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David G Pfister,
Kie-Kian Ang,
David M Brizel,
Barbara Burtness,
Anthony J Cmelak,
A Dimitrios Colevas,
Frank Dunphy,
David W Eisele,
Jill Gilbert,
Maura L Gillison, [......],
John A Ridge,
Sandeep Samant,
Giuseppe Sanguineti,
David E Schuller,
Jatin P Shah,
Sharon Spencer,
Andrea Trotti,
Randal S Weber,
Gregory Wolf,
Frank Worden
Journal of the National Comprehensive Cancer Network: JNCCN 03/2012; 10(3):320-38. · 4.41 Impact Factor
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ABSTRACT: Previous reports on postoperative outcomes following thyroid and parathyroid surgery are limited by relatively small sample size. We report 30-day outcomes following thyroid and parathyroid surgery and analyze factors affecting length of stay (LOS) and postoperative adverse events (AEs).
The multicenter, prospective, National Surgical Quality Improvement Program (NSQIP) datasets (2007/2008) were used. Multivariable logistic regression and analysis of covariance (ANCOVA) were performed.
Patients undergoing thyroidectomy, parathyroidectomy, or both were identified (n = 13,380, 6154, 1535, respectively). Thirty-day mortality was 0.08%, 0.16%, and 0.2%, respectively; 30-day morbidity was 3.50%, 3.02%, and 4.04%, respectively. Mean LOS values were 1.1 ± 1.4, 1.1 ± 2.1, and 1.4 ± 3.1 days, respectively. Congestive heart failure, dependent functional status, dialysis dependence, and chronic corticosteroid use were significantly associated with increased LOS and postoperative AE.
Morbidity and mortality rates following thyroid and parathyroid surgery are low. These data could be used by third-party interests, and surgeons should be aware of them to ensure their outcomes are in the national norm.
Head & Neck 06/2011; 34(4):477-84. · 2.40 Impact Factor
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David G Pfister,
Kie-Kian Ang,
David M Brizel,
Barbara A Burtness,
Anthony J Cmelak,
A Dimitrios Colevas,
Frank Dunphy,
David W Eisele,
Jill Gilbert,
Maura L Gillison, [......],
John A Ridge,
Sandeep Samant,
Giuseppe Sanguineti,
David E Schuller,
Jatin P Shah,
Sharon Spencer,
Andy Trotti,
Randal S Weber,
Gregory T Wolf,
Frank Worden
Journal of the National Comprehensive Cancer Network: JNCCN 06/2011; 9(6):596-650. · 4.41 Impact Factor
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ABSTRACT: The risk-benefit analysis of any operation is influenced by its perioperative complications. Our objective was to examine the relationship between preoperative clinical characteristics and postoperative respiratory failure (PRF: mechanical ventilation for >48 hours after surgery or reintubation) within 30 days of thyroid and parathyroid surgeries.
American College of Surgeons' multicenter, prospective, National Surgical Quality Improvement Program (NSQIP) datasets (2007/2008) were used. Multivariable logistic regression was performed.
Eighty-three of 20,778 (0.4%) patients developed PRF. Comparing patients who developed PRF to those who did not, 30-day mortality was seen in 13 of 83 versus 11 of 20,695 patients (p < .0001); and mean length of stay (LOS) was 9.1 (±9.5) days versus 1.1 (±1.6) days (p < .0001). Multivariable analysis demonstrated preoperative pneumonia, dependent functional status, dyspnea, dialysis dependence, hypertension, advanced age, and combined thyroid and parathyroid surgery as risk factors for PRF.
PRF after thyroid and parathyroid surgeries is uncommon, but associated with significantly increased 30-day morbidity and mortality.
