bluuebunny/crossref_metadata_2025 huggingface dataset:
Fusion of the FUS gene with ERG in acute myeloid leukemia with t(16;21)(p11;q22)
Authors: Panagopoulos Ioannis , Åman Pierre , Fioretos Thoas , Höglund Mattias , Johansson Bertil , Mandahl Nils , Heim Sverre , Behrendtz Mikael , Mitelman Felix
Published: February 2007

It has been shown that the gene ERG in 21q22 is rearranged in the the t(16;21)(p11;q22) associated with acute myeloid leukemia (AML). ERG is a member of the ETS gene family and is fused with EWS in a subset of Ewing's sarcomas. EWS in 22q12 has a very high homology with FUS (also called TLS) in 16p11; the latter gene is rearranged in the t(12;16)(q13;p11) that characterizes myxoid liposarcoma. To investigate whether FUS is involved in the t(16;21) of AML, we used the Southern blot technique and polymerase chain reaction (PCR) to examine the bone marrow of a 3‐year‐old boy with a t(16;21)(p11;q22)‐positive AML. Hybridization of Southern blot filters containing digested DNA with probes for FUS and ERG showed both germline and aberrant fragments. Using specific primers for the 5′ part of FUS and the 3′ part of ERG, we amplified a 4.4 kb genomic FUS/ERG DNA fragment from the leukemic sample. In a second PCR experiment, in which we used primers upstream of the 5′ part of ERG and downstream of the 3′ part of FUS, a 5.6 kb fragment was amplified. Blotting and hybridization with specific probes for FUS and ERG revealed that the amplified fragments consisted of FUS/ERG and ERG/FUS hybrid DNA. Both PCR fragments, when used as probes, detected germline ERG and FUS as well as aberrant fragments on Southern blot filters. The results suggest that the t(16;21) in AML leads to rearrangement and fusion of the FUS and ERG genes. This is the first example in which two genes, each known to recombine with other genes in different solid tumor types (FUS in myxoid liposarcoma and ERG in Ewing's sarcoma), are fused in a hematologic malignancy.
Chromosome aberrations in choroid plexus papillomas
Authors: Donovan Michael J. , Yunis Eduardo J. , Degirolami Umberto , Fletcher Jonathan A. , Schofield Deborah E.
Published: February 2007

Karyotypic data on choroid plexus papillomas are scarce and, to date, have revealed no consistent aberrations. We karyotyped a choroid plexus papilloma which was characterized by a stemline of 52,XX, + 7, + 11, + 12, + 12, + 15, + 18. Additional copies of chromosomes 16, 17, and 20 were also observed in a significant proportion of the metaphase cells analyzed. Based upon this index case, we retrospectively analyzed eight additional choroid plexus papillomas by fluorescence in situ hybridization by using pericentromeric probes to chromosomes 7, 11, 12, 15, 16, 17, 18, and 20. Extra hybridization signals were observed in five of the eight cases examined. All five cases had extra signals with the chromosome 7 probe, four cases had extra signals with the chromosome 12 probe, and three cases had extra signals with the chromosome 15, 17, and 18 probes. The overall DNA content of these same cases (as determined by image analysis) suggests that gains of additional chromosomes other than those examined may be present.
Clonal structural chromosome aberrations in fibrous dysplasia
Authors: Mertens Fredrik , Albert Auxilium , Heim Sverre , Lindholm Johan , Brosjö Otte , Mitelman Felix , Mandahl Nils
Published: February 2007

Cytogenetic analysis of short‐term cultures from a case of monostotic fibrous dysplasia in a 14‐year‐old girl revealed multiple clonal structural rearrangements with evidence of clonal evolution. The karyotype was 46,XX,del(3)(q27),add(10)(q22), add(12)(p13)/46,idem,t(3;8)(p21;q13),add(10)(q26),der(15)del(15)(q15q22)ins(15;?)(q15;?)/46,idem,‐X, + 2,t(3;8),add(10),der(15). The finding of clonal structural aberrations suggests that fibrous dysplasia is a neoplastic lesion which develops as the result of somatic mutations.
Enhancement of activity of the primary visual cortex during processing of emotional stimuli as measured with event‐related functional near‐infrared spectroscopy and event‐related potentials
Authors: Herrmann Martin J. , Huter Theresa , Plichta Michael M. , Ehlis Ann‐Christine , Alpers Georg W. , Mühlberger Andreas , Fallgatter Andreas J.
Published: February 2007

In this study we investigated whether event‐related near‐infrared spectroscopy (NIRS) is suitable to measure changes in brain activation of the occipital cortex modulated by the emotional content of the visual stimuli. As we found in a previous pilot study that only positive but not negative stimuli differ from neutral stimuli (with respect to oxygenated haemoglobin), we now measured the event‐related EEG potentials and NIRS simultaneously during the same session. Thereby, we could evaluate whether the subjects (n = 16) processed the positive as well as the negative emotional stimuli in a similar way. During the task, the subjects passively viewed positive, negative, and neutral emotional pictures (40 presentations were shown in each category, and pictures were taken from the International Affective Picture System, IAPS). The stimuli were presented for 3 s in a randomized order (with a mean of 3 s interstimulus interval). During the task, we measured the event‐related EEG potentials over the electrode positions O1, Oz, O2, and Pz and the changes of oxygenated and deoxygenated haemoglobin by multichannel NIRS over the occipital cortex. The EEG results clearly show an increased early posterior negativity over the occipital cortex for both positive as well as negative stimuli compared to neutral. The results for the NIRS measurement were less clear. Although positive as well as negative stimuli lead to significantly higher decrease in deoxygenated haemoglobin than neutral stimuli, this was not found for the oxygenated haemoglobin. Hum Brain Mapp 29:28–35, 2008. © 2007 Wiley‐Liss, Inc.
Ultrastructural contributions to the study of morphological differentiation in malignant mixed (pleomorphic) tumors of salivary gland
Authors: Dardick Irving , Hardie John , Thomas M. Jane , Peter Nostrand A. W. Van
Published: February 2007

