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1.
Head Neck ; 43(10): 2869-2875, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34050580

RESUMO

BACKGROUND: Medical litigation is different than it was 20 years ago due to changes in health care. This study provides an updated analysis of oral cavity malpractice litigation from the past two decades (2000-2010 and 2011-2019). METHODS: Verdict reviews from the Westlaw database were analyzed from January 2000 to August 2019. Data were collected and analyzed with the Statistical Package for the Social Sciences. RESULTS: Sixty-five lawsuits were evaluated across 24 states. Failure to diagnose was the most common allegation in both decades. Adjusting for inflation, the average amount awarded from 2000 to 2010 was $1 721 068 and $3 925 504 from 2011 to 2019. CONCLUSIONS: There has been a significant rise in allegations of failure to biopsy and failure to refer (p < 0.05). In addition, while award amounts appear different between decades, the difference is not statistically significant (p = 0.248). Education should focus on early diagnosis, biopsy, and referral to physicians who routinely care for this patient population.


Assuntos
Imperícia , Neoplasias Bucais , Médicos , Bases de Dados Factuais , Humanos , Neoplasias Bucais/terapia , Estados Unidos
2.
Int J Pediatr Otorhinolaryngol ; 144: 110671, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33730604

RESUMO

OBJECTIVES: Post tonsillectomy hemorrhage (PTH) is a common complication of tonsillectomy. Our objectives were to: 1) Examine the postoperative course of patients presenting to St. Christopher's Hospital for Children (SCHC) with PTH; 2) Compare patients with and without a blood clot visualized in the tonsillar fossa at time of presentation to determine if outcomes regarding return to the operating room (OR) differ. METHODS: This was a retrospective chart review conducted at an academic, tertiary, pediatric hospital in an urban setting. Pediatric patients who underwent a tonsillectomy with concurrent adenoidectomy and were admitted for observation following secondary post tonsillectomy hemorrhage were reviewed. The effects of age, gender, indication, and clinical exam findings on admission on the rate of eventual return to the OR for control of hemorrhage were also analyzed. Chi-square analysis and Fisher's exact test were used to compare the significance of categorical frequencies. RESULTS: The rate of blood clot presence in our cohort was 50.9% (28/55). Return to OR rates were defined as patients who began actively hemorrhaging following admission for observation, further stratified by presence or absence of clot on admission physical exam. There was a statistically significant higher rate of return to OR in patients who presented with a clot (46.6%) on clinical exam versus no clot (18.5%) after resolved post tonsillectomy hemorrhage (p < .027). Furthermore, patients with a blood clot present were significantly more likely to require OR sooner (21.31 h from admission) than those without a clot (100.75 h from admission) (p < .012). There was no statistically significant higher rate of blood clot presence or rate of return to OR in groups based on age, gender, or indication. DISCUSSION: Pediatric patients presenting after resolved secondary PTH with a blood clot visualized in the tonsillar fossa are more likely to require return to the OR for hemostasis and cautery than are those without a blood clot, and this is more likely to occur within 24 h of admission. Thus, patients with a blood clot on initial presentation may benefit from admission for a 24-h observation period, while a similar observation period may be unproductive for patients without a blood clot. CONCLUSIONS: Patients who present with a resolved secondary PTH and a blood clot present on clinical exam require return to the OR more often than patients presenting without a blood clot. While previously controversial, we feel that this demonstrates that a 24-h observation of a patient with a clot on exam is reasonable.


Assuntos
Tonsilectomia , Adenoidectomia , Criança , Hospitais Pediátricos , Humanos , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Tonsilectomia/efeitos adversos
3.
Otolaryngol Head Neck Surg ; 165(3): 398-405, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33399526

RESUMO

OBJECTIVES: A systematic review and meta-analysis was conducted to determine the cumulative incidences of decannulation and mechanical ventilation weaning in patients with coronavirus disease 2019 (COVID-19) who have undergone a tracheotomy. Weighted average mean times to tracheotomy, to decannulation, and to death were calculated from reported or approximated means. DATA SOURCES: PubMed, SCOPUS, CINAHL, and the Cochrane library. REVIEW METHODS: Studies were screened by 3 investigators independently. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Studies including patients with COVID-19 who underwent a tracheotomy were identified. Studies without reported mechanical ventilation weaning or decannulation were excluded. Data were pooled using a random-effects model. RESULTS: After identifying 232 unique studies, 18 articles encompassing outcomes for 3234 patients were ultimately included for meta-analysis, with a weighted mean follow-up time of 28.6 ± 6.2 days after tracheotomy. Meta-analysis revealed that 55.0% of tracheotomized patients were weaned successfully from mechanical ventilation (95% CI, 47.4%-62.2%). Approximately 34.9% of patients were decannulated successfully, with a mean decannulation time of 18.6 ± 5.7 days after tracheotomy. The pooled mortality in tracheotomized patients with COVID-19 was 13.1%, with a mean time of death of 13.0 ± 4.0 days following tracheotomy. CONCLUSION: At the current state of the coronavirus pandemic, over half of patients who have required tracheotomies are being weaned off of mechanical ventilation. While 13.1% patients have died prior to decannulation, over a third of all tracheotomized patients with COVID-19 reported in the literature have undergone successful decannulation.


