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Harris M, Zloczower E, Pinhas S, Allon R, Zornitzki T, Malka L, Cohen Y, Lahav Y, Cohen O. Consistency in the distribution of Bethesda System for Reporting Thyroid Cytology (BSRTC) Categories over 9 years: A single institute, retrospective study. Endocr Pract 2024:S1530-891X(24)00476-2. [PMID: 38570016 DOI: 10.1016/j.eprac.2024.03.393] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) has evolved since it was first introduced in 2009 to become a worldwide accepted cytologic analysis reference, due to its simplicity and reproducibility. To date, the consistency of BSRTC throughout time has yet to be investigated. METHODS Retrospective single institution case series with chart review of all patients who underwent FNAs for a thyroid nodule in our institution between the years 2010 to 2018 with a documented BSRTC classification. Data collection included demographics, risk factors, sonographic evaluation, nodule size, and final pathology when feasible. The main outcome is the difference in the rates of BSRTC categories benign, AUS, FN, SFM, and malignant (BSRTC II-VI, respectively) between the study years. RESULTS A total of 2830 thyroid nodules were included. BSRTC II-VI distribution was 83.9% (2,373), 8.2%, (232), 2.7% (75), 3.3% (93), and 2.0% (57) respectively. There was no significant change in the overall trend of each BSRTC category distribution throughout the study. There was a significant increase in the benign cytology rate (BSRTC II) in 2011 compared to 2015 and 2018 (76.4% compared to 88.7% and 87.6%, respectively. p < 0.005) alongside a significant decline in the AUS category rate (BSRTC III) between the same years (13.0% compared to 4.8% and 5.5%, respectively. p < 0.005). CONCLUSION BSRTC showed consistency throughout the study across all observed categories. An overlap between AUS and benign may exist, possibly due to the heterogenic definition of AUS as reflected in the 2023 BSRTC subclassification for AUS.
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Affiliation(s)
- Mai Harris
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Medical School for International Health, Ben-Gurion University of the Negev, Israel
| | - Elchanan Zloczower
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine; Hebrew University of Jerusalem, Israel
| | - Sapir Pinhas
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine; Hebrew University of Jerusalem, Israel
| | - Raviv Allon
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine; Hebrew University of Jerusalem, Israel
| | - Taiba Zornitzki
- Hebrew University of Jerusalem, Israel; Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center
| | - Liron Malka
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine; Hebrew University of Jerusalem, Israel
| | - Yonatan Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine; Hebrew University of Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine; Hebrew University of Jerusalem, Israel
| | - Oded Cohen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
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Zloczower E, Netanely K, Shapira-Galitz Y, Pinhas S, Aharonovich N, Lahav Y, Allon R. Outcomes of abscess tonsillectomy in patients awaiting tonsillectomy: A comparison with interval tonsillectomy. Am J Otolaryngol 2024; 45:104198. [PMID: 38104468 DOI: 10.1016/j.amjoto.2023.104198] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Peritonsillar abscesses (PTA) occasionally occur in patients who have a concurrent history of recurrent tonsillitis or prior PTA episodes. These patients sometimes meet the indications for elective tonsillectomy even prior to the current PTA event. Abscess ("Quinsy") tonsillectomy (QT) could serve as definitive treatment in this specific subgroup, though it is not performed often. The purpose of this study was to compare the perioperative outcomes between immediate QT and tonsillectomy performed several days (delayed QT) or weeks (Interval tonsillectomy, IT) after incision and drainage (I&D) of the PTA in this specific subgroup. MATERIALS AND METHODS A retrospective perioperative outcomes analysis of patients undergoing tonsillectomy (2002-2022) compared QT to delayed QT and IT in patients with PTA meeting AAO-HNS elective tonsillectomy criteria. RESULTS 110 patients were included: 55 underwent IT, 36 underwent delayed QT, and 19 underwent immediate QT. Postoperative hemorrhage rates were 14.5 %, 11.1 %, and 5.3 % for IT, delayed QT, and immediate QT, respectively (P = 0.08). Mean hospitalization durations were 7.98, 6.92, and 5.37 days for IT, delayed QT, and immediate QT, respectively (P < 0.01). IT had a higher readmission rate due to pain compared to QT (14.5 % vs. 1.9 %, p = 0.032). CONCLUSION Immediate QT in PTA patients eligible for elective tonsillectomy is associated with lower postoperative hemorrhage, shorter admission time, and potentially reduced postoperative pain compared to I&D and delayed or interval tonsillectomy. These findings suggest that immediate QT should be considered as a primary treatment in this subgroup of eligible patients.
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Affiliation(s)
- Elchanan Zloczower
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katya Netanely
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sapir Pinhas
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noy Aharonovich
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raviv Allon
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Betito HR, Tandler N, Allon R, Ganz B, Lahav Y, Shapira-Galitz Y. Evaluation of the Whiteout During Fiberoptic Endoscopic Evaluation of Swallowing and Examination of Its Correlation with Pharyngeal Residue and Aspiration. Dysphagia 2024:10.1007/s00455-023-10663-1. [PMID: 38358550 DOI: 10.1007/s00455-023-10663-1] [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: 10/14/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024]
Abstract
To evaluate the whiteout duration (WOd) and intensity (WOi) during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and examine their correlation with each other and age, gender, bolus consistencies, residue, and aspiration. Retrospective review of 75 videorecorded FEES. The first swallow of each of the following were scored: "Empty" swallow, semisolids, solids, and liquids (International dysphagia diet standardization initiative (IDDSI) 4, 7, 0, respectively). Data scored for each swallow included WOd, WOi, Penetration and aspiration scale (PAS), Pharyngeal residue (Yale Pharyngeal Residue Severity Rating Scale, YPR-SRS), and saliva pooling (Murray Secretion scale, MSS). The highest PAS and YPR-SRS for each consistency during the entire examination were also collected. WOd was significantly longer for stronger WOi in IDDSI4 swallows (p = 0.019). WOi was weaker for IDDSI0 swallows compared to IDDSI7, IDDSI4, and empty swallows (p < 0.05). Patients with saliva pooling had significantly shorter WOd (0.81 ± 0.3 s for MSS = 0 vs. 0.62 ± 0.24 for MSS = 3, p = 0.04). Lower WOi was associated with higher mean age for IDDSI0 (mean ages of 73 ± 12, 64 ± 14, 73 ± 7, 59 ± 16 years for intensity levels 1-4 respectively, p = 0.019). Swallows with weaker WOi and longer WOd had significantly more aspirations in IDDSI7 (28.8% of PAS ≥ 6 for intensity 2 vs 0% for intensity 4, p = 0.003 and 0.77 ± 0.4 s for PAS 1-2 vs. 1.02 ± 0.08 for PAS 6-8, p = 0.049). WOi and WOd are significantly associated with each other. WOi may vary for different bolus consistencies and decreases with age. Longer WOd and weaker WOi are associated with penetration-aspiration. Shorter WOd is associated with saliva pooling.
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Affiliation(s)
- Hadar Rotem Betito
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Noy Tandler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raviv Allon
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Boaz Ganz
- Department of Speech and Language Pathology, Kaplan Medical Center, Rehovot, Israel
| | - Yonatan Lahav
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Yael Shapira-Galitz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.
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Shoffel-Havakuk H, Lahav Y, Reuven Y, Shopen Y, Shapira-Galitz Y, Hamzany Y. Subtotal Submucosal Arytenoidectomy with Lateralization Sutures (SMALS) Covered by a Mucosal Flap. Laryngoscope 2024; 134:353-360. [PMID: 37551887 DOI: 10.1002/lary.30940] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Glottic airway stenosis (GAWS) may result from bilateral paralysis (BVFP) or posterior glottic stenosis (PGS). Since the glottis is the principal airway sphincter, surgeons shift on the balance between airway, aspirations, and voice. We aim to describe our surgical technique and outcome of the SMALS procedure for GAWS correction. METHODS A retrospective cohort of patients who underwent SMALS for PGS between 2018 and 2021. SMALS involves: endoscopic submucosal subtotal arytenoidectmy (preserving medial mucosal flap) and lateralization sutures. The sutures lateralize the mucosal flap to cover the arytenoidectomy bed without lateralization of the membranous vocal fold; expanding the posterior glottis, while preserving a relatively good voice. Covering the arytenoidectomy bed enhances healing. Medical and surgical data, airway, voice, and swallowing symptoms were collected. Relative glottic opening area (RGOA) and relative glottic insufficiency area (RGIA) were calculated. RESULTS Eleven PGS patients who underwent 15 SMALS were included (4 bilateral), all patients had post-intubation PGS, 1 patient also had prior radiation to the larynx. All patients were tracheostomy-dependent. There were no major complications. No granulation or retracting scar was observed at follow-up. None had a persistent voice or swallowing disability. Successful outcome (decannulation) was achieved in 8 (73%); RGOA increased in all (Δ = 0.37; p = 0.003), while RGIA remained relatively stable (Δ = 0.02; p = 0.055). CONCLUSIONS SMALS is a safe and effective, novel modification of the classic arytenoidectomy, for GAWS correction that can be easily applied and may expand the airway without significant glottic insufficiency symptoms. LEVEL OF EVIDENCE 4 Laryngoscope, 134:353-360, 2024.
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Affiliation(s)
- Hagit Shoffel-Havakuk
- Faculty of Medicine, Tel Aviv University School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Yonatan Reuven
- Faculty of Medicine, Tel Aviv University School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yoni Shopen
- Faculty of Medicine, Tel Aviv University School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yeal Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Yaniv Hamzany
- Faculty of Medicine, Tel Aviv University School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
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Jahshan F, Marshak T, Qarawany J, Markel B, Sberro A, Lahav Y, Layous E, Eisenbach N, Shochat I, Sela E, Ronen O. Incidental Laryngeal Findings in Routine Laryngopharyngeal Reflux Diagnosis. Isr Med Assoc J 2024; 26:40-44. [PMID: 38420641] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Laryngopharyngeal reflux (LPR) refers to the backflow of acidic stomach content into the larynx, pharynx, and upper aerodigestive tract. The diagnosis of LPR is based on the patient's history and findings of the laryngoscopy associated with LPR. Other possible manifestations consistent with LPR symptoms include laryngeal cancer, vocal fold granulomas, Reinke's space edema, and vocal polyps. In this study, we compared the characteristics of patients with LPR symptoms and incidental laryngeal findings (ILF) in the laryngoscopic evaluation to those without ILF (WILF). OBJECTIVES Determine the characteristics of LPR-symptomatic patients with ILF versus WILF. METHODS In this retrospective study, we examined 160 medical charts from patients referred to the otolaryngology clinic at Galilee Medical Center for LPR evaluation 2016-2018. The reflux symptoms index (RSI), reflux finding score (RFS), and demographics of the patient were collected. All patients with a positive RSI score for LPR (RSI > 9) were included, and the profiles of patients with versus without ILF on laryngoscopy examination were compared. RESULTS Of the 160 patients, 20 (12.5%) had ILF during laryngoscopy. Most had vocal cord findings such as leukoplakia (20%), polyps (15%), and nodules (20%). Hoarseness, throat clearing, swallowing difficulty, breathing difficulties, and total RSI score were significantly higher in patients with ILF. CONCLUSIONS Evaluation of LPR symptoms may provide otolaryngologists with a tool to identify patients with other findings on fiberoptic laryngoscopy. A laryngoscopic examination should be part of the examination of every patient with LPR to enable diagnosis of incidental findings.
