bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Case of Paranasal Sinus Angiolipoma
Authors: Pfannenstiel Travis J. , Boseley Mark , Roach Latonia 
Published: November 2003

AbstractObjective To present the first documented case of an angiolipoma of the maxillary sinus, our treatment of the patient, and the 1‐year follow‐up results. At the conclusion of the report, the reader should be able to discuss the incidence, treatment options, and long‐term prognosis of angiolipomas of the paranasal sinuses.Study Design A case study reporting on a single patient with the diagnosis of maxillary sinus angiolipoma.Methods Review of diagnostic studies, the operative technique, and the patient's chart for the 1‐year period after treatment.Results The patient remains free of disease 1 year after definitive surgical treatment.Conclusions Angiolipomas are exceedingly rare in this location. The accepted treatment for this disease in other regions of the body consists of wide local excision with close follow‐up. The extent of the disease found in this patient required a medial maxillectomy for en bloc resection. We would advocate such an approach for other physicians who are faced with a patient with this rare diagnosis.
Quality of Life Assessment in Nasal Airway Obstruction
Authors: Rhee John S. , Book David T. , Burzynski Mary , Smith Timothy L. 
Published: November 2003

AbstractObjectives/Hypothesis Quality of life (QOL) assessment of patients with nasal obstruction has not been well studied. The objectives of the study were to determine the QOL of patients with nasal obstruction, to identify baseline variables predictive of patients' QOL, and to examine the relationship of QOL scores with patient assessment of nasal obstruction.Study Design Preliminary, cross‐sectional study of a larger, prospective investigation.Methods Forty individuals met the criteria for inclusion. Participants were required to have a surgically treatable diagnosis of septal deviation, nasal valve collapse, and/or turbinate hypertrophy. Quality of life assessment was performed using the Rhinoconjunctivitis Quality of Life Questionnaire and the Rhinosinusitis Disability Index. Demographic data, along with patient assessment of nasal obstruction with a visual analogue scale, were recorded.Results Both instruments demonstrated good inter‐item correlation as measured by Cronbach's alpha. Demographic variables, previous nasal surgeries, and comorbid conditions were not significantly correlated with QOL scores with either instrument. Correlations between visual analogue scale scores and the Rhinoconjunctivitis Quality of Life Questionnaire “sleep” (correlation coefficient [r] = 0.35, P = .02) and “nasal symptom” (r = 0.36, P = .02) domains demonstrated a trend toward significance. Patients with nasal valve collapse reported higher visual analogue scale scores for nasal obstruction compared with those with septal deviation alone (P <.01).Conclusions Patients with nasal valve collapse demonstrated greater perception of nasal obstruction than those with septal deviation alone. The Rhinoconjunctivitis Quality of Life Questionnaire appears to be a more sensitive instrument than the Rhinosinusitis Disability Index for patients with nasal obstruction. However, existing measures may lack sensitivity in estimating the QOL of patients with nasal obstruction. A disease‐specific instrument for nasal obstruction may be necessary to further evaluate this disease process.
Age‐Related Mechanisms of Cricoid Cartilage Response to Injury in the Developing Rabbit
Authors: Cherukupally Shilpa Reddy , Adams Allison B. , Mankarious Leila A. 
Published: November 2003

AbstractObjective To evaluate age‐related mechanisms of cricoid cartilage response to injury in an animal model.Study Design A pilot study using monoclonal antibodies to chondrocyte proliferation markers collagen II, aggrecan, and proliferating cell nuclear antigen (PCNA) to evaluate age‐related response of injured cricoid cartilage.Methods Twenty‐seven New Zealand white rabbits aged 4 weeks, 8 weeks, and 1.5 years were studied. Six animals in each age group underwent intracartilaginous injury through cricofissure and tracheofissure. Three animals of each group were used as control subjects. The animals were killed 4 weeks after injury, their cricoid cartilages harvested, and 7‐μm sections of tissue obtained. The cricoid tissue sections were stained with immunofluorescent monoclonal antibody markers to collagen II, aggrecan, and PCNA.Results In all age groups, no control animals had symptoms of airway compromise or immunohistochemical abnormality. For all three markers of chondrocyte proliferation, the 4‐week‐old animals showed markedly increased staining at the injured edges of cartilage. The 8‐week‐old animals showed mild increased extracellular staining, and the 1.5‐year‐old animals showed no increased staining compared with uninjured areas of the cricoid ring and with control animals.Conclusion There was a progressive, age‐related attenuation of staining for markers of chondrocyte proliferation in the 8‐week and 1.5‐year‐old rabbits compared with the 4‐week‐old rabbit cricoids.
Dermatofibrosarcoma Protuberans of the Head and Neck: Treatment With Mohs Surgery Using Inverted Horizontal Paraffin Sections
Authors: Tom William David , Hybarger Charles Patrick , Rasgon Barry Mitchell 
Published: November 2003

