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SP194 – Endovascular management of carotid blowout syndrome
Program Poster Presentations
SP194 – Endovascular management of carotid blowout syndrome Steven Hong, MD (presenter); Jon Robitschek, MD; Joseph Sniezek, MD OBJECTIVES: 1) Demonstrate general knowledge of the initial management and stabilization of a patient who presents with carotid blowout syndrome. 2) Understand the decisionmaking algorithm for the appropriate use of the different modalities of endovascular management in patients with advanced head and neck cancers. METHODS: Retrospective review of three cases of acute or imminent carotid hemorrhage managed with either endovascular stents or permanent endovascular occlusion. RESULTS: One patient presented with acute carotid blowout, whereas two patients presented with probable sentinel bleeds. One patient was deemed appropriate for undergoing a permanent balloon occlusion (PBO) after a carotid angiography revealed a small pseudoaneurysm. The other two patients were at high-risk for strokes and were treated with stent-placements. All achieved immediate hemostasis. The PBO patient exhibited no major complications including no rebleed episodes during six years post-occlusion. One patient suffered a stroke two months post stent placement and died four months later of disease progression. The other patient suffered a rebleed one month post stent placement and died of disease progression a month later. CONCLUSIONS: There are several technical limitations to either endovascular procedure, along with many confounding clinical variables that must be taken into consideration in choosing the appropriate endovascular treatment in carotid blowout syndrome. For short-term control of hemorrhage, both occlusion and stenting have been shown to be quite effective, while the literature and our own experience suggest that endovascular occlusion provides a longer period of hemostasis and less complications than stent placement. SP167 – Esophageal pathology after treatment for head and neck cancer Debbie Mouadeb, MD (presenter); Danny Enepekides, MD; Peter C Belafsky, MD; Catherine Rees, MD; Jacqueline Allen; Allen Chen; D Gregory Farwell, MD
OBJECTIVES: To determine the prevalence of esophageal pathology following treatment for primary head and neck cancer (HNCA). METHODS: Esophagoscopy was performed routinely on persons at-least 3 months after treatment for HNCA. Patient demographics, symptoms surveys, treatment received, reflux medications prescribed and esophageal findings were prospectively determined. RESULTS: 100 patients underwent esophagoscopy. The mean age of the cohort was 64 (⫹/- 10) years. 74% was male. The mean time between the end of treatment and endoscopy was 40 (⫹/- 51) months. 77% of HNCA were advanced stage (3 or 4). The distribution of site of the primary HNCA was: oral cavity (16%), oropharynx (38%), larynx (36%), hypopharynx (2/%), unknown primary (7%), and nasopharynx (1%). Treatment modalities included surgery (15%), radiation (5%), radiation and chemotherapy and surgery (24%), and radiation ⫹/- chemotherapy (54%). The findings on esophagoscopy included stricture (22%), candidiasis (9%), peptic esophagitis (67%), Barretts (8%), and carcinoma(4%). Only 13% had a normal esophagoscopy. CONCLUSIONS: Esophageal pathology is extremely common in patients treated for head and neck cancer. These findings support routine esophageal screening after head and neck cancer treatment. SP213 – Evolution of parotidectomy outcomes Amy S Ketcham, MD (presenter) OBJECTIVES: 1) To understand the current demographics of patients requiring parotidectomy. 2) To re-evaluate the incidence of facial nerve paralysis and its contributing factors. METHODS: Retrospective review of parotidectomies performed by a single surgeon at a tertiary medical center from 9/01-11/08. Demographics, diagnoses, comorbidities, cancer staging, extent of operation, and complications were analyzed. Basic statistical analysis was performed and included Students t-test and Chi-square tests. RESULTS: The 98 patients in this study underwent 62 superficial, 7 total, and 9 radical parotidectomies. Average age was 57 years. 63% of parotid lesions were benign; 34% were malignant. Pleomorphic adenoma and squamous cell carcinoma were the most common benign and malignant lesions respectively. 7 lesions were recurrent. Left-sided lesions outnumbered right-sided (56% vs. 44%). Complications included 2 Freys syndromes, keloid, 12 temporary facial nerve paralysis, 15 permanent facial nerve paralysis (13 intentional), and 1 mortality from perioperative MI. Temporary facial nerve paralysis was not influenced by age, sex, side of lesion, or malignancy (p⬎0.05). CONCLUSIONS: Parotidectomy morbidity is a well-known risk. However, the rate of temporary facial nerve paralysis seems to be lower in more recent years. More complications
POSTERS
of EGCG and within 10 minutes. EGCG 40M causes a significant decrease in the amount of cell surface EGFR. c-Src was detected in the fraction containing proteins that bind to EGCG with high affinity. CONCLUSIONS: Our studies provide the first evidence that EGCG can bind to and preferentially activate c-Src and that this activation may play a role in EGCG-induced internalization of the EGFR.
