bluuebunny/crossref_metadata_2025_split huggingface dataset:
Powered Endoscopic Dacryocystorhinostomy
Authors: Wormald Peter John 
Published: November 2003

AbstractObjectives To describe powered endoscopic dacryocystorhinostomy (DCR) with full sac exposure and primary mucosal anastomosis and report perioperative and follow‐up results achieved with this procedure.Study Design Prospective, nonrandomized cohort study.Methods Operative and postoperative data were prospectively collected on 36 unselected patients (15 men and 21women; mean age, 62.4 y; range 14–91 y) who presented to a lacrimal clinic with epiphora and obstruction of the drainage of the nasolacrimal system and who consecutively underwent either primary or revision powered endoscopic DCR. A total of 47 procedures were performed; all were done by the same surgeon, who used a standardized surgical technique. Follow‐up evaluations included symptom evaluation and endoscopic assessment of the newly created ostium with fluorescein testing at each postoperative visit.Results The only surgical complication was one case of orbital fat exposure. Forty‐five of the 47 DCRs were patent after a mean follow‐up of 11 months (standard deviation = 5 mo), yielding a success rate of 95.7%. Patency was assessed by endoscopic visualization of the ostium and fluorescein (initially placed on the conjunctiva) in the ostium. One of the 47 DCRs was a failure and one patient had O'Donaghue tubes in place with symptoms. Two patients with a patent ostium and positive results on fluorescein testing continued to have some symptoms.Conclusion Powered endoscopic DCR with full sac exposure and primary mucosal apposition has a success rate comparable to that achieved with external DCR.
Botulinum Toxin to Reduce Saliva Flow: Selected Indications for Ultrasound‐Guided Toxin Application Into Salivary Glands
Authors: Ellies Maik , Laskawi Rainer , Rohrbach‐Volland Saskia , Arglebe Christian , Beuche Wolfgang 
Published: November 2003

AbstractObjectives/Hypothesis The study investigates the effect of local injections of botulinum toxin type A (Botox) into the major salivary glands of the head in various states of hypersalivation. In particular, we studied pathological states with permanent as well as passing hypersalivation disorders and present new indications for local application of botulinum toxin to the salivary glands.Study Design Retrospective clinical investigation.Methods A total of 55 to 65 units of Botox were injected under sonographic control into the left and right parotid and submandibular glands of four patients with hypersalivation resulting from head and neck carcinoma, tracheostomy, and “idiopathic” hypersalivation disorder. At defined time intervals following injection, flow rate, total protein and immunoglobulin A content, and the enzymatic activities of amylase, acid phosphatase, and kallikrein were determined in the saliva. The patients were clinically examined to assess the severity of their symptoms, including sonographic control of the major salivary glands.Results All four patients reported distinct improvement of their symptoms within 1 week after injection. Salivary flow rate had considerably dropped, whereas the concentrations of the salivary components were much increased. Sonography did not reveal any changes of the salivary gland parenchyma. Therapeutic side effects were absent.Conclusions Treatment of hypersalivation by local injections of Botox into the salivary glands of the head is a reliable and efficient therapy without side effects for certain otolaryngological diseases, especially if injections are performed under sonographic control. Extension of this therapeutic concept to other indications is suggested.
Evaluation of Paragangliomas Presenting as a Cervical Mass on Color‐Coded Doppler Sonography
Authors: Stoeckli Sandro J. , Schuknecht Bernhard , Alkadhi Hatem , Fisch Ugo 
Published: November 2003

