bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring Endoscopic Neck Surgery in a Porcine Model
Authors: Carreno Octavio J. , Wilson William R. , Nootheti Pavan K. 
Published: November 2003

AbstractObjectives: This study uses a porcine model to establish the feasibility of performing endoscopic procedures in the neck using standard techniques currently being employed in preperitoneal endoscopy in the abdomen. Study Design; It is a pilot study presented as a case series. Methods: Ten animals were subjected to anterior deep cervical fascia dissection using standard endoscopic instrumentation. Results: Balloon dissection and CO2 insufflation poses a number of problems: CO2 gas dissection into the chest, CO2 gas embolism into the venous circulation, carotid artery occlusion, and limited visualization causing increased risk of injury to adjacent structures. Conclusion: These issues need to be dealt with before such a method could be employed safely in humans. However, with further research and development, endoscopic neck surgery may someday become a reality.
Safety and Biological Efficacy of an Adeno‐Associated Virus Vector–Cystic Fibrosis Transmembrane Regulator (AAV‐CFTR) in the Cystic Fibrosis Maxillary Sinus
Authors: Wagner John A. , Messner Anna H. , Moran Mary Lynn , Daifuku Richard , Kouyama Keisuke , Desch Julie K. , Manley Sara , Norbash Alexander M. , Conrad Carol K. , Friborg Sandra , Reynolds Thomas , Guggino William B. , Moss Richard B. , Carter Barrie J. , Wine Jeffrey J. , Flotte Terence R. , Gardner Phyllis 
Published: November 2003

AbstractObjective: The host immune response and low vector efficiency have been key impediments to effective cystic fibrosis transmembrane regulator (CFTR) gene transfer for cystic fibrosis (CF). An adeno‐associated virus vector (AAV‐CFTR) was used in a phase I dose‐escalation study to transfer CFTR cDNA into respiratory epithelial cells of the maxillary sinus of 10 CF patients. Study Design: A prospective, randomized, unblinded, dose‐escalation, within‐subjects, phase I clinical trial of AAV‐CFTR was conducted. Patients: Ten patients with previous bilateral maxillary antrostomies were treated. Main Outcome Measures: Safety, gene transfer as measured by semiquantitative polymerase chain reaction (PCR), and sinus transepithelial potential difference (TEPD) were measured. Results: The highest level of gene transfer was observed in the range of 0.1–1 AAV‐CFTR vector copy per cell in biopsy specimens obtained 2 weeks after treatment. When tested, persistence was observed in one patient for 41 days and in another for 10 weeks. Dose‐dependent changes in TEPD responses to pharmacologic intervention were observed following treatments. Little or no inflammatory or immune responses were observed. Conclusion: AAV‐CFTR administration to the maxillary sinus results in successful, dose‐dependent gene transfer to the maxillary sinus and alterations in sinus TEPD suggestive of a functional effect, with little or no cytopathic or host immune response. Further study is warranted for AAV vectors as they may prove useful for CFTR gene transfer and other in vivo gene transfer therapies. A prospective, randomized, double‐blind, placebo‐controlled, within‐subjects, phase II clinical trial of the effect AAV‐CFTR on clinical recurrence of sinusitis will determine the clinical efficacy of AAV gene therapy for CF.
Analysis of HLA Antigens in Japanese Patients With Chronic Sinusitis
Authors: Takeuchi Kazuhiko , Majima Yuichi , Shimizu Takeshi , Ukai Kotaro , Sakakura Yasuo 
Published: November 2003

AbstractObjectives: Genetic factors likely play a role in the etiology of chronic sinusitis and this disease is often associated with diffuse panbronchiolitis, which is strongly associated with HLA B54 antigen. The purpose of this study is to examine whether genetic factors are involved in the pathogenesis of chronic sinusitis. Study Design: Eighty‐two Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells in plain X‐ray films. Methods: Both class I and class II HLA antigens were analyzed by conventional micro‐cytotoxicity assays in these patients and 176 healthy control subjects. Results: In class I antigens, B54 antigen significantly increased in the patient group (antigen frequency = 29.3%, relative risk = 3.23, corrected P value = .037) compared with normal control group (antigen frequency = 11.4%). For class II antigens, no antigens were significantly increased. Conclusion: These data indicate that certain genetic factors play a role in the etiology of chronic sinusitis.
Short‐term objective and long‐term subjective results of laser‐assisted uvulopalatoplasty for obstructive sleep apnea
Authors: Mickelson Samuel A. , Ahuja Anoop 
Published: November 2003

