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Kejner AE, Harris BN, Patel R, McMullen C, Weir J, Dahshan BA, Carroll WR, Gillespie MB. Management of the parotid for high-risk cutaneous squamous cell carcinoma: A review from the salivary section of the American Head and Neck Society. Am J Otolaryngol 2022; 43:103374. [PMID: 35158264 DOI: 10.1016/j.amjoto.2022.103374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Metastases to the parotid nodal basin in patients with high-risk cutaneous squamous cell carcinoma (HRcSCC) impact disease specific survival (DSS) and overall survival (OS). METHODS A writing group convened by the Salivary Section of the American Head and Neck Society (AHNS) developed contemporary, evidence-based recommendations regarding management of the parotid nodal basin in HRcSCC based on available literature, expert consultation, and collective experience. The statements and recommendations were then submitted and approved by the AHNS Salivary Committee. RESULTS These recommendations were developed given the wide variation of practitioners who treat HRcSCC in order to streamline management of the parotid nodal basin including indications for imaging, surgery, radiation, and systemic treatment options as well. CONCLUSIONS This clinical update represents contemporary optimal management of the parotid nodal basin in HRcSCC and is endorsed by the Salivary Section of the AHNS.
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Poonia SK, Harris BN. Use of xenografts and allografts in scalp reconstruction. Curr Opin Otolaryngol Head Neck Surg 2021; 29:424-428. [PMID: 34374665 DOI: 10.1097/moo.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Scalp reconstruction requires a full array of reconstructive options given the complex anatomy and protection of vital structures. Not all patients qualify for advanced reconstructive options and therefore rely on short, effective procedures with minimal morbidity. This review aims to focus on xenografts and allografts to achieve an adequate reconstruction while minimizing morbidity. RECENT FINDINGS Although bovine xenografts have been used for many decades, there have been recent advances in porcine xenografts to aid in scalp defects. Similarly, new allogenic materials have emerged as additional tools in the armamentarium to promote wound healing. SUMMARY Both xenografts and allografts offer viable options for complex scalp reconstruction.
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Affiliation(s)
- Seerat K Poonia
- University of Pennsylvania, Department of Otolaryngology, Philadelphia, Pennsylvania
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Kejner AE, Harris BN. Extent and Indications for Elective and Therapeutic Neck Dissection for Salivary Carcinoma. Otolaryngol Clin North Am 2021; 54:641-651. [PMID: 34024490 DOI: 10.1016/j.otc.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although salivary gland malignancies account for only a small percentage of all head and neck cancers, the incidence is increasing. Furthermore, there is a wide variety of histologic subtypes which must be taken into account in the context of their location. Each is associated with a different rate of regional metastasis and overall survival. This article examines the incidence of salivary gland malignancies and provides evidence for the indications for and extent of elective or therapeutic neck dissection based on location, pathologic type, and histopathologic characteristics.
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Affiliation(s)
- Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY, USA.
| | - Brianna N Harris
- Department of Otolaryngology-Head and Neck Surgery, Scripps Health
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Harris BN, Patel R, Kejner A, Russell B, Ramadan J, Bewley A. Thrombocytosis Predicts Surgical Site Infection in Head and Neck Microvascular Surgery- A Pilot Study. Laryngoscope 2021; 131:1542-1547. [PMID: 33443771 DOI: 10.1002/lary.29386] [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: 09/01/2020] [Revised: 12/07/2020] [Accepted: 01/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS Early and objective prediction of complications in head and neck reconstructive surgery could decrease morbidity and prolonged hospital stays but unfortunately most complications are not identified until their effect is fully realized. There are limited data regarding the association of platelet levels and post-operative complications. Post-operative thrombocytosis (POTCT) is proposed as a possible indicator for complications following free-flap reconstruction. STUDY DESIGN Retrospective review. METHODS A multisite retrospective chart review of patients undergoing free tissue transfer between 2013 and 2018 was undertaken. POTCT was recorded and data normalized between institutions. Data were compared between groups using t-tests and logistic regression (P < .05). A lag-1 difference was used to compare the rate of change in platelet values. RESULTS A total of 398 patients were included. POTCT and a rate of change of 30 K between POD5 and POD6 was significantly associated with the presence of post-operative complication (P = .007). Additionally, lag-1 difference demonstrated a significant association of change in daily platelet counts and complication rates. CONCLUSIONS Isolated POTCT may be an early predictor of complications in HNC patients undergoing free-flap reconstruction. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1542-1547, 2021.
