Expression levels of miR-34-family microRNAs are associated with TP53 mutation status in head and neck squamous cell carcinoma.

PURPOSE: The majority of head and neck squamous cell carcinoma (HNSCC) cases in developing countries are associated with cigarette smoking and TP53 mutations. p53 is a transcription factor that activates downstream genes, including the hsa-miR-34a and hsa-miR-34b/c loci, to achieve cell-cycle arrest, senescence, and/or apoptosis. This study examined the differences in expression levels of miR-34 in HNSCC with or without TP53 mutations. METHODS: We examined surgically resected tumor samples and normal adjacent tissues from HNSCC in oral cavity, larynx, and hypopharynx for TP53 mutations (exons 5-8) and miR-34 expression levels. RESULTS: miR-34a, miR-34b, miR-34b*, and miR-34c are significantly up-regulated in tumors with wild-type TP53 genes (n = 23); while such up-regulation is not observed in tumors with mutant TP53 (n = 19). Although expression levels of miR-34-family miRNAs do not correlate with gender, age, or tumor staging, interestingly they are correlated with smoking status and tumor sites. miR-34b/b*/c are up-regulated in tumors from those who ever smoked or recently smoked (quit smoking less than 15 years ago); but such up-regulation was not seen in those who never smoked or quit smoking for at least 15 years. HNSCC of the oral cavity also up-regulated miR-34b/b*/c while no such overexpression was observed in HNSCC of the larynx and hypopharynx. CONCLUSIONS: Surgically resected HNSCC samples with no TP53 mutations have elevated levels of miR-34a and miR-34b/b*/c, while those with TP53 mutations show no such up-regulation. miR-34b/b*/c expression is also correlated with smoking status and tumor sites.

Hypothyroidism after Hemithyroidectomy: The Incidence and Risk Factors.

OBJECTIVE: To evaluate the incidence of post-hemithyroidectomy hypothyroidism and identify possible risk factors that indicates whether patients require thyroid function monitoring after surgery. MATERIAL AND METHOD: A retrospective review of patients with benign non-toxic thyroid disease undergoing hemithyroidectomy between April 2004 and November 2008 in the Department of Otorhinolaryngology, Siriraj Hospital was conducted All patients were in euthyroid state preoperatively. Thyroid specimens were examined for pathological diagnosis and degree of lymphocytic infiltration in thyroid tissue, and thyroid function was evaluated again six weeks after surgery. RESULTS: One hundred patients who received hemithyroidectomy were recruited for the present study. All had normal preoperative thyroid function. Six weeks after surgery, 27% of the cases developed hypothyroidism (6% overt or symptomatic hypothyroidism and 21% subclinical hypothyroidism). The mean preoperative thyrotropin level was significantly higher in the hypothyroid group than in the euthyroid group (1.9±1.2 vs. 1.1±0.7 micro IU/ml). Fifty-eight point three percent of patients with preoperative thyroid stimulating hormone (TSH) level more than or equal 2 micro IU/ml developed hypothyroidism in comparison to only 17.1% of those with preoperative TSH <2 micro IU/ml (odds ratio 6.8). Fifteen patients had signifcant lymphocytic infiltration (grade 2-4); nine of those (60%) had post-operative hypothyroidism. In contrary, only 18 of 85 patients (21.2%) with minimal infiltrates (grade 0-1) developed hypothyroidism (odds ratio 5.6). CONCLUSION: Twenty-seven percent of the patients in the present study developed hypothyroidism after hemithyroidectomy. Preoperative TSH more than or equal 2 micro IU/ml and significant lymphocytic infiltration in thyroid tissue or thyroiditis warrant post-operative close TSH monitoring. The awareness of such risk factors for post-operative hypothyroidism would improve patients care.

Central Neck Lymph Node Size Measured by Ultrasound Significantly Predicts Central Neck Lymph Node Metastasis of Papillary Thyroid Carcinoma.

Objective: The aim of this study was to investigate whether Central lymph node (CLN) size as measured by an ultrasound can significantly predict CLN metastasis of papillary thyroid carcinoma (PTC). Materials and methods: This retrospective chart review of patients diagnosed with PTC who underwent ultrasound and central neck dissection (CND). We excluded patients who received previous thyroid surgery or radiation. We analyzed the correlation between CLN size and characteristics by ultrasound and histopathologic findings among positive CLN patients. Results: Of the 48 patients who underwent preoperative ultrasound and CND, 34 patients had positive CLN identified by ultrasound. The positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of ultrasound in this diagnostic setting was 88.0%, 21.0%, 73.2%, 42.9%, and 68.7%, respectively. The risk of CLN metastasis of PTC was 67.7% and 85.7% for lymph node size 3.1 to 4 mm and 4.1 to 5 mm, respectively. The risk increased to 100% when the lymph node size was >5 mm. Positive preoperative ultrasound of lateral neck lymph node was found to be a significant risk factor for CLN metastasis (P = .003). Conclusion: Ultrasound was found to be an effective preoperative evaluation in patients with PTC to determine the likelihood of CLN metastasis and whether CND is indicated, especially in the ultrasound-positive central lymph node. A high risk of metastasis was found in CLN size >3 mm by ultrasound, and the risk dramatically increased in CLN size >5 mm. We also found positive lateral neck node from preoperative ultrasound to be a significant risk factor for CLN metastasis.