AbstractObjectives: To determine the short‐term and long‐term effects of laser‐assisted uvulopalatoplasty (LAUP) on symptoms and polysomnographic measures in patients with obstructive sleep apnea syndrome (OSAS). Study Design: Prospective assessment of outcomes after LAUP in patients with OSAS. Methods: Fifty‐nine patients with OSAS underwent LAUP, and 36 completed postoperative sleep studies. Questionnaires ranking snoring and apneic symptoms were completed by the patient and bed partner before LAUP, 6 to 12 weeks after LAUP, and in the long term (>2 years). Results: The apnea index decreased from 14.4 to 5.8 (P = .0012), respiratory disturbance index (RDI) decreased from 28.1 to 7.9 (P = .0046), and the mean lowest oxyhemoglobin saturation increased from 80.6% to 84.0% (P = .055). The RDI was reduced to 10 or less in 44.4% of patients. Subjective questionnaires showed statistically significant improvements in snoring, morning fatigue, morning headaches, daytime somnolence, and daytime psychometric measures. The symptomatic improvement persisted in the long term. Conclusions: LAUP is an effective method for the management of OSAS. We have demonstrated short‐term improvement in polysomnographic measures and short‐term and long‐term improvement in subjective measures.
Intranasal verrucous carcinoma: Relationship to inverting papilloma and human papillomavirus
Authors: Orvidas Laura J. , Lewis Jean E. , Olsen Kerry D. , Weiner Jordan S. 
Published: November 2003

AbstractObjectives: To establish the incidence, appearance, behavior, and appropriate treatment of intranasal verrucous carcinoma and determine its relationship to inverting papilloma and human papillomavirus (HPV). Study Design: Retrospective review of all cases of intranasal verrucous carcinoma seen at the Mayo Clinic from 1960 through May 1996. Methods: Retrospective chart review and data collection for age, sex, smoking history, location, association with inverting papilloma, treatment, recurrence, and follow‐up. Polymerase chain reaction (PCR) testing for the presence of HPV DNA was performed on all specimens. Results: Of the 13 patients identified, most presented with nasal obstruction (10) or a noticeable intranasal lesion (8). The maxillary sinus was the extranasal site most often involved. Five patients had verrucous cancer develop in an inverting papilloma, and one had squamous cell carcinoma with the verrucous component (a hybrid tumor). All but one patient underwent surgery as initial treatment; only one patient had preoperative radiation therapy. Surgical procedures ranged from local excision to a craniofacial resection. Follow‐up ranged from 2 months to 32 years (mean, 6.5 y). Four patients had a single recurrence and two tumors recurred a second time. No metastases developed and no one died from the tumor. In seven patients (10 specimens), DNA was successfully amplified for PCR testing, and no HPV DNA was detected. Conclusions: When verrucous tumors are discovered early, they can be treated effectively with wide local excision. In some cases, a more extensive procedure may be required. A possible role for HPV in the etiology of these tumors was not found.
Bone density measurements of the paranasal sinuses on plastinated whole‐organ sections: Anatomic data to prevent complications in endoscopic sinus surgery
Authors: Sprinzl Georg Mathias , Menzler Andreas , Eckel Hans Edmund , Sittel Christian , Koebke Juergen , Thumfart Walter Franz 
Published: November 2003

