bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Angiography in the Evaluation of Patients With Pulsatile Tinnitus
Authors: Shin Edward J. , Lalwani Anil K. , Dowd Christopher F. 
Published: November 2003

AbstractObjectives/HypothesisPulsatile tinnitus in the face of normal findings on otoscopy is a common otological diagnostic dilemma and can be due to serious vascular malformations such as transverse or sigmoid sinus dural arteriovenous fistula (transverse or sigmoid sinus [TS] DAVF). Left untreated, TS DAVF may result in significant morbidity and mortality. TS DAVF can be suspected or diagnosed with computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA), with the gold standard being angiography. Our objective was to assess the utility of these various diagnostic modalities in the diagnosis of dural arteriovenous fistula.Study DesignRetrospective clinical review.MethodsBetween 1986 and 1996, 54 patients were evaluated and treated for TS DAVF. Between 1996 and 1999, an additional 33 patients underwent MRI combined with MRA for the evaluation of pulsatile tinnitus. A retrospective review of the medical records for both groups, with special attention to clinical presentation, diagnostic evaluation, therapy, and outcome, was performed.ResultsAll patients had pulsatile tinnitus with normal findings on otoscopy. CT scan was relatively insensitive in the detection of TS DAVF. MRI and MRI/MRA were significantly more sensitive than CT. In the evaluation of patients with subjective pulsatile tinnitus, MRI/MRA defined anatomical abnormalities that may contribute to pulsatile tinnitus in 63% of patients.ConclusionsIn the absence of objective pulsatile tinnitus, MRI/MRA is an appropriate initial diagnostic step. When a patient has an objective bruit, the clinician may choose to proceed directly to angiography to make certain that a TS DAVF is not missed.
Absence of Bacterial Infection in the Mucosal Secretion in Chronic Laryngitis
Authors: Ebenfelt Anders , Finizia Caterina 
Published: November 2003

AbstractObjectives To examine whether an infectious process is present in the laryngeal secretion in patients with chronic laryngitis.Study Design Mucosal secretion from vocal cords and ventricular folds from 14 patients with chronic laryngitis was examined. Twelve patients with healthy larynxes served as control subjects.Methods Secretion from the laryngeal mucosa was sampled with an imprint technique during general anesthetic. The samples were stained and examined by light and fluorescence microscopy. The numbers of leukocytes and bacteria and the extension of phagocytosis were estimated.Results In the secretion from eight of the patients with chronic laryngitis we could observe huge numbers of bacteria, whereas only few bacteria were seen in the secretion from the control subjects. However, in both groups, only a few neutrophils were observed and phagocytosis was not present, indicating that the bacteria were present as colonizers.Conclusions No infectious process is present in the secretion in chronic laryngitis. Further studies concerning the pathogenesis should focus on the pathological processes or conditions of the mucosa.
Acute Sinusitis: A Histopathological and Immunohistochemical Study
Authors: Berger Gilead , Kattan Avi , Bernheim Joelle , Ophir Dov , Finkelstein Yehuda 
Published: November 2003

AbstractObjective To provide data on the histopathological and immunohistochemical characteristics of acute sinusitis in humans.Study Design A nonrandomized, retrospective, controlled, qualitative and quantitative study.Methods Inflamed sinus mucosal tissues were removed during functional endoscopic sinus surgery from 11 patients with acute sinusitis, of whom 6 had complications with extension of inflammation to the orbit (4) or the meninges (2), 3 had recurrent sinusitis, and 2 had acute exacerbation of chronic sinusitis. Normal sinus mucosal tissues were retrieved from four patients with various nasal tumors and served as controls. All specimens underwent routine histological processing. Representative sections from each region were stained with hematoxylin and eosin, periodic acid‐Schiff, and toluidine blue. Immunohistochemical staining for T and B lymphocytes was also applied. A two‐phase examination was designed: low‐magnification microscopic assessment (×40) to yield the typical pathological features and high‐magnification assessment (×400) to count various inflammatory cells.Results The lamina propria displayed the most significant changes with edema, extensive infiltration of neutrophils and mononuclear cells, formation of microabscesses, thrombophlebitis, and necrotic foci, whereas the involvement of the epithelial layer in the inflammatory reaction was relatively modest. Immunohistochemistry revealed an increase in the population of T and B lymphocytes. The former were diffusely scattered, whereas the latter also formed distinct clusters: around small venules, adjacent to seromucous glands, and under the epithelium.Conclusions The inflammatory reaction of the lamina propria exceeded that of the epithelial layer. It is assumed that the clusters of B lymphocytes around blood vessels may point to the fact that these cells were recruited from the blood during acute sinusitis.
Age‐Related Mitochondrial DNA Mutations in the Human Larynx
Authors: Manaligod Jose M. , Milam Michael , Hill Sarah Ann , Sanders Tammy , Skaggs Jennifer , Smith Richard J. H. 
Published: November 2003

