bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheal Autotransplantation: A Reliable Reconstructive Technique for Extended Hemilaryngectomy Defects
Authors: Delaere Pierre R. , Poorten Vincent Vander , Goeleven Ann , Feron Michel , Hermans Robert 
Published: November 2003

AbstractObjectives: Current surgical treatment for a glottic cancer with significant subglottic extension is a total laryngectomy. The objective of this study was to expand laryngeal conservation procedures by using a reconstructive technique that allows for the repair of hemicricolaryngectomy defects.Study Design: After resection of the ipsilateral thyroid, cricoid, and arytenoid for advanced T3 glottic cancer, the laryngeal defect was reconstructed by means of an autotransplanted segment of trachea in four patients. The reconstruction consisted of a transferable patch that was constructed from a segment of revascularized cervical trachea.Methods: During a 14‐day period, a 4‐cm segment of cervical trachea was wrapped by a free radial forearm fascial flap. In the second stage, the glottic cancer was removed and the cervical trachea was isolated on its fascial blood supply and transformed into a patch that was used to repair the extended hemilaryngectomy defect. Two different patch designs were used. Two patients underwent reconstruction with a patch augmented at the glottic level (group A); two patients underwent reconstruction without glottic augmentation on the patch (group B). Tracheal continuity was restored by an end‐to‐end reanastomosis. The postreconstruction morphology of the two patch designs was compared with the preoperative laryngeal morphology.Results: The autotransplantation technique led to complete restoration of the subglottic airway lumen in all four patients. Although the anterior‐posterior glottic diameter was reduced by 36% in group A patients and by 43.5% in group B patients, a sufficient glottic airway lumen was obtained. The glottic sphincteric function was restored in both groups.Conclusions: Tracheal autotransplantation may be used reliably to repair hemicricolaryngectomy defects. Augmentation of the patch at the level of the glottis is not essential for successful rehabilitation.
Computer‐aided endoscopic sinus surgery
Authors: Anon Jack B. 
Published: November 2003

AbstractObjectives: To examine four different types of computer‐aided endoscopic sinus surgical devices—the ISG Viewing Wand, the ISG infrared OptoTrak, the IGT FlashPoint 5000, and the VTI InstaTrak—with emphasis on their accuracy and ease of use. Study Design: Prospective study utilizing laboratory experiments and intraoperative data collection. Methods: A review of the literature is presented. Patients undergoing endoscopic sinus surgery during the study period were enlisted under FDA protocols with IRB consent. Groups of patients had surgery performed with each of the above devices—except the FlashPoint 5000. Accuracy measurements were recorded, and user and operating staff comments about ease of use were collected. The FlashPoint 5000 was used exclusively in the laboratory setting, where accuracy measurements were obtained on a cadaver skull. Results: The systems all demonstrated accuracy to within 2.00 mm. Ease of use was somewhat variable, but following a learning curve by the surgeon and operating department personnel, all of the units were considered to be relatively user friendly. Conclusions: Computer‐aided endoscopic sinus surgery appears to be the wave of the future. Nevertheless, the modern endoscopic sinus surgeon must have thorough training in the basic anatomy of the paranasal sinuses as well as the various surgical techniques.
Immune responses of adenoidal lymphocytes specific to haemophilus influenzae in the nasopharynx
Authors: Sakamoto Naoko , Kurono Yuichi , Suzuki Masashi , Kerakawauchi Hideomi , Mogi Goro 
Published: November 2003

