Giant Lin | St BArnabas Hospital (original) (raw)

Papers by Giant Lin

Otolaryngology Case Reports

Ear, Nose & Throat Journal, 2020

Sinonasal organized hematomas (OHs) are rare lesions that primarily localize to the maxillary sin... more Sinonasal organized hematomas (OHs) are rare lesions that primarily localize to the maxillary sinus. The rate of growth of these masses has not been described in the literature. We present a case of a 59-year-old gentleman with polyostotic fibrous dysplasia who presented with acute loss of vision in the left eye from an expanding OH of the sphenoid sinusitis. After expanded endonasal, transpterygoid approach and debulking, patient experienced significant vision improvement. Close follow-up imaging preoperatively allowed radiologic documentation of the rate of OH growth and this is presented in detail.

International Journal of Pediatric Otorhinolaryngology, 2019

OBJECTIVE To identify risk factors and interventions affecting length of hospitalization (LOH) an... more OBJECTIVE To identify risk factors and interventions affecting length of hospitalization (LOH) and clinical outcome in children with intracranial complications of rhinosinusitis. METHODS Retrospective chart review of 12 children hospitalized at 2 academic medical centers for intracranial complications of rhinosinusitis over the past 5 years. RESULTS 12 patients were identified with an average age at presentation of 13 years old. 92% were male and 75% were African American. The most common presenting symptoms were fever and headache. Localizing neurological symptoms including hemiparesis and aphasia, in addition to seizures occurred in 33% of patients and increased LOH significantly (33 versus 15 days, p = 0.03). Epidural (EA) and subdural abscesses (SA) were the most common intracranial complications. 58% of patients were initially treated with a combination of open neurosurgical (ON) intervention and endoscopic sinus surgery (ESS) and LOH was significantly shorter for these patients compared to those treated otherwise (14 versus 31 days, p = 0.02). Streptococcus species were the most common group of bacteria identified in 75% of cases, with S. anginosus accounting for 42% of cases. The overall average LOH was 21 days with 92% of patients having complete resolution of symptoms by time of discharge. CONCLUSIONS Treatment of intracranial complications of acute rhinosinusitis can have favorable outcomes after appropriate surgical management. Localizing neurologic symptoms and seizures portend longer hospital stay and recovery time. Shorter hospital stay was seen in those undergoing early combined ON and ESS interventions.

American journal of rhinology & allergy, 2017

To compare the causes of failure between external and endoscopic dacryocystorhinostomy (DCR) tech... more To compare the causes of failure between external and endoscopic dacryocystorhinostomy (DCR) techniques for the treatment of lacrimal obstruction. A retrospective cohort study. The study population consisted of 53 consecutive patients who underwent revision endoscopic DCR from 2002 to 2013 for lacrimal duct obstruction. Identified causes of previous DCR failure were compared between patients whose initial surgery was performed through an external versus an endoscopic approach. Reasons for surgical failure after external (n = 21) versus endoscopic (n = 32) DCR included cicatricial closure of the internal lacrimal ostium (52.4 versus 53.1%; p = 0.96), inadequate removal of bone overlying the lacrimal sac (23.8 versus 9.4%; p = 0.15), sump syndrome (9.5 versus 9.4%; p = 0.99), and intranasal adhesions (65 versus 37.5%; p = 0.05). Adhesions that involved the middle turbinate were a particularly impactful cause of failure when the DCR was performed through an external versus the endoscop...

Circulation, Oct 31, 2007

American journal of rhinology & allergy, 2016

The medial rectus muscle (MRM) is the medial boundary to the intraconal space of the orbit, and r... more The medial rectus muscle (MRM) is the medial boundary to the intraconal space of the orbit, and retraction of the MRM is oftentimes necessary for endoscopic removal of intraconal tumors, e.g., orbital hemangioma. We evaluated each of the reported methods of MRM retraction for endoscopic orbital surgery and quantified the degree of intraconal exposure conferred by each method. Eight orbits from four cadaver heads were dissected. In each orbit, medial orbital decompression was performed and the MRM was retracted by using four previously described techniques: (1) external MRM retraction at the globe insertion point by using vessel loop (external group), (2) transseptal MRM retraction by using vessel loop (transseptal group), (3) transchoanal retraction of the MRM by using vessel loop (choanal group), and (4) transseptal four-handed technique by using double ball retraction by a second surgeon (transseptal double ball group). The length, height, and area of exposure of the medial intrac...

