Shamir Chandarana - Academia.edu (original) (raw)
Papers by Shamir Chandarana
Head & Neck, 2015
The purposes of this study were to explore the association of a postoperative clinical care pathw... more The purposes of this study were to explore the association of a postoperative clinical care pathway for patients undergoing major head and neck surgery with microvascular reconstruction on postdischarge health care utilization and cost and to compares a nonpathway group (n = 60) to a prospective, pathway-managed group (n = 54). Our primary purpose was to understand whether pathway-managed patients used postdischarge health care resources differently than patients managed without a care pathway. Health care utilization data (counts and costs) were collected for the 3 months after discharge. Differences in utilization were compared using Poisson regression. The null hypothesis was that there were no differences in utilization between the pathway and nonpathway groups. Pathway patients had fewer postdischarge encounters in 2 of 4 sectors. Readmission costs were significantly less in the pathway group only. A postoperative inpatient clinical care pathway in patients with head and neck cancer is associated with decreased health care utilization and inpatient costs in the 3 months after discharge. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.
Journal of biological regulators and homeostatic agents
Objectives: To evaluate the effect of autologous platelet and plasma adhesives (APA) on postopera... more Objectives: To evaluate the effect of autologous platelet and plasma adhesives (APA) on postoperative drainage and soft-tissue fibrosis following neck dissections. Design: This was a blinded comparative prospective cohort study done as two parts: part one evaluated early post-surgical outcomes and part two evaluated late tissue fibrosis. Method: Salvage neck dissections were stratified into two groups based on severity of prior treatment. High risk patients were defined as those who had previously undergone chemoradiation therapy and autologous platelet adhesives were administered to the surgical wound intraoperatively. The low risk group consisted of patients undergoing salvage neck dissections following radiation only and acted as controls. Part one evaluated postsurgical wound drainage as the primary outcome as well as length of hospital stay and complications. Part two evaluated late postoperative tissue fibrosis by comparing neck skin using the Cutometer. R2 and F0 were the spe...
Head & Neck Oncology
Introduction: Pilomatrix carcinoma is a rare cutaneous malignancy of hair matrix cells. They exhi... more Introduction: Pilomatrix carcinoma is a rare cutaneous malignancy of hair matrix cells. They exhibit an aggressive and infiltrative growth pattern and, despite treatment to the local disease, there is a high propensity for recurrence. The literature reports a poor prognosis associated with regional spread occurring with distant metastasis. The patient we report is alive at over two years post-operatively. With only one other case of a head and neck pilomatrix carcinoma ever reported in Canada, our report and review of the literature contributes to what little is known currently about the treatment of this malignancy. Case report: In previously reported cases, regional lymph node metastasis is always associated with distant metastatic disease on presentation, thus rendering the treatment palliative in nature. We present the unique case of a 63-year-old man with a pilomatrix carcinoma of the left parotid region. He had bilateral cervical lymph node spread but no detectable distant met...
AJNR. American journal of neuroradiology, 2015
Head and neck cancer is common, and understanding the prognosis is an important part of patient m... more Head and neck cancer is common, and understanding the prognosis is an important part of patient management. In addition to the Tumor, Node, Metastasis staging system, tumor biomarkers are becoming more useful in understanding prognosis and directing treatment. We assessed whether MR imaging texture analysis would correctly classify oropharyngeal squamous cell carcinoma according to p53 status. A cohort of 16 patients with oropharyngeal squamous cell carcinoma was prospectively evaluated by using standard clinical, histopathologic, and imaging techniques. Tumors were stained for p53 and scored by an anatomic pathologist. Regions of interest on MR imaging were selected by a neuroradiologist and then analyzed by using our 2D fast time-frequency transform tool. The quantified textures were assessed by using the subset-size forward-selection algorithm in the Waikato Environment for Knowledge Analysis. Features found to be significant were used to create a statistical model to predict p53...
Current opinion in otolaryngology & head and neck surgery, 2008
To evaluate the clinical applications of tissue adhesives in soft-tissue surgery of the head and ... more To evaluate the clinical applications of tissue adhesives in soft-tissue surgery of the head and neck, and to highlight the practical and theoretical differences between the various synthetic and biologic products. Fibrin glues have been used extensively in head and neck procedures. Fibrin glues have been successfully used to reduce wound drainage and to improve other short-term postoperative results. More recently, commercial systems have become available that allow easy and rapid isolation of autologous tissue adhesives from the patient's own blood during or immediately prior to surgery. There is intuitive appeal of autologous over donor-derived products. Platelet-rich adhesives possess the added potential of improving wound healing beyond fibrin glues alone. Strong evidence for its efficacy in the clinical setting is, however, lacking. Future investigations need to evaluate the benefits of autologous products in both complex and high-risk surgical wounds, incorporating both s...
