bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exophytic Brain Tumors Mimicking Primary Lesions of the Cerebellopontine Angle
Authors: Ahn Min S. , Jackler Robert K. 
Published: November 2003

AbstractThe vast majority of cerebellopontine angle (CPA) tumors are extraaxial masses arising from either the eighth nerve (acoustic neuroma) or meninges (meningioma). Rarely, a tumor that arises from the brain parenchyma may protrude laterally to present with a clinical and radiographic picture simulating that of the much more common extraaxial lesions. Three individuals with CPA lesions that ultimately proved at operation to be exophytic brain tumors (pontine medulloblastoma, cerebellar astrocytoma, and fourth ventricular ependymoma) are described. The clinical manifestations of these lesions, although not entirely typical, fell well within the possible range of presentation of benign tumors primary to the CPA. In two of these cases the tumor actually penetrated into the internal auditory canal. As the optimal management strategy for treating parenchymal tumors differs substantially from that for extraaxial lesions, it is essential that the surgeon have a preoperative awareness of the lesion's nature before embarking on a surgical endeavor. Critical to arriving at the correct diagnosis is the close examination of preoperative imaging studies. The clinician should be alerted to the possibility that a CPA tumor is of intraaxial origin when the preoperative magnetic resonance imaging scan shows 1) blurring of the margin between the tumor and brainstem or cerebellum; 2) a degree of peritumoral hyperintensity on T2‐weighted scans disproportionate to the size of the extraaxial mass; and 3) dilation of the lateral recess of the fourth ventricle.
Noninvasive Tracking of Patient's Head Movements During Computer‐Assisted Intranasal Microscopic Surgery
Authors: Hauser Rolf , Westermann Birgit , Probst Rudolf 
Published: November 2003

AbstractA noninvasive system designed for patient tracking during image‐guided intranasal sinus surgery is described. It is based on optical digitizing with a custom‐made registration and reference system, locatable surgical instruments, and a self‐localizing operating microscope. Experimental and clinical results reveal a high degree of accuracy for the system. A mean spatial error of 0.82 ± 0.31 mm was determined for repositioning of the reference system in a plastic model of the skull. For the positioning of the microscope, a mean error of 2.3 ± 0.83 mm was calculated. Measurements of repositioning accuracy in 24 patients who received surgery for various sinus diseases had a mean spatial error of 1.56 ± 0.76 mm. The 95% error interval for locating intranasal structures using the surgical instrument was 2.05 mm, and it was 4.92 mm using the microscope. These results suggest that the use of our noninvasive registration and reference system may be effective, accurate, and useful for noninvasive tracking of patient movements in computer‐assisted intranasal surgery.
Long‐Term Outcome Analysis of Functional Endoscopic Sinus Surgery: Correlation of Symptoms With Endoscopic Examination Findings and Potential Prognostic Variables
Authors: Chambers David W. , Davis William E. , Cook Paul R. , Nishioka Gary J. , Rudman David T. 
Published: November 2003

AbstractOne hundred eighty‐two patients were evaluated after functional endoscopic sinus surgery. The goal was to establish whether any anatomical finding correlated with symptoms and to find any historical predictors of symptomatic failure. Of all physical findings reviewed, only scarring of middle meatal antrostomy and scarring of the ethmoids approached significance in predicting poor outcome. Surprisingly, of the historical factors reviewed, only gastroesophageal reflux disease was statistically significant as a predictor of poor symptomatic outcome.
Contemporary Management of the Aging Brow and Forehead
Authors: Koch R. James , Troell Robert J. , Goode Richard L. 
Published: November 2003

AbstractManagement of the aging brow and forehead has recently evolved based on available innovative technologies. Likewise, procedure‐specific indications have changed based on collective surgical experiences. No longer is the approach based solely on hair pattern or degree of brow ptosis. Patients require varying combinations of brow elevation (prior to blepharoplasty), correction of brow asymmetries, and hairline‐preserving forehead elevation. Some may only require excisional or paralytic procedures of the frontalis muscle (horizontal forehead creases), corrugator supercilii muscles (vertical glabellar furrows), and procerus muscle (horizontal glabellar furrows). We present a 3‐year experience using a problem‐specific approach. This incorporates endoscopic technology, botulinum toxin type A purified neurotoxin complex (Botox, Allergan, Irvine, CA) intramuscular injection, and traditional procedures such as the coronal, pretrichial, midforehead, and direct browlift. Current indications, patient selection, and results are also discussed.
Resorbable Fixation Plates in Head and Neck Surgery
Authors: Weisberger Edward C. , Eppley Barry L. 
Published: November 2003

