bluuebunny/crossref_metadata_2025_split huggingface dataset:
How reliably can computed tomography predict thyroid invasion prior to laryngectomy?
Authors: Harris Andrew S. , Passant Carl D. , Ingrams Duncan R. 
Published: October 2017

Objectives/HypothesisThere is little evidence to support the removal of thyroid tissue during total laryngectomy. Although oncological control of the tumor is the priority, thyroidectomy can lead to hypothyroidism and hypoparathyroidism. This study aimed to test the usefulness of preoperative computed tomography in predicting histological invasion of the thyroid.Study DesignAmbispective cohort study.MethodsAll patients undergoing total laryngectomy for squamous cell carcinoma at one center from 2006 to 2016 were included. Data were recorded prospectively as part of the patients' standard care, but were collated retrospectively, giving this study an ambispective design. The histology report for thyroid invasion was taken as the gold standard. The computed tomography report was categorized by invasion of tumor into intralaryngeal, laryngeal cartilage involvement, and extralaryngeal tissues.ResultsSeventy‐nine patients were included. Nine patients had thyroid involvement on histology, translating to an incidence of 11.29% in this population. The positive predictive value for cartilage involvement on computed tomography for thyroid invasion was 52.9% (95% confidence interval [CI]: 28.5%‐76.1%) and the negative predictive value was 100% (95% CI: 92.7%‐100%).The positive predictive value for extralaryngeal spread on computed tomography for thyroid involvement was 100% (95% CI: 62.9%‐100%), and the negative predictive value was also 100% (95% CI: 93.5%‐100%).ConclusionsThis study has shown that preoperative computed tomography is an effective method of ruling out thyroid gland invasion. The absence of extralaryngeal spread on computed tomography has been shown to be the most useful finding, with a high negative predictive value and a narrow 95% CI.Level of Evidence4. Laryngoscope, 128:1099–1102, 2018
Safety of outpatient thyroidectomy: Review of the American College of Surgeons National Surgical Quality Improvement Program
Authors: McLaughlin Eamon J. , Brant Jason A. , Bur Andres M. , Fischer John P. , Chen Jinbo , Cannady Steven B. , Chalian Ara A. , Newman Jason G. 
Published: October 2017

Objectives/HypothesisTo investigate national trends in admission status after thyroidectomy in the United States and to evaluate the factors associated with 30‐day unplanned readmission and reoperation.Study DesignRetrospective review of American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP)MethodsThe ACS‐NSQIP database was queried for patients who underwent a partial or total thyroidectomy between 2005 and 2014. Outpatient surgery was defined as discharge on the day of surgery. Patient demographic information, unplanned hospital readmission, and reoperation were reviewed. Risk factors were identified using logistic regression modeling.ResultsA total of 76,604 cases met inclusion criteria as described above. There were 1,473 (1.9%) patients who underwent reoperation and 477 unplanned 30‐day readmissions (1.4%) for procedures performed since 2012. There was a significant positive trend in the percentage of thyroidectomy (partial and total) patients who underwent outpatient procedures by year of operation (P < .001). Outpatient procedures were not more likely to have unplanned readmissions or reoperations. Independent patient risk factors for unplanned readmission and reoperation included current dialysis, chronic steroid use, unintentional weight loss, American Society of Anesthesiologists class 3 to 4, and active bleeding disorders.ConclusionsOver the past decade there has been a clear trend toward increasing outpatient thyroid surgery. Thyroidectomy performed as an outpatient was not found to be an independent risk factor for readmission or reoperation. Patients with serious medical comorbidities and active bleeding disorders are at increased risk of unplanned readmission or reoperation and should have their surgery performed on an inpatient basis.Level of Evidence2c. Laryngoscope, 128:1249–1254, 2018
Risk factors for salvage surgery failure in oral cavity squamous cell carcinoma
Authors: Matsuura Danielli , Valim Tiago Dias , Kulcsar Marco Aurélio Vamondes , Pinto Fábio Roberto , Brandão Lenine Garcia , Cernea Claudio Roberto , Matos Leandro Luongo 
Published: October 2017