The Journal of Otolaryngology, 2003
To survey the current practices and opinions of Canadian otolaryngologists with regard to the per... more To survey the current practices and opinions of Canadian otolaryngologists with regard to the perioperative management of the sinus patient and to explore practice variations and examine the preferred methods of experts. A mailed survey was designed and sent to all members of the Canadian Society of Otolaryngology-Head and Neck Surgery who practice in Canada. The multiple-choice questionnaire addressed issues including diagnostic evaluation; routine preoperative, intraoperative, and postoperative methods; and practice demographics. A total of 242 questionnaires were returned, for an overall response rate of 72%. Preoperatively, the majority of surgeons obtained a computed tomographic scan (70%) and administered inhaled steroids (83%). Half of those surveyed performed endoscopic sinus surgery (ESS) using the image on the video monitor, and close to 70% routinely used postoperative nasal packing. There were significant variations in practice habits between the general respondents and a subgroup of self-defined "experts" in the field, defined as those who spent greater than 40% of their clinical time managing sinonasal disease. Analysis uncovered that the experts were statistically more likely to use preoperative systemic steroids (p = .008), use the video monitor (p = .045), and perform surgery under neuroleptic anaesthesia (p = .045). As a group, they were also less likely to routinely use postoperative place nasal packing (p = .004). Considerable variations in clinical practices were identified among Canadian surgeons. Continued efforts aimed at diminishing these variations through the establishment of evidence-based practice guidelines will assist in standardizing the care of these patients.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2012
Radiotherapy is commonly used to treat neoplasms of the head and neck, and fibrosis is a known si... more Radiotherapy is commonly used to treat neoplasms of the head and neck, and fibrosis is a known side effect. The Cutometer is a device that quantifies properties of the skin. The goal of the study was to validate the Cutometer in normal neck tissues and then quantify fibrosis in radiated necks. We performed a prospective study of 251 patients. The elasticity and stiffness parameters were recorded. Control patients were compared to determine the correlation between their left and right sides. Next, the treatment groups were compared using a nonparametric test (Kruskal-Wallis). We found a significant correlation between the left and right sides of the control patients' necks, supporting the view that the Cutometer provides reproducible measurements in the normal neck. Furthermore, the Cutometer demonstrated reduced elasticity in necks treated with radiation, surgery-radiation, and chemoradiation. No significant difference in stiffness was seen. The Cutometer may serve as a valuable...
The Annals of otology, rhinology, and laryngology, 2005
A cross-sectional observational study was designed to evaluate patient satisfaction after stapedo... more A cross-sectional observational study was designed to evaluate patient satisfaction after stapedotomy. Two validated questionnaires, the Psychosocial Impact of Assistive Devices Scale (PIADS) and the Hearing Handicap Inventory (HHI), were used to assess patients for whom audiometric data were available. The response rate was 79%. The PIADS score showed that 96% of patients reported an improvement in quality of life. The HHI score, however, showed that 32% of patients still experienced a marked degree of handicap after surgery. The HHI scores correlated positively with postoperative audiometric data, and the PIADS scores correlated positively with the degree of change in audiometric data. The results of this study support the role of small fenestra stapedotomy as a primary treatment for otosclerosis. The study also identifies a certain subpopulation of patients with residual handicap who may require further aural rehabilitation.
JAMA Otolaryngology–Head & Neck Surgery, 2013
There are reports in the literature of anaplastic thyroid carcinoma in cervical lymph nodes with ... more There are reports in the literature of anaplastic thyroid carcinoma in cervical lymph nodes with evidence of only papillary carcinoma in the thyroid gland. There have been no cases of this clinical scenario with only papillary microcarcinoma in the thyroid gland. We describe the case of a 60-year-old man who initially presented with an enlarged right, level 5, supraclavicular lymph node. Initial fine-needle aspiration demonstrated evidence of papillary thyroid carcinoma. The final pathologic finding in the thyroid gland showed only multiple foci of papillary thyroid microcarcinoma. The index neck mass showed evidence of anaplastic thyroid carcinoma. This is the first instance in the literature in which anaplastic thyroid carcinoma has appeared in metastatic cervical lymph nodes with only a focus of papillary microcarcinoma in the thyroid gland. With this case, we hope to build awareness of this rare finding.
