bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sinus Tissue Pharmacokinetics After Oral Administration of Amoxicillin/Clavulanic Acid
Authors: Borges Dinis Paulo , Conceição Monteiro Maria , Luz Martins Maria , Silva Nuno , Gomes Augusto 
Published: November 2003

AbstractObjectives The in vitro synergy of the amoxicillin/clavulanic acid combination has not always translated in vivo into clinical superiority compared with amoxicillin alone. Specifically, conflicting reports have disputed the superiority of the combination in the treatment of both acute otitis media and acute sinusitis. One possible reason for this may have to do with inadequate target tissue pharmacokinetics. To explore this possibility in the sinuses, we undertook the present investigation.Study Design A randomized, open, single‐dose, sinus tissue pharmacokinetic study with oral amoxicillin/clavulanic acid.Methods Twenty‐three adult patients with chronic rhinosinusitis who had been selected for surgery were randomly allocated to receive a tablet of 875/125 mg amo‐icillin/clavulanate 2 to 4 hours before surgery began. During the operation tissue samples were collected at specific sinonasal sites for determination of both amo‐icillin and clavulanic acid concentration levels.Results Amoxicillin displayed adequate tissue levels throughout the sinuses, high enough to cover common susceptible pathogens. However, the presence of clavulanate was detected in only half of the sinonasal tissue samples.Conclusions The kinetics of oral clavulanic acid apparently fails to provide a widespread anti–β‐lactamase activity capable of enhancing the activity of amoxicillin in all parts of the sinuses. Despite this, amoxicillin/clavulanic acid maintains a central role in the treatment of acute rhinosinusitis, because amoxicillin is still the most effective oral β‐lactam against Streptococcus pneumoniae, a particularly virulent and increasingly resistant upper respiratory tract pathogen. Also, as our data show, a concomitant anti–β‐lactamase activity can be expected to occur, although in an unpredictable fashion.
Pediatric Tracheotomies: Changing Indications and Outcomes
Authors: Carron Jeffrey D. , Derkay Craig S. , Strope Gerald L. , Nosonchuk Jane E. , Darrow David H. 
Published: November 2003

AbstractObjective/Hypothesis To study the outcomes and complications associated with pediatric tracheotomy, as well as the changing trend in indications and outcomes since 1970.Study Design Retrospective chart review at a major tertiary care children's hospital.Methods On children who underwent tracheotomy at Children's Hospital of the King's Daughters (Norfolk, VA) between 1988 and 1998, inpatient and outpatient records were reviewed. Of 218 tracheotomies, sufficient data were available on 204. Indications for tracheotomy were placed into the following six groups: craniofacial abnormalities (13%), upper airway obstruction (19%), prolonged intubation (26%), neurological impairment (27%), trauma (7%), and vocal fold paralysis (7%).Results The average age at tracheotomy was 3.2 ± 0.6 years. Although the prolonged intubation group was significantly younger than all others, the neurological impairment and trauma groups were significantly older. Decannulation was accomplished in 41%. Time to decannulation was significantly higher in the neurological impairment and prolonged intubation groups, but was significantly shorter in the craniofacial group. Complications occurred in 44%. Overall mortality was 19%, with a 3.6% tracheotomy‐related death rate. Comparison of our series to other published series of pediatric tracheotomies since 1970 shows fewer being performed for airway infections and more for chronic diseases, with a corresponding increase in duration of tracheotomy and decreased decannulation rates.Conclusions Tracheotomy is a procedure performed with relative frequency at tertiary care children's hospitals. While children receiving a tracheotomy have a high overall mortality, deaths are usually related to the underlying disease, not the tracheotomy itself.
Endoscopically Monitored Percutaneous Dilational Tracheotomy in a Residency Program
Authors: R. Donaldson David , Emami Afshin J. , Wax Mark K. 
Published: November 2003

AbstractObjectives/Hypothesis Endoscopically guided percutaneous dilational tracheotomy (PDT) has become a well‐established alternative to the more traditional open tracheotomy, yet its use by otolaryngologists is limited. As airway management specialists, otolaryngologists should be familiar with a wide range of definitive procedures, including PDT. Few otolaryngology programs teach the technique. The objective of the present study was to determine the complication rate and outcome of PDT after its introduction in a residency teaching program. We also wished to evaluate whether the time savings reported by experienced surgeons could be repeated in our setting.Setting Tertiary referral teaching hospital.Methods We prospectively reviewed our first 54 consecutive PDTs and compared them to 29 consecutive standard open tracheotomies, which were reviewed retrospectively.Results Complications (13% vs. 33%, P = .030), operative time (12 vs. 24 min, P < .0001) and total procedure time (37 vs. 80 min, P < .001) were significantly reduced in the PDT group as compared with standard tracheotomy. Initial outcome data were equal in both groups .Conclusions We found that PDT can be safely and effectively taught as part of an otolaryngology residency training program.
Frontal Sinus Stents
Authors: Freeman Stephen B. , Blom Eric D. 
Published: November 2003

