bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with the wish to hasten death: a study of patients with terminal illness
Authors: KELLY B. , BURNETT P. , PELUSI D. , BADGER S. , VARGHESE F. , ROBERTSON M. 
Published: February 2003

Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions.Method. A sample of terminally ill cancer patients (N=256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998–2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated.Results. A high WTHD was reported by 14% of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P<0·001): higher levels of depressive symptoms, being admitted to an in-patient hospice setting, a greater perception of being a burden on others, lower family cohesion, lower levels of social support, higher levels of anxiety and greater impact of physical symptoms.Conclusions. Psychological and social factors are related to a WTHD among terminally ill cancer patients. Greater attention needs to be paid to the assessment of psychological and social issues in order to provide appropriate therapeutic interventions for terminally ill patients.
The health effects of peace-keeping in the UK Armed Forces: Bosnia 1992–1996. Predictors of psychological symptoms
Authors: HOTOPF M. , DAVID A. S. , HULL L. , ISMAIL K. , PALMER I. , UNWIN C. , WESSELY S 
Published: February 2003

Background. Peace-keeping duties are associated with unique stresses for military personnel. There have been few reports on the effects of peace-keeping on psychological health.Method. We used data from a cross-sectional study originally established to examine health effects of service in the Gulf War, which included a control group who had been deployed in Bosnia (N=2049). This group was examined to establish which demographic, occupational, and deployment-related risk factors were associated with psychological distress measured on the General Health Questionnaire (GHQ-12) and stress symptoms akin to a post-traumatic stress reactions.Results. The main risk factors for stress symptoms in the Bosnia group were – lower rank, being deployed early in the campaign, having more deployment-related exposures, and serving on staff duties. There was no protective effect of previous deployments to the Falklands or Northern Ireland, and time off following deployment was not protective. For GHQ-12 cases, the main risk factors were: female gender, lower rank, increased deployment-related exposures and serving on staff duties.Conclusions. This study suggests that stress symptoms and GHQ-12 cases, are strongly predicted both by experiences during deployment and demographic factors.
Impaired distractor inhibition in patients with schizophrenia on a negative priming task
Authors: MACQUEEN G. M. , GALWAY T. , GOLDBERG J. O. , TIPPER S. P. 
Published: February 2003

Background. Numerous studies have suggested, via the interpretation of negative priming effects, that subjects with schizophrenia are less able than controls to inhibit irrelevant distracting information. Further issues concerning impairment in inhibitory processes are investigated here. First, recent research has revealed that negative priming (NP) effects can be caused by different processes, distractor inhibition or perceptual review. Therefore, conclusions concerning reduced inhibition in patients with schizophrenia are not possible from previous NP research. Secondly, previous NP studies have required subjects to identify some feature of the target. This is the first study to examine NP that uses a spatial task in patients with schizophrenia.Method. Twenty-eight subjects with schizophrenia and 28 age and sex matched non-psychiatric control subjects completed a computerized NP task that eliminated the possible contribution of perceptual review.Results. Subjects with schizophrenia had reduced levels of NP compared to control subjects on this spatial NP task (t=2·46, P<0·02). Current age, positive, negative or total PANNS scores did not correlate with negative priming scores, but post hoc analyses revealed that clozapine-treated patients had significantly greater levels of negative priming than patients receiving typical antipsychotic medications.Conclusions. The present experiment eliminated the contribution of perceptual review to negative priming and demonstrated that when a pure measure of inhibition is taken on a localization task, patients with schizophrenia were less able to inhibit irrelevant distracting stimuli. The fact that NP was reduced in a spatial task suggested a more diffuse reduction in inhibition than previous studies that examined only identification-based responses.
Focal brain stimulation with repetitive transcranial magnetic stimulation (rTMS): implications for the neural circuitry of depression
Authors: LISANBY SARAH H. 
Published: February 2003

