bluuebunny/crossref_metadata_2025 huggingface dataset:
Divergent Roles of Matrix Metalloproteinase 2 in Pathogenesis of Thoracic Aortic Aneurysm
Authors: Shen Mengcheng , Lee Jiwon , Basu Ratnadeep , Sakamuri Siva S.V.P. , Wang Xiuhua , Fan Dong , Kassiri Zamaneh
Published: February 2015

Objective—

Aortic aneurysm, focal dilation of the aorta, results from impaired integrity of aortic extracellular matrix (ECM). Matrix metalloproteinases (MMPs) are traditionally known as ECM-degrading enzymes. MMP2 has been associated with aneurysm in patients and in animal models. We investigated the role of MMP2 in thoracic aortic aneurysm using 2 models of aortic remodeling and aneurysm.

Approach and Results—

Male 10-week-old MMP2-deficient (MMP2
−/−
) and wild-type mice received angiotensin II (Ang II, 1.5 mg/kg/day) or saline (Alzet pump) for 4 weeks. Although both genotypes exhibited dilation of the ascending aorta after Ang II infusion, MMP2
−/−
mice showed more severe dilation of the thoracic aorta and thoracic aortic aneurysm. The Ang II–induced increase in elastin and collagen (mRNA and protein) was markedly suppressed in MMP2
−/−
thoracic aorta and smooth muscle cells, whereas only mRNA levels were reduced in MMP2
−/−
-Ang II abdominal aorta. Consistent with the absence of MMP2, proteolytic activities were lower in MMP2
−/−
-Ang II compared with wild-type-Ang II thoracic and abdominal aorta. MMP2-deficiency suppressed the activation of latent transforming growth factor-β and the Smad2/3 pathway in vivo and in vitro. Intriguingly, MMP2
−/−
mice were protected against CaCl
2
-induced thoracic aortic aneurysm, which triggered ECM degradation but not synthesis.

Conclusions—

This study reveals the dual role of MMP2 in ECM degradation, as well as ECM synthesis. Moreover, the greater susceptibility of the thoracic aorta to impaired ECM synthesis, compared with vulnerability of the abdominal aorta to aberrant ECM degradation, provides an insight into the regional susceptibility of the aorta to aneurysm development.
Clinical Correlates and Prognostic Significance of Change in Standardized Left Ventricular Mass in a Community‐Based Cohort of African Americans
Authors: Fox Ervin R. , Musani Solomon K. , Samdarshi Tandaw E. , Taylor Jared K. , Beard Walter L. , Sarpong Daniel F. , Xanthakis Vanessa , McClendon Eric E. , Liebson Philip R. , Skelton Thomas N. , Butler Kenneth R. , Mosley Thomas H. , Taylor Herman , Vasan Ramachandran S.
Published: February 2015

Background

Though left ventricular mass (
LVM
) predicts cardiovascular events (
CVD
) and mortality in African Americans, limited data exists on factors contributing to change in
LVM
and its prognostic significance. We hypothesized that baseline blood pressure (
BP
) and body mass index (
BMI
) and change in these variables over time are associated with longitudinal increases in
LVM
and that such increase is associated with greater incidence of
CVD
.

Methods and Results

We investigated the clinical correlates of change in standardized logarithmically transformed‐
LVM
indexed to height2.7 (log‐
LVMI
) and its association with incident
CVD
in 606 African Americans (mean age 58±6 years, 66% women) who attended serial examinations 8 years apart. Log‐
LVMI
and clinical covariates were standardized within sex to obtain z scores for both visits. Standardized log‐
LVMI
was modeled using linear regression (correlates of change in standardized log‐
LVMI
) and Cox proportional hazards regression (incidence of
CVD
[defined as coronary heart disease, stroke, heart failure and intermittent claudication]). Baseline clinical correlates (standardized log‐
LVM
,
BMI
, systolic
BP
) and change in systolic
BP
over time were significantly associated with 8‐year change in standardized log‐
LVMI
. In prospective analysis, change in standardized
LVM
was significantly (P=0.0011) associated with incident
CVD
(hazards ratio per unit standard deviation change log‐
LVMI
1.51, 95%
CI
1.18 to 1.93).

Conclusions

In our community‐based sample of African Americans, baseline
BMI
and
BP
, and change in
BP
on follow‐up were key determinants of increase in standardized log‐
LVMI
, which in turn carried an adverse prognosis, underscoring the need for greater control of
BP
and weight in this group.
Regional Availability of Mechanical Embolectomy for Acute Ischemic Stroke in California, 2009 to 2010
Authors: Choi Jay Chol , Hsia Renee Y. , Kim Anthony S.
Published: February 2015

Background and Purpose—

We sought to assess the geographic proximity of patients with stroke in California to centers that performed specific threshold volumes of mechanical embolectomy procedures each year.

Methods—

We identified all patients who were hospitalized for acute ischemic stroke at all nonfederal acute care hospitals in California from 2009 to 2010, and all hospitals that performed any mechanical embolectomy procedures by case volume during the same period, using nonpublic data from the Office of Statewide Health Planning and Development. We computed geographic service areas around each hospital on the basis of prespecified ground transport distance thresholds. We then calculated the proportion of hospitalized patients with stroke who lived within service areas for centers that performed a low volume and high volume of mechanical embolectomy procedures each year.

