Search PubMed⌕ Search

Biomedical subjects

A R Shaha

Publications and source records attributed to A R Shaha.

At least 19 recordsLinked to original sources
PubMed1997

Thyroid hemiagenesis.

BACKGROUND AND OBJECTIVES: Thyroid hemiagenesis is a rare embryological condition, predominantly in females (3:1) with a left lobe being absent. The associated diseases in the remaining thyroid lobe include benign adenoma, multinodular goiter, hyperthyroidism, chronic thyroiditis, and rarely carcinoma. The most common pathology involved in thyroid hemiagenesis is hyperthyroidism. Presence of carcinoma in a patient with hemiagenesis is quite rare and very few cases are reported in the world literature. METHODS: We report a 30-year-old female who presented with left thyroid mass gradually increasing in size over a period of 3 months. The patient's pre-operative workup included a thyroid scan, which revealed a cold nodule in the left lobe with absent right lobe. A fine-needle aspiration biopsy was suspicious for papillary thyroid carcinoma. The patient underwent thyroid exploration and left thyroid lobectomy. RESULTS: The operative findings confirmed hemiagenesis of the right lobe and papillary carcinoma in the left lobe. All four parathyroids were in normal position. CONCLUSIONS: The purpose of this presentation is to discuss and review the literature on thyroid hemiagenesis and present a rare case of absent right thyroid lobe with carcinoma in the remaining left thyroid lobe.

Adult↗
PubMed1997

Sestamibi scan for preoperative localization in primary hyperparathyroidism.

BACKGROUND: Various invasive and noninvasive localizing tests are available for the evaluation of primary hyperparathyroidism. The surgical success in primary intervention exceeds 90% without localization studies. However, localization tests are absolutely essential for re-exploration and in certain select circumstances, even in primary exploration. The traditional noninvasive localization studies include the sonogram, thallium-technetium scan, computed tomography (CT) scan, and magnetic resonance imaging (MRI). The purpose of this report is to review our recent experience with sestamibi scan. The sestamibi scan appears to be the most sensitive and accurate noninvasive test available today. METHODS: Technetium 99m sestamibi has recently been used for parathyroid localization, in conjunction with iodine123 subtraction. We have evaluated 24 patients with suspected primary hyperparathyroidism to study the role of technetium 99m sestamibi scan. Tc-sestamibi was used either with or without iodine123 for subtraction of thyroid activity. RESULTS: None of these patients had renal failure or secondary hyperparathyroidism. Of 24 patients, the parathyroid adenoma was localized by scintigraphy in 19 patients. Twenty patients underwent surgical exploration. In 17 patients there was a complete correlation between the imaging study and the operative findings (positive predictive value, 89%). There were no false positives in this series. The interpretation of the parathyroid images was relatively easy; however, the depth of the adenoma could not be predicted, based on the scan alone. The largest adenoma weighed 2.7 g, the smallest, 700 mg. CONCLUSION: This newer radiopharmaceutical, technetium 99m sestamibi, appears to be quite useful and accurate in the preoperative localization of patients with primary hyperparathyroidism. Parathyroid enlargement can also be studied by sestamibi imaging alone if delayed imaging is performed.

Adult↗
PubMed1997

Resection and immediate microvascular reconstruction in the management of osteoradionecrosis of the mandible.

BACKGROUND: Management of osteoradionecrosis (ORN) remains a difficult and challenging problem. The traditional approach using debridement, antibiotics, and occasionally hyperbaric oxygen is usually successful in treating minimal ORN. However, when bone and soft-tissue necrosis is extensive, the conservative approach usually requires intensive care over a long period of time and often yields unsatisfactory functional and cosmetic results. METHODS: Within the past 5 years, we have used radical resection of the mandible with immediate microvascular reconstruction in the treatment of extensive ORN of the mandible. This aggressive surgical approach was used in six patients with advanced ORN of the mandible, all of whom had failed initial conservative treatment, including hyperbaric oxygen therapy in three. A fibular free graft with microvascular anastomosis was used in all patients. RESULTS: All the patients healed primarily with minimal postoperative morbidity and excellent cosmetic results. Two patients subsequently required removal of some of their hardware. One patient had placement of osseointegrated implants with an excellent cosmetic and functional result. CONCLUSION: Microvascular reconstruction with its own blood supply seems to expedite bone healing and limit further osteoradionecrosis of the remaining mandible. Although prevention is the primary goal in radiation injury, our experience suggests that radical resection with free microvascular reconstruction offers significant advantages to selected patients with extensive ORN of the mandible.

Dental Implantation, Endosseous↗
PubMed1997

Low-risk differentiated thyroid cancer: the need for selective treatment.

