bluuebunny/crossref_metadata_2025_split huggingface dataset:
Who Is Performing Tracheotomies: A 10‐Year Review
Authors: Patel Hetal H. , Siltumens Aldis P. , Bess Leah , Camacho Fabian , Goldenberg David 
Published: September 2014

Objectives:(1) Determine the trend of the number of tracheotomies performed by otolaryngologists. (2) Determine the changes in surgical technique over time.Methods:A retrospective chart review of all patients undergoing tracheotomy between 1999 and 2013 was performed at a large tertiary care hospital. Data were gathered from billing and operative reports to determine the specialty service performing the tracheotomy. Additionally, the surgical technique and indication for surgery were recorded. Negative binomial regressions (extension of Poisson regression to account for over dispersion) were conducted to examine number of tracheotomies for each specialty as function of year.Results:In 1999, 46.55% of tracheotomies were being performed by the otolaryngology service, compared with only 28% in 2013. This is a decline of 21.55% over time. Since 1999, general surgery has a steady increase in number of tracheotomies performed in comparison to the steady decrease performed by otolaryngology. Since 2008 general surgeons have significantly increased the number of percutaneous tracheotomies they perform (76%/year). Over the same period, the number of tracheostomies performed by the cardiothoracic (CT) surgery service has steadily increased by 26% per year. Most of the tracheotomies performed by CT surgery are percutaneous tracheotomies.Conclusions:This study illustrates that otolaryngologists in our institution are performing fewer tracheotomies over time. If this trend continues, the experience of our trainees may become diluted through reduction in surgical volume. While multi‐institutional studies are warranted, this review provides a summary of the trend at a tertiary care institution which may well reflect national trends.
3D Endoscopic Endonasal Approach in Skull Base Surgery: Experience on 87 Consecutive Patients
Authors: Pecorari Giancarlo , Zenga Francesco , Raimondo Luca , Pacca Paolo , Ducati Alessandro , Garzaro Massimiliano 
Published: September 2014

Objectives:Assess advantages and disadvantages of 3‐dimensional endoscopy in the transnasal approach to sellar region, posterior skull base, and cervical junction.Methods:Between January 2012 and December 2013, 87 patients were consecutively treated at the Neurosurgery Division of the University of Turin for sellar, skull base, and cervical junction pathologies. All procedures were performed by the same team (2 ENT surgeons and 2 neurosurgeons) using a 3‐dimensional (3D) stereoendoscope (VSII system, Visionsense Ltd, Petach Tikva, Israel). After each procedure each surgeon was asked to fill out a questionnaire (based on visual analogue scales) designed to assess comfort and learning curve.Results:Seventy patients were treated for pituitary macroadenomas, 10 for chordomas, 6 for a malformation of the cervical junction, and 1 for a chondrosarcoma of the odontoid process of C2. A cerebrospinal fluid (CSF) leak was observed in 6 out of 70 patients, 1 out of 10 patients, and 0 out of 7 patients, respectively; 5 out of 7 CSF leaks were intraoperatively solved and 2 out of 7 required revision surgery. No vascular complications were recorded. Median global comfort score (sensation of strain + dizziness + system ergonomics scores), recorded at the end of the first and second procedure, was 9.1 and 9.6, respectively; after the third procedure it reached 10. The learning curve score reached the maximum level of 9.5 after the eighth procedure.Conclusions:3D stereoscopic vision system is comfortable for the surgeons allowing them to have a better visualization of anatomic structures and landmarks; it is easy to use and after only a few procedures surgeon skills reach high levels.
Analysis of Clinical Negligence Claims Arising from Thyroidectomy in the UK from 1995 to 2013
Authors: Mathew Rajeev , Tornari Chrysostomos , Hay Ashley , Odutoye Babtunde 
Published: September 2014

