bluuebunny/crossref_metadata_2025 huggingface dataset:
Y chromosome loss in chronic myeloid leukemia detected in both normal and malignant cells by interphase fluorescence in situ hybridization
Authors: Kirk Judy A. , Vandevanter Donald R. , Biberman Jennifer , Bryant Eileen M.
Published: February 2007

Loss of the Y chromosome in bone marrow (BM) cells is a normal age‐associated event. Y chromosome loss is also observed in the Philadelphia chromosome (Ph) positive BM cells of some patients with chronic myeloid leukemia (CML) in chronic phase, but at a younger age than in normal individuals. While the significance of loss of the sex chromosome in normal males is uncertain, ‐Y marrow cells are not believed to be of clonal origin. However, because CML is a clonal disease, CML sub‐populations with Y loss may constitute a disease‐related sub‐clone. We used a PCR‐amplified yeast artificial chromosome containing the BCR gene region for single color interphase analysis of BCR rearrangement by fluorescence in situ hybridization (FISH). Then, using two color FISH, with one fluorochrome detecting the BCR gene region and the other detecting Y chromosome repeat sequences, we surveyed peripheral and BM Y loss in both normal Ph‐ (BCR not disrupted) and CML Ph+ (BCR rearranged) interphase nuclei of two patients with Y loss in Ph positive cells observed by metaphase analysis. ‐Y was seen in a proportion of Ph+ cells in both cases, and the proportion matched that seen in Ph‐ cells, indicating that Y loss is probably sporadic in both normal and CML populations, and that the propensity for Y loss in normal BM cells may be a phenotype that can be retained by malignant cells in CML.
Integrated YAC contig containing the 3pl4.2 hereditary renal carcinoma 3;8 translocation breakpoint and the fragile site FRA3B
Authors: Boldog Ferenc L. , Waggoner Barbara , Glover Thomas W. , Chumakov Ilya , Paslier Denis Le , Cohen Daniel , Gemmill Robert M. , Drabkin Harry A.
Published: February 2007

An extended YAC contig has been developed for the 3p14 region containing the hereditary renal carcinoma 3;8 translocation breakpoint and the 3p 14.2 fragile site FRA3B. This region of chromosome 3 has been implicated by chromosomal translocation, deletion, and loss of heterozygosity in the pathogenesis of several malignant diseases. The contig allows accurate positioning of candidate genes, polymorphic markers, and other 3p rearrangements within this region. The contig, spanning approximately 6 Mb of DNA, contains 51 YACs identified by 27 markers, including a subset of CA repeats located in the 3p 14.1–14.2 interval. The order of CA microsatellites, derived from marker content of the YACs, is in agreement with the order previously determined by genetic linkage studies. We find that the protein‐tyrosine phosphatase gamma gene, PTPRG, is located minimally 1 Mb proximal to the t(3;8) breakpoint The more proximal 3p homozygous deletion in the small‐cell lung cancer cell line, U2020, is more than 5 Mb from the site of the 3;8 translocation. This integrated physical and genetic map provides a framework for further investigations of malignant diseases associated with proximal 3p loss. In addition, the positioning of separate 3p 14.2 aphidicolin‐induced breakpoints suggests that FRA3B may represent a region rather than a single site.
Dynamics of spontaneous transitions between global brain states
Authors: Ito Junji , Nikolaev Andrey R. , Leeuwen Cees van
Published: February 2007

Phase patterns of human scalp alpha EEG activity show spontaneous transitions between different globally phase‐synchronized states. We studied the dynamical properties of these transitions using the method of symbolic dynamics. We found greater predictability (deterministicity) and heterogeneity in the dynamics than what was expected from corresponding surrogate series in which linear correlations are retained. A possible explanation of these observations within the framework of chaotic itinerancy is discussed. Hum Brain Mapp, 2007. © 2007 Wiley‐Liss, Inc.
Sex specificity of ventral anterior cingulate cortex suppression during a cognitive task
Authors: Butler Tracy , Imperato‐McGinley Julianne , Pan Hong , Voyer Daniel , Cunningham‐Bussel Amy Christine , Chang Luke , Zhu Yuan‐Shan , Cordero Juan J. , Stern Emily , Silbersweig David
Published: February 2007

Ventral anterior cingulate cortex (vACC) is a highly interconnected brain region considered to reflect the sometimes competing demands of cognition and emotion. A reciprocal relationship between vACC and dorsal ACC (dACC) may play a role in maintaining this balance between cognitive and emotional processing. Using functional MRI in association with a cognitively‐demanding visuospatial task (mental rotation), we found that only women demonstrated vACC suppression and inverse functional connectivity with dACC. Sex differences in vACC functioning—previously described under conditions of negative emotion—are extended here to cognition. Consideration of participant sex is essential to understanding the role of vACC in cognitive and emotional processing. Hum Brain Mapp, 2007. © 2007 Wiley‐Liss, Inc.
Cortical functional connectivity networks in normal and spinal cord injured patients: Evaluation by graph analysis
Authors: Fallani Fabrizio De Vico , Astolfi Laura , Cincotti Febo , Mattia Donatella , Marciani Maria Grazia , Salinari Serenella , Kurths Jurgen , Gao Shangkai , Cichocki Andrzej , Colosimo Alfredo , Babiloni Fabio
Published: February 2007