International Journal of Pediatric Otorhinolaryngology Extra, 2010
JAMA Facial Plastic Surgery, 2013
Numerous techniques have been described to repair nasal septal perforations (SPs). However, many ... more Numerous techniques have been described to repair nasal septal perforations (SPs). However, many are technically challenging, with varying degrees of success. To evaluate the use of polyethylene (Medpor; Porex Technologies) implants in the closure of nasal SPs. Prospective cohort study in an academic research setting. Fourteen patients with a nasal SP were identified between March 1, 2008, and February 1, 2011. Each patient underwent repair of the nasal SP with a polyethylene orbital sheet implant. After measuring the size of the SP, the implant was trimmed and shaped to fit appropriately. The implant was then placed between bilateral mucoperichondrial flaps using an endonasal approach. Successful closure of the nasal SP with an intact polyethylene graft and complete remucosalization by the 1-year follow-up visit. The most common initial symptoms of SPs were nasal obstruction, crusting, and epistaxis. The SPs ranged from 0.5 to 4.0 cm in diameter. Thirteen of 14 patients (93%) who underwent repair of their nasal SPs with a polyethylene implant had successful closure. The use of polyethylene implants is effective and technically easy and is associated with low patient morbidity because it does not require the harvesting of tissue from other donor sites. 4.
Background: Resistance to apoptosis is a hallmark of cancer and proteins regulating apoptosis hav... more Background: Resistance to apoptosis is a hallmark of cancer and proteins regulating apoptosis have been proposed as prognostic markers in several malignancies. However, the prognostic impact of apoptotic markers has not been consistently demonstrated in oral squamous cell carcinoma (OSCC). This inconsistency in reported associations between apoptotic proteins and prognosis can be partly attributed to the intrinsic low resolution and misclassification associated with manual, semi-quantitative methods of biomarker expression measurement. The aim of this study was to examine the association between apoptosis-regulating proteins and clinical outcomes in oral squamous cell carcinoma (OSCC) using the quantitative fluorescence immunohistochemistry (IHC) based AQUAnalysis technique. Methods: Sixty-nine OSCC patients diagnosed between 1998-2005 in Calgary, Alberta, Canada were included in the study. Clinical data were obtained from the Alberta Cancer Registry and chart review. Tissue microarrays (TMAs) were assembled from triplicate cores of formalin-fixed paraffin embedded pre-treatment tumour tissue. Bax, Bcl-2 and Bcl-XL protein expression was quantified using fluorescent IHC and AQUA technology in normal oral cavity squamous epithelium (OCSE) and OSCC tumour samples. Survival was analyzed using Kaplan-Meier plots and the Cox proportional hazard model. Results: Bax expression was predominantly nuclear in OCSE and almost exclusively cytoplasmic in OSCC. No similar differences in localization were observed for Bcl-2 or Bcl-XL. Only Bax expression associated with disease-specific survival (DSS), with 5-year survival estimates of 85.7% for high Bax versus 50.3% for low Bax (p = 0.006), in univariate analysis. High Bax expression was also significantly associated with elevated Ki67 expression, indicating that increased proliferation might lead to an improved response to radiotherapy in patients with elevated Bax expression. In multivariate analyses, Bax protein expression remained an independent predictor of DSS in OSCC , p = 0.013].
