Mark D. DeLacure, M.D.

Eyelash trichomegaly secondary to panitumumab therapy
Morris, L G T; Hochster, H S; Delacure, M D
2011 Jun;18(3):145-146, Current oncology (Toronto, Ont.)
— id: 136473, year: 2011, vol: 18, page: 145, stat: Journal Article,

Validation of the histologic risk model in a new cohort of patients with head and neck squamous cell carcinoma
Brandwein-Gensler, Margaret; Smith, Richard V; Wang, Beverly; Penner, Carla; Theilken, Andrea; Broughel, Darcy; Schiff, Bradley; Owen, Randall P; Smith, Jonathan; Sarta, Cathy; Hebert, Tiffany; Nason, Rick; Ramer, Marie; DeLacure, Mark; Hirsch, David; Myssiorek, David; Heller, Keith; Prystowsky, Michael; Schlecht, Nicolas F; Negassa, Abdissa
2010 May;34(5):676-688, American journal of surgical pathology
BACKGROUND: Half of the patients with head and neck squamous cell carcinoma (HNSCC) can be expected to fail therapy, indicating that more aggressive treatment is warranted for this group. We have developed a novel risk model that can become a basis for developing new treatment paradigms. Here we report on the performance of our model in a new multicenter cohort. DESIGN: Eligible patients from 3 institutions (Montefiore Medical Center, University of Manitoba, and New York University Medical Center) were identified and pathology slides from their resection specimens were reviewed by Margaret Brandwein-Gensler; risk category was assigned as previously published. Kaplan-Meier analysis was performed for disease progression and survival. Cox proportional hazards regression was performed, adjusted for potential confounders. A teaching module was also developed; attending pathologists were asked to score coded slides after a lecture and multiheaded microscope teaching session. Agreement was assessed by calculating Cohen unweighted kappa coefficients. RESULT: The validation cohort consisted of 305 patients, from the above institutions, with 311 primary HNSCC of the oral cavity, oropharynx, and larynx. The median follow-up period for all patients was 27 months. Risk category predicts time to disease progression (P=0.0005), locoregional recurrence (P=0.013), and overall survival (P=0.0000) by Kaplan-Meier analysis. High-risk status is significantly associated with decreased time to disease progression, adjusted for clinical confounders (P=0.015, hazard ratio 2.32, 95% confidence interval 1.18-4.58) compared with collapsed intermediate and low-risk groups. We also demonstrate substantial interrater agreement (kappa=0.64), and very good rater agreement when compared with the standard (kappa=0.87). CONCLUSIONS: We demonstrate significant predictive performance of the risk model in a new cohort of patients with primary HNSCC, adjusted for confounders. Our training experience also supports the feasibility of adapting the risk model in clinical practice
— id: 120802, year: 2010, vol: 34, page: 676, stat: Journal Article,

Pathology quiz case 1: ameloblastic carcinoma
Immerman, Sara B; Morris, Luc G T; DeLacure, Mark D; Wang, Beverly Y; Kurago, Zoya
2010 Jun;136(6):634, 636-, Archives of otolaryngology, head & neck surgery
— id: 110665, year: 2010, vol: 136, page: 634, 636, stat: Journal Article,

Incidental trichinellosis of strap muscle identified after thyroglossal duct cyst excision
Kuhn, Maggie A; Zeitler, Daniel M; Wang, Beverly Y; DeLacure, Mark D
2010 ;120 Suppl 4:S158-S158, Laryngoscope
OBJECTIVES: (1) Present a unique case of a thyroglossal duct cyst (TGDC) excised for recurrent infections with Trichinella spiralis in adjacent strap muscle; (2) review the literature regarding the diagnosis and treatment of subclinical trichinellosis of the head and neck. STUDY DESIGN: Case report and literature review. METHODS: Case report and literature review. RESULTS: We present the case of a male immigrant who suffered from recurrent midline neck infections due to aTGDC. The patient underwent an uneventful Sistrunk procedure. Histological examination of the surgical specimen revealed a chronically infected TGDC as well as remnants of skeletal muscle adjacent to the cyst containing nematode larvae, positively identified as Trichinella spiralis. The patient was subsequently evaluated by an infectious disease specialist and required no further treatment for his parasitic infection. DISCUSSION: The presence of nematode infections in developed countries is rare today given improved hygiene practices and control of meat quality. We present a unique case of incidentally noted Trichinella spiralis infection of the head and neck. To our knowledge, this is the first described case of trichinellosis of strap muscle adjacent to an excised TGDC and furthermore highlights the rarity of Trichinella spiralis infections of the head and neck. CONCLUSIONS: Trichinella spiralis may exist subclinically in a variety of human tissues including neck muscles
— id: 121324, year: 2010, vol: 120 Suppl 4, page: S158, stat: Journal Article,

Malignant melanoma metastatic to the larynx: treatment and functional outcome
Lanson, B G; Sanfilippo, N; Wang, B; Grew, D; Delacure, M D
2010 Aug;17(4):127-132, Current oncology (Toronto, Ont.)
The review considers management strategies for malignant melanoma metastatic to the larynx. This rare clinical entity lacks clear treatment recommendations because extirpative surgery can often result in severe functional debilitation in patients with limited life expectancy. Here, we report a case of melanoma metastatic to the larynx in a patient with a prior history of Hodgkin lymphoma. The patient was treated with partial laryngectomy and local radiation therapy. The rationale for treatment decisions and for surgical and radiotherapeutic techniques and the associated literature are discussed
— id: 133827, year: 2010, vol: 17, page: 127, stat: Journal Article,

Toxicity of head-and-neck radiation therapy in human immunodeficiency virus-positive patients
Sanfilippo, Nicholas J; Mitchell, James; Grew, David; DeLacure, Mark
2010 Aug 1;77(5):1375-1379, International journal of radiation oncology biology physics
PURPOSE: To examine the acute morbidity of high dose head and neck RT and CRT in patients with infected with HIV. METHODS AND MATERIALS: All HIV-positive patients who underwent radiation therapy for head and neck cancer in our department between 2004 and 2008 were reviewed. Treatment related data were examined. All treatments were delivered with megavoltage photon beams or electron beams. Patients were evaluated by an attending radiation oncologist for toxicity and response on a weekly basis during therapy and monthly after treatment in a multidisciplinary clinic. Acute toxicities were recorded using the Radiation Therapy and Oncology Group (RTOG) common toxicity criteria. Response to treatment was based on both physical exam as well as post-treatment imaging as indicated. RESULTS: Thirteen patients who underwent RT with a diagnosis of HIV were identified. Median age was 53 years and median follow-up was 22 months. Twelve had squamous cell carcinoma and one had lymphoproliferative parotiditis. Median radiation dose was 66.4 Gy and median duration of treatment was 51 days. The median number of scheduled radiotherapy days missed was zero (range 0 to 7). One patient (8%) developed Grade 4 confluent moist desquamation. Eight patients (61%) developed Grade 3 toxicity. CONCLUSION: Based on our results, HIV-positive individuals appear to tolerate treatment for head and neck cancer, with toxicity similar to that in HIV-negative individuals
— id: 111341, year: 2010, vol: 77, page: 1375, stat: Journal Article,

Head and neck radiotherapy compliance in an underserved patient population
Sethi, Rajni A; Stamell, Emily F; Price, Leah; DeLacure, Mark; Sanfilippo, Nicholas
2010 Jul;120(7):1336-1341, Laryngoscope
OBJECTIVES/HYPOTHESIS: Compliance to intensive multiweek radiation therapy (RT) regimens in head and neck cancer (HNC) patients is challenging, particularly among medically underserved patients with fewer financial and social resources. Treatment prolongation reduces local control and overall survival rates, making adherence to treatment a key factor in optimal outcome. We evaluated factors affecting compliance in medically underserved patients who received RT for HNC in a large municipal hospital setting in New York City. STUDY DESIGN: Retrospective review. METHODS: Treatment records of patients treated between July 2004 and August 2008 were reviewed. Number of and reasons for missed treatments were identified. Several demographic, toxicity, and treatment variables were analyzed for impact on compliance. RESULTS: Eighty consecutive HNC patients who underwent RT with a 5- to 7-week regimen were identified. Thirty-two patients (40%) missed no treatments, 36 (45%) missed one to six treatments, six (8%) missed seven to 14 treatments, two (3%) missed more than 14 treatments, and four (5%) did not complete treatment. Reasons for missed treatments were hospitalization (31% of events) and toxicity (20%). Patients with percutaneous endoscopic gastrostomy tube were more likely to miss treatments (P = .01, chi(2) test). No other variable showed a significant association with missed treatments (chi(2) test). CONCLUSIONS: Intensive RT for HNC can be delivered with very good adherence within a medically underserved population. Eighty-five percent of patients completed treatment with 0 to 6 days of interruption. Efforts to further improve adherence in this population are ongoing
— id: 110686, year: 2010, vol: 120, page: 1336, stat: Journal Article,

