bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analytic lymph node number establishes staging accuracy by occult tumor burden in colorectal cancer
Authors: Hyslop Terry , Weinberg David S. , Schulz Stephanie , Barkun Alan , Waldman Scott A. 
Published: January 2012

AbstractBackground and ObjectivesRecurrence in lymph node‐negative (pN0) colorectal cancer suggests the presence of undetected occult metastases. Occult tumor burden in nodes estimated by GUCY2C RT‐qPCR predicts risk of disease recurrence. This study explored the impact of the number of nodes analyzed by RT‐qPCR (analytic) on the prognostic utility of occult tumor burden.MethodsLymph nodes (range: 2–159) from 282 prospectively enrolled pN0 colorectal cancer patients, followed for a median of 24 months (range: 2–63), were analyzed by GUCY2C RT‐qPCR. Prognostic risk categorization defined using occult tumor burden was the primary outcome measure. Association of prognostic variables and risk category were defined by multivariable polytomous and semi‐parametric polytomous logistic regression.ResultsOccult tumor burden stratified this pN0 cohort into categories of low (60%; recurrence rate (RR) = 2.3% [95% CI 0.1–4.5%]), intermediate (31%; RR = 33.3% [23.7–44.1%]), and high (9%; RR = 68.0% [46.5–85.1%], P < 0.001) risk of recurrence. Beyond race and T stage, the number of analytic nodes was an independent marker of risk category (P < 0.001). When >12 nodes were analyzed, occult tumor burden almost completely resolved prognostic risk classification of pN0 patients.ConclusionsThe prognostic utility of occult tumor burden assessed by GUCY2C RT‐qPCR is dependent on the number of analytic lymph nodes. J. Surg. Oncol. 2012; 106:24–30. © 2012 Wiley Periodicals, Inc.
Minimally invasive approach for the management of the leaking tracheoesophageal puncture
Authors: Shuaib Stefan W. , Hutcheson Katherine A. , Knott Jodi K. , Lewin Jan S. , Kupferman Michael E. 
Published: January 2012

AbstractObjectives/Hypothesis:An enlarging tracheoesophageal puncture (TEP) site after total laryngectomy is associated with substantial functional, hygienic, and potentially life‐threatening problems. The enlarged TEP is challenging to manage. TEP injection (TEP‐I) for control of the enlarged puncture site may be beneficial in avoiding surgery. Our study reviewed the clinical outcomes of patients at a single institution with enlarged TEP treated by office‐based TEP‐I.Study Design:Retrospective study.Methods:Chart review of eight patients who had an enlarged TEP with leakage around the prosthesis treated with TEP‐I after attempted customization of voice prostheses. Patient demographics and treatments were reviewed, and injection efficacy was evaluated by the duration of leakage resolution.Results:Eight patients underwent 20 TEP‐I procedures. The average duration of leak resolution after each injection was 174.5 days. There were no complications. Six patients required custom modifications of the voice prosthesis to control TEP leakage after TEP‐I, and all patients resumed their baseline speech and swallowing function. There was a trend toward an increase in number of injections among patients with N+ disease, disease recurrence, a history of irradiation and secondary TEP. No patients required surgical closure of the TEP.Conclusions:Office‐based TEP‐I is a safe and effective treatment option for patients with an enlarged TEP site who have failed more conservative measures. A history of irradiation, disease recurrence, secondary TEP, and high‐volume neck disease were predictive of multiple injections. Further study is warranted to accurately identify patients who may benefit from TEP‐I to control leakage around the TEP.
The oncology of otology
Authors: Gidley Paul W. , Thompson Christopher R. , Roberts Dianna B. , DeMonte Franco , Hanna Ehab Y. 
Published: January 2012

