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Lee, Walter T

Overview:

Global Health, Virtue-Based Professional Development and Leadership, Device Development for Cancer Detection

Positions:

Associate Professor of Surgery

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

Associate Professor in Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1999

M.D. — George Washington University

M.H.S. 2015

M.H.S. — Duke University

Grants:

A Quantitative Optical Sensor to Monitor Tumor Vascular Physiology

Administered By
Radiation Oncology
AwardedBy
Zenalux Biomedical, Inc.
Role
Investigator
Start Date
September 01, 2015
End Date
December 31, 2016

TERT promoter mutation frequency in subsets of oral tongue cancer patients

Administered By
Surgery, Head and Neck Surgery and Communication Sciences
AwardedBy
American Medical Association Foundation
Role
Principal Investigator
Start Date
April 01, 2015
End Date
October 15, 2016

CHECKPOINT Head & Neck Nerve Stimulator/Locator Product Validation Study (9394-CSP-000-B)

Administered By
Surgery, Head and Neck Surgery and Communication Sciences
AwardedBy
Checkpoint Surgical
Role
Principal Investigator
Start Date
June 01, 2014
End Date
May 31, 2015

Can Optical Spectroscopy Predict Early Treatment Response in Solid Tumors

Administered By
Biomedical Engineering
AwardedBy
National Institutes of Health
Role
Co-Mentor
Start Date
May 07, 2010
End Date
September 07, 2012
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Publications:

Solar-powered hearing aids for children with impaired hearing in Vietnam: a pilot study.

Hearing loss is a barrier to speech and social and cognitive development. This can be especially pronounced in children living in low- and middle-income countries with limited resources.To determine the feasibility, durability and social impact of ComCare GLW solar-powered hearing aids provided for Vietnamese children with hearing impairment.A retrospective review of data from an international, multi-discipline humanitarian visit was performed. Hearing aids were given to 28 children enrolled at the Khoai Chau Functional Rehabilitation School, Hung Yen Province, Vietnam. Device inspection and observational assessments were performed by teachers using a modified Parents' Evaluation of Aural/Oral Performance of Children and an Infant Hearing Program Amplification Benefit Questionnaire. Qualitative interviews were undertaken to assess the study aims.Hearing aids were well tolerated for use during regular school hours. All units remained functional during the study period (12 months). Teachers noted increased student awareness and responsiveness to surrounding sounds, but the degree of response to amplification varied between children. There was no significant improvement in speech development as all subjects had prelingual deafness. Teachers felt confident in troubleshooting any potential device malfunction.A solar-powered hearing aid may be a viable option for children in low- and middle-income countries. This study demonstrates that device distribution, maintenance and function can be established in countries with limited resources, while providing feasibility data to support future studies investigating how similar devices may improve the quality of life of those with hearing loss.

Authors
Vo, QT; Pham, D; Choi, KJ; Nguyen, UTT; Le, L; Shanewise, T; Tran, L; Nguyen, N; Lee, WT
MLA Citation
Vo, QT, Pham, D, Choi, KJ, Nguyen, UTT, Le, L, Shanewise, T, Tran, L, Nguyen, N, and Lee, WT. "Solar-powered hearing aids for children with impaired hearing in Vietnam: a pilot study." Paediatrics and international child health (January 25, 2017): 1-6.
PMID
28121245
Source
epmc
Published In
Paediatrics and international child health
Publish Date
2017
Start Page
1
End Page
6
DOI
10.1080/20469047.2016.1276119

Quantifying the Dynamics of Field Cancerization in Tobacco-Related Head and Neck Cancer: A Multiscale Modeling Approach.

High rates of local recurrence in tobacco-related head and neck squamous cell carcinoma (HNSCC) are commonly attributed to unresected fields of precancerous tissue. Because they are not easily detectable at the time of surgery without additional biopsies, there is a need for noninvasive methods to predict the extent and dynamics of these fields. Here, we developed a spatial stochastic model of tobacco-related HNSCC at the tissue level and calibrated the model using a Bayesian framework and population-level incidence data from the Surveillance, Epidemiology, and End Results (SEER) registry. Probabilistic model analyses were performed to predict the field geometry at time of diagnosis, and model predictions of age-specific recurrence risks were tested against outcome data from SEER. The calibrated models predicted a strong dependence of the local field size on age at diagnosis, with a doubling of the expected field diameter between ages at diagnosis of 50 and 90 years, respectively. Similarly, the probability of harboring multiple, clonally unrelated fields at the time of diagnosis was found to increase substantially with patient age. On the basis of these findings, we hypothesized a higher recurrence risk in older than in younger patients when treated by surgery alone; we successfully tested this hypothesis using age-stratified outcome data. Further clinical studies are needed to validate the model predictions in a patient-specific setting. This work highlights the importance of spatial structure in models of epithelial carcinogenesis and suggests that patient age at diagnosis may be a critical predictor of the size and multiplicity of precancerous lesions. Cancer Res; 76(24); 7078-88. ©2016 AACR.

Authors
Ryser, MD; Lee, WT; Ready, NE; Leder, KZ; Foo, J
MLA Citation
Ryser, MD, Lee, WT, Ready, NE, Leder, KZ, and Foo, J. "Quantifying the Dynamics of Field Cancerization in Tobacco-Related Head and Neck Cancer: A Multiscale Modeling Approach." Cancer research 76.24 (December 2016): 7078-7088.
PMID
27913438
Source
epmc
Published In
Cancer Research
Volume
76
Issue
24
Publish Date
2016
Start Page
7078
End Page
7088
DOI
10.1158/0008-5472.can-16-1054

Oxygen and Perfusion Kinetics in Response to Fractionated Radiation Therapy in FaDu Head and Neck Cancer Xenografts Are Related to Treatment Outcome.

To test whether oxygenation kinetics correlate with the likelihood for local tumor control after fractionated radiation therapy.We used diffuse reflectance spectroscopy to noninvasively measure tumor vascular oxygenation and total hemoglobin concentration associated with radiation therapy of 5 daily fractions (7.5, 9, or 13.5 Gy/d) in FaDu xenografts. Spectroscopy measurements were obtained immediately before each daily radiation fraction and during the week after radiation therapy. Oxygen saturation and total hemoglobin concentration were computed using an inverse Monte Carlo model.First, oxygenation kinetics during and after radiation therapy, but before tumor volumes changed, were associated with local tumor control. Locally controlled tumors exhibited significantly faster increases in oxygenation after radiation therapy (days 12-15) compared with tumors that recurred locally. Second, within the group of tumors that recurred, faster increases in oxygenation during radiation therapy (day 3-5 interval) were correlated with earlier recurrence times. An area of 0.74 under the receiver operating characteristic curve was achieved when classifying the local control tumors from all irradiated tumors using the oxygen kinetics with a logistic regression model. Third, the rate of increase in oxygenation was radiation dose dependent. Radiation doses ≤9.5 Gy/d did not initiate an increase in oxygenation, whereas 13.5 Gy/d triggered significant increases in oxygenation during and after radiation therapy.Additional confirmation is required in other tumor models, but these results suggest that monitoring tumor oxygenation kinetics could aid in the prediction of local tumor control after radiation therapy.

Authors
Hu, F; Vishwanath, K; Salama, JK; Erkanli, A; Peterson, B; Oleson, JR; Lee, WT; Brizel, DM; Ramanujam, N; Dewhirst, MW
MLA Citation
Hu, F, Vishwanath, K, Salama, JK, Erkanli, A, Peterson, B, Oleson, JR, Lee, WT, Brizel, DM, Ramanujam, N, and Dewhirst, MW. "Oxygen and Perfusion Kinetics in Response to Fractionated Radiation Therapy in FaDu Head and Neck Cancer Xenografts Are Related to Treatment Outcome." International journal of radiation oncology, biology, physics 96.2 (October 2016): 462-469.
PMID
27598811
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
462
End Page
469
DOI
10.1016/j.ijrobp.2016.06.007

Does an Otolaryngology-Specific Database Have Added Value? A Comparative Feasibility Analysis.

There are multiple nationally representative databases that support epidemiologic and outcomes research, and it is unknown whether an otolaryngology-specific resource would prove indispensable or superfluous. Therefore, our objective was to determine the feasibility of analyses in the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases as compared with the otolaryngology-specific Creating Healthcare Excellence through Education and Research (CHEER) database.Parallel analyses in 2 data sets.Ambulatory visits in the United States.To test a fixed hypothesis that could be directly compared between data sets, we focused on a condition with expected prevalence high enough to substantiate availability in both. This query also encompassed a broad span of diagnoses to sample the breadth of available information. Specifically, we compared an assessment of suspected risk factors for sensorineural hearing loss in subjects 0 to 21 years of age, according to a predetermined protocol. We also assessed the feasibility of 6 additional diagnostic queries among all age groups.In the NAMCS/NHAMCS data set, the number of measured observations was not sufficient to support reliable numeric conclusions (percentage standard error among risk factors: 38.6-92.1). Analysis of the CHEER database demonstrated that age, sex, meningitis, and cytomegalovirus were statistically significant factors associated with pediatric sensorineural hearing loss (P < .01). Among the 6 additional diagnostic queries assessed, NAMCS/NHAMCS usage was also infeasible; the CHEER database contained 1585 to 212,521 more observations per annum.An otolaryngology-specific database has added utility when compared with already available national ambulatory databases.

Authors
Bellmunt, AM; Roberts, R; Lee, WT; Schulz, K; Pynnonen, MA; Crowson, MG; Witsell, D; Parham, K; Langman, A; Vambutas, A; Ryan, SE; Shin, JJ
MLA Citation
Bellmunt, AM, Roberts, R, Lee, WT, Schulz, K, Pynnonen, MA, Crowson, MG, Witsell, D, Parham, K, Langman, A, Vambutas, A, Ryan, SE, and Shin, JJ. "Does an Otolaryngology-Specific Database Have Added Value? A Comparative Feasibility Analysis." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 155.1 (July 2016): 56-64.
PMID
27371627
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
155
Issue
1
Publish Date
2016
Start Page
56
End Page
64
DOI
10.1177/0194599816651036

Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement.

(1) Compare postoperative bleeding in the CHEER network (Creating Healthcare Excellence through Education and Research) among age groups, diagnoses, and practice types. (2) Report the incidence of bleeding by individual CHEER practice site based on practice guidelines.Retrospective data collection database review of the CHEER network based on ICD-9 and CPT codes related to tonsillectomy patients.Multisite practice-based network.A total of 8347 subjects underwent tonsillectomy as determined by procedure code within the retrospective data collection database, and 107 had postoperative hemorrhage. These subjects had demographic information and related diagnoses based on the CPT and ICD-9 codes collected. Postoperative ICD-9 and CPT codes were used to identify patients who also had postoperative bleed. Variables included age (<12 vs ≥12 years), diagnoses (infectious vs noninfectious), and practice type (community vs academic). Statistical analysis included multivariate logistic regression variables predictive of postoperative bleeding, with P < .05 considered significant.Thirteen sites contributed data to the study (7 academic, 6 community). There was postoperative bleeding for an overall bleed rate of 1.3%. Patients ≥12 years old had a significantly increased bleed rate when compared with the younger group (odds ratio, 5.98; 95% confidence interval: 3.79-9.44; P < .0001). There was no significant difference in bleed rates when practices or diagnoses were compared.A site descriptor database built to expedite clinical research can be used for practice assessment and quality improvement. These data were also useful to identify patient risk factors for posttonsillectomy bleed.

Authors
Lee, WT; Witsell, DL; Parham, K; Shin, JJ; Chapurin, N; Pynnonen, MA; Langman, A; Nguyen-Huynh, A; Ryan, SE; Vambutas, A; Roberts, RS; Schulz, K
MLA Citation
Lee, WT, Witsell, DL, Parham, K, Shin, JJ, Chapurin, N, Pynnonen, MA, Langman, A, Nguyen-Huynh, A, Ryan, SE, Vambutas, A, Roberts, RS, and Schulz, K. "Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 155.1 (July 2016): 28-32.
PMID
27371623
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
155
Issue
1
Publish Date
2016
Start Page
28
End Page
32
DOI
10.1177/0194599816630523

Variation in the Use of Vestibular Diagnostic Testing for Patients Presenting to Otolaryngology Clinics with Dizziness.

We used a national otolaryngology practice-based research network database to characterize the utilization of vestibular function testing in patients diagnosed with dizziness and/or a vestibular disorder.Database review.The Creating Healthcare Excellence through Education and Research (CHEER) practice-based research network of academic and community providersDizzy patients in the CHEER retrospective database were identified through ICD-9 codes; vestibular testing procedures were identified with CPT codes. Demographics and procedures per patient were tabulated. Analysis included number and type of vestibular tests ordered, stratified by individual clinic and by practice type (community vs academic). Chi-square tests were performed to assess if the percentage of patients receiving testing was statistically significant across clinics. A logistic regression model was used to examine the association between receipt of testing and being tested on initial visit.A total of 12,468 patients diagnosed with dizziness and/or a vestibular disorder were identified from 7 community and 5 academic CHEER network clinics across the country. One-fifth of these patients had at least 1 vestibular function test. The percentage of patients tested varied widely by site, from 3% to 72%; academic clinics were twice as likely to test. Initial visit vestibular testing also varied, from 0% to 96% of dizzy patients, and was 15 times more likely in academic clinics.There is significant variation in use and timing of vestibular diagnostic testing across otolaryngology clinics. The CHEER network research database does not contain outcome data. These results illustrate the critical need for research that examines outcomes as related to vestibular testing.

Authors
Piker, EG; Schulz, K; Parham, K; Vambutas, A; Witsell, D; Tucci, D; Shin, JJ; Pynnonen, MA; Nguyen-Huynh, A; Crowson, M; Ryan, SE; Langman, A; Roberts, R; Wolfley, A; Lee, WT
MLA Citation
Piker, EG, Schulz, K, Parham, K, Vambutas, A, Witsell, D, Tucci, D, Shin, JJ, Pynnonen, MA, Nguyen-Huynh, A, Crowson, M, Ryan, SE, Langman, A, Roberts, R, Wolfley, A, and Lee, WT. "Variation in the Use of Vestibular Diagnostic Testing for Patients Presenting to Otolaryngology Clinics with Dizziness." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 155.1 (July 2016): 42-47.
PMID
27371625
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
155
Issue
1
Publish Date
2016
Start Page
42
End Page
47
DOI
10.1177/0194599816650173

Thyroid Disease and Surgery in CHEER: The Nation's Otolaryngology-Head and Neck Surgery Practice-Based Network.

(1) Describe thyroid-related diagnoses and procedures in Creating Healthcare Excellence through Education and Research (CHEER) across academic and community sites. (2) Compare management of malignant thyroid disease across these sites. (3) Provide practice-based data related to flexible laryngoscopy vocal fold assessment before and after thyroid surgery based on the American Academy of Otolaryngology-Head and Neck Surgery Foundation's clinical practice guidelines.Review of retrospective data collection (RDC) database of the CHEER network using ICD-9 and CPT codes related to thyroid conditions.Multisite practice-based network.There were 3807 thyroid patients (1392 malignant, 2415 benign) with 10,160 unique visits identified from 1 year of patient data in the RDC. Analysis was performed for identified cohort of patients using demographics, site characteristics, and diagnostic and procedural distribution.Mean number of patients with thyroid disease per site was 238 (range, 23-715). In community practices, 19% of patients with thyroid disease had cancer versus 45% in the academic setting (P < .001). While academic sites manage more cancer patients, community sites are also surgically treating thyroid cancer and performed more procedures per cancer patient (4.2 vs 3.5, P < .001). Vocal fold function was assessed by flexible laryngoscopy in 34.0% of preoperative patients and in 3.7% postoperatively.This is the first overview of malignant and benign thyroid disease through CHEER. It shows how the RDC can be used alone and with national guidelines to inform of clinical practice patterns in academic and community sites. This demonstrates the potential for future thyroid-related studies utilizing the otolaryngology-head and neck surgery practice-based research network.

Authors
Parham, K; Chapurin, N; Schulz, K; Shin, JJ; Pynnonen, MA; Witsell, DL; Langman, A; Nguyen-Huynh, A; Ryan, SE; Vambutas, A; Wolfley, A; Roberts, R; Lee, WT
MLA Citation
Parham, K, Chapurin, N, Schulz, K, Shin, JJ, Pynnonen, MA, Witsell, DL, Langman, A, Nguyen-Huynh, A, Ryan, SE, Vambutas, A, Wolfley, A, Roberts, R, and Lee, WT. "Thyroid Disease and Surgery in CHEER: The Nation's Otolaryngology-Head and Neck Surgery Practice-Based Network." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 155.1 (July 2016): 22-27.
PMID
27371622
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
155
Issue
1
Publish Date
2016
Start Page
22
End Page
27
DOI
10.1177/0194599815627641

Ménière's Disease: A CHEER Database Study of Local and Regional Patient Encounter and Procedure Patterns.

