bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Antral Tap With Endoscopically Directed Nasal Culture
Authors: Casiano Roy R. , Cohn Stephen , Villasuso Eloy , Brown Margaret , Memari Faramarz , Barquist Erik , Namias Nicholas 
Published: November 2003

AbstractObjectives/Hypothesis The diagnosis of acute bacterial rhinosinusitis continues to generate controversy in critically ill patients. The efficacy of endoscopically directed cultures in these patients is unknown. We compared antral tap (AT) with endoscopic tissue culture (ETC) of the osteomeatal complex in an intensive care unit (ICU) setting.Methods Twenty patients admitted to a surgical/trauma ICU were evaluated by AT and ENB for the presence of rhinosinusitis. All patients had 1) a fever of unknown origin without resolution on empiric antibiotic therapy for ≥48 hrs; 2) other sources of fever ruled out; 3) computed tomography scan evidence of mucoperiosteal thickening ± sinus air/fluid levels; and 4) attempt at conservative treatment with topical decongestants and removal of all nasal intubation. Microbiologic data were collected and analyzed for any statistical difference between groups.Results A total of 29 sides underwent simultaneous tap and endoscopically directed tissue culture. The mean age was 40 years (range, 23–77 y) with 85% being males. Fifteen of 20 (75%) patients in the AT group were culture‐positive. Of the 49 isolates from the AT, 55% yielded Gram‐negative bacilli (Acinetobacter sp. 37%) and 45% yielded Gram‐positive cocci. The ETC group was culture‐positive in 18 of 20 (90%) patients. Of the 52 isolates from the ETC, Gram‐negative bacilli were found in 58% (Acinetobacter sp. 33%) and 42% yielded Gram‐positive cocci. The ETCs were culture‐positive in all but 1 patient with positive taps. There appeared to be a concordance between AT and ETC in 60% of the patients. In five instances (25%), results of the AT or ETC changed ICU management. Two patients ultimately required sinus surgery.Conclusions Sinus taps and/or endoscopically directed tissue cultures led to a change in ICU care in 25% of ICU patients studied. In patients with fever of unknown origin and computed tomography evidence of sinusitis, an antral tap continues to provide important information concerning maxillary sinusitis. However, ETC may give as good a representation of the microbiology and secondary inflammatory changes responsible for bacterial ICU rhinosinusitis causing fever of unknown origin. Further study on a larger group of patients is needed.
Sinusitis Complicated by Meningitis: Current Management
Authors: Younis Ramzi T. , Anand Vinod K. , Childress Curt 
Published: November 2003

AbstractObjectives Meningitis is the most common intracranial complication of sinusitis. We review the incidence, current management, outcomes, and complications of this serious infection. Our study also examines the evolving roles of endoscopic sinus surgery and other new therapeutic and diagnostic modalities in our armamentarium.Study Design A retrospective chart review was performed at a tertiary academic medical center of all patients diagnosed with sinusitis with complications between January 1985 and December 1999.Methods The patients were divided into two main groups: intracranial versus orbital complications. Meningitis was the most common intracranial complication. Data on patients with sinusitis and meningitis were collected and analyzed.Results Intracranial complications were present in 39 of 82 patients whereas orbital complications were noted in 43 patients. Twenty‐one of the 39 intracranial complications were meningitis. The most common computed tomography finding in adults (54%) was sphenoid sinusitis. All patients with AIDS (6 of 21) had unique cryptococcus meningitis. In patients without AIDS, the most common organism was Streptococcus pneumoniae (10 of 21). The most common sequela was seizure disorder (4 of 21). Endoscopic sinus surgery was performed on 7 of 21 patients. One patient with AIDS who had sinusitis and meningitis died.Conclusions Meningitis as a complication of sinusitis may still pose a serious threat. Although outcomes are encouraging, sequelae such as seizure disorders and hearing loss are common complications. The introduction of high‐resolution computed tomography scans and magnetic resonance imaging and the availability of wide‐spectrum antibiotics have improved our management significantly.
Molecular Differences in Mucoepidermoid Carcinoma and Adenoid Cystic Carcinoma of the Major Salivary Glands
Authors: Gibbons Mark D. , Manne Upender , Carroll William R. , Peters Glenn E. , Weiss Heidi L. , Grizzle William E. 
Published: November 2003