The present work aims at analyzing the structure of cortical connectivity during the attempt to move a paralyzed limb by a group of spinal cord injured (SCI) patients. Connectivity patterns were obtained by means of the Directed Transfer Function applied to the cortical signals estimated from high resolution EEG recordings. Electrical activity were estimated in normals (Healthy) and SCI patients on twelve regions of interest (ROIs) coincident with Brodmann areas. Degree distributions showed the presence of few cortical regions with a lot of outgoing connections in all the cortical networks estimated irrespectively of the frequency band investigated. For both of the groups (SCI and Healthy), bilateral cingulate motor area (CMA) acts as hub transmitting information flows. The efficiency index, allowed to assert the ordered properties of such estimated cortical networks in both populations. The comparison of such estimated networks with those obtained from random networks, elicited significant differences (P < 0.05, Bonferroni‐corrected for multiple comparisons). A statistical comparison (ANOVA) between SCI patients and healthy subjects showed a significant difference (P < 0.05) between the local efficiency of their respective networks. For three frequency bands (theta 4–7 Hz, alpha 8–12 Hz, and beta 13–29 Hz) the higher value observed in the spinal cord injured population entails a larger level of internal organization and fault tolerance. This fact suggests a sort of compensative mechanism as local response to the alteration in their MIF areas, which is probably due to the indirect effects of the spinal injury. Hum Brain Mapp, 2007. © 2007 Wiley‐Liss, Inc.
Catastrophic payments for health care in Asia
Authors: van Doorslaer Eddy , O'Donnell Owen , Rannan‐Eliya Ravindra P. , Somanathan Aparnaa , Adhikari Shiva Raj , Garg Charu C. , Harbianto Deni , Herrin Alejandro N. , Huq Mohammed Nazmul , Ibragimova Shamsia , Karan Anup , Lee Tae‐Jin , Leung Gabriel M. , Lu Jui‐Fen Rachel , Ng Chiu Wan , Pande Badri Raj , Racelis Rachel , Tao Sihai , Tin Keith , Tisayaticom Kanjana , Trisnantoro Laksono , Vasavid Chitpranee , Zhao Yuxin
Published: February 2007

Out‐of‐pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low/middle‐income countries, the better‐off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments. Copyright © 2007 John Wiley & Sons, Ltd.
Population ageing and health care expenditure: a school of ‘red herrings’?
Authors: Werblow Andreas , Felder Stefan , Zweifel Peter
Published: February 2007

This paper revisits the debate on the ‘red herring’, viz. the claim that population ageing will not have a significant impact on health care expenditure (HCE). It decomposes HCE into seven components, includes both survivors and deceased individuals, and estimates a two‐part model of the demand for health care services, using a large Swiss data set for 1999. It finds no or weak age effects on HCE for the components of HCE when proximity to death is controlled for, and points to differences between users and non‐users of long‐term care (LTC). For deceased non‐users of LTC services, a falling age curve for all components of HCE except for inpatient care is observed, while survivors show a weak age effect in ambulatory and inpatient care once proximity to death is controlled for. As to surviving users of LTC services, their probability of incurring LTC expenses markedly increases in old age, while most of the components of their conditional HCE show a decreasing age profile. Thus, a ‘school of red herrings’ can be claimed to exist–with the possible exception of LTC, where ageing might matter regardless of proximity to death. Copyright © 2007 John Wiley & Sons, Ltd.
Child health: evidence on the roles of family income and maternal mental health from a UK birth cohort
Authors: Propper Carol , Rigg John , Burgess Simon
Published: February 2007

There is a growing literature showing an association between higher family income and better child health. This paper uses cohort data with rich information on mother's early life events, her health, child‐health‐related behaviours, and her child's health to examine this association for the UK and to identify some of the mechanisms through which income affects child health. The paper examines the cross‐sectional association between income and health, finds the expected association, but concludes that the association with current income cannot be distinguished from one between permanent income and child health. It then focuses on the mechanisms by which income translates into better child health; these include parental behaviours that may affect child health and parental health, including maternal mental health. Controlling for these factors, there is almost no direct impact of income. A significant role is played by mother's own health, particularly her mental health. No clear role is played by child‐health production behaviours of the mother. Examining the maternal mental health–child health link in more detail suggests a role for maternal anxiety and somaticism. Copyright © 2007 John Wiley & Sons, Ltd.
Prognostic impact of HER‐2/neu expression on squamous head and neck carcinomas
Authors: Cavalot Andrea , Martone Tiziana , Roggero Nicolò , Brondino Gabriele , Pagano Marco , Cortesina Giorgio
Published: February 2007

Background.

HER‐2/neu gene amplification and protein overexpression have been identified in various solid tumors, but its prognostic relevance in head and neck squamous cell carcinoma (HNSCC) is still controversial.

Methods.

The study investigated the expression of HER‐2/neu oncoprotein in HNSCC and sought possible correlations to various clinicopathologic parameters. Expression of HER‐2/neu oncoprotein was assessed in archival tumor tissues from 87 untreated HNSCC patients by immunohistochemical technique. Data were correlated with both the clinicopathologic parameters and patient survival.

Results.

A high membranous HER‐2/neu protein expression level was found in 39% of patients. Multivariate analysis indicated that HER‐2/neu protein expression and pN lymph‐node status were independent prognostic factors for disease‐free survival.

Conclusions.

