Biomedical subjects

J Scott Magnuson

Publications and source records attributed to J Scott Magnuson.

11 recordsLinked to original sources

PubMed2007

Influence of social support on health-related quality of life outcomes in head and neck cancer.

BACKGROUND: Evidence that social support influences health-related quality of life (HRQOL) in oncologic patients could be particularly important for head and neck cancer because this disease can affect speech, eating, and facial aesthetics. METHODS: Multiple regression analyses were used in this prospective, observational study to determine the association between 394 patients' ratings of perceived post-treatment social support and HRQOL outcomes while controlling for possible confounding variables. RESULTS: Higher social support scores were significantly associated with higher scores in speech (p = .007), aesthetics (p = .015), social disruption (p = .045), and general mental health (p = .016) and with fewer depressive symptoms (p = .023) but not with general physical health (p = .191) or eating (p = .114). The magnitude of differences in the HRQOL outcomes for patients whose social support scores fell in the lowest and highest quartiles were clinically meaningful. CONCLUSIONS: Given the association between social support and HRQOL outcomes in this patient population, modification of perceived social support through clinical interventions could improve the survivorship of these patients.

Aged↗

PubMed2006

Persistent posttreatment depressive symptoms in patients with head and neck cancer.

BACKGROUND: This study examined the prevalence and risk factors of persistent (versus short-term) depressive symptoms in patients with head and neck cancer. METHODS: Patients with 10+ and 18+ posttreatment Beck Depression Inventory scores for 6 or more months during their first year were identified. Regression analyses determined risk factors associated with persistently high scores. RESULTS: Of the 148 patients, 25.0% and 7.4% were persistently above the 10+ and 18+ cutoff scores, respectively (compared with 33.6% to 44.2% and 9.2% to 18.6% when measured at single points across this time period.) The strongest predictor of persistent posttreatment depressive symptoms was pretreatment depressive symptoms. CONCLUSIONS: The percentage of patients with persistently high levels of depressive symptoms, although considerable, is substantially lower when patients with transient mood disorders are omitted. A screening tool that determines high levels of pretreatment depressive symptoms could identify patients at high risk of experiencing posttreatment depression who would be good candidates for clinical intervention.

Aged↗

PubMed2006

In vivo detection of head and neck cancer orthotopic xenografts by immunofluorescence.

PURPOSE: To determine whether Cy5.5-labeled antiepidermal growth factor (EGFR) antibody could be used to detect head and neck squamous cell carcinoma (HNSCC) xenografts in vivo. METHODS: AntiEGFR antibody (cetuximab) was labeled with Cy5.5, a fluorophore with emission in the near infrared range. The cetuximab-Cy5.5 conjugate was systemically administered in subtherapeutic doses (50 microg) to mice bearing orthotopically xenografted HNSCC cell lines (SCC1, CAL27, and FaDu). As a control, isotype-matched human immunoglobulin (Ig)G1k antibody labeled with Cy5.5 was systemically injected in parallel experiments. All tumor regions (n = 6) were imaged by fluorescent stereomicroscopy at 0, 6, 24, 48, or 72 hours. Tumor size was measured by high-frequency ultrasonography at 72 hours. Transcervical partial and near-total resections were then performed with stereomicroscopic imaging after each resection. The mandible and associated structures were then resected, paraffin embedded, and then serial sectioned for analysis. RESULTS: Tumors could be clearly visualized by near infrared fluorescent stereomicroscopy at 48 and 72 hours after systemic administration of cetuximab-Cy5.5 but not after administration with the labeled isotype control antibody, IgG1k-Cy5.5. Ultrasound measurement of tumors (n = 5) correlated with fluorescent measurements of tumor (Spearman's coefficient, 0.92, P </= .01). When fluorescent stereomicroscopic findings were correlated with histologic findings in near-total resections, this technique could accurately identify residual tumor less than 1 mm in size. CONCLUSION: Fluorescent immunoguided neoplasm detection may be used as a diagnostic tool and to guide surgical therapy by providing real-time imaging information about the extent of disease or the presence of residual disease.

Animals↗

PubMed2006

Expandable tracheal stenting for benign disease: worth the complications?

