bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Adenoidectomy Under Vision Using Suction‐Diathermy Ablation
Authors: Walker Paul 
Published: November 2003

AbstractObjectives To compare adenoidectomy using suction‐diathermy ablation with adenoidectomy by way of curettage in a pediatric tertiary care setting.Study Design A prospective series of 68 children undergoing adenoidectomy (without tonsillectomy) under vision using a suction‐diathermy ablation technique over 2 years was compared with an historical control group of 58 children undergoing adenoidectomy (without tonsillectomy) by way of curettage over 2 years.Method Intraoperative blood loss was recorded and compared. Efficacy in improving nasal symptomatology was compared between the two groups using an ordinal “nasal symptom score” preoperatively and postoperatively. Complications were recorded and compared. Analysis was performed using two‐tailed t tests.Results The two groups were well matched for age, weight, and adenoid size (P >.4). Follow‐up ranged from 4 to 48 months. Adenoidectomy using suction‐diathermy resulted in significantly less blood loss (P <.001). The technique was no less efficacious in terms of reducing the nasal symptom score than conventional adenoidectomy by way of curettage (P = .07). Complication rates were no different. No recurrences were identified and no instances of nasopharyngeal stenosis were recognized.Conclusions Routine use of suction‐diathermy ablation for adenoidectomy converts a difficult, often bloody procedure into a surgically precise operation. It is especially applicable to children. It may have additional advantages in aiding the prevention of the spread of the human form of bovine spongiform encephalopathy (variant Creutzfeldt‐Jakob disease [CJD]). Compared with other recently introduced techniques for adenoidectomy, it is considerably less expensive.
The Use of Buccal Mucosa Graft at Posterior Cricoid Splitting for Subglottic Stenosis Repair
Authors: Thomé Robert , Thomé Daniela Curti , Behlau Mara 
Published: November 2003

AbstractBackground Since 1955, when Réthi established the posterior cricoid split augmentation (PCSA) method, several authors have published supporting reports of the validity and proven efficacy of its basic principles. A 27‐year prospective, retrospective study.Objectives To report on experience in performing the PCSA method for subglottic and/or posterior–glottic stenosis repair using buccal mucosa interposition grafting at posterior cricoid split and stenting for 8 weeks, and to assess the impact on vocal function.Methods From 1972 on, 60 patients (45 adults, 15 children, aged 8 mo to 72 y) with subglottic and/or posterior–glottic stenosis were operated on using a modified PCSA method. The surgical technique consisted of posterior cricoid splitting, including or not the interarytenoid muscle; wide lateral retraction of the posterior cricoid halves; buccal mucosa interposition grafting and stenting for 8 weeks. The factors evaluated included the subglottic remodeling rate, donor and recipient sites morbidity, time to decannulation, rate of graft take, and phonatory function tests.Results The modified PCSA procedure resulted in a decannulation rate of 90%, 18 (30%) of which had further procedure to achieve decannulation, and 6 adult patients (10%) were considered failures because of restenosis. The rate of take of the mucosa graft was 100% in both children and adults, with complete epithelialization of the grafted area, the mucosa not becoming dry and crusty. No interarytenoid muscle division resulted in near‐normal to normal glottic voicing. Interarytenoid muscle division determined supraglottic voicing with inspiratory noise and pneumophonic incoordination, breathy and hoarse voice, low fundamental frequency, limited dynamic range, and shortened phonation time.Conclusion The PCSA procedure with buccal mucosa graft is reliable, safe, and highly successful with respect to the graft incorporation and subglottic remodeling. The division or not of the interarytenoid muscle is the most important factor influencing the postoperative vocal function.
Histopathology of Pleomorphic Adenoma in the Parotid Gland: A Prospective Unselected Series of 100 Cases
Authors: Stennert Eberhard , Guntinas‐Lichius Orlando , Klussmann Jens Peter , Arnold Georg 
Published: November 2003

