bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheal Transplantation: Cytological Changes Studied by Scanning and Transmission Electron Microscopy in the Rabbit
Authors: Zagalo Carlos , Grande Nuno R. , dos Santos José Martins , Monteiro Emanuel , Brito José , Aguas Artur P. 
Published: November 2003

AbstractObjectives Our goal was to offer a comprehensive cytological study of the changes in the trachea after experimental transplantation of the organ.Study Design Autografting of four tracheal rings was done in rabbits and tracheal samples were observed by electron microscopy from 1 week to 6 months after the surgery was performed.Methods Transmission and scanning electron microscopy were used to investigate the fine structure of tracheal samples of rabbits submitted to autotransplantation, and quantitative methods were used to compare several cytological parameters of the different groups of animals.Results We found that tracheal autografting was associated with acute injury of ciliated cells expressed by loss of more than 90% of cilia density on the tracheal epithelium 1 week after the transplantation was performed. The loss of cilia was balanced by an increase in mucous cells present on the tracheal lumen. Recovery of ciliated cells was observed 1 month after the tracheal autografting was performed. In contrast, only mild cytological modifications were seen in the cartilage tissue of the autografted trachea during the first weeks of transplantation; the structural alterations of the cartilage progressed up to the third month after transplantation, resulting in a moderate tracheal stenosis.Conclusions The data indicate that 1) autotransplantation of four tracheal rings is a viable surgical procedure; 2) tracheal grafting causes severe acute changes of the epithelium that are, however, reversible in nature; whereas 3) the initial mild alterations induced by the autografting in the cartilage may evolve into tracheal stenosis.* Although the authors carried out the study they planned, it appears that their experiment was not well thought out from the onset. The clinical goal is to be able to transplant segments of trachea of two or more tracheal rings. In this procedure, as in most true transplants, one must expect some element of ischemia time, temperature changes (usually hypothermia), alterations in the dynamics of blood flow resulting from the inevitable sympathectomy, and the significant effects of lymphatic disruption. Virtually none of these effects were simulated in the “autotransplantation” carried out in this study. Thus, the study provides us with little practical clinical information and is useful primarily as a preliminary step in studying the effects of true transplantation.—Reviewer's Commentary
Two‐Step External Ear Canal Construction in Atresia as Part of Auricular Reconstruction
Authors: Siegert Ralf , Weerda Hilko 
Published: November 2003

AbstractObjectives One of the common complications of atresia surgery is restenosis of the surgically constructed external ear canal. To avoid this complication, a new two‐step technique of creating an external ear canal was developed and evaluated.Study Design Prospective clinical evaluation.Patients and Methods Thirty‐six patients with third‐degree microtia and aural atresia have been treated this way. In the first step, the canal is drilled into the petrous bone, a Silastic cylinder is inserted and wrapped into pieces of cartilage and bone dust. In the second step several months later, the implant is removed and a slightly smaller tube covered with a split thickness skin graft is inserted.Results E‐cept the first three patients operated with a slightly different technique, none of the following 33 patients showed a severe restenosis. Instead, all had a nice, smooth e‐ternal ear canal.Conclusion With this two‐step technique of creating a new e‐ternal ear canal in atresia, we could avoid one of the major complications of this kind of surgery. The e‐ternal ear canal is either necessary for the reconstructed middle ear or it can be used to adapt a (behind or in the ear) hearing aid. By integrating this technique into a three‐step concept for auricular reconstruction, the patient does not need any additional operation, and his or her rehabilitation from ear malformation can be enhanced.
Single‐Stage Adult Laryngotracheal Reconstruction Without Stenting
Authors: Rhee John S. , Toohill Robert J. 
Published: November 2003

