bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three‐Layer Reconstruction for Large Defects of the Anterior Skull Base
Authors: Sinha Uttam K. , Johnson Terence E. , Crockett Dennis , Vadapalli Satish , Gruen Peter 
Published: November 2003

AbstractObjectives To evaluate and discuss a three‐layer rigid reconstruction technique for large anterior skull base defects.Study Design Prospective, non‐randomized, non‐blinded.Setting Tertiary teaching medical center.Methods Twenty consecutive patients underwent craniofacial resection for a variety of pathology. All patients had large anterior cranial base defects involving the cribriform plate, fovea ethmoidalis, and medial portion of the roof of the orbit at least on one side. A few patients had more extensive defects involving both roof of the orbits, planum sphenoidale, and bones of the upper third of the face. The defects were reconstructed with a three‐layer technique. A watertight seal was obtained with a pericranial flap separating the neurocranium from the viscerocranium. Rigid support was provided by bone grafts fixed to a titanium mesh, anchored laterally to the orbital roofs. All patients had a computed tomography scan of the skull on the first or second postoperative day. Patients were observed for immediate and long‐term postoperative complications after such reconstruction.Results Postoperative computed tomography scans showed small pneumocephalus in all patients. It resolved spontaneously and did not produce neurologic deficits in any patient. There was no cerebrospinal fluid leak, hematoma, or infection. On long‐term follow‐up, exposures of bone graft or mesh, brain herniation, or transmission of brain pulsation to the eyes were not observed in any patient.Conclusions Three‐layer reconstruction using bone grafts, titanium mesh, and pericranial flap provides an alternative technique for repair of large anterior cranial base defects. It is safe and effective, and provides rigid protection to the brain.
Microvascular Transfer of Long Tracheal Autograft Segments in the Canine Model
Authors: Genden Eric M. , Gannon Patrick J. , Smith Shane , Keck Nancy , Deftereos Maria , Urken Mark L. 
Published: November 2003

AbstractObjective The reconstruction of long segment tracheal defects represents an unsolved clinical dilemma. Prior attempts to directly revascularize tracheal segments have been unsuccessful. The objective of this study was to evaluate orthotopic autotransplantation of revascularized long tracheal segments in the canine model.Methods Ten randomly selected mongrel dogs underwent excision, orthotopic reimplantation, and microvascular revascularization of a long segment (8.0 cm) of cervical trachea. The cranial thyroid artery and the internal jugular vein served as the vascular supply for the tracheal segment. The animals were maintained for a period of 30 days during which time graft viability was measured by routine endoscopic assessment and tracheal biopsies. Ex vivo, tracheal autografts were examined grossly for graft healing and microscopically for histologic architecture.Results Seven of 10 dogs survived the predetermined 30‐day postoperative study period without complications. Postmortem examination demonstrated that 7 dogs had healed tracheal autograft segments with normal histologic architecture, 2 dogs sustained a postoperative wound infection and tracheal dehiscence, and 1 dog sustained a fatal postoperative hematoma.Conclusions For the first time, we have demonstrated direct revascularization of long segment tracheal autografts in the dog model using the cranial thyroid artery and internal jugular vein as the vascular supply.
Vestibular Rehabilitation Using Visual Displays: Preliminary Study
Authors: Viirre Erik , Sitarz Robert 
Published: November 2003

AbstractObjectives/Hypothesis Interactive computer displays can alter vestibular function. We hypothesized that by placing a vestibulopathic subject with chronic vertigo in a computer scene, slowing the visual scene motion to a rate slightly higher than their vestibulo‐ocular reflex (VOR) gain, and gradually speeding up the scene, we could cause VOR improvement and symptom reduction.Study Design Randomized, nonblinded treatment/control study.Methods Subjects were selected for VOR gain less than 0.5 at 0.16, 0.32, or 0.64 Hz. They wore a computer display that interacted with the movement of their head. The scene magnification controlling image motion was initially set approximately 5% higher than the VOR gain. Subjects had interaction tasks for 10 sessions of 30 minutes twice daily for 5 days. The scene magnification was gradually increased over the sessions. Control subjects had a similar procedure but were shown a normal, ×1.0 magnification for each interaction session.Results Nine subjects and six control subjects were tested. Test subjects showed an average increase in VOR gain of 0.05 at 0.16 Hz, 0.048 at 0.32 Hz, and 0.098 at 0.64 Hz. In contrast, control subjects showed a decrease of 0.008 at 0.16 Hz, an increase of 0.016 at 0.32 Hz, and a decrease of 0.058 at 0.64 Hz. Improvement remained after 1 week but at a lower level than immediately after testing. Subject Dizziness Handicap Inventory scores decreased by 2.8 from 38.5 in the first week. Control subjects reported no symptom improvement.Conclusion Immersive computer environments can improve VOR function and reduce vertigo.
Management of Chronic Otitis Media in the Only Hearing Ear
Authors: Battaglia Alex S. , Sabri Alain N. , Jackson C. Gary 
Published: November 2003

