bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adhesion Molecules as Prognostic Factors in Nasopharyngeal Carcinoma
Authors: Shnayder Yelizaveta , Kuriakose M. Abraham , Yee Herman , Chen Fang‐An , DeLacure Mark D. , Xue Xiao Nan , Jagirdar Jaishree 
Published: November 2003

AbstractObjective/Hypothesis To identify the significance of molecular markers in determining the risk of recurrence and distant metastases in nasopharyngeal carcinoma.Study Design In this retrospective case study, we evaluated archival nasopharyngeal carcinoma specimens for patterns of expression of E‐cadherin, β‐catenin, c‐erb‐B2, and Ki‐67, which have been demonstrated to be important in other tumors.Methods Fifty‐four cases of nasopharyngeal carcinoma were identified, with a maximum follow‐up of 13 years. The histopathological sections were stained using an automated immunohistochemical stainer (NexES, Ventana Medical Systems, Tucson, AZ) for E‐cadherin (Zymed Laboratories [San Francisco, CA] and Transduction Laboratories [Lexington, KY] clones), β‐catenin (Zymed), c‐erb‐B2 (Ventana Medical Systems), and Ki‐67 (Novocastra, Burlingame, CA). The numbers of positively staining cells were scored as follows: 0%, 1% to 33%, 34% to 66%, or greater than 67%.Results E‐cadherin (Zymed) stained positively in only one case. The Transduction Laboratories clone demonstrated a spectrum of staining in all cases, from complete to disrupted to no identifiable membranous staining. The staining was consistently absent at the advancing tumor border, regardless of stage. The loss of β‐catenin expression did not correlate with that of E‐cadherin or with clinical outcomes. No staining was identified for c‐erb‐B2. Ki‐67 staining was variable and did not correlate with clinical outcomes.Conclusions Altered expression or loss of E‐cadherin, or both, may result in loss of function, particularly at the infiltrating edge, with resultant loss of cell polarity, cell migration, and eventual metastasis. The interpretation of E‐cadherin staining depends on antibody source. In contrast to recent studies, β‐catenin expression is not altered and c‐erb‐B2 expression not identified, suggesting that these markers are not important in the prognosis of nasopharyngeal carcinoma.
Chemoradiation for Metastatic SCCA: Role of Comorbidity
Authors: Hathaway Bridget , Johnson Jonas T. , Piccirillo Jay F. , Snyderman Carl H. , Wagner Robin L. , Labriola Suzanne , Myers Eugene N. 
Published: November 2003

AbstractObjectives A previous study of 371 patients with extracapsular spread (ECS) of cervical metastases from squamous cell carcinoma (SCCA) of the head and neck revealed a survival advantage for patients treated with adjuvant chemoradiation, compared with those treated with surgery and radiation or surgery alone. While all patients in the study were offered adjuvant chemotherapy, only 35% selected this option. Comorbidity was identified as a reason for declining chemotherapy. Recently, Piccirillo demonstrated that the Modified Medical Comorbidity Index (MMCI) is a valid instrument to classify and quantify severity of comorbidity. We applied this instrument to previously reported patients with ECS to determine 1) how comorbidity affected treatment selection, 2) whether the survival advantage of adjuvant chemoradiation persisted after controlling for comorbidity, and 3) the impact of comorbidity on outcome.Study Design This was a nonrandomized, retrospective study.Methods Patients in the initial study underwent resection of the primary tumor and neck dissection. Eligible patients elected to receive chemoradiation, radiation, or no further treatment. Comorbidity scores were assigned according to the MMCI. Data were analyzed according to disease‐specific survival and overall survival.Results The study population consisted of 330 patients. More severe comorbidity was related to higher overall mortality rates after controlling for treatment. Adjuvant chemoradiation resulted in improved disease‐specific and overall survival compared with adjuvant radiation after adjusting for severity of comorbidity.Conclusions These results substantiate the benefits of adjuvant chemoradiation for patients with SCCA of the head and neck. Furthermore, these results reinforce the importance of comorbidity as a prognostic indicator for this population of patients.
MRI Detection of Cervical Metastasis From Differentiated Thyroid Carcinoma
Authors: Gross Neil D. , Weissman Jane L. , Talbot J. Michael , Andersen Peter E. , Wax Mark K. , Cohen James I. 
Published: November 2003

