bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restoration of Function in the Paralyzed Rabbit Orbicularis Oculi Muscle by Direct Functional Electrical Stimulation
Authors: Otto Randal A. 
Published: November 2003

AbstractRestoration of the ability to blink and protect the eye in the patient with facial paralysis remains a challenge. Although many treatments exist, no one approach corrects all the deficits associated with the loss of orbicularis oculi function. In this study, the author investigated the feasibility of restoring function by direct electrical stimulation of the paralyzed orbicularis oculi muscle in the rabbit model.Using a pacing device developed by the author, functional restoration of a normal‐appearing blink was produced throughout 30 days of continuous pacing in six rabbits with transected facial nerves. Histologic evaluations of the paced tissues demonstrated no evidence of detrimental effects attributable to the electrical stimulation.The findings of this study support the feasibility of employing direct electrical stimulation to restore the function of paralyzed orbicularis oculi muscles. Potential applications may also exist in other areas in which peripheral denervation creates functional impairment.
Time Course of Recovery After Epley Maneuvers for Benign Paroxysmal Positional Vertigo
Authors: Smouha Eric E. 
Published: November 2003

AbstractThe canalith repositioning maneuver (CRP) of Epley is an effective treatment for benign paroxysmal positional vertigo (BPPV). While CRP has been advocated by some as a “single treatment” for BPPV, others have had less uniform results for this self‐limited disorder. In order to better define the role of CRP in relieving vertigo, we studied the time course of recovery in 27 consecutive cases of BPPV. We recorded nystagmus after each head maneuver and at each evaluation until complete resolution took place, using absence of nystagmus as a strict criterion for cure. We found that while 93% of patients improved, many had persistent nystagmus at the first evaluation, and in only 63% was resolution clearly related to a CRP session. We believe that in certain cases, the effect of CRP may be due to adaptive conditioning, rather than particle redistribution.
Prognostic Features in Tall Cell Papillary Carcinoma and Insular Thyroid Carcinoma
Authors: van den Brekel Michiel W. M. , Hekkenberg Robert J. , Asa Sylvia L. , Tomlinson George , Rosen Irving B. , Freeman Jeremy L. 
Published: November 2003

AbstractTall cell papillary carcinoma (TCPC) and insular carcinoma (IC) are variants of thyroid carcinoma that are considered to be more aggressive than well differentiated papillary or follicular carcinoma. To determine the clinical significance of these diagnoses, we evaluated 65 patients with these tumors. There were 30 TCPCs, 27 ICs, and 8 ICs or TCPCs with focal anaplastic carcinoma (FAC). Forty‐two patients (27 TCPCs, 14 ICs, and 1 FAC) are alive and free of disease. Nine patients with IC are alive with distant metastases. Ten patients (2 TCPCs, 2 ICs, and 7 FACs) died of disease. Univariate analysis of disease‐free interval determined that, as for all thyroid carcinomas, patient age, tumor size, extrathyroidal extension, and lymph node metastases were significant for prognosis. ICs did significantly worse than TCPCs. Focal anaplastic dedifferentiation predicted a worse prognosis. Multivariate analysis for disease‐free interval showed age, number of lymph node metastases, and tumor type to be significant. Analysis of the same factors for prediction of mortality showed that TCPC and IC were not significantly different. These data suggest that TCPC is less aggressive than IC, which often results in disseminated disease. Focal AC predicts poor survival.
Quantitative Evaluation of the Effects of Thyroarytenoid Muscle Activity upon Pliability of Vocal Fold Mucosa in an In Vivo Canine Model
Authors: Yumoto Eiji , Kadota Yoshimi 
Published: November 2003

AbstractStiffness of the vocal fold is a significant factor in determining mucosal wave propagation and in the control of the fundamental frequency of phonation. We measured pliability of the vocal fold mucosa in an in vivo canine model as an index of stiffness while the histological layer‐by‐layer structure of the vocal fold was not disrupted.The point 1 mm below the free edge showed a maximal pliability that gradually diminished toward the tracheal side and reached a minimum. When the thyroarytenoid (TA) muscle contracted, pliability of the mucosa was significantly increased (P < 0.001). Mucosal pliability of the excised larynx was significantly increased compared with that in vivo (P < 0.001). The point of minimal pliability in the absence of TA muscle contraction did not shift after excision of the larynx, while TA muscle contraction caused a downward shift of the point of minimal pliability. Mucosal pliability can thus be used to quantitatively assess the effects of TA muscle contraction on stiffness of the vocal fold mucosa.
Mucociliary Clearance and Buffered Hypertonic Saline Solution
Authors: Talbot Andrew R. , Herr Timothy M. , Parsons David S. 
Published: November 2003

