bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Course of Pediatric Congenital Inner Ear Malformations
Authors: Park Albert H. , Kou Brenda , Hotaling Andrew , Azar‐Kia Behrooz , Leonetti John , Papsin Blake 
Published: November 2003

AbstractObjective To determine any factors that could improve the early detection and management of congenital inner ear malformations.Study Design A retrospective review was performed of all patients with a diagnosis of inner ear malformation at Loyola University Medical Center (LUMC) and the Hospital for Sick Children (HSC) between 1987 and 1995. Clinical records and audiometric data were accumulated. One neuroradiologist reviewed every temporal bone computed tomography (CT) scan.Methods Forty‐six pediatric patients with congenital inner ear anomalies evaluated at two tertiary care hospitals.Results The average patient age at initial assessment was 25.7 months. A family history of hearing loss was noted in only five patients (12.8%). A major nonotological deformity was seen in 41% of patients. The average hearing threshold was 88 dB. All three patients with sudden hearing loss had vestibular aqueduct enlargement. Two of the three patients with common cavity anomalies had a history of recurrent meningitis. Twenty‐seven patients had a vestibular aqueduct deformity, the most frequent radiographic abnormality in the series.Conclusions Because inner ear malformation was diagnosed after 24 months of age in a significant percentage of patients, we recommend increased parental education and vigilance by primary care practitioners. Universal newborn screening may be the key to earlier detection of these infants. For children with idiopathic sensorineural hearing loss, we recommend a temporal bone CT scan. Patients with vestibular aqueduct enlargement must be counseled about the risk of progressive sensorineural hearing loss, meningitis, and the need to avoid contact sports. Patients with common cavity abnormalities should be considered for exploratory tympanotomy and also educated about the risk for meningitis.
New Options for Aerodigestive Tract Replacement After Extended Pharyngolaryngectomy
Authors: Succo Giovanni , Mioli Pierroberto , Merlino Giorgio , Sartoris Alberto 
Published: November 2003

AbstractObjectives Assess the results of a new type of reconstruction of the aerodigestive tract after extended pharyngolaryngectomy.Study Design Follow‐up of a total of eight patients who had surgery using ileocolic free graft.Methods The surgical technique is described. Five patients underwent pharyngolaryngectomy/cervical esophagectomy, and three patients had total laryngectomy with subtotal pharyngectomy. Patients were monitored to assess complications and recovery of satisfactory swallowing and speech.Results The technique, thanks to the use of material from the colon, proved to be extremely useful for the reconstruction of the digestive tract. At the same time, ileal anastomosis with the tracheal stump enabled aerodigestive crossing restoration, protected by the ileocecal valve. All patients recovered good swallowing capacity and phoniatric expression, which were obtained by digital occlusion of the tracheostomy, forcing the expiratory air through the ileum and ileocecal valve. Manometric tests also showed that after a while there was a gradual synchronization of swallowing between the transplanted colic segment and the residual esophagus.Conclusions The technique described in the present study may be regarded, also in the light of possible further applications, as a new and interesting option for the reconstruction of the aerodigestive tract.
Raman Spectroscopy for Early Detection of Laryngeal Malignancy: Preliminary Results
Authors: Stone Nicholas , Stavroulaki Pela , Kendall Catherine , Birchall Martin , Barr Hugh 
Published: November 2003

