bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Transplant Patients Treated Surgically for Node Positive Cutaneous Squamous Cell Carcinoma
Authors: Wester Jacob L. , Hernandez Jose , Stott William , Andersen Peter E. , Wax Mark K. , Gross Neil D. 
Published: August 2013

Objectives:Patients with chronic immune suppression are at increased risk of developing cutaneous squamous cell carcinoma of the head and neck (cSCCHN) and often present with advanced stage disease. The purpose of our study was to investigate the survival of transplant patients on chronic immunosuppressive therapies treated surgically for node‐positive cSCCHN.Methods:Patients from a tertiary‐care center with node‐positive cSCCHN were identified from 1993‐2012. Demographic, surgical, and pathological data were extracted from the electronic medical record for all patients treated surgically with curative intent. Outcomes were compared between transplant and non‐transplant patients using Kaplan‐Meier estimates.Results:Eighty‐six (80M, 6F) patients with a median age of 73 years were identified. Seven (8%) patients had previous transplant surgery. The median time of immune suppression prior to diagnosis was 8 years (range 5‐19). Four (57%) transplant patients presented with recurrent disease. Surgical pathology showed positive margins in 5 (71%) transplant patients compared to 18 (23%) non‐transplant patients, P = 0.01. Perineural invasion, angiolymphatic invasion, and extracapsular spread were not significantly different on tumor pathology between groups. Four (57%) transplant patients had adjuvant radiotherapy. The median survival of transplant patients was 13.0 months (range 9‐26) vs. 29.9 months (range 1.5‐149) in non‐transplant patients. Patients with recurrent disease demonstrated reduced survival, P = 0.03. Adjuvant radiotherapy improved survival regardless of transplant status, P = 0.001.Conclusions:Transplant patients treated surgically for node‐positive cSCCHN have an increased risk of recurrent disease, adverse pathological features, and reduced survival compared to non‐transplant patients.
Parathyroid Hormone as a Predictor for Calcium Replacement after Total or Completion Thyroidectomy
Authors: Yaneza May , Little Mhairi , Kasbekar Anand V. , McAllister Kerrie , Blacoe David , Kang Swee K. 
Published: August 2013

Objectives:1) Analyze whether postoperative parathyroid hormone (PTH) level predicts the need for calcium replacement treatment after total or completion thyroidectomy. 2) Evaluate our calcium replacement regimen that is based on PTH levels.Methods:Prospective data collected between April 2010 and April 2011. Study Population: Patients undergoing a total or completion thyroidectomy (n = 40). All patients had calcium (Ca2+) checked at 2200h on day 0 (D0), day 1 (D1), day 3 (D3), and day 6 or onwards (D6+). PTH levels were checked on D1, D3, and D6+. Patients with Ca2+ < 1.95 on D1 were given Calcichew (2 tablets) and 1 microgram 1‐alphacalcidol. On D1, patients with PTH > 1.5 and calcium > 1.95 were discharged with no supplementation, and patients with PTH < 1.5 were started on a calcium supplementation regimen depending on their D1 calcium level. –Twenty‐nine patients had PTH > 1.5 on D1; none had calcium < 1.95 on D0 or D1, 12 had calcium < 2.2 on D0, 9 had calcium < 2.2 but > 1.95 on D1, and 1 patient became normocalcaemic. Thus 68.9% (n = 20) had calcium < 2.2 but > 1.95 by D1. Ten patients (34.8%) had calcium < 2.2 but > 1.95 on D6+. Eleven patients were started on a calcium replacement regimen on D1, as their PTH was < 1.5.Conclusion:PTH level is a good predictor for the need for calcium replacement after total or completion thyroidectomy, as the patient's calcium levels do not fall to a level that requires treatment if PTH > 1.5 on D1.
Robot/Endoscope–Assisted Selective Neck Dissection by a Postauricular Facelift Approach for cN0 SCCHN
Authors: Tae Kyung , Ji Yong‐Bae , Song Chang‐Myeon 
Published: August 2013

