bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early postoperative calcium levels as predictors of hypocalcemia
Authors: Adams Jeff , Andersen Peter , Everts Edwin , Cohen James 
Published: November 2003

AbstractObjective: Early, safe postoperative hospital discharge has become a priority in the current environment of cost containment and managed care. One determinant for this following operations of the thyroid or parathyroid glands is a stable postoperative calcium level. This study sought to determine whether early postoperative calcium levels could safely predict hypocalcemia following operations of the thyroid or parathyroid glands. Study Design: A retrospective chart review of 197 patients undergoing such operations was undertaken. Methods: The study population was divided into patients undergoing parathyroid exploration with removal of one or more glands for parathyroid disease (“parathyroid” group) and patients undergoing bilateral thyroid operations (“nonparathyroid” group). Postoperative calcium levels were plotted as a function of time, and the slope between the first two postoperative calcium levels examined. Results: A positive slope predicted normocalcemia in 100% of “nonparathyroid” and 90% of “parathyroid” surgeries. A negative slope was predictive in its magnitude. The nonparathyroid patients who developed postoperative hypocalcemia had an average slope significantly more negative (‐0.84% change/h) than patients remaining normocalcemic (‐0.49% change/h) (P = .03). Similarly, the parathyroid patients who became hypocalcemic had an average initial slope nearly twice as negative (‐1.4% change/h) as patients remaining normocalcemic (‐0.78% change/h) (P = .005). Conclusions: These results indicate that an initial upsloping postoperative calcium curve based on two early postoperative calcium measurements is strongly predictive of a stable postoperative calcium level, and a steeply downsloping initial calcium curve is worrisome for eventual hypocalcemia.
Pretreatment and midtreatment measurement of oxygen tension levels in head and neck cancers
Authors: Gabalski Edward C. , Adam Markus , Pinto Harlan , Brown J. Martin , Bloch Daniel A. , Terris David J. 
Published: November 2003

AbstractObjective: Considerable evidence exists to suggest that tumor hypoxia results in radioresistance. Historically, it has been difficult to assess tumor oxygen tension levels reliably. These levels can now be assessed in head and neck malignancies using the Eppendorf Po2 histograph, which uses a fine‐needle electrode and a computerized micromanipulator. This technology was used to compare the pretreatment tumor oxygen tension level in lymph node metastases of patients with head and neck cancer to measurements taken during nonsurgical treatment after a partial response had been achieved. Study Design: Prospective study. Methods: Oxygen tension levels were measured in the cervical lymph nodes of 10 patients with biopsy‐proven head and neck squamous cell carcinoma and cervical metastases who were being treated with nonsurgical management. These levels were obtained using the Eppendorf pO2 histograph system. Measurements were taken before the start of treatment and were repeated when the size of the cervical metastatic node had decreased by 50%. Normal subcutaneous tissue was measured during the same session. The mean and median pO2 levels, as well as the percentage of measurements with pO2 less than 5 mm Hg were determined. Results: A mean of 72.6 measurements per session was taken from each lymph node. The median tumor pO2 measurement fell from a mean (±SD) of 13.9 ± 8.0 mm Hg to 7.3 ± 9.9 mm Hg. Even more dramatic, however, was the substantial increase in the percentage of values less than 5 mm Hg, a rise from 29% to 52%. Conclusions: While there is variability both in the pretreatment oxygenation of head and neck cervical metastases and in the change in tumor oxygen tension during treatment, there appears to be a decrease in the overall oxygenation of the tumors. The dramatic increase in very low oxygen measurements may reflect selective survival of radioresistant or chemoresistant hypoxic tumor cells. Cells at the very low level would be expected to be radiobiologically hypoxic (resistant to radiation‐induced cell kill).
Management of the N0 Neck During Salvage Laryngectomy
Authors: Wax Mark K. , Touma B. Joseph 
Published: November 2003

