bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laryngeal Dystonia Causing Inspiratory Stridor in Children with Cerebral Palsy
Authors: Worley Gordon , Witsell David L. , Hulka Gregory F. 
Published: December 2003

AbstractObjective To present three cases of inspiratory stridor caused by laryngeal dystonia (LD) in children with cerebral palsy (CP), one of whom is being treated by periodic botulinum toxin type A (BTX) injection into a vocalis muscle, thereby avoiding tracheostomy.Study Design Case series.Results and Conclusions Laryngeal dystonia was diagnosed in three children with CP who presented with inspiratory stridor associated with generalized dystonia, all of whom were thought previously to have had laryngomalacia. The inspiratory stridor was severe enough in one patient that a tracheostomy was planned. In common with the movement disorder of generalized dystonia, the inspiratory stridor caused by LD was present in our patients when they were awake, worse when they were excited or agitated, diminished when they were awake and calm, and absent when they were asleep. Although there is overlap between the symptoms of LD and laryngomalacia (and other structural causes of upper airway obstruction) in children with CP, structural causes result in inspiratory stridor that is often persistent when patients are awake and relaxed or when they are asleep. Fiberoptic laryngoscopy in an awake patient with LD reveals vocal cord adduction in inspiration causing inspiratory stridor in association with generalized dystonia. Baclofen and gabapentin used together relieved the inspiratory stridor and improved the generalized dystonia of two patients, confirming the clinical diagnosis of LD, but for the last 2 years the third patient (the one with the most severe inspiratory stridor) also has required a periodic BTX injection into a vocalis muscle (the major vocal cord adductor) to relieve her inspiratory stridor, alternating the side of injection. Her mother considers this is a small price to pay to avoid tracheostomy. This is the first report of LD causing inspiratory stridor in patients with CP and the first reported use of BTX injection into a vocalis muscle for relief of inspiratory stridor due to LD in a child.
Parathyroid Hormone: An Early Predictor of Postthyroidectomy Hypocalcemia
Authors: Lam Allen , Kerr Paul D. 
Published: December 2003

AbstractObjective To determine whether there is a correlation between the level of parathyroid hormone (PTH) soon after thyroidectomy and the development of hypocalcemia.Study Design Prospective series of 40 consecutive patients undergoing total thyroidectomy or completion thyroidectomy between January 2001 and October 2002.Method Ionized calcium was measured before surgery and at 1, 6, 18, 30, and 42 hours after surgery. PTH was measured before surgery and at 1 and 6 hours after surgery using an assay that accurately measures low levels of PTH. Patients were followed up at 1 week and 3 months after surgery with respect to their symptoms and need for calcium supplementation. Clinically significant hypocalcemia was defined as an ionized calcium level of less than or equal to 0.9 mmol/L.Results The incidence of postoperative hypocalcemia was 30% (12/40). The mean PTH level 1 hour after surgery was much lower in patients who ultimately became hypocalcemic than in those who remained normocalcemic (3.8± 1.9 vs. 33 ± 21 pg/mL, P = .001). All patients with a PTH level less than or equal to 8 pg/mL 1 hour after surgery developed hypocalcemia, whereas all those with greater than or equal to 9 pg/mL remained normocalcemic.Conclusions A single PTH level of less than or equal to 8 pg/mL 1 hour postthyroidectomy is a strong predictor for the development of clinically significant hypocalcemia. Once validated, this test may serve to identify those who require more intensive monitoring, prompt early therapy in those deemed at risk, and enable confident early discharge in the majority of thyroidectomy patients.
Hypopharyngeal Acid Exposure: An Independent Risk Factor for Laryngeal Cancer?
Authors: Geterud Åke , Bove Mogens , Ruth Magnus 
Published: December 2003

