bluuebunny/crossref_metadata_2025_split huggingface dataset:
Otological Manifestations of Churg‐Strauss Syndrome
Authors: Ishiyama Akira , Canalis Rinaldo F. 
Published: November 2003

AbstractObjectives/Hypothesis To describe the clinical features, pathogenesis, and management of the otological complications in Churg‐Strauss syndrome (CSS).Study Design Retrospective review of five patients with documented CSS who had otological manifestations in the later stages of CSS.Methods The history, treatment, and outcome were evaluated using office and hospital chart data in these five cases.Results In all cases, otological manifestations occurred during an advanced stage of CSS and was characterized by the presence of dense aural discharge, granulomatous eosinophilic infiltration into mastoid and middle ear, and subacute severe to profound hearing loss. In all cases, the recurrent aural discharge and granulomatous infiltrate was unresponsive to conventional treatment including repeated myringotomies and aggressive antibiotics. Systemic steroid administration resulted in a rapid, complete cessation of aural discharge and reversal or stabilization of hearing loss. Otological manifestations have been stable over a range of follow‐up from 1 to 20 years on a maintenance regimen of steroids.Conclusions Temporal bone involvement in CSS is rare. Surgical intervention of the temporal bone is relegated to complications that may include infectious mastoiditis and intracranial involvement. Recognition of the association between CSS and otological disease is important because it is highly responsive to systemic steroids, and early steroid treatment may prevent progression to irreversible hearing loss, infectious otomastoiditis, or intracranial complications.
CO2 Laser Treatment in 244 Patients With Respiratory Papillomas
Authors: Dedo Herbert H. , Yu Kenneth C. Y. 
Published: November 2003

AbstractObjective Respiratory papillomas (RP) tend to recur and the difficulty in eradicating the disease makes their treatment frustrating. Meticulous CO2 laser excisions every 2 months has been the most effective treatment to date. This article analyzes the results of this plan in 244 patients with RP in the nose, nasopharynx, pharynx, hypopharynx, larynx, trachea, lung parenchyma, and skin.Methods Two hundred forty‐four patients with recurrent RP were treated by the senior author with CO2 laser excisions and, in some cases, podophyllum and alpha interferon. Demographics, initial distribution of papillomas, number of operations performed on each patient, and current results were evaluated.Results Careful laser excisions of RPs every 2 months achieved “remission” of disease (no visible RP on indirect or often direct laryngoscopy 2 mo after last removal) in 37% of patients, “clearance” of the disease process (no RP clinically apparent for 3 y after last removal) in 6%, and “cure” (no clinical recurrence for 5 y after last removal) in 17%. Juvenile‐onset RP tends to follow a more aggressive course than adult‐onset RP. Four patients (1.6%) developed malignant transformation of their papillomas. Except for ones in lung parenchyma, RP in areas other than the true vocal cords tend to be cleared faster because aggressive removal does not cause hoarseness. Lung parenchyma RPs are eventually fatal because of pulmonary failure from abscesses and cysts resulting from a lack of effective treatment.Conclusion Frequent and meticulously performed CO2 laser excisions can achieve significant voice and airway improvement, and some clinical “cures.” However, effective antiviral medicines and/or immunologic agents are needed to achieve true cures with elimination of all human papilloma virus 6 and 11 viruses.
The Use of Palatal Island Flaps as an Adjunct to Microvascular Free Tissue Transfer for Reconstruction of Complex Oromandibular Defects
Authors: Ducic Yadranko , Herford Alan S. 
Published: November 2003

