bluuebunny/crossref_metadata_2025_split huggingface dataset:
S133 – Boron Neutron Capture Therapy for Melanoma in Nasal Cavity
Authors: Morita Norimasa , Teruhito Aihara , Uno Msako , Ono Koji , Harada Tamotsu 
Published: August 2008

ObjectivesBoron neutron capture therapy (BNCT) is one of the radiation therapies known to have a selective lethal effect on tumor cells. Thermal neutrons are captured by the 10B atom, resulting in the emission of linear recoiling Alfa particles and 7Li nuclei, with traveling ranges of ∼9 and ∼5 micrometers respectively. These particles are high linear energy transfer (LET) radiation and lethally damage DNA. BNCT for cutaneous melanoma, using 10B‐para‐boronophe‐nylalanine (BPA) as the boron delivery agent, was developed and successful BNCT treatment of 18 melanoma patients has been reported by Mishima et al.MethodsBased on their treatment regimen and with the approval of the Nuclear Safety Bureau of the Japanese government and the Medical Ethics Committees of Kawasaki Medical School and Kyoto University, we have conducted BNCT clinical trials on patients with mucosal melanomas in head‐and‐neck at the Kyoto University Research Reactor (KUR) and the Japan Research Reactor No. 4 (JRR‐4) since 2005.ResultsTo date, we have treated 6 patients with mucosal melanomas in the nasal cavity with BNCT. 4 patients showed a complete response (CR) by 6 months and 2 patients showed a partial response (PR) 3 months after BNCT. None of the patients showed any serious damage in normal tissue surrounding tumor site. One patient from this study died due to distant metastasis. However, no local recurrence of melanoma has been observed in all CR patients and no regrowth of melanoma in all PR patients.ConclusionsBNCT thus is a promising treatment for achieving local control of mucosal melanomas.
S137 – Microsatellite Instability Analysis of Sinonasal Carcinomas
Authors: Llorente‐Pendas Jose‐Luis , Jorge Garcia‐Martinez , Pérez‐Escuredo Jhudit , Hermsen Mario , Alvarez‐Marcos Cesar , Suarez‐Nieto Carlos , Hermsen Mario 
Published: August 2008

ObjectivesMicrosatellite instability (MSI) is a type of genetic instability due to errors in the mismatch repair system. In the respiratory mucosa of the nasal and paranasal cavities, the 2 major types of carcinoma are intestinal‐type sinonasal adenocarcinoma (ITAC) and squamous cell carcinoma (SCCNC). ITAC is histopathologically similar to colorectal adenocarcinoma. However, it is unknown if this similarity extends to the pattern of genetic abnormalities involved. The aim of this study was to investigate if these results could be related to a possible role of MSI in these 2 types of nasal carcinoma.MethodsDNA was extracted from frozen tumor samples of 34 ITAC and 25 SCCNC as well as corresponding blood samples of these patients. 5 mononucleotide microsatellite loci that show very little polymorfism between different individuals were amplified by multiplex PCR and analyzed by capillary electrophoresis.ResultsThe allelic patterns showed normality for all 34 ITAC studied, whereas 2 SCCNC revealed an allelic shift for one of the 5 loci, indicating microsatellite instability.ConclusionsMSI does not appear to play a role in ITAC as in colorectal adenocarcinoma. This finding is supported by immunohistochemistry studies of MMR protein expression levels. It remains to be elucidated what genetic mechanism propels tumorigenesis in diploid ITAC without gross chromosomal aberrations. In SSCNC, however, it cannot be excluded that MSI is involved in (a subset of) cases. Interestingly, only 1 of the 2 positive cases had the characterizing absence of chromosomal changes; the other carried multiple abnormalities.
S139 – Intact Parathyroid Hormone as a Predictor of Hypocalcaemia
Authors: Ng Yuk Hui , Teo Dawn Tw , Li‐Chung Khoo Mark 
Published: August 2008