Objectives:We have developed a new novel neck dissection procedure by postauricular facelift incision using the da Vinci robot or endoscope to avoid a long visible neck scar. The aim of this study is to investigate the feasibility and efficacy of this novel procedure in squamous cell carcinoma of head and neck (SCCHN) comparing with conventional neck dissection.Methods:We analyzed 30 SCCHN patients with clinically node negative neck (cN0) who underwent robot/endoscope assisted selective neck dissection (SND) by postauricular facelift approach (11 patients, 12 necks) or conventional neck dissection (19 patients, 21 necks).Results:The distributions of gender and age did not differ between the two groups. The extent of SND was level I, II, and III in oral cancer, and level II, III, with/without IV, V in oropharynx, larynx, and hypopharynx cancer in both group. The robot/endoscope assisted SND was completed successfully in all patients. The mean operative time of SND was longer in the robot/endoscope group (219 ± 65 min) than the conventional group (144 ± 43 min) (P < 0.05). The mean number of lymph nodes removed was 24.6 ± 8.0 and 28.9 ± 8.2 in the robot/endoscope and conventional group, respectively (P = 0.151), and the number of lymph nodes removed in each levels also did not differ between the two groups. There was no major postoperative complication in both groups.Conclusions:Robot or endoscope assisted SND by postauricular facelift approach is a cosmetically excellent procedure and comparable to conventional neck dissection in selected patients with cN0 SCCHN.
Wnt Signaling Pathway Inhibition Enhances Efficacy of Cetuximab
Authors: Schmale Isaac , Thylur David , Yamamoto Vicky , Kalra Vijay , Sinha Uttam K. 
Published: August 2013

Objectives:1) Investigate whether Wnt pathway inhibition via a small molecule inhibitor, ICG‐001, enhances cetuximab efficacy in head and neck squamous cell carcinoma (HNSCC). 2) Elucidate the mechanism of cetuximab sensitization and increased cell death that results from ICG‐001/cetuximab cotreatment.Methods:HNSCC cell line SCC‐15 was grown for 24 hours then incubated with: ICG‐001, cetuximab, or both for 48‐72 hrs. Cells grown in media alone served as control. Cell proliferation was analyzed using WST‐1 and clonogenic assays. The mechanism of ICG‐001/cetuximab interaction was investigated using reverse transcription polymerase chain reaction (RT‐PCR), Western blot, immunohistochemistry, and TUNEL staining.Results:SCC‐15 cells treated with ICG‐001/cetuximab demonstrated significantly decreased viability (19.9%) as determined by WST‐1 assay compared to control (100%), cetuximab (90.3%), or ICG‐001 (35.1%) treatment (P < 0.05). Additionally, clonogenic assay demonstrated that combination ICG‐001/cetuximab treatment led to significantly decreased cell proliferation (2.6%) compared to control (100%) or monotherapy (cetuximab 94.3%; ICG‐001 20.2%; P < 0.05). ICG‐001 treatment resulted in increased epidermal growth factor receptor (EGFR) expression, as demonstrated by Western blot, RT‐PCR, and immunohistochemistry. TUNEL‐positive cells were shown to be significantly increased in both ICG‐001 and ICG‐001/cetuximab treatment groups. Additionally, combination therapy increased levels of cleaved caspase‐3, a marker of apoptosis.Conclusions:ICG‐001/cetuximab cotreatment results in cetuximab sensitization and increased cell death in HNSCC in vitro. Increased EGFR expression and pathway dependence leading to cetuximab vulnerability, along with increased apoptosis, play a major role in this observed effect. ICG‐001/cetuximab cotreatment represents a potential novel therapy in HNSCC management which may offer superior outcomes with fewer side effects compared to existing first‐line treatment.
A Telerobotic System for Transnasal Surgery of the Larynx and Upper Airways
Authors: Dharamsi Latif M. , Bajo Andrea , Netterville James L. , Garrett C. Gaelyn , Simaan Nabil 
Published: August 2013

Objectives:The trend toward minimally invasive surgery has been an historic force driving the development of new surgical technique, specifically endoscopy. Transnasal endoscopic approaches to the larynx have been used but are limited by the precision and accuracy afforded to the surgeon. The objective of this study is to analyze and describe the feasibility, accuracy, and precision of a rapidly deployable telerobotic system for enabling transnasal microsurgery of the larynx and upper airways, specifically injection laryngoplasty.Methods:A feasibility study was conducted in which a tele‐operated system composed of a 5 degree of freedom continuum manipulator, 2 instrumentation ports, and a 1.2mm fiberoptic endoscope, to list a few key components, was deployed in both a human intubation trainer mannequin and cadaver using a nasopharyngeal airway as the conduit. Novel control algorithms assist the insertion by autonomously conforming the shape of the robot to the unknown curvature of the anatomy. A flexible needle was passed through the endoscope and used to target specific areas of the vocal folds to simulate injection laryngoplasty in our experimental models. Experiments were recorded with both still and video photography. Our outcome measure was the feasibility of this surgical approach.Results:This transnasal telerobotic system is well suited for surgery of the larynx and upper airways.Conclusions:Based on our preliminary results, our telerobotic system is suitable for accurate and precise injection laryngoplasty. We propose that such a system has widespread utility for additional surgical procedures of the larynx and upper airway.
Mouse Model to Study the Effect of Noise‐Induced Hearing Loss on the Retrocochlear Auditory Neurons
Authors: Dean Clare , Chen Leon M. , Nahm Edmund A. , Mattiace Linda , Kim Ana H. 
Published: August 2013