AbstractA skeletal fixation system employing plates made of polylactic and polyglycolic acid has been employed at Indiana University Medical Center since July 1993 in 105 craniofacial reconstructions, 45 cases of maxillofacial trauma, 10 craniotomy flap repairs, and five cases involving reconstruction of the laryngotrachea. Because these plates eventually resorb, they offer significant theoretical advantages. No inhibition of structural growth should occur when using this system in children. Tissue tolerance of these plates has been excellent. The technical details of using heat to allow reshaping of the plates as well as the methods of fixation of the plates are discussed.
Retropalatal Airway Characteristics in Uvulopalatopharyngoplasty Compared With Transpalatal Advancement Pharyngoplasty
Authors: Woodson B. Tucker 
Published: November 2003

AbstractUvulopalatopharyngoplasty (UPPP) is reported successful in treatment of obstructive sleep apnea for approximately 50% of patients. Several modifications of the procedure have been described, including transpalatal advancement pharyngoplasty, which resects a portion of posterior hard palate and advances the soft palate anteriorly. Comparing effectiveness of different techniques based on sleep and respiratory data is confounded by multiple variables including clinical failure at nonsurgical sites and imprecise patient selection techniques. Since pharyngeal surgical procedures prevent collapse and obstruction by structurally modifying the upper airway, measuring structural changes in size and collapsibility provides a method to compare techniques. To evaluate whether transpalatal advancement pharyngoplasty is more effective in modifying upper airway characteristics than UPPP, upper airway cross‐sectional size and collapsibility were measured after UPPP and transpalatal advancement pharyngoplasty. Six patients were evaluated using a quantitative endoscopic technique. After transpalatal advancement pharyngoplasty maximal retropalatal airway size increased 321% from 29.7 ± 9.9 to 95.3 ± 16 mm2 (P < 0.01), and retropalatal closing pressure decreased from 4.7 ± 1.6 to ‐3.8 ± 0.7 cm/H2O (P < 0.01) compared with UPPP. Respiratory disturbance index decreased from 74.5 ± 13.5 to 29.2 ± 9 events/hour postoperatively (P < 0.05). Results support the conclusion that transpalatal advancement pharyngoplasty increases retropalatal size and decreases retropalatal collapsibility compared with UPPP. Since these characteristics are postulated to contribute to increased stability during sleep, transpalatal advancement pharyngoplasty may potentially improve UPPP outcome in selected patients with small retropalatal airway areas after traditional surgery.
Correlation Between Vocal Functions and Glottal Measurements in Patients With Unilateral Vocal Fold Paralysis
Authors: Inagi Katsuhide , Khidr Aliaa A. , Ford Charles N. , Bless Diane M. , Heisey Dennis M. 
Published: November 2003

AbstractObservations and analysis of glottal characteristics are critical in choosing the best modality for surgery in patients with unilateral vocal fold paralysis (UVP). This study suggests that multiple glottal characteristics influence the vocal product in patients with UVP. In addition to the horizontal position of the paralyzed vocal fold (deviation from the midline), the glottal area, degree of bowing of the paralyzed and contralateral vocal folds, maximum separation between vocal folds, compensatory glottal maneuvers, and the vertical glottic closure plane significantly influenced the quality of the voice. Clinicians should be aware of these observations to facilitate treatment planning and assessment of the results of surgical procedures used to improve voice quality in cases of UVP.
Surgical Experience With Bone‐Anchored Hearing Aids In Children
Authors: Papsin Blake C. , Sirimanna Tony K.S. , Albert David M. , Bailey C. Martin 
Published: November 2003