Oral Oncology Supplement, 2009
Plastic and Reconstructive Surgery, 2014
Pulmonary complications are common after major head and neck oncologic surgery with microsurgical... more Pulmonary complications are common after major head and neck oncologic surgery with microsurgical reconstruction and are associated with increased mortality and morbidity. Clinical care pathways are evidence-based tools that reduce unnecessary practice variation and ultimately improve patient outcomes. In this study, the authors evaluate the effectiveness of a comprehensive care pathway on reducing postoperative pulmonary complications and hospital length of stay in patients undergoing major head and neck carcinoma resection with free flap reconstruction. Fifty-five consecutive patients treated according to a prescribed postoperative clinical care pathway were compared to a historical cohort of patients treated before the implementation of the pathway. The incidence of pulmonary complications, hospital length of stay, and free flap survival were compared between the control and intervention groups. Patients on the clinical care pathway had 32.5 percent fewer pulmonary complications (p < 0.0001) and 7.4 days' shorter hospital length of stay (p = 0.0007) than patients not on the postoperative pathway. There was no significant difference in the rate of flap reoperation. A multidisciplinary, comprehensive, clinical care pathway for patients undergoing major head and neck surgery with microsurgical reconstruction is effective in reducing postoperative pulmonary complications and hospital length of stay. The postoperative pathway is safe in this patient population and should be considered for adoption into clinical practice. Therapeutic, III.
Journal of Otolaryngology - Head and Neck Surgery, 2013
Objective: Patients with head and neck cancer frequently present to academic tertiary referral ce... more Objective: Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management. Methods: Our institutional review board approved the retrospective review of randomized original and second opinion reports for 94 consecutive cases of biopsy proven or clinically suspected head and neck cancer in calendar year 2010. Discrepancy rates for staging and recommended patient management were calculated and, for the 32% (30/94) of cases that subsequently went to surgery, the accuracies of the reports were determined relative to the pathologic staging gold standard.
Head & Neck, 2014
Background: It is unclear if surgeons are performing comprehensive central neck dissections (CND)... more Background: It is unclear if surgeons are performing comprehensive central neck dissections (CND) for well-differentiated thyroid cancer. Our objective was to determine mean lymph node (LN) retrieval in CND as well as variability across surgeons and institutions. Methods: A prospectively collected database identified 18 surgeons performing 425 CNDs, 313 unilateral and 112 bilateral. Demographics, peri-operative and pathologic factors were analyzed. Results: Mean LN yield was 7.4 and 11.9 for unilateral and bilateral CND, respectively. While 224 CND were prophylactic, both total and pathologic LN yields were significantly higher in therapeutic CND. There was a significant variation in LN yield across individual surgeons, institutions, and regions. High-volume CND surgeons have significantly lower LN yield compared to low-volume surgeons. Conclusions: CND appears to be performed adequately; however, there is a significant variation in LN yield. Future initiatives should try to standardize the CND performed, with emphasis on obtaining a sufficient yield. This article is protected by copyright. All rights reserved.
Placenta, 1999
To determine the temporal and spatial distribution of insulin-like growth factor (IGF) and its fa... more To determine the temporal and spatial distribution of insulin-like growth factor (IGF) and its family of binding proteins (IGFBPs), guinea-pig yolk sac and chorioallantoic placentae were collected at 15, 20, 25, 29,[44][45] 55 and 65-66 days of gestation. Messenger RNAs for IGF I, IGF II and IGFBP 1-6 were identified in tissue sections by in situ hybridization, using 35 S-cRNA probes. Epithelial and mesenchymal cell types were identified by immunohistochemistry for cytokeratin and vimentin, respectively. At 15 days of gestation, IGF-II mRNA was expressed in ectoplacental mesoderm, cytotrophoblasts and syncytiotrophoblast, and IGFBP-5 mRNA was detected in the syncytiotrophoblast. In the mid-gestation placenta, IGFBP-5 mRNA was expressed in the marginal and interlobular syncytium and IGF-II mRNA in the labyrinth. Near term, when expansion of the labyrinth was complete, IGFBP-5 mRNA was coexpressed with IGF-II mRNA in the marginal and interlobular syncytium. These observations suggest that interaction between IGF-II and IGFBP-5 plays a role in the vascularization of the placenta by fetal vessels. IGF-II mRNA was not expressed in the maternal tissues at any gestational age. IGFBP-2, -3 and -5 mRNAs were expressed in the endometrial stroma at 7-12 days of gestation but, following establishment of the placenta, IGFBP mRNAs were more abundant in the myometrium than in the decidua. IGF-II mRNA was detected in trophoblasts invading the walls of maternal vessels, and the endothelium of the preplacental vessels expressed IGFBP-4 mRNA, while IGFBP-2 and IGFBP-5 mRNAs were present in the tunica media of mesometrial arteries that had not been invaded by trophoblast. These findings suggest that IGF-II produced by the trophoblast acts in an autocrine and/or paracrine fashion to promote trophoblast invasion and that this process is modulated by interaction with IGFBPs present in maternal tissues.