Objectives:To create a noise‐induced hearing loss (NIHL) mouse model to examine its effect on neuronal cells in the cochlear nucleus (CN), superior olivary complex (SOC), and lateral lemniscus (LL).Methods:Three month old CBA male mice were exposed to 110‐120dB noise over 6 hours. Auditory brainstem response (ABR) tested at 1‐day, 1‐week, 1‐month, and 2‐months after acoustic trauma (AT) confirmed profound hearing loss. Distortion product otoacoustic emission (DPOAE) remained present after AT. FluoroGold (FG) was injected through the right tympanic membrane for retrocochlear neuronal staining.Results:The average click ABR threshold shifts were 55dB, 55dB, 45dB, and 48dB after 1‐day, 1‐week, 1‐month, and 2‐months post‐AT, respectively. The average tonal ABR threshold shifts from 8‐28 kHz were 51dB, 50.5dB, 49.8dB, and 43.8dB after 1‐day, 1‐week, 1‐month, and 2‐months, respectively. DPOAE signals from 12‐28 kHz were present at higher thresholds (14.3dB, 12.7dB, 13dB, and 17dB after 1‐day, 1‐week, 1‐month, and 2‐months, respectively) after the NIHL. The average neuronal cell counts in the CN, SOC, LL, and contralateral SOC in deafened mice were 1390 ± 404, 2083 ± 190, 104 ± 21, and 163 ± 27, respectively; compared to 1483 ± 190, 2807 ± 67, 112 ± 20, and 208 ± 23, respectively, in control mice. The SOC yielded the only statistically significant difference between the two groups (P < 0.05).Conclusions:A reliable NIHL mouse model has been established. At 2‐months post‐deafening, we found significant decrease in neuronal cells in the SOC. This model serves as a tool to further investigate protective pharmacotherapy against NIHL.
A Novel Rapid‐Prototyped Temporal Bone Model for Surgical Dissection
Authors: Hochman Jordan B. , Unger Bertram , Kraut Jay 
Published: August 2013

Objectives:Temporal bone surgery requires knowledge of complex 3D anatomical features and significant technical skill. An adjunctive training methodology is needed, as educational experiences are limited while public expectations regarding outcome are understandably high. Models employed in training must accurately duplicate the surgical experience, simulating bone structure and procedural drilling qualities. This study describes a novel rapid‐prototyped model made of 3D printed rigid, bone‐like material and includes both face and content validation. In contrast to previous iterations, the model represents requisite subcortical density, and air spaces are void of printing material.Methods:Model aeration was assessed. Different harden‐ing agents/resins were compared to sheep femur in accelerometer‐based vibrational properties, penetration depth, and tensile and compressive strength analysis. Two subjective trials provided face validation. Surgeons compared disparate resin agents to sheep femur, while residents compared the model to cadaveric bone. The residents evaluated appearance, mechanical properties, surgical approaches, and educational value.Results:The model illustrates comparable aeration to the template images. Hardening resins all compared favorably to sheep bone in mechanical properties and subjective ratings. Face validation found the Rapid Prototyped Model to have realism in appearance, drill character, and surgical approach and significant perceived educational benefit.Conclusions:The model performs well in subjective and objective analysis, with representative mechanical properties, and provides a platform for adjunctive training.
Otolith Dysfunction Is Prevalent in Refractory Benign Paroxysmal Positional Vertigo
Authors: Abouyared Marianne , Jethanamest Daniel , Angeli Simon I. 
Published: August 2013

