bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transverse/Sigmoid Sinus Dural Arteriovenous Fistulas Presenting As Pulsatile Tinnitus
Authors: Shah Saurabh B. , Lalwani Anil K. , Dowd Christopher F. 
Published: November 2003

AbstractObjective/Hypothesis: Transverse/sigmoid sinus dural arteriovenous fistula (TSDAVF) is a diagnostically elusive entity that is critical for the otologist to account for, when confronted by pulsatile tinnitus in the face of normal otoscopy. Left untreated, TSDAVF may result in catastrophic outcome. We have previously proposed a grading system specifically for TSDAVF based on venous restrictive disease. Our objective was to assess the validity of this grading system for clinical severity and therapeutic outcome. Methods: Through a retrospective review of 41 patients with TSDAVF, we evaluated clinical presentation, diagnostic evaluation, therapy, and outcome. Patients were classified into four grades based on the severity of venous restrictive disease as determined by superselective angiography. Our treatment algorithm combined compression therapy, transarterial embolization, and for more severe grades, surgery. Results: Pulsatile tinnitus was the chief complaint of all the patients in this series, and of 90% of all cases of TSDAVF treated at our institution. While angiography remains the gold standard, magnetic resonance imaging/magnetic resonance arteriography is far superior to computed tomography scanning in detecting dural arteriouvenous fistulas. As normal venous outflow gives way to aberrant cortical venous drainage in higher grades, there is a dramatically increased risk for adverse consequences with therapeutic intervention. Using our treatment algorithm, 82% of patients achieved clinical resolution of symptoms. Half of these patients had complete angiographic obliteration of their TSDAVF. Conclusions: The TSDAVF‐specific grading system for the severity of venous restrictive disease is reflective of clinical presentation, fundamental in planning treatment, and predictive of therapeutic outcome.
Radiologic and Mechanical Properties of Inactivated Ossicle Homografts
Authors: Hotz Michel A. , Speirs Andrew D. , Oxland Thomas , Müller Markus , Hämmerle Christoph , Häusler Rudolf 
Published: November 2003

AbstractObjective: This study examined the effects of old and new inactivation (sterilization) techniques on the radiologic and mechanical properties of ossicle homografts. Materials and Methods: Ninety normal incuses and malleuses received either treatment with 1) 5% formaldehyde/cialit, 2) 1N NaOH, 3) 0.9% LpH,R̊ or 4) autoclaving at 134°C, or no treatment. All ossicles were assessed radiologically by high‐resolution computed tomography. After imaging, all ossicles underwent mechanical testing by destructive axial compression in a mechanical testing machine measuring force and displacement. Results: Ossicles treated with cialit, NaOH, or autoclaving showed a significant decrease of ultimate force and stiffness compared with controls. LpH treatment caused no such changes in these structural properties. Material properties of yield strength, ultimate strength, and elastic modulus were also altered by cialit, NaOH, and autoclaving, but were much more difficult to assess because of uncertainty in parameter estimates. There was a significant increase in radiologic density in autoclaved ossicles, a reduction in cialit‐ and LpH‐treated ossicles, and no change in NaOH‐treated ossicles. Conclusions: All tested inactivation procedures changed the biomechanical and/or radiologic properties of ossicle homografts. However, the new procedures used to inactivate infectious agents produced changes similar to the older treatments with formaldehyde/cialit. Human allografts are able to withstand harsh but safe sterilization procedures. The NaOH treatment seems to be the most suitable method for the future. The biologic (osteogenic) potentials of ossicle homografts treated with these new preservation/inactivation methods are still unknown. Further investigations are necessary to re‐evaluate the clinical use of ossicle homografts in middle ear reconstructive surgery.
Laser‐Assisted Uvulopalatoplasty for the Treatment of Mild, Moderate, and Severe Obstructive Sleep Apnea
Authors: Walker Regina Paloyan , Grigg‐Damberger Madeleine M. , Gopalsami Chellam 
Published: November 2003

