bluuebunny/crossref_metadata_2025 huggingface dataset:
YouTube as an Information Source for Pediatric Adenotonsillectomy and Ear Tube Surgery
Authors: Pusz Max D. , Sorensen Jeff , Brietzke Scott E.
Published: August 2013

Objectives:

1) Assess the overall quality of information on adenotonsillectomy (TA) and ear tube surgery (BMTT) presented on YouTube from the perspective of a parent searching for information for their child's surgery.

Methods:

YouTube was systematically searched on select dates with a formal search strategy to identify videos pertaining to pediatric TA and BMTT. Comprehensive search terms were developed to include terms most likely entered by parents/patients seeking information on these procedures. Only videos with at least an average of 5 (BMTT) or 10 views (TA) per day were included. Each video was viewed and scored by three independent viewers. Scores were given for category, goal, video/audio quality, accuracy, comprehensiveness, procedure‐specific content, and total quality. Descriptive statistics and comparison of means analysis (t‐test) were performed.

Results:

Fifty‐five videos were scored for TA and 47 for BMTT. The most common category was educational (65.3%), followed by testimonial (28.4%) and news program (9.8%). Testimonials were more common for TA than BMTT (41.8% vs. 12.8%, P = 0.001). Testimonials had a significantly lower total quality score than other types of videos (8.7 vs. 9.6, P = 0.035), and news programs had a significantly higher score (10.7 vs. 9.2, P = 0.04). Only six videos (5.9%) received high scores in both video/audio quality and accuracy/comprehensiveness of content. There was no association between the total quality score and views, likes, dislikes, and likes/dislikes ratio. There was an association between likes and video quality (Spearman's rho = 0.262, P = 0.008).

Conclusions:

Parents/patients searching YouTube for information on these procedures will generally encounter low quality information with testimonials being common but of particularly poor quality.
Adverse Events Associated with Postsurgery of Early‐Stage Oral Cancer in a Phase III Surgical Trial
Authors: Durham J. Scott , Liu Kelly Y. Ping , Chen W. Alice , Poh Catherine
Published: August 2013

Objectives:

1) Investigate the adverse events (AEs) associated with surgery for early‐stage oral cancer. 2) Characterize surgical procedure and its related AEs.

Methods:

Based on the National Institute of Health/National Cancer Institute Common Terminology Criteria for Adverse Events (v4.0), patient self‐reported AEs post‐surgery in a pan‐Canadian multi‐center phase III randomized controlled surgical trial (the COOLS trial) were captured during the follow‐up visits.

Results:

From September 2010 to January 2013, 228 eligible patients were recruited and received surgeries, including tumor excision, and/or free flap or neck dissection. Among these, 188 (82%) patients had at least 3 months follow‐up with an average of 24.8±19 months. There were 83 types and 593 counts of AEs from 148 (79%) patients. The most occurring AEs were oral pain (146 patients) and oral dysesthesia (64 patients). Thirty patients (20%) presented with prolonged oral pain (≥3 months) with an average duration of 6.5±10.5 months for Grade I and 2.0±5.6 months for Grade 2 or greater (77 patients). The average duration of oral dysethesia was 18.6±16.4 months with 52 (80%) over 3 months. Univariate analysis had shown that neck dissection and longer surgery time have significant impact on the reported Grade 2 oral pain (P = 0.03 for both). Interestingly, excision type [cold knife (9%) vs. electric knife/laser (23%)] had significant effect on experiencing prolonged post‐surgical oral pain (P = 0.01).

Conclusions:

Post‐surgical AEs surveillance is critical to understand the factors impacting patients’ quality of life. Concurrent neck dissection has impacts on patients’ experience in prolonged post‐surgical oral pain.
Anxiety, Depressive Symptoms, and Quality of Life in Newly Diagnosed Head and Neck Cancer Patients
Authors: Cash Elizabeth , Self Elizabeth , Wilson Liz , Russ Eric , Bumpous Jeffrey M.
Published: August 2013

Objectives:

Psychological distress, including anxiety and depressive symptoms, is prevalent among newly diagnosed cancer patients. Greater distress may be related to poorer health‐related quality of life (HRQOL). Here we describe a sample of newly diagnosed patients who reported on anxiety, depressive symptoms, and HRQOL upon initial presentation to a multidisciplinary head and neck clinic.

Methods:

Retrospective medical record review (October 2012 ‐ February 2013) yielded 43 patients (33 male) who provided data of interest. This cohort completed screening measures of anxiety and depressive symptoms (HADS), and health‐related social and physical quality of life (UW‐QOL). These data were provided during the initial clinic visit, prior to initiation of adjuvant treatment. Average age was 61.8 years (SD=13.6). Eighteen (41.9%) patients had oral cavity/laryngeal cancers. Squamous cell pathology was noted in 28 (65%) cases. Many patients (n=19, 44.2%) scored above clinical cutoff for distress. A moderate impact to social‐emotional and physical QOL was also noted. Younger patients had significantly greater anxiety symptoms (r=‐.373, P =. 015), and patients with more advanced cancer reported poorer social‐emotional QOL (r=‐.330, P =. 040). Greater depressive symptoms were related to poorer physical QOL (r=‐.454; P =. 003), especially for those who scored above the clinical cutoff (F(1,42)=7.54; P =. 009).

Results:

Relationships between psychological distress and HR‐QOL are evident at the time of diagnosis, particularly for patients reporting clinically significant distress. Distress that begins with diagnosis and continues with treatment is also linked with circadian, endocrine, and immune disruption.

