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Rigbi S, Joshua BZ, Baraf L, Yoel U, Fraenkel M. Thyroglobulin is a poor predictor of differentiated thyroid cancer in patients who undergo surgery for thyroid nodular diseases. Eur Arch Otorhinolaryngol 2023; 280:1311-1319. [PMID: 36205785 DOI: 10.1007/s00405-022-07678-z] [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: 08/31/2022] [Accepted: 09/25/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Thyroglobulin, produced exclusively by thyroid follicular cells, serves as a specific tumor marker for the follow-up of differentiated thyroid cancer (DTC) patients after thyroidectomy. However, its role as a predictor of malignancy in patients with thyroid nodules is controversial. We assessed the potential role of preoperative serum thyroglobulin concentration to predict DTC in patients without a preoperative diagnosis of malignancy who underwent partial or total thyroidectomy. METHODS This retrospective study included patients with a preoperative diagnosis of benign multinodular goiter (MNG) or a thyroid nodule with indeterminate cytology (INC) (Bethesda system categories III/IV) who underwent partial or total thyroidectomy between January 2014 and May 2019. We compared the patients' demographic, clinical, imaging, and biochemical data according to their final diagnosis: DTC or benign thyroid nodular disease. Further statistical analysis included odds ratio calculation and receiver operating characteristic (ROC) curve analysis. RESULTS Of 131 patients who met inclusion and exclusion criteria, the indication for surgery was benign MNG in 69 patients and a thyroid nodule with INC in 62 patients. A final diagnosis of DTC was reported in 18 of the 69 benign MNG patients (26%) and in 30 of the 62 thyroid nodule with INC patients (48%). The preoperative measurements of nodule diameter and serum thyroid-stimulating hormone and thyroglobulin concentrations did not significantly differ between patients with a final diagnosis of DTC and those with benign histology. CONCLUSIONS Preoperative serum thyroglobulin alone is insufficient to differentiate between malignant and benign thyroid nodular disease.
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Affiliation(s)
- Shoham Rigbi
- Goldman School of Medicine, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology Head and Neck Surgery, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva, Israel
| | - Lior Baraf
- Endocrine Unit, Soroka University Medical Center, Yitzchak Rager, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva, Israel
| | - Uri Yoel
- Endocrine Unit, Soroka University Medical Center, Yitzchak Rager, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva, Israel
| | - Merav Fraenkel
- Endocrine Unit, Soroka University Medical Center, Yitzchak Rager, Beer Sheva, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva, Israel.
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Baraf L, Avidor Y, Bahat Dinur A, Yoel U, Samueli B, Joshua BZ, Fraenkel M. Rates of Malignancy in Cytology Indeterminate Thyroid Nodules: A Single Center Surgical Series. Isr Med Assoc J 2023; 25:147-151. [PMID: 36841986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND Due to the high variability in malignancy rate among cytologically indeterminate thyroid nodules (Bethesda categories III-V), the American Thyroid Association recommends that each center define its own categorical cancer risk. OBJECTIVES To assess cancer risk in patients with cytologically indeterminate thyroid nodules who were operated at our center. METHODS In a retrospective study, we analyzed the pathology results of all the patients whose fine needle aspiration results showed Bethesda III-V cytology and who subsequently underwent total thyroidectomy or lobectomy from December 2013 to September 2017. RESULTS We analyzed 56 patients with indeterminate cytology on fine needle aspiration. Twenty-nine (52%) were defined as Bethesda III, 19 (34%) Bethesda IV, and 8 (14%) Bethesda V category. Malignancy rates were 38%, 58%, and 100% for Bethesda categories III, IV, and V, respectively. Most malignancies in Bethesda categories III and IV were follicular in origin (follicular thyroid carcinoma and follicular type papillary thyroid carcinoma), while 100% of the patients with Bethesda category V were diagnosed with classical papillary thyroid carcinoma. No correlation was found between sonographic and cytological criteria of nodules with Bethesda categories III and IV and rates of malignancy. CONCLUSIONS We found higher than expected rates of malignancy in indeterminate cytology. This finding reinforces the guidelines of the American Thyroid Association to establish local malignancy rates for thyroid nodules with indetermined cytology.
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Affiliation(s)
- Lior Baraf
- Department of Endocrinology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yuval Avidor
- Department of Otolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Anat Bahat Dinur
- Department of Otolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Uri Yoel
- Department of Endocrinology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Benzion Samueli
- Pathology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Merav Fraenkel
- Department of Endocrinology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Frenkel A, Bichovsky Y, Arotsker N, Besser L, Joshua BZ, Fraenkel M, Zahger D, Klein M. Ivabradine for Uncontrolled Sinus Tachycardia in Thyrotoxic Cardiomyopathy – Case Report. Endocr Metab Immune Disord Drug Targets 2022; 23:992-995. [DOI: 10.2174/1871530323666221214141205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
Background:
Beta-blockers, mainly propranalol, are usually administered to control heart rate in patients with thyrotoxicosis, especially when congestive heart failure presents. However, when thyrotoxicosis is not controlled, heart rate may be difficult to control even with maximal doses of propranolol. This presentation alerts physicians to the possibility of using ivabradine, a selective inhibitor of the sinoatrial pacemaker, for the control of heart rate.
Case presentation:
We present a 37-year-old woman with thyrotoxicosis and congestive heart failure whose heart rate was not controlled with a maximal dose of beta blockers during a thyroid storm. The addition of ivabradine, a selective inhibitor of the sinoatrial pacemaker, controlled her heart rate within 48 hours.
Conclusion:
Ivabradine should be considered in patients with thyrotoxicosis, including those with heart failure, in whom beta blockers are insufficient to control heart rate.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Bichovsky
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Natan Arotsker
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Limor Besser
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otorhinolaryngology and Head and Neck Surgery, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Merav Fraenkel
- Endocrine Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Averbukh K, Goldbart A, Goldbart A, Tal A, Kaplan DM, Puterman M, El-Saied S, Joshua BZ. Safety and long-term efficacy of tonsillectomy versus subtotal tonsillectomy in children with sleep disordered breathing. Am J Otolaryngol 2022; 43:103494. [PMID: 35636085 DOI: 10.1016/j.amjoto.2022.103494] [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: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES to compare safety and long-term symptoms after TE compared to Subtotal Tonsillectomy (STT). METHODS A retrospective review data of 412 patients, one to twelve years old that underwent either TE or STT, as treatment for sleep disorder breathing, at two different medical centers. Symptoms were assessed by a questionnaire 3-5 years post-surgery. Additionally, data regarding immediate post-operative symptoms and complications were also collected. RESULTS Long-term symptoms score was significantly lower in the TE group: 1.585 (±1.719) compared to 1.967 (±1.815) in the STT group (p = 0.033); 51.3% of patients in the ST group presented long-term SDB symptoms, compared to 40.6% in the TE group (p = 0.035); The main difference between the groups was snoring as 49% of the STT group suffered from snoring, versus 28.9% in the TE group (p < 0.001). CONCLUSIONS TE showed an advantage over STT in resolving snoring in the long term.
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Sagiv R, Delgado B, Lavon O, Osipov V, Sade R, Shashar S, Yegodayev KM, Elkabets M, Joshua BZ. Assessment of parathyroid gland cellularity by digital slide analysis. Ann Diagn Pathol 2022; 58:151907. [DOI: 10.1016/j.anndiagpath.2022.151907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 01/01/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
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Ben Arie G, Shafat T, Belochitski O, El-Saied S, Joshua BZ. Treatment Modality and Second Primary Tumors of the Head and Neck. ORL J Otorhinolaryngol Relat Spec 2021; 83:420-427. [PMID: 34587611 DOI: 10.1159/000513617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 12/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Second primary tumors (SPTs) in head and neck cancer are thought to occur from premalignant lesions that are present at the time of the primary tumor diagnosis. The association of the modality used to treat the primary lesion with SPT occurrence is not clear. OBJECTIVE The aim of the study was to assess the incidence of SPTs in patients with head and neck malignancies, according to treatment modality. METHODS We conducted a retrospective cohort study. All patients who were treated at Soroka Medical Center between 2000 and 2013 for a head and neck squamous cell carcinoma were assessed. Data analysis included tumor site of the primary and second primary and treatment modality of the primary tumor. In addition, demographics as well as habits were recorded as well. RESULTS Of the 184 patients included in the cohort, SPT developed in 31 patients (17%) with a median time to diagnosis of 4.3 years. Smoking was reported in 74% of those with SPT and 78% of those without. The most common site for SPT was the lungs, with 13 cases, 42% of the total SPTs. Among patients who developed an SPT, for 12 of those with an index tumor in the oral cavity or oro-hypopharynx, 8 (67%) developed an SPT in the same location; for 18 of those with an index tumor in the larynx, 11 (61%) developed a SPT in the lungs and bronchi (p = 0.001). On multivariate analysis, the treatment modality used was not found to be associated with the occurrence of SPTs and the radiotherapy showed no protective or harmful effect (HR 0.64 p = 0.24). CONCLUSION Treatment modality used for head and neck cancer does not seem to be associated with the occurrence of SPTs.
