bluuebunny/crossref_metadata_2025_split huggingface dataset:
Corticosteroid Treatment in Nasal Polyposis With a Three‐Year Follow‐Up Period
Authors: Bonfils Pierre , Norès Jean‐Marc , Halimi Philippe , Avan Paul 
Published: November 2003

AbstractObjectives/Hypothesis The management of nasal polyposis is undoubtedly a controversial subject. The part played by surgery seems to be steadily growing, if the number of published reports dedicated to this approach is any yardstick. Although the medical treatment remains the undisputed therapeutic mainstay, trials dedicated to the long‐term assessment of its overall efficacy are scarce.Study Design Retrospective medical record review.Methods The aim of the study is focused on the evaluation of a dual modality, topical and systemic, over a follow‐up period of 3 years. In all, 100 patients were treated according to a standardized therapeutic protocol combining short‐term oral administration of prednisolone and daily intranasal spray of beclomethasone.Results Over the follow‐up period of 3 years, this dual modality proved to be successful in 85% of the patients; only 15% had to undergo surgery after its failure. The average symptom reduction reached an improvement rate varying from 58% to 80%, according to the symptom type. The daily dosage of prednisolone and beclomethasone was progressively decreased while the gain in nasal comfort was being preserved.Conclusions Management of nasal polyps should be primarily medical. Resorting to surgical procedures should not be envisaged before a trial is conducted of dual steroid therapy under a regimen of strict compliance to treatment.
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 assesses 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.
Gene Expression Analysis of Human Middle Ear Cholesteatoma Using Complementary DNA Arrays
Authors: Tokuriki Masaharu , Noda Ichiro , Saito Takehisa , Narita Norihiko , Sunaga Hiroshi , Tsuzuki Hideaki , Ohtsubo Toshio , Fujieda Shigeharu , Saito Hitoshi 
Published: November 2003

AbstractObjective To identify genes regulated in human cholesteatoma compared with normal skin tissue using complementary DNA arrays.Study Design In vitro analysis.Methods Eight cholesteatoma and retroauricular skin samples were obtained from the same patients during surgery. Upregulated and downregulated genes were highlighted using complementary DNA arrays for screening. Reverse transcriptase‐polymerase chain reaction and immunohistochemical staining were performed to confirm the results of the complementary DNA array.Results Twelve genes were found to be induced or upregulated in cholesteatoma compared with skin samples. These included genes involved in cell proliferation and differentiation (eg, calgranulin A, calgranulin B, psoriasin, thymosin β‐10) and cell invasion (eg, cathepsin C, cathepsin D, cathepsin H). Analyses by means of reverse transcription‐polymerase chain reaction showed enhanced expression of several genes including calgranulin A, calgranulin B, psoriasin, thymosin β‐10, cathepsin C, cathepsin D, and cathepsin H in cholesteatoma, supporting the findings from the gene array. In addition, it was verified by immunohistochemical analysis that the expressions of Calgranulin A, Calgranulin B, and Cathepsin D were mainly located in cholesteatoma epithelium.Conclusion The observed alteration in gene expression may play a role in various mechanisms of pathogenesis in cholesteatoma.
Development of a Novel Eighth‐Nerve Intraneural Auditory Neuroprosthesis
Authors: Badi Arunkumar N. , Kertesz Thomas R. , Gurgel Richard K. , Shelton Clough , Normann Richard A. 
Published: November 2003

AbstractObjectives/Hypothesis Cochlear nerve stimulation using a linear array of electrodes, the cochlear implant, has become an accepted treatment for profound deafness. Major limitations of this technology are high threshold of stimulation, poor performance in a noisy background, cross‐talk between electrodes, unsatisfactory channel selectivity, and variable reconstruction of frequency space. A novel auditory neuroprosthesis is proposed that is expected to overcome these problems by implanting an array of three‐dimensional microelectrodes, the Utah Electrode Array, directly into the cochlear nerve.Study Design We have conducted acute, extending for up to 12 hours and semichronic, extending for up to 52 hours, electrophysiological experiments, radiologic and histologic studies in 12 cats.Methods The electrically evoked auditory brainstem response was used as a means to characterize the threshold, dynamic range, and stability of cochlear nerve stimulation through the implanted Utah Electrode Array neuroprosthesis. Plain film, computed tomographic, and histological studies were conducted to determine the result of the implant.Results The electrically evoked auditory brainstem response thresholds were approximately one to two orders of magnitude lower than those evoked with conventional cochlear implants. We were able to close the cochleostomy, bring the cat into normal anatomical position, and obtain stable electrically evoked auditory brainstem responses for up to 52 hours. Plain film and computed tomographic studies indicated that the Utah Electrode Array neuroprosthesis was in the intended position in the nerve. Histological studies did not reveal hemorrhage or significant damage to the nerve.Conclusion Because the presented stimulation paradigm appears to significantly mitigate some of the problems of conventional cochlear implants, it may offer a new therapeutic approach to profound deafness.
Endoscopic Removal of Sinonasal Inverted Papilloma Including Endoscopic Medial Maxillectomy
Authors: Wormald Peter John , Ooi Eng , van Hasselt C. Andrew , Nair Salil 
Published: November 2003

