bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Procedures, Treatments, and Outcomes in Stroke Patients Admitted to Different Types of Hospitals
Authors: Asplund Kjell , Sukhova Maria , Wester Per , Stegmayr Birgitta
Published: February 2015

Background and Purpose—

In many countries, including Sweden, initiatives have been taken to reduce between-hospital differences in the quality of stroke services. We have explored to what extent hospital type (university, specialized nonuniversity, or community hospital) influences hospital performance.

Methods—

Riksstroke collects clinical data during hospital stay (national coverage 94%). Follow-up data at 3 months were collected using administrative registers and a questionnaire completed by surviving patients (response rate 88%). Structural data were collected from a questionnaire completed by hospital staff (response rate 100%). Multivariate analyses with adjustment for clustering were used to test differences between types of hospitals.

Results—

The proportion of patients admitted directly to a stroke unit was highest in community hospitals and lowest in university hospitals. Magnetic resonance, carotid imaging, and thrombectomy were more frequently performed in university hospitals, and the door-to-needle time for thrombolysis was shorter. Secondary prevention with antihypertensive drugs was used less often, and outpatient follow-up was less frequent in university hospitals. Fewer patients in community hospitals were dissatisfied with their rehabilitation. After adjusting for possible confounders, poor outcome (dead or activities of daily living dependency 3 months after stroke) was not significantly different between the 3 types of hospital.

Conclusions—

In a setting with national stroke guidelines, stroke units in all hospitals, and measurement of hospital performance and benchmarking, outcome (after case-mix adjustment) is similar in university, specialized nonuniversity, and community hospitals. There seems to be fewer barriers to organizing well-functioning stroke services in community hospitals compared with university hospitals.
Imaging of a Clinically Relevant Stroke Model
Authors: Arnberg Fabian , Grafström Jonas , Lundberg Johan , Nikkhou-Aski Sahar , Little Philip , Damberg Peter , Mitsios Nicholas , Mulder Jan , Lu Li , Söderman Michael , Stone-Elander Sharon , Holmin Staffan
Published: February 2015

Background and Purpose—

Ischemic stroke has been shown to cause hypermetabolism of glucose in the ischemic penumbra. Experimental and clinical data indicate that infarct-related systemic hyperglycemia is a potential therapeutic target in acute stroke. However, clinical studies aiming for glucose control in acute stroke have neither improved functional outcome nor reduced mortality. Thus, further studies on glucose metabolism in the ischemic brain are warranted.

Methods—

We used a rat model of stroke that preserves collateral flow. The animals were analyzed by [2-
18
F]-2-fluoro-2-deoxy-
d
-glucose positron emission tomography or magnetic resonance imaging during 90-minute occlusion of the middle cerebral artery and during 60 minutes after reperfusion. Results were correlated to magnetic resonance imaging of cerebral blood flow, diffusion of water, lactate formation, and histological data on cell death and blood–brain barrier breakdown.

Results—

We detected an increased [2-
18
F]-2-fluoro-2-deoxy-
d
-glucose uptake within ischemic regions succumbing to infarction and in the peri-infarct region. Magnetic resonance imaging revealed impairment of blood flow to ischemic levels in the infarct and a reduction of cerebral blood flow in the peri-infarct region. Magnetic resonance spectroscopy revealed lactate in the ischemic region and absence of lactate in the peri-infarct region. Immunohistochemical analyses revealed apoptosis and blood–brain barrier breakdown within the infarct.

Conclusions—

The increased uptake of [2-
18
F]-2-fluoro-2-deoxy-
d
-glucose in cerebral ischemia most likely reflects hypermetabolism of glucose meeting increased energy needs of ischemic and hypoperfused brain tissue, and it occurs under both anaerobic and aerobic conditions measured by local lactate production. Infarct-related systemic hyperglycemia could serve to facilitate glucose supply to the ischemic brain. Glycemic control by insulin treatment could negatively influence this mechanism.
‘A Voice Shouting in the Wilderness’
Authors: Kaunda Chammah Judex
Published: February 2015

The purpose of this article is to contribute to an on-going call for more life-giving public prophetic preaching in the context of multidimensional social injustice in Africa by evaluating some sermons of Desmond Tutu as an African model for public prophetic preaching. Tutu has been one of South Africa’s leading sociotheological praxis theologians esteemed for persistently calling for social justice, moral-ethical responsibility and social emancipation. With consistency, he confronts social injustice, exposing inequalities since the apartheid era and continues to do so in post-apartheid. Through evaluation of the prophetic discourse of such a great personality, this article proposes an African theology of public prophetic preaching for social justice and wholeness.
Investigating visual attention during scene perception of safe and unsafe occupational performance
Authors: MacKenzie Diane E. , Westwood David A.
Published: February 2015

Background.

Occupational therapists routinely use observation for evaluation, intervention planning, and prediction of a client’s occupational performance and/or safety within the environment. Perception of safety contributes to the decision-making process for discharge or placement recommendations.

Purpose.

The purpose of this study was to determine if differences exist in safety ratings and eye movements between occupational therapists and nontrained matched individuals while viewing domain-specific versus non-domain-specific images.

Method.

Ten licensed occupational therapists and 10 age-, gender-, and education level–matched participants completed this eye-tracking study.

Findings.

