Publications by authors named "Duncan A Meiklejohn"

17 Publications

  • Page 1 of 1

Evaluation of Antibiotic Prophylaxis for Acute Nonoperative Orbital Fractures.

Ophthalmic Plast Reconstr Surg 2021 Sep-Oct 01;37(5):462-464

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico, Albuquerque, New Mexico, U.S.A.

Purpose: The use of antibiotic prophylaxis for the prevention of infection in nonoperative orbital fractures is controversial, with limited high-quality evidence and inconsistent recommendations in the current scientific literature. Our primary study objective was to identify the prophylactic antibiotic prescribing pattern at our institution for nonoperative orbital fractures and to determine the effect of antibiotic prophylaxis.

Methods: We retrospectively reviewed 16 years of data from a single institution on patients with acute traumatic fractures of the orbital floor or medial orbital wall. Prophylactic administration of antibiotics and complication rates were evaluated, and complication rates and patient characteristics analyzed.

Results: Of 154 patients with nonoperative orbital fractures, 17 patients (group 1) received IV or oral antibiotics and 137 patients (group 2) did not. No patient in either group had documented infectious orbital complications following their orbital injury. Patients receiving antibiotics were more likely to have a concurrent periorbital laceration (58.8% ± 11.9% vs. 28.5% ± 3.9%; P = 0.01).

Conclusion: We present the largest cohort yet reported of patients managed without antibiotic prophylaxis for nonoperative orbital fractures, with no infectious complications identified. Currently there is no evidence of utility to prophylactic antibiotics in the setting of nonoperative traumatic orbital fractures. Rather than prescribing antibiotics, we recommend clinicians educate patients on return precautions and offer close follow up for the rare, but potentially severe infectious complications of orbital trauma.
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http://dx.doi.org/10.1097/IOP.0000000000001915DOI Listing
October 2021

Occult Malignancy in Adult Tonsillectomy for Benign Indication.

Ann Otol Rhinol Laryngol 2021 Apr 25;130(4):356-362. Epub 2020 Aug 25.

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico Hospital, Albuquerque, NM, USA.

Objective: National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued.

Study Design: Retrospective chart review and systematic review of the literature.

Setting: Tertiary care academic hospital and multi-hospital private healthcare system.

Subjects And Methods: A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated.

Results: Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000.

Conclusion: Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens.

Level Of Evidence: Pooled analysis of case series from the literature and a single institution, level 4.
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http://dx.doi.org/10.1177/0003489420952474DOI Listing
April 2021

Primary Presentation of Pediatric Hematopoietic Malignancy in the Temporal Bone: Case Report and Review of the Literature.

Ear Nose Throat J 2020 May 8:145561320924146. Epub 2020 May 8.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, NM, USA.

Malignancy of hematopoietic origin comprises a large portion of all pediatric malignancies; however, it is uncommon for patients with this condition to present only with symptoms related to temporal bone involvement. Here, we report a case of Burkitt Lymphoma of the temporal bone in an 8-year-old patient who initially presented with symptoms of acute otitis media. Additionally, we review the current literature on pediatric hematopoietic malignancy with primary temporal bone involvement and discuss the clinical presentation, management, and outcomes of these rare cases.
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http://dx.doi.org/10.1177/0145561320924146DOI Listing
May 2020

Cold Technique in Adult Tonsillectomy Reduces Waste and Cost.

Ear Nose Throat J 2021 Sep 20;100(5_suppl):427S-430S. Epub 2019 Oct 20.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 21764University of New Mexico Hospital, Albuquerque, NM, USA.

Objectives: To quantify differences in waste and cost of disposable equipment between different tonsillectomy techniques.

Methods: Prospective study of waste attributable to disposable waste produced by tonsillectomy surgery. Disposable equipment required for tonsillectomy using cold, monopolar electrocautery (ME), and coblation techniques was measured; and differences in mass, volume, and cost of equipment between the 3 techniques were quantified.

Results: Cold technique was found to produce the least waste and have the lowest cost attributable to disposable surgical equipment. Projected single-case savings in mass and volume of waste resulting from using cold technique compared to ME were 1.272 kg and 1.013 L, respectively, and 1.043 kg and 1.723 L compared to coblation. Projected single-case savings in cost of disposable equipment for cold technique compared to ME were US$9.35 and US$185.05 compared to coblation.