AbstractObjective Raman spectroscopy, the analysis of scattered photons after monochromatic laser excitation, is well established in nonbiological sciences. Recently this method has been used to differentiate premalignant and malignant lesions from normal tissue. Its application for early diagnosis has been explored in a variety of sites (e.g., esophagus, cervix), but not, to date, in laryngeal cancer. The objective of this study was to perform a feasibility study of the use of Raman spectroscopy for early diagnosis of laryngeal malignancy.Methods Biopsy specimens were snap‐frozen, and top sections were sent for histopathological analysis. Only homogenous samples with clearly defined pathological findings were used in this study: seven histologically normal samples, four exhibiting dysplasia, and four with carcinoma. Samples were defrosted and placed under a Renishaw (Wotton‐Under‐Edge, UK) System 1000 Raman microspectrometer for analysis. Between 5 and 12 spectra were acquired from each sample, with an excitation wavelength of 830 nm. Average characteristic spectra for each disease or condition were compared. Further multivariate statistical analysis of the data was carried out to evaluate and maximize the differences in the spectra for each disease or condition.Results The most visible differences in the spectra occur between 850 and 950 cm−1 and 1200 and 1350 cm−1. The later peaks are directly related to protein conformation and C‐H bond stretch in nucleic acid bases. The relative intensity of the nucleic acid peak increases with progression to malignancy. Use of linear discriminant analysis made it possible to separate the spectra with disease to a greater degree of accuracy than using empirical peak ratio methods alone. Classification results obtained from cross‐validation of the discriminant model showed prediction sensitivities of 83%, 76%, and 92% and specificities of 94%, 91%, and 90% for normal, dysplastic, and squamous cell carcinoma of the larynx, respectively.Conclusions There was strong evidence to support spectral identification of malignancy and earlier abnormal changes. More substantive studies of the spectral differences between malignant and non‐neoplastic tissue are warranted. Raman spectroscopy may become a useful adjunct to pathological diagnosis allowing directed or guided biopsies and assessment of adequacy of resection margins.
Incidence of Carcinoma in Incidental Tonsil Asymmetry
Authors: Syms Mark J. , Birkmire‐Peters Deborah P. , Holtel Michael R. 
Published: November 2003

AbstractObjective To determine the incidence of malignancy in patients with incidentally discovered unilateral tonsillar enlargement with an otherwise normal physical examination.Study Design A retrospective review of our institution's experience with unilateral tonsillar enlargement.Results During a five‐year period, 570 patients underwent tonsillectomy at our institution. Of patients undergoing tonsillectomy, 49 patients (8.6%) underwent tonsillectomy with normal mucosa, no lymphadenopathy, and asymmetry of the tonsils. Two (4.8%) of the 49 patients with unilateral enlargement had the presence of malignancy. The two adult patients had B‐cell lymphoma. Of all of the patients undergoing tonsillectomy, 0.35% had occult malignancy. In additional, the ability of the clinically assessed size (1+, 2+, 3+, and 4+) to predict volume was evaluated. The clinically assessed size and pathologically measured volume were significantly correlated (R = 0.333, P < .013). In 60.5% of the patients, the clinically assessed size and the pathologically measured volume agreed with the asymmetry reported on physical examination.Conclusion A relatively high number of tonsillectomies will be performed to yield an approximately 5% positive rate of malignancy within removed tonsils that are asymmetrical with normal mucosa and no cervical adenopathy.
Pursestring Closure of Radial Forearm Fasciocutaneous Donor Sites
Authors: Winslow Catherine P. , Hansen Juliana , Mackenzie Doug , Cohen James I. , Wax Mark K. 
Published: November 2003

AbstractBackground The radial forearm fasciocutaneous free flap has become one of the most common methods of reconstructing defects after head and neck ablative surgery. The fasciocutaneous flap is an excellent replacement for the tissue that has been removed. Unfortunately, donor site morbidity remains a problem. Donor site morbidity is primarily related to poor skin graft take, cosmesis, and neural dysfunction. Decreasing the size of the donor site defect may allow for improved cosmesis with decreased morbidity.Material and Methods Prospective evaluation of a pursestring closure of radial forearm fasciocutaneous donor sites over a 16‐month period.Results Seventy‐one radial forearm free flaps were used. Sixty‐seven had a pursestring closure of the donor site. After flap elevation the mean size of the defect was 61 cm2 (range, 28–140 cm2). Pursestring closure decreased the mean of the defect to 34 cm2 (range, 10–104 cm2) (P <.0001). Defect size was decreased by a mean of 44.5% (range, 24.5%–66.7%) (P <.0001).Complications The rate of skin graft loss (>25%) (9% of patients) was less than that reported in the literature. No patient required a second surgical procedure. Neural morbidity was equal in both groups. Cosmesis was much improved.Conclusions Pursestring closure allowed for a significantly decreased donor defect, associated with better cosmesis and less skin graft loss.
Autonomic Nervous System Evaluation of Patients With Vasomotor Rhinitis
Authors: Jaradeh Safwan S. , Smith Timothy L. , Torrico Laura , Prieto Thomas E. , Loehrl Todd A. , Darling Ronald J. , Toohill Robert J. 
Published: November 2003