AbstractObjectives/Hypothesis: Until recently, laser‐assisted uvulopalatoplasty (LAUP) has been used to treat only snoring and mild cases of obstructive sleep apnea (OSA). The purpose of this study was to evaluate the efficacy and safety of LAUP in patients with mild, moderate, and severe OSA. Study Design: A prospective study of 38 patients who completed LAUP for the treatment of OSA who were evaluated based on the severity level of their preoperative apnea. Materials and Methods: Between July 1993 and December 1995, 96 patients with a diagnosis of OSA based on polysomnography underwent staged outpatient LAUP treatment. Thirty‐eight patients completed treatment and obtained postoperative polysomnography. Postoperative complications and polysomnographic findings were reviewed. Results: Fifteen patients had a diagnosis of mild apnea, 12 had moderate apnea, and 11 had severe apnea based on preoperative polysomnography. The surgical response rates, defined as greater than or equal to 50% reduction in the postoperative respiratory disturbance index (RDI) and a postoperative RDI of less than 20, were 46.7% in the mild apneics, 41.7% in the moderate apneics, and 45.5% in the severe apneics. Postoperative complications in this series included minor bleeding, oral candidiasis, and temporary velopharyngeal insufficiency. There were no serious complications. Conclusions: In the carefully selected and prepared patient with mild, moderate, or severe OSA, LAUP should be considered a surgical option for the treatment of this disorder. LAUP remains a cost‐effective and safe alternative to uvulopalatopharyngoplasty.
Biomechanics of A‐to‐T Flap Design
Authors: Stevens Carl “Rusty” , Tan Luke , Kassir Ramtin , Calhoun Karen 
Published: November 2003

AbstractObjectives/Hypothesis: The objective of this study was to determine the vertical height, horizontal incision width, and extent of undermining that correlated with the lowest closure tension. Study Design: Prospective, cadaver study. Methods: Forty “A‐to‐T” flaps were made on the torso and lower extremities of fresh cadavers. Ten flaps each were designed at heights of three, four, and five defect radii. Closing tensions were measured for each of these flaps initially, followed by serial base extensions. Based on the information from these first flaps, 10 additional flaps were made at the optimal height and base extensions. These flaps were then serially undermined and tension measurements taken. Results: Our results suggest that making the vertical height of the “A” twice the height of the defect yields a significant decrease in tension of closure when compared with a vertical height one and a half times the defect (P < .01), while increasing the height to two and a half times the defect height provides only a minimal further reduction in closure tension. Extending the base (horizontal) incision one defect diameter in each direction offers the greatest reduction in closing tension. Undermining up to three times the diameter of the defect offers progressive improvement in the tension of closure, while further undermining confers little additional benefit. Conclusions: Our findings indicate that the ideal A‐to‐T flap is designed to be twice the height of the original defect, with base extensions one defect diameter in each direction, and undermined to three times the diameter of the defect.
Clinical Experience With Gore‐Tex for Vocal Fold Medialization
Authors: Giovanni Antoine , Vallicioni Jean‐Marc , Gras Régis , Zanaret Michel 
Published: November 2003

AbstractObjectives/Hypothesis: Present clinical experience with vocal fold medialization under local anesthesia using a Gore‐Tex implant. The procedure consists of placing the implant into a pocket formed by dissection of the inner perichondrium of the thyroid cartilage through a small window made in the thyroid ala. Study Design: During 2 years, we used this technique preferentially in 13 of the 16 cases of vocal fold medialization (three patients underwent Teflon injection because of a contraindication to local anesthesia). Follow‐up was longer than 3 months in 11 cases (mean, 13 mo). Methods: Vocal result was analyzed by the means of perceptual analysis and by the measurement of jitter factor. Glottal leakage was evaluated perceptually using videolaryngoscopy, and oral airflow was measured during the production of a vowel. In cases with preoperative aspiration, videofluoroscopy was performed. Results: Implantation was successful in all but one patient in whom extrusion of the implant material occurred. In the latter case, the implant was removed and the patient recuperated his preoperative voice without any other complication. In the 10 other cases, voice improvement assessed by perceptual and objective evaluation was satisfactory. Conclusions: Results compare favorably with those of endoscopic techniques using Teflon or collagen and laryngeal frame surgery techniques using silicone or cartilage. We conclude that Gore‐Tex implantation is a simple, reproducible, and minimally invasive procedure for management of selected cases of vocal fold unilateral paralysis in the abductory position.
Quantification of lymph nodes in selective neck dissection
Authors: Friedman Michael , Lim Jessica W. , Dickey William , Tanyeri Hasan , Kirshenbaum Gary L. , Phadke Dattatreya M. , Caldarelli David 
Published: November 2003

