11 results on '"St John MA"'
Search Results
2. Surgery for papillary thyroid carcinoma: is lobectomy enough?
- Author
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Mendelsohn AH, Elashoff DA, Abemayor E, and St John MA
- Published
- 2010
- Full Text
- View/download PDF
3. Radiology quiz case 1. Metastatic cutaneous angiosarcoma of the scalp with perineural spread.
- Author
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Lau OD, Bhuta S, Smart CN, Kirsch CM, and St John MA
- Published
- 2010
- Full Text
- View/download PDF
4. Decontamination Methods for Reuse of Filtering Facepiece Respirators.
- Author
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Su-Velez BM, Maxim T, Long JL, St John MA, and Holliday MA
- Subjects
- COVID-19 transmission, Clinical Protocols, Eye Protective Devices, Gloves, Protective, Hand Disinfection, Humans, Infectious Disease Transmission, Patient-to-Professional prevention & control, N95 Respirators supply & distribution, SARS-CoV-2, Time Factors, Decontamination methods, N95 Respirators virology
- Abstract
Importance: The novel coronavirus disease 2019 (COVID-19) has proven to be highly infectious, putting health care professionals around the world at increased risk. Furthermore, there are widespread shortages of necessary personal protective equipment (PPE) for these individuals. Filtering facepiece respirators, such as the N95 respirator, intended for single use, can be reused in times of need. We explore the evidence for decontamination or sterilization of N95 respirators for health care systems seeking to conserve PPE while maintaining the health of their workforce., Observations: The filtration properties and fit of N95 respirators must be preserved to function adequately over multiple uses. Studies have shown that chemical sterilization using soap and water, alcohols, and bleach render the respirator nonfunctional. Decontamination with microwave heat and high dry heat also result in degradation of respirator material. UV light, steam, low-dry heat, and commercial sterilization methods with ethylene oxide or vaporized hydrogen peroxide appear to be viable options for successful decontamination. Furthermore, since the surface viability of the novel coronavirus is presumed to be 72 hours, rotating N95 respirator use and allowing time decontamination of the respirators is also a reasonable option. We describe a protocol and best practice recommendations for redoffing decontaminated N95 and rotating N95 respirator use., Conclusions and Relevance: COVID-19 presents a high risk for health care professionals, particularly otolaryngologists, owing to the nature of viral transmission, including possible airborne transmission and high viral load in the upper respiratory tract. Proper PPE is effective when used correctly, but in times of scarce resources, institutions may turn to alternative methods of preserving and reusing filtering facepiece respirators. Based on studies conducted on the decontamination of N95 respirators after prior outbreaks, there are several options for institutions to consider for both immediate and large-scale implementation.
- Published
- 2020
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- View/download PDF
5. Risk Factors, Causes, and Costs of Hospital Readmission After Head and Neck Cancer Surgery Reconstruction.
- Author
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Goel AN, Raghavan G, St John MA, and Long JL
- Subjects
- Aged, Comorbidity, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Social Class, Head and Neck Neoplasms surgery, Hospital Costs statistics & numerical data, Patient Readmission economics, Postoperative Complications economics, Plastic Surgery Procedures economics, Surgical Flaps
- Abstract
Importance: Thirty-day hospital readmissions have substantial direct costs and are increasingly used as a measure of quality care. However, data regarding the risk factors and reasons for readmissions in head and neck cancer surgery reconstruction are lacking., Objective: To describe the rate, risk factors, and causes of 30-day readmission in patients with head and neck cancer following free or pedicled flap reconstruction., Design, Setting, and Participants: This retrospective, population-based cohort study analyzed medical records from the Nationwide Readmissions Database of 9487 patients undergoing pedicled or free flap reconstruction of head and neck oncologic defects between January 1, 2010, and December 31, 2014. Data analysis was performed in October 2017., Exposures: Pedicled or free flap reconstruction of an oncologic head and neck defect., Main Outcomes and Measures: The primary outcome was 30-day all-cause readmissions. Secondary outcomes included risk factors, causes, and costs of readmission. Multivariate regression analyses were conducted to determine factors independently associated with 30-day readmissions., Results: Among 9487 patients included in the study (6798 male; 71.7%), the median age was 63 years (interquartile range, 55-71 years), and the 30-day readmission rate was 19.4% (n = 1839), with a mean cost per readmission of $15 916 (standard error of the mean, $785). The most common indication for readmission was wound complication (26.5%, n = 487). On multivariate regression, significant risk factors for 30-day readmission were median household income in the lowest quartile (vs highest quartile: odds ratio [OR], 1.58; 95% CI, 1.18-2.11), congestive heart failure (OR, 1.68; 95% CI, 1.14-2.47), liver disease (OR, 2.02; 95% CI, 1.22- 3.33), total laryngectomy (OR, 1.40; 95% CI, 1.12-1.75), pharyngectomy (OR, 1.47; 95% CI, 1.08-2.01), blood transfusion (OR, 1.30; 95% CI, 1.04-1.64), discharge to home with home health care (vs routine: OR, 1.32; 95% CI, 1.04-1.67), and discharge to a nursing facility (vs routine: OR, 1.77; 95% CI, 1.30-2.40)., Conclusions and Relevance: Using the Nationwide Readmissions Database, we demonstrate that approximately 1 in 5 patients undergoing head and neck cancer surgery reconstruction is readmitted within 30 days of surgery. Readmissions are most commonly associated with wound complications. Socioeconomic status, complex ablative procedures, and patient comorbidities are independent risk factors for readmission. These findings may be useful to clinicians in developing perioperative interventions aimed to reduce hospital readmissions and improve quality of patient care.
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- 2019
- Full Text
- View/download PDF
6. Scaffold-Assisted Artificial Hair Implantation in a Rat Model.
- Author
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Au JK, Palma Diaz MF, Aghaloo T, and St John MA
- Subjects
- Animals, Male, Rats, Models, Animal, Random Allocation, Rats, Sprague-Dawley, Biocompatible Materials pharmacology, Hair transplantation, Polyethylene pharmacology, Polytetrafluoroethylene pharmacology, Tissue Scaffolds chemistry
- Abstract
Importance: Current treatments for alopecia with autograft hair transplantation face limitations that may preclude complete hair restoration and leave patients with donor site scars. Scaffold assisted artificial hair implantation as demonstrated in a rat model may provide an adjunct for hair restoration without donor site morbidity., Objective: To design and create porous high-density polyethylene (PHDPE) and expanded polytetrafluoroethylene (ePTFE) hair-bearing scaffolds and evaluate their biocompatibility in a rat model., Design, Setting, and Participants: For this single-institution randomized prospective animal study, 34 Sprague Dawley rats were randomly selected into 2 groups: 24 rats for direct implantation and 10 rats for delayed implantation. The direct-implantation group was randomly divided into 3 subgroups of 8 rats, which were observed for 2, 12, and 24 week., Interventions: Each rat dorsum was implanted with 4 scaffolds-PHDPE and ePTFE with and without hair-in a randomized 4-quadrant manner. The rats in the direct-implantation group were observed to their selected time points of 2, 12, and 24 weeks. The rats in the delayed-implantation group were observed for 4 weeks at which, all well-healed scaffolds without hair were then percutaneously implanted with 2 follicular units of hair. These rats were then observed for another 4 weeks., Main Outcomes and Measures: During the clinical observation period, scaffolds were observed for signs of infection, extrusion, and persistence of follicular units. Following sacrifice, sagittal sections of scaffold and surrounding skin were fixed in formalin, stained with hematoxylin-eosin, and evaluated for degree of fibrovascular invasion and acute and chronic inflammation., Results: Overall 94.5% (86 of 91) of the scaffolds were well healed at time of evaluation (2 week, 100% [32 of 32]; 12 week, 96.3% [26 of 27]; 24 week, 87.5% [28 of 32]); while 85.6% of artificial hair follicular units were intact at time of evaluation (2 week, 93.8% [30 of 32]; 12 week, 86.7% [26 of 30]; 24 week, 75.0% [21 of 28]). Within the delayed implant group 100% (19 of 19) of the hair-implanted scaffolds were well healed at 8 weeks, with 94.7% (36 of 38) of the follicular units intact; 100% of the delayed-hair implant scaffolds were well healed with 86.1% (36 of 38) of the follicular units intact. Kaplan-Meier log-rank analysis showed no significant difference in survival between ePTFE and PHDPE scaffolds, as well as scaffolds with hair and scaffolds without hair. Upon histological analysis, overall scaffolds with hair were noted to have greater chronic inflammation (95% CI, -0.81 to -1.10; P = .01), and PHDPE was noted to have significantly great fibrovascular integration (95% CI, -11.42 to -1.96; P = .01) compared with ePTFE., Conclusions and Relevance: Overall, PHDPE and ePTFE hair bearing scaffolds were well tolerated in a rat model. Progressive loss of artificial hair may be percutaneously implanted without significant increases in infection or extrusion., Level of Evidence: NA.
