bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Variation in Tonsillectomy and Adenoidectomy Procedures
Authors: Sethi Rosh , Leslie Jessica , Bannos Cassandra , Roberson David W. , Lee Gi Soo 
Published: August 2013

Objectives:Identify potential sources of variation in tonsillectomy/ tonsillotomy and adenoidectomy procedures that may impact operating room (OR) efficiency and cost. Background: Surgeons display substantial variability in use of equipment and technique for same procedure. Examination of process variability may lead to valuable insights about potential improvements in efficiency and cost.Methods:Observational quality improvement initiative conducted at an academic inpatient children's hospital and a satellite site in 2012. One author (RS) observed 65 procedures consisting of tonsillectomy/tonsillotomy with or without adenoidectomy; an additional 50 cases were included by review of patient records. Over 100 variables were measured for each case, including patient demographics, indication, and technique used. Univariate and multivariate analysis was used to determine predictors of OR times and total charges.Results:Multivariate analysis showed: Significantly lower charges at satellite location compared to main campus (34.1% reduction, P < 0.0001). Longer total OR time is associated with higher total charges. Anesthesia time did not vary between the two sites. Individual surgeons’ operating time varies up to two‐fold. Factors with a statistically significant association with shorter total OR time are location (satellite vs. main campus, P = 0.0233), deep vs. awake extubation (P < 0.0001), and identity of surgeon (P = 0.0016).Conclusions:Results of this study suggest substantial opportunities for increased efficiency by identification of those process steps associated with shorter OR time and lower total charges, including satellite location, deep extubation, and possibly by using the more efficient surgeons as exemplars of most efficient techniques.
Using a Modified Frailty Index to Predict Mortality Risk after Tracheostomy
Authors: Johnson Matthew S. , Bailey Travis , Schmid Kendra , Johanning Jason 
Published: August 2013

Objectives:Evaluate the utility of a modified frailty index to predict post‐operative mortality in patients undergoing tracheostomy.Methods:A retrospective chart review was conducted including all patients who underwent tracheostomy between 2007 and 2012. A modified frailty index consisting of 11 items based on the Revised Minimum Data Set Mortality Rating Index was retrospectively applied using the patients’ status immediately prior to tracheostomy. The resultant 6‐month predicted mortality was compared to the Veterans Health Administration Surgical Quality Improvement Program's (VASQIP) 30‐day predicted mortality as well as actual mortality.Results:A total of 100 patients underwent tracheostomy during the study period. No patients were excluded. Sixty‐nine patients died within the study period. The 1, 6, and 12‐month mortality rates after tracheostomy were 25%, 43%, and 59% respectively. The predicted 30‐day mortality risk was 9.1% for non‐survivors compared to 5.2% for survivors (p = 0.05). The predicted 6‐month mortality risk was 40.5% for non‐survivors compared to 25.4% for survivors (p = 0.0003). The VASQIP calculator and modified frailty index both differentiated mortality risks between patients who survived less than 6 months versus greater than 6 months (p = 0.004 and 0.001, respectively). However, neither the VASQIP or modified frailty index differentiated mortality risks for head and neck cancer patients who survived less than 6 months versus greater than 6 months (p = 0.46 and 0.13, respectively).Conclusions:The modified frailty index identifies non‐cancer patients at high risk of post‐operative mortality after tracheostomy but does not identify high‐risk patients with head and neck cancer.
Accuracy of Intraoperative Determination of Central Lymph Node Metastasis by Surgeon in Papillary Thyroid Carcinoma
Authors: Tae Kyung , Ji Yong‐Bae , Song Chang‐Myeon , Lee Dong‐Won 
Published: August 2013