Objectives/HypothesisLocoregional recurrences of oral cavity squamous cell carcinoma (SCC) may be diagnosed during follow‐up of surgically treated patients. Nevertheless, few studies have investigated factors that impact salvage surgery failure and the mortality rates of these patients. The objectives were to identify predictive factors of salvage surgery failure and mortality in patients who undergo surgical treatment for recurrent oral cavity SCC and to compare the overall survival rates of these patients with those of patients who undergo only one surgical treatment.Study DesignRetrospective cohort study.MethodsForty‐six patients submitted to salvage surgery for local or locoregional recurrence.ResultsThe presence of lymph node metastasis and positive surgical margins at the salvage surgery time were the only independent factors associated with both recurrence rates (hazard ratio [HR]: 5.04 and 2.82, respectively) and mortality (HR: 3.51 and 3.24, respectively). When the overall survival rates of the 199 patients who only underwent one surgical treatment were compared to those of the 46 patients subjected to salvage surgery, a similarity was evident when patients who underwent salvage surgery did not have a new disease recurrence (70.7% vs. 54.7%, respectively; P = .158). Likewise, patients with new recurrences after salvage surgery and patients who received palliative treatment for relapsed disease had similar overall survival rates (0.6% vs. 0.0%, respectively; P = .475).ConclusionsThe presence of lymph node metastasis at the time of recurrence and positive surgical margins after the salvage surgery were associated with a worse overall survival rate in patients with oral cavity SCC relapse.Level of Evidence2b. Laryngoscope, 128:1113–1119, 2018
Maternal and obstetrical outcome in 35 cases of well‐differentiated thyroid carcinoma during pregnancy
Authors: Boucek Jan , de Haan Jorine , Halaska Michael J. , Plzak Jan , Van Calsteren Kristel , de Groot Christianne J. M. , Dahl Steffensen Karina , Fruscio Robert , Massolt Elske T. , Klaritsch Philipp , Zola Paolo , Amant Frédéric ,   on behalf of the International Network on Cancer, Infertility, and Pregnancy
Published: October 2017

Objectives/HypothesisThyroid cancer, with 6% to 10% of cancer diagnoses, is one of the most common malignancies during pregnancy. Its treatment poses a risk for the pregnancy, as the thyroid gland plays a crucial role in the evolution of pregnancy. The aim of this study is to evaluate treatment of primary well‐differentiated thyroid carcinoma during pregnancy and fetal and maternal outcomes.Study DesignThis is an international cohort study.MethodsPrimary thyroid cancer patients were identified from the database of the International Network on Cancer, Infertility, and Pregnancy registration study. Data on histopathological characteristics, diagnostic and therapeutic interventions, outcome (obstetrical, neonatal, and maternal) and maternal follow‐up were analyzed.ResultsThirty‐five patients with well‐differentiated thyroid carcinoma were eligible. All 35 patients underwent surgery, 29 (83%) of which during pregnancy. Procedures during pregnancy were mainly total thyroidectomies (n = 24). The median number of days between diagnosis and surgical treatment was different between the groups with surgery during and after pregnancy (27 vs. 139 days, P < .001). Both maternal and neonatal outcomes were uncomplicated, regardless of gestational age during surgery.ConclusionsWell‐differentiated thyroid carcinoma diagnosed during pregnancy has a favorable outcome for both mother and child. Surgical management during pregnancy has no negative impact on the pregnancy regardless of the trimester at the time of surgery. However, the potential negative effects of thyroid surgery early in pregnancy demand management of these patients in an experienced multidisciplinary team to provide the best possible care for these patients and their unborn babies.Level of Evidence4. Laryngoscope, 128:1493–1500, 2018
Evidence against the mucosal traction theory in cholesteatoma
Authors: Pauna Henrique F. , Monsanto Rafael C. , Schachern Patricia , Paparella Michael M. , Chole Richard A. , Cureoglu Sebahattin 
Published: October 2017