BRAIN STIMULATION IN THE TREATMENT OF MAJOR DEPRESSIONRepetitive transcranial magnetic stimulation (rTMS) is an experimental medical procedure that is currently under investigation for its potential therapeutic value in major depression and other psychiatric and neurological disorders (Wassermann & Lisanby, 2001). The idea of using brain stimulation to treat depression dates back to the origins of ECT, and includes more recently developed techniques such as deep brain stimulation and vagus nerve stimulation. The value of brain stimulation in psychiatry is still most clearly seen in the, as yet, unparalleled efficacy of ECT in treating severe depression (American Psychiatric Association, 2001). While ECT is the most effective and most rapidly acting treatment for depression, it also causes a variable degree of undesirable cognitive side effects that limit its clinical utility and prevent many patients who could benefit from receiving this often life-saving treatment (McElhiney et al. 1995; Lisanby et al. 2000b). The search for an effective somatic treatment for medication resistant depression with fewer cognitive side effects than ECT has motivated much of the work with rTMS in psychiatry.
Modified Supracricoid Partial Laryngectomy with Cricohyoidopexy: Series Report and Analysis of Results
Authors: Adamopoulos George , Yiotakis John , Stavroulaki Pelagia , Manolopoulos Leonidas 
Published: February 2003

Aiming to improve voice quality and to facilitate swallowing rehabilitation, we modified the supracricoid partial laryngectomy with cricohyoidopexy by preserving the posterior segment of the true vocal cord on the less involved side of the larynx. Between 1983 and 1994, 13 patients with supraglottic cancer were treated with this modified procedure. The possibility of incomplete tumor excision was eliminated by careful patient selection and intraoperative reconfirmation of tumor extent with frozen sections. Our results have been promising, with a 76.9% 3‐year survival rate and a 69.2% laryngeal preservation rate. There were 7 recurrences, 3 local (2 at the superior border of the cricoid and 1 at the cricoarytenoid region) and 4 nodal, in 5 patients. Distant metastases developed in another patient. Three patients, 2 with local and nodal recurrence and 1 with distant metastases, died of disease. Functional outcomes were also good, with all patients achieving normal swallowing by the end of the first year, although 5 patients required temporary gastrostomy for transient swallowing impairment. Early decannulation and satisfactory voice quality were achieved in all cases. We believe that with proper patient selection this modified procedure is effective both for tumor control and for preserving a more functional larynx.
Pain in the Neck after Neck Dissection
Authors: Talmi Yoav P. , Horowitz Zeev , Pfeffer M. Raphael , Stolik‐Dollberg Orit C. , Shoshani Yitzhak , Peleg Michael , Kronenberg Jona 
Published: February 2003

BACKGROUNDReports of disability after neck dissection have been directed toward shoulder dysfunction and pain. We could find no report addressing the issue of pain localized to the actual operative site. We have conducted a combined prospective and retrospective study of pain in patients undergoing neck dissection.METHODSEighty‐eight disease‐free patients were evaluated in 3 groups for neck pain. One group was followed up prospectively for 1 to 8 months after surgery, and 2 retrospective groups were followed up for more than 2 years or for 6 months to 2 years. Pain was assessed by a body map and visual analog scale.RESULTSNone of 31 patients followed up for more than 2 years reported neck pain. Four of 27 patients followed up for 6 to 24 months had pain, with a mean visual analog scale score of 3.7. Seventy percent of the prospective group of 30 patients had pain during the first postoperative week, and only 1 patient had pain persisting for more than 2 months. Shoulder pain and disability after radical neck dissection were encountered in all groups, comparable with the incidence reported in the literature. No postoperative neuromas were found.CONCLUSIONSChronic pain localized to the operative site is an uncommon occurrence even after radical neck dissection. Chronic pain in the shoulder region may follow radical neck dissection, whereas modified neck dissection is usually a painless procedure.
Magnetic Resonance Imaging versus Clinical Palpation in Evaluating Cervical Metastasis from Head and Neck Cancer
Authors: Hao Sheng‐Po , Ng Shu‐Hang 
Published: February 2003

