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Biomedical subjects

George L Adams

Publications and source records attributed to George L Adams.

At least 19 recordsLinked to original sources
PubMed2006

Effectiveness of prehospital wireless transmission of electrocardiograms to a cardiologist via hand-held device for patients with acute myocardial infarction (from the Timely Intervention in Myocardial Emergency, NorthEast Experience [TIME-NE]).

Percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction (STEMI) decreases morbidity and mortality if performed within the first 2 hours of symptom onset. However, the American College of Cardiology/American Heart Association guideline for percutaneous coronary intervention door-to-balloon time (<90 minutes) in patients with STEMI is a infrequently accomplished goal. This study enrolled 277 patients with STEMI who were self-transported or transported by emergency medical services to NorthEast Medical Center for primary percutaneous coronary intervention. This study tested the hypothesis that prehospital wireless transmission of an electrocardiogram to a cardiologist's hand-held device results in shorter emergency department door-to-reperfusion time. A comparison was made between patients whose electrocardiogram was successfully transmitted during the intervention phase with (1) patients transported by the emergency medical services in the preintervention, (2) patients self-transported in the intervention phase, and (3) patients whose wireless transmission failed in the intervention phase. During the preintervention phase (2001 to 2003), 48 patients were enrolled. During the intervention phase (2003 to 2005), the following patients were enrolled: 101 self-transported patients, 24 patients with successful electrocardiographic transmission, and 19 patients for whom transmission failed. The median door-to-reperfusion time for patients with successful electrocardiographic transmission was 50 minutes, which was significantly shorter than a preintervention time of 101 minutes (p <0.0001), an intervention phase self-transport time of 96 minutes (p <0.0001), and a failed transmission time of 78 minutes (p <0.0001). In conclusion, prehospital wireless electrocardiographic transmission to a cardiologist's hand-held device significantly decreased emergency department door-to-reperfusion time, thus achieving the American College of Cardiology/American Heart Association guideline for patients with STEMI.

Aged↗
PubMed2006

Genes associated with early development, apoptosis and cell cycle regulation define a gene expression profile of adenoid cystic carcinoma.

Adenoid cystic carcinoma (ACC) is an uncommon salivary gland malignancy characterized by indolent yet relentless growth that exhibits inherent resistance to systemic chemotherapy, surgical salvage and conventional radiotherapy. We used microarray analysis to characterize gene expression changes associated with ACC. Eight ACC patient specimens were compared with normal parotid gland tissue and the ACC3 cell line. Differentially expressed genes were identified (512 total) using supervised analysis methods and functional categories assigned using OntoExpress. Genes associated with morphogenesis, neurogenesis, proliferation and apoptosis characterized ACC tumors. Genes associated with saliva production and immune response characterized normal parotid tissues while the ACC3 cell line expressed genes primarily associated with proliferation, chromosome maintenance and the cell cycle. These results demonstrate that ACC tumors express genes associated with early developmental processes including morphogenesis and neurogenesis implicating oncogenic events that result in dedifferentiation of normal salivary glands.

Adult↗
PubMed2006

Predictors for resident success in otolaryngology.

BACKGROUND: This study aimed to determine predictors for otolaryngology resident success using data available at the time candidates are interviewed (eg, medical school attended, letters of recommendation, test scores) and data that emerge during residency. STUDY DESIGN: We performed a retrospective cohort study of 36 residents who entered our program between 1983 and 1993. RESULTS: Seventy percent of Alpha Omega Alpha (AOA) members and 13% of nonmembers were in the highest tertile based on faculty ranking (p<0.01), and candidates with an exceptional trait were more likely than those without an exceptional trait to rank in the highest tertile (57% versus 10%, p<0.01). AOA membership was also related to current academic appointment (p=0.02). Significant correlations included United States Medical Licensing Examination (USMLE) I score, year 2 in-training score (0.48, p=0.03), and years 3 and 4 in-training score and faculty ranking (minus 0.39, minus 0.50, respectively, p 50% of the interviewers (p<0.05 for both). CONCLUSIONS: In our program designed to train academic otolaryngologists, postresident success was strongly predicted by having an exceptional trait and AOA membership. Success during residency was predicted by interviewer's impression of the candidate and a USMLE I score>570. Knowledge of these factors at the time of the resident interview could increase the likelihood of selecting the most appropriate candidates for academic otolaryngology. Resident success is a complex outcome, and other unmeasured and unexamined characteristics can provide additional insight into choosing successful residents.

