bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microvascular Reconstruction in the Setting of Difficult Vascular Anatomy: The Reverse Arterial Flow Technique
Authors: Deschler Daniel G. , Lin Alice 
Published: August 2013

Objectives:We present one case where challenging vascular anatomy was circumvented by changing the conventional vascular dissection and geometry successfully.Methods:Variations in the quality and suitability of donor vessel anatomy can significantly impact microvascular free tissue transfer reconstruction and may require innovative approaches to allow successful revascularization. Although greatest variability is noted in the venous system of transferred tissue segments, arterial anatomy and quality can also be severely limiting. However, unlike the recipient vessels where multiple options may be available, there is only one available donor artery. In the setting of unfavorable physical properties of the artery, the reconstructive surgeon is often forced to sacrifice the flap in favor for a second harvest.Results:In our case, the artery was affected by Monckeberg's arteriosclerosis, which is a process of arterial calcification classically described as calcification of the tunica media of the arterial wall. This creates a hardened wall through which microvascular suture cannot be passed and microvascular anastomosis is not successful.Conclusions:In our case, the fibula free flap was salvaged by using the distal end of the artery for anastamosis to create reverse flow perfusion of the flap. We present the details of the technique required for harvest and inset of a reverse arterial flow fibula free flap.
Negative Prognostic Implication of Fibrotic Pattern in Papillary Thyroid Cancer
Authors: Lee Rang , Park Young‐Min , Woo Chang‐Ki , Lee Il‐Woo , Wie Chan‐Eun , Wang Soo‐Geun , Lee Byung‐Joo 
Published: August 2013

Objectives:Lymph node metastasis in papillary thyroid cancer occurs 40‐60% of the time. Extrathyroidal extension and large tumor size are the most reliable predicting factors for central lymph node metastasis whose prognostic value is controversial. In this study, we evaluated the relationship between a specific finding of primary tumor in the thyroid, fibrosis, and negative prognostic factors.Methods:We reviewed patients who underwent total thyroidectomy and central lymph node dissection with or without lateral lymph node dissection for papillary thyroid cancer (PTC), from January to December, 2011. We defined (+) finding when the degree of fibrosis comprised 10% or more of the primary tumor. Correlation between degree of fibrosis and negative prognostic factors, including age, gender, tumor size, extrathyroidal extension (ETE), number of central lymph node (CLN) metastases, and lateral cervical lymph node metastasis (LCLNM), was analyzed.Results:Of the 481 patients, fibrosis (+) group included 387 patients (80.5%). On the chi‐square test, age, gender, tumor size, and LCLNM were not correlated with fibrosis. ETE (+) group comprised of higher rate of fibrosis (+) group (90.4%) compared to ETE (‐) group (64.9%, P < 0.001). CLN metastasis (+) comprised of higher rate of fibrosis (+) group (84.6%) compared to CLN metastasis (‐) group (76.5%, P = 0.017). On the multivariate analysis, ETE was a significant risk factor of fibrosis (odds ratio = 2.545, P < 0.001, confidence interval from 1.775 to 3.649).Conclusions:Fibrosis in PTC can be a risk factor of extrathyroidal extension, a negative prognostic factor. This suggests that the behavior of fibrotic tumor is, possibly, more aggressive than non‐fibrotic tumor.
Non‐localizing Parathyroid Adenomas: Radiologic Error or True Entity
Authors: Goldenberg David , Portela Rafael A. , Smucker Joanne , Bruno Michael , Winner Louis , Saunders Brian 
Published: August 2013

Objectives:Investigate radiographic assessment of non‐localizing parathyroid adenomas (NLPA). Our goal was to determine whether non‐localization is a result of radiologic interpretive error, or truly representative of non‐visible parathyroid adenoma.Methods:We performed a retrospective chart review of 364 patients who underwent parathyroidectomy over a 5‐year period. Thirty patients who were identified as having NLPA on pre‐operative imaging were included. All available patient images were re‐reviewed by two senior radiologists. Both readers were blinded to surgical outcomes and adenoma location on the first read of the imaging studies. Surgical outcomes were then revealed and the imaging was re‐reviewed. The two reader's results were subsequently compared for inter‐reader reliability using Cohen's kappa test.Results:All 30 patients with NLPA had pre‐operative 99mTc sestamibi imaging available and 18 also had an ultrasound performed. Adenomas were identified intra‐operatively and removed in all cases. Twenty‐nine of the thirty (97%) 99mTc sestamibi studies were scored by the two readers as either negative or equivocal. There was excellent inter‐observer agreement between the readers, with a kappa value of 0.706. For the ultrasound studies, however, the two readers’ inter‐observer agreement was only fair, with a kappa value of 0.351.Conclusions:The inter‐reader agreement in our series supports the conclusion that, for a sub‐population of patients with parathyroid adenoma, pre‐operative imaging will be truly negative/non‐localizing.
North American Survey on HPV and p16 Testing in Head and Neck Cancer
Authors: Maniakas Anastasios , Moubayed Sami Pierre , Ayad Tareck , Guertin Louis , Nguyen‐Tan Phuc‐Felix , Gologan Olga E. , Christopoulos Apostolos 
Published: August 2013