AbstractObjective/Hypothesis: Although anatomic data regarding the gross anatomy of the paranasal sinuses are available, severe complications of endonasal sinus surgery (ESS) are frequently reported. To understand and to avoid these complications, density of bony walls of the paranasal sinuses were studied in this report. Special attention was given to the analysis of the bone density in regions where minor and major complications occur in ESS. Methods: Thirty cadaver heads were embedded in epoxy resin. The plastic blocks were sectioned with a diamond‐coated wire saw into 1.0‐mm thick, parallel slices in axial, coronal, and sagittal planes for 10 specimens each. The slices were x‐rayed and scanned with a computerized image analyzing system. For each specimen the bone density in 12 regions of interest was measured. Results: Besides the macroscopic examination of the plastinated specimens, a bone density analysis based on x‐ray films is presented. Lowest bone density was found at the lateral wall of the sphenoid sinus (3.31 ± 0.99 mm aluminum [Al]); highest density was measured at the roof of the sphenoid sinus (12.91 ± 1.75 mm Al). Overall bone density in female specimens was 0.41 mm Al (mean) lower than in male specimens. Conclusions: This study is the first to use plastinated whole‐organ serial sections and bone density images for the analysis of potential complications in ESS. The illustration of regions with minor and major bone density of the paranasal sinuses and the ethmoid floor as presented in this study may help the novice sinus surgeon to minimize the risks of ESS and to avoid severe complications.
Body mass index less than 28 kg/m2 is a predictor of subjective improvement after laser‐assisted uvulopalatoplasty for snoring
Authors: Rollheim Jan , Miljeteig Harald , Osnes Terje 
Published: November 2003

AbstractObjective/Hypothesis: To investigate whether body mass index (BMI) can be used to predict subjective improvement of snoring after laser‐assisted uvulopalatoplasty (LAUP). Study Design: One hundred nineteen consecutive adult patients who had LAUP performed for socially disruptive snoring were contacted by mail 3 months after surgery and asked to complete a questionnaire with the following alternatives as to the effect of surgery on their snoring: no improvement (1); some improvement (2); moderate improvement (3); substantial improvement (4) and abolished snoring (5). Patients reporting to categories 3, 4, or 5 were referred to as responders and to categories 1 or 2 as nonresponders. Seventy patients (59%) completed the questionnaire. Methods: A one‐stage LAUP was performed with local anesthesia in an outpatient ear, nose, and throat clinic with a CO2 laser. Patients were divided into two categories with BMI above and below 28 kg/m2 at the time of surgery. Results: BMI correlated significantly with subjective postoperative improvement. (R = 0.29; P < .02; Pearson's correlation test). Odds ratio (OR) for success by BMI less than 28 kg/m2 compared to patients with BMI greater than 28 kg/m2 was 4.8 (95% confidence interval [CI]: 1.48–15.53). Conclusions: BMI is a simple, yet important predictor of subjective reduction of snoring after LAUP and should be considered before performing such surgery.
A retrospective study of contact granuloma
Authors: Ylitalo Riitta , Lindestad Per‐Åke 
Published: November 2003

AbstractObjectives: This study evaluates the clinical features of contact granuloma and compares the results of voice therapy in operated versus unoperated cases. Study Design: Retrospective review of 123 patients with contact granuloma. Thirty‐six patients had undergone one or more surgeries before phoniatric consultation. After their final operation, 33 patients had recurrence. The three patients who were cured by operation were not studied further. The course of disease in the 33 patients with recurrence was compared with that of 87 patients who did not have surgery. Methods: The hospital records were reviewed concerning age, sex, symptoms, side of granuloma, and outcome of treatment. Results: The predominant symptoms were vocal fatigue, vocal discomfort, the need for excessive throat clearing, and hoarseness. The recurrence rate after operation was 92%. Twelve months after voice therapy, 35% of the operated group and 51% of the unoperated group were cured. The patients who had surgery had almost twice as many sessions of voice therapy as the unoperated group, and their mean recovery time was 17 months, compared with 8 months for the unoperated group. Conclusions: The recurrence rate after surgery was high. Surgery may prolong the recovery time. Subjective symptoms diminished during voice therapy, but we cannot confirm that it was beneficial for the healing process.
Preoperative permanent balloon occlusion of internal carotid artery in patients with advanced head and neck squamous cell carcinoma
Authors: Adams George L. , Madison Michael , Remley Kent , Gapany Markus 
Published: November 2003

