bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Steroids on Recovery After Uvulopalatopharyngoplasty
Authors: Williams Paul M. , Strome Marshall , Eliachar Isaac , Lavertu Pierre , Wood Benjamin G. , Vito Kenneth J. 
Published: November 2003

AbstractObjective: To determine whether perioperative systemic corticosteroid administration can reduce uvulopalatopharyngoplasty (UPPP) postoperative morbidities (e.g., pain, anorexia, sleep disturbance, mouth odor, and fatigue) or reduce narcotic analgesic usage.Study Design: A prospective, double‐blinded study with random assignment of treatment agent (placebo or corticosteroid).Methods: From 1995 to 1998, a consecutive sample of 48 adults presenting for elective UPPP surgery alone or in combination with tonsillectomy or septoplasty, or both, were enrolled. Twenty‐eight subjects completed the protocol and were equally distributed by random assignment to intramuscular (IM) and intravenous (IV) doses of placebo (saline) or corticosteroid (60 mg methylprednisolone IM and 12 mg dexamethasone IV). Acetaminophen with codeine analgesic was available to both groups as needed. Subjects recorded a diary of symptom severity scores over the first postoperative week relating to eight commonly reported morbidities (1‐4 points) and the daily quantity of narcotic consumed.Results: Statistical comparison (Wilcoxon's rank sum test) showed no significant differences between subjects treated with placebo or corticosteroid on postoperative day 1 or 7. Three subjects (21%) in each treatment group reported no postoperative use of narcotic analgesic.Conclusions: No statistically or clinically significant benefits were derived from perioperative systemic corticosteroid treatment in this sample of 28 adults treated with UPPP alone or in combination with tonsillectomy or septoplasty, or both. Some individuals tolerate post‐UPPP discomfort without a narcotic analgesic.
Role of Sensation in Swallowing Function
Authors: Bastian Robert W. , Riggs Landon C. 
Published: November 2003

AbstractObjectives: Sensation in the oral cavity and laryngopharynx has long been believed to be crucial for normal swallowing. One illustration of this belief has been intense interest in reconstruction after cancer resection using sensate tissue transfer as a means of improving swallowing function. A contrarian view is that mucosal sensation, by itself, is, in fact, relatively unimportant to swallowing function.Study Design: A prospective study was designed to test the hypothesis that normal swallow function can occur with anesthesia of the upper aerodigestive tract mucosa.Methods: Baseline (sensate) swallowing function of 13 healthy adults was assessed via video endoscopic swallow studies (VESS). Each subject was then topically anesthetized with lidocaine applied to the oral cavity, oropharynx, hypopharynx, and larynx. Swallowing was then reassessed via VESS and compared to the baseline examination to look for differences in function.Results: There was little difference in swallowing ability between sensate and anesthetized states, even though all the subjects felt that their swallowing had been profoundly disrupted after lidocaine was applied. The main difference was a small increase in the time from food administration to swallowing. A few experienced trace aspiration, which was instantly eliminated on subsequent swallows with simple coaching.Conclusion: Normal swallowing can occur spontaneously or with simple coaching even with complete anesthesia of the upper aerodigestive tract mucosa. Current beliefs about the value of sensate free flaps and the importance of sensation in swallowing in general may need refinement.
Audiologic Evaluation of Neonates With Severe Hyperbilirubinemia Using Transiently Evoked Otoacoustic Emissions and Auditory Brainstem Responses
Authors: Rhee Chung‐Ku , Park Hyun‐Min , Jang Yong‐Ju 
Published: November 2003