Head & Neck, 2015
The purposes of this study were to explore the association of a postoperative clinical care pathw... more The purposes of this study were to explore the association of a postoperative clinical care pathway for patients undergoing major head and neck surgery with microvascular reconstruction on postdischarge health care utilization and cost and to compares a nonpathway group (n = 60) to a prospective, pathway-managed group (n = 54). Our primary purpose was to understand whether pathway-managed patients used postdischarge health care resources differently than patients managed without a care pathway. Health care utilization data (counts and costs) were collected for the 3 months after discharge. Differences in utilization were compared using Poisson regression. The null hypothesis was that there were no differences in utilization between the pathway and nonpathway groups. Pathway patients had fewer postdischarge encounters in 2 of 4 sectors. Readmission costs were significantly less in the pathway group only. A postoperative inpatient clinical care pathway in patients with head and neck cancer is associated with decreased health care utilization and inpatient costs in the 3 months after discharge. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.
Journal of biological regulators and homeostatic agents
Objectives: To evaluate the effect of autologous platelet and plasma adhesives (APA) on postopera... more Objectives: To evaluate the effect of autologous platelet and plasma adhesives (APA) on postoperative drainage and soft-tissue fibrosis following neck dissections. Design: This was a blinded comparative prospective cohort study done as two parts: part one evaluated early post-surgical outcomes and part two evaluated late tissue fibrosis. Method: Salvage neck dissections were stratified into two groups based on severity of prior treatment. High risk patients were defined as those who had previously undergone chemoradiation therapy and autologous platelet adhesives were administered to the surgical wound intraoperatively. The low risk group consisted of patients undergoing salvage neck dissections following radiation only and acted as controls. Part one evaluated postsurgical wound drainage as the primary outcome as well as length of hospital stay and complications. Part two evaluated late postoperative tissue fibrosis by comparing neck skin using the Cutometer. R2 and F0 were the spe...
Head & Neck Oncology
Introduction: Pilomatrix carcinoma is a rare cutaneous malignancy of hair matrix cells. They exhi... more Introduction: Pilomatrix carcinoma is a rare cutaneous malignancy of hair matrix cells. They exhibit an aggressive and infiltrative growth pattern and, despite treatment to the local disease, there is a high propensity for recurrence. The literature reports a poor prognosis associated with regional spread occurring with distant metastasis. The patient we report is alive at over two years post-operatively. With only one other case of a head and neck pilomatrix carcinoma ever reported in Canada, our report and review of the literature contributes to what little is known currently about the treatment of this malignancy. Case report: In previously reported cases, regional lymph node metastasis is always associated with distant metastatic disease on presentation, thus rendering the treatment palliative in nature. We present the unique case of a 63-year-old man with a pilomatrix carcinoma of the left parotid region. He had bilateral cervical lymph node spread but no detectable distant met...
AJNR. American journal of neuroradiology, 2015
Head and neck cancer is common, and understanding the prognosis is an important part of patient m... more Head and neck cancer is common, and understanding the prognosis is an important part of patient management. In addition to the Tumor, Node, Metastasis staging system, tumor biomarkers are becoming more useful in understanding prognosis and directing treatment. We assessed whether MR imaging texture analysis would correctly classify oropharyngeal squamous cell carcinoma according to p53 status. A cohort of 16 patients with oropharyngeal squamous cell carcinoma was prospectively evaluated by using standard clinical, histopathologic, and imaging techniques. Tumors were stained for p53 and scored by an anatomic pathologist. Regions of interest on MR imaging were selected by a neuroradiologist and then analyzed by using our 2D fast time-frequency transform tool. The quantified textures were assessed by using the subset-size forward-selection algorithm in the Waikato Environment for Knowledge Analysis. Features found to be significant were used to create a statistical model to predict p53...
Current opinion in otolaryngology & head and neck surgery, 2008
To evaluate the clinical applications of tissue adhesives in soft-tissue surgery of the head and ... more To evaluate the clinical applications of tissue adhesives in soft-tissue surgery of the head and neck, and to highlight the practical and theoretical differences between the various synthetic and biologic products. Fibrin glues have been used extensively in head and neck procedures. Fibrin glues have been successfully used to reduce wound drainage and to improve other short-term postoperative results. More recently, commercial systems have become available that allow easy and rapid isolation of autologous tissue adhesives from the patient's own blood during or immediately prior to surgery. There is intuitive appeal of autologous over donor-derived products. Platelet-rich adhesives possess the added potential of improving wound healing beyond fibrin glues alone. Strong evidence for its efficacy in the clinical setting is, however, lacking. Future investigations need to evaluate the benefits of autologous products in both complex and high-risk surgical wounds, incorporating both s...
