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Kahmke, Russel Roy

Positions:

Assistant Professor of Surgery

Surgery, Head and Neck Surgery and Communication Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2010

M.D. — SUNY Upstate Medical University

General Surgery Intern, Surgery

Duke University School of Medicine

Otolaryngology-Head & Neck Surgery Resident, Surgery

Duke University School of Medicine

Otolaryngology-Head & Neck Surgery Fellow, Surgery

University of Alabama at Birmingham

Publications:

Laser-Assisted Indocyanine Green Dye Angiography for Postoperative Fistulas After Salvage Laryngectomy.

Pharyngocutaneous fistula formation is an unfortunate complication after salvage laryngectomy for head and neck cancer that is difficult to anticipate and related to a variety of factors, including the viability of native pharyngeal mucosa.To examine whether noninvasive angiography with indocyanine green (ICG) dye can be used to evaluate native pharyngeal vascularity to anticipate pharyngocutaneous fistula development.This cohort study included 37 patients enrolled from June 1, 2013, to June 1, 2016, and follow-up was for at least 1 month postoperatively. The study was performed at the University of Alabama at Birmingham, a tertiary care center. Included patients were those undergoing salvage total laryngectomy who were previously treated with chemoradiotherapy or radiotherapy alone.The ICG dye was injected intraoperatively, and laser-assisted vascular imaging was used to evaluate the native pharyngeal mucosa after the ablative procedure. The center of the native pharyngeal mucosa was used as the reference to compare with the peripheral mucosa, and the lowest mean ICG dye percentage of mucosal perfusion was recorded for each patient.The primary outcome was the formation of a postoperative fistula, which was assessed by clinical and radiographic assessment to test the hypothesis formulated before data collection.A total of 37 patients were included (mean [SD] age, 62.3 [8.5] years; 32 [87%] male and 5 [14%] female); 20 had a history of chemoradiotherapy, and 17 had history of radiotherapy alone. Thirty-four patients (92%) had free flap reconstruction, and 3 had primary closure (8%). Ten patients (27%) developed a postoperative fistula. No significant difference was found in fistula rate between patients who underwent neck dissection and those who did not and patients previously treated with chemoradiotherapy and those treated with radiotherapy alone. A receiver operator characteristic curve was generated to determine the diagnostic performance of the lowest mean ICG dye percentage of mucosal perfusion determined by fluorescence imaging, which was found to be a threshold value of 26%. The area under the curve was 0.85 (95% CI, 0.73-0.97), which was significantly greater than the chance diagonal. The overall mean lowest ICG dye percentage of mucosal perfusion was 31.3%. The mean lowest ICG dye percentage of mucosal perfusion was 22.0% in the fistula group vs 34.9% in the nonfistula group (absolute difference, 12.9%; 95% CI, 5.1%-21.7%).Patients who developed postoperative fistulas had lower mucosal perfusion as detected by ICG dye angiography when compared with patients who did not develop fistulas.

Authors
Partington, EJ; Moore, LS; Kahmke, R; Warram, JM; Carroll, W; Rosenthal, EL; Greene, BJ
MLA Citation
Partington, EJ, Moore, LS, Kahmke, R, Warram, JM, Carroll, W, Rosenthal, EL, and Greene, BJ. "Laser-Assisted Indocyanine Green Dye Angiography for Postoperative Fistulas After Salvage Laryngectomy." August 2017.
PMID
28520896
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
143
Issue
8
Publish Date
2017
Start Page
775
End Page
781
DOI
10.1001/jamaoto.2017.0187

Trends in Otolaryngology Consultation Patterns at an Academic Quaternary Care Center.