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Affiliation(s)
- Gal Ben Arie
- Department of Medical Imaging, Soroka University Medical Center, Beer- Sheva, Israel
| | - Tali Shafat
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Olga Belochitski
- Department of Oncology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology and Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology and Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Frenkel A, Bichovsky Y, Arotsker N, Besser L, Joshua BZ, Fraenkel M, Zahger D, Klein M. WITHDRAWN: Ivabradine for Uncontrolled Sinus Tachycardia in Thyrotoxic
Cardiomyopathy – Case Report. Endocr Metab Immune Disord Drug Targets 2021; 21:EMIDDT-EPUB-118032. [PMID: 34544353 DOI: 10.2174/1871530321666210920094411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
Since the authors are not responding to the editor’s requests to fulfill the editorial requirement, therefore, the article has been withdrawn by the publisher. Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused. The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policies-main.php Bentham Science Disclaimer It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit,Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel
| | - Yoav Bichovsky
- General Intensive Care Unit,Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel
| | - Natan Arotsker
- General Intensive Care Unit,Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel
| | - Limor Besser
- General Intensive Care Unit,Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel
| | - Ben-Zion Joshua
- Department of Otorhinolaryngology and Head and Neck Surgery,Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel
| | - Merav Fraenkel
- Endocrine Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel
| | - Moti Klein
- General Intensive Care Unit,Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel
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Badarni M, Prasad M, Golden A, Bhattacharya B, Levin L, Yegodayev KM, Dimitstein O, Joshua BZ, Cohen L, Khrameeva E, Kong D, Porgador A, Braiman A, Grandis JR, Rotblat B, Elkabets M. IGF2 Mediates Resistance to Isoform-Selective-Inhibitors of the PI3K in HPV Positive Head and Neck Cancer. Cancers (Basel) 2021; 13:cancers13092250. [PMID: 34067117 PMCID: PMC8125641 DOI: 10.3390/cancers13092250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary In the current study, we delineate the molecular mechanisms of acquisition of resistance to two isoform-selective inhibitors of PI3K (isiPI3K), alpelisib and taselisib, in human papillomavirus positive head and neck cell lines. By comparing RNA sequencing of isiPI3K-sensitive tumor cells and their corresponding isiPI3K-acquired-resistant tumor cells, we found that overexpression of insulin growth factor 2 (IGF2) is associated with the resistance phenotype. We further demonstrated by gain and loss of function studies that IGF2 plays a causative role in limiting the sensitivity of human papillomavirus-positive head and neck cell lines. Moreover, we show that blocking IGF2 stimulation activity, using an inhibitor of the IGF1 receptor (IGF1R), enhances isiPI3K efficacy and displays a synergistic anti-tumor effect in vitro and superior anti-tumor activity ex vivo and in vivo. Abstract Over 50% of human papilloma positive head-and-neck cancer (HNCHPV+) patients harbor genomic-alterations in PIK3CA, leading to hyperactivation of the phosphatidylinositol-4, 5-bisphosphate 3-kinase (PI3K) pathway. Nevertheless, despite PI3K pathway activation in HNCHPV+ tumors, the anti-tumor activities of PI3K pathway inhibitors are moderate, mostly due to the emergence of resistance. Thus, for potent and long-term tumor management, drugs blocking resistance mechanisms should be combined with PI3K inhibitors. Here, we delineate the molecular mechanisms of the acquisition of resistance to two isoform-selective inhibitors of PI3K (isiPI3K), alpelisib (BYL719) and taselisib (GDC0032), in HNCHPV+ cell lines. By comparing the transcriptional landscape of isiPI3K-sensitive tumor cells with that of their corresponding isiPI3K-acquired-resistant tumor cells, we found upregulation of insulin growth factor 2 (IGF2) in the resistant cells. Mechanistically, we show that upon isiPI3K treatment, isiPI3K-sensitive tumor cells upregulate the expression of IGF2 to induce cell proliferation via the activation of the IGF1 receptor (IGF1R). Stimulating tumor cells with recombinant IGF2 limited isiPI3K efficacy and released treated cells from S phase arrest. Knocking-down IGF2 with siRNA, or blocking IGF1R with AEW541, resulted in superior anti-tumor activity of isiPI3K in vitro and ex vivo. In vivo, the combination of isiPI3K and IGF1R inhibitor induced stable disease in mice bearing either tumors generated by the HNCHPV+ UM-SCC47 cell line or HPV+ patient-derived xenografts. These findings indicate that IGF2 and the IGF2/IGF1R pathway may constitute new targets for combination therapies to enhance the efficacy of PI3K inhibitors for the treatment of HNCHPV+.
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Affiliation(s)
- Mai Badarni
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (M.B.); (M.P.); (B.B.); (K.M.Y.); (L.C.); (A.P.); (A.B.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
| | - Manu Prasad
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (M.B.); (M.P.); (B.B.); (K.M.Y.); (L.C.); (A.P.); (A.B.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
| | - Artemiy Golden
- Center of Life Sciences, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (A.G.); (E.K.)
| | - Baisali Bhattacharya
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (M.B.); (M.P.); (B.B.); (K.M.Y.); (L.C.); (A.P.); (A.B.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
| | - Liron Levin
- Bioinformatics Core Facility, National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Ksenia M. Yegodayev
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (M.B.); (M.P.); (B.B.); (K.M.Y.); (L.C.); (A.P.); (A.B.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
| | - Orr Dimitstein
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
- Department of Otolaryngology—Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva 84105, Israel
| | - Ben-Zion Joshua
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
- Department of Otorhinolaryngology and Head & Neck Surgery, Barzilay Medical Center, Ashkelon 7830604, Israel
| | - Limor Cohen
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (M.B.); (M.P.); (B.B.); (K.M.Y.); (L.C.); (A.P.); (A.B.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
| | - Ekaterina Khrameeva
- Center of Life Sciences, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (A.G.); (E.K.)
| | - Dexin Kong
- School of Pharmaceutical Sciences, Tianjin Medical University, Tianjin 300070, China;
| | - Angel Porgador
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (M.B.); (M.P.); (B.B.); (K.M.Y.); (L.C.); (A.P.); (A.B.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
| | - Alex Braiman
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (M.B.); (M.P.); (B.B.); (K.M.Y.); (L.C.); (A.P.); (A.B.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
| | - Jennifer R. Grandis
- Department of Otolaryngology—Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Barak Rotblat
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
- Department of Life Sciences, Faculty of Life Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
- Correspondence: (B.R.); (M.E.); Tel.: +972-(0)8-6428806 (B.R.); +972-86428846 (M.E.)
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (M.B.); (M.P.); (B.B.); (K.M.Y.); (L.C.); (A.P.); (A.B.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (O.D.); (B.-Z.J.)
- Correspondence: (B.R.); (M.E.); Tel.: +972-(0)8-6428806 (B.R.); +972-86428846 (M.E.)