AbstractObjectives The formation of scar tissue, synechiae, or osteogenesis in the narrow frontal outflow tract after instrumentation of the frontal sinus has led to attempts to enlarge the frontal duct or stenting.Study Design Prospective pilot study.Results Sixty‐four Freeman frontal sinus stents were used to maintain patency in 46 patients. Stents were inserted using an endoscopic technique in 26 sinuses containing polyps, 20 with pansinusitis, and 18 cavities with stenosis of the frontal duct. External incisions with frontal sinusotomy were required to remove the stenosis and insert the stent in nine sinuses. Polypoid degeneration, granulation, purulent drainage, and lateralization of the middle turbinate were encountered infrequently. Frontal obliteration was subsequently required in six sinuses.Conclusion The Freeman frontal sinus stent prevented blockage of the outflow tract in patients who had removal of disease in the sinus or duct or treatment of frontal stenosis.
Regulation of Immunoglobulin Secretion by Plasma Cells Infiltrating Nasal Polyps
Authors: Sánchez‐Segura Antonio , Antonio Brieva José , Rodríguez Carmen 
Published: November 2003

AbstractObjective/Hypothesis To learn more about the role of plasma cells infiltrating nasal polyps in the pathogenesis of nasal polyposis, we examined their function by analyzing immunoglobulin (Ig) production and the factors implicated in the secretion.Study Design A series of 19 consecutive nasal polyp tissue samples and, as a control, peripheral blood samples from the same patients, were studied by histopathological and immunological examination.Methods Hematoxylin‐eosin and immunohistochemical staining was carried out to identify plasma cells infiltrating nasal polyps. Nasal polyp mononuclear cells (NPMNCs) were purified from nasal polyp tissue samples, and Ig‐secreting cells were identified in cytospin preparations stained with fluorescein isothiocyanate–conjugated antibodies against IgA, IgG, IgM, and IgE. Purified NPMNCs were cultured in basal conditions and after the addition of several stimuli. Ig secreted into the culture supernatants was evaluated by an enzyme‐linked immunosorbent assay.Results Plasma cells accounted for an important fraction of the inflammatory infiltrate. The main Ig isotype synthesized by these cells was IgA, whereas little IgE was detected. In vitro cultures demonstrated that the plasma cells actively secreted Ig for a short period. When cytokine dependence was analyzed, interleukin‐10 (IL‐10) and tumor necrosis factor‐α (TNF‐α) were shown to be partially responsible for the Ig production. Dependence on CD95‐mediated apoptosis was not observed.Conclusions Nasal polyp–infiltrating plasma cells are mainly IgA‐secreting cells, the latter property being related to the mucosal immune system. The IgA production is partly dependent on IL‐10 and TNF‐α. The absence of IgE‐secreting cells in most of the samples suggests that a type I hypersensitivity reaction is not essential for the development of nasal polyp.
In Vivo Interaction of Cis‐platinum and Fosfomycin on Squamous Cell Carcinoma
Authors: Tandy James R. , Tandy Richard D. , Farris Paul , Truelson John M. 
Published: November 2003

AbstractObjectives/Hypothesis Cis‐platinum is the most frequently used chemotherapeutic agent for the treatment of head and neck squamous cell carcinoma (SCCA). Ototoxicity and nephrotoxicity continue to be the primary dose‐limiting toxicities encountered. Fosfomycin, a broad‐spectrum antibiotic, has been previously shown to be both otoprotective and nephroprotective against cis‐platinum toxicity. Previous in vitro work demonstrated that fosfomycin does not inhibit the tumoricidal actions of cis‐platinum. This study tests whether fosfomycin inhibits cis‐platinum in vivo.Methods An SCCA cell line was grown in vivo in four groups of nude mice, which then received no treatment, standard‐dose cis‐platinum, high‐dose cis‐platinum, or high‐dose cis‐platinum with fosfomycin.Results Fosfomycin did not inhibit the tumoricidal activity of cis‐platinum. Mice treated with fosfomycin also had longer survival, which is probably due to lessening of immediate cis‐platinum systemic toxicity.Conclusion This study shows that fosfomycin in combination with cis‐platinum may be useful in treating advanced, and possibly relatively chemoresistant, SCCA of the head and neck.
Reconstruction of Nasal Defects Larger Than 1.5 Centimeters in Diameter
Authors: Park Stephen S. 
Published: November 2003

