bluuebunny/crossref_metadata_2025 huggingface dataset:
Tracheostomy Timing and Outcomes in the Critically Ill
Authors: Tong Charles C. L. , Kubinski Jacqueline , Kleinberger Andrew J. , Altman Kenneth W.
Published: September 2011

Objective

Although data supports the use of tracheostomy in trauma patients admitted to intensive care units (ICUs), optimal timing of tracheostomy in nontrauma patients remains controversial. The purpose of this study is to examine the impact of early tracheostomy on duration of ICU and overall hospital stay in unselected ICU patients.

Method

The following data were collected from records of adult patients (n = 1097) who underwent tracheostomy from 2005 to 2010: demographics, survival, duration of oral intubation, mechanical ventilation (MV), ICU stay, overall hospital stay, and incidence of ventilator‐associated pneumonia (VAP). Tracheostomy was considered early if it was performed by day 7 of MV.

Results

Of the 114 unselected ICU patients who underwent tracheostomies with preliminary data available, 26 were early and 88 were late. Differences between age, sex, and survival were not statistically significant. Duration of MV, ICU stay, and overall hospital stay were significantly shorter in the early tracheostomy group (mean ± standard error: 16.54 ± 2.54 days vs 31.18 ± 1.83 days).

Conclusion

Early tracheostomy in unselected ICU patients is associated with early movement from the ICU, shorter duration of mechanical ventilation, and shorter length of overall hospital stay without affecting mortality. Development of clinical guidelines that describe the criteria for early tracheostomy of non‐trauma patients is warranted.
Unverifiable Ghost Publications in Otolaryngology Residency Applications
Authors: Ishman Stacey L. , Benke James , Donahue Rachel , Carvey Roxann , Mettel Tiffany L. , Ishii Lisa M.
Published: September 2011

Objective

Determine the incidence of unverifiable (or “ghost”) publications in applications to an otolaryngology residency program through the Electronic Residency Application Services and determine if this incidence changed after the addition of pubmed (PMID) numbers to the application.

Method

ERAS applications submitted in 2007 and 2008 to an academic otolaryngology residency program were reviewed. Publications were verified against Medline, PubMed, ISI Web of Science, and Google. Ghost publications were defined as journals, books, abstracts, or posters that could not be verified as presented, published or including the applicant author.

Results

A total of 546 applications were reviewed: 256 before PMID numbers were requested and 248 after. Of 1967 publications, 41% (821 of 1967) could not be verified: 706 out of 1156 (61%) abstracts/posters, 92 out of 774 (12%) journal articles, and 23 out of 37 (62%) chapters. An additional 281 (14%) listings were not actual publications. Overall, abstracts/posters and book chapters were hardest to verify. The overall proportion of publications that could be verified was unchanged after the addition of the PMID to the ERAS application (P =. 67), and the proportion of verified journal articles decreased from 96% to 84% (P =. 005). Positive predictors of ghost publications were age and foreign medical school.

Conclusion

A substantial number of publications, especially book chapters and posters/abstracts, listed on otolaryngology residency ERAS applications cannot be verified. The addition of the PMID to ERAS applications has not significantly reduced the number of ghost journal publications.
Using the iPhone for Voice Recordings in Laryngology
Authors: Hornibrook Jeremy , Lin Emily , Ormond Tika
Published: September 2011

Objective

1) Evaluate the adequacy of an iPhone for voice recording enabling acoustic measurement of voice quality, and 2) demonstrate the usefulness of an iPhone‐based acoustic analysis for identifying voice aberration and monitoring voice changes after phonosurgery.

Method

Twenty‐two voice patients, aged from 25 to 92 years (mean, 54.8 years; SD, 18.5 years), read sentences taken from a standard passage. An iPhone (Model 1303) with an internal microphone was used for voice recording. Vowels segmented from the sentences were submitted to an acoustic analysisprocedure to yield measures.

Results

Compared with the simultaneous voice recordings via another direct digitization method, the iPhone voice recordings showed relatively high measure‐remeasure and acceptable between‐system reliabilities for aselection of acoustic measures. In patients with pre‐ and posttreatment recordings, perturbation measures, including percent jitter, percentage shimmer, and signal‐to‐noise ratios, and the vowel space area consistently demonstrated positive changes after treatment. Measures of the amplitude difference between the first 2 harmonics, which has been related to breathiness, reflected subtle voice changes due to treatment. Changes in singing power ratio were found to be vowel‐dependent, while those in spectral tilt might be gender or pathology‐dependent.

Conclusion

Voice recordings using the iPhone model with a high sampling rate are adequate for acoustic measurement of speech and voice quality. However, due to large inter‐subject variations, most of these measures are more useful for intra‐subject than for norm‐referenced comparisons inmonitoring the progression of the disorder or treatment effect.
A Report on Outpatient Thyroid Surgery from the University Health System Consortium
Authors: Stack Brendan C. , Spencer Horace , Bodenner Donald
Published: September 2011

Objective

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

Method

The University Health System Consortium (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 non‐profit academic medical centers in the United States (www.uhc.edu). Data were compiled from discharge summaries into a secure data base.

Results

There were 28,648 patients who had outpatient thyroid surgery. A total of 19,487 patients had thyroid surgery for benign disease. A total of 8,909 patients had surgery for thyroid cancer. A total of 36.2% of surgeries were hemithyroidectomy and 44.5% were totals. A total of 1,333 of the thyroid cancer patients had a simultaneous neck dissection (5%). A total of 252 patients had neck dissection for thyroid cancer as a separate procedure. The average age was 48.7 (14.7) years and 71.8% of patients were female.

