bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transoral Robot‐Assisted CO2 Laser Supraglottic Laryngectomy: Experimental and Clinical Data
Authors: Solares C Arturo , Strome Marshall 
Published: April 2007

AbstractBackground: Transoral CO2 laser surgery for selected supraglottic tumors results in improved postoperative function and decreased morbidity, with comparable survival to open surgery. Recently, robot‐assisted techniques have been reported for the management of supraglottic lesions. There are no reports in the English literature of robotic technology coupled with CO2 laser technology. Our objective was to report the use of such technology.Study Design: Experimental resection of the supraglottis in a cadaver and a dog model using a commercially available surgical robot coupled with CO2 laser technology. Initial human experience with such technology is reported.Methods: With use of a hollow core fiber that allows the transmission of CO2 laser energy linked to the daVinci Surgical Robot, a supraglottic laryngectomy was performed in an edentulous female cadaver. The FK Laryngo‐Pharyngoscope was used for exposure. In a second experiment, a supraglottic partial laryngectomy was performed in an 80 pound dog. On the basis of our experimental experience, a CO2 laser robotic‐assisted supraglottic laryngectomy was attempted in three patients.Results: Removal of the supraglottic larynx in both a cadaver and canine experimental models was believed to be satisfactory using this technology. Bleeding was easily controlled in the live canine model. A 74‐year‐old woman with a large supraglottic mass for which she had been offered a total laryngectomy was resected successfully with this technology. The FK Laryngo‐Pharyngoscope provided excellent exposure. The patient was able to swallow without difficulty on postoperative day 5. Follow‐up endoscopic examination at 1 month showed no evidence of residual laryngeal tumor. Robot‐assisted procedures were attempted in two additional patients, but adequate exposure could not be achieved, and more traditional techniques were performed.Conclusions: The use of the daVinci Surgical robot coupled with CO2 laser technology is feasible, as demonstrated by our experimental and clinical data. Although further development of the robotic technology is required at present, the use of robotics coupled with CO2 laser technology may have important implications in the management of supraglottic laryngeal cancer in the future.
A New De Novo Missense Mutation in Connexin 26 in a Sporadic Case of Nonsyndromic Deafness
Authors: Primignani Paola , Trotta Luca , Castorina Pierangela , Lalatta Faustina , Cuda Domenico , Murri Alessandra , Ambrosetti Umberto , Cesarani Antonio , Curcio Cristina , Coviello Domenico , Travi Maurizio 
Published: April 2007

AbstractObjectives: Mutations in the GJB2 gene, encoding Connexin 26, can cause nonsyndromic recessive deafness or dominant hearing loss (HL) with or without keratoderma. The objective was to perform a molecular evaluation to establish the inherited pattern of deafness in the sporadic cases afferent to our center.Methods: The subject was a 2‐year‐old Italian girl with nonsyndromic early onset HL. We performed DNA sequencing of the GJB2 gene and deletion analysis of the GJB6 gene in all family members.Results: Direct sequencing of the gene showed a heterozygous C→G transition at nucleotide 172 resulting in a proline to alanine amino acid substitution at codon 58 (P58A). The analyses indicate that the P58A mutation appeared de novo in the proband with a possible dominant effect.Conclusions: This mutation occurs in the first extracellular domain (EC1), which seems to be very important for connexon‐connexon interaction and for the control of voltage gating of the channel. The de novo occurrence of an EC1 mutation in a sporadic case of deafness is consistent with the assumption that P58A can cause dominant HL.
Laryngeal Electromyography in Adults With Parkinson's Disease and Voice Complaints
Authors: Zarzur Ana Paula , Duprat André C. , Shinzato Gilson , Eckley Claudia A. 
Published: April 2007

AbstractObjective: To study the laryngeal electromyography (LEMG) pattern in patients with Parkinson's disease (PD) and vocal complaints.Study Design and Setting: Twenty‐six adults with PD and vocal complaints and 26 controls with presbyphonia underwent videolaryngoscopy (VL) and LEMG.Results: No tremor was found on LEMG of the cricothyroid and thyroarytenoid muscles, even in cases with clinical and VL tremor. LEMG hypertonicity during voice rest was the typical feature observed in 73% of the patients with PD versus 23% of the controls. This difference was statistically significant. The severity of the disease, diagnosis, and the time of treatment did not correlate with LEMG findings.Conclusion: This is the first study reporting the use of LEMG in a large series of patients with PD and vocal complaints. Patients with PD presented spontaneous intrinsic laryngeal muscle activity during voice rest.Significance: The typical patterns in LEMG suggest this to be a valuable diagnostic tool in PD.
A Possible Role of CD4+CD25+ T Cells as Well as Transcription Factor Foxp3 in the Dysregulation of Allergic Rhinitis
Authors: Xu Geng , Mou Zhonglin , Jiang Hongyan , Cheng Lei , Shi Jianbo , Xu Rui , Oh Yun , Li Huabin 
Published: April 2007

