bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fourth branchial arch sinus: Clinical presentation, diagnostic workup, and surgical treatment
Authors: Yang Caroline , Cohen James , Everts Edwin , Smith James , Caro James , Andersen Peter 
Published: November 2003

AbstractObjectives/Hypothesis: Abnormalities of the fourth branchial arch are much less common than those of the second arch and present in a different manner. The authors report their experience with five cases of fourth arch sinuses. Methods: Retrospective chart review of patients at a tertiary care center. Results: All patients presented in the first or second decade of life, and all but one had left‐sided neck involvement. Four patients presented with recurrent low neck inflammatory episodes, and one with respiratory compromise. Diagnostic studies performed included ultrasound, computed tomography (CT) scan, barium swallow, magnetic resonance imaging, and fine‐needle aspiration. Barium contrast studies and CT scan were the most useful in demonstrating a fourth arch sinus tract preoperatively. Surgical treatment with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the lateral piriform sinus to facilitate complete sinus tract excision was successful in all patients. Conclusion: The clinical history of recurrent low neck inflammatory episodes in young patients, especially on the left side, should raise the suspicion of this entity. Investigation using barium swallow in combination with CT scanning is useful. Excision of the sinus tract taking care not to injure the recurrent laryngeal nerve is curative.
Prognostic significance of p53 gene mutations in laryngeal cancer
Authors: Chomehai Joseph S. , Du Wei , Sarkar Fazlul H. , Li Yi W. , Jacobs John R. , Ensley John F. , Sakr Wael , Yoo George H. 
Published: November 2003

AbstractObjective/Hypothesis: We examined whether p53 gene mutations were predictive of clinical behavior in laryngeal cancer. Study Design: Retrospective study of 45 patients with laryngeal cancer from 1985 to 1997. Methods: DNA was extracted from tumor tissue and subject to polymerase chain reaction single‐strand conformational polymorphism (PCR‐SSCP) as well as DNA sequencing. The clinical outcome was correlated to the presence or absence of a p53 mutation. Results: The p53 gene was analyzed by direct DNA sequencing and was found to be mutated in 33% (15/45) of patients. The presence of a p53 mutation was associated with a significant improvement in overall survival (80% vs. 43%, P < .03) and a trend toward improved disease‐free survival (87% vs. 60%, P = .08). When other prognostic factors were adjusted, multivariate analysis revealed a trend toward improvement in overall survival as well as disease‐free survival. Conclusion: Depending on the location of a p53 mutation, the suppressive functions or clinical outcome may or may not be affected. Fifty‐three percent of mutations were detected in nonconserved regions as opposed to 17% as reported in colon cancer. In colon cancer, mutations in conserved regions of the p53 gene predicted a poorer survival, whereas nonconserved gene mutations were not predictive. In our group of patients, p53 mutations predicted a better prognosis, which may be due to a large proportion of mutations that lie within nonconserved areas. The predictive power of p53 gene mutations may depend on functional loss and inactivation of highly conserved areas and must be tested in a prospective trial.
Otogenic intracranial infections in adults
Authors: Barry Béatrix , Delattre Jérome , Vié François , Bedos Jean‐Pierre , Géhanno Pierre 
Published: November 2003

AbstractObjective: To assess the type and bacteriology of otologic diseases associated with bacterial meningitis in adults. Method: Retrospective review of 79 patients over an 18‐year period. Results: Acute otitis media was diagnosed in 32 patients, chronic otitis in 29 (16 with cholesteatoma), and cerebrospinal fluid leak in 18. Streptococcus pneumoniae was a common cause of meningitis‐complicating acute otitis media (69%) or cerebrospinal fluid leak (50%), whereas other bacteria or negative cultures were found in the cerebrospinal fluid of patients with chronic otitis. Surgery was performed promptly in 26 patients; four patients died. Conclusions: Early diagnosis of otogenic bacterial meningitis is essential to allow appropriate antimicrobial treatment. Antimicrobials active on gram negative bacilli and anaerobes should be used in patients with chronic otitis. An emergency surgical procedure is required in patients whose neurologic or infectious status fails to improve under antimicrobial treatment.
Middle ear pathologic changes associated with chronic anaerobic sinusitis in rabbits
Authors: Kennedy Cynthia A. , Jyonouchi Harumi , Kajander Keith C. , Sun Sining , Rimell Frank L. 
Published: November 2003

