bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching and Assessing Microscopy Skills in Medical Students
Authors: Wong Stephanie Jung‐Ying , Devaiah Anand K. 
Published: August 2013

Objectives:Otolaryngology residents learn important skills as medical students, but typically not binocular microscopy. This study aims to 1) evaluate instructional methods teaching medical students binocular microscopy, 2) assess student ability to perform simulated clinical tasks, and 3) measure student feedback on this training.Methods:Fifteen students were randomized into one of three training arms: 1) video instruction, 2) personal demonstration, and 3) combination of video and personal instruction. Time to complete two tasks was used to determine training effectiveness. Task 1: focus on an object in a cup; Task 2: focus and use alligator forceps to remove the object from the cup. For each subject, three trials were done for each task at three magnifications. Participants filled out pre‐ and post‐study questionnaires.Results:Groups were compared using one‐tail t‐tests. For Task 1, there was no significant difference between educational methods. For Task 2, those who received any video instruction were significantly faster at focusing than those who only received personal instruction (10.35s and 11.19s vs. 14.80s; P < 0.01 and P = 0.02). Those who had video and personal instruction were faster at the manual task than those receiving only personal instruction (17.58s vs. 23.02s; P = 0.04). Post‐training questionnaires showed greater interest in surgical specialties, particularly otolaryngology.Conclusions:Video instruction plus personal instruction enhances learning clinical microscopy. This may be extrapolated to other skills students and residents must learn. This training is perceived as positive by students and may be important in teaching, as well as in the residency selection process.
Three‐Dimensional, Virtual Technologies and Haptic Simulation Temporal Bone Surgical Training
Authors: Liu Chih‐Hsien , Fang Te‐Yung , Wang Pa‐Chun , Yeh Shih‐Ching 
Published: August 2013

Objectives:Simulation has become an important teaching format in medical education; it is especially useful to teach complex anatomy of temporal bone (TB). We developed a TB simulator consisting of 1) software with high resolution three‐dimensional (3D) TB volumetric images; 2) A haptic device from which the user can sense the force feedback and the sound of drilling. The aim of this study is to evaluate and compare the effectiveness of TB simulator in medical student teaching.Methods:A total of 18 rotating medical students were randomly assigned to the “simulation” (N = 13) or “traditional’ (N = 5) TB training groups. Both groups were oriented with TB anatomy and dissection procedures by slide presentation and didactic lecture. The simulation group practiced on the simulator to complete 1 session of TB dissection. Written examinations were given at day 0 and day 14. Using paired t‐test, the before‐after test scores were compared between simulation and traditional groups.Results:Both groups showed significant improvement in their comprehension to TB anatomy. The anatomy comprehension showed 10% improvement in traditional and 20% in simulation groups, respectively (P < 0.05) The written examination showed that the “simulation” group had significantly greater magnitude of improvement (40 vs. 20 points) than “traditional” group. (P < 0.05).Conclusions:The test results confirm that the 3D, virtual technology, and haptic simulator might be a worthwhile and superior substitute to traditional class‐based lecture in teaching TB anatomy.
Unexplained Recurrent Subcutaneous Emphysema of the Face, Neck, and Mediastinum in an Otherwise Healthy Adult
Authors: Rangarajan Sanjeet V. , Agrawal Amit 
Published: August 2013

Objectives:1) Understand the presentation and work‐up of a rare cause of recurrent, diffuse subcutaneous emphysema in the head and neck. 2) Apply the findings from this case report and related literature.Methods:We describe a case of a 23 year‐old man who presented to the Emergency Department at a tertiary care center complaining of an acute onset of diffuse swelling throughout his face, neck, and chest.Results:The full diagnostic work‐up for this patient included routine laboratory studies, computed tomography (CT) imaging of the head, neck, and chest, fluoroscopic esophagram, and prior esophagogastroduodenoscopy and bronchoscopy. Thoracic and otolaryngology consultations were sought. The patient demonstrated a leukocytosis and severe, diffuse subcutaneous emphysema throughout the face, neck, and mediastinum visible on CT imaging. The remaining work‐up was negative for organic causes. Several small, inconspicuous wounds were noticed on the patient's right cheek and buccal mucosa, consistent with self‐inflicted needle injuries. It was determined that the patient had intentionally created percutaneous facial and neck defects with a needle and expired against a closed glottis to create the observed symptoms. A psychiatry consultation was sought, and the patient was discharged shortly thereafter in stable condition. A review of the literature suggests that this factitious etiology of subcutaneous emphysema is quite rare and emphasizes the importance of the physical exam the consulting otolaryngologist may employ when evaluating new patients.Conclusions:Factitious subcutaneous emphysema in the United States is a rare, seldom reported finding in the otolaryngology literature but may be suspected when the patient has a prior history of psychiatric disorder or self‐harm and work‐up for organic causes is negative.
Analysis of the Effect of Metformin in the Treatment of Oral and Oropharyngeal Cancer
Authors: Seok Jungirl , Kim Hyo‐Sang , Kim Heejin , Hah J. Hun , Sung Myung‐Whun , Ahn Soon‐Hyun , Jeong Woo‐Jin 
Published: August 2013