AbstractObjectives: To audiologically clarify the lesion site and to test the reliability of transiently evoked otoacoustic emissions (TEOAEs) in hearing screening of hyperbilirubinemic neonates.Study Design: Eleven neonates with severe hyperbilirubinemia who had exchange transfusion in the neonatal intensive care unit of an academic hospital over a 3‐year period were included in this study. They were tested with auditory brainstem response (ABR) and TEOAEs after exchange transfusion during hospitalization or at an immediate follow‐up visit after discharge. Follow‐up ABR tests were performed when infants showed significant hearing loss.Methods: ABR and TEOAE tests were performed on the 11 neonates with severe hyperbilirubinemia after exchange transfusion. Follow‐up ABR tests were carried out in 3‐month intervals in the four neonates who showed abnormal or no response on initial ABR.Results: Four neonates showed abnormal or no response and the other seven demonstrated normal response in ABR. All 11 neonates passed TEOAEs. Two neonates showed improvement in auditory function at 3‐ or 6‐month follow‐up ABR.Conclusion: The results of this study indicate that the site of lesion in hearing loss caused by hyperbilirubinemia may be at the retrocochlear location while the cochlea remains intact. TEOAEs may have limitations in evaluation of hearing in the neonates with hyperbilirubinemia.
Evaluation of Airway Obstruction Using Virtual Endoscopy
Authors: Burke Alan J. , Vining David J. , McGuirt William F. , Postma Gregory , Browne J. Dale 
Published: November 2003

AbstractObjectives: This study examines the use of virtual endoscopy (VE) in the evaluation of patients with upper airway obstruction. The utility of VE compared with actual endoscopy was investigated with respect to accuracy of diagnosis and reproduction of endoscopic images.Study Design: A random cohort of 30 patients with various causes of airway obstruction was examined.Methods: The computed tomography (CT) data were reconstructed using a proprietary VE software program, FreeFlight, blind to the actual endoscopic findings. The cause of obstruction was identified and compared with actual endoscopic findings. This included 21 patients with airway stenoses, 8 patients with laryngotracheomalacia, 3 tracheal tumors, 2 glottic webs, 5 patients with innominate artery compression, 2 tracheal granulomas, and 7 patients with impaired true vocal cord mobility.Results: Virtual endoscopic evaluation was accurate in assessing stenosis width and length of fixed airway lesions. Correlation of stenosis shape and contour between actual endoscopy and VE was excellent. The stenosis‐to‐lumen ratios were compared between VE and actual endoscopy and were found to be within 10% (SD = 8). However, virtual endoscopic evaluation could not illustrate one of the glottic webs, half of the cases of tracheomalacia, or any of the cases of impaired true vocal cord mobility.Conclusions: Virtual endoscopy was not as sensitive as actual endoscopy in detecting the cause of airway obstruction that was based on dynamic movement. However, VE was excellent for the measurement and definition of fixed airway lesions.
Patency and Flow of the Internal Jugular Vein After Functional Neck Dissection
Authors: Prim María P. , de Diego Juan I. , Fernández‐Zubillaga Amelia , García‐Raya Pilar , Madero Rosario , Gavilán Javier 
Published: November 2003

AbstractObjectives: To assess the patency and flow of the internal jugular vein after functional neck dissection.Study Design: Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997.Methods: Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography.Results: In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery.Conclusions: According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure.
Detection of Squamous Cell Carcinoma of the Oral Cavity by Imaging 5‐Aminolevulinic Acid‐Induced Protoporphyrin IX Fluorescence
Authors: Leunig Andreas , Betz Christian S. , Mehlmann Michael , Stepp Herbert , Arbogast Susanne , Grevers Gerhard , Baumgartner Reinhold 
Published: November 2003

AbstractObjectives: Early cancer detection is the best way to improve the prognosis of patients with oral cancer. Therefore this study presents quantitative fluorescence measurements and results in the visualization of cancerous oral mucosa with 5‐aminolevulinic acid (5‐ALA)‐induced protoporphyrin IX (PPIX).Methods: Time progression and type of porphyrin accumulation were analyzed in neoplastic and surrounding healthy tissue of 58 patients with a suspected cancer of the oral cavity by measuring emission spectra of 5‐ALA‐induced PPIX fluorescence. Fluorescence images in the red and green spectral range from the tumor tissue were recorded with a charge‐coupled device camera.Results: After topical application of 0.4% 5‐ALA and incubation for 1 to 2.5 hours, all patients revealed higher intensities of red fluorescence in neoplastic tissue compared with the surrounding normal tissue. Maximum contrast was reached after 1.5 hours of incubation. In 13.8% (n = 8) of the patients, additional findings like dysplasia, carcinoma in situ, primary tumor, secondary carcinomas, and tumor branches were found by means of fluorescence marking in contrast to white light examination. An evaluation of the biopsy specimens resulted in a specificity of 60% and a sensitivity of 99%.Conclusions: As a fluorescent marker, PPIX could represent a possible new diagnostic tool to detect early malignant and secondary lesions in the oral cavity. In addition, 5‐ALA‐induced PPIX fluorescence is promising as a useful intraoperative tool for determining adequate surgical margins of resection. Further investigations aim to assess this diagnostic procedure as a sensitive and clinically reliable method for patients with oral cancer.
Expression of Angiogenic Growth Factors in Paragangliomas
Authors: Jyung Robert W. , LeClair Elizabeth E. , Bernat Richard A. , Kang Thomas S. , Ung Feodor , McKenna Michael J. , Tuan Rocky S. 
Published: November 2003