AbstractObjectives/Hypothesis To present the indications, surgical technique, and results of single‐stage laryngotracheal reconstruction (SSLTR) without stenting for laryngotracheal stenosis (LTS) in adults. Various open surgical techniques have been previously described for LTS in adults; however, these techniques usually involve placement of intraluminal stents. The practice of early extubation without stenting is common for pediatric SSLTR. The success of this technique in the pediatric population has led to a trial of the same technique in selected cases of adult LTS.Study Design Retrospective review.Methods A retrospective review was conducted on 15 patients with glottic, subglottic, or tracheal stenosis or a combination of these, who underwent SSLTR with composite nasal septal grafts or costal cartilage grafts without stenting.Results All patients were extubated or decannulated 1 to 7 days after surgery. Three of the 15 patients had no further procedures. Three patients had a second SSLTR to repair stenosis at a different level with no further difficulties. Eight patients had additional endoscopic airway procedures after extubation or decannulation, and one patient died in the immediate postoperative period. All 14 surviving patients are decannulated and well at the time of writing.Conclusion For LTS in selected adult cases, SSLTR without stenting is a viable option. Indications, surgical technique, and complications are presented.
Labyrinthine Fistula: An Unreported Complication of the Grote Prosthesis
Authors: Gadre Arun K. , Hammerschlag Paul E. 
Published: November 2003

AbstractObjectives To alert the otological surgeon that labyrinthine fistula is a rare and avoidable complication of the Grote hydroxyapatite ceramic external auditory canal (EAC) prosthesis. The reasons for its causation and strategies to prevent its formation are discussed.Study Design Case study and retrospective review of the literature.Methods Labyrinthine fistula that occurred after the use of the Grote hydroxyapatite ceramic EAC prosthesis is presented. The literature is reviewed retrospectively for various methods of reconstruction of the EAC following canal wall down mastoidectomy. Strategies and principles are outlined to avoid complications associated with reconstruction of the mastoid and EAC.Results The Grote hydroxyapatite (HA) prosthesis is a reliable prosthesis for reconstruction of the external auditory canal (EAC) in the absence of a draining mastoid cavity or cholesteatoma and with adequate soft tissue cover. Contact of the medial end of the prosthesis with the lateral semicircular canal must be avoided. Immobilization or rigid fixation and avoidance of infection are essential for optimal prosthesis stability and osseointegration. Covering the prosthesis with vascularized soft tissue appears to be important for the achievement of a successful reconstruction.Conclusion The Grote prosthesis is safe and effective provided it does not contact the lateral semicircular canal, is stabilized, and covered by vesicular tissue, in the absence of infection.
Radial Forearm Free Flap Pharyngoesophageal Reconstruction
Authors: Azizzadeh Babak , Yafai Sherry , Rawnsley Jeffrey D. , Abemayor Elliot , Sercarz Joel A. , Calcaterra Thomas C. , Berke Gerald S. , Blackwell Keith E. 
Published: November 2003

AbstractObjectives This study evaluates the outcome of pharyngoesophageal reconstruction using radial forearm free flaps with regard to primary wound healing, speech, and swallowing in patients requiring laryngopharyngectomy.Study Design Retrospective review in the setting of a tertiary, referral, and academic center.Patients and Methods Twenty patients underwent reconstruction of the pharyngoesophageal segment using fasciocutaneous radial forearm free flaps.Results All free flap transfers were successful. An oral diet was resumed in 85% of the patients after surgery. Postoperative pharyngocutaneous fistulas occurred in 4 patients (20%) with 3 resolving spontaneously. Distal strictures also occurred in 20% of the patients. Five patients who underwent tracheoesophageal puncture achieved useful speech.Conclusions Advantages of radial forearm free flaps for microvascular pharyngoesophageal function include high flap reliability, limited donor site morbidity, larger vascular pedicle caliber, and the ability to achieve good quality tracheoesophageal speech. The swallowing outcome is similar to that achieved after jejunal flap pharyngoesophageal reconstruction. The main disadvantage of this technique relates to a moderately high incidence of pharyngocutaneous fistulas, which contributes to delayed oral intake in affected patients.
Combination Nonviral Cytokine Gene Therapy for Head and Neck Cancer
Authors: Li Daqing , Zeiders Jacob W. , Liu Shixi , Guo Ming , Xu Yun , Bishop Jeffrey S. , O'Malley Bert W. 
Published: November 2003