Otolaryngologic Clinics of North America, 2016

The true incidence of spontaneous epistaxis is unknown, but it is estimated that 60% of individua... more The true incidence of spontaneous epistaxis is unknown, but it is estimated that 60% of individuals experience epistaxis in their lifetime. Of these, 6% seek medical treatment. 1 No standard definition of severe epistaxis exists, but a reasonable definition is any epistaxis that requires surgical intervention, extensive nasal packing, or blood products. In one study, 2 45% of patients hospitalized for epistaxis had systemic conditions that can contribute to severe epistaxis. Although high-dose aspirin increases bleeding risk and leads to higher chance of rebleeding after intervention for epistaxis, low-dose aspirin (81 mg daily) increases epistaxis risk only slightly (19.1 vs 16.7% in one study). 3 Hypertension as a primary cause of severe epistaxis is controversial. If possible, systemic conditions should be addressed along with surgical intervention in severe cases of epistaxis. PATIENT OPTIMIZATION Many patients with severe epistaxis benefit from endoscopic intervention for control of bleeding. However, active bleeding worsens endoscopic visualization. A few initial

Sataloff’s Comprehensive Textbook of Otolaryngology: Head & Neck Surgery (Rhinology/Allergy and Immunology) -Volume 2, 2016

Journal of Neurological Surgery Part B: Skull Base, 2015

International forum of allergy & rhinology, Jan 16, 2015

The role of human papillomavirus (HPV) in sinonasal inverted papillomas (IPs) is controversial. D... more The role of human papillomavirus (HPV) in sinonasal inverted papillomas (IPs) is controversial. Determining the prevalence of HPV infection and its impact on the molecular biology of these tumors is critical to characterizing its role in the pathogenesis of IPs. A total of 112 paraffin-embedded IPs from 90 patients were studied. A tissue microarray was constructed and stained for p16, p53, epidermal growth factor receptor (EGFR), and cyclin D1. HPV presence and types were determined using PGMY 09/11 primers and integration using HPV 11 detection of integrated papillomavirus sequences by ligation-mediated polymerase chain reaction (DIPS-PCR). HPV was detected in 11 of 90 (12%) patients. HPV 11 was found in 9 samples. HPV 6 and HPV 27 were found in 1 sample each. EGFR staining proportion was higher in HPV-positive IPs vs HPV-negative specimens (56.2% vs 23.6%; p = 0.009). Differences in p16, p53, and cyclin D1 staining were not significant. HPV-positive lesions tend to progress to mal...

American Journal of Rhinology & Allergy, 2015

BackgroundThe relationship between orbit and maxillary sinus volumes in patients with chronic max... more BackgroundThe relationship between orbit and maxillary sinus volumes in patients with chronic maxillary atelectasis (CMA), commonly known as silent sinus syndrome if enophthalmos is present, is poorly understood.MethodsA retrospective review of 22 patients who underwent endoscopic sinus surgery (ESS) for CMA from 2005 to 2013 was performed. Computed tomography (CT) images were analyzed using OsiriX 5.8.2 software for volumetric analysis of the orbit and maxillary sinus at presentation and after surgical treatment with ESS.ResultsPretreatment mean orbit volumes on the diseased side (DS) and the contralateral side (CS) were 29.22 and 26.50 mL, respectively (p < 0.001); mean sinus volumes on the DS and CS were 8.51 and 17.20 mL, respectively (p < 0.001); and pretreatment mean midorbit heights (MOHs) on the DS and CS were 3.39 cm and 3.07 cm, respectively (p < 0.001). The percent decrease in sinus volume on the DS compared to that on the CS did not correlate significantly with ...