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Madgar O, Avior G, Shochat I, Joshua BZ, Baraf L, Avidor Y, Avi Khafif, Assadi N, Alon EE. Thyroid malignancy rates according to the Bethesda reporting system in Israel - A multicenter study. Eur J Surg Oncol 2021; 47:1370-1375. [PMID: 33745793 DOI: 10.1016/j.ejso.2021.03.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The Bethesda System for Reporting Thyroid Cytopathology was developed in 2007 to facilitate an accurate, reproducible communication of thyroid fine-needle aspiration (FNA) interpretations between clinicians and cytopathologists and to serve as a guide for treatment. Based on large patient series, the system details the risk of malignancy for each category as well as a suggested management for each FNA result. Though this system has been widely adopted, there are only few studies to determine whether results are applicable for Israel. METHODS A multicenter, retrospective analysis of medical charts of all patients who underwent thyroid surgery between January 1st, 2012 and December 31st, 2016 in four medical centers in Israel was performed. Data was analyzed for the overall risk of malignancy for the Bethesda system groups as well as comparison between the different laboratories performing the test. RESULTS Records of 810 thyroidectomies in which preoperative cytological reports and final pathology were available and reviewed. The malignancy rates according to the Bethesda groups' I-VI for our cohort were: 27.8%, 17.6%, 41.4%, 41.4%, 86.9%, and 98.1% respectively. Similar results were seen when results were analyzed according to the different laboratories performing the tests. CONCLUSIONS Post-surgical review of all Bethesda groups had higher malignancy rates than those reported in the original report. These results indicate a difference in the malignancy rates for the different Bethesda system groups in Israel compared to those reported. Physicians are encouraged to use data validated for their own country or patients' community in addition to published values.
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Affiliation(s)
- Ory Madgar
- Department of Otolaryngology, Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Galit Avior
- Otolaryngology - Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Isaac Shochat
- Otolaryngology - Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology, Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel. Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Baraf
- Endocrinology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yuval Avidor
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Khafif
- ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel; Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Niddal Assadi
- ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology, Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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10
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El-Saied S, Zaknoun M, Alatawna O, Joshua BZ, Kabahaa N, Kaplan DM, Lewis EC. Trauma-induced vestibular dysfunction: Possible functional repair under α1-antitrypsin-rich conditions. Cell Immunol 2020; 356:104150. [PMID: 32823037 DOI: 10.1016/j.cellimm.2020.104150] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
Transient vestibular organ deafferentation, such that is caused by traumatic tissue injury, is presently addressed by corticosteroid therapy. However, restoration of neurophysiological properties is rarely achieved. Here, it was hypothesized that the tissue-protective attributes of α1-antityrpsin (AAT) may promote restoration of neuronal function. Inner ear injury was inflicted by unilateral labyrinthotomy in wild-type mice and in mice overexpressing human AAT. A 2-week-long assessment of vestibular signs followed. All animals responded with peak vestibular dysfunction scores within 4 h after local trauma. While wild-type animals displayed partial or no recovery across 7 days post-injury, AAT-rich group exhibited early recovery: from behavioral score 9-out-of-9 at peak to 4.8 ± 0.44 (mean ± SD) within 8 h from injury, a time when wild-type mice scored 8.6 ± 0.54 (p < 0.0001), and from vestibular score 15-out-of-15 to 7.8 ± 2.2 within 24 h, when wild-type mice scored 13.0 ± 2.0 (p < 0.01). Thus, recovery and functional normalisation of an injured vestibular compartment is achievable without corticosteroid therapy; expedited tissue repair processes appear to result from elevated circulating AAT levels. This study lays the foundation for exploring the molecular and cellular mediators of AAT within the repair processes of the delicate microscopic structures of the vestibular end organ.
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Affiliation(s)
- Sabri El-Saied
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel; Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Melodie Zaknoun
- Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Osama Alatawna
- Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noor Kabahaa
- Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel M Kaplan
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Eli C Lewis
- Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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11
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Bahat Dinur A, Quint E, Lupo L, Fraenkel M, El-Saied S, Joshua BZ. Limitations of ultrasound in predicting bilaterality vs unilaterality of well-differentiated carcinoma of the thyroid. Am J Otolaryngol 2020; 41:102543. [PMID: 32474327 DOI: 10.1016/j.amjoto.2020.102543] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/24/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to assess the efficacy of ultrasonography in the differentiation of a bilateral and a unilateral WDTC to help physicians decide on performing a total or a partial thyroidectomy. MATERIALS AND METHODS Retrospective chart review of all patients diagnosed with papillary thyroid carcinoma following a total thyroidectomy or a complete thyroidectomy between January 2013 and December 2015 at the Department of Otorhinolaryngology and Head and Neck Surgery in Soroka University Medical Center in southern Israel. The preoperative ultrasound images of the thyroid were compared to the final pathology in the contralateral lobe. RESULTS Seventy seven patients (77) were included in this study, There was no correlation between the sonography in the contralateral lobe and the malignancy on that side (p = 0.479). US had a 39% false negative rate and 69% false positive rate. CONCLUSION The patients with a well-differentiated carcinoma of the thyroid, a benign nodule detected sonographically in the contralateral lobe should not bear a high weight in decision making regarding the extent of surgery.
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Affiliation(s)
- Anat Bahat Dinur
- Department of Otolaryngology and Head and Neck Surgery, Soroka Medical Center, Israel
| | - Elhanan Quint
- Department of Surgery B, Soroka Medical Center, Beer Sheva, Israel
| | - Liliana Lupo
- Department of Radiology, Soroka Medical Center, Beer Sheva, Israel
| | - Merav Fraenkel
- Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka Medical Center, Israel; Endocrinology Unit, Soroka Medical Center, Beer Sheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology and Head and Neck Surgery, Soroka Medical Center, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka Medical Center, Israel.
| | - Ben-Zion Joshua
- Department of Otolaryngology and Head and Neck Surgery, Soroka Medical Center, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka Medical Center, Israel
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12
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El-Saied S, Schmitt H, Durisin M, Joshua BZ, Abu Tailakh M, Prenzler N, Lenarz T, Kaplan DM, Lewis EC, Warnecke A. Endogenous α1-antitrypsin levels in the perilymphatic fluid correlates with severity of hearing loss. Clin Otolaryngol 2020; 45:495-499. [PMID: 32246580 DOI: 10.1111/coa.13541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/09/2020] [Accepted: 03/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the levels of endogenous α1-antitrypsin in the perilymph of patients undergoing cochlear implant (CI), and its reverse association with the severity of hearing loss. STUDY DESIGN Retrospective study. SETTING Tertiary care university hospital. PARTICIPANTS The study includes 38 patients undergoing CI surgery, 11 patients diagnosed with congenital deafness and 27 non-congenital deafness, eight patients diagnosed with moderate hearing loss (N = 8; PTA = 70 dB), severe hearing loss (N = 11; PTA 70-90 dB) and profound hearing loss (N = 19; PTA > 90 dB). MAIN OUTCOME AND MEASURE 1 to 12 μL perilymphatic fluids were collected by micropipette. α1-antitrypsin levels were determined, and current and historic audiological parameters were obtained. RESULTS The congenital and non-congenital group exhibited AAT concentrations of 2.5 ± 1.9 × 106 LFQ and 3.2 ± 1.2 × 106 LFQ, respectively (mean ± SD; P = .38). Mean levels of α1-antitrypsin in the perilymph fluid within the moderate group was 3.64 × 106 ± 2.1 × 106 LFQ vs 3.5 × 106 ± 1.2 × 106 in severe hearing loss (P = .81) and 2.4 × 106 ± 1.1 × 106 LFQ in the profound hearings loss group (P = .06). The difference in levels of AAT in samples from the severe hearings loss group vs the profound hearings loss group reached statistical significance (P = .04). CONCLUSION Insufficiency in α1-antitrypsin levels in the perilymph fluid of the inner ear appears to display a relationship with the severity of hearing loss. The prospect of introducing clinical-grade plasma-purified α1-antitrypsin directly onto the site of cochlear injury deserves thorough investigation.
