bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultracytochemical Localization of the NADPH‐d Activity in the Human Nasal Respiratory Mucosa in Vasomotor Rhinitis
Authors: Ruffoli Riccardo , Fattori Bruno , Giambelluca Maria A. , Soldani Paola , Giannessi Francesco 
Published: November 2003

AbstractObjectives Description of the ultrastructural localization of nitric oxide synthase in the blood vessels of the nasal respiratory mucosa in patients with vasomotor rhinitis.Study Design This research was conducted on seven patients—men and women, ages 20 to 45 years—suffering from vasomotor rhinitis and who had undergone surgical therapy for reduction of the inferior turbinates.Methods To study the ultrastructural localization of nitric oxide synthase, NADPH‐diaphorase cytochemistry was employed. Samples of the nasal mucosa were obtained from inferior turbinates.Results The endothelial cells of the arterioles, capillaries , venules and cavernous sinuses revealed a distribution of the enzymatic activity similar to that found in unaffected subjects. A strong enzymatic activity was recognized in the smooth muscle cells of the cavernous sinuses. The smooth muscle cells of arterioles and venules were generally found to be negative to enzymatic reaction.Conclusions This study suggests that the vascular disorders of the vasomotor rhinitis depend, at least in part, from nitric oxide synthase induction in the smooth muscle cells of the cavernous sinuses.
Functional Magnetic Resonance Imaging Using Iron Oxide Particles in Characterizing Head and Neck Adenopathy
Authors: Hoffman Henry T. , Quets Jerome , Toshiaki Taoka , Funk Gerry F. , McCulloch Timothy M. , Graham Scott M. , Robinson Robert A. , Schuster Michael E. , Yuh William T. 
Published: November 2003

AbstractObjectives In lymph nodes harboring metastases the reticuloendothelial system is replaced by tumor cells and does not concentrate iron particles. This study assesses the value of contrast magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide particles (Combidex, Advanced Magnetics, Inc., Cambridge, MA) to characterize and stage neck nodes.Study Design Prospective analysis of neck imaging by Combidex MRI, with correlation from pathological assessment of resected lymph nodes.Methods Nine patients underwent MRI and subsequent bilateral neck dissections (three), unilateral neck dissections (five) or fine‐needle aspiration (one). Each case was evaluated for the number, location, MRI characteristics, and pathological assessment of lymph nodes.Results Forty‐nine separate nodal levels were evaluated with both Combidex MRI and pathological assessment. The presence of metastatic nodal involvement among 45 levels was correctly assessed by the Combidex MRI (three false‐negative results, one false‐positive result; sensitivity, 84%; specificity, 97%). Analysis was possible for 101 of the individual lymph nodes identified by MRI that could be correlated with individual nodes pathologically examined. Combidex MRI assessment was correct for 99 nodes (one‐false positive result, one false‐negative result; sensitivity, 95%, specificity, 99%). Standard MRI interpretation without Combidex identified that 12 of 18 nodes (67%) that were greater than or equal to 10 mm (greatest dimension) contained tumor, whereas 9 of 83 nodes (11%) that were less than 10 mm contained tumor.Conclusions Combidex MRI provides functional information to characterize lymph nodes in the clinical staging of squamous cell carcinoma of the head and neck. The inability of MRI to identify small lymph nodes restricts the usefulness of this technique.
Follicular Variant of Papillary Carcinoma: The Diagnostic Limitations of Preoperative Fine‐Needle Aspiration and Intraoperative Frozen Section Evaluation
Authors: Lin Ho‐Sheng , Komisar Arnold , Opher Elana , Blaugrund Stanley M. 
Published: November 2003

