bluuebunny/crossref_metadata_2025_split huggingface dataset:
Descending Necrotizing Mediastinitis: Surgical Management
Authors: Pérez‐Fernández C. Aranzazu , Rombola Carlos A. , Javier Diaz‐Fernández Francisco J. , Contreras J. Diego , Ceballos Juan C. , Rodríguez‐Francos M. Isabel , de Sevilla Tomas G. F. 
Published: September 2011

ObjectiveDescending necrotizing medistinitis (DNM) is commonly caused by odontogenic infection, peritonsillar abscess, or retropharyngeal abscess. The diagnosis must be established rapidly. Because mortality rates are too high, aggressive surgical treatment is indicated. This investigation reviews the effects of surgical drainage on the survival of patients with DNM.MethodA retrospective review of patients from 2003 through 2010 with a diagnosis of DNM was performed. Their records were abstracted for personal demographics, hospital course, surgical treatment, morbidity, and mortality. The records of all patients were statistically analyzed for the impact of several clinical factors on survival.ResultsWe treated 13 patients (12 men, 1 woman) in whom DNM was identified. DNM was consecutive to dental abscess (6 cases), pharyngitis (5 cases), foreign body infection (1 case), and after tracheotomy (1 case). The mean age of the patients was 56 years (range, 26‐85 years). Surgical treatment consisted of: in 6 patients combined transthoracic mediastinal and cervical drainage and in 7 patients with a less aggressive surgical approach, such as cervical drainage and transcervical mediastinal drainage. Four patients required reoperation. Tracheotomy was performed in 4 patients. Two deaths occurred. The mean duration of hospitalization was 29 days.ConclusionDNM must be detected as soon as possible by computer tomography scanning in patients with persistent symptomatologia after treatment for pharyngeal infections. Early diagnosis and aggressive treatment are important. Ample cervicotomy associated with mediastinal drainage is essential in managing these critical patients and can significantly reduce the mortality rate.
Does Academic Output Affect Mortality Rates in NHS Trusts?
Authors: Bennett Warren , Bird Jonathan , Burrows Stuart , Reddy Venkat 
Published: September 2011

ObjectiveIt has been claimed that institutions engaging in academic activities provide better care. The aim of this study was to establish whether there is an association between academic output and mortality rates for NHS Trusts (NT).MethodStandardized mortality rates for 2010 were obtained from www.drfosterhealth.co.uk. MEDLINE was queried to establish the number of citations credited to NT from 2006 to 2010. Admissions for NT for 2009‐2010 were obtained from www.hesonline.nhs.uk. The number of citations per admission was calculated and used as an indicator of academic output.ResultsSpearman rank analysis was performed to identify any correlation between citations per admission and the inverse of 4 types of mortality rates: high risk conditions r = 0.20 (P =. 01); low risk conditions r = ‐0.06 (P =. 46); deaths after surgery r = 0.193 (P =. 019); overall mortality 0.291 (P <. 01).ConclusionThe results of this preliminary study demonstrate a statistically significant correlation between academic output and mortality rates. However, it should be noted that the correlation coefficients are small, but the findings of this study encourage further debate.
Preclinical Strategies to Optimize Optical Imaging in Head and Neck Cancer
Authors: Sweeny Larissa , Zinn Kurt , Cheng Zheng , Miao Zheng , Bishop Elliot S. , Rosenthal Eben L. , Knowles Joseph 
Published: September 2011

ObjectiveThere is a need for cancer imaging in the clinic and operating room. We have shown that fluorescently labeled antibodies can detect microscopic islands of head and neck cancer cells using modified intraoperative microscopes in preclinical animal studies. Here we evaluated the optimal targeting molecule for clinical translation.MethodWe assessed in vitro binding of fluorescently labeled antibodies targeting EGFR (cetuximab/Erbitux and panitumumab/Vectibix) and an antibody mimetic (anti‐EGFR affibody) in multiple cell lines (SCC5, OSC19, FADU). To compare in vivo imaging characteristics, HNSCC xenografts (SCC5, SCC1, FADU) were imaged after systemic injection of fluorescently labeled antibodies over 5 days.ResultsThe binding affinity was lower for the control antibody IgG (KD = 9.55 nM) compared with either panitumumab (KD = 6.82 nM) or cetuximab (KD = 2.86 nM). In vitro, panitumumab had a two fold increase in relative fluorescence compared with cetuximab and a four fold increase in fluorescence compared with control antibody (nonspecific IgG). Xenograft imaging in vivo demonstrated a variation in fluorescence intensity that correlated with circulating half‐lives: peaks in fluorescence intensity were seen at 1.5 h (affibody) and 48 to 72 h (cetuximab, panitunumab). The pantitumumab and affibody images demonstrated greater tumor fluorescence and lower background signal compared to cetuximab.ConclusionPanitumumab/Vectibix demonstrated optimal imaging characteristics which appeared to be related to its binding affinity and increased circulation time. These characteristics may allow for increased localization to the tumor site. Panitumumab may be the optimal antibody for clinical translation since it will decrease false positive rates associated with non‐specific uptake.
Report of Outpatient Parathyroid Surgery: The UHC Database
Authors: Stack Brendan C. , Bodenner Donald , Spencer Horace , Moore Evan R. 
Published: September 2011

