bluuebunny/crossref_metadata_2025_split huggingface dataset:
High‐Dose‐Rate Brachytherapy for Primary Carcinomas of the Oral Cavity and Oropharynx
Authors: Rudoltz Marc S. , Perkins Ryan S. , Luthmann Robert W. , Fracke Todd D. , Green Tina M. , Moye Linda , Wludyka Peter , Choi Young‐Ku , Ackerman Scot N. 
Published: November 2003

AbstractObjective: Local control for patients treated with primary radiation therapy for tumors of the oral cavity is improved using low‐dose‐rate brachytherapy. Oropharyngeal carcinomas have also been treated with brachytherapy. The few reports in the literature regarding high‐dose‐rate brachytherapy (HDRBT) for head and neck cancer involve small numbers of patients and often contain a mix of palliative and curative cases. The purpose of this study is to evaluate the feasibility of HDRBT in the largest reported cohort of primary head and neck cancer patients treated with primary radiation therapy.Study Design: This is a prospective nonrandomized study.Methods: Fifty‐five patients with primary untreated squamous cell carcinomas of the oral cavity and oropharynx were analyzed. There were 16 patients with T1, 26 with T2, 8 with T3, and 5 with T4 tumors. All patients received external‐beam radiotherapy (EBRT) followed by HDRBT. Thirty‐eight patients received hyperfractionated (twice daily) EBRT followed by HDRBT two or three times daily. Patients with cervical adenopathy also received hyperthermia and an electron boost to the site(s) of positive nodes. Median follow‐up was 2.7 years. Toxicity and local control were analyzed. Data were analyzed by the Kaplan‐Meier life‐table method with statistical significance determined by the χ2 and log‐rank tests.Results: High‐dose‐rate brachytherapy was extremely well tolerated. Only 9 patients (16%) developed a complication. Four patients developed osteoradionecrosis, and five developed soft tissue necrosis, all of which healed with conservative medical management. No complication required surgical intervention or hospitalization. Actuarial 2‐year local control for the entire cohort was 79%. Local control was 87% for patients with T1 (15/16) and T2 (22/26) tumors versus 47% for T3 (5/8) and T4 (2/5) tumors (P < .01).Conclusions: High‐dose‐rate brachytherapy is feasible as a boost for patients with primary squamous cell carcinomas of the oral cavity and oropharynx. Patients with T1 and T2 tumors fared exceptionally well; those with advanced tumors may require more aggressive treatment, such as higher radiation doses, surgical resection, or systemic chemotherapy. The use of HDRBT both shortens the overall treatment time and limits the volume of tissue exposed to high doses of radiation therapy. In the future, as more patients treated with HDRBT are evaluable, we hope to identify potential factors that predict for local control so that we may select patients optimally for this treatment.
Stereotactic Radiosurgery for Glomus Jugulare Tumors
Authors: Jordan Jennifer A. , Roland Peter S. , McManus Chris , Weiner Richard L. , Giller Cole A. 
Published: November 2003

AbstractObjectives/Hypothesis: Surgery is considered to be the mainstay of treatment for glomus jugulare tumors. A subset of patients are poor surgical candidates based on age, medical problems, tumor size, or prior treatment failure. The purpose of this study was to review our results with stereotactic radiosurgery (gamma knife treatment) in this group of patients, with particular attention to adverse reactions and symptom relief.Study Design: Retrospective review and phone survey.Methods: Charts were reviewed for size and location of tumor, history of previous treatment, symptoms before and after treatment, amount of radiation received, acute and late complications, and functional level before and after treatment. Pretreatment and posttreatment magnetic resonance imaging scans were also reviewed. Identified patients were then contacted for a phone interview.Results: Eight patients were identified. Phone interviews were conducted with four patients. Four patients had failed previous treatment. Follow‐up ranged from 7 to 104 months. One patient experienced an acute complication: intractable vertigo requiring hospitalization. No patient experienced delayed cranial neuropathies. No patient reported worsening of any of the following symptoms: pulsatile tinnitus, hearing loss, facial weakness, hoarseness, or difficulty swallowing. Three patients reported improvement in their pulsatile tinnitus. Two patients reported improvement in hearing loss, and one patient each reported improvement in vertigo and difficulty swallowing.Conclusions: Preliminary results suggest that stereotactic radiosurgery is useful to control symptoms and may be delivered safely in patients with primary or recurrent glomus jugulare tumors who are poor surgical candidates.
Histological Pattern of Mandibular Invasion by Oral Squamous Cell Carcinoma
Authors: Wong Richard J. , Keel Suzanne B. , Glynn Robert J. , Varvares Mark A. 
Published: November 2003