AbstractBackground With the advent of the use of serum thyroglobulin as a marker for the recurrence of well‐differentiated thyroid cancer (WDTC) after total thyroidectomy, clinicians are increasingly faced with the diagnostic dilemma of detecting the site of recurrence in thyroglobulin‐positive patients with normal clinical examinations. The high protein content of this thyroglobulin may make it specifically detectable by magnetic resonance (MR) imaging.Objective To determine the ability of MR imaging to detect the presence of metastatic WDTC in cervical lymph nodes.Study Design Retrospective cohort.Methods Blinded review by two independent head and neck radiologists of 34 head and neck MR scans obtained from 26 patients with thyroid cancer (12 with primary disease and 14 with recurrent disease) all of whom subsequently underwent surgical removal of the lymph nodes considered at risk by imaging.Results The average overall percent sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MR imaging were 95%, 51%, 84%, 78%, and 83%, respectively. The concordance between the two radiologists was 69%. There was no overall difference in the ability of the MR scan to detect the presence of disease in the upper jugular, lower jugular, or paratracheal nodal stations. However, it was more useful for papillary carcinoma (PPV 86%, accuracy 85%) than for follicular carcinoma or the follicular variant of papillary carcinoma (PPV 63%, accuracy 67%).Conclusion MR imaging is a sensitive and accurate technique for the detection of WDTC, particularly papillary carcinoma, metastatic to cervical lymph nodes. However, the lower specificity of this modality precludes its use as a screening tool.
Reconstruction of Pharyngeal Defects Using AlloDerm and Sternocleidomastoid Muscle Flap
Authors: Sinha Uttam K. , Chang Kristi E. , Shih Charles W. 
Published: November 2003

AbstractObjective To report our experience in reconstructing pharyngeal defects that cannot be closed primarily, using acellular dermal matrix (AlloDerm, LifeCell Corp., Branchburg, NJ) and sternocleidomastoid (SCM) muscle flap.Study Design Prospective, nonrandomized, nonblinded study in the setting of an academic tertiary care medical center.Methods Fourteen patients underwent reconstruction of through‐and‐through defects of partial pharyngectomy for squamous cell carcinoma using AlloDerm graft. Primary closure of the defects was not possible because of substantial loss of pharyngeal tissue. The graft was reinforced with superiorly based SCM muscle flap in 10 patients. The remaining four patients did not receive any flap. Eleven lesions involved the lateral pharyngeal wall, and three were piriform sinus lesions. Patients were followed for a period ranging from 3 to 20 months. Outcome measures were determined on several parameters including graft take rate, evidence of graft contracture, postoperative complications, resumption of diet, intelligibility of speech, and decannulation. All patients were evaluated by a speech pathologist by means of a bedside swallowing examination. Five patients had videofluoroscopic studies. The three patients with piriform sinus lesions underwent videostroboscopic examination to assess vocal cord function.Results There was a high success rate for graft take. Two patients developed postoperative fistulas that resolved with conservative management . One of the 10 patients with SCM flap and one of the 4 patients without SCM flap developed fistulas. Clinically significant graft contracture or pharyngeal stenosis was not observed in any patients. All patients resumed oral intake. Ten patients resumed a normal diet, two tolerated a soft diet, and two could take purees. Decannulation was successful in all patients. Two of the three patients with piriform sinus lesions had vocal cord palsies after surgery resulting in breathy dysphonia. They underwent type I thyroplasty for vocal rehabilitation. All patients had intelligible speech.Conclusions Thick AlloDerm, reinforced with SCM muscle or cervical soft tissue, provides a useful alternative option for reconstruction of pharyngeal defects that cannot be closed primarily. It is safe and effective and provides excellent functional outcomes.
The Occurrence of Sleep‐Disordered Breathing Among Patients With Head and Neck Cancer
Authors: Friedman Michael , Landsberg Roee , Pryor Shepherd , Syed Zubair , Ibrahim Hani , Caldarelli David D. 
Published: November 2003

