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Biomedical subjects

Avi Khafif

Publications and source records attributed to Avi Khafif.

At least 19 recordsLinked to original sources
PubMed2006

Lymphoscintigraphy for sentinel node mapping using a hybrid single photon emission CT (SPECT)/CT system in oral cavity squamous cell carcinoma.

BACKGROUND: We assessed the added clinical value of fused single photon emission computed tomography (SPECT) and low-dose CT images compared with planar images for sentinel node (SN) mapping in patients with oral cavity squamous cell carcinoma (SCC). METHODS: Twenty consecutive patients with newly diagnosed biopsy-proven SCC of the oral cavity were enrolled. Scintigraphy was performed using a hybrid gamma-camera/low-dose CT system. Planar images and fused SPECT/CT images were interpreted separately. All patients underwent a sentinel node biopsy (SNB) followed by a neck dissection. All SNs underwent meticulous pathologic examination and immunohistochemistry staining (cytokeratin complex) in addition to routine pathologic examinations of the neck dissection specimen. RESULTS: The sensitivity for the detection of nodal metastases was 87.5%. SPECT/CT improved SN identification and/or localization compared with planar images in 6 patients (30%). CONCLUSIONS: SPECT/CT SN mapping provides additional preoperative data of clinical relevance to SNB in patients with oral cavity SCC.

Aged↗
PubMed2006

Parathyroid hormone: a sensitive predictor of hypocalcemia following total thyroidectomy.

OBJECTIVE: To investigate whether monitoring parathyroid hormone (PTH) could predict hypocalcemia following total thyroidectomy or other bilateral thyroid manipulations. STUDY DESIGN AND SETTING: Forty patients undergoing total thyroidectomy as well as other bilateral thyroid procedures were prospectively enrolled. PTH levels were measured preoperatively and 30 minutes postoperatively. Calcium levels were measured preoperatively and every 8-12 hours for the first 72 postoperative hours. Changes in PTH levels as well as symptoms of hypocalcemia were correlated with postoperative hypocalcemia. RESULTS: Hypocalcemia developed in 13/40 patients (32.5%), mainly those patients undergoing total thyroidectomy in conjunction with paratracheal neck dissections. The respective sensitivity and specificity of a drop in PTH for detecting hypocalcemia was 92% and 66% (50% drop), 23% and 75% (75% drop), and 46% and 100% (drop below normal range). CONCLUSIONS: A 50% drop in PTH levels 30 minutes following bilateral thyroid procedures is a sensitive predictor of hypocalcemia. A drop of 75% is a highly specific indicator of postoperative hypocalcemia, though not highly sensitive. EBM RATING: C-4.

Adolescent↗
PubMed2006

Treatment of pain after head and neck surgeries: control of acute pain after head and neck oncological surgeries.

OBJECTIVE: To devise an effective postoperative analgesic protocol. STUDY DESIGN AND SETTING: Two consecutive groups participated in this study. In the first group (n = 100), the pain-control management was pro re nata (PRN). In the second group, (n = 109) we tailored a procedure-specific pain-control protocol for each patient according to the level of pain recorded in the first group. These patients were treated with analgesics given at predetermined hours. Pain was evaluated by using a verbal scale of 1 to 10. RESULTS: In the first group, a significant reduction in the level of pain was monitored 1 hour after PRN drug administration; however, patients reported the return of pain several hours later, after the drug effect subsided. Overall, the patients suffered a substantial level of pain during the entire postoperative period. In the second group, significant reduction in the level of pain was recorded throughout the hospitalization. CONCLUSION: The PRN protocol is not adequate for management of pain after head and neck surgeries. SIGNIFICANCE: We can substantially reduce our patients' postoperative pain by adopting a procedure-specific analgesic regimen instead of a PRN regimen. EBM RATING: B-3b.

Adult↗
PubMed2005

Skull base approaches in the pediatric population.