Lymph node central necrosis on computed tomography as predictor of extracapsular spread in metastatic head and neck squamous cell carcinoma: pilot study
Zoumalan, R A; Kleinberger, A J; Morris, L G T; Ranade, A; Yee, H; Delacure, M D; Myssiorek, D
2010 Dec;124(12):1284-1288, Journal of laryngology & otology
Objective:This study aimed (1) to investigate the relationship between the presence of lymph node central necrosis, viewed on pre-operative computed tomography imaging, and the occurrence of histopathologically determined metastatic lymph node extracapsular spread and (2) to determine whether a larger scale study would be valuable.Materials and methods:Pre-operative computed tomography scans, surgical records and post-operative histopathological analysis results were reviewed for 19 consecutive neck dissections performed in 17 patients with head and neck squamous cell carcinoma.Results:A total of 20/26 (77 per cent) lymph nodes with central necrosis had extracapsular spread on histopathological analysis. Twenty of 21 (95 per cent) lymph nodes with extracapsular spread had central necrosis on pre-operative computed tomography. Thirty-four of 40 (85 per cent) lymph nodes without extracapsular spread had no evidence of central necrosis on computed tomography. Only three of 12 (25 per cent) patients with lymph node central necrosis identified on pre-operative computed tomography were found to have actual necrosis on final histopathological analysis.Conclusions:Lymph node central necrosis viewed on pre-operative computed tomography scans is a useful indicator of metastatic lymph node extracapsular spread, with a sensitivity of 95 per cent, a specificity of 85 per cent, a positive predictive value of 69 per cent and a negative predictive value of 98 per cent. Lymph node diameter is not a sensitive indicator of extracapsular spread
— id: 114815, year: 2010, vol: 124, page: 1284, stat: Journal Article,

Conditional survival in head and neck melanoma
Jethanamest D.; Morris L.G.T.; Delacure M.D.
2009 ;119(SUPPL .3):S243-S243, Laryngoscope
Objectives: To report changes in survival probabilities as patients survive one or more years with head and neck melanoma, and to characterize prognostic factors for this conditional survival statistic. Study Design: Retrospective population-based cohort study. Methods: All subjects from the Surveillance, Epidemiology and End Results (SEER 17) database of the National Cancer Institute with head and neck cutaneous melanoma were analyzed. Using the life table actuarial method, conditional 5 year disease specific survival (DSS) and relative survival were determined for patients surviving one to ten years after diagnosis. Grouped comparisons were performed for anatomic subsites within the head and neck and the rest of the body. Probabilities were also stratified by histologic subtype, thickness of invasion and lymph node status. Results: Five year DSS for scalp and neck melanomas increases from 83.1% to 93.9% for patients surviving five years, compared to an increase from 89.2% to 96.2% for other anatomic sites. Nodular melanoma displayed the worst initial survival among histologic subtypes (73.4%) but improves to 91% at five years. Conditional DSS for node positive patients improves from 47.9% to 83.1%. Survival at diagnosis is stratified by tumor thickness from 96.7% (T1) to 62.3% (T4), but tends to converge between five to ten years of survivorship. Conclusions: For patients with head and neck melanoma who have survived several years, conditional survival provides accurate and useful prognostic information. In general, expected survival increases with time survived since diagnosis, and for low and high T-stage patients, conditional survival statistics converge over time
— id: 122700, year: 2009, vol: 119, page: S243, stat: Journal Article,

SWALLOWING PHYSIOLOGY AFTER SKULL BASE TUMOR RESECTION
Lazarus, C; Roland, J; Golfinos, J; DeLacure, M; Amin, M; Lalwani, A
2009 DEC ;24(4):465-465, Dysphagia
— id: 107740, year: 2009, vol: 24, page: 465, stat: Journal Article,

TONGUE STRENGTH AND SWALLOWING IN ORAL CANCER PATIENTS
Prasse, J; Sanfilippo, N; DeLacure, M; Falciglia, D; Branski, R; Ho, M; Ganz, C; Kraus, D; Lee, N; Lazarus, C
2009 DEC ;24(4):475-476, Dysphagia
— id: 107741, year: 2009, vol: 24, page: 475, stat: Journal Article,

CTLA-4, IL17A/B/C/D/E/F, PLZF, CD27, FOXP3, RORgammaT and CD70 expression in mucosal melanoma of head and neck
Wang, YB; Shibata, R; Zhu, H; Delacure, M; Levis, W; Martiniuk, F
2009 ;455(Suppl 1):28-28, Virchows archive
— id: 102310, year: 2009, vol: 455, page: 28, stat: Journal Article,

Cavernous hemangioma of the carotid sheath
Zagzag J.; Morris L.G.T.; Immerman S.B.; DeLacure M.D.
2009 ;119(SUPPL 1):19-19, Laryngoscope
— id: 102152, year: 2009, vol: 119, page: 19, stat: Journal Article,

Cavernous hemangioma of the carotid sheath
Zagzag, Jonathan; Morris, Luc G T; DeLacure, Mark D
2009 Apr;140(4):608-609, Otolaryngology, head & neck surgery
— id: 99227, year: 2009, vol: 140, page: 608, stat: Journal Article,

Functional reconstruction of glossectomy defects: the vertical rectus abdominus myocutaneous neotongue
Haddock, Nicholas T; DeLacure, Mark D; Saadeh, Pierre B
2008 Jul;24(5):343-350, Journal of reconstructive microsurgery
The vertical rectus abdominus myocutaneous (VRAM) flap is a valuable option for tongue reconstruction. However, the traditional inset (skin to remaining oral mucosa) obviates a more anatomic reconstruction. Eight patients underwent total or subtotal glossectomy with VRAM reconstruction. The muscle inset was supported at the inferior mandibular border attached to the remaining lingual mucosa or gingiva. The neotongue, consisting of skin and subcutaneous fat, was sutured posteriorly to the remaining tongue base, and the other surfaces were trimmed and left unsutured. Reconstruction was successful in all patients. The neotongue assumed palatal configuration, and within 2 weeks uniform granulation tissue followed by mucosalization occurred. One year postoperatively, all patients tolerated ad lib diets, spoke intelligibly, were gastrostomy tube and tracheotomy free and had no evidence of aspiration. This neotongue sits on the mandible under voluntary control, permitting effective obturation against the hard palate and providing successful speech and swallowing
— id: 91434, year: 2008, vol: 24, page: 343, stat: Journal Article,

Less Is More: VRAM Inset Modification in Glossectomy Reconstruction
Haddock, Nicholas T; Delacure, Mark D; Saadeh, Pierre B
2008 Aug;122(2):70e-72e, Plastic & reconstructive surgery
— id: 94600, year: 2008, vol: 122, page: 70e, stat: Journal Article,

Quantitative evaluation of transtemporal and facial translocation approaches to infratemporal fossa
Kuriakose, Moni A; Sorin, Alex; Sharan, Rajeev; Fishman, Andrew J; Babu, Ramesh; Delacure, Mark D
2008 Jan;18(1):17-27, Skull base
Objective: To compare the extent of exposure and surgical maneuverability provided by facial translocation and transtemporal approaches for access to the infratemporal fossa and anterolateral skull base. Materials and Methods: Surgical procedures were performed on five fresh frozen adult cadavers (ten sides) with no known pathology. Facial transfacial approaches with and without a mandibulotomy and transtemporal approaches were evaluated. Objective measures were (1) the distance from the surgical plane to designated anatomic landmarks and (2) the surgical angle of exposure. Results: Distances from the surgical plane to the anatomic reference points were comparable for most of the access procedures (3 to 6 cm). The extended midfacial translocation and bilateral facial translocation approaches did, however, provide a shorter operative distance (1 to 3 cm) for access to the infratemporal fossa and contralateral structures, respectively. The transtemporal approaches facilitate a better angle of exposure (74 to 84 degrees) to the petrotemporal region, while the transfacial approaches were superior for access to the infratemporal structures. Conclusions: Based on the results, we propose a clinical algorithm for selecting a surgical approach based on the position and extent of an infratemporal or petrotemporal lesion
— id: 96303, year: 2008, vol: 18, page: 17, stat: Journal Article,

The basis of racial differences in the incidence of thyroid cancer
Morris, Luc G T; Sikora, Andrew G; Myssiorek, David; DeLacure, Mark D
2008 Apr;15(4):1169-1176, Annals of surgical oncology
BACKGROUND: The incidence of thyroid cancer in black Americans is half that in white Americans. It is unknown whether this gap represents a population difference in disease or is attributable to inferior cancer screening in the black population. METHODS: A population-based cohort study of 53,990 patients (1973-2003) was performed using the National Cancer Institute's Surveillance Epidemiology End Results database. Socioeconomic variables were explored using the Healthcare Cost and Utilization Project database and macroeconomic data. RESULTS: Since 1973, thyroid cancer incidence among whites has increased 150.2% (4.0 to 9.9 of 100,000), while incidence among blacks has increased 73.2% (3.0 to 5.1 of 100,000). Across 17 regions, the incidence correlated with the percentage of the population with health insurance (r = 0.56, P = .02). Regression analysis suggested that half of the black-white incidence gap might be attributable to differences in health insurance status. Patients with thyroid cancer were more likely to be insured or reside in wealthier ZIP codes. Black patients were more likely to present at advanced age (RR 1.08, P < .0001) and with tumors >4 cm in size (RR 1.13, P <.0001). Black patients were slightly less likely to present with advanced disease (RR 0.96, P = .0008). Cancer-specific mortality was identical in the two populations. DISCUSSION: Sociodemographic data and differences at presentation support a small detection disparity in thyroid cancer, which may contribute to part of the incidence gap. However, this effect is not sufficiently strong to fully explain the incidence gap. A population difference in the incidence of disease may be coexistent
— id: 76861, year: 2008, vol: 15, page: 1169, stat: Journal Article,