AbstractObjective:Mandibular invasion by oral squamous cell carcinoma may progress by either an infiltrative or an erosive histological pattern. The infiltrative pattern is marked by nests and cords of tumor cells along an irregular tumor front, and the erosive pattern exhibits a broad, pushing tumor front. The objectives of this study were 1) to define the characteristics associated with each histological pattern of mandibular invasion, 2) to assess the relationship between pattern of invasion and clinical outcome as measured by death with disease and disease presence at last follow‐up, and 3) to determine whether the cell cycle markers cyclin D1 and Ki‐67 are associated with the histological pattern of invasion or are predictive of outcome.Study Design:Retrospective study of 68 patients with mandibular invasion by oral cavity squamous cell carcinoma treated by mandibulectomy.Methods:The clinical records, pathology reports, and original H&E‐stained slides were reviewed for each patient. Immunohistochemical staining of cyclin D1 and Ki‐67 was performed on slides cut from the paraffin blocks of these patients' specimens.Results:The parameters found to be significantly associated with the infiltrative pattern of mandibular invasion included higher tumor grade, medullary space invasion, positive bone or soft tissue margins, history of previously failed treatment, and postoperative tumor recurrence. The infiltrative pattern had a positive bone margin rate of 47.6% and a primary site recurrence rate of 52.6%. In contrast, the erosive pattern had a positive bone margin rate of 4.9% and a primary site recurrence rate of 16.7%. The infiltrative pattern of invasion gave a fourfold increased risk of death with disease and disease presence at last follow‐up in univariate and multivariate analyses when compared with the erosive pattern of invasion. The 3‐year disease‐free survival was 30% for the infiltrative pattern and 73% for the erosive pattern. The median disease‐free survival was 1.5 years for the infiltrative pattern and 5.5 years for the erosive pattern. There was no correlation between cyclin D1 or Ki‐67 staining and invasion pattern or clinical outcome.Conclusions:The infiltrative pattern of mandibular invasion by oral squamous cell carcinoma is correlated with a significantly worse prognosis when compared with the erosive pattern of invasion. The infiltrative pattern clearly exhibits a more aggressive behavior with an increased likelihood of positive margins, recurrence, death with disease, and shorter disease‐free survival. We recommend that pathologists routinely comment on the histological pattern of invasion when reviewing oral squamous cell carcinoma with mandibular invasion.
Controversies in the Management of Thyroid Nodule
Authors: Shaha Ashok R. 
Published: November 2003

AbstractFew subjects in surgery have generated as much controversy as the management of thyroid nodule. The controversial issues include classification and histology, diagnostic evaluation including needle biopsy, indications for surgery, management of incidentalomas of the thyroid, the role of frozen section, extent of thyroidectomy, management of neck nodes, the role of suppressive therapy, the use of radioactive iodine, and appropriate follow‐up. The two major issues in relation to the controversies are diagnostic workup and extent of thyroidectomy. Whenever the issue related to extent of thyroidectomy is discussed, there are two strong groups believing in total thyroidectomy or less than total thyroidectomy. This has generated considerable debate and panel discussions, and this article reviews this on‐going debate.
Saline Irrigation in the Prevention of Otorrhea After Tympanostomy Tube Placement
Authors: Gross Rick D. , Burgess Lawrence P. , Holtel Michael R. , Hall Daniel J. , Ramsey Mitchell , Tsai Paulus D. , Birkmire‐Peters Deborah 
Published: November 2003