Adult↗
PubMed2005

c-kit expression in adenoid cystic carcinoma does not have an impact on local or distant tumor recurrence.

BACKGROUND: Adenoid cystic carcinoma (ACC) is a neoplasm with unpredictable behavior with frequent late relapses that lacks good prognostic indicators. c-kit tyrosine kinase oncogene has recently been found to be expressed in ACC. The aim of this study is to correlate the expression of c-kit in ACC with clinical follow-up. METHODS: Paraffin sections of 45 cases of ACC diagnosed during a 15-year period were immunostained for c-kit. RESULTS: Seventy-eight percent of tumors stained positive for c-kit. Mean follow-up time was 6 years. No degree/pattern of c-kit expression correlated to local or distant tumor recurrence. However, there was a significant association between surgical margin involvement by tumor and cell membrane expression of c-kit. Staining quality was not affected by storage time. CONCLUSIONS: Our results suggest that expression of c-kit may not serve as a useful marker for predicting outcome in ACC, although they need to be confirmed in a larger patient population with longer clinical follow-up.

Adult↗
PubMed2005

Prehospital triage of acute myocardial infarction: wireless transmission of electrocardiograms to the on-call cardiologist via a handheld computer.

BACKGROUND: Use of intravenous fibrinolytic agents and percutaneous coronary interventions produce the greatest benefit when they are implemented in the first 2 hours after symptom onset. Further delays in the time to treatment typically lead to reduced benefits and poorer outcomes. METHODS: Cabarrus County Emergency Medical Service personnel complete an acute myocardial infarction case report form and assess a 12-lead electrocardiogram (ECG) to determine if ST elevation of at least 1 mV in at least 2 contiguous leads is present and then to transmit the ECG wirelessly to the emergency department (ED). The ECG is then forwarded wirelessly from the ED to the on-call cardiologist who is carrying the IPAQ handheld computer. RESULTS: Five representative patients managed using this system during the initial year of its implementation are presented. CONCLUSION: The examples included in this article illustrate that the system and technology can work if applied in a coordinated fashion using multiple disciplines including emergency medical service, cardiologists, ED personnel, and the hospital cardiac care team, which includes the catheterization laboratory call team, acute coronary care nurses, and clerical support staff.

Adult↗
PubMed2005

Induction of heat shock protein 70 inhibits NF-kappa-B in squamous cell carcinoma.

OBJECTIVE: To determine the relationship between heat shock proteins (HSPs) and the proinflammatory, anti-apoptosis mediator NF-kappa-B in squamous cell carcinoma. STUDY DESIGN AND SETTING: CA-9-22 cells were exposed to heat stress to induce the production of HSPs. Immunoblot and reporter gene experiments determined the inducibility of HSP production and the activation of cytokine-induced NF-kappa-B. Immunoblot experiments determined the presence of the inhibitor-kappa-B-alpha (IkappaB alpha). RESULTS: CA-9-22 cells can be induced by heat stress to produce HSPs at 100-fold above baseline levels. The induction of HSPs prevents the activation and nuclear translocation of NF-kappa-B despite stimulation with IL-1beta and TNF-alpha. CONCLUSIONS: Constitutive activation of NF-kappa-B is prevented by HSP induction through an increase in IkappaB alpha synthesis. SIGNIFICANCE: The induction of HSP70 alters the inflammatory milieu associated with squamous cell carcinoma progression through the inhibition of NF-kappa-B and may ultimately promote apoptosis in head and neck carcinoma.

Apoptosis↗
PubMed2004

Identification of a gene expression signature associated with recurrent disease in squamous cell carcinoma of the head and neck.

Molecular studies of squamous cell carcinoma of the head and neck (HNSCC) have demonstrated multiple genetic abnormalities such as activation of various oncogenes (Ras, Myc, epidermal growth factor receptor, and cyclin D1), tumor suppressor gene inactivation (TP53 and p16), and loss of heterozygosity at numerous chromosomal locations. Despite these observations, accurate and reliable biomarkers that predict patients at highest risk for local recurrence have yet to be defined. In an effort to identify gene expression signatures that may serve as biomarkers, we studied 41 squamous cell carcinoma tumors (25 primary and 16 locally recurrent) from various anatomical sites and 13 normal oral mucosal biopsy samples from healthy volunteers with microarray analysis using Affymetrix U133A GeneChip arrays. Differentially expressed genes were identified by calculating generalized t tests (P < 0.001) and applying a series of filtering criteria to yield a highly discriminant list of 2890 genes. Hierarchical clustering and image generation using standard software were used to visualize gene expression signatures. Several gene expression signatures were readily identifiable in the HNSCC tumors, including signatures associated with proliferation, extracellular matrix production, cytokine/chemokine expression, and immune response. Of particular interest was the association of a gene expression signature enriched for genes involved in tumor invasion and metastasis with patients experiencing locally recurrent disease. Notably, these tumors also demonstrated a marked absence of an immune response signature suggesting that modulation of tumor-specific immune responses may play a role in local treatment failure. These data provide evidence for a new gene expression-based biomarker of local treatment failure in HNSCC.