Objectives:Patients with diabetes mellitus (DM) are at significantly higher risk for many forms of cancers. There have been studies about the effect of metformin in cancer, but few studies presented in head and neck cancer. In this study, we investigated the anti‐cancer effect of metformin in oral and oropharyngeal cancer.Methods:Patients with type II DM who were diagnosed with oral and oropharyngeal cancers and treated in our institution from 2004 through 2010 were enrolled. Medical records, imaging, and pathologic reports were reviewed retrospectively.Results:Of 2286 patients who were diagnosed with head and neck cancers in that period, 8.6% of patients had type II DM, and eventually 68 patients were enrolled. Half of them had history of using metformin, and mean age was 69.3 years. Metformin usage did not affect overall survival (P =. 359) and recurrence (P =. 538) in oral and oropharyngeal cancer patients. The same results were shown when patients limited in squamous cell carcinoma and early stage cancer.Conclusions:Metformin usage was not associated with favorable survival or recurrence outcomes in oral and oropharyngeal cancer patients. Subset analysis revealed possible association of metformin usage with pathology/stage. A large prospective cohort study is warranted to elucidate the effect of metformin usage on oral and oropharyngeal cancer.
Curcumin Analogue May Be Used as Therapeutic Agent for Head and Neck Cancer
Authors: Patel Ronica R. , Masood Rizwan , Sinha Uttam K. , Prakash G. K. Surya 
Published: August 2013

Objectives:Curcumin has shown anti‐proliferative effects in multiple cancers and is an inhibitor of NF‐kB. Downstream curcumin inhibits various genes which play an important role in tumor growth and metastasis. However, curcumin's effects are greatly diminished due to its poor solubility. This study compared the effect of curcumin against more soluble curcumin analogues on the cell proliferation and gene expression in head and neck cancer (HNC) cell lines.Methods:Two novel curcumin analogues were synthesized, 1‐flouro‐curcumin (CF1) and 2‐flouro‐curcumin (CF2), which have shown increased solubility compared to curcumin. Our lab developed three HNC cell lines: 351GFP, 351GFP G1, and 351GFP G2. 351GFP G1 and 351GFP G2 are more metastatic HNC cell lines. The effect of CF1 and CF2 was tested in these three cell lines on the cell growth and the inhibition of genes (IL8, MMP7, COX2, and epidermal growth factor receptor [EGFR]) which are important in growth and metastasis of HNC.Results:The IC50s of curcumin, CF1, and CF2 in the 351GFP G1 cell line are 7.38microM, 0.33microM, and 0.1microM, respectively. Curcumin analogues were 20‐80 times more potent than curcumin. Western Blot analysis showed that curcumin analogues blocked expression of IL8, MMP7, COX2, and EGFR. The analogues also showed several fold greater inhibition of these genes compared to curcumin in the HNC cell lines.Conclusions:Both curcumin analogues show greater anti‐proliferative effect than curcumin, inhibiting cell proliferation and expression of genes involved in HNC growth and metastasis. Because of their increased activity, curcumin analogues may be of potential benefit in future HNC therapies.
Dynamic Risk Stratification for Recurrence in Medullary Thyroid Cancer
Authors: Ho Allen S. , Palmer Frank L. , Shah Jatin P. , Tuttle R. Michael , Ganly Ian 
Published: August 2013

