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McBrinn S, Antoni C, Al Yaghchi C. Current approaches to gender-affirming vocal care. Curr Opin Otolaryngol Head Neck Surg 2024; 32:143-150. [PMID: 38393690 DOI: 10.1097/moo.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
PURPOSE OF REVIEW This review addresses the challenges faced by transgender women in achieving congruence between gender identity and voice characteristics and emphasizes the importance of a multidisciplinary approach involving therapeutic and surgical interventions. RECENT FINDINGS Recent literature on gender-affirming vocal care emphasizes key themes such as assessment, voice feminization therapy, and various surgical techniques, including glottoplasty and its modifications. Recent publications focused on outcomes, duration, and impact on vocal quality and scrutinized complications associated with surgical interventions. SUMMARY Most publications in the last 18 months advocate for the integration of voice therapy and surgery for optimal outcomes. Utilising a combined approach is significantly more effective in terms of fundamental frequency gain compared to therapy alone. Modified Wendler's glottoplasty remains the preferred and most reliable surgical intervention. However, surgery is not without its complications and vocal trade-offs, in particular, its impact on vocal projection and the risk of long-term dysphonia. Postsurgery rehabilitation improves long-term outcomes. Recent publications on alternative surgical approaches, namely laser reduction glottoplasty and feminization laryngoplasty, show promise but the results are more difficult to generalise. FUTURE DIRECTION Prospective multicentre studies with standardized protocols are needed to establish best evidence-based practices.
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Affiliation(s)
- Sarah McBrinn
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust
| | | | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust
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Dronkers EAC, Geneid A, Al Yaghchi C, Lechien JR. Evaluating the Potential of AI Chatbots in Treatment Decision-making for Acquired Bilateral Vocal Fold Paralysis in Adults. J Voice 2024:S0892-1997(24)00059-6. [PMID: 38584026 DOI: 10.1016/j.jvoice.2024.02.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES The development of artificial intelligence-powered language models, such as Chatbot Generative Pre-trained Transformer (ChatGPT) or Large Language Model Meta AI (Llama), is emerging in medicine. Patients and practitioners have full access to chatbots that may provide medical information. The aim of this study was to explore the performance and accuracy of ChatGPT and Llama in treatment decision-making for bilateral vocal fold paralysis (BVFP). METHODS Data of 20 clinical cases, treated between 2018 and 2023, were retrospectively collected from four tertiary laryngology centers in Europe. The cases were defined as the most common or most challenging scenarios regarding BVFP treatment. The treatment proposals were discussed in their local multidisciplinary teams (MDT). Each case was presented to ChatGPT-4.0 and Llama Chat-2.0, and potential treatment strategies were requested. The Artificial Intelligence Performance Instrument (AIPI) treatment subscore was used to compare both Chatbots' performances to MDT treatment proposal. RESULTS Most common etiology of BVFP was thyroid surgery. A form of partial arytenoidectomy with or without posterior transverse cordotomy was the MDT proposal for most cases. The accuracy of both Chatbots was very low regarding their treatment proposals, with a maximum AIPI treatment score in 5% of the cases. In most cases even harmful assertions were made, including the suggestion of vocal fold medialisation to treat patients with stridor and dyspnea. ChatGPT-4.0 performed significantly better in suggesting the correct treatment as part of the treatment proposal (50%) compared to Llama Chat-2.0 (15%). CONCLUSION ChatGPT and Llama are judged as inaccurate in proposing correct treatment for BVFP. ChatGPT significantly outperformed Llama. Treatment decision-making for a complex condition such as BVFP is clearly beyond the Chatbot's knowledge expertise. This study highlights the complexity and heterogeneity of BVFP treatment, and the need for further guidelines dedicated to the management of BVFP.
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Affiliation(s)
- Emilie A C Dronkers
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK.
