bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Emergency Surgical Airway Procedures in a Hospital‐Wide Setting
Authors: Gillespie M. Boyd , Eisele David W. 
Published: November 2003

AbstractObjective: To review the circumstances, complications, and outcomes of emergency surgical airway procedures and to compare the relative merits of cricothyroidotomy and tracheotomy for airway control in a hospital‐wide patient population.Study Design: Retrospective review.Methods: Patient data were obtained from the inpatient charts and electronic patient records of 35 patients who required an emergency surgical airway over a 6‐year period at an urban medical center.Results: Emergency cricothyroidotomy and tracheotomy were successfully performed in 34 of 35 patients (97%). Orotracheal intubation was successfully achieved in one patient with a failed cricothyroidotomy. The overall complication rates for emergency cricothyroidotomy and tracheotomy were similar (20% and 21%, respectively). Inpatients requiring an emergency surgical airway had a higher complication rate (32% vs. 0%) but better overall survival (91% vs. 46%) than patients treated in the emergency department. No long‐term complications were observed from emergency cricothyroidotomies that were not converted to tracheotomies.Conclusion: The establishment of an emergency surgical airway by either tracheotomy or cricothyroidotomy is effective with low overall morbidity. The need to convert every emergency cricothyroidotomy to a tracheotomy should be reevaluated.
Laryngomalacia and Its Treatment
Authors: Olney Daniel R. , Greinwald John H. , Smith Richard J. H. , Bauman Nancy M. 
Published: November 2003

AbstractObjective: To determine 1) airway outcome of infants with laryngomalacia who do not undergo routine direct laryngoscopy (DL) and bronchoscopy (B), 2) the age at resolution of laryngomalacia, and, 3) outcome of supraglottoplasty as a function of the type of laryngomalacia and the presence of concomitant disease.Study Design: Retrospective chart review.Methods: The records of all infants diagnosed with laryngomalacia by flexible fiberoptic laryngoscopy (FFL) between 1990 and 1998 in the Department of Otolaryngology‐Head and Neck Surgery, University of Iowa (Iowa City, IA) were reviewed. The type of laryngomalacia was designated by a new classification scheme (types 1‐3) based on the site of supraglottic obstruction and the type of supraglottoplasty indicated, should the patient later require surgical intervention. The log rank test was used to compare age at resolution and outcome between types of laryngomalacia and between infants with isolated laryngomalacia versus those with additional congenital abnormalities and/or severe neurological compromise.Results: The type of laryngomalacia was evident in 48 of the 58 charts reviewed and included type 1 (57%), type 2 (15%), type 3 (13%), or combined types (15%). Twenty percent had severe neurological compromise and/or multiple congenital anomalies. The median time to resolution of stridor in these patients was not significantly delayed when compared with infants who had isolated airway anomalies (36 and 72 wk, respectively, vs. 36 wk for isolated laryngomalacia; P < .4). Time to resolution did not correlate with the type of laryngomalacia. In 22 infants, clinical symptoms or findings suggested a synchronous airway lesion, and direct laryngoscopy and bronchoscopy were performed. In 11 infants, a second airway lesion was diagnosed (in four cases by FFL and in 7 cases by direct laryngoscopy and bronchoscopy). Complications did not arise in infants who did not undergo direct laryngoscopy and bronchoscopy. Eleven infants with severe laryngomalacia required surgical intervention. The success of supraglottoplasty did not correlate with the type of laryngomalacia or the presence of other congenital anomalies.Conclusions: Routine direct laryngoscopy and bronchoscopy as part of the evaluation of laryngomalacia are not warranted. Performing these procedures should be based on clinical and physical evidence of a concomitant airway lesion. In general, laryngomalacia will resolve within the first year of life, even in children with multiple congenital anomalies and/or severe neurological compromise. The proposed classification scheme is advantagous in that it is simple and correlates the site of obstruction with the surgical procedure most likely to effect a cure, should the patient require a supraglottoplasty. Surgical management is necessary in approximately 15% to 20% of affected infants.
Management Implications of Evaluating the N2 and N3 Neck After Organ Preservation Therapy
Authors: Strasser Mark D. , Gleich Lyon L. , Miller Mary Ann , Saavedra Harold I. , Gluckman Jack L. 
Published: November 2003