AbstractObjective To review the repair of larger nasal defects (>1.5 cm in diameter) and the vascular supply to the forehead flap.Study Design Retrospective chart review (1994–1999) and cadaver analysis of forehead flap vasculature.Methods Chart review was made of patients with cutaneous nasal defects greater than 1.5 cm in diameter. An intravascular silicone cast was used to detail the arterial supply to forehead flaps focusing on contribution from the supratrochlear and angular vessels.Results In 127 patients with nasal defects, 76 defects were greater than 1.5 cm in diameter and were repaired with a midline forehead flap (44 [58%]), paramedian forehead flap (3 [4%]), single‐stage midline forehead flap (8 [11%]), interpolated melolabial flap (5 [7%]), local nasal flap (7 [9%]), or skin graft (9 [12%]). All original defects were modified to some degree with an aggressive application of the nasal esthetic subunit principle. Forty‐three patients (57%) had cartilage grafts, 18 (24%) had a full‐thickness defect requiring repair of the internal lining, and 11 (14%) had some degree of complication, although no patient had full‐thickness necrosis of a flap or required a second flap. Analysis of the vascular pedicle to the midline and paramedian forehead flaps demonstrated significant contributions from the angular artery. Skin paddles from a midline and paramedian forehead flap had similar vascular arcades.Conclusions Nasal reconstruction has reached a standard of consistent esthetic results with restoration of nasal function. The midline forehead flap is dependable and robust and leaves a donor site scar consistent with the principle of esthetic units.
Sphenoid Marsupialization for Chronic Sphenoidal Sinusitis
Authors: Donald Paul J. 
Published: November 2003

AbstractObjectives To review experience with sphenoid marsupialization and describe the technique using new instrumentation.Study Design Retrospective review of five cases of chronic sphenoid sinusitis that were resistant to standard medical and surgical methods, which were treated by sphenoid marsupialization.Methods Charts were reviewed and patients were interviewed regarding postoperative resolution of symptoms.Results Five cases of recalcitrant sphenoid sinusitis were reviewed. All patients had headache before surgery, and two had visual disturbance. In follow‐up ranging from 1 to 87 months, all were free of symptoms related to the sphenoid sinus.Conclusions Marsupialization is an effective method of exteriorizing a chronically infected sphenoid sinus. The use of functional endoscopic sinus surgery instruments and the TAC attachment of the Midas Rex drill make this surgery possible.
Botulinum Toxin for Essential Tremor of the Voice With Multiple Anatomical Sites of Tremor: A Crossover Design Study of Unilateral Versus Bilateral Injection
Authors: Warrick Paul , Dromey Christopher , Irish Jonathan C. , Durkin Lisa , Pakiam Anthony , Lang Anthony 
Published: November 2003

AbstractObjectives/Hypothesis To evaluate the relative efficacy of unilateral and bilateral injections of botulinum toxin injection (BOTOX) in the treatment of essential tremor of the voice (ETV).Study Design Prospective open‐label crossover study.Methods Patients referred to the Neurolaryngology Clinic at Toronto General Hospital with a diagnosis of ETV were eligible for the study. Patients were sequentially assigned to receive BOTOX as either a bilateral 2.5‐U or a unilateral 15‐U electromyography‐guided injection, followed by the alternative injection 16 to 18 weeks later. Acoustic, aerodynamic, and nasopharyngoscopic data were collected approximately 2, 6, 10, and 16 weeks after each injection. Patients were asked to provide a perceptual evaluation of BOTOX effects at the conclusion of the study.Results Three of 10 patients demonstrated an objective reduction in tremor severity with bilateral injection, and 2 of 9 with unilateral injection. However, 8 of 10 patients wished to be re‐injected at the conclusion of the study. A reduction in vocal effort appeared to be coincident with reduction in laryngeal airway resistance after BOTOX injection.Conclusions Using objective acoustic measures, only a small proportion of patients achieved benefit from BOTOX injection for ETV. However, a majority of patients in our study benefited from a subjective reduction in vocal effort that may have been attributable to reduced laryngeal airway resistance.
Assessment of Gustatory Function by Means of Tasting Tablets
Authors: Ahne Gabi , Erras Angelo , Hummel Thomas , Kobal Gerd 
Published: November 2003

