bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic Maxillary Sinusitis of Dental Origin: Is External Surgical Approach Mandatory?
Authors: Lopatin Andrey S. , Sysolyatin Svyatoslav P. , Sysolyatin Pavel G. , Melnikov Mikhail N. 
Published: November 2003

AbstractObjective The study evaluated a minimally invasive endoscopic shaver‐assisted technique for treatment of chronic maxillary sinusitis of dental origin.Study Design A retrospective multicenter chart review was performed at two clinics of all patients who had a diagnosis of chronic maxillary sinusitis of dental origin and were treated using the technique.Methods The patients were divided into two main groups: patients with and without chronic oral antral fistula. Data from the patients were collected and analyzed.Results Seventy patients aged 16 to 62 years had surgery using the endoscopic technique. Thirty‐nine patients presented with oral antral fistula of different locations, the most common being third molar fistula (26 cases). Foreign bodies were found in 21 sinuses, among them teeth roots (in 11), dental fillings (in 7), and packs (in 3). Fungal ball was found in six sinuses. The surgical technique included retrograde resection of the uncinate process, enlargement of the natural maxillary ostium posteriorly, and removal of the polyps and foreign bodies from the sinus through the middle meatal antrostomy window. Approach through the oral antral fistula facilitated additional access to the alveolar recess. Removal of polyps from the alveolar recess was performed using the microdebrider, which was introduced through the fistula under endoscopic control through the nasoantral window. The fistula was closed in two layers. Good results were obtained in all but four patients in terms up to 3 years. No complications occurred. Overall recovery rate after primary surgery was 94.7%.Conclusion Endoscopic approach to chronic maxillary sinusitis of dental origin is a new, reliable method associated with less morbidity and lower incidence of complications.
A Novel Connexin 26 Compound Heterozygous Mutation Results in Deafness
Authors: Harris Kevin C. , Erbe Christy B. , Firszt Jill B. , Flanary Valerie A. , Wackym Phillip A. 
Published: November 2003

AbstractObjective Mutations of the gap junction beta 2 (GJB2) gene coding for the protein connexin 26 account for up to 50% of nonsyndromic sensorineural hearing loss (NSHL), with specific mutations associated with distinct ethnic groups. A biracial family with nonsyndromic sensorineural deafness consistent with autosomal recessive inheritance was examined for connexin 26 (Cx26) mutations.Study Design Prospective observational study.Methods A family consisting of a Caucasian mother and a Chinese father with two of six children affected by NSHL was examined for Cx26 mutations. Peripheral blood lymphocyte DNA was used to amplify by polymerase chain reaction the Cx26 coding region, followed by mutation detection enhancement gel screening and complete sequencing. Phenotypic characterization using audiometric testing was completed for all children and both parents.Results The two affected children were found to be compound heterozygotes for Cx26 mutations, displaying a previously unreported combination of 35delG and 235delC. The parents were each unaffected heterozygotes consistent with their ethnic heritage, specifically, the Caucasian mother a 35delG heterozygote and the Chinese father a 235delC heterozygote.Conclusions Connexin 26 mutations account for a significant proportion of NSHL worldwide, with specific mutations linked to distinct ethnic groups. Genetic analysis of a biracial family with NSHL revealed a novel 35delG/235delC compound heterozygous state in phenotypically affected children. These results highlight the usefulness of Cx26 mutation screening for genetic counseling and suggest that the 235delC mutation is present in China as it is in Japan and Korea.
Exertional Dizziness and Autonomic Dysregulation
Authors: Staab Jeffrey P. , Ruckenstein Michael J. , Solomon David , Shepard Neil T. 
Published: November 2003

