bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Low Titers of Pneumococcal Antibodies
Authors: Beltran Constanza , Aranis Carolina A. , Talesnik Eduardo , Garcia Raimundo
Published: September 2011

Objective

1) Determine the prevalence of low titers of pneumococcal antibodies (PAB) in patients with recurrent infections. 2) Assess whether there is a difference in PAB titers between patients unimmunized and patients vaccinated against pneumococcus.

Method

Cross‐sectional study between September 2006 and May 2008 in patients with recurrent infections. PAB levels against 10 serotypes were measured in all patients, and it was established if they had been vaccinated against pneumococcus. We compared the frequency of PAB low titers between both groups using the chi‐square test.

Results

A total of 257 patients were included in the study, aged between 0 and 68 years (median: 5 years) and with 54% being male. Sixty‐one patients (24%) were vaccinated against pneumococcus. The prevalence of low titers of PAB (more than 50% of the serotypes with levels lower than 1.3 ug/mL) was 43% overall, with 8.2% and 53.6% in vaccinated and unvaccinated patients, respectively (P <. 0001).

Conclusion

Low levels of specific antibodies to pneumococcus is a common condition in patients with recurrent infections. It appears that the pneumococcal vaccine plays an important role in reducing the prevalence of this condition, but prospective studies are needed to prove it and show the clinical usefulness of the vaccine.
Prevertebral Calcific Tendinitis
Authors: Cheng Alex , Zapanta Philip E.
Published: September 2011

Objective

1) Recognize that prevertebral calcific tendinitis of the longus colli is a rare inflammatory noninfectious cause of retropharyngeal fluid. 2) Understand that appropriate treatment of this condition is with anti‐inflammatory medications rather than antibiotics and/or surgical drainage.

Method

We report a rare case of retropharyngeal effusion caused by prevertebral calcific tendinitis of the longus colli muscle. The patient was evaluated and treated in the emergency department of an urban university hospital and was seen one week later in the otolaryngology clinic.

Results

Prevertebral calcific tendinitis of the longus colli is a rare entity that may cause an effusion that can be misdiagnosed as a retropharyngeal abscess. Our patient presented with a 1 day history of worsening neck pain and stiffness, and dysphagia. Absence of fever and a normal white cell count were noted. CT scan revealed a nonrim‐enhancing, nonbulging retropharyngeal fluid collection and calcification of the longus colli tendons near the C2 vertebrae. One dose of intravenous dexamethasone was administered, and the patient’s neck stiffness markedly improved. At 1‐week follow‐up, his symptoms had completely resolved on a steroid taper.

Conclusion

Prevertebral calcific tendinitis of the longus colli may cause a retropharyngeal effusion mimicking abscess. Prompt diagnosis can be made by recognizing the characteristic CT findings in the context of absent clinical evidence for infection. Anti‐inflammatory medications are the treatment of choice.
Basal Cell Carcinoma and Rhinophyma: A Novel Treatment Option
Authors: Velargo Parker A. , Sebelik Merry E.
Published: September 2011

Objective

Resection of basal cell carcinoma (BCCA) from a background of advanced rhinophyma can present a reconstructive challenge, thus a novel surgical treatment option is presented. Report a case of concurrent rhinophyma and BCCA, review the literature, and discuss surgical options available.

Method

A review of the literature reveals only 12 reported cases of concurrent BCCA and rhinophyma since 1955, all describing occult discovery of BCCA. This is the first reported case of known BCCA complicated by rhinophyma.

Results

The traditional repair options after excision of BCCA from the nasal tip include healing by secondary intention, skin grafting, and local flap rotation. In patients with rhinophyma, these options are less than ideal. As a novel alternative, wide local excision of the lesion with intra‐operative frozen section margin control was carried out, followed by single‐stage tangential excision and dermabrasion of the nasal skin involved with rhinophyma. Negative margins were obtained, symmetry and homogeneity of the nasal skin was achieved, and the patient was very pleased with the results. Before and after photo documentation and representative histologic sections will be presented.

Conclusion

The reported synchronous presence of known BCCA and rhinophyma is exceedingly rare. This case demonstrates that both cancer cure and an optimal aesthetic result can be achieved by this novel treatment option.
Screening for Lesions with an Oral Mucosal Brush Biopsy
Authors: Seltzer Paul , Gold Daniel R. , Loewenstein Ronald K. , Carroll Deborah J.
Published: September 2011

Objective

Evaluate the use and impact of providing a noninvasive oral brush biopsy to patients presenting on an initial visit with a mildly or nonsuspicious oral lesion. The cytopathologic findings can be used as confirmatory evidence in support of the clinical impression.

Method

The brush biopsy test provided an option to patients presenting nonsuspicious lesions at our office over a 24‐month period. Impressions regarding obtaining a specimen and time required were monitored. When brush biopsy tests were ordered, cytologic evaluation was performed. Doctors were surveyed on their impressions of the test.

Results

The brush biopsy test was performed on patients with mildly to nonsuspicious lesions. Cytology evaluation was performed, and abnormal or dysplastic cells were reported. Results showed how the brush biopsy cytology confirmed the clinical impressions. Survey of clinicians indicated that tests were relatively easy to perform and could be completed in a reasonable timeframe of less than 10 minutes during the initial visit. Doctors reported benefits of ease of performance, absence of identifiable risks, and complications from the tests.

