bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tc99m Sestamibi Scan in Parathyroid Surgery: Positive Scan Obviates Routine Intra‐operative Parathormone Monitoring
Authors: Gurunathan Ramesh K. , McCadden Luke , McBride Greg , Nadig Shrinath 
Published: August 2013

Objectives:Parathyroid surgery for hyperparathyroidism has moved from traditional four gland exploration to a minimally invasive procedure with advent of better imaging tools, intraoperative parathyroid hormone (PTH0 monitoring, and endoscopic techniques. In our hospital parathyroid operation is accomplished with preoperative sestamibi and serum PTH monitoring at D1 post‐op. Intra‐operative PTH assay is done only in selected patients.Methods:Analyze the outcome of parathyroid surgery at our hospital and correlate pre‐operative sestamibi localisation of adenoma with operative findings. Retrospective chart review of 40 patients who had parathyroid operations from 2009 to 2012.Results:The majority of referrals came through GP and were seen at Joint Endocrinology and ear, nose, and throat (ENT) clinic but there were occasional referrals from renal, urology, orthopedics and surgical admissions. Half presented with incidental hypercalcemia and other half had varied clinical presentations like calculi, renal failure, fractures, fatigue, dehydration, acute abdomen etc. Majority (30/40) were females. Age ranged from 22 to 88 with mean of 58. Average operating time was 50 minutes with incision length from 2.5 to 4 cms. Two patients needed 2nd exploration. Postoperative PTH and calcium levels returned to normal in 38/40 patients. 36 had sestamibi scan and localization was positive in 24/36 patients (66.6%) and correlated 100% with surgical findings. In patients with negative scan, 4 gland explorations were done. Inferior gland pathology was found in two thirds with left inferior in majority.Conclusions:In our view, a preoperative sestamibi scan is sufficient in majority of patients. 4 gland explorations with intraoperative PTH assay are useful in selective patients with negative scan.
Total Laryngectomy following Successful Chemoradiation Therapy for Advanced Laryngeal Carcinoma
Authors: Sappington Joshua M. , Borrowdale Richard W. 
Published: August 2013

Objectives:1) Describe the Loyola University Medical Center experience of total laryngectomies performed for a non‐functional larynx following successful chemoradiation therapy for advanced laryngeal malignancies. 2) Recognize the impact surgical as well as non‐surgical therapy has on head and neck cancer patients quality of life.Methods:A retrospective study was conducted using chart review to identify patients who underwent total laryngectomy between 2004 and 2012 at LUMC, an academic tertiary medical center. Patients that completed chemoradiation therapy and subsequently underwent total laryngectomy were identified and divided into two groups. The first group underwent total laryngectomy for a non‐functional larynx and the second group underwent surgery for persistent or recurrent disease. Only patients with squamous cell carcinoma of the larynx were included in this study.Results:A total of 143 total laryngectomies were performed at LUMC between 2004‐2012. Seven patients were identified that underwent total laryngectomy following successful chemoradiation. All seven patients were tracheostomy and/or gastrostomy tube dependent prior to their laryngectomy. This patient population accounted for approximately 5% of all total laryngectomies performed at LUMC since 2004.Conclusions:This study identifies a patient population not previously described in the literature: those who underwent successful chemoradiation for advanced laryngeal carcinomas but failed organ preservation therapy due to a non‐functional larynx. These patients suffered a significant impact on their quality of life and underwent a surgery they initially strived to avoid.
Trans‐axillary Robotic Thyroidectomy: Avoiding the Chest Port
Authors: Wilson Meghan N. , Dileo Michael D. , Walvekar Rohan R. 
Published: August 2013