AbstractNasal irrigations have been used for centuries without any scientific data to determine efficacy. For 10 years, the senior author has used buffered hypertonic saline nasal irrigation for patients with acute/chronic sinusitis and for those having undergone sinus surgery. A simple study was undertaken using volunteers without any significant sinonasal disease. Patients served as their own control using a saccharin clearance test before any nasal irrigation was used. Patients then used one of two solutions to irrigate their nose‐buffered normal saline or buffered hypertonic saline‐and were then retested. On a separate day, the control test was repeated, followed by irrigation with the alternate solution and a second saccharin clearance test. The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times of saccharin, while buffered normal saline had no such effect.
Electrocautery Versus Carbon Dioxide Laser for Uvulopalatoplasty in the Treatment of Snoring
Authors: Gnuechtel Michael M. , Keyser Jeffrey S. , Greinwald John H. , Postma Gregory N. 
Published: November 2003

AbstractLaser‐assisted uvulopalatoplasty is a popular method for reducing snoring. Drawbacks are the large initial expense of the laser unit and related equipment and required safety precautions. The equipment required for electrocautery for cautery‐assisted uvulopalatoplasty is significantly less expensive to obtain and operate compared with the carbon dioxide laser. Ninety‐eight patients were randomly assigned to one of two treatment groups to undergo uvulopalatoplasty: one performed with the carbon dioxide laser and the other with electrocautery. We compared postoperative pain, time off work, efficacy, and the number of treatments required to achieve a satisfactory result. We found no statistically significant difference in any of these parameters between the two treatment groups (P > 0.05). Our data show that the use of the carbon dioxide laser offers no advantage over electrocautery in performing uvulopalatoplasty to treat snoring.
Experience With Segmental Reconstruction of the Radiated Mandible With Alloplastic Prostheses
Authors: Greene David , Sussman Stephen , Singer Mark I. 
Published: November 2003

AbstractReconstruction of the mandible after radiation therapy and segmental resection is often complicated by wound breakdown, osteoradionecrosis, and crippling of the oral cavity. These complications make patient salvage after radiated oral carcinoma a high‐risk endeavor. Although head and neck surgeons have improved the reliability of mandibular reconstruction with microvascular free tissue transfer, medical and oncologic issues may prohibit their application. This report presents 12 selected cases undergoing alloplastic reconstruction of the mandible and soft tissue reconstruction of the oral cavity. Although not as reliable as some reports of free tissue transfers, the results were reproducible and satisfactory in these cases, with time‐efficient hospitalization and functional rehabilitation. Ten of 12 prosthetic reconstructions have been durable in this study population for as long as 36 months.
Medial Antebrachial Cutaneous Nerve: A New Donor Graft for Repair of Facial Nerve Defects at the Skull Base
Authors: Haller Jeffrey R. , Shelton Clough 
Published: November 2003

AbstractWhen grafting a facial nerve defect after resection of a skull base cancer, the use of the greater auricular nerve is generally contraindicated because of concern of malignant involvement. In the past, the sural nerve was used as a donor graft for reconstruction of the facial nerve. We have found a sensory branch of the median nerve of the upper arm, the medial antebrachial cutaneous(MAC) nerve, to be a suitable option for facial nerve grafting. The MAC nerve provides a good diameter match for the facial nerve and has branching to allow reconstruction of the distal facial nerve in the parotid bed. The length is adequate to graft from the brainstem to the distal facial branches. Loss of sensation is limited and well tolerated by the patient. The MAC nerve has been used in grafting in 15 patients with skull base disease and facial nerve defects. No complications have been encountered, and the functional return appears to be similar to other grafts. In our practice the MAC nerve is a valuable option for facial nerve repair at the skull base.
Calcium Channel Blockade Reduces Noise‐Induced Vascular Permeability in Cochlear Stria Vascularis
Authors: Goldwyn Benzion G. , Quirk Wayne S. 
Published: November 2003

