bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Amylase Levels in the Peritonsillar Abscess Pus
Authors: El‐Saied Sabri , Joshua Benzion , Puterman Marc 
Published: September 2011

ObjectiveStudy the relationship between peritonsillar abscess and minor salivary glands surrounding the palatine tonsils.MethodProspective study measuring amylase levels in the pus of patients with peritonsillar abscess compared with the Amylase level in the serum and to the amylase level in pus from other abscesses in the neck. Data regarding age, sex, length of hospitalization, and recurrence were additionally recorded.ResultsA total of 40 patients diagnosed with PTA, 19 male (47.5%) and 21 female (52.5%) with an average age of 19 years. The average level of amylase in the pus of the PTA group was 827 u/dl and 9 u/dl in the control group (P <. 001). There were no recurrences in patients with amylase greater than 65 u/dl 0/16 (0%) vs 6/24 (25%) for amylase lower than 65 u/dl (P =. 03).ConclusionHigh amylase in the pus lends further support for involvement of minor salivary glands in the pathogenesis of peritonsillar abscess. However, high recurrence rates related to low amylase in the pus imply an additional pathogenesis possibly related to tonsillar infection.
Mortality after Tracheostomy at a Tertiary Care Hospital
Authors: Rosenthal Eben L. , Kejner Alexandra E. , Castellanos Paul 
Published: September 2011

ObjectiveHospitals are increasingly being evaluated for postoperative mortality, which includes intensive care patients who succumb to their medical disease after routine tracheostomy. Here we evaluate the expediency of tracheostomy performance and perioperative mortality over a 6‐month period.MethodProspective analysis of medical intensive care patients who underwent tracheostomy placement over a 6‐month period at a tertiary care hospital. Variables evaluated were time to tracheostomy, time to death, and cause of death.ResultsThere were 76 consultations that resulted in 64 patients receiving tracheostomy. Four (5.3%) patients expired the day prior to or the day of planned tracheostomy. Six (7.9%) were extubated prior to tracheostomy. Many were performed within 24 hours from consultation time (37%), and some were performed on the same day as consultation (9.3%). The overall 30‐day postoperative mortality rate was 11%. Cause of death in all cases was due to pre‐existing conditions and not related to tracheostomy. Thirty‐six (57%) survived to discharge. The mean time from consultation to tracheostomy was 2.5 days (range 0 ‐12).ConclusionHigh rates of mortality after tracheostomy negatively impact hospital postoperative mortality and hospital ratings. Although there were no surgical deaths, only 57% of tracheostomy patients survived to discharge, illustrating the significant disease burden in this patient population and the need to stratify postoperative mortality.
Nasopharyngeal Carcinoma Characteristics in Portugal
Authors: Breda Eduardo L. , Pereira Maria , Monteiro Eurico , Catarino Raquel , Sousa Hugo , Medeiros Rui 
Published: September 2011

Objective1) Learn the histologicdistribution of nasopharyngeal carcinoma (NPC) in a nonendemic European country. 2) Learn epidemiological data of NPC in a nonendemic European country. 3) Understand the implications of some genetic polymorphisms on NPC development.MethodUsing data collected from a retrospective study of 320 NPC patients obtained at the Oporto Portuguese Institute of Oncology during 31 years, a study is made concerning histological characterization, median age, gender profiles, NPC‐EBV relationship, and relevance of concerned genetic polymorphisms on probability of disease and age of onset.ResultsA total of 300 out of 320 patients had nonkeratinizing carcinomas (93.75%), with a mean age of 48 years old and twofold male preponderance. Using PCR analysis, EBV‐DNA was found in 91.7% of 36 tumor tissue samples. Regarding genetic polymorphisms, 2 case‐control studies were performed, including 104 patients and 285 control individuals. TP53 codon 72 pro/pro genotype (P =. 012; OR = 2.67; 95% CI 1.21‐5.90) and A870G cyclin D1 GG genotype (P =. 016; OR = 2.09; 95% CI 1.15‐3.79) were associated with increased risk for NPC development. Moreover, cyclin D1 GG genotype was also correlated with earlier disease onset.ConclusionThe high relative proportion of nonkeratinizing carcinomas is a relevant finding in this nonendemic European country, and so is the association of EBV‐DNA with NPC. This study may help to understand the biologic mechanisms of NPC and the correlation of EBV infection with disease in a low‐risk nonendemic region.
Novel Regulation of MicroRNAs in Nasal Epithelial Cancer
Authors: Wang Weihua , Upadhyay Daya , Le Wei , Hwang Peter H. 
Published: September 2011