AbstractObjectives To define the clinical characteristics and treatment of dizziness induced by physical exertion and to investigate autonomic nervous system function in exertional dizziness.Study Design Retrospective case series from a review of 1400 patients evaluated for dizziness at a neurotology referral center, identifying those with predominantly exertional symptoms.Methods Records of patients with exertional dizziness were screened to eliminate those with known vestibular deficits, cardiopulmonary illnesses, and psychiatric disorders. The clinical characteristics, evaluation results, and treatment of nine patients with purely exertional dizziness were described.Results The cohort included 4 male and 5 female patients (age range, 13–53 y) with symptoms for 1 to 8 years. Only one patient had a history of autonomic symptoms: phlebotomy‐induced syncope in childhood. No patient was taking medications that caused dizziness or orthostasis. All patients experienced “spacey” or “foggy” head sensations without vertigo during exertion. Provocative activities ranged from standing upright for extended periods to running and swimming. On examination, voluntary hyperventilation provoked moderate symptoms in all patients (without nystagmus or anxiety), although no patient had spontaneously occurring, hyperventilation‐related complaints. Seven patients underwent autonomic testing. Tilt table tests (n = 5) produced severe symptoms in one patient and mild symptoms in two patients. Sodium lactate infusions (n = 6) provoked marked symptoms in four patients and moderate symptoms in one patient. All were treated for autonomic dysregulation. Seven patients improved substantially and resumed all of their premorbid activities. Two improved slightly.Conclusions In nine patients with exertional dizziness, autonomic challenges were provocative, and medications for autonomic dysregulation were effective. Exertional dizziness may be a clinical manifestation of autonomic nervous system dysregulation.
Impact of Cochlear Implants on the Functional Health Status of Older Adults
Authors: Francis Howard W. , Chee Nelson , Yeagle Jennifer , Cheng Andre , Niparko John K. 
Published: November 2003

AbstractObjectives To assess the impact of cochlear implantation on quality of life changes in older adults aged 50 years and above.Study Design Retrospective study by questionnaire and chart review.Methods Forty‐seven patients aged 50 to 80 years (mean age, 63.4 y [SD = 8.6 y]), who have multiple‐channel cochlear implants received at The Listening Center at Johns Hopkins Hospital, completed the Ontario Health Utilities Index Mark 3 survey and a questionnaire on quality of life changes. Health utility scores before and after cochlear implantation were measured, and audiologic data before implantation and at 6 months and 1 year after implantation were analyzed.Results Cochlear implantation in older adults is associated with a mean gain in health utility(P <.0001) of 0.24 (SD = 0.33), which corresponds to a favorable cost‐utility of $9530 per quality‐adjusted life‐year. Improvements in hearing and emotional health attributes were primarily responsible for this increase in health‐related quality of life measure. There was a significant increase in speech perception scores at 6 months after surgery (P <.0001 for both CID sentence and monosyllabic word tests) and a strong correlation between the magnitude of health utility gains and the postoperative increase in speech perception scores (r = 0.45, P <.05).Conclusions Cochlear implants have a significant impact on the quality of life of older deaf patients, and are a cost‐effective intervention in this population. Improvements in speech perception are predictive of gains in health‐related quality of life and associated emotional benefits after cochlear implantation.
Round Window Gentamicin Absorption: An In Vivo Human Model
Authors: Becvarovski Zoran , Bojrab Dennis I. , Michaelides Elias M. , Kartush Jack M. , Zappia John J. , LaRouere Michael J. 
Published: November 2003

AbstractObjective/Hypothesis Using a novel human labyrinthine sampling model, in vivo gentamicin absorption through the round window can be measured.Study Design A prospective study.Methods Gentamicin was delivered either transtympanically (preoperative) or through a facial recess approach (intraoperative). The lateral semicircular canal and vestibule were opened, and by means of a microsyringe, labyrinthine fluid was aspirated. A sample of serum was also drawn. In all patients cerebrospinal fluid was also drawn. The samples were analyzed using a standard chemistry analyzer.Results Intratympanic gentamicin diffused through the round window membrane and achieved concentrations in the labyrinthine fluid ranging from 0 to 16 mg/L. Intratympanic gentamicin was absorbed into the systemic circulation in 4 of 11 patients with serum levels ranging from 0.3 to 0.4 mg/L. No gentamicin was detected in the cerebrospinal fluid.Conclusions Intratympanic gentamicin diffuses rapidly through the round window membrane and achieves significant levels in the inner ear. Thus, this new model can be used to assess round window permeability to clinically relevant medications such as steroids and ototopical antibiotics.
Intraoperative Assessment of Perilymphatic Fistulas With Intrathecal Administration of Fluorescein
Authors: Gehrking Eckard , Wisst Frank , Remmert Stephan , Sommer Konrad 
Published: November 2003

