bluuebunny/crossref_metadata_2025_split huggingface dataset:
Topical Therapies in Chronic Sinonasal Disease
Authors: Harvey Richard J. , Wormald Peter J. , Cohen Noam A. , Psaltis Alkis , Schlosser Rodney J. , Chiu Alexander G. 
Published: September 2011

Program DescriptionThere has been an explosion in the understanding of the mechanisms of chronic sinonasal inflammation. Multiple approaches to control and modify the inflammatory reaction in chronic rhinosinusitis have lead to many new agents being introduced topically to the nose. This miniseminar aims to provide an evidence‐based approach to the science behind topical management of sinonasal disease. Current research into irrigation dynamics and delivery device will be discussed. There are a range of products available to deliver solutions topically to nose. The scientific basis behind high and low volume along with negative and positive pressure delivery is presented. The general therapeutic goal of topical management often lies between, potentially competing actions of mechanical and pharmaceutical intervention. Distribution research behind nebulizers, sprays, irrigations, and other delivery techniques is discussed within this framework. The over‐the‐counter (OTC) market for topical sinonasal treatments is likely to exponentially grow over the next few years. Increasingly, the pharmaceutical options have also grown. Antibiotics, such as mupriocin, and steroids are often added to solutions. Novel innate immunity enhancers and modifiers of mucus rheology are also emerging. The science behind the OTC agents and pharmaceutical additions to saline are presented. Potential adverse risks also needs to balanced with greater local intervention. The influence of pre‐ and postsurgical distribution efficacy is an important factor that significantly changes how these solutions should be used. The miniseminar is presented by rhinologists actively involved in the topical management of chronic sinonasal conditions both clinically and in research. Presentations for delivery, device, saline, and pharmaceutical additives will be given with video used to illustrate research. There is direct clinical application of current research and available products to the management of chronic sinonasal disease in general otolaryngology practice.Educational Objectives1) Define the therapeutic goals of topical therapies. 2) Understand the influence of device and surgical state on topical delivery. 3) Learn about the science behind novel topical agents.
OSA Surgery: Reviewing the Reviews and Their Implications
Authors: Kezirian Eric J. , Weaver Edward M. , Brietzke Scott E. 
Published: September 2011

Program DescriptionThe American Academy of Sleep Medicine and Agency for Healthcare Research and Quality have recently published controversial systematic reviews of the obstructive sleep apnea (OSA) surgery literature. These are now being used by third‐party payors to reconsider coverage policies, including those for soft palate procedures such as uvulopalatopharyngoplasty. The purpose of this miniseminar is to present these reviews and the debates they raise, examine the available higher level studies, and present a framework for evaluating OSA surgery outcomes. AASM and AHRQ reviews. Systematic reviews can synthesize are powerful but challenging tools that can help guide clinical decisions. Any review has general as well as specific strengths and weaknesses, whether related to methods that require oversimplification of each study’s findings, selection of outcome measures to compare results across studies, or the scope of the review that leaves certain studies excluded. This segment will examine the reviews’ methods and findings, highlighting their importance as well as gaps, particularly those regarding multilevel OSA surgery and the evaluation of sleep study outcomes alone. As for most surgical fields, the bulk of the OSA surgery literature consists of case series studies, with all of their inherent limitations. However, there are a number of higher level OSA surgery studies, including randomized trials and cohort studies. The program will review these higher level studies and provide grades for the available evidence concerning OSA surgical interventions. As for every surgical intervention, outcomes after OSA surgery vary widely, not only among various procedures but also for individual patients. There is a tendency to criticize or discard procedures that do not achieve ideal outcomes universally. The alternative is to pursue a nuanced evaluation of whether those patients who appear to respond to surgery achieve meaningful clinical improvements and also to match procedures and patients in order to increase the proportion of treated patients who do respond to surgery. This portion of the miniseminar will review evidence showing that there is a subgroup of patients who obtain meaningful clinical improvements after surgery, strategies to match procedures and patients, and a framework for presenting and reading results of sleep surgery trials that is based on this variation in outcomes.Educational Objectives1) Learn the findings of recent OSA surgery reviews, along with their strengths and weaknesses. 2) Understand the findings of higher‐level studies in the field. 3) Appreciate the variation in outcomes across procedures and patients, along with the implications.
Online Script Concordance Test for ENT
Authors: Kania Romain E. , Verillaud Benjamin , Tran Hugo , Mardion Nicolas Bon , Charlin Bernard , Ba‐Huy Patrice Tran , Herman Philippe 
Published: September 2011

