bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pattern of Lymphatic Spread of Barrett’s Cancer
Authors: Feith Marcus , Stein Hubert J. , Siewert J. Rüdiger 
Published: November 2003

AbstractAs in squamous cell esophageal cancer, the presence and number of lymph node metastases constitutes the major prognostic factor in patients with adenocarcinoma of the distal esophagus (the so‐called Barrett’s cancer) who have had complete tumor resection (R0 resection). In contrast to squamous cell esophageal cancer, however, lymphatic spread in patients with Barrett’s cancer appears to follow certain rules. Lymphatic spread is closely correlated with the pT category of the primary tumor; it starts only after infiltration of the basal membrane, and initially it is limited to the regional lymph nodes. Lymph node metastases at distant locations—i.e., the upper mediastinum and the celiac axis—are found almost exclusively in patients with multiple positive regional nodes. Skipping of regional lymph node stations occurs in less than 5% of the patients. These observations set the stage for individualized and tailored lymphadenectomy strategies. The sentinel lymphadenectomy concept may be applicable to patients with early Barrett’s cancer.
Postlaryngectomy Voice Rehabilitation: State of the Art at the Millennium
Authors: Brown Dale H. , Hilgers Frans J.M. , Irish Jonathan C. , Balm Alfons J.M. 
Published: November 2003

AbstractTotal laryngectomy or laryngopharyngectomy remains the procedure of choice for advanced laryngeal/hypopharyngeal carcinoma, either as a primary procedure or as salvage following irradiation alone or concurrent chemoradiation therapy. Over the past 25 years there has been significant improvement in the rehabilitation of these patients, with speech restoration that has dramatically altered and improved their quality of life. This article reviews postlaryngectomy voice rehabilitation with a historical background as well as the present state‐of‐the‐art tracheoesophageal shunt voice with an artificial valve. Finally, this article reviews and compares artificial valve prostheses as to their voice characteristics, patient satisfaction, complications associated with the procedure, and devices used at a center in Europe (The Netherlands Cancer Institute, Amsterdam) and a North American center (The Wharton Head and Neck Center, Princess Margaret Hospital, University of Toronto, Canada).
Functional Reconstruction of the Oral Cavity
Authors: Neligan Peter C. , Gullane Patrick J. , Gilbert Ralph W. 
Published: November 2003

AbstractReconstruction of the oral cavity is an intricate subject that reflects the complexity of the oral cavity itself. There is no perfect reconstruction. Presented here are the current optimal choices for the various regions within the oral cavity. We are constantly seeking to improve these reconstructions in an effort to restore optimal function to patients unfortunate enough to require surgical excision of this most elaborate of anatomic structures.
Stress reactions among Swedish peacekeeping soldiers serving in Bosnia: A longitudinal study
Authors: Michel Per‐Olof , Lundin Tom , Larsson Gerry 
Published: November 2003

AbstractAssessments of mental health (GHQ‐28) were performed on a Swedish battalion serving in Bosnia at 4 times: before deployment, immediately after deployment, 6 months after deployment, and 1 year after deployment. Complete responses were obtained from 316 participants (61% response rate). No significant change of mental health over time was noted. Individuals having experienced traumatic events in Bosnia, as well as stressful life events postdeployment, reported the poorest mental health. Logistic regression analysis showed that postdeployment stressors made the strongest contribution to registering a poor mental health score after one year.
Positive adaptation to trauma: Wisdom as both process and outcome
Authors: Linley P. Alex 
Published: November 2003

AbstractPositive adaptation to psychological trauma and wisdom both have a rich history in European literature and philosophy. Although the literature on posttraumatic growth has recognized the possibility of wisdom as an outcome of adaptation, its role in the process of adaptation has been neglected. A theoretical framework is presented that conceptualizes three dimensions of wisdom as crucial to an understanding of the role it can play in posttraumatic positive adaptation. These dimensions are the recognition and management of uncertainty; the integration of affect and cognition; and the recognition and management of uncertainty; the integration of affect and cognition; and the recognition and acceptance of human limitation. The role of these dimensions in the process and outcome of traumatic adaptation is considered, together with limitations of the framework and directions for future research.
Gaseous Dynamics of the Rabbit Maxillary Sinus
Authors: Mikula Suzette K. , Gannon Patrick J. , Shapiro Jack , Lawson William 
Published: November 2003

