bluuebunny/crossref_metadata_2025_split huggingface dataset:
When Can Acute Supraglottitis Patients Be Discharged from Intensive Care?
Authors: Shaul Chanan , Israel Ariel , Schwarz Yehuda , Peleg Uri , Sichel Jean‐Yves 
Published: August 2013

Objectives:Acute supraglottitis in adults is usually managed by admitting the patient for airway monitoring in the intensive care unit (ICU). However, data are lacking on when patients could be transferred from the ICU to the ward. Our aim is to suggest decision criteria for transferring patients to the regular ward.Methods:A retrospective review of medical records from adult patients admitted for supraglottitis to our center was conducted. The information obtained included airway management, length of stay in the ICU and in the ward, clinical condition of the patients at the time of their transfer from the ICU to the ward, and outcome.Results:Between 2006 and 2012, 38 adult patients were treated in our department for supraglottitis with antibiotics and systemic steroids. All patients were admitted to the ICU for monitoring. Fiberoptic laryngoscopy was performed every 12 hours. 5 patients required intubation at admission. 33 patients were admitted to the ICU for monitoring and did not require further intubation. Average time in the ICU was 27.4 hours. We observed that all patients who had a mild swelling regression did not deteriorate or require re‐intubation or re‐admission to the ICU. They were all discharged from the regular ward without any complications.Conclusions:Patients without severe airway compromise could undergo monitoring in the ICU without intubation. Since all patients who began to improve did not suffer from deterioration afterwards, we suggest that even mild airway improvement could be considered as a sufficient criterion for safe transfer of patients to the regular ward.
YouTube as an Information Source for Pediatric Adenotonsillectomy and Ear Tube Surgery
Authors: Pusz Max D. , Sorensen Jeff , Brietzke Scott E. 
Published: August 2013

Objectives:1) Assess the overall quality of information on adenotonsillectomy (TA) and ear tube surgery (BMTT) presented on YouTube from the perspective of a parent searching for information for their child's surgery.Methods:YouTube was systematically searched on select dates with a formal search strategy to identify videos pertaining to pediatric TA and BMTT. Comprehensive search terms were developed to include terms most likely entered by parents/patients seeking information on these procedures. Only videos with at least an average of 5 (BMTT) or 10 views (TA) per day were included. Each video was viewed and scored by three independent viewers. Scores were given for category, goal, video/audio quality, accuracy, comprehensiveness, procedure‐specific content, and total quality. Descriptive statistics and comparison of means analysis (t‐test) were performed.Results:Fifty‐five videos were scored for TA and 47 for BMTT. The most common category was educational (65.3%), followed by testimonial (28.4%) and news program (9.8%). Testimonials were more common for TA than BMTT (41.8% vs. 12.8%, P = 0.001). Testimonials had a significantly lower total quality score than other types of videos (8.7 vs. 9.6, P = 0.035), and news programs had a significantly higher score (10.7 vs. 9.2, P = 0.04). Only six videos (5.9%) received high scores in both video/audio quality and accuracy/comprehensiveness of content. There was no association between the total quality score and views, likes, dislikes, and likes/dislikes ratio. There was an association between likes and video quality (Spearman's rho = 0.262, P = 0.008).Conclusions:Parents/patients searching YouTube for information on these procedures will generally encounter low quality information with testimonials being common but of particularly poor quality.
Adverse Events Associated with Postsurgery of Early‐Stage Oral Cancer in a Phase III Surgical Trial
Authors: Durham J. Scott , Liu Kelly Y. Ping , Chen W. Alice , Poh Catherine 
Published: August 2013

Objectives:1) Investigate the adverse events (AEs) associated with surgery for early‐stage oral cancer. 2) Characterize surgical procedure and its related AEs.Methods:Based on the National Institute of Health/National Cancer Institute Common Terminology Criteria for Adverse Events (v4.0), patient self‐reported AEs post‐surgery in a pan‐Canadian multi‐center phase III randomized controlled surgical trial (the COOLS trial) were captured during the follow‐up visits.Results:From September 2010 to January 2013, 228 eligible patients were recruited and received surgeries, including tumor excision, and/or free flap or neck dissection. Among these, 188 (82%) patients had at least 3 months follow‐up with an average of 24.8±19 months. There were 83 types and 593 counts of AEs from 148 (79%) patients. The most occurring AEs were oral pain (146 patients) and oral dysesthesia (64 patients). Thirty patients (20%) presented with prolonged oral pain (≥3 months) with an average duration of 6.5±10.5 months for Grade I and 2.0±5.6 months for Grade 2 or greater (77 patients). The average duration of oral dysethesia was 18.6±16.4 months with 52 (80%) over 3 months. Univariate analysis had shown that neck dissection and longer surgery time have significant impact on the reported Grade 2 oral pain (P = 0.03 for both). Interestingly, excision type [cold knife (9%) vs. electric knife/laser (23%)] had significant effect on experiencing prolonged post‐surgical oral pain (P = 0.01).Conclusions:Post‐surgical AEs surveillance is critical to understand the factors impacting patients’ quality of life. Concurrent neck dissection has impacts on patients’ experience in prolonged post‐surgical oral pain.
Anxiety, Depressive Symptoms, and Quality of Life in Newly Diagnosed Head and Neck Cancer Patients
Authors: Cash Elizabeth , Self Elizabeth , Wilson Liz , Russ Eric , Bumpous Jeffrey M. 
Published: August 2013

