bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteomyelitis following Palatoplasty: A Rare Complication
Authors: Lee Arnold , Insalaco Louis , Scott Andrew R. 
Published: August 2013

Objectives:Raise awareness of potential serious complications of oropharyngeal surgery such as osteomyelitis and discuss the role of perioperative antibiotics in such operations. Explore the events leading up to the development of osteomyelitis in a 13‐month‐old boy following palatoplasty. Discuss the role of perioperative antibiotics in oropharyngeal surgery. Study Design: Single case report with chart and literature review.Methods:We present the case of a 13‐month‐old boy who underwent palatoplasty, received perioperative antibiotics, and subsequently developed group A streptococcal bacteremia along with osteomyelitis of the right calcaneus. A literature review was done to explore the role of antibiotics in oropharyngeal surgery.Results:The patient underwent treatment with antibiotics, and the osteomyelitis resolved.Conclusions:Surgeons and clinicians should maintain a high level of suspicion for bone and joint infections in any child presenting postoperatively with fevers, bacteremia, and musculoskeletal symptoms. The role of perioperative antibiotics in the prevention of severe postoperative infections such as osteomyelitis is unclear. In the era of evidence‐based medicine there is a movement to temper, if not eliminate, the once standard practice of discharging children on a short course of prophylactic antibiotics following palate repair. It should therefore be noted that even when these antibiotics are given, rare infectious complications may still occur.
Radon Levels in Pennsylvania and the Rise in Incidence of Thyroid Cancer
Authors: Goyal Neerav , Camacho Fabian , Mangano Joseph , Goldenberg David 
Published: August 2013

Objective:Determine if there is a temporal association between radon levels and the rise in incidence of thyroid cancer in Pennsylvania.Methods:Ecological study: The Pennsylvania Cancer Registry and the Department of Environmental Protection were used as data sources for this study for the years 1990‐2009. From the registry, geographic information regarding thyroid incidence was recorded. Using SAS, Poisson regression models were fit predicting county level thyroid incidence and change as a function of radon/ lagged radon levels. To account for measurement error in radon levels, a Bayesian Model extending the Poisson models was fit using the winBUGS program.Results:Contour plots showing correlations between radon levels by year and yearly thyroid incidence rates failed to detect any association consistent with a causal connection. In the Poisson modeling, no significant association was noted between county radon level and thyroid cancer incidence (P = 0.23). Looking for a lag between the radon level and its effect, no significant effect was seen for a lag of 0 to 6 years between exposure and expected effect (P = 0.063 to P = 0.59). The Bayesian models fit also failed to show a statistically significant association.Conclusions:While there is evidence of rising levels of radon as well as thyroid cancer in Pennsylvania, the two do not correlate according to our analysis. Through a variety of models, no association could be elicited between radon levels in Pennsylvania and the rising incidence of thyroid cancer. Further studies, such as using an animal model, may be helpful in determining an association.
Reconstruction of the Maxilla with Pedicled Temporalis Muscle
Authors: Bundgaard Troels 
Published: August 2013

Objectives:Resection of the maxilla requires adequate restoration of the maxilla structure to replace form and functions, especially vocal and eating functions. A host of reconstructive options are available to restore the maxilla, most of which include free flap reconstruction. The aim of this study was to clinically evaluate the use of pedicled temporalis flap for reconstruction of the maxilla and to assess patient quality of life.Methods:In the period 2000‐2007, a total of 32 patients with malignant tumors of the maxilla were operated with immediate reconstruction of the maxilla using pedicled temporalis flap at the ear, nose, and throat (ENT) department, Aarhus University Hospital. Follow up was implemented in 2007. Twenty‐seven of 28 patients alive at the time of follow up participated in the study. The patients were evaluated objectively as well as subjectively by answering the European Organisation for Research and Treatment of Cancer's (EORTC's) standard questionnaire concerning quality of life and functional results.Results:Few patients had complaints and these were mostly minor functional deficits. The most common complaints were slightly impaired mouth opening. One temporalis muscle flap necrotized and was removed. Three patients developed oro‐nasal/antral fistula, which were later closed using local flaps.Conclusions:The follow up study of 27 patients showed a most satisfactory result evaluated objectively as well as subjectively using the EORTC questionnaire.
Recurrent Genomic Alterations of FHIT Gene with Impact on Lymphatic Metastasis in Early Oral Carcinoma
Authors: Nam In‐Chul , Kim Chung‐Soo , Cho Kwang‐Jae , Kim Min Sik 
Published: August 2013

