bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fiberoptic Endoscopic Evaluation of Swallowing in the Pediatric Population
Authors: Leder Steven B. , Karas David E. 
Published: November 2003

AbstractObjective To investigate the diagnostic and rehabilitative usefulness of routine fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric population.Study Design Prospective, consecutive, blinded.Patients and Methods Thirty pediatric inpatients from a large, urban, tertiary care teaching hospital participated. Their ages ranged from 11 days to 20 years (mean, 10 years and 4 months). In a random fashion, seven subjects were assessed with both videofluoroscopic evaluation of swallowing (VFES) and FEES and 23 subjects were assessed solely with FEES. Diagnosis of dysphagia was determined by spillage, residue, laryngeal penetration, and aspiration. Rehabilitative strategies, e.g., positioning and modification of bolus consistencies, were based on diagnostic findings.Results There was 100% agreement between the blinded diagnostic results and implementation of rehabilitative strategies for subjects randomly assigned to receive both VFES and FEES and for subjects who received solely FEES. Of the 23 subjects assessed solely with FEES, 13 of 23 (57%) exhibited normal swallowing and 10 of 23 (43%) exhibited dysphagia. The feeding recommendation for 4 of 10 subjects with dysphagia (40%) was for a non‐oral diet because of aspiration. FEES allowed for specific feeding recommendations (i.e., bolus consistency modifications, positioning, and feeding strategies) to reduce aspiration risk in 6 of 10 subjects with dysphagia (60%).Conclusion FEES can be used routinely to diagnose and treat pediatric dysphagia in the acute care setting.
Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: A Meta‐Analysis
Authors: Hegazy Hassan M. , Carrau Ricardo L. , Snyderman Carl H. , Kassam Amin , Zweig Julie 
Published: November 2003

AbstractObjectives/Hypothesis Trauma and surgery are the most common causes of cerebrospinal fluid (CSF) rhinorrhea. Surgical repair is recommended for patients with CSF leaks that do not respond to conservative measures, traumatic CSF leaks that require transcranial surgery for associated brain injuries, and iatrogenic defects that are discovered intraoperatively. The purpose of our study was to ascertain the outcome after transnasal endoscopic repair of CSF leaks and to identify factors regarding the patient, CSF fistula, and treatment that may influence the results of the repair.Methods We performed a meta‐analysis of all studies published in English between 1990 and 1999 that reported a minimum of five patients with CSF fistulae that were repaired using an endoscopic approach. We analyzed data that included type of graft and technique used during the repair, surgical complications, the use of packing, and the use of lumbar drains and antibiotics. The success rate was monitored and correlated with the other variables. The meta‐analysis database was compared with and added to a database comprising our own patients.Results Fourteen studies comprising 289 CSF fistulae met the inclusion criteria. Endoscopic repair of CSF leaks was successful in 90% (259/289) of the cases after a first attempt. Seventeen of 30 persistent leaks (52%) were closed after a second attempt. Thus ultimately 97% (276/289) of the leaks were repaired using an endoscopic approach. The success rate of repairs using any of the reported techniques and materials was high and not statistically different. The incidence of major complications such a meningitis, subdural hematoma, and intracranial abscess was less than 1% for each complication.Conclusion The endoscopic approach is highly effective and is associated with low morbidity. The literature supports the endoscopic approach using a variety of techniques and materials for the repair of CSF leaks.
Neck Dissection for Advanced Lymph Node Metastasis Before Definitive Radiotherapy for Primary Carcinoma of the Head and Neck
Authors: Smeele Ludwig E. , Leemans Charles R. , Reid Colin B.A. , Tiwari Rammohan , Snow Gordon B. 
Published: November 2003