AbstractObjectives Assessment of perilymphatic fistulas remains a diagnostic problem. Because of a lack of reliable clinical tests, exploratory tympanotomy is necessary to detect membrane leaks in the middle ear. To improve objectivity in the intraoperative visualization of perilymphatic fistulas, we used intrathecal fluorescein for perilymph staining to increase the sensitivity and specificity of diagnosis of perilymphatic fistulas.Study Design Prospective study in the setting of a tertiary, referral, and academic center.Methods Twenty‐eight patients with suspected traumatic, idiopathic, iatrogenic, or inflammatory perilymphatic fistulas were admitted for exploratory tympanoendoscopy for perilymphatic fistula detection. Twenty‐five to 100 mg sodium fluorescein 10%, diluted with cerebrospinal fluid, was administered by lumbar puncture 2.5 to 23.5 hours before tympanoendoscopy. The oval and round window niches were microscopically and endoscopically observed with white and blue light, using specific filters.Results In two patients (7%), obvious fluorescence was detected behind the round window membrane with blue light. Direct observation of perilymph in stapedectomy and in semicircular canal fistula revealed no staining. Neurological complications of intrathecal fluorescein, as reported by other authors, were not observed.Conclusions Probably because of a different patency of the cochlear aqueduct, intrathecal fluorescein for intraoperative detection of perilymphatic fistula resulted in a significant perilymph staining in only a few patients. Considering the possible complications of this method, we would not recommend it for routine evaluation of perilymphatic fistula.
Dysrhythmia of Caloric Nystagmus
Authors: Proctor Leonard R. , Lam Anthony P. 
Published: November 2003

AbstractObjectives Objectives of the study were 1) to determine the prevalence and characteristics of dysrhythmia, 2) to identify associations between dysrhythmia and other patient variables, and 3) to determine whether dysrhythmia is more a characteristic of individuals than simply a correlate of alertness or response intensity.Study Design Cross‐sectional.Methods Review of records from 150 patients undergoing the caloric test.Results Dysrhythmia severe enough to interfere with accurate analysis of the caloric test was present in 40% of the cases. Individuals were entered into an “orderly” group (n = 67) or a “dysrhythmic” group (n = 83) and were 5.8 times more likely to remain in the same group on a second visit than to change groups. Stronger response scores were associated with less dysrhythmia. Higher caloric‐induced vertigo scores were associated with both stronger response scores and lower dysrhythmia scores. Cases in the dysrhythmic group were 3.8 times more likely to have abnormal caloric test results than individuals in the orderly group.Conclusions Dysrhythmia frequently interferes with valid and accurate interpretation of the caloric test. Current methods of “mental alerting” frequently fail to eliminate dysrhythmia. The presence of dysrhythmia appears to be a strong predictor of an abnormal caloric test result, and there is a moderate correlation between dysrhythmia and response intensity. Nevertheless, our results suggest that dysrhythmia is specific to individuals, rather than simply a manifestation of peripheral vestibular disease or a correlate of alertness or response intensity.
Sphenoid Encephaloceles: Disease Management and Identification of Lesions Within the Lateral Recess of the Sphenoid Sinus
Authors: Lai Stephen Y. , Kennedy David W. , Bolger William E. 
Published: November 2003

AbstractObjectives Encephaloceles usually involve herniation of frontal lobe tissue through an anterior cranial fossa defect into the ethmoid sinus or nasal cavity. Encephaloceles can also result from temporal lobe herniation through a middle fossa defect into the sphenoid sinus. Within the sphenoid, encephaloceles are thought to occur most commonly in the central or midline aspect of the sinus. Lateral sphenoid encephaloceles, especially within the lateral aspect of the sphenoid sinus when the sphenoid sinus has pneumatized extensively into the pterygoid recess, are considered exceedingly rare. The objectives of the study were to review our experience with sphenoid encephaloceles to understand the relative frequency and the locations in which they occur within the sphenoid sinus and to report our experience in caring for patients with this condition.Study Design Retrospective review.Methods Retrospective review of patient records and operative reports from 1991 to 2000.Results Twelve patients were treated for intrasphenoid encephaloceles during a 10‐year period. Eight patients had lesions located in the lateral recess of the sphenoid sinus. Surgical repair was undertaken in all 12 cases using endoscopic techniques. In 11 of 12 cases, the repair was successful with follow‐up times of 12 to 69 months (mean follow‐up, 31.9 mo).Conclusions Temporal lobe encephaloceles in the lateral sphenoid sinus have been reported rarely in the literature. Careful preoperative evaluation and localization of the sphenoid defect are critical for the selection of the optimal surgical approach for repair of the skull base defect. Our 10‐year experience represents the largest group of patients treated endoscopically for intrasphenoid encephaloceles reported to date.
The Effect of Topical Epinephrine on Peripheral Nerve Conduction
Authors: Miller Quintessa , Meekin Gregory , Murdock Cabot 
Published: November 2003