AbstractObjective/Hypothesis: To study the histopathologic changes in association with the inflammatory/immune response present in the middle ears of a rabbit model of unilateral chronic anaerobic sinusitis. Study Design: New Zealand white rabbits, two at each experimental time point. Normal rabbits and sham‐operated animals served as controls. Methods: Left maxillary sinusitis was induced by inoculating Bacteroides fragilis surgically after closure of the ostium. Cultures, lavages, and mucosa were harvested from bilateral middle ear and sinus cavities at 1, 2, 3, and 4 weeks following inoculation. Parameters analyzed include tissue for histopathologic study, immunoglobulin G antibody (IgG Ab) against B fragilis, and lactate dehydrogenase (LDH) levels in lavage samples, interferon gamma (IFNγ) messenger RNA (mRNA) expression in mucosal tissue, and bacterial culture. Results: Despite closure of the ostium of the left sinus, mild to moderate dissemination of B fragilis into the right sinus and left and right ears were observed in some but not all rabbits (2/8,5/7, and 2/8, respectively). Histopathologic changes in the right sinus and middle ears were much less severe in contrast to the severe inflammatory changes in the left sinus. An immune response against B fragilis appeared to occur in the sinuses and ears bilaterally independent of bacterial dissemination, as evidenced by a rise of IgG Ab in lavage fluid and detection of IFNg mRNA. Neither control nor sham‐operated animals had detectable levels of IFNg mRNA or IgG Ab. In B fragilis–inoculated rabbits, the magnitude of IgG Ab responses was equivalent in the right and left ear, independent of B fragilis dissemination; IgG Ab levels in the middle ear positively correlated to each other (P < .01) and to the levels in the sinuses (P < .01 and P < .01). LDH levels were closely associated with bacterial growth and degree of tissue inflammation. Conclusion: This reproducible model of chronic sinusitis provides an opportunity to study the middle ear infection and inflammatory/immune responses occurring with sinusitis. Our results indicate bilateral middle ear mucosal immune responses to an elicited sinus infection, independent of B fragilis dissemination.
A Meta‐Analysis of Swimming and Water Precautions
Authors: Lee Dennis , Youk Ada , Goldstein Nira A. 
Published: November 2003

AbstractObjective: To reconcile conflicting reports concerning the incidence of otorrhea in children with tympanostomy tubes who swim without ear protection.Study Selection: Articles were identified by MEDLINE search, Current Contents, and references from review articles, textbook chapters, and retrieved reports. Controlled trials of water precautions following tympanostomy tube placement were selected by independent observers and scored on 10 measures of study validity. Five English‐language articles met all inclusion criteria.Data Extraction: Data were abstracted for an endpoint of otorrhea following swimming without ear protection with a minimum follow‐up of 6 weeks.Data Synthesis: Pooled analysis of 619 children revealed a rate difference of −5.04 (95% confidence interval [CI], −11.62 to 1.54). No significant difference in the incidence of otorrhea was noted between patients who swam without ear protection and nonswimmers.Conclusion: There is no increase in incidence of otorrhea in children who swim without ear protection compared with children who do not swim following tympanostomy tube placement.
Amplification of RNA From Archival Human Temporal Bone Sections
Authors: Ohtani Fumio , Furuta Yasushi , Iino Yukiko , Inuyama Yukio , Fukuda Satoshi 
Published: November 2003