Conclusions:

These pathways are intriguing, as they may mediate relationships to HR‐QOL highlighted here, and warrant further study.
Can We Restrict Selective Neck Dissection for Well‐Differentiated Thyroid Cancer Based upon Preoperative Ultrasound?
Authors: Givens Daniel J. , Hunt Jason P. , Buchmann Luke O. , Abraham Devaprabu
Published: August 2013

Objectives:

Describe the use of preoperative ultrasound lymphatic mapping to restrict the scope of neck dissection for thyroid cancer.

Methods:

Adults who underwent surgery for well‐differentiated thyroid cancer with lateral neck metastases and had preoperative ultrasound lymphatic mapping were identified by billing codes. A retrospective review was performed. An ultrasound was determined to be diagnostically accurate if no false negative results were present.

Results:

45 patients were included. Two patients underwent a comprehensive neck dissection levels I‐V, 38 underwent a lateral neck dissection levels II‐IV (level V included 23 times), and five underwent a more restricted selective neck dissection. Nine previously underwent lateral neck dissection, and 32 previously underwent thyroidectomy. Seven patients (15.5%) recurred in the contralateral neck or within the previously‐dissected nodal basin. There were no recurrences in the ipsilateral neck outside the previously‐dissected levels. Median follow‐up was 771 days. Diagnostic accuracy for levels II‐V was 76.1%, 81.6%, 89.8%, and 73.9% respectively. Grouped diagnostic accuracy for levels II‐V was 46.7% (ie no errors in any level). Variables such as experience of ultrasonographer, delay between ultrasound and surgery, and previous surgery did not significantly influence the accuracy of ultrasound. Grouped positive predictive value of levels II‐V was 80.4%.

Conclusions:

The current study suggests that it is feasible to restrict the scope of selective neck dissection for well‐differentiated thyroid carcinoma based upon the findings of ultrasound lymphatic mapping. High positive predictive value indicates that if suspicious nodes are seen, they should be targeted. Undergoing comprehensive neck dissection did not protect against recurrence.
CD44 Expression in Biopsy Specimens of Patients with Nasopharyngeal Carcinoma Is Associated with Prognosis
Authors: Sagawa Kosuke , Uwa Nobuhiro , Terada Tomonori , Kida Kota , Sakagami Masafumi
Published: August 2013

Objectives:

CD44 is a major cancer stem cell marker, and it has been reported to be associated with biological malignancy in several cancers. However, the potential oncogenic role of CD44 and its clinical/prognostic significance in nasopharyngeal carcinoma (NPC) are unclear. In this study, we evaluated the association of CD44, especially its variant isoforms V3 and V6, with prognostic factors in NPC patients. We examined CD44 expression by immunohistochemical analysis of biopsy specimens obtained from 42 NPC patients who underwent treatment.

Methods:

The subjects were 42 patients (35 men and 7 women; average age, 56.3 years) who received concurrent chemoradiotherapy (CCRT) consisting of chemotherapy (CBDCA or CDGP or DOC) and radiation therapy (60‐66 Gy) as an initial treatment. Thereafter, the biopsy specimens from these patients were examined immunohistochemically to study the association between CD44 expression (V3, V6) and prognosis of NPC.

Results:

High CD44 (V3, V6) expression was significantly correlated with increased clinical incomplete response to CCRT at the primary site (P = 0.008 in V3 and V6 by Ï‡2‐test) and poor disease‐specific survival (P = 0.0003 in V3 and P = 0.0029 in V6 by log‐rank test). However, distant metastasis showed no association with CD44 expression.

Conclusions:

High expression of CD44 (V3, V6) is associated with poor prognosis in patients with NPC. Evaluation of CD44, especially the variant isoforms V3 and V6, may be useful for predicting tumor response to CCRT and prognosis of patients with NPC.
Facial Cleft Repair on Surgical Mission Trips: Safety, Feasibility, and Impact on Quality of Life
Authors: Petersson Rajanya S. , Scott Andrew R.
Published: August 2013

Objectives:

1) Discuss the safety, feasibility, and technical limitations of facial cleft repair performed on medical missions in developing countries. 2) Present several representative cases of oculofacial clefting which were successfully repaired and another that was deferred due to safety concerns and limited resources.

Methods:

Case series and literature review.

Results:

On two separate visits over a two‐year period (2011‐2013), 4 patients with orofacial clefts were evaluated. Three oculofacial clefts (Tessier 3 (n=1), Tessier 4 (n=1), and Tessier 4‐10 (n=1)) were successfully repaired. One of these patients had over 1 year of follow‐up. Another patient with frontonasal dysplasia and a wide Tessier 0‐14 cleft was screened and operative intervention deferred.

Conclusions:

When feasible, a soft tissue‐only repair of oculofacial clefts may offer an acceptable aesthetic result with a reasonable expenditure of resources as part of a larger cleft mission. Facial clefts that require pre‐operative imaging, extended procedure time, bone grafting, significant blood loss, and/or neurosurgical involvement demand a greater expenditure of scarce resources and are not advisable in the context of a surgical mission in most areas of the developing world.
Circulating MicroRNAs as Biomarkers for Papillary Thyroid Cancer: Preliminary Study
Authors: Lee Yoon‐Se , Lim Yun‐Sung , Woo Chang‐Ki , Lee Won‐Yong , Wie Chan‐Eun , Wang Soo‐Geun , Lee Byung‐Joo
Published: August 2013

Objectives:

MicroRNAs can function either as tumor suppressors or oncogenes, and some miRNAs are associated with papillary thyroid cancer (PTC), such as miR‐146b, miR‐155, miR‐221, and miR‐222. We tried to detect miRNAs in serum and analyzed correlation between expression level.