ObjectiveAccumulating studies show the role of microRNAs in multiple human cancers. However, little is known about the role of microRNAs in nasopharyngeal cancers (NPC). Given the role of microRNAs in survival and death pathways in cancers, we hypothesized that the microRNAs may regulate the effects of cancer therapeutic agents.MethodTumor specific MicroRNA expressions were studied in vitro in primary human NC cells (CCL‐30) treated with statins. The effects on cell survival, cell cycle, and apoptosis were examined.ResultsRecently, we showed the promising antitumor effects of statins in NPC via HMG Co‐A pathway. Our new study examines the novel role of microRNAs in mediating the effects of statin in the inhibition of survival in NPC. Statins induced apoptosis and decreased survival of NPC. The regulation of tumor suppressor Let‐7a was enhanced in cells treated with statins associated with decrease in the cell viability and proliferation, and increase in apoptosis in these cells. Further, we found that the miR‐21 and miR‐155 played a role in the regulation of apoptotic pathways in NPC.ConclusionTumor‐specific microRNAs, Let‐7a, miR‐21, and miR‐155 play a role in the regulation of the disease process and the effects of cancer therapeutic agents in NPC.
Risk Factors for Multiple Malignancies in Head and Neck
Authors: Mannelli Giuditta , Gitti Gianni , Meccariello Giuseppe , Deganello Alberto , Gallo Oreste 
Published: September 2011

ObjectiveOur aim was to assess the prognostic role of several epidemiological, clinical andbiological factors, related to a higher risk for multiple malignancies in head and neck cancer (HNC) patients.MethodIn 76 consecutive patients treated with curative radiotherapy, p53 gene status, microsatellite instability (MSI) of the index tumor, and inherited chromosome fragility (CF), with epidemiological and clinical characters, were analyzed and correlated with the risk for second primary tumor (SPT). The follow‐up was 77 months in mean (2‐180 months).ResultsSPT was observed in 22 patients (28.9%). p53 mutation was detected in 36 (47.3%) out of 76 first primary HNC analyzed. MSI was documented in the first primary HNC from 22 out of 63 (34.9%). Susceptibility to bleomycin‐induced chromatid breaks (CF+) was found in 26 out of 54 (48.1%). Statistical analysis suggests that MSI, CF and smoking persistence after index tumor treatment were significantly correlated with an increased risk of developing multiple malignancies (P =. 05, P <. 01 and P =. 02).ConclusionA genetic susceptibility to DNA damage may play a central role in development of multiple malignancies in HNC patients. Testing for MSI phenotype and CF at the time of the original cancer diagnosis could identify high risk patients.
Simulation in Otolaryngology Education: A Systematic Review of the Peer‐Reviewed Evidence
Authors: Sardesai Maya G. , Kim Sara , Whipple Mark 
Published: September 2011

ObjectiveSystematically synthesize the peer‐reviewed evidence for use of simulation in otolaryngology education.MethodA systematic review of the peer‐reviewed literature was performed to identify evidence for use of simulation in otolaryngology education. Identified articles were analyzed by three independent coders across 19 parameters encompassing study methodology, simulator information, subject information, skills taught, and outcome measures.ResultsLevel V evidence dominates the peer‐reviewed literature. Medical knowledge is the ACGME core competency most frequently taught. Many subspecialties within otolaryngology are underrepresented. Most simulators consist of anatomical models, and most studied simulators are high‐fidelity simulators. Most studies lack a control group, and most do not use validated outcome measures. Education theory is underused. However, most studies conclude that the device employed or described is effective.ConclusionWhile there is a modest amount of peer‐reviewed evidence for the use of simulation in otolaryngology education, there remain many gaps that translate to opportunities for academic otolaryngologists.
Survey on Tobacco‐Cessation Practices and Policies (SToPP)
Authors: Carniol Eric T. , Mahoney Elizabeth , Jalisi Scharukh , McDonough Katie A. , Murthy Namitha 
Published: September 2011

Objective1) Analyze current practices and policies of otolaryngologists on tobacco‐cessation counseling. 2) Analyze the relationship between formal training in tobacco‐cessation and confidence in counseling and prescription therapy behavior by otolaryngologists.MethodThis survey of smoking cessation practices was performed at the American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS) and associated meetings in September 2010. Attendees were surveyed, and the results were compiled. Regression analysis was performed to further assess the effects of training on otolaryngologists’ confidence in counseling.ResultsA total of 207 surveys were collected; 202 respondents indicated training in otolaryngology. A total of 88.5% of otolaryngologists ask most or all of their patients about tobacco use at an initial encounter; 83.7% advise most to all of their patients to quit at this encounter; 64.5% assess most to all of their patients’ interest in quitting; 49.7% assess their reasons to quit; 22.3% arrange support between visits for most to all of their patients. Regression analysis revealed that training during medical school and after residency were independently associated with higher levels of confidence and higher rates of prescribed therapy for patients (all P <. 025).ConclusionOtolaryngologists counsel their patients on tobacco at a low rate, and fewer provide patients with the support necessary to assist them in quitting. Formal training in tobacco‐cessation was associated with higher levels of confidence. Further research is indicated to assess the utility and cost‐effectiveness of tobacco‐cessation training programs for otolaryngologists.
Contemporary Morbidity and Mortality in Head and Neck Surgery
Authors: Lin Harrison W. , Bhattacharyya Neil 
Published: September 2011