Objectives:Psychological distress, including anxiety and depressive symptoms, is prevalent among newly diagnosed cancer patients. Greater distress may be related to poorer health‐related quality of life (HRQOL). Here we describe a sample of newly diagnosed patients who reported on anxiety, depressive symptoms, and HRQOL upon initial presentation to a multidisciplinary head and neck clinic.Methods:Retrospective medical record review (October 2012 ‐ February 2013) yielded 43 patients (33 male) who provided data of interest. This cohort completed screening measures of anxiety and depressive symptoms (HADS), and health‐related social and physical quality of life (UW‐QOL). These data were provided during the initial clinic visit, prior to initiation of adjuvant treatment. Average age was 61.8 years (SD=13.6). Eighteen (41.9%) patients had oral cavity/laryngeal cancers. Squamous cell pathology was noted in 28 (65%) cases. Many patients (n=19, 44.2%) scored above clinical cutoff for distress. A moderate impact to social‐emotional and physical QOL was also noted. Younger patients had significantly greater anxiety symptoms (r=‐.373, P =. 015), and patients with more advanced cancer reported poorer social‐emotional QOL (r=‐.330, P =. 040). Greater depressive symptoms were related to poorer physical QOL (r=‐.454; P =. 003), especially for those who scored above the clinical cutoff (F(1,42)=7.54; P =. 009).Results:Relationships between psychological distress and HR‐QOL are evident at the time of diagnosis, particularly for patients reporting clinically significant distress. Distress that begins with diagnosis and continues with treatment is also linked with circadian, endocrine, and immune disruption.Conclusions:These pathways are intriguing, as they may mediate relationships to HR‐QOL highlighted here, and warrant further study.
Can We Restrict Selective Neck Dissection for Well‐Differentiated Thyroid Cancer Based upon Preoperative Ultrasound?
Authors: Givens Daniel J. , Hunt Jason P. , Buchmann Luke O. , Abraham Devaprabu 
Published: August 2013

Objectives:Describe the use of preoperative ultrasound lymphatic mapping to restrict the scope of neck dissection for thyroid cancer.Methods:Adults who underwent surgery for well‐differentiated thyroid cancer with lateral neck metastases and had preoperative ultrasound lymphatic mapping were identified by billing codes. A retrospective review was performed. An ultrasound was determined to be diagnostically accurate if no false negative results were present.Results:45 patients were included. Two patients underwent a comprehensive neck dissection levels I‐V, 38 underwent a lateral neck dissection levels II‐IV (level V included 23 times), and five underwent a more restricted selective neck dissection. Nine previously underwent lateral neck dissection, and 32 previously underwent thyroidectomy. Seven patients (15.5%) recurred in the contralateral neck or within the previously‐dissected nodal basin. There were no recurrences in the ipsilateral neck outside the previously‐dissected levels. Median follow‐up was 771 days. Diagnostic accuracy for levels II‐V was 76.1%, 81.6%, 89.8%, and 73.9% respectively. Grouped diagnostic accuracy for levels II‐V was 46.7% (ie no errors in any level). Variables such as experience of ultrasonographer, delay between ultrasound and surgery, and previous surgery did not significantly influence the accuracy of ultrasound. Grouped positive predictive value of levels II‐V was 80.4%.Conclusions:The current study suggests that it is feasible to restrict the scope of selective neck dissection for well‐differentiated thyroid carcinoma based upon the findings of ultrasound lymphatic mapping. High positive predictive value indicates that if suspicious nodes are seen, they should be targeted. Undergoing comprehensive neck dissection did not protect against recurrence.
CD44 Expression in Biopsy Specimens of Patients with Nasopharyngeal Carcinoma Is Associated with Prognosis
Authors: Sagawa Kosuke , Uwa Nobuhiro , Terada Tomonori , Kida Kota , Sakagami Masafumi 
Published: August 2013