AbstractObjectives/Hypothesis Histopathological characteristics of pleomorphic adenomas, especially of capsular alterations such as thin capsule areas, capsule‐free regions, capsule penetration, satellite nodules, and pseudopodia in the different subtypes, are described.Study Design Prospective unselected series of 100 consecutive cases from 1997 to 2000.Methods Light microscopic examination and semiquantitative analysis of the pleomorphic adenomas.Results Fifty‐one (51%) pleomorphic adenomas were classified as myxoid (stroma‐rich) type, 35 (35%) specimens as cellular type, and 14 (14%) as classic subtype. Ninety‐seven percent of all tumors showed areas with thin (<20 μm) capsule independent of the tumor subtype. Tumors of myxoid subtype showed the absolute greatest regions of a thin capsule. Especially, tumors of myxoid type (71%) often had a distinct focal absence of encapsulation with tumor merging into normal parotid gland tissue; 11% of the cellular subtype and 43% of the classic subtype presented capsule‐free areas. Thirty‐three percent of the myxoid pleomorphic adenomas, 23% of the cellular subtype, and 21% of the classic subtype had satellite nodules or pseudopodia.Conclusions Almost all pleomorphic adenomas have focally thin capsules. One‐fourth of all pleomorphic adenomas contain abnormalities such as satellite nodules or pseudopodia. More than two‐thirds of pleomorphic adenomas of the myxoid (stroma‐rich) subtype and at least half of all tumors show a focal absence of the capsule. Therefore, enucleation or local dissection of the pleomorphic adenoma is not a sufficient surgical treatment of this special tumor entity. We recommend, depending on the location of the tumor, a lateral or total parotidectomy as the treatment of choice.
The Prevalence of Occult Carotid Artery Stenosis in Patients With Head and Neck Squamous Cell Carcinoma
Authors: Cote Christopher R. , Goff James , Barry Patricia , Casler John 
Published: November 2003

AbstractObjectives/Hypothesis Risk factors for atherosclerotic carotid artery disease (ASCAD) and squamous cell carcinoma of the head and neck region (HNSCCA) are similar. This study was conducted to determine whether patients with HNSCCA have an increased rate of occult ASCAD compared with the general population.Study Design A cross‐sectional study was performed to identify the prevalence of clinically significant ASCAD in the specific population of patients with a diagnosis of HNSCCA using noninvasive color flow duplex imaging. In addition, the demographic variables and risk factors for head and neck cancer and for carotid disease, as identified in the literature, were recorded with the use of a questionnaire.Methods Forty‐nine patients with a diagnosis of HNSCCA completed the questionnaire and then had a duplex screening examination.Results The most common risk factor identified was tobacco smoking in 41 of 49 patients (84%). ASCAD was identified in one patient (2%). The stenosis in that patient was less than 60%.Conclusions We conclude from this study that even though patients with HNSCCA usually have risk factor(s) associated with ASCAD, the rate of occult ASCAD was not different from that found in the general population. Thus, routine screening of patients with HNSCCA with color flow duplex imaging to detect occult ASCAD is not warranted.
Use of Laboratory Evaluation and Radiologic Imaging in the Diagnostic Evaluation of Children With Sensorineural Hearing Loss
Authors: Mafong Derek D. , Shin Edward J. , Lalwani Anil K. 
Published: November 2003

AbstractObjective Laboratory testing and radiologic imaging are commonly used to delineate syndromic from nonsyndromic sensorineural HL (SNHL). The aim of this study was to examine the yield of laboratory tests and radiologic imaging commonly used in the diagnostic evaluation of SNHL in children.Study Design Retrospective analysis of 114 (54 female, 60 male) consecutively investigated children with SNHL between 1998 and 2000 at a tertiary‐care university hospital.Methods Results of routine laboratory testing to assess autoimmunity, blood dyscrasias, endocrine abnormalities, renal function, infection, and cardiac testing were reviewed. Results of radiologic evaluation were also reviewed. In general, computed tomography (CT) was obtained in patients with symmetric SNHL, whereas magnetic resonance imaging (MRI) with or without CT was obtained in asymmetric SNHL.Results Laboratory evaluation of the blood did not yield the etiology of SNHL in any patient. Blood tests for autoimmune disease were often positive but did not correlate with clinical disease. Nonspecific elevation of erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) was present in 22% of cases. An abnormal electrocardiogram with a prolonged QT interval resulted in the diagnosis of Jervall and Lange‐Nielsen syndrome. In the 97 patients who underwent radiologic studies, abnormalities were present in 38 of 97 studies (39%). Isolated inner ear malformations were twice as common as multiple abnormalities with large vestibular aqueducts as the most common isolated finding.Conclusion In the evaluation of children with unexplained SNHL, routine laboratory evaluation should be reconsidered given its low diagnostic yield. However, radiologic abnormalities of the inner ear are common. Identification of inner ear malformations has direct impact on management of these children, suggesting that all children should undergo radiologic imaging as an integral component of evaluation of SNHL.
Eosinophilia and Cell Activation Mediators in Nasal Secretions
Authors: Besançon‐Watelet Clotilde , Béné Marie C. , Montagne Paul , Faure Gilbert C. , Jankowski Roger 
Published: November 2003