Assuntos
COVID-19/terapia , Pneumonia Viral/terapia , Respiração Artificial , Traqueotomia , Desmame do Respirador , Humanos , Pneumonia Viral/virologia , SARS-CoV-2
5.
Otolaryngol Head Neck Surg ; 164(5): 911-917, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32660346

RESUMO

OBJECTIVE: Surgical lasers are used extensively in head and neck surgery. Laser use in the upper airway offers many advantages but also presents risks to patients and operators that are not reported comprehensively. This study aims to summarize device malfunctions, patient complications, and subsequent interventions related to laser use in the upper airway. METHODS: The US Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for reports of surgical laser adverse events from January 2010 to March 2020. Data were extracted from reports pertaining to the upper airway. RESULTS: Sixty-two reports involving upper airway laser use in an operating room were identified, from which 95 events were extracted. Of these, 40 (42.1%) were adverse events to patients, 2 (2.1%) adverse events to operators, and 53 (55.8%) device malfunctions. Dislodgement of laser fiber in the airway (23 [57.5%]), burn (8 [20%]), and scar (5 [12.5%]) were the most common adverse events to patients. Two incidents of eye exposure through unfiltered microscope lenses were the only adverse events to operators. Fiber break (26 [49.1%]) and flare (12 [22.6%]) were the most common device malfunctions. DISCUSSION: Surgical lasers have demonstrated utility in head and neck surgery but are associated with risks. This study discusses adverse events and device malfunctions associated with airway laser surgery and emphasizes shortcomings in current reporting. IMPLICATIONS FOR PRACTICE: Standardized reporting and multi-institutional research are needed to better understand adverse events related to surgical laser use and to allow accurate estimation of their prevalence.


Assuntos
Complicações Intraoperatórias/etiologia , Laringe/cirurgia , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Boca/cirurgia , Nariz/cirurgia , Faringe/cirurgia , Falha de Equipamento , Humanos
6.
Am J Otolaryngol ; 42(1): 102826, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33220495

RESUMO

PURPOSE: The pulsed-electron avalanche knife (PEAK) PlasmaBlade TnA (Medtronic, n.d.) is a relatively new electrosurgical technology that is used widely in head and neck surgery (Medtronic Manuals, n.d.). This study aims to summarize device malfunctions, patient complications, and subsequent interventions related to PEAK PlasmaBlade TnA during tonsillectomy and adenoidectomy. MATERIALS AND METHODS: The US Food and Drug Administration's Manufacture and User Facility Device Experience database was queried for reports of PlasmaBlade TnA adverse events from June 6, 2009, to August 30, 2020. Data were extracted from reports pertaining to tonsillectomy with or without adenoidectomy. RESULTS: 128 reports were identified, from which 163 adverse events were extracted. Of these, 23 (14.6%) were related to patients, and 140 (85.4%) were related to device malfunction. The most frequently reported patient-related adverse event was a burn injury (17 [73.9%]). The most common device malfunctions were dislodgment of device component (39 [27.9%]), followed by tip ignition (32 [22.9%]), damaged tip or wire during operation (28 [20%]), and melted device (24 [17.1%]). CONCLUSIONS: PEAK PlasmaBlade TnA have demonstrated utility in tonsillectomy with or without adenoidectomy but are associated with adverse events. Interventions aimed at improving both physician and patient education may help reduce adverse events attributed to improper use. Further study is needed to clarify optimal approaches to education.


Assuntos
Adenoidectomia/instrumentação , Eletrocirurgia/instrumentação , Falha de Equipamento/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Medição de Risco , Instrumentos Cirúrgicos/efeitos adversos , Tonsilectomia/instrumentação , Adenoidectomia/efeitos adversos , Queimaduras/epidemiologia , Queimaduras/etiologia , Queimaduras/prevenção & controle , Eletrocirurgia/efeitos adversos , Feminino , Educação em Saúde , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Segurança do Paciente , Tonsilectomia/efeitos adversos
7.
J Voice ; 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32981809