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Affiliation(s)
- Sabri El-Saied
- Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Be'er Sheva, Israel.,Department of clinical biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Heike Schmitt
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Martin Durisin
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Ben-Zion Joshua
- Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Be'er Sheva, Israel
| | - Muhammad Abu Tailakh
- Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel and Soroka University Medical Center, Be'er Sheva, Israel
| | - Nils Prenzler
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Thomas Lenarz
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Daniel M Kaplan
- Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Be'er Sheva, Israel
| | - Eli C Lewis
- Department of clinical biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Athanasia Warnecke
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
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13
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Yegodayev KM, Novoplansky O, Golden A, Prasad M, Levin L, Jagadeeshan S, Zorea J, Dimitstein O, Joshua BZ, Cohen L, Khrameeva E, Elkabets M. TGF-Beta-Activated Cancer-Associated Fibroblasts Limit Cetuximab Efficacy in Preclinical Models of Head and Neck Cancer. Cancers (Basel) 2020; 12:cancers12020339. [PMID: 32028632 PMCID: PMC7073231 DOI: 10.3390/cancers12020339] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 01/07/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/22/2022] Open
Abstract
Most head and neck cancer (HNC) patients are resistant to cetuximab, an antibody against the epidermal growth factor receptor. Such therapy resistance is known to be mediated, in part, by stromal cells surrounding the tumor cells; however, the mechanisms underlying such a resistance phenotype remain unclear. To identify the mechanisms of cetuximab resistance in an unbiased manner, RNA-sequencing (RNA-seq) of HNC patient-derived xenografts (PDXs) was performed. Comparing the gene expression of HNC-PDXs before and after treatment with cetuximab indicated that the transforming growth factor-beta (TGF-beta) signaling pathway was upregulated in the stromal cells of PDXs that progressed on cetuximab treatment (CetuximabProg-PDX). However, in PDXs that were extremely sensitive to cetuximab (CetuximabSen-PDX), the TGF-beta pathway was downregulated in the stromal compartment. Histopathological analysis of PDXs showed that TGF-beta-activation was detected in cancer-associated fibroblasts (CAFs) of CetuximabProg-PDX. These TGF-beta-activated CAFs were sufficient to limit cetuximab efficacy in vitro and in vivo. Moreover, blocking the TGF-beta pathway using the SMAD3 inhibitor, SIS3, enhanced cetuximab efficacy and prevented the progression of CetuximabProg-PDX. Altogether, our findings indicate that TGF-beta-activated CAFs play a role in limiting cetuximab efficacy in HNC.
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Affiliation(s)
- Ksenia M. Yegodayev
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, 84105 Beer-Sheva, Israel (O.N.); (M.P.); (S.J.); (J.Z.); (L.C.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
| | - Ofra Novoplansky
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, 84105 Beer-Sheva, Israel (O.N.); (M.P.); (S.J.); (J.Z.); (L.C.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
| | - Artemiy Golden
- Center of Life Sciences, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia;
| | - Manu Prasad
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, 84105 Beer-Sheva, Israel (O.N.); (M.P.); (S.J.); (J.Z.); (L.C.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
| | - Liron Levin
- Bioinformatics Core Facility, National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel;
| | - Sankar Jagadeeshan
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, 84105 Beer-Sheva, Israel (O.N.); (M.P.); (S.J.); (J.Z.); (L.C.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
| | - Jonathan Zorea
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, 84105 Beer-Sheva, Israel (O.N.); (M.P.); (S.J.); (J.Z.); (L.C.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
| | - Orr Dimitstein
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, 84105 Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, 84105 Beer-Sheva, Israel
| | - Limor Cohen
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, 84105 Beer-Sheva, Israel (O.N.); (M.P.); (S.J.); (J.Z.); (L.C.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
| | - Ekaterina Khrameeva
- Center of Life Sciences, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia;
- Correspondence: (E.K.); (M.E.); Tel.: +7-495-280-14-81 (E.K.); +972-8642-8846 (M.E.)
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, 84105 Beer-Sheva, Israel (O.N.); (M.P.); (S.J.); (J.Z.); (L.C.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel; (O.D.); (B.-Z.J.)
- Correspondence: (E.K.); (M.E.); Tel.: +7-495-280-14-81 (E.K.); +972-8642-8846 (M.E.)
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14
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Yoel U, Joshua BZ, Shoukrun R, Dyomin V, Levin D, Sufaro YZ, Fraenkel M. INTRAMEDULLARY SPINAL CORD METASTASIS AS THE PRESENTING FEATURE OF PAPILLARY THYROID CARCINOMA. AACE Clin Case Rep 2019; 5:e271-e275. [PMID: 31967051 DOI: 10.4158/accr-2019-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/06/2019] [Indexed: 11/15/2022] Open
Abstract
Objective The objective of this report is to present an unusual case of intramedullary spinal cord metastasis (ISCM) as the presenting feature of papillary thyroid carcinoma (PTC). Methods The presented case includes clinical, biochemical, and imaging findings as well as surgical and pathology reports. Treatment with radioactive iodine (RAI) and the response to this treatment are presented. Results A 71-year-old woman was evaluated for debilitating low back pain and walking disability. Magnetic resonance imaging demonstrated an oval, lumbar, intramedullary mass with benign features and surgery was scheduled. On preoperative evaluation for the lumbar mass, a multinodular thyroid goiter (unfortunately overlooked previously) was noticed, causing severe narrowing of the trachea. Total thyroidectomy was performed with a pathology diagnosis of PTC. In a second operation, the lumbar lesion was removed and proved to represent metastatic PTC. External beam radiation was subsequently administered to the thyroid bed, lumbar spine, and other skeletal metastases, followed by 150 milliCurie of RAI. A post-treatment scan showed high uptake over the lumbar spine, and skeletal and lung lesions. Clinically, the patient restored her walking ability and back pain improved. Conclusion ISCM rarely is the presenting feature of PTC. Our patient presented with back pain which is the typical, though non-specific symptom, of ISCM. She showed good clinical response to multimodal treatment which is in line with the few other differentiated thyroid cancer patients with ISCM reported in the literature. Prompt surgical resection, followed by external beam radiation and RAI, may improve neurological signs, alleviate pain, and improve quality of life.
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15
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Kundu K, Ghosh S, Sarkar R, Edri A, Brusilovsky M, Gershoni-Yahalom O, Yossef R, Shemesh A, Soria JC, Lazar V, Joshua BZ, Campbell KS, Elkabets M, Porgador A. Inhibition of the NKp44-PCNA Immune Checkpoint Using a mAb to PCNA. Cancer Immunol Res 2019; 7:1120-1134. [PMID: 31164357 DOI: 10.1158/2326-6066.cir-19-0023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/09/2019] [Accepted: 05/30/2019] [Indexed: 02/05/2023]
Abstract
mAb-based blocking of the immune checkpoints involving the CTLA4-B7 and PD1-PDL1 inhibitory axes enhance T-cell-based adaptive immune responses in patients with cancer. We show here that antitumor responses by natural killer (NK) cells can be enhanced by a checkpoint-blocking mAb, 14-25-9, which we developed against proliferating cell nuclear antigen (PCNA). PCNA is expressed on the surface of cancer cells and acts as an inhibitory ligand for the NK-cell receptor, NKp44-isoform1. We tested for cytoplasmic- and membrane-associated PCNA by FACS- and ImageStream-based staining of cell lines and IHC of human cancer formalin fixed, paraffin embedded tissues. The mAb, 14-25-9, inhibited binding of chimeric NKp44 receptor to PCNA and mostly stained the cytoplasm and membrane of tumor cells, whereas commercial antibody (clone PC10) stained nuclear PCNA. NK functions were measured using ELISA-based IFNγ secretion assays and FACS-based killing assays. The NK92-NKp44-1 cell line and primary human NK cells showed increased IFNγ release upon coincubation with mAb 14-25-9 and various solid tumor cell lines and leukemias. Treatment with 14-25-9 also increased NK cytotoxic activity. In vivo efficacy was evaluated on patient-derived xenografts (PDX)-bearing NSG mice. In PDX-bearing mice, intravenous administration of mAb 14-25-9 increased degranulation (CD107a expression) of intratumorally injected patient autologous or allogeneic NK cells, as well as inhibited tumor growth when treated long term. Our study describes a mAb against the NKp44-PCNA innate immune checkpoint that can enhance NK-cell antitumor activity both in vitro and in vivo.
