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Biomedical subjects

Andrew H Murr

Publications and source records attributed to Andrew H Murr.

16 recordsLinked to original sources
PubMed2006

Fungal speciation using quantitative polymerase chain reaction (QPCR) in patients with and without chronic rhinosinusitis.

OBJECTIVES/HYPOTHESIS: The objectives of this study were to determine the mycology of the middle meatus using an endoscopically guided brush sampling technique and polymerase chain reaction laboratory processing of nasal mucous; to compare the mycology of the middle meatus in patients with sinus disease with subjects without sinus disease; to compare the responses on two standardized quality-of-life survey forms between patients with and without sinusitis; and to determine whether the presence of fungi in the middle meatus correlates with responses on these data sets. STUDY DESIGN: The authors conducted a single-blind, prospective, cross-sectional study. METHODS: Patients with sinus disease and a control group without sinus disease were enrolled in the study. A disease-specific, validated Sinonasal Outcomes Test survey (SNOT-20) was completed by the subjects and a generalized validated Medical Outcomes Short Form 36 Survey (SF-36) was also completed. An endoscopically guided brush sampling of nasal mucous was obtained from the middle meatus. Fungal specific quantitative polymerase chain reaction (QPCR) was performed on the obtained sample to identify one of 82 different species of fungus in the laboratory. Statistical analysis was used to categorize the recovered fungal DNA and to crossreference this information with the outcomes surveys. RESULTS: The fungal recovery rate in the study was 45.9% in patients with sinus disease and 45.9% in control subjects. Patients with chronic rhinosinusitis had a mean SNOT-20 score of 1.80 versus the control group mean score of 0.77 (P < .0001). SF-36 data similarly showed a statistically significant difference between diseased and control populations with controls scoring a mean of 80.37 and patients with chronic rhinosinusitis scoring a mean of 69.35 for a P value of .02. However, no statistical significance could be ascribed to the presence or absence of fungi recovered, the type of fungi recovered, or the possible impact of fungi on the quality-of-life survey results. CONCLUSION: The recovery rate of fungi from the middle meatus of patients with chronic rhinosinusitis and a control population without chronic rhinosinusitis is 45.9% using QPCR techniques. No direct causation with regard to fungal species or presence was proven; however, a species grouping for future studies is proposed based on trends in this data and other reports. Disease-specific outcomes surveys revealed a statistically significant difference between the two groups.

Chronic Disease↗
PubMed2005

Complications and the time to repair of mandible fractures.

OBJECTIVE: Treatment delays in the operative management of mandible fractures are often unavoidable. We were interested in determining whether delays increased the incidence of complications in these patients. STUDY DESIGN AND SETTING: A retrospective chart review was performed on all patients who presented to the San Francisco General Hospital with an operative mandible fracture in 2002. On the basis of the number of days from initial injury to surgery, the patients were divided into two groups: those repaired in 3 days or less and those repaired after 3 days. The incidence of infectious and technical complications was then compared between these groups. Substance abuse was also evaluated for its role in complication risk. RESULTS: Of the 84 patients in the study, 11 had infectious complications, and 10 had technical complications. Although treatment delay did not increase the risk of developing an infectious complication, substance abuse considerably increased this risk. The incidence of technical complications was remarkably higher in patients repaired after 3 days. CONCLUSION: Although patients with mandible fractures treated after 3 days do not have a higher risk of developing an infectious complication, this risk is elevated in patients who abuse substances regularly. The risk of technical complications increases with treatment delay, and therefore the surgical team must be even more vigilant when reducing these fractures.

Adult↗
PubMed2005

Impact of socioeconomic status on the diagnosis to treatment interval in Waldeyer's ring carcinoma.