AbstractObjectives: Provide reference for surgeon and pathologist regarding expected yield from selective neck dissections. Quantify lymph nodes obtained from cadaver dissection based on current nodal classification and compare with clinical series. Study Design: 1. Quantification of lymph nodes at levels I–V harvested from human cadavers and correlation with nodal grouping for supraomohyoid (I–III) and lateral (II–IV) neck dissections. 2. Retrospective review of operative specimens from clinical neck dissections for lymph node quantity. Methods: 1. Twenty radical neck dissection specimens, harvested from 10 fresh human cadavers without evidence of head and neck cancer, were separated by nodal level for gross and microscopic examination by a pathologist. The quantity of nodes obtained per level for each specimen was tabulated. 2. Charts of patients treated with neck dissection for squamous cell carcinoma were reviewed and tabulated for type of dissection and number of lymph nodes reported. Results: In the 20 cadaver neck dissections, the average number of lymph nodes removed for levels I–V was 24, with 13 for levels I–III and 19 for levels II–IV. In the clinical review, 98 total neck dissections were included. In the six supraomohyoid dissections, an average of 20 lymph nodes (range, 14–26) were found, with an average of 30 (range, 15–43) in the 11 lateral compartment specimens. In 81 radical or modified radical dissections, an average of 31 nodes (range, 19–63) was reported. Conclusions: The number of lymph nodes removed in selective neck dissection should be comparable to that of the corresponding levels in radical neck dissection, provided that strict adherence to surgical boundaries is maintained. Dissection of normal cadavers provides a reference for the surgeon and the pathologist but may under‐represent lymph node quantity in the diseased state.
Olfactory secretion and sodium, potassium–adenosine triphosphatase: Regulation by corticosteroids
Authors: Fong Karen J. , Kern Robert C. , Foster James D. , Zhao Jin‐Cheng , Pitovski Dimitri Z. 
Published: November 2003

AbstractObjectives: To investigate the cellular distribution and relative intensity of the immunoreactivity associated with the expression of sodium, potassium‐adenosine triphosphatase (Na, K–ATPase) in cells of the olfactory mucosa. Second, changes in the activity of this enzyme in the olfactory mucosa are correlated with changes in the circulating corticosteroid aldosterone. Methods: Combination of immunohistochemical and biochemical techniques were employed to examine the olfactory Na, K–ATPase. Results: Within the olfactory epithelium, the Na, K–ATPase immunoreactivity was greatest at the supranuclear region of sustentacular cells and/or dendrites of olfactory receptor neurons (ORNs). Cell bodies of ORNs demonstrated moderate immunoreactivity, whereas the duct cells of Bowman's gland exhibited moderate to intense immunoreactivity. Acinar cells of the Bowman's gland were the most intensely stained components of the lamina propria, exhibiting strong immunoreactivity at the basolateral plasma membrane domains of the acinar cells and less within the cytoplasm. Binding of ouabain, a specific inhibitor of Na, K–ATPase, was significantly elevated for aldosterone‐injected versus sham‐injected controls. Conclusion: These results suggest that olfactory Na, K–ATPase is regulated by the systemic corticosteroid aldosterone. The results are consistent with the hypothesis that corticosteroids regulate olfactory secretion.
Inhibitory effect of erythromycin on interleukin‐8 secretion from exudative cells in the nasal discharge of patients with chronic sinusitis
Authors: Suzuki Hideaki , Asada Yukinori , Ikeda Katsuhisa , Oshima Takeshi , Takasaka Tomonori 
Published: November 2003

AbstractObjectives: The mechanism of the efficacy of long‐term low‐dose macrolide therapy for chronic sinusitis is not fully understood. The authors studied the inhibitory effect of erythromycin on interleukin‐8 (IL‐8) secretion from exudative cells in the nasal discharge of patients with chronic sinusitis. Study Design and Methods: Exudative cells in the nasal discharge were isolated from six patients with nonallergic chronic sinusitis. The cells, more than 90% of which were neutrophils, were incubated with or without erythromycin in the presence of 10 μg/mL of lipopolysaccharide. The IL‐8 concentrations in the culture supernatants were measured by enzyme‐linked immunoassay. Results: The amount of secreted EL‐8 in the absence of erythromycin was 682 ± 226 pg/106 cells/24 h. The IL‐8 secretion was significantly reduced to 66 ± 15% and 46 ± 13% of the control in the presence of 10−6 and 10−5 M of erythromycin, respectively. Conclusion: Erythromycin may act as a biologic modulator that inhibits IL‐8 secretion from exudative cells and thereby blocks the vicious circle of neutrophil recruitment and IL‐8 generation in the inflammatory site in chronic sinusitis.
CO2Laser endoscopic posterior partial transverse cordotomy for bilateral paralysis of the vocal fold
Authors: Laccourreye Ollivier , Escovar Maria‐Isabel Paz , Gerhardt Jean , Hans Stéphane , Biacabe Bernard , Brasnu Daniel 
Published: November 2003

