bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature
Authors: Gottschalk E. M. , Siedentopf J.‐P. , Schoenborn I. , Gartenschlaeger S. , Dudenhausen J. W. , Henrich W. 
Published: August 2008

AbstractApproximately 15% of women have a retroverted uterus prior to pregnancy, and retroversion occurs in 11% of women in the first trimester of pregnancy. However, the uterus usually moves to an upward position before 14 weeks' gestation. Incarceration and sacculation of a retroverted uterus occur in 1 in 3000 pregnancies and are difficult to diagnose. They have often been missed until shortly before delivery and can lead to serious obstetric emergencies such as labor dystocia, uterine rupture, retained placenta and uncontrollable postpartum hemorrhage. Performing a Cesarean section without correct diagnosis may cause difficulties in identifying the bladder and the cervix, and therefore in opening the lower uterine segment. This leads to bladder injuries, vaginal transsection and trans‐ or supracervical hysterectomy. Early diagnosis and detailed scanning are crucial for the obstetric management and operative approach.We report a case of an incarcerated uterus in a patient presenting at 24 weeks' gestation with severe bilateral flank and lower abdominal pain. The symptoms were misdiagnosed as appendicitis. Digital examination revealed a ventralized vaginal axis. The cervix was not palpable. The clinical course, and two‐ and three‐dimensional ultrasound and magnetic resonance imaging findings, are presented. The delivery was performed by midline laparotomy Cesarean section. The management for different gestational ages and a review of the literature are discussed. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
Effects of α‐Tocopherol on Oxidative Stability and Phytosterol Oxidation During Heating in Some Regular and High‐Oleic Vegetable Oils
Authors: Tabee Elham , Azadmard‐Damirchi Sodeif , Jägerstad Margaretha , Dutta Paresh C. 
Published: August 2008

AbstractThe first part of this study evaluated oxidative stability in high‐oleic rapeseed oil, palm olein, refined olive oil, low erucic acid rapeseed oil and sunflower oil. The results showed oxidative stability in the order: palm olein > high‐oleic rapeseed oil > refined olive oil > low erucic acid rapeseed oil > sunflower oil, as determined by the Rancimat method. Addition of α‐tocopherol at high levels of up to 0.2% increased the oxidative stability of refined olive oil, whereas the opposite effect was generally observed in the other oil samples. In the second part of the study, high‐oleic rapeseed oil, palm olein, refined olive oil and refined olive oil containing 0.2% α‐tocopherol were heated for 3, 6, 9 and 12 h at 180 °C. The peroxide and p‐anisidine values generally increased over time in the samples, including olive oil containing 0.2% α‐tocopherol. High‐oleic rapeseed oil contained the highest amount of total sterols and total phytosterol oxidation products (POPs), but during heating the total POPs content increased moderately (~10%), in contrast to the threefold increase after 12 h of heating in palm olein and refined olive oil. Very high levels of 6‐hydroxy derivatives of brassicastanol, campestanol and sitostanol and of 7‐ketobrassicasterol were observed in high‐oleic rapeseed oil samples. Addition of 0.2% α‐tocopherol during heating significantly decreased POPs formation in refined olive oil (P < 0.05).
Modified Quantitative Testing and QoL in Allergic Rhinitis
Authors: Coffey Charles S. , Harvey Richard J. , Woody Jamie I. , Koepp Sarah K. , Sheahan Patrick , Schlosser Rodney J 
Published: August 2008