AbstractBackground: Radiotherapy is effective treatment for laryngeal carcinoma. Early‐stage laryngeal carcinoma has a low incidence of cervical metastasis. Patients initially clinically N0 usually remain N0 when they fail at the primary site. The incidence of subclinical metastasis in these patients is not well described. Watchful waiting or elective neck dissections are advocated. Objective: Examine the incidence of subclinical metastatic disease in patients undergoing elective neck dissections with salvage laryngectomy. Study Design: Prospective study (1991–1996) of patients who failed radiotherapy and underwent salvage laryngectomy with elective neck dissection. Methods: Thirty‐four patients underwent salvage laryngectomy with neck dissection (30 bilateral, 4 unilateral). All were clinically N0 at initial presentation and remained N0 at recurrence. Pathologic study of the neck dissection specimens was undertaken. Patients were followed for a minimum of 2 years (mean, 4 y). Results: The male‐to‐female ratio was 4.5:1, with a mean age of 62 years (range, 38 to 75 y). Metastatic disease was present in 6 patients (17%); 4 of 14 (28%) supraglottis and 2 of 20 (10%) glottic. Presence of disease in the neck according to stage at recurrence was as follows: T2, 2 of 12; T3, 3 of 14; and T4, 2 of 8. Neck disease was ipsilateral in 4 and contralateral in 2 patients (both supraglottic primaries). Conclusions: Subclinical cervical metastasis may be present in N0 laryngeal carcinoma patients who have recurrence following radiotherapy. Morbidity of a lateral neck dissection is minimal, with excellent control of the neck being possible. Supraglottic and advanced glottic (T3‐T4) patients may benefit the most.
Effect of Internal Maxillary Arterial Occlusion on Nasal Blood Flow in Swine
Authors: Weaver Edward M. , Chaloupka John C. , Putman Christopher M. , Roth Toni C. , Horky John K. , Sasaki Clarence T. 
Published: November 2003

AbstractObjectives: The precise effects of therapeutic occlusion of the internal maxillary artery (IMA) on distal nasal mucosal perfusion are unknown. A better understanding of these effects has important implications regarding the rationale and expected efficacy of certain therapeutic interventions for epistaxis management. The authors developed an animal model to assess these issues. Study Design: The effects of “proximal” and progressively more “distal” occlusions of the IMA on nasal mucosal blood flow (NBF) were assessed in anesthetized swine using continuous laser Doppler flowmetry. The levels of arterial occlusion were selected to simulate clinical therapeutic occlusions used for the management of epistaxis. Methods: Nineteen swine were entered into one of four experimental groupings: proximal IMA occlusion using platinum micro‐coils (n = 6), mid‐grade distal IMA occlusion with polyvinyl alcohol particulate (PVA) suspensions (300 to 500 microns, n = 5), high‐grade distal IMA occlusion with polyvinyl alcohol particulate suspensions (50 to 150 microns, n = 5), and sham control (n = 2). Results: All embolizations resulted in acute decreases in average NBF from 120 mL/min per 100 g to 40 mL/min per 100 g (P <.05 for all groups). NBF returned to baseline in all three treated groups within 2 to 8 days after therapeutic embolization, depending on the level of occlusion (coils, 2 d; mid‐grade PVA, 2–3 d; high‐grade PVA, 8 d). Follow‐up angiography showed recanalization and collateralization as possible methods of reestablishing NBF. Conclusions: This study supports the rationale for performing distal IMA occlusion with transarterial particulate embolization, in order to provide a longer period of time of diminished NBF. This theoretically should promote hemostasis within an injured portion of the nasal mucosa by decreasing perfusion pressure within the capillary bed. However, the benefits of distal IMA embolization must be balanced against potential ischemic complications, as may be more commonly seen with high‐grade particulate embolization.
Gustatory Disturbance Due to Cerebrovascular Disorder
Authors: Onoda Keiko , Ikeda Minora 
Published: November 2003