AbstractObjectives: Comparison of intraoperative saline irrigation to otic drops in the prevention of postoperative otorrhea in children with middle ear effusion undergoing bilateral myringotomy with ventilation tubes.Study Design: This study was designed as a blinded, controlled, prospectively randomized trial.Methods: Study children were randomly assigned to receive either otic drops for 3 days postoperatively or saline irrigation of the middle ear space at the time of myringotomy. Only children with effusion present at the time of surgery were included. All children were evaluated for drainage 7 to 14 days postoperatively, and the degree of drainage was graded from 0 to 4.Results: Of the 84 patients entered into the study, 62 patients were eligible for data analysis (16 failed follow‐up, 6 records were lost). Of the patients who completed the study, not all had bilateral effusions, resulting in 111 ears for inclusion in the study. Fifty‐two ears underwent irrigation, and 10 were noted to have otorrhea (19.2%). Fifty‐nine ears received otic drops, resulting in 21 ears with otorrhea (35.6%). Evaluating the degree of otorrhea with a five‐point Leichert scale, the average score per ear was 0.42 for the saline irrigation group and 1.07 for the control group. The rate and degree of drainage were both statistically reduced in the saline irrigation group (P < .05).Conclusions: Using middle ear irrigation at the time of tympanostomy may be more effective than antibiotic drops in preventing postoperative otorrhea.
Endoscopic Sinus Surgery Using Intraoperative Computed Tomography Imaging for Updating a Three‐Dimensional Navigation System
Authors: Cartellieri Monika , Vorbeck Fritz 
Published: November 2003

AbstractObjectives: The use of three‐dimensional navigation systems provides information on the structures surrounding the field of operation and thereby reduces the risk of iatrogenic damage. The computed tomography (CT) data conventionally used are provided by preoperative scanning procedures, which means that tissue changes coming about during surgery are not seen on the screen. An intraoperative CT scanning procedure being able to update the CT data could provide a solution.Study Design: Endoscopic sinus operations using an intraoperative CT updating the three‐dimensional navigation system were performed on six persons to find out, whether the above is true.Methods: Different parameters, advantages, and disadvantages in the cases of these six patients were compared with a group of 22 patients who underwent conventional endoscopic sinus surgery with different three‐dimensional navigation systems without updating the CT data set.Results: The intraoperative CT for updating the three‐dimensional navigation system provides useful information for the surgeon.Conclusion: Balancing its advantages against its disadvantages, the updating of the CT data set with intraoperative CT cannot be recommended for conventional standard endoscopic sinus surgery.
Increased Female Authorship in Otolaryngology Over the Past Three Decades
Authors: Bhattacharyya Neil , Shapiro Nina L. 
Published: November 2003

AbstractObjective To identify changing trends in female authorship and publication in the otolaryngology literature.Methods All articles published in the four major otolaryngology journals in each of the years 1978, 1988, and 1998 were reviewed. The authorship panel of each article was examined for number of authors, gender, educational degree category, and subspecialty area of publication. Data were analyzed for trends in female authorship and the association of gender with the other design variables.Results A total of 2,463 articles were analyzed. The average percentage of female authorship increased from 4.1% in 1978 to 8.7% in 1988 and 12.4% in 1998, and the percentage of articles with a female “first author” increased from 3.2% to 7.4% and 11.4% for the same years, respectively. Each of these increases was statistically significant (P < .001). The weighted rank of female authorship also increased from 0.063 to 0.164 and 0.243 for the same years, respectively (P < .001). With respect to subspecialty publication, women were first authors of 14.7% of articles concerning pediatric otolaryngology but accounted for 9.9% or less of the first authors in the other subspecialty areas (P < .001). Female authors were also much more likely to be nonphysicians (P < .001) than men.Conclusions There has been a significant trend toward increased female authorship in the otolaryngology literature. A significant portion of this is accounted for by nonphysician female authors, and female authorship tends to be concentrated in pediatric otolaryngology.
Hypoxia Depresses Nitric Oxide Output in the Human Nasal Airways
Authors: Haight James S. J. , Qian Wei , Daya Hamid , Chalmers Patsy , Zamel Noe 
Published: November 2003