AbstractObjectives To assess the potential of color Doppler sonography to identify cervical mass lesions as paragangliomas.Study Design Prospective evaluation.Methods Fifteen patients with 18 paragangliomas (13 carotid body tumors, 3 vagal and 2 temporal) presenting as a mass in the neck were investigated using color Doppler sonography.Results All paragangliomas presented in B‐mode sonography as solid, well‐defined, and hypoechoic tumors. Color Doppler imaging revealed hypervascularity in 15 (82%) tumors. No flow signal was detected in 3 carotid body tumors at standard velocity encoding (30 cm/s). Only carotid body tumors could be assessed in their full extent. Temporal and vagal paragangliomas were only partially visible. Carotid body tumors showed a splaying of the carotid bifurcation with displacement of the external carotid anteriorly and both the internal carotid and the internal jugular vein posteriorly. Anterior displacement of both carotid arteries and posterior displacement of the internal jugular vein was found in the 3 vagal paragangliomas. The caudal tumor extension of the 2 temporal paragangliomas was recognized within the expanded lumen of the internal jugular vein. According to the direction of tumor growth and vascular supply, the intratumoral flow signal was predominantly directed upward in carotid body tumors and downward in vagal and temporal paragangliomas.Conclusions Based on the appearance in the B‐mode, the hypervascularity, the relationship toward the carotid arteries and the internal jugular vein, and the intratumoral flow direction, color Doppler sonography was able to establish the diagnosis and type of a paraganglioma.
The Incidence and Distribution of Cupular Deposits in the Pediatric Vestibular Labyrinth
Authors: Bachor Edgar , Wright Charles G. , Karmody Collin S. 
Published: November 2003

AbstractObjectives Deposits of basophilic material on the cupulae of the semicircular ducts have been described in adult human temporal bones, and such deposits have been implicated in the clinical phenomenon of benign paroxysmal positional vertigo (BPPV). Although relatively rare, BPPV has been reported to occur in children. The goal of this study was to evaluate the occurrence of cupular deposits in pediatric material.Study Design Basic science, two‐center histopathologic temporal bone study.Methods We examined 186 temporal bones from 121 individuals between the ages of newborn and 10 years. The average age was 14.7 months. All temporal bones were acquired at autopsy, embedded in celloidin, and sectioned for light microscopic study. The cupulae of the semicircular ducts were identified and any deposits found were graded according to their size and position on the cupula.Results A total of 276 cupulae were identified, and in 35 (12.7%) of these a basophilic deposit was found. In many cases the deposits contained recognizable otoconial crystals. Most deposits were small and they were almost equally distributed between the three semicircular ducts. However, the lateral and posterior cupulae were somewhat more involved than the superior cupula. Our data showed that cupular deposits are less frequently found in the pediatric labyrinth, compared with adults as reported in previous studies.Conclusions The lower occurrence in children versus adults suggests that the deposits may be a phenomenon of the aging vestibular labyrinth.
Distance From Acoustic Neuroma to Fundus and a Postoperative Facial Palsy
Authors: Kobayashi Mari , Tsunoda Atsunobu , Komatsuzaki Atsushi , Yamada Ichiro 
Published: November 2003

AbstractObjective/Hypothesis Generally, patients with small acoustic neuroma have less facial palsy after its removal. The middle cranial fossa approach is mainly applied to the small acoustic neuroma and tumor size does not influence the prognosis of facial palsy. The internal auditory canal cannot be fully opened in the middle cranial fossa approach, and the facial nerve is tightly attached in the fundus. According to these anatomical factors, we hypothesized that acoustic neuromas located away from the fundus might be removed with less facial nerve damage. We investigated the distance between the acoustic neuroma and fundus and its clinical relationship.Study Design Retrospective study of 45 patients with acoustic neuroma who underwent a middle cranial fossa approach.Methods The distance between the acoustic neuroma and fundus and the tumor diameter were measured on T2‐weighted and contrast‐enhanced magnetic resonance images, respectively. These data were compared with the postoperative facial nerve function.Results The mean distance was 3.0 ± 1.8 mm (range, 0–10 mm), and the mean diameter was 11.3 ± 3.7 mm (means ± standard deviation; range, 4–20 mm). Neither the distance nor the diameter had any correlation to the degrees of postoperative facial palsy either immediately or at 3 months after surgery.Conclusions As far as the nerve was anatomically preserved, postoperative facial nerve function seemed to be influenced by factors other than surgical manipulation among small acoustic neuromas. Although the tumor fills in the fundus, it may not influence postoperative facial nerve function and also may not interfere with indication of the middle cranial fossa approach for removal of the acoustic neuroma.
Neonatal Hearing Loss in the Indigent
Authors: Oghalai John S. , Chen Lei , Brennan Megan L. , Tonini Ross , Manolidis Spiros 
Published: November 2003