Acoustic Characteristics of Voice Before and After Endoscopic Partial Laryngectomy in Early Glottic Cancer.

OBJECTIVES: To evaluate the voice changes after narrow-margin endoscopic partial laryngectomy in subjects with T1N0M0 glottic cancer. STUDY DESIGN: Uncontrolled retrospective comparison of preoperative and postoperative mean phonation time; fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio; and voice-related quality of life (V-RQOL) survey scores. METHODS: Seventeen adults diagnosed with T1N0M0 glottic cancer who underwent narrow-margin endoscopic partial laryngectomy were included. All subjects had preoperative and postoperative acoustic evaluation and V-RQOL scores. Subjects were separated into three groups based on age and depth of resection. Group A (mean age, 52 years) consisted of seven subjects who underwent superficial resection (superficial layer of lamina propria) and were younger than 60 years. Group B (mean age, 76 years) consisted of six subjects who were older than 60 years and underwent superficial resection (superficial layer of lamina propria). The four subjects in group C were older than 60 years and underwent deep resection (into the vocal ligament and/or into the thyroarytenoid muscle). RESULTS: There was a statistically significant improvement in V-RQOL in group A. The acoustic measures did not change after surgery (no P<0.05). CONCLUSION: For early-stage cancer, patients younger than 60 years and superficial resection of cancer are predictive for better voice.

Foreign bodies injuries in children: analysis of Thailand data.

OBJECTIVES: Suffocation due to foreign bodies (FB) is a leading cause of death in children aged 0-3 and it is common also in older ages, up to 14 years old. Based on the RPA report the estimated number of incidents per year in children aged 0-14 is in European Union (EU) of approximately 50,000, 10% of which are fatal. The need of an improvement of knowledge led to the development of the pan European study ESFBI (European Survey on Foreign Bodies Injuries) that collected data on FB injuries in the aerodigestive tract in paediatric patients from 19 European Hospitals (Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Germany, Greece, Italy, Poland, Romania, Slovakia, Slovenia, Spain, Sweden, Swiss, Turkey and United Kingdom). Recognizing that the rapid management is one of the main goals in the presence of such injury the aim of this paper is to confront data coming from 4 ESFBI case series with a Thailand's case series, in order to broaden the knowledge on FBs injuries characteristics, knowing that features like shape, dimension, consistency are fundamental in determine the consequences that might occur. METHODS: Data coming from the Siriraj Hospital, Thailand from June 2006 to 2010 were collected and compared with 4 case series chosen amongst the ESFBI study cases (Finland, Slovenia, Sweden and Turkey). RESULTS: 172 cases were collected from the Siriraj Hospital in Bangkok, Thailand. The chosen ESFBI members were Finland, Sweden, Slovenia and Turkey, with a sample numerosity respectively of 307, 235, 104 and 196 cases. All countries showed a male prevalence higher than the female one, and injuries occurred most frequently in children younger than 3 years old. The most frequent retrieval location was the digestive system (oesophagus) in Thailand data (97 cases, 56.40% of cases), whilst European cases involved more frequently the nose in Slovenia (58.65%), Finland (37.79% of cases) and Sweden (54.47%). In Turkey's case series, the highest prevalence of cases interested the airways. In Thailand and Finland case series, the main FB's type were represented by bones (respectively 66 case, 38.37% and 48 cases, 15.64%), whilst pearl, ball and marble were the most frequent FB both in Slovenia (16, 15.38%) and Sweden (83, 35.32%). Turkey case series had nuts, seeds and grain as most prevalent FB (126, 64.29%). CONCLUSIONS: The nature of foreign bodies varies from country to country and is dependent on diverse cultural, social, religious and economic factors that include parental attitudes, eating habits, availability and types of potentially threatening objects, and prevention strategies. The need to study in more depth specific characteristics of foreign bodies associated with increased hazard, such as nature, size, shape, hardness or firmness, lubricity, pliability and elasticity, in order to better identify risky foods and to describe more precisely the pathogenetic pathway is therefore a necessity.