Try a new search

Format these results:

Searched for:

person:myssid01

Total Results:

115


Endoscope-assisted approach to excision of branchial cleft cysts

Teng, Stephanie E; Paul, Benjamin C; Brumm, John D; Fritz, Mark; Fang, Yixin; Myssiorek, David
OBJECTIVES/HYPOTHESIS: The purpose of this study is to describe an endoscope-assisted surgical technique for the excision of branchial cleft cysts and compare it to the standard approach. STUDY DESIGN: Retrospective case series review. METHODS: Twenty-seven cases described as branchial cleft excisions performed by a single surgeon at one academic medical center were identified between 2007 and 2014. Twenty-five cases (8 endoscopic, 17 standard approach) were included in the study. Cases were excluded if final pathology was malignant. Patient charts were reviewed, and two techniques were compared through analysis of incision size, operative time, and surgical outcomes. RESULTS: This study showed that the length of incision required for the endoscopic approach (mean = 2.13 +/- 0.23) was significantly less than that of the standard approach (mean = 4.10 +/- 1.46, P = 0.008) despite the fact that there was no significant difference in cyst size between the two groups (P = 0.09). The other variables examined, including operative time and surgical outcomes, were not significantly different between the two groups. CONCLUSION: This transcervical endoscope-assisted approach to branchial cleft cyst excision is a viable option for uncomplicated cases. It provides better cosmetic results than the standard approach and does not negatively affect outcomes, increase operative time, or result in recurrence. LEVEL OF EVIDENCE: 4. Laryngoscope, 2015.
PMID: 26466762
ISSN: 1531-4995
CID: 1803692

The Effect of an Oral Care Intervention in Decreasing the Expression of Proinflammatory Cytokines in Patients Receiving Chemoradiation for Oral Cancer: A Randomized Clinical Trial [Meeting Abstract]

Sanfilippo, NJ; Vasconcelos, R; Moya, J; Malamud, D; Barber, C; Smith, BE; DeLacure, M; Kerr, R; Schmidt, B; Myssiorek, D; Corby, P
ISI:000371581900071
ISSN: 1879-355x
CID: 2056892

Treatment of carotid paraganglioma

Myssiorek, D; Persky, M
Carotid paragangliomas, commonly known as carotid body tumors, are the most commonly reported head and neck paragangliomas. They are slow growing and always associated with the carotid arteries and adjacent nerves. They are rarely malignant. The estimates for familial transmission of this tumor range from 30%-50%. When multiple paragangliomas are present, the most common combination is 2 carotid paragangliomas. There are no absolute indications for surgical resection, but tumors expressing biochemical activity, a growth rate >1-2 mm per year or demonstrating airway or alimentary tract compression should be resected. Patients younger than 50 years should have small-to-medium sized paragangliomas resected. Patients with significant comorbidities or a contralateral cranial nerve dysfunction should not have surgery. Large carotid paragangliomas involving the skull base would likely result in multiple lower cranial nerve dysfunction after resection requiring multispecialty care afterwards. When dealing with bilateral carotid paragangliomas, resection of the smaller tumor first is recommended. Simultaneous carotid paraganglioma excision is discouraged because of acute baroreceptor failure. The second carotid paraganglioma may be observed for growth or it may be radiated depending on symptoms, size, or growth. The role and indications for angiography and embolization are covered elsewhere in this issue. If a carotid paraganglioma is biochemically active, alpha-adrenergic blockade followed by beta blockade is recommended and should be commenced 10 days before surgery. The complications associated with carotid paraganglioma excision are lower cranial nerve palsies and cerebrovascular accidents, although these are quite uncommon for small-to-medium sized tumors. Meticulous surgery and control of the carotid arteries can decrease these morbidities dramatically. Recently, a "top down" or craniocaudal approach to these tumors has gained acceptance among many surgeons. This approach controls the cephalad internal carotid artery and external carotid artery and removes the tumor down to the bifurcation. This technique has decreased the incidence of cranial neuropathy and blood loss in these patients. Following treatment, the uncomplicated patient requires yearly follow-up consisting of physical examination and magnetic resonance imaging. The familial patient should be genetically tested for succinate dehydrogenase mutations. Depending on the type of mutation yearly imaging and evaluation of siblings, parents and children is strongly advised. As metachronous lesions are possible, this follow-up is a lifetime undertaking
SCOPUS:84961153603
ISSN: 1043-1810
CID: 2170362