(1) Integrate practice-based patient encounters using the Dartmouth Atlas Medicare database to understand practice treatments for Ménière's disease (MD). (2) Describe differences in the practice patterns between academic and community providers for MD.Practice-based research database review.CHEER (Creating Healthcare Excellence through Education and Research) network academic and community providers.MD patient data were identified with ICD-9 and CPT codes. Demographics, unique visits, and procedures per patient were tabulated. The Dartmouth Atlas of Health Care was used to reference regional health care utilization. Statistical analysis included 1-way analyses of variance, bivariate linear regression, and Student's t tests, with significance set at P < .05.A total of 2071 unique patients with MD were identified from 8 academic and 10 community otolaryngology-head and neck surgery provider centers nationally. Average age was 56.5 years; 63.9% were female; and 91.4% self-reported white ethnicity. There was an average of 3.2 visits per patient. Western providers had the highest average visits per patient. Midwest providers had the highest average procedures per patient. Community providers had more visits per site and per patient than did academic providers. Academic providers had significantly more operative procedures per site (P = .0002) when compared with community providers. Health care service areas with higher total Medicare reimbursements per enrollee did not report significantly more operative procedures being performed.This is the first practice-based clinical research database study to describe MD practice patterns. We demonstrate that academic otolaryngology-head and neck surgery providers perform significantly more operative procedures than do community providers for MD, and we validate these data with an independent Medicare spending database.

Authors
Crowson, MG; Schulz, K; Parham, K; Vambutas, A; Witsell, D; Lee, WT; Shin, JJ; Pynnonen, MA; Nguyen-Huynh, A; Ryan, SE; Langman, A
MLA Citation
Crowson, MG, Schulz, K, Parham, K, Vambutas, A, Witsell, D, Lee, WT, Shin, JJ, Pynnonen, MA, Nguyen-Huynh, A, Ryan, SE, and Langman, A. "Ménière's Disease: A CHEER Database Study of Local and Regional Patient Encounter and Procedure Patterns." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 155.1 (July 2016): 15-21.
PMID
27371621
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
155
Issue
1
Publish Date
2016
Start Page
15
End Page
21
DOI
10.1177/0194599815617752

[(99m)Tc]Tilmanocept Accurately Detects Sentinel Lymph Nodes and Predicts Node Pathology Status in Patients with Oral Squamous Cell Carcinoma of the Head and Neck: Results of a Phase III Multi-institutional Trial.

[(99m)Tc]Tilmanocept, a novel CD206 receptor-targeted radiopharmaceutical, was evaluated in an open-label, phase III trial to determine the false negative rate (FNR) of sentinel lymph node biopsy (SLNB) relative to the pathologic nodal status in patients with intraoral or cutaneous head and neck squamous cell carcinoma (HNSCC) undergoing tumor resection, SLNB, and planned elective neck dissection (END). Negative predictive value (NPV), overall accuracy of SLNB, and the impact of radiopharmaceutical injection timing relative to surgery were assessed.This multicenter, non-randomized, single-arm trial (ClinicalTrials.gov identifier NCT00911326) enrolled 101 patients with T1-T4, N0, and M0 HNSCC. Patients received 50 µg [(99m)Tc]tilmanocept radiolabeled with either 0.5 mCi (same day) or 2.0 mCi (next day), followed by lymphoscintigraphy, SLNB, and END. All excised tissues were evaluated for tissue type and tumor presence. [(99m)Tc]Tilmanocept identified one or more SLNs in 81 of 83 patients (97.6 %). Of 39 patients identified with any tumor-positive nodes (SLN or non-SLN), one patient had a single tumor-positive non-SLN in whom all SLNs were tumor-negative, yielding an FNR of 2.56 %; NPV was 97.8 % and overall accuracy was 98.8 %. No significant differences were observed between same-day and next-day procedures.Use of receptor-targeted [(99m)Tc]tilmanocept for lymphatic mapping allows for a high rate of SLN identification in patients with intraoral and cutaneous HNSCC. SLNB employing [(99m)Tc]tilmanocept accurately predicts the pathologic nodal status of intraoral HNSCC patients with low FNR, high NPV, and high overall accuracy. The use of [(99m)Tc]tilmanocept for SLNB in select patients may be appropriate and may obviate the need to perform more extensive procedures such as END.

Authors
Agrawal, A; Civantos, FJ; Brumund, KT; Chepeha, DB; Hall, NC; Carroll, WR; Smith, RB; Zitsch, RP; Lee, WT; Shnayder, Y; Cognetti, DM; Pitman, KT; King, DW; Christman, LA; Lai, SY
MLA Citation
Agrawal, A, Civantos, FJ, Brumund, KT, Chepeha, DB, Hall, NC, Carroll, WR, Smith, RB, Zitsch, RP, Lee, WT, Shnayder, Y, Cognetti, DM, Pitman, KT, King, DW, Christman, LA, and Lai, SY. "[(99m)Tc]Tilmanocept Accurately Detects Sentinel Lymph Nodes and Predicts Node Pathology Status in Patients with Oral Squamous Cell Carcinoma of the Head and Neck: Results of a Phase III Multi-institutional Trial." Annals of surgical oncology 22.11 (October 2015): 3708-3715.
PMID
25670018
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
11
Publish Date
2015
Start Page
3708
End Page
3715
DOI
10.1245/s10434-015-4382-x

Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients.

To assess whether patient age or sex was predictive of a bilaterally absent cervical or ocular vestibular evoked myogenic potential (cVEMP or oVEMP).Retrospective case review.Tertiary center.Patients presenting with normal vestibular tests (i.e. normal caloric and rotational chair) who underwent cVEMP and/or oVEMP testing. Patients with conductive hearing loss were excluded as were those with unilaterally abnormal VEMP results because they presented with evidence of a possible unilateral vestibular impairment. A total of 895 patients met criteria for cVEMPs and 297 for oVEMPs.The presence or absence of cVEMP and oVEMP responses elicited with a 500-Hz 125-dB pSPL air conduction stimulus.A logistic regression was performed including odd ratios and confidence intervals. Compared with adults in their 20s, the odds of bilaterally absent cVEMP responses are 6 times greater for patients in their 50s and 60s and over 22 times greater for patients in their 70s and 80s. A bilaterally absent oVEMP response is 6 times more likely for patients in their 40s, 50s, and 60 and 13 times greater for patients in their 70s.VEMPs in response to air conduction stimuli are bilaterally absent in a large percentage of older patients complaining of dizziness who otherwise have normal vestibular and auditory testing for their age. In combination with other abnormal vestibular findings, an absence of VEMP responses may be of value. However, the functional consequence of an isolated bilaterally absent VEMP is not known and may provide minimal information to an older patient's diagnostic picture. In cases where the response is bilaterally absent, a more intense AC stimulus should be used or bone conducted vibration should be considered.

Authors
Piker, EG; Baloh, RW; Witsell, DL; Garrison, DB; Lee, WT
MLA Citation
Piker, EG, Baloh, RW, Witsell, DL, Garrison, DB, and Lee, WT. "Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients." Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 36.7 (August 2015): 1238-1244.
PMID
26111076
Source
epmc
Published In
Otology and Neurotology
Volume
36
Issue
7
Publish Date
2015
Start Page
1238
End Page
1244
DOI
10.1097/mao.0000000000000793

Epiglottic cyst causing dysphagia and impending airway obstruction.

Laryngeal cysts are relatively rare benign lesions of the larynx. Congenital cysts can cause neonatal respiratory distress and death, but airway obstruction due to acquired cysts in adults is rare. We present a case report of 51-year-old male with dysphagia who was found to have a mobile pedunculated epiglottic cyst that intermittently caused partial obstruction of the laryngeal inlet. Patient was taken to operating room and following transoral fiberoptic intubation, endoscopic excision of this cyst was accomplished. Patient's postoperative course was uneventful.

Authors
Collins, AM; Chapurin, N; Lee, WT
MLA Citation
Collins, AM, Chapurin, N, and Lee, WT. "Epiglottic cyst causing dysphagia and impending airway obstruction." American journal of otolaryngology 36.3 (May 2015): 492-493.
PMID
25683302
Source
epmc
Published In
American Journal of Otolaryngology
Volume
36
Issue
3
Publish Date
2015
Start Page
492
End Page
493
DOI
10.1016/j.amjoto.2015.02.002

Gene Expression Profile of Dendritic Cell-Tumor Cell Hybrids Determined by Microarrays and Its Implications for Cancer Immunotherapy.

Dendritic cell- (DC-) tumor fusion cells stimulate effective in vivo antitumor responses. However, therapeutic approaches are dependent upon the coadministration of exogenous 3rd signals. The purpose of this study was to determine the mechanisms for inadequate 3rd signaling by electrofused DC-tumor cell hybrids.Murine melanoma cells were fused with DCs derived from C57BL/6 mice. Quantitative real-time PCR (qPCR) was used to determine relative changes in Th (T helper) 1 and Th2 cytokine gene expression. In addition, changes in gene expression of fusion cells were determined by microarray. Last, cytokine secretion by fusion cells upon inhibition of signaling pathways was analyzed by ELISA.qPCR analyses revealed that fusion cells exhibited a downregulation of Th1 associated cytokines IL-12 and IL-15 and an upregulation of the Th2 cytokine IL-4. Microarray studies further showed that the expression of chemokines, costimulatory molecules, and matrix-metalloproteinases was deregulated in fusion cells. Lastly, inhibitor studies demonstrate that inhibition of the PI3K/Akt/mTOR signaling pathway could restore the secretion of bioactive IL-12p70 by fusion cells.Our results suggest that combining fusion cell-based vaccination with administration of inhibitors of the PI3K/Akt/mTOR signaling pathway may enhance antitumor responses in patients.

Authors
Dannull, J; Tan, C; Farrell, C; Wang, C; Pruitt, S; Nair, SK; Lee, WT
MLA Citation
Dannull, J, Tan, C, Farrell, C, Wang, C, Pruitt, S, Nair, SK, and Lee, WT. "Gene Expression Profile of Dendritic Cell-Tumor Cell Hybrids Determined by Microarrays and Its Implications for Cancer Immunotherapy." Journal of immunology research 2015 (January 2015): 789136-.
PMID
26605345
Source
epmc
Published In
Journal of Immunology Research
Volume
2015
Publish Date
2015
Start Page
789136
DOI
10.1155/2015/789136

Comparison of complications in free flap reconstruction for osteoradionecrosis in patients with or without hyperbaric oxygen therapy.

BACKGROUND: Hyperbaric oxygen (HBO) therapy induces native tissue oxygenation. The hypothesis was patients with mandibular osteoradionecrosis (ORN) and a history of HBO therapy would have less free flap reconstruction complications than patients without HBO therapy. METHODS: We conducted a multisite retrospective review involving radical debridement and free flap reconstruction for ORN between January 1, 1995 and June 30, 2011. Patients were stratified based on receiving prior HBO therapy or not. RESULTS: Thirty-nine of 89 patients (43.8%) had HBO therapy whereas 50 of 89 (56.2%) did not. The HBO therapy group had significantly less patients with diabetes. There was no statistical difference in overall complication in patients between groups (p = .5478). However, there was marginal significance of increased infections in the patients with a history of HBO therapy (p = .0545). CONCLUSION: Although no significant differences in free flap reconstruction complication rates were observed between these 2 patient cohorts, there was marginal significance of increased infections in the patients with a history of HBO therapy. A prospective multi-institutional randomized study examining issues of infection would address issues inherent in this retrospective study.

Authors
Nolen, D; Cannady, SB; Wax, MK; Scharpf, J; Puscas, L; Esclamado, RM; Fritz, M; Freiberger, J; Lee, WT
MLA Citation
Nolen, D, Cannady, SB, Wax, MK, Scharpf, J, Puscas, L, Esclamado, RM, Fritz, M, Freiberger, J, and Lee, WT. "Comparison of complications in free flap reconstruction for osteoradionecrosis in patients with or without hyperbaric oxygen therapy." Head Neck 36.12 (December 2014): 1701-1704.
PMID
24123657
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
36
Issue
12
Publish Date
2014
Start Page
1701
End Page
1704
DOI
10.1002/hed.23520

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

Assessment of the sensitivity and specificity of tissue-specific-based and anatomical-based optical biomarkers for rapid detection of human head and neck squamous cell carcinoma.

We propose the use of morphological optical biomarkers for rapid detection of human head and neck squamous cell carcinoma (HNSCC) by leveraging the underlying tissue characteristics in aerodigestive tracts.Diffuse reflectance spectra were obtained from malignant and contra-lateral normal tissues of 57 patients undergoing panendoscopy and biopsy. Oxygen saturation, total hemoglobin concentration, and the reduced scattering coefficient were extracted. Differences in malignant and normal tissues were examined based on two different groupings: anatomical site and morphological tissue type.Measurements were acquired from 252 sites, of which 51 were pathologically classified as SCC. Optical biomarkers exhibited statistical differences between malignant and normal samples. Contrast was enhanced when parsing tissues by morphological classification rather than anatomical subtype for unpaired comparisons. Corresponding linear discriminant models using multiple optical biomarkers showed improved predictive ability when accounting for morphological classification, particularly in node-positive lesions. The false-positive rate was retrospectively found to decrease by 34.2% in morphologically- vs. anatomically-derived predictive models. In glottic tissue, the surgeon exhibited a false-positive rate of 45.7% while the device showed a lower false-positive rate of 12.4%. Additionally, comparisons of optical parameters were made to further understand the physiology of tumor staging and potential causes of high surgeon false-positive rates. Optical spectroscopy is a user-friendly, non-invasive tool capable of providing quantitative information to discriminate malignant from normal head and neck tissues. Predictive models demonstrated promising results for real-time diagnostics. Furthermore, the strategy described appears to be well suited to reduce the clinical false-positive rate.

Authors
Hu, F; Vishwanath, K; Wolfgang Beumer, H; Puscas, L; Afshari, HR; Esclamado, RM; Scher, R; Fisher, S; Lo, J; Mulvey, C; Ramanujam, N; Lee, WT
MLA Citation
Hu, F, Vishwanath, K, Wolfgang Beumer, H, Puscas, L, Afshari, HR, Esclamado, RM, Scher, R, Fisher, S, Lo, J, Mulvey, C, Ramanujam, N, and Lee, WT. "Assessment of the sensitivity and specificity of tissue-specific-based and anatomical-based optical biomarkers for rapid detection of human head and neck squamous cell carcinoma." Oral oncology 50.9 (September 2014): 848-856.
PMID
25037162
Source
epmc
Published In
Oral Oncology
Volume
50
Issue
9
Publish Date
2014
Start Page
848
End Page
856
DOI
10.1016/j.oraloncology.2014.06.015

Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer.

Physicians must participate in end-of-life discussions, but they understand poorly their patients' end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life discussions.To determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation.Otolaryngology-head and neck surgery (OHNS) physicians were recruited to use a validated online tool to create a Medicare health plan for advanced cancer patients. During the exercise, participants allocated a limited pool of resources among 15 benefit categories. These data were compared with preliminary data from patients with cancer and their caregivers obtained from a separate study using the same tool. Attitudes toward quality vs quantity of life were assessed for both physicians and patients and caregivers.Participation in online assessment exercise.Medicare resource allocation.Of 9120 OHNS physicians e-mailed, 767 participated. Data collected from this group were compared with data collected from 146 patients and 114 caregivers. Compared with patients and caregivers, OHNS physician allocations differed significantly in all 15 benefit categories except home care. When stratified by answers to 3 questions about baseline attitudes toward quality vs quantity of life, there were 3 categories in which allocations of patients and caregivers differed significantly from the group with the opposite attitude for at least 2 questions: other medical care (question 1, P < .001; question 2, P = .005), palliative care (question 1, P = .008; question 2, P = .006; question 3, P = .009), and treatment for cancer (questions 1 and 2, P < .001). In contrast, physician preferences showed significant differences in only 1, nonmatching category for each attitude question: cash (question 1, P = .02), drugs (question 2, P = .03), and home care (question 3, P = .048).Patients with cancer and their caregivers have different preferences from physicians. These preferences are, for these patients and their caregivers, affected by their baseline health attitudes, but physician preferences are not. Understanding the effect of baseline attitudes is important for effective end-of-life discussions.

Authors
Rocke, DJ; Beumer, HW; Taylor, DH; Thomas, S; Puscas, L; Lee, WT
MLA Citation
Rocke, DJ, Beumer, HW, Taylor, DH, Thomas, S, Puscas, L, and Lee, WT. "Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer." JAMA otolaryngology-- head & neck surgery 140.6 (June 2014): 497-503.
PMID
24763550
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
140
Issue
6
Publish Date
2014
Start Page
497
End Page
503
DOI
10.1001/jamaoto.2014.494

Effect of physician perspective on allocation of Medicare resources for patients with advanced cancer.