- Published
- 2018
- Full Text
- View/download PDF
7. Epidemiology of Squamous Cell Carcinoma of the Lip in the United States: A Population-Based Cohort Analysis.
- Author
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Han AY, Kuan EC, Mallen-St Clair J, Alonso JE, Arshi A, and St John MA
- Subjects
- Adolescent, Adult, Age Distribution, Age Factors, Aged, Aged, 80 and over, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell therapy, Child, Child, Preschool, Female, Humans, Lip Neoplasms pathology, Lip Neoplasms therapy, Male, Middle Aged, Multivariate Analysis, Neoplasm Staging, Radiotherapy, Adjuvant, SEER Program, Sex Distribution, United States epidemiology, Young Adult, Carcinoma, Squamous Cell epidemiology, Lip Neoplasms epidemiology
- Abstract
Importance: Squamous cell carcinoma of the lip (lip SCC) composes more than 25% of all oral cancers. Most of the demographic and prognostic indicators for lip SCC are only available through retrospective case series., Objective: To examine the incidence, treatment, overall survival, and disease-specific survival (DSS) of patients with lip SCC., Design, Setting, and Participants: Population-based cohort analysis using the Surveillance, Epidemiology, and End Results database identified patients with lip SCC between January 1, 1973, and December 31, 2012., Main Outcomes and Measures: Overall survival and DSS., Results: A total of 15 832 cases of lip SCC were identified. The cohort was composed of 12 945 men (81.8%) and 2887 women (18.2%). The mean age at diagnosis was 66.1 years. White patients accounted for 98.4% of the cases. Most of the tumors presented in the lower lip (77.8% external and 10.2% mucosal), whereas the external upper lip, mucosal upper lip, and the oral commissure represented 8%, 1%, and 1.2% of all cases, respectively. Of the patients, 91.2% underwent surgical therapy, 7.7% received radiation therapy, and 4.7% received both. Overall survival at 2 years, 5 years, and 10 years was 85.5%, 69.9%, and 50.2%, respectively. Multivariate analysis revealed that age, primary site, T stage, and N stage were determinants of overall survival and DSS. Kaplan-Meier survival analysis showed that SCC of the upper and lower lip had similar overall survival (163.6 months vs 163.8 months) and DSS (418.6 months vs 423.6 months). In contrast, SCC of the oral commissure had significantly lower overall survival (128.5 months) and DSS (286.7 months)., Conclusions and Relevance: Our study demonstrates that lip SCC predominantly affects white men in their mid-60s. The determinants of survival for lip SCC include age at diagnosis, primary site, T stage, and N stage. Squamous cell carcinoma of the upper lip and lower lip had similar survival, whereas SCC of the oral commissure was associated with decreased survival.
- Published
- 2016
- Full Text
- View/download PDF
8. Radiology quiz case 2. Nonrecurrent laryngeal nerve (NRLN).
- Author
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St John MA, Lufkin RB, and Abemayor E
- Subjects
- Aged, Female, Humans, Radiography, Recurrent Laryngeal Nerve diagnostic imaging, Subclavian Artery abnormalities, Subclavian Artery diagnostic imaging, Recurrent Laryngeal Nerve abnormalities
