Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Otolaryngology
Total Results:
7768
Osteoradionecrosis of the Sub-axial Cervical Spine Following Treatment for Head and Neck Carcinomas
Objectives: To study the MRI and PET/CT imaging of osteoradionecrosis of the sub-axial cervical spine, a serious long-term complication of radiation therapy for head and neck cancers that can lead to pain, vertebral instability, myelopathy, and cord compression. Methods and Materials: This is a single-institution retrospective review of patients diagnosed and treated for osteoradionecrosis of the sub-axial cervical spine following surgery and radiation for head and neck cancer. Results: We report PET/CT and MRI imaging for four patients, each with extensive treatment for recurrent head and neck cancer. Osteomyelitis and discitis are the end stage manifestations of osteoradionecrosis of sub-axial spine. Conclusions: Osteoradionecrosis of the sub-axial spine has variable imaging appearance and needs to be differentiated from recurrent or metastatic disease. Surgical violation of the posterior pharyngeal wall on top of compromised vasculature in patients treated heavily with radiation therapy may predispose the sub-axial cervical vertebrae to osteoradionecrosis, with possible resultant osteomyelitis and discitis. MRI and PET/CT imaging are complimentary in this setting. PET/CT images may be misinterpreted in view of history of head and neck cancer. MRI should be utilized for definitive diagnosis of osteomyelitis and discitis in view of its imaging specificity. Advances in Knowledge: We identify the end-stage manifestation of osteoradionecrosis in the sub-axial spine on PET/CT and MRI to facilitate its correct diagnosis.
PMCID:4277380
PMID: 25375626
ISSN: 0007-1285
CID: 1341352
Journal of the National Comprehensive Cancer Network : JNCCN. 2015:13(1):69-77.DOI: 10.6004/jnccn.2015.0010
Guideline Familiarity Predicts Variation in Self-Reported Use of Routine Surveillance PET/CT by Physicians Who Treat Head and Neck Cancer
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
Spontaneous CSF rhinorrhea: Prevalence of multiple simultaneous skull base defects
BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leaks are caused by intracranial hypertension. Given this underlying etiology, patients may be at risk for developing multiple skull base defects. OBJECTIVE: The purpose of our study is to present the prevalence of multiple simultaneous skull base defects in patients with spontaneous CSF rhinorrhea. METHODS: We performed a retrospective chart review in a tertiary care practice of 44 consecutive patients with spontaneous CSF rhinorrhea who underwent endoscopic repair by the senior author (R.R.C.) to determine the prevalence of having multiple simultaneous skull base defects identified at the time of surgery. We defined this as two or more bony defects identified endoscopically with intact intervening bone with or without soft tissue prolapse into the nasal cavity or paranasal sinus cavity. RESULTS: Eight of 44 patients (18.2%) were found to have multiple simultaneous skull base defects. The average body mass index (BMI) of the study population was 34.5 (range, 22.7-59). CONCLUSION: A significant number of patients with spontaneous CSF rhinorrhea may have more than one skull base defect present at the time of presentation. The clinical significance of this finding in surgical and medical decision making is not clear at this time.
PMID: 25590325
ISSN: 1945-8932
CID: 1436402
Cross-Disorder Genome-Wide Analyses Suggest a Complex Genetic Relationship Between Tourette's Syndrome and OCD
Objective: Obsessive-compulsive disorder (OCD) and Tourette's syndrome are highly heritable neurodevelopmental disorders that are thought to share genetic risk factors. However, the identification of definitive susceptibility genes for these etiologically complex disorders remains elusive. The authors report a combined genome-wide association study (GWAS) of Tourette's syndrome and OCD. Method: The authors conducted a GWAS in 2,723 cases (1,310 with OCD, 834 with Tourette's syndrome, 579 with OCD plus Tourette's syndrome/chronic tics), 5,667 ancestry-matched controls, and 290 OCD parent-child trios. GWAS summary statistics were examined for enrichment of functional variants associated with gene expression levels in brain regions. Polygenic score analyses were conducted to investigate the genetic architecture within and across the two disorders. Results: Although no individual single-nucleotide polymorphisms (SNPs) achieved genome-wide significance, the GWAS signals were enriched for SNPs strongly associated with variations in brain gene expression levels (expression quantitative loci, or eQTLs), suggesting the presence of true functional variants that contribute to risk of these disorders. Polygenic score analyses identified a significant polygenic component for OCD (p=2x10-4), predicting 3.2% of the phenotypic variance in an independent data set. In contrast, Tourette's syndrome had a smaller, nonsignificant polygenic component, predicting only 0.6% of the phenotypic variance (p=0.06). No significant polygenic signal was detected across the two disorders, although the sample is likely underpowered to detect a modest shared signal. Furthermore, the OCD polygenic signal was significantly attenuated when cases with both OCD and co-occurring Tourette's syndrome/chronic tics were included in the analysis (p=0.01). Conclusions: Previous work has shown that Tourette's syndrome and OCD have some degree of shared genetic variation. However, the data from this study suggest that there are also distinct components to the genetic architectures of these two disorders. Furthermore, OCD with co-occurring Tourette's syndrome/chronic tics may have different underlying genetic susceptibility compared with OCD alone.
