Δευτέρα 16 Αυγούστου 2021

Regarding “Accuracy, predictability and prognostic implications of fine needle aspiration biopsy for parotid gland tumors: A retrospective case series”

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Abstract

We reviewed Tomer Boldes et al. manuscript entitled "Accuracy, predictability and prognostic implications of fine-needle aspiration biopsy for parotid gland tumors: A retrospective case series".1 The authors highlight the limitations of fine‑needle aspiration biopsy (FNAB) as a decision-making tool in the diagnostic process of parotid gland tumors. Furthermore, the authors analyzed the FNAB results of adults and correlated them with postoperative histological examination. Therefore, we want to pay attention to some aspects concerning the diagnostic tools of parotid tumors.

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Quality of life following treatment for T1a glottic cancer with surgery or radiotherapy: outcomes from the Head and Neck 5000 cohort

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Abstract

Introduction

Recent guidelines have stated transoral laser microsurgery be recommended for the management of T1a glottic carcinoma over radiotherapy. If radiotherapy offered superior quality of life (QoL) outcomes, this guidance would need revisiting. There is a paucity of good quality evidence on QoL outcomes.

Design

This prospective cohort study aims to assess generic and disease specific patient reported QoL in patients treated with either surgery or RT for T1a glottic carcinoma.

Participants

Participants were recruited as part of the multicentre, prospective Head and Neck 5000 cohort between 2011 and 2014.

Main Outcome Measures

Baseline demographic data were collected. All participants completed the EORTC QLQ C30 and EORTC QLQ H&N35 questionnaires at baseline, 4 months, 12 months, and after 36 months.

Results

123 participants received radiotherapy only (n=68) or surgery only (n=55). Overall QoL scores were similar between both groups. The median (IQR) EORTC QLQ C30 summary scores at 12 months were 89.3 (79.1, 95.7) and 92.6 (74.4, 97.9) for the radiotherapy and surgery groups respectively. The equivalent summary scores for the EORTC QLQ H&N35 were 91.9 (83.8, 94.9) and 90.4 (85.5, 94.9). There was a modest difference in some QoL subscales between the groups but no differences existed beyond 4 months.

Conclusions

Patient reported QoL is similar following either radiotherapy or surgery for T1a glottic carcinoma. This data supports current guidance recommended TLM for this disease.

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A novel landmark for endonasal surgery of the pterygopalatine fossa and inferior orbital fissure: The orbito‐pterygo‐sphenoidal ligament

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Abstract

The pterygopalatine fossa contains a dense and complex array of neurovascular structures vulnerable to accidental surgical injury. This study aims to describe a novel landmark, the orbito-pterygo-sphenoidal ligament (OPSL), and implications of this structure for surgery in the pterygopalatine fossa and the inferior orbital fissure. Six cadaveric specimens (12 sides) were dissected using an endonasal approach to expose the periosteal layers associated with the pterygopalatine fossa and orbit. The thickened triangular-shaped ligament at their confluence was termed the OPSL. Dimensions of its lateral, inferior, and medial borders were measured, and their anatomical relationships defined. The pterygopalatine ganglion and the maxillary nerve lie immediately inferior and deep into the OPSL. The superior aspect of the posterior nasoseptal artery and nerve are covered by the medial OPSL. The lateral and inferior borders of the OPSL are contiguous with the periorbita and the periosteum of the pterygopalatine fossa, respectively. Along the medial border of the ligament, the openings of the palatovaginal fissure, vidian canal, and foramen rotundum were sequentially identified in a medial to lateral trajectory. The length of the lateral, inferior, and medial borders of the triangular OPSL were 13.25 ± 0.62, 14.25 ± 0.45, and 12.08 ± 0.90 mm, respectively. The OPSL is a thick, triangular-shaped fascial confluence, which may serve as a landmark for procedures within the pterygopalatine fossa and the inferior orbital fissure.

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Fukushima Nuclear Power Plant accident: Various issues with iodine distribution and medication orders

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Am J Disaster Med. 2021 Spring;16(2):123-133. doi: 10.5055/ajdm.2021.0394.