AbstractObjectives/Hypothesis: To determine if metastatic squamous cell carcinoma with proliferative potential persists in N2 and N3 necks after conventional radiation.Study Design: Retrospective case series.Materials and Methods: We identified 17 patients from our head and neck tumor database who underwent organ‐preserving radiotherapy for primary aerodigestive squamous cell cancer and N2‐3 regional metastasis. Archival tissue from these 17 neck specimens was evaluated for routine histopathologic evidence of tumor, as well as immunohistochemically for cytokeratin and Ki‐67 activity. An assay for apoptosis was also performed on 10 of the specimens.Results: Routine H&E evaluation suggested metastatic cancer in 11 of 17 irradiated neck specimens. Cytokeratin immunostaining confirmed squamous cell carcinoma in these 11 necks as well as 1 additional specimen that had tested H&E negative. Ki‐67 staining demonstrated proliferating tumor in 3 of 17 necks. The apoptosis assay confirmed regions of apoptosis in all of the specimens analyzed.Conclusions: The discovery of proliferating cancer cells in 3 of 17 irradiated specimens (18%) supports the practice of planned neck dissection after primary radiotherapy for patients with pretherapeutic N2+ metastatic disease.
Profound Hearing Loss Attributable to Cochlear Nerve Disease: Diagnosis With Combination of Otoacoustic Emission and Magnetic Resonance Imaging
Authors: Ogura Masaki , Kawase Tetsuaki , Ikeda Katsuhisa , Oshima Takeshi , Furuta Susumu , Takahashi Shoki , Takasaka Tomonori 
Published: November 2003

AbstractObjective: To detect the causes of deafness based on the combined findings of auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAEs), and three‐dimensional Fourier transformation‐constructive interference in steady state (3DFT‐CISS) magnetic resonance imaging (MRI).Study Design: Retrospective review of the medical records of 13 patients with unilateral profound hearing loss since childhood.Methods: Subjects were tested with pure‐tone audiometry, ABR, DPOAEs, and 3DFT‐CISS imaging.Results: No significant components of ABR were observable in any of the deaf ears. In 10 cases, the cochlear nerves of the deaf ears were found to be as normal as the healthy sides by 3DFT‐CISS imaging, and no significant levels of DPOAEs were recorded. In the other three cases, no apparent cochlear nerves were identified by 3DFT‐CISS imaging. Although no significant levels of DPOAEs were observable in two cases with cochlear nerves invisible by the MRI study, almost the same level of DPOAEs as that in the healthy side was recorded in the last case.Conclusions: In the last particular case, the cochlear nerve seemed to be mainly responsible for the profound deafness. 3DFT‐CISS imaging in combination with preexisting audiological measures may provide direct evidence for the cochlear nerve disease.
Fish Bones at the Cricopharyngeus: A Comparison of Plain‐Film Radiology and Computed Tomography
Authors: Palme Carsten E. , Lowinger David , Petersen Alexander J. 
Published: November 2003

AbstractObjectives: To compare and contrast the use of plain film radiology and computed tomography (CT) scanning in the detection of fish bones at the level of the cricopharyngeus.Study Design: Prospective study of 30 different fish bones placed at the level of the cricopharyngeus in a fresh human cadaver head and neck specimen and imaged using both plain films and CT scans.Methods: Thirty different bones from 10 different local species of fish were selected and grouped as small, medium, or large in size. Both plainfilm and CT images of the bones were reported by a radiologist as A, easily seen; B, seen on close inspection; or C, not seen. Results were analyzed using McNemar's test.Results: CT scanning was superior to plain‐film radiology in demonstrating the presence of fish bones at the level of the cricopharyngeus (P < .0001, McNemar's test, df = 1 when comparing report type A with B and C).Conclusion: The superior usefulness of CT scans in demonstrating the presence of fish bones lodged at the cricopharyngeus has been clearly shown in this study; therefore we advocated its use in selected cases.
Prevention of Nausea and Vomiting After Middle Ear Surgery: Granisetron Versus Ramosetron
Authors: Fujii Yoshitaka , Tanaka Hiroyoshi , Kobayashi Noriaki 
Published: November 2003