AbstractObjective To determine whether age‐related mitochondrial DNA mutations occur in the human larynx.Study Design Genetic study of cadaveric larynx specimens.Methods Vocal fold mucosa, thyroarytenoid muscle, and cricoarytenoid joint tissue were harvested from 13 fresh postmortem larynges (age range, 2 d–82 y). DNA was extracted from each sample, and the polymerase chain reaction (PCR) was used to amplify a target DNA sequence resulting from the common age‐associated, 4977–base‐pair (bp) mitochondrial DNA deletion. PCR products were visualized by agarose gel electrophoresis. Automated sequencing determined the sequence of identified PCR products.Subjects Thirteen cadaveric larynges were obtained through the University of Kentucky Medical Center (Lexington, KY). Specimens from patients with a history of head and neck cancer, previous laryngeal trauma, or surgery were excluded.Results Strongly positive bands were identified in samples from three individuals. Weaker bands were seen in samples from four other samples. No band was noted from the two pediatric larynges. Different band patterns were seen among the three different tissue sites in the larynges with positive PCR products, but no consistent pattern was seen. Sequencing of the identified PCR products from selected samples confirmed that they were products of the age‐associated, 4977‐bp mitochondrial DNA deletion.Conclusions An age‐associated mitochondrial DNA deletion was detected in several postmortem human larynges. Its presence seemed to increase in appearance with age. In the larynges in which the deletion occurred, there were individual regional differences in the occurrence of the deletion, but no consistent pattern was noted across all individuals who carried the deletion.
Neonatal Subglottic Stenosis—Incidence and Trends
Authors: Walner David L. , Loewen Mark S. , Kimura Robert E. 
Published: November 2003

AbstractObjective/Hypothesis Neonatal subglottic stenosis is a known entity arising from endotracheal tube intubation. In the 1970s and 1980s, estimates of the incidence of subglottic stenosis were in the range of 0.9% to 8.3% of intubated neonates. Because of improved techniques of handling neonates who require ventilatory support, we thought the actual incidence of neonatal subglottic stenosis in the late 1990s was much lower.Study Design We retrospectively reviewed all neonatal intensive‐care unit (NICU) admissions from 1997 at our institution, which serves as a level 3 NICU. We also performed a MEDLINE search of the reported incidence of neonatal subglottic stenosis between 1960 and 1999.Methods Analysis was performed to identify all children who developed subglottic stenosis at our institution. Data were also collected and analyzed with regard to average gestational age, average birth weight, average duration of intubation, and the number of children requiring tracheostomy. The reports identified in the literature were reviewed as to the incidence of subglottic stenosis.Results A total of 544 neonates were admitted to the unit. Of these, 281 were intubated for an average of 11 days. No patients developed subglottic stenosis. Three patients required tracheostomies for other reasons. All studies published after 1983 reported an incidence of neonatal subglottic stenosis as less than 4.0%, and all studies published after 1990 reported an incidence of neonatal subglottic stenosis as less than 0.63%.Conclusions Although our report applies to only a single institution in a single year, after reviewing the literature we think a downward trend exists in the incidence of neonatal subglottic stenosis in the late 1990s. The current incidence of neonatal subglottic stenosis is likely between 0.0% and 2.0%.
Electroporation Therapy for Head and Neck Cancer Including Carotid Artery Involvement
Authors: Allegretti Joseph P. , Panje William R. 
Published: November 2003