| | - Ahmed Geneid
- Department of Otolaryngology and Phoniatrics-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Jerome R Lechien
- Division of Laryngology and Broncho-esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
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Magos T, Massa G, Burdett E, Al Khalfan A, Thaj J, Al Yaghchi C, Ali S. Enhanced recovery after laryngectomy: A feasibility study in 25 patients. J Perioper Pract 2022; 32:338-345. [PMID: 34250857 DOI: 10.1177/17504589211015611] [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] [Indexed: 01/12/2023]
Abstract
PURPOSE To describe the development and implementation of an enhanced recovery programme for patients undergoing total laryngectomy. METHODS A feasibility study set in a tertiary head and neck unit in London, United Kingdom. The programme was developed based on Enhanced Recovery After Surgery (ERAS) Society guidelines for head and neck cancer surgery and local expert group consensus. An ERAS 'booklet' was devised which accompanied all laryngectomy patients during their inpatient stay. Contributors included otolaryngologists, anaesthetists, dieticians, physiotherapists, speech and language therapists and nurses. A 12-month pilot study was undertaken. The main outcome measures were feasibility and adherence. RESULTS An enhanced recovery programme for 25 people undergoing total laryngectomy was successfully piloted in a tertiary referral head and neck unit. Median length of stay was reduced in the post-ERAS group by 1.5 days. No statistically significant difference in length of stay, time to first gastrografin swallow, rate of fistula nor postoperative normalcy of eating between the pre and post-ERAS patients who underwent laryngectomy was observed. Clavien-Dindo-grouped complication rates were significantly higher in the post-ERAS group. CONCLUSION This enhanced recovery programme for patients undergoing laryngectomy is the first of its kind in the literature. Implementation has been demonstrated feasible. Further longitudinal studies are required to reliably inform us on ERAS programmes' effects on laryngectomy outcomes.
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Affiliation(s)
- Tiarnan Magos
- Department of Otolaryngology and Head and Neck Surgery, Guys Hospital, London, UK
| | - Gabriella Massa
- Department of Head and Neck Surgery, University College Hospital, London, UK
| | - Edward Burdett
- Department of Anaesthesia, University College Hospital, London, UK
| | - Abdulla Al Khalfan
- Department of Head and Neck Surgery, University College Hospital, London, UK
| | - Jabin Thaj
- Department of Otolaryngology and Head and Neck Surgery, Queens Hospital, Romford, UK
| | - Chadwan Al Yaghchi
- Department of Otolaryngology and Head and Neck Surgery, Charing Cross Hospital, London, UK
| | - Safina Ali
- Department of Otolaryngology and Head and Neck Surgery, Guys Hospital, London, UK
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Maughan EF, Hynds RE, Pennycuick A, Nigro E, Gowers KH, Denais C, Gómez-López S, Lazarus KA, Orr JC, Pearce DR, Clarke SE, Lee DDH, Woodall MN, Masonou T, Case KM, Teixeira VH, Hartley BE, Hewitt RJ, Al Yaghchi C, Sandhu GS, Birchall MA, O’Callaghan C, Smith CM, De Coppi P, Butler CR, Janes SM. Cell-intrinsic differences between human airway epithelial cells from children and adults. iScience 2022; 25:105409. [PMID: 36388965 PMCID: PMC9664344 DOI: 10.1016/j.isci.2022.105409] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
The airway epithelium is a protective barrier that is maintained by the self-renewal and differentiation of basal stem cells. Increasing age is a principle risk factor for chronic lung diseases, but few studies have explored age-related molecular or functional changes in the airway epithelium. We retrieved epithelial biopsies from histologically normal tracheobronchial sites from pediatric and adult donors and compared their cellular composition and gene expression profile (in laser capture-microdissected whole epithelium, fluorescence-activated cell-sorted basal cells, and basal cells in cell culture). Histologically, pediatric and adult tracheobronchial epithelium was similar in composition. We observed age-associated changes in RNA sequencing studies, including higher interferon-associated gene expression in pediatric epithelium. In cell culture, pediatric cells had higher colony formation ability, sustained in vitro growth, and outcompeted adult cells in a direct competitive proliferation assay. Our results demonstrate cell-intrinsic differences between airway epithelial cells from children and adults in both homeostatic and proliferative states.
