bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of Fungal DNA in Effusion Associated With Acute and Serous Otitis Media
Authors: Kim Eugene J. , Catten Michael D. , Lalwani Anil K. 
Published: November 2003

AbstractObjectives/Hypothesis Routine bacterial and viral cultures of middle ear fluid are often negative, suggesting that other infectious agents may be involved. Because of the similarities between the paranasal sinuses and middle ear space and the recent recognition of fungi as important pathogens in inflammation of the paranasal sinuses, we investigated the potential role of fungi in acute otitis media and serous otitis media using culture and polymerase chain reaction techniques.Study Design Prospective study.Methods Middle ear effusions of 29 patients who underwent myringotomy and pressure equalization tube placement for persistent serous otitis media or recurrent acute otitis media were collected. Fungal culture of the effusion samples was performed on potato flake agar. DNA from the effusion was isolated using standard techniques. Polymerase chain reaction, using radiolabeled universal fungus primer for internal transcribed spacer of 5.8s ribosomal DNA, was performed to detect the presence of any fungal DNA in the samples.Results Culture of middle ear effusions showed no evidence of fungal growth. Polymerase chain reaction analysis was able to detect the constituent ribosomal DNA of a single fungal genome. Fungal DNA was present in 34% of middle ear effusion samples.Conclusions Fungal DNA is present in recurrent acute otitis media and serous otitis media suggesting that it may play an etiological role in serous otitis media and acute otitis media. However, additional studies are necessary to delineate the role of fungi in the pathogenesis of otitis media.
Hearing Preservation in Acoustic Neuroma Surgery: The Impact of Different Patient Selection Criteria
Authors: Dugar Jay , Nikolopoulos Thomas P. , O'Donoghue Gerard M. 
Published: November 2003

AbstractObjectives/Hypothesis The aim of the present study was to assess whether applying the various selection criteria for hearing preservation surgery on the same group of patients with acoustic neuroma leads to significantly different numbers of patients being considered suitable for this kind of surgery.Study Design We used different selection criteria for hearing conservation surgery based on a range of studies in the published literature. We applied these criteria to a consecutive group of patients presenting to our unit with acoustic neuroma. We then calculated the numbers of patients deemed suitable for hearing preservation surgery as a function of these different selection criteria.Methods Studies with published selection criteria, total numbers of patients, and numbers of patients suitable for hearing preservation surgery were found in the literature. These selection criteria were applied to our patient data. A χ2 statistical analysis was used to assess whether applying different selection criteria to the same group of patients (the subjects of the present study) resulted in different numbers of patients suitable for hearing preservation surgery.Results The numbers of patients suitable for hearing preservation showed wide variation, ranging from 8 (10%) to 45 (56%) patients (of the total number of 80 patients in the present study). The χ2 statistical analysis revealed that the various selection criteria did have an effect on the numbers of patients suitable for hearing preservation surgery, and the statistical significance reached the level of P <.001.Conclusions Different selection criteria lead to significantly different numbers of patients being considered suitable for hearing preservation surgery. Consensus and agreed selection criteria would help set patient expectations, refine candidate selection, and facilitate the comparison of outcomes across centers.
HLA‐DR and ICAM‐1 Expression and Modulation in Epithelial Cells From Nasal Polyps
Authors: Papon Jean‐François , Coste André , Gendron Marie‐Claude , Cordonnier Catherine , Wingerstmann Laure , Peynègre Roger , Escudier Estelle 
Published: November 2003