Results—

During the 2-year study period, 15% (53/360) of hospitals performed at least 1 mechanical embolectomy for acute stroke, but only 19% (10/53) performed >10 cases per year. Most hospitalized patients with stroke (94%) lived within a 2-hour transport time (65 miles) to a hospital that performed ≥1 procedure during the 2-year period. Approximately 93% of the patients with stroke who received mechanical embolectomy lived within 20 miles from an embolectomy-capable hospital compared with 7% of those who lived >20 miles.

Conclusions—

In California, most patients with stroke lived within reasonable ground transport distances from centers that performed ≥1 mechanical embolectomy in a 2-year period. The probability of receiving mechanical embolectomy for acute ischemic stroke was associated with living in close geographic proximity to these hospitals.
Relevance of Blood–Brain Barrier Disruption After Endovascular Treatment of Ischemic Stroke
Authors: Renú Arturo , Amaro Sergio , Laredo Carlos , Román Luis San , Llull Laura , Lopez Antonio , Urra Xabier , Blasco Jordi , Oleaga Laura , Chamorro Ángel
Published: February 2015

Background and Purpose—

Computed tomographic (CT) high attenuation (HA) areas after endovascular therapy for acute ischemic stroke are a common finding indicative of blood–brain barrier disruption. Dual-energy CT allows an accurate differentiation between HA areas related to contrast staining (CS) or to brain hemorrhage (BH). We sought to evaluate the prognostic significance of the presence of CS and BH after endovascular therapy.

Methods—

A prospective cohort of 132 patients treated with endovascular therapy was analyzed. According to dual-energy CT findings, patients were classified into 3 groups: no HA areas (n=53), CS (n=32), and BH (n=47). The rate of new hemorrhagic transformations was recorded at follow-up neuroimaging. Clinical outcome was evaluated at 90 days with the modified Rankin Scale (poor outcome, 3–6).

Results—

Poor outcome was associated with the presence of CS (odds ratio [OR], 11.3; 95% confidence interval, 3.34–38.95) and BH (OR, 10.4; 95% confidence interval, 3.42–31.68). The rate of poor outcome despite complete recanalization was also significantly higher in CS (OR, 9.7; 95% confidence interval, 2.55–37.18) and BH (OR, 15.1; 95% confidence interval, 3.85–59.35) groups, compared with the no-HA group. Patients with CS disclosed a higher incidence of delayed hemorrhagic transformation at follow-up (OR, 4.5; 95% confidence interval, 1.22–16.37) compared with no-HA patients.

Conclusions—

Blood–brain barrier disruption, defined as CS and BH on dual-energy CT, was associated with poor clinical outcomes in patients with stroke treated with endovascular therapies. Moreover, isolated CS was associated with delayed hemorrhagic transformation. These results support the clinical relevance of blood–brain barrier disruption in acute stroke.
Field Attunement for a Strong Therapeutic Alliance
Authors: Day Elizabeth
Published: February 2015

This article addresses the basis for the centrality of the therapeutic relationship in effective therapeutic outcomes, especially as distinct from technique, which prevails in the 21st-century Australian mental health context as a focus in determining what constitutes evidence-based practice. Presence-oriented therapeutic approaches infer an intersubjective field within which transformative enquiry can occur. This forms the basis of the article’s exploration of the function of the phenomenon of the “field” for intersubjective therapeutic relationship and its relationship to Levinas’ “third” as the basis for transformative, ethical, therapeutic practice. Work on “fields,” in different disciplinary domains that share a focus on understanding underlying processes and patterns of physical and social organization, yields sufficient common ground to speak of a field as a substantive principle on which to base practice. Relational Gestalt psychotherapy has developed the concept of field sufficiently to have evolved principles for working with the felt effects of the field, without firm resolve yet as to the ontological status of relational fields. Paradigmatically the work remains emergent in most disciplines. Further transdisciplinary research into field theory may yield more nuanced analysis of how to work intentionally with field conditions.
Core Pedagogy
Authors: Dotger Benjamin H.
Published: February 2015

Attention to the core practices of teaching necessitates core pedagogies in teacher preparation. This article outlines the diffusion of one such pedagogy from medical to teacher education. The concept of clinical simulations is outlined through the lens of “signature pedagogies” and their uncertain, engaging, formative qualities. Implemented in five different teacher preparation programs, simulation data highlight design principles and resulting outcomes for general scholastic and subject-specific problems of practice.
When “Comoners Were Made Slaves by the Magistrates”
Authors: Williamson Fiona
Published: February 2015

This article tells the story of a contested provincial election for sheriff which took place in Norwich during 1627. In light of recent scholarly critiques of studies that frame the early-modern period in terms of binary opposites, this article demonstrates that 1620s political culture is hard to define in such stark terms. Through a close reading of the events, characters, and outcomes of the election, this article also shows the importance of embedding local peculiarities into wider historiographical narratives of change, or continuity, and reveals the essential role of the urban middling sorts in shaping the political narratives of the Stuart period.
An Ecological Perspective on Diabetes Self-care Support, Self-management Behaviors, and Hemoglobin A1C Among Latinos
Authors: Soto Sandra C. , Louie Sabrina Y. , Cherrington Andrea L. , Parada Humberto , Horton Lucy A. , Ayala Guadalupe X.
Published: February 2015

Purpose

The purpose of this study was to examine the role of self, interpersonal (ie, family/friend), and organizational (ie, health care) support in performing diabetes-related self-management behaviors and hemoglobin A1C (A1C) levels among rural Latinos with type 2 diabetes.