Objectives:Prophylactic central neck dissection (CND) in papillary thyroid carcinoma (PTC) remains controversial because of its potential morbidity and unclear benefit. If we can judge central lymph node metastasis preoperatively or intraoperatively, we can avoid unnecessary CND. However, ultrasound (US)/computed tomography (CT) or sentinel node biopsy is not enough to determine central lymph node metastasis accurately. The aim of this study was to evaluate the accuracy of intraoperative determination of central lymph node metastasis by surgeon during thyroidectomy.Methods:From October 2011 to September 2012, 122 consecutive patients with clinically node negative PTC on US and CT were enrolled. Any suspicious metastatic lymph node on palpation or inspection was sent for frozen biopsy, and then bilateral CND with total thyroidectomy was completed in all patients. The criteria of suspicious lymph node included dark cystic or hard palpable lymph node, or larger than about 7 mm in diameter. We compared the intraoperative surgeon's judgment with final pathologic results.Results:Suspicious metastatic lymph nodes were found in 37 (30.3%) patients, and 15 of them had metastasis in permanent biopsy. Of 85 patients with no suspicious lymph node, 27 patients had metastasis in permanent biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative determination of lymph node metastasis was 35.7%, 72.5%, 40.5%, and 68.2%, respectively. In 22 of false positive patients, 14 (63.6%) had Hashimoto's thyroiditis.Conclusions:Intraoperative determination of central lymph node metastasis by surgeon is limited to guide CND in clinically node negative PTC because of its low sensitivity.
Reducing Readmission Rates at a Large Academic Otolaryngology Practice
Authors: Rajasekaran Karthik , Revenaugh Peter C. , Benninger Michael S. , Sindwani Raj 
Published: August 2013

Objectives:Hospital readmissions are an important focus of national quality and cost containment efforts. With increased emphasis on readmissions in the current healthcare climate, it is critical to evaluate factors contributing to readmission rates and strategies aimed at reducing these rates. The objectives of this study are to analyze the reasons for hospital readmission within 30 days of discharge and discuss methods implemented to reduce readmissions.Methods:A retrospective chart analysis was performed from 2010 to 2012 at a tertiary‐care medical center. A quality plan was developed and implemented during this time to reduce readmissions. All patients who were admitted to an otolaryngology inpatient service and readmitted within 30 days of discharge were identified.Results:There were 763, 820, and 804 admissions during the years 2010, 2011, and 2012, respectively. The number of readmissions during this time were 51 (6.7%), 54 (6.6%), and 28 (3.5%), respectively. Common diagnoses for readmissions included dehydration, syncope, venous thromboembolism, postoperative bleeding, and cellulitis. There were no statistically significant differences in demographics and subsequent length of stay for those patients requiring readmission. The reduction in number of readmissions in 2012 compared to 2011 and 2010 was statistically significant.Conclusions:Readmission within 30 days in a large otolaryngology practice can be multifactorial. In order to reduce rates of readmission it is essential to understand post‐operative complications, diagnoses, and comorbidities contributing to readmission. Implementation of a quality plan comprising comprehensive discharge planning efforts and close post‐discharge follow‐up can lead to a reduction in readmissions.
BMP‐2 Expression Correlates with Local Failure in Surgically Treated Head and Neck Squamous Cell Carcinoma
Authors: Sand Jordan P. , Zakharkin Stanislav , Kokorina Natalia , Lewis James S. , Nussenbaum Brian 
Published: August 2013

Objectives:Preclinical data show that exogenous administration of recombinant human bone morphogenetic protein‐2 (rhBMP‐2) to human oral carcinoma cell lines increases pathogenicity using a nude mouse model. The objectives of this study are to 1) describe the characteristics of baseline protein expression of BMP‐2 in head and neck squamous cell carcinomas (HNSCCs), and 2) determine if BMP‐2 expression level correlates with worse oncologic outcomes.Methods:Tissue samples from 149 patients with oral, oropharyngeal, and laryngeal/hypopharyngeal squamous cell carcinomas treated at an academic medical center between 1999 and 2010 were assembled into a tissue microarray. Immunohistochemistry for BMP‐2 was performed, and staining was quantified using a standardized scoring system. Specimens were categorized by high or low expression level. Statistical analyses using log‐rank, Wilcoxon, and Fisher's exact test were performed for associations between clinical and pathologic features and patient survival.Results:BMP‐2 expression at any level was present in 146 of 149 (97.9%) tissue samples. Tumors with high BMP‐2 expression had higher rates of local failure compared with low‐expressing tumors (17.3% vs 6.3% P = 0.04). However, there was no significant association for BMP‐2 expression level and tumor location, T stage, N stage, regional failure, distant failure, or overall survival.Conclusions:HNSCCs with high levels of BMP‐2 protein expression are associated with higher rates of local recurrence. These data may have important implications for using rhBMP‐2 in tissue engineering reconstructive approaches in the setting of cancer‐related defects. Further, the consistent expression of BMP‐2 suggests this pathway may be a novel therapeutic target.
CD147 and the EGFR Signaling Cascade in Head and Neck Cancer
Authors: Frederick John W. , Sweeny Larissa , Hartman Yolanda , Rosenthal Eben L. 
Published: August 2013

