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Objective: To report outcomes of a large cohort of patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for resection of a pituitary adenoma with subsequent Resorb-X plate (RXP) sellar reconstruction. Methods: A retrospective review of 620 EETS operations performed at a single academic center between 2005 and 2020 was conducted. Results: A total of 215 EETS operations of 208 patients were identified between 2012 and 2020 who underwent reconstruction with the RXP after EETS for pituitary tumor resection with a final pathologic diagnosis of pituitary adenoma. Analysis of pooled data revealed a mean preoperative tumor volume of 6.8 cm3 (range: 0.038-51.03 cm3). Postoperative cerebrospinal fluid leak occurred in 2 patients (0.93%). Postoperative meningitis occurred in 1 patient (0.47%). There were no cases of RXP extrusion. Conclusions: The rate of postoperative CSF leak and meningitis after use of the RXP for sellar reconstruction compares favorably to other methods, including use of autologous grafts and flaps. Use of RXP during EETS is a safe and efficacious method of sellar reconstruction and may obviate the need for autologous tissue reconstruction after pituitary adenoma resection. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic repair of skull base defects is required following resection of intracranial pathology via the endoscopic endonasal approach (EEA). Many closure techniques have been described, but choosing between techniques remains controversial. We report outcomes of 560 EEA procedures of skull base reconstruction performed on 508 patients over a 15‐year‐period. Halfway through this period, we adopted the use of a rigid, bioabsorbable extrasellar plate for reconstruction, enabling a comparison between this technique and those used previously. Methods: All patients undergoing EEA from 2005 to 2019 at our institution were retrospectively reviewed. Demographic information, surgical pathology, tumor dimensions and radiographic features, reconstructive technique, and patient‐related outcomes were collected and analyzed with univariate and multivariate statistical modeling. Results: Five‐hundred sixty procedures were performed on 508 patients. The series complication rate was 8.2%. Overall, cerebrospinal fluid (CSF) leak rate was 5.0% but varied significantly across closure techniques (p < 0.001). Critically, the CSF leak rate in the 272 cases prior to our 2013 adoption of the Resorb‐X Plate (RXP) was 8.5%, whereas leak rate in the subsequent 288 cases was 1.7%. RXP was protective against CSF leak (p = 0.001), whereas gross total resection (GTR) correlated with increased leak rate (p = 0.001). Patient BMI was significantly associated with risk of leak (p = 0.047). Other variables did not impact leak risk. Conclusion: Reconstructive technique, extent of resection, and patient BMI significantly contributed to CSF leak rate. GTR was associated with increased leak risk while the RXP was protective. The bioabsorbable RXP is an effective option for rigid skull base repair with comparatively few complications. Level of Evidence: 3 Laryngoscope, 133:1092–1098, 2023 [ABSTRACT FROM AUTHOR]

Background: Pituitary tumors surgery is increasingly performed via endoscopic transsphenoidal approach (TSP). This study describes outcomes of TSP surgery in the United States. Methods: A retrospective cross‐sectional analysis of adult patients with pituitary adenoma was performed using the Nationwide Readmissions Database, 2010–2015. Results: A total of 5891 patients were identified. The average age was 51.29 ± 0.29 years. The risk of postoperative epistaxis, diabetes insipidus, cerebrospinal fluid (CSF) leak, and other general postoperative complications was 0.71%, 10.20%, 8.35%, and 2.37%, respectively. Independent risk factors of CSF leak included: age <65‐year, male, body mass index ≥25, and multiple comorbidities (p < 0.001 each). The prevalence of CSF leak was not associated with hospital TSP volume and teaching status. Conclusion: This study provides a national epidemiological perspective on TSP in the United States. The risk of postoperative CSF leak appears to be associated with intrinsic patient factors rather than resource and expertise availability. [ABSTRACT FROM AUTHOR]

Introduction  Pituitary apoplexy commonly presents with visual and hormonal deficits. While traditionally regarded as an emergency, there have been increasing trends toward conservative management. Our institutional practice consists of early surgery; therefore, we reviewed our series evaluating vision outcomes, hormone function, and complications compared with the present literature. Methods  We retrospectively reviewed our institution's medical records to identify pituitary apoplexy patients who were treated via the endoscopic endonasal approach by a single neurosurgeon (senior author). We recorded basic demographics, radiographic and operative features, and preoperative and postoperative vision and hormone status. Univariate and multivariate statistical analyses were performed. Pooled data analysis of visual outcomes in the current literature using Bayesian inference was performed. Results  We identified 44 patients with histologically confirmed pituitary apoplexy treated by endoscopic transsphenoidal decompression; 77% were treated within 24 hours of presentation. Total 45% had cranial nerve (CN) palsy, 36% anopsia, and 20% had visual acuity deficits. Postoperatively, 100% of CN palsies improved, 81% of anopsias improved, and 66.7% of visual acuity deficits improved. Long-lasting panhypopituitarism (25%) and hypothyrodism (22%) were common. Cavernous sinus involvement predicted residual tumor (p  = 0.006). Pooled Bayesian inference showed 30% improvement in vision outcomes with surgical management compared with medical management with a number needed to treat of 3.3. Conclusion  Early surgery for pituitary apoplexy was associated with excellent visual outcomes and the need for long-term hormone replacement is common. Cavernous sinus involvement is an independent predictor of residual tumor. Pooled statistical analysis favors aggressive surgical management of apoplexy for improved visual outcomes. [ABSTRACT FROM AUTHOR]