AbstractObjective To compare the risk factor profile for neonatal hearing loss (HL), and the follow‐up rate of those identified with HL in an indigent population with those in an insured population.Study Design Retrospective review.Methods We studied 4526 neonates from the high‐risk nursery or neonatal intensive care unit from two adjacent hospitals in Houston, Texas. Ben Taub General Hospital (BTGH) is a county public hospital that serves mainly the indigent. Texas Children's Hospital (TCH) is a private tertiary care center that serves patients with private insurance and Medicaid.Results Overall, 133 infants failed the screening test. Follow‐up diagnostic testing identified 48 patients with definite HL. Although nearly twice as many patients at BTGH failed screening compared with TCH (88 vs. 45), four times as many patients at BTGH did not return for diagnostic testing (43 vs. 10). When a hearing aid was needed, there was a delay in getting one at BTGH (P <.05). There was a higher prevalence of dysmorphic facial features and central nervous system disease and a lower prevalence of long‐term ventilatory support at BTGH (P <.05). There were no differences between BTGH and TCH in the prevalence of low birth weight, neonatal asphyxia, syndromic stigmata, neonatal infection, family history of HL, or neonatal transfusion (P >.1).Conclusions Significant differences in the risk factor profile for neonatal HL exist between the indigent and the general population. A worrisome problem exists with the timely intervention in hearing‐impaired indigent neonates.
Histopathology of the Uvula and the Soft Palate in Patients With Mild, Moderate, and Severe Obstructive Sleep Apnea
Authors: Berger Gilead , Gilbey Peter , Hammel Ilan , Ophir Dov 
Published: November 2003

AbstractObjective To study morphometric and qualitative histopathologic changes of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea.Study Design A prospective, nonrandomized controlled study.Methods The distal soft palate and uvula were excised during uvulopalatopharyngoplasty from 34 male patients with obstructive sleep apnea. Control specimens were retrieved from 7 male cadavers with no related disorders. All specimens underwent routine processing and the mid‐sagittal sections were studied. Morphometric analysis of the relative proportions of the tissue constituents was carried out. Also, a qualitative assessment was performed to detect possible pathologic changes.Results The body mass index of patients was significantly higher from that of control subjects. The area fraction occupied by the tissue constituents of the distal portion of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea and in control subjects was similar, with small and insignificant differences regarding the contents of glands, muscle, fat, blood vessels, and the epithelium. Only the connective tissue was significantly greater in patients with moderate obstructive sleep apnea than in those with severe obstructive sleep apnea and control subjects. The qualitative assessment of the specimens disclosed normal tissue architecture without evidence of destruction. Vascular engorgement, fibrosis, edema, inflammatory cell infiltration, and dilated glandular ducts were observed in a portion of patients and control subjects.Conclusions The structure of the distal soft palate and uvula of patients with obstructive sleep apnea undergoes insignificant changes and is independent of the body mass index levels, indicating that the pathologic changes are probably the sequela of airway obstruction rather than its cause.
Microsurgical Anatomy of the Laryngeal Nerves as Related to Thyroid Surgery
Authors: Monfared Ashkan , Gorti Goutham , Kim Daniel 
Published: November 2003