Objectives:Establish the relationship between two membrane bound proteins, CD147 and epidermal growth factor receptor (EGFR), through cutaneous squamous cell carcinoma (cSCC) cell lines.Methods:A pre‐clinical investigation using three cSCC cell lines (Colo‐16, SRB‐1, and SRB‐12) that were treated in vitro with a range of chimeric anti‐CD147 mAb (0, 50, 100, 200 µg/mL) or transfected with a small interfering RNA against CD147 (SiCD147). Cell proliferation, migration, and protein expression was then assessed. PCR analysis and immunofluorescent staining were also obtained. In vivo, Colo‐16 xenografts were treated with anti‐CD147 mAb (200µg i.p. triweekly), and tumors were then harvested for histologic analysis.Results:In response to anti‐CD147 treatments there was a significant decrease in cell proliferation (P <.05) and migration in vitro (P <. 001). These findings were confirmed with a Colo‐16 SiCD147 cell line. Western blot analysis showed a decrease in not only CD147 expression but also the EGFR signaling cascade, specifically EGFR, BAD, and AKT. EGFR mRNA expression was decreased on PCR analysis in response to anti‐CD147. In vivo response to anti‐CD147 showed decreased tumor growth and, on histologic analysis, decreased CD147 and EGFR expression.Conclusions:Blocking CD147 inhibits cell growth in vitro and in vivo and results in downregulation of EGFR expression and signaling cascades. CD147 could be exploited as a therapeutic target in cSCC by modulation of the EGFR signaling pathway.
Cervical Metastasis of Unknown Primary: Use of Discovering Occult Primary Lesions
Authors: Davis Kara , Byrd James K. , Mehta Vikas , Kim Seungwon , Ferris Robert L. , Johnson Jonas T. , Duvvuri Umamaheswar 
Published: August 2013

Objectives:Cancer of an unknown primary squamous cell carcinoma (CUP) metastatic to cervical lymph nodes is a challenging problem for the treating physician. The use of discovering the primary lesion in these patients with regards to oncologic outcomes remains unclear. Our aim is to determine if identification of the primary is associated with improved oncologic outcomes.Methods:Records of 136 patients initially diagnosed as CUP were retrospectively reviewed (1980‐2010). Patients were divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan‐Meier analysis. A nested subset of 34 patients in which the primary was discovered were matched to 34 patients remaining undiscovered according to nodal stage and age. Matched‐pair analysis was compared using the stratified Cox regression model.Results:Discovery of the occult primary was associated with improvement in overall survival (10.19 vs 8.83 years, P < 0.001) when stratified across N1‐N2c disease. Matched‐pairs analyses demonstrated that discovery of the primary was associated with better overall survival (hazard ratio [HR] = 0.222; 95% confidence interval [CI] 0.06 to 0.81; P = 0.023). Discovery of the primary trended towards association with lower recurrence (HR = 0.33; 95% CI 0.09 to 1.19; P = 0.091).Conclusions:Discovery of the primary lesion is associated with improved overall survival in patients initially presenting as CUP, both in matched‐pair and cohort comparison analyses. Within this subset, improved locoregional control with discovery of the primary was suggested by a trend towards decreased recurrence. Further studies may clarify treatment discrepancies and molecular differences.
Changing Trends of Speech Outcomes after Total Laryngectomy in the 21st Century
Authors: Moon Seo Y. , Raffa Francesca , Ojo Rosemary B. , Landera Mario A. , Weed Donald T. , Sargi Zoukaa B. , Lundy Donna 
Published: August 2013