Conclusion

Thyroid surgery is increasingly being done outpatient. Improved surgical technique, anesthesia technique, hemostatic methods, and calcium management make this possible. This becomes a cost‐effective way to manage both benign and malignant thyroid diseases. This is the largest series reporting outpatient thyroid surgery.
The Cost and Challenges of Facial Trauma: AAO‐HNS Survey
Authors: McCusker Scott B. , Schmalbach Cecelia E.
Published: September 2011

Objective

1) Define practice patterns and perceptions of young otolaryngologists treating maxillofacial trauma. 2) Identify manners in which the AAO‐HNS can meet future maxillofacial trauma needs.

Method

A 26‐question survey was designed to identify demographic factors, practice patterns, perceptions of facial trauma, and areas for improvement in trauma care. It was distributed anonymously to AAO‐HNS members who completed residency from 2005 to 2009 and analyzed using descriptive statistics.

Results

A total of 444 of 1378 (32%) otolaryngologists responded. A total of 85% treat maxillofacial trauma (<1 case/month). A total of 64% identify trauma as part of their ideal practice. Sense of duty (54%) and institutional requirement (33%) are the most common reasons for trauma participation. Major deterrents: patient noncompliance (60%) and lifestyle limitations (47%). While insufficient reimbursement is a major deterrent (52%), only 35% would increase their volume if reimbursement improved. Sixteen (3.7%) have had a trauma‐related lawsuit. Increased education represents the most common request to the AAO‐HNS (59%), followed by focus on improved reimbursement/tort reform (28%). Topics proposed: practice guidelines, pediatric, laryngeal, and midface trauma.

Conclusion

Most otolaryngologists treat facial trauma, but do so infrequently. A total of 64% of young otolaryngologists identify trauma as a component of their ideal practice. However, universal concerns include inadequate reimbursement, limited pool of treating physicians, and lack of practice guidelines.
Adenoviral Therapy in Radioresistant Squamous Cell Cancer
Authors: Lee Sei‐Young , Kim Se‐Heon
Published: September 2011

Objective

Resistance to radiation is one of the main determinants of treatment outcome in the oral squamous cell carcinoma. We aim to identify that genetically modified adenovirus expressing RLX (Relaxin), which affects collagen metabolism, can effectively inhibit growth of the radioresistant oral SCC cell line.

Method

Radioresistant oral SCC cell line was established. LDH assay was used to confirm the acquisition of radioresistance and cytotoxic effect of adenovirus. Tumor bearing nude mice were treated with expressing RLX adenovirus, dose dependently. Spread of adenovirus throughout the tumor mass was verified by immunohistochemistry.

Results

Radioresistant oral SCC cell line was more resistant to radiation therapy than mother oral SCC cell lines (p3 vs 45mm3 vs 0mm3 at Day 21). Also, the data shown that the minimum dose of adenovirus has the ability to kill the tumor cells (MOI = 5). In IHC data, the RLX expressing adenovirus eliminated collagens more effectively than non‐RLX expressing adenovirus.

Conclusion

Oncolytic adenovirus can effectively inhibit growth of the radioresistance oral cancer cell line.
Analysis of Normative Vagal and Recurrent Laryngeal Nerve Electrophysiological Data
Authors: Eimear Phelan , Slough Chris , Randolph Gregory W.
Published: September 2011

Objective

1) Provide normative electrophysiological vagal and recurrent laryngeal nerve reference range values for intraoperative nerve monitoring in humans. 2) Highlight potential documentation implications of intraoperative nerve monitoring.

Method

Consecutive monitored adult patients undergoing thyroid, parathyroid, and related neck surgery were included in this IRB approved study performed over an 8 month period. All patients had a preoperative and postoperative laryngeal examination to assess vocal cord function. Patients with an abnormal preoperative laryngeal examination were excluded.

Results

In 64 patients the mean amplitude of the RLN (704mV, SD ± 512.7mV) was greater than the vagus nerve (524.5mV, SD± 388.0mV). The mean latency of the left and right RLN were 3.36ms (SD ± 0.92) and 3.45ms (SD ± 0.62) respectively. The mean latency of the left vagus was 7.48ms (SD ± 1.32), and the right vagus was 6.65ms (SD ± 1.28). The mean threshold intensity of stimulation of the right (0.41 mV, SD 0.20 mV) and left vagus (0.40 mV, SD 0.23 mV) were similar. The mean threshold of stimulation was higher in the right RLN (0.51 mV, SD 0.44). Amplitudes tended to be higher in females.

Conclusion

Normative vagal and RLN data is presented. The mean amplitude of the RLN was greater than the vagus nerve. The mean latency of the left vagus is longer than the right side. The threshold of stimulation is well below the standard stimulation current of 1 to 2 milliamps.
AntiBiofilm Molecules on Tracheo‐esophageal Speaking Valves
Authors: Shakir Adam , Burgess Grant , Jakubovics Nick , Shields Robert , El‐Badawey Mohamed Reda
Published: September 2011

Objective

The collection of biofilms on tracheo‐esophageal speaking valves (TESV) detrimentally shortens their lifespan. A novel nontoxic enzyme (NucB) was discovered in the University of Newcastle and proved effective for dispersing marine biofilms. We propose to ascertain the effect of NucB on disrupting and removing mixed organism biofilms on TESVs.

Method

We designed a case control study of ex‐vivo TESVs, with build up of biofilms. Each TESV was divided into 2 equal parts. One half was treated with NucB and the other half with a nonactive control solution. Outcomes are measured by microscopy and culture of biofilm organisms.

