bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lateral Thigh Free Flap for Head and Neck Reconstruction
Authors: Hayden Richard E. , Deschler Daniel G. 
Published: November 2003

AbstractObjectives: To present the technique of lateral thigh free flap reconstruction in the head and neck and review the use of this procedure in 58 head and neck defect reconstructions.Study Design: Retrospective review in the setting of a tertiary, referral, and academic center.Methods: Retrospective review of patient records in cases of lateral thigh free flap reconstruction for head and neck defects. Records were reviewed for patient age, gender, pathologic findings, type of reconstruction (pharyngoesophageal, glossectomy, oropharyngeal, or external soft tissue defects), recipient and donor‐site complications, and flap failure.Results: Fifty‐eight patients underwent lateral thigh flap reconstruction from 1984 to 1997. Patient age ranged from 10 to 76 years. Thirty‐nine patients were men, and 19 were women. Forty‐three flaps were used for pharyngoesophageal reconstruction, nine for glossectomy defects, two for oropharyngeal defects, and four for external, soft tissue defects. All resections were for squamous cell carcinoma, except one case of recurrent hemangiopericytoma. One flap failure occurred from venous thrombosis (1.7%). Forty‐two of 43 pharyngoesophageal defects were successfully reconstructed (97.6%). Five temporary salivary leaks were noted, but no frank fistulas occurred. One fistula occurred in the oropharyngeal reconstruction group. Four minor donor‐site complications were noted (6.9%).Conclusion: This series demonstrates the low donor‐site morbidity, as well as the reliability and versatility, of the lateral thigh free flap for head and neck reconstruction.
Myosin Heavy Chain Composition in Human Laryngeal Muscles
Authors: Shiotani Akihiro , Westra William H. , Flint Paul W. 
Published: November 2003

AbstractObjectives: Myosin heavy chain (MHC) composition of human thyroarytenoid (TA), lateral cricoarytenoid (LCA), interarytenoid (IA), vocalis, posterior cricoarytenoid (PCA), and cricothyroid muscles were examined using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS‐PAGE) and Western bolt techniques. The presence of superfast MHC was also assessed using antibodies directed against the extraocular MHC.Study Design: MHC protein was analyzed using fresh human laryngeal muscles.Methods: Laryngeal muscles excised from cadavers were processed for SDS‐PAGE. The composition of MHC isoforms was determined by densitometry. Western blot was carried out to identify specific bands.Results: MHC types IIA and IIB are the predominant MHC components in human laryngeal muscles. The adductor muscles‐TA, LCA, and IA‐have a higher percentage of type IIB MHC and a lower percentage of type I when compared with the abductor‐PCA. The rank file order for type IIB MHC composition (TA>LCA≥IA>PCA) is the same in all specimens. A band migrating between type IIA and type I was observed in several specimens. Although similar to type IIL in rats, this atypical band did not react with antiextraocular MHC antibody on Western blot.Conclusion: Characterization of laryngeal muscles determined by the composition of MHC is correlated with function and neural input. Human laryngeal muscle is characterized by a predominance of fast‐type MHCs in laryngeal closing muscle and mixed fast‐slow type MHCs in respiratory and phonatory muscle groups. Although an atypical myosin band similar to type IIL (superfast) MHC in rat was identified, it did not react with anti‐extraocular MHC antibody.
Progressive Cochleovestibular Impairment Caused by a Point Mutation in the COCH Gene at DFNA9
Authors: Bom Steven J.H. , Kemperman Martijn H. , De Kok Yvonne J.M. , Huygen Patrick L.M. , Verhagen Wim I.M. , Cremers Frans P.M. , Cremers Cor W.R.J. 
Published: November 2003