AbstractObjective/Hypothesis: A clinical evaluation of CO2laser endoscopic posterior partial transverse cordotomy (EPPTC) in patients with severely compromised airway due to bilateral paralysis of the vocal fold.Study Design: An inception cohort of 25 patients over a 10‐year period.Methods: The CO2laser EPPTC was unilateral in 15 patients and bilateral in 10. Variables were tested for potential statistical relation to successful rehabilitation of the airway.Results: The use of the CO2laser never resulted in adverse side effects. Complications were not encountered. A one‐step, successful restoration of the airway was achieved in 68% (17/25) of patients. In univariate analysis, the CO2laser EPPTC was statistically more likely to be successful if bilateral EPPTC was performed (P= .018). None of the following variables—age, sex, cause of bilateral paralysis, prior treatment, laser parameters, and duration of postoperative antibiotherapy and oral steroids—was statistically related to a successful restoration of the airway. Revision CO2laser EPPTC, performed in six patients, resulted in an overall 92% (23/25) rate for a successful restoration of the airway. The overall tracheotomy rate was 8% (2/25).Conclusion: The authors' data confirm the safety, ease of performance, and efficiency of the CO2laser EPPTC in patients with bilateral vocal fold paralysis. This report also suggests that the completion of bilateral CO2laser EPPTC statistically increases the likelihood of restoring the airway in a one‐step surgical procedure.
Fibro‐osseous lesions of the external auditory canal
Authors: Ramírez‐Camacho Rafael , Vicente Javier , Berrocal José Ramón García , Cajal Santiago Ramón Y 
Published: November 2003

AbstractObjectives: To differentiate a novel type of benign circumscribed bone lesion of the external auditory canal from those described previously, such as exostoses and osteomas. Study Design: Information was obtained from computed tomography (CT) images, surgical findings, and pathologic study. Methods: Five patients (26 to 82 years old) who presented a hard, round, unilateral, skin‐covered mass occluding the external auditory canal to varying degrees were studied. A CT study carried out before resection of the lesions by curettage disclosed the absence of a bony connection to the underlying structures. All the tissue specimens underwent pathologic study. Results: CT and surgical findings demonstrated the absence of a connective pedicle. The pathologic findings showed lesions consisting of an osteoma‐like bone formation with sparse osteoblastic areas; mature lamellar bone was observed in three cases, bone marrow containing adipose tissue and hematopoietic remnants in two, and a dense, collagenous stroma in another. They all showed irregular trabeculae, bordered by osteoid osteoblasts. In no case was there evidence of a relationship to the cartilaginous tissue or to the bony structures of the external auditory canal. Conclusions: The data obtained from the clinical, CT, surgical, and pathologic findings suggest the existence of a lesion unlike those previously known, possibly related to ossifying reactions in other parts of the organism.
Efficacy of Treatments for Posterior Canal Benign Paroxysmal Positional Vertigo
Authors: Cohen Helen S. , Jerabek Jaroslav 
Published: November 2003

AbstractObjective: This study was performed to determine the relative effectiveness of several passive head maneuvers for treating benign paroxysmal positional vertigo.Study Design: This prospective study used 87 subjects diagnosed by their physicians with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal.Methods: Subjects were randomly assigned to three treatment groups: modified Epley maneuver, modified Epley maneuver with augmented head rotations, and modified Semont maneuver. They were interviewed 1 week after receiving one maneuver. If subjects desired further treatment, they were treated again with the same maneuver, a methodology repeated until subjects desired no further treatment; they were telephoned 3 and 6 months after the last treatment.Results: The groups did not differ significantly, but subjects decreased significantly on vertigo intensity and frequency and improved significantly on independence in activities of daily living. Before treatment, tasks requiring pitch rotations of the head induced vertigo; common comorbid conditions were osteoporosis, cervical spine problems, and head trauma.Conclusions: These data suggest that augmented head rotations are unnecessary and that the modified Epley and Semont maneuvers are equally effective in the remediation of vertigo in this population.
Objective Aerodynamic and Acoustic Measurement of Voice Improvement After Phonosurgery
Authors: Giovanni Antoine , Revis Joana , Triglia Jean‐Michel 
Published: November 2003