AbstractObjective To establish the feasibility and efficacy of combination nonviral murine interferon‐α (mIFN‐α) and murine interleukin‐2 (mIL‐2) or murine interleukin‐12 (mIL‐12) gene therapy for head and neck squamous cell carcinoma in a murine model.Study Design Randomized controlled studies in a murine head and neck cancer model were performed to assess antitumor responses, secondary cytokine expression, and both natural killer (NK) cell and cytolytic T‐cell (CTL) activity.Methods Tumors were established in the floor of mouth in C3H/HeJ immunocompetent mice. Established tumors were directly injected with polymer‐formulated murine interferon‐α (mIFN‐α), lipid‐formulated mIL‐2, and polymer‐formulated mIL‐12 alone or in combination. Primary and secondary cytokine expression, NK cell activity, and CTL activity were assayed.Results The use of mIFN‐α gene therapy in combination with either mIL‐2 or mIL‐12 resulted in significant antitumor effects as compared with each of the single cytokine and control treatment groups (P = .002). Increased levels of NK cell activity and tumor specific CD8+ cytotoxic T‐lymphocyte activity were found in the combination mIFN‐α and mIL‐2 or mIL‐12 groups. Augmented immune responses correlated with clinical antitumor effects.Conclusions The present study demonstrates that mIL‐2 or mIL‐12 augments tumor inhibition from mIFN‐α and increases activation of NK and CD8+ T cells. These data support further investigation of polymer and lipid mediated delivery of cytokine genes for head and neck cancer.
Endolymphatic Hydrops in Asymptomatic Ears in Unilateral Ménière's Disease
Authors: Friedrichs Ilka , D. Thornton Arthur R. 
Published: November 2003

AbstractObjectives/Hypothesis The aim of our study was the objective assessment of endolymphatic hydrops in asymptomatic ears in unilateral Ménière's disease with a noninvasive electrophysiological test and investigation of significant clinical signs. The null hypothesis was that there would be no signs of endolymphatic hydrops in the asymptomatic ear.Study Design Prospective study using the traveling wave velocity test for endolymphatic hydrops.Methods The traveling wave velocity test was used in conjunction with standard audiological tests to investigate both ears of 181 Ménière's patients attending the Medical Research Council Institute of Hearing Research in Southampton, United Kingdom. The test uses derived auditory brainstem responses to estimate the velocity of the cochlear traveling wave that is altered in endolymphatic hydrops. Ménière's disease was assessed using Arenberg's five staging criteria. Significant correlations were evaluated using standard statistical methods.Results Of 100 patients with clinically unilateral Ménière's disease, 27% showed evidence of endolymphatic hydrops in their asymptomatic ear. There was a significant correlation between signs of hydrops and the mean air‐conduction threshold at 500 Hz.Conclusions We recommend that a full assessment of incipient disease in the asymptomatic ear in unilateral Ménière's disease should be undertaken before offering any treatment options to patients. Any suspicion of early disease in the asymptomatic ear in unilateral Ménière's disease should lead to full electrophysiological assessment to assess the evidence of endolymphatic hydrops in that ear.
Growth Factors Influence Growth and Differentiation of the Middle Ear Mucosa
Authors: Palacios Sean D. , Oehl Heinz J. , Rivkin Alexander Z. , Aletsee Christoph , Pak Kwang , Ryan Allen F. 
Published: November 2003

