scholarly journals Metastatic Tumors of the Sinonasal Cavity: A 15-Year Review of 17 Cases

2019 ◽  
Vol 8 (4) ◽  
pp. 539 ◽  
Author(s):  
Miao-Hsu Chang ◽  
Ying-Ju Kuo ◽  
Ching-Yin Ho ◽  
Edward C. Kuan ◽  
Ming-Ying Lan
Keyword(s):  
Medical Center ◽  
Metastatic Cancer ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Tumor Resection ◽  
Palliative Therapy ◽  
Previous History ◽  
Rare Condition ◽  
Treatment Modalities ◽  
Patient Demographic Data

Extranasal cancers that metastasize to the sinonasal cavity are very rare. To date, there are only limited reports regarding this rare condition within the literature. Therefore, we retrospectively reviewed all patients diagnosed with metastatic cancer of the sinonasal tract from 2003 to 2018 at a tertiary academic medical center. Patient demographic data, clinical presentation, treatment modalities, and outcomes were investigated. There were a total of 17 patients (9 males and 8 females) included in the analysis. The mean age was 56.8 years (range 27–80). The most common primary malignancies were hepatocellular carcinoma (n = 3) and gastrointestinal tract adenocarcinoma (n = 3). The most common site of metastasis was the nasal cavity (n = 8). Five patients received radical tumor resection and the others underwent radiotherapy, chemotherapy, or combined chemoradiotherapy. The 2-year survival was 28%. In summary, metastasis to the sinonasal cavity remains extremely rare. A high degree of suspicion regarding the possibility of metastatic spread to the sinonasal region is necessary for patients with a previous history of malignancy who present with new sinonasal symptoms. The treatment strategy of sinonasal metastatic cancer is usually palliative therapy and the prognosis remains poor. However, early detection and diagnosis, coupled with aggressive treatment, may improve patient quality of life.

scholarly journals Nasopharyngeal Lymphoma: A 22-Year Review of 35 Cases

2019 ◽  
Vol 8 (10) ◽  
pp. 1604 ◽  
Author(s):  
Hsueh ◽  
Yang ◽  
Gau ◽  
Kuan ◽  
Ho ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Medical Center ◽  
Demographic Data ◽  
B Cell Lymphoma ◽  
Neck Mass ◽  
Treatment Modalities ◽  
Primary Malignancy ◽  
Barr Virus ◽  
Mantle Cell ◽  
Epstein Barr

Nasopharyngeal (NP) lymphoma is a rare primary malignancy of the head and neck and represents a minority of malignancies originating from the nasopharynx. For this reason, there are limited data regarding epidemiologic and treatment outcomes. This is a retrospective review of patients diagnosed with NP lymphoma from 1995 to 2017 at a tertiary medical center. The patients’ demographic data, clinical presentations, treatment modalities, Epstein–Barr virus (EBV)-encoded small RNA (EBER) staining, and outcomes were investigated. We considered a total of 35 patients, including 20 males and 15 females, diagnosed with NP lymphoma. The age ranged from 17 to 88 years (mean = 59.6). The common presentations were nasal obstruction, epistaxis, and neck mass. In our study, the most common pathological diagnosis of NP lymphoma was diffuse large B cell lymphoma (DLBCL) (n = 17), followed by NK/T cell lymphoma (NKTCL) (n = 9). Other pathologic diagnoses included extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALToma), small lymphocytic lymphoma, mantle cell lymphoma. There were 13 cases showing EBER positivity, including 7 cases of NKTCL, 5 cases of DLBCL, and 1 case of post-transplant lymphoproliferative disorder (PTLD). Most patients received chemotherapy alone, while some patients received both chemotherapy and radiotherapy. Seven patients had local recurrence, and fewer than half of the patients (n = 16) were alive at the time of the study (mean follow-up duration: 54.4 months). The five-year overall survival was 50.4%. NP lymphoma is very rare, and the most common pathologic type is DLBCL. EBER positivity is found in both NKTCL and DLBCL. Identifying more effective therapeutic agents is extremely important to improve patients’ survival.

scholarly journals The Prescribing and Education of Naloxone in a Large Academic Medical Center