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Affiliation(s)
- Forsan Jahshan
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Department of Otolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tal Marshak
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jamal Qarawany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Boaz Markel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amiel Sberro
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eli Layous
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Netanel Eisenbach
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Isaac Shochat
- Department of Otolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eyal Sela
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Betito HR, Chaushu H, Lahav Y, Pinhas S, Warman M, Zornitzki T, Malka L, Cohen J, Lahav G, Cohen O. The impact of iodine deficiency exposure on thyroid nodule cytology and pathology - A single institute, case-control study. Am J Otolaryngol 2024; 45:104022. [PMID: 37738882 DOI: 10.1016/j.amjoto.2023.104022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/27/2023] [Accepted: 08/06/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE The association between follicular carcinoma and iodine deficiency (ID) is based on epidemiological studies and their inherent biases. The aim of the study was to assess the impact of long-term ID exposure on thyroid nodule cytology and final pathology in a distinct group of patients within a single institution. METHODS Ethiopian origin patients were compared to an aged-matched group of non-Ethiopian patients. Demographics, risk factors, clinical presentation, cytology and pathology were collected and compared. Final outcomes were cytology and pathology distribution. RESULTS A total of 489 (246 Ethiopian, 243 control) nodules of 461 patients (230 and 231 respectively) were included. Ethiopian patients had lower rates of thyroid cancer risk factors (p=0.05). Cytology analysis demonstrated significant group differences (p=0.03), as Ethiopian patients had higher rates of benign cytology (85% vs. 75.7%, respectively). Pathology analysis demonstrated a significantly lower malignancy rate among Ethiopian patients (39.2% (20/51) vs. 63.3% (31/49), p=0.027, respectively). The Ethiopian group had a significant higher rate of follicular carcinoma compared to the control group (25% [5/20] vs. 3.2% [1/31], p=0.034, respectively) and lower rates of papillary thyroid carcinoma (25% [5/20] vs. 61.3% [19/31], p=0.017, respectively). CONCLUSIONS The association between ID and FC exists years following immigration and exposure to a better iodine diet, implying that differentiation may be affected in earlier stages and levels of exposure.
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Affiliation(s)
- Hadar Rotem Betito
- Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.
| | - Hen Chaushu
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yonatan Lahav
- Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Sapir Pinhas
- Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Meir Warman
- Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Taiba Zornitzki
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Israel
| | - Liron Malka
- Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Jonathan Cohen
- Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Gil Lahav
- Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Oded Cohen
- Hebrew University-Hadassah Medical School, Jerusalem, Israel; Samson Assuta Ashdod University Hospital
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Lahav Y, Pinhas S, Shapira-Galitz Y, Warman M, Cohen O, Shoffel-Havakuk H, Tessler I. In-office KTP laser treatment for laryngeal pathologies: 5-years outcomes. Lasers Surg Med 2023. [PMID: 37061889 DOI: 10.1002/lsm.23660] [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: 08/08/2022] [Revised: 02/11/2023] [Accepted: 03/21/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION In the past two decades, laser systems were introduced into the office setting for laryngeal pathologies, offering the advantages of a shorter procedure and recovery. To date, long-term data on outcomes is limited. This study aims to evaluate the efficacy and safety of the office-based potassium-titanyl-phosphate (KTP) laser procedure for laryngeal pathologies. METHODS A retrospective cohort of in-office KTP laser procedures for two main vocal folds lesions groups: (i) benign and pre-malignant; and (ii) intraepithelial lesions in a prior invasive cancer field between 2010 and 2020. Data were collected from electronic medical records, telephone interviews, and video documentation of the procedure, including treatment completion, disease control, and whether additional interventions were required. RESULTS A total of 81 patients underwent 153 in-office KTP laser procedures for benign (36, 44.4%), pre-malignant (15, 18.5%), and lesions in a prior malignancy field (30, 37.1%) with a mean of 1.89 ± 1.81 procedures per patient. One hundred and thirty-eight (90.2%) procedures were well tolerated and completed successfully. During the 5-years of follow-up, 63% of the patients with previous malignancy were managed exclusively in the office. In the pre-malignant group, 76% required no additional type of intervention. Patients with papilloma required significantly more procedures per patient compared with other pathologies (3.6 ± 4 vs. 1.61 ± 1, p-value = 0.02). Surgery was required only in 18.2% of the papilloma patients. Three (1.9%) patients had short-term complications, all resolved within 6 months. Failure to complete the procedure was significantly associated with active smoking (p-value < 0.001) and, in most cases (90%), was related to patient intolerance. CONCLUSION Office-based KTP laser laryngeal procedures have shown promising results for both benign and selected cases of lesions in a prior malignancy field with a high compliance and a very low complication rate, suggesting its use as an effective and safe treatment modality for selected patients.
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Affiliation(s)
- Yonatan Lahav
- Medical School, The Hebrew University, Jerusalem, Israel
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Sapir Pinhas
- Medical School, The Hebrew University, Jerusalem, Israel
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Yael Shapira-Galitz
- Medical School, The Hebrew University, Jerusalem, Israel
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Meir Warman
- Medical School, The Hebrew University, Jerusalem, Israel
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Oded Cohen
- Department of Surgery, Division of Otolaryngology, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel, Israel
| | - Hagit Shoffel-Havakuk
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Idit Tessler
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
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Shoffel-Havakuk H, Lahav Y, Shopen Y, Reuven Y, Bachar G, Hamzany Y. Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis. Laryngoscope 2023; 133:883-889. [PMID: 35815928 DOI: 10.1002/lary.30293] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/14/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the DISCO protocol (Dilation, Steroid injection, and post-operative Cough Exercise); a novel treatment for posterior glottic stenosis (PGS). Restoring glottic mobility in PGS is a major challenge. In orthopedic and plastic surgery, post-operative physical therapy is associated with improved motion range and flexibility; yet, this principle was never applied to laryngeal surgery. METHODS A retrospective cohort of PGS adult patients, treated by the DISCO protocol during 2018-2020. DISCO involves the following: scar release, glottic dilation, and steroid injection, followed by post-operative cough as glottic physical therapy. Maximal glottic opening angle (MGOA), relative glottic opening area (RGOA), and relative glottic insufficiency area (RGIA) were calculated before and post-operatively. RESULTS Seventeen patients were included; PGS etiology was post-intubation (n = 10), post-irradiation (n = 3), both (n = 1) and joint sclerosis (n = 3). Six patients also had additional airway disorders. Sixteen patients were tracheostomy-dependent. 2 (12%), 8 (47%) and 7 (41%) patients had type II, III and IV stenosis, respectively. Surgery included scar release, dilation and steroid injection alone in 7 patients; and additional unilateral sub-mucosal arytenoidectomy in 10. The mean follow-up was 17.5 months. There were no major complications. Successful outcomes (e.g., decannulation or permanent capping) were achieved in 14 (82%) patients with some restoration of joint movement. None had a persistent voice or swallowing complaints. Both MGOA and RGOA increased in all patients (p < 0.001). RGIA remained unchanged (p = 0.878). CONCLUSIONS The DISCO protocol is a novel, effective and safe approach for PGS correction that can be easily applied. It can restore vocal fold mobility and may expand the glottic airway without causing glottic insufficiency. LEVEL OF EVIDENCE 4 Laryngoscope, 133:883-889, 2023.
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Affiliation(s)
- Hagit Shoffel-Havakuk
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yoni Shopen
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Reuven
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Hamzany
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Allon R, Bhardwaj S, Sznitman J, Shoffel-Havakuk H, Pinhas S, Zloczower E, Shapira-Galitz Y, Lahav Y. A Novel Trans-Tracheostomal Retrograde Inhalation Technique Increases Subglottic Drug Deposition Compared to Traditional Trans-Oral Inhalation. Pharmaceutics 2023; 15:pharmaceutics15030903. [PMID: 36986764 PMCID: PMC10056688 DOI: 10.3390/pharmaceutics15030903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
Subglottic stenosis represents a challenging clinical condition in otolaryngology. Although patients often experience improvement following endoscopic surgery, recurrence rates remain high. Pursuing measures to maintain surgical results and prevent recurrence is thus necessary. Steroids therapy is considered effective in preventing restenosis. Currently, however, the ability of trans-oral steroid inhalation to reach and affect the stenotic subglottic area in a tracheotomized patient is largely negligible. In the present study, we describe a novel trans-tracheostomal retrograde inhalation technique to increase corticosteroid deposition in the subglottic area. We detail our preliminary clinical outcomes in four patients treated with trans-tracheostomal corticosteroid inhalation via a metered dose inhaler (MDI) following surgery. Concurrently, we leverage computational fluid-particle dynamics (CFPD) simulations in an extra-thoracic 3D airway model to gain insight on possible advantages of such a technique over traditional trans-oral inhalation in augmenting aerosol deposition in the stenotic subglottic region. Our numerical simulations show that for an arbitrary inhaled dose (aerosols spanning 1–12 µm), the deposition (mass) fraction in the subglottis is over 30 times higher in the retrograde trans-tracheostomal technique compared to the trans-oral inhalation technique (3.63% vs. 0.11%). Importantly, while a major portion of inhaled aerosols (66.43%) in the trans-oral inhalation maneuver are transported distally past the trachea, the vast majority of aerosols (85.10%) exit through the mouth during trans-tracheostomal inhalation, thereby avoiding undesired deposition in the broader lungs. Overall, the proposed trans-tracheostomal retrograde inhalation technique increases aerosol deposition rates in the subglottis with minor lower-airway deposition compared to the trans-oral inhalation technique. This novel technique could play an important role in preventing restenosis of the subglottis.
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Affiliation(s)
- Raviv Allon
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot 76100, Israel
- Correspondence: or
| | - Saurabh Bhardwaj
- Department of Biomedical Engineering, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petach-Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Sapir Pinhas
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - Elchanan Zloczower
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - Yael Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot 76100, Israel
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10
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Shoffel-Havakuk H, Cohen O, Lahav Y, Khafif A. Scarless Neck Feminization by Transoral Endoscopic Vestibular Approach Chondrolaryngoplasty: A Prospective Cohort. Otolaryngol Head Neck Surg 2023. [PMID: 36802074 DOI: 10.1002/ohn.296] [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: 09/16/2022] [Revised: 12/16/2022] [Accepted: 01/05/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Chondrolaryngoplasty (laryngeal-prominence reduction) is a gender affirmation surgery for transgender women, or for cisgender people desiring an esthetic correction. Up until recently, chondrolaryngoplasty required a visible neck scar. The transoral endoscopic vestibular approach (TOEVA) is gaining widespread use as a scarless alternative for thyroid/parathyroid surgeries. This study aims to describe the feasibility, safety, and outcomes of TOEVA-chondrolaryngoplasty, based on the first-ever performed cases. STUDY DESIGN A prospective cohort. SETTING An academic referral center. METHODS Adult patients interested in chondrolaryngoplasty underwent scarless TOEVA-chondrolaryngoplasty between 2019 and 2022, according to the described protocol. Video stroboscopy was recorded pre-and postoperatively. Surgical data, adverse events, and complications were recorded. Patients' satisfaction was measured using an outcome instrument for esthetic chondrolaryngoplasty. RESULTS Twelve patients (10 transgender women, a cisgender man, and a woman) were included. The mean age was 26.7 ± 6.5 years, ranging from 19 to 37. The average operative time was 3:01 ± 0:51 hours. The thyroid cartilage and laryngeal prominence were easily and safely approached and reduced, with no adverse events or major complications. All patients were discharged on postoperative day 1. A single patient had a temporary mental nerve hypoesthesia that resolved spontaneously. Otherwise, no other complications were encountered. Vocal folds' function remained unchanged in all patients. Patients were very much to completely satisfied with the surgical results as measured by the outcome instrument; median (interquartile range), 25 (21-27.75). CONCLUSION In this first reported cohort of scarless TOEVA-chondrolaryngoplasty, this approach was proven to be safe and feasible, with no adverse events or major complications, and with high patient satisfaction.
