bluuebunny/crossref_metadata_2025 huggingface dataset:
Epoxidation of Canola Oil with Hydrogen Peroxide Catalyzed by Acidic Ion Exchange Resin
Authors: Mungroo Rubeena , Pradhan Narayan C. , Goud Vaibhav V. , Dalai Ajay K.
Published: August 2008

Canola oil with an iodine value of 112/100 g, and containing 60% oleic acid and 20% linoleic acid, was epoxidised using a peroxyacid generated in situ from hydrogen peroxide and a carboxylic acid (acetic or formic acid) in the presence of an acidic ion exchange resin (AIER), Amberlite IR 120H. Acetic acid was found to be a better oxygen carrier than formic acid, as it produced about 10% more conversion of ethylenic unsaturation to oxirane than that produced by formic acid under otherwise identical conditions. A detailed process developmental study was then performed with the acetic acid/AIER combination. The parameters optimised were temperature (65 °C), acetic acid to ethylenic unsaturation molar ratio (0.5), hydrogen peroxide to ethylenic unsaturation molar ratio (1.5), and AIER loading (22%). An iodine conversion of 88.4% and a relative conversion to oxirane of 90% were obtained at the optimum reaction conditions. The heterogeneous catalyst, AIER, was found to be reusable and exhibited a negligible loss in activity.
Frontal Sinus Posterior Table Fractures in a Goat
Authors: Maturo Stephen C. , Weitzel Erik K , Brennan Joseph
Published: August 2008

Objective

The goal of this study was to investigate how patency of the nasofrontal outflow tract would affect the healing of the frontal sinus in the setting of displaced, posterior table fractures in the adult goat (Capra Hircus).

Methods

Posterior table fractures were created in 20 adult goats (Capra Hircus). The nasofrontal outflow tract was obstructed in 10 goats and left patent in 10. Gross, radiologic, and histological evaluation was carried out at 6 months post‐operatively.

Results

All posterior table fractures healed without gross or radiological evidence of mucosal ingrowth. Obstruction of the nasofrontal outflow tract resulted in an increased rate of mucocele formation. Histological analysis did not reveal significant mucosal ingrowth in either group.

Conclusions

An occluded nasal frontal outflow tract leads to an increase rate in mucocele formation at 6 months. There is no gross or radiographic evidence that mucosal ingrowth into the posterior table occurs at 6 months. These findings would suggest that not all significantly displaced posterior table fractures need to be surgically addressed if the nasofrontal outflow tract is patent.
3D CT for Diagnosis of Facial/Mandibular Fractures
Authors: Schalch Paul , Kim Jason H
Published: August 2008

Objective

To describe how the use of 3‐D reformatted computer tomographic (CT) images increases the accuracy of diagnosis of facial and mandibular fractures and influences surgical planning.

Methods

Retrospective review of 20 patients with facial and/or mandibular fractures between 2005 and 2006, diagnosed with CT facial bones (axial and coronal images and 3‐D renderings). The study was conducted at a university‐ affiliated institution. Standard CT facial bones protocol consisting of 1.5mm contiguous axial and coronal sections were performed on a 40‐slice scanner (Philips Medical Systems, Cleveland, OH). 3‐D reconstructions were then obtained. Scans were reviewed by the consulting surgeon. Pre‐operative diagnoses were confirmed intraoperatively.

Results

Patient mean age was 31 years (17–46). Pre‐operative diagnoses included: 18 mandible fractures, 8 zygomatico‐maxillary/orbital floor, and 4 midface fractures. Mechanisms of injury included assault, motor‐vehicle accidents, sports‐ and work‐related injuries, and falls. Diagnosis and surgical planning was influenced in 1/3 of fractures after reviewing 3‐D reformatted images. 3‐D reformatting did not add any cost to the CT scans performed, did not expose patients to additional radiation, nor did it significantly increase the time to obtain the study.

Conclusions

3‐D CT reformatting is an inexpensive, easy‐to‐obtain diagnostic imaging modality that increases the accuracy of diagnosis and helps improve planning of surgical repair of facial and mandibular fractures.
Nasal Tip Surgery in Asians
Authors: Won Tae‐Bin , Jin Hong‐Ryul , Lee Hyeon‐Jong
Published: August 2008

Objective

The authors intended to review our surgical techniques used in Asian tip surgery and to suggest effective techniques, according to the types of the nasal tip that are addressed.

Methods

107 patients who had nasal tip surgery from Jan. 2005 to Dec. 2006 in a tertiary hospital were enrolled in the study. Medical records, graphic operation records, and standardized patient photographs were retrospectively reviewed. Initial diagnosis, types of nasal tip surgery, associated operative techniques, surgical results and complications were analyzed.

Results

Initial diagnosis included deviated nose, hump nose, combine deviated and saddle nose, low profile nose, short nose, and cleft nose deformity, in order of frequency. Nasal tip surgery included augmentation of projection, control of rotation, restoration of symmetry and volume reduction, among which augmentation was used in all cases. External approach was used in 74% and intranasal approach in 26%. For augmentation of the tip projection, onlay grafts (39%), septal extension grafts (25%), and tip modifying suture with onlay grafts (20%) were the most commonly used methods. Infection or extrusion of the grafts was not found. Complications included tip deviation due to the deviation of the septal extension graft in 1 case, visible tip graft in 1 case, and slight upward rotation of the tip in 1 case.

