It is important to keep in mind that the thyroid gland can be a site of metastases for a variety of tumors when evaluating a thyroid nodule, especially in a patient with a prior history of malignancy. In patients with thyroid lesions and a history of malignant disease, regardless of time elapsed since the initial diagnosis of the primary neoplasm, disease recurrence or progression of malignancy must be considered until proven otherwise.

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IMPORTANCE Opioid misuse and overuse has become an epidemic. Chronic opioid use among oral cavity cancer patients after surgery has not been described. OBJECTIVES To assess the prevalence of chronic opioid use in patients undergoing surgery for oral cavity cancer, and evaluate possible associated clinical factors; and the association between opioid use and survival. DESIGN, SETTING, AND PARTICIPANTS For this retrospective cohort study of patients undergoing surgery for oral cavity cancer a consecutive sample of 99 patients between January 1, 2011, and September 30, 2016, were identified through the institutional cancer registry from a single academic center. EXPOSURES Surgery for oral cavity cancer. MAIN OUTCOMES AND MEASURES Chronic opioid use, defined as more than 90 days from surgery. Factors associated with chronic opioid use were investigated by univariable and multivariable logistic regression. The Kaplan-Meier method and Cox proportional hazards model were used to assess overall survival and disease-free survival. RESULTS The mean (SD) patient age was 62.6 (14.3) years; 60 patients (60%) were male. Chronic opioid use was observed in 41 patients (41%). On multivariable logistic regression, preoperative opioid use (odds ratio [OR], 5.6; 95% CI, 2.2-14.3), tobacco use (OR, 2.8; 95% CI, 1.0-8.0), and development of persistence, recurrence, or a second primary tumor (OR, 2.8; 95% CI, 1.0-7.4) were associated with chronic opioid use. Among preoperative opioid users, estimated overall survival (hazard ratio [HR], 3.2; 95% CI, 1.4-7.1) was decreased, and chronic opioid use was associated with decreased disease-free survival (HR, 2.7; 95% CI, 1.1-6.6). CONCLUSIONS AND RELEVANCE In patients undergoing surgery for oral cavity tumors, the prevalence of chronic opioid use was considerable. Preoperative opioid use, tobacco use, and development of persistence, recurrence, or a second primary tumor were associated with chronic opioid use after surgery, and both preoperative and chronic opioid use were associated with decreased survival.

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ABSTKACT : Acanthamoebu sp. take up polystyrene and polyvinyltoluene latex beads. There appear to be no requirements for specific organic molecules for uptake providing the appropriate osmotic conditions are maintained. This requirement can be satisfied by glucose, mannitol, inulin, or proteose-peptone. The proper osmolarity depends on the previous history of the amoebas and they can adapt to an unfavorable osmolarity. Uptake is inhibited by 2 X M dinitrophenol, 2 x M cyanide, and 2 X M azide but not by 4 x 10-2 M fluoride or 2 X M iodoacetate. Uptake is optimal at 30-35". A quantitative measure of bead uptake has been developed by application of the dioxane extraction method of J. Roberts and J. H. Quastel (Biochem. J . 89, 150 (1963)). The rate of uptake was found to be a linear function of the time of incubation and the concentration of cells over a broad pH range. Once taken in, beads are retained by amoebae for at least 4.5 hr. The rates of uptake of each of six different size beads (0.126-2.68 p) were directly proportional to the concentration of beads;