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Affiliation(s)
- Hagit Shoffel-Havakuk
- A.R.M. Center for Head and Neck Surgery and Oncology, Assuta Hospital Ramat Hachayal, Tel Aviv, Israel.,Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Cohen
- A.R.M. Center for Head and Neck Surgery and Oncology, Assuta Hospital Ramat Hachayal, Tel Aviv, Israel.,Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center, Be'er Sheva, Israel.,Faculty of Medicine, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Yonatan Lahav
- A.R.M. Center for Head and Neck Surgery and Oncology, Assuta Hospital Ramat Hachayal, Tel Aviv, Israel.,Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Khafif
- A.R.M. Center for Head and Neck Surgery and Oncology, Assuta Hospital Ramat Hachayal, Tel Aviv, Israel.,Faculty of Medicine, Ben Gurion University of the Negev, Be'er Sheva, Israel
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11
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Zloczower E, Bartov N, Allon R, Sokolov M, Lahav Y, Shoffel-Havakuk H. The impact of birth weight and gestational age on acute mastoiditis in children. Eur Arch Otorhinolaryngol 2022; 280:2133-2139. [PMID: 36153783 DOI: 10.1007/s00405-022-07672-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Previous data correlate preterm and low birth weight (LBW) with acute otitis media, but there is a gap concerning the relations with acute mastoiditis (AM). This study investigates the effect of LBW and preterm birth on AM disease severity, neuro-otological complications, and recurrence. STUDY DESIGN Retrospective cohort. SETTING Tertiary medical center. METHODS The cohort is retrospective in nature consisting of 294 children with AM admitted between 1999 and 2020. Data collection included: patient gestational age and birth weight, signs and symptoms, physical examination, laboratory tests, imaging findings, and long-term outcomes. RESULTS 294 cases of AM were included, 41/281 (15%) had LBW (< 2500 g), and 46/294 (15.7%) were preterm (gestational age < 37 weeks). We found no significant differences in laboratory tests, imaging studies (CT), rate of mastoidectomy performed, or late complications between LBW and normal birth weight (NBW) and between preterm and normal gestational age children. LBW children tended to develop AM at an older age compared with NBW children, 2.28 + 1.64 Vs. 1.84 + 1.4 years, respectively (p-value = 0.016). Additionally, preterm children were more prone to develop a second event of AM, with a shorter interval between these episodes. CONCLUSIONS LBW and preterm birth are not independent risk factors for disease severity, need for intervention, or future complications in AM. Yet, LBW children present with AM at an older age, and preterm children are more prone for recurrent episodes of AM with a shorter interval between episodes suggesting a distinct disease course in these populations.
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Affiliation(s)
- Elchanan Zloczower
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah Medical School, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Noam Bartov
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah Medical School, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Raviv Allon
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah Medical School, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Meirav Sokolov
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah Medical School, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hagit Shoffel-Havakuk
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
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12
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Allon R, Schiller T, Ziv Y, Lahav Y, Cohen O, Zornizki T. Post-hemithyroidectomy Pregnancy Thyroid Function Surveillance - Frequency, Adherence and Guideline Impact. Endocr Pract 2022; 28:847-852. [PMID: 35724833 DOI: 10.1016/j.eprac.2022.06.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Post-hemithyroidectomy women are at increased risk for gestational subclinical hypothyroidism. Therefore, the American Thyroid Association (ATA) recommends increased thyroid function surveillance for this subgroup of pregnant women. The Purpose of this study was to evaluate the frequency of thyroid function surveillance during pregnancy in post-hemithyroidectomy women, and to evaluate the adherence to the 2017 ATA guidelines and its possible impact since being published, on thyroid function surveillance rates. METHODS A retrospective study including all pregnancies conceived by post-hemithyroidectomy women operated at our institution between the years 1997-2020. The study cohort was subdivided by pregnancy date prior to 2018 and 2018 and onwards to evaluate the impact of the 2017 ATA guidelines. Adherence to the guidelines was defined as at least one TSH test in each trimester. RESULTS After exclusions, a total of 120 pregnancies conceived by 66 women who underwent hemithyroidectomy surgeries were included in this study. Overall, serum TSH examinations were performed during the first, second and third pregnancy trimesters in 86.6%, 40% and 16.6% of pregnancies (P<0.005), respectively. The examination rate since 2018 was 88%, 40% and 8% for first, second and third trimester, respectively (P<0.005). CONCLUSION Adherence to the latest ATA guidelines is low and its publication in 2017 did not increase the thyroid function surveillance rate in post-hemithyroidectomy women. Better patient education regarding the risks of gestational hypothyroidism following hemithyroidectomy and improved communications between treating surgeons, obstetricians, and endocrinologists may improve these rates.
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Affiliation(s)
- Raviv Allon
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University, Hadassah Medical School, Jerusalem, Israel
| | - Tal Schiller
- Hebrew University, Hadassah Medical School, Jerusalem, Israel; Endocrinology, Diabetes and Metabolism Institute, Kaplan Medical Center, Rehovot, Israel
| | - Yuval Ziv
- Hebrew University, Hadassah Medical School, Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University, Hadassah Medical School, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University, Hadassah Medical School, Jerusalem, Israel.
| | - Taiba Zornizki
- Hebrew University, Hadassah Medical School, Jerusalem, Israel; Endocrinology, Diabetes and Metabolism Institute, Kaplan Medical Center, Rehovot, Israel
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13
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Warman M, Syn-Hershko A, Cohen O, Tzipin Y, Lahav Y, Tessler I. Sino-nasal hemangiopericytoma: a case series and systematic literature review. Eur Arch Otorhinolaryngol 2022; 279:3989-3996. [PMID: 35103868 DOI: 10.1007/s00405-021-07239-w] [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: 06/03/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hemangiopericytoma is a rare tumor of the sino-nasal tract. Its clinical behavior is controversial. Whereas some describe an indolent course, others consider it to be an aggressive lesion with a tendency toward rapid local recurrence. Here, we describe our experience in the management of sino-nasal hemangiopericytoma (SN-HPC), comparing our experience with the current literature, and evaluating signs and tools to improve diagnosis and treatment. METHODS All cases of SN-HPC between 2010 and 2020 were extracted and reviewed from our institutional electronic medical records. SN-HPC cases from PubMed and EMBASE between 2010 and 2020 were analyzed in a systematic literature review using the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. Data regarding demographics, presentation, diagnosis, treatment, and outcome were collected. RESULTS We identified four cases of SN-HPC in the nasal cavity in our institution and an additional 53 cases in previous reports. The mean age at the time of diagnosis was 59 years, with a 1.2:1 male to female ratio. SN-HPC mostly appears unilaterally, arising in the ethmoid sinus (42.1%). The most common presenting symptoms were epistaxis (47.3) and nasal obstruction (47.3%). Both computed tomography (CT) and magnetic resonance imaging (MRI) were required for diagnosis and for tailoring the treatment plan. Endoscopic surgical excision was used in 85.9% of the patients, and in 15.7%, an additional preoperative embolization was performed, which was associated with septal necrosis in one patient (2.6%). The recurrence rate was 7%. CONCLUSION Although previous reports attribute an aggressive tumoral behavior to SN-HPC, our experience and the literature review support a more indolent course with low recurrence rates following complete endoscopic resection. Preoperative embolization can be useful in certain cases, but due to potential complications, it should not be routinely indicated.
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Affiliation(s)
- Meir Warman
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel. .,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Adi Syn-Hershko
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yevgeny Tzipin
- Department of Radiology, Invasive Radiology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Idit Tessler
- Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
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14
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Lahav Y, Warman M, Halperin D, Cohen O, Shapira-Galitz Y, Shoffel-Havakuk H. Subglottic Mucosal Flap: Endoscopic Single-Stage Reconstruction for Anterior Glottic Stenosis. Laryngoscope 2021; 132:612-618. [PMID: 34342884 DOI: 10.1002/lary.29799] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/11/2021] [Accepted: 07/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Anterior glottic stenosis (AGS) results from surgical intervention, carcinoma, papillomatosis, congenital, or idiopathic causes. It may be present as elastic web or fibrotic scar. It impairs vocal function and glottic airway. Reconstructive options include resection and placement of a keel or glottic web-based mucosal flaps to prevent restenosis. These methods may not be sufficient for reconstructing a thick anterior scar and may require multiple interventions. The aim of the study was to describe the anterior subglottic mucosal flap (ASGMF), a one-stage, keel-free technique for AGS repair. STUDY DESIGN A retrospective cohort. METHODS Patients with AGS were operated using the ASGMF between 2017 and 2020. The stenotic segment was excised, and then an ASGMF was developed. A unilateral oblique incision was performed to allow rotation and advancement of the flap toward the contralateral vocal fold. The flap was sutured to the mucosal edge of the vocal fold to create mucosal continuity and prevent restenosis. Vocal fold length ratio (VFLR), which is between the free part and the total vocal fold length, as well as stroboscopic measures, were calculated before and after surgery. RESULTS Twelve patients were enrolled. Etiologies were iatrogenic, dysplasia, papillomatosis, carcinoma, and congenital. Average VFLR improved from 0.33 to 0.87 (P-value < .0001). Median amplitude and mucosal wave propagation improved from 12.3% and 9.5% to 28.6% and 22.7%, respectively (P-values = .0278, .0385). Phase symmetry improved from 24.5% to 60.9% (P-value = .0413). No complications were encountered. CONCLUSIONS ASGMF for AGS is an effective surgical procedure, allowing for one stage, keel-free reconstruction of the anterior commissure. ASGMF can significantly elongate the free portion of the vocal folds and improve vibratory function. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Yonatan Lahav
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Otolaryngology, Head and Neck surgery, Kaplan Medical Center, Rehovot, Israel.,A.R.M. Center of Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Meir Warman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Otolaryngology, Head and Neck surgery, Kaplan Medical Center, Rehovot, Israel
| | - Doron Halperin
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Otolaryngology, Head and Neck surgery, Kaplan Medical Center, Rehovot, Israel
| | - Oded Cohen
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Otolaryngology, Head and Neck surgery, Kaplan Medical Center, Rehovot, Israel
| | - Yael Shapira-Galitz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Otolaryngology, Head and Neck surgery, Kaplan Medical Center, Rehovot, Israel
| | - Hagit Shoffel-Havakuk
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otolaryngology, Head and Neck surgery, Rabin Medical Center, Petach-Tikva, Israel
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15
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Lahav Y, Cohen O, Huszar M, Levy I, Cata JP, Halperin D, Shoffel-Havakuk H. Mu-Opioid Receptor Expression in Laryngeal Cancer. J Voice 2021; 37:433-439. [PMID: 33750623 DOI: 10.1016/j.jvoice.2021.02.018] [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: 01/01/2021] [Revised: 02/07/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Expression of mu-opioid receptors (MORs) has not been investigated in head and neck cancer. In this study, we aimed to assess the expression of opioids receptors in laryngeal cancer, compared to adjacent non-malignant tissue. STUDY DESIGN A retrospective case series in a single academic center. METHODS Sixty-four specimens were taken from 32 matched patients, diagnosed with laryngeal-carcinoma (20 supraglottic and 12 glottic), and were analyzed using immunohistochemical stains for MOR. All sections were examined and evaluated with a semi-quantitative analysis for staining intensity and cell count for a percentage of the positively stained cells. Survival of patients was compared based on MOR expression. RESULTS MOR staining intensity was significantly increased in laryngeal-carcinoma compared to the normal tissue adjacent to the carcinoma (P = 0.019). The percentage of stained cells in non-involved supraglottis was significantly higher compared to the non-involved glottis (P = 0.022), yet this difference was no longer found between supra- and glottic-carcinoma tissues. CONCLUSION MOR may play a role in the laryngeal cancer environment, as the expression in tumor cells alters from adjacent non-cancerous tissue.
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Affiliation(s)
- Yonatan Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hadassah School of Medicine, The Hebrew University, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hadassah School of Medicine, The Hebrew University, Jerusalem, Israel
| | - Monica Huszar
- Hadassah School of Medicine, The Hebrew University, Jerusalem, Israel; Department of Pathology, Kaplan Medical Center, Rehovot, Israel
| | - Iris Levy
- Hadassah School of Medicine, The Hebrew University, Jerusalem, Israel
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Doron Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hadassah School of Medicine, The Hebrew University, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv Israel.