AbstractObjective/Hypothesis: To determine the value of preoperative balloon occlusion in predicting the safety of carotid artery resection in advanced recurrent head and neck squamous cell carcinoma. Study Design: Retrospective chart review of all cases undergoing planned carotid artery resection for recurrent disease at a major university hospital. Methods: If the carotid artery was encased, a nonemergent carotid artery balloon test occlusion was performed for 30 minutes. If the patient tolerated this, he or she underwent permanent carotid artery occlusion. Results: Twenty‐three patients were prospectively evaluated for resection. Three underwent emergent carotid artery ligation. Twenty others underwent nonemergent carotid artery test occlusion. Of these, 5 patients failed preoperative carotid artery balloon occlusion and 15 patients successfully underwent permanent carotid balloon occlusion. Although eight of these patients died of recurrent disease in less than 1 year, seven patients survived more than 1 year with two patients surviving more than 2 years. Conclusions: Preoperative carotid balloon occlusion predicted patients who could tolerate permanent occlusion. All patients eventually developed recurrent disease, but in 14 of the 15 patients, no hemorrhages occurred.
Upper neck (level II) dissection for N0 neck supraglottic carcinoma
Authors: Tu Gui‐Yi 
Published: November 2003

AbstractObjectives: Elective neck dissection for the N0 neck in head and neck surgery is still controversial. This prospective nonrandomized study of N0 supraglottic carcinoma was designed to find an appropriate method of neck management. Study Design: Anatomical studies show that the first echelon of lymphatic drainage from the supraglottic larynx is toward the upper jugular nodes (level II). An upper neck dissection (UND) was applied and all the lymph nodes were sent for frozen section. If the subclinical metastasis was found, a modified neck dissection was performed. If the nodes harbored no foci of cancer, the patients were observed after surgery on the supraglottic lesions. Methods: Patient records of 142 patients with supraglottic laryngeal cancer (T1–4N0M0) were reviewed, with special attention paid to neck recurrences and survival rates. The cases were treated between 1976 and 1990 and all were observed for at least 5 years after the operation or until the time of death. Results: The UND specimens of 142 patients were negative for metastasis. The 5‐year survival rate for this group after surgery was 80.8%, according to the life table analysis. Fifteen of the 142 patients (10.6%) had neck recurrences during the period of observation within 5 years. The recurrence rate of this series with limited dissection on the neck was comparable with those reported in the literature after neck dissection, either radical or modified. Conclusions: There is no need for a comprehensive neck dissection for N0 supraglottic laryngeal cancer. A selective neck dissection such as UND (level II) or a supraomohyoid neck dissection (sparing the submandibular region) of level II and III will serve the purpose of radical neck treatment for the supraglottic cancer.
Hearing Preservation in Microvascular Decompression for Trigeminal Neuralgia
Authors: Rizvi Syed S. , Goyal Ravi N. , Calder H. B. 
Published: November 2003

AbstractObjective/Hypothesis: Sensorineural hearing loss is a disturbing complication of microvascular decompression (MVD) for trigeminal neuralgia with an incidence of 1% to 23.8%. Cerebellar retraction with increasing I‐V interpeak latency (IPL) during intraoperative brainstem auditory evoked potentials (BAEP) has been identified as the chief cause of acoustic injury. This study was designed to eliminate cerebellar retraction by a modification of the standard suboccipital craniectomy.Study Design: Nine consecutive patients undergoing surgery for trigeminal neuralgia were prospectively selected for this study between 1994 and 1995.Methods: Preoperative and postoperative audiograms were obtained. Preoperative and intraoperative BAEPs were performed. The surgical modification describes initiating a partial mastoidectomy to enhance early recognition and delineation of the sigmoid and transverse sinuses crucial to maximizing the lateral extent of the craniectomy. The additional exposure gained by this technique allows for improved visualization of the brainstem without cerebellar retraction.Results: All patients were relieved of neuralgic pain. Postoperative IPL values were not significantly different from preoperative values (4.9 ± 0.6 vs. 4.7 ± 0.3 ms). Maintaining IPL of less than 1.5 ms is considered critical for preventing injury to the auditory nerve. In this study the average increase in postoperative IPL was 0.25 ms for the ipsilateral ear and 0.1 ms for the contralateral ear.Conclusions: The authors offer a surgical modification of the standard suboccipital craniectomy and furnish intraoperative neurophysiologic data to demonstrate how cerebellar compression can be eliminated and hearing preserved in MVD for trigeminal neuralgia.
Granisetron, Droperidol, and Metoclopramide for Preventing Postoperative Nausea and Vomiting After Thyroidectomy
Authors: Fujii Yoshitaka , Tanaka Hiroyoshi , Kobayashi Noriaki 
Published: November 2003