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Affiliation(s)
- Brianna N Harris
- Department of Otolaryngology, University of California, Davis, Sacramento, California, U.S.A
| | - Rusha Patel
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Alexandra Kejner
- Department of Otolaryngology, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Benjamin Russell
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Jad Ramadan
- Department of Statistics, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Arnaud Bewley
- Department of Otolaryngology, University of California, Davis, Sacramento, California, U.S.A
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Harris BN, Ghazizadeh S, Bayon R, Kejner AE, Cannady SB, Greene BJ, Huang AT, Curry J, Blackwell KE, Ducic Y, Wax MK. Safety of fibula free flap in patients following total knee replacement. Head Neck 2020; 43:585-589. [PMID: 33089587 DOI: 10.1002/hed.26519] [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: 04/29/2020] [Revised: 07/21/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Fibula free flap (FFF) is the preferred osteocutaneous flap for reconstruction of large head and neck composite defects. There is a paucity of data whether FFF can be performed safely in patients with knee replacement (total knee arthroplasty [TKA]). METHODS Multi-institutional review of outcomes following FFF in patients who had prior TKA. RESULTS Ten surgeons reported successful FFF in 53 patients with prior TKA. The most common preoperative imaging was a CT angiogram of the bilateral lower extremities. There was no evidence of intraoperative vascular abnormality. Physical therapy began between postoperative day 1 to postoperative day 3. At 1 month postoperatively, 40% of patients were using a cane or walker to ambulate, but by 3 months all had returned to baseline ambulatory status. At >1 year, there were no gait complications. CONCLUSION FFF appears safe in patients with prior knee replacement without an increased risk of complications compared to baseline.
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Affiliation(s)
- Brianna N Harris
- Department of Otolaryngology - Head and Neck Surgery, Scripps Health, San Diego, California, USA
| | - Shabnam Ghazizadeh
- Department of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rodrigo Bayon
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Alexandra E Kejner
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Steven B Cannady
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin J Greene
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama, Birmingham, Alabama, USA
| | - Andrew T Huang
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Curry
- Department of Otolaryngology - Head and Neck Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Keith E Blackwell
- Department of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| | - Mark K Wax
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
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Harris BN, Hoshal SG, Evangelista L, Kuhn M. Reconstruction technique following total laryngectomy affects swallowing outcomes. Laryngoscope Investig Otolaryngol 2020; 5:703-707. [PMID: 32864442 PMCID: PMC7444795 DOI: 10.1002/lio2.430] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/26/2020] [Accepted: 07/02/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES How reconstruction affects function following total laryngectomy is unclear. This study seeks to determine whether reconstruction method is associated with differences in swallowing outcomes. METHODS Retrospective review of reconstruction technique in patients undergoing TL was compared by pharyngeal transit time (PTT), patient-reported dysphagia (EAT-10), and diet-tolerated (FOIS). RESULTS Ninety-five patients met inclusion criteria, with 40 patients (42.1%) undergoing primary closure and 55 patients (57.9%) undergoing tissue transfer. There was no difference in EAT-10 scores between the groups (P = .09). There was a significantly higher proportion of patients achieving oral diet (FOIS >3) with primary closure (P = .003). Patients undergoing PMC vs free flap had similar rates of g-tube dependency. Primary closure had the shortest PTT (1.89 seconds) compared to free flap (3.47-4.65 seconds) or PMC (5.1 seconds; P = .035). CONCLUSIONS When primary closure is achievable, these results suggest improved swallowing outcomes with better tolerance of oral diet and shorter pharyngeal transit times. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Brianna N. Harris
- Department of OtolaryngologyUniversity of California, DavisSacramentoCaliforniaUSA
| | - Steven G. Hoshal
- Department of OtolaryngologyUniversity of California, DavisSacramentoCaliforniaUSA
| | - Lisa Evangelista
- Department of OtolaryngologyUniversity of California, DavisSacramentoCaliforniaUSA
| | - Maggie Kuhn
- Department of OtolaryngologyUniversity of California, DavisSacramentoCaliforniaUSA
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Hoshal SG, Timbang M, Harris BN, Darrow MA, Bewley AF. Endotracheal Tube Bridle Associated With Full-Thickness Facial Necrosis and Parotid Gland Mucormycosis. Ear Nose Throat J 2020; 101:NP18-NP20. [PMID: 32627585 DOI: 10.1177/0145561320936489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Steven G Hoshal
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Maryroz Timbang
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Brianna N Harris
- Department of Head and Neck Microvascular and Reconstructive Surgery, SENTA Clinic, San Diego, CA, USA
| | - Morgan A Darrow
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA
| | - Arnaud F Bewley
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
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Brody RM, Albergotti WG, Shimunov D, Nicolli E, Patel UA, Harris BN, Bur AM. Changes in head and neck oncologic practice during the COVID-19 pandemic. Head Neck 2020; 42:1448-1453. [PMID: 32357380 PMCID: PMC7267666 DOI: 10.1002/hed.26233] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has raised controversies regarding safe and effective care of patients with head and neck cancer. It is unknown how much the pandemic has changed surgeon practice. METHODS A questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff. RESULTS A total of 88 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider nonsurgical therapy for patients with early glottic cancers and HPV-mediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees. CONCLUSIONS This study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high.
