bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pneumococcal Antibiotic Resistance and Rates of Meningitis in Children
Authors: Ryan Matthew W. , Antonelli Patrick J. 
Published: November 2003

AbstractObjectives/Hypothesis Recent studies have shown alarmingly high rates of antibiotic resistance in Streptococcus pneumoniae isolates from patients with otitis media. A recent study has implicated resistant S pneumoniae for rising rates of acute mastoiditis. The purpose of this study was to determine whether S pneumoniae antibiotic resistance has similarly affected the rate of pediatric community‐acquired meningitis, the most common intracranial complication of otitis media.Study Design Retrospective chart review.Methods All cases of pediatric community‐acquired meningitis treated at an academic tertiary care hospital during a 10‐year period were reviewed, and meningitis rates were calculated as a proportion of yearly admissions.Results The overall rate of meningitis decreased linearly during the study period (P = .001). This was largely because of a drop in the rate of Haemophilus influenzae meningitis (P = .001), corresponding with the introduction of H influenzae type B vaccine. Annual rates of S pneumoniae meningitis did not change. Only one case of S pneumoniae meningitis was due to a highly penicillin‐resistant strain and isolates from four cases had intermediate sensitivity. Twenty‐four of 83 cases were associated with antecedent acute otitis media and 63% of these had been treated with antibiotics before admission. Otitis media, as a cause of meningitis, did not increase during the study period.Conclusion
S pneumoniae is responsible for a greater proportion of cases of pediatric community‐acquired meningitis. However, this is because of a decline in the rate of H influenzae cases, not the rise in S pneumoniae antibiotic resistance.
Controlling Advanced Neck Disease: Efficacy of Neck Dissection and Radiotherapy
Authors: Richards Bryan L. , Spiro Jeffrey D. 
Published: November 2003

AbstractObjective Neck dissection remains the standard method of treating cervical metastasis from head and neck squamous cell carcinoma. In light of recent trends to modify the classic radical neck dissection (RND) for early neck disease, we reviewed our experience with radical and modified RND (MRND) plus radiotherapy as treatment for N2/N3 neck disease in head and neck squamous cell carcinoma.Methods We retrospectively reviewed our clinical records from July 1989 to June 1996 to identify 43 neck dissections in 39 patients who were found to have pathologically N2 or N3 neck disease treated primarily by neck dissection and postoperative radiotherapy. All patients had head and neck squamous cell carcinoma with a minimum follow‐up of 24 months.Results Nine percent (4/43) of the dissected necks were pathologically N2a, 72% (31/43) were N2b, 7% (3/43) were N2c, and 12% (5/43) were N3. Of these, 28% (12/43) underwent a RND and 72% (31/43) underwent a MRND. The most common modification of RND was preservation of the spinal accessory nerve. All patients underwent postoperative radiotherapy with a mean dose of 55 Gy. Only 4 of 43 dissected necks had isolated treatment failure, for a regional control rate of 91%.Conclusions The combination of RND or MRND and radiotherapy is highly effective in controlling neck disease in the absence of persistent or recurrent local disease. Also, in our e‐perience, MRND appears to be as effective as RND in controlling even advanced neck disease, which supports preservation of the spinal accessory nerve whenever oncologically feasible.
Transoral CO2 Laser for Surgical Management of Glottic Carcinoma in Situ
Authors: Damm Michael , Sittel Christian , Streppel Michael , Eckel Hans E. 
Published: November 2003

AbstractObjectives/Hypothesis In carcinoma in situ (CIS) tumors malignant cells have not penetrated the basement membrane and therefore have no metastatic potential. Treatment strategies of CIS are topics of ongoing discussion. The aim of this study was to evaluate long‐term results of CO2 laser therapy in laryngeal CIS.Methods From 1986 to 1995, 29 patients with glottic CIS with a minimum follow‐up of 2 years were treated initially with transoral CO2 laser surgery and were included is this series.Results A complete removal of the tumor was possible with superficial laser cordectomy in 21 patients and with subligamental laser cordectomy in 8 cases. There was no tumor‐related death in this series. Repeated laser resections were performed in four patients for local recurrences. No patient required total laryngectomy or radiotherapy during a follow‐up ranging from 25 to 143 months.Conclusions Local control rates presented in this study are superior to those previously reported with conventional surgery and similar to those after radiotherapy. The ultimate rate of larynx preservation was seven times higher than reported after radiotherapy. Our results add further support to the observation that laser surgery is the best treatment option for CIS of the larynx. Based on the material of this study, recommended treatment for CIS is CO2 laser resection in combination with a meticulous follow‐up for early recognition of local recurrence.
Endoscopic Stapled Diverticulotomy: Treatment of Choice for Zenker's Diverticulum
Authors: Philippsen Luke P. , Weisberger Edward C. , Whiteman Thomas S. , Schmidt Jonathan L. 
Published: November 2003