AbstractObjective To evaluate the outcome of neck dissection for advanced metastasis and subsequent planned radiotherapy to the neck and primary tumor.Study Design Single‐center, retrospective case series.Methods From 1988 to 1998, 37 previously untreated patients were included into the study protocol. Two had a single tumor‐positive neck node and the remaining 35 had multiple tumor‐positive neck nodes (mean number, 6.0). Extranodal spread was reported in 35 cases (95%); mean nodal size was 5.7 cm (SD, 2.4 cm). Five patients (14%) were not irradiated or were irradiated with palliative intention. Of the remaining patients, 30 received irradiation of 60 Gy or more to the neck and the primary tumor (mean dose, 66.9 Gy; SD, 4.2 Gy). Cumulative survival distributions were estimated by the Kaplan‐Meier method, and differences between groups were analyzed with the log‐rank test.Results Treatment‐related mortality was observed in three patients (8%). Disease‐specific survival was 49% at 2 years and the overall locoregional control rate was 43% at 2 years. Patients with T1 to T2 primary lesions were compared with those with advanced primary disease, and the 2‐year local control rates were 76% and 47%, respectively (P = .056). The following prognostic factors were identified for distant metastasis: three or more positive nodes (P = .037), positive surgical margins in the neck dissection specimen (P = .004), and time from diagnosis until neck dissection of 23 days or more (P = .043). The influence of distant metastasis on disease‐specific survival was evident (P = .0003).Conclusion Patients with low‐T‐stage tumors have a better local control rate with this regimen and survival depends on the status of the neck.
Esthesioneuroblastoma and Sinonasal Undifferentiated Carcinoma: Impact of Histological Grading and Clinical Staging on Survival and Prognosis
Authors: Christopher Miyamoto R. , Gleich Lyon L. , Biddinger Paul W. , Gluckman Jack L. 
Published: November 2003

AbstractObjectives Hyams proposed a histological grading system for esthesioneuroblastoma in which grade I tumors have an excellent prognosis and grade IV tumors are uniformly fatal. The Hyams grading system predated advanced craniofacial techniques, extensive use of immunohistochemistry, and the recognition of sinonasal undifferentiated carcinoma (SNUC) as a distinct entity. Therefore we aimed to determine whether Hyams classification is useful in predicting outcome for esthesioneuroblastoma and SNUC.Study Design A retrospective review of cases from 1970 to 1999.Methods Twenty‐six patients (12 with esthesioneuroblastoma and 14 with SNUC) were reviewed. The Kadish clinical stage was determined, and histopathological slides were reviewed and graded using the Hyams system.Results Kadish staging was available for 26 patients (2 patients with stage A tumors; 7 with stage B; and 17 with stage C). Of the 8 evaluable patients with Kadish stage A or B tumors, 6 remained disease free for more than 2 years compared with only 5 of the 17 Kadish stage C tumors. Slides were available for Hyams grading in 21 patients (2 patients with grade I tumors; 4 with grade II; 4 with grade III; and 11 with grade IV). Of the 6 patients with Hyams grade I or II tumors, 4 remained disease free for more than 2 years compared with only 4 of the 15 patients with Hyams grade III or IV tumors. Of note, three patients with Kadish stage C tumors (two with esthesioneuroblastoma, one with SNUC) and two patients with Hyams grade IV tumors (one with esthesioneuroblastoma and one with SNUC) survived for more than 5 years.Conclusions Both the Hyams grading system and the Kadish staging system can be used as independent predictors of outcome. Although limited by small numbers, the results of this study demonstrate that patients with either advanced clinical stage or pathological grade of esthesioneuroblastoma or SNUC have poor prognosis, but that long‐term survival is possible in these patients if aggressive treatment is used.
The Aspiration‐Irrigation Maneuver
Authors: Martin Richard A. 
Published: November 2003

AbstractObjectives/Hypothesis To compare cultures obtained from the aspiration‐irrigation maneuver (AIM) with other reports and compare diagnostic and therapeutic value after AIM versus the Proetz maneuver and needle aspiration‐irrigation.Study Design Patients with radiographic evidence (mucous membrane thickness greater than 6 mm, air‐fluid levels, or complete opacification) and symptoms (nocturnal cough, fever, postnasal drainage [PND], otitis, mucopurulent discharge from the nose) of sinus disease who were referred from pediatrician and/or family physician and who otherwise would be candidates for surgery were selected to receive treatment with AIM. The study was divided into three separate groups (54 patients who were age 8 years and younger, 54 patients who were age 9 years and older, and 32 adult patients who were treated with both needle aspiration and AIM.Methods Using Bernoulli's principle and the Venturi effect, saline and a vacuum apparatus were used to capture the contents of the sinuses for culture, and results were compared with results of needle aspirate cultures.Results Children's cultures from group 1 compared favorably with the literature (Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae or a combination of these); cultures in patients age 9 years and older revealed a greater variety of bacteria, depending on chronicity of infection, and a high incidence of Staphylococcus aureus (β‐lactamase positive). There was a 66% correlation of AIM with needle aspiration.Conclusions AIM was found to be a safe, simple, painless, and inexpensive adjunct to the diagnosis and treatment of sinus disease.
Cranioplasty in Acoustic Neuroma Surgery
Authors: Wazen Jack J. , Sisti Michael , Lam Samuel M. 
Published: November 2003