AbstractObjectives: Analysis of phenotype‐genotype correlation.Study Design: Family study.Methods: Auditory and vestibulo‐ocular functions were examined in a Dutch family with autosomal dominantly inherited sensorineural hearing impairment caused by a 208C>T mutation in the COCH gene, located in chromosome 14q12‐q13 (DFNA9). Linear regression analysis of individual longitudinal hearing threshold data (n = 11) on age was performed.Results: Fifteen of the 16 genetically affected persons could be evaluated. They all developed hearing and vestibular impairment symptoms‐and in many cases also cardiovascular disease‐in the fourth to fifth decade. At the low frequencies (0.25‐2 kHz), hearing loss started at the age of about 40 years and showed an average annual progression of approximately 3 dB, finally resulting in profound hearing losses. In two exceptional cases, annual progression attained levels of up to 24 dB. At the high frequencies (4‐8 kHz), the average threshold increased from about 50 dB at the age of 35 years to about 120 dB at the age of 75 years (which amounts to 1.8 dB annual threshold increase). All affected individuals tested showed normal ocular motor functions. The patients older than 46 years generally showed absence of the vestibulo‐ocular reflex, but their cervico‐ocular reflex was enhanced compared with normal subjects, whereas those aged 40 to 46 years showed either severe vestibular hyporeflexia or unilateral caloric areflexia.Conclusion: These findings suggest a gradual development of cochleovestibular impairment caused by the new mutation found.
Head and Neck Cancer in CNonsmokers: A Distinct Clinical and Molecular Entity
Authors: Koch Wayne M. , Lango Miriam , Sewell Duane , Zahurak Marianna , Sidransky David 
Published: November 2003

AbstractObjectives/Hypothesis: Clinical and molecular patterns of head and neck squamous cell carcinoma (HNSCC) in nonsmokers and smokers may be different. Analysis of these patterns may improve understanding and management of this disease.Study Design: three hundred five subjects were included (46 nonsmokers, 29 former smokers, and 230 smokers). Subsets were analyzed for p53 mutation, human papillomavirus (HPV), and loss of heterozygosity (LOH) at 10 chromosomal loci.Methods: Clinical information was analyzed for common patterns of disease among the groups. The p53 gene was sequenced, and polymerase chain reaction was used to detect HPV DNA and LOH at two microsatellite markers for each loci. The χ2 test was used to assess differences in genetic alterations between groups, logistic regression to examine the independence of association of tobacco exposure with each alteration, and Kaplan Meier estimates and the log‐rank statistic to assess differences in survival.Results: Nonsmokers included a disproportionate number of women, oral cavity (especially tongue) tumors, and very young or old individuals. Smokers had more tumors of the larynx, hypopharynx, and floor of mouth. The rate of p53 mutation was much greater in smokers; the percentage with HPV was marginally lower. The percentage of LOH at 3p, 4q, and 11q13, and the overall average number of chromosomal losses, was significantly lower in nonsmokers' tumors. Survival did not vary with smoking or age.Conclusions: The clinical and genetic features of HNSCC are distinct between groups defined by tobacco use. Tumors of nonsmokers contain a lower frequency of common genetic alterations, suggesting that the underlying changes in these tumors may remain undiscovered.
A Method for Quantitative Assessment of Vestibular Otopathology
Authors: Merchant Saumil N. 
Published: November 2003

AbstractBackground: Quantitative studies of the vestibular system using serial sections from human temporal bones have been limited because it has been generally difficult to reliably differentiate hair cells from supporting cells and type I from type II hair cells.Objectives: 1. To develop a new method to overcome the above limitations and permit quantitative assessments of types I and II vestibular hair cells in archival temporal bone sections. 2. To demonstrate that this method is reliable, valid, and repeatable. 3. To describe the advantages of this method compared with other traditional techniques. 4. To discuss the potential of this method to provide new insight into the etiology, pathology, and pathophysiology of vestibular disorders.Study Design: Examination of archival human temporal sections prepared for conventional light microscopy.Methods: The method used Nomarski (differential interference contrast) microscopy to permit visualization of the cuticular plate and stereociliary bundle, to allow unambiguous identification of hair cells. Types I and II hair cells were distinguished by their morphological characteristics. The method was used to measure the density of types I and II hair cells in each vestibular sense organ. Raw‐density counts were corrected for potential double counting using Abercrombie's formula.Results: Intrarater and interrater reliability was strong as judged by high Pearson and Spearman correlation values (P < .01). Abercrombie's formula was shown to be valid by comparison with counts made by an unbiased calibration technique using the optical disector principle (correlation coefficients > 0.9, P < .01).Conclusions: The method described in this report has several advantages when compared with alternative techniques such as surface preparations. The method is applicable to archival bones, permits simultaneous evaluation of the rest of the labyrinth, is relatively inexpensive, and does not preclude other techniques of study (e.g., polymerase chain reaction and immunostaining). Case studies of temporal bones with aminoglycoside ototoxicity and Meniere's disease are used to show how this method has the potential to provide new insight into the pathology and pathophysiology of vestibular disorders.
Margins of Partial Cricotracheal Resection in Children
Authors: Walner David L. , Stern Yoram , Cotton Robin T. 
Published: November 2003