AbstractObjective/Hypothesis: Middle ear surgery is associated with a relatively high incidence of postoperative nausea and vomiting. This study was undertaken to compare the efficacy of ramosetron with granisetron for preventing nausea and vomiting after middle ear surgery.Study Design: Prospective, randomized, double‐blind study.Methods: In a randomized, double‐blind manner, 100 ASA I patients (69 women), aged 23 to 65 years, received either ramosetron 0.3 mg or granisetron 3 mg intravenously (n = 50 of each) immediately before the induction of anesthesia. A standard general anesthetic technique and postoperative analgesia were used. Postoperative nausea and vomiting and safety assessments were performed continuously during the first 24 hours (0‐24 h) and the next 24 hours (24‐48 h) after anesthesia.Results: A complete response, defined as no nausea and vomiting and no need for another rescue medication, during the first 24 hours after anesthesia (0‐24 h) occurred in 90% of patients receiving ramosetron and in 86% of patients receiving granisetron, respectively (P = .379); the corresponding incidence rates in the second 24 hours after anesthesia (24‐48 h) were 90% and 66% (P = .003). No clinically important adverse events were observed in either group.Conclusion: Prophylactic use of ramosetron is more effective than granisetron for long‐term prevention of nausea and vomiting after middle ear surgery.
Laryngeal Cancer Cost Analysis: Association of Case‐Mix and Treatment Characteristics With Medical Charges
Authors: Arnold David J. , Funk Gerry F. , Karnell Lucy Hynds , Chen Achih H. , Hoffman Henry T. , Ricks Joan M. , Zimmerman M. Bridget , Corbae Dean P. , Zhen Weining , McCulloch Timothy M. , Graham Scott M. 
Published: November 2003

AbstractObjectives: To examine the relationship of various pretreatment case‐mix characteristics and treatment modalities with medical charges incurred during diagnosis, treatment, and 2‐year follow‐up for patients with laryngeal cancer.Design: Retrospective chart review and billing record analysis.Methods: The charts and billing records of patients diagnosed with laryngeal cancer at the University of Iowa Hospitals and Clinics (UIHC) between January 1, 1991 and December 31, 1994 were reviewed. The independent variables included various pretreatment patient‐mix and tumor characteristics (age, AJCC TNM clinical stage, smoking history, ASA class, and comorbidity as defined by Kaplan‐Feinstein grade) as well as type of treatment. The dependent variables included total physician, office, and university hospital‐based charges incurred during the pretreatment evaluation and 0‐ to 3‐, 3‐ to 12‐, and 12‐ to 24‐month billing periods after the initiation of cancer‐directed therapy. Total 1‐year and 2‐year charges were also evaluated. Univariate and multivariate analyses were used to investigate the relationships between dependent and independent variables and to develop models predictive of management charges during the individual and total billing periods.Results: Pretreatment charges showed no significant associations (P < .05) with any of the independent variables. Multiple regression analyses indicated that comorbidity, stage, and initial treatment modality were significant variables in one or more of the models predicting charges incurred during the 0‐ to 3‐month, 3‐ to 12‐month, total 1‐year, and total 2‐year billing periods. The models yielded R2 values for the total 1‐ and 2‐year billing periods of 0.5246 and 0.5055, respectively.Conclusions: This work supports continued study of measures that may result in earlier detection of laryngeal cancer as a potential means of reducing management charges. These results also indicate that a more accurate method of stratifying the disease severity of laryngeal cancer patients for reimbursement purposes would include measurements of the severity of the index disease as well as comorbid diseases.
Polymerase Chain Reaction Detection of Mycobacterium tuberculosis From Fine‐Needle Aspirate for the Diagnosis of Cervical Tuberculous Lymphadenitis
Authors: Baek Chung‐Hwan , Kim Sun‐Il , Ko Young‐Hyeh , Chu Kwang‐Chol 
Published: November 2003