Objective(1) Assess the relationship between QoL, objective assessment and confounding factors. (2) Describe a model representing the severity of pathology and predicting potential responses from therapeutic interventions beyond Quality of Life measurements alone.MethodsA cross‐sectional study of allergic rhinitis (AR) patients, from a teritary rhinology clinic in 2007, with Modified Quantitative Testing (MQT) and Mini‐Rhinoconjuctivitis Quality of Life Questionnaire (mRQLQ) assessments was performed. Correlation and regression analyses assessed the relationship of mRQLQ, MQT endpoints, and number of reactive antigens.Results47 patients (53% female, mean age 36.0 ± 16.3yrs) were assessed. Percentage of positive antigens was a significant factor that decreased mRQLQ (p=0.05). Maximal MQT endpoint (mMQT) correlates well to mRQLQ when controlled for percentage of positive antigens (p=0.038). In a regression analysis to predict mRQLQ, percentage of positive antigens and mMQT were good predictors (p=0.018 for percent positive antigens; p=0.038 for mMQT) and such a model was significantly linked to those factors (F=3.2, p=0.05).ConclusionsSemi‐quantitative measurement by MQT correlates with symptom severity in AR when broad reactivity does not exist. Adaptation in QoL scores may occur with more atopic individuals. A model for predicting QoL and symptom severity as measured by mRQLQ based upon MQT is presented. Such systems may enhance our ability to predict clinical outcomes, compare research cohorts, and better educate patients on treatment benefits.
mRAST to Quantify Allergy and Initiate Immunotherapy
Authors: Lim Keng‐Hua , Leong Jern‐Lin 
Published: August 2008

ObjectiveAim to quantify mRAST by comparing it with skin testing (SPT and MQT) among patients with clinically diagnosed AR for both diagnosis of inhalant allergy and initiation of immunotherapy.MethodsA prospective randomized controlled study was designed to recruit patients with allergic rhinitis selected for screening for the initiation of immunotherapy from our outpatient clinic. Multi‐testTM skin prick testing (SPT), modified quantitative testing (MQT) and blood taken for mRAST was performed on all recruited subjected at the same setting. SPT, MQT and mRAST grading of common allergens were tested for their correlations.Results21 patients (12 male, 9 female) were recruited between May 2006 and Dec 2007. After comparing results from all 3 tests, 262 sets of allergens were available for analysis. We found that there was significant correlation between SPT and mRAST results (r=0.504, p<0.01). Similarly mRAST grading also correlated significantly with MQT grading ((r=0.51, p<0.01).ConclusionsWith good correlations between mRAST grading and MQT grading, in vitro testing could be the preferred mode of quantification for vial preparation during initiaition of immunotherapy. Patient would experience less pain and had no anaphylaxis risk. Both initiation and follow‐up of patient undergoing immunotherapy would be easier.
Anterolateral Thigh Flap for Skull Base Reconstruction
Authors: Hanasono Matthew M , Goel Neha , Ayad Martina , Skoracki Roman , Sacks Justin Michael 
Published: August 2008

Objective1) Review our experience with the anterolateral thigh (ALT) free flap in skull base reconstruction. 2) Describe reconstructive techniques for skull base defects and dural coverage with simultaneous facial reanimation.MethodsA retrospective review was performed for 25 consecutive patients with defects of the skull base who were reconstructed with the ALT free flap.ResultsReconstructed sites consisted of 2 anterior, 7 lateral, and 16 posterior skull base defects. Neoadjuvant and adjuvant radiotherapy (RT) was administered to 32% and 36% of the patients, respectively. The overall complication rate was 36% (66% recipient site and 34% donor site). One patient developed a CSF leak and one a nasocutaneous fistula. RT was associated with a two‐fold increase in wound complications relative to controls. There were no flap losses and no long‐term donor site probleMS 3 nerve grafts using the lateral femoral cutaneous nerve and 12 static slings for facial reanimation using the tensor fascia lata were performed simultaneously with free flap reconstruction from the same donor site. 4 gold eyelid weights, 2 lateral canthoplasties, and 3 direct browlifts were also performed simultaneously.ConclusionsThe ALT free flap provides reliable and versatile reconstruction of skull base defects. Primary advantages of this flap reside in the ability to harvest variable amounts of skin and vastus lateralis muscle along with nerve and fascial grafts from the same operative site, minimizing operative time and donor site morbidity. In our practice, the ALT flap represents a first‐line option for composite skull base defects.
Endonasal Access to the Orbital Floor for Blowout Fractures
Authors: Hinohira Yasuyuki , Shiraishi Atsushi , Hato Naohito , Komori Masahiro 
Published: August 2008