Head & Neck 03/2011; 34(3):321-7. · 2.40 Impact Factor
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R Michael Tuttle,
Douglas W Ball,
David Byrd,
Raza A Dilawari,
Gerard M Doherty,
Quan-Yang Duh,
Hormoz Ehya,
William B Farrar,
Robert I Haddad,
Fouad Kandeel, [......],
Judith C McCaffrey,
John A Olson,
Lee Parks,
John A Ridge,
Jatin P Shah,
Steven I Sherman,
Cord Sturgeon,
Steven G Waguespack,
Thomas N Wang,
Lori J Wirth
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ABSTRACT: Overview Epidemiology Thyroid nodules are approximately 4 times more common in women than in men. Palpable nodules increase in frequency throughout life, reaching a prevalence of approximately 5% in the United States population aged 50 years and older.(1-3) Nodules are even more prevalent when the thyroid gland is examined at autopsy or surgery, or when using ultrasonography, and 50% of these have nodules, which are almost always benign.(2,4) New nodules develop at a rate of approximately 0.1% per year beginning in early life, but at a much higher rate (∼2% per year) after exposure to head and neck irradiation.(5,6) By contrast, thyroid carcinoma is uncommon. For the United States population, the lifetime risk of being diagnosed with thyroid carcinoma is less than 1% (0.83% for women and 0.33% for men).(7) Approximately 37,200 new cases of thyroid carcinoma were diagnosed in the United States in 2009.(8) As with thyroid nodules, thyroid carcinoma occurs 2 to 3 times more often in women than in men. With the incidence increasing by 6.2% per year, thyroid carcinoma is currently the sixth most common malignancy diagnosed in women.(8) Among persons age 15 to 24 years, thyroid carcinoma accounts for 7.5% to 10% of all diagnosed malignancies.(9-11) The disease is also diagnosed more often in white North Americans than in African Americans. Although thyroid carcinoma can occur at any age, the peak incidence from 2004 to 2006 was near age 45 to 49 years in women and 65 to 69 years in men.(7) Thyroid carcinoma has...
Journal of the National Comprehensive Cancer Network: JNCCN 11/2010; 8(11):1228-74. · 4.41 Impact Factor
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ABSTRACT: The Portraits of Care study used portraiture to investigate ideas about care and care giving at the intersection of art and medicine. The study employed mixed methods involving both qualitative and quantitative research techniques. All aspects of the study were approved by the Institutional Review Board. The study included 26 patient and 20 caregiver subjects. Patient subjects were drawn from across the lifespan and included healthy and ill patients. Caregiver subjects included professional and familial caregivers. All subjects gave their informed consent for the study and the subsequent exhibition of artwork. The artist drew or painted 100 portraits during the 2-year study. A multi-disciplinary analysis team carried out the initial analysis of portraits and subject data. Findings from their qualitative analysis were used to develop a quantitative survey and qualitative journal tool that the public used to give feedback at the subsequent exhibition. Exhibition data confirmed the initial findings. Study results showed the introspection of subjects that revealed their sense of identity and psychological status. Patients appear as 'whole people', not fragmented by diagnosis. Caregivers' portraits reveal their commitment to care. There is also a sense of mutuality and fluidity in the background stories of subjects. Many patient subjects have been caregivers and, at times, caregivers are also patients. Public data emphasised the identity transformation of subjects, the centrality of the idea of mortality, the presence of hope despite adversity, and the importance of empathy and compassion in care.
Medical Humanities 06/2010; 36(1):5-13.
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R Michael Tuttle,
Douglas W Ball,
David Byrd,
Gilbert H Daniels,
Raza A Dilawari,
Gerard M Doherty,
Quan-Yang Duh,
Hormoz Ehya,
William B Farrar,
Robert I Haddad, [......],
Judith McCaffrey,
John A Olson,
Lee Parks,
John A Ridge,
Jatin P Shah,
Steven I Sherman,
Cord Sturgeon,
Steven G Waguespack,
Thomas N Wang,
Lori J Wirth
Journal of the National Comprehensive Cancer Network: JNCCN 05/2010; 8(5):512-30. · 4.41 Impact Factor
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ABSTRACT: Head and neck cancer patients experience among the highest rates of major depressive disorder of all oncology patients with an incidence of 15-50%. Correct diagnosis is critical to expeditious management. Oncologists are not always adept at making the diagnosis as medical and treatment side effects can mimic the signs and symptoms of depression. Treatment can be successful and typically involves medical, social, and psychologic interventions. Causes of depression, obtaining an accurate diagnosis, and treatment options are all discussed in this review.
Clinical advances in hematology & oncology: H&O 07/2009; 7(6):397-403.
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ABSTRACT: To determine if depression portends a worse prognosis in patients with head and neck cancer, we conducted a retrospective chart analysis of subjects who participated in a randomized placebo-controlled trial of citalopram for the prevention of depression during head and neck cancer treatment. Thirty-five patients were randomized, 34 with 1 or more evaluations form the basis of this report.
We used the Hamilton Depression Rating Scale (HDRS), with a minimum follow-up of 24 months if no evidence of disease, or until recurrence or death from disease.
Fourteen of 34 subjects were depressed at any time during the 16 week RCT (HAMD >15). Seven of the 14 subjects in the depressed group were dead from disease or had recurrence, compared to 4 of 20 who never developed depression (p = .03). Stage of disease was equivalent in the 2 groups.
This study suggests that depression in patients with head and neck cancer reduces survival.