Objectives:Determine the outcome and cause of negligence claims relating to thyroid surgery in the National Health Service (NHS).Methods:A request was submitted to the NHS Litigation Authority for claims relating to thyroid surgery between 1995 and 2013 by searching for the key words: “thyroid,” “endocrine,” or “neck.” Claims were analyzed for cause of injury, type of injury, outcome of claim, and costs.Results:Of 132 cases, 90% were closed with 55% of closed claims leading to payment of damages and 72% of closed claims leading to payment of any sort (including settlement out of court). Fifty‐two percent of claims were related to complications of surgery with the rest being related to errors in diagnosis and treatment. Lack of informed consent was claimed in 11 cases. The most common injuries claimed were vocal cord dysfunction (n = 28) followed by endocrine disturbance such as hypocalcemia or hypothyroidism (n = 20). Eight fatalities occurred, of which 7 were due to hematoma and one was due to hypocalcemia. The highest payment was £945,700 ($1,585,000) for bilateral vocal cord paresis requiring a permanent tracheostomy. The median payment per claim was £21,390 ($35,850).Conclusions:Thyroidectomy‐related claims in the National Health Service are rare but have a high success rate. Negligence from operator error correlates well with known complications of thyroid surgery. However, a significant proportion of claims are not related to surgery and represent areas where good care should be addressed by a multidisciplinary approach to the management of thyroid pathology.
Antibiotic Choice in Laryngectomy Affects Outcomes and Costs: An Analysis of University HealthSystem Consortium Data
Authors: Langerman Alexander , Pisano Jennifer , Ham Sandra 
Published: September 2014

Objectives:(1) Identify antibiotic practice patterns for laryngectomy. (2) Determine the clinical and cost outcomes associated with antibiotic management strategies.Methods:University HealthSystem Consortium inpatient billing data on patients undergoing laryngectomy in 2008 to 2011 for 95 academic and affiliated medical centers were analyzed for antibiotic use, outcomes, and cost.Results:Data from 1912 patients (18.1% women) were included in the study. Antibiotic management over the first 72 hours revealed 458 unique management strategies. Antibiotic choice had a significant association with rate of surgical site infection (SSI), with standard regimens of ampicillin/sulbactam (1.4%) or cefazolin+metronidazole (4.3%) having lower rates compared to clindamycin (11.8%; P <. 0001). Non–penicillin‐allergic patients treated with nonstandard regimens had a higher likelihood of wound dehiscence (odds ratio = 2.8 [1.7‐4.5]). Flap procedures on the day of surgery did not have an association with SSI or wound dehiscence in adjusted models. The total cost of hospital admission for patients who were managed with either ampicillin/sulbactam or cefazolin+metronizadole was substantially less than for patients managed with clindamycin ($30,120 [$28,807‐$31,432] versus $37,164 [$33319‐$41009]; P =. 0007).Conclusions:There is substantial variability in perioperative antibiotic strategies for laryngectomy. Clindamycin had a much higher rate of SSI compared with other common regimens and was associated with a higher total hospital cost. Based on this data, standardization of antibiotic practices should be considered and clinical trials should be planned to firmly establish the most cost‐effective antibiotic management for laryngectomy and determine potential alternatives to clindamycin for penicillin‐allergic patients.
Assessing Impact of Sociodemographic, Clinical, and Facility Characteristics on Survival after T1 Laryngeal Cancer Treatment
Authors: Misono Stephanie , Marmor Schelomo , Yueh Bevan , Virnig Beth A. 
Published: September 2014

Objectives:Prior work identified differences in survival by treatment type for localized laryngeal squamous cell carcinoma (LSCC) in the Surveillance Epidemiology and End Results (SEER) registries. We sought to determine whether these differences were attributable to sociodemographic, clinical, and treatment facility characteristics in the elderly.Methods:The SEER‐Medicare linked files (1991‐2009) identified patients (ages 66+ years) with T1 LSCC. Logistic regression models were constructed to identify sociodemographic characteristics associated with treatment type. Kaplan‐Meier methods were used to examine the association of treatment type and survival. Cox proportional hazards modeling was used to assess the impact of potentially important factors such as sociodemographic, clinical, or facility characteristics.Results:We identified 1369 patients with T1 LSSC. Radiation alone was the most common treatment. Treatment with local surgery ± radiation was associated with slightly better survival than treatment with radiation alone in our unadjusted Kaplan Meier model. Adjusted for comorbidity, treatment with both local surgery and radiation was associated with greater survival (P =. 002) than treatment with local surgery or radiation alone. No significant association was observed between sociodemographic factors (income and urban/rural location) or facility characteristics (hospital size or volume) and hazard of death.Conclusions:Previously observed differences in survival across single modality treatment types for T1 LSSC in the elderly may be partially attributable to medical comorbidity, but treatment with both surgery and radiation was associated with improved survival independent of comorbidity. Other patient and facility characteristics showed no appreciable impact on survival after treatment of T1 LSSC in this population.
Biomarkers pS6 and pERK as Predictors of Skin Cancer Aggressiveness
Authors: Nathan Cherie Ann O. 
Published: September 2014