Objectives1) To investigate intact Parathyroid Hormone (ipth) as a predictor of hypocalcaemia in post‐total thyroidectomy patients. 2) To determine the sensitivity and specificity of ipth as a predictor of hypocalcaemia.MethodsProspective study involving 65 patients in a single institution accrued over 2 years. All patients scheduled for total thyroidectomy were empirically started on calcium and vitamin D replacement on the day of surgery. Intact Parathyroid Hormone (ipth) levels were taken 4–6 hours after completion of operation. Corrected calcium levels were also obtained 4–6 hours after completion of operation and 24 hours later. All patients were subsequently monitored for development of hypocalcaemia. Hypocalcaemia is defined as corrected serum calcium of < 1.9 mmol/L or clinical symptoms of cramps or peri‐oral numbness.Results18 of 65 patients developed hypocalcaemia. All patients who developed hypocalcaemia had a ipth level of < 0.6 pmol/L. Using 0.6 as a cut‐off value, ipth has a sensitivity of 100% and specificity of 76% in our study.ConclusionsUsing a cut‐off value of 0.6pmmol/L, early postoperative intact parathyroid hormone has a high sensitivity and good specificity in identifying patients who subsequently develop hypocalcaemia post‐total or completion thyroidectomy and can be used identify patients who need close calcium monitoring in the postoperative period.
S141 – Total Laryngectomy in Patients with Advanced Bulbar ALS
Authors: Garvey Chris , Kathleen Kennelly , Salassa John R 
Published: August 2008

Objectives1) Identify patients with Amyotrophic Lateral Sclerosis (ALS) who would benefit from a total laryngectomy (TL) and outline specific surgical indications. 2) Educate physicians about the surgical procedure, perioperative course, and benefits from having a TL. 3) Review the clinical course and results of patients with ALS who had a TL.MethodsFrom January 1999 to January 2008, charts from the Mayo Clinic in Jacksonville, FL, were retrospectively reviewed. 3 patients who underwent TL for advanced bulbar symptoms related to ALS were identified and their clinical course reviewed.ResultsAt the time of surgery, all patients were aphonic with a multitude of symptoms including: dysphagia, drooling, respiratory insufficiency, aspiration pneumonia, choking and coughing. Average surgical time was 103 minutes. No intraoperative complications occurred. 2 patients with pre‐existing respiratory insufficiency experienced postoperative pulmonary complications, resulting in a prolonged hospital course, median stay 17 days (range 6–29 days). One patient was lost to follow‐up postoperatively. The other 2 and their caregivers were pleased with the results of TL. Benefits reported were: elimination of choking spells, improved comfort with mechanical ventilation, safe and easy tracheostomy tube changing and cleaning, less traumatic tracheobronchial suctioning, increased oral intake, reduced anxiety of aspiration, and less coughing.ConclusionsTL is a relatively safe, quick, and uncomplicated surgery that should be considered earlier and more frequently in the treatment plan of patients with advanced bulbar symptoms of ALS. Patients with preoperative respiratory insufficiency may experience prolonged recovery times.
S144 – Management of the Symptomatic Lingual Thyroid
Authors: Massick Douglas D , Chio Eugene G 
Published: August 2008

ObjectivesUnderstand management strategies for symptomatic lingual thyroid tissue.MethodsProspective evaluation of 6 patients undergoing transoral resection of symptomatic lingual thyroid tissue between 2002 and 2007, with analysis of the evolution of our technique and patient outcomes.Results6 patients underwent transoral resection of symptomatic lingual thyroid tissue. Operative time, duration of postoperative hospitalization, and blood loss were significantly reduced over the course of the study.ConclusionsSymptomatic lingual thyroid tissue can be successfully treated via transoral excision with minimal morbity and excellent patient outcomes.
S145 – RAP1 Expression in Squamous Cell Carcinoma of Head and Neck
Authors: Huang Chao‐Cheng , Chen Ching‐Mei , Chien Chih‐Yen 
Published: August 2008

ObjectivesRap1 has been shown to be activated in response to various growth factors, cytokines, and chemokines that act on receptor tyrosine kinases (RTKs) or G‐protein‐coupled receptors, and implicated in a wide range of biochemical pathways in all eukaryotic cells through a number of distinct effectors. This study was aimed to investigate the role of RAP1 in the tumorigenesis of squamous cell carcinoma of head and neck (HNSCC).MethodsImmunohistochemical analysis was performed to study RAP1, CK 10, and E‐cadherin expressions on the paraffin‐embedded tissue of 198 HNSCCs. The relationship between RAP1 expression and the clinical prognosis was also investigated.ResultsRAP1 expression was readily detected in the normal epithelium and the well‐differentiated HNSCC, whereas its expression turned to be weak or undetectable in the poorly differentiated HNSCC (p < 0.001). When RAP1 expression was decreased, the expressions of CK 10 (differentiation marker) and E‐cadherin protein were also down regulated. In addition, patients with high RAP1 expression had significantly longer median survival than patients with low RAP1 expression (median = 51.21 vs. 13.14 months, p <0.001) by survival analysis based on the Kaplan‐Meier method.ConclusionsRAP1 expression may be related to cell differentiation in HNSCC. In addition, RAP1 could be a useful biomarker for tumor progression and survival of HNSCC.
S149 – Sinonasal Mucosal Melanoma: A 12‐Year Experience
Authors: Narasimhan Kailash , Kucuk Omer , Mathog Robert , Carron Michael A 
Published: August 2008

