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1.
Tissue Eng Part A ; 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32640938

RESUMO

Craniofacial reconstruction of critical bone defects typically requires a bone graft. As graft availability may be restricted by disease or co-morbidities, tissue engineering approaches are actively sought. The pericranium could provide new bone graft material. During development and repair, bone transitions through a chondrogenic phase. However, with tissue engineering pluripotent cells can differentiation directly into bone cells. Does ability to recapitulate bone formation in vitro affect osteogenesis and vascularization of pericranium grafts? To answer this, we obtained tissue from nine patients with pre-planned craniotomy surgery and studied 3D osteogenesis and angiogenesis of pericranium-derived spheroids. First, we established growth and differentiation conditions on Matrigel. For each spheroid sample we investigated a) continuous osteogenic differentiation (COD), and b) osteogenic differentiation preceded by chondrogenesis (CDOD). The effect of VEGF was compared to VEGF supplemented with FGF, IL-1, IL-6, PDGF, and TNF-α, a growth factor mix (GFM) with possible synergistic effects. In this limited sample we observed no age or sex-related differences in cell expansion. Similarly, no statistically significant differences in osteogenic or angiogenic scores between COD or CDOD spheroids were noted with regular media. In COD however, VEGF statistically significantly increased angiogenesis compared to control media (p=0.007)). Also in COD, both VEGF and VEGF+GFM increased osteogenesis (p=0.047 and p=0.038, respectively). By contrast, in CDOD neither VEGF nor VEGF+GFM yielded statistically significant angiogenesis or osteogenesis scores compared to control media. To understand these results we characterized spheroid protein expression by nano-liquid chromatography coupled to tandem mass spectrometry (nLC-MS/MS). Nine angiogenic proteins were either uniquely expressed or upregulated in COD compared to CDOD: a) endothelial markers JUP, PTGIS, PTGS2, and TYMP, b) tissue remodeling factors CHI3L1 and MMP14, and c) metabolic pathways modulators ANGPTL4, ITGA5, and WNT5A. ANGPTL4, ITGA5, PTGIS, PTGS2, WNT5A define a conserved angiogenic network and were >2 fold increased in VEGF compared to VEGF+GFM. Finally, we examined bone formation on printable poly-(propylene-fumarate) (PPF) scaffolds for individualized grafting. Under COD+VEGF conditions, PPF scaffolds loaded with PDCs displayed hallmarks of spongiform-like bone formation. Thus, the human pericranium may be a potential repository for bone-generating cells with applications in craniofacial bone repair using tissue printing.

2.
Laryngoscope ; 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32413165

RESUMO

OBJECTIVES: To describe pain experience and opioid use after major head and neck reconstructive surgery. STUDY DESIGN: Retrospective cohort study. METHODS: Patients undergoing major head and neck surgery with microvascular free tissue transfer (free flaps) at a tertiary academic center were included. Pain scores (0-10) and demographic and clinical data were ascertained from medical records. Discharge opioid prescriptions and refills obtained within 30 days were recorded. Patient characteristics were compared with pain scores using nonparametric rank-sum tests and with likelihood of refill using logistic regression models to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: The study population comprised 445 patients. Median age was 60 years (interquartile range 50-68). Most patients had cancer (N = 350, 78%). The majority of free flaps were fibula (N = 153, 34%) or radial forearm (N = 159, 36%). Older patients reported significantly lower pain scores, whereas patients with opioid tolerance, anxiety, current smokers, and those undergoing larger volume resections or boney free flaps reported significantly higher pain scores. One-quarter (N = 115, 26%) of patients obtained opioid refills. Patients aged ≥ 60 years had one-half the odds of obtaining a refill compared with patients aged < 60 years (adjusted odds ratio [aOR] = 0.52, 95% confidence interval [CI] = 0.33-0.84), whereas surgical defect volume ≥ 100 cm3 (aOR = 1.92, 95% CI = 1.21-3.07) and higher pain score (aOR = 1.19, 95% CI = 1.07-1.32 per 1 point increase) increased the odds of refill. CONCLUSION: Continued opioid use after discharge is common among patients undergoing major head and neck reconstruction, particularly for younger patients and after more extensive surgery. Older patients reported lower pain intensity and were less likely to obtain opioid refills, highlighting the wisdom of judicious opioid use for this vulnerable population. LEVEL OF EVIDENCE: IV Laryngoscope, 2020.

