bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Carotid ‘Blowout’ With Endovascular Stent Grafts
Authors: Warren Frank M. , Cohen James I. , Nesbit Gary M. , Barnwell Stanley L. , Wax Mark K. , Andersen Peter E. 
Published: November 2003

AbstractObjectives/Hypothesis Since 1992, endovascular techniques for vascular occlusion and stenting have evolved significantly. Endovascular occlusion of the carotid artery has been used in the management of carotid “blowout.” Although it seems logical to expand this application to the use of arterial stents to repair rather than occlude the artery when cerebral cross‐circulation is inadequate, concerns remain regarding the placement of a foreign body in a contaminated field. The purpose of the present report is to describe our experience with endovascular stents for control of carotid hemorrhage.Study Design Retrospective case review.Methods Retrospective review of three cases of acute or threatened carotid hemorrhage managed with endovascular stent placement.Results Two patients presented with acute carotid blowout, and one patient with a probable sentinel bleed. All patients previously had been heavily treated with surgery and irradiation: Two had developed pharyngocutaneous fistulas, and one had an open wound filled with tumor that surrounded the carotid artery. All were thought to be at significant risk for stroke if the carotid artery was occluded. In all three patients, stent placement resolved the acute hemorrhage. Mean duration of follow‐up was 8.3 months. In two patients, the stent became exposed, ultimately thrombosed or extruded, or both. The third patient had no residual sequelae of stenting but died 3 months later.Conclusion When an unacceptable risk of cardiovascular accident makes occlusion unwise, acute carotid hemorrhage can be successfully managed with directed placement of endovascular stents, but the long‐term sequelae of placing these foreign bodies in a field with ongoing contamination make this a temporizing rather than permanent measure for use while more definitive long‐term solutions are pursued.
Medical Malpractice and Cancer of the Larynx
Authors: Lydiatt Daniel D. 
Published: November 2003

AbstractObjective To analyze the frequency, clinical characteristics, and legal outcomes of malpractice litigation initiated by patients with cancer of the larynx.Study Design Retrospective review of 23 jury verdict reports from 11 states.Method Jury verdict reviews from 1976 to 1997 were obtained from a computerized legal database compiled from all state and federal civil court decisions. Reviews compile pertinent data on defendants, plaintiffs, verdict outcomes, indemnity payments, allegations of wrongdoing, and provide case summaries.Results Delays in diagnosis were alleged in 19 of 23 (83%) suits. Hoarseness was present in 10 of 19 (53%), a neck mass in 3 of 19 (16%), and no biopsy was taken in 11 of 19 (58%) of those delayed. Mean age was 47 years, with a peak incidence in the general population of 70 to 74 years. Laryngectomy was alleged to be a result or complication of delay in 12 of 19 (63%). Over half of the patients delayed received compensation, and over half of the defendants were in general practice. Outcome was poor with a 35% mortality and a total of 47% either dead of disease or alive with disease. Complications, incorrect diagnosis, and informed consent did not play a significant role in initiating litigation.Conclusions The delayed diagnosis of cancer of the larynx associated with litigation is frequently seen in younger patients presenting with hoarseness or neck masses. These patients frequently have poor outcomes. Patients with symptoms of cancer of the larynx must be aggressively evaluated regardless of age. Risk management goals to prevent delays in diagnosis may help prevent subsequent litigation.
Augmentation of Vestibular Evoked Myogenic Potentials: An Indication for Distended Saccular Hydrops
Authors: Young Yi‐Ho , Wu Chen‐Chi , Wu Chih‐Hsiu 
Published: November 2003