Head & Neck 04/2009; 31(7):888-92. · 2.40 Impact Factor
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Archives of otolaryngology--head & neck surgery 12/2008; 134(12):1345-1346. · 1.92 Impact Factor
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Arlene A Forastiere,
Kie-Kian Ang,
David Brizel,
Bruce E Brockstein,
Barbara A Burtness,
Anthony J Cmelak,
Alexander D Colevas,
Frank Dunphy,
David W Eisele,
Helmuth Goepfert, [......],
Marshall R Posner,
John A Ridge,
Sandeep Samant,
David E Schuller,
Jatin P Shah,
Sharon Spencer,
Andy Trotti,
Randal S Weber,
Gregory T Wolf,
Frank Worden
Journal of the National Comprehensive Cancer Network: JNCCN 09/2008; 6(7):646-95. · 4.41 Impact Factor
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ABSTRACT: The TNM system is a widely accepted prognostic system worldwide. Limitations in prognostic accuracy are recognized but have remained for fear the remedy would unnecessarily complicate the system. Understanding of the genetic and molecular mechanisms of cancer will allow the gap between the ideal and the practical prognostic system to be closed and the staging system drastically revised to a modular structure. Novel computational technology, which is reliable and reproducible, is likely to provide the basis for such a modular prognostic system.
Journal of Surgical Oncology 07/2008; 97(8):653-7. · 2.10 Impact Factor
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ABSTRACT: To determine whether prophylactic treatment with the antidepressant citalopram hydrobromide, compared with placebo, could prevent major depressive disorder in patients undergoing therapy for head and neck cancer (HNC).
Prospective, randomized, placebo-controlled trial.
Academic medical center.
Thirty-six subjects were randomized, and 23 completed the study.
Subjects were randomized to receive 40 mg of citalopram hydrobromide or matching placebo (herein after, citalopram group and placebo group, respectively) for 12 weeks with a final visit at 16 weeks.
The Hamilton Depression Rating Scale, psychiatric interview, and the University of Washington Quality of Life (UW-QOL) and Clinician Global Impression-Severity (CGI-S) scales.
The numbers of subjects who met predefined cutoff criteria for depression during the 12 weeks of active study were 5 of 10 (50%) taking placebo and 2 of 12 (17%) taking citalopram (Fisher exact test, P = .17). No patients in the citalopram group became suicidal, compared with 2 in the placebo group. Global mood state at the conclusion of the study as measured by the CGI-S scale was rated as at least mildly ill in 15% of those receiving citalopram compared with 60% in the placebo group (Fisher exact test, P = .04). Quality of life, measured by the UW-QOL, deteriorated in both groups from baseline but less so in the citalopram group.
This study reports data from the first depression prevention trial in HNC and suggests that prophylactic treatment may decrease the incidence of depression during HNC therapy. The clinical significance of the reduction in depression was best demonstrated by the CGI-S scale, which showed a notable difference in global psychiatric and physical well-being.
Archives of otolaryngology--head & neck surgery 06/2008; 134(5):528-35. · 1.92 Impact Factor
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Steven I Sherman,
Peter Angelos,
Douglas W Ball,
David Byrd,
Orlo H Clark,
Gilbert H Daniels,
Raza A Dilawari,
Hormoz Ehya,
William B Farrar,
Robert F Gagel, [......],
Dominick M Lamonica,
Thom R Loree, William M Lydiatt,
Judith McCaffrey,
John A Olson,
John A Ridge,
Jatin P Shah,
James C Sisson,
R Michael Tuttle,
Marshall M Urist
Journal of the National Comprehensive Cancer Network: JNCCN 08/2007; 5(6):568-621. · 4.41 Impact Factor
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ABSTRACT: Synovial sarcoma is a malignant mesenchymal tumor composed of varying proportions of spindle and epithelial cell components. Because of the histologic and immunohistochemical similarity of synovial sarcoma to epithelial carcinomas, we hypothesized that the human epithelial growth factor receptor 2 (C-erb-B2, also termed HER2/neu) may contribute to the tumor phenotype and provide a new therapeutic target for this soft tissue tumor.
Three head and neck, one chest wall, and seven extremity synovial sarcomas were evaluated for C-erb-B2 (HER2/neu) expression by immunohistochemistry, Western immunoblotting, and fluorescence in situ hybridization (FISH).
The head and neck cases demonstrated immunohistochemically strong positive staining, whereas tumors from other anatomic locations showed neither positive nor cytoplasmic restricted staining. Antigen-targeted antibody therapy (trastuzumab) was initiated in two patients.