ObjectiveThe Script Concordance Test (SCT) involves the use of authentic clinical scenarios to compare a medical trainee’s judgment skills with those of experts. The aim of this work is to produce valid, reliable SCT for the ear, nose, and throat (ENT) discipline.MethodIn total, 132 participants were asked to test an online ENT‐SCT of 20 cases and 94 questions based on the major educational objectives of the ENT residency program. Three levels of experience were tested: medical students, ENT residents, and board‐certified otorhinolaryngologists as an expert panel.ResultsThe 65 respondents with useable data were medical students (n = 21), ENT residents (n = 22), and experts (n = 22). Total mean test scores significantly differed: 76.81 ± 3.31 for the expert panel, 69.05 ± 4.35 for residents, and 58.29 ± 5.86 for students. The Cronbach alpha coefficient was 0.95. More than two‐thirds of the participants found the test realistic and relevant for assessing clinical reasoning. The test was also considered interesting and intuitive.ConclusionThe web‐based ENT‐SCT is feasible, reliable, and useful for assessing clinical reasoning. This online assessment tool may have applications for residency programs and continuing medical education.
Deviated Nose Affects Surgical Success and Quality of Life
Authors: Cingi Cemal , Eskiizmir Görkem 
Published: September 2011

ObjectiveAnalyze and compare the surgical outcome and quality of life in patients with and without deviated nose in rhinoplasty.MethodA total of 191 patients who underwent primary rhinoplasty between 2006 to 2009 were enrolled. The study population was separated into nondeviated or deviated groups. The surgical outcome, pre‐ and postoperative quality of life were assessed using rhinoplasty outcome evaluation (ROE) and EuroQol, and statistically analyzed.ResultsA hundred ten cases had deviated nose and 81 cases had nondeviated nose. The vast majority of cases were operated using endonasal approach except 3 cases. When non‐deviated and deviated groups were compared according to satisfaction with appearance, breathing problems, friends’ satisfaction with appearance, social interactions, self‐confidence, need for additional procedures, ROE score, statistically significant differences were determined. The comparison of pre‐ and postoperative change in EuroQol (EQ‐5 index, living quality index and visual analogue scale) between 2 groups also demonstrated statistically significant differences.ConclusionThe deviated nose is a challenging nasal morphology which may lead to lesser satisfaction in surgical outcome and inadequate improvement in quality of life. Therefore, it should be precisely evaluated in candidates of rhinoplasty.
DNA Aneuploidy and Its Role in Oral Leukoplakia
Authors: Cashman Emma , Bin‐Woo Sook 
Published: September 2011

Objective1) Determine the presence, if any, of aneuploidy in premalignant oral leukoplakia (OL). 2) Review the literature with respect to the relevance of aneuploidy as in OL.MethodTissue was mechanically disaggregated, and cell suspensions were centrifuged (300 rpm/ 5 minutes). After 10 minutes trypsin digestion and treatment with RNAase inhibitors, cell suspension was stained with propidium iodide and spermine. Nuclear DNA content FCM (flow cytometry) measurements were preformed using FACS Calibur FCM with argon laser (488 nm beam).ResultsScrapings from 17 patients for FCM and tissue for morphological evaluations were obtained. Thirteen out of 17 (76%) patients were male. A total of 4 out of 17 were female (24%). All patients were smokers. A total of 4 out of 17 (82%) patients were graded as moderate dysplasia by 2 different oral pathologists, and 3/17 (18%) were graded as having severe dysplasia. The rate of detection of aneuploidy was 0% (0/17).ConclusionMost published studies focus on DNA aneuploidy in HNC, and evidence for its role in OL is scant. On the basis of our results and the few published trials on this subject, we analyze whether aneuploidy plays a role in the prediction of risk of malignant transformation in OL.
Evaluation of Trends in Use of IMRT in Head and Neck Cancer
Authors: Mundi Jagmeet , St. John Maie 
Published: September 2011