AbstractTo better understand the mechanisms underlying maxillary sinus function, the gas composition of the sinus antrum in spontaneously breathing and tracheotomized rabbits (n = 17) was compared. The gas composition of samples (n = 117) obtained from rabbit maxillary sinuses was determined by gas chromatography. Results demonstrated significant differences (P<.005) in sinus gas composition between nasal breathing and tracheotomized animals for oxygen (O2) and carbon dioxide (CO2). In tracheotomized animals O2 levels decreased while CO2 levels increased markedly to suprasystemic levels. This unexpected finding may be due to reduced sinus blood flow and the effects of nasal versus tracheal respiration. We conclude that the gaseous dynamics and perhaps the function of the maxillary sinus vary under different respiratory conditions. A better understanding of these processes may lead to earlier diagnosis and the development of improved treatments for sinus disease.
Beta‐2 Transferrin
Authors: Levenson Mark J. , Desloge Rosemary B. , Parisier Simon C. 
Published: November 2003

AbstractBeta‐2 transferrin is a protein marker that can be used in the clinical setting to reliably identify the presence of cerebrospinal fluid (CSF). Recent literature has suggested that beta‐2 transferrin can also be used as a clinical marker for perilymph. This study investigates the use of a beta‐2 transferrin assay as a method to identify the presence of perilymph. Twenty‐two patients were enrolled in the study. Fluid samples were obtained intraoperatively and tested for the presence of beta‐2 transferrin. As expected, four CSF samples collected were positive for beta‐2 transferrin; however, four known perilymph samples collected from patients undergoing cochlear implantation were negative for beta‐2 transferrin, seven of nine known perilymph samples obtained during stapedectomies were negative for beta‐2 transferrin, and four of five samples collected during middle ear explorations for fistula were negative for beta‐2 transferrin. With current methodology beta‐2 transferrin does not appear to be a reliable clinical marker for perilymph in the operative setting.
Angiography and Transcatheter Arterial Embolization of Vascular Injuries of the Face and Neck
Authors: Sclafani Anthony P. , Sclafani Salvatore J.A. 
Published: November 2003

AbstractThe condition of patients sustaining penetrating neck trauma often appears deceptively stable, even when major structures have been injured. The clinician must identify patients who require treatment and limit invasive procedures in those without significant injuries. Angiography is often used to search for vascular damage following penetration of the neck and face.The charts of 401 hemodynamically stable patients with penetrating cervicofacial wounds who were evaluated by angiography followed, when necessary, by either transcatheter arterial embolization and observation or surgery were reviewed. One hundred twelve patients (27.9%) had 131 vascular injuries identified by angiography; 77 (68.8%) of these patients sustained injuries to zone III of the neck or the face.The most commonly injured vessels were the internal carotid artery (ICA), the vertebral artery, and the external carotid artery (ECA) system. Multiple vessel injuries were seen in 17 (15.2%) of 112 patients and were more likely in patients with wounds in zone III or above than in those wounded in zone II or below (20.8% vs. 2.9%, respectively; P<.025). Injuries to the internal maxillary artery (IMA) (60%), ECA (53.3%), and the ICA (30.8%) were also significantly more likely to be accompanied by additional vascular injuries (P<.005). No clinically significant venous injuries were missed. Complications were noted in only 4 patients, and no deaths occurred as a result of angiography.Angiography is a safe, effective modality in the head and neck trauma setting. Particular scrutiny should be given to patients with zone III or facial wounds, particularly those with documented ICA, IMA, and ECA injuries, since these patients have a higher incidence of multiple vascular injuries.
Vocal Cord Injection With Autogenous Fat
Authors: Brandenburg James H. , Unger June M. , Koschkee Danna 
Published: November 2003