Objectives:Management of laryngeal cancer has changed significantly in the past decade. Total laryngectomy (TL) has been mainly reserved for patients with recurrence or failure after chemo‐radiation or patients requiring major ablative and reconstructive surgeries. Tracheoesophageal puncture (TEP) continues to be the gold standard for speech rehabilitation, yet it is unknown what the overall speech outcomes are for individuals undergoing TL in the 21st century. Our study will describe the speech rehabilitation outcomes of patients after TL in the 21st century.Methods:This is a retrospective analysis of 391 patients who underwent TL from June 2000 to February 2012 with a minimum of one year follow‐up. Demographic variables and medical/surgical factors related to laryngectomy will be reviewed. Patient speech rehabilitation outcomes will be assessed and categorized into the following groups: 1) use of esophageal speech; 2) use of electrolarynx; 3) use of TEP; 4) failure to achieve functional speech; and 5) non‐compliant. To be in groups 1, 2, or 3, patients must use speech as the dominant mode of communication.Results:Patients who underwent TL in the 21st century may have overall decreased success rate in speech rehabilitation; there may be decreased success rate in the use of esophageal speech and TEP.Conclusions:The current gold standard for speech rehabilitation should be readdressed, as it may not adequately meet the need of the current patient populations. More up‐to‐date techniques and technologies are needed to improve the communication and speech rehabilitation of current laryngectomy patients.
Chemoprevention with 2 Weeks of COX‐2 Inhibitors Predict Malignant Transformation of Oral Potentially Malignant Disorders
Authors: Hao Sheng‐Po 
Published: August 2013

Objectives:Use 2 weeks of chemoprevention with Celecoxib® (80mg /day) to screen malignant transformation of oral potentially malignant disorders (PMD).Methods:In a chemopreventive trial with 12 weeks of Celecoxib®, 133 testers out of 374 had persistent or growing tumors after 2 weeks of Celecoxib® and underwent excisional biopsy to define the tumor.Results:Pathology diagnosis of these 133 testers found squamous cell carcinoma in 46; verrucous carcinoma in 2; dysplasia in 21, including severe (2), moderate (5), and mild (14); verrucous hyperplasia in 60; and epithelial hyperplasia with ulcer in 4. Thus, chemoprevention screening identified 48 cancers and 2 severe dysplasias [(48+2)/133 = 37.6%] who needed definite surgical resection.Conclusions:Chemoprevention with 2 weeks of Celecoxib® can be a screening procedure to pick up oral PMD cases with possible malignant transformation that need definite surgical resection, and the incidence could be as high as 37.6%.
A Comparison of Cellular Damage Using Electrocautery and CO2 Laser in Transoral Robotic Glossectomy
Authors: Cavenaugh Rachel , Schniederjan Ryan W. , Brown Robert , Karni Ron J. 
Published: August 2013

Objectives:1) Compare the zone of cellular damage using monopolar electrocautery and CO2 laser during transoral robotic glossectomy. 2) Examine the effect of tissue tension during glossectomy on the extent of cellular damage. 3) Highlight the choice of energy source during transoral robotic glossectomy with margin assessment.Methods:Setting: Memorial Hermann Robotics Institute, November 2012.. A live anesthetized porcine model placed supine with the ventral tongue exposed. Multiple robotic glossectomies were performed using monopolar cautery (15 watts delivered via a robotic arm) and CO2 laser (8 watts delivered via FlexGuide Fiber Introducer carried by a Robotic needle driver). The study was then repeated with 4 lbs of weighted tension on each side of the tongue to simulate the concept of tension‐countertension. Glossectomy specimens were harvested and evaluated in a blinded manner by a pathologist for the zone of cellular damage.Results:Unpaired t‐test with unequal variance was conducted to compare the zone of cellular damage (mm) from the electrocautery and the CO2 laser glossectomy. There was a significant difference in the damage zone for EC and CO2; two‐tailed P less than 0.0001; t(27) = 7.08; Standard Error of Difference = 0.062.Conclusions:The zone of cellular damage from the edge of the incision is significantly greater with electrocautery than CO2 laser in this robotic porcine glossectomy model. The difference is further amplified when tension‐countertension is applied to the tissues. These data suggest that robotic CO2 laser glossectomy may preserve more normal tissue (margins) around a specimen than electrocautery.
Section for Residents and Fellows Leaders: Where Are They Now?
Authors: Wilson Meghan N. , Roby Brianne B. , Deckard Nathan A. , Carter John M. , Yoo Estelle S. , Kelley Kanwar , Raol Nikhila M. 
Published: August 2013