Methods

Cross-sectional data from baseline interviews and medical records were used from a randomized controlled trial conducted in rural Southern California involving a clinic sample of Latinos with type 2 diabetes (N = 317). Self-management behaviors included fruit and vegetable intake, fat intake, physical activity, glucose monitoring, daily examination of feet, and medication adherence. Multivariate linear and logistic regression models were used to assess the relationships of sources of support with self-management behaviors and A1C.

Results

Higher levels of self-support were significantly associated with eating fruits and vegetables most days/week, eating high-fat foods few days/week, engaging in physical activity most days/week, daily feet examinations, and self-reported medication adherence. Self-support was also related to A1C. Family/friend support was significantly associated with eating fruits and vegetables and engaging in physical activity most days/week. Health care support was significantly associated with consuming fats most days/week.

Conclusions

Health care practitioners and future interventions should focus on improving individuals’ diabetes management behaviors, with the ultimate goal of promoting glycemic control. Eliciting family/friend support should be encouraged to promote fruit and vegetable consumption and physical activity.
Open culture and innovation: integrating knowledge across boundaries
Authors: Powell Alison B
Published: February 2015

What does open source mean for culture? For knowledge? As cultural production has come to be characterized by contribution as well as consumption and as alternative modes of intellectual property transfer challenge the ‘dominant paradigm’ that knowledge and information should be protected and monetized, the logic of ‘open sourcing’ has extended into many cultural spheres. This article positions ‘openness’ as a value that intermediates between re-usable software code, institutional transparency, and expanded opportunities for participation in knowledge production cultures. By observing and analyzing the expansion of ‘openness’ from computer software to electronics hardware, we can develop a framework that identifies the tensions between socio-cultural visions of knowledge commons and the realities of governing those commons. This research focuses in particular on the knowledge related to electronics hardware and other material objects governed by open hardware licenses. The insights in this article are valuable for anyone studying open source and peer production processes and the knowledge claims surrounding them.
Evaluating the Safety of Harmonic Scalpel in Thyroidectomy
Authors: Seo Min Young , Son Young‐Ik , Baek Chung Hwan , Park Ki‐Nam , Kim Dohun
Published: February 2015

Objective

Harmonic scalpel (HS) is widely used in thyroidectomy because of its multiple advantages. However, there are concerns on thermal damage to the adjacent lateral. This study aimed to compare the incidence of EBSLN or cricothyroid muscle injury, and patterns of voice discomfort between thyroidectomy using HS and classic knot‐tie ligation.

Method

Thirty‐four patients with papillary thyroid microcarcinoma completed the study. Patients were randomly divided into 2 groups; knot‐tying group (KT, n = 18) and harmonic scalpel group (HS, n = 16).

Results

Subjective voice assessment with questionnaires, acoustical analyses including voice range profile, and stroboscopic laryngeal evaluation were performed before and 3 months after surgery.

Conclusion

When compared to conventional knot‐tying method, using HS does not increase SLN injury, subjective voice discomfort or perturbation parameters of acoustic voice analyses. Regardless of using HS, thyroidectomy may result in subjective voice discomfort until the third month after surgery, which usually recovers to the preoperative level during 6 months.
Facial Nerve Palsy following Parotidectomy
Authors: Amin Nikul , Dixon Hannah , Gibbins Nicholas , Lew‐Gor Simione
Published: February 2015

Objective

To determine the incidence of temporary and permanent facial nerve dysfunction in patients following parotidectomy in a UK teaching hospital.

Method

All parotidectomies performed between January 1, 2009, and January 1, 2012, were analyzed using patients’ clinical and operative records. The grade of the surgeon, the operation, and the presence of a facial nerve monitor were recorded. House‐Brackmann scores were recorded preoperatively and postoperatively. The length of time until recovery of facial nerve function was recorded.

Results

Sixty‐five parotidectomies were performed. The indications for surgery included pleomorphic adenoma 31%, warthin 23%, malignant disease 34%, and other 15%. Overall postoperative palsy rate was 43% (28/65). The most commonly affected branch was the marginal mandibular, 25% (16/65 %). Six were permanent and 22 temporary. The rate of facial nerve palsy was 44% for benign disease and 41% for malignant. Of the 6 permanent facial nerve palsies, 4 (67%) facial nerves were sacrificed because of preoperative disease involvement. MM was the branch commonly involved in these cases often due to Level 1 nodal clearance. In patients with temporary facial nerve palsy, mean recovery time was 4.3 months (range, 24 hours‐12 months).

Conclusion

Facial nerve palsy is a distressing and debilitating complication of parotidectomy, not only functionally but also emotionally and socially. Informed consent is an important part of preoperative assessment and accurate facial nerve palsies incidence rates should be discussed with patients.
Hereditary Head and Neck Paragangliomas
Authors: Crockett David , Bentz Brandon G.
Published: February 2015

Objective

Paragangliomas are rare neuroendocrine tumors derived from the extra‐adrenal paraganglia of the autonomic nervous system. Little information has been accumulated describing the differences in clinical expression between hereditary versus nonhereditary paraganglia. We examined the differences in clinical characteristics, presenting symptoms, and tumor types of hereditary head and neck paragangliomas.

Method

A retrospective review of the medical records was performed in order to formulate a database of patients with head and neck paragangliomas. Clinical characteristics, tumor type and location, presentation, and genetic results of each patient were included. Hereditary paragangliomas were compared to the general database of head and neck paragangliomas.