HER2/neu overexpression and its relationship with survival suggest that new therapeutic approaches targeting epidermal growth factor receptor (EGFR) family receptors could provide a new way of treating HNSCC patients with HER2/neu‐positive neoplastic lesions. © 2007 Wiley Periodicals, Inc. Head Neck, 2007
β‐Catenin nuclear accumulation in head and neck mucoepidermoid carcinoma: Its role in cyclin D1 overexpression and tumor progression
Authors: Shiratsuchi Hideki , Nakashima Torahiko , Hirakawa Naoya , Toh Satoshi , Nakagawa Takashi , Saito Tsuyoshi , Tsuneyoshi Masazumi , Komune Shizuo
Published: February 2007

Background.

Nuclear/cytoplasmic accumulation of β‐catenin is mainly regulated by its degradation, which is initiated by interaction with adenomatous polyposis coli (APC) protein. Accumulation of β‐catenin activates the transcription of 1 of the target oncogenic genes, cyclin D1, in the Wnt/Wingless pathway. The role of β‐catenin and cyclin D1 in this pathway has not been previously studied in head and neck mucoepidermoid carcinoma (MEC). This study investigates abnormalities of β‐catenin and the APC gene in MEC and correlates the patterns of cyclin D1 overexpression and nuclear/cytoplasmic accumulation of β‐catenin with the clinical outcome.

Methods.

Mutations of the β‐catenin and APC genes, as well as overexpression of cyclin D1, were investigated by polymerase chain reaction single‐strand conformation polymorphism (PCR‐SSCP) in tissue samples from 44 cases of MEC. In addition, we employed differential PCR method to detect amplification of the cyclin D1 gene. Furthermore, the overexpression of cyclin D1 and nuclear/cytoplasmic accumulation of β‐catenin was examined by immunohistochemistry, and any correlation with clinicopathologic parameters was evaluated.

Results.

Nuclear/cytoplasmic accumulation of β‐catenin was observed in 6 of 44 MEC cases (13.6%), 5 of which were high‐grade MEC, while the other 1 case was intermediate‐grade tumor. Mutational analysis of exon 3 of the β‐catenin gene revealed that 4 of 26 cases (15.4%) contained point mutations (3 in codon 32, GAC [Asp] to GGC [Gly]; 1 in codon 42, ACA [Thr] to ATA [Ile]), and all these 4 cases showed β‐catenin accumulation immunohistochemically. The nuclear/cytoplasmic accumulation of β‐catenin was significantly correlated with the adverse outcome of patients (p = .011). Two APC gene alterations were detected in 2 cases of low‐grade MEC, where there was no β‐catenin nuclear accumulation. Amplification of the cyclin D1 gene was observed in 10 of 26 cases (38.5%). Cyclin D1 overexpression was recognized in 19 of 44 cases (43.2%) and was significantly correlated with β‐catenin accumulation (p = .003).

Conclusions.

These findings suggest that β‐catenin, which, in cooperation with cyclin D1, plays crucial role in the Wnt‐signaling pathway, may also contribute to the adverse outcome and high‐grade tumor staging of MEC. © 2007 Wiley Periodicals, Inc. Head Neck, 2007
Role of aerobic gram‐negative rods, anaerobes, and fungi in wound infection after head and neck surgery: Implications for antibiotic prophylaxis
Authors: Johnson Jonas T. , Yu Victor L.
Published: February 2007

The prevention of wound infection after major contaminated head and neck surgery is a critical issue for the head and neck surgeon. The proper interpretation of cultures taken from wounds is uncertain. Multiple organisms are invariably isolated from this nonsterile site including indigenous aerobic and anaerobic flora, aerobic gram‐negative rods, and fungi. We present evidence from controlled antibiotic trials that demonstrate the pathogenicity of oropharyngeal anaerobic flora. The presence of aerobic gram‐negative rods and fungi generally represent colonization and antibiotic coverage need not routinely be directed at these organisms. On the other hand, the antibacterial spectrum of an agent used for head and neck would prophylaxis should include coverage for pathogenic oral flora, namely the gram‐positive aerobic cocci (especially streptococci) and anaerobic bacteria.
Modern management of cervical scrofula
Authors: Deitel Mervyn , Bendago Mansour , Krajden Sigmund , Ronald Alfred C. , Borowy Zenon J.
Published: February 2007

From 1970 to 1984, 32 patients were treated for tuberculous (TB) masses, which measured 1.2–5.5 cm. The posterior triangle was involved in 19 patients, anterior triangle in 7, and more than one triangle in 6 (3 bilateral). A superficial node was excised for diagnosis. Acid‐fast bacilli were identified on the smear of 18 patients. Caseation necrosis was present in 27 specimens, sarcoidosis in four, nonspecific lymphadenitis in one; all cultures grew Mycobacterium tuberculosis. A chest x‐ray showed no active TB. Chemotherapy was given for 9–18 months (9 months when only one node was diseased and 18 months with extensive nodal involvement). Follow‐up examinations in all patients (> 3 years, mean 8.6 years) has revealed no recurrence. The need to excise all cervical TB nodes, chronically inflamed and often fused to important structures, was eliminated by adequate chemotherapy.
Desmoplastic fibroma of the jaws: Surgical management and review of the literature
Authors: Kwon Paul Hak Joo , Horswell Bruce B. , Gatto Daniel J.
Published: February 2007