AbstractObjectives The objectives were to explore microsurgical anatomy of the superior and recurrent laryngeal nerves and their importance in thyroid surgery, and to examine areas of potential morbidity, means of identification, and arterial supply of the laryngeal nerves.Study Design Descriptive analysis of anatomical features.Methods Twenty‐one adult cadavers, some perfused with colored silicon, were dissected for the study project.Results The right recurrent laryngeal nerve (RLN) branches off the vagus at the level of the subclavian artery and the left one at the level of the aorta. Both ascend parallel to the tracheoesophageal groove and innervate trachea, esophagus, and the inferior pharyngeal constrictors en route. The RLN has the highest probability to pass between the branches of the inferior thyroid artery on the right side and posterior to them on the left side. The RLN always passes posterior to the cricothyroid joint. The RLN is supplied by the branches of the inferior thyroid artery. The superior laryngeal nerve (SLN) branches into internal and external branches deep to the carotid bifurcation. The internal branch passes deep to the superior thyroid artery and descends toward thyrohyoid membrane. The external branch travels deep and parallel to the superior thyroid artery to innervate cricothyroid muscle. The internal branch is supplied by the superior laryngeal artery, and the external branch by the cricothyroid artery.Conclusions The only consistent location of the RLN is when it passes posterior to the cricothyroid joint. Because of extreme variability of the inferior thyroid artery and the RLN, it is suggested that the artery be ligated either proximally or at its tertiary branches on thyroid capsule. The internal branch of the SLN is not potentially at risk during thyroidectomy unless the superior thyroid artery is ligated proximally. The external branch of the SLN accompanies the superior thyroid artery for most of its course and is at potential risk if the trunk of the superior thyroid artery is ligated outside the pretracheal fascia.
Association Between High Initial Tissue Levels of Cyclin D1 and Recurrence of Nasopharyngeal Carcinoma
Authors: Lai Jin‐Ping , Tong Cai‐Li , Hong Cheng , Xiao Jian‐Yun , Tao Zheng‐De , Zhang Zheng , Tong Wei‐Min , Betz Christian S. 
Published: November 2003

AbstractObjectives/Hypothesis Cyclin D1 expression and the rate of apoptosis have been reported to serve as important prognostic indicators in human cancers. The purpose of the present study was to determine the prognostic significance of both initial cyclin D1 expression and the apoptotic index in nasopharyngeal carcinoma.Study Design Cohort study.Methods Cyclin D1 protein levels and apoptosis in tumors and their corresponding adjacent, histologically normal tissues were determined at the time of initial diagnosis using immunohistochemical staining, Western blot analysis, and in situ end labeling, respectively, in 64 patients with T1‐T4/N0‐N2, poorly differentiated squamous cell carcinoma of the nasopharynx. All cases were treated by routine radiation therapy with a total median dose of 70 Gy and followed up for 10 years.Results High levels of cyclin D1 were found in 35 of 64 tumor specimens (54.7%); no cyclin D1–positive cells were determinable in normal epithelium of the nasopharynx. Rates of early local recurrence (within 5 y) were significantly higher (P <.01) for patients with high levels of cyclin D1 before radiation therapy (24 of 35 patients [68.6%]) as compared with patients with low or no expression (3 of 29 [10.3%]). Furthermore, patients bearing high levels of cyclin D1 had a poorer prognosis concerning 10‐year survival than the others (P <.001), whereas overexpression of cyclin D1 did not correlate with the initial TMN classification (P >.05). According to the rate of spontaneous apoptosis in tumors below or above the median, patients were divided into two groups. There was no statistically significant difference for the overall survival between the two groups (P >.05).Conclusions The present study demonstrates that cyclin D1 can be used as an indicator of recurrence and subsequent prognosis in nasopharyngeal carcinoma after radiation therapy. At the same time, the apoptotic state before radiation therapy is of no value in predicting the prognosis of patients with nasopharyngeal carcinoma.
Observations on Conduction of Caloric Stimulation to the Middle Ear Cavity by Thermoscanning
Authors: Nishizawa Shinji 
Published: November 2003

AbstractObjective To elucidate the ways in which caloric stimulation conducts and the temperature recovers on the temporal bone by the caloric stimulation test.Methods Four cases examined temperature changes of the bony lateral semicircular canal eminence with thermal images by caloric stimulation tests. Changes in the heat distribution were observed by means of a Thermoscan (Nihondenki Sanei Thermotracer 6T67R, Tokyo, Japan).Results The temperature began to decrease from the external canal and the decrease reached the posterior cranial fossa plate through the middle ear cavity while the stimulation continued. After the end of stimulation, the stimulation advanced in the direction opposite to the order in which it was transmitted and recovered in a manner resembling a mirror image despite the difference in speed.Conclusions The way in which the caloric stimulation was conducted and the way in which the temperature recovered were in the opposite direction.
Differences in Endolymphatic Sac Mitochondria‐Rich Cells Indicate Specific Functions
Authors: Peters Theo A. , Tonnaer Edith L. G. M. , Kuijpers Wim , Cremers Cor W. R. J. , Curfs Jo H. A. J. 
Published: November 2003