AbstractObjective To describe results of treating dermatofibrosarcoma protuberans of the head and neck with a Mohs surgical technique in which tumor margins were evaluated with inverted horizontal paraffin sections to identify the margin of resection necessary to achieve tumor‐free borders.Study Design Retrospective case study of nine patients.Methods In each case, Mohs surgery using inverted horizontal frozen‐section analysis was continued until tumor‐free margins were achieved. The tumor‐free specimens collected during this procedure were immediately reprocessed by using inverted horizontal paraffin sectioning, and the histological results of the two techniques were compared. To identify the margins of resection needed to achieve tumor‐free margins, preoperative lesion size was compared with postoperative defect size.Results Paraffin section analysis showed persistent tumor in seven of the nine patients in whom the frozen‐section technique was used to clear the tumor. Tumor‐free margins were achieved in all patients by using one additional excision. The tumor had spread extensively beyond clinical margins and required a mean minimum margin of 3.7 cm around the gross area of tumor (margin range, 2.5–6.0 cm). Patients treated by this technique showed no local, regional, or distant recurrence at follow‐up performed at a mean time of 43 months postoperatively (range, 19–74 mo).Conclusions Dermatofibrosarcoma protuberans of the head and neck is a tumor that shows extensive infiltration beyond gross margins. Wide local excision with 2‐ to 3‐cm margins results in an unacceptably high recurrence rate; larger excisional margins are necessary to remove all disease. Accurate margin identification achieved by using Mohs surgery with rush paraffin section analysis results in complete tumor removal and excellent control rates. This method should be preferred for treatment of dermatofibrosarcoma protuberans of the head and neck.
Alpha 1‐Antitrypsin and Ilomastat Inhibit Inflammatory Proteases Present in Human Middle Ear Effusions
Authors: Antonelli Patrick J. , Schultz Gregory S. , Kim Karen M. , Cantwell John S. , Sundin David J. , Pemberton Philip A. , Barr Philip J. 
Published: November 2003

AbstractObjectivesProteases of both the serine and metalloproteinase families have been shown to play a role in the pathogenesis of otitis media (OM). Inhibitors of proteases from each of these families have been shown to beneficially impact disease progression in a number of related chronic inflammatory conditions, but their use has not been studied in OM. The purpose of this study was to assess the activity of the protease inhibitors recombinant alpha 1‐antitrypsin (rAAT) and ilomastat on inflammatory proteases present in human middle ear effusions (MEEs), with a view to their potential utility in the treatment of OM.Study DesignProspective and ex vivo.MethodsMEEs were collected from 100 patients presenting for middle ear surgery, most commonly tympanostomy tube placement or treatment of acute posttympanostomy otorrhea (APTO). MEEs were analyzed for the presence of matrix metalloproteinases (MMPs) and human neutrophil elastase (HNE) and the inhibitory activity of rAAT and ilomastat on these proteases, respectively.ResultsMMP levels were highest in APTO, and HNE was highest in chronic suppurative OM and APTO. High levels of MMP and HNE (>3 mAU/min) were found in 52% and 37% of MEEs, respectively. Ilomastat and rAAT demonstrated significant inhibition of MMP and HNE activity (>30% reduction), respectively, in 80% and 82% of MEEs with high levels of activity.ConclusionsProteases are commonly found in OM. Ilomastat and rAAT are potent inhibitors of proteases in MEEs across a wide range of OM in humans. Investigation into the potential therapeutic benefits of these protease inhibitors is warranted.
Botulinum Neurotoxin for Pharyngeal Constrictor Muscle Spasm in Tracheoesophageal Voice Restoration
Authors: Hamaker Ronald C. , Blom Eric D. 
Published: November 2003