Desmoplastic fibroma of the jaws is a rare and locally aggressive tumor that has a high rate of recurrence. The cellularity, extent of the tumor, and completeness of the local excision may be factors in its tendency to recur. We reviewed the literature in an attempt to determine if there was any correlation between the histologic features of a desmoplastic fibroma, or the surgical procedure utilized, and the tumor's recurrence. From the information gathered, it was found that a more cellular desmoplastic fibroma or inadequate surgical procedure may be factors that contribute to the recurrence of the tumor. A case report of desmoplastic fibroma of the mandible in a 9‐year‐old child is presented. The tumor, which displayed areas of moderate cellularity, was resected via a partial hemimandibulectomy. There has been no recurrence to date (46 months).
Endolaryngeal synovial sarcoma: Case report with immunohistochemical studies
Authors: Pruszczynski Maciej , Manni Johannes J. , Smedts Frank
Published: February 2007

Endolaryngeal synovial sarcoma has only been reported in the literature three times. We add to this a fourth report of a 28‐year‐old woman. This case distinguishes itself by being a monophasic variant and by being the first to be substantiated with extensive immunohistochemical analysis. Treatment consisted of shelling‐out followed by radiotherapy, which is a variant from standard therapy. The patient is tumor‐free 3 years after therapy.
Frey's syndrome: Treatment with topical glycopyrrolate
Authors: May John S. , McGuirt W. Frederick
Published: February 2007

Gustatory sweating and flushing of the facial skin, or Frey's syn drome, is fairly common after parotidectomy. The most likely mechanism is aberrant reinnervation of the sweat glands of the face by the severed parotid parasympathetic nerve fibers. A sur vey of 61 patients having undergone parotidectomy yielded 29 (47.5%) with gustatory sweating. Twenty‐three percent (14 pa tients) considered the symptoms severe. In a double‐blind study, five of those 14 patients were alternately treated with top ically applied placebo and with glycopyrrolate (an anticholinergic agent) as 0.5% lotion, 2% lotion, and 2% cream. All five patients showed some improvement with the test preparations, but had longer lasting and more effective lessening of symptoms with the 2% glycopyrrolate preparations. There were no adverse side effects. We therefore believe that the topical application of a 2% glycopyrrolate preparation is a safe and effective treatment for severe gustatory sweating following parotidectomy.
Supraomohyoid neck dissection: Rationale, indications, and surgical technique
Authors: Medina Jesus E. , Byers Robert M.
Published: February 2007

The supraomohyoid neck dissection is a selective cervical node dissection that removes the contents of the submentai and submandibular triangles (lymph node level I), the jugulodigastric and jugulo‐omohyoid lymph node groups, and the lymph nodebearing tissues located anterior to the cutaneous branches of the cervical plexus and above the omohyoid muscle (lymph node levels II and III). The sternocleidomastoid muscle, the spinal accessory nerve, and the internal jugular vein are preserved. This type of neck dissection is indicated in the surgical management of the neck in patients with large T2, T3, and T4 squamous cell carcinomas of the oral cavity in whom the cervical lymph nodes are either clinically negative (NO) or single, discrete, and less than 3 cm in diameter (N1). In this paper, we discuss the rationale for this operation, its staging, and its therapeutic value, and present a detailed description of the surgical technique.
Radiotherapy after excisional biopsy of carcinoma of the oral tongue/floor of the mouth
Authors: Mendenhall William M. , Parsons James T. , Stringer Scott P. , Cassisi Nicholas J. , Million Rodney R.
Published: February 2007

This is an analysis of 16 patients with excisionally biopsied (TXNO) squamous cell carcinoma of the oral tongue (nine patients) and floor of mouth (seven patients) treated with radiotherapy. All patients had a minimum 2‐year follow‐up and 81% had at least 5 years of follow‐up. One patient died of intercurrent disease 16 months after treatment and was excluded from analysis of local control. All patients were evaluable for analysis of survival and complications. Local control was achieved in 14 of 15 patients; one patient with local recurrence underwent a surgical salvage procedure, which was unsuccessful. No patients developed recurrent disease in the neck or in distant sites. Five‐year absolute and cause‐specific survival rates were 10 of 13 and 10 of 11. respectively.
Primary branchiogenic carcinoma
Authors: Khafif Rene A. , Prichep Robert , Minkowitz Stanley
Published: February 2007

An extensive historical review of branchial cleft cyst carcinoma is undertaken and a critical analysis of all 67 cases reported in the English literature since Martin's landmark report is carried out and tabulated. Forty‐one of the 67 cases were definitely ruled out as carcinomas of branchial cysts. Though only eight of the remaining 26 cases satisfied Martin's criterion of 5‐year follow‐up without evidence of primary carcinoma elsewhere, 14 patients had incontrovertible evidence of branchiogenic carcinoma, evidenced by a branchial cyst with histologic evidence of epithelial dysplasia progressing to squamous cell carcinoma within the cyst wall. Two previously unreported cases are presented. A therapeutic approach including wide local excision, radical neck dissection, and radiotherapy is recommended. A more thorough search for an occult head and neck primary, and a clearer understanding of the histopathology of branchiogenic carcinoma, are suggested as alternate requirements for this diagnosis.
Plasma cell granuloma of the thyroid gland
Authors: Talmi Yoav P. , Finkelstein Yehuda , Gal Rivka , Zohar Yuval
Published: February 2007