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Affiliation(s)
- Kiran Kundu
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Susmita Ghosh
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Rhitajit Sarkar
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Avishay Edri
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Brusilovsky
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Orly Gershoni-Yahalom
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Rami Yossef
- Surgery Branch, NCI, NIH, Bethesda, Maryland
| | - Avishai Shemesh
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Vladimir Lazar
- Worldwide Innovative Network (WIN) Association - WIN Consortium, Villejuif, France
| | - Ben-Zion Joshua
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Kerry S Campbell
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Angel Porgador
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. .,National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel
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16
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Badarni M, Prasad M, Balaban N, Zorea J, Yegodayev KM, Joshua BZ, Dinur AB, Grénman R, Rotblat B, Cohen L, Elkabets M. Repression of AXL expression by AP-1/JNK blockage overcomes resistance to PI3Ka therapy. JCI Insight 2019; 5:125341. [PMID: 30860495 DOI: 10.1172/jci.insight.125341] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 01/09/2023] Open
Abstract
AXL overexpression is a common resistance mechanism to anti-cancer therapies, including the resistance to BYL719 (Alpelisib) - the p110α isoform specific inhibitor of phosphoinositide 3-kinase (PI3K) - in esophagus and head and neck squamous cell carcinoma (ESCC, HNSCC respectively). However, the mechanisms underlying AXL overexpression in resistance to BYL719 remain elusive. Here we demonstrated that the AP-1 transcription factors, c-JUN and c-FOS, regulate AXL overexpression in HNSCC and ESCC. The expression of AXL was correlated with that of c-JUN both in HNSCC patients and in HNSCC and ESCC cell lines. Silencing of c-JUN and c-FOS expression in tumor cells downregulated AXL expression and enhanced the sensitivity of human papilloma virus positive (HPVPos) and negative (HPVNeg) tumor cells to BYL719 in vitro. Blocking of the c-JUN N-terminal kinase (JNK) using SP600125 in combination with BYL719 showed a synergistic anti-proliferative effect in vitro, which was accompanied by AXL downregulation and potent inhibition of the mTOR pathway. In vivo, the BYL719-SP600125 drug combination led to the arrest of tumor growth in cell line-derived and patient-derived xenograft models, and in syngeneic head and neck murine cancer models. Collectively, our data suggests that JNK inhibition in combination with anti-PI3K therapy is a new therapeutic strategy that should be tested in HPVPos and HPVNeg HNSCC and ESCC patients.
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Affiliation(s)
- Mai Badarni
- The Shraga Segal Department of Microbiology, Immunology and Genetics, and.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Manu Prasad
- The Shraga Segal Department of Microbiology, Immunology and Genetics, and.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noa Balaban
- The Shraga Segal Department of Microbiology, Immunology and Genetics, and.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jonathan Zorea
- The Shraga Segal Department of Microbiology, Immunology and Genetics, and.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ksenia M Yegodayev
- The Shraga Segal Department of Microbiology, Immunology and Genetics, and.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Otolaryngology - Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Anat Bahat Dinur
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Otolaryngology - Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Reidar Grénman
- Department of Otorhinolaryngology - Head & Neck Surgery, Turku University and Turku University Hospital, Turku, Finland
| | - Barak Rotblat
- Department of Life Sciences, Ben-Gurion University of the Negev, and.,The National Institute for Biotechnology in the Negev, Beer Sheva, Israel
| | - Limor Cohen
- The Shraga Segal Department of Microbiology, Immunology and Genetics, and.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology and Genetics, and.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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17
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Novoplansky O, Fury M, Prasad M, Yegodayev K, Zorea J, Cohen L, Pelossof R, Cohen L, Katabi N, Cecchi F, Joshua BZ, Popovtzer A, Baselga J, Scaltriti M, Elkabets M. MET activation confers resistance to cetuximab, and prevents HER2 and HER3 upregulation in head and neck cancer. Int J Cancer 2019; 145:748-762. [PMID: 30694565 DOI: 10.1002/ijc.32170] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/11/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022]
Abstract
An understanding of the mechanisms underlying acquired resistance to cetuximab is urgently needed to improve cetuximab efficacy in patients with head and neck squamous cell carcinoma (HNSCC). Here, we present a clinical observation that MET pathway activation constitutes the mechanism of acquired resistance to cetuximab in a patient with HNSCC. Specifically, RNA sequencing and mass spectrometry analysis of cetuximab-sensitive (CetuxSen ) and cetuximab-resistant (CetuxRes ) tumors indicated MET amplification and overexpression in the CetuxRes tumor compared to the CetuxSen lesion. Stimulation of MET in HNSCC cell lines was sufficient to reactivate the MAPK pathway and to confer resistance to cetuximab in vitro and in vivo. In addition to the direct role of MET in reactivation of the MAPK pathway, MET stimulation abrogates the well-known cetuximab-induced compensatory feedback loop of HER2/HER3 expression. Mechanistically, we showed that the overexpression of HER2 and HER3 following cetuximab treatment is mediated by the ETS homologous transcription factor (EHF), and is suppressed by MET/MAPK pathway activation. Collectively, our findings indicate that evaluation of MET and HER2/HER3 in response to cetuximab in HNSCC patients can provide the rationale of successive line of treatment.
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Affiliation(s)
- Ofra Novoplansky
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Matthew Fury
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manu Prasad
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ksenia Yegodayev
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jonathan Zorea
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Limor Cohen
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Raphael Pelossof
- Computational Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Liz Cohen
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ben-Zion Joshua
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Aron Popovtzer
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,The Head and Neck Cancer Radiation Clinic, Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel
| | - Jose Baselga
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maurizio Scaltriti
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ghosh S, Prasad M, Kundu K, Cohen L, Yegodayev KM, Zorea J, Joshua BZ, Lasry B, Dimitstein O, Bahat-Dinur A, Mizrachi A, Lazar V, Elkabets M, Porgador A. Tumor Tissue Explant Culture of Patient-Derived Xenograft as Potential Prioritization Tool for Targeted Therapy. Front Oncol 2019; 9:17. [PMID: 30723707 PMCID: PMC6350270 DOI: 10.3389/fonc.2019.00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/18/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
Despite of remarkable progress made in the head and neck cancer (HNC) therapy, the survival rate of this metastatic disease remain low. Tailoring the appropriate therapy to patients is a major challenge and highlights the unmet need to have a good preclinical model that will predict clinical response. Hence, we developed an accurate and time efficient drug screening method of tumor ex vivo analysis (TEVA) system, which can predict patient-specific drug responses. In this study, we generated six patient derived xenografts (PDXs) which were utilized for TEVA. Briefly, PDXs were cut into 2 × 2 × 2 mm3 explants and treated with clinically relevant drugs for 24 h. Tumor cell proliferation and death were evaluated by immunohistochemistry and TEVA score was calculated. Ex vivo and in vivo drug efficacy studies were performed on four PDXs and three drugs side-by-side to explore correlation between TEVA and PDX treatment in vivo. Efficacy of drug combinations was also ventured. Optimization of the culture timings dictated 24 h to be the time frame to detect drug responses and drug penetrates 2 × 2 × 2 mm3 explants as signaling pathways were significantly altered. Tumor responses to drugs in TEVA, significantly corresponds with the drug efficacy in mice. Overall, this low cost, robust, relatively simple and efficient 3D tissue-based method, employing material from one PDX, can bypass the necessity of drug validation in immune-incompetent PDX-bearing mice. Our data provides a potential rationale for utilizing TEVA to predict tumor response to targeted and chemo therapies when multiple targets are proposed.