AbstractObjective/Hypothesis The aim of the study was to determine the effect of direct application of epinephrine solution on peripheral nerve conduction latency and amplitude. It was hypothesized that epinephrine does not cause neurapraxia when a standard (1:10,000) solution is applied topically.Study Design Eleven animals were divided into two groups of five and six. Group I had their left sciatic nerves and group II had their right sciatic nerves treated with epinephrine‐soaked patties. The contralateral nerves of each group served as controls.Methods Nerve conduction studies were performed at baseline and immediately, at 1 minute, and at 5 minutes after patty application.Results Latency was found to increase above baseline immediately after patty application (P = .003) for the epinephrine‐treated and saline‐treated groups. Furthermore, the amplitude at 5 minutes after patty application increased from baseline (P = .009) for both groups. These observed differences were below what is considered to be clinically significant.Conclusion Topical epinephrine at a standard solution (1:10,000) does not lead to clinically significant nerve conduction abnormalities.
Isolated Inverting Papilloma of the Sphenoid Sinus
Authors: Lee Jivianne T. , Bhuta Sunita , Lufkin Robert , Castro Dan J. 
Published: November 2003

AbstractObjectives/Hypothesis Primary inverting papilloma of the sphenoid sinus is rare. We present a case of inverting papilloma with isolated involvement of the sphenoid sinus and discuss the incidence, clinical presentation, radiographic features, histological findings, and management of patients with this disease.Study Design Case report.Methods The medical records, films, and pathology slides of a patient with isolated inverting papilloma of the sphenoid sinus seen at University of California Los Angeles Medical Center were reviewed. The clinical presentation, radiographic features, histopathological findings, treatment, and outcome of the case were examined.Results A single case of inverting papilloma with isolated involvement of the sphenoid sinus is presented. Headache and diplopia were the presenting complaints, as is often seen with other isolated sphenoid sinus lesions. Endoscopic intranasal sphenoid sinusotomy was performed, and no evidence of recurrent disease has been seen after 6 months of follow‐up.Conclusions Isolated inverting papilloma of the sphenoid sinus is a rare phenomenon. In contrast to the vast majority of cases that present with nasal complaints (i.e., unilateral nasal obstruction, epistaxis) because of involvement of the lateral nasal wall, the clinical presentation of inverting papillomas confined to the sphenoid sinus is often nonspecific and insidious, with visual deficits being the predominant feature. Nevertheless, functional endoscopic intranasal sphenoidotomy remains an effective mode of treatment for patients with these lesions.
Management of Cerebrospinal Fluid Leaks Involving the Temporal Bone: Report on 92 Patients
Authors: Savva Athanasia , Taylor Matthew J. , Beatty Charles W. 
Published: November 2003

AbstractObjective To investigate the success of different surgical and nonsurgical techniques in the management of cerebrospinal fluid otorrhea or otorhinorrhea.Study Design Retrospective case analysis.Methods Ninety‐two patients with confirmed diagnosis of cerebrospinal fluid otorrhea or otorhinorrhea treated at our institution between 1976 and 1998 were followed up long‐term by retrospective chart review and patient interviews.Results Conservative treatment was successful in most cases of cerebrospinal fluid otorrhea or otorhinorrhea resulting from head injury (26 of 29 patients). In contrast, surgical intervention was required in all but 1 of 53 patients with cerebrospinal fluid otorrhea or otorhinorrhea caused surgically. The primary operative success rate was 76.9%. When relapse occurred, the interval ranged from 0 days to 24 months (mean interval, 3.9 mo; median, 1.3 mo). All leaks requiring surgery eventually were closed successfully. Surgical results were chronologically dependent. Before 1989, 11 failures occurred in 37 primary procedures. After 1989, only 4 failures occurred in 28 primary procedures. Of seven patients undergoing primary dural closure alone, three (43%) had recurrence of the leak. Closure rates were highest among patients in whom a multilayer technique for leak closure was used: combining a primary graft or sealing material such as bone wax, free muscle, or fascia for closure of the defect with additional autologous free grafts or allogenic materials. This resulted in a 2‐year closure rate of 100% compared with a 2‐year rate of 75.4% for patients whose primary closure was supported by a single layer of autologous or allogenic material (P = .034). Fibrin glue with primary closure alone did not have additional benefit. Postoperative meningitis occurred in two patients and was treated without sequelae.Conclusions Conservative treatment should be reserved for cerebrospinal fluid otorrhea or otorhinorrhea resulting from head injury. Postoperative and nontraumatic cerebrospinal fluid otorrhea or otorhinorrhea should have early operative intervention. A multilayer technique combining allogenic materials with free autologous grafts is recommended.
Predictive Value of Serum Thyroglobulin After Surgery for Thyroid Carcinoma
Authors: Hall Francis T. , Beasley Nigel J. , Eski Spiro J. , Witterick Ian J. , Walfish Paul G. , Freeman Jeremy L. 
Published: November 2003