International Forum of Allergy & Rhinology, 2013

The aim of this study was be er characterize the staining pa erns of inverted papilloma (IP) with... more The aim of this study was be er characterize the staining pa erns of inverted papilloma (IP) with and without carcinoma by performing immunohistochemistry for p16, epidermal growth factor receptor (EGFR), p53, and cyclin D1 antibodies in a large patient cohort. Methods: A total of 162 IP specimens were collected from 147 patients treated at the University of Michigan between 1996 and 2011. Twenty-two specimens contained carcinoma. Tumor was extracted for construction of 2 tissue microarrays and stained for p16, EGFR, p53, and cyclin D1. Tumor staining intensity and percentage staining were scored. Results: Benign disease was positive for p16 in 64%, EGFR in 50%, p53 in 30%, and cyclin D1 in 76%. IP with carcinomatous degeneration was positive for p16 in 14%, EGFR in 71%, p53 in 62%, and cyclin D1 in 76%. The differences in staining positivity between benign and malignant disease reached significance for p16 and p53 only. Mean percentage staining by tumor surface area for IP and IP with carcinoma was 12% vs 7% for p16 (no statistical significance [NS]), 20% vs 34% for EGFR (NS), 4% vs 24% for p53 (p < 0.001), and 17% vs 21% for cyclin D1 (NS). Conclusion: Important characteristic staining pa ern for IP with and without carcinoma are highlighted in this study. Unlike recent trends in human papilloma virus (HPV)related head and neck malignancies, low expression of p16 is a marker for malignancy in this series. Positive staining for p53 correlates with the development of carcinoma in IP.

Journal of Neurological Surgery Reports, 2015

Background Schwannomas of the vidian canal are an extremely rare type of intracranial tumor that ... more Background Schwannomas of the vidian canal are an extremely rare type of intracranial tumor that can have variable clinical presentations including headache, facial pain, facial muscle paralysis, decreased lacrimation, or nasal dryness. We present an atypical case of an incidentally identified asymptomatic vidian canal schwannoma. Case Description A 49-year-old woman with a history of multiple sclerosis presented for routine surveillance magnetic resonance imaging that detected an ovoid mass originating in the vidian canal. Given the unusual location of the lesion, an endoscopic endonasal biopsy was performed and confirmed the diagnosis of a vidian canal schwannoma, for which the patient chose to receive fractionated radiation therapy. Conclusion When a vidian canal tumor is identified, endoscopic endonasal biopsy can be used to confirm the diagnosis before pursuing either surgical or radiotherapy treatment. In particular, fractionated radiation therapy offers a radiobiologically safe means of delivering radiation when there is concern for late radiation-related side effects following treatment completion.

Otology & Neurotology, 2014

To discuss the differential diagnosis of petrous ridge lesions based on a rare case of metastatic... more To discuss the differential diagnosis of petrous ridge lesions based on a rare case of metastatic pituitary carcinoma. A 41-year-old man with a past medical history of pituitary adenoma and hypopituitarism presented with imbalance and vertigo. Imaging showed a mass eroding the left posterior petrous face. Transtemporal, transmastoid approach for complete resection of tumor. Surgical pathology and imaging studies. Surgical pathology revealed metastatic pituitary carcinoma. The patient has been followed at our institution for 28 months postoperatively without evidence of recurrence. Lesions of the petrous ridge are rare. The wide differential diagnosis includes endolympatic sac tumor, meningioma, jugulotympanic paraganglioma, myeloma, and metastasis. The clinician must take into account unique imaging features on CT and MRI, and final diagnosis often requires pathologic analysis.

JAMA Otolaryngology–Head & Neck Surgery, 2014

IMPORTANCE To compare the efficacy of treatments commonly offered to patients with Ménière's dise... more IMPORTANCE To compare the efficacy of treatments commonly offered to patients with Ménière's disease who fail conservative medical therapy including diuretics and a sodium-restricted diet. OBJECTIVES This study compared three second-echelon treatments: the Meniett device, endolymphatic sac decompression, and intratympanic gentamicin injections to determine their comparative effectiveness and capacity to mitigate against the necessity of a surgical labyrinthectomy. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study at an academic tertiary care center. Patients with Ménière's disease who failed primary medical management were evaluated after treatment with a Meniett device (n=20), endolymphatic sac decompression (n=23) or intratympanic gentamicin injections (n=17). Cases were included if auditory and vertigo control data were available before and a minimum of two years after treatment, in patients without previous otologic surgery or intratympanic injections. Average age ranged from 54 to 75 years. INTERVENTIONS Use of the Meniett device, endolymphatic sac shunt decompression surgery or intratympanic gentamicin injections using variable doses and injection schedules. MAIN OUTCOMES AND MEASURES Proportion of patients with vertigo control and hearing preservation by a modified version of the AAO-HNS criteria after second-echelon treatment, thus not requiring definitive labyrinthectomy. RESULTS Despite endolymphatic sac surgery demonstrating a longer duration (61 months) prior to labyrinthectomy, no differences were found between the 3 treatment options in terms of patients going on to definitive labyrinthectomy or in the number of months of symptom relief following treatment. There was also no difference in residual auditory perception across the 3 groups. CONCLUSIONS AND RELEVANCE No significant therapeutic differences were found between the studied second-echelon treatments for symptom relief of Ménière's disease.