AbstractObjectives Electroporation therapy with intralesional bleomycin (EPT) is a novel, technically simple outpatient technique in which high‐voltage electric impulses delivered into a neoplasm transiently increase cell membrane permeability to large molecules, including cytotoxic agents, causing localized progressive necrosis. Unlike many laser ablation methods, EPT can treat bulky tumors (>2 cm) with complete penetration. Our recent publication confirms an excellent response rate in the use of EPT in a clinical trial.Study Design, Patients, and Methods Following our initial prospective study report in 1998, we have followed our entire initial cohort (10 patients) of patients with head and neck cancer beyond 24‐months follow‐up. Additionally, we have used this approach to treat four additional patients (total: 9 males/5 females) with upper aerodigestive tract squamous cell carcinoma, including three with internal carotid artery (ICA) involvement up to or within the skull base. Two patients underwent preoperative balloon test occlusion with cerebral perfusion studies followed by carotid embolization. EPT was then done safely at least 2 weeks later to avoid the temporary hypercoagulable state.Results Within the overall cohort (14 patients) 6 patients had a complete response, 6 had a partial response, and 2 did not respond (overall 85.7% response rate). Both patients with ICA involvement had a partial or complete response to treatment; neither patient had a hemorrhagic or neurologic complication. Overall, 13 of the 14 patients were treated for persistent or recurrent head and neck cancer. Two of the four patients with early recurrent stage tumors had no evidence of recurrence after EPT with an average follow‐up of 31.5 months. The overall early stage tumor group had four complete responders out of five (80%). On the contrary, only 2 of 9 patients with advanced recurrent stage tumors were disease‐free at 18 months. Morbidity was low for early stage tumors, but higher for advanced tumors with complications, including poor wound healing, dysphagia, and osteomyelitis. There were no treatment‐related deaths.Conclusion We found EPT to be safe and efficacious in patients with head and neck cancer, even with internal carotid artery involvement. Patients with early stage recurrences have the potential for prolonged survival beyond 2 years without the morbidity of surgery and radiation or toxicity of systemic chemotherapy. Because of its superb access qualities even for bulky tumors, EPT is a potential method of delivery for other tumoricidal agents such as in genetic‐altering schemes.
Changes of Nasal Function After Temperature‐Controlled Radiofrequency Tissue Volume Reduction for the Turbinate
Authors: Rhee Chae‐Seo , Kim Dong‐Young , Won Tae‐Bin , Lee Hyo‐Jung , Park Seok‐Won , Kwon Tae‐Young , Lee Chul Hee , Min Yang‐Gi 
Published: November 2003

AbstractObjectives Temperature‐controlled and temper‐ature‐monitored radiofrequency tissue volume reduction (RFTVR) for the turbinate is a new treatment modality for nasal obstruction secondary to turbinate hypertrophy. We compared the nasal functions after the treatment of RFTVR and laser vaporizing turbinoplasty (LVT) using subjective symptom scores and objective tests.Study Design Prospective, randomized clinical trial.Methods Twenty‐four patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively evaluated from March 1999 to October 1999 at Seoul National University Hospital (Seoul, Korea). Si‐teen patients were treated with RFTVR, and eight patients with LVT. The preoperative and postoperative nasal functions were investigated by visual analogue scale of symptoms, butanol threshold test, saccharine test, acoustic rhinometry, rhinomanometry, and ciliary beat frequency.Results At 8 weeks postoperatively, the severity and the frequency of nasal obstruction improved subjectively in 81.3% and 93.8% of RFTVR group and in 87.5% and 87.5% of LVT group, respectively. Significant improvement of nasal symptoms began from 2 to 3 days after the operation in the RFTVR group, whereas there was significant improvement of nasal symptoms at 8 weeks after operation in the LVT group. However, objective nasal functions including nasal volume and total nasal resistance were significantly improved at 8 weeks after surgery in both groups. Among patients reporting symptoms of hyposmia, 55.6% of RFTVR group and 63.6% of LVT group showed improved olfaction. Saccharin transit time and ciliary beat frequency were preserved after RFTVR.Conclusion RFTVR for the turbinate may be useful as an alternative approach for the treatment of chronic turbinate hypertrophy.
Facial Purpura
Authors: Goldman Andrew C. , Govindaraj Satish , Franco Ramon A. , Lim Jessica 
Published: November 2003