AbstractObjective: To review the surgical margins of partial cricotracheal resection in our series of patients. This includes specific anatomic detail as to each superior and inferior resection margin. To apply this information and access the utility of partial cricotracheal resection for the treatment of subglottic stenosis.Study Design/Methods: A retrospective review was performed of 38 children with severe subglottic stenosis who underwent partial cricotracheal resection. Information was obtained with regard to the specific anatomic location of the superior and inferior resection margins, the grade of subglottic stenosis preoperatively, the type of stenting material used postoperatively, and other surgical details specific to each procedure.Results: The superior resection margins were generally to the superior aspect of the cricoid cartilage but as high as the undersurface of the true vocal folds in a minority of patients. Inferior resection margins were generally to the second tracheal ring. Length of resection varied, but was as long as 3.0 cm in one patient. Overall surgical success based on decannulation was > 86%.Conclusion: Partial cricotracheal resection is a safe and successful procedure for the treatment of subglottic stenosis. The margins and length of resection should be tailored specifically for each patient; and special considerations must be taken when extensive resection to the level of the true vocal folds is required. Safe airway management in the postoperative period is essential.
Management of Lateral Sinus Thrombosis
Authors: Syms Mark J. , Tsai Paulus D. , Holtel Michael R. 
Published: November 2003

AbstractObjectives: Review the clinical signs and symptoms, management, bacteriology and outcomes of patients treated for lateral sinus thrombosis.Study Design: A retrospective review of six patients, treated from 1993 through 1998, with an intraoperatively confirmed diagnosis of lateral sinus thrombosis.Methods: All charts from 1993 through 1998 coded for sinus thrombosis, meningitis, brain abscess, otitic hydrocephalus, subdural abscess, and mastoidectomy were reviewed. Operative reports, radiological examinations, laboratory data, culture data and other pertinent data were reviewed.Results: The presenting symptoms ranged from headache to mental status changes. All patients had a history of chronic ear disease and all had at least one additional intracranial complication. The range of additional intracranial complications included otitic hydrocephalus, epidural abscess, and brain abscess. All of the infections were polymicrobial, with a predominance of anaerobes. There were no mortalities; morbidities included anacusis, acute respiratory distress syndrome, reoperation, seizures, septic cardiomyopathy, transfusion, ventriculoperitoneal shunt and nutritional supplementation.Conclusion: In patients with otologic disease, complaints of headache, earache or photophobia should warrant an evaluation. The presence of lateral sinus thrombosis mandates further investigation for additional intracranial complications. Conservative surgical intervention, consisting of removal of all perisinus infection and needle aspiration of the sinus, has been found to be effective. Lateral sinus thrombosis is an uncommon complication of otitis media, with potentially significant morbidities, necessitating a high index of suspicion.
Ossiculoplasty in Young Children With the Applebaum Incudostapedial Joint Prosthesis
Authors: Schwetschenau Eric Leland , Isaacson Glenn 
Published: November 2003

AbstractObjective: To evaluate the performance of the Applebaum incudostapedial joint prosthesis in young children in terms of hearing results and long‐term stability despite continuing eustachian tube dysfunction and otitis media.Study Design: Retrospective review of all Applebaum prostheses placed in children at our institution from June 1993 to June 1998.Results: In 1993 Applebaum proposed the use of a hydroxylapatite ossicular prosthesis as an alternative to incus interposition for the repair of incudostapedial discontinuity. We have used this prosthesis exclusively for the repair of such defects in children over the past 5 years. Among 12 operated ears, all healed, all prostheses remain in place (average duration, 2.6 y), and all children have excellent hearing (mean air‐bone gap, 15 dB; range, 5‐25 dB).Conclusions: The Applebaum incudostapedial joint prosthesis restores conductive hearing even in young children. It has been stable in the face of recurrent otitis media and has not interfered with revision surgery. Placement of the prosthesis at primary cholesteatoma surgery should be considered in children.
Pierre Robin Sequence: Secondary Respiratory Difficulties and Intrinsic Feeding Abnormalities
Authors: Cruz Michael J. , Kerschner Joseph E. , Beste David J. , Conley Stephen F. 
Published: November 2003

