bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Clarithromycin on Cultured Human Nasal Epithelial Cells and Fibroblasts
Authors: Miyanohara Toshio , Ushikai Masato , Matsune Shoji , Ueno Kazuyoshi , Katahira Shoko , Kurono Yuichi 
Published: November 2003

AbstractObjective/Methods: Long‐term administration of clarithromycin has been reported to be effective in the treatment of chronic sinusitis. To investigate the mechanism underlying the anti‐inflammatory activity of clarithromycin, the authors evaluated the effect of clarithromycin on the gene expression of proinflammatory cytokine and the DNA‐binding activity of nuclear factor (NF)‐κB in cultured human nasal epithelial cells and fibroblasts. Cells were incubated with endotoxin purified from nontypeable Haemophilus influenzae or interleukin (IL)‐1β in the presence of clarithromycin.Results: Northern blot analysis revealed that clarithromycin suppressed IL‐1β gene expression in human nasal epithelial cells stimulated by H influenzae endotoxin (HIE). Intercellular adhesion molecule‐1 gene expression in nasal fibroblasts stimulated by IL‐1β was also suppressed by clarithromycin. Furthermore, electrophoretic mobility shift assay demonstrated that clarithromycin reduced DNA‐binding activity of NF‐κB in both human nasal epithelial cells and fibroblasts stimulated by HIE or IL‐1β, respectively.Conclusion: The present results suggest that clarithromycin may reduce gene expression of proinflammatory cytokines and adhesion molecules from nasal mucosa at the transcriptional factor level and exert an anti‐inflammatory effect on nasal mucosa in chronic sinusitis.
Postoperative Quality of Life in Vestibular Schwannoma Patients Measured by the SF36 Health Questionnaire
Authors: da Cruz Melville J. , Moffat David A. , Hardy David G. 
Published: November 2003

AbstractObjective: To quantify the postoperative quality of life in patients following surgical treatment for vestibular schwannoma.Study Design: Patient self‐assessment using the short form 36 (SF36) multidimensional quality of life health questionnaire. Sex‐ and age‐matched normalized scores were calculated using a standardized process and accepted normative data.Setting: Tertiary referral skull base unit.Results: An 80% response rate (90 patients) was achieved. The postoperative quality of life in vestibular schwannoma patients, as quantified by seven of the eight SF36 health scales was less than the appropriate matched healthy standard. Comparison of a variety of preoperative patients and tumor factors‐different operative approaches (translabyrinthine and retrosigmoid), tumor size (group cut of points of tumor diameter 1.5 mm and 2.5 mm), patient sex, and ranking of patient age‐showed no statistically significant difference in measured quality of life outcomes for each of these traditional predictors.Conclusion: Reduced quality of life in patients after surgical treatment for vestibular schwannoma, coupled with the low tumor growth rates and minimal preoperative symptoms, supports a conservative approach to patient management. The advantages and disadvantages of a variety of approaches used to measure the quality of life after surgical treatment of vestibular schwannoma and their impact on clinical decision making for patients, are discussed.
A Cost‐Utility Analysis of Pediatric Cochlear Implantation
Authors: O'Neill Ciaran , O'Donoghue Gerard M. , Archbold Susan M. , Normand Charles 
Published: November 2003