Malpractice litigation after surgical injury of the spinal accessory nerve: an evidence-based analysis
Morris, Luc G T; Ziff, David J S; Delacure, Mark D
2008 Jan;134(1):102-107, Archives of otolaryngology, head & neck surgery
OBJECTIVE: To review the background, case characteristics, and outcomes of malpractice litigation resulting from surgical injury of the spinal accessory nerve. DESIGN: Retrospective review of indemnity insurance cases (part 1) and court trials (part 2) between January 1, 1985, and January 1, 2007. In part 1, records of the Medical Liability Mutual Insurance Company identified 41 lawsuits in New York State; part 2 was a review of a national legal database (WestLaw) that identified 81 court trials. Case details were analyzed, and awards were adjusted for inflation. RESULTS: For part 1, of 41 indemnity insurance cases, 39 (95%) involved a posterior triangle lymph node biopsy. Defendants were mainly general surgeons and otolaryngologists. Most lawsuits against surgeons (22 of 34 [65%]) were settled before trial, and only 4 of 34 (12%) were discontinued. Of these 34 cases, 28 (82%) ultimately compensated the plaintiff. The mean inflation-adjusted pretrial settlement was $264 395, and the mean settlement at trial was $443 538. Cases reaching trial received significantly higher settlements (P = .01). For part 2, 81 cases of alleged surgical injury to the spinal accessory nerve were identified. Defendant physicians were mainly general surgeons and otolaryngologists. Most operations were cervical lymph node biopsies (55 [68%]), followed by sebaceous cyst excisions (6 [7%]), neck dissections (4 [5%]), and other procedures (12 [15%]). Morbidity included weakness (81 patients [100%]), pain (30 patients [37%]), inability to work (20 patients [25%]), need for a nerve repair procedure (16 patients [20%]), deformity (9 patients [11%]), and numbness (4 patients [5%]). Types of malpractice alleged included negligent surgical technique (79 cases [98%]), lack of informed consent (17 cases [21%]), and failure to diagnose the injury (16 cases [20%]). Thirty-seven cases (46%) were decided for the defendant, 32 (40%) were decided for the plaintiff, and 12 (15%) were settled (percentages do not total 100 because of rounding). The mean inflation-adjusted settlement was $356 132, and the mean jury award was $515 968. Jury awards were significantly higher than settlements (P = .003). CONCLUSIONS: Unintended injury to the spinal accessory nerve after head and neck surgery is a significant source of malpractice litigation. Timely diagnosis and treatment of this complication are essential. Regardless of whether the medical community considers careful surgical technique and nerve preservation to be the standard of care, the legal system clearly treats it as such, awarding compensation in 82% of cases. Strategies for optimal surgical care and litigation risk reduction are discussed
— id: 76341, year: 2008, vol: 134, page: 102, stat: Journal Article,

PNL2 melanocytic marker in immunohistochemical evaluation of primary mucosal melanoma of the head and neck
Morris, Luc G; Wen, Yong Hannah; Nonaka, Daisuke; DeLacure, Mark D; Kutler, David I; Huan, Youming; Wang, Beverly Y
2008 Jun;30(6):771-775, Head & neck
BACKGROUND: Histologic diagnosis of mucosal melanoma of the head and neck is difficult, requiring immunohistochemical stains which are less reliable than in cutaneous lesions. PNL-2 is a novel marker that has not been examined in mucosal melanoma. METHODS: Nine formalin-fixed tissue sections of mucosal melanoma were stained with PNL-2, human melanoma black (HMB)-45, Melan-A, S-100, and microphthalmia transcription factor (MITF). RESULTS: Disease in all 9 patients arose from the sinonasal mucosa. Rates of diffuse positive staining with the 4 stains were PNL-2 (77.8%), HMB-45 (77.8%), Melan-A (50%), S-100 (87.5%), and MITF (40%). In 3 patients, PNL2 staining was superior to Melan-A or MITF. CONCLUSION: We report the first characterization of PNL-2 staining in head and neck mucosal melanoma. PNL-2 demonstrates high sensitivity for mucosal melanoma, likely superior to Melan-A and MITF, and comparable to HMB-45, with specificity superior to S-100. We advocate inclusion of PNL2 as an important adjunctive marker in the evaluation of these lesions. (c) 2008 Wiley Periodicals, Inc. Head Neck, 2008
— id: 75750, year: 2008, vol: 30, page: 771, stat: Journal Article,

Oropharyngeal kaposi sarcoma in related persons negative for human immunodeficiency virus
Sikora, Andrew G; Shnayder, Yelizaveta; Yee, Herman; DeLacure, Mark D
2008 Mar;117(3):172-176, Annals of otology rhinology & laryngology
OBJECTIVES: Kaposi sarcoma (KS) is a vascular tumor that can affect the mucosa of the upper aerodigestive tract. Although KS is the most common malignancy in patients with acquired immunodeficiency syndrome, it is rare in immunocompetent persons. We describe an unusual presentation of KS in 2 related individuals and describe our attempts to determine whether oropharyngeal KS is associated with human herpesvirus 8 (HHV-8). METHODS: All relevant clinical and surgical information, including information on tumor histopathologic and human immunodeficiency virus (HIV) serologic tests, was abstracted from the patient charts and electronic databases. HHV-8 immunohistochemistry was performed on paraffin-fixed specimens. RESULTS: Both patient 1 and patient 2 (the nephew of patient 1) were referred for workup of a tonsillar mass that was pathologically confirmed to be KS. In each case, HIV serologic testing was negative, and a screening immunologic workup, including a quantitative natural killer cell count, a B- and T-lymphocyte count, and immunoglobulin analysis, also yielded findings that were within normal limits. Immunohistochemistry performed on 1 pathological specimen showed positive staining for the presence of HHV-8, the etiologic agent of KS. CONCLUSIONS: The presence of oropharyngeal KS in 2 related HIV-negative individuals supports a role for genetic factors in susceptibility to KS, a common exposure to an infectious agent such as HHV-8, or both. Whereas most KS cases in industrialized countries are associated with immunodeficiency, clinical and laboratory data do not suggest that either of the patients described in this report are immunodeficient. Their susceptibility to KS may be secondary to a subtle inherited defect in host resistance to HHV-8, or another unknown factor
— id: 79149, year: 2008, vol: 117, page: 172, stat: Journal Article,

Early experience with minimally invasive esophagectomy in head and neck surgical patients
Morris, Luc G T; Tran, Theresa N; DeLacure, Mark D
2007 Dec;137(6):947-949, Otolaryngology, head & neck surgery
BACKGROUND: Minimally invasive esophagectomy (MIE) via thoracoscopy and laparoscopy have reduced the morbidity and mortality of total esophagectomy at experienced centers. MIE has not been evaluated in combination with major head and neck surgery, or in the otolaryngology literature. METHODS: Case series of 11 consecutive patients undergoing either open or MIE with an ablative neck procedure. RESULTS: Comparing 4 MIEs and 7 open operations, similar operative time, blood loss, and ICU and hospital length of stay were observed. There was one mortality in the open group. A 100% rate of major complications was observed in the MIE group. CONCLUSION: Our multidisciplinary team was unable to achieve improved outcomes in a series of head and neck surgical patients undergoing MIE. This result may represent an early stage of the learning curve for MIE, but may also be attributed to the escalated surgical requirements of head and neck patients
— id: 96304, year: 2007, vol: 137, page: 947, stat: Journal Article,

Tamoxifen therapy for aggressive fibromatosis of the posterior triangle of the neck
Morris, Luc G; Sikora, Andrew G; Kuriakose, M Abraham; DeLacure, Mark D
2007 Apr;136(4):674-676, Otolaryngology, head & neck surgery
— id: 72817, year: 2007, vol: 136, page: 674, stat: Journal Article,

Modified tarsorrhaphy for management of the eye in facial nerve palsy
Morris, Luc G; Palu, Richard N; DeLacure, Mark D
2006 Jul;116(7):1293-1295, Laryngoscope
— id: 67536, year: 2006, vol: 116, page: 1293, stat: Journal Article,