AbstractObjectives: Review three cases of unilateral gustatory disturbance due to central lesions caused by cerebrovascular disorders, describe clinical findings and the results of taste examinations, and discuss the central gustatory pathways in humans. Study Design: Retrospective review of three gustatory disturbance cases due to cerebrovascular disorders. Additional review of 12 cases with central gustatory disturbance that have been reported. Methods: Central lesions of three cases were examined by magnetic resonance imaging or computed tomography scan. Electrogustometry and a filter‐paper disk assay using taste solutions were performed in these cases for each of the bilateral gustatory nerves. Results: In one case of pontine infarct, gustatory disturbance ipsilateral to the lesion was found, and in one case of thalamic infarct and one case of internal capsular infarct, gustatory disturbance contralateral to the lesion was observed. Conclusions: Fifteen cases of unilateral gustatory disturbance due to central lesions, including the present cases, have been reported to our knowledge. Examination of these cases strongly suggested that the central gustatory pathways in humans ascend ipsilaterally from the solitary nucleus of medulla oblongata to the pons, and from the pons, cross to a higher position in midbrain and reach the thalamus contralaterally.
Nitric oxide synthase activity in human squamous cell carcinoma of the head and neck
Authors: Gavilanes Javier , Moro María A. , Lizasoain Ignacio , Lorenzo Pedro , Pérez Ana , Leza Juan C. , Alvarez‐Vicent Juan J. 
Published: November 2003

AbstractObjectives: To test whether nitric oxide synthase (NOS) is expressed in primary otolaryngologic tumors and whether this expression is associated with the degree of malignancy. Study Design: Twenty‐six samples from the primary localization of human pharyngolaryngeal squamous cell carcinoma. Materials and Methods: the activity of calcium‐dependent and calcium‐independent NOS was analyzed by the conversion of L‐[14C]‐arginine into L‐[14C]‐citrulline. Results: NOS activity is below detectable levels in pharyngolaryngeal mucosa from noncancer patients. In the primary localization of the tumor, calcium‐independent NOS activity is maximal at early stages of tumor growth, whereas calcium‐dependent activity increases from early to advanced stages. Conclusions: These data suggest that tumor growth and malignancy is associated with a change in the enzymatic source of NO from calcium‐independent NOS to calcium‐dependent NOS isoform in primary localization. These data suggest that the inhibition of calcium‐independent NOS activity in early stages and/or inhibition of calcium‐dependent NOS activity in later stages could delay growth of solid tumors.
Cochlear Implantation in Auditory Neuropathy
Authors: Miyamoto Richard T. , Kirk Karen Her , Renshaw Julia , Hussain Debra 
Published: November 2003

AbstractObjective: Auditory neuropathy is a recently described clinical entity characterized by sensorineural hearing loss in which the auditory evoked potential (ABR) is absent but otoacoustic emissions are present. This suggests a central locus for the associated hearing loss. In this study the results observed in a child with auditory neuropathy who received a cochlear implant are presented and compared with those of a matched group of children who were recipients of implants. Methods: A single‐subject, repeated‐measures design, evaluating closed‐set and open‐set word recognition abilities was used to assess the subject and a control group of matched children with implants who had also experienced a progressive sensorineural hearing loss. Results: The subject demonstrated improvements in vowel recognition (82% correct) by 1 year after implantation, which were only slightly lower than the control group. Consonant recognition and open‐set word recognition scores were significantly lower. Conclusion: Caution should be exercised when considering cochlear implantation in children with auditory neuropathy. As with conventional hearing aids, less than optimal results may be seen.
Management Options and Survival in Malignant Melanoma of the Sinonasal Mucosa
Authors: Lund Valerie J. , Howard David J. , Harding Laura , Wei William I. 
Published: November 2003