AbstractObjective/Hypothesis Through human leukocyte antigen–DR (HLA‐DR) and intercellular adhesion molecule‐1 (ICAM‐1) expression, nasal epithelial cells could actively participate in the chronic inflammation and eosinophil infiltration observed in nasal polyps. The objective of the study was to evaluate HLA‐DR and ICAM‐1 expression in polyp epithelium and in a culture model of polyp epithelial cells allowing ciliated and secretory differentiation.Study Design Prospective non‐randomized controlled in vitro study.Methods The in vitro HLA‐DR and ICAM‐1 expression was studied under basal conditions or after exposure to interferon‐γ, transforming growth factor‐β1, lipopolysaccharide, dexamethasone, or cetirizine. HLA‐DR and ICAM‐1 expression was investigated in situ by immunohistochemical staining of polyps and in vitro by immunofluorescent staining of cell cultures. HLA‐DR and ICAM‐1 were localized in cultured cells by confocal microscopy. Cultured cells expressing HLA‐DR and ICAM‐1 were quantified by flow cytometry.Results Both HLA‐DR and ICAM‐1 showed significant immunostaining of nasal polyp epithelium. In nasal polyp epithelial cell cultures, less than 5% of cells were positive for HLA‐DR whereas 40% were positive for ICAM‐1 at day 3. In vitro, HLA‐DR was mainly located in the cytoplasm and ICAM‐1 predominated on the apicolateral cytoplasmic membrane. Comparison of in situ and in vitro results showed that well‐differentiated and poorly differentiated cells predominantly expressed HLA‐DR and ICAM‐1, respectively. Interferon‐γ significantly increased HLA‐DR and ICAM‐1 expression, whereas transforming growth factor‐β1 significantly decreased HLA‐DR expression and lipopolysaccharide significantly increased ICAM‐1 expression.Conclusion HLA‐DR and ICAM‐1 epithelial expression in nasal polyps in situ and in vitro and their in vitro modulation reinforce the active role of epithelial cells in chronic inflammatory diseases of the upper airways.
Free Tissue Transfer Versus Pedicled Flap in Head and Neck Reconstruction
Authors: McCrory Allison Lee , Magnuson J. Scott 
Published: November 2003

AbstractObjectives Free flaps are often criticized as being medically risky for the patient, expensive, and too time‐consuming when compared with the traditional rotational flap repair. Perhaps the costs do not outweigh the benefits. The study analyzes many aspects of resource utilization and patient outcome to determine whether these criticisms hold true.Study Design Retrospective patient review.Methods Sixty‐five patient charts were reviewed. The following data were abstracted: flap type, tumor location and stage, preoperative American Society of Anesthesiologists score, preoperative irradiation, postoperative medical complications, flap outcome, length of hospital stay, date of first intake by mouth, and date of decannulation. The data were analyzed for free flaps and rotational flaps. Then data were analyzed again for free and rotational flaps performed for only patients who underwent a composite resection, to further standardize the results.Results For all defect types, free flap operative time was statistically greater (9 h 35 min for free flaps vs. 4 h 58 min for rotational flaps). Regarding hospital charges, only patients who had a free flap after composite resection differed in amount charged when free versus rotational flaps were compared ($53,585 for free flaps vs. $32,984 for rotational flaps). Length of intensive care unit stay differed between patients having composite resection of the two flap types (0.1 d after rotational flap vs. 1.4 d after free flap).Conclusions The differences between the two reconstruction methods are only a few. We do not think that longer operative time, longer length of intensive care unit stay, and increased hospital charges are significant enough to deny a patient a superior repair. We also think that as surgeons' experience increases, these differences may one day no longer hold true.
Synchronized Electrical Stimulation in Treating Pharyngeal Dysphagia
Authors: Leelamanit Vitoon , Limsakul Chusak , Geater Alan 
Published: November 2003

AbstractObjective/Hypothesis The objectives were to test the hypothesis that synchronous contraction of the thyrohyoid muscle by electrical stimulation during swallowing would improve dysphagia resulting from reduced laryngeal elevation and to evaluate the effectiveness of the synchronous electrical stimulator.Study Design Prospective study.Methods Eleven male and 12 female patients (age range, 35–87 y) with moderate to severe degree of dysphagia resulting from reduced laryngeal elevation who did not respond to medical treatment were treated by stimulating synchronous contraction of the thyrohyoid muscle during swallowing with the synchronous electrical stimulator. Treatment was given daily for 4 hours until criteria for improved swallow were fulfilled or other intervention was deemed necessary. Follow‐up was performed monthly (range, 3–33 mo).Results Of the 23 patients, 20 showed marked improvement at the first course of treatment. The duration of stimulation varied from 2 to 4 days (median duration, 2 d) in patients with moderate dysphagia and from 3 to 30 days (median duration, 6 d) in patients with severe dysphagia. Three patients showed failed synchronous electrical stimulator treatment, one owing to device failure and two requiring gastrostomy for feeding. Six patients who achieved improved swallow criteria relapsed at 2 to 9 months after the first treatment course and were successfully treated with an additional course of synchronous electrical stimulation.Conclusions The study supports the hypothesis that stimulating synchronous contraction of the thyrohyoid muscle by synchronous electrical stimulator during swallowing improves dysphagia resulting from reduced laryngeal elevation. Synchronized electrical stimulation has the advantages of noninvasiveness and actively assisting swallowing and can be used as an alternative treatment. The synchronized feature of the synchronous electrical stimulator helps to restore normal swal‐ lowing mechanism and decreases the incidence of nasogastric tube insertion and gastrostomy.
Suspension Laryngoscopy for Endotracheal Stenting
Authors: Eckel Hans Edmund , Berendes Shahindocht , Damm Michael , Klussmann Jens Peter , Wassermann Klaus 
Published: November 2003