For all image exposure durations, occupational therapists had more polarized safety ratings for stroke-related image content but little evidence of differences in eye movements between groups. Eye movement group differences did not emerge in the regions of interest identified by an independent expert panel.

Implications.

The results point to a complex relationship between decision making and observational behaviour in occupational assessment and highlight the need to look beyond image features.
Necessity and murder
Authors: Tamblyn Nathan
Published: February 2015

This article argues that there is an alternative and hitherto unarticulated defence of necessity latent in the case law which could be a defence to murder.
Domestic violence and the criminal law
Authors: Youngs Jennifer
Published: February 2015

This article is an examination of domestic violence and the criminal law, incorporating proposals for reform. Its analysis of the nature of domestic violence reveals that the government’s consultation in this area has misunderstood the problem it seeks to address, divorcing coercion and control from physical abuse when in reality it is an integral part of the phenomenon as a whole. The existing criminal law fails to address this intention to control, as well as to acknowledge the totality of harm suffered by victims and the pattern-based nature of the wrong. Having reached this conclusion it then considers whether a specific offence is an appropriate option for reform and, having concluded that this is the case, puts forward a proposal for a specific offence of domestic violence, formulated to remedy the three deficiencies it had previously identified.
Critiquing Teacher Preparation Research
Authors: Cochran-Smith Marilyn , Villegas Ana Maria , Abrams Linda , Chavez-Moreno Laura , Mills Tammy , Stern Rebecca
Published: February 2015

This is the second of a two-part article intended to offer teacher educators a cohesive overview of the sprawling and uneven field of research on teacher preparation by identifying, analyzing, and critiquing its major programs. The article discusses research on teacher preparation for the knowledge society and research on teacher preparation for diversity and equity, the second and third programs of research the authors identified through their massive review of research on initial teacher education, 2000-2012. Guided by their “Research on Teacher Preparation as Historically Situated Social Practice” theoretical/analytic framework, the authors describe the multiple clusters of studies comprising each of these programs of research and examine the social practices in which researchers engaged within one cluster selected from each. This article also suggests new directions for research on teacher education based on lacunae in the literature and on our analysis of the strengths and weaknesses of the existing field.
It’s Not Who You Are! It’s How You Teach! Critical Competencies Associated with Effective Teaching
Authors: Farrell Thomas S.C.
Published: February 2015

Recently a dichotomy has developed in the field of TESOL between native English speaker teachers (NESTs) and non-native English speaker teachers (NNESTs) with some in each camp promoting one over the other, but this only separates rather than unifies our profession. In this article I suggest that it is not in anybody’s interests to continue with this dichotomy if we are to be recognized as a profession within the wider academic community and that we should be debating critical competencies related to effective teaching instead, regardless of if one is a NEST or NNEST. In this paper, I point out that it is not who you are in terms of your ethnicity, culture or race as a TESOL teacher, but what you know in terms of your effectiveness as a teacher regardless of your background.
Understanding the Antecedents of Adverse Peer Relationships Among Early Adolescents in the United States
Authors: Hong Jun Sung , Espelage Dorothy L. , Sterzing Paul R.
Published: February 2015

This study examines ecological level correlates of adverse peer relationships among early adolescents (ages 12-14). Data analysis was conducted using the National Longitudinal Survey of Youth (NLSY). The sample was drawn from the mother–child data set, which included youth who in 2002 or 2004 were living with their mothers and enrolled in school. Eligible participants responded to at least 1 of the 13 items from the survey and their mothers responded to at least 1 of the 2 items measuring adverse peer relationships at Times 1 (2002/2004) and 2 (2004/2006). Multivariate hierarchical logistic regression was estimated. The presence of a learning disorder and adverse peer relationships at Time 1 (socio-demographics), perceptions of school environment (microsystem), and area of residence and perceptions of safety (exosystem) were all significantly associated with adverse peer relationships at Time 2. Assessing and targeting these ecological levels hold the potential to decrease adverse peer relationships among early adolescents.
Individual and Environmental Sources of Work Stress Among Prison Officers
Authors: Steiner Benjamin , Wooldredge John
Published: February 2015

Work stress has been linked to a number of negative outcomes for employees and organizations. Drawing from the Job Demand–Control (–Support) model, we examined the influences of work stress among more than 1,800 prison officers working in 45 prisons across Ohio and Kentucky. Multilevel analyses revealed that individual factors such as experiencing victimization and greater job demands were related to more stress among prison officers, whereas perceived control over inmates and support from coworkers and supervisors were associated with less stress. Facility violence was also linked to higher levels of officer stress across prisons.
Clinical Experience With Numeta in Preterm Infants
Authors: Kreissl Alexandra , Repa Andreas , Binder Christoph , Thanhaeuser Margarita , Jilma Bernd , Berger Angelika , Haiden Nadja
Published: February 2015