Base Sequence↗
PubMed2003

An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer.

PURPOSE: The Head and Neck Intergroup conducted a phase III randomized trial to test the benefit of adding chemotherapy to radiation in patients with unresectable squamous cell head and neck cancer. PATIENTS AND METHODS: Eligible patients were randomly assigned between arm A (the control), single daily fractionated radiation (70 Gy at 2 Gy/d); arm B, identical radiation therapy with concurrent bolus cisplatin, given on days 1, 22, and 43; and arm C, a split course of single daily fractionated radiation and three cycles of concurrent infusional fluorouracil and bolus cisplatin chemotherapy, 30 Gy given with the first cycle and 30 to 40 Gy given with the third cycle. Surgical resection was encouraged if possible after the second chemotherapy cycle on arm C and, if necessary, as salvage therapy on all three treatment arms. Survival data were compared between each experimental arm and the control arm using a one-sided log-rank test. RESULTS: Between 1992 and 1999, 295 patients were entered on this trial. This did not meet the accrual goal of 362 patients and resulted in premature study closure. Grade 3 or worse toxicity occurred in 52% of patients enrolled in arm A, compared with 89% enrolled in arm B (P <.0001) and 77% enrolled in arm C (P <.001). With a median follow-up of 41 months, the 3-year projected overall survival for patients enrolled in arm A is 23%, compared with 37% for arm B (P =.014) and 27% for arm C (P = not significant). CONCLUSION: The addition of concurrent high-dose, single-agent cisplatin to conventional single daily fractionated radiation significantly improves survival, although it also increases toxicity. The loss of efficacy resulting from split-course radiation was not offset by either multiagent chemotherapy or the possibility of midcourse surgery.

Adult↗
PubMed2003

Diagnosis and management of pulmonary metastasis from recurrent respiratory papillomatosis.

OBJECTIVE: We sought to review the current and proposed management, as well as bring about discussion, of managing the patient with distal tracheal and pulmonary parenchymal involvement by recurrent respiratory papillomatosis (RRP). DESIGN, SETTING, AND PATIENTS: We conducted a review of 6 patients with pulmonary metastasis from RRP at 3 academic tertiary care hospitals. Interventions included surgical and medical management with antiviral, chemotherapeutic, and/or immune-modulating agents. RESULTS: Although treatment with alpha-2-beta interferon, isotretinoin, and methotrexate have not proved to eradicate pulmonary involvement by RRP, possible epithelial stabilization and slowing of disease progression are noted. CONCLUSIONS: The rates of distal tracheal and pulmonary metastasis as seen in our cohort were higher than previously reported. Approximately 12% of our patients with RRP have distal tracheal spread and as many as 7% of all patients with RRP at our institutions have pulmonary dissemination. Also, high suspicion for malignant conversion to squamous carcinoma in the patient with pulmonary spread should be maintained. In addition, aggressive treatment, although not proved to eradicate the pulmonary disease, should be undertaken due to the high morbidity and mortality associated with pulmonary dissemination of RRP in our cohort.

Adolescent↗
PubMed2002

Analysis by cDNA microarrays of altered gene expression in middle ears of rats following pneumococcal infection.

