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Biomedical subjects

A Shaha

Publications and source records attributed to A Shaha.

At least 19 recordsLinked to original sources
PubMed2001

Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin.

Radioiodine ablation (RA) of normal thyroid remnants after thyroidectomy for differentiated thyroid carcinoma improves the sensitivity of subsequent radioiodine scans and serum thyroglobulin measurements for detection of residual thyroid carcinoma. Local cancer recurrences are also lower after RA. One standard preparation for RA involves rendering the patient hypothyroid in order to stimulate endogenous thyrotropin (TSH) secretion and sodium iodide symporter (NIS) activity. An alternative approach is to prescribe thyroxine after thyroidectomy and to stimulate NIS with exogenous recombinant human thyrotropin (rhTSH). This latter approach was used in 10 patients at our medical center. Complete resolution of all visible 131I thyroid bed uptake was achieved in all when follow-up scans were performed 5 to 13 months later. This approach has the potential to successfully ablate thyroid remnants without the need to induce hypothyroidism.

Adult↗
PubMed2001

Spectral karyotyping analysis of head and neck squamous cell carcinoma.

OBJECTIVES/HYPOTHESIS: The genetic content of head and neck squamous cell carcinomas is ill defined. Spectral karyotyping (SKY) is a new technique that allows the simultaneous detection of all chromosomal translocations by labeling each individual chromosome with different fluorescent agents. In the current study we used SKY to analyze cell lines and a primary tumor derived from head and neck squamous cell carcinomas (HNSCC) to delineate recurrent translocations and breakpoints. STUDY DESIGN: Spectral karyotyping analysis of head and neck cancer. METHODS: Two cell lines (MDA886 and MSK922) and one primary tumor in short-term culture were subjected to metaphase growth arrest with colcemide in their exponential growth phase and fixed onto glass slides. Painting probes for each of the autosomes and the sex chromosomes were generated from flow-sorted human chromosomes using sequence-independent DNA amplification. The probes were labeled using a polymerase chain reaction-based reaction and hybridized to metaphase preparations for 2 days at 37 degrees C. Biotinylated probes were detected using avidin Cy5 and digoxigenin-labeled probes with an anti-mouse digoxigenin antibody followed by goat anti-mouse antibody conjugated to Cy5.5. Chromosomes were counterstained with 4,6-diamino-2-phenyliodole (DAPI), and a minimum of five metaphases were captured and analyzed for each case. Breakpoints on the SKY-painted chromosomes were determined by comparison of corresponding DAPI banding. RESULTS: Spectral karyotyping analysis revealed a complex pattern of chromosomal abnormalities. A total of 66 translocations were identified in the three cases, with one new recurrent translocation at (der(4)t(4;20)(q35;?)). Nine complex translocations, involving three or more chromosomes, were identified in these cases. Overall, 96 breakpoints were assigned to metaphase chromosomes and another 74 breakpoints could not be assigned. Breakpoints most commonly involved chromosomes in genetic rearrangements were 1, 3, 5, 8, 13, 16, and 17. CONCLUSIONS: Spectral karyotyping analysis reveals the true complexity of chromosomal aberrations in cell lines derived from head and neck squamous cell carcinomas. The use of SKY, in combination with other techniques, may allow for a more complete assessment of the genetic abnormalities of head and neck cancers and serve as a starting point for gene identification.

Carcinoma, Squamous Cell↗
PubMed1999

Alterations in head and neck cancer occurring in HIV-infected patients--results of a pilot, longitudinal, prospective study.

To assess the impact of human immunodeficiency virus (HIV) infection on the presentation and course of head and neck squamous cell carcinoma (HNSCC), we performed a pilot, prospective, longitudinal study of all patients with HNSCC presenting to our institutions over a 6-month period (n = 10). A 60% incidence of HIV infection was seen in this study population, with SCC presenting as the initial manifestation of HIV infection in 2 of the 6 patients. In addition. HIV-infected patients were significantly younger than non-infected patients at (p = 0.01). None of the HIV-infected patients had acquired immunodeficiency syndrome (AIDS) at the time of presentation, but 5 of 6 patients had an abnormal CD4 count, compared to none of the non-infected patients (p = 0.05). The absolute CD4 count in HIV-infected patients decreased to less than 100x10(9)/L in the majority of these patients within 3 months of presentation with HNSCC (p = 0.05). Treatment-associated complications were common in HIV-infected patients, occurring in 4 of the 6 cases in contrast to none of the patients without HIV infection (p = 0.046). Outcome was significantly poorer for HIV-Infected patients, with 5 patients succumbing to their disease within one year, in contrast to none of the non-infected patients (p = 0.046). These data, combined with our previous work, justify further investigation of the relationship between HNSCC and HIV infection and the possibility of its inclusion as an AIDS-defining process.