BACKGROUND: The well recognized prognostic factors in differentiated carcinoma of the thyroid are age, grade, extracapsular extension, distant metastasis, and size of the tumor. Based on these prognostic factors, we have divided patients into low-, intermediate-, and high-risk categories. Clearly, there are significant differences in these three groups. This article analyzes in depth our data on low-risk thyroid cancer patients. METHODS: A retrospective review of 1,038 patients with differentiated carcinoma of the thyroid was undertaken. Various prognostic factors and risk groups were analyzed. Univariate and multivariate analyses were performed, and the survival curves were plotted by the Kaplan-Meier method. The inclusion criteria for the low-risk group were age younger than 45 years, tumors < 4 cm in size, low-grade histology, absence of distant metastasis, and absence of extrathyroidal extension. There were 465 patients in the low-risk group. Four hundred three patients had papillary and 62 patients had follicular thyroid cancer. There were 120 male and 354 female patients. Two hundred seventy-eight patients (60%) presented with clinically apparent lymph node metastasis. RESULTS: With a median follow-up of 20 years, the 10- and 20-year survival in this select group was 99%. The local, regional, and distant recurrence rates were 5, 9, and 2% in this series. The analysis of the data showed statistical difference in local recurrence rate between partial lobectomy and total lobectomy (27 vs. 4%; p = 0.005). There was no statistical difference in local recurrence rate between total lobectomy compared with total thyroidectomy (4 vs. 1%; p = 0.10). The overall failure rate between partial lobectomy and total thyroidectomy (27 vs. 8%) was statistically significant (p = 0.04). There was no statistical difference in the overall failure rate between total lobectomy and total thyroidectomy (13 vs. 8%; p = 0.06). There was no survival difference between various histologies or nodal status. CONCLUSIONS: Patients with low-risk tumors have excellent long-term survival. Nodulectomy or partial lobectomy should be avoided. The intraoperative decisions regarding the extent of thyroidectomy should be based on gross clinical findings and risk group analysis.

Adenocarcinoma, Follicular↗
PubMed1997

The role of chemotherapy in the curative treatment of head and neck cancer.

Historically, the application of chemotherapy in patients with squamous cell head and neck cancer had been limited to the palliative setting; however, the role of chemotherapy in the definitive management of these tumors has undergone great evolution during the last 5 to 10 years. Available randomized data currently support a role for chemotherapy as part of combined modality, curative treatment strategies in the management of patients with unresectable disease, advanced nasopharynx cancer, and as part of a larynx preservation approach in patients with advanced larynx or hypopharynx cancer requiring total laryngectomy. Chemoprevention as a strategy to prevent second primary tumors also shows great promise.

Antineoplastic Agents↗
PubMed1996

Upper aerodigestive tract squamous cell carcinoma. The human immunodeficiency virus connection.

OBJECTIVE: To evaluate the incidence, distribution, and course of squamous cell carcinoma (SCC) of the upper aerodigestive tract in patients infected with the human immunodeficiency virus (HIV) and compare it to SCC in non-HIV-infected patients. DESIGN: Case-control study of all patients with SCC during a 9.5-year period from January 1985 through June 1994. SETTING: Two academic tertiary care centers in a metropolitan location. PARTICIPANTS: Five hundred thirty-nine patients (18 to 95 years old) with SCC of the upper aerodigestive tract. RESULTS: Infection with HIV was present in 4.5% of the patients with SCC of the upper aerodigestive tract. Patients infected with HIV were significantly younger than noninfected patients (P < or = < .001), accounting for 21.3% of those patients younger than 45 years (P < .001). No significant difference in tumor location was present between HIV-infected and noninfected patients; however, HIV-infected patients had larger tumors (P = .004) and a more advanced tumor stage (TNM classification) at presentation (P = .05). Tumor-related survival was significantly poorer in patients with HIV infection (P = .01), with 57% at 1 year and 32% at 2 years, compared with 74% and 59%, for non-HIV-infected patients. The detrimental effect of HIV infection on survival remained significant after adjusting for the confounding effects of age, tumor stage, and location of the tumor. All study patients with HIV infection had cancer risk factors such as tobacco and/or alcohol abuse. CONCLUSIONS: Infection with HIV possibly accelerates the development of SCC in patients with significant risk factors, presumably by impairing normal immune surveillance mechanisms. The decreased survival rates among these patients suggests that the SCC may be more aggressive or that other cofactors assume greater importance. A history of tobacco and/or alcohol abuse in patients with HIV infection warrants aggressive screening and early detection, to allow for early detection, which may help increase survival.