Conclusions

In Asians, augmentation of the tip projection is the main issue in tip surgery and is best performed with cartilage onlay grafts or septal extension graft rather than suture modification.
PDT for Tis‐T2N0 Oral Cavity and Oropharyngeal Malignancies
Authors: Schweitzer Vanessa G , Somers Melissa L
Published: August 2008

Objective

To evaluate the efficacy of PHOTOFRIN‐mediated photodynamic therapy (PDT) for treatment of diffuse ‘field cancerization’ and Tis‐T2N0M0 squamous cell carcinoma (SqCCa) of the oral cavity and oral pharynx in patients not amenable to or that failed conventional head and neck treatment.

Methods

This is nonrandomized prospective study of 28 patients with field cancerization and early stage Tis‐T2N0M0 squamous cell carcinoma of the oral cavity/oropharynx treated with PHOTOFRIN‐mediated PDT. Intravenous PHOTOFRIN (porfimer sodium)(dose 2.0 mg/kg) was administered outpatient, followed 48–60 hours later by intraoperative photoactivation at 630nm via fiberoptic microlens surface delivery (surgical light dose 50–100 J/cm2).

Results

21 of 27 patients (77%) have demonstrated complete remission (follow‐up 1 month to 12 years). There were 5 patients that had partial remission with recurrence observed at 3, 3, 8, 22, and 23 months subsequently retreated with conventional therapy. All locally disease‐free individuals were followed up between 1 to 144 months. 14 of the 21 patients in complete remission were disease‐free for a period greater than 1 year following photodynamic therapy.

Conclusions

PHOTOFRIN‐mediated photodynamic therapy can be used as a primary modality to treat Tis‐T2N0 tumors of the oral cavity and oropharynx or for treatment for those that have failed prior surgery and/or radiation therapy. PDT allows for preservation of function and structure with absence of systemic toxicity, and patients may have multiple drug administrations and laser light retreatments for local disease control.
PTH Testing Reduces Post‐thyroidectomy Hypocalcemia
Authors: Sabour Sarmad , Manders Ernest C , Steward David L
Published: August 2008

Objective

To determine if routine rapid intact parathyroid hormone (PTH) testing in the post‐anesthesia care unit (PACU) would reduce post‐thyroidectomy hypocalcemia.

Methods

Controlled cohort study comparing mean serum calcium and rate of hypocalcemia on postoperative day 1 (POD1) following total or completion thyroidectomy by a single surgeon. The control group consists of 133 subjects undergoing surgery between 2003–2005 prior to availability of rapid PTH testing for whom calcium and vitamin D supplementation was instituted only if patients developed hypocalcemia (calcium<8.0mg/dl) postoperatively. The routine PACU PTH group consists of 169 subjects undergoing surgery between 2006–2007 with routine PACU PTH testing for whom calcium and vitamin D supplementation was instituted for PACU PTH < 15 or subsequent development of hypocalcemia.

Results

Mean serum calcium corrected for albumin was significantly lower in the control group than the routine PACU PTH group on POD1 (8.2 vs 8.6, p<0.0001). The rate of hypocalcemia on POD1 was higher in the control group than the routine PACU PTH group (35% vs. 14%, p<0.0001).

Conclusions

Routine PACU PTH testing and early calcium and vitamin D supplementation for patients with hypoparathyroidism significantly reduced the proportion of patients experiencing hypocalcemia following total or completion thyroidectomy.
Controlling MRSA in Surgical Head&Neck Patients: What Works?
Authors: Supriya Mrinal , Santangeli Louise , Shakeel Muhammad , Ah‐See Kim
Published: August 2008

Objective

Can we control MRSA incidence in head and neck cancer patients by 1) Active surveillance cultures of patients fulfilling Society for Healthcare Epidemiology of America (SHEA) & Scottish Infection Standards and Strategy (SISS) guideline? 2) Cohorting these patients? 3) Restricted Health Care Workers (HCW) access?

Methods

Prospective case series: July 2007–January 2008. 26 preoperative head and neck cancer patients had a questionnaire filled in to identify known predictors for MRSA as suggested by SISS Group. Intervention: Preoperative nasal swabs, cohorting away from other cases, restricted access. MRSA incidence compared to that over the preceding year(Jan 2006‐Jan 2007).

Results

26 eligible patients. None of them had known risk factors for MRSA. 17 patients had swabs taken pre‐admission. All screened patients were non‐carriers of MRSA in their nose and none of them developed MRSA infection during hospital stay. Of remaining 9 patients swabbed after admission, 3 developed MRSA during hospital stay. The incidence of MRSA was 11.5% (3/26) during study period, compared to 28.5% (24/84) the year before implementing these interventions.

Conclusions

Head and neck cancer patients do not have increased risk factors for MRSA colonization and their active surveillance cultures are unlikely to influence MRSA incidence. Cohorting these patients with restricted HCW access decreased the MRSA rate at our centre.
Distal Facial Nerve Exposure: A Key to Partial Parotidectomy
Authors: Wang Robert C , Barber Annabel E , Vantine Paul , Ditmyer Marcia
Published: August 2008

Objective

1) Learn techniques and outcomes of distal facial nerve identification compared with antegrade exposure in partial parotidectomy. 2) Be able to incorporate other modifications of parotidectomy facilitated by distal facial n. isolation including preservation of the greater auricular nerve, superficial musculo‐aponeurotic system (SMAS), and parotid duct.

