Shirley Y. Su

Bio: Shirley Y. Su is an academic researcher from University of Texas MD Anderson Cancer Center. The author has contributed to research in topics: Medicine & Radiation therapy. The author has an hindex of 18, co-authored 60 publications receiving 1028 citations. Previous affiliations of Shirley Y. Su include University of Pittsburgh & University of Texas at Austin.

Significance of perihematomal edema in acute intracerebral hemorrhage: The INTERACT trial

Abstract: Background: Uncertainty surrounds the effects of cerebral edema on outcomes in intracerebral hemorrhage (ICH). Methods: We used data from the INTERACT trial to determine the predictors and prognostic significance of “perihematomal” edema over 72 hours after ICH. INTERACT included 404 patients with CT-confirmed ICH and elevated systolic blood pressure (BP) (150–220 mm Hg) who had the capacity to commence BP lowering treatment within 6 hours of ICH. Baseline and repeat CT (24 and 72 hours) were performed using standardized techniques, with digital images analyzed centrally. Predictors of growth in edema were determined using generalized estimating equations, and its effects on clinical outcomes were estimated using a logistic regression model. Results: Overall, 270 patients had 3 sequential CT scans available for analyses. At baseline, there was a highly significant correlation between hematoma and perihematomal edema volumes ( r 2 = 0.45). Lower systolic BP and baseline hematoma volume were independently associated with absolute increase in perihematomal edema volume. History of hypertension, baseline hematoma volume, and earlier time from onset to CT were independently associated with relative increase in edema volume. Both absolute and relative increases in perihematomal edema growth were significantly associated with death or dependency at 90 days after adjustment for age, gender, and randomized treatment, but not when additionally adjusted for baseline hematoma volume. Conclusions: The degree of, and growth in, perihematomal edema are strongly related to the size of the underlying hematoma of acute intracerebral hemorrhage, and do not appear to have a major independent effect in determining the outcome from this condition.

Induction Chemotherapy Response as a Guide for Treatment Optimization in Sinonasal Undifferentiated Carcinoma

Abstract: PURPOSEMultimodal therapy is a well-established approach for the treatment of sinonasal undifferentiated carcinoma (SNUC); however, the optimal sequence of the various treatments modalities is yet ...

Esthesioneuroblastoma, Neuroendocrine Carcinoma, and Sinonasal Undifferentiated Carcinoma: Differentiation in Diagnosis and Treatment

Abstract: Introduction Malignant sinonasal tumors comprise less than 1% of all neoplasms. A wide variety of tumors occurring primarily in this site can present with an undifferentiated or poorly differentiated morphology. Among them are esthesioneuroblastomas, sinonasal undifferentiated carcinomas, and neuroendocrine carcinomas. Objectives We will discuss diagnostic strategies, recent advances in immunohistochemistry and molecular diagnosis, and treatment strategies. Data Synthesis These lesions are diagnostically challenging, and up to 30% of sinonasal malignancies referred to the University of Texas MD Anderson Cancer Center are given a different diagnosis on review of pathology. Correct classification is vital, as these tumors are significantly different in biological behavior and response to treatment. The past decade has witnessed advances in diagnosis and therapeutic modalities leading to improvements in survival. However, the optimal treatment for esthesioneuroblastoma, sinonasal undifferentiated carcinoma, and neuroendocrine carcinoma remain debated. We discuss advances in immunohistochemistry and molecular diagnosis, diagnostic strategies, and treatment selection. Conclusions There are significant differences in prognosis and treatment for esthesioneuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma. Recent advances have the potential to improve oncologic outcomes but further investigation in needed.

Hypothyroidism following hemithyroidectomy: a retrospective review.

Abstract: Objective: To investigate the incidence, time to onset, and risk factors for the development of hypothyroidism after hemithyroidectomy. Background: The incidence and risk factors for hypothyroidism in patients undergoing partial thyroid surgery remains unclear. Hypothyroidism is an under appreciated sequel of hemithyroidectomy. The early recognition of this postoperative complication may prevent symptoms of hypothyroidism and recurrent thyroid disease. Methods: We conducted a retrospective review of all patients undergoing hemithyroidectomy from August 1992 to June 2006 by a single surgeon. Patients were analyzed for age, sex, family history of thyroid disease, thyroid antibody levels, pre- and postoperative thyroid stimulating hormone (TSH), histologic diagnosis, weight of resected tissue, histologic evidence of thyroiditis, and lag time to diagnosis of hypothyroidism. χ 2 or Fisher exact test or Student t test were performed. Results: Hypothyroidism was diagnosed in 10.9% of 294 patients. The mean time to diagnosis was 8.2 ± 10.9 months. The mean thyroxine dose was 69.4 ± 31.6 micrograms. Patients with postoperative hypothyroidism had a higher incidence of a high-normal preoperative TSH level (TSH: 2.5-4.0 mIU/L, 18.8% vs. 3.8%; P < 0.01), thyroiditis on histology (46.8% vs. 11.8%; P < 0.01) and elevated thyroid antibodies levels (47.8% vs. 11.5%; P < 0.01). Age, gender, family history of thyroid disease, thyroid pathology, and weight of resected tissue were not significant risk factors for hypothyroidism. Conclusions: An incidence of 10.9% is higher than anticipated and all patients should have postoperative thyroid function assessment. However, a high-normal preoperative TSH, elevated thyroid antibody levels, and the presence of thyroiditis on histology are indications for close monitoring.