AbstractObjectives/Hypothesis In rhinologic disorders such as polyposis or rhinitis, nasal cytology allows differentiation between patients according to the degree of eosinophilia in nasal secretions. The egress of eosinophil and/or neutrophil polymorphonuclears from the underlying mucosa might correlate with the release of soluble mediators of cell activation such as the chemokine IL‐8, and such molecules of the innate immunity as the LPS‐receptor CD14 or lysozyme. We assayed the levels of these three molecules in nasal secretions in correlation with cytologic findings and especially the degree of eosinophilia.Study Design Fifty‐four patients from a prospective study of nasal secretions were enrolled in this work. They constituted two groups of 27 patients each, respectively, with or without more than 20% eosinophils in nasal secretions. Nasal secretions were collected by aspiration, weighed and diluted in a fixed amount of buffer. Classic cytologic analyses were performed on the pelleted cells and IL‐8, sCD14, and lysozyme levels were assayed in the cell‐free supernatants.Methods Cytologic analyses included cell‐enumeration in Neubauer's chambers, and differentials performed on May‐Grünwald Giemsa‐stained cytospins. ELISA tests were used to assay the levels of IL‐8 and sCD14. Lysozyme concentrations were assayed in immuno‐nephelometry.Results Significantly lower levels of IL‐8 and sCD14 were observed in patients with eosinophilia than in patients with a predominance of neutrophils, whereas no difference was observed in lysozyme concentrations.Conclusion These data show that the egress of neutrophils in nasal secretions is associated with high levels of IL‐8 and sCD14.
Effects of Intranasal Azelastine on the Response to Nasal Allergen Challenge
Authors: Saengpanich Supinda , Assanasen Paraya , deTineo Marcy , Haney Lauran , Naclerio Robert M. , Baroody Fuad M. 
Published: November 2003

AbstractObjectives/Hypothesis Azelastine, a second‐generation H1‐receptor antagonist, is available for topical administration. The aim of the study was to evaluate the effects of topical intranasal azelastine on the early‐phase and the late‐phase allergic responses and on nasal hyper‐responsiveness to methacholine.Study Design Double‐blind, placebo‐controlled, two‐way crossover study in 20 subjects with seasonal allergic rhinitis, out of their allergy season.Methods Subjects were randomly assigned to receive either placebo or two puffs of azelastine twice a day (548 μg/d) for 2 weeks followed by nasal challenge with allergen. Twenty‐four hours later, while still receiving treatment, subjects underwent a nasal lavage and a nasal challenge with methacholine. End points included symptom scores, levels of mediators and number of eosinophils in nasal lavages, and the weight of secretions after methacholine challenge.Results Compared with placebo, treatment with intranasal azelastine resulted in significant reductions in allergen‐induced sneezing, rhinorrhea, itching, nasal congestion, and levels of albumin during the early‐phase response (P <.05). Azelastine had no effect on levels of histamine or tryptase during the early‐phase response. There was a significant eosinophil influx 24 hours after challenge, which was not inhibited by azelastine. Treatment with azelastine had no effect on the levels of albumin, interleukin‐4, interleukin‐5, intercellular adhesion molecule‐1, tumor necrosis factor‐α, and eosinophil cationic protein during the late‐phase response. However, azelastine did show a significant inhibitory effect on the methacholine response 24 hours after nasal allergen challenge (P <.05).Conclusions The effects of intranasal azelastine are similar to those of oral second‐generation antihistamines.
Histopathological Features of Occult Metastasis Detected by Sentinel Lymph Node Biopsy in Oral and Oropharyngeal Squamous Cell Carcinoma
Authors: Stoeckli Sandro J. , Pfaltz Madeleine , Steinert Hans , Schmid Stephan 
Published: November 2003