AbstractObjectives/Hypothesis Gastroesophageal reflux disease has in recent years been linked to a variety of extraesophageal conditions including laryngeal cancer. However, whether a causal relationship exists is still under debate. The present study aimed to compare the occurrence and severity of gastroesophago‐hypopharyngeal reflux in patients with laryngeal cancer with those of healthy volunteers.Study Design Prospective, controlled study.Methods Forty‐one consecutive patients with newly diagnosed laryngeal cancer were examined by esophageal manometry and an ambulatory, 24‐hour, double‐probe pH monitoring. Their results were compared with those of 40 healthy volunteers.Results Hypopharyngeal acid exposure was registered mainly in the upright body position. A pathological acid exposure, as compared with the upper levels of normality among the healthy volunteers, was found in the hypopharynx in six (16%) patients with laryngeal cancer and in the distal esophagus in 10 (25%) patients. Pathological acid exposure in either location was found in 15 (37%) patients and in both locations in 1 (3%) patient. However, the mean acid exposure time and the mean value of the number of reflux events did not differ significantly between cancer patients and control subjects at either location. The exclusion of meal periods from the analysis did not alter these observations. Nonsmoking cancer patients (n = 5) and nonsmoking control subjects (n = 36) had similar acid exposure both in the hypopharynx and in the distal esophagus.Conclusion The present results do not support gastroesophago‐hypopharyngeal reflux as being an independent risk factor for laryngeal cancer.
Compliance with hormone replacement therapy at Songklanagarind Hospital
Authors: Wattanakumtornkul Saranya , Chichareon Saibua , Geater Alan , Suwan Kobkaew 
Published: December 2003

AbstractAim:  To determine compliance with hormone replacement therapy (HRT) over a 2‐year period, reasons for discontinuing HRT and the factors associated with non‐compliance.Methods:  A total of 202 women attending the menopause clinic at Songklanagarind Hospital and taking HRT were included in this retrospective study. Compliance was assessed for each 6‐month interval within the first 2 years. Reasons for discontinuation were requested from women who had stopped using HRT.Results:  Compliance rates with HRT for the study group were 57.9% at 6 months, 42.6% at 12 months, 35.1% at 18 months and 32.7% at 24 months. The main reasons for discontinuing HRT were improvement of climacteric symptoms (20.9%), fear of cancer (16.4%) and irregular bleeding (11.9%). Logistic regression analysis revealed a significant increase in the risk of non‐compliance of HRT among agriculturists or untrained workers (OR 4.7, 95% CI 1.2–18.8; reference, government employees), those with delayed onset of treatment (>1 years; OR 3.0, 95% CI 1.1–8.0; reference, 0–3 months) and those prescribed HRT for climacteric symptoms or reasons other than oophorectomy or ovarian failure (OR 18.2–41.6 depending on reasons). Agriculturists or untrained workers who delayed onset of treatment for climacteric symptoms had the highest expected non‐compliance rate of 0.95%.Conclusion:  Long‐term compliance of HRT was not good at Songklanagarind menopause clinic. More attention has to be paid to the counseling of patients about HRT. Agricultural or untrained workers, late starting HRT, and presence of climacteric complaints were the significant factors for poor HRT compliance.
Hyalinizing spindle cell tumor with giant rosettes of the omentum
Authors: Koishi Asako , Gomibuchi Hideto , Inoue Jun , Minoura Shigeki , Itoh Eisaku , Saito Masumi 
Published: December 2003

AbstractWe report the first case of a hyalinizing spindle cell tumor with giant rosettes of the omentum. The mesenchymal tumor arises from a multiplication of fibroblastic cells containing large rosette‐like structures composed of a central collagen core surrounded by plump oval to spindle tumor cells. A 38‐year‐old woman exhibited the symptom of abdominal pain in the right side, with a correlated sensation of a mass in the same area. A tumor consisting of both solid and cystic cytologic features was subsequently diagnosed, on the right side of the uterus. Her serum level of CA‐125 was only slightly elevated. Surgical intervention indicated that the tumor originated from lower pole of the omentum and the histological diagnosis was hyalinizing spindle cell tumor with giant rosettes. The metastatic potential of this type of tumor is considered similar to that of the metastatic low‐grade fibromyxoid sarcoma, which indicated the need for careful clinical follow up of this case.
Leiomyoma of the vagina: An unusual presentation
Authors: Gowri Raju , Soundararaghavan Subramanium , Oumachigui Asha , Sistla Sarath Chandra , Iyengar Krishnan R 
Published: December 2003