AbstractObjective To demonstrate the utility of quantitative neurological laboratory testing of autonomic nervous system dysfunction and to apply this methodology to further study the relation of chronic vasomotor (nonallergic) rhinitis to the autonomic nervous system.Methods It has been suspected that vasomotor rhinitis is due either to a hyperactive parasympathetic nervous system or an imbalance between it and the sympathetic nervous system. The exact relation has not been determined. Recently neurological laboratories have been developed in which a battery of tests can be performed to determine reactivity of the autonomic nervous system.Results Autonomic nervous system testing was performed on 19 patients with symptoms fulfilling the diagnostic criteria for vasomotor rhinitis and the results were compared with 75 sex‐ and age‐matched control subjects. Patients with vasomotor rhinitis had significant abnormalities of their sudomotor, cardiovagal, and adrenergic subscores. Their composite autonomic scale score was significantly impaired at 2.43, as compared with 0.11 for controls (P < .005).Conclusion Autonomic nervous system dysfunction is significant in patients with vasomotor rhinitis. Possible factors that trigger this dysfunction including nasal trauma and extraesophageal manifestations of gastroesophageal reflux are discussed.
A New Pathogenesis of Mesotympanic (Congenital) Cholesteatoma
Authors: Tos Mirko 
Published: November 2003

AbstractObjectives To introduce a new, acquired pathogenetic theory of mesotympanic cholesteatoma behind an intact eardrum in children and to present some doubts on congenital pathogenesis.Study Design Literature review.Methods The incidence and origination of mesotympanic cholesteatoma in children were thoroughly analyzed in the world literature and correlated to the histopathological studies on human middle ear epithelia and to epidemiological studies on secretory otitis, tubal occlusion, and acute suppurative otitis media.Results The new, acquired theory is based on the fact that that the place of origin of the anterosuperior mesotympanic cholesteatoma is the area of the malleus handle and malleus neck, and of the posterosuperior cholesteatoma, the long process of the incus. During the common pathological conditions there is a great risk of retractions and adhesions of the eardrum to these ossicles. After subsequent loosening of the retracted eardrum some cells of the keratinized squamous epithelium may be left behind and become included into the tympanic cavity, eventually causing an inclusion cholesteatoma. Four basic mechanisms of inclusions are proposed and the presence of great dynamics in middle ear disease in children, with high incidence of tubal dysfunction, retractions, secretory otitis, and acute suppurative otitis, is documented, making the acquired pathogenesis probable. The place of origin does not fit with the congenital pathogenesis of epithelial formation localized on the lateral wall of the eustachian tube close to the annulus. The origination around the malleus and incus fits better with the proposed acquired pathogenesis.Conclusions There are no definitive proofs for the acquired pathogenesis of the mesotympanic cholesteatoma, nor is there e‐perimental research to prove or disprove it.
Role of Topical Steroids in Reducing Dysfunction After Nerve Injury
Authors: Galloway Edgar B. , Jensen Randy L. , Dailey Andrew T. , Gregory Thompson B. , Shelton Clough 
Published: November 2003

AbstractObjective To determine the efficacy of topical dexamethasone in reducing nerve dysfunction after axonotmesis injury.Study Design A three‐armed, blinded study including sham, control, and test groups was designed using the rat sciatic nerve crush injury model.Methods Twenty‐two rats were randomly assigned to a control group or a topical steroid group. A standardized sciatic nerve crush injury was performed under sterile conditions on each animal. A separate group of five rats underwent a sham operation to isolate the crush injury as the source of postoperative dysfunction in the control and steroid groups. All animals underwent walking track analysis with calculation of the sciatic functional index (SFI) before surgery and through the postoperative recovery period. Dexamethasone saturated Gelfoam was placed at the site of injury in the topical steroid group. The functional performance of each group was compared throughout the recovery period.Results No morbidity associated with topical application of steroids at the injury site was noted. The topical steroid group had improved recovery at postoperative days 14, 18, and 22. This difference was statistically significant at day 14. At the termination of the study, there was a clear trend toward superior recovery for the steroid group compared with controls (90% vs. 73%), but this difference did not reach statistical significance.Conclusions Clinical use of topical steroids to reduce postoperative nerve dysfunction warrants further study.
An Evaluation of Fibrin Tissue Adhesive Concentration and Application Thickness on Skin Graft Survival
Authors: O'Grady Kevin M. , Agrawal Amit , Bhattacharyya Tapan K. , Shah Ami , Toriumi Dean M. 
Published: November 2003

