Faculty Bibliography

Lung cancer is the leading cause of cancer deaths world-wide. Recent advances in cancer biology have led to the identification of new targets in neoplastic cells and the development of novel targeted therapies. At this time, two targeted agents are approved by the FDA in advanced non-small cell lung cancer (NSCLC): the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) erlotinib, and the anitangiogenic bevacizumab. A third agent, cetuximab, which was recently shown to enhance survival when used with cisplatin and vinorelbine as first line therapy for advanced NSCLC, will likely be approved by regulatory agencies. With more than 500 molecularly targeted agents under development, the prospects of identifying novel therapies that benefit individual patients with lung cancer are bright.

A variety of autoantibodies have been identified with complex neurological disorders including limbic encephalitis. The underlying trigger for the immune-mediated process and the role of autoantibodies in the pathogenesis of limbic encephalitis remain to be clarified. Here, we report a 16-year-old female who was diagnosed with acute-onset non-neoplastic limbic encephalitis. The initial treatment with pulse doses of i.v. methylprednisolone improved the neurological symptoms. During the next 12 months, progressive decline was reported in her academic functioning and seizure control. Additional diagnostic evaluation revealed no evidence of malignancy or central nervous system infection but circulating anti-GAD antibodies were present in the serum and cerebrospinal fluid. Intravenous gammaglobulin infusion was initiated and continued monthly. Intravenous and oral steroids were added to the intravenous immunoglobulin treatment because of the worsening course and seizures, despite treatment with antiepileptic medications. Screening for quantitative immunoglobulins demonstrated hypogammaglobulinaemia with low immunoglobulin M and G in addition to low immunoglobulin A levels. There was a lack of protective pneumococcal antibody titers before and after immunization. Therefore, common variable immunodeficiency was suspected despite there being no history of recurrent infections. To our knowledge, this is the first report describing a possible link between immune-mediated limbic encephalitis and immune deficiency.

CONCLUSIONS: The historical study of serous otitis media (SOM) demonstrates steps in recognition of the disease, shifts in prevalence, and relationships between the disease's affect and evolving economic bases of society. OBJECTIVE: SOM, although noted in early Roman and Arabic medicine, was only identified as a distinct and significant pathology in the last half of the 20th century. This paper examines the development of understanding of SOM, and ways in which it has been cared for during the 20th and 21st centuries. MATERIALS AND METHODS: The medical literature from antiquity to the present was reviewed for mention of otological conditions that related to SOM. For this report, the primary source of each notation was examined. RESULTS: The first part of the 20th century saw little change from earlier times in the recognition or treatment of SOM. Our current 21st century conceptualization and concern for SOM has come about from five advances: antibiotics, the rediscovery of the tympanostomy tube, the clinical use of middle ear impedance, the association of a history of otitis with linguistic deficiency, and recognition of the significance of transformation to a communication-based economy.

The role that otolaryngologist Ross McIntire, MD, played in the care of Franklin Delano Roosevelt, 32nd President of the United States, was documented by reviewing primary source material pertaining to the relationship of McIntire and Roosevelt. This included material from various archives including the Franklin D. Roosevelt Presidential Library at Hyde Park, New York; United States National Archives; and numerous autobiographies and diaries. McIntire's belief in the value of confidentiality and to provide information only on a need-to-know basis is consistent with the strategy that he had devised earlier for protecting his patient's privacy. In the context of his time and his position, Dr McIntire served his patient and his country well by making appropriate medical and wise personal judgments. The career of Dr Ross T. McIntire, otolaryngologist and personal physician to the 32nd president of the United States, engenders a sense of honor to our profession.

BACKGROUND: In the past, surgeons believed that in order to eradicate regional disease, a radical or modified radical neck dissection was necessary. An evolution in surgical principles and the popularization of primary chemoradiation has raised the questions regarding the role of neck dissection and the extent of neck dissection following therapy. The aim of this study was to determine the efficacy of selective neck dissection (SND) for patients with N2 or N3 disease following treatment with primary radiation therapy or chemoradiation. METHODS: A retrospective review of 58 patients with stage III or IV head and neck squamous cell carcinoma was conducted. The primary sites included base of tongue (n = 15), hypopharynx (n = 12), tonsil (n = 16), larynx (n = 11), and unknown primary (n = 4). Definitive treatment consisted of either concomitant chemoradiation (67.2%) or external beam radiation therapy (32.8%). In the monotherapy group, all patients received a total curative dose of 66 to 72 Gy in once-daily fractions of 180 to 200 cGy. The combined chemoradiation group received a similar radiation schedule and a 4-day continuous infusion of cisplatin (20 mg/m(2)/day) and 5-fluorouracil (1000 mg/m(2)/day). A planned SND of levels II to IV was performed on all the patients 3 to 6 weeks after completion of definitive medical therapy. RESULTS: Seventy neck dissections were performed on 58 patients with advanced neck disease following radiation or chemoradiation. The median time of follow-up was 34 months (range, 9-71 months) following the neck dissection. Pathologically, 22.4% (13/58) of the patients had viable tumor cells identified in the neck dissection specimen. Seventy-two percent of the patients are currently alive, and 28% died as a result of distant disease, local or regional recurrence, or other causes. Of patients who died from distant disease, 11% had pathological evidence of residual tumor cells identified in the neck dissection specimen. Of patients who died from local or regional disease, 50% had pathological evidence of residual tumor cells identified in the neck dissection specimen. CONCLUSION: The rate of regional recurrence following SND is similar to reported rates following modified/radical neck dissection. This suggests that SND provides an appropriate surgical option for advanced neck disease in select patients following adjuvant therapy.

OBJECTIVES/HYPOTHESIS: The successful harvest and transplant of a fibular flap depends on many factors, including healthy inflow and outflow systems. A contraindication to harvesting a fibular flap is disease of the lower extremity arterial system; therefore, preoperative evaluation of the arterial system is routine. Preoperative evaluation of the venous system is not routine, unless there is clinical suspicion of venous disease. METHODS: Retrospective chart review. RESULTS: Two cases of occult deep venous thrombosis (DVT) were encountered intraoperatively resulting in nontransplantable flaps. CONCLUSIONS: This finding represents a serious concern, and we believe that venous imaging should be considered in patients with significant risk factors for harboring an occult DVT. Laryngoscope, 2009.

A 48-year-old woman with a history of chronic intranasal cocaine abuse presented with unilateral proptosis associated with severe visual loss from optic neuropathy in the right eye. Imaging showed extensive bone and soft tissue destruction in the paranasal region and an orbital mass. Initial biopsies suggested a low-grade neoplasm. The correct diagnosis was established only on repeat biopsy, which revealed marked pleomorphism and nonspecific chronic inflammation with irregular collagen bundles containing thick-walled blood vessels. This case emphasizes that intranasal cocaine abuse may clinically, radiographically, and histopathologically mimic a neoplasm or a necrotizing vasculitis.