To examine the effects of "operationally relevant" loads on postural stability and to determine the effects of unilateral and bilateral strength training programs on postural stability in healthy, recruit-aged men. Fifteen subjects were randomly assigned to either a unilateral (UL; n = 7) or bilateral (BL; n = 8) strength training group, which performed strength training 3 times a week for 4 weeks. Subjects completed the following pretest and post-test assessments: 1 repetition maximum in bilateral (1RM-BL) and unilateral (1RM-UL) stance positions and bilateral and unilateral balance tasks with eyes open and eyes closed. Balance tasks were performed over 3 loading conditions: body mass (BM), 50% BM, and 70% BM. Sample entropy (SE) and root mean square (RMS) were calculated from the center of pressures collected during each balance assessment. The UL strength training group showed significant improvement after training in both 1RM-UL (p < 0.01) and 1RM-BL (p < 0.01). The BL strength training group only showed significant improvement in 1RM-BL (p = 0.01). There was a significant main effect of load on RMS (p < 0.05) across all balance tasks with RMS increasing with increasing load. Sample entropy was found to decrease with increasing load in the unilateral eyes open and bilateral stance tasks. Significant increases in strength (~10 to -29%) were observed; however, increased strength alone is not enough to mitigate the effects of load carriage on the postural control, even when training is performed in stance positions that are posturally challenging. Therefore, "operationally relevant" loads negatively impact postural stability in novice load carriers when assessing nonlinear measures. [ABSTRACT FROM AUTHOR]

High rates of occupational training-related lower-limb musculoskeletal (MSK) overuse injuries are reported for British Army recruits during basic training. Foot drill is a repetitive impact loading occupational activity and involves striking the ground violently with an extended-knee (straight-leg) landing. Foot drill produces vertical ground reaction force (vGRF) equal to or greater than those reported for high-level plyometric exercises/activities. Shock absorbing footwear aid in the attenuation of the magnitude of vGRF, resulting in a reduced risk of lower-limb MSK overuse injury when running. The potential shock absorbing characteristics of standard issue British Army footwear on the magnitude of vGRF and temporal parameters of foot drill are scant. Therefore, this study sought to determine the magnitude of and examine changes in vGRF and temporal parameters of foot drill across 3 types of British Army footwear. Sampled at 1,000 Hz, the mean of 8 trials from 15 recreationally active men were collected from 4 foot drills; stand-at-ease, stand-at-attention, quick-march (QM), and halt. Analysis of a normal walk was included to act as a comparison with QM. Significant main effects (P ≤ 0.05) were observed between footwear and foot drill. The training shoe (TR) demonstrated significantly greater shock absorbing capabilities when compared with the combat boot and ammunition boot. Foot drill produced peak vGRF and peak vertical rate of force development in excess of 5 bw, and 350 bw·s, respectively. Time to peak vGRF ranged from 0.016 to 0.036 ms across foot drills, indicating that passive vGRF may not be under neuromuscular control. The marginal reductions in the magnitude of vGRF and temporal parameters in foot drill associated with the TR may act to reduce the accumulative impact loading forces experienced by recruits, subsequently minimizing the severity and rates of lower-limb MSK overuse injuries and recruit medical discharges during basic training. [ABSTRACT FROM AUTHOR]

Purpose: A vertical jump (VJ) is a common task performed in several sports, with the height achieved correlated to skilled performance. Loaded VJs are often used in the training of recreational and professional athletes. The bilateral deficit (BLD), which refers to the difference between the heights achieved by a bilateral jump and the sum of two unilateral jumps, has not been reported for loaded jumps and the findings for unloaded jumps are inconclusive. The purpose of this study was threefold: (a) to quantify and compare BLD in countermovement (CMJ) and squat jumps (SJ), (b) to explore the effects of an additional 10% of body weight (BW) load on the BLD in both CMJ and SJ, and (c) examine the relationship between magnitude of BLD and jump performance in both jumps and conditions. Methods: Forty participants (22 for CMJ and 18 for SJ) performed a bilateral jump and unilateral jumps on each leg with and without an added load equivalent to 10% of each participant's bodyweight. Results: BLD was evident in all conditions, with CMJ BLD values nearly double those for the SJ. The extra load did not affect the magnitude of BLD. BLD had a significant correlation with unilateral jump height, expect for the 110%BW SJ. Conclusions: BLD is present in SJs and CMJs at both loaded and unloaded conditions. The SJs have about half of the BLD observed in CMJs regardless of additional load. Participants who had higher single leg jumps seemed to also have higher BLDs, but there was no evidence of association between the bilateral jump height and BLD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to quantify the reliability of kinetic variables of British Army foot drill performance within untrained civilians and report the magnitude of vertical ground reaction force (vGRF) and vertical rate of force development (RFD) of foot drills. Fifteen recreational active males performed 3 testing sessions across a 1-week period, with each session separated by 24 hours. Within each testing session participants (mean ± SD; age 22.4 ± 1.7 years; height 177 ± 5.6 cm; weight 83 ± 8.7 kg) completed 10 trials of stand-at-attention (SaA), stand-at-ease (SaE), Halt, quick-march (QM) and a normal walking gait, with vGRF and vertical RFD measured on a force plate. Between-session and within-session reliability was calculated as systematic bias, coefficient of variation calculated from the typical error (CVte%), and intraclass correlation coefficient (ICC). Significant (p ≤ 0.05) between-session differences were found for the vGRF SaA and SaE, and vertical RFD SaA and SaE conditions. Significant (p ≤ 0.05) within-session differences were found for the vGRF SaA and SaE conditions. A mean vGRF CVte% ≤10% was observed across all foot drills. However, the mean vertical RFD CVte% observed was ≥10% (excluding SaE) across all foot drills. The ICC analyses indicated that the vGRF Halt, QM, SaA, and Walk condition achieved moderate to large levels of test--retest reliability, with only SaE failing to achieve an ICC value ≥0.75. The vertical RFD QM, SaE, and Walk condition achieved moderate levels of test--retest reliability, with Halt and SaA failing to achieve an ICC value ≥0.75. It was determined that a single familiarization session and using the mean of 8 trials of vGRF are required to achieve acceptable levels of reliability. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases in adults in both developing and developed countries. The etiology and pathogenesis of CRS remain poorly understood, and the disease is refractory to therapy in many patients. Mast cell activation has been demonstrated in the sinonasal mucosa of patients with CRS; however, the specific contribution of mast cells to the development and pathogenesis of this disease has not been established. Objective: The objective of this study was to investigate the role of mast cells in the development of CRS. Methods: C57BL/6 wild-type and C57BL/6-KitW-sh/W-sh mast cell–deficient mice were immunized by intraperitoneal allergen injection and subsequent chronic low dose intranasal allergen challenges. The sinonasal phenotypes of these groups were then evaluated and compared to saline-treated controls using radiologic, histologic, and immunologic methods. Results: Wild-type mice exposed to chronic intranasal allergen developed many features seen in human CRS, including mucosal thickening, cystic changes, polyp development, eosinophilia, goblet cell hyperplasia, and mast cell activation. In contrast, sinonasal pathology was significantly attenuated in mast cell–deficient mice subjected to the same chronic allergen protocol. Specifically, tissue eosinophilia and goblet cell hyperplasia were reduced by approximately 50% compared to wild-type levels. Surprisingly, none of the mast cell–deficient mice subjected to chronic allergen challenge developed cystic changes or polypoid changes in the nose or sinuses. Conclusions: These data identify a critical role for mast cells in the development of many features of a mouse model of eosinophilic CRS, suggesting that therapeutic strategies targeting mast cells be examined in humans afflicted with this disease. [ABSTRACT FROM AUTHOR]