Methods:

Serum was obtained from patients who underwent thyroidectomy with or without neck dissection from 2008 to 2009. Patients with benign nodule and PTC were divided. In PTC, patients were divided into 3 groups according to N stage. We investigated miRNA expression level by reverse transcription / quantitative PCR kit. It was expressed by log102(‐ΔΔCT), and mean value was compared.

Results:

We obtained serum from 89 patients comprised of 19 benign nodules and 70 PTC. There were no differences between age or gender. MiR‐146b and miR‐155 were expressed −5.06 (±0.069) and −4.48 (±0.115), respectively in benign, compared to −4.79 (±0.0598) and −4.19 (±0.091) in PTC, respectively. Discriminating between benign and malignant nodule, AUC (area under the ROC curve) was 0.649 in miR‐146b and 0.695 in miR‐155. Although miR‐155 expression of N0 group was not significantly different from that of N1, miR‐155 of benign (‐4.48 ± 0.115) was significantly lower than PTC with lymph node metastasis (−4.22 ± 0.097, P = 0.022).

Conclusions:

This study was preliminary study to detect miRNA from serum to discriminate benign group from PTC group. MiR‐146b and miR‐155 was increased in PTC group compared to benign. MiR‐155 was increased in lymph node metastasis group compared to benign. Further study using available serum miRNA to predict recurrence or diagnosis of PTC is needed.
Cisplatin+Vinorelbine (DDP+VNB) in Recurrent/Metastatic Salivary Gland Malignancies
Authors: Pecorari Giancarlo , Garzaro Massimiliano , Raimondo Luca , Riva Giuseppe , Sensini Matteo , Salonia Laura , Airoldi Mario
Published: August 2013

Objectives:

Describe clinical outcomes of DDP+VNB chemotherapy (CT) scheme in 60 pts affected by recurrent/metastatic salivary gland malignancies (RMSGM).

Methods:

From April 2001 to February 2009, 60 cases with RMSGM were enrolled. All patients received the following regimen: DDP 80 mg/sm d.1 + VNB 25 mg/sm d.1,8 every 3 weeks. The study foresees a maximum of 6 cycles.

Results:

Patient characteristics were as follows: 35 males (58%) and 25 females (42%); median age: 56 yrs (range 20‐68); median ECOG PS: 1 (0‐2); histology: adenocarcinoma 15 (25%), adenoid cystic ca. 34 (57%), others 11 (18%); site of disease: local 30 (50%), mts +/‐ local 30 (50%). Forty‐two patients received DDP+VNB as first line CT (70%) while 18 pts (30%) had the combination as second‐line CT (30%). After a median of 5 cycles of first line DDP+VNB responses were: 3 CR (7%), 10 PR (24%), 14 NC (33%) and 15 PD (36%). After a median of 4 cycles of second line CT responses were: 0 CR; 1 PR (5%), 6 NC (33%) 11 PD (62%). Median survival: 10 months (3‐29) for first line CT; 4 months (1‐12) for second line CT. G3‐4 toxicity: neutropenia (20%), anemia (12%), nausea/vomiting (12%), peripheral toxicity (3%).

Conclusions:

DDP+VNB is an effective first line CT in RMSGM; second line CT has a low palliative activity. Toxicity seems acceptable. This regimen could be suitable for an integration with new biologic target agents.
Computer Planning in the Research, Analysis and Design of Skull Base Surgical Approaches
Authors: Bly Randall A. , Ramikrishna Rohan , Ferreira Manuel , Moe Kris S.
Published: August 2013

Objectives:

No integrated system exists to plan skull base operations, nor to design and test new surgical approaches. Our objective was to develop a method of surgical planning, selection of optimal surgical approach(es), and design of surgical corridor geometry using a computer model that creates physical models for iterative optimization, pre‐surgery approach trial, and surgical education and evaluation.

Methods:

The analysis was applied to a specific clinical scenario of accessing the lateral cavernous sinus. A computer analysis was performed to select the optimal surgical approach portal. Once derived, the specific geometry of the surgical corridor was designed for optimal visualization and instrumentation, while applying retraction limit constraints on specific soft tissue structures. A physical model of the surgical pathway was produced for testing, and the resultant approach was performed on 4 cadaver specimens.

Results:

A lateral retrocanthal transorbital approach was selected based on computer analysis. The pathway length was 55.6 mm (SD: 4.4) to 67.1 mm (SD: 0.7), retraction distance away from orbital rim was 8.2 mm (SD: 0.1), corridor volume was 2,751 mm3 (SD: 736), and cross sectional areas at the portal entrance and greater wing of sphenoid were 127 mm2 (SD: 19.2) and 210 mm2 (SD: 14.0), respectively. Dry lab and cadaver testing validated the computer planning analysis.

Conclusions:

A method was created and validated to determine the optimal surgical approach and pathway geometry for accessing a specific target pathology. It was robust and is applicable to many clinical scenarios. Initial evaluation in surgical cases has begun.
Concomitant Weekly Cisplatin and Radiotherapy for HPV‐Positive Oropharyngeal Squamous Cell Carcinoma in Japan
Authors: Mizumachi Takatsugu , Homma Akihiro , Sakashita Tohohiro , Kano Satoshi , Hatakeyama Hiromitsu , Fukuda Satoshi
Published: August 2013

Objectives:

The most common chemoradiotherapy regimen is high‐dose (100mg/m2) three‐weekly cisplatin with concomitant radiotherapy; however, this protocol is associated with acute and late toxicities. Recent study demonstrated that human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) patients showed good prognosis. We reviewed the efficacy for concomitant weekly cisplatin and radiotherapy in patients with HPV‐positive OPSCC.