AbstractObjective Fine‐needle aspiration (FNA) and frozen section (FS) have been widely reported in the literature as having high sensitivity in the diagnosis of papillary carcinoma. With the increased recognition of the follicular variant of papillary thyroid carcinoma (FVPTC), several reports have pointed out the difficulty in diagnosing this variant of papillary carcinoma owing to its overlapping cytomorphological features with benign and malignant follicular lesions. We undertook this study to determine the sensitivity of FNA and FS in the diagnosis of FVPTC.Methods Retrospective review of patients who underwent thyroidectomy from June 1994 to June 1999. Of the 63 patients found with a final pathological diagnosis of papillary thyroid carcinoma, only 47 had an adequate FNA and FS and were included in the study. These patients were divided into two groups, the usual type (n = 23) and the follicular variant (n = 24) of papillary carcinoma. Sensitivities of FNA and FS for these two groups of papillary carcinoma were then determined.Results The sensitivity of the FNA was 25% and of the FS was 29% for the follicular variant of papillary thyroid carcinoma. This is in contrast to the sensitivity of FNA and FS for the usual papillary carcinoma, which were 74% and 87%, respectively.Conclusion FNA and FS have low sensitivity in the diagnosis of the FVPTC. High degree of suspicion may increase the accuracy in the diagnosis of this variant of papillary carcinoma before or during surgery. However, the thyroid surgeon needs to realize that, like follicular carcinoma, FVPTC is often diagnosed only on final pathological examination.
Upper Airway Complications in Children After Bone Marrow Transplantation
Authors: Drew Brian , Peters Charles , Rimell Frank 
Published: November 2003

AbstractObjective To describe the upper and lower airway complications in children during bone marrow transplantation (BMT).Study Design Review of medical records of patients requiring airway intervention during BMT over a 4‐year period.Results During the 4‐year period, 832 pediatric BMTs were performed. Of these, 87 patients (10.5%) required mechanical ventilation. Patients had intubation for a mean of 79 days (range, −7–638 d) after BMT. Patients received mechanical ventilation for a mean of 12 days (range, 1–85 d). Duration of ventilation was significantly longer in patients with difficult intubation; in these 54 patients there were 64 intubations. Of these intubations, 19 (30%) were difficult. These difficult intubations occurred in 16 (30%) patients. Patients with Hurler syndrome and congenital immunodeficiencies had significantly more difficult intubations than children with leukemia. The incidence of complications causing difficult intubation were difficulty visualizing cords, because of the presence of blood (63%); difficulty visualizing cords, because of edema (19%); anatomically narrowed airway (13%); limited neck extension (13%); and limited jaw opening (6%). The resulting mortality rate was 82% in children requiring intubation. Survivors were significantly younger than nonsurvivors.Conclusions Pediatric BMT has become increasingly more common. Airway management is rarely required during the engraftment phase, but when intervention is required, it is often difficult, particularly in the nonleukemic child, and may require the skills of an otolaryngologist. Representative cases are presented, and management is discussed.
Esophageal Dysmotility As an Important Co‐factor in Extraesophageal Manifestations of Gastroesophageal Reflux
Authors: Knight Robert E. , Wells James R. , Parrish Rudolph S. 
Published: November 2003

AbstractObjective Esophageal motility problems have been demonstrated in patients with noninflammatory typical gastroesophageal reflux (GER) and esophagitis, but the frequency of motility disorders in patients with extraesophageal manifestations of GER has not been studied. The primary aim of this study was to assess the frequency of esophageal motility disorders in patients with atypical GER.Methods A prospective study of 112 consecutive patients with laryngopharyngeal reflux (LPR) symptoms and demonstrated physical findings consistent with LPR were studied. Patients were divided into one of the following diagnostic categories: hoarseness; chronic cough; dysphagia or globus pharyngeus; and paroxysmal laryngospasm. Of the 112 patients, 81 (72%) underwent esophageal manometry and ambulatory 24‐hour pH monitoring (pH‐metry), 19 (17%) had motility studies only, and 12 (11%) had pH‐metry studies only. Only patients who had motility studies were included in the analysis. Therefore the study population was 100 patients. Associations between diagnostic category, motility disorder, and abnormal reflux were evaluated with contingency‐table analyses.Results Of the 100 patients, 29 (29%) presented normal motility function, 48 (48%) had ineffective esophageal motility, 10 (10%) had hypertensive lower esophageal sphincter (LES), and 9 (9%) and 4 (4%) had nutcracker esophagus and achalasia, respectively. There was a significant association between esophageal dysmotility and extraesophageal manifestations of GER. However, there was no statistically significant association between esophageal motility disorders and abnormal acid reflux in our patients with atypical GER.Conclusions In the present study, the frequency of esophageal motility problems in patients with extraesophageal or atypical manifestations of GER was 73% and suggested that these problems exist as an accompanying condition or pathogenic co‐factor in some patients with atypical GER.
Elimination of Temporal Bone Cerebrospinal Fluid Otorrhea Using Hydroxyapatite Cement
Authors: Kveton John F. , Goravalingappa Ravi 
Published: November 2003