The Journal of Otolaryngology, 2003
To survey the current practices and opinions of Canadian otolaryngologists with regard to the per... more To survey the current practices and opinions of Canadian otolaryngologists with regard to the perioperative management of the sinus patient and to explore practice variations and examine the preferred methods of experts. A mailed survey was designed and sent to all members of the Canadian Society of Otolaryngology-Head and Neck Surgery who practice in Canada. The multiple-choice questionnaire addressed issues including diagnostic evaluation; routine preoperative, intraoperative, and postoperative methods; and practice demographics. A total of 242 questionnaires were returned, for an overall response rate of 72%. Preoperatively, the majority of surgeons obtained a computed tomographic scan (70%) and administered inhaled steroids (83%). Half of those surveyed performed endoscopic sinus surgery (ESS) using the image on the video monitor, and close to 70% routinely used postoperative nasal packing. There were significant variations in practice habits between the general respondents and a subgroup of self-defined "experts" in the field, defined as those who spent greater than 40% of their clinical time managing sinonasal disease. Analysis uncovered that the experts were statistically more likely to use preoperative systemic steroids (p = .008), use the video monitor (p = .045), and perform surgery under neuroleptic anaesthesia (p = .045). As a group, they were also less likely to routinely use postoperative place nasal packing (p = .004). Considerable variations in clinical practices were identified among Canadian surgeons. Continued efforts aimed at diminishing these variations through the establishment of evidence-based practice guidelines will assist in standardizing the care of these patients.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2012
Radiotherapy is commonly used to treat neoplasms of the head and neck, and fibrosis is a known si... more Radiotherapy is commonly used to treat neoplasms of the head and neck, and fibrosis is a known side effect. The Cutometer is a device that quantifies properties of the skin. The goal of the study was to validate the Cutometer in normal neck tissues and then quantify fibrosis in radiated necks. We performed a prospective study of 251 patients. The elasticity and stiffness parameters were recorded. Control patients were compared to determine the correlation between their left and right sides. Next, the treatment groups were compared using a nonparametric test (Kruskal-Wallis). We found a significant correlation between the left and right sides of the control patients' necks, supporting the view that the Cutometer provides reproducible measurements in the normal neck. Furthermore, the Cutometer demonstrated reduced elasticity in necks treated with radiation, surgery-radiation, and chemoradiation. No significant difference in stiffness was seen. The Cutometer may serve as a valuable...
The Annals of otology, rhinology, and laryngology, 2005
A cross-sectional observational study was designed to evaluate patient satisfaction after stapedo... more A cross-sectional observational study was designed to evaluate patient satisfaction after stapedotomy. Two validated questionnaires, the Psychosocial Impact of Assistive Devices Scale (PIADS) and the Hearing Handicap Inventory (HHI), were used to assess patients for whom audiometric data were available. The response rate was 79%. The PIADS score showed that 96% of patients reported an improvement in quality of life. The HHI score, however, showed that 32% of patients still experienced a marked degree of handicap after surgery. The HHI scores correlated positively with postoperative audiometric data, and the PIADS scores correlated positively with the degree of change in audiometric data. The results of this study support the role of small fenestra stapedotomy as a primary treatment for otosclerosis. The study also identifies a certain subpopulation of patients with residual handicap who may require further aural rehabilitation.
JAMA Otolaryngology–Head & Neck Surgery, 2013
There are reports in the literature of anaplastic thyroid carcinoma in cervical lymph nodes with ... more There are reports in the literature of anaplastic thyroid carcinoma in cervical lymph nodes with evidence of only papillary carcinoma in the thyroid gland. There have been no cases of this clinical scenario with only papillary microcarcinoma in the thyroid gland. We describe the case of a 60-year-old man who initially presented with an enlarged right, level 5, supraclavicular lymph node. Initial fine-needle aspiration demonstrated evidence of papillary thyroid carcinoma. The final pathologic finding in the thyroid gland showed only multiple foci of papillary thyroid microcarcinoma. The index neck mass showed evidence of anaplastic thyroid carcinoma. This is the first instance in the literature in which anaplastic thyroid carcinoma has appeared in metastatic cervical lymph nodes with only a focus of papillary microcarcinoma in the thyroid gland. With this case, we hope to build awareness of this rare finding.