Background: A new “ready‐to‐use” triple‐chamber container, Numeta (Baxter, Deerfield, IL), is available for preterm parenteral nutrition (PN) to provide nutrients according to the recommendations of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) Guidelines for Pediatric Parenteral Nutrition. We investigated the clinical application of Numeta compared with individualized PN in preterm infants (≤1.500 g) and evaluated the effects on nutrient intake, costs, and preparation time. Materials and Methods: In a clinical observational study, prescriptions for preterm infants were performed with the new prescription software catoPAN (Cato Software Solutions, Becton Dickinson, Vienna, Austria). Individualized PN and Numeta prescriptions were mirrored, and nutrition content of the PNs was compared with each other and with ESPGHAN/ESPEN recommendations. Furthermore, costs and preparation time were assessed. Results: In total, 374 PN solutions (>1000 g [n = 333]/≤1000 g [n = 41]) were analyzed. Protein intake with Numeta was significantly lower compared with individualized PN and did not meet the recommendations for infants <1500 g during the first day and the period of transition after birth. Energy intake was significantly higher with Numeta. The costs for Numeta preparations were €18 (about US$20) higher than for individualized PN. However, the preparation time/solution was 2 minutes faster with Numeta. Conclusion: Numeta is an alternative to individualized PN for infants >1000 g in the period of stable growth when enteral feedings have already started. Protein intake is significantly lower than in individualized PN solutions. Numeta is more expensive in comparison to individualized PN but saves human resources.
Endoscopic Treatment of Benign Sinonasal Tumors
Authors: Jankee Vic , Srinivasan Venkat R. , Achar Priya
Published: February 2015

Objective

1) To assess the effectiveness of endoscopic surgery in the management of benign sinonasal tumors. 2) To compare our complication and recurrence rates with the literature.

Method

We performed a retrospective case note review of patients having endoscopic surgery for benign sinonasal tumors between 2001 to 2010. Our results in terms of success rate and complications were compared with similar studies in the literature. A systematic review was carried out including 5 case series studies and 1 meta‐analysis.

Results

Fourteen patients were treated endoscopically (11 inverted papillomas, 1 pleomorphic adenoma, 1 oncocytoma, and 1 schwannoma). Exclusion criteria: Tumors eroding maxillary antrum, and extending into orbit, soft tissue, skull base, or intracranially. There were 9 men and 5 women; average age was 61 years (range, 42‐80 years). Minor complications were encountered in 20% of patients. Average follow‐up was 46 months (range, 13‐120 months). The recurrence rate was 7% (1 patient with inverted papilloma, revised endoscopically). A review of a case series in the literature showed an identical recurrence rate between the 2 types of surgery (9%), and a meta‐analysis showed greater difference (endoscopy 12% vs open 19.5%).

Conclusion

Endoscopic excision is an effective treatment modality and beneficial to patients with benign sinonasal tumors as it offers a similar, if not decreased, chance of recurrence with additional benefits of fewer complications and scarring.
Fast Track Head and Neck Referrals Audit
Authors: Davey Shaun , Dixon Hannah , Gibbins Nicholas , Lew‐Gor Simione , Weighill John , Harries Meredydd L.
Published: February 2015

Objective

The National Institute for Clinical Excellence (NICE) outlines 10 key urgent referral guidelines. The Department of Health in the UK requires all cancer referrals to be seen within 2 weeks. The audit’s aim was to assess the appropriateness of referrals to the Head and Neck Cancer Clinic.

Method

A retrospective analysis of all “2‐week‐wait” fast track referrals to the department over a 1‐year period (starting August 2010). The referring diagnosis, time of consult, and initial management were recorded. A database of all referrals, the picture archiving and communications system (PACS), and computer and paper records were consulted.

Results

For the period of the study a total of 446 referrals were received, 425 or 95% were seen within 14 days. The average wait was 9 days. The most common reasons for referral included neck lumps, dysphagia, and voice change. Referrals for inappropriate symptoms were not uncommon, however the main issue was duration of symptoms prior to referral, which averaged over 6 months. The diagnostic yield for malignancy was 6%, significantly lower when compared with a number of comparative studies. Although 59.5% of referrals were females, 70.4% of cancer diagnoses were in men.

Conclusion

The use of the NICE guidelines by primary care physicians is far from common practice. A greater awareness of the guidelines would have several beneficial outcomes. The number of inappropriate referrals would be reduced and those with cancer should be picked up earlier, thus improving prognosis.
Gut Instinct: A Diagnostic Tool?
Authors: Iqbal Isma Z. , Kara Naveed , Hartley Chris
Published: February 2015

Objective

It is generally accepted that with experience, clinicians develop an ability to identify patients who present with neoplasia prior to any diagnostic procedure or investigation. However, this cannot be quantified, nor is it a plausible substitute to investigation. We aim to evaluate the association between instinct and diagnosis of cancer.

Method

A prospective study of patients in the outpatient department between August and December 2010 was performed. Patients requiring urgent procedures for suspected cancer were included. Risk factors, symptoms, signs, and the clinicians’ impression were recorded. This was graded from 1 (highly unlikely) to 10 (very likely) and subsequently correlated with histology.

Results

Twenty‐seven patients underwent a diagnostic procedure. The mean age was 62.2 years. A total of 29.6% of the patients were referred under the 2‐week rule. Of the patients, 18.5% had a previous history of head and neck cancer. The number of patients presenting with 1 symptom was 40.7%, with 2 symptoms was 40.7%, with 3 symptoms 11.1%, and with 4 symptoms 7.4%. A total of 37% of the patients had a cancer diagnosis. The procedure was cancelled for one patient because of illness. There was a positive correlation between clinical suspicion and cancer diagnosis (Kendall’s tau b = 0.648749). However, the number of symptoms did not correlate with abnormal histology (Kendall’s tau = −0.333333).