Methods:

Twenty‐two patients with untreated OPSCC were enrolled and evaluated at our institution from July 2006 to June 2012. Weekly cisplatin (40mg/m2) was given on weeks 1,2,3,5,6 and 7 with radiotherapy, which comprised a standard dose of 70 Gy delivered in 35 daily fractions over 7 weeks. The presence of HPV was analyzed using multiplex PCR method. Median follow‐up time was 26 months for surviving patients.

Results:

Of the 22 oropharyngeal carcinomas, 13 (59%) were HPV‐positive. Twenty‐one patients (95.4%) received the full dose of radiotherapy. Over the course of the chemotherapy, 14 patients (63.6%) received more than 200 mg/m2 cisplatin. The acute and late toxicity was manageable in all cases. HPV‐positive patients had better two‐year‐overall survival rates (90.0% vs 66.7%) than HPV‐negative patients. For patients who were HPV‐positive, 1 of 13 died of distant metastasis, but those who were HPV‐negative, 1 of 9 died of local recurrence and 2 of 9 died of distant metastasis.

Conclusions:

Because of its favorable outcome and less toxicity, concomitant weekly cisplatin and radiotherapy appears to be suitable treatment for HPV‐positive OPSCC.
Conservative Management of Postoperative Chyle Fistulas
Authors: Felekis Dimitrios , Gkotsis Antonis , Marinou Athanasia , Chaidas Constantinos , Giopanou Maria , Zacharioudaki Evaggelia , Papouliakos Sotirios
Published: August 2013

Objectives:

1) Describe our experience in the diagnosis and conservative treatment of postoperative chyle fistulas. 2) Introduce a protocol of conservative treatment based on the volume of the chyle drainage.

Methods:

Over the last 10 year period, 354 neck dissections were performed in our department. Of the 354 patients, 11 (3,1%) developed postoperatively chyle leakage confirmed by biochemical analysis of the drain output. All 11 patients were managed conservatively. Treatment varied according to the volume of drain output. Patients with mean chyle leakage less than 300cc/day (7 patients) were treated with low fat diet and oral nutrition with medium chain triglycerides (MCT). In four cases, the volume of the chyle was over 300cc/day and was adequately managed with combination of total parenteral nutrition (TPN) and somatostatine. Among them, there was a single case that developed an excessive chylous drain output (3100cc) on the third postoperative day after introduction to oral feeding and was also treated conservatively with TPN and subcutaneous administration of somatostatine.

Results:

None of the patients required surgical intervention. In all patients the amount of chyle decreased after the first day of somatostatine implementation and was resolved successfully in the next three to six days respective to the amount.

Conclusions:

Conservative management based on the volume of chyle output by means of either combination of low fat diet and MCT oral intake, or combination TPN and somatostatine, may be an efficient treatment in patients with chyle fistulas.
Correlation of Treg Prevalence and Function in Head and Neck Melanoma SLNs to Clinical Outcome
Authors: Ryan Marisa A. , Crow Jennifer , Fisher Samuel R. , Lee Walter T. , Proia Alan
Published: August 2013

Objectives:

Sentinel lymph node (SLN) status is the most important prognostic factor in head and neck melanoma. Regulatory T cells (Tregs) are known to suppress tumor immunity. Indoleamine 2,3‐dioxygenase (IDO) is an enzyme that promotes Tregs to become activated and promote tumor immune escape. Research objectives were to 1) assess Treg Prevalence and IDO in melanoma SLN and 2) correlate these scores with clinical outcome from patients with head and neck melanoma.

Methods:

Retrospective analysis of clinical and pathologic data of patients with SLN biopsy for head and neck melanoma between March 2004 and September 2011 at a tertiary medical center. Treg cells (CD4+C25+FoxP3+) and IDO were determined by immunohistochemistry. Specimens were scored to determine both intensity and prevalence of Treg and IDO positive cells. Scores were then correlated with clinical outcome using Fisher's exact test.

Results:

26 total SLN were obtained, with 4 positive for melanoma. 22 SLN were negative for melanoma with 7 of 22 associated with poor patient outcomes (ie recurrence). All three SLN with high scores of Treg and IDO had poor outcomes. 23 SLN had either low Treg or IDO with 10 of 23 having both low. 4 of 23 were correlated with poor outcomes. There was a significant correlation of having high Treg and IDO levels with poor clinical outcome (P = 0.014).

Conclusions:

FoxP3 and IDO expression in both positive and negative SLN may correlate with poor clinical outcome in head and neck melanoma.
Day Case Hemithyroidectomy: The Scottish Experience
Authors: Kasbekar Anand V. , Lupton Kenneth , Blacoe David , Kang Swee K.
Published: August 2013

Objectives:

Analyze our new patient pathway that practices day‐case hemithyroidectomy.

Methods:

Prospective re‐audit of patients undergoing primary hemithyroidectomy over 2 years (January 2010‐January 2011) and compared it to the first cycle in January 2008‐January 2009. Procedures were done by a single surgeon and anaesthetist in a district general hospital. Drains were never used. In the latest audit cycle, all patients underwent standardized anaesthesia and surgical procedures, including pain and nausea management. Patients completed questionnaires at discharge and follow‐up 1‐2 weeks postoperatively. Hospital stay, complications, and patient satisfaction scores were recorded.