Objectives:1) Evaluate systematic testing of human papillomavirus (HPV) and p16 status on head and neck cancer in North America. 2) Assess if HPV or p16 status is used to influence treatment in this population.Methods:An online survey was sent to three professional associations: the American Head & Neck Society, the Canadian Society of Otolaryngology, and the Quebec Association of Otolaryngology. Inclusion criteria were physicians practicing in North America. Incomplete surveys were disregarded. Chi‐square analyses were conducted.Results:There was a response rate of 20% with a total of 216 complete responses. Most respondents were otolaryngologists (196; 90.7%), English‐speaking (178; 82.4%), and practicing in an academic setting (138; 63.9%). Routine HPV or p16 testing was performed by 146 respondents for the oropharynx, 69 for oral cavity, and 44 for other subsites. Most physicians (113; 77.4%) test for both HPV and p16, while 58.3% indicated that HPV/p16 status influences their treatment approach for oropharyngeal cancer. In Quebec, 15.4% of respondents test for HPV/p16, versus 61.0% in the rest of Canada and 88.1% of the American Head & Neck Society members (P < 0.001). Practicing in an academic center of having a primarily (≥50%) oncology practice was associated with a higher rate of HPV/p16 testing (P < 0.001).Conclusions:The majority of North American otolaryngologists test for HPV or p16 status in head and neck cancer. Furthermore, the majority indicate that this testing influences their treatment approach for oropharyngeal cancer. Concurrently, multiple treatment deintensification protocols for this type of cancer are currently underway.
A Novel Use of Data Mining to Inform Outcome of Oropharyngeal Squamous Cell Carcinoma
Authors: Martin James , Mehrotra Swati , Wirth Sarah , Strus Maria , Malliaris Mary , Bier‐Laning Carol M. 
Published: August 2013

Objectives:1) Recognize that data mining is useful to analyze multiple patient and tumor factors and make predictions about outcome in head and neck cancer patients.Methods:Retrospective study of 124 patients with oropharyngeal squamous cell carcinoma treated at a tertiary care institution from 2000‐2009 for whom 2 year outcome was known. Data was collected from the medical chart. PASW Modeler was used to analyze the data. The outcome measurement was overall 2 year survival. Receiver‐operating characteristic (ROC) values (false positive rate (FPR), true positive rate (TPR)) were calculated for each outcome predictor model.Results:For the entire group, overall two year survival was 82%. The models used to predict survival were p16 status, Stage IV status and PASW Modeler Decision Tree analysis. ROC values for each model were as follows: p16 training 0.56, 0.74; p16 validation 0.25, 0.83. Stage IV training 0.83, 0.73; Stage IV validation 0.75, 0.61. Decision Tree training 0.00, 0.88; Decision Tree validation 0.75, 0.78.Conclusions:Data mining shows promise in making outcome predictions in patients with head and neck cancer. This study shows that data mining performs better than outcome prediction using a stage‐based model. Although the ROC curve analysis for the Decision Tree training set was excellent, the validation set fell below the p16 validation set. We suspect that this may be due to the small size of our data set. To overcome this downfall, we will discuss the results from a K‐fold cross‐validation process which sequentially uses all the data in the validation set.
Outcomes of Primary Surgery with Radiotherapy for pN2 Head and Neck Squamous Cell Carcinoma
Authors: Kim Chung Soo , Nam In‐Chul , Park Jun‐Ook , Cho Kwang‐Jae , Kim Min‐Sik 
Published: August 2013