OBJECTIVE: To examine the impact of socioeconomic status on the diagnosis to treatment interval in Waldeyer's ring cancers by comparing the experience of a public hospital and an academic tertiary care medical center. DESIGN: Retrospective review. SETTING: Otolaryngology clinic of a public hospital and an academic medical center. PATIENTS: One hundred seven patients with Waldeyer's ring carcinoma who were diagnosed and treated at San Francisco General Hospital (SFGH) or at the University of California, San Francisco Medical Center (UCSFMC) from January 1995 through December 2000 were included in the study. The same departments of otolaryngology-head and neck surgery and radiation oncology staff both hospitals. All radiation therapy was provided at UCSFMC. Patients included in the study had a histologic diagnosis of Waldeyer's ring carcinoma, primary treatment with radiation, and no prior treatment of Waldeyer's ring carcinoma. MAIN OUTCOME MEASURES: The time of diagnosis to start of radiation therapy, dose of radiation, number of treatment days, duration of treatment, and 1 and 3 year survival were recorded. Differences between the two groups were analyzed using Student's t test. RESULTS: The time course from diagnosis of nasopharyngeal carcinoma to start of radiation therapy was 56 days at SFGH compared with 34 days at UCSFMC. This difference was statistically significant (P = .0001). Difference in diagnosis to treatment intervals for base of tongue cancer was also significant at 66 days at SFGH compared with 31 days at UCSFMC (P = .0038). For cancer of the tonsil, the diagnosis to treatment interval was 70 days at SFGH versus 40 days at UCSFMC (P = .0005). Dose of radiation, number of days of treatment, and duration of treatment were not statistically different. Only patients with cancer of the tonsil demonstrated a statistically significant difference in 3 year survival (P = .0175). CONCLUSION: Although radiation therapy delivery appears similar between the public and tertiary care medical centers, there appears to be a statistically significant delay in the initiation of therapy for patients at the public institution. It is possible that this influences 3 year survival in cancer of the tonsil.

Academic Medical Centers↗
PubMed2004

The importance of etiology on the clinical course of neck abscesses.

OBJECTIVE: Formation of neck abscesses from injecting illicit drugs continues to be a common problem in the United States. We sought to determine whether neck abscesses resulting from direct inoculation differ in their clinical course and severity from those that arise from direct spread through inflamed tissue, as in pharyngitis or odontogenic infections. STUDY DESIGN AND SETTING: Patients were separated based on the cause of their neck abscess into either an injection drug use group or a noninjection drug use group. We retrospectively compared both groups of patients by examining multiple clinical endpoints, including the number of operations, length of hospital stay, and requirement for emergent airway intervention. RESULTS: Injection drug use was the most common cause of neck abscess. Only 1 of these patients needed more than 1 drainage procedure, and no patients required emergent airway intervention or an intensive care unit (ICU) stay. The majority of the patients in the noninjection drug group had a neck abscess as a result of unknown causes; nearly one half required an emergent operation for airway management and the mean ICU stay was 2.5 days. CONCLUSION: Neck abscesses formed by direct inoculation have a relatively more benign clinical course than those resulting from spread through inflamed tissue. The latter require a longer hospital stay, more days in the ICU, and more emergent intervention.

Abscess↗
PubMed2004

Contemporary indications for external approaches to the paranasal sinuses.

The term minimally invasive functional endoscopic sinus surgery is surely a misnomer. First, the surgery is not minimally invasive. Extensive surgery, even skull base tumor resection, can be accomplished through the approach. In fact, because of the improved visualization provided by the adaptation of the endoscope to this technique, it can be argued that the surgery is now more invasive than it has ever been historically. More correctly, the technique is "minimal incision" surgery, and this term more accurately reflects the philosophy. External incisions, however, can be cleverly minimized or cosmetically acceptable. Second, the term "functional" is relative. There is no doubt that the greatest advance that the endoscope has afforded is the ability to assess disease in the clinic or office with far more accuracy. Endoscopic assessment has added to the general appreciation of the physiologic function of the sinuses as part of the respiratory tract in general. Certain endoscopic procedures, however, are not entirely directed at improving the physiology of sinuses. The endoscopic Lothrop procedure, for example, does not have a sensible physiologic basis. It does maintain the frontal sinus as an aerated space: this preservation is often, but not always and automatically, an advantage. One of the key factors in successfully disseminating surgical technology is the ability to teach the technique to the physician in clinical practice. This process requires constant research and development in instrument technology and the constant sharing of information and technology at courses and meetings. The types of instruments used to conduct endoscopic surgery have advanced dramatically in the last 10 years. The advent and distribution of image guidance and microdebriders and drills is an important adjunct to endoscopic techniques. Perhaps more important is the refinement that has occurred in the development of angled instruments, micro-throughcutting forceps, and 45 degrees endoscopes that will allow advanced endoscopic technology to be disseminated throughout the otolaryngology community. Nevertheless, many of the external approaches use commonly available instrumentation that is available in every operating room in the United States. This availability is certainly an advantage under certain circumstances. The wastebasket of history sometimes contains procedures that can afford efficient and effective treatment. Ignoring the past will result in a need to rediscover it. A broad perspective and the ability to think creatively about clinical problems will probably result in the occasional need to employ the techniques described in this article.