AbstractObjective/Hypothesis Mucoepidermoid carcinoma (MEC) and adenoid cystic carcinoma (ACC), the most common malignancies of the major salivary glands, are clinically and pathologically different. To determine whether MEC and ACC have different molecular characteristics, we examined the expression of erbB‐2, erbB‐3, epidermal growth factor receptor (EGFR), and transforming growth factor‐α (TGF‐α), important molecular features in other malignancies.Study Design/Methods Archival tissue sections of 22 MEC and 6 ACC tumors of the major salivary glands were evaluated immunohistochemically for expression of erbB‐2, erbB‐3, EGRF, and TGF‐α. A differential immunostaining score, reflecting the difference in immunostaining between carcinoma and uninvolved salivary gland tissue, was calculated for cytoplasmic and membranous staining.Results Positive immunostaining for all biomarkers was observed in the cytoplasm and membrane of both tumors. However, expression was higher in MEC than in ACC tumors and was statistically significant for cytoplasmic EGFR (P = .009), TGF‐α (P = .041), and membranous EGFR (P = .004). A significantly higher percentage of MEC cells also demonstrated positive immunostaining for cytoplasmic erbB‐3 (P = .022), EGFR (P = .005), membranous erbB‐3 (P = .022), and EGFR (P = .013). The differential immunostaining score was significantly higher for MEC compared with uninvolved alveolar tissue and the membranes of uninvolved ductal tissue. There were no statistically positive differential immunostaining scores for ACC.Conclusions There is a clear difference in the molecular phenotypes of MEC and ACC. The lack of statistically significant expression in ACC, when compared with similar uninvolved salivary gland tissue, suggests minimal involvement for these molecular structures in the pathogenesis of ACC. Conversely, erbB‐2, erbB‐3, EGFR, and TGF‐α may have a role in the development and progression of MEC. These results have therapeutic implications for MEC of the major salivary glands.
Prognostic Factors in Major Salivary Gland Cancer
Authors: Hocwald Eitan , Korkmaz Hakan , Yoo George H. , Adsay Volkan , Shibuya Terry Y. , Abrams Judith , Jacobs John R. 
Published: November 2003

AbstractObjective To identify features of major salivary gland cancers that are prognostic for disease‐free survival.Study Design A retrospective study of 78 patients with major salivary gland cancer (64 parotid and 14 submandibular gland) who underwent surgery for definitive treatment from 1976 to 1996. A select group of patients also received adjuvant radiation (56%) and/or chemotherapy (13%).Method Clinical and pathological risk factors were obtained from patients' charts and pathology reports. Age, gender, tumor site, T‐stage, facial paralysis, histologic neck involvement, perineural invasion, and cancer grade were analyzed with respect to disease‐free survival. The role of adjuvant treatment in terms of clinical outcome was also investigated.Results In our series, the 5‐year disease‐free survival was 65%. Examining clinical and histologic features one at a time, we found poorer prognosis was associated with submandibular tumors compared with parotid (P = .02), higher T‐stage (P = .001), positive cervical nodes (P <.001), perineural invasion (P = .002), and high‐grade or adenoid cystic tumors (P = .002). A multivariable analysis indicated that positive lymph nodes (P = .07) and perineural invasion (P = .03) were important histologic predictors of shorter disease‐free survival. Receipt of both adjuvant radiation and cisplatin‐based chemotherapy (P = .05) was an independent predictor of longer disease‐free survival.Conclusion Our study indicated that the presence of positive lymph nodes and perineural invasion is important independent predictors of disease‐free survival. Our limited data also suggest that adjuvant chemotherapy and radiation therapy may improve disease‐free survival.
Dendritic Cells Pulsed With Apoptotic Squamous Cell Carcinoma Have Anti‐Tumor Effects When Combined With Interleukin‐2
Authors: Son Young‐Ik , Mailliard Robbie B. , Watkins Simon C. , Lotze Michael T. 
Published: November 2003

