bluuebunny/crossref_metadata_2025_split huggingface dataset:
Our Experience in Endoscopic CO2 Laser Surgery for Supraglottic Carcinoma
Authors: Cotulbea Stan , Poenaru Marioara , Doros Caius , Lupescu Stelian , Iovanescu Gheorghe , Marin Alin Horia , Stefanescu Horatiu 
Published: August 2004

ObjectivesThis study presents the indications, general principles, contraindications, limits, and results of this modern therapeutic method. Supraglottic laryngeal carcinoma is an aggressive, with high tendency for nodal metastasis. Therefore early detection and effective treatment is of outmost importance. Open surgical procedures, primary radiotherapy, and endoscopic procedures are therapeutic alternatives, with or without neck dissection and adjuvant radiotherapy.MethodsBetween 1998‐2002, 24 patients with supraglottic carcinoma T1 or T2 and N0 have been treated with supraglottic laryngectomy with CO2 laser. All patients were carefully selected using modern videoendoscopical procedures and CT scan or neck ultrasonography. Careful preoperative selection is of outmost importance for the clinical patients outcome. In the studied group, we applied horizontal supraglottic laryngectomy in 20 cases T2N0 and epiglottectomy in 4 cases T1N0. Postoperative follow‐up was between 12‐48 months (average, 36 months). The thracheostomy and nasogastric tube were not necessary in any case.ResultsIn our group we obtained the following oncological results: no evidence of disease (NED) 19 cases (79.17%), and local recurrence in 5 cases (20.83%). All patients who presented local recurrence were stage T2N0; the salvation treatment we applied consisted in total laryngectomy. Immediate functional results were very good in all cases.ConclusionsEndoscopic CO2 laser microsurgery appears to be an effective and safe alternative treatment for T1‐T2, N0 supraglottic carcinoma, with superior oncological and functional results than the other techniques, requiring short hospitalization, no tracheostomy and feeding tube, and providing superior rehabilitative result with a good quality of life.
CO2 Laser Microsurgery for Tis, T1, and Selected Cases of T2 Glottic Carcinoma
Authors: Puxeddu Roberto , Ledda Gian Peppino 
Published: August 2004

ObjectivesTo define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carcinoma.MethodsRetrospective study of 103 patients with well to undifferentiated glottic carcinoma (14 Tis, 68 pT1a, 14 pT1b, and 7 pT2 with impairment of vocal cord mobility) were treated from October 1993 to June 2001 at the Section of Otorhinolaryngology at the Department of Surgical Sciences and Organ Transplantations of Cagliari University, Italy. Mean follow‐up was 3.9 years. Surgical treatment included endoscopic CO2 laser cordectomies from type I to type Vc, according to the classification proposed by the European Laryngological Society in 2000.ResultsAccording to the Kaplan‐Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 100% for the Tis group, 93.4% for the T1 group (SE 3.85%) and 100% for the T2 group. Local control at 3 years after exclusive CO2 laser salvage surgery was 94.95% (SE 3.54%). The probability of remaining free of local recurrence 3 years after any type of salvage surgery was 100% for all the classes. Laryngeal preservation was achieved in 100% of the cases. Anterior commissure spread resulted in a not statistically significant difference in local control (P = 0.6), between the group of patients without (96.54%; SE 2.43%) and with anterior commissure involvement (87.5%; SE 11.69%).ConclusionsAccording to our experience, endoscopic CO2 laser surgery is an efficacious treatment for early stage glottic cancer.
Cysts, Sulcus Vocalis, and Mucosal Bridges of the Vocal Fold and Their Association with Polyps
Authors: Sakae Flavio Akira , Sasaki Fernando , Sennes Luis Ubirajara , Imamura Rui , Tsuji Domingos H 
Published: August 2004

ObjectivesPolyps are common lesions of vocal folds. Phonotrauma is related to physiopathology of this lesion. The objective of our study was to analyze the association with polyps and other benign vocal fold lesions (BVFLs).MethodsSixty‐eight patients underwent microlaryngeal surgery due to polyps of vocal folds. We analyzed retrospectively the presence of polyps in association with sulcus vocalis, cysts, and mucosal bridges.ResultsThe presence of BVFLs associated with polyps occurred in 14 (20.5%) patients. In 8 (57%) patients the polyp was associated with sulcus vocalis, in 4 (29%) with vocal fold cyst and in 2 (14%) with mucosal bridge. BVFLs was contralateral to the polyp in 9 (64%) patients (6 sulcus and 3 cysts).ConclusionThe association between polyps and others BVFLs is relatively frequent (20.5%). The polyp appears to arise from alterations in vocal fold vibration caused by the ipsilateral BVFL or as a result of repeated trauma of the contralateral BVFL.
The Effects of Ototopical Steroid, NSAID, and Antihistamine on Rat Auditory Function
Authors: Cutler Jeffrey Lyle , Hackett Troy A , Labadie Robert F 
Published: August 2004