Neck management in malignant head and neck paragangliomas

Roden, D; Myssiorek, D
The vast majority of paragangliomas are benign. It is unclear what percentage is malignant but it has been estimated between 6% and 10% of those reported. Despite their distinct radiologic and pathologic appearance, there is no reliable way to distinguish benign from malignant paragangliomas preoperatively. There are no absolute pathologic criteria for malignancy. The accepted criteria for determining malignancy preoperatively are spread to regional lymph nodes or distant metastasis.There are predictors of malignancy. They include location of the paraganglioma (vagal paragangliomas are malignant more often than any other paraganglioma), pain as a presenting symptom, recent rapid growth, and the succinate dehydrogenase B subunit mutation. The 5-year survival rate for malignant paraganglioma has been estimated to be around 60%. As the presence of lymph node metastasis could be the only sign of malignancy, it is recommended that lymph nodes be removed during the resections of these tumors. In the case of paragangliomas presenting in the neck, levels II and III are easily approached and should be sampled. In cases where there is preoperative involvement of lymph nodes by paraganglioma, a modified neck dissection is indicated. It should address minimally levels II through IV
SCOPUS:84961192604
ISSN: 1043-1810
CID: 2170372

Surgical management of vagal paraganglioma

Khan, MJ; Goldenberg, D; Myssiorek, D
Vagal paragangliomas are nonchromaffin tumors that originate from paraganglionic chemoreceptor cell bodies associated with the vagus nerve. Although both surgical excision and radiation therapy have been reported to be effective treatment modalities, the effectiveness of one over the other remains unclear. There are several surgical approaches that have been described. As with any surgical disease, the utility of a technique over another has been justified at some point in time. Clearly, there has been a shift away from the more radical approaches with the primary goal of surgery being complete extirpation of the tumor along with avoidance of iatrogenic cranial neuropathies and preservation and restoration of cranial nerve function. In addition, early rehabilitation of speech and swallowing dysfunction results in improved functional outcomes and reduced hospital stay and morbidity
SCOPUS:84961158925
ISSN: 1043-1810
CID: 2170382

Treatment of laryngeal paraganglioma

Myssiorek, D
Laryngeal paragangliomas are rare tumors that arise from 3 superior and 1 inferior paraganglia within the larynx. They present as painless, submucosal masses that become symptomatic after they surpass a critical size. At this point, hoarseness followed by dysphagia becomes evident. These tumors are rarely familial and rarely, if at all, malignant. Diagnosis is made by a thorough head and neck examination. On laryngoscopy, the most common finding is a submucosal mass in the false vocal fold. Imaging reveals a rather round mass with clear margins. The lesion is hyperintense on imaging. Delineation from nerve sheath tumors can be accomplished by somatostatin receptor imaging. No biopsy is needed to treat these tumors as all laryngeal submucosal tumors require surgery. Transoral laryngeal biopsy is discouraged because of subsequent profuse bleeding and unnecessary disruption of the overlying mucosa. Transcervical excision via a lateral laryngotomy is the procedure of choice for supraglottic paragangliomas. It can be accomplished with minimal blood loss, complete extirpation, and no tracheotomy. Embolization is unnecessary because supraglottic paragangliomas are rarely larger than 3 cm without obstructing the patient's airway. The blood supply to these tumors is through the laryngeal branch of the superior thyroidal artery, which is controlled during the excision. Patients with infraglottic paragangliomas are rare and are best approached through laryngofissure. Patients can expect rapid recovery, no significant blood loss, and minimal, if any, temporary dysphagia
SCOPUS:84961119433
ISSN: 1043-1810
CID: 2170392

Microbial biomarkers of oral mucositis onset [Meeting Abstract]

Vasconcelos, R; Paster, B; Sanfilippo, N; Kerr, A R; Li, Y; Faller, L; Smith, B; Concert, C; Queiroz, E; Howard, C; Nightingale, K; Gabinsky, M; Ramalho, L; Hu, K; De, Lacure M; Myssiorek, D; Corby, P
Introduction: Oral mucositis (OM) is among the most common, painful and debilitating toxicities of cancer regimen-related treatment, resulting in the formation of ulcers, which are susceptible to increased colonization of microorganisms. Objectives: The aim of this study is to explore the changes in the microbiome associated with OM onset in head and neck cancer patients (oral cavity and oropharynx squamous cell carcinoma) undergoing radiotherapy alone (RT) or chemoradiotherapy (chemoRT) using molecular techniques. Methods: We recruited patients scheduled for receiving radiotherapy alone or chemoRT. Site-specific oral biofilms samples were collected using Isohelix swabs at two time points: before initiating RT/ChemoRT (pre-OM), and at the onset of OM (post-OM ie OM > 1, WHO scale). Changes in microbial abundance were detected using the Human Oral Microbe Identification using Next Generation Sequencing (HOMINGS) and metagenomic analyses. An integrative computational model estimated average changes of microbial abundance patterns of 768 species identified from pre-and-post OM onset. Results: Relative changes in abundance of 54 microbial biomarkers in 16 subjects were discriminative between pre and post OM onset. Discriminant species such as Gemella haemolysans, Granulicatella elegans, Haemophilus spp., Prevotellaoris, and Aggregatibacter sp. HOT512 were found to be significantly overabundant in post-OM onset samples as compared to pre-OM. (Table Presented) Conclusions: Our results suggest a dynamic shift in the oral microbiome during the onset of OM. These species may act as opportunistic pathogens in this population, and further investigation is warranted to explore if they facilitate further tissue damage and subsequent pain
EMBASE:616579112
ISSN: 1433-7339
CID: 2608262