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Affiliation(s)
- Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William Greer Albergotti
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - David Shimunov
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth Nicolli
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA
| | - Urjeet A Patel
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
| | - Brianna N Harris
- Department of Otolaryngology-Head and Neck Surgery, Scripps Memorial, San Diego, California, USA
| | - Andrés M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
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Civantos AM, Byrnes Y, Chang C, Prasad A, Chorath K, Poonia SK, Jenks CM, Bur AM, Thakkar P, Graboyes EM, Seth R, Trosman S, Wong A, Laitman BM, Harris BN, Shah J, Stubbs V, Choby G, Long Q, Rassekh CH, Thaler E, Rajasekaran K. Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: National study. Head Neck 2020; 42:1597-1609. [PMID: 32496637 PMCID: PMC7300862 DOI: 10.1002/hed.26292] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background Otolaryngologists are among the highest risk for COVID‐19 exposure. Methods This is a cross‐sectional, survey‐based, national study evaluating academic otolaryngologists. Burnout, anxiety, distress, and depression were assessed by the single‐item Mini‐Z Burnout Assessment, 7‐item Generalized Anxiety Disorder Scale, 15‐item Impact of Event Scale, and 2‐item Patient Health Questionnaire, respectively. Results A total of 349 physicians completed the survey. Of them, 165 (47.3%) were residents and 212 (60.7%) were males. Anxiety, distress, burnout, and depression were reported in 167 (47.9%), 210 (60.2%), 76 (21.8%), and 37 (10.6%) physicians, respectively. Attendings had decreased burnout relative to residents (odds ratio [OR] 0.28, confidence interval [CI] [0.11‐0.68]; P = .005). Females had increased burnout (OR 1.93, CI [1.12.‐3.32]; P = .018), anxiety (OR 2.53, CI [1.59‐4.02]; P < .005), and distress (OR 2.68, CI [1.64‐4.37]; P < .005). Physicians in states with greater than 20 000 positive cases had increased distress (OR 2.01, CI [1.22‐3.31]; P = .006). Conclusion During the COVID‐19 pandemic, the prevalence of burnout, anxiety, and distress is high among academic otolaryngologists.
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Affiliation(s)
- Alyssa M Civantos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yasmeen Byrnes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Changgee Chang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Chorath
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Seerat K Poonia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn M Jenks
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrés M Bur
- Department of Otolaryngology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Punam Thakkar
- Department of Otolaryngology, George Washington University, Washington, District of Columbia, USA
| | - Evan M Graboyes
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rahul Seth
- Department of Otolaryngology, University of San Francisco, San Francisco, California, USA
| | - Samuel Trosman
- Department of Otolaryngology, Mt. Sinai Health System, New York, New York, USA
| | - Anni Wong
- Department of Otolaryngology, Mt. Sinai Health System, New York, New York, USA
| | - Benjamin M Laitman
- Department of Otolaryngology, Mt. Sinai Health System, New York, New York, USA
| | - Brianna N Harris
- Department of Otolaryngology, Scripps Health/Senta Clinic, San Diego, California, USA
| | - Janki Shah
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vanessa Stubbs
- Department of Otolaryngology, University of Miami, Miami, Florida, USA
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Qi Long
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Harris BN, Pipkorn P, Nguyen KNB, Jackson RS, Rao S, Moore MG, Farwell DG, Bewley AF. Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck. JAMA Otolaryngol Head Neck Surg 2020; 145:153-158. [PMID: 30570645 DOI: 10.1001/jamaoto.2018.3650] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors worldwide. There is conflicting evidence regarding the indications for and benefits of adjuvant radiation therapy for advanced CSCC tumors of the head and neck. Objective To assess indications for adjuvant radiation therapy in patients with CSCC. Design, Setting, and Participants Retrospective analysis of 349 patients with head and neck CSCC treated with primary resection with or without adjuvant radiation therapy at 2 tertiary referral centers from January 1, 2008, to June 30, 2016. Main Outcomes and Measures Data were compared between treatment groups with a χ2 analysis. Disease-free survival (DFS) and overall survival (OS) were analyzed using a Kaplan-Meier survival analysis with log-rank test and a Cox proportional hazards multivariate regression. Results A total of 349 patients had tumors that met the inclusion criteria (mean [SD] age, 70 [12] years; age range, 32-94 years; 302 [86.5%] male), and 191 (54.7%) received adjuvant radiation therapy. The 5-year Kaplan-Meier estimates were 59.4% for DFS and 47.4% for OS. Patients with larger, regionally metastatic, poorly differentiated tumors with perineural invasion (PNI) and younger immunosuppressed patients were more likely to receive adjuvant radiation therapy. On Cox proportional hazards multivariate regression, patients with periorbital tumors (hazard ratio [HR], 2.48; 95% CI, 1.00-6.16), PNI (HR, 1.90; 95% CI, 1.12-3.19), or N2 or greater nodal disease (HR, 2.16; 95% CI, 1.13-4.16) had lower DFS. Immunosuppressed patients (HR, 2.17; 95% CI, 1.12-4.17) and those with N2 or greater nodal disease (HR, 2.43; 95% CI, 1.42-4.17) had lower OS. Adjuvant radiation therapy was associated with improved OS for the entire cohort (HR, 0.59; 95% CI, 0.38-0.90). In a subset analysis of tumors with PNI, adjuvant radiation therapy was associated with improved DFS (HR, 0.47; 95% CI, 0.23-0.93) and OS (HR, 0.44; 95% CI, 0.24-0.86). Adjuvant radiation therapy was also associated with improved DFS (HR, 0.36; 95% CI, 0.15-0.84) and OS (HR, 0.30; 95% CI, 0.15-0.61) in patients with regional disease. Conclusions and Relevance Among patients with advanced CSCC, receipt of adjuvant radiation therapy was associated with improved survival in those with PNI and regional disease.