AbstractObjectives/Hypothesis The purpose of the study was to evaluate the effectiveness of Botulinum neurotoxin (Botox) for elimination of pharyngeal constrictor muscle spasm in tracheoesophageal voice restoration.Study Design A retrospective review was made of 62 patients between 1991 and 2002 who had Botox as the initial treatment for pharyngeal constrictor muscle spasm.Methods One hundred units of Botox properly diluted in 3 mL saline was instilled unilaterally under electromyographic guidance after fluoroscopic identification and marking of the contracted pharyngeal constrictor muscles. The patients were divided into three groups based on their response to the first Botox injection: group I, complete relaxation of the pharyngeal constrictors resulting in fluent voice, intratracheal phonation pressure of 20 to 40 cm H2O, and the ability to say 15 to 20 uninterrupted syllables; group II, hypertonic or incomplete relaxation of the pharyngeal constrictors resulting in intratracheal phonation pressure of 45 to 70 cm H2O and the ability to say 7 or 8 syllables; and group III, failure to produce relaxation of the pharyngeal constrictors.Results After the first injection of Botox, 49 (79%) patients were in group I or II (41 in group I and 8 in group II) and group III consisted of 13 patients. Thirty‐four patients (55%) had group I (28) or II (6) responses for greater than 6 months. A second Botox injection enabled 6 of the 13 failures to move into group I. In all, 8 pharyngeal constrictor muscle myotomies (13%) were ultimately required in the 62 patients. The group I speaker for the longest period has enjoyed 11 years of fluency and successful daily use of a tracheostoma valve after two Botox injections.Conclusion Botox relaxation of the pharyngeal constrictor muscles has proven to be effective, has replaced secondary pharyngeal myotomy for the initial treatment of pharyngeal muscle spasm, and is the only treatment in patients who are not candidates for elective surgery. Radiographic assessment, electromyographically monitored injection, and the number of Botox units appear to be important to successful outcomes.
Invasive Fungal and Bacterial Infections of the Temporal Bone
Authors: Marzo Sam J. , Leonetti John P. 
Published: November 2003

AbstractObjectives/Hypothesis Objectives were to highlight the importance of surgical therapy in treating invasive polymicrobial infections of the temporal bone, to discuss the importance of antifungal therapy, and to review the differential diagnosis of ear canal granulomatous disorders.Study Design Retrospective case review at a tertiary care medical center.Methods A retrospective chart review of all patients diagnosed with invasive polymicrobial temporal bone infections was performed. Four patients were identified. All patients required surgical therapy for definitive management. All patients were followed for at least 1 year or until death.Results Three of four patients had invasive fungi as pathogens. One patient had an occult squamous cell carcinoma. At the time of writing, one patient was free of disease, two were dead of disease, and one was alive with disease.Conclusion Invasive polymicrobial temporal bone infections can occur in immunocompromised patients and can possibly harbor an occult malignancy. Surgical debridement may be necessary to arrive at a correct diagnosis. Modified radical mastoidectomy with parenteral antibiotic therapy and other adjunctive measures may be necessary for disease resolution.
Tutorials in Clinical Research: Part VII. Understanding Comparative Statistics (Contrast)–Part A: General Concepts of Statistical Significance
Authors: Neely J. Gail , Hartman James M. , Forsen James W. , Wallace Mark S. 
Published: November 2003

AbstractObjectives/Hypothesis The present tutorial is the seventh in a series of Tutorials in Clinical Research. The specific purpose of the tutorial (Part A) and its sequel (Part B) is to introduce and explain three commonly used statistical tools for assessing contrast in the comparison between two groups.Study Design Tutorial.Methods The authors met weekly for 10 months discussing clinical research studies and the applied statistics. The difficulty was not in the material but in the effort to make the report easy to read and as short as possible.Results The tutorial is organized into two parts. Part A, which is the present report, focuses on the fundamental concepts of the null hypothesis and comparative statistical significance. The sequel, Part B, discusses the application of three common statistical indexes of contrast, the χ2, Mann‐Whitney U, and Student t tests.Conclusions Assessing the validity of medical studies requires a working knowledge of research design and statistics; obtaining this knowledge need not be beyond the ability of the busy surgeon. The authors have tried to construct an accurate, easy‐to‐read, easy‐to‐apply, basic introduction to comparing two groups. The long‐term goal of the present tutorial and others in the series is to facilitate basic understanding of clinical research, thereby stimulating reading of some of the numerous well‐written research design and statistical texts. This knowledge may then be applied to the continuing educational review of the literature and the systematic prospective analysis of individual practices.
Lesion Formation in Radiofrequency Surgery of the Tongue Base
Authors: Stuck Boris A. , Köpke Julian , Maurer Joachim T. , Verse Thomas , Eckert Andreas , Bran Gregor , Düber Christoph , Hörmann Karl 
Published: November 2003

