Faculty Bibliography

BACKGROUND: There is a paucity of outcomes data for patients with lymph node metastasis from cutaneous squamous cell carcinoma of head and neck (SCCHN). METHODS: Patients from a tertiary care center with cutaneous SCCHN metastatic to parotid and or cervical lymph nodes were identified. Data were abstracted and analyzed using COX multivariate analysis. RESULTS: Fifty-one patients (47 men, and 4 women) with a median age of 73 years were identified. Eight patients (16%) had recurrent disease and 11 (22%) were immunosuppressed. Forty patients (71%) received adjuvant radiation therapy. Median overall survival was 23 months (range, 3-148 months). Recurrent disease was associated with higher risk of death (hazard ratio [HR], 2.7; 95% confidence interval [CI] 1.1-6.9) and radiation therapy with reduced risk (HR, 0.18; 95% CI, 0.06-0.54). CONCLUSION: Lymph node metastases from cutaneous SCCHN is associated with poor survival.

We report the pathology and outcome of secondary skull base tumors in patients previously treated with external beam radiation for retinoblastoma (Rb). Rb patients are at increased risk of second head and neck primary malignancies due to early radiation exposure during treatment and loss of RB1 protein in genetic carriers. An institutional database was reviewed for patients with retinoblastoma who had previously received radiation therapy and subsequently developed skull base tumors. Seventeen patients met the selection criteria. The median age of Rb diagnosis was 12 months. Thirteen cases underwent enucleation in addition to radiation therapy as part of initial Rb treatment. A median of 19 years elapsed between the diagnosis of Rb and diagnosis of skull base malignancy. The most common tumors were osteogenic sarcoma (39%) and leiomyosarcoma (22%). Eleven (71%) patients received postoperative chemotherapy, and 7 (41%) received postoperative radiotherapy. Three (24%) patients underwent salvage surgery for recurrent disease. Five-year survival was 68%, and 10-year survival was 51% by Kaplan-Meier analysis. Secondary malignancy in Rb patients is a well-defined event. The use of surgery with appropriate adjuvant therapy was associated with a 51% 10-year survival in this study population.

Where are the 'prime movers' that control behavior? Which circuits in the brain control the order in which individual motor gestures of a learned behavior are generated, and the speed at which they progress? Here we describe two techniques recently applied to localizing and characterizing the circuitry underlying the generation of vocal sequences in the songbird. The first utilizes small, localized, temperature changes in the brain to perturb the speed of neural dynamics. The second utilizes intracellular manipulation of membrane potential in the freely behaving animal to perturb the dynamics within a single neuron. Both of these techniques are broadly applicable in behaving animals to test hypotheses about the biophysical and circuit dynamics that allow neural circuits to march from one state to the next.

Two former U.S. presidents, Ulysses S. Grant and Grover Cleveland, were diagnosed with head and neck cancer in 1884 and 1893, respectively. A historical review of the risk factors, diagnoses, and treatments is examined and compared with modern-day interpretations. A comparison was made using the original diagnoses with today's equivalent diagnosis. Different treatment outcomes at the time of the original diagnoses relative to today's treatment are reviewed. Clinicians must be familiar with risk factors, signs, symptoms, diagnosis, and treatment of head and neck cancer.

OBJECTIVE: To investigate the effects, if any, of the presence of an orogastric tube on incidence of aspiration and oral diet recommendations. STUDY DESIGN: Case series with planned data collection. SETTING: Large, urban, tertiary care teaching hospital. SUBJECTS AND METHODS: Referred sample of 10 consecutively enrolled inpatients (2 pediatric, aged 17 days and 3 months, respectively; and 8 adults, mean age 63 years). An orogastric tube was present for the first videofluoroscopic swallowing study or fiberoptic endoscopic evaluation of swallowing and then removed for the second swallow study. RESULTS: There were no significant differences (P = 1.0) for both overall incidence of aspiration and aspiration by food consistency (liquid or puree) dependent on orogastric tube presence. All 9 participants recommended for an oral diet ate successfully. CONCLUSIONS: An orogastric tube did not affect incidence of aspiration. A videofluoroscopic or endoscopic evaluation of swallowing can be performed with an orogastric tube present, and there is no contraindication to keeping an orogastric tube in place to supplement oral alimentation until prandial nutrition is adequate.

The relationship between behavioral and neural performance has been explored in adult animals, but rarely during the developmental period when perceptual abilities emerge. We used these naturally occurring changes in auditory perception to evaluate underlying encoding mechanisms. Performance of juvenile and adult gerbils on an amplitude modulation (AM) detection task was compared with response properties from auditory cortex of age-matched animals. When tested with an identical behavioral procedure, juveniles display poorer AM detection thresholds than adults. Two neurometric analyses indicate that the most sensitive juvenile and adult neurons have equivalent AM thresholds. However, a pooling neurometric revealed that adult cortex encodes smaller AM depths. By each measure, neural sensitivity was superior to psychometric thresholds. However, juvenile training improved adult behavioral thresholds, such that they verged on the best sensitivity of adult neurons. Thus, periods of training may allow an animal to use the encoded information already present in cortex.

Sudden sensorineural hearing loss (SSNHL) is commonly encountered in audiologic and otolaryngologic practice. SSNHL is most commonly defined as sensorineural hearing loss of 30 dB or greater over at least three contiguous audiometric frequencies occurring within a 72-hr period. Although the differential for SSNHL is vast, for the majority of patients an etiologic factor is not identified. Treatment for SSNHL of known etiology is directed toward that agent, with poor hearing outcomes characteristic for discoverable etiologies that cause inner ear hair cell loss. Steroid therapy is the current mainstay of treatment of idiopathic SSNHL in the United States. The prognosis for hearing recovery for idiopathic SSNHL is dependent on a number of factors including the severity of hearing loss, age, presence of vertigo, and shape of the audiogram.