Results

Ten TESVs were collected for our analysis in the microbiology laboratory. The more efficient our agent is in dispersing biofilms, the more organisms are released that can be cultured. With aerobic growth mediums, more organisms were cultured in 9 samples (90%, 95% CI 57‐99%). With the use of growth mediums favouring fungal organisms, more organisms were cultured in 6 samples (60%, 95% CI 31‐83%). The macroscopic appearances of TESVs were noticeably improved after treatment with NucB, with less visible contamination compared to control treated valves.

Conclusion

NucB, which is a nontoxic nuclease, was effective in the dispersion of the biofilms matrix collecting on TESVs. The treatment effect was greater for aerobic bacteria than fungal organisms. Our aim would be to use this agent to prolong the lifespan of TESVs and thus reduce costs.
Association of DNA Copy Number and miRNA Expression in OSCC
Authors: Serrano Nicholas Anthony , Xu Chang , Houck John , Wang Pei , Fan Wenhong , Liu Yan , Lohavanichbutr Pawadee
Published: September 2011

Objective

Better understand possible mechanisms involved in the dysregulation unique to OSCC metastasis, we examined whether DNA copy number aberrations (CNAs) are associated with differential expression of miRNA that are found in OSCC metastasis.

Method

Tumor cells were laser capture microdissected from 17 nonmetastatic primary tumors and 20 metastatic lymph nodes. CNAs and gene expression profiles were previously determined using Affymetrix 250K Nsp I SNP Arrays and HU133 plus 2.0 expression profiles. MiRNAs were interrogated with Exiqon’s Ready‐to‐use PCR Panels.

Results

We found 155 miRNAs expressed in >80% of metastatic or nonmetastatic samples with 31 of them differentially expressed in metastatic tumor cells (FDR<0.4; 27 over‐expressed, 4 under‐expressed). We found the expression of 11 miRNAs to be significantly associated with their DNA copy numbers (p < 0.5) and 7 of these were among the differentially expressed miRNAs. Among these, miR‐140‐3p, miR‐29c, and miR‐29a showed a correlation between their expression and corresponding DNA copy number. These miRNAs were also associated with the down‐regulation of their target genes in the MAP/ERK oncogenic pathway.

Conclusion

Our results suggest that DNA copy number aberration may play a role in the dysregulation of miRNA in OSCC metastasis and that copy number driven miRNAs warrant further investigation.
Bilateral IJV Sampling for Parathyroid Adenoma Localization
Authors: Kalyoussef Evelyne , Henick David H. , Rosen Arie , Patel Chirag
Published: September 2011

Objective

1) Study the accuracy and utility of direct intraoperative internal jugular vein (IJV) sampling of parathyroid hormone (PTH) for localization of parathyroid adenoma. 2) Compare the accuracy of intraoperative IJV PTH sampling to that of preoperative Sestamibi scanning for lateralization.

Method

A retrospective chart review of 51 consecutive neck explorations for primary hyperparathyroidism between 2007 and 2011. Direct bilateral IJV PTH sampling was performed prior to excision in all cases. Laterality based on IJV samples was compared with preoperative Sestamibi scans and operative findings.

Results

There were no complications associated with sampling. 50 patients had single parathyroid adenomas, and 1 patient had ipsilateral double adenomas. All IJV sampling value difference was considered lateralizing. In 39 cases, IJV sampling successfully predicted laterality of adenoma, yielding a positive predictive value (PPV) of 76.5%. Sestamibi scans correctly lateralized in 37 cases (72.5%), 12 (23.5%) were nonlocalizing, and 2 (3.9%) were incorrect. PPV of Sestamibi scanning was 95%. IJV sampling successfully predicted the laterality of adenoma in 9 (75%) of the nonlocalizing Sestamibi scans and in 1 of the 2 incorrect scans.

Conclusion

In patients with unilateral parathyroid adenomas, intraoperative bilateral IJV PTH sampling is a safe means of determining laterality of adenomas with a positive predictive value of 76.5%. This can be a valuable adjunct in cases where preoperative localization studies were unsuccessful or inaccurate in localizing the adenoma.
Calcium Management after Thyroidectomy: A Simple and Cost‐Effective Method
Authors: Singer Michael C. , Bhakta Dimpal , Terris David J. , Seybt Melanie Wilson
Published: September 2011

Objective

Hypocalcemia is one of the principal complications of total or completion thyroidectomy. A number of different protocols for managing this potential complication have been published. Our simple postoperative regimen is described and the safety and cost‐effectiveness assessed.

Method

Prospective analysis of a consecutive series of patients undergoing thyroid surgery from January 2008 through June 2010 was performed. Data collected included age, gender, procedure performed, levels of ionized calcium, parathyroid hormone, vitamin D, complications, and need for readmission. Standard descriptive statistics were used to summarize this data.

Results

A total of 526 patients had thyroid surgery during the 30‐month study period. Of these, 307 patients underwent completion or total thyroidectomy and were prescribed a 3‐week, tapering course of calcium carbonate postoperatively. Twenty‐four patients (7.8%) experienced symptoms of hypocalcemia which were managed easily with additional doses of oral calcium. A single patient (0.3%) required readmission. The cost of a 3‐week regimen of calcium carbonate is approximately $15. This is considerably less expensive than the cost of overnight admission or published laboratory protocols that are designed to predict the risk of hypocalcemia.