ObjectiveDetermine demographics and cost analysis for outpatients undergoing parathyroid surgery at hospitals belonging to the University Health System Consortium (UHC).MethodThe UHC, Oak Brook, Illinois, was formed in 1984 and consists of 107 academic medical centers and 232 of their affiliated hospitals. This represents 90% of the nonprofit academic medical centers in the United States (www.uhc.edu). Data was collected from 2004 through 2009 (21 quarters).ResultsThere were 13,969 patients who had outpatient parathyroid surgery. The average age was 58.3 (13.5) years. A total of 76.2% of patients were female. The outpatient data is collected from fewer UHC institutions than report their inpatient data. Outpatient data was compared by institutions which reported both out‐ and inpatient data. A total of 1,890 inpatients (from 12 quarters, 2007‐9) with an average LOS of 2.3 days and average facility cost of $7,852 served as an inpatient reference group.ConclusionParathyroid surgery is increasingly being done in the outpatient setting. By virtue of improved surgical technique, anesthesia technique, hemostatic methods, and calcium management this can be done safely. The outpatient approach is a cost effective way to manage parathyroid disease. This is the largest known series reporting outpatient parathyroid surgery.
Robotic Surgery as Monotherapy for HPV Positive Oropharyngeal Cancer
Authors: Steven Olsen , Price Daniel L. , Moore Eric J. , Kasperbauer Jan L. , Janus Jeffrey R. , Olsen Kerry D. 
Published: September 2011

ObjectiveDescribe the oncologic results achievable when treating oropharyngeal squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) and neck dissection as monotherapy. Evaluate the patient selection, functional outcomes, morbidity, and cost of this treatment option.MethodData was collected prospectively on patients undergoing TORS and neck dissection for OPSCC from April 2007‐present. Patients treated with surgery alone and a minimum 18‐month follow‐up were included in the study. Primary outcomes include disease control, survival, HPV status, and tracheostomy and G‐tube rate.ResultsDuring the study period 90 patients underwent TORS for OPSCC and 18 were treated with surgery alone due to favorable tumor findings or refusal of adjuvant therapy. Sixty‐eight percent of tumors were HPV positive. Stage distribution included; 7 stage I, 5 stage II, 3 stage III, and 3 stage IVa. Mean follow‐up was 27 months. Complete disease control and disease‐specific survival was achieved in 83% and 94% of patients, respectively. Among HPV‐positive patients, 100% survival and 90% disease control were achieved. No patients required long‐term tracheostomy or G‐tube placement.ConclusionTORS is an effective modality for treating select OPSCC. Low complication rates and excellent functional outcomes were achieved with TORS.
The Clinical Implications of Non‐diagnostic Fine Needle Aspirates of the Thyroid Gland
Authors: Sofferman Robert A. , Elhosseiny Abdel , Song Tara 
Published: September 2011

ObjectiveInvestigate the findings in repeat samples of patients with initial ultrasound‐guided non‐diagnostic fine needle aspirates (FNA) of thyroid tissue performed and interpreted over the most recent 10‐year period at the University of Vermont.MethodRetrospective review of medical records for patients with nondiagnostic thyroid FNAs. Patients were identified using a pathology laboratory information system according to specific search parameters. Patients were excluded if ultrasound guidance was not used and if documentation in the medical records was limited.ResultsA total of 239 patients met inclusion criteria. Of the 239, 145 have undergone follow‐up FNA, surgical intervention, or both. There were 19 documented neoplasms after initial non‐diagnostic FNA, including 2 incidental papillary microcarcinomas, 3 incidental follicular variant of papillary microcarcinomas, 1 follicular carcinoma, 7 papillary carcinomas, 2 follicular variant of papillary carcinomas, 1 non‐Hodgkin DLBCL, 2 Hurthle cell neoplasms, and 1 follicular neoplasm. Excluding the 3 microcarcinomas, there were 13 significant neoplasms in the ipsilateral lobe (5%). For the 61 patients (25%) who were lost to follow‐up before a definitive diagnosis was made, we cannot draw final conclusions regarding malignancy.ConclusionOur study reveals significant potential for malignancy in patients with nondiagnostic FNAs. The IRB has granted permission to contact the 61 patients lost to follow‐up before a definitive diagnosis was made. Delayed samples will be included as a separate analysis to profile this series of patients with nondiagnostic cytology.
The Learning Curve in Transoral Robotic Surgery: A Multi‐institutional Registry
Authors: Vergez Sebastien , Lallemant Benjamin , De Mones Erwann , Ceruse Philippe , Mallet Yann , Aubry Karine , Morinier Sylvain 
Published: September 2011