Incomplete excision of squamous cell carcinoma of the skin: a prospective observational study.

Abstract: Background: Squamous cell carcinoma is the second most common cancer of the skin. It behaves differently from basal cell carcinoma. Few large-scale studies have identified risk factors for incomplete excision of cutaneous squamous cell carcinoma. The authors report the largest prospective study to identify the risk factors for incomplete excision of these lesions. Methods: A total of 517 histopathologically confirmed squamous cell carcinomas were excised from January of 2001 to December of 2002 at the Peter MacCallum Cancer Institute. Of these, 480 primary excisions were analyzed. Data pertaining to patient age, sex, lesion size, margin of excision, recurrence, previous excision, site, anesthetic choice, and repair method were collected prospectively. Results: The overall incomplete excision rate was 6.3 percent. Lesions on the ear (p < 0.003), re-excisions (p < 0.001), and invasive lesions (p < 0.001) were associated with the highest incomplete resection rates. Age (p = 0.61), sex (p = 0.075), tumor size (p = 0.521), surgeon's experience (p = 0.092), and recurrent lesions (p = 0.408) were not statistically significant risk factors. Conclusions: Statistically significant risk factors were ear lesions, invasive lesions, and previously incompletely excised lesions referred for re-excision. The authors recommend more care with tumor markings, taking margins of at least 5 mm, using deeper margins, and referring patients to more experienced centers.

Prescribing in Dermatology: Skin cancer

Abstract: The incidence of skin cancer is increasing and nurses are in an ideal position to help patients prevent and identify the disease at an early stage.

Complications of intracerebral haemorrhage.

Abstract: Intracerebral haemorrhage (ICH) is the most devastating type of stroke and is a leading cause of disability and mortality By contrast with advances in ischaemic stroke treatment, few evidence-based targeted treatments exist for ICH Management of ICH is largely supportive, with strategies aimed at the limitation of further brain injury and the prevention of associated complications, which add further detrimental effects to an already lethal disease and jeopardise clinical outcomes Complications of ICH include haematoma expansion, perihaematomal oedema with increased intracranial pressure, intraventricular extension of haemorrhage with hydrocephalus, seizures, venous thrombotic events, hyperglycaemia, increased blood pressure, fever, and infections In view of the restricted number of therapeutic options for patients with ICH, improved surveillance is needed for the prevention of these complications, or, when this is not possible, early detection and optimum management, which could be effective in the reduction of adverse effects early in the course of stroke and in the improvement of prognosis Further studies are needed to enhance the evidence-based recommendations for the management of this important clinical problem

Minimally Invasive Surgery Plus Recombinant Tissue-type Plasminogen Activator for Intracerebral Hemorrhage Evacuation Decreases Perihematomal Edema

Abstract: Background and Purpose—Perihematomal edema (PHE) can worsen outcomes after intracerebral hemorrhage (ICH). Reports suggest that blood degradation products lead to PHE. We hypothesized that hematoma evacuation will reduce PHE volume and that treatment with recombinant tissue-type plasminogen activator (rt-PA) will not exacerbate it. Methods—Minimally invasive surgery and rt-PA in ICH evacuation (MISTIE) phase II tested safety and efficacy of hematoma evacuation after ICH. We conducted a semiautomated, computerized volumetric analysis on computed tomography to assess impact of hematoma removal on PHE and effects of rt-PA on PHE. Volumetric analyses were performed on baseline stability and end of treatment scans. Results—Seventy-nine surgical and 39 medical patients from minimally invasive surgery and rt-PA in ICH evacuation phase II (MISTIE II) were analyzed. Mean hematoma volume at end of treatment was 19.6±14.5 cm3 for the surgical cohort and 40.7±13.9 cm3 for the medical cohort (P<0.001). Edema volume at...