OBJECTIVES: To assess how physician perspective (perspective of patient vs perspective of physician) affects Medicare resource allocation for patients with advanced cancer and compare physician allocations with actual cancer patient and caregiver allocations. STUDY DESIGN: Cross-sectional assessment. SETTING: National assessment. SUBJECTS: Otolaryngologists. METHODS: Physicians used a validated tool to create a Medicare plan for patients with advanced cancer. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (assessment 2, November/December 2012). Results were compared with data from a prior assessment made from a physician's perspective (assessment 1, February/March 2012) and with data from a separate study with patients with cancer and caregivers. RESULTS: In total, 767 physicians completed assessment 1 and 237 completed assessment 2. Results were compared with 146 cancer patient and 114 caregiver assessments. Assessment 1 physician responses differed significantly from patients/caregivers in 14 categories (P < .05), while assessment 2 differed in 11. When comparing physician data, assessment 2 allocations differed significantly from assessment 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, assessment 2 allocations in emotional care, drug coverage, and nursing facility categories were not significantly different. Assessment 1 allocations in cosmetic care, dental, home care, and primary care categories were more similar to patient/caregiver preferences, although all but home care were still significantly different. CONCLUSIONS: Otolaryngology-head and neck surgery physician perspectives on end-of-life care differ significantly from cancer patient/caregiver perspectives, even when physicians take a patient's perspective when allocating resources. This demonstrates the challenges inherent in end-of-life discussions.

Authors
Rocke, DJ; Beumer, HW; Thomas, S; Lee, WT
MLA Citation
Rocke, DJ, Beumer, HW, Thomas, S, and Lee, WT. "Effect of physician perspective on allocation of Medicare resources for patients with advanced cancer." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 150.5 (May 2014): 792-800.
PMID
24474714
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
150
Issue
5
Publish Date
2014
Start Page
792
End Page
800
DOI
10.1177/0194599814520689

Surgical innovation, industry partnership, and the enemy within.

Authors
Lee, WT; Rocke, D; Holsinger, FC
MLA Citation
Lee, WT, Rocke, D, and Holsinger, FC. "Surgical innovation, industry partnership, and the enemy within." Head & neck 36.4 (April 2014): 461-465.
PMID
23996465
Source
epmc
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
36
Issue
4
Publish Date
2014
Start Page
461
End Page
465
DOI
10.1002/hed.23476

Physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act.

OBJECTIVE: To assess otolaryngology physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act (PPACA) and compare the association of bias toward the PPACA with knowledge of the provisions of the PPACA. STUDY DESIGN: Cross-sectional survey. SETTING: Nationwide assessment. SUBJECTS: Members of the American Academy of Otolaryngology-Head and Neck Surgery. METHODS: Otolaryngology physicians answered 10 true/false questions about major provisions of the PPACA. They also indicated their level of agreement with 9 statements about health care and the PPACA. Basic demographic information was collected. RESULTS: Email solicitation was sent to 9972 otolaryngologists and 647 responses were obtained (6.5% response rate). Overall correct response rate was 74%. Fewer than 60% of physicians correctly answered questions on whether small businesses receive tax credits for providing health insurance, the effect of the PPACA on Medicare benefits, and whether a government-run health insurance plan was created. Academic center practice setting, bias toward the PPACA, and Democratic Party affiliation were associated with significantly more correct responses. CONCLUSION: Overall physician knowledge of the PPACA is assessed as fair, although better than the general public in 2010. There are several areas where knowledge of physicians regarding the PPACA is poor, and this knowledge deficit is more pronounced within certain subgroups. These knowledge issues should be addressed by individual physicians and medical societies.

Authors
Rocke, DJ; Thomas, S; Puscas, L; Lee, WT
MLA Citation
Rocke, DJ, Thomas, S, Puscas, L, and Lee, WT. "Physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 150.2 (February 2014): 229-234.
PMID
24334959
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
150
Issue
2
Publish Date
2014
Start Page
229
End Page
234
DOI
10.1177/0194599813515839

Local secretion of IL-12 augments the therapeutic impact of dendritic cell-tumor cell fusion vaccination.

BACKGROUND: The development of dendritic cell (DC)-tumor fusion vaccines is a promising approach in cancer immunotherapy. Using fusion vaccines allows a broad spectrum of known and unidentified tumor-associated antigens to be presented in the context of MHC class I and class II molecules, with potent co-stimulation provided by the DCs. Although DC-tumor fusion cells are immunogenic, murine studies have shown that effective immunotherapy requires a third signal, which can be provided by exogenous interleukin 12 (IL-12). Unfortunately, systemic administration of IL-12 induces severe toxicity in cancer patients, potentially precluding clinical use of this cytokine to augment fusion vaccine efficacy. To overcome this limitation, we developed a novel approach in which DC-tumor fusion cells locally secrete IL-12, then evaluated the effectiveness of this approach in a murine B16 melanoma model. MATERIALS AND METHODS: Tumor cells were stably transduced to secrete murine IL-12p70. These tumor cells were then electrofused to DC to form DC-tumor heterokaryons. These cells were used to treat established B16 pulmonary metastases. Enumeration of these metastases was performed and compared between experimental groups using Wilcoxon rank sum test. Interferon γ enzyme-linked immunosorbent spot assay was performed on splenocytes from treated mice. RESULTS: We show that vaccination with DCs fused to syngeneic melanoma cells that stably express murine IL-12p70 significantly reduces counts of established lung metastases in treated animals when compared with DC-tumor alone (P = 0.029). Interferon γ enzyme-linked immunosorbent spot assays suggest that this antitumor response is mediated by CD4(+) T cells, in the absence of a tumor-specific CD8(+) T cell response, and that the concomitant induction of antitumor CD4(+) and CD8(+) T cell responses required exogenous IL-12. CONCLUSIONS: This study is, to the best of our knowledge, the first report that investigates the impact of local secretion of IL-12 on antitumor immunity induced by a DC-tumor fusion cell vaccine in a melanoma model and may aid the rational design of future clinical trials.

Authors
Tan, C; Dannull, J; Nair, SK; Ding, E; Tyler, DS; Pruitt, SK; Lee, WT
MLA Citation
Tan, C, Dannull, J, Nair, SK, Ding, E, Tyler, DS, Pruitt, SK, and Lee, WT. "Local secretion of IL-12 augments the therapeutic impact of dendritic cell-tumor cell fusion vaccination." J Surg Res 185.2 (December 2013): 904-911.
PMID
23891424
Source
pubmed
Published In
Journal of Surgical Research
Volume
185
Issue
2
Publish Date
2013
Start Page
904
End Page
911
DOI
10.1016/j.jss.2013.06.045

An analysis of registered clinical trials in otolaryngology from 2007 to 2010: ClinicalTrials.gov.

OBJECTIVE: To describe the conditions studied, interventions used, study characteristics, and funding sources of otolaryngology clinical trials from the ClinicalTrials.gov database; compare this otolaryngology cohort of interventional studies to clinical visits in a health care system; and assess agreement between clinical trials and clinical activity. STUDY DESIGN: Database analysis. SETTING: Trial registration data downloaded from ClinicalTrials.gov and administrative data from the Duke University Medical Center from October 1, 2007 to September 27, 2010. METHODS: Data extraction from ClinicalTrials.gov was done using MeSH and non-MeSH disease condition terms. Studies were subcategorized to create the following groupings for descriptive analysis: ear, nose, allergy, voice, sleep, head and neck cancer, thyroid, and throat. Duke Health System visits were queried by using selected ICD-9 codes for otolaryngology and non-otolaryngology providers. Visits were grouped similarly to ClinicalTrials.gov for further analysis. Chi-square tests were used to explore differences between groups. RESULTS: A total of 1115 of 40,970 registered interventional trials were assigned to otolaryngology. Head and neck cancer trials predominated. Study models most frequently incorporated parallel design (54.6%), 2 study groups (46.6%), and randomization (69.1%). Phase 2 or 3 studies constituted 46.4% of the cohort. Comparison of the ClinicalTrials.gov database with administrative health system visit data by disease condition showed discordance between national research activity and clinical visit volume for patients with otolaryngology complaints. CONCLUSIONS: Analysis of otolaryngology-related clinical research as listed in ClinicalTrials.gov can inform patients, physicians, and policy makers about research focus areas. The relative burden of otolaryngology-associated conditions in our tertiary health system exceeds research activity within the field.

Authors
Witsell, DL; Schulz, KA; Lee, WT; Chiswell, K
MLA Citation
Witsell, DL, Schulz, KA, Lee, WT, and Chiswell, K. "An analysis of registered clinical trials in otolaryngology from 2007 to 2010: ClinicalTrials.gov." Otolaryngol Head Neck Surg 149.5 (November 2013): 692-699.
PMID
24107478
Source
pubmed
Published In
Otolaryngology
Volume
149
Issue
5
Publish Date
2013
Start Page
692
End Page
699
DOI
10.1177/0194599813506545

Dendritic cell vaccines targeting survivin in head and neck cancer.

Evaluation of: Turksma AW, Bontkes HJ, Ruizendaal JJ et al. Exploring dendritic cell based vaccines targeting survivin for the treatment of head and neck cancer patients. J. Transl. Med. 11, 152-165 (2013). Survivin has been identified to be an inhibitor of apoptosis and is highly expressed in many cancers. A number of strategies have targeted survivin as a novel cancer therapy approach. The evaluated paper makes a number of observations regarding the presence of survivin-specific T cells, as well as attempts for in vitro expansion. The research team has shown that survivin-specific T cells can be measured ex vivo in the peripheral blood of patients with head and neck squamous cell carcinoma by tetramer analysis and from the tumor-draining lymph node of a patient with locally advanced breast cancer by ELIspot analysis. Furthermore, dendritic cells electroporated with survivin and cytokine (i.e., IL-12 and IL-21) mRNA can be used to generate survivin-specific T cells in vitro. However, the enriched or cloned survivin-specific T cells isolated from patients or obtained by in vitro induction could not be maintained for prolonged periods of time. The study team proposed that one explanation for this is fracticide, as activated T cells were shown to express survivin. The evaluated paper therefore concluded that strategies that rely on expansion and adoptive transfer of survivin-specific T cells would not be possible.

Authors
Lee, WT
MLA Citation
Lee, WT. "Dendritic cell vaccines targeting survivin in head and neck cancer." Immunotherapy 5.11 (November 2013): 1169-1171.
PMID
24188670
Source
pubmed
Published In
Immunotherapy
Volume
5
Issue
11
Publish Date
2013
Start Page
1169
End Page
1171
DOI
10.2217/imt.13.120

Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents.

INTRODUCTION: Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. METHODS: As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership 'Basic Training' is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this 'Basic Training'. RESULTS: Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (p<0.001) in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on 'Basic Training'. All residents responded in the post-test that the STEPP program was valuable, up from 56%. CONCLUSIONS: A virtue-based approach is valued by residents as a part of leadership training during residency.

Authors
Schulz, K; Puscas, L; Tucci, D; Woodard, C; Witsell, D; Esclamado, RM; Lee, WT
MLA Citation
Schulz, K, Puscas, L, Tucci, D, Woodard, C, Witsell, D, Esclamado, RM, and Lee, WT. "Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents. (Published online)" Med Educ Online 18 (October 29, 2013): 22440-.
PMID
24172053
Source
pubmed
Published In
Medical Education Online: an electronic journal
Volume
18
Publish Date
2013
Start Page
22440

Selecting Among Otolaryngology Residency Applicants to Train as Tomorrow's Leaders.

Authors
Lee, WT; Esclamado, RM; Puscas, L
MLA Citation
Lee, WT, Esclamado, RM, and Puscas, L. "Selecting Among Otolaryngology Residency Applicants to Train as Tomorrow's Leaders." JAMA Otolaryngol Head Neck Surg 139.8 (August 1, 2013): 770-771.
PMID
23949347
Source
pubmed
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
139
Issue
8
Publish Date
2013
Start Page
770
End Page
771
DOI
10.1001/jamaoto.2013.3982

Physician allocation of Medicare resources for patients with advanced cancer.

BACKGROUND: Little is known about what patients and physicians value in end-of-life care, or how these groups would craft a health plan for those with advanced cancer. OBJECTIVE: The study objective was to assess how otolaryngology, head and neck surgery (OHNS) physicians would structure a Medicare benefit plan for patients with advanced cancer, and to compare this with cancer patient and cancer patient caregiver preferences. DESIGN: OHNS physicians used an online version of a validated tool for assessing preferences for health plans in the setting of limited resources. These data were compared to cancer patient and caregiver preferences. SETTING AND PARTICIPANTS: OHNS physicians nationwide were assessed with comparison to similar data obtained in a separate study of cancer patients and their caregivers treated at Duke University Medical Center. RESULTS: Otolaryngology physicians (n=767) completed the online assessment and this was compared with data from 146 patients and 114 caregivers. OHNS physician allocations differed significantly in 14 of the 15 benefit categories when compared with patients and caregivers. Physicians elected more coverage in the Advice, Emotional Care, Palliative Care, and Treatment for Cancer benefit categories. Patients and their caregivers elected more coverage in the Cash, Complementary Care, Cosmetic Care, Dental and Vision, Drug Coverage, Home Improvement, House Calls, Nursing Facility, Other Medical Care, and Primary Care benefit categories. CONCLUSIONS: Otolaryngology physicians have significantly different values in end-of-life care than cancer patients and their caregivers. This information is important for efficient allocation of scarce Medicare resources and for effective end-of-life discussions, both of which are key for developing appropriate health policy.

Authors
Rocke, DJ; Lee, WT; Beumer, HW; Taylor, DH; Schulz, K; Thomas, S; Puscas, L
MLA Citation
Rocke, DJ, Lee, WT, Beumer, HW, Taylor, DH, Schulz, K, Thomas, S, and Puscas, L. "Physician allocation of Medicare resources for patients with advanced cancer." J Palliat Med 16.8 (August 2013): 857-866.
PMID
23802131
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
16
Issue
8
Publish Date
2013
Start Page
857
End Page
866
DOI
10.1089/jpm.2012.0636

Effectiveness of a postoperative disposition protocol for sleep apnea surgery.

PURPOSE: 1) Evaluate the effectiveness of a postoperative disposition protocol for upper airway surgery in patients with sleep apnea. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery versus surgical intensive care admission determined by preoperative screening criteria. MATERIALS AND METHODS: A new preoperative protocol for sleep apnea surgery was instituted at the Durham Veterans Affairs Medical Center in 2008 to triage patients undergoing sleep apnea surgery to one of three postoperative dispositions: intensive care, routine ward bed, or discharge home. An Institutional Review Board approved retrospective chart review of patients undergoing sleep apnea surgery between May 2008 and January 2012 was performed. Postoperative complications and cost comparisons were assessed between each of the three postoperative disposition groups. RESULTS: 115 patients underwent sleep apnea surgery between July 2008 and January 2012. 11 patients were excluded leaving 104 patients in the final analysis. Median follow-up was 1.25months. Overall complication rate was 12.5%. Eight complications occurred in the group triaged to intensive care, and 5 occurred in those triaged to lesser levels of postoperative care. All serious complications occurred during the immediate postoperative period. Based on only room charges, $125,275 was saved over the 3.6years of this study. CONCLUSION: A post operative disposition protocol can be effectively used to triage patients to less than intensive postoperative care. In institutions like the Durham VA, where sleep apnea patients were routinely triaged to intensive care, postoperative resources will be more efficiently utilized.

Authors
Rocke, D; Sharp, S; Wiener, D; Puscas, L; Lee, WT
MLA Citation
Rocke, D, Sharp, S, Wiener, D, Puscas, L, and Lee, WT. "Effectiveness of a postoperative disposition protocol for sleep apnea surgery." American journal of otolaryngology 34.4 (July 2013): 273-277.
PMID
23332409
Source
epmc
Published In
American Journal of Otolaryngology
Volume
34
Issue
4
Publish Date
2013
Start Page
273
End Page
277
DOI
10.1016/j.amjoto.2012.11.017

Impact of anti-CD25 monoclonal antibody on dendritic cell-tumor fusion vaccine efficacy in a murine melanoma model.

BACKGROUND: A promising cancer vaccine involves the fusion of tumor cells with dendritic cells (DCs). As such, a broad spectrum of both known and unidentified tumor antigens is presented to the immune system in the context of the potent immunostimulatory capacity of DCs. Murine studies have demonstrated the efficacy of fusion immunotherapy. However the clinical impact of DC/tumor fusion vaccines has been limited, suggesting that the immunosuppresive milieu found in patients with malignancies may blunt the efficacy of cancer vaccination. Thus, novel strategies to enhance fusion vaccine efficacy are needed. Regulatory T cells (Tregs) are known to suppress anti-tumor immunity, and depletion or functional inactivation of these cells improves immunotherapy in both animal models and clinical trials. In this study, we sought to investigate whether functional inactivation of CD4+CD25+FoxP3+ Treg with anti-CD25 monoclonal antibody (mAb) PC61 prior to DC/tumor vaccination would significantly improve immunotherapy in the murine B16 melanoma model. METHODS: Treg blockade was achieved with systemic PC61 administration. This blockage was done in conjunction with DC/tumor fusion vaccine administration to treat established melanoma pulmonary metastases. Enumeration of these metastases was performed and compared between experimental groups using Wilcoxon Rank Sum Test. IFN-gamma ELISPOT assay was performed on splenocytes from treated mice. RESULTS: We demonstrate that treatment of mice with established disease using mAb PC61 and DC/tumor fusion significantly reduced counts of pulmonary metastases compared to treatment with PC61 alone (p=0.002) or treatment with control antibody plus fusion vaccine (p=0.0397). Furthermore, IFN-gamma ELISPOT analyses reveal that the increase in cancer immunity was mediated by anti-tumor specific CD4+ T-helper cells, without concomitant induction of CD8+ cytotoxic T cells. Lastly, our data provide proof of principle that combination treatment with mAb PC61 and systemic IL-12 can lower the dose of IL-12 necessary to obtain maximal therapeutic efficacy. CONCLUSIONS: To our knowledge, this is the first report investigating the effects of anti-CD25 mAb administration on DC/tumor-fusion vaccine efficacy in a murine melanoma model, and our results may aide the design of future clinical trials with enhanced therapeutic impact.

