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Biomedical subjects

Christine G Gourin

Publications and source records attributed to Christine G Gourin.

At least 19 recordsLinked to original sources
PubMed2006

Serum protein profile analysis in patients with head and neck squamous cell carcinoma.

OBJECTIVES: To analyze surface-enhanced laser desorption and ionization time-of-flight mass spectrometry (SELDI-TOF-MS) protein profiles of patients with head and neck squamous cell carcinoma (HNSCC) and healthy controls and to determine the sensitivity and specificity of SELDI assay for HNSCC detection before and after treatment. DESIGN: Proteomic analysis and comparison of serum samples. SETTING: Tertiary care academic medical center. SUBJECTS: Seventy-eight patients with HNSCC and 68 healthy controls. MAIN OUTCOME MEASURES: Serum samples were prospectively collected from 78 patients with HNSCC and 68 healthy control volunteers. SELDI-TOF-MS was performed on serum samples to identify protein peaks in the range of 0 to 100 kDa. Classification analysis of the spectral data was performed and used to classify the disease status of the patients. RESULTS: The SELDI-TOF-MS assay generated serum protein profiles ranging from 0 to 100 kDa. After background subtraction, mass calibration, and normalization, 545 protein peaks were identified. Classification tree analysis based on peak expression correctly classified patients with HNSCC with 82% sensitivity and 76% specificity. Subgroup analysis correctly classified 83% of oral cavity tumors, 81% of oropharyngeal tumors, and 88% of laryngeal tumors. Pretreatment and posttreatment samples were available from 12 patients, and the posttreatment samples were correctly classified in 86% of the patients at 3 months and 75% of the patients at 6 months. CONCLUSIONS: Proteomic SELDI-TOF-MS analysis of serum protein profiles distinguishes patients with HNSCC from controls with a high degree of sensitivity and specificity. Further investigation into the clinical utility of this technology in HNSCC detection and surveillance is warranted.

Adult↗
PubMed2006

Planned neck dissection following chemoradiotherapy for advanced head and neck cancer: is it necessary for all?

In the absence of large-scale randomized trials evaluating dissection versus observation of the involved neck after neoadjuvant chemoradiotherapy, there is a need to collect data that will either support or ultimately refute a role for planned posttreatment neck dissection. A significant percentage of patients with extensive (N2 or N3) neck disease who demonstrate a complete response to chemoradiation therapy may harbor residual occult metastases, and identification of this subset of patients remains a clinical challenge. Because surgical salvage rates are greatly diminished when occult nodal disease becomes clinically manifest, planned posttreatment neck dissection is advocated but may not be necessary in all patients. The role of positron emission tomography chemoradiotherapy (PET-CT) in this scenario remains unproven but holds promise in being able to identify which patients may be harboring residual disease in the neck after chemoradiotherapy. The implementation of as yet unidentified molecular tumor markers in combination with PET-CT may ultimately prove to be effective in identifying patients who will best benefit from posttherapy neck dissection. Correlation of imaging results and pathologic node status will be important in determining the accuracy and, therefore, the value of this imaging modality for predicting the presence or absence of residual disease.

Carcinoma, Squamous Cell↗
PubMed2006

A comparison of polysomnography and the SleepStrip in the diagnosis of OSA.

OBJECTIVE: To investigate the role of a portable screening device (SleepStrip) in the diagnosis of obstructive sleep apnea (OSA). METHODS AND MATERIALS: Prospective, nonrandomized double-blinded single cohort study at an academic health center. Patients with suspected OSA scheduled for an attended overnight Level I polysomnogram (PSG) and who consented to participate in the study wore the SleepStrip device at home the night after the PSG. The apnea-hypopnea index (AHI) determined by PSG was compared with the results of the SleepStrip recording. RESULTS: Thirty-seven patients with a mean age of 52.1 +/- 12.2 years and mean body mass index of 35.7 +/- 5.2 participated in the study. The overall agreement between the AHI and the SleepStrip results using Cohen's Kappa value was 0.139 (P = 0.19). The sensitivity and specificity of the SleepStrip for diagnosing severe OSA when the AHI was >40 were 33.3% and 95% (P = 0.05). When the AHI was >25, the SleepStrip sensitivity and specificity were 43.8% and 81.3% (P = 0.26). The sensitivity and specificity of the SleepStrip for diagnosing OSA in patients with an AHI >15 were 54.6% and 70%, respectively (P = 0.26). CONCLUSION: The SleepStrip has a low correlation with the AHI as measured by PSG. Further studies are needed before this device can be recommended as a screening tool for the diagnosis of OSA. EBM RATING: B-2b.

