D. Deschler - Academia.edu (original) (raw)

Papers by D. Deschler

Journal of Clinical Oncology, 2011

5579 Background: Salivary gland cancers (SGCs) are rare and heterogeneous malignancies, with SDC ... more 5579 Background: Salivary gland cancers (SGCs) are rare and heterogeneous malignancies, with SDC being one of the more aggressive subtypes. Establishing effective therapy for SGCs is challenging given their rarity and heterogeneity. Cytotoxic chemotherapy has limited efficacy, and of the targeted therapies that have been studied, few objective responses have been seen. It is clear that disease management with targeted agents is most effective when directed by tumor genotype. To address this need, we utilized a clinical test, SNaPshot, designed to detect tumor-specific mutations to help direct treatment of SDC with targeted therapies. METHODS 24 SDC specimens were genotyped. These included 7 patients seen at the Massachusetts General Hospital Cancer Center who were prospectively tested. The SNaPshot assay uses DNA extracted from FFPE tissue and was designed to detect sequence variants in a panel of 14 clinically-relevant cancer genes. FISH was used to detect HER2 gene amplification. Retrospective review of clinical charts and of tumor pathological features was performed. RESULTS Mutually exclusive genetic aberrations were detected in 13 of 24 (54%) tumors, including 2 mutations in BRAF(8%), 4 mutations in PIK3CA (16%), and 7 cases of HER2 amplification (29%). Prospective clinical testing of 7 SDC identified mutations in 4 tumors, and influenced therapeutic decisions for 3 patients: 1 patient with a BRAF mutation enrolled on a phase I study of GSK1120212 + GSK118436, and experienced a near complete response lasting > 6 months; 1 with a PIK3CA mutation was enrolled on a phase I study of a PI3 kinase inhibitor; and 1 with HER2 amplification received trastuzumab with adjuvant chemoradiotherapy. Given the cohort size, statistical analysis was limited, with no significant correlations being found between genotype and pathologic features or survival. CONCLUSIONS SNaPshot genetic profiling identified novel genetic changes in SDCs, expanded the therapeutic options for patients with this rare tumor, and is changing SDC management at our institution. These findings highlight the importance of using broad genetic profiling to expedite the identification of effective targeted therapies for patients with rare malignancies.

Scientific reports, Jan 22, 2015

Vestibular schwannomas (VSs) are the most common tumours of the cerebellopontine angle. Ninety-fi... more Vestibular schwannomas (VSs) are the most common tumours of the cerebellopontine angle. Ninety-five percent of people with VS present with sensorineural hearing loss (SNHL); the mechanism of this SNHL is currently unknown. To establish the first model to study the role of VS-secreted factors in causing SNHL, murine cochlear explant cultures were treated with human tumour secretions from thirteen different unilateral, sporadic VSs of subjects demonstrating varied degrees of ipsilateral SNHL. The extent of cochlear explant damage due to secretion application roughly correlated with the subjects' degree of SNHL. Secretions from tumours associated with most substantial SNHL resulted in most significant hair cell loss and neuronal fibre disorganization. Secretions from VSs associated with good hearing or from healthy human nerves led to either no effect or solely fibre disorganization. Our results are the first to demonstrate that secreted factors from VSs can lead to cochlear damage...

Ear, nose, & throat journal, 2010

Hamartomas of the parotid gland are very rare. We present the case of a parotid gland hamartoma w... more Hamartomas of the parotid gland are very rare. We present the case of a parotid gland hamartoma with oncocytic and sebaceous metaplasia arising as a 3-cm mass in a 70-year-old man. To the best of our knowledge, there has been no previous report of a tumor with the same features. We present this case to create awareness of hamartomas as part of the differential diagnosis of parotid masses.

Head & Neck, 2015

BackgroundCompliance with Surgical Care Improvement Project (SCIP) parameters regarding antibioti... more BackgroundCompliance with Surgical Care Improvement Project (SCIP) parameters regarding antibiotic prophylaxis may affect surgical site infection rates. The purpose of this study was for us to report SCIP compliance, surgical site infection rates, and risk factors in a large series of head and neck free flap surgeries.MethodsA retrospective review of 480 free flap cases was performed. Surgical site infections occurring within 30 days postoperatively were noted.ResultsSurgical site infection occurred in 13.3% of cases. Prophylaxis was given in 99.8% of cases; ampicillin‐sulbactam (83%) and clindamycin (9%) were most common. Prophylaxis was “on‐time” in 92.3% of cases. There were no significant associations between surgical site infection and tumor stage, American Society of Anesthesiologists (ASA) classification, tumor subsite, or flap type. Prior radiation was a risk factor for surgical site infection in patients treated for malignancy.ConclusionA surgical site infection rate of 13....