Results:

The first cycle (54 patients) demonstrated that a third of patients stayed at least 1 night and two thirds stayed 2 nights or more. Following a new protocol, the latest audit cycle (62 patients) demonstrated a 75% day‐case rate (P < 0.0001). 98% of day‐case patients were happy (questionnaire scoring 8/10 or greater) to be discharged on day of surgery. Of the 25% who stayed overnight, 50% had surgery in the afternoon compared to 21% in the day‐case group (P =0.015). 80% of all patients did not need opioid analgesia. 5% had problems with postoperative pain and nausea and were likely to stay overnight. There were no readmissions. Subjective and objective patient experience data will be discussed as well as our hemithroidectomy patient pathway.

Conclusions:

Successful day case hemithyroidectomy relies on preoperative counseling, specific anaesthesia techniques, meticulous surgery. and careful patient selection. Day case hemithyroidectomy can be safely undertaken in the vast majority and is highly desirable by patients.
Fibula Free Flap Survival after Early Arterial Avulsion
Authors: Reilly Michael , Chu Eugenia
Published: August 2013

Objectives:

1) Recognize factors that influence free flap survival. 2) Describe early neovascularization in free tissue transfer.

Methods:

Retrospective case report.

Results:

A 58‐year‐old male patient underwent composite resection with fibula osteocutanous free flap reconstruction for a floor of mouth squamous cell carcinoma involving the anterior mandible. On postoperative day 10, the patient was found to have a rapidly expanding neck hematoma and intraoperatively was found to have complete arterial avulsion of the pedicle. No revision microanastomosis was performed due to the lack of an available microsurgeon. Although arterial inflow to the vascular pedicle was lost, the flap showed 100% survival at 4 weeks post‐op. This rare outcome suggests early neovascularization in this free tissue transfer. The exact timing of neovascularization in free flaps is not clearly delineated. Experimental animal models have suggested neovascularization as early as postoperative day 7. Review of the literature shows that successful neovascularization is dependent on many factors, especially previous radiation treatment, quality of the recipient site, infection, and vascular ischemia.

Conclusions:

This and other rare case reports of maintained flap viability despite loss of the vascular pedicle suggest early neovascularization. This report stresses the importance of flap surveillance in order to avoid premature flap revision in cases of early neovascularization.
Diagnostic Value of FNA‐BRAF Mutation Analysis in Papillary Thyroid Cancer: A Systematic Review and Meta‐analysis
Authors: Fnais Naif , Soobiah Charlene , Idriss Hend , Dong Bin , Straus Sharon , Tricco Andrea
Published: August 2013

Objectives:

Fine needle aspiration (FNA) with cytological analysis is an initial step in investigating thyroid nodules. We systematically reviewed the diagnostic value of adding B‐type Raf kinase (BRAFV600E) gene mutation analysis to the conventional FNA in the diagnosis of papillary thyroid cancer (PTC).

Methods:

Studies reporting BRAFV600E mutation analysis following FNA for evaluation of thyroid nodules were identified through searching electronic databases (eg, MEDLINE, EMBASE) through 1948‐2011, scanning reference lists of relevant studies, and contacting experts. Two independent reviewers screened literature results, abstracted data, and appraised study quality. Meta‐analysis of sensitivity and specificity was performed using bivariate random effects models.

Results:

Forty‐two studies met our inclusion criteria after screening 787 citations and 117 full‐text articles. The included studies enrolled approximately 7,676 patients with 8,196 FNA samples evaluated for BRAFV600E mutation. Bivariate‐pooled sensitivity and specificity results from 29 included studies that examined BRAFV600E mutation among cytologically confirmed PTC samples were 72.6% (95% confidence interval [CI] 66.1‐78.3%) and 50.8% (95% CI; 32.3‐69.1%), respectively. For samples that were diagnosed cytologically as suspicious for PTC, and confirmed by histology as PTC, bivariate‐pooled sensitivity and specificity results were 52.1% (95% CI; 36.3‐67.4%) and 85.3% (95% CI; 55.2‐96.5%), respectively. Eleven studies reported non‐diagnostic FNA samples. The pooled sensitivity and specificity results for these samples were 50.5% (95% Cl; 31‐69.8%) and 92.9% (95% Cl; 74.2‐98.3%), respectively.

Conclusions:

BRAFV600E mutation analysis is associated with increase specificity and moderate increase in the sensitivity of FNA in the diagnosis of papillary thyroid cancer.
Endoscopic Retro‐auricular Thyroidectomy: A Preclinical Feasibility Study in Three Cadavers
Authors: Lee So‐Yoon , Sun Dong Il , Ahn Su Hyun , Lee Il Hwan , Park Young‐Hak
Published: August 2013

Objectives:

A number of remote‐access thyroidectomy techniques with the assistance of endoscopic or robotic technology have been described. Most gasless endoscopic thyroidectomies require additional incision on the chest or mammary areola for instrumentation. Recently, Terris DJ et al. developed a novel remote‐access robotic facelift thyroidectomy technique. We aimed to evaluate the preclinical feasibility of endoscope‐assisted thyroidectomy and central neck dissection via retro‐auricular single incision in three cadavers.

Methods:

Three fresh, unembalmed human cadavers were used. A 5‐mm, 30‐degree rigid telescope, endoscopic instruments, and a Harmonic scalpel were used. Working space was created through the retro‐auricular incision. Surgical procedures included the identification and ligation of the superior thyroid pedicle, peri‐thyroid fascia dissection, dissection of the inferior pole, identification of the recurrent laryngeal nerve (RLN), dissection near the Berry ligament, and isthmusectomy.