AbstractObjectives Patients with facial purpura can have acute and dramatic illnesses. For this reason, the clinician must be aware of certain diagnoses that can present as facial purpura and know how to initiate treatment efficiently. According to our review of the literature, no paradigm currently exists for the diagnosis and management of facial purpura. Our goal is to develop a schema for the identification and management of facial purpura.Study Design Case series.Methods A case series of five cases is presented followed by a systematic development of a differential diagnosis based on etiology of the lesion.Results Facial purpura can be classified into conditions that are primarily or secondarily vasculitic, thrombocytopenic, neoplastic, infectious, toxic, and miscellaneous, which encompasses episodic reports that do not fit into the other categories. A paradigm to diagnose patients with facial purpura is developed based on clinical presentation and etiology. To demonstrate the utility of our algorithm, the five cases presented are re‐examined using the algorithm. To our knowledge, this represents the first reported series of facial purpura in the modern English literature. A flow chart based on our diagnostic paradigm is presented.Conclusion Clinicians caring for patients with facial purpura must recognize the acute conditions that require emergent medical intervention. Once these diagnoses have been considered, the clinician can employ a systematic approach to the diagnosis based on etiology. This study provides a useful reference for the otolaryngologist when encountering a patient with facial purpura.
Mucosal Immunity of the Middle Ear: Analysis at the Single Cell Level
Authors: Suenaga Satoshi , Kodama Satoru , Ueyama Shigehiro , Suzuki Masashi , Mogi Goro 
Published: November 2003

AbstractObjective Studies have suggested that the middle ear is a potential site of immunological regulation and that the middle ear mucosa constitutes a part of the mucosal immune system. We clarify the characteristics of the middle ear mucosa with respect to immune potential.Study Design We investigated lymphocyte subsets, mRNA of cytokines, and induction of antigen‐specific IgA‐producing cells in the middle ear mucosa in specific pathogen‐free C57BL/6 mice.Results Flow cytometric analysis showed a certain amount (10%–15%) of γδ T cells among CD3+ T cells. P6‐specific IgA‐producing cells were induced by intranasal immunization with P6 together with cholera toxin. RT‐PCR assay of mucosal T cells detected mRNA of Th2 type cytokines such as IL‐5 and IL‐10.Conclusion These findings support the fact that the middle ear is potentially an effector site of the mucosal immunity.
Excision of the Preauricular Sinus: A Comparison of Two Surgical Techniques
Authors: Lam Henry Chuen Kwong , Soo Gordon , Wormald Peter John , Van Hasselt Charles Andrew 
Published: November 2003

AbstractObjectives To compare the long‐term recurrence rate of the standard technique (simple sinectomy) and the supra‐auricular approach (wide local excision) for the surgical management of preauricular sinuses.Study Design Retrospective cohort.Methods Fifty‐four patients with a preauricular sinus excised between May 1986 and December 1996 were included in this study. All patients were categorized into one of two groups based on the type of surgery performed: the standard technique or the supra‐auricular approach. The medical records were then reviewed and the latest information concerning the recurrence of a preauricular sinus were updated by phone interview. The recurrence rate of these two groups was statistically analyzed by the Fisher exact test.Results Forty‐nine of 54 patients were successfully contacted with data updated and analyzed. The 32% recurrence rate of the standard excision (n = 25) was significantly higher than the 3.7% recurrence rate of the supra‐auricular approach (n = 27; two‐tailed test, P = .01).Conclusion The supra‐auricular approach for excision of a preauricular sinus has a statistically lower recurrence rate in comparison to the standard technique.
External Osteotomy in Rhinoplasty
Authors: Giacomarra Vittorio , Russolo M. , Arnez Z. M. , Tirelli G. 
Published: November 2003