AbstractObjective Chronic ear surgery is difficult. The management of such a disease either with or without cholesteatoma and in an only hearing ear is particularly challenging. Consequences of disease or unintended outcomes of therapy can both result in patient lifestyle alterations of major proportion. This report offers a diagnostic and treatment plan for chronic otitis media with and without cholesteatoma in the only hearing ear.Methods More than 10,000 charts of patients with chronic otitis media were retrospectively reviewed. Twenty‐seven charts of patients with chronic otitis media in an only hearing ear who underwent surgical treatment were identified. The patients were followed for an average time of 43 months.Results Overall, the chronic otitis media was well controlled, and there was no change in the average discrimination or hearing thresholds when comparing preoperative and postoperative results.Conclusions Chronic otitis media with and without cholesteatoma in an only hearing ear can be treated successfully with hearing preservation. Canal wall down tympanomastoidectomy is performed in most cases. Manipulation of the ossicular chain is avoided, and cholesteatoma that lies over a potential fistula is exteriorized.
Increased Botulinum Toxin Type A Dosage Is More Effective in Patients With Frey's Syndrome
Authors: Guntinas‐Lichius Orlando 
Published: November 2003

AbstractObjective To compare the duration of effect of two dosage regimes of botulinum toxin A to treat patients with Frey's syndrome.Study Design Prospective study of two unselected cohorts of 20 patients each.Methods The dimension of the affected skin area was determined with Minor's iodine–starch test. The skin was infiltrated with botulinum toxin type A (Dysport, Ipsen Pharma, Ettlingen, Germany) using an interinjection distance of 1 cm. In the first group, a concentration of 10 mount units (MU)/0.1 mL and in the second group a concentration of 20 MU/0.1 mL was used. At each injection site, 0.1 mL of the respective solution was injected. The outcome measures were the time of reappearance of gustatory sweating, and the results of an iodine–starch test 10 and 20 months after treatment.Results Using the lower concentration, the mean duration of effectiveness was 8.3 ± 2 months (mean ± standard deviation). Using the higher concentration, the effect was much longer at 16.5 ± 6 months. Eighty‐five percent of the first group but only 5% of the second had a positive Minor's iodine–starch test 10 months after treatment. After 20 months four patients in the second group still had a negative iodine–starch test. In both groups, the amount of required botulinum toxin for the second treatment after recurrence of Frey's syndrome was the same as for the first treatment.Conclusions Using a higher concentration of botulinum toxin type A (20 MU Dysport/0.1 mL) is more effective than a lower concentration (10 MU Dysport/0.1 mL) in the treatment of Frey's syndrome.
Tumor Angiogenesis as a Predictive Marker for Organ Preservation in Patients With Advanced Laryngeal Carcinoma
Authors: Teknos Theodoros N. , Cox Claudell , Barrios Martin A. , Chepeha Douglas B. , Bradford Carol R. , Fisher Susan G. , Wolf Gregory T. 
Published: November 2003