AbstractObjective/Hypothesis Vestibular evoked myogenic potential (VEMP) testing has become a well‐established test to explore the sacculo‐collic pathways in human. The aim of the present study is to establish a clinical indication for saccular hydrops by VEMP testing.Study Design Prospective study.Methods Ten patients (three men and seven women) with Meniere's disease and 10 patients (four men and six women) with sudden deafness were admitted and given pure‐tone audiometry and VEMP testing daily. Interaural amplitude difference over the sum of amplitudes of both ears was measured, and when the ratio exceeded 0.36, the test result was coined “augmented VEMP.”Results During admission, three hydropic ears presented with augmented VEMP test results, with increased interaural amplitude difference ratio (mean difference ratio, 0.40 ± 0.03). Seven hydropic ears had steady VEMP test results, with a mean interaural amplitude difference ratio of 0.15 ± 0.07. Compared with the normal control ears, all had steady VEMP test results, with a mean interaural amplitude difference ratio of 0.14 ± 0.11, which is significantly different from the hydropic ears with augmented VEMP test results (P <.05). In another 10 patients with sudden deafness, all had positive steady VEMP test results, with their mean interaural amplitude difference ratio of 0.14 ± 0.12, which is similar to that in the control ears.Conclusions Augmented VEMP test results are an indication of distended saccular hydrops, whose distended wall is in contact with the footplate. VEMP testing may be beneficial in differentiating the initial stage of Meniere's disease and sudden deafness.
Clinical Presentation of Allergic Fungal Sinusitis in Children
Authors: McClay John E. , Marple Brad , Kapadia Lav , Biavati Michael J. , Nussenbaum Brian , Newcomer Mark , Manning Scott , Booth Tim , Schwade Nathan 
Published: November 2003

AbstractObjective To compare the differences in the clinical and radiographic presentation of allergic fungal sinusitis in children and adults.Study Design Retrospective chart and computed tomography review.Methods The settings included a tertiary care children's hospital, adult academic private hospital, and academic affiliated county hospital. All patients with documented allergic fungal sinusitis who underwent computed tomography evaluation and had surgical treatment of their disease from 1988 to 1999 were included in the study. In total, 151 patients aged 5 to 75 years; 44 of these patients were less than or equal to 17 years of age (children) and 107 were greater than 17 years of age (adults). Main outcome measures included 1) the presence of obvious bony facial abnormalities on presentation, 2) bilateral or unilateral sinus disease on presentation, 3) the presence of asymmetrical disease on presentation, 4) the presence of bony extension on computed tomography scan, and 5) type of fungus present.Results Fifteen of 36 (42%) pediatric patients and 10 of 103 (10%) adult patients had obvious alteration of their facial skeleton (proptosis, telecanthus, or malar flattening) on presentation (P <.05). Proptosis was the most common facial abnormality in both groups and was seen more often in children (8 of 36 [22%]) than in adults (9 of 103 [9%]) (P <.05). Twenty‐eight of 40 (70%) pediatric patients and 37 of 100 (37%) adult patients presented with unilateral sinus disease (P <.05). Thirty‐five of 40 (88%) pediatric patients and 58 of 100 (58%) adults presented with asymmetrical disease (P <.05). Computed tomography scans showed that 10 of 40 (25%) pediatric patients and 23 of 100 (23%) adult patients had bony erosion with extension of disease into surrounding structures (P >.05). Cultures from both adults and children showed mainly Bipolaris and Curvilaria species in equal amounts (P >.05). Adults had a greater incidence of Aspergillus species.Conclusions Presentation in pediatric patients with allergic fungal sinusitis is different from that in adults, with children having obvious abnormalities of their facial skeleton, unilateral sinus disease, and asymmetrical disease more often. Findings on computed tomography scan show an equal amount of bony erosion with extension of disease. The types of fungus cultured in the sinus cavities are similar in both groups.
Human Leukocyte Antigens and Prognosis in Patients With Head and Neck Cancer: Results of a Prospective Follow‐up Study
Authors: Tisch M. , Kyrberg H. , Weidauer H. , Mytilineos J. , Conradt C. , Opelz G. , Maier H. 
Published: November 2003