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Affiliation(s)
- Elizabeth F. Maughan
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Robert E. Hynds
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Adam Pennycuick
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Ersilia Nigro
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Kate H.C. Gowers
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Celine Denais
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Sandra Gómez-López
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Kyren A. Lazarus
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Jessica C. Orr
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - David R. Pearce
- University College London Cancer Institute, University College London, London WC1E 6DD, UK
| | - Sarah E. Clarke
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Dani Do Hyang Lee
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Maximillian N.J. Woodall
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Tereza Masonou
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Katie-Marie Case
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Vitor H. Teixeira
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | | | | | - Chadwan Al Yaghchi
- The National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London W6 8RF, UK
| | - Gurpreet S. Sandhu
- The National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London W6 8RF, UK
| | - Martin A. Birchall
- University College London Ear Institute, University College London, London WC1X 8EE, UK
| | - Christopher O’Callaghan
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Claire M. Smith
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Colin R. Butler
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
- Tracheal Service, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
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Kanzara T, Rotman A, Kinshuck A, Al Yaghchi C, Tan MY, Yu C, Sandu G. Endoscopic management of idiopathic subglottic stenosis in pregnancy. Obstet Med 2021; 14:225-229. [PMID: 34880935 DOI: 10.1177/1753495x21991407] [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: 06/23/2020] [Accepted: 12/30/2020] [Indexed: 11/15/2022] Open
Abstract
Aims To describe the use of laser, endoscopic balloon dilatation with jet ventilation anaesthesia in the treatment of pregnant women with idiopathic subglottic stenosis. Materials and methods This is a case review of pregnant women with idiopathic subglottic stenosis, presenting to a tertiary referral centre with worsening breathlessness. Data were extracted from patient case notes. Results Four women underwent surgical management of subglottic stenosis in pregnancy. One patient required two procedures during the course of their pregnancy due to restenosis. All women had improvement in symptoms post-operatively and went on to deliver healthy babies at term. Conclusion Endoscopic balloon dilatation of idiopathic subglottic stenosis is a safe and viable treatment option in pregnancy and should be offered as first-line treatment in symptomatic women.
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Affiliation(s)
- Todd Kanzara
- ENT Department, Aintree University Hospital, Liverpool, UK
| | - Anthony Rotman
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | | | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Min Yi Tan
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Christina Yu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
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Rouhani MJ, Morley I, Lovell L, Roe J, Devabalan Y, Bidaye R, Sandhu G, Al Yaghchi C. Assessment of swallow function pre- and post-endoscopic CO2 laser medial arytenoidectomy: a case series. Clin Otolaryngol 2021; 47:347-350. [PMID: 34800322 DOI: 10.1111/coa.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/14/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Maral J Rouhani
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Isobel Morley
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Lindsay Lovell
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Roe
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Yadsan Devabalan
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Rohan Bidaye
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Maughan EF, Rotman A, Rouhani MJ, Thong G, Poncia J, Myatt J, Al Yaghchi C, Sandhu G. Suspension laryngoscopy experiences in a tertiary airway service: A prospective study of 150 procedures. Clin Otolaryngol 2021; 47:52-60. [PMID: 34570956 DOI: 10.1111/coa.13867] [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: 12/08/2020] [Revised: 05/12/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In most cases, suspension laryngoscopy (SL) is efficient, bloodless and with minimal post-procedure discomfort. We aimed to identify predictive patient factors for acceptable surgical views at SL as well as quantify our tertiary airway unit's complication rates. DESIGN Prospective cohort study of 150 consecutive microlaryngoscopy procedures involving SL over an 8-month period between November 2019 and July 2020. Patients were assessed preoperatively for pre-existing oral, temporomandibular, dental, pharyngeal or laryngeal pathology, interincisor distance and qualitative gross limitations to neck extension and forward head posture. Intraoperatively, the laryngoscopic view was graded by anaesthetic and surgical teams, and complications were recorded on patient interview in recovery. SETTING Tertiary adult airway service for predominantly benign pathology. RESULTS Adequate surgical views were obtained in 149/150 procedures. BMI had a weak positive correlation with a more difficult view (r = .22, p = .008) but did not correlate with a statistically significant increase in any complication. There was a weak negative correlation between age and interincisor gap (r = -.20, p = .014), and wider mouth opening correlated very weakly with a lower incidence of sore throat (r = -.19, p = .023). Gross macroglossia showed a significant moderate positive correlation with tongue symptoms (r = .45, p = 1.611 × 10-8 ). CONCLUSION In the context of an experienced airway unit with a high caseload of predominantly benign pathology, SL is very effective and safe with low associated morbidity and no mortality. The most common complication of SL is temporary sore throat and there remain recognised risks of temporary tongue and dental symptoms.