Objectives1) Describe the Sinonasal Mucosal Melanoma patients (SNMM) our institution has treated. 2) Assess outcomes of surgical and adjuvant therapies for this disease.MethodsRecords of 18 patients diagnosed between 1995 and 2007 were reviewed, with a focus on patient characteristics, treatment outcomes, and modalities.ResultsPatients’ ages ranged from 31 to 85. Most common anatomic locations were maxillary sinus in 12 patients and lateral nasal walls in 6. 5 patients had cribriform plate involvement, and 3 had orbital involvement. Tumor thickness averaged 3.1 cm. 15 of the 18 patients had definitive surgical resection of their primary. Most common surgical procedure was medial maxillectomy. 6 patients were operated on despite disease in prognostically poor locations such as skull base, orbit, cribiform plate, and nasopharynx. Margins ranged from 0.5 to 4 cm. 10 patients received chemo‐ or immunotherapy, 11 received radiotherapy, and 6 received both. Recurrence rate was 10/18 (55%), while distant metastatic rate was 6/18 (33%), the lung being the most common metastatic location (4 patients). Average follow‐up was 38.6 months, with disease‐free intervals ranging from 8 to 39 months in patients with recurrences. After 2000, patients only received limited surgical resections, and were treated at stages I‐II.ConclusionsDespite the poor prognosis of SNMM, over the past 13 years at our institution the trend has been towards patients being diagnosed and treated at an earlier stage and having less extensive surgical resections. Advances in imaging, negative margins, radiation, and the use of immunotherapy may have influenced patient outcomes and recurrence rates.
S153 – Radiological Balloon Dilatation of Neo‐Pharyngeal Strictures
Authors: Harris Robert L , Alan Grundy , Odutoye Tunde A 
Published: August 2008

ObjectivesRadiological balloon dilatation of lower oesophageal strictures is common practice. Other than some early reports from our own centre, there is little published regarding radiological dilatation of pharyngeal and upper oesophageal strictures and less still on radiological balloon dilatation of post‐total laryngectomy and pharyngolaryngectomy neo‐pharyngeal strictures. Standard practise is bouginage under general anaesthaesia. The objective of this study is to assess the efficacy of radiological balloon dilatation for the treatment of dysphagia secondary to neopharyngeal strictures in patients who have undergone laryngectomy.MethodsA tertiary care centre case series of 20 consecutive patients (17 males and 3 females aged 40 to 84) with pharyngeal stricture and dysphagia post‐total laryngectomy or pharyngolaryngectomy who underwent balloon dilatation of the stricture under radiological guidance. Maintenance of swallowing was the main outcome measure.Results5 patients gained relief of their dysphagia with 1 balloon dilatation only. 9 patients required more than 1 dilatation to maintain swallowing. 2 patients had balloon dilatation procedures and stent insertion for palliative relief of dysphagia from known recurrent malignant disease. 3 patients failed to maintain swallowing with repeat dilatations. No patients suffered any significant complications such as perforation.ConclusionsBalloon dilatation is minimally invasive and less traumatic than rigid pharyngoscopy with bouginage dilatation. It is well tolerated. It may be repeated frequently and can successfully relieve strictures of the pharynx in patients who have undergone total laryngectomy or pharyngolaryngectomy.
S154 – Primary TEP and Patch Free‐Flap Laryngectomy Reconstruction
Authors: Ghanem Tamer Abdel‐Halim , McLarty Justin , Ardeshirpour Farhad , Baranano Christopher F , Rosenthal Eben L , Wax Mark 
Published: August 2008