3.
BMJ ; 369: m718, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349978

RESUMO

Head and neck structures govern the vital functions of breathing and swallowing. Additionally, these structures facilitate our sense of self through vocal communication, hearing, facial animation, and physical appearance. Loss of these functions can lead to loss of life or greatly affect quality of life. Regenerative medicine is a rapidly developing field that aims to repair or replace damaged cells, tissues, and organs. Although the field is largely in its nascence, regenerative medicine holds promise for improving on conventional treatments for head and neck disorders or providing therapies where no current standard exists. This review presents milestones in the research of regenerative medicine in head and neck surgery.


Assuntos
Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Otolaringologia/tendências , Procedimentos Cirúrgicos Reconstrutivos/tendências , Medicina Regenerativa/tendências , Tecidos Suporte , Bioengenharia , Transplante de Células/métodos , Transplante de Células/tendências , Cóclea , Cartilagem da Orelha , Ossos Faciais , Humanos , Laringe , Cartilagens Nasais , Procedimentos Cirúrgicos Reconstrutivos/métodos , Glândulas Salivares , Crânio , Engenharia Tecidual/métodos , Engenharia Tecidual/tendências , Traqueia , Membrana Timpânica
4.
Laryngoscope ; 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32368799

RESUMO

INTRODUCTION: Patients who become severely ill from coronavirus disease 2019 (COVID-19) have a high likelihood of needing prolonged intubation, making tracheostomy a likely consideration. The infectious nature of COVID-19 poses an additional risk of transmission to healthcare workers that should be taken into consideration. METHODS: We explore current literature and recommendations for tracheostomy in patients with COVID-19 and look back at previous data from severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), the virus responsible for the SARS outbreak of 2003. RESULTS: Given the severity and clinical uncertainty of patients with COVID-19 and the increased risk of transmission to clinicians, careful consideration should be taken prior to performing tracheostomy. If tracheostomy is performed, we recommend a bedside approach to limit exposure time and number of exposed personnel. Bronchoscopy use with a percutaneous approach should be limited in order to decrease viral exposure. CONCLUSION: Thorough preprocedural planning, use of experienced personnel, enhanced personal protective equipment where available, and a thoughtful anesthesia approach are instrumental in maximizing positive patient outcomes while successfully protecting the safety of healthcare personnel. Laryngoscope, 2020.

5.
J Oral Pathol Med ; 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449549

RESUMO

BACKGROUND: Buccal squamous cell carcinoma (SCC) is a locoregionally aggressive malignancy, representing a small subset of oral cancers in North America. We investigated the prognostic value of several clinicopathologic factors in a cohort of patients diagnosed with buccal SCC. METHODS: Between years 1992 and 2017, 52 patients were diagnosed with conventional buccal SCC. Archival surgical pathology material was retrospectively reviewed for reportable findings according to the latest reporting guidelines published by the College of American Pathologists. Clinical data were obtained through chart review. RESULTS: The majority of patients were of older age, current or past smokers, and without specific gender predilection. Most presented at a clinically advanced stage and were treated with surgery alone, or surgery followed by adjuvant radiotherapy. The tumor recurred in about 40% of patients, and almost half of the patients died from the disease by the end of the follow-up period. The worst pattern of invasion (WPOI) was associated with greater depth of invasion (DOI) (P = .031) and perineural invasion (P < .001). In univariate analyses, older age (P = .004), positive nodal status (P = .047), lymphovascular invasion (P = .012), perineural invasion (P = .05), and WPOI-5 (P = .015) were adverse predictors of 5-year overall survival (OS). In multivariate analysis, older age (P = .011), WPOI-5 (P < .001), and perineural invasion (P = .001) remained statistically significant independent prognosticators of worse 5-year OS. CONCLUSIONS: Older age, WPOI-5, and perineural invasion are significant prognosticators of worse OS. WPOI is associated with DOI, a finding which may have important implications for the pathogenesis and biologic behavior of the disease.