Objectives:Determine the prevalence of otolith dysfunction in patients who have failed treatment for benign paroxysmal positional vertigo (BPPV).Methods:Case‐control study of patients with BPPV who failed standard treatment and subsequently underwent vestibular testing and supervised vestibular rehabilitation. Interventions included videonystagmography, rotary chair, subjective visual vertical test (SVV), and cervical vestibular evoked myogenic potentials (VEMP). We compared the prevalence of abnormalities in tests of otolith dysfunction (SVV and VEMP) in patients who responded or failed vestibular rehabilitation.Results:In 2012, 46 of 251 patients with BPPV failed initial treatment with canalith repositioning maneuvers performed in the office; of these 46 patients, 28 patients had posterior semicircular canal BPPV and 18 cases had atypical presentations (multicanal BPPV, anterior canal BPPV, or signs of uncompensated unilateral peripheral vestibulopathy). Vestibular testing followed by customized vestibular rehabilitation was completed in 40 patients: 21 patients had resolution of their positional vertigo and nystagmus, and 19 patients did not respond to therapy. Abnormal otolith tests (SVV and/or VEMP) were more common in patients who failed therapy (Pearson Chi square, P = 0.002). Conversely, abnormalities of caloric testing did not predict response to therapy.Conclusions:Abnormalities of utricle and saccular function are prevalent in patients with refractory BPPV. This fact is important to take into account when designing rehabilitation strategies for BPPV patients who fail canalith repositioning maneuvers.
The Correlation between Presenting Features and Surgical Outcomes in Pediatric Cholesteatoma
Authors: Vilchez Luis D. , Cushing Sharon L. , Papsin Blake C. , Jamesg Adrian L. 
Published: August 2013

Objectives:Determine how presenting features of cholesteatoma in children influence surgical outcome.Methods:A prospective database of 319 consecutive children with cholesteatoma was analyzed to compare features of cholesteatoma at presentation with patient‐focused outcome measures. Features of disease included the presence of otorrhea, hearing loss (mean 4 tone air conduction audiogram more than 30dB HL), the type and extent of cholesteatoma, and ossicular status. Outcomes included hearing threshold, number of surgeries, and canal wall preservation. Cases with cholesteatoma surgery or tympanoplasty prior to referral were excluded.Results:Of 200 children with cholesteatomas, 32 ears presented with congenital lesions and 178 ears presented with acquired lesions. The mean age at diagnosis was 6.6 years for congenital and 11.5 years for acquired cholesteatoma. A history of continuous otorrhea had a sensitivity of 0% for diagnosis of congenital cholesteatoma and 37% for acquired. Hearing loss had a sensitivity of 57% for congenital and 72% for acquired cholesteatoma. The canal wall was preserved in 181 (86%) ears at first surgery. Mean hearing level was unchanged after surgery at 36dB HL. More extensive cholesteatoma correlated with more ossicular erosion, more canal wall down surgery, worse postoperative hearing, and more repeated surgeries (P < 0.05; multiple regression analysis).Conclusions:Better outcomes for children with cholesteatoma can be achieved by early identification and surgery when lesions are smaller. As cholesteatoma can be relatively silent in children, without otorrhea or hearing loss. Physicians must be trained to identify otoscopic features of congenital and acquired cholesteatoma and initiate prompt referral.
A Prospective Assessment of Biomechanical Changes in Skin after the Injection of Onabotulinum Toxin
Authors: Bonaparte James P. , Ellis David A. 
Published: August 2013

Objectives:Although primarily used as a neuromodulator, a recent case series suggests that botulinum toxin A (onabotulinum) may also improve skin elasticity. The purpose of this study was to test the hypothesis that the administration of onabotulinum for lateral orbital and glabellar rhytides will result in an increase in patient's skin elasticity and reduce the pliability.Methods:Forty patients were prospectively enrolled for administration of onabotulinum to their lateral orbit and glabella. To assess skin biomechanics, we used the Cutometer MP580. All patients were assessed pre‐treatment and at 2‐weeks and 2‐months post‐treatment. An analysis of variance (ANOVA) with repeated measures was used to assess for differences between assessments.Results:There was a significant increase in both skin elasticity (f = 46.9, P = 0.001) and pliability (f=46.8, P < 0.001) with a mean (+/‐SE) increase in elastic recoil of the skin by 20% (4.4%) for the glabellar region (P < 0.001) and 18% (4.0%) for the lateral orbit (P < 0.0001) while there was an increase in skin pliability of 26% (5.4%) for the lateral orbit (P = 0.001) and 52% (8.3%) for the glabellar region (P < 0.001). There was no significant difference on the patients forearm (control site) for both elasticity (P = 0.57) and pliability (P = 0.16).Conclusions:Injection of onabotulinum results in skin that has increased pliability as well as increased elastic recoil. Although this study demonstrates the positive effect of onabotulinum on skin elasticity, it is unclear whether this is due to specific histological changes.
Impact of Evolution of the Eardrum Bridge on the Healing Process of Traumatic Eardrum Perforation
Authors: Lou Zheng C. 
Published: August 2013