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16
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Yaniv D, Reuven Y, Lahav Y, Cohen O, Hamzany Y, Moore A, Rapana OG, Argaman N, Halperin D, Popovtzer A, Bachar G, Shoffel-Havakuk H. Supraglottic Carcinoma in Intravenous Opioid Drug Abusers: A Distinct Disease with Improved Survival. Laryngoscope 2020; 131:E1190-E1197. [PMID: 32946621 DOI: 10.1002/lary.29067] [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: 05/13/2020] [Revised: 07/24/2020] [Accepted: 08/11/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recent evidence indicates an increased prevalence of intravenous opioid drug abusers (IVDAs) among supraglottic squamous cell carcinoma (SG-SCC) patients. This study investigates whether the clinical course of SG-SCC in IVDA differs from SG-SCC in non-IVDA. STUDY DESIGN A retrospective case-control study conducted in a in two tertiary referral centers. METHODS This case-control study compares IVDA with non-IVDA patients diagnosed and treated for SG-SCC in between 2005 and 2018. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier estimator. Adjusted odds ratios (ORs) for mortality were calculated using multivariant analyses. RESULTS A total of 124 patients were included; 21% (26) were IVDA, and 79% (98) were non-IVDA. Age at diagnosis in the IVDA group versus the non-IVDA group was 53 and 66 years, respectively (P = .001). Nevertheless, the age hazard ratio for OS was calculated and found to have minimal to no effect, 1.05 (95% Cl: 1.025-1.076). Otherwise, the two groups were comparable regarding demographics, other risk factors (i.e., gender, smoking, and alcohol), and comorbidities status, as well as the comparable stage at diagnosis, histologic grading, and treatment modalities. Although the DFS was comparable in both groups, the 5-year OS was 55% in the IVDA group compared with 34% among the non-IVDA patients (P = .04). In multivariant analyses for mortality, positive IVDA history was found to be protective, adjusted OR: 0.263 (95% CI: 0.081-0.854). Similarly, within the subgroup of 100 patients with advanced-stage disease (III and IV), the adjusted OR was 0.118 (95% CI: 0.028-0.495). CONCLUSIONS SG-SCC in IVDA patients has a distinct clinical course, presenting at a younger age, and may have improved prognosis. LEVEL OF EVIDENCE NA Laryngoscope, 131:E1190-E1197, 2021.
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Affiliation(s)
- Dan Yaniv
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yonatan Reuven
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Yaniv Hamzany
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Assaf Moore
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Olga G Rapana
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natan Argaman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Aron Popovtzer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Gideon Bachar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Hagit Shoffel-Havakuk
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
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17
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Jahshan F, Ronen O, Qarawany J, Markel B, Sberro A, Yeung W, Lahav Y, Layous E, Eisenbach N, Sela E, Marshak T. Inter-Rater Variability of Reflux Finding Score Amongst Otolaryngologists. J Voice 2020; 36:685-689. [PMID: 32873431 DOI: 10.1016/j.jvoice.2020.07.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laryngopharyngeal reflux (LPR) is an extra-oesophageal variant of gastro-oesophgeal reflux disease. Patients often do not present with the classic reflux symptoms of heartburn or regurgitation. Accurate diagnosis of LPR can be challenging. The reflux finding score (RFS) is system based on the assessment of eight parameters seen on fibre optic laryngoscopy, used to determine the presence and the severity of laryngopharyngeal reflux (LPR). Scoring the RFS is subjective and highly dependent on the examiner's eye and experience. In this study, we investigated the inter-rater reliability between three otolaryngologists scoring a large library of video-recorded laryngoscopies for RFS. AIM To evaluate the usefulness of RFS in daily clinical practice by assessing inter-rater reliability among otolaryngologists when interpreting a bank of identical fibre optic laryngoscopy examinations. METHOD Three board-certified otolaryngologists with different subspecialist interests examined video-recorded fibre optic laryngoscopies of 193 patients with or without LPR symptoms and rated each video for RFS. Statistical analysis was performed. Results were compared to determine the inter-rater reliability. RESULTS Fair to poor correlation was found between the three expert raters for total RFS score, as well as for RFS component items with nonbinary outcomes. For the dichotomous items, the inter-rater reliability was slight to moderate. Inter-rater correlation for determining whether an examination is pathological or nonpathological was fair. CONCLUSION The RFS alone was not reliable for confirming the diagnosis of LPR, due to low inter-rater reliability and the subjective nature of the scoring system.
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Affiliation(s)
- Forsan Jahshan
- Department of Otolaryngology Head and Neck Surgery, Nottingham University Hospitals NHS Trust, United Kingdom.
| | - Ohad Ronen
- Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jamal Qarawany
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Boaz Markel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Amiel Sberro
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Winnie Yeung
- Department of Otolaryngology Head and Neck Surgery, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University, Hadassah Medical School, Jerusalem, Israel
| | - Eli Layous
- Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Netanel Eisenbach
- Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Eyal Sela
- Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Tal Marshak
- Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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18
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Lahav Y, Malka-Yosef L, Shapira-Galitz Y, Cohen O, Halperin D, Shoffel-Havakuk H. Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes. Otolaryngol Head Neck Surg 2020; 164:631-638. [PMID: 32777994 DOI: 10.1177/0194599820947000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/16/2022]
Abstract
OBJECTIVE There is a debate regarding the durability of fat implants. Our experience and recent publications suggest fat implantation may deliver a long-lasting improvement. This study aims to present the long-term outcomes for vocal fold fat augmentation using strict harvesting, preparing, and implantation protocols. STUDY DESIGN A prospective cohort conducted between 2014 and 2020 (recruitment 2014-2017). SETTING An academic tertiary referral center. SUBJECTS AND METHODS Twenty-two patients with glottic insufficiency were enrolled: 11 had unilateral vocal fold paralysis (UVFP), and 11 had atrophy or scar. Harvested fat was injected unilaterally or bilaterally into multiple sites. Six of these patients also had simultaneous microlaryngoscopic removal of other benign glottic lesions. Outcome measurements included video stroboscopy; Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) score; Voice Handicap Index (VHI); and acoustic analysis, performed preoperatively, 3, 12, 24, and 36 months after surgery. RESULTS Ten augmentations were unilateral and 12 bilateral. Comparing the preoperative and 36-month postoperative periods, the mean VHI score improved from 73.45 (±22.78) to 44.88 (±28.93), P = .001, and the mean GRBAS decreased from 8.64 (±3.89) to 2.82 (±2.3), P = .001; 24 months postoperatively, the mean fundamental frequency decreased from 163.88 Hz (±41.61) to 150.44 Hz (±41.47), P = .012. Stroboscopic analysis revealed statistically significant improvement in mucosal wave propagation, phase closure, and phase symmetry. Best results were achieved in the UVFP subgroup. Computed tomography scans demonstrated long-term viability of the implanted adipose tissue. CONCLUSION Fat is an excellent source of autologous graft. With careful patient selection and proper surgical technique, fat is suitable for long-term correction of glottic insufficiency. Fat augmentation should be considered as a long-lasting or even permanent solution, rather than temporary.
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Affiliation(s)
- Yonatan Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Liron Malka-Yosef
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Yael Shapira-Galitz
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Tessler I, Adi M, Diment J, Lahav Y, Halperin D, Cohen O. Spontaneous neck hematoma secondary to parathyroid adenoma: a case series. Eur Arch Otorhinolaryngol 2020; 277:2551-2558. [PMID: 32279105 DOI: 10.1007/s00405-020-05959-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Spontaneous neck hematoma is a rare yet potentially fatal complication of primary hyperparathyroidism (PHPT). Here we aim to describe novel presentations of neck hematomas secondary to PHPT, discussing tools and signs that facilitate diagnosis. METHODS Case series data were extracted by retrospective chart reviews of our institution's electronic medical records, including all neck hematoma cases from parathyroid origin between 2005 and 2020. Cases from PubMed and EMBASE between 1999 and 2020 were analyzed in a systematic literature review. RESULTS Four patients were identified with five acute bleeding events, including a novel report of recurrent neck hemorrhage due to parathyroid adenoma. There was postmenopausal female predominance (75%), consistent with previous reports (72.7%). Common presentations included neck pain, dysphagia and hoarseness. All bleedings spread into the retropharyngeal space. Vocal cord paralysis was found in a single case and in 8.6% of the benign lesions in the reviewed cases. A single case presented with normal calcium levels (20% of bleeding episodes), in line with the reviewed cases (17.4%). A subtle CT sign of an enhancing area within the parathyroid gland, which led to the diagnosis, was identified in a single case. Conservative treatments were employed in 80% of our cases and in 51.5% of the reviewed cases, all being successful. Neck explorations performed after a 3-month waiting period from the acute event demonstrated better results compared to immediate surgery. CONCLUSION A high suspicion index is needed, particularly in post-menopausal women, to reach a diagnosis and allow optimal management. Normal laboratory values do not exclude parathyroid etiology, yet assessment should include calcium and PTH levels along with targeted imaging. Since bleeding may recur, we suggest that PHPT complicated with neck hematoma should be an independent indication for definitive parathyroidectomy surgery. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Idit Tessler
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Meital Adi
- Department of Radiology, Kaplan Medical Center, Rehovot, Israel.,Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Judith Diment
- Department of Pathology, Kaplan Medical Center, Rehovot, Israel.,Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel. .,Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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20
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Gokhman D, Nissim-Rafinia M, Agranat-Tamir L, Housman G, García-Pérez R, Lizano E, Cheronet O, Mallick S, Nieves-Colón MA, Li H, Alpaslan-Roodenberg S, Novak M, Gu H, Osinski JM, Ferrando-Bernal M, Gelabert P, Lipende I, Mjungu D, Kondova I, Bontrop R, Kullmer O, Weber G, Shahar T, Dvir-Ginzberg M, Faerman M, Quillen EE, Meissner A, Lahav Y, Kandel L, Liebergall M, Prada ME, Vidal JM, Gronostajski RM, Stone AC, Yakir B, Lalueza-Fox C, Pinhasi R, Reich D, Marques-Bonet T, Meshorer E, Carmel L. Differential DNA methylation of vocal and facial anatomy genes in modern humans. Nat Commun 2020; 11:1189. [PMID: 32132541 PMCID: PMC7055320 DOI: 10.1038/s41467-020-15020-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Changes in potential regulatory elements are thought to be key drivers of phenotypic divergence. However, identifying changes to regulatory elements that underlie human-specific traits has proven very challenging. Here, we use 63 reconstructed and experimentally measured DNA methylation maps of ancient and present-day humans, as well as of six chimpanzees, to detect differentially methylated regions that likely emerged in modern humans after the split from Neanderthals and Denisovans. We show that genes associated with face and vocal tract anatomy went through particularly extensive methylation changes. Specifically, we identify widespread hypermethylation in a network of face- and voice-associated genes (SOX9, ACAN, COL2A1, NFIX and XYLT1). We propose that these repression patterns appeared after the split from Neanderthals and Denisovans, and that they might have played a key role in shaping the modern human face and vocal tract. How traits specific to modern humans have evolved is difficult to study. Here, Gokhman et al. compare measured and reconstructed DNA methylation maps of present-day humans, archaic humans and chimpanzees and find that genes that affect vocal tract and facial anatomy show methylation changes between archaic and modern humans.
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Affiliation(s)
- David Gokhman
- Department of Genetics, The Alexander Silberman Institute of Life Sciences, Faculty of Science, The Hebrew University of Jerusalem, 91904, Jerusalem, Israel.