Results

Eighty patients with the diagnosis of a head and neck paraganglioma were evaluated at the University of Utah during the years of 2000 to 2010. Thirteen of the 80 were confirmed to be hereditary paragangliomas through genetic testing or through family history. Patients with a known hereditary component presented earlier in life than those of the general paraganglioma population. Over half of the patients who presented under the age of 30 years were confirmed to be hereditary. The most common presenting symptom was a neck mass (54%). A genetic mutation was found in all those tested under the age of 30 years.

Conclusion

Our study evaluates a large population of hereditary paragangliomas. We found that patients who present at a younger age may be at an increased risk of possessing a genetic mutation. Further research will determine if genetic testing is necessary in all patients who present under the age of 30 years.
Improved Outcomes in Primary Prosthesis Placement during Tracheoesophageal Puncture
Authors: Fowler Nicole M. , Kmiecik Joann , Khan Mumtaz J. , Scharpf Joseph , Lorenz Robert R. , Burkey Brian B.
Published: February 2015

Objective

Tracheoesophageal prosthesis facilitates esophageal speech in postlaryngectomy patients. The vocal prosthesis can be placed either during tracheoesophageal puncture (TEP) or, more commonly, in a delayed fashion. Our objectives were to: 1) analyze the voice outcomes and 2) compare the pain and emergency care, following primary versus delayed prosthesis placement.

Method

A 2011 cohort study. A tracheoesophageal puncture occurred in conjunction with, or within 3 months of, total laryngectomy. Nine patients underwent primary and 11 patients underwent delayed prosthesis placement. The primary outcome was voice production at the first postoperative appointment. Secondary outcomes included pain and perioperative emergency room visits.

Results

All patients (100%) with prostheses placed at the time of the TEP had voice production at the first postoperative clinic visit, in comparison to only 45% (5/11) of patients with prostheses placed in delayed fashion. Significant pain with vocalization occurred in zero primary placement prosthesis patients, but in 55% (6/11) of delayed placement prosthesis patients. Only one primary placement prosthesis patient (11%) sought emergency medical care related to their stoma or voice prosthesis versus 7 (64%) delayed placement prosthesis patients.

Conclusion

Primary prosthesis placement during TEP has significantly improved voice and quality of life outcomes with earlier voice production, reduced postoperative pain and the virtual elimination of perioperative emergency room visits. This significant modification of the standard technique represents a highly successful and cost‐effective approach to vocal rehabilitation in post‐laryngectomy patients.
Innate Immune Reactions in Locally Early Tonsillar Cancer
Authors: Kuratomi Yuichiro , Kusano Kenichiro , Shimazu Rintaro , Inokuchi Akira
Published: February 2015

Objective

The palatine tonsil contains innate immune cells such as natural killer (NK) cells and macrophages. Tonsillar cancers often present locally early tumors with cervical metastases. This study was performed to clarify the possibility that the growth of primary tumors might be inhibited by innate immune cells in the palatine tonsil.

Method

NK cells and macrophages were immunohistochemically identified using anti‐HNK‐1 and anti‐CD68 antibodies. The degree of the immune cell infiltration in tonsillar cancers, tongue cancers, and normal tonsils was estimated by counting the number of NK cells and macrophages in formalin‐fixed, paraffin‐embedded blocks. Phagocytosis of the tumor cells was also studied.

Results

There was a significant increase in the number of NK cells in locally early tonsillar cancers (a median of 100 in 8 patients) in comparison to locally early tongue cancers (a median of 8 in 15 patients) and 5 normal tonsils (a median of 35; P <. 0001). The number of macrophages was also significantly increased in tonsillar cancers (a median of 247) in comparison to tongue cancers (a median of 81) and normal tonsils (a median of 82; P <. 0001). Phagocytosis of tumor cells by macrophages was observed significantly more frequently in tonsillar cancers than in tongue cancers (P <. 01).

Conclusion

The innate immune reactions were observed to significantly increase and they might therefore inhibit the growth of the primary tumor in locally early tonsillar cancer. In addition, these inhibitory immune reactions against the primary tumor in the palatine tonsil might be part of the etiology of developing primary‐unknown cervical metastasis.
Intraoperative Hyperkalemia: Death in Renal Parathyroidectomy
Authors: Zahoor Tosief , Bajaj Yogesh , Roberts S. , England James
Published: February 2015

Objective

Recognize potential life‐threatening complications of intraoperative hyperkalemia during parathyroid surgery to control secondary hyperparathyroidism in renal patients. We present a case of a 20‐year‐old renal patient who died from VF arrest intraoperatively during elective surgery for secondary hyperparathyroidism. Understand the importance of intraoperative potassium monitoring.

Method

Prospective analysis of intraoperative monitoring of potassium levels in patients with CRF undergoing total parathyroidectomy from April 2006 to July 2009 at Hull Royal Infirmary (UK). All patients had postdialysis preoperative potassium levels checked, at least 2 intraoperative levels, and 1 postoperative level.

Results

Twenty‐nine patients underwent total parathyroidectomy. A total of 17 out of 29 had intraoperative potassium rises, 55% (95% CI 38‐71%) had intraoperative potassium rise above the normal limit (5.3 mM). Six patients (21% (95% CI 10‐38%)) required intraoperative treatment with dextrose‐insulin infusion. Active intervention was taken for patients who had rises greater than 0.5 mM or active ECG changes. Four patients had increasing potassium levels despite treatment indicating that without treatment these could potentially have been very high. Comparative results of postinduction and first intraoperative potassium levels were a good indicator of potassium rise later and the need for treatment (P =. 003).