Adult↗
PubMed1999

Critical care for the severely ill head and neck patient.

OBJECTIVE: To delineate the frequency and causes of admission to a critical care environment for patients undergoing head and neck surgery at Memorial Sloan-Kettering Cancer Center. DESIGN: Retrospective clinical investigation. SETTING: Adult intensive care unit of a tertiary referral cancer center. PATIENTS: All head and neck surgery patients admitted to the special care unit (SCU) of Memorial Sloan-Kettering Cancer Center between January 1, 1994 and December 31, 1995 were included in this study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The data collected included demographic, operative procedures, clinical, laboratory, and physiologic variables at time of SCU admission, at 24 hrs, as well as vital status at the time of discharge from the SCU and hospital. Other data collected were the need for mechanical ventilation and inotropic agents. During the period of January 1, 1994 through December 31, 1995, 37 (1.5%) of 2,346 patients undergoing head and neck surgical procedures required admission to the SCU. During the same period, six patients receiving medical treatment only for head and neck malignant disease were transferred to the SCU. These 43 admissions served as the basis for the study. The causes of admission to the SCU were pulmonary (15/43), cardiac (14/43), wound related (8/43), and other (15/43). The median length of stay in the SCU was 2 days, and the median hospitalization for patients requiring critical care services was 22 days. Seventy-four percent of patients requiring critical care services were eventually discharged to home. CONCLUSIONS: Current preoperative evaluation, operative and anesthetic techniques, and perioperative care result in a low frequency of utilization of critical care services by patients undergoing head and neck surgery. There is no single identifiable cause of complications for patients after head and neck surgery leading to utilization of critical care services.

Adolescent↗
PubMed1998

A prospective phase II trial of concomitant chemotherapy and radiotherapy with delayed accelerated fractionation in unresectable tumors of the head and neck.

BACKGROUND: Our study is a prospective evaluation of unresectable malignant cancers of the head and neck treated with concomitant chemotherapy and radiotherapy (RT) using delayed accelerated fractionation (concomitant boost). METHODS: Between January 1988 and March 1995, 82 patients with unresectable cancers of the head and neck were enrolled in this phase II study. Of these, 52 patients were treated and followed for a minimum of 3 years and are the subject of this analysis. All patients had T4 lesions and were stage IV according to the American Joint Committee on Staging Criteria (AJCC). Patients received RT with accelerated fractionation to a total of 70 Gy in 6 weeks using a concomitant-boost technique. Concomitant cis platin (100 mg/M2) was given on days 1 and 22 of RT. Twenty-seven patients received mitomycin-C (7.5 mg/M2) on days 1 and 22, and 1 patient received mitomycin-C on day 1. In addition, 27 patients received adjuvant chemotherapy with cis platin and vinblastine. The mean follow-up was 45 months (range, 36-72 months). The minimum follow-up for surviving patients in 3 years. RESULTS: At 3 years, the local control rate was 58%. Three-year local control rates for paranasal sinus, nasopharynx, oropharynx, and larynx/hypopharynx were 78%, 78%, 64%, and 100%, respectively. For all patients, the distant-metastasis-free survival was 56%, and the overall survival rate was 36%. Patients with oral cavity cancers experienced worse overall survival versus other sites, 0% versus 47% (p = .03). Salivary cancers also showed worse survival versus other sites, 0% versus 47%, but was not statistically significant. Severe acute complications occurred in 34% of patients. Treatment-related toxicity also resulted in the death of 2 patients. Severe late complications occurred in 7% of patients. CONCLUSIONS: Treatment of this poor prognostic group of patients with aggressive chemotherapy and RT produced surprisingly good local control and survival.

Adolescent↗
PubMed1998

Presentation, course, and outcome of head and neck skin cancer in African Americans: a case-control study.