We prospectively compared the value of MRI and clinical palpation for detecting cervical metastases in patients with primary cancer of the head and neck. Sixty patients with squamous cell carcinoma of the upper aerodigestive tract were evaluated with MRI and clinical palpation before undergoing a total of 81 neck dissections. The results of preoperative clinical palpation and MRI were compared with the histopathologic outcome. The sensitivity and specificity were 75.6% and 97.5%, respectively, for clinical palpation and 73.2% and 95%, respectively, for MRI. The rate of occult cervical metastasis was 24% with clinical palpation and 26.8% with MRI. The use of MRI did not improve the rate of early detection of occult metastasis, nor did it improve the detection of extracapsular spread. Our findings show that we could not depend on palpation or MRI alone to determine the need for elective neck dissection. However, MRI can be used to improve the preoperative grading of cervical lymph nodes. In selected cases, this may direct surgeons to convert the treatment plan to choose a more conservative neck dissection or, after sentinel node sampling and frozen‐section control, to convert the treatment to a more radical dissection.
Quality of Life for Children with Obstructive Sleep Apnea
Authors: Franco Ramon Arturo , Rosenfeld Richard M. , Rao Madu 
Published: February 2003

The caregivers of 61 eligible children (6 months to 12 years old) completed a 20‐item (OSA‐20) health‐related quality‐of‐life survey after polysomnography was performed to psychometrically validate the OSA‐20. Excellent test‐retest reliability was obtained for the individual survey items (R > 0.74). Construct validity was shown by significant correlation of the mean survey score with the respiratory distress index (R = 0.43) and adenoid size (R = 0.43). Two items with poor validity were dropped, reducing the survey to 18 items (OSA‐18). The relationship between the OSA‐18 summary score and respiratory distress index remained significant when adjusted for tonsil size, adenoid size, body mass index, and child age. On the basis of the total survey score, the impact of OSAS on quality of life was small for 20 children (33%), moderate for 19 (31%), and large for 22 (36%). The OSA‐18 is a practical means of office‐based determination of quality‐of‐life impact for obstructive sleep apnea syndrome in children.
Comparative External Versus Endoscopic Dacryocystorhinostomy: Results in 115 Patients (130 Eyes)
Authors: Cokkeser Yasar , Evereklioglu Cem , Er Hamdi 
Published: February 2003

BACKGROUNDEpiphora is an annoying symptom, embarrassing the patient both socially and functionally. The two widely accepted treatment modalities of epiphora resulting from obstruction of the nasolacrimal ductus are external and endoscopic dacryocystorhinostomy (DCR).OBJECTIVEThe aim was to compare the results, operative time, and complications of external and videoendoscopic endonasal DCR performed between December 1994 and December 1998.METHODSIn group 1, conventional primary external DCR with or without silicone tube intubation was performed in 79 patients (66 women and 13 men) with unilateral dacryocystitis. In group 2, endoscopic primary endonasal DCR with hammer‐chisel removal of bone located over the lacrimal sac was performed in 51 eyes of 36 patients, 33 women and 3 men (15 bilateral procedures).RESULTSThe follow‐up period was 6 to 48 months (mean 25 months) after surgery. The age range was from 4 to 76 years (mean 38.5 years). The success rates of external and endoscopic hammer‐chisel DCR were found to be 89.8% and 88.2%, respectively. A lower complication rate was observed in the endoscopic group, with minimal morbidity and shorter operative time compared with the external approach.CONCLUSIONSHammer‐chisel endoscopic DCR is practical, less traumatic, less time‐consuming, and cosmetically more convenient than the external approach. The success rate of the endoscopic DCR procedure is comparable with that of traditional external DCR, and it also allows simultaneous correction of any intranasal pathology.
Does the Severity of Sinus Computed Tomography Findings Predict Outcome in Chronic Sinusitis?
Authors: Stewart Michael G. , Donovan Donald T. , Parke Robert B. , Bautista Marilyn H. 
Published: February 2003