Objectives:Describe modification of port placement for the four‐arm technique for robotic thyroidectomy to avoid a chest incision and eliminate crowding of the working space provided by the trans‐axillary incision.Methods:Description of port placement modification to avoid chest incision as well as report of two cases and appropriate literature review.Results:Placement of four arms via a trans‐axillary incision requires expertise. Transitioning from a chest port for placement of the fourth arm to a single‐incision surgery, avoiding a visible chest incision, can be challenging. We describe this technique and two cases of trans‐axillary robotic hemithyroidectomy (TART) using a trans‐axillary incision and a separate 1 cm incision in the anterior axilla, 2.5 centimeters below the trans‐axillary incision, for placement of the fourth arm. This design allowed for a more ergonomic placement of the fourth arm while not compromising the working space provided by the trans‐axillary incision. Additionally this port is used for surgical drain placement.Conclusions:Robot‐assisted trans‐axillary thyroidectomy poses several challenges in the early surgical learning curve. One roadblock to exposure and efficiency is appropriate port and arm placement. Our modification offers an alternative where a four‐arm technique is made possible without a chest port and without occupying the restricted working space provided by the trans‐axillary incision. Use of this inferior axillary port is cosmetically acceptable, surgically efficient, and allows avoidance of a visible chest incision for placement of the fourth arm.
Transoral Robotic Surgery versus External Approach: Oncologic Results and Comparison of the Cost of Treatment
Authors: Moriniere Sylvain , Hammoudi Karim , Beutter Patrice , Pinlong Eric 
Published: August 2013

Objectives:Compare functional outcomes, oncologic outcomes and treatment costs between a group of consecutive patients operated by transoral robotic surgery (TORS) for squamous cell carcinoma of the upper aero‐digestive tract (UADT) and a matched group of patients operated by CC.Methods:21 patients who underwent TORS from December 18, 2008 to January 21, 2012, were matched on age, sex, TNM stage, tumor location, type of neck dissection realized and operator with 21 patients operated by CC from July 19, 2005 to May 22, 2008 (before the arrival of the robot in our center).Results:In each group there were 3 T1 tumors, 16 T2 and 2 T3. The number of tracheotomy was significantly lower in the TORS group (3 vs18, respectively 14 and 86%, P < 0.001). The average length of feeding by NT and hospitalization were shorter in the TORS group (respectively, 9 vs 16 days, P = 0.01 and 11 vs 19 days, P = 0.001). There was no significant difference in the rate of recurrence‐free survival at 3 years between the 2 groups (89% for the TORS group and 85% in the CC group, P = 0.76). The average treatment cost was reduced by 5488 euros for the TORS group (P = 0.03).Conclusions:Robotic technology allows the treatment of T1‐T2‐T3 selected squamous cell carcinoma of the UADT, reducing morbidity and treatment costs while providing an equivalent cancer control at 3 years. Prospective and longitudinal studies could confirm these encouraging results.
Treatment of Cutaneous Head and Neck Squamous Cell Carcinoma Metastatic to the Parotid Gland
Authors: Lin Jiahui , Kuhel William I. , Parashar Bhupesh , Voigt Erich P. , Cohen Marc A. , Kutler David I. 
Published: August 2013

Objectives:1) Recognize challenges in managing metastatic squamous cell carcinomas (SCC) to the parotid gland. 2) Describe our 5‐year experience of treating metastatic SCC of the parotid gland.Methods:Retrospective case series of 22 consecutive patients undergoing parotidectomies for treatment of metastatic SCC to the parotid gland between August 2006 and December 2011 at Weill Cornell Medical College. Interventions included parotidectomy and radiation therapy (RT). Outcome measures included complications, survival, and locoregional recurrence.Results:Seventy‐seven percent of patients were male, with a mean age of 77 years (range 46 ‐ 93 years). Eighteen patients underwent superficial parotidectomy, four received total parotidectomy, and 16 underwent neck dissection. Fifteen patients received post‐operative RT, and 1 patient had neoadjuvant radiation 4 months prior to surgery. Median dose of radiation delivered was 6300 cGy at 200 cGy per fraction. Overall 2‐year survival was 77.4%, and 2‐year disease‐free survival was 33.3%. Recurrence rate was 54.5%, with a median time to recurrence of 14 months. The 2‐year survival rate was 32% and 80% in patients with positive versus negative margins, respectively (P =. 01). The 2‐year survival rate was 56% and 100% in patients with positive versus negative cervical lymph nodes, respectively (P = 0.03). Five of 6 patients receiving conventional RT developed severe skin toxicity or could not complete treatment; none receiving intensity‐modulated radiation therapy (IMRT) developed such complications.Conclusions:Positive lymph nodes in neck dissection specimens are an important prognostic factor in treating patients with metastatic SCC to the parotid gland. IMRT is better tolerated compared to conventional RT techniques.
Tumor Grade and Immunohistochemical Expression for Predicting Nodal Disease in Early‐Staged Oral Squamous Cell Carcinomas
Authors: Anderson Donald W. , Liu Kelly Yi Ping , Berean Ken , Poh Catherine 
Published: August 2013