AbstractObjectives Dendritic cells, the most potent of the antigen‐presenting cells, have been widely studied as a promising tool for antitumor immunotherapies. However, little has been determined about the efficacy of dendritic cell–based therapy for the treatment of squamous cell carcinoma (SCC) because there are no known SCC‐specific antigens. Recent reports indicate that dendritic cells can acquire antigens in the form of apoptotic cells and induce cytotoxic T‐lymphocyte responses. The aim of this study was to test the feasibility of adoptive dendritic cell immunotherapy against SCC by using apoptotic tumor cells as a source of tumor antigens.Study Design A poorly immunogenic SCC line KLN 205 was used to make subcutaneous tumors on the flank of DBA2/J syngeneic mice. Bone marrow–derived dendritic cells were pulsed with ultraviolet B–irradiated (apoptotic) KLN 205 cells in vitro and transferred to the opposite flank subcutaneously. Some of the animals received simultaneous intraperitoneal injections of low‐dose interleukin‐2.Results When combined with interleukin‐2, adoptive transfers of dendritic cells that were pulsed with apoptotic SCC significantly suppressed the tumor growth (P <.001) without notable side effects. Splenic T cells of treated mice produced greater amounts of interferon‐γ when restimulated with the relevant tumor (P <.001) as compared with control groups, indicative of an effective T‐cell–mediated systemic immune response.Conclusion Adoptive transfer of dendritic cells pulsed with apoptotic tumor cells as a source of tumor antigens, can elicit effective antitumor responses in the poorly immunogenic SCC model when combined with interleukin‐2.
Role of Clonazepam in the Treatment of Idiopathic Downbeat Nystagmus
Authors: Young Yi‐Ho , Huang Tsung‐Wei 
Published: November 2003

AbstractObjective/Hypothesis Downbeat nystagmus is defined as spontaneous nystagmus present with fixation in the primary position or lateral gaze. Those who have downbeat nystagmus but negative magnetic resonance imaging results are termed as idiopathic. Patients with idiopathic downbeat nystagmus, although unconcerned with their etiology, have visual symptoms such as oscillopsia, diplopia, or blurred vision. The purpose of this study is to evaluate the efficacy of clonazepam in treating idiopathic downbeat nystagmus.Methods Patients with downbeat nystagmus were rechecked by electronystagmography (ENG); then 0.5 mg clonazepam was administered orally. One hour later, follow‐up ENG was performed again to evaluate the evolution of the downbeat nystagmus. If the test was effective, then 1.0 mg clonazepam twice daily was administered to the patients.Results Seven cases had downbeat nystagmus, including idiopathic in five, cerebellar degeneration in one, and cerebellopontine angle tumor in one. The efficacy rate for the clonazepam test was 100% in five cases of idiopathic downbeat nystagmus, whereas it was ineffective in the case of cerebellar degeneration. After long‐term therapy with clonazepam, all patients with idiopathic downbeat nystagmus experienced elimination of oscillopsia, relief of diplopia, and improvement of visual acuity. Although temporary relief of downbeat nystagmus was observed 1 hour after the clonazepam test, downbeat nystagmus was not eliminated permanently.Conclusion We recommend long‐term therapy by clonazepam with a dosage of 1.0 mg twice daily in cases of idiopathic downbeat nystagmus. Reducing the downbeat nystagmus as well as eliminating the oscillopsia can be anticipated.
Preoperative Differences Between Male and Female Patients With Sleep Apnea
Authors: Walker Regina Paloyan , Durazo‐Arvizu Ramon , Wachter Bryan , Gopalsami Chellam 
Published: November 2003

AbstractObjectives/Hypothesis To evaluate the differences between female and male patients with obstructive sleep apnea syndrome (OSAS) in the preoperative period.Study Design Nonrandomized cross‐sectional study.Methods An analysis of 686 patients (111 women and 575 men) with OSAS was completed. Multivariate modeling techniques were employed to correlate gender with the preoperative respiratory disturbance index (RDI), apnea index (AI), hypopnea index (HI), body mass index (BMI), age, and initial symptoms.Results At presentation, the male patients were significantly younger and had a lower BMI and a higher RDI and AI than the female patients. For the entire OSAS population studied, the RDI increased as the BMI increased (correlation coefficient [r] = 0.35, P = <.001). For the female patients there was a weaker correlation (r = 0.21, P = .034), and in male patients there was a stronger correlation (r = 0.40, P <.001). For the entire population there was a negative correlation between age and RDI (r = −0.15, P <.001). In female patients there was a nonsignificant correlation (r = −0.09, P = .35), and in male patients the correlation was significant (r = −0.16, P <.001). There was no difference in the reporting of the number of symptoms based on gender (P = .355). Female patients noted headaches on awakening more commonly than male patients (P = .001), and male patients noted snoring (P = .014) and stopping breathing during sleep (P = .001) more often than female patients.Conclusions The analysis demonstrated that within a surgical population sample, gender differences exist. The findings of this series were as follows: 1) Apnea severity in women was less weight‐dependent than in men; (2) in men there was a significant negative correlation between age and apnea severity; and (3) female and male patients reported the same number of signs or symptoms on presentation, although certain signs and symptoms were more commonly reported based on gender. Current clinical evaluation practices must take into account this gender disparity.
Use of Helium–Oxygen Mixtures to Relieve Upper Airway Obstruction in a Pediatric Population
Authors: Grosz Anna H. , Jacobs Ian N. , Cho Catherine , Schears Gregory J. 
Published: November 2003