AbstractVaginal leiomyomas are rare. They usually arise from the anterior vaginal wall. We report a case of a vaginal leiomyoma arising from the right lateral wall that presented as a gluteal swelling with pus discharging per vagina, creating a clinical dilemma in diagnosis. Preoperative imaging and biopsy may help to rule out malignancy. The size of the tumor necessitated abdominoperineal approach and hysterectomy for better surgical access. To the best of our knowledge such a clinical presentation of a vaginal leiomyoma has not been reported in the literature.
Imperforate hymen: Report of an unusual familial occurrence
Authors: Lim Yun‐Hsuen , Ng Soon Pheng , Jamil Muhammad A. 
Published: December 2003

AbstractImperforate hymen is an uncommon obstructive anomaly of the female reproductive tract, which usually presents with intermittent and cyclical abdominal pain. Although it is usually sporadic, four cases of familial occurrence of imperforate hymen have been reported so far. Imperforate hymen is seldom associated with complications if it is detected early. In view of the possible familial occurrence, it is important to have a high index of suspicion in women who present with imperforate hymen. A detailed menstrual history of other female family members is necessary to enable early detection.
Facial and body blood contamination in major gynecologic surgeries
Authors: Sharma Jai B. , Gupta Amita , Malhotra Monika , Arora Raksha 
Published: December 2003

AbstractAim:  To determine the incidence of facial and body blood contamination in various major gynecologic surgeries.Methods:  A prospective study was conducted over a 6‐month period on 122 major gynecologic surgeries (abdominal and vaginal) to determine the incidence of blood splashes on masks, goggles (or spectacles), body and feet of surgeons and assistants.Results:  The overall incidence of blood splashes was 49.18%, 59.5%, 28.68% and 22.95% on surgeons masks, goggles, body and feet, respectively. This incidence was significantly higher (P < 0.05) than for first assistants, who showed an incidence of blood splashes of 35.24% (mask), 38.13% (goggles), 20.49% (body) and 9.83% (feet). The lowest incidence of splashes was seen on second assistants, with 22.1% (mask), 24.73% (goggles), 10.52% (body) and 7.36% (feet). There was no significant difference in the facial splash rate between major abdominal and vaginal surgeries, but body and feet contamination was significantly higher in major vaginal surgeries (P < 0.05).Conclusion:  There is a very high risk of facial and body blood contamination in major gynecologic surgeries, putting the surgeon and assistants at risk of acquiring viral disease. Routine use of universal precautions in all gynecologic surgeries is strongly recommended.
Successful management of a pregnant woman with heterozygous protein C deficiency using activated protein C concentrate
Authors: Sekiyama Kentaroh , Itoh Hiroaki , Sagawa Norimasa , Tatsumi Keiji , Yura Shigeo , Takayama Hiroshi , Fujii Shingo 
Published: December 2003

AbstractHeterozygous protein C deficiency frequently causes deep vein thrombosis during pregnancy. We report the successful management of delivery using activated protein C concentrate in a patient with heterozygous protein C deficiency, who developed deep vein thrombosis in mid gestation.
Effect of montelukast pretreatment on inducible nitric oxide synthase mRNA expression in the lungs of antigen‐challenged allergic mice
Authors: Sade K. , Schwartz I. , Schwartz D. , Wolman Y. , Chernichovski T. , Fireman E. , Iaina A. , Kivity S. 
Published: December 2003