Conclusion

Prophylactic calcium supplementation without routine laboratory assessment proved to be a safe and cost‐effective method of preventing and managing postoperative hypocalcemia following total or completion thyroidectomy.
Can Pathology of a Thyroid Nodule Be Determined by Positron Emission Tomography?
Authors: Stack Brendan C. , Boeckmann Jacob O. , Bodenner Donald , Siegel Eric R.
Published: September 2011

Objective

Positron emission tomography (PET) uptake in the thyroid gland is common. It occurs incidentally in diagnosis or surveillance of many cancers. Focal uptake indicates thyroid mass lesions. The goal was to determine if standardized uptake values (SUV) on PET can predict pathology in masses of the thyroid gland.

Method

A total of 23,982 PET scans were retrospectively reviewed from the University of Arkansas for Medical Sciences in Little Rock, AR. These scans were performed from 2002 to 2010. 1,290 (5.4%) of scans had uptake in the thyroid gland, 614 were considered to be diffuse and 676 were considered focal.

Results

A total of 112 patients had PET scan with accompanying thyroid cytology or pathology. The mean SUV for benign (N = 78) was 3.75 ± 2.99 and for malignant (N = 35) was 8.22 ± 7.91, × 2 0.0011. Age, lesion size, and gender were not significant. Receiver operating curves (ROC) were constructed with empirical or binormal distribution assumptions. The area under the curve (AUC) was 0.693 and 0.702 respectively. A SUV of 3.6 maximized empirical sensitivity and sensitivity while minimizing (FP) and negatives (FN). A SUV threshold of 3.6 minimized binormal FP and FN whereas a SUV of 7.9 maximized sensitivity and specificity.

Conclusion

Uptake on the thyroid on PET scan is a common incidental finding. The above data can help inform providers as to when these incidental lesions need to be aggressively evaluated through ultrasound guided needle biopsy or excision or when they can be observed.
Cartilaginous Reinforcing Sutures in Tracheal Anastomosis
Authors: Schilt Peter Nielsen , McRae Bryan R. , Kokoska Mimi S. , Halum Stacey L. , Musunuru Swapna
Published: September 2011

Objective

1) Determine what additional stability, if any, the addition of cartilaginous reinforcing sutures adds to tracheal stability. 2) Further clarify mechanisms of tracheal rupture.

Method

Prospective cadaver study. Eleven cadaver tracheas were harvested and divided in half. Each half trachea was cut and anastomosed using circumferential sutures. The other half underwent the exact same procedure with the addition of cartilaginous reinforcing sutures. The force necessary for anastomosis rupture was measured for each half trachea.

Results

Eleven tracheas were used for a total of 22 trials. Analysis demonstrated a mean anastomotic rupture point for tracheas with reinforcing sutures was 297 N ± 94.6, while the mean for trials without reinforcing sutures was 173 N ± 51.4 (P <. 05). The point of rupture occurred at the anastomosis in 1 out of 11 cases with reinforcing sutures and in 8 out of 11 cases without reinforcing sutures. In all trials, the reinforcing sutures remained intact.

Conclusion

Cartilaginous reinforcing sutures were found to provide a higher force requirement for rupturing tracheal anastomoses when compared to anastomoses without these sutures. This improved stability in tracheal anastomoses may result in a decreased risk of tracheal rupture after anastomosis.
Cervical Root Branches Preservation in Head and Neck Surgery
Authors: Garzaro Massimiliano , Raimondo Luca , Giordano Carlo , Pecorari Giancarlo , Riva Giuseppe , Aghemo Laura
Published: September 2011

Objective

1) Evaluate the hypothesis that the preservation of cervical root branches will be associated with better quality of life (QoL), greater shoulder motility, and lower loss of sensation in the neck after functional neck dissection sparing spinal accessory nerve. 2) Investigate the impact of physiotherapy.

Method

This retrospective study evaluated 41 patients surgically treated for head and neck cancer between 2006 and 2009 at our department. Patients were divided in 2 groups, according to the preservation or removal of cervical root branches during functional neck dissection. QoL, shoulder motility, and neck sensation were evaluated.

Results

The analysis of the University of Washington‐Quality of Life questionnaire, fourth version, demonstrated lower pain, less shoulder complaints, and less limitations to activities and recreation in patients who hadn’t undergone removal of cervical root branches (P 0.05).

Conclusion

This study demonstrated that the preservation of cervical root branches improved QoL and shoulder motility in patients who underwent functional neck dissection. Physiotherapy had a positive impact on the analyzed outcomes.
Thyroidectomy Related Malpractice Claims Are Rare
Authors: Singer Michael C. , Terris David J. , Iverson Kenneth
Published: September 2011

Objective

Little information is available regarding the frequency of thyroidectomy related malpractice claims. Previous studies have not assessed claims that were settled or dropped before trial, providing only a limited view of the medical‐legal environment. We sought to determine the frequency of thyroid surgery related malpractice claims, their causes and outcomes.

Method

The database of the Physician Insurers Association of America (PIAA) was reviewed. This data is estimated to represent 25% of medical malpractice claims in the United States. Claims from 1985 to 2008 with thyroid‐related procedure codes were evaluated for claimant information, insured’s specialty, loss description and causation, and claim outcomes.

Results

During the 23‐year period reviewed, 381 claims related to thyroid surgery were reported. 128 claims (33.6% of total claims) resulted in an indemnity payment either due to settlement or a finding against the defendant. The average indemnity payment was $185,366 (range $363 to $2,000,000). Among cases in which a specific outcome was reported, 55 were related to laryngeal nerve injury or voice disturbance. No marked change occurred in the incidence of claims across the study period. During this time, approximately 2,585,000 thyroidectomies were performed. Extrapolating from PIAA data, this works out to an estimated 1.5 claims per 10,000 cases.