Methods

29 parotidectomies done using antegrade facial nerve trunk exposure (Group 1) and 13 consecutive partial parotidectomies done with distal facial nerve branch dissection (Group 2) for benign neoplasms and intraparotid lymph nodes were reviewed from 2001 to 2008. The greater auricular nerve and SMAS were preserved when possible. Branches draining to the main parotid duct from the lesion were incised rather than the main parotid duct whenever feasible. Outcomes examined include postoperative facial nerve function, cutaneous sensation, SMAS preservation, sialocele or salivary fistula. Logistic Regression was used to determine if select variables (age; antegrade vs. retrograde nerve exposure; and size of tumor) significantly affected outcomes. A series of univariate analysis of variance with Bonferroni post hoc tests were subsequently used to confirm findings of the logistic regression.

Results

No difference in facial nerve function was found between the groups. Group 2 had better cutaneous sensation and SMAS preservation. More salivary fistulas and parotid swelling were associated with parotid duct transection in Group 1. There were no tumor recurrences.

Conclusions

Partial parotidectomy utilizing distal facial nerve exposure can reduce the extent of surgical dissection, facilitate preservation of the parotid duct and greater auricular nerve, improve contour with primary SMAS closure, and allow greater flexibility in skin incisions.
FAS and FASL Polymorphisms in Oral / Oropharyngeal Cancer
Authors: Lehn Carlos Neutzling , Beserra Ivo Marquis , Carvalho Paulo , Silva Adriana , Carvalho Marcos , Santos Viviane
Published: August 2008

Objective

Examine the hypothesis if genetic polymorphisms in FAS and FASL genes, alone or in combination, are associated with oral and oropharyngeal squamous‐cell carcinoma.

Methods

Prospective study based on 225 pacients with oral and oropharyngeal squamous‐cell carcinoma and 215 controls, analyzed with PCR‐RFLP.

Results

We observed a statistically significantly increased risk of oral and oropharyngeal squamous‐cell carcinoma associated with the FASL ‐844 CT genotype (p=0,031). An increased risk of oral and oropharyngeal squamous‐cell carcinoma was also associated with the FASL −844 T allele (p=0,04). Gene‐gene interactions of FAS and FASL polymorphisms increased the risk of oral and oropharyngeal squamous‐cell carcinoma in a multiplicative manner (p=0,04).

Conclusions

The results suggest that the presence of the allele T of FASL and its combination with G allele potentially increase the risk of cancer development.
Female Gender: A Post‐Thyroidectomy Hypocalcemia Risk Factor
Authors: Sands Noah Benjamin , Cote Valerie , Tamilia Michael , Hier Michael P , Black Martin J , Payne Richard J
Published: August 2008

Objective

1) To evaluate the role of patient gender as a potential risk factor for post‐thyroidectomy hypocalcemia. 2)To elucidate, from previous studies, potential physiologic mechanisms underlying any identified gender disparity. 3)To help better predict post‐thyroidectomy hypocalcemia and ultimately limit its incidence with prophylactic/early calcium supplementation.

Methods

A retrospective review of 270 consecutive total thyroidectomy patients (October 2004‐December 2006) was conducted, consisting of 219 females and 51 males. Postoperative hypocalcemia was defined as any one of the following: total serum calcium of less than or equal to 1.90 mmol/L up to 1 month following surgery or symptoms of hypocalcemia. The following were evaluated as potential confounding factors in the study: age, menopause, pre‐operative calcium and parathyroid hormone levels, magnesium and phosphate levels, pathology and number of parathyroid glands preserved in situ. Chisquared testing was used to evaluate for statistical significance.

Results

Female patients experienced transient postoperative hypocalcemia in 24.7% (54/219) of cases, which was significantly greater than the 11.8% (6/51) incidence detected in males (p less than 0.05). This represents a female:male relative risk ratio of 2.1 (C.I. 1.0–4.6). There was no significant difference in rates of hypocalcemia between pre‐menopausal (age less than 50) and post‐menopausal women (22.7% vs. 26.6%).

Conclusions

These findings suggest that being female is a significant risk factor for transient post‐thyroidectomy hypocalcemia. Furthermore, females appear to experience this postoperative complication more than twice as frequently as males. Additional research is needed in order to ascertain the physiologic mechanisms underlying this identified gender difference.
Fine Needle Aspiration Analysis of B‐RAF in Thyroid Nodules
Authors: Bentz Brandon G , Miller Brian Thomas , Holden Joseph , Rowe Leslie R , Bentz Joel
Published: August 2008

Objective

Fine needle aspiration (FNA) represents the most useful initial diagnostic tool with which to analyze thyroid nodules for carcinoma. A mutation of the B‐type RAF kinase (BRAF) represents the most common genetic alteration in sporadic papillary thyroid cancer (PTC), and may signify a more aggressive biological behavior within PTCs. Our objective was to determine if BRAF analysis of FNA cytology may provide clinically useful information in the analysis of thyroid nodules.

Methods

An IRB‐approved retrospective chart review of clinically relevant data for classic PTCs (CPTC), follicular‐variant of PTC (FV‐PTC), or non‐malignant goiter was performed following a blinded pathologic re‐review. Both pathologic and cytology samples were analyzed by fluorescent melting curve analysis (FMCA) for the V600E mutation of BRAF, and mutational status was compared with clinical information.

Results

A 100% concordance was found for BRAF mutation determination between the cytologic and final pathologic malignant and benign tissue samples studied. BRAF mutation was found to be significantly higher in papillary carcinomas when compared to follicular‐variant of papillary thyroid carcinomas (55.6% vs. 14.3%, p=0.05), and correlated with cytologic interpretation (p=0.025) and histologic diagnosis (p=0.03).