AbstractSince 1987, the senior author has injected autogenous fat into paralyzed or atrophic vocal cords as an alternative to alloplastic substances for vocal cord augmentation and medialization.To determine the fate of the injected autogenous fat, the injected vocal cords of 10 patients were evaluated by laryngeal magnetic resonance imaging (MRI) in the sagittal, coronal, and axial planes. Imaging studies were performed as early as 17 hours after surgery to as long as 31 months after fat injection. In 9 patients, identification of a fat signal within the previously injected vocal cords was observed (including the 31‐month postoperative follow‐up). In 1 patient, no fat signal was identified 13 months after surgery, but the vocal cord was noted to have a bulging, enlarged contour.The results of this imaging study provide further evidence that autogenous fat, which has not been damaged during harvesting or microinjection, can survive transplantation into the vocal cord. The bulk of the vocal cord is maintained by microlipocytes and fibrous connective tissue, both of which replace the damaged fat cells that are gradually being reabsorbed.
Evolution of the Management of Hydrocephalus Associated with Acoustic Neuroma
Authors: Atlas Marcus D. , Perez de Tagle Juan Ramon V. , Cook James A. , Sheehy John P. , Fagan Paul A. 
Published: November 2003

AbstractThe management of hydrocephalus in association with a cerebellopontine angle tumor is controversial. There is a widely held belief that initial therapy should always be directed toward treatment of hydrocephalus before definitive surgery. The potential problems of cerebrospinal fluid (CSF) shunting and drainage have led to an evolution in the management of hydrocephalus at St. Vincent's Hospital. There is growing evidence that complete removal of cerebellopontine angle tumors will result in resolution of hydrocephalus without requiring other methods of CSF decompression. The authors present their experience of 14 patients with hydrocephalus found in a recent series of 104 consecutive cases of acoustic neuroma. This study has detected a significant correlation between hydrocephalus and increasing tumor size (P=.0234). The mean tumor size in this series was 3.8 cm. The series has also demonstrated that successful, safe, and complete tumor removal can be achieved without CSF drainage before surgery.
A Combined Endoscopic CO2 Laser and External Approach for Treatment of Glottic Cancer Involving the Anterior Commissure: An Animal Study
Authors: Shapshay Stanley M. , Wang Zhi , Rebeiz Elie E. , Perrault Donald F. , Pankratov Michail M. 
Published: November 2003

AbstractEndoscopic laser resection usually has been discouraged for anterior commissure (AC) carcinoma because of inadequate exposure and close proximity to underlying cartilage. A new technique combining endoscopic CO2 laser incision and an external approach, creating a window in the thyroid cartilage, was tested in this in vivo study of six dogs. An en bloc specimen including adjacent cartilage was excised while preserving the thyroid framework. The glottic reconstruction was accomplished with external placement of a sternohyoid muscle flap, by either using a bipedicled muscle flap with overlying skin or a unipedicled muscle flap with a graft of free mucosa.The results showed a satisfactory anatomic reconstruction and acceptable functions. The bipedicled muscle flap was superior to the unipedicled muscle flap due to a better AC reconstruction. It is believed that this new combined technique may overcome limited access with endoscopic technique and excessive cartilage resection with the external partial laryngectomy.
Basic Innervation Pattern and Distribution of Classic Autonomic Neurotransmitters in Human Nasal Mucosal Vasculature
Authors: Riederer Andreas , Fischer Axel , Knipping Stephan , Unger Jürgen , Lange Winfried , Kastenbauer Ernst 
Published: November 2003

AbstractThe neural control of human nasal vasculature is still not completely understood. This study was performed to demonstrate the innervation pattern of the different vessel types and to distinguish between nor‐adrenergic and cholinergic structures. General innervation was demonstrated using antibodies to neuron‐specific enolase and S‐100 protein. Autonomic structures were shown by using antibodies to tyrosine hydroxylase and choline acetyltransferase(ChAT). In addition, choline acetyltransferase (AChe) histochemistry was performed.Nasal vasculature is controlled by a dense innervation that increases with the thickness of the tunica media. While all larger vessels show a mixed autonomic innervation, sympathetic structures seem to predominate in veins. These findings demonstrate that classic neurotransmitters play a major role in the regulation of nasal vasculature. The stronger innervation of arteries and cushion veins underlines their central position in the control of nasal air flow.
Effects of Botulinum Toxin Type A Injections on Aerodynamic Measures of Spasmodic Dysphonia
Authors: Adams Scott G. , Durkin Lisa C. , Irish Jonathan C. , Wong David L.H. , Hunt Elizabeth J. 
Published: November 2003

