bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cell Penetrating Peptide Uptake by Human Tissue
Authors: Vorasubin Nopawan , Nguyen Quyen To , Olson Emilia , Aguilera Todd A , Jiang Tao , Tsien Roger Y 
Published: August 2008

Objective1) Assess activatable cell penetrating peptide (ACPP) uptake by human tissue. 2) Compare ACPP uptake in normal and cancer tissue.MethodsACPPs are peptides that become activated for cellular uptake by cleavage in the presence of specific proteases. Fluorescently tagging ACPPs and designing a cleavage site recognized by proteases abundant in cancer allows for selective uptake and imaging. Cleavable ACPPs consist of L‐amino acids linkers, while uncleavable linkers consist of corresponding D‐isomers. To assess ACPP uptake by human tissue, we imaged freshly ressected surgical specimens following incubation with ACPP. Uptake was analyzed by measuring average fluorescent intensities (AFI) for histologically identified areas of cancer and normal tissue. Standardized uptake value (SUV) measurements, which represents fluorescence uptake per given tissue weight, and zymography were also performed.ResultsAverage cancer‐to‐normal AFI ratio when treated with cleavable ACPP was 2.6±0.6 (p=0.003) and with uncleavable control was 1.4±0.5 (p=0.5). Considering cancer tissue alone, average AFI was 22.5 ±2.2 when treated with cleavable and 11.4 ±1.2 when treated with uncleavable ACPP (p=0.004). Tissue SUV when treated with cleavable ACPP was 2.5±0.8mg‐1, whereas tissue treated with control ACPP was 1.7±1.0mg‐1 (p=0.24). Zymography results show that inactive protease is ubiquitous in cancer and normal tissue while active form is more abundant in cancer.ConclusionsIn freshly resected human cancer tissue, uptake of cleavable ACPP is ∼2‐fold greater than that of uncleavable ACPP. Furthermore, cleavable ACPP uptake is ∼2.5‐fold greater in cancer compared to normal tissue. This differential uptake can potentially be used for in vivo imaging of cancer to guide surgical resection.
Defining Success of Parathyroidectomy in Hyperparathyroidism
Authors: Dolev Yalon , Black Martin J , Hier Michael P , Tamilia Michael , Payne Richard J 
Published: August 2008

ObjectiveTo clearly define what constitutes successful parathyroidectomy in patients with primary hyperparathyroidism and to review our institution's results.MethodsA retrospective chart review was conducted for consecutive patients who underwent parathyroidectomy at a university‐affiliated tertiary care center between January 1998 and February 2006. Intraoperative pre‐ and post‐excision PTH levels were recorded. PTH and calcium levels were recorded at 3 – 6 month intervals in the first 2 years and then yearly.Results84 patients were analyzed. 50 (60%) had normal calcium and normal PTH levels following surgery, 28 (33%) had normal calcium and elevated PTH following surgery, and 6 (7%) had both elevated calcium and PTH. The mean follow‐up time was 2.23 years, with a range of 0.25 to 5 years.ConclusionsSurgery was successful, as indicated by normocalcemia, in 78 patients (93%). Of these 78 patients, 28 (33%) developed persistent PTH elevation without developing hypercalcemia. Other studies have studied this subgroup of patients with normalized post‐operative calcium and consistently elevated PTH levels and noted that these new set points persist. Consequently, successful parathyroidectomy should be defined by serum calcium and not PTH levels.
Efficacy of Flutamide in Nasopharyngeal Angiofibroma
Authors: Thakar Alok , Gupta Gaurav , Seith Ashu 
Published: August 2008