Authors
Tan, C; Reddy, V; Dannull, J; Ding, E; Nair, SK; Tyler, DS; Pruitt, SK; Lee, WT
MLA Citation
Tan, C, Reddy, V, Dannull, J, Ding, E, Nair, SK, Tyler, DS, Pruitt, SK, and Lee, WT. "Impact of anti-CD25 monoclonal antibody on dendritic cell-tumor fusion vaccine efficacy in a murine melanoma model. (Published online)" J Transl Med 11 (June 17, 2013): 148-.
PMID
23768240
Source
pubmed
Published In
Journal of Translational Medicine
Volume
11
Publish Date
2013
Start Page
148
DOI
10.1186/1479-5876-11-148

Measuring the Immeasurable Core Competency of Professionalism

Authors
Lee, WT
MLA Citation
Lee, WT. "Measuring the Immeasurable Core Competency of Professionalism." JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY 139.1 (January 2013): 12-13.
PMID
23329086
Source
wos-lite
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
139
Issue
1
Publish Date
2013
Start Page
12
End Page
13
DOI
10.1001/jamaoto.2013.1071

Patient reported outcomes in endoscopic and open transcervical treatment for Zenker's diverticulum

Objectives/Hypothesis: To compare long-term symptomatic outcomes between external transcervical (ET) and endoscopic stapling diverticulotomy (ESD) surgeries for Zenker's diverticulum. Study Design: Retrospective review. Methods: Patients undergoing surgery for Zenker's diverticulum surgery between 1998 and 2010 with at least 1 year follow-up were telephoned and questioned for dysphagia, choking, regurgitation, and halitosis based on a validated Gastrointestinal Quality-of-Life Index. Symptom degree preoperatively and at phone call was assessed. Patients rated their overall postoperative symptoms as worsened, unchanged, improved, or completely resolved. Results: A total of 96 patients were eligible for inclusion and 55 were successfully contacted. Of these, 24 underwent ESD and 31 had ET operations. Average follow-up time was significantly longer for the ET group than the ESD group (5.7 vs. 3.1 years respectively, P<0.01). Gender, age at operation, diverticulum size, and preoperative symptom scores were not statistically different between the two groups. For both techniques, symptom scores showed significant improvement postoperatively (P<0.01). A greater proportion of patients undergoing ET procedures reported their symptoms to be completely resolved or improved compared with the ESD group (93% vs. 67%, P=0.015). Patients undergoing ET demonstrated a greater change or improvement in survey score compared to ESD patients (7.23 vs. 3.42, P=0.014). Conclusion: Both the ET and ESD surgeries significantly benefit patients, regardless of diverticulum size. Long-term symptomatic outcomes between the two populations indicate that patients with ET procedures attain a greater degree of resolution of preoperative symptoms. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Authors
Seth, R; Rajasekaran, K; Lee, WT; Lorenz, RR; Wood, BG; Kominsky, A; Scharpf, J
MLA Citation
Seth, R, Rajasekaran, K, Lee, WT, Lorenz, RR, Wood, BG, Kominsky, A, and Scharpf, J. "Patient reported outcomes in endoscopic and open transcervical treatment for Zenker's diverticulum." Laryngoscope (2013).
PMID
24151013
Source
scival
Published In
The Laryngoscope
Publish Date
2013
DOI
10.1002/lary.24152

Rapid determination of oxygen saturation and vascularity for cancer detection.

A rapid heuristic ratiometric analysis for estimating tissue hemoglobin concentration and oxygen saturation from measured tissue diffuse reflectance spectra is presented. The analysis was validated in tissue-mimicking phantoms and applied to clinical measurements in head and neck, cervical and breast tissues. The analysis works in two steps. First, a linear equation that translates the ratio of the diffuse reflectance at 584 nm and 545 nm to estimate the tissue hemoglobin concentration using a Monte Carlo-based lookup table was developed. This equation is independent of tissue scattering and oxygen saturation. Second, the oxygen saturation was estimated using non-linear logistic equations that translate the ratio of the diffuse reflectance spectra at 539 nm to 545 nm into the tissue oxygen saturation. Correlations coefficients of 0.89 (0.86), 0.77 (0.71) and 0.69 (0.43) were obtained for the tissue hemoglobin concentration (oxygen saturation) values extracted using the full spectral Monte Carlo and the ratiometric analysis, for clinical measurements in head and neck, breast and cervical tissues, respectively. The ratiometric analysis was more than 4000 times faster than the inverse Monte Carlo analysis for estimating tissue hemoglobin concentration and oxygen saturation in simulated phantom experiments. In addition, the discriminatory power of the two analyses was similar. These results show the potential of such empirical tools to rapidly estimate tissue hemoglobin in real-time spectral imaging applications.

Authors
Hu, F; Vishwanath, K; Lo, J; Erkanli, A; Mulvey, C; Lee, WT; Ramanujam, N
MLA Citation
Hu, F, Vishwanath, K, Lo, J, Erkanli, A, Mulvey, C, Lee, WT, and Ramanujam, N. "Rapid determination of oxygen saturation and vascularity for cancer detection. (Published online)" PLoS One 8.12 (2013): e82977-.
PMID
24358243
Source
pubmed
Published In
PloS one
Volume
8
Issue
12
Publish Date
2013
Start Page
e82977
DOI
10.1371/journal.pone.0082977

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-.
PMID
23401692
Source
pubmed
Published In
International Journal of Otolaryngology
Volume
2013
Publish Date
2013
Start Page
496138
DOI
10.1155/2013/496138

Channelling Aristotle: virtue-based professionalism training during residency.

Authors
Lee, WT; Schulz, K; Witsell, D; Esclamado, R
MLA Citation
Lee, WT, Schulz, K, Witsell, D, and Esclamado, R. "Channelling Aristotle: virtue-based professionalism training during residency." Med Educ 46.11 (November 2012): 1129-1130.
PMID
23078720
Source
pubmed
Published In
Medical Education
Volume
46
Issue
11
Publish Date
2012
Start Page
1129
End Page
1130
DOI
10.1111/medu.12000

A non-oncogenic HPV 16 E6/E7 vaccine enhances treatment of HPV expressing tumors

Authors
Wieking, BG; Vermeer, DW; Spanos, WC; Lee, KM; Vermeer, P; Lee, WT; Xu, Y; Gabitzsch, ES; Balcaitis, S; Jr, BJP; Jones, FR; Lee, JH
MLA Citation
Wieking, BG, Vermeer, DW, Spanos, WC, Lee, KM, Vermeer, P, Lee, WT, Xu, Y, Gabitzsch, ES, Balcaitis, S, Jr, BJP, Jones, FR, and Lee, JH. "A non-oncogenic HPV 16 E6/E7 vaccine enhances treatment of HPV expressing tumors." CANCER GENE THERAPY 19.10 (October 2012): 667-674.
PMID
22918471
Source
wos-lite
Published In
Cancer Gene Therapy
Volume
19
Issue
10
Publish Date
2012
Start Page
667
End Page
674
DOI
10.1038/cgt.2012.55

Treatment-induced changes in vocal cord mobility and subsequent local recurrence after organ preservation therapy for laryngeal carcinoma.

BACKGROUND: As multidisciplinary cancer treatment evolves, strategies to identify patients needing early resection/salvage are necessary. Some have suggested that vocal cord function after organ-preservation treatment may be an indicator. METHODS: A retrospective review was performed of patients presenting with fixed or impaired vocal cord function at a tertiary center. Local recurrence rates were examined in patients with and without improved/normal mobilization after treatment. RESULTS: Sixty-nine patients met the inclusion criteria, with 35 patients having vocal cord fixation and 34 patients with impaired mobility. After treatment, 44 patients had normalization of vocal cord function, while 25 patients did not, with 2-year local control rates of 70% and 77%, p = .23, respectively. No difference in local control was found between patients with normalized/improved cord function (n = 53) and those who remained the same/worsened (n = 16; p = .81). CONCLUSION: Therapy-induced changes in vocal cord mobility did not correlate with local recurrence. Other criteria are needed to identify patients most likely to benefit from early surgical resection/salvage after organ preservation.

Authors
Lee, WT; Yoo, DS; Puscas, L; Witsell, D; Cohen, SM; Fisher, SR; Scher, R; Broadwater, G; Ready, N; Brizel, DR; Esclamado, RM
MLA Citation
Lee, WT, Yoo, DS, Puscas, L, Witsell, D, Cohen, SM, Fisher, SR, Scher, R, Broadwater, G, Ready, N, Brizel, DR, and Esclamado, RM. "Treatment-induced changes in vocal cord mobility and subsequent local recurrence after organ preservation therapy for laryngeal carcinoma." Head Neck 34.6 (June 2012): 792-796.
PMID
21850701
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
34
Issue
6
Publish Date
2012
Start Page
792
End Page
796
DOI
10.1002/hed.21813

Evaluation of endoscopic harmonic diverticulostomy.

OBJECTIVES/HYPOTHESIS: The purpose of this study is to review a consecutive series of patients with Zenker's diverticulum who were treated with endoscopic diverticulostomy using either the endoscopic stapler (ENDO GIA 30 Autosuture; Covidien, Dublin, Ireland) or Harmonic Ultrasonic Surgical Instrumentation (Ethicon Endo-Surgery, Cincinnati, OH) to evaluate the safety and optimal application of Harmonic technology to the treatment of patients with Zenker's diverticulum. STUDY DESIGN: This is a retrospective review at a tertiary academic hospital with institutional review board approval. METHODS: All patients undergoing endoscopic repair of Zenker's diverticulum between April 1, 2009 and December 1, 2010 at a single institution were studied. RESULTS: A total of 65 endoscopic diverticulostomies were performed: 24 Harmonic assisted, 41 stapler assisted. Average diverticulum size was 3.46 cm. There were two complications with staple-assisted (pharyngeal leak and recurrence) and six complications with Harmonic-assisted diverticulostomies (two pharyngeal leaks, two chest pains, one recurrence, and one subcutaneous emphysema). There was a statistically significant difference in the complication rates between the staple-assisted (4.88%) and Harmonic-assisted (25%) cohorts (P = .04). There were no complications with diverticula <2 cm. CONCLUSIONS: Endoscopic Harmonic esophagodiverticulostomy has been reported for the treatment of Zenker's diverticula. However, our data demonstrate a significantly higher complication rate with use of the Harmonic technology compared to the staple-assisted method (P = .04). Additional evaluations are warranted to validate these findings and before Harmonic diverticulostomy can be recommended as treatment for the majority of cases.

Authors
Whited, C; Lee, WT; Scher, R
MLA Citation
Whited, C, Lee, WT, and Scher, R. "Evaluation of endoscopic harmonic diverticulostomy." Laryngoscope 122.6 (June 2012): 1297-1300.
PMID
22447228
Source
pubmed
Published In
The Laryngoscope
Volume
122
Issue
6
Publish Date
2012
Start Page
1297
End Page
1300
DOI
10.1002/lary.23251

Abstract 4389: Impact of regulatory T cell depletion on dendritic cell-tumor fusion vaccine immunotherapy

Authors
Tan, C; Reddy, V; Ding, E; Dannull, J; Nair, S; Pruitt, SK; Lee, WT
MLA Citation
Tan, C, Reddy, V, Ding, E, Dannull, J, Nair, S, Pruitt, SK, and Lee, WT. "Abstract 4389: Impact of regulatory T cell depletion on dendritic cell-tumor fusion vaccine immunotherapy." Cancer Research 72.8 Supplement (April 15, 2012): 4389-4389.
Source
crossref
Published In
Cancer Research
Volume
72
Issue
8 Supplement
Publish Date
2012
Start Page
4389
End Page
4389
DOI
10.1158/1538-7445.AM2012-4389

Leukotriene C4 induces migration of human monocyte-derived dendritic cells without loss of immunostimulatory function.

Generation of human monocyte-derived dendritic cells (DCs) for cancer vaccination involves ex vivo maturation in the presence of proinflammatory cytokines and prostaglandin E(2) (PGE(2)). Although the inclusion of PGE(2) during maturation is imperative for the induction of DC migration, PGE(2) has unfavorable effects on the immunostimulatory capacity of these cells. Like PGE(2), leukotrienes (LTs) are potent mediators of DC migration. We therefore sought to characterize the migratory and immunologic properties of DCs that matured in the presence of LTB(4), LTC(4), LTD(4), and PGE(2). Here, we demonstrate that DCs matured in the presence of LTC(4), but not LTB(4) or LTD(4), are superior to PGE(2)-matured DCs in stimulating CD4(+) T-cell responses and in inducing antigen-specific cytotoxic T lymphocytes (CTLs) in vitro without concomitant induction or recruitment of regulatory T cells (Tregs). LTC(4)-matured DCs migrate efficiently through layers of extracellular matrix and secrete higher levels of immunostimulatory IL-12p70 while producing reduced levels of immune-inhibitory IL-10, IL12p40, indoleamine-2,3-dioxidase, and TIMP-1 (tissue inhibitor of matrix metalloproteinases). Intracellular calcium mobilization and receptor antagonist studies reveal that, in contrast to LTD(4), LTC(4) did not signal through CysLTR(1) in DCs. Collectively, our data suggest that LTC(4) represents a promising candidate to replace PGE(2) in DC maturation protocols for cancer vaccination.

Authors
Dannull, J; Schneider, T; Lee, WT; de Rosa, N; Tyler, DS; Pruitt, SK
MLA Citation
Dannull, J, Schneider, T, Lee, WT, de Rosa, N, Tyler, DS, and Pruitt, SK. "Leukotriene C4 induces migration of human monocyte-derived dendritic cells without loss of immunostimulatory function." Blood 119.13 (March 29, 2012): 3113-3122.
PMID
22323449
Source
pubmed
Published In
Blood
Volume
119
Issue
13
Publish Date
2012
Start Page
3113
End Page
3122
DOI
10.1182/blood-2011-10-385930

Qualities of residency applicants: comparison of otolaryngology program criteria with applicant expectations.

OBJECTIVES: To evaluate the criteria used by otolaryngology programs in ranking residency candidates and to compare residency candidate ranking criteria among otolaryngology programs and applicant expectations. DESIGN: Cross-sectional, anonymous survey administered during the 2009 and 2010 match cycles. SETTING: Otolaryngology residency programs. PARTICIPANTS: Otolaryngology residency program applicants (PAs) and otolaryngology program directors (PDs). MAIN OUTCOME MEASURES: The PDs were asked to rank the importance of 10 criteria in choosing a residency candidate on a 20-point scale (with 1 indicating utmost importance; 20, not important at all). The PAs were asked to express their expectations of how candidates should be ranked using those same criteria. RESULTS: The interview and personal knowledge of the applicant (mean rank, 3.63) were the most important criteria to PDs, whereas the interview and letters of recommendation (mean rank, 3.65) were the most important criteria among PAs. Likelihood to rank program highly and ethnicity/sex were the least valued by PDs and PAs. CONCLUSIONS: Although PDs and PAs agree on the least important criteria for ranking otolaryngology residency candidates, they disagree on the most important criteria. This information provides insight into how programs select residency candidates and how this compares with applicant expectations. Furthermore, this information will assist applicants in understanding how they might be evaluated by programs. Improved understanding of the match process may increase the likelihood of having a good fit between otolaryngology programs and matched applicants.

Authors
Puscas, L; Sharp, SR; Schwab, B; Lee, WT
MLA Citation
Puscas, L, Sharp, SR, Schwab, B, and Lee, WT. "Qualities of residency applicants: comparison of otolaryngology program criteria with applicant expectations." Arch Otolaryngol Head Neck Surg 138.1 (January 2012): 10-14.
PMID
22249622
Source
pubmed
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
138
Issue
1
Publish Date
2012
Start Page
10
End Page
14
DOI
10.1001/archoto.2011.214

Bilateral renal cell carcinoma metastasis in the oral cavity.

Cancer metastases to the oral cavity are reported infrequently. Renal cell carcinoma has a high metastatic potential, with approximately one third of patients presenting with metastatic disease. New lesions in the oral cavity often rely on preoperative biopsy to establish the diagnosis. However, we report an unusual case in a setting of known renal cell carcinoma disease, where initial pathology and culture data were misleading. Appropriate follow-up and a high index of suspicion will remain necessary. Surgical excision is the treatment of choice.

