Search

ImportanceOptimal management of subglottic stenosis has not been established. Endoscopic techniques include balloon dilation, radial incisions with carbon dioxide laser or cold knife, and combinations of techniques. Adjunctive measures include mitomycin application and glucocorticoid injection.ObjectiveTo determine whether surgical technique or adjunctive measures are associated with duration between surgical procedures.Design, setting, and participantsAdult patients with subglottic stenosis treated endoscopically between 1995-2015 at a quaternary academic medical center were identified. Patients with isolated subglottic (cricotracheal) stenosis 18 years and older were included. Patients with prior open surgical procedures, prior laryngeal surgical procedures, glottic stenosis, or vocal fold paralysis were excluded.InterventionsPatients underwent endoscopic procedures including laser radial incisions, balloon dilation, or both, with some patients receiving topical mitomycin, glucocorticoid injection, or both.Main outcomes and measuresTime interval between endoscopic treatments.ResultsA total of 101 patients (mean [SD] age, 52.3 [15.9] years; 77.2% female) were included in the analysis, with etiologies including idiopathic (47 [46.5%]), intubation (31 [30.7%]), granulomatosis with polyangiitis (9 [8.9%]), and other autoimmune diseases (6 [5.9%]). Among the 219 operations, both laser and balloon dilation were used in 117 (53.4%), while balloon dilation alone was used in 96 (43.8%) and laser alone in 6 (2.7%). Mitomycin application and steroid injection were used in 144 (65.8%) and 93 (42.5%) cases, respectively. Mitomycin application was associated with improvement in the mean interval to next procedure from 317 to 474 days (absolute difference, 157 days; 95% CI, 15-299 days). Advanced grade of stenosis, dilation technique, and steroid injection did not significantly alter the surgical intervals.Conclusions and relevanceEndoscopic surgery for subglottic stenosis is a critical aspect of patient management. Neither surgical technique nor grade of stenosis was seen to alter the surgical intervals. Mitomycin application was associated with an extended time interval between endoscopic treatments.

ImportanceCough is a critical human reflex and also among the most frequent symptoms in medicine. Despite the prevalence of disordered cough in laryngeal pathologies, comprehensive and quantitative evaluation of cough in these patients is lacking.ObjectiveHerein we seek to establish normative values for cough aerodynamics to provide a population standard for reference in future studies.Design, setting, and participantsHealthy subjects were recruited from an outpatient clinic to perform voluntary cough. Subjects were instructed on the technique for maximal voluntary cough production with measurements recorded on pneumotachograph. Fifty-two subjects were studied, including 29 women and 23 men with a mean age of 51.6 and 52.3 years, respectively. Main Outcomes and Measures: Cough peak airflow, peak pressure, and expiratory rise time. Results were stratified by age, gender, and height.ResultsPeak airflow demonstrated significant differences across age, gender, and height, with flow increasing according to increasing height. Peak cough pressure also increased with height and was significantly greater in males versus females. Expiratory rise time, the time from glottal opening to peak airflow, did not vary with age or height but was statistically significantly longer in women.ConclusionsCough aerodynamics can be readily measured objectively in the outpatient setting. Expiratory rise time, peak flow, and peak pressure are important aspects of each cough epoch. Normative data provided herein can be used for future studies of patients with laryngotracheal disorders, and these cough parameters may prove to be simple, accessible, and repeatable outcome measures.

BackgroundWarthin tumors presenting concomitantly with a lymphoma is vanishingly rare with only 15 reported cases in English literature. Herein, we report an unusual initial presentation of a mantle cell lymphoma involving the lymphoid stroma of a Warthin tumor.Case presentationA seventy-seven year old otherwise healthy gentleman with a 50-pack year smoking history presents with a slowly enlarging left cheek mass. CT scan of the neck demonstrated a left parotid gland tumor measuring 3.4 cm in greatest dimension. He underwent a left superficial parotidectomy, with subsequent histopathologic examination revealing a Warthin tumor with extensive expansion of the lymphoid stroma. Flow cytometric, immunohistochemical, and cytogenetic studies of the stromal component of the tumor confirmed the presence of a mantle cell lymphoma. Clinical staging demonstrated stage IVa disease, and was considered to be at low to intermediate risk due to the slow growth of the parotid lesion. The patient is undergoing close follow up with repeat PET-CT scans at six months.ConclusionTo the best of our knowledge, this is the first well documented collision tumor between mantle cell lymphoma and a Warthin tumor. This case also brings to light the significance of thorough evaluation of the lymphoid component of Warthin tumor.