AbstractTitanium osseointegrated implants for boneanchored hearing aids (BAHAs) have been in use since 1977. A series of 32 children who received implantation since 1990 is reported. The report focuses on the surgical aspects of BAHAs, predisposing factors, and prevention of complications in an unusual pediatric population. The records of 32 children who had undergone two‐stage implantation of a BAHA were retrospectively reviewed. The majority of the patients had craniofacial abnormalities. Of the 32 implantees, 29 use their BAHA at present. Five children failed to achieve osseointe‐gration, and eight patients have had revision surgery for lost abutments, trauma, or chronic skin problems. There were no differences between preimplantation and postimplantation bone or air conduction thresholds. The pediatric BAHA carries with it a unique set of challenges and problems but can be successfully implanted and maintained.
Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options
Authors: Peterson K. Linnea , Wang Marilene , Canalis Rinaldo F. , Abemayor Elliot 
Published: November 2003

AbstractRhinocerebral mucormycosis is recognized as a potentially aggressive and commonly fatal fungal infection. The classic presentation is involvement of nasal mucosa with invasion of the paranasal sinuses and orbit. Mucormycosis is most commonly seen in association with diabetic ketoacidosis, but disease demographics have changed with the onset of AIDS and the advent of powerful immunosuppressive drugs. Treatment includes aggressive debridement, systemic antifungal therapy, and control of underlying comorbid factors. Although surgical intervention remains essential, advances in medical therapy have permitted a more limited surgical approach to minimize functional loss without compromising survival. We present the UCLA experience with rhinocerebral mucormycosis from 1955 to 1995, with emphasis on the evolution of disease presentation and alternative treatment options.
Intracranial Complications of Sinusitis
Authors: Giannoni Carla M. , Stewart Michael G. , Alford Eugene L. 
Published: November 2003

AbstractIntracranial suppurative complications of sinusitis remain a challenging and contemporary topic. To determine the prevalence of sinogenic sources in intracranial infectious complications, we reviewed the records at a large public hospital between 1985 and 1995. There were 203 patients with 212 suppurative intracranial infections. Sinogenic sources were identified in 12 patients with 19 infections. Most patients had ethmoid or frontal sinusitis. We discuss the presentation, microbiology, diagnosis, treatment, and clinical course of these 12 cases. The diagnosis of intracranial complications of sinusitis requires a high index of suspicion and radiographic imaging of the head and paranasal sinuses. The mean hospital stay was 31.4 days and all 12 patients survived, although three patients had significant neurologic sequelae.
Can Sensitized Lymphocytes Retain Reactivity to Inner Ear Antigens After Retrieval From Frozen Storage?
Authors: Hughes Gordon B. , Paulic Zlatko M. , Shu Suyu , Fairchild Robert L. , Barna Barbara P. 
Published: November 2003

AbstractImmune inner ear disease results in rapidly progressive, bilateral sensorineural hearing loss and is one of the few forms of sensorineural hearing loss that can be treated medically. The purpose of this study is to identify and preserve several populations of sensitized lymphocytes from patients with immune inner ear disease as a first step toward cloning autoreactive T cells, in order to study the pathogenesis of disease. Lymphocytes from four patients with high reactivity (stimulation index of 2.5 or greater) were placed in frozen storage. At 8 to 14 months they were thawed and restimulated. All four samples were viable. Two reacted again to inner ear homogenate, but with different intensities. Some lymphocytes sensitized to inner ear antigens can retain reactivity after frozen storage. This methodology may be useful to clone highly reactive T cells.
Hyperparathyroidism Associated With a Chronic Hypothyroid State
Authors: Walker Regina Paloyan , Kazuko Ernst , Gopalsami Chellam , Bassali Joanne , Lawrence Ann M. , Paloyan Edward 
Published: November 2003