Conclusion

This study highlights the importance of clinical suspicion in diagnosis of cancer. Reliance on presence or absence of clinical signs alone may lead to missing a diagnosis. Although clinical suspicion cannot be quantified it should be regarded as an integral factor in patient management.
Nasal Valve Reconstruction: A Quality of Life Assessment
Authors: Alexander Richard L. , Goldman Neal D.
Published: February 2015

Objective

1) Evaluate patient reported outcomes of nasal valve repair using a survey. 2) Understand quality of life measures following nasal valve reconstruction.

Method

This retrospective study evaluated patients who underwent nasal valve reconstruction between December 2005 and December 2011. The study involved a 39‐question survey that measured quality of life, overall satisfaction with the surgical outcomes, and patient‐reported surgical outcomes in multiple symptoms including nasal obstruction, exercise tolerance, sleep, etc.

Results

Forty‐four patients completed the survey, and 25 had prior nasal surgery. The most common postoperative complaint was breathing difficulties (36%). Seventeen patients (39%) reported no change in the size of the nose despite augmentation of the nasal valve. Of those patients who did notice a change, 52% stated they notice the increase in size occasionally and never hear comments from others (70%). Overall, patients were satisfied with the results (81%), and 98% would recommend the procedure to others. There was a statistically significant improvement in nasal blockage/obstruction, breathing through the nose, sleeping, and breathing through the nose during exercise.

Conclusion

Our data suggest that nasal valve reconstruction is a reasonable approach to patients with nasal obstruction and trouble breathing through the nose. This approach may be especially important in patients who have already had prior nasal surgery but refractory symptoms.
Life following Lateral Skull Base Tumor Treatment
Authors: Al‐hadad Ihsaan , Taha Omar
Published: February 2015

Objective

Treatment advances have evolved to prolong the duration of life in lateral skull base tumor patients, but focus is now being placed more on quality of life. The aim of this study was to help elucidate the quality of life in participants following treatment for lateral skull base tumors.

Method

A total of 21 participants agreed to take part in the study. Each completed a semistructured interview, focusing on quality of life following radiotherapy or surgical treatment for different lateral skull base tumor diagnoses. Interviews were recorded and transcribed verbatim, with a thematic analysis of the transcripts undertaken.

Results

Four overriding themes were identified and labeled: 1) perceptions of quality of life and coping strategies; 2) impact of specific symptoms on daily life activities; 3) initial recovery period posttreatment; 4) information surrounding treatment and administration. The majority of participants reported an indifferent or positive impact of treatment on quality of life, with various coping mechanisms such as adjustment, thinking positively, and selective attention used to deal with stressors. Many participants described frustration and concern at the lack of information surrounding management; however, others were aware of the risks of excessive information and tentative of receiving more.

Conclusion

Adjustment following treatment could possibly support the phenomena of cognitive adaptation or response shift. The positive role of social support and lack of information has highlighted the need for more support in this cohort of patients, but crucially within a patient‐centered holisitc framework. Implications for a tailored quality of life tool are discussed.
Liposarcoma of Nasopharynx
Authors: Bianco Andrea S. , Garcia Esperanza , Sanchez Mariana , Agostini Gabriela
Published: February 2015

Objective

Considering this rare entity, the clinical and morphological similarity with more common diseases, the aim of this publication is to understand and be able to aid in the diagnosis, avoiding the possibility of it going unnoticed.

Method

A case of liposarcoma in the nasopharynx was presented, diagnosed, and treated in the Avila Clinic in Caracas, Venezuela. This was followed by a retrospective review of cases in the published literature.

Results

A 29‐year‐old white woman with a 2‐year history of bilateral chronic nasal obstruction and rhinolalia clausa on whom nasal endoscopy showed a 3 centimeter gray‐white lesion attached to the nasopharynx. Histopathological report confirmed the diagnosis of well‐differentiated liposarcoma. The incidence of liposarcoma of nasopharynx is extremely low, presenting as a painless, hard‐edged, slow growth, with the lesion usually going unnoticed. Though nonspecific, authors consider magnetic resonance imaging the gold standard radiologic tool. The role of radiotherapy and chemotherapy is still not clear.

Conclusion

By the time of this report the patient was free of disease following surgical resection. There is no sufficient data for statistical significance on the prevalence, clinical aspects, treatment of choice, or prognosis of this unusual disease. Radiological studies may help to exclude other entities, but are nonspecific.
Metastatic Lymph Node Metastasis Has Predictive Values for Recurrence in Papillary Thyroid Carcinoma
Authors: Jang Min‐Seok , Son Young‐Ik , Baek Jeong‐Hwan , Park Ki‐Nam , Kim Dohun
Published: February 2015

Objective

The authors aimed to evaluate the significance of absolute number of lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC) and the metastatic lymph node ratio (the ratio between metastatic lymph node and harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence.

Method

Through retrospective chart review between 2005 and 2009, 573 patients who underwent total thyroidectomy and central neck dissection and were followed‐up more than 36 months were enrolled. Regarding the risk of recurrence, multivariate analyses were performed with the following variables: multiplicity of tumor, extrathyroidal extension, number of harvested lymph nodes.

Results

Both the number of LNM and MLNR exhibited predictive significance toward locoregional recurrence (P <. 001). The lowest cutoff value of MLNR for a meaningful separation of disease recurrence was 0.44 (HR = 8.86, 95% CI = 1.49‐52.58, P =. 001) when 3 or more lymph nodes were harvested.