AbstractObjectives To measure the incidence of postoperative headaches after retrosigmoid resections of acoustic neuromas and to evaluate the impact of cranioplasty on the prevention and management of these headaches.Study Design A prospective evaluation was performed on 30 consecutive patients who underwent a cranioplasty after retrosigmoid excision of their acoustic neuroma. The results were compared with 30 historical control patients who underwent the same procedure but did not have reconstruction with a cranioplasty. The patients were evaluated by review of office records and via telephone questionnaire.Methods One group of patients (30 patients) had no cranioplasty, and the other group of 30 patients had primary reconstruction with a titanium mesh‐acrylic cranioplasty. All 60 patients were asked to report on the duration and severity of their headaches by means of a standard questionnaire, grading their symptoms on a scale of 1 to 4. The data were subjected to χ2 and Student t test statistical analyses.Results New‐onset, postoperative headaches occurred in 27% of patients, 23% in the cranioplasty group compared with 30% in the group without cranioplasty (a difference that was not statistically significant [P = .158]). However, there was a statistically significant difference in the severity of the headaches (P < .03). The headaches in the cranioplasty group were less severe and were not disabling. There were no complications, infections, or extrusions related to the cranioplasty.Conclusions Cranioplasty has not been able to eliminate postoperative headaches. However, the use of cranioplasty has significantly decreased the severity of postoperative headaches after retrosigmoid excision of acoustic neuromas.
Prognostic Significance of p53/bcl‐2 Co‐expression in Patients With Laryngeal Squamous Cell Carcinoma
Authors: Jäckel Martin C. , Sellmann Ludger , Dorudian Mansur A. , Youssef Sumaya , Füzesi Làszlò 
Published: November 2003

AbstractObjective The p53, bcl‐2, and bax genes are known to be involved in control of cell cycle progression and regulation of apoptotic cell death. Although they are frequently altered in laryngeal squamous cell carcinoma, their clinical relevance is not yet fully understood. In the present study, individual and combined expressions of these genes were related with patient survival as well as with proliferative and apoptotic activity.Design Retrospective study.Methods Paraffin‐embedded tissue sections of 88 laryngeal squamous cell carcinomas that were diagnosed and treated between 1986 and 1996 were investigated for p53, bcl‐2, and bax protein expression by immunohistochemistry. Apoptotic cells were visualized using the nick end labeling method. To assess proliferative activity of tumors, mitotic indices were determined.Results Age of patients, advanced disease (stages III and IV), high mitotic activity, positive bcl‐2 expression, high level of p53 expression, and p53/bcl‐2 co‐expression were significantly associated with shortened overall survival in univariate analysis. In multivariate analysis, only age and p53/bcl‐2 co‐expression had independent prognostic value. Other combinations of genes, i.e., bcl‐2‐to‐bax and p53‐to‐bax ratios, were not associated with patient outcome. A significant positive correlation was found between apoptotic and mitotic activity. However, protein levels of p53, bcl‐2, and bax were unrelated to proliferation and apoptosis of tumor cells.Conclusions The co‐expression of p53/bcl‐2 was an independent predictor of patient outcome and had a prognostic value superior to both parameters considered separately. The rate of apoptosis mainly counterbalanced proliferative activity but appeared not to be significantly influenced by p53, bcl‐2, and bax.
Effectiveness of the Particle Repositioning Maneuver in Subtypes of Benign Paroxysmal Positional Vertigo
Authors: O'Reilly Robert C. , Elford Brian , Slater Robert 
Published: November 2003

AbstractObjectives To assess the efficacy of the particle repositioning maneuver (PRM) in patients presenting with idiopathic benign paroxysmal positional vertigo (BPPV) compared with those with evidence of additional peripheral vestibulopathies.Methods Retrospective administration of the Dizziness Handicap Inventory (DHI) to 41 patients with primary BPPV and 31 patients with secondary BPPV to subjectively evaluate their symptoms before and after the PRM.Results Both groups indicated a marked improvement in symptoms after the PRM. Only two patients reported an increase in their symptoms after the PRM and both had secondary BPPV.Conclusions The PRM was found to be highly effective in all forms of BPPV, but careful history and judicious testing may identify patients requiring additional intervention to relieve their symptoms.
Nasal Alar Necrosis
Authors: Rachel John D. , Mathog Robert H. 
Published: November 2003