Adolescent↗
PubMed2006

Minimally invasive thyroidectomy: basic and advanced techniques.

OBJECTIVE: Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. We advocate at least two distinct approaches, depending on the disease process and multiple patient factors. The technical aspects are explored in depth with liberal use of videographic demonstration. METHODS: The authors conducted a comparison of two distinct surgical techniques with photographic and videographic documentation of two distinct minimal access approaches to the thyroid compartment termed minimally invasive thyroidectomy (MITh) and minimally invasive video-assisted thyroidectomy (MIVAT). Both historic and previously unpublished data (age, gender, pathology, incision length, and complications) are systematically analyzed. RESULTS: Patients who underwent minimally invasive thyroidectomy (n = 31) had a mean age of 39.4 +/- 10.7 years; seven were male and 24 were female. The most common diagnosis was follicular or Hürthle cell adenoma (29%), followed by papillary or follicular cancer (26%). The mean incision length was 4.9 +/- 1.0 cm. One patient developed a hypertrophic scar and one patient developed thrombophlebitis of the anterior jugular vein. There were 14 patients in the MIVAT group with a mean age of 43.7 +/- 11.4 years; one was male and 13 were female. The majority of patients had follicular adenoma (42.9%) or papillary carcinoma (21.4%) as their primary diagnosis. The mean incision length was 25 +/- 4.3 mm (range, 20-30 mm), and there were no complications. CONCLUSIONS: Two distinct approaches to minimal access thyroid surgery are now available. The choice of approach depends on a number of patient and disease factors. Careful patient selection will result in continued safe and satisfactory performance of minimally invasive thyroid surgery.

Adenoma, Oxyphilic↗
PubMed2006

Thyroid surgery: changing patterns of practice.

OBJECTIVE: The practice of thyroidectomy has evolved over the past 10 years with the introduction of minimally invasive surgery, laryngeal nerve monitoring, and outpatient surgery. We sought to investigate corresponding trends in the disciplines performing thyroid surgery. METHODS AND MATERIALS: The authors conducted a nonrandomized, case-controlled comparison of surgical volumes and systematic analysis of publication volumes. Two surrogates for the proportion of thyroidectomies being performed by otolaryngologists-head and neck surgeons (OHNS) and general surgeons (GS) were chosen: 1) the operative case logs of graduates from American training programs in OHNS and GS from 1995 through 2004 were compared; and 2) the number of scientific articles published relating to thyroid surgery were systematically queried for two timeframes (1990-1994 and 2000-2004). RESULTS: There was a gradual increase in the mean number of thyroidectomies performed by GS residents from 13.2 in 1995 to 18.2 in 2004. During the same timeframe, the mean number of thyroidectomies performed by OHNS residents more than doubled from 15.0 to 33.5. The number of American GS thyroid publications from 1990 to 1994 was 79, compared with 98 in the period 2000 to 2004, representing a 24% increase. During the same timeframe, the number of American OHNS articles increased from 14 to 49 (a 250% increase). The relative proportion of thyroid publications authored by American otolaryngologists more than doubled from 15.1% to 33.3% (P = .0017). CONCLUSIONS: A clear trend is emerging in the pattern of thyroid surgery in that a growing proportion of publications are being authored by otolaryngologists compared with general surgeons, and the average number of procedures performed by graduating chief residents is now 84% higher in otolaryngology compared with general surgery.

Case-Control Studies↗
PubMed2006

Utility of positron emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer.