Conclusion

Both the number of LNM and MLNR in the central neck have predictive values for loco‐regional recurrence. When MLNR is higher than 0.44, there is an increased risk of locoregional recurrence with a HR of 8.86. These findings will supplement in further risk‐stratification of locoregional recurrence.
Midline Carcinoma with NUT Rearrangement
Authors: Wein Richard O. , Mosesso Kara
Published: February 2015

Objective

1) Report the clinicopathologic features of a rare, midline carcinoma. 2) Review the literature on NUT midline carcinoma and associated treatment protocols.

Method

Case report with review of the literature on NUT midline carcinoma.

Results

A 23‐year‐old Chinese man presented with a 10‐day history of enlarging nontender cervical lymphadenopathy, dysphagia, and dysarthria. Clinical examination demonstrated right tongue atrophy and a 6‐cm ipsilateral level III neck mass. CT of the neck with contrast revealed an infiltrating hypopharyngeal lesion and bilateral necrotic cervical lymphadenopathy. At microlaryngoscopy, the patient was noted to have a friable postcricoid mucosal lesion that on multiple biopsies revealed only necrosis. Cytogenetic analysis of a lymph node biopsy demonstrated chromosomal rearrangements consistent with a translocation between chromosomes 15 and 19, ie, t(15;19), resulting in the fusion oncogene BRD4‐NUT consistent with diagnosis of NUT midline carcinoma (NMC). NMC is a newly recognized entity identified by the presence of chromosomal rearrangements involving the nuclear protein in testis (NUT) gene on chromosome 15q14. The clinical course is rapid and fatal and to date there is not a well‐established treatment protocol. NMC is likely under‐diagnosed and should be considered within the differential diagnoses in all poorly differentiated and undifferentiated midline carcinomas, particularly in young adult, nonsmokers. The patient presented is currently under treatment.

Conclusion

Accurate and prompt diagnosis of this rapidly progressing carcinoma is crucial to improving prognosis and identifying effective treatment regimens.
MRSA Thyroiditis and Thyrotoxicosis
Authors: Sweeney Alex D. , Pattisapu Prasanth , Parke Robert B.
Published: February 2015

Objective

1) Learn that methicillin‐resistant staphylococcus aureus (MRSA) thyroiditis causing thyrotoxicosis is a rare and potentially life‐threatening condition. 2) Understand the diagnosis and management of suppurative thyroiditis and related thyrotoxicosis. 3) Understand the rising incidence of both community‐acquired and hospital‐acquired MRSA infections.

Method

We present a patient with MRSA thyroiditis and thyrotoxicosis who was evaluated by the otolaryngology–head and neck surgery service of an academic, tertiary care hospital in 2012. The literature was also reviewed through a directed PubMed search, and a relevant case was identified and discussed.

Results

A patient was transferred from an outside hospital in respiratory failure with a recent history of progressive neck pain and dysphagia. Computed tomography of the neck revealed an enlarged and inflamed thyroid gland, which was causing airway compression. Thyrotoxicosis was subsequently identified. MRSA was cultured in samples from an ultrasound guided thyroid biopsy and a surgical debridement. Antibiotics were started, and the thyrotoxicosis was followed clinically. With this management, the thyrotoxicosis resolved, and hypothyroidism immediately ensued. A literature review revealed only one previously reported case of MRSA thyroiditis and thyrotoxicosis, which resolved with medical management.

Conclusion

MRSA thyroiditis with associated thyrotoxicosis represents a rare complication of a bacterium that is becoming more common in community and hospital settings. To our knowledge, this is the second reported case of this particular clinical entity. Prompt identification of a causative organism and thyrotoxicosis can allow for potentially life‐saving interventions.
Neurinoma of the Submandibular Space
Authors: Piccioni Lucia O. , Sarandria Daniela , Pilolli Francesco , Bussi Mario
Published: February 2015

Objective

Describe an uncommon lesion of the submandibular space.

Method

We describe the surgical approach to a submandibular mass in a young boy.

Results

The patient had a preoperative evaluation with a ultrasound examination that showed a well‐defined, disomogeneous lesion of 50 × 36 × 36 mm of the left submandibular region. Magnetic resonance imaging showed a lesion of the submandibular space, extended to the left parapharyngeal space. This lesion had disomogeneous enhancement and a diameter of 6 cm. The patient underwent a fine needle aspiration cytology of the lesion that resulted compatible with a pleomorphic adenoma.The patient underwent the surgical excision of the lesion.The lesion occupied the left parapharyngeal space. The histological examination defined the lesion as a neurinoma of the parapharyngeal space.

Conclusion

A neurinoma of the parapharyngeal space should be considered in the evaluation of the submandibular masses.
Novel Techniques in Head and Neck Ultrasound
Authors: Meacham Ryan K. , Sebelik Merry E.
Published: February 2015

Objective

1) Report new uses of ultrasound within the head and neck. 2) Emphasize how the use of ultrasound can enhance patient management and alter treatment delivery.

Method

Present a series of 7 cases from the past year at a single academic institution where ultrasound was used in a novel way to enhance patient care. Compare the ultrasound images obtained with other imaging modalities.