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Affiliation(s)
- Susmita Ghosh
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Manu Prasad
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Kiran Kundu
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Limor Cohen
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ksenia M. Yegodayev
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Jonathan Zorea
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Batel Lasry
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orr Dimitstein
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Anat Bahat-Dinur
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology-Head and Neck Surgery and The Center for Translational Research in Head and Neck Cancer, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Lazar
- Worldwide Innovative Network Association-WIN Consortium, Villejuif, France
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Angel Porgador
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Mendel R, Yitshak-Sade M, Nash M, Joshua BZ. Assessment of the Association Between Post-tonsillectomy Hemorrhage and Weather Conditions. Isr Med Assoc J 2018; 20:349-353. [PMID: 29911754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The most common complication after tonsillectomy is bleeding. We investigated whether performing the procedure during the summer or the winter affects the bleeding rate. OBJECTIVES To investigate whether there is an association between meteorological conditions and the occurrence of post-tonsillectomy hemorrhage (PTH) in the southern Israel Negev region. METHODS All patients who underwent tonsillectomy from 2001-2013 at the Soroka Medical Center were included. We collected patient demographic data and indications for surgery. Meteorological data were obtained from a weather station operated by the Israel Ministry of Environmental Protection. RESULTS Of 4438 patients who underwent tonsillectomy, with or without adenoidectomy, 432 (9.73%) experienced hemorrhage. Patients who suffered from PTH were significantly older: median age 9.61 years vs.4.7 years, P < 0.0001. When comparing patients without PTH to those who bled within 0-3 days after surgery, there was a higher risk for bleeding during the warmer seasons: relative risk (RR) 1.38, 95% confidence interval ([95%CI] 1.07-1.77), RR 1.45 (95%CI 1.17-1.80), and 1.62 (95%CI 1.27-2.06) comparing the winter to spring, summer, and fall, respectively. A statistically significant positive association was also found with the average temperature on the day of surgery. Bleeding more than 3 days after surgery was less likely in summer: RR 0.82, 95%CI 0.69-0.97. We found no association with temperature on the day of surgery and PTH after postoperative day 3. CONCLUSIONS Seasonality, and to an extent temperature, seem to play only a minor role in PTH.
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Affiliation(s)
- Rom Mendel
- Department of Neurology, Rabin Medical center, Petah Tikva, Israel
| | - Maayan Yitshak-Sade
- Clinical Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Ben-Zion Joshua
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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20
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Nevo-Shor A, Kogan S, Joshua BZ, Bahat-Dinur A, Novack V, Fraenkel M. Seasonal changes in serum calcium, PTH and vitamin D levels in patients with primary hyperparathyroidism. Bone 2016; 89:59-63. [PMID: 27260647 DOI: 10.1016/j.bone.2016.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/16/2016] [Accepted: 05/30/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Seasonal variations of 25-hydroxyvitamin D, PTH and calcium levels are not well characterized in primary hyperparathyroidism (PHPT). Our objectives were to characterize seasonal changes in these parameters in PHPT patients, and to assess whether these seasonal changes affect clinical decision making. METHODS This is a retrospective study based on the electronic medical records of Clalit Health service in the south of Israel between 2000 and 2012. Patients 18years and older with PHPT (PTH>upper limit of norm (ULN) and serum calcium>10.5mg%) were included. Patients with renal failure or on Thiazide diuretics were excluded. All serum levels of calcium, PTH and 25-hydroxyvitamin D were collected and then stratified according to season. RESULTS 792 patients were classified as PHPT (72.2% female) and had a total of 2659 PTH tests, 1395 25-hydroxyvitamin D tests and 7426 calcium test. Fifty six percent of 25-hydroxyvitamin D levels were <50nmol/L. Seasonality was demonstrated in all three parameters: mean 25-hydroxyvitamin D was 13% higher in the summer compared to the winter (P<0.001), median PTH values showed opposite trend with a fall of about 8.4% in summer compared to winter (P<0.001). Calcium levels were higher during the autumn with a rise of about 0.2mg/dL in the mean calcium levels compared to spring and summer (P<0.001). The odds ratio of calcium level above 11.5mg/dL is highest in the autumn (OR=1.275, P=0.018). CONCLUSION We show seasonal variation in serum 25-hydroxyvitamin D, PTH, and calcium levels in patients with PHPT. These seasonal variations cause transition to pathological values that may influence diagnosis and treatment of PHPT patients.
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Affiliation(s)
- Anat Nevo-Shor
- Soroka University Medical Center, Endocrinology Unit, Beer-Sheva, Israel
| | - Slava Kogan
- Soroka University Medical Center, Clinical Research Center, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Soroka University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Beer-Sheva, Israel
| | - Anat Bahat-Dinur
- Soroka University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Beer-Sheva, Israel
| | - Victor Novack
- Soroka University Medical Center, Clinical Research Center, Beer-Sheva, Israel
| | - Merav Fraenkel
- Soroka University Medical Center, Endocrinology Unit, Beer-Sheva, Israel.
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21
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Kordeluk S, Goldbart A, Novack L, Kaplan DM, El-Saied S, Alwalidi M, Shapira-Parra A, Segal N, Slovik Y, Max P, Joshua BZ. Randomized study comparing inflammatory response after tonsillectomy versus tonsillotomy. Eur Arch Otorhinolaryngol 2016; 273:3993-4001. [PMID: 27216303 DOI: 10.1007/s00405-016-4083-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/03/2016] [Indexed: 11/26/2022]
Abstract
To determine if there was a difference in the inflammatory reaction after tonsil surgery with "traditional" techniques (tonsillectomy and adenoidectomy or TA) compared to partial intracapsular tonsillectomy and adenoidectomy (PITA). DESIGN Randomized, double-blind study. SETTING tertiary care academic hospital. Children under the age of 16 years with a diagnosis of obstructive sleep disordered breathing were randomly allocated into three study groups: TA with electrocautery (n = 34), PITA with CO2 laser (n = 30) and PITA with debrider (n = 28). All of the children underwent adenoidectomy with a current at the same surgical procedure. MAIN OUTCOME MEASURE c-reactive protein level (CRP) was the primary endpoint. In addition, the following were assessed: white blood cells (WBC), neutrophils (NEU), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Pre- and post-procedure measurements were compared between the groups. Parents filled out a questionnaire daily during the first postoperative week assessing pain, swallowing and snoring. CRP levels ascended higher in the PITA groups after surgery (p = 0.023), WBC and NEU showed the same pattern, IL-6 levels were higher in PITA group and there was no difference in TNF-alpha levels between the two types of procedures. Postoperative pain and postoperative hemorrhage were significantly lower in the PITA groups as compared to the TA group (p = 0.01 and 0.048). PITA in comparison to TA is associated with lower morbidity; however, the inflammatory response does not differ significantly in the first 24 h after surgery. Additional long-term studies assessing efficacy of PITA are warranted. LEVEL OF EVIDENCE Level 1, prospective randomized controlled trial.
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Affiliation(s)
- Sofia Kordeluk
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
| | - Aviv Goldbart
- Department of Pediatrics and Sleep-Wake Disorders Unit, Soroka University Medical Center, Beersheva, Israel
| | - Lena Novack
- Department of Public Health, Faculty of Medical Sciences, Ben-Gurion University in the Negev, Beersheva, Israel
| | - Daniel Michael Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel
| | - Musa Alwalidi
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel
| | - Angelica Shapira-Parra
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel
| | - Nili Segal
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel
| | - Yuval Slovik
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel
| | - Puterman Max
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel
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Abstract
BACKGROUND Mucoceles are common cystic lesions of the oral mucosa. Extravasation mucoceles (EMs) are mainly found in the lower lip of young patients, whereas retention mucoceles (RMs) are usually located in the cheek or palate of older patients. This study was undertaken to more fully characterize the clinicopathologic features of mucoceles in pediatric patients. METHODS The records of 56 pediatric patients with mucoceles were included in the study. Age, sex, history of trauma, intraoral site, size, and method of treatment were evaluated. Histopathologically the lesions were classified as being EMs or RMs. RESULTS The age range was 1.5 to 16 years (mean age 11.2 yrs). Of the 56 patients, 24 (43%) were males and 32 (57%) were females, with a male:female ratio of 1:1.33. A history of trauma was recorded in 32 (57%) patients of the lower lip. The intraoral sites were the lower lip (38 [68%]), tongue (10 [18%]), and floor of the mouth (8 [14%]). Of the 56 patients, 44 (79%) were EM and 12 (21%) were ranulas. No RMs were found. Mucoceles ranged from 0.3 to 3.8 cm in diameter (mean 0.9 cm). The treatment of EMs was surgical excision. Cryosurgey, electrosurgery, and carbon dioxide laser were also used. CONCLUSION In contrast to adults, where EM and RM types can be found, among children all cases are of the EM type. The disparate site and age incidences of EMs and RMs of the oral mucosa suggest that these two types are not related and possibly have a different etiopathogenesis.