ObjectiveEvaluate the trends of use of IMRT for head and neck cancer (HNC), with emphasis on Medicare reimbursement patterns and their effect on clinical use.MethodAll patients are selected from the Surveillance, Epidemiology, and End Results (SEER) database with HNC who were treated with radiation. These were then subdivided into those that were treated with IMRT. We then analyzed Medicare records for reimbursement patterns for Planning and Delivery of IMRT (CPT Codes 77301 and 77418).ResultsRegression analysis was then performed on the SEER data to evaluate cancer subsites, regional differences, and outcomes. Reimbursement for IMRT for Head and Neck cancer has increased since the introduction of CPT codes for Medicare from $1579 to $2643 from 2002 to 2010. In 2000 Medicare reimbursement for IMRT was 4x that of conventional radiation. This has more recently been adjusted to 3x conventional radiation. Compensation has been cited as a major factor in the adoption of this technology. The percentage of patients receiving IMRT vs traditional radiation has increased substantially from 3% in 2001 to 46% in 2005.ConclusionAdvantages of IMRT include decreased xerostomia and improved quality‐of‐life. No reports have demonstrated improved local‐regional control/survival. We show recent Medicare adjustments have not had a significant change in utilization of IMRT. This study raises questions about the role of economic incentives potentially driving IMRT usage.
Functional Impact of the Arytenoidectomy in SCPL
Authors: Kim Min Sik , Joo Young Hoon , Park Jun Ook , Cho Kwang‐Jae , Nam Inn Chul 
Published: September 2011

ObjectiveThe arytenoid is one of the components of sphincteric function of the larynx, and arytenoid resection during supracricoid partial laryngectomy (SCPL) may negatively affect the functional results. The purpose of this study was to evaluate the functional results in patients who underwent unilateral arytenoidectomy during SCPL.MethodRetrospectively reviewed medical records of 116 patients who received SCPL. Regarding the extended procedure of unilateral arytenoidectomy, the patients were divided into 2 groups: Nonextended group and extended group. We evaluated and compared the functional results between the 2 groups.ResultsThere was a significantly higher rate of aspiration pneumonia (P =. 003*), delay of oral feeding (P =. 038*), and longer hospitalization time (P =. 008*) in the extended group. There was no significant difference in the score of “normalcy of diet,” “eating in public,” and “understandibility of speech” of PSS‐HNS (Performance status scale for head and neck cancer patients) at last follow‐up between the 2 groups (P =. 675, P =. 645, P = 1.000).ConclusionResection of the arytenoid may interrupt physiologic airway protection in the early postoperative period, so special cautions may be needed to prevent aspiration pneumonia. However, extended SCPL including arytenoidectomy allows avoidance of functional handicap and social maladjustment.
IMRTSIB and Concurrent CT for LAHNC: Toxicity and Quality of Life
Authors: Piccinini Alessia , Rocchi Andrea , De Marco Giuseppina , Marra Laura , Ghidini Angelo , Molteni Gabriele , Presutti Livio 
Published: September 2011

ObjectiveEvaluate the acute toxicity of postoperative radiotherapy with intensity modulated simultaneous integrated boost (IMRT‐SIB) and the impact of this treatment on quality of life for patients with head and neck cancer locally advanced (LAHNC).MethodA total of 21 patients with histologically confirmed LAHNC received, from July 2008 to August 2010, postoperative IMRT‐SIB and concurrent Cisplatin 100mg/m2 every 3 weeks. Quality of life was evaluated in 13 patients with M.D. Anderson Dysphagia Inventory, Karnofsky Performance Status, Performance Status Scale for Head & Neck Cancer, and EORTC H&N35.ResultsMedian follow‐up was 10 months (range, 2‐30 months). Acute mucositis ≥ G2 occurred in 18 patients. Acute reactions ≥ G2 on salivary glands in 15 patients. Acute reaction ≥ G3 appeared in 4 patients on mucosae and in 5 on pharynx. At time of analysis 18 patients were free from locoregional recurrence.ConclusionIMRT‐SIB and concurrent cisplatin is feasible and well tolerated in LAHNC and is not correlated with a decrease in healthy functioning, global health status, or subjective evaluation of level of illness.
Is sIL2R Helpful for Diagnosis of Malignant Lymphoma in Neck Lymph Node Swelling?
Authors: Shinohara Shogo , Fujiwara Keizo , Kanazawa Yuji , Yamazaki Hiroshi , Kikuchi Masahiro , Naito Yasushi 
Published: September 2011