The article discusses the study regarding the reliability of the 1 repetition maximum (1RM) test split-squat (SS) performance as well as the efficacy of the assessment on both bilateral squat (BLS) and 1RM split-squat for the non-resistance-trained recreationally active men. The method to examine the intersession reliability of the 1RM-SS performance through repeated-mesure design was developed. The result were outlined and concludes a systematic bias in the 1RM-SS data.

Background: This study was designed to investigate the clinical features and the growth rate of craniofacial osteomas. Methods: Retrospective chart review was performed of 200 cases of craniofacial osteomas diagnosed from January 2001 to September 2011. Data pertinent to patient and osteoma lesion characteristics were collected. Histology of operated cases was reviewed. Computer tomography (CT) charts were reviewed and those with multiple images were analyzed for growth characteristics. Results: One hundred forty-nine patients met our inclusion criteria. Eighty-nine percent of these osteomas were found incidentally. Forty-three percent were in the frontal sinus. Fifteen percent of the patients complained of headaches and only 6.71% of patients with osteoma had headaches congruent with osteoma location. Thirty-one percent of CT scans had sinus mucosal disease; only 8% had mucosal disease adjacent to the osteoma. Ten of the 149 patients underwent surgery for cosmetic and/or rapidly growing osteomas. Thirteen patients had intestinal tubular adenoma, and one was genetically positive for Gardner's syndrome. Fifty-two patients had multiple CT scans that were included in growth rate analysis. The mean linear growth rate of osteomas was estimated to be 0.117 mm/yr (95% CI, 0.004, 0.230) in maximal dimension, assuming linear growth. A descriptive analysis of osteoma growth divided the osteomas into several intervals and studied the growth rate separately in each interval. The median change in maximum dimension was different in each interval in a nonsystematic manner, ranging from -0.066 mm, over 3- to 9-month interval (interquartile range [IQR] = -0.404-1.069), to 0.369 mm over 9- to 15-month interval (IQR = -0.032-0.855), and 0.082 mm over 45- to 51-month interval (IQR = -0.000-0.197). There was no significant association between tumor size, location, or complications. Conclusion: Craniofacial osteomas are slow-growing lesions with no specific growth pattern and rare complications. Their clinical behavior is ill defined and justifies a conservative approach toward asymptomatic lesions with close radiological follow-up. [ABSTRACT FROM AUTHOR]

Objectives: We review the use and outcomes of osteoplastic flap surgery in the current era of almost entirely endoscopic management of frontal sinus disease. Methods: A retrospective review was performed of 312 consecutive sinus surgeries performed for frontal sinus disease at the University of Iowa Hospitals and Clinics from July 2002 to July 2008. Results: Seventeen subjects (10 men and 7 women; mean age, 56 years) were identified. The indications for osteoplastic flap surgery were laterally located mucoceles in 8 patients, tumors in 7 patients, and osteomyelitis in 2 patients. Ten patients had skull base erosion, and 5 underwent cranialization for large posterior frontal bone defects. The average blood loss was 175 mL, and the average hospital stay was 3 days. There were no major intraoperative or perioperative complications. Two patients with mucoceles required revision surgery for disease recurrence. The mean follow-up was 25 months (range, 6 to 66 months). Conclusions: Osteoplastic flap surgery is an uncommon procedure in the modern endoscopic era of sinus surgery. In our series it was most commonly indicated for laterally located disease. Osteoplastic flap surgery is relatively safe and effective for a wide range of recalcitrant and complicated frontal sinus disorders. [ABSTRACT FROM AUTHOR]