Ultrastructural studies of pleomorphic adenoma have shown a coordinated differentiation of luminal epithelial and modified myoepithelial cells with the latter cells related to processes resulting in the myxochondroid stroma. Five examples of various histologic types of malignant mixed tumor of parotid origin were examined by electron microscopy to see if underlying patterns of tumor cell differentiation and organization matched those of pleomorphic adenoma. Whether they were intracapsular tumors (with or without identifiable pleomorphic adenoma), carcinomas ex pleomorphic adenoma, or a true malignant mixed tumor, all lesions had cell types and organizations either identical to those in pleomorphic adenoma or, as in less‐differentiated examples, displayed features suggesting origin from luminal cells, myoepithelial cells, or both. Even the chondroid cells in the true malignant mixed tumor expressed ultrastructural features indicating their epithelial derivation. On the basis of these findings, some alterations to the classification and terminology of the subtypes of malignant mixed tumor are suggested.
Evaluation of the frontonasal duct in frontal sinus fractures
Authors: Heller Elliot M. , Jacobs Joseph B. , Holliday Roy A.
Published: February 2007

Successful management of frontal sinus fractures depends on correct identification of structural pathology, which may lead to inflammatory complications. Obstruction of the frontonasal duct is a significant factor predisposing to such complications and its evaluation is thus critical in the management of these fractures. Specific radiographic CT criteria and an intraoperative dye irrigation test are presented to determine the likelihood of frontonasal duct injury. Eighteen cases of frontal sinus fractures are reviewed, which have been treated based on these principles. A scheme is presented outlining the management of frontal sinus trauma using these methods.
Invasive histoplasmosis of the mandible
Authors: Dobleman Thomas J. , Scher Natan , Goldman Michael , Doot Shane
Published: February 2007

We present a case of an 82‐year‐old man with a 1‐year history of a slowly enlarging, nontender, exophytic oral mucosal lesion with focal ulceration of the right alveolar ridge of the mandible associated with cortical bone resorption. Two consecutive biopsies revealed histoplasma capsulatum. A review of the literature confirms that this is an uncommon manifestation of this fungal disease, but must be considered in the differential diagnosis of an oral ulcerative lesion.
Effects of general anesthesia on the human blink reflex
Authors: Marelli Russell A. , Hillel Allen D.
Published: February 2007

The blink reflex was studied in 10 patients undergoing elective procedures under general anesthesia. Anesthetic agents were isoflurane, halothane, nitrous oxide, methohexital, and thiopental in various combinations. At induction, blink reflexes were diminished by low‐dose thiopental (1‐1.5 mg/kg) and abolished by high‐dose thiopental (4‐8 mg/kg) and methohexital (1.5 mg/ kg). Blink reflexes were absent during halogenated vo/itile inhalational anesthesia and did not return until patients were in the recovery room, well after end‐tidal anesthetic levels were zero by mass spectroscopy. Recovery of consciousness and the ability to blink on command often preceded return of any blink reflex activity, indicating that the blink reflex is not useful as a postoperative test of facial nerve function in the operating room after anesthesia. In six patients, blink reflexes were still diminished 2‐3 hours after cessation of anesthesia, at a time when patients were fully oriented and corneal and eyelid reflexes were clinically normal. This finding suggests that the blink reflex might be a sensitive test of subtle CNS dysfunction after inhalational anesthesia and potentially could serve as a useful objective indicator of recovery from anesthesia for outpatient surgery.
Postanginal sepsis
Authors: Shapiro Jo , Fried Marvin P. , Strome Marshall
Published: February 2007

Postanginal sepsis is a septicemia resulting from an antecedent pharyngitis that causes an internal jugular vein thrombophlebitis. Because of the severity of the disease and the difficulty in its diagnosis, familiarity with all aspects of the disease is essential. We present three cases and review the literature on postanginal sepsis. The clinical course of the disease is described and its evaluation and treatment are outlined.
Vascular ring anomaly
Authors: Kraus Dennis H. , Hayes James D. , Tucker Harvey M.
Published: February 2007

Congenital vascular ring anomalies frequently present to the pediatric otolaryngologist with symptoms oftracheoesophageal compression. One such case is reported and the literature reviewed. The role of the otolaryngologist in the diagnosis and management of congenital vascular ring anomalies is discussed.
Renal cell carcinoma with metastasis to the parotid gland: Case reports and review of the literature
Authors: Owens Ruth M. , Friedman Craig D. , Becker Stephen P.
Published: February 2007

Two cases of renal cell carcinoma metastatic to the parotid gland are presented. The parotid mass was the initial manifestation of the first patient's renal cell malignancy and the pathologic evaluation was the first clue to the diagnosis. The second case demonstrates discovery of metastasis to the parotid gland 8 years after resection of a hypemephroma. A review of the literature on this subject is presented and the pathologic characteristics as well as recommendations for diagnosis and treatment of this entity are reviewed.
Synchronous unilateral parotid neoplasms of different histologic types
Authors: Schilling Janice A. , Block Blaine L. , Speigel Jerome C.
Published: February 2007