Discussion: Using cold technique for adult tonsillectomy reduces waste and cost of disposable equipment compared to ME and coblation. Surgeons desiring to reduce cost and waste associated with tonsillectomy surgery may consider transitioning to cold technique.
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http://dx.doi.org/10.1177/0145561319882779DOI Listing
September 2021

Myoepithelial Cell Carcinoma of the Oral Tongue: Case Report and Review of the Literature.

Clin Med Insights Oncol 2019 2;13:1179554919838254. Epub 2019 Apr 2.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, UNM School of Medicine, Albuquerque, NM, USA.

Background: Myoepithelial cell carcinoma is a rare malignant neoplasm of salivary gland origin that typically presents in the parotid gland and minor salivary glands. It has been described previously in head and neck sites such as buccal mucosa, alveolar ridge, and base of tongue.

Methods: A 55-year-old man presented with 30 years of right-sided tongue pain and 10 years of gradually worsening ulceration. Physical examination demonstrated a 2.5 cm ulcerative lesion of the anterior right oral tongue. An initial biopsy was consistent with moderately to poorly differentiated squamous cell carcinoma. Imaging included a positron emission tomography (PET)/computed tomography (CT) scan that demonstrated the right tongue lesion as well as hypermetabolic right level II adenopathy. The patient underwent surgical excision of the right tongue, upper aerodigestive tract endoscopy, and a bilateral supraomohyoid neck dissection. The tongue defect was closed primarily.

Results: Final pathology of the surgical specimen demonstrated myoepithelial cell carcinoma. All of the margins were free of tumor and no cervical lymph nodes showed metastasis. Immunohistochemistry demonstrated myoepithelial differentiation. The tumor did not show EWSR1 gene rearrangement on genetic testing, suggesting salivary gland origin. Multidisciplinary tumor board evaluation recommended no adjuvant therapy. The patient recovered well after surgery and nearly a year later is without evidence of recurrent or residual disease.

Conclusions: We present the first reported case of myoepithelial cell carcinoma with primary origin in the oral tongue and review the available literature on this unusual tumor. We discuss the clinical, pathological, and immunohistochemical features and treatment of myoepithelial cell carcinoma.
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http://dx.doi.org/10.1177/1179554919838254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448097PMC
April 2019

What antibiotic should be used in the management of an otherwise healthy adult with a peritonsillar abscess?

Laryngoscope 2018 04 8;128(4):783-784. Epub 2017 Oct 8.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A.

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http://dx.doi.org/10.1002/lary.26881DOI Listing
April 2018

Occult central venous stenosis leading to airway obstruction after subtotal parathyroidectomy.

Ear Nose Throat J 2016 Jul;95(7):E11-3

Corresponding author: Duncan A. Meiklejohn, MD, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico, 2211 Lomas Blvd., NE 2ACC, 1 University of New Mexico mSC10 5610, Albuquerque, NM 87131-0001. Email: From the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico, Albuquerque (Dr. Meiklejohn); the Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco (Dr. Chan); and the Stanford Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology, Santa Clara Valley Medical Center.

Subtotal parathyroidectomy may be indicated in patients with chronic renal failure and tertiary hyperparathyroidism, a population at increased risk for central venous stenosis (CVS) due to repeated vascular access. Here we report a case of complete upper airway obstruction precipitated by subtotal parathyroidectomy with ligation of anterior jugular vein collaterals in a patient with occult CVS. This case demonstrates a previously unreported risk of anterior neck surgery in patients with chronic renal failure. We present a review of the literature and discuss elements of the history and physical examination suggestive of occult CVS, with additional workup proposed for appropriate cases. Recommendations are discussed for perioperative and postoperative care in patients at increased risk for CVS.
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July 2016

Pediatric Semicircular Canal Dehiscence: Radiographic and Histologic Prevalence, With Clinical Correlation.

Otol Neurotol 2015 Sep;36(8):1383-9

*Stanford University Medical Center, Palo Alto, California; †Brigham and Women's Hospital, Boston, Massachusetts; ‡The Johns Hopkins University Hospital, Baltimore, Maryland; and §Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A.