Results

Three patients underwent ultrasound‐guided fine‐ needle aspiration (FNA) of tongue base tumors, which avoided the necessity of a tracheotomy in 1 patient with a difficult airway. Two patients underwent ultrasound‐guided FNA of supraglottic tumors through the thyrohyoid membrane, which obviated the need for biopsy with general anesthesia. One noncancer patient had a highly metabolic enlarged lymph node on PET/CT though it demonstrated benign characteristics on ultrasound. Both ultrasound‐guided FNA and incisional biopsy confirmed the lymph node’s benignity. One patient had a vallecular foreign body seen on ultrasound but not on flexible laryngoscopy, and it was retrieved in the operating room.

Conclusion

Ultrasound can be used to guide FNA for tissue diagnosis from tongue base and larynx tumors. Ultrasound‐guided FNA may eliminate the need for biopsy under general anesthesia for some patients. Ultrasound has an expanding array of applications and is a useful tool in the otolaryngologist’s hands.
Outcomes for Patients at Head and Neck Cancer Consultation
Authors: Pereira Sonia , Montalvão Pedro , Magalhães Miguel
Published: February 2015

Objective

Head and neck cancer outpatient departments have to deal with challenging, impairing, and highly lethal diseases. As the search for better treatments continues, we aimed to analyze the clinical outcomes of our patients and to identify factors that may affect short‐term survival.

Method

We performed a retrospective cohort study concerning all patients referred to the head and neck consultation of a Portuguese cancer center (Lisbon’s Instituto Português Oncologia) during 2008. Clinical and demographic data were obtained from medical records of those patients, from their first appointment until December 2011.

Results

Four hundred forty‐four patients were referred to our consultation over the study period. Most of them were men (87%) and the mean age was 60.4 years (range, 14‐86 years). The most common cancers were laryngeal (37%) and oropharyngeal (23%), and the majority (58%) were advanced (stage IVa or higher). Sixty percent of our patients were treated with surgery and adjuvant radiotherapy. The average time elapsed between treatment and first appointment was 80 days (range, 2‐275 days). The overall 2‐year survival rate was 58% and the 2‐year disease‐specific survival rate was 64%. The overall recurrence rate was 25%, mostly at the primary site.

Conclusion

Most of our patients had advanced tumors at the time of referral. Despite the early beginning of treatment at our center, survival, locoregional control, and treatment options are compromised. Public health policies should be developed to improve public health education regarding head and neck cancer prevention and early referral.
Outcomes of Total Laryngectomy: How to Improve?
Authors: Pereira Sonia , Montalvão Pedro , Magalhães Miguel
Published: February 2015

Objective

1) To analyze postoperative clinical outcomes in patients after total laryngectomy (TL). 2) To identify factors that may affect long‐term survival. 3) To evaluate the computed tomography (CT) scan’s value in the study of laryngeal and hypopharyngeal cancer.

Method

We performed a retrospective cohort study of patients who underwent TL for cancer between January 1, 2000, and December 31, 2004, at Instituto Português de Oncologia, Lisbon. Baseline characteristics, pretreatment clinical variables, and follow‐up data were collected from medical records.

Results

Three hundred seventy‐eight patients underwent TL. Most of the cancers were in advanced stage (IVa or higher), and arising at the larynx (71%). CT scan correctly evaluated the T stage only in 35%. The patients were primarily treated with surgery and adjuvant radiotherapy in 86%. The overall 5‐year survival rate and the 5‐year disease‐specific survival rate were 31% and 38%, respectively. The overall locoregional control was 66% and the overall recurrence rate was 55% (39% distant metastasis). Factors identified as related to long‐term survival: Cancer site in the larynx, T3 stage, N0‐N1 stage, and no more than 2 comorbidities.

Conclusion

Most of our patients had advanced tumors, which compromised survival. Other clinical variables (tumor site, comorbidities) may affect survival and treatment options. Those are often decided based on tumor evaluation by CT scan, which showed limited value. Public health education, earlier referral, and attention in treatment selection should be held.
Pharyngeal Horizontal Closure in Total Laryngectomies
Authors: Clavenna Matthew , Obokhare Joy , Gill Matthew T. , Lian Timothy S.
Published: February 2015

Objective

To determine the viability of horizontal pharyngeal closure during total laryngectomies, as an alternative to vertical and T‐closure methods, by evaluating the rates of pharyngocutaneous fistulas (PCFs) and dysphagia postoperatively.

Method

Retrospective analysis of postoperative complications associated with horizontal pharyngeal closure during total laryngectomies at a tertiary institution from 2007 to 2011. Chart reviews were performed on a total of 15 total laryngectomy patients with horizontal pharyngeal closure, evaluating for fistula formation and dysphagia compared to reported rates in the literature.

Results

Twenty percent (3/15) of patients developed postoperative PCFs, and 18% (2/11) with dysphagia. Patients that had not been tried on oral feeds due to wound complications or those with recurrent disease were excluded for evaluating dysphagia.

Conclusion

A literature search revealed no studies evaluating horizontal pharyngeal closure. Reported ranges of PCFs are 13% to 25%, with dysphagia 17% to 70%. This study shows PCFs and dysphagia rates within these ranges. Thus, horizontal pharyngeal closure appears to be a viable alternative to T and vertical closures.
Pharyngoceles: Photo‐Anatomic Study and Novel Management
Authors: Naunheim Margaret , Langerman Alexander
Published: February 2015

Objective

Pharyngoceles are outpouchings of the lateral pharyngeal wall through the thyrohyoid membrane. They are often noted as incidental findings on pharyngoesophageal imaging studies and are rarely symptomatic. Open surgical repair has been the mainstay of treatment for symptomatic pharyngoceles, save 2 reports of stapling which lack detailed anatomical description.