Synchronous parotid neoplasms are rare. Unilateral, synchronous neoplasms of two separate and histologically distinct types are extremely unusual. Our review of the literature revealed 31 previously reported cases. We add two additional cases found in 291 parotid neoplasms seen in our institutions over the last 10 years; both including a pleomorphic adenoma and a War‐thin's tumor. This combination was found in 15 of 33 cases, while Warthin's tumors were found in association with another tumor in 24 of 33 reported cases (82%).
Low‐grade papillary adenocarcinoma of buccal mucosa salivary gland origin
Authors: Fliss Dan M. , Zirkin Howard , Puterman Marco , Tovi Ferit
Published: February 2007

The clinicopathologic features of a low‐grade papillary adenocarcinoma arising in minor salivary gland tissue are presented. This tumor demonstrates a predilection for minor salivary glands of the oral cavity, a slow growth pattern, recurrence in spite of radical excision, and a tendency to produce nodal metastasis. This is the second documented case in the English literature of this recently defined subtype of polymorphous low‐grade adenocarcinoma arising in a minor salivary gland of the buccal mucosa.
Magnetic resonance imaging of paranasal sinus tumors for craniofacial resection
Authors: Lund Valerie J. , Howard David J. , Lloyd Glyn A. S. , Cheesman Anthony D.
Published: February 2007

Computerized tomography (CT) has been shown to be 78% accurate with respect to anatomic extent of tumor when correlated with operative findings and histology in patients undergoing craniofacial resection. To determine whether preoperative evaluation could be improved by the combination of CT and magnetic resonance imaging (MRI), 26 patients with tumor of the paranasal sinuses had undergone MRI before surgery in addition to CT. Ten patients also received Gadolinium‐DTPA as a contrast‐enhancement agent during MRI. The radical approach offered by craniofacial resection allows accurate evaluation of imaging techniques and when these are compared with histologic findings, a 94% correlation is found. The use of Gadolinium further improves the accuracy of tumor delineation to 98%. Despite the intrinsic disadvantage of absent bone detail, MRI demonstrates the extent of tumor better than CT and can distinguish it from inflammed mucosa, retained secretions, and normal mucosa provided the correct sequences are used.
Carcinoma of the skin of the head and neck with perineural invasion
Authors: Mendenhall William M. , Parsons James T. , Mendenhall Nancy Price , Brant Timothy A. , Stringer Scott P. , Cassisi Nicholas J. , Million Rodney R.
Published: February 2007

This is an analysis of 25 patients with carcinoma of the skin of the head and neck with clinical evidence of perineural invasion, who were managed with curative intent by radiotherapy alone (16) or surgery and radiotherapy (9). All patients had a minimum of 5 years of follow‐up. Local control following treatment was observed in 20% of patients treated with radiotherapy alone and 38% of those treated with surgery and radiotherapy. Local control was diminished for recurrent lesions and for tumors that also invaded bone and/or cartilage. The 5‐year absolute survival rates were 31% for patients treated with radiotherapy alone and 33% for those in the combined‐treatment group. The incidence of significant complications was similar: 25% with radiotherapy alone and 33% with surgery and adjuvant radiotherapy.
Computed tomographic evaluation of regional lymph node involvement in cancer of the oral cavity and oropharynx
Authors: Close Lanny Garth , Merkel Marie , Vuitch Milan F. , Reisch Joan , Schaefer Steven D.
Published: February 2007

To evaluate the efficacy of computed tomography (CT) in the identification of metastatic cervical node involvement from cancer of the oral cavity and oropharynx, 61 consecutive, previously untreated patients with T2 or greater squamous cell carcinoma of these sites were studies prospectively by CT, followed within 1 month by surgery to the primary and neck as initial treatment. The CT scan of each patient was evaluated according to the location, size, and appearance of visible nodes, and each feature was correlated with the histopathologic findings of all 83 neck specimens. A significant relationship was found between CT findings (node size, node appearance, and multiplicity of nodes) and the pathologic status of the neck using Chi‐square contingency table analysis (overall x2 = 30.928, p < 0.001). This data supports the role of CT in the evaluation of patients with cancer of these sites.
Radioresistant tumor cell lines derived from head and neck radiation failures
Authors: Weichselbaum Ralph R. , Beckett Michael A. , Vijayakumar Srinivasan , Ahmed‐Swan Susan , Dritschilo Anatoly , Schwartz Jeffrey L , Moran William J. , Goldman Michael E. , Tybor Allen G. , Vokes Everett E. , Panje William R.
Published: February 2007

We studied the in vitro radiobiological parameters of 16 human head and neck squamous cell carcinoma tumor cell lines cultured from patients who suffered local failure after a curative course of radiotherapy. The radiobiological parameters determined included D0, n, and D̄. When compared with in vitro radiobiological parameters of tumor cells cultured from head and neck cancer patients prior to radiotherapy, human sarcoma cell lines, and normal human diploid fibroblasts studied in our laboratory (as well as other human tumor cell lines reported in the literature), tumor cells derived from radiotherapy failures on average are resistant to the cytotoxic effects of ionizing radiation.
Histiocytic necrotizing lymphadenitis (Kikuchi's disease)
Authors: Sterman Bruce M. , Benninger Michael S. , Eliachar Isaac
Published: February 2007

Histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a benign disorder predominantly of young women who present with cervical adenopathy. It has, on occasion, been misdiagnosed as a malignant neoplasm. Little mention of this condition has appeared in the otolaryngologic literature. A patient with Kikuchi's disease is reported and the pertinent literature is reviewed. Because both the clinical and pathological aspects of Kikuchi's disease are important in establishing the diagnosis, effective consultation between the head and neck surgeon and the pathologist is crucial.
Management of the thyroid nodule
Authors: Campbell Jeffrey P. , Pillsbury Harold C.
Published: February 2007

The approach to the patient with a palpable solitary thyroid nodule remains controversial. In the rare patient with signs and symptoms suggestive of malignancy, the course of action is reasonably established. However, the patient with an asymptomatic solitary thyroid nodule presents a dilemma. The therapeutic alternatives range from suppressive medical therapy with serial examinations to surgical excision; therefore, to obviate unnecessary surgery, several diagnostic techniques and approaches have evolved which attempt to predict the presence of malignancy. A multitude of articles reflects the widespread disagreement among physicians regarding these diagnostic approaches. Thus, many questions still remain as to the proper management of patients with solitary nodules. The issue is further confounded by problems in assimilating and practically applying the results of the various studies, which often differ in their results.

In this report, data regarding the prevalence of the solitary thyroid nodule are reviewed, and the clinical significance of the solitary thyroid nodule is discussed. The problem of management is examined in terms of the various diagnostic approaches to the solitary thyroid nodule: history and physical examination, laboratory tests, ultrasonography, thyroid suppressive therapy, scanning techniques, and fine‐needle aspiration. The efficacy of each technique is critically evaluated with an emphasis upon the ability to distinguish benign from malignant disease. The overall aim of this report is to establish a reasonable diagonostic approache to the asymptotic patient with the solitary palpable thyroid nodule, based upon a critical review of the literature.
Endotracheal intubation as an alternative to tracheostomy after intraoral or oropharyngeal surgery
Authors: Scher Natan , Dobleman Thomas J. , Panje William R.
Published: February 2007

Patients who undergo oral or oropharyngeal surgery usually require a tracheostomy for postoperative airway maintenance. However, the development in recent years of soft endotracheal tubes now provides the alternative of short‐term endotracheal intubation, with minimal sequelae. Our favorable experience with the use of short‐term intubation in children with epiglottitis prompted us to apply the technique to adults. Over a 2‐year period at the University of Chicago Medical Center, we successfully used postoperative endotracheal intubation for 19 adult and pediatric patients who underwent major intraoral procedures, thus avoiding the possible complications, discomfort, and anxiety associated with tracheostomy. The patients were given intravenous steroids and antibiotics concomitantly, so that tissue edema and inflammation were minimized. No complications related to intubation and no postextubation airway compromise were noted in any of the patients.
Preclinical chemotherapy on human head and neck cancer xenografts grown in athymic nude mice
Authors: Braakhuis Boudewijn J. M. , Van Dongen Guus A. M. S. , Bagnay Marian , Van Walsum Marijke , Snow Gordon B.
Published: February 2007

This study was undertaken to investigate the potential role of xenografts established from human head and neck squamous cell carcinoma (HNSCC) in the selection of new anticancer agents for phase M clinical trials. Eight HNSCC tumor lines were established in NMRI nude mice. The tumor‐bearing animals were then treated with drugs at the maximum tolerated dose level. Treatment with drugs known for their activity in 15%–30% of HNSCC patients [cisplatin (CDDP), bleomycin (BLEO), 5‐fluorouracil (5‐Fu), cyclophosphamide (CY), and doxorubicin (DOX)] caused strong responses in up to 38% and moderate responses in 50%–67% of the HNSCC tumor lines. Methotrexate (MTX), known to cause remissions in about 40% of HNSCC patients, was only minimally active in this model system. A clinically ineffective drug, amsacrine (m‐AMSA), was included as a negative control and showed no or minimal activity in all four HNSCC lines tested. A number of experimental drugs that have promising preclinical activity were also tested. Brequinar sodium (Dup 785) and 10‐ethyl, 10‐deaza‐aminopterin (10‐EdAM) showed activity in three of five, and two of the four tested tumor lines respectively. N, N‐dimethylformamide (DMF) and 5‐aza‐2′‐deoxycytidine (5‐aza‐dCyd), agents with the capacity to induce differentiation in in vitro systems, showed moderate activity in 43% and 40%, and strong activity in 14% and 40% of the lines, respectively. Our results indicate that the nude mouse xenograft model may play a role in the screening of new drugs, and in particular, it could be of help in the selection of drugs to be tested in phase II HNSCC clinical trials.
Use of xenograft bone with aspirated bone marrow for treatment of cystic defect of the jaws
Authors: Horowitz Isack , Bodner Lipa
Published: February 2007

Xenografts of Kiel bone in combination with autologous aspirated bone marrow were used to graft 20 cystic defects in the jaws. Sixteen cases (80%) were successful. Results were evaluated by clinical and radiographie follow‐up of the patient up to 4 years (average 2.3 years) after surgery. Inability to create a water‐tight closure followed by immediate secondary infection were considered as the causes for failure rather than rejection by the host.
Near‐fatal complications of tracheotomy infections and their prevention
Authors: Wang Robert C. , Perlman Philip W. , Parnes Steven M.
Published: February 2007