AbstractObjectives Temperature controlled radiofrequency volumetric tissue reduction (RFVTR) of the tongue base is a minimally invasive technique for the treatment of obstructive sleep apnea. But despite its widespread use, little is yet known about in vivo effects in humans. Such knowledge would be essential for evidence‐based criteria in the selection of energy application.Methods In a preparatory in vitro study, porcine tongues were preserved in growing medium. Lesions with different amounts of energy were applied, and maximum diameters were assessed. In the in vivo study, 11 patients were treated with RFVTR at the tongue base by employing different energy levels (800, 600, 400, or 200 J) on two application sites. Magnetic resonance imagery scans were performed 4 to 6, 8 to 10, and 24 hours after surgery. An inversion recovery technique was used to visualize the lesions.Results RFVTR created lesions at the porcine tongue from 50 J and higher. Maximum lesion sizes were achieved with 400 J. In vivo, all the lesions were clearly visible in the postoperative scans. Lesion size increased with the amount of energy applied. Maximum diameters were created from 600 J and higher. Higher amounts of energy only resulted in a slight increase in lesion length.Conclusions The application of 600 J at 85°C leads to optimal lesion sizes. Higher amounts of energy will not lead to a relevant increase in tissue necrosis. With regard to the time needed for application, 600 J appears to be the ideal adjustment for energy delivery in the treatment of the human tongue.
Modified Maxillomandibular Advancement for the Treatment of Obstructive Sleep Apnea: A Preliminary Report
Authors: Goh Yau Hong , Lim Kheng Ann 
Published: November 2003

AbstractObjective A prospective study to evaluate the modified maxillomandibular advancement (MMA) technique for the treatment of obstructive sleep apnea (OSA).Methods Eleven patients underwent modified MMA for the treatment of OSA. All the patients underwent presurgical and postsurgical polysomnography, nasolaryngoscopy, and clinical facial photographic assessment. The results were analyzed after a minimum of 6 months postsurgery (mean, 7.7 months).Results The preoperative polysomnography results were as follows: apnea index, 55.7 ± 19.8; apnea‐hypopnea index, 70.7 ± 15.9; lowest oxygen saturation, 58.6 ± 12.3%; longest apnea/hypopnea, 67.9 ± 23.7 seconds; and arousal index, 47.1 ± 18.2. The postoperative polysomnography results were as follows: apnea index, 3.4 ± 3.4; apnea/hypopnea index, 11.4 ± 7.4; lowest oxygen saturation, 83.9 ± 8.8%; longest apnea/hypopnea, 38.2 ± 24.6 seconds; and arousal index, 15.1 ± 7.3. The mean postoperative body mass index (BMI) was 27.2 ± 3.3. The mean BMI change after surgery was 6.5%.Conclusion The preliminary review has demonstrated that the modified MMA technique for the treatment of OSA is highly effective in the treatment of severe OSA without the significant facial profile change commonly associated with the traditional MMA technique.
Paratracheal Lymph Node Involvement in Advanced Cancer of the Larynx, Hypopharynx, and Cervical Esophagus
Authors: Timon Conrad V. , Toner Mary , Conlon Brendan J. 
Published: November 2003