AbstractObjective Otitis media is a major cause of morbidity in pediatric and adult patients. This inflammatory condition is characterized by mucosal hyperplasia that is thought to be mediated by the complex actions of growth factors and their respective receptors. It was the purpose of this study to determine which growth factors might be responsible for the growth and differentiation of the middle ear epithelium during otitis media.Study Design The effect of several growth factors on the expansion and differentiation of normal middle ear mucosa was evaluated in tissue culture.Materials and Methods Explants of normal rat middle ear mucosa were exposed in vitro to six different growth factors known to influence epithelial cells in other tissues: epidermal growth factor, amphiregulin, betacellulin, heregulin‐α, keratinocyte growth factor, and hepatocyte growth factor.Results After 12 days, the growth and level of cytokeratin expression were analyzed for each of the explant outgrowths. Each factor appeared to have a significant, concentration‐dependent effect on either the growth or differentiation of the cultured middle ear epithelial cells.Conclusion The results suggest that several of the tested growth factors may play a significant role in controlling hyperplasia of the middle ear mucosa during otitis media.
Rise of Medical Specialization and Organizations Affecting Otolaryngology
Authors: Goldstein Jerome C. 
Published: November 2003

AbstractAs we enter the third millennium, there are in the United States 24 medical specialties recognized by the American Board of Medical Specialties. The majority of the members of each of these specialties have their education, training, and knowledge “certified” by an examining board unique to their specialty. One hundred years ago virtually none of the foregoing existed. At the turn of the 20th century, nearly all physicians practiced all of medicine. How and why did this evolution occur and what controls evolved to contain this? The goal of this presentation is to review the rise of medical specialties and the board examination system and describe some of the many organizations, often known by acronyms, which deal with this now complex architecture.
Combined External and Endoscopic Frontal Sinusotomy With Stent Placement: A Retrospective Review
Authors: Benoit Craig M. , Duncavage James A. 
Published: November 2003

AbstractObjectives To examine the long‐term results of combined external and endoscopic frontal sinusotomy using frontal sinus stents and to compare our results with those reported for the endoscopic Lothrop procedure.Study Design We performed a retrospective review of 40 patients with chronic frontal sinusitis refractory to medical management who underwent a total of 62 combined external and endoscopic frontal sinusotomies with stent placement. All procedures were performed by the senior author at Vanderbilt University Medical Center.Main Outcome Measures Postoperative nasofrontal duct patency and subjective patient improvement based on the last clinical examination.Results The overall patency rate of the nasofrontal duct was 79% (95% confidence interval [CI] of ±10%.) The overall subjective patient improvement rate was 78% (95% CI of ±14%.). The average length of stent placement was 5 weeks. The mean patient follow‐up time was 12 months. There were no surgical complications. The nasofrontal duct patency rate and patient improvement rate from our study did not differ statistically from results reported by other authors using the endoscopic Lothrop procedure.Conclusion We have found endoscopic frontal sinusotomy, in conjunction with external frontal sinusotomy and placement of frontal sinus stents, to be as effective in obtaining frontal sinus patency rates and overall patient improvement rates as the endoscopic Lothrop procedure.
Intratemporal Facial Nerve Neuroma: Anatomical Location and Radiological Features
Authors: Kertesz Thomas R. , Shelton Clough , Wiggins Richard H. , Salzman Karen L. , Glastonbury Christine M. , Harnsberger Ric 
Published: November 2003