Objectives:Develop a dynamic postoperative risk stratification tool for medullary thyroid cancer (MTC) recurrence, based on patient, tumor and treatment characteristics.Methods:124 MTC patients who were treated entirely at Memorial Sloan‐Kettering Cancer Center between 1986‐2010 were identified. Immediate postoperative risk groups were defined as low, intermediate, and high based upon extent of extrathyroid extension, presence of regional or distant metastases and preoperative calcitonin level. Response to therapy categories were then defined as excellent, acceptable, and poor based upon 6‐month calcitonin level and presence of radiological structural disease. Overall risk groups based upon the immediate postoperative risk and the response to therapy category were then defined.Results:The median age was 55 years (range: 6‐88). Median follow‐up was 66 months (range: 1‐229). In the immediate postoperative risk groups, the 5‐year risk of structural recurrence for low, intermediate, and high risk groups was 5.9%, 24.9%, and 67.8% respectively (P < 0.001). For the overall risk groups, the 5‐year risk of structural recurrence for low, intermediate, and high risk groups was 3.2%, 24.0%, and 45.9% (P < 0.001). Low risk patients with poor responses increased their recurrence risk from 5.9% to 24.9%, while high risk patients with excellent responses reduced their recurrence risk from 67.8% to 24.9%.Conclusions:A clinically useful dynamic risk stratification tool to predict risk of recurrence in MTC patients over time is introduced. Its prognostic value may augment patient counseling on prognosis and help determine the frequency and extent of follow up investigations.
The Effect of Geography on Survival of Patients with Oral Cavity Squamous Cell Carcinoma
Authors: Zhang Han , Nguyen T. T. Jean , Jeffrey Caroline C. , Biron Vincent L. , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi 
Published: August 2013

Objectives:Patients with oral cavity squamous cell carcinoma (OCSCC) residing in urban setting have traditionally improved survival. The main theory of the urban effect on survival is improved access to healthcare. We aimed to evaluate effects of residing in an urban setting on the survival of patients with OCSCC in a system with universal access to health care.Methods:This is a population based study set in the province of Alberta, Canada. Demographic, pathologic, treatment, and survival data was obtained from all patients diagnosed with OCSCC in the province of Alberta between 1998 and 2010. The overall and disease specific survival were calculated using Kaplan‐Meir and Cox‐Regression analysis. The log rank test was employed for comparisons between groups.Results:A total of 624 patients were included. There was no difference between patients residing in an Urban or rural setting in regards to, stage, demographics, and treatment paradigms. Urban patients benefitted from 5 and 10 year overall survival improvements (77.4%, P = 0.04) and early stage OCSCC (83.4%, P = 0.002).Conclusions:OCSSC patients residing in an urban setting have improved survival. Factors other than access to health care seem to be causing this effect.
Endoscopic Evaluation of the Local Complications after Radiotherapy and Radiochemotherapy for Nasal Cavity, Nasopharynx Neoplasms
Authors: Kizler‐Sobczyk Krystyna , Sobczyk Grzegorz , Wójtowicz Piotr , Nowakowski Filip , Mazurek Maciej J. , Kawecki Andrzej , Krzeski Antoni 
Published: August 2013

Objectives:Determine complications of the radiotherapy or radiochemotherapy in patients with nasal cavity, pharynx and soft palate neoplasms in endoscopic examination.Methods:Out of 184 patients for nasal cavity, pharynx or soft palate neoplasm, 65 patients with previous surgical intervention were excluded from the study. Group of 119 patients (19‐87 years old) were evaluated endoscopically in the Head and Neck Cancer Department of the Memorial Cancer Center in Warsaw between 2000 and 2012. Follow up was from 30 days up to 12 years. 115 patients were treated for cancer, 1 for sarcoma and 3 for melanoma. Nasopharynx was a primary localization in 74 cases, nasal cavity in 9 cases, soft palate in 4 cases. In 32 cases there were metastases to the regional lymph nodes without the primary focus. 31 patients were treated by radiotherapy, and 88 by radiochemotherapy.Results:The following complications were diagnosed: 47 skin and mucosal reactions, 23 permanent nasal cavity obturations, 11 hearing impairments, 6 ear leakages, 2 tinnituses, 2 vision impairments, 2 trismuses, 2 obturations of nasolacrimal canal, 2 Eustachian tube obturations, 2 palatal movement impairments 1 case of mandible bone exposition. There were also 3 cases of tissue necrosis and one case of bleeding. There were 13 cancer recurrences treated by 3 salvage surgeries, 1 brachytherapy, and 3 palliative chemotherapies.Conclusions:The regular endoscopic examinations allows to control negative aspects associated with radiotheraphy or radiochemotherapy. Complications and recurrence can be diagnosed easily by non‐invasive, method. Endoscopic evaluation provide quick and precise assessment of treatment results.
Exome Sequencing Identifies Patterns of Disruptive Mutations in Oropharyngeal Squamous Cell Carcinoma
Authors: Janus Jeffrey R. , Laborde Rebecca R. , Olsen Steven , Olsen Kerry D. , Moore Eric J. , Kasperbauer Jan L. , Smith David 
Published: August 2013