Conclusions

FMCA of thyroid nodule FNAs can accurately determine the mutational status of the BRAF gene. Since the presence of BRAF mutation can predict a more aggressive biological behavior, an analysis of BRAF mutational status of initial FNAs may add useful information to the list of risk stratification criteria for PTCs.
Incidence and Management of Siaolocele Post‐Parotidectomy
Authors: Witt Robert L
Published: August 2008

Objective

(1)To determine if a post‐parotidectomy sialocele occurs at a higher incidence with a partial superficial parotidectomy compared to a near complete parotidectomy; both with facial nerve dissection. (2)To determine if needle aspiration vs. observation yields more persistant sialoceles beyond 4 weeks.

Methods

Retrospective, single surgeon, single institution study comparing 100 consecutive partial superficial parotidectomy procedures and 20 consecutive near‐total parotidectomy procedures for formation of post‐operative sialocele. Study period 2004–2007. The first 18 sialoceles were treated with one or more needle aspirations. The last 21 sialoceles were treated with observation and no needle aspiration. Antibiotics were not used beyond the first week of surgery in either group. Chi Square analysis was performed.

Results

There were 39 sialoceles in the partial superficial parotidecotomy group (39/100–39%) and none in the near‐total parotidectomy group (0/20–0%). (p<0.05). All sialoceles resolved by the end of the fourth post‐operative week whether aspirated or not aspirated.

Conclusions

Sialoceles are common post‐partial superficial parotidectomy and did not occur after near‐total parotidectomy. Patients should be advised in the pre‐operative counseling period of this possible event after partial superficial parotidectomy. Sialoceles after parotidectomy can generally be treated by observation. Needle aspiration and antibiotics are optional.
Incidence of Micropapillary Carcinoma in Total Thyroidectomy
Authors: Pakdaman Michael Navid , Hier Michael P , Tamilia Michael , Black Martin J , Payne Richard J
Published: August 2008

Objective

(1) Compare prognostic factors in thyroid micropapillary carcinoma (MPC) <5 mm versus >=5 mm. (2) To compare MPC characteristics in patients with pre‐existing thyroid carcinoma to patients with no other thyroid carcinoma.

Methods

Pathology results were reviewed for consecutive total thyroidectomy patients between 2002 and 2007 (n=835). Hemithyroidectomies and completion thyroidectomies were excluded. Statistical significance of the difference in incidences was calculated using Fisher's exact test and chi‐squared analysis.

Results

MPC was found in 50.2% of total cases. Where the size was <5mm (64%), 9.3% extended beyond the thyroid capsule, 51.7% were multifocal, and 27.5% were bilateral. In MPCs >=5 mm (36%), the data showed 25.2%, 70.9%, 51%, respectively (p‐value always < 0.05). In the 314 patients with no other thyroid malignancy, MPC was found in 47.1% of cases. 14.9% had capsular extension; 50% were multifocal, of which 56.8% were bilateral. In the 521 patients with malignant disease, the data showed 52.1%, 15.1%, 63.2%, and 63.3%, respectively, with p‐values via Fisher's exact test. 22,. 112,. 003, and. 07.

Conclusions

In this study, MPC was found in 50.2% of patients. MPCs >=5 mm carried an increased risk for extracapsular spread, multifocality, and bilaterality. While patients with malignancies of the thyroid (aside from MPC) more commonly have multifocal MPCs, there was no significant difference in bilaterality, size, or extracapsular spread in MPCs in the presence of malignant vs. benign disease.
Increased Survival in HPV Positive Oropharyngeal SCCa
Authors: Nichols Anthony C. , Faquin William , Begum Shanaz , Westra William H , Clark John , Rocco James W
Published: August 2008

Objective

To determine if HPV16 infection is associated with improved survival in advanced oropharyngeal squamous cell carcinoma (OPSCC) treated with chemoradiation.

Methods

A retrospective chart review was performed in 44 patients with stage III and IV OPSCC who were treated with curative intent using chemoradiation. Tumor specimens were evaluated for the presence of HPV16 DNA with the in‐situ hybridization‐catalyzed signal amplification method applied to pre‐treatment archival tumor specimens. Tumors were scored as HPV positive if a signal specific to tumor nuclei was detected. Progression‐free survival was estimated by Kaplan‐Meier analysis. Outcome analyses were performed in the subsets of those with documented local, regional or distant relapse, and in disease‐free patients, with a minimum of 2 years for follow‐up.

Results

The incidence of HPV16 positive tumors in this patient population was 59%. Overall progression‐free survival independent of HPV status was 62%, while survival for patients with HPV16 positive tumors was 78%. Survival of patients with HPV negative tumors was considerably less at 40%. Only HPV status was associated with response to chemoradiation (p=0.006). Patient age, performance status, and tumor stage were not predictive of response. Patients with a history of smoking and heavy alcohol use had an inverse association with HPV status and lower survival in response to chemoradiation (p=.00015).

Conclusions

Patients with OPSCC tumors resulting from HPV16 infection are more likely to respond to platinum‐based concurrent chemoradiation, than HPV negative patients with traditional risk factors for oropharyngeal head and neck cancer.
Medial Wall Orbital Decompression in Graves’ Orbitopathy
Authors: Sellari‐Franceschini Stefano
Published: August 2008

Objective

1) To delineate useful criteria when choosing between different techniques for orbital decompression. 2) To discuss indications and limits of the medial wall only approach.