ABSTRACT

Immediately after the Great East Japan Earthquake on March 11, 2011, the public could not receive accurate information concerning about the reality of the accident at the Fukushima Nuclear Power Plant because of communication problems with mobile phone base stations caused by power outages and the inadequate use of communication satellites between local governments. These telecommunications troubles caused not only a delay between the Japanese central government to local governments, but also a failure in conveying the seriousness of the accident to residents. The central government issued evacuation orders, but in some areas, a delay was seen in the time residents took to notice the orders. Some residents were forced to change their evacuation site several times and move to areas with higher radiation exposure. Although iodine preparations needed to be distributed to saturate the thyroid gland and reduce the uptake of iodine-131, a radioactive isotope, many municipalities were unable to secure them. Preparations were distributed on March 15, 2011 when the detectable amount of radioactive isotopes peaked, but only the Naraha and Miharu towns received them. At the time of the Fukushima Nuclear Power Plant accident, communication lines had already been interrupted by the major earthquake that struck on March 11, and information systems between local governments were not communic ating well. With such a social infrastructure, residential evacuation orders were inadequate, and the delivery of medication was extremely difficult. The experience of the Fukushima Nuclear Power Plant accident suggests that the government should have distributed iodine preparations to residents living within a 30-km radius of the plant in advance, so that they could learn about the background and side effects of the drug beforehand. This distribution strategy is similar to that of targeted antivirus prophylaxis (TAP), which is an extralegal policy carried out in situations where face-to-face medical treatment is impossible because of an outbreak during a pandemic.

PMID:34392524 | DOI:10.5055/ajdm.2021.0394

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Current Therapeutic Approaches to Subglottic Stenosis in Patients With GPA: A Systematic Review

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Ear Nose Throat J. 2021 Aug 15:1455613211036246. doi: 10.1177/01455613211036246. Online ahead of print.

ABSTRACT

BACKGROUND: The management of subglottic stenosis (SGS) in granulomatosis patients with polyangiitis (GPA) has no clear guidelines. This systematic review aimed to identify different surgical techniques and evaluate the outcomes of applied procedures.

METHODS: An electronic search was performed using 3 major databases, CINAHL, PubMed, and Clinical key, to in clude relevant studies published from the databases from inception through January 2017. All primary studies reporting treatment of SGS in cases with GPA were included. Articles were excluded if not relevant to the research topic or if they were duplicates, review articles, editorials, short comments, unpublished data, conference abstracts, case reports, animal studies, or non-English studies.

RESULTS: Thirteen papers were included in our systematic review with a total of 267 cases for the qualitative review Endoscopic approaches showed favorable outcomes with the need to use multiple procedures to achieve remission. The open transcervical approach showed excellent results mainly after failure of other endoscopic techniques. Tracheostomy was necessary for severe respiratory obstruction symptoms. Medical treatment was essential for stabilizing the active disease and therefore may enhance the success rate postoperatively.

CONCLUSION: Subglottic stenosis in patients with GP A requires a multidisciplinary approach to provide optimal management regarding disease activity, grade of stenosis, and severity of symptoms.

PMID:34392732 | DOI:10.1177/01455613211036246

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Tension Pneumocephalus Following Balloon Sinuplasty

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Ear Nose Throat J. 2021 Aug 15:1455613211037629. doi: 10.1177/01455613211037629. Online ahead of print.

ABSTRACT

Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related complications have also been reported. Here, we report a case of pneumocephalus and cerebrospinal fluid leak following BSD of the frontal sinus. Additionally, a review of the literature regarding BSD complica tions was performed.

PMID:34392735 | DOI:10.1177/01455613211037629

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Recurrent Respiratory Papillomatosis With Complete Response to Systemic Bevacizumab Therapy

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Ear Nose Throat J. 2021 Aug 15:1455613211040578. doi: 10.1177/01455613211040578. Online ahead of print.

ABSTRACT

Recurrent respiratory papillomatosis is a condition caused by human papilloma virus, usually sub types 6 and 11. Papillomas are benign neoplasms that are most commonly found on the larynx and can be often associated with significant airway involvement. Frequency of episodes varies among patients as do the clinical symptoms. Patients often present with symptoms suc h as hoarseness but there is potential for respiratory compromise and even complete airway obstruction.

PMID:34392730 | DOI:10.1177/01455613211040578

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Tension Pneumocephalus Following Balloon Sinuplasty

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Ear Nose Throat J. 2021 Aug 15:1455613211037629. doi: 10.1177/01455613211037629. Online ahead of print.

ABSTRACT

Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related complications have also been reported. Here, we report a case of pneumocephalus and cerebrospinal fluid leak following BSD of the frontal sinus. Additionally, a review of the literature regarding BSD complications was performed.

PMID:34392735 | DOI:10.1177/01455613211037629

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Post-dural puncture headache following lumbar spinal drain: an atypical presentation with cognitive symptoms

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Anaesth Rep. 2021 Jul 23;9(2):e12127. doi: 10.1002/anr3.12127. eCollection 2021 Jul-Dec.