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 31
Author(s):  
Sabrina Miller ◽  
Lauren Williams ◽  
Amy N. Thompson
Keyword(s):  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Reversal Agents ◽  
Outpatient Prescription ◽  
Current State ◽  
Academic Medical ◽  
History Of ◽  
Improvement Measures

The opioid epidemic has led to increased needs for opioid reversal agents which require education and counseling for proper use. The purpose of this study was to evaluate outpatient naloxone prescribing and education practices at an academic medical center to understand the current state and inform quality improvement measures. This retrospective chart review study included 439 patients that were at least 18 years old and received an outpatient prescription for naloxone between 1 July 2017 and 30 June 2018. Descriptive and demographic data were collected. The primary endpoint was whether an indication for naloxone and education on administration were documented when naloxone was initially prescribed to patients. Overall, 39% of naloxone prescriptions did not have an indication for prescribing listed in the medical record. Of those with a documented indication, concomitant benzodiazepines and history of overdose or substance abuse were most common (22% and 14%). The average morphine milligram equivalents were 165. Additionally, 69% of dispenses did not have documentation that the patient or a caregiver received education regarding the use and administration of naloxone. These findings suggest that patients are receiving naloxone for appropriate indications. Documentation of medication education is needed to ensure it is occurring and that patients are informed.

scholarly journals OTHR-05. THE ABILITY TO MAKE INFORMED TREATMENT DECISIONS IS COMPROMISED IN ADULTS WITH ADVANCED STAGE CANCER

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i19-i19
Author(s):  
Kristen Triebel ◽  
Kyler Mulhauser ◽  
Meredith Gammon ◽  
Adam Gerstenecker ◽  
L Burt Nabors ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Medical Center ◽  
Metastatic Cancer ◽  
Academic Medical Center ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Control Group ◽  
Advanced Stage ◽  
Advanced Stage Cancer

Abstract OBJECTIVE: To investigate medical decision-making capacity (MDC) in patients with advanced stage cancer. METHODS: Participants were 113 newly diagnosed adults with brain metastases and 41 adults with metastatic cancer without brain metastases who were recruited from an academic medical center and 40 demographically-matched healthy controls recruited from the community. We evaluated MDC using the Capacity to Consent to Treatment Instrument (CCTI) Vignette B and its four clinically relevant consent standards (expressing a treatment choice, appreciation, reasoning, and understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, and severe impairment) on the consent standards were also assigned to each participant using cutoff scores derived statistically from the performance of the control group. RESULTS: Both of the metastatic cancer groups (with and without brain metastasis) performed significantly below controls on consent standards of understanding and reasoning. The brain metastasis group performed below the non-metastatic cancer group on understanding. Capacity compromise was defined as performance ≤1.5 standard deviations (SD) below the control group mean. Using this definition, approximately 65% of the participants with brain metastases and 51% of participants with metastatic cancer without brain metastases were impaired on at least one MDC standard. CONCLUSION: Over half of participants with metastatic cancer regardless of whether they have brain disease have reduced capacity to make treatment decisions. The finding of impaired MDC in patients without brain metastases is surprising and suggests this group likely exhibits cognitive deficits that impact their ability to understand and reason about different treatment options. The reasons underlying this impairment will be investigated. This highlights the importance of routine clinical assessment of MDC in all patients with metastatic cancer when important treatment decisions are being discussed. These results also indicate a need for the development and investigation of interventions to support or improve MDC in this patient population.

scholarly journals Neoplastic causes of nonacute facial paralysis: A review of 221 cases

2016 ◽  
Vol 95 (9) ◽  
pp. 390-396 ◽  
Author(s):  
John P. Leonetti ◽  
Sam J. Marzo ◽  
Douglas A. Anderson ◽  
Joshua M. Sappington
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Surgical Approaches ◽  
Facial Weakness ◽  
Gradual Onset