AbstractObjectives/Hypothesis The presence of nodal metastatic disease in head and neck cancer is the foremost prognostic factor. Although neck dissection is the surgical gold standard for the treatment of cervical lymphatic spread, the paratracheal nodal group is not routinely included in the dissection. The study determined the nodal yield, presence of metastases, and prognostic importance of paratracheal nodes in patients with advanced carcinoma of the upper aerodigestive tract.Study Design Prospective histological and survival analysis.Methods Over a 4‐year period (October 1994–June 1998), consecutive patients undergoing laryngectomy with or without pharyngectomy or cervical esophagectomy underwent paratracheal node dissection on a prospective basis. Nodal tissue was examined for the presence of metastases. Statistical comparison of survival probability was determined by use of log‐rank/χ2 test.Results Fifty patients have been included in the study to date, with a minimal follow‐up of 3 years. The average number of paratracheal nodes dissected was three per side (range, 1–5). Thirteen (26%) patients demonstrated histological evidence of paratracheal nodal metastases (larynx, 20%; postcricoid/cervical esophageal region, 43%). Five patients (10%) had positive paratracheal nodes alone in a histologically negative cervical neck dissection. The majority of positive paratracheal nodes were less than 1 cm in diameter and appeared negative preoperatively. The absence of positive paratracheal nodes may have a survival benefit.Conclusion The study highlighted the propensity of advanced carcinoma of the upper aerodigestive tract to involve the paratracheal nodes. This area should be routinely dissected in the surgical management of these tumors.
Role of Mannitol in Reducing Postischemic Changes in Distortion‐Product Otoacoustic Emissions (DPOAEs): A Rabbit Model
Authors: Morawski Krzysztof , Telischi Fred F. , Merchant Faisal , Abiy Lidet W. , Lisowska Grazyna , Namyslowski Grzegorz 
Published: November 2003

AbstractObjectives The aim of this study was to observe the effects of mannitol, administered topically at the round window (RW), on cochlear blood flow (CBF) and distortion‐product otoacoustic emission (DPOAE) after repeated episodes of cochlear ischemia.Methods Ten young rabbits were used for this study. Reversible ischemic episodes within the cochlea were induced by directly compressing the internal auditory artery (IAA). CBF was measured using a laser‐Doppler (LD) probe positioned at the RW niche. DPOAEs were measured at 4, 8, and 12 kHz geometric mean frequency (GMF) using 60 dB sound pressure level (SPL) primary tone stimuli. In five test ears, mannitol was administered topically at the RW for 30 minutes before the IAA compressions. In five control ears, the IAA compressions were undertaken without application of RW medication. Each ear underwent three 5 minute IAA compressions with a 60 minute rest period between compressions.Results In the control animals, it was observed that a progressive reduction in DPOAE level followed each successive IAA compression at all three test frequencies. The reduction in DPOAE amplitudes was consistently greater at the higher test frequencies. In the test rabbits, the RW administration of mannitol resulted in significantly less reduction in DPOAE level measures after repeated IAA compressions. For example, 30 minutes after reperfusion at 12 kHz GMF, DPOAE levels in the control ears were reduced by 1.5, 6.0, and 16 dB, compared with 1.5, 4.0, and 6.0 dB in the mannitol test ears.Conclusions Mannitol appears to exert a protective effect on cochlear function after periods of ischemia. The RW appears to be an efficacious route for topical administration of mannitol into the inner ear.
Presbycusis: A human temporal bone study of individuals with flat audiometric patterns of hearing loss using a new method to quantify stria vascularis volume
Authors: Nelson Erik G. , Hinojosa Raul 
Published: November 2003

AbstractObjective: The purpose of this study was to determine the prevalence of stria vascularis atrophy in individuals with presbycusis and flat audiometric patterns of hearing loss. Individuals with presbycusis have historically been categorized by the shape of their audiograms, and flat audiometric thresholds have been reported to be associated with atrophy of the stria vascularis. Stria vascularis volume was not measured in these studies. Study Design: Retrospective case review. Methods: Archival human temporal bones from individuals with presbycusis were selected on the basis of strict audiometric criteria for flat audiometric thresholds. Six temporal bones that met these criteria were identified and compared with 10 temporal bones in individuals with normal hearing. A unique quantitative method was developed to measure the stria vascularis volume in these temporal bones. The hair cell and spiral ganglion cell populations also were quantitatively evaluated. Results: Only one of the six individuals with presbycusis and flat audiometric thresholds had significant atrophy of the stria vascularis. This individual with stria vascularis atrophy also had reduced inner hair cell, outer hair cell, and ganglion cell populations. Three of the individuals with presbycusis had spiral ganglion cell loss, three individuals had inner hair cell loss, and all six individuals had outer hair cell loss. Conclusions: The results of this investigation suggest that individuals with presbycusis and flat audiometric patterns of hearing loss infrequently have stria vascularis atrophy. Outer hair cell loss alone or in combination with inner hair cell or ganglion cell loss may be the cause of flat audiometric thresholds in individuals with presbycusis.