AbstractObjectives/Hypothesis Surgical excision is regarded as the treatment of choice for sinonasal inverted papilloma. Resection can be performed endoscopically or through an external approach. Debate exists about which approach to use. The study presents different endoscopic techniques for various tumor locations and reviews the results.Study Design A prospective study and an integrated literature review.Methods Seventeen consecutive patients with inverted papilloma who underwent endoscopic surgical excision, including medial maxillectomies and modified Lothrop procedures, were analyzed. Preoperative symptoms, computed tomography and magnetic resonance imaging findings, operative findings, tumor stage, and outcomes were recorded.Results Thirteen male and four female patients presented with inverted papilloma between December 1993 and October 2001. Nasal obstruction was the most common presenting symptom (50%). Sixty‐five percent of tumors were either stage II or stage III. Endoscopic resection was the primary treatment in 14 patients. Of the three patients who were secondarily treated endoscopically, one had recurrence and was subsequently found to have focus of squamous cell carcinoma. The overall recurrence rate was 6% and the incidence of malignancy was 6% (1 of 17). Recurrence rate for primary resections was zero (0 of 14). Five patients underwent endoscopic medial maxillectomies, and one patient with frontal sinus inverted papilloma was successfully treated with a modified endoscopic Lothrop procedure.Conclusions Endoscopic sinus surgery is a viable treatment alternative for sinonasal inverted papilloma. Recurrence rates for primary treatment are comparable to external approaches. Close follow‐up of patients is mandatory because recurrence may be associated with malignancy.
Radiofrequency Tonsil Reduction: Safety, Morbidity, and Efficacy
Authors: Friedman Michael , LoSavio Phillip , Ibrahim Hani , Ramakrishnan Vidyasagar 
Published: November 2003

AbstractObjectives To evaluate the safety, morbidity, and efficacy of radiofrequency tissue volume reduction of tonsils using two different surgical techniques and to compare these two techniques with each other and with classic tonsillectomy.Study Design A nonrandomized retrospective review of tonsil reductions was made between 2000 and 2002 using in vivo studies associated with tonsil reduction and tonsillectomy performed either in the hospital operating room or in the outpatient treatment area.Methods We studied 150 patients and divided them into three main groups based on surgical technique. Group A consisted of 50 consecutive patients who underwent tonsil “ablation,” Group B contained another 50 consecutive individuals who received tonsil “coblation,” and Group C consisted of 50 patients who underwent classic tonsillectomy (cold dissection). Each group consisted of two subcategories of children (age range, 1–12 y) and adults (age range, 12–60 y) with chronic tonsillar hypertrophy. Most of the pediatric patients underwent adenoidectomy during the same surgical procedure. Indications for tonsillectomy were those listed by the American Academy of Otolaryngology—Head and Neck Surgery. A retrospective chart review was used to assess procedures, safety, morbidity, and efficacy of tonsil reduction and tonsillectomy. Four specific end points of morbidity were investigated: pain, return to normal diet, return to normal activity, and use of pain medication. Efficacy of tonsillectomy was determined by the clinical observation of the remaining tonsillar tissue and compared with pretreatment photographs of the tonsils.Results There were no complications in any of the groups. Efficacy was assessed based on the mean tonsil reduction and was found to be 100% for tonsillectomy, 86% for the tonsil coblation technique, but only 53.6% for the ablation technique. Morbidity was minimal in groups A and B and significantly greater in Group C. The number of pain days, narcotic‐use days, and days before return to normal diet and activity were greatly reduced in groups A and B when compared with classic tonsillectomy (group C). Pain levels on day 1 were less than 3 (on a scale of 1–10) in groups A and B. The number of pain days and narcotic‐use days was less than 4 days in groups A and B. Similarly, most patients returned to solid diet and normal activity by day 4. Pain levels, number of narcotic‐use days, and number of days to return to normal diet and activity were significantly higher for classic tonsillectomy.Conclusions Tonsil coblation has distinct advantages when compared with tonsil ablation and standard tonsillectomy. Tonsil coblation resulted in greater than 86% elimination of tonsillar tissue in both children and adults. In most patients, pain levels were minimal and limited to the first 48 hours after surgery. Return to normal diet and activity was much earlier in the coblation group versus classic tonsillectomy.
Detection of Occult Cervical Micrometastases in Patients With Head and Neck Squamous Cell Cancer
Authors: Barrera Jose E. , Miller Mark E. , Said Sherif , Jafek Bruce W. , Campana John P. , Shroyer Kenneth R. 
Published: November 2003

