bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epinephrine/Lidocaine Injection Vs. Saline During Endoscopic Sinus Surgery
Authors: Cohen‐Kerem Raanan , Brown Stephen , Villaseñor Luis Velazquez , Witterick Ian 
Published: February 2009

AbstractObjectives: To assess the safety and effectiveness of an epinephrine/lidocaine mixture administered by injection versus epinephrine administered topically and to learn its pharmacokinetics following administration to the nasal mucosa.Design: A double‐blind randomized controlled trial.Methods: Patients were assigned into two groups and were injected with either epinephrine 1:100,000 and lidocaine 1% or saline alone during endoscopic nasal surgery under general anesthesia. Pledgets soaked in epinephrine 1:1,000 were used throughout the procedure in both groups. Hemodynamic measurements and catecholamine blood levels were obtained.Results: Ten patients were randomized to the epinephrine group and 12 to the saline group. We were able to measure epinephrine and norepinephrine levels following injection in all patients. Epinephrine levels were similar in both groups immediately after injection; however, 15 minutes following injection, epinephrine was significantly higher in saline‐injected patients. Mean arterial pressure and heart rate were affected by epinephrine and norepinephrine levels immediately after injection but were never elevated over the normal range. Heart rate was higher (P < .05) in the saline injected group than in the epinephrine group throughout the measurement period. The surgeons believed that the surgical field was bloodier in saline‐injected patients (P < .05) however objective estimation of blood loss showed no difference.Conclusions: Injection of epinephrine/lidocaine mixture does not produce higher blood levels of epinephrine when compared to saline injection and did not induce any harmful side effects. We postulate that the combination with lidocaine 1% may reduce the patients' stress and thus prevent higher catecholamine levels.
Free Abdominal Fat Transfer for Reconstruction of the Total Parotidectomy Defect
Authors: Conger Bryant T. , Gourin Christine G. 
Published: February 2009

AbstractObjectives: Free abdominal fat transfer (FAT) grafts have been used after superficial parotidectomy to restore facial contour. We reviewed our experience with the use of FAT reconstruction of total parotidectomy defects to determine the safety and efficacy of this procedure.Study Design: Non‐randomized retrospective analysis.Materials and Methods: The medical records of all patients who underwent total parotidectomy with the harmonic scalpel at the Medical College of Georgia from September 2004 to June 2007 were retrospectively reviewed. Patients with a prior bleeding disorder, facial nerve weakness, or who had undergone concurrent neck dissection were excluded.Results: Twenty‐two patients met the study criteria; nine patients underwent FAT reconstruction. There was a greater percentage of malignancy in the FAT group (44%) compared with controls (15%), and a larger tumor size in the FAT group (3.8 ± 2.1 cm) compared with controls (2.6 ± 1.2 cm), but these differences did not achieve significance. FAT reconstruction was associated with increased length of surgery (324.6 ± 86.9 minutes vs. 206.6 ± 61.8 minutes for controls, P = .0013) and intraoperative blood loss (138.9 ± 95.3 mL vs. 50.1 ± 30.9 mL, P = .0052). There were no significant differences between FAT and control groups with respect to postoperative drain output (42.0 ± 35.0 mL vs. 52.5 ± 41.3, P > .05), duration of drainage (32.0 ± 12.0 h vs. 34.8 ± 15.1 h, P > .05), or facial nerve function. All patients who underwent FAT reconstruction were satisfied with their postoperative appearance, compared to 70% of control patients who reported some degree of dissatisfaction postoperatively.Conclusions: FAT reconstruction of the total parotidectomy defect is associated with greater blood loss from the FAT donor site and increased surgical time, but is safe and highly effective. These data suggest that the benefits of FAT reconstruction outweigh the additional increment in operative time and blood loss observed.
The Effect of Occult Nodal Metastases on Survival and Regional Control in Patients With Head and Neck Squamous Cell Carcinoma
Authors: Gourin Christine G. , Conger Bryant T. , Porubsky Edward S. , Sheils W. Chris , Bilodeau Paul A. , Coleman Teresa A. 
Published: February 2009