AbstractObjectives To compare external and internal lateral osteotomy in rhinoplasty.Study Design Retrospective review and study on cadavers.Methods One hundred forty‐two patients who underwent aesthetic rhinoplasty were examined. The following criteria were taken into consideration: edema and ecchymosis around the eyes, the degree of closure of the roof, symmetry and level of fractures, solidity of the bone pyramid, and any scarring at the access point of the osteotome. In the last 25 patients who had surgery, a nasal endoscopy with optical fibers was carried out to evaluate any damage to the mucosa caused by the 2‐mm osteotome. Furthermore, to compare the two routes in vivo, for five of these patients a lateral osteotomy was carried out externally for one side and internally for the other. Lateral osteotomy were performed on five cadavers by an external route on one side and by an internal one on the other. A midface degloving procedure was performed to expose the osteotomy sites.Results Edema and ecchymosis were always much less severe in patients who were treated with external osteotomy. The control of the fracture line was always excellent. Endoscopic evaluation and study on cadavers revealed damages to the mucosa caused from the internal osteotomy and a better control of fracture line in external osteotomy.Conclusions External osteotomy is an easy and precise approach. Because the fracture is of a greenstick type, the bone stumps are stable. The reduced bleeding reduces the formation of edemas and ecchymosis around the eyes. The damage to the nasal mucosa is minimal, and the cutaneous scars are virtually invisible a month after surgery.
Esthesioneuroblastoma: The University of Iowa Experience 1978–1998
Authors: Simon James H. , Zhen Weining , McCulloch Timothy M. , Hoffman Henry T. , Paulino Arnold C. , Mayr Nina A. , Buatti John M. 
Published: November 2003

AbstractObjective Esthesioneuroblastoma is rare and the best treatment has yet to be defined. The purpose of this study is to analyze the natural history, treatment, and patterns of failure of esthesioneuroblastoma treated at one institution.Methods Between 1978 and 1998, 13 patients with esthesioneuroblastoma were identified using the University of Iowa Tumor Registry. All patients were staged according to Kadish criteria. Mean follow‐up was 6.3 years. Six patients had 5 or more years of follow‐up and four had follow‐up exceeding 9.5 years. One patient was lost to follow‐up at 36 months.Results No patients had Kadish stage A disease, five were stage B, and eight stage C. Overall actuarial 5‐ and 10‐year survival rate was 61% and 24%, respectively. Disease‐free survival rate at 5 and 10 years was 56% and 42%, respectively. Seven patients have died, three of intercurrent disease and three of disease progression, one with an unknown disease status. Six patients remain alive, three without evidence of disease and three have experienced a local or regional recurrence. Five patients who were initially controlled developed recurrence, three local only, one locoregional, and one regional and distant. Median time to failure was 96 months. All patients with follow‐up exceeding 12 years have experienced either a local or regional recurrence. Survival after salvage therapy in these patients ranged from 3 to 12 years.Conclusion Esthesioneuroblastoma has a long natural history characterized by frequent local or regional recurrence after conventional treatment. Successful retreatment can lead to prolonged survival.
Effect of Anemia on the Fasciocutaneous Flap Survival in a Rat Model
Authors: Desyatnikova Stella , Winslow Catherine , Cohen James I. , Wax Mark K. 
Published: November 2003

AbstractObjective/Hypothesis Ablative surgery for head and neck cancer that creates large composite defects often results in a significant decrease in the hematocrit level. These defects are best reconstructed with a microvascular free tissue transfer. Effect of the decreased hematocrit on microvascular flap survival is controversial. The purpose of this study was to assess the effect of isovolemic anemia on flap survival in a rat model.Study Design Prospective analysis.Methods Ninety rats were used (30 control and 60 experimental animals). Experimental animals were rendered anemic by blood draw and volume resuscitated with either a colloid (30 animals) or crystalloid (30 animals) solution. In all animals a ventral fasciocutaneous flap was raised. A vascular clamp was applied to the arteriovenous pedicle, and different ischemic times were allowed to elapse before clamp removal. Flap survival was assessed at 5 days. Probit analysis was performed for the three animal groups.Results A significantly increased probability of the flap survival was found in the anemic animals compared with the control group (P ≤.05). No difference was found between the colloid and crystalloid resuscitation groups.Conclusions A decreased hematocrit level increases fasciocutaneous flap tolerance to ischemia and significantly increases the primary ischemic time in the ventral flap clamp model in rats. Fluid replacement with either crystalloid or colloid produces identical results.