AbstractObjective/Hypothesis: To determine if angiogenic growth factors including vascular endothelial growth factor (VEGF) and platelet‐derived endothelial cell growth factor (PD‐ECGF) are expressed in human paragangliomas.Study Design: A histopathologic and molecular examination of paraganglioma specimens obtained from surgical cases or retrieved from the Pathology Department of the Massachusetts Eye and Ear Infirmary.Methods: Fresh tumor or archival, paraffin‐embedded paraganglioma specimens were analyzed by immunohistochemistry, Western blotting, and ELISA.Results: Positive immunohistochemical staining for VEGF was observed in five of nine surgical specimens and in six of eight archival specimens (11/17, or 65%). PD‐ECGF immunoreactivity was detected in four of five surgical specimens and six of eight archival specimens (10/13, or 77%). The presence of PD‐ECGF was confirmed by Western blot assay and ELISA confirmed the presence of VEGF in tumor extract.Conclusions: Both VEGF and PD‐ECGF are expressed in paragangliomas and may contribute to the extreme vascularity of these tumors.
Documentation of Variations in Sinonasal Anatomy by Intraoperative Nasal Endoscopy
Authors: Joe John K. , Ho Steven Y. , Yanagisawa Eiji 
Published: November 2003

AbstractObjectives: Functional endoscopic sinus surgery (FESS) requires a thorough understanding of the variability in sinonasal anatomy. Previous reports have relied primarily on anatomic studies of cadaveric specimens or skulls, or on radiographic analysis. Relatively few comparative anatomic data have been accumulated with endoscopic examination of living patients.Study Design: Retrospective review of video recordings of 119 consecutive patients undergoing intraoperative nasal endoscopy at the time of sinonasal surgery.Methods: At the beginning of each surgical procedure, endoscopic examination of the nasal cavities was performed with 0° and 30° telescopes and recorded with a three‐chip video camera on 3/4‐inch U‐matic videotape. These video records were then reviewed with attention to variations in anatomical configuration of different sinonasal structures.Results: Data demonstrating variations in the anatomical configuration of the following structures of the lateral nasal wall are presented. Middle turbinate: typical (63%), concha bullosa (15%), sagittal cleft (6%), laterally displaced (4%), “L” shaped (3%), medially bent (3%), laterally bent (3%), medially displaced (2%), and transverse cleft (0.5%). Uncinate process: typical (85%) and medially rotated (15%). Ethmoid bulla: typical or balloon (45%), sausage‐shaped (34%), and flat (21%). Accessory ostium: round (50%), oval (46%), and kidney‐shaped (4%). Sphenoid sinus ostium: oval (42%), slit (32%), and round (26%). The classification system for the anatomical categories is illustrated with digitized images.Conclusions: This study attempts to provide statistical data regarding variations in sinonasal anatomy in living subjects. Familiarity with such anatomy is important in differentiating normal variants from pathological conditions to optimize surgical treatment of sinus disease, while avoiding complications.
Update on Intratympanic Gentamicin for Meniere's Disease
Authors: Blakley Brian W. 
Published: November 2003