Objectives:Determine the role of genetic factors related to the lymph node metastasis (LNM) in early oral squamous cell carcinoma (OSCC).Methods:Array‐based comparative genomic hybridization with individual gene‐level resolution using primary tumor materials from 14 early OSCC patients with (n = 7) or without (n = 7) cervical LNM. To confirm the genomic copy number alterations, immunohistochenical stain was conducted in 30 early OSCC specimens.Results:The number of recurrent (>25%) copy number alterations with LNM group is 34, whereas that without LNM group is 23 by array‐based comparative genomic hybridization in the first cohort. We detected 10 recurrently altered regions (10 losses) associated with cervical LNM (P < 0.05). Among them, loss of 3p14.2 for the FHIT gene was the most frequent one (5 out of 7 patients with LNM, 71.4%) and significantly associated with a worse disease specific survival (P = 0.005). In the independent validation cohort of 30 early OSCC cases, loss of FHIT determined by an immunohistochemical analysis was associated with cervical LNM (P = 0.032) and disease specific survival (P = 0.045).Conclusions:Copy number alterations of FHIT are associated with LNM and poor prognosis, and risk stratification based on the copy‐number status of this gene is useful to select the optimal treatment strategy in early OSCC patients.
Relationship between the Number of Preserved Parathyroid Glands and Clinical Aspects after Thyroidectomy in PTC
Authors: Wie Chan‐Eun , Lim Yun‐Sung , Park Young‐Min , Lee Won‐Yong , Wang Soo‐Geun , Lee Jin‐Choon , Lee Byung‐Joo 
Published: August 2013

Objectives:Identify the relationship between the preservation status of the parathyroid gland and risk of hypoparathyroidism after total thyroidectomy in papillary thyroid carcinoma.Methods:Medical records of 63 patients with papillary thyroid carcinoma who satisfied our inclusion criteria were reviewed retrospectively. Patients with PTC who underwent total thyroidectomy with central lymph node dissection (CLND) were included. Patients were grouped according to the number of intact preserved parathyroid glands into Group 1 (more than four), Group 2 (three), Group 3 (under two). The total and ionized serum calcium, intact parathyroid hormone (PTH) levels of each group were monitored after the surgery. Patients with postoperative symptomatic hypocalcemia were considered to have postoperative hypoparathyroidism and received calcium/vitamin D therapy. The hypoparathyroidism was considered to be permanent when calcium/vitamin D therapy was still required six months after surgery.Results:31 cases (49.2%) showed postoperative hypoparathyroidism as demonstrated by laboratory findings. Permanent hypoparathyroidism did not occur in this case. The development of hypoparathyroidism was not significantly related with the number of preserved parathyroid glands.Conclusions:To prevent postoperative and permanent hypoparathyroidism following total thyroidectomy, at least two parathyroid glands should be preserved in situ with an intact blood supply. Patients with more extensive CLND procedure did not necessarily show an increased rate of transient hypoparathyroidism. With PTC, the rates of metastasis and recurrence in central lymph nodes are high. Therefore, this study suggests that CLND should be more routinely done for PTC. Hypoparathyroidism can be kept to a minimum by a thorough knowledge of the anatomy and by meticulous hemostasis and delicate surgical technique.
Reliability of Sentinel Node Biopsy in Head and Neck Cutaneous Squamous Cell Carcinoma
Authors: Ahmed Mostafa , Moore Brian A. , Schmalbach Cecelia E. 
Published: August 2013