AbstractObjective To describe an unrecognized clinical entity, nasal alar necrosis, and propose recommendations regarding the diagnosis, pathophysiology, and management of these cases.Study Design Retrospective review of four patients with this condition.Methods Histories, treatments, and outcomes were evaluated using office and hospital chart data.Results We noted that three patients had prior trauma or surgery, other than to the nose, in the head and neck region. All four patients had comorbidities such as diabetes, hypothyroidism, depression, or tobacco abuse. Three patients had sensory deficits over the distribution of the maxillary nerve, and three volunteered that they had a habit of picking the crusted wound. Two patients improved over several months with aggressive wound care. One patient refused treatment and another underwent successful reconstruction.Conclusions After malignant and granulomatous diseases were ruled out, our evaluations suggested that the pathogenesis was multifactorial including several factors alone or in combination, such as, hypoesthesia, self‐mutilation, and an inadequate blood supply. Deficits in vascularity and sensory innervation must be considered as potential obstacles in reconstruction. Psychological problems causing factitious wounding may complicate therapeutic interventions.
Salvage Surgery for Recurrent Nasopharyngeal Carcinoma
Authors: Shu Chih‐Hung , Cheng Henrich , Lirng Jiing‐Feng , Chang Feng‐Chi , Chao Yee , Chi Kwan‐Hwa , Yen Sang‐Hue 
Published: November 2003

AbstractObjective To evaluate the efficacy of salvage surgery in the treatment of recurrent nasopharyngeal carcinoma (NPC) at the primary site.Study Design A retrospective investigation of the outcome of salvage surgery for 28 patients with recurrent NPC after definite radiation therapy.Methods The nasopharynx was approached anteroposteriorly by the transmaxillary approach (maxillary swing, maxillectomy) or inferior approach (midline mandibulotomy or median labiomandibular glossotomy), or laterally by modified facial translocation or transpterygoid approach; intentional ligation of the internal carotid artery was performed after establishment of extracranial‐intracranial (EC‐IC) bypass in one patient; postoperative irradiation was given to the patients with positive pathological margins.Results Nine patients lived without disease for 20 to 93 months (mean interval, 52 mo) after surgery; among them, eight patients had T1 tumors that were resected totally by surgery via anteroposterior approaches and the other patient had postoperative irradiation to control the disease. Seven patients had local recurrence 8 to 21 months after treatment. Four patients developed distant metastases, including one patient with a T2b tumor that was totally resected through modified facial translocation approach with ligation of internal carotid artery. Eight patients died of other causes; internal carotid artery blowout was the cause of death in four of these eight patients.Conclusions In most cases of recurrence, T1 nasopharyngeal tumors can be resected totally by anteroposterior approaches; for T2 or larger tumors, postoperative irradiation is usually necessary. Otherwise, facial translocation offers a better chance to completely resect the tumors. Internal carotid artery is better ligated if patients have received greater than 70 Gy irradiation or if the artery must be exposed during the surgery. We suggest that EC‐IC bypass be used to avoid the possible complications (or cerebral ischemic stroke) caused by ligation of internal carotid artery. The transmaxillary approach is favored in the management of nasopharyngeal tumor recurrence with nasal cavity extension, and midline mandibulotomy is more suitable for resection of posterior margin of nasopharyngeal tumor recurrence. Facial translocation offers the widest operative field and is the most versatile approach for radical resection of nasopharyngeal tumor recurrence, but the surgeon should be skilled in the management of the facial nerves to reduce morbidity.
Non‐Hodgkin's Lymphoma of the Sinonasal Tract
Authors: Quraishi M. S. , Bessell E. M. , Clark D. , Jones N. S. , Bradley P. J. 
Published: November 2003

