bluuebunny/crossref_metadata_2025_split huggingface dataset:
Day Case Hemithyroidectomy: The Scottish Experience
Authors: Kasbekar Anand V. , Lupton Kenneth , Blacoe David , Kang Swee K. 
Published: August 2013

Objectives:Analyze our new patient pathway that practices day‐case hemithyroidectomy.Methods:Prospective re‐audit of patients undergoing primary hemithyroidectomy over 2 years (January 2010‐January 2011) and compared it to the first cycle in January 2008‐January 2009. Procedures were done by a single surgeon and anaesthetist in a district general hospital. Drains were never used. In the latest audit cycle, all patients underwent standardized anaesthesia and surgical procedures, including pain and nausea management. Patients completed questionnaires at discharge and follow‐up 1‐2 weeks postoperatively. Hospital stay, complications, and patient satisfaction scores were recorded.Results:The first cycle (54 patients) demonstrated that a third of patients stayed at least 1 night and two thirds stayed 2 nights or more. Following a new protocol, the latest audit cycle (62 patients) demonstrated a 75% day‐case rate (P < 0.0001). 98% of day‐case patients were happy (questionnaire scoring 8/10 or greater) to be discharged on day of surgery. Of the 25% who stayed overnight, 50% had surgery in the afternoon compared to 21% in the day‐case group (P =0.015). 80% of all patients did not need opioid analgesia. 5% had problems with postoperative pain and nausea and were likely to stay overnight. There were no readmissions. Subjective and objective patient experience data will be discussed as well as our hemithroidectomy patient pathway.Conclusions:Successful day case hemithyroidectomy relies on preoperative counseling, specific anaesthesia techniques, meticulous surgery. and careful patient selection. Day case hemithyroidectomy can be safely undertaken in the vast majority and is highly desirable by patients.
Fibula Free Flap Survival after Early Arterial Avulsion
Authors: Reilly Michael , Chu Eugenia 
Published: August 2013

Objectives:1) Recognize factors that influence free flap survival. 2) Describe early neovascularization in free tissue transfer.Methods:Retrospective case report.Results:A 58‐year‐old male patient underwent composite resection with fibula osteocutanous free flap reconstruction for a floor of mouth squamous cell carcinoma involving the anterior mandible. On postoperative day 10, the patient was found to have a rapidly expanding neck hematoma and intraoperatively was found to have complete arterial avulsion of the pedicle. No revision microanastomosis was performed due to the lack of an available microsurgeon. Although arterial inflow to the vascular pedicle was lost, the flap showed 100% survival at 4 weeks post‐op. This rare outcome suggests early neovascularization in this free tissue transfer. The exact timing of neovascularization in free flaps is not clearly delineated. Experimental animal models have suggested neovascularization as early as postoperative day 7. Review of the literature shows that successful neovascularization is dependent on many factors, especially previous radiation treatment, quality of the recipient site, infection, and vascular ischemia.Conclusions:This and other rare case reports of maintained flap viability despite loss of the vascular pedicle suggest early neovascularization. This report stresses the importance of flap surveillance in order to avoid premature flap revision in cases of early neovascularization.
Diagnostic Value of FNA‐BRAF Mutation Analysis in Papillary Thyroid Cancer: A Systematic Review and Meta‐analysis
Authors: Fnais Naif , Soobiah Charlene , Idriss Hend , Dong Bin , Straus Sharon , Tricco Andrea 
Published: August 2013