ObjectivesOtotopical application of medication for the treatment of a variety of otologic disorders is becoming commonplace. With the increased use of ototopical agents, auditory toxicity must be analyzed. Our objective was to study the effects of transtympanic injection of steroid, NSAID, or antihistamine on Sprague‐Dawley rat auditory function.MethodsTwelve Sprague‐Dawley rats had their auditory function assessed through ABR. The rats were randomly divided into 6 groups (n = 2 each group): dexamethasone, rimexalone, patanol, astelin, diclofenac, and gentamycin (positive control). Baseline ABR were recorded prior to transtympanic injection and again recorded at 1 and 7 days after treatment. Wave 1 latency and amplitude were measured at 80, 60, 40, and 20 dB using click stimulus. The gentamycin group received an additional 10 days of intramuscular gentamycin after the initial treatment in order to demonstrate significant latency shift.ResultsThe steroid, antihistamine, and NSAID groups did not demonstrate shifts in wave 1 latency at postinjection day 1 or 7. The gentamycin group revealed a significant latency shift and decrease in amplitude at 40 and 20 db on postinjection day 1. Ten days of intramuscular gentamycin significantly shifted the latency of wave 1 compared to pretreatment.ConclusionSingle dose steroid, NSAID, and antihistamine do not demonstrate a significant ABR latency shift. Transtympanic gentamycin causes a temporary latency shift and amplitude reduction at low intensity stimulus with a return in function at 1 week posttreatment. Performing ABR in the Sprague‐Dawley rat is an excellent model to assess auditory toxicity from transtympanic injection.
Analysis of RET Gene Point Mutation in a Family with Familial Medullary Thyroid Cancer
Authors: Dae Lee Kang , Mun Hyo Sung , Noguchi Shiro 
Published: August 2004

ObjectivesHereditary medullary thyroid cancer is presented as part of MEN 2A or MEN 2B, but can also be inherited alone, which is called familial medullary thyroid cancer(FMTC). Author sought to detect point mutation of RET proto‐oncogene by using molecular genetic method on the family line of FMTC.MethodsDNA was extracted from the peripheral blood leukocyte of 6 medullary thyroid cancer patients (5 assumed sporadic and 1 assumed FMTC). After PCR amplification of exon 10, 11, 13, 14, 15, 16, point mutation of RET protooncogene was investigated using DNA sequence analyzer. When point mutation was identified in index patient of FMTC, same genetic study was conducted in their familyResultsWe identified point mutation of TGC(Cys)æCG‐C(Arg) at codon 618 of RET proto‐oncogene exon 10 in 1 assumed FMTC patient. The same point mutation was detected in 4 of the 9 family members. Among them, index patient and her mother had biochemical and clinical symptoms and underwent total thyroidectomy and neck dissection. Operations are scheduled for remaining members with point mutation later on.ConclusionGenetic analysis of RET proto‐oncogene will overcome the limitations of classic calcitonin stimulation test and make the earlier diagnosis and treatment of FMTC be possible.
Evaluation of Postoperative Morbidity in Pediatric Tonsillectomy with Sucralfate
Authors: Sampaio Fernando , Oliveira Carlos A 
Published: August 2004

ObjectivesTo evaluate the efficacy of sucralfate in alleviating posttonsillectomy morbidity in a pediatric group of patientsMethodsA prospective double‐blind, randomized, and controlled study comparing the irrigation of a solution containing either 1 g of sucralfate or 1 g of lactose was conducted on 58 children undergoing tonsillectomy, after the purpose and method of study were described to the parents, at Brasilia University Hospital. The anesthetic was standardized and no premedication was used; no analgesic drugs were used during the procedure. Tonsillectomy was performed using cold dissection by the same attending surgeon. Each patient used the same solution to swish and swallow 4 times daily during 7 days. Pain using Mcgraft analogue scale, vomiting and bleeding, time to return to normal diet, analgesic drugs intake, changes in the weight and temperature and interincisor teeth distance were assessed by the same author 6, 12 hours, and 7 days after the surgery. Results were compared between groups using t test and P value was considered statistic significant when it was less than 0.05.ResultsWe evaluated 29 children in each group with ages ranging from 3 to 12 years (mean, 6,2). We found no demographic difference between the groups. No patient was excluded from the study. No statistic difference between the groups was found comparing the parameters above, as well as, no difference was found in the evolutive assessment of the face scale for pain between the groups.ConclusionSucralfate showed no benefice in alleviating posttonsillectomy morbidity in this group of patients.
Rhinoscleroma: A Case Report and Update on Medical and Surgical Management
Authors: Drawert Casey , Simpson C Blake , Velazquez Ruben , McGuff Howard S 
Published: August 2004