Significant national attention has been paid to the rising costs of cancer care. However, few studies have evaluated the association between trends in costs and survival outcomes. We used the Surveillance, Epidemiology, and End Results (SEER) Program-Medicare linked database to compare changes in costs and survival rates over time, among women ages 67-94 who were diagnosed with stage II or III breast cancer in 1994-96 or 2004-06.We found that median cancer-related costs increased from $12,335 to $17,396 among women with stage II disease, and from $18,107 to $32,598 among women with stage III disease. Although the median cost of breast surgery declined between the two study periods, the median cost of chemo- and radiation therapy increased substantially, leading to an overall rise in cancer-related costs. Meanwhile, adjusted overall five-year survival improved, from 67.8 percent to 72.5 percent for women with stage II disease and from 38.5 percent to 51.9 percent for those with stage III disease. These findings suggest that increases in cancer care costs have been accompanied by improved outcomes. Future work should identify opportunities to optimize efficiency in cancer care. [ABSTRACT FROM AUTHOR]

The article presents a study concerning the use of transnasal esophagoscope (TNE) in the management of esophageal stenosis following chemoradiation therapy for head and neck squamous cell carcinoma. Methods used in the study are noted, including the Functional Outcome Swallowing Scale to assess preoperative and postoperative swallowing function. Results suggest TNE as an effective treatment strategy for esophageal stenosis.

Importance: Optimal management of subglottic stenosis has not been established. Endoscopic techniques include balloon dilation, radial incisions with carbon dioxide laser or cold knife, and combinations of techniques. Adjunctive measures include mitomycin application and glucocorticoid injection., Objective: To determine whether surgical technique or adjunctive measures are associated with duration between surgical procedures., Design, Setting, and Participants: Adult patients with subglottic stenosis treated endoscopically between 1995-2015 at a quaternary academic medical center were identified. Patients with isolated subglottic (cricotracheal) stenosis 18 years and older were included. Patients with prior open surgical procedures, prior laryngeal surgical procedures, glottic stenosis, or vocal fold paralysis were excluded., Interventions: Patients underwent endoscopic procedures including laser radial incisions, balloon dilation, or both, with some patients receiving topical mitomycin, glucocorticoid injection, or both., Main Outcomes and Measures: Time interval between endoscopic treatments., Results: A total of 101 patients (mean [SD] age, 52.3 [15.9] years; 77.2% female) were included in the analysis, with etiologies including idiopathic (47 [46.5%]), intubation (31 [30.7%]), granulomatosis with polyangiitis (9 [8.9%]), and other autoimmune diseases (6 [5.9%]). Among the 219 operations, both laser and balloon dilation were used in 117 (53.4%), while balloon dilation alone was used in 96 (43.8%) and laser alone in 6 (2.7%). Mitomycin application and steroid injection were used in 144 (65.8%) and 93 (42.5%) cases, respectively. Mitomycin application was associated with improvement in the mean interval to next procedure from 317 to 474 days (absolute difference, 157 days; 95% CI, 15-299 days). Advanced grade of stenosis, dilation technique, and steroid injection did not significantly alter the surgical intervals., Conclusions and Relevance: Endoscopic surgery for subglottic stenosis is a critical aspect of patient management. Neither surgical technique nor grade of stenosis was seen to alter the surgical intervals. Mitomycin application was associated with an extended time interval between endoscopic treatments.

Reduced EphB4 expression is observed during vein graft adaptation and is associated with increased venous wall thickening. These findings suggest that EphB4 may mediate normal adult venous endothelial cell (EC) function and vein graft adaptation. We therefore tested the functional significance of EphB4 using EC with genetically reduced EphB4 signaling. EC were isolated from EphB4(+/+) and EphB4(+/-) mice. In vitro function was assessed through EC proliferation, migration, nitric oxide (NO) synthesis, and chemokine production. A mouse vein graft model was used to correlate in vitro findings with in vivo vein grafts. Smooth muscle cells (SMC) were subjected to proliferation and migration assays using EphB4(+/+) and EphB4(+/-) EC-conditioned medium. EphB4(+/-) EC exhibited diminished proliferation (P < 0.0001, n = 6), migration (P < 0.0001, n = 3), and NO production (P = 0.0012, n = 3). EphB4(+/-) EC had increased VEGF-A mRNA (P = 0.0006, n = 6) and protein (P = 0.0106, n = 3) as well as increased secretion of VEGF-A (P = 0.0010, n = 5), PDGF-BB (P < 0.0001, n = 6), and TGF-β1 (P < 0.0001, n = 6). EphB4(+/-)-conditioned medium promoted SMC proliferation (P < 0.0001, n = 7) and migration (P = 0.0358, n = 3). Vein grafts and EphB4(+/-) EC showed similarity with regard to VEGF-A and eNOS mRNA and protein expression. In conclusion, reduced venous EC EphB4 function is associated with a proangiogenic and mitogenic phenotype. EphB4(+/-) EC have increased secretion of SMC mitogens and reduced NO production that correlate with the thickened neointima formed during vein graft adaptation. These findings suggest that EphB4 remains active in adult venous EC and that loss of EphB4 plays a role in vein graft adaptation.