Conclusion

Hyperkalemia is a recognized complication within the first 24 hours postparathyroidectomy; however, it can occur more commonly intraoperatively in renal patients with potential devastating effects. Our unfortunate mortality complication has led us to change practice and we advocate active intraoperative monitoring and treatment to prevent such complications.
Laryngeal Cancer: A 2‐Year Follow‐up Study
Authors: Smith Matthew D. , Fleming Jason , Lew‐Gor Simione , Simcock Richard , Weighill John , Harries Meredydd L.
Published: February 2015

Objective

1) To report the process of management and 2‐year disease‐free survival statistics for laryngeal cancer cases presenting to a United Kingdom tertiary cancer center. 2) To investigate which modality of treatment is the most appropriate for specific stages of laryngeal cancer.

Method

A retrospective cohort study was carried out on laryngeal cancer patients presenting to a tertiary head and neck center from 2007 to 2009. Information on primary tumor staging and management was collected using the Somerset Cancer Registry. Patient notes, imaging, and histology reports were consulted to complete data retrieval.

Results

Forty‐seven cases presented during the study period (2 stage‐0, 8 stage‐I, 12 stage‐II, 13 stage‐III, 12 stage‐IV). Nodal disease was present in 10.6%, and 2.1% had metastatic disease at presentation. Overall 2‐year disease‐free survival was 100% for stage‐0, 87.5% stage‐I, 69.2% stage‐II, 36.4% stage‐III, and 32.2% for stage‐IV disease. Stage‐I/II cases were treated by transoral laser (36.8%) or radiotherapy (63.2%), with 85.7% and 83.3% 2‐year disease‐free survival rates, respectively. Stage‐III/IV cases were treated by surgery (38.1%) or radiotherapy/chemoradiotherapy (61.9%) with 2‐year disease‐free survival rates of 62.5% and 21.4%, respectively.

Conclusion

Early‐stage disease is equally well treated with transoral laser or radiotherapy alone in line with other studies. Larynx preservation with chemoradiotherapy demonstrates significantly poorer outcomes compared to surgery in this study. Accurate contemporary data recording is required to allow critical review of treatment modalities.
Laryngeal Hibernoma
Authors: Cain Rachel B. , Landry April M. , Hinni Michael L.
Published: February 2015

Objective

Recognize hibernoma as an uncommon, benign tumor composed of brown adipose tissue that can occur in the head and neck. Learn the unique radiographic features of this rare tumor, and understand the principles of treatment.

Method

A systematic review of the English literature was conducted. In addition, we present a series of 2 laryngeal hibernomas treated with transoral laser microsurgical resection at a tertiary referral center over a period of 18 years.

Results

Nineteen cases of hibernoma in the cervicofacial region have been described in the literature. This includes only 2 cases of laryngeal hibernoma ever reported. We present a series of 2 laryngeal hibernomas encountered at our institution. In each case, preoperative imaging demonstrated a well‐circumscribed neoplasm with fat density compatible with lipoma, but internal heterogeneity and vascularity seen in the context of liposarcoma. Transoral laser microsurgical resection was successfully completed in each case. Grossly, the tumors had the fatty appearance of a lipoma, however final pathology revealed myxoid hibernoma. Both patients healed well with normal speech and swallowing postoperatively.

Conclusion

Hibernoma is a tumor composed of brown adipose tissue. There have been only 2 cases of para‐glottic hibernoma reported to date. We report 2 additional cases of laryngeal hibernoma. In our experience, complete resection via transoral laser microsurgery is a safe and effective treatment modality with very little associated morbidity.
Mammary Analogue Secretory Carcinoma of the Parotid Gland
Authors: Huang Lilleen M. , Petersson Frederik , Loke David
Published: February 2015

Objective

Mammary analogue secretory carcinoma is a new entity in salivary gland tumors that has only been recently described. It has overlapping histopathological features with acinic cell carcinoma and low grade variants of cystadenocarcinoma. It has a distinct chromosomal translocation, t(12;15)‐(p13;q25), resulting in a fusion gene ETV6 NTRK3. The clinical course of this disease entity is uncertain at present. We present a case of MASC of the parotid gland occurring in a 34‐year‐old man and discuss the difficulties in diagnosis and subsequent treatment of this tumour.
Metformin Decreases Recurrence in Patients with Oral Cavity and Oropharyngeal Squamous Cell Carcinoma
Authors: Thompson Christopher F. , Kim Brandon , Elashoff David , Lai Chi , Wang Marilene B. , John Maie
Published: February 2015

Objective

Metformin has been associated with decreased cancer risk and mortality. However, the effects of metformin on clinical outcomes in oral cavity and oropharyngeal squamous cell carcinoma (OC/OP SCCA) have not been defined. We aimed to evaluate the association of metformin use and cancer recurrence in diabetic patients with OC/OP SCCA.

Method

We performed a retrospective review of all patients with diabetes mellitus type II treated at our tertiary medical center for OC/OP SCCA from 2001 to 2011. The patients’ demographics, cancer TNM stage, treatment, and outcomes were analyzed.

Results

We identified 69 patients with diabetes mellitus type 2 and OC/OP SCCA from 2001 to 2011. Twenty‐three patients were taking metformin (11 early stage and 12 late stage) and 46 patients were not taking metformin (20 early stage and 26 late stage). Kaplan‐Meier (KM) analysis and coproportional hazard univariate (Coph) analysis were performed. For early stage patients, the KM curve is promising, and the HR from the Comodel is 0.36 (P =. 34), suggesting a substantial effect. There is less of an effect in late stage patients.