AbstractObjective The incidence of occult nodal metastases associated with head and neck squamous cell carcinoma (HNSCC) and the clinical significance of nodal micrometastases by cytokeratin immunohistochemical analysis are examined.Study Design In all, 1012 lymph nodes from 50 patients treated between 1992 and 2001 at the University of Colorado Health Sciences Center (Denver, CO) were evaluated retrospectively for micrometastases.Methods Serial sectioning in 5‐to 6‐μm interval specimens stained either with hematoxylin and eosin (H&E) or immunostaining for cytokeratins using the monoclonal antibody cocktail AE1/AE3 was performed in 21 N0, 11 N1, and 14 N2 patient cases. Cases that showed scattered cells with suspect staining qualities but without morphological features consistent with HNSCC were further evaluated by epithelial membrane antigen (EMA) immunohistochemical analysis.Results H&E‐stained and cytokeratin‐stained sections revealed occult nodal micrometastases in 3.8% of N0 and 5% of N1 cases. Overall, 26 micrometastases were identified in N0 and N1 patients, causing 29% of N0 patients and 45% of N1 patients to be upstaged. Cytokeratin immunostaining detected micrometastases in eight cases that were negative on H&E serial sectioning. Serial sectioning by H&E alone identified three additional micrometastases. Negative EMA immunostaining confirmed the absence of malignant cells in lymph node sections that were equivocal on cytokeratin staining.Conclusions The use of serial sectioning with H&E and cytokeratin immunohistochemical analysis increases the detection of micrometastases that are often elusive by routine processing in patients with HNSCC. Improved methods of detecting micrometastases may provide a basis for improved planning of postoperative therapy for patients already at risk for tumor recurrence.
Voice Quality After Laser Surgery or Radiotherapy for T1a Glottic Carcinoma
Authors: Tamura Etsuyo , Kitahara Satoshi , Ogura Masami , Kohno Naoyuki 
Published: November 2003

AbstractObjective To compare the effect on phonation of radiotherapy and endoscopic laser surgery for stage T1a glottic squamous cell carcinoma.Study Design Retrospective.Methods Patients treated for stage T1a glottic carcinoma from August 1994 to March 2000 and who had been followed for at least 1 year were candidates. Eight patients who underwent radiotherapy and 22 who underwent laser surgery were enrolled. Indirect laryngoscopy and stroboscopic examination were performed, and voice quality was analyzed using standard parameters.Results Maximum phonation time, average airflow rate, sound pressure level, and average fundamental frequency during unconditional phonation were similar after laser surgery and radiotherapy. However, compared with normal men who were 50 years of age or older, the average fundamental frequency was higher after laser surgery.Conclusions Contrary to some reports, the voice quality is minimally affected by laser surgery for T1a glottic carcinoma, and outcome is similar to radiotherapy. The average fundamental frequency is higher than normal after laser surgery, but the effect on the quality of life was trivial.
Airway Management After Maxillectomy: Routine Tracheostomy Is Unnecessary
Authors: Lin Ho‐Sheng , Wang David , Fee Willard E. , Goode Richard L. , Terris David J. 
Published: November 2003

AbstractObjectives/Hypothesis There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management.Study Design Retrospective analysis at a university hospital.Methods We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty‐four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split‐thickness skin graft being the most common reconstructive option.Results Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year‐old man with oxygen‐dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise.Conclusions The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.
Correlation Between Facial Pain or Headache and Computed Tomography in Rhinosinusitis in Canadian and U.S. Subjects
Authors: Shields Gordon , Seikaly Hadi , LeBoeuf Matthew , Guinto Faustino , LeBoeuf Herve , Pincus Thomas , Calhoun Karen 
Published: November 2003