PMCID:4282594
PMID: 25158072
ISSN: 0002-953x
CID: 1162352
Physiologic swallow measures and swallow safety using the MBSImP and penetration/aspiration scale for upright and supine swallows via videofluoroscopy (VFS) in healthy subjects [Meeting Abstract]
Purpose: Dynamic MRI has been used to examine swallowing in sagittal and axial planes with good temporal resolution. However, few studies have examined temporal measures and none have compared upright vs. supine swallowing in both positions with the MBSImP. We report physiologic variables and swallow safety upright and supine with MBSImP and Penetration/Aspiration scales in healthy subjects. Method(s): Twenty healthy subjects (mean = 28 years) underwent VFS study upright and supine with a C-Arm. Subjects were viewed in the sagittal plane and swallowed 5 mL liquid and pudding barium. Pen/Asp scores and 14 MBSImP variables were analyzed (overall Impression score) in both positions, with means and ranges across subjects upright and supine. Paired t-tests compared MBSImP scores upright vs. supine. Level of significance: p<.05. Result(s): All subjects tolerated the supine position while swallowing. Mean MBSImP scores were WNL across subjects for both positions, except Component 6, Initiation of the Pharyngeal Swallow (Table 1). Nosignificant differences were found for MBSImP scores upright vs. supine. Although the range of Pen/Asp scores was higher for supine, 3 subjects penetrated upright only, 1 penetrated supine only, and 1 aspirated on 1 supine swallow. Pearson coefficients for inter/intra-judge reliability:0.94, 0.91. Conclusions (Including Clinical Relevance): Physiologic measurse revealed a pharyngeal delay in both positions with scores not significantly different. Although Pen/Asp range was higher in supine, more subjects penetrated upright. Future research should examine swallow physiology in both positions in dysphagic and older healthy subjects. (Table Presented)
EMBASE:613971523
ISSN: 1432-0460
CID: 2401682
LOWER RISK OF HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS B PATIENTS TREATED WITH ENTECAVIR: A REACH-B ANALYSIS OF THE ENUMERATE STUDY [Meeting Abstract]
ISI:000362830600363
ISSN: 1600-0641
CID: 1821942
Mucous Membrane Pemphigoid With Ocular Involvement: A Case Report
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2015
pp. 8-9
ISBN: n/a
CID: 1872682
Differential Regulation of 6- and 7-Transmembrane Helix Variants of mu-Opioid Receptor in Response to Morphine Stimulation
The pharmacological effect of opioids originates, at the cellular level, by their interaction with the mu-opioid receptor (mOR) resulting in the regulation of voltage-gated Ca2+ channels and inwardly rectifying K+ channels that ultimately modulate the synaptic transmission. Recently, an alternative six trans-membrane helix isoform of mOR, (6TM-mOR) has been identified, but its function and signaling are still largely unknown. Here, we present the structural and functional mechanisms of 6TM-mOR signaling activity upon binding to morphine. Our data suggest that despite the similarity of binding modes of the alternative 6TM-mOR and the dominant seven trans-membrane helix variant (7TM-mOR), the interaction with morphine generates different dynamic responses in the two receptors, thus, promoting the activation of different mOR-specific signaling pathways. We characterize a series of 6TM-mOR-specific cellular responses, and observed that they are significantly different from those for 7TM-mOR. Morphine stimulation of 6TM-mOR does not promote a cellular cAMP response, while it increases the intracellular Ca2+ concentration and reduces the cellular K+ conductance. Our findings indicate that 6TM-mOR has a unique contribution to the cellular opioid responses. Therefore, it should be considered as a relevant target for the development of novel pharmacological tools and medical protocols involving the use of opioids.
PMCID:4640872
PMID: 26554831
ISSN: 1932-6203
CID: 1859562
Changes in Rat 50-kHz Ultrasonic Vocalizations During Dopamine Denervation and Aging: Relevance to Neurodegeneration
Vocal communication is negatively affected by neurodegenerative diseases, such as Parkinson disease, and by aging. The neurological and sensorimotor mechanisms underlying voice deficits in Parkinson disease and aging are not well-understood. Rat ultrasonic vocalizations provide a unique behavioral model for studying communication deficits and the mechanisms underlying these deficits in these conditions. The purpose of this review was to examine the existing literature for methods using rat ultrasonic vocalization with regard to the primary disease pathology of Parkinson disease, dopamine denervation, and aging. Although only a small amount of papers were found for each of these topics, results suggest that both shared and unique acoustic deficits in ultrasonic vocalizations exist across conditions and that these acoustic deficits are due to changes in either dopamine signaling or denervation and in aging models changes to the nucleus ambiguus, at the level of the neuromuscular junction, and the composition of the vocal folds in the larynx. We conclude that ultrasonic vocalizations are a useful tool for studying biologic mechanisms underlying vocal communication deficits in neurodegenerative diseases and aging.
PMCID:4598432
PMID: 26411763
ISSN: 1875-6190
CID: 2290472
International journal of pediatric otorhinolaryngology extra. 2015:10(3):49-52.DOI: 10.1016/j.pedex.2015.03.005
Pediatric ethmoid sinus desmoplastic fibroma: Case report and review of pediatric bony sinus tumors
While intraosseous tumors of the pediatric sinonasal tract are rare and tend to be slow growing, they can be locally aggressive and have a tendency to recur. Due to the possibility of devastating outcomes secondary to mass effect, it is important for physicians to promptly diagnose and properly manage these tumors. We report an extremely rare case of a desmoplastic fibroma of the ethmoid sinus in a pediatric patient and review its clinical findings, methods of diagnosis, and treatment
SCOPUS:84940461716
ISSN: 1871-4048
CID: 1842122