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Affiliation(s)
- Elizabeth F Maughan
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Anthony Rotman
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Maral J Rouhani
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Gerard Thong
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - James Poncia
- Anaesthetics Department, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - John Myatt
- Anaesthetics Department, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Chadwan Al Yaghchi
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Gurpreet Sandhu
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
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Cereceda-Monteoliva N, Rouhani MJ, Maughan EF, Rotman A, Orban N, Al Yaghchi C, Sandhu G. Sarcoidosis of the ear, nose and throat: A review of the literature. Clin Otolaryngol 2021; 46:935-940. [PMID: 34051056 DOI: 10.1111/coa.13814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/26/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Sarcoidosis is a multisystemic inflammatory disease with extrathoracic manifestations, most commonly affecting the young and middle-aged, female and Black populations. Diagnosis usually requires evidence of non-caseating granulomata and, when treated, prognosis is usually favourable. We aim to establish the incidence, clinical features and optimal treatment of ENT manifestations of this disease. DESIGN We performed a PubMed literature review to determine the evidence base supporting this. RESULTS ENT manifestations are present in 5%-15% of patients with sarcoidosis, often as a presenting feature, and require vigilance for swift recognition and coordinated additional treatment specific to the organ. Laryngeal sarcoidosis presents with difficulty in breathing, dysphonia and cough, and may be treated by speech and language therapy (SLT) or intralesional injection, dilatation or tissue reduction. Nasal disease presents with crusting, rhinitis, nasal obstruction and anosmia, usually without sinus involvement. It is treated by topical nasal or intralesional treatments but may also require endoscopic sinus surgery, laser treatment or even nasal reconstruction. Otological disease is uncommon but includes audiovestibular symptoms, both sensorineural and conductive hearing loss, and skin lesions. CONCLUSIONS The consequences of ENT manifestations of sarcoidosis can be uncomfortable, disabling and even life-threatening. Effective management strategies require good diagnostic skills and use of specific therapies combined with established treatments such as corticosteroids. Comparisons of treatment outcomes are needed to establish best practice in this area.
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Affiliation(s)
| | - Maral J Rouhani
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Anthony Rotman
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nara Orban
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Chadwan Al Yaghchi
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandhu
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Fehervari M, Patel S, Towning R, Haire K, Al Yaghchi C, Sabharwal A, Sandhu G, Efthimiou E. Management of Laryngotracheal Stenosis in Obesity. Is This Another Co-morbidity that Can Be Improved with Weight Loss Following Bariatric Surgery? Obes Surg 2021; 31:4815-4820. [PMID: 34389931 PMCID: PMC8490261 DOI: 10.1007/s11695-021-05647-9] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Bariatric surgery improves several obesity-related comorbidities. Laryngotracheal stenosis is a rare condition that is usually managed with repeated endoscopic airway interventions and reconstructive airway surgery. The outcome of these definitive operations is worse in individuals with obesity. There are no studies investigating the effect of weight loss following bariatric surgery in the management of laryngotracheal stenosis. MATERIALS AND METHODS In an observational study, consecutive patients with a BMI over 35 kg/m2 and laryngotracheal stenosis were prospectively recruited to a bariatric and airway stenosis database in two tertiary care centres. Patients were treated with laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy and control subjects were managed conservatively. RESULTS A total of eleven patients with an initial body mass index of 43 kg/m2 (37-45) were enrolled to this study. Six patients underwent bariatric surgery and five subjects were treated conservatively. After 12 months, the total weight loss of patients undergoing bariatric surgery was 19.4% (14-24%) whilst 2.3% (1-3%) in the control group. The annual number of endoscopic airway interventions following bariatric surgery reduced (p = 0.002). Higher weight loss in patients led to less frequent interventions compared to control subjects (p = 0.004). Patients undergoing laryngotracheal reconstruction following bariatric surgery needed less endoscopic intervention, an annual average of 1.9 interventions before vs 0.5 intervention after. Conservatively managed control subjects required more frequent endoscopic intervention, 1.8 before vs 3.4 after airway reconstruction. CONCLUSION Bariatric surgery reduced the number of endoscopic airway interventions and enabled patients to undergo successful definitive airway reconstructive surgery.
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Affiliation(s)
- Matyas Fehervari
- Chelsea and Westminster Hospital, London, UK.
- Imperial College London, London, UK.
