bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laboratory Diagnosis of Specific Antibody Deficiency to Pneumococcal Capsular Polysaccharide Antigens
Authors: Jeurissen Axel , Moens Leen , Raes Marc , Wuyts Greet , Willebrords Luc , Sauer Kate , Proesmans Marijke , Ceuppens Jan L , De Boeck Kris , Bossuyt Xavier 
Published: January 2007

Abstract
Background: Measurement of postimmunization antibody response to pneumococcal capsular polysaccharide (caps-PS) is the standard method to identify deficiency of antipolysaccharide antibody production. However, no standardized criteria have been defined for classification of patients into responders or nonresponders to caps-PS.
Methods: We vaccinated 37 healthy children and 39 healthy adults with Pneumovax® and measured the anti–caps-PS antibody response to 5 serotypes. We also measured antipneumococcal antibody titers in 82 patients with increased susceptibility to airway infection. The ELISA was performed according to the 3rd-generation assay format.
Results: The lower 5th percentile (cutoff) concentrations for the postimmunization antibody titer in healthy individuals were 0.67 mg/L, 0.45 mg/L, 0.46 mg/L, 0.31 mg/L, and 1.04 mg/L for serotypes 3, 4, 9N, 18C, and 19F, respectively. In 96% of healthy individuals, antibody responses higher than the cutoff concentration were seen for at least 3 of the 5 serotypes. Nine of 82 patients (11%) failed to mount an adequate antibody response for at least 4 of the 5 serotypes tested, whereas only 1 control (1.3%) failed to do so.
Conclusion: The cutoffs for antibody responses to caps-PS identified in this study appear useful for identifying individuals with an inadequate response to vaccine.
Evaluation of the Risk for Tay-Sachs Disease in Individuals of French Canadian Ancestry Living in New England
Authors: Martin Dianna C , Mark Brian L , Triggs-Raine Barbara L , Natowicz Marvin R 
Published: January 2007

AbstractBackground: The assessment of risk for Tay-Sachs disease (TSD) in individuals of French Canadian background living in New England is an important health issue. In preliminary studies of the enzyme-defined carrier frequency for TSD among Franco-Americans in New England, we found frequencies (1:53) higher than predicted from the incidence of infantile TSD in this region. We have now further evaluated the risk for TSD in the Franco-American population of New England.Methods: Using a fluorescence-based assay for β-hexosaminidase activity, we determined the carrier frequencies for TSD in 2783 Franco-Americans. DNA analysis was used to identify mutations causing enzyme deficiency in TSD carriers.Results: We determined the enzyme-defined carrier frequency for TSD as 1:65 (95% confidence interval 1:49 to 1:90). DNA-based analysis of 24 of the enzyme-defined carriers revealed 21 with sequence changes: 9 disease-causing, 4 benign, and 8 of unknown significance. Six of the unknowns were identified as c.748G&gt;A p.G250S, a mutation we show by expression analysis to behave similarly to the previously described c.805G&gt;A p.G269S adult-onset TSD mutation. This putative adult-onset TSD c.748G&gt;A p.G250S mutation has a population frequency similar to the common 7.6 kb deletion mutation that occurs in persons of French Canadian ancestry.Conclusions: We estimate the frequency of deleterious TSD alleles in Franco-Americans to be 1:73 (95% confidence interval 1:55 to 1:107). These data provide a more complete data base from which to formulate policy recommendations regarding TSD heterozygosity screening in individuals of French Canadian background.
Once-Daily Administration of Intranasal Corticosteroids for Allergic Rhinitis: A Comparative Review of Efficacy, Safety, Patient Preference, and Cost
Authors: Herman Howard 
Published: January 2007