AbstractObjectives: To determine factors associated with disease‐free survival (DFS) and regional control in clinically node‐negative head and neck squamous cell cancer (HNSCC) patients with occult metastasis.Study Design: Non‐randomized retrospective analysis.Materials and Methods: Patients who underwent elective neck dissection (END) from 1985 to 2002 were analyzed.Results: A total of 337 patients underwent END. The majority of patients (67%) had advanced stage disease (T3/T4). Occult metastases were present (pN+) in 168 patients (50%), with extracapsular spread (ECS) present in 72 patients (43%). Five‐year DFS for patients with histologically node negative necks was 62% versus 36% for pN+ patients (P < .0001). Postoperative radiation (XRT) did not significantly influence DFS for pN+ patients with less than three nodes involved, but had a significant association with DFS with three or more nodes involved (P < .0001). XRT showed a trend toward improved regional control rates in patients with less than three positive nodes (86% vs. 78%; P = .7579) and patients with three or more positive nodes (62% vs. 50%; P = .0014). When ECS was present, XRT did not affect DFS in patients with less than three nodes (36%), but had a significant effect on DFS in patients with three or more nodes (20% vs. 0%; P = .0075). Regional control rates were not improved with XRT in ECS‐positive patients with less than three nodes (62% vs. 75%) or with three or more nodes involved (43% vs. 50%; P = .0678).Conclusions: There is a high incidence of occult metastases in clinically node‐negative patients which adversely affects survival, regardless of the use of adjuvant XRT. Postoperative XRT did not significantly affect regional control or survival rates in patients with <3 positive nodes. When ECS was present, survival was poor regardless of the number of nodes. These data emphasize the prognostic and therapeutic role of END and highlight the need for the development of novel therapeutic regimens to improve disease control and survival in HNSCC patients with nodal metastases.
Onset and Offset Phonation Threshold Flow in Excised Canine Larynges
Authors: Regner Michael F. , Tao Chao , Zhuang Peiyun , Jiang Jack J. 
Published: February 2009

AbstractObjectives/Hypothesis: In this study, we examined the hypothesis that the minimum flow required for phonation onset, the onset phonation threshold flow (PTF), is greater than the minimum flow to sustain phonation, the offset PTF. We also explored the hypothesis that the ratio of these two (PTF offset divided by PTF onset) falls within [0.707, 1.0].Study Design: This was a methodology study to measure onset and offset PTFs in 10 excised canine larynges; their ratio (PTF offset divided by PTF onset) was predicted to fall in a specific domain.Methods: The onset and offset PTF and phonation threshold pressure (PTP) values were observed using 10 excised canine larynges mounted on a bench apparatus. The subglottal flow was increased until phonation was observed, and then decreased until phonation ceased; airflow and pressure measurements at critical conditions of phonation were observed as the PTF and PTP. Larynges with elongated vocal folds were then tested to observe PTF and determine if the hypothesis was observed in pathologic‐like larynges.Results: The offset PTF was always less than the onset PTF (P ≪ .0001) and 80.0% of the observed onset‐offset PTF ratios were bound by [0.707, 1.0].Conclusions: PTF onset or offset could be a useful diagnostic parameter of the voice, particularly when used in conjunction with PTP to describe laryngeal resistance and aerodynamic power. Further exploration of the relationship between onset and offset PTF values could augment clinical diagnostic ability and advance current theories on the physics of phonation.
Lingual Thyroid in Children: A Rare Clinical Entity
Authors: Rahbar Reza , Yoon Michelle J. , Connolly Leonard P. , Robson Caroline D. , Vargas Sara O. , McGill Trevor J. , Healy Gerald B. 
Published: February 2009