AbstractObjective: There is considerable variation in opinion regarding the optimal management of patients with Pierre Robin sequence (PRS). No single method of airway intervention or feeding strategy is universally appropriate and effective. This study was performed to examine methods used for airway and feeding management and to identify specific problems encountered.Study Design: A retrospective study of 252 patient charts between 1989 and 1997 at Children's Hospital of Wisconsin.Methods: Patient information was collected regarding perinatal history, genetics evaluation, and airway and feeding evaluations and intervention. A group of 47 patients was determined as having PRS.Results: Secondary respiratory difficulties, defined as respiratory abnormalities in addition to the expected PRS obstruction, were identified in 23% of patients. Also, intrinsic feeding abnormalities not associated with airway obstruction were identified in 11% of patients. Analysis by Fisher's Exact Test revealed patients with a syndromic diagnosis to have a significantly higher rate for tracheotomies and gastrostomy tube placement (P = .041, and P = .0004, respectively). Syndromic patients were also found to have significantly lower Apgar scores and longer hospital stays. Positioning techniques, tongue‐lip adhesion, and tracheotomy were also employed effectively with specific indications and specific difficulties that need to be considered.Conclusion: Patients with PRS require thorough airway and feeding evaluation. Those with additional syndromic diagnoses demonstrate higher rates of more invasive interventions. Patients with PRS must undergo individualized approaches with consideration of multiple factors for successful management.
Diagnostic Yield of High‐Resolution Computed Tomography for Pediatric Sensorineural Hearing Loss
Authors: Antonelli Patrick J. , Varela Adrian E. , Mancuso Anthony A. 
Published: November 2003

AbstractObjectives/Hypothesis: In recent years, relatively subtle inner ear anomalies have become apparent using high‐resolution computed tomography (CT). The purpose of this study was to determine the diagnostic yield of high‐resolution CT for pediatric sensorineural hearing loss (HL) (SNHL).Methods: A review was performed on the records of all children (<18 y of age) who had undergone CT of the temporal bones over a 5‐year period, since the introduction of current CT techniques.Results: Three hundred eighty‐three studies were performed in 351 subjects. The indication for the CT was SNHL or mixed HL in 157 children. Forty‐nine (31%) of these studies revealed significant inner ear findings. Large vestibular aqueducts (LVAs) were reported in 15%, commonly in association with cochlear modiolar deficiencies. Modiolar deficiencies (11%) and other cochlear dysplasias (12%) followed LVA in frequency. The incidence of inner ear dysplasia in children with perinatal or postnatal risk factors was only slightly lower than those without (22% vs. 32%, P > .05). The rate of dysplasias did not correlate with SNHL severity, pattern of HL, or type of HL (mixed vs. sensorineural).Conclusions: These findings suggest that radiographic imaging has a relatively high diagnostic yield in children with SNHL. These findings may be of value in counseling patients and guiding the management of their SNHL.
Aural Symptoms and Signs of Temporomandibular Disorder in Association With Treatment Need and Visits to a Physician
Authors: Kuttila Seppo , Kuttila Maraana , Le Bell Yrsa , Alanen Pentti , Jouko Suonpää 
Published: November 2003