ObjectiveTo assess the efficacy and safety of Flutamide (androgen receptor blocker) as an adjuvant therapy for presurgical tumor volume reduction in cases of Juvenile Nasopharyngeal Angiofibroma (JNA).MethodsTherapeutic trial, Janurary‐December 2007. 10 previously untreated cases of JNA (Radkowski stage IIC‐IIIB) were administered Flutamide (10 mg/kg in 3 divided doses) for 6 weeks prior to surgical excision. Pre‐ and post‐therapy tumor volume assessment undertaken by MR Imaging. All cases had periodic liver function tests and assessment of primary and secondary sexual characteristics continuing till 6 months post‐therapy.ResultsPre‐pubertal cases had inconsistent and minimal responses to Flutamide. All 7 post‐pubertal cases (as indicated by age and serum testosterone levels) however, demonstrated consistent tumor volume reduction ranging from 6% to 35% (mean 16.6 %). Two cases with optic nerve compression had significant improvements in visual acuity and visual fields. No adverse effect was noted excepting for mild and transient breast tenderness.ConclusionsPreoperative use of Flutamide is safe and leads to partial tumor regression in post‐pubertal patients. The regression of the tumor away from adjacent vital structures may facilitate surgical excision and limit complications.
Hemorrhagic Shock and Death following Tonsillectomy
Authors: Windfuhr Jochen P. , Schloendorff Georg , Baburi Diwa , Kremer Bernd 
Published: August 2008

ObjectiveEvaluate the incidence and clinical course of serious bleeding complications following tonsillectomy, in terms of hemorrhagic shock and death.MethodsCases with lethal outcome or presenting with hemorrhagic shock, requiring resuscitation or major medical treatment between 1980 and 2007, were collected based on personal experiences and material collected after a plea published in a national journal.Results113 cases were eligible for further analysis, comprising 30 cases with lethal outcome (19 children, 11 adults). 83 patients had experienced serious bleeding complications (36 children and 43 adults; age not stated for 4 patients). Of the 133 patients, only 10 experienced primary bleeding (<24 h) including one case with lethal outcome. Repeated episodes of PTH occurred in 91 patients, including 19 cases with lethal outcome.ConclusionsRepeated episodes of bleeding classified the majority of the clinical courses studied. Only few cases experienced bleeding complications in the early phase after surgery. It appears as if children are over‐represented in our study, suggesting that they are more at risk to experience serious bleeding complications. Gender appears not to be a risk factor. Secondary post‐tonsillectomy hemorrhage (>24h) can no longer be assessed to be less dangerous than primary bleeding.
Improved Quality of Life in Patients Treated with ChemoIMRT
Authors: Mowry Sarah , Sadeghi Ahmad , Tang Christopher , Wang Marilene B 
Published: August 2008

ObjectiveTo identify differences in quality of life between patients with advanced oropharyngeal cancer following traditional opposed port chemoradiation (CRT) vs. chemotherapy with intensity modulated radiation therapy (CIMRT).MethodsA cohort study from academic tertiary referral center was performed. 50 patients were identified from an institutional database of patients who had undergone primary chemotherapy and radiation (traditional or IMRT) for advanced oropharyngeal carcinoma. Patients responded via mail using the University of Washington quality of life instrument version 4 (UW‐QOLv4). Data was analyzed using chi‐square and Wilcoxon tests.Results17 CRT patients responded (57%), and 14 CI‐MRT patients responded (70%). Patients completed the survey between 9 and 44 months following end of treatment. When adjusted for tumor stage and time since treatment, CIMRT patients reported improved appearance (p = 0.05), chewing (p = 0.02), and mood (p = 0.01). There was a trend toward significance for improved activity (p = 0.07), recreation (p = 0.07), and anxiety (p = 0.08). There were no differences between the 2 groups for saliva, taste, shoulder function, speech, and swallowing. There was a trend for significance for improved overall quality of life in patients who had undergone CIMRT (p = 0.06).ConclusionsMany patients with advanced oropharyngeal carcinoma are being treated with primary chemoradiation. CIMRT results in improved quality of life for some domains but surprisingly not for swallowing or saliva. Patients undergoing CIMRT also report slightly better quality of life overall when compared to patients receiving more traditional forms of radiation therapy.
Micropapillary Thyroid Carcinoma and Hashimoto's Thyroiditis
Authors: Pakdaman Michael Navid , Hier Michael P , Black Martin J , Tamilia Michael , Payne Richard J 
Published: August 2008