Objectives: To determine the prevalence of radiographic and histologic superior semicircular canal dehiscence (SSCD) and posterior semicircular canal dehiscence (PSCD) and associated changes in temporal bone thickness in children aged 0 to 7 years.

Study Design: Retrospective chart review and histopathologic review of cadaveric bone specimens.

Setting: Two tertiary referral centers.

Patients: Children younger than 7 years who underwent high-resolution computed tomography scan including the temporal bones between 1998 and 2013 and temporal bones harvested from children younger than 7 years.

Intervention(s): Two hundred twenty-eight computed tomography studies and 58 temporal bone specimens were reviewed. Available patient demographics were tabulated.

Main Outcome Measure(s): Prevalence of SSCD and PSCD and bone thickness over semicircular canals, with comparison across age groups. Clinical data were extracted for patients with radiographic dehiscence.

Results: Prevalence by ear of SSCD was 11.9%, 4.9%, 2.8%, and 0% and of PSCD was 16.7%, 2.4%, 1.4%, and 0% in children aged less than 6 months, 6 to 11 months, 12 to 35 months, and 3 to 7 years, respectively. SSCD was statistically more common before 1 year of age and PSCD before 6 months of age. Bone thickness overlying both the SSC and the PSC increased with age. Radiographic PSC bone was significantly thicker than SSC bone in patients older than 12 months. No dehiscences were found in the histologic specimens.

Conclusion: Radiographic dehiscence of the canals is common in the first 6 months of life, with thin bone seen histologically. Prevalence decreases with increasing age as the bone overlying the canals increases in thickness.
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http://dx.doi.org/10.1097/MAO.0000000000000811DOI Listing
September 2015

LINE-1 retrotransposable element DNA accumulates in HIV-1-infected cells.

J Virol 2013 Dec 2;87(24):13307-20. Epub 2013 Oct 2.

Department of Immunology, University of Toronto, Toronto, Ontario, Canada.

Type 1 long-interspersed nuclear elements (L1s) are autonomous retrotransposable elements that retain the potential for activity in the human genome but are suppressed by host factors. Retrotransposition of L1s into chromosomal DNA can lead to genomic instability, whereas reverse transcription of L1 in the cytosol has the potential to activate innate immune sensors. We hypothesized that HIV-1 infection would compromise cellular control of L1 elements, resulting in the induction of retrotransposition events. Here, we show that HIV-1 infection enhances L1 retrotransposition in Jurkat cells in a Vif- and Vpr-dependent manner. In primary CD4(+) cells, HIV-1 infection results in the accumulation of L1 DNA, at least the majority of which is extrachromosomal. These data expose an unrecognized interaction between HIV-1 and endogenous retrotransposable elements, which may have implications for the innate immune response to HIV-1 infection, as well as for HIV-1-induced genomic instability and cytopathicity.
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http://dx.doi.org/10.1128/JVI.02257-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838212PMC
December 2013

Ganglioneuroma of the internal auditory canal presenting as a vestibular schwannoma.

Skull Base Rep 2011 Nov 11;1(2):89-94. Epub 2011 Apr 11.

Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

In most series, 90% of cerebellopontine angle tumors are vestibular schwannomas. Meningiomas and epidermoid tumors follow with decreased frequency. Ganglioneuroma is a benign tumor usually found in the retroperitoneum and posterior mediastinum. We report a case of a 21-year-old man with gradual sensorineural hearing loss and a minimally enhancing lesion of the internal auditory canal, which was excised through a middle fossa approach and found histologically to be a ganglioneuroma. Like vestibular schwannomas, these lesions are benign in nature and may be managed in a similar fashion, although the possibility of malignant transformation may support surgical resection over conservative management or radiosurgery. Ganglioneuromas should be considered in patients with atypical radiographic findings for vestibular schwannomas.
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http://dx.doi.org/10.1055/s-0031-1276722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743606PMC
November 2011

Rapid progressing allele HLA-B35 Px restricted anti-HIV-1 CD8+ T cells recognize vestigial CTL epitopes.

PLoS One 2010 04 21;5(4):e10249. Epub 2010 Apr 21.

Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.

Background: The HLA-B*35-Px allele has been associated with rapid disease progression in HIV-1 infection, in contrast to the HLA-B*35-Py allele.

Methodology/principal Findings: Immune responses to two HLA-B*35 restricted HIV-1 specific CTL epitopes and their variants were followed longitudinally during early HIV-1 infection in 16 HLA-B*35+ individuals. Subjects expressing HLA-B*35-Px alleles showed no difference in response to the consensus epitopes compared to individuals with HLA-B*35-Py alleles. Surprisingly, all the HLA-B*35-Px+ individuals responded to epitope-variants even in the absence of a consensus response. Sequencing of the viral population revealed no evidence of variant virus in any of the individuals.

Conclusions/significance: This demonstrates a novel phenomenon that distinguishes individuals with the HLA-B*35-Px rapid progressing allele and those with the HLA-B*35-Py slower progressing allele.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0010249PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858076PMC
April 2010

Immune escape mutations detected within HIV-1 epitopes associated with viral control during treatment interruption.

J Acquir Immune Defic Syndr 2010 Jan;53(1):36-46

Monogram Biosciences, Inc, 345 Oyster Point Boulevard, South San Francisco, CA 94080, USA.

We analyzed immune responses in chronically HIV-infected individuals who took part in a treatment interruption (TI) trial designed for patients who initiated antiretroviral therapy within 6 months of seroconversion. In the 2 subjects who exhibited the best viral control, we detected CD8(+) T-cell responses against 1-2 Gag epitopes during the early weeks of TI and a subsequent increase in the number of epitopes recognized by the later time points. Each of these subjects developed mutations within the epitopes targeted by the highest magnitude responses. In the subject with the worst viral control, we detected responses against 2 Gag epitopes throughout the entire TI and no Gag mutations. The magnitude of these responses increased dramatically with time, greatly exceeding those detected in the virologic controllers. The highest levels of contemporaneous autologous neutralizing antibody activity were detected in the virologic controllers, and a subsequent escape mutation developed within the envelope gene of one controller that abrogated the response. These data suggest that immune escape mutations are a sign of viral control during TI, and that the absence of immune escape mutations in the presence of high levels of viral replication indicates the lack of an effective host immune response.
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http://dx.doi.org/10.1097/QAI.0b013e3181c4b885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843510PMC
January 2010

T cell responses to human endogenous retroviruses in HIV-1 infection.

PLoS Pathog 2007 Nov;3(11):e165

Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.

Human endogenous retroviruses (HERVs) are remnants of ancient infectious agents that have integrated into the human genome. Under normal circumstances, HERVs are functionally defective or controlled by host factors. In HIV-1-infected individuals, intracellular defense mechanisms are compromised. We hypothesized that HIV-1 infection would remove or alter controls on HERV activity. Expression of HERV could potentially stimulate a T cell response to HERV antigens, and in regions of HIV-1/HERV similarity, these T cells could be cross-reactive. We determined that the levels of HERV production in HIV-1-positive individuals exceed those of HIV-1-negative controls. To investigate the impact of HERV activity on specific immunity, we examined T cell responses to HERV peptides in 29 HIV-1-positive and 13 HIV-1-negative study participants. We report T cell responses to peptides derived from regions of HERV detected by ELISPOT analysis in the HIV-1-positive study participants. We show an inverse correlation between anti-HERV T cell responses and HIV-1 plasma viral load. In HIV-1-positive individuals, we demonstrate that HERV-specific T cells are capable of killing cells presenting their cognate peptide. These data indicate that HIV-1 infection leads to HERV expression and stimulation of a HERV-specific CD8+ T cell response. HERV-specific CD8+ T cells have characteristics consistent with an important role in the response to HIV-1 infection: a phenotype similar to that of T cells responding to an effectively controlled virus (cytomegalovirus), an inverse correlation with HIV-1 plasma viral load, and the ability to lyse cells presenting their target peptide. These characteristics suggest that elicitation of anti-HERV-specific immune responses is a novel approach to immunotherapeutic vaccination. As endogenous retroviral sequences are fixed in the human genome, they provide a stable target, and HERV-specific T cells could recognize a cell infected by any HIV-1 viral variant. HERV-specific immunity is an important new avenue for investigation in HIV-1 pathogenesis and vaccine design.
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http://dx.doi.org/10.1371/journal.ppat.0030165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065876PMC
November 2007

Individuals with pulmonary tuberculosis have lower levels of circulating CD1d-restricted NKT cells.