AbstractObjectives: Investigate immune responses of adenoidal lymphocytes against outer‐membrane protein P6 purified from nontypeable Haemophilus influenzae (HI). Clarify the role of adenoids in regulating the colonization of HI in the nasopharynx. Study Design: Microbiological and immunological examinations of adenoids obtained from 21 children, 15 boys and five girls, from 1 to 13 years of age (median, 5 y), suffering from adenoidal hypertrophy complicated by otitis media with effusion (OME). Methods: The incidence of HI in adenoids was compared with the number of P6‐specific immunoglobulin (Ig) A–secreting cells in adenoids, determined by enzyme‐linked immunoassay. Results: Quantitative culture assay showed significant correlation between the numbers of HI in adenoids and those in nasopharyngeal secretions (NS). In children aged 5 years and younger, the numbers of P6‐specific IgA‐secreting cells in adenoids were significantly correlated with IgA antibody titers in NS (r = 0.68, P < .05). The numbers of P6‐specific IgG‐ and IgA‐secreting cells were lower in children aged 6 years and older than in children aged 5 years and younger. Furthermore, the number of P6‐specific IgA‐secreting cells was significantly increased in HI‐negative subjects when compared with HI‐positive subjects (P < .05). Conclusions: Adenoids play an important role as an effector site of the mucosal immune system in the upper respiratory tract. IgA immune responses in adenoids are responsible for the clearance of HI from the nasopharynx. Key Words: Haemophilus influenzae, adenoid, nasopharyngeal secretion, P6, IgA.
Topical gentamicin and ethacrynic acid: Effects on cochlear function
Authors: Conlon Brendan J. , McSwain S. David , Smith David W. 
Published: November 2003

AbstractObjective: To determine whether concurrent intravenous administration of the loop diuretic ethacrynic acid potentiates the toxicity of the aminoglycoside antibiotic gentamicin applied topically on the round window. Study Design: The authors studied the effects on cochlear sensitivity of co‐administered intracardiac ethacrynic acid (40 mg/kg) and high‐dose topical gentamicin solution (100%) applied to the round window. Comparisons were made with animals receiving ethacrynic acid plus systemic gentamicin (100 mg/kg); topical gentamicin alone; systemic gentamicin alone; and intravenous ethacrynic acid alone. Methods: Experiments were carried out on pigmented guinea pigs weighing 400 to 500 g. Changes in cochlear function were characterized by monitoring shifts in compound action potential (CAP) thresholds by use of chronic indwelling electrodes implanted at the round window, vertex, and contralateral mastoid. Results: After 20 days animals receiving ethacrynic acid in combination with topical gentamicin to the round window failed to demonstrate a significant deterioration in cochlear sensitivity, whereas all animals receiving systemic gentamicin plus ethacrynic acid experienced profound increases in CAP thresholds. Conclusions: This study supports the contention that ethacrynic acid potentiates aminoglycoside ototoxicity by facilitating the entry of the antibiotics from the systemic circulation into the endolymph. In addition, this study answers important clinical concerns regarding the safety of the use of topical aminoglycoside agents in combination with loop diuretics.
Intravenous delivery of 5′‐iododeoxyuridine during hyperfractionated radiotherapy for locally advanced head and neck cancers: Results of a pilot study
Authors: Epstein Alan H. , Lebovics Robert S. , Van Waes Carter , Smith Judy , Okunieff Paul , Cook John A. 
Published: November 2003

AbstractObjectives: Locally advanced cancers of the head and neck require aggressive treatment, often with limited effectiveness and significant toxicity and morbidity. This pilot study was designed to assess tolerance using combined hyperfractionated radiotherapy and the halogenated pyrimidine radiosensitizer 5′‐iododeoxyuridine (IdUrd). Study Design: This was a prospective single‐arm study open to patients with advanced head and neck cancers that had a poor chance of control with conventional radiation therapy. Patients were treated with hyperfractionated radiation therapy at standard doses in combination with an IdUrd infusion and observed for tumor response and normal tissue tolerances. Methods: Radiation therapy was delivered in fractions of 1.2 Gy or 1.5 Gy twice daily to a total dose in the range of 70 to 76 Gy. IdUrd was delivered as an intravenous infusion (1000 mg/m2 per day) for a maximum of 14 days at the beginning and then again during the middle of the radiotherapy. Results: Twelve patients with advanced squamous cell lesions were enrolled and 11 were observed to have complete clinical remissions. Seven patients remained clinically free of local disease at the time of death or most recent follow‐up. Acute toxicities, usually hematologic or mucosal, were severe and all patients required treatment modifications and considerable supportive care. Conclusions: Although a high rate of response was achieved using this regimen, the toxicities are prohibitive. The kinetic profile of IdUrd incorporation suggests the need for future studies using repetitive short courses of IdUrd.
Round window atresia in association with congenital stapes fixation
Authors: Pappas Dennis G. , Pappas Dennis G. , Hedlin Gary 
Published: November 2003