Objectives:Characterize the otoendoscopic features of traumatic tympanic membrane perforations (TMPs) with an “eardrum bridge” and evaluate the evolution of the eardrum bridge during the spontaneous healing process.Methods:Data for 427 patients with barotrauma‐associated traumatic TMPs who met the case selection criteria were retrieved and categorized into two groups: those with and those without an eardrum bridge.Results:Of the 427 patients with traumatic TMPs during the two‐year study period between January 2006 and December 2007, only 36 (8.4%) had an eardrum bridge. For small‐sized perforations, the overall closure rate was significantly different (100% versus 87.7%, P=0.03) between those with and without an eardrum bridge. However, the average closure time was not significantly different (21.2 versus 26.8 days, P>0.05), although the mean closure in cases with an eardrum bridge was shortened by 5 days compared to that in cases without an eardrum bridge. For medium and large perforations, statistical analysis was not performed due to the much smaller number of cases with eardrum bridges.Conclusions:Eardrum bridge with traumatic TMP can result in necrosis, migration of stratified epithelium, and epithelium proliferation during the healing process. However, the eardrum bridge seems to improve the healing rate of traumatic perforations.
Postoperative Tonsillectomy Pain Management: A Prospective Randomized Trial
Authors: Standring Robert T. , Guglielmo Robert , Yaremchuk Kathleen L. , Gardner Glendon M. , Ko Alvin B. , Seidman Michael D. , Darrat Ilaaf 
Published: August 2013

Objectives:Examine the efficacy of three separate pain regimen groups for patients who have undergone tonsillectomies by multiple otolaryngologic surgeons at one institution.Methods:This study was an institutional review board (IRB) approved prospective randomized cohort study comparing the efficacy of nonsteroidal anti‐inflammatory drugs (NSAIDs), acetaminophen/hydrocodone, and acetaminophen/codeine for post‐operative tonsillectomy pain control. Setting: A tertiary referral hospital. Patients of any age undergoing tonsillectomy from June 2011 until the present were randomized into one of three post‐op pain regimen groups. All tonsillectomy procedures were performed using the same technique, no preoperative local anesthetic injections were given, and no post‐operative antibiotics were provided. Patients/families were given a packet of information to complete that included pain control, time to return to diet, school/work, and baseline activity. Pain control was measured using a validated faces pain scale as well as the amount of drug being administered.Results:Eighty‐five patients were enrolled in the study, and twenty‐four patients completed the study packet: 11 patients from the ibuprofen arm, 7 patients from the acetaminophen/hydrocodone arm, and 6 patients from the acetaminophen/codeine arm. The preliminary data were analyzed with Kruskal‐Wallis tests and demonstrated no significant difference in time to return to regular diet (p =0.867), time to return to work (p=0.849), or time to return to work/school (p=0.915).Conclusions:These preliminary results demonstrate efficacy of all three pain modalities with no significant difference in returning to pre‐operative function.
Patient Satisfaction as a Quality Indicator in Pediatric Surgical Care: A Systematic Review
Authors: Espinel Alexandra G. , Shah Rahul , McCormick Michael E. , Boss Emily F. 
Published: August 2013

Objectives:Synthesize evidence‐based findings related to patient satisfaction as a quality indicator in pediatric surgical care.Methods:We conducted a qualitative systematic review, querying 4 standard search engines (1992‐2013) for studies specific to pediatric surgical fields in which patient/parent satisfaction or experience‐of‐care was a primary outcome measure. Data were systematically analyzed to determine study characteristics, setting, parent/patient focus, measure of experience, and bias. Two independent investigators independently reviewed all articles.Results:The initial search yielded 4678 publications (1433 duplicates) of which 170 underwent full text review. Thirty‐five were included for analysis; the majority (24/35,77%) were published in the last 5 years. Studies examined experience of the child (4/35), parent (19/35), or both (12/35). Experience and satisfaction were evaluated either by validated self‐assessment instruments (9) or satisfaction tools (13), or by non‐standard institutional or author‐developed tools (20). Experience was measured in the outpatient (7), pre‐operative (11), peri‐operative (14), and post‐operative care (3) settings. Specific findings were unique to setting; however, pooled conclusions revealed that continuous communication with parents and an empathetic care team are associated with increased satisfaction with care.Conclusions:Experience‐of‐care is a valuable quality measure which is being more frequently evaluated as a mechanism to improve pediatric surgical care processes. Future investigation of patient experience in this discipline should employ validated tools for measurement. This review emphasizes that communication with families in each stage of the surgical process improves the patient experience and parent satisfaction. These findings bear significance as patient experience measures become routinely integrated with quality and reimbursement.