AbstractObjectives/Hypothesis Airway stents have recently been used to establish and maintain patent airways in patients with malignant central airway obstruction, but insertion modalities remain controversial to date. The study seeks to determine the role of suspension laryngoscopy in interdisciplinary airway stenting.Study Design Retrospective, single‐institution analysis of a case series treated by a multidisciplinary airway team.Methods Ninety‐three consecutive patients with malignant obstruction of the trachea and/or tracheobronchial bifurcation underwent endotracheal stenting through a suspension laryngoscopy approach for the relief of impending respiratory distress. Feasibility, mortality, survival, and complications were analyzed as main outcome measures.Results Stenting through a suspension laryngoscopy approach was feasible 91 of 93 patients (97.8%). Fifteen patients needed repeated stenting, and in all, 121 stents were implanted during the observation period. This approach allowed for the repeated insertion of rigid bronchoscopes of graded sizes to establish an airway and for precise stent positioning. Optical instruments and stent introducer systems could easily be used while adequate ventilation was continuously maintained. Silicone stents of maximal size were inserted without injury of the vocal cords during intubation. Median survival for all patients was 8 months. No intraoperative airway complications were observed, and no patient died secondary to stenting.Conclusions Suspension laryngoscopy and jet ventilation provide an ideal setting for the precise placement of tracheal and bifurcation airway stents. Laryngologists should actively participate in interdisciplinary airway stenting programs.
Neuropsychological Testing in the Screening for Cochlear Implant Candidacy
Authors: Kutz Walter , Wright Crystal , Krull Kevin R. , Manolidis Spiros 
Published: November 2003

AbstractObjective To demonstrate the utility of neuropsychological assessment in the screening process for pediatric cochlear implant candidacy.Study Design Prospective and ongoing evaluation of children with profound bilateral hearing loss using age‐specific neuropsychological test batteries.Methods Eighteen children who met audiological criteria for cochlear implantation were evaluated by two age‐specific neuropsychological tests. The Vineland Adaptive Behavior Scales survey assesses several domains of behavioral functions (communication, daily living skills, socialization, and gross motor skills). The Mullen Scales of Early Learning assess the child's visual perception, speech and language, and motor abilities. The Leiter International Performance Scale–Revised assesses intellectual ability.Results All patients underwent the Vineland Adaptive Behavior Scales survey. Overall scores were lower than normative means with a mean composite score in the 7th percentile. In addition, there was a strong inverse correlation between score and age of testing. Ten children were assessed using the Mullen Scales of Early Learning, and, again, there was a strong inverse correlation between score and age of testing. Intellectual ability was assessed in seven children using the Leiter International Performance Scale–Revised and was found to be lower than normative means with a mean score in the 13th percentile.Conclusions Neuropsychological testing of profoundly deaf children provides a detailed and accurate assessment of the child's cognitive, behavioral, and motor functions. The profoundly deaf child does not develop at the same rate as normal children in cognitive and behavioral domains. Neuropsychological testing is a useful tool for screening for cochlear implant candidacy and has the potential to track changes before and after implantation.
Endoscopic Staple Diverticulostomy for Recurrent Zenker's Diverticulum
Authors: Scher Richard L. 
Published: November 2003