| | - Malka Nissim-Rafinia
- Department of Genetics, The Alexander Silberman Institute of Life Sciences, Faculty of Science, The Hebrew University of Jerusalem, 91904, Jerusalem, Israel
| | - Lily Agranat-Tamir
- Department of Genetics, The Alexander Silberman Institute of Life Sciences, Faculty of Science, The Hebrew University of Jerusalem, 91904, Jerusalem, Israel.,Department of Statistics, The Hebrew University of Jerusalem, 91905, Jerusalem, Israel
| | - Genevieve Housman
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, 85281, USA.,Center for Evolution and Medicine, Arizona State University, Tempe, AZ, 85287, USA
| | | | - Esther Lizano
- Institute of Evolutionary Biology (UPF-CSIC), PRBB, 08003, Barcelona, Spain
| | - Olivia Cheronet
- Department of Evolutionary Anthropology, University of Vienna, 1090, Vienna, Austria
| | - Swapan Mallick
- Broad Institute, Cambridge, MA, 02138, USA.,Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA.,Howard Hughes Medical Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Maria A Nieves-Colón
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, 85281, USA.,Center for Evolution and Medicine, Arizona State University, Tempe, AZ, 85287, USA
| | - Heng Li
- Broad Institute, Cambridge, MA, 02138, USA
| | | | - Mario Novak
- Institute for Anthropological Research, 10000, Zagreb, Croatia.,Earth Institute and School of Archaeology, University College Dublin, Dublin 4, Ireland
| | | | - Jason M Osinski
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA
| | | | - Pere Gelabert
- Institute of Evolutionary Biology (UPF-CSIC), PRBB, 08003, Barcelona, Spain
| | - Iddi Lipende
- Gombe Stream Research Center, Jane Goodall Institute, Kigoma, Tanzania
| | - Deus Mjungu
- Gombe Stream Research Center, Jane Goodall Institute, Kigoma, Tanzania
| | - Ivanela Kondova
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
| | - Ronald Bontrop
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
| | - Ottmar Kullmer
- Department of Palaeoanthropology and Messel Research, Senckenberg Center of Human Evolution and Paleoecology, Frankfurt am Main, Germany
| | - Gerhard Weber
- Department of Evolutionary Anthropology, University of Vienna, 1090, Vienna, Austria
| | - Tal Shahar
- Department of Neurosurgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Mona Dvir-Ginzberg
- Laboratory of Cartilage Biology, Institute of Dental Sciences, Faculty of Dental Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Marina Faerman
- Laboratory of Bioanthropology and Ancient DNA, Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Ellen E Quillen
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, 85287, USA
| | - Alexander Meissner
- Broad Institute, Cambridge, MA, 02138, USA.,Harvard Stem Cell Institute, Cambridge, MA, 02138, USA.,Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, 02138, USA
| | - Yonatan Lahav
- Otolaryngology - Head & Neck Surgery Department, Laryngeal Surgery Unit, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Medical School, Jerusalem, Israel
| | - Leonid Kandel
- Orthopaedic Department, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Meir Liebergall
- Orthopaedic Department, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - María E Prada
- I.E.S.O. 'Los Salados'. Junta de Castilla y León, León, Spain
| | - Julio M Vidal
- Junta de Castilla y León, Servicio de Cultura de León, León, Spain
| | - Richard M Gronostajski
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA.,Genetics, Genomics and Bioinformatics Program, New York State Center of Excellence in Bioinformatics and Life Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA
| | - Anne C Stone
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, 85281, USA.,Center for Evolution and Medicine, Arizona State University, Tempe, AZ, 85287, USA.,Institute of Human Origins, Arizona State University, Tempe, AZ, 85287, USA
| | - Benjamin Yakir
- Department of Statistics, The Hebrew University of Jerusalem, 91905, Jerusalem, Israel
| | - Carles Lalueza-Fox
- Institute of Evolutionary Biology (UPF-CSIC), PRBB, 08003, Barcelona, Spain
| | - Ron Pinhasi
- Department of Evolutionary Anthropology, University of Vienna, 1090, Vienna, Austria
| | - David Reich
- Broad Institute, Cambridge, MA, 02138, USA.,Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA.,Howard Hughes Medical Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Tomas Marques-Bonet
- Institute of Evolutionary Biology (UPF-CSIC), PRBB, 08003, Barcelona, Spain.,Catalan Institution of Research and Advanced Studies (ICREA), 08010, Barcelona, Spain.,CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), 08028, Barcelona, Spain.,Institut Català de Paleontologia Miquel Crusafont, Universitat Autònoma de Barcelona, Edifici ICTA-ICP, c/ Columnes s/n, Barcelona, Spain
| | - Eran Meshorer
- Department of Genetics, The Alexander Silberman Institute of Life Sciences, Faculty of Science, The Hebrew University of Jerusalem, 91904, Jerusalem, Israel. .,The Edmond and Lily Safra Center for Brain Sciences (ELSC), The Hebrew University of Jerusalem, 91904, Jerusalem, Israel.
| | - Liran Carmel
- Department of Genetics, The Alexander Silberman Institute of Life Sciences, Faculty of Science, The Hebrew University of Jerusalem, 91904, Jerusalem, Israel.
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21
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Bregman G, Lahav Y, Kishinevsky Y, Grinevich G, Ezri T, Dukhan A. Early postoperative seizures after vocal fold surgery attributed to shigellosis. Anaesth Rep 2020; 7:43-46. [PMID: 32051946 DOI: 10.1002/anr3.12013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 11/11/2022] Open
Abstract
A 44-year-old previously healthy woman underwent surgery of the vocal folds and developed early postoperative seizures caused by an unusual aetiology. Clinical assessment and laboratory results revealed that the patient suffered from an acute-onset shigellosis infection which was thought to be the cause of her early postoperative seizures. The shigellosis infection was treated with azithromycin which resulted in rapid clinical improvement, and the seizures were successfully managed with benzodiazepines, sodium valproate and levetiracetam. To our knowledge, this is the first reported case of shigellosis-induced seizures in an adult in the peri-operative period. Early detection of the aetiology of seizures is crucial to ensure appropriate management and a safe patient outcome.
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Affiliation(s)
- Gennady Bregman
- General Intensive Care Unit Kaplan Medical Center Rehovot Israel
| | - Yonatan Lahav
- Otolaryngology Head and Neck Surgery Kaplan Medical Center Rehovot Israel
| | | | - Galina Grinevich
- Surgical Outpatient Clinics Anesthesia Unit Kaplan Medical Center Rehovot Israel
| | - Tiberiu Ezri
- Surgical Outpatient Clinics Anesthesia Unit Kaplan Medical Center Rehovot Israel.,Outcomes Research Consortium Cleveland OH USA
| | - Alexander Dukhan
- Surgical Outpatient Clinics Anesthesia Unit Kaplan Medical Center Rehovot Israel
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22
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Warman M, Lahav Y, Huszar M, Hadad L, Halperin D, Cohen O. Down-Expression of Kinin Receptors in Allergic Nasal Polyps Epithelia: An Immunohistochemistry Study. Otolaryngol Head Neck Surg 2020; 162:375-381. [PMID: 31986968 DOI: 10.1177/0194599819900899] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the expression of B1 and B2 receptors in patients with nasal polyps (NPs) compared to controls. STUDY DESIGN Retrospective case series. SETTINGS Single academic center. SUBJECTS AND METHODS Nasal biopsies of patients with NPs were compared to inferior turbinates of control patients. Comparisons included basic demographics and comorbidities, intensity of inflammation, and immunohistochemical staining of B1 and B2 receptors measured by immunohistochemistry staining scores (ISSs). RESULTS A total of 41 patients were enrolled, with 21 patients (51.2%) in the NP group and 20 patients as controls. No differences were found in the prevalence of allergic comorbidities and smoking between the groups. The NP group demonstrated significantly higher prevalence of moderate and severe mononuclear infiltrates compared to the control group (57.1% vs 5.3%, P < .001). The NP group had significantly lower B1 expression in smooth muscle compared to the control group (mean ISS 0.22 vs 1.56, P < .001, respectively) and significantly more B2 expression in epithelial cells (mean ISS 1.81 vs 0, P < .001, respectively). CONCLUSION Patients with NPs exhibit different expression patterns of B1 and B2 compared to control patients. This implies that bradykinin receptor regulation participates in the pathogenesis of NPs.
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Affiliation(s)
- Meir Warman
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Monica Huszar
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Pathology, Kaplan Medical Center, Rehovot, Israel
| | - Liad Hadad
- Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
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23
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Yariv O, Popovtzer A, Wasserzug O, Neiderman NC, Halperin D, Lahav Y, Lahav G, Yehuda M. Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions. Am J Otolaryngol 2020; 41:102293. [PMID: 31732301 DOI: 10.1016/j.amjoto.2019.102293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/11/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the clinical value of ultrasound (US) and fine needle aspiration (FNA) of salivary gland lesions prior to surgery, for preoperative decision-making and long-term follow-up/outcome. MATERIALS & METHODS We retrospectively analyzed the medical charts of 98 consecutive patients with major salivary gland lesions who were treated in a single medical from 2008 to 2017. Preoperative US and FNA was performed in all patients. Cytology results were compared with histopathological diagnoses. The correlation between preoperative US findings, cytology and histopathological diagnoses was assessed. RESULTS Twenty-three specimens were histopathologically malignant, and 75 were diagnosed as benign. Three false-positive results diagnosed as malignant in cytology had a final histology of sialadenitis, pleomorphic adenoma and Warthin's tumor, respectively. In six cases, cytology yielded false-negative results. The overall accuracy of FNA in distinguishing benign from malignant lesions was 91%. Sensitivity was 70% and specificity 93%. There was no significant correlation between US features and final pathology, but larger size had some correlation with malignancy (p = 0.306). No complications were observed during or after performing FNA. CONCLUSION FNA from salivary gland lesions is safe and in many cases can help in preoperative decision making or surgical planning. Hence, the results of FNA cytology should have an integral role in clinical decision-making and management of major salivary gland lesions. False-negative results do occur and therefore should be used only as an adjunctive measure.
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Affiliation(s)
- Orly Yariv
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel.
| | - Aron Popovtzer
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Oshri Wasserzug
- Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Narin Carmel Neiderman
- Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel.
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
| | - Gil Lahav
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
| | - Moshe Yehuda
- Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
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24
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Lahav Y, Cohen O, Shapira‐Galitz Y, Halperin D, Shoffel‐Havakuk H. CO
2
Laser Cordectomy Versus KTP Laser Tumor Ablation for Early Glottic Cancer: A Randomized Controlled Trial. Lasers Surg Med 2019; 52:612-620. [DOI: 10.1002/lsm.23202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Yonatan Lahav
- Department of Otolaryngology Head and Neck SurgeryKaplan Medical Center POB 1, Pasternak Rd Rehovot Israel
- Faculty of MedicineThe Hebrew University Ein Kerem, POB 12000 Jerusalem Israel
| | - Oded Cohen
- Department of Otolaryngology Head and Neck SurgeryKaplan Medical Center POB 1, Pasternak Rd Rehovot Israel
- Faculty of MedicineThe Hebrew University Ein Kerem, POB 12000 Jerusalem Israel
| | - Yael Shapira‐Galitz
- Department of Otolaryngology Head and Neck SurgeryKaplan Medical Center POB 1, Pasternak Rd Rehovot Israel
- Faculty of MedicineThe Hebrew University Ein Kerem, POB 12000 Jerusalem Israel
| | - Doron Halperin
- Department of Otolaryngology Head and Neck SurgeryKaplan Medical Center POB 1, Pasternak Rd Rehovot Israel
- Faculty of MedicineThe Hebrew University Ein Kerem, POB 12000 Jerusalem Israel
| | - Hagit Shoffel‐Havakuk
- Department of Otolaryngology Head and Neck SurgeryRabin Medical Center 39 Ze'ev Jabotinski St Petach‐Tikva 4941492 Israel
- Sackler Faculty of MedicineTel Aviv University Tel Aviv 6997801 Israel
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25
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Cohen O, Betito HR, Adi M, Shapira‐Galitz Y, Halperin D, Lahav Y, Warman M. Development of the nasopharynx: A radiological study of children. Clin Anat 2019; 33:1019-1024. [DOI: 10.1002/ca.23530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Hadar Rotem Betito
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Meital Adi
- Department of Radiology Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Yael Shapira‐Galitz
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Meir Warman
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
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Cohen O, Lahav Y, Halperin D, Yehuda M. Surgeon-Performed Ultrasonographic Evaluation and Predication for Large Thyroid Nodules—A Case-Control Study. Surgery 2019; 166:1148-1153. [DOI: 10.1016/j.surg.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
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Lahav Y, Shats M, Huszar M, Haimovich Y, Warman M, Halperin D, Shoffel-Havakuk H. Local inflammatory reaction to benign, pre-malignant and malignant glottic lesions: A matched case-control study. Clin Otolaryngol 2019; 44:628-638. [PMID: 31038820 DOI: 10.1111/coa.13352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/28/2017] [Revised: 02/06/2019] [Accepted: 04/25/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To study the inflammatory infiltrates associated with the different stages of laryngeal carcinogenesis. DESIGN Observational, matched case-control study of histopathologic specimens. SETTING An academic referral centre. PARTICIPANTS A total of 45 patients who underwent removal of glottic lesions between 2008 and 2015. Patients were enrolled and categorised into three matched groups according to lesions' histopathologic diagnoses, 15 patients in each group: benign, pre-malignant and squamous cell carcinoma (SCC). Matching was based on age, gender and pack-years. MAIN OUTCOME MEASURES Immunohistochemistry staining using monoclonal antibodies against CD4, CD8, CD68, CD20 and S100 representing T-helper cells, cytotoxic T cells, macrophages, B cells and dendritic cells, respectively. Cell counts and distributions were measured and compared between groups. Correlations between the different cells were examined. RESULTS The predominant cell type was CD8+, followed by CD68+ and CD4+. All inflammatory cells increased significantly in number in SCC (P-value < 0.001), with no significant difference between benign and pre-malignant groups. Strong correlations between the different cells were demonstrated only in the malignant group. S100+ cells correlated with both T-cell subsets, CD4+ (rho = 0.769, P-value = 0.001) and CD8+ (rho = 0.697, P-value = 0.0004). Infiltrates exhibited more extensive distribution in SCC compared to pre-malignant and benign; CD8+ and CD68+ cells were demonstrated in both intraepithelial and stromal regions in 93% of SCC lesions (P-value = 0.0001). CONCLUSIONS Laryngeal carcinoma demonstrates a unique pattern of inflammatory infiltrates, with significant changes in cell counts and distribution. Leucocyte infiltrates increased significantly in the transition from laryngeal pre-malignant lesion to malignancy while no significant differences were seen between benign and pre-malignant lesions.