Acellular dermal composite allografts for reconstruction of the radial forearm donor site
Rowe, Norman M; Morris, Luc; Delacure, Mark D
2006 Sep;57(3):305-311, Annals of plastic surgery
PURPOSE: Since its description in the 1970s, the radial forearm free flap has earned a clearly defined role in the armamentarium of reconstructive head and neck surgery. Three decades later, the donor site remains an intrinsic drawback primarily due to its esthetic impact, although functional morbidity is significant in a minority. These points do not outweigh significant advantages but are occasionally reasons for the choice of alternative flaps. Modifications evolved in an effort to improve these undesirable features include primary closure, rotation-advancement, proximal paddle placement, full-thickness skin graft (FTSG) and suprafascial dissection. We describe a novel technique of engineering a composite graft of cadaveric acellular dermal matrix and autologous split-thickness skin graft (STSG) for a better donor-site closure. METHODS: From December 1995 to August 2003, 23 patients underwent radial forearm reconstruction of head and neck defects. Control patients (Group I; n = 5) had donor sites closed by conventional STSG technique (0.014-0.016 inch). In 18 patients (Group II), the donor site was closed with a composite technique (dermal allograft, 0.020-0.030 inch, and an ultrathin STSG, 0.0080 inch). Both groups of patients were retrospectively studied for comparative defects. Contralateral upper extremities also served as controls. All patients underwent a standardized functional examination of the donor and contralateral extremities, as well as an outcome questionnaire. All extremities were photographed for visual comparison by the author. RESULTS: Three of the 5 group I patients were available for follow-up, which averaged 64 months (60-72 months). Thirty-three percent had a decrease in functional parameters and 67% complained of paresthesia. Patient satisfaction was 3.5/5. Six of the 18 patients were excluded from Group II due to insufficient follow-up or inability to follow. Follow-up averaged 8 months (1-24 months). Functional parameters in all patients were comparable to the contralateral extremity, except in 1 patient. In this case, a 0.030-inch allograft was used which never revascularized, inhibiting wrist motion. Other patients exhibited excellent range of motion of the wrist and fingers. This was the only patient in this group that exhibited paresthesia of the donor site. Patient satisfaction was 4.6/5. Esthetic results were extremely gratifying as judged by the author. Esthetic results were better than those observed in Group I. CONCLUSIONS/SIGNIFICANCE: Composite grafting with acellular dermal matrix and STSG provides a comparable (trending to superior) result with traditional STSG for the treatment of radial forearm graft donor sites. Even if functionally equivalent, it is esthetically superior and therefore a technique warranting further investigation
— id: 69343, year: 2006, vol: 57, page: 305, stat: Journal Article,

Comparison of quality of life outcomes in laryngeal cancer patients following chemoradiation vs. total laryngectomy
LoTempio, Maria M; Wang, Kevin H; Sadeghi, Ahmed; Delacure, Mark D; Juillard, Guy F; Wang, Marilene B
2005 Jun;132(6):948-953, Otolaryngology, head & neck surgery
OBJECTIVE: To evaluate quality of life issues in patients with laryngeal cancer after treatment with either chemoradiation or total laryngectomy and radiation therapy. METHODS: Forty-nine patients with a history of stage II-IV laryngeal squamous cell carcinoma treated primarily with either chemoradiation or by total laryngectomy with postoperative radiation completed the University of Washington Quality of Life instrument, version 4. Patients were identified on a volunteer basis in an academic university head and neck clinic setting. Each patient completed the above instrument, and statistical analysis was performed by Wilcoxon and chi 2 tests. RESULTS: Instruments were completed by all 49 patients: 15 patients who underwent primary chemoradiation and 34 patients who underwent a total laryngectomy followed by radiation. Domains reported in both treatment groups without significant differences were appearance, activity, recreation, moods, taste, saliva, anxiety, and general questions. However, there were significant differences between the 2 groups in the domains of pain, swallowing, chewing, speech, and shoulder function. The laryngectomy patients reported greater impairment of speech (P = 0.001), and shoulder function (P = 0.018), whereas the chemoradiation patients suffered from greater pain, difficulty swallowing (P = 0.061), and problems chewing (P = 0.027). CONCLUSIONS: Most patients with laryngeal cancer, whether treated primarily with chemoradiation or total laryngectomy, reported excellent functional outcomes and health-related quality of life. Pain, swallowing, chewing, saliva, and shoulder function were recorded as significant factors affecting their daily quality of life
— id: 96306, year: 2005, vol: 132, page: 948, stat: Journal Article,

Superficial dorsal artery of the forearm: case report and review of the literature
Morris, Luc G; Rowe, Norman M; Delacure, Mark D
2005 Nov;55(5):538-541, Annals of plastic surgery
Although abnormalities of vascular anatomy in the forearm are common, variations of the radial and ulnar arteries are rare. Nevertheless, arterial variants in the forearm may present clinically with neurovascular signs or symptoms. Even when anomalous arteries are not apparent, they may complicate surgery of the forearm and hand, as well as reconstructive surgery that involves the harvest of radial or ulnar artery-based forearm free flaps. For example, the superficial ulnar artery has an incidence of 2.7% and has been well described as a 'hidden trap' in the harvest of radial forearm flaps. We present a case report of a variant of the radial artery-the superficial dorsal artery of the forearm. This artery has an estimated incidence of 0.75% and is associated with either an absent or small-caliber radial artery. We believe this is the first report of such an artery presenting to clinical attention, as well as the first imaging of this structure with magnetic resonance angiography. The embryology of this structure and its clinical implications to the hand surgeon, peripheral vascular surgeon, and reconstructive microsurgeon, are also discussed
— id: 62603, year: 2005, vol: 55, page: 538, stat: Journal Article,

Impact of tissue heterogeneity corrections on tumor and normal structure dosimetry in nasopharyngeal carcinoma treated with intensity modulated radiation therapy
Sanfilippo, N; Hitchen, C; Tran, T; DeLacure, M; Kutler, D; Formenti, S
2005 NOV 16 ;63(2):S374-S375, International journal of radiation oncology biology physics
— id: 58994, year: 2005, vol: 63, page: S374, stat: Journal Article,

Laryngeal tumors
Galli SKD; Delacure MD
Handbook of plastic surgery New York : Marcel Dekker, 2004,
— id: 3528, year: 2004, vol: , page: 149, stat: Chapter,

Pharyngeal tumors
Galli SKD; Delacure MD
Handbook of plastic surgery New York : Marcel Dekker, 2004,
— id: 3577, year: 2004, vol: , page: 145, stat: Chapter,

Salivary gland tumors
Grinberg D; Delacure MD
Handbook of plastic surgery New York : Marcel Dekker, 2004,
— id: 3529, year: 2004, vol: , page: 153, stat: Chapter,

Tumors of the skull base
Grinberg D; Delacure MD
Handbook of plastic surgery New York : Marcel Dekker, 2004,
— id: 3530, year: 2004, vol: , page: 157, stat: Chapter,

Selection and validation of differentially expressed genes in head and neck cancer
Kuriakose, M A; Chen, W T; He, Z M; Sikora, A G; Zhang, P; Zhang, Z Y; Qiu, W L; Hsu, D F; McMunn-Coffran, C; Brown, S M; Elango, E M; Delacure, M D; Chen, F A
2004 Jun;61(11):1372-1383, Cellular & molecular life sciences: CMLS
We applied a robust combinatorial (multi-test) approach to microarray data to identify genes consistently up- or down-regulated in head and neck squamous cell carcinoma (HNSCC). RNA was extracted from 22 paired samples of HNSCC and normal tissue from the same donors and hybridized to the Affymetrix U95A chip. Forty-two differentially expressed probe sets (representing 38 genes and one expressed sequence tag) satisfied all statistical tests of significance and were selected for further validation. Selected probe sets were validated by hierarchical clustering, multiple probe set concordance, and target-subunit agreement. In addition, real-time PCR analysis of 8 representative (randomly selected from 38) genes performed on both microarray-tested and independently obtained samples correlated well with the microarray data. The genes identified and validated by this method were in comparatively good agreement with other rigorous HNSCC microarray studies. From this study, we conclude that combinatorial analysis of microarray data is a promising technique for identifying differentially expressed genes with few false positives
— id: 44893, year: 2004, vol: 61, page: 1372, stat: Journal Article,

The changing demographics of head and neck squamous cell carcinoma in the United States
Sikora, Andrew G; Toniolo, Paolo; DeLacure, Mark D
2004 Nov;114(11):1915-1923, Laryngoscope
OBJECTIVES/HYPOTHESIS: Head and neck squamous cell carcinoma (HNSCCA) has declined in the United States since the late 1970s. During this time, substantial immigration from other countries has occurred, and the average lifespan has increased. We tested the hypothesis that these trends have altered the HNSCCA patient population. STUDY DESIGN: Retrospective analysis was made of population-based data from the SEER database, a national registry capturing roughly 10% of all U.S. cancer diagnoses. METHODS: We examined all unique diagnoses of HNSCCA in the database from 1976 to 1999 and determined the breakdown of cases by age, sex, and race. RESULTS: The absolute number of new HNSCCA diagnoses per year declined overall by 5% during the time period of the study, whereas new diagnoses in patients older than 74 years of age increased by more than 20%. The rate of HNSCCA per 100,000 person-years in elderly women did not change, and the rate in elderly men decreased, indicating that the observed increase in cases is explained by a growing population of elderly persons at risk. An increase in the absolute number of cases, but not the incidence rate, was also seen among persons younger than 50 years of age. Although both the absolute number of new cases and the incidence rates of HNSCCA in white male patients declined substantially, the percentage of HNSCCA patients classified as minorities increased from 14.5% to more than 20% of all cases. During the time period of the study, the overall number of HNSCCA cases in nonwhite and Hispanic patients increased by 36%. CONCLUSION: Increasing numbers of elderly and minority patients with HNSCCA are likely to alter patterns of disease and utilization of health care resources
— id: 48079, year: 2004, vol: 114, page: 1915, stat: Journal Article,