Objectives:Fine needle aspiration (FNA) with cytological analysis is an initial step in investigating thyroid nodules. We systematically reviewed the diagnostic value of adding B‐type Raf kinase (BRAFV600E) gene mutation analysis to the conventional FNA in the diagnosis of papillary thyroid cancer (PTC).Methods:Studies reporting BRAFV600E mutation analysis following FNA for evaluation of thyroid nodules were identified through searching electronic databases (eg, MEDLINE, EMBASE) through 1948‐2011, scanning reference lists of relevant studies, and contacting experts. Two independent reviewers screened literature results, abstracted data, and appraised study quality. Meta‐analysis of sensitivity and specificity was performed using bivariate random effects models.Results:Forty‐two studies met our inclusion criteria after screening 787 citations and 117 full‐text articles. The included studies enrolled approximately 7,676 patients with 8,196 FNA samples evaluated for BRAFV600E mutation. Bivariate‐pooled sensitivity and specificity results from 29 included studies that examined BRAFV600E mutation among cytologically confirmed PTC samples were 72.6% (95% confidence interval [CI] 66.1‐78.3%) and 50.8% (95% CI; 32.3‐69.1%), respectively. For samples that were diagnosed cytologically as suspicious for PTC, and confirmed by histology as PTC, bivariate‐pooled sensitivity and specificity results were 52.1% (95% CI; 36.3‐67.4%) and 85.3% (95% CI; 55.2‐96.5%), respectively. Eleven studies reported non‐diagnostic FNA samples. The pooled sensitivity and specificity results for these samples were 50.5% (95% Cl; 31‐69.8%) and 92.9% (95% Cl; 74.2‐98.3%), respectively.Conclusions:BRAFV600E mutation analysis is associated with increase specificity and moderate increase in the sensitivity of FNA in the diagnosis of papillary thyroid cancer.
Endoscopic Retro‐auricular Thyroidectomy: A Preclinical Feasibility Study in Three Cadavers
Authors: Lee So‐Yoon , Sun Dong Il , Ahn Su Hyun , Lee Il Hwan , Park Young‐Hak 
Published: August 2013

Objectives:A number of remote‐access thyroidectomy techniques with the assistance of endoscopic or robotic technology have been described. Most gasless endoscopic thyroidectomies require additional incision on the chest or mammary areola for instrumentation. Recently, Terris DJ et al. developed a novel remote‐access robotic facelift thyroidectomy technique. We aimed to evaluate the preclinical feasibility of endoscope‐assisted thyroidectomy and central neck dissection via retro‐auricular single incision in three cadavers.Methods:Three fresh, unembalmed human cadavers were used. A 5‐mm, 30‐degree rigid telescope, endoscopic instruments, and a Harmonic scalpel were used. Working space was created through the retro‐auricular incision. Surgical procedures included the identification and ligation of the superior thyroid pedicle, peri‐thyroid fascia dissection, dissection of the inferior pole, identification of the recurrent laryngeal nerve (RLN), dissection near the Berry ligament, and isthmusectomy.Results:We successfully performed total thyroidectomy and central neck dissection in all three cadavers. In all thyroidectomies, the RLN and superior or inferior parathyroid glands were preserved. There was no tracheal or esophageal injury. To confirm surgical completeness after thyroidectomy and central neck dissection, we analyzed the specimen to determine if there was violation of the thyroid capsule, and we reviewed the surgical field to check for remnant thyroid tissue. There was neither capsule injury in the specimen nor remnant thyroid tissue in the surgical field. The working space was adequate for the instrumentation, and no additional incision was needed.Conclusions:Our study demonstrates the feasibility of endoscope‐assisted thyroidectomy using a gasless, retro‐auricular single approach that results in safety, surgical completeness and sufficient access.
Enhanced Recovery Achieving the Aims of Head and Neck Cancer Surveillance: A Traffic Light System
Authors: Lee Alexandra M. , Oakley Richard J. , Joshi Anil , Lyons Andrew , Simo Ricard , Urbano Teresa G. 
Published: August 2013

Objectives:Post‐treatment head and neck cancer surveillance (PTHNCS) shows inconsistency in the duration of surveillance and frequency between reviews; its rationale is controversial although generally accepted. We pilot a PTHNCS that uses the principles of enhanced recovery and implements the recommendations of the Head and Neck Cancer multi‐disciplinary 2011 guidelines (HNCMDG).Methods:Retrospective review. The recommendations of the HNCMDG 2011 were used to generate a 15 visit, 5 year PTHNCS protocol. A traffic light analogy explains its rationale and reinforces the positive implications associated with progression to patients. A patient appointment/information card has been developed to outline the five year surveillance schedule and highlight red flag symptoms that suggest recurrence and require early review. The follow up of all patients who completed chemoradiation for HNC in the first half of 2011 was compared.Results:47 patients received treatment: 21 patients on PTHNCS protocol, 20 (95%) attended the minimum number of visits, 4 requested additional reviews (one for a synchronous primary), none lost to follow up, 1 died. 26 patients followed at the clinicians discretion, 11 (42%) attended the minimum number of appointments, 2 did not, 1 never saw the surgical team, 1 lost to follow up, 11 died.Conclusions:Empowering patients to participate in their follow up while educating them as to symptoms that require earlier review allows an increase in interval follow up of asymptomatic patients. Symptomatic patients initiate an earlier review. Fewer patients are lost to follow up.
Extensive Nasopharyngeal Angiofibromas: The Maxillary Swing Approach
Authors: Mathur Neeraj N. , Vashishth Ashish 
Published: August 2013