AbstractThe effects of botulinum toxin type A (BOTOX®) injections on aerodynamic measures of phonation were examined in 30 patients with adductor spasmodic dysphonia. Patients received bilateral injections of 2.5 U of botulinum toxin type A in each thyroarytenoid muscle. Measures of air pressure, average airflow, coefficient of variation (CV) of airflow, and laryngeal resistance were obtained before the injections and at 2 and 10 weeks after the injections. These measures were also obtained from 12 normal subjects.Compared with normal subjects, the spasmodic dysphonia patients had significantly higher preinjection values for air pressure, CV of airflow, and laryngeal resistance. At 2 and 10 weeks after the botulinum toxin type A injections, the spasmodic dysphonia patients showed a significant increase in the average airflow values and a significant decrease in the CV of airflow values and the laryngeal resistance values. At 10 weeks after the injections, the values for the three measures began to approach the preinjection values. It is concluded that these aerodynamic measures of phonation can provide useful measures of treatment outcome in adductor spasmodic dysphonia.
Endoscopic Treatment of Tracheal Stenosis Using the Carbon Dioxide Laser and the Gianturco Stent: Indications and Results
Authors: Remacle M. , Lawson G. , Minet M. , Mayné A. , Watelet J.B. , Jamart J. 
Published: November 2003

AbstractThe self‐expandable Gianturco stent was used in 11 patients with tracheal stenosis who were treated from September 1992 through July 1994. Under optical control, the stent was placed through a bronchoscope with an outside diameter of 9 mm after cross‐section and dilation of the stenosis were performed with the carbon dioxide laser according to the Shapshay technique. The follow‐up period varied from 3 to 22 months, with a mean of 12±6 months.Pulmonary function tests showed a mean improvement of the peak expiratory flow (50%), from 0.95±0.45 L/sec before the operation to 2.13±0.86 L/sec after the procedure. Radiologic and fibroscopic controls showed prosthesis stability. Three patients needed a second endoscopic procedure because of malposition of the stent, the formation of granuloma at the superior end of the prosthesis, and the development of a mucous membrane webbing between the two loops of a stent. Due to the lack of long‐term follow‐up, this technique is reserved for the treatment of severe tracheal stenosis with cartilage impairment in patients who have contraindications for external reconstructive surgery.
Late Sequelae of Cochlear Infection
Authors: Keithley Elizabeth M. , Harris Jeffrey P. 
Published: November 2003

AbstractInflammatory reactions within the inner ear are deleterious to cochlear function and can result in severe hearing loss that does not recover. This study investigated a guinea pig model of long‐term cytomegalovirus infection. At high doses active inflammation was still present after 35 days. At lower doses some ears showed partial resolution while others were still inflamed. Hearing was totally lost in all cases of persistent inflammation. There was some residual hearing in the cases that had resolved. Cochlear structures including the organ of Corti, stria vascularis, and spiral ganglion were partially degenerated. Fibrotic matrix within scala tympani was ossified in many cases. These changes are consistent with those described for human cochleas following putative viral infections.
Image‐Guided Surgery in a New Magnetic Resonance Suite: Preclinical Considerations
Authors: Fried Marvin P. , Hsu Liangge , Topulos George P. , Jolesz Ferenc A. 
Published: November 2003

AbstractSurgical procedures require correct identification of exposed anatomy with concomitant localization amidst contiguous structures. In endoscopic procedures the surgeon is provided a real‐time endoscopic view and is prepared with radiologic images. Here we present an overview of a methodology of localization using intraoperatively acquired magnetic resonance(MR) images in preparation for magnetic resonance imaging‐guided endoscopic sinus surgery. The methodology centers around a unique prototype imaging device and operating environment. An “open” 0.5 Tesla MR unit has been created that allows complete access to the patient's head and neck while concomitant images are obtained. Illustrative examples of the localization technique from cadaver experiments are presented, as well as insights into the host of concerns for anesthesia, equipment, surgical instrumentation, communications, and documentation.
Laryngeal Muscle Activity During Speech Breaks in Adductor Spasmodic Dysphonia
Authors: Nash Eric Anthony , Ludlow Christy L. 
Published: November 2003