AbstractObjectives To present the imaging findings and anatomical locations of a series of 88 facial nerve neuromas from two centers over a 30‐year period. We describe the salient radiological features of neuromas in each anatomical location and outline the ways in which modern imaging techniques have altered our perception of this entity.Study Design A retrospective review of tumors presenting to two tertiary care referral institutions since 1970.Methods The charts and available imaging of patients with the diagnosis of facial neuroma were reviewed. These patients presented to the House Ear Clinic between 1970 and 1994 and to the University of Utah Medical Center (Salt Lake City, UT) between 1986 and August 2000. We examined anatomical location to determine patterns of tumor presentation and compared the findings before and after the era of magnetic resonance imaging (MRI).Results All segments of the facial nerve were represented. Overall, multiple‐segment tumors were almost twice as common (63.6%) as single‐segment tumors (36.4%). Before the advent of MRI, all segments of the nerve from the cerebellopontine angle to the tympanic portion were almost equally represented (29.5%–36.3%). After MRI, the geniculate ganglion (68.2%) and labyrinthine portion (52.3%) were by far the most commonly affected areas. Before MRI, there were, on average, 1.89 segments involved per tumor. After MRI, this average number increased to 2.57 segments per tumor. Radiologically, the high‐resolution computed tomography and MRI features cannot be generalized. Rather, the imaging features depend on which segments are involved. This is because of the variation in the surrounding anatomical landscape of the facial nerve in its course through the temporal bone.Conclusion The more sensitive imaging provided by newer radiological techniques has altered our perception of facial neuroma. It has provided us with an increased ability to diagnose and fully evaluate this neoplasm preoperatively, allowing improved patient counseling and surgical planning.
Bone‐Anchored Hearing Aid Quality of Life Assessed by Glasgow Benefit Inventory
Authors: Arunachalam Perumkulam S. , Kilby David , Meikle David , Davison Tom , Johnson Ian J. M. 
Published: November 2003

AbstractObjective/Hypothesis The bone‐anchored hearing aid (BAHA) is a well established mode of treatment and many studies show the audiological benefit, but none has assessed the benefit to the quality of life of patients. This study uses the validated Glasgow Benefit Inventory to quantify the changes in quality of life.Study Design Retrospective questionnaire study.Methods Sixty consecutive patients receiving treatment with BAHA were enrolled in the study. The male/female ratio was 1.26 to 1; mean patient age was 45 years. The most common indication was hearing loss secondary to mastoid disease and surgery followed by congenital atresia and chronic discharge from the ear.Results The response rate was 85%, which is high and adds weight to the results. The general benefit score was +34 (range, +27–+48), which is comparable to middle ear surgery but just below benefit from cochlear implantation. The social benefit was +21 (range, +12–+37) with only +10 (range, +2–+26) for the physical score. This pattern mirrors that reported for other ear interventions. Maximum benefit was noted in patients with congenital atresias followed by discharging mastoid cavities.Conclusion This study is the first to demonstrate significant quality of life benefit from BAHA surgical intervention as measured by the Glasgow Benefit Inventory.
Degranulation of Mast Cells Provokes a Massive Inflammatory Reaction in the Tympanic Membrane
Authors: Eriksson Per Olof , Hellström Sten 
Published: November 2003

AbstractObjective The pars flaccida is extremely rich in mast cells. On stimulation the mast cells release preformed and de novo synthesized inflammatory substances. The purpose of this study was to examine how these mast cell substances provoke inflammatory changes in the tympanic membrane.Study Design In vivo, murine model.Methods In a rat model, the mast cell secretagogue compound 48/80 was applied locally to the tympanic membrane on 4 consecutive days and the ensuing inflammatory changes were evaluated by otological, light, and electron microscopy 3, 6, 9, 12, 18, 24, 36, and 48 hours and 4, 6, and 8 days later.Results Degranulation of the mast cells occurred within 3 hours of applying compound 48/80. Release of the mast cell substances coincided with an inflammatory event characterized by a two‐stage reaction: an edema stage, peaking 6 hours after application, followed by a massive invasion of inflammatory cells, peaking at 24 and 48 hours. Pars flaccida and pars tensa were both involved, pars flaccida showing the earliest changes. Pars tensa exhibited the same biphasic reaction as pars flaccida, but approximately 6 hours later.Conclusions The mast cells of the pars flaccida have the capacity to elicit an intense inflammation of the tympanic membrane. The biphasic reaction pattern resembles that observed in experimental otitis media, suggesting involvement of the mast cells in this inflammatory condition of the middle ear.