AbstractObjective: To document an association of round window atresia with congenital stapes fixation, discuss the diagnostic role of computed tomography, and implicate the clinical significance of these anomalies. Study Design: Retrospective chart review and review of the literature. Results: The authors report three pediatric cases of round window atresia. All cases presented with hearing loss of a conductive nature (two cases bilateral, one unilateral). Two patients underwent middle ear exploration, demonstrating stapes fixation and the absence of a round window. Stapedectomy was performed in both cases without postoperative hearing improvement. Subsequent revision stapedectomy was also unsuccessful in one of these cases. The unoperated case represents the fraternal twin of one patient. In all cases, computed tomography scanning demonstrated findings consistent with atresia of the round window niche without cochlear anomaly. Conclusions: An association of round window atresia and congenital stapes fixation is apparent. The mechanism of the conductive hearing loss following stapedectomy remains poorly understood. Computed tomography imaging and surgical confirmation are probably both necessary to establish the diagnosis of round window atresia.
Photodynamic therapy and the treatment of head and neck neoplasia
Authors: Biel Merrill A. 
Published: November 2003

AbstractObjective: To present the theory, technique, and results of photodynamic therapy for the treatment of oral, laryngeal, and head and neck cancers. Study Design: Retrospective review of the literature of more than 500 patients with head and neck cancer treated with photodynamic therapy, as well as a retrospective review of the author's 107 patients treated with photodynamic therapy for head and neck neoplasia between 1990 and 1997. Methods: The literature was retrospectively reviewed, as were patient records, and tabulaled for age, sex, site, and staging of lesions, with special focus on post‐photodynamic therapy treatment outcome, long‐term disease‐free survival, and complications. Results: Twenty‐five patients with carcinoma in situ and T1 squamous cell carcinoma of the true vocal cord who underwent photodynamic therapy treatment for cure obtained a complete response after a single photodynamic therapy treatment. Only one patient has had recurrence to date, with a cure rate to 79‐month follow‐up of 95%. Twenty‐nine patients with carcinoma in situ and T1 recurrent squamous cell carcinomas of the oral cavity and tongue were treated. All obtained a complete response after a single photodynamic therapy treatment; however, five patients developed local recurrence with follow‐up to 70 months, for an 80% cure rate. A review of 217 patients with early squamous cell carcinomas of the head and neck treated with photodynamic therapy in the literature demonstrated an 89.5% complete response rate. The most common complication in these patients was limited prolonged skin photosensitivity without any permanent sequelae. Conclusions: Photodynamic therapy is effective for treating carcinoma in situ and T1 squamous cell carcinoma of the larynx and oral cavity and may be of benefit as an adjuvant intraoperative treatment of stages III and IV tumors of the head and neck in conjunction with surgery and radiation therapy to improve cure rates. Further controlled studies need to be performed to further demonstrate the effectiveness of photodynamic therapy and the treatment of head and neck cancers.
Laser and cisplatinum for treatment of human squamous cell carcinoma
Authors: Paiva Marcos B. , Graeber Ines P. , Castro Dan J. , Suh Michael J. , Paek Woo H. , Eshraghi A. Amir , Saxton Romaine E. 
Published: November 2003

AbstractObjective: Interstitial laser therapy (ILT) with the neodynuumiyttrium‐aluminum‐garnet (Nd:YAG) (1064 nm) laser via fiberoptics is becoming a more precise, minimally invasive alternative for thermoablation of unresectable or recurrent head and neck neoplasms, but recurrence is often seen at the margin. Combining intratumor chemotherapy with interstitial laser should be most effective using drugs activated by thermal energy. The objective of the current study was to test intratumor cisplatinum (cis‐diaminedichloroplatinum [CDDP]) injections given in conjunction with laser therapy as an experimental approach for improved treatment of squamous cell carcinoma (SCC).Methods: Human SCC tumors were grown as subcutaneous transplants in nude mice and injected with CDDP (0.4 to 1.2 mg/g) in water or in collagen‐based gel carrier with epinephrine (epi‐gel) followed by ILT via 0.6‐mm fiberoptics coupled to an Nd:YAG laser (1064 nm/180 J).Results: Tumors injected with CDDP epi‐gel exhibited a partial response with two‐ to fourfold tumor delay compared with aqueous drug or untreated SCC transplants during 10 weeks' follow‐up. Combined drug and laser therapy significantly (P< .01) decreased tumor volume, with recurrence in only 25% of animals tested compared with 78% tumor regrowth after ILT alone.Conclusion: These initial results suggest that laser chemotherapy may become an effective treatment for advanced head and neck cancer.
Relationships between otitis media sequelae and age
Authors: Daly Kathleen A. , Hunter Lisa L. , Levine Samuel C. , Lindgren Bruce R. , Giebink G. Scott 
Published: November 2003