AbstractObjectives Helium as a component of inspired gas decreases turbulent flow and airway resistance. Helium–oxygen mixtures have been used since the 1930s in the management of patients with upper airway obstruction. The objective of this study was to evaluate the efficacy of helium–oxygen mixtures in relieving upper airway obstruction in a pediatric population.Study Design Retrospective chart review of 42 pediatric patients who received helium–oxygen mixtures for upper airway obstruction within a 3‐year period.Methods The study protocol included 42 pediatric patients, aged 1 week to 14 years, who were admitted to the Children's Hospital of Philadelphia from June 1997 to December 2000 and who received a total of 44 treatments of helium–oxygen therapy for upper airway obstruction. Response to treatment was determined by reduction in work of breathing noted on the chart.Results Thirty‐two of 44 helium–oxygen treatments resulted in a positive response (73%). There were no significant differences in demographic characteristics between responders and nonresponders, except all of the premature infants were responders and 6 of the 9 patients with syndromes were nonresponders.Conclusions Helium–oxygen therapy is a useful adjunct therapy for upper airway obstruction. Controlled clinical trials are necessary to better define the appropriate settings for use of helium–oxygen.
Predicting Fall Risks in an Elderly Population: Computer Dynamic Posturography Versus Electronystagmography Test Results
Authors: Girardi Marian , Konrad Horst R. , Amin Manali , Hughes Larry F. 
Published: November 2003

AbstractObjectives/Hypothesis Falls are the leading cause of morbidity and mortality for persons aged 65 years and older, with more than 2 million people falling and sustaining serious injury annually. This study compared computer dynamic posturography (CDP) and electronystagmography (ENG) results as predictors of falls.Study Design Retrospective.Methods Thirty‐three patients over the age of 65 years who presented to a balance disorders and falls prevention clinic were used for this study (22 women and 11 men, with an average age of 78.0 y and a mean fall rate of 3.5 times). All had experienced at least one fall in the year before visiting the clinic and were tested with both CDP and ENG. The CDP results were divided into subcategories (sensory organization testing and limits of stability); ENG results were divided into four categories (ocular motor, rotational chair, positional, and caloric studies).Results Test findings were classified as normal or abnormal based on age‐matched normative data. Of the patients in the study, 27.3% were normal for one type of testing and abnormal for the other. Twenty‐six patients (78.8%) had abnormal results on CDP, and 20 individuals (60.6%) showed ENG abnormalities (42.4% for ocular motor, 28.6% for positional, 13.6% for caloric, and 11.2% for rotational chair studies). The limits of stability category was significant in predicting multiple falls.Conclusion For this population, CDP was determined to be a more sensitive test for identifying patients who have fallen, with limits of stability testing the most significant part of the CDP battery; for ENG studies, the best falls indicator was the ocular motor battery.
Water‐Jet Dissection in Parotid Surgery: An Experimental Study in Dogs
Authors: Magritz Ralph , Jurk Viktor , Reusche Erich , Siegert Ralf 
Published: November 2003

AbstractObjective The objective of the present study was to investigate the application of the water‐jet dissection method in parotid surgery by way of animal experiments, paying particular attention to the clinical and histological reactions of the facial nerve.Study Design An animal experimental study.Methods Total bilateral parotidectomies with retention of the facial nerve were performed on 19 beagle dogs by means of the Hydro‐Jet device (Andreas Pein Medizintechnik Company, Schwerin, Germany) using different jet diameters and operating pressures. All operations were performed with continuous intraoperative facial monitoring (Neurosign 100, Inomed Company, Teningen, Germany). The dogs were monitored postoperatively over an average period of 20.3 days (range, 14–35 d). Local findings and facial nerve status were documented daily. In a second phase, the dissected nerves were resected and the animals were killed. Samples of water‐jet–dissected parotid tissue, as well as all dissected nerve branches, underwent histological examination and were compared with clinical and electrophysiological findings.Results It was possible to perform operations easily on all parotid glands by means of the Hydro‐Jet using the small, 120‐μm jet at operating pressures of 40 to 60 bar and to dissect the facial nerve quickly and safely with retention of its functional capability (n = 34). The dissection of nerves using larger‐diameter jets (150 and 200 μm [n = 64]) resulted in a total of two reversible and seven irreversible partial pareses.Conclusions The study has shown that it is possible to perform tissue‐selective operations on the parotid gland by means of the Hydro‐Jet using the 120‐μm jet at operating pressures of 40 to 60 bar, ensuring safe, atraumatic dissection of the facial nerve with retention of its functional capability. The advantages of the new Hydro‐Jet method offer a valuable alternative compared with the normal dissection methods adopted in parotid surgery. Thus the results of the present investigation currently are being checked within the framework of a clinical study at our clinic.
Microinvasive Nd:YAG Laser Therapy of Early Glottic Carcinoma and Its Effect on Soluble Interleukin‐2 Receptor, Interleukin‐2, and Natural Killer Cells
Authors: Lai Jin‐Ping , Tao Zheng‐De , Xiao Jian‐Yun , Chen Xiang‐Hui , Zhao Su‐Ping , Tian Yong‐Quan , Betz Christian S. 
Published: November 2003