Objective1) Understand contemporary data for morbidity and mortality in head and neck surgery (HNS). 2) Identify factors that influence length of stay (LOS) to be targeted for quality improvement.MethodA database specific for patients undergoing inpatient primary head and neck surgical procedures was extracted from the National Hospital Data Survey (2005‐2007). The frequency of perioperative complications, mortality, and LOS were quantified. The influence of these medical complications on mortality and LOS were determined with multivariate statistics.ResultsAn estimated total of 330,629 ± 9097 head and neck patient‐procedures were studied (mean age, 53.0 ± 0.6 years; 63% female). The overall medical morbidity and mortality rates were 5.0 ± 0.7% and 0.4 ± 0.2%, respectively. The most common medical complications were hospital‐acquired pneumonia (3.3 ± 0.6%), acute renal failure (0.9 ± 0.2%), stroke (0.6 ± 0.4%), acute myocardial infarction (0.3 ± 0.1%), pulmonary embolism (0.2 ± 0.1%), and deep venous thrombosis (0.1 ± 0.1%). The mean LOS for patients without a major complication was 3.30 ± 0.2 days vs 14.0 ± 1.9 with a major complication (P <. 001). The presence of a major medical complication did not increase mortality odds when adjusted for age, sex, and Charlson comorbidity (P =. 177).ConclusionComplication rates for inpatient HNS procedures have declined in the past decade, although complications are still associated with longer LOS. The presence of a postoperative complication is no longer significantly associated with increased mortality. Enhancements in perioperative medical management of HNS inpatients are likely responsible for these improved results.
Crawling Wave Sonoelastography of Benign and Malignant Thyroid Nodules
Authors: Walsh Jonathan M. , Mills Bradley , Rubens Deborah , Parker Kevin , An Liwei , Miller Matthew , Z Hah 
Published: September 2011

ObjectiveThe purpose of this study is to determine if Crawling Wave (CrW) Elastography, a novel sonoelastography technique, can be utilized to provide quantitative measurements of thyroid tissue shear velocity (a measure of tissue stiffness) and distinguish between benign and malignant thyroid nodules.MethodFresh thyroid specimens (N = 21) with 44 regions of interest were imaged over a 9‐month period in 2010 at a single institution. CrW sonoelastography was performed and shear velocity (SV) estimations with contrast to noise ratios (CNR) were calculated. Histologic diagnosis was correlated with SV and CNR values.ResultsThe SV and CNR of Papillary Thyroid Ca (PTC) (N = 11, CNR = 4.04, SV = 2.39 m/s) was significantly higher than benign nodules (N = 22, CNR = ‐0.988, SV = 1.90 m/s) (for CNR pp = 0.003, [95% CI 0.199 ‐ 0.801]). CNR values have a sensitivity and specificity of 100% and 90.9%, respectively, for differentiating PTC from benign nodules. Additionally, SV has a sensitivity and specificity of 81.8% and 68.2%, respectively. Insufficient samples were obtained for SV and CNR comparison of other histologic types.ConclusionCrawling wave sonoelastography can provide quantitative estimations of shear velocity (SV) depicting the elastic properties of thyroid nodules. The SV with CNR can differentiate between benign thyroid nodules and papillary thyroid carcinoma. However, prospective in‐vivo studies are needed to verify the accuracy and utility of CrW elastography.
Elevated Urinary 1‐HOP, NNN, and NNAL in Smokers with Head and Neck Squamous Cell Carcinoma
Authors: Khariwala Samir , Hatsukami Dorothy , Stepanov Irina , Hecht Stephen , Fernandes Patricia , Lassig Amy Anne D. , Yueh Bevan 
Published: September 2011