AbstractObjective To evaluate the efficacy and safety of endoscopic stapled diverticulotomy in the treatment of patients with Zenker's diverticulum.Study Design Cohort study.Methods Fourteen elderly patients (11 men and 3 women) with Zenker's diverticulum were evaluated in a community hospital setting from July 1996 to November 1999. Before surgery patients had significant dysphagia, regurgitation, cough, or aspiration pneumonia. The common septum between the diverticulum and cervical esophagus was visualized with a Weerda diverticuloscope. While using videoendoscopic monitoring, the septum was divided and the edges simultaneously sealed with a linear endoscopic stapler. Average operative time was 31 minutes.Results The operation was successfully performed in 11 of 14 patients. In the three unsuccessful cases, one patient's pouch was too small to staple and the other two patients had a septum that was difficult to visualize with the diverticuloscope. There was no significant postoperative morbidity or mortality. Patients started a liquid diet on the first postoperative day and resumed a soft diet a week later. They were usually discharged on the first postoperative day. Most patients reported significant improvement with resolution of dysphagia and regurgitation.Conclusions Compared with the traditional open technique, the endoscopic stapled diverticulotomy technique is safe, quick, and effective and requires a shorter length of stay in the hospital. Therefore it has become our treatment of choice for elderly, high‐risk patients with a large (>2 cm) hypopharyngeal (Zenker's) diverticulum.
Preservation of Olfaction in Anterior Skull Base Surgery
Authors: Dale Browne J. , Mims James W. 
Published: November 2003

AbstractObjectives/Hypothesis In selected unilateral tumors and defects of the anterior skull base, the preservation of contralateral olfaction is achievable through a localized subcranial approach without compromising surgical objectives of resection or repair.Study Design Description of a functional adaptation of anterior skull base surgical techniques through a retrospective patient series.Methods Nine patients underwent anterior skull base surgery for unilateral cribriform plate disease including four malignant and two benign tumors, two encephaloceles, and one iatrogenic cribriform injury with cerebrospinal rhinorrhea. All nine patients consented to a localized subcranial approach to the anterior skull base to preserve the contralateral olfactory nerves. In four patients with benign disease a portion of the ipsilateral nerves was additionally conserved. Postoperative olfaction was assessed objectively with a commercially available smell test. Indications, technique, results, and complications are reported and discussed.Results All patients had eradication of disease with preservation of functional olfactionConclusions Conservation of olfaction is possible in selected cases of anterior skull base surgery when the lesion is unilaterally confined.
Odontogenic Keratocysts: A Clinicopathological Study in Hong Kong Chinese
Authors: Lam K. Y. , L. Chan Alexander C. 
Published: November 2003