AbstractBackground: Despite its well‐established usefulness in the diagnosis of cervical tuberculous lymphadenitis, fine‐needle aspiration cytology (FNAC) has several limitations in its clinical applications, especially when the presence of acid‐fast bacilli is not proven. Furthermore, fine‐needle aspirate is sometimes inadequate for diagnosis, and the sensitivity and specificity of this technique for cervical tuberculous lymphadenitis has not been firmly established.Objective: The authors performed Mycobacterium tuberculosis polymerase chain reaction (PCR) for mycobacterial DNA sequences from the remainder of fine‐needle aspirate after cytological examination and evaluated its diagnostic efficacy in clinical situations.Methods: Conventional diagnostic procedures including FNAC and M tuberculosis PCR were performed simultaneously in 29 cases that had been suspected to be cervical tuberculous lymphadenitis on patients' first visit. The results of FNAC and M tuberculosis PCR were compared with the clinical outcomes after several months of follow‐up and pathological results from open biopsy of some cases.Results: Among the 17 cases of cervical tuberculous lymphadenitis diagnosed in clinical situations, M tuberculosis DNA was found by PCR in 13 cases (76.4%). Negative findings on PCR were achieved in 12 cases, which revealed non‐granulomatous lymphadenopathy.Conclusion: From these results, we conclude that M tuberculosis PCR using the remainder of aspirate for cytological examination is a very useful tool for the diagnosis of cervical tuberculous lymphadenitis, and its clinical application with FNAC could reduce the necessity for open biopsy.
Absence of Nuclear p16 From Epstein‐Barr Virus‐Associated Undifferentiated Nasopharyngeal Carcinomas
Authors: Shibosawa Eriko , Tsutsumi Kouichiro , Koizuka Izumi , Hoshikawa Masahiro , Takakuwa Toshifumi 
Published: November 2003

AbstractObjective: Epstein‐Barr virus (EBV) is detected in the majority of undifferentiated nasopharyngeal carcinomas (UNPCs, World Health Organization type III). However, the exact mechanism involved in the carcinogenesis of EBV‐associated UNPCs remains to be elucidated. An important unresolved question is: how is the normal cell cycle deregulated during EBV‐associated UNPC development? The p16CDKN2 gene encodes a nuclear protein, p16, which inhibits the D‐type cyclin/cyclin‐dependent kinase complexes that phosphorylate the retinoblastoma gene product (pRb), thus blocking G1 cell cycle progression. The objective of this study was to determine whether p16 absence is involved in the development of EBV‐associated UNPCs.Methods: We performed immunohistochemistry to detect p16 and pRb and in situ hybridization to detect EBV‐encoded small RNA (EBER) in UNPCs from 28 patients.Results: No p16 was detected in 23 of 28 UNPCs (82.1%), whereas pRb was expressed in all those examined and EBER was detected in 22 of 28 (78.6%). The absence of p16 was associated with the presence of EBER in UNPCs (P < .0001): none of the 22 EBER+ UNPCs expressed p16, whereas 5 of 6 EBER− UNPCs did.Conclusion: Our data suggest that loss of p16‐related cell cycle regulation plays an important role in the development of EBV‐associated UNPCs.
Microdissection or Microspot CO2Laser for Limited Vocal Fold Benign Lesions: A Prospective Randomized Trial
Authors: Benninger Michael S. 
Published: November 2003