6.
Otolaryngol Head Neck Surg ; : 194599820915529, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32312161

RESUMO

OBJECTIVES: Clinical variables affecting anesthetic recovery following transoral robotic surgery (TORS) to resect oropharyngeal squamous cell carcinoma have not been described. We aimed to explore risk factors associated with prolonged postanesthesia recovery following TORS. STUDY DESIGN: Retrospective case-control study. SETTING: Tertiary referral center, January 2010 to November 2016. SUBJECTS AND METHODS: Patients included adults undergoing primary TORS ± neck dissection for oropharyngeal squamous cell carcinoma. Patients were categorized by phase I recovery time into the "goal" recovery group (75th percentile [lower 3 quartiles], n = 272) and the "prolonged" recovery group (n = 91). Univariate and multivariate logistic regression analyses were performed to assess the associations between clinical characteristics and prolonged phase I recovery. RESULTS: A total of 363 patients were included. Median (interquartile range) duration of postanesthesia recovery was 1.5 hours (1.0-2.0). Prolonged recovery was associated with isoflurane (odds ratio, 2.83 [95% CI, 1.56-5.14], P < .001), midazolam (2.77 [1.50-5.12], P = .001), and larger opioid doses (1.26 [1.01-1.58] per 10-mg intravenous morphine equivalents, P = .040) and inversely associated with multimodal antiemetic therapy (0.34 [0.15-0.78], P = .011). Prolonged cases had higher rates of postoperative nausea and vomiting (n = 43 [47.2%] vs 86 [31.6%], P = .008), respiratory depression (28 [30.8%] vs 12 [4.4%], P < .001), sedation (Richmond Agitation-Sedation Scale < -2; 26 [28.6%] vs 35 [12.9%], P = .001), severe pain (numeric rating score ≥7; 31 [34.4%] vs 45 [17.2%], P = .001), and longer hospital stays (4 vs 3 days, P < .001). CONCLUSIONS: Several anesthetic factors are associated with anesthesia recovery duration, which may be shortened by efforts to reduce postoperative sedation, severe pain, and nausea/vomiting. Shortened anesthesia recovery time may reduce hospital stay.

7.
Am J Otolaryngol ; 41(3): 102414, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32093975

RESUMO

PURPOSE: This study summarizes the treatment modalities of basal cell adenocarcinoma (BCAC) of the parotid gland and subsequent outcome at a single institution to better define the treatment of this rare tumor. MATERIAL AND METHODS: A retrospective review of patients treated for BCAC of the parotid gland from 1/01/1996 to 08/1/2018 was performed. Patients were identified using our institution's Cancer Registry. RESULTS: A total of thirteen patients (46% female, median age of 56) treated for BCAC of the parotid gland were identified. Eight patients (57%) were staged as T1, four were staged as T2 (29%), and two were stage T4a (14%) due to tumor involvement of the facial nerve. None of the patients had nodal involvement or distant metastases. Three patients (21%) underwent radiation therapy ranging from 60-70Gy for positive margin or facial nerve involvement by tumor. Five patients (36%) underwent a neck dissection (ND) ranging from just a level IIb dissection up to levels IIa, IIb, and III with none of the nodes being positive for disease. The remainder of patients did not undergo a neck dissection. Follow-up was 8.1 ± 6.2 (mean ± SD) years with no local or regional recurrence at time of last follow-up in any patient cohort. CONCLUSIONS: Our review suggests that elective neck dissections are not necessary following resection of T1/T2N0M0 basal cell adenocarcinoma for the prevention of local or regional recurrence. No longer performing neck dissections for T1/T2N0M0 BCAC would reduce the morbidity associated with the treatment of this rare parotid tumor.