RESUMO

OBJECTIVE: To clarify the relationship between voice and respiratory function, and to understand the role for airflow measures in the evaluation of voice patients. METHODS: Literature searches of MEDLINE (Ovid) and Web of Science were performed on April 6, 2020, to include articles written in English that both discussed voice in relation to lower respiratory function and reported evaluation of airflow. Search strategies included the keywords voice, respiratory, airflow, and aerodynamic measures. Data were extracted from articles that met inclusion criteria. RESULTS: Twenty studies were included for review. Fourteen (70%) studies evaluated at least 1 spirometric respiratory measure, including Forced Vital Capacity, Forced Expiratory Volume in 1 second, and Forced Expiratory Flow. Other measures assessed included mean flow rate, mean peak airflow, phonatory airflow, inspiratory airflow, expiratory airflow, and phonation quotient. Notably, four studies which included pulmonary function tests (PFTs) as part of voice evaluation discovered previously undiagnosed respiratory disease in their study populations. CONCLUSION: This review confirms that respiratory function contributes significantly to voice and reveals that few studies have explored the role for airflow measures in clarifying this relationship. Including airflow measures such as PFTs in standard voice evaluation may allow recognition of underlying respiratory disease contributing to voice dysfunction. Further research is recommended to establish indications and diagnostic criteria for the use of PFTs in voice patients.

8.
Am J Otolaryngol ; 41(6): 102652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32711236

RESUMO

PURPOSE: Tracheoesophageal puncture with voice prosthesis placement remains the gold standard for voice restoration following total laryngectomy, but may cause various complications. This study aims to summarize patient-related and device-related adverse events associated with tracheoesophageal puncture and voice prosthesis placement. MATERIALS AND METHODS: The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for reports of adverse events related to tracheoesophageal puncture with voice prosthesis placement from January 1, 2010, to April 30, 2020. Data were extracted from reports pertaining to tracheoesophageal prostheses. RESULTS: Seventy-seven reports involving tracheoesophageal voice prostheses were identified, from which 111 adverse events were extracted. Of these, 58 (52.3%) were patient-related, while 53 (47.7%) were device-related. The most frequently reported patient-related adverse events were aspirated prosthesis (24 [41.4%]), foreign body during placement (11 [19.0%]), aspiration pneumonia (9 [15.5%]), and aspirated brush tip (8 [13.8%]). The most common device-related adverse events were detached brush tip (15 [28.3%]), leak (14 [26.4%]), and torn esophageal flange (11 [20.8%]). CONCLUSIONS: While tracheoesophageal puncture with voice prosthesis placement has revolutionized voice rehabilitation following total laryngectomy, the procedure may be associated with adverse events both at the time of placement and later. Interventions aimed at improving both physician and patient education may help reduce adverse events attributed to improper use. Further research is needed to clarify optimal approaches to education.


Assuntos
Laringe Artificial/efeitos adversos , Distúrbios da Voz/reabilitação , Análise de Dados , Bases de Dados Factuais , Esôfago/cirurgia , Corpos Estranhos/epidemiologia , Corpos Estranhos/etiologia , Corpos Estranhos/prevenção & controle , Humanos , Laringectomia/efeitos adversos , Educação de Pacientes como Assunto , Pneumonia Aspirativa/epidemiologia , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/prevenção & controle , Falha de Prótese/etiologia , Punções/métodos , Traqueia/cirurgia , Distúrbios da Voz/etiologia
9.
Am J Otolaryngol ; 41(5): 102610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32580067

RESUMO

OBJECTIVE: To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms. DATA SOURCES: MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials. REVIEW METHODS: A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. Studies were included if they reported surgical management and outcomes of patients with accessory parotid gland neoplasms. RESULTS: After screening 3532 records, 15 studies were included with a total of 187 patients. Benign tumors consisted of 61.5% of cases. External open, transoral, and preauricular endoscopic approaches were used for 82.3%, 11.3%, and 6.5% of cases, respectively. Accessory lobe resection alone, concurrent with partial parotidectomy, and concurrent with total parotidectomy were used in 54.8%, 43.0%, and 2.2% of cases, respectively. Complication rates were similar between histology groups (7.8% benign vs. 8.3% malignant, p = 0.82). Accessory lobe resection with concurrent partial parotidectomy had the lowest overall complication rate (6.3%). Resections limited to the accessory lobe were found to have an overall complication rate of 8.7%. CONCLUSION: The results offer an overview of the surgical management and complications for accessory parotid gland tumors. Overall surgical complication rates found in these case series may be lower for management of accessory gland tumors than rates available in the literature for tumors within the main parotid gland.


