William H. Moretz

Correlation of intraoperative parathyroid hormone levels with parathyroid gland size

Objectives: To study the relationship of intraoperative intact parathyroid hormone levels (iPTH) with parathyroid adenoma weight and volume in patients with primary hyperparathyroidism.

Ossiculoplasty with an intact stapes: Superstructure versus footplate prosthesis placement

Objectives/Hypothesis: Many techniques and prostheses are used for ossiculoplasty in the various situations of ossicular chain status that the surgeon may encounter in tympanoplasty procedures. The current study seeks to determine whether any particular technique or prosthesis used by the author demonstrates superior hearing results with fewer failures. Study Design: Retrospective review. Methods: This study retrospectively reviews a consecutive series of cases with intact stapes superstructures, with an intact malleus handle (Austin‐Kartush group A) and without (Austin‐Kartush group C). The ossiculoplasties were performed with either partial prosthesis techniques from the stapes superstructure to the drum, malleus, or malleus/drum (as is traditionally reported by most authors) or with less frequently advocated total prosthesis techniques from the stapes footplate to the drum, malleus, or malleus/drum. Results/Conclusions: Of cases for which 1‐year postoperative air and bone hearing results were available, group A cases had significantly smaller air‐bone gaps than group C cases. There was no difference in mean air‐bone gaps between partial and total reconstruction within either group A or C. A few partial and total prosthesis types had low failure rates, good mean air‐bone gap hearing results, and tight spread of results to recommend them in group A cases. Total reconstruction had a lower prosthesis failure rate than partial reconstruction in group C cases, although mean air‐bone gap hearing results were the same.

Subjective headache before and after endoscopic sinus surgery.

Background The aim of this study was to show the effect of endoscopic sinus surgery on subjective headache scores in patients diagnosed with chronic rhinosinusitis (CRS) with or without nasal polyps. Methods We performed a retrospective analysis of prospectively collected data from 201 patients over a 2-year period. Headache and Sino-Nasal Outcomes Test (SNOT-20) mean scores were compared preoperatively and 2 years postoperatively on patients diagnosed with CRS with or without nasal polyps. Results Two hundred one patients underwent surgical management of CRS with or without nasal polyps over a 3-year period. One hundred four patients were men and 97 were women, with a mean age of 49 (range, 18–80 years) years. Polyps were present in 78 patients with CRS. The mean subjective headache score based on a 0–10 visual analog scale improved from 4.7 preoperatively to 0.8 2 years postoperatively (p < 0.0001). The mean headache score of 123 patients without polyps was larger compared with 78 patients with polyps (5.1 versus 4.1, respectively; p < 0.05). As previously reported, the mean overall preoperative and postoperative SNOT-20 scores were 28.7 and 6.7, respectively (p < 0.0001). Conclusion Headache is a common symptom with CRS, present in 73.6% of our patients undergoing functional endoscopic sinus surgery for CRS with or without nasal polyps. An overall decrease in mean headache scores was noted at 2-year follow-up.

Detection of Papillary Thyroid Carcinoma With Serum Protein Profile Analysis

OBJECTIVE To determine the sensitivity and specificity of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) for papillary thyroid carcinoma (PTC) detection. DESIGN The SELDI-TOF-MS protein profiles of patients with PTC, patients with benign nodular disease (BND), and healthy controls were analyzed to determine the sensitivity and specificity of SELDI-TOF-MS assay for PTC detection. Data analysis was performed to process the spectral data and classify the disease status of the patients. SETTING Academic tertiary care hospital. PATIENTS Serum samples were collected prospectively from 7 patients with PTC, 8 patients with BND, and 7 healthy control volunteers. INTERVENTION All patients diagnosed as having PTC or BND underwent thyroidectomy from October 21, 2004, to January 31, 2006. MAIN OUTCOME MEASURES Twenty-two serum samples were analyzed. RESULTS Most protein peaks resolved by the SELDI-TOF-MS assay were in the range of 1 to 20 kDa. Classification tree analysis based on peak expression distinguished patients with PTC from those with BND with 85.7% sensitivity and 100% specificity. Serum samples from patients with PTC differed most significantly from those of patients with BND by the underexpression of a protein peak at 11 101 Da. CONCLUSIONS This pilot study demonstrates that proteomic analysis of serum protein profiles distinguishes patients with PTC from patients with BND with a high degree of sensitivity and specificity. Further investigation into the clinical utility of this technology in PTC biomarker detection and surveillance is warranted.

The use of fibrinolysin in the prevention of thrombus formation in small artery anastomoses.

Vascular surgery has progressed rapidly in recent years with the accomplishment of results that a few years ago hardly seemed possible to achieve. The advances have largely been accomplished in the heart and large vessels of the body, but the procedures that have been developed have been somewhat less successful when applied to smaller vessels. When one deals with arteries smaller than 4 mm in diameter, whether accomplishing a simple anastomosis or inserting a graft, a high incidence of thrombosis occurs.4 The thrombus that forms

A survey of 151 patients having surgery for aneurysmal and occlusive arterial disease.

IT IS THE PURPOSE of this paper to present an analysis of some of the pertinent features of a series of patients having surgery for aneurysmal and occlusive arterial disease, to correlate the coexistence of renal, eoronary artery, and hypertensive disease with the arterial disease being treated surgically, and to show the influence of these concomitant diseases on the early occurrence of cardiovascular and renal complications.

The effect of fibrinolysin on the incidence of thrombosis in small-artery suturing.

anastomosed, but most investigators agree that a high incidence of failure occurs when the outside diameter of the artery is 4 mm or less. In some reports the incidence of thrombosis has been in the range of 65 per cent’ while in others it has been about 50 per cent6. In our hands the thrombosis rate has also been about 50 per cent2. Efforts have been made in our laboratory to reduce this high incidence so that results in small artery surgery might compare more favorably with results in surgery of the larger arteries. One of the ways in which we have tried to reduce this high incidence of thrombotic occlusion has been by the use of fibrinolysin,. Since fibrinolysin has been shown to have the ability of dissolving fresh thrombi,’, 5 it would seem that this enzyme might have a beneficial effect in preventing thrombotic occlusion after small artery suturing. In a previous series3 no beneficial effect was demonstrated with fibrinolysin in 10,000and 20,000-unit dosages. It was thought that our poor results may have been due to the small amounts of fibrinolysin used and that the effect of larger amounts should be studied. This report gives the results of these further studies.

Headache and the Patient who Failed Primary Sinus Surgery

Headache is a common symptom in patients diagnosed with chronic rhinosinusitis (CRS), being present in up to 83% of patients [1]. The severity of headaches has been reported to be one of the highest among the most common symptoms associated with CRS [2]. Persistent headache symptoms after primary functional endoscopic sinus surgery (FESS) for CRS may create an unhappy patient and a frustrated physician. An appropriate understanding of the differential diagnoses of headache is important for treating patients presenting to a rhinology practice. In 1997, the American Academy of Otolaryngology – Head and Neck Surgery Rhinosinusitis Task Force published recommendations for symptom-based criteria for the accurate diagnosis of CRS [8, 20]. Headache is considered a minor diagnostic symptom using these criteria.