AbstractObjective To identify the incidence of obstructive sleep apnea (OSA) in patients treated for head and neck cancer. Obstructive sleep apnea is a relatively common and highly morbid condition that affects 9.1% of male and 4% of female middle‐aged adults. 1 Patients who have been successfully treated for head and neck cancer may often have a partially obstructed upper airway which is functional during the day, but collapses during sleep.Study Design/Methods Twenty‐four patients successfully treated for tumors of the tongue‐base, pharynx, or supraglottic larynx were enrolled. Through OSA‐related questionnaires, physical examination, and polysomnography, the incidence of OSA in this patient population was determined and compared with that of the general population.Results The incidence of OSA (91.7%) in this head and neck cancer patient population was found to be significantly (P = .001) higher than that of the general population. (In a random sampling of middle‐aged adult males between the ages of 30 and 60 years old with a respiratory disturbance index (RDI) >15, the prevalence was previously reported to be 9.1%. 1) Sixteen of 24 patients (72.7%) had clinically defined symptoms of sleep apnea. Ten of 24 patients (41.7%) received radiation therapy; all had an RDI >15. Eleven of the 14 patients (78.5%) who did not receive radiation therapy also had an RDI >15. Eight patients (33.3%) continue to regularly use continuous positive airway pressure with significant improvement in symptoms.Conclusions Identification and treatment of OSA may be an important factor in improving quality of life for patients with head and neck cancer.
Cystic Hygroma/Lymphangioma: A Rational Approach to Management
Authors: Kennedy Thomas L. , Whitaker Mark , Pellitteri Phillip , Wood W. Edward 
Published: November 2003

AbstractObjective To outline a rational approach to the management of cystic hygroma based on the authors' experience, the natural history of the disease, and the results of surgical treatment.Study Design and Methods A retrospective review of all patients with the diagnosis of lymphangioma or cystic hygroma from 1958 to 2000 was performed.Results Seventy‐four patients were identified with 46 cases confined to the cervicofacial region. Surgical excision was performed on 60 of the 74 cases involving all regions of the body and 34 of the 46 patients with head and neck lesions. The location of the malformation is the most important determinate for surgical success. While surgical excision was the main treatment modality, 11 of 12 untreated patients were noted to improve, with 8 patients showing complete resolution.Conclusions In the treatment of lymphangiomas, the physician should be experienced in the management of such lesions, be aware of spontaneous resolution, and recognize the limitations and potential harm of surgery in certain instances.
Aesthetic Comparison of Wound Closure Techniques in a Porcine Model
Authors: Tritle Nathan M. , Haller Jeffrey R. , Gray Steven D. 
Published: November 2003

AbstractObjective To compare various commonly used closure techniques and their esthetic results. Also to look for differences in cost, time, and ease of use among the methods.Design A prospective comparison in a porcine skin model with a blinded assessment of outcomes.Methods Thirty 6‐cm, full‐thickness skin incisions were made on the back of two domestic white swine. Undermining was accomplished, and buried simple, interrupted, absorbable, braided (Polysorb, US Surgical) subdermal sutures were placed in a uniform fashion in each wound. The skin was then closed using one of the following five methods: running subcuticular 4‐0 nylon, running subcuticular 4‐0 absorbable monofilament (Biosyn, US Surgical), tissue glue (Dermabond, Ethicon), adhesive tape, or running subcuticular nylon with intradermal injection of hyaluronic acid. Nonabsorbable sutures and tape were removed on postoperative day 7, and photographs were taken at regular intervals during a 12‐week healing period. Biopsies were taken from wounds in each group at 2 weeks and 12 weeks for histologic comparison. Independent observers evaluated the photographs, and an independent histologist evaluated the biopsies to look for differences in inflammation and scar formation. The surgeons who performed the wound closure rated the ease of use and amount of time required for each technique.Results Adhesive tape closure was faster and easier to perform. There were no significant differences among the adhesive tape, nylon, or absorbable suture groups regarding cosmetic appearance throughout the study period. The tissue glue wounds had more of a tendency to dehisce. Adhesive tape is less expensive than the other methods when material costs and operating room time are considered.Conclusion Adhesive tape closure of surgical wounds is cosmetically acceptable, convenient, and saves both time and material costs. We recommend it as an alternative for closure of neck incisions.
Cortical Representation of the Orbicularis Oculi Muscle as Assessed by Transcranial Magnetic Stimulation (TMS)
Authors: Roedel Ralph M. W. , Laskawi Rainer , Markus Holger 
Published: November 2003