Objectives:Examine treatment outcomes and define factors that influence survival in patients underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma.Methods:Two hundred nine patients underwent primary surgery with postoperative radiotherapy between 1994 and 2011. Primary tumor sites were 70 oropharynx, 48 hypopharynx, 47 larynx, 41 oral cavity, and 3 sinonasal cavity. There were 21, 83, 60 and 45 patients with stage T1 to T4 cancers, respectively. The N stages were 20 N2a, 129 N2b, and 60 N2c.Results:The recurrence rate was 40% (83/209) over a mean observation period of 39 months. The 5‐year disease free survival (DFS), disease specific survival (DSS), and overall survival (OS) rate in our cohort was 44%, 60%, and 56%, respectively. Patients with advanced T stage or extracapsular spread had a significant adverse effect on 5‐year DFS, DSS, OS rate according to the Kaplan‐Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between 5‐year DSS rate and advanced T stage (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.26‐3.82; P = 0.005) and extracapsular spread (HR, 2.29; 95% CI, 1.24‐4.21; P = 0.008).Conclusions:Factors that affected prognosis were T stage and extracapsular spread in patients who underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma. An aggressive therapeutic approach may be suitable for these patients.
Overexpression of EphB4, EphrinB2, and EGFR in Papillary Thyroid Carcinoma
Authors: Sharma Giriraj K. , Dhillon Vaninder , Maceri Dennis R. 
Published: August 2013

Objectives:1) Analyze the expression of EphB4, EphrinB2 and epidermal growth factor receptor (EGFR) in papillary thyroid carcinoma (PTC). 2) Analyze the association of each of these biomarkers with lymph node disease.Methods:Twenty one patients with newly diagnosed PTC (stages I‐III) were enrolled in this study between 2009‐2012. All 21 patients were treated with total thyroidectomy and central (level VI) neck dissection. EphB4, EphrinB2 and EGFR expression in tumor and surrounding normal thyroid tissue was evaluated by complimentary DNA (cDNA) microarray (n = 4), Western blot (n = 21) and immunohistochemistry (IHC) (n = 21). Clinicopathologic data (tumor size, histologic extension, lymph node disease, stage) was collected from patient records.Results:cDNA microarray analysis showed a statistically significant average fold change in gene expression for EphB4 (2.5, P =. 004), EphrinB2 (2.4, P =. 001) and EGFR (2.9, P =. 003) in tumor samples compared to normal tissue. Linear regression analysis of IHC integrated optical density (IOD) measurements confirmed overexpression of EphB4 (P <. 001), EphrinB2 (P <. 001) and EGFR (P <. 001) in tumor versus benign tissue. We noted an association between lymph node disease and EphB4 (P <. 001), EphrinB2 (P <. 001) and EGFR (P =. 069) expression in tumor samples.Conclusions:Overexpression of EphB4, EphrinB2 and EGFR is associated with PTC. Our results are the first to demonstrate the association between EphB4, EphrinB2 and EGFR overexpression with lymph node metastases in PTC. These three genes may be used as biomarkers for early identification of lymph node involvement in PTC and potential small‐molecule targets for future research in PTC pharmacotherapy.
Patients with Thyroid Carcinoma Distant Metastasis Are Identified at Initial Treatment
Authors: Tavares Marcos R. 
Published: August 2013

Objectives:Distant metastases (DM) worsen prognosis in patients with well differentiated thyroid carcinoma (WDTC), and. DM can be identified at initial evaluation or follow up. These patients must be followed aggressively and treated appropriately. Our goal was to identify when distant metastases are identified in patients with WDTC and patients’ initial clinical features.Methods:Retrospective chart review of patients with WDTC and distant metastasis treated with radioactive iodine at our department.Results:Between 1988 and 2009, 73 patients with WDTC and distant metastasis had radioactive iodine at our hospital. Sixty were female; patient ages ranged from 7 to 74 years old (mean 47), 40% under 45 y/o. The lung was the most affected organ (70%); bones (12%); lungs and bones (12%); liver and breast. Tumor diameter was ≤4cm in 74% of the patients (15% ≤1cm) and ≤4cm in 26%. In 48% of patients, the primary tumor histology was a classic papillary thyroid cancer, followed by follicular carcinoma or follicular variant of papillary carcinoma in 41% of the patients and Hurthle cell carcinoma in 3%. Only 8% had poorly differentiated carcinoma. Lymph node metastases were present in 64% of patients, 14% in both central and lateral neck compartments. Distant metastases were present in the first postoperative whole body scan in 90% of the patients.Conclusions:The majority of patients with distant metastasis (90%) were identified at initial treatment. Follow up intensity can be reduced in the remaining patients. Clinical features do not prevent complete evaluation of patients with WDTC. Patients with distant metastasis of thyroid cancer had small well differentiated carcinomas and were under 45 years old.
Mucoepidermoid Carcinoma of Parotid Gland
Authors: Alkhalifa Salman A. , Abdulkarim Noor Y. , Abulfateh Fatima N. 
Published: August 2013