Conclusion

Oral brush biopsy can be provided to patients as a screening option for oral mucosal lesions that are not highly suspicious. Surveys indicated the test was perceived as an instrument to provide confidence to patients and gather information early with no complications and risk factors during the visit.
The Modified Nasal Trumpet: Revisiting a Novel Technique in Management of the Difficult Airway
Authors: Rodwell David Watson , Saltzman Joel , Thompson Jerome W.
Published: September 2011

Objective

1) Highlight an underutilized method for use of the nasal trumpet in management of the difficult airway. 2) Review the application of this technique in multiple clinical scenarios.

Method

Report of technique and application in airway management.

Results

There are a multitude of techniques and devices available to assist with intubation and ventilation for both the difficult patient and those that do not pose a significant challenge in airway management. The use of a nasal trumpet with an endotracheal tube connector represents an additional means of establishing ventilation and providing inhalational anesthesia. This technique has proven extremely useful to the senior author over many years in the pediatric population in a wide variety of clinical scenarios. We review the technique and clinical application.

Conclusion

The use of the modified nasal trumpet has been previously reported in the anesthesiology literature, but represents a critical skill and technique of airway management that should be familiar to all otolaryngologists.
Tick Bites for the Otolaryngologist
Authors: Walton Benjamin , Pine Harold S.
Published: September 2011

Objective

The human head and neck can provide multiple environments ideal for parasitic invasion. One of the more common parasites encountered is the tick. We report a specific case involving a tick bite involving the external auditory canal. There is a lack of evidence on the proper treatments.

Method

“Ticks,” “tick bites,” “head and neck,” and “otolaryngology” were searched in PubMed, and relevant articles were selected and reviewed.

Results

Ticks and tick‐borne diseases are outlined, and common presentations of head and neck involvement are examined. Ticks appear to be resistant to common anesthetic chemicals used in the ear. Proper removal is important in preventing transmission of disease and local skin infection. Geography and tick species dictate treatment and follow‐up. We recommend antibiotic prophylaxis for certain tick species making proper tick identification important.

Conclusion

The otolaryngologist must be aware of the many differing pathogens, their epidemiology, and their treatments. Proper removal and identification of the tick are very important in further follow‐up and treatment. We present an invaluable but simplified tool in the identification, removal, and management of ticks and tick bites.
Transepithelial Monitoring for Reoccurrence of Oral Cavity Cancer
Authors: Seltzer Paul , Loewenstein Ronald K. , Carroll Deborah J. , Buechler R. Bruce
Published: September 2011

Objective

Attempting to minimize additional biopsy and disfigurement in suspicious areas with resection from previous oral cavity cancers, we utilized and evaluated the results provided from a brush biopsy prior to making further treatment decisions.

Method

Over the past 2 years, brush biopsies were performed on patients with a past history of oral cancer who, during periodic reevaluation, presented with a suspicious lesion. During the evaluation period, cytopathology results were evaluated in conjunction with provided clinically relevant information and correlated with clinical treatment decisions.

Results

In a review of 22 cases, evaluation of brush biopsy specimens revealed abnormal or dysplastic cells in 27% of cases; these patients either had surgical biopsy or definitive treatment. In 72% of cases abnormal or dysplastic cells were not identified; these patients were placed on a periodic reevaluation protocol.

Conclusion

Brush biopsy cytology can provide information useful for monitoring patients with a history of oral cancer who present with suspicious lesions. Findings from brush biopsy can be utilized in some cases to place a patient into definitive treatment or on an observation.
Transoral Robotic Surgery: A Novel Technique to Treat Eagle Syndrome
Authors: Gudis David , Newman Jason G. , Leahy Kevin
Published: September 2011

Objective

1) Report a novel surgical approach to perform a styloidectomy for Eagle syndrome. 2) Propose a new indication for transoral robotic surgery.3) Demonstrate improved exposure and visualization of a skull base region where critical neurovascular structures are at risk.

Method

We report a case from 2010 of a 47‐year‐old woman presenting with unilateral vocal cord dysfunction, neck pain, throat pain, dysphagia, and odynophagia. Her symptoms, beginning after neck trauma, fluctuated with neck positioning. The diagnosis of Eagle syndrome was confirmed by CT, and a transoral robotic styloidectomy was performed.

Results

When conservative management failed to improve the patient’s symptoms, a transoral robotic‐assisted tonsillectomy, pharyngoplasty, and styloidectomy of her elongated right styloid process were successfully performed with the da Vinci surgical robot. Postoperatively the patient recovered well and reported significant improvement of her symptoms. To the authors’ knowledge a transoral robotic styloidectomy for Eagle syndrome has never before been described. The improved exposure and magnified visualization achieved with the transoral robotic approach represents a significant advent in a skull base procedure in which several critical neurovascular structures are at risk.

Conclusion

Eagle syndrome is a rare diagnosis of unilateral lower cranial neuropathy (IX, X) secondary to irritation from an elongated styloid process. Traditionally transoral and transcervical styloidectomy procedures are performed. We propose that transoral robotic surgery provides improved visualization and exposure of a surgically high‐risk region of the skull base.
Understanding the Role of PAs in Otolaryngology
Authors: Reilly Brian K. , Zalzal George H. , Shah Rahul K. , Preciado Diego A.
Published: September 2011

Objective

Examine the impact and trends for academic physician assistants (PAs) who have become contributing members of an urban pediatric otolaryngology practice. We will compare these outcomes to regional and national trends among otolaryngology groups.

Method

This will be an electronic survey study. This survey will be through the web‐based service “SurveyMonkey.” There will be complete anonymity among respondents. Survey data will be password protected.