AbstractObjective To determine the efficacy of using palatal island flaps in combination with free tissue transfer for reconstruction of large, complex oral cavity defects.Study Design Prospective evaluation of patients with large, combined defects of the oral cavity reconstructed with palatal flaps in conjunction with microvascular free tissue transfer.Methods Elevation of a palatal flap was performed after completion of tumor resection. The flap was rotated and secured into place. A free flap was then harvested and inset to reconstruct the remaining oromandibular defect. Free flaps included the rectus abdominis (6), fibula (16), and radial forearm (6).Results Large complex oral cavity defects were repaired with a palatal island flap in conjunction with microvascular free tissue transfer in 28 consecutive patients. There were no complications associated with this flap.Conclusion Maximal functional rehabilitation of large, complex oral defects requires independent reconstruction of the various regions of the oral cavity rather than single flap reconstruction. When used as an adjunct to free tissue transfer, the palatal island flap offers a reliable method for reconstructing large combination defects.
Verification of Improved Patient Outcomes With a Partially Implantable Hearing Aid, The SOUNDTEC Direct Hearing System
Authors: Roland Peter S. , Shoup Angela G. , Shea M. Coyle , Richey Hyla S. , Jones D. Betty 
Published: November 2003

AbstractIntroduction Partially implantable hearing devices have been developed to address some of the user‐perceived shortcomings of standard amplification systems. Partially implantable devices are purported to provide improved sound quality as a result of decreased occlusion, decreased feedback, and enhanced clarity resulting from increased high‐frequency gain. Such improvements may result in greater user satisfaction. To justify selection of a partially implantable device and undergoing a minor surgical procedure, verification techniques must be used to document user improvement or increased satisfaction over conventional amplification.Objective To evaluate patient satisfaction with the SOUNDTEC direct hearing system.Study Design Within‐subjects repeated measures design.Methods Objective and subjective evaluation pre‐ and post‐implantation with the SOUNDTEC device. Verification techniques included tonal functional gain measures with traditional amplification and the SOUNDTEC device, word recognition in quiet (NU‐6) and in noise (SPIN), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Hough Ear Institute Profile (HEIP).Results Although there was no significant difference between optimal traditional amplification and the SOUNDTEC device for speech perception measures, the SOUNDTEC device yielded statistically significant increased high‐frequency functional gain. Subjective reports indicated that the SOUNDTEC device provides a cleaner, more natural sound without feedback than traditional amplification.Conclusions Partially implantable hearing aids may address some of the limitations of traditional amplification systems.
Optimal Concentration of Epinephrine for Vasoconstriction in Ear Surgery
Authors: Gessler Eric M. , Hart A. Kristina E. , Dunlevy Timothy M. , Greinwald John H. 
Published: November 2003

AbstractObjective To determine the optimal concentration of epinephrine required for vasoconstriction in ear surgery by evaluating changes in laser doppler blood flow.Study Design Prospective, randomized, double‐blinded.Methods Forty subjects undergoing surgical procedures under general anesthesia were injected in a standard posterior external auditory canal block with 1 mL of 1% lidocaine containing varying concentrations of epinephrine (nil, 1:50,000, 1:100,000, or 1:200,000) determined by randomization. Ear canal blood flow measurements were then made at 1‐minute intervals for a 10‐minute period using a laser doppler flow meter and compared with baseline blood flow.Results The control solution of 1% lidocaine had a significantly higher blood flow than the epinephrine‐containing solutions with an actual 200% increase in blood flow for the first 5 minutes before returning to baseline. All epinephrine‐containing solutions had an approximately 50% decrease in blood flow from baseline over the 10‐minute period as compared with the control which was statistically significant (P <.0001). There was no significant difference between the blood flow reduction of 1:50,000, 1:100,000, and 1:200,000 epinephrine‐containing solutions (P = .8875).Conclusions One percent lidocaine control exhibited the expected initial vasodilatory effect for approximately 5 minutes. In this experimental model, using a lower concentration of 1:200,000 epinephrine would supply equivalent vasoconstriction in the ear compared with higher concentrations, thus reducing the possible systemic toxicity and related morbidity.
5196 Mandible Fractures Among 4381 Active Duty Army Soldiers, 1980 to 1998
Authors: Boole Jason R. , Holtel Michael , Amoroso Paul , Yore Michelle 
Published: November 2003