Objectives:The role of elective parotidectomy and the extent of surgery for occult nodal metastasis in cutaneous squamous cell carcinoma (SCC) is controversial. We wanted to determine if the MEK/ERK pathway and pathologic features in the tumor could predict skin cancer aggressiveness and allow for preemptive treatment of occult metastasis.Methods:Retrospective experimental laboratory study and chart review. Specimens from basal cell carcinoma (BCC; n = 13), squamous cell carcinoma (SCC; N = 10), and SCC with parotid metastasis (n = 11) were analyzed by immunohistochemistry (IHC) for pERK (Thr202/Tyr204) and pS6 (Ser235/236) and scored by the study pathologist. Simple logistic regression analysis evaluated all subjects with previous resection of cSCC and parotidectomy (n = 13) for independent risk factors of disease aggressiveness.Results:Expression of pS6 increased in cSCC with parotid metastasis (P =. 01) compared with other groups. BCCA and SCCA comparison showed an increase in pS6 expression in SCC (P <. 01). There was no significant difference in pERK expression between groups. Factors associated with cSCC with nodal metastasis were previous skin positive margins (P =. 03) and parotid perineural invasion (P =. 04). Positive margins on primary lesions is an independent risk factor for deep lobe involvement (P =. 03).Conclusions:Positive margins on primary skin lesions, perineural involvement of parotid specimens, and Biomarker pS6 appear to be predictors of aggressiveness in cSCC and should prompt increased monitoring or elective treatment. As pERK was not significantly activated, pS6 overexpression could indicate activation of the Akt/mTOR pathway.
Can Preoperative Thyroglobulin Antibody Levels Be Used as a Marker for Well‐Differentiated Thyroid Cancer?
Authors: Hosseini Sarah , Zawawi Faisal , Varshney Rickul , Mlynarek Alex M. , Hier Michael P. , Forest Veronique‐Isabelle , Payne Richard J. 
Published: September 2014

Objectives:Evaluate whether the presence of preoperative thyroglobulin antibody (TgAb) levels can help predict the final pathology of thyroid nodules. Assess whether higher levels of preoperative TgAb increase the likelihood that a thyroid nodule is malignant.Methods:A retrospective chart review of patients who underwent thyroidectomy in 3 McGill University‐affiliated hospitals between January 2012 and 2014 was conducted. Demographic data, TgAb levels, and final histopathology were recorded. Patients were divided into 2 groups: TgAb positive (defined as TgAb ≥30 IU/mL) and TgAb low/negative (defined as TgAb <30). Micropapillary thyroid carcinomas were considered to be benign. These data were then statistically analyzed using SPSS.Results:Preoperative TgAb levels were available in 412 patients. There were 360 patients in the TgAb low/negative group (malignancy rate: 51.39%) and 52 patients in the TgAb positive group (malignancy rate: 65.38%). The sensitivity, specificity, positive predictive value, and negative predictive value of TgAb ≥30 IU/mL as a diagnostic test for thyroid malignancy were 15.53% (confidence interval [CI] 11.00‐21.01), 90.67% (CI 85.66‐94.38), 65.38% (50.91‐78.03), and 48.61% (CI 43.34‐53.91), respectively. The relative risk was 1.2723 (CI 1.0192‐1.5883) and the odds ratio was 1.7868 (CI 0.9732‐3.2804). Both the Pearson chi‐square test (P =. 024) and Fisher's exact test (P =. 017) yielded statistical significance between the 2 groups.Conclusions:Our study demonstrates that patients with preoperative TgAb ≥30 IU/mL had a higher rate of malignancy when compared to patients with TgAb <30 IU/mL. This suggests that an elevated TgAb level may increase the risk that a thyroid nodule is malignant.
Cervical Lymph Node P16 Status in Diagnosis of the Unknown Primary
Authors: Martin James R. , Dial Brian , Mehrotra Swati , Jaber James J. 
Published: September 2014