OBJECTIVES:We studied the association between the severity of pretreatment CT scan findings and the improvement in symptoms of chronic sinusitis after treatment.METHODS:We analyzed data from an ongoing prospective, nonrandomized clinical outcomes study of patients treated for chronic sinusitis at a tertiary‐care academic medical center (n = 57, mean age 46.8 years). Disease‐specific symptom severity was measured with a validated health status instrument, and CT stage was quantified with the Harvard CT staging system.RESULTS:In a multivariate analysis, symptom severity based on CT findings emerged as a strong predictor of both improvement in symptom score outcome (β = 0.47, P = 0.01) and absolute symptom level after treatment (P = −0.58, P = 0.001).CONCLUSIONS:Severity as assessed by a pretreatment CT scan is a strong predictor of outcome. Patients with higher symptom severity based on CT scans showed significantly larger improvement and lower absolute levels of symptom severity after treatment. This study links CT scan findings and subjective patient‐based outcomes (symptom scores) using a validated outcomes instrument.
Inlay Butterfly Cartilage Tympanoplasty (Eavey Technique) Modified for Adults
Authors: Lubianca‐Neto José Faibes 
Published: February 2003

INTRODUCTIONPopular myringoplasty techniques include either an underlay or an onlay approach using tissues such as temporalis fascia or perichondrium as grafts. In 1998, Eavey described an inlay tympanoplasty technique in children using a cartilage graft which resembled butterfly wings. This technique was effective for closure of tympanic membrane perforations, while being more rapid for the surgeon and more comfortable for the patient. The aim of this study was to describe our results with modification of this technique in adults under local anesthesia.METHODS AND MATERIALCartilage butterfly inlay tympanoplasty was carried out in 20 adult patients to close small‐to‐medium tympanic membrane perforations over a period of 11 months. Compared with the original description, 3 modifications are noted: (1) adult patients, (2) local anesthesia, and (3) no skin graft over the cartilage. We evaluated the success rate and postoperative hearing results.RESULTSTwo patients were not evaluated in terms of hearing gain because they had profound preoperative hearing loss. Fourteen patients had a postoperative 4 pure‐tone average between 0 and 9 dB, 3 patients between 10 and 20 dB, and 1 patient greater than 20 dB. The graft “take rate” was 90% (18/20) at the end of the follow‐up period (mean follow‐up 7.25 months). Seventeen of 18 successful cases had cartilage grafts that were intact and dry at the last visit.CONCLUSIONSThe tympanoplasty technique described by Eavey is effective to close tympanic membrane perforation in adults as well as children. The technique modifications introduced here (abandonment of the skin graft and local anesthesia) reduced surgery time and postoperative morbidity. Postoperative results compared with those of the original technique were good.
Influence of the Prosthetic Restoration Modality on Bone Loss Around Dental Implants Placed in Vascularized Iliac Bone Grafts for Mandibular Reconstruction
Authors: Kovács Adorján F. 
Published: February 2003

OBJECTIVESIs bone loss associated with implants placed in vascularized iliac crest bone grafts for mandibular reconstruction dependent on the prosthetic restoration modalities used?STUDY DESIGNEleven vascularized iliac crest bone grafts for mandibular reconstruction were examined after ablative tumor surgery. Forty implants loaded for at least 1 year were observed for up to 6 years. Horizontal and peri‐implant bone loss was assessed for 2 groups: 6 patients with implant‐supported bridges and 5 patients with implant‐retained overdentures.RESULTSHorizontal bone loss reached a steady state around 2 mm after an observation time of 2 years. Bony pockets had a depth of less than 1 mm. The described pattern was nearly independent of the prosthetic restoration modality used. The implant survival rate was 97.6%.CONCLUSIONSVascularized iliac crest bone grafts are safe implant‐bearing areas. Implant‐retained overdentures can be used with as good a long‐term efficacy as the more complicated implant‐supported bridges.
Third Place—Resident Basic Science Award 1999 Elevated Nitric Oxide Metabolite Levels in Chronic Sinusitis
Authors: Schlosser Rodney J. , Spotnitz William D. , Peters Edward J. , Fang Kezhong , Gaston Benjamin , Gross Charles W. 
Published: February 2003