Objectives:1) Categorize oral squamous cell carcinoma (OSCC) patients according to nodal status at and after surgery. 2) Determine demographics, clinicopathological and histological factors contributing to nodal disease. 3) Investigate biomarkers to predict nodal status.Methods:Using the BC Cancer Registry Database, 303 primary OSCC patients who received primary curative surgical treatment from 2003 to 2007 with at least 5 years of follow‐up were identified. Patients were categorized based on nodal status at and after surgery. Demographics, clinico‐pathological details, treatment modalities and time to outcomes were collected and compared among groups. Immunohistochemistry (IHC) was performed on a pilot tissue microarray (n = 21) for p16, cyclin D1 (CD‐1), Ki‐67, p53, and pRB.Results:Patients with nodal diseases (n = 303) at the time of surgery or during the FU has a pivotal impact on the 5‐year survival rates (P < 0.0001). Cox proportional hazard models identified usage of adjuvant radiotherapy and presence of nodal disease as significant predictors for poor survival (hazard ratio [HR]: 6.53, 95% confidence interval [CI], 2.86‐14.91, P < 0.0001; 2.43, 95%CI, 1.18‐5.02, P = 0.02, respectively). Among the 205 N0‐at‐surgery, one in four of them developed nodal disease and with 76% at the first 18 months post‐surgery. Among those markers examined, nuclear CD‐1 expression is a negative predictor for nodal disease (100% vs. 58%, P < 0.05).Conclusions:The data strongly support aggressiveness of neck metastasis either at‐time‐of surgery or during follow‐up. Effective pathological or IHC markers to predict nodal disease pre‐surgery can benefit high‐risk patients receiving early intervention and avoid unnecessary ND for the low‐risk patients.
Use of FDG‐PET/CT Response Evaluation after Chemoradiotherapy in HPV+ Oropharyngeal Cancer
Authors: Vainshtein Jeffrey M. , Spector Matthew E. , Stenmark Matthew , Carey Thomas E. , Chepeha Douglas B. , Wong Ka K. , Eisbruch Avraham 
Published: August 2013

Objectives:Evaluate the use of 3‐month positron emission tomography (PET)/computed tomography (CT)–response assessment post‐chemoradiotherapy (CRT) in predicting locoregional failure (LRF) in HPV+ oropharyngeal cancer (OPC).Methods:101 consecutive patients with stage III/IV HPV+ OPC who received definitive carboplatin/paclitaxel‐based CRT from 2005‐2010 and underwent PET/CT pre‐treatment and at 3‐months post‐therapy were retrospectively identified. PET/CT‐response was reported as complete (CR), near‐complete (nCR), or partial (PR); nCR was classified as CR at the primary site and as PR in the neck. CT‐response for the neck was graded per RECIST‐1.1. Test characteristics for predicting 3‐year local failure (LF) and regional failure (RF) were calculated.Results:Among 98 patients with an evaluable primary, LF occurred in 2/67 patients with CR, 0/20 with nCR, and 1/11 with PR. For LF, PET/CT demonstrated 88% accuracy, 33% sensitivity, 90% specificity, 9% positive predictive value (PPV), and 98% negative predictive value (NPV). Among 91 patients with evaluable necks by RECIST, RF occurred in 6/67 with CR, 2/11 with nCR, and 0/7 with PR. For RF, PET/CT demonstrated 76% accuracy, 25% sensitivity, 81% specificity, 11% PPV, and 92% NPV, which compared favorably with CT characteristics of 56%, 38%, 45%, 6%, and 88%, respectively. Quantitative SUVmax thresholds did not improve the predictive accuracy of 3‐month PET/CT for LRF. Overall, PET/CT surveillance was 92% and 89% accurate for detecting LF and RF.Conclusions:In this largest reported study to‐date of post‐CRT response assessment by PET/CT for HPV+ OPC, 3‐month PET/CT demonstrated high negative predictive value for LRC. PET/CT surveillance was highly accurate for detecting LRF.
The 4‐Hour Rule: An ENT Perspective
Authors: Ha Jennifer , Lu Png H. , Chapman Kate , Friedland Peter 
Published: August 2013