Objectives:Sentinel lymph node biopsy (SLNB) is the standard of care for melanoma staging, but its role in cutaneous squamous cell carcinoma (cSCC) has not been established. This study seeks to: 1) analyze the feasibility and reliability SLNB for head and neck (H&N) cSCC and 2) identify risk factors associated with a positive SLN.Methods:A comprehensive systematic review of MEDLINE, PubMed, Cochrane, and ASCO databases was conducted to identify H&N cSCC SLNB studies with associated recurrence rates. Dual‐blinded data extraction was conducted. Primary outcomes were successful SLN harvest and false omission rate, with secondary outcomes of risk factors for a positive SLN.Results:221 articles were screened; 74 patients from 11 publications met inclusion criteria (3 case series; 8 prospective cohorts). Studies ranged from 1 to 15 patients (median 5), with a median follow‐up of 21 months. Median age was 73.5 years. Average tumor size was 3.08 cm. At least 1 SLN was identified in 100% of patients (median 2.5). 10 (13.5%) had a positive SLN; no additional metastatic nodes were identified in 9 patients receiving completion lymphadenectomy. Tumor size was not associated with SLN status (P = 0.09; 95% CI: ‐.27, 3.02). Additional high risk features (thickness, perineural invasion, location, and differentiation) were inconsistently recorded. 3 of 64 (4.7%) failed regionally in the setting of a negative SLNB.Conclusions:H&N cSCC SLNB is feasible and reliable for staging, with a false omission rate of 4.7%, mirroring that of melanoma. Prospective studies documenting high risk features are required.
The Role of Interventional Radiology in Head and Neck Cancer
Authors: Tulunay‐Ugur Ozlem E. , Kocdor Pelin , Rutledge Jonathan W. , Akdol Mehmet S. , Erdem Eren , Vural Emre 
Published: August 2013

Objectives:Evaluate the indications for endovascular techniques in the management of patients with head and neck squamous cell carcinoma.Methods:Retrospective chart review of patients with head and neck cancer who underwent endovascular embolization. Patients’ demographics, type of cancer, type of cancer treatment, TNM staging, bleeding site, and medical outcomes were recorded from 2004‐2012, at a university medical center.Results:A total of 14 patients out of 1000 undergoing endovascular procedures had an endovascular procedure due to a head and neck cancer. Their ages ranged from 33‐67 years old (mean = 54 years old). 7 patients had oropharyngeal, 3 laryngeal, 1 hypopharyngeal, 2 oral cavity and 1 skin squamous cell cancer. 8 patients had hypertension. 7 patients underwent chemoradiation therapy as a primary treatment. 9 patients with oral hemorrhage underwent emergency embolization due to bleeding and 5 patients underwent elective embolization. Bleeding arose from the common carotid artery in 2 patients, and external carotid artery and its branches in 6 patients, internal carotid artery in 3 patients, internal maxillary artery in 3 patients. Hemorrhage was successfully controlled in all patients. 2 patients had carotid rupture one month post‐embolization and one patient died. At last follow‐up 6 patients were alive with disease, 4 patients had no evidence of disease and 4 patients were dead due to disease.Conclusions:Interventional radiologic techniques are safe and effective treatment techniques not only for treating life‐threatening hemorrhage but also for pre‐emptive management in the treatment of head and neck cancer.
The Role of Macrophage‐Induced Inflammation in Thyroid Cancer Progression
Authors: Saman Masoud , Rajoria Shilpi , Tuli Neha , Hanley Elyse , Shin Edward J. , Tiwari Raj 
Published: August 2013

Objectives:Tumor microenvironment, specifically inflammation‐mediated molecular changes, define tumor phenotype. Papillary thyroid cancer (PTC) is the commonest thyroid cancer and those with tumor associated macrophages (TAMs) portend a poorer prognosis and higher metastatic propensity. Since epithelial‐mesenchymal transition (EMT) is closely linked to metastasis, in this study we examine the cross‐talk between macrophages and epithelial cells in modulating metastatic propensity. The aims of this study are to: 1) investigate ability of the macrophages to induce EMT in PTC, and 2) assess functional changes in PTC in their invasive properties.Methods:In this in vitro study performed in January 2013, normal thyrocytes (NThy‐ori 3‐1) and two papillary cancer cell lines (BCPAP and 8505C,) were treated with either physiologic media (PM) or macrophage conditioned media (MCM) and nuclear and cytoplasmic extracts were obtained. Western blot analysis was performed for expression of EMT markers including slug, twist and snail. Cell morphology, migration and invasion assays were also performed to examine in vitro phenotypic characteristics of tumor cells.Results:EMT markers were modulated in thyroid cells in response to MCM which potentially lead to changes in in vitro phenotypic characteristics of cells including statistically significant (p<.05) upregulation of migration and invasion.Conclusions:Secreted molecules from macrophages lead to EMT as well as increased migratory and invasive properties in PTC. Validation of these findings in human PTC samples is underway to define the clinical relevance the phenotypic changes.
Roux‐En‐Y Gastric Bypass and Thyroidectomy: Risks and Management of Critical and Refractory Hypocalcemia
Authors: Hong Steven S. , Rieth Katherine , Yheulon Christopher , Klem Christopher 
Published: August 2013