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Affiliation(s)
- Brianna N Harris
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ky Nam Bai Nguyen
- Department of Radiation Oncology, University of California, Davis, Sacramento
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Shyam Rao
- Department of Radiation Oncology, University of California, Davis, Sacramento
| | - Michael G Moore
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - D Gregory Farwell
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California, Davis, Sacramento
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Phillips TJ, Harris BN, Moore MG, Farwell DG, Bewley AF. Pathological margins and advanced cutaneous squamous cell carcinoma of the head and neck. J Otolaryngol Head Neck Surg 2019; 48:55. [PMID: 31653276 PMCID: PMC6815033 DOI: 10.1186/s40463-019-0374-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 03/01/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022] Open
Abstract
Objective The recommended treatment for cutaneous squamous cell cancer (CuSCC) of the head and neck is Mohs surgical excision or wide local excision. Excision is recommended to a gross surgical margin of 4–6 mm however this is based on limited evidence and specify a goal histologic margin. The objective of this study was therefore to examine the reported histological margin distance following WLE of advanced CuSCC and its association with recurrence and survival. Study design Retrospective database review. Setting All patients included received treatment at UC Davis Department of Otolaryngology-Head and Neck Surgery and/or Radiation Oncology in Sacramento, California. Subjects and methods The patients included were treated for advanced CuSCC with primary surgery with or without adjuvant therapy. Kaplan Meier survival curves with log rank analysis were then performed to compare 5-year recurrence free survival, and disease-specific survival for patients with different margin distances. Results Total number of subjects was 92. The overall 5-year DSS and RFS was 68.8 and 51.0% respectively. When the pathological margin distance was ≥5 mm, 5-year disease specific survival was improved when compared to margin distance less than 5 mm (94.7 vs 60.7 p = 0.034). Conclusion The findings of this study suggest that a histologic margin of at least 5 mm may increase survival in advanced head and neck CuSCC patients.
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Affiliation(s)
- T J Phillips
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA. .,Division of Head and Neck Surgery, Kingston Health Science Center, Queen's University, 2nd Floor Murray Building, Hotel Dieu Hospital, Bagot Street, Kingston, Ontario, Canada.
| | - B N Harris
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA
| | - M G Moore
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA
| | - D G Farwell
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA
| | - A F Bewley
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA
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Harris BN, Bayoumi A, Rao S, Moore MG, Farwell DG, Bewley AF. Factors Associated with Recurrence and Regional Adenopathy for Head and Neck Cutaneous Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 156:863-869. [DOI: 10.1177/0194599817697053] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignancies worldwide. With advanced CSCC of the head and neck, there is conflicting evidence on what constitutes high-risk disease. Our objective is to evaluate which factors are predictive of recurrence and nodal spread and survival. Study Design Case series with chart review. Setting Tertiary academic institution. Subjects and Methods Patients with advanced head and neck CSCC treated with primary resection identified by chart review. Results A total of 212 patients met inclusion criteria, with a mean age of 70.4 years; 87.3% were men. Mean tumor diameter was 3.65 cm, with an average depth of invasion of 1.38 cm. The mean follow-up time was 35 months (median, 21.5), and over that period 67 recurrences were recorded, 49 of which were local. The 5-year Kaplan-Meier estimate of disease-free survival for the cohort was 53.2%. On Cox multivariate analysis, recurrent disease, perineural invasion (PNI), and poorly differentiated histology were independent predictors of recurrence. On multinomial logistic regression, patients with primary tumors on the ear, cheek, temple, or lip, as well as those with PNI, were more likely to present with nodal metastasis. Conclusion For advanced CSCCs of the head and neck, patients with recurrent disease, PNI, and poorly differentiated tumors are at highest risk for local recurrence. Patients with tumors or the ear, cheek, temple, or lip, as well as those with PNI, are at increased risk of harboring nodal disease.