Objectives:(1) Evaluate the role of p16 status of cervical lymph node (LN) metastases in localizing carcinoma of unknown primary (CUP). (2) Compare the sensitivity, specificity, and accuracy of positron emission tomography PET scan for locating the primary site in the setting of p16 positive and p16 negative LN metastases.Methods:Retrospective review of 30 patients that were identified from archived tumor board lists from 2010 to 2013. All patients presented to a tertiary care center with squamous cell carcinoma metastases to cervical LN of unknown source despite initial clinical evaluation and computed tomography scan. Fine needle biopsy or excisional biopsy specimens were tested for the p16 biomarker. The accuracy of the PET scan was assessed by comparing the fludeoxyglucose‐avid predicted site against a standard panendoscopy with directed biopsies.Results:A primary was identified in 61% of cases presenting as CUP. All p16+ LN metastases were from an oropharyngeal primary or remained unknown. All primaries located outside the upper aerodigestive tract were p16–. The sensitivity and specificity of PET in patients with p16+ LN metastases were worse than in p16‐ metastases (71%, 33% vs 100%, 100%).Conclusions:LN p16 status can help localize CUP. In our series, the sensitivity and specificity of PET scan were much worse in p16+ LN metastases. PET scan may be of limited utility for localizing CUP with p16+ LN metastasis.
Variables for Repeated No‐Showing to Clinic Appointments
Authors: Miller Anya J. , Chae Esther , Ko Alvin B. 
Published: September 2014

Objectives:Determine the variables that contribute to non‐compliance with showing up to clinic appointments. Patients no‐showing to their appointments represent a significant burden to the health care system by decreasing access to care and lost potential revenue. Identifying patient factors correlated with missed appointments may help characterize why these appointments are missed and identify opportunities to help patients get the care they need.Methods:Retrospective chart review. Patients who did not show up to 3 or more clinic appointments in the otolaryngology department in the Henry Ford system in metro Detroit, Michigan, between July 1, 2011, and June 30, 2012, were analyzed. Controls were patients who had appointments on the same day with the same provider as the no‐show patients.Results:A total of 106 patients were identified who no‐showed to 3 or more clinic appointments. Younger age, black race, and lower income were found to be significant factors for patients not showing up to appointments on multiple variate model. On logistic regression, Medicaid insurance, closer distance from home to appointment, less bus transfers, and less time by bus travel were also found to be significant for no‐showing.Conclusions:Age, race, and income are significant contributors to patient noncompliance with clinic appointments. Paradoxically, proximity to the clinical appointment location is also a significant factor; we hypothesize this may be the result of relative income inequality in the metro Detroit population. Follow‐up studies include analyzing severity of patient complaints and weather as a factor of noncompliance.
Diagnostic Accuracy of Galectin‐3 for Well‐Differentiated Thyroid Cancer on Fine‐Needle Aspiration: A Meta‐analysis
Authors: Scheffler Patrick , Forest Veronique‐Isabelle , Rochon Louise , Tamilia Michael , Mlynarek Alex M. , Hier Michael P. , Payne Richard J. 
Published: September 2014