AbstractObjectives A review of the presenting features, management, and outcome of extranodal non‐Hodgkin's lymphoma (NHL) of the sinonasal tract during a 10‐year period in Nottingham, UK.Study Design Twenty‐four patients received a diagnosis of extranodal NHL of the nasal cavity, paranasal sinuses, or both, from 1987 to 1996. The patients' data were collected prospectively in the Nottinghamshire Lymphoma Registry.Methods All patients' records and their histology were reviewed along with data entered into the Nottinghamshire Lymphoma Registry, noting the patient's age, sex, presenting symptoms and signs, staging, computed tomography findings, histology, treatment, complications, and outcome.Results The 24 patients with extranodal NHL of the sinonasal tract represent 1.63% of the 1,457 patients with NHL seen in the 10‐year period of this study in Nottinghamshire. The median age was 72 years (range, 42–96 y), with a male dominance (male‐to‐female ratio: 15:9). Most patients presented with nonspecific nasal symptoms such as nasal obstruction and epistaxis. Only one patient had a relapse involving the central nervous system after treatment. All the histology was reviewed and showed a predominance of large B‐cell subtype (21 patients). The overall 5‐year survival was 40% (95% CI, 19%–61%) and 33% for 10‐year (95% CI, 12%–54%). The cause‐specific survival at 5 years and 10 years was 62% (95% CI, 39%–86%).Conclusions A high degree of suspicion and appropriate use of computed tomography scans and surgical biopsy are the keys to the management of NHL.
Connexin26 Mutations Associated With Nonsyndromic Hearing Loss
Authors: Park Hong‐Joon , Houn Hahn Si , Chun Young‐Myoung , Park Keehyun , Kim Hee‐Nam 
Published: November 2003

AbstractObjective Mutations in the GJB2 gene are a major cause of autosomal recessive and sporadic types of congenital deafness. The 35delG mutation is the most frequent type of mutation in white populations. However, several other forms were reported, such as 167delT among Ashkenazi Jews and R143W in Africans. The present study investigated the mutations of connexin26 (Cx26) found in patients with nonsyndromic hearing loss (NSHL) and newborns in the Korean population.Study Design The sequencing data for 147 unrelated patients with congenital NSHL and 100 audiologically screened newborns were included in this prospective study.Methods Genomic DNA samples from all patients and newborns were sequenced in both directions for detection of Cx26 mutations.Results Thirteen different types of mutations were found in the patients and newborns. V27I and E114G are the popular types of polymorphic mutations in both groups. 235delC—deletion and frameshift—was detected in patients (15 in 294 alleles) and newborns (1 in 200 alleles). 35delG was rarely found in both group. In addition to above mutations, several types of mutations—S85P, K41R, S72C, V84A, 176‐191del, and 299‐300del—were identified. The family study of the 235delC showed a typical autosomal recessive trait of NSHL in their audiological evaluation of hearing threshold.Conclusion The frequency of 235delC allele showed much higher in the patients (5%) than in newborns (0.5%). We rarely found 35delC mutant in both groups. These results suggest that the different types of Cx26 mutations affect autosomal recessive NSHL according to ethnic background.
Correlation of Findings on Direct Laryngoscopy and Bronchoscopy With Presence of Extraesophageal Reflux Disease
Authors: Carr Michele M. , Nguyen Anthony , Poje Christopher , Pizzuto Michael , Nagy Mark , Brodsky Linda 
Published: November 2003

AbstractObjective To determine the correlation between findings at direct laryngoscopy and bronchoscopy and presence of extraesophageal reflux disease (EERD).Study Design Retrospective chart reviewMethods Operative notes of 155 children undergoing direct laryngoscopy and bronchoscopy between 1996 and 1999 for airway symptoms for whom there was a suspicion of EERD were examined. Gastroesophageal reflux disease (GERD) was considered present if at least one test was positive (including upper GI series, pH probe, gastric scintiscan, or esophageal biopsy).Results A total of 130 (84%) patients had GERD diagnosed. Ninety percent had at least one laryngotracheal abnormality: 83% had an abnormal larynx and 66% had an abnormal trachea. Laryngeal abnormalities in GERD included postglottic edema, 69%; arytenoid edema, 30%; large lingual tonsil, 16%; vocal fold edema, 12%; vocal fold nodule, 12%; ventricular obliteration, 5%; and hypopharyngeal cobblestoning, 3%. Tracheobronchial abnormalities in GERD included tracheal cobblestoning, 33%; blunting of carina, 12.5%; subglottic stenosis, 11%; increased secretions, 11%; and generalized edema or erythema, 5%. The best sensitivity or specificity was obtained by combining postglottic edema, arytenoid edema, and vocal fold edema, resulting in a sensitivity of 75% and a specificity of 67%. Positive predictive value was 100% for the combination of postglottic edema and any vocal fold or ventricular abnormality.Conclusion Laryngoscopy and bronchoscopy can reveal findings with a high positive predictive value for the presence of GERD. Endoscopy of the upper airway in children with clinical signs and symptoms of EERD is a promising tool for diagnosis.