Authors
Schwab, B; Lee, WT
MLA Citation
Schwab, B, and Lee, WT. "Bilateral renal cell carcinoma metastasis in the oral cavity." Am J Otolaryngol 33.1 (January 2012): 154-155.
PMID
21371782
Source
pubmed
Published In
American Journal of Otolaryngology
Volume
33
Issue
1
Publish Date
2012
Start Page
154
End Page
155
DOI
10.1016/j.amjoto.2010.12.006

Sentinel node biopsy for head and neck melanoma: a systematic review.

OBJECTIVE: This systematic review was conducted to examine the test performance of sentinel node biopsy in head and neck melanoma, including the identification rate and false-negative rate. DATA SOURCES: PubMed, EMBASE, ASCO, and SSO database searches were conducted to identify studies fulfilling the following inclusion criteria: sentinel node biopsy was performed, lesions were located on the head and neck, and recurrence data for both metastatic and nonmetastatic patients were reported. REVIEW METHODS: Dual-blind data extraction was conducted. Primary outcomes included identification rate and test performance based on completion neck dissection or nodal recurrence. RESULTS: A total of 3442 patients from 32 studies published between 1990 and 2009 were reviewed. Seventy-eight percent of studies were retrospective and 22% were prospective. Trials varied from 9 to 755 patients (median 55). Mean Breslow depth was 2.53 mm. Median sentinel node biopsy identification rate was 95.2%. More than 1 basin was reported in 33.1% of patients. A median of 2.56 sentinel nodes per patient were excised. Sentinel node biopsy was positive in 15% of patients. Subsequent completion neck dissection was performed in almost all of these patients and revealed additional positive nodes in 13.67%. Median follow-up was 31 months. Across all studies, predictive value positive for nodal recurrence was 13.1% and posttest probability negative was 5%. Median false-negative rate for nodal recurrence was 20.4%. CONCLUSION: Sentinel node biopsy of head and neck melanoma is associated with an increased false-negative rate compared with studies of non-head and neck lesions. Positive sentinel node status is highly predictive of recurrence.

Authors
de Rosa, N; Lyman, GH; Silbermins, D; Valsecchi, ME; Pruitt, SK; Tyler, DM; Lee, WT
MLA Citation
de Rosa, N, Lyman, GH, Silbermins, D, Valsecchi, ME, Pruitt, SK, Tyler, DM, and Lee, WT. "Sentinel node biopsy for head and neck melanoma: a systematic review." Otolaryngol Head Neck Surg 145.3 (September 2011): 375-382. (Review)
PMID
21540313
Source
pubmed
Published In
Otolaryngology
Volume
145
Issue
3
Publish Date
2011
Start Page
375
End Page
382
DOI
10.1177/0194599811408554

Tongue entrapment in metal drinking bottle.

Authors
Whited, CW; Rocke, DJ; Lee, WT
MLA Citation
Whited, CW, Rocke, DJ, and Lee, WT. "Tongue entrapment in metal drinking bottle." Archives of otolaryngology--head & neck surgery 137.6 (June 2011): 625-627.
PMID
21690517
Source
epmc
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
137
Issue
6
Publish Date
2011
Start Page
625
End Page
627
DOI
10.1001/archoto.2011.94

Detection of squamous cell carcinoma and corresponding biomarkers using optical spectroscopy.

OBJECTIVES: Investigate the use of optical reflectance spectroscopy to differentiate malignant and nonmalignant tissues in head and neck lesions and characterize corresponding oxygen tissue biomarkers that are associated with pathologic diagnosis. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary Veterans Administration Medical Center. SUBJECTS AND METHODS: All patients undergoing panendoscopy with biopsy for suspected head and neck cancer were eligible. Prior to taking tissue samples, the optical probe was placed at 3 locations to collect diffuse reflectance data. These locations were labeled "tumor," "immediately adjacent," and "distant normal tissue." Biopsies were taken of each of these respective sites. The diffuse reflectance spectra were analyzed, and biomarker-specific absorption data were extracted using an inverse Monte Carlo algorithm for malignant and nonmalignant tissues. Histopathological analysis was performed and used as the gold standard to analyze the optical biomarker data. RESULTS: Twenty-one patients with mucosal squamous cell carcinoma of the head and neck were identified and selected to participate in the study. Statistically significant differences in oxygen saturation (P = .001) and oxygenated hemoglobin (P = .019) were identified between malignant and nonmalignant tissues. CONCLUSION: This study established proof of principle that optical spectroscopy can be used in the head and neck areas to detect malignant tissue. Furthermore, tissue biomarkers were correlated with a diagnosis of malignancy.

Authors
Beumer, HW; Vishwanath, K; Puscas, L; Afshari, HR; Ramanujam, N; Lee, WT
MLA Citation
Beumer, HW, Vishwanath, K, Puscas, L, Afshari, HR, Ramanujam, N, and Lee, WT. "Detection of squamous cell carcinoma and corresponding biomarkers using optical spectroscopy." Otolaryngol Head Neck Surg 144.3 (March 2011): 390-394.
PMID
21493201
Source
pubmed
Published In
Otolaryngology
Volume
144
Issue
3
Publish Date
2011
Start Page
390
End Page
394
DOI
10.1177/0194599810394290

Comparison of applicant criteria and program expectations for choosing residency programs in the otolaryngology match.

OBJECTIVE: To evaluate criteria used by residency applicants in ranking otolaryngology residency programs and to compare applicant criteria with program expectations of ranking otolaryngology residency programs. STUDY DESIGN: Cross-sectional survey. SETTING: 2009 and 2010 match cycles. SUBJECTS AND METHODS: Program applicants and otolaryngology program directors. MAIN OUTCOME MEASURES: Applicants were asked to rank the importance of 10 criteria in choosing a residency program (1 = criterion was of the utmost importance and 20 = not important at all). Program directors were asked to express expectations of how applicants should rank programs using those same criteria. The Mann-Whitney U test was used to analyze responses between groups. RESULTS: Comprehensiveness of subspecialties and resident satisfaction were the most important criteria for both groups; salary, call schedule, and likelihood to rank the resident highly were least valued. Four criteria were significantly different between groups. Applicants significantly valued location (4.36 vs 8.9, P < .0001) and call schedule (9.85 vs 12.73, P = .002) more than program directors did. Program directors valued didactic schedule (6.1 vs 9.18, P < .0001) and comprehensiveness of subspecialties (2.53 vs 3.02, P = .007) more than applicants did. Forty-one of 105 (39%) program directors completed the survey. CONCLUSION: While applicants and program directors agree on the most and least important criteria for ranking residency programs, there are several significant differences in these criteria. This study provides insight on ranking criteria that may improve the resident match process and subsequent training experience. However, the ability to generalize the results is limited by the low response rate.

Authors
Sharp, S; Puscas, L; Schwab, B; Lee, WT
MLA Citation
Sharp, S, Puscas, L, Schwab, B, and Lee, WT. "Comparison of applicant criteria and program expectations for choosing residency programs in the otolaryngology match." Otolaryngol Head Neck Surg 144.2 (February 2011): 174-179.
PMID
21493411
Source
pubmed
Published In
Otolaryngology
Volume
144
Issue
2
Publish Date
2011
Start Page
174
End Page
179
DOI
10.1177/0194599810391722

Dendritic cell-tumor cell fusion vaccines.

The use of cell fusion has been applied to the development of immunotherapy cancer vaccines. This has typically involved the fusion of dendritic cells and tumor cells. The resultant hybrid uses the specialized antigen presentation properties supplied by the dendritic cell fusion partner to present tumor antigens, both known and yet undefined, to the immune system. This chapter critically examines the scientific foundation of this approach mainly focusing on studies over the last decade. This will include basic principles of tumor fusion vaccines, summary of pre-clinical and clinical data, concluding with remaining challenges and directions.

Authors
Lee, WT
MLA Citation
Lee, WT. "Dendritic cell-tumor cell fusion vaccines." 2011. 177-186.
PMID
21432020
Source
pubmed
Volume
713
Publish Date
2011
Start Page
177
End Page
186
DOI
10.1007/978-94-007-0763-4_11

Systematic review of 99mTc human serum albumin and 99mTc sulfur colloid studies of sentinel lymph node biopsy of cutaneous melanoma of the head and neck

Introduction: Sentinel lymph node biopsy (SLNB) of head and neck melanoma presents a technical challenge due to the multiplicity of basins and variable lymph node drainage. Radiotracer size and particulate nature determines speed of lymphatic drainage into nodal basins, as well as nodal uptake and retention. Human serum albumin (HSA) and sulfur colloid (SC) are commonly used radiotracers with divergent chemical characteristics. Results: Eligibility criteria were met for 26 studies (n=2257), 7 prospective and 19 retrospective. Of these, 8 studies (n=422) used HSA and 18 studies (n=1835) used SC. The identification rates of sentinel nodes for HSA and SC were 91.7% and 97.5%, respectively. The false negative rate was 12.5% and 12.2% in HSA and SC, respectively. The median post-test probability negative for nodal recurrence and for total recurrence was 3.9% and 12.6%, and 2.1% and 11.6%, respectively, for HSA and SC. Conclusion Although HSA and SC have different intrinsic chemical properties, both are efficacious for use in SLNB of cutaneous melanoma of the head and neck.

Authors
Rosa, ND; Lyman, GH; Silbermins, D; Valsecchi, ME; Wong, S; Pruitt, SK; Lee, WT
MLA Citation
Rosa, ND, Lyman, GH, Silbermins, D, Valsecchi, ME, Wong, S, Pruitt, SK, and Lee, WT. "Systematic review of 99mTc human serum albumin and 99mTc sulfur colloid studies of sentinel lymph node biopsy of cutaneous melanoma of the head and neck." 2011.
Source
scival
Published In
The Laryngoscope
Volume
121
Issue
SUPPL. 4
Publish Date
2011
Start Page
s106
DOI
10.1002/lary.21983

Immunotherapy using allogeneic squamous cell tumor-dendritic cell fusion hybrids.

BACKGROUND: Tumor-associated antigens (TAAs) are known to be immunotherapy targets; thus tumor-sharing TAA may be used as a fusion hybrid partner to confer protection against subsequent tumor challenge. METHODS: The squamous cell carcinomas (SCCs), SCCVII and B4B8, were used in C3H/HEN mice: SCCVII (H-2(k)) is syngeneic, B4B8 (H-2(d)) is allogeneic. Experiments using tumor alone included hyperimmunization schedule, subdermal and intranodal routes. Mice were challenged 2 weeks later. Fusion hybrids were created from both SCC tumor cell lines and syngeneic dendritic cells (DCs). These were delivered intranodally for immunization, and mice were challenged with tumor 2 weeks later. RESULTS: Only syngeneic tumor given subdermally was able to protect after tumor challenge 2 weeks later. Hyperimmunization schedule did not alter these findings. However, fusion hybrid immunization from both allogeneic and syngeneic SCCs conferred protection after tumor challenge. CONCLUSIONS: Allogeneic tumor-DC fusion hybrids targeting TAA can protect against subsequent tumor challenge.

Authors
Lee, WT; Tan, C; Koski, G; Shu, S; Cohen, P
MLA Citation
Lee, WT, Tan, C, Koski, G, Shu, S, and Cohen, P. "Immunotherapy using allogeneic squamous cell tumor-dendritic cell fusion hybrids." Head Neck 32.9 (September 2010): 1209-1216.
PMID
20054852
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
32
Issue
9
Publish Date
2010
Start Page
1209
End Page
1216
DOI
10.1002/hed.21323

Toll-like receptor agonists as third signals for dendritic cell-tumor fusion vaccines.

BACKGROUND: The aim of the present study was to evaluate the therapeutic efficacy of dendritic cell (DC)-tumor fusion hybrids with Toll-like receptor (TLR) agonists. METHODS: DC-tumor fusion hybrids were generated by electrofusion and injected into the inguinal lymph nodes of C57BL/6 mice with 3-day established pulmonary metastases. Paired TLR agonists polyinosine:polycytadilic acid [poly(I:C)] and cytosine-phosphate-guanine (CpG) were then injected intraperitoneally. Enzyme-linked immunosorbent assay (ELISA) was used to evaluate interleukin (IL)-12 production from the DC-tumor fusion hybrids in vitro. RESULTS: Fusion + TLR agonists (60 metastases) had significantly fewer metastases than did the untreated control (262 metastases, p = .0001) and fusion alone (150 metastases, p = .02). ELISA showed that the DC-tumor fusion hybrids yielded 90 pg of IL-12 after TLR stimulation compared with 1610 pg from dendritic cells alone. CONCLUSIONS: CpG and poly(I:C) administered as a third signal with fusion hybrids as described significantly reduce melanoma metastasis compared with fusion hybrids alone. Fusion hybrids do not appear to be a significant source for IL-12 secretion.

Authors
Cho, EI; Tan, C; Koski, GK; Cohen, PA; Shu, S; Lee, WT
MLA Citation
Cho, EI, Tan, C, Koski, GK, Cohen, PA, Shu, S, and Lee, WT. "Toll-like receptor agonists as third signals for dendritic cell-tumor fusion vaccines." Head Neck 32.6 (June 2010): 700-707.
PMID
19908319
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
32
Issue
6
Publish Date
2010
Start Page
700
End Page
707
DOI
10.1002/hed.21241

Impact of preepiglottic space tumor involvement on concurrent chemoradiation therapy.

PURPOSE: The aim of the study was to determine the prognostic impact of preepiglottic space (PES) involvement on local failure after concurrent chemoradiation therapy for squamous cell carcinoma. MATERIALS AND METHODS: Retrospective chart review of patients who underwent concurrent chemoradiation therapy for T3 or T4 laryngeal, T4 hypopharyngeal, and T3 or T4 oropharyngeal squamous cell carcinoma were eligible for inclusion. Patients were then stratified by the presence or absence of PES tumor involvement. A multivariate analysis was performed on the presence of recurrence using the following pretreatment variables: PES involvement, tumor extent, pathologic cell differentiation, lymph node involvement, age, and sex. RESULTS: A total of 102 patients were included in the study. Twenty-seven (28%) patients had documented PES involvement. Mean follow-up for all patients was 46 months. Involvement of the PES was not significantly associated with local tumor persistence or recurrence (P = .69). No other variables significantly impacted tumor recurrence. CONCLUSION: Preepiglottic space involvement does not negatively impact local tumor control after concurrent chemoradiation therapy.

Authors
Lee, WT; Rizzi, M; Scharpf, J; Lorenz, RR; Saxton, JP; Adelstein, DJ; Esclamado, RM
MLA Citation
Lee, WT, Rizzi, M, Scharpf, J, Lorenz, RR, Saxton, JP, Adelstein, DJ, and Esclamado, RM. "Impact of preepiglottic space tumor involvement on concurrent chemoradiation therapy." Am J Otolaryngol 31.3 (May 2010): 185-188.
PMID
20015743
Source
pubmed
Published In
American Journal of Otolaryngology
Volume
31
Issue
3
Publish Date
2010
Start Page
185
End Page
188
DOI
10.1016/j.amjoto.2009.02.001

HPV status-independent association of alcohol and tobacco exposure or prior radiation therapy with promoter methylation of FUSSEL18, EBF3, IRX1, and SEPT9, but not SLC5A8, in head and neck squamous cell carcinomas.

Head and neck squamous cell carcinoma (HNSCC) is an aggressive malignancy with more than half a million people being diagnosed with the disease annually. Within the last 2 decades, the human papillomavirus (HPV) has been found to be associated with this malignancy. More recently, HPV-infected HNSCC has been found to exhibit higher levels of global DNA methylation. In a recent study, we identified five tumor suppressive genes (IRX1, EBF3, SLC5A8, SEPT9, and FUSSEL18) as frequently methylated in HNSCC biopsies using a global methylation analysis via restriction landmark genomic scanning. In this study, we verify these genes as valid methylation markers in two separate sets of HNSCC specimens. By using the available clinical information linked to the patient specimens, we found a strong association between promoter methylation of FUSSEL18, IRX1, and EBF3 and prior radiation therapy (P < 0.0001) irrespective of HPV status. Also, promoter methylation of FUSSEL18 and SEPTIN9 was found to correlate significantly with exposure to alcohol and tobacco (P = 0.021). Importantly, in this study, we preliminarily show a trend between HPV16 positivity and specific target gene hypermethylation of IRX1, EBF3, SLC5A8, and SEPT9. If replicated in a larger study, the HPV status may be a patient selection biomarker when determining the most efficacious treatment modality for these different subsets of patients (e.g., inclusion or exclusion of epigenetic therapies). Equally notable and independent of HPV status, hypermethylation of the promoters of a subset of these genes in recurrences especially in the setting of prior radiation or in the setting of alcohol and tobacco use might help guide adjunctive inclusion or exclusion or epigenetic therapy.