Objective1) Describe how to endonasally access the inferior orbital wall for the reduction surgery using endoscope. 2) Show the usefulness of the endoscopic endonasal approach for alternative to the current approaches.MethodsBetween 1997 and 2007, 41 patients with isolated inferior blowout fractures not involving the medial wall underwent surgery. The surgical treatment was determined due to persisting diplopia for 2 to 4 weeks after the trauma. In 38 of the 41 patients the reduction surgery was completed using only the endoscopic endonasal approach. To achieve the endoscopic endonasal reduction surgery, via the middle nasal meatus, septoplasty was supplemented in 7 patients and sub‐mucous conchotomy in 36. In 16 patients the inferior antrostomy was additionally required to reach the fracture site. The bone fragments entrapping the orbital content were carefully removed. An ophthalmologist verified the ocular motility improvement by eye traction test. No permanent supporting material except temporary balloon fixation was used.ResultsNo surgical complications were encountered in any of the patients. Postoperatively, diplopia disappeared in 32 of the 35 patients (91.4%) followed over 6 months. No patients complained of postoperative buccal paresthesia or enophthalmos.ConclusionsAn endoscopic endonasal reduction surgery for isolated blowout fractures has so far been considered as technically difficult. Our procedure to access the inferior orbital wall comprise sinonasal surgery techniques that have been conventionally used. We conclude that the endoscopic endonasal approach can be an alternative to the extranasal methods because of safety and usefulness.
Management of Combined Deviated and Saddle Nose
Authors: Jin Hong‐Ryul , Won Tae‐Bin , Lee Hyeon‐Jong 
Published: August 2008

ObjectiveTo present the surgical algorithm and key maneuvers that were successfully applied in the correction of post‐traumatic combined deviated and saddle nose deformity.Methods25 consecutive patients who had undergone primary rhinoplasty in a tertiary hospital for a post‐traumatic combined deviated and saddle nose were enrolled in the study. The patterns of deformity, surgical maneuvers applied, surgical results, and complications were analyzed with chart review, interview with patients, and evaluation of the patient photographs. Mean follow‐up period was 19 months.ResultsDeviated nose combined with minor saddling that had sufficient septal support was most commonly encountered (n=18, 72%) and were treated by straightening the nose and septum, followed by simple onlay grafts. Five patients had combined deviated and saddle nose with loss of septal support (n=5, 20%) and needed septal replacement to facilitate other procedures for correction. In 2 patients (8%) showing deviation with generalized saddling with loss of septal support, an integrated dorsal graft with columellar strut was performed, bypassing the major septal reconstruction. The key maneuvers for correction were septal reconstruction (92%), bilateral osteotomies (84%), and dorsal onlay grafts (100%). No major complications were found. Objective evaluation showed complete correction of the deviation and saddling in 84%, persistent deviation but less than before surgery in 12%, mild residual saddle in 4%.ConclusionsEstablishing a straight and firm septum supporting the overlying nasal structures is the most important step in correction of post‐traumatic combined deviated and saddle nose.
Novel STSG Donor Site for Forearm Flaps: Radial Skin Paddle
Authors: Ghanem Tamer Abdel‐Halim , Wax Mark K 
Published: August 2008

ObjectiveSplit thickness skin grafts (STSG) harvested from the thigh are often utilized to provide coverage for radial forearm donor sites. To eliminate the morbidity of the thigh STSG donor site, we assessed the feasibility of harvesting the STSG from the radial.MethodsProspective data was collected from patients undergoing forearm free flap reconstruction at a tertiary medical center in a 6‐month period. The radial forearm free flap (RFFF) harvesting procedure was modified to incorporate STSG harvest from the paddle site as the first step after arm tourniquet activation.ResultsThere were 27 patients in this cohort, with mean age of 68.2. There were 24 fasciocutaneous RFFF, 2 osteocutaneous RFFF, and 1 ulnar flap. The indications for free tissue transfer were as follows: intraoral defects (n=13), pharyngeal patch repair (n=8), total laryngopharyngectomy (n=1), external skin coverage (n=5). The mean forearm defect was 41.2 cm2 (24–77 cm2). 22 out of 27 skin grafts were non‐meshed. Harvesting from the forearm skin paddle was successful in 25 patients (93%). Two patients required a thigh STSG; both patients were octagenerians with frail skin. All the forearm donor sites healed well, except one patient required a later revision procedure for exposed tendon.ConclusionsBased on this study, the thigh STSG donor site can be eliminated in 9 out of 10 patients undergoing radial forearm free flaps. This translates to decreased risk of pain, infection, and wound oozing. Older patients with frail skin and atrophied forearm muscles were likely to require a thigh donor site.
Ocular Outcomes after Gold Weight and Facial Nerve Resection
Authors: Razfar Ali , Afifi Ahmed , Manders Ernest Kelvin , Myers Eugene N , Johnson Jonas T , Deleyiannis Frederic 
Published: August 2008