| | | | - Rebecca Towning
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Kevin Haire
- Chelsea and Westminster Hospital, London, UK
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | | | - Guri Sandhu
- Imperial College London, London, UK
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Evangelos Efthimiou
- Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
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Ahmed J, Chard LS, Yuan M, Wang J, Howells A, Li Y, Li H, Zhang Z, Lu S, Gao D, Wang P, Chu Y, Al Yaghchi C, Schwartz J, Alusi G, Lemoine N, Wang Y. A new oncolytic V accinia virus augments antitumor immune responses to prevent tumor recurrence and metastasis after surgery. J Immunother Cancer 2021; 8:jitc-2019-000415. [PMID: 32217766 PMCID: PMC7206973 DOI: 10.1136/jitc-2019-000415] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 01/02/2023] Open
Abstract
Background Local recurrence and remote metastasis are major challenges to overcome in order to improve the survival of patients with cancer after surgery. Oncolytic viruses are a particularly attractive option for prevention of postsurgical disease as they offer a non-toxic treatment option that can directly target residual tumor deposits and beneficially modulate the systemic immune environment that is suppressed post surgery and allows residual disease escape from control. Here, we report that a novel Vaccinia virus (VV), VVΔTKΔN1L (with deletion of both thymidine kinase (TK) and N1L genes) armed with interleukin 12 (IL-12), can prolong postoperative survival when used as a neoadjuvant treatment in different murine and hamster surgical models of cancer. Methods A tumor-targeted replicating VV with deletion of TK gene and N1L gene (VVΔTKΔN1L) was created. This virus was armed rationally with IL-12. The effect of VVΔTKΔN1L and VVΔTKΔN1L-IL12 on modulation of the tumor microenvironment and induction of tumor-specific immunity as well the feasibility and safety as a neoadjuvant agent for preventing recurrence and metastasis after surgery were assessed in several clinically relevant models. Results VVΔTKΔN1L can significantly prolong postoperative survival when used as a neoadjuvant treatment in three different surgery-induced metastatic models of cancer. Efficacy was critically dependent on elevation of circulating natural killer cells that was achieved by virus-induced cytokine production from cells infected with N1L-deleted, but not N1L-intact VV. This effect was further enhanced by arming VVΔTKΔN1L with IL-12, a potent antitumor cytokine. Five daily treatments with VVΔTKΔN1L-IL12 before surgery dramatically improved postsurgical survival. VVΔTKΔN1L armed with human IL-12 completely prevented tumor recurrence in surgical models of head and neck cancer in Syrian hamsters. Conclusions These data provide a proof of concept for translation of the regime into clinical trials. VVΔTKΔN1L-IL12 is a promising agent for use as an adjuvant to surgical treatment of solid tumors.
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Affiliation(s)
- Jahangir Ahmed
- Centre for Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Louisa S Chard
- Centre for Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Ming Yuan
- Centre for Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Jiwei Wang
- National Centre for International Research in Cell and Gene Therapy, Zhengzhou University, Zhengzhou, Henan, China
| | - Anwen Howells
- Centre for Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Yuenan Li
- National Centre for International Research in Cell and Gene Therapy, Zhengzhou University, Zhengzhou, Henan, China
| | - Haoze Li
- National Centre for International Research in Cell and Gene Therapy, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhongxian Zhang
- National Centre for International Research in Cell and Gene Therapy, Zhengzhou University, Zhengzhou, Henan, China
| | - Shuangshuang Lu
- National Centre for International Research in Cell and Gene Therapy, Zhengzhou University, Zhengzhou, Henan, China
| | - Dongling Gao
- National Centre for International Research in Cell and Gene Therapy, Zhengzhou University, Zhengzhou, Henan, China
| | - Pengju Wang
- National Centre for International Research in Cell and Gene Therapy, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongchao Chu
- National Centre for International Research in Cell and Gene Therapy, Zhengzhou University, Zhengzhou, Henan, China
| | - Chadwan Al Yaghchi
- Centre for Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Joel Schwartz
- University of Illinois at Chicago, Chicago, Illinois, USA.,University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ghassan Alusi
- Centre for Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Nicholas Lemoine
- Centre for Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Yaohe Wang
- Centre for Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
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Haywood M, Lovell L, Roe J, Clunie G, Sandhu G, Al Yaghchi C. Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study. Clin Otolaryngol 2021; 46:1229-1236. [PMID: 34087029 DOI: 10.1111/coa.13820] [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: 02/12/2021] [Revised: 04/13/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well-recognised sequela of LTS and airway surgery, however studies have employed mostly non-validated assessments post-operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post-operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold-standard management framework for its management. DESIGN, SETTING, PARTICIPANTS AND MAIN OUTCOME MEASURES We performed a retrospective cohort study of adult airway reconstruction procedures from 2016-2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post-operative day one and post-stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores. RESULTS Forty-four patients underwent forty-six reconstructions. Baseline incidence of penetration-aspiration was considerably higher than the general population and worsened in the immediate post-operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post-operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent. CONCLUSIONS We present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may avoid the complications, costs and morbidity of prolonged nutritional support.