AbstractBackground Prognostic information is essential for optimal treatment of patients with head and neck cancer. We studied the relationship of class I and class II human leukocyte antigens (HLA) on prognosis in patients with head and neck cancer.Methods HLA‐A, ‐B, ‐C and ‐DR antigens were determined in 209 patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. The patients were subjected to follow‐up investigations for a period of 5 years.Results Five‐year survival rates in relation to tumor stage varied between 86% for stage I tumors and 28% for stage IV tumors (P <.0001, log‐rank trend test). The HLA‐A11 antigen showed a significant negative correlation with survival. While the 5‐year survival of 124 HLA‐A11‐negative patients was 58%, none of the 17 HLA‐A11‐positive patients survived 5 years (P = .0002). A significant negative correlation with survival was also observed for HLA‐DR6. While the 5‐year survival rate of 106 HLA‐DR6‐negative patients was 60%, it was only 40% in 35 HLA‐DR6‐positive patients (P = .0313).Conclusions If the findings of our study can be confirmed, HLA‐A11 and HLA‐DR6 might become clinically important supplemental prognostic markers in head and neck cancer.
Treatment of Benign Positional Vertigo Using the Semont Maneuver: Efficacy in Patients Presenting Without Nystagmus
Authors: Haynes David S. , Resser John R. , Labadie Robert F. , Girasole Christopher R. , Kovach Bradley T. , Scheker Luis E. , Walker Donald C. 
Published: November 2003

AbstractObjective To evaluate and compare the efficacy of the Semont liberatory maneuver on “objective” benign paroxysmal positional vertigo (BPPV) defined as vertigo with geotropic nystagmus in Dix‐Hallpike positioning versus “subjective” BPPV defined as vertigo without nystagmus in Dix‐Hallpike positioning.Study Design Retrospective chart review.Methods One hundred sixty‐two patients with positional vertigo during Dix‐ Hallpike positioning were identified. Patients were evaluated for the presence or absence of nystagmus. All patients underwent the Semont liberatory maneuver. The patient's condition at follow‐up was documented at 3 weeks as complete, partial, or failure. Repeated procedures were performed if necessary.Results There were 127 cases of objective BPPV and 35 cases of subjective BPPV. Overall, 90% of all patients tested had significant improvement of their vertigo after 1.49 maneuvers on average. Improvement was seen in 91% of patients with objective BPPV after 1.59 maneuvers on average, compared with 86% in subjective BPPV after 1.13 maneuvers on average (χ2 test, not significant [P = .5]). Patients with a history of traumatic origin or cause had an overall success rate of 81% compared with 92% for nontraumatic causes or origins (χ2 test, not significant [P = .1]). Recurrences were seen in 29% of patients after a successful initial maneuver; however, 96% of these patients responded to further maneuvers. Four patients with persistent symptoms after conservative management underwent posterior semicircular canal occlusion with resolution of symptoms.Conclusion The Semont liberatory maneuver provides relief of vertigo in patients with positional vertigo, even in patients without objective nystagmus.
Antiangiogenic and Chemopreventive Activities of Celecoxib in Oral Carcinoma Cell
Authors: Wang Zhi , Fuentes Cesar F. , Shapshay Stanley M. 
Published: November 2003

AbstractObjectives Chemoprevention is a promising strategy to inhibit carcinoma before invasive tumors develop, but a new molecular target is desirable. Celecoxib is a newly developed cyclo‐oxygenase (COX)‐2 inhibitor with significantly less toxicity. The study was conducted to determine whether celecoxib is effective and safe in prevention of oral cancer. The antiangiogenic activity of celecoxib was studied to explore the potential mechanism involved.Study Design Randomized animal study.Methods The study consisted of two phases. In the phase 1, 10 mice were used to determine the efficacy and safety of celecoxib with intradermal inoculation with oral carcinoma cells. The 10 mice were equally divided into two groups 5 mice (30 inoculated sites) in each group to receive 1,500 parts per million (ppm) celecoxib mixed in with the diet or to eat a normal diet, respectively, for 21 days. In phase 2, 10 more mice were inoculated to determine the effect of celecoxib on angiogenesis. Five mice received 3,000 ppm celecoxib in the diet, with the other five mice as control animals. The antiangiogenic activity was evaluated by comparing the density of newly growing microvessels after the inoculation.Results The results indicated that celecoxib significantly delayed cell growth and reduced tumor volume. There was statistical significance in the quantity of new vasculature in the tumor sites between the two groups. No toxic effect was found by means of measurement of body weight loss and microscopic dissection of organs.Conclusions The study provided the first evidence to show the chemopreventive efficacy of celecoxib on oral cancer in a nude mouse model. Clinical trials are warranted to determine the efficacy in humans.
Basic Fibroblast Growth Factor in Human Saliva Decreases With Aging
Authors: Westermark Anders , Pyykkö Ilmari , Magnusson Mikael , Ishizaki Hisayoshi , Jäntti Pirkko , van Setten Gysbert 
Published: November 2003