AbstractBackground The purpose of this study was to retrospectively investigate tumor angiogenesis as a predictive marker for response to neoadjuvant chemotherapy, organ preservation, and survival in patients with advanced laryngeal carcinoma.Methods A total of 332 patients with stage III (188 patients) or stage IV (144 patients) squamous cell carcinoma of the larynx were entered in the prospective trial conducted by the Department of Veteran Affairs Laryngeal Cancer Study Group. Of this patient population, 20 pretreatment biopsy specimens were available from the chemotherapy arm for immunohistochemical analysis of Factor VIII expression. Two blinded investigators determined microvessel density in each patient by manual inspection of 10 high‐power (400×) fields (HPF).Results The patients who had a partial response (>50% decrease in tumor volume) or complete response to chemotherapy had a mean value of 20.90 (± 8.09 standard deviation [SD]) blood vessels per HPF. Those who did not respond to chemotherapy and thus required a total laryngectomy had a mean value of 32.99 (± 10.10 SD) vessels per HPF. The difference of the means was statistically significant using a two‐tailed t test (P <.0085). Kaplan‐Meier survival curve analysis also revealed that patients with vessel counts above the mean tended to have poorer survival than those below the mean regardless of treatment selection. The most‐vascular tumors, those greater than 1 SD above the mean, had a statistically significant difference in survival and laryngeal preservation (P = .0345).Conclusions These results indicate that tumor angiogenesis, as measured by number of vessels per HPF, was associated with decreased responsiveness to chemotherapy and radiation for larynx preservation. The most‐vascular tumors also were associated with poorer survival than those with lesser degrees of angiogenesis.
Acanthamoeba: A Rare Primary Cause of Rhinosinusitis
Authors: Rivera Miguel A. , Padhya Tapan A. 
Published: November 2003

AbstractParasitic infections, especially Acanthamoeba, are rarely implicated as a specific cause of rhinosinusitis. It is a fatal disease found in the immunocompromised population, in particular in patients infected with the human immunodeficiency virus (HIV). Less than 10 cases of Acanthamebic rhinosinusitis have been reported in the literature, and only 1 has survived. This case report presents an Acanthamebic infection misdiagnosed as a squamous cell carcinoma of the nasal septum on a presumptive healthy, immunocompetent 35‐year‐old woman. She was later diagnosed with AIDS (AIDS) along with disseminated Acanthamoebiasis and became the second reported case surviving this deadly illness. This case report also discusses the difficulty in diagnosing this rare parasite, the pathogenesis, and the multidisciplinary treatment required to control and manage this uniformly fatal disease.
Long‐Term Follow‐up of Fat Injection Laryngoplasty for Unilateral Vocal Cord Paralysis
Authors: McCulloch Timothy M. , Andrews Brian T. , Hoffman Henry T. , Graham Scott M. , Karnell Michael P. , Minnick Corey 
Published: November 2003

AbstractObjective The objective of the study was to evaluate the results of autologous fat injection laryngoplasty in the long‐term management of unilateral vocal cord paralysis.Study Design A retrospective chart review and clinical voice re‐evaluation of patients treated for unilateral vocal cord paralysis with autologous fat injection at the University of Iowa Hospitals and Clinics (Iowa City, IA) between May 1992 and September 1999.Methods The data analyzed included patient demographics, early and long‐term vocal outcomes, additional surgical treatments, and patient survival.Results Fifty patients were treated with fat injection laryngoplasty, which included 44 treated for unilateral vocal cord paralysis. Thirty‐one of the patients had fat injection as their primary procedure for permanent voice restoration. Eight patients treated had preoperative and postoperative voice data available. Using the GRBAS subjective voice assessment scale (0, normal; 3, severely abnormal), mean grade improved from 2.1 to 1.3 and breathiness improved from 1.4 to 0.5, at a mean period of 52 days. Thirteen of the 31 patients (41%) required additional procedures to achieve acceptable vocal outcomes. The median time to failure for these patients was 163 days. The initial treatment failure rate at 2 years was 30%, and the rate reached 45% by 4 years.Conclusion Although fat injection laryngoplasty reliably improves the voice over the short term, the long‐term voice outcome is unpredictable. Additional surgeries to deal with subsequent vocal deterioration are common. The role of autologous fat injection laryngoplasty in the modern era is limited.
Voice Quality After Radiofrequency Volumetric Tissue Reduction of the Soft Palate in Habitual Snorers
Authors: Haraldsson P. ‐O. , Karling J. , Lysdahl M. , Svanborg E. 
Published: November 2003