AbstractObjectives/Hypothesis:To describe the population of patients with malignancy affecting the ear canal and temporal bone.Study Design:Retrospective review.Methods:The charts of 157 patients with temporal bone cancer were reviewed for clinical outcomes.Results:Between 1999 and 2009, 157 patients underwent temporal bone surgery for cancer involving the ear canal (n = 25), external ear with ear canal involvement (n = 26), periauricular skin (n = 40), parotid gland (n = 40), temporal bone (n = 13), and lateral skull base (n = 13). All surgeries involved one or more otologic approaches: mastoidectomy (28.0%), lateral temporal bone resection (TBR) (59.2%), subtotal TBR (2.5%), total TBR (3.2%), transtemporal approach (TTA) to the jugular foramen (8.2%), TTA to the middle fossa (5.7%), and TTA to the infratemporal fossa (3.2%). Cancers of the cartilaginous ear canal were managed with wide local excision of canal skin and cartilage in nine patients (5.7%). A combination of approaches was performed in 32 patients (20.4%). The 5‐year overall survival rate was 58.0%. Patients whose disease was limited to the ear canal had significantly better overall survival than did patients who had skull base primaries (P = .02989), periauricular skin cancer (P = .00138), or temporal bone tumors (P = .02598). Patients with parotid tumors also had better overall survival than did those with periauricular skin tumors (P = .02357).Conclusions:Otologic surgery plays an important role in managing cancers that involve the ear canal, temporal bone, or lateral skull base. The specialty of otologic oncology is emerging as a defined area of practice.
Botulinum toxin in the treatment of facial synkinesis and hyperkinesis
Authors: Filipo Roberto , Spahiu Irma , Covelli Edoardo , Nicastri Maria , Bertoli Gian Antonio 
Published: January 2012

AbstractObjectives/Hypothesis:Facial synkinesis and hyperkinesis commonly impair the outcome of facial nerve palsy. Botulinum toxin type A has shown positive results in the treatment of these symptoms. Our experience is reported in this article.Study Design:Prospective study.Methods:Forty‐one patients affected by facial synkinesis and hyperkinesis due to facial palsy were treated. The etiology of the facial palsy was: 28 Bell's palsy cases, nine iatrogenic cases (seven acoustic neuroma surgeries, one tympano‐jugular glomus tumor removal, and one middle ear surgery), three herpes zoster virus cases, and one case of Melkersson‐Rosenthal syndrome. Botulinum toxin type A was used in the treatment. Clinical evaluation was obtained through the Sunnybrook Grading Scale and an author's modification of this method purposely designed for evaluation of hyperkinesis. Further evaluation through a self‐administered synkinesis questionnaire was also performed.Results:All patients showed some improvement of synkinesis and hyperkinesis after treatment. The mean values of the data obtained, regardless of the method of evaluation, gave statistically significant results. Correlation between objective and subjective evaluation methods was also statistically positive.Conclusions:This work stresses the importance of considering synkinesis and hyperkinesis separately because they are different conditions. These two symptoms showed improvement after botulinum toxin treatment, but only hyperkinesis showed a positive correlation when objective and subjective evaluations were performed. This treatment is effective in the management of facial synkinesis and hyperkinesis due to facial palsy, thus improving quality of life. It is a safe, minimally invasive treatment that can be repeated.
Incidence of laryngospasm and bronchospasm in pediatric adenotonsillectomy
Authors: Orestes Michael I. , Lander Lina , Verghese Susan , Shah Rahul K. 
Published: January 2012

AbstractObjectives/Hypothesis:To evaluate and describe airway complications in pediatric adenotonsillectomy.Study Design:Retrospective case‐control study.Methods:A chart review of patients that underwent adenotonsillectomy between 2006 and 2010 was performed. Perioperative complications, patient characteristics, and surgeon and anesthesia technique were recorded.Results:A total of 682 charts were reviewed. Eleven cases (1.6%) of laryngospasm were identified: one was preoperative, seven occurred in the operating room postextubation, and three occurred in the recovery area. Four patients were given succinylcholine, one was reintubated, and the other cases were managed conservatively. Mean age of patients with laryngospasm was 5.87 years (standard deviation [SD], 4.01; 1.9–15.8 years). There were 12 cases (1.8%) of bronchospasm; all were treated with nebulized albuterol. Mean age of patients with bronchospasm was 5.81 years (SD, 4.17; 1.8–14.1 years). Overall, 22 patients required antiemetics (3.3%), 19 required albuterol (2.9%), and five required racemic epinephrine (0.8%). Compared to the children without airway complications, there was no difference in age, weight, American Society of Anesthesiologists status, length of surgery, need for admission, and anesthesia technique in those that had laryngospasm. Patients with bronchospasm, compared to the patients without complications, had faster surgeries (P < .05), were more likely to have underlying asthma (P < .05), and were more likely to be admitted (P < .05). There were no unexpected admissions or other morbidities.Conclusions:The rates of laryngospasm (1.6%) and bronchospasm (1.8%) are significantly lower than reported in the literature, reflecting refinements in modern anesthesia/surgical technique. Knowledge of at‐risk patients can facilitate planning to potentially reduce the incidence of perioperative airway complications during adenotonsillectomy.
Saccular cysts: A current review of characteristics and management
Authors: Young VyVy N. , Smith Libby J. 
Published: January 2012