Methods

A retrospective analysis was made of the medical charts of 256 patients operated on by a single surgeon from 1998 to 2006. 228 patients were operated on using a balanced technique, 17 by an inferomedial decompression, 11 by a medial decompression. Patients operated on by the medial wall removal had a mild to moderate proptosis, and a slight involvement of the extraocular muscles in the disease.

Results

Mean proptosis reduction was 4 mm with the inferomedial approach, 5.5 mm with the balanced procedure, and 2.6 mm with the medial wall removal. Postoperative deterioration or new onset of diplopia was 29% after inferomedial orbital decompression, 17.1% after balanced decompression, and 9% after medial wall removal.

Conclusions

When a proptosis reduction of less than 3 mm is needed, the medial wall approach is suggested. When a greater proptosis reduction is needed, a balanced decompression is advisable, since the inferomedial approach carries with it a higher risk of postoperative diplopia.
Natural History of Arteriovenous Malformations
Authors: Suen James Y , Buckmiller Lisa M , Fan Chun‐Yang , Shafirstein Gal , Glade Robert
Published: August 2008

Objective

1) To demonstrate the natural history of arteriovenous malformation (AVMs) when left untreated or inadequately managed. 2) To demonstrate the need for major treatment to patients, families, healthcare providers, and insurance companies.

Methods

Records from 10 of 50 representative patients treated at University of Arkansas for Medical Sciences (UAMS) for advanced AVMs were reviewed for age at presentation, gender, presenting symptoms, previous treatment, disease course, and post‐presentation management. Patients were asked if quality of life had improved after treatment at UAMS Facial photos from childhood were obtained and compared with photos taken at time of presentation.

Results

10 patients (7 male, 3 female, range 21–46 years) received treatment. All patients presented with bleeding, pain and/or facial destruction. 6 of 10 patients received previous embolization. No patients had undergone previous surgical resection. All were informed by a previous physician that the disease was incurable or treatment options had been exhausted. All patients experienced subsequent worsening of symptoMS All patients were treated at UAMS with preoperative embolization followed by surgical resection and required multiple surgeries to remove persistent AVM. All patients indicated quality of life improved after embolization/surgical resection. Comparison of photos revealed progression of disease in all cases marked by facial destruction and deformity.

Conclusions

AVMs display a progressive and destructive nature when left untreated or inadequately managed. Natural history can be used to demonstrate to patients, families, and healthcare providers the seriousness of disease and convince insurance companies that radical treatment is typically necessary to obtain control or cure.
p53 Protein Overexpression in Oral Squamous Cell Carcinomas
Authors: Awan Sohail M. , Syed Adnan , Ghaffar Shehzad
Published: August 2008

Objective

1. To determine whether p53 protein expression is prognostic indicator of patient survival. 2. Learn its correlation with habits and histological variables of the tumor in Pakistani patients.

Methods

A retrospective case series of 140 patients with primary oral squamous cell carcinoma at a tertiary care setting during the period of January 1991 to Dec 2004. p53 protein overexpression was investigated by means of immunohistochemistry. Results of p53 overexpression were evaluated in relation to different clinicopathological parameters and survival. Overall survival and disease‐free survival were measured. Event time distributions for these end points were estimated by use of the method of Kaplan and Meier and compared by use of the log‐rank statistic. Factors associated with p53 status were selected on cross‐tabulations and logistic regression. Cross‐tabulations were analyzed by use of the chi‐square test or Fisher's exact test, where appropriate. Results were summarized as odds ratio (OR) with corresponding 95% Confidence Interval.

Results

Overexpression of p53 protein was observed in 75 patients (54%). Patients with p53 negative tumors had improved overall survival (OS) when compared with patients with p53 positive tumors (p=0.036). The p53 overexpression did not correlate with disease‐free survival (DFS) (p=0.126), histological differentiation (p=0.611) and patients’ habits (p=0.894) In univariate analysis, AJCC stage, nodal status, tumor size and histological grade were significantly associated with shortened OS and DFS.

Conclusions

Our study supports that patients with p53 overexpression had a significantly poor overall survival compared to p53 negative patients. However, p53 overexpression was not associated with patients disease‐free survival.
Patterns of Neck Metastasis in Recurrent/Persistent PTC
Authors: Farrag Tarik Y. , Michelli Shien , Tufano Ralph P
Published: August 2008

Objective

To determine the patterns of cervical LN disease recurrence in the lateral and central neck in patients with recurrent/persistent papillary thyroid cancer undergoing reoperative surgery. Recommendation of level dissection.

Methods

We reviewed the charts of 45 consecutive patients (February 2002‐November 2007) with PTC who underwent first‐time reoperative surgery by the senior author (R.P.T) for recurrent/persistent PTC.

Results

43 had PTC, and 2 had PTC with tall cell variant on final pathology. 38 underwent unilateral neck dissection; 7 had bilateral neck dissection, with a total of 52 lateral neck dissections. 48/52(92%) were + for metastasis. Level II was dissected in 46/52(88%) and was + in 30/46(65%) times. Level III was dissected in 46/52(88%) and was + in 30/ 46(65%) times. Level IV was dissected in 50/52(97%) and was + in 38/50(76%) times. Level V was dissected in 25/52(48%) and was + in 14/25(56%) times. Size of largest LN ranged from (0.5 to 3) cm. 18/46(39%) had extra‐nodal spread. 25/ 45(55%) had reoperative bed surgery and all had + metastasis; where 22/25(88%) had also + lateral LN, while 3/25(12%) had ‐ lateral LN.

