7 results on '"Simental Jr., Alfred A."'
Search Results
2. Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review.
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Frank, Ethan, Ale‐Salvo, Daniela, Park, Joshua, Liu, Yuan, Simental, Jr, Alfred, and Inman, Jared C.
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PREOPERATIVE care ,DIAGNOSTIC imaging ,THYROID diseases ,HYPERPARATHYROIDISM ,HISTOPATHOLOGY ,THYROID gland physiology ,SYSTEMATIC reviews ,PARATHYROID gland diseases ,DIAGNOSIS ,PATIENTS - Abstract
Abstract: Background: Thyroid disease occurs more frequently in patients with hyperparathyroidism than the general population and hinders parathyroid localization. Identifying thyroid pathology before operating improves management and avoids the risks of reoperation in the neck. This review assesses imaging studies in patients with hyperparathyroidism and thyroid pathology to identify the ideal imaging methodology for patients with multigland disease. Methods: Systematic review of original articles reporting sensitivity or positive predictive value (PPV) for one or more imaging modalities in patients with hyperparathyroidism and thyroid disease. Results: Twenty‐eight studies, 13 prospective and 15 retrospective, met inclusion criteria. Nine modalities were evaluated, including: cervical ultrasound (n = 18), dual‐phase
99m Tc‐sestamibi (n = 14), subtraction scintigraphy (n = 11), combined ultrasound and scintigraphy (n = 8), single photon emission CT (SPECT; n = 5), SPECT‐CT (n = 4), contrast‐enhanced ultrasound (n = 1), CT (n = 1), and MRI (n = 1). Conclusion: Combined ultrasound and scintigraphy is the most sensitive study to localize parathyroid adenomas in patients with hyperparathyroidism and thyroid disease, followed by hybrid SPECT‐CT and SPECT. [ABSTRACT FROM AUTHOR]- Published
- 2018
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3. Hypopharyngeal cancer.
- Author
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Wycliffe, Nathaniel D., Grover, Ryan Shane, Kim, Paul D., Simental Jr, Alfred, and Simental, Alfred Jr
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- 2007
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4. Selective Neck Dissection in Patients With Upper Aerodigestive Tract Cancer With Clinically Positive Nodal Disease.
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Simental Jr., Alfred A., Duvvuri, Umamaheswar, Johnson, Jonas T., and Myers, Eugene N.
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CANCER patients , *LYMPH node diseases , *VOCAL cords , *NECK dissection , *CLINICAL trials , *HEAD & neck cancer , *RESEARCH - Abstract
Objectives: We evaluated the efficacy of the application of selective neck dissection to cases of clinically node-positive disease. Methods: We performed a retrospective review at the University of Pittsburgh Head and Neck Cancer Database. A database of 65 patients was followed for an average of 36 months (range, 2 to 128 months) after they underwent selective neck dissection for clinically node-positive regional disease. Results: Regional failure occurred in 8 patients (12.3%). In-field failure was experienced in 4 patients (6.1%), and failures outside the field of dissection occurred in 4 patients (6.1%). The overall incidence of extracapsular spread was 33.8% (22 of 65). Only 2 of 8 regional recurrences were associated with extracapsular spread at the initial neck dissection; however, both recurrences were in the contralateral, undissected side of the neck. Four regional failures were salvaged with surgery, with eventual overall regional control in the neck of 93.9%. Only 1 of 4 ipsilateral recurrences (25%) was successfully salvaged. In contrast, 3 of 4 contralateral failures (75%) were successfully salvaged. In our study population, 21 of 65 cases (32%) that were initially staged as clinically node-positive had no evidence of nodal metastases on pathologic examination. Conclusions: The application of selective neck dissection and postoperative irradiation in patients with clinically N1 and limited N2 clinical disease appears to be oncologically efficacious. Clinical overstaging occurred frequently in this sample, and may put patients at risk for more morbid surgical procedures. [ABSTRACT FROM AUTHOR]
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- 2006
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5. Six-Year Experience of Outpatient Total and Completion Thyroidectomy at a Single Academic Institution.