OBJECTIVE: Streptococcus pneumoniae is the most common pathogen in otitis media. Infection of the middle ear with S. pneumoniae potentiates development of thick effusion in the middle ear which frequently causes hearing loss and communication disorders in children. What has changed immediately in the middle ear cleft following pneumococcal infection is extensively studied and characterized but what has changed ever after remains elusive. The purpose of this study is to explore the cellular and molecular basis that remains on a longer time after acute pneucmococcal middle ear infection and potentiates development of thick effusion in the middle ear. METHODS: 12 rats were intrabullarly inoculated with pneumococcus at 2.5x10(6) CFU/ear and profiles of gene expression in the middle ear were examined by cDNA microarrays in combination with reverse transcription-polymer chain reaction (RT-PCR) 6 weeks after infection while the morphologic changes in middle ear were simultaneously characterized by histopathologic techniques. Twelve rats receiving phosphate-buffered saline (PBS) served as controls. RESULTS: it demonstrated that pneumococcus infected ears had the expression of the following genes at a high level compared to the controls: mitogenic signaling proteins (mitogen-activated protein kinase [MEK1 and MEK2], helix-loop-helix transcriptional regulators (Id3 and Id1), ion channels (sodium channel beta 1 and sodium channel 2), and mucin glycoproteins (Muc2 and Muc5). The morphology demonstrated a thickened mucosa and submucosa with increased expression of macroglycoconjugates compared to the controls. CONCLUSION: the expression of several genes remains high even after the acute episode of pneumococcal otitis media has been resolved. The up-regulated expression of these genes may serve as the basis for the development of thick effusion and mucous cell metaplasia/hyperplasia once it is complicated with other factors such as dysfunction of the Eustachian tube.

Animals↗
PubMed2002

Treatment of patients with spinal metastases from head and neck neoplasms.

BACKGROUND: Spinal metastases are uncommon in patients with advanced head and neck cancer. Treatment strategies in this patient group have not been defined. Although it has been established that neurologic dysfunction in patients with spinal metastases and cord compression constitutes an oncologic emergency, the role of surgical treatment remains controversial. OBJECTIVE: To clarify the treatment options in patients with head and neck cancer who develop spinal metastases. METHODS: The clinical course of patients seen at our institution with head and neck neoplasms and spinal metastases from January 1992 to January 2000 was reviewed. RESULTS: Eleven patients were identified. Nine developed spinal metastases more than 3 months after the diagnosis of advanced head and neck cancer. The other 2 presented with synchronous spinal involvement and skull base neoplasms. Patients without neurologic symptoms were offered intravenous steroids and palliative radiation. Patients with neurologic symptoms were treated with either intravenous steroids and radiation or surgical decompression and spinal fusion. In 1 patient, no improvement occurred within the first 2 days of radiotherapy, and the patient underwent surgical decompression. Patients with an unstable spine underwent surgical decompression and spinal fusion. Patients with a life expectancy of more than 6 months and neurologic symptoms were offered surgical therapy. In the 9 patients with advanced cancer, the average survival time was 3 months. Two of these patients have survived longer than 6 months. CONCLUSIONS: We propose that surgical decompression is a viable, justifiable option for selected patients with advanced head and neck cancer and spinal cord compression. Furthermore, we recommend surgical decompression as a first option in patients with an unstable bony spine and/or in whom survival is expected to be longer than 6 months. Finally, we propose a patient management algorithm in these cases.

Adult↗
PubMed2002

Squamous cell carcinoma of the head and neck in solid organ transplant recipients.

BACKGROUND: The increased incidence of cancer after solid organ transplantation is well established in the literature, yet outcome studies in this population are rare. Excluding skin cancers, squamous cell carcinomas make up most head and neck cancers in transplant recipients. METHODS: At our institution, of 5300 solid organ transplant recipients, 34 have had head and neck cancer develop. We reviewed the records of the 23 recipients whose cancer was treated here. RESULTS: Only 6 of the 23 recipients were alive at the time of our chart review. Of these, three had already survived 5 years. The 10 recipients diagnosed early (stage I or II) had significantly longer survival after cancer diagnosis than the 13 diagnosed at an advanced stage (stage III or IV) (96.0 mo vs 9.0 mo, p <.001). In all, 14 (60.8%) of the 23 recipients died of cancer within 2 years after diagnosis, 12 (50.2%) within 12 months. The sum of the daily doses of immunosuppressive drugs at cancer diagnosis was significantly greater for recipients who died within 2 years (p =.02). Furthermore, the difference in average doses of both prednisone (p =.001) and azathioprine (p =.028) was also significantly greater for those who died within 2 years. The average dose of cyclosporine was also greater, but this difference did not reach statistical significance (p =.18). The average dose of prednisone was significantly lower for recipients diagnosed early (p =.001). This correlation between high immunosuppressive drug doses and worse outcome has not been shown previously. CONCLUSIONS: Solid organ transplant recipients who are diagnosed with advanced head and neck cancer while receiving high doses of immunosuppressive drugs fare extremely poorly. High doses of immunosuppressive drugs, most notably prednisone, correlate significantly with advanced diagnosis of head and neck cancer and earlier death.

