Correcting for Rater Effects in Operating Room Surgical Skills Assessment.

Objective: To estimate and adjust for rater effects in operating room surgical skills assessment performed using a structured rating scale for nasal septoplasty.

Methods: We analyzed survey responses from attending surgeons (raters) who supervised residents and fellows (trainees) performing nasal septoplasty in a prospective cohort study. We fit a structural equation model with the rubric item scores regressed on a latent component of skill and then fit a second model including the rating surgeon as a random effect to model a rater-effects-adjusted latent surgical skill.

Do Attending and Trainee Surgeons Agree on What Happens in the Operating Room During Septoplasty?

Surgeons must select cases whose complexity aligns with their skill set. To determine how accurately trainees report involvement in procedures, judge case complexity, and assess their own skills. We recruited attendings and trainees from two otolaryngology departments.

Quantitative fractography as a novel approach to measure fracture toughness of direct resin composites.

Dental resin composites generally fail from small cracks. Large crack techniques are not representative of in vivo failures. Quantitative fractography relies on the observation of small "natural flaws".

Association Between Surgical Trainee Daytime Sleepiness and Intraoperative Technical Skill When Performing Septoplasty.

Importance: Daytime sleepiness in surgical trainees can impair intraoperative technical skill and thus affect their learning and pose a risk to patient safety.

Objective: To determine the association between daytime sleepiness of surgeons in residency and fellowship training and their intraoperative technical skill during septoplasty.

Design, Setting, And Participants: This prospective cohort study included 19 surgical trainees in otolaryngology-head and neck surgery programs at 2 academic institutions (Johns Hopkins University School of Medicine and MedStar Georgetown University Hospital).

Serotonin Disinhibits a Sensory Neuron by Suppressing Ca-Dependent Negative Feedback.

Neuromodulators, such as serotonin (5-HT), alter neuronal excitability and synaptic strengths, and define different behavioral states. Neuromodulator-dependent changes in neuronal activity patterns are frequently measured using calcium reporters because calcium imaging can easily be performed on intact functioning nervous systems. With only 302 neurons, the nematode provides a relatively simple, yet powerful, system to understand neuromodulation at the level of individual neurons.

Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck.

Background: The current study presents mature results from a Phase III randomized trial comparing radiation therapy and concurrent chemoradiotherapy in patients with resectable American Joint Committee on Cancer Stage III and IV disease.

Methods: One hundred patients were randomized to receive either radiation therapy alone (Arm A) (at a dose of between 66-72 grays [Gy] at 1.8-2 Gy per day) and the identical radiation therapy with concurrent chemotherapy (Arm B) (5-fluorouracil, 1000 mg/m(2)/day, and cisplatin, 20 mg/m(2)/day, both given as continuous intravenous infusions over 4 days beginning on Days 1 and 22 of the radiation therapy).

Diagnosis of papillary carcinoma in a thyroglossal duct cyst by fine-needle aspiration biopsy.

The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst is rare and occurs in about 1 % of thyroglossal duct cysts. Only 17 such cases diagnosed with fine-needle aspiration biopsy have been previously reported in the English-language literature, with a diagnostic rate of 53%. In this article, the cytologic features of the current case are emphasized and those of the previous reported cases are briefly reviewed.

Plasmacytomas of the head and neck.

Plasmacytomas are rare tumors that often appear in the head and neck region and are characterized by a monoclonal proliferation of plasma cells. On both clinical presentation and pathologic examination these tumors may be confused with more common tumors of the head and neck. The purpose of this article is to review our experience with these rare neoplasms, with emphasis on clinical, pathologic, and therapeutic features.

Vagal paraganglioma: a review of 46 patients treated during a 20-year period.

Background: Vagal paragangliomas (VPs) arise from paraganglia associated with the vagus nerve. Approximately 200 cases have been reported in the medical literature. Because of their rarity, most information regarding these tumors has arisen from case reports and small clinical series.

Comparison of surgical complications after organ-preservation therapy in patients with stage III or IV squamous cell head and neck cancer.

Objective: To determine the incidence of minor and major complications in patients with squamous cell carcinoma of the upper aerodigestive tract who require surgical salvage or planned neck dissection after an initial treatment regimen with radiotherapy or concurrent chemoradiotherapy for organ preservation.

Design: The medical records of 100 patients treated in a phase 3 trial comparing radiotherapy alone with concurrent chemoradiotherapy for stage III and IV head and neck squamous cell carcinoma were reviewed. Fifty-four patients underwent 59 surgical procedures.

Extranodal lymphomas of the head and neck. A 20-year experience.