Otolaryngology–Head and Neck Surgery, 2015

ObjectiveTo characterize patterns of utilization and outcomes following transfusion in head and n... more ObjectiveTo characterize patterns of utilization and outcomes following transfusion in head and neck patients undergoing free flap reconstruction.Study DesignCase series with chart review.SettingTertiary academic medical center.Subjects and MethodsTwo hundred eighty‐two head and neck patients undergoing free flap reconstruction from 2011 to 2013. Outcome parameters included post‐transfusion hematocrit increase, length of stay (LOS), flap survival, and perioperative complications.ResultsOf all head and neck free flap patients, 48.9% received blood transfusions. Average pretransfusion hametocrit (Hct) was 24.7% ± 0.2% with 2.5 ± 0.1 units of blood transfused. Transfused patients were more likely to have been taken back to the operating room. Rates of transfusion were similar between flap types, although anterolateral thigh (ALT) and fibular free flap (FFF) patients had higher transfusion requirements compared to radial forearm free flap (RFFF) patients. Further, FFF patients trended t...

Otolaryngology--Head and …, 2008

Objectives Nasopharyngeal stenosis is a rare and challenging problem that is difficult to treat s... more Objectives Nasopharyngeal stenosis is a rare and challenging problem that is difficult to treat successfully. We present a novel solution in a patient with idiopathic inflammatory nasopharyngeal stenosis by using a tracheoesophageal puncture prosthesis.

Journal of Computer Assisted Tomography, 1991

Journal of Neurological Surgery Part B: Skull Base, 2013

Otology & Neurotology, 2005

Exostosis of the external ear canal is a disease unique to man. It has been identified in prehist... more Exostosis of the external ear canal is a disease unique to man. It has been identified in prehistoric man, affecting the aborigines of the North American continent. Aural exostoses are typically firm, sessile, multinodular bony masses which arise from the tympanic ring of the bony portion of the external auditory canal. These growths develop subsequent to prolonged irritation of the canal. The large, primitive jaw of prehistoric man placed great mechanical stress on the tympanic ring. Chronic aural suppuration seen in the preantibiotic era was soon followed by exostoses. Today, prolonged contact of the external ear canal with cold sea water is the most prevalent cause (aquatic theory). As a result the disease is now essentially limited to coastal regions. In this way we have seen exostoses appear in different stages of the evolution of man as a result of mechanical, chemical and now thermal irritation. The author is an otolaryngologist in a coastal region. In examining 11,000 patients during a ten-year period, 70 cases of symptomatic exostoses of the external auditory canal were identified. The incidence of exostoses was found to be 6.36 per 1,000 patients examined for otolaryngologic disease. It is a predominantly male disease. The development of these &amp;quot;irritation nodules&amp;quot; is painless until the tenth year of aquatic exposure to irritation, when symptoms of obstruction occur. The hearing loss associated with exostoses is usually a conductive type, secondary to occlusion of the canal by impacted cerumen or acute external otitis. The results of studying the thermal characteristics of the body of water used for such aquatic activities is presented.

The Annals of otology, rhinology, and laryngology, Jan 9, 2015

The optimal initial size of tracheoesophageal voice prosthesis (TEVP) for tracheoesophageal voice... more The optimal initial size of tracheoesophageal voice prosthesis (TEVP) for tracheoesophageal voice restoration (TEVR) remains unclear. As purported advantages exist favoring the placement of both 16F and 20F prostheses, this study compares complications and voicing outcomes after placement of 16 and 20 French (F) prostheses. All cases of TEVR at an academic medical center were retrospectively reviewed (2007-2013). Complications including dislodgement, leakage, infection, and granulation tissue were compared. Outcomes including frequency of prosthesis change, acquisition of speech, and time to fluent speech were compared. Of 47 patients, 25 received 20F prostheses, and 22 received 16F. Postoperative complications were similar between groups, including leakage around the prosthesis (P = .373) and aspiration pneumonia (P = .670). There were no significant differences in timing of voicing or ability to achieve fluency. Although the 20F group appeared to undergo fewer prostheses changes p...

Otolaryngology -- Head and Neck Surgery, 2014

ABSTRACT Tracheoesophageal voice restoration (TEVR) has traditionally been described with fistula... more ABSTRACT Tracheoesophageal voice restoration (TEVR) has traditionally been described with fistula tract creation, catheter placement, and prosthesis placement. Prosthesis placement at the time of tracheoesophageal puncture (TEP) utilizing 20-French prostheses has been previously described. Smaller initial prostheses may allow fluent speech with reduced long-term complications, such as widening of the fistula and peri-prosthesis leakage. This study evaluates the safety and efficacy of the 16-French prostheses placement at the time of secondary TEP. All cases of 16-French tracheoesophageal voice prosthesis (TEVP) placement at the time of secondary TEP were reviewed from 1/2011 through 12/2013 at a large academic medical center. Perioperative complications attributable to device placement were recorded, including inability to place prosthesis, intraoperative complications, post-operative infection, prosthesis dislodgement, prosthesis leakage, and inability to obtain voice. Twenty-one patients received placement of a 16-French TEVP at the time of secondary TEP. All prostheses were placed without intraoperative complications. The proportion of patients who had minor complications within the first postoperative month was 23.8%, including leakage through the prosthesis (3 of 21), granulation tissue near the prosthesis (1 of 21), retained sheath (1 of 21) and prosthesis displacement (1 of 21). Leakage and displacement were addressed with change and replacement, respectively. Fluent voicing was achieved in 85.7% patients, with a median time to voicing of 18.5days. Placement of 16-French TEVPs is effective and safe, with an acceptable rate of minor complications attributable to the prosthesis. Therefore, a smaller prosthesis may be primarily placed at the time of secondary TEP and is our preference. Copyright © 2015. Published by Elsevier Inc.