AbstractExposure to noise results in multiple perturbations of cochlear microcirculation, including increases in vascular permeability. There is evidence that these events are mediated, in part, by calcium channels. The current study examined the effects of calcium channel blockade on the diameter and permeability of cochlear vessels during noise exposure. Subjects were exposed to either noise alone or noise after verapamil pretreatment. Vessels of the cochlear stria vascularis were imaged using intravital microscopy. Animals exposed to noise showed decreases in diameter and increased permeability above baseline levels. Animals pretreated with the calcium channel blocker verapamil and exposed to noise demonstrated increases in vessel diameter and no changes in permeability. These data indicate that calcium channel blockade reduces noise‐induced microvascular permeability. Treatment strategies designed to protect from increases in vascular permeability due to noise exposure may reduce temporary threshold shifts.
Planned Early Neck Dissection Before Radiation for Persistent Neck Nodes After Induction Chemotherapy
Authors: Thomas Giovana R. , Greenberg Jason , Wu Kuo‐Tsung , Moe Kris , Esclamado Ramon , Bradford Carol , Carroll William , Eisbruch Avraham , Urba Susan , Wolf Gregory T. 
Published: November 2003

AbstractOptimal management of advanced neck metastases as part of an organ preservation treatment approach for head and neck squamous carcinoma (HNSC) is unclear. Since 1989, our management paradigm for patients on organ preservation was modified to incorporate planned early neck dissection before radiation therapy for patients who did not achieve a complete response (CR) of neck nodes after induction chemotherapy (IC). The purpose of this study was to determine if planned early neck dissection is a safe and effective approach in the management of advanced nodal disease as part of organ preservation. Fifty‐eight consecutive patients with advanced HNSC who were entered in organ preservation trials using induction chemotherapy and radiation with surgical salvage were studied. Median follow‐up was 26 months. Of the 58 patients, 71% were stage IV. Patients were grouped by nodal response to chemotherapy and N class, and were analyzed with respect to patterns of recurrence, complications, and survival. Overall, the rate of CR of neck nodes was 49%. Fifty‐one percent had less than a complete response of neck nodes after IC and required planned early neck dissection. There were no significant differences in patterns of recurrence, complications, interval time to start of radiation, recurrence, or survival rates between the CR and less than CR groups. These data suggest that planned early neck dissection for patients with less than CR in the neck after IC is not detrimental with respect to neck relapse or overall survival. We believe that planned early neck dissection can be safely incorporated into future organ preservation treatment protocols for patients with advanced head and neck carcinoma.
Outcome‐Based Assessment of Endolymphatic Sac Surgery for Meniere's Disease
Authors: Smith Darrell R. , Pyle G. Mark 
Published: November 2003

AbstractThis study reports the preliminary results of an outcomes approach to analysis of the effectiveness of endolymphatic sac decompression (ELSD). Using the medical outcomes survey's 36‐item, shortform health survey (SF‐36), we assessed the quality of life in 33 patients with disabling Meniere's disease undergoing ELSD for medically intractable vertigo. Results indicate that patients with 1995 American Academy of Otolaryngology‐Head and Neck Surgery(AAO/HNS) class A or B outcomes showed no significant difference from population norms on the SF‐36, whereas patients with AAO/HNS classes C to E outcomes scored significantly below norms. Six patients who were given the SF‐36 preoperatively scored consistently below population norms. Postoperatively, they showed a statistically significant improvement and were statistically equal to norms. These findings suggest that the SF‐36 is a good measure of the quality of life impairment in patients with disabling Meniere's disease. In addition, SF‐36 scores correlated well with the 1995 AAO/HNS classification.
Fallopian Bridge Technique in Surgery for Chronic Ear Disease
Authors: Pensak Myles L. , Friedman Rick A. 
Published: November 2003