The appearance of creatine kinase (CK) in blood has been generally considered to be an indirect marker of muscle damage, particularly for diagnosis of medical conditions such asmyocardial infarction,muscular dystrophy, and cerebral diseases.However, there is controversy in the literature concerning its validity in reflecting muscle damage as a consequence of level and intensity of physical exercise. Nonmodifiable factors, for example, ethnicity, age, and gender, can also affect enzyme tissue activity and subsequent CK serum levels. The extent of effect suggests that acceptable upper limits of normal CK levels may need to be reset to recognise the impact of these factors. There is a need for standardisation of protocols and stronger guidelines which would facilitate greater scientific integrity. The purpose of this paper is to examine current evidence and opinion relating to the release of CK from skeletal muscle in response to physical activity and examine if elevated concentrations are a health concern. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the prevalence and contribution of humoral immunodeficiency in refractory chronic rhinosinusitis (RCRS). This study was performed at a tertiary care academic referral center. Methods: RCRS patients who had at least three episodes of documented sinusitis in the previous year despite antibiotic therapy, who had endoscopic sinus surgery performed at University of Iowa Health Care (UIHC), and who were evaluated by the UIHC Adult Immune Disorder Clinic were included. Exclusion criteria included allergic fungal sinusitis, human immunodeficiency virus, and other causes of secondary immunodeficiency. Sixty-seven patients fulfilled the inclusion and exclusion criteria. The results of their immunologic evaluation for atopy and humoral immune function were examined. Results: The average age of these patients was 50 years (±11.6 years). Twenty-eight (42%) patients had at least one positive result on allergy skin testing. Determination of quantitative immunoglobulins showed low IgG in 9%, low IgA in 3%, and low IgM in 12% of patients. Common variable immunodeficiency was diagnosed in one case. Immunoglobulin G subclasses were tested in 31 cases and found low in 6 patients. Fifty-one patients underwent a dynamic assessment of their antibody response by examining the increase in antibody titer to an unconjugated pneumococcal polysaccharide vaccine. Sixty-seven percent of patients failed to produce more than a fourfold increase in postimmunization antibody titer for >7 of 14 serotypes being tested and were considered to have functional antibody deficiency. Conclusion: This retrospective review shows an unexpectedly high prevalence of humoral immune dysfunction in patients with RCRS. These findings suggest that assessment of immune function should be undertaken routinely in RCRS. Immune assessment should first include measurement of serum immunoglobulin levels; if these are normal, then functional antibody responses should be evaluated. [ABSTRACT FROM AUTHOR]

Identifying field measures to estimate backpack load-carriage work intensity in elite soldiers is of interest to the military. This study developed rating of perceived exertion (RPE) and heart rate models to define metabolic workload for a backpack load-carriage task valid for a population of elite soldiers using serial data. Male soldiers (n = 18) from the British Parachute or Special Air Service Regiment completed an incremental treadmill walking and (or) running protocol while carrying a 20-kg backpack. Heart rate, RPE, and oxygen uptake were recorded at each incremental stage of the protocol. Linear mixed models were used to model the RPE and heart rate data in the metric of measured peak oxygen uptake. Workload was accurately estimated using RPE alone (SE = 6.03), percentage of estimated maximum heart rate (%E-MHR) (SE = 6.9), and percentage of measured maximum heart rate (%M-MHR) (SE = 4.9). Combining RPE and %E-MHR resulted in a field measure with an accuracy (SE = 4.9) equivalent to the %M-MHR model. We conclude that RPE, %E-MHR, and %M-MHR provide accurate field-based proxy measures of metabolic workload in elite British soldiers performing a backpack load-carriage task. The model is accurate for the metabolic range measured by these serial data for the backpack load-carriage task. Le milieu militaire s'intéresse particulièrement aux mesures sur le terrain pour estimer l'intensité de travail suscitée par le port d'un sac à dos chez des soldats d'élite. Cette étude présente à partir de données sérielles des modèles basés sur la perception de l'intensité de l'effort (RPE) et sur la fréquence cardiaque pour estimer l'intensité métabolique suscitée par le port d'un sac à dos chez des soldats d'élite. Dix-huit soldats masculins appartenant au Régiment britannique des parachutistes ou du SAS participent à une épreuve d'effort progressif fait de marche et de course tout en portant au dos une charge de 20 kg. On enregistre les mesures de la fréquence cardiaque, de la RPE et de la consommation d'oxygène à chaque palier de l'épreuve d'effort. On utilise des modèles linéaires mixtes pour estimer la consommation d'oxygène de pointe au moyen de la RPE et de la fréquence cardiaque. On obtient une estimation précise de l'intensité de travail à partir de la RPE seule (ET = 6,03), du pourcentage de la fréquence cardiaque maximale estimée (%E-MHR) (ET = 6,9) et du pourcentage de la fréquence cardiaque maximale mesurée (%M-MHR) (ET = 4,9). En combinant la RPE et le %E-MHR, la précision (ET = 4,9) de la mesure sur le terrain est équivalente au modèle incluant le %M-MHR. En conclusion, la RPE, le %E-MHR et le %M-MHR sont des variables substitutives donnant des mesures précises sur le terrain de l'intensité métabolique observée chez des soldats britanniques réalisant une tâche avec un sac au dos. Le modèle convient pour l'étendue des mesures du métabolisme obtenues lors de la prise des données sérielles s'appliquant au port du sac à dos. [ABSTRACT FROM AUTHOR]