Otolaryngology -- Head and Neck Surgery, 2015

Otolaryngology - Head and Neck Surgery, 1999

MMP activity is negatively regulated by tissue inhibitors of metalloproteinases (TIMPs). The purp... more MMP activity is negatively regulated by tissue inhibitors of metalloproteinases (TIMPs). The purpose of this work was to determine the expression of MMPs and TIMP-1 in SCC of the larynx and pharynx.

Case Reports in Otolaryngology, 2015

We present a unique case of an extensively ossified carcinoma ex pleomorphic adenoma (CXPA) in a ... more We present a unique case of an extensively ossified carcinoma ex pleomorphic adenoma (CXPA) in a 76-year-old man with a five-year history of a slowly growing parotid mass. Fine-needle aspiration of the mass was nondiagnostic. A computed tomography (CT) scan of the lesion revealed a well-circumscribed mass with peripheral calcification. Initial pathological analysis suggested a benign parotid mass, but rigorous decalcification revealed noninvasive CXPA. The patient underwent complete resection of the mass and remained disease-free nine months later. Extensive ossification of a seemingly benign parotid mass may mask areas of carcinoma that may progress if left untreated.

Health & Social Work, 2015

Patients who undergo surgical therapy for head and neck cancer often face a tremendous challenge ... more Patients who undergo surgical therapy for head and neck cancer often face a tremendous challenge involving considerable psychological distress and impaired social functioning. These difficulties are often compounded by logistical difficulties such as transportation, financial assistance, and continuity of care after the acute hospitalization. Social workers have a unique opportunity to address the psychosocial and logistical issues facing these patients through preadmission counseling and coordination. The study reported in this article aimed to assess the effect of preadmission counseling for patients planning to undergo major surgical therapy for head and neck cancer. Ten patients who received preadmission counseling were surveyed to ascertain the utility of it in regard to multiple social and logistical factors. Comparisons were made with patients who did not receive such counseling. Staff perceptions were likewise obtained. The surveys indicated that preadmission counseling helped in regard to improving peri-admission support and access to financial and logistical resources, and lowered levels of anxiety during admission. Areas of potential improvement were identified, including addressing substance abuse issues in a timely manner.

Otolaryngology -- Head and Neck Surgery, 2012

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Otolaryngology -- Head and Neck Surgery, 2011

detecting early superficial pharyngeal cancers, which are difficult to detect with a standard end... more detecting early superficial pharyngeal cancers, which are difficult to detect with a standard endoscopy. In this study, we investigated the usefulness of submucosal dissection for such superficial lesions of pharyngeal cancer retrospectively.

The Annals of otology, rhinology, and laryngology, 2001

As inadvertent eustachian tube injury during adenoidectomy can have serious short- and long-term ... more As inadvertent eustachian tube injury during adenoidectomy can have serious short- and long-term implications, a simple anatomic correlate that could predict the optimal curette choice for adenoidectomy, especially in severely hypertrophic cases, is beneficial. This study evaluates the correlation of the distance between the lateral borders of the upper central incisors and the distance between the tori tubarius in the nasopharynx. One hundred one consecutive patients undergoing adenoidectomy at a pediatric tertiary care hospital were enrolled in this study. The patients ranged in age from 7 months to 15 years. No complications were noted in any of the procedures. During the operation, the distance between the central upper incisors was measured in millimeters, as was the inter-tubarius width (ITW). A multiple regression analysis was completed to assess the correlation between central incisor width and ITW. Age and inter-incisor width were positively correlated with ITW in a statist...

The Annals of otology, rhinology, and laryngology, 2000

Because pharyngoesophageal spasm can limit successful voice restoration after total laryngectomy,... more Because pharyngoesophageal spasm can limit successful voice restoration after total laryngectomy, 24 patients underwent a modified pharyngeal closure in an effort to avoid this problem. All patients underwent total laryngectomy with appropriate neck dissections and pharyngeal closure with a half-muscle closure technique in which only one side of the remnant constrictor muscles was used to reinforce the primary closure. Twenty-three patients underwent voice restoration. Twenty-two (96%) had a functional voice, and 1 patient (4%) had pharyngoesophageal spasm that required a secondary myotomy. One fistula (4%) occurred and resolved with conservative measures. Quantitative voice analysis demonstrated no significant differences between half-closure patients and control patients for fundamental frequency (96 Hz versus 101 Hz) or intensity (57 dB versus 64 dB). Extensive qualitative analysis by trained and naive listeners revealed no differences. This preliminary report indicates the half-...

Archives of otolaryngology--head & neck surgery, 2000