Objectives1. Assess speech outcomes for patients undergoing primary tracheoesophageal puncture (TEP) following total laryngectomy (TL) with patch free flap reconstruction. 2. Evaluate risk of fistulization following primary TEP vs. no TEP in patch free flap TL reconstruction.MethodsPatients undergoing reconstruction with patch free‐flaps following TL were studied retrospectively. Demographic data, surgical procedures, speech outcomes, and postoperative complications were collected. Patients were divided in 2 groups depending on whether TEP was performed at the time of ablation (primary TEP). Voice outcomes were assessed by a speech therapist.Results77 patients underwent TL, mean age of 63 years. Glottis (60%), followed by hypopharynx (18%), and supraglottis (17%) were the most common tumor sites. Most patients had T3 and T4 disease (71%) on initial presentation, and there were 57% undergoing salvage total laryngectomy. The radial forearm fascioucutaneous free flap was used in 90% of the cases. Primary TEP was performed in 44 patients (57%), and only 1 of 33 patients underwent a TEP procedure secondarily. Voice outcomes for the TEP group were good. The overall fistula rate was 39%, half of which healed spontaneously. The fistula rate in the primary TEP group was 41%, and in the group not receiving primary TEP it was 36.7% (p=0.87).ConclusionsPrimary TEP performed at the time of free‐flap patch reconstruction after TL enhances speech outcomes for patients, and does not lead to an increased risk in fistula formation.
S155 – Spontaneous Regression of Mucosal Melanoma
Authors: Rajan Roy , Samant Sandeep 
Published: August 2008

ObjectivesSpontaneous regression of melanoma is a rare phenomenon, and it has yet to be described in the literature for mucosal melanomas, which ordinarily have a grim prognosis with a 10–15%, 5‐year survival rate. We present a case of a hard palate melanoma that spontaneously regressed.MethodsWe present a case report, review of the literature, and a discussion.ResultsA 49‐year‐old female presented with a pigmented lesion recently on her hard palate that was biopsy‐proven to be spindle‐cell type malignant melanoma with a depth of 2.3 mm. It stained positive for S‐100 and Melan‐A. Subsequent PET/CT imaging did not show hypermetabolic activity either at the lesion or elsewhere. A wide local excision of the lesion was performed. The histopathology showed oral mucosa with focal cicatrix formation, chronic inflammation, and pigmented macrophages, but no evidence of residual melanoma.ConclusionsThe case illustrates histopathologic findings in a mucosal melanoma undergoing spontaneous regression. These findings point to a potentially critical role for histiocytes in effecting tumor elimination. Analysis of spontaneous melanoma regression may help understand this phenomenon better and may lead to improved immunotherapy.
S156 – What Can Determine the Length of a Thyroidectomy Incision?
Authors: Vasan Nilesh R 
Published: August 2008

ObjectivesPatient expectations regarding cosmesis following surgical procedures have increased. Subsequently, many surgeons are now utilizing very small incisions when performing thyroidectomy. This study evaluated the association between patient weight, nodule size, and maximum thyroid diameter, and the length of a thyroidectomy incision.MethodsData from a cohort of 28 consecutive patients treated by a single surgeon was analyzed. Patient demographics, clinical exam, ultrasound findings, operative findings, and pathology were recorded. All incisions were measured pre‐operatively.ResultsOf the 28 patients (79% female), 24 underwent a hemithyroidectomy and isthmusectomy. One patient had papillary thyroid cancer and 7 (25%) required operation for compressive symptoms. The mean patient weight was 200.76 lbs (median=188 lbs; IQR 75lbs). The mean clinical nodule diameter was 3.64 cm (median=3.7 cm; IQR=1.7 cm), and the mean maximum thyroid diameter was 6.22 cm (median=5.25 cm; IQR=3.7 cm). The mean incision size was 5.32 cm (median=5.0 cm; IQR=2.0 cm). Independently, patient weight, maximum thyroid diameter, and maximum nodule diameter were shown in regression models to be statistically significant predictors of incision size. In stepwise regression analysis that included all three listed variables, only maximum thyroid diameter remained a significant predictor of incision size (p<0.0001).ConclusionsThe use of small incisions when performing thyroidectomy is becoming common. To further reduce incision size, video‐assisted thyroidectomy is now being advocated. For thyroidectomy, surgeon preference and comfort level are obviously important factors in deciding incision length. This retrospective study has shown that this decision is taken in context of the patients’ weight, maximum nodule diameter, and most importantly, maximum thyroid diameter.
S161 – Surgical Management of Dysphagia and Dysphonia
Authors: Lee Peng Grace , Sinha Uttam K 
Published: August 2008

