bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Reflux in Young Children Undergoing Adenoidectomy
Authors: Carr Michele M. , Poje Christopher P. , Ehrig Deborah , Brodsky Linda S. 
Published: November 2003

AbstractObjective To compare the incidence of gastroesophageal reflux disease (GERD) in children under 2 years of age who have symptomatic adenoid hypertrophy requiring surgical removal or who have otitis media with effusion requiring ventilation tube insertion without adenoidectomy.Study Design Retrospective chart review.Setting An academic pediatric otolaryngology unit.Patients All children under age 2 undergoing adenoidectomy (Ad group) between January 1998 and May 2000 were compared with children in the same age range having ventilation tube insertion without adenoidectomy (VT group).Main Outcome Measures Whether a diagnosis of GERD was made, how it was made, GERD treatment, and resolution of symptoms were compared.Results There were 95 children in the Ad group and 99 in the VT group. GERD incidence was significantly higher in the Ad group where it was 42% versus 7% in the VT group (P <.001). In the Ad group, 88% of children age 1 or less had GERD, and 32% of those older than 1 had GERD diagnosed. In the VT group, 14% of patients age 1 or less and 2% of those older than 1 had a diagnosis of GERD.Conclusions Children under age 2 with symptomatic adenoid enlargement requiring adenoidectomy have a significantly higher incidence of GERD than children in the same age group presenting with otitis media requiring ventilation tube insertion.
Magnetic Resonance Imaging–Guided Fine‐Needle Aspiration Biopsies of Retropharyngeal Lesions
Authors: Maghami Ellie G. , Bonyadlou Shahram , Larian Babak , Borges Alexandra , Abemayor Elliot , Lufkin Robert B. 
Published: November 2003

AbstractObjective The retropharyngeal space is a deep neck space susceptible to a host of disease processes. Surgical access to this space is technically difficult and associated with potential morbidity. An image‐guided fine‐needle aspiration (FNA) biopsy, if proven accurate and safe, would be of great benefit as an alternative diagnostic approach to this space. This study reports on the use of magnetic resonance imaging (MRI)–guided FNA for diagnostic evaluation of retropharyngeal lesions. Technical details of needle systems, approach to this space, and reliability of this method are described.Study Design This is a prospective study of 14 patients with retropharyngeal lesions who underwent MRI‐guided FNA biopsy at the University of California at Los Angeles Center for the Health Sciences between October 1989 and October 1998.Methods A 0.2‐tesla open magnet was used to obtain magnetic resonance images of each retropharyngeal lesion. After standard skin preparation a coaxial needle system was used to reach and sample the lesion. In most instances, the specimen was immediately stained and examined by a cytopathologist for adequacy before removing the patient from the scanner.Results Eleven of 14 (78%) patients had diagnostic aspirations; only 2 of these 11 patients required additional surgical biopsy for more specific histological characterization of their lesions before definitive treatment recommendations were given. All aspiration procedures were well tolerated and without any complications.Conclusion We have demonstrated that MRI‐guided approach to the retropharynx is feasible, safe, and sensitive enough to obviate the need for open biopsies in a large percentage of patients.
Use of Bacteriologic Studies in the Outpatient Management of Peritonsillar Abscess
Authors: Cherukuri Sreekant , Benninger Michael S. 
Published: November 2003

AbstractObjective To examine whether obtaining bacterial Gram stain and aerobic/anaerobic cultures alters management of patients with peritonsillar abscess.Study Design Retrospective study.Materials and Methods A total of 221 cases of suspected peritonsillar abscess from July 1990 to February 1999 were analyzed with regard to outcomes and management patterns of those who had bacteriologic studies performed and those who did not.Results Pus was aspirated in 153 (69%). Eighty‐two had bacterial studies performed whereas 71 did not. Of patients that followed up, all patients had complete resolution in the first group based on initial management. Three patients of the latter group had a complicated course secondary to dehydration and antibiotic noncompliance (P = .24). Of the 82 cultures sent, sensitivities were conducted on only 17 (21%). Nine of 17 grew organisms that were penicillin‐resistant. No patient in the study had any treatment decisions based on microbiologic studies.Conclusion In the routine management of peritonsillar abscess, bacteriologic studies are unnecessary on initial presentation. They should be reserved for patients with a high likelihood of infection by resistant organisms, i.e., diabetics, immunocompromised patients, and patients with recurrent peritonsillar abscess.
Frontal Sinus Obliteration With Hydroxyapatite Cement
Authors: Petruzzelli Guy J. , Stankiewicz James A. 
Published: November 2003