AbstractDisease that lies in the posterior mesotympanum, including inflammatory polyps, cholesterol granuloma, and cholesteatoma, is often difficult to extirpate. The literature reflects a divided and often controversial opinion regarding the removal of the bony posterior canal wall to reach this disease. Recently, endoscopic visualization has been advocated to enhance exposure. Employing a fallopian bridge technique wherein the bone medial to the facial nerve is opened into the posterior mesotympanum the authors have used this approach in selective circumstances to optimize the eradication of disease. Three hundred patients undergoing tympanomastoidectomy were included in this analysis. The fallopian bridge technique was attempted in 58 cases and was successfully employed in 42 patients. Indications as well as limitations for this procedure are discussed.
Optimizing Suicide Gene Therapy for Head and Neck Cancer
Authors: Sewell Duane A. , Li Daqing , Duan Ling , Schwartz Mary R. , O'Malley Bert W. 
Published: November 2003

AbstractAn effective “suicide gene” therapy strategy in experimental studies has been the use of the herpes simplex virus thymidine kinase gene(HSV‐tk) to sensitize tumors to the cytotoxic effects of ganciclovir administration. Previous studies using this model have focused on utilizing maximal viral titers and high levels of ganciclovir that are not compatible with human dosing. Because of the high ganciclovir doses and the maximal viral titers, this strategy has limited application to actual clinical scenarios. In the following studies the authors investigate tumor regression in an oral squamous cell carcinoma animal model as a function of variable adenoviral titers and more physiologic ganciclovir dosing. Using adenoviral titers ranging from 1 × 108 to 2 × 109 plaque forming units(pfu) to treat oral tumors, they found no statistical difference in tumor regression among the different viral doses, despite differences in mitotic activity. Each treatment group, however, demonstrated a significant effect on tumor regression when compared with controls. Furthermore, the authors were able to reduce the level of ganciclovir administration to 10 mg/kg twice daily from established levels of 100 to 150 mg/kg twice daily while maintaining significant tumor responses to the HSV‐tk therapy. Mean survival of animals treated with this lower ganciclovir dose was significantly higher than in controls and was equal to established means based on previous studies using higher ganciclovir doses. The optimization of this suicide gene therapy strategy is imperative in order to minimize theoretical and known viral and ganciclovir toxicities while establishing a foundation upon which to design appropriate and effective clinical trials.
Clinical Diagnoses Associated With Histologic Findings of Fibrotic Tissue and New Bone in the Inner Ear
Authors: Keithley Elizabeth M. , Chen Mien‐Chi , Linthicum Fred 
Published: November 2003

AbstractFibrotic tissue or new bone occurs following inner ear inflammation, fracture, or surgery. The prevalence is unknown and was investigated using the National Temporal Bone, Hearing and Balance Pathology Resource Registry database. A search yielded 264 temporal bones with diagnoses of otosclerosis, tumor, Meniere's disease, meningitis, labyrinthitis, chronic otitis media, autoimmune disease, temporal bone fracture, or sensorineural hearing loss. All autoimmune cases contained some new bone, whereas only 20% to 30% of the labyrinthitis/meningitis cases were reported to contain new bone. Otosclerosis, Meniere's disease, and otitis media had relatively few cases containing new bone. Although new bone may derive from surgical trauma, it is also likely to be a result of the disease process. It seems that all these disease processes may contain a common feature that acts as a stimulus to induce fibrosis or bone growth in the inner ear.
Review of Percutaneous Tracheostomy
Authors: Powell David M. , Price Phillip D. , Forrest L. Arick 
Published: November 2003

AbstractThe purpose of this study is to assess the safety and efficacy of the four known methods of percutaneous tracheostomy. Perioperative, postoperative, and late complication rates were generated for each method after a complete literature review identified 1684 percutaneous tracheostomy patients reported in 40 series. Two methods, the Toye and the guide wire dilator forceps (GWDF) methods, have been the subject of few investigations. Two other methods have been extensively studied. A high perioperative complication rate was calculated for the Rapitrac™ method, whereas percutaneous dilational tracheostomy (PDT) has complication rates similar to those reported for standard operative tracheostomy. A retrospective review of 22 patients who underwent PDT at a local community hospital confirmed a “learning curve” for this technique that had been previously suggested. Review of the literature suggests that PDT can be safe and cost‐effective for selected patients, but a learning curve for this technique exists that dictates caution, experience, and preparation on the part of any surgeon who wishes to add percutaneous tracheostomy to his or her repertoire.
Laryngotracheal Reconstruction With Tracheal Patch Allografts
Authors: Delaere Pierre R. , Liu Ziying , Hermans Robert 
Published: November 2003