8.
Laryngoscope ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31909842

RESUMO

OBJECTIVES: To assess the outcomes of abdominal dermal-fat grafting following superficial and total parotidectomy. METHODS: A retrospective chart review of parotidectomy patients was performed. Patients were divided into four groups based on surgical extent and grafting status: superficial parotidectomy (SP), superficial parotidectomy with grafting (SPg), total parotidectomy (TP), and total parotidectomy with grafting (TPg). Complication rates and operative times were then compared between surgically matched groups (SP vs. SPg, TP vs. TPg). Complications included graft necrosis, gustatory sweating, first-bite syndrome, infection, hematoma, sialocele, and seroma. Data was analyzed via chi-square and two-sample t testing, logistic regression, and one-way analysis of variance. RESULTS: The cohort consisted of 330 patients: 106 SP (32.12%), 61 SPg (18.48%), 82 TP (24.85%), and 81 TPg (24.55%). No donor site complications occurred. TPg resulted in seven graft necroses (8.64%), and 22 reported gustatory sweating (27.20% vs. 10 TP patients (12.2%), P = 0.016); SPg resulted in two necroses (3.28%). There were no other statistically significant differences in complication rates. Graft recipients receiving adjuvant radiation were more likely to develop necrosis (odds ratio [OR] 4.60, 95% confidence interval [CI], 1.16-18.27, P = .0194). Patients who developed gustatory sweating were 8.38 years younger (95% CI 2.66-14.10, P = 0.002, follow-up time > 48 days). Grafting did not increase operative times (TP/TPg: mean = 275.91/263.65 minutes, standard error of the mean = 41.96/33.75, P = 0.822). CONCLUSION: An abdominal dermal-fat graft is an excellent reconstructive choice for a parotidectomy defect and is not associated with increased complication rates or prolonged operative time. LEVEL OF EVIDENCE: 4 Laryngoscope, 2020.

9.
Laryngoscope ; 130(3): 622-627, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31077407

RESUMO

OBJECTIVES/HYPOTHESIS: Sinonasal mucosal melanoma (SNMM) is a rare malignant neoplasm. No study to date has analyzed the impact that nodal metastases and distant metastases at diagnosis have on overall survival (OS) and disease-specific survival (DSS). STUDY DESIGN: Retrospective database review. METHODS: The Surveillance, Epidemiology, and End Results database was queried for cases of SNMM. Descriptive statistics were used analyze patient demographic and clinicopathologic variables. The Kaplan-Meier model was used to analyze survival, and the Cox proportional hazards model was used for multivariate analysis. RESULTS: Three hundred twenty-eight cases of SNMM were identified. The most frequent sinonasal anatomic location was the nasal cavity in 279 (73.0%) patients, followed by the maxillary sinus in 60 (15.7%) patients. Regional nodal metastases at diagnosis occurred in 33 (8.6%) patients, whereas distant metastases at diagnosis occurred in 41 (10.7%) patients. Five-year OS was 22.7%, and 5-year DSS was 26.8%. The presence of positive nodes at diagnosis (OS P < .0001, DSS P < .0001), distant metastases at diagnosis (OS P = .0442, DSS P = .0442), primary tumor site (OS P < .0001, DSS P < .0001), and increasing age (OS P = .0012, DSS P = .0016) were found to be significant as negative predictors of OS and DSS. CONCLUSIONS: SNMM is a rare pathologic entity with a poor prognosis. The presence of nodal and distant metastases at diagnosis are negative prognostic factors in OS and DSS. These factors can be used in the development of new models of risk stratification and to inform treatment strategies and surveillance patterns. LEVEL OF EVIDENCE: NA Laryngoscope, 130:622-627, 2020.

