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Leff M, Quimby A, Morgan E, Brant JA. An Unusual Case of an ALK-Negative Epithelioid Fibrous Histiocytoma in the External Auditory Canal. Laryngoscope 2024. [PMID: 38264975 DOI: 10.1002/lary.31302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
This article represents the first reported case in the external auditory canal of epithelioid fibrous histiocytoma (EFH), a rare benign cutaneous epithelioid neoplasm. Immunostaining revealed uncommon negative staining for anaplastic lymphoma kinase (ALK) expression. This case and literature review outline the diagnostic strategy for this highly unusual neoplasm. Laryngoscope, 2024.
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Affiliation(s)
- Morgan Leff
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexandra Quimby
- Department of Otolaryngology-Head & Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology and Communication Science, Upstate Medical University, Syracuse, New York, U.S.A
| | - Eric Morgan
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jason A Brant
- Department of Otolaryngology-Head & Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
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Cao AC, Hwa TP, Cavarocchi C, Quimby A, Eliades SJ, Ruckenstein MJ, Bigelow DC, Choudhri OA, Brant JA. Diagnostic Yield and Utility of Radiographic Imaging in the Evaluation of Pulsatile Tinnitus: A Systematic Review. Otol Neurotol Open 2023; 3:e030. [PMID: 38516122 PMCID: PMC10950154 DOI: 10.1097/ono.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 03/23/2024]
Abstract
Objective The objective of this study is to assess diagnostic yield of imaging modalities used to evaluate patients presenting with pulsatile tinnitus (PT). Databases Reviewed PubMed, Embase, and Scopus were queried using the search terms "pulsatile tinnitus," "pulse-synchronous tinnitus," and "pulse synchronous tinnitus" with no date limitations. Methods Studies that reported diagnostic imaging for patients presenting with PT were included. Data were reviewed for sample size, gender, age, imaging study, indications, and diagnoses. The primary outcome measure from aggregated data was the yield of positive diagnoses made with each imaging modality. The quality of evidence was assessed for risk of bias. Results From an initial search of 1145 articles, 17 manuscripts met inclusion criteria, of which 12 studies evaluated individual imaging modalities. The number of unique patients included was 1232. The diagnostic yield varied between modalities: carotid ultrasound (21%, 95% confidence interval [CI]: 12%-35%), CT temporal bone (65%, CI: 20%-93%), computed tomographic angiography (86%, CI: 80%-90%), and MRI/magnetic resonance angiography (58%, CI: 43%-72%). Conclusion Studies on the diagnostic approach to PT are limited by heterogeneity in both inclusion criteria and reporting standards. A wide range of imaging modalities are used in practice during the initial evaluation of PT, and the diagnostic yield for imaging can be improved by utilizing more specific clinical indications.
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Affiliation(s)
- Austin C Cao
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Tiffany P Hwa
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Caitlin Cavarocchi
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alexandra Quimby
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Steven J Eliades
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael J Ruckenstein
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Douglas C Bigelow
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Omar A Choudhri
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jason A Brant
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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Sivarajah S, Ghods-Esfahani D, Quimby A, Makki F, Montagna G, Seikaly H. The effect of insurance status on treatment modality in advanced oral cavity cancer. J Otolaryngol Head Neck Surg 2023; 52:26. [PMID: 37072807 PMCID: PMC10114465 DOI: 10.1186/s40463-022-00608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/04/2022] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Insurance status has been shown to impact survival outcomes. We sought to determine whether insurance affects the choice of treatment modality among patients with advanced (T4) oral cavity squamous cell carcinoma. METHODS This is a retrospective, population-based cohort study using the Survival, Epidemiology, and End Results Program database. The population included all adult (age ≥ 18) patients with advanced (T4a or T4b) oral cavity squamous cell carcinoma diagnosed from 2007 to 2016. The main outcome was the odds of receiving definitive treatment, defined as primary surgical resection. Insurance status was categorized into uninsured, any Medicaid, and insured groups. Univariable, multivariable, and subgroup analyses were performed. RESULTS The study population consisted of 2628 patients, of whom 1915 (72.9%) were insured, 561 (21.3%) had Medicaid, and 152 (5.8%) were uninsured. The multivariable model showed that patients who were 80 years or older, unmarried, received treatment in the pre-Affordable Care Act (ACA) period, and who were on Medicaid or uninsured were significantly less likely to receive definitive treatment. Insured patients were significantly more likely to receive definitive treatment compared to those on Medicaid or uninsured (OR = 0.59, 95% CI 0.46-0.77, p < 0.0001 [Medicaid vs. Insured]; and OR = 0.48, 95% CI 0.31-0.73 p = 0.001 [Uninsured vs. Insured]), however these differences did not persist when considering only those patients treated following the 2014 expansion of the ACA. CONCLUSIONS Insurance status is significantly associated with treatment modality among adults with advanced stage (T4a) oral cavity squamous cell carcinoma. These findings support the premise of expanding insurance coverage in the US.