AbstractObjective We present the frequencies of various types of mandibular fractures along with associated mechanisms and injuries.Methods Retrospective analysis of 5196 mandible fractures in 4381 patients extracted from the Total Army Injury and Health Outcomes Database (TAIHOD), a comprehensive database developed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) that links population data to all hospitalizations among active duty army soldiers. The database is based on the ICD‐9 CM coding system.Results We found the following frequencies for specific mandible fracture locations: angle 35.6%, symphysis 20.1%, subcondylar 14.2%, body 12.7%, condylar process 9.1%, ramus 4.5%, alveolar border 2.7%, and coronoid process 1%. The mechanisms of injury were separated into seven categories. Fighting accounts for 36.2%, automobile accidents for 18.6%, athletics for 13.6%, falls for 9.7%, motorcycle accidents for 3.1%, other land transport accidents for 3%, and miscellaneous causes for 15.8%. A few fracture locations appear to be associated with specific mechanisms. Of 82 alveolar border fractures with known mechanisms, 37% resulted from automobile accidents. Of 1094 angle fractures with known mechanisms, 48.6% resulted from fighting. Our data show that the majority of fractures were isolated to one location. Only one fracture was recorded for 70.6%, 29.2% have two fractures recorded, 0.2% have three or more fractures recorded. Associated injuries were common and include facial lacerations 1236 (28.2%), non‐mandible facial bone fractures 733 (16.7%), intracranial injury 403(9.2%), internal injuries 229 (5.2%), fractures of the upper limb 295 (6.7%), fractures of the lower extremity 302 (6.9%), and cervical fractures 34 (0.8%).Conclusions The mechanism of injury is important in determining the most likely resultant mandible fracture in the case of angle of mandible and alveolar ridge fractures. The clinician should maintain a high level of suspicion for associated injuries that occur more than one fourth of the time and even more frequently in motor vehicle accident victims. Associated intracranial injury is particularly important to rule out. Associated facial fractures, intracranial injury, internal injuries, and extremity injuries are all more common than cervical fractures.
Do Steroids Reduce Morbidity of Tonsillectomy? Meta‐Analysis of Randomized Trials
Authors: Steward David L. , Welge Jeffrey A. , Myer Charles M. 
Published: November 2003

AbstractObjectives/Hypothesis The study aims to reconcile conflicting published reports regarding the clinical efficacy of a single intraoperative dose of dexamethasone in reducing post‐tonsillectomy morbidity.Study Design Systematic overview (meta‐analysis).Methods To critically evaluate the existing evidence, we performed a formal meta‐analysis of eight double‐blinded, randomized, placebo‐controlled studies of dexamethasone in pediatric patients undergoing tonsillectomy or adenotonsillectomy. Reduction in postoperative emesis and pain, as well as early return to soft or solid diet, were studied as distinct end points.Results Children being given a single intraoperative dose of dexamethasone (dosing, 0.15–1.0 mg/kg; maximum dose, 8–25 mg) were two times less likely to vomit in the first 24 hours than children being given placebo (relative risk [RR] = 0.55; 95% confidence interval [CI], 0.41–0.74;P <.0001). Routine use in four children would be expected to result in one less patient having post‐tonsillectomy emesis (risk difference [RD] = −0.24; 95% CI, −0.38 to −0.10;P = .0006). In addition, children being given dexamethasone were more likely to advance to a soft or solid diet on post‐tonsillectomy day 1 (RR = 1.69; 95% CI, 1.02–2.79;P = .04) than those being given placebo. Because of missing data and varied outcome measures, pain could not be meaningfully analyzed as a distinct end point.Conclusion Given the frequency of tonsillectomy, relative safety and low cost of dexamethasone, and the reduction in postoperative morbidity, we recommend routine use of a single intravenous dose during pediatric tonsillectomy.
Angioedema Associated With Angiotensin II Receptor Antagonists: Challenging Our Knowledge of Angioedema and Its Etiology
Authors: Chiu Alexander G. , Krowiak Edward J. , Deeb Ziad E. 
Published: November 2003