AbstractObjectives Sentinel lymph node biopsy has been introduced for head and neck cancer with promising results. Research in breast cancer has revealed different histopathological features of occult lymph node metastasis with possibly different clinical and prognostic implications. The aim of the study was to evaluate the histopathological features of occult metastasis detected by sentinel lymph node in oral and oropharyngeal squamous cell carcinoma.Study Design Prospective.Methods According to Hermanek, 5 occult metastasis was differentiated into isolated tumor cells and infiltration of lymph node parenchyma smaller than 2 mm in diameter (micrometastasis) and larger than 2 mm in diameter (metastasis).Results Occult metastases were found in 6 of 19 (32%) sentinel lymph nodes. Three patients showed micrometastasis with a mean size of 1.4 mm (range, 1.2–1.5 mm), the first with three separate micrometastases within the same sentinel lymph node, the second with an additional cluster of isolated tumor cells within the same sentinel lymph node, and the third with an additional micrometastasis in one lymph node of the elective neck dissection. Two patients had macrometastasis (3.4 and 8 mm), both with multiple metastases in the elective neck dissection. One patient had two clusters of isolated tumor cells in the sentinel lymph node and an additional cluster of isolated tumor cells in one lymph node of the elective neck dissection.Conclusions Occult metastasis can be subdivided histopathologically in isolated tumor cells, micrometastasis, and macrometastasis. We present the first study describing a great variety of these subtypes in sentinel lymph nodes from head and neck squamous cell carcinoma. Because the independent prognostic factor and clinical relevance of these subtypes is still unclear, we emphasize the importance of reporting these findings uniformly and according to well‐established criteria.
Chondrosarcoma of the Skull Base
Authors: Neff Brian , Sataloff Robert Thayer , Storey Leslie , Hawkshaw Mary , Spiegel Joseph R. 
Published: November 2003

AbstractObjectives Sarcomas of the skull base are challenging, potentially lethal tumors. Prognosis is considered poor. The present report reviews treatment options and presents a case of treatment with en bloc resection of the temporal bone and adjacent skull base.Study Design Single case report and literature review.Results Extensive skull base resection for chondrosarcoma can be performed successfully and may be curative.Conclusion There is a role for en bloc resection of large areas of the skull base for treatment of chondrosarcoma. It appears that treatment combining surgery and radiation therapy is most likely to be effective.
The Treatment of Horizontal Canal Positional Vertigo: Our Experience in 66 Cases
Authors: Casani Augusto P. , Vannucci Giovanni , Fattori Bruno , Berrettini Stefano 
Published: November 2003

AbstractObjectives/Hypothesis The horizontal semicircular canal variant of paroxysmal positional vertigo (HSC‐PPV) shows three subtype nystagmic patterns: 1) bilateral geotropic nystagmus, 2) bilateral apogeotropic nystagmus that may switch into bilateral geotropic, and 3) bilateral apogeotropic nystagmus that never switches into bilateral geotropic. In recent years, many methods of physical treatment have been proposed for HSC‐PPV, yet no standard protocol has been defined. We studied the effects of different methods according to each different form of HSC‐PPV after a precise definition of the nystagmic and clinical features.Study Design A prospective trial of 66 patients with horizontal canal paroxysmal positional vertigo treated with a combination of rotational maneuver and forced prolonged position.Methods We evaluated 66 patients with HSC‐PPV in its three subtypes. For patients with bilateral geotropic nystagmus, the “barbecue” method was combined with “forced prolonged position.” Patients with bilateral geotropic nystagmus were submitted to maneuvers aimed at a switch to bilateral geotropic. The cases that did not switch were submitted to a modified fourth step of the Semont maneuver.Results Eighty percent of the patients with bilateral geotropic nystagmus became symptom free within the second session, and in 90% of the patients, symptoms were resolved by the third session. In the bilateral apogeotropic cases, the modified fourth step of the Semont maneuver resulted in 75% of the patients being symptom free.Conclusions The correct identification of both nystagmic pattern and site of the lesion is crucial for the choice of physical treatment of HSC‐PPV and its success. We have standardized the treatment protocol consisting of a “barbecue” maneuver followed by “forced prolonged position” in cases of geotropic nystagmus and a modified fourth step of the Semont maneuver for apogeotropic nystagmus. Our results appear encouraging because 90% of the entire study group was symptom free after three sessions.
Active High‐Frequency Vestibulo‐Ocular Reflex and Seasickness Susceptibility
Authors: Nachum Zohar , Gordon Carlos R. , Shahal Baruch , Spitzer Orna , Shupak Avi 
Published: November 2003