AbstractObjective/Hypothesis: The aim of this study was to explore the cost‐utility of pediatric cochlear implantation, incorporating savings associated with education into the analysis.Methods: The costs of pediatric cochlear implantation were based on the full costs levied to purchasers, inclusive of complications and maintenance, by a large pediatric cochlear implant program in the United Kingdom. After implantation, profoundly hearing‐impaired children have been found to develop hearing threshold levels equivalent to severely hearing‐impaired children who wear hearing aids. An independent study calculated the educational costs for severely hearing‐impaired and profoundly hearing‐impaired children. From this study, savings in educational costs that would result from enabling the profoundly hearing‐impaired to function as severely hearing‐impaired were determined. Cost‐utility was established conservatively by applying to children the known gains in utility reported by adults with cochlear implants.Results: The discounted costs of creating a pediatric cochlear implant user and of maintaining the child over the first 12 years were £48,757 ($78,011). The discounted difference in education costs associated with a profoundly hearing‐impaired child (HL >95 dB) as compared with a severely hearing‐impaired child (HL 70‐95 dB) over the same period was £26,781 ($42,850). These represent the potential savings in educational costs associated with pediatric cochlear implantation. Assuming implantation at age 4 years, the discounted net average cost of pediatric cochlear implantation over compulsory school years (ages 4‐16) was £21,976 ($35,162). Cochlear implants have been shown to improve the quality of life in adults by 0.23 points per annum (where quality of life is rated on a scale from 0 to 1). Applying this weight to children receiving implantation at age 4 years, and assuming a life expectancy of 74 years, the quality‐adjusted life‐year (QALY) gain is calculated to be 16.33. The cost per undiscounted QALY gain was estimated to be £1,345.70 ($2153.12) and per discounted QALY gain to be £10,341 ($16,545.60).Conclusion: This study provides evidence, based on conservative assumptions, to support the view that pediatric cochlear implantation is a cost‐effective health care intervention in profoundly hearing‐impaired young children.
Sentinel Lymph Node Radiolocalization in Head and Neck Squamous Cell Carcinoma
Authors: Alex James C. , Sasaki Clarence T. , Krag David N. , Wenig Barry , Pyle Paula B. 
Published: November 2003

AbstractObjectives: To determine the feasibility of sentinel node radiolocalization in stage N0 in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel node could be prognostic of regional micrometastatic disease.Study Design: A prospective report on the application sentinel node radiolocalization in eight patients with N0 squamous cell carcinoma of the head and neck region.Methods: For each patient a peritumoral submucosal injection of filtered technetium (99mTc) prepared with sulfur colloid was performed immediately following intubation. After at least 30 minutes, focal areas of accumulation corresponding to a sentinel node were marked on the skin surface. Complete neck dissections were performed, and the sentinel nodes were identified for later histological evaluation and comparison to the remaining lymphadenectomy specimen.Results: Sentinel node radiolocalization accurately identified two or more sentinel lymph nodes in all eight cases. In one patient, two of the three lymph nodes containing micrometastatic disease were sentinel lymph nodes. There was no instance in which sentinel node was negative for micrometastatic disease while being positive in a nonsentinel lymph node.Conclusions: Accurate localization of the sentinel lymph node using radiolabeled sulfur‐colloid is feasible in patients with squamous cell carcinoma of the head and neck region. Although sentinel node radiolocalization in head and neck squamous cell cancer may potentially reduce the time, cost, and morbidity of regional lymph node management, more experience with technique is required before its role can be determined.
Long‐Standing Lateral Neck Mass As the Initial Manifestation of Well‐Differentiated Thyroid Carcinoma
Authors: Coleman Sean C. , Smith Jonathan C. , Burkey Brian B. , Day Terrence A. , Page Robert N. , Netterville James L. 
Published: November 2003