AbstractCO2lasers have become an important technological advance and an integral tool for the laryngeal surgeon since the 1960s. Surgeons have used lasers for a variety of benign and malignant lesions in the larynx with good success. With better understanding of the microarchitecture of the vocal folds and the recognition of heat distribution into surrounding tissues that occurs with the use of standard CO2lasers, questions and concerns have been raised regarding the use of the CO2laser for benign lesions of the vocal folds. With the advent of the microspot CO2laser with a spot size of less than 250 μm, the potential heat distribution to the deeper layers of the lamina propria has been reduced. The microspot CO2laser has been suggested to be an appropriate tool for the excision of superficial benign lesions of the vocal fold and may be considered as an appropriate treatment alternative to microdissection. Only a limited number of studies have compared the efficacy of microdissection versus microspot CO2laser surgery in the larynx, and no prospective, randomized trials have been performed.ObjectiveThis study was designed to compare microspot CO2laser excision and microdissection for superficial benign lesions confined to the free margin of the vocal fold.Study Design:A randomized, prospective trial comparing microspot CO2laser excision and microdissection in the removal of nodules, polyps, and mucous retention cysts of the vocal fold.MethodsAcoustic and aerodynamic measures and videostroboscopic and perceptual audio recordings evaluated by a panel of blinded viewers and listeners were studied preoperatively and 2 to 3 weeks and 5 to 12 weeks postoperatively. Surgical and recovery times were compared between the two groups.ResultsThirty‐seven patients met selection criteria and were enrolled, 21 in the microdissection group and 16 in the laser excision group. Significant improvements in videostroboscopic parameters were found over time in both groups. Significant improvements were noted for perceptual analysis over time for the laser excision group with nonsignificant improvements over time for the microdissection group. There was no difference in any measure between laser excision and microdissection at the two postoperative visits. There was no difference in surgical or recovery time between laser excision and microdissection. Acoustic and aerodynamic parameters were noncontributory in evaluating outcomes of treatment, since most values were normal before surgery.ConclusionNo differences in clinical outcomes are identified when comparing microdissection with laser excision of nodules, polyps, and mucous retention cysts of the vocal folds.
Length of Stay After Free Flap Reconstruction of the Head and Neck
Authors: Ryan Matthew W. , Hochman Marcelo 
Published: November 2003

AbstractObjectives: To analyze the incidence and timing of postoperative complications after free tissue transfer (FTT) and relate that to length of stay (LOS.)Study Design: We reviewed one surgeon's experience with 97 patients undergoing 100 head and neck reconstructions via FTT for a variety of traumatic and ablative defects.Methods: Charts were reviewed for demographic data, type of defect and flap, complications, LOS, length of intensive care unit (ICU) stay, date of decannulation, and first oral intake, any readmission to the hospital, and preoperative radiation status.Results: Using strict guidelines, 31% of patients had some form of complication, including a 9% flap failure rate. Average postoperative LOS for all patients was 11 days. Average LOS for uncomplicated cases was 9 and for complicated cases was 16 days. For cases with flap‐related complications the average LOS rose to 20 days. All reconstructive failures (defined as patients requiring subsequent surgical procedures after a flap‐related complication, regardless of outcome) occurred within the first 7 postoperative days. Three patients were readmitted for various reasons: a partial flap dehiscence (postoperative day [POD] 9), meningitis (POD 24), and orocutaneous fistula (POD 22), for a 3.2% readmission rate. Fourteen percent of patients were on a regimen of oral intake, and 13% had decannulation by the time of discharge. Resumption of oral intake and tracheostomy decannulation were accomplished on an outpatient basis in the remainder of patients.Conclusions: There were no preventable complications associated with early hospital discharge, nor was there evidence of adverse patient outcome. We conclude that early hospital discharge is feasible after FTT reconstruction and is consistent with quality care.
Radiation Dose to Otologic Structures During Head and Neck Cancer Radiation Therapy
Authors: Ondrey Frank G. , Greig J. Robert , Herscher Laurie 
Published: November 2003

AbstractBackground: Otologic structures are often contained within head and neck cancer radiation treatment ports. The dosimetry to otologic structures has not been routinely analyzed and radiation treatment planning does not currently attempt to specifically avoid the inner ear structures when dosimetry is calculated. Recent studies demonstrate that up to 30% of patients experience sensorineural hearing loss on multimodality therapy with cisplatin and radiation.Methods: In the current case series, radiation dosimetry to otologic structures was calculated from computed tomogram treatment plans on patients. Fifteen nasopharyngeal, oral cavity, oropharyngeal, and hypopharyngeal cancer patients were analyzed.Results: Between 8% and 102% of the total dose is delivered to the petrous bone/cochlea, with 4 of 15 patients getting more than 50% of the dose to at least one cochlea. The mastoid air cells received between 3% and 75% of the total dose, with higher doses being delivered to patients with bulky high neck metastases or nasopharyngeal tumors. The eustachian tubes received between 2% and 102% of the total dose, with 10 of 15 patients receiving more than 50% of the dose to this anatomic site.Conclusion: We conclude that the cochlea and eustachian tubes receive significant radiation during treatment, particularly in nasopharyngeal cancer patients. Careful design of radiation treatment ports may allow for the reduction of radiation to hearing structures.