Endoscopy↗
PubMed2004

Internal jugular vein thrombosis and deep neck infection from intravenous drug use: management strategy.

OBJECTIVE: Internal jugular vein thrombosis (IJVT) manifests in multiple clinical scenarios including traumatic, neoplastic, and infectious processes. No clear management algorithm exists for IJVT in the setting of deep neck infections. This study examines the cause, diagnosis, and treatment strategy for IJVT in the setting of deep neck infections caused by intravenous drug use (IVDU). STUDY DESIGN: Retrospective chart review. METHODS: The clinical, radiographic, and laboratory data of 11 IVDU patients with deep neck infections and IJVT are reviewed in a retrospective fashion. The patients were seen in a university tertiary care facility. RESULTS: Eleven patients with deep neck infections, recent history of IVDU, and concurrent IJVT were identified. All patients underwent computed tomography (CT) scanning. Antibiotic therapy was instituted in all cases, abscesses were treated invasively with aspiration or incision and drainage, and no veins were ligated or resected. Three patients received anticoagulation. One patient had bilateral IJVT with thrombus extension through the sigmoid sinus to the lateral sinus. This patient received anticoagulation and developed bacteremia. No further IJVT complications have been diagnosed at an average of 14 months postintervention. CONCLUSION: IJVT and deep neck infection caused by IVDU constitute a clinical entity present even in the modern day era of antibiotic therapy. Aggressive antibiotic therapy and surgical intervention for the deep neck infection is recommended. The indications for anticoagulation remain variable. Although anticoagulation is often recommended in the presence of thrombus progression or septic emboli, the very presence of IJVT does not mandate the need for anticoagulation. Ligation or resection of the thrombosed vein may be reserved for selected cases, but was not necessary in our series.

Adult↗
PubMed2004

Quantitative analysis of fungal DNA in chronic rhinosinusitis.

OBJECTIVES/HYPOTHESIS: Fungi have been recognized as important pathogens in sinusitis; however, they are equally present in patients with and without sinusitis. The authors postulated that the quantity of fungal DNA in the nose is determinant of disease, is greater in patients with chronic rhinosinusitis, and is directly correlated to their quality of life. STUDY DESIGN: Prospective recruitment of patients with chronic rhinosinusitis. METHODS: Objective quality of life data were collected using three validated questionnaires: the Sinonasal Outcomes Test (SNOT-20), Medical Outcomes Short-Form 36 Survey (SF-36), and Guy Marks Asthma Questionnaire (GMAQ). Endoscopically guided middle meatus mucosal samples were collected from patients with chronic rhinosinusitis and normal control subjects. Fungal-specific polymerase chain reaction was performed on each sample. Every fungal-positive sample underwent fungal-specific quantitative polymerase chain reaction analysis. Statistical analysis was used to correlate fungal DNA quantities with outcomes indices between groups. RESULTS: Patients with chronic rhinosinusitis had a mean SNOT-20 index of 32.0 as compared with a SNOT-20 index of 17.3 (P <.01) in the normal control subjects. There were no statistical differences between the groups' indices for the SF-36 or GMAQ outcomes questionnaires. Four of 19 (21.1%) patients with chronic rhinosinusitis and 7 of 19 (36.8%) normal control subjects had positive findings for fungal DNA using polymerase chain reaction. The median relative quantity of fungal DNA to human DNA for chronic rhinosinusitis and control samples was identical (0.13) using quantitative polymerase chain reaction. CONCLUSION: The quantity of fungal DNA in the middle meatus did not differ in patients with and without chronic rhinosinusitis and was not correlated with quality of life outcomes. Therefore, the quantity of fungi does not explain pathogenicity in patients with chronic rhinosinusitis. However, because of small sample size, the study must be replicated in a larger patient population.