Infectious complications of tracheotomy range from minor to potentially fatal. Three cases are presented: clavicular osteomyelitis; innominate artery blowout with mediastinitis; and the first reported case of necrotizing fasciitis involving the chest wall related to tracheotomy infection. All patients were debilitated, with one diabetic and another steroid‐dependent. Infectious sequelae occurred as late as 8 weeks following tracheotomy. The mechanism, treatment, and prevention of tracheotomy infections are reviewed. Indications for the creation of a permanent but reversible tracheostome should be expanded to prevent infections in debilitated or immunosuppressed patients in whom decannulation is unlikely.
Cancer of distant primary site relapsing in the nasopharynx: A report of two cases and review of the literature
Authors: McKay Michael Jerome , Carr Peter John , Jaworski Richard , Kalnins Inars
Published: February 2007

Cancers metastatic to the nasopharynx are rarities. We present here two more such tumors. Although the clinical features of primary and secondary tumors in the nasopharynx are indistinguishable, a past history of treatment for malignant disease is an obvious clue to the correct diagnosis.
Gigantiform cementoma of the jaws
Authors: Thompson Stevan H. , Altini Mario
Published: February 2007

Fibro‐osseous cemental lesions of the jaw remain a controversial area of bone/cementum pathology. This article describes the clinicopathological features of 28 lesions classified as gigantiform cementoma. Black women are affected more frequently than other race and sex groups, with a peak frequency of occurrence in the fourth and fifth decades. The posterior mandible is preferentially affected and unifocal lesions (67.9%) occur more frequently than multifocal lesions (32.1%). Dull pain and a centrifugal size increase are the most prevalent presenting symptoms. Of 28 cases with parental and sibling clinical information, there were no cases which exhibited an autosomal dominant genetic association. The pathogenesis of this lesion in relation to other cemental lesions of the jaws, as well as the clinical management of cemental jaw lesions, is discussed.
The tooth as a foreign body in soft tissue after head and neck trauma
Authors: Houck John R. , Klingensmith Mark R.
Published: February 2007

Thorough evaluation of dentition is important in the management of craniofacial trauma. Avulsed or fractured teeth in the pulmonary and gastrointestinal tracts can lead to serious complications that are well described. However, the penetration of avulsed teeth into soft tissues of the head and neck is unusual and may not be recognized. Two cases in which a tooth became a foreign body in these soft tissues are illustrative. One patient had bronchoscopy for possible aspiration of an avulsed maxillary canine; it was later found embedded in the premaxillary tissues. The other patient had a right mandibular molar propelled into the posterior triangle of the left side of the neck. Physicians must be aware of dental injury resulting from facial trauma and account for all teeth as part of their evaluation, keeping an open mind as to where a missing tooth might be located.
Free jejunal interposition graft for reconstruction of the esophagus
Authors: Fisher Samuel R. , Cameron Ray , Hoyt David J. , Cole T. Boyce , Seigler Hilliard F. , Meyers William C.
Published: February 2007

Forty‐seven patients underwent pharyngoesophageal reconstruction using a free jejunal interposition graft (FJIG) at Duke University Medical Center from 1978 through 1987. There were 30 men and 17 women with ages ranging from 38 to 87 years old (mean age, 64 years). Twenty‐one patients (group A) had no prior surgical procedures, 20 (group B) were reconstructed following radiation and/or surgical failure, with 6 patients (group C) having benign strictures of the upper alimentary tract. Follow‐up ranged up to 122 months (mean, 23 months), with 3 patients lost to follow‐up, and 4 perioperative deaths (within 3 months of surgery). There were a total of 9 initial graft failures, 4 patients undergoing successful re‐implantation, resulting in an overall success rate of 89% (42 of 47). Excluding patients with graft failures, perioperative deaths, and patients lost to follow‐up, 33 of 36 patients with a viable FJIG were able to maintain adequate swallowing function yielding a physiologic success rate of 86%. All of the 21 patients dying of recurrent disease had excellent palliation with the FJIG. Of the 7 patients who are alive, only 1 has dysphagia secondary to stricture. In conclusion, it is felt that the FJIG is a sophisticated method of reconstructing large surgical defects of the pharyngoesophagus with a high technical and physiologic success rate.
Modification of compensatory swallowing in a supraglottic laryngectomy patient
Authors: Hamlet Sandra , Mathog Robert , Fleming Susan , Jones Lewis , Muz Jaroslaw
Published: February 2007

Results are presented for repeated videofluoroscopic and scintigraphic examinations of a supraglottic laryngectomy patient, illustrating the successful use and later changes in a compensatory swallow. Issues in patient management are outlined, stressing the importance of interaction between radiologists and dysphagia therapists in the rehabilitation of such patients.
Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx
Authors: Candela Frank C. , Kothari Kiran , Shah Jatin P.
Published: February 2007

A retrospective review of 333 previously untreated patients from 1965 to 1986, with primary squamous cell carcinoma of the oropharynx or hypopharynx, was undertaken to ascertain the prevalence of neck node metastases by neck level. The 333 patients underwent 344 classical radical neck dissections. Patients were grouped by clinical neck status at the time of neck dissection: elective dissection in the NO neck (N = 71), and immediate therapeutic dissection in the N+ neck (N = 259). Detailed analysis was performed for each group based on the specific primary site. This revealed a predominance of neck node metastases in levels II, III, and IV for both oropharyngeal and hypopharyngeal primaries. Isolated “skip” metastases outside of levels II, III, or IV occurred in only 1 patient (0.3%). Otherwise, level I or V involvement was always associated with nodal metastases at other levels (ie, N2 disease). These data support the trend toward selective limited neck dissection (anterior modified) in NO patients. Furthermore, they provide the foundation for planning of future prospective trials to assess the efficacy of modifications in the extent of neck dissection for carcinomas of the oropharynx or hypopharynx.
Interstitial brachytherapy and early tongue squamous cell carcinoma management
Authors: Lefebvre J. L. , Coche‐Dequeant B. , Castelain B. , Prevost B. , Buisset E. , Ton Van J.
Published: February 2007