We conducted a retrospective review to assess the clinical presentation of patients with tumor-related nonacute complete peripheral facial weakness or an incomplete partial facial paresis and to provide an algorithm for the evaluation and management of these patients. Our study population was made up of 221 patients—131 females and 90 males, aged 14 to 79 years (mean: 49.7)—who had been referred to the Facial Nerve Disorders Clinic at our tertiary care academic medical center over a 23–year period with a documented neoplastic cause of facial paralysis. In addition to demographic data, we compiled information on clinical signs and symptoms, radiologic and pathologic findings, and surgical approaches. All patients exhibited gradual-onset facial weakness or facial twitching. Imaging identified an extratemporal tumor in 128 patients (58%), an infratemporal lesion in 55 patients (25%), and an intradural mass in 38 (17%). Almost all of the extratemporal tumors (99%) were malignant, while 91 % of the infratemporal and intradural tumors were benign. A transtemporal surgical approach was used in the 93 infratemporal and intradural tumor resections, while the 128 extratemporal lesions required a parotidectomy with partial temporal bone dissection. The vast majority of patients (97%) underwent facial reanimation. We conclude that gradual-onset facial paralysis or twitching may occur as a result of a neoplastic invasion of the facial nerve along its course from the cerebellopontine angle to the parotid gland. We caution readers to beware of a diagnosis of “atypical Bell's palsy.”

scholarly journals Role of drug-induced sleep endoscopy in evaluation of positional vs non-positional OSA

2020 ◽  
Vol 49 (1) ◽  
Author(s):  
Ming-Chin Lan ◽  
Stanley Yung-Chuan Liu ◽  
Ming-Ying Lan ◽  
Yun-Chen Huang ◽  
Tung-Tsun Huang ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Lateral Wall ◽  
Treatment Modalities ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Cross Sectional ◽  
Drug Induced Sleep Endoscopy ◽  
Positional Dependency

Abstract Background The study aimed to evaluate the anatomical differences between positional and non-positional OSA, and to identify the potential predictors for distinguishing between these two types of OSA. Methods A cross-sectional study of 230 consecutive patients with OSA undergoing DISE (Drug-induced Sleep Endoscopy) was carried out at a tertiary academic medical center. The factors correlating with positional and non-positional OSA were analyzed, including clinical characteristics, polysomnography data, and DISE findings. Results Univariate analysis revealed that non-positional dependency was correlated with a higher BMI (p < 0.001), neck circumference (p < 0.001), modified Mallampati score (p = 0.003), AHI (p < 0.001), degree of velum concentric collapse (p = 0.004), degree of oropharyngeal lateral wall collapse (p < 0.001), and degree of tongue base anteroposterior collapse (p = 0.004). Multivariate analysis revealed that oropharyngeal lateral wall collapse (OR = 1.90, p = 0.027) was the only anatomical factor significantly predicted non-positional dependency in OSA patients. AHI (OR = 1.04, p < 0.001), although significant, made only a marginal contribution to the prediction of non-positional dependency. Conclusions Oropharyngeal lateral wall collapse was identified as the only anatomical predictor for non-positional dependency in OSA patients. Therefore, further treatment modalities should address the distinct anatomical trait between positional and non-positional OSA. Graphical abstract

scholarly journals Advantages and Complications of Fisch Partial Mastoidotympanectomy for Tumors of the Retromandibular Fossa and Poststyloid Space

2017 ◽  
Vol 78 (05) ◽  
pp. 380-384
Author(s):  
Dominic Catalano ◽  
Michael Gluth
Keyword(s):  
Wound Healing ◽  
Temporal Bone ◽  
External Auditory Canal ◽  
Soft Tissues ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tumor Resection ◽  
Bone Resection ◽  
Intraoperative Complication ◽  
Temporal Bone Resection

Objective This study aims to characterize a single surgeon's experience with resection of tumors of the retromandibular fossa and poststyloid space utilizing the Fisch partial mastoidotympanectomy (FPMT) technique of partial temporal bone resection. Design Retrospective review. Setting Academic medical center. Participants Seven patients who underwent tumor resection with FPMT. Main Outcome Measures Complications. Results Six males and one female underwent FPMT, with ages ranging from 44 to 79 years. The facial nerve was sacrificed in six cases, no cases were converted to more extensive temporal bone resection procedures, and no postoperative hearing loss occurred. The only intraoperative complication experienced was a violation of the external auditory canal in four cases, which resulted in postoperative wound healing issues in two cases. Conclusions FPMT allows for the release of tumors of the poststyloid space and retromandibular fossa without compromise of hearing status. Preservation of external auditory canal soft tissues is challenging, and the violation is experienced relatively frequently due to shearing forces during soft tissue retraction. When encountered, robust repair of defects is encouraged to prevent further wound healing complications.