Objectives:CD44 is a major cancer stem cell marker, and it has been reported to be associated with biological malignancy in several cancers. However, the potential oncogenic role of CD44 and its clinical/prognostic significance in nasopharyngeal carcinoma (NPC) are unclear. In this study, we evaluated the association of CD44, especially its variant isoforms V3 and V6, with prognostic factors in NPC patients. We examined CD44 expression by immunohistochemical analysis of biopsy specimens obtained from 42 NPC patients who underwent treatment.Methods:The subjects were 42 patients (35 men and 7 women; average age, 56.3 years) who received concurrent chemoradiotherapy (CCRT) consisting of chemotherapy (CBDCA or CDGP or DOC) and radiation therapy (60‐66 Gy) as an initial treatment. Thereafter, the biopsy specimens from these patients were examined immunohistochemically to study the association between CD44 expression (V3, V6) and prognosis of NPC.Results:High CD44 (V3, V6) expression was significantly correlated with increased clinical incomplete response to CCRT at the primary site (P = 0.008 in V3 and V6 by Ï‡2‐test) and poor disease‐specific survival (P = 0.0003 in V3 and P = 0.0029 in V6 by log‐rank test). However, distant metastasis showed no association with CD44 expression.Conclusions:High expression of CD44 (V3, V6) is associated with poor prognosis in patients with NPC. Evaluation of CD44, especially the variant isoforms V3 and V6, may be useful for predicting tumor response to CCRT and prognosis of patients with NPC.
Facial Cleft Repair on Surgical Mission Trips: Safety, Feasibility, and Impact on Quality of Life
Authors: Petersson Rajanya S. , Scott Andrew R. 
Published: August 2013

Objectives:1) Discuss the safety, feasibility, and technical limitations of facial cleft repair performed on medical missions in developing countries. 2) Present several representative cases of oculofacial clefting which were successfully repaired and another that was deferred due to safety concerns and limited resources.Methods:Case series and literature review.Results:On two separate visits over a two‐year period (2011‐2013), 4 patients with orofacial clefts were evaluated. Three oculofacial clefts (Tessier 3 (n=1), Tessier 4 (n=1), and Tessier 4‐10 (n=1)) were successfully repaired. One of these patients had over 1 year of follow‐up. Another patient with frontonasal dysplasia and a wide Tessier 0‐14 cleft was screened and operative intervention deferred.Conclusions:When feasible, a soft tissue‐only repair of oculofacial clefts may offer an acceptable aesthetic result with a reasonable expenditure of resources as part of a larger cleft mission. Facial clefts that require pre‐operative imaging, extended procedure time, bone grafting, significant blood loss, and/or neurosurgical involvement demand a greater expenditure of scarce resources and are not advisable in the context of a surgical mission in most areas of the developing world.
Circulating MicroRNAs as Biomarkers for Papillary Thyroid Cancer: Preliminary Study
Authors: Lee Yoon‐Se , Lim Yun‐Sung , Woo Chang‐Ki , Lee Won‐Yong , Wie Chan‐Eun , Wang Soo‐Geun , Lee Byung‐Joo 
Published: August 2013

Objectives:MicroRNAs can function either as tumor suppressors or oncogenes, and some miRNAs are associated with papillary thyroid cancer (PTC), such as miR‐146b, miR‐155, miR‐221, and miR‐222. We tried to detect miRNAs in serum and analyzed correlation between expression level.Methods:Serum was obtained from patients who underwent thyroidectomy with or without neck dissection from 2008 to 2009. Patients with benign nodule and PTC were divided. In PTC, patients were divided into 3 groups according to N stage. We investigated miRNA expression level by reverse transcription / quantitative PCR kit. It was expressed by log102(‐ΔΔCT), and mean value was compared.Results:We obtained serum from 89 patients comprised of 19 benign nodules and 70 PTC. There were no differences between age or gender. MiR‐146b and miR‐155 were expressed −5.06 (±0.069) and −4.48 (±0.115), respectively in benign, compared to −4.79 (±0.0598) and −4.19 (±0.091) in PTC, respectively. Discriminating between benign and malignant nodule, AUC (area under the ROC curve) was 0.649 in miR‐146b and 0.695 in miR‐155. Although miR‐155 expression of N0 group was not significantly different from that of N1, miR‐155 of benign (‐4.48 ± 0.115) was significantly lower than PTC with lymph node metastasis (−4.22 ± 0.097, P = 0.022).Conclusions:This study was preliminary study to detect miRNA from serum to discriminate benign group from PTC group. MiR‐146b and miR‐155 was increased in PTC group compared to benign. MiR‐155 was increased in lymph node metastasis group compared to benign. Further study using available serum miRNA to predict recurrence or diagnosis of PTC is needed.
Cisplatin+Vinorelbine (DDP+VNB) in Recurrent/Metastatic Salivary Gland Malignancies
Authors: Pecorari Giancarlo , Garzaro Massimiliano , Raimondo Luca , Riva Giuseppe , Sensini Matteo , Salonia Laura , Airoldi Mario 
Published: August 2013