Adolescent↗
PubMed1996

Risk group stratification and prognostic factors in papillary carcinoma of thyroid.

BACKGROUND: Our understanding of the natural history of differentiated thyroid carcinoma has improved with the definition of prognostic factors. These prognostic factors have helped us identify patients in various risk groups. METHODS: A retrospective review of a consecutive series of 810 previously untreated patients with papillary carcinoma of the thyroid was undertaken to analyze the prognostic factors and risk groups. There were 403 patients in the low-risk group, 313 in the intermediate group, and 94 classified in the high-risk group. RESULTS: With a median follow-up of 20 years, 99% survival was achieved in the low-risk group, whereas only 43% survived in the high-risk group. The intermediate-risk group had a 20-year survival of 83%. The favorable prognostic factors included female sex, young age, absence of distant metastases and extrathyroidal extension of the disease, size < 4 cm, and low-grade histology. Focality, presence of lymph node metastasis, and pure papillary or mixed variant had no statistical significance on prognosis. CONCLUSIONS: Based on various prognostic factors, low-, intermediate-, and high-risk groups are identified. Patients in the low-risk group have excellent survival (99%). Appropriate selection of surgical and adjuvant treatment should therefore be used based on prognostic factors and risk group stratification.

Age Factors↗
PubMed1996

The extent of neck disease after regional failure during observation of the N0 neck.

BACKGROUND: The optimum management of the N0 neck remains controversial. When the neck is observed it is hoped that close follow-up will detect regional failure at an early stage. To test this hypothesis we examined patients undergoing therapeutic neck dissection for newly developed neck metastases during observation after treatment of the primary tumor. METHODS: A retrospective chart review of 47 patients undergoing neck dissection for regional failure after surgical treatment of the primary tumor and observation of the neck from 1987 to 1992 was performed. The median time to failure in the neck was 13 months. RESULTS: The clinical neck stage at the time of neck dissection was N1 in 37, N2A in 6, N2B in 1, and N3 in 3. However, pathologic staging revealed stages of N1 in 19, N2A in 5, N2B in 20, and N3 in 3. Extracapsular spread (ECS) was present in 23 patients (49%). Overall 36 patients (77%) had adverse pathologic findings (N greater than 1 or ECS). CONCLUSIONS: These data indicate that when observation is used for the neck at risk for metastasis, patients tend to fail with high stage disease in the neck. This supports the philosophy of elective treatment of the neck but cannot show whether elective treatment will improve survival.

Aged↗
PubMed1996

Supraspinal accessory lymph node metastases in supraomohyoid neck dissection.

BACKGROUND: Some patients undergoing surgical resection of primary squamous cell carcinoma of the oral cavity and oropharynx also undergo supraomohyoid neck dissection for staging of the negative (N(o)) neck. Dissection of the supraspinal accessory lymph node pad requires significant traction of the spinal accessory nerve. There are currently no data to indicate the incidence of metastases to this site and thus the necessity of performing dissection of these nodes. METHODS: A prospective analysis of a consecutive series of 44 patients with newly diagnosed squamous carcinoma of the oral cavity or oropharynx undergoing surgical management of the primary lesion with staging neck dissection was performed. Patients underwent unilateral (41) or bilateral (3) supraomohyoid neck dissection with separate submission of the supraspinal accessory lymph node pad for pathologic evaluation to determine the incidence of nodal metastases. RESULTS: A total of 15 patients (32%) had microscopic metastatic squamous cell carcinoma involving the supraomohyoid neck dissection specimen. Only 1 patient had a metastatic deposit involving the supraspinal accessory lymph node pad. This patient also had metastases in additional lymph nodes at level II. There was an equal incidence of metastases for all patients when stratifying by T stage. CONCLUSION: This preliminary report reveals a small incidence of supraspinal accessory lymph node metastases in patients with T + NO squamous cell carcinoma of the oral cavity and oropharynx. We continue to accrue patients to determine if the incidence of supraspinal accessory lymph node metastases varies with an increased number of patients.

Adolescent↗
PubMed1996

Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid.