Background The aim of this review was to compare the efficacy, safety, patient preference, and cost-effectiveness of once-daily budesonide aqueous nasal spray (BANS), fluticasone propionate nasal spray (FPNS), mometasone furoate nasal spray (MFNS), and triamcinolone aqueous nasal spray (TANS) for treatment of allergic rhinitis (AR) in adult patients. Methods A MEDLINE search (1966 to January 2004) was conducted to identify potentially relevant English language articles. Pertinent abstracts from recent allergy society meetings were identified also. The medical subject heading search terms included were intranasal corticosteroid (INS), nasal steroid, BANS, MFNS, FPNS, or TANS and AR. Selected studies were randomized, controlled, comparison trials of patients with AR treated with once-daily BANS, MFNS, FPNS, or TANS. Results All four INSs administered once daily were effective and well tolerated in the treatment of AR in adult patients, with similar efficacy and adverse event profiles. No differences were seen between INSs in systemic effects, except for significantly lower overnight urinary cortisol levels in healthy volunteers treated with FPNS compared with placebo. Based on sensory attributes, patients preferred BANS and TANS versus MFNS and FPNS. BANS was associated with more days of treatment per prescription at a lower cost per day for adults compared with the other INSs and is the only INS with a pregnancy category B rating. Conclusion BANS, FPNS, MFNS, and TANS have similar efficacy and safety profiles. Differences in sensory attributes, documented safety during pregnancy, and cost may contribute to better patient acceptance of one INS versus another and promote better adherence to therapy.
Cavernous Carotid Injury during Functional Endoscopic Sinus Surgery: Case Presentations and Guidelines for Optimal Management
Authors: Pepper Jon-Paul , Wadhwa Ashish K. , Tsai Fong , Shibuya Terry , Wong Brian J.F. 
Published: January 2007

Background Surgery in the parasellar and paranasal regions is technically challenging because of the complex anatomic relationships between the sphenoid sinus, cavernous sinus, optic nerve, and internal carotid artery. Normal anatomic variations and pathological changes can lead to disastrous outcomes including carotid artery injury. Methods We present two cases of carotid injury managed at our institution. The first case involves an elective endoscopic biopsy of a clival tumor encasing a friable carotid artery. The second case features a patient transferred emergently to our medical center when brisk bleeding was encountered during functional endoscopic sinus surgery (FESS). Both carotid injuries were managed via balloon embolization with close interaction between otolaryngology and interventional radiology. We review pertinent anatomic and surgical considerations as a backdrop to a treatment algorithm for cavernous carotid hemorrhage secondary to FESS complication. Results The treatment algorithm prevented mortality and minimized morbidity in the two cases considered. Conclusion Through rare, injury to the cavernous carotid during FESS can be managed successfully given efficient hemostasis and seamless cooperation among emergency room physicians, otolaryngologists, and interventional radiologists.
Efficacy and Safety of Topical Combinations of Ipratropium and Xylometazoline for the Treatment of Symptoms of Runny Nose and Nasal Congestion associated with Acute Upper Respiratory Tract Infection
Authors: Eccles Ronald , Pedersen Anette , Regberg Dan , Tulento Heikki , Borum Peter , Stjärne Pär 
Published: January 2007

Background Rhinorrhea and nasal congestion are simultaneous symptoms associated with the common cold. This study investigated the efficacy and safety of a combination nasal spray of ipratropium and xylometazoline for simultaneous treatment of these symptoms. Methods The trial was a multicenter double-blind, parallel-group, randomized design on patients with common cold symptoms. Patients scored symptoms of runny nose and nasal congestion and recorded adverse events in a diary for up to 7 days. Patients also recorded tissue use. The five test treatments consisted of ipratropium, 0.6 mg/mL, and xylometazoline, 1.0 mg/mL; ipratropium, 0.6 mg/mL, and xylometazoline, 0.5 mg/mL; ipratropium, 0.6 mg/mL; xylometazoline, 1.0 mg/mL; and placebo solution. Results Eight hundred sixty-four patients were screened and 786 patients received treatment. One day after treatment there was a clear separation between the scores for the placebo and ipratropium treatment groups for rhinorrhea and between the placebo and xylometazoline treatment groups for congestion. Both ipratropium/xylometazoline 1.0 and ipratropium/xylometazoline 0.5 treatments were superior to xylometazoline with respect to rhinorrhea (p < 0.0001) and superior to ipratropium with respect to nasal congestion scores (p < 0.001). Both the ipratropium combination treatments had significantly lower tissue use than the xylometazoline treatment group (p < 0.0001). Adverse events were distributed equally between the treatments, except mucus tinged with blood, epistaxis, nasal passage irritation, and nasal dryness, which had a higher incidence in the three groups that received medicines containing ipratropium. Conclusion The results indicate that a combination medicine of ipratropium and xylometazoline is safe and effective for treatment of rhinorrhea and nasal congestion associated with common cold.
An Animal Model for the Study of Topical Medications in Sinusitis
Authors: Chiu Alexander G. , Antunes Marcelo B. , Feldman Michael , Cohen Noam A. 
Published: January 2007