AbstractObjective To evaluate the efficacy hydroxyapatite cement as an alternative to autologous fat in the obliteration of the frontal sinus after trauma or chronic suppuration.Methods Single institution, nonrandomized, prospective analysis of patients treated in an academic, tertiary care center. Patients were followed with physical examinations and were monitored for recurrent infections, which would have necessitated removal of the implant. Follow‐up radiographs were obtained at 12 months. Standard surgical techniques were used to obliterate the frontal sinus with the addition of the placement of a vascularized pericardial flap along the frontal sinus floor.Results Eleven patients underwent hydroxyapatite frontal sinus obliteration. There were 2 women and 9 men in the series with age ranges from 33 to 82 years (mean, 48 y). Three patients underwent obliteration for trauma and 8 for chronic infections with or without mucopyocele. The mean follow‐up is 27 months (range, 3.3–37 mo). No patient has developed clinical or radiographic evidence of recurrent frontal sinusitis and at this point no implants have been removed. Nine of 11 patients (91%) report complete resolution of all symptoms.Conclusion Hydroxyapatite cement had demonstrated efficacy in full‐thickness reconstruction of frontal sinus defects. The pericranial flap may provide a barrier to prevent infection of the implant in the face of acute ethmoid sinusitis. Hydroxyapatite cement offers the advantages of no donor site morbidity and the potential for complete osseointegration.
Nuclear Factor‐Kappa B Activation in the Nasal Polyp Epithelium: Relationship to Local Cytokine Gene Expression
Authors: Takeno Sachio , Hirakawa Katsuhiro , Ueda Tsutomu , Furukido Kyosuke , Osada Rika , Yajin Koji 
Published: November 2003

AbstractObjectives A panel of cytokines has been found to be important for eosinophil accumulation and activation in nasal polyps. The aims of this study were to ascertain whether the activation of nuclear factor‐kappa B (NF‐κB) occurred in the polyp epithelium, and to examine the relationship between the degree of activation and local cytokine gene expression.Study Design/Methods: Nasal polyp specimens were obtained from 26 untreated patients. The proportion of nuclear translocation of the NF‐κB p50 subunit in the polyp epithelium was quantitatively analyzed by a combination of fluorescent immunohistochemistry and a laser scanning confocal microscope image system. The levels of GM‐CSF, IL‐5, IL‐8, IL‐16, and eotaxin mRNA expression in the same speci‐mens were measured using reverse transcription‐polymerase chain reaction.Results Both cytoplasmic and nuclear localization of the p50 subunit was observed mainly in the epithelial layer in all specimens. The percentages of epithelial cells with nuclear translocation ranged from 4.5% to 40.5% (median, 18%). Significant correlations were observed between the degree of epithelial NF‐κB activation and the levels of IL‐8, IL‐16, and eotaxin mRNA expression (r = 0.468, 0.47, and 0.739, respectively).Conclusion The activation of NF‐κB in the nasal polyp epithelium is responsible for the recruitment of inflammatory cells, particularly eosinophils, through the initiation of the transcriptional pathway of the related cytokines. The increased NF‐κB activity in the polyp epithelium may reflect hypersensitivity to unknown stimuli.
Prognostic Significance of the Proline Form of p53 Codon 72 Polymorphism in Nasopharyngeal Carcinoma
Authors: Tsai Ming‐Hsui , Lin Chia‐Der , Hsieh Yao‐Yuan , Chang Florence Chi‐Chen , Tsai Fuu‐Jen , Chen Wen‐Chi , Tsai Chang‐Hai 
Published: November 2003