Conclusion

Malpractice claims related to thyroid surgery are surprisingly infrequent. While the rates of thyroid surgery have risen steadily, there has not been a corresponding increase in related malpractice claims.
Cyclin D1 and FADD as Biomarkers in Head and Neck Squamous Cell Carcinoma
Authors: Rasamny J. K. J. , Allak Amir , Frierson Henry , Policarpio‐Nicolas Maria , Jo Vickie , Jameson Mark J.
Published: September 2011

Objective

Cyclin D1 and FADD (Fas‐associated protein with death domain) regulate the cell cycle and apoptosis, respectively, and are located on chromosome 11q13.3, which is frequently amplified in head and neck squamous cell carcinoma (HNSCC). This study evaluates these proteins as predictors of clinical outcomes for HNSCC.

Method

Immunohistochemical assessment of 366 archival HNSCC specimens in tissue microarrays and correlation with retrospectively collected clinical data. Outcomes for patients with tumors that exhibited strong cyclin D1 or FADD staining were compared with outcomes for patients with weakly or non‐staining tumors.

Results

Patients with tumors that were strongly positive for cyclin D1 had reduced overall (P =. 010) and disease‐free (P =. 040) survival, while patients with tumors that were strongly positive for FADD had reduced overall (P =. 019) and disease‐specific (P =. 049) survival. Together, the 2 markers effectively stratified overall (P =. 002), disease‐specific (P =. 032), and disease‐free (P =. 059) survival. Strong cyclin D1 positivity correlated with higher overall stage (P =. 023) and T‐stage (P =. 016), while strong FADD staining correlated with T‐stage (P =. 041). In multivariate analysis strong cyclin D1 staining was a better predictor of recurrence (P =. 018) than strong FADD positivity, overall stage, and T‐stage, and was independent of N‐stage (P =. 005).

Conclusion

Cyclin D1 and FADD may have utility as predictors of long‐term outcomes for patients with HNSCC. Further study is needed to determine if these proteins predict response to different treatment approaches or assist in selecting patients for multi‐modality therapy.
Decision Making in Post‐chemoradiotherapy Neck Dissections
Authors: Tulunay‐Ugur Ozlem E. , Stack Brendan C. , Vural Emre A. , Suen James Y. , Archer Kaete , Young Zachary
Published: September 2011

Objective

There is continued debate as to whether to perform a neck dissection as a planned vs “wait and see” procedure in patients with head and neck cancer treated with chemoradiotherapy. In this study we aimed to review our results to help with the decision making process.

Method

A retrospective review of 140 oropharyngeal cancer cases treated with chemoradiotherapy was performed. Demographic data and treatment outcomes were extracted. The patients who underwent neck dissections were selected and evaluated as to how the decision was made; this included clinical examination, imaging studies, and fine needle aspiration biopsy.

Results

Of the 140 patients, 19 underwent ND for persistent disease. This included 9 patients with tonsil and 10 with base of tongue cancer. The decision for a ND was made according to CT scan findings in 7 patients, FNAB in 2 patients, PET imaging in 3 patients, clinical examination in 4 patients, and the combination of imaging and clinical findings in three patients. The dissections were performed at an average of 10 weeks (range, 4‐20 weeks). Seven patients (37%) had no viable cancer in the ND specimen. The pre‐treatment neck staging showed no significant difference.

Conclusion

Head and neck surgeons are in search of reliable methods to determine patients at risk of persistent disease. In this series, 37% of the patients had no viable tumor in the ND specimen. Further studies are needed to identify patients who are not in need of a ND.
Differences between 2 Robotic Thyroidectomy Techniques
Authors: Terris David J. , Seybt Melanie W. , Singer Michael C.
Published: September 2011

Objective

Two distinct remote access robotic thyroidectomy techniques were implemented in a high‐volume endocrine surgery practice. Important technical and clinical differences were observed and are described.

Method

Demographic and clinical parameters were prospectively captured in a series of patients undergoing 1 of 2 robotic thyroidectomy techniques (robotic axillary thyroidectomy [RAT] or robotic facelift thyroidectomy [RFT]). Attention was paid to time of surgery, ease of dissection, complications, use of drains, and length of stay.

Results

Fifteen robotic hemithyroidectomies were accomplished by either RAT (n = 5) or RFT (n = 10). The duration of surgery for the 5 RATs averaged 196 ± 38.1 minutes, with no clear downward trend observed; time of surgery for RFT was 156.9 ± 16.3 minutes with a steady trend towards shorter surgical times. All 5 RAT patients were managed with drains and on an inpatient basis (LOS = 1.0 days); 9 of 10 RFT patients were managed without drains and on an outpatient basis. Ease of surgery, familiarity with anatomic dissection planes, and surgeon comfort level all favored RFT.

Conclusion

In the implementation phase, a more rapid learning curve, reflected by shorter operative times, was observed with RFT compared with RAT. Furthermore, the vast majority of patients could be managed as outpatients even early in the experience, which represents one of several apparent advantages.
Differences in Head and Neck Cancer Risk Perception between Smoking and Nonsmoking NASCAR Attendees
Authors: White Laura , Quee Anthony Chin , Berg Carla , Wise Justin , Hapner Edie
Published: September 2011

Objective

There is a lack of knowledge regarding the risk of head and neck cancer. Studies have demonstrated a difference in cancer risk perception between smokers and nonsmokers. The aim of this study was to determine differences in risk perception among smokers and nonsmokers in an at‐risk population.

Method

A 28‐item questionnaire was utilized to survey NASCAR attendees at Atlanta Motor Speedway. The survey collected demographic information, highest education level, smoking status, cigarettes smoked in the past 30 days, and psychosocial factors related to concern about head and neck cancer.