AbstractBackground: Allergic rhinitis (AR) is a Th2 predominant disease, and its pathogenic mechanism is still poorly understood. CD4+CD25+ T cells account for approximately 5% to 10% peripheral CD4+ T cells and has been shown to regulate the activation of effector T cells in the periphery. The activity of CD4+CD25+ T cells is associated with the transcription factor Foxp3. The present study aimed to evaluate the possible role of CD4+CD25+ T cells as well as Foxp3 in the pathogenesis of AR.Methods: Nasal tissues and peripheral blood mononuclear cells (PBMCs) were obtained from 17 patients with AR and 11 control subjects. Foxp3 was detected in nasal tissues by immunohistochemistry and real‐time reverse transcription‐polymerase chain reaction (RT‐PCR). CD4+CD25+ T cells and Foxp3 were evaluated in PBMCs by using flow cytometry. Concentrations of interleukin‐2 (IL‐2) and interferon‐γ (IFN‐γ) were measured by enzyme‐linked immunosorbent assay (ELISA) in cultured PBMCs in the presence or absence of stimulation with phorbol ester (PMA) and Ionomycin.Results: The numbers of Foxp3+ cells was 129.5 ± 35.6 and 44.2 ± 20.5 cells/mm2 in nasal mucosa of two groups (P < .05). There were less Foxp3+ lymphocytes and decreased Foxp3 mRNA in AR compared with the control (P < .05). The frequencies of the CD4+CD25+ population in PBMCs of two groups were 1.99 ± 0.95% and 3.55 ± 1.27% (P < .05). There was significant difference in the frequencies of the Foxp3+CD4+ CD25+ population (1.81 ± 0.77 vs 3.37 ± 1.04, P < .05) and mean fluorescence intensity (MFI) of Foxp3 (5.93 ± 2.64 vs 11.72 ± 4.29, P < .05) in PBMCs of two groups. After stimulation, the concentrations of IL‐2 and IFN‐γ were 182.72 ± 85.11 pg/mL and 348.94 ± 151.88 pg/mL in PBMCs with AR, while those were 90.6 ± 61.5 pg/mL and 155.64 ± 68.33 pg/mL in controls (P < .05).Conclusion: Our results indicate that CD4+ CD25+ regulatory T cells as well as Foxp3 may play a crucial role in immunological imbalance of AR. These findings suggest that increasing Foxp3 and CD4+CD25+ T cells have the potential to be new therapeutic targets for the treatment of AR.
Spinal Accessory Nerve Monitoring in Selective and Modified Neck Dissection
Authors: Witt Robert Lee , Rejto Lidia 
Published: April 2007

AbstractObjectives: To determine whether a threshold increase in current is required to stimulate the spinal accessory nerve (SAN), comparing current on initial identification of the SAN and after completion of the dissection and before closure for selective neck dissection (SND), zones 1, 2, and 3, and modified radical neck dissection (MRND), zones 1, 2, 3, 4, and 5, and compare clinical outcome measures for “shoulder syndrome” for SND and MRND.Study Design: Prospective study of 22 consecutive patients receiving SND or MRND by one surgeon at one institution.Methods: Electrophysiologic recording of current on initial identification of the SAN was compared with the current recorded at the completion of the procedure and before closure for SND and MRND. Clinical correlation measured and compared parameters of “shoulder syndrome” (shrug, flexion, abduction, winging, and pain) for SND and MRND at 2 months.Results: Zero of 11 (0%) patients with SND and 3 of 11 (27%) patients with MRND had significant threshold increases (>0.4 mAmp) on completion of the dissection. One of 11 (9%) patients with SND and 3 of 11 (27%) with MRND had less than 90 degrees of shoulder abduction, scapular winging, or significant pain.Conclusions: Electrophysiologic integrity of the SAN does not completely correlate with clinical outcome measures for “shoulder syndrome.” It is significant that 17 of 19 (89%) patients without an electrophysiologic threshold increase did not develop “shoulder syndrome.” This study demonstrated less electrophysiologic threshold shift and “shoulder syndrome” with SND compared with MRND.
Laryngeal Sensation Recovery by Reinnervation in Rabbits
Authors: Bouchetemblé Pierre , Marcolla Aurore , Lacoume Yann , Verin Eric , Dehesdin Danièle , Marie Jean Paul 
Published: April 2007