ObjectivesTo investigate the distribution of ciliated epithelium in the human middle ear and its potential role in the formation of cholesteatoma.Study DesignComparative human temporal bone study.MethodsWe selected temporal bones from 14 donors with a diagnosis of cholesteatoma, 15 with chronic otitis media without retraction pockets, 14 with chronic otitis media with retraction pockets, 14 with cystic fibrosis (CF), and 16 controls. We mapped the distribution of the ciliated cells in the mucosal lining of the middle ear and tympanic membrane using three‐dimensional reconstruction analysis, and counted the number of ciliated cells in the middle ear mucosa.ResultsCiliated cells are extremely sparse in the epithelial lining of the lateral surface of the ossicles in the epitympanum and the medial surface of the tympanic membrane. Furthermore, there is a significant decrease in the number of ciliated cells in these areas in temporal bones with cholesteatoma, chronic otitis media, chronic otitis media with retraction pockets, and CF compared to controls. Ciliated cells most commonly are located at the hypotympanum and the Eustachian tube opening but not the tympanic membrane or epitympanum.ConclusionThe paucity of ciliated epithelial cells on the medial side of the tympanic membrane and the lateral surface of the ossicles in the epitympanum in cases with cholesteatoma and/or chronic otitis media do not support the mucosal migration theory of cholesteatoma formation.Level of EvidenceNA. Laryngoscope, 128:1663–1667, 2018
Evolving trends in sinus surgery: What is the impact of balloon sinus dilation?
Authors: Svider Peter F. , Darlin Spencer , Bobian Michael , Sekhsaria Vibhav , Harvey Richard J. , Gray Stacey T. , Baredes Soly , Folbe Adam J. , Eloy Jean Anderson 
Published: October 2017

Objectives/HypothesisBalloon dilation (BD) represents a minimally invasive alternative to endoscopic sinus surgery (ESS). Although BD was introduced in 2006, distinct Current Procedural Terminology (CPT) codes were not available until 2011, making prior analysis of population‐based trends difficult. Our objectives were to evaluate these trends and compare any changes to the use of traditional ESS techniques. Geographic trends also were evaluated.MethodsMedicare Part B national datasets encompassing procedures from 2011 to 2015 were obtained. ESS CPT codes (frontal sinusotomy, maxillary antrostomy with/without tissue removal, sphenoidotomy) and BD codes were searched to determine temporal trends in their use. Additionally, state carriers were individually evaluated for geographic trends.ResultsNational use of BD increased greater than five‐fold (39,193 from 7,496 among Medicare patients), whereas the use of ESS increased by only 5.9%. This increase in BD was observed across all sites, including the sphenoid (7.0x), maxillary (5.1x), and frontal (4.7x) sinuses. In the most recent year for which data was available (2015), a significantly greater portion of sinus procedures in these sites utilized BD in the South (42.1%) compared to the Northeast (30.6%), West (29.5%), and Midwest (25.3%) regions (P < 0.0001).ConclusionThe performance of BD has increased markedly in recent years. Because the use of ESS codes remain stable, observed BD trends are unlikely to be due simply to greater familiarity with newer CPT coding. The reasons for the striking increase in BD popularity are speculative and beyond the scope of this analysis, but further study may be needed.Level of EvidenceNA. Laryngoscope, 128:1299–1303, 2018
Online and call center referral for endocrine surgical pathology within institutions
Authors: Dhillon Vaninder K. , Al Khadem Mai G. , Tufano Ralph P. , Russell Jonathon O. 
Published: October 2017

Objectives/HypothesisWe hypothesized that self‐referred patients to academic centers will be equally distributed between general surgery and otolaryngology departments that perform thyroid surgery. We sought to quantify disparities in the assignment of these self‐referred patients who may reach an institution through call centers or online pathways.Study designCross‐sectional survey.MethodsKey words “thyroid surgery” and “thyroid cancer” were used along with the name of the Accreditation Council for Graduate Medical Education–listed otolaryngology program in both Google and Bing search engines. The top three search results for departments were reviewed, and a tally was given to general surgery (GS), otolaryngology–head and neck surgery (OLHNS), or neither. A multidisciplinary center with both GS and OLHNS was recorded as “equitable.” Telephone calls were tallied if they were directed to GS or OLHNS.ResultsOut of 400 program tallies, 117 (29.25%) patients were directed to GS and 50 (12.5%) were directed to OLHNS. An additional 181 (45.25%) were directed to neither group (“neither”) (P < .05). Fifty‐two (13%) of the patients were referred to multidisciplinary groups (“equitable”). A telephone call survey had 62 patients (62%) assigned to a general surgeon, as opposed to 38 (38%) for OLHNS (P < .05). Five institutions offered a multidisciplinary group when searching with Bing, and 11 were found by searching with Google.ConclusionsThere is not an equal distribution of self‐referred patients with thyroid surgical pathology. It may be important to increase the online presence of OLHNS surgeons who perform thyroid surgery at academic medical institutions. Multidisciplinary centers focused on thyroid and parathyroid surgical disease represents one model of assigning self‐referred patients.Level of EvidenceNA Laryngoscope, 1977–1981, 2018
Toolbox of assessment tools of technical skills in otolaryngology–head and neck surgery: A systematic review
Authors: Labbé Mathilde , Young Meredith , Nguyen Lily H. P. 
Published: October 2017

