bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic Value of PET‐CT for Oropharyngeal Carcinoma
Authors: Wallin Jordan L. , Mintz Akiva , Young Evan , Isom Scott , Browne J. Dale , Greven Katherine 
Published: September 2011

ObjectiveUnderstand local, nodal, and distant cure rates and the prognostic value of [18F]Fluorodeoxyglucose positron emission tomography (PET‐CT) after chemoradiation (CRT) for advanced oropharyngeal squamous cell carcinoma (OPSCC). Propose a potential algorithm for surveillance PET‐CT based on patient history.MethodA retrospective chart review of 53 patients treated from 2005 to 2008 with CRT for stage 3 (6%) or stage 4 (94%) OPSCC at a tertiary referral center. Variables reviewed included type of CRT, PET‐CT results, and smoking history. Outcomes evaluated included patterns of recurrence, survival, and progression free survival (PFS).ResultsOverall PFS rate was 77% at 3 years. The first post‐treatment PET‐CT obtained a median of 2.3 months after CRT was normal in 32 patients, however 5 patients ultimately relapsed. Sixteen patients had elevated FDG uptake of which 3 recurred. The result of the first PET‐CT was not significantly associated with recurrence (P =. 2988). The second post‐treatment PET‐CT, obtained a median of 8.6 months after CRT, was normal in 28 patients, of which only one relapsed. Four out of 12 patients with abnormal scans recurred. A normal delayed PET‐CT predicted the absence of disease (P =. 0211).ConclusionA normal PET‐CT early after CRT for OPSCC did not reflect the absence of disease. A normal PET‐CT 6 to 8 months after treatment predicted good control of disease. The optimal time for PET‐CT to demonstrate prognostic value may be 6 to 8 months after completion of CRT.
Proliferative Verrucous Leukoplakia: Rare but Lethal
Authors: Abadie Wesley M. , Schmalbach Cecelia 
Published: September 2011

ObjectiveProliferative verrucous leukoplakia (PVL) is a rare, recalcitrant, and lethal form of leukoplakia necessitating special attention. The purpose of this review is to further educate the otolaryngology community and to characterize the risk factors, clinical course, and optimal treatment for this highly aggressive, premalignant oral lesion.MethodA retrospective review was performed on all PVL cases treated at WMHC from 1985 to 2010. This data was pooled with additional PVL cases identified following a systemic review of the English‐language literature. Only articles addressing epidemiology, histopathology, treatment outcomes, and malignant progression were pooled and analyzed with our data.ResultsA total of 243 PVL cases met inclusion criteria. The mean patient age was 66 years. The majority of patients were female (72%) and nonsmokers (64.6%). HPV has not been found to be a risk factor. The average length of follow‐up was 5.5 years, with an average of 10.7 biopsies per patient during this period. PVL exhibits histopathologic features along a progressive spectrum, evolving from leukoplakia and verrucous hyperplasia eventually to invasive carcinoma. Definitive treatment was rarely successful, with PVL recurrence rates reaching 88%. Rate of progression to verrucous carcinoma or oral squamous cell carcinoma was high (63.6%).ConclusionPVL is a rare but recalcitrant form of leukoplakia with a malignant transformation rate reaching 64%. PVL warrants high clinical suspicion, to include a lifetime of close follow‐up by a physician well versed in oral carcinoma. Repeat biopsy should be considered an integral part of this routine follow‐up.
PTH Level, Gland Radioactivity, and Gland Weight in MIRP
Authors: Moore Evan Robert , Spencer Horace , Stack Brendan C. , Bodenner Donald 
Published: September 2011

ObjectiveBetter understand the relationships of parathyroid hormone production (PTH), adenoma gamma counts, and adenoma weight in patients undergoing minimally invasive parathyroidectomy for primary hyperparathyroidism due to single gland disease.MethodA retrospective review of 68 patients that had minimally invasive parathyroid surgery for single gland disease. All patients underwent intraoperative PTH monitoring as well as radioguided parathyroid surgery. All glands were weighed and examined by a pathologist.ResultsAdenoma weight was 0.58 gms ± 0.44 gms. Day of surgery preoperative PTH was 132 ± 68 pg/mL. Intraoperative PTH level dropped to 35 ± 22 pg/mL. The drop in PTH was 72.1 ± 17.2 %. Ex‐vivo gamma counts of the adenomas were 2233 counts per second ± 2058. Percentage of background for the adenoma was 107.2 ± 86.8%. Correlations between the preoperative PTH and percentage of background gamma counts showed a likely correlation. There were significant correlations between both percentage of background and preoperative PTH levels with adenoma weight and preoperative PTH and adenoma weight.ConclusionCorrelation exists between gland weight, radioactivity, and PTH. Radiation counts are not a proxy for changes in PTH levels as claimed by some authors. A radioguided parathyroid surgery technique and intraoperative parathyroid hormone measurements can provide complementary information in making an assessment of completion of focused/minimally invasive parathyroid procedures.
Injection Filler, Vascular Occlusion, and Tissue Necrosis
Authors: Czyz Craig , Allen Shannon H. 
Published: September 2011