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Affiliation(s)
- Yonatan Lahav
- The Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Maya Shats
- Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Monica Huszar
- Hadassah Medical School, The Hebrew University, Jerusalem, Israel.,The Department of Pathology, Kaplan Medical Center, Rehovot, Israel
| | - Yaara Haimovich
- The Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Meir Warman
- The Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Doron Halperin
- The Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- The Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Shoffel-Havakuk H, O'Dell K, Johns MM, Reder L, Popova M, Halperin D, Feldberg E, Lahav Y. The rising rate of nonsmokers among laryngeal carcinoma patients: Are we facing a new disease? Laryngoscope 2019; 130:E108-E115. [PMID: 31090946 DOI: 10.1002/lary.28067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 03/29/2019] [Accepted: 04/23/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngeal squamous cell carcinoma (SCC) is strongly associated with tobacco smoking. With the rising awareness of tobacco's adverse health effects, we have witnessed a global decrease in tobacco use. Nevertheless, laryngeal SCC remains prevalent and includes a subset of patients lacking the traditional risk factors. STUDY DESIGN A two-center retrospective cohort. METHODS Medical records of patients diagnosed with laryngeal SCC between 2009 and 2016 were reviewed. Data collected included demographics, smoking status, and tumor site. Patients who have never smoked were designated as nonsmokers. RESULTS The study included 330 patients with laryngeal SCC, of whom 75 (22.7%) were nonsmokers; this rate was relatively similar for each of the two institutions independently (21.9% and 25%). There were 285 patients with glottic SCC and 45 with supraglottic SCC. All nonsmoking patients in this cohort had glottic SCC, representing 26.3% (75/285) of the glottic SCC cases. The rate of female patients was significantly higher among nonsmokers. Of the patients with glottic SCC, females represented 25.3% (19/75) of the nonsmokers compared with 12.4% (26/210) of the smokers (P = .008). Mean age at diagnosis was 60.2 ± 17.5 years for nonsmoking glottic SCC patients and 63.6 ± 12.4 years for smokers (P = .280). However, nonsmokers demonstrated a distinct age distribution pattern. Nonsmoking females with glottic SCC demonstrated a bimodal age distribution pattern; 73.7% (14/19) were age <40 years or >75 years at diagnosis. CONCLUSIONS The rate of laryngeal SCC in nonsmokers is higher than what has previously been reported, representing a growing proportion, and may suggest a shift in etiology. Knowing that laryngeal SCC in nonsmokers predominantly affects the glottis, and that females and age extremities are more vulnerable, the traditional screening paradigm should be revised. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E108-E115, 2020.
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Affiliation(s)
- Hagit Shoffel-Havakuk
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karla O'Dell
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Michael M Johns
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Lindsay Reder
- Department of Otolaryngology, Head and Neck Surgery, Southern California Permanente Medical Group, Los Angeles, California
| | - Margarita Popova
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, and the Hebrew University, Jerusalem, Israel
| | - Edit Feldberg
- Department of Pathology, Kaplan Medical Center, Rehovot, and the Hebrew University, Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, and the Hebrew University, Jerusalem, Israel
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Cohen O, Shapira-Galitz Y, Shnipper R, Stavi D, Halperin D, Adi N, Lahav Y. Outcome and survival following tracheostomy in patients ≥ 85 years old. Eur Arch Otorhinolaryngol 2019; 276:1837-1844. [PMID: 31041516 DOI: 10.1007/s00405-019-05447-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/25/2019] [Accepted: 04/22/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate percutaneous dilatational tracheostomy in patients ≥ 85 years old: its complication rate and possible risk factors. In addition, to assess prognostic factors for short, intermediate and long term survival following the procedure. METHODS A retrospective case-control study of 72 patients ≥ 85 years who received percutaneous dilatation tracheotomy (PTD), compared to a control group of younger patients (n = 182). Demographics, clinical and laboratory data were collected. Survival and risk for complications were analyzed. RESULTS The study group's mean age was 89 ± 4. Twelve patients had complications, three (4.2%) were major. No significant difference was found in overall complication rates between the groups. Cerebrovascular disease with neurologic deficits and pre-procedure albumin levels were significantly associated with complications. Survival rates did not differ in 1 week and 1 month following procedure between study and control group. There was a significant difference in the 1-year survival rates between the patients ≥ 85 years and the control groups (18.1% vs. 34.4%, p = 0.01, respectively). Congestive heart failure, a frailty score > 0.27 and failure to wean from a cannula were associated with reduced 1-year survival. CONCLUSION PTD is safe for patients ≥ 85 years. Complication risk factors and reduced survival should be discussed with patients and families before conducting tracheostomies. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel.
- Hebrew University- Hadassah Medical School, Jerusalem, Israel.
| | - Yael Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel
- Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Ruth Shnipper
- Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Dekel Stavi
- Intensive Care Unit, Kaplan Medical Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel
- Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Nimrod Adi
- Intensive Care Unit, Kaplan Medical Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel
- Hebrew University- Hadassah Medical School, Jerusalem, Israel
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Shapira-Galitz Y, Shoffel-Havakuk H, Halperin D, Lahav Y. Association Between Laryngeal Sensation, Pre-swallow Secretions and Pharyngeal Residue on Fiberoptic Endoscopic Examination of Swallowing. Dysphagia 2019; 34:548-555. [DOI: 10.1007/s00455-019-10001-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/14/2019] [Indexed: 12/22/2022]
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Cohen O, Zornitzki T, Yarkoni TR, Lahav Y, Schindel D, Halperin D, Yehuda M. Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes. Head Neck 2019; 41:1696-1702. [DOI: 10.1002/hed.25641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 10/07/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Oded Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Taiba Zornitzki
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Tom Raz Yarkoni
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Yonatan Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Doron Schindel
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Doron Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Moshe Yehuda
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of MedicineTel Aviv University Tel Aviv Israel
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Shapira-Galitz Y, Yousovich R, Halperin D, Wolf M, Lahav Y, Drendel M. Does the Hebrew Eating Assessment Tool-10 Correlate with Pharyngeal Residue, Penetration and Aspiration on Fiberoptic Endoscopic Examination of Swallowing? Dysphagia 2019; 34:372-381. [DOI: 10.1007/s00455-018-9964-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
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Shapira-Galitz Y, Karp G, Cohen O, Halperin D, Lahav Y, Adi N. Evaluation and Predictors for Nasogastric Tube Associated Pressure Ulcers in Critically Ill Patients. Isr Med Assoc J 2018; 20:731-736. [PMID: 30550000] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Nasal device-related pressure ulcers are scarcely addressed in the literature. OBJECTIVES To assess the prevalence and severity of cutaneous and mucosal nasogastric tube (NGT)-associated pressure ulcers (PU) in critically ill patients and to define predictors for their formation. METHODS A single center observational study of intensive care unit patients with a NGT for more than 48 hours was conducted. Nasal skin was evaluated for PU. Ulcers were graded according to their depth. Consenting patients underwent a nasoendoscopic examination to evaluate intranasal mucosal injury. RESULTS The study comprised 50 patients, 17 of whom underwent nasoendoscopic examination. Mean time of NGT presence in the nose was 11.3 ± 6.17 days. All patients had some degree of extranasal PU, 46% were low grade and 54% were high grade. Predictors for high grade extranasal PU compared to low grade PU were higher peak Sepsis-related Organ Failure Assessment (SOFA) scores (11.52 vs. 8.87, P = 0.009), higher peak C-reactive protein (CRP) levels (265.3 mg/L vs. 207.58, P = 0.008), and bacteremia (33.3% vs. 8.7%, P = 0.037). The columella was the anatomical site most commonly involved and the most severely affected. The number of intranasal findings and their severity were significantly higher in the nasal cavity containing the NGT compared to its contralateral counterpart (P = 0.039 for both). CONCLUSIONS NGTs cause injury to nasal skin and mucosa in critically ill patients. Patients with bacteremia, high CRP, and high SOFA scores are at risk for severe ulcers, warranting special monitoring and preventive measures.
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Affiliation(s)
- Yael Shapira-Galitz
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Hadassah Medical School, Hebrew University of Jerusalem, Israel
| | - Galia Karp
- Department of Intensive Care Medicine, Kaplan Medical Center, Rehovot, Israel
- Hadassah Medical School, Hebrew University of Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Hadassah Medical School, Hebrew University of Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Hadassah Medical School, Hebrew University of Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Hadassah Medical School, Hebrew University of Jerusalem, Israel
| | - Nimrod Adi
- Department of Intensive Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Shapira-Galitz Y, Shoffel-Havakuk H, Halperin D, Lahav Y. Correlation Between Pharyngeal Residue and Aspiration in Fiber-Optic Endoscopic Evaluation of Swallowing: An Observational Study. Arch Phys Med Rehabil 2018; 100:488-494. [PMID: 29959934 DOI: 10.1016/j.apmr.2018.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/22/2018] [Revised: 04/24/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To examine the correlation between pharyngeal residue severity and clearance to penetration/aspiration on fiber-optic endoscopic examination of swallowing (FEES). DESIGN Retrospective cohort. SETTING Kaplan Medical Center dysphagia clinic. PARTICIPANTS Patients (N=110) visiting a dysphagia clinic between 2014 and 2016 undergoing FEES. INTERVENTIONS FEES were scored for penetration/aspiration with the Penetration Aspiration Scale (PAS), for residue severity using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). The numbers of swallows required to clear the pharynx were recorded. The first and the worst bolus challenges for each consistency (liquid, purée, solid) were analyzed. MAIN OUTCOME MEASURES YPR-SRS and number of clearing swallows were correlated with the PAS of the same bolus challenge. RESULTS The study population's mean age was 67±13.4 years; 54% were men (n=58). A significant correlation was found between the YPR-SRS and the PAS for all consistencies tested, in each anatomical site (vallecula or pyriform sinus) and for both the first and worst bolus challenges (P<.001 for all). The correlation of residue with aspiration was stronger when vallecula and pyriform sinuses scores were summated (Pearson product-moment correlation coefficient=0.573/0.631/0.446 for liquid/purée/solid for worst bolus challenge). Incorporating the number of clearing swallows to the YPR-SRS strengthened the correlation with PAS. CONCLUSIONS Residue severity and clearance correlate with penetration/aspiration on FEES. The YPR-SRS can be applied to standardize description of residue in FEES and to aid in dysphagia evaluation.
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Affiliation(s)
- Yael Shapira-Galitz
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel.
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel; Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikvah, Israel, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Doron Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel
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Cohen O, Shnipper R, Yosef L, Stavi D, Shapira-Galitz Y, Hain M, Lahav Y, Shoffel-Havakuk H, Halperin D, Adi N. Bedside percutaneous dilatational tracheostomy in patients outside the ICU: a single-center experience. J Crit Care 2018; 47:127-132. [PMID: 29957510 DOI: 10.1016/j.jcrc.2018.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 02/11/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the safety of medical-ward bedside percutaneous dilatational tracheostomy (GWB-PDT). MATERIALS AND METHODS A retrospective study of all patients who underwent elective GWB-PDT between 2009 and 2015. A joint otolaryngology-ICU team performed all GWB-PDTs. The patients were followed until decannulation, discharge or death. Complications were divided into early (within 24 h) and late, and into minor and major. RESULTS Two hundred and fifty six patients were included in the study. The mean age was 77.7 ± 11.8 Medical history included cardiac comorbidities (42.6%) and cerebrovascular accidents (34.4%). Overall, 48 patients (18.9%) had 60 complications, of which 70% (42/60) were minor (13 early; 29 late complications). Fifteen patients (5.9%) had major complications. Eight patients had early major complications (loss of airway - two patients [0.8%], pneumothorax - two patients [0.8%], resuscitation - one patient [0.4%], and a single patient (0.4%) died within 24 h following PDT). Two additional patients (0.8%) underwent conversion to an open tracheostomy. Seven patients had late complications (airway complications in six patients [2.3%] and major bleeding in a single patient [0.4%]). Of the seven patients with late major complications, three had two major complications. Half of the complications occurred by POD 3. CONCLUSION GWB-PDT is a feasible and safe solution for tracheostomies in general-ward ventilated patients.