AbstractObjectives The role of oxygen in the nasal air on nasal nitric oxide (NO) output was studied in 13 adult volunteers.Methods Nasal NO was measured while air containing oxygen (0%–100% in nitrogen) was aspirated through the nasal airway before and after the topical application of xylometazoline.Results The mean nasal NO output of the untreated nose was 507.8 ± 161.9 nL/min (mean ± SD) when 21% oxygen was aspirated through the nasal cavities in series and remained unaltered by 100% O2 (P = .79). Below 10% oxygen the reduction in nasal NO output correlated positively and significantly with the decrease in oxygen concentration (r2 = 0.14). NO output was 245.2 ± 153.4 nL/min at 0% oxygen, a significant decline from 21% oxygen (P < .0001). Nasal vasoconstriction induced by xylometazoline and alterations in the blood oxygen content by a maximal breath‐holding or breathing 100% oxygen did not alter nasal NO in hypoxia (P = .41).Conclusions Nasal NO output is markedly depressed in hypoxia and is oxygen dependent at concentrations of less than 10%. Approximately 50% of nasally generated NO is produced from oxygen in nasal air or regulated by it.
Clinical Outcomes in Patients With Chronic Sinusitis
Authors: Metson Ralph B. , Gliklich Richard E. 
Published: November 2003

AbstractAlthough sinusitis is one of the most common chronic illnesses in this country, relatively little is known about the effect of this disease or its treatment on quality of life. In a series of studies utilizing both disease‐specific and general health instruments, patients with chronic sinusitis were found to have significant decrements in several subscales of general health, including bodily pain and social functioning (P < .05), compared with the general US population. Surgery for sinus disease was shown to result in significant reduction in both symptoms and medication usage (P < .05) after 12 months. These same outcome instruments can be used by health care providers to document clinical outcomes in similar populations of patients with chronic sinusitis.
MOSHER AWARD HONORABLE MENTION
Authors: Rosenberg Seth I. 
Published: November 2003

AbstractObjectives/Hypothesis 1) Develop a computerized technique to accurately compare acoustic neuroma size on routine computed tomography and magnetic resonance imaging (MRI) scans; 2) use this technique to determine the growth pattern in a large series of patients with acoustic neuroma who were conservatively managed; 3) describe the natural history of patients with acoustic neuromas who did not receive surgical intervention and those who underwent subtotal resection; 4) correlate the size and growth rate of acoustic neuromas to clinical presentation and auditory and vestibular testing; and 5) recommend guidelines for the management of patients with acoustic neuromas.Study Design A retrospective study from 1974 to 1999 of patients with unilateral acoustic neuromas who had conservative treatment by serial imaging studies (80 patients) or subtotal resection (49 patients).Methods All patient charts were evaluated for presenting symptoms, reasons for the type of management given, and clinical outcome. Charts were also reviewed with respect to serial audiological assessment, electronystagmography, and brainstem auditory evoked response. Imaging studies were analyzed using a computer technique so that serial studies could be compared to determine growth rates.Results Rigorous computer analysis of tumor size and growth rate was statistically the same as the radiologist's description of the tumor size and growth rate. Of 70 patients who were older than 65 years of age old at the time their tumor was discovered, 4 (5.7%) required intervention and 18 (26%) were dead of unrelated causes. These patients had a mean follow‐up of 4.8 years (range, 0.01–17.2 y). Overall, growth rate for nonsurgical patients was 0.91 mm per year. Nonsurgical tumors did not grow or regressed in 42.3%. Overall postoperative growth rate for surgical subtotal resection patients was 0.35 mm per year. Surgical tumors did not grow or regressed after subtotal resection of acoustic neuroma in 68.5% of patients. Three patients (6.1%) required revision surgery because of tumor growth or the development of symptoms. Neither auditory nor vestibular testing was a reliable measure for determining tumor growth.Conclusion Measurement of the maximal tumor diameter on MRI scans is a reliable method for following acoustic neuroma growth. There is no need to perform a rigorous analysis of tumor size to determine whether the tumor is growing significantly. The vast majority of patients older than 65 years with acoustic neuromas do not require intervention. The indications for intervention should be based on a combination of rapid tumor growth with the development of symptoms.
Hearing Results in Pediatric Patients With Chronic Otitis Media After Ossicular Reconstruction With Partial Ossicular Replacement Prostheses and Total Ossicular Replacement Prostheses
Authors: Murphy Terrence P. 
Published: November 2003