Plasma cell granuloma is a tumor‐like lesion consisting of mature plasma cells, sometimes with Russell bodies and reticuloendothelial cells, supported by a stroma of granulation tissue. These tumors are most common in the lungs and were sporadically reported in extrapulmonary sites. A rare case of plasma cell granuloma of the thyroid is reported. The value of immunohistochemical staining is demonstrated.
Tracheotomy in children with recurrent respiratory papillomatosis
Authors: Cole Randolph R. , Myer Charles M. , Cotton Robin T.
Published: February 2007

Fifty‐eight patients with laryngeal papillomatosis were managed at Children's Hospital Medical Center, Cincinnati, OH, between January 1978 and December 1987. Twelve of these patients (21%) had tracheotomies. A retrospective review of these 12 cases was undertaken to determine the incidence, pattern, timing, and clinical risk factors for trachéal spread after tracheotomy. Six of 12 patients (50%) developed tracheal papillomas after tracheotomy. Peristomal mucosa was consistently the site of initial involvement followed by progressive distal spread along the length of the tracheotomy tube. Stomal involvement followed tracheotomy by an average of 14 weeks, occurring as early as 7 weeks postoperatively. Mid‐tracheal spread followed stomal involvement by an average of 10 weeks. Risk factors for tracheal spread included the presence of subglottic disease at the time of tracheotomy and prolonged cannulation. Whenever possible, tracheotomy should be avoided in patients with recurrent respiratory papillomatosis. When unavoidable, every effort should be made to keep the duration of cannulation as short as possible.
Trumpet maneuver for visual and ct examination of the pyriform sinus and retrocricoid area
Authors: Hillel Allen D. , Schwartz Alan N.
Published: February 2007

The trumpet maneuver, a technique to inflate the hypopharynx with air, allows visualization of the pyriform sinuses and retrocricoid area during both fiberoptic examination and CT scanning. The technique is useful in delineating both normal and abnormal anatomy, and is especially useful in the evaluation of patients with hypopharyngeal symptoms in whom there is a low suspicion of anatomic disease. The methods, endoscopic photographs, and CT scan images are presented.
DNA ploidy in oral cavity carcinomas, with special reference to prognosis
Authors: Tytor Maciej , Franzén Gunnar , Olofsson Jan
Published: February 2007

Single‐cell DNA cytofluorometry was performed on paraffin‐em bedded tissue of 140 patients with squamous cell carcinomas of the oral cavity. Half of the tumors (71 of 140) were DNA nondip loid. Well‐differentiated carcinomas were more often DNA dip loid than moderately well‐differentiated ones (P<0.001; chi square). The aneuploid tumors responded better to preoperative radiotherapy than did the DNA diploid (P<0.001) and polyploid tumors (P<0.05; chi‐square). Using the multivariate Cox's re gression analysis multiploid type tumor, age of the patients and presence of lymph node metastases were the only significant factors influencing survival. DNA diploid tumors in stages I and II had a better prognosis than DNA nondiploid (P<0.01; Kaplan‐Meier). The reverse was true for stages III and IV, where DNA nondiploid tumors had a better prognosis (P<0.05; Kaplan‐Meier). Tumor stages (P<0.001; Kaplan‐Meier) and especially lymph node metastases (P<0.0005; Kaplan‐Meier) were major prognostic factors. Tumor DNA ploidy may be a complement to clinical and morphologic parameters as a prognostic predictor in squamous cell carcinoma of the oral cavity.
Oral feeding after total laryngectomy
Authors: Boyce Stephen E. , Meyers Arlen D.
Published: February 2007

Pharyngocutaneous fistulae occur in 15%‐25% of patients after total laryngectomy. Factors that may predispose to fistulae formation include prior radiation, surgical technique, tumor size and location, and patient nutritional status. In addition, many surgeons believe that the timing of oral feeding after surgery contributes to fistula development. Thus, they advocate delaying feeding postoperatively, especially in high‐risk patients. The traditional guidline has been to wait until the seventh postoperative day. The purpose of this study was to examine the relationship between the timing of postoperative oral feeding and the development of pharyngocytaneous fistulae after total laryngectomy with primary closure in patients with squamous cell carcinoma. A questionnaire was sent to 210 members of the American Society for Head and neck Surgery to determine practice patterns toward feeding after laryngectomy. We also reviewed the records of 137 patients who underwent total laryngectomy at the University of Colorado Health Sciences Center and the Denver VA Medical Center from January 1975 through December 1987. Of the surgeons polled, 84.5% waited at least 7 days after surgery to begin oral feeding. However, in reviewing 94 patients eligible for study, we found no difference in the rate of fistula formation between patients fed on or before the fifth postoperative day and those fed on or after the sixth postoperative day. In fact, most fistulae were evident before the patient started oral feeding. Pyriform sinus tumors were predisposed to fistulae but prior radiotherapy and neck dissection seemed to have no effect. Earlier oral feeding after total laryngectomy may improve patient comfort and shorten hospital stay without increasing the incidence of complications. Patients with pyriform sinus tumors or complicated closures are more likely to develop fistulae and therefore may benefit from delayed oral feeding.
Electrosurgical dissection to reduce blood loss in head and neck surgery
Authors: Weber Randal S. , Byers Robert M. , Robbins K. Thomas , Lichtiger Benjamin , Guillamondegui Oscar M. , Ballantyne Alando J. , Campbell Bruce , Schantz Stimson , Hankins Patti , Pou Anna , Goepfert Helmuth
Published: February 2007