Results

Our study will contribute the following: 1) A better understanding of trends among otolaryngology practices regarding utilization of PAs between different subspecialties within otolaryngology. 2) An analysis of the evolving role of PAs, looking at how they complete their subspecialty training, the length of the shadow period, and the breakdown between the outpatient and inpatient setting. A comparison of PAs’ practice patterns in private versus academic practice. (3) An analysis of patient satisfaction and department and physician productivity measures. (4) A better understanding of trends among otolaryngology practices regarding utilization of PAs versus Nurse Practitioners (NPs).

Conclusion

PAs have been providing medical care for patients since the 1960s and perform many of the supervised services that physicians offer. PAs are able to consult patients, formulate treatment plans, perform procedures, and prescribe medications. In addition, PAs have been fulfilling a critical need when there is a shortage of doctors.
Virtual Reality Rehabilitation for Vestibular Dysfunction
Authors: Wang Pa‐Chun , Chang Chia‐Huang , Su Mu‐Chun , Yeh Shih‐Ching , Fang Te‐Yung
Published: September 2011

Objective

People with chronic vestibular dysfunction can be treated with balance rehabilitation. Virtual reality (VR) technology may serve as a useful therapeutic tool to facilitate rehabilitation. The aim of this pilot study was to investigate the clinical applicability of VR technology in treating patients with vestibular dysfunction.

Method

Five patients with chronic vestibular dysfunction were recruited for this uncontrolled clinical study. The rehabilitation protocol (modified Cawthorne‐Cooksey exercises, MCCE) was adapted into a VR‐based training system. Patients followed the instructions of MCCE to complete 20 sessions of vestibular rehabilitation within a 4‐week period.

Results

A VR‐based rehabilitation system was developed with various latest technologies, including Kinect Xbox for full‐body interaction, 3D‐ready projector with shutter‐glasses for stereo imaging, Wii Fit pressure pad for tracing the center of gravity, and Unity game engine for leveled‐difficulty design. Five VR tasks were built, and more than 100 training trials were designed. Subjectively, all patients experienced the improvement of balance function performing daily activities and were overall positive to the training protocol. After intervention the fast component of postural sway (P <. 05) was reduced. The follow‐up interview showed decreased disability and increased general health.

Conclusion

VR has many advantages over traditional rehabilitation techniques in improving the testing or training environment of human performance. This study demonstrates that VR technology offers great promise in the field of vestibular rehabilitation.
Warthin Tumor of Nasolacrimal Duct
Authors: Ahmadi Neda , Grant Nazaneen N.
Published: September 2011

Objective

1) Review anatomy of the nasolacrimal apparatus. 2) Learn about common primary tumors of the nasolacrimal apparatus and their clinical presentation. 3) Present a rare type of nasolacrimal duct tumor. 4) Discuss the utility of combined endoscopic and external techniques for removal of nasolacrimal duct tumors.

Method

Retrospective case report and review of literature.

Results

A 67‐year‐old woman presented with cough and post‐nasal drip. Examination revealed a right‐sided nasal cavity mass anterior to the middle turbinate. Upon further questioning, she reported a history of right nasal dorsal pain, but denied epiphora, epistaxis, and ocular symptoms. Imaging revealed a mass originating from the right nasolacrimal duct with extension into the right peri‐orbital soft tissues. The tumor was completely excised via combined endoscopic and external approaches. Histopathologic examination identified the lesion as Warthin tumor. At 1 year postoperatively, the patient is disease‐ and symptom‐free.

Conclusion

Primary tumors of the nasolacrimal apparatus are rare. These tumors must be in the differential diagnosis of a patient presenting with nasal obstruction, epiphora, and nasal‐cavity mass. It is important for otolaryngologists to be familiar with the different pathologies that involve the nasolacrimal apparatus and their clinical presentation.
Acellular Dermal Matrix Reconstruction of the Head and Neck: A Versatile Reconstructive Option
Authors: Mitchell Joshua R. , Robinson Jamie , Rangarajan Sanjeet , Dhulipala Sravan , Netterville James L. , Athavale Sanjay M.
Published: September 2011

Objective

Ablative procedures of the head and neck often result in significant contour defects. Acellular dermal matrices (ADM) are relatively resistant to infection and accommodate long term facial growth. Our objective is to confirm the benefits of acellular dermal matrix reconstruction in post‐ablative head and neck defects.

Method

Patients who underwent ADM reconstruction of the head and neck since 1997 were identified. Of 265 patients identified, 205 met the inclusion criteria. The pathology, surgical location, long term imaging, cosmetic outcome, and complications were analyzed. Postoperative cosmetic results were assessed by a novel patient‐based numerical grading scale.

Results

The mean age was 60.4 years. One hundred thirty‐two patients were male (77%) and 40 patients were female (23%). ADM were used to correct a variety of defects with the most common location being the parotid gland (n = 65) followed by the neck (n = 60), low neck/thyroid bed (n = 35), and skull base (n = 30). A majority of patients had a diagnosis of benign parotid lesions (n = 40) although numerous pathologies were identified. Only 3 patients had a complication related to their ADM recipient site (4%). The patient postoperative cosmesis survey is still pending.

Conclusion

With regard to function and cosmesis, ADM is an excellent head and neck reconstructive option with few complications. Moreover, ADM can be used in a variety of locations and patients tend to be very happy with their final cosmetic outcome.
Bacteriology of Deep Neck Abscesses: A Retrospective Review of 96 Cases
Authors: Lee Yan Q. , Kanagalingam Jeevendra
Published: September 2011

Objective

Review the microbiology of deep neck abscesses and identify the factors that influence their occurrence.