Objectives:Discuss the increasing prevalence of gastric bypass surgery and the subsequent metabolic and physiologic changes. Discuss the risks, pathophysiology, and management of critical and refractory hypocalcemia following total thyroidectomies in this population in order to optimize perioperative management.Methods:Retrospective review of three cases of patients with a history of Roux‐En‐Y gastric bypass surgery following total thyroidectomies with or without neck dissections at an academic medical center.Results:All three patients had Roux‐En‐Y gastric bypass surgeries prior to their thyroidectomies. One patient underwent a total thyroidectomy for Graves disease and became symptomatically hypocalcemic with a nadir serum calcium of 6.3 postoperative day three. Patient two underwent a total thyroidectomy with central and lateral neck dissection for papillary thyroid carcinoma (PTC). This patient became symptomatically hypocalcemic with a nadir serum calcium of 6.4 postoperative day two. Both patients required extensive oral and intravenous calcium supplementation with extended hospitalizations. Patient three underwent a total thyroidectomy and central neck dissection for PTC and discharged postoperative day two with stable calcium levels.Conclusions:With increasing popularity of gastric bypass surgeries, thorough evaluation of prior surgeries is crucial for optimal perioperative management in thyroidectomies. Postoperatively if hypocalcemic, these patients appear to be refractory to oral calcium and calcitriol supplementation. They may require extensive intravenous calcium supplementation and prolonged hospitalization to stabilize serum calcium levels.
Salvage of Recurrent Hypopharyngeal Carcinoma after Primary Curative Treatment
Authors: Yasumatsu Ryuji , Nakashima Torahiko , Toh Satoshi , Komune Shizuo 
Published: August 2013

Objectives:Despite improvements in surgery, radiotherapy and chemotherapy, hypopharyngeal cancer has one of the worst prognoses of head and neck malignant disease. In this study, the efficacy of salvage treatment of recurrent hypopharyngeal squamous cell carcinoma (Hypo SCC) after primary curative treatment was evaluated.Methods:The management outcome of 49 patients who had recurrent Hypo SCC between January 2002 and December 2010 at Kyushu University Hospital was reviewed.Results:The mean time of detection of recurrence from the initial treatment was 10 months (range:2‐61 months). The total salvage rates of recurrence were 45% (local: 89%, nodal: 29%, distant: 17%). The 1 and 3‐year tumor‐free actuarial survival rates of those patients who received salvage treatment were 96% and 79%. There was no 3‐year survivor of any patient without salvage treatment.Conclusions:There was a moderate chance of cure after surgical salvage of recurrent Hypo SCC. However, surgical salvage was only feasible for early recurrent tumor. Close follow‐up surveillance of early recurrence is essential after primary treatment of patients.
Submandibular Triangle Masses
Authors: Dalgic Abdullah , Karakoc Omer , Hidir Yusuf , Gamsizkan Mehmet , Karahatay Serdar , Birkent Hakan 
Published: August 2013