Objectives:Evaluate the efficacy and outcome of the maxillary swing approach for management of extensive nasopharyngeal angiofibromas.Methods:Retrospective analysis in a tertiary care center revealed 5 patients with extensive nasal angiofibromas operated on using the maxillary swing approach between 2010 and 2012. All patients had tumor extension to lateralmost portions of infratemporal fossa with complete occupation, destruction of lateral wall of sphenoid sinus causing abutment to cavernous sinus, and complete involvement of pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of maxillary sinus in consequence to erosion of posterior and medial walls of maxillary sinus, with another causing severe temporal lobe compression through roof of infratemporal fossa. All patients underwent tumor excision with the maxillary swing approach. Patients were followed up for a minimum period of one year after surgery.Results:The maxillary swing resulted in an optimal exposure of the entire central skull base including the infratemporal fossa and its far lateral and superior aspects. An adequate tumor exposure and vascular control could be achieved in all cases resulting in complete tumor excision. The mean operative time was 4.1 hrs. Postoperative healing was satisfactory with palatal fistula formation in 2 cases with all patients remaining disease free till present. One had minimal misalignment of the halves of upper jaw and two had epiphora, of which one required dacryocystorhinostomy.Conclusions:The maxillary swing is an effective approach in management of extensive nasopharyngeal angiofibromas and leads to an optimal anatomical exposure with minimal morbidity.
Maxillectomy Reconstruction with Various Flaps: Preliminary Results and Suggested Algorithm
Authors: Kim Heejin , Kim Dong Wook , Chang Hyun , Cha Wonjae , Sung Myung‐Whun , Kim Kwang H. , Hah J. Hun 
Published: August 2013

Objectives:Although maxillary reconstruction after maxillectomy for the malignant tumor is still controversial, various reconstruction techniques have been introduced. Since reconstruction methods could be varied by the defects and surgeon's preference, we would like to share our reconstruction algorithm and show preliminary results.Methods:Thirteen cases of maxillectomy reconstruction during the past 18 months were reviewed. The types of defects, reconstruction methods, and outcomes were reviewed. The types of defects after maxillectomy were as various as Brown class IIa, IIb, IIIb, IIId, IVb, IVd, and V. Reconstructions were performed using free flaps from the iliac crest, radial forearm, rectus abdominis, and latissimus dorsi. When the maxillectomy included orbital exentration, soft tissue free flaps for defects were preferred. On the other hand, defects for bony lesions including alveolar ridge and orbital rim were reconstructed with iliac crest osteomuscular (or osteomusculocutaneous) free flap.Results:All of them were well reconstructed without any complication. The content, especially the orbital content and bony structure, and size of the maxillectomy defect, tumor characteristics, and patients’ prognosis should be considered in the selection of maxillectomy reconstruction.Conclusions:The iliac crest free flap might be one of the best options to reconstruct the bony defect after maxillectomy.
Functional Outcomes and Nutrition in Patients Undergoing Pharyngo‐Laryngo‐Esophagectomy with Laparoscopic Gastric Transposition
Authors: Watson Natalie A. , Garcia Donna , Hughes Rhys , Sullivan Allana , Ballis Sarah , Wade‐McBane Kelly , Lee Michael S. W. 
Published: August 2013