Method

Retrospective chart review of 96 patients diagnosed with deep neck abscesses in the Department of ENT at Tan Tock Seng Hospital, Singapore between 2004 and 2009. Logistic regression was applied to analyze and compare the incidence of common organisms in various conditions (age, gender, etiology, and effect of diabetes).

Results

Of the 96 patients recruited, 18 had polymicrobial cultures. The leading pathogens cultured were Klebsiella pneumoniae (27.1%), Streptococcus milleri group (SMG) bacteria (21.9%), anaerobic bacteria ‐ not otherwise specified (NOS) (20.8%). Klebsiella pneumoniae (50.0%) was over‐represented in the diabetic group. SMG bacteria (68.8%) and anaerobic bacteria ‐ NOS (43.8%) were most commonly isolated in patients with odontogenic infections. Klebsiella pneumoniae was found more commonly among the female patients (39.3%). Klebsiella pneumoniae was the most common organism cultured in parapharyngeal space abscesses, while the submandibular space and parotid space most commonly isolated SMG bacteria and Staphylococcus aureus respectively.

Conclusion

Broad‐spectrum antibiotics are recommended for treating deep neck abscesses. Empirical antibiotic coverage against Klebsiella pneumoniae infection in diabetic patients and SMG and anaerobic bacteria in patients with an odontogenic infection is advocated. Routine antibiotic coverage against gram‐negative bacteria is not paramount.
Classification System for Lateral Pharyngotomy
Authors: Shires Courtney B. , Rodwell David W. , Sebelik Merry E. , Samant Sandeep
Published: September 2011

Objective

1) Propose a classification system of lateral pharyngotomy (LP) used in exposing various sites of the oropharynx, supraglottis, and hypopharynx. 2) Describe the structures visible with each category of lateral pharyngotomy.

Method

An anatomic study on 5 fresh‐frozen human cadavers was carried out at the Medical Education and Research Institute. After exposure of the anterior compartment of the neck and laryngeal framework, progressively more extensive pharyngotomy was performed. The pharyngeal structures exposed with each extension were recorded by video and still photography.

Results

Entry into the pharynx between the hypoglossal nerve cephalically and the superior laryngeal nerve caudally (Type I LP) provided exposure of the epiglottis and ipsilateral tongue. Exposure toward the pyriform apex was facilitated by dividing the superior laryngeal artery (Type II LP). This provided exposure to the postcricoid area, arytenoids, and cervical esophageal inlet. The digastric and stylohyoid muscles were transected (Type III LP) to provide exposure of the entire base of tongue, uvula, and soft palate. Division of the hyoglossus and mylohyoid muscles was classified as Type IV LP, adding visualization of the vallecula and contralateral tonsil.

Conclusion

An appropriate class of pharyngotomy may be chosen depending on the structures requiring exposure. This cadaver‐based anatomic study delineated the anatomic structures to be divided to facilitate exposure of pharyngeal subsets. A classification system is proposed that defines the steps in gaining access to the pharynx.
Clinicopathologic Review of Mucoepidermoid Carcinoma
Authors: Ann Byrd Serena , Light Emily , McHugh Jonathan , Bradford Carol R. , Prince Mark E. , Spector Matthew E. , Carey Thomas
Published: September 2011

Objective

1) Describe the epidemiology of mucoepidermoid carcinoma (MEC) in the head and neck treated at a tertiary care hospital. 2) Determine clinical and pathologic predictors of recurrence and survival in patients with mucoepidermoid carcinoma in the head and neck treated at a tertiary care hospital.

Method

Medical records of 94 patients (mean age, 50.4 years; M:F, 48:46) who underwent surgical treatment for MEC of the head and neck between 1995 and 2010 were reviewed. Main outcome measures were DFS, DSS, and OS. Clinicopathologic parameters evaluated were age, sex, TNM stage, subsite, adjuvant therapy, tumor grade, and margin status.

Results

Of the 94 patients, 42 parotid, 26 palate, 12 oral, 9 submandibular/sublingual, 4 orbital, and 1 parapharyngeal tumors were identified. All patients underwent surgical resection, 32 patients had postoperative radiation and 3 postoperative chemoradiation. The 5‐year OS and DSS were 79% and 90% with a median follow‐up of 72 months and 45 months, respectively. The 5‐year DFS was 74% with 12 patients developing recurrence. On univariate analysis, age >50 (P =. 01), male sex (P =. 008), positive nodal status (P =. 01) and high‐grade histology (P =. 003) were predictive of poor prognosis. On multivariate analysis, high‐grade histology (P =. 02) and male sex (P =. 04) were predictive of poor prognosis.

Conclusion

The epidemiology of MEC is consistent with previous studies. High grade histology continues to be the strongest independent predictor of survival in MEC followed by male sex. Further studies into the molecular biology of MEC that may account for such clinicopathologic features are warranted.
Descending Necrotizing Mediastinitis: Surgical Management
Authors: Pérez‐Fernández C. Aranzazu , Rombola Carlos A. , Javier Diaz‐Fernández Francisco J. , Contreras J. Diego , Ceballos Juan C. , Rodríguez‐Francos M. Isabel , de Sevilla Tomas G. F.
Published: September 2011

Objective

Descending necrotizing medistinitis (DNM) is commonly caused by odontogenic infection, peritonsillar abscess, or retropharyngeal abscess. The diagnosis must be established rapidly. Because mortality rates are too high, aggressive surgical treatment is indicated. This investigation reviews the effects of surgical drainage on the survival of patients with DNM.