AbstractObjectives To analyze characteristic features and details on motor‐evoked potentials (MEPs) of the orbicularis oculi muscle resulting from cortical transcranial magnetic stimulation (TMS) in normal subjects as a basis for further investigations on motorcortical representation in patients presenting with facial nerve diseases.Study Design MEPs of the orbicularis oculi muscle resulting from focal cortical TMS with a figure‐8‐shaped coil were investigated in 17 healthy subjects with special regard to amplitude and onset latency as a function of the coil position on the head surface along the interaural line and in the anterior–posterior direction. The results were then compared with our data on lower‐lip mimetic muscles and on the frontalis muscle obtained in previous studies.Results Bilateral reproducible responses could be observed at coil positions varying from 1 to 13 cm lateral to the vertex. During moderate muscle activation, maximum responses (mean amplitude 0.75 ± 0.44 mV contralateral, 0.74 ± 0.36 mV ipsilateral) were obtained at a mean stimulus position of 8.6 ± 1.6 cm lateral and 2.0 ± 2.2 cm anterior to the vertex for contralateral responses, and of 8.6 ± 2.0 cm lateral and 2.8 ± 2.4 cm anterior to the vertex for ipsilateral responses, respectively. Voluntary muscle activation by forced eye‐closure was associated with a further increase in mean amplitudes. At rest, bilateral responses could be elicited in 15 subjects (88.2%). During moderate muscle activation, the shortest mean onset latencies were obtained at the optimum stimulus position on the interaural line, both for contralateral (10.2 ± 1.3 ms) and ipsilateral (10.6 ± 1.5 ms) MEPs. Comparing our data on the orbicularis oculi muscle with those obtained on lower‐lip muscles and on the frontalis muscle, there was a considerable overlap of coil positions from which reproducible MEPs could be elicited in all three groups of mimetic muscles, but with the orbicularis oculi area being placed between forehead and lower‐lip motorcortical areas.Conclusions A statistically significant separation of the cortical representation areas of forehead, orbicularis oris, and lower‐lip mimetic muscles is possible by focal cortical TMS reflecting a kind of somatotopic organization of the face‐associated motorcortex. Compared with the results on lower‐lip and forehead muscles, orbicularis oculi muscle responses show characteristics of both.
Bolus Transit and Airway Protection Coordination in Older Dysphagic Patients
Authors: Kendall Katherine A. , Leonard Rebecca J. 
Published: November 2003

AbstractObjectives/Hypothesis The intent of this study was to identify and characterize abnormalities of bolus pharyngeal transit and airway protection in a group of elderly patients with dysphagia.Study Design A retrospective analysis of dynamic videofluoroscopic swallowing studies performed in patients over the age of 65 was carried out. The study was limited to individuals with no obvious medical or surgical cause of dysphagia.Methods Pharyngeal bolus transit times were determined and compared with those from 60 young normal control subjects and 23 elderly control subjects. The timing of airway closure was analyzed in terms of bolus position in the pharynx.Results Prolonged bolus transit times were identified in 61% of patients investigated and 65% of elderly control subjects. Overall, the onset of airway closure was appropriate for the position of the bolus in the pharynx but was slow to achieve completion. Elderly control subjects were found to elevate the larynx early in the swallow. Delayed airway closure was identified as a contributor to aspiration in some dysphagic subjects.Conclusions Pharyngeal transit of the bolus may be prolonged in elderly individuals. Swallowing coordination mechanisms appear to be intact in the majority of elderly patients with dysphagia, but gestures may be weak and ineffective. Early laryngeal elevation may be an effective strategy to avoid aspiration.
Dynamic Laryngotracheal Closure for Aspiration: A Preliminary Report
Authors: Broniatowski Michael , Grundfest‐Broniatowski Sharon , Tyler Dustin J. , Scolieri Paul , Abbass Fadi , Tucker Harvey M. , Brodsky Sheryl 
Published: November 2003