AbstractObjective To develop a simple test for the screening of gustatory function in clinical settings.Study Design We tested 101 healthy volunteers (44 male and 57 female volunteers; mean age, 47 y) with the following gustatory test: the substances sucrose (sweet), citric acid (sour), sodium chloride (salty), and caffeine (bitter) were presented as tablets (diameter 4 mm) similar to common sweetener tablets. For quantitative assessment of whole‐mouth gustatory function we used six different dosages with dilutions of each tastant in 50% steps. The highest dosage could be easily detected (sucrose, 30 mg; citric acid, 3 mg; sodium chloride, 2 mg; caffeine, 2 mg), and the lowest concentration was within threshold range.Methods Twenty‐eight tablets (si‐ different dosages of the four basic tastes plus four tasteless tablets) were tried in a randomized order. The entire test required 15 to 20 minutes. To evaluate the within‐subject test‐retest reliability, sessions were repeated after 1 week. Results were compared with those obtained by means of a conventional three‐drop, forced‐choice procedure using the method of ascending limits.Results Results of the new gustatory test were significantly correlated with those obtained using the three‐drop, forced‐choice procedure (correlation coefficient [r] = 0.66, P < .001). In general, women performed better than men. Furthermore, younger subjects exhibited a significantly higher gustatory sensitivity in both tests compared with older subjects.Conclusions This quantitative test of whole‐mouth gustatory function is easy to use, can be self‐administered, requires little time, and has a long shelf‐life. It appears to be suited for routine clinical assessment of gustatory function.
Increasing Use of the Scapula Osteocutaneous Free Flap
Authors: Coleman Sean C. , Burkey Brian B. , Day Terry A. , Randall Resser J. , Netterville James L. , Dauer Eileen , Sutinis Emily 
Published: November 2003

AbstractObjectives To determine the appropriate use of the scapula osteocutaneous free flap (SOFF) and to document donor site morbidity.Study Design Retrospective review and prospective physical therapy evaluation.Methods A computer database of all free flap procedures performed at a single institution was created. Specific clinical and operative details from cases involving a bone flap were extracted from the database. Rates of usage of the various osteocutaneous flaps were compared over four successive 2‐year intervals (1992–1999). A single physical therapist performed a structured evaluation of the donor site.Results Overall, 64 bone flap procedures were performed, of which 24 (37.5%) were SOFF procedures. The SOFF utilization has increased from 6.6% to 63.6%, while fibula and iliac crest utilization has fallen significantly. This is in part because of the greater versatility of the SOFF, with the possibility of separate skin paddles and adequate bone length. The mean cutaneous area harvested with the SOFF was 110 cm2 (range, 48–200 cm2) compared with 55.4 cm2 (range, 25–102 cm2) and 77.6 cm2 (range, 50–120 cm2) for the fibula and iliac crest, respectively. Mean bone flap lengths were 8.37, 7.65, and 10.1 cm, respectively, for the SOFF, fibula, and iliac crest. Dual skin paddles were used in 50% of the SOFF procedures versus 2.8% for the fibula flap procedures. There were no significant complications of the donor site in any patient, and there was only one flap failure (4.1%). Related to the SOFF, donor site morbidity was subjectively judged as “mild,” for pain, mobility, and strength. There were no complaints of poor appearance of the donor site. Activities of daily living were judged as “not limited” or “limited a little” in the majority of patients. Objective measurements of range of motion revealed an average reduction of 1° to 12° in five different shoulder functions. Elbow and arm ranges of motion were not limited. Strength was minimally reduced in the shoulder, while the arm and forearm showed no reduction in strength.Conclusions The SOFF is a versatile osteocutaneous free flap that can be used for a multitude of reconstructive problems. This and its relative lack of significant donor site morbidity have caused its use to increase significantly.
Positron Emission Tomography With Fluorodeoxyglucose for Suspected Head and Neck Tumor Recurrence in the Symptomatic Patient
Authors: Lonneux Max , Lawson Georges , Ide Christophe , Bausart Raymond , Remacle Marc , Pauwels Stanislas 
Published: November 2003