AbstractObjective To evaluate whether radiofrequency volumetric tissue reduction of the soft palate is causing voice changes as a result of velopharyngeal insufficiency in patients with heavy snoring.Study Design A prospective study of 16 habitual snorers (oxygen desaturation index, <6 in all cases) were investigated concerning nasopharyngeal competence before and, at minimum, 2 months after the procedure (mean period, 165 d). Speech evaluation was made objectively with a nasal‐oral ratio meter and also was made subjectively by a trained speech‐language pathologist. The patients received a mean of three Somnoplasty radiofrequency volumetric tissue reduction treatments of 1200 J each (600 J in the midline and 300 J on each side of the soft palate).Result Comparison between preoperative and postoperative nasal‐oral ratio meter analysis of hypernasality revealed no significant change. Neither did listener judgment of hypernasality, nasal escape, or pharyngeal snort reveal any influence on velopharyngeal function by the surgical procedures. Snoring was somewhat successfully treated, as evaluated by spouses; snoring score was reduced from 8.2 ± 2.9 to 4.1 ± 2.5 (P <.01) on a 10‐grade rating scale. Maximum nocturnal decibel levels were also reduced in 79% of the cases.Conclusion Radiofrequency volumetric tissue reduction in the soft palate as a treatment for snoring did not show any significant adverse effect on nasopharyngeal function.
Familial Head and Neck Cancer: Molecular Analysis of a New Clinical Entity
Authors: Yu Kathy K. , Zanation Adam M. , Moss Jonathan R. , Yarbrough Wendell G. 
Published: November 2003

AbstractObjective The tumor suppressor gene p16 encodes a cyclin‐dependent kinase inhibitor that normally inhibits cell proliferation by causing a G1 cell cycle arrest. The p16 gene is frequently mutated in a variety of somatic tumors, as well as in familial melanoma and familial pancreatic carcinoma. We identified a family with a high incidence of head and neck squamous cell carcinoma (HNSCC) and melanoma. Molecular analyses of the p16 gene locus in blood and tumor DNA from this family was performed to determine whether an association between germline p16 gene mutation and HNSCC exists.Study Design Molecular pedigree analyses.Methods Exon 2 of p16 was polymerase chain reaction amplified from blood, tumor, or nontumor DNA isolated from affected and unaffected members, then directly sequenced and compared with consensus p16 sequence. Cell cycle position of cells expressing wild‐type or mutant p16 was determined by flow cytometry.Results Molecular analyses revealed a nonfunctional germline point mutation within exon 2 of the p16 gene that encodes a mutant p16 protein substituting proline at amino acid position 87 for the wild‐type arginine (p16R87P). Relative to wild‐type p16, p16R87P lost ability to cause a growth arrest following ectopic expression. The mutant (p16R87P) allele segregated with cancer predisposition in tested family members, and analyses of HNSCC tumor tissues demonstrated universal loss of wild‐type allele.Conclusions Significance of the mutant p16 (p16R87P) in HNSCC tumorigenesis is strongly suggested by its loss of cell cycle arrest activity and its retention in tumor tissue with simultaneous loss of the wild‐type allele. Further, the germline p16 mutation segregated with cancer predisposition within the family. In aggregate, these data suggest that there is a direct causal relationship between the germline p16 mutation in this family and HNSCC tumorigenesis. Based on our observations, the spectrum of familial cancers associated with p16 mutations should include a new clinical entity, familial HNSCC.
Effects of Gap Junction Uncoupling in the Gerbil Cochlea
Authors: Spiess Adam C. , Lang Hainan , Schulte Bradley A. , Spicer S. S. , Schmiedt Richard A. 
Published: November 2003

AbstractObjective To gain insight into molecular and cellular mechanisms regulating cochlear potassium (K+) recycling, including the possible effects of mutations in the GJB2 gene, which encodes the gap junction protein connexin 26. Intercellular K+ flux was manipulated in vivo by infusion of the gap junction uncoupler proadifen (SKF‐525A) into perilymph. Functional and structural alterations induced by gap junction blockade were assessed by electrophysiological and morphologic analysis.Study Design Laboratory study using an animal model.Methods Physiological effects of acute and chronic uncoupling of gap junctions in the Mongolian gerbil inner ear were evaluated by measurement of compound action potential (CAP) thresholds and input‐output (I/O) functions, distortion product otoacoustic emissions (DPOAE), and the endocochlear potential (EP). Morphologic changes were assessed by electron microscopy.Results Acute exposures to proadifen resulted in large decreases in EP values, DPOAE magnitudes, and CAP I/O maximum amplitudes and an increase in high‐frequency CAP thresholds. These physiological changes were accompanied by vacuolization of type II and type V fibrocytes in the lateral wall of the cochlea. Chronic treatments revealed some recovery in EP values and CAP thresholds, which showed a relatively flat 15‐ to 20‐dB elevation across frequencies.Conclusions Gap junctions play a significant role in normal cochlear function. In particular they appear to be essential for maintaining the EP, an activity that could be related to their participation in K+ recycling. Thus, hearing losses associated with mutations in the GJB2 gene that alter the expression or function of connexin 26 may result from a diminished capacity to recycle K+ from perilymph back to the stria vascularis and a consequent decline in the EP.
Internal Carotid Artery Transposition as Risk Factor in Pharyngeal Surgery
Authors: Galletti Bruno , Bucolo Sebastiano , Abbate Giuseppe , Calabrese Giancarla , Romano Giuseppe , Quattrocchi Carmelo , Freni Francesco 
Published: November 2003