Objective1) To assess the effectiveness of acute gold weight placement following facial nerve resection. 2) To determine the role of concomitant lower eyelid procedures.Methods22 patients who received an upper eyelid gold weight at the time of parotidectomy and facial nerve resection were retrospectively reviewed (mean follow‐up: 23 months). Outcomes included the assessment of eye closure, gold weight complications (i.e., extrusion, need to upsize weight), ectropion, and need for tarsal strip procedure.ResultsThe range of gold weight size used was 1–1.4 (g), where 1.2 g was the predominant size used (18/22). 12 patients (12/22, 54.5%) presented with ocular symptoms following gold weight placement. Within these 12 patients, 9 presented with lower lid ectropion, 5 with lagopthalmos, and 6 with corneal exposure. 9 of the 12 patients subsequently received a tarsal strip procedure. The mean time to lower eyelid procedure was 14.2 months (range: 0–61) following gold weight placement. 6 patients, in addition to a gold weight, also underwent a static sling to the midface at the time of facial nerve resection. None of these 6 patients received subsequent lower eyelid procedure. Two patients required gold weight upsizing. Two patients required weight removal because of exposure.ConclusionsInsertion of 1.2 gm upper eyelid weight with concomitant placement of midface sling is recommended at the time of acute facial nerve resection. Due to the need to tighten the lower eyelid in a majority of patients, we now also recommend performing a tarsal strip procedure at the time of facial nerve resection.
TGF‐β1 Modulates HGF/SF in Keloid Fibroblast Cell Culture
Authors: Naim Ramin , Naumann Andreas , Barnes James , Sauter Alexander , Hormann Karl , Bloching Marc 
Published: August 2008

ObjectiveAbnormal wound healing processes can result in hypertrophic scars and keloids. TGF‐β1 and HGF/SF are biphasic growth factor cytokines in physiological and pathophysiological conditions. TGF‐β1 has been found to be pivotal in the formation of keloid tissue and therefore neutralising antibodies may allow wound healing without keloid formation. TGF‐β1 has been reported to be antagonised by HGF/SF. Some authors have reported that exogenous administration of HGF/SF prevented scar formation. Hence in this study, we targeted TGF‐β1 and determined the levels of HGF/SF in fibroblast cell culture.MethodsKeloid tissue was taken from 7 patients while another 7 patients with mature non‐hypertrophic scar served as controls. All tissues were cultured and fibroblast cultures were used for further experiments. TGF‐β1 antisense was administered at 3 and 6 μmol/ml and HGF/SF levels were determined after 16, 24 and 48 hours of incubation.ResultsThe levels of HGF/SF showed significant differences after incubation with antisense oligonucleotides. The increasing antisense levels resulted in increased HGF/SF levels (up to 87.66pg/ml after 48 hours of incubation).ConclusionsIn conclusion, targeting TGF‐β1 resulted in significantly increased levels of HGF/SF. The clinical relevance could include the use of locally administered HGF/SF in protein or gene form to minimise keloid formation. Nevertheless, wound healing is the result of many interacting cytokines and therefore neutralising or targeting one protein could result in no significant effect.
Electrocautery Adenoidectomy Outcomes: A Metaanalysis
Authors: Reed Jeremy T. , Sridhara Shankar K. , Brietzke Scott E 
Published: August 2008