Method

A retrospective review of patients from 2003 through 2010 with a diagnosis of DNM was performed. Their records were abstracted for personal demographics, hospital course, surgical treatment, morbidity, and mortality. The records of all patients were statistically analyzed for the impact of several clinical factors on survival.

Results

We treated 13 patients (12 men, 1 woman) in whom DNM was identified. DNM was consecutive to dental abscess (6 cases), pharyngitis (5 cases), foreign body infection (1 case), and after tracheotomy (1 case). The mean age of the patients was 56 years (range, 26‐85 years). Surgical treatment consisted of: in 6 patients combined transthoracic mediastinal and cervical drainage and in 7 patients with a less aggressive surgical approach, such as cervical drainage and transcervical mediastinal drainage. Four patients required reoperation. Tracheotomy was performed in 4 patients. Two deaths occurred. The mean duration of hospitalization was 29 days.

Conclusion

DNM must be detected as soon as possible by computer tomography scanning in patients with persistent symptomatologia after treatment for pharyngeal infections. Early diagnosis and aggressive treatment are important. Ample cervicotomy associated with mediastinal drainage is essential in managing these critical patients and can significantly reduce the mortality rate.
Does Academic Output Affect Mortality Rates in NHS Trusts?
Authors: Bennett Warren , Bird Jonathan , Burrows Stuart , Reddy Venkat
Published: September 2011

Objective

It has been claimed that institutions engaging in academic activities provide better care. The aim of this study was to establish whether there is an association between academic output and mortality rates for NHS Trusts (NT).

Method

Standardized mortality rates for 2010 were obtained from www.drfosterhealth.co.uk. MEDLINE was queried to establish the number of citations credited to NT from 2006 to 2010. Admissions for NT for 2009‐2010 were obtained from www.hesonline.nhs.uk. The number of citations per admission was calculated and used as an indicator of academic output.

Results

Spearman rank analysis was performed to identify any correlation between citations per admission and the inverse of 4 types of mortality rates: high risk conditions r = 0.20 (P =. 01); low risk conditions r = ‐0.06 (P =. 46); deaths after surgery r = 0.193 (P =. 019); overall mortality 0.291 (P <. 01).

Conclusion

The results of this preliminary study demonstrate a statistically significant correlation between academic output and mortality rates. However, it should be noted that the correlation coefficients are small, but the findings of this study encourage further debate.
Preclinical Strategies to Optimize Optical Imaging in Head and Neck Cancer
Authors: Sweeny Larissa , Zinn Kurt , Cheng Zheng , Miao Zheng , Bishop Elliot S. , Rosenthal Eben L. , Knowles Joseph
Published: September 2011

Objective

There is a need for cancer imaging in the clinic and operating room. We have shown that fluorescently labeled antibodies can detect microscopic islands of head and neck cancer cells using modified intraoperative microscopes in preclinical animal studies. Here we evaluated the optimal targeting molecule for clinical translation.

Method

We assessed in vitro binding of fluorescently labeled antibodies targeting EGFR (cetuximab/Erbitux and panitumumab/Vectibix) and an antibody mimetic (anti‐EGFR affibody) in multiple cell lines (SCC5, OSC19, FADU). To compare in vivo imaging characteristics, HNSCC xenografts (SCC5, SCC1, FADU) were imaged after systemic injection of fluorescently labeled antibodies over 5 days.

Results

The binding affinity was lower for the control antibody IgG (KD = 9.55 nM) compared with either panitumumab (KD = 6.82 nM) or cetuximab (KD = 2.86 nM). In vitro, panitumumab had a two fold increase in relative fluorescence compared with cetuximab and a four fold increase in fluorescence compared with control antibody (nonspecific IgG). Xenograft imaging in vivo demonstrated a variation in fluorescence intensity that correlated with circulating half‐lives: peaks in fluorescence intensity were seen at 1.5 h (affibody) and 48 to 72 h (cetuximab, panitunumab). The pantitumumab and affibody images demonstrated greater tumor fluorescence and lower background signal compared to cetuximab.

Conclusion

Panitumumab/Vectibix demonstrated optimal imaging characteristics which appeared to be related to its binding affinity and increased circulation time. These characteristics may allow for increased localization to the tumor site. Panitumumab may be the optimal antibody for clinical translation since it will decrease false positive rates associated with non‐specific uptake.
Report of Outpatient Parathyroid Surgery: The UHC Database
Authors: Stack Brendan C. , Bodenner Donald , Spencer Horace , Moore Evan R.
Published: September 2011

Objective

Determine demographics and cost analysis for outpatients undergoing parathyroid surgery at hospitals belonging to the University Health System Consortium (UHC).

Method

The UHC, Oak Brook, Illinois, was formed in 1984 and consists of 107 academic medical centers and 232 of their affiliated hospitals. This represents 90% of the nonprofit academic medical centers in the United States (www.uhc.edu). Data was collected from 2004 through 2009 (21 quarters).

Results

There were 13,969 patients who had outpatient parathyroid surgery. The average age was 58.3 (13.5) years. A total of 76.2% of patients were female. The outpatient data is collected from fewer UHC institutions than report their inpatient data. Outpatient data was compared by institutions which reported both out‐ and inpatient data. A total of 1,890 inpatients (from 12 quarters, 2007‐9) with an average LOS of 2.3 days and average facility cost of $7,852 served as an inpatient reference group.