The consultation patterns of an otolaryngology-head and neck surgery service have not previously been reported. The time, resources, and attention required to operate such a consultation service are unknown.To assess trends in otolaryngology-head and neck surgery consultations conducted in emergency departments (EDs) and inpatient services.A retrospective analysis was conducted of the medical records of patients at a quaternary care center receiving inpatient otolaryngology consultations from January 1 to December 31, 2014.Clinical evaluation and bedside and operative procedures performed by the otolaryngology-head and neck surgery service.Demographics, reason for consultation, diagnosis, bedside procedures, operative interventions, and admission variables.A total of 1491 consultations were completed for adult (1091 [73.2%]; 854 men and 637 women; mean [SD] age 50.3 [19.3] years) and pediatric (400 [26.8%]; 232 boys and 168 girls; mean [SD] age, 4.0 [5.2] years) patients. Of the 1491 consultations, 766 (51.4%) originated from inpatient teams vs 725 (48.6%) from the ED. A total of 995 of all consultations (66.7%) resulted in a bedside procedure, and 243 (16.3%) required operative intervention. Consultations regarding airway evaluation (362 [47.3%] vs 143 [19.7%]), management of epistaxis (78 [10.2%] vs 33 [4.6%]), and rhinologic evaluation (79 [10.3%] vs 18 [2.5%]) were more frequent from inpatient teams than from the ED. Consultations regarding management of head and neck infections (162 [22.3%] vs 32 [4.2%]), facial trauma (235 [32.4%] vs 16 [2.1%]), and postoperative complications (73 [10.1%] vs 2 [0.3%]) were more frequent in the ED. Of the 725 consultations performed in the ED, 212 patients (29.2%) required hospitalization.The consultation volume of an otolaryngology-head and neck surgery service requires significant time and resources. Consultations are most often for rhinologic or laryngologic issues and are reflective of the clinical setting in which the patient is evaluated. Cost savings may be realized by increasing health care access points for nonurgent concerns that can be evaluated in an outpatient setting.

Authors
Choi, KJ; Kahmke, RR; Crowson, MG; Puscas, L; Scher, RL; Cohen, SM
MLA Citation
Choi, KJ, Kahmke, RR, Crowson, MG, Puscas, L, Scher, RL, and Cohen, SM. "Trends in Otolaryngology Consultation Patterns at an Academic Quaternary Care Center." JAMA otolaryngology-- head & neck surgery 143.5 (May 2017): 472-477.
PMID
28056150
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
143
Issue
5
Publish Date
2017
Start Page
472
End Page
477
DOI
10.1001/jamaoto.2016.4056

Utility of Daily Mobile Tablet Use for Residents on an Otolaryngology Head & Neck Surgery Inpatient Service.

The objective of this study was to investigate the utility of electronic tablets and their capacity to increase hospital floor productivity, efficiency, improve patient care information safety, and to enhance resident education and resource utilization on a busy Otolaryngology - Head & Neck Surgery inpatient service. This was a prospective cohort study with a 2-week pre-implementation period with standard paper census lists without mobile tablet use, and a 2-week post-implementation period followed with electronic tablets used to place orders, look up pertinent clinical data, educate patients as appropriate, and to record daily to-dos that would previously be recorded on paper. The setting for the study was Duke University Medical Center in Durham, North Carolina, with 13 Otolaryngology residents comprising the study population. The time for inpatient rounding was shorter with the use tablets (p = 0.037). There was a non-significant trend in the number of times a resident had to leave rounds to look up a clinical query on a computer, with less instances occurring in the post-implementation study period. The residents felt that having a tablet facilitated more detailed and faster transfer of information, and improved ease of documentation in the medical record. Seventy percent felt tablets helped them spend more time with patients, 70 % could spend more time directly involved in rounds because they could use the tablet to query information at point-of-care, and 80 % felt tablets improved morale. The utility of a mobile tablet device coupled with the electronic health record appeared to have both quantitative and qualitative improvements in efficiency, increased time with patients and attendance at academic conferences. Tablets should be encouraged but not mandated for clinical and educational use.

Authors
Crowson, MG; Kahmke, R; Ryan, M; Scher, R
MLA Citation
Crowson, MG, Kahmke, R, Ryan, M, and Scher, R. "Utility of Daily Mobile Tablet Use for Residents on an Otolaryngology Head & Neck Surgery Inpatient Service." Journal of medical systems 40.3 (March 2016): 55-.
PMID
26645319
Source
epmc
Published In
Journal of Medical Systems
Volume
40
Issue
3
Publish Date
2016
Start Page
55
DOI
10.1007/s10916-015-0419-8

Incidence of Retrocochlear Pathology Found on MRI in Patients With Non-Pulsatile Tinnitus.