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Affiliation(s)
- Lipa Bodner
- Department of Oral and Maxillofacial Surgery, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Esther Manor
- Institute of Human Genetics, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruthy Shaco-Levy
- Institute of Pathology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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El-Saied S, Joshua BZ, Segal N, Kraus M, Kaplan DM. Sudden hearing loss with simultaneous posterior semicircular canal BPPV: possible etiology and clinical implications. Am J Otolaryngol 2014; 35:180-5. [PMID: 24060342 DOI: 10.1016/j.amjoto.2013.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 08/10/2013] [Accepted: 08/14/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objectives of this study were to describe the clinical course and outcome of patients with sudden sensorineural hearing loss (SSNHL) in conjunction with benign paroxysmal positional vertigo (BPPV), and hypothesize the possible pathophysiology of this entity. STUDY DESIGN Retrospective study of all patients with evidence of SSNHL with any type of BPPV between 2008 and 2012. SETTINGS Tertiary care university hospital. SUBJECTS AND METHODS Five patients aged 56 to 71 were diagnosed with unilateral profound SSNHL and BPPV. Neurotologic examination revealed an ipsilateral torsional, up-beating nystagmus on Dix-Hallpike exam. Severe or profound ipsilateral-sensorineural hearing loss was recognized on audiometry. The rest of the exam was normal; this was in keeping with the diagnosis of SSNHL with ipsilateral posterior semicircular canal BPPV. RESULTS All patients were treated with a modified Epley maneuver; oral steroids were administered for two weeks. In all cases vertigo resolved and the Dix-Hallpike exam became normal within several weeks. However, the hearing loss remained unchanged in two patients. Magnetic resonance imaging of the head was normal and ENG caloric test demonstrated mild ipsilateral canal paresis in two patients. CONCLUSIONS 1. Patients with SSNHL and BPPV can have a variable clinical course and outcome. This entity may be quite common, but the diagnosis of BPPV can be missed if a complete neurological physical examination is not performed. 2. Arterial occlusions or selective multiple vascular or neural involvement may explain the pathophysiology of SSNHL with BPPV of the posterior semicircular canal.
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Affiliation(s)
- Sabri El-Saied
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center and the Faculty of Health Science, Ben-Gurion University in the Negev, Beer-Sheva, Israel.
| | - Ben-Zion Joshua
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center and the Faculty of Health Science, Ben-Gurion University in the Negev, Beer-Sheva, Israel
| | - Nili Segal
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center and the Faculty of Health Science, Ben-Gurion University in the Negev, Beer-Sheva, Israel
| | - Mordechai Kraus
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center and the Faculty of Health Science, Ben-Gurion University in the Negev, Beer-Sheva, Israel
| | - Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center and the Faculty of Health Science, Ben-Gurion University in the Negev, Beer-Sheva, Israel
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Hindy J, Novoa R, Slovik Y, Puterman M, Joshua BZ. Epiglottic abscess as a complication of acute epiglottitis. Am J Otolaryngol 2013; 34:362-5. [PMID: 23391346 DOI: 10.1016/j.amjoto.2013.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE An epiglottic abscess is considered a life-threatening medical situation that can cause death by obstruction the upper airways. We describe a 58-year-old man who presented to our hospital with sore throat, dysphagia and dysphonia. MATERIALS AND METHODS A fiberoptic laryngoscope (FOL) demonstrated beefy red edematous epiglottis with edema extending from the base of the tongue to the aryepiglottic folds and arytenoids. CT scan showed multiple air bubbles inside the swollen epiglottis, in keeping with the diagnosis of necrotizing epiglottic abscess. RESULTS Under local anesthesia we performed puncture of the abscess at the tip of the epiglottis. He was dismissed 5days from his admission to the hospital after an improvement was noticed in his epiglottis. CONCLUSION Treatment consists of airway management if needed under anesthesia and draining of the abscess. An IV antibiotics plus corticosteroids should be administrated the moment a suspicion of epiglottitis is present.
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25
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Joshua BZ, Gluck O, Puterman M. [Unilateral choanal atresia: a missed diagnosis]. Harefuah 2012; 151:614-655. [PMID: 23367729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bilateral choanal atresia is a congenital anomaly usually diagnosed at birth. In contrast, unilateral atresia causes variable degrees of nasal stuffiness and discharge that might mask the diagnosis and delay the proper treatment. We present five cases of unilateral atresia in which the correct diagnosis was delayed and erroneous treatments were instituted--two adults who had undergone unnecessary septal and turbinate surgery, two older children who were treated medically and one patient who was treated for epiphora. Insufficient awareness of this entity occurring in adults and older children and other possible causes of diagnostic error are discussed. A unilateral mucoid or watery rhinorrhea and obstruction, that lasts from early childhood without evidence of sinusitis and not responding to any medical treatment, should alert the physician to consider unilateral atresia and to perform endoscopic and computed tomography examinations at an early age. Careful interpretation of the computed tomography scan including the axial planes is required.
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Affiliation(s)
- Ben-Zion Joshua
- Department of ENT Head and Neck Surgery, Soroka Medical Center, Beer Sheba
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Joshua BZ, Sachs O, Shelef I, Vardy-Sion N, Novack L, Vaiman M, Puterman M. Comparison of clinical data, CT, and bone histopathology in unilateral chronic maxillary sinusitis. Otolaryngol Head Neck Surg 2012; 148:145-50. [PMID: 23112270 DOI: 10.1177/0194599812465396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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
OBJECTIVES To evaluate bone changes demonstrated by computed tomography (CT) as a predictor of the severity of chronic rhinosinusitis. STUDY DESIGN Cross-sectional study. SETTINGS Tertiary referral university medical center. SUBJECTS AND METHODS Thirty-eight patients diagnosed with unilateral chronic maxillary sinusitis underwent endoscopic sinus surgery from 2003 to 2009. Preoperative CTs of all patients were reviewed by a single radiologist blinded to the pathologic diagnosis. Bone density was evaluated and expressed in Hounsfield units (HU). Sinus wall thickness (WT) was also measured and compared with the contralateral side. All the histopathologic specimens were reviewed. A database was constructed containing demographic data, clinical symptoms, CT measurements, and histopathologic findings. RESULTS Average age was 44.07 years, with 22 women (57.9%) and 16 men (42.1%). The average wall density (WD) was 828.7 HU, and no correlation was found between the density of the diseased maxillary sinus bony walls and the severity of the histopathologic inflammatory process of the soft tissue (P = .474). The average wall thickness of the diseased sinuses was 2.6 mm, and a correlation was found between inflammation severity and wall thickness (P = .018). Wall thickening was found in 97.3% of the cases and an increase in density in 78.9% without correlation between WD and WT. CONCLUSION Wall thickness but not WD obtained from CT scans may be a simple index for evaluation of unilateral chronic rhinosinusitis and its severity. Further studies confirming these results and comparing them with clinical correlates are indicated.
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Affiliation(s)
- Ben-Zion Joshua
- Department of Otolaryngology & Head and Neck Surgery, Soroka Medical Center and Ben Gurion University of Negev, Beer-Sheva, Israel.
