Prophylactic total thyroidectomy using the minimally invasive video-assisted approach in children with multiple endocrine neoplasia type 2.

BACKGROUND: There have been few reports of prophylactic thyroidectomy using the minimally invasive video-assisted thyroidectomy (MIVAT) approach in children with multiple endocrine neoplasia 2 (MEN2). METHODS: We conducted a retrospective review of a prospectively maintained database of patients who underwent MIVAT for total thyroidectomy. RESULTS: Six children underwent MIVAT; RET codon mutations identified were 634, 620, 611, and 918. Mean operative time was 93 minutes (range, 68-105 minutes). Five patients were discharged on the first postoperative day; however, 1 patient had a postoperative hematoma and was discharged 2 days postoperatively. There were no cases of laryngeal nerve palsy or postoperative hypoparathyroidism. High levels of satisfaction with postoperative cosmesis were reported. Calcitonin levels have been undetectable at follow-up thus far (mean follow-up, 42.8 months). CONCLUSION: Although our outcomes are similar to those reported using the traditional approach, it is important to note that MIVAT is essentially the same operation, just performed through a smaller incision, with resulting benefits in terms of pain, cosmesis and, perhaps, morbidity.

Human papillomavirus-associated oral intraepithelial neoplasia.

This study evaluated an unusual subset of oral epithelial dysplasia for the presence of transcriptionally active high-risk HPV subtypes and to further characterize the histological criteria for this condition. There were 20 cases diagnosed as epithelial dysplasia with marked apoptosis of the anterior oral cavity. Clinical and follow-up data were collected and histopathological features were documented. Immunoperoxidase studies were performed for p16 and in situ hybridization studies were performed for low- and high-risk HPV sub-types. Gender- and site-matched controls of conventional moderate-to-severe oral epithelial dysplasia were similarly evaluated using immunoperoxidase studies for p16 and in situ hybridization; the number of apoptotic cells for study and control cases was counted at two different tissue sites. There were 17 men and 3 women with a median age of 56 years. Seventeen lesions were described as white and five were described as rough or papillary. Thirteen were located on the lateral or ventral tongue, some extending onto the floor of the mouth. Epithelial hyperplasia with marked karyorrhexis and apoptosis were present in all the cases, along with features of conventional oral epithelial dysplasia. A statistically significant number of apoptotic cells were identified in the study cases when compared with controls (P>0.0001). Twenty cases were positive for high-risk HPV by in situ hybridization and all 19 nineteen cases evaluated for p16 demonstrated overexpression. Two patients were diagnosed with squamous cell carcinomas and one patient developed recurrent disease. We report a subset of oral epithelial dysplasia that occurs mostly in adult men on the ventral or lateral tongue and is positive for high-risk HPV and for p16. We propose use of the term 'HPV-associated Oral Intraepithelial Neoplasia' to characterize these lesions of the oral cavity for consistency in nomenclature with HPV-associated lesions of the lower anogenital tract. One case recurred and one developed invasive cancer.

Role of positron emission tomography--computed tomography in head and neck cancer.

Head and neck squamous cell carcinoma (HNC) is the sixth most common cancer worldwide. In the United States, it accounts for approximately 2% of all cancers and 2% of cancer deaths. The introduction of integrated positron emission tomography and computed tomography (PET/CT) has revolutionized imaging by permitting improved and more accurate anatomic localization of functional abnormalities in the complex territory of the head and neck region, and PET/CT has become a standard clinical imaging modality in patients with HNC. The main indications for PET/CT in HNC are in pretherapy staging, detection of unknown primaries, and monitoring of therapy response or disease surveillance. Although PET/CT is a promising tool in diagnosis and surveillance of HNC, there is lack of consensus as to its use, accuracy, and implications for patient management. The existing literature on the role of PET/CT in the management of HNC is reviewed, and a summary of the current debate is provided. Second primary cancers are the main cause of death among HNC patients with early disease, and the presence of distant metastases greatly impairs the survival of patients with advanced HNC. Therefore, early detection of second primary and metastatic tumors is imperative for optimizing survival outcome. However, given the lack of randomized, prospective trials addressing the role of PET/CT after chemoradiotherapy, the ideal function of PET/CT in disease surveillance has yet to be defined.

Computed tomography scans of paranasal sinuses before functional endoscopic sinus surgery.

This review aims to familiarize the radiologist with the common types of sinus surgery including their indications and techniques. We also illustrate how surgeons interpret 3D sinus anatomy when evaluating computed tomography (CT) studies. Preoperative evaluation by CT is mandatory for all patients undergoing functional endoscopic sinus surgery (FESS). In the past decade in particular, CT of the paranasal sinuses has become a roadmap for FESS. The radiologist's goal is to report on five key points: the extent of sinus opacification, opacification of sinus drainage pathways, anatomical variants, critical variants, and condition of surrounding soft tissues of the neck, brain and orbits. We present a systematic approach to the use of coronal, axial, and sagittal images in CT evaluation before FESS.

Otolaryngology and Irish literature: an important medico-literary alliance.

For a comparatively small island, Ireland has made a disproportionately large contribution to world literature in all its aspects. The literary lineage of those who pursue medicine and also write is long and well established. The Irish contribution to world literature in all its aspects is well documented. Less explored, however, is the prominent influence of Dublin-based otolaryngologists in the Irish literary movement at the turn of the last century. Here, we examine two such figures, Sir William Wilde and Oliver St. John Gogarty, and their pivotal roles both professionally and in establishing Ireland on the world's literary stage. During the early part of the 1800s, otology was perceived as a defunct subspecialty that could be adequately managed, without much expertise, in the primary care setting. It was through the efforts of William Wilde and others that otology gained clinical and scientific credence during the latter half of the 19th century.