ObjectivesRhinoscleroma is a chronic, progressive, granulomatous infection caused by Klebsiella rhinoscleromatis. The bacteria can infect the upper and/or lower airways, with the sinonasal cavity being affected 95%‐100% of the time. We present the case of a 42‐year‐old Hispanic man who presented with Stage 3 rhinoscleroma, resulting in nasopharyngeal, glottic, and subglottic stenosis.MethodsThe patient was taken to the operating room for direct microlaryngoscopy. A posterior cordotomy of the left vocal fold and laser radial incisions/dilation of the subglottis were performed along with topical application of Mitomycin‐C.ResultsBiopsies of the nasopharygeal and subglottic lesions showed inspissated mucin with foamy histiocytes, gram negative bacilli, and acute and chronic inflammation with fibrosis. Cultures were positive for Klebsiella rhinoscleromatis, sensitive to gatifloxacin. These pathological findings were consistent with Stage 3 rhinoscleroma. The patient was treated with a 6‐month course of gatifloxacin. Purulent rhinorrhea and airway difficulties were improved at 6 weeks and resolved at 6 months.ConclusionWe report a case of synchronous rhinoscleromatous lesions. A combination treatment of surgical laser debridement, Mitomycin‐C and long‐term fluoroquinolones appears to be effective in treating this condition. There are 3 stages of rhinoscleroma and with prompt recognition and early treatment, the natural history of the disease can be halted. The advantages of fluoroquinolones over traditional antibiotic treatment for this condition (tetracycline) include low incidence of side effects, once daily dosing and concentration within the macrophages, the region of bacterial replication. When surgical treatment is necessary, stenosis can be effectively managed with CO2 laser treatments and Mitomycin‐C.
A Rare Case Report about Noma or Cancrum Oris Occurring in a Neutropenic Patient
Authors: Majmundar Kshitij V , Heller Andrew J 
Published: August 2004

ObjectivesTo discuss the etiology, diagnosis, and management of Noma, a rare and devastating disease of the facial tissuesMethodsCase reportResultsThe authors describe a case of Noma in a 50‐year‐old female who developed a gangrenous oro‐facial lesion of her left face after cytotoxic chemotherapy for acute lymphoblastic leukemia. The patient was treated with broadspectrum intraveous antibiotics and extensive debridement of necrotic tissues followed by reconstruction of the large fullthickness defect.ConclusionNoma, or cancrum oris, is an uncommon ailment not well known in Europe or North America. Without treatment, the mortality rate of this dehumanizing infectious disease is 70%−90%. Early intervention and prevention of noma lesions in immunocompromised adults by optimizing their nutritional status, encouraging oral hygiene, maintaining adequate hydration, and closely monitoring intraoral lesions seems to be the key. Early lesions, such as acute necrotizing ulcerative gingivitis (ANUG), should be treated aggressively with oral hygiene, antibiotics (intravenous penicillin), and conservative debridement of necrotic tissues in addition to addressing the patient's hydration and nutritional status. If uncontrolled, Noma can destroy large amounts of both hard and soft tissues of the face which can present a formidable reconstructive challenge.
Endolymphatic Sac Decompression with and without Shunt for Vertigo and Hearing Sensitivity
Authors: Quinonez Rafael E , King Robert E , Marzo Sam J , Leonetti John P 
Published: August 2004