AbstractReports of the coexistence of hyperparathyroidism and thyroid disease have raised the issue of a possible etiologic relationship. The present study tests the hypothesis that chronic elevation of thyroid‐stimulating hormone (TSH) is related to the development of hyperparathyroidism. Four groups of 60 female rats were treated as follows: group 1, control; group 2, propylthiouracil (PTU) 0.0025%; group 3, PTU 0.0025% plus thyroxine, 5 μg two times per week; and group 4, only thyroxine. The animals' serum calcium, phosphorus, TSH, thyroxine, and parathyroid hormone (PTH) levels were evaluated at 0, 6, 12, and 18 months. Significant elevation of TSH was sustained throughout the 18 months in groups 2 and 3. The PTH levels were also significantly elevated in both group 2 and group 3 animals (P = 0.02). The histopathologic features of the parathyroids were evaluated at 18 months. In the group 2 (PTU only) animals, which had profound hypothyroid, 44% developed parathyroid adenomas. In the group 3 (PTU plus thyroxine) animals, who had mildly elevated TSH levels, 53% developed parathyroid adenomas. These findings are consistent with the hypothesis that prolonged TSH stimulation may lead to hyperparathyroidism in the rat model.
Congenital Encephalocele of the Medial Skull Base
Authors: Mulcahy Maureen M. , McMenomey Sean O. , Talbot J. Michael , Delashaw Johnny B. 
Published: November 2003

AbstractMeningoencephaloceles of the temporal bone are rare. Although most often seen following otologic surgery or trauma, congenital meningoencephaloceles can exist. The clinical presentation, diagnostic evaluation, and surgical management of three patients with congenital meningoencephalocele are presented. Two of the three patients presented to our institution with recurrent episodes of meningitis; one presented with partial complex seizures. Diagnostic evaluation included temporal bone computed tomography with magnetic resonance imaging. In two patients, defects were imaged following high‐pressure subarachnoid cisternography with computed tomography. All three patients were found to have congenital defects in the area of Meckel's cave. Early recognition of congenital meningoencephalocele is important to avoid delay of definitive surgical management and neurologic sequelae.
Management of Laryngotracheobronchial Sequelae and Complications of Relapsing Polychondritis
Authors: Spraggs Paul D.R. , Tostevin Philippa M.J. , Howard David J. 
Published: November 2003

AbstractRelapsing polychondritis is a rare multisystem disorder of unknown etiology characterized by recurrent inflammation and degeneration of cartilage and connective tissue. Laryngotracheobronchial complications are the most severe manifestations of the disease and present the most challenging management decisions. We present four cases of relapsing polychondritis with laryngotracheobronchial manifestations that illustrate the clinical features and review the treatment options.
Coinfection of HPV‐11 and HPV‐16 in a Case of Laryngeal Squamous Papillomas With Severe Dysplasia
Authors: Lin Ken‐Yu , Westra William H. , Kashima Haskins K. , Mounts Phoebe , Wu T.‐C. 
Published: November 2003

AbstractHuman papillomavirus (HPV) types 6 and 11 have been associated with benign laryngeal papilloma, while HPV‐16 is occasionally associated with laryngeal carcinoma. In this study, a case of laryngeal squamous papillomas with severe dysplasia was evaluated for the presence of HPV infection. The biopsy specimens were taken from a 58‐year‐old female patient at two different time points 3 months apart. Architecturally, the tumor showed papillary configuration reminiscent of squamous papilloma. Cytologically, the lesion showed morphologic features characteristic of severe squamous epithelial dysplasia. HPV infection was determined by DNA in situ hybridization using type‐specific HPV‐DNA probes. HPV‐11 probes demonstrated homogeneous nuclear staining, suggesting productive viral replication. In contrast, HPV‐16 probe produced a speckled pattern, suggesting HPV‐16 DNA integration. Normal laryngeal epithelium did not yield specific hybridization. The presence of HPV‐11 and HPV‐16 was confirmed by PCR using HPV type‐specific primers. Immunocytochemical staining was performed to detect Ki‐67, a proliferation marker, and p53. Ki‐67 expression was demonstrated throughout the whole thickness of epithelium. Staining for p53 was negative. This study suggests that multiple HPV infections can occur in the same lesion and that HPV‐16 infection and its DNA integration may contribute to the occurrence of severe dysplasia in the lesion described.
Treatment of Ventricular Dysphonia With Botulinum Toxin
Authors: Kendall Katherine A. , Leonard Rebecca J. 
Published: November 2003