AbstractTo determine the laryngeal muscle activation abnormalities that are associated with speech symptoms in adductor spasmodic dysphonia (ADSD), electromyographic measures of extrinsic and intrinsic laryngeal muscles during speech compared 1) muscle activity when ADSD patients had breaks in words with when they produced the same words without breaks; and 2) muscle activity in ADSD patients during speech without voice breaks with normal controls producing phonetically similar words. Simultaneous electromyographic recordings were made from the thyroarytenoid (TA), cricothyroid (CT), sternothyroid (ST), thyrohyoid(TH) and the posterior cricoarytenoid (PCA) muscles during speech testing in 11 ADSD patients and 10 control subjects. Speech breaks were identified and mean muscle activity measured starting 100 ms preceding a voice break and for the remainder of the word. Mean muscle activity level was significantly greater on break than non break words in ADSD patients only for the thyroarytenoid muscle(p<.001). No significant differences were found between the ADSD and control subjects during non break words for any of the laryngeal muscles studied. The results demonstrated that 1) only the thyroarytenoid, of the muscles tested, was affected in ADSD, 2) that muscle activation abnormalities were spasmodic, only appearing when symptoms occurred and 3) no imbalances of muscle tone were evident when speech disruptions did not appear.
Primary Closure of Pharyngeal Remnant After Total Laryngectomy and Partial Pharyngectomy: How Much Residual Mucosa Is Sufficient?
Authors: Hui Y. , Wei W.I. , Yuen P.W. , Lam L.K. , Ho W.K. 
Published: November 2003

AbstractAfter total laryngectomy with or without partial pharyngectomy, the remaining pharyngeal defect can be repaired either by primary closure or with additional tissue, depending on the amount of pharyngeal tissue remnant available. The aim of this study was to determine the minimum width of the pharyngeal remnant that could be safely closed primarily without causing difficulty in swallowing.A total of 52 consecutive patients who underwent total laryngectomy were entered into the study. The relaxed and stretched widths of the pharyngeal remnant were measured after removal of the specimen. The widths of the pharyngeal mucosa ranged from 1.5 to 5.0 cm relaxed (mean, 3.24 cm) and from 2.5 to 8.0 cm stretched (mean, 4.83 cm). All neopharynx was reconstructed by closing the pharynx primarily.Seven of the 52 patients developed recurrent tumor with concomitant dysphagia. Two of the 45 patients without recurrence presented with acute dysphagia from food bolus obstruction, and 1 patient developed benign inflammatory stricture following an episode of fish‐bone impaction.The narrowest widths of the pharyngeal remnant in this group of 45 were 1.5 cm relaxed and 2.5 cm stretched. As these patients do not have swallowing difficulty, we conclude that in the absence of tumor recurrence, this amount of residual pharyngeal tissue is sufficient both for primary closure of the pharynx and in restoring swallowing function.
Laser Versus Cold Instruments for Microlaryngoscopic Surgery
Authors: Zeitels Steven M. 
Published: November 2003

AbstractControversy has arisen concerning the merits of the CO2 laser in microlaryngoscopic surgery because of the potentially harmful effects that the injudicious application of the laser could have on voice production. In an effort to develop a logical approach to instrument selection, the author examined the use of both cold instruments and the CO2 laser in the treatment of various benign and malignant lesions.A retrospective review of 307 microlaryngeal procedures performed over a 3‐year period revealed that 263 (86%) were glottal and 44 (14%) were supraglottal. Of the 263 glottal procedures, 203 (77%) employed cold instruments alone and 60 (23%) used both cold instruments and the CO2 laser. The laser was used to assist in all 44 supraglottal procedures. Therefore, 203 (66%) of 307 procedures were done with cold instruments alone, and 104 (34%) of 307 procedures were performed using the CO2 laser with cold instruments. Lesions were stratified on the basis of pathology and size, as well as surgical approach.A primary phonomicrosurgical principle in glottal surgery is to maximally preserve the vocal fold's layered microstructure (laminae propria and epithelium). Precise tangential dissection was necessary for achieving this goal. For limited lesions, this dissection was best accomplished with cold instruments alone. The CO2 laser facilitated hemostatic surgical dissection for all supraglottal lesions and for selected larger glottal lesions in which bleeding would obscure visualization of the microanatomy of the musculomembranous vocal fold.Laryngoscope, 106:545‐552, 1996