10.
Thyroid ; 29(11): 1615-1622, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31595822

RESUMO

Background: Anaplastic thyroid cancer (ATC) has poor prognosis with median overall survival (OS) of ∼6 months. We previously reported high PD-1/PDL-1 staining in ATC, raising the possibility of the productive application of the immunotherapeutic pembrolizumab. However, having found pembrolizumab to anecdotally have limited single-agent activity in ATC, we sought to alternatively define whether pembrolizumab might synergistically combine with chemoradiotherapy as initial ATC therapy. Methods: An investigator-initiated therapeutic phase 2 trial of pembrolizumab, 200 mg intravenously (IV) every 3 weeks, combined with chemoradiotherapy (docetaxel/doxorubicin, 20 mg/m2 each IV weekly plus volumetric modulated arc therapy) was initiated as frontline therapy (with or without surgery) in ATC to assess efficacy and toxicities. Six-month OS was selected as the primary endpoint using a Simon's optimal design with interim analysis (targeting accrual of 25 patients; Cohort A: prior resection, Cohort B: no resection). Based on a prior patient cohort-treated similarly, but without pembrolizumab, the design was such that, if 6-month true survival is 75%, the probability of declaring the approach worthy of further pursuit would be 91%. Results: Three patients were enrolled, two with rapidly enlarging unresectable neck masses. Early tumor responses were favorable in all three, and all three satisfactorily completed: intended radiotherapy, preceding and radiotherapy-concurrent pembrolizumab, and concurrent chemoradiotherapy. However, all three patients died <6 months following therapy initiation-one from pulmonary metastases and two from otherwise unexpected fatal pulmonary complications occurring subsequent to chemoradiotherapy completion-prompting study closure. Conclusions: Although initially tolerated and effective in terms of locoregional disease control, disappointing survival outcomes compared with historical controls raise uncertainty that the piloted approach merits further pursuit in ATC.

11.
Ear Nose Throat J ; : 145561319869609, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31569975
13.
J Neurosurg ; : 1-5, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31518983

RESUMO

Benign notochordal cell tumors (BNCTs) are considered to be benign intraosseous lesions of notochord origin; however, recent spine studies have suggested the possibility that some chordomas arise from BNCTs. Here, the authors describe two cases demonstrating histological features of BNCT and concomitant chordoma involving the clivus, which, to the best of the authors' knowledge, have not been previously documented at this anatomical site.An 18-year-old female presented with an incidentally discovered clival mass. Magnetic resonance imaging revealed a 2.8-cm nonenhancing lesion in the upper clivus that was T2 hyperintense and T1 hypointense. She underwent an uneventful endoscopic transsphenoidal resection. Histologically, the tumor demonstrated areas of classic chordoma and a distinct intraosseous BNCT component. The patient completed adjuvant radiation therapy. Follow-up showed no recurrence at 18 months.A 39-year-old male presented with an incidentally discovered 2.8-cm clival lesion. The nonenhancing mass was T2 hyperintense and T1 hypointense. Surgical removal of the lesion was performed through an endoscopic transsphenoidal approach. Histological analysis revealed areas of BNCT with typical features of chordoma. Follow-up did not demonstrate recurrence at 4 years.These cases document histologically concomitant BNCT and chordoma involving the clivus, suggesting that the BNCT component may be a precursor of chordoma.

14.
J Neurol Surg B Skull Base ; 80(4): 392-398, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31316885

RESUMO

Background There is little data regarding postoperative outcomes of patients with obstructive sleep apnea (OSA) undergoing skull base surgery. The purpose of this study is to determine an association between risk factors and proximity of cerebrospinal fluid (CSF) leak to surgery in patients with OSA undergoing endoscopic skull base surgery. Methods A retrospective review of neurosurgical inpatients, with and without OSA, at a tertiary care institution from 2002 to 2015 that experienced a postoperative CSF leak after undergoing endoscopic skull base surgery. Results Forty patients met inclusion criteria, 12 (30%) with OSA. OSA patients had significantly higher body mass index (BMI; median 39.4 vs. 31.7, p < 0.01) and were more likely to have diabetes (41.7 vs. 10.7%, p = 0.04) than non-OSA patients; otherwise there were no significant differences in clinical comorbidities. No patients restarted positive pressure ventilation (PPV) in the inpatient setting. The type of repair was not a significant predictor of the time from surgery to leak. Patients with OSA experienced postoperative CSF leak 49% sooner than non-OSA patients (Hazard Ratio 1.49, median 2 vs. 6 days, log-rank p = 0.20). Conclusion Patients with OSA trended toward leaking earlier than those without OSA, and no OSA patients repaired with a nasoseptal flap (NSF) had a leak after postoperative day 5. Due to a small sample size this trend did not reach significance. Future studies will help to determine the appropriate timing for restarting PPV in this high risk population. This is important given PPV's significant benefit to the patient's overall health and its ability to lower intracranial pressure.