Conclusion

Parathyroid surgery is increasingly being done in the outpatient setting. By virtue of improved surgical technique, anesthesia technique, hemostatic methods, and calcium management this can be done safely. The outpatient approach is a cost effective way to manage parathyroid disease. This is the largest known series reporting outpatient parathyroid surgery.
Robotic Surgery as Monotherapy for HPV Positive Oropharyngeal Cancer
Authors: Steven Olsen , Price Daniel L. , Moore Eric J. , Kasperbauer Jan L. , Janus Jeffrey R. , Olsen Kerry D.
Published: September 2011

Objective

Describe the oncologic results achievable when treating oropharyngeal squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) and neck dissection as monotherapy. Evaluate the patient selection, functional outcomes, morbidity, and cost of this treatment option.

Method

Data was collected prospectively on patients undergoing TORS and neck dissection for OPSCC from April 2007‐present. Patients treated with surgery alone and a minimum 18‐month follow‐up were included in the study. Primary outcomes include disease control, survival, HPV status, and tracheostomy and G‐tube rate.

Results

During the study period 90 patients underwent TORS for OPSCC and 18 were treated with surgery alone due to favorable tumor findings or refusal of adjuvant therapy. Sixty‐eight percent of tumors were HPV positive. Stage distribution included; 7 stage I, 5 stage II, 3 stage III, and 3 stage IVa. Mean follow‐up was 27 months. Complete disease control and disease‐specific survival was achieved in 83% and 94% of patients, respectively. Among HPV‐positive patients, 100% survival and 90% disease control were achieved. No patients required long‐term tracheostomy or G‐tube placement.

Conclusion

TORS is an effective modality for treating select OPSCC. Low complication rates and excellent functional outcomes were achieved with TORS.
The Clinical Implications of Non‐diagnostic Fine Needle Aspirates of the Thyroid Gland
Authors: Sofferman Robert A. , Elhosseiny Abdel , Song Tara
Published: September 2011

Objective

Investigate the findings in repeat samples of patients with initial ultrasound‐guided non‐diagnostic fine needle aspirates (FNA) of thyroid tissue performed and interpreted over the most recent 10‐year period at the University of Vermont.

Method

Retrospective review of medical records for patients with nondiagnostic thyroid FNAs. Patients were identified using a pathology laboratory information system according to specific search parameters. Patients were excluded if ultrasound guidance was not used and if documentation in the medical records was limited.

Results

A total of 239 patients met inclusion criteria. Of the 239, 145 have undergone follow‐up FNA, surgical intervention, or both. There were 19 documented neoplasms after initial non‐diagnostic FNA, including 2 incidental papillary microcarcinomas, 3 incidental follicular variant of papillary microcarcinomas, 1 follicular carcinoma, 7 papillary carcinomas, 2 follicular variant of papillary carcinomas, 1 non‐Hodgkin DLBCL, 2 Hurthle cell neoplasms, and 1 follicular neoplasm. Excluding the 3 microcarcinomas, there were 13 significant neoplasms in the ipsilateral lobe (5%). For the 61 patients (25%) who were lost to follow‐up before a definitive diagnosis was made, we cannot draw final conclusions regarding malignancy.

Conclusion

Our study reveals significant potential for malignancy in patients with nondiagnostic FNAs. The IRB has granted permission to contact the 61 patients lost to follow‐up before a definitive diagnosis was made. Delayed samples will be included as a separate analysis to profile this series of patients with nondiagnostic cytology.
The Learning Curve in Transoral Robotic Surgery: A Multi‐institutional Registry
Authors: Vergez Sebastien , Lallemant Benjamin , De Mones Erwann , Ceruse Philippe , Mallet Yann , Aubry Karine , Morinier Sylvain
Published: September 2011

Objective

Assess the learning curve of transoral robotic surgery (TORS) observed in the French TORS group, gathering 7 different tertiary referral centers. The oncologic results are presented separately.

Method

A multi‐institutional prospective record was done between 2008 and 2010. A total of 76 consecutive patients scheduled for a TORS have been included. The benefits observed with this technique, the operative times, conversion rate, and morbidity are described. The pitfalls encountered are detailed and responses are formulated to avoid them.

Results

Most patients had a laryngeal (supraglottic) and/or hypopharyngeal resection (65%). 30/76 patients operated by TORS would have had a transoral laser resection as alternative surgery. Tumor exposure was suboptimal in 24% of cases. Two out of 76 conversions in open‐approach were necessary. In the beginning, there were 2 deaths due to complications after hemorrhage in patients with high co‐morbidities. The median‐time of set‐up and procedure were respectively 60 ± 55 and 120 ± 89 minutes. The learning curve was characterized by a decrease of these durations in all the centers (P = ns), a better selection and management of patients candidates.

Conclusion

Excellent visualization and skill offered by the robotic assistance allowed transoral resection of tumors unresectable with laser surgery. Surgeons improved rapidly their exposure and resection abilities. Nevertheless, a strict selection of patients is essential. Even with a minimal invasive intent, some of them need a tracheostomy for safety reasons.
TKI258 Is Efficacious as a Multitargeted TKI in Head and Neck Squamous Cell Carcinoma Models
Authors: Sweeny Larissa , Hartman Yolanda , Liu Zhiyong , Rosenthal Eben L. , Knowles Joseph
Published: September 2011

Objective

Dovitinib (TKI28) is a multitargeted tyrosine kinase inhibitor that has not been previously investigated in the pre‐clinical setting for the treatment of head and neck squamous cell carcinoma (HNSCC). Dovitinib is administered orally and targets receptors (FGFR1/2/3 and PDGF‐beta) known to promote cell survival and proliferation and decrease cell apoptosis.