Objectives: We hypothesized that the endoscopic approach to pituitary surgery improves rhinology-specific quality of life and has satisfactory tumor outcomes compared with the open approach. Methods: Cases of pituitary surgery from the Department of Neurosurgery database included an inception cohort of all patients who had endoscopic procedures and consecutive patients who had open procedures between January 1998 and February 2008. The Sino-Nasal Outcome Test-22 was mailed. Results: Since January 1998, 71 endoscopic and 122 open pituitary surgeries had been performed. The mean follow-up was longer for open procedures (49.3 months) than for endoscopic procedures (18.8 months). Recurrence was more common after open surgery (28.4%) than after endoscopic surgery (18.2%; p = 0.219). The most common diagnosis was macroadenoma (77.1 % of endoscopic procedures and 93.4% of open procedures). The mean hospital stay was shorter for endoscopic procedures (4.1 days) than for open procedures (6.0 days; p < 0.001). Of patients who presented with visual deterioration, 53.8% with endoscopic surgery and 46.7% with open surgery had improvement. Among patients with normal preoperative hormonal function, 27.5% of patients in the endoscopy group and 29.4% of patients in the open group required medication for more than 2 months after surgery. Complications occurred in 33.3% of endoscopic procedures and 43.4% of open procedures. Cerebrospinal fluid leaks were more common in the endoscopy group (p = 0.035), and diabetes insipidus lasting more than 30 days was more common in the open group (p - 0.017). The mean Sino-Nasal Outcome Test-22 score was lower for patients in the endoscopy group (20.4) than for those in the open group (23.2; p = 0.41). Patients in the endoscopy group had a significantly lower rhinology-specific mean score (6.5) than did patients in the open group (9.2; p = 0.03). Conclusions: The endoscopic approach to pituitary surgery offers tumor outcomes comparable to those of open surgery, with no greater incidence of complications and an improved rhinology-specific quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the impact of facial nerve sacrifice and postoperative radiotherapy on the outcome of adenoid cystic carcinoma of the parotid gland. Study Design: Inception cohort. Methods: Retrospective review of Department of Pathology, SNOMED database, and Tumor Registry including health-related quality of life data for the subset enrolled in the longitudinal Outcomes Assessment Project. Fisher exact, χ2, and Wilcoxon tests were used to determine significant differences. Results: Fifty-two cases (follow-up mean: 9.1 years, range: 0.5-40.8 years) demonstrated local control rates of 84.6% (5 years), 76.9% (10 years), and 50% (20 years). Compared with facial nerve preservation, facial nerve sacrifice had better control at 5 years (100 vs. 78.9% P = .259) while having detrimental effects on eating, speech, and esthetics. Local control at 5 years was significantly better ( P = .048) with postoperative radiotherapy (100%) than without (84.6%). Overall survival was 79.4% (5 years), 50% (10 years), and 32.3% (20 years). At 10 years, there was a trend toward improved survival with facial nerve sacrifice (58.8 vs. 46.8%, P = .569) and postoperative radiotherapy (62.4 vs. 39.3%, P = .409). Eleven patients with lung metastases survived an average of 67.8 months after metastases were identified. Only 4 of 46 patients N0 patients (8.3%) subsequently developed lymph node metastases. Conclusion: Selective facial nerve sacrifice was associated with trends toward improved local control and survival but worse quality of life. Patients managed with postoperative radiotherapy had better local control rates than those without. N0 patients rarely developed metastases to regional lymph nodes. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Aspirin-sensitivity, asthma, and nasal polyposis (NP) comprise the clinical entity of Samter's triad. The aim of this study is to report the sinonasal outcomes of endoscopic sinus surgery (ESS) in treating NP in asthmatic patients, comparing aspirin-induced asthmatic (AIA) patients with aspirin-tolerant asthmatics (ATA). Study Design: Retrospective chart review. Methods: The records of 66 patients with NP and asthma were retrospectively reviewed. Forty-one AIA patients were compared with 25 ATA patients. For each patient, a Lund-Mackay computed tomography (CT) score of the preoperative scans and the available postoperative CT scans in a period of 18 months were calculated and used as primary endpoint. Sinonasal improvement assessed by patients and reported with a symptoms scale was used as the secondary endpoint for the comparison immediately before surgery and 6 months and 12 months following ESS. Results: Preoperative CT scores in AIA patients compared with ATA patients were significantly higher 19 (standard deviation, 4.82) vs. 14 (standard deviation, 6.8), respectively ( P = .006). This difference was sustained for the available postoperative CT scans ( P < .0001). During the period of 18 months follow-up, 63.4% of AIA patients vs. 96% of ATA patients had CT improvement with a statistically significant difference between the two groups ( P = .003). At 6 months following ESS, 63.4% of AIA patients vs. 56% of ATA patients had symptomatic improvement. At 12 months, 68.3% of AIA patients vs. 60% of ATA patients had symptomatic improvement, with no significant difference between the two groups. Conclusion: AIA patients had more extensive sinonasal disease than ATA patients. Both groups showed statistically significant improvement in sinonasal outcomes after ESS. The difference between the two groups was statistically significant for patients' CT improvement with worse CT scores being seen in AIA patients. [ABSTRACT FROM AUTHOR]

Introduction: Vocal outcomes after medialization laryngoplasty are variable and may change over time. A revision procedure via open approach or an injection laryngoplasty may be necessary to improve vocal outcomes. Methods: A retrospective chart review was performed. Results: Twenty-nine subjects were identified and stratified into group 1A (n = 9) if the allograft was repositioned/replaced, group 1B (n = 4) if the allograft was removed, and group 2 (n = 16) if an injection laryngoplasty was performed. Statistically significant differences were found between all data prerevision to postrevision (P ≤ 0.05) for group 1A and group 2 when multiple paired-sample t tests were calculated for patient-reported voice severity ratings and voice impact ratings as well as clinician-reported voice ratings of grade, roughness, and breathiness. Results of group 2 were often temporary, with 10 of 16 (62.5%) subjects receiving multiple injections. Conclusion: Both open revision laryngoplasty and injection laryngoplasty are successful at providing improved vocal outcomes. Results are often temporary after injection laryngoplasty and often require multiple procedures. [Copyright &y& Elsevier]