15.
J Clin Oncol ; 37(22): 1909-1918, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31163012

RESUMO

PURPOSE: The purpose of this study was to determine if dose de-escalation from 60 to 66 Gy to 30 to 36 Gy of adjuvant radiotherapy (RT) for selected patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma could maintain historical rates for disease control while reducing toxicity and preserving swallow function and quality of life (QOL). PATIENTS AND METHODS: MC1273 was a single-arm phase II trial testing an aggressive course of RT de-escalation after surgery. Eligibility criteria included patients with p16-positive oropharyngeal squamous cell carcinoma, smoking history of 10 pack-years or less, and negative margins. Cohort A (intermediate risk) received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m2 docetaxel once per week. Cohort B included patients with extranodal extension who received the same treatment plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. The primary end point was locoregional tumor control at 2 years. Secondary end points included 2-year progression-free survival, overall survival, toxicity, swallow function, and patient-reported QOL. RESULTS: Accrual was from September 2013 to June 2016 (N = 80; cohort A, n = 37; cohort B, n = 43). Median follow-up was 36 months, with a minimum follow-up of 25 months. The 2-year locoregional tumor control rate was 96.2%, with progression-free survival of 91.1% and overall survival of 98.7%. Rates of grade 3 or worse toxicity at pre-RT and 1 and 2 years post-RT were 2.5%, 0%, and 0%. Swallowing function improved slightly between pre-RT and 12 months post-RT, with one patient requiring temporary feeding tube placement. CONCLUSION: Aggressive RT de-escalation resulted in locoregional tumor control rates comparable to historical controls, low toxicity, and little decrement in swallowing function or QOL.

16.
Int J Dermatol ; 58(10): 1184-1190, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30968948

RESUMO

BACKGROUND: Previous wide local excision prior to sentinel lymph node biopsy (SLNB) may have the potential to disrupt lymphatic channels, thus incorrectly identifying the sentinel node. The purpose of this study was to investigate: (1) regional recurrence rates of prior wide local excision compared to other biopsy techniques and (2) survival outcomes in patients with melanoma of the head and neck. METHODS: Between the years 2000 and 2016, 391 cases were reviewed with a median follow-up time of 30 months in a large tertiary care center. Biopsy practices included shave, punch, wide local excision, and narrow margin excisional/Mohs, and associations with time to local or regional relapse and death from melanoma were evaluated. Main outcomes included identification of sentinel lymph nodes, overall survival, and melanoma-specific survival. RESULTS: Of the 391 patients, biopsy patterns were as follows: 77 (19%) unknown biopsy, 30 (8%) prior wide local excision (WLE), 105 (27%) narrow margin excisional biopsy, 69 (18%) punch biopsy, and 110 (28%) shave biopsy. SLNB was successfully identified in all 30 patients whom had a prior WLE. There were 50 regional recurrences in the neck and 27 local recurrences with the median (IQR) at 1.2 years and 1.0 years, respectively. Multivariable associations of type of prior biopsy, depth of invasion, and nodal status with time to regional recurrence, local recurrence, overall survival, and melanoma-specific survival were not significantly different. CONCLUSIONS: Sentinel lymph node biopsy for melanoma of the head and neck can be successfully performed in patients after previous wide local excision.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Melanoma/cirurgia , Cirurgia de Mohs/métodos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Idoso , Biomarcadores Tumorais/análise , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Estimativa de Kaplan-Meier , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Masculino , Margens de Excisão , Melanoma/mortalidade , Melanoma/patologia , Pessoa de Meia-Idade , Cirurgia de Mohs/efeitos adversos , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/prevenção & controle , Biópsia de Linfonodo Sentinela/métodos , Pele/patologia , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia
17.
Laryngoscope ; 129(9): 1998-2007, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31032986