SummaryBackground
Growing evidence suggests that inducible nitric oxide synthase (iNOS) is the main source of the high output of exhaled nitric oxide (NO) in asthma. Treatment of asthmatic patients with glucocorticoids reduces high levels of exhaled NO mainly by inhibiting the transcription of iNOS. A similar reduction in exhaled NO was recently observed in patients treated with the leukotriene receptor antagonists, but the exact interaction between these drugs and iNOS remains obscure.Objective
The purpose of this study was to evaluate the effect of a leukotriene receptor antagonist, montelukast, on the expression and activity of iNOS in a murine model of allergic asthma.Methods
Twenty‐four BALB/c mice were sensitized to OVA and were equally divided into 3 groups (Groups 1–3). Eight additional mice were sham sensitized and served as a negative control group (Group 4). Group 1 received montelukast 1 mg/kg/day in their drinking water, Group 2 received dexamethasone 1 mg/kg/day in their drinking water and Groups 3 and 4 received plain tap water. After 1 week, the animals were challenged by inhalation of OVA and, 3 h later, they were killed and their lung cells were isolated by enzymatic tissue digestion. NO generation was measured by a Griess assay, and iNOS mRNA was studied by RT‐PCR.Results
A significant increase in iNOS mRNA expression and in NO generation was evident after allergen challenge compared with the controls. Pretreatment with montelukast mildly decreased NO production without producing a concomitant significant decrease in iNOS mRNA expression.Conclusion: Unlike pretreatment with glucocorticoids, we failed to find compelling evidence for a major role for montelukast treatment in the modulation of iNOS mRNA in a murine model of acute asthma.
Anaphylaxis from topical bovine thrombin (Thrombostat®) during haemodialysis and evaluation of sensitization among a dialysis population
Authors: Wai Y. , Tsui V. , Peng Z. , Richardson R. , Oreopoulos D. , Tarlo S. M. 
Published: December 2003

SummaryBackground
Topical bovine thrombin (TBT) is used as a topical haemostatic agent in haemodialysis (HD) units and for surgical procedures. It has caused allergic reactions during surgical procedures, but no previous cases have been reported with dialysis usage.Objective
A case is reported of anaphylaxis due to TBT in an HD patient. This led to a determination of whether HD patients exposed to TBT develop specific IgE and IgG antibodies to TBT and an assessment of the frequency of allergic symptoms in HD patients as compared with peritoneal dialysis (PD) patients.Methods
A cross‐sectional study of 100 HD and 52 PD patients was performed using a questionnaire to determine allergic symptoms. An ELISA assay was developed to determine TBT‐specific IgE and IgG serum antibodies among HD patients. HD patients without TBT exposure and age‐ and gender‐matched blood donors served as controls.Results
Allergic symptoms temporally related to dialysis reported by a questionnaire were significantly more frequent for HD patients than for PD patients: rhinoconjuctivitis 11% vs. 2%, asthma symptoms 20% vs. 6%, urticaria 23% vs. 8% (P values <0.05). Positive TBT‐specific IgE and IgG antibodies were more frequent among 65 exposed HD patients (28% for IgE and 26% for IgG) than for controls (4% and 9%), P<0.05.Conclusions
Results indicate the potential for sensitization and clinical allergic responses to beef thrombin when used for haemostasis in HD and suggest that other haemostatic methods should be considered.
Repeated measurements of allergens and endotoxin in settled house dust over a time period of 6 years
Authors: Topp R. , Wimmer K. , Fahlbusch B. , Bischof W. , Richter K. , Wichmann H.‐E. , Heinrich J. ,   for the INGA study group
Published: December 2003

SummaryBackground  Studies investigating the effect of exposure to indoor allergens and endotoxin on human respiratory health usually take dust samples only at one single point of time and consider them to be representative for the indoor biocontaminant burden during a time period of several years. This singly measured biocontaminant concentration is related to adverse respiratory outcomes such as asthma, wheeze or others.Objective  We analysed two repeated measurements of mite and cat allergens in mattress and living room floor dust as well as endotoxin concentrations in living room floor dust. The repeated samples were taken over a time period of about 6 years. We investigated the repeatability over time of their concentrations by determining correlation coefficients and computing within‐ and between‐home variance components.Methods  Our analysis was based on the population of a study on Indoor Factors and Genetics in Asthma (INGA) being carried out in 1995/96 and followed up in 2000/01. Complete data were available from 152 participants.Results  The measured allergen concentrations were low and a considerable percentage of the values was below the limit of detection. The crude Spearman's rank correlation coefficients between the two measurements taken in 1995/96 and 2000/01 ranged from 0.32 to 0.61 for the dust mites allergens, from 0.21 to 0.44 for cat allergen and from 0.35 to 0.51 for endotoxin. Correlations were higher if measurements were performed on the same floor or the same mattress at both sampling time‐points. The within‐home variance for all measured biocontaminant concentrations was of about the same order as the between‐home variance.Conclusion  For studies like ours with low allergen and endotoxin concentrations, the repeatability of these concentrations over a time period as long as 6 years is low and a single measurement does not accurately reflect the true long‐term exposure in the homes.
Validation of an environmental exposure unit for controlled human inhalation studies with grass pollen in patients with seasonal allergic rhinitis
Authors: Krug N. , Loedding H. , Hohlfeld J. M. , Larbig M. , Buckendahl A. , Badorrek P. , Geldmacher H. , Behnke W. , Dunkhorst W. , Windt H. , Luettig B. , Koch W. 
Published: December 2003