AbstractObjectives/Hypothesis: To assess the possibilities of restoring laryngeal sensation in an animal model by way of the internal branch of the superior laryngeal nerve (ibSLN) bilateral section and anastomosis to itself or to transposition nerves (i.e., lingual, glossopharyngeal, and great auricular nerves).Study Design: Prospective study using New Zealand rabbits.Methods: Six groups of rabbits were operated on and evaluated: healthy controls (n = 6); section without reinnervation (denervated group, n = 7); section and reinnervation with ibSLN (SLN‐SLN group, n = 9); and section and anastomosis with the lingual nerve (lingual group, n = 7), the glossopharyngeal nerve (glossopharyngeal group, n = 6), and the great auricular nerve (GA group, n = 7). After 9 months, recovery of a laryngeal closure reflex was assessed by stimulation of the epiglottis and nerve anastomosis.Results: Laryngeal sensation was restored in 14.3% in the denervated group, 66.6% in the SLN‐SLN group, 71.4% in the lingual group, 100% in the GA group (P < .001), 50% in glossopharyngeal group. Some anastomoses were severed. When anastomosis was intact, a laryngeal closure reflex was observed in 91.7% of the rabbits of the SLN‐SLN group (P < .001), 80% in the lingual group (P < .001), 100% in the GA group (P < .05) and 100% of the glossopharyngeal group.Conclusions: Rehabilitation of supraglottic laryngeal sensation is feasible by way of anastomosis of the ibSLN to itself, but also to the lingual, glossopharyngeal, and great auricular nerves. These results suggest that this type of procedure may be useful in humans to prevent aspiration and subsequent pneumonia as related to lesions of the laryngeal reflex pathway. It could also be considered one stage toward the functional rehabilitation of a transplanted larynx.
Technique of Optical Coherence Tomography of the Larynx During Microlaryngoscopy
Authors: Kraft Marcel , Lüeren Kathrin , Lubatschowski Holger , Glanz Hiltrud , Arens Christoph 
Published: April 2007

AbstractOptical coherence tomography (OCT) is a new, noninvasive imaging technology for the evaluation of superficial lesions. Because of a penetrating depth of a few millimeters and an ultrahigh tissue resolution, it qualifies for use in the larynx and might in the near future play an important role in the pre‐, intra‐, and postoperative investigation of early laryngeal cancer and its precursor lesions. Especially directed to otolaryngologists, this paper describes the technique of in vivo OCT imaging of the larynx in detail during microlaryngoscopy and supplies a number of personal hints.
Cranial Nerve Involvement in Malignant External Otitis: Implications for Clinical Outcome
Authors: Mani Navin , Sudhoff Holger , Rajagopal Sandeep , Moffat David , Axon Patrick R. 
Published: April 2007

AbstractBackground: Malignant external otitis is an uncommon, potentially lethal infection of the temporal bone primarily affecting elderly diabetic patients.Objective: To determine whether cranial nerve involvement in malignant external otitis affects or predicts the clinical outcome in terms of morbidity and mortality.Methods: Diagnosis of malignant external otitis was established in 23 patients (average age, 71 yr; range, 39–87) based on inclusion criteria of severe pain, otitis externa refractory to conventional treatments, diabetes mellitus, and Pseudomonas aeruginosa detection. Computed tomography confirmed temporal bone involvement extending outside the external auditory canal.Data Analysis: Retrospective analysis of hospital records.Results: Ten of 23 (43.5%) patients showed cranial nerve involvement. The following cranial nerves were affected: facial nerve (6/10), lower cranial nerves (combination of IX, X, XI, XII) (3/10), and extended nerve palsy (VI, VII, IX, X, XI) (1/10). Thirteen of 23 (56.5%) patients displayed no cranial nerve involvement. All patients were treated with long‐term, high‐dose antibiotic treatment dependent on the microbiological findings.Conclusions: All patients with lower cranial nerve palsy recovered normal function; however, the facial nerve palsy was significantly less likely to improve by medical treatment. Cranial nerve involvement did not affect the patient survival rate under an optimized medical treatment in our series.
Surgical Outcomes of Drillout Procedures for Complex Frontal Sinus Pathology
Authors: Batra Pete S. , Cannady Steven B. , Lanza Donald C. 
Published: April 2007