Biodegradable polymer-mediated intratumoral delivery of cisplatin for treatment of human head and neck squamous cell carcinoma in a chimeric mouse model
Chen, Fang-An; Kuriakose, M Abraham; Zhou, Ming-Xing; DeLacure, Mark D; Dunn, Richard L
2003 Jul;25(7):554-560, Head & neck
BACKGROUND: The effectiveness of chemotherapeutic agents is proportional to the dose of the agents at their targets; however, the dose is limited by systemic toxicity. Attempts have been made to improve therapeutic effectiveness by increasing maximum tolerated dose (MTD) of chemotherapeutic agents using various local and regional drug delivery systems. Herein we report the use of an injectable biodegradable polymer to deliver cisplatin for intratumoral treatment of human head and neck squamous cell carcinoma (HNSCC) in a chimeric mouse model. The objectives of this research project were (1) to determine the release kinetics of cisplatin from the polymer delivery system, (2) to identify the MTD of polymer-delivered cisplatin, and (3) to evaluate its therapeutic efficacy. METHODS: To determine the in vivo release kinetics, cisplatin-loaded polymer was injected subcutaneously into rats. Implants were removed and analyzed for remaining cisplatin by a high-performance liquid chromatography technique. Sera from these rats were assayed for platinum by atomic absorption spectrophotometry. For MTD determination, SCID mice were engrafted subcutaneously with fresh biopsy specimens of HNSCC. Various doses of free or polymer-loaded cisplatin were injected intratumorally. MTD was estimated based on the threshold at which all mice survived. The antitumor efficacy of free and polymer-loaded cisplatin at their respective MTD was assayed on the same chimeric mouse model. RESULTS: The polymer delivery system released 80% of the loaded cisplatin in vivo over a 7-day period. The polymer-delivered cisplatin exhibited higher MTD (36 mg/kg) than free cisplatin (18 mg/kg) and had a statistically significant tumor suppression effect compared with free cisplatin when used at their respective MTD. CONCLUSIONS: The polymer delivery system can sustain cisplatin release for a period of 7 days. It can increase MTD and potentially enhance the antitumor efficacy of cisplatin against human head and neck cancers
— id: 44894, year: 2003, vol: 25, page: 554, stat: Journal Article,

Inferior alveolar nerve-preserving mandibulectomy for nonmalignant lesions
Kuriakose, M Abraham; Lee, James J; DeLacure, Mark D
2003 Jul;113(7):1269-1273, Laryngoscope
— id: 39167, year: 2003, vol: 113, page: 1269, stat: Journal Article,

Reconstruction of segmental mandibular defects by distraction osteogenesis for mandibular reconstruction
Kuriakose, M Abraham; Shnayder, Yelizaveta; DeLacure, Mark D
2003 Oct;25(10):816-824, Head & neck
BACKGROUND: Distraction osteogenesis is an established technique for the lengthening of long bones and correction of selected craniofacial deformities. Regenerate osteoid bone matrix formed during the distraction phase is malleable and can recreate the three-dimensional form of native bones. Animal experiments and early clinical experience have confirmed that distraction osteogenesis can be used for the reconstruction of segmental bony defects. Herein we discuss the principles of distraction osteogenesis in reference to reconstruction of segmental bony defects and report its clinical application of the mandible continuity defects. PATIENTS AND METHODS: Four patients (age, 7-83 years) with critical segmental mandibular defects (range, 3.5 cm-6.5 cm), resulting from ablative oncologic head and neck surgery underwent primary mandibular reconstruction by transport distraction osteogenesis. Two defects were at the angle and body region, one at the body, and the other at the parasymphysis and body region. Synthes Titanium Multi-vector and Leibinger Multi-guide distractors in bifocal (n = 2) and trifocal (n = 2) architecture were used after the stabilization of the segmental continuity defect using a defect-bridging mandibular reconstruction plate. Osteodistraction was carried out at a rate of 1 mm per day, with once or twice a day rhythm, after a 1-week latency period. The consolidation period was equal to the period of distraction. RESULTS: All patients tolerated the distraction procedure. Satisfactory bone formation was observed in two patients, and partial bone formation was seen in one patient. Treatment failure was encountered in one patient who had a second oral cavity primary tumor observed during the consolidation period, requiring interruption of the treatment sequence. CONCLUSIONS: Mandibular reconstruction with distraction osteogenesis is a potentially useful technique in selected patients with segmental mandibular continuity defects after ablative head and neck cancer surgery
— id: 39079, year: 2003, vol: 25, page: 816, stat: Journal Article,

Malignant solitary fibrous tumor of the tongue
Shnayder, Yelizaveta; Greenfield, Barak J; Oweity, Thaira; DeLacure, Mark D
2003 Jul-Aug;24(4):246-249, American journal of otolaryngology
Solitary fibrous tumor is a generally benign spindle-cell neoplasm that has been predominantly described in the visceral pleura and other serosal sites and is extremely rare in the head and neck area. We report the first known case of malignant solitary fibrous tumor of the tongue in a 57-year-old female patient who experienced rapid growth of a longstanding right anterior tongue mass, with associated dysphagia and dysarthria. Magnetic resonance imaging was suggestive of a low-flow vascular malformation not requiring preoperative embolization. The patient underwent partial peroral glossectomy for the excision of the tumor. Final pathology, however, was consistent with solitary fibrous tumor, characterized as malignant by histopathologic criteria, and the patient was returned for re-excision of the close surgical margins. The patient has experienced symptomatic improvement, and she remains free of recurrence 12 months later. All reports of solitary fibrous tumors of the oral cavity and 3 reports of the tongue tumors described in the literature to date represent benign lesions. To our knowledge, this is the first report of a malignant solitary fibrous tumor of the tongue. Presentation, differential diagnosis, criteria for malignancy, treatment, and possible prognostic implications of this rare entity are discussed
— id: 39128, year: 2003, vol: 24, page: 246, stat: Journal Article,

Tissue-specific gene expression of head and neck squamous cell carcinoma in vivo by complementary DNA microarray analysis
Sok, John C; Kuriakose, M Abraham; Mahajan, Vinit B; Pearlman, Aaron N; DeLacure, Mark D; Chen, Fang-An
2003 Jul;129(7):760-770, Archives of otolaryngology, head & neck surgery
OBJECTIVES: To identify distinct gene expression profiles of human head and neck squamous cell carcinomas (HNSCCAs) using complementary DNA (cDNA) microarray analysis and to create a preliminary, comprehensive database of HNSCCA gene expression. PATIENTS AND METHODS: Nine patients with histologically confirmed HNSCCAs, staged according to the American Joint Committee on Cancer, were enrolled. The HNSCCA tumor tissue and normal mucosal tissue were harvested at the time of surgery. A cDNA library was constructed from the paired fresh-frozen human surgical specimens of HNSCCAs and nonmalignant epithelial tissues. Biotinylated RNA was transcribed from the cDNA library and hybridized to high-density microarrays containing approximately 12 000 human genes. Altered gene expression of HNSCCAs was identified by comparison to corresponding normal mucosal tissues after a bayesian statistical analysis of variance. Results were analyzed using the gene database of the National Institutes of Health. Hierarchical clustering of the genomic data sets was determined by similarity metrics based on Pearson correlation. RESULTS: Hierarchical clustering analysis revealed that the gene expression profiles obtained from the nonselected panel of 12 000 genes could distinguish the tumors from nonmalignant tissues. Gene expression changes were reproducibly observed in 227 genes representing previously identified chemokines, tumor suppressors, differentiation markers, matrix molecules, membrane receptors, and transcription factors that correlated with neoplasia, including 46 previously uncharacterized genes. Moreover, significant expression of the collagen type XI alpha1 gene and a novel gene was reproducibly observed in all 9 tumors, whereas these genes were virtually undetectable in their corresponding, adjacent nonmalignant tissues. CONCLUSIONS: Complementary DNA microarray analysis of human HNSCCAs has produced a preliminary, comprehensive database of tumor-specific gene expression profiles and provided important insights into modeling gene expression changes implicated in carcinogenesis. A large-scale analysis of gene expression carries the future potential of identifying sensitive molecular markers for early tumor detection, prognosis, and novel targets for interceptive therapeutics
— id: 39132, year: 2003, vol: 129, page: 760, stat: Journal Article,

A precision method for contouring bioresorbable implants in craniomaxillofacial surgery
Delacure, Mark D; Kuriakose, M Abraham
2002 May;12(2):103-106, Skull base
Bioresorbable implants (meshs and plates) are increasingly used in reconstructive craniofacial and skull base surgery. Usually these implants must be contoured to fit the complex craniofacial anatomy ex vivo; occasionally final contouring is performed in vivo and must be done without damaging surrounding structures (e.g., dura, brain). We report a precision method for in vivo contouring of bioresorbable implants using the Shaw hemostatic thermal scalpel
— id: 96305, year: 2002, vol: 12, page: 103, stat: Journal Article,