ObjectivesEndolymphatic sac decompression (ELSD) is a surgical alternative for those patients with Meniere's disease that are resistant to medical therapy. This safe, nondestructive surgical option can be performed with and without shunt placement. The present retrospective study investigates the long‐term efficacy of this surgical treatment with and without shunt placement.MethodsSeventy‐five patients who underwent ELSD with or without shunts were included in the present investigation based on availability of pre‐ and postoperative data. Four‐tone average using. 5, 1, 2, and 3 kHz and speech discrimination scores were used to compare hearing pre‐ and postoperatively. Postoperative vertigo was rated as absent, decreased, unchanged, and increased when compared to preoperative vertigo. The preoperative data were obtained within 6 months prior to surgery and postoperative data within 6‐24 months following surgery.ResultsNo improvement in hearing sensitivity was found postoperatively in either study group and no statistical difference was measured in hearing sensitivity between both groups. Vertigo was absent in 55%, decreased in 13%, unchanged in 15%, and increased in 17% of those patients not receiving a shunt. Vertigo in contrast was absent in 50%, decreased in 29%, unchanged in 14%, and increased in 7% of those patients with shunts.ConclusionThese data suggest no benefit with regard to hearing. However, the data do suggest that postoperative vertigo in the shunt group is better controlled.
Otoacoustic Emissions in Patients with Tinnitus and Normal Hearing
Authors: Dall Igna Celso , Schmidt Leticia P , Smith Mariana , Facchini Luciana , Kang Suzie 
Published: August 2004

ObjectivesTinnitus is defined as a sound perception in the absence of a sonorous external stimulus. This symptom is highly associated to hearing loss, although about 10% of the patients with tinnitus have a normal hearing. We studied the otoacoustic emissions (OE) in patients with complaints of tinnitus and normal hearing.MethodsWe evaluated 104 patients with tinnitus. Only 10 met the inclusion criterion that was to have thresholds of 20 dB or less in each frequency at tonal audiometry; 5 were men with average age of 36.1 years. OE was performed in each patient. History of occupational noise exposition was evaluated.ResultsSixty percent had OE absent or lowered in one or more frequencies; 60% of them had a positive history of occupational noise exposition (time average of 7.58 years); and 83% of them did not use individual protection equipment.ConclusionOne of the theories that try to explain the pathogenesis of tinnitus is the imbalance between external hairy cells (EHC) and internal hairy cells (IHC). The EHC are more prone to damage and, when it occurs, they fail to perform the inhibition over the ICH function. This lost of IHC inhibition results then in tinnitus. Our results agree with this theory mainly because our patients had alterations in the EHC demonstrated by the OE.
CO2 Laser for Lingual Tonsillectomy
Authors: Lomeo Paul E , McDonald John Edward , Finneman Judith L 
Published: August 2004

ObjectivesHypertropic lingual tonsils are a known obstruction in the upper airway. Enlarged linguals are responsible for obstructive sleep apnea, potential infections, and difficult intubations for routine surgeries. In our institution all patients were treated with protection of the airway, and ablation of lingual tonsils with a CO2 laser.MethodsThe patients were diagnosed with direct visualization and a CT scan of the neck. All patients were intubated with a laser reinforced endotracheal tube and fire precautions were taken when draping patient. One patient had a tracheotmy performed before being treated for hypertrophic lingual tonsils. A wide funnell larynscope was suspended. The CO2 laser was used at 15 watts continuous along with an operating microscope to ablate the tissue.ResultsAll patients were admitted for a 23‐hour stay. Postoperatively, no patient required intubation to protect the airway. Three of the 50 patients required a revision surgery to completely ablate all the lingual tonsils. The patient with the tracheotomy was decannulated. All patients were relieved and asymptomatic after surgery.ConclusionCO2 laser is a safe and acceptable method for lingual tonsillectomy. All patients in our institution had no complications and were free of all symptoms. The laser compleletly ablated the lingual tonsils removing the obstruction in the airway.
Development of an enhanced needle and syringe programme: the First Step programme pilot
Authors: HUDOBA MICHELLE , GRENYER BRIN F. S. , O'TOOLE MIRIAM 
Published: August 2004

AbstractThe First Step programme is a new approach to needle and syringe exchange services established to help intravenous drug users reduce harmful drug use behaviours, provide psychoeducation and act as a point of transition enhancing access to other health and community services. The First Step assertive treatment approach was implemented in a medium‐sized community area health service and evaluated over an 18‐month period. A pilot evaluation of staff training was also conducted, demonstrating a significant improvement in staff skills in assertive outreach, needs assessment, engagement, psychoeducation and referral. Measures of drug‐related harm showed the benefits of new early engagement‐enhancing psychoeducational interventions, with increases in needles distributed and returned and greater referrals to drug and alcohol and other health services. Training needle and syringe workers towards a more assertive community outreach role gives them the ability to provide psychoeducation and harm minimization strategies and act as a conduit for intravenous drug users to enter treatment.
A pilot study of buprenorphine—naloxone combination tablet (Suboxone®) in treatment of opioid dependence
Authors: BELL JAMES , BYRON GAYE , GIBSON AMY , MORRIS AMANDA 
Published: August 2004