OBJECTIVES: Planned neck dissection after chemoradiation (CR) is often advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease who demonstrate a clinical complete response to CR because identification of residual occult nodal disease is difficult. We sought to investigate the utility of positron emission tomography-computed tomography (PET-CT) in identifying patients with occult nodal disease after CR. STUDY DESIGN: Nonrandomized retrospective cohort analysis. MATERIALS AND METHODS: The medical records of all patients treated with primary CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2005 were reviewed. Patients with a clinical complete response were eligible for inclusion if PET-CT performed at 8 to 10 weeks after CR showed no evidence of distant disease and they were treated with a planned neck dissection. RESULTS: Seventeen patients met study criteria. PET-CT was positive for residual nodal disease in 11 (64.7%) patients, with a standardized uptake value (SUV) range of 1.7 to 3.8. Pathologic examination revealed residual viable carcinoma in five (29.4%) patients, with tumor size ranging from 2.0 to 9.5 mm. Carcinoma was present in 2 of 11 (18.2%) patients with positive PET-CT scans and 3 of 6 (50%) patients with negative PET-CT scans. The sensitivity and specificity of PET-CT in predicting occult nodal disease was 40% and 25%, respectively. There was no correlation between PET-CT findings and histologic findings (P = .26) or between SUV and size of viable tumor (P = .67). CONCLUSIONS: A significant proportion of HNSCC patients with advanced neck disease harbor residual occult metastases after CR. PET-CT is not sufficiently specific or sensitive to reliably predict the need for posttreatment neck dissection.

Adult↗
PubMed2006

Ultrasonic technology facilitates minimal access thyroid surgery.

OBJECTIVES: Options for controlling the vasculature during thyroid surgery include suture ligatures, vessel clips, and bipolar cautery. Ultrasonic technology represents an alternative to conventional techniques in which the vessels are simultaneously sealed and divided. We sought to determine the safety and efficacy of thyroidectomy with ultrasonic technology. DESIGN: Nonrandomized, prospective analysis of a series of patients undergoing thyroidectomy at the Medical College of Georgia. METHODS AND MATERIALS: The records of 51 consecutive patients who underwent thyroid surgery between December 2004 and June 2005 were reviewed. Patients in whom ultrasonic technology (Harmonic-ACE, Ethicon Endo-Surgery, Cincinnati, OH) was used comprised the study population. RESULTS: Forty-four of 51 patients underwent thyroidectomy with the assistance of ultrasonic technology. There were 4 males and 40 females with a mean age of 43.5 +/- 15.8 years. Twenty-two patients had a total thyroidectomy, 18 underwent unilateral lobectomy, and 4 underwent completion thyroidectomy. The overall mean incision length was 5.0 +/- 2.6 (range 2-12) cm. A subgroup of patients underwent minimally invasive video-assisted thyroidectomy (n = 13) and had a mean incision length of 29.3 +/- 0.8 mm. There were no cases of permanent injury to the recurrent laryngeal nerve and no cases of persistent hypoparathyroidism. Blood loss ranged from 5 mL to 100 mL, with a mean of 26.7 +/- 21.8 mL. CONCLUSIONS: Ultrasonic technology facilitates thyroid surgery, particularly when a minimally invasive approach is undertaken. It reliably seals and divides the thyroid vasculature and will likely replace other methods of managing the thyroid blood supply.

Adult↗
PubMed2006

Racial disparities in patients with head and neck squamous cell carcinoma.