ObjectiveAssess the learning curve of transoral robotic surgery (TORS) observed in the French TORS group, gathering 7 different tertiary referral centers. The oncologic results are presented separately.MethodA multi‐institutional prospective record was done between 2008 and 2010. A total of 76 consecutive patients scheduled for a TORS have been included. The benefits observed with this technique, the operative times, conversion rate, and morbidity are described. The pitfalls encountered are detailed and responses are formulated to avoid them.ResultsMost patients had a laryngeal (supraglottic) and/or hypopharyngeal resection (65%). 30/76 patients operated by TORS would have had a transoral laser resection as alternative surgery. Tumor exposure was suboptimal in 24% of cases. Two out of 76 conversions in open‐approach were necessary. In the beginning, there were 2 deaths due to complications after hemorrhage in patients with high co‐morbidities. The median‐time of set‐up and procedure were respectively 60 ± 55 and 120 ± 89 minutes. The learning curve was characterized by a decrease of these durations in all the centers (P = ns), a better selection and management of patients candidates.ConclusionExcellent visualization and skill offered by the robotic assistance allowed transoral resection of tumors unresectable with laser surgery. Surgeons improved rapidly their exposure and resection abilities. Nevertheless, a strict selection of patients is essential. Even with a minimal invasive intent, some of them need a tracheostomy for safety reasons.
TKI258 Is Efficacious as a Multitargeted TKI in Head and Neck Squamous Cell Carcinoma Models
Authors: Sweeny Larissa , Hartman Yolanda , Liu Zhiyong , Rosenthal Eben L. , Knowles Joseph 
Published: September 2011

ObjectiveDovitinib (TKI28) is a multitargeted tyrosine kinase inhibitor that has not been previously investigated in the pre‐clinical setting for the treatment of head and neck squamous cell carcinoma (HNSCC). Dovitinib is administered orally and targets receptors (FGFR1/2/3 and PDGF‐beta) known to promote cell survival and proliferation and decrease cell apoptosis.MethodHNSCC cell lines and human tumor samples were evaluated for FGFR1/2/3, and PDGF‐beta expression levels. Cell lines (FADU, SCC1, OSC19, Cal27, SCC22A) were treated with a range of physiological concentrations of dovitinib and assessed for proliferation, cytotoxicity, and apoptosis. Mice bearing HNSCC xenografts were treated with dovitinib (20 mg/kg).ResultsElevated expression of FGFR2, FGFR3, and PDGF‐beta were indentified in HNSCC cell lines and human tumor specimens. In vitro, dovitinib reduced HNSCC cell proliferation (40‐80%) and viability (40‐60%). In a dose‐dependent fashion, dovitinib also induced cytotoxicity and apoptosis in HNSCC cell lines. When co‐cultured with fibroblasts, HNSCC cells proliferation was also decreased by dovitinib. In vivo, oral administration of dovitinib resulted in significant tumor regression and growth inhibition (67%). Disease‐free survival at 75 days following completion of treatment was 33% and stable disease occurred in another 33%.ConclusionThis is the first report to demonstrate dovitinib inhibits HNSCC cell growth in vitro and in vivo.
Trends in Total Laryngectomy: A Population Based Study
Authors: Maddox Patrick Tate , Davies Louise 
Published: September 2011