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Affiliation(s)
- Brianna N. Harris
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Ahmed Bayoumi
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Shyam Rao
- Department of Radiation Oncology, University of California–Davis, Sacramento, California, USA
| | - Michael G. Moore
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - D. Gregory Farwell
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
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Harris BN, Bhuskute AA, Rao S, Farwell DG, Bewley AF. Primary surgery for advanced-stage laryngeal cancer: A stage and subsite-specific survival analysis. Head Neck 2016; 38:1380-6. [PMID: 27014858 DOI: 10.1002/hed.24443] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Accepted: 02/02/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Treatment recommendations for advanced-stage laryngeal squamous cell carcinoma (SCC) have evolved significantly over the last 2 decades. METHODS We retrospectively analyzed patients in the Surveillance, Epidemiology, and End Results (SEER) database with advanced-stage laryngeal SCC treated between 2004 and 2012. RESULTS A total of 6797 patients were identified in the SEER database who met inclusion criteria, with 2051 patients undergoing primary surgery and 4746 patients undergoing primary radiotherapy (RT) or chemoradiotherapy (CRT). Disease-specific survival (DSS) and overall survival (OS) were significantly better for patients treated with primary surgery when compared using Kaplan-Meier curves and a Cox multivariate regression. When survival analysis was repeated for patients stratified by T classification, N classification, and subsite, OS and DSS benefits from primary surgery were observed for patients with T3 and T4a tumors, N0 neck disease, or supraglottic primaries. CONCLUSION Patients with advanced-stage laryngeal SCC with T3 and T4a tumors, N0 neck disease, or supraglottic primaries have the greatest chance of survival when treated with primary surgery. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1380-1386, 2016.
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Affiliation(s)
- Brianna N Harris
- Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Aditi A Bhuskute
- Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Shyam Rao
- Department of Oncology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California
| | - D Gregory Farwell
- Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Arnaud F Bewley
- Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California
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Harris BN, Biron VL, Donald P, Farwell DG, Luu QC, Bewley AF, Chen AM, Daly ME. Primary Surgery vs Chemoradiation Treatment of Advanced-Stage Hypopharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2015; 141:636-40. [PMID: 25973578 DOI: 10.1001/jamaoto.2015.0659] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is no consensus whether primary surgery followed by either adjuvant radiotherapy (RT) or adjuvant chemoradiation (CRT) or definitive CRT should be the standard treatment approach to advanced-stage hypopharyngeal squamous cell carcinoma (HP SCC). OBJECTIVES To determine survival outcomes for patients with advanced-stage HP SCC treated at a single institution with either primary surgery plus RT or CRT or definitive CRT. EVIDENCE AND DATA ACQUISITION We conducted a retrospective analysis of prospectively collected medical records in an institutional database for patients with HP SCC newly diagnosed between January 1999 and April 2013. Overall survival (OS) and recurrence-free survival (RFS) were calculated and compared between treatment groups using the Kaplan-Meier method, with multivariate Cox regression analysis used to control for demographic and clinicopathologic features. RESULTS We identified 166 consecutively treated patients, 90 of whom did not meet study criteria. Of the 76 included patients, 48 (63%) had undergone definitive CRT, and 28 (37%) had undergone primary surgery with adjuvant RT or CRT. The groups were well balanced by age, smoking history, and alcohol use. Five-year OS and RFS for patients treated surgically were 66.3% and 53.6%, respectively; for patients treated with definitive CRT, OS and RFS were 41.3% and 34.5%, respectively. Multivariate Cox regression analysis showed that surgical management was associated with clinically improved OS (hazard ratio [HR], 4.78; 95% CI, 0.91-25.03; P = .06) and RFS (HR, 2.97; 95% CI, 0.76-11.53; P = .12), although the difference was not statistically significant. CONCLUSIONS AND RELEVANCE Patients with advanced-stage HP SCC treated surgically with adjuvant RT or CRT showed a trend toward clinically improved OS and RFS compared with patients treated with definitive CRT. However, the difference was not statistically significant, and further investigation with larger controlled trials using modern approaches should be undertaken to optimize the initial management of advanced-stage HP SCC.
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Affiliation(s)
- Brianna N Harris
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Vincent L Biron
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Paul Donald
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - D Gregory Farwell
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Quang C Luu
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Allen M Chen
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles
| | - Megan E Daly
- Department of Radiation Oncology, University of California, Davis, Sacramento
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Mitra AP, Alemozaffar M, Harris BN, Schuckman AK, Skinner EC, Daneshmand S. Outcomes After Urothelial Recurrence in Bladder Cancer Patients Undergoing Radical Cystectomy. Urology 2014; 84:1420-6. [DOI: 10.1016/j.urology.2014.05.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/08/2014] [Accepted: 05/03/2014] [Indexed: 10/24/2022]
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De Jong TR, Harris BN, Perea-Rodriguez JP, Saltzman W. Physiological and neuroendocrine responses to chronic variable stress in male California mice (Peromyscus californicus): Influence of social environment and paternal state. Psychoneuroendocrinology 2013; 38:2023-33. [PMID: 23582312 PMCID: PMC3821767 DOI: 10.1016/j.psyneuen.2013.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 01/09/2013] [Revised: 02/20/2013] [Accepted: 03/18/2013] [Indexed: 11/26/2022]
Abstract
Social environment and parental state affect stress responses in mammals, but their impact may depend on the social and reproductive strategy of the species. The influences of cohabitation with a male or female conspecific, and the birth of offspring, on the physiological and endocrine responses to chronic variable stress were studied in the monogamous and biparental California mouse (Peromyscus californicus). Adult male California mice were housed either with a male cage mate (virgin males, VM), a female cage mate (pair-bonded males, PBM), or a female cage mate and their first newborn litter (new fathers, NF). VM, PBM and NF underwent a 7-day chronic variable stress paradigm (CVS, three stressors per day at semi-random times, n=7-8 per housing condition). Compared to control males (CON, n=6-7 per housing condition), CVS caused loss of body mass, increased basal plasma corticosterone concentrations, and increased basal expression of arginine vasopressin (AVP) mRNA in the paraventricular nucleus of the hypothalamus (PVN). These effects were independent of housing condition. Neither CVS nor housing condition altered novel-stressor-induced corticosterone release, spleen or testis mass, or basal expression of corticotropin-releasing hormone (CRH) mRNA in the PVN. Although CVS appeared to increase adrenal mass and reduce thymus mass specifically in NF, these effects were explained by the lower adrenal mass and higher thymus mass of NF compared to PBM and VM under control conditions. These results suggest that neither engaging in a pair bond nor becoming a father attenuates typical responses to CVS, but that fatherhood may provide a buffer against transient mild stressors (i.e., weighing and blood sampling in the control groups) in this monogamous and biparental rodent.