OBJECTIVES: To characterize the limitations of self-expandable stents in the management of benign tracheal stenosis, we performed a retrospective review at a tertiary care medical center. METHODS: Patients who underwent tracheal stenting were assessed for the cause and severity of tracheal stenosis, comorbidities, stent-related complications, and follow-up airway procedures. RESULTS: Sixteen adults (12 women, 4 men; mean age, 47 years) had a total of 26 stents placed for benign disease. Intubation-related stenoses were most frequent (81%). The average follow-up time was 20 months (range, 1 to 40 months). Each stent remained functional for an average of 12.4 months. In the study group, 87% had a complication that required surgical intervention to maintain a patent airway. The most common problem was granulation tissue formation at the ends of the stent causing airway restenosis (81%), and 5 patients (31%) required tracheotomy as a result of restenosis around the stent. Fourteen of the stents (56%) were removed or expelled from the patients. CONCLUSIONS: The implantation of self-expandable stents is a minimally invasive method of managing benign tracheal stenosis. Although a small subset of patients may benefit from placement, the majority of patients have complications that require intervention to maintain a patent airway. Thoughtful discretion is critical in selecting patients for this intervention.

Adult↗

PubMed2006

Use of negative-pressure dressings to manage a difficult surgical neck wound.

We used negative-pressure dressings to treat a poorly healing cervical rotation flap following radical neck dissection in an elderly man. The wound had failed to heal properly after 2 weeks of conservative management. Following application of the negative-pressure dressings, the wound granulated quickly and healed well by secondary intention.

Aged↗

PubMed2004

Expression of proteolytic enzymes in head and neck cancer-associated fibroblasts.

OBJECTIVE: To elucidate tumor-stromal interactions during tumor invasion by assessing the expression of proteolytic enzymes by carcinoma-associated fibroblasts (CAFs) in vivo using complementary DNA (cDNA) array analysis. METHODS: Tumor-associated stroma was isolated from tumor and adjacent mucosal specimens of the same patient by laser capture microdissection, and the messenger RNA (mRNA) was assessed by cDNA microarray specific for proteolytic enzymes and their inhibitors. Protein overexpression was then analyzed by immunoblotting of primary fibroblast isolates derived from skin, mucosa, and tumor specimens. RESULTS: Array analysis of 4 tumor and 4 adjacent mucosal samples demonstrated significant (2.6-fold) overexpression of membrane type 1 matrix metalloproteinase (MT1-MMP) but not of serine proteases or other matrix metalloproteinases. Analysis of normal dermal fibroblasts, normal mucosal fibroblasts, and CAFs similarly demonstrated up-regulation of MT1-MMP. CONCLUSIONS: These results suggest that MT1-MMP mRNA is specifically up-regulated in CAFs in vivo whereas MT1-MMP protein is specifically up-regulated in CAFs in vitro. Known to induce tumor cell invasion when expressed in tumor cells, CAF expression of MT1-MMP may be important in the stromal response to tumor cells that characterizes the desmoplastic reaction.

Biomarkers, Tumor↗

PubMed2004

Simplifying head and neck microvascular reconstruction.

BACKGROUND: Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. METHODS: This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. RESULTS: Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. CONCLUSIONS: This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results.

Adult↗

PubMed2004

The effects of upper airway surgery for obstructive sleep apnea on nasal continuous positive airway pressure settings.

OBJECTIVES/HYPOTHESIS: The objectives were to determine whether upper airway surgery lowers nasal continuous positive airway pressure (CPAP) settings for patients who require CPAP postoperatively for unresolved obstructive sleep apnea and to assess CPAP tolerability after upper airway surgery. STUDY DESIGN: Retrospective chart review. METHODS: Patients who underwent upper airway surgery with preoperative and postoperative polysomnography at the University of Alabama at Birmingham (Birmingham, AL) between 1995 and 2000 were the focus of the study. Upper airway surgery was defined as uvulopalatopharyngoplasty alone or in addition to septoplasty and turbinoplasty. Recommended CPAP settings were recorded from preoperative and postoperative polysomnography studies to determine whether CPAP settings were decreased following surgery. A response to surgery was defined as a decrease of the recommended CPAP setting by at least 1 cm of water. A telephone interview was conducted to determine whether upper airway surgery improved CPAP comfort. RESULTS: In 51.4% of the patients, CPAP settings were decreased following surgery. Continuous positive airway pressure settings were increased in 28.6% of patients and unchanged in 20%. Of the six patients who consistently used CPAP before and after surgery, four reported increased comfort postoperatively. CONCLUSION: Upper airway surgery does not predictably reduce CPAP settings in the patient who requires postoperative CPAP for unresolved obstructive sleep apnea. Upper airway surgery may improve CPAP tolerability.