BACKGROUND: Several reports have shown that the presentation, course, and outcome of skin cancer is altered in African Americans. Subset data from these studies suggest that the course of head and neck skin cancer may be different from that occurring in other sites. However, very few studies have specifically investigated skin cancer involving the head and neck region in African-American patients. METHODS: Retrospective case-control study including 215 patients with skin cancer (squamous cell carcinoma [SCC], basal cell carcinoma [BCC], malignant melanoma, and adnexal tumors) presenting to a tertiary care institution over a 9.5-year period. Cases were defined as African Americans with skin cancer, and the control group included white and Latin-American patients with skin cancer. RESULTS: Skin cancer occurred in the head and neck region in 135 cases (62%). However, head and neck involvement was less common in African-American patients (44%) than the control group (76%; P < .001). The anatomic distribution of head and neck skin lesions was similar between the groups, with nasal and scalp skin most often involved. In the head and neck region, the ratio of BCC to SCC (4:1) was similar among all groups. In contrast, in non-sun-exposed regions, the ratio was 1:8.5 for African-American patients compared with 1:1 for the control group (P < .001). The overall distribution of malignant melanoma was not influenced by sun exposure in either groups. The study groups were similar in gender distribution, primary treatment modality, rates of positive margins, and development of second skin cancers. Although African Americans presented with more advanced lesions (P < .001), their disease-free interval was similar to the control group. Only the margin status was a significant predictor of disease-free survival by multivariate analysis, with a relative risk of 1.68 (95% CI: 1.58-18.24) CONCLUSIONS: Head and neck skin cancer is similar with regard to presentation and distribution in patients of all skin types. Moreover, in contrast to previous reports, the course of head and neck skin cancer may be less aggressive in African Americans, if appropriate treatment is provided. This report suggests that differences in skin cancer in African Americans reported in the literature reflect cancer occurring in non-sun-exposed regions.

Black or African American↗
PubMed1994

Changing trends in deep neck abscess. A retrospective study of 110 patients.

We have conducted a retrospective study of 110 patients with the diagnosis of deep neck abscess who had been seen between 1981 and 1990. Etiologic factors, common pathogens, and antimicrobial therapy were reviewed with reference to diagnostic methods of choice and management principles. The findings were compared with the literature. We have identified trends of change in the following aspects of deep neck abscess: cause, presentation, diagnostic methods, and bacteriology. Management principles of airway protection, intravenous antibiotics, and drainage have not changed.

Abscess↗
PubMed1993

Malignant fibrous histiocytoma of the head and neck.

Malignant fibrous histiocytomas are now recognized as the most common soft tissue sarcomas in adults. These tumors involve the head and neck region in 1 to 3% of cases. In this report we describe our experience with two typical and one unusual case of malignant fibrous histiocytoma of the head and neck region. In addition we review the diagnostic and therapeutic aspects of these tumors.

Aged↗
PubMed1993

Resection of tracheal stenosis with end-to-end anastomosis.

We present our experience with circumferential tracheal resection with end-to-end anastomosis. Between 1985 and 1992 we performed this procedure on 19 patients with tracheal stenosis. The cause of the stenosis was related to intubation and/or tracheotomy in 78.9% of the patients. Two to 8 tracheal rings were resected and a tension-free anastomosis was achieved with mobilization techniques that were limited to suprahyoid release, peritracheal dissection, and chin-to-chest suture. Infrahyoid release and intrathoracic perihilar mobilization techniques were not used. The anastomosis success rate was 94.7%.

Adolescent↗
PubMed1992

A long-term follow-up of pectoralis osteomyocutaneous flaps.

Reconstruction of the arch of the mandible has always been a difficult problem. The problem of reconstruction is compounded by bony defect and also the loss of soft tissue after resection of tumors of the floor of the mouth. A variety of different methods have been utilized for immediate and delayed reconstruction of the arch of the mandible with limited success. There are various post-operative complications and problems related to infection, soft tissue loss, and recurrence of the tumor. A free microvascular reconstruction is considered the best and the state of the art. However, it requires specialized training and expertise in microvascular surgery. Other methods have been successful, such as the pectoralis myocutaneous flap, pectoralis osteomyocutaneous flap, K wire, Steinman pin, and trapezius osteomyocutaneous flap. We have utilized the pectoralis osteomyocutaneous flap in six instances. Two of these patients have been followed for a long time, ranging from 7-8 years and we have noticed certain changes in the soft tissue and the rib. We are reporting here the long term results of the two patients who are alive from 7-8 years. The major finding in these patients was rib resorption and deteriorating cosmetic appearance and development of "Andy Gump" deformity.

Adult↗
PubMed1991

Parotid manifestations of HIV infection.