Chronic Disease↗
PubMed2004

Role of cytomegalovirus, Epstein-Barr virus, and human herpes virus-8 in benign lymphoepithelial cysts of the parotid gland.

OBJECTIVE: To provide background and evaluate the role of herpesviruses in benign lymphoepithelial cysts (BLC) of the parotid gland. STUDY DESIGN: Case series derived from review of pathology specimens. METHODS: Radiolabeled polymerase chain reaction (PCR) analysis was used to detect for the presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes virus 8 (HHV-8) DNA sequences in 14 paraffin embedded specimens and 1 freshly aspirated BLC specimen. Thirteen normal parotid tissue specimens obtained from paraffin embedded blocks were used as a control group. RESULTS: CMV was detected with nearly equal frequency between the two groups (23% of normal vs. 20% in BLC). HHV-8 was found in 13% of the BLC group and in none of the normal group (P =.4841). There was significant difference in EBV detection between the normal (0%) and the BLC (33%) groups (P =.0437). CONCLUSION: CMV and HHV-8 does not appear to be associated with BLCs. Although EBV is found more frequently in BLC than in normal parotid controls, further studies are needed to elucidate the role of this virus in BLC pathogenesis.

Adult↗
PubMed2003

Multiple-use atomizers in outpatient otolaryngology clinics are not necessarily an infectious risk.

OBJECTIVE: We sought to determine the risk of bacterial transmission from multiple-use atomizers in an outpatient otolaryngology clinic. STUDY DESIGN AND SETTING: Atomizers in 6 examination rooms were analyzed for bacterial contamination. Sterility of associated tubing from 1 atomizer was assessed. Multidose drug solutions in the atomizers (phenylephrine and tetracaine) were cultured multiple times over a 2-week period. Serial dilutions of the original sample were cultured to minimize inhibitory effects of antiseptic agents in the drug formulations. RESULTS: No bacteria were recovered from tubing cultures. Only 2 (0.6%) of 336 cultures of the drug solutions yielded bacterial growth. In both cases, coagulase-negative Staphylococcus was recovered in 1 of the dilutions prepared from original samplings. CONCLUSION: Multiple-use atomizers that contain phenylephrine and tetracaine solutions with bacteriostatic preservatives in an outpatient otolaryngology clinic do not yield significant bacterial growth and, when used as described, do not pose an infectious risk of bacterial transmission between patients.

Ambulatory Care↗
PubMed2003

Contemporary issues in rhinosinusitis and HIV infection.

The medical issues involving patients infected with HIV continue to evolve dramatically. As they live longer sustained on antiretroviral therapy, their prevalence of acute and chronic sinusitis has increased. The common infectious causes of rhinosinusitis found in the general population are often the culprits in HIV-infected patients. However, as their CD4 counts dip below 200 cells/mm, these patients become susceptible to more opportunistic infections and neoplasms. The diagnostic and therapeutic measures used should reflect the physician's suspicion for these usual causes. The otolaryngologist should manage these patients aggressively because sinusitis can have a significant impact on the patients' quality of life as well as survival. Selected patients with either recurrent or chronic sinusitis may benefit from endoscopic sinus surgery.

AIDS-Related Opportunistic Infections↗
PubMed2002

Role of Epstein-Barr virus and cytomegalovirus in the etiology of benign parotid tumors.

BACKGROUND: Pleomorphic adenomas and Warthin's tumors are the two most common benign parotid tumors. Previous studies investigating the role of viruses in tumorigenesis of these neoplasms have been conflicting. The aim of this study was to determine whether Epstein-Barr virus (EBV) or cytomegalovirus (CMV) might play a role in the pathogenesis of pleomorphic adenomas and Warthin's tumors. METHODS: Paraffin-embedded surgical specimens of 24 pleomorphic adenomas, 10 Warthin's tumors, and 13 normal parotid tissues were obtained from the University of California-San Francisco Pathology Department. Genomic DNA was extracted from the specimens, and primers for connexin 26, a gap junction protein, were used to confirm the integrity of this DNA. The presence or absence of EBV and CMV DNA within the samples was determined with PCR-based assays, in which radiolabeled primers were used for maximal sensitivity of detection. RESULTS: PCR analysis of serially diluted control DNA revealed that using radiolabeled primers, five copies of viral DNA could be detected. By use of this method, we showed that none of the 24 pleomorphic adenomas, 10 Warthin's tumors, or 13 normal parotid samples contained EBV DNA or CMV DNA. CONCLUSIONS: These results do not support CMV or EBV as etiologic factors in pleomorphic adenomas or Warthin's tumors. In addition, normal parotid seems not to harbor either of these viruses. Future studies with larger numbers of specimens are needed to confirm these findings.