AbstractObjectives: The purpose of this report is two‐fold: 1) to determine the incidence and 2) to determine the efficacy of drillout procedures in the management of frontal sinus disease in a tertiary rhinology practice.Study Design: Retrospective data analysis.Methods: Chart review was performed for all patients undergoing frontal sinus surgery from May 1999 to April 2004. The incidence of drillout surgery was determined. Demographic data, symptomatology, type of drillout procedure, and primary pathology were determined. Postoperative outcome was assessed based on subjective symptomatology and objective endoscopic patency.Results: A total of 186 patients underwent 207 frontal sinus procedures during this time period; 25 patients (13.4%) required a total of 30 (14.5%) drillout procedures. The patient population had previously undergone an average of 3.2 procedures; four cases were primary and 26 were revision procedures. The breakdown of the procedures was as follows: Draf III, 17; Draf IIB, 7; and transseptal frontal sinusotomy, 6. The major indications included mucoceles (11 cases), chronic frontal sinusitis (6 cases), and tumors (5 cases). Postoperatively, presenting symptomatology resolved in 32%, improved in 56%, and remained unchanged in 12% of the patients. Endoscopic patency of the neo‐ostium was noted in 23 cases (92%). Average follow‐up was 16.3 months.Conclusions: In this series, drillout procedures were successfully used in 25 patients as an important adjunct to the standard endoscopic techniques for management of complex frontal sinus disease. Because the procedure was used only 30 times during a 5‐year period, it was reserved for specific circumstances in carefully selected patients.
Validation of the Synkinesis Assessment Questionnaire
Authors: Mehta Ritvik P. , WernickRobinson Mara , Hadlock Tessa A. 
Published: April 2007

AbstractObjective: To validate the Synkinesis Assessment Questionnaire (SAQ), a newly developed patient‐graded instrument to evaluate facial synkinesis.Study Design: This was a prospective clinical questionnaire validation study.Methods: A total of 65 patients with facial nerve disorders were recruited from the Facial Nerve Center. In 28 patients (group I), the SAQ, a preliminary 10‐item instrument, was administered at the initial visit and repeated within 3 weeks without any medical or surgical intervention. In 37 patients (group II), the SAQ was administered before botulinum toxin therapy for facial synkinesis and again 2 weeks after Botox therapy. In addition, the instrument was administered to 20 healthy subjects without facial nerve dysfunction (group III). The reliability, validity, and responsiveness of the SAQ were assessed.Results: Test‐retest reliability for the SAQ was high (Spearman's rank correlation r = 0.876, P < .0001). Internal consistency of the instrument was assessed by calculating the Cronbach α value. This analysis supported the deletion of one item from the final SAQ. The Cronbach α for the final SAQ was 0.859. Construct validity analysis showed a statistically significant improvement in SAQ scores (P < .001) after successful administration of botulinum toxin for treatment of facial synkinesis. There was a highly statistically significant difference (P < .0001) in SAQ scores between normal subjects (group III) and patients with facial synkinesis (group II).Conclusions: The SAQ is a simple, patient‐graded instrument designed to assess facial synkinesis. Instrument analysis suggests that it is a reliable and valid instrument for the assessment of facial synkinesis. The validated SAQ is the first dedicated instrument designed to assess facial synkinesis.
Impact of Trendelenburg positioning on functional residual capacity and ventilation homogeneity in anaesthetised children
Authors: Regli A. , Habre W. , Saudan S. , Mamie C. , Erb T. O. , Von Ungern‐Sternberg B S. ,   on behalf of the Swiss Paediatric Respiratory Research Group
Published: April 2007