OBJECTIVES/HYPOTHESIS: Black patients are reported to have a higher incidence of advanced disease and increased mortality from head and neck squamous cell carcinoma (HNSCC) but constitute the minority of patients in large-scale studies investigating the effect of race on outcome. This study sought to determine if racial disparities exist between black and white patients with HNSCC treated at a single large institution in the South with a high proportion of black patients. STUDY DESIGN: The authors conducted a nonrandomized retrospective cohort analysis. METHODS: The tumor registry was used to identify patients diagnosed with HNSCC from 1985 to 2002. The medical records of non-Hispanic white and black adult patients were retrospectively reviewed. Median household income, percentage of population below poverty level, and education level based on census tract and block information were obtained from U.S. Census 2000 data. Standard statistical analysis, including Kaplan-Meier survival curve analysis and Cox proportional hazards models, was used to analyze the effects of covariables on survival. RESULTS: A total of 1,128 patients met study criteria (478 black, 650 white). Compared with white patients, black patients were significantly younger (mean age, 53.9 vs. 56.4 years, P<.0001), male (81.2% vs. 72.3%, P=.0005), more commonly abused alcohol (88.0% vs. 74.3%, P<.0001), and were significantly less likely to have insurance (8.6% vs. 21.7%, P<.0001). There was no difference in the incidence of tobacco use (91.7%), advanced comorbidity (35.9%), or primary tumor site. Black patients had a significantly greater incidence of stage IV disease (65.7% vs. 46.6%, P<.0001) and nonoperative treatment (48.7% vs. 30.8%, P<.0001), which was performed for inoperable disease in 57.1% of black compared with 31.0% of white patients (P<.0001). Black patients resided in census block groups with significantly lower mean education level, median income, and a higher percentage of population below poverty compared with white patients. The 5-year disease-specific survival differed significantly between black (29.3%) and white (54.7%) patients (P<.0001). Cox proportional hazards models revealed that alcohol abuse, advanced TNM stage, high tumor grade, nodal disease, extracapsular spread, advanced comorbidity, and regional or distant metastatic disease were associated with poorer survival for all patients. An interaction with race was found for insurance status, nonoperative treatment, and extracapsular spread. Stepwise variable selection adjusting for patient, tumor, and treatment characteristics showed a significant effect only for race by payor status on disease-specific survival (P=.0228). CONCLUSIONS: Insurance status, treatment, and extracapsular spread differentially affected the survival of black patients compared with white patients. Only insurance status had a significant effect on survival in black patients after controlling for other variables. These data suggest that racial differences in HNSCC outcomes are primarily related to differences in access to health care.

Adolescent↗
PubMed2006

Surgical treatment of acquired tracheocele.

Acquired tracheoceles are rare clinical entities that can cause a variety of chronic and recurrent aerodigestive tract symptoms. The management of acquired tracheoceles is primarily conservative, but surgical intervention may be indicated for patients with refractory symptoms. We present a case of acquired tracheocele and describe a method of successful surgical management.

Humans↗
PubMed2006

Polymorphous low-grade adenocarcinoma of the parotid gland.

Polymorphous low-grade adenocarcinoma (PLGA) of the parotid gland is rare. We describe a new case in which the patient underwent parotidectomy only to experience an extensive recurrence 2 years later. The recurrence was treated with radical surgical excision and radiation therapy, and the patient remained disease-free at 5 years of follow-up. We also review the literature on primary parotid PLGA.

Adenocarcinoma↗
PubMed2005

Management of the N0 neck--reference or preference.

For patients with squamous cell carcinoma of the upper aerodigestive tract, appropriate management of the regional lymph nodes is an important and often controversial issue that has significant influence on survival. Over the years radical treatment either by surgery or radiotherapy contributed to improvement in prognosis. Recently, a more conservative approach has achieved a similar level of cancer control with less morbidity. This review considers the issues of selection of patients for treatment of the neck, choice of modality and extent of therapy, treatment of the contralateral neck, management of recurrence and influence of the site and status of the primary lesion.

Carcinoma, Squamous Cell↗
PubMed2005

Elective and therapeutic selective neck dissection.

Selective neck dissection is a modification of the more comprehensive modified radical or radical neck dissection that is designed to remove only those nodal levels considered to be at risk for harboring nodal metastases. The role of selective neck dissection continues to evolve: while initially designed as a staging and diagnostic procedure for patients without clinical evidence of nodal disease, a growing body of literature suggests that selective neck dissection has a therapeutic role in patients with clinical and histologic evidence of nodal metastases. The rationale behind selective neck dissection, its application in the clinically negative but histologically node-positive neck and the extended application of selective neck dissection in patients with clinical evidence of nodal disease are discussed.

Carcinoma, Squamous Cell↗
PubMed2005

Endo-robotic resection of the submandibular gland in a cadaver model.