AbstractHypothesis: Objective analysis of the outcome of phonosurgery is needed to allow comparison of different surgical techniques or indications, or both. We tried to demonstrate that measurement of mean oral airflow during the production of a sustained vowel could be used in combination with acoustic measurements such as jitter or shimmer for assessment of voice improvement after phonosurgery.Study Design: This prospective study included 27 consecutive patients who underwent phonosurgery during a 3‐month period.Method: Perceptual analysis served as the “gold standard.” Objective measurements (oral airflow, jitter, shimmer) on the most stable portion of a sustained vowel /a/ were made using the EVA system (SQ‐Lab, Aix‐en‐Provence, France).Results: Oral airflow was significantly greater in patients with poor perceptual results than in patients with good perceptual results. Jitter and shimmer were not significantly different because of the dispersion of the values. Discriminant factorial analysis showed that a combination of jitter, shimmer, and oral airflow was able to identify patients with good or poor perceptual results in 77% of cases.Conclusions: Oral airflow allows simple, quick, and reliable assessment of the outcome of phonosurgery and can be used in everyday clinical practice.
Postparotidectomy facial nerve paralysis: Possible etiologic factors and results with routine facial nerve monitoring
Authors: Dulguerov Pavel , Marchal Francis , Lehmann Willy 
Published: November 2003

AbstractObjective: Analyze the incidence and factors responsible for postparotidectomy facial nerve paralysis when the surgery is performed with the routine use of facial nerve monitoring. Study Design: A prospective, nonrandomized study. Methods: Seventy consecutive patients underwent parotidectomy with intraoperative facial nerve monitoring. Two devices were used: a custom mechanical transducer and a commercial electromyograph‐based apparatus. All patients were analyzed, including those with cancer and those with deliberate or accidental sectioning of facial nerve branches. The outcome variables were the motor facial nerve function according to the House‐Brackmann grading scale (HB) at 1 week (temporary paralysis) and 6 to 12 months (definitive paralysis). Facial nerve grading was performed blindly from reviewing videotapes. Results: The overall incidence of facial paralysis (HB > 1) was 27% for temporary and 4% for permanent deficits. Most of the deficits were partial, most often concerning the marginal mandibular branch. Temporary deficits with HB scores of greater than 2 were only present in patients with parotid cancer or infection. Permanent deficits were present in three patients, including one patient with facial nerve sacrifice. Factors significantly associated with an increased incidence of temporary facial paralysis include the extent of parotidectomy, the intraoperative sectioning of facial nerve branches, the histopathology and the size of the lesion, and the duration of the operation. Conclusions: Despite a stringent accounting of postoperative facial nerve deficits, these data compare favorably to the literature with or without the use of monitoring. An overall incidence of 27% for temporary facial paralysis and 4% for permanent facial paralysis was found. Although the lack of a control group precludes definitive conclusions on the role of electromyograph‐based facial nerve monitoring in routine parotidectomy, the authors found its use very helpful.
Age‐related changes in orofacial force generation in women
Authors: Mchenry Monica A. , Minton John T. , Hartley Leila L. , Calhoun Karen , Barlow Steven S. 
Published: November 2003

AbstractObjectives: This study was designed to assess the effect of age on orofacial force generation. Study Design: Forty women participated in a cross‐sectional design, with 10 in each age group from 20 to 39, 40 to 59, 60 to 79, and 80 to 100 years of age. Methods: Measures of force generation were obtained for the upper lip, lower lip, tongue, and jaw. Results: There were no statistical differences among age groups, probably because of large individual variability within groups. Trends indicated a decline, particularly after age 80 years. Conclusion: Although trends in the data suggest some decline in the function of orofacial structures with age, it is unlikely that these changes would noticeably affect functional communication.