RESUMO

OBJECTIVES: Determine the effect of endoscopic skull base surgery (ESBS) on long-term olfactory outcomes after surgery. METHODS: An English-language search was conducted using the Cochrane, MEDLINE, Scopus, and Embase databases from January 2000 to October 2017 for adult patients undergoing ESBS with subjective and objective olfaction outcomes. Two authors independently examined articles to identify those meeting inclusion criteria. Studies examining objective olfactory outcomes after ESBS were included in the meta-analysis. A random-effects meta-analysis of patients undergoing sellar and parasellar ESBS was conducted to compare preoperative and postoperative olfactory outcomes using the University of Pennsylvania Smell Identification Test (UPSIT) and Cross-Cultural Smell Identification Test (CCSIT). RESULTS: Among 339 eligible articles, 29 articles met inclusion criteria. Twenty-five of these focused on sellar and parasellar tumors. Individual articles not meeting criteria for meta-analysis were qualitatively reported. Meta-analysis showed there was no difference in preoperative and postoperative olfactory function after sellar and parasellar ESBS based on the UPSIT (five studies, mean difference [MD] = -1.03; 95% CI: -3.98, 1.93; P = .50) and the CCIST (three studies, MD = -0.77; 95% CI: -3.03, 1.49; P = .50). A pooled overall meta-analysis revealed similar results (eight studies, effect size = -0.30; 95% CI: -0.79, 0.18; P = .22). However, heterogeneity for all meta-analyses was high (I2 > 95%, P < .01), suggesting significant variation in the included studies. CONCLUSIONS: Based on published objective olfaction outcomes after sellar and parasellar ESBS, there was no significant difference between preoperative and postoperative olfaction. Further prospective studies using validated objective measures of olfaction are required to improve our understanding on this subject. LEVEL OF EVIDENCE: 2a Laryngoscope, 129:1998-2007, 2019.


Assuntos
Neoplasias do Sistema Nervoso Central/cirurgia , Neuroendoscopia/efeitos adversos , Transtornos do Olfato/etiologia , Complicações Pós-Operatórias/etiologia , Neoplasias da Base do Crânio/cirurgia , Humanos , Neuroendoscopia/métodos , Base do Crânio/cirurgia , Resultado do Tratamento
18.
Int Forum Allergy Rhinol ; 9(5): 493-500, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30657649

RESUMO

BACKGROUND: Olfactory nerve fibers are at risk of injury during transnasal endoscopic skull-base approaches. Olfactory outcomes for various techniques have not been thoroughly investigated. This study aims to report long-term olfactory outcomes when a cold knife upper septal limb incision technique is used compared to monopolar cautery. METHODS: A prospective cohort study was performed at a tertiary referral center. Adult patients undergoing endoscopic approaches with septal incisions were randomized to cold knife or monopolar cautery groups. Patient demographics, clinical history, surgical data, and outcomes were collected. Preoperative, 3-month, and 12-month postoperative scores on the University of Pennsylvania Smell Inventory Test (UPSIT) and 22-item Sino-Nasal Outcome Test (SNOT-22) were measured. Fisher's exact tests were performed for categorical variables and t tests were performed for continuous variables. RESULTS: Twenty-two (22) patients (10 cold knife, 12 cautery) were enrolled between March 2016 and August 2017. The average age ± standard deviation was 50.2 ± 14.0 years (p = 0.59), 54% (p = 0.69) were female, and the primary pathology was pituitary adenoma (73%, p = 1.00). Preoperative, 3-month, and 12-month postoperative UPSIT scores were similar between the cold knife and cautery groups (32.8 vs 32.4, p = 0.80; 33.1 vs 33.0, p = 0.96; 33.6 vs 33.3, p = 0.84). On the "sense of smell/taste" question of the SNOT-22, there was also no difference at all time points (p > 0.22). CONCLUSION: There was no significant change in patient UPSIT scores 1 year after transnasal skull-base approaches, and no short-term or long-term differences between cold knife and cautery upper septal limb incision techniques. Our study supports an individualized approach based on surgeon preference.