Objectives: Laryngotracheostenosis (LTS) is a condition in which the airway is narrowed between the vocal cords and the carina. We seek to examine whether flexible bronchoscopy with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser incision and balloon dilation tracheoplasty is a practical choice in the management of patients with subglottic or tracheal stenosis. Methods: A retrospective chart review was performed at a tertiary care hospital. All subjects with laryngotracheostenosis treated between January 1, 2000, and April 2005 who underwent endoscopic Nd:YAG laser incision and balloon dilation tracheoplasty performed using topical anesthesia and intravenous sedation were included. Results: A total of 18 patients comprised the study and 36 procedures were performed without complication. Only one procedure was required by eight subjects, while five subjects required two procedures, three subjects had three procedures, one subject had four procedures, and one subject had five procedures until an adequate stable airway was obtained. The average follow-up was 22 months (range 3-55 months). The average body mass index (BMI) was 32.0 kg/m2 (range = 20.8-42.2 kg/m2) and 11 of the 18 subjects (61.1%) were categorized as obese or morbidly obese by BMI criteria. Conclusion: Combined Nd:YAG laser incision and balloon dilation in an awake, spontaneously breathing patient is a safe and effective management tool in the treatment of laryngotracheostenosis. This technique may be particularly beneficial in patients who are at increased risk for general anesthesia such as those with morbid obesity or who have had a history of airway problems during anesthesia. [ABSTRACT FROM AUTHOR]

Objectives: The pathogenesis of nasal polyps, thought to involve complex interactions between different factors, is currently not fully understood. Recent studies have suggested the involvement of cysteinyl leukotrienes (CysLTs) in nasal polyp development. To further understand the role of CysLTs in polyp pathogenesis, we studied the expression of CysLT1 receptors in nasal polyps. Methods: The study group comprised polyps removed endoscopically from 20 consecutive patients. Samples of ethmoid mucosa from 4 patients who underwent orbital decompression for Graves' ophthalmopathy were used as controls. The presence of CysLT1 receptors was determined with a rabbit anti-human anti-CysLT1 receptor polyclonal antibody. Cells with and without CysLT1 receptor expression were counted within the epithelial layer and stroma by means of light microscopy (40x magnification). Results: There were significantly more cells expressing CysLT1 receptors in the stroma than in the epithelium in both nasal polyps and control specimens. The stroma of polyps also contained more CysLT1 receptor-expressing cells than did controls (29 × 10³ 7 × 10³ versus 3 × 10³ ± 3 × 10³ cells per square millimeter; p < .01). In the epithelium of polyps, there was significantly higher expression of CysLT1 receptors than in controls (7 × 10³ ± 3 ×10³ versus 0 cells per square millimeter; p = .02). No significant differences in polyps were found between patients with and patients without Samter's triad and asthma. Conclusions: The significant up-regulation of CysLT1 receptors we found in both the stroma and the epithelium of nasal polyps suggests the presence of an inflammatory component in the pathogenesis of polyps, and possibly explains the efficacy of leukotriene modifiers in their treatment. [ABSTRACT FROM AUTHOR]

Objectives: In 1965, Bakamjian described the deltopectoral (DP) flap as a reconstructive option in head and neck surgery. It served as the premier flap for reconstructing complex head and neck defects until the late 1970s. Today, the DP flap is often overlooked; although its role has diminished, its use is still warranted in certain select clinical situations. Methods: A retrospective patient chart review of 25 DP flap procedures performed at the University of Iowa Hospitals and Clinics and Iowa City Veterans Administration Hospital between January 1, 1991, and June 1, 2002, was undertaken. The data collected included patient demographics and assessment of DP flap survival and its ability to accomplish established preoperative reconstructive goals. Results: The DP flap was used for the following situations: vascularized skin coverage of the neck, carotid arteries, and face (16 cases), including simultaneous coverage of other reconstructive flaps in 6 cases; controlled orocutaneous fistula development (3 cases) or fistula closure (5 cases); and pharyngoesophageal reconstruction (4 cases). In 3 cases the flap was used for more than one of the preoperative goals described above (n = 25). Minor flap-related complications that required local wound treatment developed in 5 cases (20.0%), but the flaps were successfully salvaged and no subsequent reconstructive procedure was required. In an additional 5 cases (20.0%), the flap failed in some measure to accomplish its preoperative goal, necessitating further surgical reconstruction. Sixteen patients (64%) had undergone previous or simultaneous reconstructive procedures that limited other available reconstructive options. Conclusions: The technical simplicity of the DP flap, coupled with its predictable vascular supply, has allowed it to maintain a niche role in contemporary reconstructive surgery. The DP flap provides an excellent method of reconstruction in select cases in which vascularized skin coverage of the neck is needed. The DP flap also provides a valuable salvage option in situations in which other reconstructive techniques are not possible. [ABSTRACT FROM AUTHOR]

Objective To compare the long-term, health-related quality-of-life outcomes in patients with advanced head and neck cancer (HNC) treated with surgery and postoperative radiation therapy (SRT) or concurrent chemotherapy and radiation therapy (CRT). Design Matched-pair study comparing patients with advanced HNC treated with SRT or CRT at least 12 months after treatment. Patients completed 2 validated surveys addressing HNC-specific outcomes and depressive symptoms and provided information on employment and tobacco and alcohol use. Results for the 2 groups were compared using paired-sample t test and χ2 analysis. Setting University-based study. Patients Patients with stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, and larynx who underwent SRT or received CRT. Main Outcome Measures Head and neck cancer–specific health-related quality of life from the Head and Neck Cancer Inventory and level of depressive symptoms from the Beck Depression Inventory. Results The matching process resulted in 27 patients in each treatment group. The HNC-specific domain scores (with higher scores representing better outcomes) for CRT vs SRT were eating, 37.8 vs 40.8 (P = .69); speech, 65.1 vs 56.0 (P = .23); aesthetics, 80.3 vs 69.2 (P = .14); and social disruption, 69.7 vs 70.6 (P = .90). Overall health-related quality of life was 64.0 with SRT and 55.0 with CRT (P = .142). For the Beck Depression Inventory (with higher scores representing worse outcomes), patients who underwent SRT had a mean score of 9.6 compared with 11.6 for patients who received CRT (P = .42). Conclusion As nonsurgical means of treating HNC have become more aggressive and surgical techniques have become more focused on function preservation and rehabilitation, the overall health-related quality of life resulting from these different approaches is similar. [ABSTRACT FROM AUTHOR]