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Affiliation(s)
- TR De Jong
- Department of Biology, University of California, Riverside,Department of Behavioral and Molecular Neurobiology, University of
Regensburg, Regensburg, Germany
| | - BN Harris
- Department of Biology, University of California, Riverside,Evolution, Ecology, and Organismal Biology Graduate Program,
University of California, Riverside
| | - JP Perea-Rodriguez
- Department of Biology, University of California, Riverside,Evolution, Ecology, and Organismal Biology Graduate Program,
University of California, Riverside
| | - W Saltzman
- Department of Biology, University of California, Riverside,Evolution, Ecology, and Organismal Biology Graduate Program,
University of California, Riverside
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Ghobrial IM, Munshi NC, Harris BN, Shi P, Porter NM, Schlossman RL, Laubach JP, Anderson KC, Desaiah D, Myrand SP, Wooldridge JE, Richardson PG, Abonour R. A phase I safety study of enzastaurin plus bortezomib in the treatment of relapsed or refractory multiple myeloma. Am J Hematol 2011; 86:573-8. [PMID: 21630305 DOI: 10.1002/ajh.22048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 03/29/2011] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to assess the safety and identify the recommended doses of enzastaurin and bortezomib in combination for future Phase II studies in patients with relapsed or refractory multiple myeloma. Three dose levels (DLs) of oral enzastaurin and intravenous bortezomib were used according to a conventional "3 + 3" design. A loading dose of enzastaurin (250 mg twice/day [BID]) on Day 1 was followed by enzastaurin 125 mg BID for 1 week, after which bortezomib was added (Cycle 1, 28 days, 1.0 mg/m(2) : Days 8, 11, 15, and 18; seven subsequent 21-day cycles, 1.3 mg/m(2) : Days 1, 4, 8, and 11). Twenty-three patients received treatment; all patients received prior systemic therapy. Most patients received ≥3 regimens; 17 patients were bortezomib-refractory. A median of four treatment cycles (range 1-24) was completed. No dose-limiting toxicities were observed; thus, DL 3 was the recommended Phase II dose. The most common drug-related Grade 3/4 toxicities were thrombocytopenia (n = 6) and anemia (n = 2). No patients died on therapy. One patient (DL 1) achieved a very good partial response; three patients (DLs 2 and 3), a partial response; nine patients, stable disease; and four patients, progressive disease. The recommended Phase II doses in patients with relapsed or refractory multiple myeloma are as follows: enzastaurin loading dose of 375 mg three times/day on Day 1 followed by 250 mg BID, with bortezomib 1.3 mg/m(2) on Days 1, 4, 8, and 11 of a 21-day cycle. The combination was well-tolerated and demonstrated some antimyeloma activity.
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Affiliation(s)
- Irene M Ghobrial
- The Multiple Myeloma/Waldenstrom's Macroglobulinemia Program, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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18
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Schiller I, Oesch B, Vordermeier HM, Palmer MV, Harris BN, Orloski KA, Buddle BM, Thacker TC, Lyashchenko KP, Waters WR. Bovine tuberculosis: a review of current and emerging diagnostic techniques in view of their relevance for disease control and eradication. Transbound Emerg Dis 2010; 57:205-20. [PMID: 20561288 DOI: 10.1111/j.1865-1682.2010.01148.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Existing strategies for long-term bovine tuberculosis (bTB) control/eradication campaigns are being reconsidered in many countries because of the development of new testing technologies, increased global trade, continued struggle with wildlife reservoirs of bTB, redistribution of international trading partners/agreements, and emerging financial and animal welfare constraints on herd depopulation. Changes under consideration or newly implemented include additional control measures to limit risks with imported animals, enhanced programs to mitigate wildlife reservoir risks, re-evaluation of options to manage bTB-affected herds/regions, modernization of regulatory framework(s) to re-focus control efforts, and consideration of emerging testing technologies (i.e. improved or new tests) for use in bTB control/eradication programs. Traditional slaughter surveillance and test/removal strategies will likely be augmented by incorporation of new technologies and more targeted control efforts. The present review provides an overview of current and emerging bTB testing strategies/tools and a vision for incorporation of emerging technologies into the current control/eradication programs.