Adenolymphoma↗
PubMed2002

Mentorship through advisory colleges.

OBJECTIVE: Medical students face pressures ranging from the need to create a social network to learning vast amounts of scientific material. Students often feel isolated in this system and lack mentorship. In order to counteract feelings of bureaucratic anonymity and isolation, the University of California San Francisco has created an advisory college to foster the professional and personal growth and well being of students. DESCRIPTION: UCSF has developed a formal structure to advise medical students. A selection committee, chaired by the associate dean of student affairs, appointed five faculty mentors to head advisory colleges. These five colleges serve as the advising and well-being infrastructure for the students. Mentors were chosen from a balanced range of clinical disciplines, both primary and specialty. The disciplines are obstetrics-gynecology, otolaryngology/head and neck surgery, medicine, pediatrics, and psychiatry. The mentors have demonstrated excellence in advising and counseling of students. Mentors meet individually at the beginning of the academic year with incoming first-year and second-year students. They then have bimonthly meetings with eight to ten students within each college throughout the academic year. Curricula for these group sessions include well-being discussions and coping techniques, sessions on the hidden and informal curriculum of professionalism, and discussions on career choices and strategies. For third-year students, advisory college meetings are scheduled during intersessions, which are weeklong courses that occur between the eight-week clerkship blocks. Mentors are available throughout the year to meet with students on an as-needed basis, and advisory colleges may hold group social activities. The dean's office supports each mentor with 20% salary and provides administrative support for the group college activities. DISCUSSION: Historically, UCSF students feel they receive an excellent education and appropriate job opportunities, but they do not feel they receive adequate advising and mentoring. This may have as its root cause the financial, clinical, and research pressures placed upon a faculty who are also responsible for mentoring residents and fellows. The advisory colleges begin by providing an infrastructure for developing a relationship for the student with a single faculty member. The advisory college system is incorporated into the academic schedule rather than relying on ad-hoc activities from well-meaning but inconsistently available faculty. In the early part of medical school, the advisory college relationship concentrates on assimilation into the new environment and provides the student with advice pertaining to mastering academic material. The college also serves as a sounding board for problems that can then be relayed to course directors to improve the educational experience. For students encountering academic difficulty, the college advisor can provide discreet advice about tutoring resources and can direct the student to a separately staffed Student Well-being Program. As time progresses, the mentors can direct students to key people in different fields of interest such as program directors and keep the students on track to make career decisions in a timely manner. The college system can help transform an anonymous medical school experience into a supportive, rich environment.

Academic Medical Centers↗
PubMedDate not supplied

Embolization for the treatment of idiopathic posterior epistaxis.

BACKGROUND: The goal of this study was to examine safety and efficacy of transarterial embolization for the treatment of idiopathic posterior epistaxis. METHODS: A retrospective chart review was conducted to characterize the underlying conditions of eighty-one consecutive patients for whom complete records were available presenting with posterior epistaxis, the associated risk factors for patients with idiopathic posterior epistaxis, and the success rate of embolization in this patient population. RESULTS: One hundred consecutive patients undergoing embolization for epistaxis were identified and 81 patients were included in the analysis. Nineteen patients did not have sufficient and retrievable medical records to be included in the study. Idiopathic posterior epistaxis was the most common underlying etiology of patients with refractory posterior epistaxis (34%). Hypertension, vascular disease, and diabetes were frequently detected comorbid diseases. Patients were equally as likely to be hypertensive as normotensive at the time of presentation (45 and 55%, respectively). Most patients (83%) had failed at least one prior treatment modality. Few patients had a recurrence of epistaxis within 72 hours (three patients [12%]) or had an adverse effect associated with embolization (three patients [12%]). CONCLUSION: Embolization for the treatment of posterior epistaxis is a safe and effective treatment modality.

Adult↗