Results:

We successfully performed total thyroidectomy and central neck dissection in all three cadavers. In all thyroidectomies, the RLN and superior or inferior parathyroid glands were preserved. There was no tracheal or esophageal injury. To confirm surgical completeness after thyroidectomy and central neck dissection, we analyzed the specimen to determine if there was violation of the thyroid capsule, and we reviewed the surgical field to check for remnant thyroid tissue. There was neither capsule injury in the specimen nor remnant thyroid tissue in the surgical field. The working space was adequate for the instrumentation, and no additional incision was needed.

Conclusions:

Our study demonstrates the feasibility of endoscope‐assisted thyroidectomy using a gasless, retro‐auricular single approach that results in safety, surgical completeness and sufficient access.
Enhanced Recovery Achieving the Aims of Head and Neck Cancer Surveillance: A Traffic Light System
Authors: Lee Alexandra M. , Oakley Richard J. , Joshi Anil , Lyons Andrew , Simo Ricard , Urbano Teresa G.
Published: August 2013

Objectives:

Post‐treatment head and neck cancer surveillance (PTHNCS) shows inconsistency in the duration of surveillance and frequency between reviews; its rationale is controversial although generally accepted. We pilot a PTHNCS that uses the principles of enhanced recovery and implements the recommendations of the Head and Neck Cancer multi‐disciplinary 2011 guidelines (HNCMDG).

Methods:

Retrospective review. The recommendations of the HNCMDG 2011 were used to generate a 15 visit, 5 year PTHNCS protocol. A traffic light analogy explains its rationale and reinforces the positive implications associated with progression to patients. A patient appointment/information card has been developed to outline the five year surveillance schedule and highlight red flag symptoms that suggest recurrence and require early review. The follow up of all patients who completed chemoradiation for HNC in the first half of 2011 was compared.

Results:

47 patients received treatment: 21 patients on PTHNCS protocol, 20 (95%) attended the minimum number of visits, 4 requested additional reviews (one for a synchronous primary), none lost to follow up, 1 died. 26 patients followed at the clinicians discretion, 11 (42%) attended the minimum number of appointments, 2 did not, 1 never saw the surgical team, 1 lost to follow up, 11 died.

Conclusions:

Empowering patients to participate in their follow up while educating them as to symptoms that require earlier review allows an increase in interval follow up of asymptomatic patients. Symptomatic patients initiate an earlier review. Fewer patients are lost to follow up.
Extensive Nasopharyngeal Angiofibromas: The Maxillary Swing Approach
Authors: Mathur Neeraj N. , Vashishth Ashish
Published: August 2013

Objectives:

Evaluate the efficacy and outcome of the maxillary swing approach for management of extensive nasopharyngeal angiofibromas.

Methods:

Retrospective analysis in a tertiary care center revealed 5 patients with extensive nasal angiofibromas operated on using the maxillary swing approach between 2010 and 2012. All patients had tumor extension to lateralmost portions of infratemporal fossa with complete occupation, destruction of lateral wall of sphenoid sinus causing abutment to cavernous sinus, and complete involvement of pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of maxillary sinus in consequence to erosion of posterior and medial walls of maxillary sinus, with another causing severe temporal lobe compression through roof of infratemporal fossa. All patients underwent tumor excision with the maxillary swing approach. Patients were followed up for a minimum period of one year after surgery.

Results:

The maxillary swing resulted in an optimal exposure of the entire central skull base including the infratemporal fossa and its far lateral and superior aspects. An adequate tumor exposure and vascular control could be achieved in all cases resulting in complete tumor excision. The mean operative time was 4.1 hrs. Postoperative healing was satisfactory with palatal fistula formation in 2 cases with all patients remaining disease free till present. One had minimal misalignment of the halves of upper jaw and two had epiphora, of which one required dacryocystorhinostomy.

Conclusions:

The maxillary swing is an effective approach in management of extensive nasopharyngeal angiofibromas and leads to an optimal anatomical exposure with minimal morbidity.
Maxillectomy Reconstruction with Various Flaps: Preliminary Results and Suggested Algorithm
Authors: Kim Heejin , Kim Dong Wook , Chang Hyun , Cha Wonjae , Sung Myung‐Whun , Kim Kwang H. , Hah J. Hun
Published: August 2013

Objectives:

Although maxillary reconstruction after maxillectomy for the malignant tumor is still controversial, various reconstruction techniques have been introduced. Since reconstruction methods could be varied by the defects and surgeon's preference, we would like to share our reconstruction algorithm and show preliminary results.

Methods:

Thirteen cases of maxillectomy reconstruction during the past 18 months were reviewed. The types of defects, reconstruction methods, and outcomes were reviewed. The types of defects after maxillectomy were as various as Brown class IIa, IIb, IIIb, IIId, IVb, IVd, and V. Reconstructions were performed using free flaps from the iliac crest, radial forearm, rectus abdominis, and latissimus dorsi. When the maxillectomy included orbital exentration, soft tissue free flaps for defects were preferred. On the other hand, defects for bony lesions including alveolar ridge and orbital rim were reconstructed with iliac crest osteomuscular (or osteomusculocutaneous) free flap.

Results:

All of them were well reconstructed without any complication. The content, especially the orbital content and bony structure, and size of the maxillectomy defect, tumor characteristics, and patients’ prognosis should be considered in the selection of maxillectomy reconstruction.