AbstractObjective To investigate the effectiveness of microinvasive Nd:YAG laser therapy in human glottic Tis and T1 carcinomas, as well as its effect on the cellular immune function of the tumor‐bearing hosts.Study Design We treated 34 patients with microinvasive Nd:YAG laser therapy and evaluated its effect on the cellular immune function of the host.Methods Thirty‐four patients with glottic Tis or T1 squamous cell carcinoma were treated with fiberoptic laryngoscopic Nd:YAG laser surgery. Both before and after therapy, serum levels of soluble interleukin‐2 receptor (SIL‐2R) and interleukin‐2 (IL‐2), as well as natural killer (NK) cell activity, were determined by means of double‐antibody sandwich technique, tritiated thymidine‐deoxyribonucleoside incorporation, and iodine 125‐uridine‐deoxyribonucleoside release technique, respectively.Results All 34 patients tolerated the procedure well. A 3‐ to 7‐year follow‐up in a subgroup of 27 patients resulted in an estimated cure rate of 85.2% (23 of 27 patients). In all 27 patients with a regular follow‐up, a subjective improvement of phonation was noted after therapy to various degrees. In 74% (20 of 27 patients), voice and speech subjectively recovered to almost normal levels. The post‐therapy serum levels of SIL‐2R were significantly declined (P <.001), whereas those of IL‐2 and the NK activity were significantly elevated (P <.001) as compared with those detected before therapy.Conclusions Therapy with fiberoptic laryngoscopic Nd:YAG laser surgery is simple, safe, effective and only minimally invasive for patients with glottic Tis or T1 carcinoma. At the same time, it has an immunoenhancing effect on its host.
Long‐Term Results of Inferior Turbinate Reduction With Argon Plasma Coagulation
Authors: Bergler Wolfgang F. , Sadick Haneen , Hammerschmitt Nicolas , Oulmi Jasmina , Hörmann Karl 
Published: November 2003

AbstractObjectives Surgical reduction of the inferior turbinates is a commonly used therapy in patients with hyperplastic inferior turbinates when medical management remains ineffective. Current surgical methods have disadvantages (e.g., necessity of nasal packing, extended postoperative swelling, and high costs). Theoretical considerations render argon plasma coagulation (APC) a promising new therapeutic approach.Study Design In a prospective study, 121 patients with chronic nasal obstruction were treated for inferior turbinate reduction with APC. Hyperplasia of the nasal turbinates was diagnosed rhinoscopically and endoscopically and confirmed rhinomanometrically. The mean follow‐up period was 12 months, ranging from 10 to 16 months. The treatment results were evaluated by a questionnaire, rhinomanometric findings, and electron microscopic studies of the nasal mucosa. In 50 patients a ciliary function test was performed preoperatively and postoperatively.Methods Argon plasma coagulation, a high‐frequency electrosurgery, has been used for volume reduction of the inferior turbinate in local anesthesia.Results Seventy‐six percent of the patients reported an improvement of the postoperative swelling within the first week. After 6 weeks, macroscopically the turbinates were re‐epithelialized by normal mucosa in 63% of the patients. Electron microscopic studies after 3 months verified normal cilia. After 12 months, 83% of the patients stated that they had a better nasal airflow than preoperatively. Crust formation was minimal. No bleeding or impaired ciliary function occurred. Ninety‐five percent of the patients were willing to undergo the same operation again.Conclusion The long‐term results have proved APC to be an effective and easy‐to‐perform alternative for inferior turbinate reduction with comparable results to other established surgical methods.