Method

HNSCC cell lines and human tumor samples were evaluated for FGFR1/2/3, and PDGF‐beta expression levels. Cell lines (FADU, SCC1, OSC19, Cal27, SCC22A) were treated with a range of physiological concentrations of dovitinib and assessed for proliferation, cytotoxicity, and apoptosis. Mice bearing HNSCC xenografts were treated with dovitinib (20 mg/kg).

Results

Elevated expression of FGFR2, FGFR3, and PDGF‐beta were indentified in HNSCC cell lines and human tumor specimens. In vitro, dovitinib reduced HNSCC cell proliferation (40‐80%) and viability (40‐60%). In a dose‐dependent fashion, dovitinib also induced cytotoxicity and apoptosis in HNSCC cell lines. When co‐cultured with fibroblasts, HNSCC cells proliferation was also decreased by dovitinib. In vivo, oral administration of dovitinib resulted in significant tumor regression and growth inhibition (67%). Disease‐free survival at 75 days following completion of treatment was 33% and stable disease occurred in another 33%.

Conclusion

This is the first report to demonstrate dovitinib inhibits HNSCC cell growth in vitro and in vivo.
Trends in Total Laryngectomy: A Population Based Study
Authors: Maddox Patrick Tate , Davies Louise
Published: September 2011

Objective

1) Understand time trends in total laryngectomy rates across the US, including rates of surgery, cost, length of stay, teaching status, size of hospital, and insurance payer. 2) Understand what role the paradigm shift in primary treatment of laryngeal cancer may mean for surgical outcomes, cost, and length of stay.

Method

Population‐based study from 1997 to 2008 utilizing the HCUP‐NIS database: a stratified sample of all US hospital discharges. The sample was all patients who had a principal procedure of ICD‐9 code 30.3 or 30.4 (complete or radical laryngectomy). The unit of analysis was census area: Northeast, South, Midwest, and West.

Results

The number of laryngectomies done in the US decreased by 32% during the study period. New cases of laryngeal cancer decreased 26% during the same time. The highest rate of laryngectomy is in the South, the lowest in the Midwest and West. Mortality for the procedure is highest in the Northeast: 2.1%. Mean length of stay over the study period increased from 12.7 days to 13.9 days. Length of stay is shortest in the South. Median hospital charges rose dramatically (in 2008 dollars), from $34,934 in 1997 to $61,507 in 2008. Medicare remains the dominant insurance source.

Conclusion

The rate of total laryngectomy has dropped more than the incidence of laryngeal cancer has dropped—suggesting that larynx preservation treatment has become dominant. Some implications of this shift are previously unexplored. As the number of procedures drops, the utility of a detailed registry to track outcomes becomes even greater.
Ultrasound Therapy Boosts Drug Toxicity In Vitro and In Vivo
Authors: Knowles Joseph , Sorace Anna , Heath C. Hope , Lancaster Will , Rosenthal Eben L. , Hoyt Kenneth
Published: September 2011

Objective

Ultrasound‐mediated therapy (UST) utilizes mechanical vibration of microbubble contrast agent to enhance cell permeability and anti‐cancer drug delivery. Here we determine if UST can improve cisplatin or cetuximab treatment of HNSCC in vitro and in vivo.

Method

Cell permeability was assessed after UST in four HNSCC cell lines (SCC1, SCC5, Cal27, and FaDu). Combination of UST with cisplatin or cetuximab was assessed by cell survival in vitro. In vivo effects on flank tumors were measured in immune‐suppressed mice.

Results

Cell permeability was 48.2 ± 4.8% greater in cells treated with UST compared to controls (P in vitro, UST alone had no effect on cell survival (P =. 59), but combination treatment with cetuximab (P =. 002) or cisplatin (P in vivo) (P =. 81), but combination with cetuximab (P =. 04) orcisplatin (P =. 01) enhanced their antitumor effects. TUNEL analysis of flank tumors demonstrated increased apoptosis in UST+ cetuximab (55% vs 44%, P =. 05), and UST+ cisplatin (84% vs 77%, P =. 24) compared with monotherapy with either drug.

Conclusion

The antitumor effects of cetuximab and cisplatin in HNSCC are enhanced by concurrent treatment with ultrasound‐mediated therapy in vitro and in vivo.
Assessment of Donor Site Morbidity for Osteocutaneous Radial Forearm Free Flaps
Authors: Sinclair Catherine Fiona , Givi Babak , Schneider Daniel S. , Rosenthal Eben L. , Gleysteen John , Wax Mark K.
Published: September 2011

Objective

1) Assess donor site morbidity following harvest of osteocutaneous radial forearm free flaps (OCRFF). 2), Evaluate patient perceived upper limb disability for osteocutaneous vs fasciocutaneous radial forearm free flaps

Method

Retrospective cross‐institutional review of OCRFF performed between 2001 and 2010. There were 218 included patients. The primary outcome measure was forearm donor site morbidity. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to compare patient perceived arm disability for osteocutaneous vs fasciocutaneous radial forearm flaps.