ObjectiveCase report examining an incident of distant tissue necrosis following glabella radiesse injection. Review current literature on injection fillers, incidence of resulting tissue damage, patterns, and treatment options.MethodLiterature review: 1) Calcium hydroxylapetite; 2) Hyaluronic acids; 3) All injection fillers. Identifying patterns of injury and treatment consensus.ResultsLiterature reviewed and presented on patterns to injury and treatment.ConclusionBased on available data and identified patterns of damage and treatment.
Quantitative Frozen Biopsy of Central Metastasis in PTC
Authors: Lim Yun‐Sung , Lee Yoon Se , Lee Byung‐Joo , Lee Jin‐Choon , Wang Soo‐Geun 
Published: September 2011

ObjectiveNodal metastasis in PTC occurs in the central compartment of the ipsilateral neck and spreads laterally. Occult lateral neck metastasis can be predictable by lymphatic status of central compartment. This study was to evaluate the diagnostic accuracy of frozen biopsy for quantitative nodal evaluation of central neck metastasis.MethodA total of 264 patients with papillary thyroid cancer underwent total thyroidectomy with central compartment neck dissection as an initial operation. All fresh tissues from ipsilateral central neck dissection were examined by frozen biopsy for central neck metastasis with quantitative nodal analysis.ResultsAmong them, 134 patients (51% [134/262]) had central neck metastasis. The sensitivity and specificity of frozen biopsy for the detection of central neck metastasis were 100% and 99.2% in 264 patients who underwent total thyroidectomy with bilateral central neck dissection. The diagnostic accuracy for the number of metastatic ipsilateral central lymph nodes was 85.8% compared with permanent biopsy in 134 patients who had central neck metastasis.ConclusionFrozen biopsy for quantitative analysis of central compartment is a precise tool for intraoperative evaluation of central lymphatic status and would also be helpful for prediction of nodal involvement of lateral neck.
Regional Control of Head and Neck Melanoma with Selective Neck Dissection
Authors: Geltzeiler Mathew , Givi Babak , Vetto John , Monroe Marcus M. , Gross Neil D. , Andersen Peter E. 
Published: September 2011

ObjectiveHistorically, patients with cervical metastases from melanoma of the head and neck were treated with a modified radical or radical neck dissection. The purpose of our study was to evaluate the efficacy of therapeutic selective neck dissection (SND) in this high‐risk population.MethodRetrospective, single‐cohort study from a prospective institutional database. Patients underwent therapeutic SND for clinically node positive head and neck melanoma (n = 14) or pathologically node positive disease after sentinel lymph node biopsy (SLNB) (n = 27). Univariate and multivariate analyses were conducted. Primary end points were regional recurrence and regional recurrence free survival.ResultsForty‐one patients underwent therapeutic SND from 2001 to 2010. The median number of positive nodes was 1 (range, 1‐16 months). Twenty‐six patients (63%) received adjuvant radiation and 23 patients (56%) received adjuvant immunotherapy or chemotherapy. The median follow‐up time was 17 months (range, 1‐116 months). Regional control was achieved in 29 patients (71%). Median regional recurrence‐free survival was 21 months (range, 1‐116 months). Advanced age was a significant predictor of regional recurrence (P =. 012) while tumor depth, extracapsular spread, number of nodes positive, prior SLNB, extent of neck dissection, adjuvant radiotherapy, and adjuvant immunotherapy were not significant.ConclusionTherapeutic SND with frequent use of adjuvant radiation therapy is effective in achieving regional control of head and neck melanoma with cervical metastases. Older patients may be at increased risk of regional recurrence after SND for head and neck melanoma.
Retropharyngeal Node Metastasis in Nasopharyngeal Carcinoma
Authors: Chen Mu‐Kuan , We Wu Iuan‐Sheng 
Published: September 2011