AbstractObjectiveTo examine hearing results in pediatric patients after ossicular reconstruction with partial ossicular replacement prostheses (PORPs) and total ossicular replacement prostheses (TORPs) in children with chronic otitis media.MethodsA retrospective chart review was performed on 55 pediatric patients with chronic otitis media who underwent ossicular reconstruction from 1991 to 1998. Patients' audiograms were evaluated preoperatively and postoperatively for pure‐tone average (PTA), air‐bone gap (ABG), speech reception threshold (SRT), method of ossicular reconstruction, and management of the mastoid.ResultsTwenty‐seven patients underwent ossicular reconstruction with TORPs. The average preoperative ABG was 40.1 dB, and the average postoperative ABG was 31.6 dB. Forty‐one percent of the children improved their PTA greater than 10 dB postoperatively, and 52% of children did not change their ABG by more than 10 dB postoperatively. Nineteen percent of children with TORPs had a postoperative ABG less than 20 dB, and 44% of children with TORPs had a postoperative ABG less than 30 dB. Twenty‐eight patients underwent ossicular reconstruction with PORPs. The average preoperative ABG was 29.7 dB, and the average postoperative ABG was 22.5 dB. Thirty‐two percent of patients improved their PTA by greater than 10 dB, while 57% of children with PORPs did not change their ABG by more than 10 dB postoperatively. Forty‐three percent of children with PORPs had an ABG of less than 20 dB postoperatively, and 71% of children with PORPs had a postoperative ABG less than or equal to 30 dB.ConclusionsChildren who underwent ossicular reconstruction with PORPs had slightly better postoperative hearing than did children with TORPs. Postoperative hearing was essentially unchanged in approximately 55% of both groups. Preoperative hearing levels may be the most important factor determining postoperative hearing in nonstaged surgery for children with chronic otitis media. Long‐term hearing results in children with single‐stage surgery were not as good as those reported in the literature for staged surgery. Severe mucosal disease and eustachian tube dysfunction may contribute to poorer hearing results in children.
An Objective Method of Analyzing Cochlear Versus Noncochlear Patterns of Distortion‐Product Otoacoustic Emissions in Patients With Acoustic Neuromas
Authors: Telischi Fred 
Published: November 2003

AbstractObjectives To objectify the effects of retrocochlear disease on distortion‐product otoacoustic emissions (DPOAEs) by developing a computer‐based software strategy for classifying DPOAE patterns as cochlear or noncochlear and to evaluate the sensitivities of these techniques in a large series of patients with unilateral acoustic neuromas.Study Design Development of a novel, software‐based method of DPOAE analysis, which was evaluated with data obtained from a retrospective review of the results from audiometric tests performed in a series of patients.Methods A computer‐based software strategy was developed, using frequency‐specific data from normal‐hearing adults, for the purpose of distinguishing cochlear from noncochlear patterns of hearing loss, by determining the discrepancies between DPOAEs and behavioral audiometry. Preoperative pure‐tone thresholds and DPOAEs from 97 patients with surgically confirmed acoustic neuroma were compared using an objective method and a standard, subjective technique that was considered to be the gold standard. The effects of bilateral hearing losses, such as noise‐induced hearing loss and presbycusis, were accounted for during the analysis to isolate the effects of the tumors on hearing thresholds and DPOAEs.Results Overall, 55 (57%) of the tumor ears were assigned to the cochlear group (i.e., DPOAEs consistent with hearing thresholds), 40 (41%) to the noncochlear group (i.e., DPOAEs inconsistent with hearing thresholds), and 2 (2%) to an indeterminate group, using the subjective technique for classifying DPOAEs. There was no significant difference in the categorization of the patients with acoustic neuroma when employing the objective strategy. The objective algorithm, when modified to maximize the number of noncochlear identifications, led to assignments of 36 (37%) to the cochlear, 57 (59%) to the noncochlear, and 4 (4%) to the indeterminate categories.Conclusions Subjective analysis of a large series patients with acoustic neuromas showed that the majority of ears with tumors demonstrated cochlear (57%), rather than non‐ cochlear (41%), patterns of DPOAEs. The computerized, software‐based algorithm developed for differentiating cochlear from noncochlear patterns of DPOAEs in patients with retrocochlear disease had a maximum sensitivity of 59%. This value was significantly higher than that reported in previous studies.