Results

Mean patient age was 63 years with a male predominance (63%). The left arm was the donor site in 86%. Median bone length harvested was 8 cm (range, 3‐12 cm). Following harvest, the radius was plated in 99% of patients. Recipient sites primarily included the mandible (62%) and maxilla (34%). Donor site morbidity included fracture (2 patients, 0.9%) and sensory neuropathy (5 patients, 2%). Fractures were treated with open reduction and internal fixation without functional deficits. Hardware extrusion was the most common complication at the recipient site (29 patients, 13%).

Conclusion

Reluctance to perform OCRFF by surgeons usually centers on potential donor site morbidity. However, we identified minimal objective or patient perceived donor site morbidity following harvest of OCRFFs.
Can the Reflux Symptom Index Score Predict the Reflux Finding Score?
Authors: Marcum Kristin K. , Lintzenich Catherine R. , Butler Susan G. , Wright S. Carter
Published: September 2011

Objective

1) Learn if reflux symptom index (RSI) score correlates with reflux finding score (RFS). 2) Determine if there is a difference in calculating the Reflux Finding Score between experienced laryngologists and novice otolaryngologists. 3) Determine if age, body mass index, sex, or RSI can predict the reflux finding score.

Method

A total of 204 healthy subjects, ages 20 to 88 years, underwent a distal chip laryngoscopy and completed a RSI questionnaire. Two otolaryngologists blinded to the subjects’ age, sex, BMI, and RSI then calculated the RFS. Data were then collected and used to calculate a relationship between the RSI and RFS.

Results

The objective was to determine if we could predict a subject’s RFS based on their RSI score. The findings were not significant. The subject’s age, BMI, sex, and RSI score were all compared against the RFS score, and no significant correlation was identified. To calculate interrater reliability, the junior otolaryngologist’s and laryngologist’s scores were compared. To calculate the intrarater reliability, 22 of the 204 subjects’ captured images were duplicated and placed into the pool of subjects with a new number to compare if both scores were similar.

Conclusion

RSI cannot accurately predict a subject’s RFS from a distal chip laryngoscopy in normal healthy subjects. We did not see a correlation between age, sex, or BMI in predicting RFS. Test‐retest intrarater reliability for both the experienced laryngologist and novice otolaryngologist were each significant; however, interrater reliability was not significant.
Endoscopic vs Open‐Neck Zenker Diverticulum Surgery
Authors: Seth Rahul , Rajasekaran Karthik , Kominsky Alan , Scharpf Joseph , Lorenz Robert R. , Lee Walter
Published: September 2011

Objective

Compare long‐term symptomatic outcomes between open‐neck surgery and endoscopic stapling diverticulotomy (ESD) for Zenker diverticulum.

Method

Patients at least 1 year after surgery for Zenker diverticulum were telephoned and questioned of dysphagia, choking, regurgitation, and halitosis based on a validated Gastrointestinal Quality‐of‐Life Index. Symptom degree preoperatively and at phone call was assessed. Patients rated their overall postoperative symptoms as worsened, unchanged, improved, or completely resolved.

Results

A total of 55 of 102 patients were contacted. Of these, 24 underwent ESD and 31 had open‐neck procedures. Average follow‐up time was longer for the open‐neck group (5.7 vs 3.1 years, P <. 01). Gender, age at operation, diverticulum size, and preoperative symptom scores were not statistically different between the 2 groups. For both techniques, symptom scores showed significant improvement postoperatively (P <. 01). A greater proportion of patients undergoing open‐neck procedures reported their symptoms to be completely resolved or improved (93% vs 67%, P =. 015). Specifically, complete resolution of symptoms was achieved more often in those who had open‐neck surgery (77% vs 50%, P =. 047).

Conclusion

Both the open neck and ESD surgeries significantly benefit patients, regardless of diverticulum size. Long‐term symptomatic outcomes between the 2 populations indicate that patients with open‐neck procedures attain a greater degree of resolution of preoperative symptoms. This may be due to fundamental differences between the surgical techniques.
GERD: Stroboscopy and Voice Analysis
Authors: Ravikumar Arunachalam , Chirakkal Pramod , Kumar Prasanna , Lakshmanan Somu
Published: September 2011

Objective

1) Identify the laryngopharyngeal features of GERD and its impact on voice. 2) Assess the response to antireflux therapy.

Method

Prospective study of 30 patients with GERD and laryngopharyngeal symptoms in Tertiary Referral University Hospital over 2 years. All subjects underwent videolaryngoscopy, stroboscopy, upper GI endoscopy and biopsy, esophageal pH monitoring, and treatment. Pre‐ and posttreatment questionnaires on lifestyle and symptoms were used.

Results

Difficulty in swallowing and throat clearing were the most common symptoms. H pylori infection was found in 43% of patients. Videolaryngoscopy: edema and congestion of arytenoids. Stroboscopy: posterior laryngitis (83%). Voice analysis by GRBAS scale showed subtle changes in grade, pitch, and range. Comparison of 24‐hour pH monitoring pre‐ and postantireflux therapy showed significant improvement in the posttreatment group (pThe lifestyle profile showed increased stress, improper food habits, and lack of sleep. Smoking and alcohol intake were minimal in this group of patients. Lifestyle modification, proper dietary habits, vocal hygiene, treatment of H pylori infection, and antireflux medication cured 90% of patients.

Conclusion

Analysis showed laryngopharyngeal symptoms and signs to be associated with GERD, which adversely affects vocal function. A new management protocol has been developed to treat patients with laryngopharyngeal symptoms with GERD. Emphasis on identification of GERD in patients with laryngopharyngeal symptoms needs to be recognized by otorhinolaryngolgists.