SummaryTrendelenburg positioning, a head‐down tilt, is routinely used in anaesthesia when inserting a central venous catheter to increase the calibre of the jugular or subclavian veins and to prevent an air embolism. We investigated the impact of Trendelenburg positioning on functional residual capacity and ventilation homogeneity as well as the potential reversibility of these changes by repositioning and/or a recruitment manoeuvre in children with congenital heart disease.Functional residual capacity and ventilation homogeneity were assessed in 20 anaesthetised children between the ages of 3 months and 8 years who required central venous catheterisation before undergoing cardiac surgery. Functional residual capacity was measured (1) in the supine position, (2) in the Trendelenburg position, (3) after repositioning supine and (4) after a recruitment manoeuvre to total lung capacity which was performed by manually elevating the airway pressure to 40 cmH2O for ten consecutive breaths. Adopting the Trendelenburg position led to a significant decrease in functional residual capacity (median [range]− 12 (6–21)%) and increase in lung clearance index (12 (2–19)%). Baseline values were not reached after repositioning supine in any patient until after a standardised recruitment manoeuvre was performed.
The optimal dose of remifentanil for intubation during sevoflurane induction without neuromuscular blockade in children
Authors: Min S. K. , Kwak Y. L. , Park S. Y. , Kim J. S. , Kim J. Y. 
Published: April 2007

SummaryThe optimal dose of remifentanil needed to produce successful intubating conditions following inhalation induction of anaesthesia using 5% sevoflurane without the use of neuromuscular blocking drugs, was investigated in 25 children aged 3–10 years. Sixty seconds after inhalation induction of anaesthesia using sevoflurane 5% in 100% oxygen, a predetermined dose of remifentanil was injected over 30 s. The dose of remifentanil was determined using the modified Dixon's up‐and‐down method (0.2 μg.kg−1 as a step size). The first patient was tested at 1.0 μg.kg−1 remifentanil. Ninety seconds following the bolus administration of remifentanil, the child's trachea was intubated. The optimal bolus dose of remifentanil required for successful tracheal intubation was 0.56 (0.15) μg.kg−1 in 50% of children during inhalation induction using 5% sevoflurane in the absence of neuromuscular blocking drugs. Using probit analysis, the 95% effective dose (ED95) of remifentanil was 0.75 μg.kg−1 (95% confidence limits 0.63–1.38 μg.kg−1).
Repeated cycles of electrical stimulation decrease vasoconstriction and axon‐reflex vasodilation to noradrenaline in the human forearm
Authors: Drummond Peter D. 
Published: April 2007

What is already known about this subject • Repeated cycles of electrical stimulation inhibit cutaneous vasoconstriction to noradrenaline, but the mechanism is unknown.• Investigating this is important because peripheral electrical stimulation is useful for pain modulation and appears to assist cutaneous wound healing. What this study adds • Intermittent, brief electrical stimulation of the forearm over a 10‐day period inhibited vasoconstriction and axon‐reflex vasodilation to noradrenaline, but did not affect vasoconstriction to vasopressin or axon‐reflex vasodilation to histamine.• Thus, electrical stimulation may evoke a specific reduction in responsiveness to noradrenaline.AimTo investigate whether desensitization to the vasomotor effects of noradrenaline is a specific effect of electrical stimulation.MethodsThree sites on the forearm of 10 healthy volunteers were stimulated with 0.2 mA direct current for 2 min twice daily for 10 days. Noradrenaline and histamine were then displaced from ring‐shaped iontophoresis chambers into two of the pretreated sites and two untreated sites on the contralateral forearm. Axon‐reflex vasodilation was measured from the centre of the ring described by the iontophoresis chamber with a laser Doppler flowmeter. One or two days later, noradrenaline and vasopressin were introduced into pretreated and untreated sites by iontophoresis, and vasoconstriction at sites of administration was measured in the heated forearm.ResultsThe pretreatment blocked vasoconstriction to noradrenaline [median increase in flow 1%, interquartile range (IR) −41 to 52%; median decrease at the untreated site 53%, IR. −70 to −10%; P < 0.05], but did not block vasoconstriction to vasopressin (median decrease 42% at the untreated site and 45% at the pretreated site). Axon‐reflex vasodilation to noradrenaline was diminished at the pretreated site (median increase in flow 33%, IR 2–321%; untreated site 247%, IR 31–1087%; P < 0.05). However, axon‐reflex vasodilation to histamine did not differ significantly between the pretreated site (median increase 1085%) and the untreated site (median increase 1345%).ConclusionsThe conditioning pretreatment appears to evoke a specific decrease in responsiveness to noradrenaline. Repeated cycles of electrical stimulation may downregulate neural and vascular responses to noradrenaline by repetitively activating cutaneous sympathetic nerve fibres.