Assuntos
Eletrocoagulação , Endoscopia , Septo Nasal/cirurgia , Procedimentos Cirúrgicos Nasais , Base do Crânio/cirurgia , Olfato , Adenoma/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos
19.
Head Neck ; 41(5): 1335-1341, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30536472

RESUMO

BACKGROUND: Past research established that surgery plus adjuvant radiotherapy (S + AR) improves overall survival (OS) in esthesioneuroblastoma (ENB). However, it is unknown if the addition of adjuvant chemotherapy (AC) further improves survival. The primary objective of this study was to compare survival among patients treated with S + AR alone to patients who underwent S + AR + AC. METHODS: Retrospective review of patient records. RESULTS: Thirty-eight patients met inclusion criteria for either S + AR or S + AR + AC treatment groups. The S + AR + AC group contained more patients with Kadish stage D disease, dural invasion, and positive histologic margins postsurgery. All S + AR + AC patients received platinum-based regimens, combined with etoposide in 67%. OS and recurrence-free survival did not differ between the two groups, even when restricting the analysis to patients with Kadish stages B and C disease. CONCLUSION: Patients who received platinum-based AC did not exhibit improved survival compared to S + AR alone. Further investigation, preferably prospective, into the optimal use of systemic therapy in ENB is warranted.

20.
Laryngoscope ; 128(12): E402-E408, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30208202

RESUMO

OBJECTIVES/HYPOTHESIS: Vocal fold (VF) paralysis by sectioning the recurrent laryngeal nerve dramatically impacts the life of thyroidectomy patients. Volume-expanding materials can temporarily restore VF medialization. To prolong this benefit, adipose mesenchymal stem cells (ADSCs) and micronized acellular dermis (MACD) were co-injected in a rabbit model of injection medialization laryngoplasty. Biomarkers of in situ proliferation were identified by mass spectrometry proteomics and pathway analysis to guide future efforts to increase the length of benefit. METHODS: ADSCs were expanded and/or differentiated into chondrocytes (CHON) as collagen microspheres. After VF paralysis rabbits received MACD, MACD + undifferentiated ADSC, or MACD+CHON, ADSCs differentiated into chondrocytes. After 12 weeks, animals were sacrificed and 5-µm paraffin-embedded cryosections were prepared from larynges for hematoxylin and eosin visualization and nanoflow liquid chromatography electrospray-ionization tandem-mass spectrometry analysis of tissue collections. Validated proteins were processed by Venn subtraction and gene ontology (GO) overrepresentation analysis to identify unique pathways and biomarkers. RESULTS: Confirmed proteins numbered 147 (MACD), 1,243 (MACD+ADSC), and 1,033 (MACD+CHON). Totally, 333 proteins were uniquely found in the MACD+ADSC group, including mesenchymal surface markers CD9, CD44, fibronectin, and vimentin. Over 70% of proteins belonged to catalytic activity and binding GO categories, with the histone (H) family being overrepresented (P < 0.05). Histone variants H3.3, H2A.V, and H2A.Z (associated with open chromatin states) were overrepresented in the MACD+ADSC group, whereas structural histones H2A, H2B, and H4 were not. CONCLUSION: Biomarkers, including atypical histones, are associated with in vivo proliferation of ADSCs and an expanded VF medialization volume. LEVEL OF EVIDENCE: NA Laryngoscope, 128:E402-E408, 2018.


Assuntos
Histonas/análise , Laringoplastia/métodos , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/fisiologia , Prega Vocal/citologia , Derme Acelular/metabolismo , Animais , Biomarcadores/análise , Diferenciação Celular/genética , Proliferação de Células/genética , Condrócitos , Colágeno , Injeções , Espectrometria de Massas , Proteômica , Coelhos , Nervo Laríngeo Recorrente/citologia , Transdução de Sinais/genética , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/prevenção & controle
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