ObjectiveTo support the development of programs of assessment of technical skills in the operating room (OR), we systematically reviewed the literature to identify assessment tools specific to otolaryngology–head and neck surgery (OTL‐HNS) core procedures and summarized their characteristics.MethodsWe systematically searched Embase, MEDLINE, PubMed, and Cochrane to identify and report on assessment tools that can be used to assess residents' technical surgical skills in the operating room for OTL‐HNS core procedures.ResultsOf the 736 unique titles retrieved, 16 articles met inclusion criteria, covering 11 different procedures (in otology, rhinology, laryngology, head and neck, and general otolaryngology). The tools were composed of a task‐specific checklist and/or global rating scale and were developed in the OR, on human cadavers, or in a simulation setting.ConclusionsOur study reports on published tools for assessing technical skills for OTL‐HNS residents during core procedures conducted in the OR. These assessment tools could facilitate the provision of timely feedback to trainees including specific goals for improvement. However, the paucity of publications suggests little agreement on how to best perform work‐based direct‐observation assessment for core surgical procedures in OTL‐HNS. The sparsity of tools specific to OTL‐HNS may become a barrier to a fluid transition to competency‐based medical education. Laryngoscope, 128:1571–1575, 2018
Outcomes and reliability of the flow coupler in postoperative monitoring of head and neck free flaps
Authors: Fujiwara Rance J. T. , Dibble Jacqueline M. , Larson Scott V. , Pierce Matthew L. , Mehra Saral 
Published: October 2017

Objectives/HypothesisTo assess the accuracy and reliability of the flow coupler relative to the implantable arterial Doppler probe in postoperative monitoring of head and neck free flaps.Study DesignRetrospective single‐institution study, April 2015 to March 2017.MethodsBoth the venous flow coupler and arterial Doppler were employed in 120 consecutive head and neck free flap cases. When Doppler signal loss occurred, flaps were evaluated by physical exam to determine whether signal loss was a true positive necessitating operating room takeback. Sensitivity, specificity, and false positive rate (FPR) were recorded for each device. Logistic regression was conducted to identify user trends over time.ResultsEleven of 120 patients (9.2%) required takeback, 10 from venous thrombosis and one from arterial thrombosis. Permanent signal loss (PSL) occurred in the flow coupler in all takebacks; PSL occurred in the arterial Doppler only in the case of arterial thrombosis. Salvage rate was 9/11 (81.8%). For the flow coupler, sensitivity was 100%, specificity 86.4%, and FPR 13.6%. For the arterial probe, sensitivity was 9.1%, specificity 97.1%, and FPR 2.9%. A 4.1% decrease in false positives with each additional flow coupler use was observed.ConclusionsMonitoring the vein via flow coupler has high sensitivity in identifying vascular compromise compared to the arterial probe, especially for venous thrombosis. There is moderate FPR; this decreases with increased usage and, when supplemented with physical examination, does not result in unnecessary takebacks. The flow coupler can be a valuable tool in postoperative monitoring of head and neck free flaps.Level of Evidence4. Laryngoscope, 128:812–817, 2018
Clinical utility of 18F‐fluorodeoxyglucose/positron emission tomography in diagnosis of immunoglobulin G4–related sclerosing sialadenitis
Authors: Takano Kenichi , Yajima Ryoto , Kamekura Ryuta , Yamamoto Motohisa , Takahashi Hiroki , Yama Naoya , Hatakenaka Masamitsu , Himi Tetsuo 
Published: October 2017