Conclusions:

The iliac crest free flap might be one of the best options to reconstruct the bony defect after maxillectomy.
Functional Outcomes and Nutrition in Patients Undergoing Pharyngo‐Laryngo‐Esophagectomy with Laparoscopic Gastric Transposition
Authors: Watson Natalie A. , Garcia Donna , Hughes Rhys , Sullivan Allana , Ballis Sarah , Wade‐McBane Kelly , Lee Michael S. W.
Published: August 2013

Objectives:

Explore functional outcomes and nutrition in patients undergoing pharyngo‐laryngo‐esophagectomy with laparoscopic gastric transposition.

Methods:

A retrospective case‐note review of patients who have undergone pharyngo‐laryngo‐esophagectomy with laparoscopic gastric transposition for squamous cell carcinoma of the hypopharynx between 1/2/2010 and 31/1/2013 at a tertiary referral center. History, anthropometrics, length of admission, biochemical markers, nutritional requirements, provision, complications, readmission, pre‐operative voice quality, timeframes to secondary TOP, perceptual measures of TOP speech, normalcy of diet and public eating performance status score were collated.

Results:

Eight patients, mean age of 55 at operation. Voice outcome: The timeframe from surgery to completion of a secondary puncture was approximately one calendar year. One patient has functional hypotonic voice 3 years post‐op. Nutrition: Pre‐operative nutritional support was inconsistent. Patients had a jejunal (JEJ) feeding tube inserted at the time of surgery. Post‐operatively patients were nil by mouth with JEJ feeding being commenced between day 1 and 12. Mean body mass index at 6 months and 3 years 20.8kg/m2 and 19.65 kg/m2 (latter in 2 patients of 3 survivors). Swallowing: Mean pre‐operative PSS scores for normalcy of diet and public eating were 30/100 and 50/100 respectively. Dysphagia was an issue for all patients post‐operatively with none achieving normalcy of diet PSS levels >50/100. Following surgery compared with pre‐operative scores, all public‐eating scores reduced.

Conclusions:

Voice restoration and swallowing functions are reduced following surgery. Pre‐ and post‐operative nutritional support is essential. We believe our experience over 3 years is the longest and largest case series review of functional outcomes worldwide.
Gracilis Muscle‐Only Flap for Soft‐Tissue Coverage following Oncologic Surgery of the Neck
Authors: Romak Jonathan J. , Patel Neil S. , Price Daniel L.
Published: August 2013

Objectives:

1) Describe the use of the gracilis muscle‐only flap for the protection of neurovascular structures in the neck. 2) Recognize situations where minimizing donor‐site morbidity and optimizing the aesthetic outcome preclude the use of the pectoralis or latissimus flaps.

Methods:

A review of records, imaging, and photographs was performed along with a review of the literature. Previous cases where the gracilis muscle was used for free tissue transfer were reviewed.

Results:

A 13‐year‐old female was referred for management of a right‐sided residual malignant peripheral nerve sheath tumor. The tumor was ipsilateral to her dominant hand, and the patient was an avid volleyball player and violinist. Imaging demonstrated the tumor diffusely infiltrating structures of the carotid sheath, sternocleidomastoid muscle (SCM), and levels II ‐ IV in the neck. The patient underwent surgical resection of the tumor and the ipsilateral SCM, carotid artery, jugular vein, vagus nerve, hypoglossal nerve, and cervical sympathetic chain. The carotid artery, vagus, and hypoglossal nerves were reconstructed with grafts. Post‐operative radiation was planned, necessitating protection of the underlying grafts. A portion of the right gracilis muscle was harvested and sutured to the mastoid tip and clavicle. Vascular anastomoses were performed to nearby vessels. The patient experienced no flap donor or recipient site complications. Symmetry was excellent post‐operatively.

Conclusions:

This novel use of the gracilis muscle for soft tissue coverage following an ablative procedure in the neck resulted in negligible donor site morbidity and an excellent aesthetic outcome in both the neck and the inner thigh.
Emerging city policies: Devolution, deals and disorder
Authors: Waite David , Maclennan Duncan , O’Sullivan Tony
Published: August 2013

In this article we consider whether the city policy frameworks that are currently emerging in England and Scotland, under the influence of devolution and localism, are likely to result in a locally effective yet nationally coherent set of economic outcomes or generate a disorderly pattern of local autonomies based on a series of ad hoc, local deals. Mindful of the context of slow economic growth and austerity, we look at the evolution of city policies in Scotland and England in the light of some rather fundamental requirements for cohesive decentralised policy design and implementation. Each can learn from the policy experiences of the other, but key questions remain as to whether sufficient resources and governance cohesion, to deliver greater city-led national economic growth, will emerge in England and Scotland.
Redeveloping local economic strategy for the post-regionalist era: A contextual benchmarking approach
Authors: Salder Jacob
Published: August 2013

The decline of the regionalist era and introduction of localism has set a number of emerging issues for economic development at the local level. Amongst the spatial, organisational and functional challenges facing local government a prevalent one is re-engineering a local development trajectory to represent this new environment. The dissolution of the regional governance hierarchy alongside a fundamental shift in aspirations for economic shape and structure has forced localities to reconsider approaches to both economic development and spatial economy. Using an action-based case study of the Borough of Poole, a coastal conurbation in Southern England, this article looks at the local response in revising the economic development strategy through a contextual benchmarking approach. It proposes an alternative method to adopt in developing local strategy contributing toward questions on defining spatial economy, integrating local context and actors, and adapting to a wider set of structural and fiscal issues.
Explicitly permissive? Understanding actor interrelationships in the governance of economic development: The experience of England’s Local Enterprise Partnerships
Authors: Deas Iain , Hincks Stephen , Headlam Nicola
Published: August 2013