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Affiliation(s)
- Matthew Haywood
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Lindsay Lovell
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Justin Roe
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Gemma Clunie
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
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12
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Rouhani MJ, Sandhu G, Al Yaghchi C. In Response to Voice, Swallow and Airway Outcomes Following Tracheostomy for COVID-19. Laryngoscope 2021; 131:E1639. [PMID: 33635561 PMCID: PMC8014616 DOI: 10.1002/lary.29483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Maral J Rouhani
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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13
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Rouhani MJ, Clunie G, Thong G, Lovell L, Roe J, Ashcroft M, Holroyd A, Sandhu G, Al Yaghchi C. A Prospective Study of Voice, Swallow, and Airway Outcomes Following Tracheostomy for COVID-19. Laryngoscope 2020; 131:E1918-E1925. [PMID: 33341953 DOI: 10.1002/lary.29346] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/28/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has led to unprecedented demands on healthcare with many requiring intubation. Tracheostomy insertion has often been delayed and the enduring effects of this on voice, swallow, and airway outcomes in COVID-19 tracheostomy patients are unknown. The aim of this study was to prospectively assess these outcomes in this patient cohort following hospital discharge. METHODS All COVID-19 patients who had undergone tracheostomy insertion, and were subsequently decannulated, were identified at our institution and followed up 2 months post-discharge. Patient-reported (PROMS) and clinician-reported outcome measures, endoscopic examination, and spirometry were used to assess voice, swallow, and airway outcomes. RESULTS Forty-one patients were included in the study with a mean age of 56 years and male:female ratio of 28:13. Average duration of endotracheal intubation was 24 days and 63.4% of tracheostomies were performed at day 21 to 35 of intubation. 53.7% had an abnormal GRBAS score and 30% reported abnormal swallow on EAT-10 questionnaire. 81.1% had normal endoscopic examination of the larynx, however, positive endoscopic findings correlated with the patient self-reported VHI-10 (P = .036) and EAT-10 scores (P = .027). 22.5% had spirometric evidence of fixed upper airway obstruction using the Expiratory-Disproportion Index (EDI) and Spearman correlation analysis showed a positive trend between abnormal endoscopic findings and EDI scores over 50 (P < .0001). CONCLUSION The preliminary results of this study reveal a high incidence of laryngeal injury among patients who underwent intubation and tracheostomy insertion during the COVID-19 pandemic. As these patients continue to be followed up, the evolution of these complications will be studied. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E1918-E1925, 2021.
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Affiliation(s)
- Maral J Rouhani
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Gemma Clunie
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Gerard Thong
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Lindsay Lovell
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Justin Roe
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Margaret Ashcroft
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Andrew Holroyd
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, U.K
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Rotman A, Maughan EF, Rouhani MJ, Holroyd A, Ashcroft M, Al Yaghchi C, Sandhu G. Laryngeal sarcoidosis at a tertiary airway centre: Our experience with 32 patients. Clin Otolaryngol 2020; 46:445-450. [PMID: 33274590 DOI: 10.1111/coa.13679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Anthony Rotman
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth F Maughan
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Maral J Rouhani
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Holroyd
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Margaret Ashcroft
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
OBJECTIVES To determine the number of patients with idiopathic subglottic stenosis (iSGS) who have contracted coronavirus disease 2019 (COVID-19), the impact of the pandemic on patients' attitudes on seeking help and attending hospitals, as well as the delays in the offer of treatment from the local health care systems. METHODS A 29-question survey was distributed to an international mailing list of patients with subglottic stenosis to assess the patient experience during the COVID-19 pandemic. RESULTS A total of 543 patients with iSGS participated. Fewer than 1 in 10 patients with iSGS have experienced COVID-19 symptoms, which were predominantly mild to moderate, with only 2 hospitalizations. Most patients with iSGS (80.0%) have not been advised they are high risk for COVID-19, despite 36.5% of patients with iSGS being obese (body mass index of 30+). Delays to surgeries and in-office procedures have impacted 40.1% of patients currently receiving treatment, with 38.8% of patients increasingly struggling to breathe as a result. Anxiety and stress are increasing among patients, with 3 in 4 (75.2%) reporting they are anxious about travelling by public transport, contracting the virus in hospital and infecting loved ones (69.0% and 71.9%, respectively). Of greater concern is that 23.1% with increasing dyspnea state they are staying away from hospital despite their deteriorating health. CONCLUSIONS The COVID-19 pandemic has had an impact on the physical and psychological health of patients with iSGS. Surgeons managing cases of laryngotracheal stenosis need to offer appropriate support and communication to these high risk patients. During the pandemic, this should include self-isolation if they are dyspneic or on treatments that may have reduced their immunity. In addition, they should offer safe clinical pathways to airway assessment and treatments, if they become necessary. To minimize unnecessary travel, much of the clinical monitoring can be carried out remotely, using telephone or video-based consultations, in conjunction with local health professionals.
