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Biomedical subjects

Matthew Posner

Publications and source records attributed to Matthew Posner.

4 recordsLinked to original sources
PubMed2006

Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors.

PURPOSE: While targeted inhibitors of tyrosine kinase activity demonstrate dramatic efficacy in the majority of patients with advanced gastrointestinal stromal tumors (GISTs), cure remains elusive and resistance to systemic therapy is a challenge. To assess the role of surgery in multimodality management of GISTs, we studied postoperative outcomes in patients treated with targeted kinase inhibitors for advanced GIST. METHODS: We evaluated outcomes in a single institution series of 69 consecutive patients who underwent surgery for advanced GISTs while receiving kinase inhibitors. Patients were categorized based on extent of disease before surgery (stable disease, limited disease progression, generalized disease progression) and surgical result (no evidence of disease, minimal residual disease, bulky residual disease). RESULTS: Disease status before surgery was associated with surgical result (P < .0001; median follow-up, 14.6 months). After surgery, there was no evidence of disease in 78%, 25%, and 7% of patients with stable disease, limited progression, and generalized progression, respectively. Bulky residual disease remained after surgery in 4%, 16%, and 43% of the patients with stable disease, limited progression, and generalized progression. Twelve-month progression-free survival was 80%, 33%, and 0% for patients with stable disease, limited progression, and generalized progression (P < .0001). Twelve-month overall survival was 95%, 86%, and 0% for patients with stable disease, limited progression, and generalized progression (P < .0001). CONCLUSION: Patients with advanced GISTs exhibiting stable disease or limited progression on kinase inhibitor therapy have prolonged overall survival after debulking procedures. Surgery has little to offer in the setting of generalized progression.

Adult↗
PubMed2006

Treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast.

BACKGROUND: Initial treatment of Eichenholtz stage I Charcot arthropathy of the foot generally is total contact casting and nonweightbearing. This method, however, often is time-consuming and has a poor result. This study was done to determine the success rate of total contact casting in a small group of patients and to establish a benchmark time period for treatment. METHODS: Ten subjects with acute Eichenholtz stage I (stage of development) Charcot foot arthropathy were prospectively treated with weightbearing total contact cast therapy, undergoing biweekly cast changes. One subject did not complete the study. Subjects were monitored with biweekly clinical examination, limb volume measurement, and radiographs. The average age was 58.2 (range 39 to 72) years and weight was 216.9 (range 160 to 275) pounds. RESULTS: All subjects were able to use commercially available depth-inlay shoes and custom accommodative foot orthoses at an average of 9.2 (range 8 to 16) weeks. One subject developed a superficial ulcer that resolved with footwear modification. CONCLUSION: This preliminary study supports the use of total contact cast therapy and weightbearing in the treatment of acute Charcot foot arthropathy. When the total contact cast was changed every 14 days, all subjects were able to use commercially available depth-inlay shoes and custom orthoses.

Adult↗
PubMed2002

The use of readily available equipment in a simple method for intraoperative monitoring of recurrent laryngeal nerve function during thyroid surgery: initial experience with more than 300 cases.

HYPOTHESIS: An inexpensive and widely applicable technique to monitor recurrent laryngeal nerve (RLN) function during thyroid surgery can be safely implemented. DESIGN: Consecutive sample. SETTING: Single-surgeon academic practice. PATIENTS: Three hundred sixty-three consecutive patients undergoing surgery for thyroid disease in the 18 months from November 1, 1999, to May 31, 2001. INTERVENTIONS: Anesthetic management using laryngeal mask airway and spontaneous ventilation, combined with electrical RLN stimulation and fiberoptic video laryngoscopy to confirm vocal cord response. MAIN OUTCOME MEASURES: Vocal cord response to RLN stimulation, intraoperative anatomic findings, postoperative voice quality, and anesthetic complications. RESULTS: We used the laryngeal mask airway-based technique in 327 cases. Visualization of vocal cords was maintained throughout the surgery in 310 cases (95%). In 10 cases (3%), the branch of the RLN carrying vocal cord function could not be identified until electrical testing was performed. A single inadvertent RLN palsy was seen in 1 of the 17 cases in which vocal cord visualization was lost during the procedure (0.03% overall). Upper airway obstruction occurred in 16 (5%) of 327 attempted procedures, requiring tracheal intubation in 3 (1%). No further complications regarding airway management were seen. Pneumothorax was observed in 5 cases (2%), each of which resolved without chest tube placement. CONCLUSIONS: This technique can be applied to thyroid surgery as a safe means of managing the airway. It is associated with an ability to test RLN function at will in more than 95% of cases using readily available equipment.

Bronchoscopy↗