ObjectiveAn increase in papillary thyroid carcinoma in patients with Hashimoto's thyroiditis has been described. We have yet to find literature discussing a relationship with micropapillary thyroid carcinoma(MPC). Our objective is (1) to assess the relationship between Papillary Microcarcinoma and Hashimoto's Thyroiditis in thyroids without malignant disease, (2) compare effect of the presence of Hashimoto's on prognostic factors in patients.MethodsPathology reports were reviewed for consecutive patients undergoing total thyroidectomy over a 6‐year period from 2002 to 2007. Patients with benign pathologies were included. Patients with MPC and no other malignancy were also included. This lead to a cohort of 314 patients. Statistical significance was calculated using Fisher's exact test and a chi‐squared analysis.ResultsOut of the 314 patients, 98 were positive for Hashimoto's thyroiditis on biopsy of the removed thyroid. 58% of the patients with Hashimoto's thyroiditis had an incidental MPC, as compared to 42% of patients where Hashimoto's was not found. Additionally, in Hashimoto patients, 61% of the MPCs were multifocal versus 43% multifocal in the non‐Hashimoto group (p‐value <0.05 in each comparison). Bilaterality of MPC was also increased in patients with Hashimoto's (22% vs 39%).ConclusionsPatients with Hashimoto's thyroiditis in this study had an incidence of MPC of 58%, which is significantly greater than the 42% in those without. Hashimoto's was also associated with an increased risk of bilaterality and multifocality. Studies are needed to further corroborate these findings.
Minimally Invasive Video‐assisted Thyroidectomy: 2 Yrs Work
Authors: Snissarenko Eugene P. , Kim Grace H , Simental Alfred A , Zwart Jon E. , Ransbarger Darron M. , Kim Paul Dae‐Gwon 
Published: August 2008

ObjectiveThe minimally invasive video‐assisted thyroidectomy (MIVAT) technique was first pioneered in Europe in the 1990s. It has shown to have comparable results to traditional thyroidectomy and additional advantages such as better cosmetic results as well as faster recovery. This project aims to analyze the results from the MIVAT procedure utilizing a 2‐person technique over the initial 2 years of inception at an academic training center.MethodsRetrospective review of 170 cases between May 2006 and September 2007 at LLUMC. The demographic and clinical data collected includes age, sex, incision, operative times, hospitalization, identification of recurrent laryngeal nerves, pathology, size of the dominant nodule and entire gland, and postoperative complications.Results23 male and 147 female patients underwent MIVAT by a single surgeon; of those, 59 total thyroidectomies and 111 hemithyroidectomies were performed. The mean incision length was 3.5cm. The average weight/volume on pathology was 19.25g/19cm3, 21.03g/22cm3 and 31.29g/40cm3 for the right lobe, left lobe, and entire gland respectively. Average nodule size was 3.6cm3. The mean surgical time was 91.7 minutes and the mean blood loss was 31cc. Average hospitalization stay was 1.43 days. 17 patients experienced temporary hypocalcemia, and 1 patient remained hypocalcemic for more then 6 months. Two patients experienced transient pitch problems, 7 patients experienced temporary unilateral vocal cord paresis, and 1 patient experienced mild diplophonia.ConclusionsWhile enabling smaller surgical access for thyroidectomy, 2‐surgeon technique MIVAT can be performed safely and quickly. Voice problems were the most common complications that usually resolved in 8 weeks.
Open vs. Total Endoscopic Approach to the Thyroid
Authors: Chang Eugene H. , Wright Simon K 
Published: August 2008

Objective1) Learn the TATE approach to the thyroid. 2) Compare open vs. TATE approach.MethodsFrom June 2005 to February 2008, 10 patients underwent TATE procedures for hemi‐thyroidectomy with isthmusectomy. We used a control group of 10 consecutive open approaches. Hospital records were reviewed. Postoperatively, patients were asked to rate aspects of their surgery on a scale of 1–5.ResultsThyroid pathology consisted of benign nodules as well as foci of papillary carcinoma in both groups. No patients in the TATE group required conversion to an open approach. The TATE approach to the thyroid gland added 37 minutes on average to the operative time (142 vs 105). The average of the last 5 TATE approaches decreased (114) compared to the first 5 TATE approaches (170). Blood loss was less in the TATE group (10 to 43). Patients expressed a greater satisfaction with the TATE approach for the surgery (1.375 to 1.5) and the incision (1.375 to 1.4). Patients did express greater pain 24 hrs after surgery in the TATE group (2.625 to 1.7), but this became equivalent 1 week after surgery (1.5 to 1.4). Patients returned to normal activites sooner in the TATE group than the control (2.125 / 2.4). No patients in either group experienced hoarseness 3 months after surgery.ConclusionsThe TATE approach to the thyroid gland is safe. Advantages include the absence of any surgical incisions in the neck and greater patient satisfaction. Operative time is longer in the TATE approach but this differential decreases with operative experience.
Parotid Tumors: Fine‐Needle Aspiration and/or Frozen Section
Authors: Zbaren Peter , Loosli Heinz , Stauffer Edouard 
Published: August 2008

