral symptoms and signs suggestive of revealed or incipient BPPV as a complication of Epley maneuver.Study Design: A prospective cohort of 198 cases over a period of 11 years.Results: Ten (5.0%) developed contralateral symptoms and signs suggestive of revealed or incipient posterior canal BPPV within 2 weeks of treatment.Conclusion: This novel observation has not been previously described and may influence the strategy for future management of patients with BPPV. Particle repositioning maneuvers for the previously asymptomatic contralateral ear may need to be considered in a subset of patients with posterior canal BPPV who suffer contralateral symptoms after undergoing treatment for the original ear.
Burnout in Academic Faculty of Otolaryngology—Head and Neck Surgery
Authors: Golub Justin S. , Johns Michael M. , Weiss Paul S. , Ramesh Atul K. , Ossoff Robert H. 
Published: October 2008

AbstractObjective/Hypothesis: To characterize burnout in academic faculty of otolaryngology—head and neck surgery. To identify associated modifiable factors to reduce burnout and improve the health of the field.Study Design: Mailed survey.Methods: A cross section of US academic otolaryngologists was sampled through a mailed survey. Content included the Maslach Burnout Inventory‐Human Services Study (MBI‐HSS) and questions assessing potential burnout predictors such as demographic information, professional stressors, satisfaction, self‐efficacy, and support systems.Results: Burnout was common among academic otolaryngologists. High burnout was observed in 4% of faculty, moderate burnout in 66%, and low burnout in 30%. Women experienced a statistically higher level of emotional exhaustion than men. In addition, associate professors were significantly more burned out than full professors and microvascular surgeons were notably more burned out than all other subspecialists. The strongest predictors of burnout were dissatisfaction with the balance between personal and professional life, low self‐efficacy, inadequate research time, and inadequate administration time. A significant association was seen between high burnout and likelihood to leave academic medicine within the next 1 to 2 years.Conclusions: Burnout was prevalent among US academic otolaryngologists, although levels were lower than those of otolaryngology chairs and residents. Modification of risk factors, such as allowing sufficient faculty time for research and administrative activities, should be undertaken to curb the development of burnout and its deleterious sequelae.
Gentian Violet and Ferric Ammonium Citrate Disrupt Pseudomonas Aeruginosa Biofilms
Authors: Wang Eric W. , Agostini Gabriela , Olomu Osarenoma , Runco Daniel , Jung Jae Y. , Chole Richard A. 
Published: October 2008

AbstractObjective/Hypothesis: Bacterial biofilms are resistant to antibiotics and may contribute to persistent infections including chronic otitis media and cholesteatoma. Discovery of substances to disrupt biofilms is necessary to treat these chronic infections. Gentian violet (GV) and ferric ammonium citrate (FAC) were tested against Pseudomonas aeruginosa biofilms to determine if either substance can reduce biofilm volume.Study Design: The biofilm volume and planktonic growth of PAO1 and otopathogenic P. aeruginosa (OPPA8) isolated from an infected cholesteatoma was measured in the presence of GV or FAC.Methods: OPPA8 and PAO1 expressing a green fluorescent protein plasmid (pMRP9‐1) was inoculated into a glass flow chamber. Biofilms were grown under low flow conditions for 48 hours and subsequently exposed to either GV or FAC for an additional 24 hours. Biofilm formation was visualized by confocal laser microscopy and biofilm volume was assayed by measuring fluorescence. Planktonic cultures were grown under standard conditions with GV or FAC. Statistical analysis was performed by Student t test and one‐way ANOVA.Results: GV reduced PAO1 and OPPA8 biofilm volume (P < .01). GV delayed the onset and rate of logarithmic growth in both strains. FAC reduced OPPA8 biofilm volume (P < .01), but did not effect of PAO1 biofilms. FAC had no effect on planktonic growth.Conclusions: The efficacy of GV in disrupting biofilms in vitro suggests that it may disrupt biofilms in vivo. The effect of FAC on Pseudomonas aeruginosa biofilms is strain dependent. Strain differences in response to increasing iron concentration and biofilm morphology stress the importance of studying clinically isolated strains in testing antibiofilm agents.