AbstractBackground: The amplification of DNA from celloidin‐embedded human temporal bone sections by polymerase chain reaction (PCR) has been applied to some auditory diseases, such as herpes zoster oticus and hearing loss caused by the mutations of mitochondrial DNA. However, few studies have reported detection of RNA from temporal bone sections.Objectives: Because RNA analysis from temporal bone sections may elucidate the development of the diseases in the auditory, vestibular, and facial nerves, the authors investigated whether RNA in these sections can be amplified by reverse transcription (RT)‐PCR.Methods: Sections that were formalin‐fixed, decalcified, and embedded between 1972 and 1986 were used. Nucleic acid was extracted from the celloidin‐embedded temporal bone sections and subjected to RT‐PCR. Human α‐tubulin RNA was reverse transcribed to cDNA and amplified by nested PCR using two sets of primers that were designed to distinguish cDNA from genomic DNA based on the presence of an intron between the primers.Results: Human α‐tubulin RNA was detected in 11 of 14 temporal bone sections (79%) by RT‐PCR. RNA was detected in even the oldest sections, which were processed in 1972.Conclusions: These results indicate that RNA can be analyzed from archival celloidin‐embedded human temporal bone sections.
Evaluation of Endoscope Sheaths As Viral Barriers
Authors: Baker Karen H. , Chaput Maria P. , Clavet Clark R. , Varney George W. , To Theresa M. , Lytle C. David 
Published: November 2003

AbstractObjectives: Evaluate ENT endoscope sheaths as barriers to virus passage.Study Design: “Defective” sheaths covering an endoscope were challenged with virus to determine how many virus particles could be recovered from the endoscope.Methods: Sheaths with small laser‐drilled holes (2 to 30 μm) were challenged with high‐titer virus suspensions (108 viruses/mL). The inside of the sheath and the endoscope were separately rinsed to recover any virus that penetrated through the hole in the sheath. In an attempt to assess the possible importance of holes in the sheaths, a sequential test was conducted with an initial virus challenge outside a defective sheath (30‐micron hole in the sheath), after which the possibly contaminated endoscope was removed and inserted into a second defective sheath (with a 20‐micron hole at the same location) to determine whether the contaminating virus would pass outward through the second sheath.Results: Small volumes of virus‐containing fluid penetrated through the hole, e.g., 500 virus particles passed through one of three 30‐μm holes. A significant fraction of those virus particles was occasionally found on the endoscope after removal from the sheath. Similar results were obtained with sheaths that had small tears (34‐84 μm in length, from punctures with fine wires). Although some virus penetration could occur during the initial challenge contaminating the endoscope, no virus was detected passing outward through the second sheath.Conclusions: Use of a sheath combined with intermediate level disinfection should provide a safe instrument for ENT endoscopy.
Peer Review: Studying the Major Otolaryngology Journals
Authors: Bhattacharyya Neil 
Published: November 2003

AbstractObjective: To determine if the otolaryngology literature is comparable to other surgical specialty journals with respect to quality and types of articles published.Methods: The four major otolaryngology journals‐Annals of Otology, Rhinology and Laryngology, Archives of Otolaryngology‐Head and Neck Surgery, Laryngoscope, and Otolaryngology‐Head and Neck Surgery‐were studied for 6‐months and examined for the following variables: 1) proportion of clinical or basic science research, 2) proportion of prospective or retrospective studies, 3) types of statistics used, 4) sample sizes of the studies, and 5) proportion of single case reports. A composite group of surgical specialty journals consisting of Journal of Bone and Joint Surgery, Neurosurgery, and Ophthalmology was also studied for the same time period. The otolaryngology journals and other specialty journals were compared with respect to each of these variables, after which the comparison was conducted within the group of otolaryngology journals.Results: Analysis of 905 articles, comprising 508 articles from the four major otolaryngology journals and 397 articles from the composite of the other specialty journals, was conducted. No significant difference in the proportion of single case reports between the otolaryngology journals (15.0%) and the other specialty journals (12.8%) was noted (P = .364). The otolaryngology journals had a significantly higher proportion of basic research than the other specialty journals (27.4% vs. 14.5%, P < .001) as well as a higher percentage of prospective studies (62.1% vs. 49.0%, P = .001). The studies in the otolaryngology journals had a much lower mean sample size than those in the other specialty journals (70.2 vs. 373.8, P = .010). No difference between the two groups was found in the use of statistics (P = .228). Among the otolaryngology journals, Laryngoscope was found to publish fewer single case reports than the other three journals, and Annals of Otology, Rhinology and Laryngology had the highest proportion of prospective studies (P = .031 and .012, respectively). No differences were found for sample sizes and use of statistical analysis (P = .266 and P .710, respectively) among the otolaryngology journals.Conclusions: The otolaryngology literature compares quite favorably with the literature of other surgical specialties, excelling in prospective studies and basic science research. It only lags with respect to sample size. The study composition among the different major otolaryngology journals is largely similar with respect to basic study parameters, suggesting comparable quality among the journals.
Clinical evidence for dystrophin dysfunction as a cause of hearing loss in locus DFN4
Authors: Pfister Markus H. F. , Apaydin Fazil , Turan Onur , Bereketoglu Muslum , Bilgen Vecihi , Braendle Uwe , Kose Suheyla , Zenner Hans‐Peter , Lalwani Anil K. 
Published: November 2003

