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Wade Chien

Publications and source records attributed to Wade Chien.

5 recordsLinked to original sources
PubMed2006

Type 1 laryngeal cleft: establishing a functional diagnostic and management algorithm.

OBJECTIVES: To report our experience with all patients diagnosed with type 1 laryngeal cleft over a period of 3 years in our referral practice and to describe a functional diagnostic and management algorithm for children with this disorder. METHODS: A prospective longitudinal study in a tertiary care referral center. Twenty pediatric patients diagnosed with type 1 laryngeal cleft in a 3-year period (5/1/2002-5/1/2005) were included in this study. The incidence, presenting symptoms, diagnostic procedures, medical and surgical interventions performed, and clinical outcomes were evaluated. RESULTS: The incidence of type 1 laryngeal cleft was 7.6%. Among the 20 patients in this study, aspiration with thin liquids was the most common presenting symptom (18 patients, 90%). Three patients underwent modified barium swallow (MBS) alone, 3 patients underwent functional endoscopic evaluation of swallow (FEES) alone, and 11 patients underwent both MBS and FEES prior to intraoperative endoscopic evaluation. Four patients (20%) were successfully treated with conservative therapy. Sixteen patients (80%) required endoscopic surgical repair after failing a course of conservative measures. The success rate of surgical repair was 94% (15 out of 16 patients). CONCLUSIONS: Type 1 laryngeal cleft can be challenging diagnostically. We propose a functional diagnostic and management algorithm that includes MBS, FEES, suspension laryngoscopy with bimanual interarytenoid palpation, and a trial of conservative therapy, as a way to diagnose and manage type 1 laryngeal cleft prior to consideration of surgical repair. If conservative therapy fails, then surgical intervention is indicated.

Algorithms↗
PubMed2006

The effect of methodological differences in the measurement of stapes motion in live and cadaver ears.

Methodological differences in sound-induced stapes velocity (Vs) measurements in live and cadaveric ears were examined using fresh cadaveric temporal bones. On average, differences in preparation (sectioning the stapedius tendon, removing the facial nerve, and widely opening the facial recess) had statistically insignificant effects on measured Vs. Differences in the achievable measurement angle (with respect to the axis of piston-like stapes motion) had a significant effect on measured Vs below 2 kHz. These results suggest that much if not all of the differences in Vs measurements between live and cadaveric ears can be explained by the differences in measurement angle between the two preparations. Measurement angle was found to have minimal effect on measured Vs above 2 kHz. This demonstrates that the commonly used method of estimating stapes translational velocity by dividing the measured velocity by the cosine of the measurement angle is not valid above 2 kHz.

Aged↗
PubMed2006

Risk of second primary malignancy after radioactive iodine treatment for differentiated thyroid carcinoma.

OBJECTIVES: The association between second primary malignancy (SPM) and radioactive iodine (RAI) is controversial. We examined the association between RAI and SPM after treatment of differentiated thyroid carcinoma (DTC) using a large cohort from a national cancer database. METHODS: From the Surveillance, Epidemiology and End Results (SEER) database, all index cases of DTC (papillary or follicular) were extracted for the years 1988 to 2001. Two cohorts were constructed: 1) patients with DTC who were not treated with RAI, and 2) patients with DTC who were treated with RAI. For each cohort, we tabulated all subsequent malignancies for each patient, identifying patients in each group with 1 or more SPMs. RESULTS: According to inclusion criteria, 18,882 cases of DTC treated without RAI (mean follow-up, 55.5 months) and 10,349 cases treated with RAI (mean follow-up, 61.8 months) were identified. The most common SPM sites were breast or prostate followed by colon or lung for both groups. On univariate analysis, SPMs developed in 6.7% of patients without RAI versus 4.8% of those with RAI (p < .001, univariate chi-squared). However, on multivariate analysis, only age and male gender had statistically significant hazard ratios (1.052 and 1.438, respectively; p < .001); follicular carcinoma histology and use of RAI did not influence occurrence of SPM after DTC (p = .180 and p = .789, respectively). CONCLUSIONS: Use of RAI does not elevate the risk of SPM. Concern about SPM induction should not adversely affect the decision to administer RAI for DTC.

Adenocarcinoma, Follicular↗
PubMed2005

Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps.

OBJECTIVE: The success of microvascular free-tissue transfer to the head and neck has been greatly increased secondary to increased experience, yet postoperative anticoagulation continues to be routinely used to prevent pedicle thrombosis. However, there is currently no consensus as to what the ideal regimen, if any, is recommended for postoperative anticoagulation. This study reviews the outcome and incidence of perioperative complications in patients undergoing free flaps for head and neck reconstruction, using a simple postoperative anticoagulation regimen of aspirin and subcutaneous heparin (SQH). DESIGN: Retrospective chart review. METHODS: With institutional review board approval, the charts of 261 patients undergoing free flap reconstruction from January 2000 to January 2004 were retrospectively reviewed. Patients who received a standard postoperative anticoagulation regimen of SQH (5000 U SC bid) and aspirin (325 mg PO qd) were included in the study (216 patients). Charts were reviewed for postoperative complications, specifically for free flap failure, vascular compromise (arterial insufficiency/venous congestion), and hematoma. RESULTS: There were six flap failures (2.8%), resulting in an overall free flap survival rate of 97.2%. There were six patients with venous congestion of the flap that required neck exploration (2.8%), and 12 patients with postoperative hematoma (5.6%), requiring surgical intervention. CONCLUSION: The free flap survival rate in patients undergoing head and neck reconstruction using this simple anticoagulation regimen of aspirin and SQH appears to be equivalent to the free flap survival rate in patients using other anticoagulation agents. In addition, aspirin and SQH do not increase the incidence of postoperative hematoma when compared with the other anticoagulation agents. Therefore, aspirin and SQH appear to be reliable postoperative anticoagulation agents for patients undergoing head and neck reconstruction using free flaps.

Adolescent↗