BACKGROUND: Understanding of differentiated carcinoma of the thyroid has improved in recent years with the definition of prognostic factors and risk group analysis. We intend to review our experience of differentiated thyroid cancer in relation to the risk of nodal and distant metastasis based on various histologic subgroups. METHODS: This is a retrospective review of a consecutive series of 1,038 previously untreated patients with differentiated carcinoma of the thyroid treated over a period of 55 years. Univariate and multivariate analysis of various prognostic factors was performed. The incidence of nodal and distant metastasis was analyzed based on various histologic varieties of differentiated thyroid cancer. RESULTS: There were 337 male and 701 female patients. The various histologic subgroups included papillary (810), follicular (169), and Hurthle cell cancer (59). The cumulative risk of nodal metastasis based on histological group was 61%, 30%, and 21% for papillary, follicular, and Hurthle cell variety, respectively. The risk of distant metastasis for the same histologic varieties was 10%, 22%, and 33%, respectively. The 5- and 20-year survival for these histologic subgroups was papillary (94% and 87%, respectively), follicular (87% and 81%), and Hurthle cell tumors (81% and 65%; P < 0.001). CONCLUSIONS: The incidence of nodal metastasis is highest in the papillary subgroup; however, the incidence of distant metastasis was 33% in the Hurthle cell variety. The risk of nodal and distant metastasis varies considerably based on individual histologic variety.

Adenocarcinoma↗
PubMed1996

The radial forearm fasciocutaneous free-tissue transfer for tracheostomy reconstruction.

Wide resection of parastomal tissues after stomal recurrence significantly benefits patient survival. The defect thus created often requires coverage with a flap that provides (1) well-vascularized skin and soft tissue for uncomplicated wound closure and (2) pliable skin that can be inset easily around the often-shortened tracheal remnant. The radial forearm fasciocutaneous flap is ideal for these types of reconstructive problems. It should therefore be included on the reconstructive ladder for tracheostomy reconstruction both as a first choice and as a backup flap.

Aged↗
PubMed1995

Substernal goiter.

The management of a substernal goiter is a problem which has challenged surgeons since its first description in 1749. While the overall incidence in the United States has decreased with the routine use of iodized salt, the development of large multinodular substernal goiters in the rest of the world is still common. In addition, even in those regions where they are less common, knowledge of their treatment is important as they can represent up to 7% of mediastinal tumors. Certainly, the majority are large, benign masses found in the superior and anterior mediastinum, although from 3 to 15% can be malignant in nature. The presenting symptoms generally relate to the compressive nature of the mass on nearby structures. Up to 90% of patients report some form of respiratory symptoms in association with these masses. Diagnostic evaluation should include chest x-ray and computed tomographic (CT) scan. Needle aspiration biopsy should be avoided due to its dangerous substernal location. The treatment is surgical, as medical therapy is generally unsuccessful. Perioperative management should include careful evaluation of the airway as the extent of compression and deviation caused by the mass can lead to a difficult intubation. The vast majority of substernal goiters can be removed via a cervical incision; occasionally sternotomy or thoracotomy is necessary. Although rare, tracheomalacia secondary to prolonged compression of the trachea by the mass needs to be watched for postoperatively. Overall, the results of surgical treatment are excellent, as morbidity and mortality are minimal and patients can expect full relief of symptoms secondary to these mediastinal masses.

Female↗
PubMed1995

Impact of clinicopathologic parameters on patient survival in carcinoma of the cervical esophagus.

BACKGROUND: The survival of patients with carcinoma of the cervical esophagus remains poor in spite of multimodality treatment and technical improvements in surgical resection and reconstruction. This study was undertaken to update our experience with cervical esophageal carcinoma and to identify factors that had an impact on patient survival and quality of life. PATIENTS AND METHODS: Clinical data encompassing 132 variables were collected on 67 patients with cervical esophageal carcinoma from 1980 to 1993. Statistical analysis was performed: independent Student's t-tests, Cox regression, Kaplan-Meier curves, and log rank analyses were used in the statistical evaluation. The mean age of the patients was 63 years (range 31 to 88). Dysphagia was the primary symptom in 86% of patients; 80% had received no prior treatment. The most common abnormal finding (21%) on physical examination was a neck mass. RESULTS: Curative resection was performed in 22 patients, 7 had palliative procedures, and 7 were found to be inoperable at exploration and received palliative treatment. Radiation with or without chemotherapy was definitive treatment for 10 patients, whereas 4 patients were treated with chemotherapy alone for cure, and 17 patients received palliative treatment. The mean survival following diagnosis was 17 months (range 1 to 96). Cumulative 5-year survival was 12%. CONCLUSIONS: Persistent disease, chemotherapy prior to presentation, and chemotherapy for cure remained as statistically significant parameters associated with decreased survival by multivariate analysis. There was a trend toward improved survival in patients treated with surgical resection.

Adult↗
PubMed1995

Differentiated carcinoma of the thyroid with extrathyroidal extension.