Objectives:Describe clinical outcomes of DDP+VNB chemotherapy (CT) scheme in 60 pts affected by recurrent/metastatic salivary gland malignancies (RMSGM).Methods:From April 2001 to February 2009, 60 cases with RMSGM were enrolled. All patients received the following regimen: DDP 80 mg/sm d.1 + VNB 25 mg/sm d.1,8 every 3 weeks. The study foresees a maximum of 6 cycles.Results:Patient characteristics were as follows: 35 males (58%) and 25 females (42%); median age: 56 yrs (range 20‐68); median ECOG PS: 1 (0‐2); histology: adenocarcinoma 15 (25%), adenoid cystic ca. 34 (57%), others 11 (18%); site of disease: local 30 (50%), mts +/‐ local 30 (50%). Forty‐two patients received DDP+VNB as first line CT (70%) while 18 pts (30%) had the combination as second‐line CT (30%). After a median of 5 cycles of first line DDP+VNB responses were: 3 CR (7%), 10 PR (24%), 14 NC (33%) and 15 PD (36%). After a median of 4 cycles of second line CT responses were: 0 CR; 1 PR (5%), 6 NC (33%) 11 PD (62%). Median survival: 10 months (3‐29) for first line CT; 4 months (1‐12) for second line CT. G3‐4 toxicity: neutropenia (20%), anemia (12%), nausea/vomiting (12%), peripheral toxicity (3%).Conclusions:DDP+VNB is an effective first line CT in RMSGM; second line CT has a low palliative activity. Toxicity seems acceptable. This regimen could be suitable for an integration with new biologic target agents.
Computer Planning in the Research, Analysis and Design of Skull Base Surgical Approaches
Authors: Bly Randall A. , Ramikrishna Rohan , Ferreira Manuel , Moe Kris S. 
Published: August 2013

Objectives:No integrated system exists to plan skull base operations, nor to design and test new surgical approaches. Our objective was to develop a method of surgical planning, selection of optimal surgical approach(es), and design of surgical corridor geometry using a computer model that creates physical models for iterative optimization, pre‐surgery approach trial, and surgical education and evaluation.Methods:The analysis was applied to a specific clinical scenario of accessing the lateral cavernous sinus. A computer analysis was performed to select the optimal surgical approach portal. Once derived, the specific geometry of the surgical corridor was designed for optimal visualization and instrumentation, while applying retraction limit constraints on specific soft tissue structures. A physical model of the surgical pathway was produced for testing, and the resultant approach was performed on 4 cadaver specimens.Results:A lateral retrocanthal transorbital approach was selected based on computer analysis. The pathway length was 55.6 mm (SD: 4.4) to 67.1 mm (SD: 0.7), retraction distance away from orbital rim was 8.2 mm (SD: 0.1), corridor volume was 2,751 mm3 (SD: 736), and cross sectional areas at the portal entrance and greater wing of sphenoid were 127 mm2 (SD: 19.2) and 210 mm2 (SD: 14.0), respectively. Dry lab and cadaver testing validated the computer planning analysis.Conclusions:A method was created and validated to determine the optimal surgical approach and pathway geometry for accessing a specific target pathology. It was robust and is applicable to many clinical scenarios. Initial evaluation in surgical cases has begun.
Concomitant Weekly Cisplatin and Radiotherapy for HPV‐Positive Oropharyngeal Squamous Cell Carcinoma in Japan
Authors: Mizumachi Takatsugu , Homma Akihiro , Sakashita Tohohiro , Kano Satoshi , Hatakeyama Hiromitsu , Fukuda Satoshi 
Published: August 2013