Authors
Bennett, KL; Lee, W; Lamarre, E; Zhang, X; Seth, R; Scharpf, J; Hunt, J; Eng, C
MLA Citation
Bennett, KL, Lee, W, Lamarre, E, Zhang, X, Seth, R, Scharpf, J, Hunt, J, and Eng, C. "HPV status-independent association of alcohol and tobacco exposure or prior radiation therapy with promoter methylation of FUSSEL18, EBF3, IRX1, and SEPT9, but not SLC5A8, in head and neck squamous cell carcinomas." Genes Chromosomes Cancer 49.4 (April 2010): 319-326.
PMID
20029986
Source
pubmed
Published In
Genes, Chromosomes and Cancer
Volume
49
Issue
4
Publish Date
2010
Start Page
319
End Page
326
DOI
10.1002/gcc.20742

Extent of neck dissection required after concurrent chemoradiation for stage IV head and neck squamous cell carcinoma.

BACKGROUND: The management of initially bulky nodal disease after primary nonsurgical treatment for stage IV head and neck squamous cell carcinoma (HNSCC) continues to be a subject of debate. METHODS: A retrospective chart review of neck management in patients after chemoradiation was performed. RESULTS: Of the initially positive necks analyzed, 210/329 (65%) had a complete clinical response to treatment and 161 necks underwent neck surgery. Patients were pathologically positive 13.8% and 39.6% of the time after clinical complete or partial response, respectively. Regional recurrence was more frequent in necks with partial clinical (p = .04) or pathologic responses (p < .01) and with primary site recurrences (p < .01). CONCLUSIONS: It is still safest at our institution to perform selective neck dissection on patients with > or = N2 neck disease when initially observed to prevent unsalvageable regional recurrence until more accurate interval assessment tools are confirmed.

Authors
Cannady, SB; Lee, WT; Scharpf, J; Lorenz, RR; Wood, BG; Strome, M; Lavertu, P; Esclamado, RM; Saxton, JP; Adelstein, DJ
MLA Citation
Cannady, SB, Lee, WT, Scharpf, J, Lorenz, RR, Wood, BG, Strome, M, Lavertu, P, Esclamado, RM, Saxton, JP, and Adelstein, DJ. "Extent of neck dissection required after concurrent chemoradiation for stage IV head and neck squamous cell carcinoma." Head Neck 32.3 (March 2010): 348-356.
PMID
19672875
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
32
Issue
3
Publish Date
2010
Start Page
348
End Page
356
DOI
10.1002/hed.21189

Multiagent concurrent chemoradiotherapy (MACCRT) and gefitinib in locoregionally advanced head and neck squamous cell cancer (HNSCC)

Authors
Rodriguez, CP; Adelstein, DJ; Saxton, JP; Rybicki, LA; Lorenz, RR; Wood, BG; Scharpf, J; Lee, WT; Ives, DI
MLA Citation
Rodriguez, CP, Adelstein, DJ, Saxton, JP, Rybicki, LA, Lorenz, RR, Wood, BG, Scharpf, J, Lee, WT, and Ives, DI. "Multiagent concurrent chemoradiotherapy (MACCRT) and gefitinib in locoregionally advanced head and neck squamous cell cancer (HNSCC)." May 20, 2009.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
27
Issue
15
Publish Date
2009

Multiagent concurrent chemoradiotherapy (MACCRT) and gefitinib in locoregionally advanced head and neck squamous cell cancer (HNSCC).

6037 Background: In patients (pts) with stage III-IV HNSCC, MACCRT has led to excellent locoregional control. Distant metastases (DM) are now the most common cause of treatment failure. This phase II study tested whether the oral EGFR inhibitor gefitinib (G) added to our Cleveland Clinic MACCRT regimen would decrease DM and improve survival.Between 4/03 and 9/07, 60 previously untreated pts with stage III-IV (M0) HNSCC, and a performance status of <1 were enrolled on this study. Pts received hyperfractionated radiation (72-74.4 Gy at 120cGy bid) and concurrent chemotherapy with cisplatin (20 mg/m2/day) and fluorouracil (1,000 mg/m2/day), both given as 96-hour continuous IV infusions during weeks 1 and 4. G 250 mg daily was begun on day 1 of the radiation and continued for 2 years. The results were retrospectively compared to our previous study of 44 pts treated with the same MACCRT regimen without G between 1/96 and 9/00.The study population included a preponderance of Caucasian (97%) males (88%) with stage IV (80%) oropharynx tumors (68%), and with a median age of 58 (range 24-75) years. Patient and tumor characteristics were similar to the non-G treated historical cohort. When comparing the G vs. non-G treated pts, acute toxicities including transient renal dysfunction (28% v. 5% p = 0.002) and all-cause re-hospitalization (83% v. 64%, p = 0.022) were worse. Myelosuppression was similar. G-specific toxicity included > grade 1 rash in 60% and diarrhea in 35%. There were 5 deaths during treatment in the G group v. one in the non-G group (p = 0.19). Only a projected 44% of pts will complete the 2-year course of G. With a median follow-up in this trial of 37 (range 13-64) months, 3-year Kaplan-Meier outcome estimates do not differ between the study and the historical cohorts. Local control without surgery is 80% v. 88% (p = 0.21), DM control is 86% v. 76% (p = 0.19), freedom from recurrence is 72% v. 71% (p = 0.79), and overall survival is 67% v. 68% (p = 0.63) respectively.The addition of G to our MACCRT regimen was difficult for pts to complete. It did not improve any measured outcome and was associated with increased toxicity when compared to historical controls. [Table: see text].

Authors
Rodriguez, CP; Adelstein, DJ; Saxton, JP; Rybicki, LA; Lorenz, RR; Wood, BG; Scharpf, J; Lee, WT; Ives, DI
MLA Citation
Rodriguez, CP, Adelstein, DJ, Saxton, JP, Rybicki, LA, Lorenz, RR, Wood, BG, Scharpf, J, Lee, WT, and Ives, DI. "Multiagent concurrent chemoradiotherapy (MACCRT) and gefitinib in locoregionally advanced head and neck squamous cell cancer (HNSCC)." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27.15_suppl (May 2009): 6037-.
PMID
27961912
Source
epmc
Published In
Journal of Clinical Oncology
Volume
27
Issue
15_suppl
Publish Date
2009
Start Page
6037

Laryngeal transplantation in the setting of cancer: a rat model.

OBJECTIVE: Traditional immunosuppressive regimens make laryngeal transplantation in cancer patients prohibitive because of the increased risk of recurrence. Everolimus, a recently developed immunosuppressant, has demonstrated significant antitumor properties. The purpose of this study was to examine the effects of everolimus alone and in combination with other immunosuppressants on tumor growth in a combined laryngeal transplantation and tumor model. STUDY DESIGN: Animal, prospective, randomized, controlled, and blinded. METHODS: One million squamous cell carcinoma cells (SCC-158) were injected intravenously into a total of 40 rats 1 day before laryngeal transplantation. Rats were divided into four groups differing by immunosuppressive regimens. Lung surface metastases were counted 21 days after inoculation, and numerical transplantation rejection scores were recorded. A separate experiment for comparison was performed with no transplant on 24 rats, but with the same immunosuppressive treatment groups. RESULTS: The median number of lung surface metastases were: a) control (i.e., no immunosuppression): 85; b) everolimus 1.0 mg/kg: 25; c) tacrolimus 1.2 mg/kg: 1650; d) everolimus 1.0 mg/kg + tacrolimus 0.05 mg/kg: 1300. Rats receiving everolimus alone showed a statistically significant decrease in pulmonary surface metastases compared with the other groups. Transplanted rats had no difference in their outcomes when compared with non-transplanted rats. CONCLUSION: Everolimus significantly decreases SCC-158 growth in our combined transplantation and tumor model compared with controls and other immunosuppressants.

Authors
Shipchandler, TZ; Lorenz, RR; Lee, WT; Teker, AM; Dan, O; Strome, M
MLA Citation
Shipchandler, TZ, Lorenz, RR, Lee, WT, Teker, AM, Dan, O, and Strome, M. "Laryngeal transplantation in the setting of cancer: a rat model." Laryngoscope 118.12 (December 2008): 2166-2171.
PMID
18948827
Source
pubmed
Published In
The Laryngoscope
Volume
118
Issue
12
Publish Date
2008
Start Page
2166
End Page
2171
DOI
10.1097/MLG.0b013e3181855108

Use of in situ hybridization to detect human papillomavirus in head and neck squamous cell carcinoma patients without a history of alcohol or tobacco use.

CONTEXT: Head and neck squamous cell carcinoma is commonly associated with tobacco and alcohol use. There are, however, a group of patients without a significant history of tobacco or alcohol use, and the etiology of these tumors is incompletely understood. OBJECTIVE: To examine tumors in this subpopulation for association with human papillomavirus (HPV) using newly available in situ hybridization probes. DESIGN: Between October 2004 and October 2005, 22 patients who did not use alcohol or tobacco were included. Formalin-fixed, paraffin-embedded tissue sections were used to perform in situ hybridization using newly available probe sets (Ventana Medical Systems, Tucson, Ariz). The slides were examined for the presence of integrated HPV using light microscopy. Positive and negative xenograft controls were run with the assay. Results.-The mean age of the patients was 64 years. There were 14 men and 8 women. The most common anatomic sites included tongue (n = 8), tonsil (n = 7), and larynx (n = 7). All cases and controls were successfully stained. Only 2 cases were positive for high-risk HPV, and both demonstrated an integrated pattern. Both cases were tumors of the tonsil. No cases were positive for low-risk HPV. CONCLUSIONS: These results demonstrate that the new probe sets for HPV can be used very efficiently in clinical pathology material of head and neck squamous cell carcinoma. Our data show that high-risk HPV is an uncommon finding in head and neck squamous cell carcinoma from patients who do not have a history of tobacco or alcohol use; low-risk HPV was not seen in any case.

Authors
Lee, WT; Tubbs, RR; Teker, AM; Scharpf, J; Strome, M; Wood, B; Lorenz, RR; Hunt, J
MLA Citation
Lee, WT, Tubbs, RR, Teker, AM, Scharpf, J, Strome, M, Wood, B, Lorenz, RR, and Hunt, J. "Use of in situ hybridization to detect human papillomavirus in head and neck squamous cell carcinoma patients without a history of alcohol or tobacco use." Arch Pathol Lab Med 132.10 (October 2008): 1653-1656.
PMID
18834225
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
132
Issue
10
Publish Date
2008
Start Page
1653
End Page
1656
DOI
10.1043/1543-2165(2008)132[1653:UOISHT]2.0.CO;2

Paired Toll-like receptor agonists enhance vaccine therapy through induction of interleukin-12.

Minimal requirements for generating effective immunity include the delivery of antigenic (signal 1) and costimulatory (signal 2) signals to T lymphocytes. Recently, a class of third signals, often delivered by antigen-presenting dendritic cells, has been shown to greatly enhance immune responses, especially against tumors. Among signal 3 factors, interleukin (IL)-12 is particularly effective and can be conditionally induced by agonists of Toll-like transmembrane receptors (TLR). In this study, we assessed the therapeutic effect of adjuvant TLR agonist administration upon the capacity of dendritic cell (DC)-tumor electrofusion hybrids to eradicate established MCA205 sarcomas in syngeneic mice. Paired, but not solitary combinations of polyinosine:polycytadilic acid (P[I:C]; TLR3 agonist) and CpG DNA (ODN1826l; TLR9 agonist) stimulated IL-12 secretion from DCs in vitro and synergized with vaccination to achieve potent tumor rejection. Therapeutic effects, however, required coadministration of paired TLR agonists and DC-tumor fusion hybrids. The administration of TLR agonists alone or with fusion vaccine induced transient splenomegaly but without apparent toxicity. The therapeutic effects of this immunization regimen were significantly abrogated through the neutralization of IL-12p70, indicating that production of this third signal was essential to the observed tumor regression. These results show the profound functional consequences of TLR cooperativity and further highlight the critical role of IL-12 in antitumor immunity.

Authors
Zheng, R; Cohen, PA; Paustian, CA; Johnson, TD; Lee, WT; Shu, S; Koski, GK
MLA Citation
Zheng, R, Cohen, PA, Paustian, CA, Johnson, TD, Lee, WT, Shu, S, and Koski, GK. "Paired Toll-like receptor agonists enhance vaccine therapy through induction of interleukin-12." Cancer Res 68.11 (June 1, 2008): 4045-4049.
PMID
18519662
Source
pubmed
Published In
Cancer Research
Volume
68
Issue
11
Publish Date
2008
Start Page
4045
End Page
4049
DOI
10.1158/0008-5472.CAN-07-6669

Immunotherapy of established murine squamous cell carcinoma using fused dendritic-tumor cell hybrids.

OBJECTIVE: To investigate the therapeutic efficacy of fused dendritic-tumor cell hybrids against murine squamous cell carcinoma (SCC). DESIGN: Squamous cell carcinoma VII is a poorly immunogenic murine SCC tumor in C3H/HEN (H-2(K)) mice. Subdermal tumors were established by inoculation in the mid abdomen of mice. Tumor diameters were measured with a Vernier caliper and used as an indication of treatment efficacy. Survival studies were performed on mice with 3-day pulmonary metastasis or subdermal tumors. Dendritic cells were generated from bone marrow and cultured for 8 days. Dendritic cells were harvested and mixed with cultured tumor cells in a 1:1 ratio. Cell fusion was achieved by exposing the cell mixture to an alternate electrical current to bring cells into alignment and close together, followed by a short direct electrical current pulse. SUBJECTS: Female C3H/HEN mice aged 8 to 12 weeks. INTERVENTIONS: Mice with 3-day established SCCVII tumors were vaccinated by inguinal intranodal injection of fusion cells (0.3 x 10(6) per side). To support the development of antitumor immunity, mice were given adjuvant injections intraperitoneally. Anti-OX40R monoclonal antibodies or interleukin 12 were used. Treatment groups included no treatment, anti-OX40R monoclonal antibodies or adjuvant IL-12 alone, fusion cells alone, and fusion cells with adjuvant treatment. MAIN OUTCOME MEASURES: Tumor size and overall survival. RESULTS: Mice treated with adjuvant treatment or fusion cells alone did not show a statistical difference in tumor growth when compared with controls. In contrast, fusion cells with adjuvant treatment demonstrated a significant decrease in tumor size when compared with nontreated mice (P < .001). Treatment with fusion cells also resulted in increased survival in the pulmonary metastasis and subdermal tumor models. CONCLUSION: Immunotherapy with fused dendritic-tumor cell hybrids can significantly affect 3-day established sSCC VII tumor growth.

Authors
Lee, WT; Tamai, H; Cohen, P; Teker, AM; Shu, S
MLA Citation
Lee, WT, Tamai, H, Cohen, P, Teker, AM, and Shu, S. "Immunotherapy of established murine squamous cell carcinoma using fused dendritic-tumor cell hybrids." Arch Otolaryngol Head Neck Surg 134.6 (June 2008): 608-613.
PMID
18559727
Source
pubmed
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
134
Issue
6
Publish Date
2008
Start Page
608
End Page
613
DOI
10.1001/archotol.134.6.608

Lateral lamella of the cribriform plate: software-enabled computed tomographic analysis and its clinical relevance in skull base surgery.

OBJECTIVE: To describe a quantitative analysis of the lateral lamella of the cribriform plate (LLCP) height in computed tomographic (CT) images. The LLCP is the thinnest anatomic structure in the skull base. DESIGN: Software-enabled CT scan measurements. SETTING: Academic center. RESULTS: The CT scans from 50 patients were analyzed. The median height of the LLCP in 100 sides was 2.4 mm. The LLCP height was 0 to 3.9 mm in 83 sides, 4.0 to 7.0 mm in 15 sides, and greater than 7.0 mm in 2 sides. When analyzing differences among sides, the LLCP height was greater on the right side in 28 patients and greater on the left side in 22. The differences between sides was 0 to 1.9 mm in 39 patients, 2.0 to 3.9 mm in 9 patients, and greater than 4.0 mm in 2 patients. CONCLUSIONS: Computer-aided CT scan analysis allows for a quantitative analysis of the paranasal sinus skull base anatomy. Knowledge of these dimensions is invaluable during surgical planning and navigation. Asymmetry of the relative ethmoid roof position is common. Thus, the rhinologic surgeon must exercise caution to prevent unintentional skull base injury and cerebrospinal fluid leak.

Authors
Solares, CA; Lee, WT; Batra, PS; Citardi, MJ
MLA Citation
Solares, CA, Lee, WT, Batra, PS, and Citardi, MJ. "Lateral lamella of the cribriform plate: software-enabled computed tomographic analysis and its clinical relevance in skull base surgery." Arch Otolaryngol Head Neck Surg 134.3 (March 2008): 285-289.
PMID
18347254
Source
pubmed
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
134
Issue
3
Publish Date
2008
Start Page
285
End Page
289
DOI
10.1001/archotol.134.3.285

Ansa cervicalis-to-recurrent laryngeal nerve anastomosis for unilateral vocal fold paralysis: experience of a single institution.