AbstractObjective: To review the literature relating to intratympanic gentamicin injection therapy for Meniere's disease to detect consistencies and differences that might suggest optimal technique.Design: Retrospective literature review.Methods: Eighteen papers from the literature regarding clinical experience with intratympanic gentamicin injections for treatment of Meniere's disease were reviewed and tabulated.Results: All papers reported high success rates in treating episodic vertigo of Meniere's disease, but technique, dose, duration, and treatment philosophy varied considerably. Hearing loss was typically reported in about 30% of patients.Conclusion: No single technique of gentamicin injection has a significant medical advantage over the others. Until controlled studies indicate otherwise, nonmedical needs such as convenience and safety may be considered when choosing a technique.
Fontanelle and Uncinate Process in the Lateral Wall of the Human Nasal Cavity
Authors: Yoon Joo‐Heon , Kim Kyung‐Su , Jung Dong Hak , Kim Sung‐Shik , Koh Ki Seok , Oh Chang Seok , Kim Hee Jin , Lee Jeung‐Gweon , Chung In‐Hyuk 
Published: November 2003

AbstractObjectives: Although a complete anatomic knowledge of the fontanelle is a prerequisite to perform a surgical antrostomy opening, little is known about the boundary, shape, and size of the fontanelle. The purpose of this paper is to determine the best site for maintaining the patency of a surgical antrostomy opening by defining the anatomic boundaries, shape, and size of the fontanelle as well as its histological structure.Materials and Methods: One hundred sagittally divided heads were utilized. Mucosa overlying the lateral nasal wall was carefully removed with an operating microscope under 6× magnification. In some cases, a double mucous membrane, including the posteroinferior portion of the uncinate process, was cut as a whole and embedded in paraffin. The sections were stained with H&E.Results: The boundary of the fontanelle and the location of the natural ostium were described in detail. Eight patterns of the posteroinferior portion of the uncinate process were observed. There were three major fontanelle shapes when observed from the medial aspect to the lateral: triangular, pencil‐like, and oval. The triangular type was the most common. The anterior portion of the fontanelle was shorter than the posterior when observed medially and was wider than the posterior portion when observed inferiorly.Conclusions: The anterior portion of the fontanelle is more prone to stenosis than the posterior portion. An antrostomy in the posterior fontanelle may be more ideal for a middle meatal antrostomy of the maxillary sinus.
Early Arytenoid Adduction for Vagal Paralysis After Skull Base Surgery
Authors: Bielamowicz Steven , Gupta Ashmit , Sekhar Laligam N. 
Published: November 2003

AbstractObjectives To evaluate the efficacy of early arytenoid adduction in the management of vagal paralysis after skull base surgery.Study Design Retrospective evaluation at a tertiary care skull base center.Methods Aggressive surgical management of skull base lesions has become increasingly popular owing to advances in surgical technique and intraoperative monitoring. Temporary and permanent lower cranial neuropathies occur frequently, especially after the surgical management of lesions involving the vertebrobasilar system and the jugular foramen. An injury to the proximal vagus nerve is usually associated with dysphonia and swallowing dysfunction. An early arytenoid adduction has been employed in 26 patients with a vagal paralysis after skull base surgery. Most commonly, the neurosurgical patient underwent an arytenoid adduction under general anesthesia on postoperative day 2.Results Videostroboscopy after arytenoid adduction demonstrated 76% of patients had complete glottic closure. Of those with inadequate glottic closure, all demonstrated a well‐medialized posterior glottis with a persistent anterior glottal gap. These patients were easily treated with a secondary type I thyroplasty under local anesthesia with sedation resulting in complete glottic closure. Despite excellent voice outcomes, 66% of these patients had dysphagia requiring enteral feedings for nutritional support.Conclusions An early arytenoid adduction is an excellent medialization technique that can be performed safely in the early postoperative period under general anesthesia after skull base surgery.
Technical Modifications of the Latissimus Dorsi Pedicled Flap to Increase Versatility and Viability
Authors: Hayden Richard E. , Kirby Simon D. , Deschler Daniel G. 
Published: November 2003