Conclusions

Patients undergoing lateral neck dissection for persistent/recurrent PTC are likely to harbor metastatic disease in levels 2–5 with a high incidence of extra‐nodal spread. Those that are undergoing reoperative thyroid bed surgery for nodal disease in the central neck are very likely to harbor concomitant gross nodal disease in the lateral neck. We encourage a level 2–5 lateral neck dissection or removal of all previously undissected levels when possible for this patient population.
Randomized Trial Tissue Adhesive/Staples in Thyroidectomy
Authors: Amin Mohamed , Glynn Fergal , Timon Conrad A
Published: August 2008

Objective

Closure of thyroidectomy skin incision with tissue adhesive was compared to staples for the cosmetic appearance 3 months postoperatively, and proportion of wound infection as well as patient pain score.

Methods

A prospective randomized control trial, study conducted over 8 months. Disease/condition studied – Skin closure in thyroidectomy surgery. 43 patients undergoing thyroid surgery. The setting in which subjects were studied is a tertiary referral centre. Intervention – tissue adhesive and staples. Outcome measurements – cosmetic appearance 3 months postoperatively, using the Manchester Scar Assessment Tool, pain levels and wound infection. Statistical methods were Fisher exact test/paired t‐test.

Results

43 patients ranging in age between 16 to 72 years were included, of whom 34 (79%) were female and 9 (21%) were male; none developed wound infection. Pain level ranged between 0 and 6 on the 1st and 10th postoperative day with no significant different between the 2 modalities. Assessment using Manchester tool showed no statistically significant difference (P greater than 0.05). There was a statistically significant difference in patient satisfaction regarding ability to shower on the same day with dermabond compared to staples (p less than 0.05). Pain on removal of staples was reported by 91% of patients. There was no difference in patient rating of wound cosmesis.

Conclusions

Tissue adhesive is an acceptable method of skin incision closure in thyroid surgery, with the added advantage of ability to shower on the same day and avoidance of pain associated with staples removal.
Role of 18F‐FDG PET in Management of Sinonasal Neoplasms
Authors: Lamarre Eric D. , Scharpf Joseph , Batra Pete S , Lorenz Robert R , Citardi Martin J , Adelstein David J , Saxton Jerrold
Published: August 2008

Objective

PET/CT in sinonasal malignancies is largely undefined. The objective of this study was to evaluate PET/CT in the initial staging and oncologic surveillance of paranasal sinus carcinomas.

Methods

Retrospective review was performed of patients undergoing PET/CT for sinonasal neoplasms from 2001–2006 at tertiary care referral center. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of PET/CT were calculated. The gold standard was histology and clinical course when histology was not available. Any uptake in PET was considered a positive study.

Results

78 PET/CT scans were reviewed from 32 patients. Most common histopathologies included esthesioneuroblastoma (28.1%), sinonasal undifferentiated carcinoma (18.8%), sinonasal melanoma (18.8%), squamous cell carcinoma (18.8%), and adenosquamous carcinoma (9%). Overall sensitivity and specificity of PET/CT was 89% and 90% with PPV of 67% and NPV of 98%. PPV at the primary site, neck, and distant sites was 81%, 47% and 69%; NPV was 94%, 100%, and 98% respectively. For initial staging, 9.5% of patients were accurately upstaged at the neck or distant sites. During restaging, 29.6% of patients were accurately upstaged at the neck or distant sites.

Conclusions

PET/CT serves as a useful adjunct to conventional imaging in initial staging and restaging of sinonasal malignancies. Negative studies are effective in predicting the absence of disease as seen in the consistently higher NPV. Positive studies need to be examined with caution, given the high rate of false positive studies. When viewed along with clinical exam and focused biopsies, they may effectively result in upstaging patients as noted in our series.
Spinal Accessory Nerve Neuropathies Followng Neck Dissection
Authors: Lehn Carlos Neutzling , Lima Luciana Pereira , Amar Ali
Published: August 2008

Objective

To evaluate through electromyography (EMG) the injury to the 11th cranial nerve following neck dissection.

Methods

Prospective study with 60 patients submitted to neck dissection as part of treatment of head and neck tumors. All the cases underwent physiotherapic evaluation of shoulder dysfunction. Nerve integrity was evaluated pre‐ and postoperatively through surface EMG registering the electric activity of descendent fibers of trapezius muscle during maximal isometric voluntary contraction. The patients were grouped according the type of neck dissection, presence of shoulder pain, impairment during abduction movement, and hypotrophy or atrophy of trapezius muscle.

Results

The action potential had mean and standard deviation of 61,7±31,6mcV in preoperative evaluation and 15,6±12,4mcV in postoperative evaluation (p<0.001). According to the neck dissection extension, there were mean values of 18,8±14,2mcV after dissection includiog level IIb and 18,8±14,2 mcV after dissection including levels IIb and V (p<0.002).

Conclusions

Surface EMG is a sensitive and painless for 11th cranial nerve disfunction evaluation. In all cases, the superior fibers of trapezius muscle were affected with presence of pain and impairment abduction movement of the arm. The results suggest the benefit of trapezius muscle EMG to confirm the diagnosis and early physiotherapic intervention in neuropathies of the 11th cranial nerve.
Standard Bipolar Diathermy Vessel Ligation for Thyroidectomy
Authors: Tysome James Russell , Hassan Rudaina , Davis Jeremy
Published: August 2008

Objective

Assess the safety and possible advantages of using bipolar diathermy with standard forceps, compared to clamp‐and‐tie for vessel ligation in thyroidectomy.