ObjectiveAssess the difficulties of preoperative and intraoperative tumor typing of parotid neoplasms. Know the advantages and pitfalls of fine‐needle‐aspiration cytology (FNAC) and frozen section (FS) analysis in primary parotid neoplasms.MethodsIn 113 parotid neoplasms (70 malignancies and 43 benign tumors) preoperative FNAC as well as intraoperative FS analysis were performed. FNAC and FS findings were analyzed and compared with the final histopathologic diagnosis.ResultsThe FNAC smear was non‐diagnostic in 6 tumors. In 2 FS specimens, it was not possible to determine the tumor dignity. FNAC findings and FS findings were both available in 105 neoplasMS The FNAC findings were true positive for malignancy in 54, true negative in 36, false positive in 4, and false negative in 11 tumors. The accuracy, sensitivity, and specificity were 86%, 83%, and 90% respectively. The FS findings were true positive in 60, true negative in 38, false positive in 2, and false negative in 5 tumors. The accuracy, sensitivity, and specificity were 93%, 92% and 95% respectively. The exact histologic tumor typing by FNAC was correct, false or not mentioned in 58%, 20% and 22% true positive or true negative evaluated tumors, and by FS in 83%, 5% and 12% true positive or true negative evaluated tumors.ConclusionsThe current analysis showed a superiority of FS compared with FNAC regarding the diagnosis of malignancy and especially of tumor typing. FNAC alone is not prone in many cases to determine the surgical management of primary parotid carcinomas.
Path‐Positive Specimens in Post ChemoRT Neck Dissections
Authors: Howell Lori K. , Yao Mike , Pytynia Kristen B , Gast Tom 
Published: August 2008

ObjectiveTo determine the likelihood of pathologically positive neck dissections after primary chemoradiotherapy for advanced squamous cell carcinoma (SCC) of the head and neck, and to examine the impact of persistent neck disease on regional recurrence, distant metastasis, and survival.Methods57 patients with N2 and N3 neck disease undergoing primary chemoradiotherapy for SCC of the oral cavity, oropharynx, larynx, and hypopharynx who underwent post‐treatment neck dissections (PND) from 1999–2007 at the University of Illinois Chicago were evaluated for clinical complete response (CCR) and pathologic complete response (PCR). CCR was determined by physical examination (PE) and CT findings performed 4 to 6 weeks after chemoradiotherapy. Positive predictive value (PPV) was defined as CCR predictive of PCR. We also determined the impact of pathologically positive PND on surgical complications, regional recurrence, distant metastasis, disease‐free survival, and overall survival using the chi‐squared and log‐rank tests.ResultsOf the 57 patients who underwent neck dissections, 17 (30%) had pathologically positive neck dissection specimens. When PE and CT findings showed resolution of disease (CCR), 85% (PPV) of pathologic specimens demonstrated no residual cancer. Conversely, when CCR was not achieved, 40% (NPV) of pathologic specimens demonstrated residual cancer. Positive pathologic disease in PND was associated with worse overall survival (p=0.014).ConclusionsPersistent neck disease is common in advanced head and neck patients undergoing primary chemoradiotherapy. Failure to achieve CCR increases the likelihood of pathologically positive neck specimens by more than two‐fold.
Radionecrosis after Treating Oral Cavity & Oropharyngeal SCC
Authors: Patel Sundip H , Yao Mike , Brennan Tara 
Published: August 2008