AbstractObjectives/Hypothesis: To study the presentation, management, and long‐term outcome of children presenting with lingual thyroid.Study Design: Institutional review board approved, retrospective study (1993–2004).Methods: The study was conducted at a tertiary care pediatric medical center. The main outcomes measured were initial presentation, radiographic findings, endocrine evaluation, surgical outcome, pathologic features, complications, need for hormonal replacement.Results: Four patients presented to the Department of Otolaryngology and Communications Enhancement, Children's Hospital Boston with lingual thyroid between 1993 and 2004. All patients were female, with an age range of 2 to 12 years (x = 6). All patients presented with a mass (1.4–3.5 cm) and most with respiratory or feeding difficulty. Magnetic resonance imaging was obtained in three patients and revealed a mass consistent with lingual thyroid. Thyroid scan confirmed the lingual thyroid as the only functioning thyroid in all four patients. None of the patients responded to hormonal replacement, and all underwent surgical excision of the mass. Surgical approach included midline glossotomy (n = 2) and CO2 laser excision (n = 2). Pathologic evaluation confirmed lingual thyroid in all four patients. No evidence of malignancy was seen in any patient. All four patients require lifelong hormonal replacement.Conclusions: Lingual thyroid is a rare condition, with an incidence of 1:100,000. This infrequent congenital anomaly is often asymptomatic until a pathologic stress such as systemic disease or physiologic stress such as puberty causes enlargement of the ectopic tissue, leading to dysphagia, dysphonia, and dyspnea. The work‐up should include routine blood work including thyroid function tests thyrotropin, thyroxine, and thyroid hormone binding ratio; iodine thyroid scintigraphy; and computerized tomography or magnetic resonance imaging. The majority of patients require surgical excision of the symptomatic mass and, in case of absence of orthotopic thyroid tissue, long‐term thyroid hormone replacement.
Effects of Long‐Term Denervation on the Rat Thyroarytenoid Muscle
Authors: Miyamaru Satoru , Kumai Yoshihiko , Ito Takaaki , Yumoto Eiji 
Published: February 2009

AbstractObjectives/Hypothesis: To determine the effects of long‐term denervation on the rat thyroarytenoid (TA) muscle and neuromuscular junctions.Study Design: A quantitative histologic assessment of the TA muscle after long‐term denervation.Methods: Thirty Wistar rats were euthanized 10, 18, 26, 42, and 58 weeks after left recurrent laryngeal nerve resection. The areas of the entire muscle and individual muscle fibers were evaluated using hematoxylin‐eosin staining, and neuromuscular junctions were detected by immunohistochemistry. Changes after denervation were evaluated by comparing the treated (T) and untreated (U) sides (T/U ratio). The ratio of the number of nerve terminals (NTs) to that of acetylcholine receptors (AChRs) (NT/AChR ratio) was also assessed.Results: The average T/U ratio for the entire muscle area of the denervation groups ranged between 61.1% and 72.5% and did not differ significantly. Similarly, the T/U ratios for the individual muscle fiber area ranged between 45.0% and 51.9%, and the differences were not significant. The T/U ratio of AChRs at 58 weeks (35.3 ± 20.2%) was significantly lower than that at 10 weeks (76.3 ± 9.0%; P < .01). The NT/AChR ratios ranged between 30.3% and 35.6% and did not differ significantly among the denervation groups.Conclusions: The entire TA muscle area, individual muscle fiber area, and NT/AChR ratio did not decrease with long‐term denervation. Thus, the TA muscle may retain an ability to receive regenerating nerve axons. However, the ability of the TA muscle to receive nerve axons may deteriorate after an excessively long denervation period because the T/U ratio of AChRs decreased with long‐term denervation.
Effect of Body Mass Index on Chemoradiation Outcomes in Head and Neck Cancer
Authors: McRackan Theodore R. , Watkins John M. , Herrin Amy E. , Garrett‐Mayer Elizabeth M. , Sharma Anand K. , Day Terry A. , Gillespie M Boyd 
Published: February 2009

AbstractObjective: To investigate the association between initial body mass index (BMI) and chemoradiation therapy (CRT) outcomes in head and neck cancer patients.Methods: Retrospective study of 72 patients with American Joint Committee on Cancer stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, or larynx treated with primary concurrent CRT with curative intent over a 5 year period. Logistic and Cox regression analyses were used to determine the association between initial BMI and percutaneous endoscopic gastrostomy tube dependence, tumor recurrence, disease‐free survival, and overall survival while controlling for the independent variables of age, sex, race, site, stage, and smoking and alcohol use.Results: Patients with normal or low BMI (BMI ≤25 kg/m2) were significantly more likely to be percutaneous endoscopic gastrostomy dependent at last follow‐up (odds ratio 4.13; 95% confidence interval [CI] 1.3–12.9; P = .014). This group also had significantly earlier recurrence (hazard ratio 4.4; 95% CI 1.2–15.9; P = .026) and shorter overall survival (hazard ratio 3.6; 95% CI 1.04–12.6, P = .043).Conclusions: The present study suggests that CRT patients with BMI greater than 25 have improved swallowing outcomes, longer time to disease recurrence, and improved survival when compared with similar patients with lower BMI. BMI at presentation may be an important clinical factor to consider when determining the optimal treatment modality for a head and neck cancer patient. Further investigation is required to determine whether primary surgery should be the preferred treatment in normal or low BMI patients.
Endoscopic Transnasal Craniotomy and the Resection of Craniopharyngioma
Authors: Stamm Aldo C. , Vellutini Eduardo , Harvey Richard John , Nogeira João Flávio , Herman Diego R. 
Published: February 2009