Objectives:Explore functional outcomes and nutrition in patients undergoing pharyngo‐laryngo‐esophagectomy with laparoscopic gastric transposition.Methods:A retrospective case‐note review of patients who have undergone pharyngo‐laryngo‐esophagectomy with laparoscopic gastric transposition for squamous cell carcinoma of the hypopharynx between 1/2/2010 and 31/1/2013 at a tertiary referral center. History, anthropometrics, length of admission, biochemical markers, nutritional requirements, provision, complications, readmission, pre‐operative voice quality, timeframes to secondary TOP, perceptual measures of TOP speech, normalcy of diet and public eating performance status score were collated.Results:Eight patients, mean age of 55 at operation. Voice outcome: The timeframe from surgery to completion of a secondary puncture was approximately one calendar year. One patient has functional hypotonic voice 3 years post‐op. Nutrition: Pre‐operative nutritional support was inconsistent. Patients had a jejunal (JEJ) feeding tube inserted at the time of surgery. Post‐operatively patients were nil by mouth with JEJ feeding being commenced between day 1 and 12. Mean body mass index at 6 months and 3 years 20.8kg/m2 and 19.65 kg/m2 (latter in 2 patients of 3 survivors). Swallowing: Mean pre‐operative PSS scores for normalcy of diet and public eating were 30/100 and 50/100 respectively. Dysphagia was an issue for all patients post‐operatively with none achieving normalcy of diet PSS levels >50/100. Following surgery compared with pre‐operative scores, all public‐eating scores reduced.Conclusions:Voice restoration and swallowing functions are reduced following surgery. Pre‐ and post‐operative nutritional support is essential. We believe our experience over 3 years is the longest and largest case series review of functional outcomes worldwide.
Gracilis Muscle‐Only Flap for Soft‐Tissue Coverage following Oncologic Surgery of the Neck
Authors: Romak Jonathan J. , Patel Neil S. , Price Daniel L. 
Published: August 2013

Objectives:1) Describe the use of the gracilis muscle‐only flap for the protection of neurovascular structures in the neck. 2) Recognize situations where minimizing donor‐site morbidity and optimizing the aesthetic outcome preclude the use of the pectoralis or latissimus flaps.Methods:A review of records, imaging, and photographs was performed along with a review of the literature. Previous cases where the gracilis muscle was used for free tissue transfer were reviewed.Results:A 13‐year‐old female was referred for management of a right‐sided residual malignant peripheral nerve sheath tumor. The tumor was ipsilateral to her dominant hand, and the patient was an avid volleyball player and violinist. Imaging demonstrated the tumor diffusely infiltrating structures of the carotid sheath, sternocleidomastoid muscle (SCM), and levels II ‐ IV in the neck. The patient underwent surgical resection of the tumor and the ipsilateral SCM, carotid artery, jugular vein, vagus nerve, hypoglossal nerve, and cervical sympathetic chain. The carotid artery, vagus, and hypoglossal nerves were reconstructed with grafts. Post‐operative radiation was planned, necessitating protection of the underlying grafts. A portion of the right gracilis muscle was harvested and sutured to the mastoid tip and clavicle. Vascular anastomoses were performed to nearby vessels. The patient experienced no flap donor or recipient site complications. Symmetry was excellent post‐operatively.Conclusions:This novel use of the gracilis muscle for soft tissue coverage following an ablative procedure in the neck resulted in negligible donor site morbidity and an excellent aesthetic outcome in both the neck and the inner thigh.
Low-contrast-dose protocol in cardiac CT: 20% contrast dose reduction using 100 kVp and high-tube-current-time setting in 256-slice CT
Authors: Kidoh Masafumi , Nakaura Takeshi , Nakamura Shinichi , Nakamura Shota , Sakaino Naritsugu , Harada Kazunori , Uemura Shouzaburou , Yamashita Yasuyuki 
Published: August 2013