AbstractObjective: Locus DFN4 is an X‐linked nonsyndromic hearing loss locus originally mapped to Xp21.2. Recently, we have mapped deafness in a second family from Turkey to the same region, refining the location to within the Duchenne muscular dystrophy (DMD) locus. The objective of this study was to characterize the clinical phenotype of the Turkish family with comprehensive audiovestibular testing and high‐resolution temporal bone computerized tomography. Methods: Fourteen members of a three‐generation family were studied in detail including two deaf affected males. Members of the family underwent general physical and otologic examination, vestibular testing, pure‐tone audiometry, otoacoustic emissions, and immitance testing. An affected male underwent high‐resolution computerized tomography of the temporal bone, electroretinogram (ERG), electromyography, electroneurography, and determination of serum creatinine phosphokinase level. Results: Affected males were congenitally deaf with normal vestibular function. Carrier females showed a mild sensorineural hearing loss affecting all frequencies and absent otoacoustic emissions. Otoacoustic emissions in a younger, 3‐year‐old carrier girl were normal. In an affected male, ERG demonstrated subnormal scotopic b‐wave typically seen in DMD. Computerized tomography of the temporal bone was normal. With the exception of the ERG finding, there was no clinical or laboratory evidence of DMD or Becker muscular dystrophy (BMD). Conclusion: The abnormal ERG in the Turkish family in conjunction with mapping of the DFN4 locus to within DMD strongly suggests that a defect in dystrophin is responsible for the hearing loss in this family. Patients with DMD and BMD should be screened systematically for sensorineural hearing loss. This family provides additional evidence for the critical role of cytoskeletal proteins in normal hearing.
Expression of protein p27 is associated with progression and prognosis in laryngeal cancer
Authors: Fan Guo‐Kang , Fujieda Shigeharu , Sunaga Hiroshi , Tsuzuki Hideaki , Ito Nobuhisa , Saito Hitoshi 
Published: November 2003

AbstractObjective: A cyclin‐dependent kinase inhibitor, p27kip1, is recognized as a negative regulator of the cell cycle. To clarify whether immunohistochemical detection of p27 might provide prognostic information, we investigated the expression of p27 in laryngeal squamous cell carcinoma (SCC). Study Design: A retrospective study of patients was performed in 109 cases of laryngeal SCC. In addition, we investigated the expression of p53 and granulocyte colony‐stimulating factor receptor (GCSF‐R) to examine the prognostic significance of them in the same samples. Methods: Immunohistochemical staining by specific monoclonal antibodies was performed using the avidin‐biotin‐peroxidase complex technique. Results: Advanced tumor size and clinical stage and the occurrence of lymph node metastasis were associated with the absence of p27 expression, but not correlated with p53 expression and GCSF‐R expression. The overall 5‐year survival rate in the p27‐positive group was significantly higher than that in the p27‐negative group. In the Cox proportional hazard model, p27 was demonstrated to be the most powerful prognostic factor among gender, tumor size, lymph node metastasis, stage of disease, and p53 and GCSF‐R expression. Conclusions: We concluded that assessment of p27 expression is useful as a prognostic factor for laryngeal SCC and of value in selecting patients with laryngeal SCC for aggressive therapy.
Vocal fold proteoglycans and their influence on biomechanics
Authors: Gray Steven D. , Titze Ingo R. , Chan Roger , Hammond Thomas Hale 
Published: November 2003