ObjectiveReview and assess the current published literature regarding clinical outcomes of suction electrocautery adenoidectomy (ECA) in pediatric patients.MethodsThe MEDLINE database was systematically reviewed for articles reporting on the use of ECA. Inclusion criteria included English language, sample size greater than 5, and presentation of extractable data regarding pediatric outcomes with ECA. Random effects modeling was used to estimate summary outcomes.Results9 studies met the inclusion criteria. There were 2 level 1b studies, 2 level 3b studies, and 5 level 4 studies. The mean sample size was 276 patients with a grand mean age of 6.0 years. Random effects modeling of summary estimates of intra‐operative hemorrhage (4.1 cc vs. 24.0 cc 95% CI of difference = 16.5–23.1, p<0.001) and operative time (10.0 minutes vs. 11.9 minutes 95% CI of difference=0.82–2.90, p<0.001) favored ECA vs. traditional curette adenoidectomy. Subjective success was reported in 95.0% (95% CI=92.7–97.3%, p<0.001) of ECA patients with a grand mean of 5.8 months of postoperative follow‐up and a grand mean lost to follow‐up rate of 23.2%. Adenoid regrowth was evaluated objectively (endoscopy or X‐ray) in only 116 of 2,132 (5.4%) total patients with an observed regrowth rate of 2.8% (95% CI=0–5.5%, p=0.052) with 846 total person years of follow‐up.ConclusionsThe preponderance of evidence favors ECA versus curette adenoidectomy in terms of decreased intraoperative hemorrhage and decreased operative time. Long‐term outcomes data for ECA are scarce, despite the fact that the procedure is likely performed hundreds of times each day, but suggest a low regrowth rate.
Is Surgical Innovation Reduced with More Strict Regulations?
Authors: Rosow David E , Likhterov Ilya , April Max M , Stewart Michael G 
Published: August 2008

ObjectiveWith ever‐increasing regulatory requirements on human subject research, we postulated that there would be a corresponding decline in the number of published reports of surgical innovation in the otolaryngology literature.MethodsWe defined innovations as new procedures, techniques, or approaches that should require IRB approval in 2007, and modifications as non‐substantive changes in existing procedures or techniques that should not require IRB approval. We reviewed every abstract from 4 months of the years 1988 and 2006, from the journals Laryngoscope, Oto‐HNS, and Archives. After identifying information was concealed, abstracts were reviewed and classified independently by two authors, for innovation, modification, or neither. All disagreements were judged by a third author, who reviewed the entire article. Proportions were compared using chi‐square analysis.ResultsThere were 367 publications reviewed from 1988, and 548 from 2006. The proportion of articles representing either innovation or modification was significantly lower in 2006 than 1988: 59/548 (10.8%) vs. 67/367 (18.3%), p<0.001. Eliminating radiology and pathology quiz cases yielded similar results: 11.1% vs. 18.9%, p<0.001. Very few articles (4 total) were classified as innovation.ConclusionsThe proportion of published studies describing surgical innovations and modifications was significantly lower in 2006 than in 1988. One cause of this decrease in innovation could be increased barriers for research approval in the current era. However, other explanations are plausible, such as increased publication of other study types, e.g., basic research. While our analysis does not prove cause and effect, it is an important finding that deserves further study.
Post‐Tonsillectomy Hemorrhage Diagnosis and Management
Authors: Morris Michael S 
Published: August 2008

Objective1) Better recognize pathophysiology of postoperative tonsillectomy hemorrhage. 2) Be able to better differentiate the different types of post‐tonsillectomy hemorrhage based upon understanding the vascular physiology and adjust management accordingly.MethodsPost‐tonsillectomy complications in children and adults were reviewed. 7 cases of hemorrhage, including 5 deaths, were carefully reviewed. Patients ranged between 2–40 years of age. This represents the largest series of post‐tonsillectomy deaths reported to date. All postoperative deaths were due to bleeding and cardiopulmonary arrest. Post‐mortem analysis was undertaken on those patients. CT angiography was reviewed in one surviving patient and the utility of this type of scanning is discussed.ResultsPost‐tonsillectomy bleeding is one of the most worrisome otolaryngology concerns. Patients with bleeding on postoperative days 2–3 reported episodic bleeding stopping spontaneously. In these patients, the episode of unobserved bleeding signaled a vascular spasm with a likehood of recurrence. When the bleeding recurred it was massive and occured in a uncontrolled setting, leading to a poor outcome. Vascular trauma and spasm is likely.ConclusionsPostoperative tonsillectomy bleeding is better managed by differentiating those patients with early stage bleeding on postoperative days 2–3. Direct examination of the operative field is imperative. Ancillary testing including CT angiograpy is helpful in the evaluation.