OBJECTIVES: One treatment option for unilateral vocal fold paralysis (UVFP) is ansa cervicalis-to-recurrent laryngeal nerve (ansa-RLN) anastomosis to provide reinnervation to the affected vocal fold. The advantages of this treatment approach are that it 1) provides vocal fold tone, bulk, and tension, 2) is technically simple, and 3) does not preclude other medialization procedures. We present all patients who have undergone ansa-RLN anastomosis for UVFP at our institution. METHODS: An Institutional Review Board-approved retrospective chart review was performed to include all patients who had undergone an ansa-RLN anastomosis procedure for UVFP at our institution. Data from clinical and endoscopic laryngoscopy with stroboscopy were recorded. Statistical analysis was performed on visual and perceptual vocal data. RESULTS: A total of 46 patients were included in the study. Stroboscopic analysis and perceptual vocal evaluation was performed in a blinded fashion on the 21 patients who had preoperative and postoperative stroboscopy. Severity, roughness, breathiness, and strain all improved significantly over time. Glottic closure, vocal fold edge, and supraglottic effort all significantly improved after operation. Of the 38 patients with at least 3 months of follow-up, all except 1 demonstrated evidence of reinnervation. CONCLUSIONS: This technique for treating UVFP results in significant improvements in patients' voice and on visual examination.

Authors
Lorenz, RR; Esclamado, RM; Teker, AM; Strome, M; Scharpf, J; Hicks, D; Milstein, C; Lee, WT
MLA Citation
Lorenz, RR, Esclamado, RM, Teker, AM, Strome, M, Scharpf, J, Hicks, D, Milstein, C, and Lee, WT. "Ansa cervicalis-to-recurrent laryngeal nerve anastomosis for unilateral vocal fold paralysis: experience of a single institution." Ann Otol Rhinol Laryngol 117.1 (January 2008): 40-45.
PMID
18254370
Source
pubmed
Published In
The Annals of otology, rhinology, and laryngology
Volume
117
Issue
1
Publish Date
2008
Start Page
40
End Page
45
DOI
10.1177/000348940811700109

Regional spread of cutaneous squamous cell carcinoma of the face via facial vein tumor thrombus: a case report

Cutaneous squamous cell carcinoma of the head and neck most often spreads via direct extension or through lymphatics to regional lymph nodes. This is a unique case of a cutaneous squamous cell carcinoma of the nasal dorsum with direct vascular invasion of the facial vein. This was initially incorrectly identified as a regional level Ib lymph node metastases, and the intervening venous structures were neither extirpated during an initial surgery nor recognized during subsequent radiation therapy. The patient then presented with a sizable recurrence in the right suborbital subcutaneous tissue region extending into the neck and internal jugular vein. During further resection, direct tumor invasion into the facial vein was pathologically confirmed. This unusual involvement is presented as the first documented report of regional spread via tumor thrombosis within the facial vein as demonstrated in the facial vein with a tumor thrombus, as demonstrated by computed tomography and microscopic findings.

Authors
Teker, AM; Lorenz, RR; Lee, WT; Hoschar, A
MLA Citation
Teker, AM, Lorenz, RR, Lee, WT, and Hoschar, A. "Regional spread of cutaneous squamous cell carcinoma of the face via facial vein tumor thrombus: a case report." American Journal of Otolaryngology - Head and Neck Medicine and Surgery 29.6 (2008): 423-425.
PMID
19144305
Source
scival
Published In
American Journal of Otolaryngology
Volume
29
Issue
6
Publish Date
2008
Start Page
423
End Page
425
DOI
10.1016/j.amjoto.2007.10.007

Radiology quiz case 1. Tracheocele.

Authors
Teker, AM; Lorenz, RR; Lee, WT; Murthy, SC
MLA Citation
Teker, AM, Lorenz, RR, Lee, WT, and Murthy, SC. "Radiology quiz case 1. Tracheocele." Arch Otolaryngol Head Neck Surg 133.9 (September 2007): 940-943.
PMID
17875864
Source
pubmed
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
133
Issue
9
Publish Date
2007
Start Page
940
End Page
943
DOI
10.1001/archotol.133.9.940

Obstructing pyogenic granuloma as a result of blunt laryngeal trauma.

Authors
Garrett, MM; Lee, WT
MLA Citation
Garrett, MM, and Lee, WT. "Obstructing pyogenic granuloma as a result of blunt laryngeal trauma." Otolaryngol Head Neck Surg 136.3 (March 2007): 489-490.
PMID
17321885
Source
pubmed
Published In
Otolaryngology - Head and Neck Surgery
Volume
136
Issue
3
Publish Date
2007
Start Page
489
End Page
490
DOI
10.1016/j.otohns.2006.10.005

Results of ansa to recurrent laryngeal nerve reinnervation.

OBJECTIVE: We sought to describe the results of ansa cervicalis to recurrent laryngeal nerve (ansa-RLN) reinnervation for unilateral vocal fold paralysis. STUDY DESIGN: A chart review was performed on patients undergoing ansa-RLN reinnervation for unilateral vocal cord paralysis at a tertiary care center. Patient perceptions of preoperative and postoperative voice quality was surveyed. Acoustic and visual parameters were assessed from videostroboscopy. RESULTS: From a total of 25 study patients, 15 patients underwent both preoperative and postoperativ video stroboscopies. In stroboscopies within 6 months, the average improvement in overall severity, roughness, and breathiness was 69, 79, and 100 percent, respectively. In stroboscopies after 6 months, the average improvement in overall severity, roughness, and breathiness was 63, 66, and 100 percent, respectively. Postoperatively, all patients had reinnervation of the vocal fold. CONCLUSIONS: Voice outcomes were improved in patients with preoperative and postoperative stroboscopies. SIGNIFICANCE: Ansa-RLN reinnervation should be considered as a treatment for unilateral vocal fold paralysis.

Authors
Lee, WT; Milstein, C; Hicks, D; Akst, LM; Esclamado, RM
MLA Citation
Lee, WT, Milstein, C, Hicks, D, Akst, LM, and Esclamado, RM. "Results of ansa to recurrent laryngeal nerve reinnervation." Otolaryngol Head Neck Surg 136.3 (March 2007): 450-454.
PMID
17321876
Source
pubmed
Published In
Otolaryngology - Head and Neck Surgery
Volume
136
Issue
3
Publish Date
2007
Start Page
450
End Page
454
DOI
10.1016/j.otohns.2006.11.040

Immunogenicity of dendritic-tumor fusion hybrids and their utility in cancer immunotherapy.

Cancer immunotherapy using fusion hybrid cells generated from dendritic cells (DCs) and tumor cells may be more effective than other DC-based vaccines. DC-tumor fusion potentially confers not only the DCs' antigen-presenting functionality but also a continuing source of endogenous tumor antigens for major-histocompatibility-complex-restricted T-cell sensitization. In animal models, many investigators demonstrated that vaccination with fusion hybrids was protective against tumor challenge and therapeutic, resulting in the regression of established tumors. In clinical trials for patients with a variety of metastatic diseases, fusion hybrid vaccines were well tolerated, but the overall objective response rate was only 10.9%. Careful scrutiny of a large number of publications revealed that, in most cases, no definitive evidence of heterokaryonic fusion cell formation was found. Further corroboration of this conclusion comes from reports that fusion hybrids generated from autologous (syngeneic) and allogeneic DCs displayed equivalent immunological function and therapeutic effects in vitro and in vivo. This puzzling finding suggests that effective fusion immunotherapy depends on tumor antigen scavenging and presentation by antigen-presenting cells (APCs) of host origin and is in violation of the basic tenet of the principle of DC function. We believe that conclusions drawn from reported clinical trials have not properly evaluated the efficacy of the DC-tumor hybrid vaccine, and therefore, they neither confirm nor disclaim the potential benefits that may be derived from this form of immunotherapy.

Authors
Shu, S; Zheng, R; Lee, WT; Cohen, PA
MLA Citation
Shu, S, Zheng, R, Lee, WT, and Cohen, PA. "Immunogenicity of dendritic-tumor fusion hybrids and their utility in cancer immunotherapy." Crit Rev Immunol 27.5 (2007): 463-483. (Review)
PMID
18197808
Source
pubmed
Published In
Critical Reviews in Immunology
Volume
27
Issue
5
Publish Date
2007
Start Page
463
End Page
483

Significance of regional draining lymph nodes in the development of tumor immunity: implications for cancer immunotherapy.

Authors
Zheng, R; Kjaergaard, J; Lee, WT; Cohen, PA; Shu, S
MLA Citation
Zheng, R, Kjaergaard, J, Lee, WT, Cohen, PA, and Shu, S. "Significance of regional draining lymph nodes in the development of tumor immunity: implications for cancer immunotherapy." Cancer Treat Res 135 (2007): 223-237. (Review)
PMID
17953420
Source
pubmed
Published In
Cancer Treatment and Research
Volume
135
Publish Date
2007
Start Page
223
End Page
237

Radiology quiz case 1

Authors
Teker, AM; Lorenz, RR; Lee, WT; Murthy, SC
MLA Citation
Teker, AM, Lorenz, RR, Lee, WT, and Murthy, SC. "Radiology quiz case 1." Archives of Otolaryngology - Head and Neck Surgery 133.9 (2007): 940+942-940+943.
Source
scival
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
133
Issue
9
Publish Date
2007
Start Page
940+942
End Page
940+943

Comparison of frontal pneumatization patterns between Koreans and Caucasians.

OBJECTIVE: To evaluate the prevalence of specific frontal recess cells in Korean and Caucasian populations; to evaluate and compare the relationship between anterior skull base length and frontal recess pneumatization in these two populations. MATERIALS AND METHODS: Frontal recess anatomy was studied with high resolution sinus CT scans obtained in 60 Korean adults and 41 Caucasian adults. None of the subjects had a history of frontal sinus disease or trauma. The anterior cranial base length (ACBL, distance between the nasion and center of the pituitary fossa) and anterior ethmoid length (AEL, distance between the nasion and upper attachment of basal lamella) was also measured on each side. RESULTS: Supraorbital ethmoid cells were more common in Caucasians whereas suprabullar cells and recessus terminalis were more common in Koreans. The prevalence of some frontal recess pneumatization patterns (specifically supraorbital ethmoid cell, suprabullar cell, and recessus terminalis) were more commonly associated with race rather than with ACBL or AEL. CONCLUSION: Frontal recess pneumatization patterns differ in the Korean and Caucasian adult populations. Because corresponding differences in skull base length were not identified, these differences seem likely to reflect other factors. Such information has clinical significance for frontal recess surgery in these patient populations.

Authors
Cho, JH; Citardi, MJ; Lee, WT; Sautter, NB; Lee, H-M; Yoon, J-H; Hong, S-C; Kim, JK
MLA Citation
Cho, JH, Citardi, MJ, Lee, WT, Sautter, NB, Lee, H-M, Yoon, J-H, Hong, S-C, and Kim, JK. "Comparison of frontal pneumatization patterns between Koreans and Caucasians." Otolaryngol Head Neck Surg 135.5 (November 2006): 780-786.
PMID
17071312
Source
pubmed
Published In
Otolaryngology - Head and Neck Surgery
Volume
135
Issue
5
Publish Date
2006
Start Page
780
End Page
786
DOI
10.1016/j.otohns.2006.05.750

Risk factors for hypopharyngeal/upper esophageal stricture formation after concurrent chemoradiation.

BACKGROUND: Concurrent chemoradiation therapy has been demonstrated to be effective as an organ-sparing treatment for select advanced head and neck squamous cell carcinoma (HNSCC). However, this treatment modality is not without side effects. One side effect is the formation of upper esophageal strictures. As concurrent chemoradiation treatment is used more frequently, it is important to identify risk factors associated with stricture formation. METHODS: A retrospective chart review of all patients who had undergone definitive concurrent chemoradiation treatment between 1989 and 2002 was performed. Exclusion criteria included death within 1 year or persistent/recurrent disease that required surgical salvage at the primary site. The outcome measure was stricture formation as determined by both objective findings (barium swallow or endoscopy) and the need for dilation after treatment. RESULTS: Of the 222 patients in this cohort, there were enough data for 199 patients to assess for stricture formation. Strictures developed in a total of 41 patients (21%). Significant predictive factors were a twice-daily (BID) radiation fractionation (p = .007), female sex (p = .015), and a hypopharyngeal primary site (p = .01). Age and tumor extent were not significant factors in stricture formation (p = .15 and p = .23, respectively). CONCLUSIONS: Symptomatic strictures occur in 21% of patients undergoing concurrent chemoradiation for HNSCC. Female sex, BID radiation fractionation, and a hypopharyngeal primary site are significant predictive factors for stricture formation.

Authors
Lee, WT; Akst, LM; Adelstein, DJ; Saxton, JP; Wood, BG; Strome, M; Butler, RS; Esclamado, RM
MLA Citation
Lee, WT, Akst, LM, Adelstein, DJ, Saxton, JP, Wood, BG, Strome, M, Butler, RS, and Esclamado, RM. "Risk factors for hypopharyngeal/upper esophageal stricture formation after concurrent chemoradiation." Head Neck 28.9 (September 2006): 808-812.
PMID
16732601
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
28
Issue
9
Publish Date
2006
Start Page
808
End Page
812
DOI
10.1002/hed.20427

Acute external laryngotracheal trauma: diagnosis and management.

Laryngotracheal trauma may result in lifelong complications or even death if diagnosis or treatment is delayed. Emergency room physicians, trauma surgeons, anesthesiologists, and especially otolaryngologists should maintain a high level of awareness of and suspicion for laryngotracheal trauma whenever a patient presents with multiple trauma in general or with cervical trauma in particular. Although there is some controversy regarding care, treatment in experienced hands will usually result in a favorable outcome. In this article, we review and update the diagnosis and management of acute external laryngotracheal trauma.

Authors
Lee, WT; Eliashar, R; Eliachar, I
MLA Citation
Lee, WT, Eliashar, R, and Eliachar, I. "Acute external laryngotracheal trauma: diagnosis and management." Ear Nose Throat J 85.3 (March 2006): 179-184. (Review)
PMID
16615601
Source
pubmed
Published In
Ear, Nose and Throat Journal
Volume
85
Issue
3
Publish Date
2006
Start Page
179
End Page
184

A pneumatic orthotic cranial molding helmet for correcting positional plagiocephaly

The objective of this study was o determine the efficacy of a newly developed pneumatic orthotic cranial molding helmet for correcting positional plagiocephaly. The design was retrospective and the setting was a tertiary care center. Subjects were all patients in whom positional plagiocephaly has been diagnosed and who have been fitted by the Orthotics and Prosthetics Department for the helmet. Diagonal cranial lengths and widths were measured at each visit. Analysis included the calculation of the ratio change in oblique diameters compared with time, patient's age, and head circumference. Seventy-five patients met inclusion criteria (50 boys, 25 girls). Patients with pneumatic orthotic cranial molding helmet therapy had significantly improved outcomes as compared with pretreatment measurements (P ≤ 0.0001). The helmet did not limit cranial growth as evidenced by significant normalization of the oblique measurement ratio when compared with increasing cranial circumference and age (P = 0.0003, P ≤ 0.0001, respectively). The pneumatic orthotic cranial molding helmet successfully corrects positional plagiocephaly and does not hinder cranial growth. Copyright © Mutaz B. Habal, MD.

Authors
Lee, WT; Richards, K; Redhed, J; Papay, FA
MLA Citation
Lee, WT, Richards, K, Redhed, J, and Papay, FA. "A pneumatic orthotic cranial molding helmet for correcting positional plagiocephaly." Journal of Craniofacial Surgery 17.1 (2006): 139-144.
PMID
16432421
Source
scival
Published In
Journal of Craniofacial Surgery
Volume
17
Issue
1
Publish Date
2006
Start Page
139
End Page
144
DOI
10.1097/01.scs.0000195375.24754.38

First case of laryngeal glomangiomyoma.

Glomus tumors are derived from the normal glomus body, which is an arteriovenous confluence involved with thermoregulation. These true glomus tumors are different from the "glomus tumors" derived from the paraganglion system often encountered by the otolaryngologist. Glomus tumors have been reported in a variety of locations including the pancreas, perineum, nasal cavity, and torso; however, most are found in the extremities. We present the first case of a laryngeal glomangiomyoma. Furthermore, this lesion was successfully excised endoscopically with a CO2 laser.

Authors
Lee, WT; Murthy, SC; Gildea, TR; Lorenz, RR
MLA Citation
Lee, WT, Murthy, SC, Gildea, TR, and Lorenz, RR. "First case of laryngeal glomangiomyoma." Laryngoscope 115.11 (November 2005): 2038-2040.
PMID
16319620
Source
pubmed
Published In
The Laryngoscope
Volume
115
Issue
11
Publish Date
2005
Start Page
2038
End Page
2040
DOI
10.1097/01.mlg.0000177097.19336.eb

Tumor-dendritic cell fusion as a basis for cancer immunotherapy.