AbstractObjective To analyze the clinicopathological features of odontogenic keratocysts in Chinese patients.Study Design Retrospective analysis.Methods The clinical records and pathological features of odontogenic keratocysts from 69 ethnic Hong Kong Chinese patients (40 male and 29 female patients) were reviewed.Results The male‐to‐female ratio was 1.4:1; patient age ranged from 6 to 69 years with a modal peak in the third decade (mean age, 28 y; median age, 23 y). The preoperative diagnosis was correct in 78% of the cases and the most common misdiagnosis was dentigerous cyst. Sixty‐two percent of the cysts were found in the mandible, and 38% in the maxilla. Multiple cysts occurred in 9% (including three cases of basal cell nevus syndrome). Histologically, 82.6%, 5.8%, and 11.6% of the cysts were parakeratinized, orthokeratinized, and mixed types, respectively. Patients with multiple cysts all showed parakeratinization. The majority (80%) of the cysts were lined by epithelia with a thickness of five to eight cells. Surface corrugation, subepithelial split, suprabasal split, satellite microcysts, epithelial islands, significant inflammation, hyaline bodies, and dystrophic calcification were present in 100%, 81%, 25%, 38%, 42%, 46%, 7%, and 10% of cysts, respectively. The overall recurrence rate was 24%, with a median time for first recurrence of 19 months (range, 1 mo–22 y). Cysts showing orthokeratinization or mixed types of keratinization recurred less often than parakeratinized cysts. Recurrence had the same type of keratinization as the initial cyst.Conclusions Pathological examination of keratocysts is important, because keratocysts have different clinicopathological features and carry a risk for clinical misdiagnosis.
Microvascular Angiogenesis and Apoptosis in the Survival of Free Fat Grafts
Authors: Nishimura Toshiro , Hashimoto Harumi , Nakanishi Isao , Furukawa Mitsuru 
Published: November 2003

AbstractObjectives/Hypothesis Autologous fat is an ideal material for augmentation in plastic surgery because of its minimal tissue reaction and easy availability, but its long‐term graft survival is somewhat unpredictable. This study was conducted to determine how fat grafts get their vascular supply from the recipient bed and why they keep reducing in volume and weight.Study Design Experimental study using animal models.Methods The expression of vascular endothelial growth factor (VEGF) in grafted fat tissue was examined by using immunohistochemical staining, and apoptotic cell death in the grafted fat was studied by using terminal deoxynucleotidyl transferase (TdT)–mediated deoxy‐uridine triphosphate (dUTP)‐biotin nick end‐labeling method. Twenty‐five Wistar rats were used as models of free fat grafts. Fat tissue taken from inguinal fat pads was grafted to the back skin with an 18‐gauge needle injection.Results The weight of the injected fat was significantly reduced on the 180th day compared with the original weight (32% ± 10%). VEGF+ cells were observed in fibrous connective tissue of the grafts on days 7 and 30 but not after day 90. Apoptotic cells were also observed on days 7 and 30.Conclusions Angiogenic factors including VEGF started to revascularize the graft around day 7, and the extent of the vasculature was not reduced after the revascularization. In addition to necrosis in the graft's early stages, apoptosis induced by many factors in the graft's environment is also, at least in part, a cause of long‐term volume reduction of the fat graft. Thus clinical application of angiogenic factors such as VEGF to fat grafts and control of apoptosis may contribute to improvements in fat‐grafting techniques.
Molecular Pathogenesis in Sporadic Head and Neck Paraganglioma
Authors: Bikhazi Paul H. , Messina Louis , Mhatre Anand N. , Goldstein Jayne A. , Lalwani Anil K. 
Published: November 2003

AbstractHypothesis Similar to familial tumors, sporadic head and neck paragangliomas are associated with chromosomal deletions at either 11q13 or 11q22‐23.Background Familial paragangliomas are inherited in an autosomal dominant pattern with genomic imprinting of the maternal allele. Genetic studies of familial paragangliomas have localized the causative genetic defect to two separate loci: 11q13.1 and 11q22‐23. The molecular pathogenesis of sporadic head and neck paragangliomas has not been studied.Methods Blood and tumor samples from patients with sporadic head and neck paragangliomas were screened for deletions on chromosome 11 using DNA microsatellite markers and polymerase chain reaction. Polymerase chain reaction–amplified alleles from tumor specimens were compared with those from the blood of eight patients. A greater than 50% reduction in band intensity (as determined by densitometric analysis) between blood and tumor sample was indicative of a chromosomal deletion.Results Three of the eight patients were found to have deletions at chromosome 11q: two at chromosome 11q22‐23 and one at 11q13.Conclusions Sporadic head and neck paragangliomas are associated with deletions at chromosome 11q13 and 11q22‐23. It is thus likely that sporadic and familial paragangliomas share a similar molecular pathogenesis.
Neurological Consequences of Scuba Diving With Chronic Sinusitis
Authors: Joseph Parell G. , Becker Gary D. 
Published: November 2003