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Affiliation(s)
- Catherine Anderson
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, 129367Charing Cross Hospital, London, United Kingdom
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, 129367Charing Cross Hospital, London, United Kingdom
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, 129367Charing Cross Hospital, London, United Kingdom
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Maughan EF, Michaels J, Miller B, Weir J, Salama A, Warner E, Ghufoor K, Sandhu G, Al Yaghchi C. Primary Immunoglobulin G4-Related Laryngeal Disease: A Case Series and Review of Literature. Clin Med Insights Case Rep 2020; 13:1179547620960197. [PMID: 33192112 PMCID: PMC7597568 DOI: 10.1177/1179547620960197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
Objective: Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognised cause of various systemic fibro-inflammatory conditions. However, laryngeal involvement as a primary feature is extremely rare. We aimed to report on a case series of such patients and examine the global literature relating to laryngeal involvement. Methods: Having previously reported a case of IgG4-RD laryngeal pseudotumour, we describe a case series of further 4 patients with primary laryngeal IgG4-RD managed by our UK quaternary airway service and provide a brief overview of laryngeal IgG4-RD. Results: Including our cases, 14 cases of primary laryngeal IgG4-RD have been reported. Vocal cord involvement is relatively uncommon. Repeat biopsies may be required to achieve histological diagnosis. Remission is achievable by commencement of immunomodulatory treatment, following which laryngeal reconstruction may be necessary. Conclusion: Laryngeal involvement is a rare presentation of IgG4-RD, itself a rare and difficult-to-diagnose condition. A high and prolonged index of suspicion is necessary from both surgical and pathological specialists for correct diagnosis and management.
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Affiliation(s)
- Elizabeth F Maughan
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Joshua Michaels
- Department of Otolaryngology, Barts Health NHS Trust, London, UK
| | - Benjamin Miller
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Weir
- Department of Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Alan Salama
- Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
| | - Elinor Warner
- Department of Otolaryngology, Barts Health NHS Trust, London, UK
| | - Khalid Ghufoor
- Department of Otolaryngology, Barts Health NHS Trust, London, UK
| | - Gurpreet Sandhu
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Chadwan Al Yaghchi
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
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Al Yaghchi C, Ferguson C, Sandhu G. Percutaneous tracheostomy in patients with COVID-19: sealing the bronchoscope with an in-line suction sheath. Br J Anaesth 2020; 125:e185-e186. [PMID: 32386837 PMCID: PMC7184020 DOI: 10.1016/j.bja.2020.04.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 12/03/2022] Open
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18
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Affiliation(s)
- Keli Dusu
- Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Robert Quiney
- ENT, Royal National Throat Nose and Ear Hospital, London, UK
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19
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Eweiss A, Al Yaghchi C, Sharma S, Wong PY. Assessment of posterior choanal obstruction caused by adenoidal hypertrophy: Intra-operative mirror versus rigid nasendoscopic examination. Int J Pediatr Otorhinolaryngol 2018; 110:144-146. [PMID: 29859577 DOI: 10.1016/j.ijporl.2018.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aim of the study is to compare the degree of posterior choanal obstruction caused by adenoidal hypertrophy intra-operatively, when assessed by mirror versus rigid nasendoscopic examination, in children undergoing adenoidectomy. METHODS This is a prospective blinded study including all consecutive paediatric cases undergoing adenoidectomy under care of the senior author during the period from June 2015 to December 2016. All cases were performed under general anaesthesia. The degree of posterior choanal obstruction caused by adenoidal hypertrophy was assessed in each patient using both a rigid nasendoscope and a nasopharyngeal mirror. Photographs of the choanae and the adenoids were obtained for both methods. Two independent ENT specialists (a registrar and a consultant), who were blinded to the clinical history and identity of the patients, assessed these photographs. Assessors scored the degree of choanal obstruction on the right and left sides separately out of 100%. The scores were analysed using the Two-Sample equal variance T-test function. RESULTS A total of 26 patients were included; all of them were children aged between 2 and 13 years. A total of 52 choanae were assessed and photographed, resulting in 52 photographs for the nasendoscopic views and 26 photographs for the mirror views. The trans-nasal nasendoscopic views consistently showed a significantly higher degree of posterior choanal obstruction compared to trans-oral mirror examination views (P-value < 0.001). There was no significant difference between the scores of both assessors (P-value > 0.05). In 8 of the 26 patients (30.7%), the registrar's decision would have changed from not proceeding with surgery had he only used the mirror view, to proceeding with surgery had he also used the nasoendoscopic view. This was the case for 6 of the 26 patients (23%) reviewed by the consultant. There were three patients in common in which both the registrar and the consultant would have similarly changed decisions. CONCLUSION Intra-operative nasendoscopy is more sensitive than mirror examination in assessing the degree of posterior choanal obstruction due to adenoidal hypertrophy. It is important to consider nasendoscopy in patients with symptoms of adenoidal hypertrophy where mirror examination of the posterior choanae is negative.
