Alfred A. Simental

Minimally Invasive Video-Assisted Thyroidectomy A Multi-institutional North American Experience

OBJECTIVE To report the results of a multi-institutional experience with the minimally invasive video-assisted thyroidectomy, which was conceived in Europe and Asia and has only recently been embraced in the United States. DESIGN Prospective, nonrandomized analysis. SETTING Four academic thyroid surgical practices. PATIENTS Consecutive series of 228 patients who required thyroid surgery and were deemed at surgeon discretion to be eligible for a minimal access surgery. INTERVENTIONS Minimally invasive video-assisted thyroidectomy was performed in 216 patients. MAIN OUTCOME MEASURES The data, which were recorded prospectively, included age, sex, indication for surgery, incision length, and complications of surgery. RESULTS Because conversion to an open approach was required in 12 of the 228 patients, the study group comprised 216 patients (25 men and 191 women; mean [SD] age, 44.5 [14.1] years). There were no hematomas and no cases of permanent hypoparathyroidism or permanent vocal cord paralysis. Nine patients had a transient vocal cord paresis (3.2% of nerves at risk); 5 patients experienced temporary hypocalcemia (8.1% of total thyroidectomies); 1 patient reported a change in voice pitch; and 1 patient required a scar revision. CONCLUSIONS Use of the minimally invasive video-assisted thyroidectomy technique has been adopted cautiously in the United States. The safety of the procedure represented by the data from this multi-institutional experience would support its expanded adoption by high-volume thyroid surgeons.

Cervical Metastasis From Squamous Cell Carcinoma of the Maxillary Alveolus and Hard Palate

Objectives: Squamous cell carcinoma has a predilection for regional lymphatic metastasis. The occurrence of occult cervical metastases from squamous cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed many patients who have returned after resection of a primary cancer in these sites with a delayed cervical metastasis. Some of these patients have died of regional or distant metastasis despite control of their primary cancer.

Minimally invasive video-assisted thyroidectomy: A retrospective study over two years of experience

Objective: The minimally invasive video-assisted thyroidectomy technique has slowly gained acceptance. Previous studies have reported advantages of better cosmetic results and faster postoperative recovery. We report preliminary results from our single assistant technique over the initial two years of inception at an academic training center. Methods: This study consists of a retrospective chart review of 172 cases between May 2005 and September 2007. All cases started as video-assisted thyroidectomy were included. Demographic, pre- and postoperative clinical data, imaging results, and hospital stay were collected. Results: Acceptable data were available for 24 male and 148 female patients who underwent the video-assisted procedure. Five cases were converted to the conventional thyroidectomy. Of the 172 cases, 60 total thyroidectomies and 112 hemithyroidectomies were performed, with 37 cases of malignancy. The average hospitalization was 1.43 days with mean incision length was 3.51 cm, mean surgical time of 91.37 minutes, and mean blood loss of 31 cc. Transient voice problems were noted in 10 patients. Conclusion: We found statistically improved operative times, hospital stay, and blood loss the first 2 years with a low rate of temporary complications. It appears that minimally invasive video-assisted thyroidectomy is a safe and feasible option to standard thyroidectomy in selected patients.

A Prospective Assessment of Nasopharyngolaryngoscope Recording Adaptor Use in Residency Training

Flexible fiberoptic nasopharyngolaryngoscope (FN) examinations are important to the practice of otolaryngology (ENT). We sought to assess whether a portable recording adaptor for the FN can enhance resident learning and improve patient management. The adaptor was used prospectively on consultations by first- and second-year ENT residents, and changes in diagnosis and management were recorded in the patient care workflow. In 43 patients, we found a 23% change in diagnosis, 44% change in management, and 19% change in surgical management after an attending reviewed recorded videos. Residents and attendings reported that discussing the video enhanced learning in 88% and 81% of cases, respectively. A portable FN recording adaptor has the potential to improve resident training and perhaps lead to more prompt health care delivery.

Linifanib (ABT-869), enhances cytotoxicity with poly (ADP-ribose) polymerase inhibitor, veliparib (ABT-888), in head and neck carcinoma cells.

OBJECTIVES PARP inhibitors (PARPi) may provide an opportunity to gain selective killing of tumor cells which have deficiencies in cellular DNA repair systems. We previously demonstrated linifanib (ABT-869), a multi-receptor tyrosine kinase inhibitor of VEGF and PDGF receptor families, radiosensitized Head and Neck Squamous Cell Carcinoma cells (HNSCC) via inhibiting STAT3 activation. Given that STAT3 can modulate DNA damage response (DDR) pathway, in this study, we evaluate the effects of linifanib to enhance cytotoxicity with the PARPi, veliparib (ABT-888), in HNSCC. MATERIALS AND METHODS UMSCC-22A and UMSCC-22B cells were treated with linifanib (ABT-869) and veliparib (ABT-888). Cell viability, cytotoxicity, apoptosis induction, DNA single strand break (SSB) and double strand break (DSB) damages were examined by MTT assay, colony formation assay, flow cytometry and comet assay. In addition, the expression of DNA homologous recombination repair protein Rad51, γH2AX, a double strand break marker and cleaved PARP, an apoptotic cell death marker, were assessed using western immunoblotting. RESULTS Combination treatment resulted in more cell growth inhibition, induction of apoptosis, DNA damages and double strand breaks, lower expression of Rad51, increase γH2AX expression and PARP cleavage. CONCLUSION These data suggest the possibility of combining targeted therapeutic such as linifanib with veliparib to augment the inhibition of cell growth and apoptosis via synthetic lethality in HNSCC cells. Thus, it may provide a novel therapeutic strategy and improve efficacy and outcome in HNSCC.