Objective1) Understand time trends in total laryngectomy rates across the US, including rates of surgery, cost, length of stay, teaching status, size of hospital, and insurance payer. 2) Understand what role the paradigm shift in primary treatment of laryngeal cancer may mean for surgical outcomes, cost, and length of stay.MethodPopulation‐based study from 1997 to 2008 utilizing the HCUP‐NIS database: a stratified sample of all US hospital discharges. The sample was all patients who had a principal procedure of ICD‐9 code 30.3 or 30.4 (complete or radical laryngectomy). The unit of analysis was census area: Northeast, South, Midwest, and West.ResultsThe number of laryngectomies done in the US decreased by 32% during the study period. New cases of laryngeal cancer decreased 26% during the same time. The highest rate of laryngectomy is in the South, the lowest in the Midwest and West. Mortality for the procedure is highest in the Northeast: 2.1%. Mean length of stay over the study period increased from 12.7 days to 13.9 days. Length of stay is shortest in the South. Median hospital charges rose dramatically (in 2008 dollars), from $34,934 in 1997 to $61,507 in 2008. Medicare remains the dominant insurance source.ConclusionThe rate of total laryngectomy has dropped more than the incidence of laryngeal cancer has dropped—suggesting that larynx preservation treatment has become dominant. Some implications of this shift are previously unexplored. As the number of procedures drops, the utility of a detailed registry to track outcomes becomes even greater.
Ultrasound Therapy Boosts Drug Toxicity In Vitro and In Vivo
Authors: Knowles Joseph , Sorace Anna , Heath C. Hope , Lancaster Will , Rosenthal Eben L. , Hoyt Kenneth 
Published: September 2011

ObjectiveUltrasound‐mediated therapy (UST) utilizes mechanical vibration of microbubble contrast agent to enhance cell permeability and anti‐cancer drug delivery. Here we determine if UST can improve cisplatin or cetuximab treatment of HNSCC in vitro and in vivo.MethodCell permeability was assessed after UST in four HNSCC cell lines (SCC1, SCC5, Cal27, and FaDu). Combination of UST with cisplatin or cetuximab was assessed by cell survival in vitro. In vivo effects on flank tumors were measured in immune‐suppressed mice.ResultsCell permeability was 48.2 ± 4.8% greater in cells treated with UST compared to controls (P in vitro, UST alone had no effect on cell survival (P =. 59), but combination treatment with cetuximab (P =. 002) or cisplatin (P in vivo) (P =. 81), but combination with cetuximab (P =. 04) orcisplatin (P =. 01) enhanced their antitumor effects. TUNEL analysis of flank tumors demonstrated increased apoptosis in UST+ cetuximab (55% vs 44%, P =. 05), and UST+ cisplatin (84% vs 77%, P =. 24) compared with monotherapy with either drug.ConclusionThe antitumor effects of cetuximab and cisplatin in HNSCC are enhanced by concurrent treatment with ultrasound‐mediated therapy in vitro and in vivo.
Assessment of Donor Site Morbidity for Osteocutaneous Radial Forearm Free Flaps
Authors: Sinclair Catherine Fiona , Givi Babak , Schneider Daniel S. , Rosenthal Eben L. , Gleysteen John , Wax Mark K. 
Published: September 2011

Objective1) Assess donor site morbidity following harvest of osteocutaneous radial forearm free flaps (OCRFF). 2), Evaluate patient perceived upper limb disability for osteocutaneous vs fasciocutaneous radial forearm free flapsMethodRetrospective cross‐institutional review of OCRFF performed between 2001 and 2010. There were 218 included patients. The primary outcome measure was forearm donor site morbidity. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to compare patient perceived arm disability for osteocutaneous vs fasciocutaneous radial forearm flaps.ResultsMean patient age was 63 years with a male predominance (63%). The left arm was the donor site in 86%. Median bone length harvested was 8 cm (range, 3‐12 cm). Following harvest, the radius was plated in 99% of patients. Recipient sites primarily included the mandible (62%) and maxilla (34%). Donor site morbidity included fracture (2 patients, 0.9%) and sensory neuropathy (5 patients, 2%). Fractures were treated with open reduction and internal fixation without functional deficits. Hardware extrusion was the most common complication at the recipient site (29 patients, 13%).ConclusionReluctance to perform OCRFF by surgeons usually centers on potential donor site morbidity. However, we identified minimal objective or patient perceived donor site morbidity following harvest of OCRFFs.
Can the Reflux Symptom Index Score Predict the Reflux Finding Score?
Authors: Marcum Kristin K. , Lintzenich Catherine R. , Butler Susan G. , Wright S. Carter 
Published: September 2011