AbstractObjective/Hypothesis Injuries to the internal carotid artery during simple pharyngeal surgical procedures can be catastrophic for the risk of massive bleeding. The aims of the study were 1) to report five cases of congenital and asymptomatic anomalies of the internal carotid artery with a review of the literature, 2) to assess the relationships between these anomalies and the possible risk in “routine” pharyngeal surgery, and 3) to determine the most accurate imaging techniques to evaluate these anomalies.Study Design Retrospective study of five patients with congenital anomalies of the internal carotid artery bulging the pharyngeal wall.Methods Clinical records, pathology reports, and original imaging features of these kind of vascular lesions (computed tomography scans, three‐dimensional time‐of‐flight magnetic resonance angiogram, and Doppler ultrasonography) were reviewed for each patient; vascular lesions were related to possible risk factors for pharyngeal surgery; and a review of the literature was made.Results All the patients were admitted for other diseases. The five anomalies, except one, were bulging the posterior pharyngeal wall and were asymptomatic. The peculiar literature referred 14 previous descriptions of similar anomalies.Conclusions Some of the anomalies of the internal carotid artery can determine a bulge of the posterior pharyngeal wall. Because of the submucous position of the carotid artery at this level, such anomalies can constitute a risk factor for serious hemorrhage in routine surgical procedures that have become outpatient procedures and are often performed by inexperienced surgeons. The three‐dimensional time‐of‐flight magnetic resonance angiogram together with Doppler ultrasonography were shown to be the most accurate imaging techniques to evaluate these anomalies.
Implication of 18F‐Fluoro‐2‐Deoxy‐D‐Glucose Positron Emission Tomography on Management of Carcinoma of Unknown Primary in the Head and Neck: A Danish Cohort Study
Authors: Johansen Jørgen , Eigtved Annika , Buchwald Christian , Theilgaard Sune A. , Hansen Hanne S. 
Published: November 2003

AbstractObjectives To demonstrate the efficacy of whole‐body 18F‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography (18F‐FDG PET) in the detection of a carcinoma of unknown primary after conventional diagnostic workup in patients with a metastatic neck lesion and to demonstrate how the treatment policy of wide‐field irradiation can be safely modified in relation to the findings from PET scanning.Study Design Prospective cohort study of consecutive patients.Methods Forty‐two consecutive patients with squamous cell or undifferentiated metastatic disease in the neck from a carcinoma of unknown primary were enrolled after standard clinical workups. These patients underwent extensive clinical investigations including endoscopy under anesthesia with multiple mucosal biopsies and diagnostic imaging as well. If no primary site was indicated at this stage, a whole‐body 18F‐FDG PET scan was performed.Results Potential focal pathological uptake indicated a primary tumor in 20 of 42 cases (48%). After PET, this was confirmed by additional investigations in 10 patients (24%). Of these, seven primaries were found in the head and neck region (hypopharynx [three], base of tongue/vallecula [two], nasopharynx [1], floor of mouth [1]), and three primaries were found below the clavicles (lung [1], esophagus [1], and abdomen [1]. Positron emission tomography resulted in significant modifications of radiation treatment fields or fractionation prescriptions in all the patients who were diagnosed with a primary tumor after PET.Conclusion With our present strategy of wide‐field irradiation in patients with neck node metastases from a carcinoma of unknown primary, whole‐body 18F‐FDG PET had treatment‐related implications in 24% (10 of 42) of the patients.