Decreased exhaled nitric oxide (NO) is found in chronic sinusitis. NO metabolites (nitrates, nitrites, and S‐nitrosothiols) were measured in sinus lavages with a rabbit model of chronic sinusitis. NO metabolite levels (mean ± SD) were 3.0 ± 1.6 μmol/L in uninfected rabbits, 10.7 ± 11.4 μmol/L in infected animals, and 7.6 ± 5.4 μmol/L in postantrostomy recovering animals. Infected sinuses had elevated levels of NO metabolites that were statistically significant (P < 0.01) when compared with uninfected sinuses. Mucociliary transport velocity was measured in uninfected (16.0 ± 5.7 mm/minute), infected (5.2 ± 1.3 mm/minute), and recovery phases (3.0 mm/minute). Endoscopic appearance, light and electron microscopy, and bacterial cultures improved during recovery. Elevated levels of NO metabolites were found during chronic sinusitis and began to return to normal levels during recovery. The possible link between NO in epithelial autotoxicity and host defense mechanisms warrants further investigation. (Otolaryngol Head Neck Surg 2000;123:357‐62.)
Endoscope‐Assisted Microvascular Decompression of the Trigeminal Nerve
Authors: Jarrahy Reza , Berci George , Shahinian Hrayr K. 
Published: February 2003

Twenty‐one patients with classic symptoms of trigeminal neuralgia underwent microvascular decompression of the trigeminal nerve through a retrosigmoid approach to the cerebellopontine angle. Endoscopy was used as an adjunctive imaging modality to microscopy. Specifically, endoscopes were used to confirm nerve‐vessel conflicts identified by the microscope and to reveal others that escaped microscopic survey. Endoscopes were also used to assess the adequacy of the decompression performed microscopically. A total of 51 nerve‐vessel conflicts were identified and treated, 14 of which were discovered only after endoscopy. Additionally, in 5 patients endoscopic examination of the surgical intervention demonstrated that further maneuvers were required to completely decompress the nerve. These results highlight the value of endoscopy in the diagnosis and therapy of cranial nerve pathology in the posterior fossa.
Endoscopic Repair of Cerebrospinal Fluid Leaks to the Sinonasal Tract: Predictors of Success
Authors: Zweig Julie L. , Carrau Ricardo L. , Celin Scott E. , Schaitkin Barry M. , Pollice Phillip A. , Snyderman Carl H. , Kassam Amin , Hegazy Hassan 
Published: February 2003

INTRODUCTIONCerebrospinal fluid (CSF) leaks may arise as a complication of endoscopic sinus surgery, trauma, or hydrocephalus, or they may occur spontaneously without any identifiable cause. Despite general agreement that CSF leaks should not be left untreated, their initial management, the surgical indications, and the technique of repair are controversial.OBJECTIVEWe undertook this study to ascertain whether a particular surgical technique or material was more successful for repair. Additionally, we tried to identify which specific characteristics of the patient, the CSF fistula, or the adjunctive treatment influenced the result of the repair.STUDY DESIGNWe completed a retrospective review of all patients undergoing endoscopic repair of a CSF leak at our academic hospitals.RESULTSForty‐eight patients with 53 CSF fistulas were included in the study. Fifty sites were successfully repaired endoscopically on the first attempt. Three persistent leaks were repaired successfully on the second attempt. Location and size of the leak, cause, technique, and choice of material used for the repair did not significantly affect surgical outcome. However, the presence of hydrocephalus had a statistically significant negative influence on surgical outcome. All patients with increased intraventricular pressure required a ventricular shunt in addition to a second endoscopic repair.CONCLUSIONIf the surgical technique is sound, endoscopic repair of CSF leaks is highly successful, independent of the choice of the material and technique used in the repair.