Motility-related proteins as markers for head and neck squamous cell cancer
Abraham MT; Kuriakose MA; Sacks PG; Yee H; Chiriboga L; Bearer EL; Delacure MD
2001 Jul;111(7):1285-1289, Laryngoscope
HYPOTHESIS: Increased cell motility is a hallmark of cancer cells. Proteins involved in cell motility may be used as molecular markers to characterize the malignant potential of tumors. METHODS: Molecular biology and immunohistochemistry techniques were used to investigate the expression of a selected panel of motility-related proteins (Rho A, Rac 2, Cdc42, PI3K, 2E4, and Arp2) in normal, premalignant, and squamous cell cancer cell lines of human head and neck origin. To assess the clinical potential of these proteins as molecular markers for cancer, immunohistochemistry was performed on paraffin-fixed head and neck cancer specimens (n = 15). RESULTS: All six motility-associated proteins were overexpressed in the premalignant and squamous cell cancer cell lines relative to normal keratinocytes. Immunohistochemistry with Rho A and Rac 2 showed increased staining in areas of cancer but not in normal tissue. CONCLUSION: Proteins involved in cell motility can be used as markers for head and neck squamous cell carcinoma. The head and neck cell lines used in this study may be used as a model to further investigate cell motility. Molecular markers of motility could have a significant impact on the diagnosis and staging of cancers originating from differentiated non-motile cells
— id: 26693, year: 2001, vol: 111, page: 1285, stat: Journal Article,

The external approach for submucosal lesions of the larynx
Myssiorek D; Madnani D; Delacure MD
2001 Oct;125(4):370-373, Otolaryngology, head & neck surgery
OBJECTIVE: The surgical excision of benign submucosal lesions of the larynx can be performed using a variety of techniques including direct laryngoscopy and external approaches. We propose that small submucosal lesions of the larynx can be removed via the external approach without a tracheotomy. STUDY DESIGN: Retrospective chart review. SETTING: Six patients at The Long Island Jewish Medical Center and at the New York University School of Medicine underwent an external approach for the removal of benign submucosal laryngeal lesions without tracheotomies. Lesions included a mixed laryngopyocele, an internal laryngopyocele, a mixed laryngocele, a paraganglioma, a neurilemmoma and a lymphoma. Follow-up ranged from 1 to 9 years. RESULTS: All patients were female with an average age of 72. No patient required a tracheotomy. One patient remained intubated for 24 hours postoperatively to ensure an adequate airway. Mild dysphagia was noted in all patients, but it was short-lived and did not require alternate methods of alimentation. There have been no recurrences of disease. CONCLUSION: The external approach without tracheotomy allows for good exposure with minimal functional disability for the removal of benign submucosal lesions of the larynx
— id: 48961, year: 2001, vol: 125, page: 370, stat: Journal Article,

Adhesion molecules as prognostic factors in nasopharyngeal carcinoma
Shnayder Y; Kuriakose MA; Yee H; Chen FA; DeLacure MD; Xue XN; Jagirdar J
2001 Oct;111(10):1842-1846, Laryngoscope
OBJECTIVE/HYPOTHESIS: To identify the significance of molecular markers in determining the risk of recurrence and distant metastases in nasopharyngeal carcinoma. STUDY DESIGN: In this retrospective case study, we evaluated archival nasopharyngeal carcinoma specimens for patterns of expression of E-cadherin, beta-catenin, c-erb-B2, and Ki-67, which have been demonstrated to be important in other tumors. METHODS: Fifty-four cases of nasopharyngeal carcinoma were identified, with a maximum follow-up of 13 years. The histopathological sections were stained using an automated immunohistochemical stainer (NexES, Ventana Medical Systems, Tucson, AZ) for E-cadherin (Zymed Laboratories [San Francisco, CA] and Transduction Laboratories [Lexington, KY] clones), beta-catenin (Zymed), c-erb-B2 (Ventana Medical Systems), and Ki-67 (Novocastra, Burlingame, CA). The numbers of positively staining cells were scored as follows: 0%, 1% to 33%, 34% to 66%, or greater than 67%. RESULTS: E-cadherin (Zymed) stained positively in only one case. The Transduction Laboratories clone demonstrated a spectrum of staining in all cases, from complete to disrupted to no identifiable membranous staining. The staining was consistently absent at the advancing tumor border, regardless of stage. The loss of beta-catenin expression did not correlate with that of E-cadherin or with clinical outcomes. No staining was identified for c-erb-B2. Ki-67 staining was variable and did not correlate with clinical outcomes. CONCLUSIONS: Altered expression or loss of E-cadherin, or both, may result in loss of function, particularly at the infiltrating edge, with resultant loss of cell polarity, cell migration, and eventual metastasis. The interpretation of E-cadherin staining depends on antibody source. In contrast to recent studies, beta-catenin expression is not altered and c-erb-B2 expression not identified, suggesting that these markers are not important in the prognosis of nasopharyngeal carcinoma
— id: 26886, year: 2001, vol: 111, page: 1842, stat: Journal Article,

Digital documentation and the enigma of the TTL macroflash
DeLacure MD
2000 Nov;106(6):1433-1434, Plastic & reconstructive surgery
— id: 48962, year: 2000, vol: 106, page: 1433, stat: Journal Article,

The oral cavity
Delacure MD; Kuriakose MA
Plastic surgery St. Louis : Mosby, 2000,
— id: 3527, year: 2000, vol: , page: ?, stat: Chapter,

Imaging quiz case 3. Laryngeal schwannoma
Galli SK; Zimbler MS; Kaufman DP; DeLacure MD
2000 Oct;126(10):1268, 1271-2, Archives of otolaryngology, head & neck surgery
— id: 48963, year: 2000, vol: 126, page: 1268, 1271, stat: Journal Article,

A novel approach to laryngeal suspension after partial laryngectomy
Giacchi RJ; Kuriakose MA; Kaufman D; DeLacure MD
2000 Jun;110(6):938-941, Laryngoscope
OBJECTIVES: Supraglottic laryngectomy is a well-established surgical therapy for selected carcinomas of the larynx and hypopharynx. Most compromised by this procedure and its variations is the laryngeal mechanism that protects the lower respiratory tract from aspiration. Laryngeal suspension serves to compensate for the loss of the resected laryngeal elevator muscles by pulling the larynx upward and forward beneath the tongue base. In this study we describe a method of laryngeal suspension in supraglottic laryngectomy using a cartilage-anchored suture carrier device. STUDY DESIGN: Report of this novel approach to laryngeal suspension using seven suture anchors in two patients undergoing supraglottic laryngectomy. METHODS: Seven Mitek Micro anchors (Mitek, Westwood, MA) were used to perform laryngeal suspension in two patients undergoing supraglottic laryngectomy. Our technique is compared with traditional methods. Operative data as well as postoperative functional results are reviewed. RESULTS: Laryngeal suspension using suture anchors was successful, with failure of only one anchor. Oral alimentation was quickly reestablished in both patients. There were no perioperative or postoperative complications. CONCLUSIONS: We describe a novel approach to laryngeal suspension that overcomes some of the technical challenges inherent in traditional suturing techniques. This novel approach is technically easier and more efficient than traditional methods and accomplishes distribution of stress forces on the thyroid cartilage remnant
— id: 11650, year: 2000, vol: 110, page: 938, stat: Journal Article,

Interleukin-12 delivered by biodegradable microspheres promotes the antitumor activity of human peripheral blood lymphocytes in a human head and neck tumor xenograft/SCID mouse model
Kuriakose MA; Chen FA; Egilmez NK; Jong YS; Mathiowitz E; DeLacure MD; Hicks WL Jr; Loree TL; Bankert RB
2000 Jan;22(1):57-63, Head & neck
BACKGROUND: The role of cytokines in tumor regression is now well established. The major limitation for the clinical use of cytokines is the lack of a simple and effective protocol for the local and sustained delivery of cytokines to the tumor milieu. This study reports suppression of human head and neck squamous cell carcinoma (HNSCC) by human peripheral blood lymphocytes (HuPBL) following local, sustained delivery of interleukin-12 (IL-12) to tumors with biodegradable microspheres in a human/SCID mouse chimeric model. Materials and Methods Nondisrupted biopsy pieces (120 mg) of primary HNSCC were implanted s.c. into severe combined immunodeficient (SCID) mice and were expanded by serial passage in mice. Tumors were then titrated with different doses of allogeneic HuPBL by coengraftment of tumor pieces and HuPBL into the subcutis of SCID mice to determine whether the HuPBL possessed antitumor activity (the SCID/Winn model). The lymphocyte subsets that were responsible for the suppression of tumor engraftment were identified by selective depletion of the CD4+, CD8+, and CD56+ cells from the HuPBL prior to engraftment into mice. Attempts were then made to augment the antitumor activity of the HuPBL either by repeated intralesional bolus injections of recombinant human IL-12 (0.5 &mgr;g x 10 doses) or with a single dose of IL-12-loaded microspheres ( approximately 1.65 &mgr;g IL-12/mg microspheres, 2 mg microspheres/mouse). RESULTS: Successful engraftment of HNSCC was observed in 12 of 19 different patient samples. Normal histological architecture of tumor was maintained up to four serial passages in the SCID mice. After the first tumor engraftment, but not in subsequent passages, human immunoglobulin produced by plasma cells present in the tumor infiltrating lymphocyte population was detected in the mouse sera. Allogeneic human PBL displayed antitumor cytotoxic activity in a cell dose-dependent fashion when coengrafted with the tumors passaged in SCID mice. Lymphocyte subset depletion studies established that tumor suppression was dependent on both the CD8+ T lymphocytes and the CD56+ natural killer cells. Treatment of tumors with a single intralesional injection of IL-12-loaded microspheres was highly effective, resulting in the complete suppression of tumor engraftment in 50% of the mice. In contrast, treatment of tumors with repeated bolus IL-12 injections suppressed tumor engraftment only transiently and did not result in complete tumor rejection in any of the mice. CONCLUSION: The coengraftment of HNSCC and allogeneic lymphocytes into SCID mice provides a viable model with which to evaluate immunotherapeutic strategies for human cancer. The use of biodegradable microspheres for local sustained delivery of cytokines to augment lymphocyte mediated antitumor immunity within the tumor microenvironment provides a safer and simpler alternative to current cytokine immunotherapy protocols.
— id: 8589, year: 2000, vol: 22, page: 57, stat: Journal Article,