AbstractSinus barotrauma from scuba diving is relatively common, usually self‐limiting, and often the result of transient nasal pathology. We describe serious neurological sequelae occurring in two scuba divers who had chronic sinusitis. We suggest guidelines for evaluating and treating divers who have chronic sinusitis. Divers with nasal or sinus pathology should be aware of the potentially serious consequences associated with scuba diving even after endoscopic sinus surgery to correct this condition.
Postnatal Maturation of the Human Endolymphatic Sac
Authors: Ng Matthew 
Published: November 2003

AbstractObjective/HypothesisThe objective of this study was to trace the postnatal development of the human endolymphatic sac. The endolymphatic sac starts as a pouch‐like structure during the fetal period in the human but later develops into a complex network of tubules in its mature form.Study DesignObservational study.MethodsLight microscopic examination of the morphology of the endolymphatic sac in a population of temporal bones.ResultsExamination of 28 temporal bones from 19 infants and children reveals that endolymphatic sac morphological maturation is usually completed in the first year of life, although it may occur as late as 4 years of age. There was good correlation of maturation levels between sides when pairs of temporal bones were evaluated. Immature pouch‐like endolymphatic sacs may appear as late as 4 years of age.ConclusionsEndolymphatic sac maturation to its adult tubular form is usually completed by the first year. This finding contrasts with other studies examining the growth of the endolymphatic sac to adult size after birth. Histological evidence suggests that the endolymphatic sac, although not morphologically mature by appearance, may still be participating at some level of functioning.
Interleukin‐1 Receptor Antagonist As an Adjunct in the Treatment of Haemophilus influenzae Otitis Media in the Chinchilla
Authors: Kerschner Joseph E. , Beste David J. , Lynch Jennifer B. , Fox Mary C. , Sue Kehl Karen 
Published: November 2003

AbstractObjectives This purpose of this study was to investigate the effect of blockade of the inflammatory cytokine pathway on experimentally induced otitis media in the chinchilla model.Study Design Pilot, randomized placebo‐controlled trial.Methods Ampicillin‐sensitive Haemophilus influenzae otitis media was induced in 45 adult chinchillas. The animals were randomly assigned to the following treatment groups: 1) transbullar injections (TBI) of interleukin‐1 receptor antagonist (IL‐1ra) and intramuscular ampicillin, 2) TBI of saline and intramuscular ampicillin, 3) TBI of IL‐1ra and intramuscular saline or 4) TBI of saline and intramuscular saline. Blinded investigators measured resolution of otitis media by otomicroscopy, tympanogram, and culture results.Results Comparisons were made between the treatment groups to assess the ability of IL‐1ra to assist with resolution of otitis media using exact two‐group binomial tests with the StatXact statistical program. The group with TBI of IL‐1ra and intramuscular ampicillin as a treatment demonstrated trends suggesting more rapid resolution of positive cultures and more rapid and complete return to normal results on tympanograms and otomicroscopic findings compared with the group treated with TBI of saline and intramuscular ampicillin. These trends did not achieve statistical significance with the relatively small sample sizes used in this pilot study.Conclusions This investigation provides further evidence that the inflammatory cytokine cascade plays a significant role in the pathophysiology of otitis media and that modulation of this inflammatory pathway may provide novel and efficacious treatments for otitis media. Further studies with larger groups of animals are warranted to determine whether the trends identified in this pilot study are reproducible and achieve statistical significance.
Vocal Fold Paralysis After Anterior Cervical Spine Surgery: Incidence, Mechanism, and Prevention of Injury
Authors: Kriskovich Mark D. , Apfelbaum Ronald I. , Haller Jeffrey R. 
Published: November 2003