Methods

Retrospective case‐control study of 153 patients undergoing thyroid surgery at our unit using the clamp‐and‐tie technique (January 2000‐December 2002), compared to bipolar diathermy with standard bipolar forceps (January 2003‐January 2006) for vessel ligation. Patient demographics, operating time, length of hospital stay, need for drain insertion, and complications (recurrent laryngeal nerve palsies, reactionary haemorrhage requiring re‐exploration or late (>24h post‐op) haematomas, hypocalcaemia) were compared between the two groups. Outcomes were compared using Prism (GraphPad Software, CA, USA). Data sets were initially tested for normal distribution using the D'Agostino and Pearson test of normality before comparison using two‐tailed, unpaired t‐tests, Mann‐Whitney U test, Chi‐squared or Fisher exact tests as appropriate, with p<0.05 considered significant.

Results

Significantly fewer drains were inserted and patients were discharged significantly earlier when standard bipolar diathermy was used for vessel ligation in hemithyroidectomies (p<0.001). The complication rates were similar for thyroidectomy using either technique, comparable to rates in large published series.

Conclusions

The use of bipolar diathermy with standard forceps for vessel ligation in thyroid surgery has been shown to be as safe and effective as the clamp‐and‐tie technique, while providing the advantage of the use of fewer drains, resulting in earlier patient discharge. This is a cost‐efficient technique as it gives the advantage of reduced inpatient stay seen by others using bipolar vessel sealing devices or the harmonic scalpel, but without the expense.
Transoral Laser Excision of Base of Tongue Cancer
Authors: Camp April A. , Petruzzelli Guy J , Fundakowski Christopher
Published: August 2008

Objective

Recently, the use of laser in head and neck surgery has increased, consequent to technical advances in laser technology and visualization techniques. The objective of this study was to determine survival and qualitative results in patients who have undergone transoral laser excision of base of tongue (BOT) squamous cell carcinoma (SCCA).

Methods

A retrospective chart review was performed of patients with previously untreated, biopsy proven SCCA of the BOT treated with transoral laser excision at a tertiary care facility. All patients had follow‐up for at least 24 months. Disease specific and overall survival data was determined using Kaplan‐Meier approximations. Quality of life (QOL) data was obtained via interview using a well established questionnaire.

Results

Between 1995 and 2005, 71 patients, ages 38–85, were treated with transoral laser excision for BOT SCCA; 1.4, 12.7, 9.9, and 75% were stage I, II, III, and IV, respectively, at diagnosis. At 24 months, overall survival was 90%, while disease‐specific survival was 94%. No correlation was found between survival and gender, overall stage, tumor size, nodal status, or adjuvant therapy. Local‐regional recurrence occurred in 10% of patients. QOL data was obtained for 46 patients and yielded acceptable results, with 52% of patients reporting mild or no pain, 98% reporting minimal impairment to normal swallowing, and 70% reporting normal speech.

Conclusions

Transoral laser excision is an innovative method for excision of BOT SCCA and offers an improved approach in terms of survival and quality of life for treatment of these lesions.
Tumour Size and Bilateral Thyroid Cancer after Thyroidectomy
Authors: Hwang Euna , Pakdaman Michael Navid , Black Martin J , Payne Richard J
Published: August 2008

Objective

1) Determine the incidence of bilateral papillary thyroid cancer (PTC) after total thyroidectomy (TT). 2) Compare tumour size, demographic and prognostic factors between bilaterality and non‐bilaterality (unilateral and/or isthmian involvement).

Methods

Pathology reports of 491 patients who underwent TT between 2002 and 2007 and had a definite diagnosis of PTC were reviewed. Statistical significance was obtained using chi‐square analysis.

Results

66 patients (13.4%) had bilateral PTC, of whom 4 also had isthmian involvement; 26 (5.3%) had PTC in the isthmus only; and 399 (81.3%) had unilateral PTC, of whom 15 also had isthmian involvement. Bilaterality was present in 12.1% of women and 19.5% of men; and in 14.9% of patients aged below 45 and 12.4% of patients aged 45 and above (all p‐values non‐significant). Among bilateral PTC patients, 69.7% had a primary tumour greater than 2 cm, 48.5% had extracapsular extension, and 37.8% had lymph node (LN) metastasis; as compared to 66.1%, 21.9%, and 16.1%, respectively, in non‐bilateral PTC patients (p‐values non‐significant, <0.001, and <0.01). Incidence of bilaterality was 25.8% and 23.7% in presence of extracapsular extension and LN metastasis, correspondingly; as opposed to 9.4% and 8.9% in their absence.

Conclusions

In our study, 13.4% of patients had bilateral PTC at TT. No significant correlation was established between bilaterality and gender, age, and tumour size. Bilateral PTC patients were more commonly found to have extracapsular extension and LN metastasis. Both these prognostic factors were associated with a higher incidence of bilaterality. These findings elucidate that bilateral involvement may constitute a poor prognostic indicator.
Ultrasound‐Guided Mechanical Fragmentation of Sialoliths
Authors: Geisthoff Urban , Maune Steffen
Published: August 2008

Objective

Assess the efficacy of ultrasound‐guided mechanical intraductal stone fragmentation and removal of sialoliths (SonoFragmentation). SonoFragmentation has been described recently as a new technique for the treatment of sialolithiasis (Surg Endosc 2006;20(4):690–4).

Methods

Retrospective analysis of cases treated within the last 3 years.