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Affiliation(s)
- Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel.
| | - Ruth Shnipper
- Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Liron Yosef
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Dekel Stavi
- Intensive Care Unit, Kaplan Medical Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Moshe Hain
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Nimrod Adi
- Intensive Care Unit, Kaplan Medical Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Shapira-Galitz Y, Drendel M, Yousovich-Ulriech R, Shtreiffler-Moskovich L, Wolf M, Lahav Y. Translation and Validation of the Dysphagia Handicap Index in Hebrew-Speaking Patients. Dysphagia 2018; 34:63-72. [PMID: 29882103 DOI: 10.1007/s00455-018-9914-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/28/2017] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
The Dysphagia Handicap Index (DHI) is a 25-item questionnaire assessing the physical, functional, and emotional aspects of dysphagia patients' quality of life (QoL). The study goal was to translate and validate the Hebrew-DHI. 148 patients undergoing fiberoptic endoscopic examination of swallowing (FEES) in two specialized dysphagia clinics between February and August 2017 filled the Hebrew-DHI and self-reported their dysphagia severity on a scale of 1-7. 21 patients refilled the DHI during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency), penetration and aspiration (1 point for penetration, 2 points for aspiration, per consistency). 51 healthy volunteers also filled the DHI. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was established by comparing DHI scores of dysphagia patients and healthy controls. Concurrent validity was established by correlating the DHI score with the FEES score. Internal consistency of the Hebrew-DHI was high (Cronbach's alpha = 0.96), as was the test-retest reproducibility (Spearman's correlation coefficient = 0.82, p < 0.001). The Hebrew-DHI's total score, and its three subscales (physical/functional/emotional) were significantly higher in dysphagia patients compared to those in healthy controls (median 38 pts, IQR 18-56 for dysphagia patients compared to 0, IQR 0-2 for healthy controls, p < 0.0001). A strong correlation was observed between the DHI score and the self-reported dysphagia severity measure (Spearman's correlation coefficient = 0.88, p < 0.0001). A moderate correlation was found between the DHI score and the FEES score (Pearson's correlation coefficient = 0.245, p = 0.003). The Hebrew-DHI is a reliable and valid questionnaire assessing dysphagia patients' QoL.
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Affiliation(s)
- Yael Shapira-Galitz
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel.
| | - Michael Drendel
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Ruth Yousovich-Ulriech
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Liat Shtreiffler-Moskovich
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel
| | - Michael Wolf
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Yonatan Lahav
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel
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Shoffel-Havakuk H, Carmel-Neiderman NN, Halperin D, Shapira Galitz Y, Levin D, Haimovich Y, Cohen O, Abitbol J, Lahav Y. Menstrual Cycle, Vocal Performance, and Laryngeal Vascular Appearance: An Observational Study on 17 Subjects. J Voice 2018; 32:226-233. [DOI: 10.1016/j.jvoice.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
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Ravn S, Sterling M, Lahav Y, Andersen T. Reciprocal associations of pain and post-traumatic stress symptoms after whiplash injury: A longitudinal, cross-lagged study. Eur J Pain 2018; 22:926-934. [DOI: 10.1002/ejp.1178] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/10/2022]
Affiliation(s)
- S.L. Ravn
- Department of Psychology; University of Southern Denmark; Odense M Denmark
- Specialized Hospital for Polio and Accident Victims; Rødovre Denmark
| | - M. Sterling
- Recover Injury Research Centre; NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries; The University of Queensland; Brisbane Qld Australia
| | - Y. Lahav
- Department of Psychology; University of Southern Denmark; Odense M Denmark
- I-Core Research Center for Mass Trauma; Tel Aviv Israel
| | - T.E. Andersen
- Department of Psychology; University of Southern Denmark; Odense M Denmark
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Shoffel-Havakuk H, Cohen O, Slavin M, Haimovich Y, Halperin D, Lahav Y. Intravenous opioid drug abuse as an independent risk factor for supraglottic squamous cell carcinoma-A case-control study. Clin Otolaryngol 2017; 43:456-462. [PMID: 28950046 DOI: 10.1111/coa.12990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Intravenous opioid drug abuse (IVDA) was previously correlated with laryngeal cancer. However, discrimination of this correlation by anatomical subsites has not yet been described. In this study, we aim to further establish the association between IVDA and laryngeal squamous cell carcinoma (SCC) and to indicate the laryngeal subsites that are predisposed for this correlation. DESIGN A retrospective matched case-control study. SETTING AND PARTICIPANTS Patients diagnosed with supraglottic SCC (SG-SCC) between 1996 and 2016 treated in a tertiary academic referral centre were enrolled to the case group. The control group comprised of matched patients diagnosed with glottis SCC (G-SCC). Matching was based on gender, age and socio-economic rank. MAIN OUTCOME MEASURES Variables studies as risk factors included the following: smoking, alcohol consumption, history of IVDA and infectious diseases. The variables were tested for association with the 2 groups and with each other. RESULTS Forty-eight patients with SG-SCC were matched with 48 patients with G-SCC. IVDA rates significantly increased among patients with SG-SCC. Of the SG-SCC group, 18.8% had a positive history for IVDA compared with 2.1% of the G-SCC (P = .008). A history of IVDA was found to be a risk factor for SG-SCC, independent of smoking, excessive alcohol and socio-economic status. The odds ratio for patients with an IVDA history to have SG-SCC relatively to G-SCC was 10.846 (95% CI: 1.3-89.4). CONCLUSIONS Intravenous opioid drug abuse represents an independent risk factor for SG-SCC. The pathogenesis should be investigated not just as a risk factor, as opioids are commonly used for pain management in oncologic patients.
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Affiliation(s)
- H Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel.,Department of Otolaryngology Head and Neck Surgery, USC Voice Center, University of Southern California, Los Angeles, CA, USA
| | - O Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - M Slavin
- Department of General Surgery B, Meir Medical Center, Kfar Saba, Israel
| | - Y Haimovich
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - D Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Y Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
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Cohen O, Raz Yarkoni T, Lahav Y, Azoulay O, Halperin D, Yehuda M. Surgeon-performed thyroid ultrasound-proving utility and credibility in selecting patients for fine needle aspiration according to the American thyroid association guidelines. A retrospective study of 500 patients. Clin Otolaryngol 2017; 43:267-273. [PMID: 28892590 DOI: 10.1111/coa.12984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Abstract
DESIGN Case series with chart review. SETTING Single academic centre. PARTICIPANTS The data of all patients who underwent surgeon-performed ultrasound (SUS) between 7/2009 and 9/2012 were retrospectively reviewed. MAIN OUTCOME MEASURES A correlation between sonographic features and a non-benign cytology\malignant pathology. RESULTS Four hundred ninety-eight nodules were included. Solid texture, irregular margins, hypo-echogenicity and intranodular vascularity were significantly associated with malignancy when benign to non-benign cytology was compared, and when compared to malignant pathology. Lack of suspicious features was significantly associated with benign lesions, with a negative predictive value of 94%. Except for taller than wider shape, malignancy odds ratio was significantly higher for known suspicious features, reaching 4.81 for irregular borders (CI 2.42-9.55, P < .001). CONCLUSIONS SUS has proven to be a reliable and consistent tool to assess the thyroid nodule risk stratification. Surgeons should recognise the potential of this tool and its implementation.
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Affiliation(s)
- O Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - T Raz Yarkoni
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - Y Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - O Azoulay
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - D Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - M Yehuda
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel.,Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Cohen O, Tzelnick S, Galitz YS, Shoffel-Havakuk H, Hain M, Halperin D, Lahav Y. Potential Causative Factors for Saccular Disorders: Association with Smoking and Other Laryngeal Pathologies. J Voice 2017; 31:621-627. [DOI: 10.1016/j.jvoice.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/07/2017] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
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Cohen O, Tzelnick S, Lahav Y, Schindel D, Halperin D, Yehuda M. Selection of Atypia/Follicular Lesion of Unknown Significance Patients for Surgery Versus Active Surveillance, Without Using Genetic Testing: A Single Institute Experience, Prospective Analysis, and Recommendations. Thyroid 2017; 27:928-935. [PMID: 28463595 DOI: 10.1089/thy.2016.0237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atypia/follicular lesion of unknown significance (AUS/FLUS) has variable rates of malignancy. The recommended management includes active surveillance (AS), repeated fine-needle aspiration (RFNA), diagnostic surgery, or genetic testing for malignancy. The objective of this study was to assess the management of AUS/FLUS patients in a dedicated thyroid clinic without implementing genetic testing. METHODS This was a single institute cohort study of all patients aged ≥18 years who underwent ultrasound-guided FNA thyroid biopsies between January 2009 and January 2013 and were followed until January 2016. The median follow-up time was 4.6 years (range 3.2-6.8 years). Forty-eight (57%) patients were referred to AS, and 36 (43%) patients were referred for diagnostic surgery. Thirty-six (75%) patients from the AS group underwent RFNA. An additional eight patients from the AS group subsequently underwent diagnostic surgery. RESULTS Malignancies were found in 15/44 (34%) diagnostic surgical samples, and benign cytologies were found in 61.1% of the RFNAs. Analysis of adherence to follow-up in the 36 AS patients showed an adherence rate of only 53%, with males tending to comply better than females did (31.6% vs. 5.8%, respectively; p = 0.052), especially males in their sixth decade of life. CONCLUSIONS Genetic tests for AUS/FLUS patients are accepted today as complementary evaluations in many well-developed health systems. Yet, when these tests are not feasible due to financial or availability issues, careful management of AUS/FLUS patients may still offer good results in the selection of patients for surgery or AS. The present results also indicate that compliance to follow-up schedules is a major consideration when selecting patients for AS.
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Affiliation(s)
- Oded Cohen
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Sharon Tzelnick
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Yonatan Lahav
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Doron Schindel
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Doron Halperin
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Moshe Yehuda
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
- 2 Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University , Tel-Aviv, Israel
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Shapira Galitz Y, Shoffel-Havakuk H, Cohen O, Halperin D, Lahav Y. Adult acute supraglottitis: Analysis of 358 patients for predictors of airway intervention. Laryngoscope 2017; 127:2106-2112. [DOI: 10.1002/lary.26609] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/08/2017] [Accepted: 03/06/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Yael Shapira Galitz
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery; University of Southern California; Los Angeles California U.S.A
| | - Oded Cohen
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
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Cohen O, Shoffel-Havakuk H, Warman M, Tzelnick S, Haimovich Y, Kohlberg GD, Halperin D, Lahav Y. Early and Late Recurrent Epistaxis Admissions: Patterns of Incidence and Risk Factors. Otolaryngol Head Neck Surg 2017; 157:424-431. [PMID: 28463569 DOI: 10.1177/0194599817705619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/16/2022]
Abstract
Objective Epistaxis is a common complaint, yet few studies have focused on the incidence and risk factors of recurrent epistaxis. Our objective was to determine the patterns of incidence and risk factors for recurrent epistaxis admission (REA). Study Design Case series with chart review. Settings Single academic center. Subjects and Methods The medical records of patients admitted for epistaxis between 1999 and 2015 were reviewed. The follow-up period was defined as 3 years following initial admission. REAs were categorized as early (30 days) and late (31 days to 3 years) following initial admission. Logistic regression was used to identify potential predictors of REAs. Results A total of 653 patients were included. Eighty-six patients (14%) had REAs: 48 (7.5%) early and 38 (6.5%) late. Nonlinear incidence curve was demonstrated for both early and late REAs. Based on logistic regression, prior nasal surgery and anemia were independent risk factors for early REAs. According to multivariate analysis, thrombocytopenia was significantly associated with late REAs. Conclusion Early and late REAs demonstrate different risk predictors. Knowledge of such risk factors may help in risk stratification for this selected group of patients. All patients at risk should be advised on possible preventive measures. Patients at risk for early REA may benefit from a more proactive approach.