Assuntos
Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Adulto Jovem
11.
Otolaryngol Head Neck Surg ; 163(1): 3-11, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32369429

RESUMO

OBJECTIVE: To determine the pooled global prevalence of olfactory and gustatory dysfunction in patients with the 2019 novel coronavirus (COVID-19). DATA SOURCES: Literature searches of PubMed, Embase, and Scopus were conducted on April 19, 2020, to include articles written in English that reported the prevalence of olfactory or gustatory dysfunction in COVID-19 patients. REVIEW METHODS: Search strategies developed for each database contained keywords such as anosmia, dysgeusia, and COVID-19. Resulting articles were imported into a systematic review software and underwent screening. Data from articles that met inclusion criteria were extracted and analyzed. Meta-analysis using pooled prevalence estimates in a random-effects model were calculated. RESULTS: Ten studies were analyzed for olfactory dysfunction (n = 1627), demonstrating 52.73% (95% CI, 29.64%-75.23%) prevalence among patients with COVID-19. Nine studies were analyzed for gustatory dysfunction (n = 1390), demonstrating 43.93% (95% CI, 20.46%-68.95%) prevalence. Subgroup analyses were conducted for studies evaluating olfactory dysfunction using nonvalidated and validated instruments and demonstrated 36.64% (95% CI, 18.31%-57.24%) and 86.60% (95% CI, 72.95%-95.95%) prevalence, respectively. CONCLUSIONS: Olfactory and gustatory dysfunction are common symptoms in patients with COVID-19 and may represent early symptoms in the clinical course of infection. Increased awareness of this fact may encourage earlier diagnosis and treatment, as well as heighten vigilance for viral transmission. To our knowledge, this is the first meta-analysis to report on the prevalence of these symptoms in COVID-19 patients.


Assuntos
Ageusia/epidemiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Transtornos do Olfato/epidemiologia , Pandemias , Pneumonia Viral/complicações , Ageusia/etiologia , Ageusia/fisiopatologia , COVID-19 , Saúde Global , Humanos , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Prevalência , SARS-CoV-2 , Olfato , Paladar
12.
Mol Cancer Res ; 16(2): 243-255, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29117944

RESUMO

Emerging evidence suggests that Sigma1 (SIGMAR1, also known as sigma-1 receptor) is a unique ligand-regulated integral membrane scaffolding protein that contributes to cellular protein and lipid homeostasis. Previously, we demonstrated that some small-molecule modulators of Sigma1 alter endoplasmic reticulum (ER)-associated protein homeostasis pathways in cancer cells, including the unfolded protein response and autophagy. Programmed death-ligand 1 (PD-L1) is a type I integral membrane glycoprotein that is cotranslationally inserted into the ER and is processed and transported through the secretory pathway. Once at the surface of cancer cells, PD-L1 acts as a T-cell inhibitory checkpoint molecule and suppresses antitumor immunity. Here, we demonstrate that in Sigma1-expressing triple-negative breast and androgen-independent prostate cancer cells, PD-L1 protein levels were suppressed by RNAi knockdown of Sigma1 and by small-molecule inhibition of Sigma1. Sigma1-mediated action was confirmed by pharmacologic competition between Sigma1-selective inhibitor and activator ligands. When administered alone, the Sigma1 inhibitor decreased cell surface PD-L1 expression and suppressed functional interaction of PD-1 and PD-L1 in a coculture of T cells and cancer cells. Conversely, the Sigma1 activator increased PD-L1 cell surface expression, demonstrating the ability to positively and negatively modulate Sigma1 associated PD-L1 processing. We discovered that the Sigma1 inhibitor induced degradation of PD-L1 via autophagy, by a mechanism distinct from bulk macroautophagy or general ER stress-associated autophagy. Finally, the Sigma1 inhibitor suppressed IFNγ-induced PD-L1. Our data demonstrate that small-molecule Sigma1 modulators can be used to regulate PD-L1 in cancer cells and trigger its degradation by selective autophagy.Implications: Sigma1 modulators sequester and eliminate PD-L1 by autophagy, thus preventing functional PD-L1 expression at the cell surface. This posits Sigma1 modulators as novel therapeutic agents in PD-L1/PD-1 blockade strategies that regulate the tumor immune microenvironment.Visual Overview: http://mcr.aacrjournals.org/content/molcanres/16/2/243/F1.large.jpg Mol Cancer Res; 16(2); 243-55. ©2017 AACR.


Assuntos
Autofagia , Antígeno B7-H1/química , Neoplasias de Próstata Resistentes à Castração/metabolismo , Receptores sigma/metabolismo , Bibliotecas de Moléculas Pequenas/farmacologia , Neoplasias de Mama Triplo Negativas/metabolismo , Antígeno B7-H1/genética , Antígeno B7-H1/metabolismo , Linhagem Celular Tumoral , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Interferon gama/farmacologia , Masculino , Piperazinas/farmacologia , Proteólise , Receptores sigma/antagonistas & inibidores , Receptores sigma/genética , Microambiente Tumoral/efeitos dos fármacos
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