Background Rhinosinusitis after functional endoscopic sinus surgery often is recalcitrant to conventional medical management. Topical therapies have been popularized as a method to deliver powerful medications to diseased mucosa while limiting systemic toxicity. The aim of this study was to develop an animal model that will provide objective data in studying the efficacy of topical medications and establish a platform for translation to human clinical trials. Methods The maxillary sinus ostium of white rabbits was obstructed with a pledget through an antrostomy created in the anterior face of the maxilla. The sinus was inoculated with Pseudomonas aeruginosa (PAO1) and 7 days later the antrostomy was reopened, the ostial obstruction was removed, and a single lumen catheter was placed. Normal saline was irrigated through the catheter for 7 days in one group of rabbits while a control group received no irrigation. At the end of 7 days, the rabbits were euthanized, analyzed under light microscopy, and bacterial counts of the nasal lavage were determined. Results Sinusitis was confirmed in all rabbits 7 days after inoculation. Purulence, mucosal, and underlying bony inflammation persisted in both the control and the saline irrigation groups at study end. Nasal lavage bacterial counts were persistently elevated throughout the study period, indicative of bacterial viability. Conclusion An animal model has been created for the study of topical medications in sinusitis. A novel catheter delivery system within an unoccluded maxillary sinus is described that will aid in efficacy studies of topical medications in the management of recalcitrant rhinosinusitis.
The Delta F508 Mutation in Cystic Fibrosis and Impact on Sinus Development
Authors: Woodworth Bradford A. , Ahn Chadwick , Flume Patrick A. , Schlosser Rodney J. 
Published: January 2007

Background Cystic fibrosis (CF) patients often have widespread inflammatory paranasal sinus disease with an increased incidence of frontal, maxillary, and sphenoid hypoplasia. The most common genetic defect in CF is the delta F508 mutation. The effect of specific CF genotypes on phenotypic sinus development and infections is not well understood. The purpose of this study was to determine whether the homozygous delta F508 mutation is associated with an increased incidence of sinus hypoplasia when compared with other mutations. Methods This study is a retrospective review of all adult patients seen at our CF center from 1996 to 2005. Patients ≥18 years old with a CF diagnosis using genetic and sweat chloride testing and sinus CT scans were included. Frontal sinus aplasia/hypoplasia and maxillary and sphenoid sinus hypoplasia were documented using published criteria. Data collected included patient demographics, genetic mutations, and prior sinus surgeries. Results Forty-five patients were identified with an average age of 32 years (range, 18–48 years). Thirty-one patients had prior sinus surgeries. Delta F508 homozygotes (n = 25) had a significantly increased frequency of underdeveloped frontal (98%), maxillary (70%), and sphenoid (100%) sinuses (p < 0.001) when compared with other mutations (69, 8, and 50%, respectively). Conclusion CF patients homozygous for the delta F508 mutation have a greater incidence of hypoplastic or underdeveloped sinuses. Whether this is secondary to an increased frequency of sinus infections or a phenotypic expression of the genetic mutation itself remains an area for further investigation.
Intracranial Polyps in Patients with Samter's Triad
Authors: Majithia Anooj , Tatla Taran , Sandhu Gurpreet , Saleh Hesham M. , Clarke Peter M. 
Published: January 2007

Background We describe three patients with Samter's triad (nasal polyps, aspirin intolerance, and asthma) with skull base dehiscence in whom the polyps extended into the extradural space and also resulted in hypertelorism and widening of the nasal bridge. Methods One patient died in a road traffic accident while awaiting surgery. The other two patients underwent endoscopic resection of the polyps with a combined osteoplastic flap. Results Histology confirmed benign eosinophilic polyps with edematous stroma and a markedly thickened basement membrane. There were no complications or revision procedures. Both are symptomatically well with improvement of the hypertelorism. Conclusion These cases indicate that polyps in Samter's triad may be extremely aggressive, resulting in intracranial extension. A combined endoscopic and osteoplastic flap approach is a safe and effective surgical option.
Fos Expression in the Brainstem Nuclei Evoked by Nasal Air-Jet Stimulation in Rats
Authors: Kunibe Isamu , Nonaka Satoshi , Katada Akihiro , Adachi Masaaki , Arakawa Takuya , Harabuchi Yasuaki 
Published: January 2007