International Journal of Pediatric Otorhinolaryngology Extra, 2010
JAMA Facial Plastic Surgery, 2013
Numerous techniques have been described to repair nasal septal perforations (SPs). However, many ... more Numerous techniques have been described to repair nasal septal perforations (SPs). However, many are technically challenging, with varying degrees of success. To evaluate the use of polyethylene (Medpor; Porex Technologies) implants in the closure of nasal SPs. Prospective cohort study in an academic research setting. Fourteen patients with a nasal SP were identified between March 1, 2008, and February 1, 2011. Each patient underwent repair of the nasal SP with a polyethylene orbital sheet implant. After measuring the size of the SP, the implant was trimmed and shaped to fit appropriately. The implant was then placed between bilateral mucoperichondrial flaps using an endonasal approach. Successful closure of the nasal SP with an intact polyethylene graft and complete remucosalization by the 1-year follow-up visit. The most common initial symptoms of SPs were nasal obstruction, crusting, and epistaxis. The SPs ranged from 0.5 to 4.0 cm in diameter. Thirteen of 14 patients (93%) who underwent repair of their nasal SPs with a polyethylene implant had successful closure. The use of polyethylene implants is effective and technically easy and is associated with low patient morbidity because it does not require the harvesting of tissue from other donor sites. 4.
Background: Resistance to apoptosis is a hallmark of cancer and proteins regulating apoptosis hav... more Background: Resistance to apoptosis is a hallmark of cancer and proteins regulating apoptosis have been proposed as prognostic markers in several malignancies. However, the prognostic impact of apoptotic markers has not been consistently demonstrated in oral squamous cell carcinoma (OSCC). This inconsistency in reported associations between apoptotic proteins and prognosis can be partly attributed to the intrinsic low resolution and misclassification associated with manual, semi-quantitative methods of biomarker expression measurement. The aim of this study was to examine the association between apoptosis-regulating proteins and clinical outcomes in oral squamous cell carcinoma (OSCC) using the quantitative fluorescence immunohistochemistry (IHC) based AQUAnalysis technique. Methods: Sixty-nine OSCC patients diagnosed between 1998-2005 in Calgary, Alberta, Canada were included in the study. Clinical data were obtained from the Alberta Cancer Registry and chart review. Tissue microarrays (TMAs) were assembled from triplicate cores of formalin-fixed paraffin embedded pre-treatment tumour tissue. Bax, Bcl-2 and Bcl-XL protein expression was quantified using fluorescent IHC and AQUA technology in normal oral cavity squamous epithelium (OCSE) and OSCC tumour samples. Survival was analyzed using Kaplan-Meier plots and the Cox proportional hazard model. Results: Bax expression was predominantly nuclear in OCSE and almost exclusively cytoplasmic in OSCC. No similar differences in localization were observed for Bcl-2 or Bcl-XL. Only Bax expression associated with disease-specific survival (DSS), with 5-year survival estimates of 85.7% for high Bax versus 50.3% for low Bax (p = 0.006), in univariate analysis. High Bax expression was also significantly associated with elevated Ki67 expression, indicating that increased proliferation might lead to an improved response to radiotherapy in patients with elevated Bax expression. In multivariate analyses, Bax protein expression remained an independent predictor of DSS in OSCC , p = 0.013].
Oral Oncology Supplement, 2009
Plastic and Reconstructive Surgery, 2014
Pulmonary complications are common after major head and neck oncologic surgery with microsurgical... more Pulmonary complications are common after major head and neck oncologic surgery with microsurgical reconstruction and are associated with increased mortality and morbidity. Clinical care pathways are evidence-based tools that reduce unnecessary practice variation and ultimately improve patient outcomes. In this study, the authors evaluate the effectiveness of a comprehensive care pathway on reducing postoperative pulmonary complications and hospital length of stay in patients undergoing major head and neck carcinoma resection with free flap reconstruction. Fifty-five consecutive patients treated according to a prescribed postoperative clinical care pathway were compared to a historical cohort of patients treated before the implementation of the pathway. The incidence of pulmonary complications, hospital length of stay, and free flap survival were compared between the control and intervention groups. Patients on the clinical care pathway had 32.5 percent fewer pulmonary complications (p < 0.0001) and 7.4 days' shorter hospital length of stay (p = 0.0007) than patients not on the postoperative pathway. There was no significant difference in the rate of flap reoperation. A multidisciplinary, comprehensive, clinical care pathway for patients undergoing major head and neck surgery with microsurgical reconstruction is effective in reducing postoperative pulmonary complications and hospital length of stay. The postoperative pathway is safe in this patient population and should be considered for adoption into clinical practice. Therapeutic, III.