Tumour volume estimated by computed tomography as a predictive factor in carcinoma of the tongue
Kuriakose MA; Loree TR; Hicks WL; Welch JJ; Wang H; DeLacure MD
2000 Oct;38(5):460-465, British journal of oral & maxillofacial surgery
This retrospective study evaluated tumour volume, estimated by computed tomography (CT), as a predictive factor in carcinoma of the tongue. Tumour volume was measured from pretreatment CT scans of 20 consecutive patients, followed up for at least 3 years, and this measurement was compared with tumour volume estimated from pathological specimens. T-stage and CT-derived tumour volume were compared with the clinical and pathological status of the nodes, and with the outcome of treatment.The measurement of tumour volume derived from CT correlated well with measurements derived from pathological examination, and tumour volume also predicted overall treatment failure. The disease-specific survival rate was 100% for patients with low-volume tumours (<13 cc) compared with 79% for those with stage T1 and T2 tumours.CT is a reliable way of measuring the volume of tumours in carcinoma of the tongue, and tumour volume is useful adjunct to the clinical tumour-node-metastases staging system.
— id: 11482, year: 2000, vol: 38, page: 460, stat: Journal Article,

Lymphoscintigraphy, sentinel lymph node biopsy, and Mohs micrographic surgery in the treatment of Merkel cell carcinoma
Zeitouni NC; Cheney RT; Delacure MD
2000 Jan;26(1):12-18, Dermatologic surgery
BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high incidence of occult nodal metastases. MCC is believed to be similar in natural history to thick or ulcerated melanomas in its propensity for locoregional recurrence and early lymph node metastasis. Studies have shown that nodal status is statistically correlated to survival in MCC. Radiolocalization and superselective lymph node biopsy is a recent technique that has been proven to be of great value in evaluating the status of occult lymph node disease in malignant melanoma and breast cancer patients. OBJECTIVE: In previously untreated patients, an orderly progression of metastases is observed for both cutaneous carcinomas and malignant melanomas and is anticipated for MCC. METHODS/RESULTS. We present two patients with MCC of the head and neck who underwent simultaneous Mohs micrographic surgery and sentinel lymph node biopsy with intraoperative radiolocalization. CONCLUSION: Sentinel lymph node biopsy and intraoperative lymphoscintigraphy may prove to be a useful technique in evaluating occult nodal involvement and in limiting the potentially unnecessary morbidity of more comprehensive lymph node dissections in MCC patients who do not yet have metastatic involvement
— id: 27881, year: 2000, vol: 26, page: 12, stat: Journal Article,

Primary leiomyosarcoma of the mandible in a 7-year-old girl: report of a case and review of the literature
Carter LC; Aguirre A; Boyd B; DeLacure MD
1999 Apr;87(4):477-484, Oral surgery, oral medicine, oral pathology, oral radiology, & endodontics
Leiomyosarcoma is a malignant neoplasm of smooth muscle origin that manifests itself uncommonly in the oral cavity because of the paucity of smooth muscle in that location. To the best of our knowledge, only 10 cases of leiomyosarcoma primary to the jawbones have been reported in the English language literature. We report the first pediatric case of leiomyosarcoma arising from the mandible. Facial asymmetry and swelling were accompanied by a rapidly growing exophytic soft tissue mass that caused buccal displacement of the mandibular left permanent first molar. The lesion, observed radiographically as an extensive ill-defined area of osteolytic alveolar destruction, perforated the lingual cortex, displaced the inferior alveolar nerve canal inferiorly, and produced a 'floating-in-air' appearance of the first molar. Diagnosis of leiomyosarcoma was made after initial incisional biopsy of the lesion. A 5-cm segmental mandibulectomy and supraomohyoid neck dissection were followed by reconstruction with a dynamic mandibular reconstruction plate and placement of a multidimensional mandibular distraction device in a transport rectangle of bone to promote bifocal distraction osteogenesis. Forty millimeters of distraction (the technical limit of the device) were performed; this was followed by terminal iliac crest bone grafting. Seventeen months after the definitive surgical procedure, the patient remains free of disease
— id: 48964, year: 1999, vol: 87, page: 477, stat: Journal Article,

Clinical experience in end-to-side venous anastomoses with a microvascular anastomotic coupling device in head and neck reconstruction
DeLacure MD; Kuriakose MA; Spies AL
1999 Aug;125(8):869-872, Archives of otolaryngology, head & neck surgery
BACKGROUND: Microvascular anastomosis remains one of the most technically sensitive aspects of free-tissue transfer reconstructions. Despite the availability of various mechanical anastomotic coupling systems for human clinical use during the last 8 years, reported clinical series remain rare. OBJECTIVE: To describe a clinical experience in applying a mechanical microvascular anastomotic coupling device (MACD) to end-to-side anastomotic configurations in head and neck free-flap reconstruction. METHODS: The MACD is a readily available high-density polyethylene ring-stainless steel pin system that has been found to be highly effective in clinical studies of end-to-end arterial and venous anastomosis and in laboratory studies of end-to-side anastomosis of rabbit arteries. RESULTS: Thirty-seven end-to-side venous anastomoses were attempted, of which 33 (89%) were completed. Of these, 9 patients had critical anastomoses (only 1 venous anastomosis per patient). In patients undergoing parallel venous anastomoses, 6 had both anastomoses performed using the MACD; in the remaining 12 patients, 1 of the anastomoses was performed using the MACD. A variety of donor flaps and clinical contexts were encountered. Flap survival in the MACD series was 100%. Four anastomoses were converted to conventional suture technique intraoperatively. CONCLUSIONS: The MACD is well suited to end-to-side venous anastomosis when carefully and selectively used by experienced microvascular surgeons. The most common clinical situation requiring this configuration and technique was the lack of ipsilateral recipient veins for end-to-end anastomosis or a ligated internal jugular vein stump that required this approach for device application. Previous radiation therapy does not appear to be a contraindication to its use
— id: 8489, year: 1999, vol: 125, page: 869, stat: Journal Article,

On the blood supply of microvascular bone transfers
DeLacure MD
1998 Mar;101(3):862-863, Plastic & reconstructive surgery
— id: 48965, year: 1998, vol: 101, page: 862, stat: Journal Article,

Differentiated thyroid carcinoma: risk group assignment and management controversies
Fuchshuber P; Loree TR; DeLacure MD; Hicks WL Jr
1998 Jan;12(1):99-106, Oncology
In this review, we provide a framework for clinical decision-making in the treatment of differentiated thyroid cancer. The clinical discussion and treatment recommendations are relevant to an adult population (> 16 years of age). The natural history, pathogenesis, diagnostic tools, and treatment controversies in the management of this disease are explored. The roles of radioiodine therapy and thyroid-stimulating hormone (TSH) suppression and the treatment of locoregional disease are reviewed. This discussion provides a comprehensive assessment of management and treatment issues in differentiated thyroid cancer
— id: 48966, year: 1998, vol: 12, page: 99, stat: Journal Article,

Magnetic resonance imaging assessment of a microvascular anastomotic device for ferromagnetism
DeLacure MD; Wang HZ
1997 Nov;13(8):571-574, Journal of reconstructive microsurgery
Microvascular free-tissue transfers have assumed particular importance as reconstructive techniques of choice in centers where ablative surgery for primary and recurrent malignant disease is a focus. In the context of malignant disease, issues of surveillance for recurrence are paramount. As clinical experience with the diagnostic imaging characteristics of flap reconstructions has been acquired, magnetic resonance imaging (MRI) has assumed a prominent role in the evaluation for recurrent malignant disease. This has provided an important supportive role for contemporary concepts of immediate reconstruction. The Precise-TM Microvascular Anastomotic Device (MACD) is based on the friction-fit union of implant rings composed of high-density polyethylene and surgical stainless steel. Many characteristics of the device have been described in histologic and laboratory studies. As yet uncharacterized is the effect of clinical MRI electromagnetic fields on the device, which is composed, in part, of type 316 stainless steel. The MACD is in wide use in centers where microsurgeons are experienced with the system and it is designed to facilitate the performance and reliability of microvascular anastomoses. The implications for MRI as a safe imaging modality for the acute perioperative evaluation of patients reconstructed with microvascular free flaps anastomosed with the MACD are obvious. MACD implants of varying sizes were evaluated for displacement in each of three orthogonal planes within a 1.5 Tesla magnetic field. No change in displacement was observed for any of the devices. Magnetic resonance imaging may thus be considered a safe imaging modality for the acute perioperative diagnostic imaging of free-tissue transfers that have been anastomosed with the MACD
— id: 48968, year: 1997, vol: 13, page: 571, stat: Journal Article,