Background Noxious stimulation of the nasal mucosa may induce protective reflexes in the upper airway in rats. Previously, we have reported that nasal air-jet stimulation increases the activities of the laryngeal muscles in decerebrate cats; however, the neuronal mechanism of this phenomenon still is not clarified. Methods After the application of nasal air-jet stimulation for 2 hours, we investigated the distribution of Fos-positive cells (FPCs) throughout the medulla compared with sham-operated rats using Fos immunoreactivity. Results FPCs in the spinal trigeminal nucleus, the parvocellular reticular nucleus, and the nucleus of the solitary tract were more frequent than the sham-operated rats. Conclusion These results suggest that the afferents induced by air-jet stimulation were conveyed to these FPCs and that some of these cells might participate in the augmentation of laryngeal muscle activities during nasal air-jet stimulation.
Antiadhesive Effect of the Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose after Endoscopic Sinus Surgery
Authors: Kim Jeong Hong , Lee Joo-Hwan , Yoon Joo-Heon , Chang Jung Hyun , Bae Jung Ho , Kim Kyung-Su 
Published: January 2007

Background We evaluated the clinical efficacy and safety of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HA-CMC) for prevention of adhesion after endoscopic sinus surgery. Methods Preoperative computed tomography (CT) scans were graded. At the completion of surgery, HA-CMC was applied to Merocel and repeatedly applied after the removal of Merocel. As a control, normal saline was applied. Endoscopic examination was performed postoperatively and grading was done. Results The rate of adhesion was the highest at 2 weeks postoperatively and was significantly lower in the HA-CMC–treated group than the control on all postoperative days. The grouping of cases by CT scores at 2 weeks postoperatively showed lower adhesion formation with the HA-CMC treatment than the control. The safety profile of the patients was normal at 4 weeks postoperatively. Conclusion HA-CMC is an efficacious and safe material in decreasing the incidence of adhesion after endoscopic sinus surgery.
Endoscopic Resection of Malignant Tumors of the Nose and Sinuses
Authors: Lund Valerie , Howard David J. , Wei William I. 
Published: January 2007

Background Since the introduction of endoscopic surgery, its role has been gradually extended to encompass a range of pathologies, including sinonasal tumors, facilitated by the ability to repair significant skull-base defects. However, the rarity and long natural history of malignant tumors make it difficult to accrue cohorts comparable with the established gold standard of craniofacial resection. Methods In this prospective cohort study, after histological confirmation and a staging imaging protocol, patients deemed suitable were offered the option of an entirely endoscopic resection as an alternative to craniofacial resection. The procedure was performed under frozen section control. The long-term follow-up protocol included both MRI and examination under anesthesia at 3- to 4-month intervals in the first 2 years and 6-month intervals thereafter. Results There were 49 patients, 26 men and 23 women, aged 34–88 years (mean, 60 years). Follow-up ranged from 6 to 126 months (mean, 36 months). Thirty-seven cases underwent radiotherapy and 14 cases underwent adjuvant chemotherapy. A wide range of pathologies included 15 cases of adenocarcinoma, 11 malignant melanomas, and 11 olfactory neuroblastomas. Hospital stay was a mean of 5 days, with no significant postoperative complications. Thirty-six patients are alive and well, 7 patients have residual disease, 4 patients are dead of disease, and 2 patients have died of intercurrent disease. Three patients have been subsequently converted to craniofacial resection. Overall survival was 88% at 5 years. Conclusion These initial results suggest that endoscopic resection may provide an alternative to craniofacial resection in selected cases of sinonasal malignancy.
Clinical Outcomes of Chronic Rhinosinusitis in Response to Medical Therapy: Results of a Prospective Study
Authors: Hessler Jill L. , Piccirillo Jay F. , Fang David , Vlahiotis Anna , Banerji Aleena , Levitt Robert G. , Kramper Maggie A. , Thawley Stanley E. , Hamilos Daniel L. 
Published: January 2007