BACKGROUND: This study aimed to examine the surgical, oncologic, and developmental results of infants and children undergoing extirpation of skull base tumors. METHODS: Sixty-seven children aged 0.5 to 18 years (mean, 11 years) who were operated on during a 6-year period made up the study cohort. Eighteen cases (27%) involved malignant tumors, and 49 (73%) involved benign tumors. The most common benign tumors were craniopharyngioma (n = 10) and juvenile nasopharyngeal angiofibroma (n = 8). The most common malignant tumor was sarcoma (n = 5). Thirty-six tumors (55%) involved the anterior skull base, and the rest involved the lateral (n = 24) and posterior (n = 7) skull base. Subcranial, transfacial, and subfrontal approaches were used for extirpation of anterior skull base tumors. Voluminous or malignant tumors were excised by use of combined approaches (subcranial-transfacial, subcranial-degloving, or pterional-degloving). Twenty-two children underwent adjuvant therapy (chemotherapy, radiation, or both). Postoperative follow-up was 3 to 60 months. RESULTS: No severe postoperative complications (ie, meningitis, cerebrospinal fluid leak, tension pneumocephalus) and no perioperative mortality occurred. Two and a half years later, 54 of the children (80%) are alive and well. Five children, two with optic glioma and one each with squamous cell carcinoma, ependymoma, and germinoma, have died of their disease. The subcranial approach had no cosmetic impact on the craniofacial development of the patients. CONCLUSION: The extirpation of skull base tumors by use of conventional surgical techniques is feasible and safe among infants and children. The complication and mortality rates are lower than those in adults. The long-term cosmetic effect of the subcranial approach is negligible.

Adolescent↗
PubMed2005

Survival with intact cerebral function after gunshot injury to both internal carotid arteries.

A 24-year-old man was admitted after sustaining a single gunshot wound to the neck with an expanding hematoma on the left. Computed tomography angiography demonstrated bilateral internal carotid artery pseudoaneurysms, with disruption of flow on the left and a carotid-jugular fistula on the right. At operation, transection of the left internal carotid artery necessitated ligation of the artery. No injuries to the trachea or larynx were found, but the pharynx was lacerated and was repaired. The patient was transferred to the angiography suite where a stent graft was placed in the right internal carotid artery. This served to close the pseudoaneurysm and the arteriovenous fistula while preserving distal flow. The patient recovered with intact cerebral function and with mild paresis of the tongue related to hypoglossal nerve injury. He was discharged home after 7 days.

Adult↗
PubMed2005

Curcumin: a new radio-sensitizer of squamous cell carcinoma cells.

PURPOSE: Curcumin, a potential chemopreventive agent, was found to inhibit cancer cells in S/G2M phases of the cell cycle, when radiation is more effective. The purpose of the current study was to investigate whether curcumin can sensitize squamous cell carcinoma (SCC) cells to the ionizing effects of irradiation. METHODS: Curcumin (3.5 microM) was added for 48 hours to an SCC cell line prior to irradiation. Cell growth (counts) and colony-formation (colonogenic assay) were examined after radiation. RESULTS: Incubation with curcumin only (3.75 microM) for 48 hours did not decrease the number of cells or the ability to form colonies in the absence of radiation. However, in plates that were exposed to 1-5 Gy of radiation, cell counts dropped significantly if pretreated with curcumin with a maximal effect at 2.5 Gy (where the cell counts dropped from 1240 to 1017, P < 0.001). The colonogenic assay revealed a significant decrease in the ability to form colonies following pretreatment with curcumin in all radiation doses ( P < 0.05). CONCLUSIONS: Given the appropriate doses, curcumin exhibits radio-sensitizing effects on SCC cells in vitro.

Carcinoma, Squamous Cell↗
PubMed2005

Surgical management of parapharyngeal space tumors: a 10-year review.