Anti-Inflammatory Agents↗
PubMed2002

Role of planned neck dissection for advanced metastatic disease in tongue base or tonsil squamous cell carcinoma treated with radiotherapy.

OBJECTIVE: At the conclusion of this article, the reader should be able to discuss the need for planned neck dissection for advanced cervical diseases in the tongue base and tonsil cancer after treatment with radiotherapy. BACKGROUND: In the past 5 years, we have treated patients with squamous cell carcinoma of the tonsil and tongue base with radiotherapy as the primary therapeutic modality. A planned complete neck dissection was performed on all patients with N2 or greater cervical disease regardless of response to radiotherapy. Composite resection was performed when there was persistent disease at the primary site. Although the "radiation-first" therapeutic approach for tongue base and tonsil cancer is widely accepted, the planned neck dissection for neck metastases remans controversial. The objective of the study was to determine the validity of planned neck dissection after radiotherapy for N2 disease. METHODS: Medical records of patients with primary squamous cell carcinoma of the tongue base and tonsil with neck metastasis staged N2 or greater were reviewed. Between 1994 and 1999, 36 such patients were treated with curative radiation therapy. Response was assessed 6 to 8 weeks after completion of treatment with clinical examination and CT imaging. All patients underwent planned neck dissection. We reviewed the clinical and radiographic response of neck disease to radiotherapy as it correlated with the histopathologic findings. RESULTS: Of the 36 patients, 17 had clinical and CT evidence of persistent disease. In this group, 65% had pathologically confirmed diseases at surgery. Of the 9 patients with no evidence of disease on clinical examination, negative biopsy at the primary site, and a negative CT scan, 33% (three of nine) still had residual disease in the neck dissection specimen. CONCLUSIONS: Positive findings on clinical examination and CT can predict the presence of malignancy after radiation therapy. However, a negative CT and clinical examination are limited in predicting a complete response. These data lend support to the role of planned neck dissection after radiotherapy of N2 neck disease.

Adult↗
PubMed2002

Metastatic head and neck squamous cell carcinoma to the brain.

BACKGROUND: To evaluate the natural history of patients with metastatic squamous cell carcinoma (SCCA) of the head and neck to the brain. METHODS: A retrospective review of patients with brain metastases treated over a 20-year period identified five that had a head and neck SCCA primary. RESULTS: Five cases of patients with SCCA of the head and neck that developed brain metastases are presented in detail. CONCLUSION: In patients with aggressive disease, large infiltrative lesions, and in late survivors with initially advanced disease, metastasis to the brain should be considered. Perineural metastasis appears to be the most common mode of spread of head and neck SCCA to the brain. Pain, paresis, or paresthesias in the distribution of cranial nerves or other neurological symptoms should alert the otolaryngologist to neural or central nervous system involvement in patients with SCCA of the head and neck. Surgery with or without post-operative whole brain radiation therapy is the mainstay of treatment in most patients. Stereotactic radiosurgery may play a major role in treating brain metastases from head and neck primary tumors.

Aged↗
PubMed2002

Correlating selection criteria with subsequent performance as residents.

The objective of this study was to determine which criteria in the residency application had the highest correlation with subsequent performance of orthopaedic residents. Data collected from the application files of 58 residents included scores on standardized tests, number of honors grades in the basic and clinical years of medical school, election to Alpha Omega Alpha, numbers of research projects and publications, and numbers of extracurricular activities. Measures of performance included scores on the Orthopaedic In-Training Examination and American Board of Orthopaedic Surgery Part I Examination, and faculty evaluations of overall, cognitive, affective, and psychomotor performance. The number of honors grades on clinical rotations was the strongest predictor of performance, whereas election to Alpha Omega Alpha was second. The only other significant correlation was between the number of fine motor activities and psychomotor performance. None of the predictor variables had a significant correlation with Orthopaedic In-Training Examination or American Board of Orthopaedic Surgery Examination scores. Consistency between faculty rankings in each of the four categories was supported by regression analysis. From the results of this study, it appears that academic performance in clinical clerkships in medical school is the most predictive of resident performance. Range restriction in the data available for orthopaedic residency applicants, however, likely precludes the development of a reliable model to assist in the selection of orthopaedic residents.

Clinical Competence↗