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FRANK, ETHAN, PARK, JOSHUA, SIMENTAL, JR., ALFRED, VUONG, CHRISTOPHER, LEE, STEVE, FILHO, PEDRO ANDRADE, KWON, DANIEL, YUAN LIU, Simental, Alfred Jr, and Liu, Yuan
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THYROIDECTOMY , *COGNITION , *HEMATOMA , *THYROID gland surgery , *AMBULATORY surgery , *PATIENT safety , *SURGICAL complications , *THYROID diseases , *TREATMENT effectiveness , *RETROSPECTIVE studies - Abstract
Outpatient thyroidectomy has become slowly accepted with various published reports predominantly examining partial or subtotal thyroidectomy. Concerns regarding the safety of outpatient total and completion thyroidectomy remain, especially with regard to vocal fold paralysis, hypocalcemia, and catastrophic hematoma. We aimed to evaluate the safety of outpatient thyroid surgery in a large cohort by retrospectively comparing outcomes in those who underwent outpatient (n = 251) versus inpatient (n = 291) completion or total thyroidectomy between February 2009 and February 2015. Outpatient completion and total thyroidectomy had lower rates of temporary hypocalcemia (6% vs 24.4%; P < 0.001) and no significant difference in rates of return to emergency department (1.2% vs 1.4%), hematoma formation (0.8% vs 0.7%), temporary (2% vs 4.1%) or permanent (0.4% vs 0.7%) vocal fold paralysis, or permanent hypocalcemia (0.4% vs 0%) compared with the inpatient group. Outpatients requiring calcium replacement had shorter duration of postoperative calcium supplementation (44.4 ± 59.3 days vs 63.3 ± 94.4 days; P < 0.001). Our data demonstrate similar safety in outpatient and inpatient total and completion thyroidectomy. [ABSTRACT FROM AUTHOR]
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- 2017
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6. Minimally Invasive Video-Assisted Thyroidectomy: Almost a Decade of Experience at an Academic Center.
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FRANK, ETHAN, PARK, JOSHUA, SIMENTAL JR., ALFRED, VUONG, CHRISTOPHER, YUAN LIU, KWON, DANIEL, YI LIN, FILHO, PEDRO ANDRADE, Simental, Alfred Jr, Liu, Yuan, and Lin, Yi
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HYPOCALCEMIA , *THYROIDECTOMY , *VIDEO-assisted thoracic surgery , *BLOOD loss estimation , *THERAPEUTICS , *ACADEMIC medical centers , *COMPARATIVE studies , *MINIMALLY invasive procedures , *ENDOSCOPY , *LENGTH of stay in hospitals , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *PATIENT safety , *POSTOPERATIVE pain , *PROGNOSIS , *RESEARCH , *RISK assessment , *THYROID gland tumors , *EVALUATION research , *TREATMENT effectiveness , *RETROSPECTIVE studies , *SURGICAL blood loss ,LAPAROSCOPIC surgery complications - Abstract
Minimally invasive video-assisted thyroidectomy (MIVAT) has gained acceptance as an alternative to conventional thyroidectomy. This technique results in less bleeding, postoperative pain, shorter recovery time, and better cosmetic results without increasing morbidity. We retrospectively assessed outcomes in 583 patients having MIVAT from May 2005 to September 2014. The study population was divided into groups according to periods: 2005 to 2009 and 2010 to 2014. Operative data, complications, and length of stay were collected and compared. Total thyroidectomy was undertaken in 185, completion thyroidectomy in 49, and hemithyroidectomy in 349. Malignancy was present in 127 (21.8%). Mean incision was 3.4 ± 0.7 cm and estimated blood loss was 23.7 ± 21.7 mL. Mean operative time was 86.5 ± 39.3 minutes for all operations, 78.5 ± 37.0 minutes for hemithyroidectomy, 70.9 ± 30.1 minutes for completion thyroidectomy, and 106.8 ± 41.3 minutes for total thyroidectomy. Postoperatively, 56 (9.6%) had unilateral vocal cord dysfunction, which resolved except for one case (0.17%). Fifty-nine patients (10.1%) developed hypocalcemia, but only three cases (0.51%) became permanent. Only one patient required readmission. In conclusion, MIVAT results in short operative times, minimal blood loss, and few complications and is safely performed in an academic institution. [ABSTRACT FROM AUTHOR]
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- 2016
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7. Management of Completion and Total Thyroidectomy Patients Based on 1-Hour Postoperative Parathyroid Hormone.
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PARK, JOSHUA, FRANK, ETHAN, SIMENTAL JR., ALFRED, SARA YANG, VUONG, CHRISTOPHER, LEE, STEVE, FILHO, PEDRO ANDRADE, Simental, Alfred Jr, and Yang, Sara
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THYROIDECTOMY , *PARATHYROID hormone , *SURGICAL complications , *HYPOCALCEMIA , *LENGTH of stay in hospitals , *MEDICAL protocols , *DISEASE risk factors , *ACADEMIC medical centers , *DRUG administration , *DOSE-effect relationship in pharmacology , *LONGITUDINAL method , *POSTOPERATIVE care , *RISK assessment , *TIME , *DISEASE management , *TREATMENT effectiveness , *RETROSPECTIVE studies , *PREVENTION - Abstract
After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16.8% vs 15.9%; P = 0.786). Those in the 1-hour PTH groups had lower overnight observation rates (97.4% vs 53.7%; P < 0.001) and length of stay (1.98 ± 2.61 vs 0.89 ± 1.87 days; P < 0.001), and required less calcium (3.9% vs 0.8%; P = 0.015) and vitamin D (2.6% vs 0%; P = 0.002) supplementation one year after surgery. Less than 1 per cent of patients discharged on the day of surgery in accordance with the 1-hour PTH guidelines returned to the emergency room for symptomatic hypocalcemia; none experienced significant morbidity. This protocol facilitates early discharge of low-risk patients and results in a similar or improved postoperative course compared with traditional overnight observation. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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