OBJECTIVE: The purpose of this article is to describe the diagnostic evaluation and surgical approaches to parapharyngeal space tumors in a tertiary referral center. STUDY DESIGN AND SETTING: The study is a retrospective review of 47 patients diagnosed with tumors of the parapharyngeal space (12 with malignant diseases and 35 with benign lesions) and surgically treated during a 10-year period. The transcervical (40%) and the transcervical-transparotid approaches (46%) were the most commonly performed surgical procedures followed by the orbitozygomatic-middle fossa approach (12%) and the transmandibular approach (2%). RESULTS: The surgical procedures were uneventful and there were no postoperative mortalities. Complications were rare; the most common was transient facial nerve paralysis (5 patients). After an average follow-up of 35 months, only 1 of 35 patients with benign diseases had a recurrence 5 years following transcervical resection of a pleomorphic adenoma. Of 12 patients with malignant tumors, 5 (42%) are alive with no evidence of disease. The sensitivity of preoperative fine needle aspiration biopsy (n = 23 patients) was 87% for detection of malignant disease and specificity was 100%. CONCLUSIONS: Most benign parapharyngeal space tumors can be removed surgically with a low rate of complications and recurrence. Malignant neoplasms, however, carry an ominous prognosis and a low rate of disease-free survival. Fine needle aspiration may be helpful in preoperative diagnostic evaluation of patients with parapharyngeal space tumors.

Adolescent↗
PubMed2005

Adenoid cystic carcinoma of the salivary glands: a 20-year review with long-term follow-up.

The behavior of adenoid cystic carcinoma (ACC) of the salivary glands has been shown to be unpredictable in terms of local and distant spread and mortality. We retrospectively studied 35 operations in 34 patients who had had a pathologic diagnosis of ACC of the salivary glands and who had been treated over a 20-year period and followed for a minimum of 10 years. We analyzed the effect that different factors had on outcomes. The site of origin appeared to be an important factor in survival rates; survival among patients with tumors that had originated in the parotid gland was fairly good, while survival among those with tumors that originated in the minor salivary glands was significantly worse. TNM staging was another significant factor in survival. Other poor prognostic indicators were local spread, nodal positivity, distant metastasis, and local and regional recurrence. Radiation and chemotherapy did not appear to be beneficial for patients with advanced disease. We recommend radical surgery with complete resection for all patients with ACC of the salivary glands and a careful assessment of the neck in patients with minor salivary gland tumors.

Adenoma↗
PubMed2004

Patient, caregiver, and surgeon perceptions of quality of life following anterior skull base surgery.

OBJECTIVE: To estimate the agreement between surgeons' and lay caregivers' quality-of-life (QOL) perceptions of patients undergoing major skull base surgery. DESIGN: Cohort survey of patients who had undergone anterior skull base tumor excision. SETTING: University-affiliated medical center. PARTICIPANTS: Thirty-five patients and their lay caregivers participated in the study. MAIN OUTCOME MEASURES: A triple survey was performed: each patient and his or her caregiver were asked to answer 35 questions related to 6 distinct QOL domains: role of performance, physical function, vitality, pain, specific symptoms, and effect on emotions. The composite health-related QOL of the patients was also rated on an ordinal scale by 3 surgeons who participated in the operation and follow-up. RESULTS: An overall significant agreement was found between patients' and caregivers' scores at the group level (mean scores of each domain) and individual level (patient-caregiver pairs) (r = 0.76, P<.001). There was a minor correlation in the effect on emotions domain and no correlation in the pain domain. We found no correlation between the surgeons' and patients' ratings. The operating surgeons tended to overate their patients' QOL. CONCLUSIONS: The study results show that the surgeon's perception of his or her patient's QOL is not sufficiently accurate to correctly estimate patients' QOL status. These judgments should come from the patient or from the caregiver, whose perception can be used in clinical trials as a proxy for estimation of a patient's QOL.