Background Little information exists regarding the outcome of medical management of chronic rhinosinusitis (CRS) in adults. The aim of this study was to examine whether baseline patient demographics, symptoms, objective findings, or treatment strategies were associated with improved CRS outcomes over time. Methods Eighty-four new patients with CRS were evaluated and medically treated for up to 12 months. Patients completed monthly health status questionnaires. The average change of symptom scores using the Sino-Nasal Outcome Test plus one additional symptom–-sense of smell (SNOT-20+1)–-was the primary outcome measure. Results Overall, patients experienced a modest improvement in SNOT-20+1 scores (Δ = -0.61; p< 0.0001), but this did not reach the predetermined level of a clinically meaningful effect (Δ = -0.80). Baseline facial pain or facial pressure was negatively associated with outcome (p = 0.048 and 0.029, respectively) and did not correlate with extent of disease by sinus CT scoring. Other factors, including nasal discharge, hyposmia, cough, nasal polyps, and sinus CT severity, did not predict outcomes. The use of either oral antibiotics or oral steroids was associated with trends toward improved outcomes only when sinus-specific symptoms alone were considered. Conclusion The majority of CRS patients receiving medical treatment show modest improvement over time in SNOT-20+1 scores. Facial pain or facial pressure at entry are negatively associated with outcomes and may reflect causes other than CRS. These findings highlight the limitations of current medical treatment for CRS and the need for novel treatment strategies.
Indications for Image-Guided Sinus Surgery: The Current Evidence
Authors: Smith Timothy L. , Stewart Michael G. , Orlandi Richard R. , Setzen Michael , Lanza Donald C. 
Published: January 2007

Background Evidence-based medicine calls for a critical evaluation of the scientific evidence for treatments of disease. This report synthesizes the available evidence supporting the indications for image guidance in sinus surgery, examining two important questions: (1) Does image-guided sinus surgery (IGSS) reduce complication rates? (2) Does IGSS improve clinical outcomes? Methods Primary research articles evaluated for this report were identified using appropriate search terms and a PubMed search. Two authors independently reviewed each article. Articles were assigned an evidence level based on accepted guidelines: level 1 = randomized trials, level 2 = prospective cohort studies with comparison group, level 3 = case-control studies, level 4 = retrospective case series, and level 5 = expert opinion. Results We identified 105 articles for full review and highlight 5 articles in our report. Primarily, there is expert opinion (level 5) and case series (level 4) with and without comparison groups supporting the indications for IGSS. In addition, authors point out that sample size and design issues preclude definitive randomized trials using IGSS. Conclusion Although randomized trials of IGSS are not practical, ethical, or feasible, clinical experience, expert opinion, and case series support the current indications for IGSS. Studies designed to draw conclusions about the role of IGSS in decreasing major complications of sinus surgery are not possible.
Steroid Injection for Sinonasal Polyps: The University of Virginia Experience
Authors: Becker Samuel S. , Rasamny JK , Han Joseph K. , Patrie James , Gross Charles W. 
Published: January 2007

Background Sinonasal polyps are treated with topical steroids, systemic oral steroids, surgical excision, and intrapolyp steroid injection. Use of steroid injection is not widespread because of reported complications. The objective of this study was to evaluate the complications of intrapolyp steroid injections and compare it to the complications of surgical removal of polyps. Methods All patients seen between 1994 and 2003 with a diagnosis of nasal polyps were reviewed retrospectively. Demographics, complications, follow-up, and comorbidities were collected. Frequency of each treatment modality used and complications of each treatment were compared. Results Three hundred fifty-eight patients were in the study with a mean follow-up of 30 months. Respiratory comorbidities were asthma alone (35%), aspirin triad (16%), and cystic fibrosis (15%). Other comorbidities were smokers (21%). Treatment modalities were medical treatment alone (14%); medical treatment and steroid injections (19%); medical treatment and surgery (33%); and medical treatment, injections, and surgery (34%). Patients who underwent injection had fewer surgeries (p < 0.001). There was 1 minor complication associated with 1495 injections and 11 major and 16 minor complications associated with the 310 surgeries. The differences in complication rates were statistically significant (p < 0.001). There was no significant difference in demographics, follow-up, or comorbidities between patients who received injections and patients who underwent surgery. Conclusion Intrapolyp steroid injection is associated with a significantly lower rate of complication than is surgical excision of sinonasal polyps. Steroid injection also may decrease the need for further surgical intervention of polyps.