AbstractObjectives To e‐amine the effects of fibrinogen concentration and application thickness of fibrin tissue adhesive on skin graft survival.Study Design Prospective controlled study.Methods Ten domestic pigs were included in the study. A 20 − 5‐cm area of skin was harvested bilaterally along the flanks of the animals using a Padgett dermatome. The harvested grafts were trimmed into four 4 − 4‐cm squares. Donor sites were treated according to group assignment and the non‐meshed grafts were placed on the side opposite their initial orientation and secured with staples. Both single‐ and multiple‐donor human fibrin tissue adhesive preparations, with low and high average fibrinogen concentrations of 30 mg/mL and 60 mg/mL, were used. Adhesive preparations were applied in either a thin layer (0.015 mL/cm2) or a thick layer (0.06 mL/cm2) using a spray applicator. A constant thrombin concentration of 10 U/mL was used in the study. No adhesive was used in the control group and grafts were stabilized with staples. No topical dressings were applied to any of the treatment sites. Animals were sacrificed 4 weeks after graft application.Results Based on statistical analysis, thickness of adhesive application had a significant effect on skin graft survival. Percent mean graft survival in the control and thin application groups was found to be 92% and 97.8% respectively; the mean survival rate in the thick application group was 63.1%. Fibrinogen concentration, when evaluated independently within the thin and thick application groups, was found to have no significant effect on graft survival.Conclusion Independent of fibrinogen concentration, a thin layer of fibrin tissue adhesive, when applied between two opposing surfaces, does not interfere with and may support the healing process, whereas a thick layer of adhesive inhibits skin graft healing.
Rationale for Intralesional Valrubicin in Chemoradiation of Squamous Cell Carcinoma of the Head and Neck
Authors: Wani Manish K. , Koseki Yoshihiro , Yarber Robert H. , Sweatman Trevor W. , Ahmed Asif , Samant Sanjiv , Hengesteg Arne , Israel Mervyn , Thomas Robbins K. 
Published: November 2003

AbstractObjectives/Hypothesis With some advanced squamous cell carcinomas (SCCs) of the head and neck, chemoradiation therapy may obviate the need for surgical intervention. However, both modalities are known to produce organ to‐icities, and tumor insensitivity remains problematic. Thus there is a clear need for the development of new treatment strategies. Accordingly, preclinical studies to evaluate the use of valrubicin, a contact‐safe, mechanistically novel antitumor agent, combined with low‐dose radiation for the therapy of SCC have been conducted.Methods The comparative in vitro antitumor activities of valrubicin with or without irradiation versus cisplatin were evaluated using human‐derived sensitive and cisplatin‐resistant SCC cell lines. A hamster cheek pouch model of SCC was used to assess the efficacy of weekly intratumoral valrubicin injections with and without concurrent low‐dose irradiation.Results Valrubicin cytoto‐icity was found to be comparable in both sensitive and platinum‐resistant cell lines and superior to cisplatin. The addition of minimally cytoto‐ic cell irradiation (300–450 cGy) resulted in prolonged G2/M cell cycle arrest and a supra‐additive increase in apoptotic cell death. In hamsters, once a week × 3 intratumoral drug injections (3, 6, or 9 mg) were growth inhibitory; however, when valrubicin (6 mg) was combined with minimally cytotoxic irradiation (150, 250, or 350 cGy) significant tumor shrinkage was observed.Conclusions Valrubicin produces supra‐additive effects against SCC when combined with low‐dose irradiation. This effect appears to correlate with the ability of valrubicin, a cytoplasmic‐localizing drug, to inhibit protein kinase C. Therapeutic use of valrubicin against SCC could provide for reduced radiation doses with consequent improved efficacy and reduction in host to‐icity.
Reliability of Frozen Section in Determining Tumor Thickness Intraoperatively in Laryngeal Cancer
Authors: Dadaş Burhan , Başak Tülay , Özdemir Tuncay , Polat Nedim , Turgut Suat 
Published: November 2003