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Affiliation(s)
- Shanmugappiriya Sivarajah
- Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
| | | | - Alexandra Quimby
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Canada
| | - Fawaz Makki
- Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Giacomo Montagna
- Department of Surgery, Memorial Sloan Kettering Cancer Center, Breast Service, New York, USA
| | - Hadi Seikaly
- Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
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Rockafellow A, Salman S, WuDunn D, Grover S, Busby E, Quimby A. Ophthalmology Consult Protocol for Orbital Fractures Utilizing Evidence-Based Data. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Li HOY, Bailey AJM, Grose E, McDonald JT, Quimby A, Johnson-Obaseki S, Nessim C. Socioeconomic Status and Melanoma in Canada: A Systematic Review. J Cutan Med Surg 2020; 25:87-94. [PMID: 32955341 DOI: 10.1177/1203475420960426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
As melanoma is one of the leading cancers in average years of life lost per death from disease, screening and early diagnosis are imperative to decrease morbidity and mortality. Socioeconomic status (SES) has been shown to be associated with melanoma incidence. However, it is unclear if this association holds true in universal healthcare systems where screening, diagnostic, and treatment services are available to all patients. The objective of this systematic review was to evaluate the evidence on the association of SES and melanoma incidence in Canada. A comprehensive search of PubMed and EMBASE yielded 7 studies reporting on melanoma incidence or outcomes with respect to SES in Canada. High SES was associated with increased melanoma incidence across all studies, which encompassed all Canadian provinces, and time periods spanning from 1979 to 2012. Studies also reported an increasing incidence of melanoma over time. There were substantial discrepancies in melanoma incidence across Canadian provinces, after controlling for SES and demographic characteristics. Populations of lower SES and living within certain healthcare regions had increased risks of advanced melanoma at diagnosis. This review highlights the potential for inequities in access to care even within a universal healthcare system. Future research is needed to characterize specific risk factors within different patient groups and within the universal health system context in order to implement targeted strategies to lower melanoma incidence, morbidity, and mortality.
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Affiliation(s)
| | | | - Elysia Grose
- 12365 Faculty of Medicine, University of Ottawa, ON, Canada
| | | | - Alexandra Quimby
- 27337 Department of Otolaryngology, The Ottawa Hospital, ON, Canada
| | | | - Carolyn Nessim
- 27337 Division of Surgical Oncology, Department of Surgery, The Ottawa Hospital, ON, Canada
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Weyh A, Nocella R, Abdelmalik M, Pucci R, Quimby A, Bunnell A, Fernandes R. An analysis of unplanned readmissions after head and neck microvascular reconstructive surgery. Int J Oral Maxillofac Surg 2020; 49:1559-1565. [PMID: 32475708 DOI: 10.1016/j.ijom.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/08/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
The 30-day readmission rate is a highly scrutinized metric of quality surgical care, because readmission is costly and perceived to be avoidable with planning and patient education. Head and neck surgery patients generally have multiple risk factors for readmission, as readmitted patients are generally older, with more co-morbidities, lower socio-economic status, and a history of multiple emergency department visits and readmissions. A retrospective cohort study was implemented to determine the incidence and etiology of 30-day readmission after microvascular head and neck reconstructive surgery, focusing on social risk factors. Data were analyzed by χ2 test, analysis of variance, t-test, and logistic regression, with statistical significance set at P<0.05. Of 209 patients included in this study, 35 (16.7%) had a 30-day readmission. Increased needs at discharge were associated with increased readmission, while other social risk factors were less significant for a readmission in this study.
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Affiliation(s)
- A Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Nocella
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - M Abdelmalik
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Pucci
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - A Quimby
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - A Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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Murray S, Luo L, Quimby A, Barrowman N, Vaccani JP, Caulley L. Immediate versus delayed surgery in congenital choanal atresia: A systematic review. Int J Pediatr Otorhinolaryngol 2019; 119:47-53. [PMID: 30665176 DOI: 10.1016/j.ijporl.2019.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/28/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate immediate versus delayed surgical intervention on treatment outcomes in the management of congenital choanal atresia. METHODS This study adhered to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines in reporting a systematic review of the literature. OVID Medline, EMBASE and Pubmed databases were searched using relevant key terms. Inclusion and exclusion criteria were designed to capture studies examining immediate versus delayed primary surgery for congenital choanal atresia. Timing of surgery was classified as immediate or delayed based on median age of intervention stratified by type of obstruction. Primary outcomes were primary treatment failure, respiratory function and mortality rates. RESULTS A total of 2765 abstracts were identified and screened by 2 independent reviewers. Of the 688 articles reviewed in full text, 23 articles met the study criteria and were subjected to quality assessment. The full study assessment and quality control measures yielded 23 studies (representing 362 patients) for pooled patient-level analysis in the systematic review. Primary treatment failures occurred in 24.8% of patients that underwent immediate surgery and 42.6% of patients that underwent delayed surgery for bilateral choanal atresia (p = 0.01). There were no differences in mortality rates (5.6% vs 4.2%; p = 1.00) or qualitative measures of respiratory function. There were no difference in treatment outcomes for patients with unilateral choanal atresia (p > 0.05). CONCLUSIONS Through an analysis of pooled individual patient data, this systematic review of the literature demonstrated that there was significantly higher rates of treatment failure in patients that underwent delayed surgery for bilateral choanal atresia. Clinical trials and large prospective cohort studies investigating outcomes following immediate and delayed surgical intervention will provide further insight into treatment strategies.
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Affiliation(s)
- Scott Murray
- University of Alberta, Department of Otolaryngology, Head and Neck Surgery, Edmonton, AB, Canada
| | - Lindy Luo
- University of Ottawa, Department of Undergraduate Medical Education, Ottawa, ON, Canada
| | - Alexandra Quimby
- University of Ottawa, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada; The Ottawa Hospital, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jean-Philippe Vaccani
- University of Ottawa, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada; The Ottawa Hospital, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, Division of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada
| | - Lisa Caulley
- University of Ottawa, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada; The Ottawa Hospital, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada.
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Caulley L, Quimby A, Karsh J, Ahrari A, Tse D, Kontorinis G. Autoimmune arthritis in Ménière’s disease: A systematic review of the literature. Semin Arthritis Rheum 2018; 48:141-147. [DOI: 10.1016/j.semarthrit.2017.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/08/2017] [Accepted: 11/27/2017] [Indexed: 01/08/2023]
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