ObjectivePET/CT has been proposed to enhance pretreatment evaluation of cervical nodal status in patients with nasopharyngeal carcinoma (NPC). The purpose of this study was to compare PET/CT and enhanced CT in the detection of retropharyngeal lymph node (RLN) metastasis in NPC, and to ascertain the factors affecting its diagnostic performance.MethodFrom 2007 to 2008, 33 patients with newly diagnosed NPC were prospectively studied. All patients underwent an enhanced CT scan and FDG‐PET/CT.ResultsThe detection rate of RLN metastasis on PET/CT was significantly lower than that on enhanced CT (36.4% vs 75.8%), Pmax of RLNs was positively correlated with the minimal axial diameter (r=0.803), P < 5 mm, 9% for those 5 to 10 mm, and 73% for those ≥1 cm. The detection rate of PET/CT at C1 level was significant lower than that at C2 level (22% vs 67%, P =. 035), suggesting that RLNs in close proximity to the primary tumor hindered the recognition by PET/CT.ConclusionPET/CT is inferior to enhanced CT in detecting RLN metastasis in NPC, especially in lymph nodes with a diameter less than 1 cm or in close proximity to the primary tumor. Using enhanced CT in PET/CT is complementary in delineating the RLN metastasis in patients with NPC.
Retrospective Study of Esophageal Food Bolus Impaction
Authors: Bennett Warren , Bird Jonathan , Burrows Stuart , Reddy Venkat , Counter Paul R. 
Published: September 2011

ObjectiveEstablish the recurrence rate of food bolus impaction (FBI) and identify demographic/pathological features associated with food bolus obstruction recurrence.MethodRetrospective case note review of patients (greater than or equal to 16 years) admitted to the hospital with FBI between 2002 and 2007. Patient demographics, co‐morbidities, interventions, radiological investigations, and results were recorded. Statistical analysis was performed using SPSS 13.ResultsA total of 99 patients fulfilled the inclusion criteria (65 males and 34 females; median ages 59 and 71.5 years), IQR 47‐74, and 53‐81 years respectively). A total of 22 patients died between first presentation with FBI and the time of this study being conducted (mean follow up 34 months ±17). A total of two patients had recurrences but died before this study. For all other patients without recurrences the mean follow‐up was 68 months ±20. Logistic regression demonstrated that only hiatus hernia demonstrated a statistical significance in its association with FBI recurrence (OR 4.77 95% CI 1.15‐19.82, P =. 032). All other variables were not statistically significant.ConclusionThe recurrence rate of food bolus impaction of the esophagus was 9%. Hiatus hernia was the only esophageal pathology associated with recurrence of food bolus impaction.
Salivary Gland Cancer: Experience of Coimbra Cancer Institute
Authors: Simoes Ana Margarida , Neves Antonio , Cardoso Azenha , Cruz Carlos 
Published: September 2011

Objective1) Perform a comprehensive survey of the primitive malignant diagnoses of the salivary glands and characterize them in terms of clinical and biological behavior. 2) Draw conclusions on the treatment and disease control.MethodRetrospective study with analysis of the patients with histological diagnosis of malignant epithelial disease of the salivary glands between 2000 and 2010 treated in Coimbra’s Portuguese Cancer Institute. Demographic information, location, risk factors, complementary evaluation, treatment modalities, histological features, follow‐up, and failures were analyzed.ResultsPresented 55 cases, aged between 23 and 86 years old, 56% male. A total of 75% were located at the parotid, 20% in the submandibular and 5% in minor salivary glands. Only 2 patients were not submitted to surgical excision. Most patients were in Stage II and IV. There were 12 (22%) adenoid cystic carcinoma, 10 (18%) mucoepidermoid carcinomas, 10 (18%) adenocarcinomas, 7 (13%) acinic cell carcinoma, and 16 (29%) of several other entities. A total of 55% underwent radiation and 18% chemotherapy. Survival rates at 1 year were 95% and at 5 years 78%. Failures were observed in 42% (local and distant).ConclusionThe analysis of these cases is in line with the literature‐‐the stage of the tumor being the principal prognosis factor in salivary gland malignancies, even when dealing with different grade histology entities. Radiation seems to be an important option in controlling local disease.
Salvage Supracricoid Laryngectomy Oncologic and Functional
Authors: de Barros e Silva Botelho Maíra , Freitas Emilson , Soares Jose , Toscano Ullyanov B. , Dias Fernando Luiz , Barbosa Mauro , Lima Roberto 
Published: September 2011