Objective1) Learn if reflux symptom index (RSI) score correlates with reflux finding score (RFS). 2) Determine if there is a difference in calculating the Reflux Finding Score between experienced laryngologists and novice otolaryngologists. 3) Determine if age, body mass index, sex, or RSI can predict the reflux finding score.MethodA total of 204 healthy subjects, ages 20 to 88 years, underwent a distal chip laryngoscopy and completed a RSI questionnaire. Two otolaryngologists blinded to the subjects’ age, sex, BMI, and RSI then calculated the RFS. Data were then collected and used to calculate a relationship between the RSI and RFS.ResultsThe objective was to determine if we could predict a subject’s RFS based on their RSI score. The findings were not significant. The subject’s age, BMI, sex, and RSI score were all compared against the RFS score, and no significant correlation was identified. To calculate interrater reliability, the junior otolaryngologist’s and laryngologist’s scores were compared. To calculate the intrarater reliability, 22 of the 204 subjects’ captured images were duplicated and placed into the pool of subjects with a new number to compare if both scores were similar.ConclusionRSI cannot accurately predict a subject’s RFS from a distal chip laryngoscopy in normal healthy subjects. We did not see a correlation between age, sex, or BMI in predicting RFS. Test‐retest intrarater reliability for both the experienced laryngologist and novice otolaryngologist were each significant; however, interrater reliability was not significant.
Endoscopic vs Open‐Neck Zenker Diverticulum Surgery
Authors: Seth Rahul , Rajasekaran Karthik , Kominsky Alan , Scharpf Joseph , Lorenz Robert R. , Lee Walter 
Published: September 2011

ObjectiveCompare long‐term symptomatic outcomes between open‐neck surgery and endoscopic stapling diverticulotomy (ESD) for Zenker diverticulum.MethodPatients at least 1 year after surgery for Zenker diverticulum were telephoned and questioned of dysphagia, choking, regurgitation, and halitosis based on a validated Gastrointestinal Quality‐of‐Life Index. Symptom degree preoperatively and at phone call was assessed. Patients rated their overall postoperative symptoms as worsened, unchanged, improved, or completely resolved.ResultsA total of 55 of 102 patients were contacted. Of these, 24 underwent ESD and 31 had open‐neck procedures. Average follow‐up time was longer for the open‐neck group (5.7 vs 3.1 years, P <. 01). Gender, age at operation, diverticulum size, and preoperative symptom scores were not statistically different between the 2 groups. For both techniques, symptom scores showed significant improvement postoperatively (P <. 01). A greater proportion of patients undergoing open‐neck procedures reported their symptoms to be completely resolved or improved (93% vs 67%, P =. 015). Specifically, complete resolution of symptoms was achieved more often in those who had open‐neck surgery (77% vs 50%, P =. 047).ConclusionBoth the open neck and ESD surgeries significantly benefit patients, regardless of diverticulum size. Long‐term symptomatic outcomes between the 2 populations indicate that patients with open‐neck procedures attain a greater degree of resolution of preoperative symptoms. This may be due to fundamental differences between the surgical techniques.
GERD: Stroboscopy and Voice Analysis
Authors: Ravikumar Arunachalam , Chirakkal Pramod , Kumar Prasanna , Lakshmanan Somu 
Published: September 2011

Objective1) Identify the laryngopharyngeal features of GERD and its impact on voice. 2) Assess the response to antireflux therapy.MethodProspective study of 30 patients with GERD and laryngopharyngeal symptoms in Tertiary Referral University Hospital over 2 years. All subjects underwent videolaryngoscopy, stroboscopy, upper GI endoscopy and biopsy, esophageal pH monitoring, and treatment. Pre‐ and posttreatment questionnaires on lifestyle and symptoms were used.ResultsDifficulty in swallowing and throat clearing were the most common symptoms. H pylori infection was found in 43% of patients. Videolaryngoscopy: edema and congestion of arytenoids. Stroboscopy: posterior laryngitis (83%). Voice analysis by GRBAS scale showed subtle changes in grade, pitch, and range. Comparison of 24‐hour pH monitoring pre‐ and postantireflux therapy showed significant improvement in the posttreatment group (pThe lifestyle profile showed increased stress, improper food habits, and lack of sleep. Smoking and alcohol intake were minimal in this group of patients. Lifestyle modification, proper dietary habits, vocal hygiene, treatment of H pylori infection, and antireflux medication cured 90% of patients.ConclusionAnalysis showed laryngopharyngeal symptoms and signs to be associated with GERD, which adversely affects vocal function. A new management protocol has been developed to treat patients with laryngopharyngeal symptoms with GERD. Emphasis on identification of GERD in patients with laryngopharyngeal symptoms needs to be recognized by otorhinolaryngolgists.