AbstractObjective: To analyze the presentation, evaluation, and treatment of a subset of patients with well‐differentiated thyroid carcinoma who present with a lateral neck mass and no palpable disease in the thyroid gland.Study Design: A retrospective review of all patients undergoing thyroidectomy for malignancy.Methods: A database of all thyroidectomies performed for malignancy by the Vanderbilt University Department of Otolaryngology—Head and Neck Surgery from 1992 to 1997 was created. Patients who presented with an isolated neck mass without evidence of palpable disease in the thyroid were selected for the study population.Results: There were 60 cases of thyroid malignancy, with 14 cases (23.3%) that presented as isolated lateral neck mass. The characteristics of this group (compared with the population of all thyroid malignancies) include younger age at presentation (37.7 ± 15.2 y vs. 49.8 ± 15.6 y; Student t test:P = .019) and long‐standing presence of symptoms (27.4 ± 39.6 mo vs. 3.6 ± 3.9 mo;P = .023). These patients generally presented from a referring facility after having an excisional biopsy, which was 100% accurate. Fine‐needle aspiration is becoming more useful and was 66.7% accurate. Histological examination revealed cancer in the thyroid gland in all patients, 11 cases of papillary carcinoma, 2 follicular carcinomas, and one medullary carcinoma. The mean size of the primary focus was 10.9 ± 8.7 mm, with 29% demonstrating bilateral disease and 14% demonstrating multifocal disease in the ipsilateral gland. The neck specimens revealed an average of 5.3 ± 3.2 metastatic nodes in levels II–IV and 3.9 ± 4.6 metastatic nodes in the paratracheal region.Conclusion: Based on this patient population, the long‐standing lateral neck mass in the young patient should raise the physician's index of suspicion for thyroid carcinoma. Fine‐needle aspiration should be used in conjunction with judicious excisional biopsy. The bilateral and multifocal nature of otherwise occult primary disease argues for total thyroidectomy in this setting.
Quantification of the Learning Curve for Percutaneous Dilatational Tracheotomy
Authors: Massick Douglas D. , Powell David M. , Price Phillip D. , Chang Susan L. , Squires Gregory , Forrest L. Arick , Young Donn C. 
Published: November 2003

AbstractObjectives/Hypothesis: Although numerous investigators have reported a bedside percutaneous dilatational tracheotomy (PDT) complication incidence similar to that of standard operative tracheostomy, others have proposed a “learning curve” for PDT resulting in increased complications early in individual or institutional experience with this procedure. The objective of this investigation is to characterize and quantify the proposed learning curve for PDT.Study Design: Prospective analysis of complication incidence for the first 100 PDT procedures performed in a local community hospital Department of General Surgery.Methods: Demographic data, patient disease variables, and patient anatomic features, as well as perioperative, postoperative, and late complications, were recorded prospectively. Patients were divided into sequential cohorts of 20 and were evaluated for complications at regular intervals.Results: Perioperative and late complication incidence was significantly higher in the first 20 patients who underwent PDT. However, postoperative complication incidence did not significantly vary with operator or institutional experience. In addition, patients with suboptimal anatomy were found to have a significantly increased complication incidence, independent of operator and institutional experience.Conclusions: Percutaneous dilational tracheotomy has an identifiable learning curve that is most prominent in the first 20 patients treated. Early experience with PDT should be obtained under controlled circumstances, ideally the operating suite. Although most complications occur during acquisition of early experience with PDT, certain life‐threatening complications such as tube dislodgment or inability to complete procedure may occur even after extensive experience is obtained. Bedside PDT has an acceptable complication incidence, but any surgeon employing this technique must be prepared to perform immediate standard open tracheotomy to minimize potentially lethal complications of this elective procedure.
Redefining the Survival of the Fittest: Communication Disorders in the 21st Century
Authors: Ruben Robert J. 
Published: November 2003

AbstractObjectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language.Study Design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language.Method: Analysis of epidemiological and economic data for industrialized countries, North America, and the United States.Results: Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities. The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product.Conclusions: Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication‐based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.
Dynamic Asymmetry of the Vestibulo‐ocular Reflex in Unilateral Peripheral Vestibular and Cochleovestibular Loss
Authors: Maire Raphaël , van Melle Guy 
Published: November 2003