AbstractObjectives/Hypothesis: To describe the utility of a large transnasal craniotomy and its reconstruction in the surgical management of patients with craniopharyngioma.Study Design: Observational retrospective cohort study.Methods: Retrospective review of patients treated in an academic neurosurgery/rhinology practice between 2000 and 2007. Patient characteristics (age, sex, follow‐up), tumor factors (size, position extension, previous surgery), type of repair (pedicled mucosal flaps, free mucosal grafts), and outcomes (visual, endocrine, and surgical morbidity) were defined and sought in patients who had an entirely endoscopic resection of extensive craniopharyngioma (defined as requiring removal of the planum sphenoidale in addition to sella exposure in the approach).Results: Seven patients had an entirely endoscopic resection of extensive craniopharyngioma during the study period. Mean age was 23.4 years (standard deviation ± 16.3). Mean tumor size was 3.2 cm (standard deviation ± 2.0). The majority of these pathologies had extensive suprasellar disease, and two (28.6%) had ventricular disease. Cerebrospinal fluid leak rate was 29% (2 of 7). These leaks occurred only in reconstructions with free mucosal grafts. There were no cerebrospinal fluid leaks in patients who had vascularized pedicled septal flap repairs.Conclusions: The endoscopic management of large craniopharyngioma emphasizes recent advancements in endoscopic skull base surgery. The ability to provide exposure through a large (4 cm+) transnasal craniotomy, near‐field assessment of neurovascular structures, and the successful reconstruction of a large skull defect have significantly advanced the field in the past decade. The use of a two‐surgeon approach and bilateral pedicled septal mucosal flaps have greatly enhanced the reliability of this approach.
Efficacy of Powered Intracapsular Tonsillectomy and Adenoidectomy
Authors: Tunkel David E. , Hotchkiss Karin S. , Carson Kathryn A. , Sterni Laura M. 
Published: February 2009

AbstractObjectives/Hypothesis: We sought to determine the effectiveness of powered intracapsular tonsillectomy and adenoidectomy (PITA) in the treatment of children with moderately severe obstructive sleep apnea and to measure changes in quality of life that occur with such treatment.Study Design: Prospective, nonrandomized clinical trial in an academic pediatric otolaryngology practice.Methods: Convenience sample of children ages 3 to 12 years diagnosed with obstructive sleep apnea of moderate severity, defined as an apnea‐hypopnea index (AHI) between 5 and 20 on polysomnography. Children with recurrent streptococcal pharyngitis, chromosomal abnormalities, craniofacial abnormalities, neuromotor disease, sickle cell disease, obesity, or coagulopathy were excluded. PITA was performed by using the microdebrider. Polysomnography was performed before surgery and repeated 4 to 8 weeks after surgery. The Obstructive Sleep Apnea (OSA)‐18 questionnaire was completed at surgery and at the time of postoperative polysomnography to assess quality of life changes. The main outcome measure was cure of obstructive sleep apnea, as defined by a postoperative AHI of 1 or less for complete cure and less than 5 for partial cure. Improvements in quality of life were assessed by changes in the OSA‐18 questionnaire.Results: Nineteen children underwent PITA for moderate obstructive sleep apnea syndrome (OSAS), and 14 completed postoperative polysomnography. All 14 subjects who completed the study achieved at least partial cure. Thirteen of 14 (93%) subjects had a complete cure of OSAS after PITA. The median preoperative AHI was 7.9, and the median AHI after surgery was 0.1. The mean number of arousals per hour before surgery was 9.5, and this was reduced to a mean of 5.6 after surgery. Quality of life measures on OSA‐18 also improved, with large improvements in total quality of life scores and in all five domains seen after surgery.Conclusions: PITA cures otherwise healthy children with obstructive sleep apnea of moderate severity, at least in the short‐term, as documented by postoperative polysomnography. Improvements in quality of life measures, as documented by changes in OSA‐18, were seen in all children as well.
Endoscopic Treatment of Subcondylar Fractures
Authors: Ducic Yadranko 
Published: February 2009