Background The use of the smallest contrast dose is highly desirable in performing cardiac computed tomography (CT), especially for patients with cardiovascular diseases to prevent contrast-induced nephropathy. Purpose To evaluate the feasibility of 20% reduced contrast dose protocol in cardiac CT using 100 kVp and high-tube-current-time product setting. Material and Methods Fifty patients were scanned with our conventional 120 kVp protocol, and the other 50 patients underwent scans using a tube voltage of 100 kVp, a high-tube-current-time product, and a 20% reduced contrast dose. We evaluated estimated effective dose (ED), CT attenuation, image noise, and contrast-to-noise ratio (CNR) of the ascending aorta. We also evaluated CT attenuation of the coronary arteries. Two radiologists independently assessed image quality of coronary arteries. Results There was no significant difference in the ED between the 100 kVp and 120 kVp protocols (21.7 mSv ± 1.6 vs. 21.8 mSv ± 1.1, P = 0.65). There was no significant difference in the CNR of the ascending aorta between the 100 kVp and 120 kVp protocols (18.8 ± 3.5 vs. 18.7 ± 3.8, P = 0.98). Mean CT attenuation of the coronary arteries of the 100 kVp protocols was significantly higher than that of 120 kVp protocols ( P < 0.05). There was no significant difference in the overall image quality of the coronary artery between the 100 kVp and 120 kVp protocols (3.7 ± 0.4 vs. 3.7 ± 0.5, P = 0.65). Conclusion For cardiac CT a voltage setting of 100 kVp and a high-tube-current-time product enable 20% reduction in the contrast dose without affecting the quality of coronary artery images compared with a 120 kVp and standard-contrast-dose CT protocol.
Bortezomib induces apoptosis and autophagy in osteosarcoma cells through mitogen-activated protein kinase pathway in vitro
Authors: Lou Zhiyuan , Ren Tingting , Peng Xianbo , Sun Yifeng , Jiao Guangjun , Lu Qunshan , Zhang Shuai , Lu Xinchang , Guo Wei 
Published: August 2013

Objective To investigate the effects of bortezomib on human osteosarcoma cells from the HOS cell line, and the underlying associated mechanisms. Methods Viability of HOS cells treated with bortezomib (5–20 nM) for different time periods was measured and changes in the cell cycle were assessed. Apoptosis and autophagy in HOS cells treated with bortezomib were analysed using annexin V-fluorescein isothiocyanate assay, transmission electron microscopy and Western blotting. Surges in mitogen-activated protein kinase (MAPK) pathways including MAPK/extracellular signal-regulated kinase (ERK) kinase (MEK1/2), ERK1/2, c-Jun N-terminal kinase (JNK) and p38 MAPK were analysed using Western blotting. Results Bortezomib induced growth inhibition in a time- and dose-dependent manner, and autophagy and apoptosis in a dose-dependent manner, in HOS cells. HOS cell autophagy and apoptosis in response to bortezomib, corresponded with changing levels of intracellular MAPK signalling molecules. Conclusions This study provided new insights into the mechanisms underlying bortezomib-induced apoptosis in human osteosarcoma HOS cells, and suggests that bortezomib could be a potent chemotherapeutic agent in the treatment of osteosarcoma.
Pharmacist-led medication education in cancer pain control: A multicentre randomized controlled study in Guangzhou, China
Authors: Wang Yan , Huang Hongbing , Zeng Yingtong , Wu Junyan , Wang Ruolun , Ren Bin , Xu Feng 
Published: August 2013

Objective To evaluate clinical pharmacist-led pain-medication education in patients with cancer. Methods A controlled study was conducted prospectively at six tertiary hospitals in China. In-patients with cancer were randomized to receive conventional treatment plus medication education or no education (controls). Education consisted of access to information booklets and eight 30-min face-to-face counselling sessions given by clinical pharmacists over 4 weeks. Patients completed pain- and analgesic-knowledge assessments and a Brief Pain Inventory, pre- and post-study. Results A total of 123 and 114 patients in the education and control groups, respectively, completed follow-up. At the end of the study, patient knowledge regarding cancer pain and pain control was significantly increased in both groups; pain and analgesic knowledge scores were significantly higher in the education group compared with controls. In the control group, the increase in total pain-related knowledge was significantly greater in analgesic-naïve patients compared with those who were using/had used analgesics. Pain intensity scores and pain interference of daily activities were significantly reduced in the education group compared with controls. Conclusions Clinical pharmacist-led medication education resulted in improved pain control in patients with cancer.