AbstractObjective This report introduces a new method to control cerebrospinal fluid (CSF) otorrhea using hydroxyapatite cement (HAC) via a transmastoid approach. This technique eliminates the need for a transmastoid or middle cranial fossa approach with soft tissue repair and prolonged hospitalization caused by lumbar drainage.Study Design Retrospective review.Methods Thirteen cases of transmastoid repairs of CSF otorrhea using HAC from August 1996 to February 1999 were reviewed.Results The CSF leak was controlled in every patient using HAC through a transmastoid approach. The reconstruction involved eight tegmen defects, three posterior fossa dural plate defects, and two congenital inner ear fistula secondary to Mondini malformation. Postoperative wound infection in one patient was the only complication that occurred. The average hospital stay was 48 hours. Follow‐up ranged from 12 to 44 months with no recurrence of CSF otorrhea.Conclusion The successful use of HAC to control CSF otorrhea through a transmastoid approach reduces patient morbidity by obviating the need for middle cranial fossa approaches, donor soft tissue sites, and spinal drainage.
Selective Indications for the Management of Extensive Anterior Epitympanic Cholesteatoma via Combined Transmastoid/Middle Fossa Approach
Authors: Steward David L. , Choo Daniel I. , Pensak Myles L. 
Published: November 2003

AbstractObjectives/Hypothesis Cholesteatoma that is present in the anterior epitympanic space may extend medially along the supralabyrinthine route to the geniculate ganglion, labyrinth, and cochlea and medially toward Kawase's triangle and the anterior petrous apex. Superiorly it may erode into the middle fossa. Contemporary microsurgical techniques allow for optimal management of these lesions with minimal morbidity, provided that the irregular and complex osteology of the petrous base is understood. The objective of the study was to review the relevant regional anatomy, pathobiology, and current algorithm used in treatment of this select patient population using a combined transmastoid/middle fossa (TM/MF) approach.Methods A retrospective review was performed of all clinical and radiographic data from patients undergoing combined TM/MF management of extensive anterior epitympanic cholesteatoma between July 1984 and June 1998. Data from physical examinations, preoperative imaging studies, and operative findings and other relevant data were tabulated and analyzed for patients undergoing TM/MF management of cholesteatoma.Results Of 488 patients with cholesteatoma treated by the otological service between 1984 and 1998, 11 patients underwent TM/MF exposure and removal of anterior epitympanic cholesteatoma. Total cholesteatoma removal was accomplished in six patients. In three patients, because of facial nerve involvement, labyrinthine fistulae, or internal carotid artery involvement, open‐cavity surgery was performed. In two patients, residual or recurrent cholesteatoma was exteriorized at “second‐look” procedures. In this small cohort of patients the majority had extension to the arcuate eminence, geniculate ganglion, or Kawase's triangle or had “blue‐lining” of the cochlea or labyrinth. To a lesser degree, the middle ear and mastoid contents were involved. Further facial nerve dysfunction or sensorineural hearing loss was not noted after surgery.Conclusions Selective TM/MF removal of cholesteatoma provides an optimal route for removing complex cholesteatoma in patients with intact sensorineural function and medial cholesteatoma extension.
Otolaryngology Consultation for Peritonsillar Abscess in the Pediatric Population
Authors: Blotter James W. , Yin Leopold , Glynn Matthew , Wiet Gregory J. 
Published: November 2003