Objectives:The pervasive theme in Western Australian medicine in 2011/2012 was the newly introduced 4‐hour rule in emergency departments. This article approaches the various issues and problems from an ear, nose, and throat (ENT) perspective, with subsequent recommendations.Methods:We performed a retrospective audit looking at the most commonn ENT diagnoses according to the ICD‐10‐AM classification: acute pharyngitis, streptococcal tonsillitis, acute tonsillitis, and peritonsillar abscess. Patients looked at included those who presented 6 months before and after the 4‐hour rule implementation.Results:We found a decreased diagnostic accuracy (41.2% vs 28.6%), reduced intravenous hydration commencement (94.1% vs 64.3%), and reduced intravenous antibiotics commencement (70.6% vs 50.0%).Conclusions:Although positivity has been seen within certain aspects of patient outcomes since the introduction of the 4‐hour rule, certain inherent issues must be acknowledged. Recommendations and modifications have been suggested as possible alternatives.
The West Scotland Experience of Using 18FDG‐PET Scans in Head and Neck Malignancy
Authors: Oozeer Nashreen B. , MacKenzie Kenneth 
Published: August 2013

Objectives:Fluorodeoxyglucose Positron Emission Tomography (FDG‐PET) scans are increasingly being adopted in head and neck cancer (HNC) practice in the United Kingdom. The aim of this study is to review the West of Scotland (WoS) HNC reasons for requesting FDG‐PET.Methods:A prospective database of FDG‐PET requested by HNC teams was reviewed. All scans between January 2008 and December 2011 were examined recording the indications compared to the National Health Service NHSScotland PET‐CT clinical indications guidelines.Results:Over the study period, 299 scans with a HNC indication were requested including 180 pre‐treatment. The current indications in our region are assessing primary site (possible primary in 52.3% of 132 “unknown primary” cases), identification of recurrence (16%), distant metastasis (16%) and treatment response (13%). The latter two are not current NHSScotland indications. The proportion of scans following national recommended guidelines improved over time from 39% to 75%.Conclusions:NHSScotland PET recommendations should be modified to include our current indications, closely reflecting recent Royal College of Radiologists evidence‐based indications for use of PET‐CT in the UK.
3D Measurement of Paralyzed Larynx in Japanese Using Cone Beam CT
Authors: Yabe Haruna , Saito Koichiro , Uno Kosuke , Momoshima Suketaka , Ogawa Kaoru 
Published: August 2013

Objectives:Precise measurement of human organs with an error by less than one millimeter was realized by cone beam computed tomography (CBCT) imaging technology. The purpose of this study was to measure the shape/size of paralyzed larynges in Japanese patients with multiple parameters using CBCT.Methods:Eighty‐nine Japanese patients who referred to our institution with unilateral vocal fold paralysis from April 2007 to November 2011 were incorporated in this case series study. There were 54 males and 35 females, and the mean age was 59.9 years. Laryngeal CBCT images were taken in 2 conditions: 1) patients sitting relaxed (R image), and 2) patients applying pressure at their diaphragm (P image). Lengths of bilateral vocal folds, bilateral horizontal glottal angles, and sizes of gaps from a median plane of each larynx were measured in R images. Vertical gaps of bilateral vocal folds were measured in P images.Results:Mean lengths of non‐diseased vocal folds (males, 18.5 mm; females, 12.9 mm) were significantly longer compared with diseased side (males, 17.7 mm; females, 12.4 mm) in both males (P =0.011) and females (P = 0.001). Glottal angles were significantly wider in no diseased side (16.1°) compared with diseased side (9.4°, P = 0.0011). Vertical gaps were normalized with the lengths of non‐diseased vocal folds with mean value of 0.057.Conclusions:Our study showed the first correct measurement of paralyzed larynx in live Japanese patients. These data will contribute to the improvement of diagnosis and surgical procedures for the patients with laryngeal paralysis in the future.
Comparative Assessment on Laryngeal Function after Radiotherapy and Laser Surgery against Early Glottic Cancer
Authors: Kono Takeyuki , Saito Koichiro , Yabe Haruna , Uno Kosuke , Ogawa Kaoru 
Published: August 2013