AbstractObjectives/ Hypothesis An important tumor suppressor gene, p53, plays a role in the regulation of cell progression and prevention of carcinogenesis. Mutated p53 is related to cell progression and malignancy. We aimed to evaluate the association between nasopharyngeal carcinoma and p53 polymorphism.Study Design Case control study.Methods All individuals were divided into two groups: nasopharyngeal carcinoma (n = 50) and non–nasopharyngeal carcinoma groups (n = 59). Their p53 codon 72 polymorphisms (arginine [Arg] homozygotes, heterozygotes, proline [Pro] homozygotes) were detected by polymerase chain reaction. Associations between nasopharyngeal carcinoma and p53 polymorphism were evaluated.Results Distributions of various p53 polymorphisms significantly differed between the two groups. We noted a dominant presentation of Pro homozygotes in the nasopharyngeal carcinoma population over that in the non–nasopharyngeal carcinoma population. Proportions of Pro homozygotes and heterozygotes and Arg homozygotes were 32%, 28%, and 40% in the nasopharyngeal carcinoma population and were 13.5%, 44.1%, and 42.4% in the non‐nasopharyngeal carcinoma population, respectively.Conclusions An association exists between nasopharyngeal carcinoma and p53 codon 72 polymorphism. The p53 Pro homozygotes are to a higher risk of development of nasopharyngeal carcinoma.
Telemedicine: Teleproctored Endoscopic Sinus Surgery
Authors: Burgess COL Lawrence P. A. , Syms Mark J. , Holtel CDR Michael R. , Birkmire‐Peters Deborah P. , Johnson MAJ Robert E. , Ramsey MAJ Mitchell J. 
Published: November 2003

AbstractObjective/Hypothesis Teleproctored surgery projects a surgeon's expertise to remote locations. The objective of the present study was to evaluate the safety and feasibility of this technique as compared with the current standard of care.Study Design Prospective.Methods A study was conducted in a residency training program comparing conventionally proctored endoscopic sinus surgery cases with teleproctored cases, with the faculty surgeon supervising through audiovisual teleconferencing (VTC) in a control room 15 seconds from the operating room.Results Forty‐two control patients (83 sides) and 45 teleproctored patients (83 sides) were evaluated. There were no internal differences between groups regarding extent of polypoid disease, revision status, procedures per case, degree of difficulty, general or local anesthesia, or microdebrider use. There were no cases of visual disturbance, orbital ecchymosis or hematoma, or cerebrospinal fluid leak. Orbital fat herniation and blood loss were equal between groups. Three teleproctored cases required faculty intervention: two for surgical difficulty, one for VTC problems. Teleproctored cases took 3.87 minutes longer per side (28.54 vs. 24.67 min, P <.024), a 16% increase. This was thought to be a result of nuances of VTC proctoring. Residents had a positive learning experience, with nearly full control of the operating suite combined with remote supervision through telepresence. Faculty thought such supervision was safe but had concerns regarding personal skills maintenance.Conclusions Teleproctored endoscopic sinus surgery can be safely performed on selected cases with an acceptable increase in time. Teleproctored surgery with remote sites may continue to be safely investigated. Incorporating remote supervision through telepresence into the curriculum of surgical residency training requires further study.
Use of AlloDerm for Coverage of Radial Forearm Free Flap Donor Site
Authors: Sinha Uttam K. , Shih Charles , Chang Kristi , Rice Dale H. 
Published: November 2003

AbstractObjectives To evaluate and discuss the role of acellular human dermal matrix (AlloDerm, LifeCell Corp., Branchburg, NJ) graft for coverage of radial forearm free flap donor site.Study Design Prospective, nonrandomized study.Methods Fifty‐two consecutive patients underwent harvest of 52 radial forearm fasciocutaneous free flaps. All 52 donor sites were covered by AlloDerm graft. Split‐thickness skin graft was not used to reinforce the acellular dermal graft in the series. Clinical phases of healing, duration of healing, and donor site complications were studied.Results No donor site complications except seroma formation in five patients was noted. This was treated by conservative measures. Full range of hand motion was allowed in 3 days. Complete healing occurred within 8 to 12 weeks. Scar contracture after complete healing was minimum in all patients. Range of motion of the hand and fingers during flexion, extension, supination, and pronation was identical on the operated and nonoperated sides.Conclusion AlloDerm graft is a viable alternative to split‐thickness skin graft for coverage of the radial forearm free flap donor site.
Topical Mitomycin C and Cephalosporin in Endolymphatic Sac Surgery
Authors: Huang Tsun‐Sheng 
Published: November 2003