AbstractObjective/Hypothesis: To determine whether surgery combined with radiotherapy confers any survival benefit on radical local excision alone in the management of mucosal malignant melanoma of the nose and sinuses. Study Design: Retrospective review. Methods: From a cohort of 72 patients treated between 1963 and 1996 within a single unit, complete data were available for 58 individuals who were examined to determine whether there was any significant statistical difference in local control and/or survival between those receiving surgery and those receiving combined surgery and radiotherapy. Results: There were 30 men and 28 women. Their ages ranged from 39 to 90 years (mean, 64 y). Twenty‐nine patients underwent surgery alone; 23 patients underwent surgery and radiotherapy; 6 patients received surgery and chemotherapy; and 3 patients received surgery, chemotherapy, and radiotherapy. Primary surgery included lateral rhinotomy (42 cases), maxillectomy (8 cases [orbital clearance in 3 cases]), craniofacial resection (3 cases), total rhinectomy (3 cases), and endoscopic clearance (2 cases). Survival ranged from 1 to 228 months with rapid patient loss due to local (and/or systemic) disease during the first 36 months, irrespective of the treatment modality. Overall 5‐year actuarial survival was 28%, and overall 10‐year actuarial survival 20%, with a median survival of 21 months. There was no statistical difference in local control or survival between patients receiving surgery alone and those receiving surgery and radiotherapy, irrespective of whether this treatment was given in the early part of the series (i.e., before 1983) or thereafter. The addition of chemotherapy had no impact on survival, nor did the site of the tumor, the surgical procedure, the presence of lymph node metastases or the age of the patient. Conclusion: In this large cohort of sinonasal melanoma, overall survival was poor and did not appear to be improved by the addition of radiotherapy.
Contralateral Hemilaryngotracheal Flap Reconstruction of the Hypopharynx in Pyriform Carcinoma Resection
Authors: Tai Shyh‐Kuan , Chang Shyue‐Yih 
Published: November 2003

AbstractObjectives: To simplify the approach and reconstruction for advanced hypopharyngeal cancer, a modified technique—laryngotracheal fissure approach and laryngotracheal flap reconstruction—is presented. Study Design: Prospective. Methods: From August 1991 to December 1995, 44 consecutive patients with advanced hypopharyngeal cancer, mostly involving pyriform sinus, were operated on with this technique. The functional and oncologic results and complications were evaluated. Results: Reconstruction was completed by using the laryngotracheal flap in 75% of patients, while the other 25% required ddditional patch‐on pectoralis major myocutaneous flaps. Pharyngoesophageal stenosis occurred in one patient after radiotherapy and pharyngocutaneous fistula was noted in two. No local recurrence was noted. Seven cervical metastases developed in the follow‐up period and six over the contralateral neck not treated surgically. The 5‐year Kaplan‐Meier disease‐free survival was 46.8%. Conclusions: The authors' experience indicates that this is a simplified, radical treatment for most advanced hypopharyngeal cancer, with high applicability, good oncologic results, and low complication.
Three‐Dimensional Imaging of the Speaking Shunt in Patients With Near‐Total Laryngectomy
Authors: Su Chih‐Ying , Lui Chun‐Chung , Liao Ting‐Yi 
Published: November 2003

AbstractObjectives: Near‐total laryngectomy with creation of a speaking shunt is generally considered suitable treatment for most T3 and some T4 laryngopharyngeal cancers. In some patients, poor speech production by the shunt can be problematic and usually means that a shunt lumen is stenotic or too small. Conventional axial computed tomography (CT) of the neck is of little value in predicting the shunt function and the patency of the shunt lumen. Such defect, however, can be better overcome if the spiral CT is used. Study Design: This study was designed to evaluate the dynamic speaking shunt by spiral CT and a three‐dimensional (3‐D) imaging model of the upper airway in 59 near‐total laryngectomees. Methods: During scanning, the patients were asked to make a single, 20‐second phonation. A high‐quality 3‐D surface model was then rendered at an independent workstation. The 3‐D model took on the appearance of the speaking shunt which could serve as a tracheopharyngeal fistulography. Results: 3‐D reconstruction of the images could clearly demonstrate the dynamic anatomy and patency of the speaking shunt. We found the 3‐D model to be of diagnostic value, particularly in the near‐total laryngectomy patients with stenotic shunts. The most common site of stenosis was at the top portion of the shunt. Conclusion: The 3‐D image findings of the shunts significantly improved the assessment and therapies of the patients undergoing revision surgeries of the shunt stenoses.
Protein C Deficiency in Microvascular Head and Neck Reconstruction
Authors: Ayala Carlos , Blackwell Keith E. 
Published: November 2003