Caregivers↗
PubMed2004

Routine inclusion of level IV in neck dissection for squamous cell carcinoma of the larynx: is it justified?

BACKGROUND: Dissection of levels II-IV as part of an elective or therapeutic neck dissection is common practice during laryngectomy for laryngeal squamous cell carcinoma (SCC). The necessity of routine dissection at level IV has recently been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent neck dissections. METHODS: The charts of 71 suitable patients were reviewed. Forty-two had supraglottic primary cancers, and 29 had transglottic primary tumors. Levels II-IV had been removed in them all, and their neck specimens were marked according to the levels of the neck. The surgical specimens were pathologically diagnosed. RESULTS: Of 43 patients who underwent elective lateral neck dissection, the only one (2.3%) with level IV metastases also showed metastases at level II. Nine (32%) of the other 28 patients with clinical adenopathy had level IV metastases. CONCLUSIONS: Dissection of level IV as part of a therapeutic neck dissection for supraglottic and transglottic SCC is recommended for patients with clinically enlarged lymph nodes, but its necessity in the absence of detectable adenopathy is challenged.

Adult↗
PubMed2004

Tracheal mucormycosis presented as an intraluminal soft tissue mass.

BACKGROUND: Mucormycosis is a potentially lethal disease caused by an opportunistic fungal infection. It occurs mostly in diabetic or immunosuppressed patients and usually involves the lungs or paranasal sinuses. METHODS: We report a rare case of a patient with diabetic ketoacidosis who presented with progressive cough and dyspnea. CT of the neck and chest showed an intraluminal soft-tissue mass extending from the first tracheal ring to the thoracic inlet, causing severe destruction of the trachea. Direct laryngoscopy and biopsy demonstrated hyphal invasion with architecture typical of invasive mucormycosis. RESULTS: The patient underwent resection of the upper trachea and prolonged amphotericin B therapy and is disease free at 24 months after surgery. CONCLUSIONS: In patients with diabetes presenting with progressive hoarseness, dyspnea, and endobronchial mass, a fungal infection should be considered. In case of invasive tracheal mucormycosis, prompt diagnosis and early surgical resection may help improve survival.

Cough↗
PubMed2004

Development of a cancer-specific anterior skull base quality-of-life questionnaire.

OBJECT: The goal of this study was to develop a disease-specific, multidimensional quality of life (QOL) assessment instrument for patients undergoing surgical extirpation of anterior skull base tumors. METHODS: This investigation included 35 patients who had been surgically treated for more than 3 months before the study was begun. Relevant QOL questions were generated from a review of the literature and interviews with health professionals, patients, and their caregivers. The initial multidimensional, 80-item questionnaire was reduced to a 35-item questionnaire by using standard psychometric criteria. Six relevant domains were identified using factor analysis: performance, physical function, vitality, pain, specific symptoms, and influence on emotions. The internal consistency of the instrument had a correlation coefficient of 0.8 and a reliability coefficient (test-retest reliability) of 0.9. The validity of the construct was assessed by testing whether the clinical variable of the patient influenced his QOL domain score as hypothesized. Patients older than 60 years of age had significantly poorer scores in the domains of performance and physical function than younger patients. Patients with malignant tumors had significantly poorer scores in the domains of specific symptoms, influence on emotions, physical function, and performance compared with patients with benign tumors. Radiotherapy was associated with poorer scores in the domains of specific symptoms and influence on emotions. Comorbidity was associated with poor physical function scores. Using the final questionnaire, we prospectively evaluated the QOL of 12 additional patients before they underwent surgery and again between 5 and 6 months postoperatively to test the utility and validity of the instrument further. Again, significantly poorer QOL scores were recorded for patients with malignancy. CONCLUSIONS: The proposed questionnaire appears to be sufficiently reliable and valid in estimating a patient's QOL after extirpation of anterior skull base tumors. The instrument can be used in face-to-face interviews and via electronic or regular mail.