AbstractObjective To determine whether intraoperative topical application of the drug mitomycin C to the endolymphatic sac area in conjunction with endolymphatic sac ballooning surgery (ESBS) can safely achieve longer‐lasting relief from incapacitating, medically intractable Meniere symptom‐complex than ESBS alone.Study Design/Method A retrospective study is presented of 142 cases of ESBS performed by the author between May 1998 and November 1999, in which a solution of mitomycin C diluted to 1 mg/mL of physiological saline was applied to the sac area for 5 minutes followed by irrigation with a cephalosporin antibiotic solution. The results of the 103 of 142 cases diagnosed as classic Meniere's disease or endolymphatic hydrops are given special attention, comparing them with the results of an earlier‐reported series of 109 cases of ESBS sharing the same diagnostic and result evaluation criteria but not using mitomycin C.Results In terms of vertigo control, the comparative short‐term rates (<3 y) of complete/substantial control for the aforementioned 103‐case series and earlier 109‐case series are similar: respectively, 90.3% (after 1.5–3 years' follow‐up) versus 91.7% (after 2.5–3 years' follow‐up). In the 103‐case series, to date, there has been no recurrence of incapacitating vertiginous symptoms necessitating revision surgery, whereas in the 109‐case series, although there were likewise no cases necessitating revision surgery during the reported 2.5‐to 3‐year follow‐up period, at least 8 patients in that series are known to have undergone revision surgery at later dates. Hearing results were significantly better (P = .004) in the 103‐case series than the 109‐case series: respectively, 30.0% versus 12.8% hearing improvement.Conclusions Preliminarily, the superior hearing results in the present series indicate that possible adverse effects of mitomycin C on the inner ear and endolymphatic system have been averted; and no recurrence of incapacitating symptoms to date offers hope that longer‐term efficacy of endolymphatic sac surgery using mitomycin C can be maintained.
Tutorials in Clinical Research: Part V: Outcomes Research
Authors: Stewart Michael G. , Neely J. Gail , Hartman James M. , Wallace Mark S. , Forsen James W. 
Published: November 2003

AbstractObjectives This is the fifth in a series of sequential “Tutorials in Clinical Research.” The objective of the present report is to give the reader a broad overview of the field of outcomes research. This summary is intended to enable the reader to understand outcomes research methodology and to start the design of an outcomes research study.Study Design Tutorial.Methods The authors developed the report from available materials and refined it to be concise but complete for use by the practicing clinician.Results We describe the basic steps of record‐based and patient‐based outcomes research, including development of a staging system, identification of comorbid conditions, and creation or identification of an outcomes instrument.Conclusion Outcomes research is a unique methodology that uses patient‐based outcomes to assess the effectiveness of medical treatment.
Spironolactone Blocks Glucocorticoid‐Mediated Hearing Preservation in Autoimmune Mice
Authors: Gross Neil D. , Kempton J. Beth , Trune Dennis R. 
Published: November 2003

AbstractHypothesis Although autoimmune sensorineural hearing loss can be effectively treated with corticosteroids, little is known about how these drugs affect cochlear function. MRL/MpJ‐Faslpr autoimmune mice treated with a mineralocorticoid (aldosterone) have previously been shown to have hearing improvement equal to those treated with a glucocorticoid (prednisolone). This suggested that the restoration of hearing with steroids was the result of an effect on sodium transport rather than an antiinflammatory or immunosuppressive role. We hypothesized that corticosteroids reverse autoimmune hearing loss through the mineralocorticoid receptor and that blocking the mineralocorticoid receptor will prevent glucocorticoid effects.Methods Spironolactone, a mineralocorticoid receptor antagonist, was administered to MRL/MpJ‐Faslpr autoimmune mice alone or in combination with corticosteroids. The four treatment groups were: spironolactone, spironolactone + aldosterone, spironolactone + prednisolone, and untreated water controls. Auditory brainstem response (ABR) thresholds were recorded before and during treatment (2, 3, and 4 mo) to measure the effect of steroids on hearing decline.Results Hearing in spironolactone and spironolactone + prednisolone mice showed progressive decline in hearing similar to water controls. The hearing was preserved in spironolactone + aldosterone mice, presumably as a result of the fact that aldosterone has a higher affinity for the mineralocorticoid receptor than spironolactone. Thus, aldosterone was able to maintain cochlear function with autoimmune disease progression, similar to previous reports of aldosterone treatment effects.Conclusions Spironolactone effectively blocked prednisolone from improving hearing in MRL/MpJ‐Faslpr autoimmune mice. This offers evidence that the inner ear mineralocorticoid receptor is the therapeutic target for corticosteroids used to treat autoimmune and sudden sensorineural hearing loss. Pharmacologic treatments that selectively target the mineralocorticoid receptor may provide greater clinical benefit with fewer systemic side effects than prednisone in patients with autoimmune sensorineural hearing loss.
The Evolution of Surgery on the Maxillary Sinus for Chronic Rhinosinusitis
Authors: Lund Valerie 
Published: November 2003