We prospectively determined the intraoperative blood loss in 250 patients who underwent major head and neck surgical procedures over a 13‐month period to demonstrate the efficacy of electrosurgical dissection for reducing blood loss and to determine those factors predictive of the need for blood replacement. Transfusions were required in 30 (12%) of the 250 patients, and a total of 66 units of packed red blood cells was administered. Two patients were transfused preoperatively, 16 patients intraoperatively, and 14 patients postoperatively. Factors predicting the necessity for blood replacement included the patient's preoperative hematocrit level, intraoperative blood loss, the duration and type of procedure, and the surgeon's level of experience. The principles of electrosurgical dissection are discussed.
Neck dissection after twice‐a‐day radiotherapy: Morbidity and recurrence rates
Authors: Parsons James T. , Mendenhall William M. , Cassisi Nicholas J. , Stringer Scott P. , Million Rodney R.
Published: February 2007

Between March 1978 and April 1986, 56 patients underwent planned unilateral, and five patients underwent planned bilateral, radical neck dissections following high‐dose twice‐a‐day radiotherapy, usually with 60Co. Neck dissections were generally performed 6 weeks after radiotherapy. The overall rate of control of disease in the neck in all 61 patients was 81% at 5 years. Patients who underwent neck dissections following radiotherapy had significantly higher rates of heck‐disease control than patients treated by radiotherapy alone during the same time period for stages N2A‐N3A and N2B‐N3B, but not for N1 disease. No carotid ruptures or fatal complications occurred. The rate of wound complications was judged to be acceptable.
Radiographic evaluation for nasal dysfunction: Computed tomography versus plain films
Authors: Davidson Terence M. , Brahme Folke J. , Gallagher Mitchell E.
Published: February 2007

Sixty‐two patients, presenting to the Nasal Dysfunction Clinic at the University of California, San Diego, were radiographically examined with plain sinus x‐rays and computed tomographic (CT) scans. The x‐rays were evaluated independently, and the reported findings were compared. In maxillary sinuses the CT and plain film observations corresponded poorly with a concordance of 77%. There was a tendency to overread the plain films. In the ethmoid sinuses the lack of concordance between CT scans and plain films was 76%, and a tendency to under‐read the plain films was noted. In the lower nasal compartment the correspondence between CT and plain film readings was 57%, with a notable tendency to overread the plain films. In the olfactory recess, the CT/plain film concordance was 66%. At our institution, a sinus CT series costs $400; a conventional sinus series costs $102. The CT radiation dose is 5.2 to 6.5 cGY compared with 1.4 cGY for plain films.

We conclude that plain films are unreliable and no longer routinely indicated for the evaluation of nasal and paranasal sinus disease. When radiographic evaluation is indicated a limited CT series provides superior information. Exceptions may include children and some cases of sinus disease isolated to a single sinus.
Circulating immune complexes and chemotherapy response in patients with head and neck cancer
Authors: Blazar Beverly A. , Fried Marvin P. , Strome Marshall , Clark John R. , Sereno Patricia , Rodliff Susan , Caminear David
Published: February 2007

An assay which could prospectively predict a response to chemotherapy prior to instituting therapy would be beneficial, especially for nonresponders. We evaluated at random a total of 50 patients with previously untreated stage III and IV head and neck squamous cell carcinoma for T‐cell subsets and levels of circulating immune complexes (CIC). Of this group 23 patients had induction chemotherapy as their first modality of treatment. These patients received standard protocols of therapy consisting of cisplatin, 5‐fluorouracil, methotrexate, and bleomycin. Of the laboratory measures assessed, only CIC correlated with clinical response to chemotherapy [no response (NR), partial response (PR), complete response (CR)] at the completion of the induction period (two to four cycles). Levels of CIC were determined by a polyethylene glycol (PEG) precipitation assay, and measured by spectrophotometry at 280 nm. In our population of all head and neck cancer patients, CIC were elevated (mean ∓ SD values: 0.475 ∓ 3.8 compared with controls: 0.184 ∓ 0.07). In the NR group, the mean ∓ SD was 0.707 ∓ 0.43 (P = 0.001). Complete responders had a mean value of 0.332 ∓ 0.21; partial responders had a mean value of 0.255 ∓ 0.13. On the basis of the values determined, patients with markedly elevated levels of CIC would be predicted to respond poorly, or not all, to current induction chemotherapy protocols.
Pectoralis myocutaneous flap for replacement of cervical esophagus
Authors: Cusumano Robert J. , Silver Carl E. , Brauer Richard J. , Strauch Berish
Published: February 2007

The authors report experience with 10 cases of pharyngoesophageal replacement with tubed pectoralis major myocutaneous (PM) flap. Six patients had primary reconstruction following total pharyngolaryngectomy for cancer; the other 4 had severe pharyngoesophageal stenosis requiring resection and replacement following previous laryngectomy. Seven of the patients were octogenarians, 6 had been irradiated previously, and all were severely debilitated. Two patients died postoperatively of cardiac disease. The remaining eight regained satisfactory with lasting deglutition. Four fistulae healed spontaneously, and one postoperative stenosis responded to a single dilitation. The interval to swallowing was 10‐21 days in nonirradiated patients and 3‐13 weeks in irradiated patients. There was one local recurrence 6 months after resection; the other patients remained free of disease. The authors conclude that the tubed PM flap is a reliable technique for pharyngoesophageal reconstruction that is particularly useful in elderly and debilitated patients.
Paraganglioma of the thyroid
Authors: DeVries Egbert J. , Watson Charles G.
Published: February 2007