AbstractObjective To analyze the impact of positron emission tomography with fluorodeoxyglucose (FDG‐PET) in the treatment of patients suspected of having head and neck cancer recurrence.Study Design Prospective and consecutive inclusion of 44 patients presenting with clinical symptoms suggestive of head and neck tumor recurrence.Methods FDG‐PET was compared with combined computed tomography (CT) plus magnetic resonance imaging (MRI) procedures for the differential diagnosis between tumor recurrence and benign post‐therapeutic changes. For FDG‐PET, the potential additional value of semiquantitative indexes was studied. The impact on patient treatment (i.e., their ability to accurately select patients for panendoscopic exploration) was analyzed retrospectively for both CT+MRI and PET workups.Results The diagnostic accuracy was found higher for PET than for combined CT+MRI: sensitivity ranged from 96% to 73%, specificity from 61% to 50%, and accuracy from 81% to 64% for PET and CT+MRI, respectively. The accuracy of FDG‐PET was the highest (94%) in patients included more than 12 weeks after the end of therapy. In 15 discordant cases, PET was correct in 11 and CT+MRI in 4. Patient selection for panendoscopic exploration and biopsy was correct in 79% and 50% of patients with FDG‐PET and CT+MRI, respectively. Quantification of FDG uptake had no additional value over visual analysis alone, although we found that a SUVlbm (standardized uptake value corrected for lean body mass) threshold of 3 could be helpful in patients scanned less than 12 weeks after the end of therapy.Conclusion FDG‐PET has a major additional diagnostic value to CT+MRI for the evaluation of the symptomatic patient suspected of having head and neck cancer recurrence. PET could have a direct impact on management by correctly selecting patients in whom a panendoscopic exploration with biopsy is indicated.
Scanning Electron Microscopy Images and Energy‐Dispersive X‐Ray Microanalysis of the Stapes in Otosclerosis and Van der Hoeve Syndrome
Authors: Vallejo‐Valdezate Luis Angel , Martín‐Gil Jesús , José‐Yacamán Manuel , Martín‐Gil Francisco Javier , Gil‐Carcedo Luis Maria 
Published: November 2003

AbstractObjective/Hypothesis The objective of this study was to evaluate the morphological and microchemical changes that affect sclerotic stapes in otospongiosis and van der Hoeve syndrome.Methods A scanning electron microscope equipped with an energy‐dispersive x‐ray analyzer was used in the experiments.Results In otosclerosis, focal lesions are poorly mineralized, with low calcium salt and reduced calcium‐to‐phosphorus (Ca/P) ratio (1.9:1). This finding correlates with a spongiotic type of lesion and indicates unstable mineralization with possible change from hydroxyapatite to calcium triphosphate. In van der Hoeve syndrome the presence of magnesium in stapes suggests osteoclastic function stimulation. The osteoclasts secrete many protons, causing an acidified microenvironment. Brushite is formed, and Ca/P ratio decreases in comparison with that of control patients (2.0:1 vs. 2.6:1).
Vestibular and Cochlear Ototoxicity of Topical Antiseptics Assessed by Evoked Potentials
Authors: Perez Ronen , Freeman Sharon , Sohmer Haim , Sichel Jean‐Yves 
Published: November 2003

AbstractObjectives/Hypothesis To evaluate and compare the effect of chlorhexidine gluconate, povidone‐iodine, and alcohol—three antiseptics used before ear surgery—on the function of the vestibular and cochlear parts of the sand rat's inner ear. The assessment of damage is based on the recording of vestibular evoked potentials (VsEPs) and auditory brainstem response (ABR).Study Design Prospective controlled animal study.Methods Fat sand rats were randomly assigned to five different groups, each receiving topical application of a different agent: saline (control), gentamicin (ototoxic control), chlorhexidine, povidone‐iodine, and alcohol. Right‐side total labyrinthectomy was performed, and a polyethylene tube was inserted into the left (contralateral) middle ear. After baseline recordings were taken of VsEPs and ABR, each animal received five consecutive daily applications of the specific agent into the left middle ear. Three days after the fifth application, evoked potential recordings (VsEPs and ABRs) were repeated and compared with baseline measurements.Results Administration of saline affected neither VsEPs nor ABR. In contrast, as expected, neither of these responses could be recorded after gentamicin application. After application of chlorhexidine all waves disappeared in all sand rats. Alcohol caused the waves to disappear in some of the animals only. Povidone‐iodine did not affect VsEP recordings and had only a small effect on ABR.Conclusions Chlorhexidine and alcohol had a clear toxic effect on the vestibular and cochlear function of the inner ear of the sand rat, whereas povidone‐iodine did not. Thus, taking into consideration that this is an animal study, it appears that povidone‐iodine might be preferable to the other agents tested in disinfecting ears with a perforated tympanic membrane.