Objectives/HypothesisThe aim of this study was to evaluate the utility of 18F‐fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for accurately diagnosing immunoglobulin G4‐related sclerosing sialadenitis (IgG4‐SS).Study DesignRetrospective cohort study.MethodsWe reviewed the records of 64 patients with IgG4‐SS (35 male and 29 female patients) and 10 patients with clinically suspected IgG4‐SS. Pathological diagnoses of patients clinically suspected with IgG4‐SS included four cases of malignant lymphoma, one case of multicentric Castleman disease, one case of Sjögren's syndrome, and four cases of sialadenitis. All patients underwent submandibular gland (SMG) biopsies and baseline FDG‐PET/CT evaluation. Clinical, serological, pathological, and PET/CT findings were analyzed. We also investigated maximum standardized uptake values (SUVmax) in the salivary glands of 15 patients with malignant disease of the salivary glands during the same period.ResultsIncreased FDG uptake in the SMG and parotid gland was found in 63 (98%) and 23 (35%) patients with IgG4‐SS, respectively. FDG uptake of the bilateral SMG and unilateral SMG was recorded in 57 patients (89%) and six patients (9%), respectively. Mean SUVmax in patients with malignant disease of the salivary glands was significantly higher than that in patients with IgG4‐SS (P = .035). We defined a positive test for IgG4‐SS diagnosis as high SMG FDG uptake and serum IgG4 level ≥135 mg/dL, resulting in a sensitivity, specificity, and accuracy of 96.9%, 90.0%, and 86.4%, respectively.ConclusionsFDG‐PET/CT findings in combination with serological and clinical findings may have the capacity to diagnose IgG4‐SS and lead to less‐invasive biopsy procedures.Level of Evidence4. Laryngoscope, 128:1120–1125, 2018
Hydroxyurea therapy in UK children with sickle cell anaemia: A single‐centre experience
Authors: Phillips Kate , Healy Laura , Smith Louise , Keenan Russell 
Published: October 2017

AbstractIntroductionDespite the demonstrated efficacy of hydroxyurea therapy, children with sickle cell anaemia in the UK are preferentially managed with supportive care or transfusion. Hydroxyurea is reserved for children with severe disease phenotype. This is in contrast to North America and other countries where hydroxyurea is widely used for children of all clinical phenotypes. The conservative UK practice may in part be due to concerns about toxicity, in particular marrow suppression with high doses, and growth in children.Methods and resultsWe monitored 37 paediatric patients with sickle cell anaemia who were treated with hydroxyurea at a single UK treatment centre. Therapy was well tolerated and mild transient cytopenias were the only toxicity observed. Comparative analysis of patients receiving ≥26 mg/kg/day versus <26 mg/kg/day demonstrates increasing dose has a significant positive effect on foetal haemoglobin (Hb; 29.2% vs. 20.4%, P = 0.0151), mean cell volume (94.4 vs. 86.5, P = 0.0183) and reticulocyte count (99.66 × 109/l vs. 164.3 × 109/l, P = 0.0059). Marrow suppression was not a clinical problem with high‐dose treatment, Hb 92.25 g/l versus 91.81 g/l (ns), neutrophil count 3.3 × 109/l versus 4.8 × 109/l (ns) and platelet count 232.4 × 109/l versus 302.2 × 109/l (ns). Normal growth rates were maintained in all children. Good adherence to therapy was a significant factor in reducing hospitalisations.ConclusionThis study demonstrates the effectiveness and safety in practice of high‐dose hydroxyurea as a disease‐modifying therapy, which we advocate for all children with sickle cell anaemia.
Inconsistency in classifying vascular anomalies: What's in a name?
Authors: Pahl Kristy S. , Kim Kyung , Sams Casey , Alvarez Hortensia , Smith Scott V. , Blatt Julie 
Published: October 2017

AbstractBackgroundVascular anomalies are a heterogeneous group of disorders seen in children and adults. A standard nomenclature for classification has been offered by the International Society for the Study of Vascular Anomalies. Its application is important for communication among the multiple specialties involved in the care of patients and for planning treatment, as well as for research and billing. We hypothesized that terminology still is not uniformly applied, and that this could have an impact on treatment.MethodsWe retrospectively reviewed the medical records of patients with nonbrain lesions from our institutional vascular anomalies database seen during 2010–2016 for whom at least one clinic visit, radiologic imaging report, and pathology report were available to compare diagnoses among and within disciplines, and treatment recommendations. Diagnoses and referral patterns by community healthcare providers were also reviewed.ResultsOf 400 patients seen during the targeted time interval, 35 had clinical, imaging, and pathology reports. Agreement in terminology from initial clinic notes with imaging and pathology reports was noted in only three cases (9%). “Hemangioma” was often misused; “lymphangioma” and “cystic hygroma” persist as diagnostic labels. Community healthcare providers referred vascular malformations with a diagnosis of “mass” or “hemangioma” in 17 of 18 cases where that information was available. Incomplete or mislabeling of vascular anomalies sometimes delayed referrals to appropriate clinics, though it did not have a major impact on treatment.ConclusionsAn understanding of vascular anomalies as tumors or malformations is not uniform. Ongoing education will be needed to promote consensus terminology and facilitate referrals.