Necessity for lifelong follow-up of patients with familial paraganglioma syndrome: A case report

Persky, Michael J; Adelman, Mark; Zias, Elias; Myssiorek, David
BACKGROUND: Patients with established familial paraganglioma (PGL) syndrome may have multiple metachronous lesions. This article illustrates, via imaging and findings, the need for lifetime follow-up of patients with familial PGL syndromes. METHODS: Patients' medical charts and radiological images were reviewed in a retrospective analysis. RESULTS: Over the course of 18 years, this patient developed 2 simultaneous carotid PGLs, a cardiac PGL, and a biochemically active interaortocaval PGL. CONCLUSION: PGLs do not necessarily occur simultaneously in patients with familial PGL syndrome. Lifelong observation is needed to detect these lesions before they become large and symptomatic. Lack of biochemical activity is not a predictor of future lesions being inactive. Cardiac PGLs are rare and require resection. (c) 2015 Wiley Periodicals, Inc. Head Neck 37: E174-E178, 2015.
PMID: 25783443
ISSN: 1097-0347
CID: 1920802

Guideline Familiarity Predicts Variation in Self-Reported Use of Routine Surveillance PET/CT by Physicians Who Treat Head and Neck Cancer

Roman, Benjamin R; Patel, Snehal G; Wang, Marilene B; Pou, Anna M; Holsinger, F Christopher; Myssiorek, David; Goldenberg, David; Swisher-McClure, Samuel; Lin, Alexander; Shah, Jatin P; Shea, Judy A
BACKGROUND: Use of routine surveillance testing beyond guideline recommended levels is common in many oncologic disciplines, including head and neck cancer. The impact of guideline familiarity and other physician characteristics on surveillance imaging use are not well understood. METHODS: A cross-sectional national survey was performed of physicians responsible for surveillance of patients with head and neck squamous cell carcinoma (HNSCC). The primary outcome was self-reported use of routine surveillance PET/CT in asymptomatic patients. A secondary outcome was familiarity with guideline recommendations. Using multivariable regression, the impact of guideline familiarity and other physician characteristics on PET/CT use was examined. RESULTS: Of the 502 responders, 79% endorsed ever using PET/CT scans for routine surveillance imaging, and 39% were high imaging users (used PET/CT scans on more than half of their asymptomatic patients); 76% were familiar with the NCCN Clinical Practice Guidelines in Oncology for Head and Neck Cancers recommending against routine surveillance PET/CT scans. Although guideline familiarity was associated with being a low imaging user or a never-user, among those who were familiar with guidelines, 31% were nonetheless high imaging users and 73% endorsed ever using PET/CT scans. In multivariable analysis controlling for physician characteristics, guideline familiarity was the strongest predictor of PET/CT use. CONCLUSIONS: Familiarity with the NCCN Guidelines predicts self-reported routine surveillance PET/CT use among physicians who treat patients with HNSCC. However, given the observed variation and high levels of imaging even among physicians who are familiar with the guidelines, further research should examine the reasons physicians choose to use surveillance PET/CT scans.
PMID: 25583771
ISSN: 1540-1405
CID: 1459782

Metformin inhibits salivary adenocarcinoma growth through cell cycle arrest and apoptosis

Guo, Yuqi; Yu, Tao; Yang, Jian; Zhang, Tianqing; Zhou, Yang; He, Fan; Kurago, Zoya; Myssiorek, David; Wu, Yingjie; Lee, Peng; Li, Xin
The inhibitory effects of metformin have been observed in many types of cancer. However, its effect on human salivary gland carcinoma is unknown. The effect of metformin alone or in combination with pp242 (an mTOR inhibitor) on salivary adenocarcinoma cells growth were determined in vitro and in vivo. We found that metformin suppressed HSY cell growth in vitro in a time and dose dependent manner associated with a reduced expression of MYC onco-protein, and the same inhibitory effect of metformin was also confirmed in HSG cells. In association with the reduction of MYC onco-protein, metformin significantly restored p53 tumor suppressor gene expression. The distinctive effects of metformin and PP242 on MYC reduction and P53 restoration suggested that metformin inhibited cell growth through a different pathway from PP242 in salivary carcinoma cells. Furthermore, the anti-tumor efficacy of metformin was confirmed in vivo as indicated by the increases of tumor necrosis and reduced proliferation in xenograft tumors from metformin treated group. For the first time, the inhibitory effect of metformin on human salivary gland tumor cells was documented. Moreover, metformin inhibitory effects were enhanced by mTOR inhibitor suggesting that metformin and mTOR inhibitor utilize distinctive signaling pathways to suppress salivary tumor growth.
PMCID:4731634
PMID: 26885449
ISSN: 2156-6976
CID: 1948892