AbstractObjective To assess clinical outcomes of children seen in consultation for peritonsillar abscess treated without the routine use of computed tomography or needle aspiration.Study Design Retrospective review of patients evaluated in the emergency department for possible peritonsillar abscess. Patient outcomes are reviewed with a statistical analysis of children grouped according to age.Methods A series of 102 patients, ages 8 months to 19 years, who were evaluated by the emergency department with otolaryngology consultation for possible peritonsillar abscess. All patients were admitted and given intravenous fluid replacement, antibiotics, and analgesia. Patients who responded to 24 hours of medical treatment were discharged, whereas patients who did not respond underwent elective tonsillectomy.Main Outcome Measure Outcome of patients evaluated for peritonsillar abscess treated without immediate surgery, needle aspiration, or computed tomography. Outcomes are correlated with age and clinical findings.Results Fifty‐two patients were discharged after initial medical therapy. Fifty patients underwent elective tonsillectomy; 40 of these patients were found to have abscesses at the time of surgery. When analyzed according to age, patients ages 8 months to 6 years were more likely to respond to medical treatment than children ages 7 to 12 and 12 to 19 (P = .023). Significant differences in the mean age of children requiring surgery (11.0 y) compared with those who responded to medical treatment (7.9 y) were observed (P = .003). Younger children who underwent tonsillectomy had a lower incidence of surgically confirmed abscess.Conclusions A significant number of children presenting with odynophagia, malaise, pharyngotonsillar bulge, and decreased oral intake respond to medical therapy without radiological evaluation or surgical intervention. Additionally, younger children (1–6 y) are more likely to respond to medical treatment than older children. Pertinent clinical data, as well as advantages and disadvantages of this approach, are discussed.
Influence of Serum Lipids on Auditory Function
Authors: Suzuki Kensaku , Kaneko Mitsuru , Murai Kazuo 
Published: November 2003

AbstractObjective To evaluate the influence of serum lipids on auditory function.Study Design The study group comprised 607 men and 317 women who underwent medical examination at our hospital. Eligibility criteria included 1) age of 40 to 59 years; 2) normal ear drums; 3) no history of noise exposure or of diseases associated with hearing loss; 4) normal results of a glucose tolerance test; and 5) normal hearing or sensorineural hearing loss with a flat‐form or high‐tone gradual‐form audiogram. We investigated the relation between the hearing level of the better‐hearing ear and serum concentrations of total cholesterol, triglyceride, and high‐density lipoprotein cholesterol.Methods For each variable, the subjects were divided into two groups—a high‐level group (serum lipid concentration ≥ 1 SD higher than the mean) and a low‐level group (serum lipid concentration ≤ 1 SD lower than the mean). Differences in hearing level between the two groups were compared according to sex with the t test.Results For total cholesterol and total triglyceride, there was no significant difference in hearing level between the high‐level group and the low‐level group in either sex. As for high‐density lipoprotein cholesterol, hearing levels at 2000 Hz (P < .05) and 4000 Hz (P < .01) in the high‐level group were significantly better than those in the low‐level group in men.Conclusion A low high‐density lipoprotein cholesterol concentration is associated with hearing loss. Arteriopathy may play a role in auditory dysfunction.
Combined Radiotherapy With Planned Neck Dissection for Small Head and Neck Cancers With Advanced Cervical Metastases
Authors: Wang Steven J. , Wang Marilene B. , Yip Helena , Calcaterra Thomas C. 
Published: November 2003

AbstractBackground We have previously described our treatment algorithm for patients with small head and neck cancers with advanced cervical metastases (stage N2 or greater). Primary radiotherapy is given to the primary site and neck, followed 6 weeks later with endoscopy and biopsy of the primary site. If biopsy of the primary site is negative by frozen section, an immediate neck dissection is performed even when no clinical residual neck disease is present. Our initial review found that 36% of patients with a complete clinical response to radiotherapy had positive nodes on histological examination.Study Design Retrospective.Methods The medical records of 71 patients treated at UCLA Medical Center from 1986 to 1999 by this algorithm were reviewed.Results After radiotherapy, 69 of 71 patients had a complete response at their primary site. Forty‐two patients had a complete clinical response in the neck. Seventy‐one neck dissections were performed. Overall, 31 of 71 neck dissections (44%) had positive nodes. Among the 42 patients with a complete response to radiotherapy, 13 (31%) had positive histological nodes. Among the 29 patients with a partial response to radiotherapy, 17 (59%) had positive nodes. Follow‐up and incidence of neck recurrence are discussed.Conclusion Planned neck dissection for advanced cervical metastases remains controversial for patients with a complete clinical response to radiotherapy. However, our results suggest that clinical assessment after radiotherapy cannot assure the absence of neck disease. Until there are reliable methods to distinguish which patients are truly free of neck disease, we believe the benefits of a planned neck dissection outweigh the low morbidity of this procedure.
Role of Middle Turbinate Biopsy in the Diagnosis of Fulminant Invasive Fungal Rhinosinusitis
Authors: Boyd Gillespie M. , Huchton David M. , O'Malley Bert W. 
Published: November 2003