Objectives:Present a case of mucoepidermoid carcinoma of the left parotid gland, which has been removed surgically.Methods:A thirty‐five year‐old gentleman presented with swelling of the left cheek for 6 months. The swelling was gradually increasing and painless; the patient had facial weakness since childhood. A swelling 3x2 cm was seen in the parotid area, which was normothermic, non‐tender, firm in consistency, not fluctuant, and fixed to the skin. The facial nerve was intact, and the regional lymph nodes were not palpable.Results:Excisional biopsy was done. The histopathology revealed mucoepidermoid carcinoma of low grade. Repeated ultrasound showed normal echogenicity of the left parotid gland and no discrete nodule seen. One cm hypoechoic mass was seen in the subcutaneous tissue of the left cheek, which indicates a residual mass or postoperative fibrosis. Magnetic resonance imaging of the parotid glands showed one cm mass of the left cheek. The patient had excisional biopsy and transposition flap of the left cheek. The lesion excised with 5 mm clear radial margins and 5 mm clear deep layer. The zygomatic branch of the VII cranial nerve was sacrificed because it was intralesional. Transposition of S‐shaped flap was created and fixed through layers.Conclusions:A case of excised parotid mucoepidermoid carcinoma was presented; the patient was disease free at 79 months. Clinical stage and histological grade of mucoepidermoid carcinoma are the main prognostic factors.
A Preliminary Report on Platelet‐Rich Plasma (PRP) Gel Application in Exofacial Parotidectomy
Authors: Raimondo Luca , Garzaro Massimiliano , D'Antico Sergio , Sensini Matteo , Naqe Nertila , Mastrapasqua Rodolfo , Pecorari Giancarlo 
Published: August 2013

Objectives:Platelet‐rich plasma (PRP) is widely used in different kind of surgeries to improve hemostasis and wound healing. We set out to evaluate PRP gel efficacy, in drainage, drainage tube stay duration, and pain and length of hospital stay reduction after exofacial parotidectomy for pleomorphic adenoma.Methods:Between November and December 2012, exofacial parotidectomy was performed on 12 consecutive patients enrolled in this prospective randomized controlled clinical trial. Autologous PRP gel was applied on the remaining gland before wound closure in the treatment group (6 pts), while direct closure was applied in the controls (6 pts).Results:The mean 24‐hour cumulative drainage was 128.64 ml vs. 50.33 ml (P = 0.049), mean pain score at 4 hours was 5.3 vs 1.5 (P = 0.046) and 5.2 vs 1.5 (P = 0.037) at 8 hours in treatment and control group respectively; the drainage tube was removed after a mean of 5.6 days in control group and after 3.3 days in the treatment one (P = 0.037); PRP gel pts were discharged after a mean of 3.33 days whereas no‐PRP gel pts after a mean of 6.33 days (P = 0.046).Conclusions:These preliminary data suggest that PRP gel application in parotid surgery could be a feasible, low cost, and efficient tool in improving surgical outcomes and in reducing patients effort in terms of pain, drainage tube endurance and hospital staying.
Preoperative Vitamin D Deficiency as a Predictor of Post‐total‐thyroidectomy Hypocalcemia
Authors: Falcone Todd E. , Noordzij J. Pieter , Jalisi Scharukh , McAneny David , Pearce Elizabeth N. , Holick Michael F. , Stein Daniel J. 
Published: August 2013