AbstractObjectives: To explore relationships between age and sequelae in two groups of children treated with tympanostomy tubes for chronic otitis media with effusion (OME). Study Design: Cross‐sectional study of sequelae among children, adolescents, and adults at 4 years and 9 to 23 years after tympanostomy tube treatment. Methods: Group I was examined with otomicroscopy, tympanometry, and audiometry two to four times a year as part of a prospective study, and they were evaluated 4 years after initial tube treatment for this study. Group II received tubes while participating in a chronic OME study, but participants were not followed prospectively after treatment. Nine to 23 years after tube treatment, they were examined with otomicroscopy, tympanometry, and hearing screening. Results: Among the 5− to 28− year‐old subjects, cholesteatoma (⩽1%) and perforation (⩽2%) were rare. In Group I, tympanosclerosis increased with age (P < .01), and OME (flat tympanograms) decreased with age in Group II (P < .01). The older cohort was more likely to have severe retractions (18% vs. 4%, P = .02), hearing loss (21% vs. 10%, P < .01), and severe atrophy (24% vs. 0%, P < .01) than the younger cohort, but they were less likely to have flat tympanograms (2% vs. 12%, P < .01). Conclusions: Although OME became less prevalent with age, important sequelae (severe atrophy, severe tympanic membrane retraction, hearing loss, cholesteatoma, and chronic perforation) may develop in children with chronic OME as they become adolescents and young adults. Long‐term prospective studies are important in defining the progression of sequelae in these children.
Sinus lateralis in endoscopic ethmoidectomy
Authors: Picerno Nicolette A. , Bent John P. 
Published: November 2003

AbstractObjective: To characterize the anatomy of the sinus lateralis and enable a more accurate and safe approach to endoscopic ethmoidectomy. Study Design: An anatomic study of 33 cadaver heads providing a prospective evaluation of 50 ethmoid sinuses. The sinus lateralis, in particular, was thoroughly examined and typical variations were classified into four categories. A technique using the sinus lateralis as a critical landmark is described which allows calculated removal of anterior ethmoid cells in a posterior‐to‐anterior direction, avoiding inadvertent entry into the posterior ethmoid. Prospective evaluation of this technique in 12 pediatric patients found it to be safe and particularly useful for neophyte endoscopic surgeons. Methods: Endoscopic examination of 50 cadaver sinuses using 0−, 30−, and 70‐degree, 4‐mm telescopes to dissect the anterior ethmoid. The characteristics of each sinus lateralis were documented. To confirm the endoscopic findings, we grossly examined each specimen. Results: Four different categories of sinus lateralis formation were identified: type I (n = 22), posterosuperior extension to skull base; type II (n =15), posterior extension to sphenoid face; type III (n = 8), abrupt termination posterior to ethmoid bulla; and type IV (n = 5), extension into posterior ethmoid through dehiscent basal lamella. Conclusions: The sinus lateralis is a consistent feature of the anterior ethmoid. Type I and II patterns are most conducive to the aforementioned technique. Type III is the most difficult to identify endoscopically, whereas type IV is most apt to encourage an unplanned posterior ethmoidectomy. Regardless of the chosen ethmoidectomy technique, careful assessment of the sinus lateralis should enable more accurate and safe removal of ethmoid disease with reduced complications.
Spectral analysis of photoplethysmograms from radial forearm free flaps
Authors: Stack Brendan C. , Futran Neal D. , Shohet Michael J. , Scharf John E. 
Published: November 2003