Background: The efficacy of using a double-bundle versus single-bundle graft for posterior cruciate ligament reconstruction has not been demonstrated. Hypothesis: A double-bundle graft restores knee kinematics better than a single-bundle graft does in tibial inlay PCL reconstructions. Study Design: Controlled laboratory study. Methods: Eight cadaveric knees were subjected to 6 cycles from a 40-N anterior reference point to a 100-N posterior translational force at 10°, 30°, 60°, and 90° of flexion. Testing was performed for the intact and posterior cruciate deficient knee as well as for both reconstructed conditions. Achilles tendons, divided into 2 equal sections, were prepared as both single-bundle and double-bundle grafts. Both grafts were employed in the same knee, and the order of graft reconstruction was randomized. Results: There were no statistical differences in translation between the intact state and either of the reconstructions (P > .05) or between either of the reconstructions at any flexion angle (P > .05). Conclusion: No differences in translation between the 2 graft options were identified. Clinical Relevance: The use of a double-bundle graft may not offer any advantages over a single-bundle graft for tibial inlay posterior cruciate reconstructions. [ABSTRACT FROM AUTHOR]

Objectives: Factors that alter airway surface liquid (ASL) ionic concentrations may influence the course of sinusitis. Xylitol has been shown to effect ASL ionic composition in vitro and to reduce nasal bacterial carriage, otitis media, and dental caries in vivo. We examined the effect of xylitol on experimental sinusitis in the rabbit model.Study Design: Prospective randomized controlled study of xylitol, saline, and Pseudomonas aeruginosa administration to the rabbit maxillary sinus.Methods: P. aeruginosa was administered to the sinuses of 26 New Zealand white rabbits. Saline was placed in the left maxillary sinus and xylitol in the right. The rabbits were randomly assigned to one of three groups: one, simultaneous administration of bacteria and solutions with bacterial analysis at 20 minutes, 11 rabbits; two, preadministration of solutions 1 hour before bacterial infection with analysis at 20 minutes, 11 rabbits; three, established sinusitis, 4 rabbits had daily injections of solutions for 5 days starting 7 days after P. aeruginosa administration.Results: In group 1, 6.96% of injected bacteria were retrieved on the left (saline), whereas 0.095% were retrieved on the right (xylitol) (P = .034). In group 2, 5.64% of inoculum was recovered from the left and 2.89% from the right (P = .188). Group 3 demonstrated evidence of sinusitis with recovery of noninoculate bacteria. with no difference between right and left.Conclusions: Xylitol reduces experimental sinusitis when administered simultaneously with bacteria. Its effect in established sinusitis is less clear. A role may exist for xylitol in nasal irrigation fluid in human disease. [ABSTRACT FROM AUTHOR]

Objective: A major goal of maxillary antrostomy is to increase sinus ventilation. Limited data exist regarding the effect of maxillary antrostomy size on sinus ventilation. We sought to quantify the effect of uncinectomy, small antrostomy, and large antrostomy on maxillary sinus ventilation using xenon-enhanced CT in the sheep model. MATERIALS, STUDY DESIGN, AND METHODS: A xenon-oxygen-air mixture was delivered to 8 fresh cadaveric sheep heads while repeated CT scans were performed through the maxillary sinuses. Baseline and postoperative studies were performed after an endoscopic uncinectomy, small antrostomy, or large antrostomy was created. Images were analyzed to measure the density of the xenon gas in the maxillary sinus as a function of time, generating a time constant. Results: The time constants for both small antrostomy and large antrostomy were significantly different compared to baseline ( P = 0.003 for both). The time constant comparison between small antrostomy and large antrostomy was not significant ( P = 0.948). Conclusions: A small antrostomy produces a statistically significant increase in maxillary sinus ventilation over baseline. No significant further ventilation increase is obtained by creating a large antrostomy in the sheep model. This lends credence to the use of small antrostomies to improve maxillary sinus ventilation in human sinus surgery. [ABSTRACT FROM AUTHOR]

Objective The objective of the study was to evaluate the results of autologous fat injection laryngoplasty in the long-term management of unilateral vocal cord paralysis. Study Design A retrospective chart review and clinical voice re-evaluation of patients treated for unilateral vocal cord paralysis with autologous fat injection at the University of Iowa Hospitals and Clinics (Iowa City, IA) between May 1992 and September 1999. Methods The data analyzed included patient demographics, early and long-term vocal outcomes, additional surgical treatments, and patient survival. Results Fifty patients were treated with fat injection laryngoplasty, which included 44 treated for unilateral vocal cord paralysis. Thirty-one of the patients had fat injection as their primary procedure for permanent voice restoration. Eight patients treated had preoperative and postoperative voice data available. Using the GRBAS subjective voice assessment scale (0, normal; 3, severely abnormal), mean grade improved from 2.1 to 1.3 and breathiness improved from 1.4 to 0.5, at a mean period of 52 days. Thirteen of the 31 patients (41%) required additional procedures to achieve acceptable vocal outcomes. The median time to failure for these patients was 163 days. The initial treatment failure rate at 2 years was 30%, and the rate reached 45% by 4 years. Conclusion Although fat injection laryngoplasty reliably improves the voice over the short term, the long-term voice outcome is unpredictable. Additional surgeries to deal with subsequent vocal deterioration are common. The role of autologous fat injection laryngoplasty in the modern era is limited. [ABSTRACT FROM AUTHOR]