To identify the incidence of retrocochlear pathology on MRI in patients with non-pulsatile tinnitus.Retrospective review.Tertiary referral center.Adults with MRIs performed between March 1, 2008 and February 1, 2014 for non-pulsatile tinnitus with or without hearing loss.MRI.Incidence of retrocochlear pathology.Of the 218 patients who met inclusion criteria, 198 (91.3%) had unremarkable MRIs. Six patients (2.7%) had MRI findings that accounted for their tinnitus. Of these patients, five had unilateral tinnitus with asymmetric hearing loss because of acoustic neuroma found on MRI. One patient presented with bilateral tinnitus with asymmetric hearing loss and was found to have a right acoustic neuroma. Twenty (9.2%) patients had bilateral or unilateral tinnitus without hearing loss, all with unremarkable MRIs. Fourteen patients (6.4%) had incidental findings including two acoustic neuromas that were identified contralateral to the side of presenting tinnitus.Imaging should be used judiciously in the evaluation of tinnitus. Patients with unilateral tinnitus and asymmetric hearing loss were most likely to have abnormal findings. The majority of MRIs performed for tinnitus were normal in our study. Given the low incidence of MRI findings in the workup of tinnitus, every effort should be made to optimize screening protocols. Noncontrasted fast spin-echo T2-weighted MRI should be used to assess patients with tinnitus when there is low suspicion for retrocochlear pathology. Patients with unilateral non-pulsatile tinnitus with symmetric hearing may be observed, but clinical judgement should determine the need for further imaging.

Authors
Choi, KJ; Sajisevi, MB; Kahmke, RR; Kaylie, DM
MLA Citation
Choi, KJ, Sajisevi, MB, Kahmke, RR, and Kaylie, DM. "Incidence of Retrocochlear Pathology Found on MRI in Patients With Non-Pulsatile Tinnitus." Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 36.10 (December 2015): 1730-1734.
PMID
26496672
Source
epmc
Published In
Otology and Neurotology
Volume
36
Issue
10
Publish Date
2015
Start Page
1730
End Page
1734
DOI
10.1097/mao.0000000000000890

Dysphagia, hoarseness, and globus in a postoperative patient.

Sore throat, hoarseness, and dysphagia are known and recognized postoperative complications of laryngeal mask airway use during operative procedures. The patient's symptoms, present immediately after surgery, are thought related to airway manipulation. Airway foreign bodies, although low on the differential, can cause similar symptoms. We present a case of a single patient who presented to a tertiary care center after an elective outpatient procedure with postoperative sore throat, hoarseness, and dysphagia. A foreign body was found lodged in the patient's hypopharynx. The differential diagnosis of sore throat, hoarseness, and dysphagia in the postoperative patient is explored in further detail.

Authors
Kahmke, R; Woodard, CR
MLA Citation
Kahmke, R, and Woodard, CR. "Dysphagia, hoarseness, and globus in a postoperative patient." American journal of otolaryngology 36.2 (March 2015): 310-311.
PMID
25498994
Source
epmc
Published In
American Journal of Otolaryngology
Volume
36
Issue
2
Publish Date
2015
Start Page
310
End Page
311
DOI
10.1016/j.amjoto.2014.11.011

FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients.