- Published
- 2004
- Full Text
- View/download PDF
9. Interleukin 6 and interleukin 8 as potential biomarkers for oral cavity and oropharyngeal squamous cell carcinoma.
- Author
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St John MA, Li Y, Zhou X, Denny P, Ho CM, Montemagno C, Shi W, Qi F, Wu B, Sinha U, Jordan R, Wolinsky L, Park NH, Liu H, Abemayor E, and Wong DT
- Subjects
- Adult, California, Female, Humans, Interleukin-6 blood, Interleukin-8 blood, Male, Middle Aged, Predictive Value of Tests, RNA, Messenger metabolism, Reverse Transcriptase Polymerase Chain Reaction, Saliva chemistry, Saliva metabolism, Sensitivity and Specificity, Biomarkers, Tumor metabolism, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell metabolism, Interleukin-6 metabolism, Interleukin-8 metabolism, Mouth metabolism, Mouth pathology, Mouth Neoplasms diagnosis, Mouth Neoplasms metabolism, Oropharyngeal Neoplasms diagnosis, Oropharyngeal Neoplasms metabolism
- Abstract
Background: Since morbidity and mortality rates due to oral cavity and oropharyngeal squamous cell carcinoma (OSCC) have improved little in the past 30 years, early detection or prevention of this disease is likely to be most effective. Using laser-capture microdissection, we have identified the expression of 2 cellular genes that are uniquely associated with OSCC: interleukin (IL) 6 and IL-8. These cytokines may contribute to the pathogenesis of this disease, and have been linked with increased tumor growth and metastasis., Objectives: To investigate whether IL-6 and/or IL-8 could serve as informative biomarkers for OSCC in saliva and/or serum and to determine if there is a role for saliva as a diagnostic medium for OSCC., Patients and Methods: Patients with newly diagnosed T1 or T2 oral cavity or oropharyngeal histologically confirmed squamous cell carcinoma were recruited for the study. Age and sex-matched disease-free subjects were used as controls. Using quantitative real-time polymerase chain reaction analysis and enzyme-linked immunosorbent assay, we respectively assessed the expression of IL-6 and IL-8 in serum (controls, n = 32; patients with OSCC, n = 19) and saliva (controls, n = 32; patients with OSCC, n = 32) at the messenger RNA (mRNA) and protein levels., Main Outcome Measures: Specificity and sensitivity of these biomarkers for OSCC and their predictive value., Results: Interleukin 8 was detected at higher concentrations in saliva (P<.01) and IL-6 was detected at higher concentrations in serum of patients with OSCC (P<.01). We confirmed these results at both the mRNA and the protein levels, and the results were concordant. The concentration of IL-8 in saliva and IL-6 in serum did not appear to be associated with sex, age, or alcohol or tobacco use (P>.75). Using statistical analysis, we were able to determine the threshold value, sensitivity, and specificity of each biomarker, as well as a combination of biomarkers, for detecting OSCC., Conclusions: Our findings indicate that IL-8 in saliva and IL-6 in serum hold promise as biomarkers for OSCC. A saliva-based test could be a cost-effective adjunctive tool in the diagnosis and follow-up of patients with OSCC.
- Published
- 2004
- Full Text
- View/download PDF
10. Radiology quiz case 1. Vascular leiomyoma of the larynx.
- Author
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St John MA, Maghami EG, Bhuta S, Lufkin RB, and Abemayor E
- Subjects
- Aged, Biopsy, Needle, Follow-Up Studies, Humans, Immunohistochemistry, Laryngeal Neoplasms surgery, Laryngoscopy methods, Leiomyoma surgery, Male, Risk Assessment, Tomography, X-Ray Computed, Treatment Outcome, Laryngeal Neoplasms diagnostic imaging, Laryngeal Neoplasms pathology, Leiomyoma diagnostic imaging, Leiomyoma pathology
- Published
- 2002
- Full Text
- View/download PDF
11. Eikenella corrodens empyema in children.
- Author
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St John MA, Belda AA, Matlow A, and Prober CG
- Subjects
- Adolescent, Anti-Bacterial Agents therapeutic use, Bacteroides Infections drug therapy, Child, Eikenella corrodens, Empyema drug therapy, Humans, Male, Pneumonia drug therapy, Pneumonia microbiology, Bacteroides Infections microbiology, Empyema microbiology
- Abstract
Eikenella corrodens is a slow-growing, Gram-negative, facultative, anaerobic organism that is normally found among oropharyngeal flora. Its isolation as a pathogen is increasingly being reported. Although well documented in the literature on adults, few cases of E corrodens infection have been reported in children. We describe two children with E corrodens pneumonia and empyema. In one, infection was mixed, but in the other the organism was isolated in pure culture. Both patients recovered after therapy with a combination of an antibiotic active in vitro against the organism, and surgical drainage. The diagnosis, bacteriology, and evidence for potential pathogenicity of the organism are reviewed; E corrodens should be considered as a potential pathogen, especially in predisposed patients.
- Published
- 1981
- Full Text
- View/download PDF
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