AbstractObjective To determine the efficacy of middle turbinate biopsy in the diagnosis of fulminant invasive fungal rhinosinusitis.Study Design Nonrandomized prospective study.Methods Directed middle turbinate biopsy was performed in 25 patients suspected of having fulminant invasive fungal rhinosinusitis. All patients were immunocompromised and had fever of unknown origin, symptoms of rhinosinusitis, or both.Results Six patients were found to have fungal invasion on histopathological review (6 true‐positive findings), disease developed in 2 patients with negative results on biopsy (2 false‐negative findings), and disease never developed in 17 patients with negative results on biopsy (17 true‐negative findings), resulting in an overall sensitivity of 75% and a specificity of 100%.Conclusions Middle turbinate biopsy is a safe and effective method of making a timely diagnosis of fulminant invasive fungal rhinosinusitis. The added morbidity and cost of surgery can be avoided in the patient with a negative finding on biopsy. However, the effect of earlier diagnosis on overall patient survival is unclear at present.
A Meta‐analysis Comparing Outcomes of Microsurgery and Gamma Knife Radiosurgery
Authors: Kaylie David M. , Horgan Michael J. , Delashaw Johnny B. , McMenomey Sean O. 
Published: November 2003

AbstractObjectives/Hypothesis Surgery has been the most common treatment for acoustic neuromas, but gamma knife radiosurgery has emerged as a safe and efficacious alternative to microsurgery. This meta‐analysis compares the outcomes of the two modalities.Study Design A retrospective MEDLINE search was used to find all surgical and gamma knife studies published from 1990 to 1998 and strict inclusion criteria were applied.Results For tumors less than 4 cm in diameter, there is no difference in hearing preservation (P = .82) or facial nerve outcome (P = .2). Surgery on all sized tumors has a significantly lower complication rate than radiosurgery performed on tumors smaller than 4 cm (P = 3.2 × 10−14). Surgery also has a lower major morbidity rate than gamma knife radiosurgery (P = 2.4 × 10−14). Tumor control was defined as no tumor recurrence or no tumor re‐growth. Surgery has superior tumor control when tumors are totally resected (P = 9.02 × 10−11). Assuming that all partially resected tumors will recur, surgery still retains a significant advantage over radiosurgery for tumor control (P = .028).Conclusion Data from these studies date back to the late 1960s and do not completely reflect outcomes using current imaging and procedures. A major difficulty encountered in this study is inconsistent data reporting. Future surgical and radiation reports should use standardized outcomes scales to allow valid statistical comparisons. In addition, long‐term results from gamma knife radiosurgery using lower dosimetry have not been reported. Surgery should remain the therapy of choice for acoustic neuromas until tumor control rates can be established.
Clinical Indicators Useful in Predicting Response to the Medical Management of Meniere's Disease
Authors: Devaiah Anand K. , Ator Gregory A. 
Published: November 2003

AbstractObjectives To identify factors that may correlate with responsiveness to medical management of Meniere's disease.Study Design Retrospective chart review.Methods The 1995 guidelines of the American Academy of Otolaryngology—Head and Neck Surgery (AAOHNS) Committee on Hearing and Equilibrium were used for data acquisition and measuring clinical response. New patients with 2 years' follow‐up were evaluated and grouped as either medically or surgically treated. Patients were e‐cluded for inadequate follow‐up or prior otological surgery. Dietary sodium restriction (<1500 mg/d) and a diuretic were employed initially. A compliance rating system was devised to evaluate diet adherence. Patients whose medical management failed were offered surgery.Results Of 65 patients reviewed, 29 patients qualified for analysis. Seventeen patients were treated medically (patients had either definite or possible Meniere's disease), and 12 patients required surgery. Patients with definite Meniere's disease were at a higher stage (based on audiogram) than patients with possible Meniere's disease (P = .002). Patients who required surgery for Meniere's disease were at a higher stage than patients with either definite or possible disease (P < .001). Patients with definite disease had lower compliance than patients with possible disease (P = .004), but both groups showed symptom improvement. Patients with possible disease had better control than patients with definite disease (P < .001). Hearing was stabilized in patients with possible disease and improved at 500 Hz in patients with definite disease (P = .04).Conclusions Sodium restriction and diuretic treatment response are correlated to clinical measures of Meniere's disease. Patients with possible Meniere's disease should be treated with aggressive medical therapy to prevent disease progression.