AbstractObjectives/Hypothesis: To evaluate the effectiveness of endoscopic treatment of subcondylar fractures, highlighting an improved technique of repair that facilitates ease of repair.Study Design: A retrospective review.Methods: All subcondylar fractures treated by the author with the improved endoscopic technique from 2001 to 2007 were reviewed.Results: A total 34 subcondylar fractures were initially treated with the outlined technique. Thirty‐three of 34 were successfully managed with the endoscopic technique alone. There were no instances of facial nerve paralysis or palsy noted. There were two instances of malocclusion that were believed to be minor in the 27 of 34 patients who made themselves available for 6 week follow‐up. Both of these patients had associated multiple maxillofacial fractures repaired. Average operative time from ramus incision start to completion of plate fixation for the subcondylar fracture was 32 (range, 21–49) minutes.Conclusions: The outlined technique results in improved ease of rigid endoscopic fixation of subcondylar fractures in the majority of patients.
Airway Management in Anaplastic Thyroid Carcinoma
Authors: Shaha Ashok R. 
Published: February 2009

AbstractObjectives/Hypothesis: In patients who present with advanced anaplastic thyroid cancer, airway management is difficult because of bilateral vocal cord paralysis or tracheal invasion by the tumor. Airway management can be extremely complex in these patients.Study Design: This is the author's 25 year experience with 30 patients who presented with anaplastic thyroid cancer and acute airway problems.Methods: The patients' airway issues developed soon after presentation or a few months after treatment. Ten patients presented with initial symptoms of acute airway distress. All of these patients were treated with tracheostomy or cricothyrotomy.Results: The 10 patients who presented with initial symptoms of acute airway distress died within 4 months. Eight of the remaining 20 patients developed bilateral vocal cord paralysis. Airway management for these patients depended on the extent of distant disease and the family's understanding of the advanced nature of the disease and the palliative efforts. The remaining patients had a palliative and supportive approach.Conclusions: Airway management was the most critical issue in patients who presented with anaplastic thyroid cancer and initial airway distress. Cricothyrotomy was helpful in avoiding acute airway catastrophe. It is important to distinguish between poorly differentiated and anaplastic thyroid cancer and lymphoma for appropriate airway management.
Gefitinib (Iressa) Potentiates the Effect of Ionizing Radiation in Thyroid Cancer Cell Lines
Authors: Lopez Jay Patrick , Wang‐Rodriguez Jessica , Chang Catherine Y. , Sneh Gabriel , Yu Michael Andrew , Pardo Francisco S. , Aguilera Joseph , Ongkeko Weg M. 
Published: February 2009

AbstractObjectives/Hypothesis: To determine whether inactivation of epidermal growth factor receptor (EGFR) kinase activity will sensitize thyroid cancer cell lines to ionizing radiation‐induced death.Study Design: Established human thyroid cancer cells lines were studied.Methods: Colony formation assay was used to determine the effect of Gefitinib, a small molecule inhibitor of EGFR, on anaplastic (ARO) and follicular (WRO) thyroid cancer cell lines. In addition, colony formation assay was used to determine the effect of ionizing radiation in the presence or absence of Gefitinib. EGFR protein expression on the cell lines and inactivation of EGFR kinase by Gefitinib was analyzed by Western blot. Immunohistochemistry was performed on archived thyroid cancer tissue to demonstrate expression of EGFR.Results: Incubation with Gefitinib caused decreased phosphorylation of EGFR protein in established thyroid cancer cell lines as measured by Western blot. Inhibition of EGFR kinase activity by Gefitinib resulted in a dose‐dependent decrease in colony formation in both ARO and WRO thyroid cancer cell lines. Addition of Gefitinib in combination with ionizing radiation reduced cell proliferation in ARO (P = .0084) and WRO (P = .0252) as measured by colony formation assay.Conclusions: Inactivation of the EGFR kinase by Gefitinib potentiates the ionizing radiation‐induced inhibition of cell proliferation in thyroid cancer cell lines. Use of this combination treatment of Gefitinib and ionizing radiation may be a promising therapy for anaplastic thyroid and metastatic follicular thyroid cancer and should be extended into animal models.