AbstractObjective: Rotatory tests in the horizontal plane have shown various degrees of vestibulo‐ocular reflex (VOR) asymmetry in patients after surgical deafferentation of one labyrinth. The purpose of this work was to characterize dynamic horizontal VOR responses among patients presenting with a unilateral peripheral labyrinthine deficit of nonsurgical origin and to compare results in isolated vestibular loss versus cochleovestibular loss.Study Design: This study included 40 patients who presented with an acute, spontaneous unilateral peripheral labyrinthine lesion. Twenty‐two patients had vestibular loss alone (without associated hearing impairment) and 18 presented with a cochleovestibular deficit (sudden hearing loss with vertigo). The majority of these patients were part of a long‐term protocol to evaluate vestibular compensation.Methods: All patients underwent both the clockwise test and the counterclockwise rotatory test in the horizontal plane, using brief impulses of moderate intensity. Results were analyzed by a simplified model of vestibular function, allowing a parametric estimation of the response.Results: A weak and transitory horizontal VOR asymmetry was observed in the 22 patients with vestibular loss. However, the 18 patients with cochleovestibular loss demonstrated a more severe and persistent asymmetry.Conclusions: This study revealed a difference in the dynamic characteristics of the horizontal VOR between patients with vestibular loss and those with cochleovestibular loss. Our results support the presence of an extensive labyrinthine lesion in cochleovestibular deficit that involves the otolith organs. The implications of this involvement on the central mech‐ anisms of otolith‐canal interaction are discussed.
Assessing Olfactory Function in Laryngectomees Using the Sniffin'Sticks Test Battery and Chemosensory Evoked Potentials
Authors: Welge‐Luessen Antje , Kobal Gerd , Wolfensberger Markus 
Published: November 2003

AbstractObjectives/Hypothesis: Laryngectomees are often considered to be completely anosmic. The aim of this study was to determine whether anosmia in laryngectomees reflects diminished transport of odorants to the olfactory epithelium or olfactory epithelial damage.Study Design: Twenty‐five laryngectomees were examined psychophysically using the Sniffin'Sticks test battery. All patients rated the degree of their subjectively perceived deficit on a rating scale. Chemosensory evoked potentials were also recorded in 11 of 25 patients.Results: Sixteen patients complained very little about their smell deficit, even though the psychophysical testing found 18 patients to be anosmic and 7 hyposmic. Olfactory potentials could be recorded in only 7 of the 11 patients who received this evaluation, despite the fact that all 11 perceived, at least vaguely, the olfactory stimulus, H2S, during the recording sessions. No meaningful correlation between the psychophysical and electrophysiological data was observed.Conclusions: The psychophysical data revealed the laryngectomees to be either functionally anosmic or hyposmic. The olfactory evoked potential data suggested that at least in two thirds of the laryngectomized patients the olfactory system had some function, even up to 22 years after surgery. Because patients in everyday situations find ways to bring odorants to the olfactory mucosa, the low number of complaints about subjectively perceived deficits is reasonable.
Long‐Term Use of Preservatives on Rat Nasal Respiratory Mucosa: Effects of Benzalkonium Chloride and Potassium Sorbate
Authors: Cho Jin‐Hee , Kwun Yong‐Sig , Jang Han‐Sung , Kang Jun‐Myung , Won Yu‐Sung , Yoon He‐Ro 
Published: November 2003

AbstractObjectives: The preservatives benzalkonium chloride (BZC) and potassium sorbate (PS) are widely used, not only for nasal drops, but also for eyedrops and cosmetics. However, there have been many case reports that consider lesions such as dermatitis or conjunctivitis to be the results of irritation induced by BZC or PS.Methods: We evaluated the histological changes after the long‐term administration of BZC or PS on rat nasal respiratory mucosa. Forty rats were used for the BZC group and 40 rats for PS group. Animals in each group were divided into four subgroups. The first subgroup received a low‐concentration preservative solution that was commonly used for nasal sprays. The second subgroup received a high‐concentration preservative solution that was reported to induce dermatitis in humans. The third and fourth subgroups received a steroid mixed preservative solution of low and high concentrations, respectively. The control group was administrated normal saline. After each group received 1, 2, and 4 weeks of topical administration, the symptomatic and histological changes on H&E stain were observed.Results: Sneezing and nasal rubbing with forelegs were observed in almost all subgroups by the seventh day of treatment. The preservatives induced nasal lesions, including intraepithelial glandular formation, inflammatory cell infiltration, vascular hyperplasia, and edematous change. The symptomatic and histological changes were pronounced with the prolonged duration of administration. Similar results were observed in the steroid mixed‐solution groups. In the PS steroid mixed‐solution group, however, symptoms and nasal lesions were reduced with the prolonged duration of administration.Conclusion: It is our finding that even a low‐concentration solution of preservative can lead to nasal lesion. Hence there is a strong need to develop both a preservative that can be safely and widely used and a nasal spray without preservatives.
Postoperative Airway Findings After Maxillomandibular Advancement for Obstructive Sleep Apnea Syndrome
Authors: Li Kasey K. , Riley Robert W. , Powell Nelson B. , Zonato Adriana , Troell Robert , Guilleminault Christian 
Published: November 2003