Objectives:Understand the relationship between preoperative vitamin D deficiency and post‐total‐thyroidectomy hypocalcemia.Methods:Retrospective study examining 264 total and completion thyroidectomies between 2007‐2011. Included patients had a recorded 25OH‐D level within 21 days prior to or 1 day following surgery, were not taking ergocalciferol (D2) at the time of their lab draw, did not have a primary parathyroid gland disorder, and were not taking calcitriol (1,25 dihydroxy‐D3) prior to surgery. Some patients were repleted preoperatively if a low 25OH‐D level was identified. Preoperative 25OH‐D, concurrent neck dissection, integrity of parathyroid glands, final pathology, postoperative parathyroid hormone (PTH), calcium nadir and repletion, and length of stay were examined.Results:In this cohort, a mean of 3 parathyroid glands were identified during surgery. Multinodular goiter and papillary thyroid carcinoma were the most common pathologies. Hypocalcemia, defined as a corrected calcium <8.4 mg/dL, and drain placement were the most common reasons for length of stay >1 night. The average preoperative 25OH‐D for all patients was 24.98 ng/mL and the overall rate of hypocalcemia was 37.5%. Low preoperative 25OH‐D did not predict postoperative hypocalcemia (P = 0.96), however, it did predict the need for postoperative calcitriol administration (p=0.01). Lower postoperative PTH levels (P = 0.001) predicted postoperative hypocalcemia.Conclusions.Lower postoperative PTH predicts post total thyroidectomy hypocalcemia. Preoperative 25OH‐D did not predict hypocalcemia as has been previously described although it did predict the use of calcitriol postoperatively. We recommend that 25OH‐D be assessed and, if indicated, repleted preoperatively in patients undergoing total thyroidectomy.
Primary Parotid Gland Lymphomas
Authors: Felekis Dimitrios , Giopanou Maria , Grigoropoulos Ilias , Aggelidaki Eirini , Gotsis Antonis , Zacharioudaki Evaggelia , Papouliakos Sotirios 
Published: August 2013

Objectives:1) Describe our experience in the diagnosis and management of the parotid gland lymphomas. 2) Present a rare case of synchronous MALT lymphoma of the parotid and high‐ grade non‐Hodgkin lymphoma of the breast (DLBCL). Primary lymphomas of the salivary glands are rare, consisting less than 5% of all cases of extranodal lymphomas and about 2%‐5% of salivary gland neoplasms. The most common subtype in the parotid is marginal zone B‐cell mucosa‐associated lymphoid tissue type lymphoma (MALT).Methods:We retrospectively reviewed the histopathologic reports of 251 parotidectomies that were performed in our department during the last decade. All patients presented with parotid gland swelling and had no previous diagnosis or symptoms of lymphoma. Management included computed tomography and/or magnetic resonance imaging scan and fine‐needle aspiration (FNA).Results:Of the 251 patients, 10 were diagnosed with non‐ Hodgkin lymphoma (3.98%). Among them, 3 were identified as MALT subtype (30% of parotid lymphomas, 1.2% of all parotid neoplasms). FNA accuracy was 100% for the7 non‐Hodgkin lymphomas, but only 33.3% (1 in 3 cases) regarding the MALT subtype. Interestingly, in these two patients, Warthin's tumor was diagnosed by FNA. In one of the 3 cases of MALT lymphoma we came across a synchronous MALT lymphoma of the left parotid and high‐grade non‐Hodgkin lymphoma of the right breast (DLBCL).Conclusion:Our data suggest that MALT lymphoma of the parotid gland is rare and could be difficult to diagnose with FNA, probably due to similar underlying cytologic features to benign tumors.
Prognostic Factors in Head and Neck Sarcomas: Analysis of the SEER Database
Authors: Peng Kevin A. , Wang Marilene B. 
Published: August 2013

Objectives:1) Summarize the epidemiology of sarcomas occurring in the head and neck. 2) Identify prognostic factors for patient survival.Methods:Cross‐sectional analysis of the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program.Results:The SEER 18 database, spanning the years 1973 to 2009, was analyzed. A total of 2134 cases of sarcoma arising in the head and neck were identified, accounting for 3.9% of all sarcomas. Of head and neck sites, the bones of the skull and face were most commonly affected (n = 856), followed by the oral cavity and pharynx (n = 532), nasal cavity and paranasal sinuses (n = 365), and major salivary glands (n = 192). Overall disease‐specific 2‐, 5‐, and 10‐year survival rates for head and neck sarcoma were 69.5%, 55.9%, and 49.9%, respectively. On Cox regression analysis, histologic subtype, tumor location, gender, and patient age were found to influence mortality rate significantly (P < 0.05), with male gender and older age portending worse outcomes.Conclusions:Sarcomas, a heterogeneous group of malignant mesenchymal tumors, are uncommonly found in the head and neck. This study represents the largest analysis of patients with head and neck sarcoma in the literature and demonstrates the impact of histology, tumor location, age, and gender on overall prognosis.