Objectives:The most common chemoradiotherapy regimen is high‐dose (100mg/m2) three‐weekly cisplatin with concomitant radiotherapy; however, this protocol is associated with acute and late toxicities. Recent study demonstrated that human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) patients showed good prognosis. We reviewed the efficacy for concomitant weekly cisplatin and radiotherapy in patients with HPV‐positive OPSCC.Methods:Twenty‐two patients with untreated OPSCC were enrolled and evaluated at our institution from July 2006 to June 2012. Weekly cisplatin (40mg/m2) was given on weeks 1,2,3,5,6 and 7 with radiotherapy, which comprised a standard dose of 70 Gy delivered in 35 daily fractions over 7 weeks. The presence of HPV was analyzed using multiplex PCR method. Median follow‐up time was 26 months for surviving patients.Results:Of the 22 oropharyngeal carcinomas, 13 (59%) were HPV‐positive. Twenty‐one patients (95.4%) received the full dose of radiotherapy. Over the course of the chemotherapy, 14 patients (63.6%) received more than 200 mg/m2 cisplatin. The acute and late toxicity was manageable in all cases. HPV‐positive patients had better two‐year‐overall survival rates (90.0% vs 66.7%) than HPV‐negative patients. For patients who were HPV‐positive, 1 of 13 died of distant metastasis, but those who were HPV‐negative, 1 of 9 died of local recurrence and 2 of 9 died of distant metastasis.Conclusions:Because of its favorable outcome and less toxicity, concomitant weekly cisplatin and radiotherapy appears to be suitable treatment for HPV‐positive OPSCC.
Conservative Management of Postoperative Chyle Fistulas
Authors: Felekis Dimitrios , Gkotsis Antonis , Marinou Athanasia , Chaidas Constantinos , Giopanou Maria , Zacharioudaki Evaggelia , Papouliakos Sotirios 
Published: August 2013

Objectives:1) Describe our experience in the diagnosis and conservative treatment of postoperative chyle fistulas. 2) Introduce a protocol of conservative treatment based on the volume of the chyle drainage.Methods:Over the last 10 year period, 354 neck dissections were performed in our department. Of the 354 patients, 11 (3,1%) developed postoperatively chyle leakage confirmed by biochemical analysis of the drain output. All 11 patients were managed conservatively. Treatment varied according to the volume of drain output. Patients with mean chyle leakage less than 300cc/day (7 patients) were treated with low fat diet and oral nutrition with medium chain triglycerides (MCT). In four cases, the volume of the chyle was over 300cc/day and was adequately managed with combination of total parenteral nutrition (TPN) and somatostatine. Among them, there was a single case that developed an excessive chylous drain output (3100cc) on the third postoperative day after introduction to oral feeding and was also treated conservatively with TPN and subcutaneous administration of somatostatine.Results:None of the patients required surgical intervention. In all patients the amount of chyle decreased after the first day of somatostatine implementation and was resolved successfully in the next three to six days respective to the amount.Conclusions:Conservative management based on the volume of chyle output by means of either combination of low fat diet and MCT oral intake, or combination TPN and somatostatine, may be an efficient treatment in patients with chyle fistulas.
Correlation of Treg Prevalence and Function in Head and Neck Melanoma SLNs to Clinical Outcome
Authors: Ryan Marisa A. , Crow Jennifer , Fisher Samuel R. , Lee Walter T. , Proia Alan 
Published: August 2013

Objectives:Sentinel lymph node (SLN) status is the most important prognostic factor in head and neck melanoma. Regulatory T cells (Tregs) are known to suppress tumor immunity. Indoleamine 2,3‐dioxygenase (IDO) is an enzyme that promotes Tregs to become activated and promote tumor immune escape. Research objectives were to 1) assess Treg Prevalence and IDO in melanoma SLN and 2) correlate these scores with clinical outcome from patients with head and neck melanoma.Methods:Retrospective analysis of clinical and pathologic data of patients with SLN biopsy for head and neck melanoma between March 2004 and September 2011 at a tertiary medical center. Treg cells (CD4+C25+FoxP3+) and IDO were determined by immunohistochemistry. Specimens were scored to determine both intensity and prevalence of Treg and IDO positive cells. Scores were then correlated with clinical outcome using Fisher's exact test.Results:26 total SLN were obtained, with 4 positive for melanoma. 22 SLN were negative for melanoma with 7 of 22 associated with poor patient outcomes (ie recurrence). All three SLN with high scores of Treg and IDO had poor outcomes. 23 SLN had either low Treg or IDO with 10 of 23 having both low. 4 of 23 were correlated with poor outcomes. There was a significant correlation of having high Treg and IDO levels with poor clinical outcome (P = 0.014).Conclusions:FoxP3 and IDO expression in both positive and negative SLN may correlate with poor clinical outcome in head and neck melanoma.