AbstractIntroduction Use of angiotensin converting enzyme inhibitors has long been associated with angioedema. Increased levels of bradykinin caused by the inhibition of angiotensin converting enzyme have been thought to be responsible for this side effect. Angiotensin II receptor antagonists (AT2 blockers), such as losartan potassium (Cozaar; Merck & Co., West Point, PA), are a new class of antihypertensives developed in part to eliminate cough and angioedema associated with ACE inhibitors. These agents act by selectively binding to angiotensin II receptor sites, thereby eliminating the hypertensive effects of angiotensin without affecting local and systemic bradykinin levels. We present three cases of AT2 receptor antagonist‐induced angioedema, and examine its significance in the treatment of angioedema and its proposed etiology.Methods A retrospective chart review and review of the literature.Results Three patients taking the AT2 blocker losartan presented with mucosal swelling in the head and neck clinically consistent with angioedema. All three patients had prior episodes of angioedema while on losartan. Two patients presented with involvement of the anterior tongue and face that resolved within 12 hours of discontinuation of the losartan and a course of intravenous steroids. The third patient experienced recurring episodes of angioedema that eventually required a tracheotomy for airway compromise. After discontinuing the losartan and receiving a course of intravenous steroids, the angioedema resolved in 5 days. The patient was decannulated 10 days after onset of symptoms.Conclusion Angioedema is a potentially life‐threatening condition commonly associated with ACE inhibitor use. AT2 blockers bind to angiotensin II receptor sites and have no demonstrable effect on local or systemic bradykinin levels. We present three cases that demonstrate AT2 blocker‐induced angioedema. They were all complicated by the fact that the inciting agent, losartan, was not discontinued after the initial episode and resulted in recurrent episodes of angioedema, one of which required surgical airway intervention. The incidence of AT2 blocker‐induced angioedema brings into question prior theories on the etiology of angioedema and bradykinin's role in its pathogenesis.
Nontuberculous Mycobacterial Adenitis of the Head and Neck in Children: Experience From a Tertiary Care Pediatric Center
Authors: Rahal Akram , Abela Anthony , Arcand Pierre H. , Quintal Marie‐Claude , Lebel Marc H. , Tapiero Bruce F. 
Published: November 2003

AbstractObjective To describe our experience with the diagnosis, surgical treatment, and outcome of nontuberculous mycobacterial (NTM) adenitis of the head and neck in children, and to present a preliminary report about the use of NTM skin tests in our institution.Study Design Retrospective study.Methods The medical records of all children diagnosed with cervicofacial NTM adenitis were retrospectively reviewed for the period from January 1, 1995, through December 31, 2000. We also examined the use of intradermal skin tests for the diagnosis of NTM infection.Results Fifty patients were diagnosed with NTM cervicofacial adenitis. Pertinent demographic information, clinical presentation, investigation, and type of diagnostic procedures were documented. Surgical procedures, complications, and relapses were also noted. One unusual case of retropharyngeal adenitis is illustrated. All patients were treated with complete excision of their lesion at the first operation. No major complications were noted. Only one patient relapsed and required a second operation. Forty‐one children were skin‐tested with NTM antigens. Of these, 30 patients were dual‐tested with Purified Protein Derivative (PPD) also. No adverse reactions were noted with the use of skin tests. Sensitivity of NTM antigens alone is 87%. Sensitivity of dual testing is 78%. No patient had a PPD‐dominant reaction.Conclusion Surgical excision is the treatment of choice of NTM adenitis because of the high cure rate with a single procedure, the excellent cosmetic result, and the low complication rate. NTM skin tests are safe and could be useful in early diagnosis of the infection but further investigation is needed.
Aminoglycoside Ototoxicity: A Human Temporal Bone Study
Authors: Hinojosa Raul , Nelson Erik G. , Lerner Stephen A. , Redleaf Miriam I. , Schramm David R. 
Published: November 2003

AbstractObjective Hearing loss after aminoglycoside administration has been thought to result primarily from hair cell injury. The purpose of the study was to determine the potential for direct injury of spiral ganglion cells and hair cells in cases of documented human aminoglycoside ototoxicity.Study Design Retrospective case review.Methods The clinical course of two individuals with aminoglycoside ototoxicity are documented, including the details of administration of tobramycin and other ototoxic medication and serial audiograms. The temporal bones were processed, and the cochlear elements quantified.Results Histopathological study of the temporal bones from the individuals in the study demonstrated reduction of both ganglion cell and hair cell populations. Spiral ganglion cell loss was not necessarily subadjacent to areas of hair cell loss in cases of aminoglycoside ototoxicity. Instead, spiral ganglion cell reduction may be present in segments of the cochlea with normal‐appearing hair cells.Conclusions The study suggests that aminoglycoside antibiotics can injure spiral ganglion cells directly, as well as hair cells. Thus, the characteristic hearing loss of ototoxicity can result from degeneration of either cochlear element.
Physical Therapy Outcomes for Persons With Bilateral Vestibular Loss
Authors: Brown Kathryn E. , Whitney Susan L. , Wrisley Diane M. , Furman Joseph M. 
Published: November 2003