Objectives:Comparatively assess the laryngeal function and quality of life (QOL) of the patients after laser surgery and radiotherapy against early glottic cancer.Methods:Sixty‐seven patients with T1 glottic cancer treated in our institution with radiotherapy (RT, n=30) or CO2 laser surgery (LS, n=37) were incorporated in this retrospective cohort study. LSs were performed following the type II subligamental cordectomy concept. Patients in LS group were categorized into subgroups for further analyses. Twenty‐seven patients had vaporization of the lesion with defocused mode, and a residual 10 patients had cancer excision with focused mode using relatively lower power (LS‐EX group). GRBAS subjective voice assessment scale, maximum phonation time, and acoustic parameters were measured as vocal parameters. Voice‐Related Quality of Life Measure and Voice Handicap Index were used to evaluate post‐therapeutic QOL. Laryngeal videostroboscopic images were further examined to assess post‐therapeutic laryngeal pliability. The mean follow‐up period was 46 months.Results:Compared with their pre‐therapeutic scores, worse GRBAS scores were observed at the end of the treatments in 20% and 60% of RT group and LS group respectively. Although these scores recovered 1 year after treatment, abnormal stroboscopic findings remained in 40% and 95% of RT group and LS group respectively. Interestingly, further subgroup analysis proved no significant difference of post‐therapeutic vocal parameters and QOL between RT group and LS‐EX group.Conclusions:Early glottic cancer could be treated with equivalent post‐therapeutic laryngeal function and QOL with either radiotherapy or focused low power CO2 laser surgery.
Effects of a KTP Laser on Commonly Used Endotracheal Tubes in Head and Neck Surgery
Authors: Coughlan Carolyn A. , Verma Sunil P. 
Published: August 2013

Objectives:The effects of modern KTP lasers on endotracheal tubes (ETTs) have not been formally examined. In this study we investigated the interaction of the Aura XP 532 nm KTP and commonly used ETTs.Methods:An Aura XP 532 nm KTP laser with a 600 nm fiber was used in pulsed and continuous modes. The laser beam was focused at a distance of 0.5 cm from the shaft and balloon of three laser safe ETTs and a standard polyvinylcholoride (PVC) ETT. Time to penetrate through the ETT and cuff was recorded in seconds (s).Results:The KTP laser did not penetrate any of the laser resistant ETTs or standard PVC ETTs within 90s of contact in either mode. The beam did react with the black markings on the PVC ETT by producing smoke. The KTP laser was nonreactive with all cuffs except in one of three trials with the outer balloon cuff of a Rusch Lasertubus ETT in continuous mode.Conclusions:This is the first report documenting the effects of a KTP laser on ETTs. The bodies of all ETTs were found to be resistant to the KTP laser, while only the black markings on the shaft of a PVC ETT reacted with the laser beam. This study demonstrates that there are a number of options that may be used safely during transoral laser microsurgery with a KTP laser.
Eosinophilic Angiocentric Fibrosis of the Subglottis
Authors: Kraft Shannon M. , Patel Neil , Sauer David , Hamilton Bronwyn , Schindler Joshua S. 
Published: August 2013

Objectives:Eosinophlic angiocentric fibrosis (EAF) is a rare disorder that belongs to the spectrum of IgG4‐related diseases (IgG4‐RD). We review a case of EAF presenting as a subglottic stenosis.Methods:We discuss the pertinent clinical, radiographic, and histological findings, demonstrating the diagnostic challenges associated with EAF. We review the literature on respiratory tract EAF and discuss the associated management dilemmas when this otherwise benign disease affects critical structures. A 44 year‐old female presented a twelve‐month history of progressive dyspnea and stridor. A pulmonary function test (PFT) showed flattened inspiratory and expiratory flow loops suggestive of subglottic stenosis. Pre‐operative computed tomography (CT) revealed a subglottic mass with cricoid erosion. During endoscopy, a submucosal lesion was noted to involve the conus elasticus and cricoid. The airway was temporized with CO2 laser resection of the mass and dilation.Results:Histology showed an inflammatory infiltrate composed of lymphocytes, plasma cells, and eosinophils. Fibrosclerosis was organized around thickened vessels in an onionskin pattern. Immunohistochemical revealed a minor IgG‐4 plasma cell component. Staining was negative for beta‐catenin and ALK‐1. The specimen was found to be consistent with EAF. Serum IgG‐4 was mildly elevated at 117 mg/dL. The patient has been managed with oral steroids, and her airway remains stable.Conclusions:EAF is a subtype of inflammatory fibrosclerosis that belongs in the spectrum of IgG4‐RD. Most commonly reported in the orbit or sinonasal tract, EAF lesions of the laryngotracheal complex are exceedingly rare. Although benign, EAF pseudotumors can be locally destructive, requiring a multidisciplinary approach to care.