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Lombard JE, Wagner BA, Smith RL, McCluskey BJ, Harris BN, Payeur JB, Garry FB, Salman MD. Evaluation of environmental sampling and culture to determine Mycobacterium avium subspecies paratuberculosis distribution and herd infection status on US dairy operations. J Dairy Sci 2008; 89:4163-71. [PMID: 17033002 DOI: 10.3168/jds.s0022-0302(06)72461-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The objectives of this study were to determine the distribution of Mycobacterium avium subspecies paratuberculosis (MAP) in the environment and assess the relationship between the culture status of MAP in the farm environment and herd infection status. The National Animal Health Monitoring System's Dairy 2002 study surveyed dairy operations in 21 states. One component of the study involved collection and culturing of environmental samples for MAP from areas on farms where manure accumulated from a majority of a herd's cows. Operations were selected for inclusion based on perceived risk factors for MAP infection identified in a previously administered questionnaire. Individual animal and environmental samples were collected and used to determine the efficiency of environmental sampling for determination of herd infection status. Individual animal fecal, serum, and milk samples were used to classify herds as infected or not infected based on the presence of at least one test-positive animal in the herd. A total of 483 environmental samples (approximately 5 per farm) were collected, and 218 (45.1%) were culture-positive for MAP. A similar percentage of environmental cultures collected from all designated areas were positive [parlor exits (52.3%), floors of holding pens (49.1%), common alleyways (48.8%), lagoons (47.4%), manure spreaders (42.3%), and manure pits (41.5%)]. Of the 98 operations tested with the environmental sample culture, 97 had individual serum ELISA results, 60 had individual fecal culture results, and 34 had individual milk ELISA results. Sixty-nine of the 98 operations (70.4%) had at least one environmental sample that was culture-positive. Of the 50 herds classified as infected by fecal culture, 38 (76.0%) were identified by environmental culture. Two of the 10 operations classified as not infected based on individual animal fecal culture were environmental culture-positive. Of the 80 operations classified as infected based on serum ELISA-positive results, 61 (76.3%) were identified as environmental-positive, whereas 20 of the 28 (71.4%) operations identified as infected based on milk ELISA were detected by environmental sampling. Environmental sample culturing is less costly than individual animal sampling, does not require animal restraint, and identified more than 70% of infected operations. Environmental sampling is another diagnostic tool that veterinarians and dairy producers can use to determine herd infection status for MAP.
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Affiliation(s)
- J E Lombard
- USDA, Animal and Plant Health Inspection Service, Veterinary Services, Centers for Epidemiology and Animal Health, 2150 Centre Ave., Bldg. B, Fort Collins, CO 80526-8117, USA.
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20
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Durrheim DN, Fourie A, Balt E, Le Roux M, Harris BN, Matebula M, De Villiers M, Speare R. Leprosy in Mpumalanga Province, South Africa--eliminated or hidden? LEPROSY REV 2002; 73:326-33. [PMID: 12549840] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
In South Africa, leprosy has been a notifiable condition since 1921. Although the WHO elimination target of less than one case per 10,000 population has been achieved at country level, the distribution of leprosy in the country is distinctly heterogeneous, with a prominent 'leprosy belt' of greater prevalence stretching across Mpumalanga Province into northern Kwa-Zulu Natal. The highest prevalence in this 'belt' has historically been in Ermelo District. Recent trends of few newly detected leprosy patients in this district raised concerns that health system changes may have resulted in failure to detect leprosy cases. Thus a large-scale community awareness campaign was conducted followed by an intensively advertised screening programme of 3-month duration at schools and central gathering points in villages and farms from 1 June to 31 August 2000. One thousand one hundred and seventy-seven people presented for clinical screening at designated points, while 790 scholars were screened at schools and an additional 1433 people were screened at their homes by the field team. Forty-four people with skin or nervous system lesions compatible with leprosy were referred for specialized assessment and biopsy where indicated. Four new leprosy patients were diagnosed, including an elderly lady with pronounced disability. Two of these patients had prior contact with the health service due to dermatological manifestations of leprosy without diagnosis being made. All patients provided a history of close prolonged contact with known leprosy patients. Ongoing intense tracing and follow-up of close contacts of proven leprosy cases may be a more efficient method of detecting leprosy cases in areas with relatively stable populations that have accomplished 'leprosy elimination', than resource intensive community surveys.
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Affiliation(s)
- D N Durrheim
- Communicable Disease Control, Mpumalanga Department of Health, Post Bag X11285, Nelspruit, 1200, South Africa.