AbstractObjectives The relationship between locoregional lymph metastasis and tumor thickness in head and neck cancer has been well documented in recent years. Determining tumor thickness by frozen section may help the surgeon decide intraoperatively whether to perform elective neck dissection, whereas paraffin section results could be obtained at a later time for this decision. The aim of this study was to evaluate the accuracy of tumor thickness measurements obtained by macroscopic measurement and by frozen section intraoperatively in laryngeal cancer.Study Design Prospectively we compared the tumor thickness results obtained by gross visual examination, by frozen section, and by paraffin section in 20 total, near‐total, and horizontal supraglottic laryngectomy specimens.Methods The sections were stained with hematoxylin and eosin and tumor thickness was measured under a light microscope with an ocular micrometer.Results A strong correlation was found between frozen section and paraffin section tumor thickness measurements (Pearson correlation coefficient = 0.993, P <.001). Paired t test showed a 4.59 mm mean difference between macroscopic and paraffin section measurements, and a 0.76 mm mean difference between frozen and paraffin section measurements.Conclusion Assessment of tumor thickness in laryngeal cancer intraoperatively by frozen section is a reliable method.
Vocal Fold Vibrations: High‐Speed Imaging, Kymography, and Acoustic Analysis: A Preliminary Report
Authors: Larsson Hans , Hertegård Stellan , Lindestad Per‐Åke , Hammarberg Britta 
Published: November 2003

AbstractObjectives To evaluate a new analysis system, High‐Speed Tool Box (H. Larsson, custom‐made program for image analysis, version 1.1, Department of Logopedics and Phoniatrics, Huddinge University Hospital, Huddinge, Sweden, 1998) for studying vocal fold vibrations using a high‐speed camera and to relate findings from these analyses to sound characteristics.Study Design A Weinberger Speedcam + 500 system (Weinberger AG, Dietikon, Switzerland) was used with a frame rate of 1904 frames per second. Images were stored and analyzed digitally. Analysis included automatic glottal edge detection and calculation of glottal area variations, as well as kymography. These signals were compared with acoustic waveforms using the Soundswell program (Hitech Development AB, Stockholm, Sweden).Methods The High‐Speed Tool Box was applied on two types of high‐speed recordings: a diplophonic phonation and a tremor voice. Relations between glottal vibratory patterns and the sound waveform were analyzed.Results In the diplophonic phonation, the glottal area waveform, as well as the kymogram, showed a specific pattern of repetitive glottal closures, which was also seen in the acoustic waveform. In the tremor voice, fundamental frequency (F0) fluctuations in the acoustic waveform were reflected in slow variations in amplitude in the glottal area waveform. For studying details of mucosal movements during these kinds of abnormal vibrations, the glottal area waveform was particularly useful.Conclusions Our results suggest that this combined high‐speed acoustic‐kymographic analysis package is a promising aid for separating and specifying different voice qualities such as diplophonia and voice tremor. Apart from clinical use, this finding should be of help for specification of the terminology of different voice qualities.
Expression of Fibroblast Growth Factor‐2 in the Nucleus Ambiguus Following Recurrent Laryngeal Nerve Injury in the Rat
Authors: Sanuki Tetsuji , Yumoto Eiji , Komori Masahiro , Hyodo Masamitsu 
Published: November 2003

AbstractObjectives To examine fibroblast growth factor‐2 (FGF‐2) immunoreactivity in the nucleus ambiguus (NA) after three different recurrent laryngeal nerve (RLN) injuries.Study Design Immunohistochemical analysis of FGF‐2.Methods Thirty adult rats underwent left‐sided RLN crush (group A). The left RLN was transected in groups B (n = 30) and C (n = 30); in group C, both nerve stumps were covered with silicone caps. FGF‐2 in the NA was assessed as the ratio of the positive areas on the left (operated [O]) and right (unoperated [U]) sides. The ratio (O/U) was measured 1, 3, 7, 14, and 28 days after the procedure. Three rats underwent left‐sided RLN exposure and were killed 7 days later (control).Results Left‐sided RLN paralysis occurred until day 28 in group A. In the control group, O/U was approximately 1. In group A, O/U was significantly elevated on day 7; in group B, on days 3, 7, and 14; and in group C, on day 3. O/U in group B was significantly greater than that in group A on days 14 and 28. Maximal FGF‐2 immunoreactivity was significantly lower in group C than in groups A and B.Conclusions We demonstrated elevated production of FGF‐2 in the NA after RLN injury. This endogenous FGF‐2 might contribute to preventing lesion‐induced neuronal death. Blockage of axonal regeneration might suppress FGF‐2 production in the NA. Further understanding of the roles of FGF‐2 after RLN in‐jury may contribute to the prevention of neuronal death and facilitation of axonal regeneration.