Local Enterprise Partnerships in England were intended as organic entities in which coalitions of local actors, led by business interests, would determine locally relevant policy for self-defined spatial units. Informed by ideas around localism and the desire to extend sub-national economic development policy making beyond the local state, central government envisaged an increased unevenness in local governance arrangements and policy approaches. The article assesses the experiences of four Local Enterprise Partnerships, employing social network analysis in an attempt to systematise the comparison of actor relationships and urban governance arrangements. The article considers the degree to which the discursive emphasis on liberating local policy actors from central government control has any empirical basis in the variable shape and structure of local elite actor networks. It argues that although Local Enterprise Partnerships operate within an environment characterised by lighter touch regulation, there is a dissonance between local discretion and the political imperative for central government to exercise oversight. Equally, variability in the web of actor interactions across the sample of Local Enterprise Partnerships suggests that asymmetrical urban governance and competitive localism are intrinsic features of post-regional local economic development, reflecting a wider national framework for spatial policy in which diversity in sub-national institutional form is viewed as a source of policy innovation and dynamism.
What Typically Developing Children’s Parents Say When They Read Books About Disabilities
Authors: Park Hyejin , Ostrosky Michaelene M.
Published: August 2013

The purpose of this study was to examine (a) how parents and their kindergarten-age children talk about disabilities when they read books that include characters with disabilities and (b) the relationship between the frequency of mother/child comments about disabilities and children’s attitudes toward peers with disabilities, as measured by the Acceptance Scale for Kindergarten–Revised (ASK-R). Thirteen mothers and their children audiotaped their conversations when they read books that included characters with disabilities. Seventy conversations were analyzed and 12 themes were identified. The themes that appeared most frequently in the mother–child conversations about disabilities included differences in abilities and similarities between the child and the book characters with disabilities. Although the relationship between the number of words spoken by the parent–child dyads and children’s attitudes toward peers with disabilities was not statistically significant, group differences between the number of words spoken and the content of the disability-related conversations were observed.
The Understanding of Terminal Cancer and Its Relationship with Attitudes toward End-of-Life Care Issues
Authors: Lee June Koo , Yun Young Ho , An Ah Reum , Heo Dae Seog , Park Byeong-Woo , Cho Chi-Heum , Kim Sung , Lee Dae Ho , Lee Soon Nam , Lee Eun Sook , Kang Jung Hun , Kim Si-Young , Lee Jung Lim , Lee Chang Geol , Lim Yeun Keun , Kim Samyong , Choi Jong Soo , Jeong Hyun Sik , Chun Mison
Published: August 2013

Background. Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues. Methods. A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded. Results. A “6-month life expectancy” was the most common understanding of terminal cancer (45.6%), followed by “treatment refractoriness” (21.1%), “metastatic/recurrent disease” (19.4%), “survival of a few days/weeks” (11.4%), and “locally advanced disease” (2.5%). The combined proportion of “treatment refractoriness” and “6-month life expectancy” differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as “survival of a few days/weeks” showed more negative attitudes toward disclosure of terminal status compared with participants who chose “treatment refractoriness” (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22–0.79 for patients; aOR 0.34, 95% CI 0.18–0.63 for caregivers). Caregivers who understood terminal cancer as “locally advanced” or “metastatic/recurrent disease” showed a significantly lower percentage of agreement with withdrawal of futile life-sustaining treatment compared with those who chose “treatment refractoriness” (aOR 0.19, 95% CI 0.07–0.54 for locally advanced; aOR 0.39, 95% CI 0.21–0.72 for metastatic/recurrent). Conclusions. The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.
Low-contrast-dose protocol in cardiac CT: 20% contrast dose reduction using 100 kVp and high-tube-current-time setting in 256-slice CT
Authors: Kidoh Masafumi , Nakaura Takeshi , Nakamura Shinichi , Nakamura Shota , Sakaino Naritsugu , Harada Kazunori , Uemura Shouzaburou , Yamashita Yasuyuki
Published: August 2013

Background

The use of the smallest contrast dose is highly desirable in performing cardiac computed tomography (CT), especially for patients with cardiovascular diseases to prevent contrast-induced nephropathy.

Purpose

To evaluate the feasibility of 20% reduced contrast dose protocol in cardiac CT using 100 kVp and high-tube-current-time product setting.

Material and Methods

Fifty patients were scanned with our conventional 120 kVp protocol, and the other 50 patients underwent scans using a tube voltage of 100 kVp, a high-tube-current-time product, and a 20% reduced contrast dose. We evaluated estimated effective dose (ED), CT attenuation, image noise, and contrast-to-noise ratio (CNR) of the ascending aorta. We also evaluated CT attenuation of the coronary arteries. Two radiologists independently assessed image quality of coronary arteries.

Results

There was no significant difference in the ED between the 100 kVp and 120 kVp protocols (21.7 mSv ± 1.6 vs. 21.8 mSv ± 1.1, P = 0.65). There was no significant difference in the CNR of the ascending aorta between the 100 kVp and 120 kVp protocols (18.8 ± 3.5 vs. 18.7 ± 3.8, P = 0.98). Mean CT attenuation of the coronary arteries of the 100 kVp protocols was significantly higher than that of 120 kVp protocols ( P < 0.05). There was no significant difference in the overall image quality of the coronary artery between the 100 kVp and 120 kVp protocols (3.7 ± 0.4 vs. 3.7 ± 0.5, P = 0.65).

Conclusion

For cardiac CT a voltage setting of 100 kVp and a high-tube-current-time product enable 20% reduction in the contrast dose without affecting the quality of coronary artery images compared with a 120 kVp and standard-contrast-dose CT protocol.