AbstractObjectives/Hypothesis:To review a large cohort of adult saccular cyst patients and update current management of saccular cysts.Study Design:Retrospective review of treatment of adult patients with saccular cysts.Methods:Medical records were reviewed of all adult patients with saccular cysts identified between July 1, 2005 and August 31, 2009 at a tertiary care voice center.Results:Sixteen patients were identified. All complained of dysphonia. Saccular cysts were predominantly left‐sided (62.5%). The majority were anterior (85.7%); 14.3% were combined anterior/lateral. There were no isolated lateral saccular cysts. Surgical intervention was performed in 13 patients (81%); 100% were endoscopic. No patient required an external approach. Two patients recurred (15%), both within 2 months, and were managed conservatively.Conclusions:Saccular cyst is uncommonly encountered but can cause debilitating or even life‐threatening symptoms. Over time, management of these lesions has changed dramatically. With current, improved endoscopic techniques, most saccular cysts can be managed endoscopically with great success rates, often without the need for an external approach.
Posterior pharyngeal flap for velopharyngeal insufficiency patients: A New Technique for Flap Inset
Authors: Emara Tarek Abdelzaher , Quriba Amal Saeed 
Published: January 2012

AbstractObjectives/Hypothesis:To describe a modification of the originally described superiorly based pharyngeal flap as a secondary operation to correct velopharyngeal insufficiency (VPI) in patients with nonsyndromic repaired cleft palate.Study Design:Prospective clinical trial at university medical center.Methods:Twenty‐six patients with VPI after cleft palate repair underwent a modified posterior pharyngeal flap procedure. Patients with submucous cleft palate or associated with syndromic VPI or Pierre Robin sequence were excluded from the study. Flap was harvested high up in the nasopharynx and inserted into the soft palate through a transverse full‐thickness palatal incision. Lateral pharyngeal ports were determined by 45‐degree nasoendoscopy. Speech assessment was done preoperatively and 3 months postoperatively. The flap integrity and lateral pharyngeal ports were evaluated with postoperative nasoendoscopy.Results:Postoperative speech assessment showed significant improvement in the overall velopharyngeal function, nasal emission, resonance, and articulation defects. The pattern of velopharyngeal closure was circular in 15 patients, coronal in six patients, and sagittal in five patients. Eighteen patients received medium to wide flap, five patients had narrow flap, and three patients had near obstructing flap. Velopharyngeal function was normal or borderline insufficiency in 24 patients (92%). Partial flap dehiscence was seen in two patients and was considered as failure despite the significant improvement in their preoperative VPI.Conclusions:The minimal complication and ease of flap design with precise flap inset make this modified superior flap technique easily applicable with a high success rate for patients with VPI after cleft palate repair.
Hypertrophied tonsils impair velopharyngeal function after palatoplasty
Authors: Abdel‐Aziz Mosaad 
Published: January 2012