AbstractObjective/Hypothesis The purpose of the study was to examine the specific involvement of endolymphatic sac mitochondria‐rich cells in endolymph homeostasis.Study Design Transmission electron microscopy and immunohistochemistry were performed on the endolymphatic sac of young adult rats, and two important developmental stages were also investigated.Methods Ultrastructural characteristics of endolymphatic sac mitochondria‐rich cells were studied more concisely and compared with renal mitochondria‐rich cells (i.e., the intercalated cells). In addition, expression of cytokeratins 7 and 19 was determined.Results Until birth, only one type of mitochondria‐rich cell is observed in the rat endolymphatic sac. In young adult animals, distinct differences in mitochondria‐rich cell ultrastructure in the endolymphatic sac enables classification into subtypes or configurations. Comparison of endolymphatic sac mitochondria‐rich cells with renal intercalated cells reveals striking similarities and provides additional information on their specific function in endolymph homeostasis. Furthermore, differences in cytokeratin expression are determined in endolymphatic sac mitochondria‐rich cells.Conclusions Differences in morphology of endolymphatic sac mitochondria‐rich cells develop after birth and may reflect a distinct functional or physiological state of the cell. In analogy to renal intercalated cells, the distribution patterns of H+‐adenosine triphosphatase and Cl−/HCO3− exchanger may differ between subtypes. We propose that subtype A mitochondria‐rich cells, from which protruding A mitochondria‐rich cells are the activated state, are involved in proton secretion (apical H+‐adenosine triphosphatase) and thus are potential candidates for hearing loss accompanying renal tubular acidosis. Subtype B mitochondria‐rich cells are the most likely candidates to be affected in Pendred syndrome because of the assumed function of pendrin as apical Cl−/HCO3− exchanger.
Oropharyngeal Swallowing Variability
Authors: Kendall Katherine A. 
Published: November 2003

AbstractObjectives/Hypothesis The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. However, individual variability has not been studied. The purpose of the present study was to evaluate the amount of sequence variability that normally occurs during the oropharyngeal phase of deglutition.Study Design Prospective analysis of conservative subjects.Methods Dynamic swallow studies from 60 normal volunteers were evaluated, and event sequence variability was determined around two event sequences during swallowing of three bolus sizes.Results There was found to be substantial variability in event sequences for all events analyzed. Variability was greater during a smaller bolus swallow.Conclusions The evaluation of variability within the study group of individuals reveals the complexity of the swallowing mechanism and underscores the importance of not relying on general guidelines in evaluating the coordination of swallowing gestures in a given individual with dysphagia complaints.
Effect of Bacterial Endotoxin and Middle Ear Effusion on Ciliary Activity: Implications for Otitis Media
Authors: Mason Paul S. , Adam Elizabeth , Prior Matthew , Warner John O. , Randall Christopher J. 
Published: November 2003

AbstractObjectives/Hypothesis Otitis media with effusion (OME) is the most common cause of childhood deafness. The pathogenesis is not fully understood, especially the reasons for failure of mucociliary clearance of the middle ear. It is not clear whether the cilia function normally in the middle ear and eustachian tube in the chronic phase of otitis media with effusion. However, impaired ciliary function in primary ciliary dyskinesia is known to be frequently associated with the development of otitis media with effusion. We hypothesized that endotoxin or the bacterial products in middle ear fluid in otitis media with effusion would adversely affect ciliary activity, thereby contributing to the pathogenesis of the disease.Study Design Laboratory‐based study of human ciliary activity with reference to otitis media with effusion.Methods We have studied the activity of human adenoidal cilia under various conditions. Ciliary activity in the presence of Haemophilus influenzae endotoxin additions (at varying concentrations) to cultured adenoidal explants has been measured. In addition, ciliary activity of these explants was also observed after addition of middle ear effusion aspirated from patients.Results We have shown that endotoxin in concentrations far in excess of those found in the middle ear with chronic otitis media with effusion had no effect on ciliary activity. Furthermore, ciliary activity was completely unaffected by the presence of middle ear effusion.Conclusion There is no evidence that ciliary activity is reduced by the constituents of middle ear fluid in chronic otitis media with effusion.