ObjectiveEvaluate the oncologic outcome and functional results of SCPL with CHEP or CHP in selected cases of glottic/supraglottic carcinoma recurrence after primary (surgery or radiotherapy) treatment.MethodRetrospective analysis of medical records. Twenty‐three consecutive patients treated with salvage intent by SCPL from 1998 to 2007 were collected. Main outcomes measures were recurrence, overall survival, disease‐specific survival, cause of death, and functional results.ResultsMost of our patients were males (20/86.9%), with a mean age of 57 years. Eighteen (78%) were primarily treated with endoscopic laser resection, while 5 (22%) patients received external beam radiation. Disease‐free interval ranged between 2 and 59 months (mean, 10.2 months) after primary treatment and recurrence. SCL‐CHEP was carried out in 20 patients, whereas 3 patients underwent SCL‐CHP. Tracheostomy tube was removed in 20 patients (86.9%) between 7 and 300 days (mean, 30.1 days) after surgery. Mean swallowing recovery time was 9 days (range 7 to 185 days) and was achieved in 20 patients (86.9%). The 5‐year overall survival was 82.6%ConclusionSCPL with CHEP/CHP is a feasible, oncologically safe, functionally valid alternative to total laryngectomy in selected laryngeal recurrence.
Laryngotracheal Reconstruction with a Prefabricated Flap
Authors: Detwiller Kara Y. , Schneider Daniel S. , Schindler Joshua S. , Wax Mark K. 
Published: September 2011

ObjectiveLaryngotracheal stenosis can severely alter anatomy and leave patients with airway compromise. The majority of patients can be managed with conservative or open surgical procedures. Occasionally patients cannot be reconstructed with local tissues. We describe our experience with a prefabricated composite free flap to reconstruct patients with complicated laryngotracheal stenosis.MethodCase series of 2 patients with severe laryngotracheal stenosis treated with a prefabricated composite graft consisting of auricular cartilage and a radial forearm free flap. Both patients had compromised local tissue due to extensive neck surgery, previous radiation therapy, or chronic inflammation.ResultsThe prefabricated cartilage free flap allowed for a customized reconstruction. Prefabrication, implantation of the cartilage into the arm 6 weeks prior to flap harvest, maintained the integrity of the vascular cartilage graft. Furthermore, this reconstructive method provided satisfactory cosmetic and functional results. Both patients were decannulated. As the etiology, extent of the defect, and overall tissue quality of patients with laryngotracheal stenosis are variable, this composite flap may provide surgeons with additional means of laryngotracheal reconstruction in patients who have failed previous attempts or have compromised tissue biology.ConclusionA prefabricated graft using auricular cartilage in a radial forearm free flap is a viable reconstructive option for laryngotracheal reconstruction in patients with large defects who are not candidates for conventional approaches.
Sensorineural Hearing Loss after Head‐Neck Radiation Therapy
Authors: Bhandare Niranjan , Morris Christopher , Antonelli Patrick J. , Mendenhall William M. 
Published: September 2011

ObjectiveSensorineural hearing loss (SNHL) has long been associated with radiation therapy (RT) for head and neck cancers (HNCa), but reporting criteria have been ill defined. The goal of this study was to evaluate the rate and severity of SNHL in HNCa patients receiving RT ± chemotherapy (chemo).MethodPatients with audiometry pre‐ and post‐RT for HNCa were retrospectively assessed using air and bone conduction thresholds for the pure tone average (PTA, 0.5, 1.0, 2.0 kHz) and 4 kHz. A 10 dB decrement at 2 consecutive evaluations separated by 6 months defined RT‐induced SNHL.ResultsA total of 375 patients (750 ears) were evaluated. SNHL was observed at 4kHz in 246 ears (186 patients) and PTA in 79 ears (72 patients), over a median time of 2.7 (range, 0.3 ‐9.0) and 3.3 (range, 0.5‐10) years, respectively. Cochlear dose and chemo were associated with onset of 4kHz SNHL (p60), gender, fractionation and fraction size were not. Five‐year actuarial risk of 4kHz SNHL increased from 2% for doses 45 Gy to 52% for doses ≥ 45 Gy and from 39% for RT alone to 54% for chemo+RT.ConclusionPost‐RT SNHL is more prevalent at higher frequencies and increases with RT dose received by cochlea as well as adjuvant chemo. Future studies on RT‐induced SNHL should include high frequency bone conduction thresholds and account for cochlear dose and adjuvant therapy.
Site Effect Concentrations of Remifentanil and Propofol for Intubation without Use of Neuromuscular Agent for Thyroid Surgery
Authors: Valette Gerald 
Published: September 2011