AbstractObjectives/Hypothesis: Patients undergoing thyroidectomy may be especially at risk of experiencing postoperative nausea and vomiting (PONV). This study was undertaken to compare the efficacy and safety of granisetron, droperidol, and metoclopramide for preventing PONV after thyroidectomy.Study Design: Prospective randomized, double‐blind study.Methods: One hundred twenty female patients received granisetron 40 μg/kg, droperidol 20 μg/kg, or metoclopramide 0.2 mg/kg (n = 40, each) intravenously (IV) immediately before the induction of anesthesia. A standardized general anesthetic technique was employed throughout the procedure.Results: The incidence of a complete response, that is, no PONV and no need for another rescue antiemetic during the first 3 hours (0 to 3 hours) after anesthesia was 90% with granisetron, 55% with droperidol, and 50% with metoclopramide, respectively; the corresponding incidence during the next 21 hours (3 to 24 hours) after anesthesia was 85%, 50%, and 45% (P < .05; overall Fisher's Exact probability test). No clinically important adverse events were observed in any of the groups.Conclusions: Prophylactic therapy with granisetron is superior to droperidol or metoclopramide for preventing PONV after thyroidectomy.
Incidence of vestibular schwannomas
Authors: Tos Mirko , Charabi Samih , Thomsen Jens 
Published: November 2003

AbstractObjective: To determine the incidence of vestibular schwannoma (VS) in Denmark in a period of 191/2 years. Study Design: Retrospective review of prospective registered data on all patients with VS operated on by the translabyrinthine, lateral suboccipital, or middle cranial fossa approach, as well as patients who were allocated to the “wait‐and‐scan” group. Methods: Charts were reviewed and tabulated for age, extrameatal tumor extension, and date of diagnosis. The available data were divided into three periods: June 1976 to June 1983, July 1983 to June 1990, and July 1990 to December 1995. Results: The number of newly diagnosed tumors in the first period was 278, corresponding to an incidence of 7.8 tumors/million population per year; in the second period 337, corresponding to an incidence of 9.4 tumors/million population per year; and in the third period 355, corresponding to an incidence of 12.4 tumors/million population per year. A significant increase in incidence of the newly diagnosed intracanalicular tumors in the second and third periods was observed. Conclusion: The increase in incidence of VS can probably be explained by the awareness among otolaryngologists of the diagnosis of VS and better access to computed tomography and magnetic resonance imaging scans. The observed increase in the diagnosis of the small and intrameatal tumor creates a clinical dilemma, whether to operate on tumors in this early stage or to allocate patients to the wait‐and‐scan group. This problem will still be relevant in the upcoming years, since the incidence of intrameatal and small VS is expected to increase.
Relationship between cochleovestibular disorders in hemifacial spasm and neurovascular compression
Authors: Van Hung Thai , Deguine Olivier , Esteve‐Fraysse Marie José , Bonafe Alain , Fraysse Bernard 
Published: November 2003

AbstractObjective: To investigate the evolution of cochleovestibular symptoms before, during, and after microvascular decompression (MVD) of the facial nerve in hemifacial spasm.Study Design: Prospective study in patients with hemifacial spasm. Among our 13 patients who underwent MVD of the facial nerve from 1995 to 1997, 6 had associated cochleovestibular disorders confirmed by neurotologic tests.Results: In four of these patients, a concomitant compression of the eighth and facial nerves was found at surgery. Preoperative magnetic resonance angiography studies had shown three cases of this double neurovascular compression. Intraoperative auditory brainstem response monitoring showed that interposition of Teflon between vessel and facial nerve was highly critical to the auditory function. Auditory brainstem response monitoring was used to guide the surgeon during this critical phase. Surgery improved at least one cochleovestibular symptom in each patient.Conclusions: The authors propose two pathophysiologic hypotheses. First, the concomitant facial and cochleovestibular symptoms may be due to a hyperactivity of both the facial and vestibular nuclei. According to theories about cryptogenic hemifacial spasm, the origin of this hyperactivity could be an ectopic excitation focus. However, the two nerves may have different sites of ectopic excitation. According to the second hypothesis, a pulsatile compression of the facial nerve may be transmitted to the eighth nerve. This could take place even if only the facial nerve is in contact with a vascular loop.