AbstractObjectives Objectives were 1) to determine whether a correlation exists between facial pain or headache and sinus disease severity by computed tomography (CT) scan in patients with rhinosinusitis and 2) to compare disease severity and pain perception in two geographically diverse North American patient populations.Study Design Prospective patient questionnaire before CT scan of the paranasal sinuses.Methods Patients with refractory rhinosinusitis were recruited at the University of Texas Medical Branch (Galveston, TX) and the University of Alberta (Edmonton, Alberta, Canada). Before CT scanning, patients completed a pain questionnaire. All scans were interpreted by one neuroradiologist and were scored using the Lund‐McKay, Harvard, and Kennedy staging systems for rhinosinusitis.Results Fifty‐one patients completed questionnaires (27 were Canadian). There was no correlation between pain severity and disease severity reflected by any of the three staging systems used (P >.05). The mean pain score for the U.S. patients was 7.3, and for Canadian patients, 5.2. The mean CT scores for U.S. versus Canadian patients were as follows: Lund‐McKay, 2.6 versus 6.6; Harvard, 0.7 versus 1.0; and Kennedy, 1.4 versus 2.2. The Canadian patients had more severe disease on CT scan (Lund‐McKay, P ≤.001; Harvard, P ≤.005; and Kennedy, P ≤.007) while reporting less severe pain (P ≤.004).Conclusions There was no correlation between pain severity and disease severity by sinus CT scan as graded by the Lund‐McKay, Harvard, or Kennedy staging system. Facial pain and headache, although frequent complaints of patients with rhinosinusitis, are not useful predictors of sinus disease severity. There appears to be a difference in pain perception between the two North American populations.
A Novel Model for Rapid Induction of Apoptosis in Spiral Ganglions of Mice
Authors: Lee Ji Eun , Nakagawa Takayuki , Kim Tae Soo , Iguchi Fukuichiro , Endo Tsuyoshi , Dong Youyi , Yuki Kazuo , Naito Yasushi , Lee Sang Heun , Ito Juichi 
Published: November 2003

AbstractObjectives/Hypothesis The survival of the spiral ganglion (SG) is a critical issue in preservation of hearing. Research on topics related to this issue requires a mouse experimental model because such a model has advantages including use of genetic information and knockout or “knockin” mice. Thus, the aim of the study was to establish a mouse model for induction of apoptosis of SG neurons with a definite time course.Study Design Laboratory study using experimental animals.Methods C57BL/6 mice were used as experimental animals and were subjected to direct application of cisplatin into the inner ear. Terminal deoxynucleotidyl transferase–mediated dUTP nick‐end labeling (TUNEL) assay and immunostaining for Neurofilament 200‐kD (NF) and peripherin were used for analysis of SG degeneration. In addition, generation of peroxynitrite in affected spiral ganglions was examined by immunostaining for nitrotyrosine. Cellular location of activated caspase‐9 and cytochrome‐c in dying SG neurons were examined for analysis of cell death pathway.Results The TUNEL assay and immunohistochemical analysis for NF and peripherin indicated that type I neurons in spiral ganglions were deleted through the apoptotic pathway over time. Spiral ganglion neurons treated with cisplatin exhibited expression of nitrotyrosine, indicating induction of peroxynitrite by cisplatin. In dying SG neurons, expression of activated caspase‐9 and translocation of cytochrome‐c from mitochondria to cytoplasm were observed, indicating the mitochondrial pathway of apoptosis.Conclusion The predictable fashion of induction of apoptosis in SG neurons over a well‐defined time course in the model in the study will aid studies of the molecular mechanism of cell death and elucidation of a strategy for prevention of SG degeneration.
Estimation of the Endolymphatic Sac and Vestibular Aqueduct Using Magnetic Resonance Imaging
Authors: Kobayashi Mari , Tsunoda Atsunobu , Akita Keiichi , Yamada Ichiro 
Published: November 2003

AbstractObjective To evaluate the diagnostic accuracy of magnetic resonance imaging for assessment of the endolymphatic sac and vestibular aqueduct.Study Design Imaging and histological study of the cadaver.Methods Five cadavers were studied by a 1.5‐T magnetic resonance imaging system with a 3‐inch‐diameter surface coil. Magnetic resonance imaging scans were obtained with proton density‐weighted and T2‐weighted fast spin‐echo sequences. Histological sections were made with an epoxy resin–embedding method and were compared with magnetic resonance imaging scans.Results The visibility of the endolymphatic sac on both sequences corresponded well to the presence of the endolymphatic sac on histological sections. On the histological sections, the width of the external aperture of vestibular aqueduct (endolymphatic sac including surrounding connective tissue) was 0.96 ± 0.18 mm (mean ± SD) and the width of lumen of endolymphatic sac at the same point was 0.47 ± 0.17 mm. The width of the endolymphatic sac was 1.02 ± 0.19 mm on proton density‐weighted images and was 0.81 ± 0.15 mm on T2‐weighted images. The widths of endolymphatic sac measured on proton density‐weighted image and those of vestibular aqueduct on histological section did not show statistically significant differences (P >.05). On the other hand, the endolymphatic sac as measured on T2‐weighted image tended to be smaller than the vestibular aqueduct (P <.05) and tended to be larger than the lumen of the endolymphatic sac (P <.0005).Conclusion Both sequences can precisely depict the endolymphatic sac; however, the proton density‐weighted image is a more appropriate indicator of the actual anatomical configuration of the endolymphatic sac with surrounding connective tissue and vestibular aqueduct.