ObjectiveSoluble interleukin2 receptor (sIL2R) is secreted from activated lymphocytes and is known to be a biomarker of collagen disease, retroviral infection, and malignant lymphoma (ML). The purpose of this study is to evaluate the usefulness of serum sIL2R value for diagnosis of ML in patients with cervical lymph nodes swelling.MethodA retrospective study from 155 patients who received open biopsy of a cervical lymph node in suspicion of ML and examined serum sIL2R. The differences of sIL2R value among histology were examined by Mann‐Whitney U test, and the diagnostic accuracy of sIL2R value for ML was calculated using ROC analysis.ResultsThe patients consisted of 67 B‐cell lymphoma, 30 T‐cell lymphoma, 15 Hodgkin lymphoma, 11 metastatic carcinoma, and 31 other benign lymphadenopathy including 14 reactive lymphadenitis. The serum sIL2R value was significantly higher in the ML group than the other diseases (P <. 001: median 2230 U/mL vs756 U/mL). T‐cell lymphoma showed highest sIL2R value (median 4380) among other ML groups (B‐cell median 2040 and Hodgkin median 1400). Applying the cut‐off value of 1350, which is higher than the reference range (220‐530), diagnosis of ML could be predicted with a sensitivity of 70.5% and a specificity of 89.1%.ConclusionThe value of serum sIL2R was helpful for diagnosis of ML in cervical lymph nodes swelling if the cut‐off value was properly applied.
Methylome Analysis of HPV‐Associated Head and Neck Cancer
Authors: Hernandez Maria Ivette Mucino , Ojeda Alejandro Gonzalez , Alvarea Alfonso Bencomo , Jeahns Elias Morales , Camacho Jose Gonzalo Vazquez , Rodriguez Luz Margarita Baltazar , Fuentes Hector Montoya 
Published: September 2011

ObjectiveEstimate the HPV frequency and types in neoplastic thyroid tissue by means of Polymerase Chain Reaction‐Restriction Fragments Length Polymorphisms (PCR‐RFLP).MethodTransversal study. We analyzed 157 samples from malignant and benign thyroid tumors of paraffin‐embedded tissue. All the paraffin blocks were randomly chosen from the archive of Pathology Tissue Bank (Centro Medico Nacional de Occidente, IMSS). The molecular detection and typing was performed at Molecular Microbiology II Laboratory in CIBO.ResultsThe HPV observed frequency was 2.5% (4 cases). HPV‐6 was found in 2 cases of thyroid hyperplasia (2.5%) and HPV‐33 in 2 cases of Papillary Cancer (4.6%).ConclusionHPV is not frequent in thyroid neoplasms, at least in the studied population. The HPV types found were HPV‐6 in hyperplasia and HPV‐33 in papillary cancer.
Neuroendocrine Neoplasms of the Larynx: Outcomes of 15 Cases
Authors: Mello Paulo , Klingerman Jacob , Milet Pedro , Soares Jose , Toscano Ullyanov B. , Dias Fernando Luiz , Lima Roberto 
Published: September 2011

ObjectiveNeuroendocrine neoplasms of the larynx (NNL), although rare, are the most common nonsquamous tumors of this organ. The aim of the study is to evaluate the presentation, treatment, and outcome of a consecutive series of 15 patients with NNL of the larynx and to provide information for therapeutic decision making.MethodRetrospective analysis of medical records. Cases were identified from databases maintained by the medical informatics and pathology departments. Main outcome measures were recurrence, overall survival, and disease‐specific survival (OS and DSS).ResultsFifteen patients (12 males) seen between 1990 and 2009, with a median age of 56.7 years. Seven patients had the diagnosis of moderately differentiated neuroendocrine carcinoma, and 8 were diagnosed as small cell neuroendocrine carcinoma. Multimodal treatment was established in 13 (92.8%) patients. Eight patients underwent surgical treatment. Neck node metastases developed in 6 patients (42.5%), and distant metastases occurred in 12 patients (80%). Cause of death was distant metastases in 11 patients (73.3%). At last follow‐up, only two patients were alive. The 3‐year OS and DSS were, respectively, 35.7% and 28.5%.ConclusionLaryngeal neuroendocrine malignant neoplasms (LNMN) are aggressive malignancies with a high frequency of distant metastasis. The optimal therapy for patients with LNMN remains a subject of debate.
Oropharyngeal Cancer with Neck Complete Response
Authors: Mun Sue Jean , Song Chang Myeon , Kim Kwang Hyun , Hah Jeong‐Hun , Kwon Tack‐Kyun , Jeong Woo‐Jin , Sung Myung‐Whun 
Published: September 2011

ObjectiveEvaluate the necessity of planned neck dissection in patients with oropharyngeal cancer by analyzing N2, N3 with complete response after primary treatment.MethodA retrospective chart review of 327 patients with oropharynx squamous cell carcinoma over a 24‐year period was conducted. Overall survival rate was analyzed using the Kaplan‐Meier method.ResultsAmong the 64 patients, all the recurrent cases had T staging more than 3, and N staging more than N2b without any evidence of metastasis except 1 case. Recurrence varied from 3 to 43 months. Disease recurrence was reported in 8 cases which include 3 primary recurrences, 2 neck recurrences, and 3 both primary and neck recurrences. Distant metastasis was reported in 2 cases. Survival according to initial treatment modality didn’t show any statistical significance. Overall 5 year survival rate reached 80% using the Kaplan‐Meier method.ConclusionNeck metastasis in oropharyngeal squamous cell carcinoma is well treated with chemotherapy and radiotherapy resulting in low neck recurrence and high 5‐year survival rate. Patients with oropharyngeal cancer with complete cervical response can be safely observed without planned neck dissection.
Patterns of Lateral Lymph Node Metastasis in Papillary Thyroid Cancer
Authors: Tae Kyung , Sung Eui‐Suk , Jung Joo Hwan , Bae Ji Yong , Kim Kyung‐Rae , Cho Seok‐Hyun 
Published: September 2011