AbstractObjective: Photoplethysmography utilizes a green‐light‐emitting diode to transmit light into a tissue. Reflected light from hemoglobin in dermal capillary red blood cells is received by a photo detector and is analyzed as light intensity along a frequency spectrum. This method of analysis allows for the removal of “noise” above (stray light and alternating current [AC]) and below (room vibrations and respiratory motion) the peak signal (1 to 2 Hz) and results in a means to distinguish between perfused and non‐perfused tissues. Methods: Twenty‐two of 30 consecutive radial forearm free flap (RFFF) patients were enrolled in an approved human studies protocol to collect descriptive data for RFFFs that were perfused, arterial occluded, and venous occluded. The protocol was performed following completion of flap elevation and prior to pedicle ligation, flap inset, and microvascular anastomoses. Six 90‐second measurements per flap were obtained (n = 132), processed by fast Fourier transform (FFT), and analyzed by blinded reviewers to determine their state of perfusion. Signal was collected 5 minutes after the onset or release of individual vessel occlusion. Results: The reviewers' interpretations were compared with the status of the pedicle and analyzed for sensitivity (0.96), specificity (0.95), and positive predictive value (0.98). Conclusions: FFT analysis of photoplethysmograms from RFFF patients provides an accurate and rapid means for determining RFFF pedicle vessel patency. Photoplethysmography may provide a clinically useful tool for postoperative perfusion monitoring of free flaps in the future.
The recurrent laryngeal nerve: Related vascular anatomy
Authors: Moreau Sylvain , De Rugy Marc Goullet , Babin Emmanuel , Salame Ephrem , Delmas Pierre , Valdazo Andre 
Published: November 2003

AbstractThis study was based on 34 recurrent laryngeal nerve dissections after arterial casting with red‐colored latex. The aim was to provide specific information about the perineural microvasculature. This study established the following points: 1. a great anatomic variability does exist; 2. the laryngeal nerve is usually in relation to the posterior branch of the inferior thyroid artery; and 3. this vascular branch is sometimes replaced with a vascular network. In all cases, this microvascularization must be preserved during thyroid surgery. Key Words: Recurrent laryngeal nerve, anatomy, inferior thyroid artery.
Long‐term hearing results following vestibular surgery in meniere's disease
Authors: Wazen Jack J. , Spitzer Jaclyn , Kasper Craig , Anderson Blake 
Published: November 2003

AbstractObjectives: The purpose of this study is to evaluate the long‐term hearing changes following vestibular surgery in patients with Meniere's disease. Study Design: This is a retrospective analysis of patients operated on in a tertiary referral center setting. Methods: Preoperative, postoperative, and 3‐ to 9‐year postoperative audiograms were analyzed in two patient groups. Twenty‐one patients underwent posterior fossa vestibular neurectomy (VN) and five, mastoid endolymphatic sac decompression and shunt (ELS). All frequencies, four‐frequency pure‐tone averages (PTAs), spondee thresholds, and speech recognition scores were compared for operated ear against nonoperated ear of VN subjects. The results were subjected to a covariance analysis. VN and ELS patients whose hearing deteriorated from “serviceable” (PTA ≤70 dB hearing level) and speech recognition ≤30%) to nonserviceable status were compared using nonparametric statistics. Results: Progressive hearing loss beyond the rate of change of the normal contralateral ear was evident in all patients. Serviceable hearing dropped from 81% to 43% of patients an average of 4 years following VN. Conclusions: VN patients have significant hearing deterioration over time in the operated ear. This finding suggests that continued postoperative medical management is necessary for patients undergoing VN. Laryngoscope, 108:1470–1473, 1998
Clinical update on type II first branchial cleft cysts
Authors: Sichel Jean‐Yves , Halperin Doron , Dano Itzhak , Dangoor Eric 
Published: November 2003

AbstractObjective: To describe clinical and radiological signs of type II first branchial cleft cyst in order to facilitate diagnosis. Method: Report of three cases of first branchial cleft cyst type II (one of them in association with ipsilateral agenesis of the parotid gland) and review of the literature. Results: Two clinical signs are described: the location of the sinus opening in the neck, which is situated in a triangle limited by the external auditory canal above, the mental region anteriorly, and the hyoid bone inferiorly, and the presence in some cases of a myringeal web that runs from the floor of the external auditory canal to the umbo. In addition, imaging with computed tomography and magnetic resonance of the parotid area may be helpful in confirming the diagnosis. Laryngoscope, 108:1524–1527, 1998