A lump in the parotid region is generally a salivary tumor unless proved otherwise. Recently with an epidemic of acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC), a large number of pathologies are noticed in the parotid region. These conditions generally involve the intraparotid and periparotid lymph nodes. Hyperplastic lymphadenopathy and the benign lymphoepithelial lesions are the most common variants. Our knowledge regarding these new conditions is just evolving. There remains a therapeutic dilemma starting from observation only to local excision and superficial or total parotidectomy. These lesions must be kept in mind when we evaluate a patient with risk factors for human immunodeficiency virus (HIV) infection.

AIDS-Related Complex↗
PubMed1991

Subtotal submucosal cricoid resection: an experimental study.

It has generally been considered that the cricoid cartilage is essential for maintaining airway continuity. The purpose of this experimental study was to test this concept by evaluating the effects of subtotal excision of the canine cricoid cartilage. Eight adult mongrel dogs were studied. They received general anesthesia and were intubated. By using a vertical midline incision, the cricoid cartilage was exposed. Subtotal cricoid resection was performed by submucosal dissection; the mucosal continuity was not violated. The resultant defect in the cricoid cartilage was reconstructed with a polytetrafluoroethylene (PTFE) graft which was sutured in place with prolene sutures. All the dogs were extubated immediately after surgery. None required tracheostomy or ventilatory support and none had any respiratory problems during the follow-up period. They were all able to eat soon after surgery. The animals were followed for up to 4 to 6 months and then sacrificed to permit evaluation of the condition of the airway and subglottic space. There was fibrous scarring outside the graft but no evidence of airway narrowing. Despite submucosal fibrosis, the mucosa appeared normal. The data documented that dogs tolerate subtotal cricoid resection very well and develop no subglottic stenosis. The resultant defect in the cricoid cartilage can readily be reconstructed with a PTFE graft.

Animals↗
PubMed1990

Accuracy and pitfalls of frozen section during thyroid surgery.

The purpose of this study was to assess the accuracy of frozen sections performed during thyroid surgery and to define any pitfalls they may have. The material includes a series of 190 frozen section examinations of thyroid pathology. The overall accuracy of frozen section in this series was 95%. There were no false positives in our series and false negatives related to only follicular adenomas. In two patients, the report was deferred for permanent slide examination. Nine patients had lesions reported as malignant; however, the distinct cell type was not designated on frozen section. Eight specimens initially reported to have follicular adenoma on frozen section turned out to have angioinvasion or capsular invasion indicative of follicular carcinoma. Minor discrepancies between frozen and permanent sections in the types of benign disease were noted occasionally, but were not clinically significant. There was a discrepancy in the diagnosis of Hashimoto's thyroiditis on three occasions. The major discrepancy in patients with malignant pathology was related to the cell type. The diagnosis of anaplastic thyroid cancer, though suspected, was deferred for permanent sections in all cases. The diagnosis of medullary cancer of thyroid was difficult to make on frozen section. The major problem with frozen section was the diagnosis of follicular adenoma versus carcinoma. The benign diagnosis was changed in eight instances (out of 24 frozen sections) from follicular ademona to follicular carcinoma. Because of this experience, we do not provide the frozen section diagnosis to the patient and we wait until the final diagnosis is available.

Adenocarcinoma↗
PubMed1988

Is routine triple endoscopy cost-effective in head and neck cancer?

The multicentric occurrence of tumors of the upper aerodigestive tract has been well described, with an incidence ranging from 5 to 16 percent. Detection of a synchronous primary tumor at the time of initial work-up is crucial both for management and final outcome. However, there is a diversity of opinions regarding the extent of the work-up to search for a second primary tumor. Some investigators consider routine panendoscopy to be essential for every patient with a head and neck primary tumor. Routine esophagoscopy and bronchoscopy with bronchial washings in the absence of specific symptoms appear to have minimal benefit and high cost. In our study of 140 consecutive patients with primary squamous cell carcinoma of the head and neck seen over a period of 3 years, detailed history, thorough head and neck examination, routine chest radiograph, and barium swallow when indicated were sufficient to identify 18 patients (13 percent) with a second primary tumor in the upper aerodigestive tract. The synchronous tumors of eight patients were in the head and neck area, seven patients had carcinoma of the lung, and three patients had a second primary in the esophagus. Two patients had three synchronous primaries. Follow-up of these patients ranged from 1 to 4 years. Panendoscopy with cytologic washings was performed routinely. We questioned the cost-effectiveness of routine triscopy in every patient with head and neck cancer.

Adult↗