Activities of Daily Living↗
PubMed2004

[Quality of life following anterior skull base surgery].

Surgery for craniofacial resections is continuously improving, enabling the extirpation of tumors once considered unresectable. Nevertheless, the physical and psychological sequelae of these procedures and their affect on patients' everyday lives have not been systematically evaluated. The purpose of this study was to estimate the impact of anterior skull base surgery on the long-term quality of life (QOL) and on the family relations of patients with anterior skull base tumors. Demographic, medical and outcome data on 69 patients undergoing subcranial surgery for extirpation of tumors were retrospectively analyzed. Within this group, 35 patients and their lay caregiver successfully completed a disease-specific questionnaire. We did not find significant differences in QOL estimation between patients and their caregivers. Malignancy had the most significant impact on QOL, leading to a significant decrease in the overall score. Radiotherapy significantly decreased the scores in the specific symptoms and influence upon emotions domains. Age and comorbidity reduced the scores in the role of performance and physical function domains. A better correlation was found between the scores of married couples than between patients and lay caregivers who weren't married. Eighty three percent of the married couple's replies noted that the disease and surgery did not influence their relations. We conclude that malignancy, radiotherapy, comorbidity and age over 60, significantly impair quality of life in patients undergoing anterior skull base surgery. We suggest that a rehabilitation program should be implemented in these patients in order to improve their overall QOL.

Aged↗
PubMed2003

Quality of life following surgery for anterior skull base tumors.

OBJECTIVES: To evaluate patients' quality of life (QOL) after surgical extirpation of anterior skull base tumors, to elucidate different QOL domains, and to define possible predictors of functional outcome postoperatively. DESIGN: Retrospective survey. SETTING: University-affiliated medical center. PARTICIPANTS: Sixty-nine patients (76 consecutive cases) who underwent subcranial surgery between 1994 and 2002 for extirpation of anterior skull base tumors. MAIN OUTCOME MEASURE: A multidimensional, disease-specific questionnaire with 39 items was used. Six relevant domains of QOL were assessed: role of performance, physical functioning, vitality, pain, specific symptoms, and impact on emotions. RESULTS: The response rate for completing the questionnaire was 98% (40/41) after excluding patients who died (n = 13), were lost to follow-up (n = 10), and were operated on within 3 months of commencement of the study (n = 5). Thirty patients (74%) reported a significant improvement or no change in overall QOL within 6 months after surgery. The worst impact of surgery on the patients' QOL was on their financial status and emotional state. The most influential factor on QOL was malignancy leading to a significant decrease in the overall score. Radiotherapy, old age, comorbidity, and wide resection also significantly worsened QOL scores of specific domains. CONCLUSION: After subcranial extirpation of anterior skull base tumors, the overall outcome of the patients is good. Old age, malignancy, comorbidity, wide resection, and radiotherapy are negative prognostic factors for these patients' QOL.

Activities of Daily Living↗
PubMed2003

Current management of mucosal melanoma of the head and neck.

While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies.

Head and Neck Neoplasms↗
PubMed2003

Two novel translocations, t(2;4)(q35;q31) and t(X;12)(q22;q24), as the only karyotypic abnormalities in a malignant peripheral nerve sheath tumor of the skull base.

Malignant peripheral nerve sheath tumor (MPNST) is a rare neoplasm that originates from Schwann cells and comprises 5%-10% of soft tissue sarcomas. Cytogenetic analysis of this tumor has shown a highly complex karyotype, and no single chromosomal aberration has been reported to date. We combined spectral karyotyping analysis and G-banding for cytogenetic characterization of this unique tumor, which originated in the anterior skull base. We report the simultaneous occurrence of a t(2;4)(q35;q31) and a t(X;12)(q22;q24) as the only chromosomal abnormalities in this tumor. To the best of our knowledge, apparently balanced translocations have not been identified previously in MPNST.

Adult↗