BACKGROUND: By means of a prospective, nonrandomized investigation, we evaluated the feasibility of performing endo-robotic resection of the submandibular gland in a cadaver model and compared the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique. METHODS: Procedural times were recorded in a consecutive series of 11 endoscopic submandibular gland resections using the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA) and a modified endoscopic surgical approach previously developed in a porcine model. The presence of neurovascular injury was assessed postoperatively, and the specimens were examined histologically. RESULTS: Eleven endo-robotic submandibular gland resections were successfully performed in six cadavers (no conversions to open resection were necessary). The median duration of the procedures was 48 minutes (range, 33-82 minutes). Creation of the operative pocket took an average (+/-SD) of 12.2 +/- 5.3 minutes, assembly of the robot required 9.3 +/- 4.1 minutes, and the mean time for submandibular gland resection was 29.4 +/- 8.9 minutes. The time required for robotic assembly was offset by the reduced operative time necessary compared with conventional endoscopic resection. Histologic examination confirmed the presence of normal glandular architecture, without evidence of excessive mechanical or thermal injury. There were no cases of apparent neurovascular injury. CONCLUSIONS: Robotically enhanced endoscopic surgery in the neck is feasible and offers a number of compelling advantages over conventional endoscopic neck surgery. Clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice.

Cadaver↗
PubMed2005

Alcohol withdrawal prophylaxis in patients undergoing surgical treatment of head and neck squamous cell carcinoma.

OBJECTIVES: Alcohol abuse is common in patients with squamous cell cancer of the head and neck. Postoperative alcohol withdrawal is associated with increased morbidity and prolonged hospitalization and is commonly treated with benzodiazepines. We reviewed our experience with benzodiazepine prophylaxis in high-risk patients undergoing surgical treatment of head and neck cancer. We sought to determine whether benzodiazepine prophylaxis was successful in preventing complications from alcohol withdrawal. STUDY DESIGN: Nonrandomized, retrospective patient analysis. METHODS: The medical records of all patients diagnosed with squamous cell carcinoma of the head and neck from 1999 to 2004 were retrospectively reviewed. Patients who underwent surgical resection and who were considered high risk for postoperative alcohol withdrawal received benzodiazepine prophylaxis following an established institutional protocol and comprised the study group. RESULTS: Of 96 patients who met study criteria, 13 (13.5%) patients developed alcohol withdrawal symptoms, and 9 (9.4%) patients developed delirium tremens. Patients who manifested alcohol withdrawal remained in the hospital an average of 10.8 days longer (19.0 vs. 8.2) and had an overall complication rate of 50% (11 of 22) versus a 17.6% (13 of 74) complication rate in patients that did not develop withdrawal (P < .05). CONCLUSIONS: Alcohol withdrawal is associated with a significantly greater incidence of postoperative complications and duration of hospitalization. Benzodiazepine prophylaxis does not prevent postoperative alcohol withdrawal symptoms in all patients at risk. Alternate methods of prophylaxis should be explored.

Adult↗
PubMed2005

High-risk tracheostomy: exploring the limits of the percutaneous tracheostomy.

OBJECTIVES: Modifications of the percutaneous tracheostomy (PercTrach) technique have made this a straightforward and safe procedure in appropriately selected patients. We sought to determine its value in high-risk patients. STUDY DESIGN/METHODS: A retrospective study of high-risk and low-risk patients on whom bedside PercTrach was performed between May 2003 and October 2004 at the Medical College of Georgia. The patients were prospectively stratified into groups based on their comorbidities (morbid obesity or coagulopathy). The Ciaglia Blue Rhino introducer set was used in all cases. RESULTS: Fifty-four consecutive patients were included in the study; the high-risk patients (n = 16) were younger than the low-risk (n = 38) patients (48.2 vs. 53.6 years, respectively), but had significantly higher Acute Physiology and Chronic Health Evaluation II scores (10.1 vs. 5.4, P = .0001). There were seven morbidly obese patients with a mean body mass index of 64.4 and a mean weight of 184.9 kg. There were 9 patients with a total of 10 coagulopathic conditions (7 = International Normalized Ratio [INR] of >1.5, 2 = heparin drip, 1 = platelet count < 20,000). One patient included in the study met requirements for two categories with a platelet count of 17,000 and an INR of 1.7. The procedural times ranged from 5 to 30 minutes. The high-risk PercTrachs took 14.4 +/- 5.0 minutes on average, compared with 12.2 +/- 4.8 minutes in the low-risk group (P = .115). One patient in the low-risk group bled from an anterior jugular communicating vein injury, requiring wound exploration and vein ligation. There were no other significant complications. CONCLUSIONS: There were no statistically significant differences in intraoperative or perioperative outcomes between the PercTrachs performed in high-risk versus low-risk patients. PercTrachs may be performed safely even in high-risk patients such as those with morbid obesity and coagulopathy.