The results of treatment of 341 previously untreated patients with early squamous cell carcinoma (SCC) of the anterior two thirds of the tongue using iridium 192 implants (January 1974‐December 1983) are presented. Furthermore, 265 patients underwent neck dissection, followed, in 102 cases, by radiotherapy. Incidence of local treatment complications was 19% (66 patients) however, only 3% (11 patients) needed more than a single medical treatment. Two months after completion of overall treatment, 326 patients (96%) were free of disease. Local failures occurred in 18% of cases; however, after successful salvage surgery this rate was reduced to 11%. Neck failures occurred in 18% of cases, but after successful salvage were reduced to 12%. Distant metastases were rare (1.5%), whereas metachronous cancers were frequent (102 patients). Survival rates were 61% (56% to 66%) at 3 years, 46% (41% to 51%) at 5 years, and 26% (23% to 34%) at 10 years. Deaths due to tongue cancer evolution (20%) equalled those due to metachronous cancers (18.5%) and intercurrent diseases (21%).
Reconstruction of massive defects of the scalp, cranium, and dura after resection of scalp neoplasms
Authors: Wackym Phillip A. , Feuerman Tony , Strasnick Barry , Calcaterra Thomas C.
Published: February 2007

Massive defects of the scalp, cranium, and dura can be covered with local rotation, transposition scalp flaps. Five cases of massive defects of up to 300 square centimeters resulting from resection of scalp neoplasms were reconstructed by this technique. Excellent cosmetic and functional results were obtained in all cases. Although the emphasis in the recent literature has been on free flap coverage of these massive defects, our series demonstrates that these extensive scalp defects can be reconstructed using large local scalp flap transposition.
Claudication on mastication following bilateral external carotid ligation
Authors: Liston Stephen L. , Siegel Leighton G.
Published: February 2007

Ligation of both external carotid arteries to control epistaxis can produce a decrease in the blood supply of the muscles of mastication sufficient to cause pain typical of claudication while chewing. We report 3 cases of this complication. We advocate that this procedure be used only in special circumstances.
Gadolinium‐enhanced MRI of tumors of the head and neck
Authors: Phillips C. Douglas , Gay Spencer B. , Newton Richard L. , Levine Paul A.
Published: February 2007

High‐resolution computed tomographic (CT) scanning and, more recently, magnetic resonance imaging (MRI) have provided more accurate evaluation of the extent of head and neck neoplasms. With increasing experience, better methodology is being developed to improve imaging accuracy. We present a series of patients with clinically proven neoplasms of the oropharynx and larynx, evaluated by MR using T1‐weighted, T2‐ weighted, and post‐gadolinium (Gd)‐DTPA T1‐weighted imaged. The concept behind the use of Gd‐DTPA was that it might permit the use of only pre‐ and postcontrast T1‐weighted sequences, reducing examination time and increasing the sensitivity of the examination. It was also anticipated that Gd‐DTPA could increase tumor conspicuity and edge definition. Imaging planes were chosen to best define the tumor extent and axial images were performed to evaluate adenopathy. The imaging results were compared with the clinical evaluation and with nonGd‐enhanced MRI. We present examples of the significantly improved soft tissue contrast with Gd‐DTPA T1‐weighted images and discuss the improved tumor margin definition with Gd‐ DTPA. Those cases in which it does not provide improved information will also be presented.
Conservation surgery for radiation‐failure carcinoma of the glottic larynx
Authors: Shah Jatin P. , Loree Thom R. , Kowalski Luiz
Published: February 2007

A consecutive series of 28 patients treated by conservation surgery of the larynx for radiation‐failure, recurrent rT1and T2(postradiotherapy staging) glottic squamous cell carcinoma treated at Memorial Sloan‐Kettering Cancer Center from 1966 to 1983 is reviewed. The majority of patients were men with the age ranging from 46 to 76 years. The disease‐free interval ranged from 0 to 113 months (median, 8.5 months). The stage at presentation was rT1in 25 patients and rT2in 3 patients. Surgery consisted of cordectomy (7 patients), hemilaryngectomy (18), and extended hemilaryngectomy (3). There was no operative mortality. Local recurrence developed in 8 patients (28.5%), cervical metastasis in 2, and distant metastasis in 1. Only 3 patients were salvaged by further treatment. The rate of local control was influenced by positive surgical margins. Overall, voice preservation was achieved in 75% of patients. The ultimate local control was 82.1% during a follow‐up period that ranged from 1.3 to 16.7 years (median, 6.3 years). The actuarial survival at 5 and 10 years was 73% and 71% following conservation surgery of the larynx.
Recurrent pleomorphic adenomas of the parotid gland
Authors: Myssiorek David , Ruah Carlos B. , Hybels Roger L.
Published: February 2007