OBJECTIVE: 1) Assess FoxP3/indoleamine 2,3-dioxygenase immunoreactivity in head and neck melanoma sentinel lymph nodes and 2) correlate FoxP3/indoleamine 2,3-dioxygenase with sentinel lymph node metastasis and clinical recurrence. STUDY DESIGN: Retrospective cohort study. METHODS: Patients with sentinel lymph node biopsy for head and neck melanoma between 2004 and 2011 were identified. FoxP3/indoleamine 2,3-dioxygenase prevalence and intensity were determined from the nodes. Poor outcome was defined as local, regional or distant recurrence. The overall immunoreactivity score was correlated with clinical recurrence and sentinel lymph node metastasis using the chi-square test for trend. RESULTS: Fifty-six sentinel lymph nodes were reviewed, with 47 negative and 9 positive for melanoma. Patients with poor outcomes had a statistically significant trend for higher immunoreactivity scores (p=0.03). Positive nodes compared to negative nodes also had a statistically significant trend for higher immunoreactivity scores (p=0.03). Among the negative nodes, there was a statistically significant trend for a poor outcome with higher immunoreactivity scores (p=0.02). CONCLUSION: FoxP3/indoleamine 2,3-dioxygenase immunoreactivity correlates with sentinel lymph node positivity and poor outcome. Even in negative nodes, higher immunoreactivity correlated with poor outcome. Therefore higher immunoreactivity may portend a worse prognosis even without metastasis in the sentinel lymph node. This could identify a subset of patients that may benefit from future trials and treatment for melanoma through Treg and IDO suppression.

Authors
Ryan, M; Crow, J; Kahmke, R; Fisher, SR; Su, Z; Lee, WT
MLA Citation
Ryan, M, Crow, J, Kahmke, R, Fisher, SR, Su, Z, and Lee, WT. "FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients." American journal of otolaryngology 35.6 (November 2014): 689-694.
PMID
25212103
Source
epmc
Published In
American Journal of Otolaryngology
Volume
35
Issue
6
Publish Date
2014
Start Page
689
End Page
694
DOI
10.1016/j.amjoto.2014.08.009

Utility of Intraoperative Frozen Sections during Thyroid Surgery.

Objective. To describe the usefulness of intraoperative frozen section in the diagnosis and treatment of thyroid nodules where fine needle aspirate biopsies have evidence of follicular neoplasm. Study Design. Retrospective case series. Methods. All patients have a fine needle aspirate biopsy, an intraoperative frozen section, and final pathology performed on a thyroid nodule after initiation of the Bethesda System for Reporting Thyroid Cytopathology in 2009 at a single tertiary referral center. Sensitivity, specificity, positive predictive value, and negative predictive value are calculated in order to determine added benefit of frozen section to original fine needle aspirate data. Results. The sensitivity and specificity of the frozen section were 76.9% and 67.9%, respectively, while for the fine needle aspirate were 53.8% and 74.1%, respectively. The positive and negative predictive values for the fine needle aspirates were 25% and 90.9%, respectively, while for the frozen sections were 27.8% and 94.8%, respectively. There were no changes in the operative course as a consequence of the frozen sections. Conclusion. Our data does not support the clinical usefulness of intraoperative frozen section when the fine needle aspirate yields a Bethesda Criteria diagnosis of follicular neoplasm, suspicious for follicular neoplasm, or suspicious for malignancy at our institution.

Authors
Kahmke, R; Lee, WT; Puscas, L; Scher, RL; Shealy, MJ; Burch, WM; Esclamado, RM
MLA Citation
Kahmke, R, Lee, WT, Puscas, L, Scher, RL, Shealy, MJ, Burch, WM, and Esclamado, RM. "Utility of Intraoperative Frozen Sections during Thyroid Surgery." Int J Otolaryngol 2013 (2013): 496138-.
Website
http://hdl.handle.net/10161/15371
PMID
23401692
Source
pubmed
Published In
International Journal of Otolaryngology
Volume
2013
Publish Date
2013
Start Page
496138
DOI
10.1155/2013/496138

What are the diagnostic criteria for migraine-associated vertigo?

Authors
Kahmke, R; Kaylie, D
MLA Citation
Kahmke, R, and Kaylie, D. "What are the diagnostic criteria for migraine-associated vertigo?." The Laryngoscope 122.9 (September 2012): 1885-1886. (Review)
PMID
22926936
Source
epmc
Published In
The Laryngoscope
Volume
122
Issue
9
Publish Date
2012
Start Page
1885
End Page
1886
DOI
10.1002/lary.23335
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