AbstractObjective Basic fibroblast growth factor (bFGF) has significant properties in wound healing and tissue repair and is suggested to be of importance for the maintenance of mucosal integrity in the upper digestive tract. The purpose of the present study was to identify any age‐dependent variations in the concentration of bFGF in human saliva.Study Design Non‐prospective, cross‐sectional pilot study.Methods The study was based on findings from 182 healthy volunteers with ages ranging from 4 to 97 years. Mixed saliva samples were obtained by drooling. The saliva concentration of bFGF was determined with a commercially available enzyme‐linked immunosorbent assay kit.Results The mean saliva concentration of bFGF was 0.41 pg/mL with no gender differences. In persons aged 4 to19 years, the mean concentration was 0.72 pg/mL; in those aged 20 to 65 years, 0.33 pg/mL; and in those aged 66 to 97 years, 0.005 pg/mL. These age‐dependent differences were highly significant. In the youngest group the saliva concentration of bFGF varied more than in the other groups.Conclusions The saliva concentration of bFGF varies with individual age, with the highest levels among young individuals, even levels during a mature phase of life, and low levels toward the end of the life cycle. This strongly suggests a physiological implication of bFGF in saliva.
A Preliminary Report on Micronized AlloDerm Injection Laryngoplasty
Authors: Pearl Adam W. , Woo Peak , Ostrowski Rosemary , Mojica Jackie , Mandell David L. , Costantino Peter 
Published: November 2003

AbstractObjectives To report the preliminary data of voice and quality‐of‐life improvement after micronized AlloDerm injection laryngoplasty in patients with unilateral vocal cord paralysis.Study Design A prospective study was conducted in patients with unilateral vocal cord paralysis who underwent injection laryngoplasty with micronized AlloDerm.Methods Preoperative and postoperative patient evaluation consisted of videostrobolaryngoscopy, computer voice analysis, airflow, and voice handicap index (VHI) assessment. All injections were conducted with the patient under general anesthesia using the Storz injector system and a 22‐gauge spinal needle.Results Fourteen patients received injection with an average amount of 0.641 mL. Twelve patients were available for evaluation. Initial results at 4 weeks (n = 12) showed significant increase in habitual phonation time from 3.84 to 6.72 seconds (P <.01) and a decrease in airflow from 0.616 to 0.295 L/s (P <.01). The VHI rating improved from 62.8 to 37.5 (P <.01). Jitter and shimmer also improved significantly (P <.05). Stroboscopic findings showed complete closure of glottic gap in 10 patients with excellent return of mucosal wave on the injected side. The mucosal wave return after injection was rapid with little evidence of tissue reaction. Postoperative follow‐up at 3 months (n = 8) demonstrated slight resorption of the material, but sustained excellent voice was noted in 87.5%. Minimal morbidity and tissue reaction were noted.Conclusions Micronized AlloDerm appears to be a safe new material that is suitable for injection laryngoplasty. Long‐term results are pending.
The Reliability of the Assessment of Endoscopic Laryngeal Findings Associated With Laryngopharyngeal Reflux Disease
Authors: Branski Ryan C. , Bhattacharyya Neil , Shapiro Jo 
Published: November 2003