AbstractObjectives: To analyze associations between aural symptoms and clinical signs of and treatment need for temporomandibular disorders, as well as visits to a physician, in a Finnish population.Study Design: A longitudinal study of a random sample of adults.Methods: Four hundred eleven subjects (203 men and 208 women aged 25, 35, 45, 55, or 65 years at baseline) were examined and interviewed at three consecutive examinations at 12‐month intervals, and a questionnaire on visits to physician during the preceding 12 months was completed.Results: The aural symptoms were common. The prevalence of otalgia without infection varied between 12% and 16%, while the prevalence of tinnitus and fullness of ears was 12% to 17% and 5% to 9%, respectively. Women had more aural symptoms than men. When compared with the other subjects, the subjects with aural symptoms more often had masticatory muscles that were tender to palpation or temporomandibular joint signs. Subjects with obvious treatment need for temporomandibular disorders had more aural symptoms than subjects in the other treatment need subgroups. They also visited a physician more often because of otalgia than the subjects with otalgia in the other treatment need subgroups.Conclusions: In patients with otalgia, infectious otolaryngologic diseases should be ruled out. Then the patients without infection should be remitted to a dentist with stomatognathic experience. In the absence of temporomandibular disorders, further medical consultations (e.g., otorhinolaryngological, neurological, physiatric, and psychiatric) are indicated.
Utility of Laboratory Testing in Autoimmune Inner Ear Disease
Authors: Hirose Keiko , Wener Mark H. , Duckert Larry G. 
Published: November 2003

AbstractObjectives: To assess the utility of various laboratory tests used to diagnose autoimmune inner ear disease.Study Design: Retrospective study of 82 patients evaluated at the University of Washington Otology Clinic from 1996 through 1998 with review of clinical history, laboratory tests, audiograms, response to therapy, and final diagnoses.Methods: Charts were reviewed for presenting history and initial workup including test results for erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), C1q binding assay, anticardiolipin antibody (aCL), antineutrophil cytoplasmic antibody (ANCA), microhemagglutinin assay for Treponema pallidum (microhemagglutination assay), Lyme disease titers, and the Western blot for heat shock protein 70 (hsp 70).Results: The Western blot for hsp 70 is the best test for predicting corticosteroid responsiveness. The sensitivity was low at 42%, although the specificity was 90%, and the positive predictive value of this test was excellent at 91%. The ESR was as good as the CRP in detecting acute‐phase reactants. The other, more specific tests in the laboratory panel (aCL, ANCA, MHA, and Lyme disease titers) did not detect any new cases of autoimmune disease in addition to those which were already identified by an abnormal ESR.Conclusions: A diagnostic test panel for autoimmune inner ear disease should include an ESR and the Western blot for hsp70. More specific laboratory testing for systemic disease is warranted when the ESR is elevated. In patients with a positive Western blot, a trial of corticosteroid therapy can be given with good conviction because the test is quite specific. However, many people who are Western blot negative may also respond to corticosteroid therapy because the test lacks sensitivity.
Terminal Differentiation of Epithelial Cells in Middle Ear Cholesteatoma: Investigation of Patterns of Expression of Protein Kinase C‐δ and Protein Kinase C‐η
Authors: Miyazaki Hidemi , Kojima Hiromi , Tanaka Yasuhiro , Shiwa Masanori , Koga Tomohiko , Moriyama Hiroshi 
Published: November 2003

AbstractObjectives: The objective of this study was to elucidate the differentiation mechanism of keratinocytes in cholesteatoma.Study Design: To achieve the objective, we analyzed the expressions of various cellular proteins: the delta and eta isoforms of protein kinase C (PKCδ and PKCη), which are thought to play key roles in signal transduction in differentiation; cytokeratin 1 (CK1) and cytokeratin 10 (CK10) (cytoskeletal constitutive proteins); and involucrin (a marker of differentiation).Methods: The materials used in this study were tissue specimens obtained from cholesteatoma epidermis, normal external ear canal skin, normal inguinal skin, and psoriatic skin. Immunohistochemical staining techniques were applied to compare the expressions of the above proteins (i.e., PKCδ, PKCη, CK1, CK10 and involucrin) in those various tissues.Results: No clear differences in the patterns of expression of PKCδ and PKCη were found between the cholesteatoma epidermis and the normal external ear canal skin. These proteins were expressed mainly in the stratum spinosum and stratum granulosum, and their patterns of expression were almost the same as those of the CK1, CK10, and involucrin proteins.Conclusion: The findings of this study indicate that the terminal differentiation of keratinocytes in the cholesteatoma epidermis is the same as in normal skin tissues. It was concluded that the growth of epidermis which has undergone hyperproliferation of keratinocytes because of increased levels of various cytokines is being regulated by means of normal terminal differentiation.