AbstractVentricular dysphonia, traditionally known as dysphonia plica ventricularis, is a voicing disorder in which the false vocal folds are used as a vibratory source in addition to or instead of the true vocal folds. Traditional treatment of ventricular dysphonia has been voice therapy, which may be slow to produce results if the false fold activity masks an underlying problem of the true folds, is long standing, or has produced hypertrophy of the supraglottic structures. We present seven cases of ventricular dysphonia treated with botulinum toxin injection into the false vocal folds followed by speech therapy. The addition of botulinum toxin to the treatment regimen speeds recovery of normal voicing and allows immediate evaluation of dynamic true vocal fold function by the treating professional.
A Convenient and Efficient Moldable Dressing for Skin Grafts
Authors: Ducic Yadranko , Hilger Peter A. , Fish Frederick S. , Bartlett Andrew J. 
Published: November 2003

AbstractIn this paper we present our positive experience with use of Aquaplast thermoplastic as a tiedown dressing for securing and maintaining skin grafts in good position against their nutrient recipient beds. This unique polymer is safe to use, simple to apply, and maintains uniform pressure across the entire surface of the skin graft, no matter how contoured the shape of the anatomical region.
Biomechanical Effects of e‐PTFE Implant Structure on Soft Tissue Implantation Stability: A Study in the Porcine Model
Authors: Greene David , Pruitt Lisa , Maas Corey S. 
Published: November 2003

AbstractSuccessful implantation of biocompatible materials depends on physical aspects of its structure. Meshed implants are stable but cannot be easily removed. Nonporous materials are easily removed, but subject to extrusion. We hypothesized that the microporous structure of expanded polytetrafluoroethylene(e‐PTFE) would permit limited fibrous ingrowth into the substance of the material, and that tubular implant shape would increase tissue integration while preserving ease of removal. A two‐tailed in vivo study was done comparing implant retention, strength of fixation, and removability between tubular and solid‐strip e‐PTFE implants. Differences in implant retention within tissues were assessed by implanting 396 implants subcutaneously in five swine for observation periods ranging from 3 weeks to 12 months. Strength of implant attachment to host soft tissues was measured at 52 sites by extraction with a tensiometer with forces both parallel and perpendicular to the implant used. Implant porosity was assessed with scanning electron micrography of tubular and solid‐strip e‐PTFE implants. Measurements of the force and stress tolerances of the implant‐tissue interface demonstrated significantly stronger attachment in tubular than strip‐shaped implants (P < 0.005). The 11 N (2.75 lb) force sustained by the tubular implant exceeded the 3.4 N(<1 lb) force for the e‐PTFE strip by a statistically significant margin on two‐tailed Student's t‐test (P < 0.005). Even greater forces were tolerated when applied at right angles to the axis of the tubular implant, emulating tissue suspension (21 N, 5.25 lb). The forces and stresses tolerated by both e‐PTFE implants far exceeded the fracture stress measured for the implants. Implant extrusion rates were significantly smaller in tubular (0.85%) than in strip‐shaped (4.4%) e‐PTFE implants (P< 0.05). Standard error of the mean (SEM) demonstrated lesser porosity in tubular than strip implants, suggesting lesser direct tissue attachment. Tubular e‐PTFE implant structure facilitates ingrowth of soft tissue through the tube's lumen. This increases the attachment to surrounding soft tissues, increasing fixation strength, decreasing extrusion rate, but still allowing easy removal. These properties may improve clinical applications in facial implantation.
Surgical Exposure of the Petrous Internal Carotid Artery: Practical Application for Skull Base Surgery
Authors: Dew Leigh Anne , Shelton Clough , Harnsberger H. Ric , Thompson B. Gregory 
Published: November 2003

AbstractWhen exposing the horizontal petrous carotid artery in preparation for intrapetrous carotid by‐pass, the surgeon has no definite landmarks to localize the perimeter of the cochlea. The results of this study provide a practical, consistent, and safe method to maximize carotid artery exposure while minimizing cochlear injury. We measured the carotid‐cochlea distance (mean, 4.3 mm) and the carotid‐cochlear angle (mean, 10.8°) in 33 temporal bones in which the extended middle fossa approach had been performed. We correlated this distance to the width of a Sheehy weapon knife, which can be easily measured intraoperatively. Twenty‐five temporal bones were imaged prior to surgical exposure using a new computed tomography (CT) protocol that can be used for preoperative assessment of the carotid‐cochlear anatomy. The carotid‐cochlea distance and carotid‐cochlear angle measured on CT are compared with postsurgical measurements.