AbstractObjectives The purpose of this study was to evaluate the technical feasibility, effectiveness, and morbidity of using endoscopic staple diverticulostomy (ESD) as treatment for Zenker's diverticulum (ZD) recurring after either prior endoscopic treatment or external diverticulectomy or diverticulopexy.Study Design A retrospective review of a case series of 18 patients with recurrent ZD.Methods All patients cared for with ZD were evaluated to identify those patients with recurrent ZD. The clinical records of patients with recurrent ZD were reviewed for: demographics, prior treatment, time to recurrence, factors associated with recurrence, technical feasibility of treatment, complications, effectiveness and duration of symptom relief.Results Between March 1995 and July 2001, a total of 127 consecutive patients with ZD received care. Eighteen of these patients were treated for recurrent ZD: nine treated originally by ESD, and nine by external approach (seven by diverticulectomy and two by diverticulopexy), with three of these patients treated twice. Seventeen patients had partial or complete relief of symptoms after their initial treatment, with recurrence of symptoms noted 0 to 60 months later. Specific factors associated with recurrence of symptoms were identified in only one patient. Treatment of recurrent ZD by ESD was technically feasible in 16 of the patients. Complete or improved symptom relief has been reported by 16 of the patients after revision ESD, with follow‐up from 9 to 69 months. No significant treatment complications occurred. Fifteen patients resumed clear liquid diet on the day of surgery, and one on the day after surgery. All patients were discharged from the hospital by the second postoperative day (mean = 0.6 d).Conclusions ESD is an effective, technically feasible, and safe treatment for patients with ZD recurring after prior endoscopic or external treatment, and it should be the initial treatment of choice for these patients.
Intraparotid Facial Nerve Neurofibromas
Authors: McGuirt W. Frederick , Johnson Paul E. , McGuirt Wyman T. 
Published: November 2003

AbstractObjectives To provide an awareness of intraparotid facial nerve neurofibroma as a cause of parotid masses and to describe their characteristics and management considerations.Study Design Case report with literature review.Methods The medical records of three patients with intraparotid facial nerve neurofibromas are reviewed, and data concerning the patient's presentations, treatment, and disease course are presented with a review of the world's literature on intraparotid facial nerve neurofibromas.Conclusions Tumors arising from the extratemporal course of the facial nerve are quite rare. The tumors arise from Schwann cells and include the schwannoma and the neurofibroma. The overwhelming benign nature of these lesions necessitates a conservative course of treatment. Histological diagnosis should be followed by a limited tumor excision with emphasis on retaining normal facial nerve function. Malignant lesions require wide excision with facial nerve grafting or facial nerve reanimation.
In Vitro Tissue Engineering to Generate a Human‐Sized Auricle and Nasal Tip
Authors: Kamil Syed H. , Kojima Koji , Vacanti Martin P. , Bonassar Lawrence J. , Vacanti Charles A. , Eavey Roland D. 
Published: November 2003

AbstractObjectives/Hypothesis Tissue engineering has successfully generated cartilage in a xenograft and an autograft model. However, challenges remain with both of these in vivo techniques before clinical application can be realized. We hypothesized that a human‐sized cartilaginous structure could be generated completely in vitro as a complementary or an alternative technique.Methods Scaffolds were created in the shape of five full‐sized human auricles and five nasal tip cartilaginous skeletons. Bovine shoulder chondrocytes at a concentration of 50 million cells/mL were seeded onto the scaffolds and were grown for 12 weeks in vitro. Two of the auricular scaffolds had internal support provided by soft acrylic sheets and were later implanted into nude rats.Results All of the scaffolds maintained shape and size through 12 weeks of in vitro culture. On gross examination the scaffolds were progressively replaced by cartilage, which was confirmed by histological and biochemical analysis. The auricular scaffolds with the acrylic internal support had the most natural rigidity, which was observed by gentle palpation. The nasal scaffolds maintained excellent definition even without internal support.Conclusion An adult human‐sized auricle and nasal tip cartilaginous structure can be grown entirely in vitro using principles of tissue engineering.
A Novel Technique for Peripheral Nerve Repair
Authors: Scharpf Joseph , Meirer Romed , Zielinski Maciej , Unsal Murat , Ramineni Praful , Nair Dileep , Siemionow Maria 
Published: November 2003