P151
SP194 – Endovascular management of carotid blowout syndrome Steven Hong, MD (presenter); Jon Robitschek, MD; Joseph Sniezek, MD OBJECTIVES: 1) Demonstrate general knowledge of the initial management and stabilization of a patient who presents with carotid blowout syndrome. 2) Understand the decisionmaking algorithm for the appropriate use of the different modalities of endovascular management in patients with advanced head and neck cancers. METHODS: Retrospective review of three cases of acute or imminent carotid hemorrhage managed with either endovascular stents or permanent endovascular occlusion. RESULTS: One patient presented with acute carotid blowout, whereas two patients presented with probable sentinel bleeds. One patient was deemed appropriate for undergoing a permanent balloon occlusion (PBO) after a carotid angiography revealed a small pseudoaneurysm. The other two patients were at high-risk for strokes and were treated with stent-placements. All achieved immediate hemostasis. The PBO patient exhibited no major complications including no rebleed episodes during six years post-occlusion. One patient suffered a stroke two months post stent placement and died four months later of disease progression. The other patient suffered a rebleed one month post stent placement and died of disease progression a month later. CONCLUSIONS: There are several technical limitations to either endovascular procedure, along with many confounding clinical variables that must be taken into consideration in choosing the appropriate endovascular treatment in carotid blowout syndrome. For short-term control of hemorrhage, both occlusion and stenting have been shown to be quite effective, while the literature and our own experience suggest that endovascular occlusion provides a longer period of hemostasis and less complications than stent placement. SP167 – Esophageal pathology after treatment for head and neck cancer Debbie Mouadeb, MD (presenter); Danny Enepekides, MD; Peter C Belafsky, MD; Catherine Rees, MD; Jacqueline Allen; Allen Chen; D Gregory Farwell, MD
OBJECTIVES: To determine the prevalence of esophageal pathology following treatment for primary head and neck cancer (HNCA). METHODS: Esophagoscopy was performed routinely on persons at-least 3 months after treatment for HNCA. Patient demographics, symptoms surveys, treatment received, reflux medications prescribed and esophageal findings were prospectively determined. RESULTS: 100 patients underwent esophagoscopy. The mean age of the cohort was 64 (⫹/- 10) years. 74% was male. The mean time between the end of treatment and endoscopy was 40 (⫹/- 51) months. 77% of HNCA were advanced stage (3 or 4). The distribution of site of the primary HNCA was: oral cavity (16%), oropharynx (38%), larynx (36%), hypopharynx (2/%), unknown primary (7%), and nasopharynx (1%). Treatment modalities included surgery (15%), radiation (5%), radiation and chemotherapy and surgery (24%), and radiation ⫹/- chemotherapy (54%). The findings on esophagoscopy included stricture (22%), candidiasis (9%), peptic esophagitis (67%), Barretts (8%), and carcinoma(4%). Only 13% had a normal esophagoscopy. CONCLUSIONS: Esophageal pathology is extremely common in patients treated for head and neck cancer. These findings support routine esophageal screening after head and neck cancer treatment. SP213 – Evolution of parotidectomy outcomes Amy S Ketcham, MD (presenter) OBJECTIVES: 1) To understand the current demographics of patients requiring parotidectomy. 2) To re-evaluate the incidence of facial nerve paralysis and its contributing factors. METHODS: Retrospective review of parotidectomies performed by a single surgeon at a tertiary medical center from 9/01-11/08. Demographics, diagnoses, comorbidities, cancer staging, extent of operation, and complications were analyzed. Basic statistical analysis was performed and included Students t-test and Chi-square tests. RESULTS: The 98 patients in this study underwent 62 superficial, 7 total, and 9 radical parotidectomies. Average age was 57 years. 63% of parotid lesions were benign; 34% were malignant. Pleomorphic adenoma and squamous cell carcinoma were the most common benign and malignant lesions respectively. 7 lesions were recurrent. Left-sided lesions outnumbered right-sided (56% vs. 44%). Complications included 2 Freys syndromes, keloid, 12 temporary facial nerve paralysis, 15 permanent facial nerve paralysis (13 intentional), and 1 mortality from perioperative MI. Temporary facial nerve paralysis was not influenced by age, sex, side of lesion, or malignancy (p⬎0.05). CONCLUSIONS: Parotidectomy morbidity is a well-known risk. However, the rate of temporary facial nerve paralysis seems to be lower in more recent years. More complications
POSTERS
of EGCG and within 10 minutes. EGCG 40M causes a significant decrease in the amount of cell surface EGFR. c-Src was detected in the fraction containing proteins that bind to EGCG with high affinity. CONCLUSIONS: Our studies provide the first evidence that EGCG can bind to and preferentially activate c-Src and that this activation may play a role in EGCG-induced internalization of the EGFR.
P151