Method

A systematic review was conducted to identify papers presenting cases of pharyngoceles. Articles were examined specifically for anatomic discussions, figures delineating the anatomy, and management strategies. To this data, we add 2 cases of bilateral symptomatic pharyngoceles with full multimedia documentation, including one treated successfully with a novel endoscopic suture‐pharyngoplasty.

Results

Thirty papers were identified which described 49 cases of pharyngoceles, for a total of 51 with our cases. The anatomic boundaries of the pharyngocele space are the hyoid bone, thyroid cartilage, and thyrohyoid ligament with close involvement of the superior laryngeal nerve. Both unilateral and bilateral pharyngoceles have been reported, presenting with a variety of symptoms including dysphagia, globus, and neck‐swelling. One reported case of bilateral pharyngoceles was asymptomatic. Of those patients symptomatic enough to require surgery, all endorsed resolution of symptoms postoperatively. Both of our patients had complete resolution of symptoms, as determined by interview and oropharyngeal motility study.

Conclusion

Relatively few true pharyngoceles have been reported in the literature. We offer the first detailed endoscopic anatomic description of pharyngoceles and a novel technique of endoscopic suture pharyngoplasty, as well as a formal evaluation of swallowing outcomes postoperatively. These lesions may be amenable to endoscopic repair with minimal morbidity.
Predicting Quality of Life in Hypopharynx and Larynx Cancer
Authors: Moubayed Sami P. , Sampalis John S. , Christopoulos Apostolos
Published: February 2015

Objective

1) To identify independent predictive factors of quality of life (QOL) and depression in advanced‐stage (III/IV) hypopharyngeal and laryngeal cancer. 2) To construct a clinical prediction rule of QOL and depression in this population using multivariate analyses.

Method

A historical cohort study will be conducted on stage III and IV hypopharyngeal and laryngeal cancer patients at least 12 months after diagnosis. We require 77 patients according to sample size calculations. We will evaluate QOL and depression using 3 validated questionnaires: EORTC QLQ‐C30, EORTC QLQ‐HN35, and HADS. HPV status will be evaluated using PCR on tissue samples. The following factors will be evaluated: site, sub‐site, TNM classification, stage, comorbidities, age, sex, pretreatment depression, malnutrition, neutrophil count, hemoglobin, treatment type, locoregional, specific, and global survival. Bivariate analyses will identify long‐term predictors of QOL and depression (t test, ANOVA, Pearson correlation coefficient). Multivariate linear regression will identify the factors with independent significance and will be used to construct a clinical prediction rule.

Results

We expect to identify several significant predictors of long‐term QOL in late‐stage hypopharyngeal and laryngeal cancer. This is the first study in the literature to evaluate the impact of HPV status on QOL in this population, and one of the first studies to evaluate QOL in head and neck cancer according to subsite. Results will be presented at the meeting.

Conclusion

This study can potentially generate economies in costs related to QOL assessment as it can help with predicting QOL using significant predictive factors instead of lengthy self‐administered questionnaires.
Topiramate‐Induced Unilateral Ptosis
Authors: Zhao Kathy , Spiegel Jeffrey H.
Published: February 2015

Objective

To present the case of a rare ocular side effect induced by topiramate use.

Method

This is a case of a 43‐year‐old transgender man who presented with unilateral ptosis of the right eye. Ptosis was noted after 4 years of topiramate therapy, prescribed as prophylaxis against migraines.

Results

While some adverse vision and eye effects associated with the use of topiramate have been documented, eyelid ptosis has only been reported in 0.14% of patients using the drug. Thus, topiramate‐induced ptosis is a very unusual finding.

Conclusion

Experience with this case has demonstrated that immediate discontinuation of the drug can restore eyelid function within 1 week.
Reflux Surgery for Improved TEP Outcomes after Laryngectomy
Authors: Jensen Katrina M. , Ducic Yadranko N. , Thompson Allison L. , Garcia Fernando
Published: February 2015

Objective

1) Identify the potential benefits of adequate reflux intervention in the management of TEP complications in the laryngectomized population. 2) Understand the role of PPI utilization for TEP complications. 3) Identify surgical intervention for reflux as a hierarchical treatment option for TEP complications not responsive to PPI utilization.

Method

A retrospective chart review of laryngectomy patients in an otolaryngology private practice identified 4 patients from November 2009 to November 2011 who underwent fundoplication for TEP complications not responsive to PPI utilization. Prosthetic device life (days) as well as the presence of periprosthetic leakage was compared in preoperative and postoperative groups.

Results

The 4 patients who underwent fundoplication for reflux management were referred for surgical intervention after persistent TEP complications following greater than 6 months of PPI utilization. Evidence of reflux was determined using transnasal esophagoscopy, barium swallow, and/or 24‐hour pH monitor prior to surgery. Two of 4 were noted to have periprosthetic leakage prior to fundoplication which resolved following surgery. Both individual and group mean device life was noted to increase, with individual mean increases of 71.7%, 88.4%, 188.1%, and 41.3%, respectively. Group mean increase was noted at 85.9%, with significance demonstrated; P =. 03.