Conclusion

This is the first known clinical study evaluating the effect of metformin in head and neck cancer. Our results suggest metformin decreases recurrence for diabetic patients with early TNM stage OC/OP SCCA. Further study is needed to validate this benefit, as our limitation is likely related to sample size.
Montgomery Thyroplasty after Cordectomy: Vocal Outcomes
Authors: Pecorari Giancarlo , Raimondo Luca , Gallone Giorgio Oliviero , Nadalin Juri , Sensini Matteo , Riva Giuseppe , Giordano Carlo
Published: February 2015

Objective

Providing good vocal outcomes to vocal fold cancer patients, after open or endoscopic cordectomy, is a hot topic. Several authors compared different phono‐surgical techniques focusing their attention on feasibility. The aim of our study was to evaluate objective and subjective vocal outcomes after Montgomery thyroplasty.

Method

In 2011, at the I ENT Division of Turin University, 8 patients underwent Montogomery thyroplasty followed by 6 months of speech rehabilitation. Inclusion criteria were: glottic incompetence and 3 years of follow‐up after cordectomy. Voice evaluation was performed using videolaryngostroboscopy, Multidimensional Voice Program (MDVP), and VHI‐10.

Results

Six months after the surgical procedure, the laryngostroboscopy showed an improved glottic closure during phonation even if irregular and incomplete. Preoperative and postoperative MDVP parameters were compared by means of Student t test, observing a statistically significant improvement of all parameters (P <. 05). The most relevant improvements were observed in: average fundamental frequency (192 Hz vs 161.7 Hz), absolute jitter (645 µs vs 57 µs), shimmer (2.1 dB vs 0.82 dB), amplitude perturbation quotient (17.6% vs 6.1%), and medium phonation time (3.5 s vs 5.12 s). VHI‐10 mean score improved from 33.4 to 25.7 (P <. 05).

Conclusion

Our data suggest that Montgomery thyroplasty, associated with speech rehabilitation, is an efficient and well‐ tolerated rehabilitative approach in order to improve vocal outcomes of vocal fold cancer patients treated with open or endoscopic laser cordectomies.
Multimorphic Vascular Anomaly
Authors: Sabri Alain N. , Musallam Khaled , Boulos Fouad
Published: February 2015

Objective

To describe a rare case of multimorphic vascular anomaly.

Method

A 7‐year‐old boy presented for massive congenital tumors in the intraorbital, right frontoparietal, and nasal tip areas. After excision, pathological evaluation revealed the intraorbital lesion consistent with lymphatic malformation. The frontoparietal mass was a cavernous hemangioma. The nasal lesion was a soft tissue hamartoma.

Results

A growing body of clinical, histological, and radiological evidence supports the conclusion that vascular tumors of childhood represent a number of distinct entities with diverse etiologies and clinical behaviors. Immunohistochemical and gene expression analyses yielded important clues regarding these etiologies. An absolute requisite of meaningful diagnosis and study of these lesions is precise histopathological description, combined with clinical and radiological evaluation.

Conclusion

Unfortunately, overgeneric use of the term hemangioma has led to inappropriate grouping of entities that we now know are dissimilar, hampering research efforts and causing problems when making comparisons between cases reported in the literature. This patient had 3 different tumors according to pathological evaluation.
Neck and Mediastinal Node Metasis
Authors: Martins Antonio S. , Del Negro André , Tincani Alfio J. , Casarim André M. , Aguiar Camila G. , Manso Daniel G. , Fanni Renato V.
Published: February 2015

Objective

Evaluate details of neck node metastasis (NM) and mediastinal node metastasis (MM) in carcinomas of the pharyngolaryngoesophageal (PLE) region.

Method

Chart review of 44 patients with gastric pull‐up for Ca of the PLE junction (cervical esophageal, hypopharyngeal and advanced laryngeal carcinomas). The mediastinal dissection (MD) resected mainly the paratracheal/paraesophageal lymph nodes down to the aortic arch.

Results

Fifty neck dissections (ND) were performed in 28 patients (positive nodes in 47.7%). The NM occurred in 22.2%, 60%, 70%, and 66.6% of patients with esophageal, pyriform sinus, retrocricoid, and laryngeal carcinomas, respectively. The number of neck nodes averaged 22.8 to 27.5 nodes per ND (positive in 12.5%) and was concentrated in levels II, III, and IV (84.3%). Extra capsular invasion (IE) occurred in 80.9%. Eighteen (48.6%) out of 37 patients had MM. MM occurred in 16.6%, 47.2%, and 64.2% of the patients with laryngeal, hypopharyngeal, and esophageal Ca, respectively. MD yielded 222 nodes, positive in 17%. EI occurred in 33%.

Conclusion

A high number of ND was done with positive nodes in most therapeutic ND and nearly 50% of selective ND. EI was high (80.9%). Selective ND may suffice in esophageal carcinomas (NM in 22.2%). MM was significant, cervical esophageal carcinomas (64.2%) occurrence of MM in 47.2% of hypopharyngeal was disturbing.
Papillary Thyroid Carcinoma Arising in a Branchial Cyst
Authors: Ruhl Douglas S. , Sheridan Mark F.
Published: February 2015

Objective

1) Describe the diagnostic dilemma of finding a thyroid carcinoma in a lateral neck mass without a primary. 2) Understand the etiological theories of branchial cleft cysts. 3) Be able to manage a patient with thyroid carcinoma in a lateral neck mass without a primary site identified.