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Affiliation(s)
- Oded Cohen
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Meir Warman
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Sharon Tzelnick
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Yaara Haimovich
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Gavriel D Kohlberg
- 3 Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Columbia and Weill Cornell Campuses, New York, New York, USA
| | - Doron Halperin
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Yonatan Lahav
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
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Shoffel-Havakuk H, Lahav Y, Meidan B, Haimovich Y, Warman M, Hain M, Hamzany Y, Brodsky A, Landau-Zemer T, Halperin D. Does narrow band imaging improve preoperative detection of glottic malignancy? A matched comparison study. Laryngoscope 2016; 127:894-899. [DOI: 10.1002/lary.26263] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/13/2016] [Accepted: 08/01/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Hagit Shoffel-Havakuk
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center; Rehovot Israel
- Hadassah Medical School; Hebrew University; Jerusalem Israel
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center; Rehovot Israel
- Hadassah Medical School; Hebrew University; Jerusalem Israel
| | - Barak Meidan
- Hadassah Medical School; Hebrew University; Jerusalem Israel
| | - Yaara Haimovich
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center; Rehovot Israel
| | - Meir Warman
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center; Rehovot Israel
- Hadassah Medical School; Hebrew University; Jerusalem Israel
| | - Moshe Hain
- Schneider Children's Medical Center; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yaniv Hamzany
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Otolaryngology-Head and Neck Surgery; Rabin Medical Center; Petah Tikva Israel
| | - Alexander Brodsky
- Department of Otolaryngology-Head and Neck Surgery; Bnai Zion Medical Center; Haifa Israel
- Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
| | - Tali Landau-Zemer
- Hadassah Medical School; Hebrew University; Jerusalem Israel
- Department of Otolaryngology, Head and Neck Surgery; Hadassah Medical Center; Jerusalem Israel
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center; Rehovot Israel
- Hadassah Medical School; Hebrew University; Jerusalem Israel
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Shoffel-Havakuk H, Lahav Y, Davidi ES, Haimovich Y, Hain M, Halperin D. The role of separate margins sampling in endoscopic laser surgery for early glottic cancer. Acta Otolaryngol 2016; 136:491-6. [PMID: 26817681 DOI: 10.3109/00016489.2015.1132843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Sampling surgical margins in trans-oral laser microsurgery for early glottic squamous cell carcinoma (SCC) may allow for increased local control rate, although with no difference in local control by endoscopic treatment alone. OBJECTIVE To further delineate the role of routinely sampling separate surgical margins, in patients with early glottic SCC undergoing endoscopic laser resection. METHODS A retrospective case control study. One hundres and two early glottic cancer patients staged Tis-T2 underwent endoscopic laser surgery with curative intent as the primary treatment. Separate margins from the surgical bed were sampled following complete tumor resection in 64 patients; in 38 patients no margins were sampled. RESULTS Margin sampling showed a tendency towards reduced risk for local recurrence, adjusted HR = 0.439 (p-value = 0.096). However, there was no difference in local control by endoscopic treatment alone. The patients with sampled margins were further divided based on margins' status: 39 (61%) had negative margins, and 25 (39%) had positive margins. Compared with negative margins, patients with positive margins showed increased risk for recurrence, adjusted HR = 8.492 (p = 0.008). When margins were not sampled the risk for local recurrence was increased compared to negative margins (adjusted HR = 7.875, p-value = 0.008), and relatively comparable to what was observed when sampled margins were positive (adjusted HR = 0.927, p-value = 0.88).
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Affiliation(s)
- Hagit Shoffel-Havakuk
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
- b The Hebrew University, Hadassah Medical School , Jerusalem , Israel
| | - Yonatan Lahav
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
- b The Hebrew University, Hadassah Medical School , Jerusalem , Israel
| | - Erez Shmuel Davidi
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
| | - Yaara Haimovich
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
| | - Moshe Hain
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
| | - Doron Halperin
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
- b The Hebrew University, Hadassah Medical School , Jerusalem , Israel
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Cohen O, Tzelnick S, Lahav Y, Stavi D, Shoffel-Havakuk H, Hain M, Halperin D, Adi N. Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients. Laryngoscope 2015; 126:2057-62. [PMID: 26607056 DOI: 10.1002/lary.25800] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Gradual decrease in tube size and tube capping are considered the standard of care for tracheostomy decannulation. Both of these actions result in increased airway resistance. Immediate decannulation may offer a more tolerable approach. OBJECTIVE To assess the feasibility of immediate tracheostomy decannulation compared with the traditional decannulation methods. METHODS This study is a single institute, case-control retrospective study of patients between the years 2009 to 2014. The study group included all patients who underwent immediate decannulation, whereas the control group comprised patients who underwent traditional staged decannulation. An immediate decannulation protocol included admission to the intensive care unit, a comprehensive evaluation, decannulation, 24 hours of monitoring, and observation until discharge. RESULTS Twenty-nine patients were included in the study group and 20 in the control group. No significant statistical difference was found between the two groups in the patients' medical history and tracheostomy data, except for the Acute Physiology and Chronic Health Evaluation II score and duration of the deflated cuff, which were significantly higher in the control group. A significant difference was found in the complication rate between the groups. In the staged decannulation group, four patients failed decannulation and required reinsertion of the tracheostomy cannula, whereas there were no such failures in the immediate decannulation group. Hospitalization duration after decannulation of the study group patients was significantly shorter than that of the control group. CONCLUSION Immediate decannulation may offer a safe alternative for weaning from tracheostomy. It may also reduce the duration of the weaning process and hospitalization. LEVEL OF EVIDENCE 3b Laryngoscope, 126:2057-2062, 2016.
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Affiliation(s)
- Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Sharon Tzelnick
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Dekel Stavi
- Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel.,Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Moshe Hain
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Nimrod Adi
- Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel.,Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Shoffel-Havakuk H, Frumin I, Lahav Y, Haviv L, Sobel N, Halperin D. Increased number of volatile organic compounds over malignant glottic lesions. Laryngoscope 2015; 126:1606-11. [PMID: 26490745 DOI: 10.1002/lary.25733] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/12/2015] [Accepted: 09/15/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Electronic noses can identify diseases, including head and neck squamous cell carcinoma (SCC) by the fingerprint of volatile organic compounds (VOCs) in exhaled air. However, whether these VOCs originated from the malignant lesion itself remains unclear. The objective was to test for the presence and properties of VOCs directly over the vocal folds in malignant and benign lesions, as a potential tool for noninvasive screening. STUDY DESIGN Prospective observational case control study. METHODS Samples of mucus directly covering vocal fold lesions were analyzed using gas chromatography mass spectrometry for detection of VOCs, and evaluation of the properties and quantity of VOCs in the samples. Additionally, samples of oropharyngeal mucus were analyzed to exclude VOCs found also in the vicinity of the lesion. Benign and malignant lesion groups were compared using a nonparametric (Mann-Whitney) test. RESULTS We studied 14 patients, six with SCC and eight with benign pathology. We found an increased number of discrete VOC types in patients with SCC both above the lesion (SCC = 4.333 ± 2.5, benign = 0.875 ± 0.6; Z=3, P < .001) and directly above the lesion with exclusion of its vicinity (SCC = 3.167 ± 1.9, benign = 0.5 ± 0.5; Z = 2.8, P < .003). VOCs detected in SCCs but not in benign samples included the straight-chain fatty acids: butyric acid, pentanoic acid, hexanoic acid, and heptanoic acid. CONCLUSIONS Compared with benign vocal fold lesions, the environment of vocal folds in SCC is enriched with VOCs. These preliminary findings highlight a unique pattern that may contribute to the development of a future minimally invasive technology for screening vocal fold lesions for malignancy. LEVEL OF EVIDENCE NA Laryngoscope, 126:1606-1611, 2016.
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Affiliation(s)
- Hagit Shoffel-Havakuk
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel.,Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University Jerusalem, Israel
| | - Idan Frumin
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University Jerusalem, Israel
| | - Lior Haviv
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Noam Sobel
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University Jerusalem, Israel
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Shoffel-Havakuk H, Halperin D, Haimovich Y, Raz Yarkoni T, Cohen O, Hain M, Lahav Y. Analysis of cigarette smoking mechanism by real time video-endoscopic documentation. Inhal Toxicol 2015; 27:495-501. [PMID: 26308191 DOI: 10.3109/08958378.2015.1076545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To view, document and analyze the smoking mechanism as seen via video-endoscopic examination during the action of cigarette smoking. STUDY DESIGN Observational study. METHODS Twenty-two healthy smoking volunteers were examined with a trans-nasal video-laryngoscope while breathing, sniffing and cigarette smoking. Smoking a whole cigarette was recorded in each participant. The different stages of smoking were defined and their duration was measured. The glottic opening angle was calculated during breathing, sniffing and smoking. RESULTS A smoking cycle with four distinct stages was recognized. The stages included an oral smoke accumulation, pharyngo-laryngeal jet inhalation, infralaryngeal spread, and finally humidified exhalation stage. The stages' mean duration was 1.93(±1.21), 0.39(±0.31), 2.00(±1.12) and 4.5(±2.70) seconds, respectively. The glottic opening angle during smoke inhalation was wider in 16% (p = 0.02) compared to normal inhalation during breathing. The glottic opening during smoke exhalation was comparable to what was observed during normal exhalation. The reduction in the glottic opening was more significant during the action of smoking compared with normal breathing (p = 0.042). CONCLUSIONS Smoking follows a consistent sequence of events, defined by specific anatomic configuration and relatively persistent duration. The fast turbulent flow of the smoke over the narrow glottic aperture and at the areas of bifurcation at the trachea and bronchi may have a role in the high relative risk for carcinoma in these areas.
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Affiliation(s)
- Hagit Shoffel-Havakuk
- a Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel and
- b Hadassah School of Medicine, The Hebrew University , Jerusalem , Israel
| | - Doron Halperin
- a Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel and
- b Hadassah School of Medicine, The Hebrew University , Jerusalem , Israel
| | - Yaara Haimovich
- a Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel and
| | - Tom Raz Yarkoni
- b Hadassah School of Medicine, The Hebrew University , Jerusalem , Israel
| | - Oded Cohen
- a Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel and
- b Hadassah School of Medicine, The Hebrew University , Jerusalem , Israel
| | - Moshe Hain
- a Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel and
- b Hadassah School of Medicine, The Hebrew University , Jerusalem , Israel
| | - Yonatan Lahav
- a Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel and
- b Hadassah School of Medicine, The Hebrew University , Jerusalem , Israel
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Shoffel-Havakuk H, Halperin D, Yosef L, Haimovich Y, Lahav Y. The Anatomic Distribution of Malignant and Premalignant Glottic Lesions and Its Relations to Smoking. Otolaryngol Head Neck Surg 2015; 152:678-83. [DOI: 10.1177/0194599815574254] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/02/2015] [Indexed: 11/16/2022]
Abstract
Objective To describe the anatomic location and distribution of glottic dysplasia and early glottic cancer. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods Review of 167 glottic dysplasia or carcinoma patients between 2008 and 2013. Lesions were described in terms of location and size, and a novel grid system was used to map out anatomic distribution. Results Seventy-eight patients with dysplasia and 89 with early glottic carcinoma were included. One hundred twenty-eight were smokers and 39 nonsmokers. The medial aspect of the vocal fold was more involved than the superior aspect, 95% versus 71%, respectively ( P < .001). The superior aspect was more involved in smokers, 77% versus 51% in nonsmokers ( P = .0016). Using a grid system, the most involved area was the midpoint of the membranous vocal fold at the transition between the superior and medial aspects. Ninety-seven percent of the lesions occupied this specific area, with no difference between smokers and nonsmokers. The vocal process mucosa was involved in 48 patients. Exclusive vocal process involvement was limited to 2 cases. All other 46 patients demonstrated extensive disease, encompassing more than half of the vocal fold’s length. Carcinomatous lesions tended to be larger relative to dysplastic lesions. Otherwise, all lesion types showed a similar pattern of distribution. Conclusions Premalignant and malignant glottic lesions tend to involve the medial aspect of the vocal fold and the midpoint of the membranous part in particular. In smokers, lesions tend to be larger on presentation and are more likely to involve the superior aspect.
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Affiliation(s)
- Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University Jerusalem, Israel
| | - Liron Yosef
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University Jerusalem, Israel
| | - Yaara Haimovich
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University Jerusalem, Israel
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