OBJECTIVE: To establish the basis for use of allogeneic dendritic-tumor fusion cells. STUDY DESIGN: Fusion cells were created by electrofusion. We used 2 allogeneic murine tumor lines (D5 and 4T1) that were virally transduced to express the antigen (beta-galactosidase) as a surrogate tumor marker. RESULTS: Cross-immunization was achieved with irradiated allogenic tumor cells. Successful electrofusion of dendritic cells and tumor cells was confirmed by using fluorescence-activated cell sorting and cytospin. Significant responses were shown in immunized mice against tumor challenge and established 3-day pulmonary metastasis with fusion cells. CONCLUSIONS: Allogeneic tumor sharing a common tumor antigen can immunize against syngeneic tumor challenge. Fusion cells showed successful immunization against tumor challenge and showed regression of 3-day established pulmonary metastasis. SIGNIFICANCE: These preclinical studies provide evidence that an allogenic tumor-dendritic cell fusion vaccine is a valid approach for head and neck cancer immunotherapy.

Authors
Lee, WT; Shimizu, K; Kuriyama, H; Tanaka, H; Kjaergaard, J; Shu, S
MLA Citation
Lee, WT, Shimizu, K, Kuriyama, H, Tanaka, H, Kjaergaard, J, and Shu, S. "Tumor-dendritic cell fusion as a basis for cancer immunotherapy." Otolaryngol Head Neck Surg 132.5 (May 2005): 755-764.
PMID
15886631
Source
pubmed
Published In
Otolaryngology - Head and Neck Surgery
Volume
132
Issue
5
Publish Date
2005
Start Page
755
End Page
764
DOI
10.1016/j.otohns.2005.01.018

Laryngotracheal consequences of pediatric cardiac surgery.

OBJECTIVE: To determine the incidence and character of clinically significant laryngotracheal anomalies in pediatric patients undergoing surgical repair of congenital cardiac defects at a tertiary care center. DESIGN: Single-center retrospective review. PATIENTS: The charts of pediatric patients who required surgical treatment for congenital heart disease over a 4-year period were reviewed. Forty-eight of 1957 patients were seen in inpatient consultation by the otolaryngology service. The parameters studied included cardiac diagnosis, reason for consultation, findings on examination, and follow-up. RESULTS: There were 16 (33%) cases of subglottic stenosis, which were graded according to the Cotton-Myer classification system as follows: grade 1 (n=8); grade 2 (n=3); and grade 3 (n=5). Three of the 16 patients with subglottic stenosis required tracheotomy and 4 required laryngotracheal reconstruction. Nine (19%) of the 48 patients were diagnosed as having unilateral true vocal cord paralysis and 3 (6%) as having bilateral paralysis. With the exception of 1 patient, all patients with true vocal cord paralysis on the left side had undergone repair of the aortic arch. CONCLUSIONS: Pediatric patients with congenital cardiac disease are predisposed to laryngeal anomalies owing to (1) frequent intubation, (2) prolonged ventilatory support, and (3) recurrent laryngeal nerve injury. In our patients, subglottic stenosis was the most common laryngeal abnormality. When recognized early, in the eschar phase, most of these cases can be managed with sequential endoscopic debridement, which is conceptually similar to debridement that is performed after functional endoscopic sinus surgery. Established stenosis requires more vigorous intervention, the invasive degree of which depends on the length and circumference of the narrowing. Unilateral vocal paralysis tends to be a self-limited problem, while an elegant solution to bilateral paralysis remains elusive.

Authors
Khariwala, SS; Lee, WT; Koltai, PJ
MLA Citation
Khariwala, SS, Lee, WT, and Koltai, PJ. "Laryngotracheal consequences of pediatric cardiac surgery." Arch Otolaryngol Head Neck Surg 131.4 (April 2005): 336-339.
PMID
15837903
Source
pubmed
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
131
Issue
4
Publish Date
2005
Start Page
336
End Page
339
DOI
10.1001/archotol.131.4.336

Melanoma metastasis masquerading as bilateral acoustic neuromas.

Authors
Lee, WT; Weber, PC
MLA Citation
Lee, WT, and Weber, PC. "Melanoma metastasis masquerading as bilateral acoustic neuromas." Otolaryngol Head Neck Surg 132.3 (March 2005): 505-506.
PMID
15746871
Source
pubmed
Published In
Otolaryngology - Head and Neck Surgery
Volume
132
Issue
3
Publish Date
2005
Start Page
505
End Page
506
DOI
10.1016/j.otohns.2004.05.004

3D computed tomographic analysis of frontal recess anatomy in patients without frontal sinusitis.

OBJECTIVE: Describe frontal sinus pneumatization in patients with no history of frontal sinus disease. STUDY DESIGN AND METHODS: All 1-mm axial sinus CT scans performed from 2001 through 2003 were eligible for review on a CBYON Suite workstation (CBYON, Mountain View, CA). Exclusion criteria included frontal sinusitis, sinonasal polyposis, age < 18 years, sinus malignancy, fibroosseous lesions, maxillofacial trauma, congenital anomaly, and sinus surgery. RESULTS: A total of 50 patients met the inclusion criteria. The prevalence of each structure was: agger nasi cell (89%), type 1 frontal cell (37%), type 2 frontal cell (19%), type 3 frontal cell (8%), type 4 frontal cell (0%), supraorbital ethmoid cell (62%), suprabullarcell (15%), frontal bullar cell (9%), interfrontal septal cell (14%), and recessus terminalis (22%). CONCLUSIONS: This study describes frontal pneumatization in patients without a history of conditions that influence frontal pneumatization. The results characterize normal frontal recess/sinus pneumatization patterns.

Authors
Lee, WT; Kuhn, FA; Citardi, MJ
MLA Citation
Lee, WT, Kuhn, FA, and Citardi, MJ. "3D computed tomographic analysis of frontal recess anatomy in patients without frontal sinusitis." Otolaryngol Head Neck Surg 131.3 (September 2004): 164-173.
PMID
15365531
Source
pubmed
Published In
Otolaryngology - Head and Neck Surgery
Volume
131
Issue
3
Publish Date
2004
Start Page
164
End Page
173
DOI
10.1016/j.otohns.2004.04.012

Comparative analysis of antigen loading strategies of dendritic cells for tumor immunotherapy.

Dendritic cells (DCs) loaded with antigens can effectively stimulate host immune responses to syngeneic tumors, but there is considerable controversy as to which forms of antigen-loading are most immunogenic. Here, the authors compared immunotherapeutic reactivities of DCs loaded with a variety of antigen preparations. Because DC maturation stages affect their capacities of antigen processing and presentation, two DC populations were used for the current analysis: in vivo Flt-3 ligand-induced mature DCs and in vitro bone marrow-derived DCs, which were less mature. To facilitate a direct comparison, the LacZ gene-transduced B16 melanoma model system was used, where beta-galactosidase served as the surrogate tumor-rejection antigen. DC loading strategies included pulsing with the beta-galactosidase protein, H-2K restricted peptide, tumor cell lysate, and irradiated tumor cells and fusion of DCs with tumor cells. Our results demonstrated that electrofusion of DCs and tumor cells generated a therapeutic vaccine far superior to other methods of DC loading. For the treatment of 3-day established pulmonary tumor nodules, a single intranodal vaccination plus IL-12 resulted in a significant reduction of metastatic nodules, while other DC preparations were only marginally effective. Immunotherapy mediated by the fusion cells was tumor antigen-specific. Consistent with their therapeutic activity, fusion hybrids were the most potent stimulators to induce specific IFN-gamma secretion from immune T cells. Furthermore, fusion cells also stimulated a small amount of IL-10 production from immune T cells. However, this IL-10 secretion was also induced by other DC preparations and did not correlate with in vivo therapeutic reactivity.

Authors
Shimizu, K; Kuriyama, H; Kjaergaard, J; Lee, W; Tanaka, H; Shu, S
MLA Citation
Shimizu, K, Kuriyama, H, Kjaergaard, J, Lee, W, Tanaka, H, and Shu, S. "Comparative analysis of antigen loading strategies of dendritic cells for tumor immunotherapy." J Immunother 27.4 (July 2004): 265-272.
PMID
15235387
Source
pubmed
Published In
Journal of Immunotherapy
Volume
27
Issue
4
Publish Date
2004
Start Page
265
End Page
272

Therapeutic vaccine generated by electrofusion of dendritic cells and tumour cells.

Immunotherapy with fusion of dendritic cells (DCs) and tumour cells potentially confers the advantages of DC antigen-presenting functionality and a continuous source of unaltered tumour antigens. However, fusion using chemical or viral fusogens has been inefficient. We have recently developed a high throughput electrofusion technique with which very efficient fusion rates (15-54%) were observed in over 300 experiments, using a variety of murine and human tumour cell lines. The fused cells display a mature DC phenotype and express tumour-associated antigens. In two pre-clinical animal models (B16 melanoma transduced with the LacZ gene and the MCA 205 fibrosarcoma), a single vaccination of mice bearing tumours established in the lung, brain and skin resulted in tumour regression and prolongation of life. However, therapeutic efficacy required the administration of adjuvants such as IL-12 and OX-40R mAbs. Effective immunotherapy also required the delivery of fusion cells directly into lymphoid organs (spleen or lymph nodes). Using five defined human T cell lines derived from melanoma patients, allogeneic DCs of HLA-A2, HLA-DR4 and HLA-DR7 haplotypes fused with MART-1, gp100, tyrosinase and TRP-2 expressing 888 mel melanoma cells were analysed for their ability to stimulate specific cytokine (IFN-gamma and GM-CSF) secretion. DC-888 mel hybrids presented all tumour-associated epitopes to both CD4 and CD8 T cell lines in the context of MHC class II and I molecules, respectively. The therapeutic efficacy of a DC-tumour fusion vaccine is now being evaluated for the treatment of metastatic melanoma.

Authors
Kuriyama, H; Shimizu, K; Lee, W; Kjaergaard, J; Parkhurst, MR; Cohen, PA; Shu, S
MLA Citation
Kuriyama, H, Shimizu, K, Lee, W, Kjaergaard, J, Parkhurst, MR, Cohen, PA, and Shu, S. "Therapeutic vaccine generated by electrofusion of dendritic cells and tumour cells." Developments in biologicals 116 (2004): 169-178.
PMID
15603192
Source
scival
Published In
Developments in biologicals
Volume
116
Publish Date
2004
Start Page
169
End Page
178

Stepped-dose protocol of cidofovir therapy in recurrent respiratory papillomatosis in children.

OBJECTIVE: To evaluate a stepped-dose protocol for intralesional injection of cidofovir in children with recurrent respiratory papillomatosis (RRP). DESIGN: Prospective, nonrandomized case series. SETTING: Tertiary care children's hospital. PARTICIPANTS: Eleven children undergoing evaluation for RRP from June 1, 2000, through December 31, 2001. INTERVENTION: Intralesional injection of cidofovir was performed after microlaryngoscopy and carbon dioxide laser treatment. Patients received 4 monthly injections at a concentration of 5 mg/mL and returned 1 month after the last injection for follow-up. Patients with recurrent or recalcitrant disease then started a series of 4 monthly injections at a concentration of 10 mg/mL. OUTCOME MEASURE: Papilloma stage (0-3) documented at multiple subsites by means of serial microlaryngoscopy. We calculated a severity score by summing the scores at all affected subsites. RESULTS: The severity score decreased in each of the 11 patients during the course of therapy, from a mean +/- SD of 13.7 +/- 6.0 at enrollment to 2.1 +/- 3.4 at 1-month follow-up. Six patients experienced complete resolution (stage 0) and 4 others had mild disease (stage,

Authors
Akst, LM; Lee, W; Discolo, C; Knott, D; Younes, A; Koltai, PJ
MLA Citation
Akst, LM, Lee, W, Discolo, C, Knott, D, Younes, A, and Koltai, PJ. "Stepped-dose protocol of cidofovir therapy in recurrent respiratory papillomatosis in children." Arch Otolaryngol Head Neck Surg 129.8 (August 2003): 841-846.
PMID
12925342
Source
pubmed
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
129
Issue
8
Publish Date
2003
Start Page
841
End Page
846
DOI
10.1001/archotol.129.8.841

Nasal deformity in neonates and young children.

Pediatric nasal deformities comprise a broad range of congenital and acquired pathologies. The congenital deformities are rare and often require specific surgical interventions. The acquired deformities are more common, and in the majority of cases surgical intervention is not necessary. The decision to operate is based primarily on the extent of the functional impairment and the severity of the aesthetic deformity.

Authors
Lee, WT; Koltai, PJ
MLA Citation
Lee, WT, and Koltai, PJ. "Nasal deformity in neonates and young children." Pediatr Clin North Am 50.2 (April 2003): 459-467. (Review)
PMID
12809334
Source
pubmed
Published In
Pediatric Clinics of North America
Volume
50
Issue
2
Publish Date
2003
Start Page
459
End Page
467

Indications for tracheotomy in the pediatric intensive care unit population: a pilot study.

OBJECTIVE: To define the indications for tracheotomy in patients requiring prolonged intubation (>1 week) in the pediatric intensive care unit (PICU). DESIGN: Retrospective chart review and follow-up telephone survey. SETTING: A tertiary care center PICU. OUTCOME MEASURE: Tracheotomy or extubation. PATIENTS: All patients older than 30 days in the PICU intubated for longer than 1 week between 1997 and 1999. RESULTS: During the study, 63 total admissions required intubation for longer than 1 week. A tracheotomy was necessary in 14% of admissions (n = 9). The mean length of intubation before the tracheotomy was 424 hours, whereas the mean length of intubation without the need for tracheotomy was 386 hours. Length of intubation, age, and number of intubations did not increase the probability of having a tracheotomy. Of those requiring a tracheotomy, 2 had tracheomalacia, 1 had subglottic edema, 1 had plastic bronchitis, 1 had Down syndrome with apnea resulting in right heart failure, 3 required long-term ventilation after cardiopulmonary collapse, and 1 had mitochondrial cytopathy. Of these 9 children, 7 were successfully decannulated, 1 patient died of underlying disease, and 1 patient remained cannulated secondary to the mitochondrial cytopathy. Twenty families of the patients who did not undergo a tracheotomy were reached by telephone after discharge. Most of the families reported that their children were free of stridor and hoarseness after extubation. CONCLUSIONS: Children tolerate prolonged intubation without laryngeal complications. The consideration for tracheotomy in the PICU setting must be highly individualized for each child.

Authors
Lee, W; Koltai, P; Harrison, AM; Appachi, E; Bourdakos, D; Davis, S; Weise, K; McHugh, M; Connor, J
MLA Citation
Lee, W, Koltai, P, Harrison, AM, Appachi, E, Bourdakos, D, Davis, S, Weise, K, McHugh, M, and Connor, J. "Indications for tracheotomy in the pediatric intensive care unit population: a pilot study." Arch Otolaryngol Head Neck Surg 128.11 (November 2002): 1249-1252.
PMID
12431164
Source
pubmed
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
128
Issue
11
Publish Date
2002
Start Page
1249
End Page
1252

Decreased cerebrospinal fluid absorption during abdominal insufflation

Background: Intracranial pressure (ICP) is known to rise during induced CO2 pneumoperitoneum. This rise correlates with an increase in inferior vena caval pressure; therefore, it is probably associated with increased pressure in the lumbar venous plexus. Branches of this plexus communicate with arachnoid villi in the lumbar cistern and the dural sleeves of spinal nerve roots - areas where cerebrospinal fluid (CSF) absorption to normally takes place. The increased venous pressure in this area may impede CSF absorption. Because CSF is produced at a constant rate, decreased absorption will increase ICP. We hypothesized that increased ICP occurring during abdominal insufflation is due, at least in part, to decreased absorption of CSF. The purpose of this study is to show that CSF absorption is inhibited during abdominal insufflation. Methods: After appropriate approval was obtained, 16 domestic swine were anesthetized and injected into the CSF with 100 microcuries (μCu) of I131 radioactive iodinated human serum albumin (RISA) in 2 ml of normal saline. Eight subjects underwent CO2 abdominal insufflation to 15 mmHg and were maintained for 4 h. A control group did not undergo insufflation. Blood levels of RISA were measured over a 4-h period to determine the rate of CSF absorption. Results: Blood levels of RISA increased at a slower rate in the subjects undergoing abdominal insufflation than in the control group. The mean change over 2 h in the insufflated group was 15% compared to 34% in the control group (p = 0.02). This difference indicates decreased absorption of CSF in the insufflated group. Conclusions: These results demonstrate decreased absorption of CSF during abdominal insufflation and support the hypothesis that the increase in ICP pressure occurring during abdominal insufflation is caused, at least in part, by decreased absorption of CSF in the region of the lumbar cistern and the dural sleeves of spinal nerve roots.

Authors
Halverson, AL; Barrett, WL; Iglesias, AR; Lee, WT; Garber, SM; Sackier, JM
MLA Citation
Halverson, AL, Barrett, WL, Iglesias, AR, Lee, WT, Garber, SM, and Sackier, JM. "Decreased cerebrospinal fluid absorption during abdominal insufflation." Surgical Endoscopy 13.8 (1999): 797-800.
PMID
10430688
Source
scival
Published In
Surgical Endoscopy
Volume
13
Issue
8
Publish Date
1999
Start Page
797
End Page
800
DOI
10.1007/s004649901102
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