AbstractObjective Vocal fold paralysis is the most common otolaryngological complication after anterior cervical spine surgery (ACSS). However, the frequency and etiology of this injury are not clearly defined. This study was performed to establish the incidence and mechanism of vocal fold paralysis in ACSS and to determine whether controlling for endotracheal tube/laryngeal wall interactions induced by the cervical retraction system could decrease the rate of paralysis.Study Design Retrospective review and complementary cadaver dissection.Methods Data gathered on 900 consecutive patients undergoing ACSS were reviewed for complications and procedural risk factors. After the first 250 cases an intervention consisting of monitoring of endotracheal tube cuff pressure and release of pressure after retractor placement or repositioning was employed. This allowed the endotracheal tube to re‐center within the larynx. In addition, anterior approaches to the cervical spine were performed on fresh, intubated cadavers and studied with videofluoroscopy following retractor placement.Results Thirty cases of vocal fold paralysis consistent with recurrent laryngeal nerve injury were identified with three patients having permanent paralysis. With this technique temporary paralysis rates decreased from 6.4% to 1.69% (P = .0002). The cadaver studies confirmed that the retractor displaced the larynx against the shaft of the endotracheal tube with impingement on the vulnerable intralaryngeal segment of the recurrent laryngeal nerve.Conclusion The study results suggest that the most common cause of vocal fold paralysis after anterior cervical spine surgery is compression of the recurrent laryngeal nerve within the endolarynx. Endotracheal tube cuff pressure monitoring and release after retractor placement may prevent injury to the recurrent laryngeal nerve during anterior cervical spine surgery.
Basaloid Squamous Cell Carcinoma of the Head and Neck
Authors: G. Paulino Augusto F. , Singh Bhuvanesh , Shah Jatin P. , Huvos Andrew G. 
Published: November 2003

AbstractObjective/Hypothesis Basaloid squamous cell carcinoma (BSCC), an uncommon tumor with predilection for the upper aerodigestive tract, is a distinct variant of squamous carcinoma, because of its unique histological features and ominous clinical behavior. This study reviews the experience in treating BSCC from two institutions.Study Design Retrospective.Methods H&E‐stained sections from 20 patients with BSCC of the head and neck were reviewed and clinical follow‐up was obtained for all patients.Results The study group consisted of 14 male and 6 female patients. Their ages ranged from 43 to 85 years, with a mean age of 62 years. Sites of origin included the laryn‐ (4), tongue (3), pyriform sinus (3), nose (2), floor of mouth (2), mastoid (1), tonsil (1), epiglottis (1), nasopharyn‐ (1), trachea (1), and palate (1). Pain was the most common presenting symptom (5 cases), followed by hoarseness and bleeding (3 cases each). Tobacco and alcohol abuse was noted in 17 patients. Treatment modalities included surgery with or without chemotherapy or radiotherapy in 13 patients, chemotherapy with irradiation in 2, chemotherapy alone in 2, and radiotherapy alone in 3. Clinical follow‐up revealed no evidence of disease in 11 patients. Four were alive with disease at the time of writing and five died of disease.Conclusion BSCC is a highly aggressive malignant tumor that presents in elderly patients who have a history of abuse of tobacco or alcohol, or both. Greater number of patients must be studied and compared with age‐matched and stage‐matched controls of conventional squamous cell carcinoma to determine whether the poor clinical outcome is related more to high‐stage presentation or to the tumor's high‐grade malignant cytological features.
Workforce Issues for the Academic Otolaryngologist
Authors: Smith Richard V. 
Published: November 2003

AbstractBackground The current medico‐economic environment has led to profound changes in our health care system and questions of physician surplus. These issues have particularly affected the academic health care system, as research funding and departmental support have decreased, and many young otolaryngologists are questioning academic careers because of these uncertainties. The current study was undertaken to assess the workforce environment for the academic otolaryngologist, particularly the young physician.Methods Surveys were sent to the academic chairmen of all accredited otolaryngology residency programs in the United States, requesting information on faculty appointments—actual and projected—as well as subspecialty appointments and expectations of young faculty.Results The response rate was 60% (59/98). Faculty additions have been relatively stable from 1994 to 1998, with approximately 37 assistant professor and 5 associate professor positions filled yearly. Faculty additions were the result of departmental expansion in 83% of cases and spanned many subspecialties. The subspecialty positions most frequently added from 1994 to 1998 were generalists (57), head and neck oncologists (53), pediatric otolaryngologists (48), and otologists (39), with generalists filling 15 positions in 1998. Ninety‐three percent of programs anticipate faculty additions in the next 5 years; most will be at the assistant professor level (77%), with 30% of positions for generalists, 20% for head and neck oncologists, and 18% for pediatric otolaryngologists. Faculty expectations are primarily clinical, with research being least important.Conclusions Academic positions are available for the young otolaryngologist, particularly in the fields of general otolaryngology, head and neck oncology, and pediatric otolaryngology.