We present a case of paraganglioma of the thyroid. The preoperative evaluation, surgical management, and histopathology are described. Four similar cases that have been reported are summarized, and a hypothesis for the origin of a paraganglioma within the thyroid capsule is proposed.
Evaluation and treatment of acute laryngeal fractures
Authors: Schild Joyce A. , Denneny Elise Cheng
Published: February 2007

Treatment of laryngeal fractures continues to evolve, and the airway now can be restored without stenosis or aspiration in most cases. However, the best treatment of vocal cord dysfunction from trauma remains uncertain, and the value of computerized tomographic scan (CT) is controversial. In this report, we describe the symptoms, radiologic findings, and treatment of 15 consecutive cases of laryngeal trauma. The value of CT for assessing the cricoarytenoid area is discussed. We also found CT to be reliable for defining the extent of soft tissue trauma and for diagnosing the presence and displacement of any fractures. Endoscopic photographs are compared with CT scan photographs to illustrate the correlation of CT with the degree of trauma. Finally, we present a method of laryngeal fracture repair using autologous thyroid cartilage.
Intraoral adenoid cystic carcinoma: The role of postoperative radiotherapy in local control
Authors: Van Waal Jacqueline E. Der , Snow Gordon B. , Karim Abul B. M. F. , Waal Isaac Van Der
Published: February 2007

Fourteen cases of adenoid cystic carcinoma (ACC) of the intraoral salivary glands with positive surgical margins have been reviewed in order to determine the role of postoperative radiotherapy in local control. Since local control was obtained in all patients, postoperative radiotherapy seems an adequate treatment to deal with the problem of positive surgical margins at the microscopic level, in cases of intraoral ACC, making additional surgical treatment redundant.
Gorham's disease affecting the maxillofacial skeleton
Authors: Anavi Yakir , Sabes William R. , Mintz Sheldon
Published: February 2007

Twenty‐one cases of Gorham's disease in the maxillofacial region are described in the literature. This case is an additional one. The disease has a slight male predominance. All cases involved either the mandible alone or in association with the maxilla or other bones of the head and neck. The most common symptoms were pain, tooth mobility, mandibular pathological fractures, and facial deformity. The mean duration of symptoms prior to diagnosis was 6.4 years. Treatment included surgery, radiotherapy, and various medications, alone or combined. Four patients died of their disease. The diagnosis of the initial biopsy was incorrect in 45% of these cases. The current case appears to be the only one successfully treated by excision and autogenous bone graft reconstruction. In order to make an accurate diagnosis, the histologic featuares should be correlated with the clinical features.
Microvascular flaps in head and neck reconstruction
Authors: Morais‐Besteiro Júlio , Cernea Claudio R. , Medina Santos Luiz R. Dos , Brandão Lenine G. , Ferreira Marcus C. , Ferraz Alberto R.
Published: February 2007

Twenty‐six patients with head and neck tumors were submitted to 27 microvascular reconstructive procedures. In 15, the mandible was reconstructed using the rib (4), iliac crest (7), and scapula (4). Nine patients underwent craniofacial reconstructions with the latissimus dorsi (5), rectus abdominis (2), greater omentum (2), and scapular (1) flaps. Two patients received a jejunum (1) and a stomach plus greater omentum (1) flaps for pharyngoesophageal reconstruction. Three illustrative cases, one from each group, are presented in detail. Good results were obtained in 22 patients (85%), with both functional and morphological rehabilitation. There were five flap losses (two in the same patient) due to thrombosis of the microvascular anastomoses. There was no operative mortality, and the average operative time was 11 hours. The good results observed in these very advanced cases show that there is a place for these complex procedures in the treatment of selected cases of head and neck tumors.
Serum tumor markers of head and neck cancer: Current status
Authors: Hanna Y. N. , Papay Francis A. , Gupta Manjula K. , Lavertu Pierre , Tucker Harvey M.
Published: February 2007

The serum level of a variety of substances shows significant changes in head and neck cancer patients. Such substances are collectively called biochemical tumor markers. To date, most markers lack a high degree of specificity and sensitivity. However, serial measurement of markers showing elevated pretreatment levels may help in monitoring response to therapy. Other potential uses of tumor markers include earlier detection of recurrence and/or metastasis, and possible prediction of prognosis. Measurement of more than one marker seems to enhance the diagnostic accuracy of the test. Some markers show significant correlations with various immune parameters in head and neck cancer patients and may have a possible role in potentiating the immunodepressed status of such patients. A review of currently reported tumor markers in head and neck cancer showing their nature, sources, uses, and limitations is presented.
Hemangiopericytoma of the maxillary sinus and skull base
Authors: Abdel‐Fattah Hesham M. , Adams George L. , Wick Mark R.
Published: February 2007

Since 1949, only 52 cases of hemangiopericytoma (HPC) of the nos eand paranasal sinuses have been reported in the literature. Of the latter, only 2 originated from the maxillary sinus. This article reports 2 new cases. One arose in the maxillary sinus and involved the pterygopalatine fossa, skull base, and infratemporal fossa. The second tumor was located in the sphenoethmoidal recess. A new combination of techniques for resection of hemangiopericytoma of the skull base is described. Prognostic criteria for such tumors are reviewed, in conjunction with histological diagnosis.
Parapharyngeal fibrolipoma
Authors: Kennedy Kevin S. , Wotowic Paul J. , St. John James N.
Published: February 2007