Objectives:1) Describe the frequency of disruptive gene mutations in current or never smoking patients. 2) Analyze coding regions to identify tumor specific nonsense mutations in genes related to tumor development and critical signaling pathways.Methods:Tumor and adjacent normal oropharyngeal mucosal samples were obtained from 8 patients undergoing surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) from 2010‐2012 representing HPV positive current and never smoking groups. Next generation sequencing following exome enrichment was performed to identify various classes of variants from each sample. Comparative analysis was conducted using Genesifter from PerkinElmer.Results:A global analysis of all mutation types determined that tumor tissues from current smoking patients contain 20% more missense mutations than never smoking groups, resulting in an amino acid substitution. Current smoking patients have tumor specific nonsense mutations in coding regions enriched for tumor suppressor genes and displayed extensive evidence of identical mutation in tumor and adjacent normal tissue. Never smoking patients have a greater number of tumor specific mutations that enrich for genes related to immune system function.Conclusions:Gene mutations that result in truncated proteins are known to associate with cancer development. We have identified a panel of nonsense mutations in current smoking patients that represent tumor suppressor and cell cycle regulatory genes. This group also shows extensive evidence of field cancerization. Never smoking patients carry larger numbers of tumor specific mutations than enrich for genes related to immune system regulation. This may reflect the involvement of active HPV infection in this group.
Factors Associated with Hypothyroidism following Hemithyroidectomy: A Prospective Study
Authors: Chowsilpa Sanathorn , Tananuvat Rak 
Published: August 2013

Objectives:Analyze factors associated with hypothyroidism following hemithyroidectomy.Methods:Prospective study at Chiang Mai University Hospital, Thailand. Patients who were scheduled for a hemithyroidectomy between September 2010 and April 2012 were recruited for the study. Demographic data, pre‐ and post‐operative thyroid function tests, resected side, weight and pathological diagnosis of resected thyroids between the euthyroid and hypothyroid groups were analyzed.Results:Of 50 cases, 11 cases with documented malignancy, or who required a total thyroidectomy, or who were lost to follow up were excluded. Thirty‐nine cases included seven males and 32 females, age ranged from 19 to 71 years (46.9±13.8 years). The resected thyroids were from the left (25) and the right (14). The pathology reports were as follows: adenomatous goiter (67%), follicular adenoma (20%), colloid cyst (5%), chronic lymphocytic thyroiditis (3%), and others (5%). Eight cases (20.5%) had hypothyroidism postoperatively at eight to ten weeks. The pre‐operative thyroid‐stimulating hormone (TSH) level of the hypothyroid group was normal but significantly less than in the euthyroid group (P = 0.009). Age, gender, pre‐operative free T4 and free T3, weight and resected side showed no difference between the two groups.Conclusions:One‐fifth of the hemithyroidectomy patients developed hypothyroidism within eight to ten weeks post‐operatively. Clinicians should be aware of post‐operative hypothyroidism and provide prompt treatment, particularly in patients with a pre‐operative high normal TSH level.
Feasibility and Monitoring of a Free Myofascial Anterolateral Thigh Flap in Head and Neck Reconstruction
Authors: Plein Colleen T. , Cannady Steven B. 
Published: August 2013