scholarly journals The Influence of Household Income on Survival following Posterior Fossa Tumor Resection at a Large Academic Medical Center

2020 ◽  
Author(s):  
Rachel Blue ◽  
Donald K. Detchou ◽  
Ryan Dimentberg ◽  
Kaitlyn Shultz ◽  
Michael Spadola ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Brain Tumor ◽  
Posterior Fossa ◽  
Household Income ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tumor Resection ◽  
Academic Medical ◽  
Significant Difference

Abstract Objectives The present study examines the effect of median household income on mid- and long-term outcomes in a posterior fossa brain tumor resection population. Design This is a retrospective regression analysis. Setting The study conducted at a single, multihospital, urban academic medical center. Participants A total of 283 consecutive posterior fossa brain tumor cases, excluding cerebellar pontine angle tumors, over a 6-year period (June 09, 2013–April 26, 2019) was included in this analysis. Main Outcome Measures Outcomes studied included 90-day readmission, 90-day emergency department evaluation, 90-day return to surgery, reoperation within 90 days after index admission, reoperation throughout the entire follow-up period, mortality within 90 days, and mortality throughout the entire follow-up period. Univariate analysis was conducted for the whole population and between the lowest (Q1) and highest (Q4) socioeconomic quartiles. Stepwise regression was conducted to identify confounding variables. Results Lower socioeconomic status was found to be correlated with increased mortality within 90 postoperative days and throughout the entire follow-up period. Similarly, analysis between the lowest and highest household income quartiles (Q1 vs. Q4) demonstrated Q4 to have significantly decreased mortality during total follow-up and a decreasing but not significant difference in 90-day mortality. No significant difference in morbidity was observed. Conclusion This study suggests that lower household income is associated with increased mortality in both the 90-day window and total follow-up period. It is possible that there is an opportunity for health care providers to use socioeconomic status to proactively identify high-risk patients and provide additional resources in the postoperative setting.

scholarly journals Benign Endobronchial Tumors: A Clinicopathologic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Joshua E. Insler ◽  
Christopher W. Seder ◽  
Karina Furlan ◽  
Fatima Mir ◽  
Vijaya B. Reddy ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Benign Neoplasm ◽  
Diagnosis And Treatment ◽  
Treatment Modalities ◽  
Histologic Diagnosis ◽  
Radiographic Findings ◽  
Pathologic Features ◽  
Hospital Deaths

Purpose: Benign endobronchial tumors are rare entities that can be difficult to diagnose because they often present with non-specific symptoms and vague radiographic findings. The current study reviews the clinical, radiologic and pathologic features, diagnosis, and treatment of patients with benign endobronchial tumors.Methods: We examined the charts of all patients who presented with biopsy-proven benign endobronchial tumors at a tertiary-care academic medical center between 1993 and 2018. Pertinent clinicopathologic and radiologic data were analyzed, with particular attention paid to treatment modalities and mean overall patient survival.Results: A total of 28 cases were identified. The most common benign neoplasm was hamartoma (37%), followed by lipoma (19%), squamous papilloma (11%), pleomorphic adenoma (7%), mucin gland adenoma (7%), papillary adenoma (3%), hemangioma (3%), neurofibroma (3%), leiomyoma (3%), and papillomatosis (3%). Cough (58%), shortness of breath (44%), and hemoptysis (15%) were the most frequent presentations. Most cases demonstrated well-defined submucosal or pedunculated endobronchial lesions with segmental pneumonia or atelectasis on imaging. Histologic diagnosis was obtained by endobronchial resection in 43% of patients, thoracoscopic lobectomy in 36%, endobronchial biopsy in 18%, and thoracoscopic wedge resections in 3%. All procedures were performed with no intraoperative or in-hospital deaths (mean overall survival: 20.2 years).Conclusion: Benign endobronchial tumors typically present as well-defined submucosal and/or pedunculated lesions, and may lead to post-obstructive complications. Endobronchial resection is the preferred strategy for diagnosis and treatment of these tumors.