ObjectivesLearn to surgically manage dysphonia and dysphagia.Methods22 patients treated for HNC between July 2004‐December 2005 received in‐clinic evaluation for dysphonia and modified barium swallow for dysphagia. Patients were divided into 4 groups based on function of their pharynx and larynx. All patients had a tracheotomy and gastric feeding tube (G‐tube). Treatment outcomes were determined by removal of both. Group I: Patients tolerated puree diet at the time of evaluation, and were placed on swallowing therapy protocol developed in our institution (n=53). Group II: Patients could not swallow due to obliteration of hypopharyngeal lumen but good glottic closure and cough reflex. They underwent pharyngeal reconstruction with preservation of the larynx through transcervical approach (n=5). Group III: Patients had obstruction at the hypopharynx with loss of supraglottic sensation and aspiration of saliva. These had no functional voice. They underwent laryngectomy and pharyngeal reconstruction using myocutaneous flap (n=10). Group IV: Patients had obliteration of the pharyngeal lumen and laryngeal inlet due to fusion of epiglottis and post‐cricoid area to the posterior pharyngeal wall. They underwent micro‐endoscopic laryngopharyngeal reconstruction (MELPR)(n=6).ResultsAt the end of treatment, all tolerated a regular diet and were decannulated. In Group I, G‐tube was removed after completion of CRT. In Groups II‐IV, G‐tube was removed 3–6 weeks after all procedures. For dysphonia, all patients in Groups I, II, and IV recovered voice function. In Group III, 6/10 had voice rehabilitation with use of prostheses.ConclusionsSurgical management of dysphagia and dysphonia is best attained through categorization of pharyngeal and laryngeal function.
S162 – Chronic Aspiration after Supracricoid Partial Laryngectomy
Authors: Gallo Andrea , Ruoppolo Giovanni , Di Mario Marco , Paola Calcagno , Valentina Manciocco , De Vincentiis Marco 
Published: August 2008

ObjectivesThe aim of this study is to evaluate the long‐term swallowing status and the high resolution computed tomography (HRCT) pulmonary findings of chronic aspiration in patients who have undergone supracricoid partial laryngectomy (SCPL), to demonstrate that SCPL causes a mild and well‐tolerated degree of chronic aspiration, allowing the patient to avoid a nothing‐by‐mouth status.MethodsRetrospective medical record review. Cohort study. Case series. The follow‐up period ranged from 3 to 13 years. 116 patients treated with SCPL were analyzed. The patients included in the study were NED, were followed for more than 3 years, were without tracheal cannula or nasogastric tube, and able to feed orally. A group of 20 patients with chronic obstructive pulmonary disease and normal deglutition was used as a control. Evaluation of postoperative swallowing disorders included a careful observation of the patients by the physician, fiberoptic endoscopic evaluation of swallowing (FEES), and videofluoroscopy (VFS). Clinical grading of postoperative aspiration was assessed according to the Leipzig and Pearson scale. The radiological manifestations of chronic aspiration were recorded at high resolution computed tomography (HRCT).ResultsA higher incidence of pulmonary consolidation was found in the patients affected by postoperative chronic aspiration, compared to the control group (p<0.001). No significant differences were noted between the control group and the dysphagic group regarding the remaining radiological findings.ConclusionsSCPL causes a mild and well‐tolerated degree of chronic aspiration, determining low functional impairment and allows the patient a good quality of life.
S164 – Comparison of Endoscopic and Conventional Parotid Surgeries
Authors: Yeh Shiou‐Yu , Chen Mu‐Kuan 
Published: August 2008

ObjectivesTo compare the advantages and disadvantages between endoscopic and conventional parotid surgeries, and further evaluate the benefits of the new surgical approach ‐ endoscopic parotidectomy.MethodsFrom January 2002 to August 2007 in Changhua Christian Hospital, 33 endoscopic parotid surgeries for selected patients presenting with benign parotid tail disease were compared with one hundred 99 conventional parotid surgeries for the patients with benign parotid tumors by age, gender, wound size, operation time, complication, admission length, and medical cost, retrospectively.ResultsThere is no difference between endoscopic parotid surgeries and conventional parotid surgeries in gender and age. For the wound size, the mean length of the endoscopic parotid surgeries is only 3.1 centimeter and the wounds are almost invisible due to its concealed location behind the ear. Shorter operation time and hospital stay are discovered in the endoscopic parotid surgeries. Less complication rates and medical costs are also found in the endoscopic parotid surgeries.ConclusionsMinimally invasive endoscopic parotid surgery provides a safer, less costly, and aesthetic choice for the treatment of benign lesions located in the parotid tail. The advantages of this procedure include smaller operative scar with cosmetic results, shorter operation time and hospital stay, less complication rates and medical costs.