BACKGROUND: We have analyzed our experience with differentiated thyroid cancer patients with extrathyroidal extension (ETE) to investigate patterns of recurrence and define factors that predict failure. PATIENTS AND METHODS: The records of 1,012 patients treated surgically from 1930 to 1985 were reviewed. A total of 79 patients (8%) had ETE. The median length of follow-up was 10 years. RESULTS: Patients with ETE were more likely to fail treatment and to die of their disease than were patients without ETE (77% versus 34% and 71% versus 13%, respectively; P < 0.0001). Local, regional, and distant failures were more prominent among patients with ETE than among those without ETE (48% versus 9%, 41% versus 16%, and 37% versus 11% respectively; P < 0.0001). Survival of patients with ETE was adversely affected by nonpapillary histology, distant metastasis, age > 45, tumor size > 4 cm, and incomplete excision (P < or = 0.05). After stratification for age, survival in older patients was not affected by tumor size or incomplete excision, while in younger patients tumor size or the presence of distant metastasis did not adversely affect survival. Patients younger than 45 with negative margins had similar survival to patients without ETE (P = 0.46). CONCLUSIONS: Patients with ETE are more likely to die of their disease and to fail at all sites. Survival in older patients was not affected by incomplete excision while it was in younger patients. The presence of distant metastasis did not affect survival in younger patients. Our results suggest that among patients under 45, the presence of ETE does not adversely impact upon survival when the primary tumor is completely resected.

Adenocarcinoma↗
PubMed1995

Native cellular fluorescence can identify changes in epithelial thickness in-vivo in the upper aerodigestive tract.

BACKGROUND: Change in epithelial thickness is part of the neoplastic transformation process of the upper aerodigestive tract. The quantitation of native cellular fluorescence (NCF) may represent a noninvasive means of distinguishing such a change. PATIENTS AND METHODS: Nineteen patients with squamous neoplasms and 12 surgical specimens from cancer patients were analyzed for NCF using a hand-held fiber optic probe attached to a fluorescent spectrometer. Tumors and normal sites were analyzed for fluorescence, and tissue samples were obtained. Ratios of intensities of various emitted wavelengths were computed to quantitate and compare various spectral patterns. These ratios were then correlated with mucosal thickness. RESULTS: The 330 nm peak in the excitation scan (lambda Ex 200 to 360 nm, lambda Em 380 nm) was lost in the tumors compared with the normal sites. The 390 nm peak in the emission scan (lambda Ex 340 nm, lambda Em 360 to 660 nm) was also lost. The 290 nm/330 nm ratio in the in-vivo excitation scan (lambda Ex 200 to 360 nm, lambda Em 380 nm) correlated with changes in epithelial thickness. The 390/450 ratio in the emission scan (lambda Ex 340 nm, lambda Em 360 to 660 nm) correlated negatively with the mean epithelial thickness. CONCLUSIONS: Native cellular fluorescence analysis can identify changes in neoplastic tissues, including changes in epithelial thickness.

Adult↗
PubMed1995

Prognostic factors and risk group analysis in follicular carcinoma of the thyroid.

BACKGROUND: The understanding of prognostic factors has facilitated stratification of risk groups in differentiated carcinoma of the thyroid. The prognostic factors have clearly identified the risk groups as low, intermediate, and high risk. Risk group categorization has facilitated a selective surgical approach for thyroid carcinoma. METHODS: A retrospective review of 228 patients with follicular carcinoma of the thyroid was undertaken. Various prognostic factors and risk groups were analyzed. Univariate and multivariate analyses were performed, and the survival curves were plotted by the Kaplan-Meier method. Fifty-nine (26%) patients presented with Hürthle cell histology. The risk groups revealed 62 patients in the low, 84 in the intermediate, and 82 in the high risk groups. RESULTS: The 10-year survival for low, intermediate, and high risk groups was 98%, 88%, and 56%, respectively, and the 20-year survival for the same groups was 97%, 87%, and 49%, respectively. Adverse prognostic factors included age older than 45 years (p < 0.001), Hürthle cell variety (p = 0.05), extrathyroidal extension, tumor size exceeding 4 cm, and the presence or absence of distant metastasis (p < 0.001). Gender, focality, and presence of lymph node metastasis had no significant impact on prognosis. CONCLUSIONS: Patients in the low risk group have excellent survival, whereas the high risk group behaves poorly. Appropriate selection of treatment for the primary disease and adjuvant therapy should be considered on the basis of the prognostic factors and risk group analysis.

Adenocarcinoma, Follicular↗
PubMed1995

Biopsy techniques in head and neck.

The establishment of an accurate histologic diagnosis is extremely important in the management of patients with head and neck lesions. This article describes various biopsy techniques and discusses the clinical implications in relation to common lesions involving thyroid and salivary glands and cervical lymphadenopathy. The diagnostic pitfalls and pros and cons of needle biopsy are also discussed in detail.

Biopsy↗