AbstractIn Australia, maintenance treatment for opioid dependence involves supervised daily administration of a dose of methadone or buprenorphine. A sublingual tablet combining buprenorphine and naloxone in a 4: 1 ratio (Suboxone™) has been developed, designed to deter diversion and intravenous misuse, and may be suitable for unsupervised administration. The aim of this study was to investigate the tolerability of Suboxone, and investigate whether unsupervised administration can be effective in stabilized patients. Employed patients on buprenorphine maintenance, who had ceased heroin use, were switched to Suboxone and provided with weekly supplies of medication to take without supervised administration. Subjects were monitored closely with weekly clinical reviews, and research interviews at baseline, 3 and 6 months. Only 11% of people receiving buprenorphine met eligibility criteria. Seventeen subjects were recruited. Fifteen were retained for the full 6 months. No subject appeared destabilized by unsupervised dosing. Suboxone was well tolerated. The current trial demonstrated that unsupervised administration with regular clinical monitoring can be effective in selected patients. However, using access to unsupervised dosing to promote abstinence from heroin probably limits the potential benefits of unsupervised administration to a very small proportion of patients.
‘An unacceptable risk’: the problem of alcoholic milk
Authors: MUNRO GEOFFREY , LEARMONTH ANNE 
Published: August 2004

AbstractIn 2002 Wicked Holdings Pty Ltd, a company formed for the purpose of marketing alcoholic milk, applied to the Director of Liquor Licensing Victoria (LLV) for a wholesale licence to distribute a beverage known as ‘Moo Joose’. This article outlines the case against alcoholic milk as the ultimate ‘alcopop’. The argument encompasses the risk that alcoholic milk would reinforce and increase existing levels of under‐age drinking in Australia, the risk it would reduce the age of initiation into drinking and the potential for alcoholic milk to be mistaken for a ‘healthy’ version of alcohol and a ‘safe’ alcoholic beverage. When LLV refused the application for a licence, Wicked Holdings appealed to the Victorian Civil and Administrative Tribunal. Following a public hearing the Tribunal confirmed LLV's decision to refuse a licence on the grounds the product posed an unacceptable risk to the health and well‐being of young people.
Rabbit Ear Cartilage Regeneration With a Small Intestinal Submucosa Graft
Authors: Pribitkin Edmund A. , Ambro Bryan T. , Bloeden Esa , O'Hara Brian J. 
Published: August 2004

AbstractObjectives/Hypothesis: The objective was to demonstrate that interpositional grafting with porcine small intestinal submucosa promotes cartilage regeneration following excision of rabbit auricular cartilage.Study Design: Blinded, controlled study.Methods: Eight New Zealand white rabbits underwent excision of auricular cartilage on two sites with and two sites without preservation of perichondrium. Porcine small intestinal submucosa was implanted into one site with and one site without intact perichondrium. Remaining sites served as control sites. Histological assessment was performed at 3 (n = 4) and 6 (n = 3) months and at 1 year (n = 1) after grafting.Results: Histological evaluation showed cartilage regeneration accompanied by chronic inflammation in areas in which porcine small intestinal submucosa was implanted between layers of intact perichondrium. Other sites failed to show significant cartilage regeneration.Conclusion: The results of the study using porcine small intestinal submucosa as a bioscaffold for cartilage regeneration are promising and justify further animal and human studies.
Homeowners Insurance With Bundled Catastrophe Coverage
Authors: Grace Martin F. , Klein Robert W. , Kleindorfer Paul R. 
Published: August 2004

AbstractWe estimate the demand for homeowners insurance in Florida and New York with indicated loss costs as our proxy for the quantity of real insurance services demanded. We decompose the demand into the demand for coverage of catastrophe perils and the demand for noncatastrophe coverage and estimate these demand functions separately. Our results are relatively consistent in New York and Florida, including evidence that catastrophe demand is more price elastic than noncatastrophe demand. We also find evidence that consumers value options that expand coverage, buy more insurance when it is subsidized through regulatory price constraints, and consider state guaranty fund provisions when purchasing insurance.