Objective To demonstrate the safety and use of the transcaruncular approach as a surgical technique that provides rapid exposure of the medial orbital wall and apex through a small cosmetic conjunctival incision. Methods The transcaruncular anterior orbitotomy incision is made through the conjunctiva, between the plica and caruncle, with dissection to a subperiorbital plane along the medial orbital wall. This technique was used in 49 patients (58 orbits) between July 1995 and December 2000. The patients' ages ranged from 5 to 89 years (mean, 50 y). Results The transcaruncular anterior orbitotomy approach provided appropriate surgical exposure in all cases of orbital decompression for thyroid-related orbitopathy (in 33 orbits [26 patients]); for biopsy of medial orbital or orbital apex masses in 12 patients; and for drainage of an orbital abscess or marsupialization of a mucocele in 7 orbits (6 patients). Five patients (6 orbits) underwent a transcaruncular approach for release of medial rectus entrapment after fracture. The single complication was 1 patient who required a revision procedure for treatment of medial fornix scarring with resolution of diplopia. Conclusions The transcaruncular approach provides a safe, rapid, and cosmetically pleasing surgical approach to the medial orbital wall and orbital apex. This technique can be used for a variety of indications. [ABSTRACT FROM AUTHOR]

Examines the hierarchical model of the traveling salesman problem (TSP). Details of the artificial intelligence and operations research (AI/OR) and psychological research of TSP; Comparison between the performance of AI/OR algorithms and human subjects; Information on the pyramid algorithm for solving the Euclidean TSP.

Objectives In lymph nodes harboring metastases the reticuloendothelial system is replaced by tumor cells and does not concentrate iron particles. This study assesses the value of contrast magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide particles (Combidex, Advanced Magnetics, Inc., Cambridge, MA) to characterize and stage neck nodes. Study Design Prospective analysis of neck imaging by Combidex MRI, with correlation from pathological assessment of resected lymph nodes. Methods Nine patients underwent MRI and subsequent bilateral neck dissections (three), unilateral neck dissections (five) or fine-needle aspiration (one). Each case was evaluated for the number, location, MRI characteristics, and pathological assessment of lymph nodes. Results Forty-nine separate nodal levels were evaluated with both Combidex MRI and pathological assessment. The presence of metastatic nodal involvement among 45 levels was correctly assessed by the Combidex MRI (three false-negative results, one false-positive result; sensitivity, 84%; specificity, 97%). Analysis was possible for 101 of the individual lymph nodes identified by MRI that could be correlated with individual nodes pathologically examined. Combidex MRI assessment was correct for 99 nodes (one-false positive result, one false-negative result; sensitivity, 95%, specificity, 99%). Standard MRI interpretation without Combidex identified that 12 of 18 nodes (67%) that were greater than or equal to 10 mm (greatest dimension) contained tumor, whereas 9 of 83 nodes (11%) that were less than 10 mm contained tumor. Conclusions Combidex MRI provides functional information to characterize lymph nodes in the clinical staging of squamous cell carcinoma of the head and neck. The inability of MRI to identify small lymph nodes restricts the usefulness of this technique. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship of various pretreatment case-mix characteristics and treatment modalities with medical charges incurred during diagnosis, treatment, and 2-year follow-up for patients with laryngeal cancer. Design: Retrospective chart review and billing record analysis. Methods: The charts and billing records of patients diagnosed with laryngeal cancer at the University of Iowa Hospitals and Clinics (UIHC) between January 1, 1991 and December 31, 1994 were reviewed. The independent variables included various pretreatment patient-mix and tumor characteristics (age, AJCC TNM clinical stage, smoking history, ASA class, and comorbidity as defined by Kaplan-Feinstein grade) as well as type of treatment. The dependent variables included total physician, office, and university hospital-based charges incurred during the pretreatment evaluation and 0- to 3-, 3- to 12-, and 12- to 24-month billing periods after the initiation of cancer-directed therapy. Total 1-year and 2-year charges were also evaluated. Univariate and multivariate analyses were used to investigate the relationships between dependent and independent variables and to develop models predictive of management charges during the individual and total billing periods. Results: Pretreatment charges showed no significant associations ( P < .05) with any of the independent variables. Multiple regression analyses indicated that comorbidity, stage, and initial treatment modality were significant variables in one or more of the models predicting charges incurred during the 0- to 3-month, 3- to 12-month, total 1-year, and total 2-year billing periods. The models yielded R2 values for the total 1- and 2-year billing periods of 0.5246 and 0.5055, respectively. Conclusions: This work supports continued study of measures that may result in earlier detection of laryngeal cancer as a potential means of reducing management charges. These results also indicate that a more accurate method of stratifying the disease severity of laryngeal cancer patients for reimbursement purposes would include measurements of the severity of the index disease as well as comorbid diseases. [ABSTRACT FROM AUTHOR]

The article offers information on a study conducted by the authors on the reconstruction of cranial base with the use of the resorbable polylactide acid plate. Topics discussed include manipulation of the plate according to size, use of the plate within multilayer closure without surgical flaps, reduction in the need of sealants in surgery, and reduced cost compared to the costs of tissue harvest.

Reviews cases of tumefactive fibroinflammatory lesions of the head and neck. Nature of the disease; Characteristic symptoms; Sites of origin; Diagnosis; Treatment and management strategy.