SummaryBackground
There is an increasing need for allergen inhalation systems to perform basic clinical research and test anti‐allergic drugs under well‐controlled conditions. This requires stability of environmental conditions like temperature and humidity, as well as allergen concentration and reproducible induction of allergic symptoms.Objective
The aim of this study was to validate an environmental exposure unit for controlled human pollen inhalation studies in participants with seasonal allergic rhinitis.Methods
Temperature, relative humidity, and air flow rate were kept constant with an air conditioning system. Pollen atmosphere was generated using a specially designed feeding system and monitored online by laser counter and offline using rotating rod samplers. Efficacy (total nasal symptom score, nasal air flow rate, nasal secretion) and safety (lung function) parameters were evaluated at different pollen concentrations and repeated allergen challenges.Results
Temperature, humidity, and air flow rate in the environmental exposure unit remained constant within a range of <2%. The spatial distribution and the temporal stability of the pollen concentration varied only slightly over 4 h (±10% and <4%, respectively). Dose‐dependent induction of allergic rhinitis symptoms, reduction in nasal air flow rate, and increase in nasal secretion were observed over time. These effects were reproducible from day to day. Lung function remained clinically normal at all concentrations and from day to day.Conclusions
Thus, pollen exposure in the environmental exposure unit is an effective, reproducible, safe, and suitable method for single‐centre clinical studies on the efficacy of anti‐allergic treatment or basic clinical research.
Immune and airway effects of house dust mite aeroallergen exposures during postnatal development of the infant rhesus monkey
Authors: Miller L. A. , Plopper C. G. , Hyde D. M. , Gerriets J. E. , Pieczarka E. M. , Tyler N. K. , Evans M. J. , Gershwin L. J. , Schelegle E. S. , Van Winkle L. S. 
Published: December 2003

SummaryBackground
The effect of chronic environmental aeroallergen exposure on the immune system and airways has not been experimentally defined in very young children.Objective
The purpose of this study was to determine the immunophenotype of peripheral blood and airway leucocytes in the newborn rhesus macaque monkey, following recurrent aerosol exposure to house dust mite (HDM) (Dermatophagoides farinae).Methods
A regimen of HDM aerosolization was initiated for 2 h per day, three times per week, starting when rhesus macaque monkeys were 1 week of age. All monkeys were inoculated with diptheria, tetanus, and acellular pertussis vaccine at 5 weeks of age to simulate human infant vaccination schedules.Results
Following 8 weeks of HDM aeroallergen exposure, infant monkeys exhibited a significant reduction in the total peripheral blood lymphocyte numbers and a decreased frequency of peripheral blood CD4+ T lymphocytes with a CD45RA−‘memory’ immunophenotype. Lavage CD4+ T lymphocytes from HDM‐exposed monkeys showed elevated expression of CD25, as well as an increase in CD45RA−/CD62L−/CD11ahigh immunophenotype. Eosinophils were more abundant within airways of HDM‐exposed monkeys, accumulating maximally within the trachea.Conclusion
These data demonstrate the development of immunological responses following chronic inhalation of a common environmental allergen during postnatal maturation in the non‐human primate.