Objectives:(1) Examine and meta‐analyze the literature on galectin‐3 staining on fine‐needle aspiration (FNA) samples of thyroid nodules. (2) Summarize the diagnostic test accuracy of galectin‐3 staining on FNA for well‐differentiated thyroid cancer (WDTC).Methods:A systematic review of studies from 1990 to 2014 examining the diagnostic test properties of galectin‐3 on thyroid nodule samples obtained by FNA with regard to WDTC. Data were meta‐analyzed using DerSimonian‐Laird random effect models for data pooling. Studies were weighted by inverse variance, and between‐study variance was estimated using the Empirical Bayes method. Study heterogeneity and threshold effects were analyzed using the Cochrane Q and Spearman correlation coefficient, respectively.Results:Sixteen studies with 2076 cases were identified. The pooled sensitivity of galectin‐3 for WDTC was 89.4% [confidence interval (CI): 87.2‐91.4], and specificity was 91.9% (CI: 90.2‐93.4). The positive likelihood ratio was 10.05 (CI: 8.24‐12.26), and negative likelihood ratio was 0.12 (CI: 0.10‐0.15). The diagnostic odds ratio of a positive galectin‐3 stain on FNA was 71.3 (CI: 52.7‐96.5). The area under the curve for the summary receiver operating characteristics curve (SROC) was 95.3% (standard error: 0.5%).Conclusions:The current study shows galectin‐3 staining of preoperative thyroid nodule FNA samples to be a test with strong diagnostic accuracy for WDTC, as seen by its favorable sensitivity, specificity, diagnostic odds ratio, and SROC curve. This supports its role as a useful adjunct in the preoperative workup of thyroid nodules.
Does Immediate Cytology Improve the Adequacy of Ultrasound‐Guided FNAC?
Authors: Sharma Sunil D. , Kumar Gaurav , Horsburgh Avril , Alkilani Raed , Chawda Sanjiv , Kaddour Hesham 
Published: September 2014

Objectives:Assess whether a dedicated “one stop” neck lump clinic has helped to improve the percentage of adequate fine‐needle aspiration cytology (FNAC) samples and reduce the need for repeat FNAC.Methods:Retrospective review of patients attending for ultrasound‐guided FNAC over a 6‐month period from August 2012 to February 2013. Patients were placed within 2 groups (Group 1: FNAC performed by any of the subspecialist radiologists with cytology support (n = 100) and Group 2: FNAC performed by general radiologists without cytology support (n = 112)). In order to test for intra‐observer agreement, 2 further groups were added (Group 3: FNAC performed by particular subspecialist radiologist with cytology support (n = 61) and Group 4: FNAC performed by the same subspecialist radiologist without cytology support (n = 125).Results:Seventy‐four percent of neck lumps originated from the thyroid, 13% from the salivary glands, and 4% from lymph nodes. Adequacy rates of FNAC in Group 1 were 87% as compared with 56% in Group 2. Adequacy rates of FNAC in Group 3 were 90% as compared with 78% in Group 4. Thus, the presence of immediate cytology and a subspecialist radiologist increased FNAC adequacy by 31%. The presence of cytology support increased adequacy by 12% and presence of a subspecialist radiologist increased adequacy by 22%.Conclusions:Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of noncytology supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.
Facial Nerve Monitoring during Parotidectomy: A Systematic Review and Meta‐analysis
Authors: Sood Amit J. , Houlton Jeffrey J. , Nguyen Shaun A. , Gillespie M. Boyd 
Published: September 2014

Objectives:Determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy.Methods:Systematic review and meta‐analysis. A comprehensive literature search was conducted using the PubMed‐NCBI database from 1970 to 2014. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without FNM (intraoperative nerve monitor vs. control). Primary and secondary endpoints were defined as immediate postoperative and permanent facial nerve weakness (≥2 House‐Brackmann score), respectively.Results:A total of 1414 articles were reviewed, resulting in 8 articles that met inclusion criteria. In total, 626 patients were included in the final meta‐analysis. The incidence of immediate postoperative weakness following parotidectomy was significantly lower in the FNM group compared with the unmonitored group (22.4% vs 35.0%, P =. 001). The incidence of permanent weakness was also lower, but this difference was not statistically significant (4.2% vs 7.6%, P =. 10). The number of monitored cases needed to prevent 1 incidence of immediate postoperative facial nerve weakness was 8 given an absolute risk reduction of 12.6%. This corresponded to a 49% decrease in the incidence of immediate facial nerve dysfunction (odds ratio, 0.51; 95% confidence interval, 0.34 to 0.76, P =. 001).Conclusions:In primary cases of parotidectomy, intraoperative facial nerve monitoring decreases the risk of immediate postoperative facial nerve weakness, but does not appear to influence the final outcome of permanent facial nerve weakness.