AbstractThe capacity of tracheal allotransplants in providing optimal tissues for laryngotracheal repair was studied in an animal model. Segments of cervical trachea could be revascularized completely when wrapped in a receptor fascia flap in immunosuppressed rabbits. In phase I the revascularized tracheas were incised longitudinally and transformed into four different patches after a 14‐day revascularization period. The blood supply toward the four patch designs was examined with angiography. The patch designs that showed a vascularization over at least 75% of their mucosal surface area were used in phase II to reconstruct extended anterior laryngotracheal defects. The morphologic characteristics of the tracheal patches when used inside laryngotracheal defects were studied using radiographic, angiographic, and histologic techniques. The revascularized allograft patches that were fully supported by tracheal cartilage were most suitable to repair anterior laryngotracheal defects in this animal study. This model allowed us to define the tissue characteristics necessary for obtaining a combination of primary healing and optimal luminal support in the repair of laryngotracheal defects.
Local Failure After Supracricoid Partial Laryngectomy: Symptoms, Management, and Outcome
Authors: Laccourreye Ollivier , Laccourreye Laurent , Muscatello Luca , Périé Sophie , Weinstein Gregory , Brasnu Daniel 
Published: November 2003

AbstractThe medical files of 15 patients with local recurrence after supracricoid partial laryngectomy consecutively managed at Laënnec Hospital were reviewed. The clinical symptoms and the laryngeal computed tomography appearance of local recurrence, as well as the salvage treatment performed, are presented. The main presenting symptom was dyspnea. None of the local recurrences was considered to be unresectable. One patient refused any form of salvage treatment. Radiation therapy and salvage total laryngectomy were the options retained for local salvage. A minimum 5‐year follow‐up was always achieved. In patients who underwent salvage total laryngectomy, perioperative or postoperative death and postoperative pharyngocutaneous fistula were not encountered. The 5‐year survival was 33.3%. The local control rate was 66.6%. The percentage of patients who experienced nodal recurrence was 26.6%, and the distant metastasis estimate was 53.3%. The cause of death was distant metastasis in eight patients, local recurrence in two, and intercurrent disease in one. Peristomal recurrence was not encountered. Overall, 80% local control and 6.6% laryngeal preservation rates were achieved.
Is Aspiration Necessary Before Tympanostomy Tube Insertion?
Authors: Egeli Erol , Kiriş Muzaffer 
Published: November 2003

AbstractAspiration of middle ear fluid after myringotomy is performed routinely, although investigators imply a cause‐and‐effect relationship between suction noise and acoustic trauma. This prospective randomized study investigated if aspiration was necessary. Fifty‐one myringotomies and 50 tympanostomy tube insertions were performed on 27 patients. A suction instrument was utilized in 24 ears and was not used in 27 ears. In a follow‐up period, no difference was observed between the two groups. The authors did not establish that aspiration is indeed harmful, but tympanostomy tube insertion can be performed without suctioning middle ear effusion.
Histology and Histomorphometry of Ethmoid Bone in Chronic Rhinosinusitis
Authors: Kennedy David W. , Senior Brent A. , Gannon Frank H. , Montone Kathleen T. , Hwang Peter , Lanza Donald C. 
Published: November 2003

AbstractMucosal changes have been well described in chronic sinusitis, yet little is known about the underlying bone, despite clinical and experimental evidence suggesting that bone may be involved in chronic sinusitis. Techniques of undecalcified bone analysis were used for detailed histologic examination of ethmoid bone in chronic sinusitis compared with controls. Bone synthesis, resorption, and inflammatory cell presence were specifically assessed. Additionally, histomorphometry techniques were used to determine ethmoid bone physiology in individuals undergoing surgery for chronic sinusitis. Overall, individuals undergoing surgery for chronic sinusitis were found to have evidence of marked acceleration in bone physiology with histologic changes including new bone formation, fibrosis, and presence of inflammatory cells. These findings are compared with osteomyelitis in long bone and the jaw. The suggestion that underlying bone may serve as a catalyst for chronic sinusitis is supported and implications for therapy are discussed.