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El-Saied S, Puterman M, Kaplan DM, Cohen-Lahav M, Joshua BZ. Involvement of minor salivary glands in the pathogenesis of peritonsillar abscess. Otolaryngol Head Neck Surg 2012; 147:472-4. [PMID: 22547556 DOI: 10.1177/0194599812445552] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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
OBJECTIVES To study the relationship between peritonsillar abscess (PTA) and minor salivary glands surrounding the palatine tonsils. STUDY DESIGN Prospective population-based study. SETTINGS Tertiary care university hospital. SUBJECTS AND METHOD Prospective study including 41 patients with PTA and 6 patients with a neck abscess. Amylase levels of the pus and serum were measured and compared between the 2 groups. Clinical data regarding hospitalization length and recurrence rate were also collected. RESULTS Of the 41 patients with PTA, 7 suffered from recurrent PTA. Average level of amylase in the pus of the PTA group was 3841 U/L versus 7.7 U/L in the neck abscess group (P < .001; median, 62 vs 9.5). Serum amylase was higher in the PTA group (49.3 U/L vs 37.3 U/L; P = .008). There were no recurrences in PTA patients with amylase greater than 65 U/dL in the pus in 0 of 20 (0%) versus 7 of 21 (33%) for amylase lower than 65 U/L (P = .01). CONCLUSION High amylase in the pus lends further support for involvement of minor salivary glands. However, high recurrence rates related to low amylase in the pus imply an additional pathogenesis possibly related to tonsillar infection. It is possible that both minor salivary glands as well as tonsillar infection play a role in the pathogenesis of peritonsillar infections.
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Affiliation(s)
- Sabri El-Saied
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
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Manor E, Joshua BZ, Nash M, Brennan PA, Bodner L. Cytogenetics of primary embryonal rhabdomyosarcoma of the cheek. Br J Oral Maxillofac Surg 2012; 50:788-90. [PMID: 22277700 DOI: 10.1016/j.bjoms.2011.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 12/31/2011] [Indexed: 11/28/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumour of childhood and has two main subtypes: embryonal and alveolar. The embryonal subtype accounts for most cases in the genitourinary tract and head and neck. Oral presentations are rare, and mainly in the tongue, palate, or cheek. Cytogenetically, alveolar RMS is characterised by the translocation t(2;13)(q35;q14), which plays an important part in diagnosis, but no consistent and unique genetic alterations have been identified in embryonal RMS. It is currently not known whether oral embryonal RMS is similar to those that arise from other sites, as only one cytogenetic report has been published to date. We present the case of a 9-year-old boy with embryonal RMS of the cheek, and discuss the cytogenetic alterations in his case.
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Affiliation(s)
- Esther Manor
- Institute of Human Genetics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Manor E, Kapelushnik J, Joshua BZ, Bodner L. Metastatic neuroblastoma of the mandible: a cytogenetic and molecular genetic study. Eur Arch Otorhinolaryngol 2011; 269:1967-71. [DOI: 10.1007/s00405-011-1863-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 11/22/2011] [Indexed: 12/18/2022]
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Abstract
Objective. To investigate the relationship between tonsillar and peritonsillar infections. Study Design. Retrospective population-based study and a retrospective case series review. Settings. Tertiary academic medical facility. Subjects and Methods. All individuals hospitalized with peritonsillar abscess (PTA) or peritonsillar cellulitis (PTC) during 2004-2008 were reviewed. Patient age, gender, diagnosis of PTA or PTC, recurrence, and date of presentation were recorded. In addition, a database of patients diagnosed in the community with acute tonsillitis (AT) was reviewed for the same time period. The weekly number of patients with AT was recorded, and a comparison between incidence of tonsillar infections and peritonsillar infection was performed. Results. A total of 685 patients were hospitalized with either PTA (467) or PTC (218). Incidence of both upper respiratory infections and AT peaked in January and February of every year with a nadir in August. In contrast, PTA and PTC showed a consistent rate of infection throughout the year. Likewise, assessment based on weekly intervals showed that peaks of PTA and PTC did not follow those of acute tonsillitis with a 1 to 2 weekly lag as would be expected if peritonsillar infection is a complication of AT. Rather, an association between peritonsillar infection and tonsillitis was found within the same week ( P = .04). Conclusion. Higher rates of occurrence of PTA or PTC following AT outbreaks were not found. These results lend further support to the theory that peritonsillar infection is associated not only with complications of AT but may occur from infection of Weber glands or other unknown causes.
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Affiliation(s)
- Sofia Kordeluk
- Department of Otolaryngology–Head & Neck Surgery, Soroka Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lena Novack
- Epidemiology Unit, Faculty of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moshe Puterman
- Department of Otolaryngology–Head & Neck Surgery, Soroka Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mordechai Kraus
- Department of Otolaryngology–Head & Neck Surgery, Soroka Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology–Head & Neck Surgery, Soroka Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Bahar G, Feinmesser R, Joshua BZ, Shpitzer T, Morgenstein S, Popovtzer A, Shvero J. Hyperfunctioning intrathyroid parathyroid gland: A potential cause of failure in parathyroidectomy. Surgery 2006; 139:821-6. [PMID: 16782440 DOI: 10.1016/j.surg.2005.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 02/18/2005] [Revised: 11/10/2005] [Accepted: 11/22/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND The surgical success rate of parathyroidectomy is 95%. However, in rare patients, ectopic hyperfunctioning parathyroid glands may be located in the thyroid but missed on imaging studies or during surgery. The aim of the present study was to evaluate the perioperative findings in 6 patients with intrathyroid parathyroid glands treated for hyperparathyroidism in our center over a 5-year period and to review the relevant literature. METHODS Of the 426 patients who underwent parathyroidectomy for hyperparathyroidism between 1998 and 2003 in our center, 6 (1.4%) were found to have intrathyroid glands. Their files were reviewed for clinical features, surgical approach, intraoperative findings, parathyroid gland location, and morphologic and histopathologic characteristics. RESULTS The group included 2 men and 4 women of mean age 66 years. The diagnosis in all patients was based on an increase in serum calcium concentration (10.1-13 mg/100 mL) and parathyroid hormone level (102-320 pg/mL). The clinical symptoms were kidney stones, gastrointestinal complaints, hypertension, and osteopenia. Localization studies included ultrasonography in all patients and sestamibi in 4. When the parathyroid glands were not identified, bilateral neck and mediastinum were explored. Adenoma was diagnosed histologically in 4 patients; 2 had a double adenoma. CONCLUSION Intrathyroid parathyroid gland is a rare condition in patients with hyperparathyroidism. In these patients, imaging may miss the pathologic gland. Despite its rarity, the possibility of an intrathyroid parathyroid should be kept in mind, and, when meticulous bilateral exploration of the neck fails to identity the hyperfunctioning gland, the surgeon should consider hemithyroidectomy.
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Affiliation(s)
- Gideon Bahar
- Department of Otolaryngology, Head, and Neck Surgery, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel.
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Bahar G, Dudkiewicz M, Feinmesser R, Joshua BZ, Braslavsky D, Popovtzer A, Galil D, Shpitzer T. Acute parotitis as a complication of fine-needle aspiration in Warthin's tumor. A unique finding of a 3-year experience with parotid tumor aspiration. Otolaryngol Head Neck Surg 2006; 134:646-9. [PMID: 16564390 DOI: 10.1016/j.otohns.2005.10.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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: 04/08/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE/HYPOTHESIS Fine needle aspiration (FNA) is an accurate, cost-effective tool for the study of salivary gland lesions. Although complications are extremely rare, salivary gland FNA can lead to hemorrhage, facial nerve injury, and cellulitis at the needle puncture site. Some studies suggest that FNA can cause infarction or metaplastic transformation of benign Warthin's tumors. We review our recent experience with FNA of the parotid gland, focusing on possible complications and pitfalls. STUDY DESIGN AND SETTING The medical records of all patients who underwent FNA of the parotid gland from 2000 to 2002 in the Department of Otolaryngology-Head and Neck Surgery of a major tertiary-care referral center were reviewed. Cytological results were compared to the histological diagnosis and complications were recorded. RESULTS Of the 256 lesions aspirated, 99 patients (39%), were cytologically diagnosed as benign tumors, including 31 (12%) Warthin's tumors, of which 16/17 resected and confirmed histologically. Five patients with Warthin's tumor had post-FNA parotitis and were treated accordingly. CONCLUSIONS The combination of cystic spaces surrounded by oncocytic cells and a poor blood supply makes the tumor susceptible to infarction and inflammation. Our findings indicate that FNA is a strong and reliable tool in the investigation of the salivary glands. Nevertheless, when Warthin's tumor is clinically suspected on the basis of its location (tail of the parotid gland), cystic texture, patient sex (male) and age, one should consider parotitis as a possible complication. EBM RATING C-4.
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Affiliation(s)
- Gideon Bahar
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tiqwa, Israel.
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