Background: Extranodal non-Hodgkin lymphoma (NHL) of the head and neck is a relatively uncommon disease. Over the last 3 decades, a variety of systems, including the Rappaport, Luke-Collins, and Working Formulation classifications, have been used to classify extranodal NHLs of the head and neck. Most studies have included a relatively small number of patients, used different modalities of therapy, and did not include all head and neck sites.

A phase III randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer: preliminary results.

Background: A phase III randomized comparison of radiotherapy alone versus combination chemotherapy and concurrent continuous-course radiotherapy was performed at the Cleveland Clinic Foundation.

Methods: Between March 1990 and June 1995, 100 patients with resectable stage III and IV squamous cell head and neck cancer were randomized to either Arm A: radiotherapy alone, 68-72 Gy at 1.8-2.

Management of the neck in a randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer.

Background: Treating the neck after organ-preservation treatment with radiotherapy or chemoradiotherapy can be problematic.

Methods: To develop management guidelines, we reviewed the results of a 100-patient phase-3 trial that had compared outcome after radiotherapy alone with outcome after chemoradiotherapy for head and neck cancer. Patients were randomly assigned to receive radiotherapy alone or concurrent chemoradiotherapy.

Cost accounting: toward a measure of truth.

With the reimbursement systems for home care changing and evolving, home care agencies need to be careful in choosing a cost accounting system. There is the traditional system that focuses on compliance, or the cost accounting information system, which caters to the needs of management decision making. Which system is appropriate, and when?

Secondary tracheoesophageal puncture: factors predictive of voice quality and prosthesis use.

Objective: To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy.

Methods: We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions.

Overview of the rectus abdominis myocutaneous flap in head and neck reconstruction.

The functional and aesthetic consequences of ablative head and neck oncologic surgery pose a significant challenge to the reconstructive surgeon. With the advent of microvascular free tissue transfer the reconstructive capabilities of the surgeon have been greatly expanded. The rectus abdominis musculocutaneous free flap has assumed an important role in contemporary head and neck reconstruction because of its ease of dissection, length and size of the vascular pedicle, convenience of harvest in the supine position, reliability and versatility, and low donor site morbidity.

The use of fibrin glue in the healing of skin flaps.

Purpose: To determine whether the use of fibrin glue has an impact on wound drainage created in an animal model.

Materials And Methods: Fibrin glue was prepared from single-donation autologous phlebotomy before surgery. Bilateral skin flaps were raised over the parotid gland in 10 rabbits.

Magnetic resonance imaging and the management of parapharyngeal space tumors.

Objective: The purpose of this study was to evaluate our experience with the diagnosis and management of tumors of the parapharyngeal space (PPS), with particular emphasis on the evolving role of magnetic resonance imaging (MRI).

Methods: A case series review of 51 patients with parapharyngeal tumors who underwent surgical excision between 1980 and 1992 were analyzed with regard to presenting signs and symptoms, histologic diagnosis, imaging technique (computed tomography [CT] versus MRI), surgical approach, and outcome.

Results: Fifty-one patients underwent surgical excision of a parapharyngeal tumor of which the vast majority (78%) were benign neoplasms.

An overview of treatment options for lower airway obstruction.

Effectively treating airway stenosis is a challenging problem for the otolaryngologist-head and neck surgeon. A number of options are available. The most effective management requires an approach that is flexible and individualized for each patient.

Adenomatous lesions of the temporal bone immunohistochemical analysis and theories of histogenesis.

Adenomatous lesions of the temporal bone represent a diverse group of neoplasms. At least three histopathologic patterns have been described: glandular; ribbon-like, or "festooning;" and aggressive papillary. Combinations of glandular and ribbon-like histologies in the same lesion are not uncommon.

Tension pneumocephalus following craniofacial resection.

Background: The craniofacial approach is a reliable method for excising tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and meningitis are well-known complications, tension pneumocephalus is not well described.

The AO system for primary mandibular reconstruction.

We reviewed the records of 27 patients who underwent primary mandibular reconstruction with AO plates to investigate the outcome and complications of this procedure. Immediate soft-tissue flap coverage was required in 26 patients. Early complications were seen in 44% of the patients, with the highest incidence after irradiation (P = 0.

Undifferentiated nasopharyngeal carcinoma presenting as a parotid mass.

Background: Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of cases it may present with serous otitis or cervical metastases. Although the metastases usually occur in the neck, the lymphatic network of the parotid may also serve as a site for the metastatic deposits.

Cricoarytenoid arthritis and ankylosing spondylitis.

A variety of systemic diseases may manifest with laryngeal symptoms. Cricoarytenoid arthritis with or without limitation of vocal fold motion is an example. It has been described in up to 25% of rheumatoid patients.