Faculty Bibliography

Despite multiple advances in medical imaging, noninvasive monitoring of therapeutic efficacy for malignant gliomas remains problematic. An underutilized observation is that malignancy induces characteristic abnormalities of vessel shape. These characteristic shape abnormalities affect both capillaries and much larger vessels in the tumor vicinity, involve larger vessels prior to sprout formation, and are generally not present in hypervascular benign tumors. Vessel shape abnormalities associated with malignancy thus may appear independently of increase in vessel density. We hypothesize that an automated, computerized analysis of vessel shape as defined from high-resolution MRA can provide valuable information about tumor activity during the treatment of malignant gliomas. This report describes vessel shape properties in 10 malignant gliomas prior to treatment, in 2 patients in remission during treatment, and in 2 patients with recurrent disease. One subject was scanned multiple times. The method involves an automated, statistical analysis of vessel shape within a region of interest for each tumor, normalized by the values obtained from the vessels within the same region of interest of 34 healthy subjects. Results indicate that untreated tumors display statistically significant vessel tortuosity abnormalities. These abnormalities involve vessels not only within the tumor margins as defined from MR but also vessels in the surrounding tissue. The abnormalities resolve during effective treatment and recur with tumor recurrence. We conclude that vessel shape analysis could provide an important means of assessing tumor activity.

BACKGROUND: Oral transmucosal fentanyl citrate (OTFC; ACTIQ) incorporates fentanyl into a lozenge allowing drug delivery through the oral mucosa resulting in rapid pain relief. OTFC is effective for breakthrough pain and could be particularly useful in patients with mucositis. METHODS: This randomized, double-blind, crossover study assessed two formulations of OTFC for tolerability in 14 patients with radiation-induced mucositis. On four separate days, patients with grade 3 or 4 mucositis received an OTFC unit 45 min before radiation treatment. Two units had a sweetened matrix formulation and two had a compressed powder formulation. One unit of each formulation contained 200 microg fentanyl and one was placebo. Tolerability, mucositis pain, and formulation preference were evaluated. Changes in oral mucosa were recorded. RESULTS: Both formulations of OTFC were well tolerated. There were no significant differences between formulations in tolerability, patient preference, or VAS pain scores. No changes in oral mucosa were noted. Common treatment-related adverse events included a burning sensation in the mouth, nausea, and vomiting. CONCLUSIONS: Both formulations of OTFC are well tolerated. The presence of fentanyl in either the sweetened matrix or the compressed powder did not alter tolerability or safety. The dose of fentanyl tested did not yield analgesia greater than placebo; future studies of OTFC efficacy in mucositis should evaluate higher doses than 200 microg.

During the last third of the 20th century, pediatric otolaryngology became a defined specialty in many nations, resulting in focused training, fellowships, societies, journals, textbooks, etc. This development occurred as a result of an interaction between the changing sociological and economic status of the child and medical advances. In this paper the history of the status of children is investigated during the Reformation/Counter-Reformation, Enlightenment and Romantic periods, and during the recent era of Entitlement, and an analysis is made of the relationships between otolaryngological care of children during these periods, including a consideration of selected medical advances made during the 17th to 21st centuries, and the evolving status of children. Advances in education of the deaf, understanding the role of the adenoid and care of the airway were applied to the child patient not directly, as it may sometimes seem to physicians caring for a patient in a hands-on fashion, but rather via the bridge of the social and economic context of the time. This interactive process created a special body of knowledge that is now applied in a society that places a high value on the child. In the second half of the 20th century, i.e. during the period of Entitlement, the otolaryngological needs of the child became a demand, based in part upon a need for care of airway pathology in the premature infant, which fostered the establishment of pediatric otolaryngology as a specialty.

OBJECTIVE: The objective of this study was to report an original method of malleus relocation allowing for better placement of both partial and total prostheses in ossicular reconstruction. STUDY DESIGN: We conducted a retrospective review of clinical and audiometric findings. SETTING: A tertiary referral center. MATERIALS AND METHODS: This is a study of 268 patients who underwent ossiculoplasty surgery from October 1997 to October 2000 for chronic otitis media, noninflammatory disease, and otosclerosis revision. Malleus relocation with total and partial ossicular replacement prostheses was used in all cases. Audiometric assessment included pre- and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. RESULTS: A postoperative air-bone gap closed to within 10 dB was achieved in 56% of cases. An air-bone gap smaller than 20 dB was obtained in 78% of cases. Postoperative improvement of air-conduction thresholds superior to 20 dB was found in 41.5% of cases. The postoperative bone-conduction thresholds were unchanged in 98% of cases. One case of total postoperative sensorineural hearing loss was seen in this series (0.4%). Extrusion of the protheses was not observed in this series. Follow up ranged from 6 to 36 months (mean, 12.4 months). CONCLUSION: This study shows that malleus relocation is a safe and efficient technique for ossicular reconstruction. The ideal position of the relocated malleus allows easier and more stable placement of middle ear prostheses.

A myriad of medical and surgical treatment options exist for children with airway hemangiomas. Careful application of these technologies allows for satisfying outcomes in most cases. A review of the literature is presented, plus the author's experience in pediatric otolaryngology regarding the clinical presentation and contemporary management of airway hemangiomas, with an emphasis on subglottic hemangiomas.

Cyclooxygenase (COX) is involved in modulating inflammatory response through the synthesis of prostaglandins. The inducible isoform of the enzyme, COX-2, is overexpressed in some malignant and premalignant lesions. Several preclinical and clinical studies have reported COX-2 inhibition as an effective strategy for chemoprevention. Nonsteroidal anitinflammatory drugs (NASIDs) such as celecoxib, are the most widely investigated COX-2 inhibitors. The oil-soluble diallyl sulfides (DAS) include monosulfides (DAMS), disulfides (DADS) and trisulfides (DATS). They were found to be effective against canine and human tumors, the mechanism of which remains unresolved. We attempted a comparative evaluation of the antiproliferative effect of DAS in HEK 293T cells. The cells were treated with increasing concentrations of DAMS, DADS and DATS. There were significant differences between the IC50 values of DAMS, DADS and DATS. RT-PCR was performed and the expression of COX-2 was compared with that of b actin. DATS inhibited COX-2 gene expression significantly stronger than DAMS and DADS. The data are suggestive of antineoplastic effect of DAS, mediated by controlling COX-2 expression.

Various complications of rhytidectomy have been well described. Although there have been reports of traumatic pseudoaneurysm formation after cosmetic surgery, none has concerned rhytidectomy. We report the first known case of a superficial temporal artery pseudoaneurysm that ostensibly developed 3 months after a face lift. Pseudoaneurysm is an infrequent occurrence in the facial region, and the inclusion of this lesion in the differential diagnosis of soft tissue lesions is important if hemorrhage is to be avoided.