Adult↗

PubMed2003

Use of the endoscopic microdebrider in the management of airway obstruction from laryngotracheal carcinoma.

Endoscopic debridement of obstructing laryngotracheal carcinoma with the microdebrider is an alternative to CO2 laser excision or emergency tracheotomy. This is a retrospective study of 27 patients with advanced laryngotracheal carcinoma treated with the microdebrider for airway obstruction from 1998 to 2002. In 26 patients, the carcinoma was debrided successfully and tracheotomy was safely avoided. Postoperative bleeding was encountered in 1 patient with a coagulopathy. Two of the patients later required tracheotomy during radiotherapy secondary to radiation-induced laryngeal edema. Both were safely managed without acute airway compromise. Laryngeal debridement provided up to 3 months of stable airway until definitive oncological treatment was performed. Endoscopic microdebridement of obstructing carcinoma is a relatively simple and highly accurate approach to restoring a stable airway. It provides extra time for preoperative oncological, psychological, and nutritional planning.

Adult↗

PubMed2002

Free tissue transfer versus pedicled flap in head and neck reconstruction.

OBJECTIVES: Free flaps are often criticized as being medically risky for the patient, expensive, and too time-consuming when compared with the traditional rotational flap repair. Perhaps the costs do not outweigh the benefits. The study analyzes many aspects of resource utilization and patient outcome to determine whether these criticisms hold true. STUDY DESIGN: Retrospective patient review. METHODS: Sixty-five patient charts were reviewed. The following data were abstracted: flap type, tumor location and stage, preoperative American Society of Anesthesiologists score, preoperative irradiation, postoperative medical complications, flap outcome, length of hospital stay, date of first intake by mouth, and date of decannulation. The data were analyzed for free flaps and rotational flaps. Then data were analyzed again for free and rotational flaps performed for only patients who underwent a composite resection, to further standardize the results. RESULTS: For all defect types, free flap operative time was statistically greater (9 h 35 min for free flaps vs. 4 h 58 min for rotational flaps). Regarding hospital charges, only patients who had a free flap after composite resection differed in amount charged when free versus rotational flaps were compared (53,585 dollars for free flaps vs. 32,984 dollars for rotational flaps). Length of intensive care unit stay differed between patients having composite resection of the two flap types (0.1 d after rotational flap vs. 1.4 d after free flap). CONCLUSIONS: The differences between the two reconstruction methods are only a few. We do not think that longer operative time, longer length of intensive care unit stay, and increased hospital charges are significant enough to deny a patient a superior repair. We also think that as surgeons' experience increases, these differences may one day no longer hold true.

Female↗

PubMedDate not supplied

Preemptive vessel dilator cricothyrotomy aids in the management of upper airway obstruction.

PURPOSE: Our objective was to demonstrate that preemptive vessel dilator cricothyrotomy may be useful when managing the patient with airway obstruction. METHODS: An Institutional Review Board approved retrospective study was undertaken in 88 patients for whom this technique was selected. The anesthesiologists and surgeons identified as authors were directly involved in the care of these patients. All vessel dilator cricothyrotomies were performed in the operating rooms of University Hospital, UAB, Medical Center. The patients selected for this airway management technique were afflicted with some type of supraglottic lesion, usually squamous cell carcinoma, which was obstructing their airways to an extent that complete airway obstruction during induction of anesthesia was a significant possibility. Prior to induction of anesthesia, the vessel dilator was inserted into the tracheal lumen through the cricothyroid membrane as described. Oxygenation was maintained with jet ventilation from a Sanders jetting device. Age, sex, weight, initial and lowest O(2) saturation, first recorded ETCO(2), blood pressure and duration of jet ventilation were recorded. RESULTS: The airways were successfully managed in all 88 patients with this technique. There were no deaths, and no postoperative hypoxic sequelae; also complications were minor. CONCLUSION: Vessel dilator cricothyrotomy as a preemptive procedure in the management of patients with significant supraglottic airway obstruction may be a useful addition to the anesthesiologists' armamentarium of airway management devices.

Adult↗