Long-term impact of patient navigation (PN) for breast cancer (BCA) screening in an urban academic medical center.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 130-130
Author(s):  
Lisa Phuong ◽  
Jesus Del Santo Anampa Mesias ◽  
Melanie Lozada ◽  
Della F. Makower
Keyword(s):  
Median Time ◽  
Health Care Disparities ◽  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Rank Test ◽  
Care Providers ◽  
Long Term Impact

130 Background: PN improves BCA screening rates in underserved women, and decreases health care disparities. However, there is limited data regarding the ability of PN effect sustained change. We evaluated the long-term impact of PN for BCA screening at our institution, by assessing the rate at which women who underwent screening mammogram (SM) in 2017, with the aid of PN, completed subsequent (f/u) SM within guideline-concordant time frames. Methods: Patients (pts) consisted of women seen by our institution’s primary care providers, with referral for SM in the electronic medical record (EMR), but without scheduled appointment, who received PN between June 1 and September 30, 2017, and successfully completed SM in 2017. Pts were identified from the screening navigation database. EMR was reviewed to obtain demographic data, rate of f/u SM, and time from 2017 SM to prior and f/u SM. Wilcoxon signed-rank test was used for analysis. Results: 179 pts completed SM with the aid of PN in 2017. Median age was 58 (range 37-77), 52.5% were Hispanic, 26.8% Black; and 2.8% Asian. Preferred languages were English (70.4%) and Spanish (25.7%). 6 pts had never had prior SM; 30 had no prior SM at our institution. Median time between 2017 SM and prior SM was 29 months (mo) (range 12-104); only 20 pts (11.2%) had a prior SM within 24 mo. 177 pts were eligible for f/u SM in 2018 and 2019 (1 diagnosed with BCA on 2017 SM; 1 died in 2017). 85 pts (48%) completed f/u SM; 68 (39%) completed within 24 mo. Only 2 pts required PN to complete f/u SM. In pts with time to screening data available for both 2017 SM and f/u SM (n = 80), median time to SM improved from 24 to 16 mo (p < 0.01). Decreases were seen in Black (22 to 14 mo, p < 0.01), White (31 to 16 mo, p = 0.03), and Hispanic pts (28 to 18.5 mo, p < 0.01), and in English (22 to 15 mo, p < 0.01) and Spanish speakers (26 to 20 mo, p < 0.01). Conclusions: A single episode of PN for BCA screening had a sustained impact on pts at our institution, leading to improved compliance with future SM. Improvement was seen in pts of diverse races, ethnicities, and language preferences. Focused PN for pts who did not complete f/u SM is planned.

scholarly journals Glomus Faciale Tumors: A Report of 3 Cases and Literature Review

2017 ◽  
Vol 96 (3) ◽  
pp. E7-E12 ◽  
Author(s):  
Sahar Nadimi ◽  
John P. Leonetti ◽  
Sam J. Marzo ◽  
Douglas E. Anderson ◽  
Gulrez Mahmood ◽  
...  
Keyword(s):  
Literature Review ◽  
Facial Nerve ◽  
Medical Center ◽  
Academic Medical Center ◽  
Infratemporal Fossa ◽  
Tertiary Care ◽  
Tumor Resection ◽  
Case Series ◽  
Management Options ◽  
Complete Tumor

Our objectives in reporting this case series are to familiarize readers with the rare occurrence of paragangliomas originating along the facial nerve and to provide a literature review. We describe 3 such cases that occurred at our tertiary care academic medical center. Two women and 1 man presented with a tumor adjacent to the vertical segment of the facial nerve. The first patient, a 48-year-old woman, presented with what appeared to be a parotid tumor at the stylomastoid foramen; she underwent a parotidectomy, transmastoid facial nerve decompression, and a shave biopsy of the tumor. The second patient, a 66-year-old man, underwent surgery via a postauricular infratemporal fossa approach, and a complete tumor resection was achieved. The third patient, a 56-year-old woman, presented with a middle ear mass; she underwent complete tumor removal through a transmastoid transcanal approach. All 3 patients exhibited normal facial nerve function both before and after surgery. Paragangliomas of the facial nerve are extremely rare, and their signs and symptoms are unlike those of any other temporal bone glomus tumors. Management options include surgical resection, radiologic surveillance, and radiotherapy. The facial nerve can be spared in selected cases.

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