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Affiliation(s)
- Ahmed Eweiss
- Department of Ear, Nose and Throat Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, UK; Otorhinolaryngology Department, Faculty of Medicine, University of Alexandria, Egypt
| | - Chadwan Al Yaghchi
- Department of Ear, Nose and Throat Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, UK
| | - Sunil Sharma
- Department of Ear, Nose and Throat Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, UK
| | - Phui Yee Wong
- Department of Ear, Nose and Throat Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, UK.
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Al Yaghchi C, Zhang Z, Alusi G, Lemoine NR, Wang Y. Vaccinia virus, a promising new therapeutic agent for pancreatic cancer. Immunotherapy 2015; 7:1249-58. [PMID: 26595180 DOI: 10.2217/imt.15.90] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The poor prognosis of pancreatic cancer patients signifies a need for radically new therapeutic strategies. Tumor-targeted oncolytic viruses have emerged as attractive therapeutic candidates for cancer treatment due to their inherent ability to specifically target and lyse tumor cells as well as induce antitumor effects by multiple action mechanisms. Vaccinia virus has several inherent features that make it particularly suitable for use as an oncolytic agent. In this review, we will discuss the potential of vaccinia virus in the management of pancreatic cancer in light of our increased understanding of cellular and immunological mechanisms involved in the disease process as well as our extending knowledge in the biology of vaccinia virus.
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Affiliation(s)
- Chadwan Al Yaghchi
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, UK
| | - Zhongxian Zhang
- National Centre for International Research in Cell & Gene Therapy, Sino-British Research Centre for Molecular Oncology, Zhengzhou University, China
| | - Ghassan Alusi
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, UK
| | - Nicholas R Lemoine
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, UK.,National Centre for International Research in Cell & Gene Therapy, Sino-British Research Centre for Molecular Oncology, Zhengzhou University, China
| | - Yaohe Wang
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, UK.,National Centre for International Research in Cell & Gene Therapy, Sino-British Research Centre for Molecular Oncology, Zhengzhou University, China
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Al Yaghchi C, Ferguson L, Sandhu G. Enhanced Laryngeal Suspension: A Preliminary Experience. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811416318a123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Describe and evaluate the effectiveness of enhanced laryngeal suspension on dyspagia and aspiration secondary to skull base surgery and lower cranial nerve injuries. Method: Prospective study in a tertiary ENT unit between 2007 and 2010 of patients who underwent enhanced laryngeal suspension. Demographics, pathology, and cranial nerve injuries were documented. Nutrition, oral intake, and aspiration risk grade (G 0-3) were compared pre- and postoperatively. All patients had videofloroscopy evaluation, and aspiration-penetration scale changes were documented. Results: Enhanced laryngeal suspension involves removal of the thyroid cartilage above the vocal folds and suture suspension to the hyoid bone. It can be combined with a medialization thyroplasty and botox to cricopharyngeus if indicated. To date we performed this procedure on 9 patients. At first presentation, 77% (n = 7) were nil by mouth. Today, only 22% (n = 2) remains NBM. Gastrostomy tube dependance dropped from 77% (n = 7) to 44% (n = 4), and of those only 2 are on total enteral feed. Aspiration risk improved through the follow-up period (from 66% grade 3 down to 11%). Conclusion: Enhanced laryngeal suspension is an important tool in the multimodality approach to management of dyspagia and aspiration caused by skull base surgery and lower cranial nerve injuries. This is a preliminary study with a small sample, and results must be interpreted with this in mind.
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