AbstractObjective To evaluate a novel technique for the repair of neural deficits using a single fascicle to bridge an injury in the rat sciatic nerve.Study Design Twenty‐four male Lewis rats were divided into four groups as follows: group 1 (control group), 1.5‐cm deficit without repair; group 2, conventional epineural repair with autografts (100% diameter); group 3, nerve repair with large single autograft fascicle (50% diameter); and group 4, nerve repair with small single autograft fascicle (25% diameter).Methods Nerve regeneration was evaluated at 3, 6, and 12 weeks by somatosensory evoked potential (SSEP) evaluation and standardized pin‐prick and toe‐spread tests. Nerve samples were harvested at 12 weeks and stained with toluidine blue to assess the total number of myelinated axons, axon area, and myelin sheath thickness.Results In group I, the pin‐prick and toe‐spread tests showed no response at 3, 6, and 12 weeks. Rats in groups 3 and 4 demonstrated significantly better pin‐prick test results and a trend toward better toe‐spread test responses compared with conventional‐repair animals. The SSEP evaluations displayed nondiagnostic waves in rats in group 1 rats. There was no evidence that the other surgery groups differed significantly in median SSEP latencies. Histological evaluation revealed fibrosis in rats in group 1 rats and a significantly higher median number of axons and myelin thickness in the small single fascicle (1296 axons and 4.22 μm, respectively) and large fascicle (2682 axons and 4.62 μm, respectively) groups compared with the conventional autograft group (630 axons and 2.93 μm, respectively). The small fascicle group had a significantly greater mean axon area (58.59 μm2) than the large fascicle (29.66 μm2) and conventional autograft (25.35 μm2) groups.Conclusions Peripheral nerve repair using a single fascicle graft resulted in better functional recovery and morphometric outcome without a significant difference in electrophysiological status compared with conventional nerve repair. This technique may provide expanded sources of nerve autografts and alleviate the morbidity of harvesting peripheral nerves from multiple sites for individuals with extensive peripheral nerve injuries.
The Pathogenesis of Nasal Polyposis by Immunoglobulin E and Interleukin‐5 Is Completed by Transforming Growth Factor‐β1
Authors: Hirschberg Andor , Jókúti Adrienn , Darvas Zsuzsa , Almay Krisztina , Répássy Gábor , Falus András 
Published: November 2003

AbstractObjectives/Hypothesis Nasal polyps are benign mucosal protrusions into the nasal cavity of multifactorial origin and are characterized by chronic mucosal inflammation. The suggested multifactorial pathological mechanisms comprise several factors including cytokines and immunoglobulin E (IgE). The study was designed to examine the suggested roles of IgE, interleukin‐5 (IL‐5), and transforming growth factor‐β1 (TGF‐β1) in the pathogenesis of nasal polyposis.Methods Nasal polyps (n = 34) and healthy nasal mucosa samples (n = 9) were taken during routine endonasal surgeries. Immunoglobulin E (n = 13), IL‐5 (n = 22), and TGF‐β1 (n = 27) concentrations were measured with enzyme‐linked immunosorbent assay technique in homogenized polyp tissue and in control mucosa. Atopic and nonatopic groups were selected and compared. Histomorphological examination and immunohistochemical analysis to detect IL‐5 and TGF‐β1 were performed in five specimens.Results The level of tissue‐bound IgE was significantly higher in polyps compared with control specimens and in atopic compared with nonatopic polyps, but between nonatopic polyps and control specimens the difference was not significant. However, significant correlation was found between tissue and serum IgE in the complete polyp (P = .001) and atopic polyps group (P = .05). Tissue IL‐5 concentration was significantly higher in polyps compared with control specimens, in which it was below the limit (15 pg/mL), and there was no difference between atopic and nonatopic polyps. In atopic polyps there was significant correlation between tissue IgE and IL‐5. Transforming growth factor‐β1 concentration proved to be significantly higher in control mucosa than in polyps, with no difference between atopic and nonatopic polyps. Immunohistochemical analysis revealed numerous IL‐5‐positive eosinophil cells and TGF‐β1 positivity in the lamina propria of polyp samples, but none in control specimens.Conclusions High tissue TGF‐β1 quantity in healthy nasal mucosa without its active form on the cell surface and its low quantity in polyps may reflect its essential role in the inhibitory mechanisms of nasal polyposis. Interleukin‐5 plays a key role in the eosinophil recruitment and activation, and both atopic and nonatopic pathways might activate this process. The main sources of IL‐5 and TGF‐β1 are the eosinophils and macrophages. Immediate hypersensitivity, besides other mechanisms, might be related to atopic polyps, but the involvement of other, local allergic mechanisms in IgE production of nonatopic polyp tissue cannot be excluded.