Results

Five hundred and seven participants completed the questionnaire. MANCOVA analysis using dependent variables related to risk perceptions of head and neck cancer, and covariates of age and education, evidenced a significant main effect, such that smokers (M = 1.10, SD = 0.07) worried about head and neck cancer significantly more than nonsmokers (M = 0.64, SD = 0.06), F (1,459) = 26.9.

Conclusion

Findings indicated differences in perception of risk between smokers and non‐smokers. Gaining a better understanding of the psychosocial factors related to perceived risk of head and neck cancer, otolaryngologists may better tailor interventions aimed at increasing awareness within the clinic setting.
Disparate Molecular, Histopathology, and Clinical Factors in HNSCC Racial Groups
Authors: Worsham Maria J. , Stephen Josena K. , Schweitzer Vanessa , Shah Veena , Mei Lu , Havard Shaleta , Chen Kang‐Mei
Published: September 2011

Objective

Causes of differences in the higher incidence of and mortality from squamous head and neck cancer (HNSCC) in African American (AA) vs Caucasian Americans (CA) lack a consensus. We examined a comprehensive array of risk factors influencing health and disease in an access to care, racially diverse, primary HNSCC cohort.

Method

The study cohort of 673 primary HNSCC comprised 391 CA and 282 AA. Risk variables included demographic, histopathology, and clinical/epidemiologic risk factors. Tumor DNA was interrogated for loss and gain of 113 genes with known involvement in HNSCC/cancer. Univariate analysis was followed by multivariate modeling with determination of c‐index.

Results

Of the 39 univariate differences in race as AA and CA, multivariate modeling (c‐index = 0.81) retained 6 variables (pCDKN2A) and aneupoidy of SCYA3 than CA tumors. AA were more likely to be unmarried, to have radiation treatment, and be more likely to be current and past smokers. Insurance type as HAP (Health Alliance Plan), Blue Cross, Medicaid, Medicare, and other was a significant determinant of race. AA were more likely to have Medicaid and Medicare. Insurance status by stage and radiation by stage were not significant.

Conclusion

Molecular modeling indicated significant differences between AA and CA for histopathology, patient factors, and tumor gene copy number alterations. Our data reiterate that for HNSCC, as in the case of other complex diseases, tumor genetics or biology is only one of many potential contributors to differences among racial groups.
Dual Time Point Positron Emission Tomography Imaging in the Head and Neck
Authors: Harirchian Sanaz , Chesani Nasrin , Cohen Erik
Published: September 2011

Objective

Dual time point 18F‐fluorodeoxyglucose‐positron emission tomography (DTP‐PET) is a new modality which may detect malignancy more accurately than standard PET/CT. Our main objective was to perform a pilot study to evaluate the characteristics of DTP‐PET in primary head and neck squamous cell carcinomas (HNSCC) and lymph node metastases.

Method

A total of 36 patients with previously untreated HNSCC underwent preoperative PET/CT at 2 time points (mean 41‐minute time difference) from 2007 to 2010. Mean and maximum standardized uptake values (SUV) were measured for the primary lesion and cervical lymph node metastases at both time points, and change in SUV over time was calculated.

Results

A total of 32 of 36 primary tumors (89%) had an increase in maximum SUV, between 13.93% and 264.65% (mean 43.7%) normalized to a 1‐hour time difference. A total of 16 of 21 lymph node metastases (76%) had an increase in maximum SUV, between 13.49% and 284.15% (mean 57.1%). Change in mean SUV did not correlate as well with the presence of tumor.

Conclusion

This is the first description of DTP‐PET in HNSCC. A total of 89% of primary tumors showed an increase in maximum SUV over time. These findings justify further study of DTP‐PET as a method of detecting tumor in initial staging and after treatment.
EGFR and IGF1R Inhibition in Head and Neck Cutaneous Squamous Cell Carcinoma
Authors: Clayburgh Daniel R. , Proby Charlotte , Wong Melissa , Gross Neil D.
Published: September 2011

Objective

1) Determine if upregulation of insulin‐like growth factor receptor (IGF1R) correlates with resistance to epidermal growth factor receptor (EGFR) inhibitors in patients with head and neck cutaneous squamous cell carcinoma (cSCCHN). 2) Evaluate the effect of combined inhibition of EGFR and IGF1R with tyrosine kinase inhibitors in cSCCHN.

Method

cSCC cell lines MET1, MET4, SCC12, and SCC13 were treated with the EGFR inhibitor erlotinib and/or the IGF1R inhibitor picropodophyllin, then evaluated for cell growth and expression of EGFR, IGF1R, and downstream signaling molecules. cSCCHN patient specimens were evaluated with antibodies for EGFR, IGF1R, phospho‐Akt, and phospho‐MAPK.

Results

Comparison of normal skin to cSCCHN specimens showed overexpression of EGFR (P =. 0008) and IGF1R (P =. 041). Treatment with erlotinib or picropodophyllin inhibited receptor phosphorylation (P <. 01) and showed dose‐dependent inhibition of cell growth in all cell lines. At intermediate concentrations, treatment with both inhibitors inhibited cell growth more effectively than either inhibitor alone (P <. 05). Dual inhibition also decreased downstream activation of both Akt (P <. 006) and p42/44 MAPK (P <. 01). Specimens from a patient whose cSCCHN developed resistance to an EGFR inhibitor showed upregulation of IGF1R (P <. 0001) and phosphorylated Akt (P <. 01) compared to this same tumor prior to treatment with EGFR inhibitor.