Adult↗
PubMed2005

Use of the harmonic scalpel in superficial and total parotidectomy for benign and malignant disease.

OBJECTIVES: Use of the harmonic scalpel in superficial parotidectomy for benign parotid disease has been shown to reduce surgical time as well as intraoperative blood loss. We sought to determine whether similar results could be achieved with the expanded use of the harmonic scalpel in parotidectomy for both benign and malignant disease. STUDY DESIGN: Retrospective review. METHODS: The medical records of all patients undergoing superficial or total parotidectomy from 1999 to 2004 were reviewed. Patients were excluded for a history of bleeding disorder, prior facial nerve weakness, or concurrent neck dissection at the time of parotidectomy. RESULTS: Forty-four patients underwent harmonic scalpel parotidectomy and 41 patients underwent conventional cold knife parotidectomy (control group). Use of the harmonic scalpel was associated with a significant reduction in intraoperative blood loss (38.0 +/- 3.6 mL vs. 66.0 +/- 10.8 mL for controls, P < 0.05) and duration of drainage (31.80 +/- 2.4 h vs. 39.29 +/- 2.21 h for controls, P < 0.05). Use of the harmonic scalpel in superficial parotidectomy (n = 35) compared to controls (n = 37) was associated with a significant reduction in intraoperative blood loss (38.0 +/- 4.23 mL vs. 68.0 +/- 12.0 mL, P < 0.05) and reduced incidence of facial nerve injury (P < 0.05). In patients undergoing total parotidectomy, no significant differences were observed between the harmonic scalpel (n = 9) and control groups (n = 4) in length of surgery, intraoperative blood loss, postoperative drainage, duration of drainage, and facial nerve injury. CONCLUSIONS: Use of the harmonic scalpel in the surgical treatment of parotid disease is safe and confers some advantages over conventional methods of parotid dissection.

Adolescent↗
PubMed2005

Minimally invasive thyroidectomy using the Sofferman technique.

OBJECTIVES: Access to the thyroid compartment has traditionally been achieved by a Kocher incision followed by subplatysmal flap elevation and strap muscle retraction. A combination of novel access techniques was used to allow for minimally invasive thyroidectomy (MITh). METHODS AND MATERIALS: A prospective, nonrandomized evaluation of consecutive patients undergoing thyroidectomy was performed. A minimally invasive incision (< or =6 cm) was used in conjunction with the Sofferman technique (transection of the strap muscles) and videoendoscopic assistance to perform hemithyroidectomy or total thyroidectomy in eligible patients. Prospectively collected data include age, sex, pathology, incision length, duration of surgery, and blood loss and complications were considered. RESULTS: Forty-four patients underwent 48 thyroid surgeries between September 2003 and May 2004. There were 13 men and 31 women, with a mean age of 41.9 (range 19-73) years. Thirty-one (64.6%) of these were eligible to be performed by MITh; the remainder (n = 17, 35.4%) underwent conventional thyroidectomy. The mean incision length in the MITh cohort was 4.9 +/- 1.0 cm compared with 9.1 +/- 1.5 cm for conventional thyroidectomy. The mean surgical time for minimally invasive hemithyroidectomy was 115.7 minutes (n = 23), and for total thyroidectomy was 147.4 minutes (n = 8). There were no cases of permanent hypocalcemia or recurrent laryngeal nerve paralysis in either group. No patients in the MITh group had to be converted to a conventional thyroidectomy. The cosmetic results were excellent, although one patient in the MITh group developed a mildly hypertrophic scar that responded to triamcinolone injection. CONCLUSIONS: MITh is safe in carefully selected patients and probably results in more rapid wound healing. The cosmetic result is superior to that achieved with conventional thyroidectomy.

Adult↗