AbstractObjective To examine the management of the maxillary sinus in chronic rhinosinusitis over the last 500 years.Method A literature review was conducted.Result The maxillary sinus was first recognized in the 16th century and its role as a source of infection became the focus of attention, beginning with Nathaniel Highmore in 1651 and continuing up until the 21st century. The surgical drainage of the sinus was achieved by a variety of routes, including the alveolar margin, anterior wall, and middle and inferior meati. The rationale for these procedures, developed in a pre‐antibiotic era, may be re‐examined in the context of our present understanding of the pathophysiology of chronic rhinosinusitis.Conclusion The maxillary sinus has been the focus of surgical attention from the 17th century onward largely as a result of its size and accessibility, initially reinforced by plain x‐ray. However, in the 20th century, the advent of computed tomography and nasal endoscopy has reaffirmed the relationship of the maxillary sinus to the ostiomeatal complex in chronic rhinosinusitis, as originally demonstrated by pioneers such as Zuckerkandl, and redirected the focus of our therapeutic approaches.
Magnetic Resonance Determination of Tumor Thickness as Predictive Factor of Cervical Metastasis in Oral Tongue Carcinoma
Authors: Iwai Hiroshi , Kyomoto Ryoichi , Ha‐Kawa Sang Kil , Lee Shinryu , Yamashita Toshio 
Published: November 2003

AbstractObjectives To establish an accurate and reproducible means of measuring tumor thickness as a preoperative prognostic factor for cervical metastasis in oral tongue carcinoma.Study Design Retrospective review.Methods Charts from 30 patients were reviewed, and the correlation between histopathological and magnetic resonance imaging (MRI) findings of actual tumor thickness or reconstructed tumor thickness measured between a reconstructed mucosal line and the deepest extent of the tumor was investigated. Magnetic resonance images were acquired on a 1.5 T‐scanner with a T2‐weighted sequence in the axial plane using 3‐mm‐thick sections and a 256 × 256 matrix. The correlation between N stage and tumor thickness acquired by histopathological scrutiny or MRI was also assessed.Results The correlation between histopathological and MRI examinations was more significant in terms of reconstructed than actual tumor thickness. No cervical metastasis was detected in patients with tumors of less than 6 mm of reconstructed thickness in the MRI examination. The difference in cervical metastasis between the two groups, namely, less than 6 or more than 6 mm, was statistically significant (P = .0051).Conclusions Magnetic resonance imaging examination provides useful data for prognostic assessment and planning strategies with which to treat oral tongue carcinoma. The preoperative decision as to whether to attempt neck dissection could be based on a tumor thickness of 6 mm for patients with oral tongue carcinoma.
Pulmonary Function After Pectoralis Major Myocutaneous Flap Harvest
Authors: Talmi Yoav P. , Benzaray Shlomo , Peleg Michael , Eyal Ana , Bedrin Lev , Shoshani Yitzhak , Yahalom Ran , Horowitz Zeev , Taicher Shlomo , Kronenberg Jona , Shiner Robert J. 
Published: November 2003

AbstractObjective The pectoralis major myocutaneous flap is widely used in the reconstruction of surgical defects in the head and neck region. Pulmonary atelectasis has been reported in patients undergoing these procedures, and many of these patients are heavy smokers and drinkers and have associated cardiopulmonary disorders. Flap harvest and donor site closure may lead to impairment of pulmonary function before and after the use of pectoralis major myocutaneous (PMC) in surgical reconstruction in patients with cancer of the head and neck.Methods Patients undergoing extirpation of head and neck tumors with PMC reconstruction were prospectively evaluated. Patient age, smoking history (pack‐years), anesthesia duration, percentage predicted pre‐ and postoperative FEV1, percentage‐predicted pre‐ and postoperative FVC (forced vital capacity), and preoperative SaO2 (oxygen saturation) were evaluated. Preoperative FEV1/FVC ratio was calculated. Chest x‐rays were reviewed.Results Only 11 patients, 5 of whom smoked, could be evaluated postoperatively. Preoperative FEV1/FVC was more than 70 and FEV1 more than 75% predicted in all patients. A decrease in FVC was observed in 7 of the 11 patients, which ranged between 2% and 27% without any clinically obvious respiratory manifestations. A baseline SaO2 of more than 96% was noted in all patients. Four of 9 postoperative chest x‐rays demonstrated atelectasis.Conclusions PMC harvest and donor site closure may lead to the recorded decrease in FVC measurements. These changes did not manifest clinically. Nevertheless, alternative methods of surgical defect closure should be considered in patients with severe preexisting pulmonary disorders.