Conclusion

Upregulation of IGF1R may be a pathway for resistance to EGFR inhibition in cSCCHN, possibly via increased Akt activation. Dual inhibition of EGFR and IGF1R inhibits cSCCHN cell growth more effectively than either inhibitor alone, suggesting that combination therapy with both inhibitors may be a promising therapeutic strategy for cSCCHN.
Endoscopic Surgery and IMRT Are Effective in Recurrent NPC
Authors: Chen Ming‐Yuan , Jiang Rou
Published: September 2011

Objective

Salvage surgery and radiotherapy showed positive and similar survival outcomes in rT1/2 local recurrent nasopharyngeal carcinoma (rNPC) but no curative value in rT3/4 ones in the past. We will evaluate new techniques such as endoscopic surgery and intensity‐modulated radiotherapy (IMRT) to compare with conventional radiotherapy (CRT) and chemotherapy in rNPC.

Method

We did a retrospective review of 493 rNPC patients from January 2000 to December 2009. IMRT, CRT, and/or chemotherapy were suitable to all rT stage cases, but endoscopic surgery was applied to rT1 and some selected rT2/T3 cases. The 5‐year overall survival rate (OS) and other oncological outcomes were summarized.

Results

Among 493 cases, 120, 82, 132, and 159 were restaged in rT1N0M0, rT2N0M0, rT3N0M0, and rT4N0M0 according to AJCC/UICC 2002 TNM stage system. The 5‐year OS was 73.0%, 37.0%, 17.3%, and 16.5% in rT1, rT2, rT3, and rT4 patients (P <. 05). Adjusted for rT stages, the salvage surgery and IMRT showed a better survival curve than conventional radiotherapy and chemotherapy (P <. 01). In rT1 patients, the 5‐year OS of patients who received salvage endoscopic surgery was better than that of ones who received IMRT (89.3% vs 69.0%, P <. 01). Cox analysis showed that age, stage, and salvage treatment were significant independent predictors for OS.

Conclusion

Although patients in the earlier rT stage showed better survival than ones in the advanced rT stage, new salvage treatments based on endoscopic surgery and IMRT benefited all rT stage rNPC compared with CRT and chemotherapy. Futhermore, salvage endoscopic surgery may be a more promising option than IMRT in rT1 patients.
Unplanned Re‐admissions in ENT: How Much Do They Cost?
Authors: Rashid Mamun , Khalil Hisham
Published: September 2011

Objective

Unplanned hospital re‐admissions are a significant source of morbidity and mortality and are a major fiscal burden to the National Health Service. The cost of re‐admissions to ENT services has not previously been described. We present an audit, evaluating the cost per patient for ENT re‐admissions in our department.

Method

A prospective audit of all ENT patients who were re‐admitted within 28 days of initial discharge over a 3‐month period was observed. Cost was calculated using the Department of Health reference books.

Results

n = 24 (17 emergencies, 7 elective) Emergencies: 53% otitis externa (7/17) and tonsillitis (2/17); all returned due to pain. Elective: 86% posttonsillectomy, including hemorrhage (3/7) and pain (3/7). Cost: Total: £25’237.50 (£1051.56 per patient) Otitis externa: £8983.61 (£1122.95 per patient) Post‐tonsillectomy bleed/pain: £4670.21 (£778.37 per patient) Otitis externa/post tonsillar combo: £9761 (39% of total cost).

Conclusion

Unplanned re‐admissions to ENT cost £25,237.50 over three months. Nearly 40% of this was due to otitis externa, tonsillitis, or as a postoperative complication of tonsillectomy due to suboptimal analgesia. We would recommend greater awareness of departmental caseloads as a means to develop targeted strategies in reducing re‐admissions.
Extracapsular Extension in Lymph Node Metastasis from HPV‐Associated Squamous Cell Carcinoma of the Oropharynx
Authors: Smith Ian , Rosenblatt Elizabeth , Sanguineti Giuseppe , Bishop Justin A. , Richmon Jeremy D. , Pai Sara
Published: September 2011

Objective

Oropharyngeal cancer understanding has been greatly advanced with the discovery of the role of HPV. Nonsurgical approaches that utilize chemotherapy‐radiotherapy have become common treatment. However, upfront surgery has recently gained momentum with the introduction of transoral approaches (laser/robotic). These approaches have been applied to all stages with excellent results.

Method

Determine the rate of extracapsular extension (ECE) in all patients with HPV+ oropharyngeal cancer (70 patients) treated with a neck dissection at our institution since pathologic HPV testing was first instituted (2006 to present).

Results

We looked at clinical features such as: T stage, primary site, clinical N‐stage, node count, staging, sex, race, smoking, and features on preoperative imaging (cystic?, matted?, multiple nodes, number of nodes, and laterality). Of note we found a relationship between patients with lymph nodes >4 cm on pretreatment imaging having a statistically significant (P =. 019) higher rate of extracapsular extension 47% (4cm). Clinical nodal stages related to rates of extracapsular extension with N1 (28.5% ECE), N2A (50% ECE), N2B (68.9% ECE), and N2C (75% ECE). We also noted that multiple nodes on final pathology also were associated with ECE. In specimens with one positive node, the incidence of ECE was 40.7% (P =. 007).

Conclusion

One question in treating these patients with initial surgical approach is predicting who can avoid the toxic effects of radiation and/or chemotherapy. Chemotherapy is often added to the treatment in patients with positive margins and/or ECE. This information will assist in predicting which patients may benefit from a transoral surgery.
Genetic Testing in Head and Neck Paragangliomas: Who, What, and Why?
Authors: Sridhara Shankar K. , Rich Thereasa , Jimenez Camilo , Hanna Ehab Y. N. , Kupferman Michael E.
Published: September 2011

Objective

Understand the role of genetic testing in patients with paragangliomas (PG), we studied a cohort of patients treated at a single institution and characterized the patterns of treatment and genetic mutations.