AbstractObjective: To evaluate the upper airway characteristics in the early postoperative period after maxillomandibular advancement for obstructive sleep apnea syndrome.Methods: Nasopharyngolaryngoscopy was performed before and 48 hours after surgery on 70 consecutive patients who underwent maxillomandibular advancement for obstructive sleep apnea syndrome. The preoperative and the postoperative evaluations were performed by the same examiner for consistency.Results: Mild to moderate lateral pharyngeal wall edema was identified in 70 consecutive patients. Fourteen patients (20%) had edema as well as ecchymosis involving the pyriform sinus and aryepiglottic fold. Four of these patients (6%) were also noted to have hypopharyngeal hematoma involving the pyriform sinus, aryepiglottic fold, arytenoid, and false vocal cord that partially obstructed the airway. These four patients were closely monitored for 1 to 2 additional days for possible expanding hematoma leading to airway compromise. None of these patients were found to have airway difficulty, and the minimum oxygen saturation was more than 90% throughout the hospitalization. All four patients were discharged uneventfully, and the hematoma resolved completely within 10 days.Conclusion: Although postoperative edema was expected after maxillomandibular advancement, hypopharyngeal hematoma was unexpected. Although none of our patients had evidence of airway difficulty, the possibility of an expanding hypopharyngeal hematoma should be considered in patients complaining of breathing difficulty after maxillomandibular advancement surgery.
A Pilot Study of Autofluorescent Endoscopy for the in Vivo Detection of Laryngeal Cancer
Authors: Delank Wolfgang , Khanavkar Barbara , Nakhosteen John A. , Stoll Wolfgang 
Published: November 2003

AbstractObjectives To determine the advantage of autofluorescent endoscopy for the identification of laryngeal cancer.Study Design This is a prospective, multicenter clinical study. We investigated whether autofluorescent endoscopy using the Lung Imaging Fluorescent Endoscopy (LIFE)–Lung System (Xillix, Olympus) is capable of identifying early cancer of the larynx, especially in comparison with conventional white‐light endoscopy and microscopic laryngoscopy. Benign lesions as well as microinvasive and invasive squamous cell carcinoma of the larynx were investigated. For logistic reasons and because of the pilot character of this study, the number of patients was limited.Methods Sixteen patients having 24 laryngeal lesions of both benign or malignant character were subsequently examined by autofluorescent endoscopy, white‐light endoscopy, and microscopic laryngoscopy. Based on optical appearance, and for each method separately, the lesions were classified as malignant or not. The visual results were documented and histologically verified.Results The sensitivity of autofluorescent endoscopy for laryngeal cancer detection was more than 90% and therefore higher than that of white‐light endoscopy and microscopic laryngoscopy. However, as far as laryngeal cancer is concerned, the specificity of autofluorescent endoscopy was very low. Many of the false‐positive results were due to inflammation, hypervascularization, and edema.Conclusion Autofluorescent endoscopy is advantageous only in the hands of an experienced ENT specialist. Although it does not replace the combination of white‐light endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Autofluorescent endoscopy can help in determining whether microscopic laryngoscopy performed with general anesthesia should be recommended urgently to the patient. Microscopic laryngoscopy remains the best method for the identification of malignant lesions, if it is combined with obtaining taking multiple biopsy specimens. Confirmation of the results of this pilot study with a larger series of patients is desirable.