Results

SonoFragmentation was used as a 2nd line treatment in 22/28 cases. 10 patients were free of stones (parotid gland [PG]: 2x, submandibular gland [SMG]: 7x, sublingual gland: 1x; in 2 cases sialendoscopy was additionally used). Residual stones persisted in 12 patients (PG: 2x, SMG: 10x). 6 patients with sialolithiasis of the GP were primarily treated with the technique. 4 of those patients were cured. Reasons for failure were lacking accessibility of the stone by the forceps (9x), impossibility to grasp the stone (5x) and/or the concomitant grabbing of soft tissue together with the stone (3x).

Conclusions

The efficacy of SonoFragmentation as a secondary treatment after failure of other minimally invasive methods is about 50% (10/22). Additionally, it is a promising primary therapeutic option (cure: 4/6 patients).
Use and Misuse of IOPTH Levels During Parathyroidectomy
Authors: Seybt Melanie Wilson , Loftus Kelly , Rader Kendall , Mulloy Anthony , Terris David J
Published: August 2008

Objective

The combined use of localization and intraoperative parathyroid hormone assay (IOPTH) has facilitated the performance of targeted or minimally invasive parathyroidectomy. The precise algorithm of the use of IOPTH has been debated. We sought to clarify the optimal sequence of testing.

Methods

After IRB approval was obtained, demographic data and intraoperative laboratory and surgical findings from patients undergoing parathyroidectomy were prospectively gathered and analyzed. Specific attention was paid to the value of pre‐excision (P‐E) values and the 5‐minute postoperative (5‐min) levels and their impact on intraoperative decision‐making. In the first 49 consecutive patients, a P‐E baseline value was sought; in all cases a 5‐min value was obtained when possible.

Results

112 patients underwent parathyroidectomy during the study period. 30 of these were for secondary or tertiary hyperparathyroidism and were excluded. 78 (95.1%) of the patients were eucalcemic. In 4 cases (4.9%), the incorporation of the pre‐excision baseline value represented a false positive, and surgery was aborted prematurely. In no case did the P‐E value change what was otherwise destined to be a successful result based on pre‐incision value. In 47 cases (57.3%), operative time was conserved as the procedure was correctly stopped after the 5‐min level.

Conclusions

Pre‐excision baseline levels, while logical in their original proposal, appear to play virtually no role in determining the completeness of an exploration, and may in fact be misleading. A 5‐minute postoperative level adds value in over one‐half of cases by allowing earlier termination of the operation.
Dosage Changes in Long‐Term Botox Use for Laryngeal Dystonia
Authors: Birkent Hakan , Maronian Nicole C , Waugh Patricia F. , Merati Albert L , Perkel David , Hillel Allen D
Published: August 2008

Objective

Botulinum toxin (BTX) injections continue to be the mainstay of treatment for laryngeal dystonia (LD). Many patients are entering their 2nd and 3rd decade of treatment. In this study, the dosage consistency of BTX injections over time was examined in patients with long‐term BTX use for LD.

Methods

Retrospective chart review, 1990–2007. Patients with adductor‐type LD who had received at least 20 injections to the thyroarytenoid (TA) muscles were included in the study. The change of total dose and patient‐reported effective weeks were investigated; data of the first 5 injections were excluded to eliminate initial dose searching.

Results

55 patients (11 male, 44 female, mean age 60.6) with a mean follow‐up period of 149.9 ± 43.7 months (range 44 to 211 months) were identified. Total number of treatment episodes was 1825 with a mean of 33.18 ± 10.37 (range 20 to 58) and a mean interval of 19.1 ± 1.3 (range 2 to 118) weeks. The average total dose of BTX for each treatment episode was 2.15 ± 0.37 U (range 0.125 to 10.00 U). The total dose trended downward over time; this trend became statistically significant at 13th injection. The overall mean duration of effect was 15.5 ± 1.1 (range 1 to 58) weeks and did not show a significant change over time.

Conclusions

The BTX dose needed for a constant response in the treatment of LD decreases over time, raising the concern that neural recovery from repeated BTX is not infinite.
Endoscopic Supraglottic Laryngectomies. Results on 45 Cases
Authors: Remacle Marc J , Lawson Georges , Jamart Jacques
Published: August 2008

Objective

The aim of this study was to evaluate long‐term results of transoral CO2 laser‐assisted surgery for supraglottic carcinoma.

Methods

From 1992 to 2004, 45 patients including 38 males and 7 females with a mean age of 62 years and showing a supraglottic squamous cell carcinoma (2 Tis, 9 T1N0, 27T2N0, 2T2N1, 1T2N2, 4 T3N0) underwent different types of endoscopic partial supraglottic laryngectomies according to the European Laryngological Society (ELS) proposal of classification (3 limited excision‐type I; 29 medial without resection of the pre‐epiglottic space‐type II; 4 medial with resection of the pre‐epiglottic space‐type III; 11 lateral‐type IV) in combination with neck dissection performed during the same session. Frozen sections were performed on the laryngeal margins after tumoral resection. No patient had tracheostomy perioperatively.

Results

Overall survival was 93 ± 4% after 3 years and 89 ± 6% after 5 years. The minimum follow‐up was 3 years. Frozen sections were negative in 40 cases and presented only dysplasia in 5 cases. N0 nodes were positive in 8 cases (18%). Two postoperative bleedings were controlled by electrocautery. All of them relearned undisturbed deglutition within 5 days to 3 weeks from surgery. Two patients presented aspiration pneumonia. Mean duration of hospitalization was 12.5 days.

Conclusions

Endoscopic partial laryngectomies according to the ELS proposal of classification for selected supraglottic SCC prove to be an excellent alternative to radiotherapy and open neck surgery for selected supraglottic carcinoma.