Method

A retrospective review was performed of all patients with paraganglioma who were evaluated at MD Anderson Cancer Center from 1970 to present. Patient demographics, disease patterns, outcomes, and genetic mutations were analyzed.

Results

We identified 177 patients with head and neck paragangliomas (HNPG). Genetic testing was performed on 26 patients, of whom 16 had mutations. SDHD accounted for 75% of the mutations, of which P81L [ProlineàLeucine] accounted for 75%. The remainder had SDHB mutations. Of patients with mutations, average age was 39.5 years (vs 48.4 years in those without mutation), 63% (vs 40%) had multiple tumors, 94% (60%) had at least one carotid body tumor, and family history was positive in 38% (20%). Concurrent sites outside the head and neck included adrenal pheochromocytoma, mediastinum, retroperitoneum, and spinal metastasis.

Conclusion

Our results suggest patients suspected of heritable HNPG should undergo testing first at the SDHD and SDHB loci, unlike familial PGs at other sites, which are also associated with VHL mutations. Our findings have implications for long‐term monitoring for secondary tumors, counseling family members, and cost‐efficient mutational screening.
HPV and Head and Neck Cancer in Canada: Trends 1992 to 2008
Authors: Corsten Martin , Rourke Ryan , Johnson Stephanie Elin , McDonald Ted
Published: September 2011

Objective

1) Learn how the incidence of HPV‐related and non‐HPV‐related Head and Neck Cancers (HNC) in Canada has changed in the time period 1992 to 2008. 2) Learn how the age at diagnosis and overall survival for these cancers in Canada has changed over that period.

Method

We used Canadian Cancer Registry Data (1992‐2008), categorizing HNCs into 3 groups: (High (HHPV), ie, oropharynx; Moderate (MHPV), ie, oral cavity; and Low (LHPV), ie, larynx); based on the probability that HPV causes the cancer. We calculated age‐adjusted incidence, median age at diagnosis, and survival for each category.

Results

HHPV cancers increased in incidence at an average annual rate (AAR) of 1.02% (P =. 010); MHPV and LHPV cancers decreased at an AAR of 2.38% (P =. 000) and 3.67% (P =. 000) respectively. The median age at diagnosis for HHPV cancers decreased by an average of 0.23 years/year (P =. 000). There was no change for MHPV and an increase for LHPV of 0.10 years/year (P =. 008). Survival for patients with HHPV cancers increased by 2.1%/year (P =. 000), compared with an increase of 1.6% per year for MHPV (P =. 003) and a marginal increase in LHPV of 0.6% per year (P =. 002).

Conclusion

The prevalence of HPV‐related head and neck cancers in Canada is increasing, while the prevalence of non‐HPV–related head and neck cancers is decreasing. This has been accompanied by a decrease in both age at diagnosis and mortality in HPV related head and neck cancers.
Impact of XPC LL Variant on Head and Neck Cancer Survival
Authors: Torre Carlos A. , Strom Sara , Baez Adriana
Published: September 2011

Objective

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. Several genetic polymorphisms have been shown to increase the risk of HNSCC. In this study we investigated how these genetic variations affect survival of HNSCC patients.

Method

DNA from blood lymphocytes of 180 HNSCC patients were analyzed for polymorphisms of DNA repair and carcinogen‐metabolizing genes. The association between polymorphisms with time to recurrence and survival were analyzed.

Results

There was no association between the variants analyzed and time to disease recurrence. However, increased survival that approached statistical significance was observed in patients with XPC LL genotype. They had a longer survival compared with patients with XPC LS and XPC SS genotypes (mean survival LL = 283 months, LS = 60 months, SS = 72 months; log rank P =. 06), especially in men (P =. 047).

Conclusion

The genetic variant XPC LL of the DNA repair gene XPC is associated with increased survival of HNSCC in those patients managed with treatment modalities that target DNA (ie, cisplatin and radiation). Larger and more comprehensive studies are needed to validate these findings.
Incidence and Outcomes of Stricture Formation Post‐laryngectomy
Authors: Sweeny Larissa , Golden Blake , Rosenthal Eben L. , White Hilliary , Magnuson J. Scott , Carroll William R.
Published: September 2011

Objective

Postlaryngectomy stricture formation and dysphagia negatively impact the quality of life and result in nutritional compromise. Understanding risk factors and successful treatment strategies may improve treatment outcomes.

Method

Patients at a tertiary care center who underwent a total laryngectomy between 2003 and 2009 (n = 263) were evaluated in a retrospective manner. Patient demographics, comorbidities, tobacco and alcohol usage, dietary outcomes, feeding tube dependence, and treatment modalities were assessed. Management strategies and outcomes were evaluated.

Results

Strictures developed in 19% (n = 49) of 263 laryngectomies and the majority (82%) occurred in the first year. Stricture formation rates were similar for primary (19%) and salvage laryngectomy (18%) patients. Tubed flap reconstruction significantly increased the incidence of stricture formation (P ≤. 01) in salvage laryngectomy cases. In primary laryngectomy patients, stricture formation was not correlated with flap reconstruction or adjuvant radiation therapy. Patients requiring only a single dilation had better dietary outcomes (semi‐solid) compared to patients requiring serial dilations. Stricture formation was associated with improved overall disease free survival (P ≤. 01) and recurrence rates (P =. 06).

Conclusion

Stricture formation occurs equally in salvage and primary laryngectomies and is associated with an improved disease‐free survival.