ObjectiveTobacco metabolites have been shown to be markers of tobacco exposure as well as markers of lung cancer risk. To this point, tobacco metabolites have not been studied in head and neck squamous cell carcinoma (HNSCC). We seek to study tobacco metabolites in smokers with (subjects) and without (controls) HNSCC.MethodSmokers with head and neck cancer were enrolled after they completed a detailed smoking history questionnaire. Urine samples were collected in standard fashion. Controls consisted of smokers without HNSCC. Urinary levels of total 1‐hydroxypyrene (1‐HOP) and total 4‐(Methylnitrosamino)‐1‐(3‐Pyridyl)‐1‐Butanol (NNAL) and N′‐nitrosonornicotine (NNN) were assayed using high performance liquid chromatography (HPLC).ResultsIn this pilot study, NNN data were available in 27 subjects, NNAL in 19 subjects, and 1‐HOP in 18 subjects. Control matching for NNN was done with a 1:1 ratio. Controls were matched on cigarettes per day in a 3:1 ratio for NNAL and 1‐HOP to increase power. T test was used to compare study subjects with controls. Mean levels for subjects (S) and controls (C) were: NNN [S:0.12 pmol/ml, C:0.06 pmol/ml (P =. 06)], NNAL [S:1.53 pmol/ml, C:1.25 pmol/ml (P =. 3)], and 1‐HOP [S:1.88 pmol/ml, C:0.84 pmol/ml (P =. 001)], respectively.Conclusion1) Smokers with HNSCC have higher urinary 1‐HOP (significant) and NNN (near significant) compared with matched controls. 2) The data suggest smokers who develop HNSCC process carcinogens differently than smokers without HNSCC. 3) This data is a first step toward understanding why some smokers develop carcinoma while others do not.
Functional Outcomes of Chemoradiotherapy in Patients with Head and Neck Cancer
Authors: Tulunay‐Ugur Ozlem E. , Maddox Anne‐Marie , McClinton Christopher , Penagaricano Jose , Young Zachary , Vural Emre A. 
Published: September 2011

ObjectiveConcurrent chemoradiotherapy has become the treatment of choice for oropharyngeal and hypopharyngolaryngeal cancers in many centers. Although it has increased the rates of organ preservation, there has also been an increase in treatment‐related complications. We aimed to evaluate the functional outcomes of chemoRT in head and neck cancer.MethodA retrospective study of patients treated with chemoRT at the University of Arkansas for Medical Sciences was performed. Demographic data and treatment outcomes were extracted, specifically feeding tube and tracheotomy dependence, number of esophageal dilatations, and the rate of hypothyroidism.ResultsOf the 243 patients treated with concurrent chemoRT, 152 patients received a feeding tube. The average duration of PEG use was 12 months (range, 1‐96 months). More than 70% of the patients who had a PEG more than 6 months had a T3 or T4 tumor. Thirty‐seven patients underwent esophageal dilatations, with an average of 1.8 times (range, 1‐7). The average duration for a tracheotomy was 11 months and 77% of these patients were treated for hypopharyngolaryngeal cancer. Of note, 42 patients were found to be hypothyroid, with no significant difference between the hypopharyngolaryngeal and oropharyngeal cancers.ConclusionConcurrent chemoradiotherapy leads to significant complications that reduce the quality of life of a patient. In this series 71% of the patients were feeding tube dependent despite completion of therapy more than 6 months ago. Prospective studies are needed to determine risk factors leading to increased dysphagia and tracheotomy dependence.
HPV+ Oral Cancer Patients Do Not Have Better QOL Trajectory
Authors: Sharma Arun , Doody David , Mendez Eduardo , Houck John , Lohavanichbutr Pawadee , Futran Neal D. , Yueh Bevan 
Published: September 2011

ObjectiveTo determine the role of human papillomavirus (HPV) status on quality of life (QOL) in patients with oral cavity and oropharyngeal squamous cell carcinoma (OSCC). We hypothesized that high risk HPV (HPV‐16, 18, 35, 45) tumors would be associated with better QOL trajectory.MethodHead and neck‐specific QOL was determined using the University of Washington Quality of Life (UW‐QOL) scale version 4 in patients with newly diagnosed invasive OSSC (n = 296).ResultsPre‐treatment QOL was higher in patients with high risk HPV tumors compared with patients with HPV negative or low risk HPV (HPV‐11, 32, 53, 66) tumors (P =. 004). This association remained in multivariate analysis. Patients with high risk HPV tumors had larger decreases in QOL from pre‐treatment to immediate posttreatment compared with patients with HPV negative or low risk HPV tumors (P =. 032). There was no association between HPV status and QOL 1 year posttreatment.ConclusionAmong patients with OSCC, high risk HPV was independently associated with higher pretreatment QOL. The data did not support our hypothesis that patients whose tumors contain high risk HPV have better QOL trajectory. Research exploring patient expectations, treatment effects, and psychiatric comorbidity may provide insight into this finding.
Incidental Thyroid Cancer Found during Surgery for Head and Neck Squamous Cell Carcinoma
Authors: Gilbert Mark Raymond , Kim Seungwon 
Published: September 2011