These results demonstrate that C-erb-B2 (HER2/neu) may play a role in the tumorigenesis of synovial sarcoma; and, therefore, antigrowth factor therapies may provide a previously unrecognized pharmaceutical approach to soft tissue tumors. The data also suggest that although synovial sarcoma of the head and neck and synovial sarcoma of the extremities have similar morphologic features, they may be clinically and mechanistically distinct entities.
Head & Neck 11/2005; 27(10):883-92. · 2.40 Impact Factor
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Arlene A Forastiere,
Kian Ang,
David Brizel,
Bruce Earl Brockstein,
Frank Dunphy,
David W Eisele,
Helmuth Goepfert,
Wesley L Hicks,
Merrill S Kies, William M Lydiatt, [......],
John A Ridge,
Sandeep Samant,
David E Schuller,
Jatin P Shah,
Sharon Spencer,
Andrew Trotti,
Richard H Wheeler,
Gregory T Wolf,
Frank Worden,
Bevan Yueh
Journal of the National Comprehensive Cancer Network: JNCCN 06/2005; 3(3):316-91. · 4.41 Impact Factor
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Steven I Sherman,
Peter Angelos,
Douglas W Ball,
Samuel W Beenken,
David Byrd,
Orlo H Clark,
Gilbert H Daniels,
Raza A Dilawari,
Hormoz Ehya,
William B Farrar, [......],
Dominick M Lamonica,
Thom R Loree, William M Lydiatt,
Judith McCaffrey,
John A Olson,
John A Ridge,
Richard Robbins,
Jatin P Shah,
James C Sisson,
Norman W Thompson
Journal of the National Comprehensive Cancer Network: JNCCN 06/2005; 3(3):404-57. · 4.41 Impact Factor
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ABSTRACT: The small leucine-rich proteoglycan decorin has been associated with negative regulation of cell growth. It has a prominent role in transforming growth factor (TGF)-beta and epidermal growth factor receptor activation pathways that contributes to its role in cellular proliferation, angiogenesis, and immunomodulation. Our studies are directed toward analysis of decorin gene expression, identified through DNA microarray studies, in oral premalignant and malignant tissues as well as representative cell lines of an oral cancer progression model. We have used long oligonucleotide microarray analysis, immunohistochemistry, confocal microscopy, reverse transcription-PCR, sequencing, and Western immunoblot techniques to characterize decorin expression in oral premalignant archival tissues and an oral cancer progression cellular model. We have further analyzed the deduced amino acid sequence derived from full-length cDNA that do not show any deletion or mutations of the decorin expressed in oral premalignant and malignant cell lines. In our studies, we show aberrant expression of decorin in dysplastic oral epithelial cells. Both promoters P1 and P2 drive the aberrant expression resulting in exon 1a as well as exon 1b carrying transcripts. Intracellular accumulation and nuclear localization of aberrantly expressed decorin were observed in dysplastic oral tissues and in the respective cell lines. Decorin expressed in oral cancer may have lost its ability to inhibit TGF-beta signaling and activate epidermal growth factor receptor signaling pathways because of such aberrant nuclear localization, resulting in a major dysfunction of otherwise a natural extracellular antagonist of TGF-beta and a putative tumor suppressor protein. The aberrant nuclear localization of a leucine-rich repeat protein might result in additional protein-protein interactions and resulting changes in gene expression. Further studies to characterize such interacting proteins and localization-dependent effects of aberrant decorin expressed in oral cancer progression are warranted.
Cancer Research 12/2003; 63(22):7769-76. · 7.86 Impact Factor
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ABSTRACT: Obturators have been developed for surgical defects caused by cancer of the maxillary sinus and alveolar ridge. Outcome research is necessary to develop evidence-based practice guidelines.
Thirty-two consecutively treated maxillectomy patients seen in the Facial Prosthetics Clinic at UNMC from 1994 through 1996 had their defects obturated for 1 month when speech intelligibility, speaking rate, nasality, and communication effectiveness were measured.
With the obturator removed, mean speech intelligibility was 61%, speaking rate was 138 words per minute, and nasality was rated as 5.8 on a 0-7 point scale. With the obturator inserted, mean speech intelligibility was 94%, speaking rate was 164 words per minute, and nasality was rated as 1.6. The mean self-perception of communication effectiveness was 75% of what it was before the diagnosis of cancer.
Obturation is an effective intervention for defects of the maxillary sinus and alveolar ridge on speech performance. Variations in effectiveness were noted based on site of defect and patient satisfaction with the intervention.
Head & Neck 07/2002; 24(6):530-8. · 2.40 Impact Factor