ABSTRACT

Post-dural puncture headache is a consequence of cerebrospinal fluid loss, leading to reduced intracranial pressure. Its classical symptoms include a frontal-occipital headache which is worse on standing, neck stiffness, nausea, hearing loss and photophobia. In this report, we describe an atypical presentation of post-dural puncture headache in a 72-year-old woman following an endovascular repair of an aortic aneurysm, before which a lumbar spinal drain was placed to reduce the risk of spinal cord ischemia. Following drain removal, the patient developed hypoactive delirium, challenges with both depth perception and fine motor skills and a mild headache. An epidural blood patch was performed, which resulted in the complete resolution of her symptoms. This case highlights an atypical presentation of post-dural puncture headache in an older patient, in whom the major symptoms were cognitive. Cerebrospinal fluid leakage should be considered as a cause of postoperative delirium in patients who have undergone neuraxial anaesthesia.

PMID:34396133 | PMC:PMC8340929 | DOI:10.1002/anr3.12127

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Survival and prognosis of lung large cell neuroendocrine carcinoma

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Bull Cancer. 2021 Aug 12:S0007-4551(21)00208-3. doi: 10.1016/j.bulcan.2021.04.010. Online ahead of print.

ABSTRACT

INTRODUCTION: Only a few large-scale studies have focused on large cell neuroendocrine carcinoma, a rare type of pulmonary malignancy, and uniform diagnostic criteria and standardized treatments are lacking. This study aimed to assess the treatment outcomes and factors influencing patients' prognosis with large cell neuroendocrine carcinoma.

METHODS: The data of 55 patients with pathologically confirmed large cell neuroendocrine carcinoma, treated at our hospital from January 2013 to January 2018, were collected. Relationships between clinical characteristics, diagnoses, treatment outcomes, and prognoses were retrospectively analyzed.

RESULTS: Patients were followed for a median of 18.5 (0.5-41.0) months. Thirty-four patients died before the final follow-up, resulting in a median overall survival of 17.9 (0.5-3 6.0) months, with 1-, 2-, and 3-year survival rates of 69.1%, 23.6%, and 1.8%, respectively. Single-factor analysis identified gender (P=0.036), smoking history (P=0.008), obstructive atelectasis (P=0.032), regional lymph node metastasis (P=0.020), and treatment selection (P=0.000) as factors influencing overall survival. Multifactor analysis identified treatment selection as an independent survival prognostic factor. Particularly, significant differences were observed between the combination therapies (surgery+chemotherapy, surgery+radiotherapy, surgery+radiotherapy+chemotherapy, and concurrent chemoradiotherapy) and single-therapy approaches (chemotherapy or radiotherapy alone; P<0.001), but not among the combination therapies (P=0.216).

DISCUSSION: Male patients with large cell neuroendocrine carcinoma with a history of smoking, obstructive atelectasis, and regional lymph node metastasis have a particularly poor prognosis. Our observation of the treatment approach as an independent survival prognostic factor suggests that combination therapies may yield survival benefits to patients.

PMID:34392973 | DOI:10.1016/j.bulcan.2021.04.010

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Patterns of Regional Recurrence and Salvage Treatment in Patients With Oral Cancer

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Objectives

Regional failure after primary treatment for oral squamous cell carcinoma (OSCC) carries a dismal outcome. Our goal was to investigate the recurrence patterns and salvage treatment in patients with OSCC and regional failure.

Study design

Retrospective chart review of all patients treated for OSCC in a university-affiliated tertiary care center during 2000-2018.

Methods

Data collected from patients' medical charts included demographics, clinical and pathological features, staging, treatment modalities and outcomes. Patients with insufficient data or a follow-up of less than 2 years were excluded.

Results

Out of 266 surgically treated patients, 55 developed regional recurrence and were included in the study cohort. Forty patients received surgical salvage treatment followed by adjuvant chemo-radiotherapy (CRT). Disease specific survival and overall survival were significantly higher in surgically treated patients compared to patients who received non-surgical treatment (46.7% vs. 0%, log-rank P value < .001 and 35.3% vs. 0%, log-rank P value = .001, respectively) and in patients who recurred regionally more than 10 months following initial treatment (40.8% vs 10.7%, log-rank P value = .065). Patients with early recurrence were older (73.6 vs. 61.3 years) and had a deeper invasion of the primary tumor (10.1 vs. 7 mm).

Conclusions

Salvage neck dissection is feasible in most cases, providing the best outcomes in patients with OSCC who fail regionally. Close follow-up during the first year after initial treatment is paramount as early recurrence carries a dismal prognosis. Specifically, elderly patients and patients with deeper primary tumor invasion should be closely monitored during the first post-operative year.

Level of Evidence

4 Laryngoscope, 2021

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