ObjectiveWe aim to determine the clinical significance of incidental thyroid cancer found during surgery for HNSCC. We examined the clinical outcome of these patients with regard to both HNSCC and thyroid cancer to determine the need for treatment of incidental thyroid disease.MethodUsing our head and neck cancer registry, we retrospectively reviewed 2,538 neck dissections performed at our institution over a 15‐year period. We identified 29 patients who had an incidental pathologic finding of thyroid disease at surgery. We reviewed demographics, diagnoses, histopathology, initial and subsequent management, and outcome.ResultsPapillary thyroid cancer was the principal thyroid cancer in every case in our cohort. Fifteen patients died during the period of the study (2.4‐year mean follow‐up), with 14 patients still alive (4.3‐year mean follow‐up). Seven patients received further treatment for their thyroid: 2 with completion thyroidectomy, 2 with I‐131 ablation, and 3 with both. During the follow‐up period, none of the patients developed tissue proven recurrence of thyroid cancer. Cause of death was unrelated to thyroid cancer in all of the patients who died during the follow‐up period.ConclusionThyroid cancer, in general, has excellent prognosis. This study suggests that further management of occult thyroid cancer discovered in patients undergoing surgery for HNSCC may not be necessary.
Juvenile Nasopharyngeal Angiofibromas: Does an External Approach Still Make Sense?
Authors: Herman Philippe , Verillaud Benjamin , Le Clerc Nicolas , Cloutier Tam , Sauveget Elisabeth , Ba‐Huy Patrice Tran , Kania Romain E. 
Published: September 2011

ObjectiveEndoscopic removal has recently become the standard procedure in the case of small juvenile angiofibromas. However, large lesions encroaching the skull base remain a challenge. The aim of this work is to define extensions which at present cannot be addressed reasonably endoscopically.MethodRetrospective review based on cases treated from 2000 to 2010. Ratio of endoscopically treated patients has been analyzed together with staging and topographic description of these lesions.ResultsFifty‐nine patients were treated from 2000 to 2010, of whom 31 were treated endoscopically. Ratio of endoscopic procedures raises from 37% (n = 10) for the 2000 to 2005 period to 84% (n = 26) for the 2006 to 2010 period. This trend, analyzed according to the staging following Radkowski, is not related to earlier diagnosis of smaller tumors, since ratio of stage IIIA is similar. Indeed, development of approaches to pterygopalatine fossa, infratemporal fossa, temporal fossa, inferior orbital fissure, orbital apex, and even cavernous sinus allowed control of deep and far‐seated lesions.ConclusionRefinement of hemostasis techniques and 4‐hands surgery (Castelnuovo) allows the treatment of lateral‐seated tumors, even if large. Posterior extensions may be reached through a transpterygoid approach. Only lesions which engulf the ICA or the optic nerve need further evaluation to choose between open approach or incomplete, subtotal removal.
Long‐Term Outcome of Tonsil Squamous Cell Carcinoma Managed by Surgery
Authors: Rahmati Rahmatullah , Pyke Owen J. , Kraus Dennis H. , Patel Snehal G. , Ganly Ian , Shah Jatin P. 
Published: September 2011

ObjectiveAnalyze our experience in the management of tonsil SCC managed exclusively by surgical resection followed by postoperative radiotherapy (PORT) and to identify factors predictive of outcome.MethodA retrospective chart review was conducted on 88 patients with tonsil SCC treated with surgery at Memorial Sloan‐Kettering Cancer Center between 1985 and 2005. Overall survival (OS), disease‐specific survival (DSS), recurrence‐free survival (RFS) at 5 years, and predictors of survival were determined.ResultsForty‐eight percent had advanced T3/T4 stage and 75% had an N positive neck. With a median follow‐up of 74 months, OS, DSS, and RFS at 5 years were 66%, 82%, and 80%, respectively. Age >60 years female gender, advanced T stage, positive margins, and lymphovascular invasion (LVI) were predictive of OS. Only positive margins and LVI predicted DSS while clinical T stage and LVI predicted RFS. The status of the neck was not predictive of outcome (DSS 80% for N0 patients vs 82% for N+, P =. 97).ConclusionAdvanced stage tonsil SCC patients managed with surgery and PORT had an excellent prognosis with outcome results comparable with those from concurrent chemoradiation. In contrast to advanced stage head and neck SCC at other sites, the pathological stage of the neck does not impact on outcome.