Twenty‐seven patients with recurrent pleomorphic adenomas of the parotid gland were seen. This study confirms that superficial parotidectomy with identification and dissection of the facial nerve greatly decreases the incidence of recurrent benign pleomorphic adenoma, and, in the small number that recur, are easier to cure. All lumps in the parotid area should be approached in the same manner, with the surgeon prepared to isolate the facial nerve and perform superficial parotidectomy. This technique is successful because it avoids dissection near the tumor capsule, which is the major cause of recurrence. The procedure recommended for treatment of patients to remove the first recurrent tumor is total parotidectomy and excision of the previous scar. This vigorous approach is dictated by the increasing difficulty of removing further recurrent tumors. Only 67% of patients with recurrent tumors ultimately achieve a tumor‐free status. Experienced surgeons can preserve the facial nerve even after multiple operations.
Cystic parotid masses in HIV infection
Authors: Sperling Neil M. , Lin Pi‐Tang , Lucente Frank E.
Published: February 2007

Cystic enlargement of the parotid gland is a newly described manifestation of infection with human immunodeficiency virus (HIV). A review of 15 such patients with respect to clinical presentation, natural history, and management is presented. Follow‐up ranges from 1 to 27 months, averaging 10 months. In 47% of the patients, parotid swelling was the chief complaint leading to the diagnosis of HIV infection. T‐cell analysis revealed the tendency for this lesion to occur in the early stages of immunodeficiency when T‐cell counts are high. Histologic examination revealed findings resembling benign lymphoepithelial lesion. It is felt that these lesions are a local manifestation of a systemic disease and treatment should be tailored with this in mind. Surgical excision may not be necessary. Fine‐needle aspiration (FNA) was found to be useful diagnostically and therapeutically. Recognition of this entity is essential for the head and neck specialist in providing an early diagnosis of HIV infection.
Ear preservation in the surgical treatment of auricular melanoma
Authors: Cohen Barry J. , Melisi James , Cohen Max H.
Published: February 2007

A case of retroauricular melanoma is presented, and the literature on auricular melanoma is reviewed. A method of ear preservation in the surgical treatment of auricular melanoma is discussed.
Sudden dysphonia due to parathyroid apoplexy: A rare case of recurrent laryngeal nerve palsy
Authors: Ben‐Shlomo Izhar , Zohar Shmuel , Turani Hanna , Cozacov Carlos
Published: February 2007

A case is presented of sudden onset dysphonia in a 59‐year‐old man caused by acute vocal cord paralysis due to bleeding within a hyperplastic lower right parathyroid gland. There were no laboratory findings of hyperparathyroidism nor coagulation disorder. Acute onset of vocal cord paralysis is rarely associated with benign processes; the current case is the first associated with parathyroid hyperplasia.
Folded, bipaddled composite flap in head and neck reconstruction
Authors: Bhathena Hosi M. , Kavarana Naozer M.
Published: February 2007

A series of 34 patients repaired by folded, bipaddled composite flaps for head and neck cancer surgical defects is presented. Pectoralis major composite flap was used in 33 patients on musculovascular pedicle and 1 patient had a latissimus dorsi composite flap free‐tissue transfer. The pectoralis major rib, osteomyocutaneous flap was utilized in 6 patients who had lesions of the mouth floor and anterior mandibular arch. The incorporated rib was used as a vascularized bone graft for the stability of mandibular fragments. Thus, one regional composite flap used in bipaddled fashion enabled the reconstruction of mucosal, skin, and mandibular arch defects.
Mucinous carcinoma of the external auditory canal: Case report
Authors: Kitamura Ken , Asai Masao , Kubo Toshiro , Harii Kiyonori , Hasegawa Akio
Published: February 2007

An unusual case of a mucinous carcinoma originating from the external auditory canal in a 70‐year‐old man is described. Multiple metastatic lesions also appeared in the parotid gland. After a local excision of the primary lesion, the tumor was seen to extend anterosuperiorly along the middle cranial cavity dura. The occurrence of this tumor is exceedingly rare, and, to our knowledge, this is the first report of a mucinous carcinoma of the external auditory canal. The clinical pictures of this tumor and the histological findings are discussed with reference to other reports.
Tracheal neurilemmoma: Case report and review of the literature
Authors: Stack Peter S. , Steckler Robert M.
Published: February 2007

We report a rare case of an intratracheal neurilemmoma which presented as advanced upper airway obstruction. The tumor was successfully excised by laryngofissure. A review of the world literature is provided.
Carcinosarcoma of the nasal cavity and paranasal sinuses
Authors: Shindo Maisie L. , Stanley Robert B. , Kiyabu Milton T.
Published: February 2007

Malignant neoplasms consisting of an epithelial element and 1 or more nesenchymal components are variously termed teratocarcinosarcoma, carcinosarcoma, malignant teratoma, spindle cell carcinoma, and pseudosarcomatous squamous cell carcinoma. Carcinosarcoma, consisting of a malignant epithelial element and a single malignant mesenchymal component, is extremely rare in the sinonasal tract. We report a case of carcinosarcoma involving the nasal cavity, paranasal sinuses, and anterior cranial fossa. Rapid growth and extensive local destruction are prominent features of this tumor, emphasizing the need for early diagnosis and prompt institution of aggressive therapy. The clinical presentation, pathologic features, and clinical course are detailed.
Objective assessment of swallowing function in head and neck cancer patients
Authors: Muz Jaroslaw , Mathog Robert H. , Hamlet Sandra L. , Davis Lawrence P. , Kling George A.
Published: February 2007