J Infect Dis 2007 May 20;195(9):1361-4. Epub 2007 Mar 20.

Division of Experimental Medicine, University of California, San Francisco, CA 94143, USA.

Mycobacterium tuberculosis (MTB) is a leading cause of mortality worldwide from an infectious agent. Natural killer T (NKT) cells recognize mycobacterial antigens and contribute to anti-MTB immunity in mouse models. NKT cells were measured in subjects with pulmonary tuberculosis, MTB-exposed individuals, and healthy controls. NKT cell levels are selectively lower in peripheral blood mononuclear cells from individuals with pulmonary tuberculosis than in both MTB-exposed subjects and healthy control subjects. This apparent loss of NKT cells from the peripheral blood is sustained during the 6 months after the initiation of MTB treatment. These findings indicate that NKT cells may be an important component of antituberculosis immunity.
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http://dx.doi.org/10.1086/513567DOI Listing
May 2007

R5 human immunodeficiency virus type 1 (HIV-1) replicates more efficiently in primary CD4+ T-cell cultures than X4 HIV-1.

J Virol 2004 Sep;78(17):9164-73

Gladstone Institute of Virology and Immunology, University of California, San Francisco, California 94141-9100, USA.

In this report, we present evidence that R5 human immunodeficiency virus type 1 (HIV-1) replicates more efficiently in primary CD4+ T cells than X4 HIV-1. By comparing CD3/CD28-costimulated CD4+ T-cell cultures infected by several X4 and R5 HIV-1 strains, we determined that R5-infected CD4+ T cells produce more virus over time than X4-infected CD4+ T cells. In the first comparison, we found that more cells were infected by the X4-tropic strain LAI than by the R5-tropic strain JR-CSF and yet that higher levels of viral production were detected in the R5-infected cultures. The differential viral production was partially due to the severe cytopathic effects of the X4 virus. We also compared cultures infected with the isogenic HIV-1 strains NL4-3 (X4) and 49.5 (R5). We found that fewer cells were infected by the R5 strain, and yet similar levels of viral production were detected in both infected cultures. Cell death played less of a role in the differential viral production of these strains, as the cell viability remained comparable in both X4- and R5-infected cultures over time. The final comparison involved the primary R5-tropic isolate KP1 and the primary dual-tropic isolate KP2. Although both strains infected similar numbers of cells and induced comparable levels of cytopathicity, viral production was considerably higher in the R5-infected culture. In summary, these data demonstrate that R5 HIV-1 has an increased capacity to replicate in costimulated CD4+ T cells compared to X4 HIV-1.
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http://dx.doi.org/10.1128/JVI.78.17.9164-9173.2004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC506961PMC
September 2004

ELISPOT cell rescue.

J Immunol Methods 2004 May;288(1-2):135-47

Gladstone Institute of Virology and Immunology, University of California, PO Box 419100, San Francisco, CA 94141-9100, USA.

The enzyme-linked immunospot (ELISPOT) assay is a highly sensitive and reproducible method for quantifying T cell-mediated immune responses, and has been used to measure antigen-specific responses post-vaccination. While there are several advantages of the ELISPOT assay for use in field settings for large-scale vaccination trials, blood draw volumes are often limited, and the number of antigen-specific responses that can be measured is constrained by the limited cell number. We reasoned that it should be possible to salvage and rescue viable cells from a completed ELISPOT assay post-incubation, to use for further experimentation. Here, we show that cells rescued from an ELISPOT plate after assay are viable, and may be used in a second cytokine-producing assay, in a proliferation assay, or to provide a source of DNA for genetic studies such as human leukocyte antigen (HLA) typing. Rescue of cells after an ELISPOT assay will be particularly useful for increasing sample utility and maximizing data collection from T cell assays in vaccine trials.
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http://dx.doi.org/10.1016/j.jim.2004.03.006DOI Listing
May 2004
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