AbstractObjective To determine the reliability of the assessment of laryngoscopic findings potentially associated with laryngopharyngeal reflux disease (LPRD).Study Design Prospective randomized blinded study.Methods One hundred twenty video segments of rigid fiberoptic laryngeal examinations were prospectively analyzed by five otolaryngologists blinded to patient information and were scored according to several variables potentially associated with LPRD. Separate assessments of the degree of erythema and degree of edema were scored on a five‐point scale for the anterior commissure, membranous vocal fold, and interarytenoid region. Similarly, interarytenoid pachydermia, likelihood of LPRD involvement, and severity of LPRD findings were assessed. For each of these scored physical findings, inter‐rater and intrarater reliabilities were determined.Results The inter‐rater reliabilities of the laryngoscopic findings associated with LPRD were poor. Intraclass correlation coefficients were 0.161 and 0.461 for edema of the arytenoids and membranous vocal folds, respectively (P <.001). Intraclass correlation coefficients were 0.181 and 0.369 for erythema of the arytenoids and membranous vocal folds, respectively (P <.001). Raters demonstrated poor agreement as to the severity of LPRD findings (intraclass correlation coefficient, 0.265) and the likelihood of an LPRD component for dysphonia (intraclass correlation coefficient, 0.248). Similarly, intrarater reliability was extremely variable for the various physical findings, with Kendall correlation coefficients ranging from −0.121 to 0.837.Conclusions Accurate clinical assessment of laryngeal involvement with LPRD is likely to be difficult because laryngeal physical findings cannot be reliably determined from clinician to clinician. Such variability makes the precise laryngoscopic diagnosis of LPRD highly subjective.
Angled Endoscopic Laryngeal Surgery: A New Technique for Diagnosis, Surgery, and CO2 Laser Application
Authors: Morgado Plínio Ferreira , Pontes Paulo A. L. 
Published: November 2003

AbstractObjective To present the development and application of a new technique to perform cold and laser laryngeal surgery.Study Design A prospective study of 11 patients submitted for endoscopic laryngeal surgery.Methods The technique used an endoscope with a 45° upward curve of its distal end; a set of angled instruments including an intraoral retractor, scissors, and forceps; and a surgical CO2 laser microtip. Eleven patients with laryngeal diseases and an indication for microsurgery underwent angled endoscopic laryngeal surgery successfully. Four patients underwent laser surgery. The CO2 laser was set between 0.5 and 2.0 W at normal exposure times and delivered distally through a lens composition within the angled handpiece.Results The lesions were precisely treated with minimal bleeding. The excised areas healed promptly, and no excessive scarring from laser application has been observed in a 5‐month postoperative video laryngoscopy follow‐up. No major morbidity and no worsening of the voice occurred in any of the patients. A wide‐angle view with a greater depth of field than the surgical microscope and a three‐dimensional view were obtained as a result of the use of an endoscope in this technique; visualization of undersurfaces and an unobstructed visual field have been a result of the endoscope use as well. A beam waist ranging between 200 and 350 μm was produced.Conclusions The approach described in the present study may help the laryngologist overcome some of the shortcomings and difficulties in laryngeal surgery, especially when dealing with patients in whom adverse anatomy and certain clinical conditions contraindicate microlaryngoscopy. Because of a delivery of laser waves at shorter distances from the lesions, a more precise tissue exeresis with minimal disturbances to the vocal folds might be accomplished as a result of the smaller beam waist produced. Distal delivery of laser waves also reduces the risks of stray laser beam striking nontargeted areas. Long‐term studies with a larger number of patients are necessary.
Tissue‐Engineered Cartilage on Biodegradable Macroporous Scaffolds: Cell Shape and Phenotypic Expression
Authors: Baek Chung‐Hwan , Lee Jong‐Chan , Jung Yong‐Gi , Ko Ye‐Jeung , Yoon Jun Jin , Park Tae Gwan 
Published: November 2003

AbstractObjective The purpose of the study was to establish in vitro culture of chondrocytes on biodegradable, poly(D,L‐lactic‐co‐glycolic acid) [PLGA] scaffolds.Study Design Laboratory experiment using cartilage of rat rib and biodegradable scaffolds.Methods Chondrocytes were cultured on a poly‐hydroxyethyl methacrylate (poly‐HEMA)–coated dish, proliferated, and transferred into the PLGA scaffolds. Phenotypic expression of cells was examined according to the condition of poly‐HEMA coating. Morphological, biochemical, and immunohistochemical characteristics of cells cultured within PLGA scaffolds were also examined.Results Chondrocytes cultured on a poly‐HEMA–coated dish aggregated into distinct nodules containing large clusters of spherical cells and showed cartilage‐specific phenotype, collagen type II. The results of immunostaining and reverse transcriptase–polymerase chain reaction of cells cultured within PLGA scaffolds showed cartilage‐specific morphological appearance and structural characteristics such as lacunae and expression of collagen type II.Conclusion The chondrocytes cultured on a poly‐HEMA–coated dish and PLGA scaffolds showed chondrocyte‐specific phenotypes and morphological appearance.