AbstractObjectives/Hypothesis:When tonsillar hypertrophy obstructing the airway is encountered in a child with a repaired cleft palate and velopharyngeal insufficiency, the surgeon may opt for tonsillectomy to relieve the airway obstruction, with possible effects on velopharyngeal closure. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with repaired cleft palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance.Study Design:Case series.Methods:Twelve children with repaired cleft palate and tonsillar hypertrophy underwent tonsillectomy to relieve airway obstruction. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech and nasalance scores were measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy.Results:Preoperative impairment of velopharyngeal function was detected. However, significant postoperative improvement of speech parameters (hypernasality, nasal emission of air, and weak pressure consonants measured with auditory perceptual assessment) was achieved, and the overall postoperative nasalance score was improved significantly for nasal and oral sentences. Reduction of velopharyngeal gap size was detected after removal of hypertrophied tonsils. Although the improvement of velopharyngeal closure was not significant, three cases demonstrated complete postoperative closure with no gap.Conclusions:Hypertrophied tonsils may impair velopharyngeal function in children with repaired cleft palate, and tonsillectomy is beneficial for such patients as it can improve the velopharyngeal closure and speech resonance. Secondary corrective surgery may be avoided in some cases after tonsillectomy.
Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy
Authors: Sierpina David I. , Chaudhary Hamad , Walner David L. , Villines Dana , Schneider Karen , Lowenthal Marissa , Aronov Yuri 
Published: January 2012

AbstractObjectives/Hypothesis:Evaluation of safety and postoperative outcomes of the laryngeal mask airway (LMA) during pediatric tonsil surgery compared to use of the endotracheal tube (ETT).Study Design:Randomized controlled trial.Methods:A population‐based sample of 117 patients ages 2 to 18 years requiring adenotonsillectomy, adenoidectomy, or tonsillectomy was studied. Evaluation forms covering 36 safety, surgery duration, and patient comfort variables were given to the surgeon, anesthesiologist, and phase I and phase II recovery nurses to collect data on the intra‐ and postoperative course. A phone survey was conducted 24 hours after surgery.Results:At the α level following Bonferroni correction, LMA showed less coughing or gagging during the anesthesia phase for all surgeries combined (48% for ETT vs. 20% for LMA; χ2 = 10.153, P = .002), and for ETT nontonsillectomy vs. LMA nontonsillectomy (48% for ETT vs. 3% for LMA; χ2 = 15.196, P = .000), spontaneous ventilation was used more often in the LMA group when comparing all surgeries (χ2 = 19.493, P = .000), and when comparing ETT tonsillectomy and LMA tonsillectomy (χ2 = 11.131, P = .000).Conclusions:Use of the LMA during pediatric tonsil surgery does not appear to have any major disadvantages compared to use of the ETT. In fact, analysis of safety, comfort, complications, and postoperative problems suggests that LMA may be superior for some outcome variables such as coughing and gagging. Use of spontaneous ventilation is more common among LMA patients, although the significance of this finding is uncertain.
Differential management of scaphocephaly
Authors: Tatum Sherard A. , Jones Lamont R. , Cho Minji , Sandu Ranjit 
Published: January 2012

AbstractObjectives/Hypothesis:The objective of this study was to review the outcomes of scaphocephaly management. We hypothesized that differential treatment of scaphocephaly based on age at correction and degree of severity yields consistently satisfying results while reducing the operative morbidity.Study Design:Retrospective patient record review.Methods:Three cranial vault–remodeling procedures with varying levels of aggressiveness (limited‐access, partial, and total cranial‐vault remodeling) were performed on patients with scaphocephaly from 1995 to 2010. More‐aggressive procedures were performed on older patients and patients having more‐severe deformities. Patient records were reviewed for age, weight, blood loss, and length of hospital stay, and cephalic indices (CIs) were calculated from computed tomography scans and clinical photographs.Results:Fifty‐one patients underwent surgery for scaphocephaly during the study period. The average estimated blood volume fraction lost was 0.41. The average length of hospital stay was 4.49 days. Pre‐ and postoperative CIs were calculable for 36 patients. The average preoperative CI was 68.7. The average postoperative CI was 79.3, for an average operative change of 15%. The three procedures had statistically different values for average length of stay. A trend was suggested for estimated blood loss and volume fraction lost. There was no statistically significant difference in CI outcomes.Conclusions:This study supports the concept of a proportionate response in the management of scaphocephaly. Less‐aggressive procedures do not yield less‐desirable results when properly selected to match the clinical situation of the individual patient.
Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery
Authors: Soares Danny , Sinawe Hadeer , Folbe Adam J. , Yoo George , Badr Safwan , Rowley James A. , Lin Ho‐Sheng 
Published: January 2012