The Laryngoscope, 2012

Canal switch is a complication following canalith repositioning procedure (CRP) for posterior can... more Canal switch is a complication following canalith repositioning procedure (CRP) for posterior canal benign paroxysmal positional vertigo (BPPV). Instead of being returned to the utricle, the loose otoconia migrate into the superior or horizontal semicircular canal. Patients remain symptomatic, and treatment can be ineffective unless the switch is recognized and additional repositioning maneuvers directed toward the appropriate semicircular canal are performed. This report provides the first videographic documentation of canal switch involving conversion of unilateral posterior semicircular canal BPPV to geotropic horizontal canalithiasis.

Current opinion in otolaryngology & head and neck surgery, 2012

PURPOSE OF REVIEW: To discuss current evidence of global climate change and its implications for ... more PURPOSE OF REVIEW: To discuss current evidence of global climate change and its implications for allergic rhinitis and other allergic respiratory diseases. RECENT FINDINGS: Global climate change is evidenced by increasing average earth temperature, increasing anthropogenic greenhouse gas levels, and elevated pollen levels. Pollutants of interest include carbon dioxide (CO2), ozone (O3), and nitrous oxide (NO2) because they can enhance the allergic response and lead to increased symptoms of allergic respiratory diseases. Heightened CO2 levels stimulate pollen production via photosynthesis and increased growth in multiple plant species investigated. Although worsened air quality appears to increase prevalence of allergic rhinitis, the effects of increased temperature are less certain. The findings of increased aeroallergen levels likely contribute to increases in presentation of allergic diseases, although more healthcare impact studies are necessary. SUMMARY: Although recent literatu...

Molecular Cancer Research, 2009

RhoC protein, a known marker of metastases in aggressive breast cancers and melanoma, has also be... more RhoC protein, a known marker of metastases in aggressive breast cancers and melanoma, has also been found to be overexpressed in certain head and neck cancers, thus we investigated the correlation between RhoC expression and the metastatic behavior of head and neck squamous cell carcinoma. Selective inhibition of RhoC expression was achieved using lentiviral small hairpin RNA (shRNA) transduced and tracked with green fluorescent protein to achieve 70% to 80% RhoC inhibition. Fluorescence microscopy of the RhoC knockdown stable clones showed strong green fluorescence in the majority of cells, signifying a high efficiency of transduction. Importantly, quantitative real-time PCR showed no significant decrease in the mRNA expression levels of other members of the Ras superfamily. Cell motility and invasion were markedly diminished in RhoC-depleted cell lines as compared with control transduced lines. H&E staining of lung tissue obtained from severe combined immunodeficiency mice, which ...

Journal of the American College of Cardiology, 2004

Background: Previous studies have demonstrated that myocardial acceleration during isovolumic (IV... more Background: Previous studies have demonstrated that myocardial acceleration during isovolumic (IVCa) and systolic contraction (SCa) is useful in estimating systolic function. In this study, we assessed the usefulness of IVCa , SCa , acceleration during isovolumic diastolic (IVRTa) and early diastolic relaxation (Ea) for detecting systolic and diastolic dysfunction in an experimental ischemic model. Methods and Results: In 12 open-chest anesthetized dogs, a coronary electrolytic injury thrombosis model of left circumflex coronary artery (LCx) was created. Real-time Harmonic Contrast Echocardiography in apical 4-, 2-chamber views were acquired using a commercially available echocardiographic machine (Vivid 7, GE). Using the analytical software (Echo Pac), velocity acceleration was measured from the left ventricular lateral wall using tissue Doppler echocardiography at baseline and after thrombosis. There were significant decreases in IVCa, IVRTa and Ea after ischemia. SCa did not change. Conclusion: IVCa is a measurement of left ventricular (LV) contractile function. IVRTa and Ea are measurements of LV diastolic function. These parameters may be useful for detecting the LV systolic and diastolic dysfunction in ischemic myocardial segments.