AbstractObjectives/Hypothesis An estimated 500,000 patients per year in the United States. are affected by stroke‐related dysphagia. Approximately half experience aspiration, which can lead to pneumonia or death. Aspiration may result from many factors, including delayed transport of the bolus, faulty laryngeal elevation, and poor coordination or inappropriate timing of vocal cord closure. Interventions carried out to protect the lungs are usually irreversible, destructive to the upper airway, and rarely prevent the need for enteral tube feeding.Study Design We present a report of the first implantations of a new device in an FDA‐approved study to restore dynamic laryngotracheal separation. Two stroke patients needing tracheostomy were selected based on chronic aspiration verified by clinical and radiologic criteria (modified barium swallow [MBS]).Methods The left recurrent laryngeal nerve was exposed and electrically stimulated to verify vocal fold adduction. Huntington Medical Research Institute Bipolar Helical Electrodes were then implanted around the nerve. The leads were tunneled and linked to a NeuroControl™ Implantable Receiver–Stimulator placed subcutaneously on the chest wall. Activation of the stimulator was performed through an external transmitter linked by induction.Results The device was successfully triggered intra‐ and postoperatively. Serial flexible fiberoptic endoscopies and MBS demonstrate that aspiration is systematically arrested using low levels of electrical stimulation (42 Hz, 48–100 μsec, 1 mA).Discussion This pioneering work has shown that aspiration can be controlled without airway damage for a wide population of neurologically impaired patients because it appears more physiological than standard therapies.Conclusion Based on the first two patients, paced laryngotracheal separation is clinically effective in controlling aspiration.
Lipoinjection Augmentation of the Soft Palate for Velopharyngeal Stress Incompetence
Authors: Klotz Darrell A. , Howard John , Hengerer Arthur S. , Slupchynskj Oleh 
Published: November 2003

AbstractObjectives/Hypothesis Velopharyngeal stress incompetence in professional musicians is an uncommon but potentially career‐ending problem. Pharyngeal flaps, V‐Y palatal pushback procedures, Teflon or collagen injection of the posterior pharyngeal wall, and speech therapy have all been used to address this problem. The ideal procedure for this subset of patients with velopharyngeal incompetence (VPI) with high‐pressure, mild VPI would be one that combines low morbidity and an expedient recovery for the busy musician. We describe an approach of endoscopically assisted autologous lipoinjection of the soft palate.Study Design A retrospective review of our experience treating high‐pressure stress VPI in two professional musicians.Methods Literature review and retrospective chart review.Results Two musicians underwent autologous lipoinjection of the soft palate for stress VPI. Patients resumed full play within 2 weeks of the operation with no serious complications. There has been no recurrence of the VPI after 18 and 12 months of follow‐up, respectively.Conclusions Velopharyngeal stress incompetence in musicians is an uncommon disorder. Velopharyngeal incompetence in these patients may not present as in a typical manner with hypernasality but may go undiagnosed for years mistakenly rationalized as a declining performance ability rather than a curable structural problem. The performance demands of professional musicians necessitate a timely solution to their VPI. More precise and limited contouring of palatal bulk can be achieved through the lipoinjection technique than compared with traditional palatal V‐Y pushback or a standard pharyngeal flap. Lipoinjection of the palate can be performed as an outpatient procedure with only minor discomfort and an expedient recovery for the career musician.
Mandibular and Temporomandibular Joint Arthropathy in the Differential Diagnosis of the Parotid Mass
Authors: Klenoff Jason R. , Lowlicht Roger A. , Lesnik Thomas , Sasaki Clarence T. 
Published: November 2003

AbstractObjective To increase awareness of temporomandibular joint and mandibular disease in the overall evaluation and diagnosis of the parotid mass.Study Design We describe clinical presentations of pigmented villonodular synovitis and synovial chondrocalcinosis of the temporomandibular joint, as well as osteoma of the mandible, as they may initially suggest primary neoplasms of the parotid gland.Conclusions Preauricular swelling is a common presenting symptom for patients visiting an otolaryngologist. Often this symptom is suggestive of a parotid mass. However, lesions of the temporomandibular joint and mandible may also present in this fashion.