AbstractObjective To determine the relationship between stimulated serum thyroglobulin levels (taken 3 months after total thyroidectomy) and tumor stage and recurrence in patients with well‐differentiated thyroid carcinoma.Study Design Retrospective chart review in a tertiary care institution.Methods Two hundred thirteen consecutive patients with well differentiated thyroid carcinoma treated between 1983 and 1998 were identified. Data were collected on clinicopathological variables, stimulated serum thyroglobulin levels obtained 3 months after total thyroidectomy prior to 131I therapy and recurrence.Results A high postoperative thyroglobulin level was significantly associated with advanced‐stage disease at presentation (P = .005, Kruskall‐Wallis) but not with any of the other clinicopathological variables. Patients with a thyroglobulin level greater than 20 pmol/L had a significantly increased risk of disease recurrence on univariate analysis (n = 213 [P = .0001, log rank test]), and in the Cox proportional‐hazards model, both advanced tumor stage (P = .001, relative hazard, 3.4 [95% confidence interval [CI]: 2.4–4.9]) and a thyroglobulin level greater than 20 pmol/L (P = .001, relative hazard, 5.1 [95% CI: 2.0–13.1]) were significant predictors of recurrence. No other variables significantly altered the hazards model.Conclusions Advanced tumor stage at diagnosis and a stimulated thyroglobulin level greater than 20 pmol/L taken 3 months after total thyroidectomy were independent predictors of disease recurrence. Patients with a thyroglobulin level greater than 20 pmol/L are at increased risk of recurrence and may be candidates for more intensive follow‐up or additional treatment.
Roles of Hepatocyte Growth Factor and Transforming Growth Factor β1 in Production of Extracellular Matrix by Canine Vocal Fold Fibroblasts
Authors: Hirano Shigeru , Bless Diane , Heisey Dennis , Ford Charles 
Published: November 2003

AbstractBackground/Objectives When the lamina propria of the vocal fold is replaced by fibrosis after wound healing, it is difficult to restore an appropriate viscoelasticity of the vocal fold. To treat fibrotic scarring, material that reduces collagen deposition and increases soft amorphous substances, such as hyaluronic acid, is required. The potential use of hepatocyte growth factor (HGF) is intriguing. In this study, the authors examined canine vocal fold fibroblasts to determine how HGF contributes to the production of extracellular matrix. More specifically, the authors describe how the productions of hyaluronic acid, collagen type I, and fibronectin are associated with administration of HGF and transforming growth factor β1.Study Design In vitro.Methods Fibroblasts were collected from the lamina propria of the vocal folds of five Beagles and were cultured with and without HGF or transforming growth factor β1. The productions of hyaluronic acid, collagen type I, and fibronectin in supernatants culture were examined using ELISA.Results Hepatocyte growth factor stimulated hyaluronic acid production, reduced collagen type I production, and did not affect fibronectin production, while transforming growth factor β1 stimulated the productions of all components.Conclusions Collagen type I appears to be a major contributor in creation of fibrosis, and excessive fibronectin may stiffen the tissue. Since HGF reduced collagen type I production from fibroblasts and increased hyaluronic acid, HGF is considered to have therapeutic potential in prevention and treatment of the fibrosis of the vocal fold.