Swallowing function was evaluated with scintigraphy in 37 patients with head and neck cancer. The patients were examined before and during the course of either surgery, chemotherapy, and/or radiotherapy. A total of 118 scintigraphic studies were performed. Scintigraphic results of bolus flow and aspiration were correlated with clinical findings. Both scintigraphic and clinical studies indicated a worsened swallowing function in 12 patients. These same studies indicated improvement of swallowing in another 13 patients. In 11 patients, both studies revealed either no apparent change or mixed changes in swallowing function after the course of therapy. In only 1 patient was there disagreement between the scintigraphic and clinical assessment of swallowing function. It is our opinion that scintigraphy is a useful method for objective assessment of swallowing function during and after the course of treatment of head and neck cancer patients.
Analysis of the morbidity associated with immediate microvascular reconstruction in head and neck cancer patients
Authors: Schusterman Mark A. , Horndeski Gary
Published: February 2007

Free tissue transfer has become an important adjunct in the reconstruction of head and neck cancer patients. Despite the success, the added time required to perform free flap reconstructions continues to be a concern for some head and neck surgeons. In order to investigate whether this added time increases the risk of medical complications to the patient, 20 consecutive free flap patients were compared to 20 age‐, site‐, and histology‐matched controls. These patients were analyzed for demographic data, American Society of Anesthetic risk scores, stage, tumor site, and pre‐ and postoperative medical problems. The mean occurrence of medical problems preoperatively was 1.1 occurrences per patient for the flap group and 1.5 occurrences per patient for the control group. Postoperatively, there were 0.75 occurrences per flap group and 0.9 occurrences for the control group. Neither of these was statistically significant. The length of hospitalization was 13.5 days for the control group and 15.9 days for the flap group. Again, this was not statistically significant. The only significant statistic difference was the length of the procedure: 6.95 hours for the control group and 11.0 hours for the flap group, which had a p value of less than 0.001. In conclusion, this study indicates that length of procedure alone should not be a determining factor in deciding whether or not to use immediate microvascular reconstruction in head and neck cancer patients.
Microvascular free tissue reconstruction following Mohs' micrographic surgery for advanced head and neck skin cancer
Authors: Ahn Sang Tae , Hruza George J. , Mustoe Thomas A.
Published: February 2007

Seven consecutive patients from 1986 through 1989 for 8 extensive recurrent and/or irradiated skin cancers of the face and scalp are retrospectively evaluated. One patient was treated by conventional surgical margins, and the limitations of this method in sampling margins are compared to the Mohs' micrographic surgery (MMS) used for the other 6 patients. All were treated with free flaps without flap loss or major complications in spite of advanced age. The advantages of an interdisciplinary approach to achieve maximum cure rates, optimal reconstruction, and minimizing anesthesia time are discussed.
Incisional or excisional neck‐node biopsy before definitive radiotherapy, alone or followed by neck dissection
Authors: Ellis Eric R. , Mendenhall William M. , Rao P. V. , McCarty Patricia J. , Parsons James T. , Stringer Scott P. , Cassisi Nicholas J. , Million Rodney R.
Published: February 2007

An analysis of 508 patients (660 heminecks) with head and neck squamous cell carcinoma and clinically positive neck nodes who were treated with radiotherapy alone to the primary lesion (with or without a neck dissection) was conducted to determine if open neck‐node biopsy before definitive treatment adversely affected the probability of control of neck disease, the risk of distant metastasis, or the cause‐specific survival rate. The prognostic factors analyzed included biopsy status of the neck, N stage, neck treatment, node mobility, node location, T stage, primary site, and control of disease above the clavicles. Sixty‐six patients who had undergone an open neck‐node biopsy before definitive radiotherapy were compared with a control group of 442 patients who did not undergo a neck‐node biopsy; no detrimental effect of the biopsy on neck control, distant metastasis, or cause‐specific survival was demonstrated. We conclude that the potential adverse effect of violating the neck before definitive treatment cannot be demonstrated if radiotherapy is the next step in the patient's management.
Irradiation and free tissue transfer in head and neck cancer
Authors: Jose Baby , Banis Joseph , Flynn Michael , Lindberg Robert , Spanos William J. , Paris Kristie , Rohm Janet
Published: February 2007

The aim of this study was to analyze the effects of surgery, irradiation, and free tissue transfer in locally advanced head and neck cancer patients. Forty‐one patients with head and neck cancer were treated with surgery, irradiation, and free tissue transfer for reconstruction from 1977 to 1987. The age range was 38 to 78 years with a median age of 61. Patients were staged using the AJCC (1978) staging system. Eighty‐four percent of the patients were in stage III or IV. The common sites of primary tumors were the oral cavity (22) and oropharynx (10). Forty patients had squamous cell carcinoma and 1 patient had basal cell carcinoma. Six patients had preoperative irradiation, and the rest had postoperative irradiation. The most common surgical procedures were partial glossectomy and neck dissection (17 patients) and wide excision of the primary and neck dissection (17 patients). The most common types of free tissue transfer were dorsalis pedis (13 patients) and scapular flaps (6 patients). The primary site was controlled in 22 patients (54%) and the neck in 36 patients (88%). Three patients (7.3%) had flap failure which required further surgical management. Eighteen patients are living with no evidence of disease with a median follow‐up of 18 months (5‐101 months), 10 patients are living with disease with a median follow‐up of 9 months (3‐40 months), 9 patients are dead of disease with a median survival of 13 months (6‐54 months), and 4 patients are lost for follow‐up. This study shows that free tissue transfer before or after irradiation is of benefit with few complications.