AbstractObjective The purpose of the study was to assess the efficacy of physical therapy for patients with bilateral vestibular loss.Study Design Retrospective case series.Methods Twenty‐four patients with a diagnosis of bilateral vestibular loss were identified by a retrospective chart review. Thirteen of the 24 patients met the inclusion criteria of having a moderate or greater loss of vestibular function bilaterally as rated by an otoneurologist based on the patient's vestibular function tests. These patients were treated with a custom‐designed physical therapy program for a mean of 4.6 visits over an average period of 3.8 months. Patients completed the Dizziness Handicap Inventory and the Activities‐specific Balance Confidence Scale at initial evaluation and discharge. Patients were asked to perform the balance and gait tasks of the Dynamic Gait Index, Sensory Organization Test of computerized dynamic posturography, and the Timed “Up and Go” test at their first and last physical therapy sessions. The number of falls in the previous 4 weeks and the use of an assistive device at initial evaluation and discharge were reported. Composite score, an overall score of clinical outcome, was calculated to determine clinically significant changes in physical performance and subjective information.Results On a population basis, statistically significant improvement was observed after physical therapy for each of the outcome measures including the composite score (P <.05). Clinically significant changes were demonstrated by 33% to 55% of the patients on the various outcome measures. No change was noted in the patients' risk of falling, their number of falls, and the use of assistive devices.Conclusion Many patients with bilateral vestibular loss benefit from an individualized vestibular physical therapy exercise program based on improved physical function and reduced self‐perceived levels of handicap.
Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) Expression in Squamous Cell Carcinomas of the Head and Neck
Authors: Neuchrist Csilla , Erovic Boban M. , Handisurya Alessandra , Steiner Georg E. , Rockwell Patricia , Gedlicka Claudia , Burian Martin 
Published: November 2003

AbstractObjectives Vascular endothelial growth factor receptor 2 (VEGFR2; Flk‐1 [fetal liver kinase]/KDR [kinase insert domain containing receptor]) has been identified as a high affinity receptor for vascular endothelial growth factor (VEGF) on vascular endothelium. Head and neck squamous cell carcinomas (HNSCC) have already been shown to produce substantial amounts of VEGF. VEGFR2 is supposed to play a major role in tumor‐neoangiogenesis.Methods We investigated 24 tumor specimens and 4 HNSCC cultured tumor cell lines for the incidence and distribution of VEGFR2 by immunohistochemistry using monoclonal antibodies (mAbs) and RT‐PCR.Results Analysis of frozen sections by immunohistochemistry showed that in 90% of tumor specimens VEGFR2‐positive cells were found which were associated with vascular endothelium. VEGFR2 was also expressed on tumor cells and vessels, which was confirmed by double immunolabeling of tumor cells with an a‐cytokeratin mAb. Furthermore, 2 (JPPA, SCC9) of 4 HNSCC cultured tumor cell lines revealed positive VEGFR2 immunoreactivity. Synthesis of VEGFR2 mRNA on all 4 HNSCC cultured tumor cell lines (JPPA, SCC9, SCC25, and LFFR) and in 6 tumor specimens was confirmed by RT‐PCR. In conclusion, our results showed that VEGFR2 is expressed in HNSCCs on tumor cells. VEGFR2 expression is associated with the beginning of vasculogenesis represented by accumulation of VEGFR2‐positive cells budding into new vessels (“hot spots”). The focal expression pattern of VEGFR2 on tumor cells suggests an autocrine loop for VEGF in tumor cell growth.