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Abstract
Neonatal tetanus (NNT) is a serious but preventable disease, and the World Health Organization (WHO) wants to eliminate NNT globally by reducing its incidence to <1 case per 1000 live births. South Africa adopted this goal in 1995, but Mpumalanga, a rural province, has consistently reported cases of NNT despite an appropriate vaccination strategy to eliminate the disease. The aim of the study was to investigate the completeness of the passive notification system and to explore reasons for ongoing NNT cases despite implementation of the provincial vaccination strategy. We reviewed all hospital admissions in the province between 1996 and 2000 meeting the case definition for NNT and interviewed mothers of the NNT cases reported in 2000. We identified 26 NNT cases, of which only 14 (54%) were reported through the routine notification system. Most cases occurred as a result of the cultural practice of applying cow dung or rat faeces to the umbilical stump in the neonatal period. Although all districts met the WHO elimination target during the review period, there is scope to prevent unnecessary NNT deaths through culturally acceptable public awareness campaigns aimed at changing harmful practices, and encouraging hygienic births and postnatal cord care.
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Affiliation(s)
- C D Idema
- National TB Control Programme, National Department of Health, Pretoria, South Africa
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Durrheim DN, Harris BN, Speare R, Billinghurst K. The use of hospital-based nurses for the surveillance of potential disease outbreaks. Bull World Health Organ 2001; 79:22-7. [PMID: 11217663 PMCID: PMC2566333] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To study a novel surveillance system introduced in Mpumalanga Province, a rural area in the north-east of South Africa, in an attempt to address deficiencies in the system of notification for infectious conditions that have the potential for causing outbreaks. METHODS Hospital-based infection control nurses in all of Mpumalanga's 32 public and private hospitals were trained to recognize, report, and respond to nine clinical syndromes that require immediate action. Sustainability of the system was assured through a schedule of regular training and networking, and by providing feedback to the nurses. The system was evaluated by formal review of hospital records, evidence of the effective containment of a cholera outbreak, and assessment of the speed and appropriateness of responses to other syndromes. FINDINGS Rapid detection, reporting and response to six imported cholera cases resulted in effective containment, with only 19 proven secondary cholera cases, during the two-year review period. No secondary cases followed detection and prompt response to 14 patients with meningococcal disease. By the end of the first year of implementation, all facilities were providing weekly zero-reports on the nine syndromes before the designated time. Formal hospital record review for cases of acute flaccid paralysis endorsed the value of the system. CONCLUSION The primary goal of an outbreak surveillance system is to ensure timely recognition of syndromes requiring an immediate response. Infection control nurses in Mpumalanga hospitals have excelled in timely weekly zero-reporting, participation at monthly training and feedback sessions, detection of priority clinical syndromes, and prompt appropriate response. This review provides support for the role of hospital-based nurses as valuable sentinel surveillance agents providing timely data for action.
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Affiliation(s)
- D N Durrheim
- Department of Health, Private Bag X11285, Nelspruit 1200, Mpumalanga, South Africa.
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Taylor MB, Becker PJ, Van Rensburg EJ, Harris BN, Bailey IW, Grabow WO. A serosurvey of water-borne pathogens amongst canoeists in South Africa. Epidemiol Infect 1995; 115:299-307. [PMID: 7589269 PMCID: PMC2271398 DOI: 10.1017/s0950268800058428] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Certain health risks have been associated with recreational exposure to faecally polluted water. Canoeing in certain South African waters is considered to be a high risk activity with regard to schistosomiasis, gastroenteritis and possibly hepatitis. In a cross-sectional study, a serosurvey was conducted amongst canoeists to ascertain whether or not they had a higher seroprevalence to hepatitis A virus, Norwalk virus and Schistosoma spp. than non-canoeists. In comparisons between the two groups, a significant association could not be demonstrated between canoeing and antibody response to hepatitis A and Norwalk viruses (P-values for age-adjusted chi 2 were 0.083 and 0.219 respectively), but a significant association could be demonstrated between canoeing and the antibody response to Schistosoma spp. (P < 0.001; age-adjusted).
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Affiliation(s)
- M B Taylor
- Department of Medical Virology, University of Pretoria, South Africa
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Harris BN, Davis EM, Le Beau MM, Bitter MA, Kaminer LS, Morgan E, Rowley JD. Variant translocations (9;11): identification of the critical genetic rearrangement. Cancer Genet Cytogenet 1988; 30:171-5. [PMID: 3422044 DOI: 10.1016/0165-4608(88)90108-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The t(9;11)(p22;q23) is a recurring abnormality in acute nonlymphocytic leukemia. The analysis of complex 9;11 translocations will aid in the identification of the conserved chromosomal junction or the critical genetic alteration created by the rearrangement; however, variant translocations involving chromosomes #9 and #11 have not been reported. We have identified such variants in two patients who had acute myelomonocytic leukemia and acute monocytic leukemia, characterized by a t(9;11;18)(p22;q23;q12) and a t(9;11;13)(p22;q23;q34), respectively. The conserved junction resulting from these rearrangements is created by the translocation of chromosomal material from 9p to 11q.
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Affiliation(s)
- B N Harris
- Department of Medicine, University of Chicago, Ill 60637
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