Objectives:1) Look at the experiences of prior governing council (GC) members of the American Academy of Otolaryngology (AAO) Section for Residents and Fellows (SRF), and 2) assess the impact of early Academy involvement.Methods:Survey of all prior members of the AAO SRF GC.Results:The AAO‐SRF has elected 52 GC members since its 2003 inception. Ten members are currently in training, and no data were obtained for 3. The remaining 38 prior GC members were analyzed. Each member served an average of 1.5 years (terms ranged 1 ‐ 3 years). The mean time since completion of training to present is 4.1 years (range 0 ‐ 10 years). A subspecialty fellowship was pursued in 86%, with 92% matching into their fellowship field of choice. Fifty‐seven percent practice in an academic setting, with 3 members advancing to a subspecialty division director within their department. All prior GC members are current AAO members. Over half (59%) have served on an AAO committee, and most are frequent attendees of the annual meeting. When asked, “What did being on the SRF GC do for you?”, the most common responses included understanding the importance of the AAO and involvement in it, networking, and leadership experience.Conclusions:All prior SRF GC members felt involvement in the SRF GC was a beneficial experience, enabling them to gain leadership skills and a deeper understanding of the inner‐workings of our specialty. Most prior SRF GC members have pursued fellowship training and remain involved in the Academy.
Delayed Sinonasal Complications of Radiotherapy for Nasopharyngeal Carcinoma
Authors: Yakirevitch Arkadi , Lipschitz Noga , Alon Eran E. , Yudovich Keren , Wolf Michael , Bedrin Lev 
Published: August 2013

Objectives:There are only sporadic reports of delayed sinonasal complications associated with nasopharyngeal carcinoma (NPC) treated with radiotherapy. These include choanal stenosis, osteoradionecrosis, chronic sinusitis, and intranasal synechiae. The aim of this study was to identify the time of onset and incidence of complications associated with the treatment of NPC and to compare them to the extent of the primary tumor and radiation dose.Methods:A retrospective chart review was performed on all patients who presented to our institution between 1988 through 2009 and who were diagnosed and treated for NPC. The inclusion criteria required at least a 3‐year follow‐up. Excluded were patients with disease recurrence. Furthermore, patients were contacted prospectively and were asked to complete a SNOT‐16 questionnaire.Results:Sixty‐four patients were included in our review. There were 43 males and 21 females. The average age at onset was 42. The T staging for T1, T2, T3, and T4 were 22, 11, 18, and 11 respectively. There were no T staging data for one patient. Two patients suffered from synechiae, which required synechiolysis. Five patients developed osteoradionecrosis and underwent debridement. Ten patients developed choanal stenosis, and it was repaired in 2. Ten patients suffered from sinusitis. Four of those required functional endoscopic sinus surgery.Conclusions:The incidence of delayed sinonasal complications of NPC radiotherapy is not negligible, and they should be kept in mind both for the informed consent of the patients and their active detection and treatment.
Development of a Diagnostic Panel of Methylated MicroRNA Markers for Head and Neck Cancer
Authors: Green Katherine K. , Lu Shi‐Long , Song John I. 
Published: August 2013

Objectives:Early detection of head and neck squamous cell carcinoma (HNSCC) improves long‐term survival. More than half of patients with HNSCC present with locoregional or metastatic disease at the time of diagnosis. MicroRNAs are promising markers for early detection, as they are stable, tissue‐specific, and known to be involved in processes critical for tumor development and progression. Methylated miRNA sequences have already been studied in early detection of lung and gastrointestinal (GI) cancers.Methods:Genomic DNA was extracted from 30 SCC samples, 24 samples of grossly normal adjacent mucosa from those tumor patients, and 8 samples from normal controls (no cancer). The gDNA was treated with bisulfate to identify methylation patterns, and quantitative polymerase chain reaction was run for 6 miRNA markers (9‐1, 9‐3, 124‐1, 124‐2, 124‐3, 137) to determine the level of expression in each sample.Results:Overall expression of each marker was significantly higher in the tumor group when compared to the controls (P < 0.001) and the adjacent mucosa (P < 0.001). Using the expression levels within the controls as a baseline, a positive cut‐off value was determined for each marker to create 100% specificity. The sensitivity of each individual marker ranged from 60‐76%, but when used in combination as a diagnostic panel, the sensitivity increased to 90%.Conclusions:We have successfully created a diagnostic panel of methylated microRNA markers that demonstrated 90% sensitivity and 100% specificity in the detection of HNSCC. This panel is currently being tested on saliva, blood, and tissue samples of tumor‐positive and tumor‐negative (control) patients as part of a larger early detection clinical study.