AbstractObjectives/Hypothesis The vestibular autorotation test (VAT) examines responses to active head oscillations at frequencies between 2 and 6 Hz in the horizontal and vertical planes while the subject is fixating a visible target. At these frequencies, the vestibulo‐ocular reflex (VOR) is the main source of eye movement for ocular stabilization, although other visual and somatosensory information interacts with the response. Because the neural mismatch theory places emphasis on multimodal sensory interactions as the cause of motion sickness, using the VAT, which measures eye movements resulting from vestibular, visual, and, to a certain extent, proprioceptive information and depends on the conscious participation and cooperation of the subject, could be of advantage in evaluating individuals with differing susceptibility to motion sickness. The purpose of the present study was to evaluate high‐frequency VOR parameters in seamen at the two extremes of the seasickness susceptibility scale.Study Design Cross‐sectional, parallel‐group design.Methods Participants in the study were 35 healthy male volunteers aged 18 to 23 years, of whom 20 were highly susceptible to seasickness and 15 were nonsusceptible. The vestibulo‐ocular reflex was evaluated by the VAT at frequencies ranging from 2.0 to 5.9 Hz.Results The lag of the vertical phase was significantly higher in the susceptible group. A significant interaction was also found between group and frequency, the vertical phase being significantly higher in the 3.9‐ to 5.9‐Hz range. Although no group effect was detected for the lag of the horizontal phase, there was a significant interaction between group and frequency, the horizontal phase being higher in the susceptible group at 5.5 and 5.9 Hz. No significant group differences were found for horizontal or vertical gain.Conclusions The present findings support the contention that the VAT, which measures eye movements resulting from multimodal vestibular, visual, and, to a certain extent, proprioceptive information and depends on the conscious participation and cooperation of the subject, may produce different results in subjects at the two extremes of the seasickness susceptibility scale. Despite the statistical differences that were found, VAT measurements could not be used for practical purposes to categorize individual motion sickness susceptibility.
Recurrent Attacks of Facial Nerve Palsy as the Presenting Sign of Leukemic Relapse
Authors: Rhee Dukhee , Myssiorek David , Zahtz Gerald , Diamond Alan , Paley Carol , Shende Ashok 
Published: November 2003

AbstractObjective To present an unusual case of recurrent facial palsy resulting from acute leukemic infiltration of the parotid gland.Study Design Case report.Methods An 11‐year‐old boy who had been treated for acute lymphoblastic leukemia (ALL) from 3 to 6 years of age presented with intermittent left facial nerve palsy with concurrent ipsilateral parotid fullness. The initial findings at diagnosis and workup are presented, and the disease progression and resolution with therapy are documented.Results The patient had been off therapy when this finding developed. A workup for central and viral etiologies for the facial palsy was unrevealing. Biopsy of the parotid gland demonstrated a lymphoblastic leukemic infiltrate. The patient was placed on a chemotherapy protocol for relapsed leukemia, resulting in complete resolution of the facial palsy.Conclusion Isolated facial nerve dysfunction, albeit rare, has been documented as a sign of central nervous system involvement in leukemia, but until now this presentation has not been described in the setting of leukemic relapse presenting with acute infiltration of the parotid gland.
The Potential Risk of Carotid Injury in Cochlear Implant Surgery
Authors: Gastman B. R. , Hirsch B. E. , Sando I. , Fukui M. B. , Wargo M. L. 
Published: November 2003

AbstractBackground The advent of cochlear implantation has revolutionized the options afforded to the deaf population. With the increase in the prevalence of this procedure have come larger experiences in the associated technical challenges and complications.Results We present the evaluation and management of a patient with an unusual complication of improper placement of the implant electrode into the carotid canal and its management. We discuss the anatomy of the carotid artery and its proximity to the cochlea to emphasize the potential risk to this large vessel.Conclusions Damage to the carotid canal and the carotid artery is a potential risk of cochlear implant surgery. When available, we recommend intraoperative electrical testing of the cochlear implant be performed. If there is doubt as to the placement of the electrode, a radiograph should be obtained before the patient is taken out of the operating room to avoid this complication.