Conclusion

Although PPI treatment has been found to be an effective intervention for reducing TEP complications, some patients continue to demonstrate complications, despite months of PPI utilization. These findings suggest surgical intervention may be an effective means in this population of reducing associated complications and prolonged need for PPI utilization.
Screening Laryngeal Dysplasia Using Gynecological Principles
Authors: Douglas Justin W. , McChesney Jason , Williams Harold J. , Yu Jing J.
Published: February 2015

Objective

1) Devise a pilot study to develop a noninvasive laryngeal screening technique that could be used to detect lesions not readily visible to the unaided eye via a laryngoscope. 2) Extend the validity of the screening technique that is already accepted by the FDA for gynecological and oral cavity dysplasia.

Method

Pilot study examining fresh laryngectomy specimens using chemiluminescent staining techniques was undertaken from July to December 2010 at our institution. Specimens were painted with an acetic acid solution and examined under lumenoscopic lighting. Normal appearing and aceto‐white areas were biopsied. Results of HPV testing, cytology, and tissue analysis were compared.

Results

Four (N = 4) total laryngectomy specimens from patients aged 40 to 81 years old (mean, 57 years) where examined with chemiluminescent staining techniques to detect dysplasia not readily visible. Preoperative cancer stages of these larynges ranged from T2 to T4. There were 3 men and 1 woman, 75% were smokers, and 50% used alcohol. High‐risk HPV serotype 16 or 18 was found in 75% of specimens. Dilute acetic acid solution was successful in identifying dysplasia or invasive cancer not visble. HPV 16 stained more intensely than HPV 18. Cytobrush alone was not adequate to detect cells with HPV effect.

Conclusion

There seems to be a role for a dilute acetic acid solution in the detection of laryngeal dysplasia. HPV‐16 subtypes seem to produce a more dramatic staining pattern. High‐risk subtypes found in 75% of laryngectomy specimens. Future research is needed to optimize the described technique.
Selective vs Superselective Neck Dissection in Larynx Cancer
Authors: Kim Won Shik , Byeon Hyung Kwon , Lee So‐Yoon , Hong HyunJun , Koh Yoon Woo , Choi Hong‐Shik , Choi Eun Chang
Published: February 2015

Objective

Since regional metastasis has a tremendous impact on the prognosis of laryngeal cancer, neck management is important. We reported the study regarding the necessity of level IV dissection in cN0 laryngeal carcinoma previously. Based on the previous study, we compared selective neck dissection II‐III with SND II‐IV in laryngeal cancer.

Method

Thirty‐six patients with cN0 laryngeal cancer were randomly assigned to receive SND II‐III or SND II‐IV for the elective neck dissection. The estimated blood loss and the rate of postoperative chyle leakage or phrenic nerve palsy were analyzed according to the different extent of neck dissections. Oncologic results were measured.

Results

The mean age of patients was 63.4 years. Nineteen patients (52.8%) received SND II‐III (group I) and 17 patients (47.2%) received SND II‐IV (group II). No cases of chyle leakage or phrenic nerve paralysis were reported in both groups. Ten out of 36 patients (27.8%) had recurred. In group I, recurrence rate was 21.1% (4/19) and it was 35.3% (6/17) in group II. The 5‐year recurrence‐free survivals were 64.7% and 59.2% in group I and group II, respectively. The 5‐year overall survivals for group I and group II were 93.3% and 86.9%, respectively.

Conclusion

Although more cases should be accumulated for a definitive demonstration, we suggest that SND II‐III is an appropriate modality in the neck management of cN0 laryngeal cancer in the aspects of perioperative morbidity and oncological safety compared with SND II‐IV.
Surgical Outcomes of Parotid Cancer: A 10‐Year Experience
Authors: Kim Won Shik , Lee Hyoung Shin , Park Young Min , Hong HyunJun , Koh Yoon Woo , Kim Se‐Heon , Choi Eun Chang
Published: February 2015

Objective

The aim of the study was to investigate the treatment outcomes of malignant parotid tumors. This investigation is to report our experience with the management of patients with malignant parotid tumors that were treated with combinations of surgery, radiation, and chemotherapy.

Method

From January 1999 to December 2008, 126 patients with primary parotid cancer were treated. Data including age, sex, histologic findings, tumor stage, surgery type, complications, and prognosis were collected retrospectively from medical charts.

Results

Their mean age was 55.4 years (range, 15‐96 years). Mean follow‐up was 29.7 months. Thirty three patients were stage I, 40 stage II, 30 stage III, 23 stage IVA. Fifteen patients had recurrences: 6 patients had local, 2 had locoregional, and 1 had regional failure, 6 had distant metastasis. The most common malignant tumor was mucoepidermoid carcinoma (38, 29.5%). Sixty‐one patients underwent superficial, 43 had total, and 22 had radical parotidecomy. Postoperative radiotherapy was done in 57 of 126 cases (45.2%) on the basis of the histologic findings, tumor dimensions, amount of surgery, and extent of cervical metastasis. The disease‐specific survival rate for malignant tumor was 97% for stage I, 81% for stage II, 56% for stage III, and 15% for stage IV. The most common complication was transient facial palsy (20, 14.7%).

Conclusion

Our experience allows us to confirm the results of the literature in the treatment of parotid cancers. In our study, the patients with high disease stage and tumor grade have a bad prognosis with the statistical significance.