ObjectiveThyroid surgery needs accuracy with the aim to limit major complications‐‐that is to say injury of recurrent laryngeal nerve. To help the surgeon, tracheal tube with recurrent laryngeal nerve monitoring can be used. This technique is possible when no muscle relaxant is injected. Remifentanil use with an objective of effect site concentration appears to be a solution for anesthesia for this type of surgery. Our work consists in studying the optimal concentration needed to realize the surgery without the necessity to use muscle relaxant and with the lowest side effects.MethodObservation of practice in the department of Ear, Nose and Throat (ENT) surgery at Brest University Hospital. Fifty‐two patients undergoing thyroid surgery were assigned in 4 groups according to site effect remifentanil concentration: 4, 6, 7, and 8 ng/mL. Intubation was done by a tracheal tube with EMG electrodes to monitor recurrent laryngeal nerve during surgery. Noninvasive arterial blood pressure, heart rate changes, and BIS values were recorded every minute. Intubation conditions were assessed as excellent, good, or bad.ResultsIntubation conditions were better when remifentanil site effect concentration increased (P =. 001). With a 4 ng/mL concentration, intubation conditions were always bad. On the other side, an 8 ng/mL concentration always gave good intubation conditions. Furthermore, with 4 ng/mL concentration of remifentanil, heart rate was significantly increased. There was no significant difference for all other data.ConclusionIn our study, tracheal intubation for thyroid surgery using recurrent laryngeal nerve monitoring can be performed without a neuromuscular blocking agent with good conditions when remifentanil site effect concentration is above 8 ng/mL. At this concentration, no hemodynamic adverse effect was observed.
Skin Metastases from Noncutaneous Head and Neck Cancers
Authors: Emanuel Henry John , Emanuel Patrick , Kleinberger Andrew J. , Genden Eric M. 
Published: September 2011

ObjectiveInvestigate the distribution of spread, histopathologic characteristics, and prognostic implications of skin metastases arising from primary cancers of the head and neck. We present a case series of patients with skin metastases from non‐cutaneous malignancies of the head and neck and perform a complete literature review on this topic.MethodPatients with skin metastases arising from noncutaneous cancers of the head and neck were identified by a dermatopathologist and cases were reviewed. A comprehensive literature search was performed and appropriate articles were selected and analyzed for relevant cases.ResultsTwelve patients with skin metastases from noncutaneous carcinomas of the head and neck were identified. The most common primary site, histology, and location of spread was the parotid gland (33%), squamous cell carcinoma (42%), and scalp (25%), respectively. A literature search yielded 97 cases of dermal metastases from head and neck malignancies since 1972. Oral cavity was the most frequent site of origin, but many cases involved direct tumor extension rather than true metastatic spread. Skin metastases typically presented as a discrete nodule within the scalp, but morphology and distribution varied. Overall prognosis is poor with long‐term survivors occasionally reported.ConclusionSkin metastases are clinically rare, occurring in less than 1% of head and neck cancers, and when present typically herald a poor overall prognosis. Information regarding their distribution and clinical presentation is of particular importance to the otolaryngologist and oncologist in identifying, counseling, and treating patients diagnosed with skin metastases.
Squamous Cell Carcinoma of the Buccal Mucosa: A 40‐Year Review
Authors: DeConde Adam , Palla Beth , Chhetri Dinesh , Miller Mia E. , St. John Maie , Elashoff David 
Published: September 2011

ObjectiveEvaluate the treatment results of buccal squamous cell carcinoma at a single institution during a 40‐year period.MethodA retrospective review was performed by examining the records and reviewing the pathology of 48 patients with buccal squamous cell carcinoma treated at UCLA Medical Center from 1970 to 2009. Forty‐eight patients were identified that received first‐time surgical therapy for squamous cell carcinoma of the buccal mucosa and had adequate follow‐up.ResultsTreatment entailed surgery alone in 18 out of 48 patients (37.5%) and surgery followed by radiation therapy in 30 out of 48 patients (62.5%). Composite resection of the tumor was performed in 17 out of 48 patients (35.4%) and ipsilateral neck dissections were performed in 37 out of 48 patients (77.1%). One‐year observed actuarial disease‐free survival rates were 60%, 46%, 0%, and 40% for T1 through T4, respectively. Univariate analysis revealed increased age as a risk factor (P =. 062), and multivariate analysis demonstrated age as a risk factor and performance of neck dissection having a decreased risk of recurrence (P =. 029 and. 023, respectively).ConclusionWe report fairly high disease‐free survival rates in this patient population. Performance of neck dissection and younger age were associated with a favorable prognosis. Performance of neck dissection may decrease the risk of recurrences in primary squamous cell carcinoma of the buccal mucosa.