Journal of Otolaryngology - Head and Neck Surgery, 2013
Objective: Patients with head and neck cancer frequently present to academic tertiary referral ce... more Objective: Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management. Methods: Our institutional review board approved the retrospective review of randomized original and second opinion reports for 94 consecutive cases of biopsy proven or clinically suspected head and neck cancer in calendar year 2010. Discrepancy rates for staging and recommended patient management were calculated and, for the 32% (30/94) of cases that subsequently went to surgery, the accuracies of the reports were determined relative to the pathologic staging gold standard.
Head & Neck, 2014
Background: It is unclear if surgeons are performing comprehensive central neck dissections (CND)... more Background: It is unclear if surgeons are performing comprehensive central neck dissections (CND) for well-differentiated thyroid cancer. Our objective was to determine mean lymph node (LN) retrieval in CND as well as variability across surgeons and institutions. Methods: A prospectively collected database identified 18 surgeons performing 425 CNDs, 313 unilateral and 112 bilateral. Demographics, peri-operative and pathologic factors were analyzed. Results: Mean LN yield was 7.4 and 11.9 for unilateral and bilateral CND, respectively. While 224 CND were prophylactic, both total and pathologic LN yields were significantly higher in therapeutic CND. There was a significant variation in LN yield across individual surgeons, institutions, and regions. High-volume CND surgeons have significantly lower LN yield compared to low-volume surgeons. Conclusions: CND appears to be performed adequately; however, there is a significant variation in LN yield. Future initiatives should try to standardize the CND performed, with emphasis on obtaining a sufficient yield. This article is protected by copyright. All rights reserved.
Placenta, 1999
To determine the temporal and spatial distribution of insulin-like growth factor (IGF) and its fa... more To determine the temporal and spatial distribution of insulin-like growth factor (IGF) and its family of binding proteins (IGFBPs), guinea-pig yolk sac and chorioallantoic placentae were collected at 15, 20, 25, 29,[44][45] 55 and 65-66 days of gestation. Messenger RNAs for IGF I, IGF II and IGFBP 1-6 were identified in tissue sections by in situ hybridization, using 35 S-cRNA probes. Epithelial and mesenchymal cell types were identified by immunohistochemistry for cytokeratin and vimentin, respectively. At 15 days of gestation, IGF-II mRNA was expressed in ectoplacental mesoderm, cytotrophoblasts and syncytiotrophoblast, and IGFBP-5 mRNA was detected in the syncytiotrophoblast. In the mid-gestation placenta, IGFBP-5 mRNA was expressed in the marginal and interlobular syncytium and IGF-II mRNA in the labyrinth. Near term, when expansion of the labyrinth was complete, IGFBP-5 mRNA was coexpressed with IGF-II mRNA in the marginal and interlobular syncytium. These observations suggest that interaction between IGF-II and IGFBP-5 plays a role in the vascularization of the placenta by fetal vessels. IGF-II mRNA was not expressed in the maternal tissues at any gestational age. IGFBP-2, -3 and -5 mRNAs were expressed in the endometrial stroma at 7-12 days of gestation but, following establishment of the placenta, IGFBP mRNAs were more abundant in the myometrium than in the decidua. IGF-II mRNA was detected in trophoblasts invading the walls of maternal vessels, and the endothelium of the preplacental vessels expressed IGFBP-4 mRNA, while IGFBP-2 and IGFBP-5 mRNAs were present in the tunica media of mesometrial arteries that had not been invaded by trophoblast. These findings suggest that IGF-II produced by the trophoblast acts in an autocrine and/or paracrine fashion to promote trophoblast invasion and that this process is modulated by interaction with IGFBPs present in maternal tissues.