AbstractObjectives/Hypothesis:To identify patterns of airway collapse during preoperative drug‐induced sleep endoscopy (DISE) as predictors of surgical failure following multilevel airway surgery for patients with obstructive sleep apnea‐hypopnea syndrome (OSAHS).Study Design:Retrospective clinical chart review.Methods:Medical records of patients who underwent site‐specific surgical modification of the upper airway for treatment of OSHAS were reviewed. Patients were included in this study if they had a preoperative airway evaluation with DISE as well as preoperative and postoperative polysomnography. Airway obstruction on DISE was described according to airway level, severity, and axis of collapse. Severe airway obstruction was defined as >75% collapse on endoscopy. Surgical success was described as a postoperative apnea‐hypopnea index (AHI) of <20 and a >50% decrease in preoperative AHI.Results:A total of 34 patients were included in this study. The overall surgical success rate was 56%. Surgical success (n = 19) and surgical failure (n = 15) patients were similar with regard to age, gender, body mass index, preoperative AHI, Friedman stage, adenotonsillar grades, and surgical management. DISE findings in the surgical failure group demonstrated greater incidence of severe lateral oropharyngeal wall collapse (73.3% vs. 36.8%, P = .037) and severe supraglottic collapse (93.3% vs. 63.2%, P = .046) as compared to the surgical success group.Conclusions:The presence of severe lateral pharyngeal wall and/or supraglottic collapse on preoperative DISE is associated with OSAHS surgical failure. The identification of this failure‐prone collapse pattern may be useful in preoperative patient counseling as well as in directing an individualized and customized approach to the treatment of OSHAS.
Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma: The national experience#*
Authors: Schwartz Jason J. , Pappas Lisa , Thiesset Heather F. , Vargas Gabriela , Sorensen John B. , Kim Robin D. , Hutson William R. , Boucher Kenneth , Box Terry 
Published: January 2012

Abstract
Current liver allocation policy in the United States grants liver transplant candidates with stage T2 hepatocellular carcinoma (HCC) a priority Model for End-Stage Liver Disease (MELD) score of 22, regardless of age. Because advanced age may portend an increase in all-cause mortality after transplantation for any diagnosis, the aim of this study was to examine overall posttransplant survival in elderly patients with HCC versus younger cohorts. Based on Organ Procurement and Transplantation Network data, Kaplan-Meier 5-year survival rates were compared. Recipients undergoing primary liver transplantation were stratified into cohorts based on age (<70 or ≥70 years) and the receipt of MELD exception points for HCC. Log-rank and Wilcoxon tests were used for statistical comparisons. In 2009, 143 transplants were performed for patients who were 70 years old or older. Forty-two percent of these patients received a MELD exception for HCC. Regardless of the diagnosis, the overall survival rate was significantly attenuated for the septuagenarians versus the younger cohort. After 5 years of follow-up, this disparity exceeded 10% to 15% depending on the populations being compared. The 1-, 2-, 3-, 4-, and 5-year actuarial survival rates were 88.4%, 83.2%, 79.6%, 76.1%, and 72.7%, respectively, for the patients who were younger than 70 years and 81.1%, 73.8%, 67.1%, 61.9%, and 55.2%, respectively, for the patients who were 70 years old or older. Five-year survival was negatively affected for patients with HCC who were younger than 70 years; this disparity was not observed for patients with HCC who were 70 years old or older. In conclusion, although patients who are 70 years old or older compose a small fraction of transplant recipients in the United States, patients in this group undergoing transplantation for HCC form an even smaller subset. Overall, transplantation in this age group yields outcomes inferior to those for younger cohorts. However, unlike patients who are less than 70 years old and receive MELD exception points, overall liver transplant survival is not affected by HCC at an advanced age. Liver Transpl 18:423–433, 2012. © 2011 AASLD.