Ischemic conditioning (delay phenomenon) improves esophagogastric anastomotic wound healing in the rat
Urschel JD; Antkowiak JG; Delacure MD; Takita H
1997 Dec;66(4):254-256, Journal of surgical oncology
BACKGROUND AND OBJECTIVES: Esophagogastric anastomotic leaks are a major source of morbidity after esophagectomy. Occult ischemia of the mobilized gastric fundus is an important etiological factor for this failure of healing. To test the hypothesis that ischemic conditioning (delay phenomenon) could improve esophagogastric anastomotic healing, anastomotic healing was studied in a rodent model of partial gastric devascularization. METHODS: Thirty-four Sprague-Dawley rats (two groups of 17 rats) underwent partial gastric devascularization and creation of esophagogastric anastomoses. In the acute ischemia group, devascularization and anastomosis were done at the same laparotomy. In the ischemic conditioned group, devascularization was done 3 weeks before anastomosis. Gastric tissue perfusion was assessed by laser-Doppler flowmetry before and after devascularization in both groups, and 3 weeks after devascularization in the ischemic conditioned group. All rats were killed 4 days after anastomosis, and the wounds assessed for dehiscence, breaking strength, and hydroxyproline concentration. RESULTS: Gastric tissue perfusion, measured in tissue perfusion units (TPU) decreased immediately after devascularization (before: 73.6 +/- 12.1 TPU; after: 25.0 +/- 6.5 TPU; P < 0.001). After 3 weeks, gastric tissue perfusion returned to baseline values in the ischemic conditioned rats (before: 72.3 +/- 11.0 TPU; 3 weeks, 71.1 +/- 15.1 TPU; P < 0.80). Ischemic conditioned rats had fewer anastomotic leaks (2 vs. 9, P < 0.023) and higher anastomotic wound breaking strengths (2.35 +/- 1.05 N vs. 1.56 +/- .76 N, P < 0.02) than the acute ischemic rats. Anastomotic would hydroxy-proline concentration was not significantly different in the two groups (acute ischemic--0.111 +/- .033 mumol/mg, ischemic conditions--0.097 +/- .026 mumol/mg, P < 0.20). CONCLUSIONS: In this rodent model of partial gastric devascularization, ischemic conditioning (delay phenomenon) ameliorated the harmful effect of ischemic on esophagogastric anastomotic wound healing
— id: 48967, year: 1997, vol: 66, page: 254, stat: Journal Article,

Stapled versus sutured esophagogastric anastomoses
Urschel JD; DeLacure MD; Takita H
1997 Sep;122(3):643-644, Surgery
— id: 48969, year: 1997, vol: 122, page: 643, stat: Journal Article,

Clinical experience with a microvascular anastomotic device in head and neck reconstruction
DeLacure MD; Wong RS; Markowitz BL; Kobayashi MR; Ahn CY; Shedd DP; Spies AL; Loree TR; Shaw WW
1995 Nov;170(5):521-523, American journal of surgery
BACKGROUND: Despite numerous refinements in microsurgical technique and instrumentation, the microvascular anastomosis remains one of the most technically sensitive aspects of free-tissue transfer reconstructions. MATERIALS AND METHODS: Concurrent with the development of microsurgical techniques, various anastomotic coupling systems have been introduced in an effort to facilitate the performance and reliability of microvascular anastomoses. The microvascular anastomotic coupling device (MACD) studied here is a high-density, polyethylene ring-stainless steel pin system that has been found to be highly effective in laboratory animal studies. Despite its availability for human clinical use over the last 5 years, reported clinical series remain rare. Our clinical experience with this MACD in 29 head and neck free-tissue transfers is reported herein. RESULTS: Thirty-five of 37 (95%) attempted anastomoses were completed with 100% flap survival with a variety of donor flaps, recipient vessels, and clinical contexts. Two anastomoses were converted to conventional suture technique intraoperatively, and one late postoperative venous thrombosis occurred after fistulization and vessel exposure. CONCLUSIONS: We conclude that the MACD studied here is best suited for the end-to-end anastomosis of soft, pliable, minimally discrepant vessels. Previous radiation therapy does not appear to be a contraindication to its use. Interpositional vein grafts may also be well suited to anastomosis with the device. When carefully and selectively employed by experienced microvascular surgeons, this MACD can be a safe, fast, and reliable adjunct in head and neck free-tissue transfer reconstructions, greatly facilitating the efficiency and ease of application of these techniques
— id: 48970, year: 1995, vol: 170, page: 521, stat: Journal Article,

Physiology of bone healing and bone grafts
DeLacure MD
1994 Oct;27(5):859-874, Otolaryngologic clinics of North America
Contemporary head and neck hard tissue reconstruction incorporates bone transfers in the treatment of osseous discontinuity defects subsequent to congenital malformation, traumatic injury, ablative oncologic surgery, and failures of physiologic osteosynthesis. Bone grafts may also be applied in contour augmentation and in strengthening and stabilization roles in congenital and acquired aesthetic as well as posttraumatic deformities. The osseous healing process is dynamic and unique. An understanding of the physiology of these processes allows the reconstructive surgeon to choose techniques and donor sites appropriate to specific requirements, to maximize transplanted bone volume, to achieve consistent and reliable results, and to modulate the osseous healing process in a favorable direction
— id: 48972, year: 1994, vol: 27, page: 859, stat: Journal Article,

Metal plate and screw technology
DeLacure MD; Friedman CD
1994 Oct;27(5):983-1000, Otolaryngologic clinics of North America
Fundamental to the choice and proper application of plating systems in osteosynthesis of the craniomaxillofacial skeleton is an understanding of the basic design and biomechanical characteristics that define them. Improper selection of systems and technical execution of rigid internal fixation is not uncommon and may result in hardware failure, dysfunction, and dysmorphology. The surgeon who is able to command the nuances of system design and discipline in application will achieve superior functional and aesthetic results that are predictable and reproducible
— id: 48971, year: 1994, vol: 27, page: 983, stat: Journal Article,

Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract
Davidson BJ; Kulkarny V; Delacure MD; Shah JP
1993 Oct;166(4):395-398, American journal of surgery
The trend toward function-conserving surgery in the treatment of squamous cell carcinoma of the head and neck has led to a progression from radical neck dissection to modified neck dissection and selective neck dissection has growing support. These surgical modifications have resulted from an effort to spare structures uninvolved with malignancy. Level V dissection can be associated with spinal accessory dysfunction in some patients even when the nerve remains intact. In this study, we have attempted to address the need for level V dissection by determining the prevalence of level V metastases in a large series of patients undergoing radical neck dissection. There were 1,123 patients who underwent 1,277 neck dissections between 1965 and 1986. A review of pathologic and clinical records revealed 40 patients (3%) with positive nodes at level V. The prevalence of level V metastases was greatest with hypopharynx and oropharynx primary tumors (7% and 6%, respectively). Level V metastases were found in 1% of patients with oral cancers and 2% of those with larynx cancers. Groups were divided into N0 (282), N+ (719), and subsequent N+ (276), depending on the clinical status at the time of surgery. Thirty-seven of 40 patients with posterior triangle metastases were clinically N+. The prevalence of metastases at level V was 1% for N0, 5% for N+, and 0% for subsequent N+. This large series shows minimal involvement of metastases at level V. The low likelihood of metastases at level V, even in N+ disease, should be considered when performing lymphadenectomy for squamous cell carcinoma of the upper aerodigestive tract
— id: 48973, year: 1993, vol: 166, page: 395, stat: Journal Article,

Spontaneous trigeminal-facial reinnervation
DeLacure MD; Sasaki CT; Petcu LG
1990 Sep;116(9):1079-1081, Archives of otolaryngology, head & neck surgery
Although spontaneous recovery of denervated facial muscles has been anecdotally recorded in the clinical setting, it has never been fully documented. The establishment of anastomoses between the terminal trigeminal and facial nerves provides a possible explanation of this phenomenon. Mechanisms of myoneurotization have also been described, by which regenerating branches of severed peripheral motor nerves directly reach motor end plates of denervated muscles, with variable recovery of function. A case demonstrating unequivocal clinical evidence of trigeminal-facial cross-innervation is presented, and the pertinent literature is reviewed as it applies to the mechanisms of this phenomenon
— id: 48974, year: 1990, vol: 116, page: 1079, stat: Journal Article,

Allogeneic (homograft) reconstruction of the mandible
Lowlicht RA; Delacure MD; Sasaki CT
1990 Aug;100(8):837-843, Laryngoscope
Reconstruction of the tumor-ablated patient remains one of the most challenging problems for the head-and-neck surgeon. Various methods have been described, including alloplastic reconstruction, free vascularized flaps, osteomyocutaneous flaps, and allogeneic reconstruction with particulate marrow grafts. Sixteen patients who have undergone homograft mandibular replacement at the Yale New Haven Hospital are described. Eighty-one percent of these grafts were successful in restoring form and function to a high degree of patient satisfaction. Eleven of the sixteen patients had radiation therapy after initial tumor surgery; 91% of these grafts were successful
— id: 48975, year: 1990, vol: 100, page: 837, stat: Journal Article,