AbstractObjective: To determine the incidence of perioperative protein C deficiency in patients undergoing free flap reconstruction of cancer‐related defects in the head and neck. Study Design: Prospective case series. Intervention: Ten patients underwent microvascular reconstruction after surgical therapy of carcinomas of the oral cavity or oropharynx. Coagulation studies were determined in all patients 72 hours after surgery. Setting: Academic tertiary care medical center Results: Protein C deficiency was detected in 70% of patients. One free flap failure was attributed to protein C deficiency. Conclusions: Vitamin K–dependent clotting factors are frequently deficient during the postoperative period after major head and neck surgery, which may result in a state of hypercoagulability. Protein C deficiency should be considered as a possible cause of free flap thrombosis in patients who undergo microvascular head and neck reconstruction.
A Management Strategy for Vocal Process Granulomas
Authors: Havas Thomas E. , Priestley Jocelyn , Lowinger David S. G. 
Published: November 2003

AbstractObjectives/Hypothesis: Review the roles of aggressive gastroesophageal reflux management and speech therapy in the treatment of patients with vocal process granulomas. Describe and assess our investigation and management protocol. Study Design: Retrospective review of 55 patients with 61 vocal granulomas treated according to a standard protocol at the Sydney Voice Clinic. Comparison with previous published series and review of the relevant literature pertaining to granulomas and to reflux. Description of laryngopharyngeal reflux grading, investigative modalities, and treatment regimen. Methods: Case notes were reviewed and tabulated for age, sex, diagnosis, predisposing factors for granuloma formation, grade of laryngopharyngeal reflux, investigations, treatment, resolution, and recurrence. All patients were followed up for at least 12 months after resolution. Results: Fourteen of the 61 granulomas occurred after intubation. Ten patients were professional voice users. Our assessment of the 55 granuloma patients revealed an incidence of 76% of gastroesophageal reflux disease in patients with and without known vocal fold trauma. There was a 50% recurrence rate following surgical excision. However, aggressive antireflux therapy, lifestyle modifications, and adjuvant speech therapy were successful in achieving resolution of most of the granulomas and preventing recurrence. In four patients, antireflux surgery was required and total resolution of the granulomas followed. Conclusions: Vocal process granulomas have perplexed laryngologists with their indeterminate pathogenesis and tendency to recur. Multiple surgical excisions and a variety of combined medical regimens have been used to treat granulomas with variable success. Recurrence after excision commonly occurs as the underlying causative factors have not been appropriately managed and may re‐establish the chronic inflammatory process. We found acid reflux to be a common factor in the majority of our patients with granulomas. Therefore treatment should focus on managing both reflux and any functional voice disease or disorder. The only indications for laryngeal surgery are to resolve diagnostic doubt or to treat acute airway compromise. Based on results, we suggest an algorithm for the investigation and management of vocal process granulomas founded on appropriate antireflux and speech therapy.
Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: Evolution in management of facial paralysis
Authors: Hammerschlag Paul E. 
Published: November 2003

AbstractWhen viable proximal facial nerve is inacessible, facial nerve paralysis has been classically managed with the hypoglossal facial anastomosis (HFA) for at least the past 70 years. While this procedure has proven its reliability, its problems with hemilingual atrophy (speech deglutition, drooling, mastication), hypertonia, synkinesis, and mimetic deficits indicate the need for a more perfect solution for facial paralysis. The jump interpositional graft hypoglossal facial anastomosis (JIGHFA) along with gold weight lid implantation and electromyographic (EMG) rehabilitation achieves substantial facial reanimation without hemilingual deficits. We present our results in 18 patients who underwent JIGHFA along with gold weight lid implantation and EMG rehabilitation for facial paralysis. These results were compared with those from published series of 30 patients treated with HFA with EMG rehabilitation evaluated with objective (House‐Brackmann) criteria. Anonymous retrospective information from questionnaires from 22 of 48 patients who were treated with the classic HFA was also presented. In properly selected patients, the JIGHFA technique is capable of achieving substantial facial reinnervation (House‐Brackmann grade III or better) in 83.3% of the patients without hemilingual sequelae which was seen in 45% of the HFA patients. In contrast to the HFA, this procedure can be used by patients with concomitant lower cranial nerve paralysis (except hypoglossal), and bilateral facial paralysis. Hypertonia, synkinesis, and lagophthalmus were less symptomatic in the JIGHFA patients. Mimetic expression was not improved in the JIGHFA population compared with the HFA group.