ObjectiveAnalyze the patterns and factors of lateral lymph node metastasis in papillary thyroid cancer (PTC) patients. Based on this, we can suggest the optimal surgical extent of neck dissection for PTC patients with lateral compartment lymph node metastasis.MethodFrom January 2000 to December 2009, the patient group consisted of 88 patients who underwent total thyroidectomy concomitant therapeutic neck dissection. A total of 86 (97.7%) patients confirmed as having PTC and lateral compartment neck metastasis by pathologic examination were enrolled this study.ResultsA total of 86 patients underwent 100 lateral compartment neck dissection. Level IV was found to be the predominant site for lateral compartment lymph node metastasis (83%). Level III, Level II, and Level V were 65%, 54%, 17%, respectively. Level VI lymph node metastasis was found in 84.9% (73/86). Multiple level nodal metastasis was correlated with lymphovascular invasion of PTC. Skip metastasis was correlated with age.ConclusionIn PTC patients with lateral nodal invasion, total thyroidectomy concomitant bilateral central compartment neck dissection and ipsilateral lateral compartment neck dissection including Levels II‐V may be the optimal treatment.
Placement of NP Airways after Skull Base Tumor Resection
Authors: Spector Matthew E. , Sullivan Stephen , McKean Erin L. , Pepper Jon P. , Marentette Lawrence J. 
Published: September 2011

Objective1) Assess the efficacy of nasopharyngeal (NP) airways in lieu of tracheotomy to prevent tension pneumocephalus after open resection of anterior skull base (ASB) tumors. 2) Determine predictors of tension pneumocephalus in patients undergoing NP airway placement after open resection of ASB tumors.MethodA total of 121 ASB resections (mean age, 48.5 years; M:F 73:47) performed between 1994 to 2009 with documented NP airway placement were identified and charts retrospectively reviewed. Main outcome measures were presence of tension pneumocephalus, while controlling for other clinical parameters (presence of CSF leak, placement of lumbar drain, type of reconstruction).ResultsAll patients were extubated on the day of surgery and NP airways remained in place for 3 days; no complications from NP airways were seen (eg, nasal septal pressure necrosis, displacement of the tubes). A total of 3 (2.5%) cases of tension pneumocephalus occurred. There were 34 (28%) lumbar drains placed and 14 (12%) CSF leaks. Although only 3 events were recorded, there was a statistically significant difference in the rate of tension pneumocephalus stratified by lumbar drain placement (P =. 02), presence of CSF leak (P =. 04), and both together (P =. 004). Type of reconstruction did not affect rate of tension pneumocephalus (P = 1.0).ConclusionResection of anterior skull base tumors does not necessitate prophylactic tracheotomy and use of a nasopharyngeal airway to divert airflow is well tolerated and highly successful. Lumbar drainage, the presence of a CSF leak, or both together may increase the risk of tension pneumocephalus.
Polymorphous Low‐Grade Adenocarcinoma
Authors: Fife Tim , Smith Brooks , Waltonen Joshua 
Published: September 2011

ObjectiveWe present a series of 18 cases of polymorphous low‐grade adenocarcinoma.MethodWe retrospectively reviewed all documented cases of polymorphous low‐grade adenocarcinoma at our institution since 1984. Each case was confirmed by pathologic examination.ResultsThe median age of this series is 59 years. Eleven out of the 18 patients were female and 13 were white. Fifteen of the tumors were located on the hard/soft palate. Nearly every patient was treated with wide local excision, and 8 required reconstruction with flaps. Only 3 patients were treated with postoperative radiation. 4 patients were treated for recurrences, 2 of which were originally treated 20 years prior.ConclusionPolymorphous low‐grade adenocarcinoma is a rare and slow growing entity. Surgical excision is the treatment of choice and radiation therapy is generally not needed. Long term follow‐up is required, as recurrences have been noted after long periods of time. Differentiation from adenoid cystic carcinoma can be difficult.