AbstractObjective/Hypothesis: To examine the interstitial proteins of the vocal fold and their influence on the biomechanical properties of that tissue.Study Design: Anatomic study of the lamina propria of human cadaveric vocal folds combined with some viscosity testing.Methods: Identification of proteoglycans is performed with histochemical staining. Quantitative analysis is performed using an image analysis system. A rheometer is used for viscosity testing. Three‐dimensional rendering program is used for the computer images.Results: Proteoglycans play an important role in tissue biomechanics. Hyaluronic acid is a key molecule that affects viscosity.Discussion: The proteoglycans of the lamina propria have important biological and biomechanical effects. The role of hyaluronic acid in determining tissue viscosity is emphasized. Viscosity, its effect on phonatory threshold pressure and energy expended due to phonation is discussed.Conclusion: Proteoglycans, particularly hyaluronic acid, play important roles in determining biomechanical properties of tissue oscillation. Future research will likely make these proteins of important therapeutic interest.
Surgical management of thyroid masses: Assessing the need for frozen section evaluation
Authors: Lin Ho‐Sheng , Komisar Arnold , Opher Elana , Blaugrund Stanley M. 
Published: November 2003

AbstractObjective/Hypothesis: To determine the need for intraoperative frozen section to guide the extent of thyroid surgery in the presence of an adequate preoperative fine‐needle aspiration (FNA) finding. Methods: Charts of patients who presented from 1995 to 1998 to the two senior authors were reviewed. A total of 82 patients were found who satisfied the inclusion criteria of having both an adequate FNA and frozen section. The extent of surgery was based on the frozen section finding for all the patients in this study. The authors looked at the number of cases in which the surgical management would be changed if the frozen section was not obtained and the surgical decision was based only on preoperative FNA and intraoperative findings. Results: FNA revealed papillary carcinoma in 18 patients that was confirmed by intraoperative frozen section and final pathology. In the remaining 64 patients, the FNA diagnosis was either benign or suspicious. When routine frozen section was done, 61 of these 64 patients were found to have either benign pathology or pathological diagnosis that was deferred to permanent section. Only three patients were found to have malignancy on frozen section that was missed by FNA. Of these three patients, two had obvious findings of malignancy at the time of surgery. This leaves only one patient with carcinoma that was missed by FNA and intraoperative findings but detected by the intraoperative frozen section. Conclusion: Of the 82 patients in this study, only one extra case of malignancy would be missed by elimination of the routine use of intraoperative frozen section. The authors conclude that the routine use of intraoperative frozen section may be unnecessary. The use of an adequate preoperative FNA together with sound clinical judgment at time of surgery can adequately guide the extent of surgical resection.
Open bedside tracheotomy in the intensive care unit
Authors: Wang Steven J. , Sercarz Joel A. , Blackwell Keith E. , Aghamohammadi Mazda , Wang Marilene B. 
Published: November 2003

AbstractObjective: To demonstrate that open bedside tracheotomy is an efficient, safe, and cost‐effective procedure. Study Design: Retrospective review of more than 200 open bedside tracheotomies performed at UCLA Medical Center, Harbor‐UCLA Medical Center, and West Los Angeles VA Medical Center from 1995 to 1998. Methods: The only personnel required for the procedure were an attending or senior resident and a junior resident or intern, as well as the respiratory therapist to withdraw the endotracheal tube. No anesthetist or scrub nurse was present for any of the procedures. The procedure took an average of 15 to 25 minutes. Patients were followed for 30 days after surgery to determine the incidence of complications. Results: The incidence of major complications related to the procedure, including hemorrhage and myocardial infarction, was less than 1%. The incidence of minor complications, including moderate bleeding at the tracheotomy site, was 4%. Overall mortality within 30 days was 8%, but was not related to the tracheotomy for any patients in this series. The charge for the procedure was $233 for the tracheotomy tube supplies and instruments. This cost compares favorably with an average charge of more than $3000 for the procedure in the operating room and about $1000 for a percutaneous tracheotomy kit. Conclusion: Review of our experience demonstrates that open bedside tracheotomies can be performed more efficiently and economically than operating room tracheotomies. The safety of this procedure is comparable to percutaneous tracheotomy but at a decreased cost. Key Words: Tracheotomy, percutaneous tracheotomy