Andrew C. Urquhart

Hodgkin's and Non‐Hodgkin's Lymphoma of the Head and Neck

Objectives/Hypothesis Lymphomas are a frequent cause of malignant lymphadenopathy in the head and neck. This study was performed to evaluate the head and neck manifestations of lymphomas and to emphasize the different presentations of Hodgkins disease (HD) and non‐Hodgkins lymphoma (NHL).

PCR analysis of nasal polyps, chronic sinusitis, and hypertrophied turbinates for DNA encoding bacterial 16S rRNA.

Background Nasal polyps are considered to result from chronic inflammation, but the initial or persisting stimulus for the inflammation is not known. A variety of bacteria and fungi have been cultured from nasal polyps, but ∼35% have sterile cultures. Previously, Mycoplasma pneumoniae–specific DNA was detected in human nasal polyps using polymerase chain reaction (PCR) techniques, suggesting M. pneumoniae as a causative agent in the etiology of nasal polyps. Methods In this study, we tested for the presence of bacterial DNA in nasal polyps resected from 40 patients, in nasal mucosa membrane from 9 patients undergoing turbinectomy for hypertrophy, and in sinus mucosa membrane from 6 patients undergoing endoscopic surgery for chronic sinusitis. Tissue DNA was extracted and analyzed by PCR using M. pneumoniae specific primers for DNA that encode the 16S rRNA gene in 41 specimens (31 polyps, 6 turbinates, and 4 sinus), and by consensus sequence-based PCR using broad range primers for most eubacterial DNA encoding the 16S rRNA gene in 38 specimens (26 polyps, 7 turbinates, and 5 sinuses). Results Only two samples were positive for bacterial DNA encoding 16S rRNA: Streptococcus sp. DNA was isolated from one polyp specimen and Pseudomonas aeruginosa DNA was isolated in one maxillary sinusitis specimen. No evidence of M. pneumoniae–specific DNA encoding 16S rRNA was found in any of the tissues. Conclusions This study suggests that chronic bacterial infection is not a major component of nasal polyp etiology.

Zenker's diverticulum

Symptomatic Zenkers diverticula are usually treated with diverticulectomy and myotomy. Other, more conservative open procedures consist of diverticulopexy, imbrication, and myotomy alone. These more conservative procedures do not result in a breach of esophageal mucosa and should have more rapid postoperative recovery. We performed a retrospective chart review of all open surgical procedures performed at the Marshfield Clinic and St. Josephs Hospital between 1975 and 1996. Using Wilcoxons rank sum test, the conservative procedures were compared with the standard diverticulectomy for duration of hospitalization and length of time to resumption of oral intake. Fifty‐nine patients are reported. Statistically significant differences between the surgery groups were found for hospitalization ( P < 0.001) and days to resumption of oral intake ( P < 0.001). Conservative open surgical procedures for repair of Zenkers diverticula result in decreased hospitalization and earlier resumption of oral diet compared with diverticulectomy.

Nasal Septum After Sublabial Transseptal Transsphenoidal Pituitary Surgery

Transseptal transsphenoidal approach to the pituitary fossa is a well-described and effective procedure. This article relates our experience with this procedure with specific emphasis on the nasal septum, both before and after surgery. It has been our experience that this surgery has minimal local complications in the nose and it would appear to improve septal alignment with subjective improvement in nasal function as reported by the patient. A total of 55 patients undergoing a sublabial transseptal transsphenoidal approach to the pituitary fossa were included in this study. All other approaches to the pituitary gland were excluded. Visual changes and headaches were the most common presenting symptoms, occurring alone or in combination in 28 (51%) patients. Twelve (22%) patients reported symptoms of nasal obstruction before surgery and only one (2%) after surgery. A moderately or severely deviated septum was noted in 30 (54%) patients before surgery and 4 (7%) patients after surgery. The septum was straight in 21 (38%) patients before the procedure and 49 (89%) patients afer the surgery. Sinusitis developed in two patients, and one patient subsequently required surgery. No synechiae or septal perforations were noted.

Preoperative computed tomography scans for parotid tumor evaluation

Objective We sought to determine whether an advantage is obtained in the routine use of computed tomography (CT) scans in preoperative assessments of parotid tumors.

Thyroid drains and postoperative drainage

OBJECTIVE: To evaluate postoperative drainage in patients undergoing thyroid lobectomy versus total thyroidectomy and to establish a correlation between intraoperative blood loss and postoperative drainage. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Consecutive patients (n = 100) undergoing thyroid surgery from October 2006 through November 2008 were examined. Data collected included age, gender, postoperative drainage, estimated intraoperative blood loss, type of surgery, length of hospital stay, pathology, and postoperative complications. Standard descriptive statistics were used to summarize characteristics of subjects, surgical procedures, and outcomes. Spearman rank correlation was used to evaluate association of drainage with blood loss and Kruskal-Wallis test to compare results by surgery type. RESULTS: There were 100 surgeries performed: 52 lobectomies and 48 total thyroidectomies. Total postoperative drainage ranged from 0 to 230 mL, median was 32 mL. Estimated intraoperative blood loss ranged from 10 to 300 mL, median was 20 mL. We noted a statistically significant association of postoperative drainage with intraoperative blood loss (r = 0.39, P = 0.001), but substantial variability in drainage was observed even among patients with similar blood loss. Although there was significantly less drainage among thyroid lobectomies (P = 0.012), the distributions were quite similar apart from 10 patients (9 lobectomy) with exceptionally low drainage. CONCLUSION: There was a statistically significant association of postoperative drainage with intraoperative blood loss and significantly less postoperative drainage among patients undergoing thyroid lobectomies. However, the observed associations do not appear to be strong enough to accurately predict patients who will experience substantial drainage.

Neck dissections =: Predicting postoperative drainage

Objectives Most head and neck dissections performed in conjunction with carcinomas of the upper aerodigestive tract require drain insertion. The time that the drains remain in place largely determines the duration of postoperative hospitalization. This study sought to retrospectively compare different neck dissections in terms of postoperative drainage and duration of hospitalization. We also sought to identify any correlation between total intraoperative blood loss and postoperative drainage.

Telemedicine—An efficient and cost-effective approach in parathyroid surgery†

To demonstrate the effectiveness and cost benefit of using telemedicine for the postoperative visit in patients undergoing parathyroidectomy for primary hyperparathyroidism.

Head and Neck Melanoma

Wide local excision is the mainstay in the treatment of the primary lesion with consideration given to specific anatomic constraints in head and neck melanoma. Sentinel lymph node biopsy is considered in all lesions with ulceration, mitoses greater than or equal to 1/mm(2), stage1B or higher, and in all high-risk nonmetastatic melanoma. Reconstructive strategy must be considered in multidisciplinary teams with reconstructive surgeons for large head and neck defects.

Distinguishing non-Hodgkin lymphoma from squamous cell carcinoma tumors of the head and neck by computed tomography parameters.

Objective Computed tomography (CT) remains the first‐line imaging procedure for pre‐therapeutic staging of head and neck tumors. Non‐Hodgkin lymphoma (NHL) is not easily distinguished from squamous cell carcinoma (SCC), especially because NHL often appears in extranodal locations. We sought to explore whether specific CT characteristics could be used to distinguish these tumor types.