Management of Mucocele and Ranula

Epidemiology of mucoceles and ranulas. Anatomy of the minor salivary, sublingual and submandibular glands. Pathophysiology of mucocele and ranula formation. Clinical findings of mucoceles and ranula. Management of mucoceles and ranula. Surgical procedure for mucocele, ranula, and plunging ranula. Complications of surgical treatment of mucocele and ranula.

Lipopolysaccharide and Curcumin Co-Stimulation Potentiates Olfactory Ensheathing Cell Phagocytosis Via Enhancing Their Activation.

The gradual deterioration following central nervous system (CNS) injuries or neurodegenerative disorders is usually accompanied by infiltration of degenerated and apoptotic neural tissue debris. A rapid and efficient clearance of these deteriorated cell products is of pivotal importance in creating a permissive environment for regeneration of those damaged neurons. Our recent report revealed that the phagocytic activity of olfactory ensheathing cells (OECs) can make a substantial contribution to neuronal growth in such a hostile environment. However, little is known about how to further increase the ability of OECs in phagocytosing deleterious products. Here, we used an in vitro model of primary cells to investigate the effects of lipopolysaccharide (LPS) and curcumin (CCM) co-stimulation on phagocytic activity of OECs and the possible underlying mechanisms. Our results showed that co-stimulation using LPS and CCM can significantly enhance the activation of OECs, displaying a remarkable up-regulation in chemokine (C-X-C motif) ligand 1, chemokine (C-X-C motif) ligand 2, tumor necrosis factor-α, and Toll-like receptor 4, increased OEC proliferative activity, and improved phagocytic capacity compared with normal and LPS- or CCM-treated OECs. More importantly, this potentiated phagocytosis activity greatly facilitated neuronal growth under hostile culture conditions. Moreover, the up-regulation of transglutaminase-2 and phosphatidylserine receptor in OECs activated by LPS and CCM co-stimulation are likely responsible for mechanisms underlying the observed cellular events, because cystamine (a specific inhibitor of transglutaminase-2) and neutrophil elastase (a cleavage enzyme of phosphatidylserine receptor) can effectively abrogate all the positive effects of OECs, including phagocytic capacity and promotive effects on neuronal growth. This study provides an alternative strategy for the repair of traumatic nerve injury and neurologic diseases with the application of OECs in combination with LPS and CCM.

Subpopulations of cancer stem cells found in papillary thyroid carcinoma

&NA; Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer and while it has a generally good prognosis, tumor recurrence remains a major clinical challenge. Studying laboratory cell lines as well as clinical specimens indicate that PTC may follow the cancer stem cell (CSC) model. However, CSC characteristics relevant in PTC initiation and progression remain largely unknown. Here we studied a population of sphere‐growing tumor cells isolated from primary cultures of clinical PTC. These sphere‐growing cells consisted of aldehyde dehydrogenase positive (ALDH+) and ALDH negative (ALDH‐) cell subpopulations and demonstrated a hierarchical pattern of cell division. Using combinations of selective depletion, specific inhibition and cell sorting, we found that both subpopulations of the sphere cells were able to self‐renew and initiate xenograft tumors independently, and fulfilled the definition of CSC. Importantly, when the subpopulations functioned together, the cancer‐initiation efficiency and the xenograft tumor progression were significantly enhanced compared to either subpopulation alone. These data revealed crucial roles of ALDH‐ CSC in PTC biology and suggested that CSC subpopulations function cooperatively to control PTC initiation and progression. Together, our study indicates that CSC subpopulations isolated from clinical specimens offer unprecedented opportunities for investigating PTC pathogenesis and developing effective therapies.

Proteomic Profiling of Tumor Exosomes

Abstract Exosomes contain various molecular constituents of their cells of origin, including proteins and nucleic acid material. Exosomes have been isolated from blood, urine, saliva, synovial fluid, breast milk, cerebrospinal fluid, and various other body fluids and are also secreted by most cell types in culture. Although the exosomal protein content varies with the cell of origin, most exosomes contain an evolutionary-conserved common set of protein molecules detected by mass spectrometry. Heat shock proteins, CD63, and tetraspanins are the most prominent evolutionary-conserved proteins in exosomes. Cytoskeleton- and metabolism-related proteins form the pool of other frequently found proteins. Exosomes also contain proteins that are involved in cell signaling pathways, apoptotic pathways, and evasion of metastasis. The existence of these multifaceted proteins in tumor exosomes and its sources, isolation techniques and its association with cancer development, sustenance, and drug resistance is further expanded in different cancer types in this chapter.

Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review

Thyroid disease occurs more frequently in patients with hyperparathyroidism than the general population and hinders parathyroid localization. Identifying thyroid pathology before operating improves management and avoids the risks of reoperation in the neck. This review assesses imaging studies in patients with hyperparathyroidism and thyroid pathology to identify the ideal imaging methodology for patients with multigland disease.