Method

We report a rare case of papillary thyroid carcinoma incidentally found within a branchial cleft cyst. Only 4 other cases have been described in the literature. A total thyroidectomy and selective neck dissection was performed and no evidence of occult primary disease was found after review of fine sections.

Results

Branchial cleft cysts are the most common lateral neck masses. Ectopic thyroid tissue within a branchial cleft cyst is an unusual phenomenon and papillary thyroid carcinoma arising from this tissue is extremely rare. Clinicians are left with a diagnostic dilemma when presented with thyroid tissue neoplasm within a neck cyst in the absence of a thyroid primary—is this a case of metastatic disease with a missed primary or rather carcinoma arising in ectopic thyroid tissue? A thorough discussion of the etiologies of these lateral neck masses is reviewed including the embryogenesis of thyroid tissue in a branchial cleft cyst.

Conclusion

The prognosis of patients with papillary thyroid carcinoma in lateral neck cysts without a primary site identified appears to be good following excision of the cyst and total thyroidectomy. Other management recommendations regarding these unique lateral neck malignancies are also presented.
Prevalence of a HPV Laryngeal Squamous Cell Carcinoma and a Novel Cell Line
Authors: Chinn Steven B. , Walline Heather M. , McHugh Jonathan B. , Prince Mark E. , Carey Thomas E.
Published: February 2015

Objective

Recently, HPV has been associated with HNSCC. However its role in laryngeal SCC (LSCC) is unknown. The objective of this study is to 1) describe a novel HPV‐positive LSCC cell line and 2) report the prevalence of HPV‐positive LSCC in a select patient population.

Method

Culture of an HPV‐positive LSCC primary tumor and derived cell‐line determined by p16 immunohistochemical (IHC) staining, HPV in‐situ hybridization (ISH), and HPV PCR‐MassArray using E6‐type‐specific primers. Retrospective analysis of the HPV‐status in 123 LSCC tissue micro array (TMA) patient specimens from 1985‐2000 as determined by p16‐IHC and HPV‐ISH staining.

Results

A 51‐year‐old man with no tobacco or alcohol history was diagnosed with a T4N0M0 of the true vocal cord. Tumor location was confirmed by laryngoscopy and CT‐imaging. After total laryngectomy the tumor was cultured into a cell line (UM‐SCC‐105). The primary tumor specimen and LSCC derived UM‐SCC‐105 are HPV‐positive and contain HPV‐18 as established by p16 IHC, HPV‐ISH and PCR‐MassArray. In the TMA cohort, 19% (23/123) of tumors were positive for p16, and 3 were positive for HPV‐ISH. Based on p16 and ISH results, 2.4% (3/123) of tumor samples were determined to be HPV‐positive.

Conclusion

In this cohort, prevalence of HPV in LSCC was 2.4%. Given the HPV‐induced HNSCC cancer epidemic, greater understanding for HPV in LSCC is warranted. UM‐SCC‐105 is the first HPV‐18 positive LSCC cell line described, and it will aid in future research to better understand the pathogenesis of HPV in LSCC.
Prospective Evaluation of the McGill Thyroid Nodule Score
Authors: Dolev Yalon , Hier Michael P. , Tamilia Michael , Payne Richard J.
Published: February 2015

Objective

1) Familiarize the audience with the new McGill Thyroid Nodule Score (MTNS) scoring system for thyroid nodules. 2) Present the statistics on the MTNS and why we feel this is a great adjunct in the management of thyroid nodules. 3) Describe a new tool at the clinician’s disposal that will help better manage patients with thyroid nodules.

Method

This is a prospective study. A total of 245 consecutive patients were enrolled between July 2009 and March 2011. McGill Thyroid Nodule Score (MTNS), age, gender, and extent of surgery were recorded preoperatively. Final pathology was recorded postthyroidectomy. The percentage of malignancy was calculated for each MTNS score. Using Fisher exact test, the risk of malignancy for each group was compared to that anticipated based on the MTNS. We then used linear regression to plot a best fit curve for both the retrospective and prospective data and compared the 2.

Results

We found no statistically significant difference when comparing the risk of malignancy between the retrospective group originally used to create the MTNS and the prospective group used to validate this tool with P >. 05 for all groups. Regression analysis revealed linear curves and also showed no significant difference between both groups (P =. 35).

Conclusion

The MTNS system has been validated prospectively and is a unified and individualized tool to help clinicians with multiple aspects in the management of patients with thyroid nodules. This includes discussion with patients regarding the risk of their nodules harbouring malignancy, decisions regarding extent of surgery, and discussion between physicians.
Robot‐Assisted Neck Dissection in Papillary Thyroid Cancer
Authors: Kim Won Shik , Lee Hyoung Shin , Lee So‐Yoon , Hong HyunJun , Choi Hong‐Shik , Choi Eun Chang , Koh Yoon Woo
Published: February 2015

Objective

Robot‐assisted neck dissection (ND) in papillary thyroid carcinoma (PTC) patients with lateral neck metastasis was proven to be feasible. However, approaches for upper neck levels are restricted. Thus, we designed novel approach for robotic ND to cover upper neck levels in PTC patients using transaxillary and retroauricular (TARA) incisions.

Method

Between January 2011 and October 2011, 11 patients underwent total thyroidectomy and comprehensive neck dissection using a da Vinci surgical robotic system via TARA incisions.

Results

In all cases, successful comprehensive NDs via TARA incisions using robotic surgical system could be performed. Axis change of robot was unnecessary to align the robotic arms and endoscope for upper neck levels. Vital structures including major vessels and nerves were preserved. No perioperative complications were developed. The numbers of retrieved lymph nodes in robotic neck dissections were comparable with those in conventional neck dissections.