Objectives:Retrospectively analyze patients operated due to submandibular triangle mass over 10 years.Methods:The charts of adult patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic findings were reviewed.Results:The study included 66 subjects who had a surgical intervention for submandibular triangle mass lesion. There were 12 patients (18.2%) with submandibular gland sialolithiasis, 18 patients (27.2%) with submandibular gland sialadenitis, 10 patients with lymphadenitis (15.1%) and 17 patients (25.7%) with neoplasia. Benign tumors of submandibular gland comprised 22.7% of all submandibular triangle masses, while malign tumors of submandibular gland comprised 3%. The most common benign tumor of submandibular gland was pleomorphic adenoma. The main symptom was a painless mass. The range of symptoms duration time was 3‐48 months. Ultrasonography was the most common preoperative diagnostic tool. Fine‐needle aspiration biopsy (FNAB) was performed in 26 patients with a correct diagnosis rate of 88%.Conclusions:Submandibular gland lesions are the most common masses located in the submandibular triangle. A detailed medical history, physical and endoscopic examinations, radiologic and histopathologic investigations should be performed for differential diagnosis in order to prevent unnecessary surgeries.
Submandibular (Undescended) Ectopic Parathyroid Glands: Elusive to Surgeons and Localization Studies
Authors: Alam Suhyla , Volsky Peter G. , Silverberg Marc , Wadsworth J. Trad , Karakla Daniel W. 
Published: August 2013

Objectives:High cervical parathyroid adenomas, known as undescended adenomas, occur with a frequency of less than 0.1%, but account for 7% of failed parathyroidectomies. Such cases are scarce in the otolaryngology‐head and neck surgery literature. Preoperative localization of undescended adenomas using Technetium 99‐c sestamibi scintigraphy (sestamibi) is difficult due to uptake and retention of sestamibi by salivary gland tissue.Methods:We present a review of the literature and two surgeons’ experience involving undescended parathyroid glands complicating the treatment of patients with primary (cases 2,3) and secondary (case 1) hyperparathyroidism. In case 1, a 52‐year‐old dialysis‐dependent male experienced recurrent secondary hyperparathyroidism, requiring three operations over two years to excise all parathyroid glands. The right inferior gland was localized to the submandibular region prior to the final operation. In case 2, two sestamibi–single‐photon emission computed tomography scans were proven incorrect when a contralateral undescended adenoma was located in a 54‐year‐old female at surgical exploration. In case 3, a 49‐year‐old male with a non‐localizing scan underwent a failed neck exploration, complicated by acute pancreatitis postoperatively. The surgeon's suspicion of an undescended adenoma was confirmed by computed tomography; the adenoma was excised.Results:When sestamibi scans are inconclusive, the contour and symmetry of uptake in and around the submandibular glands should be scrutinized. Thallium‐pertechnetate subtraction scanning (TPSS) as a second line modality may be useful. Undescended glands must be considered during an unyielding, thorough parathyroid exploration.Conclusions:Surgeons should consider the possibility of undescended adenoma, and use the aforementioned localization techniques when sestamibi scans are inconclusive.
Synchronous and Metachronous Tumors in Head and Neck Cancer: Analysis of the SEER Database
Authors: Chinn Steven B. , Spector Matthew E. , Prince Mark E. , Sun Gordon H. 
Published: August 2013

Objectives:1) Describe the prevalence of synchronous and metachronous second primary tumors in head and neck cancer patients. 2) Determine the overall survival rate of patients with second primary tumors based on location of index tumor, number of accumulated tumors, and synchronicity or metachronicity.Methods:Population based study (1973 to 2008) using the Surveillance, Epidemiology, and End Results (SEER) database. Inclusion criteria were patients with non‐esophageal mucosal head and neck squamous cell carcinoma (HNSCC) and no previous diagnosis of cancer. Synchronous tumors were defined as diagnosed within 6 months of identification of the index tumor, while metachronous tumors were diagnosed more than 6 months after the index tumor.Results:There were 58,363 HNSCC patients (M:F 42,794: 15,569) in the SEER database. Eleven percent (6,855) developed a second primary. The prevalence of head and neck and non‐head and neck second primary tumors was 3.2% (1,885) and 8.5% (4,970), respectively. Of the 1,885 patients with a second primary in the head and neck, 32% (602) were synchronous, 68% (1,283) were metachronous. Of the 4,970 patients with a non‐head and neck second primary, 21% (1056) were synchronous and 79% (3914) were metachronous. Overall survival was significantly worse in patients with second primary tumors and by total number of accumulated tumors (synchronous or metachronous; P = 0.045 and P < 0.001, respectively).Conclusions:The majority of patients with head and neck squamous cell carcinoma who developed synchronous or metachronous tumors are of non‐head and neck origin. The development of multiple second neck primaries confers a worse prognosis.