Although approximately 13% of lipomatous tumors occur in the head and neck, most of these are found in the immediate subcutaneous tissues, and lipomas of the deep head and neck tissues are rare. Lipomas consist of adipose tissue separated by fine fibrous trabeculae; if the amount of fibrous tissue is appreciable, the designation of fibrolipoma is used. We describe an unusual case of a parapharyngeal fibrolipoma with airway narrowing and ipsilateral compromise of the carotid artery and internal jugular vein blood flow. Diagnosis of deep head and neck lipomata is facilitated by utilizing computed tomographic analysis and angiography. The transcervical approach to the skull base which allows complete resection of this lesion is described.
Immunohistologic study of mononuclear cell infiltrates in oral squamous cell carcinomas
Authors: Hirota Jyusui , Ueta Eisaku , Osaki Tokio , Ogawa Yasuhiro
Published: February 2007

Intensity of mononuclear cell infiltrates in 50 oral cancer tissues was evaluated by immunohistochemical stainings. The intensity of the infiltrates was graded into four degrees from marked (+ + +) to absent (‐); and the degree of each infiltrated lymphocyte subpopulation including Leu‐3a3b/Leu‐2a ratio was matched against clinical and histopathologic features. The vast majority of the infiltrated lymphocytes had antigens which were reactive with anti‐T cell antibodies. In T cell subsets, Leu‐3a3b+ cells infiltrated clearly (grade ++ or +++) in 44 cases, and infiltration greater than grade + + of Leu‐2a+ cells was found in nearly half of the cases (26 of 50). In contrast, B cells (Leu‐14+ cells) were obviously detectable in only a few cases, and moderate or marked infiltration of the natural killer (NK) population (Leu‐11b+ cells) was not observed. Regarding correlation of T cell infiltrates with clinicopathologic features of the tumors, the degrees of Leu‐4+ cell and Leu‐2a+ cell infiltration became weak with advancing T stage. Leu‐2a+ cells also infiltrated weakly into diffusely invading tumors. Out of 28 cases with no metastasis, 22 cases (78.6%) showed grade ++ ∼ + + + of Leu‐2a+ cells, and only 4 (18.2%) of 22 cases with lymph node metastasis were clearly positive for Leu‐2a+ cells (p < 0.001). However, Leu‐3a3b+ cell infiltration was only slightly related to T stage, metastasis, and to mode of invasion. Therefore, the Leu‐3a3b/Leu‐2a ratio increased significantly in advanced (T3 + T4) tumors, metastasized cases, or diffuse invasion type.
Home enteral nutrition via gastrostomy in advanced head and neck cancer patients
Authors: Campos Antonio Carlos L. , Butters Michael , Meguid Michael M.
Published: February 2007

We investigated whether home enteral feeding via a tube gastrostomy would enable patients with advanced malignant disease, who were unable to maintain themselves nutritionally via the oral route, to be independent of the hospital setting. Thirty‐nine patients with advanced upper gastrointestinal and head and neck cancer had a tube gastrostomy placed. Before discharge, the patient was trained in the care and use of the gastrostomy feeding tube. Ten patients died of their disease before they could be discharged. During the 6‐month period before gastrostomy insertion, the mean weight loss of the remaining 29 patients was 12.8%, and the mean body weight was less than 90% of ideal body weight. Prior to operation, the mean serum albumin and total lymphocyte count were 3.7 g/L and 1,087/mL, respectively. At discharge the mean caloric intake was 1.48 times resting energy expenditure. Home enteral nutrition was provided for a median of 94 days and resulted in stabilization of nutritional indices. During their median survival of 176 days, the 29 patients were admitted a total of 52 times. Twenty‐eight percent of the patients were never re‐admitted after gastrostomy and were adequately maintained at home, whereas 24% needed to be re‐admitted once. Only 48% were re‐admitted twice to assist in their nutritional management. Twenty patients received temporary home nursing services to aid in their transition. Four patients eventually resumed oral intake, and their feeding gastrostomies were removed. Home enteral nutritional support via gastrostomy enabled patients with advanced cancer to maintain their nutritional status and be independent from the hospital setting for extended periods, with the improved comfort and quality of their limited life at home in familiar surroundings in face of malignant disease.
Risk of wound infection in patients with head and neck cancer
Authors: Robbins K. Thomas , Favrot Stephen , Hanna Dinah , Cole Randolph
Published: February 2007

The purpose of this analysis was to determine the most important factors contributing to operative wound infections for patients with head and neck cancer. Four hundred cases were studied prospectively at M. D. Anderson Cancer Center within an 18‐month interval. Potential risk factors were categorized based on the patient, the disease, and the treatment. Sixty‐three (19.75%) wound infections were recorded. Univariate analysis identified the following factors to significantly alter the incidence of the infection: nutritional status and alcohol consumption (patient factors); T stage and N stage (disease factors); and duration of surgery, type of surgical wound, complexity of the procedure, use of flaps, blood replacement and the use of drains, nasogastric tubes, and tracheostomies (treatment factors). A logistic regression analysis identified the type of surgery, the choice of antibiotic, the presence of concomitant disease, and the N stage to represent the combination of factors most predictive of infection. The initial step toward preventing surgical wound infection is to identify the high‐risk factors. The results of this study help to define these parameters so that specific measures can be taken to counteract wound infection.