Objective1) The primary goal of this study was to evaluate the incidence of radionecrosis among patients treated with radiation therapy for oral cavity & oropharynx squamous cell carcinoma at our institution. Many patients with oral cavity & oropharyngeal cancers receive radiation to preserve the tongue, knowing the risks of post‐treatment radionecrosis. However, recent protocols have intensified chemo‐radiotherapy in an effort to improve local control while possibly increasing risk. 2) Among those patients with radionecrosis, we also analyzed their cancer treatment regimen, associated risk factors, the severity of the radionecrosis and the resulting treatment they recieved.MethodsWe performed a retrospective review of all adult patients at our tertiary care facility with biopsy proven squamous cell carcinoma of the oral cavity & oropharynx from 1999 to 2007 who completed a full course of radiotherapy at our facility with at least 6 months follow‐up. Medical charts were reviewed for the presence of radionecrosis as well as for other corresponding, pertinent data.ResultsAfter reviewing 241 patients, a total of 107 patients were included. 5 of 65 with oropharynx disease had radionecrosis, revealing an incidence of 7.7%. Among the oral cavity group there were 8 out of 42 patients with radionecrosis, revealing an incidence of 19%. The overall incidence among our treatment group was 12.1%.ConclusionsRadiation‐induced necrosis of the oral cavity & oropharynx is still a significant complication in the treatment of head and neck cancer and poses a higher risk in the oral cavity than the oropharynx.
Safety and Efficay of BION Implant During Radiation Therapy
Authors: Sinha Uttam K , Masood Rizwan 
Published: August 2008

ObjectiveTo determine the safety and efficacy of BION implants during radiation therapy (XRT) of head and neck cancer (HNC). The implants were placed to treat complications of muscle disuse for swallowing.MethodsThree patients who underwent surgery for HNC received BION implants. The study was conducted under rules of good clinical practice under an Investigational Device Exemption from the U.S. FDA and monitored by the University of Southern California IRB. The implant was placed 2–3 mm above and parallel to the hypoglossal nerve just proximal to the origin of the ansa cervicalis. Two patients started XRT 3–4 weeks after surgery. The third patient did not need XRT. Two sets of stimulation protocols are used: low (low frequency, supramaximal twitch) and high (strong, fused contractions ‐ 20–30pps).ResultsNo postoperative or implant specific complication was noted. During radiation therapy, the implants were stimulated. All patients tolerated stimulation without pain or discomfort. Visible contraction of base of the tongue muscles and muscles of laryngeal elevation was observed by using an external coil. All patients received high stimulation. The patients were provided with the coils and they continue to stimulate these muscles at home 3 times a day for a total of 1h/d. All patients maintained their oral feeding and weight during treatment of cancer.ConclusionsBION is safe device to implant for stimulation of swallowing muscles. It effectively stimulate the hypoglossal and ansa cervicalis nerves. Robust contraction of swallowing muscles are visible during stimulation.
The Value of FNABs in the Management of Thyroid Lesions
Authors: Mijovic Tamara , Payne Richard J , Rochon Louise , Black Martin J , Hier Michael P , Gologan Olga E , Young Jonathan 
Published: August 2008

ObjectiveDetermine the value of fine‐needle aspiration biopsies (FNAB), and stratify the risk of malignancy within the indeterminate FNAB diagnostic category at our institution.MethodsThe preoperative FNABs of 115 consecutive patients who underwent thyroidectomy at a teaching hospital between 2005 and 2007 were reviewed and categorized into 4 groups: negative for malignancy, positive or suspicious for malignancy, indeterminate, and nondiagnostic. The final histopathological diagnosis was then compared with the FNAB result. FNABs reported as follicular or Hurthle cell lesions were considered indeterminate diagnoses, and malignancy rates were calculated within this category.ResultsThe FNAB results were as follows: 17% negative for malignancy, 35% positive or suspicious for malignancy, 40% indeterminate, and 8% nondiagnostic. The sensitivity of FNAB in detecting thyroid malignancy was 83%, specificity 92% and accuracy 85%. There were 9 discrepant cases giving a false negative rate of 17% and a false positive rate of 8%. Overall, 52% of the indeterminate cases were carcinomas, with a malignancy rate of 48% for the follicular lesions and 62% for the Hurthle cell lesions. When cytological atypia was present, the rate of malignancy increased to 75% and 83% for the follicular and Hurthle cell lesions, respectively.ConclusionsOur study confirms that FNAB is an accurate and helpful method for the evaluation of thyroid nodules with results directly correlating with management. Moreover, surgery should be strongly considered for FNABs categorized as indeterminate cases, especially in the presence of cytological atypia. Due to the high false negative rate, benign FNABs require close follow‐up and periodic rebiopsies.