AbstractObjective Describe the elevation and insetting of the pedicled latissimus dorsi musculocutaneous flap. Review history of this flap's evolution and personal series of 68 consecutive cases since 1984.Study Design Retrospective review.Setting Tertiary, referral, academic center.Methods Retrospective review of 68 consecutive patient records in which the pedicled latissimus dorsi musculocutaneous flap was used to reconstruct head and neck defects. Overall flap survival and postoperative complications were used as outcome measures.Results Thirty‐one women and 37 men underwent reconstruction with the latissimus dorsi pedicled flap between 1984 to 1998. The mean age was 61 years. Sixty‐three cases followed postoncologic ablation and 5 cases addressed traumatic tissue loss. Forty‐three patients had prior radiotherapy and 26 patients had undergone prior reconstructive surgery. The overall flap survival rate was 67/68 (98.5%), with one case of complete flap necrosis. Six cases of partial flap necrosis occurred. There were 8 other minor complications including fistula, wound dehiscence, hematoma and cerebrospinal fluid accumulation. Fifty‐six donor sites were closed primarily resulting in 2 dehiscences and 17 seromatas. Three of 12 skin grafts to the donor sites were compromised.Conclusion The excellent flap survival rate (98.5%) is the result of proper patient selection and adherence to three technical fundamentals: skin paddle design, pedicle dissection, and pedicle stabilization. The minimal donor site morbidity also demonstrated in this series supports the continued use of the latissimus dorsi pedicled flap for reconstruction of head and neck defects.
Telomerase Activity Is Upregulated in Laryngeal Squamous Cell Carcinoma
Authors: Curran Aongus J. , Gullane Patrick J. , Irish Jonathan , Macmillan Christina , Freeman Jeremy , Kamel‐Reid Suzanne 
Published: November 2003

AbstractObjective/Hypothesis The immortalizing enzyme telomerase has been linked to carcinogenesis and is being targeted as a novel molecular marker. This study investigated telomerase expression in patients with laryngeal squamous cell carcinoma and correlated telomerase activity with conventional prognostic parameters.Study Design A consecutive series of patients with laryngeal squamous cell carcinoma undergoing surgical salvage for persistent or progressive disease after failed radiation therapy.Methods Twenty patient samples of laryngeal squamous cell carcinoma and 20 adjacent histologically normal mucosal samples were assayed using the telomeric repeat amplification protocol (TRAP) method for detection of telomerase activity. The leukemic cell line, K562, acted as a positive control and the human fibroblast line, Hs21Fs, as a negative control. A sample was classified as telomerase positive when an RNase‐sensitive hexameric repeat ladder was observed. Absence of laddering was considered a negative result.Results Seventeen of 20 (85%) tumor samples and 4 of 20 (20%) adjacent histologically normal samples were telomerase positive. No statistically significant difference was observed when densitometric readings were compared by T category, tumor grade, or site (by ANOVA).Conclusions Although telomerase activity is present in laryngeal cancer, levels of activation do not correlate with conventional parameters used for prognostication. Our study indicates that the marker may be a useful adjunctive method in the diagnosis of malignancy after radiation failure.
Screening for Distant Metastases in Patients With Head and Neck Cancer
Authors: de Bree Remco , Deurloo Eline E. , Snow Gordon B. , Leemans Charles R. 
Published: November 2003

AbstractObjectives The detection of distant metastases at initial evaluation may alter the selection of therapy in patients with head and neck squamous cell carcinoma (HNSCC). In this study the value of screening for distant metastases is evaluated.Study Design Retrospective analysis.Methods The results of screening for distant metastases were retrospectively analyzed in 101 consecutive HNSCC patients with high‐risk factors who were scheduled for major surgery. All patients had computed tomography (CT) scan of the thorax, bone scintigraphy, examination of the liver by ultrasound and/or CT scan, and blood tests.Results Distant metastases were found in 17% of the patients. Patients with four or more clinical lymph node metastases or low jugular lymph node metastases had the highest incidence of distant metastases (33%). CT scan of the thorax detected in 12 patients, lung metastases; in 4, mediastinal lymph node metastases; and in 2, primary lung tumors. Bone scintigraphy detected in four patients bone metastases; in all four patients lung or mediastinal lymph node metastases were also found. Ultrasound and/or CT scan of the liver revealed one patient with metastases. Blood tests did not show any significant difference between patients with or without bone or liver metastases.Conclusions Screening in patients with three or more lymph node metastases, bilateral lymph node metastases, lymph nodes of 6 cm or larger, low jugular lymph node metastases, locoregional tumor recurrence, and second primary tumors revealed distant metastases in 10% or more. CT scan of the thorax is currently the single most important diagnostic technique for screening of distant metastases.