Faculty Bibliography

PURPOSE: Fluoro-2-deoxy-D-glucose positron emission tomography scans are becoming standard of care in the evaluation of Hodgkin disease (HD). The frequency of false positive (FP) PET scans in pediatric HD after completion of therapy has not been well studied. PATIENTS AND METHODS: All PET scan reports on pediatric HD patients at our institution between February 2000 and February 2005 were retrospectively reviewed. Scans were considered positive if the interpretation was most consistent with malignancy. FP results were determined by pathologic evaluation, resolution on scan, or absence of disease progression over at least 1 year without intervention. RESULTS: We reviewed 255 PET scans on 47 patients, including 156 posttherapy scans on 34 patients. Positive predictive value for scans obtained during routine follow-up was 11%, with an FP rate of 16%. Identifiable etiologies of FP scans included: fibrosis, progressive transformation of germinal centers, abdominal wall hernia, appendicitis, thymus and HIV associated lymphadenopathy. CONCLUSIONS: Routine PET scans after completion of therapy in pediatric HD patients have a low positive predictive value and a high FP rate. Prospective studies are needed to reduce the ambiguity of positive results. In the interim, positive PET scans after treatment should be interpreted cautiously and therapeutic decisions should not be made without histologic confirmation.

OBJECTIVE: To statistically analyze the long-term results of osteotomy after rhinoplasty. DESIGN: In a consecutive series of 51 patients who underwent reduction rhinoplasty from May 1, 2000, through September 30, 2003, all underwent the same method of bilateral lateral osteotomies, performed by one of us. Twenty patients agreed to participate in this study. The follow-up ranged from 7 to 36 months (mean, 12.6 months). By using preoperative and postoperative photographs, comparisons were made of the change in the dorsal width of the nose (the anterior junction of the nasal bones) and of the ventral width of the nose (where the nasal processes of the maxilla meet the body of the maxilla). RESULTS: There was a significant change (P = .003) in the ventral width of the nose after nasal bone osteotomy. There was no significant change (P = .24) in the dorsal width of the nose. CONCLUSIONS: By using this technique of osteotomy, it is possible to narrow the ventral width of the nose with statistical significance. The dorsal width of the nose is maintained in reduction rhinoplasty. To our knowledge, this is the first attempt to quantify the amount of narrowing achieved after nasal osteotomies

The tongue plays a critical role in bolus propulsion through the oral cavity and pharynx. This manuscript reviews the types of lingual impairment and overall oropharyngeal swallowing impairment present after treatment for head and neck cancer; specifically, surgery and primary chemoradiotherapy. Oral tongue impairment in surgically treated patients can include reduced range of motion, reduced control, and reduced ability to manipulate, seal, and propel a bolus into the pharynx. Tongue base impairment can result in reduced bolus clearance through the pharynx, resulting in pharyngeal residue and aspiration. The biologic effects of radiotherapy are described, with tissue fibrosis being a primary contributor to development of oropharyngeal swallow disorders. In patients treated with primary chemoradiotherapy, lingual strength has been found to be reduced, as has oral and pharyngeal structural movement during the swallow. The effects of skeletal muscle strengthening programs on muscle physiology are discussed, as are the effects of tongue strengthening exercise programs on tongue strength and swallowing. Future research needs are addressed

OBJECTIVES/OBJECTIVE:We evaluated the efficacy of the application of selective neck dissection to cases of clinically node-positive disease. METHODS:We performed a retrospective review at the University of Pittsburgh Head and Neck Cancer Database. A database of 65 patients was followed for an average of 36 months (range, 2 to 128 months) after they underwent selective neck dissection for clinically node-positive regional disease. RESULTS:Regional failure occurred in 8 patients (12.3%). In-field failure was experienced in 4 patients (6.1%), and failures outside the field of dissection occurred in 4 patients (6.1%). The overall incidence of extracapsular spread was 33.8% (22 of 65). Only 2 of 8 regional recurrences were associated with extracapsular spread at the initial neck dissection; however, both recurrences were in the contralateral, undissected side of the neck. Four regional failures were salvaged with surgery, with eventual overall regional control in the neck of 93.9%. Only 1 of 4 ipsilateral recurrences (25%) was successfully salvaged. In contrast, 3 of 4 contralateral failures (75%) were successfully salvaged. In our study population, 21 of 65 cases (32%) that were initially staged as clinically node-positive had no evidence of nodal metastases on pathologic examination. CONCLUSIONS:The application of selective neck dissection and postoperative irradiation in patients with clinically Nl and limited N2 clinical disease appears to be oncologically efficacious. Clinical overstaging occurred frequently in this sample, and may put patients at risk for more morbid surgical procedures.

OBJECTIVE: The role of proton pump inhibitors (PPIs) in suspected GERD-related chronic laryngitis (CL) is controversial. Hence, we performed a meta-analysis of the existing randomized controlled trials (RCTs) to evaluate the efficacy of PPIs in this disorder. METHODS: Data extracted from MEDLINE (1966 to August 2005), Cochrane Controlled Trials Register (1997 to August 2005), EMBASE (1980 to August 2005), ClinicalTrials.gov website, and meetings presentations (1999-2005). Published and unpublished randomized placebo-controlled trials of PPIs in suspected GERD-related CL were selected by consensus. Random effects model was utilized with standard approaches to quality assessment, sensitivity analysis, and an exploration of heterogeneity and publication bias. The primary outcome measure was defined as the proportion of patients with >or=50% reduction in self-reported laryngeal symptoms. RESULTS: Pooled data from 8 studies (N = 344, PPI 195, placebo 149; mean age 51 yr; males 55%; study duration 8-16 wk) were analyzed. No significant quantitative heterogeneity was found among the studies (chi2= 11.22, P= 0.13). Overall, PPI therapy resulted in a nonsignificant symptom reduction compared to placebo (relative risk 1.28, 95% confidence interval 0.94-1.74). No clinical predictors of PPI response were identified on meta-regression analysis done at study level. CONCLUSIONS: PPI therapy may offer a modest, but nonsignificant, clinical benefit over placebo in suspected GERD-related CL. Validated diagnostic guidelines may facilitate the recognition of those patients most likely to respond favorably to PPI treatment