Objectives:1) Explore the feasibility of a free anterolateral thigh myofascial flap as a reconstructive option in patients with large body habitus. 2) Present a prospective case series of patients in which this flap was successfully utilized for head and neck reconstruction. First introduced in China, the anterolateral thigh free flap is being increasingly used in head and neck reconstruction. However, patient body habitus, particularly in North American patients, can contribute to flap bulkiness and pose a significant surgical challenge.Methods:In a prospective case series, feasibility and results using a myofascial anterolateral thigh free flap were studied, an option previously unpublished in the head and neck reconstructive literature. We present five cases of its successful use in a variety of reconstructive situations. It was utilized twice for hemiglossectomy, once for scalp reconstruction, and twice for skull base defects.Results:All five flaps survived. Primary monitoring was conducted routinely via needle prick of the myofascial flap or direct muscle inspection. No complications were encountered at the harvest or reconstructive site. The fascial flap was well vascularized and muscle remained viable, while atrophy occurred in follow up.Conclusions:The anterolateral thigh myofascial flap is a versatile composite tissue flap that allows the use of the anterolateral thigh site in patients with larger body habitus. It can be monitored using routine techniques with good reliability. This flap may have applications in cases where radial forearm or rectus may have been used but forearm or abdominal wall harvest morbidity is undesirable.
The Feasibility of Free Flap Surgery in Foreign Medical Missions
Authors: Rohde Sarah L. , Mannion Kyle , Zender Chad A. , Sinard Robert J. 
Published: August 2013

Objectives:Determine the feasibility and efficacy of microvascular free flap reconstruction of head and neck defects during foreign medical mission trips in the low resource setting.Methods:Retrospective review of foreign medical mission trips by a single tertiary care institution. Eight patients with benign tumors of the maxilla or mandible underwent microvascular free flap reconstruction of a head and neck defect following composite resection. Patient charts were reviewed for demographic data, reconstruction type, tumor location, pathology, length of stay, complications, and follow‐up.Results:Eight patients underwent free flap reconstruction during four trips taking place over the span of two years in three different hospitals in Kenya. Seventy‐five percent of patients were male and the average age was 26. Final pathology was benign in all patients. There were no flap failures. One patient had a small fistula managed with packing and secondary closure.Conclusions:Free flap reconstruction of head and neck defects is feasible in the foreign medical mission setting. Careful patient selection and diligent pre‐operative planning for supplies is necessary. Partnership with a local physician comfortable with the care of the patients in the post‐operative setting is extremely helpful.
Fine‐Needle Aspiration Cytology versus Direct Laryngoscopic Biopsy in Suspicious Laryngo‐Hypopharyngeal Masses
Authors: Parasuraman Lakshminarasimman , Singh Chirom A. , Sharma Suresh C. , Thakar Alok , Iyer Venkateswaran , Bhalla Ashu S. 
Published: August 2013

Objectives:Evaluate the feasibility and performance of ultrasound‐guided fine needle aspiration cytology (FNAC) of suspicious laryngo‐hypopharyngeal masses.Methods:Cross‐sectional study (2012‐2013). After routine clinical and radiological evaluation, patients with advanced laryngo‐hypopharyngeal masses were included in the study. Early lesions and vascular masses were excluded. In all patients, ultrasound guided FNACs were performed with a free‐hand technique by a single radiologist and direct laryngoscopic biopsies were done on the subsequent day.Results:A total of 10 patients met the criteria for the study. Nine patients were primary cases and one was recurrent. There were 8 males and 2 females in the age group of 40‐73 years. Ultrasound guided FNAC reported squamous cell carcinoma in 8 patients, atypical cells in one patient and the remaining one had inadequate specimen. There was no complication following the procedure. In direct laryngoscopic biopsies 8 patients were positive for squamous cell carcinoma and two were negative. Ultrasound guided FNACs in these two negative cases were positive for squamous cell carcinoma. One case was a recurrent tumor and in the other, direct laryngoscopic biopsies were done twice. Both the patients were inoperable due to advanced disease and palliative treatments were planned based on FNAC reports.Conclusions:Although biopsy under direct laryngoscopy remains the gold standard technique, ultrasound guided FNAC can be used to diagnose advanced laryngo hypopharyngeal lesions. It is simple, safe, cost effective, and done as an out‐patient procedure. It seems to be more beneficial in deep seated submucosal tumors.