Conclusion

A robotic ND via a TARA approach to PTC patients with cervical lymph node metastasis was performed successfully. This new approach provides advantages especially in the dissection of levels IIb and V. This is a useful, alternative approach for addressing cervical lymph node metastasis in selected cases of PTC. Long‐term outcomes of robotic ND should be accumulated to determine the oncologic safety.
Robotic Thyroidectomy via a Transaxillary Approach
Authors: Koh Yoon Woo , Hong Hyun Jsun , Kim Won Shik , Lee Hyoung Shin , Lee So‐Yoon , Kim Se‐Heon , Choi Eun Chang
Published: February 2015

Objective

Recently, various robotic surgical procedures have been performed, and most reports have proved that the application of robotic technology for surgery is technically feasible and safe. The feasibility and safety of robotic thyroid surgery was examined via transaxillary single port approach without gas insufflation.

Method

The study included 109 consecutive patients with papillary thyroid cancer who underwent robot‐assisted endoscopic thyroid surgery using a gasless transaxillary single port approach by a single surgeon (Y.W.K.) between May 2010 and August 2011 at the department of otorhinolaryngology, Yonsei University College of Medicine.

Results

The console time for 50 hemithyroidectomy (HT) with ipsilateral central compartment neck dissection (CCND) was 45.67 min, and that of 59 total thyroidectomy (TT) with ipsilateral or bilateral CCND was 93.77 min. The amount of drainage was 194.07 mL, and the duration of drainage was 3.5 days. The hospital stay was 6.09 days. Mean primary tumor size was 6.58 mm. The average number of lymph nodes resected was 3.51 (range, 1‐19). Temporary hypoparathyroidism encountered with 24 patients in the TT group (40.7%, 24/59). There were 5 cases of temporary recurrent laryngeal nerve injury and 12 of seromas. One case of temporary brachial plexus injury occurred due to arm positioning.

Conclusion

The technique of robotic thyroid surgery using a gasless transaxillary single port approach is a feasible, safe, and effective method for selected patients with thyroid cancer. The authors suggest that application of robotic technology for endoscopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.
Symptoms‐Findings Correlation in Recurrent Head andNeck Cancer
Authors: Nisa Lluís , La Macchia Riccardo , Boujelbene Nouredine , Escher Anette , Khanfir Kaouthar , Giger Roland
Published: February 2015

Objective

To assess the correlation between subjective symptom evaluation and tumor recurrence status in the 2 first years of follow‐up of patients treated for head and neck squamous cell carcinomas (SCC).

Method

Retrospective study of patients treated curatively for oral, oropharyngeal, hypopharyngeal, and laryngeal SCC between 2008 and 2010. Review of reported symptoms and tumor recurrence status during the first 2 years posttherapy. Assessment of the degree of correlation with Phi coefficient and Student t test.

Results

One hundred one patients were included, of which 33% presented local and/or regional recurrence. Twenty‐one percent of the patients with recurrent disease were asymptomatic, and 50% of the patients with recurrences did not report any change in symptom’s intensity. On the other side, 66% of recurrence‐free patients mentioned various symptoms, and of these 15% reported an increase in symptom’s intensity during the 2 years following treatment. The symptom‐recurrence correlation is better in patients treated with unimodal therapy (P <. 05) and in patients with initial early‐stage tumors (stages I‐II; P <. 05).

Conclusion

Specialized and close follow‐up in head and neck cancer patients is mandatory because of the inconstant correlation between symptoms and recurrence status and due to the fact that more than 20% of the patients with recurrences are asymptomatic.
The Role of Fine‐Needle Aspiration in Parotid Pleomorphic Adenoma
Authors: Fundakowski Christopher E. , Castano Jonathan , Abouyared Marianne , Rivera Andrew , Ojo Rosemary , Sargi Zoukaa
Published: February 2015

Objective

Fine‐needle aspiration (FNA) biopsy is often used as a well‐accepted and both sensitive and specific diagnostic adjunct in the workup of parotid masses. In the case of pleomorphic adenoma, the most common benign tumor of the parotid gland, we examine cytopathologic reports to assess the performance of FNA for this particular histologic diagnosis.

Method

A total of 317 patients who underwent parotidectomy over the past 5 years and met eligibility criteria of 1) primary parotid tumor, 2) age greater than 18 years, and 3) availability of pathology (FNA, intraoperative frozen section, final pathology) were reviewed. Clinical history and demographics, physical exam findings, and intraoperative findings were noted.

Results

Pleomorphic adenoma was noted on final pathology in 136 patients (42.9%). Interestingly 24 (17.6%) of these patients had initially undergone FNA and been given a incorrect diagnosis, despite the FNA being “diagnostic.” One patient received false positive diagnosis of malignancy by FNA. Of the 24 patients with incorrect diagnosis on FNA, 15 (62.5%) received the correct diagnosis of pleomorphic adenoma with intraoperative frozen section, though one patient received a false positive for malignancy and underwent surgical upstage unnecessarily. For pleomorphic adenoma, it appears that diagnostic sensitivity increases from 82% for FNA to 92% with frozen section.

Conclusion

While FNA is commonly used as preoperative diagnostic adjunct for parotid masses, one must exercise caution, even in the context of a diagnostic sample, as nearly 18% of pleomorphic adenomas were not identified. Fortunately, misdiagnosis was benign 95% of time, and subsequently had no surgical implications.